Document Digital Signature

(DSG)

Gila Pyke / Lori Reed-Fourquet

Smart Systems for Health Agency / Identrus
IHE ITI Technical Comittee
 Providers and Vendors
Working Together to Deliver
Interoperable Health Information Systems
In the Enterprise
and Across Care Settings

WWW.IHE.NET
June 28-29, 2005 2 Interoperability Strategy Workshop
 IT Infrastructure Profiles
2004
Patient Identifier Cross-referencing for MPI (PIX)
Retrieve Information for Display (RID)
Consistent Time (CT)
Document Digital Signature
Patient Synchronized Applications (PSA)
Enterprise User Authentication (EUA)
2005 (DSG)
Patient Demographic Query (PDQ)
Use of digital signatures to provide
Cross Enterprise Document Sharing (XDS)
Audit Trail and Note Authentication (ATNA)
document integrity, non-repudiation and
Personnel White Pages (PWP)
2006 accountability.
Cross-Enterprise User Authentication (XUA)
Document Digital Signature (DSG) –
Notification of Document Availability (NAV)
Patient Administration/Management (PAM)
June 28-29, 2005 3 Interoperability Strategy Workshop
 Document Digital Signature
Value Proposition

• Leverages XDS Document infrastructure

• Providing accountability
• Providing document integrity
• Providing non-repudiation
• Providing satisfactory evidence of: Authorship,
Approval, Review, and Authentication
• Infrastructural pattern to be further profiled by
domain specific groups (e-Prescribing, e-Referral)

June 28-29, 2005 4 Interoperability Strategy Workshop

 Document Digital Signature
Abstract/scope

• Provide signature mechanism

• Provide verification/validation mechanism
• Provide signature attributes
• XDS manages document and signature
• Allows direct access to document (XDS)

June 28-29, 2005 5 Interoperability Strategy Workshop

 Document Digital Signature
Abstract/scope

• Digital Signature Document format

• Leverages XDS for signature by reference
• New document type in XDS – Linkage forward
and back.
• Profiles single / multiple signatures
• Profiles nested signatures
• Provide signature integrity across intermediary
processing

June 28-29, 2005 6 Interoperability Strategy Workshop

 Document Digital Signatures
Goals

Digital Signatures help mitigate risk for the

following attacks:
– In the storage or transmission of documents,
characteristics of clinician orders reflected in the
prescription could be modified.
– In the storage or transmission of documents,
characteristics of countersigned clinician orders
reflected in the prescription could be modified.
– A forged prescription could be introduced.
June 28-29, 2005 8 Interoperability Strategy Workshop
 Document Digital Signature
Key Technical Properties

• W3C XML Signature structure

– credentials, timestamp, and other signature attributes
such as signature purpose
• Reference to document stored in XDS
• ISO TS17090 compliant digital certificates
• Assures message integrity
• Verification of signed document validity
• Provides for multiple signers

June 28-29, 2005 10 Interoperability Strategy Workshop

 Document Digital Signature
Signature Attributes

• Expand signature to include additional data

relevant to the healthcare signature
• Includes the date and time the signature was
calculated and applied
• The identity of the signer
• Signature Purpose

June 28-29, 2005 11 Interoperability Strategy Workshop

 Document Digital Signature
Use Cases

• Attesting a document as true copy

– Each subsequent use of the original signed digital document or
a digital copy of the document can inspected signatures to
assert that the documents are true copies of information
attestable to the signer at the time of the signature ceremony
• Attesting content
– When a clinician submits a clinical document to the XDS
repository, the clinician using a digital certificate digitally
signs the document
• Attesting to whole submission set
• Translation / Transformation

June 28-29, 2005 15 Interoperability Strategy Workshop

 Cross-Enterprise Document Sharing
(XDS) Use Case (1)

• The XDS profile describes how different

health care parties can share documents
• A “document source” is responsible to
“provide and register” document in a
“registry/repository” for a “query” and
“retrieve” by a “document consumer”
• Document Digital Signature enables to
manage the “responsibility” issues

June 28-29, 2005 16 Interoperability Strategy Workshop

 Cross-Enterprise Document Sharing
(XDS) Use Case (2)

• The “document source” wants to prove it

has well “authored” the document and the
associated “submission set metadata”
• The “registry/repository” it has not
corrupted the documents and metadata
• The “document consumer” wants to check
above items and check the “identity” of
author(s) and authenticator(s)

June 28-29, 2005 17 Interoperability Strategy Workshop

 Cross-Enterprise Document Sharing
(XDS) Use Case (3)

• The “document source” includes the document(s)

signature(s) into the “submission set”
• The “registry/repository” stores the document
signature(s) as a “document” and metadata
associated with it/them as a specific “signature
object” metadata
• The “document consumer” can see the “signature
metadata” and retrieve each signature for checking
it, including the certificate(s)
June 28-29, 2005 18 Interoperability Strategy Workshop
 Document Digital Signature
Signature Purpose
From ASTM E1762 *
• “Author” - Author’s signature,
• “Author.Co” - Coauthor’s signature
• “Participant” - Co-participant’s signature
• “Transcriptionist/Recorder”
• “Verification” - Verification signature
• “Validation” - Validation signature
• “Consent” - Consent signature
• “Witness” - Witness signature
• “Witness.Event” - Event witness signature
• “Witness.Identity” - Identity witness signature such as a Notary
• “Witness.Consent” - Consent witness signature
• “Interpreter”
• “Review” - Review signature
• “Source” - Source signature
• “Addendum” - Addendum signature
• Administrative
• Timestamp
June 28-29, 2005 19 Interoperability Strategy Workshop
 Document Digital Signature
Additions to ASTM1762

The following items will be added to

ASTM1762
–Modification
–Authorization
–Transformation
–Recipient
Modification is being worked on.

June 28-29, 2005 20 Interoperability Strategy Workshop

 Document Digital Signature
Standards Used

W3C XML Signature

ISO 17090, 21091
ASTM E2212, E1985, E1762, E1084
IETF x509
DICOM supplement 41, 86
NCPDP
HL7 CDA

June 28-29, 2005 21 Interoperability Strategy Workshop

 More information….
• IHE Web sites: www.ihe.net
• Technical Frameworks, Supplements
– Fill in relevant supplements and frameworks
• Non-Technical Brochures :
• Calls for Participation
• IHE Fact Sheet and FAQ
• IHE Integration Profiles: Guidelines for Buyers
• IHE Connect-a-thon Results
• Vendor Products Integration Statements

June 28-29, 2005 23 Interoperability Strategy Workshop