NHIN-Direct SMTP/Email Notes

6/10/2010

Why we chose Email• Concepts match the charter exactly• Implementations match the charter exactly*

• Well understood by end users• Well understood by existing ISP industry• Well understood by existing vendors

• Almost no new code - security agent only (same code that is a subset of other implementations)

• ISPs can participate with their existing infrastructure and skill set

Implementation Overview

• Really, it’s just email.• Security agent plugged in at

any point in the pipeline between Client (Source) and Server (Source HISP)

• Channels can be TLS-encrypted to protect routing information

• Email Client• EHR, PHR

EmailServer

EmailServer

• Email Client• EHR, PHR

SMTP, MAPI

POP3, IMAP, MAPI

SMTP

POP3, IMAP, MAPI

SMTP, MAPI

S SH DH D

Key Technologies

• Content Packaging: RFC 5322 + MIME• Addressing: endpoint@domain• Security & Trust: S/MIME• HISP-HISP Transport: SMTP(S)• Client-HISP Transport: SMTP, POP3, IMAP,

MAPI, etc…• Certificate distribution: DNS CERT

Structure, metadata and innovation

• Scalable structure– Body Text (always available, Individual Involvement)– Unstructured attachments (PDF)– Structured attachments (CCx, SCRIPT, etc.)– Explicit metadata MIME part (XDM)

• Transport has proven itself over 20+ years• Innovate in the payload

Security Agent• S/MIME Sign and Encrypt of messages fully supports

requirements of Security & Trust Workgroup• Certificate distribution by DNS CERT records

• Scalable approach to PKI Management – starts easy as TLS, adds ability to scale down to individual– HISP manages certificates– Organization manages certificates– Individual manages certificates

• Ability to use across implementations demonstrates the value of taking a transport-independent approach

Sample Message “On the wire”

thread-index: AcsGjnbwhdd7B5CFQSuA2mgm0a8D9Q==Received: from umeshma4 ([131.107.0.72]) by nhind.hsgincubator.com with Microsoft SMTPSVC(6.0.3790.4675); Mon, 7 Jun 2010 15:12:05 -0700Message-ID: <3854EE3793424007ADEA236042807DF0@northamerica.corp.microsoft.com>From: "Dr Biff Hooper" <biff@nhind.hsgincubator.com>To:"Dr. Alsip" <highlandclinic@securehealthemail.com>, daa858cb-a066-4c76-885f-ffa67242d6c3.9c24b165-7429-4ee2-a646-3bd7986b9968@hvnhind.hsgincubator.comSubject: Fw: Patient ReferralDate: Mon, 7 Jun 2010 15:11:44 -0700Organization: Biff's ClinicContent-Transfer-Encoding:base64MIME-Version: 1.0Content-Type:application/pkcs7-mime; smime-type=enveloped-data; name="smime.p7m"X-Priority: 3X-MSMail-Priority: NormalImportance: NormalX-Mailer: Microsoft Windows Live Mail 14.0.8089.726X-MimeOLE: Produced By Microsoft MimeOLE V6.00.3790.4657Content-Class: urn:content-classes:messagePriority: normalReturn-Path: <biff@nhind.hsgincubator.com>X-OriginalArrivalTime: 07 Jun 2010 22:12:05.0717 (UTC) FILETIME=[76B95050:01CB068E]

MIMDtx4GCSqGSIb3DQEHA6CDA7cOMIMDtwkCAQAxggJvMIG6AgEAMCMwFTETMBEGA1UEAxMKVU0tQU1BTEdBMQIKFmbg8QAAAAAAGDANBgkqhkiG9w0BAQEFAASBgMrVicD/tjx0ZZ0daK0nN2GMLqJgFalBuKGxe+ZZATxHxJPCD4rg80pI5vLt/s8A3sRrCrrOSniwpl1kzg6Nunlq6wz/PpK7QTVofwptH0ZGYMRin/CxQD4tlf9YFmLuXNdvrvG7AkgRdMS7MZZzBliEdCdUZncb6qnyEf9Y1JlsMIIBrgIBADCBlTCBhzELMAkGA1UEBhMCVVMxETAPBgNVBAgTCE1pc3NvdXJpMQ8wDQYDVQQKEwZDZXJuZXIx...fEL7VbSd34tez2pUHCL9FbtRBWReSW1hcLEvlsJjeCBaVAKFrW6VZqzTt+M=

Reliable Messaging

• Store and forward model is critical in a massively distributed network – because it is likely that destinations will be unavailable– Daily issues, upgrades, disaster, remote

• Ability to route across intermediate hops will be important in a heterogeneous network– Corporate intranet gateways

Why Existing Services Matter• Operations– Administration and provisioning– Backups– System health monitoring– Patch and upgrade process

• Security history, minimal new attack surface• Multi-tenant issues worked out• Training and industry skill set– admin, NOC, customer service

• Account support: quota management, billing, fraud detection, etc.

Demo: Step 1• Source: Outlook + Windows SMTP• Destination: Thunderbird + Postfix

• Notes– Attached CCD document– Read receipt

Demo: Step 2• Source: Millennium + IronPort• Destination: Thunderbird + Postfix

• Notes– EHR integration– Flexible attachment types

Demo: Step 3• Source: Thunderbird + Postfix• Destination: Windows Live Mail + Windows SMTP

• Notes– Simple text message– Out of Office

Demo: Step 4• Source: Windows Live Mail + Windows SMTP• Destination: HealthVault & Thunderbird

• Notes– Multiple recipients– Structured PHR integration

Demo Technologies

• Clients– Cerner Millennium– Thunderbird– Outlook– Windows Live Mail– HealthVault

• DNS– Bind

• Servers– Windows SMTP– Postfix

• Operating Systems– Amazon EC2– Windows Server– Linux

Demo Topology

Since Tuesday

• Secure Exchange Solutions has successfully sent and received NHIN-D messages using the SMTP implementation

• A “desktop gateway” is available that enables any currently-live mail service (Gmail, Hotmail) to be used for NHIN-D messaging

– We believe that with the SMTP solution, the bar for the largest webmail providers to offer NHIN-D service is low enough that we can expect to see offerings emerge.