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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

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Why we chose email
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
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

SMTP, MAPI

POP3, IMAP, MAPI

  • Email Client

  • EHR, PHR

Email

Server

Email

Server

  • Email Client

  • EHR, PHR

SMTP

S

SH

DH

D

POP3, IMAP, MAPI

SMTP, MAPI


Key technologies
Key Technologies

  • Content Packaging: RFC 5322 + MIME

  • Addressing: [email protected]

  • 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
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
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
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 -0700

Message-ID: <[email protected]>

From: "Dr Biff Hooper" <[email protected]>

To:"Dr. Alsip" <[email protected]>,

daa858cb-a[email protected]hvnhind.hsgincubator.com

Subject: Fw: Patient Referral

Date: Mon, 7 Jun 2010 15:11:44 -0700

Organization: Biff's Clinic

Content-Transfer-Encoding:base64

MIME-Version: 1.0

Content-Type:application/pkcs7-mime; smime-type=enveloped-data; name="smime.p7m"

X-Priority: 3

X-MSMail-Priority: Normal

Importance: Normal

X-Mailer: Microsoft Windows Live Mail 14.0.8089.726

X-MimeOLE: Produced By Microsoft MimeOLE V6.00.3790.4657

Content-Class: urn:content-classes:message

Priority: normal

Return-Path: <[email protected]>

X-OriginalArrivalTime: 07 Jun 2010 22:12:05.0717 (UTC) FILETIME=[76B95050:01CB068E]

MIMDtx4GCSqGSIb3DQEHA6CDA7cOMIMDtwkCAQAxggJvMIG6AgEAMCMwFTETMBEGA1UEAxMKVU0t

QU1BTEdBMQIKFmbg8QAAAAAAGDANBgkqhkiG9w0BAQEFAASBgMrVicD/tjx0ZZ0daK0nN2GMLqJg

FalBuKGxe+ZZATxHxJPCD4rg80pI5vLt/s8A3sRrCrrOSniwpl1kzg6Nunlq6wz/PpK7QTVofwpt

H0ZGYMRin/CxQD4tlf9YFmLuXNdvrvG7AkgRdMS7MZZzBliEdCdUZncb6qnyEf9Y1JlsMIIBrgIB

ADCBlTCBhzELMAkGA1UEBhMCVVMxETAPBgNVBAgTCE1pc3NvdXJpMQ8wDQYDVQQKEwZDZXJuZXIx

...

fEL7VbSd34tez2pUHCL9FbtRBWReSW1hcLEvlsJjeCBaVAKFrW6VZqzTt+M=


Reliable messaging
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
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
Demo: Step 1

  • Source: Outlook + Windows SMTP

  • Destination: Thunderbird + Postfix

  • Notes

    • Attached CCD document

    • Read receipt


Demo step 2
Demo: Step 2

  • Source: Millennium + IronPort

  • Destination: Thunderbird + Postfix

  • Notes

    • EHR integration

    • Flexible attachment types


Demo step 3
Demo: Step 3

  • Source: Thunderbird + Postfix

  • Destination: Windows Live Mail + Windows SMTP

  • Notes

    • Simple text message

    • Out of Office


Demo step 4
Demo: Step 4

  • Source: Windows Live Mail + Windows SMTP

  • Destination: HealthVault & Thunderbird

  • Notes

    • Multiple recipients

    • Structured PHR integration


Demo technologies
Demo Technologies

  • Clients

    • Cerner Millennium

    • Thunderbird

    • Outlook

    • Windows Live Mail

    • HealthVault

  • DNS

    • Bind

  • Servers

    • Windows SMTP

    • Postfix

  • Operating Systems

    • Amazon EC2

    • Windows Server

    • Linux



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