Norwegian e-health infrastructure based on XML, ebXML and PKI

Øyvind Gjørven

Rikstrygdeverket (RTV)/

National Insurance Administration

The presentation will give an overall technical solution and share our experiences after two years of operation between National Insurance Administration (RTV) and general practitioners, pharmacies and hospitals.

The focus will be on how sensitive information safely can be distributed over open networks by means of end-to-end security solutions based on XML, ebXML and PKI.

National Insurance Administration’s communication partners

Citizens in general Companies in general Hospitals Pharmacies Private labs General practitioners Government EU In total RTV is paying 230 billion NOK (30 billion EURO) to its

communication partners (1/3 of the total Norwegian Government budget) The communication solution covers 10% of the total amount

History

For 10 – 15 years the standardised communication solutions have been based on EDIFACT, X.400 and ”proprietary PKI”

Three years ago it was decided to upgrade the architecture:– Existing EDIFACT messages will continue until they are

replaced with new message formats– All new messages will be based on XML format– ebXML Messaging Service specification (ebMS) will be

used as the enveloping standard– X.400 will be replaced by SMTP– RTV will be connected to the new National Health

Network (NHN) in Norway by use of SMTP– A new frame agreement on PKI will be established

What we get by using PKI and ebXML

Authentication – secure identification of the sender Integrity – a message can not be changed from sender to

receiver Confidensiality – unauthorised people can not read the

content in the message Non-repudiation – sender can not deny having signed and

sent a message Sender gets response message when receiver gets the

message– Resending until response message is received (the

resending module in ebXML defines the number of resendings and the time interval)

ebXML Message Handling Service (ebXML MHS)

MHS

Authentication, authorization, andnon-repudiation

Processing of message header

Encryption / signing

Re

ce

ipts

an

d a

ck

no

wle

dg

em

en

ts

Err

or

ha

nd

lin

g

Enveloping / de-enveloping

Interface to communciation

HTTP SMTP IIOP FTP

Application

Interface to MHS

...

ebXML MessageTransport envelope (HTTP, SMTP, etc.)

MIME envelope (SOAP with attachment)

MIME part

SOAP envelope: Envelope

SOAP envelope: MessageHeader

SOAP envelope: Body

ebXML: MessageHeader

ebXML: ErrorList

ebXML: Signature

ebXML: Acknowledgement

ebXML: Manifest

MIME part

Payload (Business message)

ebXMLenvelope

ebXMLpayload

Message

ebXML Secure Messaging

Partner BResending3 times

ebXML protocol

Sender Receiver

ebXML Message

ebXML Control

ebXML Apprec

ebXML Control

Resending3 times

Before

Pharmacy 1

Pharmacy 2

Pharmacy n

EDIFACT

EDI/PKIDoctor 1

Doctor 2

Doctor n

EDIFACTRTV

Hospital 1

Hospital 2

Hospital n

EDIFACT

X400

Now

Pharmacy 1

Pharmacy 2

Pharmacy n

XML/ebXML

ebXML/PKIDoctor 1

Doctor 2

Doctor n

XML/ebXMLRTV

Hospital 1

Hospital 2

Hospital n

EDIFACT/ebXML

SMTP

SMTPNHN

Internet

SMTP

New architecture

Strategy: RTV shall get products from the market for the central modules in the architecture, if possible. Products from market leaders will be preferred:

– ebXML: Xenos Group – GoXML MS– PKI: RSA Security – RSA BSAFE– Application server: IBM – Websphere– Message handling: IBM – MQ Series– Trusted Third Party (TTP): Ergo Group – National Service Provider– Control system: Fair Isaac - Blaze Advisor– Archive system: Ergo Group – ePhorte– Insurance Administration system: Inhouse development– Platforms: Windows, HP-UX, zOS

Applications using the new architecture

Medical sertificate– 750 doctors at 300 offices (total numer is 1850) are using the system

today• The total number of messages are 3.5 million a year

Doctors request for payment– 500 doctors at 200 offices are using the system today

Pharmacies request for payment– All the 550 pharmacies are using the system

• 10 billions NOK (1.3 billions EURO) are payed to the pharmacies a year

EHIC (European health insurance card)– 1.4 million cards have been delivered

Example: Doctor’s Office

NIA

NHN

Office Server

· Message creation· Personal signature

using SmartCard and pin-code or software based

· Message encryption· ebXML packaging· Envelope signature

SMTPSMTP

· Message decryption· ebXML unpackaging· Signature check

User PC

Example: Pharmacies

NIANAF Data (HUB)

Company signature using software based certificate

· gZip· Message encryption· ebXML packaging· Envelope signature

SMTP

· Message decryption· ebXML unpackaging· Signature check

User PC

# 550 pharmacies

Example: National Insurance Administration

Mainframe zOS

SMTP/POP 3 Server

ebXML (goXML from Xenos)RSA for PKI functionsBlaze Advisor Rule Engine

HP/UXWebSphere

Application Server

JavaMail

Ephorte Message Archive

MQ Series

External TTP

WindowsNT

MQ Series

430 NIA Local offices

Insurance Administration System

Experiences with the new architecture

Use of open standards– Many products available in the market– More flexible interface– Better error detection (by checking in other products)– A national standardisation body keeps the messages updated and

available on the Internet ebXML

– Better message identification– Flexible response messages– Automatic resending of messages– Message routing based on envelope information– Easier to operate the information about communication partners– Better tracing and monitoring of the messages

Experiences with the new architecture (continue)

XML– Better message specification– Better validation functionalities in XML– Easier to automatically validate by sending and receiving messages

PKI – The open standards for PKI exist today– Products which handle authentication, integrity, confidensiality and

non-repudiation are available in the market today– Service providers which handle certification authority (CA) and

registration authority (RA) are established– Real-time verification of certificates using LDAP– A TTP/PKI frame agreement for the whole health- and social sector

has been in place for 2 years

Next activities

Extend our use of ebXML – today we send EDIFACT over X.400

Automate Collaboration Protocol Profile (CPP) and Collaboration Protocol Agreement (CPA) handling

– from manual handling of CPP/CPA information to automated handling

Upscale the communication solution– Increase the number of communication partners – Increase the number of messages – Increase the number of applications

• The next big e-health project in Norway will be ePrescription (17 million messages a year). Developing begins early 2006.