The National Strategy for Trusted Identities in Cyberspace, a roadmap released earlier this month for protecting consumers from fraud and identity theft, calls for the voluntary building of an "identity ecosystem" in which consumers can have a single, user-specific credential to log into any participating website. This, according to federal officials, will allow security-conscious sectors, including healthcare and finance, to make new online services available.
"[I]ndividuals and businesses need to be able to check each other's identity for certain types of sensitive transactions, such as online banking or accessing electronic health records," the 52-page document reads. Among other things, the strategy calls for wider adoption of two-factor authentication and unique security credentials for each user.
This is exactly the sort of thing healthcare needs, according to Hussam Mahgoub, senior VP for corporate development and research--and resident security specialist--at Diversinet, creator of a secure platform for developing mobile healthcare applications. "There's a lot of confusion in the marketplace about security and privacy," Mahgoub said.
Of particular worry, according to Mahgoub, is that the Health Insurance Portability and Accountability Act's (HIPAA) privacy and security regulations don't address "strong authentication" for users when they access protected health information (PHI).
Diversinet, which is based in Toronto but does most of its business in the United States, recently published a white paper listing nine best practices for securing health data on mobile networks and devices, that in many ways dovetails with the federal strategy. Diversinet recommends installing apps on smartphones, tablets, and laptops to turn each device into a kind of "wallet" for PHI. Sensitive data should be encrypted and the app should be able to deactivate or delete PHI from lost or stolen devices, just as banks and retailers can deactivate lost credit cards, Mahgoub explained.
Jeff Sponaugle, chief security and technology officer for Beaverton, Ore. healthcare connectivity company Kryptiq, sees at least one recent change in healthcare that needs this kind of approach. Interim Drug Enforcement Agency (DEA) regulations that took effect in June 2010 allow the electronic prescribing of certain controlled substances such as narcotics, but only with enough security in place to satisfy the law enforcement community, which has a lot more pull with the DEA than does the health IT industry.
"With electronic prescribing of controlled substances, two-factor authentication will be coming to the desktop of physicians and staff," Sponaugle said in an email. "The requirements for [electronic prescriptions for controlled substances] are very clear and do provide a 'need' for the physician to get some kind of digital ID."
Sponaugle noted, however, that two-factor authentication and other "strong" forms of digital security have been around for years, but often place too high of a burden on users to encourage widespread adoption. Resistance may rise when the users happen to be time-crunched and technologically challenged physicians.
"The key for promoting two-factor is to make it integrated into the application the doctor uses most," reported Sponaugle, who said that Kryptiq tries whenever possible to integrate its platform for secure messaging and e-prescribing into other companies' electronic medical records (EMRs). "As the EMRs add front-facing, two-factor workflows, we will use that same infrastructure for messaging. It would be a disaster if you made a doctor use a different two-factor system for the EMR, and yet another different system for messaging or prescribing," Sponaugle said.
"In the end, the goal of the second factor is to provide some protection from the key problem in security, which is people. People choose poor passwords, reuse them, tell them to people, log in from a kiosk in a coffee shop with a key logger, etc.," Sponaugle added. "Coming up with good workflow usability of the two factors is what will make it succeed."