I should like to draw several different issues out of this thread. My 
apologies if bits of this look like a sales handout but Ahmad, at least, 
asked for an update on PharMed. My apologies also if this message arrives 
several times, but my current e-mail gateway seems troublesome or is it 
stutter-some?.

PharMed is a company set up to establish the standards, mechanisms and 
provide software to enable secure electronic messaging, in the first 
instance e-prescriptions, between pharmacy and GPs. We want to do this by 
consultation and agreement with the professions and NHS.

The current design is one based on e-mail messaging, ie push of data, 
rather than pull. The reasons for this basic decision included security and 
data control. Given the current state of GP and pharmacy systems it seemed 
more secure to permit the data owner to decide on outgoing message content, 
rather than allow some sort of browsing of the master data by someone (or a 
process) wanting to know a fact or two, to which entitlement may be 
questionable. There is also a consideration of cost. Pushed e-mail can be 
batched and transmitted at much lower cost than on-line realtime pull 
interrogations. The cost equation will change, I hope, and the model will 
evolve with the changed costs.

It seemed to us that any network connection is intrinsically insecure, or 
should be treated as such, and would require some sort of protection - 
perhaps even a 'firewall' depending on the connections allowed. By using 
e-mail we minimised the exposure, because only a very limited number of 
things can be done with the port exposure necessary to make e-mail work. I 
would not want to argue the relative security ratings of NHSNet / Internet. 
Their relative merits is irrelevant - they must both be treated as 
insecure. In this area 'more or less secure' is invalid.

There is lots of concern, probably inflated, about the confidentiality of 
data while in transit between clinical domains. The easy and off the shelf 
answer is to use strong cryptography (from the UK, not USA). But 
cryptography provides part of the solution to other issues - integrity, 
authentication, non-repudiation, all of which are essential to a system 
that will work in an hostile environment (I mean one where it would be 
financially beneficial for a criminal to be able to usurp the security 
mechanism). Initial authentication, I contend, is an auditable process, not 
necessarily one reserved for the professional bodies.

In someone else's words, I am 'network agnostic' between NHSNet and 
Internet. The delivery guarantees may make the NHSNet a better vehicle for 
an NHS Intranet - I dunno. The important issue for me, is the use of 
Internet protocols SMTP, rather than X400. The IM&T strategy makes it clear 
that NHSNet will now support SMTP. At last, the world wide investment in 
internet protocols can be used, as can the sometimes free products that 
support them. An outstanding issue with NHSNet remains the current Code of 
Connection, which has caused significant problems for pharmacy to join. A 
bit of an issue when the grand plan is to message between pharmacy and GP. 
Again, I welcome the re-evaluation to the Code of Connection promised in 
the Strategy and the strengthening of the NHSNet/Internet gateway. If 
pharmacy is allowed to join the hallowed hall of NHSNet - great. If 
pharmacy is excluded, then mails will pass through the gateway to the 
internet world. I would support the inclusion of pharmacy in NHSNet, but 
either way the fundamental system design has allow message transfer and 
maintain security.

Where I worry is that these security issues are complex and some would say 
esoteric. The same issues must be addressed to enable the plan in the 
Strategy to allow 24 hour access to a patients clinical record to support 
the delivery of care - on a need to know basis. Gulp..........

PharMed continues to discuss these and other issues with our Advisory 
Panel, and to feedback experience gained in a limited software trial. Given 
the commitment in the Strategy to electronic links between community 
pharmacy and GPs by 2002, I hope we can contribute to a system that brings 
benefits to all.

Martin Strange
PharMed Technical Manager

-----Original Message-----
From:	Adrian Midgley [SMTP:[log in to unmask]]
Sent:	25 September 1998 01:33
To:	[log in to unmask]
Subject:	Re: RE: GP nets - security of the GP system

[log in to unmask],Net wrote at 23:45 on 24/09/98
about "RE: GP nets":
-----------------------------
>
>>Do you imagine the security implications of connecting clinical
systems
>>to NHSNet are any different to connection to the internet?
>Are you saying that in either case the security of the GP system cannot
>be guaranteed.

I think the security of the GP system can be garanteed, provided
the right software and technology is used.
The security implications of connecting to a wide area IP network
are identical regardless of the flavour, name, brand of internetwork
Service Provider, and of whether the connection is direct or as
seems now to be accepted in the Strategy[1], via a metropolitan health
network such as is found in Leeds, and which I proposed in Exeter.

Big Snip>






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