I should like to draw out of this thread several different issues. My
apologies if bits of this look like a sales handout but Ahmad, at least,
asked for an update on PharMed.
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).
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>
--- OffRoad 1.9r registered to Adrian Midgley
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