Dr' Maury Pinsk FRCPC

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Shouting from the Rooftops Improving Email
Security

• Dr. Maury Pinsk FRCPC
• University of Alberta
• Division of Pediatric Nephrology

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Dr. V

• Uses email to correspond with patients
• Answers questions
• Gives test results
• Changes medications
• All emails are signed with disclaimer for
  confidentiality
• Patient A asks how secure her medical information
  is

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How secure is email?

• Depends
• Where it is being sent
• What you choose to use it for
• How it is being sent

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Email - the basics

• Your email program is a mail user agent
• Produces a text file
• Sends the file through the internet using a set
  of instructions that allow commuters to
  communicate a Protocol
• E.g. SMTP or simple message transfer protocol

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Email - the basics

• SMTP guides the email to final recipients server
• Can route through several servers if necessary
• Once it reaches its final destination server, it
  is stored to disk
• The recipient accesses the email using a Post
  office protocol (POP)

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So what are the security issues

• Sending an email is like sending a postcard
• Any server through which it passes is an
  opportunity for eyes to read
• For the keen individual, it represents an
  opportunity to alter the contents of the email as
  well.

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So what factors alter the security of the email?
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Where is it being sent?

• Data that stays on a server is less likely to
  fall into the wrong hands
• More so for dedicated service providers (e.g.
  intrauniversity, intrahospital)
• Less so for data that leaves a server (e.g.
  interhospital or interuniversity)

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How is it being sent?

• Data that is sent unprocessed is vulnerable to
  breach of confidentiality or integrity
• What do I mean by processed?
• Encryption
• Digital signatures

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Encryption

• Key a large number used by encryption
  algorithm to generate cipher code
• Public key owner can send you encrypted
  email securely, but cannot decrypt it
• Private key owner can decrypt the email.
• The two keys are related, but through very
  complex algorithms that are difficult to crack

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Encryption

• Keys are stored, encrypted, on your computer, and
  used by your email software
• Keys can be distributed by owner on disk, by
  email or via access to repository (key server)

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PGP encryption an extra layer of security for
encryption
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PGP decryption the same in reverse
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Encryption, but for whom?

• Encryption keeps on-looking eyes away from
  sensitive data, but doesnt verify the source
• Authentication and integrity is verified by a
  digital signature

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Digital Signature
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Digital signatures
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But how do you know the key is from the right
person?

• Key forgery is possible, hence the need for
  security certificates
• Security certificate digital signature
  authentication from another user public
  encryption key user identification

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What is being sent?

• The best means of preserving data integrity and
  confidentiality is to decide if it is absolutely
  necessary to send it the data by email.

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Return to Dr. V

• Patients informed
• Patient information continues to be transferred
  over the internet, but patients sign a consent
  allowing this to happen
• Information kept confidential
• Public keys are issued to patients via key server
• Patients encouraged to obtain own personal key
  and distribute public key to Dr. V

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• Integrity of information confirmed
• Security certificates issued with public key
• All correspondence with digital signature.

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Further resources

• Encryption and digital signature freeware
• Pretty Good Privacy (PGP)
• http//www.pgpi.org
• Guidelines for Patient Privacy
• HIPAA Privacy regulations
• http//www.hhs.gov/ocr/hipaa