Thursday, 23rd Nov 2017

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Jul 15

Secure Online Services

Does your practice website compromise the security of your patients confidential information?

If your practice website offers online services to your patients, providing them with facilities to order repeat prescriptions, update their contact details or cancel and request appointments, are these services secure?

As clinical professionals, you will be aware that patient related information is confidential. It is paramount that you ensure the confidentiality, security and integrity of any patient related information. This includes internet based systems such as your practice website and the security of your patients online service requests.

End to end security?

Ensuring that you have end to end security is an area where a practice should request clarification from their clinical website provider. In order to answer this question you should appreciate that there are two key areas which should be secured to ensure the confidentiality of sensitive patient information which is volunteered in order to request online services.

The first area to confirm, is that any online service request should require the patient to enter their personal information over a secure channel. This is the process of providing patients with a secure SSL enabled system which allows them to securely enter their online service request containing personal information.

The submission of a patients personal information made on the practice website could be over one of two channels:

  • HTTPS (web) – A secure encrypted channel that encrypts the patients personal information across the internet as they enter their details to submit their online service request to the practice website.
  • HTTP (web) – An insecure unencrypted channel that results in the patient entering their personal information across the internet in cleartext as they submit their online service request to the practice website.

The second area to confirm, is that the patients online service request is then transmitted to the practice using a secure channel. This process requires the practice to retrieve the patients online service request containing personal information over an encrypted channel.

The retrieval of a patients personal information from the practice website could be over one of two channels:

  • HTTPS (web) / TLS (email) – A secure encrypted channel that encrypts the patients personal information across the internet as the practice recalls the details so they can act on the patients online service request.
  • HTTP (web) / SMTP (email) – An insecure unencrypted channel that results in the practice retrieving a patients personal information across the internet in cleartext so they can act on the patients online service request.

Are we secure?

Considering the requirement to both submit and retrieve confidential patient information entered during an online service request, there are three potential combinations which could be provided to the practice by their website supplier:

  • Submission: Secure / Retrieval: Secure

This combination requires a secure encrypted submission channel where patients enter their confidential personal information to submit an online service request and a secure encrypted retrieval channel for the practice to retrieve the patients details in order to act on the online service request.

The secure submission channel would normally be a secure SSL protected (HTTPS) website and the secure retrieval channel would normally be either a secure SSL protected (HTTPS) website or a secure (TLS) protected email transfer.

OurPractice considers the security, confidentiality and integrity of confidential patient information an integral part of the website service. You can be assured that an OurPractice website secures your patients information with encrypted channels for both submission by the patient and retrieval by the practice.

  • Submission: Secure / Retrieval: Insecure

This combination results from a secure encrypted submission channel where patients enter their confidential personal information to submit an online service request and an insecure retrieval channel for the practice to retrieve the patients details in order to act on the online service request.

The secure submission channel would normally be a secure SSL protected (HTTPS) website and the insecure retrieval channel is likely to be an insecure (SMTP) email transfer.

  • Submission: Insecure / Retrieval: Insecure

This combination results from both an insecure submission channel where patients enter their confidential personal information to submit an online service request and an insecure retrieval channel for the practice to retrieve the patients details in order to act on the online service request.

The insecure submission channel is likely to be an unprotected (HTTP) website and the insecure retrieval channel is likely to be an insecure (SMTP) email transfer.

Why is email insecure?

Using standard email as the retrieval method for confidential patient information entered during the submission of a patients online service request is inherently insecure because of the cleartext (SMTP) protocol used during the transmission of email.

In contrast, TLS refers to a method for securing SMTP with transport layer security. It is intended to provide authentication of the communication partners, as well as data integrity and confidentiality. This means that the client and server speak normal SMTP at the application layer, but the connection is secured by TLS.

Currently sending a standard email to an nhs.net email address eg practice.name@nhs.net is insecure as nhs.net does not currently appear to support a secure gateway to gateway TLS connection even if the sending email service does. A standard email containing confidential patient information sent to an nhs.net email address for retrieval of a patients online service request is not encrypted and is sent as cleartext. A more detailed analysis of the current nhs.net email transport layer is in progress.

What should we do?

Having a technical insight into the submission and retrieval of patient information, should you be asking your website supplier. “Does our practice website compromise the security of our patients confidential information?”

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