[Federal Register Volume 71, Number 178 (Thursday, September 14, 2006)]
[Notices]
[Pages 54283-54284]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-7657]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES


Office of the National Coordinator for Health Information 
Technology; American Health Information Community Confidentiality, 
Privacy, and Security Workgroup Meeting

ACTION: Announcement of meeting.

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SUMMARY: This notice announces the second meeting of the American 
Health Information Community (``the Community'') Confidentiality, 
Privacy, and Security Workgroup in accordance with the Federal Advisory 
Committee Act (Pub. L. No. 92-463, 5 U.S.C., App.)

DATES: September 29, 2006 from 10 a.m. to 4:30 p.m.
    Place: Hubert H. Humphrey Building (200 Independence Avenue, SW., 
Washington, DC 20201), Conference room 800 (you will need a photo ID to 
enter a Federal building).
    Status: Open.
    Purpose: At this meeting, the Community Confidentiality, Privacy, 
and Security Workgroup will receive information on identity proofing 
and user authentication as it relates to the breakthroughs currently 
being discussed by the Community's Consumer Empowerment, Chronic Care, 
and Electronic Health Record Workgroups.
    The meeting will be conducted in hearing format, and the Workgroup 
will invite representatives who can provide information relevant to 
identity proofing and user authentication as it relates to the 
breakthroughs currently being discussed by the Community's Consumer 
Empowerment, Chronic Care, and Electronic Health Record Workgroups. The 
format for the meeting will include multiple invited panels and time 
for questions and discussion. The meeting will include a time period 
during which members of the public may deliver brief (3 minutes or 
less) oral public comment. Slots for oral comments by the public will 
be filled on the day of the meeting as time permits. To submit comments 
via e-mail, please send them to <a href="/cdn-cgi/l/email-protection#4b062228232e272e65192427272225380b232338652c243d"><span class="__cf_email__" data-cfemail="d09db9b3b8b5bcb5fe82bfbcbcb9bea390b8b8a3feb7bfa6">[email protected]</span></a> (to ensure that 
your e-mail is received and appropriately filed, we ask that your 
explicitly put ``CPS Public Comment'' in the subject line of your e-
mail) or mail your comments to Michele Rollins, Office of the National 
Coordinator (ONC), 330 C Street, SW., Suite 4090, Washington, DC 20201.

SUPPLEMENTARY INFORMATION: The Community's Confidentiality, Privacy, 
and Security (CPS) Workgroup will undertake steps to evaluate instances 
where health information technology (health IT) has shifted the CPS 
paradigm, as well as where policy (due to evolving technology) have 
become unclear or allow for varied interpretation.
    The first two issues before the CPS workgroup (identity proofing 
and user authentication) were chosen because of their foundational 
importance to any security initiative. Inextricably linked, both issues 
need discussion in order to determine how authorized entry is governed 
to a new technology product, service, or infrastructure. In typical 
workflows, identity proofing and user authentication are the first of 
many processes completed in health care environments, followed shortly 
thereafter by other more complex activities such as access control, 
data management, information matching and transmission, and information 
assurance (data integrity, business continuity, etc.).
    There is no one solution for identity proofing and user 
authentication. As health IT evolves, we expect that methods for 
identity proofing and user authentication will evolve as well. Certain 
types of health IT products may require more stringent methods while 
others may not, and understanding these tradeoffs will be critical to 
determining CPS policies. Deciding how to prove (with some degree of 
confidence) that someone is who they claim to be, followed by a 
repeatable authentication process, are necessary steps to ensure that 
an authorized person or entity can access a health IT product or 
service in a private and secure manner.
    In an effort to inform members of the public responding to the 
questions posed for testimony, we are defining

[[Page 54284]]

identity proofing and user authentication. For the purposes of the CPS 
hearing, identify proofing should be understood to mean the process of 
providing sufficient information (e.g., identity history, credentials, 
and documents) to correctly and accurately verify and establish an 
identity to be used in an electronic environment (e.g., over the 
Internet). For many everyday processes such as applying for a passport 
or driver's license, identity proofing takes place. To be granted the 
rights associated with a passport or driver's license, one first needs 
to provide documents to prove one's identity (e.g., birth certificate). 
This same principal exists to control access to electronic systems, and 
it is the intent of this hearing to discuss the types of identity 
proofing used or recommended to gain access to certain health IT 
products or services.
    For the purposes of the CPS hearing, user authentication should be 
understood to mean the process of reliably verifying a claimed or 
presented identity, often used as way to grant authorized access to 
data, resources, and other network services. User authentication takes 
place after an identity has been successfully proofed (verified by the 
appropriate authority) and a credential representing that proofed 
identity has been assigned to an individual. This does not mean the 
assignment of a unique identifier, but rather it refers to the method 
any system uses (in a unique way) to differentiate its users (e.g., a 
separate username) and challenge the user's ability to prove that they 
are who they claim to be (e.g., knowledge of a password associated with 
the username).
    While responding to the questions below, it is recommended that 
each response identify (1) The risks and benefits associated with a 
particular identity proofing and/or user authentication method; (2) the 
potential costs and/or barriers associated with the method's 
implementation; and (3) if feasible, quantify the risks, benefits, 
costs, or barriers discussed in parts 1 and 2, with respect to a health 
care consumer, provider, other entity, or all. Responses should be 
particularly focused on the Community's breakthroughs (pre-populated 
and consumer-directed medication history and registration summary as 
part of a personal health record (PHR), access to current and 
historical laboratory results and interpretations in an electronic 
health record (EHR), and secure messages between patients and their 
clinicians). Where possible, please provide references to any peer 
reviewed literature that has informed your response.

    1. Does an in-person identity proofing process provide greater 
benefit than automated, on-line processes, or vice-versa? Please 
explain.
    2. Identify and particular concerns regarding the type of 
information collected for identity proofing or the storage of such 
information.
    3. Should there be different identity proofing and user 
authentication processes for:
    a. A patient versus a clinician. If yes, please explain and 
identify the scenario;
    b. The primary user of a PHR versus a proxy for that user?
    4. Are there other industry policies and practices related to 
identity proofing and user authentication and could be used 
successfully in any of the Community identified breakthroughs (see 
above)? If so, please described these policies and specify how these 
could be implemented in a way that would minimize the risks and 
maximize the benefits as well as how they would compare to 
alternative methods in terms of risks, benefits and feasibility of 
implementation.
    5. What is the appropriate balance of access to medical 
information in electronic form (through the use of stronger identity 
proofing and user authentication) against the privacy concerns of 
the consumer/patient? If possible, please discuss comparable 
programs/efforts in the past that have been successful in doing 
this?
    6. What/how do you see the HHS's role, if any, in establishing 
guidelines for the health care industry with respect to identity 
proofing and user authentication? Or should the industry self-police 
in this area?
    7. If private industry EHR or PHR services were to import data 
from Federal agencies (who are required either by statute or policy 
to protect data in certain ways), would it be reasonable to expect 
that the EHR or PHR service provided would comply with Federal 
information security practices?
    8. Should the health care industry adopt the concept of multiple 
assurance levels when performing identity proofing and user 
authentication functions, similar to what OMB has defined for the 
Federal Government in OMB Memorandum M-04-04? When responding to 
this question, please cite, if possible other models that may exist 
specifically for health care?
    9. Based on your experience (personal/organizational) discuss 
how identity proofing and user authentication are currently 
addressed in the Personal Health Record (PHR) market from a 
technical, policy, and implementation perspective. Please ensure 
that your answers identify:
    a. How the type of PHR (i.e., who provides/sponsors the PHR) 
could impact the identity proofing and user authentication method 
chosen;
    b. Who is capable of providing data to the PHR;
    c. The potential impact the type of data (which may vary in 
levels of perceived sensitivity, e.g., a medication history that 
lists a drug for an ear infection versus a drug for HIV) could have 
on the identity proofing and user authentication method chose; and
    d. How data is entered into the PHR, for example, by a health 
care consumer, or from a provider through a ``push model'' where 
data is automatically sent to the PHR without a request by the 
consumer.
    10. Based on your experience (personal/organizational) with EHR 
technology, that can at a minimum provide access to current and 
historical laboratory results and interpretations, should identify 
proofing and user authentication methodologies (technical, policy, 
and implementation) differentiate based upon:
    a. The reception method of the data
    i. For example: Accessing a laboratory's secure Web site for 
results and typing them into a patient's EHR vs. automatic 
population from the lab to the EHR; and
    b. The interconnectivity of the EHR
    i. For example: A doctor in a large health care system may be 
able to query another provider's EHR for data as opposed to querying 
the lab directly.

    Written testimony submitted by the public is not required to 
address all of the questions listed above, and answers to any or all of 
the questions will be accepted so long as they comply with the 
following testimony guidelines. Persons wishing to submit written 
testimony (which should not exceed eight double-spaced typewritten 
pages) should endeavor to submit it by September 29, 2006.
    If you have special needs for the meeting or require further 
assistance, please contact (202) 690-7151 and reference the CPS 
meeting.
    The meeting will be available via Web cast at 
www.eventcenterlive.com/cfmx/ec/login/login1.cfm?BID=67 [Room Number: 
8285166].

Judith Sparrow,
Director, American Health Information Community, Office of Programs and 
Coordination, Office of the National Coordinator for Health Information 
Technology.
[FR Doc. 06-7657 Filed 9-13-06; 8:45 am]
BILLING CODE 4150-24-M


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