Understanding “whitelists” in Direct Project secure e-mail

What’s a “Whitelist”?

As a follow-on to the last post about Direct messaging, I want to distinguish the Mass Medical Society’s vision of a “whitelist” from another concept that confusingly shares the “whitelist” moniker. Below, I’ll introduce two distinct terms and try to clarify the distinction:

“OR-gate whitelists” expand the communication pool

Mass Medical Society envisions a kind of per-physician “whitelist” that I’ll call an OR-gate whitelist. The basic premise of an OR-gate whitelist is that a physician can add any Direct address to her OR-gate whitelist via a UI in her EHR or HISP. By doing so, she’d be able to send secure e-mail to that address — regardless of CAs, trust bundles, or pre-existing local policy. An OR-gate whitelist acts like a logical “OR gate,” meaning that a message will be sent if institutional policy allows it, or if a physician’s personal OR-gate whitelist allows it.  With OR-gate whitelists, physicians can send to any Direct endpoint in the world, full stop.

“AND-gate whitelists” restrict the communication pool

The current Massachusetts HIWay has a deployed a different kind of “whitelist” functionality that I’ll call an AND-gate whitelist. Mass HIWay maintains a state-wide AND-gate whitelist of acceptable Direct addresses to which HIWay users are allowed to send Direct messages. An AND-gate whitelist acts like a logical “AND gate,” meaning that a message will be sent only if institutional trust bundles allow it (i.e. the recipient’s cert is signed by a CA that the organization trusts) and the institution’s AND-gate whitelist allows it. So Mass HIWay’s state-wide AND-gate whitelist is a way to avoid allowing, say, “all eClinicalWorks users across the whole country” into the pool at once. Instead, access can be restricted to the intersection of two sets: “All eClinicalWorks users across the whole country” and “Users on the Mass HIWay AND-gate whitelist.”

Direct Project: Secure e-mail in MU2

MU2 is here, and with it: secure e-mail

As Meaningful Use 2014 EHRs come online this winter, clinicians across the country gain access the host of new features included in the MU 2014 Certification Requirements. In this post, we’ll dig into one of these features: EHR-based secure e-mail capabilities that operate using the “Direct Project” specification. (If you’re new to this world: when you hear “Direct Project,” you should think “secure e-mail for healthcare.”)

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SMART, FHIR, and a Plan for Achieving
Healthcare IT Interoperability

Since 2010, the SMART team has been privileged to work on an exciting frontier of health data liberation, exposing structured patient-level data through an open API. We’ve striven for simplicity, with a constrained set of well-described data models, fixed vocabularies, a clean REST API, and Web-based UI integration. And we’ve endeavored to use existing standards where they fit the bill: that is, when existing standards were openly available and met our own subjective criterion of developer-friendliness.

When we launched our first preview of the SMART API back in 2010, there was no structured data content standard that fit the bill, so we rolled our own. We started with simple models for Patient, Medication, and Fulfillment, and over time we’ve expanded the collection to encompass over a dozen top-level clinical statements. Building and maintaining these data models was never our core goal, but until recently, there hasn’t been a suitable alternative on the horizon.
Continue reading “SMART, FHIR, and a Plan for Achieving
Healthcare IT Interoperability”