ISO/TR 11636:2009
(Main)Health Informatics — Dynamic on-demand virtual private network for health information infrastructure
Health Informatics — Dynamic on-demand virtual private network for health information infrastructure
ISO/TR 11636:2009 explains the network requirements in the healthcare field, the network security of an open network for the healthcare field, and the minimum guidelines for security management of health information exchange, including personal data, between external institutions. These requirements will assist in understanding the operation of security and evaluation of security issues in the healthcare field, and the usefulness of a managed VPN, like a dynamic on-demand VPN. ISO/TR 11636:2009 introduces examples of security measures taken in a dynamic on-demand VPN for exchange of medical information; it is not intended to specify the dynamic on-demand VPN itself. These examples provide network solutions to potential risks in such a user environment.
Informatique de santé — Réseau privé, virtuel, dynamique, sur demande pour infrastructure d'information de santé
General Information
Standards Content (Sample)
TECHNICAL ISO/TR
REPORT 11636
First edition
2009-12-01
Health Informatics — Dynamic
on-demand virtual private network for
health information infrastructure
Informatique de santé — Réseau privé, virtuel, dymanique, sur
demande pour infrastructure d'information de santé
Reference number
©
ISO 2009
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ii © ISO 2009 – All rights reserved
Contents Page
Foreword .iv
Introduction.v
1 Scope.1
2 Terms and definitions .1
3 Abbreviated terms .3
4 Network features in the healthcare field .4
4.1 Pattern of current or expected information services in the healthcare field .4
4.2 Category of healthcare information to be protected (information assets).5
4.3 Network requirements in the healthcare field .6
5 Concept of network construction in the healthcare field.6
5.1 Overview.6
5.2 Responsibility to manage security of healthcare information exchange including personal
information between independent institutions .7
5.3 Security concepts in network systems for medical institutions .8
6 Threat analysis and measures .9
7 Network construction in the healthcare field .10
7.1 Minimum guidelines for security management of healthcare information exchange
including personal information between external institutions.10
7.2 Technical and operational checklists for evaluation of network security.11
7.3 Application of an on-demand VPN .11
8 Cases of security measures in a dynamic on-demand VPN for exchange of healthcare
information with external institutions .12
8.1 Introduction.12
8.2 Regional healthcare cooperation model with a healthcare portal.12
8.3 Online maintenance model.13
8.4 Regional cooperation model with the lead taken by a regional core hospital.14
8.5 Model for teleradiology, remote maintenance and network conferencing with the
cooperation of university hospitals, research institutions and regional hospitals .15
8.6 University hospital model centred around teleradiology, telepathology and network
conferences conducted between a university hospital and regional hospitals .16
Annex A (informative) Threat analysis and measures .18
Annex B (informative) Security management of medical information exchange including personal
data between independent institutions (see reference [6]) .25
Annex C (informative) Technical and operational checklists for the guideline.35
Annex D (informative) Technology used: Dynamic on-demand VPN.62
Bibliography.70
Foreword
ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies
(ISO member bodies). The work of preparing International Standards is normally carried out through ISO
technical committees. Each member body interested in a subject for which a technical committee has been
established has the right to be represented on that committee. International organizations, governmental and
non-governmental, in liaison with ISO, also take part in the work. ISO collaborates closely with the
International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization.
International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2.
The main task of technical committees is to prepare International Standards. Draft International Standards
adopted by the technical committees are circulated to the member bodies for voting. Publication as an
International Standard requires approval by at least 75 % of the member bodies casting a vote.
In exceptional circumstances, when a technical committee has collected data of a different kind from that
which is normally published as an International Standard (“state of the art”, for example), it may decide by a
simple majority vote of its participating members to publish a Technical Report. A Technical Report is entirely
informative in nature and does not have to be reviewed until the data it provides are considered to be no
longer valid or useful.
Attention is drawn to the possibility that some of the elements of this document may be the subject of patent
rights. ISO shall not be held responsible for identifying any or all such patent rights.
ISO/TR 11636 was prepared by Technical Committee ISO/TC 215, Health informatics.
iv © ISO 2009 – All rights reserved
Introduction
Currently, healthcare information is normally transferred in the form of paper documents or electronic data
through schemes such as dedicated fixed lines connecting the headquarters and branches within a company,
through public networks such as an Integrated Services Digital Network (ISDN), or through a dedicated
network between specific institutions, enabling a virtual network for the specified users in a dedicated service
network managed by communication providers, such as an Internet Protocol virtual private network (IP-VPN).
Therefore, healthcare information cannot be transferred easily while maintaining security in most cases,
because network configurations adequate to these solutions are limited and the costs are very high.
The uses of various service networks in the healthcare field include online claims for medical fees, online
maintenance of medical devices, and remote medical care, such as teleradiology, telepathology and
healthcare information services for regional healthcare cooperation. To provide such services however, it is
necessary for multiple medical institutions to pass healthcare information to each other. A network in which a
single medical institution is dynamically connected to multiple medical institutions and switched to another
institution is required.
To make such a network available to many medical institutions at low cost, an open network such as the
Internet can be used for connecting with different medical institutions, medical device providers, and patients.
We can use the following VPNs as secure channel systems in an open network:
Internet Protocol Security (IPsec) with Internet key exchange (IKE), described as IPsec + IKE which runs
in the network layer with authentication and exchange of encryption keys, and
Secure Sockets Layer (SSL) protocol, which runs in the session layer with encrypted communication
between a Web browser on a client and SSL servers.
Thus, this is adapted to web applications, but other applications, such as e-mail, File Transfer Protocol (FTP),
and unique client/server systems, cannot be used. On the other hand, the combination of IPsec + IKE can be
used with any application needed by medical institutions to provide secure channels without reconstructing
any application software. In addition, SSL has an inherent risk because it provides no protection methods
against well-known lower-layer attacks, session hijacking, false Address Resolution Protocol (ARP)
statements, and so on.
The conventional VPN using IPsec + IKE however, requires complicated configuration of network devices,
and setting up the system without expertise could result in failure to protect healthcare information. Also, it is a
fixed-type VPN and can only be connected with fixed parties.
Lately, telecommunication carriers and online service providers (OSPs) have been developing systems to
provide services with security on network lines, including setting up network devices to safeguard against
these threats, even for a VPN connected in an open network. When a medical institution uses these types of
service, most of the responsibilities related to managing the communication lines fall to these service
providers (SPs). This reduces the responsibility of the medical institution in terms of its security-related
liabilities, which is well suited for organizations without many IT engineers.
A dynamic on-demand VPN, which this Technical Report describes, is one type of VPN. It is not a fixed
connection like 1-to-1, which is generally used in ordinary VPN services. It can easily change connection to
N-to-N, and the connection parameters are provided automatically by the telecommunication carrier. This
makes it suitable for healthcare network infrastructure, as medical institutes are not required to be responsible
for or have expertise in setting up such networks. Also, utilizing the Internet makes the dynamic on-demand
VPN an inexpensive network and thus readily acceptable to medical institutions in terms of cost.
This Technical Report describes the threats anticipated in a healthcare network, as well as how a dynamic
on-demand VPN is actually applied in the healthcare field.
TECHNICAL REPORT ISO/TR 11636:2009(E)
Health Informatics — Dynamic on-demand virtual private
network for health information infrastructure
1 Scope
This Technical Report explains the network requirements in the healthcare field, the network security of an
open network for the healthcare field, and the minimum guidelines for security management of health
information exchange, including personal data, between external institutions.
These requirements will assist in understanding the operation of security and evaluation of security issues in
the healthcare field, and the usefulness of a managed VPN, like a dynamic on-demand VPN.
This Technical Report introduces examples of security measures taken in a dynamic on-demand VPN for
exchange of medical information; it is not intended to specify the dynamic on-demand VPN itself.
These examples provide network solutions to potential risks in such a user environment.
2 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
2.1
demilitarized zone
DMZ
area of a network in which any data exchange with areas outside is allowed
2.2
high security zone
HSZ
area of a network in which no data is exchanged directly with areas outside, except for the purpose of certain
remote maintenance
2.3
IPsec
standard for cipher communication, a protocol that prevents data tampering and provides confidentiality
functions for each IP packet by using an encryption technique
2.4
internet VPN
VPN created via the Internet
NOTE By using the Internet, connections between remote networks can be managed as connections in a LAN, while
maintaining confidentiality.
2.5
IP-VPN
VPN created via a wide-area IP network owned by a communication carrier
NOTE By using an IP-VPN, connections between remote networks can be managed in the same manner as
connections in a local area network (LAN).
2.6
local area network
LA
...
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