SIST EN ISO 21091:2013

Health informatics - Directory services for healthcare providers, subjects of care and other entities (ISO 21091:2013)

ISO 21091:2013 defines minimal specifications for directory services for healthcare. It can be used to enable communications between organizations, devices, servers, application components, systems, technical actors, and devices.
ISO 21091:2013 provides the common directory information and services needed to support the secure exchange of healthcare information over public networks where directory information and services are used for these purposes. It addresses the health directory from a community perspective in anticipation of supporting inter-enterprise, inter-jurisdiction, and international healthcare communications. While several options are supported by ISO 21091:2013, a given service will not need to include all of the options.
In addition to the support of security services, such as access control and confidentiality, ISO 21091:2013 provides specification for other aspects of communication, such as addresses and protocols of communication entities.
ISO 21091:2013 also supports directory services aiming to support identification of health professionals and organizations and the subjects of care.

Medizinische Informatik - Verzeichnisdienste für Sicherheit, Kommunikation und Identifikation von Heilberuflern und Patienten (ISO 21091:2013)

Informatique de santé - Services d'annuaires pour la sécurité, les communications et l'identification des patients et des professionnels (ISO 21091:2013)

L'ISO 21091:2013 définit les spécifications minimales relatives aux services d'annuaire pour les soins de santé. Elle peut être utilisée pour permettre les communications entre organisations, appareils, serveurs, composants d'applications, systèmes, acteurs techniques et dispositifs.
L'ISO 21091:2013 fournit les informations et services d'annuaire communs nécessaires pour prendre en charge l'échange en toute sécurité des informations de soins de santé sur les réseaux publics lorsque les informations et services d'annuaire sont utilisés à cette fin. Elle traite de l'annuaire de santé d'un point de vue communautaire préalablement aux communications interentreprises, inter-juridiction et internationales en matière de soins de santé. Bien que plusieurs options soient prises en charge par la présente Norme internationale, il ne sera pas nécessaire pour un service donné d'inclure toutes les options.
Outre le support des services de sécurité tels que le contrôle et la confidentialité d'accès, l'ISO 21091:2013 doit spécifier d'autres aspects de la communication, tels que les adresses et les protocoles des entités de communication.
L'ISO 21091:2013 concerne également les services d'annuaires qui ont pour objet de prendre en charge l'identification des professionnels et des organisations de santé ainsi que celle des patients.

Zdravstvena informatika - Imeniške storitve za ponudnike zdravstvenega varstva, zdravstvene delavce in paciente (ISO 21091:2013)

Ta mednarodni standard določa metodo titracije plinske faze (GPT) za umerjanje analizatorjev ozona v zunanjem zraku (O3). Metoda se uporablja za umerjanje koncentracij O3 v razponu 10 μg/m−3 (molski delež 5 nmol/mol−1) do 2000 μg/m−3 (molski delež 1000 nmol/mol−1). Ta mednarodni standard uporablja referenčne pogoje 25 °C in 101,325 kPa; sprejemljivi sta tudi referenčni temperaturi 0 °C in 20 °C.

General Information

• Status: Published
• Public Enquiry End Date: 25-Apr-2009
• Publication Date: 17-Mar-2013
• ICS: 35.240.80 - IT applications in health care technology
• Technical Committee: ITC - Information technology
• Current Stage: 6060 - National Implementation/Publication (Adopted Project)
• Start Date: 06-Mar-2013
• Due Date: 11-May-2013
• Completion Date: 18-Mar-2013
• Ref Project: EN ISO 21091:2013 - Health informatics - Directory services for healthcare providers, subjects of care and other entities (ISO 21091:2013)

Overview

EN ISO 21091:2013 / ISO 21091:2013 - "Health informatics - Directory services for healthcare providers, subjects of care and other entities" - defines minimal, healthcare‑specific specifications for directory services. It supports secure exchange of healthcare information over public networks by specifying common directory information and services used for identification, communication addressing, and security support across organizations, devices, servers and application components.

Key topics and technical requirements

• Directory scope and purpose: Community‑level directory services designed to support inter‑enterprise, inter‑jurisdictional and international healthcare communications.
• Healthcare schema: Standardized directory content models for healthcare persons, organization identities, roles/job functions/groups and related attributes.
• Naming and structure: Guidance on namespace/tree structure and Distinguished Names (DNs) including Relative Distinguished Names (RDNs).
• Security support: Directory support for confidentiality, access control and authentication; integration with public key infrastructure (PKI) for certificate distribution and certificate status information.
• Communication details: Specification of addresses and protocols for communication entities; designed to interoperate with LDAP clients, interface engines and SOA implementations.
• Interoperability: Minimum requirements to enable reliable lookups, single sign‑on support, and attribute exchange to inform authorization decisions.
• Extensibility and governance: Emphasis on extensible registration/management, distributed operation, and the need for policies and processes to ensure data integrity and role‑based privileges (e.g., assigning HCOrganizationalRole and related rights).

Practical applications and users

Who uses ISO 21091:2013:

• Health IT architects and system integrators implementing directory services for hospitals, regional health information exchanges (HIEs) and national eHealth infrastructures.
• Identity and access management (IAM) teams integrating LDAP/PKI for clinician authentication, single sign‑on and authorization.
• Software vendors building EHR interfaces, middleware, SOA services and certificate registries.
• Policy makers and data stewards defining directory governance, role management and inter‑organizational trust.

Typical applications:

• Publishing and retrieving healthcare professional and organization identifiers and contact information.
• Distributing and validating digital certificates and certificate revocation/status via directory lookups.
• Enabling secure message routing, device addressing and service discovery across healthcare systems.

Related standards

• ISO/HL7 27931:2009 (HL7 v2.5 messaging)
• X.509 (certificates and attribute certificates), PKI standards
• ISO/IEC and other ISO health informatics standards referenced in the document

ISO 21091:2013 is published as EN ISO 21091:2013 by CEN and is intended as a foundation for interoperable, secure healthcare directory services. Keywords: ISO 21091:2013, health informatics, directory services, healthcare directory, LDAP, PKI, access control, healthcare identifiers, HCOrganizationalRole.

Standards Content (Sample)

SLOVENSKI STANDARD
01-april-2013
Zdravstvena informatika - Imeniške storitve za ponudnike zdravstvenega varstva,
zdravstvene delavce in paciente (ISO 21091:2013)
Health informatics - Directory services for healthcare providers, subjects of care and
other entities (ISO 21091:2013)
Medizinische Informatik - Verzeichnisdienste für Sicherheit, Kommunikation und
Identifikation von Heilberuflern und Patienten (ISO 21091:2013)
Informatique de santé - Services d'annuaires pour la sécurité, les communications et
l'identification des patients et des professionnels (ISO 21091:2013)
Ta slovenski standard je istoveten z: EN ISO 21091:2013
ICS:
35.240.80 Uporabniške rešitve IT v IT applications in health care
zdravstveni tehniki technology
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.

EUROPEAN STANDARD
EN ISO 21091
NORME EUROPÉENNE
EUROPÄISCHE NORM
February 2013
ICS 35.240.80
English Version
Health informatics - Directory services for healthcare providers,
subjects of care and other entities (ISO 21091:2013)
Informatique de santé - Services d'annuaires pour les Medizinische Informatik - Verzeichnisdienste für Anbieter,
fournisseurs de soins de santé, les sujets de soins et zu Behandelnde und andere Entitäten im
autres entités (ISO 21091:2013) Gesundheitswesen (ISO 21091:2013)
This European Standard was approved by CEN on 2 February 2013.

CEN members are bound to comply with the CEN/CENELEC Internal Regulations which stipulate the conditions for giving this European
Standard the status of a national standard without any alteration. Up-to-date lists and bibliographical references concerning such national
standards may be obtained on application to the CEN-CENELEC Management Centre or to any CEN member.

This European Standard exists in three official versions (English, French, German). A version in any other language made by translation
under the responsibility of a CEN member into its own language and notified to the CEN-CENELEC Management Centre has the same
status as the official versions.

CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United
Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION

EUROPÄISCHES KOMITEE FÜR NORMUNG

Management Centre: Avenue Marnix 17, B-1000 Brussels
© 2013 CEN All rights of exploitation in any form and by any means reserved Ref. No. EN ISO 21091:2013: E
worldwide for CEN national Members.

Contents Page
Foreword . 3
Foreword
This document (EN ISO 21091:2013) has been prepared by Technical Committee ISO/TC 215 "Health
informatics" in collaboration with Technical Committee CEN/TC 251 “Health informatics” the secretariat of
which is held by NEN.
This European Standard shall be given the status of a national standard, either by publication of an identical
text or by endorsement, at the latest by August 2013, and conflicting national standards shall be withdrawn at
the latest by August 2013.
Attention is drawn to the possibility that some of the elements of this document may be the subject of patent
rights. CEN [and/or CENELEC] shall not be held responsible for identifying any or all such patent rights.
According to the CEN-CENELEC Internal Regulations, the national standards organizations of the following
countries are bound to implement this European Standard: Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech
Republic, Denmark, Estonia, Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece,
Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal,
Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and the United Kingdom.
Endorsement notice
The text of ISO 21091:2013 has been approved by CEN as EN ISO 21091:2013 without any modification.

INTERNATIONAL ISO
STANDARD 21091
First edition
2013-02-15
Health informatics — Directory
services for healthcare providers,
subjects of care and other entities
Informatique de santé — Services d’annuaires pour les fournisseurs
de soins de santé, les sujets de soins et autres entités
Reference number
ISO 21091:2013(E)
©
ISO 2013
ISO 21091:2013(E)
© ISO 2013
All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized otherwise in any form
or by any means, electronic or mechanical, including photocopying, or posting on the internet or an intranet, without prior
written permission. Permission can be requested from either ISO at the address below or ISO’s member body in the country of
the requester.
ISO copyright office
Case postale 56 • CH-1211 Geneva 20
Tel. + 41 22 749 01 11
Fax + 41 22 749 09 47
E-mail [e-mail]
Web www.iso.org
Published in Switzerland
ii © ISO 2013 – All rights reserved

ISO 21091:2013(E)
Contents Page
Foreword .iv
Introduction .v
1 Scope . 1
2 Normative references . 1
3 Terms and definitions . 1
4 Symbols (and abbreviated terms) . 5
5 Healthcare context . 6
5.1 General . 6
5.2 Healthcare persons . 7
5.3 Multiple affiliations . 7
5.4 Healthcare organizations . 8
5.5 Hardware/software . 8
5.6 Healthcare security services . 8
6 Directory security management framework . 8
7 Interoperability . 9
7.1 Requirements . 9
7.2 Name space/tree structure . 9
8 Healthcare schema .11
8.1 Healthcare persons .11
8.2 Organization identities .18
8.3 Roles, Job Function and Group .23
9 Distinguished Name .28
9.1 General .28
9.2 Relative Distinguished Name .29
Annex A (informative) Healthcare directory scenarios .32
Annex B (informative) Referenced object classes .40
Bibliography
.............................................................................................................................................................................................................................47
ISO 21091:2013(E)
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.
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 21091 was prepared by Technical Committee ISO/TC 215, Health informatics.
This first edition cancels and replaces ISO/TS 21091:2005, which has been technically revised.
iv © ISO 2013 – All rights reserved

ISO 21091:2013(E)
Introduction
Health informatics directory services for healthcare providers, subjects of care and other entities are
intended to support the communication and security requirements of healthcare professionals in the
conduct of clinical and administrative functions. Healthcare requires extensive encipherment and access
control requirements for the disclosure and transport of all confidential health information. In support
of the healthcare public key infrastructure, healthcare will make available a registry of certificates
including business and professional information necessary to conduct healthcare transactions. This
information necessarily includes identification of individual roles within the healthcare system as can
only be identified by the respective healthcare organizations. As such, the registration and management
functions are to be extensible, and potentially distributed throughout the healthcare community.
Support for these additional healthcare requirements for security is also to be offered through the
directory service.
The directory is becoming an increasingly popular method of providing a means for single sign-on
capabilities to support authentication. This goal has resulted in the inclusion of authentication and
identity attributes to authenticate the identity of a healthcare person or entity.
The directory also supports the communication of additional attributes that can be used to support
authorization decisions. This goal has driven directory schema extensions to include organization
employee management information, healthcare-specific contact information, and healthcare identifiers.
This International Standard addresses the healthcare-specific requirements of the directory, and defines,
as appropriate, standard specifications for inclusion of this information in the healthcare directory.
Besides technical security measures that are discussed in other ISO standards, communication of
healthcare data requires a reliable accountable “chain of trust.” In order to maintain this chain of trust
within a public key infrastructure, users (relying parties) need to be able to obtain current correct
certificates and certificate status information through secure directory management.
The healthcare directory will support standard lightweight directory access protocol (LDAP) client
searches, interface engines for message transformation, and service oriented architecture (SOA)
implementations to enable the service in any environment. Specific implementation guidance, search
criteria and support are outside the scope of this International Standard.
While specific security measures and access control specifications are out of scope of this International
Standard, due to the sensitive nature of health related and privacy information that may be supported
through the directory services, significant controls need to be enabled at branch, object classes, and
attribute levels. Processes and procedures should be in place to ensure information integrity represented
within the health directory, and responsibility for the content of the directory should be clearly
allocated through policy and process. It is anticipated that appropriate access controls managing who
can read, write or modify all items in the healthcare directory will be applied. This may be accomplished
by assigning individuals within the directory to the HCOrganizationalRole and assigning appropriate
privileges (e.g. read, modify, delete) to that role in directory management configuration.
INTERNATIONAL STANDARD ISO 21091:2013(E)
Health informatics — Directory services for healthcare
providers, subjects of care and other entities
1 Scope
This International Standard defines minimal specifications for directory services for healthcare. It can
be used to enable communications between organizations, devices, servers, application components,
systems, technical actors, and devices.
This International Standard provides the common directory information and services needed to support
the secure exchange of healthcare information over public networks where directory information and
services are used for these purposes. It addresses the health directory from a community perspective
in anticipation of supporting inter-enterprise, inter-jurisdiction, and international healthcare
communications. While several options are supported by this International Standard, a given service
will not need to include all of the options.
In addition to the support of security services, such as access control and confidentiality, this International
Standard provides specification for other aspects of communication, such as addresses and protocols of
communication entities.
This International Standard also supports directory services aiming to support identification of health
professionals and organizations and the subjects of care.
2 Normative references
The following referenced documents are indispensable for the application of this document. For dated
references, only the edition cited applies. For undated references, the latest edition of the referenced
document (including any amendments) applies.
ISO/HL7 27931:2009, Data Exchange Standards — Health Level Seven Version 2.5 — An application
protocol for electronic data exchange in healthcare environments
3 Terms and definitions
For the purposes of this document, the following terms and definitions apply.
3.1
access control
means of ensuring that the resources of a data processing system can be accessed only by authorized
entities in authorized ways
[ISO/IEC 2382-8]
3.2
attribute authority
AA
authority which assigns privileges by issuing attribute certificates
[X.509]
ISO 21091:2013(E)
3.3
attribute certificate
data structure, digitally signed by an attribute authority, that binds some attribute values with
identification about its holder
[X.509]
3.4
authentication
process of reliably identifying security subjects by securely associating an identifier and its authenticator
[ISO 7498-2]
3.5
authorization
granting of rights, which includes the granting of access based on access rights
[ISO 7498-2]
3.6
availability
property of being accessible and useable upon demand by an authorized entity
[ISO 7498-2]
3.7
certificate
public key certificate
3.8
certificate distribution
act of publishing certificates and transferring certificates to security subjects
3.9
certificate issuer
authority trusted by one or more relying parties to create and assign certificates
Note 1 to entry: Optionally the certification authority may create the relying parties’ keys.
[ISO/IEC 9594-8]
3.10
certificate management
procedures relating to certificates, i.e. certificate generation, certificate distribution, certificate
archiving and revocation
3.11
certificate revocation
act of removing any reliable link between a certificate and its related owner (or security subject owner)
because the certificate is not trusted any more, even though it is unexpired
3.12
certificate revocation list
CRL
published list of the suspended and revoked certificates (digitally signed by the CA)
3.13
certificate verification
verifying that a certificate (3.7) is authentic
2 © ISO 2013 – All rights reserved

ISO 21091:2013(E)
3.14
certification authority
CA
authority trusted by one or more relying parties to create and assign certificates and which may,
optionally, create the relying parties’ keys
Note 1 to entry: Adapted from ISO/IEC 9594-8.
Note 2 to entry: Authority in the CA term does not imply any government authorization, but only denotes that
it is trusted.
Note 3 to entry: “Certificate issuer” may be a better term, but CA is very widely used.
3.15
confidentiality
property that information is not made available or disclosed to unauthorized individuals, entities, or
processes
[ISO 7498-2]
3.16
data integrity
property that data has not been altered or destroyed in an unauthorized manner
[ISO 7498-2]
3.17
digital signature
data appended to, or a cryptographic transformation of, a data unit that allows a recipient of the data
unit to prove the source and integrity of the data unit and protect against forgery e.g. by the recipient
[ISO 7498-2]
3.18
identification
performance of tests to enable a data processing system to recognize entities
[ISO/IEC 2382-8]
3.19
identifier
piece of information used to claim an identity, before a potential corroboration by a corresponding
authenticator
[ENV 13608-1]
3.20
integrity
property that data has not been altered or destroyed in an unauthorized manner
[ISO 7498-2]
3.21
key
sequence of symbols that controls the operations of encipherment and decipherment
[ISO 7498-2]
ISO 21091:2013(E)
3.22
key management
generation, storage, distribution, deletion, archiving and application of keys in accordance with a
security policy
[ISO 7498-2]
3.23
lightweight directory access protocol
LDAP
standard access protocol for directories allowing public or controlled access to certificates and other
information needed in a PKI
3.24
object identifier
OID
unique alphanumeric/numeric identifier registered under the ISO registration standard to reference a
specific object or object class
3.25
privacy
freedom from intrusion into the private life or affairs of an individual when that intrusion results from
undue or illegal gathering and use of data about that individual
[ISO/IEC 2382-8]
3.26
private key
key that is used with an asymmetric cryptographic algorithm and whose possession is restricted
(usually to only one entity)
[ISO/IEC 10181-1]
3.27
public key
key that is used with an asymmetric cryptographic algorithm and that can be made publicly available
[ISO/IEC 10181-1]
3.28
public key certificate
PKC
certificate that binds an identity and a public key
[RFC 3280]
3.29
public key infrastructure
PKI
structure of hardware, software, people, processes and policies that uses digital signature technology
to provide relying parties with a verifiable association between the public component of an asymmetric
key pair with a specific subject
3.30
relying party
recipient of a certificate who acts in reliance on that certificate and/or digital signature verified using
that certificate
[RFC 3647]
4 © ISO 2013 – All rights reserved

ISO 21091:2013(E)
3.31
role
set of competences and/or performances associated with a task
3.32
security
combination of availability, confidentiality, integrity and accountability
[ENV 13608-1]
3.33
security policy
plan or course of action adopted for providing computer security
[ISO/IEC 2382-8]
3.34
security service
service, provided by a layer of communicating open systems, which ensures adequate security of the
systems or of data transfers
[ISO/IEC 7498]
3.35
security subject
active entity, generally in the form of a person, process or device, that causes information to flow among
objects or changes the system state
Note 1 to entry: Technically, a process/domain pair.
3.36
subject
entity whose public key is certified in the certificate
3.37
subject of care
person scheduled to receive, receiving, or having received healthcare
3.38
third party
party other than data originator, or data recipient, required to perform a security function as part of a
communication protocol
3.39
trusted third party
TTP
third party which is considered trusted for purposes of a security protocol
[ENV 13608-1]
Note 1 to entry: This term is used in many ISO/IEC standards and other documents describing mainly the services
of a CA. The concept is however broader and includes services like time stamping and possibly escrowing.
4 Symbols (and abbreviated terms)
CA Certification Authority
CN Common Name
CRL Certificate Revocation List
ISO 21091:2013(E)
DAP Directory Access Protocol
DIT Directory Information Tree
DN Distinguished Name
EDI Electronic Data Interchange
LDAP Lightweight Directory Access Protocol
MPI Master Patient Index
PDA Personal Data Assistant
PIDS Person Identification Service
PKC Public Key Certificate
PKI Public Key Infrastructure
RA Registration Authority
RDN Relative Distinguished Name
TTP Trusted Third Party
5 Healthcare context
5.1 General
In order to accommodate healthcare-specific concerns, standard directory services shall be extended.
X.500 defined attributes do not completely fill the requirements to manage and distinguish health
professionals, subjects of care, organizations and other health entities engaged in healthcare
communications and security decisions. The increasing use of networks for the communication
and management of health information expands the need for healthcare-specific directories to add
support of a number of related information and security services. With increased use of internet and
intranet-based health information systems, health information will need to be communicated across
multiple entities and across unaffiliated entities, using both automated and human-interface based
systems. Such distributed health information management and communications require a standard for
communications data, healthcare professional directories, and consumer information.
Organizations are increasingly relying on enhanced information technology infrastructures to simplify
and enhance user management functions through the use of LDAP and similar services to manage
and access a central user repository across multiple systems within an organization. These activities
include corporate and institutional directories, definition of systems and services, and definition of
partner directories. Distinct from corporate models, in healthcare, such use requires enhanced schema
context so as to support in the need to represent healthcare regulatory information, clinical credentials,
multiple affiliations at both healthcare professional and organizational levels, unaffiliated members of
the organization’s healthcare community, consumers, and business partners.
There is also an increased use of directories for user authentication. By creating a single source for
user management, healthcare organizations can enhance user identification, authentication, and exit
process user identity removal. By providing a ‘single sign-on’ capability, better password security can
be encouraged.
Directories may also be leveraged to communicate user attributes for authorization decisions for
security infrastructure management. Associating healthcare related attributes, such as healthcare role
and specialties, support enhanced associated privilege granting, privilege removal, role management,
6 © ISO 2013 – All rights reserved

ISO 21091:2013(E)
and access control. However, while this is a powerful tool for enhanced security, the complexity of the
directory and inter-directory requirements is increased.
Another security service of the healthcare directory is to support healthcare PKI efforts. Such services
utilize the directory for public key storage and access, as well as PKI services support such as CRL storage
and access. Both the PKI and enhanced security service support add to the complexity of the healthcare
directory through additional object support requirements for servers, application components, and devices.
There are multiple types of directory implementations that may be supported by this International
Standard. There is no requirement that a directory service support all options. The optionality is provided
to allow for a communication domain to establish the a directory supporting the relevant healthcare
organizations, persons, or devices. Provider directories may be implemented to support scheduling
communications, notifications, provider-provider communications, and many other functions. Provider
directories may be leveraged for implementations of credential verification supporting communication
of sanction and credential status information. Service directories may support public or provider
queries such as identifying a specialist within a specified geographic area. Directories supporting
communications with subjects of care will require substantial access control protections, and as such
should be separately managed from provider directories. Such directories may be leveraged in support
of social services activities. These are just some of the applicability of healthcare directories. Additional
use cases can be found in Annex A of this International Standard.
5.2 Healthcare persons
While the X.500 standards include multiple object classes to represent persons as individuals and
employees, there are no standard attributes within these object classes to represent key healthcare-
specific information required to support industry communications and services. The healthcare
community needs to represent within the directory professional information such as credentials,
healthcare identifiers, role-specific information, and healthcare-specific contact information. Contact
information in healthcare is more complex than in typical business environments due to the nature of
multiple affiliations discussed in the next section. Healthcare persons include:
— regulated healthcare professionals;
— non-regulated healthcare professionals;
— employees of healthcare organizations and supporting organizations;
— subjects of care.
The inclusion of the subjects of care supports potential uses such as personal health records, patient
portals, or other such healthcare-specific endeavours in which large numbers of patients require online
identification and authentication services. Supporting inclusion of the subjects of care requires a balance
of core directory information, subject of care identifying information, and confidentiality in compliance
with underlying policy, for example compliance with permitted purposes of use. Implementations of
directories supporting such capabilities for the subjects of care should be separately managed from
provider directories.
5.3 Multiple affiliations
Healthcare persons, in many environments, may be affiliated with multiple organizations. These
persons may serve different functions under each of the organizations with which they are affiliated.
Many healthcare professionals operate independently, but are allowed practicing privileges within
one or many organizations. Similarly, supporting services may be provided to multiple healthcare
organizations. Within an organization, an individual may operate under differing roles depending
upon the care setting or other factors. Healthcare consumers typically seek services from numerous
healthcare professionals and organizations. In order to minimize inaccuracies associated with duplicate
management of information, the healthcare schema shall allow for links to primary management sources
in support of multiple affiliations.
ISO 21091:2013(E)
Another important factor is that healthcare staff are also healthcare consumers, and their professional
identities should be distinct from their healthcare consumer identity. From the perspective of appropriate
use, it is important that healthcare staff and their associated professional identities be separate from
their personal identities as the purposes of use are different in the different roles or contexts.
5.4 Healthcare organizations
While X.500 provides object classes for organizations, there are insufficient attributes within these
constructs to represent healthcare-specific information needed to support the healthcare directory
requirements. Healthcare-specific information includes:
— regulatory identifiers;
— class of service provided;
— service locations;
— contact information for key information management functions.
Healthcare organizations include:
— regulated healthcare organizations (i.e. hospitals, pharmacies, clinics, mobile units, skilled nursing
facilities, specialty units);
— payers, supporting organizations (i.e. suppliers, transcription services, coding services, claims
processing services);
— regulatory/monitoring agencies (i.e. professional colleges, disease control, drug control, public health)
5.5 Hardware/software
While X.500 provides object classes for servers and applications, healthcare devices and software are
subject to regulation and validation requirements and therefore should include additional attributes to
properly represent healthcare directory requirements. PDAs and other devices may also have specific
associations with other entities within the healthcare directory. The representation of hardware and
software in the directory is limited to the identification and communication parameters of these, and
association of these with individuals and organizations. The directory may be used for asset identification
but should not be relied upon for asset management.
5.6 Healthcare security services
Healthcare certification authorities, attribute authorities and registration authorities need to be
represented within the directory, and need to be able to publish relevant key management information.
Support for healthcare role management within the directory shall be able to represent healthcare-
specific components. This includes the representation of job function, job-specific contact information
and certificates (both professional and attribute certificates) associated with a healthcare person. This
does not include direct support for the representation of functional roles.
6 Directory security management framework
Healthcare needs to be supported by a framework of strong security management policies so as to
assure the integrity of communications data and the authentication infrastructure. There are already
such strong practice principles defined in international standards. While the following standards are
not directory specific, they should be adhered to for the protection of directory infrastructures:
— ISO/IEC 27000;
— ISO/IEC 27001;
— ISO 27799;
8 © ISO 2013 – All rights reserved

ISO 21091:2013(E)
— ISO/IEC 27005;
— COBIT specification produced by the Information Systems Audit and Control Foundation.
7 Interoperability
7.1 Requirements
Healthcare directories shall be able to contact and/or exchange relative information from directories of
various trading partners. Techniques include chaining, replication, referrals and unilateral or bi-lateral
trust between the directories. Some of these techniques will be sensitive to schema inconsistencies
depending upon the application or service. The following hierarchy requirements apply to the
interoperability models:
a) shall be able to physically separate the healthcare client base/community into a controlled, high-
service environment;
b) shall be able to provide replication and load-balancing management;
c) shall be able to limit the search tree to a specific geographical or logical area in order to provide
efficient access performance (i.e. 80/20 rule);
d) shall be able to organize DIT to facilitate access control management to protect confidential
information stored in the directory (e.g. subject of care certificates shall not be publicly accessible)
through branch-point references;
e) shall be able to organize the DIT to enable distributed access to healthcare jurisdictions.
7.2 Name space/tree structure
In order to address these requirements in a consistent manner, and in order to adhere to existing healthcare
regulatory jurisdictions, the following high-level name space and tree structure should be available.
7.2.1 Country
In all cases, the country of the healthcare professional jurisdiction shall be available and shall be the
top of the tree. In the case where an organization operates in multiple countries, there shall be a view
available that subjugates the organization to the healthcare regulatory jurisdiction.
c=Required
7.2.2 Locality
In those jurisdictions where Locality represents a regulatory jurisdiction (i.e. each state in the case of
the US), Locality shall be used to delineate the region of healthcare regulatory jurisdiction.
l=Optional
7.2.3 Organization
Organization shall be used to indicate the healthcare regulatory jurisdiction issuing authority under
which the healthcare professionals in the directory are authorized. Organization may also be used to
represent healthcare professional organizations and institutions, healthcare provider organizations,
and research organizations.
o=Required (issuing authority, healthcare professional organizations)
ISO 21091:2013(E)
7.2.4 Organization unit
In those jurisdictions where the issuing authority is further broken down by Issuing Authority Professional
Branch, this Organization shall be sub-categorized by Organization Unit for those jurisdictions that
maintain multiple professional authority branches. For instance, in many jurisdictions, pharmacists,
physicians, dentists may each be managed through a separate government body or department.
ou=Optional
7.2.5 Structural roles
At each of the levels in the hierarchy, there may exist both Standard Structural Roles, and Locally-Defined
Structural Roles. Structural Role concepts are described further in Clause 9 of this International Standard.
7.2.6 Multiple instantiations of individuals
A person within the system may be represented more than once, where that person has multiple healthcare
identities in the context of professional credentials, or in the context of associations with multiple
healthcare organizations, or other such cases where multiple representations may be appropriate. The
separations and information representations for these persons represented by multiple healthcare
identities are supported through the object classes and directory information tree (see Figure 1), but
the object classes alone do not assure that the desired separation is accomplished. The distinct Common
Name structure, however, does enable such separation through instantiation of multiple instances of
that individual in each health identity.
Within healthcare, there is a need to enable and represent control over the information components
of the healthcare identity by the different regulating bodies. Individuals are represented with validly
different contact and administrative information by different regulatory bodies. For instance, the contact
information and basic communication information for each licence type and jurisdiction may have
conflicting attribute content due to such issues as multiple residences. The independent instantiations
of these across multiple jurisdictions in the same directory shall be preserved. An individual may
exist in the directory both as a subject of care and as a provider. It is also important to separate an
individual’s personal and professional instantiation within the directory to assure appropriate use of
data. It is recognized that this may violate the concept of having a single entry in the directory for a given
person, but to appropriately represent the individual’s healthcare identity, it is a correct representation
reflection of the fact that a given person may have multiple healthcare identities. For instance, a
physician may have practicing privileges in multiple jurisdictions, and be known to those jurisdictions
under distinct identifiers, and in some cases, under distinct addresses. While the DIT described enables
the representation of all health individuals, organizations and device actors, it does not require that
these all be contained within the same physical or logical information space. These may be separated
for optimal service performance and architectural design as necessary. A given healthcare directory
may contain some, all, or none of the defined actors, and this may be instantiated using centralized and
decentralized methods.
A regulated health professional need be instantiated only once in any given jurisdiction. Through the
use of the HCOrganizationalRole described below, this instantiation may be represented in numerous
organizational capacities through the use of the attribute RoleOccupant, which will contain the DN of
the professional. Using this construct, job-specific contact information may be retrieved.
10 © ISO 2013 – All rights reserved

ISO 21091:2013(E)
KEY KEY
Figure 1 — Directory information tree (DIT) for healthcare
8 Healthcare schema
8.1 Healthcare persons
8.1.1 General
Multiple types of individuals are represented in the healthcare directory. The identity of each individual
within the system should be represented once except where it may be appropriate to do otherwise. An
example of such an exception is that a healthcare professional, when interacting with the healthcare
system as a subject of care, may be represented by two object classes: one that contains profession-
specific information, and another that contains subject of care-specific information. These shall all have
a parent class of person, and shall be specialized accordingly so as to represent the following types
of individuals: Healthcare Consumer, Healthcare Professional, and Healthcare Employee. Information
attributes specific to each of the object classes shall be added as a specialization of the base object
class. Support for the healthcare consumer is intended for identification and not for direct clinical care
support. Healthcare professional support includes the ability to flag the practitioner with sanction
indicators, credential restrictions, and other such warnings.
ISO 21091:2013(E)
The object class schemas that follow include definitions for extended attributes, and include:
Attribute The name of the new attribute to be supported
OID The ISO/TC 215 assigned object identifier associated with the new attribute
Description A description of the new attribute
Syntax The LDAP supported syntax to be used in representing the attribute
Matching Rules Matching rules to be used by servers to compare attribute values against
assertion values when performing Search and Compare operations
Multi-Valued An indication as to whether there is support expected for representing multi-
ple values for the attribute
The schema extension specifications also include information as to which of the additional attributes
are mandatory and which are optional. Matching rules are described in X.520|ISO/IEC 9594-6.
8.1.2 Subjects of Care (Healthcare Consumer)
Object Class HCSubjectOfCare
Superior Object Class: Person
OID: 1.0.21091.1.1.1
Object Class Type: Structural
Mandato
...