Encryption
Encrypting information using industry standard mechanisms has been part of DICOM since 1999. Exchanging DICOM images using protocols such TLS is highly secure. The TLS protocol is part of the TCP/IP layer. When TLS is used, the information is encrypted with a public/private key, which only the receiver can decode. Anyone listening in to the conversation would not be able to understand or decode it. The problem with using TLS is that the overhead, and therefore the performance impact, of encrypting and decrypting the information is significant. Ultimately, transmission time could double or triple. The good news is that one should not assume that just encrypting anything that goes across the network is the solution, only when patient information is exchanged. Some institutions extend their own virtual private network (VPN), providing a secure tunnel to their physicians’ homes and offices, which makes application level-based TLS encryption by the DICOM protocol unnecessary. The major advantage of a VPN is that the security provision is transparent to the communication basically by providing a secure "pipe". However, if information is ever sent to a physician who happens to be outside the secure private network (VPN), the use of some sort of encryption provided by the DICOM standard (such as TLS) is a requirement. The difference between a VPN and TLS solution is that the VPN is more a static, application-to-application level solution, while the TLS can be done dynamically, as needed. Encryption can be used for media as well as for network communications. Cryptographic Message Syntax (CMS) is an encryption standard which defines a secure envelope. It can be used to encrypt media such as confidential image information on a patient CD. |
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