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- Imagine a world where you own your own health records,
the records of your vaccinations and your lab results
and where they're under your control,
where you can access and manage them
from your mobile phone or from your PC,
and where you choose how and when you share them,
and where you can have this,
whether or not you own a mobile phone.
This is our goal, and this is what we're starting
with SMART Health Cards.
My name is Karen Easterbrook
and I'm a Senior Principal Program Manager
in Microsoft Research, working on security and cryptography.
Today, I'm gonna be talking about work I'm leading
in the COVID response,
as part of our efforts in societal resilience.
SMART Health Cards, and the SMART Health Card framework
are an open specification
for an electronic version of a medical record.
They're designed to allow each of us
to carry our own vaccination records
and lab results with us.
With a SMART Health Card,
your information is under your own control,
and you can choose when you share that with others
in a way that allows the information
to be cryptographically verified.
Years of work had gone into something called FHIR,
or Fast Healthcare Interoperability Resources;
which is a standard for recording medical information
developed by HL7, an international standards org.
Work had also be done on the design for SMART Health Cards,
which hold medical information in a FHIR format.
When the pandemic hit, some very brilliant colleagues
recognized that this was the right base
to build COVID vaccination records from,
and so SMART Health Cards took off.
These cards were designed by a community
that includes medical professionals and computer scientists
from a broad variety of organizations, public and private.
I want to acknowledge those that rallied together
to build what became SMART Health Cards.
Many of them are members of VCI or The Commons Project,
but many others have contributed as well.
As we dive into the details here,
my frame of reference will be the U.S. and Canada,
and we'll be using tools my security and crypto team built
to learn more about the cards.
We'll come back
and talk about the larger picture at the end.
This work is grounded in some simple principles.
One of the most foundational,
is that a SMART Health Card is a medical record.
It's not an ID, it's not a passport,
it includes your legal name and your date of birth
and your medical information, and that's it.
Nothing else.
The cards are built from open source and open standards.
Underneath the hood, SMART Health Cards
are based on the verifiable credentials standard,
a W3C standard for digital credentials.
Verifiable credentials can hold claims about anything,
but in this case they're conveying medical information.
The cards are cryptographically signed
so that any tampering would be detected
and they can be easily verified.
The cryptographic signing ensures
that the information in the credential can be trusted.
But let's go back to why a health card isn't a passport.
It contains clinical information,
but it doesn't draw any conclusions about it.
The SMART Health Card is intentionally limited
to recording your clinical information.
This ensures that they'll remain relevant,
even as our knowledge of the virus grows
and the circumstances of the pandemic change over time.
Another principle is that this electronic record
needs to be available in a variety of formats.
For people with an Apple or an Android phone,
the SMART Health Card can be sent to you
as an electronic file that you check into a wallet app
on your phone; or if you don't have,
or don't wish to use a wallet app,
you can receive your SMART health card as a QR code,
as an image that you can have on your phone.
All of your information is stored in that QR code.
This is not a link to a cloud location.
But not everyone has access to a mobile phone
or wants to use their phone for this.
So your SMART Health Card
can also be printed out as a QR code on paper,
which contains all of your information.
You can tuck that into your pocket
and use it the same way
that you'd use the version on the phone;
which might lead you to the question,
hey, what's the difference between a paper QR code
and the paper CDC card that they hand you in the U.S.?
Well remember that this is built
to be a verifiable credential,
which means that it's cryptographically signed
by the issuer.
A verifier can scan your code
and verify that the credential is valid
in the same way it would
for an electronic version of that credential,
same exact process.
The paper QR code has another advantage,
that it can easily be reprinted
or re-issued if the original is lost.
So let's look at how all this works.
There are three important entities in the system.
The first is people like us,
who are issued a SMART Health Card.
In the standards documentation,
you'll hear our rule referred to as holder or approver.
We hold our credentials, which contain our claims,
and we use them to prove something about ourselves.
The second is an issuer.
An issuer is an organization
who can authoritatively state a medical fact,
and who is signed up to be part of this ecosystem.
Example of issuers include provinces,
state and local governments,
some health organizations, hospital systems,
and some major pharmacies.
These organizations can be issuers, not all are yet,
but they can be because they know
that an inoculation was given to an individual
on a certain date and time,
and they know the details of which vaccine it was,
which lot number.
In the language of credentials,
the fact that the issuers are signing is a claim.
The claim is signed by the private key of the issuer.
The issuer has to protect their private key
and manage it carefully.
If the private key is compromised,
then the system is compromised.
Third role is the verifier.
A verifier is someone
that you show your SMART Health Card to,
who can scan and quickly validate your card.
An example of a verifier might be your employer,
who you're showing your vaccinations
or your test results to.
Sitting logically between the issuers and verifiers
is a directory of issuers with a link to their public keys.
As issuers sign up, they're added to this directory.
When a verifier is presented with a credential,
they check against the directory of issuers; doing some math
to verify that the credential has been properly signed
with the private key of a trusted issuer,
someone who is in that directory.
If the math checks out, the card is valid.
Let's talk through the steps that happen
when your SMART Health Card is created by your issuer.
Your medical information
goes through a series of encoding steps
to build the credential.
So first, your clinical information
is encoded as a FHIR bundle.
You'll remember that this is the F-H-I-R standard
for encoding medical information.
The FHIR bundle is in turn encoded
as a JSON web signature, or JWS payload,
using the verifiable credential format.
The JWS payload is minimized, compressed,
and base64url encoded.
The JWS header is encoded
with the compression algorithm used,
the signature algorithm used, and the issuer key ID,
which identifies which key
is required to verify the signature.
The JWS header and payload
are signed with the issuers private key,
encoding the signature in the JWS.
Now the next step depends upon the forms
that you want your health card in.
The JWS can be encoded in a SMART Health Card file
for storing on your wallet app in the phone,
or the JWS can be encoded as a numeric QR,
from which the QR code image
is created for either printing or storing on your phone.
In our developer tools portal,
you can use sample test data to watch those transformations
or test your own code.
Let's take a quick look at the developer portal,
which offers tooling for issuing,
creating, a SMART health card.
Clicking on the question mark
will provide you with more details
on each gage of the test.
To use our sample data,
click download sample and again on the question mark,
and then click on use sample key.
This now allows you to see each step
of the transformation of your FHIR data
into a SMART Health Card.
At the time we're filming this,
SMART Health Cards are beginning to roll out
in the U.S. and Canada.
This is a work in progress
and there's conversations underway now
about how the different credential systems
in different countries will interact.
Some countries are choosing different approaches,
and we're all figuring out now
how to make them work together.
Beyond the immediate pandemic response,
the same format and approach
can be used for other types of information,
other claims that we may wanna carry with us.
As researchers, we're really excited by the potential here.
Just over 15 years ago, Microsoft sent me to Mississippi
to build ad hoc networks in the wake of hurricane Katrina
to help the recovery.
I saw firsthand the chaos and destruction
that an event like that brings;
and beyond the need for immediate relief,
how recovering was hard for people,
because in many cases, they'd lost the information
that they needed in that recovery.
Not just medical history; insurance information,
auto registration, proof of your identity, and more.
The scattering of your community
and the difficulty of reconnecting made all of this worse.
This can also happen to people
who've gone through hard personal times.
They may have lost touch
with the records that will help them get back on track.
We imagine a world where you own your own records,
where you can access and manage them,
and they're backed up to the cloud all under your control,
no matter what life throws at you;
and where you don't need a mobile phone
to have access to any of this.
That's where we're going.
If you write code and are curious,
or if your organization is interested
in becoming a SMART Health Card issuer or verifier,
there's specifications, sample code, and developer tools
available under open-source license
to anyone who is interested.
The first thing to check out
is the technical specification for SMART Health Cards.
This will give you more details on how these cards work.
Next, is the GitHub for SMART Health Cards,
where you can see the code for yourself.
And here's the link to our developer tools
for writing issuer and verifier code.
They're a great way to explore how these work.
If you're curious,
you can use the sample data and with one click,
see the transformation steps yourself.
You can learn more about VCI
and The Commons Project at their website.
And lastly, you can learn more
about the Microsoft Research societal resilience work
at our website.
Thank you.
And I hope you've enjoyed this introduction
to SMART Health Cards.
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