Nuance UK Cloud services
Nuance offers Dragon® Medical One (DMO), PowerMicTM Mobile (PMM),Dragon Medical Embedded (DME) and eScription UK as Nuance UK cloud services.

For a full technical service document and FAQ's please email: one@exonera.co.uk

Premium secure cloud providers
Nuance has partnered with Microsoft Azure UK to host DMO, PMM, and DME out of the Azure regions UK South and UK West.
Nuance is hosting eScription UK out of a data centre in Slough. The secondary data centre is located in the Azure region UK South.
The Microsoft Azure cloud is designed to be highly available 24x7 and delivers consistent uptimes of 99.95%. Details of Microsoft Azure in the UK are available here https://azure.microsoft.com/en-gb/.
Microsoft Azure meets a broad set of international and industry-specific compliance standards. Details of all certifications per region can be found at: https://azure.microsoft.com/en-gb/overview/trusted-cloud/.

Nuance security measures
In addition to the core secure services offered by Microsoft Azure, Nuance has implemented numerous additional security measures to protect customer data.

Engineered for security
Nuance employs software development and engineering security best practices. We develop according to Secure Software Development Lifecycle and utilise Veracode for static code analysis to scan for vulnerabilities. Each release is scanned prior to production release and all critical and high issues are resolved before production rollout.

Data transmission—encryption in transit
Nuance speech-enabled client applications stream audio in real time to Nuance cloud services for speech recognition processing. All
communication between client applications and Nuance cloud services is transmitted via HTTPS utilising TLS 1.1 or TLS 1.2, with an AES 256-bit cipher algorithm.

Security standards and transmission protocols are constantly evolving in response to new security threats. To that end, we monitor security standards and perform external audits to ensure that our data centres meets thehighest standards for secure data transmission.

Our Nuance cloud services hosting environments routinely receive an “A+” rating from Qualys SSL Labs, which performs a deep analysis on our TLS endpoints. Among other things, the test checks the strength of our certificates, supported protocols (TLS 1.1, 1.2), supported ciphers, and vulnerabilities in our configuration.

Data storage—encryption at rest
Nuance safeguards all customer data that resides in Nuance or Nuance Azure data centres using encryption at rest.
At the Nuance Azure data centres Nuance cloud services leverage Azure Managed Disks with Storage Service Encryption (SSE) to persist all customer text and audio. Customer metadata, such as licensing information, user accounts, etc., are stored in SQL Server databases utilising Azure’s Transparent Data Encryption.

In all UK data centres AES 256-bit encryption is implemented to ensure the highest level of protection for data at rest. Data retention and usage Audio files and text are stored in the Nuance data centres to “train” and optimise the speech engine for individual user profiles, and to improve speech recognition accuracy for every user. The audio and text that Nuance stores in its data centre is largely anonymous.

DMO and DME do not have direct access to the patient record and do not require any patient metadata. For example, if a physician dictates “the patient has community-acquired pneumonia,” there is no stored information that associates that information with an individual patient.

For eScription metadata is securely transmitted from the EHR via an HL7 feed and securely stored with the transcription job.

Data centre security
In addition to the core Azure data centre security, Nuance employs many industry best practices to further safeguard customer data and bolster the overall security of Nuance cloud services.

– Physical access.
Physical access to the data centres is secured using many advanced security techniques, including advanced biometrics. For Microsoft Azure data centres Nuance employees do not have or need physical access to the data centre.

– Electronic access.
Nuance follows the requirement of “minimum necessary” when granting electronic access to the data centre for support purposes. All requests for electronic access are subject to VP-level approval. A list of all Nuance employees with access is submitted annually to NHS Digital as part of Nuance’s IG Toolkit re-certification.
– Two-factor authentication/jump hosts.
When accessing the data centre, all Nuance employees are required to use two-factor authentication. In addition, all production access is via an intermediate “jump host,” which provides an extra level of insulation.
– Anti-virus and malware protection.
Nuance has deployed Trend Micro anti-virus to proactively protect the Nuance cloud services from virus or malware infection.
– Intrusion detection and protection system (IDPS). Nuance leverages Trend Micro’s IDS solution, which examines every packet that is transmitted to the data center for potential irregularities.
– Penetration testing. Nuance utilises a third-party service to conduct annual penetration testing against the hosted Nuance cloud services. Vulnerabilities that are discovered are resolved with the highest priority.
– Patches and updates.
In addition to penetration testing, Nuance operations personnel perform monthly scans of the Nuance hosted
services using Nexpose to identify potential vulnerabilities and their related remedies. Based on the severity of the vulnerability, the vendor patch is tested and deployed to production.
– Security monitoring. To provide an integrated comprehensive view into the security status of Nuance cloud services, Nuance leverages Azure Operations Management Suite (OMS) and other tools. This provides a “single pane of glass” that gives real-time insight into all security aspects of our operations.

High availability and service continuity
Nuance has partnered with Microsoft Azure UK to host DMO, PMM, and DME out of the Azure regions UK South and UK West. Nuance is hosting eScription UK out of a data centre in Slough. The secondary data centre is located in the Azure region UK South.
The services are deployed in an active/stand-by configuration, with the primary data centre taking live traffic, and all relevant data is replicated to the secondary data centre continuously. In the unlikely event of a data centre failure, all traffic will be rerouted to the secondary data centre. The potential for data loss in the event of an outage, Recovery Point Objective
(RPO), is 15 minutes or less.

Within each data center, the system architecture of Nuance cloud services provides the following high-availability features:
– Fully redundant network infrastructure, including load balancers and switches
– Multiple clustered application server
– High-availability network storage with fiber optic connections
– Clustered database server
– Clustered and extensible speech server farm

Secure and robust cloud offering
Our security practices, combined with our highly available and redundant infrastruc-ture, ensure that your physicians will enjoy fast, secure, and uninterrupted clinical speech recognition.