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FHIR AuthZ Meetup: SMART, TEFCA, & Beyond

@JoshCMandel

Outline

  • Granular scopes in SMARTv2
  • Focused sharing with SMART Health Links
  • Patient rights vis-a-vis B2B sharing in TEFCA

Granular Scope Capabilities

FHIR Resource Scope Syntax

  • [level]/[Resource].[cruds]?param=value&param=value
  • Example: patient/Observation.rs?category=vital-signs

Bucketing permissions by level

  • patient/ Allow access to specific data about a single patient
  • user/ Allow access to all data that the authorizing user can access
  • system/ Allow access to all data that the client is authorized to access

Examples

  • patient/Observation.rs?category=vital-signs - Read and search all vitals for a patient
    • Allows an app to view a patient's vital signs, lab results, etc.
  • user/Immunization.rs - Read and search all observations that the user can access
    • Allows a parent to coordinate family's immunizations
  • system/Observation.c - Create observations from a backend service
    • Allows B2B integration that can submit new observations
    • Allows an app to record new vital signs, lab results, etc. for a patient

Challenges with Custom Operations

  • No standardized scopes for custom operations like…
    • /Patient/$export
    • /Patient/:id/$purge
    • /Patient/$update-name
  • Difficult to standardize a scope for operations given
    • Attachment point types (/, /:type, /:type/:instance)
    • Attachment point instances (any? any visible?)
    • Input parameter restrictions?

Suggestions

TL;DR Define custom scopes for now. Start with your operation URL for transparency, e.g. https://myo.example.org/OperationDefinition/locate-patient

Looking ahead, SMART might focus on standardizing data element-level permissions (example syntax only):

  • Read Patient.name

    • patient/Patient.r{{name}}

  • Write Patient.address or Patient.photo

    • patient/Patient.u{{address | photo}}
  • Simple way for patients to share data directly with apps/individuals
  • Example: Sharing glucose measurements via a SMART Health Link
  • Patient generates a link that provides access to their glucose data
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  • Can share this link with a coach, family member, or trusted app
  • Recipient can view/download the patient's glucose measurements
  • Straightforward way to grant targeted data access without complex policies

TEFCA and Network-Based Exchange

  • Organizational-level authorization decisions with broad impact
    • Example: All TEFCA participants support "treatment" PoU
    • Participants can query everywhere for treatment
  • But what if the query seems unrelated to treatment?
    • Recent issues in the tech news, perceived misuse
    • Highlights grey areas & need for transparency
  • Transparency for individuals
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Agenda -- live notes at https://hackmd.io/@jmandel/saner-ig-live-minutes?both

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