[Openid-specs-heart] Considering profiling resource sets/scopes for the "before first visit" sharing scenario

Mon Jun 27 12:49:41 UTC 2016

Hi Adrian,

Small but important clarification. The confidentiality classifications I
gave are universal in healthcare. They are used in all forms of HL7,
including FHIR and CDA. They are used in DICOM. They are used in IHE
XDS/XCA and Direct. There is even a mapping to 13606 equivalent risk scale.
So by starting with this group you are not picking something special for
FHIR, but you are picking something that works with FHIR and other
exchanges. In all of these cases this value-set is built right into the
core of each of these standards.  We could use a smaller subset, like older
CDA did.  Note this set also supports when data has been de-identified and
thus moved to a lower risk, where lower risk is an assessment and an
appropriate movement down the scale. So it even works where
differential-privacy might move the data down to "M" or "L".

Are we tying to determine the FINAL list of scopes? Or just a starter set
that seems to be useful? I was hoping we were just looking for something
useful. I understand that our need is to enable interoperability, as the
scopes do need to be agreed to by all parties. Thus this starter set just
gets us back to focusing on the HEART specifics. Scopes are infinitely
expandable so the starter set can be enhanced or even replaced (deprecated)
later.

John

John Moehrke
Principal Engineering Architect: Standards - Interoperability, Privacy, and
Security
CyberPrivacy – Enabling authorized communications while respecting Privacy
M +1 920-564-2067
JohnMoehrke at gmail.com
https://www.linkedin.com/in/johnmoehrke
https://healthcaresecprivacy.blogspot.com
"Quis custodiet ipsos custodes?" ("Who watches the watchers?")

On Sun, Jun 26, 2016 at 11:03 PM, Adrian Gropper <agropper at healthurl.com>
wrote:

> Thank you John for making things clear. Changing the subject line of my
> "Is HEART Profiling Privacy?" thread does not solve the problem but I do
> appreciate and respect Eve's intent.
>
> I'm not sure the OpenID Connect analogy is useful for HEART or for UMA in
> general.
>
> I claim that building on FHIR Confidentiality Classification is beyond
> HEART's charter. Patient Privacy Rights would love to participate in that
> discussion with whomever in HL7 wants to join in but it's not easy to see
> who else would be at that table and I don't see anyone clamoring to charter
> that group. For reference, I've attache a nice study of what might be
> involved in such an exercise.
>
> I hope UMA does not force HEART to profile privacy. As John makes clear,
> FHIR resource types are not being designed to make privacy classifications
> or patient understanding of privacy issues particularly easy or hard. I
> suspect the same thing is true outside of healthcare.
>
> My suggestion does not require that HEART profiles privacy or make use of
> confidentiality classification. A HEART resource server (a) can publish the
> list of resource types it supports, and
> (b) can post to a specific HEART AS which resource types are or are not
> available for a particular resource registration, and maybe
> (c) can optionally post explanations, hints, resource type groupings, or
> examples to the specific HEART AS. This would enable a RS to send the
> equivalent of their current Release of Information form to the AS.
>
> Note that (c) is optional. Whether (c) is there or not, FHIR supports
> whatever granularity it supports and there's no reason an AS should not
> choose to take advantage of that.
>
> Therefore (a) and (b) together allow any RS to register with any AS and
> it's up to the AS to map the resource types into policy choices for the
> resource owner. Rather than HEART profiling privacy, i suggest we allow ASs
> to compete on how to present the privacy issues to the resource owner.
>
> Adrian
>
>
>
>
> On Sun, Jun 26, 2016 at 9:21 PM, John Moehrke <johnmoehrke at gmail.com>
> wrote:
>
>> Hi Eve,
>>
>> It would seem that we would indeed have this figured out. But reality is
>> that we never quite talk about it so bluntly, mostly because classifying
>> healthcare data is so very hard. Further the various ways that would be
>> logical don't fall nicely upon the logical ways that data can be segmented.
>> That is the way that people would like to segment their data is according
>> to how sensitive it is; yet this doesn't align with FHIR resources, or
>> departments, or function, etc...  Plus data changes sensitivity based on
>> current medical knowledge (HIV was very sensitive a few years ago, today it
>> tends to trend closer to normal data).
>>
>> So the best I have to offer is the _confidentiality classifications we
>> have in the security-tags: It is a scale that centers around Normal - that
>> group of data that everyone agrees is the typical healthcare data
>> (mathematically normal). Think of it as a risk scale of 6 different risk
>> quantum. All data MUST have one of these values assigned to it.
>>    http://hl7-fhir.github.io/v3/ConfidentialityClassification/vs.html
>>
>> so U, L, M, N, R, V --- definitions are on the page above.
>>
>> Is this a good solution? NO! but it does exist today.
>>
>> More on my blog article
>>
>> https://healthcaresecprivacy.blogspot.com/2015/07/how-to-set-confidentialitycode.html
>> or
>>   https://healthcaresecprivacy.blogspot.com/2016/01/fhir-oauth-scope.html
>>
>> John
>>
>> John Moehrke
>> Principal Engineering Architect: Standards - Interoperability, Privacy,
>> and Security
>> CyberPrivacy – Enabling authorized communications while respecting Privacy
>> M +1 920-564-2067
>> JohnMoehrke at gmail.com
>> https://www.linkedin.com/in/johnmoehrke
>> https://healthcaresecprivacy.blogspot.com
>> "Quis custodiet ipsos custodes?" ("Who watches the watchers?")
>>
>> On Sun, Jun 26, 2016 at 11:18 AM, Eve Maler <eve.maler at forgerock.com>
>> wrote:
>>
>>> This message is intended to give shape to our profiling efforts. I
>>> apologize in advance if I "step in it" due to my lack of HL7 or FHIR
>>> knowledge. :-)
>>>
>>> Given our first sharing scenario
>>> <https://bitbucket.org/openid/heart/wiki/Alice_Shares_with_Physicians_and_Others_UMA_FHIR> (in
>>> the latest use case) of providing basic data before a first visit, are
>>> there various subsets or supersets of such data, e.g., in different
>>> jurisdictions, that Alice would be expected to provide, or one obvious and
>>> universally understood data set? I'm guessing that payment data is one
>>> subset of data that doesn't apply in some jurisdictions, whereas quite a
>>> lot of "medically related data" would generally be considered desirable to
>>> share if available.
>>>
>>> What I'm going for here is: If you could have a system of "keywords"
>>> representing virtual clipboard-type data sets and how you want them shared,
>>> what's the smallest arrangement of keywords that would do the trick?
>>>
>>> By (very rough) analogy, look at how OpenID Connect standardizes client
>>> requests for claims using scope values
>>> <http://openid.net/specs/openid-connect-core-1_0.html#ScopeClaims>. It
>>> rolls up multiple identity claims under single scope names, so that
>>> "openid" gives the client full access at the UserInfo endpoint, "profile"
>>> gets access to 14 specific claims, "email" gets access to two claims, etc.
>>>
>>> UMA gives us two dimensions to play with, so it could be like this:
>>>
>>> Potential resource sets to access (I'm totally making this up! for all I
>>> know, HL7 figured this out 10 years ago and it doesn't look anything like
>>> this...):
>>>
>>>    - BasicVirtualClipboardData
>>>    - FinancialVirtualClipboardData (or a unique version per
>>>    jurisdiction?)
>>>    - AllVirtualClipboardData (an aggregation of the two of them)
>>>
>>> Potential scopes of action across them (same for each one? it doesn't
>>> have to be that way, and other resource sets might have deidentified-read
>>> options or something...):
>>>
>>>    - read
>>>    - write
>>>
>>> Note that the scope work already begun in our OAuth FHIR profile, coming
>>> from the SMART on FHIR work, gives us ideas for things like a "read" verb
>>> and a "write" verb, but for right now, we can think outside the box if
>>> that's the right thing to do.
>>>
>>>
>>> *Eve Maler*ForgeRock Office of the CTO | VP Innovation & Emerging
>>> Technology
>>> Cell +1 425.345.6756 | Skype: xmlgrrl | Twitter: @xmlgrrl
>>> *ForgeRock Summits and UnSummits* are coming to
>>> <http://summits.forgerock.com/> *Sydney, London, and Paris!*
>>>
>>> _______________________________________________
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>>>
>>>
>>
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>>
>>
>
>
> --
>
> Adrian Gropper MD
>
> PROTECT YOUR FUTURE - RESTORE Health Privacy!
> HELP us fight for the right to control personal health data.
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>
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