[Openid-specs-heart] HEART 2015-08-05 meeting notes
Glen Marshall [SRS]
gfm at securityrs.com
Fri Aug 7 00:09:01 UTC 2015
It appears that we are discussing a five-part problem:
* The technical aspects, driven by use cases, of how to secure,
communicate, and assure identity, authentication, authorizations,
and obligations.
* The technical aspects, also driven by uses cases, of how to express,
communicate, and assure patients', and their delegates', disclosure
preferences at sufficient (TBD) granularity.
* The human engineering aspects of how to minimize the effort and
technical knowledge required for the end-users - both patients and
providers.
* The technical, business, and legal aspects of federating the
participants and their automated systems.
* The economic aspects of how to minimize costs while allocating those
costs equitably.
I'm sure there may be other ways to slice and dice the problem space.
However, the first two points above seem to be well within our immediate
capabilities. The human engineering aspects require additional
expertise as well as end-user input. And the last two points need
policy-level resolution, i.e., out of this group's scope.
I'd recommend we revisit these points before we engage in the next use
case, but after we finalize the current one.
Thanks,
Glen
*Glen F. Marshall*
Consultant
Security Risk Solutions, Inc.
698 Fishermans Bend
Mount Pleasant, SC 29464
Tel: (610) 644-2452
Mobile: (610) 613-3084
gfm at securityrs.com
www.SecurityRiskSolutions.com
On 8/6/15 19:05, Adrian Gropper wrote:
> The only information Alice should have to give to her provider is the
> URL of her UMA Authorization Server (if she has one) or something else
> that resolves to her UMA Authorization Server. In many cases, this
> pointer to her UMA AS could be accessible as part of a federated IdP
> service but we may not be able to count on federation being readily
> acceptable to the providers.
>
> Adrian
>
> On Thu, Aug 6, 2015 at 5:00 PM, Maxwell, Jeremy (OS/OCPO)
> <Jeremy.Maxwell at hhs.gov <mailto:Jeremy.Maxwell at hhs.gov>> wrote:
>
> This thread began when I asked what does this look like for the
> patient? What information does Alice need to give her provider?
>
> *From:*Moehrke, John (GE Healthcare)
> [mailto:John.Moehrke at med.ge.com <mailto:John.Moehrke at med.ge.com>]
> *Sent:* Thursday, August 06, 2015 4:51 PM
> *To:* Adrian Gropper; Maxwell, Jeremy (OS/OCPO)
> *Cc:* Josh Mandel; openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
>
>
> *Subject:* RE: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> Those of us that are not in Mass, have great healthcare
> interoperability through the NwHIN… I agree that it is not
> patient directed, but my records are available anywhere in the
> NwHIN. I am not trying to disagree with you, but when you say that
> “Apple has shown us how patient-directed interoperability can
> work in a highly integrated system.†is just way too
> argumentative. A walled-garden is always well manicured.
>
> I too have lost track of what the argument is… all this
> discussion around ‘technical savvy’ vs not is irrelevant to
> the work that we can accomplish in HEART.
>
> John
>
> *From:*agropper at gmail.com <mailto:agropper at gmail.com>
> [mailto:agropper at gmail.com] *On Behalf Of *Adrian Gropper
> *Sent:* Thursday, August 06, 2015 3:06 PM
> *To:* Maxwell, Jeremy (OS/OCPO)
> *Cc:* Josh Mandel; Moehrke, John (GE Healthcare);
> openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
> *Subject:* Re: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> I'm not sure what we're negotiating here. The current approach to
> interoperability does not work for many, maybe most people. Part
> of the reason it doesn't is that privacy approaches that work at a
> scale of 10K or 100K people don't work when the scale is 100
> Million people. I've been a party to four or five generations of
> attempts at interoperability (IHE, NwHIN, CONNECT, DIRECT,
> BlueButton Plus) and we still don't have a clear solution. We've
> also seen that even completely centralized systems like the UK NHS
> can't deal with this problem very well so I can't see why
> CommonWell or Carequlality or Epic everywhere would succeed.
>
> The one thing we haven't tried is patient-driven interoperability.
> Apple has shown us how patient-directed interoperability can work
> in a highly integrated system. UMA is the only standard we have
> that has the potential to introduce patient-driven
> interoperability to healthcare.
>
> We have to give patients that understand UMA the option to use it.
> Patients who don't care will see no difference at all because the
> Resource Server will offer a default AS.
>
> Once patients have the option to specify the AS the other
> interoperability issues, including scopes, will incrementally get
> fixed. But the first step is to agree that there's only one Alice
> and she has an AS. That is the only scalable and non-coercive
> solution.
>
> Adrian
>
> On Thu, Aug 6, 2015 at 9:51 AM, Maxwell, Jeremy (OS/OCPO)
> <Jeremy.Maxwell at hhs.gov <mailto:Jeremy.Maxwell at hhs.gov>> wrote:
>
> How many patients do we expect to have the technical savvy to say
> this to their provider? In practice, where will these
> authorization servers reside?
>
> "Dear Dr. Jones: please treat my authorization server, at
> https://authz.alice.org
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__authz.alice.org&d=AwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=cpoRMhQHerIlja_ffVTQNKS7xUf9tRDFgogzkp23Ycs&s=YNb7HB0fsZmQTY8glywsqyEBVsXi88kGWmzbLaDQU9U&e=>,
> as representing my wishes for disclosure of my health data. Use
> the decisions that server renders to guide your access control
> decisions about my data."
>
> *From:*Openid-specs-heart
> [mailto:openid-specs-heart-bounces at lists.openid.net
> <mailto:openid-specs-heart-bounces at lists.openid.net>] *On Behalf
> Of *Josh Mandel
> *Sent:* Thursday, August 06, 2015 9:19 AM
> *To:* Moehrke, John (GE Healthcare)
>
> *Cc:* openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
> *Subject:* Re: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> As to the division between "gross ceremony" and "finer-grain
> adjustments", I want to suss out whether the following model
> (which readily applies to UMA, though not to vanilla OAuth) is
> consistent with you have in mind, or whether this model is
> addressing a different question entirely:
>
> 1. *Gross ceremony* consists of Alice introducing her resource
> server to an authorization server of her choice. For example, she
> might sign a document saying (effectively): "Dear Dr. Jones:
> please treat my authorization server, at https://authz.alice.org
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__authz.alice.org&d=AwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=cpoRMhQHerIlja_ffVTQNKS7xUf9tRDFgogzkp23Ycs&s=YNb7HB0fsZmQTY8glywsqyEBVsXi88kGWmzbLaDQU9U&e=>,
> as representing my wishes for disclosure of my health data. Use
> the decisions that server renders to guide your access control
> decisions about my data." This document is easily comprehensible,
> could serve as evidence in court, etc.
>
> 2. And then the *finer-grain adjustments* would be made by Alice
> in concert with her authorization server (for example,
> establishing specific policies about who can access her data, and
> which data, and for what purposes, and under what conditions).
>
> On Thu, Aug 6, 2015 at 9:06 AM, Moehrke, John (GE Healthcare)
> <John.Moehrke at med.ge.com <mailto:John.Moehrke at med.ge.com>> wrote:
>
> I agree with your proposal for ‘Authorize for Disclosure’ and
> to de-emphasize ‘Consent’… (although this problem with
> ‘Consent’ is only a USA problem)…
>
>
> But I don’t think that a UMA/OAuth ‘token’ will be seen as
> legitimate evidence in a court. It would be quickly shown to be
> not intelligible by the layperson, I can barely read them. Thus it
> is not evidence of the act of ‘authorizing for disclosure’
> ceremony. This is indeed a practice-of-law problem that we all
> hope changes, but I have little hope that it will change in the
> coming 10 years. This is why I want the gross ceremony to be a
> pre-condition, with the UMA/OAuth technology be the fine-grain
> solution. I expect that a gross ceremony can be shown in a court
> as evidence that all parties understood the use of the technology
> would be used for fine-grain. Note that if the courtroom antics
> change, then this pre-condition simply goes away. But by putting
> it there we enable it to be used, and thus make our solution more
> palatable to the legal folks at those custodian organizations that
> are afraid to release information today.
>
> John
>
> *From:*Aaron Seib [mailto:aaron.seib at nate-trust.org
> <mailto:aaron.seib at nate-trust.org>]
> *Sent:* Thursday, August 06, 2015 7:58 AM
> *To:* Moehrke, John (GE Healthcare); 'Adrian Gropper'; 'Debbie Bucci'
> *Cc:* openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
> *Subject:* RE: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> I tend to agree with John’s recommendation with a friendly
> amendment.
>
> We should not mis-use the word consent. We should use the term
> – authorize for disclosure.
>
> The primary reason being that the term consent has a lot of
> baggage and is defined in law for Human research protections and
> authorize for disclosure is more accurate to me. Consent – as
> pointed out by the Kind Sir from Boston (Adrian) to point out –
> meant something before 2002 that it doesn’t mean anymore.
>
> In my opinion the notion of authorize for disclosure also
> conveniently aligns with my understanding of what ab
> “UMA/OAuth token†would represent on a per transaction basis.
>
> In court we would expect the entity accused of unauthorized
> disclosure to be able to produce a valid UMA/OAuth token as a
> sufficient defense from mis-representations of trial lawyers.
>
> Aaron Seib
>
> NATE
> <https://urldefense.proofpoint.com/v2/url?u=http-3A__www.nate-2Dtrust.org_&d=AwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=87vCtxeoEunALdecDlNur8aIU5qcY6YWTAxWw6j34cs&s=PU_01do09mzHBYjfdhFvZCLDAP7Tpxnm1P001w-6AlU&e=>,
> CEO
>
> @CaptBlueButton
>
> (o) 301-540-2311 <tel:301-540-2311>
>
> (m) 301-326-6843 <tel:301-326-6843>
>
> *From:*Openid-specs-heart
> [mailto:openid-specs-heart-bounces at lists.openid.net] *On Behalf Of
> *Moehrke, John (GE Healthcare)
> *Sent:* Thursday, August 6, 2015 7:27 AM
> *To:* Adrian Gropper; Debbie Bucci
> *Cc:* openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
> *Subject:* Re: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> At the federal level, under HIPAA alone, there is no need for
> consent for purposes of using the data within the Covered Entity
> for Treatment, Payment, and Normal operations.
>
> BUT, there are plenty of states that require consent… Ignoring
> reality of states regulations is not useful.
>
> AND, there are some institutions that would rather have a consent
> that authorizes them to share beyond their Covered Entity
> boundary. Not everyone reads HIPAA ‘Treatment’ as an
> authorization to share with any treating provider.
>
> AND, there are some ‘sensitive’ health topics covered by
> federal money that do come with a requirement for consent for
> sharing. This was the main focus of the DS4P efforts.
>
> So, let’s not focus on HIPAA alone. Let’s expect that ‘for
> whatever reason an organization wants to have positive evidence
> that the patient desires sharing to happen’ as the trigger to
> allow it to happen (otherwise deny it from happening. This would
> seem more helpful to the community we are doing this work for.
>
> An important aspect of all of this is how will the organization
> holding the data be able to legally defend that a UMA/OAuth token
> was valid evidence of consent that would hold up in a courtroom…
> We can’t address this in HEART, but it should not slow us down.
> We again, document this as a precondition to our work. One way
> this is done is that a paper trail is a part of the initial setup
> of a patient engaging with the system.
>
> John
>
> *From:*Openid-specs-heart
> [mailto:openid-specs-heart-bounces at lists.openid.net] *On Behalf Of
> *Adrian Gropper
> *Sent:* Wednesday, August 05, 2015 11:49 PM
> *To:* Debbie Bucci
> *Cc:* openid-specs-heart at lists.openid.net
> <mailto:openid-specs-heart at lists.openid.net>
> *Subject:* Re: [Openid-specs-heart] HEART 2015-08-05 meeting notes
>
> I have never heard the term "simple consent". There's nothing like
> "consent" in the context of data sharing that I can think of.
> HIPAA removed the patient's right of consent in 2002
> https://patientprivacyrights.org/?s=HIPAA+Consent
> <https://urldefense.proofpoint.com/v2/url?u=https-3A__patientprivacyrights.org_-3Fs-3DHIPAA-2BConsent&d=AwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=QPfpP6tNPhNn0uCYFnfBuRqSH5IVEwKw_Jqp3j4NGRQ&s=u1OCcH7ZkX-4jzmNs_eIhVZUi0lQOy0npXd30zYGE8I&e=>
>
> There are consent forms for research but that's not part of the
> use cases we're tackling these days.
>
> Does anyone have an example of consent for clinical data sharing
> to share with us?
>
> Adrian
>
> On Thu, Aug 6, 2015 at 12:10 AM, Debbie Bucci <debbucci at gmail.com
> <mailto:debbucci at gmail.com>> wrote:
>
> @Eve - yes I know its client but I'm really hung up on the token
> generation/choices. Thanks for the tweaks.
>
> I know we clarified that the release form is NOT consent in one of
> our earlier meetings but is this (release of information) what I
> have heard others refer to as simple consent? During this process
> would access to problems/meds/allergies be included in that
> authorization/consent flow? I visualized more than demographics in
> the conversation.
>
> On Wed, Aug 5, 2015 at 9:21 PM, Justin Richer <jricher at mit.edu
> <mailto:jricher at mit.edu>> wrote:
>
> Thank you, Adrian, this is a great reference! I think your
> annotations make sense as well, things should map pretty plainly
> to the OAuth process. The tricky part (that we got a start on
> today) is going to be the scopes bits and getting those right.
>
> For an UMA flow, it's also similar, except that the "who can see
> it" is a set of claims instead of the client application.
>
> -- Justin
>
> On 8/5/2015 9:12 PM, Adrian Gropper wrote:
>
> I've attached a very typical Release of Information
> authorization. I've annotated the 5 elements common to all
> such documents that I have ever seen. The stuff outside if the
> rectangles is more or less optional.
>
> This form covers one direction of the EHR-PHR Use Case. It is
> presented to the Custodian (the patient or their designate )
> and approved by them by the Resource Server and pre-filled
> with information supplied by the Client, if available.
>
> In some cases, the Client information is not available at the
> time the Authorization form is signed. In that case, it will
> be up to the Authorization Server to consider the Client and
> User information and provide the authorization to the Resource
> Server.
>
> The Resource Server has the final say in all cases and could
> decide to ignore the authorization based on local or
> jurisdictional policy. This is outside the control of the
> Resource Owner and likely to be out of scope for HEART in all
> use-cases.
>
> This ROI Authorization Form is the only "consent" that I'm
> aware of in clinical IT. Patients are asked to sign other
> documents, including:
>
> Registration Form, Notice of Privacy Practices, and Treatment
> Consent but none of these has anything to do with sharing of
> health data (except for HIPAA TPO which we will not get into
> here.)
>
> Adrian
>
> On Wed, Aug 5, 2015 at 8:27 PM, jim kragh <kragh65 at gmail.com
> <mailto:kragh65 at gmail.com>> wrote:
>
> Thanks for sharing,... informative and constructive in
> reaching the patient end point.
>
> May all have a nice evening!
>
> On Wed, Aug 5, 2015 at 3:26 PM, Debbie Bucci
> <debbucci at gmail.com <mailto:debbucci at gmail.com>> wrote:
>
> Attendees:
>
> Eve Maler
>
> Justin Richer
>
> Josh Mandel
>
> Adrian Gropper
>
> Thomas Sullivan
>
> Debbie Bucci
>
> We have decided to delineate between mechanical and
> semantic scope docs.
>
> For the PCP <-> PHR use case:
>
> The pre determined choice token confidential token choice
> and exactly what information needs (example:
> PHR's authorization endpoint) to be shared in advance
> between the PCP's EHR and Alice's PCP was left out of the
> discussion for now.
>
> There is one basic mechanical Oauth generic flow that
> occurs twice in the use case.
>
> Given the group has generally agreed that the SMART
> specifications are a good place to */start /*/... /for
> this particular use case the only semantic FHIR scope
> that is necessary is the patient/*.read scope that grants
> permission to read any resource for the current patient.
>
> During the registration process Alice should be able to
> select at a fine grain level which resources she is
> willing to share with the PHR. This mimic's a specific
> process - Adrian please provide. This information will be
> used to generate the access token.
>
> The one thing left at the end of the discussion is whether
> the patient record is implicit or explicitly stated. This
> is a design decision that may make a difference as we move
> towards our next use case in which delegation is a factor.
>
> Corrections/updates appreciated.
>
>
>
>
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>
>
>
> --
>
> Adrian Gropper MD
>
> RESTORE Health Privacy!
> HELP us fight for the right to control personal health data.
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>
> Adrian Gropper MD
>
> RESTORE Health Privacy!
> HELP us fight for the right to control personal health data.
> DONATE: http://patientprivacyrights.org/donate-2/
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>
>
>
> --
>
> Adrian Gropper MD
>
> RESTORE Health Privacy!
> HELP us fight for the right to control personal health data.
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