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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Getting closer to understanding…<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Aaron Seib, CEO<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>@CaptBlueButton <o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> (o) 301-540-2311<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>(m) 301-326-6843<o:p></o:p></span></p><p class=MsoNormal><a href="nate-trust.org"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D;text-decoration:none'><img border=0 width=205 height=48 id="Picture_x0020_1" src="cid:image001.jpg@01D13668.61A0C580"></span></a><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p></o:p></span></p></div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><div><div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Justin Richer [mailto:jricher@mit.edu] <br><b>Sent:</b> Monday, December 14, 2015 11:23 AM<br><b>To:</b> Aaron Seib<br><b>Cc:</b> Adrian Gropper; openid-specs-heart@lists.openid.net<br><b>Subject:</b> Re: [Openid-specs-heart] "Scope" of sharing and purpose of use<o:p></o:p></span></p></div></div><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal>“Permission Type” is really a whole lot simpler than people are making it out to be. <o:p></o:p></p><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>“patient” means “get me a single specific record for a single specific person”. When there is no other indicator (the “aud” parameter) this is the record for the currently logged in person. This is going to be a common enough use case, and it’s the default OAuth case, that optimizing for this makes sense. <o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>“user” means “get me all of the records that I have access to”. There is no record indicator here in the query because it’s basically a get-all-the-stuff type of request. What matches might be a single record. It might be many records. It might be aggregate data. But it’s not a query for a specific record when this permission type is used.<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal>Both of these can be in cases where Alice has user-to-user delegated access <span style='color:#1F497D'>(her little sister Joanne has granted her access to her records at Regional Hospital where they both had their babies) </span>to her family members. For the “patient” scope with no “aud” parameter, the token is good for Alice’s record. For the “patient” scope with an “aud” parameter, the token is good for the record indicated by that aud parameter. But just that one specific record! Using this token to get other records will fail. For the “user” scope it’s a request for all records Alice has access to. She can’t specify which one, since that’s not what this kind of scope is for.<o:p></o:p></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I think that is clear. I think where the consternation comes from is when the User isn’t a consumer but a list of people who have claimed TPO access rights to a set of records (patients). Is the Heart Profile silent on that. This is where the policy gets confounded if each of the patients doesn’t have the chance to first “recognize” that the person who claims to have a Tx relationship with them is in fact a doc that they believe they have a treatment relationship with. This is the fly in the ointment that has Serpico buzzing and I think rightly so. Not that we have to address the issue that he described as Discovery for the HEART work to make progress and sense – it just needs to be clearly isolated.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The bottom line is there are creative trial lawyers who will ascert that a breach occurred is some Provider was claimed to have had a Treatment relationship with someone when in fact they didn’t. Perhaps Permission Type is too simple if it can’t address this concern. That or make it easy enough for us to demarcate the breadth of where it comes into play and put it in a parking lot for a future need.<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>This is a real case we had at the state level. Male Doc is working in a practice. He has access to the EMR that every other doc in his practice has access to so could see the data of all the patients that went there. Turns out the Husband of the woman he is committing adultery with was a patient of another doc at the practice. This guy is a father and has two kids. Husband and Wife split up. Doc and woman get married and want to get custody of the kids. Doc looks at ex-husbands medical records and finds some sensitive information that the new couples lawyers use to argue that the dad isn’t a fit parent. Fortunately – the father’s lawyer figures it out and puts the keibash on using that breached data and the Judge makes his custody decision sans the sensitive health information that shouldn’t be available (and later in another court room the doc gets convicted of a HIPAA violation).<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The concern that we are all twisting around seems to be the lack of distinction about the permission types. Maybe there is a way to clarify it using another construct that I haven’t come up with. Is this kind of concern addressed somewhere else?<o:p></o:p></span></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal> — Justin<o:p></o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p></div><div><p class=MsoNormal><o:p> </o:p></p><div><blockquote style='margin-top:5.0pt;margin-bottom:5.0pt'><div><p class=MsoNormal>On Dec 13, 2015, at 11:10 PM, Aaron Seib <<a href="mailto:aaron.seib@nate-trust.org">aaron.seib@nate-trust.org</a>> wrote:<o:p></o:p></p></div><p class=MsoNormal><o:p> </o:p></p><div><div><div><p class=MsoNormal><a name="_MailEndCompose"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I still don’t think I am 100% on what Discovery means in this context.</span></a><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Here is the def you provided:</span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><p class=MsoNormal style='margin-left:.5in'>Discovery means: the user<sup>(1)</sup> doesn't know who will be on the list. That puts a lot of responsibility on the RS to <u>do the right thing</u><sup>(2)</sup>. In HIEs for example, they insist the user is a practicing physician because they want to reduce their liability if someone's name pops up on a list that the user should not have seen.<o:p></o:p></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l1 level1 lfo2'><![if !supportLists]><span style='mso-list:Ignore'>(1)<span style='font:7.0pt "Times New Roman"'> </span></span><![endif]><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Who is the user? I am still looking to the</span><a href="http://openid.bitbucket.org/HEART/openid-heart-fhir-oauth2.html#rfc.section.2.1"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'> Permission Type</span></a><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> to see if I can get that set of terms to line up in my head. Patient was a permission type which in the health domain correlates to the patient who is the subject of the PHI that the Resource Server may be disclosing. The assumption being that we can match the identity of the person who is using a client application to connect to the resource server (owned by the institution that operates the Resource Server – in the API TF scope the typical example being a EMR used by the caregiver that the patient has had treatment) with the Medical Record Number (MRN) or equivalent in the Resource Servers enterprise context (I don’t see any reason why we can’t say that an HIE with an MPI might be able to simplify this by correlating the MPI values to the person who is using the client app to access data about themselves across Resource Servers that have data about that person “Patient”).</span><o:p></o:p></p><p class=MsoListParagraph style='text-indent:-.25in;mso-list:l1 level1 lfo2'><![if !supportLists]><span style='mso-list:Ignore'>(2)<span style='font:7.0pt "Times New Roman"'> </span></span><![endif]><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Do the Right Thing - </span><o:p></o:p></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Sorry for all the verbiage – I want to get my meager understanding spelt out so it can be corrected. This may not be fruitful but it occurs to me that something that isn’t apparent that is becoming more apparent to me as I wrestle with this is that the idea of User may be better understood as a set of several or more sub-categories.</span><o:p></o:p></p></div><p class=MsoNormal style='mso-margin-top-alt:6.0pt;margin-right:0in;margin-bottom:0in;margin-left:24.0pt;margin-bottom:.0001pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>user</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:24.0pt;margin-bottom:0in;margin-left:.5in;margin-bottom:.0001pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>The scope is for a bulk set of records <i>(I am assuming that it is implied here that set of records is meant to convey data for more than one person – the notion of a record is not clear to me here I must admit)</i> or for aggregate data not representing a single patient <i>(is this meant to be a distinction or a reiteration of the bulk set of records? What is the difference?)</i>, based on what is available <u>to the current user</u> <i>(here is where the turn of phrase seems to be slipping. I am still struggling with the some notion being conveyed here</i>. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:24.0pt;margin-bottom:0in;margin-left:.5in;margin-bottom:.0001pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:0in;margin-right:24.0pt;margin-bottom:0in;margin-left:.5in;margin-bottom:.0001pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>The question that comes to mind is if we look at the set of records being made available ‘to the current user’ is that person’s record one of those found in the set of records? There seem to be a couple of distinctions that are probably implied but might help to make explicit. At a minimum there are two cases that come to mind:</span><o:p></o:p></p><p class=MsoListParagraph style='mso-margin-top-alt:0in;margin-right:24.0pt;margin-bottom:0in;margin-left:1.0in;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l0 level1 lfo4'><![if !supportLists]><span style='mso-list:Ignore'>(1)<span style='font:7.0pt "Times New Roman"'> </span></span><![endif]><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>The case where the ‘Current User’ may have a record in the set being returned and any other person’s record being disclosed is permitted because that other person granted the User permission.</span><o:p></o:p></p><p class=MsoListParagraph style='mso-margin-top-alt:0in;margin-right:24.0pt;margin-bottom:0in;margin-left:1.0in;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l0 level1 lfo4'><![if !supportLists]><span style='mso-list:Ignore'>(2)<span style='font:7.0pt "Times New Roman"'> </span></span><![endif]><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>The case where the ‘Current User’ does not have a record in the current set and is accessing them as a result of capacity being vested in them by the Record owner, because of their professional role.</span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>I am not sure if there is a more precise way to look at it but it would seem to be that the root difference has something to do with how the User got the permission. It may not be evident I am seeing the difference being based on how the user got the permission. In case (1) I think of the person as a family care giver who has access to other ‘family’ members records because they granted that to him\her to have access and it is not in the role of providing treatment as traditionally defined by HIPAA. In the (2) case I see it being derived based on the fact that the person is in a Treatment role as defined by HIPAA and the Record Owner (i.e., the Hospital et al) gives them permission to access certain records.</span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>I think the key to unraveling this not is to differentiate between users who are not acting in a professional capacity from those that are as the applicable authorization to disclose is derived from two separate authorities. In Case (1) the User is getting permission to access those other records because the patients whom the records are about gave him\her permision as they may given their right to share with whomever they please while under case (2) they are getting permission as an aspect of their professional requirements as warranted by the resource owner.</span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>Not sure if this is half baked or not but there if there is a fly in the ointment it seems to me that it has to do with what John referred to as purpose of use earlier on. Assume that the User in case 2 has a purpose of use to be treatment and I think it is easier to digest. The word to use for the Consumer’s purpose of use alludes me right now. </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>I think the unifying issue is that the user’s purpose of use must be the same for all the records being retrieved. </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>I think that is the issue with Discovery that is hard to get a grasp on. </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'> </span><o:p></o:p></p><p class=MsoNormal style='margin-right:24.0pt'><span lang=EN style='font-size:10.0pt;font-family:"Verdana","sans-serif"'>If an HIE is granting permission to a Requesting party (why do we use the word User rather then requeting party here?) for a set of records it should only be for one or the other purpose of use and the purpose of use must match the part being played for the transaction being responded to by the RS as known to the RO. </span><o:p></o:p></p><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Aaron Seib</span><o:p></o:p></p></div><div><p class=MsoNormal><a href="http://www.nate-trust.org/"><span style='font-size:11.0pt;font-family:"Calibri","sans-serif"'>NATE</span></a><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>, CEO</span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>@CaptBlueButton</span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>(o) 301-540-2311</span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>(m) 301-326-6843</span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><div><p class=MsoNormal><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div><div><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> <a href="mailto:agropper@gmail.com">agropper@gmail.com</a> [<a href="mailto:agropper@gmail.com">mailto:agropper@gmail.com</a>] <b>On Behalf Of </b>Adrian Gropper<br><b>Sent:</b> Friday, December 11, 2015 5:29 PM<br><b>To:</b> Aaron Seib<br><b>Cc:</b> <a href="mailto:openid-specs-heart@lists.openid.net">openid-specs-heart@lists.openid.net</a><br><b>Subject:</b> Re: [Openid-specs-heart] "Scope" of sharing and purpose of use</span><o:p></o:p></p></div><div><p class=MsoNormal> <o:p></o:p></p></div><div><div><div><p class=MsoNormal style='margin-bottom:12.0pt'>Hi Aaron, Thanks for highlighting the important issue of discovery.<br><br>Discovery means: the user doesn't know who will be on the list. That puts a lot of responsibility on the RS to do the right thing. In HIEs for example, they insist the user is a practicing physician because they want to reduce their liability if someone's name pops up on a list that the user should not have seen.<br><br>I meant RO (resource owner), It makes no sense for the RS to send a notice to themselves.<o:p></o:p></p></div><p class=MsoNormal style='margin-bottom:12.0pt'>Yes, RqP is the Requesting Party which is the party that controls the Client that is accessing the AS and the RS. The RqP might be the patient subject (the RO) themselves using an app or PHR but that case would be handled by OAuth. (We call that the Alice-to-Alice case). UMA is interesting because it allows the RqP user to be someone other than Alice therefore enabling true health information exchange. This is what makes HEART so useful and our HEART Profiles so important.<o:p></o:p></p></div><div><p class=MsoNormal>Adrian<o:p></o:p></p></div></div><div><div><p class=MsoNormal> <o:p></o:p></p></div><div><div><p class=MsoNormal>On Fri, Dec 11, 2015 at 4:53 PM, Aaron Seib <<a href="mailto:aaron.seib@nate-trust.org" target="_blank">aaron.seib@nate-trust.org</a>> wrote:<o:p></o:p></p></div><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Hi – I meant to ask you last week. When you say Discovery in the first bullet I am not sure I know what you mean. Can you expand on that for me? I think I get everything except that below.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I don’t know why we are trying to be so cryptic on the work group. This is unfortunate. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>You use RO below and I think it might be a typo but have to confirm. Is it meant to have been something else?</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>What is RqP an abbreviation of? Requesting Party?</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Openid-specs-heart [<a href="mailto:openid-specs-heart-bounces@lists.openid.net" target="_blank">mailto:openid-specs-heart-bounces@lists.openid.net</a>] <b>On Behalf Of </b>Adrian Gropper<br><b>Sent:</b> Friday, December 11, 2015 3:37 PM<br><b>To:</b> Moehrke, John (GE Healthcare)<br><b>Cc:</b> <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openid.net</a><br><b>Subject:</b> Re: [Openid-specs-heart] "Scope" of sharing and purpose of use</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'>Let me attempt at mediation :-)<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'>- We're talking about resources that have a single subject (the patient) Resources with more than one subject, such as a patient list are a completely different matter <span style='background:yellow'>because they involve discovery</span><span style='color:#1F497D'> (I don’t get this? Discovery of what? The identity of each person in the list?)</span>. The special case of a mom with 2 kids can simply, if inelegantly, be handled by polling for each of the subjects. There's no discovery involved.<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'>- The major difference between OAuth and UMA is that in UMA the resource is under the control of a separate legal entity. Therefore, when a client (and the client's user) shows up to request the resource, the client may present claims or attributes to either or both the resource server (RS) and/or the authorization server (AS). To say this another way: In UMA there's some kind of legal agreement between the resource server and the authorization server. In OAuth there is none because they are the same.<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'>- The sharing of control between the RS and the AS is subject to institutional, local, and federal controls. All of the situations that John listed boil down to "good faith" and "notice" to the <span style='background:yellow'>RO</span> when the resource server acts on the instructions of the AS based on the actual attributes of the client (C)<i><span style='color:#1F497D'> by client attributes do you mean attributes of MSHV or of the User of MSHV, Aaron Seib?</span></i> and the client's user (RqP<span style='color:#1F497D'> – this is Aaron Seib, right? What does RqP stand for?</span>).<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>Adrian<o:p></o:p></p></div></div><div><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>On Fri, Dec 11, 2015 at 3:01 PM, Moehrke, John (GE Healthcare) <<a href="mailto:John.Moehrke@med.ge.com" target="_blank">John.Moehrke@med.ge.com</a>> wrote:<o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Hi Eve,</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>It is clear that there is a communications problem between those that are comfortable in the language of speaking about OAuth/UMA, and those that are comfortable in the language of speaking about Healthcare Access Control needs. I can read every word you have said, but I have no idea what you said.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I think one of our problems is that we keep skipping from use-cases where the “user” is the “patient” trying to access their own data; and use-cases where the “user” is a clinician trying to help the “patient”. There are many MORE use-cases including parents, children, guardians. There are many MORE use-cases around researchers, public-health, billing, payers. And there are a huge variety of all of these. There are authorization mechanisms that stem from direct authorization by the patient, to indirect because of context, and the ultimate for healthcare ‘because their life is in jeopardy and I am a licensed clinician that can save their life’. Followed by many medical-ethical traps like having a personal discussion about a particularly tragic test result before the lab fact is directly exposed.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>We need to solve all of these, however to solve any one would be helpful.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>John</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>From:</span></b><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'> Eve Maler [mailto:<a href="mailto:eve.maler@forgerock.com" target="_blank">eve.maler@forgerock.com</a>] <br><b>Sent:</b> Friday, December 11, 2015 11:43 AM<br><b>To:</b> Moehrke, John (GE Healthcare)<br><b>Cc:</b> <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openid.net</a><br><b>Subject:</b> "Scope" of sharing and purpose of use</span><o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>Hi John-- (I changed the subject line and deleted older parts of the thread.)<o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>When you say "scope" here, I suspect you mean "scope" of the sharing use case, rather than something like an OAuth or UMA scope, so I'm just checking. So a "single-patient scope" means that the only human we're paying attention to in the use case is the patient, and "any application with users that are authorized to multiple patients" seems to mean a use case that involves party-to-party sharing, with multiple humans involved. However, you follow the latter with "would need to get multiple scopes", so I'm not sure. Note that "getting multiple scopes" as a technical construct doesn't have anything to do with sharing with an autonomous third party.<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>FWIW, here is how I think, at a high level, about <b>configuring the delegation of rights to access resources</b>. It's all about <b>parts of speech</b>.<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>OAuth lets a user (patient) do this configuration at run time while using a client app, by opting in to the authorization server's issuance of an access token to that app. By contrast, UMA lets a user (patient) do this configuration anytime, generally by instructing the authorization server to check whether some combination of the client app and the requesting party using the app meet various requirements (policy). So OAuth is kind of an attenuated version of UMA wrt the constraints on delegation of access rights.<o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-family:"Courier New"'>system subject verb object adjective</span><o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:7.5pt;font-family:"Courier New"'>OAuth client ID OAuth scopes (implicitly some endpoints) n/a</span><o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:7.5pt;font-family:"Courier New"'> (and always Alice)</span><o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:7.5pt;font-family:"Courier New"'>UMA claims-based eg Bob, UMA scopes over... UMA resource sets claims-based e.g. TPO,</span><o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:7.5pt;font-family:"Courier New"'> client ID/type, etc. time limitations, etc.</span><o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>It's possible to conflate purpose-of-use into the UMA scopes system, but it's as awkward as conflating (ordinarily implicit) resource sets into the OAuth scopes system (resource1.read, resource1.write, etc.), which is why OAuth has invented the audience parameter to try and solve the problem of a single authorization server protecting several APIs. This is why I suggest using a claims-based system above.<o:p></o:p></p></div><div><div><div><div><div><div><div><p class=MsoNormal><b>Eve Maler<br></b>ForgeRock Office of the CTO | VP Innovation & Emerging Technology<br>Cell <a href="tel:%2B1%20425.345.6756" target="_blank">+1 425.345.6756</a> | Skype: xmlgrrl | Twitter: @xmlgrrl<br>Join our <a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__forgerock.org_openuma_&d=CwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=PHeMeoVZ7WGQVkHh4j1pjEo3WjxiOtW0zWBvptezqXM&s=BWKe_zUfK7VyJCEdTSN-5cG7TelP0b1X-x3kyeaODmk&e=" target="_blank">ForgeRock.org OpenUMA</a> community!<o:p></o:p></p></div></div></div></div></div></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>On Mon, Dec 7, 2015 at 2:00 PM, Moehrke, John (GE Healthcare) <<a href="mailto:John.Moehrke@med.ge.com" target="_blank">John.Moehrke@med.ge.com</a>> wrote:<o:p></o:p></p><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The discussion on the call today was too hard to break into. Even for a big mouth like me.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>I am okay with limiting our next couple of profiles to single patient scopes. As much of the email discussion has pointed out patient controlled access is our primary scope, and logically (if not technically) this is easy to understand with scopes that are single patient. </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Yes this means that any application with users that are authorized to multiple patients would need to get multiple scopes; so be it. For now… For Enterprise use, this is troubling; but for most uses that happen from outside of an enterprise or between enterprises this limitation is not unreasonable. The most common APIs in healthcare for this are already patient centric. So it is not a big problem.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The user experience does not need to be impacted by this profiled limitation</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>The future does not need to be impacted by this profiled limitation.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Which means that one viewpoint for scope can be the identity of the patient that one is asking for access to. This is not the only scope we will ever support; but is one method that would satisfy some use-cases today.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Another view on scope, that I have been involved with in other groups, is to use a high-level vocabulary that is used often in the Access Control policy – PurposeOfUse. This vocabulary is items like: Treatment, Payment, Research, Emergency, etc…</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>To go deeper than these two vectors through scopes in a general purpose healthcare access control infrastructure is futile.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>Next level deeper in scopes would come from workflow centric implementation guides. That is a specification that is defining a workflow, could define a scope(s) for that workflow.</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'>John</span><o:p></o:p></p><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><span style='font-size:11.0pt;font-family:"Calibri","sans-serif";color:#1F497D'> </span><o:p></o:p></p></div></div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'>_______________________________________________<br>Openid-specs-heart mailing list<br><a href="mailto:Openid-specs-heart@lists.openid.net" target="_blank">Openid-specs-heart@lists.openid.net</a><br><a href="https://urldefense.proofpoint.com/v2/url?u=http-3A__lists.openid.net_mailman_listinfo_openid-2Dspecs-2Dheart&d=CwMFaQ&c=IV_clAzoPDE253xZdHuilRgztyh_RiV3wUrLrDQYWSI&r=B4hg7NQHul-cxfpT_e9Lh49ujUftqzJ6q17C2t3eI64&m=PHeMeoVZ7WGQVkHh4j1pjEo3WjxiOtW0zWBvptezqXM&s=b-IeKH8ALrT6jaP_pgYHavTt27UVQVYtlz9y5w5CRak&e=" target="_blank">http://lists.openid.net/mailman/listinfo/openid-specs-heart</a><o:p></o:p></p></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p></div></div></div></div></div></div><p class=MsoNormal style='mso-margin-top-alt:auto;margin-bottom:12.0pt'><br>_______________________________________________<br>Openid-specs-heart mailing list<br><a href="mailto:Openid-specs-heart@lists.openid.net" target="_blank">Openid-specs-heart@lists.openid.net</a><br><a href="http://lists.openid.net/mailman/listinfo/openid-specs-heart" target="_blank">http://lists.openid.net/mailman/listinfo/openid-specs-heart</a><o:p></o:p></p></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'><br><br clear=all><br>-- <o:p></o:p></p><div><div><div><div><div><div><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'> <o:p></o:p></p><div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>Adrian Gropper MD<br><br><span style='font-family:"Arial","sans-serif";color:#1F497D'>PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>HELP us fight for the right to control personal health data.<br>DONATE: <a href="http://patientprivacyrights.org/donate-2/" target="_blank"><span style='color:#0563C1'>http://patientprivacyrights.org/donate-2/</span></a></span> <o:p></o:p></p></div></div></div></div></div></div></div></div></div></div></div><div class=MsoNormal align=center style='text-align:center'><hr size=1 width="100%" noshade style='color:#A0A0A0' align=center></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>No virus found in this message.<br>Checked by AVG - <a href="http://www.avg.com/" target="_blank">www.avg.com</a><br>Version: 2016.0.7294 / Virus Database: 4483/11158 - Release Date: 12/11/15<o:p></o:p></p></div></div></div><div><p class=MsoNormal><br><br clear=all><br>-- <o:p></o:p></p></div><div><div><div><div><div><div><div><div><p class=MsoNormal> <o:p></o:p></p></div><div><div><p class=MsoNormal>Adrian Gropper MD<br><br><span style='font-family:"Arial","sans-serif";color:#1F497D'>PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>HELP us fight for the right to control personal health data.<br>DONATE: <a href="http://patientprivacyrights.org/donate-2/" target="_blank"><span style='color:#0563C1'>http://patientprivacyrights.org/donate-2/</span></a></span> <o:p></o:p></p></div></div></div></div></div></div></div></div></div></div></div><p class=MsoNormal>_______________________________________________<br>Openid-specs-heart mailing list<br><a href="mailto:Openid-specs-heart@lists.openid.net">Openid-specs-heart@lists.openid.net</a><br><a href="http://lists.openid.net/mailman/listinfo/openid-specs-heart">http://lists.openid.net/mailman/listinfo/openid-specs-heart</a><o:p></o:p></p></div></blockquote></div><p class=MsoNormal><o:p> </o:p></p></div><div class=MsoNormal align=center style='text-align:center'><hr size=1 width="100%" noshade style='color:#A0A0A0' align=center></div><p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto'>No virus found in this message.<br>Checked by AVG - <a href="http://www.avg.com">www.avg.com</a><br>Version: 2016.0.7294 / Virus Database: 4483/11177 - Release Date: 12/14/15<o:p></o:p></p></div></body></html>