<div dir="ltr"><div><div><div><div><div><div>Yes.<br><br></div>My point was not just about data blocking but also about governance of Authorization Servers. I made several points:<br><br></div>1 - Federal laws place constraints on Authorization Servers that are not directly controlled by one patient. Therefore, many consent management problems can be solved by simply allowing patients that care to specify and control their own Authorization Server. This is easily handled by UMA and OAuth as long as the (FHIR) Resource pertains to just one patient. It's obviously impossible for bulk or other Resources that pertain to more than one patient. I believe this consent management problem was the essence of the use-case you raised and that the HEART profiles can easily solve it.<br><br></div>2 - HEART, UMA, and OAuth do not need to concern themselves with "other" Authorization Servers operated by the Hospital. These are internal to the institution. Since the institution also has the patient's data, the institution always has the last word on its release. The Hospital can always bypass the HEART Authorization Server and can always transfer information by other means. For all HEART, UMA, and OAuth purposes a Resource has only one Authorization Server.<br><br></div>3 - It's very important that HEART not constrain what John called the "ethics" of health information blocking such as 72 hour delays for data sharing. Policies regarding this kind of block are beyond our purview. What HEART profiles need to do is to allow the Hospital to verify attributes of the Requesting Party if they are inclined to do such verification. That way, Alice's Authorization Server can say: Send One Data Object to Bob and Bob claims he's a Licensed Practitioner in MA. The Hospital would have the option of either verifying that Bob is a licensed MD or not (the 72 hour block is nor required by law). If they chose to impose the block, the Hospital would need to make a good faith effort to determine Bob's license status. I think this kind of "trust elevation" may be out of band for UMA, but I'm not sure.<br><br></div>So to summarize, HEART needs to (1) allow patients to specify a personal AS to avoid blocks on sensitive information, (2) focus on resources that pertain to a single patient to allow (1), and (3) enable direct transfer of resources to Requesting Parties that are able to provide verified attributes to the Resource Server to avoid blocking for "ethical" reasons when such blocking would be unwarranted.<br></div><div><br></div>Adrian<br><div><div><div><div><br><br></div></div></div></div></div><div class="gmail_extra"><br><div class="gmail_quote">On Mon, Jan 4, 2016 at 5:26 PM, Aaron Seib <span dir="ltr"><<a href="mailto:aaron.seib@23eleven.net" target="_blank">aaron.seib@23eleven.net</a>></span> wrote:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">
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<p class="MsoNormal">Adrian,<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">You had a specific point that I wanted t make sure I could refine and restate accurately.<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">I wish I had a handle on the jargon used but maybe you can help me get there.<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal" style="margin-left:.5in">There is a Data Provider. For illustrative purposes let’s say a Hospital (I am learning that in some scenarios the Consumer is a Data Provider where the data is PGHD so I am learning).
<u></u><u></u></p>
<p class="MsoNormal" style="margin-left:.5in"><u></u> <u></u></p>
<p class="MsoNormal" style="margin-left:.5in">Let’s keep it simple and say that there is One Data Object that this Data Provider wants to make sharing decisions about but there are two Authorization Servers one of which is controlled by the Consumer and the
other is not.<u></u><u></u></p>
<p class="MsoNormal" style="margin-left:.5in"><u></u> <u></u></p>
<p class="MsoNormal" style="margin-left:.5in">For arguments sake let’s say that the AS controlled by Alice is has been configured to properly convey that it is her preference that whenever Hospital is going to make a disclosure to another Provider for Treatment
purposes that the Hospital share One Data Object.<u></u><u></u></p>
<p class="MsoNormal" style="margin-left:.5in"><u></u> <u></u></p>
<p class="MsoNormal" style="margin-left:.5in">Let’s say that the Hospital also operates an AS that it uses to make disclosure decisions. It is based on a Law that says “Thou shall not disclose One Data Object without consumer consent”.<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">Is the bottom line that if the Hospital does not disclose One Data Object to another Provider in accordance with the consumers wishes that they are in fact knowingly participating in information blocking if they know that the Consumer has
an AS of their own?<u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
<p class="MsoNormal">Aaron Seib<u></u><u></u></p>
<p class="MsoNormal">Principal, 2311<u></u><u></u></p>
<p class="MsoNormal">(o) <a href="tel:301-540-2311" value="+13015402311" target="_blank">301-540-2311</a><u></u><u></u></p>
<p class="MsoNormal">(m) <a href="tel:301-326-6843" value="+13013266843" target="_blank">301-326-6843</a><u></u><u></u></p>
<p class="MsoNormal"><u></u> <u></u></p>
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</blockquote></div><br><br clear="all"><br>-- <br><div class="gmail_signature"><div dir="ltr"><div><div dir="ltr"><div><div dir="ltr"><div><br><div dir="ltr">Adrian Gropper MD<span style="font-size:11pt"></span><br><br><span style="font-family:"Arial",sans-serif;color:#1f497d">PROTECT YOUR FUTURE - RESTORE Health Privacy!</span><span style="font-family:"Arial",sans-serif;color:#1f497d"><br>HELP us fight for the right to control personal health data.</span><span style="font-family:"Arial",sans-serif;color:#1f497d"></span><span style="font-family:"Arial",sans-serif;color:#1f497d"><br>DONATE:
<a href="http://patientprivacyrights.org/donate-2/" target="_blank"><span style="color:#0563c1">http://patientprivacyrights.org/donate-2/</span></a></span><span style="color:#1f497d"></span>
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