<div dir="ltr"><div><div><div><div>I'm ok with using simple static scopes until UMA figures out how to deal with its problem. <br><br></div>However, two things are absolutely required in order to claim that HEART is patient-centered:<br></div>1 - The RS MUST accept any UMA-standard AS just like they accept a patient's SMTP-standard email domain or telecom carrier.<br></div>2 - The RS MUST expose all patient-level resources to AS authorization even if it decides to override AS authorization in selected cases that are disclosed at the time of RS-AS resource registration.<br><br></div>Adrian<br></div><div class="gmail_extra"><br><div class="gmail_quote">On Thu, Aug 11, 2016 at 10:50 AM, John Moehrke <span dir="ltr"><<a href="mailto:johnmoehrke@gmail.com" target="_blank">johnmoehrke@gmail.com</a>></span> wrote:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div dir="ltr">I certainly recognize this as the pattern that OAuth and UMA wants. And I encourage us to start here. <div><br></div><div>I will caution the overall community that the complexity in healthcare data often results in an architecture were the results-about-to-be-returned need to be inspected by the Access Control engine so as to filter out items that match the query parameters, but which are forbidden from being returned because of a Privacy policy. This is fundimentally why there is continuous discussion on the HEART threads. Because those in healthcare recognize this fact, and others are advocating for the pattern that can be implemented off-the-shelf. </div><div><br></div><div>Recognizing this. I still suggest we go forward using the pattern that is available from OAuth and UMA; using simple static scopes. We can address the healthcare complexity later. Otherwise we will continuously circle around...</div><div><br></div><div>John</div></div><div class="gmail_extra"><span class="HOEnZb"><font color="#888888"><br clear="all"><div><div data-smartmail="gmail_signature"><div dir="ltr">John Moehrke<br>Principal Engineering Architect: Standards - Interoperability, Privacy, and Security<br>CyberPrivacy – Enabling authorized communications while respecting Privacy<br>M <a href="tel:%2B1%20920-564-2067" value="+19205642067" target="_blank">+1 920-564-2067</a><br><a href="mailto:JohnMoehrke@gmail.com" target="_blank">JohnMoehrke@gmail.com</a><br><a href="https://www.linkedin.com/in/johnmoehrke" target="_blank">https://www.linkedin.com/in/<wbr>johnmoehrke</a><br><a href="https://healthcaresecprivacy.blogspot.com" target="_blank">https://healthcaresecprivacy.<wbr>blogspot.com</a><br>"Quis custodiet ipsos custodes?" ("Who watches the watchers?")</div></div></div></font></span><div><div class="h5">
<br><div class="gmail_quote">On Thu, Aug 11, 2016 at 9:33 AM, Aaron Seib <span dir="ltr"><<a href="mailto:aaron.seib@nate-trust.org" target="_blank">aaron.seib@nate-trust.org</a>></span> wrote:<br><blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex"><div>
<div>Makes senseto me Professor.</div><div><br></div><div><br></div><div><br></div><div><div style="font-size:85%;color:#575757">Aaron Seib</div><div style="font-size:85%;color:#575757"><br></div><div style="font-size:85%;color:#575757">The trick to establishing trust is to avoid all tricks. Especially tricks on yourself.</div></div><br><br>-------- Original message --------<br>From: Justin Richer <<a href="mailto:jricher@mit.edu" target="_blank">jricher@mit.edu</a>> <br>Date: 8/11/16 9:19 AM (GMT-05:00) <br>To: Aaron Seib <<a href="mailto:aaron.seib@nate-trust.org" target="_blank">aaron.seib@nate-trust.org</a>>, Kathleen Connor <<a href="mailto:kathleen_connor@comcast.net" target="_blank">kathleen_connor@comcast.net</a>>, <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openi<wbr>d.net</a> <br>Cc: ddecouteau <<a href="mailto:duane.decouteau@gmail.com" target="_blank">duane.decouteau@gmail.com</a>>, "'Kretz, Jim M. (SAMHSA/CMHS)'" <<a href="mailto:Jim.Kretz@samhsa.hhs.gov" target="_blank">Jim.Kretz@samhsa.hhs.gov</a>>, "'Gonzales-Webb, Suzanne (Engility)'" <<a href="mailto:Suzanne.Gonzales-Webb@va.gov" target="_blank">Suzanne.Gonzales-Webb@va.gov</a>><wbr>, <a href="mailto:jc@securityrs.com" target="_blank">jc@securityrs.com</a>, "'Davis, John M.'" <<a href="mailto:Mike.Davis@va.gov" target="_blank">Mike.Davis@va.gov</a>>, Mohammad Jafari <<a href="mailto:mjafari@edmondsci.com" target="_blank">mjafari@edmondsci.com</a>> <br>Subject: Re: [Openid-specs-heart] Openid-specs-heart Digest, Vol 85, Issue 5 <br><br>
<p>The point here is that the AS shouldn't ever need to access the
payload to issue the appropriate tokens. Which it doesn't have to,
in either the OAuth or UMA models. That's why we say it's always
the RS that enforces the security of the token (and whatever other
additional systems there may be). The RS already has the data
(obviously, by definition), the AS doesn't.<br>
</p>
<p> -- Justin<br>
</p>
<br>
<div>On 8/11/2016 9:02 AM, Aaron Seib wrote:<br>
</div>
<blockquote type="cite">
<div>For what it is worth I have a question regarding Kathleen's
assertion that accessing the payload would be privacy leaking. </div>
<div><br>
</div>
<div>Would it be the resource owner that accessed the payload in
question? Don't they already have the content that went into
creating the payload? </div>
<div><br>
</div>
<div>Would leakage only be occurring if the AS was seperated from
the RS?</div>
<div><br>
</div>
<div><br>
</div>
<div><br>
</div>
<div>
<div style="font-size:85%;color:#575757">Aaron Seib</div>
<div style="font-size:85%;color:#575757"><br>
</div>
<div style="font-size:85%;color:#575757">The trick to
establishing trust is to avoid all tricks. Especially tricks
on yourself.</div>
</div>
<br>
<br>
-------- Original message --------<br>
From: Kathleen Connor <a href="mailto:kathleen_connor@comcast.net" target="_blank"><kathleen_connor@comcast.net></a> <br>
Date: 8/10/16 11:27 PM (GMT-05:00) <br>
To: <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openi<wbr>d.net</a> <br>
Cc: ddecouteau <a href="mailto:duane.decouteau@gmail.com" target="_blank"><duane.decouteau@gmail.com></a>, "'Kretz, Jim M.
(SAMHSA/CMHS)'" <a href="mailto:Jim.Kretz@samhsa.hhs.gov" target="_blank"><Jim.Kretz@samhsa.hhs.gov></a>, "'Gonzales-Webb,
Suzanne (Engility)'" <a href="mailto:Suzanne.Gonzales-Webb@va.gov" target="_blank"><Suzanne.Gonzales-Webb@va.gov></a><wbr>,
<a href="mailto:jc@securityrs.com" target="_blank">jc@securityrs.com</a>, "'Davis, John M.'" <a href="mailto:Mike.Davis@va.gov" target="_blank"><Mike.Davis@va.gov></a>,
Mohammad Jafari <a href="mailto:mjafari@edmondsci.com" target="_blank"><mjafari@edmondsci.com></a> <br>
Subject: Re: [Openid-specs-heart] Openid-specs-heart Digest, Vol
85, Issue 5 <br>
<br>
Hi<br>
<br>
RE " The scopes are meant to do coarse-grained authorization and
not fine<br>
grained authorization... So, scopes can help you do first level of
coarse<br>
grain authorization which will yield you an access token. Once an
access<br>
token is valid, grab the contextual information from the payload,
header,<br>
access token etc. Find a policy associated with the contextual
object, and<br>
then perform fine level authorization based on the policy."<br>
<br>
Different perspective:<br>
<br>
Scopes could be conveyed using FHIR Security Labels, which do
support fine<br>
grain authorization, and convey the key policy and context
information<br>
needed without accessing the payload. <br>
<br>
Having to access payload to make authorization decisions is
privacy leaking.<br>
There's been a lot of work done in this area by VA, ONC, SAMHSA
and others<br>
already. K<br>
<br>
Kathleen Connor<br>
VHA Security Architecture - Framework Engineering<br>
(Edmond Scientific Company)<br>
HL7 Security and Financial Management Cochair<br>
Office - <a href="tel:360%20357%203536" value="+13603573536" target="_blank">360 357 3536</a> [Primary]<br>
Cell - <a href="tel:360%20480%207599" value="+13604807599" target="_blank">360 480 7599</a> <br>
<br>
-----Original Message-----<br>
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Today's Topics:<br>
<br>
1. Re: HEART Scope Design Proposal #1 (Vivek Biswas)<br>
2. Re: HEART Scope Design Proposal #1<br>
(Salyards, Kenneth (SAMHSA/OPPI))<br>
3. Re: HEART Scope Design Proposal #1 (Adrian Gropper)<br>
<br>
<br>
------------------------------<wbr>------------------------------<wbr>----------<br>
<br>
Message: 1<br>
Date: Wed, 10 Aug 2016 17:50:18 +0000 (UTC)<br>
From: Vivek Biswas <a href="mailto:vivek_biswas@yahoo.com" target="_blank"><vivek_biswas@yahoo.com></a><br>
To: Adrian Gropper <a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a>,<br>
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">"openid-specs-heart@lists.open<wbr>id.net"</a><br>
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank"><openid-specs-heart@lists.open<wbr>id.net></a><br>
Cc: Josh Mandel <a href="mailto:jmandel@gmail.com" target="_blank"><jmandel@gmail.com></a>, Grahame Grieve<br>
<a href="mailto:grahame@healthintersections.com.au" target="_blank"><grahame@healthintersections.c<wbr>om.au></a><br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
Message-ID:<br>
<a href="mailto:1612609796.12186354.1470851418456.JavaMail.yahoo@mail.yahoo.com" target="_blank"><1612609796.12186354.147085141<wbr>8456.JavaMail.yahoo@mail.<wbr>yahoo.com></a><br>
Content-Type: text/plain; charset="utf-8"<br>
<br>
Hi Adrian,<br>
The scopes are meant to do coarse-grained authorization and not
fine grained<br>
authorization.<br>
<br>
And hence, this one of the reason why scopes are static string.<br>
If one want to perform fine grained authorization, then its based
on lot of<br>
contextual information like you mention, date-range, geo-location,
etc....<br>
The contextual information can reside in the Request Payload, in
database,<br>
within the access token (if JWT) etc. All these contextual
information<br>
associated with the request can be trusted only if the access
token is<br>
valid.?<br>
There can be a policy associated with context which can help us to
decide if<br>
the request should be authorized or not.<br>
So, scopes can help you do first level of coarse grain
authorization which<br>
will yield you an access token. Once an access token is valid,
grab the<br>
contextual information from the payload, header, access token etc.
Find a<br>
policy associated with the contextual object and than perform fine
level<br>
authorization based on the policy.<br>
<br>
RegardsVivek Biswas, CISSPConsulting Member @Oracle<br>
<br>
<br>
From: Adrian Gropper <a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a><br>
To: <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">"openid-specs-heart@lists.open<wbr>id.net"</a><br>
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank"><openid-specs-heart@lists.open<wbr>id.net></a><br>
Cc: Justin Richer <a href="mailto:jricher@mit.edu" target="_blank"><jricher@mit.edu></a>; Vivek Biswas
<a href="mailto:vivek_biswas@yahoo.com" target="_blank"><vivek_biswas@yahoo.com></a>;<br>
Josh Mandel <a href="mailto:jmandel@gmail.com" target="_blank"><jmandel@gmail.com></a>; Grahame Grieve<br>
<a href="mailto:grahame@healthintersections.com.au" target="_blank"><grahame@healthintersections.c<wbr>om.au></a><br>
Sent: Tuesday, August 9, 2016 12:57 PM<br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
<br>
There are many reasons why we need to find a way:<br>
<br>
- I have never seen a release of information form that did not
have a<br>
date range. Has anyone? If we say HEART can't do that we're
calling into<br>
question the legitimacy of HEART.<br>
- We have a lot of experience with 75-page CCDAs with the
current<br>
standards. Many patients have huge health records and it is<br>
resource-intensive to get 74-pages of information you already had
in order<br>
to find the change from the last encounter. The cost is not just
on the<br>
sender but on the recipient as well. This is probably the top
complaint of<br>
the current interop methods in my medical society.<br>
- I don't think the HEART charter set a particular limit on how
much of<br>
FHIR we would manage. It's not in our charter to treat effective<br>
provider-to-provider exchange as out-of-scope. Once we say that
HEART will<br>
not support the full patient-level feature set of FHIR, where do
we draw the<br>
line?<br>
- UMA is not OAuth. The goals of the two standards are very
different.<br>
UMA and HEART are patient-centered. If we restrict HEART to a
small fraction<br>
of the longitudinal health records or patient-centered health
rerecords<br>
transactions (because most of the traffic stays in the batch or<br>
institution-to-institution domain) then where do we host the
discussion on a<br>
future for patient-centered records?<br>
- There is no logical reason for HEART to not support date
ranges once<br>
FHIR has that capability. In some jurisdictions, this would be
seen as<br>
reducing patient's right of access and subject to legal
challenge. <br>
<br>
I've added Josh and Grahame to this thread. Let's try and find the
solution<br>
to this problem even if it involves changing UMA, FHIR or both.<br>
Adrian<br>
<br>
On Tue, Aug 9, 2016 at 12:31 PM, Vivek Biswas
<a href="mailto:vivek_biswas@yahoo.com" target="_blank"><vivek_biswas@yahoo.com></a><br>
wrote:<br>
<br>
I agree with Justin, that scopes are static string vs scope string
be<br>
parameterized. Most of the OAuth server support static string.?<br>
It will get challenging to implement a profile which requires
dynamic string<br>
which in turn will hamper the adoption of HEART.<br>
We are trying to add contextual information into the scope which
are not<br>
what scopes are intended for.<br>
RegardsVivek Biswas, CISSPConsulting member @Oracle?<br>
On Aug 9, 2016, at 9:17 AM, Justin Richer <a href="mailto:jricher@mit.edu" target="_blank"><jricher@mit.edu></a>
wrote:<br>
<br>
<br>
A problem I can see with this is that the ?date? field in
particular moves<br>
this from something that?s expressible as a table of known strings
(like in<br>
the appendix of the current spec) to something that?s dynamically<br>
parameterized with a potentially infinite set of values. This is a
problem<br>
in practice as many OAuth implementations treat all scopes as
static<br>
strings, and will do things like limit set set of scopes a client
is allowed<br>
to ask for based on a set of registered strings. That?s not
possible with a<br>
field like ?date? anymore, since the value is filled in at
runtime. We tried<br>
to have parameterized scopes in BB+ (and even implemented it) but
it was<br>
generally thought to be too complicated, and required special
tooling at the<br>
authorizations server.<br>
If at all possible, I?d like HEART scopes to not require such
special<br>
processing and support at the AS.<br>
<br>
?? Justin<br>
<br>
On Aug 8, 2016, at 9:08 PM, Adrian Gropper
<a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a> wrote:<br>
Scope Design Proposal #1 aims to support a typical ROI
authorization.<br>
<br>
The structure of SDP1 is: patient/date/confidentialitycl
ass/resource/edit<br>
<br>
The logic is as follows:<br>
<br>
- /patient because this applies to only one patient at a time.
The<br>
patient ID is local to the resource server.<br>
- /date is defined by FHIR and can be a range. Putting it at
the highest<br>
level in the hierarchy (if a scope hierarchy is useful) allows for<br>
efficiency in clients requesting updates and reduces the cost to
the<br>
resource server<br>
- /confidentialityclass filters for resources at or below the
specified<br>
value. Resources that do not have a confidentiality class are
considered N -<br>
Normal. It is up to the resource server to provide
jurisdictictionally<br>
appropriate policies and user interfaces for setting
confidentiality class<br>
other than N on particular resources.<br>
- /resource is any resource listed in the particular version of
the FHIR<br>
specification<br>
- /edit is "read", "write", "any" operation by the client on
the resource<br>
A client might request a scope for immunizations for patient 23
as:[<br>
"date=le2016-8-8","conclass=N" , "resource=Immunization",
"edit=read" ]<br>
<br>
on a resource registered as: [base]/Patient/23/ with a reference
to HEART<br>
scopes SDP1 that would tell both the AS and anyone else that
dereferenced<br>
HEART/SDP1 that the RS would process specific scope strings for
date,<br>
confidentialityclass, resource, and edit as described above.<br>
<br>
The AS would be free to present SDP1 to the RO any way that it
chose.<br>
<br>
A resource server like NYP that wanted to offer registration for
sensitive<br>
data like Mental Health Treatment would register another resource:<br>
[base]/Patient/23/ MentalHealthTx with whatever scopes it offered.
<br>
These additional resources would not be specified by HEART.<br>
<br>
Any particular RS could choose to support Confidentiality Class,
additional<br>
resources, neither, or both. <br>
<br>
It would be up to the AS to combine HEART SDP1 resources and
additional<br>
resources and scopes offered by the RS into whatever policy
setting<br>
experience it wanted.<br>
With this scheme, an AS might offer Alice a policy setting for
Observation =<br>
R - Restricted even on a resource server that did not support<br>
confidentiality class. This would cause all client requests for
Observations<br>
to fail because the RS would be forced to treat unlabeled
resources as N and<br>
the authorization tokens for observations were R. The RS could:<br>
(a) ignore this problem and treat it as an AS bug,<br>
(b) implement confidentiality classification, or<br>
(c) offer additional resources and scopes so that the AS could
tell Alice<br>
that Observations did not include those related to mental health
in the hope<br>
that Alice would set Observation = N and deal with mental health
as a<br>
separate part of her policy.<br>
<br>
I believe that, to a first approximation, SDP1 would capture the<br>
functionality of most sharing use-cases without forcing the RS to
do<br>
anything more than it is jurisdictionally already required to do.
<br>
Adrian<br>
<br>
<br>
-- <br>
<br>
Adrian Gropper MD<br>
<br>
PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
HELP us fight for the right to control personal health data.<br>
DONATE:<a href="http://patientprivacyrights" target="_blank">http://patientprivacyri<wbr>ghts</a>.<br>
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PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
HELP us fight for the right to control personal health data.<br>
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<br>
Message: 2<br>
Date: Wed, 10 Aug 2016 18:49:42 +0000<br>
From: "Salyards, Kenneth (SAMHSA/OPPI)"<br>
<a href="mailto:Kenneth.Salyards@SAMHSA.hhs.gov" target="_blank"><Kenneth.Salyards@SAMHSA.hhs.g<wbr>ov></a><br>
To: Vivek Biswas <a href="mailto:vivek_biswas@yahoo.com" target="_blank"><vivek_biswas@yahoo.com></a>, Adrian Gropper<br>
<a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a>,
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">"openid-specs-heart@lists.open<wbr>id.net"</a><br>
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank"><openid-specs-heart@lists.open<wbr>id.net></a><br>
Cc: Josh Mandel <a href="mailto:jmandel@gmail.com" target="_blank"><jmandel@gmail.com></a>, Grahame Grieve<br>
<a href="mailto:grahame@healthintersections.com.au" target="_blank"><grahame@healthintersections.c<wbr>om.au></a><br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
Message-ID:<br>
<br>
<<a href="mailto:CY1PR09MB09394BE450F53C13200ECF8CA81D0@CY1PR09MB0939.namprd09.prod.outlook" target="_blank">CY1PR09MB09394BE450F53C13200E<wbr>CF8CA81D0@CY1PR09MB0939.namprd<wbr>09.prod.outlook</a>.<br>
com><br>
<br>
Content-Type: text/plain; charset="utf-8"<br>
<br>
Fine grained authorization should be dealt with using a patients?
consent<br>
directive. FHIR DSTU2 supports consent directive as part of the
contract<br>
resource. In DSTU3, as I understand the consent directive will not
be part<br>
of contract. This can work seamlessly within the UMA resource
server<br>
construct. Ken<br>
<br>
From: Openid-specs-heart<br>
[<a href="mailto:openid-specs-heart-bounces@lists.openid.net" target="_blank">mailto:openid-specs-heart-bou<wbr>nces@lists.openid.net</a>] On Behalf Of
Vivek<br>
Biswas<br>
Sent: Wednesday, August 10, 2016 1:50 PM<br>
To: Adrian Gropper; <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openi<wbr>d.net</a><br>
Cc: Josh Mandel; Grahame Grieve<br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
<br>
Hi Adrian,<br>
<br>
The scopes are meant to do coarse-grained authorization and not
fine grained<br>
authorization.<br>
<br>
And hence, this one of the reason why scopes are static string.<br>
<br>
If one want to perform fine grained authorization, then its based
on lot of<br>
contextual information like you mention, date-range, geo-location,
etc....<br>
<br>
The contextual information can reside in the Request Payload, in
database,<br>
within the access token (if JWT) etc. All these contextual
information<br>
associated with the request can be trusted only if the access
token is<br>
valid.<br>
<br>
There can be a policy associated with context which can help us to
decide if<br>
the request should be authorized or not.<br>
<br>
So, scopes can help you do first level of coarse grain
authorization which<br>
will yield you an access token. Once an access token is valid,
grab the<br>
contextual information from the payload, header, access token etc.
Find a<br>
policy associated with the contextual object and than perform fine
level<br>
authorization based on the policy.<br>
<br>
<br>
Regards<br>
Vivek Biswas, CISSP<br>
Consulting Member @Oracle<br>
<br>
<br>
<br>
______________________________<wbr>__<br>
From: Adrian Gropper
<<a href="mailto:agropper@healthurl.com" target="_blank">agropper@healthurl.com</a><a href="mailto:agropper@healthurl.com" target="_blank"><mailto<wbr>:agropper@healthurl.com></a>><br>
To:<br>
"<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.open<wbr>id.net</a><<a href="mailto:openid-specs-heart@lists.openid" target="_blank">mailto:openid-specs-<wbr>heart@lists.openid</a>.<br>
net>"<br>
<<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.open<wbr>id.net</a><<a href="mailto:openid-specs-heart@lists.openid" target="_blank">mailto:openid-specs-<wbr>heart@lists.openid</a>.<br>
net>><br>
Cc: Justin Richer
<<a href="mailto:jricher@mit.edu" target="_blank">jricher@mit.edu</a><a href="mailto:jricher@mit.edu" target="_blank"><mailto:jriche<wbr>r@mit.edu></a>>; Vivek
Biswas<br>
<<a href="mailto:vivek_biswas@yahoo.com" target="_blank">vivek_biswas@yahoo.com</a><a href="mailto:vivek_biswas@yahoo.com" target="_blank"><mailto<wbr>:vivek_biswas@yahoo.com></a>>;
Josh Mandel<br>
<<a href="mailto:jmandel@gmail.com" target="_blank">jmandel@gmail.com</a><a href="mailto:jmandel@gmail.com" target="_blank"><mailto:jman<wbr>del@gmail.com></a>>; Grahame
Grieve<br>
<<a href="mailto:grahame@healthintersections.com.au" target="_blank">grahame@healthintersections.c<wbr>om.au</a><<a href="mailto:grahame@healthintersections.com.a" target="_blank">mailto:grahame@healthint<wbr>ersections.com.a</a><br>
u>><br>
Sent: Tuesday, August 9, 2016 12:57 PM<br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
<br>
There are many reasons why we need to find a way:<br>
<br>
1. I have never seen a release of information form that did not
have a<br>
date range. Has anyone? If we say HEART can't do that we're
calling into<br>
question the legitimacy of HEART.<br>
2. We have a lot of experience with 75-page CCDAs with the
current<br>
standards. Many patients have huge health records and it is<br>
resource-intensive to get 74-pages of information you already had
in order<br>
to find the change from the last encounter. The cost is not just
on the<br>
sender but on the recipient as well. This is probably the top
complaint of<br>
the current interop methods in my medical society.<br>
3. I don't think the HEART charter set a particular limit on
how much of<br>
FHIR we would manage. It's not in our charter to treat effective<br>
provider-to-provider exchange as out-of-scope. Once we say that
HEART will<br>
not support the full patient-level feature set of FHIR, where do
we draw the<br>
line?<br>
4. UMA is not OAuth. The goals of the two standards are very
different.<br>
UMA and HEART are patient-centered. If we restrict HEART to a
small fraction<br>
of the longitudinal health records or patient-centered health
rerecords<br>
transactions (because most of the traffic stays in the batch or<br>
institution-to-institution domain) then where do we host the
discussion on a<br>
future for patient-centered records?<br>
5. There is no logical reason for HEART to not support date
ranges once<br>
FHIR has that capability. In some jurisdictions, this would be
seen as<br>
reducing patient's right of access and subject to legal challenge.<br>
I've added Josh and Grahame to this thread. Let's try and find the
solution<br>
to this problem even if it involves changing UMA, FHIR or both.<br>
Adrian<br>
<br>
On Tue, Aug 9, 2016 at 12:31 PM, Vivek Biswas<br>
<<a href="mailto:vivek_biswas@yahoo.com" target="_blank">vivek_biswas@yahoo.com</a><a href="mailto:vivek_biswas@yahoo.com" target="_blank"><mailto<wbr>:vivek_biswas@yahoo.com></a>>
wrote:<br>
I agree with Justin, that scopes are static string vs scope string
be<br>
parameterized. Most of the OAuth server support static string.<br>
<br>
It will get challenging to implement a profile which requires
dynamic string<br>
which in turn will hamper the adoption of HEART.<br>
<br>
We are trying to add contextual information into the scope which
are not<br>
what scopes are intended for.<br>
<br>
Regards<br>
Vivek Biswas, CISSP<br>
Consulting member @Oracle<br>
<br>
On Aug 9, 2016, at 9:17 AM, Justin Richer<br>
<<a href="mailto:jricher@mit.edu" target="_blank">jricher@mit.edu</a><a href="mailto:jricher@mit.edu" target="_blank"><mailto:jriche<wbr>r@mit.edu></a>> wrote:<br>
A problem I can see with this is that the ?date? field in
particular moves<br>
this from something that?s expressible as a table of known strings
(like in<br>
the appendix of the current spec) to something that?s dynamically<br>
parameterized with a potentially infinite set of values. This is a
problem<br>
in practice as many OAuth implementations treat all scopes as
static<br>
strings, and will do things like limit set set of scopes a client
is allowed<br>
to ask for based on a set of registered strings. That?s not
possible with a<br>
field like ?date? anymore, since the value is filled in at
runtime. We tried<br>
to have parameterized scopes in BB+ (and even implemented it) but
it was<br>
generally thought to be too complicated, and required special
tooling at the<br>
authorizations server.<br>
<br>
If at all possible, I?d like HEART scopes to not require such
special<br>
processing and support at the AS.<br>
<br>
? Justin<br>
<br>
On Aug 8, 2016, at 9:08 PM, Adrian Gropper<br>
<<a href="mailto:agropper@healthurl.com" target="_blank">agropper@healthurl.com</a><a href="mailto:agropper@healthurl.com" target="_blank"><mailto<wbr>:agropper@healthurl.com></a>>
wrote:<br>
<br>
Scope Design Proposal #1 aims to support a typical ROI<br>
authorization<<a href="https://dl.dropboxusercontent.com/u/8909568/NYP%20authorizatio" target="_blank">https://dl.dropb<wbr>oxusercontent.com/u/8909568/<wbr>NYP%20authorizatio</a><br>
n.pdf>.<br>
The structure of SDP1 is:<br>
patient/date<a href="http://hl7.org/fhir/search.html#date" target="_blank"><http://hl7.org/fh<wbr>ir/search.html#date></a>/confident<wbr>ialitycl<br>
ass<a href="http://hl7-fhir.github.io/v3/ConfidentialityClassification/vs.html" target="_blank"><http://hl7-fhir.github.io/<wbr>v3/ConfidentialityClassificati<wbr>on/vs.html></a>/reso<br>
urce<a href="http://hl7.org/fhir/resourcelist.html" target="_blank"><http://hl7.org/fhir/resou<wbr>rcelist.html></a>/edit<br>
<br>
The logic is as follows:<br>
<br>
* /patient because this applies to only one patient at a time.
The<br>
patient ID is local to the resource server.<br>
* /date<a href="http://hl7.org/fhir/search.html#date" target="_blank"><http://hl7.org/fhir/sear<wbr>ch.html#date></a> is defined
by FHIR and can<br>
be a range. Putting it at the highest level in the hierarchy (if a
scope<br>
hierarchy is useful) allows for efficiency in clients requesting
updates and<br>
reduces the cost to the resource server<br>
*<br>
/confidentialityclass<<a href="http://hl7-fhir.github.io/v3/ConfidentialityClassifica" target="_blank">http://h<wbr>l7-fhir.github.io/v3/Confident<wbr>ialityClassifica</a><br>
tion/vs.html> filters for resources at or below the specified
value.<br>
Resources that do not have a confidentiality class are considered
N -<br>
Normal. It is up to the resource server to provide
jurisdictictionally<br>
appropriate policies and user interfaces for setting
confidentiality class<br>
other than N on particular resources.<br>
* /resource<a href="http://hl7.org/fhir/resourcelist.html" target="_blank"><http://hl7.org/fhir/<wbr>resourcelist.html></a> is
any resource<br>
listed in the particular version of the FHIR specification<br>
* /edit is "read", "write", "any" operation by the client on
the<br>
resource<br>
A client might request a scope for immunizations for patient 23
as:<br>
<br>
[ "date=le2016-8-8","conclass=N" , "resource=Immunization",
"edit=read" ]<br>
<br>
on a resource registered as: [base]/Patient/23/ with a reference
to HEART<br>
scopes SDP1 that would tell both the AS and anyone else that
dereferenced<br>
HEART/SDP1 that the RS would process specific scope strings for
date,<br>
confidentialityclass, resource, and edit as described above.<br>
<br>
The AS would be free to present SDP1 to the RO any way that it
chose.<br>
<br>
A resource server like NYP that wanted to offer registration for
sensitive<br>
data like Mental Health Treatment would register another resource:<br>
[base]/Patient/23/ MentalHealthTx with whatever scopes it offered.<br>
These additional resources would not be specified by HEART.<br>
<br>
Any particular RS could choose to support Confidentiality Class,
additional<br>
resources, neither, or both.<br>
<br>
It would be up to the AS to combine HEART SDP1 resources and
additional<br>
resources and scopes offered by the RS into whatever policy
setting<br>
experience it wanted.<br>
With this scheme, an AS might offer Alice a policy setting for
Observation =<br>
R - Restricted even on a resource server that did not support<br>
confidentiality class. This would cause all client requests for
Observations<br>
to fail because the RS would be forced to treat unlabeled
resources as N and<br>
the authorization tokens for observations were R. The RS could:<br>
(a) ignore this problem and treat it as an AS bug,<br>
(b) implement confidentiality classification, or<br>
(c) offer additional resources and scopes so that the AS could
tell Alice<br>
that Observations did not include those related to mental health
in the hope<br>
that Alice would set Observation = N and deal with mental health
as a<br>
separate part of her policy.<br>
I believe that, to a first approximation, SDP1 would capture the<br>
functionality of most sharing use-cases without forcing the RS to
do<br>
anything more than it is jurisdictionally already required to do.<br>
<br>
Adrian<br>
<br>
<br>
<br>
--<br>
<br>
Adrian Gropper MD<br>
<br>
PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
HELP us fight for the right to control personal health data.<br>
DONATE: <a href="http://patientprivacyrights" target="_blank">http://patientprivacyrights</a>.<br>
org/donate-2/<a href="http://patientprivacyrights.org/donate-2/" target="_blank"><http://patientpr<wbr>ivacyrights.org/donate-2/></a><br>
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<br>
<br>
--<br>
<br>
Adrian Gropper MD<br>
<br>
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">http://patientprivacyrights.or<wbr>g/donate-2/</a><br>
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------------------------------<br>
<br>
Message: 3<br>
Date: Wed, 10 Aug 2016 14:57:02 -0400<br>
From: Adrian Gropper <a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a><br>
To: "Salyards, Kenneth (SAMHSA/OPPI)"<br>
<a href="mailto:Kenneth.Salyards@samhsa.hhs.gov" target="_blank"><Kenneth.Salyards@samhsa.hhs.g<wbr>ov></a><br>
Cc: Grahame Grieve <a href="mailto:grahame@healthintersections.com.au" target="_blank"><grahame@healthintersections.c<wbr>om.au></a>,
Josh Mandel<br>
<a href="mailto:jmandel@gmail.com" target="_blank"><jmandel@gmail.com></a>, <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">"openid-specs-heart@lists.open<wbr>id.net"</a><br>
<a href="mailto:openid-specs-heart@lists.openid.net" target="_blank"><openid-specs-heart@lists.open<wbr>id.net></a><br>
Subject: Re: [Openid-specs-heart] HEART Scope Design Proposal #1<br>
Message-ID:<br>
<a href="mailto:CANYRo8goY-qq=iM+KFNP2=YKNzp9c_RH8Ld5ceLLs=iFbabRig@mail.gmail.com" target="_blank"><CANYRo8goY-qq=iM+KFNP2=YKNzp9<wbr>c_RH8Ld5ceLLs=iFbabRig@mail.<wbr>gmail.com></a><br>
Content-Type: text/plain; charset="utf-8"<br>
<br>
What is a consent directive?<br>
<br>
What is the relationship of whatever it is to FHIR or any other
standard<br>
data model?<br>
<br>
How does a consent directive interact with OAuth, UMA or OpenID
Connect?<br>
<br>
Do you have an example of how a consent directive maps into,
replaces, or<br>
changes the NYP ROI authorization form?<br>
<br>
Thanks,<br>
<br>
Adrian<br>
<br>
<br>
<br>
On Wed, Aug 10, 2016 at 2:49 PM, Salyards, Kenneth (SAMHSA/OPPI)
<<br>
<a href="mailto:Kenneth.Salyards@samhsa.hhs.gov" target="_blank">Kenneth.Salyards@samhsa.hhs.go<wbr>v</a>> wrote:<br>
<br>
> Fine grained authorization should be dealt with using a
patients? <br>
> consent directive. FHIR DSTU2 supports consent directive as
part of <br>
> the contract resource. In DSTU3, as I understand the consent
directive <br>
> will not be part of contract. This can work seamlessly within
the UMA <br>
> resource server construct. Ken<br>
><br>
><br>
><br>
> *From:* Openid-specs-heart [<a href="mailto:openid-specs-heart" target="_blank">mailto:openid-specs-heart</a>- <br>
> <a href="mailto:bounces@lists.openid.net" target="_blank">bounces@lists.openid.net</a>] *On Behalf Of *Vivek Biswas<br>
> *Sent:* Wednesday, August 10, 2016 1:50 PM<br>
> *To:* Adrian Gropper; <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">openid-specs-heart@lists.openi<wbr>d.net</a><br>
> *Cc:* Josh Mandel; Grahame Grieve<br>
><br>
> *Subject:* Re: [Openid-specs-heart] HEART Scope Design
Proposal #1<br>
><br>
><br>
><br>
> Hi Adrian,<br>
><br>
><br>
><br>
> The scopes are meant to do coarse-grained authorization and
not fine <br>
> grained authorization.<br>
><br>
><br>
><br>
> And hence, this one of the reason why scopes are static
string.<br>
><br>
><br>
><br>
> If one want to perform fine grained authorization, then its
based on <br>
> lot of contextual information like you mention, date-range, <br>
> geo-location, etc....<br>
><br>
><br>
><br>
> The contextual information can reside in the Request Payload,
in <br>
> database, within the access token (if JWT) etc. All these
contextual <br>
> information associated with the request can be trusted only
if the <br>
> access token is valid.<br>
><br>
><br>
><br>
> There can be a policy associated with context which can help
us to <br>
> decide if the request should be authorized or not.<br>
><br>
><br>
><br>
> So, scopes can help you do first level of coarse grain
authorization <br>
> which will yield you an access token. Once an access token is
valid, <br>
> grab the contextual information from the payload, header,
access token <br>
> etc. Find a policy associated with the contextual object and
than <br>
> perform fine level authorization based on the policy.<br>
><br>
><br>
><br>
><br>
><br>
> Regards<br>
><br>
> Vivek Biswas, CISSP<br>
><br>
> Consulting Member @Oracle<br>
><br>
><br>
><br>
><br>
><br>
><br>
> ------------------------------<br>
><br>
> *From:* Adrian Gropper <a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a><br>
> *To:* <a href="mailto:openid-specs-heart@lists.openid.net" target="_blank">"openid-specs-heart@lists.open<wbr>id.net"</a>
<openid-specs-heart@lists.<br>
> <a href="http://openid.net" target="_blank">openid.net</a>><br>
> *Cc:* Justin Richer <a href="mailto:jricher@mit.edu" target="_blank"><jricher@mit.edu></a>; Vivek Biswas
< <br>
> <a href="mailto:vivek_biswas@yahoo.com" target="_blank">vivek_biswas@yahoo.com</a>>; Josh Mandel
<a href="mailto:jmandel@gmail.com" target="_blank"><jmandel@gmail.com></a>; Grahame <br>
> Grieve < <a href="mailto:grahame@healthintersections.com.au" target="_blank">grahame@healthintersections.co<wbr>m.au</a>><br>
> *Sent:* Tuesday, August 9, 2016 12:57 PM<br>
> *Subject:* Re: [Openid-specs-heart] HEART Scope Design
Proposal #1<br>
><br>
><br>
><br>
> There are many reasons why we need to find a way:<br>
><br>
> 1. I have never seen a release of information form that
did not have a<br>
> date range. Has anyone? If we say HEART can't do that
we're calling<br>
into<br>
> question the legitimacy of HEART.<br>
> 2. We have a lot of experience with 75-page CCDAs with the
current<br>
> standards. Many patients have huge health records and it
is<br>
> resource-intensive to get 74-pages of information you
already had in<br>
order<br>
> to find the change from the last encounter. The cost is
not just on the<br>
> sender but on the recipient as well. This is probably the
top complaint<br>
of<br>
> the current interop methods in my medical society.<br>
> 3. I don't think the HEART charter set a particular limit
on how much<br>
> of FHIR we would manage. It's not in our charter to treat
effective<br>
> provider-to-provider exchange as out-of-scope. Once we say
that HEART<br>
will<br>
> not support the full patient-level feature set of FHIR,
where do we<br>
draw<br>
> the line?<br>
> 4. UMA is not OAuth. The goals of the two standards are
very<br>
> different. UMA and HEART are patient-centered. If we
restrict HEART to<br>
a<br>
> small fraction of the longitudinal health records or
patient-centered<br>
> health rerecords transactions (because most of the traffic
stays in the<br>
> batch or institution-to-institution domain) then where do
we host the<br>
> discussion on a future for patient-centered records?<br>
> 5. There is no logical reason for HEART to not support
date ranges<br>
> once FHIR has that capability. In some jurisdictions, this
would be<br>
seen as<br>
> reducing patient's right of access and subject to legal
challenge.<br>
><br>
> I've added Josh and Grahame to this thread. Let's try and
find the <br>
> solution to this problem even if it involves changing UMA,
FHIR or both.<br>
><br>
> Adrian<br>
><br>
><br>
><br>
> On Tue, Aug 9, 2016 at 12:31 PM, Vivek Biswas
<a href="mailto:vivek_biswas@yahoo.com" target="_blank"><vivek_biswas@yahoo.com></a><br>
> wrote:<br>
><br>
> I agree with Justin, that scopes are static string vs scope
string be <br>
> parameterized. Most of the OAuth server support static
string.<br>
><br>
><br>
><br>
> It will get challenging to implement a profile which requires
dynamic <br>
> string which in turn will hamper the adoption of HEART.<br>
><br>
><br>
><br>
> We are trying to add contextual information into the scope
which are <br>
> not what scopes are intended for.<br>
><br>
><br>
> Regards<br>
><br>
> Vivek Biswas, CISSP<br>
><br>
> Consulting member @Oracle<br>
><br>
><br>
> On Aug 9, 2016, at 9:17 AM, Justin Richer
<a href="mailto:jricher@mit.edu" target="_blank"><jricher@mit.edu></a> wrote:<br>
><br>
> A problem I can see with this is that the ?date? field in
particular <br>
> moves this from something that?s expressible as a table of
known <br>
> strings (like in the appendix of the current spec) to
something that?s <br>
> dynamically parameterized with a potentially infinite set of
values. <br>
> This is a problem in practice as many OAuth implementations
treat all <br>
> scopes as static strings, and will do things like limit set
set of <br>
> scopes a client is allowed to ask for based on a set of
registered <br>
> strings. That?s not possible with a field like ?date?
anymore, since <br>
> the value is filled in at runtime. We tried to have
parameterized <br>
> scopes in BB+ (and even implemented<br>
> it) but it was generally thought to be too complicated, and
required <br>
> special tooling at the authorizations server.<br>
><br>
><br>
><br>
> If at all possible, I?d like HEART scopes to not require such
special <br>
> processing and support at the AS.<br>
><br>
><br>
><br>
> ? Justin<br>
><br>
><br>
><br>
> On Aug 8, 2016, at 9:08 PM, Adrian Gropper
<a href="mailto:agropper@healthurl.com" target="_blank"><agropper@healthurl.com></a> wrote:<br>
><br>
><br>
><br>
> Scope Design Proposal #1 aims to support a typical ROI
authorization <br>
>
<a href="https://dl.dropboxusercontent.com/u/8909568/NYP%20authorization.pdf" target="_blank"><https://dl.dropboxusercontent<wbr>.com/u/8909568/NYP%<wbr>20authorization.pdf></a>.<br>
><br>
> The structure of SDP1 is: patient/date <br>
>
<a href="http://hl7.org/fhir/search.html#date" target="_blank"><http://hl7.org/fhir/search.ht<wbr>ml#date></a>/confidentialitycl ass
<br>
>
<a href="http://hl7-fhir.github.io/v3/ConfidentialityClassification/vs.html" target="_blank"><http://hl7-fhir.github.io/v3/<wbr>ConfidentialityClassification/<wbr>vs.html></a>/<br>
> resource <a href="http://hl7.org/fhir/resourcelist.html" target="_blank"><http://hl7.org/fhir/resourcel<wbr>ist.html></a>/edit<br>
><br>
><br>
> The logic is as follows:<br>
><br>
> - /patient because this applies to only one patient at a
time. The<br>
> patient ID is local to the resource server.<br>
> - /date <a href="http://hl7.org/fhir/search.html#date" target="_blank"><http://hl7.org/fhir/search.ht<wbr>ml#date></a> is
defined by FHIR and<br>
> can be a range. Putting it at the highest level in the
hierarchy (if a<br>
> scope hierarchy is useful) allows for efficiency in
clients requesting<br>
> updates and reduces the cost to the resource server<br>
> - /confidentialityclass<br>
>
<a href="http://hl7-fhir.github.io/v3/ConfidentialityClassification/vs.html" target="_blank"><http://hl7-fhir.github.io/v3/<wbr>ConfidentialityClassification/<wbr>vs.html></a><br>
> filters for resources at or below the specified value.
Resources that<br>
do<br>
> not have a confidentiality class are considered N -
Normal. It is up to<br>
the<br>
> resource server to provide jurisdictictionally appropriate
policies and<br>
> user interfaces for setting confidentiality class other
than N on<br>
> particular resources.<br>
> - /resource <a href="http://hl7.org/fhir/resourcelist.html" target="_blank"><http://hl7.org/fhir/resourcel<wbr>ist.html></a>
is any resource<br>
> listed in the particular version of the FHIR specification<br>
> - /edit is "read", "write", "any" operation by the client
on the<br>
> resource<br>
><br>
> A client might request a scope for immunizations for patient
23 as:<br>
><br>
> [ "date=le2016-8-8","conclass=N" , "resource=Immunization", <br>
> "edit=read" ]<br>
><br>
> on a resource registered as: [base]/Patient/23/ with a
reference to <br>
> HEART scopes SDP1 that would tell both the AS and anyone else
that <br>
> dereferenced HEART/SDP1 that the RS would process specific
scope strings<br>
for date, confidentialityclass, resource, and edit as described
above.<br>
><br>
> The AS would be free to present SDP1 to the RO any way that
it chose.<br>
><br>
> A resource server like NYP that wanted to offer registration
for <br>
> sensitive data like Mental Health Treatment would register
another<br>
resource: [base]/Patient/23/ MentalHealthTx with whatever scopes
it offered.<br>
> These additional resources would not be specified by HEART.<br>
><br>
> Any particular RS could choose to support Confidentiality
Class,<br>
additional resources, neither, or both.<br>
><br>
> It would be up to the AS to combine HEART SDP1 resources and
additional<br>
resources and scopes offered by the RS into whatever policy
setting<br>
experience it wanted.<br>
><br>
> With this scheme, an AS might offer Alice a policy setting
for <br>
> Observation = R - Restricted even on a resource server that
did not <br>
> support confidentiality class. This would cause all client
requests <br>
> for Observations to fail because the RS would be forced to
treat <br>
> unlabeled resources as N and the authorization tokens for
observations <br>
> were R. The RS<br>
> could:<br>
> (a) ignore this problem and treat it as an AS bug,<br>
> (b) implement confidentiality classification, or<br>
> (c) offer additional resources and scopes so that the AS
could tell <br>
> Alice that Observations did not include those related to
mental health <br>
> in the hope that Alice would set Observation = N and deal
with mental <br>
> health as a separate part of her policy.<br>
><br>
> I believe that, to a first approximation, SDP1 would capture
the <br>
> functionality of most sharing use-cases without forcing the
RS to do <br>
> anything more than it is jurisdictionally already required to
do.<br>
><br>
> Adrian<br>
><br>
><br>
><br>
><br>
> --<br>
><br>
><br>
><br>
> Adrian Gropper MD<br>
><br>
> PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
> HELP us fight for the right to control personal health data.<br>
> DONATE: <a href="http://patientprivacyrights" target="_blank">http://patientprivacyrights</a>. org/donate-2/ <br>
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><br>
> PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
> HELP us fight for the right to control personal health data.<br>
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<br>
PROTECT YOUR FUTURE - RESTORE Health Privacy!<br>
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<br></blockquote></div><br><br clear="all"><br>-- <br><div class="gmail_signature" data-smartmail="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:
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