The Standard

The FHIR at Scale Taskforce (FAST) community has been at the forefront of shaping the future of healthcare interoperability. By working closely with the FHIR community and other FHIR Accelerators, FAST is building the framework for a robust FHIR infrastructure that supports the scalability of FHIR solutions across the healthcare ecosystem. Today, we are excited to announce an important leadership transition as we continue this vital work.

A New Opportunity for Dana Marcelonis

Dana Marcelonis, who has been a cornerstone of FAST as our Program Manager, will be transitioning to a new role at Point-of-Care Partners, where she will provide program support for the Coalition for Health AI (CHAI) project. Dana’s expertise, dedication, and leadership have been instrumental in guiding FAST’s efforts, and her impact on our work cannot be overstated. While Dana managed both roles admirably, the increasing demands of these projects have made it necessary to have a dedicated resource for each. Dana will continue to support Janice and the team through November to ensure a smooth transition.

August 28 Webinar Features Recent Updates Direct from Federal Officials

Are you looking for guidance and insight as you plan for 2025? If so, plan to attend this month’s Health Level Seven (HL7^®) Da Vinci Project Community Roundtable, which features special guests from the Assistant Secretary for Technology Policy (ASTP) office, formerly known as the Office of the National Coordinator for Health Information Technology (ONC). ASTP presenters will highlight why the Trusted Exchange Framework and Common Agreement^TM (TEFCA^TM) is important and share recent updates to the program, including implementation, long term plans, education and outreach, and building trust.

In ASTP’s second segment, testing and adoption efforts will be discussed, covering TEFCA’s HL7 Fast Healthcare Interoperability Resources (FHIR^®) Roadmap, and ASTP’s new TEFCA Payer/Provider 10x10 Coalition. ASTP will provide an overview of the 10x10 and discuss why providers and payers should participate. They will also discuss resources available and the interplay of the 10x10 with Da Vinci.  

The session concludes with the Da Vinci PMO sharing themes and perspectives from its membership on the Health Data, Technology, and Interoperability: Patient Engagement, Information Sharing, and Public Health Interoperability (HTI-2) proposed rule.

The Vulcan FHIR® Accelerator, in coordination with the US Assistant Secretary for Technology Policy/ Office of the National Coordinator (ASTP/ONC) and the Food and Drug Administration (FDA), invites you to an informational webinar for the Vulcan Interoperability Bridge (VIB) event.

The VIB event aims to accelerate the adoption of healthcare data standards for research – underscoring the value of using HL7 Fast Healthcare Interoperability Resources (FHIR®) to solve existing challenges and explore novel opportunities in research data interoperability.

The August 21 webinar is designed to share information on how we will convene clinical research sponsors, including pharmaceutical companies and academic medical centers, EHR providers, clinical research sites, and technology solutions providers to work together to demonstrate how clinical care and research interoperability is achievable utilizing existing HL7 FHIR® standards and implementation guides.

The International Patient Summary (IPS) is a key standard for global interoperability. Its goal is to create a common foundation for patient summary exchange across borders and ensure the ability to share key information with caregivers whenever and wherever needed. Several nations and international organizations have selected the IPS as a baseline for their summaries, and recently major electronic health record (EHR) and health information technology (IT) vendors have shared their planned implementations. These include Epic, MEDITECH, CommonHealth, Google, Patient Centric Solutions, VeroSource and Verto Health. Like many successful standards, today’s progress has been years in the making.

If you can’t think of a reason to pay attention to FAST's work, we have a couple for you! Recent requirements related to TEFCA (Trusted Exchange Framework and Common Agreement) and the latest HTI-2 proposed rule have named the FAST Security Implementation Guide (IG). This recognition underscores the importance and foundational nature of FAST's contributions to healthcare interoperability. 

On July 1st, the Recognized Coordinating Entity (RCE) released the Facilitated FHIR Implementation Standard Operating Procedure (SOP), outlining the requirements for using FHIR within the TEFCA framework. Notably, these requirements include adopting the FAST HL7 UDAP Security for Scalable Registration, Authentication, and Authorization FHIR Implementation Guide (SSRAA) by January 1, 2026. This timeline allows organizations to implement FAST Security while still using SMART or other security options in the interim. 

Specifically, the SOP states: 

Prior to January 1, 2026: 

• All FHIR Adopters MAY follow the requirements of HL7 SSRAA FHIR IG 1.0.0 STU 1 US Section 3 Registration. 

• Manual registration requests for client_id MUST be resolved within 5 business days where sufficient information has been provided. Information requirements MUST NOT exceed those in Section 3 of HL7 SSRAA FHIR IG and this SOP. 

• All FHIR adopters MUST use one of the following: 
  • HL7 SSRAA FHIR IG 1.0.0 – STU 1 US Sections 4 and 5; 
  • SMART Release 1.0.0; or 
  • Another authentication and authorization framework that adheres to the QTF requirements is based on out-of-band agreements between exchange partners. 

In the realm of healthcare, accurately managing patient identities across various systems is pivotal. The FHIR at Scale Taskforce (FAST) has developed the Interoperable Digital Identity and Patient Matching implementation guide (FAST Identity IG) to address these challenges effectively. This blog delves into the nuances of this implementation guide and encourages participation in its continuous improvement. 

Exploring the FAST Identity Implementation Guide 

The FAST Identity IG aims to enhance the FHIR patient $match operation for use in cross-organizational workflows. It serves as a comprehensive set of best practices not only for transactions directly invoking $match but also for other healthcare transactions that require robust identity matching and management.

June 26discussion highlights efficiencies, burden reduction and features Blue Cross and Blue Shield Association, Providence and UC Davis Health  

This month’s roundtable focuses on the provider experience, as representatives from an academic health system and a seven-state comprehensive healthcare organization provide firsthand accounts regarding how clinicians and their teams are helping to lead the way with HL7 Da Vinci Project and HL7 Fast Healthcare Interoperability Resources (FHIR®) real-world production implementations of Da Vinci implementation guidesto enable interoperability and advance value-based care.  

Moderated by a representative of the Blue Cross and Blue Shield Association, the discussion unveils how payers’ and providers’ interactions evolve as they collaborate to tackle problems and address current pain points with the healthcare system. The panelists will share considerations, challenges and benefits of working together to establish infrastructure to streamline and automate prior authorization workflows, remove latency, and enable real-time data sharing, ultimately creating win-wins for patients, clinicians, administrators, payers and technologists. 

In May 2024, the FAST Focus webinar, "Secure Health Data Exchange," brought together experts from across the healthcare industry to delve into the intricacies of the HL7 Unified Data Access Profiles (UDAP) Security for Scalable Registration, Authentication, and Authorization Implementation Guide, commonly referred to as the FAST Security IG. This session featured insights on key components and practical implementations of the FAST Security IG. 

Introduction to the FAST Security IG 

The session began with an explanation of the role of FAST in addressing healthcare interoperability challenges. The FAST Security IG aims to create a scalable, secure framework for health data exchange across national networks like TEFCA, Carequality, and CommonWell. 

The Journey to Trustworthy Information Exchange 

A historical perspective on the FAST Security IG highlighted its roots back to 2017. The goal was to leverage existing standards like public key infrastructure (PKI), OpenID Connect, and OAuth 2.0 to ensure a scalable, secure data exchange solution. The FAST Security IG integrates these standards into a cohesive framework, emphasizing the importance of trust in health data transactions. 

Key Components of the FAST Security IG 

The core elements of the FAST Security IG include: 

• JWT-Based Authentication and Authorization: Utilizing JSON Web Tokens for secure assertions of claims from trusted third parties.
• Dynamic Client Registration: Automating client registration using digital certificates to eliminate the need for shared secrets.
• Tiered OAuth: Facilitating patient-facing workflows by directing patients to trusted identity providers for authentication.

This approach ensures that both clients and servers can be securely identified and authenticated, streamlining the registration process, and enhancing trust across the network. 

Real-World Implementations and Insights 

The panel discussion featured firsthand experiences from implementers of the FAST Security IG. The discussion emphasized the collaborative effort in refining the FAST Security IG and the importance of ongoing participation in workgroups to further enhance the specification. 

Open-source solutions to facilitate implementation were highlighted, including a .NET reference implementation and a diagnostic tool called UDAP Ed. These resources help developers visualize and test their implementations, accelerating the adoption of the FAST Security IG. 

The importance of identity assurance was underscored, advocating for a centralized, trusted entity to manage high-security registrations. The FAST Security IG's reliance on well-established standards makes it a robust and scalable solution for the healthcare industry.