The Standard

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. 

March 2024 marked a pivotal moment for the healthcare IT sector, with the FHIR at Scale Taskforce (FAST) community survey revealing critical insights into the adoption, challenges, and perspectives surrounding various FAST implementation guides (IGs). This survey, engaging various stakeholders from providers to technology vendors, sheds light on the collective journey towards seamless healthcare interoperability. Let's dive into the nuanced feedback and the path it carves for the future of healthcare IT. 

Survey Results Overview 

FAST Security IG Adoption and the Quest for Clarity   

The uptake of the HL7 FAST UDAP Security for Scalable Registration, Authentication, and Authorization Implementation Guide (FAST Security IG) is on the rise, driven by an evident market need.  A notable proportion of respondents are keen to implement the HL7 FAST Security IG, likely due to its inclusion in the TEFCA FHIR Roadmap. There were some concerns expressed about market readiness. However, respondents expressed a need for clearer guidance beyond the existing FAST Security IG, suggesting the development of a companion document to aid in implementation strategies would be helpful. 

FAST Identity IG: Overcoming Adoption Barriers   

While there seems to be adoption readiness for the Interoperable Digital Identity and Patient Matching IG, the survey highlights perceived barriers to adoption. These barriers were related to industry issues such as cross-jurisdiction consent and broader market acceptance and adoption by other industry initiatives rather than any issues with the IG itself. 

The HL7 FHIR at Scale Taskforce (FAST) UDAP Security for Scalable Registration, Authentication and Authorization Implementation Guide (FAST Security IG) was designed to streamline and secure data exchange across different healthcare stakeholders. This blog post seeks to dispel common misconceptions about the complexity of implementing the FAST Security IG. 

Journeying Through Industry Waters: FAST's Impactful Presence at Recent Events

As the dust settles from the whirlwind of activity over the past several weeks in the healthcare industry, marked by prominent events such as ViVE and HIMSS24, it'sevident that innovation and collaboration are at the forefront of progress. Amidst this bustling landscape, the FHIR at Scale Taskforce (FAST) has not only made its presence felt but has also unveiled new initiatives, including the launch of the FAST Focus webinar series and the initiation of public meetings for its scalable Consent project. This blog is a brief highlight of all the most recent excitement and includes helpful links for your reference. 

Introducing FAST Focus: A Quarterly Glimpse into FHIR Infrastructure 

Launching the inaugural FAST Focus webinar marked a significant milestone, offering a quarterly rendezvous for the FHIR and interoperability communities. This platform serves as a vital conduit for keeping stakeholders abreast of FAST's endeavors in bolstering FHIR infrastructure. Past sessions' recordings and decks are readily available on the FAST calendar page in the archive section, providing a wealth of insights for eager participants. 

HIMSS24: Spotlight on FAST's Participation 

FAST had a presence at HIMSS24 and was thrilled to interact with so many attendees, from the FHIR curious to seasoned FHIR implementers curious, to learn more about FAST’s work. FAST provided volunteer FAST representatives to staff the HL7 Accelerator kiosk in the interoperability showcase. The kiosk buzzed with activity and insightful interactions. FAST also left an indelible mark with multiple presentations at the Spotlight Theater and the HL7 booth, amplifying awareness and fostering dialogue around FHIR infrastructure work. 

Communities Advancing FHIR and Healthcare Interoperability Formalize Joint Efforts for the Public Good

HL7 and The Sequoia Project, a non-profit and trusted advocate for nationwide health information technology (health IT) interoperability, are pleased to announce a strategic collaboration to advance global health data interoperability by accelerating the adoption of the HL7 Fast Healthcare Interoperability Resources (FHIR®) standards in the U.S.

“We are thrilled to announce this alliance with HL7,” said Mariann Yeager, CEO of The Sequoia Project. “We look forward to working with HL7, alongside private and public sector subject matter experts, to advance nationwide FHIR implementation to improve interoperability nationwide.”

 HL7 and The Sequoia Project will work together to accelerate the HL7 Fast Healthcare Interoperability Resources (FHIR®) standard through coordinating with the work of FHIR at Scale Taskforce HL7 FHIR^® Accelerator (FAST).

Through this strategic relationship, HL7 and The Sequoia Project aim to continue working together in areas of mutual interest, including standards deployment and adoption, alignment between HL7 FHIR Accelerator projects and Sequoia initiatives, and creating a feedback loop to HL7 based on lessons learned from real-world production-level exchange initiatives, education, and testing. 

“At HL7, we are delighted to continue the journey toward meaningful interoperability with The Sequoia Project,” said Charles Jaffe, M.D., Ph.D., HL7 CEO. “Close collaboration is certain speed to market health IT interoperability improvements to reduce the strain on health systems, diminish clinician burden, and improve the lives of our patients.” 

Mark Your Calendar: Inaugural FAST Focus Webinar on FHIR Infrastructure Work 

Greetings, all interested in advancing healthcare through smart technology and robust infrastructure! We are thrilled to announce the launch of the FAST Focus, a quarterly webinar series that aims to keep you informed about and engaged with the work of FHIR at Scale Taskforce (FAST). You are invited to join us for the inaugural FAST Focus webinar on March 7, 2024, from 4 PM to 5 PM ET!  

Event Details

• Date and Time: March 7, 2024, 4 PM-5 PM ET 

 Speakers: 

• Alex Kontur, Public Health Analyst, Office of the National Coordinator (ONC)
• Duncan Weatherston, CEO of Smile Digital Health and Co-Chair of FAST
• David Pyke, Technical Director, FAST

 Moderator: Alix Goss, Senior Consultant, Point-of-Care Partners

The first FAST Focus Webinar will provide a deep dive into FAST's history, its pivotal role in crafting a framework for scalable FHIR infrastructure, and its current community focus. This event is not just about history; it's a glimpse into the future of health IT, revealing key projects that FAST has in the pipeline and providing a roadmap for how you can actively engage with our work. As an interactive session, we'll reserve time for a Q&A at the end to address your burning queries. Registrants will have the opportunity to submit questions when registering.  

In a recent episode of HIMSSTV, two healthcare interoperability visionaries, Deepak Sadagopan and Duncan Weatherston, took the virtual stage to share their expert insights on the critical FHIR pathway within the Trusted Exchange Framework and Common Agreement (TEFCA) model. This captivating discussion was led by the co-chairs of the HL7 FHIR at Scale Taskforce (FAST), and it shed light on the transformative potential of FHIR in shaping the future of healthcare data exchange. 

Meet the FAST Community 

Before we dive into the interview, let's take a moment to acquaint ourselves with the remarkable work being done by the FAST community. The HL7 FHIR at Scale Taskforce is a dedicated group committed to identifying scalability challenges and defining solutions to overcome the barriers to broad FHIR adoption. FAST is addressing key areas like Security for Scalable Registration, Authorization, and Authentication and Interoperable Digital Identity and Patient Matching. The FAST community’s list of projects can be found on the FAST Confluence Project Page. An upcoming project on Consent is set to kick off soon, promising exciting prospects for healthcare data sharing. To get involved, reach out to fast@hl7.org. 

On behalf of the HL7 US Realm Steering Committee (USRSC), we are pleased to share an update on last year's priorities and highlight our focus for 2022.

2021 Highlights

Visibility was a key theme of our work in 2021 and included supporting pilot work on a standards dashboard, tracking accelerator activity and promoting key ballots.

Before we dive into 2022, we want to highlight a few key points for all US Realm (USR) members.

• SMART v2: published new guidance on granular controls
• Bulk Data v2: published with numerous new features 
• Errata release of Consolidated CDA (C-CDA): companion guide to support January 2022 ballot  
• C-CDA Companion Guide: January 2022 ballot to add USCDI v2 guidance
• US FHIR Core - January 2022 ballot: to add USCDI v2 guidance
• Hosted reviews on HL7 Standards Dashboard Prototype
• C-CDA Web Publishing Trial Draft using FHIR Structure Definition
• Facilitated US@ project with ONC team

Recap of the August Da Vinci Project Community Roundtable on DRLS and FAST

As the HL7 Da Vinci Project continues to make rapid progress in developing use cases to enable the exchange of healthcare information, work has been underway to test and widely deploy these cases among industry players.

Efforts led by federal agencies have been in motion to use solutions based on HL7’s Fast Healthcare Interoperability Resources (FHIR®) standard at scale, as well as to incorporate FHIR use cases in a federal initiative that developed and tested a prototype to demonstrate the capability to streamline clinical workflow access to coverage requirements.

Presenters at a Da Vinci Project community roundtable on August 26 said the initiatives are important in bringing the benefits of automated information exchange throughout the healthcare industry, while taking steps to reduce the burden on providers.

The FAST Initiative
In one initiative, the Office of the National Coordinator for Health Information Technology (ONC) is convening a FHIR at Scale Taskforce (FAST) that brings together a representative group of motivated healthcare industry stakeholders. FAST aims to take use cases that are being demonstrated in initial efforts between partners in the industry and ensure that they can operate more broadly.

“In building solutions for FHIR for interoperability, we realize that individual solutions are being developed to work between one endpoint and another,” said Stephen Konya, senior advisor to ONC and the Department of Health and Human Services. “When we start to roll these out at scale – when there’s a large number of payers sharing a large amount of data with a large number of providers – the game changes.”