The Standard

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. 

Industry invited to join and participate in the HL7 Da Vinci Project’s newest use case conference calls

Retrieving a duplicate of remittance advice that was previously issued by a payer is a headache-inducing manual process that can involve the use of web portals, phone calls, faxes and emails.

But implementing an HL7 Fast Healthcare Interoperability Resources (FHIR®) Application Programming Interface (API) could change all that.

The HL7 Da Vinci Project has launched a Postable Remittance Advice Use Case with the goal of publishing an implementation guide (IG) for such an API next year. The API will support the request for a duplicate copy of previously issued remittance advice – paper or electronic – in real time to allow efficient, timely and accurate posting of payments.

Remittance advice is a document that healthcare providers receive from insurance companies after submitting a claim. It provides information on the payment status of the claim, including the amount paid, the patient's responsibility and the reason for any denials or adjustments. The purpose of the remittance advice is to inform the healthcare provider of the remittance details and to allow them to reconcile their accounts and ensure that the payment is accurate.

May 29 Sessionfeatures athenahealth, Availity and Humana and honors HL7 Da Vinci Project Community Champions from 4:00 - 5:30 pm ET

Join us this month to hear real-world HL7 FHIR and Da Vinci implementation stories that will provide you with inspiration and insight into how you can apply the learnings of athenahealth, Availity and Humana to your organization’s efforts to reduce friction, increase efficiency and meet the federal interoperability rules. 

After recognizing the 2023 HL7 Da Vinci Project Community Champions, representatives of Availity and Humana will provide a current snapshot of Da Vinci’s effort to create a nationwide interoperable approach among payers using the Payer Data Exchange (PDex) Implementation Guide, which enables payers to create a member’s health history using clinical resources which can be understood by providers and electronic medical records (EMR) systems. This discussion provides an opportunity to better understand dynamics you’ll encounter in achieving payer-to-payer exchange compliance such as consent and endpoint discovery.  Attendees will gain a foundational understanding of the new regulatory requirements, learn about technical and business challenges and benefits from real-world implementers and gain insight into how industry is working together. 

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. 

HL7 applauds the U.S. Department of Health and Human Services’ (HHS) Office of the National Coordinator for Health Information Technology (ONC) for its April 22, 2024 Common Agreement Version 2.0 release, which announced the requirement for health information networks participating in the Trusted Exchange Framework and Common Agreement (TEFCA) to support the HL7 Fast Healthcare Interoperability Resources (FHIR^®) standard.