FAST Releases Implementation Guides for HL7 FHIR Health Data Exchange

The FHIR at Scale Taskforce (FAST) has published its first two implementation guides (IGs) for health data exchange as an HL7 FHIR Accelerator.

FAST, which transitioned from an ONC initiative to an HL7 FHIR Accelerator in early 2022, works with the HL7 FHIR community to support the development of infrastructure for Fast Healthcare Interoperability Resources (FHIR) solutions.

“FAST is proud to be a part of the vibrant FHIR ecosystem to support the development and implementation of much-needed data standards,” Duncan Weatherston, CEO of Smile Digital Health and co-chair of FAST’s Steering Committee, said in a press release.

“Our role is to identify and foster common scalability approaches to support the real-world use cases for HL7 FHIR across multiple domains,” Weatherston said. “We are thrilled to further the work of our colleagues and publish these initial IGs around security and intermediary data exchange.”

The first IG, “Scalable Security for Registration, Authentication, and Authorization (STU 1),” describes how to extend OAuth 2.0 using Unified Data Access Profiles (UDAP) workflows for consumer-facing apps that implement the authorization code flow.

It also covers how to extend OAuth 2.0 using UDAP workflows for as business-to-business (B2B) apps that implement the client credentials flow or authorization code flow.

The second guide, “Hybrid/Intermediary Exchange (STU 1),” addresses the process of integrating intermediary entities, such as clearinghouses and health information exchanges (HIEs), into the HL7 FHIR-enabled data exchange environment.  

This guide also provides guidance for enabling HL7 FHIR REST interactions across one or more intermediaries using a passive approach, in which the intermediary acts as a “pass-through,” and the requesting actor is not necessarily aware that the request will go through an intermediary entity such as an HIE.

Potential applications of this initial IG include the Da Vinci value-based care use case, in which intermediaries may bridge connectivity between stakeholders. Other HL7 FHIR accelerators (CARIN, Gravity, etc.) are working to develop use cases that may include intermediaries.

In addition to the newly published documents, FAST has contributed to three CMS-supported guides describing technical architecture considerations for a national healthcare directory.  

These guides address challenges, including the exchange, query, and attestation and verification of data elements required for a centralized, validated directory.

CMS also recently released an RFI to collect feedback from the industry on the best approach to developing such a system. FAST officials said they will lead a coordinated team to develop a response to this RFI. 

“We are pleased to see federal agencies like CMS and ONC joining the rest of the industry in taking a keen interest in HL7 FHIR and its possibilities,” said Deepak Sadagopan, FAST Steering Committee co-chair. “It is critical to incorporate all viewpoints and convene as many stakeholders as possible to inform development of the needed infrastructure for FHIR to be scalable and have a real impact in patient care.”