CH EPR FHIR (R4)
4.0.1 - trial-use
CH EPR FHIR (R4)
4.0.1 - trial-use
This page is part of the CH EPR FHIR (R4) (v4.0.1: DSTU 4) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
This section specifies Swiss national extensions to Internet User Authorization (IUA) Profile, which is published as an IHE ITI Trial Implementation profile.
This profile provides means to retrieve EPR compliant access token and to incorporate the access token to transactions to authorize client applications when accessing protected resources.
This profile is based on the IUA Trial Implementation and adds certain restrictions to be compliant to the ordinances of the Swiss EPR.
The scope of this national extension is limited to provide FHIR based interfaces for primary systems and portals connected to the Swiss EPR. This national extension is currently not scoped for native mobile clients. This profile therefore adds the following restrictions to the IUA Trial Implementation:
For further restrictions on transactions and security consideration, see below.
A patient uses a portal which is integrated to the Swiss EPR using the profiles to access and share data and documents with healthcare professionals. To access documents from the EPR the patient authenticates at a certified Identity Provider and the portal connects to the IUA Authorization Server and sends the required claims to access the EPR.
The IUA Authorization Server verifies if the portal is authorized to access the EPR on behalf of the patient by checking that the portal is registered as a portal of the community.
The IUA Authorization Server verifies that the patient has a valid session at the Identity Provider and retrieves the Identity Assertion from the Identity Provider. The Authorization Server validates the claims together with the data from the Identity Assertion and resolves additional information required to access the EPR (e.g., resolve the digital identity to the EPR-SPID).
The IUA Authorization Server responds an IUA Authorization Token the portal shall incorporate to any transaction to retrieve the data and documents from the patients EPR.
A healthcare professional uses a primary system which is integrated to the Swiss EPR using the profiles to access and share data and documents with her patients or other healthcare professionals. To access documents from the EPR the healthcare professional authenticates in her primary system, selects the patient and switches to the user interface to display the patients documents and the primary system connects to the IUA Authorization Server and sends the required claims to access the patients EPR.
The IUA Authorization Server verifies if the primary system is authorized to access the EPR on behalf of the user by checking that the primary system has been registered during the onboarding process of the primary system.
The IUA Authorization Server verifies that the healthcare professional has a valid session at the Identity Provider and retrieves the Identity Assertion from the Identity Provider. The Authorization Server validates the claims together with the data from the Identity Assertion and resolves additional information required to access the EPR (e.g., resolve the relations to institutions or other groups).
The IUA Authorization Server responds an IUA Authorization Token the primary system shall incorporate to any transaction to retrieve the data and documents from the patients EPR.
A patient or healthcare professional uses a portal or primary system which uses SMART on FHIR Apps to connect to the Swiss EPR.
The patient or healthcare professional authenticates in the portal or primary system and launches the SMART on FHIR App from the portal or primary system. The portal or primary system first builds a SMART on FHIR launch context with the patient context and identifiers of the portal or primary system application and launches the SMART on FHIR App with the launch context.
The IUA Authorization Server verifies that the portal or primary system is authorized to launch SMART on FHIR Apps which connect to the EPR on behalf of the user by checking that the portal or primary system has been registered beforehand during the onboarding process of the portal or primary system application.
The IUA Authorization Server verifies that the patient or healthcare professional has a valid session at the Identity Provider and retrieves the Identity Assertion from the Identity Provider. The Authorization Server validates the claims together with the data from the Identity Assertion and resolves additional information the SMART on FHIR App requires to access the EPR (e.g., resolve the digital identity to the EPR-SPID).
The IUA Authorization Server responds an IUA Authorization Token the SMART on FHIR App shall incorporate to any transaction to retrieve the data and documents from the patients EPR.
A healthcare professional uses a primary system which stores documents in a clinical archive system. The clinical archive system uses specific algorithms to decide which documents shall be stored in the Swiss EPR of the patient.
The healthcare professional reports medical information of a treatment in her primary system. The primary system creates a structured or unstructured document from the data and stores them in the clinical archive system. The clinical archive system decides whether the document shall be stored in the patients EHR using the policies defined in the clinic.
To access the patient EHR the clinical archive system first request a basic authorization token using the client credential flow and uses the basic authorization token in the PIXm or PDQm transactions used to retrieve the EHR-SPID and the XAD PID of the patient.
The Authorization server returns the basic access token if the clincial archive systems is reqistered beforehand and is authorized to access the Swiss EHR.
The clinical archive system then requests a extended authorization token to be used with the MHD transaction to store the document in the patients EHR.
This national extension enhance the requirements on transactions and the expected actions of the Actors of the IUA Trial Implementation to comply to the legal requirements of the Swiss EPR.
The scope of this national extension is limited to portals and primary systems to comply with ordinances of the Swiss EPR. This national extension is currently not scoped for native mobile clients. Therefore the Client Authorization by User Consent method SHALL NOT be supported.
Portals and primary systems SHALL be identified and authorized either on the TLS connection level or by digital signatures of the messages exchanged, or both. See section Expected Actions of the Get Access Token transaction for further details.
This figure shows the actors directly involved in the Internet User Authorization Profile and the relevant transactions between them.
This national extension restricts the Actor options of the IUA Trial Implementation to comply to the legal requirements of the Swiss EPR.
The IUA Trial Implementation supports three options for the Authorization Token format; the JWT Token, the SAML Token and the Token Introspection option. Since this national extension will apply to cross community communication, the Token Introspection Option SHALL NOT be used.
This national extension intends to simplify and modernize the technologies used to connect to the Swiss EPR. The legacy SAML Token option SHALL NOT be used. To support automated client configuration the Authorization Server actor SHALL support the Authorization Metadata option.
The Swiss national extension does not define requirements on the grouping of actors in this profile, which extend or restrict the grouping required from the IUA profile.
For the process flow of this profile and its interplay with the other profiles see sequence diagrams.
This national extension enforces client authentication of the TLS network layer with X.509 client certificates. The TLS client certificate shall be used together with the OAuth 2 client ID to identify the client when granting access to the EPR. The client certificates shall match the requirements of EPRO-FDHA, Annex 2, Section 4.15.3b.
Communities shall verify and register the combination of the OAuth client ID, the URLs and the client certificate during the onboarding process.
Communities shall verify the combination of the OAuth client ID, the URLs and the client certificate of all requests against the registered values and shall reject requests in case of mismatch.
The Swiss national extension does not define further additional security requirements beyond those specified in the underlying IUA Trial Implementation.