Solution Description

The FAST Identity Tiger Team defined a spectrum of solution options ranging from lower complexity and less scalable to higher complexity and more scalable, with the understanding that different stakeholders have different technical and operational needs and capacities.  These options are meant to offer flexibility while also solving key barriers to consistent and accurate patient matching and identity management.

Collaborative Patient Matching relies on use of common or agreed upon patient identifiers known to both requesting and responding entities. This solution pattern closely mimics how certain entities across the industry match patient records today, enhanced with recommendations and best practices to help ensure the success of any implementation that allows this pattern.

This solution applies to scenarios where two parties have agreed to use a common identifier or mutually known identifiers. The FAST Identity team recommendations and best practices may  be applied to address gaps that currently exist within this type of exchange.

The Requestor Actor and Responder Actors can be either a provider or a payer as the solution applies to provider to provider, provider to payer, and payer to payer transactions.

The patient’s identity in this scenario is established by the Requester and Responder Actors as part of their onboarding process that includes appropriate attribute validation. One of the reasons why collaborative approaches are not scalable is because it becomes impossible to share and manage ever-changing patients lists beyond a 1:1 or 1:few exchange relationship.   

Mediated Patient Matching represents both an incremental advancement from collaborative patient matching along the technical complexity and maturity pathway, as well as a point of entry along the pathway for those systems with the operational and technical capacity to begin efforts toward a long-term strategy to support accurate matching and digital identity. Mediated patient matching goes one step further from common approaches to suggest a matching service using demographic data at the time of each request. This service would be FAST best practices compliant and would match patients for end users at the point of exchange.

This solution covers patient matching in near real time, leveraging  FHIR transactions to and from the matching service. The Requestor and Responder Actor pairs may be represented by provider/provider, provider/payer, and payer/payer exchange scenarios. When two entities exchange data, the requestor is responsible for sending the minimum required patient demographic data to be used for matching, and the responder is accountable for matching identities of the patient(s) involved using the matching service.

Networked Identity Management is a leap in technology requirements. It still builds on Mediated Patient Matching concepts, but recommends moving from relying entirely on demographics-based matching to a digital identity model. This solution would use a network of trusted OpenID Connect providers, similar to the identifiers within the patient application access models within Cures Update and CMS rules the industry is in the process of deploying today.

In the scope of this solution parties would rely on the OpenID Connect provider’s digital certificate and an OpenID identifier assigned to each user - as part of an onboarding process that includes identity proofing and establishes their real-world identity and the validity of demographics made available for patient or provider matching. In this scenario responders would validate the trustworthiness of the associated identity provider via its digital certificate and use the recorded patient or provider OpenID identifier and other verified user profile data to match on the identifier or (if the identifier is not yet known in their system) fall back to a demographics-based matching process or other interrogation of the OpenID provider or the holder of the identifier.

Distributed Identity Management is a solution that would give the patient the responsibility and complete control of their identity and assignment of permissions for entities to access their health information. Trusted third-party identity services would assign and manage patient identities and associated identifiers. During a patient information request, the requester relies on the identity service to validate identity claims made by the patient or requester, for use by the responder in making its authentication or authorization decision. The solution also positions the industry to explore the concept of multiple digital identities with different verifiable claims for the same patient for potential use as consent profiles.  The mechanisms for digital identity management are still being defined by the industry and processes for using them in a privacy-preserving, trusted/federated and secure health care context are only just emerging.

These four solutions allow for incremental improvements in patient matching and identity management as technology matures and adoption increases.

Read FAST Technical Barriers for more information on the barriers being addressed by this solution. 

Solution Status

February 22, 2021

Finalizing Solution Path Forward

  • Socializing recommended solutions with HL7 and considering overlap with other industry initiatives
May 5, 2021

Initiating an implementation guide development project with HL7

  • HL7 Project Proposal has been accepted by Patient Administration as the sponsoring workgroup
June 10, 2021
  • Project Scope Statement has been approved by Patient Administration as the sponsoring workgroup
  • May Connectathon testing complete
  • Planning to participate in CMS Connectathon in July 2021
August 2, 2021
  • Project Scope Statement has final approval from the HL7 FHIR Management Workgroup and the Technical Steering Committee
  • CMS July Connectathon testing is complete
  • Planning to participate in the September HL7 Connectathon
  • The FAST Identity team met with the VCI team to gain a better understanding of their work to inform FAST efforts. The group identified a need for an ongoing forum where implementers can continue to collaborate across efforts.

Get Involved!

Implementation Guide development will take place through the HL7 Patient Administration Workgroup

Join us to test during the September HL7 Connectathon!  For more details, check out the HL7 September Connectathon track page:  2021-09 ONC FAST Security & Identity

Solution Roadmap

Oct2020 Nov Dec Jan2021 Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan2022 Feb Mar May 2021 FHIR Connectathon Sept 2021 FHIR Connectathon HL7 Sept 2021 Ballot Cycle HL7 Jan 2022 Ballot Cycle
FAST Solution Documentation
HL7 FHIR Connectathon
IG Development and Balloting
Build Asset

Complete V3 Solution Document

Prepare for May 2021 Connectathon

Prepare for Sept 2021 Connectathon

Interoperable Digital Identity & Patient Matching Implementation Guide Development

Jan STU Ballot Cycle

Ballot Reconciliation

Reference Implementation Build TBD

Testing/Implementation Artifacts

Pilot Toolkit:

  • Coming in Q2/Q3 2021


  • Coming in Q2/Q3 2021

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