Add RESTful Query and Feed to ATNA

Add RESTful ATNA (Query and Feed)

Introduction

Event logging is a system facility that is used by healthcare applications and other applications. This supplement updates the Audit Trail and Node Authentication (ATNA) Profile. ATNA defines a standardized way to create and send audit records; however, it does not identify a standardized way to retrieve audit records collected by an Audit Record Repository. This supplement extends the functionalities of ATNA profile introducing RESTful operations that could be used to submit and to retrieve audit records. This allows light weight applications to easily manage the creation and the access audit information. This supplement is based on FHIR protocol and uses FHIR AuditEvent Resources in order to exchange audit records content. This supplement also defines a query transaction that enables access to raw syslog messages. This profile defines a new actor, the Audit Consumer, two new transactions and two new message interactions for the Record Audit Event [ITI-20] transaction:

1. The Retrieve ATNA Audit Event [ITI-81] transaction allows an Audit Consumer to retrieve ATNA Audit Events stored within a target Audit Record Repository. This transaction is based on a FHIR RESTful search operation on AuditEvent resources.
2. The Retrieve Syslog Event [ITI-82] transaction allows an Audit Consumer to search syslog messages stored in an Audit Record Repository. This transaction is defined as a RESTful operation. The search parameters are based on syslog metadata.
3. Reord Audit Event ITI-20 - Send Audit Resource interaction allows a Secure Node, Secure Application or Record Audit Forwarder to feed a single AuditEvent Resource to an Audit Record Repository.
4. Reord Audit Event ITI-20 - Send Audit Bundle interaction allows a Secure Node, Secure Application or Record Audit Forwarder to feed a Bundle of AuditEvent Resources to an Audit Record Repository.

Note:ATNA Audit Events are syslog events, so the Retrieve Syslog Event [ITI-82] transaction enables search of ATNA events based on syslog metadata values.

Actors and Transactions

Actors

Audit Record Repository

The Audit Record Repository receives event audit reports and stores them. It may be part of a federated network of repositories. It is expected to have analysis and reporting capabilities, but those capabilities are not specified as part of this profile. This profile does not specify the capacity of an Audit Record Repository, because the variety of deployment needs makes it impractical to set requirements for the event report volume or capacity needed. The Audit Repository shall support:

1. At least one of the audit transport mechanisms specified in ITI TF-2a: 3.20.
2. Receipt of at least one of the IHE-specified audit message formats. Note that the message format is extensible to include both future IHE specifications (e.g., audit requirements for new IHE transactions) and private extensions.
3. Local security and privacy service protections and user access controls.

Optionally the Audit Record Repository supports search capabilities as defined in ITI TF2c: 3.81 and ITI TF-2c: 3.82.

Audit Consumer

The Audit Consumer queries an Audit Record Repository for syslog and ATNA audit records using Syslog metadata and ATNA audit record content. Subsequent processing of the query result is not defined in this profile.

Transactions

Retrieve ATNA Audit Event [ITI-81]

This transaction supports the retrieval of ATNA audit record from the Audit Record Repository in accordance with a set of search parameters that determine the retrieved event reports. This transaction enables an Audit Consumer to search audit events that an Audit Record Repository created via the Record Audit Event [ITI-20] transaction. This transaction is a profiling of a standard FHIR search of the AuditEvent resource.

Retrieve Syslog Event [ITI-82]

This transaction supports the retrieval of syslog messages from the Audit Record Repository subject to parameters that limit the retrieval.

Record Audit Evnet [ITI-20] - Send Audit Resource interaction

This interaction supports the feed of an AuditEvent Resource to an Audit Record Repository. This interaction is a profiled as a standard FHIR create.

Record Audit Evnet [ITI-20] - Send Audit Bundle interaction

This interaction supports the feed of a Bundle of AuditEvent Resources to an Audit Record Repository. This interaction is a profiled as a standard FHIR transaction.

Use-Case of Reference: Patient access to his audit records process flow

During a hospitalization, Mr. Brown was asked to sign a consent to share documents produced during that clinical event with a research facility, so that researchers could analyze the efficiency of the applied treatment. Mr. Brown does not provide this consent because he is worried that his data could be used for marketing purposes. A nurse collects the patient’s consent document, but forgets to record his decision in the HIS system. Access to all the data collected during Mr. Brown’s hospitalization by clinicians involved in his care are tracked as “Export” or “Disclosure events for a “Treatment” purpose. An access to the data by the research facility would be tracked as “Export” or “Disclosure” events for a “Research” purpose. Mr. Brown’s healthcare facility provides on-line access to health information. Mr. Brown can use a web app to access this data (shared using XDS or XCA infrastructure). The web app can also display audit information related to those documents/studies. Audit records are collected by many ATNA Audit Record Repositories, but local policies or system configurations allows the web app to identify the right Audit Record Repository system that stores relevant records. Using the document and study identifiers, the web app can query the appropriate ATNA Audit Record Repository. The web app reports to Mr. Brown that his documents/studies had been disclosed or exported for both treatment and research purposes.

Process flow

Specification

Profile Status: Trial Implementation

Documents: Add RESTful ATNA (Query and Feed) Supplement

Additional Supplements: Appendix Z on HL7 FHIR

Underlying Standards: Audit Trail and Node Authentication

• HL7 FHIR HL7 FHIR standard R4 http://hl7.org/fhir/R4/index.html
  • OperationOutcome
  • Bundle
  • AuditEvent
• RFC2616 Hypertext Transfer Protocol – HTTP/1.1
• RFC4627 The application/json Media Type for JavaScript Object Notation (JSON)
• RFC3986 Uniform Resource Identifier (URI): Generic Syntax
• RFC3339 Date and Time on the Internet: Timestamps
• RFC6585 Additional HTTP Status Codes
• RFC5424 The Syslog Protocol

FHIR Implementation Guide

Informatively this profile is also as a set of FHIR conformance resources, that are also registered at https://registry.fhir.org

The conformance resources are available on the Implementation Material folder.