This page is part of the Security for Scalable Registration, Authentication, and Authorization (v1.1.0: STU 1 Update) 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

Business-to-Business

This guide supports B2B client applications using either the client credentials or authorization code grant types. The B2B transactions in this guide occur between a requesting organization (the Requestor operating the client application) and a responding organization (the Responder operating the OAuth Server and Resource Server holding the data of interest to the Requestor). In some cases, the Requestor’s client app operates in an automated manner. In other cases, there will also be a local user from the requesting organization (the User interacting with the Requestor’s client application). The client credentials grant type is always used for automated (aka “headless”) client apps. However, when a User is involved, either the client credentials or authorization code grant may be used, as discussed below.

For client credentials flow, any necessary User authentication and authorization is performed by the Requestor as a prerequisite, before the Requestor’s client app interacts with the Responder’s servers, i.e. the Requestor is responsible for ensuring that only its authorized Users access the client app and only make requests allowed by the Requestor. How the Requestor performs this is out of scope for this guide but will typically rely on internal user authentication and access controls.

For authorization code flow, the User is expected to be interacting with the Requestor’s client app in real time, at least during the initial authorization of the client app with the Responder’s OAuth Server. Typically, the User must authenticate to the Responder’s system at the time of initial authorization. If the local user has been issued credentials by the Responder to use for this purpose, the authorization code flow will typically involve use of those credentials. However, it is anticipated that in some workflows, the local user will not have their own credentials on the Responder’s system, but will instead have credentials on their “home” system. In these cases, the UDAP Tiered OAuth workflow is used so that the Responder’s OAuth Server can interact with the Requestor’s OIDC Server in an automated manner to authenticate the User, as described in Section 6.

Thus, this guide provides two different paths (client credentials grants and authorization code grants with Tiered OAuth) that a user affiliated with the Requestor without credentials on the Responder’s system may use to obtain access to data held by the Responder.

B2B client applications registered to use the authorization code grant SHALL obtain an access token for access to FHIR resources by following the OAuth 2.0 authorization code grant flow described in Section 4.1 of RFC 6749, with the additional options and constraints discussed below. 

Client applications registered to use the client credentials grant SHALL obtain an access token for access to FHIR resources by following the OAuth 2.0 client credentials grant flow described in Section 4.4 of RFC 6749, and with the additional options and constraints discussed below. As noted in Section 3, the Requestor is responsible for ensuring that the Requestor’s User, if applicable, is using the app only as authorized by the Requestor.

Obtaining an authorization code

The section does not apply to client applications registered to use the client credentials grant.

The workflow for obtaining an authorization code is summarized in the following diagram:

Client applications registered to use the authorization code grant SHALL request an authorization code as per Section 4.1.1 of RFC 6749, with the following additional constraints. Client applications that also support the SMART App Launch IG are NOT REQUIRED to include a launch scope or launch context requirement scope. Client applications and servers MAY optionally support UDAP Tiered OAuth for User Authentication to allow for cross-organizational or third party user authentication as described in Section 6.

Servers SHALL handle and respond to authorization code requests as per Section 4.1.2 of RFC 6749.

Obtaining an access token

The workflow for obtaining an access token is summarized in the following diagram:

Client applications using the authorization code flow SHALL exchange authorization codes for access tokens as per Section 4.1.3 of RFC 6749, with the following additional options and constraints. Client applications using the client credentials flow do not use authorization codes when requesting an access token.

Constructing Authentication Token

Client apps following this guide will have registered to authenticate using a private key rather than a shared client_secret. Thus, the client SHALL use its private key to sign an Authentication Token as described in this section, and include this JWT in the client_assertion parameter of its token request as described in Section 5.1 of UDAP JWT-Based Client Authentication and detailed further in Section 5.2.2 of this guide.

Authentication Tokens submitted by client apps SHALL conform to the general JWT header requirements above and SHALL include the following parameters in the JWT claims defined in Section 4 of UDAP JWT-Based Client Authentication:

Authentication JWT Claims
iss	required	The application's client_id as assigned by the Authorization Server during the registration process
sub	required	The application's client_id as assigned by the Authorization Server during the registration process
aud	required	The FHIR Authorization Server's token endpoint URL
exp	required	Expiration time integer for this authentication JWT, expressed in seconds since the "Epoch" (1970-01-01T00:00:00Z UTC)
iat	required	Issued time integer for this authentication JWT, expressed in seconds since the "Epoch"
jti	required	A nonce string value that uniquely identifies this authentication JWT. See Section 1.2.4 for additional requirements regarding reuse of values.
extensions	conditional	A JSON object containing one or more extensions. The HL7 B2B Authorization Extension Object defined below is required for B2B client apps using the client_credentials flow; omit for client apps using the authorization_code flow

The maximum lifetime for an Authentication Token SHALL be 5 minutes, i.e. the value of exp minus the value of iat SHALL NOT exceed 300 seconds. The Authorization Server MAY ignore any unrecognized claims in the Authentication Token. The Authentication Token SHALL be signed and serialized using the JSON compact serialization method.

B2B Authorization Extension Object

The B2B Authorization Extension Object is used by client apps following the client_credentials flow to provide additional information regarding the context under the request for data is authorized. The client app constructs a JSON object containing the following keys and values and includes this object in the extensions object of the Authentication JWT as the value associated with the key name hl7-b2b. Servers that support the B2B client credentials flow described in this guide SHALL support this B2B Authorization Extension Object.

B2B Authorization Extension Object Key Name: "hl7-b2b"
version	required	String with fixed value: "1"
subject_name	conditional	String containing the human readable name of the human or non-human requestor; required if known.
subject_id	conditional	String containing a unique identifier for the requestor; required if known for human requestors when the subject_name parameter is present. For US Realm, the value SHALL be the subject's individual National Provider Identifier (NPI); omit for non-human requestors and for requestors who have not been assigned an NPI. See Section 5.2.1.2 below for the preferred format of the identifier value string.
subject_role	conditional	String containing a code identifying the role of the requestor; required if known for human requestors when the subject_name parameter is present. For US Realm, trust communities SHOULD constrain the allowed values and formats, and are encouraged to draw from the National Uniform Claim Committee (NUCC) Provider Taxonomy Code Set, but are not required to do so to be considered conformant. See Section 5.2.1.2 below for the preferred format of the code value string.
organization_name	optional	String containing the human readable name of the organizational requestor. If a subject is named, the organizational requestor is the organization represented by the subject.
organization_id	required	String containing a unique identifier for the organizational requestor. If a subject is named, the organizational requestor is the organization represented by the subject. The identifier SHALL be a Uniform Resource Identifier (URI). Trust communities SHALL define the allowed URI scheme(s). If a URL is used, the issuer SHALL include a URL that is resolvable by the receiving party.
purpose_of_use	required	An array of one or more strings, each containing a code identifying a purpose for which the data is being requested. For US Realm, trust communities SHOULD constrain the allowed values, and are encouraged to draw from the HL7 PurposeOfUse value set, but are not required to do so to be considered conformant. See Section 5.2.1.2 below for the preferred format of each code value string array element.
consent_policy	optional	An array of one or more strings, each containing a URI identifiying a privacy consent directive policy or other policy consistent with the value of the purpose_of_use parameter.
consent_reference	conditional	An array of one or more strings, each containing an absolute URL consistent with a literal reference to a FHIR Consent or DocumentReference resource containing or referencing a privacy consent directive relevant to a purpose identified by the purpose_of_use parameter and the policy or policies identified by the consent_policy parameter. The issuer of this Authorization Extension Object SHALL only include URLs that are resolvable by the receiving party. If a referenced resource does not include the raw document data inline in the resource or as a contained resource, then it SHALL include a URL to the attachment data that is resolvable by the receiving party. Omit if consent_policy is not present.

Preferred format for identifiers and codes

The preferred format to represent an identifier or code as a string value within an authorization extension object is as a Uniform Resource Identifier (URI) as defined in RFC 3986. Trust communities are encouraged to use this preferred format, but are not required to do so to be considered conformant with this guide.

If the identifier or code is itself a URI, then the native representation is preferred. Otherwise, the preferred method to construct a URI is as follows:

For identifiers, concatenate a URI identifying the namespace, the ‘#’ character, and the unique identifier assigned within the namespace.

For codes, concatenate a URI identifying the code system, the ‘#’ character, and a code taken from the code system.

For example, the U.S. NPI number 1234567890 can be represented as urn:oid:2.16.840.1.113883.4.6#1234567890 and the purpose of use treatment can be represented as urn:oid:2.16.840.1.113883.5.8#TREAT.

Submitting a token request

Authorization code grant

Client applications using the authorization code grant and authenticating with a private key and Authentication Token as per Section 5.2.1 SHALL submit a POST request to the Authorization Server’s token endpoint containing the following parameters as per Section 5.1 of UDAP JWT-Based Client Authentication. Client apps authenticating in this manner SHALL NOT include an HTTP Authorization header or client secret in its token endpoint request. The token request SHALL include the following parameters:

Token request parameters
grant_type	required	Fixed value: authorization_code
code	required	The code that the app received from the Authorization Server
redirect_uri	conditional	The client application's redirection URI. This parameter SHALL be present only if the redirect_uri parameter was included in the authorization request in Section 5.1, and their values SHALL be identical.
client_assertion_type	required	Fixed value: urn:ietf:params:oauth:client-assertion-type:jwt-bearer
client_assertion	required	The signed Authentication Token JWT
udap	required	Fixed value: 1

Client credentials grant

Client applications using the client credentials grant and authenticating with a private key and Authentication Token as per Section 5.2.1 SHALL submit a POST request to the Authorization Server’s token endpoint containing the following parameters as per Section 5.2 of UDAP JWT-Based Client Authentication. Client apps authenticating in this manner SHALL NOT include an HTTP Authorization header or client secret in its token endpoint request. The token request SHALL include the following parameters:

Token request parameters
grant_type	required	Fixed value: client_credentials
client_assertion_type	required	Fixed value: urn:ietf:params:oauth:client-assertion-type:jwt-bearer
client_assertion	required	The signed Authentication Token JWT
udap	required	Fixed value: 1

An Authorization Server receiving token requests containing Authentication Tokens as above SHALL validate and respond to the request as per Sections 6 and 7 of UDAP JWT-Based Client Authentication.

For all successful token requests, the Authorization Server SHALL issue access tokens with a lifetime no longer than 60 minutes.

Refresh tokens

This guide supports the use of refresh tokens, as described in Section 1.5 of RFC 6749. Authorization Servers MAY issue refresh tokens to B2B client applications that use the authorization code grant type as per Section 5 of RFC 6749. Refresh tokens are not used with the client credentials grant type. Client apps that have been issued refresh tokens MAY make refresh requests to the token endpoint as per Section 6 of RFC 6749. Client apps authenticate to the Authorization Server for refresh requests by constructing and including an Authentication Token in the same manner as for initial token requests.