This page is part of the CARIN Digital Insurance Card (v1.1.0: STU1) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions

General Guidance

Actors

The following actors are part of the CARIN IG for Digital Insurance Card:

• CARIN IG for Digital Insurance Requestor or Consumer App: An application that initiates a data access request to retrieve patient data. This can be thought of as the client in a client-server interaction.
• CARIN IG for Digital Insurance Responder or Health Plan API: A product that responds to the data access request providing patient data. This can be thought of as the server in a client-server interaction.

Conformance Verbs

The conformance verbs - SHALL, SHOULD, MAY - used in this guide are defined in FHIR Conformance Rules.

Must Support

For profiles defined in other IGs, the meaning of Must Support is established in the defining IG. Note that the Must Support requirements for this IG are modeled after the US Core implementation guide. The requirements for Health Plan API actors are modeled on those for US Core Responders, and the requirements for Consumer App actors is modeled on those for US Core Requestors. When querying and reading CARIN IG for Digital Insurance Card Profiles, Must Support on any profile data element SHALL be interpreted as follows:

Health Plan API actors SHALL be capable of populating all data elements as part of the query results as specified by the CARIN for Digital Insurance Card CapabilityStatement.

Consumer App actors SHALL be capable of processing resource instances containing the data elements without generating an error or causing the application to fail.

Consumer App actors SHALL be capable of displaying the data elements for human use.

In situations where information on a particular data element is not present and the reason for absence is unknown, Health Plan API actors SHALL NOT include the data elements in the resource instance returned as part of the query results.

In situations where information on a particular data element is missing and the Health Plan API actor knows the precise reason for the absence of data, Health Plan API actors SHALL send the reason for the missing information using either the nullFlavors or dataAbsentReason extensions.

When querying Health Plan APIs, Consumer App actors SHALL interpret missing data elements within resource instances as data not present in the Health Plan API actor's system. Consumer App actors SHALL be able to process resource instances with missing data without generating an error or causing the application to fail for the user. Consumer App actors SHOULD configure their applications to translate nullFalvors and dataAbsentReason extensions into a user-friendly message indicating the data has not been provided by the Health Plan API actor.

NOTE: Readers are advised to understand FHIR Terminology requirements, FHIR RESTful API based on the HTTP protocol, along with FHIR Data Types, FHIR Search and FHIR Resource formats before implementing CARIN IG for Digital Insurance Card requirements.

Missing Data

If the source system does not have data for a Must Support data element with minimum cardinality = 0, the data element is omitted from the resource. If the source system does not have data for a required data element (in other words, where the minimum cardinality is > 0), follow guidance defined in the core FHIR specification and summarized in the US Core.

Conformance to US Core Profiles

Any Health Plan API actor in this IG SHALL:

• Be able to populate all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profiles StructureDefinition.
• Conform to the US Core Server Capability Statement expectations for that profile’s type.

Any Consumer App actor in this IG SHALL:

• Be able to process and retain all profile data elements that have a minimum cardinality >= 1 and/or flagged as Must Support as defined by that profiles StructureDefinition.
• Conform to the US Core Client Capability Statement expectations for that profiles type.

U.S. Core Data for Interoperability and 2015 Edition Common Clinical Data Set

The US Core Profiles were originally designed to meet the 2015 Edition certification criterion for Patient Selection 170.315(g)(7), and Application Access - Data Category Request 170.315(g)(8). They were created for each item in the 2015 Edition Common Clinical Data Set (CCDS). The 3.1.0 version of the US Core Profiles IG includes new requirements from the latest proposed ONC U.S. Core Data for Interoperability(USCDI) .

A Payer, to provide members with SMART Health Digital Insurance Cards:

• SHALL generate a complete and appropriate FHIR bundle using as described in this specification, including Coverage, Organization, and Patient information, as well as any additional information defined by this IG’s extensions.
• SHALL follow the SMART Health Cards specification to create a SMART Health Card containing the FHIR bundle.
  • SHALL create the SMART Health Card as a JWS string, as defined by https://spec.smarthealth.cards/#health-cards-are-encoded-as-compact-serialization-json-web-signatures-jws.
  • SHOULD implement revocation as defined by https://spec.smarthealth.cards/#revocation.
• SHALL follow the SMART Health Links specification to create a SMART Health Link referencing the SMART Health Card.
  • SHALL include the SMART Health Card as application/smart-health-card, a JSON file with a .verifiableCredential array containing the SMART Health Card JWS string, as specified by https://spec.smarthealth.cards#via-file-download.
  • SHALL NOT require the user to set a passcode, and SHALL NOT enforce a passcode by default.
• SHALL share the Digital Insurance Card with the member as other personal information would be shared.
• SHALL provide the member the SMART Health Link in text URI format as well as QR format, as described here https://docs.smarthealthit.org/smart-health-links/spec#sharing-user-transmits-a-shlink.
• SHALL in close proximity to the link and QR code, specify to the member:
  • Data referenced in the link.
  • Expiration date.
  • Whether or not the information is updated over time.
  • Caution about sharing the link with parties they trust.

A Consumer App, in helping members manage and share their Digital Insurance Card:

• Can process the SMART Health Link as described here https://docs.smarthealthit.org/smart-health-links/spec#shl-receiving-application-processes-a-shlink.
• SHALL display the included data elements for the card.
  • If the flag: L is present, indicating the contents are for long term use, the application SHALL update the display of the contents or display a message noting that the contents may be stale.
• SHALL display the expiration date, exp (if present) for the card.
• SHALL inform the user if the card has been revoked, as specified by https://spec.smarthealth.cards/#revocation.
• SHALL update the display of data from the SMART Health Link
• SHALL provide the member with the ability to share the SMART Health Link as they see fit.
  • SHALL provide the member the SMART Health Link in text URI format as well as QR code, as described here https://docs.smarthealthit.org/smart-health-links/spec#sharing-user-transmits-a-shlink.
  • SHALL in close proximity to the link and QR code, caution the member about sharing the link with parties they trust.

Providers, receiving the Digital Insurance Card:

Can process the SMART Health Link as described here https://docs.smarthealthit.org/smart-health-links/spec#shl-receiving-application-processes-a-shlink.

Color Palette Extension

When rendering foreground and background colors, the implementer SHOULD not use the same foreground and background colors and instead should algorithmically determine a high color contrast.