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Healthcare Data Access (HIPAA)

This example models HIPAA-compliant access control for electronic health records (EHR). It demonstrates role-based access, patient consent management, the minimum necessary principle, and break-glass emergency procedures.

<SectionHeader icon="version" level={2}>Overview

HIPAA (Health Insurance Portability and Accountability Act) requires healthcare organizations to implement strict access controls:

HIPAA Requirement	Implementation
Minimum Necessary	Only access data required for job function
Role-Based Access	Physicians, nurses, admins have different access
Patient Consent	Patients can restrict access to their records
Break-Glass	Emergency access with audit trail
Audit Trail	All access decisions logged

<SectionHeader icon="settings" level={2}>Design

Healthcare Role Hierarchy

flowchart TD
    A[Physician] --> B[Full Patient Records]
    C[Nurse] --> D[Care-Related Records]
    E[Admin] --> F[Administrative Data Only]
    G[Patient] --> H[Own Records Only]
    I[Researcher] --> J[De-identified Data]

Record Sensitivity Levels

Level	Examples	Who Can Access
Administrative	Demographics, insurance	Admin, Nurse, Physician
Clinical	Vitals, medications	Nurse, Physician
Sensitive	Mental health, HIV, substance abuse	Physician (with consent)
Restricted	Psychiatric notes, genetic data	Attending physician only

<SectionHeader icon="security" level={2}>Complete PolicyDomain

apiVersion: iamlite.manetu.io/v1beta1
kind: PolicyDomain
metadata:
  name: healthcare-hipaa
spec:
  # ============================================================
  # Policy Libraries
  # ============================================================
  policy-libraries:
    - mrn: &lib-utils "mrn:iam:library:utils"
      name: utils
      description: "Common utility functions"
      rego: |
        package utils

        import rego.v1

        # Check if request has a valid principal (authenticated)
        has_principal if {
            input.principal != {}
            input.principal.sub != ""
        }

    - mrn: &lib-hipaa-helpers "mrn:iam:library:hipaa-helpers"
      name: hipaa-helpers
      description: "HIPAA compliance helper functions"
      rego: |
        package hipaa_helpers

        import rego.v1

        # Sensitivity levels (higher = more restricted)
        sensitivity_level("administrative") := 1
        sensitivity_level("clinical") := 2
        sensitivity_level("sensitive") := 3
        sensitivity_level("restricted") := 4

        # Role clearance levels
        role_clearance("patient") := 0           # Own records only
        role_clearance("admin") := 1             # Administrative only
        role_clearance("researcher") := 1        # De-identified only
        role_clearance("nurse") := 2             # Up to clinical
        role_clearance("physician") := 3         # Up to sensitive (with consent)
        role_clearance("attending-physician") := 4  # Full access to assigned patients

        # Get highest clearance from principal's roles
        max_clearance(principal) := max_level if {
            levels := [level |
                some role in principal.mroles
                # Extract role name from MRN
                parts := split(role, ":")
                role_name := parts[count(parts) - 1]
                level := role_clearance(role_name)
            ]
            max_level := max(levels)
        }

        # Default if no roles match
        max_clearance(principal) := 0 if {
            count([role |
                some role in principal.mroles
                parts := split(role, ":")
                role_name := parts[count(parts) - 1]
                role_clearance(role_name)
            ]) == 0
        }

        # Check if principal is the patient (accessing own records)
        is_own_record(principal, resource) if {
            principal.mannotations.patient_id == resource.annotations.patient_id
        }

        # Check if principal is the attending physician
        is_attending_physician(principal, resource) if {
            principal.sub in resource.annotations.attending_physicians
        }

        # Check if principal is on the care team
        is_care_team_member(principal, resource) if {
            principal.sub in resource.annotations.care_team
        }

        # Check if patient has consented to this access
        has_patient_consent(principal, resource) if {
            # No consent restrictions on this record
            not resource.annotations.consent_required
        }

        has_patient_consent(principal, resource) if {
            # Consent is required and granted
            resource.annotations.consent_required == true
            principal.sub in resource.annotations.consented_providers
        }

        has_patient_consent(principal, resource) if {
            # Patient accessing own records doesn't need consent
            is_own_record(principal, resource)
        }

        # Check if this is a break-glass emergency access
        is_break_glass(context) if {
            context.break_glass == true
            context.emergency_reason != ""
        }

        # Determine required operation type (using set iteration)
        is_read_operation(operation) if {
            some suffix in {":read", ":view", ":list"}
            endswith(operation, suffix)
        }

        is_write_operation(operation) if {
            some suffix in {":update", ":create", ":amend"}
            endswith(operation, suffix)
        }

  # ============================================================
  # Policies
  # ============================================================
  policies:
    # Operation phase - require authentication and log access
    - mrn: &policy-require-auth "mrn:iam:policy:require-auth"
      name: require-auth
      description: "Require authentication for PHI access"
      dependencies:
        - *lib-utils
      rego: |
        package authz

        import rego.v1
        import data.utils

        # Tri-level: negative=DENY, 0=GRANT, positive=GRANT Override
        # Default deny - only grant if authenticated
        default allow = -1

        # Grant authenticated requests
        allow = 0 if utils.has_principal

    # Identity phase - healthcare staff access
    - mrn: &policy-healthcare-staff "mrn:iam:policy:healthcare-staff"
      name: healthcare-staff
      description: "Allow healthcare staff to proceed"
      dependencies:
        - *lib-utils
      rego: |
        package authz

        import rego.v1
        import data.utils

        default allow = false

        # Allow authenticated healthcare staff
        allow if utils.has_principal

    # Resource phase - patient records access with HIPAA rules
    - mrn: &policy-phi-access "mrn:iam:policy:phi-access"
      name: phi-access
      description: "HIPAA-compliant PHI access control"
      dependencies:
        - *lib-hipaa-helpers
      rego: |
        package authz

        import rego.v1
        import data.hipaa_helpers

        default allow = false

        # Rule 1: Patients can always access their own records
        allow if {
            hipaa_helpers.is_own_record(input.principal, input.resource)
            hipaa_helpers.is_read_operation(input.operation)
        }

        # Rule 2: Break-glass emergency access (logged separately)
        allow if {
            hipaa_helpers.is_break_glass(input.context)
            hipaa_helpers.is_read_operation(input.operation)
            # Any licensed provider can use break-glass
            hipaa_helpers.max_clearance(input.principal) >= 2
        }

        # Rule 3: Attending physician has full access to assigned patients
        allow if {
            hipaa_helpers.is_attending_physician(input.principal, input.resource)
        }

        # Rule 4: Care team access based on sensitivity
        allow if {
            hipaa_helpers.is_care_team_member(input.principal, input.resource)
            clearance := hipaa_helpers.max_clearance(input.principal)
            record_sensitivity := hipaa_helpers.sensitivity_level(input.resource.annotations.sensitivity)
            clearance >= record_sensitivity
            hipaa_helpers.has_patient_consent(input.principal, input.resource)
        }

        # Rule 5: Standard access based on role clearance (non-care-team)
        allow if {
            not hipaa_helpers.is_care_team_member(input.principal, input.resource)
            clearance := hipaa_helpers.max_clearance(input.principal)
            record_sensitivity := hipaa_helpers.sensitivity_level(input.resource.annotations.sensitivity)
            # Non-care-team can only access administrative data
            record_sensitivity <= 1
            clearance >= record_sensitivity
        }

    # Resource phase - administrative records (less restricted)
    - mrn: &policy-admin-records "mrn:iam:policy:admin-records"
      name: admin-records
      description: "Administrative record access"
      rego: |
        package authz

        import rego.v1

        default allow = false

        # Admin staff can access administrative records
        allow if {
            "mrn:iam:role:admin" in input.principal.mroles
        }

        # Clinical staff can also read admin records
        allow if {
            some role in input.principal.mroles
            role in {"mrn:iam:role:nurse", "mrn:iam:role:physician", "mrn:iam:role:attending-physician"}
        }

    # Resource phase - de-identified research data
    - mrn: &policy-research-data "mrn:iam:policy:research-data"
      name: research-data
      description: "De-identified research data access"
      rego: |
        package authz

        import rego.v1

        default allow = false

        # Researchers can access de-identified data
        allow if {
            "mrn:iam:role:researcher" in input.principal.mroles
            input.resource.annotations.de_identified == true
        }

        # IRB-approved research with patient consent
        allow if {
            "mrn:iam:role:researcher" in input.principal.mroles
            input.principal.mannotations.irb_approved == true
            input.resource.annotations.research_consent == true
        }

    # Resource phase - prescription/medication access
    - mrn: &policy-prescription-access "mrn:iam:policy:prescription-access"
      name: prescription-access
      description: "Prescription and medication access"
      dependencies:
        - *lib-hipaa-helpers
      rego: |
        package authz

        import rego.v1
        import data.hipaa_helpers

        default allow = false

        # Physicians can read and write prescriptions for their patients
        allow if {
            "mrn:iam:role:physician" in input.principal.mroles
            hipaa_helpers.is_care_team_member(input.principal, input.resource)
        }

        allow if {
            "mrn:iam:role:attending-physician" in input.principal.mroles
            hipaa_helpers.is_attending_physician(input.principal, input.resource)
        }

        # Nurses can read prescriptions for care team patients
        allow if {
            "mrn:iam:role:nurse" in input.principal.mroles
            hipaa_helpers.is_care_team_member(input.principal, input.resource)
            hipaa_helpers.is_read_operation(input.operation)
        }

        # Pharmacists can read prescriptions
        allow if {
            "mrn:iam:role:pharmacist" in input.principal.mroles
            hipaa_helpers.is_read_operation(input.operation)
        }

  # ============================================================
  # Roles
  # ============================================================
  roles:
    - mrn: &role-patient "mrn:iam:role:patient"
      name: patient
      description: "Patient accessing own records"
      policy: *policy-healthcare-staff

    - mrn: &role-admin "mrn:iam:role:admin"
      name: admin
      description: "Administrative staff"
      policy: *policy-healthcare-staff

    - mrn: &role-nurse "mrn:iam:role:nurse"
      name: nurse
      description: "Registered nurse"
      policy: *policy-healthcare-staff

    - mrn: &role-physician "mrn:iam:role:physician"
      name: physician
      description: "Licensed physician"
      policy: *policy-healthcare-staff

    - mrn: &role-attending-physician "mrn:iam:role:attending-physician"
      name: attending-physician
      description: "Attending physician with full patient responsibility"
      policy: *policy-healthcare-staff

    - mrn: &role-researcher "mrn:iam:role:researcher"
      name: researcher
      description: "Medical researcher"
      policy: *policy-healthcare-staff

    - mrn: &role-pharmacist "mrn:iam:role:pharmacist"
      name: pharmacist
      description: "Licensed pharmacist"
      policy: *policy-healthcare-staff

  # ============================================================
  # Groups
  # ============================================================
  groups:
    - mrn: "mrn:iam:group:clinical-staff"
      name: clinical-staff
      description: "All clinical staff"
      roles:
        - *role-nurse
        - *role-physician

    - mrn: "mrn:iam:group:attending-physicians"
      name: attending-physicians
      description: "Attending physicians"
      roles:
        - *role-attending-physician
        - *role-physician

    - mrn: "mrn:iam:group:research-team"
      name: research-team
      description: "Research department"
      roles:
        - *role-researcher
      annotations:
        - name: "irb_approved"
          value: "true"

  # ============================================================
  # Resource Groups
  # ============================================================
  resource-groups:
    - mrn: "mrn:iam:resource-group:phi"
      name: phi
      description: "Protected Health Information"
      default: true
      policy: *policy-phi-access

    - mrn: "mrn:iam:resource-group:admin-records"
      name: admin-records
      description: "Administrative records"
      policy: *policy-admin-records

    - mrn: "mrn:iam:resource-group:research-data"
      name: research-data
      description: "Research datasets"
      policy: *policy-research-data

    - mrn: "mrn:iam:resource-group:prescriptions"
      name: prescriptions
      description: "Prescription records"
      policy: *policy-prescription-access

  # ============================================================
  # Resources - Route by type
  # ============================================================
  resources:
    - name: administrative
      selector:
        - "mrn:ehr:.*:demographics:.*"
        - "mrn:ehr:.*:insurance:.*"
        - "mrn:ehr:.*:scheduling:.*"
      group: "mrn:iam:resource-group:admin-records"

    - name: prescriptions
      selector:
        - "mrn:ehr:.*:prescription:.*"
        - "mrn:ehr:.*:medication:.*"
      group: "mrn:iam:resource-group:prescriptions"

    - name: research
      selector:
        - "mrn:research:.*"
      group: "mrn:iam:resource-group:research-data"

  # ============================================================
  # Operations
  # ============================================================
  operations:
    - name: all-operations
      selector:
        - ".*"
      policy: *policy-require-auth

<SectionHeader icon="test" level={2}>Test Cases

Test 1: Patient Can Read Own Records

A patient can view their own medical records:

{
  "principal": {
    "sub": "patient-12345",
    "mroles": ["mrn:iam:role:patient"],
    "mgroups": [],
    "mannotations": {
      "patient_id": "patient-12345"
    }
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:lab-results",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "clinical",
      "care_team": ["dr-smith", "nurse-jones"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (patient accessing own records)

Test 2: Attending Physician Full Access

The attending physician can access all patient data:

{
  "principal": {
    "sub": "dr-smith",
    "mroles": ["mrn:iam:role:attending-physician"],
    "mgroups": ["mrn:iam:group:attending-physicians"],
    "mannotations": {}
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:psychiatric-notes",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "restricted",
      "care_team": ["dr-smith", "nurse-jones"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (attending physician has full access)

Test 3: Nurse Care Team Clinical Access

A nurse on the care team can access clinical records:

{
  "principal": {
    "sub": "nurse-jones",
    "mroles": ["mrn:iam:role:nurse"],
    "mgroups": ["mrn:iam:group:clinical-staff"],
    "mannotations": {}
  },
  "operation": "vitals:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:vitals",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "clinical",
      "care_team": ["dr-smith", "nurse-jones"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (nurse has clinical clearance)

Test 4: Nurse Cannot Access Sensitive Records

A nurse cannot access sensitive records without consent:

{
  "principal": {
    "sub": "nurse-jones",
    "mroles": ["mrn:iam:role:nurse"],
    "mgroups": ["mrn:iam:group:clinical-staff"],
    "mannotations": {}
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:mental-health",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "sensitive",
      "care_team": ["dr-smith", "nurse-jones"],
      "attending_physicians": ["dr-smith"],
      "consent_required": true,
      "consented_providers": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (nurse clearance < sensitive, and no consent)

Test 5: Non-Care-Team Physician Limited Access

A physician not on the care team can only access administrative data:

{
  "principal": {
    "sub": "dr-other",
    "mroles": ["mrn:iam:role:physician"],
    "mgroups": ["mrn:iam:group:clinical-staff"],
    "mannotations": {}
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:lab-results",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "clinical",
      "care_team": ["dr-smith", "nurse-jones"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (not on care team, record is clinical not administrative)

Test 6: Break-Glass Emergency Access

Any licensed provider can use break-glass access:

{
  "principal": {
    "sub": "dr-emergency",
    "mroles": ["mrn:iam:role:physician"],
    "mgroups": ["mrn:iam:group:clinical-staff"],
    "mannotations": {}
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:allergies",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "clinical",
      "care_team": ["dr-smith"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {
    "break_glass": true,
    "emergency_reason": "Patient unconscious in ER, need allergy history"
  }
}

Expected: (break-glass access for emergency)

Test 7: Researcher De-identified Access

A researcher can access de-identified data:

{
  "principal": {
    "sub": "researcher-jane",
    "mroles": ["mrn:iam:role:researcher"],
    "mgroups": ["mrn:iam:group:research-team"],
    "mannotations": {
      "irb_approved": true
    }
  },
  "operation": "dataset:read",
  "resource": {
    "id": "mrn:research:study-123:dataset:outcomes",
    "group": "mrn:iam:resource-group:research-data",
    "annotations": {
      "de_identified": true
    }
  },
  "context": {}
}

Expected: (researcher accessing de-identified data)

Test 8: Researcher Cannot Access Identified Data

A researcher cannot access identified patient data:

{
  "principal": {
    "sub": "researcher-jane",
    "mroles": ["mrn:iam:role:researcher"],
    "mgroups": ["mrn:iam:group:research-team"],
    "mannotations": {
      "irb_approved": true
    }
  },
  "operation": "record:read",
  "resource": {
    "id": "mrn:ehr:hospital:record:patient-12345:lab-results",
    "group": "mrn:iam:resource-group:phi",
    "annotations": {
      "patient_id": "patient-12345",
      "sensitivity": "clinical",
      "care_team": ["dr-smith"],
      "attending_physicians": ["dr-smith"]
    }
  },
  "context": {}
}

Expected: (researcher cannot access PHI)

Test 9: Admin Can Access Demographics

An admin can access administrative records:

{
  "principal": {
    "sub": "admin-mary",
    "mroles": ["mrn:iam:role:admin"],
    "mgroups": [],
    "mannotations": {}
  },
  "operation": "demographics:read",
  "resource": {
    "id": "mrn:ehr:hospital:demographics:patient-12345",
    "group": "mrn:iam:resource-group:admin-records",
    "annotations": {
      "patient_id": "patient-12345"
    }
  },
  "context": {}
}

Expected: (admin accessing administrative records)

<SectionHeader icon="version" level={2}>Key Concepts Demonstrated

1. Sensitivity-Based Clearance

Records have sensitivity levels, and roles have clearance levels. Access is granted when clearance >= sensitivity:

clearance := hipaa_helpers.max_clearance(input.principal)
record_sensitivity := hipaa_helpers.sensitivity_level(input.resource.annotations.sensitivity)
clearance >= record_sensitivity

2. Care Team Relationship

Access decisions consider whether the provider is on the patient's care team:

is_care_team_member(principal, resource) if {
    principal.sub in resource.annotations.care_team
}

3. Patient Consent Tracking

Sensitive records require explicit patient consent:

has_patient_consent(principal, resource) if {
    resource.annotations.consent_required == true
    principal.sub in resource.annotations.consented_providers
}

4. Break-Glass Emergency Override

Emergency access bypasses normal rules but requires documentation:

allow if {
    hipaa_helpers.is_break_glass(input.context)
    hipaa_helpers.is_read_operation(input.operation)
    hipaa_helpers.max_clearance(input.principal) >= 2
}

5. Minimum Necessary Principle

Non-care-team members can only access administrative data, enforcing minimum necessary access.

<SectionHeader icon="build" level={2}>Extending This Example

Adding Audit Annotations

Track access for compliance reporting:

audit_metadata := {
    "access_type": access_type,
    "break_glass": hipaa_helpers.is_break_glass(input.context),
    "care_team_member": hipaa_helpers.is_care_team_member(input.principal, input.resource),
    "sensitivity_level": input.resource.annotations.sensitivity
}

Adding Time-Based Consent

Implement consent expiration:

consent_valid if {
    consent_expires := time.parse_rfc3339_ns(input.resource.annotations.consent_expires)
    consent_expires > time.now_ns()
}

Adding Purpose of Use

Require providers to specify why they need access:

valid_purpose if {
    input.context.purpose_of_use in {"treatment", "payment", "operations"}
}