Introduction

In a previous post, I wrote about how to use Keycloak and the APISIX openid_connect plugin to add support for SMART on FHIR to HAPI FHIR.

In this post we are going to look at how to use Keycloak and the APISIX authz-keycloak plugin to add support for SMART on FHIR to HAPI FHIR.

Keycloak Authorization Services

Fine-grained Authorisation

You must allow the 'Authorization' capability config setting in order to enable support for fine-grained authorisation.

APISIX

AuthZ Keycloak plugin

The authz-keycloak plugin enables APISIX to leverage the fine-grained authorisation policies and access control mechanisms supported by Keycloak.

See: Keycloak - Authorization Services Guide

Static permissions

The authz-keycloak plugin can be configured to support different authorisation scenarios.

For example, you can configure Keycloak to use scope-based permissions associated with a client scope policy and configure the authz-keycloak plugin to use static permissions:

  • Resource: Patient
  • Authorisation Scope: Patient.read
  • Client Scope: system/Patient.read
  • Client Scope Policy: patient-read-client-scope-policy
  • Scope-based Permission: patient-read-scope-permission
  permissions: [ "Patient#Patient.read" ]
Create an Authorisation Scope in Keycloak

Create an Authorisation Scope (Patient.read) in Keycloak:

Create a Resource in Keycloak

Create a Resource (Patient) in Keycloak:

Create a Client Scope in Keycloak

Create a Client Scope (system/Patient.read) in Keycloak:

Create a Client Scope Policy in Keycloak

Create a Client Scope Policy (patient-read-client-scope-policy) in Keycloak:

Create a Scope-based Permission in Keycloak

Create a Scope-based Permission (patient-read-scope-permission) in Keycloak:

Configure APISIX

Create a route as follows:


  ...

  - name: hapi-fhir-api
    host: hapi-fhir.au.localhost
    uri: /fhir/Patient*
    methods: [ "GET" ]
    upstream_id: 1
    plugins:
      authz-keycloak:
        lazy_load_paths: false
        ssl_verify: true
        client_id: ${{CLIENT_ID}}
        client_secret: ${{CLIENT_SECRET}}
        discovery: ${{PROTOCOL}}://${{KEYCLOAK_HOSTNAME}}:${{KEYCLOAK_PORT}}/realms/${{KEYCLOAK_REALM}}/.well-known/openid-configuration
        permissions: [ "Patient#Patient.read" ]

See: apisix-standalone.yml

Each entry in the 'permissions' attribute must be formatted as expected by the token endpoint's permission parameter.

For example: "Resource#Authorisation Scope".

See: Keycloak - Authorization Services Guide: Obtaining permissions

Call the HAPI FHIR API

Request a token

To access the API, you must request an access token. You will need to POST to the token URL.

For example (scope=system/Patient.read):

ACCESS_TOKEN=$(curl -s -X POST https://keycloak.au.localhost:8443/realms/hapi-fhir-dev/protocol/openid-connect/token \
  -H 'content-type: application/x-www-form-urlencoded' \
  -d grant_type=client_credentials \
  -d client_id=oauth2-proxy \
  -d client_secret=aHkRec1BYkfaKgMg164JmvKu8u9iWNHM \
  -d scope=system/Patient.read | (jq -r '.access_token'))
                 
# echo "$ACCESS_TOKEN"

Note: You can use jwt.io to decode the access token.

Introspect a token

To introspect an Access Token you will need to POST to the introspect URL.

For example:

curl -X POST "https://keycloak.au.localhost:8443/realms/hapi-fhir-dev/protocol/openid-connect/token/introspect" \
  -H 'content-type: application/x-www-form-urlencoded' \
  -d client_id=oauth2-proxy \
  -d client_secret=aHkRec1BYkfaKgMg164JmvKu8u9iWNHM \
  -d "token_type_hint=access_token&token=$ACCESS_TOKEN"
Call the API

To call the HAPI FHIR API, an application must pass the access token as a Bearer token in the Authorization header of the HTTP request.

For example:

curl -X GET https://hapi-fhir.au.localhost/fhir/Patient?_id=baratz-toni \
  -H 'Content-Type: application/fhir+json' \
  -H "Authorization: Bearer $ACCESS_TOKEN"

You should see something like:

{
  "resourceType": "Bundle",
  "id": "9d80c83a-0b06-4b78-bce2-21e6666348d8",
  "meta": {
    "lastUpdated": "2025-05-23T05:43:01.959+00:00"
  },
  "type": "searchset",
  "total": 1,
  "link": [ {
    "relation": "self",
    "url": "https://hapi-fhir.au.localhost/fhir/Patient?_id=baratz-toni"
  } ],
  "entry": [ {
    "fullUrl": "https://hapi-fhir.au.localhost/fhir/Patient/baratz-toni",
    "resource": {
      "resourceType": "Patient",
      "id": "baratz-toni",
      "meta": {
        "versionId": "1",
        "lastUpdated": "2025-05-23T05:42:36.551+00:00",
        "source": "#rKTCeZfmnReSjm8X",
        "profile": [ "http://hl7.org.au/fhir/core/StructureDefinition/au-core-patient" ]
      },
      "extension": [ {
        "url": "http://hl7.org.au/fhir/StructureDefinition/indigenous-status",
        "valueCoding": {
          "system": "https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1",
          "code": "1",
          "display": "Aboriginal but not Torres Strait Islander origin"
        }
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/individual-genderIdentity",
        "extension": [ {
          "url": "value",
          "valueCodeableConcept": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "446141000124107",
              "display": "Identifies as female gender"
            } ]
          }
        } ]
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/individual-pronouns",
        "extension": [ {
          "url": "value",
          "valueCodeableConcept": {
            "coding": [ {
              "system": "http://loinc.org",
              "code": "LA29519-8",
              "display": "she/her/her/hers/herself"
            } ]
          }
        } ]
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender",
        "extension": [ {
          "url": "type",
          "valueCodeableConcept": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "1515311000168102",
              "display": "Biological sex at birth"
            } ]
          }
        }, {
          "url": "value",
          "valueCodeableConcept": {
            "coding": [ {
              "system": "http://snomed.info/sct",
              "code": "248152002",
              "display": "Female"
            } ]
          }
        } ]
      } ],
      "identifier": [ {
        "extension": [ {
          "url": "http://hl7.org.au/fhir/StructureDefinition/ihi-status",
          "valueCoding": {
            "system": "https://healthterminologies.gov.au/fhir/CodeSystem/ihi-status-1",
            "code": "active"
          }
        }, {
          "url": "http://hl7.org.au/fhir/StructureDefinition/ihi-record-status",
          "valueCoding": {
            "system": "https://healthterminologies.gov.au/fhir/CodeSystem/ihi-record-status-1",
            "code": "verified",
            "display": "verified"
          }
        } ],
        "type": {
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "NI"
          } ],
          "text": "IHI"
        },
        "system": "http://ns.electronichealth.net.au/id/hi/ihi/1.0",
        "value": "8003608000311662"
      }, {
        "type": {
          "coding": [ {
            "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code": "MC"
          } ],
          "text": "Medicare Number"
        },
        "system": "http://ns.electronichealth.net.au/id/medicare-number",
        "value": "69518252411"
      } ],
      "name": [ {
        "use": "official",
        "family": "BARATZ",
        "given": [ "Toni" ]
      } ],
      "telecom": [ {
        "system": "phone",
        "value": "0870101270",
        "use": "home"
      }, {
        "system": "phone",
        "value": "0491570156",
        "use": "mobile"
      }, {
        "system": "phone",
        "value": "0870108006",
        "use": "work"
      } ],
      "gender": "female",
      "birthDate": "1978-06-16",
      "address": [ {
        "line": [ "24 Law Cir" ],
        "city": "Bassendean",
        "state": "WA",
        "postalCode": "6054",
        "country": "AU"
      } ]
    },
    "search": {
      "mode": "match"
    }
  } ]
}
Test Data

See: HAPI FHIR and AU Core Test Data

Source Code
References
System Hardening
HL7
SMART on FHIR
SMART on FHIR - Standalone Launch
SMART on FHIR - EHR Launch
Keycloak
Keycloak-based Development
Keycloak Support
APISIX
HAPI FHIR