Restricted Data

Zus uses the term "specially regulated data" (SRD) to refer to the subset of PHI that may require specific patient consent before it can be shared among providers treating that patient (e.g., HIV status, psychotherapy notes, substance use, mental health facility information). Data may be specially regulated at the US state level and/or the federal level.

Your organization, in consultation with your legal and compliance advisors, must decide which regulations apply to you and whether you need to implement specific controls as part of your solution.

Zus automatically tags and restricts structured code-backed data related to HIV status, abortion-related, and gender-affirming care, as described below.

Patients who want to opt out of sharing altogether may do so by filling out this form.

Restricted Labels

Restricted resources in Zus are those that have a FHIR security label with a confidentiality code of “R” for “Restricted” or “V” for “Very Restricted.”

Restricted tag example:

"meta": {
    "security": [
        {
            "system": "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
            "code": "R",	
            "display": "Restricted"
        }
    ]
}

Any resources tagged as restricted in this way CANNOT be seen by other Builders, even if these Builders have a relationship with your patient, and are withheld from the national EMR networks. Users and app clients are permitted to view restricted resources if these resources are owned by their Builder or are owned by a Builder that has granted them cross-builder access.

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Note: Restricted data is excluded from Lens summarizations.

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How Zus's automatic tagging works and its limits.
Zus's automatic specially-regulated data tagging is code-based. For each category below, we evaluate a defined set of FHIR resource types and apply a label when a resource carries a code that matches our evaluation criteria. Because the logic is code-based, Zus cannot guarantee that every resource containing specially regulated content will be tagged. In particular, Zus will not automatically tag:

Resources that lack a structured code (e.g., text-only entries, or resources missing code.coding)

Resources coded with values that fall outside our evaluation criteria

Resource types not listed in the sections below

Specially regulated content embedded in unstructured data (see Unstructured data & raw documents below)

Builders remain responsible for ensuring that data they write to Zus is appropriately tagged when Zus's code-based logic does not cover it. Builders may apply the Restricted label directly to any resource that needs to be withheld.

Specially regulated data

Zus follows regulations related to the following categories of SRD.

Data related to HIV status

Zus proactively labels resources that may contain data relating to an HIV test, diagnosis, or medication, including data ingested from our data partners. We evaluate and label the following resource types:

Condition
MedicationRequest
MedicationStatement
MedicationDispense
MedicationAdministration
Observation
DiagnosticReport
Procedure

The Zus platform will apply the following HIV label to all resources that meet our evaluation criteria. In addition, HIV-labeled resources that are written by builders will automatically receive the Restricted label and be withheld from responses to CommonWell and Carequality.

"meta": {
    "security": [
        {
          system: "https://zusapi.com/speciallyregulated"
          code:   "HIV"
        }
    ]
}

Data related to gender affirming or abortion-related care

In accordance with California Assembly Bill No. 352, Zus proactively labels resources related to gender affirming or abortion-related care for all data written to Zus by customers about the care they provide. We evaluate and label the following resource types:

Condition
MedicationRequest
MedicationStatement
MedicationDispense
MedicationAdministration
Procedure

The Zus platform will apply the following labels (derived from the HL7 Information Sensitive Policy value set) to all customer-written data on the Zus platform so long as the resources meet our evaluation criteria, regardless of the patient's home address.

The GENDER label is applied to all resources related to gender affirming care:

"meta": {
    "security": [
      {
        system: "https://zusapi.com/speciallyregulated"
        code: "GENDER"
      }
    ]
}

The SEX label is applied to all resources related to abortion or abortion-related services:

"meta": {
    "security": [
      {
        system: "https://zusapi.com/speciallyregulated"
        code: "SEX"
      }
    ]
}

In addition, labeled resources that are written by builders will automatically receive the Restricted label and be withheld from responses to CommonWell and Carequality.

Other categories of specially regulated data

There are other categories of specially regulated data that Zus does not automatically tag:

Psychotherapy notes: This regulation refers to the personal notes of a therapist or counselor, as defined by HIPAA (45 CFR 164.501). These are separate from the core clinical record (EHR). If you maintain notes that meet this definition, you must ensure that they are not written to Zus.
Mental health & substance use facilities: Certain state laws prohibit sharing any records created by a mental health facility. Similarly, provider organizations that are part of Part 2 Covered Programs should not have any data shared without special consent. If your organization qualifies as a mental health facility under state law, or as a Part 2 Covered Program, please raise that with your Solutions contact during the onboarding and implementation process.

Unstructured data & raw documents

Today, Zus does not identify, label, or restrict specially regulated data in raw document binaries (such as PDFs or CCDAs) or other unstructured formats (such as clinical notes or images). You must ensure that any CCDAs, PDFs, notes, or other unstructured content you write to Zus does not contain data that you require additional patient authorization to share.