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UC-05: Patient Mediated Access and Exchange of their Patient Summary

This use case describes the process of accessing and sharing a Patient Summary using a Shareable Health Link (SHL) and QR code. It is split into two distinct parts (Part A: Patient Requests Access to Their Shareable Patient Summary and Part B: Patient presents their QR code or SHL to HCP for access to their Patient Summary), offering a complete overview of the workflow from the creation of the shareable Patient Summary to its use by Health Care Providers (HCP).

UC-05A: Generate SHLink for Patient Summary

Scenario: Patient-facing application (Mobile App, Patient Portal, or proprietary Patient Viewer Application) requests access to a shareable copy of their Patient Summary in SHLink format.

Assumption: The Patient Summary either exists or is generated on demand. This step occurs prior and is transparent to the SHLink generation.

Implementation Option : This sequence diagram demonstrates one approach using the CA:SHL Interoperability Specifications which define support for requesting the generation of a Shareable Health Link (SHLink) for a PS-CA from a Clinical Data Repository. In this example, the actors SHLink Requester and SHLink Creator participate in the CA:SHL-1 Generate SHLink transaction. The retrieval of the PS-CA supports multiple interoperability standards. This diagram illustrates the use of CA:FeX(Canadian FHIR Exchange), which includes three options for retrieving the Patient Summary:

Option A: Retrieve a document Bundle Option B: Retrieve a DocumentReference and then fetch the document Option D: Retrieve a Summary resource directly

Other standards, such as MHD (Mobile access to Health Documents), may also be used to retrieve the PS-CA in other implementations. The diagram is agnostic to the specific retrieval mechanism and is intended to illustrate the sequence when CA:FeX is used.

Once the PS-CA is retrieved, it is encrypted, stored securely, and an SHLink is generated. This SHLink may include a viewer URL and is often transformed into a QR code that the patient can download and save to their phone or other media.

Sequence Diagram

UC-05B: Consume SHLink and Access Patient Summary

Scenario: Clinical Solution A decodes SHLink and Retrieves Patient Summary from Document Repository.

Assumption: The Patient Summary is encrypted and either pre-prepared and stored in a secure location, or made available when the SHLink is accessed and the data is requested. As a prerequisite, the patient shares the passcode with the HCP to allow accessing the Patient Summary associated with the SHLink. Typically the HCP is authenticated in their clinical system such as an EMR or HIS.

Implementation Option : This sequence diagram provides the option of using the CA:SHL Interoperability Specifications that provide support for consuming a Shareable Health Link associated with a Patient Summary. This profile includes an SHLink Consumer and an SHLink Responder actor. Additionally, this sequence diagram uses the 'CA:SHL Retrieve SHLink Manifest' CA:SHL-2 transaction to retrieve the manifest file and 'CA:SHL Retrieve SHLink Clinical Data' CA:SHL-3 transaction to retrieve the Patient Summary document. The client-side consumer application has the capability of scanning QR codes, interpreting SHLinks and access encrypted data. The SHLink optionally contains a viewer URL that is recognizable by a browser and can display relevant information. A viewer might have the capability to consume the SHLink and display the Patient Summary, if the client application does not have the necessary capabilities. The location where the Patient Summary is available for access must be short-lived and and potentially limited to one-time use.

Sequence Diagram

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