UC-05 Fetch Document References

Description

This use case supports the retrieval of references to clinical documents, initiated either by a Health Care Provider at the point of care or by a Patient seeking access to their personal health information.

This use case enables the requester to view metadata about available clinical documents without retrieving the full contents. It offers greater control over document selection—for example, by allowing requesters to exclude documents that meet the criteria but are not immediately relevant. This differs from UC-02 Query and Retrieve Document, as it relies on the Data Responder supporting a predefined FHIR Operation that accepts more granular input parameters, influencing how the query is executed.

Scenario

The following examples illustrate common scenarios and do not represent an exhaustive list of implementations across Canadian jurisdictions.

1. A Health Care Provider retrieves references to a patient's clinical documents within a specified date range
   A patient visits a health care provider outside their Medical Home with symptoms of dizziness and an earache. They mention having a regular provider within their Medical Home and note that their high blood pressure is being monitored at home. The provider gathers clinical information and uses their Clinical Solution (e.g., EMR) to search the network for references to documents shared by other providers over the past three years. The search returns two references: one from the patient’s current primary care provider, dated six months ago, and another from a previous provider, dated three years ago. The provider reviews the document metadata and chooses to retrieve only the most recent document to support care for the current encounter.

2. A Health Care Provider requests references to both existing and on-demand clinical documents
   A patient visits an urgent care provider outside their Medical Home with symptoms of chest congestion and a crackling cough. They mention having a regular provider within their Medical Home. The urgent care provider gathers relevant information and, using their Clinical Solution (e.g., EMR), searches the network for references to both existing clinical documents and documents that can be generated on demand in response to the query. The provider finds two document references: one generated on demand by the patient’s primary care provider, containing the most up-to-date information, and another shared 18 months ago following a specialist visit for a gastrointestinal concern. After reviewing the document metadata, the provider chooses to retrieve only the recent on-demand record from the primary care provider to support care for the current visit.

3. A Patient fetches references to their own clinical documents
   A patient, or their designated caregiver, retrieves their personal health information (PHI) to remain informed and support self-management of care.

Triggers, Pre-conditions, Post-conditions

This section outlines example triggers, pre-conditions, and post-conditions for querying and retrieving clinical documents from the Clinical Data Repository. It does not represent all possible workflows that may be implemented across Canadian jurisdictions.

Triggers

Scenario 1 & 2:

• Patient visits Health Care Provider for care.

Scenario 3:

• The patient, or their designated caregiver, accesses their personal health information to stay informed and engaged in care.
• The patient requests a copy of their personal health information to carry while travelling, ensuring access during unexpected care encounters.
• The patient retrieves a copy of their personal health information to share with another health care provider.

Pre-conditions

Scenario 1 & 2:

• The Health Care Provider is authenticated within their clinical system (e.g., EMR).
• The Health Care Provider’s clinical system (e.g., EMR) is connected to or integrated with the Clinical Data Repository network.
• The clinical system (e.g., EMR) has access to the patient’s Resource ID within the Clinical Data Repository network.
• If consent directives exist, the Health Care Provider enforces access controls in accordance with jurisdictional privacy policy.

Scenario 2:

• An EMR on the network is configured to support on-demand document generation.

Scenario 3:

• A jurisdictional clinical system, such as a patient portal, is available to enable patient access to health information.
• If applicable, the patient has designated and authorized a caregiver to access their personal health record.

Post-conditions

Scenario 1 & 2:

• The Health Care Provider reviews returned document references and determines which documents to retrieve in support of care delivery.
• The Health Care Provider retrieves the selected clinical documents using the Retrieve a Document transaction.
• The Health Care Provider reviews the retrieved documents as part of the care delivery process.

Scenario 3:

• The patient, or their designated caregiver, reviews the available clinical document references.
• The patient retrieves the selected clinical documents using the Retrieve a Document transaction.
• The patient reviews the retrieved documents and, if needed, prints a copy for their records.
• The patient or their designated caregiver shares personal health information with another health care provider to support continuity of care.

Use Case Participants & Diagram

The participants involved in this use case are:

• Data Consumer: A system that initiates document retrieval from the Clinical Data Repository. This includes Clinical Solutions (e.g., EMRs used by Health Care Providers) and Patient Portals (used by Patients or their designated caregivers to access their clinical documents).
• Data Responder: A system that exposes clinical documents via the Clinical Data Repository and responds to queries from Data Consumers with matching documents.

This diagram illustrates the participants and their interactions, providing a high-level view of the clinical data flow within the use case.

Use Case – Primary Flow

The following provides a textual description corresponding to the use case diagram:

1. The participant (Health Care Provider or Patient/Subject of Care) identifies a need to access relevant clinical information.
2. The participant uses the clinical solution to retrieve document references, optionally applying criteria to filter the results.
3. The Clinical Data Repository enforces relevant business and policy rules, such as validating the requester’s credentials.
4. The Clinical Data Repository returns references to clinical documents matching the specified query parameters.
5. The participant evaluates the returned references and identifies the clinical documents to be retrieved.
6. The participant retrieves the selected clinical documents to support care delivery or personal health management.

Use Case – Alternate Flow

The following alternate flows are currently out of scope for this release. Reviewers are invited to provide input on their prioritization for future iterations.

• Step 2: The participant specifies that on-demand documents should be included in the document reference response.
• Step 3: Patient Consent Services are not currently supported in the CA:FeX specification but are identified as a roadmap item. A future use case will address scenarios where patient consent directives must be evaluated before clinical information can be accessed. Implementers should account for jurisdiction-specific consent services where they already exist.
• Step 4: The Clinical Data Repository dynamically generates document references in response to the request criteria.