Introduction

The pan-Canadian Patient Mediated Access (PMA) is a set of pan-Canadian specifications aiming to create a modern healthcare ecosystem and promote the building blocks in which patients have the control and authority to securely manage and share their health information with authorized healthcare providers and caregivers.

pan-Canadian Shareable Health Links (CA:SHL) based on the HL7 Health Links Specification and part of the PMA initiative, defines building blocks enabling patients to generate shareable links that encode their health data such as patient summaries or immunization records. These shareable links can often be downloaded onto their devices and converted in a QR code format, facilitating patient-mediated data sharing and interoperability within the healthcare ecosystem.

Currently, the CA:SHL includes minimal information, as the profile is in the process of being contributed to IHE (Integrating the Healthcare Enterprise) with the aim of becoming an internationally recognized Integration Profile. Until the international integration profile is available, the initial content for CA:SHL is published within the Reference Architecture release. This approach serves as a temporary measure until the final profile is established.

The initial phase of CA:SHL focuses on a subset of the standards, that can be used to build a Minimum Viable Product, that includes two main use cases;

1. Generate SHLink
2. Consume SHLink and access clinical data

The following are some examples of the benefits of SHLink:

• Enables patients to create, share, and manage their health data using standardized operations based on HL7 standards.
• Facilitates convenient access to health information through easily shareable links, such as QR codes.
• Enhances patient control over their health data, allowing them to decide who can access their information.
• Promotes seamless coordination and collaboration among healthcare providers by providing timely and accurate health information.
• Supports improved continuity of care through efficient data sharing during patient transitions across different care settings.

Security Considerations

When creating, sharing, and consuming clinical data using CA:SHL, it is crucial to also ensure the privacy, authenticity, and integrity of the information through encryption and digital signatures. 

• CA:SHL is the subject of international collaboration at IHE International, with the IHE ITI committee approving the initiative to evolve SHLinks and advance it into Verifiable Health Links, by adding a structured and robust security approach in future iterations.
• Any exchange of SHLinks must be governed by a robust trust framework that ensure security and provenance. Implementations that do not employ high-level security measures, such as digital signatures and robust encryption, are not recommended and are strongly discouraged.
• CA:SHL is a building block that is meant to be used together with added security measures, otherwise it is not suitable for exchange in environments where security and provenance cannot be reliably established by other means.