Introduction

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 yet interconnected parts (i.e., 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).

Description

A patient, via a patient-facing application, requests access to a shareable copy of their patient summary. Subsequently, the patient provides access to their encrypted patient summary via the QR code on their mobile device or by sharing a secure SHL, (e.g., via email) at the point of care (e.g., walk-in clinic, emergency department).  The HCP scans the QR code or accesses the SHL shared by the patient, addressing any security prompts, such as entering a passcode if required, and then may proceed to view/utilize and consume the patient summary.

Part A: Patient Requests Access to Their Shareable Patient Summary.

Ms. SJ, a 37-year-old non-smoker and non-drinker, recently experienced a high-risk pregnancy involving early hospitalization and pre-term delivery due to pre-eclampsia and gestational diabetes. She is currently taking metformin and an anti-hypertensive. Ms. SJ, recently moved within her province, and she found a new primary care clinic that is taking on new patients.  

Ms. SJ signs up for a patient-facing provincial application to access her personal health information and creates a shareable patient summary, which will be useful for her upcoming appointment. On the application, she is presented with privacy and security measures, such as a consent notice, passcode, and QR code timeout. After providing her consent and completing the security instructions for her shareable patient summary, the application assembles her patient summary using available data and creates a SHL and QR code, which is displayed on Ms. SJ’s mobile phone, and she is happy to see that she has the option to print a copy. Ms. SJ is ready for her appointment. 

Triggers, Pre-conditions, Post-Conditions

Triggers:

• • Patient, or their designated caregiver, choose to share their patient summary with a healthcare provider.

Pre-conditions

• • Patient has access to a patient-facing application which supports access to their patient summary and creation of a QR code with a SHL for sharing with an HCP. 

Post-conditions

• • A QR code, with a SHL, is created and displayed to the patient for accessing and sharing their patient summary.  

Use Case Participants & Diagram

The participants involved in this use case are:

• • Patient or designated caregiver requesting access to their shareable patient summary via patient-facing application.
  • PS-CA Producer (e.g., Clinical Data Repository).

Use Case - Primary Flow

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

1. Patient or their designated caregiver accesses Personal Health Information via a patient facing application (e.g., Jurisdictional Patient Portal).
2. Patient or their designated caregiver requests access to a shareable patient summary, on option available within their patient facing application.
3. Patient or their designated caregiver is presented with applicable privacy and/or security forms such as a consent statement, requirements for a PIN, passcode, validity time frame etc., according to jurisdictional policies.
4. Patient or their designated caregiver reviews the information presented and determines if they would like to proceed. If yes, proceed to step 4a. Otherwise, proceed to step 4b.
   1. Patient or their designated caregiver completes the privacy and security forms. Proceed to step 5.
   2. Patient or their designated caregiver decide not to complete the privacy and security forms. The request for their shareable patient summary is terminated. Process complete. (Refer to alternate flow for step 4b)
5. PS-CA Producer retrieves relevant patient data from available data sources ( e.g., CDR, EHR ,EMR). 
6. PS-CA Producer assembles patient summary from discrete data sources. An existing patient summary can be retrieved or a new patient summary may be generated depending on the implementer.
7. PS-CA producer applies business rules (e.g., Privacy, Policy, Data Standardization).
8. PS-CA producer applies data encryption and transformation (i.e., data formatted according to the type of request). 
9. PS-CA Producer creates shareable health link which is encoded into a QR code. 
10. Patient or their designated caregiver is presented with a QR code, and optionally the SHL. Additionally, the Patient may view the shareable patient summary on their device.
11. Patient has access to the shareable copy of their patient summary with a QR code and SHL for sharing their patient summary with a health care provider. 

Use Case - Alternate Flow

The following list provides possible alternate flows that may occur within this use case.

Step 4b.  Patient/designated care giver is not authorized to access a shareable patient summary and the process is abandoned. (For example, a jurisdictional rule identifies that a patient summary request may only occur once within a specific time period.)

Part B: Patient presents their QR code or SHL to HCP for access to their Patient Summary.

Ms. SJ attends her first in-person visit with her new family physician, Dr. Pereira. During the consultation, she displays her patient summary QR code on her mobile phone and shares the passcode. Ms. SJ explains to Dr. Pereira that, if she was not able to scan the QR code, Ms. SJ could share the SHL via email to the clinic. Dr. Pereira, having access to QR code scan technology, scans the QR code and enters the required security prompts. Dr. Pereira views Ms. SJ’s patient summary and is happy to see that there is an option to import the patient summary into her local clinical solution.   

Dr. Pereira is very happy to note that this saves her time and requires less administrative effort to gather Ms. SJ’s medical history. The consultation proceeds smoothly. 

Triggers, Pre-conditions, Post-Conditions

Triggers:

• • Patient presents a health care provider (HCP) with access to their patient summary using a QR code or SHL.

Pre-conditions

• • Patient has a QR code or SHL with access to a patient summary.
  • HCP has the necessary tools to scan the QR code or access the SHL (e.g., a QR code scanner, Health Information System).

Post-conditions

• • HCP has access to Patient Summary.

Use Case Participants & Diagram

The participants involved in this use case are:

• • Patient or designated caregiver
  • PS-CA Consumer (Health care provider/Clinical system)
  • PS-CA Solution (Health record system enabling access to the PS-CA)

Use Case - Primary Flow

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

1. Patient has a medical encounter with a health care provider (HCP) virtually or in-person to obtain health care services. 

2. Patient displays their patient summary QR code on their mobile device or shares a shareable health link (e.g., via email) with the HCP and provides them with the passcode/PIN that they created (in Part A of this use case) to access the patient summary.

3. HCP scans the QR code or accesses the SHL in a browser to retrieve the patient summary. 
4. HCP is presented with applicable privacy and/or security form and they enter required security prompts (e.g., passcode, expiration time frame etc.,) according to jurisdictional policies.
5. PS-CA Solution verifies the information submitted by the HCP in response to the security prompts (e.g., passcode/PIN). 
   1. If the security prompts are correct, proceed to step 6.
   2. If the security prompts are incorrect, PS-CA Solution denies access and prompts the user to re-submit the security prompts. If multiple failed attempts occur or the HCP abandons the process, the request for the patient summary is terminated. Process complete.
6. PS-CA Solution retrieves the patient summary. Note: This process typically involves two steps: initially, a manifest file is provided containing the link to the patient summary. The patient summary is then retrieved in a subsequent step.
7. HCP views and optionally saves/imports the patient summary in their clinical system.