Patient uses Trusted Third Party to authenticate and move EHR

Full Title of Use Case

Patient authenticates to a trusted third party to access Electronic Health Records (EHR) at one provider and extract records for their own purposes.

Context

• To provide good assurance that a patient data is kept as private as possible consistent with quality health care.
• To give the patient full control of their PHI including determination of which records will be sent to a new provider.

Goal

• The patient in the very near future has full capability to exercise their right to participate in the care plan and see who has access to their medical records.
• Provide the two apis as described in the Health Care Profile.

1. Trusted Identifiers for all providers, and perhaps patients as well.
2. Consent experience for patient

Actors

1. Patient
2. Provider of patient's general health care
3. Trusted third party that will authenticate a user to the IAL2 requirements of the Health Care Profile.

Preconditions

1. The patient is "known to the practice" where general health care is provided and that provider recognizes third party authentications.
2. A trust registry exists for covered, compliant entities which the patient knows and trusts.
3. The providers of health care and lab services present the patient with a trusted identity which confirms that they subscribe to the regulations for compliance to the regulations for a covered (HIPAA) entity.
4. Different providers are unlikely to allow each other, or the patient, to write into their EHR, so it is expected that the patient will have multiple repositories, each with their own Medical Records Identifier.
5. Patient can always get their own data, but only after strong authentication. This data will include a list of existing consent grants. The patient always has the right to revoke consent
6. The patient has a trusted identity in cyberspace that can be used to access their health records at any registered entity.

Scenarios

The goal of this scenario is to test the functionality of the APIs associated with patient trust of the providers and patient consent granting and recording.

Primary Scenario:

1. Patient schedules an appointment with primary care physician (PCP) and is authenticated at the front desk. (This might involve re-affirmation of the consent with the practice.)
2. Patient sees the doctor, is reauthenticated (this reauth will be less onerous than that at the front desk) and explains symptoms.
3. Doctor schedules a lab test for a sensitive condition (for example sexually transmitted disease) in order to test patient consent to share such information with referral.
4. The patient is given a consent receipt that tells the patient the labs trusted identity and adherence with the trust registry conditions for handling patient records.
5. The patient positively gives consent consonant with the receipt by signing a copy and returning to the doctor's practice.
6. The patient goes to the lab which gives a trusted identifier to the patient.
7. The patient is authenticated and given the test.
8. The lab has consent and so passes the patient data to the doctor's practice.
9. The doctor asks for patient consent to schedule further diagnostics with a doctor in a different practice.
10. The patient can evaluate that other practice with respect to competence and compliance with appropriate privacy practices.
11. The patient gives consent, schedules a consultation and the lab results are passed to the other practice. The patient may or may not also get the results.
12. The patient receives a consent receipt from the primary doctor as to the transfer of health records to that other practice

Alternate Scenario:

1. The patient can sign onto the various practices' web sites and preform the actions from the comfort of her living room. In this case electronic consents are appropriate.
2. In this case the consent reciepts will be renderable to the user in understandable user experience.

Alternate Scenario:

1. In the above scenario the lab delivers the patient results to the PCP for inclusion in their EHR, in some cases the patient will contract directly with the lab which will maintain an EHR for the patient.
2. In this scenario the patient needs to explicitly request the data be transfer to the PCP, or transfer it to the PCP themselves.

Results

Accepted Risks:

1. Data transfers involved work within a framework of trust and mutual understand as to the patient's wishes with respect to care and privacy.

Post Condition:

1. There are now two additional consents steps, lab with sensitive data and secondary provider with sensitive.
2. No data is ever shared with any provider that has not been strongly identified to the patient.
3. The patient results are available it is assumed that the consent receipt acknowledged that the data would be sent back to the primary care doctor.

Examples:

1. tbd

Dependencies::

1. Web Sites must be trusted before any user information is released.
2. Trust federations can be used to help users make informed decisions.
3. User consent and trust must begin with no user information transferred.
4. Standards exist to collect needed attributes where-ever they may be.

Workflow Diagram

TK