Patient pull of information

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Use Case Description: [Use an action verb name to describe the use case, not including the primary actor name, but identifying any subject actors. Verb modifiers may be used to refine the use case. Examples: authenticate to system with trusted identity, authenticate to system with pseudonymous identity, match names between systems, verify attributes with privacy protection]

Use Case Category:



Use Case Details

A patient can direct a third party electronic health record (EHR) application to aperiodically have access to his/her personal health information via the internet. The electronic health data holder will ensure this data is made available and follow certain interoperability, security, and privacy (HIPAAHIPPA) standards Both the patient EHR and data holder application will accept interoperable, high assurance patient credentials, avoiding duplicative and burdensome new account creation by the patient and providers. Supplement (not replace) existing Direct transport protocols with authentication, RESTful transport, and content standards that provide for non-repudiation (e.g. OpenID, Oauth). Actors:


Incorporate NSTIC principles into Health care interactions


Relationships between patient, data holder and EHR have already been established


Authentication and authorization events

Process Flow:

Success Scenario:

Error Conditions:

Patient at private care provider is given a lab test which results to a referral to a different practice.


To provide good assurance that a patient data is kept as private as possible consistent with quality health care.


  • 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


  1. Patient
  2. Provider of patient's general health care
  3. Lab to perform test on patient sample
  4. Provider of specialized services related to patient diagnosis


  1. The patient is "known to the practice" where general health care is provided.
  2. A trust registry exists 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 privacy regulations of the trust provider.
  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 the right to eliminate some individuals in a practice from seeing their data even when the practice has access.

An optional condition would be for the patient to have a trusted identity in cyberspace that can be used to access their health records at any of their care providers.


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 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 receipts will be renderable to the user in understandable user experience.


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.


  1. tbd


  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