Generated Narrative: Consent

status: active

scope: Privacy Consent (Consent Scope Codes#patient-privacy)

category: Consent (LOINC#59284-0)

patient: Patient/ex-patient " SMITH"

dateTime: 2022-06-13

performer: Patient/ex-patient " SMITH"

organization: Organization/ex-organization "somewhere org"

source: DocumentReference/ex-documentreference

Policies

provision

type: permit

securityLabel: normal (Details: http://terminology.hl7.org/CodeSystem/v3-Confidentiality code N = 'normal', stated as 'null')

purpose: treatment (Details: http://terminology.hl7.org/CodeSystem/v3-ActReason code TREAT = 'treatment', stated as 'null'), healthcare payment (Details: http://terminology.hl7.org/CodeSystem/v3-ActReason code HPAYMT = 'healthcare payment', stated as 'null'), healthcare operations (Details: http://terminology.hl7.org/CodeSystem/v3-ActReason code HOPERAT = 'healthcare operations', stated as 'null')

provision

type: permit

actor

securityLabel: psychiatry disorder information sensitivity (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code PSY = 'psychiatry disorder information sensitivity', stated as 'null'), sexual assault, abuse, or domestic violence information sensitivity (Details: http://terminology.hl7.org/CodeSystem/v3-ActCode code SDV = 'sexual assault, abuse, or domestic violence information sensitivity', stated as 'null')

IUA Access Token

Provided an ITI-71 results in a PERMIT access token issued. That token would have the following residual element to inform the Consent Enforcement Point that it needs to restrict the results.

Given that the token will express the permit portion, the residual would need to express the refinement. This case allows treatment access to normal data, and carves out mental health data and sexual health data as accessible only to Practitioner. The oAuth token would be expressing a general permit for most users to the given patient data. Possibly with scope restrictions based on other business rules, such as a subset of actions (CRUDE) and resources.

The token would need to include an ihe_pcf extension to point at this consent, and that would include a residual to express the refinement. Shown as followed:

For Users that are not Practitioner, the token result will be no different than consent to allow NORMAL data access.

• ITI-71 access token

For the User Practitioner, the token result will be:

• The restriction to the given purpose (Treatment, Payment, and Operations) would be expressed in the ihe_iua extension
  • The other ihe_iua extension parameters are not shown below
• The restriction to just normal data would need to be expressed:
  • First as a forbid everything
  • Second as a permit normal data
  • Third is to permit Mental Health data and Sexual Health Data

"extensions" : {
  "ihe_iua" : {
    ...
    "purpose_of_use" : [{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "TREAT"
      },{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "HPAYMT"
      },{
        "system" : "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code" : "HOPERAT"
    }]
  }
  "ihe_pcf" : {
    "patient_id" : "http://example.org/fhir/Patient/ex-patient",
    "doc_id" : ["http://example.org/fhir/Consent/ex-consent-intermediate-authoredby"],
    "residual" : [
      {
        "type" : "forbid",
      },{
        "type" : "permit",
        "securityLabel" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-Confidentiality",
            "code" : "N"
        }]
      },{
        "type" : "permit",
        "securityLabel" : [{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "PSY"
          },{
            "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
            "code" : "SDV"
        }]
      }
    ]
  }
}