Definition

Events that establish, change or terminate the terms and participants to any form of agreement. Can represent:

- a statement about the scope of responsibility that is shared between the patient, sometimes family members, and one or more healthcare providers;

- an agreement between two entities that states the scope of mutual obligations and the respective responsibilities of each party;

- an expression of a person's wishes or directions in advance in the event that mental capacity is diminished in the future.

May include consent or refusal for specific types of treatment, consent to provide donor organs, preference for treatment options acknowledging known risks, etc.

Synonyms

Consent,

Information Consent,

Treatment Consent,

Informed Consent,

Donor Consent,

Consent for Substitute Decision Maker

EHRi Identifier

An identifier will likely need to be generated to identify which set of business rules are in effect for the participating organization.

Care Provision Agreement: The EHRi may need to generate an identifier - or use the same identifier as for the Patient role.

Information Sharing Agreement: The EHRi may need to generate an identifier for each EHRi Client in a jurisdiction, or only for those who have explicit directives.

Definition References

HL7 Patient Care DMIM

Privacy and Security Architecture

Rationale

The CHDM approach separates the event that changes the state of governance from the governance entity itself. HL7 V3 approach retains the event and the record of the governance entity. This is the primary difference in the approaches between the two modeling styles. In the EHRS Reference Architecture context, the accountability governance records may be stored so that they can be used as business rules during the operation of the EHRi. The key characteristics are from the HL7 V3 RIM derived models. Modified name and definition to stand alone and add clarity for the EBE context.

Information Sharing Agreement: Modified name and definition to stand alone and add clarity for the EBE context.

Business Process Implications

Care Provision Agreement: Most business processes today do not explicitly record a care provision agreement but both regulations and professional ethics recognize that the relationship between a patient and their provider has mutually accepted responsibilities. Reaching agreement to explicitly record such an agreement will require change management. As shared responsibilities for care by teams become more prevalent, some formalization of currently implicit agreements may become necessary.

Information Sharing Agreement: Establishing that a specific provider has been given consent by the patient or their representative to access information collected by someone else in the course of providing care may be implicit or may be regulated to be explicit. In a an EHRi context, the recognition of an implicit agreement will need to be recorded explicitly to support appropriate access control. Depending on the jurisdiction, additional business processes may need to be implemented. In particular, since patient identifiers are assigned by the delivery organization,

recognizing specific individual providers

or teams may also be required.

Implementation Implications

Care Provision Agreement: The implicit agreement can be made explicit by recording attributes associated with the referral (self or otherwise) by a person to a new provider. The duration of the care provision agreement is the same as the duration of the patient role.

Information Sharing Agreement: Recording the existence of a patient/provider relationship in a separate consent registry may be required to support appropriate access control. Deriving the necessary information from an initial encounter summary record may be the least disruptive technical solution.

Attributes
Name	Type	Initial Value
Care Agreement Code
Explicit Constraint
Reason

Relations
Name	Type	Begins	Ends
	generalization	Agreeing	Governance Event
	generalization	Care Povision Agreement	Agreeing
	generalization	EHRi Business Arrangement	Agreeing
	generalization	Information Sharing Agreement	Agreeing
	generalization	Consent	Agreeing
	generalization	Consent Directives	Agreeing

Inner Relations
Association Authorized By  [Clinical Document - Consent]
Association Constrains  [Information Sharing Regulations - Information Sharing Agreement]
Association Constrains  [Information Sharing Regulations - Information Sharing Agreement]
Association Includes  [Care Povision Agreement - Information Sharing Agreement]
Association Includes  [Care Povision Agreement - Information Sharing Agreement]
Association Indexes  [Pos System - Care Povision Agreement]
Association Indexes  [Pos System - Care Povision Agreement]
Association May Include  [Information Sharing Agreement - Consent Directives]
Association May Include  [Information Sharing Agreement - Consent Directives]
Association Registers  [Pos System - Care Povision Agreement]
Association Registers  [Pos System - EHRi Business Arrangement]
Association Registers  [Pos System - Care Povision Agreement]
Association Registers  [Pos System - EHRi Business Arrangement]
Association Registers  [Pos System - Information Sharing Agreement]
Association Registers  [Pos System - Information Sharing Agreement]