Documentation Index
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Spec: PM-55
Created: 2026-05-06
Status: 📝 Planned (WS1 — schema + permissions)
Overview
PM-55 implements the ONC HTI-1 (45 CFR 170.315(b)(11) and (g)(10)) Patient Access API,
exposing USCDI v3 / US Core 7.0 FHIR R4 resources via SMART App Launch with OAuth2.
It also delivers the 21st Century Cures Act §4004 information-blocking review workflow
for Compliance Officers. PM-55 is the canonical PM owner of FHIR access logging,
app-authorization consent, and information-blocking dispositions.
Integration Points
| PF Feature | Integration Type | Usage |
|---|
| PF-01 (Organizations & Sites) | Direct | Tenant isolation on every FHIR resource read |
| PF-02 (RBAC) | Direct | pm.fhir.app.manage, pm.fhir.consent.*, pm.compliance.* keys |
| PF-04 (Audit & Event Stream) | Direct | pm.fhir_access_logged per FHIR request; immutable audit |
| PF-10 (Notifications) | Platform Integration Layer | Compliance review queue assignment notifications |
| PF-96 (Jurisdiction Profiles) | Platform Integration Layer | State info-blocking carve-outs (e.g., NY mental health, MA HIV) |
| PF-12 (Patient Portal Shell) | UI host | AuthorizedAppsPage, AppConsentSheet rendered inside portal shell |
Same-Core Dependencies
| PM Feature | Integration Type | Usage |
|---|
| PM-01 (Patient Demographics) | Direct read | Source for Patient FHIR resource (uses pm_patients.id as bare UUID) |
| PM-02 (Insurance) | Direct read | Source for Coverage FHIR resource |
| PM-03 (Scheduling) | Direct read | Source for Appointment FHIR resource via pm_appointments |
| PM-08 (Claims) | Direct read | Source for ExplanationOfBenefit FHIR resource |
Cross-Core Dependencies
| Feature | Integration Type | Usage |
|---|
| CL-11 (42 CFR Part 2 Consent) | Platform Integration Layer (@/platform/clinical) | cl_part2_check(patient_id, scope) SECURITY DEFINER helper gates serialization of Condition / Observation / DocumentReference resources flagged as SUD. Fail-closed if helper returns NULL. |
| GR-08 (Incident Reporting) | Event subscriber | Consumes pm.fhir_information_blocking_logged when disposition = info_blocking to open governance incident |
cl.part2_consent_granted / cl.part2_consent_revoked events and provide cl_part2_check() helper. Tracked in PENDING_CONTRACTS.md.
Events Published
| Event Name | Publisher | Subscribers | Status |
|---|
pm.fhir_app_authorized | PM-55 | (available — PF-04 audit) | 📝 Planned |
pm.fhir_app_revoked | PM-55 | (available — PF-04 audit) | 📝 Planned |
pm.fhir_information_blocking_logged | PM-55 | GR-08 (when category = info_blocking) | 📝 Planned |
pm.fhir_access_logged | PM-55 | PF-04 audit stream | 📝 Planned |
EVENT_CONTRACTS.md for schemas.
Events Consumed
| Event Name | Source | Usage |
|---|
cl.part2_consent_granted | CL-11 (pending) | Refresh in-memory Part 2 gate cache for affected patient |
cl.part2_consent_revoked | CL-11 (pending) | Invalidate cache; subsequent FHIR reads of SUD resources fail closed |
Database Tables
| Table | Purpose | RLS |
|---|
pm_fhir_app_registrations | SMART app metadata, JWKS, redirect URIs | Org admin manage; portal-patient read own consents only |
pm_patient_access_consents | Patient-granted scopes per app, expiration, revocation | Patient (portal) self-scoped; org admin read |
pm_fhir_access_log | Append-only access log (resource type, scope, status, timestamp) | Org admin read; INSERT-only by service role |
pm_information_blocking_log | Exception entries with disposition workflow | pm.compliance.review to read; pm.compliance.disposition to update |
organization_id, created_at, updated_at, custom_fields JSONB
(except append-only audit tables — pending governance confirmation).
FK on pm_patient_access_consents.consent_id references cl_consents.id.
Permissions
See spec § Permission Inventory. Constants exposed via PM_PERMISSIONS in
src/platform/permissions/constants.ts.
Compliance References
- ONC HTI-1: 45 CFR 170.315(b)(11), (g)(10)
- 21st Century Cures Act §4004 — Information Blocking
- HIPAA Privacy (45 CFR 164.524) and Security (45 CFR 164.312)
- 42 CFR Part 2 — SUD confidentiality (gating via CL-11)
- US Core IG 7.0 / USCDI v3
Pending Compliance Officer signoff: specs/pm/reviews/PM-55-COMPLIANCE-SIGNOFF.md.
