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Excerpt
Access to eHealth services and eHealth data in the eHealth Infrastructure are

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controlled by authentication and authorization based on tokens.

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The Token based security is described in Token Based Security. This page described how services in the eHealth Infrastructure rely on fields in the JWT access token to perform the access control. This access control comprises Role

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Based Access Control (RBAC) and Attribute Based Access Control (ABAC).

Content on this page

Table of Contents

Role-Based Access Control

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Access Token Field

Meaning

Example Value

realm_access

List of process privileges, that is, what is the user allowed to do.

Code Block

language	json

"realm_access": {


    "roles": [


       "Patient.read",


       "Patient.write"

What operations the user is allowed to invoke is stated in the "realm_access" attribute. In the example above the user is allowed to issue a "Patient.read" and a "Patient.write". This means that the user can get and edit patient records. This part of the security model is the RBAC part, as the claims here are entirely based on what role the user has.

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Access Token Field

Meaning

Example Value

context

List of items that are set in context. context in combination with items in realm_access governs the access to all resources in the eHealth infrastructure.

Code Block

language	json

"context": {


    "organization_id" : "https://fut.com/fhir/Organization/1",


    "care_team_id": https://fut.com/fhir/CareTeam/4,


    "episode_of_care_id": https://fut.com/fhir/EpisodeOfCare/10,


    "patient_id": "https://fut.com/fhir/Patient/8"

user_id

Id of the user. Can be either an FHIR patient Id, FHIR practitioner Id or a KeyCloak ID

"user_id": " e03ccef7-b0b1-4f68-8e16-6fc2f865a922"

user_type

Can be either SYSTEM, PATIENT, PRACTITIONER or SSL

"user_type": "PATIENT"

Each resource type (see IG Profiles) has certain restrictions to what context is required to allow data retrieval or data manipulation.

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These resources are not patient-related. Read and Search operations do not require any security context apart from the privilege.

PlanDefinition/ActivityDefinition

User Type

FHIR Operation

Organization Context

Property updated → role needed

Practitioner

create/update

required:

must match modifierRole.reference

PlanDefinition/ActivityDefinition creation or modifierRole changed → owner

All other updates → owner or co-author

System

-

PlanDefinition$apply

User Type

EpisodeOfCare Context

CareTeam Context

Practitioner

required:

Must match EpisodeOfCare.id

required:

Must match EpisodeOfCare.team

System

-

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These resources are not patient-related.

User Type	Context
DocumentReference.read/search
Practitioner / Patient	-
System	-

Read and Search operations do not require any security context apart from the privilege.

DocumentReference.create/update

User Type

Organization Context

Practitioner / Patient

required:

must match DocumentReference.custodian

System

-

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EpisodeOfCare cannot be created directly. They are created by calling the custom operation: create-episode-of-care

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
EpisodeOfCare.create-episode-of-care
Practitioner	must not be present	required: must match EpisodeOfCare.Patient	required: Must match EpisodeOfCare.team
The patient	must not be present	required: must match EpisodeOfCare.Patient	-
System	-	-	-

EpisodeOfCare.read

User Type

EpisodeOfCare Context

Practitioner/Patient

required:

must match EpisodeOfCare

System

-

User Type	EpisodeOfCare Context	CareTeam Context
EpisodeOfCare.patch/updateCareteams
Practitioner	required: must match EpisodeOfCare	required: Must match EpisodeOfCare.team
Patient	required: must match EpisodeOfCare	-
System	-	-

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
EpisodeOfCare.search
Practitioner	must not be present	optional but when present: must match the Patient search parameter	required: Must match CareTeam search parameter
Patient	must not be present	Always present: must match the Patient search parameter	-
System	-	-	-

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
Condition
Practitioner	required: must match Condition.episodeOfCare	required: must match Condition.subject	-
Practitioner	required: must match Condition.episodeOfCare	required: must match Condition.subject	-
Patient	required: must match Condition.episodeOfCare	required: must match Condition.subject	-
Patient	required: must match Condition.episodeOfCare	required: must match Condition.subject	-
System	-	-	-

User Type	EpisodeOfCare Context	CareTeam Context
Provenance.read
Practitioner	required: must match Provenance.target	-
Practitioner	required: must match Provenance.target	-
Patient	required: must match Provenance.target	-
Patient	required: must match Provenance.target	-
System	-	-

User Type	EpisodeOfCare Context	CareTeam Context
Provenance.search
Practitioner	required: must match the EpisodeOfCare search parameter (provenance.target)	-
Patient	required: must match the EpisodeOfCare search parameter (provenance.target)	-
System	-	-

User Type	EpisodeOfCare Context	Patient context	CareTeam Context
Consent.create/read/patch
Practitioner	Required Must match data.reference	Required Must match data.patient	-
Patient	Required Must match data.reference	Required Must match data.patient	-
System	-	-	-

User Type	EpisodeOfCare Context	CareTeam Context
Consent.search
Practitioner	required: must match the EpisodeOfCare search parameter (consent.data.reference)	-
Patient	required: must match the EpisodeOfCare search parameter (consent.data.reference)	-
System	-	-

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User Type	Patient Context	EpisodeOfCare Context	CareTeam Context
Goal Search
Practitioner	-	required: must match search param: addresses.episodeOfCare	required: must match search param addresses.episodeOfCare.team or Careplan.careteam for the CarePlan that the addresses ServiceRequest belongs to.
Patient	required: Must match search param addresses.subject	-	-
Patient	required: Must match search param addresses.subject	-	-
System	-	-	-

CommunicationRequest

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context	Details
CommunicationRequest Create/Read/Update/Delete
Practitioner	required must match CommunicationRequest.episodeOfCare	required must match CommunicationRequest.subject	required must match CommunicationRequest.recipient if the recipient contains a careteam
Practitioner	required must match CommunicationRequest.episodeOfCare	required must match CommunicationRequest.subject
Patient	optional but when present: must match CommunicationRequest.episodeOfCare	required must match CommunicationRequest.subject	-	Update: Only status
Patient		required must match CommunicationRequest.subject	-
System	-		-

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
CommunicationRequest Search
Practitioner	required if the searchparam recipient is a patient. optional otherwise. must match searchparam CommunicationRequest.episodeOfCare when present	optional but when present: must match searchparam CommunicationRequest.subject	required if searchparam recipient is a careteam
Patient	optional but when present must match CommunicationRequest.episodeOfCare	Always present and must match searchparam CommunicationRequest.recipient	-
Patient			-
System	-	-	-

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context	Details
Draft of FUTURE change as a consequence of CCR154: CommunicationRequest Create/Read/Update/Delete
Practitioner	CommunicationRequest.episodeOfCare and EpisodeOfCare security token context must match. If CommunicationRequest.episodeOfCare is null then the security token must not have an episodeOfCare context	required must match CommunicationRequest.subject	required must match CommunicationRequest.recipient if the recipient contains a careteam
Practitioner		required must match CommunicationRequest.subject
Patient	optional but when present it must match CommunicationRequest.episodeOfCare If CommunicationRequest.episodeOfCare is null then the security token must not have an episodeOfCare context	required must match CommunicationRequest.subject	-	Update: Only status
Patient		required must match CommunicationRequest.subject	-
System	-		-

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
Draft of FUTURE change as a consequence of CCR154: CommunicationRequest Search
Practitioner	If EpisodeOfCare context is present, then searchparam and context must match If EpisodeOfCare context is not present, then the search parameter must include at least one of: episodeOfCare:missing=true recipient=<careteam> matching CareTeam context	optional but when present: must match searchparam patient	required if the search param recipient is a careteam. The search param and careteam context must match.
Patient	optional but when present must match searchparam: episodeOfCare	Always present and must match searchparam CommunicationRequest.recipient	-
Patient			-
System	-	-	-

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User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
ClinicalImpression.search
Practitioner	optional but when when present:must do not need to match searchparam: episodeOfCare	optional must match searchparam: subject Only checked if EOC context is not present:	required: either searchparam: episodeOfCare or searchparam: careplan must be provided: if searchparam: episodeOfCare is provided: CareTeam context must be in EpisodeOfCare.team for all referenced EpisodeOfCare ids if searchparam: careplan is provided: CareTeam context must be in CarePlan.careTeam for all referenced CarePlan.
Patient	optional but when present: must match searchparam: episodeOfCare	required when EpisodeOfCare Context is not present: must match searchparam: subject	-
Patient			-
System	-	-	-

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User Type	EpisodeOfCare Context	Patient Context	CareTeam Context / UserId	Extra Permission
Task create/read/update
Practitioner	optional but when present: must match Task.episodeOfCare	optional, but when present: must match Task.episis odeOfCareepisodeOfCare.subject	CareTeam Context must match Task.responsible	User must have at least one corresponding restriction category privilege in Task.restriction-category.
Practitioner	optional but when present: must match Task.episodeOfCare		UserID must match Task.responsible, Task.owner or Task.requester
Patient	optional but when present: must match Task.episodeOfCare	required when EOC context is not present: must match Task.episodeOfCare.subject	UserID must match Task.responsible, Task.owner or Task.requester
Patient	optional but when present: must match Task.episodeOfCare
System	-	-	-

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User Type	EpisodeOfCare Context	Patient Context	CareTeam Context / UserId	Extra Permission
Task search
Practitioner	optional but when present: must match searchparam episodeOfCare	optional must match searchparam ContextEpisodeOfCare.subject Only checked if EOC context is not present:	CareTeam Context must match searchparam responsible	Users must have all restriction category privileges corresponding to the list in searchparam restriction-category.
Practitioner			UserID must match searchparam: Responsible, Owner or Requester
Patient	optional but when present: must match searchparam episodeOfCare	required when EpisodeOfCare Context is not present: must match searchparam theContextEpisodeOfCare.subject	UserID must match searchparam: Responsible, Owner or Requester
Patient
System	-	-	-

Draft of FUTURE change as a consequence of CCR0219: Task create/read/update
User Type	EpisodeOfCare Context	Patient Context	CareTeam Context / UserId	Extra Permission
Practitioner	optional but when present: must match Task.episodeOfCare	optional, but when present: must match Task.episodeOfCare.subject	CareTeam Context must match Task.responsible	User must have at least one corresponding restriction category privilege in Task.restriction-category.
			CareTeam Context must match one of Task.episodeOfCare.team (list)
			UserID must match Task.responsible, Task.owner or Task.requester	(not checked when UserID match searchparam: Responsible, Owner or Requester)
Patient	optional but when present: must match Task.episodeOfCare	required when EOC context is not present: must match Task.episodeOfCare.subject	UserID must match Task.responsible, Task.owner or Task.requester	-
System	-	-	-	-

Draft of FUTURE change as a consequence of CCR0219: Task search
User Type	EpisodeOfCare Context	Patient Context	CareTeam Context / UserId	Extra Permission
Practitioner	optional, but when present must match searchparam episodeOfCare	(Not checked as EOC context when present)	CareTeam Context must match searchparam responsible	Users must have all restriction category privileges corresponding to the list in searchparam restriction-category.
			CareTeam Context must match one of Task.episodeOfCare.team (list)
			UserID must match searchparam: Responsible, Owner or Requester	(not checked when UserID match searchparam: Responsible, Owner or Requester)
	(not present)	Checked when EOC context is not present: must match searchparam EpisodeOfCare.subject	CareTeam Context must match searchparam responsible	Users must have all restriction category privileges corresponding to the list in searchparam restriction-category.
			CareTeam Context must match one of Task.episodeOfCare.team (list)
			UserID must match searchparam: Responsible, Owner or Requester	(not checked if when UserID match searchparam: Responsible, Owner or Requester)
Patient	optional but when present: must match searchparam episodeOfCare	required when EpisodeOfCare Context is not present: must match searchparam EpisodeOfCare.subject	UserID must match searchparam: Responsible, Owner or Requester	-
System	-	-	-	-

When searching for tasks based on careteam, it is possible, but not necessary to specify restriction categories. If they are not specified as search criteria, then they will be inferred from the privileges in the security token.

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Privately owned devices do not have context checks. The tables below are valid for devices owned by organizations.

User Type	Organization Context	Patient Context
Device/DeviceMetric create/update/delete
SSL supplier/Practitioner	required must match the Device.owner organization	Optional but when present: must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device.
Patient	-	must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device.
System	-

User Type	Patient Context	Organization Context
Device read
SSL supplier/Practitioner	Optional but when present: must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device.	Required if patient context is not present. Must match the device.owner
Patient	must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device.	-
System		-

DeviceUseStatement create/update

User Type

Patient Context

Organization Context

SSL supplier/Practitioner

required

must match DeviceUseStatement.subject

required

must match the Device.owner organization

System

-

User Type	Patient Context	Organization Context
DeviceUseStatement read
SSL supplier/Practitioner	required must match DeviceUseStatement.subject	-
Patient	must match a DeviceUseStatement.subject	-
System	-	-

Device/DeviceMetric/DeviceUseStatement - Work in Progress (will be in effect with next release)

User Type	Organization Context	Patient Context
Device/DeviceMetric create
SSL supplier/Practitioner	required must match the Device.owner organization when the non-privately owned device	-
Patient (Must be privately owned device)	-	must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device or have no related DeviceUseStatement.
System	-	-

User Type	Organization Context	Patient Context
Device/DeviceMetric update/delete
SSL supplier/Practitioner	required must match the Device.owner organization when the non-privately owned device	Optional but when present: must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatematch device references the device. or have no related DeviceUseStatement.
Patient	-	must match a DeviceUseStatement where: DeviceUseStatement subject = patient context DeviceUseStatement device references the device or has no related DeviceUseStatement. The device must be privately owned.
System	-

User Type	Organization Context	Patient Context
DeviceUseStatement create/update
SSL supplier/Practitioner	required must match the Device.owner organization when the non-privately owned device	required must match DeviceUseStatement.subject
Patient	-	required. The DeviceUseStatement must have: DeviceUseStatement subject = patient context DeviceUseStatement device references the device The device must be privately owned.
System	-

User Type	Organization Context	Patient Context
DeviceUseStatement read
SSL supplier/Practitioner	-	required must match DeviceUseStatement.subject
Patient	-	required must match DeviceUseStatement.subject
System	-	-

User Type	Organization Context	Patient Context
DeviceUseStatement search
SSL supplier/Practitioner	-	required patient search param must match the context
Patient	-	required patient search param must match the context
System	-	-

Questionnaire

User Type	FHIR Operation	Organization Context	Property updated	Role needed
Questionnaire
Practitioner / Patient	create	required: must match Questionnaire.modifierRole.reference	-	owner
	update	required: must match Questionnaire.modifierRole.reference	Questionnaire.modifierRole	owner
	update	required: must match Questionnaire.modifierRole.reference	Not Questionnaire.modifierRole	owner or co-author
	delete	required: must match Questionnaire.modifierRole.reference	-	owner
	read/search	-	-	-
System	-	-	-	-

Actionguidance

User Type	FHIR Operation	Organization Context	Property updated	Role needed
Actionguidance
Practitioner / Patient	create	required: must match Actionguidance.modifierRole.reference	-	owner
	update	required: must match Actionguidance.modifierRole.reference	Actionguidance.modifierRole	owner
	update	required: must match Actionguidance.modifierRole.reference	Not Actionguidance.modifierRole	owner or co-author
	read/search	- Note: There are two ways to be able to search. First, if permission for both Actionguidance and view is present, it will give access. Secondly, to search, an actionguidance permission should be present, and the resource should be supplied as part of the profile search or as the search field code. All other cases will be rejected. Values to supply for a profile search profile=http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-actionguidance Values to supply for a code search code=http://ehealth.sundhed.dk/cs/basic-resource-type\|actionguidance	-	-
System	-	-	-	-

View

User Type	FHIR Operation	Organization Context	Property updated	Role needed
View
Practitioner / Patient	create	required: must match View.modifierRole.reference	-	owner
	update	required: must match View.modifierRole.reference	View.modifierRole	owner
	update	required: must match View.modifierRole.reference	Not View.modifierRole	owner or co-author
	read/search	- Note: There are two ways to be able to search. First, if permission for both View and view is present, it will give access. Secondly, to search, a View permission should be present, and the resource should be supplied as part of the profile search or as the search field code. All other cases will be rejected. Values to supply for a profile search profile=http://ehealth.sundhed.dk/fhir/StructureDefinition/ehealth-view Values to supply for a code search code=http://ehealth.sundhed.dk/cs/basic-resource-type\|view	-	-
System	-	-	-	-

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There are no context checks for CRUD and search operations for the Library resource.

User Type	EpisodeOfCare Context	Patient Context	CareTeam Context
Library evaluate
Practitioner	required: must match either Observation.episodeOfCare or QuestionnaireResponse.episodeOfCare	required: must match either Observation.subject or QuestionnaireResponse.subject	-
Patient	required: must match either Observation.episodeOfCare or QuestionnaireResponse.episodeOfCare	required: must match either Observation.subject or QuestionnaireResponse.subject	-
System	-	-	-

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User Type	Organization Context
custom/findOrCreateParty
SSL supplier	required: must match the organization parameter
Practitioner	required: must match the organization parameter
System	-

Reports

Schedule/Fetch <Report_name>

User Type

Organization Context

UserID

Extra permission

Practitioner

required

Must match input parameter: ManagingOrganization

Only the user that called schedule is allowed to read the resulting /fhir/Binary/id

The privilege Report.non-anonymized is required if input parameter: anonymization == false

System-user

System users can't have an organization context

Only the user that called schedule is allowed to read the resulting /fhir/Binary/id

The privilege Report.non-anonymized is required if input parameter: anonymization == false

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realm_access.role	Patient Context	CareTeam Context	Extra Rules / Comments
Patient.read	R*	R*	REGULAR SEARCH: To perform a regular Patient Search, the user MUST have the Patient Context. LIMITED SEARCH (Dashboard Search): It is also possible to perform a patient search witha CareTeam Context instead of a Patient Context. In that case, the patients are then retrieved from EpisodesOfCare and CarePlan objects that the CareTeam is involved in. NOTE: The patient resources that are returned from this search are limited and as such only the following information is returned: Identifier Date of Birth Gender Cpr Deceased status Home address Official name *R - THE CONTEXTS ARE MUTUALLY EXCLUSIVE, AS SUCH IF BOTH CONTEXTS ARE PROVIDED IN THE TOKEN, ONLY THE PATIENT CONTEXT IS USED.****
Patient.write	R		1: FHIR operations "create" and "update" are not available on the Patient resource. (use $createPatient and "patch") 2: Only certain attributes are allowed to be patched using HTTP PATCH
Patient$updatePatientWithSKRSData
Patient$createPatient
Appointment.read	U	U	For non-group appointments: 1: If an appointment involves a patient, then that patient must be in context 2: The appointment can be read if the user has a Care Team in context that is participating in the appointment the user is participating in the appointment (as a Practitioner or Patient) 3: Searching PATIENT users can search all Appointments that involve the user itself PRACTITIONER/SSL users can search all Appointments that involve the user itself, or the Organization/CareTeam/Patient in context
Appointment.write	U	U	For non-group appointments: 1: If an appointment involves a patient, then that patient must be in context 2: The appointment can be written if the user has a Care Team in context that is participating in the appointment the user is participating in the appointment (as a Practitioner or Patient)
Appointment$exportAsiCal	U	U	The same rules apply to reading appointments Note: Only PRACTITIONER/SSL users can see the names of Practitioner participants in the exported iCal object
RelatedPerson.read	R		Only related persons to the patient in context can be read
RelatedPerson.write	R		Only related persons to the patient in context can be written
Communication.read		U	If the message has a restriction category X, the corresponding RestrictionCategory.X role must be present in the realm_access list. 1: PATIENT users can read communication where they are either the sender or recipient 2: PRACTITIONER and SSL users can read communication where they are either the sender or recipient communication where the CareTeam in context is the sender or recipient 3: Only SYSTEM users can read communication from DEVICE senders
Communication.write		U	1: Communication must have exactly one sender and one recipient 2: Communication with the category "note" can only be created/patched/deleted if user = sender and (recipient = sender or recipient = a CareTeam). (notes can be shared with any CareTeam) 3: PATIENT users can only create/delete "mesHTTP" communication where they are the sender, and the recipient is of type CareTeam can only patch "message" communication where they are sender or recipient (the recipient can patch "received" property) 4: PRACTITIONER and SSL users can only create/delete "message" communication where the sender is the CareTeam in context and the recipient is of type PATIENT or type CareTeam can only patch "message" communication where the CareTeam in context is the sender or recipient
Person$match			Only requires the role “Person$match” Used to lookup person data by CPR, including name and a patient reference, if one exists. This is only a read operation and will not create any resources. The operations are audit logged.

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Page Comparison

Versions Compared

Old Version 40

New Version Current

Key

Content on this page

Role-Based Access Control

PlanDefinition/ActivityDefinition

PlanDefinition$apply

DocumentReference.read/search

DocumentReference.create/update

EpisodeOfCare.create-episode-of-care

EpisodeOfCare.read

EpisodeOfCare.patch/updateCareteams

EpisodeOfCare.search

Condition

Provenance.read

Provenance.search

Consent.create/read/patch

Consent.search

Goal Search

CommunicationRequest

CommunicationRequest Create/Read/Update/Delete

CommunicationRequest Search

Draft of FUTURE change as a consequence of CCR154: CommunicationRequest Search

ClinicalImpression.search

Task create/read/update

Task search

Draft of FUTURE change as a consequence of CCR0219: Task create/read/update

Draft of FUTURE change as a consequence of CCR0219: Task search

Device/DeviceMetric create/update/delete

Device read

DeviceUseStatement create/update

DeviceUseStatement read

Device/DeviceMetric/DeviceUseStatement - Work in Progress (will be in effect with next release)

Device/DeviceMetric create

Device/DeviceMetric update/delete

DeviceUseStatement create/update

DeviceUseStatement read

DeviceUseStatement search

Questionnaire

Questionnaire

Actionguidance

Actionguidance

View

View

Library evaluate

Reports

Schedule/Fetch <Report_name>