HL7 Czech Health information exchange Implementation Guide, published by HL7 Czech Republic. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7-cz/HIE/ and changes regularly. See the Directory of published versions

Audit Event Content Profiles (ATNA)

This section describes the content of the audit events that an AAfD records in its audit log and makes available to the central Activity Journal (Žurnál činností) through Retrieve ATNA Audit Event [ITI-81]. Audit records are retrieved by data subject – a patient, a healthcare professional or a healthcare provider – and are also used to evaluate security events.

There are the following categories of audit events in the context of HIE:

1. Document management – e.g. a patient's document has been uploaded to the AAfD or a list of document metadata has been retrieved.
2. Access check – the AAfD has checked in the central Consent Registry (Registr oprávnění) whether the patient has granted or restricted access to their health records. The AAfD only reads permissions from the Consent Registry; it does not set them.
3. Access to the audit trail – the Activity Journal has retrieved the audit records of a patient, a healthcare professional or a healthcare provider.
4. Security events – e.g. a connection rejected because of an invalid certificate (mTLS) or a request rejected because of an invalid access token. These events have no code of their own in the table below; they are recorded with DICOM event types as defined in Failed authentication and authorization.

Each category is described as a content profile. The content profiles are based on the AuditEvent resource, which has mapping rules to the DICOM audit message format and thus allows mapping to ATNA.

Recording of the communication security (node identities from mTLS, healthcare provider and IUA access token identifier) is common to all categories and is described in Recording the communication security.

Audit Trail Event Types

The following event types are defined in the CZ Audit Trail Event Types code system and SHALL be supported by an AAfD.

Type	Description	Content profile	Optionality
ATC_DOC_CREATE	Document upload	Document Audit Event Content Profile	R
ATC_DOC_READ	Document retrieval	Document Audit Event Content Profile	R
ATC_DOC_UPDATE	Document or document metadata update	Document Audit Event Content Profile	R
ATC_DOC_DELETE	Document removal	Document Audit Event Content Profile	R
ATC_DOC_SEARCH	Document search	Document Audit Event Content Profile	R
ATC_POL_ACCESS_CHECK	Access check in the Consent Registry	Access Check Audit Event Content Profile	R
ATC_LOG_READ	Access to the audit trail	Access Audit Trail Content Profile	R

Table 1: Audit Trail Event Types

Document Audit Event Content Profile

This content profile describes audit events related to document management. The following data elements SHALL be provided:

Data element	Description	Value
Event type		Document upload, document retrieval, document or document metadata update, document removal, document search
Event date and time		FHIR instant
Participants
Initiator	Patient	Name, RID or DRID
	Patient representative	Name, RID or DRID
	Healthcare professional	Name, KRZP identifier
	Assistant of a healthcare professional	Name, KRZP identifier
	Technical user	Name, identifier
Responsible1	Patient	Name, RID or DRID
	Healthcare professional	Name, KRZP identifier
Healthcare provider	Provider identified in the IUA access token	Name, company ID (IČO)
Purpose of use		NORM, EMER, AUTO
Patient	Concerned patient	RID or DRID
Document2	Document type	typeCode
	Document reference	uniqueId, repositoryUniqueId, homeCommunityId
	Document title	title

¹ If different from the initiator (e.g. a patient representative acts on behalf of a patient, then the patient is responsible).
² Required for document upload, retrieval, update and removal, but not for document search.

Table 2: Document Audit Event Data Elements

The structure of the audit events of the individual MHD transactions is defined by the ITI-65, ITI-66, ITI-67 and ITI-68 profiles and the general CZ Document Audit Event profile.

Access Check Audit Event Content Profile

Before making health records available, the AAfD checks in the central Consent Registry whether the patient has granted or restricted access for a third party (MZ REST or the planned [ITI-108] transaction). The AAfD records every such check as an audit event. The following data elements SHALL be provided:

Data element	Description	Value
Event type		Access check in the Consent Registry (ATC_POL_ACCESS_CHECK)
Event date and time		FHIR instant
Participants
AAfD	AAfD performing the check	Name, HCID
Consent Registry	Central eHealth service	Name, service address
Healthcare provider	Provider identified in the IUA access token	Name, company ID (IČO), token identifier (jti)
Healthcare professional	Professional for whom access is checked (if present in the request context)	Name, KRZP identifier
Purpose of use		NORM, EMER, AUTO
Patient	Patient whose records are concerned	RID or DRID
Decision	Decision of the Consent Registry	permit, restrict, deny
Transaction	traceparent of the transaction in which the check was performed (ITI-66, ITI-67, ITI-68)	traceparent

Table 3: Access Check Audit Event Data Elements

The structure is defined by the CZ Access Check Audit Event profile, see also the example.

Access Audit Trail Content Profile

This content profile describes the audit event recorded by the Audit Record Repository when the Activity Journal retrieves audit records with ITI-81. The following data elements SHALL be provided:

Data element	Description	Value
Event type		Access to the audit trail (ATC_LOG_READ)
Event date and time		FHIR instant
Participants
Initiator	Activity Journal (central eHealth service)	Identity from the mTLS certificate and the access token
Audit Record Repository	Repository that returned the audit records	Name, HCID of the AAfD
Query subject	Patient	RID or DRID
	Healthcare professional	KRZP identifier
	Healthcare provider	Company ID (IČO)

Table 4: Access Audit Trail Data Elements

Examples

To be added.