Verifiable Health Link
0.0.2-current - ci-build

Verifiable Health Link, published by IHE IT Infrastructure Technical Committee. This guide is not an authorized publication; it is the continuous build for version 0.0.2-current built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/IHE/ITI.VHL/ and changes regularly. See the Directory of published versions

## ActorDefinition: VHL Sharer

Official URL: https://profiles.ihe.net/ITI/VHL/ActorDefinition/VHLSharer | Version: 0.0.2-current
Active as of 2026-03-12 | Computable Name: VHLSharer

The VHL Sharer generates a VHL, provides the VHL to a VHL Holder, and responds to requests from a VHL Sharer to utilize the VHL.

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Jurisdiction | 001
Requirements | This actor fulfills the following requirements: Audit Event - Accessed Health Data: Purpose: Ensure that the VHL Sharer records audit events when health documents are accessed or retrieved using a Verified Health Link (VHL). Description: The VHL Sharer MAY record audit events for critical events involving document access. These MAY include: A request from a VHL Holder to generate a VHL A request from a VHL Receiver to retrieve one or more health documents using a valid VHL Any access to protected health content triggered by the use of a VHL Create Secure Channel: The VHL Sharer and VHL Receiver SHALL jointly establish a secure connection prior to executing any Verified Health Link (VHL) transactions involving the exchange of sensitive data. This requirement is satisfied by implementing secure channel establishment as defined in the Audit Trail and Node Authentication (ATNA) Profile, specifically through the Authenticate Node [ITI-19] transaction. This requirement entails: The VHL Receiver initiating a secure connection as the client and presenting valid credentials The VHL Sharer responding as the server, presenting its own credentials and validating the client's credentials against a trusted Certificate Authority or Trust Anchor Establishing this secure channel ensures confidentiality, integrity, and bilateral authentication of all subsequent communications, and fulfills the trust obligations defined in the Establish Trust requirement. Establish Trust: Before participating in any Verified Health Link (VHL) transactions, the VHL Sharer and VHL Receiver SHALL establish a trust relationship based on shared acceptance of a designated Trust Anchor. ​Trust is established by referencing and accepting public key material published and distributed in accordance with this specification ( via Retrieve Trust List Response). All participants MUST validate digital signatures using keys that are anchored in the agreed trust framework. Initiate Retrieve Trust List Request: A VHL Sharer or VHL Receiver, as a participant in the trust network, SHALL be capable of retrieving public key infrastructure (PKI) material from a designated Trust Anchor. The retrieved material MAY include: Public key certificates and associated trust lists Certificate revocation data (e.g., CRLs, OCSP responses) Metadata used to: Validate digital signatures on VHLs and related resources Establish secure connections Decrypt content protected via asymmetric encryption Participants SHOULD cache the received trust list to reduce network and server load. Preconditions: The requesting participant knows in advance the endpoint from which to retrieve PKI material, as published or distributed by the Trust Anchor. Initiate Submit PKI Material Request: When a VHL Sharer or VHL Receiver generates a new public-private key pair for use within the VHL trust network, they SHALL submit the corresponding public key material to the Trust Anchor for validation and inclusion in the trust list. The submission MAY include metadata to support categorization of key usage (e.g., digital signatures, encryption, secure channels) and business or operational context. Receive Trust List: A VHL Sharer or VHL Receiver, after receiving PKI material from a Trust Anchor, SHALL validate and process the trust information for subsequent cryptographic operations. Participants SHOULD: Cache the received trust list or certificate material to reduce network and server load Validate digital signatures or trust paths before use in VHL validation or secure channel sessions Monitor certificate expiration or revocation status where applicable Record Access to Health Data: The VHL Sharer MAY record audit events when health data is accessed through a Verified Health Link (VHL). These events support accountability, traceability, and compliance with applicable security and privacy regulations. Audit records MAY include the following metadata: Timestamp of the access event Identity of the accessing actor (e.g., person or system) Type and identifier of the accessed resource (e.g., DocumentReference) Purpose of access, where available (e.g., treatment, consent verification) Outcome of the event (e.g., success, failure) Audit events SHALL be represented using the FHIR `AuditEvent` resource, and SHOULD conform to applicable IHE profiles such as ATNA where appropriate. Implementers MAY define additional audit logging behavior to meet jurisdictional or organizational policies. Record Consent: The VHL Sharer SHALL record the consent granted by a VHL Holder to authorize the sharing of their health data via a Verified Health Link (VHL). This consent confirms that the Holder agrees to the creation of a VHL and its use by authorized VHL Receivers to access specific health documents. In this requirement, the VHL Sharer acts as a Consent Recorder, as defined in the Privacy Consent on FHIR (PCF) profile. Specifically, the Sharer SHALL initiate the Access Consent - ITI-108 transaction to formally capture the Holder's consent. The ITI-108 transaction SHOULD be invoked as part of the actions triggered by a Generate VHL request, particularly when legal, jurisdictional, or organizational policy requires explicit, recorded consent prior to enabling document sharing. This requirement enables lawful, transparent sharing of personal health information across organizations and trust domains. Generate a VHL Authorization Mechanism Based on Query Parameters: The VHL Sharer SHALL generate a Verified Health Link (VHL) to be issued to a VHL Holder. The Sharer SHALL conduct all necessary tasks to prepare the content referenced by the VHL. These tasks MAY be further defined by applicable content profiles or implementation guides, and MAY include: Generation of new documents in real time; Querying for existing documents (e.g., IPS, CDA, FHIR Bundles) associated with the VHL Holder; or Creation of digital signatures on one or more documents. Once content preparation is complete, the Sharer SHALL construct the VHL payload and sign it to produce a cryptographically verifiable authorization mechanism. Optional behaviors: The Sharer MAY record consent in accordance with the Record Consent requirement. The Sharer MAY log an audit event describing the VHL issuance, in accordance with the Audit Event – Accessed Health Data requirement.