PSHD (Patient-Shared Health Document)

import { IPS, SHL, CODE_SYSTEMS } from "@fhirfly-io/shl";
import { readFileSync } from "node:fs";

// 1. Build the FHIR Bundle with PSHD profile
const bundle = new IPS.Bundle({
  given: "Jane",
  family: "Doe",
  birthDate: "1990-01-15",
  gender: "female",
});

bundle.addMedication({
  code: "860975",
  system: CODE_SYSTEMS.RXNORM,
  display: "Metformin 500 MG Oral Tablet",
  status: "active",
});

bundle.addCondition({
  code: "44054006",
  system: CODE_SYSTEMS.SNOMED,
  display: "Type 2 diabetes mellitus",
  clinicalStatus: "active",
});

// PSHD requires at least one PDF document
const pdfContent = readFileSync("./patient-summary.pdf");
bundle.addDocument({ title: "Patient Summary", content: pdfContent });

// Validate before building
const validation = bundle.validate({ profile: "pshd" });
if (!validation.valid) {
  console.error("Validation errors:", validation.issues);
  process.exit(1);
}

const fhirBundle = await bundle.build({ profile: "pshd" });

// 2. Create the SMART Health Link with PSHD compliance
const result = await SHL.create({
  bundle: fhirBundle,
  storage: new SHL.FhirflyStorage({
    apiKey: process.env.FHIRFLY_API_KEY,
  }),
  compliance: "pshd",
  expiresAt: "point-of-care", // 15 minutes (named preset)
  label: "Jane Doe - Patient Summary",
});

console.log(result.url);     // shlink:/eyJ1cmwiOiJodHRwcz...
console.log(result.qrCode);  // data:image/png;base64,...

const result = await SHL.create({
  bundle: fhirBundle,
  storage,
  compliance: "pshd",                          // enforces everything
  expiresAt: new Date(Date.now() + 15 * 60_000),
});

// Direct mode without PSHD bundle constraints
const result = await SHL.create({
  bundle: anyFhirBundle,    // does not need to be a PSHD bundle
  storage,
  mode: "direct",           // flag U, single-request retrieval
  expiresAt: new Date(Date.now() + 60 * 60_000),  // optional here
});

// PSHD bundle profile without direct mode
const fhirBundle = await bundle.build({ profile: "pshd" });
// produces a collection bundle with CMS DocumentReference constraints

PSHD Bundle (type: "collection")        IPS Bundle (type: "document")
├── Patient                              ├── Composition ← not in PSHD
├── MedicationStatement(s)               ├── Patient
├── Condition(s)                         ├── MedicationStatement(s)
├── AllergyIntolerance(s)                ├── Condition(s)
├── Immunization(s)                      ├── AllergyIntolerance(s)
├── Observation(s)                       ├── Immunization(s)
├── DocumentReference (1..1, PDF)        ├── Observation(s)
├── Binary                               └── DocumentReference + Binary

{
  "resourceType": "DocumentReference",
  "status": "current",
  "type": {
    "coding": [{
      "system": "http://loinc.org",
      "code": "60591-5",
      "display": "Patient summary Document"
    }]
  },
  "category": [{
    "coding": [{
      "system": "https://cms.gov/fhir/CodeSystem/patient-shared-category",
      "code": "patient-shared",
      "display": "Patient Shared"
    }]
  }],
  "author": [{ "reference": "urn:uuid:<patient-id>" }],
  "meta": {
    "security": [{
      "system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
      "code": "PATAST",
      "display": "patient asserted"
    }]
  },
  "content": [{
    "attachment": {
      "contentType": "application/pdf",
      "url": "urn:uuid:<binary-id>",
      "title": "Patient Summary"
    }
  }]
}

const result = bundle.validate({ profile: "pshd" });

if (!result.valid) {
  // result.issues contains { severity, message } objects
  for (const issue of result.issues) {
    console.error(`[${issue.severity}] ${issue.message}`);
  }
}

Manifest mode (flag L):                    Direct mode (flag U):
  1. Scan QR → shlink:/                      1. Scan QR → shlink:/
  2. POST /{shlId} → manifest JSON           2. GET /{shlId} → content.jwe
  3. GET /{shlId}/content → content.jwe      (done — single round trip)

// Named presets (v0.5.0+)
expiresAt: "point-of-care"  // 15 minutes
expiresAt: "appointment"    // 24 hours

// Raw Date (still works)
expiresAt: new Date(Date.now() + 4 * 60 * 60_000) // 4 hours

await SHL.create({
  bundle: fhirBundle,
  storage,
  compliance: "pshd",
  expiresAt: new Date(Date.now() + 15 * 60_000),
  maxAccesses: 3, // fail-safe: max 3 scans even within the time window
});

const handler = createHandler({
  storage,
  onAccess: (event) => {
    auditLog.write({
      action: "patient_data_accessed",
      shlId: event.shlId,
      recipient: event.recipient,
      mode: event.mode,
      timestamp: event.timestamp,
    });
  },
});

import { AuditableStorage, AccessEvent, isAuditableStorage } from "@fhirfly-io/shl/server";

class AuditedStorage extends ServerLocalStorage implements AuditableStorage {
  async onAccess(shlId: string, event: AccessEvent): Promise<void> {
    await db.auditLog.insert({
      shlId,
      recipient: event.recipient,
      ip: event.ip,
      timestamp: event.timestamp,
    });
  }
}

app.use("/shl", expressMiddleware({ storage: new AuditedStorage({ ... }) }));

GET /shl/{shlId}?recipient=Dr.%20Smith

// Express
import { expressMiddleware } from "@fhirfly-io/shl/express";

app.use("/shl", expressMiddleware({
  storage,
  onAccess: (event) => {
    console.log(`[SHL] ${event.mode} access to ${event.shlId}`, {
      recipient: event.recipient,
      count: event.accessCount,
    });
  },
}));

// Fastify
import { fastifyPlugin } from "@fhirfly-io/shl/fastify";

app.register(fastifyPlugin({
  storage,
  onAccess: (event) => {
    console.log(`[SHL] ${event.mode} access to ${event.shlId}`);
  },
}), { prefix: "/shl" });

// AWS Lambda
import { lambdaHandler } from "@fhirfly-io/shl/lambda";

export const handler = lambdaHandler({
  storage,
  pathPrefix: "/shl",
  onAccess: async (event) => {
    console.log(JSON.stringify({
      type: "shl_access",
      shlId: event.shlId,
      mode: event.mode,
      recipient: event.recipient,
    }));
  },
});