Email addresses

Overview

This document outlines the approach PKB takes to managing how email addresses are added to, and removed from, a patient’s medical record.

Email address status values

Primary status

If one or more email addresses are associated with a medical record, then exactly one must be designated as primary. This is the email address that will receive notifications from PKB. However, any confirmed email addresses may be used to log in.

Confirmed status

Any email address that is added to a medical record is initially set as unconfirmed. First email addresses only become confirmed after the registration process has been completed. Additional email addresses only become confirmed after the patient has clicked the link in a confirmation email sent to the relevant address, and then entered their PKB credentials.

Email address optionality

Medical record

A medical record does not need to be associated with an email address. A medical record can be created and updated by anyone with appropriate permissions, without adding an email address.

Account

However, an email address forms the username for a patient account. As such, an email address must be provided in order for a patient to register for their account, allowing them to log in and access their data.

Adding the first email address

When the first email address for a patient is added to their medical record, the patient will automatically be sent an invitation to register. The invitation email will contain a link that the patient must click, after which they will be presented with a Date Of Birth (DOB) challenge, followed by the main registration screen. If the DOB is known to PKB at the time of registration, the patient must enter the correct value to progress past this screen. This acts as a security check. If the DOB is not known to PKB at the time of registration, then the patient’s answer is automatically treated as correct, and added to the PKB medical record.

Primary status

The first email address for a patient is automatically set as the primary email address.

Confirmed status

When an email address is added to a medical record, that email address is flagged as unconfirmed. If and when the patient completes the registration process, their email address will be marked as confirmed.

HL7 note

An HL7 message that tries to add an email address to a medical record which is already associated with a different medical record will be rejected.

Adding an additional email address

A patient’s account can be associated with multiple email addresses. Additional email addresses can be added at any time after the account has been created.

Primary status

When multiple email addresses are associated with a patient’s account, exactly one of them must be marked as the primary email address. Notifications will only go to the primary email address (although any confirmed email address can be used to authenticate against the web interface). A professional or the patient can change which email address is designated as primary using the web interface.

Confirmed status

An additional email address is initially set as unconfirmed. In order to confirm the email address, the patient must click the link sent to the additional email address, and then log in to their account.

HL7 note

An HL7 message that tries to add an email address to a medical record which is already associated with a different medical record will be rejected.

It is only possible to provide a maximum of 2 email addresses in a single HL7 message - one in PID-13 and one in PID-14. If more than one is provided in either field, the last email address from each field will be used.

Changing an existing email address

An email address cannot normally be changed directly. If it needs to be changed, this must be done by adding an additional email address, and then deleting the old email address if necessary. There is one exception to this; a team coordinator can change the email address associated with a patient that has not yet registered. This functionality is required to ensure a mistake with the first email address does not block access to the account.

Removing an email address

The primary email address cannot be removed from a patient’s account, as this would prevent the patient from being able to log in. Any non-primary email address can be removed within the web interface.

Invalid email addresses

PKB will validate email addresses provided to us and will only accept those that are well-formed. However, PKB will never block an action whilst trying to determine whether the target recipient can be reached via email, since an unsuccessful delivery might take a long time to be detected. As such, there might be invalid email addresses associated with a patient’s medical record. It is not currently possible for a PKB user (e.g. team coordinator) to see a list of email addresses that bounced.

Reminders

It is possible for either a team coordinator or a professional to use the web interface to send a reminder email to a patient, inviting them to register. This might be required if, for example, the patient has had an email address added to their medical record, but lost the original email inviting them to register. In addition, a team coordinator, professional, or the patient themselves can send a reminder email for an additional email address. The reminder email contains the link that the patient must click to confirm that they have access to the additional email address.

Email address of a carer

In some circumstances, a medical record is created for a patient that does not have an email address (e.g. a young child) but who does have a carer (e.g. a parent). In this situation, the email address of the carer should never be assigned as the email address of the patient. Instead, the patient’s medical record should be created first (without an email address), and then a medical record subsequently created for the carer (if they don’t already have one). The carer can then register, and be assigned access to the patient’s medical record. Notifications for a patient are also sent to the primary email address of any carers for that patient. This is the case even if the patient does not have an email address, and the wording of the email subject is modified so that the recipient (carer) can see that the notification relates to another person.

Table of functionality

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