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Informed Consent in Electronic Medical Record Systems

机译：电子病历系统的知情同意

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摘要

Informed consents, either for treatment or use/disclosure, that protect the privacy of patient information subject to law that in certain circumstances may override patient wishes, are mandatory practice in healthcare. Although the healthcare industry has widely adopted Electronic Medical Record (EMR) systems, consents are still obtained and stored primarily on paper or scanned electronic documents. Integrating a consent management system into an EMR system involves various implementation challenges. The authors show how consents can be electronically obtained and enforced using a system that combines medical workflows and ontologically motivated rule enforcement. Finally, the authors describe an implementation that uses open-source software based addition of these components to an open-source EMR system, so that existing systems needn t be scrapped or otherwise rendered obsolete.
机译：在某些情况下可能会超出患者意愿的法律保护患者信息隐私的治疗或使用/披露知情同意是医疗保健中的强制性做法。尽管医疗保健行业已广泛采用电子病历（EMR）系统，但仍可获得许可并将其主要存储在纸质或扫描的电子文档中。将同意管理系统集成到EMR系统涉及各种实施挑战。作者展示了如何使用结合了医疗工作流程和本体论规则执行的系统以电子方式获得和执行同意。最后，作者描述了一种实现方式，该实现方式使用基于开源软件的这些组件添加到开源EMR系统中，因此无需废弃现有系统或将其过时。

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