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[跨部门患者记录和远程会诊的同意管理与工作流程]

[Consent management and workflows for cross-sectoral patient records and teleconsultations].

作者信息

Bauer J, Rohner-Rojas S, Holderried M

机构信息

Geschäftsbereich Informationstechnologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 9, 72076, Tübingen, Deutschland.

Zentralbereich Medizin: Struktur‑, Prozess- und Qualitätsmanagement, Universitätsklinikum Tübingen, Tübingen, Deutschland.

出版信息

Radiologe. 2020 May;60(5):430-439. doi: 10.1007/s00117-020-00655-9.

Abstract

Cross-enterprise electronic patient records are a key element in the design of interoperable medical care networks and process chains. However, the different requirements concerning type, performance and quality assurance of available communication services within the different healthcare sectors still require that the hospitals participate in various secure communication networks which have to be bridged for cross-sectoral communication. Cross-institutional pathways for telemedicine, however, can be mapped both within and across sectoral boundaries via automated process chains using the IHE (Integrating the Healthcare Enterprise) defined integration profile CrossEnterprise Document Sharing (XDS) and associated integration profiles. The provision of medical documents in a cross-institutional patient record outside of defined medical pathways requires differentiated authorization management. In this respect, consent documents according to the IHE APPC (Advanced Patient Privacy Consents) profile enable the documentation of the patient's consent, including information about planned authorized people, document types, period and type of document access allowed. Providing access control to medical documentation by the patients themselves is an essential part of the required focusing of medical services on patients. New interoperability standards optimized for use on mobile devices, such as FHIR (Fast Healthcare Interoperability Resources), will enable simplified delivery of patient-centered health records and other medical services on mobile platforms in the future.

摘要

跨企业电子病历是可互操作医疗网络和流程链设计的关键要素。然而,不同医疗保健部门对现有通信服务的类型、性能和质量保证的不同要求,仍使得医院需要参与各种安全通信网络,而跨部门通信必须跨越这些网络。不过,通过使用IHE(整合医疗企业)定义的集成规范“跨企业文档共享”(XDS)及相关集成规范的自动化流程链,可在部门边界内和跨部门边界映射远程医疗的跨机构路径。在定义的医疗路径之外的跨机构患者记录中提供医疗文档需要差异化的授权管理。在这方面,符合IHE APPC(高级患者隐私同意书)规范的同意书能够记录患者的同意情况,包括有关计划授权人员、文档类型、文档访问期限和允许访问类型的信息。患者自身对医疗文档的访问控制是将医疗服务重点放在患者身上的必要组成部分。针对移动设备使用进行优化的新互操作性标准,如FHIR(快速医疗互操作性资源),将在未来实现以患者为中心的健康记录和其他医疗服务在移动平台上的简化交付。

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