保留患者故事：从传统病历到数字病历转变的生物伦理与法律影响
Preserving Patient Stories: Bioethical and Legal Implications Related to the Shift from Traditional to Digital Anamnesis.
作者信息
Gibelli Filippo, Bailo Paolo, Pesel Giuliano, Ricci Giovanna
机构信息
Section of Legal Medicine, School of Law, University of Camerino, 62032 Camerino, Italy.
出版信息
Clin Pract. 2024 Jun 21;14(4):1196-1213. doi: 10.3390/clinpract14040095.
It is since the beginning of the so-called 'digital revolution' in the 1950s that technological tools have been developed to simplify and optimise traditional, time-consuming, and laborious anamnestic collection for many physicians. In recent years, more and more sophisticated 'automated' anamnestic collection systems have been developed, to the extent that they can actually enter daily clinical practice. This article not only provides a historical overview of the evolution of such tools, but also explores the ethical and medico-legal implications of the transition from traditional to digital anamnesis, including the protection of data confidentiality, the preservation of the communicative effectiveness of the doctor-patient dialogue and the safety of care in patients with poor digital and health literacy.
自20世纪50年代所谓的“数字革命”开始以来，人们开发了各种技术工具，以简化和优化许多医生传统的、耗时费力的问诊过程。近年来，越来越复杂的“自动化”问诊收集系统得以开发，甚至可以实际应用于日常临床实践。本文不仅提供了此类工具演变的历史概述，还探讨了从传统问诊向数字问诊转变所涉及的伦理和医学法律问题，包括数据保密性保护、医患对话沟通有效性的维护，以及数字和健康素养较低患者的医疗安全。
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