Enforcing Careflows and Treatment Consents in Electronic Medical Record Systems




Yu, Bo

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Procedure-oriented medical treatments specify processes that embody years of experience, must be followed by care team members and have become standards of care that avoid known care procedure pitfalls. Referred to as "medical treatment workflow," these workflows are not embedded in, nor enforced by, existing Electronic Medical Record (EMR) systems. This dissertation shows a method to incorporate medical workflows into existing EMR systems with flexibility to handle unanticipated exceptions. Developing prototypes for surgical and hemodialysis (HD) procedures shows the utility and flexibility of the proposed method. Second, receiving medical treatment, choosing an alternative treatment or terminating treatment requires the patient's explicit or derived informed consent whether or not electronic systems are used. Failure to obtain informed consent is a top-ten reason for medical malpractice claims in the United States. Consequently, e-healthcare systems need effective, indeed flawless, consent management. This dissertation provides a method to incorporate medical treatment consent into existing EMR systems. The responsibility of obtaining consent in EMR systems is complex in and of itself, but much more so for obtaining appropriate consent from minors. I establish the utility and flexibility of this method by prototyping a system that enforces treatment consent for adolescent and adult treatments across all 50 states that have state-specified regulations that vary widely. I further establish that these varying and changing regulations can be enforced by a single system.



Electronic Medical Record (EMR) System, Medical Treatment Consent, Medical Treatment Workflow, Ontology, Workflow Enforcement, Workflow Management Technology