When patient information is requested, Kairon identifies relevant rules from all relevant stakeholders, mixing them together into a prioritized ruleset. ![]() The figure below (Figure 3) shows the release process. To insulate patients from complexity, we are designing rule-creation wizards. This new rules based system will integrate myriad access controls including mandated releases, emergency releases (with patient-specified exclusion of recipients), specially protected categories that require explicit patient consent (e.g., HIV), and government defaults (e.g., opt in). In addition to the patient directed consents, we have designed the ability to mix and prioritize mandates and defaults from federal, state, and organizational stakeholders. In the example below (Figure 2), the patient merely fills in information on their treatment relationships, and assigns a sensitivity level to each category a wizard tool generates the rules. Future user interfaces (UIs) may embody expert-written rulesets, which are then customized by having the patient describe their sensitivity on various topics, as well as their desire to share. For example, "release all to my primary care provider" or "release all medications and allergies to Dr. Patients access, add, or modify their consent preferences via a web interface. Kairon makes each patient's latest consent preferences available to patients for online management, and (subject to the consents themselves) to providers for enforcement and discussion with patients. Additionally, it combines this information with request attributes (e.g., the requestor's name, description of the requested data, and purpose of use), evidence about treatment relationships and affiliations, and granular medical data to enable a release decision (see Figure 1). Kairon creates an information release process framework with internet-based rule-set management and risk thresholds, that mixes policies (i.e., prioritized release rules) from federal, state, and organizational entities with those of the patient. Kairon is a system concept, a prototype, and a vision for how the management and enforcement of consent rule sets can be accomplished and offers the promise of greater flexibility and reduced effort for both patients and data custodians. When a patient wants to change their policy, they must identify and notify any relevant consent holders. ![]() Patients have very limited control over what can be done with their information, and consent is usually specific to a procedure or incident. The current approach is also provider-centric, not patient-centric. ![]() Current practice requires that the patient be present to sign a physical form for each exchange that is managed at each record holder, where minimal enforcement is done beyond determining whether a standard consent is on file. This largely manual process is a major bottleneck to today's data sharing and incompatible with large scale automation. Today how is this done? And how can we enable a patient perspective for consents?īefore disclosing information, a custodian of this patient must check patient consents as well as organizational and government policies. He would like to share the fact that he has taken Vicodin for pain, but not the fact that he has in the past, been treated at General Mental Health Center for PTSD or that he had gonorrhea. Imagine that a patient with mental health issues visits a chiropractor to have her look at his back.
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