A b s t r a c t The effective coordination of health care relies on communication of confidential information about consumers between different health and community care services. However, consumers must be able to give or withhold ''e-Consent'' to those who wish to access their electronic health information. There are several possible forms for e-Consent. In the general consent model, a patient provides blanket consent for access to his or her information by an organization for all future information requests. Conversely, general denial explicitly denies consent for information to be used in future circumstances, and in each new episode of care, a new consent would be needed to obtain information. In the general consent with specific denial model, a patient attaches specific exclusion conditions to his or her general approval to future accesses. In contrast, in the general denial with explicit consent model, a patient issues a blanket block on all future accesses but allows the inclusion of future use under specified conditions. There also are several alternative functions for an e-Consent system. Consent could be captured as a matter of legal record. E-Consent systems could be more active by prompting clinicians to indicate that they have noted consent conditions before they access a record. Finally, the record of patient consent could be fully active and used as a gatekeeper in a distributed information environment. There probably will need to be some form of data object that is associated with patient information. This e-Consent object (or e-Co) will contain the specific conditions under which the data to which it is attached can be retrieved. Given the complexity of clinical work and the substantial variation we can expect in an individual's desire to make his or her personal medical details available, it is unlikely a ''one size fits all'' approach to e-Consent will work. Consequently, with a well-chosen consent design, it should be possible to balance the specific need for privacy of some of the population against the desire by others to err on the side of clinical safety, and clinicians desire to minimize the burden that an electronic consent mechanism would impose. The effective coordination of health care relies on the communication of confidential information about consumers between different health and community care services. Electronic data exchange and Internet technologies increasingly play important roles in such communications. Consumers must, however, be able to give or withhold consent to those who wish to access their electronic health information. For example, electronic patient records are seen by many as an essential prerequisite for health care, 1 opening up patient data to the whole clinical team involved in patient care. So, by definition, the presence of an electronic environment means that more clinical workers will be able to access patient information more often and in a greater diversity of locations. With the broadening of access to patient information comes the risks that such information is used for purposes not originally consented to by the patient. While much is known about the ways in which security technology can protect information transactions from unwanted interception, 2 very little work exists to determine how a consumer's consent to view their private information is safeguarded in a networked and online environment. This
al. have identified four levels of e-consent, including general consent, general consent with specific exclusions, general denial and general denial with specific consents REF .
e-Consent: The Design and Implementation of Consumer Consent Mechanisms in an Electronic Environment
Journal of the American Medical Informatics Association : JAMIA
Journal of the American Medical Informatics Association : JAMIA
Computer Science Medicine