Over the past decade, the construction of data-driven smart hospitals has profoundly changed the medical service model and has also made data privacy and patient informed consent core ethical and legal issues. This study systematically sorts out the practical evolution of data privacy protection and informed consent in smart hospitals from 2016 to 2026, reveals the structural tension of “advanced technology and lagging system”, and finds that informed consent is falling into the dilemma of scene generalization and formalization, data ownership is still pending in the legal ambiguity zone, and technical governance brings privacy risks while improving efficiency, forming a “double-edged sword” effect. On this basis, the study puts forward that the key to break through the dilemma lies in the transition from “one-time authorization” to “dynamic informed consent” mechanism, the construction of a three-dimensional protection framework of “legal regulation-technical guarantee-collaborative governance”, and the promotion of institutional innovation in data rights confirmation and benefit distribution; only by putting patients at the center of data governance can we maintain the ethical bottom line in the digital transformation of medical care.