FHIR in Action

原文链接:Regional Shared Medications with FHIR

Regional Shared Medications with FHIR 区域范围内共享的用药信息

**译者注:用药信息是每个医疗信息标准都迈步过去的坎儿，作者围绕着这个topic的第一篇。这里面主要是介绍一个区域性的居民的用药信息库 ,其他的医疗信息系统在对自己系统中患者的用药信息进行操作时,都事先与用药库进行比对同步. 当然围绕着用药库可以做一些面向患者,医生的门户,适合与移动医疗的场景.

如何使用List来表达患者的用药列表信息
 如何使用transaction来对患者用药列表信息进行更新操作
 区域范围内该共享哪些用药信息
 FHIR Medication lists revisited

整体架构图如下

用药信息库旨在让所有的医务人员,患者都能够使用.其中包含大量不同类型的用药信息.比如:

现用药列表(FHIR List表示)
现用药列表中引用的MedicationPrescription资源
MedicationDispense资源
应用场景
考虑如下:
存储药房的药物配送记录药房每次配药的时候,就生成一个MedicationDispense资源并将数据保存到用药库
检索一段时间内某个患者的配药数据.主要是在医师reconciling the patients’ medication list的情况下使用
获取患者现用药列表.任何人在患者的诊疗过程中包括患者和护理人员,比如康复中心,全科诊所以及急诊室
获取患者现用药列表的变更记录,和前一个版本的用药列表
更新患者的现用药列表

这里面之涉及到用药信息的记录,并没有下医嘱(会用到MedicationPrescription资源)的功能.

Security安全

系统间的通讯间只能走SSL连接.使用oAUTH来认证和标识用户.简单起见,任何注册用户均可以访问每个患者的记录.后续会考虑一些隐私安全策略-尤其是在更新用药信息的情况.

FHIR接口

Patient相关接口仅提供一个已有的注册服务的接口,比如说区域平台或者社交平台的帐号 tx sina之类的 Find Patient (eg GET /Patient?name=eve) Get Patient by identifier (eg GET /Patient?identifier=PRP1660)

Practitioner相关接口与patient类似. Find Practitioner (eg GET /Practitioner?name=smith) Get Practitioner by identifier (eg GET /Practitioner?identifier=PRP1660)

MedicationDispense相关接口从药房获取到数据,然后客户端可以和对这个列表是否正确,也就是reconciling列表的过程,列表中是否包含了患者已经拿到的药假设药房在提交数据前先查询患者ID,然后将该MedicationDispense数据发送到用药库.因此,需要以下两个接口 Submit a dispense resource (POST /MedicationDispense) Get dispense records in the past (say) month (GET / MedicationDispense?patient={patientID}&whenHandedOver < {1 month ago} 另外,MedicationDispense 和 MedicationPrescription 资源都会调用Medication 资源,其中包含了具体的药品信息, medication资源有一个字段为code,可以使用某种药典来表示具体的药物. For example in New Zealand we have the ULM (Universal List of Medications) – a terminology based on SNOMED – thus the code 44362701000116107 refers to a 100mg tablet of aspirin

假设客户端根据这个字典来进行查询检索,我们需要code和code system.出于这样的考虑,我们在MedicationDispense 和 MedicationPrescription 资源直接包含Medication资源,而不是间接的引用它.

MedicationPrescription相关接口 MedicationPrescription主要用来记录患者服用的每种药物的详细情况,比方说药物名称,剂量,原因等.在另一篇文章里我们讨论了使用 "transaction"来批量更新药品信息,也就是说我们只需要一个根据资源标识来检索资源数据的接口 Get a single MedicationPrescription (GET /MedicationPrescription/{ID})

List相关接口

Get a patients list of medications (GET /Patient/{patientID}/List?code=10160-0)
Update a patients list of medications. This will be a transaction update as described earlier.
GET  /List/{listID}/_history
GET  /List/{listID}/_history/{versionID}

SecurityEvent相关接口以下情况自动生成审计事件资源

当要获取患者的用药列表
当要更新患者的用药列表

Get a bundle of SecurityEvent resources for a patient over a given time period (GET /SecurityEvent?patientId={patientID}&date > {startDate} & date < {endDate}

上面描述了一些接口功能,相较于文档存储的方式,这种方式更有利于信息的查,诸如那些人服用了某种药物,多少人有糖尿病但在过去半年内没有进行HBA1C检查

附件是一个conformance的例子

<?xml version="1.0" encoding="utf-8"?>
 <Conformance xmlns="http://hl7.org/fhir">
   <text>
     <status value="generated"/>
     <div xmlns="http://www.w3.org/1999/xhtml">
       <p>This conformance statement supports the Shared Medication repository, and specifies the following endpoints</p>
       <p>Person: Read and Search on name and identifier</p>
       <p>Practitioner: Read and Search on name and identifier</p>
       <p>MedicationDispense. Create, and search on patient,whenHandedOver</p>
       <p>MedicationPrescription. Read. </p>
       <p>List. Create and search on code,patient. Version read.</p>
       <p>SecurityEvent. Search on patient,date</p>
       <p>Transaction interfaces to update the Medication List</p>
     </div>
   </text>

   <identifier value="68D043B5-9ECF-4559-A57A-396E0D452311"/>
   <version value=".1"/>
   <name value="My List Of Medicines (MLOM) Conformance Statement"/>
   <publisher value="Elbonian MOH"/>
   <telecom>
     <system value="email"/>
     <value value="[email protected]"/>
   </telecom>
   <description value="The FHIR endpoints required to support a regional Medication repository - My List Of Medicines"/>
   <date value="2012-10-14"/>
   <software>
     <name value="MLOM"/>
     <version value="0.34.76"/>
   </software>
   <fhirVersion value="0.12"/>
   <acceptUnknown value="false"/> <!--   this system does not accepts unknown content in the resources   -->

   <!--   this system can do either xml or json. (Listing both implies full support for either, with interconversion)   -->
   <format value="xml"/>
   <format value="json"/>
   <!-- We only support REST interfaces at this time. This includes transaction to the server root to update the List-->
   <rest>
     <mode value="server"/>

     <!-- SecurityEvent record -->
     <resource>
       <type value="SecurityEvent"/>
       <operation>
         <code value="read"/>
       </operation>
       <searchParam>
         <name value="patient"/>
         <type value="reference"/>
         <documentation value="Lookup by patient."/>
       </searchParam>
       <searchParam>
         <name value="date"/>
         <type value="date"/>
         <documentation value="Lookup by date the event occurred."/>
       </searchParam>
     </resource>

     <!-- MedicationDispense record -->
     <resource>
       <type value="MedicationDispense"/>
       <operation>
         <code value="create"/>
       </operation>
       <operation>
         <code value="read"/>
       </operation>
       <searchParam>
         <name value="patient"/>
         <type value="reference"/>
         <documentation value="Lookup by patient."/>
       </searchParam>
       <searchParam>
         <name value="whenHandedOver"/>
         <type value="date"/>
         <documentation value="Lookup by date the medication was given to the patient."/>
       </searchParam>
     </resource>

     <!-- MedicationPrescription resource. The prescription records are all created through the 'transaction' process so read-only -->
     <resource>
       <type value="MedicationPrescription"/>
       <operation>
         <code value="read"/>
       </operation>
     </resource>

     <!-- List resource. Used to support the List of Medications. -->
     <resource>
       <type value="List"/>
       <operation>
         <code value="create"/>
       </operation>
       <operation>
         <code value="read"/>
       </operation>
       <operation>
         <code value="vread"/>
       </operation>
       <searchParam>
         <name value="patient"/>
         <type value="reference"/>
         <documentation value="Lookup by patient."/>
       </searchParam>
       <searchParam>
         <name value="code"/>
         <type value="token"/>
         <documentation value="Lookup by code - this will be for the MLOM"/>
       </searchParam>
     </resource>

       <!-- The Practitioner resource endpoint -->
       <resource>
         <type value="Practitioner"/>
         <operation>
           <code value="read"/>
         </operation>
         <searchParam>
           <name value="name"/>
           <type value="string"/>
           <documentation value="Lookup by practitioner name. All parts of the name are searched."/>
         </searchParam>
         <searchParam>
           <name value="identifier"/>
           <type value="token"/>
           <documentation value="Lookup by identifier. Both active and inactive practitioners will be returned."/>
         </searchParam>
       </resource>

     <!-- The Patient resource endpoint -->
     <resource>
       <type value="Patient"/>
       <operation>
         <code value="read"/>
       </operation>
       <searchParam>
         <name value="name"/>
         <type value="string"/>
         <documentation value="Lookup by patient name. Only active patients will be returned. All parts of the name are searched."/>
       </searchParam>
       <searchParam>
         <name value="identifier"/>
         <type value="token"/>
         <documentation value="Lookup by identifier. Both active and inactive patients will be returned."/>
       </searchParam>
       <searchParam>
         <name value="birthDate"/>
         <type value="date"/>
         <documentation value="Lookup by patient birts date. Supports the :before and :after modifiers to allow for age ranges"/>
       </searchParam>
     </resource>
   </rest>
 </Conformance>

FHIR in Action

Regional Shared Medications with FHIR 区域范围内共享的用药信息

应用场景

Security安全

FHIR接口