電子処方箋実証事業におけるFHIRの活用 - FHIR Meetup Tokyo #01

FHIR Meetup Tokyo #01 @ TECH PLAY SHIBUYA
https://techplay.jp/event/725549

電子処方箋実証事業におけるFHIRの活用
児玉 義憲 (株式会社メドレー)

厚生労働省の「電子処方箋の本格運用に向けた実証事業」の説明と、実証事業で開発した電子処方箋管理システムの全体像をご紹介します。また、処方箋データをFHIRの規格にマッピングした際の所感、実運用に向けての課題など、実装者の視点でお話します。

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MEDLEY DESIGN&ENGINEERING
https://www.medley.jp/recruit/creative.html

Transcript

1. ')*3.FFUVQ5PLZP
   2019.04.23 @ TECH PLAY SHIBUYA
   גࣜձࣾϝυϨʔ
   ࣇۄٛݑ
   ిࢠॲํᝦ࣮ূࣄۀʹ͓͚Δ')*3ͷ׆༻
   

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2. ࣇۄٛݑ
   ΤϯδχΞ
   㾎 ҩྍ*5اۀʹ৽ଔೖࣾిࢠΧϧςͷ։ൃ
   㾎 ಠཱܥ4*FS
   㾎 גࣜձࣾϝυϨʔ
   ೔ຊҩྍ৘ใֶձ
   ্ڃҩྍ৘ใٕࢣʢೝఆ൪߸4ʣ
   ҩྍ৘ใ҆શ؅ཧ؂ࠪਓڠձ
   ҩྍ৘ใγεςϜ؂ࠪਓิʢೝఆ൪߸"ʣ
   

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3. "HFOEB
   㾎 ')*3ʹ͍ͭͯ
   㾎 ిࢠॲํᝦʹ͍ͭͯ
   㾎 ిࢠॲํᝦ࣮ূࣄۀͷഎܠͱུ֓
   㾎 ిࢠॲํᝦ؅ཧγεςϜͷ֓ཁ
   㾎 ')*3ϦιʔεͷϚοϐϯά
   㾎 ')*3Λ࢖༻ͨ͠ॴײ
   㾎 ిࢠॲํᝦͷ࣮ӡ༻ʹ޲͚ͯͷ՝୊
   

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4. ͸͡Ίʹ
   *OUSPEVDUJPO
   

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5. *OUSPEVDUJPO
   

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6. ')*3ʹ͍ͭͯ
   "CPVU')*3
   

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7. ')*3ʹ͍ͭͯ
   Fast
   Healthcare
   Interoperability
   Resources
   ୹ظؒͰͷઃܭɾ࣮૷
   อ݈ҩྍ෼໺
   ૬ޓӡ༻ੑ
   Ϧιʔε
   1987
   HL7 v2.x
   1996
   HL7 v3
   2005
   CDA
   2012
   FHIR
   

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8. ')*3ʹ͍ͭͯ
   1987
   HL7 v2.x
   1996
   HL7 v3
   2005
   CDA
   2012
   FHIR
   ʢ࠷ۙϩΰ͕มΘΓ·ͨ͠ʣ
   

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9. ిࢠॲํᝦʹ͍ͭͯ
   "CPVUFQSFTDSJQUJPO
   

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10. ిࢠॲํᝦͱ͸
    ిࢠॲํᝦͱ͸ʁ
    ɹࢴʹҹ࡮͞ΕͨॲํᝦͰ͸ͳ͘ɺҩྍػؔͱௐࡎༀہ͕ిࢠσʔλΛ༻͍ͯ
    ɹॲํ಺༰Λ΍ΓͱΓ͢Δ࢓૊Έ
    

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11. ࢴॲํᝦͱిࢠॲํᝦ
    ࢴॲํᝦ
    HOSPITAL / CLINIC PHARMACY
    

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12. ࢴॲํᝦͱిࢠॲํᝦ
    HOSPITAL / CLINIC PHARMACY
    ిࢠॲํᝦ
    

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13. ΦϯϥΠϯ਍ྍʹ͓͚Δిࢠॲํᝦͷχʔζ
    HOSPITAL / CLINIC
    HOME
    PHARMACY
    ࢴॲํᝦ
    ΦϯϥΠϯ਍ྍ
    º
    

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14. ΦϯϥΠϯ਍ྍʹ͓͚Δిࢠॲํᝦͷχʔζ
    HOSPITAL / CLINIC
    HOME
    PHARMACY
    ࢴॲํᝦ
    Time lag
    ΦϯϥΠϯ਍ྍ
    º
    

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15. ΦϯϥΠϯ਍ྍʹ͓͚Δిࢠॲํᝦͷχʔζ
    HOSPITAL / CLINIC
    HOME
    PHARMACY
    ిࢠॲํᝦ
    ΦϯϥΠϯ਍ྍ
    º
    

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16. ిࢠॲํᝦ࣮ূࣄۀͷഎܠͱུ֓
    #BDLHSPVOEBOEPVUMJOFPGFQSFTDSJQUJPOEFNPOTUSBUJPOQSPKFDU
    

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17. ిࢠॲํᝦͷาΈ
    ްੜ࿑ಇলΑΓʮిࢠॲํᝦͷӡ༻ΨΠυϥΠϯʯެ։
    +")*4ిࢠॲํᝦ࣮૷ΨΠυ7FSެ։
    
    ްੜ࿑ಇলిࢠॲํͤΜͷӡ༻ʹ͓͚Δʮిࢠॲํᝦඪ४ϑΥʔϚοτʯ
    վఆࢧԉҰࣜௐୡ
    
    ిࢠॲํᝦͷӡ༻ΨΠυϥΠϯҰ෦վఆ
    ʢzిࢠॲํᝦ$%"هड़࢓༷zͷਖ਼ࣜ࠾༻ʣ
    +")*4ిࢠॲํᝦ࣮૷ΨΠυ7FSެ։
    ްੜ࿑ಇলిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀҰࣜௐୡ
    

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18. ిࢠॲํᝦͷӡ༻ΨΠυϥΠϯ
    

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19. ిࢠॲํᝦҾ׵ূ
    

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20. ిࢠॲํᝦҾ׵ূ
    

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21. +")*4ిࢠॲํᝦ࣮૷ΨΠυ
    

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22. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ
    

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23. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ
    ిࢠॲํᝦͷӡ༻ͷ࢓૊Έͷݕ౼ɾ࣮ূɾߟ࡯
    ɹʢʣిࢠॲํᝦͷࣄલௐࠪͱ࣮ূҊͷࡦఆ
    ᶃΨΠυϥΠϯʹ͓͚Δݱߦͷϑϩʔͷ੔ཧ
    ᶄΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    ᶅ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ
    ʹ͍ͭͯͷ੔ཧ
    ᶆ৽ͨͳӡ༻ϑϩʔ Ҋ
    Λ࣮ݱ͢ΔͨΊͷ࣮ূࣄۀͷܭըࡦఆ
    ɹʢʣ࣮ূࣄۀ
    ɹʢʣ݁Ռߟ࡯ɾ՝୊੔ཧ
    ᶃ݁Ռߟ࡯
    ᶄ՝୊੔ཧ
    ɹʢʣීٴҊͷఏࣔɺ͓ΑͼΨΠυϥΠϯվఆҊͷࡦఆ
    ᶃීٴҊͷఏࣔ
    ᶄΨΠυϥΠϯվఆҊͷࡦఆ
    ˞ްੜ࿑ಇলʮిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀҰࣜʯೖࡳ࢓༷ॻΑΓసࡌ
    

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24. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ
    ˞ްੜ࿑ಇল)1ʮೖࡳެࠂʢిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀҰࣜʣʯΑΓసࡌ
    

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25. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ
    

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26. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    ͳͥిࢠॲํᝦ͸ීٴ͍ͯ͠ͳ͍ͷ͔ʁ
    

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27. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    

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28. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    ˞+")*4ిࢠॲํᝦ࣮૷ΨΠυWFSɹਤిࢠॲํᝦΛར༻ͨ͠ҩྍػؔʹ͓͚ΔϫʔΫϑϩʔᶃʢൈਮʣ
    ෺ཧϑΝΠϧ
    ҹ࡮෺
    

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29. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    ͳ͍
    
    ͋Δ
    
    ݱࡏ·ͰʹిࢠॲํᝦͷඞཁੑΛײͨ͜͡ͱ͕͋Δ͔
    ˞ߓ۠ҩࢣձձһ޲͚Ξϯέʔτ
    /
    

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30. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    㾎 ױऀͷډ୐౳ͰॲํᝦΛަ෇͢Δࡍʹҹ࡮͕ෆཁʹͳΔͨΊʢʣ
    㾎 ΦϯϥΠϯ਍ྍͷױऀ΁ॲํᝦΛަ෇͢Δࡍʹ༣ૹ౳͕ෆཁʹͳΔͨΊʢʣ
    㾎 ࢴͰͷަ෇ʹΑΔίετ࡟ݮͷͨΊʢʣ
    㾎 ࢴͰͷަ෇ʹ൐͏ه໊ԡҹ౳ͷۀ຿ޮ཰ԽͷͨΊʢʣ
    㾎 ॲํ಺༰ͷిࢠతͳ؅ཧͷͨΊʢʣ
    㾎 ͦͷଞʢʣ
    ʮిࢠॲํᝦͷඞཁੑΛײͨ͜͡ͱ͕͋Δʯͱճ౴ͨ͠ཧ༝
    O
    

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31. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ
    ཁҼɿΨΠυϥΠϯʹجͮ͘ӡ༻ͷ൥ࡶ͞
    㾎 ࢴͷॲํᝦͱൺֱͯ͠ۀ຿͕ޮ཰Խ͞ΕΔ͜ͱ͸ͳ͍
    㾎 ௥Ճۀ຿͕ඞཁͱͳΓɺ൥ࡶʹͳΔ͜ͱ͕༧૝͞ΕΔ
    㾎 ΦϯϥΠϯ਍ྍʹ͓͍ͯ΋ɺిࢠॲํᝦҾ׵ূΛ༣ૹ͢Δۀ຿͸࢒Δ
    ཁҼɿిࢠॲํᝦʹର͢Δݶఆతͳχʔζ
    㾎 ࡏ୐ҩྍɺΦϯϥΠϯ਍ྍ
    㾎 ͦΕҎ֎ͷ໌֬ͳχʔζ͕ೝΊΒΕͳ͍
    ཁҼɿඅ༻ෛ୲ͷ௥Ճൃੜ
    㾎 ۩ମతͳඅ༻ײ͕ෆ໌Ͱ͋Δ
    

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32. ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ
    ʹ͍ͭͯͷ੔ཧ
    පӃ৘ใγεςϜ
    ॲํᝦ$%"
    ిࢠॺ໊
    λΠϜελϯϓ
    Ξοϓϩʔμʔ
    ిࢠॲํᝦαʔόʔ
    පӃ৘ใγεςϜ
    ిࢠॲํᝦαʔόʔ
    Ͳ͏͢Ε͹γϯϓϧʹͳΔ͔ʁɹۃ୺ʹߟ͑Δͱʜ
    

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33. ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ
    ʹ͍ͭͯͷ੔ཧ
    㾎 ෺ཧϑΝΠϧΛհ͞ͳ͍ʮ$MPVEUP$MPVEʯͷγϯϓϧͳӡ༻ϑϩʔ
    㾎 ্هΛ࣮ݱ͢ΔͨΊͷɺҩྍ৘ใඪ४ن֨ͷ࠾༻
    

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34. ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ
    ʹ͍ͭͯͷ੔ཧ
    

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35. ిࢠॲํᝦ؅ཧγεςϜͷ֓ཁ
    0WFSWJFXPGFQSFTDSJQUJPONBOBHFNFOUTZTUFN
    

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36. ࣮ূࣄۀͰ։ൃͨ͠ධՁγεςϜ
    

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37. ࣮ূࣄۀͰ։ൃͨ͠ධՁγεςϜ
    

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38. View Slide

39. 1 2
    3 4
    

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40. ిࢠॲํᝦΞΫηείʔυɾༀہͰͷར༻෩ܠ
    

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41. ')*3ϦιʔεͷϚοϐϯά
    ')*3SFTPVSDFNBQQJOH
    

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42. ')*3Ϧιʔε
    

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43. ')*3Ϧιʔε
    ױऀ
    

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44. 1BUJFOU
    

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45. 1BUJFOU
    OBNFױऀʹؔ࿈෇͚ΒΕ໊ͨલ
    

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46. 1BUJFOUOBNF
    

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47. ')*3ϦιʔεϚοϐϯά
    &MFNFOU %FTDSJQUJPO &YBNQMF
    OBNF ױऀࢯ໊
    VTF ໊લͷ࢖༻໨త lP⒏DJBMz
    UFYU ϑϧωʔϜ ࣇۄɹٛݑ
    GBNJMZ ੏ ࣇۄ
    HJWFO ໊ ٛݑ
    QSFpY ܟশʢ.S.T.JTT%SͳͲʣ /"
    TV⒏Y শ߸ʢ4S+SੈੈੈͳͲʣ /"
    QFSJPE ໊લͷ༗ޮظؒ /"
    

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48. ')*3ϦιʔεϚοϐϯά
    

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49. ࣮ূࣄۀͰ࢖༻ͨ͠Ϧιʔε
    1BUJFOU ױऀ
    1SBDUJUJPOFS ࢪज़ऀʢॲํҩʗༀࡎࢣʣ
    1SBDUJUJPOFS3PMF ࢪज़ऀ໾ׂ
    0SHBOJ[BUJPO ૊৫ʢҩྍػؔʗௐࡎༀہʣ
    .FEJDBUJPO3FRVFTU ౤ༀཁٻ
    .FEJDBUJPO%JTQFOTF ௐࡎ࣮ࢪ
    $PWFSBHF อݥ
    

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50. ධՁγεςϜͷσʔλϑϩʔ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    

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51. ධՁγεςϜͷσʔλϑϩʔ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    POST
    POST
    POST
    

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52. ධՁγεςϜͷσʔλϑϩʔ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    HOSPITAL / CLINIC
    ϩΩιχϯৣNHʜৣ

    ೔ճேன༦৯ޙɹ೔෼
    ˓˓පӃ
    ҩࢣଠ࿠
    ױऀҰ࿠
    ࣾอʗ૊߹
    PHARMACY
    

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53. ධՁγεςϜͷσʔλϑϩʔ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    GET
    

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54. ධՁγεςϜͷσʔλϑϩʔ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    PUT
    POST
    completed
    

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55. ධՁγεςϜͷσʔλϑϩʔ
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    Transaction Data
    Master Data
    

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56. ࿈ܞઌ͕௥Ճ͞ΕΔ৔߹ʢ&YBNQMFʣ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    LABORATORY
    Specimen Observation
    ݕମݕࠪ݁Ռ
    

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57. ࿈ܞઌ͕௥Ճ͞ΕΔ৔߹ʢ&YBNQMFʣ
    FHIR REPOSITORY
    Patient
    Practitioner Organization
    MedicationRequest
    MedicationDispense
    Coverage
    PHARMACY
    HOSPITAL / CLINIC
    LABORATORY
    Specimen Observation
    ݕମݕࠪ݁Ռ
    GET
    

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58. ϝοηʔδϯάͱͯ͠࢖༻͢Δ৔߹
    FHIR REPOSITORY
    HOSPITAL / CLINIC
    Patient

    Practitioner

    Organization

    MedicationRequest

    MedicationRequest

    MedicationRequest

    Coverage
    Bundle
    POST
    

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59. ')*3Λ࢖༻ͨ͠ॴײ
    *NQSFTTJPOTVTJOH')*3
    

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60. ')*3ͷมભ
    

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61. ')*3Λ࢖༻ͨ͠ॴײ
    සൟͳΞοϓσʔτʹ௥ै͢Δʮ֮ޛʯΛܾΊΔ
    㾎 ࠓճ͸࣮ূ࣮ݧ޲͚ͷධՁγεςϜ͕ͩͬͨʜ
    㾎 456ˠ3ʢOPSNBUJWFʣʹͳΓɺࠓޙ͸Ξοϓσʔτ΋མͪண͔͘ʁ
    8FCαʔϏε։ൃऀ͸ɺಛผͳ஌ࣝΛशಘ͢Δඞཁ͕ͳ͍
    㾎 3&45"1*
    㾎 +40/9.-
    㾎 0"VUI
    ΦʔϓϯιʔεϥΠϒϥϦ͕๛෋ʹఏڙ͞Ε͍ͯΔ
    㾎 )"1*')*3
    

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62. )-Wͱ')*3
    طʹՔಇ͍ͯ͠Δ)-WΠϯλʔϑΣΠεΛແཧͯ͠')*3ʹஔ͖׵͑Δඞཁ͸ͳ͍
    HIS RIS
    HL7v2 - OMG
    HL7v2 - ORU
    HIS LIS
    HL7v2 - OML
    HL7v2 - OUL
    Radiology
    Laboratory
    

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63. )-Wͱ')*3
    1ର1ͷγεςϜ࿈ܞɹɹɹɹɹɹHL7v2
    NରNͷγεςϜ࿈ܞɹɹɹɹɹ FHIR
    

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64. ిࢠॲํᝦͷ࣮ӡ༻ʹ޲͚ͯͷ՝୊
    $IBMMFOHFTGPSJNQMFNFOUJOHFQSFTDSJQUJPO
    

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65. ްੜ࿑ಇলɿిࢠॲํᝦͷීٴਪਐͷͨΊͷ޻ఔද
    ˞ްੜ࿑ಇলɿిࢠॲํᝦͷීٴਪਐͷͨΊͷ޻ఔදΑΓసࡌ
    

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66. ')*3ϦιʔεϚοϐϯάͷ՝୊
    ༰қʹϚοϐϯάՄೳͳ৘ใ
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69. ҩྍϔϧεέΞ෼໺ͷ՝୊Λղܾ͢Δ
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