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

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

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

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

͸͡Ίʹ *OUSPEVDUJPO

*OUSPEVDUJPO

')*3ʹ͍ͭͯ "CPVU')*3

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

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

ిࢠॲํᝦʹ͍ͭͯ "CPVUFQSFTDSJQUJPO

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

ࢴॲํᝦͱిࢠॲํᝦ ࢴॲํᝦ HOSPITAL / CLINIC PHARMACY

ࢴॲํᝦͱిࢠॲํᝦ HOSPITAL / CLINIC PHARMACY ిࢠॲํᝦ

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

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

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

ిࢠॲํᝦ࣮ূࣄۀͷഎܠͱུ֓ #BDLHSPVOEBOEPVUMJOFPGFQSFTDSJQUJPOEFNPOTUSBUJPOQSPKFDU

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

ిࢠॲํᝦͷӡ༻ΨΠυϥΠϯ

ిࢠॲํᝦҾ׵ূ

+")*4ిࢠॲํᝦ࣮૷ΨΠυ

ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ

ి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

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

ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ

ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ ͳͥిࢠॲํᝦ͸ීٴ͍ͯ͠ͳ͍ͷ͔ʁ

ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ

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

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

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

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

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

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

્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ ʹ͍ͭͯͷ੔ཧ

ిࢠॲํᝦ؅ཧγεςϜͷ֓ཁ 0WFSWJFXPGFQSFTDSJQUJPONBOBHFNFOUTZTUFN

࣮ূࣄۀͰ։ൃͨ͠ධՁγεςϜ

1 2 3 4

ిࢠॲํᝦΞΫηείʔυɾༀہͰͷར༻෩ܠ

')*3ϦιʔεͷϚοϐϯά ')*3SFTPVSDFNBQQJOH

')*3Ϧιʔε

')*3Ϧιʔε ױऀ

1BUJFOU

1BUJFOU OBNFױऀʹؔ࿈෇͚ΒΕ໊ͨલ

1BUJFOUOBNF

')*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 /"

')*3ϦιʔεϚοϐϯά

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

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

HOSPITAL / CLINIC POST POST POST

ධՁγεςϜͷσʔλϑϩʔ FHIR REPOSITORY Patient Practitioner Organization MedicationRequest MedicationDispense Coverage HOSPITAL
/ CLINIC ϩΩιχϯৣNHʜৣ  ೔ճேன༦৯ޙɹ೔෼ ˓˓පӃ ҩࢣଠ࿠ ױऀҰ࿠ ࣾอʗ૊߹ PHARMACY

HOSPITAL / CLINIC GET

HOSPITAL / CLINIC PUT POST completed

ධՁγεςϜͷσʔλϑϩʔ Patient Practitioner Organization MedicationRequest MedicationDispense Coverage Transaction Data Master
Data

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

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

ϝοηʔδϯάͱͯ͠࢖༻͢Δ৔߹ FHIR REPOSITORY HOSPITAL / CLINIC Patient  Practitioner  Organization  MedicationRequest 
MedicationRequest  MedicationRequest  Coverage Bundle POST

')*3Λ࢖༻ͨ͠ॴײ *NQSFTTJPOTVTJOH')*3

')*3ͷมભ

')*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

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

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

ిࢠॲํᝦͷ࣮ӡ༻ʹ޲͚ͯͷ՝୊ $IBMMFOHFTGPSJNQMFNFOUJOHFQSFTDSJQUJPO

ްੜ࿑ಇলɿిࢠॲํᝦͷීٴਪਐͷͨΊͷ޻ఔද ˞ްੜ࿑ಇলɿిࢠॲํᝦͷීٴਪਐͷͨΊͷ޻ఔදΑΓసࡌ

')*3ϦιʔεϚοϐϯάͷ՝୊ ༰қʹϚοϐϯάՄೳͳ৘ใ 㾎 ױऀ৘ใʢࢯ໊ੜ೥݄೔ੑผॅॴి࿩൪߸ʣ 㾎 ҩༀ඼৘ใʢҩༀ඼ίʔυҩༀ඼໊শ༻ྔ୯Ґʣ 㾎 ॲํҩɾҩྍػؔ৘ใʢॲํҩࢯ໊਍ྍՊʣ ΞυϗοΫͳϚοϐϯάΛߦͳͬͨ৘ใ 㾎
อݥ৘ใʢ๏ผ൪߸อݥऀ൪߸ه߸൪߸ຊਓɾՈ଒ʣ 㾎 ৄࡉͳௐࡎࢦࣔʢҰแԽࢦࣔคࡅࢦࣔෆۉ౳౤༩ִ೔౤༩ʣ 㾎 ίϝϯτ &YUFOTJPOT 㾎 ࣮ূࣄۀͰ͸ʮ.FEJDBUJPO3FRVFTUʯʹʮ$PWFSBHFʯͷࢀরΛ௥Ճ 㾎 3Ͱඪ४ରԠࡁ

ඪ४Ϛελʔͷ՝୊ ҩༀ඼Ϛελʔ 㾎 )05ίʔυ 㾎 :+ίʔυ 㾎 Ϩηϓτిࢉίʔυ ɹɹɹˠଟ͘ͷγεςϜ্͕هͷͲΕ͔ʹ͸ରԠՄೳ ༻๏Ϛελʔ
㾎 +".*ඪ४༻๏Ϛελʔ ɹɹɹˠ͋·Γීٴ͍ͯ͠ͳ͍

·ͱΊ 㾎 ')*3ΠϯλʔϑΣΠεΛ׆༻͢Δ͜ͱʹΑΓʮ$MPVEUP$MPVEʯͷγϯϓϧͳӡ ༻ϑϩʔΛ࣮ݱ͢Δ͜ͱ͕Ͱ͖ͨ 㾎 ')*3Ϧιʔεʹର͢ΔϚοϐϯάͷόϥ͖ͭΛ๷ࢭ͢ΔͨΊʹ͸ɺ࣮૷ऀͷࢦඪ ͱͳΔΨΠυϥΠϯͷࡦఆ͕ඞཁͰ͋Δ 㾎 ిࢠॲํᝦʹݶΒͣɺΠϯλʔωοτςΫϊϩδʔΛར༻ͯ͠ɺҩྍ৘ใͷڞ༗ɾ ར׆༻Λଅਐ͢ΔͨΊʹ͸ɺ')*3ͷ׆༻ํ๏ΛҰߟ͢ΔՁ஋͕͋Δ

ҩྍϔϧεέΞ෼໺ͷ՝୊Λղܾ͢Δ ͝ਗ਼ௌ͋Γ͕ͱ͏͍͟͝·ͨ͠

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

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

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