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

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

D879794ea42768ea417f970914430d56?s=128

Medley Inc.

April 23, 2019
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  1. ')*3.FFUVQ5PLZP 2019.04.23 @ TECH PLAY SHIBUYA גࣜձࣾϝυϨʔ ࣇۄٛݑ ిࢠॲํᝦ࣮ূࣄۀʹ͓͚Δ')*3ͷ׆༻

  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
  3. "HFOEB 㾎 ')*3ʹ͍ͭͯ 㾎 ిࢠॲํᝦʹ͍ͭͯ 㾎 ిࢠॲํᝦ࣮ূࣄۀͷഎܠͱུ֓ 㾎 ిࢠॲํᝦ؅ཧγεςϜͷ֓ཁ 㾎

    ')*3ϦιʔεͷϚοϐϯά 㾎 ')*3Λ࢖༻ͨ͠ॴײ 㾎 ిࢠॲํᝦͷ࣮ӡ༻ʹ޲͚ͯͷ՝୊
  4. ͸͡Ίʹ *OUSPEVDUJPO

  5. *OUSPEVDUJPO

  6. ')*3ʹ͍ͭͯ "CPVU')*3

  7. ')*3ʹ͍ͭͯ Fast Healthcare Interoperability Resources ୹ظؒͰͷઃܭɾ࣮૷ อ݈ҩྍ෼໺ ૬ޓӡ༻ੑ Ϧιʔε 1987

    HL7 v2.x 1996 HL7 v3 2005 CDA 2012 FHIR
  8. ')*3ʹ͍ͭͯ 1987 HL7 v2.x 1996 HL7 v3 2005 CDA 2012

    FHIR ʢ࠷ۙϩΰ͕มΘΓ·ͨ͠ʣ
  9. ిࢠॲํᝦʹ͍ͭͯ "CPVUFQSFTDSJQUJPO

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

  11. ࢴॲํᝦͱిࢠॲํᝦ ࢴॲํᝦ HOSPITAL / CLINIC PHARMACY

  12. ࢴॲํᝦͱిࢠॲํᝦ HOSPITAL / CLINIC PHARMACY ిࢠॲํᝦ

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

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

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

  16. ిࢠॲํᝦ࣮ূࣄۀͷഎܠͱུ֓ #BDLHSPVOEBOEPVUMJOFPGFQSFTDSJQUJPOEFNPOTUSBUJPOQSPKFDU

  17. ిࢠॲํᝦͷาΈ  ްੜ࿑ಇলΑΓʮిࢠॲํᝦͷӡ༻ΨΠυϥΠϯʯެ։  +")*4ిࢠॲํᝦ࣮૷ΨΠυ7FSެ։  ްੜ࿑ಇলిࢠॲํͤΜͷӡ༻ʹ͓͚Δʮిࢠॲํᝦඪ४ϑΥʔϚοτʯ վఆࢧԉҰࣜௐୡ  ిࢠॲํᝦͷӡ༻ΨΠυϥΠϯҰ෦վఆ

    ʢzిࢠॲํᝦ$%"هड़࢓༷zͷਖ਼ࣜ࠾༻ʣ  +")*4ిࢠॲํᝦ࣮૷ΨΠυ7FSެ։  ްੜ࿑ಇলిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀҰࣜௐୡ
  18. ిࢠॲํᝦͷӡ༻ΨΠυϥΠϯ

  19. ిࢠॲํᝦҾ׵ূ

  20. ిࢠॲํᝦҾ׵ূ

  21. +")*4ిࢠॲํᝦ࣮૷ΨΠυ

  22. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ

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

  25. ిࢠॲํᝦͷຊ֨ӡ༻ʹ޲͚࣮ͨূࣄۀ

  26. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ ͳͥిࢠॲํᝦ͸ීٴ͍ͯ͠ͳ͍ͷ͔ʁ

  27. ΨΠυϥΠϯʹ͓͚Δɺීٴʹରͯ͠ͷ્֐ཁҼͷ੔ཧ

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

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

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

    ిࢠॲํᝦαʔόʔ Ͳ͏͢Ε͹γϯϓϧʹͳΔ͔ʁɹۃ୺ʹߟ͑Δͱʜ
  33. ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ ʹ͍ͭͯͷ੔ཧ 㾎 ෺ཧϑΝΠϧΛհ͞ͳ͍ʮ$MPVEUP$MPVEʯͷγϯϓϧͳӡ༻ϑϩʔ 㾎 ্هΛ࣮ݱ͢ΔͨΊͷɺҩྍ৘ใඪ४ن֨ͷ࠾༻

  34. ્֐ཁҼΛղফ͢ΔͨΊͷ৽ͨͳӡ༻ϑϩʔ Ҋ ʹ͍ͭͯͷ੔ཧ

  35. ిࢠॲํᝦ؅ཧγεςϜͷ֓ཁ 0WFSWJFXPGFQSFTDSJQUJPONBOBHFNFOUTZTUFN

  36. ࣮ূࣄۀͰ։ൃͨ͠ධՁγεςϜ

  37. ࣮ূࣄۀͰ։ൃͨ͠ධՁγεςϜ

  38. None
  39. 1 2 3 4

  40. ిࢠॲํᝦΞΫηείʔυɾༀہͰͷར༻෩ܠ

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

  42. ')*3Ϧιʔε

  43. ')*3Ϧιʔε ױऀ

  44. 1BUJFOU

  45. 1BUJFOU OBNFױऀʹؔ࿈෇͚ΒΕ໊ͨલ

  46. 1BUJFOUOBNF

  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 /"
  48. ')*3ϦιʔεϚοϐϯά

  49. ࣮ূࣄۀͰ࢖༻ͨ͠Ϧιʔε 1BUJFOU ױऀ 1SBDUJUJPOFS ࢪज़ऀʢॲํҩʗༀࡎࢣʣ 1SBDUJUJPOFS3PMF ࢪज़ऀ໾ׂ 0SHBOJ[BUJPO ૊৫ʢҩྍػؔʗௐࡎༀہʣ .FEJDBUJPO3FRVFTU

    ౤ༀཁٻ .FEJDBUJPO%JTQFOTF ௐࡎ࣮ࢪ $PWFSBHF อݥ
  50. ධՁγεςϜͷσʔλϑϩʔ FHIR REPOSITORY Patient Practitioner Organization MedicationRequest MedicationDispense Coverage PHARMACY

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

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

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

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

    HOSPITAL / CLINIC PUT POST completed
  55. ධՁγεςϜͷσʔλϑϩʔ Patient Practitioner Organization MedicationRequest MedicationDispense Coverage Transaction Data Master

    Data
  56. ࿈ܞઌ͕௥Ճ͞ΕΔ৔߹ʢ&YBNQMFʣ FHIR REPOSITORY Patient Practitioner Organization MedicationRequest MedicationDispense Coverage PHARMACY

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

    HOSPITAL / CLINIC LABORATORY Specimen Observation ݕମݕࠪ݁Ռ GET
  58. ϝοηʔδϯάͱͯ͠࢖༻͢Δ৔߹ FHIR REPOSITORY HOSPITAL / CLINIC Patient
 Practitioner
 Organization
 MedicationRequest


    MedicationRequest
 MedicationRequest
 Coverage Bundle POST
  59. ')*3Λ࢖༻ͨ͠ॴײ *NQSFTTJPOTVTJOH')*3

  60. ')*3ͷมભ

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

    HIS LIS HL7v2 - OML HL7v2 - OUL Radiology Laboratory
  63. )-Wͱ')*3 1ର1ͷγεςϜ࿈ܞɹɹɹɹɹɹHL7v2 NରNͷγεςϜ࿈ܞɹɹɹɹɹ FHIR

  64. ిࢠॲํᝦͷ࣮ӡ༻ʹ޲͚ͯͷ՝୊ $IBMMFOHFTGPSJNQMFNFOUJOHFQSFTDSJQUJPO

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

  66. ')*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
  67. ඪ४Ϛελʔͷ՝୊ ҩༀ඼Ϛελʔ 㾎 )05ίʔυ 㾎 :+ίʔυ 㾎 Ϩηϓτిࢉίʔυ ɹɹɹˠଟ͘ͷγεςϜ্͕هͷͲΕ͔ʹ͸ରԠՄೳ ༻๏Ϛελʔ

    㾎 +".*ඪ४༻๏Ϛελʔ ɹɹɹˠ͋·Γීٴ͍ͯ͠ͳ͍
  68. ·ͱΊ 㾎 ')*3ΠϯλʔϑΣΠεΛ׆༻͢Δ͜ͱʹΑΓʮ$MPVEUP$MPVEʯͷγϯϓϧͳӡ ༻ϑϩʔΛ࣮ݱ͢Δ͜ͱ͕Ͱ͖ͨ 㾎 ')*3Ϧιʔεʹର͢ΔϚοϐϯάͷόϥ͖ͭΛ๷ࢭ͢ΔͨΊʹ͸ɺ࣮૷ऀͷࢦඪ ͱͳΔΨΠυϥΠϯͷࡦఆ͕ඞཁͰ͋Δ 㾎 ిࢠॲํᝦʹݶΒͣɺΠϯλʔωοτςΫϊϩδʔΛར༻ͯ͠ɺҩྍ৘ใͷڞ༗ɾ ར׆༻Λଅਐ͢ΔͨΊʹ͸ɺ')*3ͷ׆༻ํ๏ΛҰߟ͢ΔՁ஋͕͋Δ

  69. ҩྍϔϧεέΞ෼໺ͷ՝୊Λղܾ͢Δ ͝ਗ਼ௌ͋Γ͕ͱ͏͍͟͝·ͨ͠