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数据分析与知识发现  2021, Vol. 5 Issue (11): 13-28     https://doi.org/10.11925/infotech.2096-3467.2021.0260
  研究论文 本期目录 | 过刊浏览 | 高级检索 |
HL7 FHIR框架下中国医疗领域信息交换研究与解决方案
盛姝1,黄奇1,2(),杨洋1,解绮雯1,秦新国1,3
1南京大学信息管理学院 南京 210046
2南京大学国家信息资源管理南京研究基地 南京 210093
3南京审计大学信息化办公室 南京 211815
Exchanging Chinese Medical Information Based on HL7 FHIR
Sheng Shu1,Huang Qi1,2(),Yang Yang1,Xie Qiwen1,Qin Xinguo1,3
1School of Information Management, Nanjing University, Nanjing 210046, China
2Nanjing Research Based of National Information Management, Nanjing University, Nanjing 210093, China
3Information Office, Nanjing Audit University, Nanjing 211815, China
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摘要 

【目的】 将国际主流的信息交换标准HL7 FHIR核心框架引入医疗领域,使医疗数据类型和疾病术语表达标准化。【方法】 提出FHIR框架下医疗领域信息交换方法,阐述FHIR 在医疗领域层面的含义和应用,通过本体构建、本体映射与迁移予以实现,并结合疾病本体（Disease Ontology,DO）规范疾病术语的表达。【结果】 利用Python爬虫挖掘“医享网”发布的真实电子病历,在本体映射与迁移后,176份患者病例记录实现了FHIR数据格式的标准化转换以及标准疾病术语编码。【局限】 未能实现异源多类型术语的语义标准化。【结论】 研究成果为我国医疗领域标准体系的构建和技术手段的开发提供了一种新思路。
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盛姝
黄奇
杨洋
解绮雯
秦新国
关键词 ： HL7 FHIR,  信息交换,  本体映射,  迁移    
Abstract：

[Objective] This paper explores the core framework of message exchange standard——Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR), aiming to standardize medical data formats and disease terms in Chinese. [Methods] We proposed a healthcare data interoperability method based on the FHIR framework. Then, we combined the ontology standardization conceptual model and the Disease Ontology to regulate the expression of disease terms, with ontology construction, mapping and migration techniques. [Results] We retrieved 176 pieces electronic medical records from the YiXiang platform with a Python crawler. After ontology mapping and migration, we fully standardized the medical records and disease term coding using the expression of FHIR data format. [Limitations] We did not standardize the semantics of heterogeneous medical data of multiple types. [Conclusions] This study provides a new perspective for constructing standard medical records system and related technology in China.
Key words： HL7 FHIR    Information Exchange    Ontology Mapping    Migration
收稿日期: 2021-04-01      出版日期: 2021-08-26
ZTFLH:  G251  
通讯作者: 黄奇,ORCID：0000-0002-2806-3447     E-mail: huangqi@nju.edu.cn
引用本文:   
盛姝, 黄奇, 杨洋, 解绮雯, 秦新国. HL7 FHIR框架下中国医疗领域信息交换研究与解决方案[J]. 数据分析与知识发现, 2021, 5(11): 13-28.
Sheng Shu, Huang Qi, Yang Yang, Xie Qiwen, Qin Xinguo. Exchanging Chinese Medical Information Based on HL7 FHIR. Data Analysis and Knowledge Discovery, 2021, 5(11): 13-28.
链接本文:  
https://manu44.magtech.com.cn/Jwk_infotech_wk3/CN/10.11925/infotech.2096-3467.2021.0260      或      https://manu44.magtech.com.cn/Jwk_infotech_wk3/CN/Y2021/V5/I11/13
Fig.1  资源展示
Fig.2  患者UML示例
Fig.3  信息交换流程框架
Fig.4  本体迁移规则示意图
Fig.5  疾病本体“心脏动脉瘤”标准编码展示
Fig.6  资源之间的引用关系
Fig.7  实体概念图
Fig.8  FHIR本体部分概念及属性展示
Fig.9  医疗领域本体层次图
定义域 属性 值域
patient hasEMRs EMRs
EMRs hasProperty observation
disease has_record EMRs
patient hasCare careplan
patient hasInspection Imaging
diagnostic hasService patient
patient hasPay financial
diagnostic hasRefer Imaging
… … …
Table 1  医疗领域本体对象属性设置
类及字段名 所属类 含义 是否可空 字符串类型
PaId patient 患者ID 否 String
PaName patient 患者名称 否 String
PaGender patient 患者性别 否 Boolean
PaAge patient 患者年龄 否 int
dateofConsul EMRs 就诊时间 否 dateTime
PaHistory patient 患者现病史 是 String
DiComplaints diagnostic 患者主诉 是 String
DiDepartCode diagnostic 患者就诊科室编码 否 String
DiDepartName diagnostic 就诊科室名称 否 String
DocId practitioner 患者诊疗医生编码 否 String
DocName practitioner 患者诊疗医生姓名 否 String
PaHosNum patient 患者住院编号 否 String
… … … … …
Table 2  医疗领域本体数据属性设置
FHIR概念名称 相似概念匹配 FHIR数据属性 相似属性匹配
本体O1概念 相似度 属性 相似度
Observation observation 0.98 Patient.name PaName 0.63
Practitioners practitioner 0.92 Patient. identifier PaId 0.80
Patient patient 0.98 Patient. status PaStatus 0.84
Diagnostics diagnostic 0.89 Patient. telecom PaTel 0.51
Entity EMRs 0.18 Patient. gender PaGender 0.77
Medications medication 0.88 Patient. contact PaTel 0.31
NutritionOrder careplan 0.32 Patient. birthdate PaAge 0.38
Specimen BloodSample 0.41 Patient. photo PaStatus 0.57
FHIR Financial financial 0.77 Observation. category ObCategory 0.81
Documents document 0.82 Observation. identifier ObId 0.22
Procedure procedure 0.92 Observation. note ObNote 0.65
Category disease 0.32 Observation. method ObMeasured 0.59
ImagingStudy Imaging 0.74 Observation. subject ObSubject 0.70
Workflow - 0 Procedure. report PrRec 0.66
RiskAssessment - 0 Procedure. note PrNote 0.75
Payment financial 0.39 Medication. batch MedBa 0.45
RelatedPerson patient 0.54 Medication. amount MedAmount 0.70
… … … … … …
Table 3  本体 O 1与 O 2之间的部分相似性结果
患者ID 患者年龄 患者性别 诊断疾病 症状 治疗方案
1 61岁 男 高血压 头昏、活动后胸闷 Aspirin,一天0.1g
2 41岁 女 胃癌 腹痛、腹泻 波利特,一天20mg
3 45岁 男 2型糖尿病 口干、多饮、消瘦、四肢乏力 盐酸二甲双胍片（片）,1天1.5mg
4 61岁 男 冠心病 全身浮肿、胸闷 拜阿司匹林（肠溶片）,1天100mg
5 37岁 男 胃腺癌 吞咽困难、发烧、身目黄染 易善复（注射剂）,一天20ml
6 45岁 女 2型糖尿病 血糖升高、手指麻痹、尿频、尿痛 盐酸二甲双胍片（片）,1天0.75g,联合瑞易宁10mgqd降血糖治疗
7 54岁 男 肝癌 黄疸 \
8 47岁 女 乳腺浸润性导管癌 乳房肿块 枸橼酸他莫昔芬（片）,1天20mg
9 51岁 男 脑梗塞 行为异常、神志不清、言语异常 丙种球蛋白（注射剂）,1天25g
10 62岁 男 肺癌 气促、胸闷 灵芝孢子粉（胶囊）,1天12粒
… … … … … …
Table 4  部分患者病例数据展示
Fig.10  AML数据属性对齐
Fig.11  患者FHIR最终转换实例本体展示
FHIR类 下位类 字段名 含义 实例
Patient - Patient. name 患者姓名 ZXX
Patient. age 患者年龄 46
Patient. gender 患者性别 男
Patient. identifier 患者ID 430XXXXXXXXXXXXXXX
Patient. other 患者备注 喜热茶,无抽烟不良嗜好
Condition - Condition. bodySite 身体部位 腹部
Condition. severity 症状严重程度 轻
Condition. category 症状类别 疼痛
FamilyMemberHistory - FamilyMemberHistory.condition 与患者相关成员的存活状态 父母已故
MedicationRequest - MedicationRequest. dosageInstruction 药物剂量 0.1g
MedicationRequest. initialFill.duration 服药间隔时间 24小时
MedicationRequest.name 药物名称 舒敏（释缓片）
Encounter - - 患者过去经历、遭遇 -
Procedure Procedure.perform 患者过去诊疗时间 2010.6.30
Procedure.category 患者过去诊疗方式 化疗
Procedure.outcome 患者过去诊疗结果 术后效果良好
DiagnosticReport - DiagnosticReport.result 诊断报告中诊疗结果 淋巴癌‘127232002’
DiagnosticReport.category 诊疗报告采用方式 剖腹探查+腹腔淋巴结清扫术
DiagnosticReport.media. comment 诊疗报告中影像评述 检测腹腔多发淋巴结肿大,纵隔淋巴结肿大
… … … … …
Table 5  FHIR格式下的一条患者记录
Fig.12  存储在数据库中FHIR格式的患者实例
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