diff --git a/_sidebar.md b/_sidebar.md index a1b9a5f..7f07b2a 100644 --- a/_sidebar.md +++ b/_sidebar.md @@ -1,7 +1,7 @@ - HIS 医疗数据信息化 - [Readme](README.md) - [Contact](CONTACT.md) -- [FHIR In Action](in-action/index.md) +- [FHIR In Action](fhir-in-action/index.md) - [Week 2](week-2/index.md) - [Week 3](week-3/index.md) - [Week 4](week-4/_index.md) diff --git a/in-action/_images/Eclipse-Temurin-JDK.png b/fhir-in-action/_images/Eclipse-Temurin-JDK.png similarity index 100% rename from in-action/_images/Eclipse-Temurin-JDK.png rename to fhir-in-action/_images/Eclipse-Temurin-JDK.png diff --git a/in-action/_images/php-install-04.png b/fhir-in-action/_images/php-install-04.png similarity index 100% rename from in-action/_images/php-install-04.png rename to fhir-in-action/_images/php-install-04.png diff --git a/in-action/_images/php-install-05.png b/fhir-in-action/_images/php-install-05.png similarity index 100% rename from in-action/_images/php-install-05.png rename to fhir-in-action/_images/php-install-05.png diff --git a/in-action/_images/php-install-06.png b/fhir-in-action/_images/php-install-06.png similarity index 100% rename from in-action/_images/php-install-06.png rename to fhir-in-action/_images/php-install-06.png diff --git a/fhir-in-action/_sidebar.md b/fhir-in-action/_sidebar.md new file mode 100644 index 0000000..b8bc17c --- /dev/null +++ b/fhir-in-action/_sidebar.md @@ -0,0 +1,5 @@ +- [FHIR 简介](/fhir-in-action/introduction/index.md) + - [开发者眼中的 FHIR](/fhir-in-action/introduction/toreader.md) +- [Install JDK](/fhir-in-action/install_jdk.md) +- [Install Eclipse](/fhir-in-action/introduction/install_eclipse.md) +- [Naming Conventions](/fhir-in-action/naming_conventions.md) \ No newline at end of file diff --git a/in-action/index.md b/fhir-in-action/index.md similarity index 64% rename from in-action/index.md rename to fhir-in-action/index.md index 7f1999c..bcfeee3 100644 --- a/in-action/index.md +++ b/fhir-in-action/index.md @@ -21,12 +21,17 @@ FHIR 整合了 HL7 V2,V3 和 CDA 的优点,同时利用了最新的Web标准,紧 在线电子版本请访问：https://fhir.isharkfly.com -## 参考 +## 参考和框架 + +| 网站名称 | URL | NOTE | +|-----------------|-----------------------------------------------------------------------------|-------------| +| iSharkFly | https://www.isharkfly.com/c/industry-software/hospital-information-system/6 | HIS 相关信息 | +| David Hay 博客 | http://fhirblog.com/ | | +| Ewout Kramer 博客 | https://github.com/JaneBlue/PPTpaper | | +| 硕士论文 | https://github.com/JaneBlue/PPTpaper | | +| FHIR GitHub 参考 | https://github.com/wanghaisheng/fhir-in-action/ | | +| HAPI FHIR 库源代码 | https://github.com/hapifhir/hapi-fhir | | +| SMART 技术文档 | https://github.com/smart-on-fhir/smart-on-fhir.github.io | | +| Fhirbase | https://github.com/fhirbase | 使用 Go 和技术方案 | + -| 网站名称 | URL | NOTE | -|-----------------|-----------------------------------------------------------------------------|----------| -| iSharkFly | https://www.isharkfly.com/c/industry-software/hospital-information-system/6 | HIS 相关信息 | -| David Hay 博客 | http://fhirblog.com/ | | -| Ewout Kramer 博客 | https://github.com/JaneBlue/PPTpaper | | -| 硕士论文 | https://github.com/JaneBlue/PPTpaper | | -| FHIR GitHub 参考 | https://github.com/wanghaisheng/fhir-in-action/ | | diff --git a/fhir-in-action/introduction/awesome-fhir.md b/fhir-in-action/introduction/awesome-fhir.md new file mode 100644 index 0000000..bec4c78 --- /dev/null +++ b/fhir-in-action/introduction/awesome-fhir.md @@ -0,0 +1,104 @@ +## FHIR Implementation + +* The current specification: [http://www.HL7.org/fhir/](http://www.HL7.org/fhir/) (or [the development version](http://hl7.org/implement/standards/FHIR-Develop/)) + * [FHIR Profiles from other Organizations](/index.php?title=FHIR_Profiles_from_other_Organizations "FHIR Profiles from other Organizations") +* Contact Information + * Implementation help: [[ask questions about FHIR](http://stackoverflow.com/questions/tagged/hl7_fhir)] + * Formal Contact point for the project: [[fmgcontact@hl7.org](mailto:fmgcontact@hl7.org)] + * [Skype Group Chats](/index.php?title=FHIR_Skype_Chat "FHIR Skype Chat") + * [FHIR gForge Tracker](http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemBrowse&tracker_id=677) for change requests/corrections + * FHIR Project Team Leads (FHIR Core Team): [[Grahame Grieve](mailto:grahame@healthintersections.com.au)], [[Ewout Kramer](mailto:e.kramer@furore.com)], [[Lloyd Mckenzie](mailto:lloyd@lmckenzie.com)] + * [List server](/index.php?title=FHIR_email_list_subscription_instructions "FHIR email list subscription instructions") - project email list + +* Help / Getting Started + * [FHIR Starter](/index.php?title=FHIR_Starter "FHIR Starter") - tutorial for FHIR newbies + * [FHIR Cheat Sheet](http://www.furore.com/wp-content/uploads/2014/11/FURORE-CHEATSHEET-FHIR-R3.pdf) (DSTU 1) + * [Help desk FAQs & knowledge-base articles](https://healthlevelseven.desk.com/) (HL7 members only) + * [FHIR Tools Registry](/index.php?title=FHIR_Tools_Registry "FHIR Tools Registry") - a list of useful tools for FHIR implementers + * [FHIR for Clinical Users](/index.php?title=FHIR_for_Clinical_Users "FHIR for Clinical Users") - an introduction to FHIR for non-technical people that will migrate to the specification in the future + * [FHIR User Group](/index.php?title=FHIR_User_Group "FHIR User Group") +* Social Media on FHIR + * FHIR blogs [David Hay](http://fhirblog.com/), [Ewout Kramer](http://thefhirplace.com/), [Grahame Grieve](http://www.healthintersections.com.au/) + * FHIR News on Twitter [FHIR News](http://www.twitter.com/FHIRnews) + * FHIR Videos [HIMSS FHIR Session](https://live.blueskybroadcast.com/bsb/client/CL_DEFAULT.asp?Client=556675&PCAT=8341&CAT=8341&Review=true), [HL7.tv](http://www.hl7.tv/FHIR.html) and [Ringholm](https://vimeo.com/channels/hl7fhir). + +* Testing + * [Publicly Available FHIR Servers for testing](/index.php?title=Publicly_Available_FHIR_Servers_for_testing "Publicly Available FHIR Servers for testing") + * [Open Source FHIR implementations](/index.php?title=Open_Source_FHIR_implementations "Open Source FHIR implementations") + * [FHIR Connectathon 8](/index.php?title=FHIR_Connectathon_8 "FHIR Connectathon 8") (January, San Antonio) + * [Organizations interested in FHIR](/index.php?title=Organizations_interested_in_FHIR "Organizations interested in FHIR") + * [Profile Tooling](/index.php?title=Profile_Tooling "Profile Tooling") + +* [FHIR Implementations](/index.php?title=FHIR_Implementations "FHIR Implementations") + +* Connectathons + * [Connectathon 9](http://wiki.hl7.org/index.php?title=FHIR_Connectathon_9) (May 9-10, Paris, France) + +* Previous Connectathons and other events + * [Historical Connectathons](/index.php?title=Category:FHIR_Connectathons "Category:FHIR Connectathons") (list) + * [Clinical Connectathon 1](/index.php?title=FHIR_Clinical_Connectathon_Initiative "FHIR Clinical Connectathon Initiative") (September 2014, Chicago) (+ [Clinical Connectatathon 1 Tooling](/index.php?title=Clinical_Connectatathon_1_Tooling "Clinical Connectatathon 1 Tooling")) + * [2 day seminar and Connectathon](http://www.healthintersections.com.au/?p=2237) (Nov 6-7, Melbourne Australia) + * [International FHIR Development Days](http://fhir.furore.com/devdays/) (Nov 24-26, Amsterdam) + +## FHIR Development + +* How to + * [FHIR DSTU monitoring](/index.php?title=FHIR_DSTU_monitoring "FHIR DSTU monitoring") - how to monitor DSTU feedback + * [FHIR Ballot Prep](/index.php?title=FHIR_Ballot_Prep "FHIR Ballot Prep") - tasks for the next ballot and milestone dates + * [FHIR Build Process](/index.php?title=FHIR_Build_Process "FHIR Build Process") - Setting up and running the FHIR build process + * [Technical Guide](/index.php?title=FHIR_Guide_to_Authoring_Resources "FHIR Guide to Authoring Resources") - How to create resources + * Materials: [gForge](http://gforge.hl7.org/gf/project/fhir/), [SVN Trunk](http://gforge.hl7.org/svn/fhir/trunk) + * For read-only SVN access, use "anonymous" and your email as a password. + * For Commit privileges, send a request to lloyd@lmckenzie.com + * [FHIR resource and profile proposals](/index.php?title=Category:FHIR_Resource_Proposal "Category:FHIR Resource Proposal") - proposals for new resources & profiles + * [FHIR Profile authoring](/index.php?title=FHIR_Profile_authoring "FHIR Profile authoring") - Creating and maintaining FHIR profiles (see also [Profile Tooling](/index.php?title=Profile_Tooling "Profile Tooling")) + * [FHIR Change requests](/index.php?title=FHIR_Change_requests "FHIR Change requests") - Process for managing and resolving + +* Guidelines + * [Fundamental Principles of FHIR](/index.php?title=Fundamental_Principles_of_FHIR "Fundamental Principles of FHIR") + * [FHIR Methodology Process](/index.php?title=FHIR_Methodology_Process "FHIR Methodology Process") - how the methodology is developed and maintained + * [Methodology Guidelines](/index.php?title=FHIR_Guide_to_Designing_Resources "FHIR Guide to Designing Resources") - Content and quality guidelines + * [Design Patterns](/index.php?title=FHIR_Design_Patterns "FHIR Design Patterns") + * [FHIR Comparison to other RESTful API specifications](/index.php?title=FHIR_Comparison_to_other_RESTful_API_specifications "FHIR Comparison to other RESTful API specifications") + +* Resources + * [List server](/index.php?title=FHIR_email_list_subscription_instructions "FHIR email list subscription instructions") - discussions + * Discussion pages: [Active Discussions](/index.php?title=Category:Active_FHIR_Discussion "Category:Active FHIR Discussion"), [All](/index.php?title=Category:FHIR_Discussion "Category:FHIR Discussion") + * [FHIR Design Requirements Sources](/index.php?title=FHIR_Design_Requirements_Sources "FHIR Design Requirements Sources") + * [FHIR Resource Types](/index.php?title=FHIR_Resource_Types "FHIR Resource Types") + * [FHIR Resource Considerations](/index.php?title=FHIR_Resource_Considerations "FHIR Resource Considerations") + * [(old)](/index.php?title=FHIR_Governance "FHIR Governance") - governance discussion with bits of methodology mixed in (to migrate to other pages) + * [FHIR Terminology Service](/index.php?title=FHIR_Terminology_Service "FHIR Terminology Service") + * [FHIR Digital Signature Working Page](/index.php?title=FHIR_Digital_Signature_Working_Page "FHIR Digital Signature Working Page") + +* WG FHIR pages + * [Patient Administration Resource development](/index.php?title=Patient_Administration_Resource_development "Patient Administration Resource development") + * [CDA to FHIR Samples Group](/index.php?title=CDA_to_FHIR_Samples_Group "CDA to FHIR Samples Group") + * [FHIR_Patient_Care_Resources](/index.php?title=FHIR_Patient_Care_Resources "FHIR Patient Care Resources") + + +## Organizational + +* Governance + * [FHIR Governance Process](/index.php?title=FHIR_Governance_Process "FHIR Governance Process") + * [FHIR Governance Board](/index.php?title=FHIR_Governance_Board "FHIR Governance Board") (FGB) + * [FHIR Management Group](/index.php?title=FHIR_Management_Group "FHIR Management Group") (FMG) + * [Modeling and Methodology](/index.php?title=Modeling_and_Methodology "Modeling and Methodology") (MnM) + * [Work Groups](/index.php?title=FHIR_Work_Groups "FHIR Work Groups") + * [FHIR Escalation Processes](/index.php?title=FHIR_Escalation_Processes "FHIR Escalation Processes") + * [FHIR Ballot Process](/index.php?title=FHIR_Ballot_Process "FHIR Ballot Process") + * [FHIR Web Server Hosting Record](/index.php?title=FHIR_Web_Server_Hosting_Record "FHIR Web Server Hosting Record") + +* Agendas + * **[Paris WGM](/index.php?title=FHIR_Agenda_201505_WGM "FHIR Agenda 201505 WGM")** (next meeting, May 2015) + * [Past Working Group Meetings](/index.php?title=Category:FHIR_Meeting "Category:FHIR Meeting") (list of agendas/notes) + * [MnM agendas](http://wiki.hl7.org/index.php?title=MnM_Schedule) + * [FGB Agendas & Minutes](http://wiki.hl7.org/index.php?title=FHIR_Governance_Board#Meeting_Information) + * [FMG Agendas & Minutes](http://wiki.hl7.org/index.php?title=FHIR_Management_Group#Meeting_Information) + +## opensource project + +* Testing + * [FHIR 公开测试服务器的测试报告](http://www.projectcrucible.org/) +* Lib + * [Ruby语言的FHIR模型 工具等](https://github.com/fhir-crucible/) diff --git a/fhir-in-action/introduction/bb-epic-ceo.png b/fhir-in-action/introduction/bb-epic-ceo.png new file mode 100644 index 0000000..61d29e4 Binary files /dev/null and b/fhir-in-action/introduction/bb-epic-ceo.png differ diff --git a/fhir-in-action/introduction/introduction.md b/fhir-in-action/introduction/introduction.md new file mode 100644 index 0000000..a636032 --- /dev/null +++ b/fhir-in-action/introduction/introduction.md @@ -0,0 +1,8 @@ +# FHIR 简介 + +主要是介绍一些FHIR 缘起的大背景，以及产业界对其唱衰唱好的各种论调。 +* [我眼中的FHIR](toreader.md) +* [awesome FHIR](awesome-fhir.md) +* [FHIR 概述](overview.md) +* [FHIR 开发者指南](overview-dev.md) +* [开放数据专题](open-data-is-coming.md) diff --git a/fhir-in-action/introduction/open-data-is-coming.md b/fhir-in-action/introduction/open-data-is-coming.md new file mode 100644 index 0000000..18e5459 --- /dev/null +++ b/fhir-in-action/introduction/open-data-is-coming.md @@ -0,0 +1,261 @@ +开放数据专题 +1、立法推动usa 政府放开更多数据 +2、epic和CommonWell之争 +3、API能否拯救HIT +4、HIT OpenAPI之面面观 + +## 1、立法进一步推动USA政府开放更多数据—[SGR repeal opens doors to big data](http://www.medicalpracticeinsider.com/best-practices/how-sgr-repeal-law-promises-supercharge-data-analysis) + +在2015年4月16号，一个因废止了Medicare中过时的根据可持续增长率来计算医生收入的公式而出名的Medicare Access and CHIP Reauthorization +Act (MACRA)东东正式成为了法律，有人称此举给Affordable Care Act法案的Medicare Data Sharing Program注入了一剂强心剂，更有人称其中的105章节要求政府将更多的 +claim(医保索赔)数据开放给准入机构，更是给中小型医疗机构带来了春天。 +``` +1、由于平价医疗法的存在，HHS也就是美国卫生部公开了一部分Medicare claim数据给准入机构，这些机构利用医保数据和商业化数据进行数据分析，来获取 +如何更好的达到要求的医疗质量和效率等指标来指导实践。由于此举风险甚高，议会持保守态度，但很快大家都意识到这样做远远不够，故在MACRA的105章节中放开更多数据 + +2、其中要求HHS Secretary不仅开放Medicare数据，也开放Medicaid和CHIP数据。这样子系统中的医保数据将会翻倍，能够支持更加复杂的数据分析。 + +3、尽管开放多少数据，开放不开放的决定权握在了HHS Secretary手里，但还是有很大希望的，毕竟Medicare的医保数据已经开放了2年，如果够快的话，Medicare每年应该能够开放 + +``` +### 背景资料 + +ACA平价法案 +``` +美国总统奥巴马上任后积极推动医保改革，去年立法的《平价医疗法》当地时间12日却被上诉法院裁定违宪，令医保改革前路茫茫。分析指，表面上，共和党明显打赢一仗，但由于法院仅裁定强制参保条款违宪，其余部分仍然有效，最大输家其实是医保公司，民主党不但未必介怀，还可能对裁决乐观其成。 + +据报道，目前美国约有5000万人没有基本医疗保险，医院及纳税人被迫每年代为支付高达430亿美元(约合人民币2749亿元)。民主党控制的国会去年3月通过立法，规定由2014年起，美国所有18岁或以上的民众必须终生购买保险，否则会遭到税务惩罚，政府则会给予无力付款的民众津贴。 + +据介绍，强制参保条款是奥巴马医改法案的重点，能使3200万未投保的民众被纳入医保“保护伞”下，令美国全国医保覆盖率提升至95%，并要求保险公司接受已患病的民众投保。 + +分析认为，美国民主党其实并非很支持强制投保，最支持的是可赚大钱的保险公司。保险公司要求全民强制参保，才愿意接受早已患病的投保人。民主党当初为平息保险公司的反对声音，支持全民投保只是权宜之计。若该条款最后被删除，其余部分仍有效，保险公司将被迫继续接受患病者的投保，民主党也可达成全民医保的目标，民主党何乐而不为？ +``` +需求驱动的数据开放计划 +``` +https://github.com/demand-driven-open-data +Tools and methods that provide a systematic, ongoing and transparent mechanism to tell data owners what's most valuable to you +``` + +美国政府的开放数据集 +``` +自从Data.gov开放以来，美国已经公开了超过八万五千个政府数据集并提供免费下载。现在杀出了一个公司叫做enigma，把多个国家的开放数据整合索引， +提供开放数据的搜索服务。 +enigma: https://app.enigma.io 纽约时报:http://www.nytimes.com/2014/03/16/technology/a-harvest-of-company-details-all-in-one-basket.html?_r=0 +``` +开放数据计划 +``` +https://project-open-data.cio.gov/ +https://github.com/project-open-data +``` +## 2、epic和CommonWell之争 + +### 背景介绍 +主角： +Epic +``` +1、参考dr2的[新文章](http://ww2.sinaimg.cn/bmiddle/be7d1ecagw1erwsfgwnlqj20c84mob29.jpg) +2、[美国的The top 100 EHR companies (Part 1 of 4)前一百](http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/top100ehrs/top-100-ehr-companies-part-1-4) +``` + +主角： +CommonWell联盟(Cerner, McKesson, athenahealth and Greenway四大公司，亦可参考上面的top100了解其大概的规模) + +``` +1、参考http://www.commonwellalliance.org/news/commonwell-health-alliance-announces-member-expansion-plans-for-2015/ +2、参考http://www.commonwellalliance.org/ +CommonWell Health Alliance today announced the commitment of five of its health IT vendor members—athenahealth, Cerner, CPSI, Greenway Health and McKesson—to actively deploy CommonWell services to health care provider sites nationwide throughout 2015. + +Already, more than 60 provider sites are live on CommonWell services across 15 states including: Alabama, Delaware, Florida, Illinois, Indiana, Kansas, Massachusetts, Mississippi, Nebraska, North Carolina, Ohio, South Carolina, South Dakota, Texas and Washington. CommonWell expects 2015 deployments to enable at least 5,000 provider sites to be live on the services nationwide. CommonWell’s built-in services include patient identification, record location, patient privacy and consent, and trusted data access. +``` + +### 缘起 +2014年7月17号，在[众议院能源和商务委员会的小组委员会通讯技术和健康 House Energy and Commerce Committee's subcommittee on Communications and Technology and Health](http://energycommerce.house.gov/press-release/subcommittees-team-learn-how-21st-century-technology-can-improve-21st-century-cures)的[听证会上](http://www.fierceemr.com/story/phil-gingrey-ehr-interoperability-fraud-against-american-taxpayers/2014-07-22 +) ,从医生成为议员的Rep. Phil Gingrey 指责epic道： +``` +一些电子病历的供应商的系统本身就在阻碍数据的共享和交换，就不应该拿到Meaningful Use incentive计划的钱。但根据RAND的一份报告，刺激计划的240亿美金中的一半以上都被 +Epic公司拿走了，可Epic玩的是自己的封闭平台，这是HITECH的初衷么，纳税人的钱是这么花的么。 + +无独有偶，在RAND的报告中建议国会“取消那些需要额外组件、费用和定制才能够实现数据共享的医疗信息化产品的认证资格”。同期的一份研究中也指出Meaningful Use program 计划 +第二阶段的数据共享的架构是不够健壮的，不足以支撑数据的共享。 +``` +原文如下 +``` +Electronic health record vendors--particularly Epic--may not deserve Meaningful Use incentive money because their systems hinder data sharing, according to physician-turned-lawmaker Rep. Phil Gingrey (R-Ga.). + +In a July 17 hearing of the House Energy and Commerce Committee's subcommittee on Communications and Technology and Health, Gingrey (pictured) questioned whether the nation is currently on a path of interoperability or whether changes to the law need to be made. He expressed concern that according to a recent RAND report, more than half of the $24 billion spent by the Meaningful Use program has gone to Epic, a vendor operating a "closed platform." + +Pointing out that the committee has jurisdiction over the Office of the National Coordinator for Health IT and the HITECH Act--which created the Meaningful Use program--Gingrey said that if the RAND report is true, "we have been subsidizing systems that block information instead of allowing for information transfers, which was never the intent of the [HITECH] statute. + +"It may be time for this committee to take a closer look at the practices of vendor companies in this space given the possibility that fraud may be perpetrated against the American taxpayer," he added. + +The hearing was focused on how healthcare and technology can accelerate the pace of cures in the U.S., which is an initiative of the committee. + +Gingrey is not alone in his concern about EHRs' lack of interoperability. The coalition Health IT Now, buoyed by the RAND report that decried the lack of interoperability among EHRs, recommended that Congress "decertify systems that require additional modules, expenses, and customization to share data," and to investigate business practices that prohibit or restrict data sharing in federal incentive programs. + +Another recent study revealed that the current architecture for data exchange required by Stage 2 of the Meaningful Use program doesn't allow for robust patient sharing. +``` + +### [ONC发布互操作性路线图interoperability roadmap](http://www.fiercehealthit.com/story/onc-interoperability-road-map-draft-outlines-governance-certification-stand/2014-10-14?utm_medium=nl&utm_source=internal) +关于这个10年的互操作性路线图,更多中文信息可参考 + +1、[ 【OMAHA】美国联邦政府医疗信息化战略规划2015 - 2020](http://mp.weixin.qq.com/s?__biz=MzA4NDAyNTU2NQ==&mid=204074676&idx=1&sn=d4d7b74c32d1486b79a95a0172005e5b&3rd=MzA3MDU4NTYzMw==&scene=6#rd) + +2、[一张图看美国互操作性路线图](http://mp.weixin.qq.com/s?__biz=MzA5Mzg2MTMwMA==&mid=203956582&idx=4&sn=9f5ba195373b0acdec836a77af48118b&3rd=MzA3MDU4NTYzMw==&scene=6#rd) + +3、[【国外】ONC发布HIT互操作路线图 助推精准医学计划](http://mp.weixin.qq.com/s?__biz=MzA5OTA2NDg4Mg==&mid=204722876&idx=4&sn=10475865952acb6137bdb1d48c815024&3rd=MzA3MDU4NTYzMw==&scene=6#rd) + + +某个组的老大如是说“如果我们能够让不同的系统能够互相'说话'，那已经是相当牛逼了” +原文如下 +``` +"If we just get the systems themselves to talk to each other, that would be a huge accomplishment," Health IT Policy Committee member Paul Egerman, former CEO of eScription, said at the meeting. "Perhaps we're making this harder than we need to make it, and it's already pretty hard." + +尽管局部范围已经实现了一定程度的互操作性，但大规模的应用还是很大的问题。 +while interoperability has increased, widespread interoperability remains a challenge. The report identifies several barriers to interoperability, including unchanged provider practice patterns, the lack of standardization among EHRs and the lower priority placed on EHRs by providers who are ineligible for the Meaningful Use program. +``` + +### [Omnibus bill keeps ONC funding at same level as 2014](http://www.fiercehealthit.com/story/omnibus-bill-keeps-onc-funding-unchanged/2014-12-15) +Omnibus法案成为导火索 +``` +The Omnibus Appropriations bill that passed Congress over the weekend will fund the Office of the National Coordinator for Health IT at the same level as last fiscal year with a budget of just under $60.4 million. After the bill passed the House last week, the Senate approved it Saturday night. + +Additionally, the bill grants $14.9 million to the Federal Office of Rural Health Policy within the Health Resources and Services Administration to administer the Small Rural Hospital Improvement Grant program for quality improvement and adoption of health information technology. It also awards the VA $3.9 billion in IT funds, $200 million more than FY2014, including $344 million for the modernization of VistA and the development of an interoperable system with the Department of the Defense. + +Of the total IT budget, $548.34 million is earmarked for IT development, modernization and enhancement. +``` + +[国会敦促ONC ：要专注在互操作性上](http://www.fierceemr.com/story/congress-onc-focus-interoperability/2014-12-16): + +在国会通过2015 omnibus appropriation bill法案的同时提交的[报告](http://docs.house.gov/billsthisweek/20141208/113-HR83sa-ES-G.pdf)中，国会很生气，敦促ONC： +“”要合理使用你们手中的认证的权利来保障合格的产品能够医疗机构和人民群众带来价值。只给那些满足我们的认证标准的且没有阻碍区域医疗(医疗信息交换)的产品给予授权，对于阻碍信息共享的产品要收回执照。 + +``` +"[U]se its certification program judiciously in order to ensure certified electronic health record technology provides value to eligible hospitals, eligible providers and taxpayers. ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use." +``` + +同时在报告里要求ONC90天内提交一份报告，分析一下目前信息阻塞问题的严重程度，要有个大概的厂商、医疗机构的数目以及解决问题的方案。 + +### [信息化厂商和医院都是信息阻塞的罪魁祸首](http://www.fiercehealthit.com/story/providers-vendors-both-blame-information-blocking/2015-04-10) + +这里就是上面ONC给国会交的[作业](http://healthit.gov/sites/default/files/reports/info_blocking_040915.pdf) +作业中指出： +1、医院或厂商通过收费来控制转诊和加强自己的市场占有率 +A common charge is that some hospitals or health systems engage in information blocking to control referrals and enhance their market dominance +2、厂商反馈 原因很多啦 比如说HIPAA 但作业中指出 +都是借口 和HIPAA压根没多大关联 +It has been reported to ONC that privacy and security laws are cited in circumstances in which they do not in fact impose restrictions + +作业中给出的解决方案： + +1、Strengthen in-the-field surveillance of ONC certified health IT tools, which was proposed in the certification requirements accompanying the Stage 3 Meaningful Use rule +2、Constrain standards and implementation specifications +3、Promote better transparency in certified health IT products and services that would "make developers more responsive to customer demands and help ameliorate market distortions" that lead to vendor information blocking +4、Establish governance rules deterring information blocking, which the report notes is addressed in ONC's interoperability roadmap +5、Work with the U.S. Department of Health and Human Services Office for Civil Rights to ensure healthcare stakeholders understand HIPAA privacy and security standards, particularly those related to information sharing +6、Coordinate with the HHS Office of Inspector General and the Centers for Medicare & Medicaid Services on information blocking as it relates to physician self-referral and the federal anti-kickback statute +7、Refer illegal business practices to law enforcement agencies +8、Work with CMS to provide incentives for interoperability while simultaneously discouraging information blocking +9、Promote competition and innovation in health IT, which the Federal Trade Commission recommended in its comments on the interoperability roadmap + +但看了总结就知道 美帝也是各种部门互相扯皮呀，这种东西往后10年看有起色不 +``` +"While important, these actions alone will not provide a complete solution to the information blocking problem," the report's authors say. "A comprehensive approach will require overcoming significant gaps in current knowledge, programs and authorities that limit the ability of ONC and other federal agencies to effectively target, deter and remedy this conduct, even though it violates public policy and frustrates congressional intent. +``` + +### [口水仗正式开始](http://www.healthcareitnews.com/news/epic-vs-commonwell-showdown) + +Senate HELP Committee Tuesday 2015年3月17日的组委会例行会议上， +在听证会的问答环节，参议员Senator Tammy Baldwin, D-Wisconsin问 为什么Epic 没有参加CommonWell Health Alliance +Epic 的主管互操作性的头Peter DeVault说了如下一段话，引发了CommonWell Health Alliance的反击： +``` +"When we were approached by them and asked to join, we were told that it would be multiple millions of dollars for us to join and that we would have to sign an NDA.To us, the only reasons to have an NDA are if they're going to tell you something that otherwise they wouldn't want people to know" - which he said could include the possibility they may sell data downstream or wanted to ensure there were no intellectual property conflicts.That lack of transparency didn't sit well with us +``` +同时还不饶人的嘲讽 你丫们只是嘴上说说 雷声大雨点小 +CommonWell至今成立2年，目前只涵盖了1000个医生 和Epic的care Everywhere的10万医生简直高下立判 +``` +DeVault also underscored CommonWell's low participant numbers in its interoperability project so far – which he called an "aspiring network," noting a stark difference when compared to Epic's Care Everywhere network. +``` +CommonWell联盟随后在Healthcare IT News发表了联合声明： +``` +We are committed to openness and transparency," the statement read. "Accordingly we publish our services and use case specifications, along with our nominal membership and service fees on our website for everyone to see. +``` +那么Epic要入会 大概要每年缴纳多少钱呢 根据目前CommonWell会员费和服务费用标准，结合Epic2014年的年收入18亿美元，要掏 +125万美元annual subscription fee和 $50,000 to $90,000 in annual membership dues 。 + + +周三晚上 就是3.18日 athenahealth CEO Jonathan Bush在twitter上对Epic CEO Judy Faulkner 进行了高调嘲讽 +![](bb-epic-ceo.png) + +Cerner. 行业老二也发话了 +``` +His "rhetoric is a slap in the face to many parties working to advance interoperability," according to a statement released by Cerner officials shortly after the committee hearing. "It was discouraging to hear more potshots and false statements when it's clear there is real work to be done. We're committed to CommonWell as a practical, market-led way to achieve meaningful interoperability +``` + +梗在这里 2013年HIMSS上Epic and CommonWell就有口角 +``` +At that HIMSS13 announcement, athenahealth CEO Jonathan Bush 说 大家都可以加入哟 +emphasized that anyone was invited to CommonWell – even a vendor of "epic proportions." + +In a subsequent interview, Healthcare IT News asked McKesson CEO John Hammergren whether that invitation was dangled only because the founding companies suspected Epic wouldn't bite. + +"We'd like them to bite! We want them to bite," said Hammergren. "I'm hopeful that they will see it the same way we see it." +``` +但 Epic CEO说 完全不知情,这帮sb居然想背后地里阴我们，手够黑的啊 +``` +But Epic CEO Judy Faulkner noted that her company wasn't asked to join before the announcement. "We did not know about it. We were not invited," Faulkner told Bloomberg back in 2013. "It appears on the surface to be used as a competitive weapon, and that's just wrong. It's wrong for the country." +``` + +对于行业内愈演愈烈的竞争所引发这场闹剧，围观群众也有话说： +1、各位看官和Epic签合同要慎重啊 且要是Epic-to-non-Epic能达到Epic-to-Epic 的90%的功能，"哥就表演吃翔" +2、路人乙嘲讽到Epic到底是如何腆着脸皮说all of our systems can talk to each other +3、入会费是不是有点多 +4、Epic does not need to join CommonWell. CommonWell needs to join Epic. +5、CommonWell sounds like a group of union thugs who want to strong-arm their way into other vendors' businesses +6、CommonWell or is it CommonHell? Later seems to be more appropriate.此人称Epic很好合作 方案也性价比高Stop creating mindless standards organizations with a scheme to collect additional revenues from licensing. Healthcare organizations dole out enough on their EMRs to these vendors and they don't need these vendors charging nickel and dime on every petty thing that gives patients control of their health information +"我深深的表示赞同" +7、It just doesn't seem right that a private company pulling down $1.8B in revenue should be able to dictate interoperability. The government needs to step in and make sure all of these companies play well in the sandbox. Greed stands in the way of a national clinical data repository that researchers could use to find treatments and cures for diseases that have plagued us for decades. +问题不存在一个厂商上 此人观点有理 +8、Joining CommonWell doesn't seem like a great business opportunity if after two years they only have 1000 doctors live on it. Epic seems to understand the fundamentals of sharing patient data if they have 100,000 doctors on their version. My guess is that CommonWell is floundering and they want Epic in there to help them out. If they can also take some digs at Epic for not joining in the meantime - all the better in their mind. + +The healthcare market will drive the need for interoperability. I don't think getting the government involved will help anything. + +9、What would be interesting to know is how many of Epic's 100,000 physicians are using a product other than something in the Epic family. +Epic excels at interoperability between their own products, but what is their track record when connecting to someone outside the family, so to speak? Their numbers may be impressive, I don't know. But I do know that the huge challenge CommonWell has is interoperability across disparate vendors and products. +10、It seems to me that CommonWell is primarily a marketing "gimmick". Aids and standards for inter-operability e.g. LOINC, CLSI standards, and other accepted nomenclatures have existed in the marketplace for some time. We probably have enough standards but many vendors simply pay "lip service" to them. Such a "collaboration" among competitors may be a "surface phenomenon" with relatively little substance. + +11、对第10条的回复 CommonWell is a response to Epic's market share and market power by vendors that heretofore did not feel compelled to cooperate with each other on data exchange. Epic dramatically dominates the large HCDO/ Academic Medical Center market and is viewed as almost unstoppable. As Epic conquers the large market, it will target the mid-size market - probably taking advantage of a cloud service at some point in time. This probably best explains why Epic doesn't want to join CommonWell - they understand the strategic alignment and competitive response that CommonWell represents. +12、It does seem a bit childish to see these types of exchanges between behemoths of the industry. However, I do wonder why Epic would have to sign an NDA to participate in a joint effort to share and propagate openess. +### 后续报道 [Epic 投降了](http://www.healthcareitnews.com/news/epic-latest-drop-fees-data-exchanges) + +Epic CEO Judy Faulkner 在每年度最盛大HIT行业会展，也就是2015年的HIMSS15大会上宣布，直到2020年之前 咱大EPIC是不会再收大伙钱了。其实athenahealth和Cerner这俩货也是不久之前宣布他们也不收费 + + +群众观点： +1、up-front predictable cost and a pay-per-use model两种付费模式的区别而已，钱总是会出的 +2、市场的不成熟导致没有有效的激励方式来促使信息的无缝免费流动。而能因为厂商收取服务费用就认为是某个厂商作恶。要解决的是到底谁来掏钱的问题 +3、不额外收钱的话，，软件的成本、维护费咨询费必然要上涨，羊毛出在羊身上 +http://www.healthcareitnews.com/news/epic-latest-drop-fees-data-exchange + + + +### 思考 +国内最早喊互操作性的应该是李包罗老爷子了，从最初引入这样的概念至今大概也有10来个年头了，不管是学术界还是工业界，这些年来沿着的一条路是说想要给复杂的医疗领域定义出一种通用的one-fit-all的能够描述整个医疗领域的模型，进而演化出一种可以用于不同系统间交互数据的通用格式和统一的医疗术语，也就是所谓的互操作性标准。这些年也有人在提学习型的医疗信息化系统的建设，提精准医疗，大喊互联网医疗的口号，但这些目标的实现都离不开数据，离不开鲜活的在不同系统间流动的数据，就像阿里、京东、腾讯、amazon一样，没有各部门间数据的无缝整合，它们是不能提供大家每天都在享受的这些服务的。近几年不管是google还是豌豆荚，都在说一个“应用内搜索”的东西，说白了，就是想把接入各自平台的系统的数据格式标准化，这样子就可以点开具体的应用来搜索查询信息，但似乎也没有什么进展，对于如日中天的互联网应用来讲，对于宇宙第一的google来讲尚且很难突破的东西，反过来看医疗行业，业务只会更复杂，业务系统的成熟度只会更低，似乎互操作性的口号，我们喊得太早了，能从美帝、互联网厂商身上学到的是，未来势必在国内的HIT圈要成长出一两家如Epic这样的公司，在自己封闭的平台中，实现各级医疗机构的信息无缝流通，只有这样的巨无霸，通过自己所收集的患者全生命周期的数据链，利用医疗大数据的应用打造出优质的医疗服务来服务大众，但有没有其他实现互操作性的路径呢? + +### [Epic和IBM的合作不加入是另有所谋](http://www.healthcareitnews.com/news/epic-watson-work-interoperability) +Epic与IBM watson的合作 是否预示着实现互操作性的另一条路 智能的解析各种异构的数据源中的数据。 + + +### 3、API能否拯救HIT +Jason and the Argonauts +http://geekdoctor.blogspot.nl/2014/12/kindling-fhir.html +http://xmlmodeling.com/2014/12/jason-argonauts/ +http://xmlmodeling.com/2014/10/jason-task-force-final-report/ +http://argonautwiki.hl7.org/index.php?title=Main_Page + + +### [Apps and APIs: A Positive Step for Patients](http://www.healthwise.org/insights/healthwiseblog/lkhall/may-2015/2496.aspx) + + + +### OMAHA联盟 后感 +http://getmyhealthdata.org/ 请愿书 diff --git a/fhir-in-action/introduction/overview-dev.md b/fhir-in-action/introduction/overview-dev.md new file mode 100644 index 0000000..e5671fe --- /dev/null +++ b/fhir-in-action/introduction/overview-dev.md @@ -0,0 +1,411 @@ +## 1.7.1 开发者指南 + +FHIR (Fast Health Interoperability Resources)旨在数据交换，能够支撑医疗领域的多种流程。该标准基于Restful的最佳实践，能够实现跨团队的医疗系统的集成。 + +FHIR 所支持的范围很广泛，包括人、兽医、临床、公共卫生、临床试验、管理和财务等方面。全球通用且支持多种架构和场景。 + +### 1.7.1.1 框架 + +FHIR 是基于 `资源`这一通用组件. 每个资源都有如下 [通用特征](resources.html): + +* 用URL来标识 +* 通用的元数据 +* [供人可读的XHTML概述](narrative.html) +* 通用的数据元集合 +* [扩展的框架](extensibility.html)以支持医疗中的多样性 + +资源要么是 [XML](xml.html) ，要么是 [JSON](json.html)格式的. 目前已经定义了99种[资源类型](resourcelist.html) + +### 1.7.1.2 Patient实例 + +如何用JSON来表示[patient](patient.html)。 标准中也定义了XML的表达方式。 + +``` + + +{ + "resourceType": "Patient", + "id" : "23434", + "meta" : { + "versionId" : "12", + "lastUpdated" : "2014-08-18T01:43:30Z" + } + "text": { + "status": "generated", + "div": "" + }, + "extension": [ + { + "url": "http://example.org/consent#trials", + "valueCode": "renal" + } + ], + "identifier": [ + { + "use": "usual", + "label": "MRN", + "system": "http://www.goodhealth.org/identifiers/mrn", + "value": "123456" + } + ], + "name": [ + { + "family": [ + "Levin" + ], + "given": [ + "Henry" + ], + "suffix": [ + "The 7th" + ] + } + ], + "gender": { + "text": "Male" + }, + "birthDate": "1932-09-24", + "active": true +} + + +```` + +每个资源包括如下内容: + +* **resourceType** (line 2) - 必须要有: FHIR 中定义了多种资源类型，详细列表请查看[the full index](resourcelist.html) +* **id** (line 3) - 资源自身的id(而非资源中数据的ID 相当于资源在数据库中的主键). 一般而言都是要有的，除了在新建时之外。 +* **meta** (lines 4 - 7) - 通常要由 : [所有资源都会有的属性(这里和其他地方对元数据的定义略有偏差，参考https://github.com/memect/hao/issues/296)](resources.html#meta)受基础架构控制. 如果没有元数据可以为空 +* **text** (lines 12 - 17) - 推荐使用: XHTML 包含了资源中 [供人可读的部分](narrative.html) +* **extension** (lines 12 - 17) - 可选: [Extensions](extensibility.html)由扩展框架所定义 +* **data** (lines 18 - 43) - 可选: 每种资源所定义的数据项。 + +备注 尽管标准中总是以所定义的顺序来显示JSON中数据的顺序，但很多JSON库有其他排序标准。 +### 1.7.1.3 交互 + +为了操作数据，FHIR 定义了[REST API](http.html): + +* [Create](http.html#create) = POST https://example.com/path/{resourceType} +* [Read](http.html#read) = GET https://example.com/path/{resourceType}/{id} +* [Update](http.html#update) = PUT https://example.com/path/{resourceType}/{id} +* [Delete](http.html#delete) = DELETE https://example.com/path/{resourceType}/{id} +* [Search](http.html#search) = GET https://example.com/path/{resourceType}?search parameters... +* [History](http.html#history) = GET https://example.com/path/{resourceType}/{id}/_history +* [Transaction](http.html#transaction) = POST https://example.com/path/ +* [Operation](operations.html) = GET https://example.com/path/{resourceType}/{id}/${opname} + +除了RESTful API之外,FHIR 中还定义了其他的数据交换方式，包括 [文档](documents.html), +[消息](messaging.html)和其他类型的[服务](services.html). + +### 1.7.1.4 对多样性的管理 + +医疗行业的一大特点就是不同地区和细分行业都存在很大的差异性,并不存在一个集中式的权威机构来定义通用的行业规范。鉴于此, +FHIR 中定义了[通用扩展框架](extensibility.html)和 +[管理多样性的框架](profiling.html). + +### 1.7.1.5 新增资源 + +为了[新增资源](http.html#create), 需要发送一个 HTTP 的 POST 请求到某个资源节点(也就是某个URL).如下所示 + +``` + POST https://example.com/path/{resourceType} +```` + + +``` +POST {some base path}/Patient HTTP/1.1 +Authorization: Bearer 37CC0B0E-C15B-4578-9AC1-D83DCED2B2F9 +Accept: application/json+fhir +Content-Type: application/json+fhir +Content-Length: 1198 + +{ + "resourceType": "Patient", + ... +} +```` + +向服务器提交一条患者记录, 服务器可以根据自己的情况分配ID来存储该患者记录。备注： + +* **/Patient** (line 1) - 处理所有患者的节点- 这里使用资源类型的名称 +* **Authorization** (line 2) - 参考 [Security for FHIR](security.html) +* **Accept, Content-Type** (lines 3-4) - 如果资源的数据是JSON格式，content type需要设置成这样application/json+fhir (XML的话设置成 application/xml+fhir). 数据的编码始终是UTF-8 +* **id** (line 9) - 待新建的记录中并没有id，由服务器来分配 +* Resource Content, lines 8+ - 这时候也没有任何元数据。资源的其他部分同上述示例 + +### 1.7.1.6 新增资源的响应 + +响应中包含HTTP 201，表示服务器已经成功新建该条记录。location header 属性中包含了访问该资源的URL。响应中亦可包含[OperationOutcome](operationoutcome.html) 资源来表达处理的一些细节,并不做硬性要求。 + +``` +HTTP/1.1 201 Created +Content-Length: 161 +Content-Type: application/json+fhir +Date: Mon, 18 Aug 2014 01:43:30 GMT +ETag: "1" +Location: http://example.com/Patient/347 + +{ + "resourceType": "OperationOutcome", + "text": { + "status": "generated", + "div": "
The operation was successful
" + } +} +```` + +Notes: + +* **HTTP/1.1 201** (line 1) - 操作成功. Note that HTTP/1.1 is strongly recommended but not required +* **ETag** (line 5) - used in the [version aware update](http.html#update) pattern +* **Location** (line 6) - the id the server assigned to the resource. The id in the url must match the id in the resource when it is subsequently returned +* **operationOutcome** (line 9) - OperationOutcome resources in this context have no id or meta element (they have no managed identity) + +#### 1.7.1.6.1 Error response + +出于多种原因，服务器会返回一个错误信息，FHIR 内容相关的一些错误信息以HTTP 状态码加一个[OperationOutcome](operationoutcome.html)来表达. +如下是一个不满足服务器端业务规则时的返回信息: + +``` +HTTP/1.1 422 Unprocessable Entity +Content-Length: 161 +Content-Type: application/json+fhir +Date: Mon, 18 Aug 2014 01:43:30 GMT + +{ + "resourceType": "OperationOutcome", + "text": { + "status": "generated", + "div": "
MRN conflict + - the MRN 123456 is already assigned to a different patient
" + }, +} +```` + +Notes: + +* 服务器可通过[OperationOutcome](operationoutcome.html)来表达更为详细的错误信息 + +### 1.7.1.7 Read Request + +[读取资源内容](http.html#read)是通过HTTP GET请求来实现的. + +``` + GET https://example.com/path/{resourceType}/{id} +```` + +``` +GET /Patient/347?_format=xml HTTP/1.1 +Host: example.com +Accept: application/xml+fhir +Cache-Control: no-cache +```` + +Notes: + +* **347** (line 1) - 要访问资源的id +* **_format=xml** (line 1) - 希望返回的数据格式，这种方式适合于客户端无法访问HTTP 头信息的情况，例如XSLT转换时，也可以通过HTTP 头中的accept字段来指定(see [Mime Types](http.html#mimetypes) +* **cache control** (line 4) - 如何控制并发是很重要的，但FHIR中并未做出规定,更多信息请参考[http://www.w3.org/Protocols/rfc2616/rfc2616-sec13.html](http://www.w3.org/Protocols/rfc2616/rfc2616-sec13.html) 或者 [https://www.mnot.net/cache_docs/](https://www.mnot.net/cache_docs/) + +### 1.7.1.8 Read Response + +读取单个资源内容GET请求的响应是单独的一个资源. + +``` +HTTP/1.1 200 OK +Content-Length: 729 +Content-Type: application/xml+fhir +Last-Modified: Sun, 17 Aug 2014 15:43:30 GMT +ETag: "1" + + + + + + + + + + + +```` + +Notes: + +* **id** (line 8) - 资源的id，与请求中的id一致 +* **versionId** (line 11) - 该资源的最新版本. 最佳实践中要求该值与 ETag值匹配 (see [version aware update](http.html#update)), 对于客户端而言，不能认为二者总是匹配的. 一部分服务器并不记录资源的版本信息。 +* 尽管建议服务器能够保留版本信息，但不做强制性要求 +* **lastUpdated** (line 12) - 如果存在该字段，字段值应与HTTP header中的值保持一致 + +### 1.7.1.9 Search Request + +除了读取单个资源内容之外，也可以通过[查询参数和变量](search.html) [查询资源内容](http.html#search)，形式一般如下: + +
+
+  GET https://example.com/path/{resourceType}?criteria
+
+
+ +The criteria is a set of +http parameters that specify which resources to return. The search operation + +
+
+https://example.com/base/MedicationPrescription?patient=347
+
+
+ +会返回该患者的所有处方信息. + +### 1.7.1.10 Search Response + +查询请求返回的对象是一个[bundle](extras.html#bundle): 如未明确要求，只返回满足查询参数要求的资源元数据: + +``` +{ + "resourceType": "Bundle", + "id" : "eceb4882-5c7e-4ca4-af62-995dfb8cef01" + "meta" : { + "lastUpdated" : "2014-08-19T15:43:30Z" + }, + "base": "http://example.com/base", + "total": "3", + "link": [ + { + "relation" : "next", + "url" : "https://example.com/base/MedicationPrescription?patient=347&searchId=ff15fd40-ff71-4b48-b366-09c706bed9d0&page=2" + }, { + "relation" : "self", + "url" : "https://example.com/base/MedicationPrescription?patient=347" + } + ], + "entry": [ + { + "resource" : { + "resourceType": "MedicationPrescription", + "id" : "3123", + "meta" : { + "versionId" : "1", + "lastUpdated" : "2014-08-16T05:31:17Z" + }, + ... content of resource ... + }, + }, + ... 2 additional resources .... + ] +} +```` +Notes: + +* **resourceType** (line 7) - "SearchResults" is the name for a bundle returned from a search +* **id** (line 3) -服务器为该次查询响应bundle的唯一标识. 有些情况下要求该id满足 [ 全球唯一](extras.html#bundle-unique) +* **meta.lastUpdated** (line 10) - This should match the HTTP header, and should be the date the search was executed, or more recent, depending on how the [server handles ongoing updates](search.html#currency). The lastUpdated data SHALL be the same or more recent than the most recent resource in the results +* **base** (line 12) - 返回的内容中所有[资源引用](references.html) 相对地址的根地址。 +* **total** (line 13) - 满足查询条件的记录数量. 这里的数量指的是总数，而非仅该bundle中所包含的数量，详情查看 [可以对结果进行分页查询](http.html#search) +* **link** (line 14) - A set of named links that give related contexts to this bundle. Names defined in this specification: [first](http.html#search), [prev](http.html#search), [next](http.html#search), [last](http.html#search), [self](http.html#search) +* **item** (line 23) - 用来表达满足查询条件的实际资源的元数据信息 +* 如果加上include标签，可以强制要求服务器在返回结果中包含资源的内容，详情请参阅[return additional related resources](search.html#include) + +### 1.7.1.11 Update Request + +客户端用新版本的资源记录替换服务器中的老版本. + +``` + PUT https://example.com/path/{resourceType}/{id} +```` + + Note that there does not need to be a resource already existing at {id} - the server may elect to automatically create the resource at the specified address. Here is an example of updating a patient: +``` +PUT /Patient/347 HTTP/1.1 +Host: example.com +Content-Type: application/json+fhir +Content-Length: 1435 +Accept: application/json+fhir +If-Match: 1 + +{ + "resourceType": "Patient", + "id" : "347", + "meta" : { + "versionId" : "1", + "lastUpdated" : "2014-08-18T01:43:30Z" + }, + ... +} +```` + +Notes: + +* **resourceType** (line 1) - "Patient" URL请求中的资源类型必须与提交的数据中的资源类型保持一致 (line 9) +* **resource id** (line 1, "347") - URL中的资源id必须与提交的数据中id值保持一致(line 9) +* **If-Match** (line 6) - 如果存在该字段，必须与资源内容中的meta.versionId值保持一致 (line 12), 服务器必须核实版本的完整性，如果不支持版本则返回412状态码 +* **meta.lastUpdated** (line 10) - This value is ignored, and will be updated by the server +* **resource content** (line 14) - 这里省略了资源内容 + +### 1.7.1.12 Update Response + +更新请求的响应包括了元数据、状态和OperationOutcome(可选): + +``` +HTTP/1.1 200 OK +Content-Length: 161 +Content-Type: application/json+fhir +Date: Mon, 18 Aug 2014 01:43:30 GMT +ETag: "2" + +{ + "resourceType": "OperationOutcome", + "text": { + "status": "generated", + "div": "
The operation was successful
" + } +} +```` + +Notes: + +* **ETag** (line 5) - This is the versionId of the new version + +### 1.7.1.13 Base Resource Content + +所有资源都会包含的基础信息: + +``` +{ + "resourceType" : "X", + "id" : "12", + "meta" : { + "versionId" : "12", + "lastUpdated" : "2014-08-18T01:43:30Z", + "profile" : ["http://example-consortium.org/fhir/profile/patient"], + "security" : [{ + "system" : "http://hl7.org/fhir/v3/ActCode", + "code" : "EMP" + }], + "tag" : [{ + "system" : "http://example.com/codes/workflow", + "code" : "needs-review" + }] + }, + "implicitRules" : "http://example-consortium.org/fhir/ehr-plugins", + "language" : "X" +} +```` + +Implementers notes: + +* **resourceType** (line 2) - 每个资源都会资源类型的字段. XML的话也就是根节点 +* **id** (line 3) - 在资源新建之时分配后不再变化.只有在初次创建该资源时才没有该字段 +* **meta.versionId** (line 5) - 当资源内容(除了meta.security、meta.profile、meta.tag三个之外)发生变更时该值随之变化 +* **meta.lastUpdated** (line 6) - 随versionId的变化而变化. 如果服务器不维护版本信息，则不用记录该字段 +* **meta.profile** (line 7) - 表示资源的内容是否遵循某个规范(比方说满足阿里健康的开放API的要求或者说满足卫计委共享文档中的要求). 更多信息请参考 [Extending and Restricting Resources](profiling.html#resources). 当规范、值集本身发生变动时可以更改该字段的值 +* **meta.security** (lines 8 - 11) - [安全类标签](securitylabels.html). 该标签将资源与某些安全策略、基础架构策略联系起来。该字段的值可随资源内容的变动而变动,或者随安全体系的控制。 +* **meta.tag** (lines 12 - 16) - [其他类型的标签](extras.html). 如需将资源与特定的工作流程关联起来可以使用此类标签.在解读资源内容时无需考虑此类标签的值 。对此类标签值的更新不会影响资源内容版本的变化 [updated](http.html#tags) (这里好像是说 可以不变更资源的版本就修改tag标签的值 还是说tag值的修改压根就不影响资源版本 其他的security和profile tag三个字段是否都适用呢？待考证) +* **implicitRules** (lines 17) - 如何准确安全的处理资源内容而在发送接收双方达成的[协议](profiling.html#agreement). 由于使用了该字段就意味着其他系统要使用其中的数据可能会出现解读错误的情况，限制了数据的重复利用，故不推荐适用该字段 +* **language** (lines 18) - [资源内容所采用的表达语言](narrative.html#language). 当前，资源内容中亦可包含其他语言的内容; 该字段表示的是资源的主要语言。 + + +© © HL7.org 2011+. FHIR DSTU (v0.5.0-5149) generated on Fri, Apr 3, 2015 14:36+1100\. + 链接：[试行版是什么](http://hl7.org/implement/standards/fhir/dstu.html) |[版本更新情况](http://hl7.org/implement/standards/fhir/history.html) | [许可协议](http://hl7.org/implement/standards/fhir/license.html) |[提交变更建议](http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemAdd&tracker_id=677) + diff --git a/fhir-in-action/introduction/overview.md b/fhir-in-action/introduction/overview.md new file mode 100644 index 0000000..54a2c78 --- /dev/null +++ b/fhir-in-action/introduction/overview.md @@ -0,0 +1,84 @@ +tips: +详情请阅读 中文版网站[FHIR概述](http://wanghaisheng.github.io/fhir-cn/doc/overview.html) + + + +## 1.7.0 FHIR概述 + +欢迎使用 FHIR 标准，它是卫生保健信息电子化交换的一种标准。这部分是对标准的概述，作为一个路线图，希望能帮助初次接触的读者更快上手。 + +### 1.7.0.1 背景 + +医疗保健记录越来越多的被数字化。当病人在整个医疗系统中转诊的时候，要求他们的病历能够获得、能够找到和能够理解。更深层次的，能够支撑自动化地临床决策支持和其他机器处理，要求数据是结构化的 并且是标准化的。(参考[卫生保健所面临的数字化挑战](change.html)) + +[HL7](http://hl7.org/)在过去20多年里，一直致力于构建卫生保健数据交换和信息模型标准来解决这些难题。FHIR是一种新标准，采用了其他行业的通用方法，同时借鉴了在定义和实现 HL7V2，V3,RIM 和 CDA 标准过程中所获得成功、失败的教训。FHIR可以单独作为数据交换标准来使用，也可以和其他广泛应用的标准一起来使用(参考[FHIR与其他HL7标准的比较](comparison.html)) + +FHIR旨在不牺牲信息完整性的前提下简化开发和实现。它利用了现有的逻辑和理论模型，为不同的应用程序间交换数据提供了一种一致的、易于实现的、健壮的机制。FHIR的内在机制使得其能够追溯到 HL7 RIM 和其他内容模型，这就保证了与HL7之前定义的模式，最佳实践间的保持一致，毋须开发人员充分了解 RIM 和 HL7 V3 的其他衍生制品。(参考[FHIR与其他HL7标准的比较](comparison.html)) + +### 1.7.0.2 组件 + +FHIR 中最基本的组件叫做[资源](resource.html).所有可交换的内容都被定义成一个个资源。所有资源都拥有如下特征： + +* 同一种[定义](resource.html)、[表达](formats.html)它们以及从[数据类型](datatypes.html)(最基本的可重用元素)构建它们的方式 +* 同样的[元数据](resource.html#metadata)集合 +* [供人可读的部分](narrative.html) + ### 1.7.0.3 方法论 + + #### 1.7.0.3.1 信息建模的方法 + + FHIR 的理念在于定义一个资源的基础集合，要么利用它们，要么相互结合来满足大多数常见的应用场景的需求。FHIR资源旨在定义绝大多数开发实现中通用的核心信息集合的信息内容和结构。如果需要的话，有内在的[扩展机制](extensibility.html)来满足剩下的需求。 + FHIR 的建模采用了一种组合式的方法论。相比而言，HL7 V3 建模是基于“model by constranit”(参考[FHIR与其他HL7标准的比较](comparison.html)) 。对于 FHIR，特殊的应用场景通常是通过利用[资源引用](references.html)整合资源来实现的。尽管对于一个特定场景，单独一个资源可能是存在价值的，更多的是对资源互相整合和裁剪来满足特定的需求。用来描述资源如何整合使用的两类特殊资源： +* [一致性声明](../infra/conformance.html)——描述一种实现中所暴露的交换数据的接口 +* [规范profile](../infra/profile.html)——描述该实现中所使用的资源中定义的用以约束基数、可选性、术语、数据泪下和扩展的其他规则。 + +#### 1.7.0.4 标准 + +基本上，FHIR标准分为三大块： + +* 基础[文档](documentation.html)部分——描述了[资源是如何定义](resources.html)的，[数据类型](datatypes.html)、[编码](terminologies.html)的定义和[XML](xml.html) 、[JSON](json.html)格式的相关背景信息。 +* [开发实现部分](../impl/implementation)——描述在[REST](../impl/http.html) 、[消息](../impl/messaging.html)、[文档](../impl/documents.html)和[SOA](../impl/services.html)中使用资源。 +* [资源列表](resourcelist.html)——resourcelist.htmlFHIR中定义的所有资源的列表。其中又分为[临床类](../clin/clinical.html)、 [行政管理类](../admin/administration.html) 和[基础架构类](../infra/infrastructure.html)三大类。 + +资源有多种用途，从最基本的[护理计划](../clin/careplan.html)和[诊断报告](../clin/diagnosticreport.html)等临床内容到如[消息头](../infra/messageheader.html)、[一致性声明](../infra/conformance.html)等基础架构。虽然它们具有共同的技术特性，但却以完全不同的方式来使用。注意毋须为了使用资源而必须使用REST。 + +### 1.7.0.5 如何入门 + +最好是快速阅读一下 [资源列表](resourcelist.html)，对已经有了哪些资源有个感性认识，然后看一下[患者](../clin/patient.html)的定义来看看资源的定义是什么样的，接着读一下以下介绍背景信息的章节： + +* [资源](resource.html)——资源是如何定义的 +* 所有资源都有的[叙述性文本](narrative.html)，以及[资源之间如何互相引用](references.html) +* [格式](formats.html)：[XML](xml.html) 、[JSON](json.html) +* [扩展相关](extensibility.html)——标准能够保持简单的关键 +* 如果你之前了解 HL7 标准(V2 V3 CDA)的话，[FHIR 与其他 HL7 标准的比较](comparison.html)也值得一看。 + +#### 1.7.0.5.1 顶部标签 + +整个标准中都会看到这些标签，很多读者可能会遗漏： + +![](../material/header-tabs.png) +[资源](resources.html)和[数据类型](datatypes.html)都是以一种类似XML的 易于阅读的方式来呈现的，它们也有详细描述内容的正规定义。另外，大多数资源映射到很多不同的格式，如HL7V2，HL7V3 RIM ，CDA，DICOM等。同时，所有资源至少包含一个实例(有时候会有更多)，适当的时候，也会有描述它们如何在特殊情况下使用的profile规范。最后，一些资源包含了 帮助开发人员理解它们背后的设计原理的小贴士/备注。 + +### 1.7.0.6 寻求额外信息和提供反馈 + +为了能够让更多读者看懂的同时，FHIR标准是面向开发人员社区的——这些真正利用标准编写程序的人。为了满足开发人员社区的需求，编辑人员力求标准行文精确，减少在编写程序之前的阅读时间(然而这份标准并不如我们所想的那么简明扼要，有时候是医疗保健和现实世界的复杂度所致)。鉴于此，在开发过程中并不必要的信息，诸如原理、备选方案、一些争论点和将来的计划等并没有包含在标准里面。同样，开发人员时不时会发遇到标准不明晰或者不完整的清空。最终，会有一些情况，标准可能是错的，或者是对其进行修订以更好的满足开发人员的需求。 +因此HL7提供了多种方法，通过这些方法可以维护和获取一些额外的FHIR相关信息，能够提供一些帮助，响应一些变更请求。 + +#### 1.7.0.6.1 评论 + +在每页底部，都有一个评论的部分，可以就特定章节进行提问和讨论。评论由 FHIR 编辑人员和HL7工作组来监管，每个问题都会在一定的时间内给予答复。This content will occasionally be currated to ensure ongoing relevance, particularly if the specification is subsequently updated to eliminate confusion that may have spawned an initial comment. + +#### 1.7.0.6.2 FHIR Wiki + +FHIR 项目团队维护着一个[wiki](http://wiki.hl7.org/index.php?title=FHIR)，记录了开发过程、方法学和设计决策。开发人员和其他人员也可以参与到wiki中来，提供一些暂未出现在标准中的指导和补充信息。注意 FHIR wiki上的内容不具有权威性，与FHIR标准的一致性无关。同样，一些内容可能也没有和最近的FHIR版本保持一致。 +FHIR标准中的每个页面在wiki中都有一页内容。用以记录原理、决策点和其他与开发人员无关的信息。额外的页面包括[FHIR 方法论](http://wiki.hl7.org/index.php?title=FHIR_Development_Process)、[FHIR 设计工具的使用](http://wiki.hl7.org/index.php?title=FHIR_Guide_to_Authoring_Resources)等。要研究wiki的话，建议从[首页](http://wiki.hl7.org/index.php?title=FHIR)开始. + +#### 1.7.0.6.3 正式变更请求 + +正式请求可以在[这里](http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemAdd&tracker_id=677)提交。对应的工作组会审核这些请求，并作出是否将其纳入到标准中的决策，其中包括了纳入到那个版本。 + +#### 1.7.0.6.3 源码/参与机制的额外信息 + +除了上述机制，HL7提供了一个 Stack Overflow 的标签，邮件列表和skype聊天频道来提供对开发人员各个层面的全方位的支持。如何使用这些请参考[指令](http://wiki.hl7.org/index.php?title=FHIR#More_help_and_Asking_Questions) + +© © HL7.org 2011+. FHIR DSTU (v0.5.0-5149) generated on Fri, Apr 3, 2015 14:36+1100. + 链接：[试行版是什么](http://hl7.org/implement/standards/fhir/dstu.html) |[版本更新情况](http://hl7.org/implement/standards/fhir/history.html) | [许可协议](http://hl7.org/implement/standards/fhir/license.html) |[提交变更建议](http://gforge.hl7.org/gf/project/fhir/tracker/?action=TrackerItemAdd&tracker_id=677) diff --git a/fhir-in-action/introduction/toreader.md b/fhir-in-action/introduction/toreader.md new file mode 100644 index 0000000..2f69c7f --- /dev/null +++ b/fhir-in-action/introduction/toreader.md @@ -0,0 +1,44 @@ +# 对 FHIR 的认识 + +互联网医疗在过去的一年里如火如荼，希望大家能够一起来汉化和开发FHIR相关的产品。 + +FHIR – Fast Health Interoperable Resources (hl7.org/fhir) – 是由HL7创建的新一代标准框架.FHIR 整合了 HL7 V2,V3 和 CDA +的优点,同时利用了最新的Web标准,紧紧围绕着 implementability 可实现性。 + +FHIR 解决方案是基于一些称之为“资源”的模块化组件的. 这些资源可以很容易的组装进生产系统中,以已有方案的一小部分成本来解决实际的临床和管理上存在的问题。 + +FHIR 适用于多种场景– 智能手机APP、云平台上的通信、基于EHR的数据共享、大型医疗机构内服务器通信和其他。 + +大多数在HIT这个行业浸淫略久的人都听到过HL7的字眼，HIT 行业的标准不外乎有2个目的，交互共享数据(HL7 +V2消息，V3消息，CDA，X12,共享文档规范诸如此类)，表达医疗行业的知识( +各类术语字典，数据集数据元标准，Ardensyntax，CDSC，GELLO诸如此类) +，而FHIR应该归属于第一类，与它的前辈不同的是，它抛弃了既往顺着发展了10多年，乃至于20年的那块田( +封闭又自恃过高，怎么说这点呢，所有的标准文件都有自己独特的脱离了整个软件行业的编辑器生成，这些模型也不能为其他通用型软件所读取，最可恨的是没有配套的各种开源库开放给大家试错，降低学习成本，恶心的是居然个破标准还要收费) +，也就是在上世纪90年代末XML在整个软件领域刮起一阵风，到处都在说系统集成时应运而生的V3消息，CDA等，毫无疑问它们都是为不同厂家的不同系统之间交换数据而生的，而它们的下场都很惨，用现在的话说，都不够敏捷，学习成本过高，迭代也不够快。 + +在 FHIR 卷土重来的时候就把基调定好了，思想上这次要全面拥抱互联网技术，用通用的互联网技术来做原来没有成功的事情，仍然还是想实现医疗健康领域数据的无缝流动，打通整个数据闭环。 + +它的诱人之处我认为有如下三点： + +1、过去的很多年，美国人造了各种各样的标准，国际友人也造了各式各样的轮子来解决上面的问题，最近的2-3年里很多人抛出了这样一个问题，能不能用同一种模型，经过适当的演化就能表达医疗数据( +电子病历、健康档案、个人健康记录)，又能表达医学知识(临床指南类决策支持用的知识，质控指标类的知识) +，就目前FHIR发展的现状来看，这是一个还不错的选择。有很多这方面的尝试，美国的ONC最近也在这件事上砸了些钱希望能推动的更快一些。 + +2、拥抱互联网技术。卫生部这几年在推的区域平台、医院平台的技术点在我看来离现如今的互联网技术太远了，作为已经被抛弃的SOAP流的SOA架构的残留物，着实没听到在BAT等企业有何应用，最近几年在人人学Amazon的同事，新浪、京东等一批国内企业都在推一个叫open +API 或者是restful api或者叫HTTP API的东东，以此来解决各自内部千千万产品间、产品内部的数据流动的问题，简而言之就是以一种方式圈定某个领域的业务对象，每种对象都使用同样的方法来实现一些功能，类比到厨艺的话，就是说约定好如何区分食材，每种食材都有哪些烹饪方法，这样子整个医疗领域就大约有100-200种资源( +最小的信息单元，当然这里面的粒度的拿捏很是讲究)，用到的“烹饪方法”就是HTTP协议定义好的(诸如put/post/get等)。 + +数据本身的表达格式也从原来V2 V3单纯的EDI格式、XML格式演化到了目前比较流行的JSON，以后或许还会演化出其他更为适合的方式。 + +这件事情一方面降低了学习认知整个标准的门槛，另一方面即使不使用它所规定的格式，顺着这样的思路，你也能解决一些问题。 +这里的问题不单单是之前它的老前辈(v2\v3\cda)所更care的产品与产品间的数据交换数据共享，你也可以借此实现产品内部的功能(京东的李大学总裁就介绍过它们在这方面的一些探索和实践)，比如面临的移动端和PC端开发时功能复用的问题。 + +当然也有人会问，这东西能作为数据的存储模型来用么，这个问题是HL7 V3 RIM CDA所没能很好的解决的问题，它们的抽象程度太高了，但时代变了，Nosql数据库现在已经有很多可供选择，如果你要使用关系型数据库的话，也有一些这方面的探索可供参考。 + +3、尽管国内目前关注度不够，但在著名的代码托管平台Github上已经有大量的各种编程语言(java c# dephi javascipt swift等) +、各种平台可用的一些开源代码，有适合PC端的，也有适合移动端的，这是很喜人的。 + +## 联系我们 +访问： https://fhir.isharkfly.com/#/CONTACT 页面中的内容来和我们取得联系。 + +推荐访问社区，并在社区中留下您的足迹。 diff --git a/in-action/naming_conventions.md b/fhir-in-action/naming_conventions.md similarity index 100% rename from in-action/naming_conventions.md rename to fhir-in-action/naming_conventions.md diff --git a/in-action/_sidebar.md b/in-action/_sidebar.md deleted file mode 100644 index 2b25e07..0000000 --- a/in-action/_sidebar.md +++ /dev/null @@ -1,4 +0,0 @@ -- [Class Rules](/in-action/class_rules.md) -- [Install JDK](/in-action/install_jdk.md) -- [Install Eclipse](/in-action/install_eclipse.md) -- [Naming Conventions](/in-action/naming_conventions.md) \ No newline at end of file diff --git a/in-action/class_rules.md b/in-action/class_rules.md deleted file mode 100644 index 86e8dce..0000000 --- a/in-action/class_rules.md +++ /dev/null @@ -1,11 +0,0 @@ -# Reminder And Class Rules - -## Reminder -All students must participate in the first week of class or they will dropped from the course. - -Please complete the Week 1 assignment before the end of day Sunday. - -## Assignments and Schedule -Due dates for assignments and discussions are stated in day numbers. - -Day 1 is Monday, the first day of the beginning of each weekly session. diff --git a/in-action/install_eclipse.md b/in-action/install_eclipse.md deleted file mode 100644 index 84d3100..0000000 --- a/in-action/install_eclipse.md +++ /dev/null @@ -1,45 +0,0 @@ -# Eclipse Install - -## The First Eclipse Project - -The steps how to get 1st Eclipse project create and run. - -### Launch Eclipse - -1. Start Eclipse by running "eclipse.exe" in the Eclipse installed directory. -2. Choose an appropriate directory for your workspace (i.e., where you would like to save your files). -3. If the "Welcome" screen shows up, close it by clicking the "close" button. - -### Create a new Java Project - -For each Java application, you need to create a project to keep all the source files, classes and relevant resources. - -To create a new Java project: - -1. Choose "File" menu ⇒ "New" ⇒ "Java project". -2. The "New Java Project" dialog pops up. - a. In the "Project name" field, enter "FirstProject". - b. Check "Use default location". - c. In the "JRE" box, select "Use default JRE (currently 'JDK1.x')". But check the JDK version, you should be using - JDK 1.5 and above. - d. Click "Finish". - -### Write a Hello-world Java Program - -1. In the "Package Explorer" (left panel) ⇒ Right-click on "FirstProject" (or use the "File" menu) ⇒ New ⇒ Class. -2. The "New Java Class" dialog pops up. - a. In "Name" field, enter "Hello". - b. In "package" field, delete the content if it is not empty. - c. Check "public static void main(String[] args)" box. - d. Click "Finish". -3. The source file "Hello.java" opens on the editor panel. Enter the following codes: - -```java -public class HelloWorld { - public static void main(String[] args) { - System.out.println("Hello, world!"); - } - -} -``` - diff --git a/in-action/install_jdk.md b/in-action/install_jdk.md deleted file mode 100644 index 2c5b68c..0000000 --- a/in-action/install_jdk.md +++ /dev/null @@ -1,13 +0,0 @@ -# Java Install - -https://www.oracle.com/java/technologies/downloads/ - -https://adoptium.net/temurin/releases/ - -### JDK Version - -To configure project settings, select IntelliJ IDEA | Preferences on macOS or File | Settings on Windows and Linux from the main menu. - -Alternatively, you can press Ctrl+Alt+S to show the IDE settings. - -![Eclipse-Temurin-JDK.png](_images/Eclipse-Temurin-JDK.png ':size=680')