1. FHIR 中的用藥工作流程
FHIR 提供了一系列資源來描述從處方到配藥和管理的整個用藥過程。
Bác sĩ kê đơn Dược sĩ cấp phát Điều dưỡng cho thuốc
│ │ │
▼ ▼ ▼
MedicationRequest ──▶ MedicationDispense ──▶ MedicationAdministration
│ │
│ MedicationStatement ◀────────────┘
│ (bệnh nhân tự báo cáo)
▼
Medication
(thông tin thuốc)
2. 藥物資源
藥物治療 描述有關藥物的資訊：名稱、成分、劑型、製造商。
{
"resourceType": "Medication",
"id": "med-amlodipine-5mg",
"code": {
"coding": [
{
"system": "http://www.whocc.no/atc",
"code": "C08CA01",
"display": "Amlodipine"
}
],
"text": "Amlodipine 5mg"
},
"doseForm": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "385055001",
"display": "Tablet dose form"
}
],
"text": "Viên nén"
},
"ingredient": [
{
"item": {
"concept": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "386864001",
"display": "Amlodipine"
}
]
}
},
"isActive": true,
"strengthRatio": {
"numerator": {
"value": 5,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
},
"denominator": {
"value": 1,
"unit": "tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
}
]
}
3. 藥物請求－處方
藥物請求 （以前稱為 MemedicationOrder）記錄藥物處方單。
重要元素
| 元素 | 基數 | 描述 |
|---|---|---|
| 狀態。狀態 | 1..1 | 活躍 |等待 |結束 |停止|已完成 |取消 |草稿。草案 |
| 意圖。意圖 | 1..1 | 提案|計劃|訂單|原始訂單 |反射順序 |填充順序 |實例順序 |選項。選項 |
| 藥物治療。藥物。藥物治療 | 1..1 | 參考（藥物）或 CodeableConcept |
| 主題。主題 | 1..1 | 參考（患者） |
| 相遇。遭遇 | 0..1 | 參考（遭遇） |
| 請求者 | 0..1 | 參考（從業者） |
| 用量說明 | 0..* | 劑量說明 |
| 分配請求 | 0..1 | 配藥要求（數量、補充量、有效期限） |
| 替代 | 0..1 | 是否允許藥物替代？ |
例：血壓處方
{
"resourceType": "MedicationRequest",
"id": "mr-amlodipine-001",
"status": "active",
"intent": "order",
"medication": {
"reference": {
"reference": "Medication/med-amlodipine-5mg",
"display": "Amlodipine 5mg"
}
},
"subject": {
"reference": "Patient/patient-001",
"display": "Nguyễn Văn A"
},
"encounter": {
"reference": "Encounter/encounter-outpatient-001"
},
"authoredOn": "2025-01-15T08:40:00+07:00",
"requester": {
"reference": "Practitioner/practitioner-001",
"display": "BS. Trần Thị B"
},
"reason": [
{
"reference": {
"reference": "Condition/cond-hypertension-001",
"display": "Tăng huyết áp nguyên phát"
}
}
],
"dosageInstruction": [
{
"sequence": 1,
"text": "Uống 1 viên mỗi sáng sau ăn",
"timing": {
"repeat": {
"frequency": 1,
"period": 1,
"periodUnit": "d",
"when": ["ACM"]
}
},
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "Oral route"
}
]
},
"doseAndRate": [
{
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/dose-rate-type",
"code": "ordered"
}
]
},
"doseQuantity": {
"value": 1,
"unit": "tablet",
"system": "http://terminology.hl7.org/CodeSystem/v3-orderableDrugForm",
"code": "TAB"
}
}
]
}
],
"dispenseRequest": {
"numberOfRepeatsAllowed": 3,
"quantity": {
"value": 30,
"unit": "tablet"
},
"expectedSupplyDuration": {
"value": 30,
"unit": "days",
"system": "http://unitsofmeasure.org",
"code": "d"
}
}
}
4. 用藥管理
記錄實際用藥情況（護理師為住院病人用藥/注射）。
{
"resourceType": "MedicationAdministration",
"id": "ma-001",
"status": "completed",
"medication": {
"reference": {
"reference": "Medication/med-amlodipine-5mg"
}
},
"subject": {
"reference": "Patient/patient-001"
},
"occurenceDateTime": "2025-01-16T07:00:00+07:00",
"performer": [
{
"actor": {
"reference": {
"reference": "Practitioner/practitioner-002",
"display": "ĐD. Lê Thị C"
}
}
}
],
"request": {
"reference": "MedicationRequest/mr-amlodipine-001"
},
"dosage": {
"text": "1 viên uống",
"route": {
"coding": [
{
"system": "http://snomed.info/sct",
"code": "26643006",
"display": "Oral route"
}
]
},
"dose": {
"value": 5,
"unit": "mg",
"system": "http://unitsofmeasure.org",
"code": "mg"
}
}
}
5. 免疫－疫苗接種
{
"resourceType": "Immunization",
"id": "imm-covid-001",
"status": "completed",
"vaccineCode": {
"coding": [
{
"system": "http://hl7.org/fhir/sid/cvx",
"code": "208",
"display": "SARS-COV-2 (COVID-19) vaccine, mRNA, spike protein, LNP, preservative free, 30 mcg/0.3mL dose"
}
],
"text": "Pfizer-BioNTech COVID-19 Vaccine"
},
"patient": {
"reference": "Patient/patient-001"
},
"encounter": {
"reference": "Encounter/encounter-vaccination-001"
},
"occurrenceDateTime": "2024-03-15T09:30:00+07:00",
"primarySource": true,
"location": {
"reference": "Location/loc-vaccination-center"
},
"lotNumber": "EW0150",
"expirationDate": "2024-09-30",
"site": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActSite",
"code": "LA",
"display": "Left arm"
}
]
},
"route": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-RouteOfAdministration",
"code": "IM",
"display": "Intramuscular"
}
]
},
"doseQuantity": {
"value": 0.3,
"unit": "mL",
"system": "http://unitsofmeasure.org",
"code": "mL"
},
"performer": [
{
"function": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0443",
"code": "AP",
"display": "Administering Provider"
}
]
},
"actor": {
"reference": "Practitioner/practitioner-002"
}
}
],
"protocolApplied": [
{
"series": "COVID-19 Primary Series",
"doseNumber": "2"
}
]
}
6.藥品編碼系統
| 編碼系統 | 目的 | 適用範圍 |
|---|---|---|
| 空中交通管制（世界衛生組織） | 藥品分類 | 國際 |
| RxNorm (NLM) | 標準化藥品名稱 | 美國 |
| 斯諾梅德CT | 臨床術語（包括藥物） | 國際 |
| CVX（疾病預防控制中心） | 疫苗代碼 | 美國（廣泛使用） |
| 國家資料中心 | 國家藥品法規 | 美國 |
七、總結
藥物治療 — 藥品資訊（成分、劑型）
藥物請求 — 處方命令（劑量、分配、替代）
藥物管理 — 實際醫學的歸屬
藥物分配 — 藥劑師配藥
免疫接種 — 疫苗接種，包含完整的疫苗資訊、劑量、批次
使用代碼系統： 空中交通管制, 接收標準, CVX, 斯諾梅德CT