healthcare-expert

What this skill does

# Healthcare Expert

Expert guidance for healthcare systems, medical informatics, regulatory compliance (HIPAA), and health data standards (HL7, FHIR).

## Core Concepts

### Healthcare IT
- Electronic Health Records (EHR)
- Health Information Exchange (HIE)
- Clinical Decision Support Systems
- Telemedicine platforms
- Medical imaging systems (PACS)
- Laboratory information systems

### Standards and Protocols
- HL7 (Health Level 7)
- FHIR (Fast Healthcare Interoperability Resources)
- DICOM (Digital Imaging and Communications in Medicine)
- ICD-10 (diagnostic codes)
- CPT (procedure codes)
- SNOMED CT (clinical terminology)

### Regulatory Compliance
- HIPAA (Health Insurance Portability and Accountability Act)
- HITECH Act
- GDPR for health data
- FDA regulations for medical devices
- 21 CFR Part 11 for electronic records

## FHIR Resource Handling

```python
from fhirclient import client
from fhirclient.models import patient, observation, medication
from datetime import datetime

# FHIR Client setup
settings = {
    'app_id': 'my_healthcare_app',
    'api_base': 'https://fhir.example.com/r4'
}
smart = client.FHIRClient(settings=settings)

# Patient resource
def create_patient(first_name, last_name, gender, birth_date):
    """Create FHIR Patient resource"""
    p = patient.Patient()
    p.name = [{
        'use': 'official',
        'family': last_name,
        'given': [first_name]
    }]
    p.gender = gender  # 'male', 'female', 'other', 'unknown'
    p.birthDate = birth_date.isoformat()

    return p.create(smart.server)

# Observation resource (vital signs)
def create_vital_signs_observation(patient_id, code, value, unit):
    """Create vital signs observation"""
    obs = observation.Observation()
    obs.status = 'final'
    obs.category = [{
        'coding': [{
            'system': 'http://terminology.hl7.org/CodeSystem/observation-category',
            'code': 'vital-signs',
            'display': 'Vital Signs'
        }]
    }]

    obs.code = {
        'coding': [{
            'system': 'http://loinc.org',
            'code': code,  # e.g., '8867-4' for heart rate
            'display': 'Heart rate'
        }]
    }

    obs.subject = {'reference': f'Patient/{patient_id}'}
    obs.effectiveDateTime = datetime.now().isoformat()

    obs.valueQuantity = {
        'value': value,
        'unit': unit,
        'system': 'http://unitsofmeasure.org',
        'code': unit
    }

    return obs.create(smart.server)

# Search patients
def search_patients(family_name=None, given_name=None):
    """Search for patients by name"""
    search = patient.Patient.where(struct={})

    if family_name:
        search = search.where(struct={'family': family_name})
    if given_name:
        search = search.where(struct={'given': given_name})

    return search.perform(smart.server)

# Get patient observations
def get_patient_observations(patient_id, category=None):
    """Retrieve patient observations"""
    search = observation.Observation.where(struct={
        'patient': patient_id
    })

    if category:
        search = search.where(struct={'category': category})

    return search.perform(smart.server)
```

## HL7 v2 Message Processing

```python
import hl7

# Parse HL7 message
def parse_hl7_message(message_text):
    """Parse HL7 v2 message"""
    h = hl7.parse(message_text)

    # Extract message type
    message_type = str(h.segment('MSH')[9])

    # Extract patient information from PID segment
    pid = h.segment('PID')
    patient_info = {
        'patient_id': str(pid[3]),
        'name': str(pid[5]),
        'dob': str(pid[7]),
        'gender': str(pid[8])
    }

    return {
        'message_type': message_type,
        'patient': patient_info
    }

# Create ADT^A01 message (Patient Admission)
def create_admission_message(patient_id, patient_name, dob, gender):
    """Create HL7 ADT^A01 admission message"""
    message = hl7.Message(
        "MSH",
        [
            "MSH", "|", "^~\\&", "SENDING_APP", "SENDING_FACILITY",
            "RECEIVING_APP", "RECEIVING_FACILITY",
            datetime.now().strftime("%Y%m%d%H%M%S"), "",
            "ADT^A01", "MSG00001", "P", "2.5"
        ]
    )

    # PID segment
    message.append(hl7.Segment(
        "PID",
        [
            "PID", "", "", patient_id, "",
            patient_name, "", dob, gender
        ]
    ))

    # PV1 segment (Patient Visit)
    message.append(hl7.Segment(
        "PV1",
        [
            "PV1", "", "I", "ER", "", "", "",
            "", "", "", "", "", "", "",
            "", "", "", "", "", "", "", ""
        ]
    ))

    return str(message)

# Validate HL7 message
def validate_hl7_message(message_text):
    """Validate HL7 message structure"""
    try:
        h = hl7.parse(message_text)

        # Check required segments
        if not h.segment('MSH'):
            return False, "Missing MSH segment"

        # Verify message structure
        msh = h.segment('MSH')
        if len(msh) < 12:
            return False, "Invalid MSH segment"

        return True, "Valid HL7 message"
    except Exception as e:
        return False, f"Parsing error: {str(e)}"
```

## HIPAA Compliance Implementation

```python
from cryptography.fernet import Fernet
from cryptography.hazmat.primitives import hashes
from cryptography.hazmat.primitives.kdf.pbkdf2 import PBKDF2
import hashlib
import logging
from datetime import datetime

class HIPAACompliantLogger:
    """HIPAA-compliant logging system"""

    def __init__(self, log_file):
        self.logger = logging.getLogger('hipaa_audit')
        self.logger.setLevel(logging.INFO)

        handler = logging.FileHandler(log_file)
        formatter = logging.Formatter(
            '%(asctime)s - %(levelname)s - %(message)s'
        )
        handler.setFormatter(formatter)
        self.logger.addHandler(handler)

    def log_access(self, user_id, patient_id, action, phi_accessed):
        """Log PHI access (HIPAA audit requirement)"""
        self.logger.info(
            f"USER:{user_id} | PATIENT:{patient_id} | "
            f"ACTION:{action} | PHI:{phi_accessed}"
        )

    def log_modification(self, user_id, resource_type, resource_id, changes):
        """Log data modifications"""
        self.logger.info(
            f"USER:{user_id} | MODIFIED:{resource_type}/{resource_id} | "
            f"CHANGES:{changes}"
        )

    def log_disclosure(self, user_id, patient_id, recipient, purpose):
        """Log PHI disclosure"""
        self.logger.info(
            f"DISCLOSURE | USER:{user_id} | PATIENT:{patient_id} | "
            f"TO:{recipient} | PURPOSE:{purpose}"
        )

class PHIEncryption:
    """Encryption for Protected Health Information"""

    def __init__(self, master_key):
        self.fernet = Fernet(master_key)

    def encrypt_phi(self, data):
        """Encrypt PHI data"""
        if isinstance(data, str):
            data = data.encode()
        return self.fernet.encrypt(data)

    def decrypt_phi(self, encrypted_data):
        """Decrypt PHI data"""
        decrypted = self.fernet.decrypt(encrypted_data)
        return decrypted.decode()

    @staticmethod
    def hash_identifier(identifier):
        """Hash patient identifiers for de-identification"""
        return hashlib.sha256(identifier.encode()).hexdigest()

class HIPAAAccessControl:
    """Role-based access control for HIPAA compliance"""

    ROLES = {
        'physician': ['read', 'write', 'prescribe'],
        'nurse': ['read', 'write'],
        'administrative': ['read'],
        'patient': ['read_own']
    }

    def __init__(self, user_role):
        self.role = user_role
        self.permissions = self.ROLES.get(user_role, [])

    def can_access(self, action, patient_id, user_patient_id=None):
        """Check if user can perform action"""
        if action not in self.permissions:
            if action == 'read' and 'read_own' in self.permissions:
                return patient_id == user_patient_id
            return False