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系统概述

本系统旨在帮助医院实现与外部零售药店的安全、合规对接，满足2025年医保局和卫健委关于处方流转的最新规定。系统采用Python开发，基于RESTful API实现医院HIS系统与外部药房之间的处方信息传输、医保支付验证和处方状态跟踪等功能。

系统架构

核心模块实现

1. 医保合规性检查模块

import re
from datetime import datetime
from typing import Dict, List, Optional, Union
import json
import logging# 配置日志
logging.basicConfig(level=logging.INFO, format='%(asctime)s - %(name)s - %(levelname)s - %(message)s')
logger = logging.getLogger(__name__)class MedicalInsuranceComplianceChecker:"""医保合规性检查模块根据2025年医保局规定，对处方进行医保合规性检查"""def __init__(self):# 加载医保药品目录（示例数据）with open('data/医保药品目录.json', 'r', encoding='utf-8') as f:self.medicine_directory = json.load(f)# 加载医保诊疗项目目录（示例数据）with open('data/医保诊疗项目目录.json', 'r', encoding='utf-8') as f:self.treatment_directory = json.load(f)# 加载医院科室代码（示例数据）with open('data/医院科室代码.json', 'r', encoding='utf-8') as f:self.department_codes = json.load(f)# 加载医保药品分类（示例数据）with open('data/医保药品分类.json', 'r', encoding='utf-8') as f:self.medicine_categories = json.load(f)def check_prescription_compliance(self, prescription: Dict) -> Dict:"""检查处方医保合规性:param prescription: 处方字典，包含患者信息、诊断、药品/诊疗项目等:return: 合规检查结果，包含合规状态和详细问题"""result = {"is_compliant": True,"issues": [],"medicine_checks": [],"treatment_checks": [],"department_checks": []}# 1. 检查药品是否在医保目录内if not self._check_medicines(prescription.get('medicines', [])):result["is_compliant"] = Falseresult["issues"].append("处方中包含不在医保目录内的药品")# 2. 检查诊疗项目是否在医保目录内if not self._check_treatments(prescription.get('treatments', [])):result["is_compliant"] = Falseresult["issues"].append("处方中包含不在医保目录内的诊疗项目")# 3. 检查科室代码是否有效if not self._check_department(prescription.get('department_code')):result["is_compliant"] = Falseresult["issues"].append("科室代码无效或不符合规定")# 4. 检查药品与诊断是否匹配if not self._check_medicine_disease_match(prescription.get('diagnosis', ''), prescription.get('medicines', [])):result["is_compliant"] = Falseresult["issues"