healthcare-expert — скилл для Claude Code: что делает и как установить

---
name: healthcare-expert
version: 2.0.0
description: >-
  Expert-level healthcare systems, medical informatics, HIPAA compliance, and health data
  standards. Use when the user mentions medical, HIPAA, HL7, FHIR, or EHR, or when the task
  involves Healthcare IT, Standards and Protocols, Regulatory Compliance, or Security and
  Compliance.
category: domains
tags: [healthcare, medical, hipaa, hl7, fhir, ehr]
allowed-tools:
  - Read
  - Write
  - Edit
---

# 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

        return True

    def require_permission(self, action):
        """Decorator for enforcing permissions"""
        def decorator(func):
            def wrapper(*args, **kwargs):
                if action not in self.permissions:
                    raise PermissionError(
                        f"Role '{self.role}' lacks permission: {action}"
                    )
                return func(*args, **kwargs)
            return wrapper
        return decorator
```

## Best Practices

### Security and Compliance

- Encrypt PHI at rest and in transit
- Implement comprehensive audit logging
- Use role-based access control
- Conduct regular security assessments
- Implement data backup and disaster recovery
- Train staff on HIPAA requirements
- Use de-identification for research data

### Data Standards

- Use standard terminologies (SNOMED, LOINC)
- Implement FHIR for interoperability
- Support HL7 messaging
- Use ICD-10 for diagnoses
- Use CPT for procedures
- Validate data quality

### System Design

- Design for high availability
- Implement redundancy
- Ensure data integrity
- Support audit trails
- Enable patient access portals
- Integrate with HIE networks

## Anti-Patterns

❌ Storing PHI unencrypted
❌ No audit logging
❌ Inadequate access controls
❌ Using proprietary formats
❌ No data backup strategy
❌ Ignoring interoperability standards
❌ Weak authentication

## Reference Documentation

Detailed material lives alongside this skill and is read on demand:

- [Electronic Health Record System](references/ELECTRONIC_HEALTH_RECORD_SYSTEM.md)

## Resources

- FHIR Specification: https://hl7.org/fhir/
- HL7 International: https://www.hl7.org/
- HIPAA Guidelines: https://www.hhs.gov/hipaa/
- ICD-10: https://www.who.int/classifications/icd/
- LOINC: https://loinc.org/
- SNOMED CT: https://www.snomed.org/