臺灣健保預檢規則實作指引
0.0.1 - CI Build
臺灣健保預檢規則實作指引
0.0.1 - CI Build
臺灣健保預檢規則實作指引, published by Example Publisher. This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/TWNHIFHIR/cql/ and changes regularly. See the Directory of published versions
| Official URL: https://nhicore.nhi.gov.tw/cql/ImplementationGuide/tw.gov.mohw.nhi.cql | Version: 0.0.1 | |||
| Draft as of 2025-10-29 | Computable Name: TWNHIACQL | |||
臺灣健保預檢規則實作指引（Taiwan NHI Clinical Quality Language Implementation Guide，TWNHIA CQL IG）係採用 HL7® FHIR® （Fast Healthcare Interoperability Resources）與 HL7® CQL （Clinical Quality Language）之標準建置方法，並以「臺灣健保癌症用藥事前審查實作指引」（Taiwan NHI Cancer Prior Authorization Support Implementation Guide，TWPAS IG）為基礎，進一步定義符合「癌藥預檢規則」邏輯需求之 CQL Library （邏輯模組）。
其中，Library（邏輯模組） 為 CQL 中封裝並可重複使用之規則邏輯基本單位，可供其他規則、量測（Measure）或臨床決策支援模組（Clinical Decision Support, CDS）引用，以促進邏輯之模組化、標準化與重用性。
本實作指引內容涵蓋預檢規則條件、資料檢核邏輯、共用函式及代碼定義等多個 Library （邏輯模組），以確保邏輯規則於不同應用情境中具備一致性與可維護性。
衛生福利部中央健康保險署規劃建立癌症用藥預檢規則，推動癌症用藥事前審查之數位化與智慧化。為扣合「國家癌症防治計畫」建立智慧醫療的基石政策，本署刻正規劃以結構化、模組化及可重用的方式，建置健保用藥預檢規則邏輯，促進預檢規則於不同系統間的標準化與互通性，提升審查流程之效率與一致性，達成自動化審查與決策支援之目標。
| 角色 | 姓名 | 機構 |
|---|---|---|
| 作者-IG | 李麗惠 | 國立臺北護理健康大學-健康事業管理系 |
| 作者-IG | 李奇安 | |
| 貢獻者-IG | 張如薰 | 衛生福利部中央健康保險署-醫審及藥材組 |
| 貢獻者-IG | 張佐安 | |
| 貢獻者-IG | 鄧嘉欣 | |
| 貢獻者-IG | 醫藥品查驗中心(CDE) | |
This is an R4 IG. None of the features it uses are changed in R4B, so it can be used as is with R4B systems. Packages for both R4 (tw.gov.mohw.nhi.cql.r4) and R4B (tw.gov.mohw.nhi.cql.r4b) are available.
This IG Contains the following dependencies on other IGs.
Package hl7.fhir.uv.extensions.r4#5.2.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Mon, Feb 10, 2025 21:45+1100+11:00) |
Package hl7.fhir.uv.extensions.r4#5.1.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sat, Apr 27, 2024 18:39+1000+10:00) |
Package hl7.fhir.uv.ips#1.1.0 International Patient Summary (IPS) FHIR Implementation Guide (built Tue, Nov 22, 2022 03:24+0000+00:00) |
Package hl7.fhir.uv.sdc#3.0.0 The SDC specification provides an infrastructure to standardize the capture and expanded use of patient-level data collected within an EHR. |
Package tw.gov.mohw.twcore#0.3.2 臺灣核心實作指引(TW Core IG) (built Thu, Dec 12, 2024 12:41+0800+08:00) |
Package hl7.fhir.uv.extensions.r4#1.0.0 This IG defines the global extensions - the ones defined for everyone. These extensions are always in scope wherever FHIR is being used (built Sun, Mar 26, 2023 08:46+1100+11:00) |
Package hl7.fhir.uv.bulkdata#2.0.0 FHIR based approach for exporting large data sets from a FHIR server to a client application (built Fri, Nov 26, 2021 05:56+1100+11:00) |
Package ihe.formatcode.fhir#1.1.0 Implementation Guide for IHE defined FormatCode vocabulary. (built Thu, Feb 24, 2022 16:55-0600-06:00) |
Package hl7.fhir.us.core#6.1.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Fri, Jun 30, 2023 14:02+0000+00:00) |
Package hl7.fhir.us.core#7.0.0 The US Core Implementation Guide is based on FHIR Version R4 and defines the minimum conformance requirements for accessing patient data. The Argonaut pilot implementations, ONC 2015 Edition Common Clinical Data Set (CCDS), and ONC U.S. Core Data for Interoperability (USCDI) v1 provided the requirements for this guide. The prior Argonaut search and vocabulary requirements, based on FHIR DSTU2, are updated in this guide to support FHIR Version R4. This guide was used as the basis for further testing and guidance by the Argonaut Project Team to provide additional content and guidance specific to Data Query Access for purpose of ONC Certification testing. These profiles are the foundation for future US Realm FHIR implementation guides. In addition to Argonaut, they are used by DAF-Research, QI-Core, and CIMI. Under the guidance of HL7 and the HL7 US Realm Steering Committee, the content will expand in future versions to meet the needs specific to the US Realm. These requirements were originally developed, balloted, and published in FHIR DSTU2 as part of the Office of the National Coordinator for Health Information Technology (ONC) sponsored Data Access Framework (DAF) project. For more information on how DAF became US Core see the US Core change notes. (built Wed, May 8, 2024 15:33+0000+00:00) |
Package hl7.fhir.us.udap-security#0.1.0 This implementation guide describes how to extend OAuth 2.0 to support secure and scalable workflows for business-to-business (B2B) apps that implement the client credentials flow or authorization code flow. (built Fri, Aug 6, 2021 15:57+0000+00:00) |
Package hl7.fhir.us.davinci-hrex#1.0.0 The Da Vinci Payer Health Record exchange (HRex) Framework/library specifies the FHIR elements used in multiple Da Vinci implementation guides. This includes FHIR profiles, functions, operations, and constraints on other specifications such as CDS-Hooks and other aspects of Da Vinci Use Cases that are common across more than a single use case. Da Vinci HRex Implementation Guide (IG) will make use of US Core profiles that are based on the FHIR R4 specification wherever practical. The HRex IG will use the HL7 FHIR Release 4/US Core STU3 specification as its base but will provide additional guidance and documentation to support implementations that follow the HL7 FHIR STU3/US Core STU2 and HL7 FHIR DSTU2/Argonaut specifications. The HRex profiles documented in this IG will be used to exchange data between providers systems (e.g. EHRs) and other providers, payers, and third-party applications where appropriate. In addition, exchanges from payer systems to providers, other payers, and third-party applications are supported by the HRex profiles and operations. HRex may define new extensions, profiles, value sets, constraints/extension to other specification (e.g. specific CDS-Hooks) that are specific Da Vinci requirements. Where appropriate these Da Vinci specific artifacts will be promoted for incorporation into the future versions of existing standards (e.g. R4 US Core profiles) and deprecated in this guide on publication in the updated standard. (built Wed, Mar 23, 2022 18:55+0000+00:00) |
Package hl7.fhir.us.davinci-crd#2.0.0 Guidelines for conveying coverage requirements to clinicians when planning treatment (built Fri, Oct 20, 2023 14:17+0000+00:00) |
Package hl7.fhir.us.davinci-hrex#1.1.0 The Da Vinci Payer Health Record exchange (HRex) Framework/library specifies the FHIR elements used in multiple Da Vinci implementation guides. This includes FHIR profiles, functions, operations, and constraints on other specifications such as CDS-Hooks and other aspects of Da Vinci Use Cases that are common across more than a single use case.\n\nDa Vinci HRex Implementation Guide (IG) will make use of US Core profiles that are based on the FHIR R4 specification wherever practical. The HRex IG will use the HL7 FHIR Release 4/US Core STU3 specification as its base but will provide additional guidance and documentation to support implementations that follow the HL7 FHIR STU3/US Core STU2 and HL7 FHIR DSTU2/Argonaut specifications.\n\nThe HRex profiles documented in this IG will be used to exchange data between providers systems (e.g. EHRs) and other providers, payers, and third-party applications where appropriate. In addition, exchanges from payer systems to providers, other payers, and third-party applications are supported by the HRex profiles and operations.\n\nHRex may define new extensions, profiles, value sets, constraints/extension to other specification (e.g. specific CDS-Hooks) that are specific Da Vinci requirements. Where appropriate these Da Vinci specific artifacts will be promoted for incorporation into the future versions of existing standards (e.g. R4 US Core profiles) and deprecated in this guide on publication in the updated standard. (built Tue, Dec 10, 2024 16:43+0000+00:00) |
Package hl7.fhir.uv.subscriptions-backport.r4#1.1.0 The Subscription R5 Backport Implementation Guide enables servers running versions of FHIR earlier than R5 to implement a subset of R5 Subscriptions in a standardized way. (built Wed, Jan 11, 2023 15:34+1100+11:00) |
Package hl7.fhir.us.carin-bb#2.0.0 CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®) (built Mon, Nov 28, 2022 15:15+0000+00:00) |
Package hl7.fhir.us.davinci-pas#2.1.0 Guidelines for conveying coverage requirements to clinicians when planning treatment. (built Fri, Dec 20, 2024 21:03+0000+00:00) |
Package tw.gov.mohw.nhi.pas#1.0.8 臺灣健保癌症用藥事前審查實作指引(Taiwan NHI Cancer Prior Authorization Support Implementation Guide，TWPAS IG) (built Fri, Sep 26, 2025 16:56+0800+08:00) |
Package hl7.fhir.uv.cql#2.0.0 This implementation guide defines profiles, operations and guidance for the use of CQL with FHIR, both as a mechanism for querying, as well as inline and integrated usage as part of knowledge artifacts. (built Tue, Jul 8, 2025 14:47+0000+00:00) |
Package hl7.fhir.uv.tools.r4#0.8.0 This IG defines the extensions that the tools use internally. Some of these extensions are content that are being evaluated for elevation into the main spec, and others are tooling concerns (built Tue, Aug 5, 2025 20:09+1000+10:00) |
There are no Global profiles defined
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