匿名化 FHIR 的示例或插件 Json

Question

我有一组 FHIR json 格式的医疗保健信息。在存储此类敏感信息之前，我想将敏感信息匿名化，例如姓名、phone 号码、地址、医生联系方式等。

我在谷歌上搜索了有关匿名化 fhir json 的信息，发现存在一些安全标签，将信息分类为机密、受限等 - https://www.hl7.org/fhir/valueset-security-labels.html

https://www.hl7.org/fhir/extension-auditevent-anonymized.html - 这讨论了匿名数据的扩展和结构。

我不确定如何用安全代码替换这些变量。是否有任何 api 可以做到这一点，或者我必须找到所有敏感的标签并循环 json 并用安全代码替换标签。

谁能给我一个可以实现的例子。

我附上了我通过 synthea 生成的示例 json

{
  "fullUrl": "urn:uuid:7a534e34-40a2-48ab-bc92-066d23251a8b",
  "resource": {
    "resourceType": "Patient",
    "id": "7a534e34-40a2-48ab-bc92-066d23251a8b",
    "text": {
      "status": "generated",
      "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\">Generated by <a href=\"https://github.com/synthetichealth/synthea\">Synthea</a>.Version identifier: v2.5.0-378-gee8c6470\n .   Person seed: 6477291342685874262  Population seed: 1586936726889</div>"
    },
    "extension": [
      {
        "url": "http://hl7.org/fhir/StructureDefinition/patient-mothersMaidenName",
        "valueString": "Hilma831 Luettgen772"
      },
      {
        "url": "http://hl7.org/fhir/StructureDefinition/patient-birthPlace",
        "valueAddress": {
          "city": "Boston",
          "state": "Massachusetts",
          "country": "US"
        }
      },
      {
        "url": "http://synthetichealth.github.io/synthea/disability-adjusted-life-years",
        "valueDecimal": 3.3178400761167306
      },
      {
        "url": "http://synthetichealth.github.io/synthea/quality-adjusted-life-years",
        "valueDecimal": 71.68215992388328
      }
    ],
    "identifier": [
      {
        "system": "https://github.com/synthetichealth/synthea",
        "value": "7a534e34-40a2-48ab-bc92-066d23251a8b"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code": "MR",
              "display": "Medical Record Number"
            }
          ],
          "text": "Medical Record Number"
        },
        "system": "http://hospital.smarthealthit.org",
        "value": "7a534e34-40a2-48ab-bc92-066d23251a8b"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code": "SS",
              "display": "Social Security Number"
            }
          ],
          "text": "Social Security Number"
        },
        "system": "http://hl7.org/fhir/sid/us-ssn",
        "value": "999-80-4232"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code": "DL",
              "display": "Driver's License"
            }
          ],
          "text": "Driver's License"
        },
        "system": "urn:oid:2.16.840.1.113883.4.3.25",
        "value": "S99911013"
      },
      {
        "type": {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/v2-0203",
              "code": "PPN",
              "display": "Passport Number"
            }
          ],
          "text": "Passport Number"
        },
        "system": "http://standardhealthrecord.org/fhir/StructureDefinition/passportNumber",
        "value": "X66843459X"
      }
    ],
    "name": [
      {
        "use": "official",
        "family": "Kreiger457",
        "given": [
          "Anthony633"
        ],
        "prefix": [
          "Mr."
        ]
      }
    ],
    "telecom": [
      {
        "system": "phone",
        "value": "555-660-2614",
        "use": "home"
      }
    ],
    "gender": "male",
    "birthDate": "1939-12-25",
    "deceasedDateTime": "2015-02-02T22:36:55+05:30",
    "address": [
      {
        "extension": [
          {
            "url": "http://hl7.org/fhir/StructureDefinition/geolocation",
            "extension": [
              {
                "url": "latitude",
                "valueDecimal": 42.11942297974089
              },
              {
                "url": "longitude",
                "valueDecimal": -71.21834679934824
              }
            ]
          }
        ],
        "line": [
          "496 Tromp Mews Unit 96"
        ],
        "city": "Walpole",
        "state": "Massachusetts",
        "postalCode": "02081",
        "country": "US"
      }
    ],
    "maritalStatus": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/v3-MaritalStatus",
          "code": "M",
          "display": "M"
        }
      ],
      "text": "M"
    },
    "multipleBirthBoolean": false,
    "communication": [
      {
        "language": {
          "coding": [
            {
              "system": "urn:ietf:bcp:47",
              "code": "en-US",
              "display": "English"
            }
          ],
          "text": "English"
        }
      }
    ]
  },
  "request": {
    "method": "POST",
    "url": "Patient"
  }
}

Answer 1

没有 'standard' 匿名化方法，因为匿名化是一种降低风险的方法，需要了解您要防御的威胁以及需要如何使用数据。当与其他数据结合时，任何元素都可能是 'sensitive'。它对于预期的分析也可能是必不可少的。

您正在查看的扩展程序特定于审计事件。您实际将 Patient 资源标记为匿名的方式是使用 resource.meta 中的 ANONYED 安全标签。我不相信有一个标准的扩展来标记哪些元素应该被匿名化。如果有这样一个元素，该元素还需要指示如何数据应该被匿名化，并且该算法通常需要考虑多个元素——甚至多个资源。例如。日期应该更改为随机值，还是只是改变日期？相关资源集中的所有日期是否应该移动相同的数量，或者是否应该单独调整。如果你在改变不同资源指向的从业者，他们是否应该保持原样，每个随机改变，同一个从业者变成同一个随机从业者？

匿名化 FHIR 的示例或插件 Json

Example or plugin to anonymize FHIR Json

hl7-fhir