dsh-medrec-qc
病案首页形式质控与逻辑矛盾提示（依据国卫办医发〔2016〕24号等公开文件，仅提示差异，不作出定性结论）
插件会安装到这里；不确定时保持 web。
npx -y @deepseek-ai/dsh plugin --profile web add dsh-medrec-qc@0.2.13Medrec Qc 以 dsh-medrec-qc 发布，当前版本为 0.2.13。Plugin Hub 会校验它的 manifest，并保存精确安装来源，便于复现安装结果。
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What it is — Form check and logic-contradiction prompts for the inpatient medical record front sheet. It returns a list of what is inconsistent, where, and what to fix. Who it is for — medical records and quality control; no command line required. What you give it — the source material the check works on (a table, register or document); the original is never modified. Excel can be converted to JSON/YAML first, in chat if the platform supports it. What it does not do — no compliance verdict, no liability finding, no replacement for the reviewer; differences only. How to start — search "Medical Record QC Suite" in WorkBuddy / Coze (this check is one part of it; availability as listed); or:
dsh plugin --profile <name> add dsh-medrec-qc
dsh-medrec-qc reads an export of the inpatient medical record front sheet (病案首页), one row per discharge, in the column set of the national assessment export, the health statistics export or a hospital-local export, and checks that export's own form completeness, internal arithmetic and coding form: that each required column carries content or the - marker, that the admission and discharge times are present, precise to the minute and not in the wrong order, that the declared length of stay agrees with the two dates, that the primary diagnosis name and code and the primary operation name and code are filled together, that the codes have the written form the pack configures, that the three signature columns reflect three-level physician responsibility, that the discharge mode is one of the defined codes, that the age and the neonatal weights use the prescribed forms, that the count of other diagnoses stays within the configured ceiling, and that a diagnosis incompatible with the recorded sex or two disagreeing times in a death discharge are surfaced for human review.
dsh plugin --profile <name> add dsh-medrec-qc
dsh --profile <name> --dump-config | grep 'dsh-medrec-qc'
Workflow diagram for dsh-medrec-qc: call → plugin → result.
Workflow overview: call → plugin → result. The examples below use the real command surface.
The table below is the example set: the first row is the detailed walkthrough, the remaining rows are short cases.
Tool medrec_qc
Input
target: 2026 年 3 月出院病案首页导出
cases:
- row: 1
病案号: ""
入院时间: "2026-03-01 08:30"
出院时间: "2026-03-06 10:00"
Output
{
"id": "dsh-medrec-qc.MR-001.a58905f0",
"ruleId": "MR-001",
"severity": "error",
"locator": {
"row": 1,
"column": "病案号"
},
"found": "「病案号」为空",
"expected": "附件1 必填栏不能为空项，没有可填写内容时填写\"-\""
}
Observed from dsh-medrec-qc/tests/fixtures/MR-001/MR-001-unsafe.yaml
| You ask | What it answers |
|---|---|
A required column is left empty, but I typed - in it. Is that reported? | No. MR-001 treats a lone - as the marker for 'nothing to record here' and reports only the columns that are truly blank. It checks that a required column carries content, not that the content is correct. It is an error because 附件1's note now has been read verbatim (2026-10-13) — see the note below. The same - still counts as a missing signature under MR-009. |
| The admission time is written as a bare date with no hour or minute, and on one row the discharge time is earlier than the admission time. | MR-002 reports a 入院时间 or 出院时间 value that can be read only to the day, because the recorded time must be precise to the minute, and it also reports a value it cannot parse as a date and time at all. MR-003 compares the literal order of the two fields and reports the row where the discharge time comes first. Both work on the literal values and neither decides which of the two times is the true one. |
The front sheet says 5 days, but the dates are 12 June in and 15 June out. | MR-004 recounts the days as discharge date minus admission date and reports the row when the declared 实际住院天数 disagrees; admission and discharge on the same day count as 0 days, and a value that is not a whole number of days is reported too. It compares the three stored values only and does not decide which of them is wrong. |
主要诊断名称 is filled in but 主要诊断编码 is blank, and another row carries a code in a strange shape. | MR-005 requires the two to be filled together and names the one that is missing; it checks only that both exist, not that the code matches the diagnosis. MR-006 then tests the code against the written form configured in the pack, and it does not verify that the code exists in any version of the classification directory. |
| A batch contains no operation records at all. Do the operation rules pass in silence? | No. MR-007 reports itself in skipped with the reason that the material holds no operation record, so the pairing check does not apply, instead of passing in silence. When a row does record an operation, the rule requires 主要手术名称 and 主要手术编码 to be filled together, and MR-008 checks the written form of the operation code only. |
| Document | Number | Cited by rules |
|---|---|---|
| 《住院病案首页数据质量管理与控制指标（2016版）》 | 国卫办医发〔2016〕24号 | MR-001 |
| 《住院病案首页数据填写质量规范（暂行）》 | 国卫办医发〔2016〕24号 | MR-002, MR-003, MR-005, MR-006, MR-007, MR-008, MR-013, MR-015 |
| 《卫生部关于修订住院病案首页的通知》 | 卫医政发〔2011〕84号 | MR-004, MR-009, MR-010, MR-011, MR-012 |
| 国家医疗保障局"两库"知识点（诊断与患者性别不符） | 国家医疗保障局公告（第二十一批） | MR-014 |
Boundary: this plugin checks the front sheet of the inpatient medical record (病案首页) — the
one-page discharge summary coders and the national assessment system read — for form completeness,
internal contradictions and coding form. It is not dsh-nurse-record-check (which checks nursing
documentation timeliness), not dsh-icd-rule-check (which checks ICD coding rules and dagger/asterisk
pairing), and it does not judge whether a diagnosis was clinically correct. It reads an export of the
front sheet and reports literal mismatches against cited clauses.
| Surface | Status |
|---|---|
| Harness | Peer range >=0.1.2-rc.1 <0.2.0 || >=0.2.0-0 <0.3.0 — verified to accept both 0.2.0-rc.2 and 0.2.1-rc.2. engines.dsh is declared as >=0.2.1-0 <0.3.0 and is enforced by the host since 0.2.1 |
| Node | `^22.19.0 |
| Platforms | All (plain ESM; no native code, no network, no model call) |
| Tool mode | Works in native and ptc; for a month of discharges use ptc |
Registers the medrec_qc tool. It reads a list of discharged cases, applies a versioned rule pack,
and returns a report whose every finding names the clause it came from.
Why
MR-001is anerroragain (2026-10-13)Every
errorrule here rests on a document that imposes the requirement and whose clause text has been read verbatim — 国卫办医发〔2016〕24号 (obtained in full) and 卫医政发〔2011〕84号 (obtained in full, including all three attachments).MR-001was the long-standing exception: its only basis is 附件1's note, and that attachment was recorded as a PDF this environment could not decode, so the rule was downgraded towarnon 2026-10-07 under the same discipline — a clause that cannot be read does not block a workflow.The attachment does have a text layer. It was read verbatim on 2026-10-13: 328 pages, 205,847 extractable characters, no OCR used. The note reads 「注：必填栏不能为空项，没有可填写内容时填写“-”」 — identical to the rule's
excerptexcept that the PDF prints curly quotes where the rule uses straight ones, a typographic difference recorded rather than papered over (the citation gate strips both quote forms, which is why the segment matches). So the rule is back toerror, corrected on evidence.⚠️ Source tier, stated plainly:
www.nhc.gov.cnreturns HTTP 412 to automated requests (measured 2026-10-13; the site root is 412 too). The text was read from a 河南省病案质量控制中心 compilation — the very URL this rule'ssourcehas always carried. That is the same tier as the 高校／省级 reprints the other fourteen rules use, so it is not a reason to treat this rule differently. Seerules/evidence/clause-verification-homepage-attachment1.mdfor the full attempt log andrules/evidence/authority-class-audit.mdfor the classification.
| Rule | Check | Severity |
|---|---|---|
MR-001 | no required column is blank (a lone - is the approved marker) | error |
MR-002 | admission and discharge times are present and precise to the minute | error |
MR-003 | the discharge time is not before the admission time | error |
MR-004 | the recorded length of stay matches the two dates | error |
MR-005 | the primary diagnosis name and code are filled together | error |
MR-006 | the primary diagnosis code has ICD-10 form | error |
MR-007 | when there is an operation, its name and code are filled together | error |
MR-008 | the primary operation code has ICD-9-CM-3 form | error |
MR-009 | the signature block reflects three-level physician responsibility | error |
MR-010 | the discharge mode is one of the defined codes | error |
MR-011 | the age uses integer years or the N M/30 月 month fraction | warn |
MR-012 | neonatal weights are recorded to the nearest 10 grams | warn |
MR-013 | the count of other diagnoses stays within the configured ceiling | warn |
MR-014 | a diagnosis that does not match the recorded sex needs human review | warn |
MR-015 | a death discharge records the death time as the discharge time | info |
Column names are resolved through a shared dictionary, so the national-assessment export, the health
statistics export and a hospital-local export all feed the same rules. Columns the reader cannot map
are reported in warnings and unknownColumns rather than ignored — an unmapped column is exactly how
a check goes missing without anyone noticing.
Every tunable lives in the Schemastery schema in src/config.ts, so it can be changed from
cordis.yml without editing code. The per-rule field lists and thresholds live in
rules/medrec-qc.yaml.
| Key | Type | Default | Description |
|---|---|---|---|
rulesFile | string | rules/medrec-qc.yaml | Rule-pack path, relative to the package root |
disabledRules | string[] | [] | Rule ids to stop running; each appears in skipped |
onlyRules | string[] | [] | Run only these rule ids; empty runs every rule |
skipNotes | string | "" | Note appended to every skipped reason |
timeoutMs | number | 120000 | Cooperative tool timeout budget |
Rule-level parameters worth knowing:
MR-001 fields — the required-column list, taken from 附件1 of 国卫办医发〔2016〕24号. Extend it
with your own mandatory columns without touching the code.MR-011 underOnePattern / adultPattern — the accepted age spellings.MR-013 maxChecked — the other-diagnosis count above which ordering is flagged for review.MR-014 rules — the sex-versus-diagnosis term lists, expressed as { sex, label, pattern }.The tool accepts JSON or YAML with a cases list (a bare list is also accepted). Field names are
matched against the dictionary, so 医院疾病诊断名称-style local spellings resolve to the canonical
keys the rules read.
cases:
- row: 1
病案号: "A2026030001"
入院时间: "2026-03-01 08:30"
出院时间: "2026-03-06 10:00"
实际住院天数: "5"
性别: "1"
出生日期: "1972-05-04"
年龄: "53"
离院方式: "1"
科主任: "赵主任"
主任医师: "钱主任医师"
主治医师: "孙主治"
住院医师: "李医师"
责任护士: "周护士"
编码员: "吴编码"
主要诊断名称: "2型糖尿病"
主要诊断编码: "E11.900"
其他诊断: "高血压;慢性肾功能不全"
主要手术名称: "腹腔镜胆囊切除术"
主要手术编码: "51.2300"
有手术操作: "1"
Equivalent English headers such as MEDICAL_RECORD_NO, ADMISSION_TIME, DISCHARGE_TIME and
MAIN_DIAGNOSIS_CODE are accepted too, so a hospital that already exports ASCII headers does not
need a conversion step.
Rule data lives in rules/medrec-qc.yaml. Every rule carries a document, a document number, a clause
in the source's own numbering, a verbatim excerpt and the URL the excerpt was read from. The loader
enforces that an excerpt is a real quotation of at least eight characters, and that a check whose
basis is only a general principle (kind: derived-from-principle, capped at warn) or a local policy
(kind: institutional-configuration, capped at info) may never be declared error.
The clause numbers were checked against the full texts of 《住院病案首页数据填写质量规范（暂行）》 and 《住院病案首页数据质量管理与控制指标（2016版）》（国卫办医发〔2016〕24号）, 《卫生部关于修订住院病案首页的通知》（卫医政发〔2011〕84号）附件, 《医疗机构病历管理规定（2013年版）》 （国卫医发〔2013〕31号） and 《医疗保障基金结算清单填写规范（试行）》（医保办发〔2020〕20号）. Four findings shaped the pack, and are recorded here so a reviewer can see what was deliberately not claimed:
MR-009 therefore binds to those specific columns and cites 84号文
附件 二（二十八）1 for the three-level responsibility requirement, instead of writing "24号文
requires a physician signature".N M/30 月) is 卫医政发〔2011〕84号 附件 二（六）. 11号文 mentions age only as a field of the
admission note. MR-011 cites 84号文, and does not check a "write day-age under one month"
rule, because no national document states one — and 医保办发〔2020〕20号 states a different rule
(integer day-age) for the insurance channel, so the two are not made mutually exclusive.MR-014 is therefore a warn-level lead for human review, never a block.MR-015 rests on that
definition, is capped at info, and says so in its own note.main resolves to lib/index.mjs
and that pnpm run build produced it; a wrong main makes the loader skip the entry silently.skipped array: it names the rule and, when the
cause is an absent column, which column was missing. MR-008 stays skipped on an export without
operation columns, for example.CASE_FIELDS in
src/parse.ts (or to your own rule pack's field list) — the reader deliberately refuses to guess.dsh plugin add refuses the package as incompatible. The peer range covers 0.1.x and 0.2.x;
if your runtime sits outside it, grant an explicit exemption:
dsh plugin --profile <name> allow-version dsh-medrec-qc@0.1.0 --dsh-version <runtime> --accept-riskcheck reports manifest-peers as failed. The static checker compares against a hard-coded peer
range that predates the 0.2 line. The runtime enforces peer compatibility at install time, so the
declared range is the correct one; this is a known upstream issue in dsh-plugin-dev.pnpm install
pnpm run typecheck # tsc --noEmit
pnpm test # vitest, paired fixtures per rule
pnpm run build # tsdown -> lib/index.mjs + lib/index.d.mts
node ../scripts/sync-shared.mjs dsh-medrec-qc # refresh src/shared from ../_shared
Full family index: choose a checker by material and all plugins. This repository is one of them.
Apache License 2.0 © 2026 dsh-medrec-qc contributors.
| A male patient's primary diagnosis is a pregnancy-related condition. Does that block the export? | MR-014 reports it as a warn-level difference for a human to confirm, never as a block: the health-side documents contain no clause making a diagnosis incompatible with the recorded sex, and the published detail of that medical-insurance rule type does not cover the pregnancy, childbirth and puerperium chapter and allows clinical exceptions. Confirm with the clinician whether the sex or the diagnosis is wrong. |