ThTxGNN CDS Hooks 架構設計

本文件定義 ThTxGNN 的 CDS Hooks 服務架構，用於在 EHR 工作流程中提供老藥新用建議和 DDI 警示。

概覽

目標

功能	說明
老藥新用建議	當醫師開立藥物時，提示該藥物的潛在新適應症
DDI 警示	當檢測到藥物交互作用時，提供警示和替代建議
臨床試驗連結	顯示相關臨床試驗作為驗證依據

技術選型

項目	選擇	理由
CDS Hooks 版本	2.0	目前主流版本
部署方式	Serverless (Cloudflare Workers)	低成本、低延遲
資料來源	靜態 JSON + 外部 API	無後端資料庫需求

系統架構

┌─────────────────────────────────────────────────────────────────────────┐
│                              EHR 系統                                    │
│                                                                         │
│  ┌─────────────┐    ┌─────────────────────────────────────────────────┐ │
│  │   處方介面   │───►│  CDS Hooks Client (EHR 內建)                    │ │
│  └─────────────┘    └─────────────────────┬───────────────────────────┘ │
│                                           │                             │
└───────────────────────────────────────────┼─────────────────────────────┘
                                            │ HTTPS POST
                                            │ order-select / order-sign
                                            ▼
┌─────────────────────────────────────────────────────────────────────────┐
│                     ThTxGNN CDS Hooks 服務                               │
│                  (https://cds.thtxgnn.yao.care)                         │
│                                                                         │
│  ┌─────────────────────────────────────────────────────────────────┐   │
│  │                      Discovery Endpoint                         │   │
│  │                    GET /cds-services                            │   │
│  └─────────────────────────────────────────────────────────────────┘   │
│                                                                         │
│  ┌─────────────────────────────────────────────────────────────────┐   │
│  │                    Service Endpoints                            │   │
│  │                                                                 │   │
│  │  ┌────────────────────┐  ┌────────────────────┐                │   │
│  │  │  /drug-repurposing │  │  /ddi-alert        │                │   │
│  │  │  老藥新用建議       │  │  DDI 警示          │                │   │
│  │  └─────────┬──────────┘  └─────────┬──────────┘                │   │
│  │            │                       │                            │   │
│  └────────────┼───────────────────────┼────────────────────────────┘   │
│               │                       │                                │
│               ▼                       ▼                                │
│  ┌─────────────────────────────────────────────────────────────────┐   │
│  │                      資料查詢層                                  │   │
│  │                                                                 │   │
│  │  ┌──────────────────┐  ┌──────────────────┐  ┌──────────────┐  │   │
│  │  │ search-index.json│  │   DDI 資料庫     │  │ClinicalTrials│  │   │
│  │  │ (ThTxGNN 預測)   │  │ (DDInter+GtoPdb) │  │   .gov API   │  │   │
│  │  └──────────────────┘  └──────────────────┘  └──────────────┘  │   │
│  │                                                                 │   │
│  └─────────────────────────────────────────────────────────────────┘   │
│                                                                         │
└─────────────────────────────────────────────────────────────────────────┘
                                            │
                                            ▼
┌─────────────────────────────────────────────────────────────────────────┐
│                           CDS Hooks Card 回應                           │
│                                                                         │
│  ┌─────────────────────────────────────────────────────────────────┐   │
│  │ 💊 Drug Repurposing Candidate: Metformin                        │   │
│  │ ──────────────────────────────────────────────────────────────  │   │
│  │ Predicted indication: Breast Carcinoma (L2 Evidence)            │   │
│  │ 3 active clinical trials | 128 PubMed articles                  │   │
│  │                                                                 │   │
│  │ [View Details]  [Related Clinical Trials]  [Dismiss]            │   │
│  └─────────────────────────────────────────────────────────────────┘   │
│                                                                         │
└─────────────────────────────────────────────────────────────────────────┘

CDS Hooks 服務定義

Discovery Endpoint

GET /cds-services

{
  "services": [
    {
      "id": "drug-repurposing",
      "hook": "order-select",
      "title": "ThTxGNN Drug Repurposing Suggestions",
      "description": "Provides AI-powered drug repurposing predictions when medications are selected",
      "prefetch": {
        "patient": "Patient/",
        "currentMedications": "MedicationRequest?patient=&status=active"
      }
    },
    {
      "id": "ddi-alert",
      "hook": "order-sign",
      "title": "ThTxGNN DDI Alert Service",
      "description": "Checks for drug-drug interactions and suggests alternatives",
      "prefetch": {
        "patient": "Patient/",
        "currentMedications": "MedicationRequest?patient=&status=active",
        "conditions": "Condition?patient=&clinical-status=active"
      }
    }
  ]
}

Service 1: Drug Repurposing

觸發條件

Hook: order-select
觸發時機: 醫師選擇藥物時

Request 範例

{
  "hookInstance": "d1577c69-dfbe-44ad-ba6d-3e05e953b2ea",
  "hook": "order-select",
  "fhirServer": "https://fhir.example.org",
  "context": {
    "patientId": "123",
    "userId": "Practitioner/456",
    "selections": ["MedicationRequest/metformin-draft-001"],
    "draftOrders": {
      "resourceType": "Bundle",
      "entry": [{
        "resource": {
          "resourceType": "MedicationRequest",
          "id": "metformin-draft-001",
          "medicationCodeableConcept": {
            "coding": [{
              "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
              "code": "6809",
              "display": "Metformin"
            }]
          }
        }
      }]
    }
  },
  "prefetch": {
    "patient": { "resourceType": "Patient", "id": "123" }
  }
}

Response 範例

{
  "cards": [
    {
      "uuid": "thtxgnn-repurposing-001",
      "summary": "💊 Drug Repurposing: Metformin may be effective for Breast Carcinoma",
      "detail": "ThTxGNN AI prediction (score: 0.992, evidence: L2)\n\n• 45 clinical trials in progress\n• 128 PubMed publications\n\nThis is a research finding and requires clinical validation.",
      "indicator": "info",
      "source": {
        "label": "ThTxGNN",
        "url": "https://thtxgnn.yao.care/drugs/metformin/",
        "icon": "https://thtxgnn.yao.care/assets/images/icon.png"
      },
      "links": [
        {
          "label": "View Evidence Report",
          "url": "https://thtxgnn.yao.care/drugs/metformin/#breast-carcinoma",
          "type": "absolute"
        },
        {
          "label": "Search Clinical Trials",
          "url": "https://clinicaltrials.gov/search?cond=breast+cancer&intr=metformin",
          "type": "absolute"
        }
      ]
    }
  ]
}

Service 2: DDI Alert

觸發條件

Hook: order-sign
觸發時機: 醫師簽署處方前

Response 範例

{
  "cards": [
    {
      "uuid": "thtxgnn-ddi-001",
      "summary": "⚠️ Drug Interaction: Warfarin + Ibuprofen",
      "detail": "Concurrent use increases bleeding risk by 3-4x.\n\n**Patient Risk Factors:**\n• Age > 65\n• History of GI bleeding\n\n**Recommendation:** Consider alternative analgesic.",
      "indicator": "warning",
      "source": {
        "label": "ThTxGNN DDI Service",
        "url": "https://thtxgnn.yao.care/ddi/"
      },
      "suggestions": [
        {
          "label": "Replace with Acetaminophen",
          "uuid": "replace-with-acetaminophen",
          "actions": [
            {
              "type": "delete",
              "description": "Remove Ibuprofen order",
              "resourceId": ["MedicationRequest/ibuprofen-draft-001"]
            },
            {
              "type": "create",
              "description": "Order Acetaminophen instead",
              "resource": {
                "resourceType": "MedicationRequest",
                "status": "draft",
                "intent": "order",
                "medicationCodeableConcept": {
                  "coding": [{
                    "system": "http://www.nlm.nih.gov/research/umls/rxnorm",
                    "code": "161",
                    "display": "Acetaminophen"
                  }]
                }
              }
            }
          ]
        }
      ],
      "overrideReasons": [
        {
          "code": "patient-benefit",
          "display": "Benefit outweighs risk for this patient"
        },
        {
          "code": "already-monitored",
          "display": "Patient is already being monitored for bleeding"
        }
      ]
    }
  ]
}

技術實作

Cloudflare Worker 範例

// cds-hooks-worker.js

const SEARCH_INDEX_URL = 'https://thtxgnn.yao.care/data/search-index.json';

export default {
  async fetch(request, env) {
    const url = new URL(request.url);

    // Discovery endpoint
    if (url.pathname === '/cds-services' && request.method === 'GET') {
      return handleDiscovery();
    }

    // Drug repurposing service
    if (url.pathname === '/cds-services/drug-repurposing' && request.method === 'POST') {
      const body = await request.json();
      return handleDrugRepurposing(body);
    }

    // DDI alert service
    if (url.pathname === '/cds-services/ddi-alert' && request.method === 'POST') {
      const body = await request.json();
      return handleDDIAlert(body);
    }

    return new Response('Not Found', { status: 404 });
  }
};

function handleDiscovery() {
  const services = {
    services: [
      {
        id: 'drug-repurposing',
        hook: 'order-select',
        title: 'ThTxGNN Drug Repurposing Suggestions',
        description: 'AI-powered drug repurposing predictions'
      },
      {
        id: 'ddi-alert',
        hook: 'order-sign',
        title: 'ThTxGNN DDI Alert',
        description: 'Drug-drug interaction checking'
      }
    ]
  };

  return new Response(JSON.stringify(services), {
    headers: { 'Content-Type': 'application/json' }
  });
}

async function handleDrugRepurposing(request) {
  // 1. 從 context 提取藥物資訊
  const medications = extractMedications(request.context?.draftOrders);

  // 2. 查詢 ThTxGNN 預測
  const searchIndex = await fetch(SEARCH_INDEX_URL).then(r => r.json());

  // 3. 匹配藥物
  const cards = [];
  for (const med of medications) {
    const drug = findDrugInIndex(searchIndex, med.name);
    if (drug && drug.indications?.length > 0) {
      cards.push(createRepurposingCard(drug));
    }
  }

  return new Response(JSON.stringify({ cards }), {
    headers: { 'Content-Type': 'application/json' }
  });
}

function createRepurposingCard(drug) {
  const topIndication = drug.indications[0];
  return {
    uuid: `thtxgnn-${drug.slug}-${Date.now()}`,
    summary: `💊 Drug Repurposing: ${drug.name} may be effective for ${topIndication.name}`,
    detail: `ThTxGNN AI prediction (score: ${topIndication.score.toFixed(2)}, evidence: ${topIndication.level})`,
    indicator: 'info',
    source: {
      label: 'ThTxGNN',
      url: `https://thtxgnn.yao.care/drugs/${drug.slug}/`
    },
    links: [{
      label: 'View Evidence Report',
      url: `https://thtxgnn.yao.care/drugs/${drug.slug}/`,
      type: 'absolute'
    }]
  };
}

部署規劃

Phase 1：原型驗證

項目	內容
部署平台	Cloudflare Workers
功能	Drug Repurposing (order-select)
資料來源	靜態 search-index.json
驗證方式	SMART Launcher 測試

Phase 2：DDI 整合

項目	內容
新增功能	DDI Alert (order-sign)
資料來源	DDInter + GtoPdb
替代建議	整合 ThTxGNN 預測

Phase 3：CQL 整合

項目	內容
新增功能	CQL 規則引擎
情境化	根據病患資料調整警示
合規性	HL7 PDDI-CDS IG

端點 URL 規劃

環境	URL
Discovery	`https://cds.thtxgnn.yao.care/cds-services`
Drug Repurposing	`https://cds.thtxgnn.yao.care/cds-services/drug-repurposing`
DDI Alert	`https://cds.thtxgnn.yao.care/cds-services/ddi-alert`

待辦事項

設定 Cloudflare Workers 專案
實作 Discovery endpoint
實作 Drug Repurposing service
在 SMART Launcher 測試
實作 DDI Alert service
整合 ClinicalTrials.gov API
設計 Card UI 樣式指南

參考資源

建立日期：2026-03-01