dsh-medrec-qc — Form check and logic-contradiction prompts for the inpatient medical record front sheet

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.

What it looks like

Real output from this plugin over its own MR-009 test fixture — not a mock-up. The rule pack ships no invented quotations, so a finding names both the clause it applied and the fact that the clause text was not obtained.

What it answers

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, and it is capped at warn because the attachment it cites is a PDF this environment cannot decode. 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.
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.

Standards it follows

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.

Compatibility

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-alpha.1. engines.dsh is deliberately not declared: it has no reader and cannot reject a host
Node	`^22.19.0
Platforms	All (plain ESM; no native code, no network, no model call)
Tool mode	Works in native, ptc and both; for a month of discharges use ptc

What it does

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-001 is only a warn

Every error rule 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-001 is the exception: its only basis is 附件1's header note, and that attachment is a PDF this environment cannot decode. The nearest obtained wording — 84号文附件2 一（三）「栏目中没有可填写内容的，填写"-"」 — says how to fill a blank, not that a required field may not be left blank, so it cannot carry an error. A rule whose clause cannot be read does not block a workflow. See rules/evidence/authority-class-audit.md for the full classification.

Rule	Check	Severity
MR-001	no required column is blank (a lone - is the approved marker)	warn
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.

Install

dsh plugin --profile <name> add dsh-medrec-qc
dsh --profile <name> --dump-config | grep 'dsh-medrec-qc'

Configuration

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 }.

Material format

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 sources

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:

1. The required-field list is 附件1, and it has no column called "医师签名". 附件1's 「住院病案首页 必填项目列表」 runs to 76 items and lists the signature block as 科主任 / 主任（副主任）医师 / 主治医师 / 住院医师. 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".
2. The age format is in 84号文, not in the 2010 病历书写规范. The rule for ages under one year (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.
3. "A male patient cannot have a pregnancy diagnosis" is not a national clause. The National Healthcare Security Administration publishes a "diagnosis does not match patient sex" rule type, but the released detail covers eleven ICD-10 chapters (A/B/C/D/E/F/I/J/K/L/M) and contains no O chapter entry at all; the accompanying press briefing explicitly allows clinical exceptions. MR-014 is therefore a warn-level lead for human review, never a block.
4. A death discharge has no independent clause tying it to a death time. 24号文 第八条 only defines the discharge time as the death time for deceased patients. MR-015 rests on that definition, is capped at info, and says so in its own note.

Troubleshooting

• The plugin installs but the tool never appears. Check that main resolves to lib/index.mjs and that pnpm run build produced it; a wrong main makes the loader skip the entry silently.
• A check you expected did not run. Read the 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.
• A column you know exists is reported as unknown. Add its spelling to 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-risk
• check 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.

Development

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

License

Apache License 2.0 © 2026 dsh-medrec-qc contributors.