MediCare HIS — Standards Conformance

A hospital information system built to international standards.

Every claim on this page is verifiable. Hit https://renalyx-hospital.medicarehis.com/fhir/metadata from your terminal to read the live FHIR R4 CapabilityStatement. Last verified 2026-06-04.

Interoperability

FHIR R4

HL7 FHIR Release 4.0.1 — Patient, Encounter, Observation, MedicationRequest, AllergyIntolerance, Condition. CapabilityStatement at /fhir/metadata.

conformant

HL7 v2.5

Inbound MLLP listener for ORU^R01 (lab results) and ADT^A01 / A04 / A08 (admission, registration, update). Tenant routed via MSH-4 sending facility. ACK^R01 with AA / AE / AR back to sender. Configure via HL7_PORT + HL7_TENANT_MAP. OUTBOUND ORM^O01 (orders to analysers) — fire-and-forget MLLP client with 3-attempt exponential backoff; configure via HL7_OUTBOUND_TARGETS=<hospitalId>:<host>:<port>.

conformant

SNOMED CT

Clinical terminology on diagnoses, problem list, and procedures. Code system http://snomed.info/sct.

conformant

ICD-10

Diagnosis coding for NHIS claims + DHIMS2 reporting. Code system http://hl7.org/fhir/sid/icd-10. Catalog at /api/icd/search.

conformant

LOINC

Universal codes for lab analytes and vital-sign observations. Code system http://loinc.org.

conformant

RxNorm

Normalised drug nomenclature on prescriptions where the catalog carries an RxNorm CUI.

partial

UCUM

Unified Code for Units of Measure on every quantitative observation (vitals, labs). Code system http://unitsofmeasure.org.

conformant

NHIS (Ghana)

Native NHIA claims pipeline — claim built at point of care, validated against the NHIA tariff schedule, submitted electronically. Identifier system https://nhia.gov.gh/identifier/membership.

conformant

DHIMS2

Native monthly export aligned with the Ghana Ministry of Health DHIMS2 indicator dictionary. Per-tenant scope, no cross-tenant leakage.

conformant

Clinical Safety

CAP / Joint Commission — two-step lab verify

Lab results require sign-off by a different clinician (lab scientist / pathologist / lab in-charge) before release. The originating tech cannot self-verify. Per-tenant flag.

enforced

CAP / Joint Commission — critical-value read-back

Critical results auto-detected from a panic-range table cascade to consulting, ward, ED, matron, and medical supervisor. Acknowledgement captures latency for the M&M review.

enforced

WHO Surgical Safety Checklist

Three-phase (sign-in, time-out, sign-out) checklist with required-keys validation. Blocks status transition to "ready for theatre" without sign-in completion.

enforced

WHO Partograph — alert + action lines

FHR bradycardia/tachycardia, maternal pyrexia, severe maternal hypertension, meconium- or blood-stained liquor, and prolonged-labour (<1 cm/h in active first stage) alarms fire critical notifications.

enforced

WHO Postpartum Haemorrhage (PPH) bundle

Automatic activation of the WHO bundle when EBL ≥ 500 mL (vaginal) or ≥ 1000 mL (CS). Notifies matron, obstetrician, anaesthetist, blood bank, theatre, and medical supervisor with the drug ladder in the alert body.

enforced

Paediatric weight-based dose verification

Refuses pediatric prescriptions where the proposed dose exceeds the weight-based maximum with a 20% headroom. Override audited with clinician reason.

enforced

Drug-drug interaction gate at prescribe-time

Moderate + severe pairs hard-block submission with override-with-reason; severe pairs require a ≥10-character clinical justification captured in audit.

enforced

PRN cumulative 24h dose enforcement at MAR

Rolling 24-hour dose sum refuses any PRN administration that would exceed the prescription's maxDose24h cap. Non-overrideable — nurse must escalate to the prescriber.

enforced

ABO / Rh compatibility matrix at blood dispense

WHO-aligned compatibility check enforced at dispense; cold-chain < 30-min window and 4-hour transfusion duration enforced.

enforced

Pregnancy / teratogen gate

Category X / D drugs and ionising radiology refuse without explicit override + documented reason when patient status is pregnant or unknown.

enforced

Patient merge identity verification

Merge requires operator attestation, ≥10-character reason, and at least 2 of (name, DOB, phone, NHIS) matching between source + keep. Weak-match merges audit explicitly.

enforced

Security & Governance

Tenant isolation

Multi-tenant by construction. Every row carries hospitalId; every query and SSE broadcast filters by tenant. CI guards prevent legacy unscoped reads.

enforced

Hash-chained audit log

Tamper-evident chain mirrored to off-host Backblaze B2 with Object Lock (Compliance mode) and 7-year retention. Weekly automated chain verification.

enforced

Field-level PHI encryption

NHIS membership, insurance member ID, and next-of-kin phone encrypted at rest with HMAC equality indices for exact-match search.

enforced

CSP, CSRF, rate-limit, input sanitisation

OWASP-aligned defence-in-depth. Content-Security-Policy + same-origin POST gate + 600 req/min throttle + body sanitisation on every request.

enforced

OIDC Single Sign-On

Per-tenant OpenID Connect authorization code flow. Login via Microsoft 365 / Azure AD / Google Workspace / Okta / Auth0. JIT user provisioning with group→role mapping. Strict id_token verification (alg allow-list, JWKS-cached, nonce + state CSRF protection). Configure at Settings → Authentication.

conformant

SAML 2.0 SSO

XML-signature SAML 2.0 for hospitals on enterprise IdPs that don't front-channel OIDC (Shibboleth, ADFS legacy mode). Phase 6 — see roadmap.

planned

For HIS Heads & IT Directors

Issue yourself a sandbox API key via your tenant admin at /api/keys (scope: fhir:read) and verify the standards claims directly:

# CapabilityStatement (no auth)
curl https://renalyx-hospital.medicarehis.com/fhir/metadata

# Patient search (Bearer token)
curl -H "Authorization: Bearer mhk_..." \
     "https://renalyx-hospital.medicarehis.com/fhir/Patient?name=mensah"

# Observation by patient + LOINC
curl -H "Authorization: Bearer mhk_..." \
     "https://renalyx-hospital.medicarehis.com/fhir/Observation?patient=pat_xxx&code=2160-0"

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