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在线问诊与预约挂号系统设计 ​

1. 预约挂号系统 ​

1.1 号源管理 ​

1.1.1 排班计划 ​

排班计划是医院/医生在特定时间段内提供挂号服务的安排，是号源管理的基础。

排班计划表 (schedule_plan)

java
@Entity
@Table(name = "schedule_plan")
public class SchedulePlan {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "hospital_id", length = 32, nullable = false)
    private String hospitalId;                  // 医院ID

    @Column(name = "dept_id", length = 32, nullable = false)
    private String deptId;                      // 科室ID

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;                    // 医生ID

    @Column(name = "plan_date", nullable = false)
    private LocalDate planDate;                 // 排班日期

    @Column(name = "period_type", length = 16, nullable = false)
    private String periodType;                  // 时段类型：MORNING(上午)/AFTERNOON(下午)/EVENING(晚间)

    @Column(name = "start_time", nullable = false)
    private LocalTime startTime;                // 开始时间

    @Column(name = "end_time", nullable = false)
    private LocalTime endTime;                  // 结束时间

    @Column(name = "total_slots", nullable = false)
    private Integer totalSlots;                 // 总号源数

    @Column(name = "remain_slots", nullable = false)
    private Integer remainSlots;                // 剩余号源数

    @Column(name = "slot_duration", nullable = false)
    private Integer slotDuration;               // 每个号源时段时长（分钟）

    @Column(name = "schedule_type", length = 16, nullable = false)
    private String scheduleType;                // 排班类型：NORMAL(普通)/EXPERT(专家)/VIP

    @Column(name = "price", nullable = false)
    private Long price;                         // 挂号费用（单位：分）

    @Column(name = "status", length = 16, nullable = false)
    private String status;                      // 状态：ENABLED(启用)/DISABLED(停用)/FULL(已满)/FINISHED(已结束)

    @Column(name = "create_time")
    private LocalDateTime createTime;

    @Column(name = "update_time")
    private LocalDateTime updateTime;
}

1.1.2 号源池分配 ​

号源池机制用于精细化控制不同渠道、不同人群的号源配额，防止号源被单一渠道挤占。

号源池分配策略：

号源池类型分配比例说明
PUBLIC_POOL60%公共号源池，面向所有渠道开放
CHANNEL_RESERVED20%渠道预留池，为特定合作渠道（如第三方平台）预留
VIP_POOL10%VIP/绿色通道池，优先保障重点患者
FRESH_POOL10%新鲜号源池，用于放号初期动态调整

号源池表 (slot_pool)

java
@Entity
@Table(name = "slot_pool")
public class SlotPool {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "plan_id", length = 32, nullable = false)
    private String planId;                      // 排班计划ID

    @Column(name = "pool_type", length = 16, nullable = false)
    private String poolType;                    // 号源池类型：PUBLIC/CHANNEL_RESERVED/VIP/FRESH

    @Column(name = "total_slots", nullable = false)
    private Integer totalSlots;                 // 总配额

    @Column(name = "used_slots", nullable = false)
    private Integer usedSlots;                  // 已使用配额

    @Column(name = "frozen_slots")
    private Integer frozenSlots;                // 冻结配额（锁定未支付）

    @Column(name = "status", length = 16)
    private String status;                      // 状态：ACTIVE/EMPTY

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

1.1.3 放号规则 ​

放号规则定义了号源释放的时间策略和数量策略。

规则维度配置项说明
提前天数advanceDays可提前挂号的日期范围，如7天/14天/30天
放号时间releaseTime每日放号的具体时间点，如 08:00
放号方式releaseModeBATCH(批量放号)/REAL_TIME(实时放号)
批量数量batchSize每次批量放号的号源数量
时间段分段timeSegmentInterval每个就诊时段间隔（分钟）
限号规则maxPerUser单用户每周期最大挂号数
取消释放策略cancelReturnPolicy取消后号源回池时间：IMMEDIATE/DELAYED
爽约释放策略noShowReleaseTime爽约号源释放时间，如次日或就诊时段开始后30分钟

1.2 挂号流程 ​

1.2.1 完整流程图 ​

选择科室 --> 选择医生 --> 查看排班 --> 选择时段 --> 确认订单 --> 在线支付 --> 预约成功（生成就诊凭证）
                                                                        |
                                                                        --> 支付超时关闭

1.2.2 核心数据模型 ​

挂号订单表 (registration_order)

java
@Entity
@Table(name = "registration_order")
public class RegistrationOrder {

    @Id
    @Column(name = "order_id", length = 32, nullable = false)
    private String orderId;                     // 订单号，分布式ID生成

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;                      // 用户ID

    @Column(name = "patient_id", length = 32, nullable = false)
    private String patientId;                   // 就诊人ID（支持替他人挂号）

    @Column(name = "hospital_id", length = 32, nullable = false)
    private String hospitalId;                  // 医院ID

    @Column(name = "dept_id", length = 32, nullable = false)
    private String deptId;                      // 科室ID

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;                    // 医生ID

    @Column(name = "plan_id", length = 32, nullable = false)
    private String planId;                      // 排班计划ID

    @Column(name = "slot_id", length = 32, nullable = false)
    private String slotId;                      // 号源时段ID

    @Column(name = "visit_date", nullable = false)
    private LocalDate visitDate;                // 就诊日期

    @Column(name = "visit_start_time")
    private LocalTime visitStartTime;           // 就诊开始时间

    @Column(name = "visit_end_time")
    private LocalTime visitEndTime;             // 就诊结束时间

    @Column(name = "order_status", length = 16, nullable = false)
    private String orderStatus;                 // 订单状态：PENDING_PAY/PAID/CANCELLED/COMPLETED/REFUNDING/REFUNDED/NOSHOW

    @Column(name = "pay_status", length = 16)
    private String payStatus;                   // 支付状态：UNPAID/PAID/REFUNDING/REFUNDED

    @Column(name = "amount", nullable = false)
    private Long amount;                        // 订单金额（单位：分）

    @Column(name = "pay_amount")
    private Long payAmount;                     // 实付金额（单位：分）

    @Column(name = "service_fee")
    private Long serviceFee;                    // 平台服务费（单位：分）

    @Column(name = "pay_time")
    private LocalDateTime payTime;              // 支付时间

    @Column(name = "cancel_time")
    private LocalDateTime cancelTime;           // 取消时间

    @Column(name = "cancel_reason")
    private String cancelReason;                // 取消原因

    @Column(name = "qr_code", length = 256)
    private String qrCode;                      // 就诊二维码/条形码

    @Column(name = "visit_status", length = 16)
    private String visitStatus;                 // 就诊状态：WAITING(待就诊)/CHECKED_IN(已报到)/IN_CONSULTATION(就诊中)/COMPLETED(已完成)/NOSHOW(爽约)

    @Column(name = "create_time")
    private LocalDateTime createTime;

    @Column(name = "update_time")
    private LocalDateTime updateTime;
}

1.2.3 挂号订单状态机 ​

                                    +---> CANCELLED（用户取消）
                                    |
PENDING_PAY ---> PAID ---> COMPLETED
    |               |            |
    |               |            +---> NOSHOW（患者爽约）
    |               |
    |               +---> REFUNDING ---> REFUNDED（用户退号）
    |
    +---> CLOSED（支付超时自动关闭）
源状态目标状态触发条件操作
PENDING_PAYPAID支付成功回调更新支付信息，锁定号源
PENDING_PAYCLOSED超时未支付（如30分钟）释放号源，关闭订单
PENDING_PAYCANCELLED用户主动取消释放号源
PAIDREFUNDING用户发起退号进入退款流程
REFUNDINGREFUNDED退款成功释放号源
PAIDCOMPLETED就诊完成标记就诊结束
COMPLETEDNOSHOW就诊日结束未报到标记爽约

1.3 取消预约与退号规则 ​

1.3.1 阶梯退号策略 ​

退号时间退款比例说明
就诊日前 >= 3天100%全额退款
就诊日前 1-2天80%扣除20%手续费
就诊当日，未报到50%扣除50%手续费
就诊当日，已报到不退款已进入就诊流程
就诊开始后不退款无法退号

1.3.2 退号流程 ​

用户发起退号 --> 校验退号规则（时间/次数/黑名单）
               --> 扣减退号手续费
               --> 发起退款（原路返回）
               --> 释放号源回号源池
               --> 通知医生号源释放

1.4 黑名单机制 ​

1.4.1 黑名单触发规则 ​

违规类型触发条件惩罚时长说明
多次取消30天内取消 >= 5次7天限制预约挂号
频繁取消单日取消 >= 3次3天限制预约挂号
爽约单次就诊日未到警告首次记录
多次爽约90天内爽约 >= 3次30天限制预约挂号
恶意抢号疑似脚本/高频操作永久人工审核封禁
黄牛行为高频挂退号，IP异常永久人工审核封禁

黑名单表 (user_blacklist)

java
@Entity
@Table(name = "user_blacklist")
public class UserBlacklist {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;

    @Column(name = "black_type", length = 16, nullable = false)
    private String blackType;                   // 类型：CANCEL_ABUSE/NOSHOW/MALICIOUS/SCALPER

    @Column(name = "punish_start", nullable = false)
    private LocalDateTime punishStart;          // 惩罚开始时间

    @Column(name = "punish_end", nullable = false)
    private LocalDateTime punishEnd;            // 惩罚结束时间

    @Column(name = "reason", length = 512)
    private String reason;                      // 原因说明

    @Column(name = "status", length = 16)
    private String status;                      // 状态：ACTIVE/EXPIRED

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

违规记录表 (violation_record)

java
@Entity
@Table(name = "violation_record")
public class ViolationRecord {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;

    @Column(name = "order_id", length = 32)
    private String orderId;                     // 关联订单

    @Column(name = "violation_type", length = 16, nullable = false)
    private String violationType;               // 违规类型：CANCEL/NOSHOW/MALICIOUS

    @Column(name = "violation_desc", length = 256)
    private String violationDesc;               // 违规描述

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

2. 在线问诊 ​

2.1 问诊类型 ​

问诊类型交互方式适用场景时长限制价格区间
图文咨询文字+图片轻症、慢病复诊、报告解读48小时内低
电话咨询语音通话急症、需要快速沟通15/30分钟中
视频咨询视频通话需要面对面查看体征15/30分钟高
处方问诊图文+处方需要开具处方48小时内中
复诊咨询图文/视频同一医生复诊按类型低

2.2 问诊流程 ​

2.2.1 流程图 ​

选择医生 --> 选择问诊类型 --> 填写病情描述（文字/图片/病历） --> 支付问诊费
                                                                  |
                                            +---------------------+
                                            |
                                            等待医生接诊 --> 医生接诊
                                                              |
                                              +---------------+---------------+
                                              |               |               |
                                           图文交流         电话沟通       视频沟通
                                              |               |               |
                                              +-------+-------+---------------+
                                                      |
                                              开具处方/检查单
                                                      |
                                                   问诊结束
                                                      |
                                              评价与反馈

2.2.2 核心数据模型 ​

在线问诊表 (online_consultation)

java
@Entity
@Table(name = "online_consultation")
public class OnlineConsultation {

    @Id
    @Column(name = "consult_id", length = 32, nullable = false)
    private String consultId;                   // 问诊ID

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;                      // 用户ID

    @Column(name = "patient_id", length = 32, nullable = false)
    private String patientId;                   // 就诊人ID

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;                    // 医生ID

    @Column(name = "hospital_id", length = 32)
    private String hospitalId;                  // 医院ID

    @Column(name = "dept_id", length = 32)
    private String deptId;                      // 科室ID

    @Column(name = "consult_type", length = 16, nullable = false)
    private String consultType;                 // 问诊类型：TEXT/PHONE/VIDEO/PRESCRIPTION/FOLLOWUP

    @Column(name = "consult_status", length = 16, nullable = false)
    private String consultStatus;               // 问诊状态

    @Column(name = "chief_complaint", length = 2000)
    private String chiefComplaint;              // 主诉/病情描述

    @Column(name = "medical_history", length = 2000)
    private String medicalHistory;              // 既往病史

    @Column(name = "image_urls", length = 2000)
    private String imageUrls;                   // 图片附件，JSON数组

    @Column(name = "amount", nullable = false)
    private Long amount;                        // 问诊费用（单位：分）

    @Column(name = "service_fee")
    private Long serviceFee;                    // 平台服务费（单位：分）

    @Column(name = "doctor_income")
    private Long doctorIncome;                  // 医生收入（单位：分）

    @Column(name = "pay_status", length = 16)
    private String payStatus;                   // 支付状态：UNPAID/PAID/REFUNDING/REFUNDED

    @Column(name = "doctor_note", length = 2000)
    private String doctorNote;                  // 医生诊断意见

    @Column(name = "start_time")
    private LocalDateTime startTime;            // 接诊时间

    @Column(name = "end_time")
    private LocalDateTime endTime;              // 结束时间

    @Column(name = "duration_minutes")
    private Integer durationMinutes;            // 问诊时长（分钟）

    @Column(name = "create_time")
    private LocalDateTime createTime;

    @Column(name = "update_time")
    private LocalDateTime updateTime;
}

2.3 问诊状态机 ​

                              +---> CANCELLED（用户取消，未支付）
                              |
PENDING_PAY --> PAID --> WAITING_ACCEPT --> IN_CONSULTATION --> COMPLETED
                  |              |                |                |
                  |              |                |                +---> CLOSED（正常结束）
                  |              |                |
                  |              |                +---> REFUNDING ---> REFUNDED（退款中/已退款）
                  |              |
                  |              +---> AUTO_CLOSED（超时未接诊，自动关闭并退款）
                  |
                  +---> CLOSED（支付超时）

状态说明：

状态码状态名称说明
PENDING_PAY待支付用户已提交问诊单，等待支付
PAID已支付支付成功，进入待分配
WAITING_ACCEPT待接诊医生尚未接诊
IN_CONSULTATION接诊中医生已接诊，正在进行交流
COMPLETED已完成问诊正常结束
CLOSED已关闭问诊流程终结（正常或非正常）
CANCELLED已取消用户支付前取消
REFUNDING退款中用户申请退款，审核处理中
REFUNDED已退款退款已完成
AUTO_CLOSED超时关闭医生未在规定时间内接诊，系统自动关闭

状态转换矩阵：

源状态目标状态触发条件操作
PENDING_PAYPAID支付成功回调通知医生有新问诊
PENDING_PAYCANCELLED用户取消无
PENDING_PAYCLOSED超时未支付自动关闭
PAIDWAITING_ACCEPT进入医生接诊池开始计时（如30分钟内需接诊）
WAITING_ACCEPTIN_CONSULTATION医生接诊锁定医患会话，通知用户
WAITING_ACCEPTAUTO_CLOSED超时未接诊全额退款，通知用户
WAITING_ACCEPTCANCELLED用户付费后取消进入退款流程
IN_CONSULTATIONCOMPLETED医生结束问诊生成问诊总结，进入评价
IN_CONSULTATIONREFUNDING用户申请退款平台介入审核
REFUNDINGREFUNDED退款成功关闭问诊
REFUNDINGIN_CONSULTATION退款驳回继续问诊
COMPLETEDCLOSED用户评价终态

3. 医生端设计 ​

3.1 医生排班管理 ​

医生可通过医生端管理自己的排班计划：

功能说明
排班设置设置每周固定排班规则（如每周一上午、周三下午出诊）
临时停诊某天临时无法出诊，可停诊并通知已预约患者
号源调整调整单日出诊号源数量（加号/限号）
时段设置自定义每个时段的接诊人数和间隔时长
排班日历以日历形式查看和管理排班

医生排班模板表 (doctor_schedule_template)

java
@Entity
@Table(name = "doctor_schedule_template")
public class DoctorScheduleTemplate {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;

    @Column(name = "day_of_week", nullable = false)
    private Integer dayOfWeek;                  // 星期几：1-7

    @Column(name = "period_type", length = 16, nullable = false)
    private String periodType;                  // 时段：MORNING/AFTERNOON/EVENING

    @Column(name = "start_time", nullable = false)
    private LocalTime startTime;

    @Column(name = "end_time", nullable = false)
    private LocalTime endTime;

    @Column(name = "slot_count", nullable = false)
    private Integer slotCount;                  // 号源数量

    @Column(name = "slot_duration", nullable = false)
    private Integer slotDuration;               // 号源时长（分钟）

    @Column(name = "status", length = 16)
    private String status;                      // 状态：ACTIVE/INACTIVE
}

3.2 接诊池与排队管理 ​

接诊池是医生处理在线问诊请求的队列系统。

接诊池设计：

概念说明
接诊池医生视角下所有待接诊问诊单的集合
排队规则按支付时间排序，先支付先服务，VIP用户可优先
并行接诊上限医生同时接诊的最大问诊数（如图文3个，视频1个）
接诊超时新问诊单在池中等待超过阈值（如30分钟）未接诊，自动转分诊
分诊机制医生离线或超时后，问诊单重新分配至同科室其他在线医生

接诊池条目表 (consultation_queue)

java
@Entity
@Table(name = "consultation_queue")
public class ConsultationQueue {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "consult_id", length = 32, nullable = false)
    private String consultId;                   // 问诊ID

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;                    // 目标医生ID

    @Column(name = "queue_status", length = 16, nullable = false)
    private String queueStatus;                 // 队列状态：WAITING/ACCEPTED/TRANSFERRED/CLOSED

    @Column(name = "priority", nullable = false)
    private Integer priority;                   // 优先级，数值越小优先级越高

    @Column(name = "entered_time", nullable = false)
    private LocalDateTime enteredTime;          // 入池时间

    @Column(name = "expire_time")
    private LocalDateTime expireTime;           // 超时时间

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

3.3 电子病历书写 ​

电子病历表 (medical_record)

java
@Entity
@Table(name = "medical_record")
public class MedicalRecord {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "consult_id", length = 32)
    private String consultId;                   // 关联问诊ID

    @Column(name = "registration_id", length = 32)
    private String registrationId;              // 关联挂号ID

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;

    @Column(name = "patient_id", length = 32, nullable = false)
    private String patientId;

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;

    @Column(name = "hospital_id", length = 32)
    private String hospitalId;

    @Column(name = "dept_id", length = 32)
    private String deptId;

    @Column(name = "record_type", length = 16, nullable = false)
    private String recordType;                  // 记录类型：FIRST_VISIT(初诊)/FOLLOW_UP(复诊)/EMERGENCY(急诊)

    // ===== 主观部分 =====
    @Column(name = "chief_complaint", length = 2000)
    private String chiefComplaint;              // 主诉

    @Column(name = "present_illness", length = 4000)
    private String presentIllness;              // 现病史

    @Column(name = "past_history", length = 2000)
    private String pastHistory;                 // 既往史

    @Column(name = "allergy_history", length = 1000)
    private String allergyHistory;              // 过敏史

    // ===== 客观部分 =====
    @Column(name = "physical_exam", length = 2000)
    private String physicalExam;                // 体格检查

    @Column(name = "auxiliary_exam", length = 2000)
    private String auxiliaryExam;               // 辅助检查

    // ===== 诊断与处置 =====
    @Column(name = "diagnosis", length = 2000, nullable = false)
    private String diagnosis;                   // 诊断结论

    @Column(name = "treatment_plan", length = 2000)
    private String treatmentPlan;               // 治疗方案

    @Column(name = "medical_advice", length = 2000)
    private String medicalAdvice;               // 医生建议

    @Column(name = "sign_status", length = 16)
    private String signStatus;                  // 签名状态：UNSIGNED/SIGNED

    @Column(name = "sign_time")
    private LocalDateTime signTime;             // 签名时间

    @Column(name = "create_time")
    private LocalDateTime createTime;

    @Column(name = "update_time")
    private LocalDateTime updateTime;
}

3.4 处方开具与签名 ​

医生在问诊过程中可在线开具处方，并通过数字签名技术完成签章。

处方单表 (prescription)

java
@Entity
@Table(name = "prescription")
public class Prescription {

    @Id
    @Column(name = "prescription_id", length = 32, nullable = false)
    private String prescriptionId;

    @Column(name = "consult_id", length = 32)
    private String consultId;                   // 关联问诊ID

    @Column(name = "doctor_id", length = 32, nullable = false)
    private String doctorId;

    @Column(name = "user_id", length = 32, nullable = false)
    private String userId;

    @Column(name = "patient_id", length = 32, nullable = false)
    private String patientId;

    @Column(name = "hospital_id", length = 32)
    private String hospitalId;

    @Column(name = "dept_id", length = 32)
    private String deptId;

    @Column(name = "prescription_type", length = 16, nullable = false)
    private String prescriptionType;            // 处方类型：CHINESE_MEDICINE(中药)/WESTERN_MEDICINE(西药)/COMBINED(中西结合)

    @Column(name = "total_amount")
    private Long totalAmount;                   // 总金额（单位：分）

    @Column(name = "status", length = 16, nullable = false)
    private String status;                      // 状态：DRAFT/PENDING_REVIEW/PASSED/REJECTED/DISPENSING/DISPATCHED/COMPLETED

    @Column(name = "review_status", length = 16)
    private String reviewStatus;                // 审核状态：UNREVIEWED/PASSED/REJECTED

    @Column(name = "review_remark", length = 500)
    private String reviewRemark;                // 审核备注

    @Column(name = "reviewer_id", length = 32)
    private String reviewerId;                  // 审核药师ID

    @Column(name = "review_time")
    private LocalDateTime reviewTime;

    @Column(name = "doctor_sign", length = 512)
    private String doctorSign;                  // 医生数字签名

    @Column(name = "pharmacist_sign", length = 512)
    private String pharmacistSign;              // 药师数字签名

    @Column(name = "valid_days")
    private Integer validDays;                  // 有效期（天）

    @Column(name = "create_time")
    private LocalDateTime createTime;

    @Column(name = "update_time")
    private LocalDateTime updateTime;
}

处方明细表 (prescription_item)

java
@Entity
@Table(name = "prescription_item")
public class PrescriptionItem {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "prescription_id", length = 32, nullable = false)
    private String prescriptionId;

    @Column(name = "drug_code", length = 32, nullable = false)
    private String drugCode;                    // 药品编码

    @Column(name = "drug_name", length = 128, nullable = false)
    private String drugName;                    // 药品名称

    @Column(name = "specification", length = 64)
    private String specification;               // 药品规格

    @Column(name = "dosage_form", length = 32)
    private String dosageForm;                  // 剂型

    @Column(name = "manufacturer", length = 128)
    private String manufacturer;                // 生产厂商

    @Column(name = "quantity", nullable = false)
    private Integer quantity;                   // 数量

    @Column(name = "unit", length = 16)
    private String unit;                        // 单位（盒/瓶/袋）

    @Column(name = "usage_method", length = 256)
    private String usageMethod;                 // 用法

    @Column(name = "dosage", length = 64)
    private String dosage;                      // 用量（如 每次1片）

    @Column(name = "frequency", length = 64)
    private String frequency;                   // 频次（如 每日3次）

    @Column(name = "course_days")
    private Integer courseDays;                 // 疗程天数

    @Column(name = "unit_price")
    private Long unitPrice;                     // 单价（单位：分）

    @Column(name = "total_price")
    private Long totalPrice;                    // 小计金额
}

4. 处方流转 ​

4.1 电子处方 ​

4.1.1 处方模板 ​

处方模板帮助医生快速生成标准格式处方，提升效率。

模板类型说明
个人模板医生个人常用的处方组合
科室模板科室级标准治疗方案模板
医院模板医院统一制定的标准化处方
药品组合模板特定病症的标准用药组合

处方模板表 (prescription_template)

java
@Entity
@Table(name = "prescription_template")
public class PrescriptionTemplate {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "doctor_id", length = 32)
    private String doctorId;                    // 医生ID（为空表示全院/科室模板）

    @Column(name = "dept_id", length = 32)
    private String deptId;

    @Column(name = "hospital_id", length = 32)
    private String hospitalId;

    @Column(name = "template_name", length = 128, nullable = false)
    private String templateName;

    @Column(name = "template_type", length = 16, nullable = false)
    private String templateType;                // 类型：PERSONAL/DEPT/HOSPITAL

    @Column(name = "diagnosis_keywords", length = 500)
    private String diagnosisKeywords;           // 适用诊断关键词

    @Column(name = "template_content", columnDefinition = "TEXT")
    private String templateContent;             // 模板内容（JSON格式，包含药品明细列表）

    @Column(name = "status", length = 16)
    private String status;                      // 状态：ENABLED/DISABLED

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

4.1.2 药品合规与用量限制 ​

合规维度规则说明校验时机
药品目录仅限在药品目录内的药品可开具开处方时
处方权限不同职称医生可开具的药品范围不同开处方时
用量限制单次最大剂量、日最大剂量、疗程限制开处方时
配伍禁忌药品间相互作用检查提交处方时
抗生素限制抗生素使用级别与医生权限匹配开处方时
麻/精/毒药品特殊管制药品的额外审批流程开处方时
儿童用药按年龄/体重计算剂量的自动校验开处方时
妊娠禁忌孕期/哺乳期用药安全校验开处方时

4.2 处方审核 ​

4.2.1 审核流程 ​

医生开具处方 --> 合规性自动校验（规则引擎）
                    |
           +--------+--------+
           |                 |
        校验通过           校验不通过
           |                 |
        待药师审核     提示医生修改
           |
    +------+------+
    |             |
  审核通过      审核驳回
    |             |
  进入配药      通知医生修改

4.2.2 规则引擎设计 ​

规则引擎用于处方的自动合规性校验，采用可配置的规则体系。

规则表 (audit_rule)

java
@Entity
@Table(name = "audit_rule")
public class AuditRule {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "rule_code", length = 64, nullable = false, unique = true)
    private String ruleCode;                    // 规则编码

    @Column(name = "rule_name", length = 128, nullable = false)
    private String ruleName;                    // 规则名称

    @Column(name = "rule_type", length = 32, nullable = false)
    private String ruleType;                    // 规则类型：DRUG_LIMIT/DOSAGE_LIMIT/INTERACTION/PERMISSION/AGE_CHECK

    @Column(name = "rule_expression", length = 2000, nullable = false)
    private String ruleExpression;              // 规则表达式（可配置的规则脚本）

    @Column(name = "severity", length = 16, nullable = false)
    private String severity;                    // 严重级别：WARNING(警告)/ERROR(拦截)

    @Column(name = "message_template", length = 500)
    private String messageTemplate;             // 提示信息模板

    @Column(name = "status", length = 16)
    private String status;                      // 状态：ENABLED/DISABLED

    @Column(name = "priority")
    private Integer priority;                   // 执行优先级

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

处方审核记录表 (prescription_audit_log)

java
@Entity
@Table(name = "prescription_audit_log")
public class PrescriptionAuditLog {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "prescription_id", length = 32, nullable = false)
    private String prescriptionId;

    @Column(name = "audit_type", length = 16, nullable = false)
    private String auditType;                   // 审核类型：AUTO(自动审核)/MANUAL(人工审核)

    @Column(name = "audit_result", length = 16, nullable = false)
    private String auditResult;                 // 审核结果：PASSED/REJECTED/FLAGGED

    @Column(name = "rule_code", length = 64)
    private String ruleCode;                    // 触发规则（自动审核时）

    @Column(name = "auditor_id", length = 32)
    private String auditorId;                   // 审核人ID（人工审核时）

    @Column(name = "remark", length = 500)
    private String remark;                      // 审核备注

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

4.3 DTP 药房配送对接 ​

DTP（Direct to Patient）药房模式，处方审核通过后直接流转至药房进行配药和配送。

对接环节说明
处方推送审核通过的处方推送至DTP药房系统
药品库存查询实时查询药房库存，缺药时提示用户替换或转方
冷链配送需冷链运输药品的特殊配送流程
配送追踪物流状态实时追踪，用户端可查看
签收确认患者签收后系统自动确认
药事服务药师用药指导电话回访

配送订单表 (delivery_order)

java
@Entity
@Table(name = "delivery_order")
public class DeliveryOrder {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "prescription_id", length = 32, nullable = false)
    private String prescriptionId;

    @Column(name = "pharmacy_id", length = 32, nullable = false)
    private String pharmacyId;                  // 药房ID

    @Column(name = "delivery_status", length = 16, nullable = false)
    private String deliveryStatus;              // 配送状态：PENDING_DISPENSING/DISPENSING/DISPATCHED/IN_TRANSIT/DELIVERED/RECEIVED

    @Column(name = "receiver_name", length = 32, nullable = false)
    private String receiverName;                // 收货人

    @Column(name = "receiver_phone", length = 20, nullable = false)
    private String receiverPhone;               // 收货电话

    @Column(name = "receiver_address", length = 256, nullable = false)
    private String receiverAddress;             // 收货地址

    @Column(name = "delivery_company", length = 64)
    private String deliveryCompany;             // 物流公司

    @Column(name = "tracking_no", length = 64)
    private String trackingNo;                  // 物流单号

    @Column(name = "is_cold_chain")
    private Boolean isColdChain;                // 是否冷链配送

    @Column(name = "dispensing_time")
    private LocalDateTime dispensingTime;       // 配药时间

    @Column(name = "dispatch_time")
    private LocalDateTime dispatchTime;         // 发货时间

    @Column(name = "received_time")
    private LocalDateTime receivedTime;         // 签收时间

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

5. 问诊定价体系 ​

5.1 定价模型 ​

5.1.1 问诊类型定价 ​

问诊类型定价方式价格区间平台抽成比例说明
图文咨询医生自主定价10-100元15-20%按次收费，48小时内有效
电话咨询医生自主定价30-200元15-20%按次收费，限时15/30分钟
视频咨询医生自主定价50-500元15-25%按次收费，限时15/30分钟
名医问诊医院统一定价200-2000元10-15%专家级医生，价格由医院制定
复诊咨询医生自主定价5-50元10-15%同一医生复诊优惠价
处方问诊医生自主定价20-80元15-20%含处方开具服务

5.1.2 医生自主定价 ​

医生可在平台设定的价格区间内自主设定问诊价格。

定价因子说明
医生职称主任医师 > 副主任医师 > 主治医师 > 住院医师
医生声誉好评率、患者评价、接诊量综合评分
科室热度热门科室溢价（如儿科、皮肤科）
时段因素晚间/节假日问诊可溢价
医院等级三甲医院 > 二甲医院 > 社区医院

5.2 平台服务费抽成 ​

5.2.1 抽成规则 ​

规则项说明
基础抽成比例按问诊费用的 15-25% 抽取
阶梯返利月接诊量达到一定阈值后，抽成比例递减
优质医生激励高评分医生享有更低抽成比例
平台活动补贴平台营销活动期间，平台补贴部分费用
抽成上限单次问诊抽成金额设上限（如不超过200元）

平台抽成记录表 (platform_fee_record)

java
@Entity
@Table(name = "platform_fee_record")
public class PlatformFeeRecord {

    @Id
    @Column(name = "id", length = 32, nullable = false)
    private String id;

    @Column(name = "consult_id", length = 32)
    private String consultId;                   // 问诊ID

    @Column(name = "registration_id", length = 32)
    private String registrationId;              // 挂号ID

    @Column(name = "order_type", length = 16, nullable = false)
    private String orderType;                   // 订单类型：REGISTRATION(挂号)/CONSULTATION(问诊)

    @Column(name = "order_amount", nullable = false)
    private Long orderAmount;                   // 订单总金额（单位：分）

    @Column(name = "platform_ratio", nullable = false)
    private Integer platformRatio;              // 平台抽成比例（如20表示20%）

    @Column(name = "platform_fee", nullable = false)
    private Long platformFee;                   // 平台抽成金额（单位：分）

    @Column(name = "doctor_income", nullable = false)
    private Long doctorIncome;                  // 医生收入（单位：分）

    @Column(name = "settlement_status", length = 16)
    private String settlementStatus;            // 结算状态：UNSETTLED/SETTLED

    @Column(name = "settlement_time")
    private LocalDateTime settlementTime;       // 结算时间

    @Column(name = "create_time")
    private LocalDateTime createTime;
}

5.3 医生结算流程 ​

问诊完成 --> 生成抽成记录 --> 进入结算周期（T+1/T+7/月结）
                              |
                       平台汇总对账
                              |
                       财务打款（自动结算）
                              |
                       通知医生收入到账
结算周期适用场景说明
T+1优质医生、高频接诊医生次日结算
T+7普通医生每周结算一次
月结低频医生每月结算一次
按需提现所有医生达到最低提现金额后可提现

6. 系统架构概览 ​

6.1 模块划分 ​

┌─────────────────────────────────────────────────────────────────┐
│                         用户端（小程序/App/Web）                   │
├─────────────────────────────────────────────────────────────────┤
│  预约挂号    │  在线问诊    │  处方服务    │  健康档案    │  支付    │
├─────────────────────────────────────────────────────────────────┤
│                         医生端（App/Web）                        │
├─────────────────────────────────────────────────────────────────┤
│  排班管理    │  接诊池      │  电子病历    │  处方开具    │  收入    │
├─────────────────────────────────────────────────────────────────┤
│                         管理后台（Web）                           │
├─────────────────────────────────────────────────────────────────┤
│  医院管理    │  医生管理    │  药品管理    │  对账结算    │  风控    │
├─────────────────────────────────────────────────────────────────┤
│                         基础服务层                                │
├─────────────────────────────────────────────────────────────────┤
│  用户服务  │  订单服务  │  支付服务  │  消息服务  │  文件服务  │
│  号源服务  │  问诊服务  │  处方服务  │  结算服务  │  规则引擎  │
└─────────────────────────────────────────────────────────────────┘

6.2 关键业务流程涉及的服务 ​

业务流程涉及服务关键点
预约挂号用户服务、号源服务、订单服务、支付服务号源锁定与释放的原子性
在线问诊问诊服务、消息服务、文件服务、支付服务实时通信、超时处理
处方流转处方服务、规则引擎、药品服务、配送服务合规校验、签名认证
医生结算结算服务、订单服务、支付服务对账准确性、定时任务