Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { ContentType, createReference, getReferenceString, indexSearchParameterBundle, indexStructureDefinitionBundle, LOINC, } from '@medplum/core'; import { SEARCH_PARAMETER_BUNDLE_FILES, readJson } from '@medplum/definitions'; import type { Bundle, Observation, Patient, SearchParameter } from '@medplum/fhirtypes'; import { MockClient } from '@medplum/mock'; import { expect, test, describe, beforeAll, beforeEach, vi } from 'vitest'; import { handler } from './bmi-calculation-bot'; describe('BMI Calculation Bot', () => { const bot: { reference: string } = { reference: 'Bot/123' }; const contentType = ContentType.FHIR_JSON; const secrets = {}; let medplum: MockClient; let patient: Patient; beforeAll(() => { indexStructureDefinitionBundle(readJson('fhir/r4/profiles-types.json') as Bundle); indexStructureDefinitionBundle(readJson('fhir/r4/profiles-resources.json') as Bundle); for (const filename of SEARCH_PARAMETER_BUNDLE_FILES) { indexSearchParameterBundle(readJson(filename) as Bundle<SearchParameter>); } }); beforeEach(async () => { medplum = new MockClient(); patient = await medplum.createResource<Patient>({ resourceType: 'Patient', name: [{ given: ['John'], family: 'Doe' }], }); }); test('Creates BMI observation from height and weight in meters and kg', async () => { // Create height observation in meters const heightObservation = await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: LOINC, code: '8302-2', display: 'Body height', }, ], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); // Create weight observation in kg const weightObservation = await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: LOINC, code: '29463-7', display: 'Body weight', }, ], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); // Run the bot await handler(medplum, { bot, input: patient, contentType, secrets }); // Verify BMI observation was created const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); const bmiObservation = bmiObservations[0]; expect(bmiObservation.valueQuantity?.value).toBeCloseTo(22.86, 2); // BMI = 70 / (1.75)^2 = 22.86 expect(bmiObservation.valueQuantity?.unit).toBe('kg/m2'); expect(bmiObservation.derivedFrom).toHaveLength(2); expect(bmiObservation.derivedFrom?.some((ref) => ref.reference === getReferenceString(heightObservation))).toBe( true ); expect(bmiObservation.derivedFrom?.some((ref) => ref.reference === getReferenceString(weightObservation))).toBe( true ); }); test('Converts height from inches to meters', async () => { // Create height observation in inches await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 70, // 70 inches = 1.778 meters unit: 'in', system: 'http://unitsofmeasure.org', code: 'in', }, effectiveDateTime: new Date().toISOString(), }); // Create weight observation in kg await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 80, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // BMI = 80 / (70 * 0.0254)^2 = 80 / 1.778^2 ≈ 25.3 expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(25.3, 1); }); test('Converts height from centimeters to meters', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 175, // 175 cm = 1.75 meters unit: 'cm', system: 'http://unitsofmeasure.org', code: 'cm', }, effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // BMI = 70 / (175/100)^2 = 70 / 1.75^2 ≈ 22.86 expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(22.86, 2); }); test('Converts weight from pounds to kilograms', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 154.32, // 154.32 lbs ≈ 70 kg unit: 'lb', system: 'http://unitsofmeasure.org', code: 'lb', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // BMI should be approximately 22.86 (70 kg / 1.75^2) expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(22.86, 1); }); test('Converts weight from grams to kilograms', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70000, // 70000 g = 70 kg unit: 'g', system: 'http://unitsofmeasure.org', code: 'g', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(22.86, 2); }); test('Uses latest observation when multiple exist', async () => { // Create older height observation const oldHeight = await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.7, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: '2024-01-01T00:00:00Z', }); // Create newer height observation const newHeight = await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: '2024-01-15T00:00:00Z', }); // Create weight observation await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: '2024-01-10T00:00:00Z', }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // Should use newHeight (1.75m), not oldHeight (1.70m) // BMI = 70 / 1.75^2 ≈ 22.86 expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(22.86, 2); // Verify it references the latest height observation expect(bmiObservations[0].derivedFrom?.some((ref) => ref.reference === getReferenceString(newHeight))).toBe(true); expect(bmiObservations[0].derivedFrom?.some((ref) => ref.reference === getReferenceString(oldHeight))).toBe(false); }); test('Does not create BMI observation when height observation is missing', async () => { // Only create weight observation await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); const consoleSpy = vi.spyOn(console, 'log').mockImplementation(() => {}); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(0); expect(consoleSpy).toHaveBeenCalledWith(expect.stringContaining('No height observation found')); consoleSpy.mockRestore(); }); test('Does not create BMI observation when weight observation is missing', async () => { // Only create height observation await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); const consoleSpy = vi.spyOn(console, 'log').mockImplementation(() => {}); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(0); expect(consoleSpy).toHaveBeenCalledWith(expect.stringContaining('No weight observation found')); consoleSpy.mockRestore(); }); test('Does not create BMI observation when height value is missing', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, // Missing valueQuantity effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); const consoleSpy = vi.spyOn(console, 'log').mockImplementation(() => {}); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(0); expect(consoleSpy).toHaveBeenCalledWith(expect.stringContaining('Missing values')); consoleSpy.mockRestore(); }); test('Creates multiple BMI observations over time', async () => { // First set of observations await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.75, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: '2024-01-01T00:00:00Z', }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 70, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: '2024-01-01T00:00:00Z', }); await handler(medplum, { bot, input: patient, contentType, secrets }); // Second set of observations (weight changed) await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 75, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: '2024-02-01T00:00:00Z', }); await handler(medplum, { bot, input: patient, contentType, secrets }); // Should have 2 BMI observations const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(2); // First BMI: 70 / 1.75^2 ≈ 22.86 // Second BMI: 75 / 1.75^2 ≈ 24.49 const bmiValues = bmiObservations.map((obs) => obs.valueQuantity?.value).sort((a, b) => (a || 0) - (b || 0)); expect(bmiValues[0]).toBeCloseTo(22.86, 1); expect(bmiValues[1]).toBeCloseTo(24.49, 1); }); test('Handles edge case with very high BMI', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.6, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 120, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // BMI = 120 / 1.60^2 = 46.875 expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(46.875, 2); }); test('Handles edge case with very low BMI', async () => { await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '8302-2', display: 'Body height' }], }, valueQuantity: { value: 1.8, unit: 'm', system: 'http://unitsofmeasure.org', code: 'm', }, effectiveDateTime: new Date().toISOString(), }); await medplum.createResource<Observation>({ resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ system: LOINC, code: '29463-7', display: 'Body weight' }], }, valueQuantity: { value: 50, unit: 'kg', system: 'http://unitsofmeasure.org', code: 'kg', }, effectiveDateTime: new Date().toISOString(), }); await handler(medplum, { bot, input: patient, contentType, secrets }); const bmiObservations = await medplum.searchResources('Observation', { patient: getReferenceString(patient), code: `${LOINC}|39156-5`, }); expect(bmiObservations.length).toBe(1); // BMI = 50 / 1.80^2 ≈ 15.43 expect(bmiObservations[0].valueQuantity?.value).toBeCloseTo(15.43, 2); }); });