Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { createReference } from '@medplum/core'; import type { Bundle, Composition, CompositionSection, Condition, Observation, Patient, Practitioner, } from '@medplum/fhirtypes'; import { OID_HEALTH_CONCERN_ACT, OID_PROBLEM_ACT, OID_PROBLEM_OBSERVATION } from '../../oids'; import { LOINC_HEALTH_CONCERNS_SECTION, LOINC_PROBLEMS_SECTION } from '../../systems'; import { FhirToCcdaConverter } from '../convert'; import { createConditionEntry, createHealthConcernEntry, createProblemEntry } from './condition'; describe('Condition Entry Functions', () => { let converter: FhirToCcdaConverter; let bundle: Bundle; let patient: Patient; beforeEach(() => { patient = { id: 'patient-1', resourceType: 'Patient', name: [{ given: ['John'], family: 'Doe' }], }; bundle = { resourceType: 'Bundle', type: 'document', entry: [ { resource: patient }, { resource: { id: 'composition-1', resourceType: 'Composition', status: 'final', type: { text: 'test' }, date: new Date().toISOString(), author: [{ display: 'test' }], title: 'test', subject: createReference(patient), section: [], } as Composition, }, ], }; converter = new FhirToCcdaConverter(bundle); }); describe('createConditionEntry', () => { test('should return problem entry for problems section', () => { const section: CompositionSection = { title: 'Problems', code: { coding: [{ code: LOINC_PROBLEMS_SECTION }], }, }; const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createConditionEntry(converter, section, condition); expect(result).toBeDefined(); expect(result?.act).toBeDefined(); expect(result?.act?.[0]?.templateId).toContainEqual({ '@_root': OID_PROBLEM_ACT }); }); test('should return health concern entry for health concerns section', () => { const section: CompositionSection = { title: 'Health Concerns', code: { coding: [{ code: LOINC_HEALTH_CONCERNS_SECTION }], }, }; const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createConditionEntry(converter, section, condition); expect(result).toBeDefined(); expect(result?.act).toBeDefined(); expect(result?.act?.[0]?.templateId).toContainEqual({ '@_root': OID_HEALTH_CONCERN_ACT, '@_extension': '2015-08-01', }); }); test('should return undefined for unknown section', () => { const section: CompositionSection = { title: 'Unknown Section', code: { coding: [{ code: 'unknown-code' }], }, }; const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), }; const result = createConditionEntry(converter, section, condition); expect(result).toBeUndefined(); }); }); describe('createProblemEntry', () => { test('should create basic problem entry', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createProblemEntry(converter, condition); expect(result).toBeDefined(); expect(result.act).toBeDefined(); expect(result.act?.length).toBe(1); const act = result.act?.[0]; expect(act?.['@_classCode']).toBe('ACT'); expect(act?.['@_moodCode']).toBe('EVN'); expect(act?.code?.['@_code']).toBe('CONC'); expect(act?.statusCode?.['@_code']).toBe('active'); // Default status }); test('should handle condition with clinical status', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), clinicalStatus: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/condition-clinical', code: 'inactive' }], }, code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createProblemEntry(converter, condition); const act = result.act?.[0]; expect(act?.statusCode?.['@_code']).toBe('inactive'); }); test('should handle condition with dates', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), recordedDate: '2024-01-01', onsetDateTime: '2023-12-25', abatementDateTime: '2024-01-15', code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createProblemEntry(converter, condition); const act = result.act?.[0]; expect(act?.effectiveTime?.[0]?.low?.['@_value']).toBe('20240101'); const observation = act?.entryRelationship?.[0]?.observation?.[0]; expect(observation?.effectiveTime?.[0]?.low?.['@_value']).toBe('20231225'); expect(observation?.effectiveTime?.[0]?.high?.['@_value']).toBe('20240115'); }); test('should handle condition with identifiers', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), identifier: [{ system: 'http://example.org', value: 'condition-123' }], code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createProblemEntry(converter, condition); const observation = result.act?.[0]?.entryRelationship?.[0]?.observation?.[0]; expect(observation?.id).toBeDefined(); expect(Array.isArray(observation?.id)).toBe(true); }); test('should handle condition with asserter', () => { const practitioner: Practitioner = { id: 'practitioner-1', resourceType: 'Practitioner', name: [{ given: ['Dr.'], family: 'Smith' }], }; const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), asserter: createReference(practitioner), recordedDate: '2024-01-01', code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; bundle.entry?.push({ resource: practitioner }); const result = createProblemEntry(converter, condition); const observation = result.act?.[0]?.entryRelationship?.[0]?.observation?.[0]; expect(observation?.author).toBeDefined(); }); }); describe('createHealthConcernEntry', () => { test('should create basic health concern entry', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); expect(result).toBeDefined(); expect(result.act).toBeDefined(); expect(result.act?.length).toBe(1); const act = result.act?.[0]; expect(act?.['@_classCode']).toBe('ACT'); expect(act?.['@_moodCode']).toBe('EVN'); expect(act?.code?.['@_code']).toBe(LOINC_HEALTH_CONCERNS_SECTION); expect(act?.code?.['@_displayName']).toBe('Health Concern'); expect(act?.entryRelationship).toEqual([]); }); test('should handle health concern with clinical status', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), clinicalStatus: { coding: [{ system: 'http://terminology.hl7.org/CodeSystem/condition-clinical', code: 'inactive' }], }, code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.statusCode?.['@_code']).toBe('inactive'); }); test('should handle health concern with evidence observations', () => { const observation: Observation = { id: 'observation-1', resourceType: 'Observation', status: 'final', code: { coding: [{ system: 'http://loinc.org', code: '33747-0', display: 'General appearance' }], }, subject: createReference(patient), effectivePeriod: { start: '2024-01-01', end: '2024-01-02' }, valueCodeableConcept: { coding: [{ system: 'http://snomed.info/sct', code: '17621005', display: 'Normal' }], }, performer: [createReference(patient)], effectiveDateTime: '2024-01-01', identifier: [{ value: 'obs-123' }], }; const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), evidence: [ { detail: [createReference(observation)], }, ], code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; bundle.entry?.push({ resource: observation }); const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.entryRelationship).toBeDefined(); expect(act?.entryRelationship?.length).toBe(1); const entryRel = act?.entryRelationship?.[0]; expect(entryRel?.['@_typeCode']).toBe('REFR'); expect(entryRel?.observation).toBeDefined(); const obsEntry = entryRel?.observation?.[0]; expect(obsEntry?.['@_classCode']).toBe('OBS'); expect(obsEntry?.['@_moodCode']).toBe('EVN'); expect(obsEntry?.templateId).toContainEqual({ '@_root': OID_PROBLEM_OBSERVATION }); }); test('should skip non-observation evidence details', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), evidence: [ { detail: [createReference(patient)], // Not an observation }, ], code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.entryRelationship).toEqual([]); }); test('should handle missing evidence details', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), evidence: [ { detail: [{ reference: 'Observation/nonexistent' }], }, ], code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.entryRelationship).toEqual([]); }); test('should handle evidence without detail', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), evidence: [{}], // Evidence without detail code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.entryRelationship).toEqual([]); }); test('should handle health concern with recorded date', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), recordedDate: '2024-01-01', code: { coding: [{ system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia' }], }, }; const result = createHealthConcernEntry(converter, condition); const act = result.act?.[0]; expect(act?.effectiveTime?.[0]?.low?.['@_value']).toBe('20240101'); }); }); });