Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { createReference } from '@medplum/core'; import type { Bundle, Composition, Condition, Encounter, EncounterParticipant, Patient } from '@medplum/fhirtypes'; import { OID_ENCOUNTER_ACTIVITIES, OID_ENCOUNTER_LOCATION, OID_PROBLEM_OBSERVATION } from '../../oids'; import { FhirToCcdaConverter } from '../convert'; import { createEncounterEntry } from './encounter'; describe('createEncounterEntry', () => { 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); }); test('should create basic encounter entry', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, type: [ { coding: [ { system: 'http://snomed.info/sct', code: '270427003', display: 'Patient-initiated encounter', }, ], }, ], period: { start: '2024-01-01T10:00:00Z', end: '2024-01-01T11:00:00Z', }, identifier: [{ system: 'http://example.org', value: 'encounter-123' }], }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); expect(result.encounter).toBeDefined(); expect(result.encounter?.length).toBe(1); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.['@_classCode']).toBe('ENC'); expect(encounterEntry?.['@_moodCode']).toBe('EVN'); expect(encounterEntry?.templateId).toEqual([ { '@_root': OID_ENCOUNTER_ACTIVITIES }, { '@_root': OID_ENCOUNTER_ACTIVITIES, '@_extension': '2015-08-01' }, ]); expect(encounterEntry?.code?.['@_code']).toBe('270427003'); expect(encounterEntry?.code?.['@_displayName']).toBe('Patient-initiated encounter'); expect(encounterEntry?.effectiveTime?.[0]?.low?.['@_value']).toBe('20240101100000+0000'); expect(encounterEntry?.effectiveTime?.[0]?.high?.['@_value']).toBe('20240101110000+0000'); expect(encounterEntry?.id).toBeDefined(); }); test('should create encounter entry with participants', () => { const participants: EncounterParticipant[] = [ { type: [ { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType', code: 'LOC', display: 'location', }, ], }, ], }, { type: [ { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/v3-ParticipationType', code: 'ATND', display: 'attender', }, ], }, ], }, ]; const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, participant: participants, }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.participant).toBeDefined(); expect(encounterEntry?.participant?.length).toBe(2); const firstParticipant = encounterEntry?.participant?.[0]; expect(firstParticipant?.['@_typeCode']).toBe('LOC'); expect(firstParticipant?.participantRole?.['@_classCode']).toBe('SDLOC'); expect(firstParticipant?.participantRole?.templateId).toEqual([{ '@_root': OID_ENCOUNTER_LOCATION }]); expect(firstParticipant?.participantRole?.code?.['@_code']).toBe('LOC'); expect(firstParticipant?.participantRole?.code?.['@_displayName']).toBe('location'); const secondParticipant = encounterEntry?.participant?.[1]; expect(secondParticipant?.participantRole?.code?.['@_code']).toBe('ATND'); expect(secondParticipant?.participantRole?.code?.['@_displayName']).toBe('attender'); }); test('should create encounter entry with diagnosis', () => { const condition: Condition = { id: 'condition-1', resourceType: 'Condition', subject: createReference(patient), code: { coding: [ { system: 'http://snomed.info/sct', code: '233604007', display: 'Pneumonia', }, ], }, onsetDateTime: '2023-12-25', abatementDateTime: '2024-01-15', identifier: [{ system: 'http://example.org', value: 'condition-123' }], }; const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, diagnosis: [ { condition: createReference(condition), use: { coding: [ { system: 'http://terminology.hl7.org/CodeSystem/diagnosis-role', code: 'CC', display: 'Chief complaint', }, ], }, }, ], }; bundle.entry?.push({ resource: condition }); const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.entryRelationship).toBeDefined(); expect(encounterEntry?.entryRelationship?.length).toBe(1); const diagnosisEntry = encounterEntry?.entryRelationship?.[0]; expect(diagnosisEntry?.['@_typeCode']).toBe('REFR'); expect(diagnosisEntry?.act).toBeDefined(); const diagnosisAct = diagnosisEntry?.act?.[0]; expect(diagnosisAct?.['@_classCode']).toBe('ACT'); expect(diagnosisAct?.['@_moodCode']).toBe('EVN'); expect(diagnosisAct?.templateId).toEqual([ { '@_root': OID_ENCOUNTER_ACTIVITIES, '@_extension': '2015-08-01' }, { '@_root': OID_ENCOUNTER_ACTIVITIES }, ]); expect(diagnosisAct?.code?.['@_code']).toBe('29308-4'); expect(diagnosisAct?.code?.['@_displayName']).toBe('Diagnosis'); expect(diagnosisAct?.entryRelationship).toBeDefined(); expect(diagnosisAct?.entryRelationship?.length).toBe(1); const observationEntry = diagnosisAct?.entryRelationship?.[0]; expect(observationEntry?.['@_typeCode']).toBe('SUBJ'); expect(observationEntry?.observation).toBeDefined(); const observation = observationEntry?.observation?.[0]; expect(observation?.['@_classCode']).toBe('OBS'); expect(observation?.['@_moodCode']).toBe('EVN'); expect(observation?.templateId).toEqual([ { '@_root': OID_PROBLEM_OBSERVATION, '@_extension': '2015-08-01' }, { '@_root': OID_PROBLEM_OBSERVATION }, ]); expect(observation?.code?.['@_code']).toBe('282291009'); expect(observation?.code?.['@_displayName']).toBe('Diagnosis interpretation'); expect(observation?.statusCode?.['@_code']).toBe('completed'); // Value structure is dynamic based on mapCodeableConceptToCcdaValue implementation expect(observation?.value).toBeDefined(); expect(observation?.id).toBeDefined(); }); test('should skip invalid diagnosis references', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, diagnosis: [ { condition: { reference: 'Condition/nonexistent' }, }, { condition: { reference: 'Condition/invalid' } as any, // Wrong resource type for testing }, ], }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.entryRelationship).toEqual([]); }); test('should handle encounter without type', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.code).toBeUndefined(); }); test('should handle encounter without period', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.effectiveTime).toBeUndefined(); }); test('should handle encounter with extension for text reference', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#encounter-narrative', }, ], }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.text?.reference?.['@_value']).toBe('#encounter-narrative'); }); test('should handle encounter without id or identifiers', () => { const encounter: Encounter = { resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.id).toBeDefined(); }); test('should handle participants without type', () => { const encounter: Encounter = { id: 'encounter-1', resourceType: 'Encounter', status: 'finished', subject: createReference(patient), class: { system: 'http://terminology.hl7.org/CodeSystem/v3-ActCode', code: 'AMB', display: 'ambulatory', }, participant: [ { // Participant without type for testing }, ], }; const result = createEncounterEntry(converter, encounter); expect(result).toBeDefined(); const encounterEntry = result.encounter?.[0]; expect(encounterEntry?.participant).toBeDefined(); expect(encounterEntry?.participant?.length).toBe(1); const participant = encounterEntry?.participant?.[0]; expect(participant?.participantRole?.code).toBeUndefined(); }); });