Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { createReference } from '@medplum/core'; import type { Bundle, Composition, Medication, MedicationRequest, Patient } from '@medplum/fhirtypes'; import { OID_LOINC_CODE_SYSTEM, OID_MEDICATION_ACTIVITY, OID_MEDICATION_FREE_TEXT_SIG } from '../../oids'; import { LOINC_MEDICATION_INSTRUCTIONS } from '../../systems'; import type { CcdaText } from '../../types'; import { FhirToCcdaConverter } from '../convert'; import { createMedicationEntry } from './medication'; describe('medication 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('createMedicationEntry', () => { test('should create basic medication entry', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); expect(result.substanceAdministration).toBeDefined(); expect(result.substanceAdministration?.length).toBe(1); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.['@_classCode']).toBe('SBADM'); expect(substanceAdmin?.['@_moodCode']).toBe('EVN'); expect(substanceAdmin?.templateId).toEqual([ { '@_root': OID_MEDICATION_ACTIVITY, '@_extension': '2014-06-09' }, { '@_root': OID_MEDICATION_ACTIVITY }, ]); expect(substanceAdmin?.id).toBeDefined(); expect(substanceAdmin?.statusCode?.['@_code']).toBe('active'); expect(substanceAdmin?.consumable).toBeDefined(); }); test('should handle medication with contained medication resource', () => { const medication: Medication = { id: 'med-1', resourceType: 'Medication', code: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, manufacturer: { display: 'Bayer', }, extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#medication-text', }, ], }; const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), contained: [medication], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturedMaterial?.[0]?.code?.[0]).toBeDefined(); expect( substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturedMaterial?.[0]?.code?.[0]?.originalText ?.reference?.['@_value'] ).toBe('#medication-text'); expect(substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturerOrganization).toBeDefined(); expect(substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturerOrganization?.[0]?.name?.[0]).toBe( 'Bayer' ); }); test('should handle medication with manufacturer with id and identifier', () => { const medication: Medication = { id: 'med-1', resourceType: 'Medication', code: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, manufacturer: { id: 'manufacturer-1', identifier: { value: 'mfg-123' }, display: 'Bayer', }, }; const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), contained: [medication], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturerOrganization?.[0]?.id).toBeDefined(); }); test('should handle medication without manufacturer', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.consumable?.manufacturedProduct?.[0]?.manufacturerOrganization).toBeUndefined(); }); test('should handle medication with dispense validity period', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dispenseRequest: { validityPeriod: { start: '2024-01-01', end: '2024-12-31', }, }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.effectiveTime).toBeDefined(); expect(substanceAdmin?.effectiveTime?.length).toBeGreaterThan(0); }); test('should handle medication with dosage timing', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { timing: { repeat: { period: 24, periodUnit: 'h', }, }, }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.effectiveTime).toBeDefined(); expect(substanceAdmin?.effectiveTime?.length).toBe(1); expect(substanceAdmin?.effectiveTime?.[0]?.['@_xsi:type']).toBe('PIVL_TS'); expect(substanceAdmin?.effectiveTime?.[0]?.period?.['@_value']).toBe('24'); expect(substanceAdmin?.effectiveTime?.[0]?.period?.['@_unit']).toBe('h'); }); test('should handle medication with route', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { route: { coding: [ { system: 'http://snomed.info/sct', code: '26643006', display: 'Oral route', }, ], }, }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.routeCode).toBeDefined(); expect(substanceAdmin?.routeCode?.['@_code']).toBe('26643006'); }); test('should handle medication without route', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { // No route specified }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.routeCode).toBeUndefined(); }); test('should handle medication with dose quantity', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { doseAndRate: [ { doseQuantity: { value: 325, unit: 'mg', }, }, ], }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.doseQuantity).toBeDefined(); expect(substanceAdmin?.doseQuantity?.['@_value']).toBe('325'); expect(substanceAdmin?.doseQuantity?.['@_unit']).toBe('mg'); }); test('should handle medication without dose quantity', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { doseAndRate: [ { // No doseQuantity }, ], }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.doseQuantity).toBeUndefined(); }); test('should handle medication without doseAndRate', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { // No doseAndRate }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.doseQuantity).toBeUndefined(); }); test('should handle medication with extension for text reference', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#medication-narrative', }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect((substanceAdmin?.text as CcdaText).reference?.['@_value']).toBe('#medication-narrative'); }); test('should handle medication with requester', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, requester: { display: 'Dr. Smith' }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; // Note: mapAuthor may return undefined for display-only requesters expect(substanceAdmin?.author).toBeUndefined(); }); test('should handle medication with dosage instruction extensions', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, dosageInstruction: [ { extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#dosage-instruction-1', }, ], }, { extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#dosage-instruction-2', }, ], }, { // No extensions - should be filtered out }, ], authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.entryRelationship).toBeDefined(); expect(substanceAdmin?.entryRelationship?.length).toBe(2); const firstInstruction = substanceAdmin?.entryRelationship?.[0]; expect(firstInstruction?.['@_typeCode']).toBe('COMP'); expect(firstInstruction?.substanceAdministration?.[0]?.templateId).toEqual([ { '@_root': OID_MEDICATION_FREE_TEXT_SIG }, ]); expect(firstInstruction?.substanceAdministration?.[0]?.code).toEqual({ '@_code': LOINC_MEDICATION_INSTRUCTIONS, '@_codeSystem': OID_LOINC_CODE_SYSTEM, '@_codeSystemName': 'LOINC', '@_displayName': 'Medication Instructions', }); expect((firstInstruction?.substanceAdministration?.[0]?.text as CcdaText).reference?.['@_value']).toBe( '#dosage-instruction-1' ); expect( firstInstruction?.substanceAdministration?.[0]?.consumable?.manufacturedProduct?.[0] ?.manufacturedLabeledDrug?.[0]?.['@_nullFlavor'] ).toBe('NA'); }); test('should handle medication without id', () => { const medicationRequest: MedicationRequest = { resourceType: 'MedicationRequest', status: 'active', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; expect(substanceAdmin?.id).toBeDefined(); expect(substanceAdmin?.id?.length).toBe(1); expect(substanceAdmin?.id?.[0]?.['@_root']).toBeDefined(); }); test('should handle various medication statuses', () => { const medicationRequest: MedicationRequest = { id: 'medication-request-1', resourceType: 'MedicationRequest', status: 'stopped', intent: 'order', subject: createReference(patient), medicationCodeableConcept: { coding: [ { system: 'http://www.nlm.nih.gov/research/umls/rxnorm', code: '197696', display: 'Aspirin 325 mg oral tablet', }, ], }, authoredOn: '2024-01-01T10:00:00Z', }; const result = createMedicationEntry(converter, medicationRequest); expect(result).toBeDefined(); const substanceAdmin = result.substanceAdministration?.[0]; // Status mapper should handle the mapping expect(substanceAdmin?.statusCode?.['@_code']).toBeDefined(); }); }); });