Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { createReference } from '@medplum/core'; import type { Bundle, Composition, Observation, Patient } from '@medplum/fhirtypes'; import { OID_ASSESSMENT_SCALE_OBSERVATION, OID_ASSESSMENT_SCALE_SUPPORTING_OBSERVATION, OID_BASIC_INDUSTRY_OBSERVATION, OID_BASIC_OCCUPATION_OBSERVATION, OID_BIRTH_SEX, OID_DISABILITY_STATUS_OBSERVATION, OID_FUNCTIONAL_STATUS_RESULT_OBSERVATION, OID_FUNCTIONAL_STATUS_RESULT_ORGANIZER, OID_PREGNANCY_OBSERVATION, OID_PROCEDURE_ACTIVITY_OBSERVATION, OID_RESULT_OBSERVATION, OID_SELF_CARE_ACTIVITIES_ADL_AND_IADL, OID_SEX_OBSERVATION, OID_SMOKING_STATUS_OBSERVATION, OID_TOBACCO_USE_OBSERVATION, OID_TRIBAL_AFFILIATION_OBSERVATION, OID_VITAL_SIGNS_OBSERVATION, OID_VITAL_SIGNS_ORGANIZER, } from '../../oids'; import { LOINC_ADMINISTRATIVE_SEX, LOINC_BIRTH_SEX, LOINC_DISABILITY_STATUS, LOINC_FUNCTIONAL_STATUS_ASSESSMENT_NOTE, LOINC_HISTORY_OF_OCCUPATION, LOINC_HISTORY_OF_OCCUPATION_INDUSTRY, LOINC_HISTORY_OF_TOBACCO_USE, LOINC_PREGNANCY_STATUS, LOINC_TOBACCO_SMOKING_STATUS, LOINC_TRIBAL_AFFILIATION, } from '../../systems'; import { FhirToCcdaConverter } from '../convert'; import { createCcdaObservation, createObservationEntry, createVitalSignsOrganizer, mapObservationTemplateId, mapObservationValue, mapOrganizerTemplateId, mapReferenceRange, mapReferenceRangeArray, } from './observation'; describe('observation 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('createObservationEntry', () => { test('should create direct observation entry', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, }; const result = createObservationEntry(converter, observation); expect(result).toBeDefined(); expect(result.observation).toBeDefined(); expect(result.observation?.length).toBe(1); expect(result.organizer).toBeUndefined(); }); test('should create organizer entry when observation has components', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '85354-9', display: 'Blood pressure panel', }, ], }, component: [ { code: { coding: [ { system: 'http://loinc.org', code: '8480-6', display: 'Systolic blood pressure', }, ], }, valueQuantity: { value: 120, unit: 'mmHg', }, }, { code: { coding: [ { system: 'http://loinc.org', code: '8462-4', display: 'Diastolic blood pressure', }, ], }, valueQuantity: { value: 80, unit: 'mmHg', }, }, ], }; const result = createObservationEntry(converter, observation); expect(result).toBeDefined(); expect(result.organizer).toBeDefined(); expect(result.organizer?.length).toBe(1); expect(result.observation).toBeUndefined(); }); test('should create organizer entry when observation has hasMember', () => { const childObs: Observation = { id: 'child-obs', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, }; bundle.entry?.push({ resource: childObs }); const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '85354-9', display: 'Vital signs panel', }, ], }, hasMember: [createReference(childObs)], }; const result = createObservationEntry(converter, observation); expect(result).toBeDefined(); expect(result.organizer).toBeDefined(); expect(result.organizer?.length).toBe(1); expect(result.observation).toBeUndefined(); }); }); describe('createVitalSignsOrganizer', () => { test('should create organizer with components', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '85354-9', display: 'Blood pressure panel', }, ], }, component: [ { code: { coding: [ { system: 'http://loinc.org', code: '8480-6', display: 'Systolic blood pressure', }, ], }, valueQuantity: { value: 120, unit: 'mmHg', }, }, ], effectiveDateTime: '2024-01-01T10:00:00Z', identifier: [{ value: 'obs-123' }], }; const result = createVitalSignsOrganizer(converter, observation); expect(result).toBeDefined(); expect(result['@_classCode']).toBe('CLUSTER'); expect(result['@_moodCode']).toBe('EVN'); expect(result.templateId).toBeDefined(); expect(result.id).toBeDefined(); expect(result.code).toBeDefined(); expect(result.statusCode?.['@_code']).toBe('completed'); expect(result.effectiveTime?.[0]?.['@_value']).toBe('20240101100000+0000'); expect(result.component).toBeDefined(); expect(result.component?.length).toBe(1); }); test('should create organizer with hasMember observations', () => { const childObs1: Observation = { id: 'child-obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, }; const childObs2: Observation = { id: 'child-obs-2', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '85354-9', display: 'Blood pressure panel', }, ], }, component: [ { code: { coding: [ { system: 'http://loinc.org', code: '8480-6', display: 'Systolic blood pressure', }, ], }, valueQuantity: { value: 120, unit: 'mmHg', }, }, ], }; bundle.entry?.push({ resource: childObs1 }, { resource: childObs2 }); const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: 'panel-code', display: 'Vital signs panel', }, ], }, hasMember: [createReference(childObs1), createReference(childObs2)], }; const result = createVitalSignsOrganizer(converter, observation); expect(result).toBeDefined(); expect(result.component).toBeDefined(); expect(result.component?.length).toBe(2); // One direct obs + one with component }); test('should skip invalid hasMember references', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: 'panel-code', display: 'Vital signs panel', }, ], }, hasMember: [ { reference: 'Observation/nonexistent' }, createReference(patient as unknown as Observation), // Wrong resource type ], }; const result = createVitalSignsOrganizer(converter, observation); expect(result).toBeDefined(); expect(result.component).toBeDefined(); expect(result.component?.length).toBe(0); }); }); describe('createCcdaObservation', () => { test('should create basic observation', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, effectiveDateTime: '2024-01-01T10:00:00Z', identifier: [{ value: 'obs-123' }], }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); expect(result['@_classCode']).toBe('OBS'); expect(result['@_moodCode']).toBe('EVN'); expect(result.templateId).toBeDefined(); expect(result.id).toBeDefined(); expect(result.code).toBeDefined(); expect(result.statusCode?.['@_code']).toBe('completed'); expect(result.effectiveTime).toBeDefined(); expect(result.value).toBeDefined(); }); test('should handle pregnancy status special case', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: LOINC_PREGNANCY_STATUS, display: 'Pregnancy status', }, ], }, valueCodeableConcept: { coding: [ { system: 'http://snomed.info/sct', code: '77386006', display: 'Pregnant', }, ], }, }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); expect(result.code?.['@_code']).toBe('ASSERTION'); expect(result.code?.['@_codeSystem']).toBe('2.16.840.1.113883.5.4'); }); test('should handle observation with hasMember', () => { const childObs: Observation = { id: 'child-obs', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, }; bundle.entry?.push({ resource: childObs }); const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: 'panel-code', display: 'Panel', }, ], }, hasMember: [createReference(childObs)], }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); expect(result.entryRelationship).toBeDefined(); expect(result.entryRelationship?.length).toBe(1); expect(result.entryRelationship?.[0]['@_typeCode']).toBe('COMP'); expect(result.entryRelationship?.[0].observation).toBeDefined(); }); test('should skip invalid hasMember references in createCcdaObservation', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: 'panel-code', display: 'Panel', }, ], }, hasMember: [ { reference: 'Observation/nonexistent' }, createReference(patient as unknown as Observation), // Wrong resource type ], }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); expect(result.entryRelationship).toBeDefined(); expect(result.entryRelationship?.length).toBe(0); }); test('should handle observation with component', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '85354-9', display: 'Blood pressure panel', }, ], }, }; const component = { code: { coding: [ { system: 'http://loinc.org', code: '8480-6', display: 'Systolic blood pressure', }, ], }, valueQuantity: { value: 120, unit: 'mmHg', }, extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#component-text', }, ], }; const result = createCcdaObservation(converter, observation, component); expect(result).toBeDefined(); expect(result.code?.['@_code']).toBe('8480-6'); expect(result.code?.['@_displayName']).toBe('Systolic blood pressure'); expect(result.value).toBeDefined(); expect(result.text?.reference?.['@_value']).toBe('#component-text'); }); test('should handle observation with reference range', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, referenceRange: [ { low: { value: 60, unit: 'bpm' }, high: { value: 100, unit: 'bpm' }, }, ], }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); expect(result.referenceRange).toBeDefined(); expect(result.referenceRange?.length).toBe(1); }); test('should handle observation with performer', () => { const observation: Observation = { id: 'obs-1', resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [ { system: 'http://loinc.org', code: '8867-4', display: 'Heart rate', }, ], }, valueQuantity: { value: 80, unit: 'bpm', }, performer: [{ display: 'Dr. Smith' }], effectiveDateTime: '2024-01-01T10:00:00Z', }; const result = createCcdaObservation(converter, observation); expect(result).toBeDefined(); // Note: mapAuthor returns undefined for display-only performers expect(result.author).toBeUndefined(); }); }); describe('mapOrganizerTemplateId', () => { test('should return functional status organizer template for d5 code', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', code: { coding: [{ code: 'd5' }], }, subject: createReference(patient), }; const result = mapOrganizerTemplateId(observation); expect(result).toEqual([ { '@_root': OID_FUNCTIONAL_STATUS_RESULT_ORGANIZER, '@_extension': '2014-06-09' }, { '@_root': OID_FUNCTIONAL_STATUS_RESULT_ORGANIZER }, ]); }); test('should return default vital signs organizer template', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', code: { coding: [{ code: 'other-code' }], }, subject: createReference(patient), }; const result = mapOrganizerTemplateId(observation); expect(result).toEqual([ { '@_root': OID_VITAL_SIGNS_ORGANIZER }, { '@_root': OID_VITAL_SIGNS_ORGANIZER, '@_extension': '2015-08-01' }, ]); }); }); describe('mapObservationTemplateId', () => { test('should map tobacco smoking status', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_TOBACCO_SMOKING_STATUS }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_SMOKING_STATUS_OBSERVATION }, { '@_root': OID_SMOKING_STATUS_OBSERVATION, '@_extension': '2014-06-09' }, ]); }); test('should map history of tobacco use', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_HISTORY_OF_TOBACCO_USE }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_TOBACCO_USE_OBSERVATION }, { '@_root': OID_TOBACCO_USE_OBSERVATION, '@_extension': '2014-06-09' }, ]); }); test('should map administrative sex', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_ADMINISTRATIVE_SEX }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_SEX_OBSERVATION, '@_extension': '2023-06-28' }]); }); test('should map birth sex', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_BIRTH_SEX }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_BIRTH_SEX }, { '@_root': OID_BIRTH_SEX, '@_extension': '2016-06-01' }]); }); test('should map disability status', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_DISABILITY_STATUS }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_DISABILITY_STATUS_OBSERVATION }, { '@_root': OID_DISABILITY_STATUS_OBSERVATION, '@_extension': '2023-05-01' }, ]); }); test('should map history of occupation', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_HISTORY_OF_OCCUPATION }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_BASIC_OCCUPATION_OBSERVATION, '@_extension': '2023-05-01' }]); }); test('should map history of occupation industry', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_HISTORY_OF_OCCUPATION_INDUSTRY }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_BASIC_INDUSTRY_OBSERVATION, '@_extension': '2023-05-01' }]); }); test('should map pregnancy status', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_PREGNANCY_STATUS }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_PREGNANCY_OBSERVATION }]); }); test('should map tribal affiliation', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: LOINC_TRIBAL_AFFILIATION }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_TRIBAL_AFFILIATION_OBSERVATION, '@_extension': '2023-05-01' }]); }); test('should map d5 functional status with component', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'd5' }], }, }; const component = { code: { coding: [{ code: LOINC_FUNCTIONAL_STATUS_ASSESSMENT_NOTE }], }, }; const result = mapObservationTemplateId(observation, component); expect(result).toEqual([{ '@_root': OID_SELF_CARE_ACTIVITIES_ADL_AND_IADL }]); }); test('should map d5 functional status without matching component', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'd5' }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_FUNCTIONAL_STATUS_RESULT_OBSERVATION, '@_extension': '2014-06-09' }, { '@_root': OID_FUNCTIONAL_STATUS_RESULT_OBSERVATION }, ]); }); test('should map exam category', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'some-exam-code' }], }, category: [ { coding: [{ code: 'exam' }], }, ], }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_PROCEDURE_ACTIVITY_OBSERVATION }, { '@_root': OID_PROCEDURE_ACTIVITY_OBSERVATION, '@_extension': '2014-06-09' }, ]); }); test('should map laboratory category', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'lab-code' }], }, category: [ { coding: [{ code: 'laboratory' }], }, ], }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_RESULT_OBSERVATION }, { '@_root': OID_RESULT_OBSERVATION, '@_extension': '2015-08-01' }, ]); }); test('should map survey category with hasMember', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'survey-code' }], }, category: [ { coding: [{ code: 'survey' }], }, ], hasMember: [{ reference: 'Observation/child' }], }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_ASSESSMENT_SCALE_OBSERVATION, '@_extension': '2022-06-01' }]); }); test('should map survey category without hasMember', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'survey-code' }], }, category: [ { coding: [{ code: 'survey' }], }, ], }; const result = mapObservationTemplateId(observation); expect(result).toEqual([{ '@_root': OID_ASSESSMENT_SCALE_SUPPORTING_OBSERVATION }]); }); test('should return default template', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'other-code' }], }, }; const result = mapObservationTemplateId(observation); expect(result).toEqual([ { '@_root': OID_VITAL_SIGNS_OBSERVATION }, { '@_root': OID_VITAL_SIGNS_OBSERVATION, '@_extension': '2014-06-09' }, ]); }); }); describe('mapObservationValue', () => { test('should map valueQuantity', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'test' }] }, valueQuantity: { value: 120, unit: 'mmHg', }, }; const result = mapObservationValue(observation); expect(result).toEqual({ '@_xsi:type': 'PQ', '@_unit': 'mmHg', '@_value': '120', }); }); test('should map valueCodeableConcept', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'test' }] }, valueCodeableConcept: { coding: [ { system: 'http://snomed.info/sct', code: '442102008', display: 'Smoker', }, ], }, }; const result = mapObservationValue(observation); expect(result).toBeDefined(); expect(result?.['@_xsi:type']).toBe('CD'); }); test('should map valueString', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'test' }] }, valueString: 'Test result', }; const result = mapObservationValue(observation); expect(result).toEqual({ '@_xsi:type': 'ST', '#text': 'Test result', }); }); test('should map valueInteger', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'test' }] }, valueInteger: 42, }; const result = mapObservationValue(observation); expect(result).toEqual({ '@_xsi:type': 'INT', '@_value': '42', }); }); test('should return undefined when no value', () => { const observation: Observation = { resourceType: 'Observation', status: 'final', subject: createReference(patient), code: { coding: [{ code: 'test' }] }, }; const result = mapObservationValue(observation); expect(result).toBeUndefined(); }); }); describe('mapReferenceRangeArray', () => { test('should map reference ranges', () => { const referenceRange = [ { low: { value: 60, unit: 'bpm' }, high: { value: 100, unit: 'bpm' }, }, { text: 'Normal range', }, ]; const result = mapReferenceRangeArray(referenceRange); expect(result).toBeDefined(); expect(result?.length).toBe(2); }); test('should return undefined for empty array', () => { const result = mapReferenceRangeArray([]); expect(result).toBeUndefined(); }); test('should return undefined for undefined input', () => { const result = mapReferenceRangeArray(undefined); expect(result).toBeUndefined(); }); }); describe('mapReferenceRange', () => { test('should return undefined for undefined input', () => { const result = mapReferenceRange(undefined); expect(result).toBeUndefined(); }); test('should handle reference range with narrative extension', () => { const referenceRange = { extension: [ { url: 'https://medplum.com/fhir/StructureDefinition/ccda-narrative-reference', valueString: '#ref-range-1', }, ], }; const result = mapReferenceRange(referenceRange); expect(result).toBeDefined(); expect(result?.observationRange?.text?.reference?.['@_value']).toBe('#ref-range-1'); }); test('should handle reference range without narrative extension', () => { const referenceRange = { low: { value: 60, unit: 'bpm' }, high: { value: 100, unit: 'bpm' }, extension: [ { url: 'https://example.com/other-extension', valueString: 'other', }, ], }; const result = mapReferenceRange(referenceRange); expect(result).toBeDefined(); // createTextFromExtensions returns undefined if no narrative reference extension expect(result?.observationRange?.text).toBeUndefined(); }); }); });