Medplum

// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors // SPDX-License-Identifier: Apache-2.0 import { getTypedPropertyValueWithoutSchema, isPopulated, toTypedValue } from '@medplum/core'; import type { Observation, ObservationComponent, ObservationReferenceRange } from '@medplum/fhirtypes'; import { mapFhirPeriodOrDateTimeToCcda, mapFhirToCcdaDateTime } from '../../datetime'; 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, mapCodeableConceptToCcdaCode, mapCodeableConceptToCcdaValue, } from '../../systems'; import type { CcdaCode, CcdaEntry, CcdaEntryRelationship, CcdaId, CcdaObservation, CcdaOrganizer, CcdaOrganizerComponent, CcdaReferenceRange, CcdaTemplateId, CcdaValue, } from '../../types'; import type { FhirToCcdaConverter } from '../convert'; import { createTextFromExtensions, getNarrativeReference, mapIdentifiers } from '../utils'; export function createObservationEntry(converter: FhirToCcdaConverter, observation: Observation): CcdaEntry { const obsValue = getTypedPropertyValueWithoutSchema(toTypedValue(observation), 'value'); if ((observation.component || observation.hasMember) && !isPopulated(obsValue)) { // Organizer return { organizer: [createVitalSignsOrganizer(converter, observation)], }; } else { // Direct observation return { observation: [createCcdaObservation(converter, observation)], }; } } export function createVitalSignsOrganizer(converter: FhirToCcdaConverter, observation: Observation): CcdaOrganizer { const components: CcdaOrganizerComponent[] = []; if (observation.component) { for (const component of observation.component) { components.push({ observation: [createCcdaObservation(converter, observation, component)], }); } } if (observation.hasMember) { for (const member of observation.hasMember) { const child = converter.findResourceByReference(member); if (child?.resourceType !== 'Observation') { continue; } if (child.component) { for (const component of child.component) { components.push({ observation: [createCcdaObservation(converter, child as Observation, component)], }); } } else { components.push({ observation: [createCcdaObservation(converter, child as Observation)], }); } } } const result: CcdaOrganizer = { '@_classCode': 'CLUSTER', '@_moodCode': 'EVN', templateId: mapOrganizerTemplateId(observation), id: mapIdentifiers(observation.id, observation.identifier) as CcdaId[], code: mapCodeableConceptToCcdaCode(observation.code) as CcdaCode, statusCode: { '@_code': 'completed' }, effectiveTime: [{ '@_value': mapFhirToCcdaDateTime(observation.effectiveDateTime) }], component: components, }; return result; } export function createCcdaObservation( converter: FhirToCcdaConverter, observation: Observation, component?: ObservationComponent ): CcdaObservation { let code: CcdaCode | undefined = mapCodeableConceptToCcdaCode(component?.code ?? observation.code); if (code?.['@_code'] === LOINC_PREGNANCY_STATUS) { // This is a ridiculous special case. // USCDI v3 requires that the pregnancy status observation use: code = { '@_code': 'ASSERTION', '@_codeSystem': '2.16.840.1.113883.5.4', }; } const entryRelationship: CcdaEntryRelationship[] = []; if (observation.hasMember) { for (const member of observation.hasMember) { const child = converter.findResourceByReference(member); if (child?.resourceType !== 'Observation') { continue; } entryRelationship.push({ '@_typeCode': 'COMP', observation: [createCcdaObservation(converter, child as Observation)], }); } } const result: CcdaObservation = { '@_classCode': 'OBS', '@_moodCode': 'EVN', templateId: mapObservationTemplateId(observation, component), id: mapIdentifiers(observation.id, observation.identifier) as CcdaId[], code, statusCode: { '@_code': 'completed' }, effectiveTime: [mapFhirPeriodOrDateTimeToCcda(observation.effectivePeriod, observation.effectiveDateTime)], value: mapObservationValue(component ?? observation), referenceRange: mapReferenceRangeArray(component?.referenceRange ?? observation.referenceRange), text: createTextFromExtensions(component?.extension ?? observation.extension), author: converter.mapAuthor(observation.performer?.[0], observation.effectiveDateTime), entryRelationship, }; return result; } export function mapOrganizerTemplateId(observation: Observation): CcdaTemplateId[] { if (observation.code?.coding?.[0]?.code === 'd5') { // ICF functional status organizer return [ { '@_root': OID_FUNCTIONAL_STATUS_RESULT_ORGANIZER, '@_extension': '2014-06-09' }, { '@_root': OID_FUNCTIONAL_STATUS_RESULT_ORGANIZER }, ]; } // Default to vital signs organizer return [ { '@_root': OID_VITAL_SIGNS_ORGANIZER }, { '@_root': OID_VITAL_SIGNS_ORGANIZER, '@_extension': '2015-08-01' }, ]; } export function mapObservationTemplateId(observation: Observation, component?: ObservationComponent): CcdaTemplateId[] { const code = observation.code?.coding?.[0]?.code; const category = observation.category?.[0]?.coding?.[0]?.code; if (code === LOINC_TOBACCO_SMOKING_STATUS) { return [ { '@_root': OID_SMOKING_STATUS_OBSERVATION }, { '@_root': OID_SMOKING_STATUS_OBSERVATION, '@_extension': '2014-06-09' }, ]; } if (code === LOINC_HISTORY_OF_TOBACCO_USE) { return [ { '@_root': OID_TOBACCO_USE_OBSERVATION }, { '@_root': OID_TOBACCO_USE_OBSERVATION, '@_extension': '2014-06-09' }, ]; } if (code === LOINC_ADMINISTRATIVE_SEX) { return [{ '@_root': OID_SEX_OBSERVATION, '@_extension': '2023-06-28' }]; } if (code === LOINC_BIRTH_SEX) { return [{ '@_root': OID_BIRTH_SEX }, { '@_root': OID_BIRTH_SEX, '@_extension': '2016-06-01' }]; } if (code === LOINC_DISABILITY_STATUS) { return [ { '@_root': OID_DISABILITY_STATUS_OBSERVATION }, { '@_root': OID_DISABILITY_STATUS_OBSERVATION, '@_extension': '2023-05-01' }, ]; } if (code === LOINC_HISTORY_OF_OCCUPATION) { return [{ '@_root': OID_BASIC_OCCUPATION_OBSERVATION, '@_extension': '2023-05-01' }]; } if (code === LOINC_HISTORY_OF_OCCUPATION_INDUSTRY) { return [{ '@_root': OID_BASIC_INDUSTRY_OBSERVATION, '@_extension': '2023-05-01' }]; } if (code === LOINC_PREGNANCY_STATUS) { return [{ '@_root': OID_PREGNANCY_OBSERVATION }]; } if (code === LOINC_TRIBAL_AFFILIATION) { return [{ '@_root': OID_TRIBAL_AFFILIATION_OBSERVATION, '@_extension': '2023-05-01' }]; } if (code === 'd5') { const componentCode = component?.code?.coding?.[0]?.code; if (componentCode === LOINC_FUNCTIONAL_STATUS_ASSESSMENT_NOTE) { return [{ '@_root': OID_SELF_CARE_ACTIVITIES_ADL_AND_IADL }]; } return [ { '@_root': OID_FUNCTIONAL_STATUS_RESULT_OBSERVATION, '@_extension': '2014-06-09' }, { '@_root': OID_FUNCTIONAL_STATUS_RESULT_OBSERVATION }, ]; } if (category === 'exam') { return [ { '@_root': OID_PROCEDURE_ACTIVITY_OBSERVATION }, { '@_root': OID_PROCEDURE_ACTIVITY_OBSERVATION, '@_extension': '2014-06-09' }, ]; } if (category === 'laboratory') { return [{ '@_root': OID_RESULT_OBSERVATION }, { '@_root': OID_RESULT_OBSERVATION, '@_extension': '2015-08-01' }]; } if (category === 'survey') { if (observation.hasMember) { return [{ '@_root': OID_ASSESSMENT_SCALE_OBSERVATION, '@_extension': '2022-06-01' }]; } return [{ '@_root': OID_ASSESSMENT_SCALE_SUPPORTING_OBSERVATION }]; } // Otherwise, fall back to the default template ID. return [ { '@_root': OID_VITAL_SIGNS_OBSERVATION }, { '@_root': OID_VITAL_SIGNS_OBSERVATION, '@_extension': '2014-06-09' }, ]; } export function mapObservationValue(observation: Observation | ObservationComponent): CcdaValue | undefined { if (observation.valueQuantity) { return { '@_xsi:type': 'PQ', '@_unit': observation.valueQuantity.unit, '@_value': observation.valueQuantity.value?.toString(), }; } if (observation.valueCodeableConcept) { return mapCodeableConceptToCcdaValue(observation.valueCodeableConcept); } if (observation.valueString !== undefined) { return { '@_xsi:type': 'ST', '#text': observation.valueString }; } if (observation.valueInteger !== undefined) { return { '@_xsi:type': 'INT', '@_value': observation.valueInteger.toString() }; } return undefined; } export function mapReferenceRangeArray( referenceRange: ObservationReferenceRange[] | undefined ): CcdaReferenceRange[] | undefined { if (!referenceRange || referenceRange.length === 0) { return undefined; } return referenceRange.map((range) => mapReferenceRange(range)).filter(Boolean) as CcdaReferenceRange[]; } export function mapReferenceRange( referenceRange: ObservationReferenceRange | undefined ): CcdaReferenceRange | undefined { if (!referenceRange) { return undefined; } const narrativeReference = getNarrativeReference(referenceRange.extension); if (narrativeReference) { // Special case for reference ranges that are a narrative reference return { observationRange: { text: { reference: narrativeReference }, value: { '@_xsi:type': 'ED', reference: narrativeReference }, }, }; } return { observationRange: { text: createTextFromExtensions(referenceRange.extension), }, }; }