Medplum
Officialby medplum
g9.test.ts•44 kB
// SPDX-FileCopyrightText: Copyright Orangebot, Inc. and Medplum contributors
// SPDX-License-Identifier: Apache-2.0
import type { WithId } from '@medplum/core';
import { createReference, generateId, LOINC, RXNORM, SNOMED, UCUM } from '@medplum/core';
import type { AllergyIntolerance, Bundle, Composition, MedicationRequest, Patient, Resource } from '@medplum/fhirtypes';
import { convertFhirToCcda } from './fhir-to-ccda/convert';
import {
OID_ADMINISTRATIVE_GENDER_CODE_SYSTEM,
OID_BIRTH_SEX,
OID_CDC_RACE_AND_ETHNICITY_CODE_SYSTEM,
OID_SEX_OBSERVATION,
OID_SMOKING_STATUS_OBSERVATION,
OID_TOBACCO_USE_OBSERVATION,
} from './oids';
import {
ADMINISTRATIVE_GENDER_CODE_SYSTEM,
ALLERGY_CLINICAL_CODE_SYSTEM,
CLINICAL_CONDITION_CODE_SYSTEM,
LANGUAGE_MODE_CODE_SYSTEM,
LANGUAGE_MODE_URL,
LANGUAGE_PROFICIENCY_CODE_SYSTEM,
LANGUAGE_PROFICIENCY_URL,
LOINC_ADMINISTRATIVE_SEX,
LOINC_ALLERGIES_SECTION,
LOINC_ASSESSMENTS_SECTION,
LOINC_BIRTH_SEX,
LOINC_DEVICES_SECTION,
LOINC_ENCOUNTERS_SECTION,
LOINC_GOALS_SECTION,
LOINC_HEALTH_CONCERNS_SECTION,
LOINC_HISTORY_OF_TOBACCO_USE,
LOINC_IMMUNIZATIONS_SECTION,
LOINC_MEDICATIONS_SECTION,
LOINC_NOTES_SECTION,
LOINC_PLAN_OF_TREATMENT_SECTION,
LOINC_PROBLEMS_SECTION,
LOINC_PROCEDURES_SECTION,
LOINC_REASON_FOR_REFERRAL_SECTION,
LOINC_REFERRAL_NOTE,
LOINC_RESULTS_SECTION,
LOINC_SOCIAL_HISTORY_SECTION,
LOINC_TOBACCO_SMOKING_STATUS,
LOINC_VITAL_SIGNS_SECTION,
RACE_CODE_SYSTEM,
US_CORE_ETHNICITY_URL,
US_CORE_RACE_URL,
} from './systems';
import type { CcdaCode, CcdaNarrative, CcdaQuantity, CcdaText } from './types';
describe('170.315(g)(9)', () => {
describe('Patient Demographics', () => {
test('should export first name', () => {
const input = createCompositionBundle({ resourceType: 'Patient', name: [{ given: ['John'] }] });
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.given?.[0]).toEqual('John');
});
// Last Name
test('should export last name', () => {
const input = createCompositionBundle({ resourceType: 'Patient', name: [{ family: 'Doe' }] });
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.family).toEqual('Doe');
});
// Previous Name (if applicable)
test('should export previous name', () => {
const input = createCompositionBundle({
resourceType: 'Patient',
name: [
{ use: 'official', family: 'Johnson', given: ['Sarah'] },
{ use: 'maiden', family: 'Smith', given: ['Sarah'], period: { end: '2018-06-15' } },
],
});
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.['@_use']).toEqual('L');
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.given?.[0]).toEqual('Sarah');
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.family).toEqual('Johnson');
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[1]?.['@_use']).toEqual('L');
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[1]?.given?.[0]).toEqual('Sarah');
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[1]?.family).toEqual('Smith');
});
// Middle Name
test('should export middle name', () => {
const input = createCompositionBundle({ resourceType: 'Patient', name: [{ given: ['John', 'Doe'] }] });
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.given?.[1]).toEqual('Doe');
});
// Suffix
test('should export suffix', () => {
const input = createCompositionBundle({
resourceType: 'Patient',
name: [{ given: ['John'], suffix: ['Jr.'] }],
});
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.name?.[0]?.suffix?.[0]).toEqual('Jr.');
});
// Birth Sex
test('should export birth sex', () => {
const input = createCompositionBundle({ resourceType: 'Patient', gender: 'male' });
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.administrativeGenderCode?.['@_code']).toEqual('M');
});
// Date of Birth
test('should export date of birth', () => {
const input = createCompositionBundle({ resourceType: 'Patient', birthDate: '1990-01-01' });
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.patient?.birthTime?.['@_value']).toEqual('19900101');
});
// Race and Ethnicity
test('should export race and ethnicity', () => {
const patient: Patient = {
resourceType: 'Patient',
extension: [
{
url: US_CORE_RACE_URL,
extension: [
{
url: 'ombCategory',
valueCoding: {
system: RACE_CODE_SYSTEM,
code: '2106-3',
display: 'White',
},
},
{
url: 'detailed',
valueCoding: {
system: RACE_CODE_SYSTEM,
code: '2108-9',
display: 'White European',
},
},
],
},
{
url: US_CORE_ETHNICITY_URL,
extension: [
{
url: 'ombCategory',
valueCoding: {
system: RACE_CODE_SYSTEM,
code: '2186-5',
display: 'Not Hispanic or Latino',
},
},
],
},
],
};
const input = createCompositionBundle(patient);
const output = convertFhirToCcda(input);
// Test race code
expect(output.recordTarget?.[0]?.patientRole?.patient?.raceCode?.[0]?.['@_code']).toEqual('2106-3');
expect(output.recordTarget?.[0]?.patientRole?.patient?.raceCode?.[0]?.['@_displayName']).toEqual('White');
expect(output.recordTarget?.[0]?.patientRole?.patient?.raceCode?.[0]?.['@_codeSystem']).toEqual(
OID_CDC_RACE_AND_ETHNICITY_CODE_SYSTEM
);
expect(output.recordTarget?.[0]?.patientRole?.patient?.raceCode?.[0]?.['@_codeSystemName']).toEqual(
'CDC Race and Ethnicity'
);
// Test detailed race code
const detailed = output.recordTarget?.[0]?.patientRole?.patient?.['sdtc:raceCode']?.[0];
expect(detailed?.['@_code']).toEqual('2108-9');
expect(detailed?.['@_displayName']).toEqual('White European');
expect(detailed?.['@_codeSystem']).toEqual(OID_CDC_RACE_AND_ETHNICITY_CODE_SYSTEM);
expect(detailed?.['@_codeSystemName']).toEqual('CDC Race and Ethnicity');
// Test ethnicity code
expect(output.recordTarget?.[0]?.patientRole?.patient?.ethnicGroupCode?.[0]?.['@_code']).toEqual('2186-5');
expect(output.recordTarget?.[0]?.patientRole?.patient?.ethnicGroupCode?.[0]?.['@_displayName']).toEqual(
'Not Hispanic or Latino'
);
expect(output.recordTarget?.[0]?.patientRole?.patient?.ethnicGroupCode?.[0]?.['@_codeSystem']).toEqual(
OID_CDC_RACE_AND_ETHNICITY_CODE_SYSTEM
);
expect(output.recordTarget?.[0]?.patientRole?.patient?.ethnicGroupCode?.[0]?.['@_codeSystemName']).toEqual(
'CDC Race and Ethnicity'
);
});
// Preferred Language
test('should export preferred language', () => {
const patient: Patient = {
resourceType: 'Patient',
communication: [
{
language: {
coding: [
{
system: 'urn:ietf:bcp:47',
code: 'en-US',
},
],
},
preferred: true,
extension: [
{
url: LANGUAGE_MODE_URL,
valueCodeableConcept: {
coding: [
{
system: LANGUAGE_MODE_CODE_SYSTEM,
code: 'ESP',
display: 'Expressed spoken',
},
],
},
},
{
url: LANGUAGE_PROFICIENCY_URL,
valueCodeableConcept: {
coding: [
{
system: LANGUAGE_PROFICIENCY_CODE_SYSTEM,
code: 'E',
display: 'Excellent',
},
],
},
},
],
},
],
};
const input = createCompositionBundle(patient);
const output = convertFhirToCcda(input);
expect(
output.recordTarget?.[0]?.patientRole?.patient?.languageCommunication?.[0]?.languageCode?.['@_code']
).toEqual('en-US');
});
// Current Address
test('should export current address', () => {
const input = createCompositionBundle({
resourceType: 'Patient',
address: [{ use: 'home', line: ['123 Main St'], city: 'Anytown', state: 'CA', postalCode: '12345' }],
});
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.addr?.[0]?.['@_use']).toEqual('HP');
expect(output.recordTarget?.[0]?.patientRole?.addr?.[0]?.streetAddressLine?.[0]).toEqual('123 Main St');
expect(output.recordTarget?.[0]?.patientRole?.addr?.[0]?.city).toEqual('Anytown');
expect(output.recordTarget?.[0]?.patientRole?.addr?.[0]?.state).toEqual('CA');
expect(output.recordTarget?.[0]?.patientRole?.addr?.[0]?.postalCode).toEqual('12345');
});
// Phone Number
test('should export phone number', () => {
const input = createCompositionBundle({
resourceType: 'Patient',
telecom: [{ system: 'phone', value: '123-456-7890' }],
});
const output = convertFhirToCcda(input);
expect(output.recordTarget?.[0]?.patientRole?.telecom?.[0]?.['@_value']).toEqual('tel:123-456-7890');
});
});
describe('Allergies', () => {
// Must include reactions and severity
test('should export reactions and severity', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_ALLERGIES_SECTION, {
resourceType: 'AllergyIntolerance',
reaction: [{ manifestation: [{ coding: [{ code: '123' }] }] }],
});
const output = convertFhirToCcda(input);
const observation =
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.entryRelationship?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect((observation?.value as CcdaCode)?.['@_code']).toEqual('123');
});
// Include timing information and concern status Reference: Section III.A in test data samples [2]
test('should export timing information and concern status', () => {
const allergy: Partial<AllergyIntolerance> = {
resourceType: 'AllergyIntolerance',
clinicalStatus: {
coding: [
{
system: ALLERGY_CLINICAL_CODE_SYSTEM,
code: 'active',
},
],
},
category: ['medication'],
recordedDate: '2024-01-01',
onsetDateTime: '2023-12-25',
reaction: [
{
manifestation: [
{
coding: [{ code: '123' }],
},
],
},
],
};
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_ALLERGIES_SECTION, allergy);
const output = convertFhirToCcda(input);
// Check that category="medication" converts to the correct code
expect(
(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.value as CcdaCode
)?.['@_code']
).toEqual('419511003');
// Check act timing (when recorded)
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.effectiveTime?.[0]?.low?.[
'@_value'
]
).toEqual('20240101');
// Check observation timing (when started)
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.effectiveTime?.[0]?.low?.['@_value']
).toEqual('20231225');
// Check status
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.statusCode?.['@_code']
).toEqual('active');
});
test('should handle no known allergies', () => {
const allergy: Partial<AllergyIntolerance> = {
resourceType: 'AllergyIntolerance',
clinicalStatus: {
coding: [
{
system: ALLERGY_CLINICAL_CODE_SYSTEM,
code: 'active',
},
],
},
code: {
coding: [
{
system: SNOMED,
code: '716186003',
display: 'No Known Allergy (situation)',
},
],
text: 'NKA',
},
recordedDate: '2024-01-01',
onsetDateTime: '2023-12-25',
};
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_ALLERGIES_SECTION, allergy);
const output = convertFhirToCcda(input);
// Check that empty category converts to the default code
expect(
(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.value as CcdaCode
)?.['@_code']
).toEqual('419199007');
// Look for the special NKA code
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.participant?.[0]?.participantRole?.playingEntity?.code?.['@_nullFlavor']
).toEqual('NA');
});
});
// Medications
describe('Medications', () => {
test('should export timing information and dosage', () => {
const medication: Partial<MedicationRequest> = {
resourceType: 'MedicationRequest',
status: 'active',
medicationCodeableConcept: {
coding: [
{
system: RXNORM,
code: '1049221',
display: 'Insulin Glargine 100 UNT/ML Injectable Solution',
},
],
},
dispenseRequest: {
validityPeriod: {
start: '2024-01-01',
},
},
dosageInstruction: [
{
timing: {
repeat: {
when: ['HS'], // At bedtime
},
},
doseAndRate: [
{
doseQuantity: {
system: UCUM,
value: 40,
unit: '[IU]',
code: '[IU]',
},
},
],
route: {
coding: [
{
system: SNOMED,
code: '34206005',
display: 'Subcutaneous route',
},
],
},
},
],
};
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_MEDICATIONS_SECTION, medication);
const output = convertFhirToCcda(input);
// Check timing
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.effectiveTime?.[0]?.low?.['@_value']
).toEqual('20240101');
// Check dose quantity
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.doseQuantity?.['@_value']
).toEqual('40');
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.doseQuantity?.['@_unit']
).toEqual('[IU]');
// Check route
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.routeCode?.['@_code']
).toEqual('34206005');
});
});
describe('Problems', () => {
test('should export problems', () => {
// Include timing information
// - Include concern status Reference: Section III.C in test data samples [2]
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_PROBLEMS_SECTION, {
resourceType: 'Condition',
clinicalStatus: {
coding: [
{
system: CLINICAL_CONDITION_CODE_SYSTEM,
code: 'active',
},
],
},
recordedDate: '2024-01-01',
onsetDateTime: '2023-12-25',
code: {
coding: [
{
system: SNOMED,
code: '385093006',
display: 'Community acquired pneumonia',
},
],
},
});
const output = convertFhirToCcda(input);
// Check act timing (when recorded)
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.effectiveTime?.[0]?.low?.[
'@_value'
]
).toEqual('20240101');
// Check observation timing (when started)
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.entryRelationship?.[0]
?.observation?.[0]?.effectiveTime?.[0]?.low?.['@_value']
).toEqual('20231225');
// Check status
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.act?.[0]?.statusCode?.['@_code']
).toEqual('active');
});
});
describe('Immunizations', () => {
test('should export immunizations', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_IMMUNIZATIONS_SECTION, {
resourceType: 'Immunization',
});
const output = convertFhirToCcda(input);
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration
).toBeDefined();
});
test('should include status and dates', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_IMMUNIZATIONS_SECTION, {
resourceType: 'Immunization',
status: 'completed',
occurrenceDateTime: '2010-08-15',
});
const output = convertFhirToCcda(input);
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.statusCode?.['@_code']
).toEqual('completed');
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.effectiveTime?.[0]?.['@_value']
).toEqual('20100815');
});
test('should include lot number and manufacturer', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_IMMUNIZATIONS_SECTION, {
resourceType: 'Immunization',
lotNumber: '1',
manufacturer: { display: 'Manufacturer' },
});
const output = convertFhirToCcda(input);
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.consumable?.manufacturedProduct?.[0]?.manufacturedMaterial?.[0]?.lotNumberText?.[0]
).toEqual('1');
expect(
output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.substanceAdministration?.[0]
?.consumable?.manufacturedProduct?.[0]?.manufacturerOrganization?.[0]?.name?.[0]
).toEqual('Manufacturer');
});
});
describe('Vital Signs', () => {
test('should export vital signs', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_VITAL_SIGNS_SECTION, {
resourceType: 'Observation',
});
const output = convertFhirToCcda(input);
expect(output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation).toBeDefined();
});
test('should include values and units', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_VITAL_SIGNS_SECTION, {
resourceType: 'Observation',
valueQuantity: { value: 100, unit: 'mg' },
});
const output = convertFhirToCcda(input);
const observation = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
const value = observation?.value as CcdaQuantity;
expect(value?.['@_value']).toEqual('100');
expect(value?.['@_unit']).toEqual('mg');
});
test('should handle observation components', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_VITAL_SIGNS_SECTION,
{
resourceType: 'Observation',
id: '123',
component: [
{ code: { coding: [{ code: 'a' }] }, valueQuantity: { value: 100, unit: 'mg' } },
{ code: { coding: [{ code: 'b' }] }, valueQuantity: { value: 200, unit: 'mg' } },
],
},
{
resourceType: 'Observation',
id: '456',
hasMember: [{ reference: 'Observation/123' }],
}
);
const output = convertFhirToCcda(input);
const organizer = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[1]?.organizer?.[0];
expect(organizer).toBeDefined();
const components = organizer?.component;
expect(components).toBeDefined();
expect((components?.[0]?.observation?.[0]?.value as CcdaQuantity)['@_value']).toEqual('100');
expect((components?.[1]?.observation?.[0]?.value as CcdaQuantity)['@_value']).toEqual('200');
});
});
describe('Social History', () => {
test('should handle tobacco smoking status', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_SOCIAL_HISTORY_SECTION, {
resourceType: 'Observation',
status: 'final',
code: { coding: [{ system: LOINC, code: LOINC_TOBACCO_SMOKING_STATUS }] },
valueCodeableConcept: { coding: [{ system: SNOMED, code: '449868002' }] },
});
const output = convertFhirToCcda(input);
const observation = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect(observation?.templateId?.[0]?.['@_root']).toEqual(OID_SMOKING_STATUS_OBSERVATION);
expect((observation?.value as CcdaCode)?.['@_code']).toEqual('449868002');
});
test('should handle history of tobacco use', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_SOCIAL_HISTORY_SECTION, {
resourceType: 'Observation',
status: 'final',
code: { coding: [{ system: LOINC, code: LOINC_HISTORY_OF_TOBACCO_USE }] },
valueCodeableConcept: { coding: [{ system: SNOMED, code: '449868002' }] },
});
const output = convertFhirToCcda(input);
const observation = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect(observation?.templateId?.[0]?.['@_root']).toEqual(OID_TOBACCO_USE_OBSERVATION);
expect((observation?.value as CcdaCode)?.['@_code']).toEqual('449868002');
});
test('should handle administrative gender', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_SOCIAL_HISTORY_SECTION, {
resourceType: 'Observation',
status: 'final',
code: { coding: [{ system: LOINC, code: LOINC_ADMINISTRATIVE_SEX }] },
valueCodeableConcept: { coding: [{ system: SNOMED, code: '248152002' }] },
});
const output = convertFhirToCcda(input);
const observation = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect(observation?.templateId?.[0]?.['@_root']).toEqual(OID_SEX_OBSERVATION);
expect((observation?.value as CcdaCode)?.['@_code']).toEqual('248152002');
});
test('should handle birth sex', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_SOCIAL_HISTORY_SECTION, {
resourceType: 'Observation',
status: 'final',
code: { coding: [{ system: LOINC, code: LOINC_BIRTH_SEX }] },
valueCodeableConcept: { coding: [{ system: ADMINISTRATIVE_GENDER_CODE_SYSTEM, code: 'F' }] },
});
const output = convertFhirToCcda(input);
const observation = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect(observation?.templateId?.[0]?.['@_root']).toEqual(OID_BIRTH_SEX);
expect((observation?.value as CcdaCode)?.['@_code']).toEqual('F');
expect((observation?.value as CcdaCode)?.['@_codeSystem']).toEqual(OID_ADMINISTRATIVE_GENDER_CODE_SYSTEM);
});
});
describe('Procedures', () => {
test('should handle missing location', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_PROCEDURES_SECTION, {
resourceType: 'Procedure',
id: '456',
location: { reference: 'Location/123' },
});
const output = convertFhirToCcda(input);
const procedure = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.procedure?.[0];
expect(procedure).toBeDefined();
});
test('should handle empty location', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_PROCEDURES_SECTION,
{
resourceType: 'Location',
id: '123',
},
{
resourceType: 'Procedure',
id: '456',
location: { reference: 'Location/123' },
}
);
const output = convertFhirToCcda(input);
const procedure = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.procedure?.[0];
expect(procedure).toBeDefined();
const participant = procedure?.participant?.[0];
expect(participant).toBeDefined();
});
test('should create location participant', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_PROCEDURES_SECTION,
{
resourceType: 'Location',
id: '123',
name: 'Test Location',
address: { line: ['123 Main St'], city: 'Anytown', state: 'CA', postalCode: '12345' },
telecom: [{ system: 'phone', value: '123-456-7890' }],
},
{
resourceType: 'Procedure',
id: '456',
location: { reference: 'Location/123' },
}
);
const output = convertFhirToCcda(input);
const procedure = output.component?.structuredBody?.component?.[0]?.section?.[0]?.entry?.[0]?.procedure?.[0];
expect(procedure).toBeDefined();
const participant = procedure?.participant?.[0];
expect(participant).toBeDefined();
expect(participant?.participantRole?.addr?.[0]?.streetAddressLine?.[0]).toEqual('123 Main St');
expect(participant?.participantRole?.addr?.[0]?.city).toEqual('Anytown');
expect(participant?.participantRole?.addr?.[0]?.state).toEqual('CA');
expect(participant?.participantRole?.addr?.[0]?.postalCode).toEqual('12345');
expect(participant?.participantRole?.telecom?.[0]?.['@_value']).toEqual('tel:123-456-7890');
expect(participant?.participantRole?.playingEntity?.name?.[0]).toEqual('Test Location');
});
});
describe('Labs', () => {
test('should handle orders', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_PLAN_OF_TREATMENT_SECTION, {
resourceType: 'ServiceRequest',
status: 'active',
intent: 'order',
code: {
coding: [
{
system: 'http://loinc.org',
code: '24357-6',
display: 'Urinanalysis macro (dipstick) panel',
},
],
},
occurrenceDateTime: '2015-06-29T07:00:00.000Z',
authoredOn: '2025-02-27T01:32:00.000Z',
});
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_PLAN_OF_TREATMENT_SECTION);
const observation = section?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect(observation?.code?.['@_code']).toEqual('24357-6');
expect(observation?.effectiveTime?.[0]?.['@_value']).toMatch('20150629');
});
test('should handle reports', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_RESULTS_SECTION,
{
resourceType: 'Observation',
id: '123',
status: 'final',
code: {
coding: [
{
system: 'http://loinc.org',
code: '5778-6',
display: 'Color of Urine',
},
],
},
effectiveDateTime: '2015-06-22T07:00:00.000Z',
valueString: 'YELLOW',
},
{
resourceType: 'DiagnosticReport',
status: 'final',
code: {
coding: [
{
system: 'http://loinc.org',
code: '24357-6',
display: 'Urinanalysis macro (dipstick) panel',
},
],
},
effectiveDateTime: '2015-06-22T07:00:00.000Z',
issued: '2015-06-22T07:00:00.000Z',
result: [{ reference: 'Observation/123' }],
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_RESULTS_SECTION);
const organizer = section?.entry?.[1]?.organizer?.[0];
expect(organizer).toBeDefined();
const components = organizer?.component;
expect(components).toBeDefined();
expect((components?.[0]?.observation?.[0]?.value as CcdaText)['#text']).toEqual('YELLOW');
});
});
describe('Devices', () => {
test('should handle device not found', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_DEVICES_SECTION, {
resourceType: 'DeviceUseStatement',
status: 'active',
device: { reference: 'Device/123' },
});
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_DEVICES_SECTION);
expect(section?.entry).toHaveLength(0);
});
test('should handle device use statements', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_DEVICES_SECTION,
{
resourceType: 'Device',
id: '123',
udiCarrier: [
{
deviceIdentifier: '00643169007222',
issuer: 'FDA',
carrierHRF: '(01)00643169007222(17)160128(21)BLC200461H',
},
],
status: 'active',
type: {
coding: [
{
system: 'http://snomed.info/sct',
code: '704708004',
display: 'Cardiac resynchronization therapy implantable pacemaker',
},
],
},
},
{
resourceType: 'DeviceUseStatement',
status: 'active',
device: { reference: 'Device/123' },
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_DEVICES_SECTION);
const procedure = section?.entry?.[0]?.procedure?.[0];
expect(procedure).toBeDefined();
expect(procedure?.code?.['@_code']).toEqual('360030002');
expect(procedure?.participant?.length).toEqual(1);
expect(procedure?.participant?.[0]?.['@_typeCode']).toEqual('DEV');
const device = procedure?.participant?.[0]?.participantRole;
expect(device).toBeDefined();
expect(device?.playingDevice?.code?.['@_code']).toEqual('704708004');
});
});
describe('Assessments', () => {
test('should handle clinical impression', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_ASSESSMENTS_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'ClinicalImpression',
status: 'completed',
subject: {
reference: 'Patient/01953565-5b00-72a8-ac87-3c4b3de1ba88',
display: 'Alice Jones Newman',
},
date: '2015-06-22T07:00:00.000Z',
assessor: {
reference: 'Practitioner/davis',
display: 'Dr Albert Davis',
},
summary: 'Lorem ipsum',
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_ASSESSMENTS_SECTION);
expect(section?.text).toEqual('Lorem ipsum');
});
});
describe('Goals', () => {
test('should handle goal', () => {
const input = createCompositionBundle({ resourceType: 'Patient', id: '123' }, LOINC_GOALS_SECTION, {
resourceType: 'Goal',
lifecycleStatus: 'active',
startDate: '2015-06-23',
description: {
text: 'Lorem ipsum',
},
subject: {
reference: 'Patient/123',
display: 'Alice Jones Newman',
},
});
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_GOALS_SECTION);
const observation = section?.entry?.[0]?.observation?.[0];
expect(observation).toBeDefined();
expect((observation?.value as CcdaNarrative)['#text']).toEqual('Lorem ipsum');
});
});
describe('Health Concerns', () => {
test('should handle clinical impression', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_HEALTH_CONCERNS_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'ClinicalImpression',
status: 'completed',
subject: {
reference: 'Patient/01953565-5b00-72a8-ac87-3c4b3de1ba88',
display: 'Alice Jones Newman',
},
date: '2015-06-22T07:00:00.000Z',
assessor: {
reference: 'Practitioner/davis',
display: 'Dr Albert Davis',
},
summary: 'Lorem ipsum',
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_HEALTH_CONCERNS_SECTION);
const act = section?.entry?.[0]?.act?.[0];
expect((act?.text as CcdaNarrative)['#text']).toEqual('Lorem ipsum');
});
});
describe('Notes', () => {
test('should handle clinical impression', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_NOTES_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'ClinicalImpression',
status: 'completed',
subject: {
reference: 'Patient/01953565-5b00-72a8-ac87-3c4b3de1ba88',
display: 'Alice Jones Newman',
},
date: '2015-06-22T07:00:00.000Z',
assessor: {
reference: 'Practitioner/davis',
display: 'Dr Albert Davis',
},
summary: 'Lorem ipsum',
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_NOTES_SECTION);
const act = section?.entry?.[0]?.act?.[0];
expect((act?.text as CcdaNarrative)['#text']).toEqual('Lorem ipsum');
});
});
test('should handle practitioner role', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient' },
LOINC_NOTES_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'Organization',
id: 'hospital',
name: 'Hospital',
},
{
resourceType: 'PractitionerRole',
id: 'role',
practitioner: { reference: 'Practitioner/davis' },
organization: { reference: 'Organization/hospital' },
},
{
resourceType: 'ClinicalImpression',
status: 'completed',
subject: {
reference: 'Patient/01953565-5b00-72a8-ac87-3c4b3de1ba88',
display: 'Alice Jones Newman',
},
date: '2015-06-22T07:00:00.000Z',
assessor: {
reference: 'PractitionerRole/role',
},
summary: 'Lorem ipsum',
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_NOTES_SECTION);
const act = section?.entry?.[0]?.act?.[0];
expect((act?.text as CcdaNarrative)['#text']).toEqual('Lorem ipsum');
const author = act?.author?.[0];
expect(author).toBeDefined();
expect(author?.assignedAuthor?.assignedPerson?.name?.[0]?.family).toEqual('Davis');
expect(author?.assignedAuthor?.representedOrganization?.name?.[0]).toEqual('Hospital');
});
test('should handle missing author', () => {
const input = createCompositionBundle({ resourceType: 'Patient' }, LOINC_NOTES_SECTION, {
resourceType: 'ClinicalImpression',
status: 'completed',
subject: {
reference: 'Patient/01953565-5b00-72a8-ac87-3c4b3de1ba88',
display: 'Alice Jones Newman',
},
date: '2015-06-22T07:00:00.000Z',
assessor: {
reference: 'PractitionerRole/role',
},
summary: 'Lorem ipsum',
});
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_NOTES_SECTION);
const act = section?.entry?.[0]?.act?.[0];
expect((act?.text as CcdaNarrative)['#text']).toEqual('Lorem ipsum');
const author = act?.author?.[0];
expect(author).toBeUndefined();
});
});
describe('Encounters', () => {
test('should handle diagnosis code', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient', id: '123' },
LOINC_ENCOUNTERS_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'Condition',
id: 'diagnosis',
clinicalStatus: { coding: [{ code: 'active' }] },
category: [{ coding: [{ code: 'encounter-diagnosis' }] }],
code: { coding: [{ code: '386661006' }] },
onsetDateTime: '2011-10-05T07:00:00.000Z',
recordedDate: '2025-02-24T20:51:00.000Z',
recorder: { reference: 'Practitioner/davis' },
},
{
resourceType: 'Encounter',
status: 'finished',
diagnosis: [{ condition: { reference: 'Condition/diagnosis' } }],
period: { start: '2015-06-22T20:00:00.000Z', end: '2015-06-22T21:00:00.000Z' },
}
);
const output = convertFhirToCcda(input);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.code?.['@_code']).toEqual(LOINC_ENCOUNTERS_SECTION);
const encounter = section?.entry?.[0]?.encounter?.[0];
expect(encounter).toBeDefined();
const observation = encounter?.entryRelationship?.[0]?.act?.[0]?.entryRelationship?.[0]?.observation;
expect(observation).toBeDefined();
expect(observation?.[0]?.code?.['@_code']).toEqual('282291009'); // Diagnostic interpretation
expect((observation?.[0]?.value as CcdaCode)['@_code']).toEqual('386661006');
});
});
describe('Reason for Referral', () => {
test('should handle referral service request', () => {
const input = createCompositionBundle(
{ resourceType: 'Patient', id: '123' },
LOINC_REASON_FOR_REFERRAL_SECTION,
{
resourceType: 'Practitioner',
id: 'davis',
name: [{ family: 'Davis', given: ['Albert'] }],
},
{
resourceType: 'ServiceRequest',
id: 'referral',
status: 'active',
intent: 'order',
code: { coding: [{ code: '123' }] },
authoredOn: '2025-02-24T20:51:00.000Z',
requester: { reference: 'Practitioner/davis' },
performer: [{ reference: 'Practitioner/davis' }],
note: [{ text: 'Lorem ipsum' }],
}
);
const output = convertFhirToCcda(input, { type: 'referral' });
expect(output).toBeDefined();
expect(output.code?.['@_code']).toEqual(LOINC_REFERRAL_NOTE);
const section = output.component?.structuredBody?.component?.[0]?.section?.[0];
expect(section).toBeDefined();
expect(section?.text).toEqual('Lorem ipsum');
expect(section?.code?.['@_code']).toEqual(LOINC_REASON_FOR_REFERRAL_SECTION);
const act = section?.entry?.[0]?.act?.[0];
expect(act).toBeDefined();
});
});
function createCompositionBundle(patient: Patient, code?: string, ...resources: Partial<Resource>[]): Bundle {
for (const resource of resources) {
resource.id = resource.id ?? generateId();
}
const composition: Composition = {
resourceType: 'Composition',
status: 'final',
type: { text: 'test' },
date: new Date().toISOString(),
author: [{ display: 'test' }],
title: 'test',
subject: createReference(patient),
section: code
? [
{
title: 'test',
code: {
coding: [
{
code,
},
],
},
entry: (resources as WithId<Resource>[])
.filter((r) => !['Device', 'Location', 'Practitioner'].includes(r.resourceType as string))
.map(createReference),
},
]
: [],
};
return {
resourceType: 'Bundle',
type: 'document',
entry: [{ resource: composition }, { resource: patient }, ...resources.map((r) => ({ resource: r as Resource }))],
};
}
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