Merge pull request #59 from mcode/medication-reference

Support medicationReference within MedicationRequests
mcode · Dec 1, 2023 · 23029d1 · 23029d1
2 parents 01e1860 + 760b6c7
commit 23029d1
Show file tree

Hide file tree

Showing 10 changed files with 23,346 additions and 14,994 deletions.
diff --git a/package-lock.json b/package-lock.json
diff --git a/src/views/Patient/MedReqDropDown/MedReqDropDown.tsx b/src/views/Patient/MedReqDropDown/MedReqDropDown.tsx
@@ -21,6 +21,7 @@ import example from '../../../cds-hooks/prefetch/exampleHookService.json'; // TO
 import { hydrate } from '../../../cds-hooks/prefetch/PrefetchHydrator';
 import { Hook, Card as HooksCard, OrderSelectHook } from '../../../cds-hooks/resources/HookTypes';
 import OrderSelect from '../../../cds-hooks/resources/OrderSelect';
+import { getDrugCodeFromMedicationRequest } from '../../Questionnaire/questionnaireUtil';
 import './MedReqDropDown.css';
 import * as env from 'env-var';
 import { MedicationBundle, submitToREMS } from '../PatientView';
@@ -123,7 +124,7 @@ function MedReqDropDown({
   useEffect(() => {
     if (selectedMedicationCard) {
       const medName =
-        selectedMedicationCard?.medicationCodeableConcept?.coding?.[0].display?.split(' ')[0];
+        getDrugCodeFromMedicationRequest(selectedMedicationCard)?.display?.split(' ')[0];
       if (medName) {
         setMedicationName(medName);
       }
@@ -208,7 +209,7 @@ function MedReqDropDown({
                     {medication ? (
                       medication.data.map(medications => (
                         <MenuItem key={medications.id} value={medications.id}>
-                          {medications.medicationCodeableConcept?.coding?.[0].display}
+                          {getDrugCodeFromMedicationRequest(medications)?.display}
                         </MenuItem>
                       ))
                     ) : (
@@ -223,7 +224,7 @@ function MedReqDropDown({
                   <Grid item container>
                     <Grid item xs={10} sm={11}>
                       <Typography bgcolor="text.secondary" color="white" textAlign="center">
-                        Code: {selectedMedicationCard?.medicationCodeableConcept?.coding?.[0].code}
+                        Code: {getDrugCodeFromMedicationRequest(selectedMedicationCard)?.code}
                       </Typography>
                       <Typography
                         bgcolor="text.disabled"
@@ -239,7 +240,7 @@ function MedReqDropDown({
                         color="white"
                         textAlign="center"
                       >
-                        {selectedMedicationCard?.medicationCodeableConcept?.coding?.[0].display}
+                        {getDrugCodeFromMedicationRequest(selectedMedicationCard)?.display}
                       </Typography>
                     </Grid>
                     <Grid

diff --git a/src/views/Patient/MedReqDropDown/etasuStatus/EtasuStatus.tsx b/src/views/Patient/MedReqDropDown/etasuStatus/EtasuStatus.tsx
@@ -19,6 +19,7 @@ import RemsMetEtasuResponse from './RemsMetEtasuResponse';
 import MetRequirements from './MetRequirements';
 import * as env from 'env-var';
 import './EtasuStatus.css';
+import { getDrugCodeFromMedicationRequest } from '../../../Questionnaire/questionnaireUtil';
 
 interface EtasuStatusProps {
   patient: Patient | null;
@@ -41,7 +42,10 @@ const EtasuStatus = (props: EtasuStatusProps) => {
     const patientFirstName = props.patient?.name?.at(0)?.given?.at(0);
     const patientLastName = props.patient?.name?.at(0)?.family;
     const patientDOB = props.patient?.birthDate;
-    const drugCode = props.medication?.medicationCodeableConcept?.coding?.at(0)?.code;
+    let drugCode = undefined;
+    if (props.medication) {
+      drugCode = getDrugCodeFromMedicationRequest(props.medication)?.code;
+    }
     console.log(
       'refreshEtasuBundle: ' +
         patientFirstName +

diff --git a/src/views/Patient/MedReqDropDown/pharmacyStatus/PharmacyStatus.tsx b/src/views/Patient/MedReqDropDown/pharmacyStatus/PharmacyStatus.tsx
@@ -8,6 +8,7 @@ import { useState, useEffect } from 'react';
 
 import './PharmacyStatus.css';
 import DoctorOrder from './DoctorOrder';
+import { getDrugCodeableConceptFromMedicationRequest } from '../../../Questionnaire/questionnaireUtil';
 import * as env from 'env-var';
 
 interface PharmacyStatusProps {
@@ -32,7 +33,11 @@ const PharmacyStatus = (props: PharmacyStatusProps) => {
     const patientLastName = props.patient?.name?.at(0)?.family;
     const patientDOB = props.patient?.birthDate;
     const rxDate = props.medication?.authoredOn;
-    const drugNames = props.medication?.medicationCodeableConcept?.coding?.at(0)?.display;
+    let drugCodeableConcept = undefined;
+    if (props.medication) {
+      drugCodeableConcept = getDrugCodeableConceptFromMedicationRequest(props.medication);
+    }
+    const drugNames = drugCodeableConcept?.coding?.at(0)?.display;
     console.log(
       'refreshPharmacyBundle: ' +
         patientFirstName +
@@ -45,7 +50,7 @@ const PharmacyStatus = (props: PharmacyStatusProps) => {
         ' - ' +
         drugNames
     );
-    const ndcDrugCoding = props.medication?.medicationCodeableConcept?.coding?.find(
+    const ndcDrugCoding = drugCodeableConcept?.coding?.find(
       ({ system }) => system === 'http://hl7.org/fhir/sid/ndc'
     );
     let queryString: string =

diff --git a/src/views/Patient/MedReqDropDown/rxSend/buildScript.2017071.ts b/src/views/Patient/MedReqDropDown/rxSend/buildScript.2017071.ts
@@ -8,6 +8,7 @@ import {
   Patient,
   Practitioner
 } from 'fhir/r4';
+import { getDrugCodeableConceptFromMedicationRequest } from '../../../Questionnaire/questionnaireUtil';
 
 function xmlAddTextNode(
   xmlDoc: XMLDocument,
@@ -237,7 +238,8 @@ function buildNewRxMedication(doc: XMLDocument, medicationRequestResource: Medic
   const drugCoded = doc.createElement('DrugCoded');
 
   // loop through the coding values and find the ndc code and the rxnorm code
-  const medicationCodingList = medicationRequestResource.medicationCodeableConcept?.coding;
+  const medicationCodingList =
+    getDrugCodeableConceptFromMedicationRequest(medicationRequestResource)?.coding;
   if (medicationCodingList) {
     for (let i = 0; i < medicationCodingList.length; i++) {
       const coding = medicationCodingList[i];

diff --git a/src/views/Patient/PatientView.tsx b/src/views/Patient/PatientView.tsx
@@ -30,7 +30,10 @@ interface PatientViewProps {
 
 export interface MedicationBundle {
   data: MedicationRequest[];
-  reference: Patient;
+
+  // This is a json object with the key of each element matching the
+  // contained FHIR resource
+  references: any;
 }
 
 //CDS-Hook Request to REMS-Admin for cards
@@ -104,7 +107,8 @@ function PatientView(props: PatientViewProps) {
         {
           patient: 'Patient/{{context.patientId}}',
           practitioner: 'Practitioner/{{context.userId}}',
-          medicationRequests: 'MedicationRequest?subject={{context.patientId}}'
+          medicationRequests:
+            'MedicationRequest?subject={{context.patientId}}&_include=MedicationRequest:medication'
         },
         tempHook
       ).then(() => {
@@ -125,11 +129,47 @@ function PatientView(props: PatientViewProps) {
   const getMedicationRequest = () => {
     client
       .request(`MedicationRequest?subject=Patient/${client.patient.id}`, {
-        resolveReferences: ['subject', 'performer'],
+        resolveReferences: ['subject', 'performer', 'medicationReference'],
         graph: false,
         flat: true
       })
       .then((result: MedicationBundle) => {
+        result.data.forEach(e => {
+          if (e?.resourceType === 'MedicationRequest') {
+            if (e?.medicationReference) {
+              const medicationReference = e?.medicationReference?.reference;
+
+              if (medicationReference) {
+                // find the matching medication in the references
+                const medication = result?.references?.[medicationReference];
+
+                if (medication) {
+                  const code = medication?.code?.coding?.[0];
+
+                  if (code) {
+                    // add the reference as a contained resource to the request
+                    if (!e?.contained) {
+                      e.contained = [];
+                      e.contained.push(medication);
+                    } else {
+                      // only add to contained if not already in there
+                      let found = false;
+                      e?.contained.forEach(c => {
+                        if (c.id === medication.id) {
+                          found = true;
+                        }
+                      });
+                      if (!found) {
+                        e?.contained.push(medication);
+                      }
+                    }
+                  }
+                }
+              }
+            }
+          }
+        });
+
         setMedication(result);
       });
   };

diff --git a/src/views/Questionnaire/QuestionnaireForm.tsx b/src/views/Questionnaire/QuestionnaireForm.tsx
@@ -24,7 +24,8 @@ import {
   buildNextQuestionRequest,
   findValueByPrefix,
   retrieveQuestions,
-  searchQuestionnaire
+  searchQuestionnaire,
+  getDrugCodeableConceptFromMedicationRequest
 } from './questionnaireUtil';
 import './QuestionnaireForm.css';
 import { Button, Typography } from '@mui/material';
@@ -879,7 +880,7 @@ export function QuestionnaireForm(props: QuestionnaireProps) {
       } else if (request.resourceType == 'ServiceRequest') {
         c = request.code;
       } else if (request.resourceType == 'MedicationRequest') {
-        c = request.medicationCodeableConcept;
+        c = getDrugCodeableConceptFromMedicationRequest(request);
       }
     }
     console.log('getCode(): ' + request?.resourceType + ': ');

diff --git a/src/views/Questionnaire/components/RemsInterface/RemsInterface.tsx b/src/views/Questionnaire/components/RemsInterface/RemsInterface.tsx
@@ -1,6 +1,7 @@
 import React, { useEffect, useState } from 'react';
 import ResourceEntry from './ResourceEntry';
 import './RemsInterface.css';
+import { getDrugCodeableConceptFromMedicationRequest } from '../../questionnaireUtil';
 import axios, { AxiosRequestConfig, AxiosResponse } from 'axios';
 import Paper from '@mui/material/Paper';
 import Button from '@mui/material/Button';
@@ -128,8 +129,9 @@ export default function RemsInterface(props: RemsInterfaceProps) {
           const potentialPatient = getResource(props.specialtyRxBundle, patientReference);
           if (potentialPrescription && potentialPatient) {
             const prescription = potentialPrescription as MedicationRequest;
-            const simpleDrugName =
-              prescription.medicationCodeableConcept?.coding?.[0].display?.split(' ')[0];
+            const medicationCodeableConcept =
+              getDrugCodeableConceptFromMedicationRequest(prescription);
+            const simpleDrugName = medicationCodeableConcept?.coding?.[0].display?.split(' ')[0];
             const rxDate = prescription.authoredOn;
             const patient = potentialPatient as Patient;
             const patientFirstName = patient.name?.[0].given?.[0];

diff --git a/src/views/Questionnaire/fetchArtifacts.ts b/src/views/Questionnaire/fetchArtifacts.ts
@@ -212,7 +212,7 @@ function fetchArtifactsOperation(
         completeOperation(orderResource);
       });
     } else {
-      const orderResource = JSON.parse(order.replace(/\\/g, ''));
+      const orderResource = JSON.parse(order);
       completeOperation(orderResource);
     }
   });

diff --git a/src/views/Questionnaire/questionnaireUtil.ts b/src/views/Questionnaire/questionnaireUtil.ts
@@ -32,7 +32,10 @@ export function getAppContext(appContextString: string) {
       temp[0] === 'coverage' ||
       temp[0] === 'response'
     ) {
-      appContext[temp[0]] = temp[1];
+      const index = temp[0];
+      // remove the index
+      temp.shift();
+      appContext[index] = temp.join('=');
     }
   });
   return appContext;
@@ -151,6 +154,41 @@ export function buildFhirUrl(reference: string, fhirPrefix: string, fhirVersion:
   }
 }
 
+/*
+ * Retrieve the CodeableConcept for the medication from the medicationCodeableConcept if available.
+ * Read CodeableConcept from contained Medication matching the medicationReference otherwise.
+ */
+export function getDrugCodeableConceptFromMedicationRequest(medicationRequest: MedicationRequest) {
+  if (medicationRequest) {
+    if (medicationRequest?.medicationCodeableConcept) {
+      console.log('Get Medication code from CodeableConcept');
+      return medicationRequest?.medicationCodeableConcept;
+    } else if (medicationRequest?.medicationReference) {
+      const reference = medicationRequest?.medicationReference;
+      let coding = undefined;
+      medicationRequest?.contained?.every(e => {
+        if (e.resourceType + '/' + e.id === reference.reference) {
+          if (e.resourceType === 'Medication') {
+            console.log('Get Medication code from contained resource');
+            coding = e.code;
+          }
+        }
+      });
+      return coding;
+    }
+  }
+  return undefined;
+}
+
+/*
+ * Retrieve the coding for the medication from the medicationCodeableConcept if available.
+ * Read coding from contained Medication matching the medicationReference otherwise.
+ */
+export function getDrugCodeFromMedicationRequest(medicationRequest: MedicationRequest) {
+  const codeableConcept = getDrugCodeableConceptFromMedicationRequest(medicationRequest);
+  return codeableConcept?.coding?.[0];
+}
+
 export function fetchFhirVersion(fhirServer: string) {
   return new Promise<string>(function (resolve, reject) {
     console.log('fetchFhirVersion from ' + fhirServer);