From 37ab80e250fa292bd3bb48749f28d2c0aec9cc07 Mon Sep 17 00:00:00 2001
From: David Raeside <132376220+davidraeside@users.noreply.github.com>
Date: Tue, 7 Jan 2025 13:14:23 -0500
Subject: [PATCH] Enhance vital signs narrative generation (#6590)

* add support for formatting observation.component entries in vital signs narrative generation

* update
---
 ...l-signs-narrative-generation-template.yaml |  5 ++
 .../jpa/ips/narrative/utility-fragments.html  | 15 +++++
 .../fhir/jpa/ips/narrative/vitalsigns.html    |  9 ++-
 .../generator/IpsGeneratorSvcImplTest.java    | 56 +++++++++++++++++++
 4 files changed, 82 insertions(+), 3 deletions(-)
 create mode 100644 hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_8_0/6587-enhance-vital-signs-narrative-generation-template.yaml

diff --git a/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_8_0/6587-enhance-vital-signs-narrative-generation-template.yaml b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_8_0/6587-enhance-vital-signs-narrative-generation-template.yaml
new file mode 100644
index 00000000000..41531e5d239
--- /dev/null
+++ b/hapi-fhir-docs/src/main/resources/ca/uhn/hapi/fhir/changelog/7_8_0/6587-enhance-vital-signs-narrative-generation-template.yaml
@@ -0,0 +1,5 @@
+---
+type: add
+issue: 6587
+title: "Enhanced the IPS vital signs narrative template to include code and value information for 
+    all entries in the `Observation.component` property."
diff --git a/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/utility-fragments.html b/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/utility-fragments.html
index 3dea18d43a8..552e48b8753 100644
--- a/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/utility-fragments.html
+++ b/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/utility-fragments.html
@@ -247,3 +247,18 @@
       <th:block th:if="${!iter.last}" th:text="', '"/>
    </th:block>
 </th:block>
+
+<!-- /* Component list */ -->
+<th:block th:if="${list}" th:fragment="renderComponent (list)">
+	<th:block th:each="item,iter : ${list}" th:if="${!list.empty}">
+		<th:block th:if="${item.getCode().getCodingFirstRep().hasDisplay()}" th:text="${item.getCode().getCodingFirstRep().getDisplay()}">Display</th:block>
+		<th:block th:if="${!item.getCode().getCodingFirstRep().hasDisplay()}" th:text="${item.getCode().getCodingFirstRep().getCode()}">Code</th:block>
+		<th:block th:if="${item.hasValueQuantity()}" th:text="${item.getValueQuantity().getValue().toPlainString()}">Value</th:block>
+		<th:block th:if="${item.hasValueIntegerType()}" th:text="${item.getValueIntegerType().getValueAsString()}">Value</th:block>
+		<th:block th:if="${item.hasValueStringType()}" th:text="${item.getValueStringType().getValueAsString()}">Value</th:block>
+		<th:block th:if="${item.hasValueCodeableConcept()}">
+			<th:block th:insert=":: codeableConcept (cc=${item.getValueCodeableConcept()}, attr='display')"/>
+		</th:block>
+		<th:block th:if="${!iter.last}" th:text="', '"/>
+	</th:block>
+</th:block>
diff --git a/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/vitalsigns.html b/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/vitalsigns.html
index f890ad6c26e..55391cee2ed 100644
--- a/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/vitalsigns.html
+++ b/hapi-fhir-jpaserver-ips/src/main/resources/ca/uhn/fhir/jpa/ips/narrative/vitalsigns.html
@@ -4,6 +4,7 @@ Code: Observation.code.text || Observation.code.coding[x].display (separated by
 Result: Observation.valueQuantity || Observation.valueDateTime || Observation.valueCodeableConcept.text || Observation.valueCodeableConcept.coding[x].display (separated by <br />) || Observation.valueString
 Unit: Observation.valueQuantity.unit
 Interpretation: Observation.interpretation[0].text || Observation.interpretation[0].coding[x].display (separated by <br />)
+Component(s): Observation.component[x].display || Observation.component[x].code + Observation.component[x].value (items separated by comma)
 Comments: Observation.note[x].text (separated by <br />)
 Date: Observation.effectiveDateTime || Observation.effectivePeriod.start
 */-->
@@ -16,6 +17,7 @@ Date: Observation.effectiveDateTime || Observation.effectivePeriod.start
          <th>Result</th>
          <th>Unit</th>
          <th>Interpretation</th>
+			<th>Component(s)</th>
          <th>Comments</th>
          <th>Date</th>
       </tr>
@@ -23,12 +25,13 @@ Date: Observation.effectiveDateTime || Observation.effectivePeriod.start
       <tbody>
       <th:block th:each="entry : ${resource.entry}" th:object="${entry.getResource()}">
          <th:block th:unless='*{getResourceType().name() == "Composition"}'>
-            <th:block th:with="extension=${entry.getResource().getExtensionByUrl('http://hl7.org/fhir/StructureDefinition/narrativeLink').getValue().getValue()}">
-               <tr th:id="${#strings.arraySplit(extension, '#')[1]}">
+				<th:block th:with="extension=${entry.getResource().getExtensionByUrl('http://hl7.org/fhir/StructureDefinition/narrativeLink')}">
+					<tr th:id="${extension != null} ? ${#strings.arraySplit(extension.getValue().getValue(), '#')[1]} : ''">
                   <td th:insert="~{IpsUtilityFragments :: codeableConcept (cc=*{getCode()},attr='display')}">Code</td>
                   <td th:insert="~{IpsUtilityFragments :: renderValue (value=*{getValue()})}">Result</td>
                   <td th:insert="~{IpsUtilityFragments :: renderValueUnit (value=*{getValue()})}">Unit</td>
-                  <td th:replace="~{IpsUtilityFragments :: firstFromCodeableConceptList (list=*{getInterpretation()})}">Interpretation</td>
+                  <td th:insert="~{IpsUtilityFragments :: firstFromCodeableConceptList (list=*{getInterpretation()})}">Interpretation</td>
+                  <td th:insert="~{IpsUtilityFragments :: renderComponent (list=*{getComponent()})}">Component(s)</td>
                   <td th:insert="~{IpsUtilityFragments :: concat (list=*{getNote()},attr='text')}">Comments</td>
                   <td th:insert="~{IpsUtilityFragments :: renderEffective (effective=*{getEffective()})}">Date</td>
                </tr>
diff --git a/hapi-fhir-jpaserver-ips/src/test/java/ca/uhn/fhir/jpa/ips/generator/IpsGeneratorSvcImplTest.java b/hapi-fhir-jpaserver-ips/src/test/java/ca/uhn/fhir/jpa/ips/generator/IpsGeneratorSvcImplTest.java
index 96464a82b4d..80018cb7ff1 100644
--- a/hapi-fhir-jpaserver-ips/src/test/java/ca/uhn/fhir/jpa/ips/generator/IpsGeneratorSvcImplTest.java
+++ b/hapi-fhir-jpaserver-ips/src/test/java/ca/uhn/fhir/jpa/ips/generator/IpsGeneratorSvcImplTest.java
@@ -25,6 +25,8 @@ import org.hl7.fhir.r4.model.AllergyIntolerance;
 import org.hl7.fhir.r4.model.Bundle;
 import org.hl7.fhir.r4.model.CarePlan;
 import org.hl7.fhir.r4.model.ClinicalImpression;
+import org.hl7.fhir.r4.model.CodeableConcept;
+import org.hl7.fhir.r4.model.Coding;
 import org.hl7.fhir.r4.model.Composition;
 import org.hl7.fhir.r4.model.Condition;
 import org.hl7.fhir.r4.model.Consent;
@@ -45,6 +47,7 @@ import org.hl7.fhir.r4.model.Organization;
 import org.hl7.fhir.r4.model.Patient;
 import org.hl7.fhir.r4.model.PositiveIntType;
 import org.hl7.fhir.r4.model.Procedure;
+import org.hl7.fhir.r4.model.Quantity;
 import org.hl7.fhir.r4.model.Reference;
 import org.hl7.fhir.r4.model.Resource;
 import org.hl7.fhir.r4.model.StringType;
@@ -667,6 +670,59 @@ public class IpsGeneratorSvcImplTest {
 		assertSame(strategy2, svc.selectGenerationStrategy("http://2"));
 	}
 
+	@Test
+	public void testVitalSigns_withComponents() throws IOException {
+		// Setup Patient
+		initializeGenerationStrategy();
+		registerPatientDaoWithRead();
+
+		Observation observation1 = new Observation();
+		observation1.setId("Observation/1");
+		observation1.setStatus(Observation.ObservationStatus.FINAL);
+		observation1.setCode(
+			new CodeableConcept().addCoding(
+				new Coding("http://loinc.org", "85354-9", "Blood pressure panel with all children optional")
+			)
+		);
+		observation1.addComponent(
+			new Observation.ObservationComponentComponent(
+				new CodeableConcept(
+					new Coding("http://loinc.org", "8480-6", "Systolic blood pressure")
+				)
+			).setValue(new Quantity().setValue(125).setUnit("mmHg").setSystem("http://unitsofmeasure.org").setCode("mm[Hg]"))
+		);
+		observation1.addComponent(
+			new Observation.ObservationComponentComponent(
+				new CodeableConcept(
+					new Coding("http://loinc.org", "8462-4", "Diastolic blood pressure")
+				)
+			).setValue(new Quantity().setValue(75).setUnit("mmHg").setSystem("http://unitsofmeasure.org").setCode("mm[Hg]"))
+		);
+
+		ResourceMetadataKeyEnum.ENTRY_SEARCH_MODE.put(observation1, BundleEntrySearchModeEnum.MATCH);
+		IFhirResourceDao<Observation> observationDao = registerResourceDaoWithNoData(Observation.class);
+		when(observationDao.search(any(), any())).thenReturn(new SimpleBundleProvider(Lists.newArrayList(observation1)));
+		registerRemainingResourceDaos();
+
+		// Test
+		Bundle outcome = (Bundle) mySvc.generateIps(new SystemRequestDetails(), new IdType(PATIENT_ID), null);
+
+		// Verify
+		Composition compositions = (Composition) outcome.getEntry().get(0).getResource();
+		Composition.SectionComponent section = findSection(compositions, DefaultJpaIpsGenerationStrategy.SECTION_CODE_VITAL_SIGNS);
+
+		HtmlPage narrativeHtml = HtmlUtil.parseAsHtml(section.getText().getDivAsString());
+		ourLog.info("Narrative:\n{}", narrativeHtml.asXml());
+
+		DomNodeList<DomElement> tables = narrativeHtml.getElementsByTagName("table");
+		assertThat(tables).hasSize(1);
+		HtmlTable table = (HtmlTable) tables.get(0);
+		assertEquals("Code", table.getHeader().getRows().get(0).getCell(0).asNormalizedText());
+		assertEquals("Blood pressure panel with all children optional", table.getBodies().get(0).getRows().get(0).getCell(0).asNormalizedText());
+		assertEquals("Component(s)", table.getHeader().getRows().get(0).getCell(4).asNormalizedText());
+		assertEquals("Systolic blood pressure 125 , Diastolic blood pressure 75", table.getBodies().get(0).getRows().get(0).getCell(4).asNormalizedText());
+	}
+
 	@Nonnull
 	private Composition.SectionComponent findSection(Composition compositions, String theSectionCode) {
 		return compositions