send communication resource to EHR

.env

@@ -12,6 +12,7 @@ VSAC_API_KEY = changeMe
 WHITELIST = *
 SERVER_NAME = CodeX REMS Administrator Prototype
 FULL_RESOURCE_IN_APP_CONTEXT = false
+DOCKERED_EHR_CONTAINER_NAME = false
 
 #Frontend Vars
 FRONTEND_PORT=9090

README.md

@@ -118,6 +118,8 @@ Following are a list of modifiable paths:
 | WHITELIST       | `http://localhost, http://localhost:3005`  | List of valid URLs for CORS. Should include any URLs the server accesses for resources.                                     |
 | SERVER_NAME     | `CodeX REMS Administrator Prototype`       | Name of the server that is returned in the card source.                                                                     |
 | FULL_RESOURCE_IN_APP_CONTEXT     | 'false'       | If true, the entire order resource will be included in the appContext, otherwise only a reference will be.                                                                     |
+| DOCKERED_EHR_CONTAINER_NAME     | ''       | String of the EHR container name for local docker networking communication                              |
+
 | FRONTEND_PORT            | `9080`                                             | Port that the frontend  server should run on, change if there are conflicts with port usage.                   |
 | VITE_REALM | `ClientFhirServer` | Keycloak realm for frontend authentication. |
 | VITE_AUTH | `http://localhost:8180` | Keycloak authentication server URL for frontend. |

src/config.ts

@@ -41,7 +41,8 @@ export default {
   fhirServerConfig: {
     auth: {
       // This server's URI
-      resourceServer: env.get('RESOURCE_SERVER').required().asUrlString()
+      resourceServer: env.get('RESOURCE_SERVER').required().asUrlString(),
+      dockered_ehr_container_name: env.get('DOCKERED_EHR_CONTAINER_NAME').asString()
       //
       // if you use this strategy, you need to add the corresponding env vars to docker-compose
       //

src/fhir/models.ts

@@ -5,7 +5,7 @@ export interface Requirement {
   name: string;
   description: string;
   questionnaire: Questionnaire | null;
-  stakeholderType: 'patient' | 'prescriber' | 'pharmacist' | string; // From fhir4.Parameters.parameter.name
+  stakeholderType: 'patient' | 'prescriber' | 'pharmacist' | string;
   createNewCase: boolean;
   resourceId: string;
   requiredToDispense: boolean;
@@ -15,7 +15,8 @@ export interface Requirement {
 export interface Medication extends Document {
   name: string;
   codeSystem: string;
-  code: string;
+  code: string; // RxNorm code (used for CDS Hooks)
+  ndcCode: string; // NDC code (used for NCPDP SCRIPT)
   requirements: Requirement[];
 }
 
@@ -30,22 +31,41 @@ export interface MetRequirements extends Document {
   metRequirementId: any;
 }
 
+export interface PrescriptionEvent {
+  medicationRequestReference: string;
+  prescriberId: string;
+  pharmacyId?: string;
+  timestamp: Date;
+  originatingFhirServer?: string;
+  caseStatusAtTime: string;
+}
+
 export interface RemsCase extends Document {
   case_number: string;
+  remsPatientId?: string;
   status: string;
   dispenseStatus: string;
   drugName: string;
   drugCode: string;
+  drugNdcCode?: string;
   patientFirstName: string;
   patientLastName: string;
   patientDOB: string;
+  currentPrescriberId?: string;
+  currentPharmacyId?: string;
+  prescriberHistory: string[];
+  pharmacyHistory: string[];
+  prescriptionEvents: PrescriptionEvent[];
+  medicationRequestReference?: string;
+  originatingFhirServer?: string;
   metRequirements: Partial<MetRequirements>[];
 }
 
 const medicationCollectionSchema = new Schema<Medication>({
   name: { type: String },
   codeSystem: { type: String },
   code: { type: String },
+  ndcCode: { type: String },
   requirements: [
     {
       name: { type: String },
@@ -61,6 +81,8 @@ const medicationCollectionSchema = new Schema<Medication>({
 });
 
 medicationCollectionSchema.index({ name: 1 }, { unique: true });
+medicationCollectionSchema.index({ code: 1 });
+medicationCollectionSchema.index({ ndcCode: 1 });
 
 export const medicationCollection = model<Medication>(
   'medicationCollection',
@@ -89,13 +111,31 @@ export const metRequirementsCollection = model<MetRequirements>(
 
 const remsCaseCollectionSchema = new Schema<RemsCase>({
   case_number: { type: String },
+  remsPatientId: { type: String },
   status: { type: String },
   dispenseStatus: { type: String },
   drugName: { type: String },
   patientFirstName: { type: String },
   patientLastName: { type: String },
   patientDOB: { type: String },
   drugCode: { type: String },
+  drugNdcCode: { type: String },
+  currentPrescriberId: { type: String },
+  currentPharmacyId: { type: String },
+  prescriberHistory: [{ type: String }],
+  pharmacyHistory: [{ type: String }],
+  prescriptionEvents: [
+    {
+      medicationRequestReference: { type: String },
+      prescriberId: { type: String },
+      pharmacyId: { type: String },
+      timestamp: { type: Date },
+      originatingFhirServer: { type: String },
+      caseStatusAtTime: { type: String }
+    }
+  ],
+  medicationRequestReference: { type: String },
+  originatingFhirServer: { type: String },
   metRequirements: [
     {
       metRequirementId: { type: String },
@@ -107,4 +147,18 @@ const remsCaseCollectionSchema = new Schema<RemsCase>({
   ]
 });
 
+remsCaseCollectionSchema.index({
+  patientFirstName: 1,
+  patientLastName: 1,
+  patientDOB: 1,
+  drugNdcCode: 1
+});
+
+remsCaseCollectionSchema.index({
+  patientFirstName: 1,
+  patientLastName: 1,
+  patientDOB: 1,
+  drugCode: 1
+});
+
 export const remsCaseCollection = model<RemsCase>('RemsCaseCollection', remsCaseCollectionSchema);

src/fhir/utilities.ts

@@ -127,6 +127,7 @@ export class FhirUtilities {
         name: 'Turalio',
         codeSystem: 'http://www.nlm.nih.gov/research/umls/rxnorm',
         code: '2183126',
+        ndcCode: '65597-407-20',
         requirements: [
           {
             name: 'Patient Enrollment',
@@ -196,6 +197,7 @@ export class FhirUtilities {
         name: 'TIRF',
         codeSystem: 'http://www.nlm.nih.gov/research/umls/rxnorm',
         code: '1237051',
+        ndcCode: '63459-502-30',
         requirements: [
           {
             name: 'Patient Enrollment',
@@ -262,6 +264,7 @@ export class FhirUtilities {
         name: 'Isotretinoin',
         codeSystem: 'http://www.nlm.nih.gov/research/umls/rxnorm',
         code: '6064',
+        ndcCode: '0245-0571-01',
         requirements: [
           {
             name: 'Patient Enrollment',
@@ -305,6 +308,7 @@ export class FhirUtilities {
         name: 'Addyi',
         codeSystem: 'http://www.nlm.nih.gov/research/umls/rxnorm',
         code: '1666386',
+        ndcCode: '58604-214-30',
         requirements: []
       }
     ];

src/hooks/hookResources.ts

@@ -24,12 +24,14 @@
 import axios from 'axios';
 import { ServicePrefetch } from '../rems-cds-hooks/resources/CdsService';
 import { hydrate } from '../rems-cds-hooks/prefetch/PrefetchHydrator';
+import { createNewRemsCaseFromCDSHook, handleStakeholderChangesAndRecordEvent } from '../lib/etasu';
 
 type HandleCallback = (
   res: any,
   hydratedPrefetch: HookPrefetch | undefined,
   contextRequest: FhirResource | undefined,
-  patient: FhirResource | undefined
+  patient: FhirResource | undefined,
+  fhirServer?: string
 ) => Promise<void>;
 
 export interface CardRule {
@@ -366,7 +368,8 @@
   res: any,
   hydratedPrefetch: HookPrefetch | undefined,
   contextRequest: FhirResource | undefined,
-  resource: FhirResource | undefined
+  resource: FhirResource | undefined,
+  fhirServer?: string
 ): Promise<void> => {
   const patient = resource?.resourceType === 'Patient' ? resource : undefined;
 
@@ -396,13 +399,82 @@
   // find a matching REMS case for the patient and this drug to only return needed results
   const patientName = patient?.name?.[0];
   const patientBirth = patient?.birthDate;
-  const remsCase = await remsCaseCollection.findOne({
+  let remsCase = await remsCaseCollection.findOne({
     patientFirstName: patientName?.given?.[0],
     patientLastName: patientName?.family,
     patientDOB: patientBirth,
     drugCode: code
   });
 
+  // If case exists, check for stakeholder changes and record prescription event
+  if (remsCase && drug && fhirServer) {
+    const practitionerReference = request.requester?.reference || '';
+    const pharmacistReference = pharmacy?.id ? `HealthcareService/${pharmacy.id}` : '';
+    const medicationRequestReference = `${request.resourceType}/${request.id}`;
+
+    const prescriberChanged = remsCase.currentPrescriberId !== practitionerReference;
+    const pharmacyChanged =
+      pharmacistReference && remsCase.currentPharmacyId !== pharmacistReference;
+
+    if (prescriberChanged || pharmacyChanged) {
+      try {
+        const updatedCase = await handleStakeholderChangesAndRecordEvent(
+          remsCase,
+          drug,
+          practitionerReference,
+          pharmacistReference,
+          medicationRequestReference,
+          fhirServer
+        );
+        console.log(`Updated case ${updatedCase?.case_number} with stakeholder changes`);
+      } catch (error) {
+        console.error('Failed to handle stakeholder changes:', error);
+      }
+    } else {
+      // Record prescription event even if no stakeholder change
+      remsCase.prescriptionEvents.push({
+        medicationRequestReference: medicationRequestReference,
+        prescriberId: practitionerReference,
+        pharmacyId: pharmacistReference,
+        timestamp: new Date(),
+        originatingFhirServer: fhirServer,
+        caseStatusAtTime: remsCase.status
+      });
+      remsCase.medicationRequestReference = medicationRequestReference;
+      await remsCase.save();
+    }
+  }
+
+  // If no REMS case exists and drug has requirements, create case with all requirements unmet
+  if (!remsCase && drug && patient && request) {
+    const requiresCase = drug.requirements.some(req => req.requiredToDispense);
+
+    if (requiresCase && fhirServer) {
+      try {
+        const patientReference = `Patient/${patient.id}`;
+        const medicationRequestReference = `${request.resourceType}/${request.id}`;
+        const practitionerReference = request.requester?.reference || '';
+        const pharmacistReference = pharmacy?.id ? `HealthcareService/${pharmacy.id}` : '';
+
+        const newCase = await createNewRemsCaseFromCDSHook(
+          patient,
+          drug,
+          practitionerReference,
+          pharmacistReference,
+          patientReference,
+          medicationRequestReference,
+          fhirServer
+        );
+
+        remsCase = newCase;
+
+        console.log(`Created REMS case from CDS Hook with originating server: ${fhirServer}`);
+      } catch (error) {
+        console.error('Failed to create REMS case from CDS Hook:', error);
+      }
+    }
+  }
+
   const codeRule = (code && codeMap[code]) || [];
 
   const cardPromises = codeRule.map(
@@ -494,6 +566,11 @@
       const notFound = remsCase && !metRequirement;
       const noEtasuToCheckAndRequiredToDispense = !remsCase && requirement.requiredToDispense;
 
+      // Only show forms that are not required to dispense (like patient status) if case is approved
+      if (!requirement.requiredToDispense && remsCase && remsCase.status !== 'Approved') {
+        return false;
+      }
+
       return formNotProcessed || notFound || noEtasuToCheckAndRequiredToDispense;
     };
 
@@ -594,6 +671,7 @@
   const context = req.body.context;
   const patient = hydratedPrefetch?.patient;
   const practitioner = hydratedPrefetch?.practitioner;
+  const fhirServer = req.body.fhirServer;
 
   console.log('    Patient: ' + patient?.id);
 
@@ -612,7 +690,7 @@
     res.json(buildErrorCard('Context userId does not match prefetch Practitioner ID'));
     return;
   }
-  return callback(res, hydratedPrefetch, contextRequest, patient);
+  return callback(res, hydratedPrefetch, contextRequest, patient, fhirServer);
 }
 
 // handles all hooks, any supported hook should pass through this function
@@ -752,7 +830,7 @@
 
 const getCardOrEmptyArrayFromCases =
   (entries: BundleEntry[] | undefined) =>
-  async ({ drugCode, drugName, metRequirements }: RemsCase): Promise<Card | never[]> => {
+  async ({ drugCode, drugName, metRequirements, status }: RemsCase): Promise<Card | never[]> => {
     // find the drug in the medicationCollection that matches the REMS case to get the smart links
     const drug = await medicationCollection
       .findOne({
@@ -794,6 +872,11 @@
       const formNotProcessed = metRequirement && !metRequirement.completed;
       const notFound = !metRequirement;
 
+      // Only show forms that are not required to dispense (like patient status) if case is approved
+      if (!requirement.requiredToDispense && status !== 'Approved') {
+        return false;
+      }
+
       return formNotProcessed || notFound;
     };
 
@@ -836,7 +919,8 @@
   res: any,
   hookPrefetch: HookPrefetch | undefined,
   _contextRequest: FhirResource | undefined,
-  resource: FhirResource | undefined
+  resource: FhirResource | undefined,
+  fhirServer?: string
 ): Promise<void> => {
   const patient = resource?.resourceType === 'Patient' ? resource : undefined;
   const medResource = hookPrefetch?.medicationRequests;