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Experimental Medical Application Platform (EMAP)

Introduction

A technical overview of EMAP can be found in the Technical_overview_of_EMAP.md

There are currently two data sources for EMAP:

  • HL7 data
    • Persisted in the Immutable Data Store (IDS), from a copy of specific HL7 message streams
    • The IDS is read by the HL7 reader, (defined in the hl7-reader module) converting the HL7 message into a source-agnostic format (interchange message, defined in the emap-interchange module) and published to a rabbitMQ queue for processing by the core processor.

  • Hospital database polling

    The Hoover (defined in the hoover repository) service polls hospital databases (Clarity and Caboodle) for data that has changed since the last poll. It converts the query outputs into the interchange message and publishes these to a rabbitMQ queue for processing by the core processor. We can't make the Hoover repository public because the SQL queries contain the intellectual property of the hospital patient record system, EPIC.

The core processor (defined in the core module) is responsible for processing the interchange messages and updating the emap database (defined in the emap-star module).

The core processor compares what is already known in the EMAP database, with the data in the interchange message and updates the EMAP database accordingly. We can receive HL7 messages out of order so the processor must be able to handle this.

Development guide

All the EMAP services use the Spring-Boot framework and are written in Java. Setup instructions are found in the emap repo with additional information for hoover in the hoover repo.

A decision log for technical choices for a module can be found in its dev/design_choices.md file.

Hl7-reader

Development

Each HL7 message can produce one or more interchange messages, depending on the type of the message there are different patterns used in the codebase to process the HL7 message.

As an example, the following diagram shows the processing of an ORM^O01 HL7 message type which can either result in a single ConsultRequest interchange message or a list of LabOrderMsg interchange messages (these have been simplified in the diagram).

HL7 message processing class diagram

Flow of the processing:

  • All HL7 messages are processed by the mainLoop method of the AppHl7 class, which delegates reading and processing of HL7 messages into interchange messages to the IdsOperations class, and then publishes to the queue using the Publisher class.
  • The IdsOperations class is responsible for reading the HL7 messages from the IDS and delegates the processing of HL7. In this case ORM messages are an Order Message, so the message is routed to the OrderAndResultService.
  • The OrderAndResultService can determine the source and type of the message, which can delegate to the ConsultFactory for a consultation request, or LabFunnel for a lab order.
    • If this is a consultation request, the ConsultFactory will create a ConsultRequest interchange message and return this up the call stack for publishing.
  • The LabFunnel will use the OrderCodingSystem to route the HL7 message type to the correct LabOrderBuilder subclass.
    • Each builder extracts common elements from the HL7 message, using its parent class' methods to create one or more LabOrderMsg interchange message.

Testing

  • For service testing, fake HL7 messages are manually created for each message type and stored in the src/test/resources directory.
  • To reduce repetition of configuration and annotations, the TestHl7MessageStream class is extended in each test class.
    • This contains a processSingleAdtMessage method which takes the path of the fake HL7 message and processes it into an interchange message for assertions.
    • This method tests at the IdsOperations level, so the Publisher does not need to be mocked.
  • Unless there is very tricky areas of logic, we don't unit test message processing, instead setting up test cases of HL7 -> interchange messages and checking that this is processed as expected
  • To have certainty that our end-to-end testing from hl7-reader -> core -> emap-star database works correctly, test methods are added to the TestHl7ParsingMatchesInterchangeFactoryOutput test class, which takes in HL7 messages as an input and serialised interchange messages in yaml format as an expected output and asserts that they match.
    • These serialised interchange messages are then used in emap core testing
    • To ensure that all serialised interchange messages from the hl7-reader have an HL7 message that produces them, the InterchangeMessageFactory is created with Monitored Files, an exception will be thrown if there are any interchange messages which have not been read while running the test class.

Hoover

Development

The hoover service requires native queries to be written for Clarity and Caboodle, so local development uses docker containers running sqlserver with fake data to test the queries. These are defined in test-files/clarity and test-files/caboodle. Be sure to follow the local setup instructions before starting work on the service.

Each data type processed by Hoover is represented by its own class that implements the QueryStrategy interface, and has a SQL file in the src/main/resources/sql directory.

An example is shown in the following diagram (simplified):

Hoover class diagram

  • The Application class creates a Spring Component that is an instance of the Processor class, initialised with a QueryStrategy instance, in this case LocationMetadataQueryStrategy.
    • This component is taken as an argument to the runBatchProcessor method, which delegates the scheduling of the database polling to the BatchProcessor class.
  • The Processor class uses the QueryStrategy interface to get the previous progress for the data type, and query for any new data since the most recent progress.
  • Defining the SQL query and how this data is processed is implemented by the LocationMetadataQueryStrategy class.
    • To allow for sqlfluff linting of SQL queries, the SQL is persisted to the src/main/resources/sql directory, and linked to by the getQueryFilename method.
    • the getBatchOfInterchangeMessages method queries the database, returns a list of Data Transfer Objects (DTOs), in this case LocationMetadataDTO.
    • In this case, the LocationMetadataDTO can build a LocationMetadata interchange message and these are returned up the call stack for publishing using the Publisher class.

Testing

  • For each data type, as a minimum you should carry out testing from a query within a time window and assert that the expected data is returned.
    • The expected data should include the serialised interchange messages in yaml format that will be read by the core processor during testing.
    • As the databases are static, creating specific test conditions within a time window is the easiest way to have specific tests.
  • Each test class should implement the TestQueryStrategy interface, which adds in default tests once you have implemented the required methods for metadata about the test.
    • This also gives helper methods to be able to test a time window of data and assert that the batch of interchange messages matches the yaml files.

Core

Development

Message processing within core follows a general pattern of:

  • Read message from queue and delegate to processor class
  • Processor class uses one or more controllers to update or create the relevant entities from the hl7 message
  • Controllers use repositories carry out business logic for what exists in the database, and what should be updated or created.
  • Repositories use Spring Data JPA to interact with the database tables directly.

An example is shown in the following diagram (simplified)

Core message processing

  • Each interchange message uses double dispatch so that the class of the interchange message can be known at runtime without checks. The InformDbOperations class implements the EmapOperationMessageProcessor interface to enable the double dispatch.
    The processMessage method delegates to a Processor class for each family of messages, in this case the LabProcessor is used.
  • Each processor class has one or more Controller classes, which allow for the business logic of comparing the current and previous state from the database and making a decision on what the correct outcome is. The processor class uses these delegated classes to update or create entities which are used by other controllers.
  • Each controller class can use other controllers (for complex data types which span 6+ tables), interact with tables using a Cache component or directly interact with the database using a Repository interface.
    • In this case, the LabController uses the LabCache component, this is because Spring Boot caching annotations are ignored when a method call is made by the same class. Breaking this out into a separate component allows for data type metadata to be cached to reduce the number of queries to the database and improve performance. The LabCache component itself can interact with Repositories because it is a Spring Component.
    • The LabController also uses the LabOrderController, which then uses specific Repositories to interact with the SQL tables in emap star.
  • Most tables in emap star have an Audit equivalent, this allows for the history of each entity to be tracked.
    • We have defined an @AuditTable to generate Java classes for these entities that are then represented as tables in emap star. This can be found in the emap-star/emap-star-annotations maven module.
    • An Audit table must extend the TemporalCore class, generics are used to link the entity class and its audit entity class.
    • The RowState class acts as a wrapper around an entity to help with determining if differences should be persisted to the database (and if it already exists, audited).

Testing

  • All testing is carried out from interchange messages persisted in yaml format, as used by the source services.
  • Test classes should extend the MessageProcessingBase, which provides class fields and configuration for testing.
    • the messageFactory field is used to create interchange messages from yaml files
    • there are processSingleMessage and processMessages methods which take interchange messages and process the message(s) into an in memory database for testing.
  • For complex message flows such as Lab Orders (where there are several messages with different data to and from the lab system and EPIC), a test class has been created, which uses a class that extends the OrderPermutationBase class.
    • In this case the test class is TestLabsProcessingUnorderedMessages and the permutation class is the LabsPermutationTestProducer, this has test methods which take in a set of yaml filenames, which are processed in every possible non-repeating order permutation.
    • This ensures that the processing of the messages is not dependent on the order of the messages, and that the correct outcome is reached regardless of the order of the messages.
    • Admissions, discharges and transfers are also checked using this method.

Validation and Deployment

The EMAP services are deployed using Docker containers, which can interact with each-other using docker compose. To simplify the configuration and deployment of the containers, we use the emap-setup python package. This also has functionality to deploy a validation run of EMAP, setting a specific start and end date for the data to be processed from all sources.

Validation

As all input data during development is created by the developer and this is clinical data, a validation run is always required before changes should impact the running codebase. If this is an entirely new data type with no effect on existing data, then feature flags can be used to disable the processing of the messages in production. For a change to an existing data type or to release into production, then follow the validation SOP.

Deployment

Deployment is carried out using the emap-setup tool, follow the release procedure SOP