PACIO - added extended case history and prescriber/pharmacy change detection

src/fhir/models.ts

@@ -30,6 +30,15 @@ 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;
   status: string;
@@ -39,6 +48,11 @@ export interface RemsCase extends Document {
   patientFirstName: string;
   patientLastName: string;
   patientDOB: string;
+  currentPrescriberId?: string;
+  currentPharmacyId?: string;
+  prescriberHistory: string[];
+  pharmacyHistory: string[];
+  prescriptionEvents: PrescriptionEvent[];
   medicationRequestReference?: string;
   originatingFhirServer?: string;
   metRequirements: Partial<MetRequirements>[];
@@ -98,6 +112,20 @@ const remsCaseCollectionSchema = new Schema<RemsCase>({
   patientLastName: { type: String },
   patientDOB: { type: String },
   drugCode: { 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: [
@@ -111,4 +139,4 @@ const remsCaseCollectionSchema = new Schema<RemsCase>({
   ]
 });
 
-export const remsCaseCollection = model<RemsCase>('RemsCaseCollection', remsCaseCollectionSchema);
+export const remsCaseCollection = model<RemsCase>('RemsCaseCollection', remsCaseCollectionSchema);

src/hooks/hookResources.ts

@@ -24,7 +24,7 @@
 import axios from 'axios';
 import { ServicePrefetch } from '../rems-cds-hooks/resources/CdsService';
 import { hydrate } from '../rems-cds-hooks/prefetch/PrefetchHydrator';
-import { createNewRemsCaseFromCDSHook } from '../lib/etasu';
+import { createNewRemsCaseFromCDSHook, handleStakeholderChangesAndRecordEvent } from '../lib/etasu';
 
 type HandleCallback = (
   res: any,
@@ -406,11 +406,50 @@
     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) {     
+    if (requiresCase && fhirServer) {
       try {
         const patientReference = `Patient/${patient.id}`;
         const medicationRequestReference = `${request.resourceType}/${request.id}`;
@@ -871,7 +910,7 @@
   hookPrefetch: HookPrefetch | undefined,
   _contextRequest: FhirResource | undefined,
   resource: FhirResource | undefined,
   fhirServer?: string
 ): Promise<void> => {
   const patient = resource?.resourceType === 'Patient' ? resource : undefined;
   const medResource = hookPrefetch?.medicationRequests;
@@ -997,4 +1036,4 @@
     ]
   };
   return taskResource;
-}
+}

src/lib/communication.ts

@@ -8,15 +8,14 @@ import { Requirement } from '../fhir/models';
 
 const logger = container.get('application');
 
-
 export async function sendCommunicationToEHR(
   remsCase: any,
   medication: any,
   outstandingRequirements: any[]
 ): Promise<void> {
   try {
     logger.info(`Creating Communication for case ${remsCase.case_number}`);
-    
+
     // Create patient object from REMS case
     const patient: Patient = {
       resourceType: 'Patient',
@@ -60,9 +59,10 @@ export async function sendCommunicationToEHR(
     // Create Tasks for each outstanding requirement
     const tasks: Task[] = [];
     for (const outstandingReq of outstandingRequirements) {
-      const requirement = outstandingReq.requirement || 
+      const requirement =
+        outstandingReq.requirement ||
         medication.requirements.find((r: Requirement) => r.name === outstandingReq.name);
-      
+
       if (requirement && requirement.appContext) {
         const questionnaireUrl = requirement.appContext;
         const task = createQuestionnaireCompletionTask(
@@ -80,7 +80,7 @@ export async function sendCommunicationToEHR(
     const communication: Communication = {
       resourceType: 'Communication',
       id: `comm-${uid()}`,
-      status: 'completed', 
+      status: 'completed',
       category: [
         {
           coding: [
@@ -92,7 +92,7 @@ export async function sendCommunicationToEHR(
           ]
         }
       ],
-      priority: 'urgent', 
+      priority: 'urgent',
       subject: {
         reference: `Patient/${patient.id}`,
         display: `${remsCase.patientFirstName} ${remsCase.patientLastName}`
@@ -107,7 +107,7 @@ export async function sendCommunicationToEHR(
         ],
         text: 'Outstanding REMS Requirements for Medication Dispensing'
       },
-      sent: new Date().toISOString(), 
+      sent: new Date().toISOString(),
       recipient: [
         {
           reference: medicationRequest.requester?.reference || ''
@@ -119,8 +119,9 @@ export async function sendCommunicationToEHR(
       },
       payload: [
         {
-          contentString: `Medication dispensing authorization DENIED for ${remsCase.drugName}.\n\n` +
-            `The following REMS requirements must be completed:\n\n` +
+          contentString:
+            `Medication dispensing authorization DENIED for ${remsCase.drugName}.\n\n` +
+            'The following REMS requirements must be completed:\n\n' +
             outstandingRequirements
               .map((req, idx) => `${idx + 1}. ${req.name} (${req.stakeholder})`)
               .join('\n') +
@@ -142,8 +143,8 @@ export async function sendCommunicationToEHR(
     };
 
     // Determine EHR endpoint: use originatingFhirServer if available, otherwise default
-    const ehrEndpoint = remsCase.originatingFhirServer || 
-      config.fhirServerConfig?.auth?.resourceServer;
+    const ehrEndpoint =
+      remsCase.originatingFhirServer || config.fhirServerConfig?.auth?.resourceServer;
 
     if (!ehrEndpoint) {
       logger.warn('No EHR endpoint configured, Communication not sent');
@@ -152,7 +153,7 @@ export async function sendCommunicationToEHR(
 
     // Send Communication to EHR
     logger.info(`Sending Communication to EHR: ${ehrEndpoint}`);
-    
+
     const response = await axios.post(`${ehrEndpoint}/Communication`, communication, {
       headers: {
         'Content-Type': 'application/fhir+json'
@@ -164,9 +165,8 @@ export async function sendCommunicationToEHR(
     } else {
       logger.warn(`Unexpected response status from EHR: ${response.status}`);
     }
-
   } catch (error: any) {
     logger.error(`Failed to send Communication to EHR: ${error.message}`);
-    throw error; 
+    throw error;
   }
-}
+}