chore: check if an assessment has already been done in any given enco…

…unter

- this ensures that the same assessment is not repeated in the same encounter

Signed-off-by: Kathurima Kimathi <kathurimakimathi415@gmail.com>

pkg/clinical/presentation/graph/clinical.graphql

@@ -213,6 +213,7 @@ extend type Mutation {
   createQuestionnaireResponse(
     questionnaireID: String!
     encounterID: String!
+    screeningType: ScreeningTypeEnum!
     input: QuestionnaireResponseInput!
   ): String!
 

pkg/clinical/usecases/clinical/questionnaire_response.go

@@ -13,7 +13,9 @@ import (
 )
 
 // CreateQuestionnaireResponse creates a questionnaire response
-func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context, questionnaireID string, encounterID string, input dto.QuestionnaireResponse) (string, error) {
+func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(
+	ctx context.Context, questionnaireID string, encounterID string,
+	screeningType domain.ScreeningTypeEnum, input dto.QuestionnaireResponse) (string, error) {
 	questionnaireResponse := &domain.FHIRQuestionnaireResponse{}
 
 	err := mapstructure.Decode(input, questionnaireResponse)
@@ -30,19 +32,22 @@ func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context,
 		return "", fmt.Errorf("cannot create a questionnaire response in a finished encounter")
 	}
 
-	// TODO: Ensure user cannot submit the same risk assessment twice in the same encounter
-
 	patientID := encounter.Resource.Subject.ID
 	patientReference := fmt.Sprintf("Patient/%s", *patientID)
+	encounterReference := fmt.Sprintf("Encounter/%s", *encounter.Resource.ID)
+
+	// check if an assessment has already been done with the same encounter
+	err = u.checkIfAssessmentHasBeenDone(ctx, screeningType, encounterReference, patientReference)
+	if err != nil {
+		return "", err
+	}
 
 	questionnaireResponse.Source = &domain.FHIRReference{
 		ID:        patientID,
 		Reference: &patientReference,
 		Display:   encounter.Resource.Subject.Display,
 	}
 
-	encounterReference := fmt.Sprintf("Encounter/%s", *encounter.Resource.ID)
-
 	questionnaireResponse.Encounter = &domain.FHIRReference{
 		ID:        encounter.Resource.ID,
 		Reference: &encounterReference,
@@ -87,6 +92,31 @@ func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context,
 	return riskLevel, nil
 }
 
+// checkIfAssessmentHasBeenDone is a helper function to check if the assessment has already been completed
+func (u *UseCasesClinicalImpl) checkIfAssessmentHasBeenDone(ctx context.Context, screeningType domain.ScreeningTypeEnum, encounterReference, patientReference string) error {
+	searchParams := map[string]interface{}{
+		"encounter": encounterReference,
+		"patient":   patientReference,
+		"_text":     screeningType.Text(),
+	}
+
+	identifiers, err := u.infrastructure.BaseExtension.GetTenantIdentifiers(ctx)
+	if err != nil {
+		return fmt.Errorf("failed to get tenant identifiers from context: %w", err)
+	}
+
+	results, err := u.infrastructure.FHIR.SearchFHIRRiskAssessment(ctx, searchParams, *identifiers, dto.Pagination{})
+	if err != nil {
+		return err
+	}
+
+	if len(results.Edges) > 0 {
+		return fmt.Errorf("a %s questionnaire response  for patient %s already exists for encounter %s", screeningType.Text(), patientReference, encounterReference)
+	}
+
+	return nil
+}
+
 // generateQuestionnaireReviewSummary takes a questionnaire response and
 // analyzes it to determine the risk stratification based on three distinct groups:
 // symptoms, family history, and risk factors. The assumption is that the
@@ -109,8 +139,7 @@ func (u *UseCasesClinicalImpl) generateQuestionnaireReviewSummary(
 	}
 
 	switch *questionnaire.Resource.Name {
-	// TODO: Make this a controlled enum?
-	case "Cervical Cancer Screening":
+	case domain.CervicalCancerScreeningTypeEnum.Text():
 		var symptomsScore, riskFactorsScore, totalScore int
 
 		for _, item := range questionnaireResponse.Item {
@@ -141,7 +170,7 @@ func (u *UseCasesClinicalImpl) generateQuestionnaireReviewSummary(
 				questionnaireResponseID,
 				common.HighRiskCIELCode,
 				"High Risk",
-				domain.CervicalCancerScreeningTypeEnum.Text(), // TODO: This is TEMPORARY. A follow up PR is to follow supplying the value from params
+				domain.CervicalCancerScreeningTypeEnum.Text(),
 			)
 			if err != nil {
 				return "", err

pkg/clinical/usecases/clinical/questionnaire_response_test.go

@@ -15,6 +15,7 @@ import (
 	fakePubSubMock "github.com/savannahghi/clinical/pkg/clinical/infrastructure/services/pubsub/mock"
 	fakeUploadMock "github.com/savannahghi/clinical/pkg/clinical/infrastructure/services/upload/mock"
 	clinicalUsecase "github.com/savannahghi/clinical/pkg/clinical/usecases/clinical"
+	"github.com/savannahghi/firebasetools"
 )
 
 func setupMockFHIRFunctions(fakeFHIR *fakeFHIRMock.FHIRMock, score int) {
@@ -75,6 +76,7 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 		input           dto.QuestionnaireResponse
 		questionnaireID string
 		encounterID     string
+		screeningType   domain.ScreeningTypeEnum
 	}
 	tests := []struct {
 		name    string
@@ -88,6 +90,7 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 				input:           dto.QuestionnaireResponse{},
 				questionnaireID: ID,
 				encounterID:     ID,
+				screeningType:   domain.CervicalCancerScreeningTypeEnum,
 			},
 			wantErr: true,
 		},
@@ -135,6 +138,7 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 				ctx:             context.Background(),
 				encounterID:     gofakeit.UUID(),
 				questionnaireID: gofakeit.UUID(),
+				screeningType:   domain.CervicalCancerScreeningTypeEnum,
 			},
 			wantErr: false,
 		},
@@ -144,6 +148,7 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 				ctx:             context.Background(),
 				encounterID:     gofakeit.UUID(),
 				questionnaireID: gofakeit.UUID(),
+				screeningType:   domain.CervicalCancerScreeningTypeEnum,
 			},
 			wantErr: false,
 		},
@@ -183,6 +188,24 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 			},
 			wantErr: true,
 		},
+		{
+			name: "Sad Case - unable to get tenant identifiers",
+			args: args{
+				ctx:             context.Background(),
+				encounterID:     gofakeit.UUID(),
+				questionnaireID: gofakeit.UUID(),
+			},
+			wantErr: true,
+		},
+		{
+			name: "Sad Case - unable to search for risk assessment",
+			args: args{
+				ctx:             context.Background(),
+				encounterID:     gofakeit.UUID(),
+				questionnaireID: gofakeit.UUID(),
+			},
+			wantErr: true,
+		},
 	}
 	for _, tt := range tests {
 		t.Run(tt.name, func(t *testing.T) {
@@ -229,6 +252,13 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 			}
 
 			if tt.name == "Happy Case - Create questionnaire response and generate review summary - Cervical Cancer - High Risk" {
+				fakeFHIR.MockSearchFHIRRiskAssessmentFn = func(ctx context.Context, params map[string]interface{}, tenant dto.TenantIdentifiers, pagination dto.Pagination) (*domain.FHIRRiskAssessmentRelayConnection, error) {
+					return &domain.FHIRRiskAssessmentRelayConnection{
+						Edges:    []*domain.FHIRRiskAssessmentRelayEdge{},
+						PageInfo: &firebasetools.PageInfo{},
+					}, nil
+				}
+
 				fakeFHIR.MockGetFHIRQuestionnaireFn = func(ctx context.Context, id string) (*domain.FHIRQuestionnaireRelayPayload, error) {
 					questionnaireName := "Cervical Cancer Screening"
 					return &domain.FHIRQuestionnaireRelayPayload{
@@ -277,6 +307,13 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 			}
 
 			if tt.name == "Happy Case - Create questionnaire response and generate review summary - Cervical Cancer - Low Risk" {
+				fakeFHIR.MockSearchFHIRRiskAssessmentFn = func(ctx context.Context, params map[string]interface{}, tenant dto.TenantIdentifiers, pagination dto.Pagination) (*domain.FHIRRiskAssessmentRelayConnection, error) {
+					return &domain.FHIRRiskAssessmentRelayConnection{
+						Edges:    []*domain.FHIRRiskAssessmentRelayEdge{},
+						PageInfo: &firebasetools.PageInfo{},
+					}, nil
+				}
+
 				fakeFHIR.MockGetFHIRQuestionnaireFn = func(ctx context.Context, id string) (*domain.FHIRQuestionnaireRelayPayload, error) {
 					questionnaireName := "Cervical Cancer Screening"
 					return &domain.FHIRQuestionnaireRelayPayload{
@@ -347,8 +384,18 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 			if tt.name == "Sad Case - Fail to record risk assessment - High Risk" {
 				setupMockFHIRFunctions(fakeFHIR, 3)
 			}
+			if tt.name == "Sad Case - unable to get tenant identifiers" {
+				fakeExt.MockGetTenantIdentifiersFn = func(ctx context.Context) (*dto.TenantIdentifiers, error) {
+					return nil, fmt.Errorf("failed to get tenant identifiers")
+				}
+			}
+			if tt.name == "Sad Case - unable to search for risk assessment" {
+				fakeFHIR.MockSearchFHIRRiskAssessmentFn = func(ctx context.Context, params map[string]interface{}, tenant dto.TenantIdentifiers, pagination dto.Pagination) (*domain.FHIRRiskAssessmentRelayConnection, error) {
+					return nil, fmt.Errorf("failed to search for risk assessment")
+				}
+			}
 
-			_, err := q.CreateQuestionnaireResponse(tt.args.ctx, tt.args.questionnaireID, tt.args.encounterID, tt.args.input)
+			_, err := q.CreateQuestionnaireResponse(tt.args.ctx, tt.args.questionnaireID, tt.args.encounterID, tt.args.screeningType, tt.args.input)
 			if (err != nil) != tt.wantErr {
 				t.Errorf("UseCasesClinicalImpl.CreateQuestionnaireResponse() error = %v, wantErr %v", err, tt.wantErr)
 				return

pkg/clinical/usecases/usecases.go

@@ -108,7 +108,7 @@ type Clinical interface {
 
 	// Questionnaire
 	CreateQuestionnaire(ctx context.Context, questionnaireInput *domain.FHIRQuestionnaire) (*domain.FHIRQuestionnaire, error)
-	CreateQuestionnaireResponse(ctx context.Context, questionnaireID string, encounterID string, input dto.QuestionnaireResponse) (string, error)
+	CreateQuestionnaireResponse(ctx context.Context, questionnaireID, encounterID string, screeningType domain.ScreeningTypeEnum, input dto.QuestionnaireResponse) (string, error)
 	ListQuestionnaires(ctx context.Context, searchParam *string, pagination *dto.Pagination) (*dto.QuestionnaireConnection, error)
 	RecordConsent(ctx context.Context, input dto.ConsentInput) (*dto.ConsentOutput, error)