fix: return risk level after questionnaire response is submitted

This changes the workflow for generating a questionnaire response risk summary. New workflow: - After a questionnaire response is submitted, calculate the scores - Based off the score, generate a risk summary - Store the risk summary as FHIR RiskAssessment resource - Return the risk summary i.e either High Risk / Low Risk (For now)
savannahghi · Feb 9, 2024 · c8ab4fd · c8ab4fd
1 parent d8e7ede
commit c8ab4fd
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Showing 9 changed files with 130 additions and 184 deletions.
diff --git a/pkg/clinical/infrastructure/datastore/cloudhealthcare/mock/fhir_mock.go b/pkg/clinical/infrastructure/datastore/cloudhealthcare/mock/fhir_mock.go
@@ -1987,6 +1987,13 @@ func NewFHIRMock() *FHIRMock {
 			riskAssessment := &domain.FHIRRiskAssessment{
 				ID:   new(string),
 				Meta: &domain.FHIRMeta{},
+				Prediction: []domain.FHIRRiskAssessmentPrediction{
+					{
+						Outcome: &domain.FHIRCodeableConcept{
+							Text: "High Risk",
+						},
+					},
+				},
 			}
 			return &domain.FHIRRiskAssessmentRelayPayload{
 				Resource: riskAssessment,

diff --git a/pkg/clinical/presentation/graph/clinical.graphql b/pkg/clinical/presentation/graph/clinical.graphql
@@ -214,7 +214,7 @@ extend type Mutation {
     questionnaireID: String!
     encounterID: String!
     input: QuestionnaireResponseInput!
-  ): QuestionnaireResponse!
+  ): String!
 
   # Diagnostic Report
   recordMammographyResult(input: DiagnosticReportInput!): DiagnosticReport!

diff --git a/pkg/clinical/presentation/graph/clinical.resolvers.go b/pkg/clinical/presentation/graph/clinical.resolvers.go
diff --git a/pkg/clinical/presentation/graph/generated/generated.go b/pkg/clinical/presentation/graph/generated/generated.go
diff --git a/pkg/clinical/usecases/clinical/questionnaire_response.go b/pkg/clinical/usecases/clinical/questionnaire_response.go
@@ -3,6 +3,7 @@ package clinical
 import (
 	"context"
 	"fmt"
+	"time"
 
 	"github.com/mitchellh/mapstructure"
 	"github.com/savannahghi/clinical/pkg/clinical/application/common"
@@ -12,21 +13,21 @@ import (
 )
 
 // CreateQuestionnaireResponse creates a questionnaire response
-func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context, questionnaireID string, encounterID string, input dto.QuestionnaireResponse) (*dto.QuestionnaireResponse, error) {
+func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context, questionnaireID string, encounterID string, input dto.QuestionnaireResponse) (string, error) {
 	questionnaireResponse := &domain.FHIRQuestionnaireResponse{}
 
 	err := mapstructure.Decode(input, questionnaireResponse)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
 	encounter, err := u.infrastructure.FHIR.GetFHIREncounter(ctx, encounterID)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
 	if encounter.Resource.Status == domain.EncounterStatusEnumFinished {
-		return nil, fmt.Errorf("cannot create a questionnaire response in a finished encounter")
+		return "", fmt.Errorf("cannot create a questionnaire response in a finished encounter")
 	}
 
 	patientID := encounter.Resource.Subject.ID
@@ -49,7 +50,7 @@ func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context,
 
 	tags, err := u.GetTenantMetaTags(ctx)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
 	questionnaireResponse.Meta = &domain.FHIRMetaInput{
@@ -61,29 +62,29 @@ func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context,
 
 	resp, err := u.infrastructure.FHIR.CreateFHIRQuestionnaireResponse(ctx, questionnaireResponse)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
 	output := &dto.QuestionnaireResponse{}
 
 	err = mapstructure.Decode(resp, output)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
 	// TODO: This will affect the API performance. Optimize it
-	err = u.generateQuestionnaireReviewSummary(
+	riskLevel, err := u.generateQuestionnaireReviewSummary(
 		ctx,
 		questionnaireID,
 		*resp.ID,
-		encounterID,
+		encounter,
 		output,
 	)
 	if err != nil {
-		return nil, err
+		return "", err
 	}
 
-	return output, nil
+	return riskLevel, nil
 }
 
 // generateQuestionnaireReviewSummary takes a questionnaire response and
@@ -96,13 +97,13 @@ func (u *UseCasesClinicalImpl) CreateQuestionnaireResponse(ctx context.Context,
 func (u *UseCasesClinicalImpl) generateQuestionnaireReviewSummary(
 	ctx context.Context,
 	questionnaireID,
-	questionnaireResponseID,
-	encounterID string,
+	questionnaireResponseID string,
+	encounterID *domain.FHIREncounterRelayPayload,
 	questionnaireResponse *dto.QuestionnaireResponse,
-) error {
+) (string, error) {
 	questionnaire, err := u.infrastructure.FHIR.GetFHIRQuestionnaire(ctx, questionnaireID)
 	if err != nil {
-		return err
+		return "", err
 	}
 
 	switch *questionnaire.Resource.Name {
@@ -132,42 +133,42 @@ func (u *UseCasesClinicalImpl) generateQuestionnaireReviewSummary(
 
 		switch {
 		case totalScore >= 2:
-			err := u.recordRiskAssessment(
+			riskLevel, err := u.recordRiskAssessment(
 				ctx,
 				encounterID,
 				questionnaireResponseID,
 				common.HighRiskCIELCode,
 				"High Risk",
 			)
 			if err != nil {
-				return err
+				return riskLevel, err
 			}
 
 		case totalScore < 2:
-			err := u.recordRiskAssessment(
+			riskLevel, err := u.recordRiskAssessment(
 				ctx,
 				encounterID,
 				questionnaireResponseID,
 				common.LowRiskCIELCode,
 				"Low Risk",
 			)
 			if err != nil {
-				return err
+				return riskLevel, err
 			}
 		}
 	default:
-		return fmt.Errorf("questionnaire does not exist")
+		return "", fmt.Errorf("questionnaire does not exist")
 	}
 
-	return nil
+	return "", nil
 }
 
 func (u *UseCasesClinicalImpl) recordRiskAssessment(
 	ctx context.Context,
-	encounterID,
+	encounter *domain.FHIREncounterRelayPayload,
 	questionnaireResponseID string,
 	outcomeCode, outcomeDisplay string,
-) error {
+) (string, error) {
 	CIELTerminologySystem := scalarutils.URI(common.CIELTerminologySystem)
 	codingCode := scalarutils.Code(outcomeCode)
 
@@ -182,12 +183,58 @@ func (u *UseCasesClinicalImpl) recordRiskAssessment(
 		Text: outcomeDisplay,
 	}
 
-	_, err := u.RecordRiskAssessment(ctx, encounterID, questionnaireResponseID, outcome)
+	patientID := encounter.Resource.Subject.ID
+	patientReference := fmt.Sprintf("Patient/%s", *patientID)
+
+	encounterReference := fmt.Sprintf("Encounter/%s", *encounter.Resource.ID)
+
+	questionnaireResponseReference := fmt.Sprintf("QuestionnaireResponse/%s", questionnaireResponseID)
+
+	instant := scalarutils.Instant(time.Now().Format(time.RFC3339))
+
+	riskAssessment := domain.FHIRRiskAssessmentInput{
+		Status: domain.ObservationStatusEnumFinal,
+		Code:   &domain.FHIRCodeableConceptInput{},
+		Subject: domain.FHIRReferenceInput{
+			ID:        encounter.Resource.Subject.ID,
+			Reference: &patientReference,
+			Display:   encounter.Resource.Subject.Display,
+		},
+
+		Encounter: &domain.FHIRReferenceInput{
+			ID:        encounter.Resource.ID,
+			Reference: &encounterReference,
+		},
+		OccurrenceDateTime: (*string)(&instant),
+		Prediction: []domain.FHIRRiskAssessmentPrediction{
+			{
+				Outcome: &outcome,
+			},
+		},
+		Basis: []domain.FHIRReferenceInput{
+			{
+				Reference: &questionnaireResponseReference,
+			},
+		},
+	}
+
+	tags, err := u.GetTenantMetaTags(ctx)
 	if err != nil {
-		return err
+		return "", err
 	}
 
-	return nil
+	riskAssessment.Meta = &domain.FHIRMetaInput{
+		Tag: tags,
+	}
+
+	assessment, err := u.RecordRiskAssessment(ctx, &riskAssessment)
+	if err != nil {
+		return "", err
+	}
+
+	riskLevel := assessment.Prediction[0].Outcome.Text
+
+	return riskLevel, nil
 }
 
 // GetQuestionnaireResponseRiskLevel fetches the risk level associated with a questionnaire response. This is based off the scoring

diff --git a/pkg/clinical/usecases/clinical/questionnaire_response_test.go b/pkg/clinical/usecases/clinical/questionnaire_response_test.go
@@ -165,6 +165,24 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 			},
 			wantErr: true,
 		},
+		{
+			name: "Sad Case - non-existent fhir questionnaire",
+			args: args{
+				ctx:             context.Background(),
+				encounterID:     gofakeit.UUID(),
+				questionnaireID: gofakeit.UUID(),
+			},
+			wantErr: true,
+		},
+		{
+			name: "Sad Case - fail to get tenant meta tags",
+			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) {
@@ -305,6 +323,23 @@ func TestUseCasesClinicalImpl_CreateQuestionnaireResponse(t *testing.T) {
 				}
 			}
 
+			if tt.name == "Sad Case - non-existent fhir questionnaire" {
+				randomName := gofakeit.BeerName()
+				fakeFHIR.MockGetFHIRQuestionnaireFn = func(ctx context.Context, id string) (*domain.FHIRQuestionnaireRelayPayload, error) {
+					return &domain.FHIRQuestionnaireRelayPayload{
+						Resource: &domain.FHIRQuestionnaire{
+							Name: &randomName,
+						},
+					}, nil
+				}
+			}
+
+			if tt.name == "Sad Case - fail to get tenant meta tags" {
+				fakeExt.MockGetTenantIdentifiersFn = func(ctx context.Context) (*dto.TenantIdentifiers, error) {
+					return nil, fmt.Errorf("failed to get tenant identifiers")
+				}
+			}
+
 			if tt.name == "Sad Case - Fail to record risk assessment - Low Risk" {
 				setupMockFHIRFunctions(fakeFHIR, 0)
 			}