/// <summary>
/// Retrieve the list of clinical problems for a patient encounter.
/// </summary>
/// <param name="id">encounter id</param>
/// <returns>An xml serializtion string of a list of clinical problems</returns>
string IDecisionSupportService.RetrieveProblemList(int id)
{
var encounter = db.EncounterContextItemDefinitionFind(id);
if (encounter == null)
return "";
try
{
var list = new List<ClinicalProblemInstanceSimpleObject>();
foreach (var instance in AssociationHelper.SearchClinicalProblemInstance(encounter, db))
{
var simpleObject = new ClinicalProblemInstanceSimpleObject()
{
Reports = new List<KeyValuePair<string, string>>(),
Facts = new List<string>(),
OrderSet = new List<string>(),
History = new List<string>()
};
simpleObject.Id = instance.Id;
simpleObject.Priority = instance.Priority;
simpleObject.State = instance.State;
if(instance.ClinicalProblemDefinition!=null && string.IsNullOrEmpty(instance.ClinicalProblemDefinition.Name)==false)
simpleObject.Name = instance.ClinicalProblemDefinition.Name;
if(instance.ChangeRecord!=null && instance.ChangeRecord.Count()>0)
simpleObject.TimeStamp = instance.ChangeRecord.ElementAt(0).TimeStamp.Value;
if (instance.ClinicalProblemDefinition != null && instance.ClinicalProblemDefinition.TriggerRule != null)
simpleObject.TriggerRule = RuleSetHelper.GetLaymanConditionString(instance.ClinicalProblemDefinition.TriggerRule.RuleSet);
foreach (var fact in instance.Facts)
{
var factString = string.IsNullOrEmpty(fact.ContextItemDefinition.ReferenceRange) ?
fact.ContextItemDefinition.Name + " = " + fact.ValueString() :
fact.ContextItemDefinition.Name + " = " + fact.ValueString() + " (参考范围:" + fact.ContextItemDefinition.ReferenceRange + ")";
simpleObject.Facts.Add(factString);
}
foreach (var report in instance.Reports)
{
simpleObject.Reports.Add(new KeyValuePair<string, string>(report.TimeStamp + " " + report.ReportType, report.URL));
}
// Don't need to show history for now.
//foreach (var record in instance.ChangeRecord)
//{
// simpleObject.History.Add();
//}
int count = 0;
foreach (var order in db.MedicalOrderSet)
{
simpleObject.OrderContextItemDefinitionAdd(order.Name);
if (count++ > 10)
break;
}
list.Add(simpleObject);
}
var obj = list as object;
return SerializationHelper.Serialize(ref obj);
}
catch
{
return "";
}
}
/// <summary>
/// Innter Implemention of I/F Notify():
/// void IDecisionSupportService.Notify(int id)
/// </summary>
/// <param name="id">event id</param>
/// <returns>log items.
/// For each log keypair, DateTime is timestamp, string is log content.</returns>
public IEnumerable<KeyValuePair<DateTime, string>> Notify(int id)
{
var log = new List<KeyValuePair<DateTime, string>>();
var sw = Stopwatch.StartNew();
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "[BEGIN]"));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "Call I/F Notify(" + id + ")"));
// TODO: Search EMR db and construct event, report, encounter, etc. in CDS db
var evt = db.Event.Find(id);
if (evt == null)
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "Event with specified id doesnot exist. Exit funciton now."));
return log;
}
var encounter = evt.Encounter;
if (encounter == null)
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "Associated encounter doesnot exist. Exit funciton now."));
return log;
}
// Collect abnormal facts from the event
//
var abnormalFacts = new List<Fact>();
var relatedProblemInstances = new List<ClinicalProblemInstance>();
var solvedSuspectProblemInstances = new List<ClinicalProblemInstance>();
foreach (var x in evt.Report)
{
// Get facts from report and update to profile.
var facts = (new FactServiceMocker()).GetFactsFromReportMock(x.Id, db).ToList();
// TODO: var facts = factService.GetFactsFromReport(x.URL).ToList();
facts.ForEach(y =>
{
db.UpdateFactCache(encounter.Id, y);
if (y.ContextItemDefinition.Type == EnumContextItemType.ClinicalProblem.ToString() && y.IsAbnormal == false)
{
var instance = db.ClinicalProblemInstance.FirstOrDefault(z => z.State == EnumProblemState.New.ToString() && z.ClinicalProblemDefinition.Name == y.ContextItemDefinition.Name);
if (instance != null)
{
solvedSuspectProblemInstances.Add(instance);
}
}
// collect related problem instances associated with the fact. Later, use Distinct() to get full list.
foreach (var z in db.ClinicalProblemInstance)
{
if ((z.State == EnumProblemState.New.ToString() ||
z.State == EnumProblemState.ResolvedSuspected.ToString()) &&
z.ClinicalProblemDefinition.ContextItemDefinition.Contains(y.ContextItemDefinition, new PropertyComparer<ContextItemDefinition>("Id")))
{
relatedProblemInstances.Add(z);
}
}
// Collect abnormal facts as triggers
if (y.IsAbnormal == true)
{
abnormalFacts.Add(y);
}
});
};
// Update problems that are suspected no longer existing.
solvedSuspectProblemInstances.Distinct(new PropertyComparer<ClinicalProblemInstance>("Id")).ToList().ForEach(x =>
{
db.UpdateProblemState(x.Id, EnumProblemState.ResolvedSuspected.ToString(), EnumProblemStateChangeReason.CDS.ToString(), CurrentUser);
});
// Update related active problems with new report, for tracking.
relatedProblemInstances.Distinct(new PropertyComparer<ClinicalProblemInstance>("Id")).ToList().ForEach(x =>
{
var result = ReEvaluate(x.Id);
if (result.HasValue)
{
if (result.Value == false)
{
db.UpdateProblemState(x.Id, EnumProblemState.ResolvedSuspected.ToString(), EnumProblemStateChangeReason.CDS.ToString(),CurrentUser);
}
else
{
db.UpdateProblemState(x.Id, x.State, EnumProblemStateChangeReason.CDS.ToString(),CurrentUser);
}
}
});
if (abnormalFacts.Count <= 0)
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "No abnormal facts were detected. Exit funciton now."));
return log;
}
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, abnormalFacts.Count + " abnormal facts were detected:"));
abnormalFacts.ForEach(x =>
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, x.ContextItemDefinition.Name + " = " + x.ValueString()));
});
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
var triggerFacts = new List<Fact>();
abnormalFacts.ForEach(x =>
{
if (x.ContextItemDefinition.Type==EnumContextItemType.ClinicalProblem.ToString()) // The fact itself is a problem. e.g. the fact comes from a diagnosis event.
{
int ID = db.CreateClinicalProblemInstance(x.ContextItemDefinition.Name, encounter.Id, false);
if (ID != -1)
{
db.UpdateProblemState(ID, EnumProblemState.New.ToString(), EnumProblemStateChangeReason.CDS.ToString(), CurrentUser, true);
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "!!! New Problem[" + x.ContextItemDefinition.Name + "] is detected directly from fact[" + x.ContextItemDefinition.Name + "=" + x.ValueString() + "]. (the fact itself is a problem)"));
}
}
else // The fact needs reasoning by rule engine to generate problem.
{
triggerFacts.Add(x);
}
});
//
// Get candidate problems by abnormal facts
//
var candidateProblems = GetCandidateProblems(triggerFacts);
if (candidateProblems.Count() <= 0)
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "No candidate problems were detected. Exit function now."));
return log;
}
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, candidateProblems.Count() + " candidate problems were detected:"));
candidateProblems.ToList().ForEach(x =>
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, x.Name));
});
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
//
// Construct reasoning context for candidate problems
//
IEnumerable<ClinicalProblemDefinition> filteredProblems;
Context reasoningContext;
ConstructReasoningContext(encounter, candidateProblems, out filteredProblems, out reasoningContext);
if (filteredProblems.Count() <= 0)
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "Lacking reasoning facts for all candidate problems. Exit function now."));
return log;
}
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "After checking data availability, " + filteredProblems.Count() + " problems can go through rule engine:"));
filteredProblems.ToList().ForEach(x =>
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, x.Name));
});
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "Reasoning context contains: " + reasoningContext.GetAllKeys().Count() + " items:"));
foreach (var x in reasoningContext.GetAllKeys())
{
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, x + " = " + reasoningContext.GetValue(x)));
}
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
//
// Reason by Rule Engine
//
var triggeredProblems = Reason(filteredProblems, reasoningContext);
if (triggeredProblems != null && triggeredProblems.Count() > 0)
{
triggeredProblems.ToList().ForEach(x =>
{
int ID = db.CreateClinicalProblemInstance(x, encounter.Id, true);
if (relatedProblemInstances.Any(y => y.Id == ID) == false // means the problem state is already updated above
&& ID != -1)
{
db.UpdateProblemState(ID, EnumProblemState.New.ToString(), EnumProblemStateChangeReason.CDS.ToString(), CurrentUser);
var instance = db.ClinicalProblemInstance.Find(ID);
if (instance != null && instance.TriggerRule != null && string.IsNullOrEmpty(instance.TriggerRule.RuleSet) == false)
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "!!! New Problem[" + x + "] is detected from rule[" + RuleSetHelper.GetLaymanConditionString(instance.TriggerRule.RuleSet) + "]."));
}
});
}
sw.Stop();
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, ""));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "This I/F call consumes " + sw.ElapsedMilliseconds + " ms"));
log.Add(new KeyValuePair<DateTime, string>(DateTime.Now, "[END]"));
return log;
}