///<summary>This is the first step of automation, this checks to see if the new object matches one of the trigger conditions. </summary> /// <param name="triggerObject">Can be DiseaseDef, ICD9, Icd10, Snomed, Medication, RxNorm, Cvx, AllerfyDef, EHRLabResult, Patient, or VitalSign.</param> /// <param name="PatCur">Triggers and intervention are currently always dependant on current patient. </param> /// <returns>Returns a dictionary keyed on triggers and a list of all the objects that the trigger matched on. Should be used to generate CDS intervention message and later be passed to FormInfobutton for knowledge request.</returns> public static List<CDSIntervention> TriggerMatch(object triggerObject,Patient PatCur) { if(RemotingClient.RemotingRole==RemotingRole.ClientWeb) { return Meth.GetObject<List<CDSIntervention>>(MethodBase.GetCurrentMethod(),triggerObject,PatCur); } //Dictionary<string,List<object>> retVal=new Dictionary<string,List<object>>(); List<CDSIntervention> retVal=new List<CDSIntervention>(); //Define objects to be used in matching triggers. DiseaseDef diseaseDef; ICD9 icd9; Icd10 icd10; Snomed snomed; Medication medication; RxNorm rxNorm; Cvx cvx; AllergyDef allergyDef; EhrLabResult ehrLabResult; Patient pat; Vitalsign vitalsign; string triggerObjectMessage=""; string command=""; switch(triggerObject.GetType().Name) { case "DiseaseDef": diseaseDef=(DiseaseDef)triggerObject; command="SELECT * FROM ehrtrigger" +" WHERE ProblemDefNumList LIKE '% "+POut.String(diseaseDef.DiseaseDefNum.ToString())+" %'";// '% <code> %' so that we can get exact matches. if(diseaseDef.ICD9Code!="") { command+=" OR ProblemIcd9List LIKE '% "+POut.String(diseaseDef.ICD9Code)+" %'"; ICD9 icd10Cur=ICD9s.GetByCode(diseaseDef.ICD9Code); if(icd10Cur!=null){ triggerObjectMessage+=" -"+diseaseDef.ICD9Code+"(Icd9) "+icd10Cur.Description+"\r\n"; } } if(diseaseDef.Icd10Code!="") { command+=" OR ProblemIcd10List LIKE '% "+POut.String(diseaseDef.Icd10Code)+" %'"; Icd10 icd10Cur=Icd10s.GetByCode(diseaseDef.Icd10Code); if(icd10Cur!=null) { triggerObjectMessage+=" -"+diseaseDef.Icd10Code+"(Icd10) "+icd10Cur.Description+"\r\n"; } } if(diseaseDef.SnomedCode!="") { command+=" OR ProblemSnomedList LIKE '% "+POut.String(diseaseDef.SnomedCode)+" %'"; Snomed snomedCur=Snomeds.GetByCode(diseaseDef.SnomedCode); if(snomedCur!=null) { triggerObjectMessage+=" -"+diseaseDef.SnomedCode+"(Snomed) "+snomedCur.Description+"\r\n"; } } break; case "ICD9": icd9=(ICD9)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger" +" WHERE Icd9List LIKE '% "+POut.String(icd9.ICD9Code)+" %'";// '% <code> %' so that we can get exact matches. break; case "Icd10": icd10=(Icd10)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger" +" WHERE Icd10List LIKE '% "+POut.String(icd10.Icd10Code)+" %'";// '% <code> %' so that we can get exact matches. break; case "Snomed": snomed=(Snomed)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger" +" WHERE SnomedList LIKE '% "+POut.String(snomed.SnomedCode)+" %'";// '% <code> %' so that we can get exact matches. break; case "Medication": medication=(Medication)triggerObject; RxNorm rxNormCur=RxNorms.GetByRxCUI(medication.RxCui.ToString()); if(rxNormCur!=null) { triggerObjectMessage=" - "+medication.MedName+(medication.RxCui==0?"":" (RxCui:"+rxNormCur.RxCui+")")+"\r\n"; } command="SELECT * FROM ehrtrigger" +" WHERE MedicationNumList LIKE '% "+POut.String(medication.MedicationNum.ToString())+" %'";// '% <code> %' so that we can get exact matches. if(medication.RxCui!=0) { command+=" OR RxCuiList LIKE '% "+POut.String(medication.RxCui.ToString())+" %'";// '% <code> %' so that we can get exact matches. } break; case "RxNorm": rxNorm=(RxNorm)triggerObject; triggerObjectMessage=" - "+rxNorm.Description+"(RxCui:"+rxNorm.RxCui+")\r\n"; command="SELECT * FROM ehrtrigger" +" WHERE RxCuiList LIKE '% "+POut.String(rxNorm.RxCui)+" %'";// '% <code> %' so that we can get exact matches. break; case "Cvx": cvx=(Cvx)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger" +" WHERE CvxList LIKE '% "+POut.String(cvx.CvxCode)+" %'";// '% <code> %' so that we can get exact matches. break; case "AllergyDef": allergyDef=(AllergyDef)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger" +" WHERE AllergyDefNumList LIKE '% "+POut.String(allergyDef.AllergyDefNum.ToString())+" %'";// '% <code> %' so that we can get exact matches. break; case "EhrLabResult"://match loinc only, no longer ehrLabResult=(EhrLabResult)triggerObject; //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger WHERE " +"(LabLoincList LIKE '% "+ehrLabResult.ObservationIdentifierID+" %'" //LOINC may be in one of two fields +"OR LabLoincList LIKE '% "+ehrLabResult.ObservationIdentifierIDAlt+" %')"; //LOINC may be in one of two fields break; case "Patient": pat=(Patient)triggerObject; List<string> triggerNums=new List<string>(); //TODO: TriggerObjectMessage command="SELECT * FROM ehrtrigger WHERE DemographicsList !=''"; List<EhrTrigger> triggers=Crud.EhrTriggerCrud.SelectMany(command); for(int i=0;i<triggers.Count;i++) { string[] arrayDemoItems=triggers[i].DemographicsList.Split(new string[] { " " },StringSplitOptions.RemoveEmptyEntries); for(int j=0;j<arrayDemoItems.Length;j++) { switch(arrayDemoItems[j].Split(',')[0]) { case "age": int val=PIn.Int(Regex.Match(arrayDemoItems[j],@"\d+").Value); if(arrayDemoItems[j].Contains("=")) {//=, >=, or <= if(val==pat.Age) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } if(arrayDemoItems[j].Contains("<")){ if(pat.Age<val){ triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } if(arrayDemoItems[j].Contains(">")) { if(pat.Age>val) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } //should never happen, age element didn't contain a comparator break; case "gender": if(arrayDemoItems[j].Split(',')[0].StartsWith(pat.Gender.ToString())) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); } break; default: break;//should never happen } } } triggerNums.Add("-1");//to ensure the querry is valid. command="SELECT * FROM ehrTrigger WHERE EhrTriggerNum IN ("+String.Join(",",triggerNums)+")"; break; case "Vitalsign": List<string> trigNums=new List<string>(); vitalsign=(Vitalsign)triggerObject; command="SELECT * FROM ehrtrigger WHERE VitalLoincList !=''"; List<EhrTrigger> triggersVit=Crud.EhrTriggerCrud.SelectMany(command); for(int i=0;i<triggersVit.Count;i++) { string[] arrayVitalItems=triggersVit[i].VitalLoincList.Split(new string[] { " " },StringSplitOptions.RemoveEmptyEntries); for(int j=0;j<arrayVitalItems.Length;j++) { double val=PIn.Double(Regex.Match(arrayVitalItems[j],@"\d+(.(\d+))*").Value);//decimal value w or w/o decimal. switch(arrayVitalItems[j].Split(',')[0]) { case "height": if(arrayVitalItems[j].Contains("=")) {//=, >=, or <= if(vitalsign.Height==val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains("<")) { if(vitalsign.Height<val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains(">")) { if(vitalsign.Height>val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } //should never happen, Height element didn't contain a comparator break; case "weight": if(arrayVitalItems[j].Contains("=")) {//=, >=, or <= if(vitalsign.Weight==val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains("<")) { if(vitalsign.Weight<val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains(">")) { if(vitalsign.Weight>val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } break; case "BMI": float BMI=Vitalsigns.CalcBMI(vitalsign.Weight,vitalsign.Height); if(arrayVitalItems[j].Contains("=")) {//=, >=, or <= if(BMI==val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains("<")) { if(BMI<val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if(arrayVitalItems[j].Contains(">")) { if(BMI>val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } break; case "BP": //TODO break; }//end switch } }//End Triggers Vit trigNums.Add("-1");//to ensure the querry is valid. command="SELECT * FROM ehrTrigger WHERE EhrTriggerNum IN ("+String.Join(",",trigNums)+")"; break; default: //command="SELECT * FROM ehrtrigger WHERE false";//should not return any results. return null; #if DEBUG throw new Exception(triggerObject.GetType().ToString()+" object not implemented as intervention trigger yet. Add to the list above to handle."); #endif //break; } List<EhrTrigger> listEhrTriggers=Crud.EhrTriggerCrud.SelectMany(command); if(listEhrTriggers.Count==0){ return null;//no triggers matched. } //Check for MatchCardinality.One type triggers.---------------------------------------------------------------------------- for(int i=0;i<listEhrTriggers.Count;i++) { if(listEhrTriggers[i].Cardinality!=MatchCardinality.One) { continue; } string triggerMessage=listEhrTriggers[i].Description+":\r\n";//Example:"Patient over 55:\r\n" triggerMessage+=triggerObjectMessage;//Example:" -Patient Age 67\r\n" List<object> ListObjectMatches=new List<object>(); ListObjectMatches.Add(triggerObject); CDSIntervention cdsi=new CDSIntervention(); cdsi.EhrTrigger=listEhrTriggers[i]; cdsi.InterventionMessage=triggerMessage; cdsi.TriggerObjects=ListObjectMatches; retVal.Add(cdsi); } //Fill object lists to be checked------------------------------------------------------------------------------------------------- List<Allergy> ListAllergy=Allergies.GetAll(PatCur.PatNum,false); List<Disease> ListDisease=Diseases.Refresh(PatCur.PatNum,true); List<DiseaseDef> ListDiseaseDef=new List<DiseaseDef>(); List<EhrLab> ListEhrLab=EhrLabs.GetAllForPat(PatCur.PatNum); //List<EhrLabResult> ListEhrLabResults=null;//Lab results are stored in a list in the EhrLab object. List<MedicationPat> ListMedicationPat=MedicationPats.Refresh(PatCur.PatNum,false); List<AllergyDef> ListAllergyDef=new List<AllergyDef>(); for(int i=0;i<ListAllergy.Count;i++){ ListAllergyDef.Add(AllergyDefs.GetOne(ListAllergy[i].AllergyDefNum)); } for(int i=0;i<ListDisease.Count;i++){ ListDiseaseDef.Add(DiseaseDefs.GetItem(ListDisease[i].DiseaseDefNum)); } for(int i=0;i<listEhrTriggers.Count;i++) { if(listEhrTriggers[i].Cardinality==MatchCardinality.One) { continue;//we handled these above. } string triggerMessage=listEhrTriggers[i].Description+":\r\n"; triggerMessage+=triggerObjectMessage; List<object> ListObjectMatches=new List<object>();//Allergy, Disease, LabPanels, MedicationPat, Patient, VaccinePat ListObjectMatches.Add(triggerObject); //Allergy----------------------------------------------------------------------------------------------------------------------- //allergy.snomedreaction //allergy.AllergyDefNum>>AllergyDef.SnomedType //allergy.AllergyDefNum>>AllergyDef.SnomedAllergyTo //allergy.AllergyDefNum>>AllergyDef.MedicationNum>>Medication.RxCui //Disease----------------------------------------------------------------------------------------------------------------------- //Disease.DiseaseDefNum>>DiseaseDef.ICD9Code //Disease.DiseaseDefNum>>DiseaseDef.SnomedCode //Disease.DiseaseDefNum>>DiseaseDef.Icd10Code //LabPanels--------------------------------------------------------------------------------------------------------------------- //LabPanel.LabPanelNum<<LabResult.TestId (Loinc) //LabPanel.LabPanelNum<<LabResult.ObsValue (Loinc) //LabPanel.LabPanelNum<<LabResult.ObsRange (Loinc) //MedicationPat----------------------------------------------------------------------------------------------------------------- //MedicationPat.RxCui //MedicationPat.MedicationNum>>Medication.RxCui //Patient>>Demographics--------------------------------------------------------------------------------------------------------- //Patient.Gender //Patient.Birthdate (Loinc age?) //Patient.SmokingSnoMed //RxPat------------------------------------------------------------------------------------------------------------------------- //Do not check RxPat. It is useless. //VaccinePat-------------------------------------------------------------------------------------------------------------------- //VaccinePat.VaccineDefNum>>VaccineDef.CVXCode //VitalSign--------------------------------------------------------------------------------------------------------------------- //VitalSign.Height (Loinc) //VitalSign.Weight (Loinc) //VitalSign.BpSystolic (Loinc) //VitalSign.BpDiastolic (Loinc) //VitalSign.WeightCode (Snomed) //VitalSign.PregDiseaseNum (Snomed) //Use object matches to check if required conditions are met------------------------------------------------------------------------------- switch(listEhrTriggers[i].Cardinality) { case MatchCardinality.One: //should never get here, handled above. continue; case MatchCardinality.OneOfEachCategory://falls through to two or more, but then branches at the end of the case statement. case MatchCardinality.TwoOrMore: //if(ListObjectMatches.Count<2) { // continue;//Must match at least two objects for this category. //} //Medication for(int m=0;m<ListMedicationPat.Count;m++) { if(listEhrTriggers[i].MedicationNumList.Contains(" "+ListMedicationPat[m].MedicationNum+" ")) { ListObjectMatches.Add(ListMedicationPat[m]); continue; } if(ListMedicationPat[m].RxCui!=0 && listEhrTriggers[i].RxCuiList.Contains(" "+ListMedicationPat[m].RxCui+" ")) { ListObjectMatches.Add(ListMedicationPat[m]); continue; } } //Allergy for(int a=0;a<ListAllergy.Count;a++) { if(listEhrTriggers[i].AllergyDefNumList.Contains(" "+ListAllergy[a].AllergyDefNum+" ")) { AllergyDef allergyDefCur=AllergyDefs.GetOne(ListAllergy[a].AllergyDefNum); if(allergyDefCur!=null) { ListObjectMatches.Add(allergyDefCur); triggerMessage+=" -(Allergy) "+allergyDefCur.Description+"\r\n"; } continue; } } //Problem for(int d=0;d<ListDiseaseDef.Count;d++) { if(ListDiseaseDef[d].ICD9Code!="" && listEhrTriggers[i].ProblemIcd9List.Contains(" "+ListDiseaseDef[d].ICD9Code+" ")) { ICD9 currentICD9=ICD9s.GetByCode(ListDiseaseDef[d].ICD9Code); if(currentICD9!=null) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage+=" -(ICD9) "+currentICD9.Description+"\r\n"; } continue; } if(ListDiseaseDef[d].Icd10Code!="" && listEhrTriggers[i].ProblemIcd10List.Contains(" "+ListDiseaseDef[d].Icd10Code+" ")) { Icd10 icd10Cur=Icd10s.GetByCode(ListDiseaseDef[d].Icd10Code); if(icd10Cur!=null) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage+=" -(Icd10) "+icd10Cur.Description+"\r\n"; } continue; } if(ListDiseaseDef[d].SnomedCode!="" && listEhrTriggers[i].ProblemSnomedList.Contains(" "+ListDiseaseDef[d].SnomedCode+" ")) { Snomed snomedCur=Snomeds.GetByCode(ListDiseaseDef[d].SnomedCode); if(snomedCur!=null) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage+=" -(Snomed) "+snomedCur.Description+"\r\n"; } continue; } if(listEhrTriggers[i].ProblemDefNumList.Contains(" "+ListDiseaseDef[d].DiseaseDefNum+" ")) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage+=" -(Problem Def) "+ListDiseaseDef[d].DiseaseName+"\r\n"; continue; } } //Vital //TODO //Age //TODO //Gender //TODO //Lab Result for(int l=0;l<ListEhrLab.Count;l++) { for(int r=0;r<ListEhrLab[l].ListEhrLabResults.Count;r++) { if(listEhrTriggers[i].LabLoincList.Contains(" "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID+" ") || listEhrTriggers[i].LabLoincList.Contains(" "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt+" ")) { ListObjectMatches.Add(ListEhrLab[l].ListEhrLabResults[r]); if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID!="") {//should almost always be the case. Loinc loincCur=Loincs.GetByCode(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID); triggerMessage+=" -(LOINC) "+loincCur.NameShort+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt!="") { Loinc loincCur=Loincs.GetByCode(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt); triggerMessage+=" -(LOINC) "+loincCur.NameShort+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierText!="") { triggerMessage+=" -(LOINC) "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierText+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextAlt!="") { triggerMessage+=" -(LOINC) "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextAlt+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID!="") { triggerMessage+=" -(LOINC) "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt!="") { triggerMessage+=" -(LOINC) "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt+"\r\n"; } else if(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextOriginal!="") { triggerMessage+=" -(LOINC) "+ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextOriginal+"\r\n"; } else { triggerMessage+=" -(LOINC) Unknown code.\r\n";//should never happen. } continue; } } } ListObjectMatches=RemoveDuplicateObjectsHelper(ListObjectMatches); if(listEhrTriggers[i].Cardinality==MatchCardinality.TwoOrMore && ListObjectMatches.Count<2) { continue;//next trigger, do not add to retVal } if(listEhrTriggers[i].Cardinality==MatchCardinality.OneOfEachCategory && !OneOfEachCategoryHelper(listEhrTriggers[i],ListObjectMatches)) { continue; } break; case MatchCardinality.All: bool allConditionsMet=true; List<string> MatchedCodes=getCodesFromListHelper(ListObjectMatches);//new List<string>(); //Match all Icd9Codes------------------------------------------------------------------------------------------------------------------------------------------------- string[] arrayIcd9Codes=listEhrTriggers[i].ProblemIcd9List.Split(new string[] {" "},StringSplitOptions.RemoveEmptyEntries); for(int c=0;c<arrayIcd9Codes.Length;c++) { if(MatchedCodes.Contains(arrayIcd9Codes[i])){ continue;//found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet=false; break; } if(!allConditionsMet) { continue;//next trigger } //Match all Icd10Codes------------------------------------------------------------------------------------------------------------------------------------------------ string[] arrayIcd10Codes=listEhrTriggers[i].ProblemIcd10List.Split(new string[] {" "},StringSplitOptions.RemoveEmptyEntries); for(int c=0;c<arrayIcd10Codes.Length;c++) { if(MatchedCodes.Contains(arrayIcd10Codes[i])){ continue;//found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet=false; break; } if(!allConditionsMet) { continue;//next trigger } //Match all SnomedCodes----------------------------------------------------------------------------------------------------------------------------------------------- string[] arraySnomedCodes=listEhrTriggers[i].ProblemSnomedList.Split(new string[] { " " },StringSplitOptions.RemoveEmptyEntries); for(int c=0;c<arraySnomedCodes.Length;c++) { if(MatchedCodes.Contains(arraySnomedCodes[i])) { continue;//found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet=false; break; } if(!allConditionsMet) { continue;//next trigger } //Match all CvxCodes-------------------------------------------------------------------------------------------------------------------------------------------------- string[] arrayCvxCodes=listEhrTriggers[i].CvxList.Split(new string[] { " " },StringSplitOptions.RemoveEmptyEntries); for(int c=0;c<arrayCvxCodes.Length;c++) { if(MatchedCodes.Contains(arrayCvxCodes[i])) { continue;//found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet=false; break; } if(!allConditionsMet) { continue;//next trigger, do not add to retval } //Match all LoincCodes------------------------------------------------------------------------------------------------------------------------------------------------ string[] arrayLoincCodes=listEhrTriggers[i].LabLoincList.Split(new string[] { " " },StringSplitOptions.RemoveEmptyEntries); for(int c=0;c<arrayLoincCodes.Length;c++) { if(MatchedCodes.Contains(arrayLoincCodes[i])) { continue;//found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet=false; break; } if(!allConditionsMet) { continue;//next trigger, do not add to retval } //TODO:with values //Match all Vitals---------------------------------------------------------------------------------------------------------------------------------------------------- //TODO:with values //Match all Demographics--------------------------------------------------------------------------------------------------------------------------------------------- //if(listEhrTriggers[i].DemographicAgeGreaterThan!=0){ // if(PatCur.Birthdate.Year>1880 && PatCur.Birthdate.AddYears(listEhrTriggers[i].DemographicAgeGreaterThan)>DateTime.Now){//patient too young // continue;//next trigger // } //} //if(listEhrTriggers[i].DemographicAgeLessThan!=0){ // if(PatCur.Birthdate.Year>1880 && PatCur.Birthdate.AddYears(listEhrTriggers[i].DemographicAgeGreaterThan)<DateTime.Now){//patient too old // continue;//next trigger // } //} //if(listEhrTriggers[i].DemographicGender!=""){ // if(!listEhrTriggers[i].DemographicGender.Contains(PatCur.Gender.ToString())){//Patient Gender not in gender list of trigger // continue;//next trigger // } //} //TODO: construct trigger message using all the codes in the trigger. break; }//end switch trigger cardinality //retVal.Add(triggerMessage,ListObjectMatches); CDSIntervention cdsi=new CDSIntervention(); cdsi.EhrTrigger=listEhrTriggers[i]; cdsi.InterventionMessage=triggerMessage; cdsi.TriggerObjects=ListObjectMatches; retVal.Add(cdsi); }//end triggers return retVal; }
///<summary>This is the first step of automation, this checks to see if the new object matches one of the trigger conditions. </summary> /// <param name="triggerObject">Can be DiseaseDef, ICD9, Icd10, Snomed, Medication, RxNorm, Cvx, AllerfyDef, EHRLabResult, Patient, or VitalSign.</param> /// <param name="PatCur">Triggers and intervention are currently always dependant on current patient. </param> /// <returns>Returns a dictionary keyed on triggers and a list of all the objects that the trigger matched on. Should be used to generate CDS intervention message and later be passed to FormInfobutton for knowledge request.</returns> public static List <CDSIntervention> TriggerMatch(object triggerObject, Patient PatCur) { if (RemotingClient.RemotingRole == RemotingRole.ClientWeb) { return(Meth.GetObject <List <CDSIntervention> >(MethodBase.GetCurrentMethod(), triggerObject, PatCur)); } //Dictionary<string,List<object>> retVal=new Dictionary<string,List<object>>(); List <CDSIntervention> retVal = new List <CDSIntervention>(); //Define objects to be used in matching triggers. DiseaseDef diseaseDef; ICD9 icd9; Icd10 icd10; Snomed snomed; Medication medication; RxNorm rxNorm; Cvx cvx; AllergyDef allergyDef; EhrLabResult ehrLabResult; Patient pat; Vitalsign vitalsign; string triggerObjectMessage = ""; string command = ""; switch (triggerObject.GetType().Name) { case "DiseaseDef": diseaseDef = (DiseaseDef)triggerObject; command = "SELECT * FROM ehrtrigger" + " WHERE ProblemDefNumList LIKE '% " + POut.String(diseaseDef.DiseaseDefNum.ToString()) + " %'"; // '% <code> %' so that we can get exact matches. if (diseaseDef.ICD9Code != "") { command += " OR ProblemIcd9List LIKE '% " + POut.String(diseaseDef.ICD9Code) + " %'"; triggerObjectMessage += " -" + diseaseDef.ICD9Code + "(Icd9) " + ICD9s.GetByCode(diseaseDef.ICD9Code).Description + "\r\n"; } if (diseaseDef.Icd10Code != "") { command += " OR ProblemIcd10List LIKE '% " + POut.String(diseaseDef.Icd10Code) + " %'"; triggerObjectMessage += " -" + diseaseDef.Icd10Code + "(Icd10) " + Icd10s.GetByCode(diseaseDef.Icd10Code).Description + "\r\n"; } if (diseaseDef.SnomedCode != "") { command += " OR ProblemSnomedList LIKE '% " + POut.String(diseaseDef.SnomedCode) + " %'"; triggerObjectMessage += " -" + diseaseDef.SnomedCode + "(Snomed) " + Snomeds.GetByCode(diseaseDef.SnomedCode).Description + "\r\n"; } break; case "ICD9": icd9 = (ICD9)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger" + " WHERE Icd9List LIKE '% " + POut.String(icd9.ICD9Code) + " %'"; // '% <code> %' so that we can get exact matches. break; case "Icd10": icd10 = (Icd10)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger" + " WHERE Icd10List LIKE '% " + POut.String(icd10.Icd10Code) + " %'"; // '% <code> %' so that we can get exact matches. break; case "Snomed": snomed = (Snomed)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger" + " WHERE SnomedList LIKE '% " + POut.String(snomed.SnomedCode) + " %'"; // '% <code> %' so that we can get exact matches. break; case "Medication": medication = (Medication)triggerObject; triggerObjectMessage = " - " + medication.MedName + (medication.RxCui == 0?"":" (RxCui:" + RxNorms.GetByRxCUI(medication.RxCui.ToString()).RxCui + ")") + "\r\n"; command = "SELECT * FROM ehrtrigger" + " WHERE MedicationNumList LIKE '% " + POut.String(medication.MedicationNum.ToString()) + " %'"; // '% <code> %' so that we can get exact matches. if (medication.RxCui != 0) { command += " OR RxCuiList LIKE '% " + POut.String(medication.RxCui.ToString()) + " %'"; // '% <code> %' so that we can get exact matches. } break; case "RxNorm": rxNorm = (RxNorm)triggerObject; triggerObjectMessage = " - " + rxNorm.Description + "(RxCui:" + rxNorm.RxCui + ")\r\n"; command = "SELECT * FROM ehrtrigger" + " WHERE RxCuiList LIKE '% " + POut.String(rxNorm.RxCui) + " %'"; // '% <code> %' so that we can get exact matches. break; case "Cvx": cvx = (Cvx)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger" + " WHERE CvxList LIKE '% " + POut.String(cvx.CvxCode) + " %'"; // '% <code> %' so that we can get exact matches. break; case "AllergyDef": allergyDef = (AllergyDef)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger" + " WHERE AllergyDefNumList LIKE '% " + POut.String(allergyDef.AllergyDefNum.ToString()) + " %'"; // '% <code> %' so that we can get exact matches. break; case "EhrLabResult": //match loinc only, no longer ehrLabResult = (EhrLabResult)triggerObject; //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger WHERE " + "(LabLoincList LIKE '% " + ehrLabResult.ObservationIdentifierID + " %'" //LOINC may be in one of two fields + "OR LabLoincList LIKE '% " + ehrLabResult.ObservationIdentifierIDAlt + " %')"; //LOINC may be in one of two fields break; case "Patient": pat = (Patient)triggerObject; List <string> triggerNums = new List <string>(); //TODO: TriggerObjectMessage command = "SELECT * FROM ehrtrigger WHERE DemographicsList !=''"; List <EhrTrigger> triggers = Crud.EhrTriggerCrud.SelectMany(command); for (int i = 0; i < triggers.Count; i++) { string[] arrayDemoItems = triggers[i].DemographicsList.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int j = 0; j < arrayDemoItems.Length; j++) { switch (arrayDemoItems[j].Split(',')[0]) { case "age": int val = PIn.Int(Regex.Match(arrayDemoItems[j], @"\d+").Value); if (arrayDemoItems[j].Contains("=")) //=, >=, or <= { if (val == pat.Age) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } if (arrayDemoItems[j].Contains("<")) { if (pat.Age < val) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } if (arrayDemoItems[j].Contains(">")) { if (pat.Age > val) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); break; } } //should never happen, age element didn't contain a comparator break; case "gender": if (arrayDemoItems[j].Split(',')[0].StartsWith(pat.Gender.ToString())) { triggerNums.Add(triggers[i].EhrTriggerNum.ToString()); } break; default: break; //should never happen } } } triggerNums.Add("-1"); //to ensure the querry is valid. command = "SELECT * FROM ehrTrigger WHERE EhrTriggerNum IN (" + String.Join(",", triggerNums) + ")"; break; case "Vitalsign": List <string> trigNums = new List <string>(); vitalsign = (Vitalsign)triggerObject; command = "SELECT * FROM ehrtrigger WHERE VitalLoincList !=''"; List <EhrTrigger> triggersVit = Crud.EhrTriggerCrud.SelectMany(command); for (int i = 0; i < triggersVit.Count; i++) { string[] arrayVitalItems = triggersVit[i].VitalLoincList.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int j = 0; j < arrayVitalItems.Length; j++) { double val = PIn.Double(Regex.Match(arrayVitalItems[j], @"\d+(.(\d+))*").Value); //decimal value w or w/o decimal. switch (arrayVitalItems[j].Split(',')[0]) { case "height": if (arrayVitalItems[j].Contains("=")) //=, >=, or <= { if (vitalsign.Height == val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains("<")) { if (vitalsign.Height < val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains(">")) { if (vitalsign.Height > val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } //should never happen, Height element didn't contain a comparator break; case "weight": if (arrayVitalItems[j].Contains("=")) //=, >=, or <= { if (vitalsign.Weight == val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains("<")) { if (vitalsign.Weight < val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains(">")) { if (vitalsign.Weight > val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } break; case "BMI": float BMI = Vitalsigns.CalcBMI(vitalsign.Weight, vitalsign.Height); if (arrayVitalItems[j].Contains("=")) //=, >=, or <= { if (BMI == val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains("<")) { if (BMI < val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } if (arrayVitalItems[j].Contains(">")) { if (BMI > val) { trigNums.Add(triggersVit[i].EhrTriggerNum.ToString()); break; } } break; case "BP": //TODO break; } //end switch } } //End Triggers Vit trigNums.Add("-1"); //to ensure the querry is valid. command = "SELECT * FROM ehrTrigger WHERE EhrTriggerNum IN (" + String.Join(",", trigNums) + ")"; break; default: //command="SELECT * FROM ehrtrigger WHERE false";//should not return any results. return(null); #if DEBUG throw new Exception(triggerObject.GetType().ToString() + " object not implemented as intervention trigger yet. Add to the list above to handle."); #endif //break; } List <EhrTrigger> listEhrTriggers = Crud.EhrTriggerCrud.SelectMany(command); if (listEhrTriggers.Count == 0) { return(null); //no triggers matched. } //Check for MatchCardinality.One type triggers.---------------------------------------------------------------------------- for (int i = 0; i < listEhrTriggers.Count; i++) { if (listEhrTriggers[i].Cardinality != MatchCardinality.One) { continue; } string triggerMessage = listEhrTriggers[i].Description + ":\r\n"; //Example:"Patient over 55:\r\n" triggerMessage += triggerObjectMessage; //Example:" -Patient Age 67\r\n" List <object> ListObjectMatches = new List <object>(); ListObjectMatches.Add(triggerObject); CDSIntervention cdsi = new CDSIntervention(); cdsi.EhrTrigger = listEhrTriggers[i]; cdsi.InterventionMessage = triggerMessage; cdsi.TriggerObjects = ListObjectMatches; retVal.Add(cdsi); } //Fill object lists to be checked------------------------------------------------------------------------------------------------- List <Allergy> ListAllergy = Allergies.GetAll(PatCur.PatNum, false); List <Disease> ListDisease = Diseases.Refresh(PatCur.PatNum, true); List <DiseaseDef> ListDiseaseDef = new List <DiseaseDef>(); List <EhrLab> ListEhrLab = EhrLabs.GetAllForPat(PatCur.PatNum); //List<EhrLabResult> ListEhrLabResults=null;//Lab results are stored in a list in the EhrLab object. List <MedicationPat> ListMedicationPat = MedicationPats.Refresh(PatCur.PatNum, false); List <AllergyDef> ListAllergyDef = new List <AllergyDef>(); for (int i = 0; i < ListAllergy.Count; i++) { ListAllergyDef.Add(AllergyDefs.GetOne(ListAllergy[i].AllergyDefNum)); } for (int i = 0; i < ListDisease.Count; i++) { ListDiseaseDef.Add(DiseaseDefs.GetItem(ListDisease[i].DiseaseDefNum)); } for (int i = 0; i < listEhrTriggers.Count; i++) { if (listEhrTriggers[i].Cardinality == MatchCardinality.One) { continue; //we handled these above. } string triggerMessage = listEhrTriggers[i].Description + ":\r\n"; triggerMessage += triggerObjectMessage; List <object> ListObjectMatches = new List <object>(); //Allergy, Disease, LabPanels, MedicationPat, Patient, VaccinePat ListObjectMatches.Add(triggerObject); //Allergy----------------------------------------------------------------------------------------------------------------------- //allergy.snomedreaction //allergy.AllergyDefNum>>AllergyDef.SnomedType //allergy.AllergyDefNum>>AllergyDef.SnomedAllergyTo //allergy.AllergyDefNum>>AllergyDef.MedicationNum>>Medication.RxCui //Disease----------------------------------------------------------------------------------------------------------------------- //Disease.DiseaseDefNum>>DiseaseDef.ICD9Code //Disease.DiseaseDefNum>>DiseaseDef.SnomedCode //Disease.DiseaseDefNum>>DiseaseDef.Icd10Code //LabPanels--------------------------------------------------------------------------------------------------------------------- //LabPanel.LabPanelNum<<LabResult.TestId (Loinc) //LabPanel.LabPanelNum<<LabResult.ObsValue (Loinc) //LabPanel.LabPanelNum<<LabResult.ObsRange (Loinc) //MedicationPat----------------------------------------------------------------------------------------------------------------- //MedicationPat.RxCui //MedicationPat.MedicationNum>>Medication.RxCui //Patient>>Demographics--------------------------------------------------------------------------------------------------------- //Patient.Gender //Patient.Birthdate (Loinc age?) //Patient.SmokingSnoMed //RxPat------------------------------------------------------------------------------------------------------------------------- //Do not check RxPat. It is useless. //VaccinePat-------------------------------------------------------------------------------------------------------------------- //VaccinePat.VaccineDefNum>>VaccineDef.CVXCode //VitalSign--------------------------------------------------------------------------------------------------------------------- //VitalSign.Height (Loinc) //VitalSign.Weight (Loinc) //VitalSign.BpSystolic (Loinc) //VitalSign.BpDiastolic (Loinc) //VitalSign.WeightCode (Snomed) //VitalSign.PregDiseaseNum (Snomed) //Use object matches to check if required conditions are met------------------------------------------------------------------------------- switch (listEhrTriggers[i].Cardinality) { case MatchCardinality.One: //should never get here, handled above. continue; case MatchCardinality.OneOfEachCategory: //falls through to two or more, but then branches at the end of the case statement. case MatchCardinality.TwoOrMore: //if(ListObjectMatches.Count<2) { // continue;//Must match at least two objects for this category. //} //Medication for (int m = 0; m < ListMedicationPat.Count; m++) { if (listEhrTriggers[i].MedicationNumList.Contains(" " + ListMedicationPat[m].MedicationNum + " ")) { ListObjectMatches.Add(ListMedicationPat[m]); continue; } if (ListMedicationPat[m].RxCui != 0 && listEhrTriggers[i].RxCuiList.Contains(" " + ListMedicationPat[m].RxCui + " ")) { ListObjectMatches.Add(ListMedicationPat[m]); continue; } } //Allergy for (int a = 0; a < ListAllergy.Count; a++) { if (listEhrTriggers[i].AllergyDefNumList.Contains(" " + ListAllergy[a].AllergyDefNum + " ")) { ListObjectMatches.Add(AllergyDefs.GetOne(ListAllergy[a].AllergyDefNum)); triggerMessage += " -(Allergy) " + AllergyDefs.GetOne(ListAllergy[a].AllergyDefNum).Description + "\r\n"; continue; } } //Problem for (int d = 0; d < ListDiseaseDef.Count; d++) { if (ListDiseaseDef[d].ICD9Code != "" && listEhrTriggers[i].ProblemIcd9List.Contains(" " + ListDiseaseDef[d].ICD9Code + " ")) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage += " -(ICD9) " + ICD9s.GetByCode(ListDiseaseDef[d].ICD9Code).Description + "\r\n"; continue; } if (ListDiseaseDef[d].Icd10Code != "" && listEhrTriggers[i].ProblemIcd10List.Contains(" " + ListDiseaseDef[d].Icd10Code + " ")) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage += " -(Icd10) " + Icd10s.GetByCode(ListDiseaseDef[d].Icd10Code).Description + "\r\n"; continue; } if (ListDiseaseDef[d].SnomedCode != "" && listEhrTriggers[i].ProblemSnomedList.Contains(" " + ListDiseaseDef[d].SnomedCode + " ")) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage += " -(Snomed) " + Snomeds.GetByCode(ListDiseaseDef[d].SnomedCode).Description + "\r\n"; continue; } if (listEhrTriggers[i].ProblemDefNumList.Contains(" " + ListDiseaseDef[d].DiseaseDefNum + " ")) { ListObjectMatches.Add(ListDiseaseDef[d]); triggerMessage += " -(Problem Def) " + ListDiseaseDef[d].DiseaseName + "\r\n"; continue; } } //Vital //TODO //Age //TODO //Gender //TODO //Lab Result for (int l = 0; l < ListEhrLab.Count; l++) { for (int r = 0; r < ListEhrLab[l].ListEhrLabResults.Count; r++) { if (listEhrTriggers[i].LabLoincList.Contains(" " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID + " ") || listEhrTriggers[i].LabLoincList.Contains(" " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt + " ")) { ListObjectMatches.Add(ListEhrLab[l].ListEhrLabResults[r]); if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID != "") //should almost always be the case. { triggerMessage += " -(LOINC) " + Loincs.GetByCode(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID).NameShort + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID != "") { triggerMessage += " -(LOINC) " + Loincs.GetByCode(ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt).NameShort + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierText != "") { triggerMessage += " -(LOINC) " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierText + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextAlt != "") { triggerMessage += " -(LOINC) " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextAlt + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID != "") { triggerMessage += " -(LOINC) " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierID + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt != "") { triggerMessage += " -(LOINC) " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierIDAlt + "\r\n"; } else if (ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextOriginal != "") { triggerMessage += " -(LOINC) " + ListEhrLab[l].ListEhrLabResults[r].ObservationIdentifierTextOriginal + "\r\n"; } else { triggerMessage += " -(LOINC) Unknown code.\r\n"; //should never happen. } continue; } } } ListObjectMatches = RemoveDuplicateObjectsHelper(ListObjectMatches); if (listEhrTriggers[i].Cardinality == MatchCardinality.TwoOrMore && ListObjectMatches.Count < 2) { continue; //next trigger, do not add to retVal } if (listEhrTriggers[i].Cardinality == MatchCardinality.OneOfEachCategory && !OneOfEachCategoryHelper(listEhrTriggers[i], ListObjectMatches)) { continue; } break; case MatchCardinality.All: bool allConditionsMet = true; List <string> MatchedCodes = getCodesFromListHelper(ListObjectMatches); //new List<string>(); //Match all Icd9Codes------------------------------------------------------------------------------------------------------------------------------------------------- string[] arrayIcd9Codes = listEhrTriggers[i].ProblemIcd9List.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int c = 0; c < arrayIcd9Codes.Length; c++) { if (MatchedCodes.Contains(arrayIcd9Codes[i])) { continue; //found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet = false; break; } if (!allConditionsMet) { continue; //next trigger } //Match all Icd10Codes------------------------------------------------------------------------------------------------------------------------------------------------ string[] arrayIcd10Codes = listEhrTriggers[i].ProblemIcd10List.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int c = 0; c < arrayIcd10Codes.Length; c++) { if (MatchedCodes.Contains(arrayIcd10Codes[i])) { continue; //found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet = false; break; } if (!allConditionsMet) { continue; //next trigger } //Match all SnomedCodes----------------------------------------------------------------------------------------------------------------------------------------------- string[] arraySnomedCodes = listEhrTriggers[i].ProblemSnomedList.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int c = 0; c < arraySnomedCodes.Length; c++) { if (MatchedCodes.Contains(arraySnomedCodes[i])) { continue; //found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet = false; break; } if (!allConditionsMet) { continue; //next trigger } //Match all CvxCodes-------------------------------------------------------------------------------------------------------------------------------------------------- string[] arrayCvxCodes = listEhrTriggers[i].CvxList.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int c = 0; c < arrayCvxCodes.Length; c++) { if (MatchedCodes.Contains(arrayCvxCodes[i])) { continue; //found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet = false; break; } if (!allConditionsMet) { continue; //next trigger, do not add to retval } //Match all LoincCodes------------------------------------------------------------------------------------------------------------------------------------------------ string[] arrayLoincCodes = listEhrTriggers[i].LabLoincList.Split(new string[] { " " }, StringSplitOptions.RemoveEmptyEntries); for (int c = 0; c < arrayLoincCodes.Length; c++) { if (MatchedCodes.Contains(arrayLoincCodes[i])) { continue; //found required code } //required code not found, set allConditionsMet to false and continue to next trigger allConditionsMet = false; break; } if (!allConditionsMet) { continue; //next trigger, do not add to retval } //TODO:with values //Match all Vitals---------------------------------------------------------------------------------------------------------------------------------------------------- //TODO:with values //Match all Demographics--------------------------------------------------------------------------------------------------------------------------------------------- //if(listEhrTriggers[i].DemographicAgeGreaterThan!=0){ // if(PatCur.Birthdate.Year>1880 && PatCur.Birthdate.AddYears(listEhrTriggers[i].DemographicAgeGreaterThan)>DateTime.Now){//patient too young // continue;//next trigger // } //} //if(listEhrTriggers[i].DemographicAgeLessThan!=0){ // if(PatCur.Birthdate.Year>1880 && PatCur.Birthdate.AddYears(listEhrTriggers[i].DemographicAgeGreaterThan)<DateTime.Now){//patient too old // continue;//next trigger // } //} //if(listEhrTriggers[i].DemographicGender!=""){ // if(!listEhrTriggers[i].DemographicGender.Contains(PatCur.Gender.ToString())){//Patient Gender not in gender list of trigger // continue;//next trigger // } //} //TODO: construct trigger message using all the codes in the trigger. break; } //end switch trigger cardinality //retVal.Add(triggerMessage,ListObjectMatches); CDSIntervention cdsi = new CDSIntervention(); cdsi.EhrTrigger = listEhrTriggers[i]; cdsi.InterventionMessage = triggerMessage; cdsi.TriggerObjects = ListObjectMatches; retVal.Add(cdsi); } //end triggers return(retVal); }