public static long InsertOrUpdateErxMedication(RxPat rxOld, RxPat rx, long rxCui, string strDrugName, string strGenericName, bool isProv, bool canInsertRx = true)
{
if (rxOld == null)
{
if (canInsertRx)
{
rx.IsNew = true; //Might not be necessary, but does not hurt.
rx.IsErxOld = false;
SecurityLogs.MakeLogEntry(Permissions.RxCreate, rx.PatNum, "eRx automatically created: " + rx.Drug);
RxPats.Insert(rx);
}
}
else //The prescription was already in our database. Update it.
{
rx.RxNum = rxOld.RxNum;
//Preserve the pharmacy on the existing prescription, in case the user set the value manually.
//We do not pull pharmacy back from eRx yet.
rx.PharmacyNum = rxOld.PharmacyNum;
if (rxOld.IsErxOld)
{
rx.IsErxOld = true;
rx.SendStatus = RxSendStatus.SentElect; //To maintain backward compatibility.
}
RxPats.Update(rx);
}
//If rxCui==0, then third party eRx option (DoseSpot, NewCrop, etc) did not provide an RxCui.
//Attempt to locate an RxCui using the other provided drug information. An RxCui is not required for our program.
//Meds missing an RxCui are not exported in CCD messages.
if (rxCui == 0 && strDrugName != "")
{
List <RxNorm> listRxNorms = RxNorms.GetListByCodeOrDesc(strDrugName, true, true); //Exact case insensitive match ignoring numbers.
if (listRxNorms.Count > 0)
{
rxCui = PIn.Long(listRxNorms[0].RxCui);
}
}
//If rxCui==0, then third party eRx option (DoseSpot, NewCrop, etc) did not provide an RxCui and we could not locate an RxCui by DrugName
//Try searching by GenericName.
if (rxCui == 0 && strGenericName != "")
{
List <RxNorm> listRxNorms = RxNorms.GetListByCodeOrDesc(strGenericName, true, true); //Exact case insensitive match ignoring numbers.
if (listRxNorms.Count > 0)
{
rxCui = PIn.Long(listRxNorms[0].RxCui);
}
}
//If rxCui==0, then third party eRx option (DoseSpot, NewCrop, etc) did not provide an RxCui and we could not
//locate an RxCui by DrugName or GenericName.
if (rxCui == 0)
{
//We may need to enhance in future to support more advanced RxNorm searches.
//For example: DrugName=Cafatine, DrugInfo=Cafatine 1 mg-100 mg Tab, GenericName=ergotamine-caffeine.
//This drug could not be found by DrugName nor GenericName, but could be found when the GenericName was split by non-alpha characters,
//then the words in the generic name were swapped.
//Namely, "caffeine ergotamine" is in the RxNorm table.
}
//MedicationNum of 0, because we do not want to bloat the medication list in OD.
//In this special situation, we instead set the MedDescript, RxCui and ErxGuid columns.
return(MedicationPats.InsertOrUpdateMedOrderForRx(rx, rxCui, isProv));
}
///<summary>Called after file is downloaded. Throws exceptions. It is assumed that this is called from a worker thread. Progress delegate will be called every 100th iteration to inform thread of current progress. Quit flag can be set at any time in order to quit importing prematurely.</summary>
public static void ImportRxNorm(string tempFileName, ProgressArgs progress, ref bool quit)
{
if (tempFileName == null)
{
return;
}
HashSet <string> codeHash = new HashSet <string>(RxNorms.GetAllCodes());
string[] lines = File.ReadAllLines(tempFileName);
string[] arrayRxNorm;
RxNorm rxNorm = new RxNorm();
for (int i = 0; i < lines.Length; i++) //each loop should read exactly one line of code. and each line of code should be a unique code
{
if (quit)
{
return;
}
if (i % 100 == 0)
{
progress(i + 1, lines.Length);
}
arrayRxNorm = lines[i].Split('\t');
if (codeHash.Contains(arrayRxNorm[0])) //code already exists
{
continue;
}
rxNorm.RxCui = arrayRxNorm[0];
rxNorm.MmslCode = arrayRxNorm[1];
rxNorm.Description = arrayRxNorm[2];
RxNorms.Insert(rxNorm);
}
}
///<summary>Called after file is downloaded. Throws exceptions. It is assumed that this is called from a worker thread. Progress delegate will be called every 100th iteration to inform thread of current progress. Quit flag can be set at any time in order to quit importing prematurely.</summary>
public static void ImportRxNorm(string tempFileName, ProgressArgs progress, ref bool quit, ref int numCodesImported, ref int numCodesUpdated,
bool updateExisting)
{
if (tempFileName == null)
{
return;
}
//RxNorms can have two codes for each RxCui. One RxNorm will have a value in the MmslCode and a blank description and the other will have a
//value in the Description and a blank MmslCode.
List <RxNorm> listRxNorms = RxNorms.GetAll();
Dictionary <string, RxNorm> dictRxNormsMmslCodes = listRxNorms.Where(x => x.MmslCode != "").ToDictionary(x => x.RxCui, x => x);
Dictionary <string, RxNorm> dictRxNormsDefinitions = listRxNorms.Where(x => x.Description != "").ToDictionary(x => x.RxCui, x => x);
string[] lines = File.ReadAllLines(tempFileName);
string[] arrayRxNorm;
RxNorm rxNorm = new RxNorm();
for (int i = 0; i < lines.Length; i++) //Each loop should read exactly one line of code. Each line will NOT be a unique code.
{
if (quit)
{
return;
}
if (i % 100 == 0)
{
progress(i + 1, lines.Length);
}
arrayRxNorm = lines[i].Split('\t');
if (dictRxNormsMmslCodes.ContainsKey(arrayRxNorm[0])) //code with an MmslCode already exists
{
rxNorm = dictRxNormsMmslCodes[arrayRxNorm[0]];
if (updateExisting)
{
if (arrayRxNorm[1] != "" && arrayRxNorm[1] != rxNorm.MmslCode)
{
rxNorm.MmslCode = arrayRxNorm[1];
rxNorm.Description = ""; //Should be blank for all MMSL code entries. See below for non-MMSL entries with descriptions.
RxNorms.Update(rxNorm);
numCodesUpdated++;
}
}
continue;
}
if (dictRxNormsDefinitions.ContainsKey(arrayRxNorm[0])) //code with a Description already exists
{
rxNorm = dictRxNormsDefinitions[arrayRxNorm[0]];
if (updateExisting)
{
string newDescript = arrayRxNorm[2];
//if(newDescript.Length>255) {
// newDescript=newDescript.Substring(0,255);//Description column is only varchar(255) so some descriptions will get truncated.
//}
//if(arrayRxNorm[2]!="" && newDescript!=rxNorm.Description) {
if (arrayRxNorm[2] != "" && arrayRxNorm[2] != rxNorm.Description)
{
rxNorm.MmslCode = ""; //should be blank for all entries that have a description.
rxNorm.Description = arrayRxNorm[2];
RxNorms.Update(rxNorm);
numCodesUpdated++;
}
}
continue;
}
rxNorm.RxCui = arrayRxNorm[0];
rxNorm.MmslCode = arrayRxNorm[1];
rxNorm.Description = arrayRxNorm[2];
RxNorms.Insert(rxNorm);
numCodesImported++;
}
}
/// <summary>If the CodeValue of the EhrCode exists in its respective code table (I.e. Snomed, Loinc, Cpt, etc.) this will set IsInDb=true otherwise false.</summary>
private static void updateCodeExistsHelper()
{
//No need to check RemotingRole; no call to db.
if (listt.Count == 0)
{
return;
}
//Cache lists of codes.
HashSet <string> cdcrecHS = new HashSet <string>(Cdcrecs.GetAllCodes());
HashSet <string> cdtHS = new HashSet <string>(ProcedureCodes.GetAllCodes());
HashSet <string> cptHS = new HashSet <string>(Cpts.GetAllCodes());
HashSet <string> cvxHS = new HashSet <string>(Cvxs.GetAllCodes());
HashSet <string> hcpcsHS = new HashSet <string>(Hcpcses.GetAllCodes());
HashSet <string> icd10HS = new HashSet <string>(Icd10s.GetAllCodes());
HashSet <string> icd9HS = new HashSet <string>(ICD9s.GetAllCodes());
HashSet <string> loincHS = new HashSet <string>(Loincs.GetAllCodes());
HashSet <string> rxnormHS = new HashSet <string>(RxNorms.GetAllCodes());
HashSet <string> snomedHS = new HashSet <string>(Snomeds.GetAllCodes());
HashSet <string> sopHS = new HashSet <string>(Sops.GetAllCodes());
for (int i = 0; i < listt.Count; i++)
{
switch (listt[i].CodeSystem)
{
case "AdministrativeSex": //always "in DB", even though there is no DB table
listt[i].IsInDb = true;
break;
case "CDCREC":
listt[i].IsInDb = cdcrecHS.Contains(listt[i].CodeValue);
break;
case "CDT":
listt[i].IsInDb = cdtHS.Contains(listt[i].CodeValue);
break;
case "CPT":
listt[i].IsInDb = cptHS.Contains(listt[i].CodeValue);
break;
case "CVX":
listt[i].IsInDb = cvxHS.Contains(listt[i].CodeValue);
break;
case "HCPCS":
listt[i].IsInDb = hcpcsHS.Contains(listt[i].CodeValue);
break;
case "ICD9CM":
listt[i].IsInDb = icd9HS.Contains(listt[i].CodeValue);
break;
case "ICD10CM":
listt[i].IsInDb = icd10HS.Contains(listt[i].CodeValue);
break;
case "LOINC":
listt[i].IsInDb = loincHS.Contains(listt[i].CodeValue);
break;
case "RXNORM":
listt[i].IsInDb = rxnormHS.Contains(listt[i].CodeValue);
break;
case "SNOMEDCT":
listt[i].IsInDb = snomedHS.Contains(listt[i].CodeValue);
break;
case "SOP":
listt[i].IsInDb = sopHS.Contains(listt[i].CodeValue);
break;
}
}
//This updates the last column "ExistsInDatabse" based on weather or not the code is found in another table in the database.
}
/// <summary>If the number of codes in the code tables (I.e. Snomed, Loinc, Cpt, etc.) are greater than the number we expect then this will set IsInDb=true otherwise false.</summary>
private static void updateCodeExistsHelper()
{
//No need to check RemotingRole; no call to db.
if (listt.Count == 0)
{
return;
}
//Cache lists of codes.
#region Count Variables
//Counts from the DB
long countCdcDB = -1;
long countCdtDB = -1;
long countCptDB = -1;
long countCvxDB = -1;
long countHcpcsDB = -1;
long countIcd9DB = -1;
long countIcd10DB = -1;
long countLoincDB = -1;
long countRxNormDB = -1;
long countSnomedDB = -1;
long countSopDB = -1;
//Counts hard-coded from the EhrCodes.Listt. Lowered slightly to give a buffer, in case we decide to remove some codes later.
const long countCdcList = 5;
const long countCdtList = 10;
const long countCptList = 300;
const long countCvxList = 5;
const long countHcpcsList = 20;
const long countIcd9List = 1500;
const long countIcd10List = 2000;
const long countLoincList = 20;
const long countRxNormList = 40;
const long countSnomedList = 700;
const long countSopList = 100;
#endregion
for (int i = 0; i < listt.Count; i++)
{
if (listt[i].IsInDb)
{
continue; //The codes are already present in the database, so we don't need to check again.
}
switch (listt[i].CodeSystem)
{
case "AdministrativeSex": //always "in DB", even though there is no DB table
listt[i].IsInDb = true;
break;
case "CDCREC":
if (countCdcDB == -1)
{
countCdcDB = Cdcrecs.GetCodeCount();
}
if (countCdcDB > countCdcList)
{
listt[i].IsInDb = true;
}
break;
case "CDT":
if (countCdtDB == -1)
{
countCdtDB = ProcedureCodes.GetCodeCount();
}
if (countCdtDB > countCdtList)
{
listt[i].IsInDb = true;
}
break;
case "CPT":
if (countCptDB == -1)
{
countCptDB = Cpts.GetCodeCount();
}
if (countCptDB > countCptList)
{
listt[i].IsInDb = true;
}
break;
case "CVX":
if (countCvxDB == -1)
{
countCvxDB = Cvxs.GetCodeCount();
}
if (countCvxDB > countCvxList)
{
listt[i].IsInDb = true;
}
break;
case "HCPCS":
if (countHcpcsDB == -1)
{
countHcpcsDB = Hcpcses.GetCodeCount();
}
if (countHcpcsDB > countHcpcsList)
{
listt[i].IsInDb = true;
}
break;
case "ICD9CM":
if (countIcd9DB == -1)
{
countIcd9DB = ICD9s.GetCodeCount();
}
if (countIcd9DB > countIcd9List)
{
listt[i].IsInDb = true;
}
break;
case "ICD10CM":
if (countIcd10DB == -1)
{
countIcd10DB = Icd10s.GetCodeCount();
}
if (countIcd10DB > countIcd10List)
{
listt[i].IsInDb = true;
}
break;
case "LOINC":
if (countLoincDB == -1)
{
countLoincDB = Loincs.GetCodeCount();
}
if (countLoincDB > countLoincList)
{
listt[i].IsInDb = true;
}
break;
case "RXNORM":
if (countRxNormDB == -1)
{
countRxNormDB = RxNorms.GetCodeCount();
}
if (countRxNormDB > countRxNormList)
{
listt[i].IsInDb = true;
}
break;
case "SNOMEDCT":
if (countSnomedDB == -1)
{
countSnomedDB = Snomeds.GetCodeCount();
}
if (countSnomedDB > countSnomedList)
{
listt[i].IsInDb = true;
}
break;
case "SOP":
if (countSopDB == -1)
{
countSopDB = Sops.GetCodeCount();
}
if (countSopDB > countSopList)
{
listt[i].IsInDb = true;
}
break;
}
}
//This updates the last column "ExistsInDatabse" based on weather or not the code is found in another table in the database.
}
///<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);
}