///<summary>Gets most of the data necessary to fill the static text fields.</summary>
public static StaticTextData GetStaticTextData(Patient pat, Family fam, List <long> listProcCodeNums)
{
if (RemotingClient.RemotingRole == RemotingRole.ClientWeb)
{
return(Meth.GetObject <StaticTextData>(MethodBase.GetCurrentMethod(), pat, fam, listProcCodeNums));
}
StaticTextData data = new StaticTextData();
data.PatNote = PatientNotes.Refresh(pat.PatNum, pat.Guarantor);
data.ListRefAttaches = RefAttaches.Refresh(pat.PatNum);
data.ListSubs = InsSubs.RefreshForFam(fam);
data.ListPlans = InsPlans.RefreshForSubList(data.ListSubs);
data.ListPatPlans = PatPlans.Refresh(pat.PatNum);
data.ListBenefits = Benefits.Refresh(data.ListPatPlans, data.ListSubs);
data.HistList = ClaimProcs.GetHistList(pat.PatNum, data.ListBenefits, data.ListPatPlans, data.ListPlans, DateTime.Today, data.ListSubs);
data.ListTreatPlans = TreatPlans.Refresh(pat.PatNum);
data.ListRecallsForFam = Recalls.GetList(fam.ListPats.Select(x => x.PatNum).ToList());
data.ListAppts = Appointments.GetListForPat(pat.PatNum);
data.ListFutureApptsForFam = Appointments.GetFutureSchedApts(fam.ListPats.Select(x => x.PatNum).ToList());
data.ListDiseases = Diseases.Refresh(pat.PatNum, true);
data.ListAllergies = Allergies.GetAll(pat.PatNum, false);
data.ListMedicationPats = MedicationPats.Refresh(pat.PatNum, false);
data.ListFamPopups = Popups.GetForFamily(pat);
data.ListProceduresSome = Procedures.RefreshForProcCodeNums(pat.PatNum, listProcCodeNums);
return(data);
}
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>Returns a list of EhrCodes for the specified InterventionCodeSet and ValueSetOID for any medication interventions. Results will
///contain both intervention codes and medication codes that have been used in the last year.</summary>
public static List <EhrCode> GetForIntervAndMedByUse(InterventionCodeSet codeSet, List <string> listMedValueSetOIDs)
{
//get all MedicationPats where the RxCui is one of the RxCui strings for list of ValueSetOIDs provided
List <string> listMedPats = MedicationPats.GetAllForRxCuis(GetForValueSetOIDs(listMedValueSetOIDs, true).Select(x => x.CodeValue).ToList());
List <string> listInterventions = Interventions.GetAllForCodeSet(codeSet);
List <EhrCode> retVal = new List <EhrCode>();
foreach (string codeStr in listMedPats.Union(listInterventions))
{
EhrCode codeCur = Listt.FirstOrDefault(x => x.CodeValue == codeStr);
if (codeCur == null)
{
continue;
}
retVal.Add(codeCur);
}
//we might find the "wrong" ehr code, because a single code may be in multiple code sets. This is still a valid code.
return(retVal.OrderBy(x => x.Description).ToList());
}
///<summary>For CPOE. Used for both manual rx and eRx through NewCrop. Creates or updates a medical order using the given prescription information.
///Since rxCui is not part of the prescription, it must be passed in as a separate parameter.
///If isProvOrder is true, then the medical order provNum will be set to the prescription provNum. If isProvOrder is false, then the medical order provNum will be set to 0.
///The MedDescript and NewCropGuid will always be copied from the prescription to the medical order and the medical order MedicationNum will be set to 0.
///This method return the medOrderNum for the new/updated medicationPat. Unlike most medical orders this does not create an entry in the medical order table.</summary>
public static long InsertOrUpdateMedOrderForRx(RxPat rxPat, long rxCui, bool isProvOrder)
{
long medOrderNum;
MedicationPat medOrder = new MedicationPat(); //The medication order corresponding to the prescription.
medOrder.DateStart = rxPat.RxDate;
medOrder.DateStop = rxPat.RxDate.AddDays(7); //Is there a way to easily calculate this information from the prescription information? The medical order will be inactive after this date.
medOrder.MedDescript = rxPat.Drug;
medOrder.RxCui = rxCui;
medOrder.NewCropGuid = rxPat.NewCropGuid;
medOrder.PatNote = rxPat.Sig;
medOrder.PatNum = rxPat.PatNum;
if (isProvOrder)
{
medOrder.ProvNum = rxPat.ProvNum;
medOrder.IsCpoe = true;
}
MedicationPat medOrderOld = null;
if (!String.IsNullOrEmpty(rxPat.NewCropGuid)) //This check prevents an extra db call when the order is being created for a prescription written from inside of OD manually instead of using NewCrop.
{
medOrderOld = MedicationPats.GetMedicationOrderByNewCropGuid(rxPat.NewCropGuid);
}
if (medOrderOld == null)
{
medOrder.IsNew = true; //Might not be necessary, but does not hurt.
medOrderNum = MedicationPats.Insert(medOrder);
}
else //The medication order was already in our database. Update it.
{
medOrder.MedicationPatNum = medOrderOld.MedicationPatNum;
MedicationPats.Update(medOrder);
medOrderNum = medOrder.MedicationPatNum;
}
return(medOrderNum);
}
///<summary></summary>
public static List <EduResource> GenerateForPatient(long patNum)
{
if (RemotingClient.RemotingRole == RemotingRole.ClientWeb)
{
return(Meth.GetObject <List <EduResource> >(MethodBase.GetCurrentMethod(), patNum));
}
List <Disease> diseaseList = Diseases.Refresh(patNum);
List <MedicationPat> medicationPatList = MedicationPats.Refresh(patNum, false);
List <LabResult> labResultList = LabResults.GetAllForPatient(patNum);
List <EduResource> eduResourceListAll = Crud.EduResourceCrud.SelectMany("SELECT * FROM eduresource");
List <EduResource> retVal = new List <EduResource>();
for (int i = 0; i < eduResourceListAll.Count; i++)
{
if (eduResourceListAll[i].DiseaseDefNum != 0)
{
for (int j = 0; j < diseaseList.Count; j++)
{
if (eduResourceListAll[i].DiseaseDefNum == diseaseList[j].DiseaseDefNum)
{
retVal.Add(eduResourceListAll[i]);
}
}
}
else if (eduResourceListAll[i].Icd9Num != 0) //checks against same list as Diseases/Problems
{
for (int j = 0; j < diseaseList.Count; j++)
{
if (eduResourceListAll[i].Icd9Num == diseaseList[j].ICD9Num)
{
retVal.Add(eduResourceListAll[i]);
}
}
}
else if (eduResourceListAll[i].MedicationNum != 0)
{
for (int j = 0; j < medicationPatList.Count; j++)
{
if (eduResourceListAll[i].MedicationNum == medicationPatList[j].MedicationNum)
{
retVal.Add(eduResourceListAll[i]);
}
}
}
else if (eduResourceListAll[i].LabResultID != "")
{
for (int j = 0; j < labResultList.Count; j++)
{
if (eduResourceListAll[i].LabResultID != labResultList[j].TestID)
{
continue;
}
if (eduResourceListAll[i].LabResultCompare.StartsWith("<"))
{
//PIn.Int not used because blank not allowed.
try{
if (int.Parse(labResultList[j].ObsValue) < int.Parse(eduResourceListAll[i].LabResultCompare.Substring(1)))
{
retVal.Add(eduResourceListAll[i]);
}
}
catch {
//This could only happen if the validation in either input didn't work.
}
}
else if (eduResourceListAll[i].LabResultCompare.StartsWith(">"))
{
try {
if (int.Parse(labResultList[j].ObsValue) > int.Parse(eduResourceListAll[i].LabResultCompare.Substring(1)))
{
retVal.Add(eduResourceListAll[i]);
}
}
catch {
//This could only happen if the validation in either input didn't work.
}
}
}
}
}
return(retVal);
}
///<summary></summary>
public static List <EduResource> GenerateForPatient(long patNum)
{
if (RemotingClient.RemotingRole == RemotingRole.ClientWeb)
{
return(Meth.GetObject <List <EduResource> >(MethodBase.GetCurrentMethod(), patNum));
}
List <Disease> diseaseList = Diseases.Refresh(patNum);
List <MedicationPat> medicationPatList = MedicationPats.Refresh(patNum, false);
List <LabResult> labResultList = LabResults.GetAllForPatient(patNum);
List <EhrLabResult> listEhrLabResults = EhrLabResults.GetAllForPatient(patNum);
List <EduResource> eduResourceListAll = Crud.EduResourceCrud.SelectMany("SELECT * FROM eduresource");
List <EhrMeasureEvent> listTobaccoEvents = EhrMeasureEvents.RefreshByType(patNum, EhrMeasureEventType.TobaccoUseAssessed)
.FindAll(x => x.CodeSystemResult == "SNOMEDCT");
List <EduResource> retVal = new List <EduResource>();
eduResourceListAll.FindAll(x => x.DiseaseDefNum != 0 && diseaseList.Any(y => y.DiseaseDefNum == x.DiseaseDefNum)).ForEach(x => retVal.Add(x));
eduResourceListAll.FindAll(x => x.MedicationNum != 0 &&
medicationPatList.Any(y => y.MedicationNum == x.MedicationNum ||
(y.MedicationNum == 0 && Medications.GetMedication(x.MedicationNum).RxCui == y.RxCui)))
.ForEach(x => retVal.Add(x));
eduResourceListAll.FindAll(x => x.SmokingSnoMed != "" && listTobaccoEvents.Any(y => y.CodeValueResult == x.SmokingSnoMed)).ForEach(x => retVal.Add(x));
foreach (EduResource resourceCur in eduResourceListAll.Where(x => x.LabResultID != ""))
{
foreach (LabResult labResult in labResultList.Where(x => x.TestID == resourceCur.LabResultID))
{
if (resourceCur.LabResultCompare.StartsWith("<"))
{
//PIn.Int not used because blank not allowed.
try{
if (int.Parse(labResult.ObsValue) < int.Parse(resourceCur.LabResultCompare.Substring(1)))
{
retVal.Add(resourceCur);
}
}
catch {
//This could only happen if the validation in either input didn't work.
}
}
else if (resourceCur.LabResultCompare.StartsWith(">"))
{
try {
if (int.Parse(labResult.ObsValue) > int.Parse(resourceCur.LabResultCompare.Substring(1)))
{
retVal.Add(resourceCur);
}
}
catch {
//This could only happen if the validation in either input didn't work.
}
}
} //end LabResultList
foreach (EhrLabResult ehrLabResult in listEhrLabResults.Where(x => x.ObservationIdentifierID == resourceCur.LabResultID)) //matches loinc only.
{
if (retVal.Contains(resourceCur))
{
continue; //already added from loop above.
}
retVal.Add(resourceCur);
} //end EhrLabResults
}
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);
}
///<summary>For CPOE. Used for both manual rx and eRx through NewCrop. Creates or updates a medical order using the given prescription information.
///Since rxCui is not part of the prescription, it must be passed in as a separate parameter.
///If isProvOrder is true, then the medical order provNum will be set to the prescription provNum. If isProvOrder is false, then the medical order provNum will be set to 0.
///The MedDescript and ErxGuid will always be copied from the prescription to the medical order and the medical order MedicationNum will be set to 0.
///This method return the medOrderNum for the new/updated medicationPat. Unlike most medical orders this does not create an entry in the medical order table.</summary>
public static long InsertOrUpdateMedOrderForRx(RxPat rxPat, long rxCui, bool isProvOrder)
{
long medOrderNum;
MedicationPat medOrderOld = null;
if (!string.IsNullOrWhiteSpace(rxPat.ErxGuid)) //This check prevents an extra db call when making a new prescription manually inside OD.
{
medOrderOld = MedicationPats.GetMedicationOrderByErxIdAndPat(rxPat.ErxGuid, rxPat.PatNum);
}
MedicationPat medOrder = null; //The medication order corresponding to the prescription.
if (medOrderOld == null)
{
medOrder = new MedicationPat();
}
else
{
medOrder = medOrderOld.Clone(); //Maintain primary key and medicationnum for the update below.
}
medOrder.DateStart = rxPat.RxDate;
int numDays = PrefC.GetInt(PrefName.MedDefaultStopDays);
if (numDays != 0)
{
medOrder.DateStop = rxPat.RxDate.AddDays(numDays);
}
medOrder.MedDescript = rxPat.Drug;
medOrder.RxCui = rxCui;
if (rxCui != 0)
{
//The customer may not have a medication entered for this RxCui the first few times they get this particular medication back from eRx.
//Once the customer adds the medication to their medication list, then we can automatically attach the order to the medication.
//The reason we decided not to automatically create the medication if one does not already exist is because we do not want to
//accidentally bloat the medication list, if for example, the user has the medication entered but has not set the RxCui on it yet.
List <Medication> listMeds = Medications.GetAllMedsByRxCui(rxCui);
if (listMeds.Count > 0)
{
medOrder.MedicationNum = listMeds[0].MedicationNum;
}
}
medOrder.ErxGuid = rxPat.ErxGuid;
medOrder.PatNote = rxPat.Sig;
medOrder.PatNum = rxPat.PatNum;
if (isProvOrder)
{
medOrder.ProvNum = rxPat.ProvNum;
medOrder.IsCpoe = true;
}
if (medOrderOld == null)
{
medOrder.IsNew = true; //Might not be necessary, but does not hurt.
medOrderNum = MedicationPats.Insert(medOrder);
//If the ErxGuid has not been set, and it is a new medication, set the ErxGuid so that the medication can be sent to DoseSpot
if (Erx.IsManualRx(rxPat.ErxGuid))
{
try {
int medPatNumAsInt = (int)medOrderNum;
rxPat.ErxGuid = Erx.OpenDentalErxPrefix + medPatNumAsInt;
RxPats.Update(rxPat);
}
catch (Exception ex) {
//If we cannot downgrade a long to an int for the ErxGuid we can simply ignore trying to update the rxPat.
//This is because this medication would never be sent to eRx because we would attempt this downgrade again in the exact same manner.
ex.DoNothing();
}
}
}
else //The medication order was already in our database. Update it.
{
medOrder.MedicationPatNum = medOrderOld.MedicationPatNum;
MedicationPats.Update(medOrder, false); //Don't ErxGuid here, it was already purposefully set above.
medOrderNum = medOrder.MedicationPatNum;
}
return(medOrderNum);
}
///<summary>Runs the required queries to populate the necessary StaticTextData fields corresponding to staticTextDependencies.</summary>
private void LoadData(StaticTextFieldDependency staticTextDependencies, Patient pat, Family fam, List <long> listProcCodeNums)
{
bool isMiddleTier = (RemotingClient.RemotingRole == RemotingRole.ServerWeb);
System.Diagnostics.Stopwatch timer = null;
if (ODBuild.IsDebug())
{
timer = new System.Diagnostics.Stopwatch();
timer.Start();
}
if (staticTextDependencies.HasFlag(StaticTextFieldDependency.Pat))
{
//patient should already be loaded.
}
if (fam == null && staticTextDependencies.HasFlag(StaticTextFieldDependency.Fam))
{
fam = Patients.GetFamily(pat.PatNum);
}
if (PatNote == null)
{
if (staticTextDependencies.HasFlag(StaticTextFieldDependency.PatNote))
{
PatNote = PatientNotes.Refresh(pat.PatNum, pat.Guarantor);
}
else
{
PatNote = new PatientNote();
}
}
bool IsQueryNeeded <T>(ref List <T> list, StaticTextFieldDependency dependency)
{
if (list == null || (isMiddleTier && list.Count == 0)) //Middle Tier deserializes null lists to empty lists.
{
if (staticTextDependencies.HasFlag(dependency))
{
return(true);
}
else
{
list = new List <T>();
}
}
return(false);
}
if (IsQueryNeeded(ref ListRefAttaches, StaticTextFieldDependency.ListRefAttaches))
{
ListRefAttaches = RefAttaches.Refresh(pat.PatNum);
}
if (IsQueryNeeded(ref ListInsSubs, StaticTextFieldDependency.ListInsSubs))
{
ListInsSubs = InsSubs.RefreshForFam(fam);
}
if (IsQueryNeeded(ref ListInsPlans, StaticTextFieldDependency.ListInsPlans))
{
ListInsPlans = InsPlans.RefreshForSubList(ListInsSubs);
}
if (IsQueryNeeded(ref ListPatPlans, StaticTextFieldDependency.ListPatPlans))
{
ListPatPlans = PatPlans.Refresh(pat.PatNum);
}
if (IsQueryNeeded(ref ListBenefits, StaticTextFieldDependency.ListBenefits))
{
ListBenefits = Benefits.Refresh(ListPatPlans, ListInsSubs);
}
if (IsQueryNeeded(ref HistList, StaticTextFieldDependency.HistList))
{
HistList = ClaimProcs.GetHistList(pat.PatNum, ListBenefits, ListPatPlans, ListInsPlans, DateTime.Today, ListInsSubs);
}
if (IsQueryNeeded(ref ListTreatPlans, StaticTextFieldDependency.ListTreatPlans))
{
ListTreatPlans = TreatPlans.Refresh(pat.PatNum);
}
if (IsQueryNeeded(ref ListRecallsForFam, StaticTextFieldDependency.ListRecallsForFam))
{
ListRecallsForFam = Recalls.GetList(fam.ListPats.Select(x => x.PatNum).ToList());
}
if (IsQueryNeeded(ref ListAppts, StaticTextFieldDependency.ListAppts))
{
ListAppts = Appointments.GetListForPat(pat.PatNum);
}
if (IsQueryNeeded(ref ListFutureApptsForFam, StaticTextFieldDependency.ListFutureApptsForFam))
{
ListFutureApptsForFam = Appointments.GetFutureSchedApts(fam.ListPats.Select(x => x.PatNum).ToList());
}
if (IsQueryNeeded(ref ListDiseases, StaticTextFieldDependency.ListDiseases))
{
ListDiseases = Diseases.Refresh(pat.PatNum, true);
}
if (IsQueryNeeded(ref ListAllergies, StaticTextFieldDependency.ListAllergies))
{
ListAllergies = Allergies.GetAll(pat.PatNum, false);
}
if (IsQueryNeeded(ref ListMedicationPats, StaticTextFieldDependency.ListMedicationPats))
{
ListMedicationPats = MedicationPats.Refresh(pat.PatNum, false);
}
if (IsQueryNeeded(ref ListFamPopups, StaticTextFieldDependency.ListFamPopups))
{
ListFamPopups = Popups.GetForFamily(pat);
}
if (IsQueryNeeded(ref ListProceduresSome, StaticTextFieldDependency.ListProceduresSome))
{
ListProceduresSome = Procedures.RefreshForProcCodeNums(pat.PatNum, listProcCodeNums);
}
if (IsQueryNeeded(ref ListProceduresPat, StaticTextFieldDependency.ListProceduresPat))
{
ListProceduresPat = Procedures.Refresh(pat.PatNum);
}
if (IsQueryNeeded(ref ListPlannedAppts, StaticTextFieldDependency.ListPlannedAppts))
{
ListPlannedAppts = new List <PlannedAppt>();
PlannedAppt plannedAppt = PlannedAppts.GetOneOrderedByItemOrder(pat.PatNum);
if (plannedAppt != null)
{
ListPlannedAppts.Add(plannedAppt);
}
}
if (ODBuild.IsDebug())
{
timer.Stop();
Console.WriteLine("Static text field query time (ms): " + timer.ElapsedMilliseconds);
}
}