ABDM: enrich discharge FHIR with observations advice and risks

2026-07-17 17:59:54 +05:30 · 2026-07-17 17:59:54 +05:30 · d7fe05e6b0
commit d7fe05e6b0
parent 2335006c30
4 changed files with 324 additions and 3 deletions
--- a/app/Controllers/AbdmGateway.php
+++ b/app/Controllers/AbdmGateway.php
@ -2186,6 +2186,119 @@ class AbdmGateway extends BaseController
            }
        }

+        $observations = [];
+        foreach ($this->ipdRows('ipd_discharge_1_b', ['short_head', 'rdata'], $ipdId, 'ipd_d_id') as $row) {
+            $label = trim((string) ($row['short_head'] ?? ''));
+            $value = trim((string) ($row['rdata'] ?? ''));
+            if ($label === '' || $value === '') {
+                continue;
+            }
+            $observations[] = [
+                'text' => $label,
+                'value' => $value,
+                'category' => 'vital-signs',
+                'category_code' => 'vital-signs',
+                'effective_at' => $this->toIsoDateTimeOrNow($admissionRaw),
+            ];
+        }
+        foreach ($this->ipdRows('ipd_discharge_1_b_final', ['short_head', 'rdata'], $ipdId, 'ipd_d_id') as $row) {
+            $label = trim((string) ($row['short_head'] ?? ''));
+            $value = trim((string) ($row['rdata'] ?? ''));
+            if ($label === '' || $value === '') {
+                continue;
+            }
+            $observations[] = [
+                'text' => 'Discharge ' . $label,
+                'value' => $value,
+                'category' => 'vital-signs',
+                'category_code' => 'vital-signs',
+                'effective_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+            ];
+        }
+
+        $investigations = [];
+        foreach ($this->ipdRows('ipd_discharge_1_d', ['short_head', 'rdata'], $ipdId, 'ipd_d_id') as $row) {
+            $label = trim((string) ($row['short_head'] ?? ''));
+            $value = trim((string) ($row['rdata'] ?? ''));
+            if ($label === '') {
+                continue;
+            }
+            $investigations[] = [
+                'text' => $value !== '' ? ($label . ': ' . $value) : $label,
+                'authored_on' => $this->toIsoDateTimeOrNow($admissionRaw),
+            ];
+        }
+        foreach ($this->ipdRows('ipd_discharge_1_e', ['short_head', 'rdata'], $ipdId, 'ipd_d_id') as $row) {
+            $label = trim((string) ($row['short_head'] ?? ''));
+            $value = trim((string) ($row['rdata'] ?? ''));
+            if ($label === '') {
+                continue;
+            }
+            $investigations[] = [
+                'text' => $value !== '' ? ($label . ': ' . $value) : $label,
+                'authored_on' => $this->toIsoDateTimeOrNow($admissionRaw),
+            ];
+        }
+
+        $allergies = [];
+        $carePlans = [];
+        $instructionRows = $this->ipdRows('ipd_discharge_instructions', ['comp_report', 'comp_remark', 'review_after'], $ipdId);
+        if (! empty($instructionRows)) {
+            $instructionRow = $instructionRows[0];
+            $instructionMeta = $this->parseJsonArray((string) ($instructionRow['comp_report'] ?? ''));
+            $nabhMeta = is_array($instructionMeta['nabh'] ?? null) ? $instructionMeta['nabh'] : [];
+
+            $allergyStatus = strtolower(trim((string) ($nabhMeta['drug_allergy_status'] ?? '')));
+            $allergyDetails = trim((string) ($nabhMeta['drug_allergy_details'] ?? ''));
+            if ($allergyStatus !== '' || $allergyDetails !== '') {
+                $allergies[] = [
+                    'text' => $allergyDetails !== '' ? $allergyDetails : ('Drug allergy status: ' . $allergyStatus),
+                    'note' => $allergyStatus,
+                    'criticality' => $allergyStatus === 'yes' ? 'high' : 'low',
+                    'recorded_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+                ];
+            }
+
+            $dietAdvice = trim((string) ($instructionRow['comp_remark'] ?? ''));
+            if ($dietAdvice !== '') {
+                $carePlans[] = [
+                    'title' => 'Dietary Advice',
+                    'description' => $dietAdvice,
+                    'created_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+                ];
+            }
+
+            $otherAdvice = trim((string) ($instructionMeta['other_text'] ?? ''));
+            if ($otherAdvice !== '') {
+                $carePlans[] = [
+                    'title' => 'Other Advice',
+                    'description' => $otherAdvice,
+                    'created_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+                ];
+            }
+
+            $reviewAfter = trim((string) ($instructionRow['review_after'] ?? ''));
+            if ($reviewAfter !== '') {
+                $carePlans[] = [
+                    'title' => 'Follow Up',
+                    'description' => 'Review After: ' . $reviewAfter,
+                    'created_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+                ];
+            }
+        }
+
+        $courseRows = $this->ipdRows('ipd_discharge_course_remark', ['comp_remark'], $ipdId);
+        if (! empty($courseRows)) {
+            $courseText = trim((string) ($courseRows[0]['comp_remark'] ?? ''));
+            if ($courseText !== '') {
+                $carePlans[] = [
+                    'title' => 'Course In Hospital',
+                    'description' => $courseText,
+                    'created_at' => $this->toIsoDateTimeOrNow($dischargeRaw),
+                ];
+            }
+        }
+
        $hospital = $this->getHospitalProfileForFhir();
        $hfrId = trim((string) ($hospital['hfr_id'] ?? ''));

@ -2212,6 +2325,10 @@ class AbdmGateway extends BaseController
            'conditions' => $conditions,
            'procedures' => $procedures,
            'medications' => $medications,
+            'observations' => $observations,
+            'investigations' => $investigations,
+            'allergies' => $allergies,
+            'care_plans' => $carePlans,
        ];

        $factory = new FhirGeneratorFactory();
@ -2233,9 +2350,9 @@ class AbdmGateway extends BaseController
     * @param array<int,string> $columns
     * @return array<int,array<string,mixed>>
     */
-    private function ipdRows(string $table, array $columns, int $ipdId): array
+    private function ipdRows(string $table, array $columns, int $ipdId, string $ipdKey = 'ipd_id'): array
    {
-        if ($ipdId <= 0 || ! $this->db->tableExists($table) || ! $this->db->fieldExists('ipd_id', $table)) {
+        if ($ipdId <= 0 || ! $this->db->tableExists($table) || ! $this->db->fieldExists($ipdKey, $table)) {
            return [];
        }

@ -2254,7 +2371,7 @@ class AbdmGateway extends BaseController

        $builder = $this->db->table($table)
            ->select(implode(',', $available))
-            ->where('ipd_id', $ipdId);
+            ->where($ipdKey, $ipdId);

        if ($this->db->fieldExists('id', $table)) {
            $builder->orderBy('id', 'ASC');
@ -2263,6 +2380,20 @@ class AbdmGateway extends BaseController
        return $builder->get()->getResultArray();
    }

+    /**
+     * @return array<string,mixed>
+     */
+    private function parseJsonArray(string $json): array
+    {
+        $json = trim($json);
+        if ($json === '') {
+            return [];
+        }
+
+        $decoded = json_decode($json, true);
+        return is_array($decoded) ? $decoded : [];
+    }
+
    private function normalizeFhirGender(string $gender): string
    {
        $value = strtolower(trim($gender));
--- a/app/Libraries/Abdm/Fhir/FhirDocumentBuilder.php
+++ b/app/Libraries/Abdm/Fhir/FhirDocumentBuilder.php
@ -78,6 +78,24 @@ class FhirDocumentBuilder
        return $this->addResource($resource);
    }

+    /** @param array<string,mixed> $resource */
+    public function addServiceRequest(array $resource): self
+    {
+        return $this->addResource($resource);
+    }
+
+    /** @param array<string,mixed> $resource */
+    public function addAllergyIntolerance(array $resource): self
+    {
+        return $this->addResource($resource);
+    }
+
+    /** @param array<string,mixed> $resource */
+    public function addCarePlan(array $resource): self
+    {
+        return $this->addResource($resource);
+    }
+
    /** @param array<string,mixed> $resource */
    public function addDiagnosticReport(array $resource): self
    {
--- a/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php
+++ b/app/Libraries/Abdm/Fhir/Generators/DischargeFhirGenerator.php
@ -93,6 +93,131 @@ class DischargeFhirGenerator extends \App\Libraries\Abdm\Fhir\Generators\Abstrac
            ]);
        }

+        foreach ((array) ($source['observations'] ?? []) as $idx => $obs) {
+            $text = trim((string) ($obs['text'] ?? ''));
+            $value = trim((string) ($obs['value'] ?? ''));
+            if ($text === '' || $value === '') {
+                continue;
+            }
+
+            $coding = [];
+            $loincCode = trim((string) ($obs['loinc_code'] ?? ''));
+            if ($loincCode !== '') {
+                $coding[] = [
+                    'system' => 'http://loinc.org',
+                    'code' => $loincCode,
+                    'display' => trim((string) ($obs['loinc_display'] ?? '')),
+                ];
+            }
+
+            $builder->addObservation([
+                'resourceType' => 'Observation',
+                'id' => 'discharge-observation-' . $recordId . '-' . $idx,
+                'status' => 'final',
+                'category' => [[
+                    'text' => trim((string) ($obs['category'] ?? 'vital-signs')),
+                    'coding' => [[
+                        'system' => 'http://terminology.hl7.org/CodeSystem/observation-category',
+                        'code' => trim((string) ($obs['category_code'] ?? 'vital-signs')),
+                    ]],
+                ]],
+                'code' => [
+                    'coding' => $coding,
+                    'text' => $text,
+                ],
+                'subject' => ['reference' => $patientRef],
+                'encounter' => $encounterRef ? ['reference' => $encounterRef] : null,
+                'effectiveDateTime' => (string) ($obs['effective_at'] ?? $timestamp),
+                'valueString' => $value,
+            ]);
+        }
+
+        foreach ((array) ($source['investigations'] ?? []) as $idx => $inv) {
+            $text = trim((string) ($inv['text'] ?? ''));
+            if ($text === '') {
+                continue;
+            }
+
+            $coding = [];
+            $loincCode = trim((string) ($inv['loinc_code'] ?? ''));
+            if ($loincCode !== '') {
+                $coding[] = [
+                    'system' => 'http://loinc.org',
+                    'code' => $loincCode,
+                    'display' => trim((string) ($inv['loinc_display'] ?? '')),
+                ];
+            }
+
+            $builder->addServiceRequest([
+                'resourceType' => 'ServiceRequest',
+                'id' => 'discharge-investigation-' . $recordId . '-' . $idx,
+                'status' => 'active',
+                'intent' => 'order',
+                'code' => [
+                    'coding' => $coding,
+                    'text' => $text,
+                ],
+                'subject' => ['reference' => $patientRef],
+                'encounter' => $encounterRef ? ['reference' => $encounterRef] : null,
+                'authoredOn' => (string) ($inv['authored_on'] ?? $timestamp),
+            ]);
+        }
+
+        foreach ((array) ($source['allergies'] ?? []) as $idx => $alg) {
+            $text = trim((string) ($alg['text'] ?? ''));
+            if ($text === '') {
+                continue;
+            }
+
+            $builder->addAllergyIntolerance([
+                'resourceType' => 'AllergyIntolerance',
+                'id' => 'discharge-allergy-' . $recordId . '-' . $idx,
+                'clinicalStatus' => [
+                    'coding' => [[
+                        'system' => 'http://terminology.hl7.org/CodeSystem/allergyintolerance-clinical',
+                        'code' => 'active',
+                    ]],
+                ],
+                'verificationStatus' => [
+                    'coding' => [[
+                        'system' => 'http://terminology.hl7.org/CodeSystem/allergyintolerance-verification',
+                        'code' => 'unconfirmed',
+                    ]],
+                ],
+                'type' => 'allergy',
+                'category' => ['medication'],
+                'criticality' => trim((string) ($alg['criticality'] ?? 'low')),
+                'code' => [
+                    'text' => $text,
+                ],
+                'patient' => ['reference' => $patientRef],
+                'recordedDate' => (string) ($alg['recorded_at'] ?? $timestamp),
+                'note' => isset($alg['note']) && trim((string) $alg['note']) !== ''
+                    ? [['text' => trim((string) $alg['note'])]]
+                    : null,
+            ]);
+        }
+
+        foreach ((array) ($source['care_plans'] ?? []) as $idx => $cp) {
+            $title = trim((string) ($cp['title'] ?? 'Discharge Advice'));
+            $description = trim((string) ($cp['description'] ?? ''));
+            if ($description === '') {
+                continue;
+            }
+
+            $builder->addCarePlan([
+                'resourceType' => 'CarePlan',
+                'id' => 'discharge-careplan-' . $recordId . '-' . $idx,
+                'status' => 'active',
+                'intent' => 'plan',
+                'title' => $title,
+                'description' => $description,
+                'subject' => ['reference' => $patientRef],
+                'encounter' => $encounterRef ? ['reference' => $encounterRef] : null,
+                'created' => (string) ($cp['created_at'] ?? $timestamp),
+            ]);
+        }
+
        $bundle = $builder->toBundle();
        $validation = $this->validator->validate($bundle, 'discharge', ['resolved' => 1, 'unresolved' => 0, 'fallback_used' => 0]);

--- a/app/Views/abdm/task_board.php
+++ b/app/Views/abdm/task_board.php
@ -1711,7 +1711,10 @@
        var allConditions = byType('Condition');
        var observations  = byType('Observation');
        var medications   = byType('MedicationRequest');
+        var procedures    = byType('Procedure');
        var serviceReqs   = byType('ServiceRequest');
+        var allergies     = byType('AllergyIntolerance');
+        var carePlans     = byType('CarePlan');

        var complaints = allConditions.filter(function(c) {
            return (c.category || []).some(function(cat) { return (cat.text || '').toLowerCase().includes('complaint'); });
@ -1923,6 +1926,20 @@
            html += '</ol></div></div>';
        }

+        // ── Procedures / Surgeries
+        if (procedures.length) {
+            html += '<div class="card mb-2"><div class="card-header py-1 bg-light"><small class="fw-bold text-uppercase text-secondary">Procedures</small></div><div class="card-body py-2">';
+            html += '<ul class="mb-0 ps-3">';
+            procedures.forEach(function(p) {
+                var text = (p.code || {}).text || ((((p.code || {}).coding) || [])[0] || {}).display || '';
+                var at   = fmtDate(p.performedDateTime || '');
+                html += '<li class="mb-1"><strong>' + hesc(text || 'Procedure') + '</strong>';
+                if (at) html += ' <span class="text-muted small">(' + hesc(at) + ')</span>';
+                html += '</li>';
+            });
+            html += '</ul></div></div>';
+        }
+
        // ── Investigations
        if (serviceReqs.length) {
            html += '<div class="card mb-2"><div class="card-header py-1 bg-light"><small class="fw-bold text-uppercase text-secondary">Investigations</small></div><div class="card-body py-2">';
@ -1937,6 +1954,36 @@
            html += '</ul></div></div>';
        }

+        // ── Allergy & Risk Profile
+        if (allergies.length) {
+            html += '<div class="card mb-2"><div class="card-header py-1 bg-light"><small class="fw-bold text-uppercase text-secondary">Allergies / Risk Profile</small></div><div class="card-body py-2">';
+            html += '<ul class="mb-0 ps-3">';
+            allergies.forEach(function(a) {
+                var text = (a.code || {}).text || '';
+                var note = (((a.note || [])[0]) || {}).text || '';
+                var criticality = (a.criticality || '').toUpperCase();
+                html += '<li class="mb-1"><strong>' + hesc(text || 'Allergy') + '</strong>';
+                if (criticality) html += ' <span class="badge bg-warning text-dark" style="font-size:.7rem;">' + hesc(criticality) + '</span>';
+                if (note) html += ' <small class="text-muted d-block">' + hesc(note) + '</small>';
+                html += '</li>';
+            });
+            html += '</ul></div></div>';
+        }
+
+        // ── Discharge Advice / Follow-up
+        if (carePlans.length) {
+            html += '<div class="card mb-2"><div class="card-header py-1 bg-light"><small class="fw-bold text-uppercase text-secondary">Discharge Advice & Follow-up</small></div><div class="card-body py-2">';
+            html += '<ul class="mb-0 ps-3">';
+            carePlans.forEach(function(cp) {
+                var title = cp.title || 'Care Plan';
+                var desc  = cp.description || '';
+                html += '<li class="mb-2"><strong>' + hesc(title) + '</strong>';
+                if (desc) html += '<div class="text-muted small">' + hesc(desc) + '</div>';
+                html += '</li>';
+            });
+            html += '</ul></div></div>';
+        }
+
        // ── Practitioner
        if (practitioner) {
            var pName  = ((practitioner.name || [{}])[0].text || '').trim();