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feat: Adding Pregnancy Summary Organizer #140

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5a40978
Adding Pregnancy Summary Organizer
laura-puerto-skylight Jun 11, 2026
bb53b0c
Moving to Observation instead of List
laura-puerto-skylight Jun 12, 2026
8a34fe4
Minor fix
laura-puerto-skylight Jun 15, 2026
353bc31
Merge branch 'main' into laura/1498-pregnancy-organizer
laura-puerto-skylight Jul 28, 2026
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130 changes: 70 additions & 60 deletions data/Templates/eCR/Entry/Pregnancy/entry.liquid
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Original file line number Diff line number Diff line change
Expand Up @@ -5,71 +5,73 @@
{% else -%}
{% assign templateIds = entry.observation.templateId | to_array -%}
{% for tempId in templateIds -%}
{% if tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.15.3.8' or tempId.root == '2.16.840.1.113883.10.20.22.4.2' or tempId.root == '2.16.840.1.113883.10.20.22.4.4' -%}
{% continue %}
{% elsif tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.30.3.34' -%}
{% include 'Resource/ObservationLastMenstrualPeriod', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.22.4.281' -%}
{% include 'Resource/ObservationPregnancyIntent', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.22.4.294' -%}
{% include 'Resource/ObservationPregnancyLastLiveBirth', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.22.4.285' -%}
{% include 'Resource/ObservationPostpartumStatus', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.22.4.293' -%}
{% comment %} Supplemental pregnancy observation {% endcomment %}
{% include 'Resource/ObservationPregnancyStatus', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId, text: text -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% comment %} Add supplemental pregnancy data {% endcomment %}
{% assign rels = entry.observation.entryRelationship | to_array %}
{% for rel in rels -%}
{% assign relObsId = rel | to_json_string | generate_uuid %}
{% assign fullRelObsId = relObsId | prepend: 'Observation/' %}
{% comment %} Add birth outcome obs with focus on this pregnancy obs {% endcomment %}
{% if rel.typeCode == "COMP" and rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.284' %}
{% include 'Resource/ObservationPregnancyOutcome', observationCategory: 'exam', observationEntry: rel.observation, ID: relObsId, birthOrder: rel.sequenceNumber.value -%}
{% include 'Reference/Observation/Subject', ID: relObsId, REF: fullPatientId -%}
{% include 'Reference/Observation/Focus', ID: relObsId, REF: fullObservationId -%}
{% comment %} Check the entry relationships of the outcome for any procedures (expecting method of delivery) - add as a partOf this outcome obs {% endcomment %}
{% assign procedureRels = rel.observation.entryRelationship | to_array %}
{% for procedureRel in procedureRels %}
{% if procedureRel.procedure.classCode == "PROC" %}
{% assign procedureTemplateIds = procedureRel.procedure.templateId | to_array -%}
{% if procedureTemplateIds.first.root == '2.16.840.1.113883.10.20.22.4.14' or procedureTemplateIds.first.root == '2.16.840.1.113883.10.20.22.4.299' %}
{% assign procedureId = procedureRel.procedure | to_json_string | generate_uuid %}
{% assign fullProcedureId = procedureId | prepend: 'Procedure/' %}
{% include 'Resource/ProcedurePregnancyFinalRouteMethodDelivery.liquid', ID: procedureId, procedureEntry: procedureRel.procedure %}
{% include 'Reference/Observation/PartOf', ID: relObsId, REF: fullProcedureId %}
{% if tempId and tempId.root %}
{% if tempId.root == '2.16.840.1.113883.10.20.15.3.8' or tempId.root == '2.16.840.1.113883.10.20.22.4.2' or tempId.root == '2.16.840.1.113883.10.20.22.4.4' -%}
{% continue %}
{% elsif tempId.root == '2.16.840.1.113883.10.20.30.3.34' -%}
{% include 'Resource/ObservationLastMenstrualPeriod', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId.root == '2.16.840.1.113883.10.20.22.4.281' -%}
{% include 'Resource/ObservationPregnancyIntent', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId.root == '2.16.840.1.113883.10.20.22.4.294' -%}
{% include 'Resource/ObservationPregnancyLastLiveBirth', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId.root == '2.16.840.1.113883.10.20.22.4.285' -%}
{% include 'Resource/ObservationPostpartumStatus', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% elsif tempId.root == '2.16.840.1.113883.10.20.22.4.293' -%}
{% comment %} Supplemental pregnancy observation {% endcomment %}
{% include 'Resource/ObservationPregnancyStatus', observationCategory: 'exam', observationEntry: entry.observation, ID: observationId, text: text -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% comment %} Add supplemental pregnancy data {% endcomment %}
{% assign rels = entry.observation.entryRelationship | to_array %}
{% for rel in rels -%}
{% assign relObsId = rel | to_json_string | generate_uuid %}
{% assign fullRelObsId = relObsId | prepend: 'Observation/' %}
{% comment %} Add birth outcome obs with focus on this pregnancy obs {% endcomment %}
{% if rel.typeCode == "COMP" and rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.284' %}
{% include 'Resource/ObservationPregnancyOutcome', observationCategory: 'exam', observationEntry: rel.observation, ID: relObsId, birthOrder: rel.sequenceNumber.value -%}
{% include 'Reference/Observation/Subject', ID: relObsId, REF: fullPatientId -%}
{% include 'Reference/Observation/Focus', ID: relObsId, REF: fullObservationId -%}
{% comment %} Check the entry relationships of the outcome for any procedures (expecting method of delivery) - add as a partOf this outcome obs {% endcomment %}
{% assign procedureRels = rel.observation.entryRelationship | to_array %}
{% for procedureRel in procedureRels %}
{% if procedureRel.procedure.classCode == "PROC" %}
{% assign procedureTemplateIds = procedureRel.procedure.templateId | to_array -%}
{% if procedureTemplateIds.first.root == '2.16.840.1.113883.10.20.22.4.14' or procedureTemplateIds.first.root == '2.16.840.1.113883.10.20.22.4.299' %}
{% assign procedureId = procedureRel.procedure | to_json_string | generate_uuid %}
{% assign fullProcedureId = procedureId | prepend: 'Procedure/' %}
{% include 'Resource/ProcedurePregnancyFinalRouteMethodDelivery.liquid', ID: procedureId, procedureEntry: procedureRel.procedure %}
{% include 'Reference/Observation/PartOf', ID: relObsId, REF: fullProcedureId %}
{% endif %}
{% endif %}
{% endif %}
{% endfor %}
{% comment %} Add other supplemental pregnancy observations as a hasMember on this pregnancy obs {% endcomment %}
{% elsif rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.286' or rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.295' or rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.296' %}
{% include 'Resource/ObservationPregnancySupplementalData', observationEntry: rel.observation, ID: relObsId, templateId: rel.observation.templateId.root -%}
{% include 'Reference/Observation/Subject', ID: relObsId, REF: fullPatientId -%}
{% include 'Reference/Observation/HasMember', ID: observationId, REF: fullRelObsId %}
{% else %} {% comment %} Also handle related findings - may have multiple template ids {% endcomment %}
{% assign templateIds = rel.observation.templateId | to_array -%}
{% if templateIds.first.root == '2.16.840.1.113883.10.20.22.4.4' or templateIds.first.root == '2.16.840.1.113883.10.20.22.4.298' %}
{% include 'Resource/ObservationPregnancySupplementalData', observationEntry: rel.observation, ID: relObsId, templateId: templateIds.first.root -%}
{% endfor %}
{% comment %} Add other supplemental pregnancy observations as a hasMember on this pregnancy obs {% endcomment %}
{% elsif rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.286' or rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.295' or rel.observation.templateId.root == '2.16.840.1.113883.10.20.22.4.296' %}
{% include 'Resource/ObservationPregnancySupplementalData', observationEntry: rel.observation, ID: relObsId, templateId: rel.observation.templateId.root -%}
{% include 'Reference/Observation/Subject', ID: relObsId, REF: fullPatientId -%}
{% include 'Reference/Observation/HasMember', ID: observationId, REF: fullRelObsId %}
{% else %} {% comment %} Also handle related findings - may have multiple template ids {% endcomment %}
{% assign templateIds = rel.observation.templateId | to_array -%}
{% if templateIds.first.root == '2.16.840.1.113883.10.20.22.4.4' or templateIds.first.root == '2.16.840.1.113883.10.20.22.4.298' %}
{% include 'Resource/ObservationPregnancySupplementalData', observationEntry: rel.observation, ID: relObsId, templateId: templateIds.first.root -%}
{% include 'Reference/Observation/Subject', ID: relObsId, REF: fullPatientId -%}
{% include 'Reference/Observation/HasMember', ID: observationId, REF: fullRelObsId %}
{% endif %}
{% endif %}
{% endif %}
{% endfor %}
{% else -%}
{% if tempId and tempId.root and tempId.root == '2.16.840.1.113883.10.20.22.4.300' or tempId.root == '2.16.840.1.113883.10.20.22.4.301' %}
{% comment %} [C-CDA PREG] D(Rh) Type or [C-CDA PREG] D(Rh) Sensitized - Labs {% endcomment %}
{% assign observationCategory = 'laboratory' %}
{% else %}
{% assign observationCategory = 'exam' %}
{% endfor %}
{% else -%}
{% if tempId.root == '2.16.840.1.113883.10.20.22.4.300' or tempId.root == '2.16.840.1.113883.10.20.22.4.301' %}
{% comment %} [C-CDA PREG] D(Rh) Type or [C-CDA PREG] D(Rh) Sensitized - Labs {% endcomment %}
{% assign observationCategory = 'laboratory' %}
{% else %}
{% assign observationCategory = 'exam' %}
{% endif -%}
{% include 'Resource/Observation', observationCategory: observationCategory, observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% endif -%}
{% include 'Resource/Observation', observationCategory: observationCategory, observationEntry: entry.observation, ID: observationId -%}
{% include 'Reference/Observation/Subject', ID: observationId, REF: fullPatientId -%}
{% endif -%}
{% endif %}
{% endfor -%}
{% endif -%}
{% elsif entry.substanceAdministration -%}
Expand All @@ -89,4 +91,12 @@
{% endif %}
{% endif %}
{% endfor %}
{% elsif entry.organizer and entry.organizer.templateId.root == '2.16.840.1.113883.10.20.22.4.292' -%}
{% comment %} Pregnancy Summary Organizer {% endcomment %}
{% assign observationId = entry.organizer | to_json_string | generate_uuid -%}
{% include 'Resource/Observation', observationEntry: entry.organizer, ID: observationId -%}
{% assign comps = entry.organizer.component | to_array -%}
{% for component in comps %}
{% include 'Entry/Pregnancy/entry_organizer_component', component: component, organizerId: observationId %}
{% endfor %}
{% endif -%}
6 changes: 6 additions & 0 deletions data/Templates/eCR/Entry/Pregnancy/entry_organizer_component.liquid
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Original file line number Diff line number Diff line change
@@ -0,0 +1,6 @@
{% if component.observation %}
{% assign observationId = component.observation | to_json_string | generate_uuid -%}
{% assign fullObservationId = observationId | prepend: 'Observation/' -%}
{% include 'Resource/Observation', observationCategory: 'social-history', observationEntry: component.observation, ID: observationId -%}
{% include 'Reference/Observation/HasMember', ID: organizerId, REF: fullObservationId -%}
{% endif %}
7 changes: 7 additions & 0 deletions data/Templates/eCR/Resource/Composition.liquid
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Expand Up @@ -262,6 +262,13 @@
{
"reference": "{{ fullSubstanceAdministrationId }}",
},
{% elsif sectionEntry.organizer != nil and component.section.templateId.root == '2.16.840.1.113883.10.20.22.2.80' %}
{% comment %} Pregnancy Summary Organizer {% endcomment %}
{% assign organizerId = sectionEntry.organizer | to_json_string | generate_uuid -%}
{% assign fullOrganizerId = organizerId | prepend: 'Observation/' %}
{
"reference": "{{ fullOrganizerId }}",
},
{% endif -%}
{% endfor -%}
],
Expand Down
85 changes: 85 additions & 0 deletions src/Dibbs.Fhir.Liquid.Converter.UnitTests/Templates/eCR/Resource/ObservationTests.cs
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Expand Up @@ -336,5 +336,90 @@ public async System.Threading.Tasks.Task Obs_Status_GivenNoLabObsResultStatus_Re
Assert.Contains(@"""status"":""preliminary""", actualContent);
Assert.DoesNotContain(@"""url"": ""http://terminology.hl7.org/ValueSet/v2-0085""", actualContent);
}

[Fact]
public void PregnancySummaryObservation_AllFields()
{
var xmlString =
@"
<organizer classCode=""CLUSTER"" moodCode=""EVN"">
<!-- [C-CDA PREG] Pregnancy Summary Organizer -->
<templateId root=""2.16.840.1.113883.10.20.22.4.292"" extension=""2018-04-01"" />
<id root=""0a648e8a-c61c-46dd-bd0c-3081db0a9f66"" />
<code code=""10162-6""
displayName=""History of Pregnancies Narrative""
codeSystem=""2.16.840.1.113883.6.1""
codeSystemName=""LOINC"" />
<statusCode code=""active"" />
<effectiveTime value=""201801051015""/>
</organizer>";

var parser = new CcdaDataParser();
var parsedXml = parser.Parse(xmlString) as Dictionary<string, object>;

var attributes = new Dictionary<string, object>
{
{ "ID", "1234" },
{ "observationEntry", parsedXml["organizer"] },
};

var actualFhir = GetFhirObjectFromTemplate<Observation>(ECRPath, attributes);

Assert.Equal("Observation", actualFhir.TypeName);
Assert.NotNull(actualFhir.Id);
Assert.NotEmpty(actualFhir.Identifier);
Assert.Equal("Preliminary", actualFhir.Status.ToString());

Assert.Equal("http://loinc.org", actualFhir.Code.Coding.First().System);
Assert.Equal("10162-6", actualFhir.Code.Coding.First().Code);
Assert.Equal("History of pregnancies Narrative", actualFhir.Code.Coding.First().Display);

Assert.Equal("2018-01-05T10:15:00", (actualFhir.Effective as FhirDateTime)?.Value);
}

[Fact]
public void PregnancySummaryObservationComponent_AllFields()
{
var xmlString =
@"
<observation classCode=""OBS"" moodCode=""EVN"">
<!-- [C-CDA PREG] Gravidity (Total Pregnancies) -->
<templateId root=""2.16.840.1.113883.10.20.22.4.282"" extension=""2018-04-01"" />
<id root=""18701808-d4cb-4a6c-b10b-4eaeb66f1158"" />
<code code=""11996-6""
displayName=""[#] Pregnancies""
codeSystem=""2.16.840.1.113883.6.1""
codeSystemName=""LOINC"" />
<statusCode code=""completed"" />
<effectiveTime value=""201801051015"" />
<value xmlns:xsi=""http://www.w3.org/2001/XMLSchema-instance"" xsi:type=""INT"" value=""6"" />
</observation>";

var parser = new CcdaDataParser();
var parsedXml = parser.Parse(xmlString) as Dictionary<string, object>;

var attributes = new Dictionary<string, object>
{
{ "ID", "1234" },
{ "observationEntry", parsedXml["observation"] },
};

var actualFhir = GetFhirObjectFromTemplate<Observation>(ECRPath, attributes);

Assert.Equal("Observation", actualFhir.TypeName);
Assert.NotNull(actualFhir.Id);
Assert.NotEmpty(actualFhir.Identifier);
Assert.Equal("Final", actualFhir.Status.ToString());

Assert.Equal("http://loinc.org", actualFhir.Code.Coding.First().System);
Assert.Equal("11996-6", actualFhir.Code.Coding.First().Code);
Assert.Equal("[#] Pregnancies", actualFhir.Code.Coding.First().Display);

Assert.Equal("2018-01-05T10:15:00", (actualFhir.Effective as FhirDateTime)?.Value);

var fhirInteger = actualFhir.Value as Hl7.Fhir.Model.Integer;
Assert.NotNull(fhirInteger);
Assert.Equal(6, fhirInteger.Value);
}
}
}
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