cqm-reports 1.0.0.0

data/lib/qrda-import/base-importers/section_importer.rb

@@ -0,0 +1,237 @@
+module QRDA
+  module Cat1
+    class SectionImporter
+      attr_accessor :check_for_usable, :status_xpath, :code_xpath
+
+      def initialize(entry_finder)
+        @entry_finder = entry_finder
+        @code_xpath = "./cda:code"
+        @entry_id_map = {}
+        @check_for_usable = true
+        @entry_class = QDM::DataElement
+      end
+
+      # Traverses an HL7 CDA document passed in and creates an Array of Entry
+      # objects based on what it finds
+      # @param [Nokogiri::XML::Document] doc It is expected that the root node of this document
+      #        will have the "cda" namespace registered to "urn:hl7-org:v3"
+      #        measure definition
+      # @return [Array] will be a list of Entry objects
+      def create_entries(doc, nrh = NarrativeReferenceHandler.new)
+        entry_list = []
+        @entry_id_map = {}
+        entry_elements = @entry_finder.entries(doc)
+        entry_elements.each do |entry_element|
+          entry = create_entry(entry_element, nrh)
+          if @check_for_usable
+            entry_list << entry if usable_entry?(entry)
+          else
+            entry_list << entry
+          end
+        end
+        [entry_list, @entry_id_map]
+      end
+
+      def usable_entry?(entry)
+        entry.dataElementCodes.present?
+      end
+
+      def create_entry(entry_element, _nrh = NarrativeReferenceHandler.new)
+        entry = @entry_class.new
+        # This is the id found in the QRDA file
+        entry_qrda_id = extract_id(entry_element, @id_xpath)
+        # Create a hash to map all of entry.ids to the same QRDA ids. This will be used to merge QRDA entries
+        # that represent the same event. 
+        @entry_id_map["#{entry_qrda_id.value}_#{entry_qrda_id.namingSystem}"] ||= []
+        @entry_id_map["#{entry_qrda_id.value}_#{entry_qrda_id.namingSystem}"] << entry.id
+        entry.dataElementCodes = extract_codes(entry_element, @code_xpath)
+        extract_dates(entry_element, entry)
+        if @result_xpath
+          entry.result = extract_result_values(entry_element)
+        end
+        extract_reason_or_negation(entry_element, entry)
+        entry
+      end
+
+      private
+
+      def extract_id(parent_element, id_xpath)
+        id_element = parent_element.at_xpath(id_xpath)
+        return unless id_element
+
+        # If an extension is not included, use the root as the value.  Other wise use the extension
+        value = id_element['extension'] || id_element['root']
+        identifier = QDM::Id.new(value: value, namingSystem: id_element['root'])
+        identifier
+      end
+
+      def extract_codes(coded_element, code_xpath)
+        code_list = []
+        code_elements = coded_element.xpath(code_xpath)
+        code_elements.each do |code_element|
+          code_list << code_if_present(code_element)
+          translations = code_element.xpath('cda:translation')
+          translations.each do |translation|
+            code_list << code_if_present(translation)
+          end
+        end
+        code_list.compact
+      end
+
+      def code_if_present(code_element)
+        return unless code_element && code_element['codeSystem'] && code_element['code']
+
+        QDM::Code.new(code_element['code'], HQMF::Util::CodeSystemHelper.code_system_for(code_element['codeSystem']))
+      end
+
+      def extract_dates(parent_element, entry)
+        entry.authorDatetime = extract_time(parent_element, @author_datetime_xpath) if @author_datetime_xpath
+        entry.relevantPeriod = extract_interval(parent_element, @relevant_period_xpath) if @relevant_period_xpath
+        entry.prevalencePeriod = extract_interval(parent_element, @prevalence_period_xpath) if @prevalence_period_xpath
+      end
+
+      def extract_interval(parent_element, interval_xpath)
+        if parent_element.at_xpath("#{interval_xpath}/@value")
+          low_time = DateTime.parse(parent_element.at_xpath(interval_xpath)['value'])
+          high_time = DateTime.parse(parent_element.at_xpath(interval_xpath)['value'])
+        end
+        if parent_element.at_xpath("#{interval_xpath}/cda:low")
+          low_time = DateTime.parse(parent_element.at_xpath("#{interval_xpath}/cda:low")['value'])
+        end
+        if parent_element.at_xpath("#{interval_xpath}/cda:high")
+          high_time = if parent_element.at_xpath("#{interval_xpath}/cda:high")['value']
+                        DateTime.parse(parent_element.at_xpath("#{interval_xpath}/cda:high")['value'])
+                      else
+                        DateTime.new(9999,1,1)
+                      end
+        end
+        if parent_element.at_xpath("#{interval_xpath}/cda:center")
+          low_time = Time.parse(parent_element.at_xpath("#{interval_xpath}/cda:center")['value'])
+          high_time = Time.parse(parent_element.at_xpath("#{interval_xpath}/cda:center")['value'])
+        end
+        QDM::Interval.new(low_time, high_time).shift_dates(0)
+      end
+
+      def extract_time(parent_element, datetime_xpath)
+        DateTime.parse(parent_element.at_xpath(datetime_xpath)['value']) if parent_element.at_xpath("#{datetime_xpath}/@value")
+      end
+
+      def frequency_as_coded_value(parent_element, frequency_xpath)
+        # Find the frequency interval in hours
+        frequency = extract_frequency_in_hours(parent_element, frequency_xpath)
+        # If a frequency interval is not found, return nil
+        return nil unless frequency[:low]
+        # If a frequency interval is found, search for a corresponding Direct Reference Code
+        key, value = Qrda::Export::Helper::FrequencyHelper::FREQUENCY_CODE_MAP.select { |_k,v| v[:low] == frequency['low'] && v[:high] == frequency['high'] && v[:institution_specified] == frequency['institution_specified'] && v[:unit] == frequency['unit'] }.first
+        # If a Direct Reference Code isn't found, return nil
+        return nil unless key
+        # If a Direct Reference Code is found, return that code
+        QDM::Code.new(key, HQMF::Util::CodeSystemHelper.code_system_for(value[:codeSystem]))
+      end
+
+      def extract_frequency_in_hours(parent_element, frequency_xpath)
+        # Need to go get low, high and institutionspecified
+        low = parent_element.at_xpath("#{frequency_xpath}/@value").value if parent_element.at_xpath("#{frequency_xpath}/@value")
+        low = parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:low/@value").value if parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:low/@value")
+        unit = parent_element.at_xpath("#{frequency_xpath}/@unit").value if parent_element.at_xpath("#{frequency_xpath}/@unit")
+        unit = parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:low/@unit").value if parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:low/@unit")
+        high = parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:high/@value").value if parent_element.at_xpath("#{frequency_xpath}/cda:period/cda:high/@value")
+        institution_specified = parent_element.at_xpath("#{frequency_xpath}/@institutionSpecified") || false
+        # Expected units are H (hours) and D (days)
+        if unit && unit.upcase == 'D'
+          low = low * 24 if low
+          high = high * 34 if high
+        end
+        { low: low, high: high, unit: unit, institution_specified: institution_specified }
+      end
+
+      def extract_result_values(parent_element)
+        result = []
+        parent_element.xpath(@result_xpath).each do |elem|
+          result << extract_result_value(elem)
+        end
+        result.size > 1 ? result : result.first 
+      end
+
+      def extract_result_value(value_element)
+        return unless value_element && !value_element['nullFlavor']
+
+        value = value_element['value']
+        if value.present?
+          return value.strip.to_i if (value_element['unit'] == "1" || value_element['unit'].nil?)
+
+          return QDM::Quantity.new(value.strip.to_i, value_element['unit'])
+        elsif value_element['code'].present?
+          return code_if_present(value_element)
+        end
+      end
+
+      # extracts the reason or negation data. if an element is negated and the code has a null flavor, a random code is assigned for calculation
+      # coded_parent_element is the 'parent' element when the coded is nested (e.g., medication order)
+      def extract_reason_or_negation(parent_element, entry, coded_parent_element = nil)
+        coded_parent_element ||= parent_element
+        reason_element = parent_element.xpath(".//cda:entryRelationship[@typeCode='RSON']/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value | .//cda:entryRelationship[@typeCode='RSON']/cda:act[cda:templateId/@root='2.16.840.1.113883.10.20.1.27']/cda:code")
+        negation_indicator = parent_element['negationInd']
+        unless reason_element.blank?
+          if negation_indicator.eql?('true')
+            entry.negationRationale = code_if_present(reason_element.first)
+          else
+            entry.reason = code_if_present(reason_element.first) unless @entry_does_not_have_reason
+          end
+        end
+        extract_negated_code(coded_parent_element, entry)
+      end
+
+      def extract_negated_code(coded_parent_element, entry)
+        code_elements = coded_parent_element.xpath(@code_xpath)
+        code_elements.each do |code_element|
+          if code_element['nullFlavor'] == 'NA' && code_element['sdtc:valueSet']
+            entry.dataElementCodes = [{ code: code_element['sdtc:valueSet'], codeSystem: 'NA_VALUESET' }]
+          end
+        end
+      end
+
+      def extract_scalar(parent_element, scalar_xpath)
+        scalar_element = parent_element.at_xpath(scalar_xpath)
+        return unless scalar_element
+
+        QDM::Quantity.new(scalar_element['value'].to_i, scalar_element['unit'])
+      end
+
+      def extract_components(parent_element)
+        component_elements = parent_element.xpath(@components_xpath)
+        components = []
+        component_elements&.each do |component_element|
+          component = QDM::Component.new
+          component.code = code_if_present(component_element.at_xpath('./cda:code'))
+          component.result = extract_result_value(component_element.at_xpath('./cda:value'))
+          components << component
+        end
+        components
+      end
+
+      def extract_facility_locations(parent_element)
+        facility_location_elements = parent_element.xpath(@facility_locations_xpath)
+        facility_locations = []
+        facility_location_elements&.each do |facility_location_element|
+          facility_location = QDM::FacilityLocation.new
+          participant_element = facility_location_element.at_xpath("./cda:participantRole[@classCode='SDLOC']/cda:code")
+          facility_location.code = code_if_present(participant_element)
+          facility_location.locationPeriod = extract_interval(facility_location_element, './cda:time')
+          facility_locations << facility_location
+        end
+        facility_locations
+      end
+
+      def extract_related_to(parent_element)
+        related_to_elements = parent_element.xpath(@related_to_xpath)
+        related_ids = []
+        related_to_elements.each do |related_to_element|
+          related_ids << extract_id(related_to_element, './sdtc:id')
+        end
+        related_ids
+      end
+
+    end
+  end
+end

data/lib/qrda-import/cda_identifier.rb

@@ -0,0 +1,20 @@
+require 'mongoid'
+
+class CDAIdentifier
+  include Mongoid::Document
+  include Mongoid::Attributes::Dynamic
+
+  field :root, type: String
+  field :extension, type: String
+  embedded_in :cda_identifiable, polymorphic: true
+
+  def ==(other)
+    return unless other.respond_to?(:root) && other.respond_to?(:extension)
+
+    root == other.root && extension == other.extension
+  end
+
+  def hash
+    "#{root}#{extension}".hash
+  end
+end

data/lib/qrda-import/data-element-importers/adverse_event_importer.rb

@@ -0,0 +1,26 @@
+module QRDA
+  module Cat1
+    class AdverseEventImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.146']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.148']/cda:value"
+        @author_datetime_xpath = './cda:author/cda:time'
+        @relevant_period_xpath = './cda:effectiveTime'
+        @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @type_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
+        @entry_class = QDM::AdverseEvent
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        adverse_event = super
+        adverse_event.severity = code_if_present(entry_element.at_xpath(@severity_xpath))
+        adverse_event.type = code_if_present(entry_element.at_xpath(@type_xpath))
+        adverse_event.facilityLocation = extract_facility_locations(entry_element)[0]
+        adverse_event
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/allergy_intolerance_importer.rb

@@ -0,0 +1,24 @@
+module QRDA
+  module Cat1
+    class AllergyIntoleranceImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.147']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:participant/cda:participantRole/cda:playingEntity/cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @prevalence_period_xpath = "./cda:effectiveTime"
+        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @type_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.9']/cda:value"
+        @entry_class = QDM::AllergyIntolerance
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        allergy_intolerance = super
+        allergy_intolerance.severity = code_if_present(entry_element.at_xpath(@severity_xpath))
+        allergy_intolerance.type = code_if_present(entry_element.at_xpath(@type_xpath))
+        allergy_intolerance
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/assessment_order_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class AssessmentOrderImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.158']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @entry_class = QDM::AssessmentOrder
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        assessment_order = super
+        assessment_order
+      end
+
+    end
+  end
+  end

data/lib/qrda-import/data-element-importers/assessment_performed_importer.rb

@@ -0,0 +1,24 @@
+module QRDA
+  module Cat1
+    class AssessmentPerformedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.144']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @result_xpath = "./cda:value"
+        @method_xpath = './cda:methodCode'
+        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @entry_class = QDM::AssessmentPerformed
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        assessment_performed = super
+        assessment_performed.method = code_if_present(entry_element.at_xpath(@method_xpath))
+        assessment_performed.components = extract_components(entry_element)
+        assessment_performed
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/assessment_recommended_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class AssessmentRecommendedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.145']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @entry_class = QDM::AssessmentRecommended
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        assessment_recommended = super
+        assessment_recommended
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/communication_performed_importer.rb

@@ -0,0 +1,30 @@
+module QRDA
+  module Cat1
+    class CommunicationPerformedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.156']"))
+        super(entry_finder)
+        @entry_does_not_have_reason = true
+        @id_xpath = './cda:id'
+        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.88']/cda:value"
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @relevant_period_xpath = "./cda:effectiveTime"
+        @related_to_xpath = "./sdtc:inFulfillmentOf1/sdtc:actReference"
+        @category_xpath = './cda:code'
+        @medium_xpath = "./cda:participant[@typeCode='VIA']/cda:participantRole/cda:code"
+        @sender_xpath = "./cda:participant[@typeCode='AUT']/cda:participantRole/cda:code"
+        @recipient_xpath = "./cda:participant[@typeCode='IRCP']/cda:participantRole/cda:code"
+        @entry_class = QDM::CommunicationPerformed
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        communication_performed = super
+        communication_performed.category = code_if_present(entry_element.at_xpath(@category_xpath))
+        communication_performed.medium = code_if_present(entry_element.at_xpath(@medium_xpath))
+        communication_performed.sender = code_if_present(entry_element.at_xpath(@sender_xpath))
+        communication_performed.recipient = code_if_present(entry_element.at_xpath(@recipient_xpath))
+        communication_performed.relatedTo = extract_related_to(entry_element)
+        communication_performed
+      end
+    end
+  end
+  end

data/lib/qrda-import/data-element-importers/device_applied_importer.rb

@@ -0,0 +1,22 @@
+module QRDA
+  module Cat1
+    class DeviceAppliedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:procedure[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.7']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:participant/cda:participantRole/cda:playingDevice/cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @relevant_period_xpath = "./cda:effectiveTime"
+        @anatomical_location_site_xpath = "./cda:targetSiteCode"
+        @entry_class = QDM::DeviceApplied
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        device_applied = super
+        device_applied.anatomicalLocationSite = code_if_present(entry_element.at_xpath(@anatomical_location_site_xpath))
+        device_applied
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/device_order_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class DeviceOrderImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.130']"))
+        super(entry_finder)
+        @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:id"
+        @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.9']/cda:author/cda:time"
+        @entry_class = QDM::DeviceOrder
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        device_order = super
+        device_order
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/device_recommended_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class DeviceRecommendedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.131']"))
+        super(entry_finder)
+        @id_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:id"
+        @code_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:participant/cda:participantRole/cda:playingDevice/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:supply[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.10']/cda:author/cda:time"
+        @entry_class = QDM::DeviceRecommended
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        device_recommended = super
+        device_recommended
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/diagnosis_importer.rb

@@ -0,0 +1,24 @@
+module QRDA
+  module Cat1
+    class DiagnosisImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.137']"))
+        super(entry_finder)
+        @id_xpath = './cda:entryRelationship/cda:observation/cda:id'
+        @code_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:value"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:author/cda:time"
+        @prevalence_period_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:effectiveTime"
+        @anatomical_location_site_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:targetSiteCode"
+        @severity_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.135']/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.8']/cda:value"
+        @entry_class = QDM::Diagnosis
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        diagnosis = super
+        diagnosis.anatomicalLocationSite = code_if_present(entry_element.at_xpath(@anatomical_location_site_xpath))
+        diagnosis.severity = code_if_present(entry_element.at_xpath(@severity_xpath))
+        diagnosis
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/diagnostic_study_order_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class DiagnosticStudyOrderImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.17']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @entry_class = QDM::DiagnosticStudyOrder
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        diagnostic_study_order = super
+        diagnostic_study_order
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/diagnostic_study_performed_importer.rb

@@ -0,0 +1,32 @@
+module QRDA
+  module Cat1
+    class DiagnosticStudyPerformedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.18']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @relevant_period_xpath = "./cda:effectiveTime"
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @result_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:value"
+        @result_datetime_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.22.4.2']/cda:effectiveTime"
+        @status_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.93']/cda:value"
+        @method_xpath = './cda:methodCode'
+        @facility_locations_xpath = "./cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @components_xpath = "./cda:entryRelationship/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.149']"
+        @entry_class = QDM::DiagnosticStudyPerformed
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        diagnostic_study_performed = super
+        diagnostic_study_performed.resultDatetime = extract_time(entry_element, @result_datetime_xpath)
+        diagnostic_study_performed.resultDatetime ||= extract_interval(entry_element, @result_datetime_xpath).low
+        diagnostic_study_performed.status = code_if_present(entry_element.at_xpath(@status_xpath))
+        diagnostic_study_performed.method = code_if_present(entry_element.at_xpath(@method_xpath))
+        diagnostic_study_performed.facilityLocation = extract_facility_locations(entry_element)[0]
+        diagnostic_study_performed.components = extract_components(entry_element)
+        diagnostic_study_performed
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/diagnostic_study_recommended_importer.rb

@@ -0,0 +1,19 @@
+module QRDA
+  module Cat1
+    class DiagnosticStudyRecommendedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:observation[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.19']"))
+        super(entry_finder)
+        @id_xpath = './cda:id'
+        @code_xpath = './cda:code'
+        @author_datetime_xpath = "./cda:author/cda:time"
+        @entry_class = QDM::DiagnosticStudyRecommended
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        diagnostic_study_recommended = super
+        diagnostic_study_recommended
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/encounter_order_importer.rb

@@ -0,0 +1,21 @@
+module QRDA
+  module Cat1
+    class EncounterOrderImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.132']"))
+        super(entry_finder)
+        @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
+        @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:code"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:author/cda:time"
+        @facility_locations_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.22']/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @entry_class = QDM::EncounterOrder
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        encounter_order = super
+        encounter_order.facilityLocation = extract_facility_locations(entry_element)[0]
+        encounter_order
+      end
+
+    end
+  end
+end

data/lib/qrda-import/data-element-importers/encounter_performed_importer.rb

@@ -0,0 +1,46 @@
+module QRDA
+  module Cat1
+    class EncounterPerformedImporter < SectionImporter
+      def initialize(entry_finder = QRDA::Cat1::EntryFinder.new("./cda:entry/cda:act[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.133']"))
+        super(entry_finder)
+        @id_xpath = './cda:entryRelationship/cda:encounter/cda:id'
+        @code_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:code"
+        @relevant_period_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:effectiveTime"
+        @author_datetime_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:author/cda:time"
+        @admission_source_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:participant/cda:participantRole[cda:templateId/@root='2.16.840.1.113883.10.20.24.3.151']/cda:code"
+        @discharge_disposition_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/sdtc:dischargeDispositionCode"
+        @facility_locations_xpath = "./cda:entryRelationship/cda:encounter/cda:participant[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.100']"
+        @principal_diagnosis_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:entryRelationship/cda:observation[cda:code/@code='8319008']/cda:value"
+        @diagnosis_xpath = "./cda:entryRelationship/cda:encounter[cda:templateId/@root = '2.16.840.1.113883.10.20.24.3.23']/cda:entryRelationship/cda:act/cda:entryRelationship/cda:observation[cda:templateId/@root='2.16.840.1.113883.10.20.22.4.4']"
+        @entry_class = QDM::EncounterPerformed
+      end
+
+      def create_entry(entry_element, nrh = NarrativeReferenceHandler.new)
+        encounter_performed = super
+        encounter_performed.admissionSource = code_if_present(entry_element.at_xpath(@admission_source_xpath))
+        encounter_performed.dischargeDisposition = code_if_present(entry_element.at_xpath(@discharge_disposition_xpath))
+        encounter_performed.facilityLocations = extract_facility_locations(entry_element)
+        encounter_performed.principalDiagnosis = code_if_present(entry_element.at_xpath(@principal_diagnosis_xpath))
+        encounter_performed.diagnoses = extract_diagnoses(entry_element)
+        if encounter_performed&.relevantPeriod&.low && encounter_performed&.relevantPeriod&.high
+          los = encounter_performed.relevantPeriod.high - encounter_performed.relevantPeriod.low
+          encounter_performed.lengthOfStay = QDM::Quantity.new(los.to_i, 'd')
+        end
+        encounter_performed
+      end
+
+      private
+
+      def extract_diagnoses(parent_element)
+        diagnosis_elements = parent_element.xpath(@diagnosis_xpath)
+        diagnosis_list = []
+        diagnosis_elements.each do |diagnosis_element|
+          diagnosis_value = diagnosis_element.at_xpath("./cda:value")
+          diagnosis_list << code_if_present(diagnosis_value)
+        end
+        diagnosis_list.empty? ? nil : diagnosis_list
+      end
+
+    end
+  end
+end