@openmrs/esm-patient-vitals-app 11.3.1-pre.9208 → 11.3.1-pre.9211

package/dist/openmrs-esm-patient-vitals-app.js

@@ -1 +1 @@
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package/dist/openmrs-esm-patient-vitals-app.js.buildmanifest.json

@@ -718,7 +718,7 @@
       "auxiliaryFiles": [
         "5415.js.map"
       ],
-      "hash": "b1510e820a3af334",
+      "hash": "dc164ed3c3faaac4",
       "childrenByOrder": {}
     },
     {
@@ -818,9 +818,9 @@
       "initial": false,
       "entry": false,
       "recorded": false,
-      "size": 418969,
+      "size": 422524,
       "sizes": {
-        "javascript": 418927,
+        "javascript": 422482,
         "consume-shared": 42
       },
       "names": [],
@@ -834,7 +834,7 @@
       "auxiliaryFiles": [
         "5810.js.map"
       ],
-      "hash": "5f5a3e4b82f03a8e",
+      "hash": "53c2e172d7cc1359",
       "childrenByOrder": {}
     },
     {
@@ -883,7 +883,7 @@
       "auxiliaryFiles": [
         "openmrs-esm-patient-vitals-app.js.map"
       ],
-      "hash": "031b717632a0a755",
+      "hash": "2146d5a2401a96ba",
       "childrenByOrder": {}
     },
     {
@@ -1183,10 +1183,10 @@
       "initial": true,
       "entry": true,
       "recorded": false,
-      "size": 4057073,
+      "size": 4060628,
       "sizes": {
         "consume-shared": 294,
-        "javascript": 4033559,
+        "javascript": 4037114,
         "share-init": 420,
         "runtime": 22800
       },
@@ -1203,7 +1203,7 @@
       "auxiliaryFiles": [
         "main.js.map"
       ],
-      "hash": "9348e0578d595ce4",
+      "hash": "b7699801625ee5b4",
       "childrenByOrder": {}
     },
     {

package/dist/routes.json

@@ -1 +1 @@
-{"$schema":"https://json.openmrs.org/routes.schema.json","backendDependencies":{"fhir2":">=1.2","webservices.rest":">=2.2.0"},"extensions":[{"name":"vitals-overview-widget","component":"vitalsSummary","slot":"patient-chart-summary-dashboard-slot","meta":{"fullWidth":true},"order":1},{"name":"vitals-details-widget","component":"vitalsMain","slot":"patient-chart-vitals-biometrics-dashboard-slot","meta":{"title":"Vitals","view":"vitals","fullWidth":true},"order":1},{"name":"patient-vitals-info","component":"vitalsHeader","slot":"patient-info-slot"},{"name":"biometrics-overview-widget","component":"biometricsOverview","slot":"patient-chart-summary-dashboard-slot","meta":{"fullWidth":true},"order":2},{"name":"biometrics-details-widget","component":"biometricsDetailedSummary","slot":"patient-chart-vitals-biometrics-dashboard-slot","meta":{"view":"biometrics","title":"Biometrics","fullWidth":true}},{"name":"results-summary-dashboard","component":"vitalsAndBiometricsDashboardLink","slot":"patient-chart-dashboard-slot","order":2,"meta":{"slot":"patient-chart-vitals-biometrics-dashboard-slot","path":"Vitals & Biometrics"}},{"name":"weight-tile","component":"weightTile","slot":"visit-form-header-slot","order":2}],"pages":[],"workspaces":[{"name":"patient-vitals-biometrics-form-workspace","title":"recordVitalsAndBiometrics","component":"vitalsBiometricsFormWorkspace"}],"modals":[{"name":"vitals-biometrics-delete-confirmation-modal","component":"vitalsAndBiometricsDeleteConfirmationModal"}],"version":"11.3.1-pre.9208"}
+{"$schema":"https://json.openmrs.org/routes.schema.json","backendDependencies":{"fhir2":">=1.2","webservices.rest":">=2.2.0"},"extensions":[{"name":"vitals-overview-widget","component":"vitalsSummary","slot":"patient-chart-summary-dashboard-slot","meta":{"fullWidth":true},"order":1},{"name":"vitals-details-widget","component":"vitalsMain","slot":"patient-chart-vitals-biometrics-dashboard-slot","meta":{"title":"Vitals","view":"vitals","fullWidth":true},"order":1},{"name":"patient-vitals-info","component":"vitalsHeader","slot":"patient-info-slot"},{"name":"biometrics-overview-widget","component":"biometricsOverview","slot":"patient-chart-summary-dashboard-slot","meta":{"fullWidth":true},"order":2},{"name":"biometrics-details-widget","component":"biometricsDetailedSummary","slot":"patient-chart-vitals-biometrics-dashboard-slot","meta":{"view":"biometrics","title":"Biometrics","fullWidth":true}},{"name":"results-summary-dashboard","component":"vitalsAndBiometricsDashboardLink","slot":"patient-chart-dashboard-slot","order":2,"meta":{"slot":"patient-chart-vitals-biometrics-dashboard-slot","path":"Vitals & Biometrics"}},{"name":"weight-tile","component":"weightTile","slot":"visit-form-header-slot","order":2}],"pages":[],"workspaces":[{"name":"patient-vitals-biometrics-form-workspace","title":"recordVitalsAndBiometrics","component":"vitalsBiometricsFormWorkspace"}],"modals":[{"name":"vitals-biometrics-delete-confirmation-modal","component":"vitalsAndBiometricsDeleteConfirmationModal"}],"version":"11.3.1-pre.9211"}

package/package.json

@@ -1,6 +1,6 @@
 {
   "name": "@openmrs/esm-patient-vitals-app",
-  "version": "11.3.1-pre.9208",
+  "version": "11.3.1-pre.9211",
   "license": "MPL-2.0",
   "description": "Patient vitals microfrontend for the OpenMRS SPA",
   "browser": "dist/openmrs-esm-patient-vitals-app.js",
@@ -53,7 +53,7 @@
     "swr": "2.x"
   },
   "devDependencies": {
-    "@openmrs/esm-patient-common-lib": "11.3.1-pre.9208"
+    "@openmrs/esm-patient-common-lib": "11.3.1-pre.9211"
   },
   "stableVersion": "11.3.0"
 }

package/src/common/data.resource.ts

@@ -11,7 +11,12 @@ import {
 import useSWRImmutable from 'swr/immutable';
 import useSWRInfinite from 'swr/infinite';
 import { type ConfigObject } from '../config-schema';
-import { assessValue, calculateBodyMassIndex, getReferenceRangesForConcept, interpretBloodPressure } from './helpers';
+import {
+  assessValue,
+  calculateBodyMassIndex,
+  interpretBloodPressure,
+  mapFhirInterpretationToObservationInterpretation,
+} from './helpers';
 import type {
   FHIRObservationResource,
   FHIRSearchBundleResponse,
@@ -323,23 +328,13 @@ export function useVitalsAndBiometrics(patientUuid: string, mode: VitalsAndBiome
           vitalSigns.diastolic,
           concepts,
           conceptRanges,
+          vitalSigns.systolicRenderInterpretation,
+          vitalSigns.diastolicRenderInterpretation,
         );
-        result.pulseRenderInterpretation = assessValue(
-          vitalSigns.pulse,
-          getReferenceRangesForConcept(concepts.pulseUuid, conceptRanges),
-        );
-        result.temperatureRenderInterpretation = assessValue(
-          vitalSigns.temperature,
-          getReferenceRangesForConcept(concepts.temperatureUuid, conceptRanges),
-        );
-        result.spo2RenderInterpretation = assessValue(
-          vitalSigns.spo2,
-          getReferenceRangesForConcept(concepts.oxygenSaturationUuid, conceptRanges),
-        );
-        result.respiratoryRateRenderInterpretation = assessValue(
-          vitalSigns.respiratoryRate,
-          getReferenceRangesForConcept(concepts.respiratoryRateUuid, conceptRanges),
-        );
+        result.pulseRenderInterpretation = vitalSigns.pulseRenderInterpretation;
+        result.temperatureRenderInterpretation = vitalSigns.temperatureRenderInterpretation;
+        result.spo2RenderInterpretation = vitalSigns.spo2RenderInterpretation;
+        result.respiratoryRateRenderInterpretation = vitalSigns.respiratoryRateRenderInterpretation;
       }
 
       return result;
@@ -472,7 +467,9 @@ function mapVitalsAndBiometrics(resource: FHIRObservationResource): MappedVitals
   return {
     code: resource?.code?.coding?.[0]?.code,
     encounterId: extractEncounterUuid(resource.encounter),
-    interpretation: assessValue(resource?.valueQuantity?.value, referenceRanges),
+    interpretation: resource.interpretation?.[0]?.coding?.[0]?.display
+      ? mapFhirInterpretationToObservationInterpretation(resource.interpretation?.[0]?.coding?.[0]?.display)
+      : assessValue(resource?.valueQuantity?.value, referenceRanges),
     recordedDate: resource?.effectiveDateTime,
     value: resource?.valueQuantity?.value,
   };

package/src/common/helpers.ts

@@ -1,6 +1,6 @@
 import { type OpenmrsResource } from '@openmrs/esm-framework';
 import { type ConceptMetadata } from '../common';
-import type { ObsReferenceRanges, ObservationInterpretation } from './types';
+import type { FHIRInterpretation, ObsReferenceRanges, ObservationInterpretation } from './types';
 import { type VitalsBiometricsFormData } from '../vitals-biometrics-form/schema';
 import { type VitalsAndBiometricsFieldValuesMap } from './data.resource';
 
@@ -33,24 +33,49 @@ export function assessValue(value: number | undefined, range?: ObsReferenceRange
   return 'normal';
 }
 
+export function mapFhirInterpretationToObservationInterpretation(
+  interpretation: FHIRInterpretation,
+): ObservationInterpretation {
+  const normalized = interpretation?.trim();
+  switch (normalized) {
+    case 'Critically Low':
+      return 'critically_low';
+    case 'Critically High':
+      return 'critically_high';
+    case 'High':
+      return 'high';
+    case 'Low':
+      return 'low';
+    case 'Normal':
+      return 'normal';
+    default:
+      return 'normal';
+  }
+}
+
 export function interpretBloodPressure(
   systolic: number | undefined,
   diastolic: number | undefined,
   concepts: { systolicBloodPressureUuid?: string; diastolicBloodPressureUuid?: string } | undefined,
   conceptMetadata: Array<ConceptMetadata> | undefined,
+  systolicInterpretation?: ObservationInterpretation,
+  diastolicInterpretation?: ObservationInterpretation,
 ): ObservationInterpretation {
   if (!conceptMetadata) {
     return 'normal';
   }
 
-  const systolicAssessment = assessValue(
-    systolic,
-    getReferenceRangesForConcept(concepts?.systolicBloodPressureUuid, conceptMetadata),
-  );
-
-  const diastolicAssessment = concepts?.diastolicBloodPressureUuid
-    ? assessValue(diastolic, getReferenceRangesForConcept(concepts.diastolicBloodPressureUuid, conceptMetadata))
-    : 'normal';
+  const systolicAssessment =
+    systolicInterpretation ??
+    (concepts?.systolicBloodPressureUuid
+      ? assessValue(systolic, getReferenceRangesForConcept(concepts.systolicBloodPressureUuid, conceptMetadata))
+      : 'normal');
+
+  const diastolicAssessment =
+    diastolicInterpretation ??
+    (concepts?.diastolicBloodPressureUuid
+      ? assessValue(diastolic, getReferenceRangesForConcept(concepts.diastolicBloodPressureUuid, conceptMetadata))
+      : 'normal');
 
   if (systolicAssessment === 'critically_high' || diastolicAssessment === 'critically_high') {
     return 'critically_high';

package/src/common/types.ts

@@ -20,12 +20,14 @@ export type ObservationInterpretation = 'critically_low' | 'critically_high' | '
 
 export type MappedVitals = {
   code: string;
-  interpretation: string;
+  interpretation: ObservationInterpretation;
   recordedDate: string | Date;
   value: number;
   encounterId: string;
 };
 
+export type FHIRInterpretation = 'Critically Low' | 'Critically High' | 'High' | 'Low' | 'Normal';
+
 export interface FHIRObservationResource {
   resourceType: string;
   id: string;
@@ -82,13 +84,23 @@ export interface FHIRObservationResource {
   hasMember?: Array<{
     reference: string;
   }>;
+  interpretation?: Array<{
+    coding: Array<{
+      code: string;
+      display: FHIRInterpretation;
+      system: string;
+    }>;
+    text: string;
+  }>;
 }
 
 export interface PatientVitalsAndBiometrics {
   id: string;
   date: string;
   systolic?: number;
+  systolicRenderInterpretation?: ObservationInterpretation;
   diastolic?: number;
+  diastolicRenderInterpretation?: ObservationInterpretation;
   bloodPressureRenderInterpretation?: ObservationInterpretation;
   pulse?: number;
   pulseRenderInterpretation?: ObservationInterpretation;

package/src/vitals-and-biometrics-header/vitals-header.component.tsx

@@ -161,25 +161,30 @@ const VitalsHeader: React.FC<VitalsHeaderProps> = ({ patientUuid, hideLinks = fa
                 latestVitals?.diastolic,
                 config?.concepts,
                 conceptRanges,
+                latestVitals?.systolicRenderInterpretation,
+                latestVitals?.diastolicRenderInterpretation,
               )}
               unitName={t('bp', 'BP')}
               unitSymbol={(latestVitals?.systolic && conceptUnits.get(config.concepts.systolicBloodPressureUuid)) ?? ''}
               value={`${latestVitals?.systolic ?? '--'} / ${latestVitals?.diastolic ?? '--'}`}
             />
             <VitalsHeaderItem
-              interpretation={assessValue(
-                latestVitals?.pulse,
-                getReferenceRangesForConcept(config.concepts.pulseUuid, conceptRanges),
-              )}
+              interpretation={
+                latestVitals?.pulseRenderInterpretation ??
+                assessValue(latestVitals?.pulse, getReferenceRangesForConcept(config.concepts.pulseUuid, conceptRanges))
+              }
               unitName={t('heartRate', 'Heart rate')}
               unitSymbol={(latestVitals?.pulse && conceptUnits.get(config.concepts.pulseUuid)) ?? ''}
               value={latestVitals?.pulse ?? '--'}
             />
             <VitalsHeaderItem
-              interpretation={assessValue(
-                latestVitals?.respiratoryRate,
-                getReferenceRangesForConcept(config.concepts.respiratoryRateUuid, conceptRanges),
-              )}
+              interpretation={
+                latestVitals?.respiratoryRateRenderInterpretation ??
+                assessValue(
+                  latestVitals?.respiratoryRate,
+                  getReferenceRangesForConcept(config.concepts.respiratoryRateUuid, conceptRanges),
+                )
+              }
               unitName={t('respiratoryRate', 'R. rate')}
               unitSymbol={
                 (latestVitals?.respiratoryRate && conceptUnits.get(config.concepts.respiratoryRateUuid)) ?? ''
@@ -187,19 +192,25 @@ const VitalsHeader: React.FC<VitalsHeaderProps> = ({ patientUuid, hideLinks = fa
               value={latestVitals?.respiratoryRate ?? '--'}
             />
             <VitalsHeaderItem
-              interpretation={assessValue(
-                latestVitals?.spo2,
-                getReferenceRangesForConcept(config.concepts.oxygenSaturationUuid, conceptRanges),
-              )}
+              interpretation={
+                latestVitals?.spo2RenderInterpretation ??
+                assessValue(
+                  latestVitals?.spo2,
+                  getReferenceRangesForConcept(config.concepts.oxygenSaturationUuid, conceptRanges),
+                )
+              }
               unitName={t('spo2', 'SpO2')}
               unitSymbol={(latestVitals?.spo2 && conceptUnits.get(config.concepts.oxygenSaturationUuid)) ?? ''}
               value={latestVitals?.spo2 ?? '--'}
             />
             <VitalsHeaderItem
-              interpretation={assessValue(
-                latestVitals?.temperature,
-                getReferenceRangesForConcept(config.concepts.temperatureUuid, conceptRanges),
-              )}
+              interpretation={
+                latestVitals?.temperatureRenderInterpretation ??
+                assessValue(
+                  latestVitals?.temperature,
+                  getReferenceRangesForConcept(config.concepts.temperatureUuid, conceptRanges),
+                )
+              }
               unitName={t('temperatureAbbreviated', 'Temp')}
               unitSymbol={(latestVitals?.temperature && conceptUnits.get(config.concepts.temperatureUuid)) ?? ''}
               value={latestVitals?.temperature ?? '--'}

package/src/vitals-and-biometrics-header/vitals-header.test.tsx

@@ -12,7 +12,7 @@ import {
   mockVitalsConfig,
 } from '__mocks__';
 import { configSchema, type ConfigObject } from '../config-schema';
-import { useVitalsAndBiometrics } from '../common';
+import { type PatientVitalsAndBiometrics, useVitalsAndBiometrics } from '../common';
 import VitalsHeader from './vitals-header.component';
 
 const testProps = {
@@ -260,4 +260,98 @@ describe('VitalsHeader', () => {
     expect(screen.queryByRole('link', { name: /vitals history/i })).not.toBeInTheDocument();
     expect(screen.queryByRole('button', { name: /record vitals/i })).not.toBeInTheDocument();
   });
+
+  it('uses backend interpretation without recalculating', async () => {
+    // Pulse 240 would normally be calculated as "critically_high" (>= 230)
+    // Temperature 41 would normally be calculated as "high" (> 37.5 but < 43)
+    // SpO2 70 would normally be calculated as "critically_low" (< 95)
+    // Respiratory Rate 5 would normally be calculated as "critically_low" (< 12)
+    // Backend sends the interpretation for all vitals as "normal", except for Respiratory Rate which is "critically_low" (< 12)
+    // It should use backend's interpretation and NOT recalculate
+    const vitalsWithConflictingInterpretation: PatientVitalsAndBiometrics[] = [
+      {
+        id: '0',
+        date: '2021-05-19T04:26:51.000Z',
+        pulse: 240,
+        temperature: 41,
+        respiratoryRate: 5,
+        diastolic: 145,
+        systolic: 240,
+        spo2: 70,
+        diastolicRenderInterpretation: 'normal',
+        systolicRenderInterpretation: 'normal',
+        bloodPressureRenderInterpretation: 'normal',
+        pulseRenderInterpretation: 'normal',
+        temperatureRenderInterpretation: 'normal',
+        respiratoryRateRenderInterpretation: 'critically_low',
+        spo2RenderInterpretation: 'normal',
+      },
+    ];
+
+    mockUseVitalsAndBiometrics.mockReturnValue({
+      data: vitalsWithConflictingInterpretation,
+    } as ReturnType<typeof useVitalsAndBiometrics>);
+
+    renderWithSwr(<VitalsHeader {...testProps} />);
+
+    await waitForLoadingToFinish();
+
+    expect(getByTextWithMarkup(/BP\s*240 \/ 145\s*mmHg/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/Heart rate\s*240\s*beats\/min/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/Temp\s*41\s*DEG C/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/R\. Rate\s*5\s*breaths\/min/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/SpO2\s*70\s*/i)).toBeInTheDocument();
+
+    expect(screen.getAllByTitle(/abnormal value/i)).toHaveLength(1);
+    expect(screen.getByTitle(/abnormal value/i)).toHaveClass('critically-low');
+  });
+
+  it('recalculates interpretation when backend does not provide interpretation', async () => {
+    // All vitals are abnormal, and backend does not provide interpretation for any of them.
+    // It should fallback to recalculating and mark them as abnormal.
+    const vitalsWithoutInterpretation: PatientVitalsAndBiometrics[] = [
+      {
+        id: '0',
+        date: '2021-05-19T04:26:51.000Z',
+        pulse: 240, // should be marked as "critically_high"
+        temperature: 41, // should be marked as "high"
+        respiratoryRate: 5, // should be marked as "low"
+        diastolic: 145,
+        systolic: 240, // blood pressure should be marked as "high"
+        spo2: 70, // should be marked as "low"
+      },
+    ];
+
+    mockUseVitalsAndBiometrics.mockReturnValue({
+      data: vitalsWithoutInterpretation,
+    } as ReturnType<typeof useVitalsAndBiometrics>);
+
+    renderWithSwr(<VitalsHeader {...testProps} />);
+
+    await waitForLoadingToFinish();
+
+    expect(getByTextWithMarkup(/BP\s*240 \/ 145\s*mmHg/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/Heart rate\s*240\s*beats\/min/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/Temp\s*41\s*DEG C/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/R\. Rate\s*5\s*breaths\/min/i)).toBeInTheDocument();
+    expect(getByTextWithMarkup(/SpO2\s*70\s*/i)).toBeInTheDocument();
+
+    const abnormalValueElements = screen.getAllByTitle(/abnormal value/i);
+    expect(abnormalValueElements).toHaveLength(5);
+
+    const lowElements = abnormalValueElements.filter((element) => {
+      return element.className === 'low';
+    });
+    expect(lowElements).toHaveLength(2);
+
+    const highElements = abnormalValueElements.filter((element) => {
+      return element.className === 'high';
+    });
+    expect(highElements).toHaveLength(2);
+
+    const criticallyHighElements = abnormalValueElements.filter((element) => {
+      return element.className === 'critically-high';
+    });
+    expect(criticallyHighElements).toHaveLength(1);
+  });
 });