feat(assessments): layered clinical assessment engine end-to-end
Deploy Ladill Care / deploy (push) Successful in 1m26s
Deploy Ladill Care / deploy (push) Successful in 1m26s
Add a template-driven assessment system with universal intake, clinical pathways, disease instruments (stroke MVP + extended, diabetes, and ten specialty packs), scoring, patient outcome trends, REST/API + FHIR export, and Enterprise org-level assessment analytics. Seed packs and design/licensing docs ship for deploy and pre-GA review.
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isaacclad
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<?php
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namespace App\Services\Care;
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use App\Models\Assessment;
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use App\Models\AssessmentQuestion;
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use Illuminate\Support\Str;
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/**
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* Export a Care assessment as FHIR R4 Questionnaire + QuestionnaireResponse (JSON).
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* Not a full FHIR server — interchange export for completed/draft assessments.
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*/
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class FhirAssessmentExporter
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{
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public const FHIR_VERSION = '4.0.1';
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/**
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* Bundle containing Questionnaire and QuestionnaireResponse.
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*
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* @return array<string, mixed>
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*/
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public function exportBundle(Assessment $assessment): array
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{
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$assessment->loadMissing(['template.questions', 'answers.question', 'patient', 'score']);
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$questionnaire = $this->questionnaire($assessment);
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$response = $this->questionnaireResponse($assessment, $questionnaire['url']);
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return [
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'resourceType' => 'Bundle',
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'type' => 'collection',
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'timestamp' => now()->toIso8601String(),
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'meta' => [
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'tag' => [[
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'system' => 'https://care.ladill.com/fhir/tags',
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'code' => 'ladill-care-assessment-export',
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]],
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],
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'entry' => [
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['fullUrl' => $questionnaire['url'], 'resource' => $questionnaire],
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['fullUrl' => $response['id'] ? 'urn:uuid:'.$response['id'] : 'QuestionnaireResponse/'.$assessment->uuid, 'resource' => $response],
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],
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];
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}
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/**
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* @return array<string, mixed>
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*/
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public function questionnaire(Assessment $assessment): array
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{
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$template = $assessment->template;
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$url = 'https://care.ladill.com/fhir/Questionnaire/'.($template?->code ?? 'unknown').'/v'.($template?->version ?? 1);
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$items = [];
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foreach ($template?->questions ?? [] as $question) {
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$items[] = $this->questionItem($question);
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}
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return [
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'resourceType' => 'Questionnaire',
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'id' => ($template?->code ?? 'unknown').'-v'.($template?->version ?? 1),
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'url' => $url,
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'version' => (string) ($template?->version ?? 1),
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'name' => Str::studly($template?->code ?? 'Assessment'),
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'title' => $template?->name ?? 'Assessment',
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'status' => ($template?->is_active ?? true) ? 'active' : 'retired',
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'description' => $template?->description,
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'item' => $items,
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];
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}
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/**
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* @return array<string, mixed>
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*/
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public function questionnaireResponse(Assessment $assessment, ?string $questionnaireUrl = null): array
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{
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$assessment->loadMissing(['template.questions', 'answers.question', 'patient', 'score']);
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$questionnaireUrl ??= $this->questionnaire($assessment)['url'];
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$answersByQ = $assessment->answers->keyBy('question_id');
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$items = [];
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foreach ($assessment->template?->questions ?? [] as $question) {
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$answer = $answersByQ->get($question->id);
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if (! $answer) {
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continue;
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}
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$value = $answer->authoritativeValue($question->answer_type);
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if ($value === null || $value === '') {
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continue;
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}
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$items[] = [
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'linkId' => $question->code,
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'text' => $question->label,
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'answer' => $this->fhirAnswers($question, $value),
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];
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}
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$status = match ($assessment->status) {
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Assessment::STATUS_COMPLETED => 'completed',
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Assessment::STATUS_CANCELLED => 'entered-in-error',
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default => 'in-progress',
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};
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$resource = [
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'resourceType' => 'QuestionnaireResponse',
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'id' => $assessment->uuid,
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'questionnaire' => $questionnaireUrl,
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'status' => $status,
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'authored' => ($assessment->assessed_at ?? $assessment->completed_at ?? $assessment->created_at)?->toIso8601String(),
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'subject' => [
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'reference' => 'Patient/'.($assessment->patient?->uuid ?? $assessment->patient_id),
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'display' => $assessment->patient?->fullName(),
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],
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'item' => $items,
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];
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if ($assessment->score) {
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$resource['extension'] = [[
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'url' => 'https://care.ladill.com/fhir/StructureDefinition/assessment-score',
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'extension' => array_values(array_filter([
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['url' => 'total', 'valueDecimal' => (float) $assessment->score->total_score],
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$assessment->score->max_score !== null
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? ['url' => 'max', 'valueDecimal' => (float) $assessment->score->max_score]
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: null,
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$assessment->score->severity_label
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? ['url' => 'severity', 'valueString' => $assessment->score->severity_label]
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: null,
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['url' => 'templateCode', 'valueString' => $assessment->score->template_code],
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])),
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]];
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}
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return $resource;
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}
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/**
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* @return array<string, mixed>
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*/
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protected function questionItem(AssessmentQuestion $question): array
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{
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$type = match ($question->answer_type) {
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AssessmentQuestion::TYPE_BOOLEAN => 'boolean',
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AssessmentQuestion::TYPE_INTEGER => 'integer',
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AssessmentQuestion::TYPE_NUMBER,
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AssessmentQuestion::TYPE_SCALE,
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AssessmentQuestion::TYPE_SCORE_ITEM,
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AssessmentQuestion::TYPE_CALCULATED => 'decimal',
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AssessmentQuestion::TYPE_DATE => 'date',
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AssessmentQuestion::TYPE_DATETIME => 'dateTime',
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AssessmentQuestion::TYPE_MULTI_CHOICE => 'choice',
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AssessmentQuestion::TYPE_SINGLE_CHOICE => 'choice',
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default => 'string',
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};
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$item = [
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'linkId' => $question->code,
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'text' => $question->label,
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'type' => $type,
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'required' => (bool) $question->is_required,
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];
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if ($question->help_text) {
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$item['prefix'] = $question->help_text;
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}
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$choices = $question->options['choices'] ?? null;
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if (is_array($choices) && $choices !== []) {
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$item['answerOption'] = array_map(function ($c) {
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$code = (string) ($c['code'] ?? '');
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$label = (string) ($c['label'] ?? $code);
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return [
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'valueCoding' => [
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'code' => $code,
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'display' => $label,
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],
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];
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}, $choices);
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}
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return $item;
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}
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/**
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* @return list<array<string, mixed>>
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*/
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protected function fhirAnswers(AssessmentQuestion $question, mixed $value): array
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{
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return match ($question->answer_type) {
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AssessmentQuestion::TYPE_BOOLEAN => [['valueBoolean' => (bool) $value]],
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AssessmentQuestion::TYPE_INTEGER => [['valueInteger' => (int) $value]],
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AssessmentQuestion::TYPE_NUMBER,
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AssessmentQuestion::TYPE_SCALE,
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AssessmentQuestion::TYPE_SCORE_ITEM,
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AssessmentQuestion::TYPE_CALCULATED => [['valueDecimal' => (float) $value]],
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AssessmentQuestion::TYPE_DATE => [['valueDate' => $value instanceof \Carbon\Carbon
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? $value->toDateString()
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: (string) $value]],
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AssessmentQuestion::TYPE_DATETIME => [['valueDateTime' => $value instanceof \Carbon\Carbon
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? $value->toIso8601String()
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: (string) $value]],
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AssessmentQuestion::TYPE_MULTI_CHOICE => collect(is_array($value) ? $value : [$value])
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->map(fn ($v) => ['valueString' => (string) $v])
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->values()
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->all(),
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AssessmentQuestion::TYPE_SINGLE_CHOICE => [['valueString' => (string) $value]],
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default => [['valueString' => is_scalar($value) ? (string) $value : json_encode($value)]],
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};
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}
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}
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