interface/orders/gen_hl7_order.inc.php

   1 <?php
   2
   3 /**
   4 * Functions to support HL7 order generation.
   5 *
   6 * Copyright (C) 2012-2013 Rod Roark <rod@sunsetsystems.com>
   7 *
   8 * LICENSE: This program is free software; you can redistribute it and/or
   9 * modify it under the terms of the GNU General Public License
  10 * as published by the Free Software Foundation; either version 2
  11 * of the License, or (at your option) any later version.
  12 * This program is distributed in the hope that it will be useful,
  13 * but WITHOUT ANY WARRANTY; without even the implied warranty of
  14 * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  15 * GNU General Public License for more details.
  16 * You should have received a copy of the GNU General Public License
  17 * along with this program.  If not, see <http://opensource.org/licenses/gpl-license.php>.
  18 *
  19 * @package   OpenEMR
  20 * @author    Rod Roark <rod@sunsetsystems.com>
  21 * @author    Jerry Padgett <sjpadgett@gmail.com>
  22 */
  23
  24 /*
  25 * A bit of documentation that will need to go into the manual:
  26 *
  27 * The lab may want a list of your insurances for mapping into their system.
  28 * To produce it, go into phpmyadmin and run this query:
  29 *
  30 * SELECT i.id, i.name, a.line1, a.line2, a.city, a.state, a.zip, p.area_code,
  31 * p.prefix, p.number FROM insurance_companies AS i
  32 * LEFT JOIN addresses AS a ON a.foreign_id = i.id
  33 * LEFT JOIN phone_numbers AS p ON p.type = 2 AND p.foreign_id = i.id
  34 * ORDER BY i.name, i.id;
  35 *
  36 * Then export as a CSV file and read it into your favorite spreadsheet app.
  37 */
  38
  39 require_once("$webserver_root/custom/code_types.inc.php");
  40
  41 use OpenEMR\Common\Logging\EventAuditLogger;
  42
  43 function hl7Text($s)
  44 {
  45   // See http://www.interfaceware.com/hl7_escape_protocol.html:
  46     $s = str_replace('\\', '\\E\\', $s);
  47     $s = str_replace('^', '\\S\\', $s);
  48     $s = str_replace('|', '\\F\\', $s);
  49     $s = str_replace('~', '\\R\\', $s);
  50     $s = str_replace('&', '\\T\\', $s);
  51     $s = str_replace("\r", '\\X0d\\', $s);
  52     return $s;
  53 }
  54
  55 function hl7Zip($s)
  56 {
  57     return hl7Text(preg_replace('/[-\s]*/', '', $s));
  58 }
  59
  60 function hl7Date($s)
  61 {
  62     return preg_replace('/[^\d]/', '', $s);
  63 }
  64
  65 function hl7Time($s)
  66 {
  67     if (empty($s)) {
  68         return '';
  69     }
  70
  71     return date('YmdHis', strtotime($s));
  72 }
  73
  74 function hl7Sex($s)
  75 {
  76     $s = strtoupper(substr($s, 0, 1));
  77     if ($s !== 'M' && $s !== 'F') {
  78         $s = 'U';
  79     }
  80
  81     return $s;
  82 }
  83
  84 function hl7Phone($s)
  85 {
  86     if (preg_match("/([2-9]\d\d)\D*(\d\d\d)\D*(\d\d\d\d)\D*$/", $s, $tmp)) {
  87         return '(' . $tmp[1] . ')' . $tmp[2] . '-' . $tmp[3];
  88     }
  89
  90     if (preg_match("/(\d\d\d)\D*(\d\d\d\d)\D*$/", $s, $tmp)) {
  91         return $tmp[1] . '-' . $tmp[2];
  92     }
  93
  94     return '';
  95 }
  96
  97 function hl7SSN($s)
  98 {
  99     if (preg_match("/(\d\d\d)\D*(\d\d)\D*(\d\d\d\d)\D*$/", $s, $tmp)) {
 100         return $tmp[1] . '-' . $tmp[2] . '-' . $tmp[3];
 101     }
 102
 103     return '';
 104 }
 105
 106 function hl7Priority($s)
 107 {
 108     return strtoupper(substr($s, 0, 1)) == 'H' ? 'S' : 'R';
 109 }
 110
 111 function hl7Relation($s)
 112 {
 113     $tmp = strtolower($s);
 114     if ($tmp == 'self' || $tmp == '') {
 115         return 'self';
 116     } elseif ($tmp == 'spouse') {
 117         return 'spouse';
 118     } elseif ($tmp == 'child') {
 119         return 'child';
 120     } elseif ($tmp == 'other') {
 121         return 'other';
 122     }
 123
 124   // Should not get here so this will probably get noticed if we do.
 125     return $s;
 126 }
 127
 128 /**
 129  * Get array of insurance payers for the specified patient as of the specified
 130  * date. If no date is passed then the current date is used.
 131  *
 132  * @param  integer $pid             Patient ID.
 133  * @param  date    $encounter_date  YYYY-MM-DD date.
 134  * @return array   Array containing an array of data for each payer.
 135  */
 136 function loadPayerInfo($pid, $date = '')
 137 {
 138     if (empty($date)) {
 139         $date = date('Y-m-d');
 140     }
 141
 142     $payers = array();
 143     $dres = sqlStatement(
 144         "SELECT * FROM insurance_data WHERE " .
 145         "pid = ? AND (date <= ? OR date IS NULL) ORDER BY type ASC, date DESC",
 146         array($pid, $date)
 147     );
 148     $prevtype = ''; // type is primary, secondary or tertiary
 149     while ($drow = sqlFetchArray($dres)) {
 150         if (strcmp($prevtype, $drow['type']) == 0) {
 151             continue;
 152         }
 153
 154         $prevtype = $drow['type'];
 155         // Very important to check for a missing provider because
 156         // that indicates no insurance as of the given date.
 157         if (empty($drow['provider'])) {
 158             continue;
 159         }
 160
 161         $ins = count($payers);
 162         $crow = sqlQuery(
 163             "SELECT * FROM insurance_companies WHERE id = ?",
 164             array($drow['provider'])
 165         );
 166         $orow = new InsuranceCompany($drow['provider']);
 167         $payers[$ins] = array();
 168         $payers[$ins]['data']    = $drow;
 169         $payers[$ins]['company'] = $crow;
 170         $payers[$ins]['object']  = $orow;
 171     }
 172
 173     return $payers;
 174 }
 175
 176 /**
 177  * Generate HL7 for the specified procedure order.
 178  *
 179  * @param  integer $orderid  Procedure order ID.
 180  * @param  string  &$out     Container for target HL7 text.
 181  * @return string            Error text, or empty if no errors.
 182  */
 183 function gen_hl7_order($orderid, &$out)
 184 {
 185
 186   // Delimiters
 187     $d0 = "\r";
 188     $d1 = '|';
 189     $d2 = '^';
 190
 191     $today = time();
 192     $out = '';
 193
 194     $porow = sqlQuery(
 195         "SELECT " .
 196         "po.date_collected, po.date_ordered, po.order_priority, " .
 197         "pp.*, " .
 198         "pd.pid, pd.pubpid, pd.fname, pd.lname, pd.mname, pd.DOB, pd.ss, " .
 199         "pd.phone_home, pd.phone_biz, pd.sex, pd.street, pd.city, pd.state, pd.postal_code, " .
 200         "f.encounter, u.fname AS docfname, u.lname AS doclname, u.npi AS docnpi " .
 201         "FROM procedure_order AS po, procedure_providers AS pp, " .
 202         "forms AS f, patient_data AS pd, users AS u " .
 203         "WHERE " .
 204         "po.procedure_order_id = ? AND " .
 205         "pp.ppid = po.lab_id AND " .
 206         "f.formdir = 'procedure_order' AND " .
 207         "f.form_id = po.procedure_order_id AND " .
 208         "pd.pid = f.pid AND " .
 209         "u.id = po.provider_id",
 210         array($orderid)
 211     );
 212     if (empty($porow)) {
 213         return "Procedure order, ordering provider or lab is missing for order ID '$orderid'";
 214     }
 215
 216     $pcres = sqlStatement(
 217         "SELECT " .
 218         "pc.procedure_code, pc.procedure_name, pc.procedure_order_seq, pc.diagnoses, pt.specimen " .
 219         "FROM procedure_order_code AS pc, procedure_type as pt " .
 220         "WHERE " .
 221         "pc.procedure_order_id = ? AND " .
 222         "pc.procedure_name = pt.name AND " .
 223         "pc.do_not_send = 0 " .
 224         "ORDER BY pc.procedure_order_seq",
 225         array($orderid)
 226     );
 227
 228   // Message Header
 229     $out .= "MSH" .
 230     $d1 . "$d2~\\&" .               // Encoding Characters (delimiters)
 231     $d1 . $porow['send_app_id'] .   // Sending Application ID
 232     $d1 . $porow['send_fac_id'] .   // Sending Facility ID
 233     $d1 . $porow['recv_app_id'] .   // Receiving Application ID
 234     $d1 . $porow['recv_fac_id'] .   // Receiving Facility ID
 235     $d1 . date('YmdHis', $today) .  // Date and time of this message
 236     $d1 .
 237     $d1 . 'ORM' . $d2 . 'O01' .     // Message Type
 238     $d1 . str_pad((string)$orderid, 4, "0", STR_PAD_LEFT) .  // Unique Message Number
 239     $d1 . $porow['DorP'] .          // D=Debugging, P=Production
 240     $d1 . '2.3' .                   // HL7 Version ID
 241     $d0;
 242
 243   // Patient Identification
 244     $out .= "PID" .
 245     $d1 . "1" .                      // Set ID (always just 1 of these)
 246     $d1 . $porow['pid'] .            // Patient ID (not required)
 247     $d1 . $porow['pid'] .            // Patient ID (required)
 248     $d1 .                            // Alternate Patient ID (not required)
 249     $d1 . hl7Text($porow['lname']) .
 250       $d2 . hl7Text($porow['fname']);
 251     if ($porow['mname']) {
 252         $out .= $d2 . hl7Text($porow['mname']);
 253     }
 254
 255     $out .=
 256     $d1 .
 257     $d1 . hl7Date($porow['DOB']) .   // DOB
 258     $d1 . hl7Sex($porow['sex'])  .   // Sex: M, F or U
 259     $d1 . $d1 .
 260     $d1 . hl7Text($porow['street']) .
 261       $d2 .
 262       $d2 . hl7Text($porow['city']) .
 263       $d2 . hl7Text($porow['state']) .
 264       $d2 . hl7Zip($porow['postal_code']) .
 265     $d1 .
 266     $d1 . hl7Phone($porow['phone_home']) .
 267     $d1 . hl7Phone($porow['phone_biz']) .
 268     $d1 . $d1 . $d1 .
 269     $d1 . $porow['encounter'] .
 270     $d1 . hl7SSN($porow['ss']) .
 271     $d1 . $d1 . $d1 .
 272     $d0;
 273
 274     // NTE segment(s).
 275     //$msql = sqlStatement("SELECT title FROM lists WHERE type='medication' AND pid='".$porow['pid']."'");
 276     $msql = sqlStatement("SELECT drug FROM prescriptions WHERE active=1 AND patient_id=?", [$porow['pid']]);
 277     $drugs = array();
 278     while ($mres = sqlFetchArray($msql)) {
 279         $drugs[] = trim($mres['drug']);
 280     }
 281     $med_list = count($drugs) > 0 ? implode(",", $drugs) : 'NONE';
 282
 283     $out .= "NTE" .
 284         $d1 . "1" .
 285         $d1 . "L" .
 286         $d1 . "Medications:" . $med_list .
 287         $d0;
 288
 289   // Patient Visit.
 290     $out .= "PV1" .
 291     $d1 . "1" .                           // Set ID (always just 1 of these)
 292     $d1 .                                 // Patient Class (if required, O for Outpatient)
 293     $d1 .                                 // Patient Location (for inpatient only?)
 294     $d1 . $d1 . $d1 .
 295     $d1 . hl7Text($porow['docnpi']) .     // Attending Doctor ID
 296       $d2 . hl7Text($porow['doclname']) . // Last Name
 297       $d2 . hl7Text($porow['docfname']) . // First Name
 298     str_repeat($d1, 11) .                 // PV1 8 to 18 all empty
 299     $d1 . $porow['encounter'] .           // Encounter Number
 300     str_repeat($d1, 13) .                 // PV1 20 to 32 all empty
 301     $d0;
 302
 303   // Insurance stuff.
 304     $payers = loadPayerInfo($porow['pid'], $porow['date_ordered']);
 305     $setid = 0;
 306     foreach ($payers as $payer) {
 307         $payer_object = $payer['object'];
 308         $payer_address = $payer_object->get_address();
 309         $out .= "IN1" .
 310         $d1 . ++$setid .                                // Set ID
 311         $d1 .                                           // Insurance Plan Identifier ??
 312         $d1 . hl7Text($payer['company']['id']) .        // Insurance Company ID
 313         $d1 . hl7Text($payer['company']['name'])   .    // Insurance Company Name
 314         $d1 . hl7Text($payer_address->get_line1()) .    // Street Address
 315         $d2 .
 316         $d2 . hl7Text($payer_address->get_city()) .   // City
 317         $d2 . hl7Text($payer_address->get_state()) .  // State
 318         $d2 . hl7Zip($payer_address->get_zip()) .     // Zip Code
 319         $d1 .
 320         $d1 . hl7Phone($payer_object->get_phone()) .    // Phone Number
 321         $d1 . hl7Text($payer['data']['group_number']) . // Insurance Company Group Number
 322         str_repeat($d1, 7) .                            // IN1 9-15 all empty
 323         $d1 . hl7Text($payer['data']['subscriber_lname']) .   // Insured last name
 324         $d2 . hl7Text($payer['data']['subscriber_fname']) . // Insured first name
 325         $d2 . hl7Text($payer['data']['subscriber_mname']) . // Insured middle name
 326         $d1 . hl7Relation($payer['data']['subscriber_relationship']) .
 327         $d1 . hl7Date($payer['data']['subscriber_DOB']) .     // Insured DOB
 328         $d1 . hl7Date($payer['data']['subscriber_street']) .  // Insured Street Address
 329         $d2 .
 330         $d2 . hl7Text($payer['data']['subscriber_city']) .  // City
 331         $d2 . hl7Text($payer['data']['subscriber_state']) . // State
 332         $d2 . hl7Zip($payer['data']['subscriber_postal_code']) . // Zip
 333         $d1 .
 334         $d1 .
 335         $d1 . $setid .                                  // 1=Primary, 2=Secondary, 3=Tertiary
 336         str_repeat($d1, 13) .                           // IN1-23 to 35 all empty
 337         $d1 . hl7Text($payer['data']['policy_number']) . // Policy Number
 338         str_repeat($d1, 12) .                           // IN1-37 to 48 all empty
 339         $d0;
 340
 341         // IN2 segment omitted.
 342     }
 343
 344   // Guarantor. OpenEMR doesn't have these so use the patient.
 345     $out .= "GT1" .
 346     $d1 . "1" .                      // Set ID (always just 1 of these)
 347     $d1 .
 348     $d1 . hl7Text($porow['lname']) .
 349     $d2 . hl7Text($porow['fname']);
 350     if ($porow['mname']) {
 351         $out .= $d2 . hl7Text($porow['mname']);
 352     }
 353
 354     $out .=
 355     $d1 .
 356     $d1 . hl7Text($porow['street']) .
 357     $d2 .
 358     $d2 . hl7Text($porow['city']) .
 359     $d2 . hl7Text($porow['state']) .
 360     $d2 . hl7Zip($porow['postal_code']) .
 361     $d1 . hl7Phone($porow['phone_home']) .
 362     $d1 . hl7Phone($porow['phone_biz']) .
 363     $d1 . hl7Date($porow['DOB']) .   // DOB
 364     $d1 . hl7Sex($porow['sex'])  .   // Sex: M, F or U
 365     $d1 .
 366     $d1 . 'self' .                   // Relationship
 367     $d1 . hl7SSN($porow['ss']) .
 368     $d0;
 369
 370   // Common Order.
 371     $out .= "ORC" .
 372     $d1 . "NW" .                     // New Order
 373     $d1 . str_pad((string)$orderid, 4, "0", STR_PAD_LEFT) . // Placer Order Number
 374     str_repeat($d1, 6) .             // ORC 3-8 not used
 375     $d1 . date('YmdHis') .           // Transaction date/time
 376     $d1 . $d1 .
 377     $d1 . hl7Text($porow['docnpi']) .     // Ordering Provider
 378       $d2 . hl7Text($porow['doclname']) . // Last Name
 379       $d2 . hl7Text($porow['docfname']) . // First Name
 380     str_repeat($d1, 7) .             // ORC 13-19 not used
 381     $d1 . "2" .                      // ABN Status: 2 = Notified & Signed, 4 = Unsigned
 382     $d0;
 383
 384     $setid = 0;
 385     while ($pcrow = sqlFetchArray($pcres)) {
 386         // Observation Request.
 387
 388         $dl = '';
 389         $out .= "OBR" .
 390         $d1 . ++$setid .                              // Set ID
 391         $d1 . str_pad((string)$orderid, 4, "0", STR_PAD_LEFT) . // Placer Order Number
 392         $d1 .
 393         $d1 . hl7Text($pcrow['procedure_code']) .
 394         $d2 . hl7Text($pcrow['procedure_name']) .
 395         $d1 . hl7Priority($porow['order_priority']) . // S=Stat, R=Routine
 396         $d1 .
 397         $d1 . hl7Time($porow['date_collected']) .     // Observation Date/Time
 398         str_repeat($d1, 8) .                          // OBR 8-15 not used
 399         $dl . hl7Text($pcrow['specimen']) .           // Specimen source aka OBR-15
 400         $d1 . hl7Text($porow['docnpi']) .             // Physician ID
 401         $d2 . hl7Text($porow['doclname']) .         // Last Name
 402         $d2 . hl7Text($porow['docfname']) .         // First Name
 403         $d1 .
 404         $d1 . (count($payers) ? 'I' : 'P') .          // I=Insurance, C=Client, P=Self Pay
 405         str_repeat($d1, 8) .                          // OBR 19-26 not used
 406         $d1 . '0' .                                   // ?
 407         $d0;
 408
 409         // Diagnoses.  Currently hard-coded for ICD9 and we'll surely want to make
 410         // this more flexible (probably when some lab needs another diagnosis type).
 411         $setid2 = 0;
 412         if (!empty($pcrow['diagnoses'])) {
 413             $relcodes = explode(';', $pcrow['diagnoses']);
 414             foreach ($relcodes as $codestring) {
 415                 if ($codestring === '') {
 416                     continue;
 417                 }
 418
 419                 list($codetype, $code) = explode(':', $codestring);
 420                 if ($codetype !== 'ICD10') {
 421                     continue;
 422                 }
 423
 424                 $desc = lookup_code_descriptions($codestring);
 425                 $out .= "DG1" .
 426                 $d1 . ++$setid2 .                         // Set ID
 427                 $d1 .                                     // Diagnosis Coding Method
 428                 $d1 . $code .                             // Diagnosis Code
 429                     $d2 . hl7Text($desc) .                    // Diagnosis Description
 430                     $d2 . "I10" .                             // Diagnosis Type
 431                     $d1 . $d0;
 432             }
 433         }
 434
 435         // Order entry questions and answers.
 436         $qres = sqlStatement(
 437             "SELECT " .
 438             "a.question_code, a.answer, q.fldtype " .
 439             "FROM procedure_answers AS a " .
 440             "LEFT JOIN procedure_questions AS q ON " .
 441             "q.lab_id = ? " .
 442             "AND q.procedure_code = ? AND " .
 443             "q.question_code = a.question_code " .
 444             "WHERE " .
 445             "a.procedure_order_id = ? AND " .
 446             "a.procedure_order_seq = ? " .
 447             "ORDER BY q.seq, a.answer_seq",
 448             array($porow['ppid'], $pcrow['procedure_code'], $orderid, $pcrow['procedure_order_seq'])
 449         );
 450         $setid2 = 0;
 451         while ($qrow = sqlFetchArray($qres)) {
 452               // Formatting of these answer values may be lab-specific and we'll figure
 453               // out how to deal with that as more labs are supported.
 454               $answer = trim($qrow['answer']);
 455               $fldtype = $qrow['fldtype'];
 456               $datatype = 'ST';
 457             if ($fldtype == 'N') {
 458                 $datatype = "NM";
 459             } elseif ($fldtype == 'D') {
 460                   $answer = hl7Date($answer);
 461             } elseif ($fldtype == 'G') {
 462                   $weeks = intval($answer / 7);
 463                   $days = $answer % 7;
 464                   $answer = $weeks . 'wks ' . $days . 'days';
 465             }
 466
 467               $out .= "OBX" .
 468                 $d1 . ++$setid2 .                           // Set ID
 469                 $d1 . $datatype .                           // Structure of observation value
 470                 $d1 . hl7Text($qrow['question_code']) .     // Clinical question code
 471                 $d1 .
 472                 $d1 . hl7Text($answer) .                    // Clinical question answer
 473                 $d0;
 474         }
 475     }
 476
 477     return '';
 478 }
 479
 480 /**
 481  * Transmit HL7 for the specified lab.
 482  *
 483  * @param  integer $ppid  Procedure provider ID.
 484  * @param  string  $out   The HL7 text to be sent.
 485  * @return string         Error text, or empty if no errors.
 486  */
 487 function send_hl7_order($ppid, $out)
 488 {
 489     global $srcdir;
 490
 491     $d0 = "\r";
 492
 493     $pprow = sqlQuery("SELECT * FROM procedure_providers " .
 494     "WHERE ppid = ?", array($ppid));
 495     if (empty($pprow)) {
 496         return xl('Procedure provider') . " $ppid " . xl('not found');
 497     }
 498
 499     $protocol = $pprow['protocol'];
 500     $remote_host = $pprow['remote_host'];
 501
 502   // Extract MSH-10 which is the message control ID.
 503     $segmsh = explode(substr($out, 3, 1), substr($out, 0, strpos($out, $d0)));
 504     $msgid = $segmsh[9];
 505     if (empty($msgid)) {
 506         return xl('Internal error: Cannot find MSH-10');
 507     }
 508
 509     if ($protocol == 'DL' || $pprow['orders_path'] === '') {
 510         header("Pragma: public");
 511         header("Expires: 0");
 512         header("Cache-Control: must-revalidate, post-check=0, pre-check=0");
 513         header("Content-Type: application/force-download");
 514         header("Content-Disposition: attachment; filename=order_$msgid.hl7");
 515         header("Content-Description: File Transfer");
 516         echo $out;
 517         exit;
 518     } elseif ($protocol == 'SFTP') {
 519         // Compute the target path/file name.
 520         $filename = $msgid . '.txt';
 521         if ($pprow['orders_path']) {
 522             $filename = $pprow['orders_path'] . '/' . $filename;
 523         }
 524
 525         // Connect to the server and write the file.
 526         $sftp = new \phpseclib3\Net\SFTP($remote_host);
 527         if (!$sftp->login($pprow['login'], $pprow['password'])) {
 528             return xl('Login to this remote host failed') . ": '$remote_host'";
 529         }
 530
 531         if (!$sftp->put($filename, $out)) {
 532             return xl('Creating this file on remote host failed') . ": '$filename'";
 533         }
 534     } elseif ($protocol == 'FS') {
 535         // Compute the target path/file name.
 536         $filename = $msgid . '.txt';
 537         if ($pprow['orders_path']) {
 538             $filename = $pprow['orders_path'] . '/' . $filename;
 539         }
 540
 541         $fh = fopen("$filename", 'w');
 542         if ($fh) {
 543             fwrite($fh, $out);
 544             fclose($fh);
 545         } else {
 546             return xl('Cannot create file') . ' "' . "$filename" . '"';
 547         }
 548     } else { // TBD: Insert "else if ($protocol == '???') {...}" to support other protocols.
 549         return xl('This protocol is not implemented') . ": '$protocol'";
 550     }
 551
 552   // Falling through to here indicates success.
 553     EventAuditLogger::instance()->newEvent(
 554         "proc_order_xmit",
 555         $_SESSION['authUser'],
 556         $_SESSION['authProvider'],
 557         1,
 558         "ID: $msgid Protocol: $protocol Host: $remote_host"
 559     );
 560     return '';
 561 }