interface/orders/gen_hl7_order.inc.php

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