api/services/fhir_integration.py

from datetime import datetime
from typing import List, Dict, Optional
from api.utils.fhir_client import HAPIFHIRClient
from db.mongo import db

class HAPIFHIRIntegrationService:
    """
    Service to integrate HAPI FHIR data with your existing database
    """
    
    def __init__(self):
        self.fhir_client = HAPIFHIRClient()
    
    def _validate_patient_data_completeness(self, patient: Dict, require_medical_data: bool = False) -> Dict[str, any]:
        """
        Validate if a patient has complete data
        
        Args:
            patient: Patient data dictionary
            require_medical_data: Whether to require medical data (observations, medications, conditions)
            
        Returns:
            Dict with validation results:
            {
                "is_complete": bool,
                "missing_fields": List[str],
                "has_medical_data": bool,
                "validation_score": float (0-1)
            }
        """
        required_demographic_fields = [
            'full_name', 'gender', 'date_of_birth', 'address'
        ]
        
        optional_demographic_fields = [
            'phone', 'email', 'marital_status', 'language'
        ]
        
        medical_data_fields = [
            'observations', 'medications', 'conditions'
        ]
        
        missing_fields = []
        validation_score = 0.0
        total_fields = len(required_demographic_fields) + len(optional_demographic_fields)
        present_fields = 0
        
        # Check required demographic fields
        for field in required_demographic_fields:
            value = patient.get(field, '')
            if not value or (isinstance(value, str) and value.strip() == ''):
                missing_fields.append(field)
            else:
                present_fields += 1
        
        # Check optional demographic fields
        for field in optional_demographic_fields:
            value = patient.get(field, '')
            if value and (not isinstance(value, str) or value.strip() != ''):
                present_fields += 1
        
        # Check medical data
        has_medical_data = False
        if 'clinical_data' in patient:
            clinical_data = patient['clinical_data']
            for field in medical_data_fields:
                if field in clinical_data and clinical_data[field]:
                    has_medical_data = True
                    break
        
        # Calculate validation score
        validation_score = present_fields / total_fields if total_fields > 0 else 0.0
        
        # Determine if patient is complete
        is_complete = len(missing_fields) == 0 and validation_score >= 0.7
        
        # If medical data is required, check if patient has it
        if require_medical_data and not has_medical_data:
            is_complete = False
            missing_fields.append('medical_data')
        
        return {
            "is_complete": is_complete,
            "missing_fields": missing_fields,
            "has_medical_data": has_medical_data,
            "validation_score": validation_score,
            "demographic_completeness": present_fields / len(required_demographic_fields + optional_demographic_fields) if (len(required_demographic_fields) + len(optional_demographic_fields)) > 0 else 0.0
        }
    
    async def import_patients_from_hapi(self, limit: int = 20, require_medical_data: bool = False, min_completeness_score: float = 0.7) -> dict:
        """
        Import patients from HAPI FHIR Test Server with data completeness validation
        
        Args:
            limit: Number of patients to fetch from HAPI FHIR
            require_medical_data: Whether to require patients to have medical data
            min_completeness_score: Minimum validation score (0-1) for a patient to be considered complete
        """
        try:
            print(f"Fetching {limit} patients from HAPI FHIR...")
            patients = self.fhir_client.get_patients(limit=limit)
            
            if not patients:
                print("No patients found in HAPI FHIR")
                return {
                    "imported_count": 0,
                    "skipped_count": 0,
                    "filtered_count": 0,
                    "total_found": 0,
                    "imported_patients": [],
                    "skipped_patients": [],
                    "filtered_patients": [],
                    "validation_summary": {},
                    "errors": []
                }
            
            print(f"Found {len(patients)} patients, checking for duplicates and data completeness...")
            
            imported_count = 0
            skipped_count = 0
            filtered_count = 0
            imported_patients = []
            skipped_patients = []
            filtered_patients = []
            errors = []
            validation_summary = {
                "total_processed": len(patients),
                "complete_patients": 0,
                "incomplete_patients": 0,
                "with_medical_data": 0,
                "without_medical_data": 0,
                "average_completeness_score": 0.0
            }
            
            total_completeness_score = 0.0
            
            for patient in patients:
                try:
                    # Check if patient already exists by multiple criteria
                    existing = await db.patients.find_one({
                        "$or": [
                            {"fhir_id": patient['fhir_id']},
                            {"full_name": patient['full_name'], "date_of_birth": patient['date_of_birth']},
                            {"demographics.fhir_id": patient['fhir_id']}
                        ]
                    })
                    
                    if existing:
                        skipped_count += 1
                        skipped_patients.append(patient['full_name'])
                        print(f"Patient {patient['full_name']} already exists (fhir_id: {patient['fhir_id']}), skipping...")
                        continue
                    
                    # Enhance patient data with additional FHIR data
                    enhanced_patient = await self._enhance_patient_data(patient)
                    
                    # Validate data completeness
                    validation_result = self._validate_patient_data_completeness(
                        enhanced_patient, 
                        require_medical_data=require_medical_data
                    )
                    
                    # Update validation summary
                    total_completeness_score += validation_result["validation_score"]
                    
                    if validation_result["has_medical_data"]:
                        validation_summary["with_medical_data"] += 1
                    else:
                        validation_summary["without_medical_data"] += 1
                    
                    # Check if patient meets completeness criteria
                    if not validation_result["is_complete"] or validation_result["validation_score"] < min_completeness_score:
                        filtered_count += 1
                        filtered_patients.append({
                            "name": patient['full_name'],
                            "fhir_id": patient['fhir_id'],
                            "missing_fields": validation_result["missing_fields"],
                            "completeness_score": validation_result["validation_score"],
                            "has_medical_data": validation_result["has_medical_data"]
                        })
                        print(f"Patient {patient['full_name']} filtered out - missing: {validation_result['missing_fields']}, score: {validation_result['validation_score']:.2f}")
                        validation_summary["incomplete_patients"] += 1
                        continue
                    
                    validation_summary["complete_patients"] += 1
                    
                    # Insert into database
                    result = await db.patients.insert_one(enhanced_patient)
                    
                    if result.inserted_id:
                        imported_count += 1
                        imported_patients.append({
                            "name": patient['full_name'],
                            "fhir_id": patient['fhir_id'],
                            "completeness_score": validation_result["validation_score"],
                            "has_medical_data": validation_result["has_medical_data"]
                        })
                        print(f"Imported patient: {patient['full_name']} (ID: {result.inserted_id}, Score: {validation_result['validation_score']:.2f})")
                    
                except Exception as e:
                    error_msg = f"Error importing patient {patient.get('full_name', 'Unknown')}: {e}"
                    errors.append(error_msg)
                    print(error_msg)
                    continue
            
            # Calculate average completeness score
            if validation_summary["total_processed"] > 0:
                validation_summary["average_completeness_score"] = total_completeness_score / validation_summary["total_processed"]
            
            print(f"Import completed: {imported_count} imported, {skipped_count} skipped, {filtered_count} filtered out")
            print(f"Validation summary: {validation_summary}")
            
            return {
                "imported_count": imported_count,
                "skipped_count": skipped_count,
                "filtered_count": filtered_count,
                "total_found": len(patients),
                "imported_patients": imported_patients,
                "skipped_patients": skipped_patients,
                "filtered_patients": filtered_patients,
                "validation_summary": validation_summary,
                "errors": errors
            }
            
        except Exception as e:
            print(f"Error importing patients: {e}")
            return {
                "imported_count": 0,
                "skipped_count": 0,
                "filtered_count": 0,
                "total_found": 0,
                "imported_patients": [],
                "skipped_patients": [],
                "filtered_patients": [],
                "validation_summary": {},
                "errors": [str(e)]
            }
    
    async def _enhance_patient_data(self, patient: Dict) -> Dict:
        """
        Enhance patient data with additional FHIR resources
        """
        try:
            patient_id = patient['fhir_id']
            
            # Fetch additional data from HAPI FHIR
            observations = self.fhir_client.get_patient_observations(patient_id)
            medications = self.fhir_client.get_patient_medications(patient_id)
            conditions = self.fhir_client.get_patient_conditions(patient_id)
            
            # Structure the enhanced patient data
            enhanced_patient = {
                # Basic demographics
                **patient,
                
                # Clinical data
                'demographics': {
                    'id': patient['id'],
                    'fhir_id': patient['fhir_id'],
                    'full_name': patient['full_name'],
                    'gender': patient['gender'],
                    'date_of_birth': patient['date_of_birth'],
                    'address': patient['address'],
                    'phone': patient.get('phone', ''),
                    'email': patient.get('email', ''),
                    'marital_status': patient.get('marital_status', 'Unknown'),
                    'language': patient.get('language', 'English')
                },
                
                'clinical_data': {
                    'observations': observations,
                    'medications': medications,
                    'conditions': conditions,
                    'notes': [],  # Will be populated separately
                    'encounters': []  # Will be populated separately
                },
                
                'metadata': {
                    'source': 'hapi_fhir',
                    'import_date': datetime.now().isoformat(),
                    'last_updated': datetime.now().isoformat(),
                    'fhir_server': 'https://hapi.fhir.org/baseR4'
                }
            }
            
            return enhanced_patient
            
        except Exception as e:
            print(f"Error enhancing patient data: {e}")
            return patient
    
    async def sync_patient_data(self, patient_id: str) -> bool:
        """
        Sync a specific patient's data from HAPI FHIR
        """
        try:
            # Get patient from HAPI FHIR
            patient = self.fhir_client.get_patient_by_id(patient_id)
            
            if not patient:
                print(f"Patient {patient_id} not found in HAPI FHIR")
                return False
            
            # Enhance with additional data
            enhanced_patient = await self._enhance_patient_data(patient)
            
            # Update in database
            result = await db.patients.update_one(
                {"fhir_id": patient_id},
                {"$set": enhanced_patient},
                upsert=True
            )
            
            if result.modified_count > 0 or result.upserted_id:
                print(f"Synced patient: {patient['full_name']}")
                return True
            else:
                print(f"No changes for patient: {patient['full_name']}")
                return False
                
        except Exception as e:
            print(f"Error syncing patient {patient_id}: {e}")
            return False
    
    async def get_patient_statistics(self) -> Dict:
        """
        Get statistics about imported patients
        """
        try:
            total_patients = await db.patients.count_documents({})
            hapi_patients = await db.patients.count_documents({"source": "hapi_fhir"})
            
            # Get sample patient data and convert ObjectId to string
            sample_patient = await db.patients.find_one({"source": "hapi_fhir"})
            if sample_patient:
                # Convert ObjectId to string for JSON serialization
                sample_patient['_id'] = str(sample_patient['_id'])
            
            stats = {
                'total_patients': total_patients,
                'hapi_fhir_patients': hapi_patients,
                'sample_patient': sample_patient
            }
            
            return stats
            
        except Exception as e:
            print(f"Error getting statistics: {e}")
            return {}
    
    async def get_hapi_patients(self, limit: int = 50) -> List[Dict]:
        """
        Get patients from HAPI FHIR without importing them
        """
        try:
            patients = self.fhir_client.get_patients(limit=limit)
            return patients
        except Exception as e:
            print(f"Error fetching HAPI patients: {e}")
            return []
    
    async def get_hapi_patient_details(self, patient_id: str) -> Optional[Dict]:
        """
        Get detailed information for a specific HAPI FHIR patient
        """
        try:
            patient = self.fhir_client.get_patient_by_id(patient_id)
            if not patient:
                return None
            
            # Get additional data
            observations = self.fhir_client.get_patient_observations(patient_id)
            medications = self.fhir_client.get_patient_medications(patient_id)
            conditions = self.fhir_client.get_patient_conditions(patient_id)
            
            return {
                'patient': patient,
                'observations': observations,
                'medications': medications,
                'conditions': conditions
            }
            
        except Exception as e:
            print(f"Error fetching patient details: {e}")
            return None