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HTNapi.php
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<?php
namespace Stanford\HTNapi;
require_once( "emLoggerTrait.php" );
require_once( 'HTNdashboard.php' );
require_once( 'HTNtree.php' );
ini_set('display_errors', 1);
ini_set('display_startup_errors', 1);
error_reporting(E_ALL);
class HTNapi extends \ExternalModules\AbstractExternalModule {
use emLoggerTrait;
private $dashboard
,$tree;
public $enabledProjects;
public function __construct() {
parent::__construct();
// Other code to run when object is instantiated
}
//Load the pertinent EM stuff, as well as the broken off Classes for Dashboard and Tree
public function loadEM(){
$this->getEnabledProjects();
$this->dashboard = new \Stanford\HTNapi\HTNdashboard($this);
$this->tree = new \Stanford\HTNapi\HTNtree($this);
// what else? API stuff?
session_start();
}
//DEFAULT TREES
public function getDefaultTrees($provider_id=0){
$this->loadEM();
return $this->tree->getDefaultTrees($provider_id);
}
public function getDefaultMeds(){
$this->loadEM();
return $this->tree->getDefaultMeds();
}
public function getDrugList(){
$this->loadEM();
return $this->tree->getDrugList();
}
//Get All Patients
public function dashBoardInterface($provider_id, $super_delegate=null, $dag_admin=null){
$this->loadEM();
// $this->emDebug("super delegate", $_SESSION["logged_in_user"]['super_delegate']);
$intf = $this->dashboard->getAllPatients($provider_id, $super_delegate, $dag_admin);
$intf["ptree"] = $this->treeLogic($provider_id);
$intf["super_delegate"] = !empty($_SESSION["logged_in_user"]['super_delegate']) ? $this->dashboard->getAllProviders() : array();
return $intf;
}
//Get All Patients
public function getPatientDetails($record_id){
$this->loadEM();
return $this->dashboard->getPatientDetails($record_id);
}
//# Provider
public function loginProvider($login_email, $login_pw, $already_hashed=false){
$this->loadEM();
return $this->dashboard->loginProvider($login_email, $login_pw, $already_hashed);
}
//REgister PRovider
public function registerProvider($post){
$this->loadEM();
return $this->dashboard->registerProvider($post);
}
//EDIT PRovider
public function editProvider($post){
$this->loadEM();
$this->dashboard->editProvider($post);
}
public function getProvider($provider_id){
$this->loadEM();
return $this->dashboard->getProvider($provider_id);
}
public function sendResetPassword($login_email){
$this->loadEM();
return $this->dashboard->sendResetPassword($login_email);
}
public function updateProviderPassword($record_id, $login_email, $rawpw){
$this->loadEM();
return $this->dashboard->updateProviderPassword($record_id, $login_email, $rawpw);
}
public function flagPatientForDeletion($patient_record_id){
$this->loadEM();
return $this->dashboard->flagPatientForDeletion($patient_record_id);
}
//EDIT LAB READING
public function updateLabReading($record_id, $lab, $reading){
$this->loadEM();
// update the shortcut data in patient baseline
$next_instance_id = $this->getNextInstanceId($record_id, "labs_log", "lab_ts");
$data_log = array(
"record_id" => $record_id,
"redcap_repeat_instance" => $next_instance_id,
"redcap_repeat_instrument" => "labs_log",
"lab_name" => $lab,
"lab_value" => $reading,
"lab_token" => "manual",
"lab_ts" => Date("Y-m-d")
);
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode(array($data_log)) );
$this->emDebug("update lab reading", $r , $data_log);
return array("errors" => $r["errors"], "data"=> $data_log);
}
/**
* Load all enabled projects with this EM
*/
public function getEnabledProjects() {
$enabledProjects = array();
$projects = \ExternalModules\ExternalModules::getEnabledProjects($this->PREFIX);
while($project = db_fetch_assoc($projects)){
$pid = $project['project_id'];
$name = $project['name'];
$url = APP_PATH_WEBROOT . 'ProjectSetup/index.php?pid=' . $project['project_id'];
$mode = $this->getProjectSetting("em-mode", $pid);
$enabledProjects[$mode] = array(
'pid' => $pid,
'name' => $name,
'url' => $url,
'mode' => $mode
);
}
$this->enabledProjects = $enabledProjects;
// $this->emDebug($this->enabledProjects, "Enabled Projects");
}
//show enabled projects
public function showEnabledProjects(){
return $this->enabledProjects;
}
public function sendPatientConsent($patient_id, $consent_url , $consent_email){
$this->loadEM();
return $this->dashboard->sendPatientConsent($patient_id, $consent_url , $consent_email);
}
public function getProviderbyEmail($provider_email){
$this->loadEM();
return $this->dashboard->getProviderbyEmail($provider_email);
}
public function newPatientConsent($provider_id=null){
$this->loadEM();
return $this->dashboard->newPatientConsent($provider_id);
}
public function addPatient($post){
$this->loadEM();
return $this->dashboard->addPatient($post);
}
public function treeLogic($provider_id){
$this->loadEM();
return $this->tree->treeLogic($provider_id);
}
public function saveTemplate($provider_id, $post){
$this->loadEM();
return $this->tree->saveTemplate($provider_id, $post);
}
public function acceptRecommendation($patient_details){
$this->loadEM();
$next_instance_id = $this->getNextInstanceId($patient_details["record_id"], "treatment_status_log", "ptree_log_ts");
// ONLY UPDATE THIS WHEN IT RXCHANGE ACTUALLY ACCEPTED
// add log to treattment_status_log
$data_log = array(
"record_id" => $patient_details["record_id"],
"redcap_repeat_instance" => $next_instance_id,
"redcap_repeat_instrument" => "treatment_status_log",
"ptree_log_prev_step" => $patient_details["patient_treatment_status"],
"ptree_log_current_step" => $patient_details["patient_rec_tree_step"],
"ptree_current_meds" => $patient_details["current_drugs"],
"ptree_log_comment" => $patient_details["provider_comment"],
"ptree_log_ts" => Date("Y-m-d H:i:s")
);
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode(array($data_log)) );
// $this->emDebug("Saving the treatment step log?", $data_log);
// update the shortcut data in patient baseline
$data = array(
"record_id" => $patient_details["record_id"],
"patient_rec_tree_step" => '',
"patient_treatment_status" => $patient_details["patient_rec_tree_step"],
"filter" => '',
"last_update_ts" => Date("Y-m-d H:i:s")
);
// TODO THIS timestamp IS WHEN THE LAST RECOMMENDATION WAS MADE or Accepted, DONT MAKE ANOTHER ONE FOR 2 WEEKS at LEAST
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode(array($data)), "overwrite" );
// $this->emDebug("Accepting rx change", $data);
$this->updateRecLog($patient_details["record_id"], $patient_details["patient_rec_tree_step"]);
return array("rec saved");
}
public function declineRecommendation($patient_details){
$this->loadEM();
// update the shortcut data in patient baseline
$data = array(
"record_id" => $patient_details["record_id"],
"patient_rec_tree_step" => '',
"filter" => ''
);
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode(array($data)), "overwrite" );
$this->updateRecLog($patient_details["record_id"], $step_id, true);
return array("rec declined");
}
public function updateRecLog($record_id, $step_id , $reject=false){
$this->emDebug("updateing a recLog", $record_id, $step_id, $reject);
if(!empty($step_id)){
$fields = array("record_id", "rec_step");
$filter = "[rec_step] = $step_id and [record_id] = $record_id";
$params = array(
'return_format' => 'json',
'fields' => $fields,
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$rows = json_decode($q,1);
foreach($rows as $row){
if($row["redcap_repeat_instrument"] == "recommendations_log"){
$instance_id = $row["redcap_repeat_instance"];
$temp = array(
"redcap_repeat_instance" => $instance_id,
"redcap_repeat_instrument" => "recommendations_log",
"record_id" => $record_id,
"rec_accepted" => ($reject ? "0" : "1"),
);
$data[] = $temp;
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode($data) );
// $this->emDebug("accept/reject recommendtation", $data, $r);
}
}
}
}
public function getPatientBaselineFields(){
$this->loadEM();
$script_fieldnames = \REDCap::getFieldNames("patient_baseline");
return $script_fieldnames;
}
public function sendToPharmacy($patient){
//TODO, FIGURE OUT PHARMACY API
$this->emDebug("SEND TO PHARMACY FOR patient, NONE FOR NOW, IRB ISSUES");
return;
}
public function verifyAccount($verification_email,$verification_token){
$this->loadEM();
return $this->dashboard->verifyAccount($verification_email,$verification_token);
}
public function makeEmailVerifyToken(){
return $this->generateRandomString(10,false,true);
}
// Creates random alphanumeric string
public function generateRandomString($length=25, $addNonAlphaChars=false, $onlyHandEnterableChars=false, $alphaCharsOnly=false) {
// Use character list that is human enterable by hand or for regular hashes (i.e. for URLs)
if ($onlyHandEnterableChars) {
$characters = '34789ACDEFHJKLMNPRTWXY'; // Potential characters to use (omitting 150QOIS2Z6GVU)
} else {
$characters = 'abcdefghijkmnopqrstuvwxyzABCDEFGHIJKLMNPQRSTUVWXYZ23456789'; // Potential characters to use
if ($addNonAlphaChars) $characters .= '~.$#@!%^&*-';
}
// If returning only letter, then remove all non-alphas from $characters
if ($alphaCharsOnly) {
$characters = preg_replace("/[^a-zA-Z]/", "", $characters);
}
// Build string
$strlen_characters = strlen($characters);
$string = '';
for ($p = 0; $p < $length; $p++) {
$string .= $characters[mt_rand(0, $strlen_characters-1)];
}
// If hash matches a number in Scientific Notation, then fetch another one
// (because this could cause issues if opened in certain software - e.g. Excel)
if (preg_match('/^\d+E\d/', $string)) {
return generateRandomString($length, $addNonAlphaChars, $onlyHandEnterableChars);
}
return $string;
}
/*
BELOW HERE IS ALL THE OMRON AUTHORIZATION WORK FLOW STUFF
*/
//get oauthURL to presetn to Patient
public function emailOmronAuthRequest($patient){
$result = false;
if( !empty($patient) && isset($patient["record_id"]) && isset($patient["patient_email"]) ){
$auth_link = $this->getOAUTHurl($patient["record_id"]);
$msg_arr = array();
$msg_arr[] = "<p>Dear " . $patient["patient_fname"] . "</p>";
$msg_arr[] = "<p>In order to participate in this study, we need access to your Blood Pressure Cuff data.</p>";
$msg_arr[] = "<p>If you have not downloaded and set up your <b>Omron Heart Advisor</b> App yet, Please download them first.</p>";
$msg_arr[] = "<p><a href='https://apps.apple.com/us/app/omron-heartadvisor/id1444973178' target='_blank'>Apple App Store</a> or <a href='https://play.google.com/store/apps/details?id=com.omronhealthcare.heartadvisor&hl=en_US&gl=US' target='_blank'>Google Play Store</a></p>";
$msg_arr[] = "<p>Please click this <a href='".$this->getURL("pages/oauth.php", true, true)."&state=".$patient["record_id"]."'>link</a> to start the process of authorizing us to retrieve your data from Omron.<p>";
$msg_arr[] = "<p>Thank You! <br> Stanford HypertensionStudy Team</p>";
$message = implode("\r\n", $msg_arr);
$to = $patient["patient_email"];
$from = "no-reply@stanford.edu";
$subject = "HTN Study Needs Your Authorization";
$fromName = "Stanford Hypertension Study Team";
$result = \REDCap::email($to, $from, $subject, $message);
if($result){
$data = array(
"record_id" => $patient["record_id"],
"omron_auth_request_ts" => date("Y-m-d H:i:s")
);
$r = \REDCap::saveData("json", json_encode(array($data)) );
}
// $this->emDebug("emailing patient", $result,$this->enabledProjects["patients"]["pid"], $r);
}
return $result;
}
public function dailySurveyCheck(){
$this->loadEM();
//FIRST GET ALL THE PEOPLE
//THEN DETERMINE WHAT DAY THEYVE JOINED
//IF MULTIPLE OF 7 THEN SEND SURVEY INSTANCE
$filter = "";
$fields = array("record_id","patient_add_ts");
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'return_format' => 'json',
'fields' => $fields,
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$records = json_decode($q, true);
foreach($records as $patient){
$record_id = $patient["record_id"];
$patient_added = $patient["patient_add_ts"];
$dateOne = new \DateTime();
$dateTwo = new \DateTime($patient_added);
$days_since = $dateOne->diff($dateTwo)->format("%a");
$weekly_anni = $days_since % 7;
if($weekly_anni === 0){
$this->emDebug("Patient # $record_id 'weekly' anniversery" );
//if patient has weekly anniversary lets mark it.
$filter = "";
$fields = array("record_id","message_ts");
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'return_format' => 'json',
'fields' => $fields,
'records' => $record_id,
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$records = json_decode($q, true);
$most_recent_message = array_pop($records);
$current_instance_id = 0;
if(!empty($most_recent_message["message_ts"])){
$current_instance_id= $most_recent_message["redcap_repeat_instance"];
$test_date = new \DateTime($most_recent_message["message_ts"]);
$most_recent_date = $dateOne->diff($test_date)->format("%a");
if($most_recent_date < 7){
$this->emDebug("This patient already got this weeks survey $most_recent_date days ago");
//they had a survey within the last week, no need
continue;
}
}
$next_instance_id = $current_instance_id +1;
//create survey link if it gets past here
$survey_link = \REDCap::getSurveyLink($record_id, "communications", "", $next_instance_id);
if($survey_link){
$data = array(
"record_id" => $record_id,
"weekly_patient_survey" => $survey_link
);
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], "json", json_encode(array($data)));
if(empty($r["errors"])){
echo "weekly survey queued for patient # $record_id <br>";
$this->emDebug("only patient #$record_id needs a weekly survey", $survey_link, $r);
}
}
}
}
// $msg_arr = array();
// $msg_arr[] = "<p>Dear " . $patient["patient_fname"] . "</p>";
// $msg_arr[] = "<p>Please take a moment to answer your <a href='$survey_link' target='_blank'>weekly survey</a> for the Digital Hypertension Management System.</p>";
// $msg_arr[] = "<p>Thank You! <br> Stanford HypertensionStudy Team</p>";
// $message = implode("\r\n", $msg_arr);
// $to = $patient["patient_email"];
// $from = "no-reply@stanford.edu";
// $subject = "Weekly Stanford Digital Hypertension Management System Survey";
// $fromName = "Stanford Hypertension Study Team";
// $this->emDebug("emailing patient", $result,$this->enabledProjects["patients"]["pid"], $r);
return ;
}
public function dailySurveyClear(){
$this->loadEM();
$filter = "[weekly_patient_survey] <> ''";
$fields = array("record_id","patient_add_ts");
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'return_format' => 'json',
'fields' => $fields,
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$records = json_decode($q, true);
foreach($records as $patient){
$record_id = $patient["record_id"];
$data = array(
"record_id" => $record_id,
"weekly_patient_survey" => ""
);
$r = \REDCap::saveData($this->enabledProjects["patients"]["pid"], "json", json_encode(array($data)), "overwrite");
if(empty($r["errors"])){
echo "removing weekly survey for patient #$record_id";
}
}
}
//get oauthURL to presetn to Patient
public function getOAUTHurl($record_id = null){
$oauth_url = null;
if($record_id){
$client_id = $this->getProjectSetting("omron-client-id");
$oauth_url = $this->getProjectSetting("omron-auth-url");
$oauth_postback = $this->getProjectSetting("omron-postback");
$oauth_scope = $this->getProjectSetting("omron-auth-scope");
$oauth_params = array(
"client_id" => $client_id,
"response_type" => "code",
"scope" => $oauth_scope,
"redirect_uri" => $oauth_postback,
"state" => $record_id
);
$oauth_params["state"] = $record_id;
$oauth_url .= "/connect/authorize?". http_build_query($oauth_params);
}
return $oauth_url;
}
// gets or refresh omron access token
public function getOrRefreshOmronAccessToken($token, $refresh = false) {
$client_id = $this->getProjectSetting("omron-client-id");
$client_secret = $this->getProjectSetting("omron-client-secret");
$redirect_uri = $this->getProjectSetting("omron-postback"); // Ensure this is correct and URL-encoded
$omron_url = $this->getProjectSetting("omron-api-url");
$oauth_scope = $this->getProjectSetting("omron-auth-scope");
// Token endpoint
$token_url = $omron_url . "/connect/token";
// Data to be sent in the POST request
$data = array(
'client_id' => $client_id,
'client_secret' => $client_secret,
'redirect_uri' => $redirect_uri
);
if ($refresh) {
$data['grant_type'] = 'refresh_token';
$data['refresh_token'] = $token;
} else {
$data['grant_type'] = 'authorization_code';
$data['code'] = $token;
}
// cURL initiation and setting options
$ch = curl_init();
curl_setopt($ch, CURLOPT_URL, $token_url);
curl_setopt($ch, CURLOPT_POST, true);
curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($data));
curl_setopt($ch, CURLOPT_HTTPHEADER, array('Content-Type: application/x-www-form-urlencoded'));
curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
// Execute the cURL session and close it
$result = curl_exec($ch);
if (curl_errno($ch)) {
$this->emDebug("Curl error: " . curl_error($ch));
}
curl_close($ch);
// Decode JSON response
$response = json_decode($result, true);
// Log the response for debugging purposes
// $this->emDebug("getOrRefreshOmronAccessToken", $api_url, $token_url, $data, array_keys($response));
return $response;
}
//returns array, expects JWT token
public function decodeJWT($token){
return json_decode(base64_decode(str_replace('_', '/', str_replace('-','+',explode('.', $token)[1]))), true);
}
// gets or refresh omron access token
public function getOmronAPIData($omron_access_token, $omron_token_type, $hook_timestamp=null, $limit=null, $type="bloodpressure", $includeHourlyActivity=false, $sortOrder="asc"){
//There are two typical use cases when you will use the Omron API to retrieve data for a user:
// To retrieve historical data at the time the user authorizes your application
// To retrieve data whenever your application receives notification that an upload has occurred
$omron_url = $this->getProjectSetting("omron-api-url");
$data = array(
"type" => $type,
"sortOrder" => $sortOrder
);
// OPTIONAL
if($limit){
$data["limit"] = $limit;
}
if($includeHourlyActivity){
$data["includeHourlyActivity"] = $includeHourlyActivity;
}
if(!$hook_timestamp){
//supposed to default to "from the beginning" with this field empty, but it appears to be required?
$hook_timestamp = date("Y")."-".date("m")."-01";
}
$data["since"] = $hook_timestamp;
$api_url = $omron_url . "/api/measurement";
$ch = curl_init($api_url);
$this->emDebug("$api_url");
$header_data = array();
array_push($header_data, "Authorization: $omron_token_type $omron_access_token");
array_push($header_data, 'Content-Type: application/x-www-form-urlencoded');
array_push($header_data, 'Content-Length: ' . strlen(http_build_query($data)));
array_push($header_data, 'Cache-Control: no-cache' );
curl_setopt($ch, CURLOPT_POSTFIELDS, http_build_query($data));
curl_setopt($ch, CURLOPT_POST, true);
curl_setopt($ch, CURLOPT_HTTPHEADER, $header_data);
curl_setopt($ch, CURLOPT_SSL_VERIFYPEER, FALSE);
curl_setopt($ch, CURLOPT_SSL_VERIFYHOST, FALSE);
curl_setopt($ch, CURLOPT_TIMEOUT, 105200);
curl_setopt($ch, CURLOPT_RETURNTRANSFER, true);
curl_setopt($ch, CURLOPT_HEADER, 0);
curl_setopt($ch, CURLOPT_VERBOSE, 0);
$info = curl_getinfo($ch);
$result = curl_exec($ch);
$this->emDebug("curl call", $result);
curl_close($ch);
return $result;
}
// get Omron Token Details by OmronClientId
public function getTokenDetails($omron_client_id){
$filter = "[omron_client_id] = '$omron_client_id'";
$fields = array("record_id","omron_access_token","omron_token_type");
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'return_format' => 'json',
'fields' => $fields,
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$records = json_decode($q, true);
if(empty($records)){
$this->emDebug("Omron getTokenDetail() : Could not find Patient with omron_client_id = $omron_client_id", $params);
return false;
}
$this->emDebug("found token details");
return current($records);
}
// get data via API and recurse if pagination
public function recurseSaveOmronApiData($omron_client_id, $since_ts = null, $token_details = array()) {
$this->loadEM();
$first_pass = false;
if (empty($token_details)) {
$first_pass = true;
$token_details = $this->getTokenDetails($omron_client_id);
if (!$token_details) {
return false;
}
}
$record_id = $token_details["record_id"];
$omron_access_token = $token_details["omron_access_token"];
$omron_token_type = $token_details["omron_token_type"];
if (!empty($since_ts) || $first_pass) {
$adjusted_since_ts = date("Y-m-d", strtotime($since_ts .' -1 day'));
$result = $this->getOmronAPIData($omron_access_token, $omron_token_type, $adjusted_since_ts);
$api_data = json_decode($result, true);
// Check status
if ($api_data["status"] !== 0) {
$this->emDebug("Error fetching data for Omron ID $omron_client_id: " . $api_data["reason"]);
return [
'status' => false,
'reason' => $api_data["reason"] ?? 'Unknown error',
'errorCode' => $api_data["errorCode"] ?? null,
];
}
// Process API data if status is successful
$truncated = $api_data["result"]["truncated"];
$bp_readings = $api_data["result"]["bloodPressure"];
$bp_instance_data = $this->getBPInstanceData($record_id);
$next_instance_id = $bp_instance_data["next_instance_id"];
$used_bp_id = $bp_instance_data["used_bp_id"];
$data = [];
foreach ($bp_readings as $reading) {
$omron_bp_id = $reading["id"];
if (in_array($omron_bp_id, $used_bp_id)) continue;
$data[] = [
"redcap_repeat_instance" => $next_instance_id++,
"redcap_repeat_instrument" => "bp_readings_log",
"record_id" => $record_id,
"omron_bp_id" => $omron_bp_id,
"bp_reading_ts" => date("Y-m-d H:i:s", strtotime($reading["dateTime"])),
"bp_reading_local_ts" => date("Y-m-d H:i:s", strtotime($reading["dateTimeLocal"])),
"bp_systolic" => $reading["systolic"],
"bp_diastolic" => $reading["diastolic"],
"bp_units" => $reading["bloodPressureUnits"],
"bp_pulse" => $reading["pulse"],
"bp_pulse_units" => $reading["pulseUnits"],
"bp_device_type" => $reading["deviceType"],
];
}
$save_result = \REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode($data));
if (empty($save_result["errors"])) {
$this->emDebug("Saved Omron BP readings for record_id $record_id");
// Get the most recent reading if data was saved successfully
$most_recent_reading = end($bp_readings);
// Handle pagination if necessary
if ($truncated) {
return $this->recurseSaveOmronApiData($omron_client_id, $most_recent_reading["dateTime"], $token_details);
} else {
$this->evaluateOmronBPavg($record_id);
return [
'status' => $most_recent_reading,
];
}
} else {
$this->emDebug("Error saving data for record_id $record_id", $save_result["errors"]);
return ['status' => false, 'reason' => 'Error saving data', 'details' => $save_result["errors"]];
}
}
}
public function checkBPvsThreshold($bp_data, $target_threshold, $control_condition = 0.6, $external_avg = null) {
// Filter BP data to the last 2 weeks
$time_window = strtotime('-2 weeks');
$recent_bp_data = array_filter($bp_data, fn($bp) => strtotime($bp["bp_reading_ts"]) >= $time_window);
// Use recent data if there are at least 4 records, otherwise use all data
$bp_data = count($recent_bp_data) >= 4 ? $recent_bp_data : $bp_data;
// Use external average if provided and determine if it's above the threshold
if ($external_avg !== null) {
return $external_avg > $target_threshold ? $external_avg : false;
}
// Organize data into AM/PM readings for each day
$ampm_data = [];
foreach ($bp_data as $bp) {
$date_key = date("ymd", strtotime($bp["bp_reading_ts"]));
$am_pm_key = date("a", strtotime($bp["bp_reading_ts"]));
$ampm_data[$date_key][$am_pm_key][] = $bp["bp_systolic"];
}
// Calculate daily averages and whether each average is above the threshold
$total_datapoints = [];
$above_threshold_counts = 0;
foreach ($ampm_data as $day_data) {
foreach (['am', 'pm'] as $period) {
if (!empty($day_data[$period])) {
$average = array_sum($day_data[$period]) / count($day_data[$period]);
$total_datapoints[] = $average;
$above_threshold_counts += ($average > $target_threshold) ? 1 : 0;
}
}
}
// Calculate the control threshold and mean
$required_above_count = floor(count($total_datapoints) * $control_condition);
$mean_of_data = !empty($total_datapoints) ? round(array_sum($total_datapoints) / count($total_datapoints)) : 0;
$calcs = array(
"total data points" => $total_datapoints,
"above threshold counts" => $above_threshold_counts,
"required above count" => $required_above_count,
"mean of data?" => $mean_of_data
);
$this->emDebug('calculated convoluted bp threshold',
$calcs,
$above_threshold_counts >= $required_above_count,
count($total_datapoints) >= 4
);
// Return mean if threshold met; otherwise, return false
return $above_threshold_counts >= $required_above_count && count($total_datapoints) >= 4 ? $mean_of_data : false;
}
public function evaluateOmronBPavg($record_id, $external_avg = null) {
$this->loadEM();
$this->emDebug("Starting evaluation for record", $record_id);
// Prepare parameters to retrieve patient data
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'records' => array($record_id),
'return_format' => 'json',
'fields' => array(
"record_id", "filter", "patient_bp_target_systolic", "patient_bp_target_diastolic",
"patient_bp_target_pulse", "custom_target_sys_lower", "custom_target_k_upper",
"custom_target_k_lower", "custom_target_slowhr", "custom_target_cr", "custom_target_na",
"current_treatment_plan_id", "patient_treatment_status", "patient_physician_id", "last_update_ts"
)
);
// Retrieve and decode patient data
$q = \REDCap::getData($params);
$records = json_decode($q, true);
$patient = current($records);
// Extract key patient data
$provider_id = $patient["patient_physician_id"];
$current_tree = $patient["current_treatment_plan_id"];
$current_step = !empty($patient["patient_treatment_status"]) ? $patient["patient_treatment_status"]: 1;
$target_systolic = $patient["patient_bp_target_systolic"];
// Set custom target values if available
$custom_targets = array_filter([
"sys_avg_lower" => $patient["custom_target_sys_lower"],
"k_upper" => $patient["custom_target_k_upper"],
"k_lower" => $patient["custom_target_k_lower"],
"cr_upper" => $patient["custom_target_cr"],
"na_lower" => $patient["custom_target_na"],
"hr_lower" => $patient["custom_target_slowhr"],
]);
$this->emDebug("Initial data for Patient", array($provider_id,$current_tree,$current_step,$target_systolic));
if (!empty($target_systolic)) {
// Retrieve recent BP readings (last 2 weeks)
//TODO HOW THE HELL DO WE DO THIS IF THERES NO DATA WITHIN 2 weeks?
$time_window = "-80 weeks";
$filter = "[bp_reading_ts] > '" . date("Y-m-d H:i:s", strtotime($time_window)) . "'";
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'records' => array($record_id),
'return_format' => 'json',
'fields' => array("record_id", "omron_bp_id", "bp_reading_ts", "bp_systolic", "bp_diastolic", "bp_pulse"),
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$records = json_decode($q, true);
// Calculate mean pulse over the last 2 weeks
$pulse_sum = array_sum(array_column($records, 'bp_pulse'));
$pulse_count = count(array_filter(array_column($records, 'bp_pulse')));
$mean_bp_pulse = $pulse_count > 0 ? $pulse_sum / $pulse_count : null;
// Retrieve recent lab values (last 2 weeks)
$filter = "[lab_ts] > '" . date("Y-m-d", strtotime($time_window)) . "'";
$params = array(
'project_id' => $this->enabledProjects["patients"]["pid"],
'records' => array($record_id),
'return_format' => 'json',
'fields' => array("record_id", "lab_name", "lab_value", "lab_ts"),
'filterLogic' => $filter
);
$q = \REDCap::getData($params);
$labs = json_decode($q, true);
$lab_values = array_column($labs, 'lab_value', 'lab_name');
// Extract relevant lab values
$lab_k = $lab_values["k"] ?? null;
$lab_na = $lab_values["na"] ?? null;
$lab_cr = $lab_values["cr"] ?? null;
// Access current treatment tree and step logic
$provider_trees = $this->tree->treeLogic($provider_id);
$treelogic = $provider_trees[$current_tree];
$current_tree_step = $treelogic["logicTree"][$current_step];
// Evaluate side effects based on labs and BP averages
$side_effects_next_step = $this->evaluateSideEffects($current_tree_step, $lab_k, $lab_na, $lab_cr, $mean_bp_pulse, $external_avg, $custom_targets);
// $this->emDebug("side effect or check bp avg with bp records", $records);
if ($side_effects_next_step !== null) {
$next_step = $side_effects_next_step;
} else {
// Evaluate BP against threshold if no side effects
$is_above = $this->checkBPvsThreshold($records, $target_systolic, 0.6, $external_avg);
if ($is_above) {
$next_step = $current_tree_step["bp_status"]["Uncontrolled"] ?? null;
$this->emDebug("bp is above threshold!!!", $current_step, $next_step, $current_tree_step["step_id"]);
}
}
// Determine lab requirements and update record with recommendations or lab needs
if (isset($next_step)) {
$current_update_ts = date("Y-m-d H:i:s");
$need_lab = empty($lab_values) || !isset($lab_values["k"], $lab_values["cr"], $lab_values["na"]);
$filter_tag = $need_lab ? "labs_needed" : "rx_change";
$data = array(
"record_id" => $record_id,
"patient_rec_tree_step" => !$need_lab ? $next_step : null,
"last_update_ts" => $current_update_ts,
"filter" => $filter_tag,
);
\REDCap::saveData($this->enabledProjects["patients"]["pid"], 'json', json_encode(array($data)), "overwrite");
$this->emDebug('Save recommendation or lab needed status', $data);
// Log recommendations if no labs needed
if ($filter_tag == "rx_change") {
$this->emDebug("ok rx_change, logRecommendations", $record_id, $next_step, $current_tree_step, $treelogic, $systolic_mean);
$this->logRecommendations($record_id, $next_step, $current_tree_step, $treelogic, $systolic_mean ?? false);
}
}
}
return;
}
private function evaluateSideEffects($treeStep, $k, $na, $cr, $hr, $systolic_average, $custom_targets = array()) {
// Convert incoming parameters to floats for numeric comparisons
$values = [
'k' => floatval($k),
'na' => floatval($na),
'cr' => floatval($cr),
'hr' => floatval($hr),
'systolic' => floatval($systolic_average)
];
// Retrieve and set target limits, preferring custom targets if provided
$targets = [
'k_upper' => floatval($custom_targets['k_upper'] ?? $this->getProjectSetting("lab-target-k-upper")),
'k_lower' => floatval($custom_targets['k_lower'] ?? $this->getProjectSetting("lab-target-k-lower")),
'cr_upper' => floatval($custom_targets['cr_upper'] ?? $this->getProjectSetting("lab-target-cr")),
'na_lower' => floatval($custom_targets['na_lower'] ?? $this->getProjectSetting("lab-target-na")),
'hr_lower' => floatval($custom_targets['hr_lower'] ?? $this->getProjectSetting("lab-target-slowhr")),
'sys_lower' => floatval($custom_targets['sys_avg_lower'] ?? $this->getProjectSetting("target-sys-lower"))
];
// Define side effect checks with corresponding conditions
$side_effects_checks = [
'hypotension' => ['value' => $values['systolic'], 'condition' => $values['systolic'] < $targets['sys_lower']],
'hyponatremia' => ['value' => $values['na'], 'condition' => $values['na'] < $targets['na_lower']],
'hypokalemia' => ['value' => $values['k'], 'condition' => $values['k'] < $targets['k_lower']],
'elevated_cr' => ['value' => $values['cr'], 'condition' => $values['cr'] > $targets['cr_upper']],
'hyperkalemia' => ['value' => $values['k'], 'condition' => $values['k'] > $targets['k_upper']],
'slow_hr' => ['value' => $values['hr'], 'condition' => $values['hr'] < $targets['hr_lower']]
];
// Evaluate side effects and return the appropriate step if any condition is met
foreach ($side_effects_checks as $effect => $check) {
if (!empty($check['value']) && $check['condition']) {
$this->emDebug("Side effect detected: $effect with value {$check['value']}", $treeStep);
return $treeStep["side_effects"][$effect];
}
}
// Return null if no side effects are detected
return null;
}
private function logRecommendations($record_id, $next_step, $current_tree_step, $treelogic, $systolic_mean) {
$current_meds = implode(", ", $current_tree_step["drugs"]);
$this->emDebug("Handling recommendation for next step", [
"current_meds" => $current_meds,
"next_step" => $next_step
]);
// Check if $next_step is a valid key in the logic tree
if (!isset($treelogic["logicTree"][$next_step])) {
$this->emDebug("Next step '{$next_step}' is not a valid tree key (Stop or Refer). Proceeding with default logging.");
$rec_meds = $next_step; // Save the literal "Stop" or "Refer" as the recommendation
} else {
$next_tree_step = $treelogic["logicTree"][$next_step];
$rec_meds = implode(", ", $next_tree_step["drugs"]);
}
// Fetch existing recommendations for this record
$existing_recommendations = \REDCap::getData($this->enabledProjects["patients"]["pid"], 'array', [
"record_id" => $record_id
]);
// Check if the current recommendation exists
foreach ($existing_recommendations as $instance) {
if (
$instance["rec_step"] == $next_step &&
$instance["rec_meds"] == $rec_meds
) {
$this->emDebug("Duplicate recommendation found for record {$record_id}, step {$next_step}");
return; // Exit to avoid duplication
}
}
// If no duplicates, log the new recommendation
$next_instance_id = $this->getNextInstanceId($record_id, "recommendations_log", "rec_ts");
$data = array(
"record_id" => $record_id,
"redcap_repeat_instance" => $next_instance_id,
"redcap_repeat_instrument" => "recommendations_log",
"rec_current_meds" => $current_meds,
"rec_step" => $next_step,
"rec_meds" => $rec_meds,
"rec_accepted" => 0,
"rec_mean_systolic" => $systolic_mean,