NIAD-3301: Update MedicationRequest.medication datatype support. (#1250)

MartinWheelerMT · chiaramapellimt · web-flow · commit 3941a5596ff0 · 2025-06-13T10:44:13.000+01:00
* NIAD-3301: Update MedicationRequest.medication datatype support

* Add test and test file where the `MedicationRequest` contains a `medicationCodableConcept` and not a `medication.reference` to ensure that this is used if it is provided.
* Ensure existing tests still pass using the original functionality
* Update `MedicationStatementMapper` to implement this.

* Added new test file and new addition to the bundle to account for codeable concept

* Implemented new implementation to print medication codeable concept in output for supporting info

* * Refactor `RequestStatementMapperTest` for readability.
* Fix Checkstyle issues.

* * Update CHANGELOG.md

---------

Co-authored-by: Chiara &lt;chiara.mapelli@madetech.com&gt;
diff --git a/CHANGELOG.md b/CHANGELOG.md
@@ -8,11 +8,13 @@ and this project adheres to [Semantic Versioning](https://semver.org/spec/v2.0.0
 
 ### Added
 * The GP2GP Adaptor now adds the EhrComposition / confidentialityCode field when Encounter.meta.security contains NOPAT security entry
-* The GP2GP Adaptor now populates the ObservationStatement / confidentialityCode field when the .meta.security field of an Uncategorised Data Observation contains NOPAT
+* The GP2GP Adaptor now populates the ObservationStatement / confidentialityCode field when the .meta.security field of an Uncategorized Data Observation contains NOPAT
 * When List.meta.security field contains NOPAT, the GP2GP Adaptor will now populate the CompoundStatement.confidentialityCode
 
 ### Update
-* The GP2GP Adaptor is now able to identify e-referrals by using either `https://fhir.nhs.uk/Id/ubr-number` or `https://fhir.nhs.uk/Id/UBRN` when provided as an identifier system URL.
+
+* [GP Connect 1.6.1] The GP2GP Adaptor is now able to identify e-referrals by using either `https://fhir.nhs.uk/Id/ubr-number` or `https://fhir.nhs.uk/Id/UBRN` when provided as an identifier system URL.
+* [GP Connect 1.6.2] In a `MedicationRequest` the `Medication` can be provided as a reference to a `Medication` (using `Medication.medicationReference`) or, in the case that only a single resource references this medication, a `Medication.medicationCodeableConcept` can be used instead.) 
 
 
 ## [2.4.0] - 2025-04-02
diff --git a/service/src/main/java/uk/nhs/adaptors/gp2gp/ehr/mapper/MedicationStatementMapper.java b/service/src/main/java/uk/nhs/adaptors/gp2gp/ehr/mapper/MedicationStatementMapper.java
@@ -148,6 +148,10 @@ private String buildStatusCode(MedicationRequest medicationRequest) {
     }
 
     private String buildMedicationReferenceCode(MedicationRequest medicationRequest) {
+        if (medicationRequest.hasMedicationCodeableConcept()) {
+            return codeableConceptCdMapper.mapCodeableConceptForMedication(medicationRequest.getMedicationCodeableConcept());
+        }
+
         IIdType reference = medicationRequest.getMedicationReference().getReferenceElement();
         return messageContext.getInputBundleHolder()
             .getResource(reference)
diff --git a/service/src/main/java/uk/nhs/adaptors/gp2gp/ehr/utils/SupportingInfoResourceExtractor.java b/service/src/main/java/uk/nhs/adaptors/gp2gp/ehr/utils/SupportingInfoResourceExtractor.java
@@ -122,7 +122,7 @@ public static String extractReferralRequest(MessageContext messageContext, Refer
         }
 
         if (referralRequest.hasReasonCode()) {
-            CodeableConceptMappingUtils.extractTextOrCoding(referralRequest.getReasonCode().get(0)).ifPresent(
+            CodeableConceptMappingUtils.extractTextOrCoding(referralRequest.getReasonCode().getFirst()).ifPresent(
                     reasonCode -> stringBuilder
                         .append(" ")
                         .append(reasonCode)
@@ -170,47 +170,61 @@ public static String extractDiagnosticReport(MessageContext messageContext, Refe
         return stringBuilder.toString();
     }
 
+    private static String buildDispenseRequestText(MedicationRequest medicationRequest) {
+        if (medicationRequest.hasDispenseRequest() && medicationRequest.getDispenseRequest().getValidityPeriod().hasStart()) {
+            return " " + formatDateUsingDayPrecision(medicationRequest.getDispenseRequest().getValidityPeriod().getStartElement());
+        }
+        return "";
+    }
+
     public static String extractMedicationRequest(MessageContext messageContext, Reference reference) {
-        var medicationRequestOptional = messageContext
+        return messageContext
                 .getInputBundleHolder()
                 .getResource(reference.getReferenceElement())
-                .map(MedicationRequest.class::cast);
-
-        if (medicationRequestOptional.isEmpty()) {
-            return "";
-        }
-
-        var stringBuilder = new StringBuilder();
-        stringBuilder.append("{ Medication:");
+                .map(MedicationRequest.class::cast)
+                .map(medicationRequest -> buildMedicationRequestText(messageContext, medicationRequest))
+                .orElse(StringUtils.EMPTY);
+    }
 
-        var medicationRequest = medicationRequestOptional.get();
+    private static String buildMedicationRequestText(MessageContext messageContext, MedicationRequest medicationRequest) {
+        return new StringBuilder()
+            .append("{ Medication:")
+            .append(buildDispenseRequestText(medicationRequest))
+            .append(buildCodeableConceptText(messageContext, medicationRequest))
+            .append(" }")
+            .toString();
+    }
 
-        if (medicationRequest.hasDispenseRequest()) {
-            if (medicationRequest.getDispenseRequest().getValidityPeriod().hasStart()) {
-                stringBuilder
-                    .append(" ")
-                    .append(
-                        formatDateUsingDayPrecision(
-                            medicationRequest.getDispenseRequest().getValidityPeriod().getStartElement()
-                        )
-                    );
-            }
+    private static String buildCodeableConceptText(
+        MessageContext messageContext,
+        MedicationRequest medicationRequest
+    ) {
+        if (medicationRequest.hasMedicationCodeableConcept()) {
+            return buildCodeableConceptTextFromMedicationCodableConcept(medicationRequest);
+        } else if (medicationRequest.hasMedicationReference()) {
+            return buildCodeableConceptFromMedicationReference(messageContext, medicationRequest);
         }
+        return "";
+    }
 
-        if (medicationRequest.hasMedicationReference()) {
-            messageContext
-                .getInputBundleHolder()
-                .getResource(medicationRequest.getMedicationReference().getReferenceElement())
-                .map(Medication.class::cast)
-                .flatMap(medication -> CodeableConceptMappingUtils.extractTextOrCoding(medication.getCode()))
-                .ifPresent(code -> stringBuilder
-                    .append(" ")
-                    .append(code)
-                );
-        }
-        stringBuilder.append(" }");
+    private static String buildCodeableConceptFromMedicationReference(
+        MessageContext messageContext,
+        MedicationRequest medicationRequest
+    ) {
+        return messageContext
+            .getInputBundleHolder()
+            .getResource(medicationRequest.getMedicationReference().getReferenceElement())
+            .map(Medication.class::cast)
+            .flatMap(medication -> CodeableConceptMappingUtils.extractTextOrCoding(medication.getCode()))
+            .map(code -> " " + code)
+            .orElse("");
+    }
 
-        return stringBuilder.toString();
+    private static String buildCodeableConceptTextFromMedicationCodableConcept(
+        MedicationRequest medicationRequest
+    ) {
+        return " " + CodeableConceptMappingUtils.extractTextOrCoding(medicationRequest.getMedicationCodeableConcept())
+            .orElse("");
     }
 
     private static String formatDateUsingDayPrecision(BaseDateTimeType baseDateTimeType) {
diff --git a/service/src/test/java/uk/nhs/adaptors/gp2gp/ehr/mapper/MedicationStatementMapperTest.java b/service/src/test/java/uk/nhs/adaptors/gp2gp/ehr/mapper/MedicationStatementMapperTest.java
@@ -107,6 +107,10 @@ public void When_MappingObservationJson_Expect_NarrativeStatementXmlOutput(Strin
     private static Stream<Arguments> resourceFileParams() {
         return Stream.of(
             Arguments.of("mr-with-order-no-optional-fields.json", "medication-statement-with-prescribe-no-optional-fields.xml"),
+            Arguments.of(
+                "mr-with-order-no-optional-fields-with-medication-codeable-concept.json",
+                "medication-statement-with-prescribe-no-optional-fields.xml"
+            ),
             Arguments.of("mr-with-order-optional-fields.json", "medication-statement-with-prescribe-optional-fields.xml"),
             Arguments.of("mr-with-complete-status.json", "medication-statement-with-complete-status.xml"),
             Arguments.of("mr-with-active-status.json", "medication-statement-with-active-status.xml"),
diff --git a/service/src/test/java/uk/nhs/adaptors/gp2gp/ehr/mapper/RequestStatementMapperTest.java b/service/src/test/java/uk/nhs/adaptors/gp2gp/ehr/mapper/RequestStatementMapperTest.java
@@ -119,6 +119,8 @@ public class RequestStatementMapperTest {
             + "example-referral-request-supportingInfo-with-medication-request.json";
     private static final String INPUT_JSON_WITH_SUPPORTINGINFO_MEDICATIONREQUEST_NO_DATE = TEST_FILE_DIRECTORY
         + "example-referral-request-supportingInfo-with-medication-request-no-date.json";
+    private static final String INPUT_JSON_WITH_SUPPORTINGINFO_MEDICATION_REQUEST_WITH_MEDICATION_CODEABLE_CONCEPT = TEST_FILE_DIRECTORY
+            + "example-referral-request-supportingInfo-medication-request-with-medication-codeable-concept.json";
     private static final String INPUT_JSON_WITH_SUPPORTINGINFO_IGNORED_RESOURCES = TEST_FILE_DIRECTORY
         + "example-referral-request-supportingInfo-with-ignored-resources.json";
     private static final String INPUT_JSON_WITH_NO_AUTHOR_AND_TIME = TEST_FILE_DIRECTORY
@@ -189,6 +191,8 @@ public class RequestStatementMapperTest {
             + "expected-output-request-statement-supportingInfo-with-medication-request.xml";
     private static final String OUTPUT_XML_WITH_SUPPORTINGINFO_MEDICATIONREQUEST_NO_DATE = TEST_FILE_DIRECTORY
         + "expected-output-request-statement-supportingInfo-with-medication-request-no-date.xml";
+    private static final String OUTPUT_XML_WITH_SUPPORTINGINFO_FROM_MEDICATION_CODEABLE_CONCEPT_DISPLAY = TEST_FILE_DIRECTORY
+            + "expected-output-request-statement-supportingInfo-from-medication-codeable-concept-display.xml";
     private static final String OUTPUT_XML_WITH_NO_SUPPORTINGINFO = TEST_FILE_DIRECTORY
         + "expected-output-request-statement-no-supportingInfo.xml";
     private static final String OUTPUT_XML_WITH_NO_AUTHOR_AND_TIME = TEST_FILE_DIRECTORY
@@ -207,8 +211,6 @@ public class RequestStatementMapperTest {
     @Mock
     private ConfidentialityService confidentialityService;
 
-    private InputBundle inputBundle;
-
     private RequestStatementMapper requestStatementMapper;
 
     private static Stream<Arguments> resourceFileParams() {
@@ -257,9 +259,11 @@ private static Stream<Arguments> resourceFileParams() {
                 OUTPUT_XML_WITH_SUPPORTINGINFO_MEDICATIONREQUEST_NO_DATE),
             arguments(INPUT_JSON_WITH_SUPPORTINGINFO_IGNORED_RESOURCES,
                 OUTPUT_XML_WITH_NO_SUPPORTINGINFO),
+            arguments(INPUT_JSON_WITH_WITH_UBRN_SYSTEM_URL, OUTPUT_XML_WITH_SYSTEM_URL),
+            arguments(INPUT_JSON_WITH_SUPPORTINGINFO_MEDICATION_REQUEST_WITH_MEDICATION_CODEABLE_CONCEPT,
+                OUTPUT_XML_WITH_SUPPORTINGINFO_FROM_MEDICATION_CODEABLE_CONCEPT_DISPLAY),
             arguments(INPUT_JSON_WITH_NO_AUTHOR_AND_TIME, OUTPUT_XML_WITH_NO_AUTHOR_AND_TIME),
-            arguments(INPUT_JSON_WITH_WITH_UBR_NUMBER_SYSTEM_URL, OUTPUT_XML_WITH_SYSTEM_URL),
-            arguments(INPUT_JSON_WITH_WITH_UBRN_SYSTEM_URL, OUTPUT_XML_WITH_SYSTEM_URL)
+            arguments(INPUT_JSON_WITH_WITH_UBR_NUMBER_SYSTEM_URL, OUTPUT_XML_WITH_SYSTEM_URL)
         );
     }
 
@@ -286,7 +290,7 @@ private static Stream<Arguments> resourceFileParamsWithInvalidData() {
     public void setUp() {
         var bundleInput = ResourceTestFileUtils.getFileContent(INPUT_JSON_BUNDLE);
         Bundle bundle = new FhirParseService().parseResource(bundleInput, Bundle.class);
-        inputBundle = new InputBundle(bundle);
+        var inputBundle = new InputBundle(bundle);
 
         lenient().when(messageContext.getIdMapper()).thenReturn(idMapper);
         lenient().when(messageContext.getAgentDirectory()).thenReturn(agentDirectory);
diff --git a/service/src/test/resources/ehr/mapper/medication_request/mr-with-order-no-optional-fields-with-medication-codeable-concept.json b/service/src/test/resources/ehr/mapper/medication_request/mr-with-order-no-optional-fields-with-medication-codeable-concept.json
@@ -0,0 +1,65 @@
+{
+    "resourceType":"MedicationRequest",
+    "id":"3377543D-5B1B-4C4F-BFF6-9F7BC3A1C3B8",
+    "meta":{
+        "profile":[
+            "https://fhir.nhs.uk/STU3/StructureDefinition/CareConnect-GPC-MedicationRequest-1"
+        ]
+    },
+    "extension":[
+        {
+            "url": "https://fhir.nhs.uk/STU3/StructureDefinition/Extension-CareConnect-GPC-MedicationRepeatInformation-1",
+            "extension": [
+                {
+                    "url": "numberOfRepeatPrescriptionsAllowed",
+                    "valuePositiveInt": 12
+                },
+                {
+                    "url": "numberOfRepeatPrescriptionsIssued",
+                    "valuePositiveInt": 11
+                }
+            ]
+        }
+    ],
+    "identifier":[
+        {
+            "system":"https://fhir.nhs.uk/Id/cross-care-setting-identifier",
+            "value":"f2489066-7082-11eb-bb13-00505692d4aa"
+        }
+    ],
+    "status":"active",
+    "intent":"order",
+    "medicationCodeableConcept": {
+        "coding": [
+            {
+                "system": "http://snomed.info/sct",
+                "code": "430127000",
+                "display": "Oral Form Oxycodone (product)"
+            }
+        ]
+    },
+    "subject":{
+        "reference":"Patient/2"
+    },
+    "authoredOn":"2017-11-10T00:00:00+00:00",
+    "recorder":{
+        "reference":"Practitioner/1"
+    },
+    "dosageInstruction":[
+        {
+            "text":"1 tablet once a day",
+            "patientInstruction":"Take in morning"
+        }
+    ],
+    "dispenseRequest":{
+        "validityPeriod":{
+            "start":"2017-11-10T00:00:00+00:00",
+            "end":"2018-08-15T00:00:00+01:00"
+        }
+    },
+    "basedOn": [
+        {
+            "reference": "MedicationRequest/D66D84C9-C073-4EDF-8C2C-F309A83C3DC7"
+        }
+    ]
+}
diff --git a/service/src/test/resources/ehr/mapper/referral/example-referral-request-supportingInfo-medication-request-with-medication-codeable-concept.json b/service/src/test/resources/ehr/mapper/referral/example-referral-request-supportingInfo-medication-request-with-medication-codeable-concept.json
@@ -0,0 +1,9 @@
+{
+  "resourceType": "ReferralRequest",
+  "id": "2FB2C828-F8EC-11EB-9A03-0242AC139999",
+  "supportingInfo": [
+    {
+      "reference": "MedicationRequest/2F40AD96-F910-11EB-9A03-0242AC139999"
+    }
+  ]
+}
diff --git a/service/src/test/resources/ehr/mapper/referral/expected-output-request-statement-supportingInfo-from-medication-codeable-concept-display.xml b/service/src/test/resources/ehr/mapper/referral/expected-output-request-statement-supportingInfo-from-medication-codeable-concept-display.xml
@@ -0,0 +1,12 @@
+<component typeCode="COMP" >
+    <RequestStatement classCode="OBS" moodCode="RQO">
+        <id root="II-for-ReferralRequest-2FB2C828-F8EC-11EB-9A03-0242AC139999" />
+        <code code="3457005" displayName="Patient referral" codeSystem="2.16.840.1.113883.2.1.3.2.4.15"/>
+        <text>Supporting Information: { Medication: 2021-01-01 Oral Form Oxycodone (product) } </text>
+        <statusCode code="COMPLETE"/>
+        <effectiveTime>
+            <center nullFlavor="NI"/>
+        </effectiveTime>
+        <availabilityTime nullFlavor="UNK"/>
+    </RequestStatement>
+</component>
diff --git a/service/src/test/resources/ehr/mapper/referral/fhir-bundle.json b/service/src/test/resources/ehr/mapper/referral/fhir-bundle.json
@@ -489,6 +489,27 @@
                 }
             }
         },
+        {
+            "resource": {
+                "resourceType": "MedicationRequest",
+                "id": "2F40AD96-F910-11EB-9A03-0242AC139999",
+                "dispenseRequest": {
+                    "validityPeriod": {
+                        "start": "2021-01-01T00:00:00+00:00",
+                        "end": "2021-02-01T00:00:00+01:00"
+                    }
+                },
+                "medicationCodeableConcept": {
+                    "coding": [
+                        {
+                            "system": "http://snomed.info/sct",
+                            "code": "430127000",
+                            "display": "Oral Form Oxycodone (product)"
+                        }
+                    ]
+                }
+            }
+        },
         {
             "resource": {
                 "resourceType": "Medication",
