feat: add medication enrichment lookup to the medication editor
* feat: add medication enrichment lookup * fix: avoid double unescape in enrichment sanitization Co-authored-by: Copilot <223556219+Copilot@users.noreply.github.com> --------- Co-authored-by: Copilot <223556219+Copilot@users.noreply.github.com>
This commit is contained in:
Daniel Volz
GitHub
@@ -0,0 +1,541 @@
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import sensible from "@fastify/sensible";
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import Fastify, { type FastifyInstance } from "fastify";
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import { beforeEach, describe, expect, it, vi } from "vitest";
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import { documentationSchemaAjv } from "../utils/documentation-schema-keywords.js";
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const { fetchMock, requireAuthMock } = vi.hoisted(() => ({
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fetchMock: vi.fn(),
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requireAuthMock: vi.fn(async () => {}),
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}));
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vi.mock("../plugins/auth.js", () => ({
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requireAuth: requireAuthMock,
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}));
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function jsonResponse(body: unknown, status = 200): Response {
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return {
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ok: status >= 200 && status < 300,
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status,
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json: async () => body,
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} as Response;
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}
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function createEmaRow(overrides: Partial<Record<string, unknown>> = {}): Record<string, unknown> {
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return {
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category: "Human",
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medicine_status: "Authorised",
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name_of_medicine: "Aspirin 500 mg tablets",
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international_non_proprietary_name_common_name: "Acetylsalicylic acid",
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active_substance: "Acetylsalicylic acid",
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marketing_authorisation_developer_applicant_holder: "Bayer",
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therapeutic_area_mesh: "Pain",
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therapeutic_indication: "Pain relief",
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atc_code_human: "N02BA01",
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generic_or_hybrid: "No",
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biosimilar: "No",
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marketing_authorisation_date: "01/02/2024",
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ema_product_number: "EMA-ASPIRIN",
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...overrides,
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};
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}
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async function buildApp(): Promise<FastifyInstance> {
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const { medicationEnrichmentRoutes } = await import("../routes/medication-enrichment.js");
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const app = Fastify({ logger: false, ajv: documentationSchemaAjv });
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await app.register(sensible);
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await app.register(medicationEnrichmentRoutes);
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await app.ready();
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return app;
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}
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describe("medication enrichment", () => {
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beforeEach(() => {
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vi.resetModules();
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vi.clearAllMocks();
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fetchMock.mockReset();
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requireAuthMock.mockReset();
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requireAuthMock.mockImplementation(async () => {});
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vi.stubGlobal("fetch", fetchMock);
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});
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it("normalizes German ingredient queries for EMA-backed search results", async () => {
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const { searchMedicationEnrichment } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("medicines-output-medicines_json-report_en.json")) {
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return Promise.resolve(
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jsonResponse([
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createEmaRow({
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name_of_medicine: "Tylenol 500 mg tablets",
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international_non_proprietary_name_common_name: "Acetaminophen",
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active_substance: "Acetaminophen",
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ema_product_number: "EMA-TYLENOL",
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}),
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createEmaRow({
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name_of_medicine: "Ibuprofen 400 mg tablets",
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international_non_proprietary_name_common_name: "Ibuprofen",
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active_substance: "Ibuprofen",
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ema_product_number: "EMA-IBUPROFEN",
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}),
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])
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);
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}
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if (url.includes("/drugs.json?name=")) {
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return Promise.resolve(jsonResponse({ drugGroup: { conceptGroup: [] } }));
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(jsonResponse({ results: [] }));
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await searchMedicationEnrichment("Paracetamol 500 mg", 5);
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expect(response.normalizedQuery).toBe("paracetamol 500 mg");
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expect(response.results).toHaveLength(1);
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expect(response.results[0]).toMatchObject({
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code: "EMA-TYLENOL",
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name: "Tylenol 500 mg tablets",
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matchType: "ingredient",
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source: "ema",
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});
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});
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it("requires auth and returns EMA search results from the route", async () => {
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const app = await buildApp();
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("/drugs.json?name=")) {
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return Promise.resolve(jsonResponse({ drugGroup: { conceptGroup: [] } }));
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(jsonResponse({ results: [] }));
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}
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if (url.includes("medicines-output-medicines_json-report_en.json")) {
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return Promise.resolve(jsonResponse([createEmaRow()]));
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await app.inject({
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method: "GET",
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url: "/medication-enrichment/search?q=aspirin&limit=1",
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});
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expect(response.statusCode).toBe(200);
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expect(requireAuthMock).toHaveBeenCalledTimes(1);
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expect(response.json()).toMatchObject({
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query: "aspirin",
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normalizedQuery: "aspirin",
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hasMore: false,
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results: [
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{
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code: "EMA-ASPIRIN",
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name: "Aspirin 500 mg tablets",
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source: "ema",
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},
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],
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});
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await app.close();
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});
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it("falls back from EMA to RxNorm and openFDA search results when EMA has no match", async () => {
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const { searchMedicationEnrichment } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("medicines-output-medicines_json-report_en.json")) {
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return Promise.resolve(jsonResponse([createEmaRow()]));
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}
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if (url.includes("/drugs.json?name=semaglutide")) {
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return Promise.resolve(
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jsonResponse({
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drugGroup: {
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conceptGroup: [
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{
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tty: "SBD",
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conceptProperties: [
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{
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rxcui: "12345",
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name: "Semaglutide 0.25 MG Oral Tablet [Wegovy]",
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synonym: "Wegovy 0.25 mg oral tablet",
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},
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],
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},
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],
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},
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})
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);
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(
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jsonResponse({
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results: [
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{
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product_ndc: "00011-1111",
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brand_name: "Ozempic",
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generic_name: "Semaglutide",
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dosage_form: "Tablet",
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marketing_start_date: "20240101",
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},
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],
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})
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);
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await searchMedicationEnrichment("Semaglutide", 3);
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expect(response.hasMore).toBe(false);
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expect(response.results).toEqual(
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expect.arrayContaining([
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expect.objectContaining({
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code: "12345",
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name: "Wegovy",
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genericName: "Semaglutide",
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source: "rxnorm",
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}),
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expect.objectContaining({
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code: "00011-1111",
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name: "Ozempic",
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genericName: "Semaglutide",
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source: "openfda",
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}),
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])
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);
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});
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it("prioritizes RxNorm first, then openFDA, and keeps EMA last", async () => {
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const { searchMedicationEnrichment } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("medicines-output-medicines_json-report_en.json")) {
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return Promise.resolve(jsonResponse([createEmaRow()]));
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}
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if (url.includes("/drugs.json?name=")) {
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return Promise.resolve(
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jsonResponse({
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drugGroup: {
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conceptGroup: [
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{
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tty: "SBD",
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conceptProperties: [
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{
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rxcui: "1191",
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name: "Aspirin 500 MG Oral Tablet [Aspirin]",
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synonym: "Aspirin 500 mg oral tablet",
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},
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],
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},
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],
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},
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})
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);
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(
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jsonResponse({
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results: [
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{
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product_ndc: "00011-1111",
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brand_name: "Bayer Aspirin",
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generic_name: "Acetylsalicylic acid",
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dosage_form: "Tablet",
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marketing_start_date: "20240101",
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},
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],
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})
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);
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await searchMedicationEnrichment("Aspirin", 3);
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expect(response.hasMore).toBe(false);
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expect(response.results).toHaveLength(3);
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expect(response.results[0]).toMatchObject({
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code: "1191",
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source: "rxnorm",
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});
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expect(response.results[1]).toMatchObject({
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code: "00011-1111",
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source: "openfda",
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});
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expect(response.results[2]).toMatchObject({
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code: "EMA-ASPIRIN",
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source: "ema",
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});
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});
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it("validates malformed search requests", async () => {
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const app = await buildApp();
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const response = await app.inject({
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method: "GET",
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url: "/medication-enrichment/search?q=",
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});
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expect(response.statusCode).toBe(400);
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expect(fetchMock).not.toHaveBeenCalled();
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await app.close();
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});
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it("returns enrichment suggestions with optional RxNorm strength data", async () => {
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const app = await buildApp();
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fetchMock
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.mockResolvedValueOnce(
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jsonResponse([
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createEmaRow({
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name_of_medicine: "Tylenol 500 mg tablets",
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international_non_proprietary_name_common_name: "Acetaminophen",
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active_substance: "Acetaminophen",
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ema_product_number: "EMA-TYLENOL",
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}),
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])
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)
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.mockResolvedValueOnce(jsonResponse({ idGroup: { rxnormId: ["161"] } }))
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.mockResolvedValueOnce(
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jsonResponse({
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relatedGroup: {
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conceptGroup: [
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{
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conceptProperties: [
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{ name: "Acetaminophen 500 MG Oral Tablet" },
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{ name: "Acetaminophen 650 MG Oral Tablet" },
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],
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},
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],
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},
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})
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);
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const response = await app.inject({
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method: "POST",
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url: "/medication-enrichment/enrich",
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payload: {
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query: "Paracetamol",
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name: "Tylenol 500 mg tablets",
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genericName: "Acetaminophen",
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},
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});
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expect(response.statusCode).toBe(200);
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expect(response.json()).toMatchObject({
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selection: {
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name: "Tylenol 500 mg tablets",
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genericName: "Acetaminophen",
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source: "ema+rxnorm",
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},
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suggestions: {
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medicationForm: "tablet",
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strengthOptions: [
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{ label: "500 mg", pillWeightMg: 500, doseUnit: "mg" },
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{ label: "650 mg", pillWeightMg: 650, doseUnit: "mg" },
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],
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},
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meta: {
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rxNormMatched: true,
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openFdaMatched: false,
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partial: false,
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note: null,
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},
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});
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await app.close();
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});
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it("keeps incomplete-coverage messaging honest when RxNorm enrichment fails", async () => {
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const { enrichMedicationSelection } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("medicines-output-medicines_json-report_en.json")) {
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return Promise.resolve(
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jsonResponse([
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createEmaRow({
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name_of_medicine: "Tylenol 500 mg tablets",
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international_non_proprietary_name_common_name: "Acetaminophen",
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active_substance: "Acetaminophen",
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ema_product_number: "EMA-TYLENOL",
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}),
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])
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);
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}
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if (url.includes("/rxcui.json?name=acetaminophen&search=2")) {
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return Promise.reject(new Error("rxnorm timeout"));
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(jsonResponse({ results: [] }));
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await enrichMedicationSelection({
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query: "Paracetamol",
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name: "Tylenol 500 mg tablets",
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genericName: "Acetaminophen",
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});
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expect(response.selection.source).toBe("ema");
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expect(response.suggestions.strengthOptions).toEqual([]);
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expect(response.meta).toEqual({
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rxNormMatched: false,
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openFdaMatched: false,
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partial: true,
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note: "Returned EMA enrichment without RxNorm suggestions.",
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});
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});
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it("enriches RxNorm selections by code and falls back to openFDA without best-match guessing", async () => {
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const { enrichMedicationSelection } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("/rxcui/12345/related.json")) {
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return Promise.resolve(
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jsonResponse({
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relatedGroup: {
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conceptGroup: [],
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},
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})
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);
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}
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if (url.includes("api.fda.gov/drug/ndc.json")) {
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return Promise.resolve(
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jsonResponse({
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results: [
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{
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product_ndc: "00011-1111",
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brand_name: "Ozempic",
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generic_name: "Semaglutide",
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dosage_form: "Tablet",
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active_ingredients: [{ name: "Semaglutide", strength: "2 mg" }],
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},
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],
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})
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);
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}
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return Promise.reject(new Error(`Unexpected URL: ${url}`));
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});
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const response = await enrichMedicationSelection({
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query: "Ozempic",
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name: "Ozempic",
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genericName: "Semaglutide",
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code: "12345",
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source: "rxnorm",
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});
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expect(response).toMatchObject({
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selection: {
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name: "Ozempic",
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genericName: "Semaglutide",
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source: "rxnorm+openfda",
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},
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suggestions: {
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medicationForm: "tablet",
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strengthOptions: [{ label: "2 mg", pillWeightMg: 2, doseUnit: "mg" }],
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},
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meta: {
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rxNormMatched: false,
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openFdaMatched: true,
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partial: false,
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note: null,
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},
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});
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});
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it("enriches openFDA selections by code and augments them with RxNorm strength data", async () => {
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const { enrichMedicationSelection } = await import("../services/medication-enrichment.js");
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fetchMock.mockImplementation((url: string) => {
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if (url.includes("search=product_ndc%3A%2200011-1111%22")) {
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return Promise.resolve(
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jsonResponse({
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results: [
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{
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product_ndc: "00011-1111",
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brand_name: "US Ibuprofen",
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generic_name: "Ibuprofen",
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dosage_form: "Tablet",
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active_ingredients: [{ name: "Ibuprofen", strength: "200 mg" }],
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},
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],
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})
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);
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}
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if (url.includes("/rxcui.json?name=ibuprofen&search=2")) {
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return Promise.resolve(jsonResponse({ idGroup: { rxnormId: ["161"] } }));
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}
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if (url.includes("/rxcui/161/related.json")) {
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return Promise.resolve(
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jsonResponse({
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relatedGroup: {
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||||
conceptGroup: [
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||||
{
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||||
conceptProperties: [
|
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{ name: "Ibuprofen 200 MG Oral Tablet" },
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||||
{ name: "Ibuprofen 400 MG Oral Tablet" },
|
||||
],
|
||||
},
|
||||
],
|
||||
},
|
||||
})
|
||||
);
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||||
}
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||||
return Promise.reject(new Error(`Unexpected URL: ${url}`));
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||||
});
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const response = await enrichMedicationSelection({
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query: "US Ibuprofen",
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name: "US Ibuprofen",
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genericName: "Ibuprofen",
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code: "00011-1111",
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source: "openfda",
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||||
});
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||||
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||||
expect(response).toMatchObject({
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||||
selection: {
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||||
name: "US Ibuprofen",
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||||
genericName: "Ibuprofen",
|
||||
source: "rxnorm+openfda",
|
||||
},
|
||||
suggestions: {
|
||||
medicationForm: "tablet",
|
||||
strengthOptions: [
|
||||
{ label: "200 mg", pillWeightMg: 200, doseUnit: "mg" },
|
||||
{ label: "400 mg", pillWeightMg: 400, doseUnit: "mg" },
|
||||
],
|
||||
},
|
||||
meta: {
|
||||
rxNormMatched: true,
|
||||
openFdaMatched: true,
|
||||
partial: false,
|
||||
note: null,
|
||||
},
|
||||
});
|
||||
});
|
||||
|
||||
it("returns not found when an explicit selection cannot be resolved", async () => {
|
||||
const app = await buildApp();
|
||||
fetchMock.mockResolvedValueOnce(jsonResponse([createEmaRow()]));
|
||||
|
||||
const response = await app.inject({
|
||||
method: "POST",
|
||||
url: "/medication-enrichment/enrich",
|
||||
payload: {
|
||||
query: "Unknown",
|
||||
name: "Completely Different Medication",
|
||||
genericName: "No match",
|
||||
},
|
||||
});
|
||||
|
||||
expect(response.statusCode).toBe(404);
|
||||
expect(response.json()).toMatchObject({
|
||||
code: "MEDICATION_ENRICHMENT_NOT_FOUND",
|
||||
error: "Selected medication could not be resolved.",
|
||||
});
|
||||
|
||||
await app.close();
|
||||
});
|
||||
});
|
||||
Reference in New Issue
Block a user