fix(ai): Lower icd10 polling interval; no clinical data means no prompt (#5492)

Author: colin-welch

apps/ehr/src/features/visits/shared/components/AiPotentialDiagnosesCard.tsx

@@ -17,7 +17,7 @@ export const AiPotentialDiagnosesCard: FC = () => {
     requestedFields: {
       aiPotentialDiagnosis: {},
     },
-    refetchInterval: 5000,
+    refetchInterval: 3000,
   });
   const aiPotentialDiagnoses = chartFieldsData?.aiPotentialDiagnosis ?? [];
   const { mutateAsync: recommendBillingSuggestions } = useRecommendBillingSuggestions();

packages/zambdas/src/subscriptions/task/sub-recommend-diagnosis-codes/index.ts

@@ -111,8 +111,13 @@ export async function createDiagnosisCodeRecommendations(
   )[] = [];
 
   console.timeLog('time', 'before generating codes');
-  console.log('Generating ICD-10 codes from clinical notes');
-  const potentialDiagnoses = await generateIcdTenCodesFromNotes(aiClient, hpiTextUpdated, mdmTextUpdated);
+  let potentialDiagnoses: { icd10: string; diagnosis: string }[] = [];
+  if (!hpiTextUpdated && !mdmTextUpdated) {
+    console.log('No HPI or MDM text available, skipping ICD-10 code generation');
+  } else {
+    console.log('Generating ICD-10 codes from clinical notes');
+    potentialDiagnoses = await generateIcdTenCodesFromNotes(aiClient, hpiTextUpdated, mdmTextUpdated);
+  }
   console.timeLog('time', 'after generating codes');
   const existingAiDiagnoses: Condition[] = allResources.filter(
     (resource) =>

packages/zambdas/test/helpers/integration-test-seed-data-setup.ts

@@ -39,6 +39,7 @@ export interface InsertFullAppointmentDataBaseResult {
   appointment: Appointment;
   encounter: Encounter;
   questionnaireResponse: QuestionnaireResponse;
+  clinicalImpression: ClinicalImpression;
 }
 
 /**
@@ -188,6 +189,9 @@ export const insertInPersonAppointmentBase = async (
     questionnaireResponse: createdResources.find(
       (resource) => resource!.resourceType === 'QuestionnaireResponse'
     ) as QuestionnaireResponse,
+    clinicalImpression: createdResources.find(
+      (resource) => resource!.resourceType === 'ClinicalImpression'
+    ) as ClinicalImpression,
   };
 };
 

packages/zambdas/test/integration/sub-recommend-diagnosis-codes.test.ts

@@ -217,5 +217,64 @@ describe('sub-recommend-diagnosis-codes integration tests', () => {
       expect(aiConditions[0].code?.coding?.[0].code).toBe('R06.02');
       expect(aiConditions[0].code?.coding?.[0].display).toBe('Sneezing');
     });
+    it('should remove all prior recommendations when all input is empty-- success', async () => {
+      const task: Task = {
+        id: '8665a43e-d0d5-41d2-9f0e-1322db6f1bd5',
+        resourceType: 'Task',
+        status: 'requested',
+        intent: 'order',
+        focus: { reference: `Encounter/${baseResources.encounter.id}` },
+        code: {
+          coding: [
+            {
+              system: OttehrTaskSystem,
+              code: 'recommend-diagnosis-codes',
+            },
+          ],
+        },
+      };
+      const mockAIClient = new FakeListChatModel({
+        responses: [
+          `{
+  "potentialDiagnoses": [
+    {
+      "diagnosis": "Sneezing",
+      "icd10": "R06.02"
+    }
+  ]
+}`,
+        ],
+      });
+
+      await oystehr.fhir.delete({ resourceType: 'ClinicalImpression', id: baseResources.clinicalImpression.id! });
+
+      let result: { taskStatus: Task['status']; statusReason?: string } | undefined;
+      let error: any;
+      try {
+        result = await createDiagnosisCodeRecommendations(task, oystehr, mockAIClient);
+      } catch (err) {
+        error = err as Error;
+      }
+      expect(error).toBeUndefined();
+      expect(result).toBeDefined();
+      expect(result).toHaveProperty('taskStatus');
+      expect(result?.taskStatus).toEqual('completed');
+      expect(result).toHaveProperty('statusReason');
+      expect(result?.statusReason).toEqual('Recommended 0 diagnosis codes');
+
+      const savedConditions = (
+        await oystehr.fhir.search<Condition>({
+          resourceType: 'Condition',
+          params: [{ name: 'encounter', value: baseResources.encounter.id! }],
+        })
+      ).unbundle();
+      const aiConditions = savedConditions.filter((resource) => {
+        return (
+          resource.meta?.tag?.find((tag) => tag.system === `${PRIVATE_EXTENSION_BASE_URL}/ai-potential-diagnosis`)
+            ?.code === 'ai-potential-diagnosis'
+        );
+      });
+      expect(aiConditions.length).toBe(0);
+    });
   });
 });