Explore vaccination schedule designs

app/controllers/vaccination.js

@@ -48,6 +48,20 @@ export const vaccinationController = {
     response.render('vaccination/show')
   },
 
+  duplicates(request, response) {
+    const { vaccination } = response.locals
+
+    if (!vaccination) {
+      return response.redirect('/')
+    }
+
+    if (vaccination.canonicalVaccination_uuid || !vaccination.duplicates.length) {
+      return response.redirect(vaccination.uri)
+    }
+
+    response.render('vaccination/duplicates')
+  },
+
   edit(request, response) {
     const { vaccination_uuid } = request.params
     const { data, referrer } = request.session

app/datasets/vaccines.js

@@ -266,5 +266,38 @@ export default {
       PreScreenQuestion.IsHappy,
       PreScreenQuestion.IsNotContraindicated
     ]
+  },
+  // MMRV (measles, mumps, rubella, varicella) — not used on the UK schedule.
+  // Included only to simulate miscoded records surfacing in Mavis. SNOMED is
+  // fabricated (99 prefix) since there is no real UK dm+d code to lean on.
+  '99926011000001103': {
+    snomed: '99926011000001103',
+    type: 'MMRV',
+    brand: 'ProQuad',
+    manufacturer: 'Merck Sharp & Dohme (UK) Ltd',
+    criteria: VaccineCriteria.Injection,
+    method: VaccineMethod.Injection,
+    dose: 0.5,
+    sideEffects: [
+      VaccineSideEffect.Bruising,
+      VaccineSideEffect.TemperatureShiver,
+      VaccineSideEffect.SickFeeling,
+      VaccineSideEffect.PainArms
+    ],
+    healthQuestions: {
+      'bleeding': {},
+      'bloodThinning': {},
+      'bloodTransfusion': {},
+      'previousReactionMmr': {},
+      'previousReactionNeomycinGelatine': {},
+      'immuneSystem': {},
+      'immunisations': {}
+    },
+    preScreenQuestions: [
+      PreScreenQuestion.IsWell,
+      PreScreenQuestion.IsPregnant,
+      PreScreenQuestion.IsHappy,
+      PreScreenQuestion.IsNotContraindicated
+    ]
   }
 }

app/locales/en.js

@@ -1579,6 +1579,22 @@ export const en = {
       count:
         '{count, plural, =0 {No vaccination record} one {Vaccination record} other {# vaccination records}}'
     },
+    encounters: {
+      count:
+        '{count, plural, =0 {No encounters recorded} one {Encounters} other {# encounters}}'
+    },
+    vaccinationRecord: {
+      label: 'Vaccination record',
+      dosesComplete: '{complete} of {needed} doses complete.',
+      dose: {
+        label: 'Dose',
+        number: 'Dose {sequence}'
+      },
+      ignored: {
+        label: 'Out of schedule'
+      },
+      eligibleFrom: 'Eligible from {date}'
+    },
     status: {
       label: 'Status'
     },
@@ -3148,6 +3164,7 @@ export const en = {
     show: {
       summary: 'Vaccination record'
     },
+    reportProblem: 'Report a problem with this duplicate record',
     count:
       '{count, plural, =0 {No vaccination records} one {1 vaccination record} other {# vaccination records}}',
     administer: {
@@ -3260,6 +3277,9 @@ export const en = {
     countryOther: {
       title: 'Which country was the vaccination given in?'
     },
+    schedule: {
+      label: 'Schedule'
+    },
     outcome: {
       label: 'Outcome',
       title: 'Vaccination outcome',
@@ -3303,6 +3323,28 @@ export const en = {
     source: {
       label: 'Source'
     },
+    duplicates: {
+      count:
+        '{count, plural, =0 {} one {+# duplicate} other {+# duplicates}}',
+      canonical: {
+        heading: 'Canonical record'
+      },
+      reportProblem: 'Report a problem with this duplicate set',
+      list: {
+        heading:
+          '{count, plural, one {# duplicate record} other {# duplicate records}}'
+      }
+    },
+    canonicalRole: {
+      label: 'Canonical record',
+      yes: 'Yes',
+      no: 'No',
+      view: 'View canonical record'
+    },
+    duplicateRecords: {
+      label: 'Duplicate records',
+      count: '{count, plural, one {# record} other {# records}}'
+    },
     ttcv: {
       label: 'Dose'
     },

app/models/patient-programme.js

@@ -21,10 +21,12 @@ import {
   Vaccination
 } from '../models.js'
 import {
+  formatDate,
   getCurrentAcademicYear,
   getDateValueDifference,
   today
 } from '../utils/date.js'
+import { getScheduleSummary } from '../utils/dose-schedule.js'
 import { ordinal } from '../utils/number.js'
 import { getReportOutcome } from '../utils/patient-session.js'
 import { getPatientStatus } from '../utils/status.js'
@@ -137,7 +139,7 @@ export class PatientProgramme {
    */
   get lastPatientSession() {
     if (this.patientSessions?.length > 0) {
-      return this.patientSessions.at(-1)
+      return this.patientSessions.at(0)
     }
   }
 
@@ -287,6 +289,17 @@ export class PatientProgramme {
     )
   }
 
+  /**
+   * Get canonical vaccination outcomes (excluding duplicates)
+   *
+   * @returns {Array<import('./vaccination.js').Vaccination>|undefined} Vaccinations
+   */
+  get canonicalVaccinationOutcomes() {
+    return this.vaccinationOutcomes?.filter(
+      (vaccination) => !vaccination.canonicalVaccination_uuid
+    )
+  }
+
   /**
    * Get last vaccination outcome
    *
@@ -362,13 +375,38 @@ export class PatientProgramme {
    * @returns {number} Doses remaining
    */
   get dosesRemaining() {
-    if (this.vaccinationsGiven?.length > 0) {
-      return this.dosesNeeded - this.vaccinationsGiven?.length
+    const validCount = this.scheduleSummary.dosesComplete
+    if (validCount > 0) {
+      return this.dosesNeeded - validCount
     }
 
     return this.dosesNeeded
   }
 
+  /**
+   * Get dose schedule summary
+   *
+   * @returns {object} Schedule summary
+   */
+  get scheduleSummary() {
+    const canonicalGiven = (this.vaccinationsGiven || []).filter(
+      (vaccination) => !vaccination.canonicalVaccination_uuid
+    )
+    const summary = getScheduleSummary({
+      vaccinationsGiven: canonicalGiven,
+      dob: this.patient?.dob,
+      programme: this.programme
+    })
+    return {
+      ...summary,
+      dosesComplete: summary.validDoses.length,
+      dosesNeeded: this.dosesNeeded,
+      nextEligibleFromFormatted: summary.nextEligibleFrom
+        ? formatDate(summary.nextEligibleFrom, { dateStyle: 'long' })
+        : null
+    }
+  }
+
   /**
    * Get dose due (ordinal)
    *

app/models/patient-session.js

@@ -470,7 +470,9 @@ export class PatientSession {
     try {
       if (this.patient?.vaccinations && this.programme_id) {
         return this.patient.vaccinations.filter(
-          ({ programme }) => programme?.id === this.programme_id
+          (vaccination) =>
+            vaccination.programme?.id === this.programme_id &&
+            vaccination.patientSession_uuid === this.uuid
         )
       }
     } catch (error) {
@@ -832,8 +834,18 @@ export class PatientSession {
    */
   get reportDescription() {
     switch (this.report) {
-      case PatientStatus.Vaccinated:
-        return `${this.patient?.firstName} was vaccinated by ${this.lastVaccinationOutcome.createdBy.fullName} on ${this.lastVaccinationOutcome.formatted.createdAt}.`
+      case PatientStatus.Vaccinated: {
+        const vaccination =
+          this.lastVaccinationOutcome ||
+          this.patientProgramme?.lastVaccinationGiven
+        if (!vaccination) {
+          return `${this.patient?.firstName} has been vaccinated.`
+        }
+        const by = vaccination.createdBy?.fullName
+        return by
+          ? `${this.patient?.firstName} was vaccinated by ${by} on ${vaccination.formatted.createdAt}.`
+          : `${this.patient?.firstName} was vaccinated on ${vaccination.formatted.createdAt}.`
+      }
       case PatientStatus.Due:
         return this.vaccineCriteria
           ? `${this.patient?.firstName} is ready to vaccinate (${this.vaccineCriteria.toLowerCase()}).`

app/models/vaccination.js

@@ -87,6 +87,7 @@ import {
  * @property {string} [batch_id] - Batch ID
  * @property {string} [variant] - Programme variant
  * @property {string} [vaccine_snomed] - Vaccine SNOMED code
+ * @property {string} [canonicalVaccination_uuid] - UUID of the canonical record this is a duplicate of
  */
 export class Vaccination {
   constructor(options, context) {
@@ -131,6 +132,7 @@ export class Vaccination {
     this.batch_id = this.given ? options?.batch_id || '' : undefined
     this.variant = options?.variant && stringToBoolean(options.variant)
     this.vaccine_snomed = options?.vaccine_snomed
+    this.canonicalVaccination_uuid = options?.canonicalVaccination_uuid
 
     if (this.outcome === VaccinationOutcome.AlreadyVaccinated) {
       this.locationName = options?.locationName
@@ -405,6 +407,70 @@ export class Vaccination {
     }
   }
 
+  /**
+   * Whether this record is a duplicate of another vaccination record.
+   *
+   * @returns {boolean} True if this record points to a canonical record
+   */
+  get isDuplicate() {
+    return Boolean(this.canonicalVaccination_uuid)
+  }
+
+  /**
+   * Whether this record is the canonical record in a duplicate set.
+   *
+   * @returns {boolean} True if at least one other record points to this one
+   */
+  get isCanonical() {
+    if (!this.context?.vaccinations) return false
+    return Object.values(this.context.vaccinations).some(
+      (vaccination) => vaccination.canonicalVaccination_uuid === this.uuid
+    )
+  }
+
+  /**
+   * Get the canonical record this duplicate points to, or `this` if not a
+   * duplicate.
+   *
+   * @returns {Vaccination} Canonical vaccination
+   */
+  get canonical() {
+    if (this.isDuplicate) {
+      return (
+        Vaccination.findOne(this.canonicalVaccination_uuid, this.context) ||
+        this
+      )
+    }
+    return this
+  }
+
+  /**
+   * Get records that point to this one as their canonical, in chronological
+   * order. Empty for duplicate or standalone records.
+   *
+   * @returns {Array<Vaccination>} Duplicate vaccinations
+   */
+  get duplicates() {
+    if (!this.context?.vaccinations) return []
+    return Object.values(this.context.vaccinations)
+      .filter(
+        (vaccination) => vaccination.canonicalVaccination_uuid === this.uuid
+      )
+      .map((vaccination) => new Vaccination(vaccination, this.context))
+      .sort((a, b) => new Date(a.createdAt) - new Date(b.createdAt))
+  }
+
+  /**
+   * Get this record together with any duplicates pointing to it. On a
+   * duplicate record, returns `[this]`.
+   *
+   * @returns {Array<Vaccination>} Duplicate set
+   */
+  get duplicateSet() {
+    if (this.isDuplicate) return [this]
+    return [this, ...this.duplicates]
+  }
+
   /**
    * Get status of sync with NHS England API
    *
@@ -613,6 +679,21 @@ export class Vaccination {
     )
   }
 
+  /**
+   * Find all canonical vaccination records — those that are not themselves
+   * duplicates of another record. Includes standalone records (canonical-of-
+   * one).
+   *
+   * @param {object} context - Context
+   * @returns {Array<Vaccination>} Vaccinations
+   * @static
+   */
+  static findAllCanonical(context) {
+    return Vaccination.findAll(context).filter(
+      (vaccination) => !vaccination.canonicalVaccination_uuid
+    )
+  }
+
   /**
    * Find one
    *

app/routes/vaccination.js

@@ -22,6 +22,8 @@ router.all('/:vaccination_uuid/edit/:view', vaccination.readForm('edit'))
 router.get('/:vaccination_uuid/edit/:view', vaccination.showForm('edit'))
 router.post('/:vaccination_uuid/edit/:view', vaccination.updateForm)
 
+router.get('/:vaccination_uuid/duplicates', vaccination.duplicates)
+
 router.get('/:vaccination_uuid', vaccination.show)
 
 export const vaccinationRoutes = router