The MOTECH OpenMRS & Bahmni Module

See the MOTECH README for a brief introduction to OpenMRS and Bahmni in the context of MOTECH.

OpenmrsRepeater 

class corehq.motech.openmrs.repeaters.OpenmrsRepeater(*args, **kwargs)[source]

OpenmrsRepeater is responsible for updating OpenMRS patients with changes made to cases in CommCare. It is also responsible for creating OpenMRS “visits”, “encounters” and “observations” when a corresponding visit form is submitted in CommCare.

The OpenmrsRepeater class is different from most repeater classes in three details:

It has a case type and it updates the OpenMRS equivalent of cases like the CaseRepeater class, but it reads forms like the FormRepeater class. So it subclasses CaseRepeater but its payload format is form_json.
It makes many API calls for each payload.
It can have a location.

Parameters:

repeater_type (CharField) – Repeater type
id (UUIDField) – Primary key: Id
domain (CharIdField) – Domain
name (CharField) – Name
format (CharField) – Format
request_method (CharField) – Request method
is_paused (BooleanField) – Is paused
next_attempt_at (DateTimeField) – Next attempt at
last_attempt_at (DateTimeField) – Last attempt at
options (JSONField) – Options
connection_settings_id (IntegerField) – Connection settings id
is_deleted (BooleanField) – Is deleted
last_modified (DateTimeField) – Last modified
date_created (DateTimeField) – Date created

Reverse relationships:

Parameters:: repeat_records (Reverse ForeignKey from SQLRepeatRecord) – All repeat records of this repeater (related name of repeater)

OpenMRS Repeater Location 

Assigning an OpenMRS repeater to a location allows a project to integrate with multiple OpenMRS/Bahmni servers.

Imagine a location hierarchy like the following:

(country) South Africa
- (province) Gauteng
- (province) Western Cape
  - (district) City of Cape Town
  - (district) Central Karoo
    - (municipality) Laingsburg

Imagine we had an OpenMRS server to store medical records for the city of Cape Town, and a second OpenMRS server to store medical records for the central Karoo.

When a mobile worker whose primary location is set to Laingsburg submits data, MOTECH will search their location and the locations above it until it finds an OpenMRS server. That will be the server that their data is forwarded to.

When patients are imported from OpenMRS, either using its Atom Feed API or its Reporting API, and new cases are created in CommCare, those new cases must be assigned an owner.

The owner will be the first mobile worker found in the OpenMRS server’s location. If no mobile workers are found, the case’s owner will be set to the location itself. A good way to manage new cases is to have just one mobile worker, like a supervisor, assigned to the same location as the OpenMRS server. In the example above, in terms of organization levels, it would make sense to have a supervisor at the district level and other mobile workers at the municipality level.

OpenmrsConfig 

class corehq.motech.openmrs.openmrs_config.OpenmrsConfig(_obj=None, **kwargs)[source]

Configuration for an OpenMRS repeater is stored in an OpenmrsConfig document.

The case_config property maps CommCare case properties (mostly) to patient data, and uses the OpenmrsCaseConfig document schema.

The form_configs property maps CommCare form questions (mostly) to event, encounter and observation data, and uses the OpenmrsFormConfig document schema.

An OpenMRS Patient 

The way we map case properties to an OpenMRS patient is based on how OpenMRS represents a patient. Here is an example of an OpenMRS patient (with some fields removed):

{
  "uuid": "d95bf6c9-d1c6-41dc-aecf-1c06bd71386c",
  "display": "GAN200000 - Test DrugDataOne",

  "identifiers": [
    {
      "uuid": "6c5ab204-a128-48f9-bfb2-3f65fd06785b",
      "identifier": "GAN200000",
      "identifierType": {
        "uuid": "81433852-3f10-11e4-adec-0800271c1b75",
      }
    }
  ],

  "person": {
    "uuid": "d95bf6c9-d1c6-41dc-aecf-1c06bd71386c",
    "display": "Test DrugDataOne",
    "gender": "M",
    "age": 3,
    "birthdate": "2014-01-01T00:00:00.000+0530",
    "birthdateEstimated": false,
    "dead": false,
    "deathDate": null,
    "causeOfDeath": null,
    "deathdateEstimated": false,
    "birthtime": null,

    "attributes": [
      {
        "display": "primaryContact = 1234",
        "uuid": "2869508d-3484-4eb7-8cc0-ecaa33889cd2",
        "value": "1234",
        "attributeType": {
          "uuid": "c1f7fd17-3f10-11e4-adec-0800271c1b75",
          "display": "primaryContact"
        }
      },
      {
        "display": "caste = Tribal",
        "uuid": "06ab9ef7-300e-462f-8c1f-6b65edea2c80",
        "value": "Tribal",
        "attributeType": {
          "uuid": "c1f4239f-3f10-11e4-adec-0800271c1b75",
          "display": "caste"
        }
      },
      {
        "display": "General",
        "uuid": "b28e6bbc-91aa-4ba4-8714-cdde0653eb90",
        "value": {
          "uuid": "c1fc20ab-3f10-11e4-adec-0800271c1b75",
          "display": "General"
        },
        "attributeType": {
          "uuid": "c1f455e7-3f10-11e4-adec-0800271c1b75",
          "display": "class"
        }
      }
    ],

    "preferredName": {
      "display": "Test DrugDataOne",
      "uuid": "760f18ea-9321-4c31-9a43-338089fc5b4b",
      "givenName": "Test",
      "familyName": "DrugDataOne"
    },

    "preferredAddress": {
      "display": "123",
      "uuid": "c41f82e2-6af2-459c-96ff-26b66c8887ae",
      "address1": "123",
      "address2": "gp123",
      "address3": "Raigarh",
      "cityVillage": "RAIGARH",
      "countyDistrict": "Raigarh",
      "stateProvince": "Chattisgarh",
      "country": null,
      "postalCode": null
    },

    "names": [
      {
        "display": "Test DrugDataOne",
        "uuid": "760f18ea-9321-4c31-9a43-338089fc5b4b",
        "givenName": "Test",
        "familyName": "DrugDataOne"
      }
    ],

    "addresses": [
      {
        "display": "123",
        "uuid": "c41f82e2-6af2-459c-96ff-26b66c8887ae",
        "address1": "123",
        "address2": "gp123",
        "address3": "Raigarh",
        "cityVillage": "RAIGARH",
        "countyDistrict": "Raigarh",
        "stateProvince": "Chattisgarh",
        "country": null,
        "postalCode": null
      }
    ]
  }
}

There are several things here to note:

A patient has a UUID, identifiers, and a person.
Other than “uuid”, most of the fields that might correspond to case properties belong to “person”.
“person” has a set of top-level items like “gender”, “age”, “birthdate”, etc. And then there are also “attributes”. The top-level items are standard OpenMRS person properties. “attributes” are custom, and specific to this OpenMRS instance. Each attribute is identified by a UUID.
There are two kinds of custom person attributes:
1. Attributes that take any value (of its data type). Examples from above are “primaryContact = 1234” and “caste = Tribal”.
2. Attributes whose values are selected from a set. An example from above is “class”, which is set to “General”. OpenMRS calls these values “Concepts”, and like everything else in OpenMRS each concept value has a UUID.
A person has “names” and a “preferredName”, and similarly “addresses” and “preferredAddress”. Case properties are only mapped to preferredName and preferredAddress. We do not keep track of other names and addresses.

OpenmrsCaseConfig 

Now that we know what a patient looks like, the OpenmrsCaseConfig schema will make more sense. It has the following fields that correspond to OpenMRS’s fields:

patient_identifiers
person_properties
person_attributes
person_preferred_name
person_preferred_address

Each of those assigns values to a patient one of three ways:

It can assign a constant. This uses the “value” key. e.g.

"person_properties": {
  "birthdate": {
    "value": "Oct 7, 3761 BCE"
  }
}

It can assign a case property value. Use “case_property” for this. e.g.

"person_properties": {
  "birthdate": {
    "case_property": "dob"
  }
}

It can map a case property value to a concept UUID. Use “case_property” with “value_map” to do this. e.g.

"person_attributes": {
  "c1f455e7-3f10-11e4-adec-0800271c1b75": {
    "case_property": "class",
    "value_map": {
      "sc": "c1fcd1c6-3f10-11e4-adec-0800271c1b75",
      "general": "c1fc20ab-3f10-11e4-adec-0800271c1b75",
      "obc": "c1fb51cc-3f10-11e4-adec-0800271c1b75",
      "other_caste": "c207073d-3f10-11e4-adec-0800271c1b75",
      "st": "c20478b6-3f10-11e4-adec-0800271c1b75"
    }
  }
}

Note

An easy mistake when configuring person_attributes: The OpenMRS UUID of a person attribute type is different from the UUID of its concept. For the person attribute type UUID, navigate to Administration > Person > *Manage PersonAttribute Types and select the person attribute type you want. Note the greyed-out UUID. This is the UUID that you need. If the person attribute type is a concept, navigate to Administration > Concepts > View Concept Dictionary and search for the person attribute type by name. Select it from the search results. Note the UUID of the concept is different. Select each of its answers. Use their UUIDs in value_map.

There are two more OpenmrsCaseConfig fields:

match_on_ids
patient_finder

match_on_ids is a list of patient identifiers. They can be all or a subset of those given in OpenmrsCaseConfig.patient_identifiers. When a case is updated in CommCare, these are the IDs to be used to select the corresponding patient from OpenMRS. This is done by repeater_helpers.get_patient_by_id()

This is sufficient for projects that import their patient cases from OpenMRS, because each CommCare case will have a corresponding OpenMRS patient, and its ID, or IDs, will have been set by OpenMRS.

Note

MOTECH has the ability to create or update the values of patient identifiers. If an app offers this ability to users, then that identifier should not be included in match_on_ids. If the case was originally matched using only that identifier and its value changes, MOTECH may be unable to match that patient again.

For projects where patient cases can be registered in CommCare, there needs to be a way of finding a corresponding patient, if one exists.

If repeater_helpers.get_patient_by_id() does not return a patient, we need to search OpenMRS for a corresponding patient. For this we use PatientFinders. OpenmrsCaseConfig.patient_finder will determine which class of PatientFinder the OpenMRS repeater must use.

PatientFinder 

class corehq.motech.openmrs.finders.PatientFinder(_obj=None, **kwargs)[source]

The PatientFinder base class was developed as a way to handle situations where patient cases are created in CommCare instead of being imported from OpenMRS.

When patients are imported from OpenMRS, they will come with at least one identifier that MOTECH can use to match the case in CommCare with the corresponding patient in OpenMRS. But if the case is registered in CommCare then we may not have an ID, or the ID could be wrong. We need to search for a corresponding OpenMRS patient.

Different projects may focus on different kinds of case properties, so it was felt that a base class would allow some flexibility.

The PatientFinder.wrap() method allows you to wrap documents of subclasses.

The PatientFinder.find_patients() method must be implemented by subclasses. It returns a list of zero, one, or many patients. If it returns one patient, the OpenmrsRepeater.find_or_create_patient() will accept that patient as a true match.

Note

The consequences of a false positive (a Type II error) are severe: A real patient will have their valid values overwritten by those of someone else. So PatientFinder subclasses should be written and configured to skew towards false negatives (Type I errors). In other words, it is much better not to choose a patient than to choose the wrong patient.

Creating Missing Patients 

If a corresponding OpenMRS patient is not found for a CommCare case, then PatientFinder has the option to create a patient in OpenMRS. This is managed with the optional create_missing property. Its value defaults to false. If it is set to true, then it will create a new patient if none are found.

For example:

"patient_finder": {
  "doc_type": "WeightedPropertyPatientFinder",
  "property_weights": [
    {"case_property": "given_name", "weight": 0.5},
    {"case_property": "family_name", "weight": 0.6}
  ],
  "searchable_properties": ["family_name"],
  "create_missing": true
}

If more than one matching patient is found, a new patient will not be created.

All required properties must be included in the payload. This is sure to include a name and a date of birth, possibly estimated. It may include an identifier. You can find this out from the OpenMRS Administration UI, or by testing the OpenMRS REST API.

WeightedPropertyPatientFinder 

class corehq.motech.openmrs.finders.WeightedPropertyPatientFinder(*args, **kwargs)[source]: The WeightedPropertyPatientFinder class finds OpenMRS patients that match CommCare cases by assigning weights to case properties, and adding the weights of matching patient properties to calculate a confidence score.

OpenmrsFormConfig 

MOTECH sends case updates as changes to patient properties and attributes. Form submissions can also create Visits, Encounters and Observations in OpenMRS.

Configure this in the “Encounters config” section of the OpenMRS Forwarder configuration.

An example value of “Encounters config” might look like this:

[
  {
    "doc_type": "OpenmrsFormConfig",
    "xmlns": "http://openrosa.org/formdesigner/9481169B-0381-4B27-BA37-A46AB7B4692D",
    "openmrs_start_datetime": {
      "form_question": "/metadata/timeStart",
      "external_data_type": "omrs_date"
    },
    "openmrs_visit_type": "c22a5000-3f10-11e4-adec-0800271c1b75",
    "openmrs_encounter_type": "81852aee-3f10-11e4-adec-0800271c1b75",
    "openmrs_observations": [
      {
        "doc_type": "ObservationMapping",
        "concept": "5090AAAAAAAAAAAAAAAAAAAAAAAAAAAA",
        "value": {
          "form_question": "/data/height"
        }
      },
      {
        "doc_type": "ObservationMapping",
        "concept": "e1e055a2-1d5f-11e0-b929-000c29ad1d07",
        "value": {
          "form_question": "/data/lost_follow_up/visit_type",
          "value_map": {
            "Search": "e1e20e4c-1d5f-11e0-b929-000c29ad1d07",
            "Support": "e1e20f5a-1d5f-11e0-b929-000c29ad1d07"
          }
        },
        "case_property": "last_visit_type"
      }
    ]
  }
]

This example uses two form question values, “/data/height” and “/data/lost_follow_up/visit_type”. They are sent as values of OpenMRS concepts “5090AAAAAAAAAAAAAAAAAAAAAAAAAAAA” and “e1e055a2-1d5f-11e0-b929-000c29ad1d07” respectively.

The OpenMRS concept that corresponds to the form question “/data/height” accepts a numeric value.

The concept for “/data/lost_follow_up/visit_type” accepts a discrete set of values. For this we use FormQuestionMap to map form question values, in this example “Search” and “Support”, to their corresponding concept UUIDs in OpenMRS.

The case_property setting for ObservationMapping is optional. If it is set, when Observations are imported from OpenMRS (see Atom Feed Integration below) then the given case property will be updated with the value from OpenMRS. If the observation mapping is uses FormQuestionMap or CasePropertyMap with value_map (like the “last_visit_type” example above), then the CommCare case will be updated with the CommCare value that corresponds to the OpenMRS value’s UUID.

Set the UUIDs of openmrs_visit_type and openmrs_encounter_type appropriately according to the context of the form in the CommCare app.

openmrs_start_datetime is an optional setting. By default, MOTECH will set the start of the visit and the encounter to the time when the form was completed on the mobile worker’s device.

To change which timestamp is used, the following values for form_question are available:

“/metadata/timeStart”: The timestamp, according to the mobile worker’s device, when the form was started
“/metadata/timeEnd”: The timestamp, according to the mobile worker’s device, when the form was completed
“/metadata/received_on”: The timestamp when the form was submitted to HQ.

The value’s default data type is datetime. But some organisations may need the value to be submitted to OpenMRS as just a date. To do this, set external_data_type to omrs_date, as shown in the example.

Provider 

Every time a form is completed in OpenMRS, it creates a new Encounter.

Observations about a patient, like their height or their blood pressure, belong to an Encounter; just as a form submission in CommCare can have many form question values.

The OpenMRS Data Model documentation explains that an Encounter can be associated with health care providers.

It is useful to label data from CommCare by creating a Provider in OpenMRS for CommCare.

OpenMRS configuration has a field called “Provider UUID”, and the value entered here is stored in OpenmrsConfig.openmrs_provider.

There are three different kinds of entities involved in setting up a provider in OpenMRS: A Person instance; a Provider instance; and a User instance.

Use the following steps to create a provider for CommCare:

From the OpenMRS Administration page, choose “Manage Persons” and click “Create Person”. Name, date of birth, and gender are mandatory fields. “CommCare Provider” is probably a good name because OpenMRS will split it into a given name (“CommCare”) and a family name (“Provider”). CommCare HQ’s first Git commit is dated 2009-03-10, so that seems close enough to a date of birth. OpenMRS equates gender with sex, and is quite binary about it. You will have to decided whether CommCare is male or female. When you are done, click “Create Person”. On the next page, “City/Village” is a required field. You can set “State/Province” to “Other” and set “City/Village” to “Cambridge”. Then click “Save Person”.

Go back to the OpenMRS Administration page, choose “Manage Providers” and click “Add Provider”. In the “Person” field, type the name of the person you just created. You can also give it an Identifier, like “commcare”. Then click Save.

You will need the UUID of the new Provider. Find the Provider by entering its name, and selecting it.

Make a note of the greyed UUID. This is the value you will need for “Provider UUID” in the configuration for the OpenMRS Repeater.

Next, go back to the OpenMRS Administration page, choose “Manage Users” and click “Add User”. Under “Use a person who already exists” enter the name of your new person and click “Next”. Give your user a username (like “commcare”), and a password. Under “Roles” select “Provider”. Click “Save User”.

Now CommCare’s “Provider UUID” will be recognised by OpenMRS as a provider. Copy the value of the Provider UUID you made a note of earlier into your OpenMRS configuration in CommCare HQ.

Atom Feed Integration 

The OpenMRS Atom Feed Module allows MOTECH to poll feeds of updates to patients and encounters. The feed adheres to the Atom syndication format.

An example URL for the patient feed would be like “http://www.example.com/openmrs/ws/atomfeed/patient/recent”.

Example content:

<?xml version="1.0" encoding="UTF-8"?>
<feed xmlns="http://www.w3.org/2005/Atom">
  <title>Patient AOP</title>
  <link rel="self" type="application/atom+xml" href="http://www.example.com/openmrs/ws/atomfeed/patient/recent" />
  <link rel="via" type="application/atom+xml" href="http://www.example.com/openmrs/ws/atomfeed/patient/32" />
  <link rel="prev-archive" type="application/atom+xml" href="http://www.example.com/openmrs/ws/atomfeed/patient/31" />
  <author>
    <name>OpenMRS</name>
  </author>
  <id>bec795b1-3d17-451d-b43e-a094019f6984+32</id>
  <generator uri="https://github.com/ICT4H/atomfeed">OpenMRS Feed Publisher</generator>
  <updated>2018-04-26T10:56:10Z</updated>
  <entry>
    <title>Patient</title>
    <category term="patient" />
    <id>tag:atomfeed.ict4h.org:6fdab6f5-2cd2-4207-b8bb-c2884d6179f6</id>
    <updated>2018-01-17T19:44:40Z</updated>
    <published>2018-01-17T19:44:40Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/patient/e8aa08f6-86cd-42f9-8924-1b3ea021aeb4?v=full]]></content>
  </entry>
  <entry>
    <title>Patient</title>
    <category term="patient" />
    <id>tag:atomfeed.ict4h.org:5c6b6913-94a0-4f08-96a2-6b84dbced26e</id>
    <updated>2018-01-17T19:46:14Z</updated>
    <published>2018-01-17T19:46:14Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/patient/e8aa08f6-86cd-42f9-8924-1b3ea021aeb4?v=full]]></content>
  </entry>
  <entry>
    <title>Patient</title>
    <category term="patient" />
    <id>tag:atomfeed.ict4h.org:299c435d-b3b4-4e89-8188-6d972169c13d</id>
    <updated>2018-01-17T19:57:09Z</updated>
    <published>2018-01-17T19:57:09Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/patient/e8aa08f6-86cd-42f9-8924-1b3ea021aeb4?v=full]]></content>
  </entry>
</feed>

Similarly, an encounter feed URL would be like “http://www.example.com/openmrs/ws/atomfeed/encounter/recent”.

Example content:

<?xml version="1.0" encoding="UTF-8"?>
<feed xmlns="http://www.w3.org/2005/Atom">
  <title>Patient AOP</title>
  <link rel="self" type="application/atom+xml" href="https://13.232.58.186/openmrs/ws/atomfeed/encounter/recent" />
  <link rel="via" type="application/atom+xml" href="https://13.232.58.186/openmrs/ws/atomfeed/encounter/335" />
  <link rel="prev-archive" type="application/atom+xml" href="https://13.232.58.186/openmrs/ws/atomfeed/encounter/334" />
  <author>
    <name>OpenMRS</name>
  </author>
  <id>bec795b1-3d17-451d-b43e-a094019f6984+335</id>
  <generator uri="https://github.com/ICT4H/atomfeed">OpenMRS Feed Publisher</generator>
  <updated>2018-06-13T08:32:57Z</updated>
  <entry>
    <title>Encounter</title>
    <category term="Encounter" />
    <id>tag:atomfeed.ict4h.org:af713a2e-b961-4cb0-be59-d74e8b054415</id>
    <updated>2018-06-13T05:08:57Z</updated>
    <published>2018-06-13T05:08:57Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/bahmnicore/bahmniencounter/0f54fe40-89af-4412-8dd4-5eaebe8684dc?includeAll=true]]></content>
  </entry>
  <entry>
    <title>Encounter</title>
    <category term="Encounter" />
    <id>tag:atomfeed.ict4h.org:320834be-e9c8-4b09-a99e-691dff18b3e4</id>
    <updated>2018-06-13T05:08:57Z</updated>
    <published>2018-06-13T05:08:57Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/bahmnicore/bahmniencounter/0f54fe40-89af-4412-8dd4-5eaebe8684dc?includeAll=true]]></content>
  </entry>
  <entry>
    <title>Encounter</title>
    <category term="Encounter" />
    <id>tag:atomfeed.ict4h.org:fca253aa-b917-4166-946e-9da9baa901da</id>
    <updated>2018-06-13T05:09:12Z</updated>
    <published>2018-06-13T05:09:12Z</published>
    <content type="application/vnd.atomfeed+xml"><![CDATA[/openmrs/ws/rest/v1/bahmnicore/bahmniencounter/c6d6c248-8cd4-4e96-a110-93668e48e4db?includeAll=true]]></content>
  </entry>
</feed>

At the time of writing, the Atom feeds do not use ETags or offer HEAD requests. MOTECH uses a GET request to fetch the document, and checks the timestamp in the <updated> tag to tell whether there is new content.

The feeds are paginated, and the page number is given at the end of the href attribute of the <link rel="via" ... tag, which is found at the start of the feed. A <link rel="next-archive" ... tag indicates that there is a next page.

MOTECH stores the last page number polled in the OpenmrsRepeater.atom_feed_status["patient"].last_page and OpenmrsRepeater.atom_feed_status["encounter"]last_page properties. When it polls again, it starts at this page, and iterates next-archive links until all have been fetched.

If this is the first time MOTECH is polling an Atom feed, it uses the /recent URL (as given in the example URL above) instead of starting from the very beginning. This is to allow Atom feed integration to be enabled for ongoing projects that may have a lot of established data. Administrators should be informed that enabling Atom feed integration will not import all OpenMRS patients into CommCare, but it will add CommCare cases for patients created in OpenMRS from the moment Atom feed integration is enabled.

Adding cases for OpenMRS patients 

MOTECH needs three kinds of data in order to add a case for an OpenMRS patient:

The case type. This is set using the OpenMRS Repeater’s “Case Type” field (i.e. OpenmrsRepeater.white_listed_case_types). It must have exactly one case type specified.
The case owner. This is determined using the OpenMRS Repeater’s “Location” field (i.e. OpenmrsRepeater.location_id). The owner is set to the first mobile worker (specifically CommCareUser instance) found at that location.
The case properties to set. MOTECH uses the patient_identifiers, person_properties, person_preferred_name, person_preferred_address, and person_attributes given in “Patient config” (OpenmrsRepeater.openmrs_config.case_config) to map the values of an OpenMRS patient to case properties. All and only the properties in “Patient config” are mapped.

The name of cases updated from the Atom feed are set to the display name of the person (not the display name of patient because it often includes punctuation and an identifier).

When a new case is created, its case’s owner is determined by the CommCare location of the OpenMRS repeater. (You can set the location when you create or edit the OpenMRS repeater in Project Settings > Data Forwarding.) The case will be assigned to the first mobile worker found at the repeater’s location. The intention is that this mobile worker would be a supervisor who can pass the case to the appropriate person.

Importing OpenMRS Encounters 

MOTECH can import both patient data and data about encounters using Atom feed integration. This can be used for updating case properties, associating clinical diagnoses with a patient, or managing referrals.

Bahmni includes diagnoses in the data of an encounter. The structure of a diagnosis is similar to that of an observation. Diagnoses can only be imported from Bahmni; Bahmni does not offer an API for adding or updating diagnoses in Bahmni. Configurations for observations and diagnoses are specified separately in the OpenmrsFormConfig definition to make the distinction obvious.

Here is an example OpenmrsFormConfig:

[
  {
    "doc_type": "OpenmrsFormConfig",
    "xmlns": "http://openrosa.org/formdesigner/9ECA0608-307A-4357-954D-5A79E45C3879",
    "openmrs_form": null,
    "openmrs_visit_type": "c23d6c9d-3f10-11e4-adec-0800271c1b75",

    "openmrs_start_datetime": {
      "direction": "in",
      "jsonpath": "encounterDateTime",
      "case_property": "last_clinic_visit_date",
      "external_data_type": "omrs_datetime",
      "commcare_data_type": "cc_date"
    },

    "openmrs_encounter_type": "81852aee-3f10-11e4-adec-0800271c1b75",
    "openmrs_observations": [
      {
        "doc_type": "ObservationMapping",
        "concept": "f8ca5471-4e76-4737-8ea4-7555f6d5af0f",
        "value": {
          "case_property": "blood_group"
        },
        "case_property": "blood_group",
        "indexed_case_mapping": null
      },

      {
        "doc_type": "ObservationMapping",
        "concept": "397b9631-2911-435a-bf8a-ae4468b9c1d4",
        "value": {
          "direction": "in",
          "case_property": "[unused when direction = 'in']"
        },
        "case_property": null,
        "indexed_case_mapping": {
          "doc_type": "IndexedCaseMapping",
          "identifier": "parent",
          "case_type": "referral",
          "relationship": "extension",
          "case_properties": [
            {
              "jsonpath": "value",
              "case_property": "case_name",
              "value_map": {
                "Alice": "397b9631-2911-435a-bf8a-111111111111",
                "Bob": "397b9631-2911-435a-bf8a-222222222222",
                "Carol": "397b9631-2911-435a-bf8a-333333333333"
              }
            },
            {
              "jsonpath": "value",
              "case_property": "owner_id",
              "value_map": {
                "111111111111": "397b9631-2911-435a-bf8a-111111111111",
                "222222222222": "397b9631-2911-435a-bf8a-222222222222",
                "333333333333": "397b9631-2911-435a-bf8a-333333333333"
              }
            },
            {
              "jsonpath": "encounterDateTime",
              "case_property": "referral_date",
              "commcare_data_type": "date",
              "external_data_type": "posix_milliseconds"
            },
            {
              "jsonpath": "comment",
              "case_property": "referral_comment"
            }
          ]
        }
      }
    ],

    "bahmni_diagnoses": [
      {
        "doc_type": "ObservationMapping",
        "concept": "all",
        "value": {
          "direction": "in",
          "case_property": "[unused when direction = 'in']"
        },
        "case_property": null,
        "indexed_case_mapping": {
          "doc_type": "IndexedCaseMapping",
          "identifier": "parent",
          "case_type": "diagnosis",
          "relationship": "extension",
          "case_properties": [
            {
              "jsonpath": "codedAnswer.name",
              "case_property": "case_name"
            },
            {
              "jsonpath": "certainty",
              "case_property": "certainty"
            },
            {
              "jsonpath": "order",
              "case_property": "is_primary",
              "value_map": {
                "yes": "PRIMARY",
                "no": "SECONDARY"
              }
            },
            {
              "jsonpath": "diagnosisDateTime",
              "case_property": "diagnosis_datetime"
            }
          ]
        }
      }
    ]
  }
]

There is a lot happening in that definition. Let us look at the different parts.

"xmlns": "http://openrosa.org/formdesigner/9ECA0608-307A-4357-954D-5A79E45C3879",

Atom feed integration uses the same configuration as data forwarding, because mapping case properties to observations normally applies to both exporting data to OpenMRS and importing data from OpenMRS.

For data forwarding, when the form specified by that XMLNS is submitted, MOTECH will export corresponding observations.

For Atom feed integration, when a new encounter appears in the encounters Atom feed, MOTECH will use the mappings specified for any form to determine what data to import. In other words, this XMLNS value is not used for Atom feed integration. It is only used for data forwarding.

"openmrs_start_datetime": {
  "direction": "in",
  "jsonpath": "encounterDateTime",
  "case_property": "last_clinic_visit_date",
  "external_data_type": "omrs_datetime",
  "commcare_data_type": "cc_date"
},

Data forwarding can be configured to set the date and time of the start of an encounter. Atom feed integration can be configured to import the start of the encounter. "direction": "in" tells MOTECH that these settings only apply to importing via the Atom feed. "jsonpath": "encounterDateTime" fetches the value from the “encounterDateTime” property in the document returned from OpenMRS. "case_property": "last_clinic_visit_date" saves that value to the “last_clinic_visit_date” case property. The data type settings convert the value from a datetime to a date.

{
  "doc_type": "ObservationMapping",
  "concept": "f8ca5471-4e76-4737-8ea4-7555f6d5af0f",
  "value": {
    "case_property": "blood_group"
  },
  "case_property": "blood_group",
  "indexed_case_mapping": null
},

The first observation mapping is configured for both importing and exporting. When data forwarding exports data, it uses "value": {"case_property": "blood_group"} to determine which value to send. When MOTECH imports via the Atom feed, it uses "case_property": "blood_group", "indexed_case_mapping": null to determine what to do with the imported value. These specific settings tell MOTECH to save the value to the “blood_group” case property, and not to create a subcase.

The next observation mapping gets more interesting:

{
  "doc_type": "ObservationMapping",
  "concept": "397b9631-2911-435a-bf8a-ae4468b9c1d4",
  "value": {
    "direction": "in",
    "case_property": "[unused when direction = 'in']"
  },
  "case_property": null,
  "indexed_case_mapping": {
    "doc_type": "IndexedCaseMapping",
    "identifier": "parent",
    "case_type": "referral",
    "relationship": "extension",
    "case_properties": [
      {
        "jsonpath": "value",
        "case_property": "case_name",
        "value_map": {
          "Alice": "397b9631-2911-435a-bf8a-111111111111",
          "Bob": "397b9631-2911-435a-bf8a-222222222222",
          "Carol": "397b9631-2911-435a-bf8a-333333333333"
        }
      },
      {
        "jsonpath": "value",
        "case_property": "owner_id",
        "value_map": {
          "111111111111": "397b9631-2911-435a-bf8a-111111111111",
          "222222222222": "397b9631-2911-435a-bf8a-222222222222",
          "333333333333": "397b9631-2911-435a-bf8a-333333333333"
        }
      },
      {
        "jsonpath": "encounterDateTime",
        "case_property": "referral_date",
        "commcare_data_type": "date",
        "external_data_type": "posix_milliseconds"
      },
      {
        "jsonpath": "comment",
        "case_property": "referral_comment"
      }
    ]
  }
}

"value": {"direction": "in" … tells MOTECH only to use this observation mapping for importing via the Atom feed.

“indexed_case_mapping” is for creating a subcase. “identifier” is the name of the index that links the subcase to its parent, and the value “parent” is convention in CommCare; unless there are very good reasons to use a different value, “parent” should always be used.

"case_type": "referral" gives us a clue about what this configuration is for. The set of possible values of the OpenMRS concept will be IDs of people, who OpenMRS/Bahmni users can choose to refer patients to. Those people will have corresponding mobile workers in CommCare. This observation mapping will need to map the people in OpenMRS to the mobile workers in CommCare.

"relationship": "extension" sets what kind of subcase to create. CommCare uses two kinds of subcase relationships: “child”; and “extension”. Extension cases are useful for referrals and diagnoses for two reasons: if the patient case is removed, CommCare will automatically remove its referrals and diagnoses; and mobile workers who have access to a patient case will also be able to see all their diagnoses and referrals.

The observation mapping sets four case properties:

case_name: This is set to the name of the person to whom the patient is being referred.
owner_id: This is the most important aspect of a referral system. “owner_id” is a special case property that sets the owner of the case. It must be set to a mobile worker’s ID. When this is done, that mobile worker will get the patient case sent to their device on the next sync.
referral_date: The date on which the OpenMRS observation was made.
comment: The comment, if any, given with the observation.

The configuration for each case property has a “jsonpath” setting to specify where to get the value from the JSON data of the observation given by the OpenMRS API. See How to Inspect an Observation or a Diagnosis below.

Inspecting the observation also helps us with a subtle and confusing setting:

{
  "jsonpath": "encounterDateTime",
  "case_property": "referral_date",
  "commcare_data_type": "date",
  "external_data_type": "posix_milliseconds"
},

The value for the “referral_date” case property comes from the observation’s “encounterDateTime” property. This property has the same name as the “encounterDateTime” property of the encounter. (We used it earlier under the “openmrs_start_datetime” setting to set the “last_clinic_visit_date” case property on the patient case.)

What is confusing is that “external_data_type” is set to “omrs_datetime” for encounter’s “encounterDateTime” property. But here, for the observation, “external_data_type” is set to “posix_milliseconds”. An “omrs_datetime” value looks like "2018-01-18T01:15:09.000+0530". But a “posix_milliseconds” value looks like 1516218309000

The only way to know that is to inspect the JSON data returned by the OpenMRS API.

The last part of the configuration deals with Bahmni diagnoses:

"bahmni_diagnoses": [
  {
    "doc_type": "ObservationMapping",
    "concept": "all",
    "value": {
      "direction": "in",
      "case_property": "[unused when direction = 'in']"
    },
    "case_property": null,
    "indexed_case_mapping": {
      "doc_type": "IndexedCaseMapping",
      "identifier": "parent",
      "case_type": "diagnosis",
      "relationship": "extension",
      "case_properties": [
        {
          "jsonpath": "codedAnswer.name",
          "case_property": "case_name"
        },
        {
          "jsonpath": "certainty",
          "case_property": "certainty"
        },
        {
          "jsonpath": "order",
          "case_property": "is_primary",
          "value_map": {
            "yes": "PRIMARY",
            "no": "SECONDARY"
          }
        },
        {
          "jsonpath": "diagnosisDateTime",
          "case_property": "diagnosis_datetime"
        }
      ]
    }
  }
]

At a glance, it is clear that like the configuration for referrals, this configuration also uses extension cases. There are a few important differences.

"concept": "all" tells MOTECH to import all Bahmni diagnosis concepts, not just those that are explicitly configured.

"value": {"direction": "in" … The OpenMRS API does not offer the ability to add or modify a diagnosis. “direction” will always be set to “in”.

The case type of the extension case is “diagnosis”. This configuration sets four case properties. “case_name” should be considered a mandatory case property. It is set to the name of the diagnosis. The value of “jsonpath” is determined by inspecting the JSON data of an example diagnosis. The next section gives instructions for how to do that. Follow the instructions, and as a useful exercise, try to see how the JSON path “codedAnswer.name” was determined from the sample JSON data of a Bahmni diagnosis given by the OpenMRS API.

How to Inspect an Observation or a Diagnosis 

To see what the JSON representation of an OpenMRS observation or Bahmni diagnosis is, you can use the official Bahmni demo server.

Log in as “superman” with the password “Admin123”.
Click “Registration” and register a patient.
Click the “home” button to return to the dashboard, and click “Clinical”.
Select your new patient, and create an observation or a diagnosis for them.
In a new browser tab or window, open the Encounter Atom feed.
Right-click and choose “View Page Source”.
Find the URL of the latest encounter in the “CDATA” value in the “content” tag. It will look similar to this: “/openmrs/ws/rest/v1/bahmnicore/bahmniencounter/<UUID>?includeAll=true”
Construct the full URL, e.g. “https://demo.mybahmni.org/openmrs/ws/rest/v1/bahmnicore/bahmniencounter/<UUID>?includeAll=true” where “<UUID>” is the UUID of the encounter.
The OpenMRS REST Web Services API does not make it easy to get a JSON-formatted response using a browser. You can use a REST API Client like Postman, or you can use a command line tool like curl or Wget.

Fetch the content with the “Accept” header set to “application/json”.

Using curl
```
$ curl -u superman:Admin123 -H "Accept: application/json" \
    "https://demo.mybahmni.org/...?includeAll=true" > encounter.json
```
Using wget
```
$ wget --user=superman --password=Admin123 \
    --header="Accept: application/json" \
    -O encounter.json \
    "https://demo.mybahmni.org/...?includeAll=true"
```
Open encounter.json in a text editor that can automatically format JSON for you. (Atom with the pretty-json package installed is not a bad choice.)