Specialities on encounters

src/main/java/org/mitre/synthea/engine/State.java

@@ -835,6 +835,7 @@ public static class Encounter extends State {
     private List<Code> codes;
     private String reason;
     private String telemedicinePossibility;
+    private String specialty;
 
     @Override
     public Encounter clone() {
@@ -1008,7 +1009,7 @@ private void renewChronicMedicationsAtWellness(Person person, long time) {
         Provider medicationProvider = person.getCurrentProvider(module.name);
         if (medicationProvider == null) {
           // no provider associated with encounter or medication order
-          medicationProvider = person.getProvider(EncounterType.WELLNESS, time);
+          medicationProvider = person.getProvider(EncounterType.WELLNESS, null, time);
         }
         int year = Utilities.getYear(time);
         medicationProvider.incrementPrescriptions(year);
@@ -1386,7 +1387,7 @@ public boolean process(Person person, long time) {
       Provider medicationProvider = person.getCurrentProvider(module.name);
       if (medicationProvider == null) {
         // no provider associated with encounter or medication order
-        medicationProvider = person.getProvider(EncounterType.WELLNESS, time);
+        medicationProvider = person.getProvider(EncounterType.WELLNESS, null, time);
       }
 
       int year = Utilities.getYear(time);
@@ -1641,7 +1642,7 @@ public void processOnce(Person person, long time) {
       if (person.getCurrentProvider(module.name) != null) {
         provider = person.getCurrentProvider(module.name);
       } else { // no provider associated with encounter or procedure
-        provider = person.getProvider(EncounterType.WELLNESS, time);
+        provider = person.getProvider(EncounterType.WELLNESS, null, time);
       }
       int year = Utilities.getYear(time);
       provider.incrementProcedures(year);
@@ -1957,7 +1958,7 @@ public boolean process(Person person, long time) {
       if (person.getCurrentProvider(module.name) != null) {
         provider = person.getCurrentProvider(module.name);
       } else { // no provider associated with encounter or procedure
-        provider = person.getProvider(EncounterType.WELLNESS, time);
+        provider = person.getProvider(EncounterType.WELLNESS, null, time);
       }
       int year = Utilities.getYear(time);
       provider.incrementLabs(year);

src/main/java/org/mitre/synthea/export/CCDAExporter.java

@@ -13,6 +13,7 @@
 import org.mitre.synthea.helpers.RandomNumberGenerator;
 
 import org.mitre.synthea.world.agents.Person;
+import org.mitre.synthea.world.concepts.HealthRecord;
 import org.mitre.synthea.world.concepts.HealthRecord.Encounter;
 import org.mitre.synthea.world.concepts.HealthRecord.Observation;
 import org.mitre.synthea.world.concepts.RaceAndEthnicity;
@@ -138,7 +139,7 @@ public static String export(Person person, long time) {
     person.attributes.put("ethnicity_display_lookup",
         RaceAndEthnicity.LOOK_UP_CDC_ETHNICITY_DISPLAY);
 
-    if (person.attributes.get(Person.PREFERREDYPROVIDER + "wellness") == null) {
+    if (person.preferredProviders.getWellnessProvider() == null) {
       // This person does not have a preferred provider. This happens for veterans at age 20 due to
       // the provider reset and they don't have a provider until their next wellness visit. There
       // may be other cases. This ensures the preferred provider is there for the CCDA template
@@ -148,7 +149,8 @@ public static String export(Person person, long time) {
         encounter = person.record.encounters.get(person.record.encounters.size() - 1);
       }
       if (encounter != null) {
-        person.attributes.put(Person.PREFERREDYPROVIDER + "wellness", encounter.provider);
+        person.preferredProviders.forceRelationship(HealthRecord.EncounterType.WELLNESS, null,
+            encounter.provider);
       } else {
         throw new IllegalStateException(String.format("Unable to export to CCDA because "
             + "person %s %s has no preferred provider.",
@@ -157,6 +159,8 @@ public static String export(Person person, long time) {
       }
     }
 
+    person.attributes.put("wellness_provider", person.preferredProviders.getWellnessProvider());
+
     StringWriter writer = new StringWriter();
     try {
       Template template = TEMPLATES.getTemplate("ccda.ftl");

src/main/java/org/mitre/synthea/export/CDWExporter.java

@@ -463,7 +463,7 @@ public void export(Person person, long time) throws IOException {
       return;
     }
     int primarySta3n = -1;
-    Provider provider = person.getProvider(EncounterType.WELLNESS, time);
+    Provider provider = person.getProvider(EncounterType.WELLNESS, null, time);
     if (provider != null) {
       String state = Location.getStateName(provider.state);
       String tz = Location.getTimezoneByState(state);
@@ -1647,4 +1647,4 @@ private static void write(String line, OutputStreamWriter writer) throws IOExcep
       writer.flush();
     }
   }
-}
+}

src/main/java/org/mitre/synthea/export/FhirDstu2.java

@@ -559,7 +559,7 @@ private static Entry encounter(Person person, Entry personEntry,
     Provider provider = encounter.provider;
     if (provider == null) {
       // no associated provider, patient goes to wellness provider
-      provider = person.getProvider(EncounterType.WELLNESS, encounter.start);
+      provider = person.getProvider(EncounterType.WELLNESS, null, encounter.start);
     }
     if (TRANSACTION_BUNDLE) {
       encounterResource.setServiceProvider(new ResourceReferenceDt(
@@ -1866,4 +1866,4 @@ private static Entry newEntry(Bundle bundle, BaseResource resource,
 
     return entry;
   }
-}
+}

src/main/java/org/mitre/synthea/export/FhirR4.java

@@ -935,7 +935,7 @@ private static BundleEntryComponent encounter(Person person, BundleEntryComponen
     Provider provider = encounter.provider;
     if (provider == null) {
       // no associated provider, patient goes to wellness provider
-      provider = person.getProvider(EncounterType.WELLNESS, encounter.start);
+      provider = person.getProvider(EncounterType.WELLNESS, null, encounter.start);
     }
 
     if (TRANSACTION_BUNDLE) {
@@ -2176,7 +2176,7 @@ private static BundleEntryComponent provenance(Bundle bundle, Person person, lon
     }
 
     if (clinician == null && providerOrganization == null) {
-      providerOrganization = person.getProvider(EncounterType.WELLNESS, stopTime);
+      providerOrganization = person.getProvider(EncounterType.WELLNESS, null, stopTime);
       clinician =
           providerOrganization.chooseClinicianList(ClinicianSpecialty.GENERAL_PRACTICE, person);
     } else if (clinician == null || providerOrganization == null) {
@@ -2186,7 +2186,7 @@ private static BundleEntryComponent provenance(Bundle bundle, Person person, lon
       } else if (clinician != null && providerOrganization == null) {
         providerOrganization = clinician.getOrganization();
         if (providerOrganization == null) {
-          providerOrganization = person.getProvider(EncounterType.WELLNESS, stopTime);
+          providerOrganization = person.getProvider(EncounterType.WELLNESS, null, stopTime);
         }
       }
     }

src/main/java/org/mitre/synthea/export/FhirStu3.java

@@ -689,7 +689,7 @@ private static BundleEntryComponent encounter(Person person, BundleEntryComponen
     Provider provider = encounter.provider;
     if (provider == null) {
       // no associated provider, patient goes to wellness provider
-      provider = person.getProvider(EncounterType.WELLNESS, encounter.start);
+      provider = person.getProvider(EncounterType.WELLNESS, null, encounter.start);
     }
 
     if (TRANSACTION_BUNDLE) {
@@ -2707,4 +2707,4 @@ private static BundleEntryComponent newEntry(Bundle bundle, Resource resource,
 
     return entry;
   }
-}
+}

src/main/java/org/mitre/synthea/modules/EncounterModule.java

@@ -152,13 +152,7 @@ public static Encounter createEncounter(Person person, long time, EncounterType
       encounter.codes.add(code);
     }
     // assign a provider organization
-    Provider prov = null;
-    if (specialty.equalsIgnoreCase(ClinicianSpecialty.CARDIOLOGY)) {
-      // Get the first provider in the list that was loaded
-      prov = Provider.getProviderList().get(0);
-    } else {
-      prov = person.getProvider(type, time);
-    }
+    Provider prov = person.getProvider(type, specialty, time);
     prov.incrementEncounters(type, year);
     encounter.provider = prov;
     // assign a clinician

src/main/java/org/mitre/synthea/modules/LifecycleModule.java

@@ -322,9 +322,7 @@ private static boolean age(Person person, long time) {
           if (person.attributes.get("veteran_provider_reset") == null) {
             // reset providers for veterans, they'll switch to VA facilities
             person.attributes.remove(Person.CURRENTPROVIDER);
-            for (EncounterType type : EncounterType.values()) {
-              person.attributes.remove(Person.PREFERREDYPROVIDER + type);
-            }
+
             person.attributes.put("veteran_provider_reset", true);
           }
         }

src/main/java/org/mitre/synthea/world/agents/Person.java

@@ -36,6 +36,7 @@
 import org.mitre.synthea.world.concepts.HealthRecord.Code;
 import org.mitre.synthea.world.concepts.HealthRecord.Encounter;
 import org.mitre.synthea.world.concepts.HealthRecord.EncounterType;
+import org.mitre.synthea.world.concepts.PreferredProviders;
 import org.mitre.synthea.world.concepts.VitalSign;
 import org.mitre.synthea.world.concepts.healthinsurance.CoverageRecord;
 import org.mitre.synthea.world.concepts.healthinsurance.InsurancePlan;
@@ -158,7 +159,9 @@ public class Person implements Serializable, RandomNumberGenerator, QuadTreeElem
   /** History of the currently active module. */
   public List<State> history;
   /** Record of insurance coverage. */
-  public final CoverageRecord coverage;
+  public CoverageRecord coverage;
+  /** A place to maintain preferred providers by encounter type and specialty. */
+  public PreferredProviders preferredProviders;
 
   /**
    * Person constructor.
@@ -178,6 +181,7 @@ public Person(long seed) {
     }
     this.initializeDefaultHealthRecords();
     coverage = new CoverageRecord(this);
+    preferredProviders = new PreferredProviders();
   }
 
   /**
@@ -553,7 +557,7 @@ public boolean hadPriorState(String name, String since, Long within) {
    */
   public Encounter encounterStart(long time, EncounterType type) {
     // Set the record for the current provider as active
-    Provider provider = getProvider(type, time);
+    Provider provider = getProvider(type, null, time);
     record = getHealthRecord(provider, time);
     // Start the encounter
     return record.encounterStart(time, type);
@@ -643,57 +647,24 @@ public boolean reserveCurrentEncounter(long time, String module) {
 
   // Providers API -----------------------------------------------------------
   public static final String CURRENTPROVIDER = "currentProvider";
-  public static final String PREFERREDYPROVIDER = "preferredProvider";
 
   /**
    * Get the preferred provider for the specified encounter type. If none is set the
    * provider at the specified time as the preferred provider for this encounter type.
    */
-  public Provider getProvider(EncounterType type, long time) {
-    String key = PREFERREDYPROVIDER + type;
-    if (!attributes.containsKey(key)) {
-      setProvider(type, time);
-    } else {
-      Entity entity = (Entity) attributes.get(ENTITY);
-      // check to see if this is a fixed identity
-      if (entity != null) {
-        Provider provider = (Provider) attributes.get(key);
-        HealthRecord healthRecord = getHealthRecord(provider, time);
-        long lastEncounterTime = healthRecord.lastEncounterTime();
-        // check to see if the provider is valid for this see range
-        if (lastEncounterTime != Long.MIN_VALUE
-            && !entity.seedAt(time).getPeriod().contains(lastEncounterTime)) {
-          // The provider is not in the seed range. Force finding a new provider.
-          System.out.println("Move reset for " + type);
-          setProvider(type, time);
-        }
-      }
+  public Provider getProvider(EncounterType type, String speciality, long time) {
+    if (!preferredProviders.doesRelationshipExist(type, speciality)) {
+      setProvider(type, speciality, time);
     }
-    return (Provider) attributes.get(key);
-  }
-
-  /**
-   * Set the preferred provider for the specified encounter type.
-   */
-  public void setProvider(EncounterType type, Provider provider) {
-    if (provider == null) {
-      throw new RuntimeException("Unable to find provider: " + type);
-    }
-    String key = PREFERREDYPROVIDER + type;
-    attributes.put(key, provider);
+    return preferredProviders.get(type, speciality);
   }
 
   /**
    * Set the preferred provider for the specified encounter type to be the provider
    * at the specified time.
    */
-  public void setProvider(EncounterType type, long time) {
-    Provider provider = Provider.findService(this, type, time);
-    if (provider == null && Provider.USE_HOSPITAL_AS_DEFAULT) {
-      // Default to Hospital
-      provider = Provider.findService(this, EncounterType.INPATIENT, time);
-    }
-    setProvider(type, provider);
+  public void setProvider(EncounterType type, String specialty, long time) {
+    preferredProviders.startNewRelationship(this, type, specialty, time);
   }
 
   /**

src/main/java/org/mitre/synthea/world/agents/Provider.java

@@ -188,6 +188,14 @@ public boolean hasService(EncounterType service) {
     return servicesProvided.contains(service);
   }
 
+  public boolean hasSpecialty(String specialty) {
+    return clinicianMap.get(specialty) != null;
+  }
+
+  public boolean canOffer(EncounterType type, String specialty) {
+    return (type == null || hasService(type)) && (specialty == null || hasSpecialty(specialty));
+  }
+
   public void incrementEncounters(EncounterType service, int year) {
     increment(year, ENCOUNTERS);
     increment(year, ENCOUNTERS + "-" + service);
@@ -271,17 +279,19 @@ public double getRevenue() {
    * Find specific service provider for the given person.
    * @param person The patient who requires the service.
    * @param service The service required. For example, EncounterType.AMBULATORY.
+   * @param specialty the ClinicianSpecialty required. May be null.
    * @param time The date/time within the simulated world, in milliseconds.
    * @return Service provider or null if none is available.
    */
-  public static Provider findService(Person person, EncounterType service, long time) {
+  public static Provider findService(Person person, EncounterType service, String specialty,
+                                     long time) {
     double maxDistance = MAX_PROVIDER_SEARCH_DISTANCE;
     double degrees = 0.125;
     List<Provider> options = null;
     Provider provider = null;
     while (degrees <= maxDistance) {
       options = findProvidersByLocation(person, degrees);
-      provider = providerFinder.find(options, person, service, time);
+      provider = providerFinder.find(options, person, service, specialty, time);
       if (provider != null) {
         return provider;
       }
@@ -301,7 +311,7 @@ public static Provider findServiceNewProvider(Person person, EncounterType servi
     Provider provider = null;
     while (degrees <= maxDistance) {
       options = findNewProvidersByLocation(person, degrees, takenIds);
-      provider = providerFinder.find(options, person, service, time);
+      provider = providerFinder.find(options, person, service, null, time);
       if (provider != null && !takenIds.contains(provider.uuid)) {
         return provider;
       }
@@ -484,8 +494,9 @@ public static void loadProviders(Location location, String filename,
 
         parsed.location = location;
 
-        if (row.get("hasSpecialties") == null
-            || row.get("hasSpecialties").equalsIgnoreCase("false")) {
+        String aSpecialty = ClinicianSpecialty.getSpecialties()[0];
+
+        if (row.get(aSpecialty) == null) {
           parsed.clinicianMap.put(ClinicianSpecialty.GENERAL_PRACTICE,
               parsed.generateClinicianList(1, ClinicianSpecialty.GENERAL_PRACTICE,
                   random));

src/main/java/org/mitre/synthea/world/agents/behaviors/providerfinder/IProviderFinder.java

@@ -15,8 +15,10 @@ public interface IProviderFinder {
    * @param providers The list of eligible providers.
    * @param person The patient who requires the service.
    * @param service The service required. For example, EncounterType.AMBULATORY.
+   * @param specialty The specialty required. For example, ClinicianSpecialty.INFECTIOUS_DISEASE
    * @param time The date/time within the simulated world, in milliseconds.
    * @return Service provider or null if none is available.
    */
-  public Provider find(List<Provider> providers, Person person, EncounterType service, long time);
-}
+  Provider find(List<Provider> providers, Person person, EncounterType service, String specialty,
+                long time);
+}

src/main/java/org/mitre/synthea/world/agents/behaviors/providerfinder/ProviderFinderNearest.java

@@ -15,15 +15,14 @@
 public class ProviderFinderNearest implements IProviderFinder {
 
   @Override
-  public Provider find(List<Provider> providers, Person person, EncounterType service, long time) {
+  public Provider find(List<Provider> providers, Person person, EncounterType service,
+                       String specialty, long time) {
     Stream<Provider> options = providers.stream()
         // Find providers that accept the person
         .filter(p -> p.accepts(person, time));
 
-    // Find providers with the requested service, if one is given
-    if (service != null) {
-      options = options.filter(p -> p.hasService(service));
-    }
+    // Find providers with the requested service and specialties, if given
+    options = options.filter(p -> p.canOffer(service, specialty));
 
     // If it's not an emergency
     if (service == null
@@ -53,4 +52,4 @@ public Provider find(List<Provider> providers, Person person, EncounterType serv
       return null;
     }
   }
-}
+}

src/main/java/org/mitre/synthea/world/agents/behaviors/providerfinder/ProviderFinderNearestMedicare.java

@@ -14,14 +14,15 @@
 public class ProviderFinderNearestMedicare implements IProviderFinder {
 
   @Override
-  public Provider find(List<Provider> providers, Person person, EncounterType service, long time) {
+  public Provider find(List<Provider> providers, Person person, EncounterType service,
+                       String specialty, long time) {
     Stream<Provider> options = providers.stream()
         // Find providers that accept the person
         .filter(p -> p.accepts(person, time));
 
     // Find providers with the requested service, if one is given
     if (service != null) {
-      options = options.filter(p -> p.hasService(service));
+      options = options.filter(p -> p.canOffer(service, specialty));
     }
 
     // Filter to only Medicare providers...