feat: mark data/url fields inside DocRef attachments as absent

When we strip the data & url fields from DocumentReferences, we previously just deleted the fields and moved on. But in order to be able to do some QA analysis on whether those fields were provided in the first place, it's nice to have a record of them. So whenever we delete those fields, we also now leave a data-absent extension in place with the value "masked".
smart-on-fhir · Nov 7, 2024 · 4b782f2 · 4b782f2
1 parent 352ab34
commit 4b782f2
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Showing 6 changed files with 104 additions and 15 deletions.
diff --git a/cumulus_etl/deid/scrubber.py b/cumulus_etl/deid/scrubber.py
@@ -23,6 +23,10 @@ class SkipValue(Exception):
     pass
 
 
+class MaskValue(SkipValue):
+    pass
+
+
 class Scrubber:
     """
     Manages de-identification for FHIR resources.
@@ -160,6 +164,9 @@ def _scrub_node(
                             inside_extension=inside_extension,
                         )
                     )
+                except MaskValue:
+                    # TODO: (not needed yet) support masking values inside array fields
+                    self._add_data_absent_extension(node, f"_{key}")
                 except SkipValue:
                     pass
 
@@ -224,6 +231,24 @@ def _print_extension_table(self, title: str, table: ExtensionCount) -> None:
             indented = rich.padding.Padding.indent(tree, 1)
             rich.get_console().print(indented)
 
+    def _add_data_absent_extension(self, node: dict, parent: str) -> None:
+        element = node.setdefault(parent, {})
+        extensions = element.setdefault("extension", [])
+
+        # Check if the value is already marked as absent for any reason - leave it in place.
+        # (though that would be weird, since the field was present or we wouldn't be in this path)
+        for extension in extensions:
+            if extension.get("url") == "http://hl7.org/fhir/StructureDefinition/data-absent-reason":
+                return
+
+        # See https://hl7.org/fhir/extensions/StructureDefinition-data-absent-reason.html
+        extensions.append(
+            {
+                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                "valueCode": "masked",
+            }
+        )
+
     ###############################################################################
     #
     # Individual checkers
@@ -402,7 +427,7 @@ def _check_attachments(resource_type: str, node_path: str, key: str, value: Any)
             and node_path == "root.content.attachment"
             and key in {"data", "url"}
         ):
-            raise SkipValue
+            raise MaskValue
 
         return value
 

diff --git a/tests/data/i2b2/output/documentreference/documentreference.000.ndjson b/tests/data/i2b2/output/documentreference/documentreference.000.ndjson
@@ -1,2 +1,2 @@
-{"resourceType":"DocumentReference","id":"228b982ddae20b8da26a212666995acde914b941a4ff7c314adf89d02c3831f0","subject":{"reference":"Patient\/26f4d6d38eaa3347b8bd22bb4bc66ecbff5384926152738d282e841a247bfefb"},"context":{"encounter":[{"reference":"Encounter\/5388b42b262276bfbcb659b1ff937b0e3e5b0ec8901ed3ad53fa387fd6f2589f"}],"period":{"start":"2021-06-23","end":"2021-06-24"}},"type":{"coding":[{"code":"NOTE:149798455","system":"http:\/\/cumulus.smarthealthit.org\/i2b2","display":"Admission MD"}]},"status":"current","content":[{"attachment":{"contentType":"text\/plain"}}]}
-{"resourceType":"DocumentReference","id":"dfc45702900136d5fb09b8737853f5c727132882bd6ba0871942685c0b1df588","subject":{"reference":"Patient\/49fbb06b4b49eb49a096cf2a96674fb84a4d52ee74ec25c8f6f26023cb4764a7"},"context":{"encounter":[{"reference":"Encounter\/fb29ea2a68ca2e1e4bbe22bdeedf021d94ec89f7e3d38ecbe908a8f2b3d89687"}],"period":{"start":"2021-06-24","end":"2021-06-25"}},"type":{"coding":[{"code":"NOTE:149798455","system":"http:\/\/cumulus.smarthealthit.org\/i2b2","display":"Admission MD"}]},"status":"current","content":[{"attachment":{"contentType":"text\/plain"}}]}
+{"resourceType": "DocumentReference", "id": "228b982ddae20b8da26a212666995acde914b941a4ff7c314adf89d02c3831f0", "subject": {"reference": "Patient/26f4d6d38eaa3347b8bd22bb4bc66ecbff5384926152738d282e841a247bfefb"}, "context": {"encounter": [{"reference": "Encounter/5388b42b262276bfbcb659b1ff937b0e3e5b0ec8901ed3ad53fa387fd6f2589f"}], "period": {"start": "2021-06-23", "end": "2021-06-24"}}, "type": {"coding": [{"code": "NOTE:149798455", "system": "http://cumulus.smarthealthit.org/i2b2", "display": "Admission MD"}]}, "status": "current", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}]}
+{"resourceType": "DocumentReference", "id": "dfc45702900136d5fb09b8737853f5c727132882bd6ba0871942685c0b1df588", "subject": {"reference": "Patient/49fbb06b4b49eb49a096cf2a96674fb84a4d52ee74ec25c8f6f26023cb4764a7"}, "context": {"encounter": [{"reference": "Encounter/fb29ea2a68ca2e1e4bbe22bdeedf021d94ec89f7e3d38ecbe908a8f2b3d89687"}], "period": {"start": "2021-06-24", "end": "2021-06-25"}}, "type": {"coding": [{"code": "NOTE:149798455", "system": "http://cumulus.smarthealthit.org/i2b2", "display": "Admission MD"}]}, "status": "current", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}]}
diff --git a/tests/data/simple/batched-output/documentreference/documentreference.000.ndjson b/tests/data/simple/batched-output/documentreference/documentreference.000.ndjson
@@ -1 +1 @@
-{"id":"f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/d30aad4b-4503-8e22-0bc4-621b94398520"}],"period":{"end":"2021-06-24","start":"2021-06-23"}},"status":"current","subject":{"reference":"Patient\/118dc10e-7745-20d7-e98d-7c358a84c15c"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
+{"resourceType": "DocumentReference", "id": "f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/d30aad4b-4503-8e22-0bc4-621b94398520"}], "period": {"end": "2021-06-24", "start": "2021-06-23"}}, "status": "current", "subject": {"reference": "Patient/118dc10e-7745-20d7-e98d-7c358a84c15c"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}
diff --git a/tests/data/simple/batched-output/documentreference/documentreference.001.ndjson b/tests/data/simple/batched-output/documentreference/documentreference.001.ndjson
@@ -1 +1 @@
-{"id":"c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}],"period":{"end":"2021-06-25","start":"2021-06-24"}},"status":"current","subject":{"reference":"Patient\/1de9ea66-70d3-da1f-c735-df5ef7697fb9"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
+{"resourceType": "DocumentReference", "id": "c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}], "period": {"end": "2021-06-25", "start": "2021-06-24"}}, "status": "current", "subject": {"reference": "Patient/1de9ea66-70d3-da1f-c735-df5ef7697fb9"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}
diff --git a/tests/data/simple/output/documentreference/documentreference.000.ndjson b/tests/data/simple/output/documentreference/documentreference.000.ndjson
@@ -1,2 +1,2 @@
-{"id":"f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/d30aad4b-4503-8e22-0bc4-621b94398520"}],"period":{"end":"2021-06-24","start":"2021-06-23"}},"status":"current","subject":{"reference":"Patient\/118dc10e-7745-20d7-e98d-7c358a84c15c"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
-{"id":"c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}],"period":{"end":"2021-06-25","start":"2021-06-24"}},"status":"current","subject":{"reference":"Patient\/1de9ea66-70d3-da1f-c735-df5ef7697fb9"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
+{"resourceType": "DocumentReference", "id": "f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/d30aad4b-4503-8e22-0bc4-621b94398520"}], "period": {"end": "2021-06-24", "start": "2021-06-23"}}, "status": "current", "subject": {"reference": "Patient/118dc10e-7745-20d7-e98d-7c358a84c15c"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}
+{"resourceType": "DocumentReference", "id": "c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}], "period": {"end": "2021-06-25", "start": "2021-06-24"}}, "status": "current", "subject": {"reference": "Patient/1de9ea66-70d3-da1f-c735-df5ef7697fb9"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}
diff --git a/tests/deid/test_deid_scrubber.py b/tests/deid/test_deid_scrubber.py
@@ -58,13 +58,36 @@ def test_condition(self):
 
     def test_documentreference(self):
         """Test DocumentReference, which is interesting because of its list of encounters and attachments"""
-        docref = i2b2_mock_data.documentreference()
-        self.assertEqual("345", docref["id"])
-        self.assertEqual("Patient/12345", docref["subject"]["reference"])
-        self.assertEqual(1, len(docref["context"]["encounter"]))
-        self.assertEqual("Encounter/67890", docref["context"]["encounter"][0]["reference"])
-        self.assertEqual(1, len(docref["content"]))
-        self.assertIsNotNone(docref["content"][0]["attachment"]["data"])
+        docref = {
+            "resourceType": "DocumentReference",
+            "id": "345",
+            "subject": {"reference": "Patient/12345"},
+            "context": {
+                "encounter": [{"reference": "Encounter/67890"}],
+            },
+            "content": [
+                {
+                    "attachment": {
+                        "data": "aGVsbG8gd29ybGQ=",
+                        "url": "https://example.com/hello-world",
+                    },
+                },
+                {
+                    "attachment": {
+                        "data": "xxx",
+                        "_data": {
+                            "extension": [
+                                {
+                                    "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                                    "valueCode": "error",
+                                }
+                            ],
+                        },
+                        "url": "https://example.com/hello-world",
+                    },
+                },
+            ],
+        }
 
         scrubber = Scrubber()
         self.assertTrue(scrubber.scrub_resource(docref))
@@ -77,7 +100,48 @@ def test_documentreference(self):
             docref["context"]["encounter"][0]["reference"],
             f"Encounter/{scrubber.codebook.fake_id('Encounter', '67890')}",
         )
-        self.assertNotIn("data", docref["content"][0]["attachment"])
+        self.assertEqual(
+            docref["content"][0]["attachment"],
+            {
+                "_data": {
+                    "extension": [
+                        {
+                            "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                            "valueCode": "masked",
+                        }
+                    ]
+                },
+                "_url": {
+                    "extension": [
+                        {
+                            "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                            "valueCode": "masked",
+                        }
+                    ]
+                },
+            },
+        )
+        self.assertEqual(
+            docref["content"][1]["attachment"],
+            {
+                "_data": {
+                    "extension": [
+                        {
+                            "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                            "valueCode": "error",  # we left this reason in place
+                        }
+                    ]
+                },
+                "_url": {
+                    "extension": [
+                        {
+                            "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
+                            "valueCode": "masked",
+                        }
+                    ]
+                },
+            },
+        )
 
     def test_contained_reference(self):
         """Verify that we leave contained references contained but scrubbed"""
Original file line number	Diff line number	Diff line change
		@@ -1 +1 @@
		{"id":"f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/d30aad4b-4503-8e22-0bc4-621b94398520"}],"period":{"end":"2021-06-24","start":"2021-06-23"}},"status":"current","subject":{"reference":"Patient\/118dc10e-7745-20d7-e98d-7c358a84c15c"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
		{"resourceType": "DocumentReference", "id": "f29736c29af5b962b3947fd40bed6b8c3e97c642b72aaa08e082fec05148e7dd", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/d30aad4b-4503-8e22-0bc4-621b94398520"}], "period": {"end": "2021-06-24", "start": "2021-06-23"}}, "status": "current", "subject": {"reference": "Patient/118dc10e-7745-20d7-e98d-7c358a84c15c"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}
Original file line number	Diff line number	Diff line change
		@@ -1 +1 @@
		{"id":"c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971","content":[{"attachment":{"contentType":"text\/plain"}}],"context":{"encounter":[{"reference":"Encounter\/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}],"period":{"end":"2021-06-25","start":"2021-06-24"}},"status":"current","subject":{"reference":"Patient\/1de9ea66-70d3-da1f-c735-df5ef7697fb9"},"type":{"coding":[{"code":"NOTE:149798455","display":"Admission MD","system":"http:\/\/cumulus.smarthealthit.org\/i2b2"}]},"resourceType":"DocumentReference"}
		{"resourceType": "DocumentReference", "id": "c601849ceffe49dba22ee952533ac87928cd7a472dee6d0390d53c9130519971", "content": [{"attachment": {"contentType": "text/plain", "_data": {"extension": [{"url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason", "valueCode": "masked"}]}}}], "context": {"encounter": [{"reference": "Encounter/af1e6186-3f9a-1fa9-3c73-cfa56c84a056"}], "period": {"end": "2021-06-25", "start": "2021-06-24"}}, "status": "current", "subject": {"reference": "Patient/1de9ea66-70d3-da1f-c735-df5ef7697fb9"}, "type": {"coding": [{"code": "NOTE:149798455", "display": "Admission MD", "system": "http://cumulus.smarthealthit.org/i2b2"}]}}