Description

The REMS Admin application is an app that acts as a REMS Administrator in the REMS workflow. It receives CDS Hooks calls of the type order-sign, order-select, patient-view and encounter-start and returns CARDS containing links to relevant information and SMART Links to launch SMART on FHIR Apps. These links launch applications for completing forms needed to register the Patient, Provider, and Pharmacy in the REMS program as well as other necessary forms. The application also contains a built-in FHIR Server. This FHIR Server contains the Questionnaires, Libraries, CQL, and all other FHIR Resources needed to launch the REMS SMART on FHIR App Questionnaires. There is also a FHIR operation used for querying the REMS ETASU status.

Getting Started with REMS Administrator

To get started, first clone the repository using a method that is most convenient for you. If using git, run the following command:

git clone https://github.com/mcode/rems-admin.git

The following technologies must be installed on your computer to continue:

• NPM
• Node

Initialization

After cloning the repository, the submodules must be initialized. Run the following command:

git submodule update --init

Next, install the required dependencies by running the following:

npm install

Running the Mongo DB instance

The REMS Administrator relies on MongoDB for it's backing database. Follow the mongodb setup instructions in the REMS End to End Setup Guide.

If you would rather run with docker, follow the setup found in the REMS Simple Setup Guide (this will also setup the other REMS applications in docker as well).

Available Scripts

In the project directory, you can run:

npm start

Runs the app in the development mode.
Open http://localhost:8090/cds-services to view the CDS Services discovery information in the browser.

You will also see any lint errors in the console.

npm test

Launches the test runner in the interactive watch mode.
See the section about running tests for more information.

Usage

The REMS Admin interacts with the Request Generator, REMS SMART on FHIR app, and an EHR. These apps are provided as part of the REMS ecosystem, but any individual part may be swapped out for something custom. The REMS Admin responds to CDS Hooks requests as well as FHIR operations for the questionnaire package ($questionnaire-package) and REMS ETASU check ($rems-etasu).

Typically, a CDS Hook will be sent from the EHR to the REMS Admin, which will respond with cards that contain information about next steps. These cards may contain a link to a SMART app. Clicking on these links in the Request Generator or REMS SMART on FHIR App acting as the EHR will launch the SMART app automatically. These links will contain information on the requirements that must be met for the REMS program. This includes forms for registration and acknowledgement of the risks involved.

The FHIR server built into the REMS Admin can be queried for the questionnaire package at the Questionnaire/$questionnaire-package endpoint. This will return a FHIR Bundle with the FHIR Questionnaire and all other FHIR Resources including CQL Libraries embedded within FHIR Libraries. The FHIR Server also contains a REMS ETASU check at the GuidanceResponse/$rems-etasu endpoint. This will return a FHIR Parameter containing a GuidanceResponse with the status of the ETASU and nested GuidanceResponse for each requirement.

Routes

• /cds-services - The base CDS Hooks Discovery endpoint that serves a list of supported hooks/services in JSON.
• /cds-services/rems-order-sign - The CDS Hooks endpoint for order-sign
• /cds-services/rems-order-select - The CDS Hooks endpoint for order-select
• /cds-services/rems-patient-view - The CDS Hooks endpoint for patient-view
• /cds-services/rems-encounter-start - The CDS Hooks endpoint for encounter-start
• `/4_0_0 - The base of the FHIR Server
• /4_0_0/GuidanceResponse/$rems-etasu - The endpoint for FHIR Operation used for checking the ETASU status
  • Input requires a parameter containing the following:
    • patient - Patient FHIR Resource, must include medication with patient
    • medication - Medication or MedicationRequest FHIR Resource, must include patient with medication
    • authNumber - String containing the REMS Authorization Number, may be sent without patient or medication
  • Returns a GuidanceResponse within a Parameter with the status
    • Contains Nested GuidanceResponse resources for each ETASU requirement with their status
• /4_0_0/Questionnaire/\<form-name\>/$questionnaire-package - The endpoint for the FHIR Operation used for retrieving the Questionnaire package for a given form
  • Example: /4_0_0/Questionnaire/TIRFRemsPatientEnrollment/$questionnaire-package
  • This includes the Questionnaire and any other necessary FHIR resources needed for loading the questionnaire form with the REMS SMART on FHIR app

Environment Variables

How To Override Defaults

The .env file contains the default URI paths, which can be overwritten from the start command as follows: a) REACT_APP_LAUNCH_URL=http://example.com PORT=6000 npm start or b) by specifying the environment variables and desired values in a .env.local.

Bug: Do note that the SMART_ENDPOINT environment variable cannot be overwritten in a .env.local, it must be done in the .env.

Following are a list of modifiable paths:

URI Name	Default	Description
AUTH_SERVER_URI	http://localhost:8090	The base url of the auth server, currently set to the base url of this app.
HTTPS_CERT_PATH	server.cert	Path to a certificate for encryption, allowing HTTPS. Unnecessary if using HTTP.
HTTPS_KEY_PATH	server.key	Path to a key for encryption, allowing HTTPS. Unnecessary if using HTTP.
LOGGING_LEVEL	debug	Amount to output in the log, can be changed to verbose, info, warn, or error.
MONGO_DB_NAME	remsadmin	Name of the database table being used. Should be changed if not using the Mongo instructions above.
MONGO_URL	mongodb://rems-user:pass@127.0.0.1:27017	URL for the connection to the database, should be changed if not using the Mongo instructions above.
PORT	8090	Port that this server should run on, change if there are conflicts with port usage.
RESOURCE_SERVER	http://localhost:8090	Base URL of this server, should match with port.
SMART_ENDPOINT	http://localhost:4040/launch	Launch URL of associated SMART app, should be changed if not using the REMS Smart App.
USE_HTTPS	false	Change to true to enable HTTPS. Ensure that HTTPS_CERT_PATH and HTTPS_KEY_PATH are valid.
VSAC_API_KEY	changeMe	Replace with VSAC API key for pulling down ValueSets. Request an API Key from the VSAC website
WHITELIST	http://localhost, http://localhost:3005	List of valid URLs for CORS. Should include any URLs the server accesses for resources.