test/medical_transcription/coding_test.exs

defmodule Medicode.CodingTest do
  use Medicode.DataCase

  import Medicode.AccountsFixtures
  import Medicode.TranscriptionChunksFixtures

  alias Medicode.Coding
  alias Medicode.Coding.CodeVector
  alias Medicode.Feedback.CodeFeedback

  def create_code_vector!(code, description) do
    description_vector = Coding.compute_vector_as_list(description)

    changeset =
      CodeVector.changeset(%CodeVector{}, %{
        code: code,
        description: description,
        description_vector: description_vector
      })

    Repo.insert!(changeset)
  end

  def create_code_feedback!(text, response, for_code) do
    user = user_fixture()
    code_vector = Repo.one(from v in CodeVector, where: v.code == ^for_code)
    text_vector = Coding.compute_vector_as_list(text)

    changeset =
      CodeFeedback.changeset(%CodeFeedback{}, %{
        user_id: user.id,
        text: text,
        text_vector: text_vector,
        response: response,
        code_vector_id: code_vector.id
      })

    Repo.insert!(changeset)
  end

  describe "process_chunk/2" do
    @input_text "This 55-year-old man with known coronary artery disease comes for a follow-up visit today."
    @feedback_text "A 42-year-old man arrived for a return check-up who had a past history of coronary artery disease."

    setup do
      create_code_vector!("74685", "Coronary artery anomaly")
      create_code_vector!("41412", "Dissection of coronary artery")
      create_code_vector!("V717", "Observation for suspected cardiovascular disease")
      create_code_vector!("V812", "Screening for other and unspecified cardiovascular conditions")
      create_code_vector!("V4589", "Other postprocedural status")

      input_chunk = transcription_chunk_fixture(%{text: @input_text})
      feedback_chunk = transcription_chunk_fixture(%{text: @feedback_text})

      {:ok, input_chunk: input_chunk, feedback_chunk: feedback_chunk}
    end

    test "Codes can be weighted multiple times when multiple prior feedback items exist for a single code",
         %{input_chunk: chunk} do
      # One negative feedback item moves the code from 1st to 4th (x0.9).
      # The net result of 2 negative and 1 positive (x0.891) is to remove the code from the results.
      create_code_feedback!(@feedback_text, false, "74685")
      create_code_feedback!(@feedback_text, true, "74685")
      create_code_feedback!(@feedback_text, false, "74685")
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["41412", "V717", "V812"]
      assert Enum.all?(results, &(&1.weighting == [:none]))
    end

    test "Weighting can cause codes to appear in results that wouldn't have been included from the initial similarity query",
         %{input_chunk: chunk} do
      # E.g. weighting up a code that isn't in the initial results
      create_code_feedback!(@feedback_text, true, "V4589")
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["74685", "41412", "V717", "V812", "V4589"]

      assert Enum.map(results, & &1.weighting) == [
               [:none],
               [:none],
               [:none],
               [:none],
               [:positive]
             ]
    end

    test "Codes are unweighted when no prior feedback", %{input_chunk: chunk} do
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["74685", "41412", "V717", "V812"]
      assert Enum.all?(results, &(&1.weighting == [:none]))
    end

    test "Code is ranked higher when prior positive feedback", %{input_chunk: chunk} do
      create_code_feedback!(@feedback_text, true, "V717")
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["V717", "74685", "41412", "V812"]
      assert Enum.map(results, & &1.weighting) == [[:positive], [:none], [:none], [:none]]
    end

    test "Code is ranked lower when prior negative feedback", %{input_chunk: chunk} do
      create_code_feedback!(@feedback_text, false, "74685")
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["41412", "V717", "V812", "74685"]
      assert Enum.map(results, & &1.weighting) == [[:none], [:none], [:none], [:negative]]
    end

    test "Code with low similarity score is removed from result when prior negative feedback", %{
      input_chunk: chunk
    } do
      create_code_feedback!(@feedback_text, false, "V717")
      results = Coding.process_chunk(chunk)

      assert Enum.map(results, & &1.code) == ["74685", "41412", "V812"]
      assert Enum.map(results, & &1.weighting) == [[:none], [:none], [:none]]
    end
  end
end