fix(fhir): leave out the vital-signs DiagnosticReport when there are no vital signs

A window without a vital sign emitted the panel with result: [], which R4
rejects. The DiagnosticReport now goes out only when it has a result, and
the vital-signs section drops an empty entry list rather than sending one.

docs/api/openapi.yaml

@@ -1478,9 +1478,10 @@ paths:
       summary: FHIR R4 $everything (v1.11.0)
       description: "Read-only `Patient/$everything`: every resource the document bundle carries — Composition, Device,
         Patient, Coverage, Observations (including the cycle ones), MedicationStatements, MedicationAdministrations,
-        Conditions, Encounters, AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport — flattened into one
-        `searchset` Bundle. Scoped to the owner's SAVED report selection; an account that never saved one gets nothing.
-        Auth: `fhir:read` scope. Offset paging via `_count` (≤200) / `_offset`."
+        Conditions, Encounters, AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport (present when the
+        window holds a vital sign) — flattened into one `searchset` Bundle. Scoped to the owner's SAVED report
+        selection; an account that never saved one gets nothing. Auth: `fhir:read` scope. Offset paging via `_count`
+        (≤200) / `_offset`."
       parameters:
         - in: query
           name: _count

src/app/api/fhir/Patient/$everything/route.ts

@@ -5,7 +5,8 @@
  * the Composition, the authoring Device, Patient, Coverage, every Observation
  * (vitals / glucose / labs / adherence / mood / wellness AND the cycle set),
  * MedicationStatements, MedicationAdministrations, Conditions, Encounters,
- * AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport.
+ * AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport (present
+ * when the window holds a vital sign).
  *
  * The set is the document export's, flattened — same builder, same order, same
  * `urn:uuid` entry identities, so a reference between two resources still

src/lib/fhir/__tests__/build-bundle.test.ts

@@ -9,6 +9,7 @@ import type {
   FhirPatient,
   FhirCoverage,
   FhirDiagnosticReport,
+  FhirComposition,
 } from "../types";
 
 function administrationsOf(
@@ -1172,6 +1173,57 @@ describe("buildFhirDocumentBundle", () => {
     );
   });
 
+  it("emits no DiagnosticReport, and no empty array anywhere, when the window holds no vital sign", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({ measurements: {}, bmi: null }),
+      { insuranceNumber: null },
+      FIXED_NOW,
+    );
+    const types = bundle.entry.map((e) => e.resource.resourceType);
+    expect(types).not.toContain("DiagnosticReport");
+    const composition = bundle.entry[0].resource as FhirComposition;
+    const refs = (composition.section ?? []).flatMap((s) => s.entry ?? []);
+    for (const ref of refs) {
+      expect(refTarget(bundle, ref.reference)).not.toMatch(
+        /^DiagnosticReport\//,
+      );
+    }
+    // R4: an array element is absent, never empty.
+    const emptyArrays: string[] = [];
+    const walk = (value: unknown, path: string): void => {
+      if (Array.isArray(value)) {
+        if (value.length === 0) emptyArrays.push(path);
+        value.forEach((item, i) => walk(item, `${path}[${i}]`));
+      } else if (value && typeof value === "object") {
+        for (const [k, v] of Object.entries(value)) walk(v, `${path}.${k}`);
+      }
+    };
+    walk(bundle, "Bundle");
+    expect(emptyArrays).toEqual([]);
+  });
+
+  it("leaves the vital-signs section without `entry` when it has nothing to list", () => {
+    const bundle = buildFhirDocumentBundle(
+      makeData({
+        measurements: {},
+        bmi: null,
+        glucoseStats: {},
+        compliance: {},
+        medications: [],
+        mood: null,
+        labResults: [],
+      } as Partial<DoctorReportData>),
+      { insuranceNumber: null },
+      FIXED_NOW,
+    );
+    const composition = bundle.entry[0].resource as FhirComposition;
+    const vitals = composition.section?.find((s) => s.title === "Vital signs");
+    expect(vitals?.text?.div).toBeTruthy();
+    expect(
+      vitals && "entry" in vitals ? vitals.entry : undefined,
+    ).toBeUndefined();
+  });
+
   it("appends a DiagnosticReport as the LAST entry routing all Observation refs", () => {
     const bundle = buildFhirDocumentBundle(
       makeData(),

src/lib/fhir/build-bundle.ts

@@ -328,31 +328,39 @@ export function buildFhirDocumentBundle(
       : []),
   ].join(" ");
 
-  const diagnosticReport: FhirDiagnosticReport = {
-    resourceType: "DiagnosticReport",
-    id: "diagnostic-report-1",
-    status: "final",
-    code: {
-      coding: [
-        {
-          system: LOINC_SYSTEM,
-          code: "85353-1",
-          display:
-            "Vital signs, weight, height, head circumference, oxygen saturation and BMI panel",
-        },
-      ],
-      text: "Vital signs panel",
-    },
-    subject: patientRef,
-    effectivePeriod: { start: data.period.start, end: data.period.end },
-    // A vital-signs panel reports vital signs. Routing labs, adherence rates
-    // and survey scores through it would let a receiver read a questionnaire
-    // total as a vital sign because the panel code said so.
-    result: vitalSignsObservationRefs,
-  };
-  const diagnosticReportRef: FhirReference = {
-    reference: `DiagnosticReport/${diagnosticReport.id}`,
-  };
+  // A vital-signs panel with no vital signs reports nothing, and R4 forbids
+  // the empty `result: []` it would otherwise carry. With no vital-sign
+  // Observation in the window the DiagnosticReport is left out entirely,
+  // together with its Composition entry.
+  const diagnosticReport: FhirDiagnosticReport | null =
+    vitalSignsObservationRefs.length === 0
+      ? null
+      : {
+          resourceType: "DiagnosticReport",
+          id: "diagnostic-report-1",
+          status: "final",
+          code: {
+            coding: [
+              {
+                system: LOINC_SYSTEM,
+                code: "85353-1",
+                display:
+                  "Vital signs, weight, height, head circumference, oxygen saturation and BMI panel",
+              },
+            ],
+            text: "Vital signs panel",
+          },
+          subject: patientRef,
+          effectivePeriod: { start: data.period.start, end: data.period.end },
+          // A vital-signs panel reports vital signs. Routing labs, adherence rates
+          // and survey scores through it would let a receiver read a questionnaire
+          // total as a vital sign because the panel code said so.
+          result: vitalSignsObservationRefs,
+        };
+  const diagnosticReportRefs: FhirReference[] = diagnosticReport
+    ? [{ reference: `DiagnosticReport/${diagnosticReport.id}` }]
+    : [];
+  const vitalSignsEntries = [...observationRefs, ...diagnosticReportRefs];
 
   const composition: FhirComposition = {
     resourceType: "Composition",
@@ -390,7 +398,9 @@ export function buildFhirDocumentBundle(
           status: "generated",
           div: `<div xmlns="http://www.w3.org/1999/xhtml">${escapeXml(narrativeText)}</div>`,
         },
-        entry: [...observationRefs, diagnosticReportRef],
+        // `entry` is omitted rather than empty; the section still carries
+        // its narrative, which satisfies `cmp-2`.
+        ...(vitalSignsEntries.length > 0 ? { entry: vitalSignsEntries } : {}),
       },
       // Medications section carries both the active-medication
       // statements and the per-dose administration records (v1.9.0).
@@ -479,11 +489,13 @@ export function buildFhirDocumentBundle(
   };
 
   // The Composition must be the FIRST entry in a document Bundle; the
-  // DiagnosticReport is the LAST.
+  // DiagnosticReport, when there is one, is the LAST.
   const orderedEntries: FhirBundleEntry[] = [
     { fullUrl: `urn:uuid:${randomUUID()}`, resource: composition },
     ...entries,
-    { fullUrl: `urn:uuid:${randomUUID()}`, resource: diagnosticReport },
+    ...(diagnosticReport
+      ? [{ fullUrl: `urn:uuid:${randomUUID()}`, resource: diagnosticReport }]
+      : []),
   ];
 
   // Every entry identity is known only now, so the reference rewrite runs once

src/lib/openapi/routes/health-record.ts

@@ -647,7 +647,7 @@ export const healthRecordPaths: NonNullable<ZodOpenApiObject["paths"]> = {
       tags: ["FHIR"],
       summary: "FHIR R4 $everything (v1.11.0)",
       description:
-        "Read-only `Patient/$everything`: every resource the document bundle carries — Composition, Device, Patient, Coverage, Observations (including the cycle ones), MedicationStatements, MedicationAdministrations, Conditions, Encounters, AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport — flattened into one `searchset` Bundle. Scoped to the owner's SAVED report selection; an account that never saved one gets nothing. Auth: `fhir:read` scope. Offset paging via `_count` (≤200) / `_offset`.",
+        "Read-only `Patient/$everything`: every resource the document bundle carries — Composition, Device, Patient, Coverage, Observations (including the cycle ones), MedicationStatements, MedicationAdministrations, Conditions, Encounters, AllergyIntolerances, FamilyMemberHistories and the DiagnosticReport (present when the window holds a vital sign) — flattened into one `searchset` Bundle. Scoped to the owner's SAVED report selection; an account that never saved one gets nothing. Auth: `fhir:read` scope. Offset paging via `_count` (≤200) / `_offset`.",
       requestParams: {
         query: z.object({
           _count: z.coerce.number().optional(),