feature: Reconciliation Jobs

2026-06-17 14:36:10 +08:00
parent 56d052aa4f
commit 101040f9d9
40 changed files with 2845 additions and 32 deletions
@@ -0,0 +1,96 @@
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.Options;
+
+public sealed class DisconnectedMonitorsCheck
+{
+    public static readonly ReconciliationCheckType CheckType = ReconciliationCheckType.ActiveInpatientNoObservation;
+
+    private readonly AppDbContext _db;
+    private readonly ReconciliationPublisher _publisher;
+    private readonly ReconciliationJobOptions _opts;
+    private readonly ILogger<DisconnectedMonitorsCheck> _logger;
+
+    public DisconnectedMonitorsCheck(
+        AppDbContext db,
+        ReconciliationPublisher publisher,
+        IOptions<ReconciliationJobOptions> opts,
+        ILogger<DisconnectedMonitorsCheck> logger)
+    {
+        _db        = db;
+        _publisher = publisher;
+        _opts      = opts.Value;
+        _logger    = logger;
+    }
+
+    public async Task<int> RunAsync(CancellationToken ct)
+    {
+        var cutoff = DateTimeOffset.UtcNow
+            .AddHours(-_opts.NoObservationThresholdHours);
+
+        // Limitation: this check detects absence of recorded observations, not absence
+        // of actual clinical monitoring. A nurse who took manual vitals but did not
+        // enter them into the system would still trigger a reconciliation alert.
+        // This is a known gap; the check errs on the side of false positives.
+        var candidates = await _db.Encounters
+            .Where(e => e.Status       == EncounterStatus.Active
+                     && e.EncounterType == EncounterType.Inpatient)
+            .Select(e => new
+            {
+                EncounterId       = e.Id,
+                e.PatientId,
+                LastObservationAt = e.Observations
+                    .OrderByDescending(o => o.RecordedAt)
+                    .Select(o => (DateTimeOffset?)o.RecordedAt)
+                    .FirstOrDefault(),
+            })
+            .ToListAsync(ct);
+
+        var stale = candidates
+            .Where(e => e.LastObservationAt == null || e.LastObservationAt < cutoff)
+            .ToList();
+
+        if (!stale.Any())
+        {
+            _logger.LogDebug("[RECONCILIATION] Check3 — all active inpatients have recent observations");
+            return 0;
+        }
+
+        var inserted = 0;
+        foreach (var enc in stale)
+        {
+            var alreadyOpen = await _db.ReconciliationAlerts
+                .AnyAsync(r => r.CheckType   == CheckType
+                            && r.EncounterId == enc.EncounterId
+                            && r.ResolvedAt  == null, ct);
+            if (alreadyOpen) continue;
+
+            var lastObs = enc.LastObservationAt.HasValue
+                ? $"last observation {enc.LastObservationAt:u}"
+                : "no observations ever recorded";
+            var details = $"Active inpatient encounter {enc.EncounterId} has no recent observations "
+                        + $"({lastObs}). Monitor may be disconnected.";
+
+            var rec = new ReconciliationAlert
+            {
+                Id          = Guid.NewGuid(),
+                CheckType   = CheckType,  // ReconciliationCheckType enum
+                EncounterId = enc.EncounterId,
+                PatientId   = enc.PatientId,
+                Details     = details,
+                CreatedAt   = DateTimeOffset.UtcNow,
+            };
+
+            _db.ReconciliationAlerts.Add(rec);
+            await _db.SaveChangesAsync(ct);
+            await _publisher.PublishAsync(rec, ct);
+
+            _logger.LogWarning(
+                "[RECONCILIATION] {CheckType} — encounter {EncounterId}: {LastObs}",
+                CheckType, enc.EncounterId, lastObs);
+
+            inserted++;
+        }
+
+        return inserted;
+    }
+}