feature: Reconciliation Jobs
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voltsrage
@@ -0,0 +1,391 @@
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using System.Net.Http.Json;
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using System.Text.Json;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class ReconciliationTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private readonly HttpClient _http;
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public ReconciliationTests(ApiFixture fixture)
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{
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_fixture = fixture;
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_http = fixture.CreateClient();
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}
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public Task InitializeAsync() => Task.CompletedTask;
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public Task DisposeAsync() => Task.CompletedTask;
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// -------------------------------------------------------------------------
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// Check 1 — Unacknowledged critical alerts
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// -------------------------------------------------------------------------
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[Fact]
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public async Task Check1_StaleCriticalAlert_CreatesReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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var alertId = await IngestCriticalPotassiumAsync(encounterId);
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using (var scope = _fixture.Services.CreateScope())
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{
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.FindAsync(alertId);
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alert!.TriggeredAt = DateTimeOffset.UtcNow.AddMinutes(-31);
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await db.SaveChangesAsync();
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}
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<UnacknowledgedAlertsCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.Equal(1, count);
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using var verifyScope = _fixture.Services.CreateScope();
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var verifyDb = verifyScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var rec = await verifyDb.ReconciliationAlerts
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.FirstOrDefaultAsync(r => r.CheckType == UnacknowledgedAlertsCheck.CheckType
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&& r.EncounterId == encounterId
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&& r.ResolvedAt == null);
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Assert.NotNull(rec);
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Assert.Contains(alertId.ToString(), rec!.Details);
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}
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[Fact]
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public async Task Check1_AcknowledgedAlert_DoesNotCreateReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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var alertId = await IngestCriticalPotassiumAsync(encounterId);
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var ackResp = await _http.PostAsJsonAsync(
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$"/api/v1/alerts/{alertId}/acknowledge",
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new AcknowledgeAlertRequest("Dr. Mensah", "Reviewed."));
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ackResp.EnsureSuccessStatusCode();
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using (var scope = _fixture.Services.CreateScope())
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{
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.FindAsync(alertId);
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alert!.TriggeredAt = DateTimeOffset.UtcNow.AddMinutes(-31);
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await db.SaveChangesAsync();
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}
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<UnacknowledgedAlertsCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.Equal(0, count);
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}
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[Fact]
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public async Task Check1_SecondRun_DoesNotInsertDuplicate()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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await IngestCriticalPotassiumAsync(encounterId);
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using (var scope = _fixture.Services.CreateScope())
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{
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.FirstAsync(a => a.EncounterId == encounterId);
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alert.TriggeredAt = DateTimeOffset.UtcNow.AddMinutes(-31);
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await db.SaveChangesAsync();
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}
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await using (var s = _fixture.Services.CreateAsyncScope())
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{
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var c = s.ServiceProvider.GetRequiredService<UnacknowledgedAlertsCheck>();
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await c.RunAsync(CancellationToken.None);
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}
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int secondCount;
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await using (var s = _fixture.Services.CreateAsyncScope())
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{
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var c = s.ServiceProvider.GetRequiredService<UnacknowledgedAlertsCheck>();
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secondCount = await c.RunAsync(CancellationToken.None);
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}
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Assert.Equal(0, secondCount);
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}
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// -------------------------------------------------------------------------
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// Check 2 — Pending orders without results
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// -------------------------------------------------------------------------
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[Fact]
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public async Task Check2_StalePendingOrder_CreatesReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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using (var scope = _fixture.Services.CreateScope())
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{
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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db.Orders.Add(new Order
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{
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Id = Guid.NewGuid(),
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EncounterId = encounterId,
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OrderType = OrderType.Lab,
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Description = "Comprehensive metabolic panel",
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OrderedBy = "Dr. Osei",
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Status = OrderStatus.Pending,
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OrderedAt = DateTimeOffset.UtcNow.AddHours(-5),
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ResultedAt = null,
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});
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await db.SaveChangesAsync();
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}
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<PendingOrdersCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.True(count >= 1);
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using var verifyScope = _fixture.Services.CreateScope();
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var db2 = verifyScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var rec = await db2.ReconciliationAlerts
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.FirstOrDefaultAsync(r => r.CheckType == PendingOrdersCheck.CheckType
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&& r.EncounterId == encounterId
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&& r.ResolvedAt == null);
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Assert.NotNull(rec);
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Assert.Contains("Comprehensive metabolic panel", rec!.Details);
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}
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[Fact]
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public async Task Check2_ResultedOrder_DoesNotCreateReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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using (var scope = _fixture.Services.CreateScope())
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{
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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db.Orders.Add(new Order
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{
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Id = Guid.NewGuid(),
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EncounterId = encounterId,
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OrderType = OrderType.Lab,
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Description = "CBC",
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OrderedBy = "Dr. Osei",
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Status = OrderStatus.Resulted,
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OrderedAt = DateTimeOffset.UtcNow.AddHours(-5),
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ResultedAt = DateTimeOffset.UtcNow.AddHours(-4),
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});
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await db.SaveChangesAsync();
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}
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<PendingOrdersCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.Equal(0, count);
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}
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// -------------------------------------------------------------------------
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// Check 3 — Active inpatient without recent observations
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// -------------------------------------------------------------------------
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[Fact]
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public async Task Check3_ActiveInpatientNoObservations_CreatesReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<DisconnectedMonitorsCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.True(count >= 1);
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using var verifyScope = _fixture.Services.CreateScope();
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var db = verifyScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var rec = await db.ReconciliationAlerts
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.FirstOrDefaultAsync(r => r.CheckType == DisconnectedMonitorsCheck.CheckType
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&& r.EncounterId == encounterId
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&& r.ResolvedAt == null);
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Assert.NotNull(rec);
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Assert.Contains("no observations ever recorded", rec!.Details);
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}
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[Fact]
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public async Task Check3_ActiveInpatientStaleObservation_CreatesReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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var ingestResp = await _http.PostAsJsonAsync(
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$"/api/v1/encounters/{encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 72, "bpm", ObservationSource.Device,
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DateTimeOffset.UtcNow.AddHours(-3), null),
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}));
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ingestResp.EnsureSuccessStatusCode();
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<DisconnectedMonitorsCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.True(count >= 1);
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using var verifyScope = _fixture.Services.CreateScope();
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var db = verifyScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var rec = await db.ReconciliationAlerts
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.FirstOrDefaultAsync(r => r.CheckType == DisconnectedMonitorsCheck.CheckType
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&& r.EncounterId == encounterId
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&& r.ResolvedAt == null);
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Assert.NotNull(rec);
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}
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[Fact]
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public async Task Check3_RecentObservation_DoesNotCreateReconciliationAlert()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var encounterId = await CreateActiveEncounterAsync(patientId);
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var ingestResp = await _http.PostAsJsonAsync(
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$"/api/v1/encounters/{encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 72, "bpm", ObservationSource.Device,
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DateTimeOffset.UtcNow.AddMinutes(-30), null),
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}));
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ingestResp.EnsureSuccessStatusCode();
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<DisconnectedMonitorsCheck>();
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var count = await check.RunAsync(CancellationToken.None);
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Assert.Equal(0, count);
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}
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[Fact]
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public async Task Check3_OutpatientEncounter_IsIgnored()
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{
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await PrepareAsync();
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var patientId = await CreatePatientAsync();
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var resp = await _http.PostAsJsonAsync(
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$"/api/v1/patients/{patientId}/encounters",
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new OpenEncounterRequest(EncounterType.Outpatient, Department.GeneralMedicine, "Dr. Osei"));
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resp.EnsureSuccessStatusCode();
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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var encounterId = body!.RootElement.GetProperty("data").GetProperty("id").GetGuid();
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await using var checkScope = _fixture.Services.CreateAsyncScope();
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var check = checkScope.ServiceProvider.GetRequiredService<DisconnectedMonitorsCheck>();
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await check.RunAsync(CancellationToken.None);
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using var verifyScope = _fixture.Services.CreateScope();
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var db = verifyScope.ServiceProvider.GetRequiredService<AppDbContext>();
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var rec = await db.ReconciliationAlerts
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.FirstOrDefaultAsync(r => r.CheckType == DisconnectedMonitorsCheck.CheckType
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&& r.EncounterId == encounterId);
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Assert.Null(rec);
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}
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// -------------------------------------------------------------------------
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// Helpers
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// -------------------------------------------------------------------------
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private async Task PrepareAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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db.AlertThresholds.AddRange(
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new AlertThreshold
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{
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Id = Guid.NewGuid(),
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ObservationCode = "POTASSIUM_MEQ_L",
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DisplayName = "Serum Potassium",
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Unit = "mEq/L",
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CriticalLow = 2.5m,
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WarningLow = 3.5m,
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WarningHigh = 5.0m,
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CriticalHigh = 6.5m,
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CreatedAt = DateTimeOffset.UtcNow,
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},
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new AlertThreshold
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{
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Id = Guid.NewGuid(),
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ObservationCode = "HEART_RATE",
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DisplayName = "Heart Rate",
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Unit = "bpm",
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CriticalLow = 30,
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WarningLow = 50,
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WarningHigh = 100,
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CriticalHigh = 150,
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CreatedAt = DateTimeOffset.UtcNow,
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});
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await db.SaveChangesAsync();
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase(1);
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await cache.StringSetAsync(
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"threshold:POTASSIUM_MEQ_L",
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"""{"ObservationCode":"POTASSIUM_MEQ_L","CriticalLow":2.5,"WarningLow":3.5,"WarningHigh":5.0,"CriticalHigh":6.5}""");
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await cache.StringSetAsync(
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"threshold:HEART_RATE",
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"""{"ObservationCode":"HEART_RATE","CriticalLow":30,"WarningLow":50,"WarningHigh":100,"CriticalHigh":150}""");
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}
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private async Task<Guid> CreatePatientAsync()
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{
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var resp = await _http.PostAsJsonAsync(
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"/api/v1/patients",
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new RegisterPatientRequest("Reconciliation", "Test", new DateOnly(1970, 6, 1), "Other"));
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resp.EnsureSuccessStatusCode();
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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return body!.RootElement.GetProperty("data").GetProperty("id").GetGuid();
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}
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private async Task<Guid> CreateActiveEncounterAsync(Guid patientId)
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{
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var resp = await _http.PostAsJsonAsync(
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$"/api/v1/patients/{patientId}/encounters",
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new OpenEncounterRequest(EncounterType.Inpatient, Department.Icu, "Dr. Osei"));
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resp.EnsureSuccessStatusCode();
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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return body!.RootElement.GetProperty("data").GetProperty("id").GetGuid();
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}
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private async Task<Guid> IngestCriticalPotassiumAsync(Guid encounterId)
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{
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var ingestResp = await _http.PostAsJsonAsync(
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$"/api/v1/encounters/{encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("POTASSIUM_MEQ_L", 2.1m, "mEq/L", ObservationSource.Device,
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DateTimeOffset.UtcNow, null),
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}));
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ingestResp.EnsureSuccessStatusCode();
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var body = await ingestResp.Content.ReadFromJsonAsync<JsonDocument>();
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return body!.RootElement.GetProperty("data").GetProperty("alertId").GetGuid();
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}
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}
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