feature: PHI Column Encryption + Access Logging

VigilCareClinicalAPI/Services/PatientService.cs

@@ -65,7 +65,10 @@ public class PatientService : IPatientService
             AuditAction.PatientRegistered,
             "Patient",
             patient.Id,
-            newValue: new { patient.Mrn, patient.FirstName, patient.LastName });
+            newValue: new { patient.Mrn });
+
+        var path = _http.HttpContext?.Request.Path.Value ?? "/api/v1/patients";
+        await _phiAccess.LogCreateAsync(patient.Id, path);
 
         return patient;
     }
@@ -84,10 +87,20 @@ public class PatientService : IPatientService
 
         if (!string.IsNullOrWhiteSpace(q))
         {
-            query = query.Where(p =>
-                p.Mrn == q ||
-                EF.Functions.ILike(p.FirstName, $"%{q}%") ||
-                EF.Functions.ILike(p.LastName, $"%{q}%"));
+            var parts = q.Trim().Split(' ', 2, StringSplitOptions.RemoveEmptyEntries);
+            if (parts.Length == 2)
+            {
+                var token = _crypto.ComputeNameSearchToken(parts[0], parts[1]);
+                query = query.Where(p => p.Mrn == q || p.NameSearchToken == token);
+            }
+            else
+            {
+                query = query.Where(p =>
+                    p.Mrn == q ||
+                    (p.NameSearchToken != null &&
+                     (p.NameSearchToken == _crypto.ComputeNameSearchToken(q, "") ||
+                      p.NameSearchToken == _crypto.ComputeNameSearchToken("", q))));
+            }
         }
 
         var total = await query.CountAsync();
@@ -97,6 +110,12 @@ public class PatientService : IPatientService
             .Take(pageSize)
             .ToListAsync();
 
+        var path = _http.HttpContext?.Request.Path.Value ?? "/api/v1/patients";
+        await _phiAccess.LogListAsync(path, patients.Count, q);
+
+        foreach (var p in patients)
+            await _phiAccess.LogViewAsync(p.Id, $"{path}?page={page}");
+
         return new PagedResult<Patient>(patients, page, pageSize, total);
     }
 
@@ -121,6 +140,9 @@ public class PatientService : IPatientService
         if (req.EmergencyContactName is not null) patient.EmergencyContactName = req.EmergencyContactName;
         if (req.EmergencyContactPhone is not null) patient.EmergencyContactPhone = req.EmergencyContactPhone;
 
+        if (req.FirstName is not null || req.LastName is not null)
+            SetNameSearchToken(patient);
+
         await _db.SaveChangesAsync();
 
         await _audit.WriteAsync(
@@ -135,6 +157,9 @@ public class PatientService : IPatientService
                 patient.EmergencyContactName, patient.EmergencyContactPhone
             });
 
+        var path = _http.HttpContext?.Request.Path.Value ?? $"/api/v1/patients/{id}";
+        await _phiAccess.LogUpdateAsync(patient.Id, path);
+
         return patient;
     }
 
@@ -147,6 +172,9 @@ public class PatientService : IPatientService
         if (patient is null)
             throw new NotFoundException("Patient not found.", "PATIENT_NOT_FOUND");
 
+        var path = _http.HttpContext?.Request.Path.Value ?? $"/api/v1/patients/{id}";
+        await _phiAccess.LogViewAsync(patient.Id, path);
+
         return patient;
     }
 
@@ -213,6 +241,8 @@ public class PatientService : IPatientService
         var existingId = await _identifiers.ResolveInternalIdAsync(
             ExternalResourceType.Patient, req.IdentifierSystem, req.IdentifierValue);
 
+        var fhirPath = _http.HttpContext?.Request.Path.Value ?? "/fhir/R4/Patient";
+
         if (existingId.HasValue)
         {
             var patient = await _db.Patients.FindAsync(existingId.Value)
@@ -226,12 +256,13 @@ public class PatientService : IPatientService
             patient.Allergies = req.Allergies;
             patient.EmergencyContactName = req.EmergencyContactName;
             patient.EmergencyContactPhone = req.EmergencyContactPhone;
+            SetNameSearchToken(patient);
 
             await _db.SaveChangesAsync();
+            await _phiAccess.LogUpdateAsync(patient.Id, fhirPath);
             return patient;
         }
 
-        // Use hospital identifier value as MRN when it fits the column constraint (max 20 chars).
         var mrn = req.IdentifierValue.Length <= 20
             ? req.IdentifierValue
             : await GenerateMrnAsync();
@@ -250,6 +281,7 @@ public class PatientService : IPatientService
             EmergencyContactPhone = req.EmergencyContactPhone,
             CreatedAt = DateTimeOffset.UtcNow
         };
+        SetNameSearchToken(newPatient);
 
         _db.Patients.Add(newPatient);
         await _db.SaveChangesAsync();
@@ -260,6 +292,7 @@ public class PatientService : IPatientService
             req.IdentifierSystem,
             req.IdentifierValue);
 
+        await _phiAccess.LogCreateAsync(newPatient.Id, fhirPath);
         return newPatient;
     }
 

VigilCareClinicalAPI/Services/PhiAccessLogService.cs

@@ -8,17 +8,20 @@ public class PhiAccessLogService : IPhiAccessLogService
     private readonly ICurrentUserService _currentUser;
     private readonly IHttpContextAccessor _http;
     private readonly PhiEncryptionOptions _options;
+    private readonly ClinicalMetrics _metrics;
 
     public PhiAccessLogService(
         AppDbContext db,
         ICurrentUserService currentUser,
         IHttpContextAccessor http,
-        IOptions<PhiEncryptionOptions> options)
+        IOptions<PhiEncryptionOptions> options,
+        ClinicalMetrics metrics)
     {
         _db = db;
         _currentUser = currentUser;
         _http = http;
         _options = options.Value;
+        _metrics = metrics;
     }
 
     public async Task LogViewAsync(Guid patientId, string resourcePath) =>
@@ -68,6 +71,8 @@ public class PhiAccessLogService : IPhiAccessLogService
         });
 
         await _db.SaveChangesAsync();
+
+        _metrics.PhiAccessLogsTotal.WithLabels(accessType.ToDbString()).Inc();
     }
 
     private static string HashQuery(string query)