feature: Medication Tracking & Vital Sign Correlation

2026-06-19 10:47:55 +08:00
parent e2d40331b7
commit 5c7e37471b
29 changed files with 2512 additions and 4 deletions
@@ -11,6 +11,7 @@ public static class DbResetHelper
            try
            {
                await db.Database.ExecuteSqlRawAsync(@"
+                    DELETE FROM medication_administrations;
                    DELETE FROM sepsis_bundle_elements;
                    DELETE FROM sepsis_bundles;
                    DELETE FROM reconciliation_alerts;
@@ -0,0 +1,195 @@
+using FluentAssertions;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.DependencyInjection;
+using StackExchange.Redis;
+
+[Collection("Integration")]
+public class MedicationCorrelationTests : IAsyncLifetime
+{
+    private readonly ApiFixture _fixture;
+    private Guid _patientId;
+    private Guid _encounterId;
+
+    public MedicationCorrelationTests(ApiFixture fixture) => _fixture = fixture;
+
+    public async Task InitializeAsync() => await ResetAndSeedAsync();
+
+    public Task DisposeAsync() => Task.CompletedTask;
+
+    private async Task ResetAndSeedAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        await DbResetHelper.ResetAsync(db);
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(), Mrn = "MRN-CORR-001", FirstName = "Correlation", LastName = "Test",
+            DateOfBirth = new DateOnly(1970, 6, 10), Gender = "M", CreatedAt = DateTimeOffset.UtcNow
+        };
+        var encounter = new Encounter
+        {
+            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
+            Status = EncounterStatus.Active, Department = Department.Icu,
+            AttendingPhysician = "Dr. Correlation", AdmittedAt = DateTimeOffset.UtcNow,
+            CreatedAt = DateTimeOffset.UtcNow
+        };
+        db.Patients.Add(patient);
+        db.Encounters.Add(encounter);
+
+        db.AlertThresholds.Add(new AlertThreshold
+        {
+            Id = Guid.NewGuid(), ObservationCode = "SYSTOLIC_BP",
+            DisplayName = "Systolic BP", Unit = "mmHg",
+            CriticalLow = 70, WarningLow = 90, WarningHigh = 180, CriticalHigh = 220,
+            CreatedAt = DateTimeOffset.UtcNow
+        });
+        db.AlertThresholds.Add(new AlertThreshold
+        {
+            Id = Guid.NewGuid(), ObservationCode = "RESP_RATE",
+            DisplayName = "Respiratory Rate", Unit = "breaths/min",
+            CriticalLow = 5, WarningLow = 8, WarningHigh = 25, CriticalHigh = 35,
+            CreatedAt = DateTimeOffset.UtcNow
+        });
+        await db.SaveChangesAsync();
+
+        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
+        var cache = redis.GetDatabase(1);
+        await cache.StringSetAsync("threshold:SYSTOLIC_BP",
+            """{"ObservationCode":"SYSTOLIC_BP","CriticalLow":70,"WarningLow":90,"WarningHigh":180,"CriticalHigh":220}""");
+        await cache.StringSetAsync("threshold:RESP_RATE",
+            """{"ObservationCode":"RESP_RATE","CriticalLow":5,"WarningLow":8,"WarningHigh":25,"CriticalHigh":35}""");
+
+        _patientId = patient.Id;
+        _encounterId = encounter.Id;
+    }
+
+    [Fact]
+    public async Task MetoprololThenLowBp_AnnotatedDetails()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+        await medService.CreateAsync(_encounterId,
+            new CreateMedicationAdministrationRequest(
+                "metoprolol", 25m, "mg", "PO",
+                DateTimeOffset.UtcNow.AddMinutes(-45), "nurse-1"));
+
+        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
+        var created = await evaluator.EvaluateAsync(
+            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
+
+        created.Should().BeTrue();
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var alert = await db.ClinicalAlerts
+            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
+        alert.Details.Should().Contain("metoprolol");
+        alert.Details.Should().Contain("min ago");
+        alert.Details.Should().Contain("note:");
+    }
+
+    [Fact]
+    public async Task LowBpWithoutMedication_Unannotated()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
+        var created = await evaluator.EvaluateAsync(
+            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
+
+        created.Should().BeTrue();
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var alert = await db.ClinicalAlerts
+            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
+        alert.Details.Should().NotContain("note:");
+    }
+
+    [Fact]
+    public async Task UnrelatedDrug_NoAnnotation()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+        // Insulin maps to GLUCOSE_MG_DL, not SYSTOLIC_BP
+        await medService.CreateAsync(_encounterId,
+            new CreateMedicationAdministrationRequest(
+                "insulin", 10m, "units", "SubQ",
+                DateTimeOffset.UtcNow.AddMinutes(-30), "nurse-1"));
+
+        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
+        var created = await evaluator.EvaluateAsync(
+            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
+
+        created.Should().BeTrue();
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var alert = await db.ClinicalAlerts
+            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
+        alert.Details.Should().NotContain("note:");
+        alert.Details.Should().NotContain("insulin");
+    }
+
+    [Fact]
+    public async Task MedicationOutsideWindow_NoAnnotation()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        // Metoprolol administered 2 hours ago — outside 90-min window
+        db.MedicationAdministrations.Add(new MedicationAdministration
+        {
+            Id = Guid.NewGuid(),
+            EncounterId = _encounterId,
+            DrugName = "metoprolol",
+            Dose = 25m,
+            DoseUnit = "mg",
+            Route = "PO",
+            AdministeredAt = DateTimeOffset.UtcNow.AddMinutes(-120),
+            AdministeredBy = "nurse-1"
+        });
+        await db.SaveChangesAsync();
+
+        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
+        var created = await evaluator.EvaluateAsync(
+            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
+
+        created.Should().BeTrue();
+
+        var alert = await db.ClinicalAlerts
+            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
+        alert.Details.Should().NotContain("note:");
+        alert.Details.Should().NotContain("metoprolol");
+    }
+
+    [Fact]
+    public async Task MorphineThenLowRespRate_Annotated()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+        await medService.CreateAsync(_encounterId,
+            new CreateMedicationAdministrationRequest(
+                "morphine", 4m, "mg", "IV",
+                DateTimeOffset.UtcNow.AddMinutes(-20), "nurse-1"));
+
+        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
+        var created = await evaluator.EvaluateAsync(
+            Guid.NewGuid(), _encounterId, _patientId, "RESP_RATE", 7m);
+
+        created.Should().BeTrue();
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var alert = await db.ClinicalAlerts
+            .SingleAsync(a => a.AlertType == AlertType.WarningRespRate);
+        alert.Details.Should().Contain("morphine");
+        alert.Details.Should().Contain("min ago");
+        alert.Details.Should().Contain("note:");
+    }
+}
@@ -0,0 +1,154 @@
+using FluentAssertions;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.DependencyInjection;
+
+[Collection("Integration")]
+public class MedicationServiceTests : IAsyncLifetime
+{
+    private readonly ApiFixture _fixture;
+    private Guid _patientId;
+    private Guid _activeEncounterId;
+    private Guid _dischargedEncounterId;
+
+    public MedicationServiceTests(ApiFixture fixture) => _fixture = fixture;
+
+    public async Task InitializeAsync() => await ResetAndSeedAsync();
+
+    public Task DisposeAsync() => Task.CompletedTask;
+
+    private async Task ResetAndSeedAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        await DbResetHelper.ResetAsync(db);
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(), Mrn = "MRN-MED-001", FirstName = "Med", LastName = "Test",
+            DateOfBirth = new DateOnly(1980, 3, 15), Gender = "F", CreatedAt = DateTimeOffset.UtcNow
+        };
+        var activeEncounter = new Encounter
+        {
+            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
+            Status = EncounterStatus.Active, Department = Department.Icu,
+            AttendingPhysician = "Dr. Medication", AdmittedAt = DateTimeOffset.UtcNow,
+            CreatedAt = DateTimeOffset.UtcNow
+        };
+        var dischargedEncounter = new Encounter
+        {
+            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
+            Status = EncounterStatus.Discharged, Department = Department.Icu,
+            AttendingPhysician = "Dr. Medication", AdmittedAt = DateTimeOffset.UtcNow.AddDays(-3),
+            DischargedAt = DateTimeOffset.UtcNow.AddHours(-1),
+            CreatedAt = DateTimeOffset.UtcNow
+        };
+        db.Patients.Add(patient);
+        db.Encounters.Add(activeEncounter);
+        db.Encounters.Add(dischargedEncounter);
+        await db.SaveChangesAsync();
+
+        _patientId = patient.Id;
+        _activeEncounterId = activeEncounter.Id;
+        _dischargedEncounterId = dischargedEncounter.Id;
+    }
+
+    [Fact]
+    public async Task Create_OnActiveEncounter_Succeeds()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var service = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+
+        var med = await service.CreateAsync(_activeEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "metoprolol", 25m, "mg", "PO", null, "nurse-1"));
+
+        med.Should().NotBeNull();
+        med.DrugName.Should().Be("metoprolol");
+        med.Dose.Should().Be(25m);
+        med.DoseUnit.Should().Be("mg");
+        med.Route.Should().Be("PO");
+        med.EncounterId.Should().Be(_activeEncounterId);
+
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var persisted = await db.MedicationAdministrations.FindAsync(med.Id);
+        persisted.Should().NotBeNull();
+    }
+
+    [Fact]
+    public async Task Create_OnDischargedEncounter_ThrowsConflict()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var service = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+
+        var act = () => service.CreateAsync(_dischargedEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "metoprolol", 25m, "mg", "PO", null, "nurse-1"));
+
+        await act.Should().ThrowAsync<ConflictException>();
+    }
+
+    [Fact]
+    public async Task ListByEncounter_ReturnsPaginated()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var service = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+
+        await service.CreateAsync(_activeEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "metoprolol", 25m, "mg", "PO", null, "nurse-1"));
+        await service.CreateAsync(_activeEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "morphine", 4m, "mg", "IV", null, "nurse-2"));
+        await service.CreateAsync(_activeEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "insulin", 10m, "units", "SubQ", null, "nurse-1"));
+
+        var result = await service.ListByEncounterAsync(_activeEncounterId, null, 1, 2);
+
+        result.TotalCount.Should().Be(3);
+        result.Items.Should().HaveCount(2);
+        result.TotalPages.Should().Be(2);
+    }
+
+    [Fact]
+    public async Task GetRecentForEncounter_FiltersByWindow()
+    {
+        await ResetAndSeedAsync();
+
+        using var scope = _fixture.Services.CreateScope();
+        var service = scope.ServiceProvider.GetRequiredService<IMedicationService>();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        // Recent metoprolol — within 90-min window
+        await service.CreateAsync(_activeEncounterId,
+            new CreateMedicationAdministrationRequest(
+                "metoprolol", 25m, "mg", "PO",
+                DateTimeOffset.UtcNow.AddMinutes(-30), "nurse-1"));
+
+        // Old metoprolol — outside 90-min window
+        db.MedicationAdministrations.Add(new MedicationAdministration
+        {
+            Id = Guid.NewGuid(),
+            EncounterId = _activeEncounterId,
+            DrugName = "metoprolol",
+            Dose = 50m,
+            DoseUnit = "mg",
+            Route = "PO",
+            AdministeredAt = DateTimeOffset.UtcNow.AddMinutes(-120),
+            AdministeredBy = "nurse-2"
+        });
+        await db.SaveChangesAsync();
+
+        var recent = await service.GetRecentForEncounterAsync(
+            _activeEncounterId, "SYSTOLIC_BP", 90);
+
+        recent.Should().HaveCount(1);
+        recent[0].Dose.Should().Be(25m);
+    }
+}
@@ -0,0 +1,43 @@
+using System.Net;
+using System.Net.Http.Json;
+using FluentAssertions;
+
+[Collection("Integration")]
+public class MedicationValidationTests
+{
+    private readonly HttpClient _client;
+
+    public MedicationValidationTests(ApiFixture fixture) => _client = fixture.CreateClient();
+
+    [Fact]
+    public async Task EmptyDrugName_Returns400()
+    {
+        var resp = await _client.PostAsJsonAsync(
+            $"/api/v1/encounters/{Guid.NewGuid()}/medications",
+            new { drugName = "", dose = 25, doseUnit = "mg", route = "PO", administeredBy = "nurse-1" });
+
+        resp.StatusCode.Should().Be(HttpStatusCode.BadRequest);
+    }
+
+    [Fact]
+    public async Task ZeroDose_Returns400()
+    {
+        var resp = await _client.PostAsJsonAsync(
+            $"/api/v1/encounters/{Guid.NewGuid()}/medications",
+            new { drugName = "metoprolol", dose = 0, doseUnit = "mg", route = "PO", administeredBy = "nurse-1" });
+
+        resp.StatusCode.Should().Be(HttpStatusCode.BadRequest);
+    }
+
+    [Fact]
+    public async Task FutureAdministeredAt_Returns400()
+    {
+        var futureTime = DateTimeOffset.UtcNow.AddHours(1);
+        var resp = await _client.PostAsJsonAsync(
+            $"/api/v1/encounters/{Guid.NewGuid()}/medications",
+            new { drugName = "metoprolol", dose = 25, doseUnit = "mg", route = "PO",
+                  administeredBy = "nurse-1", administeredAt = futureTime });
+
+        resp.StatusCode.Should().Be(HttpStatusCode.BadRequest);
+    }
+}