feature: Medication Tracking & Vital Sign Correlation
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voltsrage
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using FluentAssertions;
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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 MedicationCorrelationTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private Guid _patientId;
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private Guid _encounterId;
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public MedicationCorrelationTests(ApiFixture fixture) => _fixture = fixture;
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public async Task InitializeAsync() => await ResetAndSeedAsync();
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public Task DisposeAsync() => Task.CompletedTask;
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private async Task ResetAndSeedAsync()
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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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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-CORR-001", FirstName = "Correlation", LastName = "Test",
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DateOfBirth = new DateOnly(1970, 6, 10), Gender = "M", CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = Department.Icu,
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AttendingPhysician = "Dr. Correlation", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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db.AlertThresholds.Add(new AlertThreshold
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{
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Id = Guid.NewGuid(), ObservationCode = "SYSTOLIC_BP",
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DisplayName = "Systolic BP", Unit = "mmHg",
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CriticalLow = 70, WarningLow = 90, WarningHigh = 180, CriticalHigh = 220,
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CreatedAt = DateTimeOffset.UtcNow
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});
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db.AlertThresholds.Add(new AlertThreshold
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{
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Id = Guid.NewGuid(), ObservationCode = "RESP_RATE",
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DisplayName = "Respiratory Rate", Unit = "breaths/min",
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CriticalLow = 5, WarningLow = 8, WarningHigh = 25, CriticalHigh = 35,
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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("threshold:SYSTOLIC_BP",
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"""{"ObservationCode":"SYSTOLIC_BP","CriticalLow":70,"WarningLow":90,"WarningHigh":180,"CriticalHigh":220}""");
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await cache.StringSetAsync("threshold:RESP_RATE",
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"""{"ObservationCode":"RESP_RATE","CriticalLow":5,"WarningLow":8,"WarningHigh":25,"CriticalHigh":35}""");
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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}
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[Fact]
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public async Task MetoprololThenLowBp_AnnotatedDetails()
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{
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await ResetAndSeedAsync();
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using var scope = _fixture.Services.CreateScope();
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var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
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await medService.CreateAsync(_encounterId,
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new CreateMedicationAdministrationRequest(
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"metoprolol", 25m, "mg", "PO",
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DateTimeOffset.UtcNow.AddMinutes(-45), "nurse-1"));
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
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created.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts
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.SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
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alert.Details.Should().Contain("metoprolol");
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alert.Details.Should().Contain("min ago");
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alert.Details.Should().Contain("note:");
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}
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[Fact]
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public async Task LowBpWithoutMedication_Unannotated()
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{
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await ResetAndSeedAsync();
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using var scope = _fixture.Services.CreateScope();
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
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created.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts
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.SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
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alert.Details.Should().NotContain("note:");
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}
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[Fact]
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public async Task UnrelatedDrug_NoAnnotation()
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{
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await ResetAndSeedAsync();
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using var scope = _fixture.Services.CreateScope();
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var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
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// Insulin maps to GLUCOSE_MG_DL, not SYSTOLIC_BP
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await medService.CreateAsync(_encounterId,
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new CreateMedicationAdministrationRequest(
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"insulin", 10m, "units", "SubQ",
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DateTimeOffset.UtcNow.AddMinutes(-30), "nurse-1"));
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
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created.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts
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.SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
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alert.Details.Should().NotContain("note:");
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alert.Details.Should().NotContain("insulin");
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}
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[Fact]
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public async Task MedicationOutsideWindow_NoAnnotation()
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{
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await ResetAndSeedAsync();
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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// Metoprolol administered 2 hours ago — outside 90-min window
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db.MedicationAdministrations.Add(new MedicationAdministration
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{
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Id = Guid.NewGuid(),
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EncounterId = _encounterId,
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DrugName = "metoprolol",
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Dose = 25m,
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DoseUnit = "mg",
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Route = "PO",
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AdministeredAt = DateTimeOffset.UtcNow.AddMinutes(-120),
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AdministeredBy = "nurse-1"
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});
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await db.SaveChangesAsync();
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);
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created.Should().BeTrue();
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var alert = await db.ClinicalAlerts
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.SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
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alert.Details.Should().NotContain("note:");
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alert.Details.Should().NotContain("metoprolol");
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}
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[Fact]
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public async Task MorphineThenLowRespRate_Annotated()
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{
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await ResetAndSeedAsync();
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using var scope = _fixture.Services.CreateScope();
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var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
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await medService.CreateAsync(_encounterId,
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new CreateMedicationAdministrationRequest(
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"morphine", 4m, "mg", "IV",
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DateTimeOffset.UtcNow.AddMinutes(-20), "nurse-1"));
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var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
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var created = await evaluator.EvaluateAsync(
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Guid.NewGuid(), _encounterId, _patientId, "RESP_RATE", 7m);
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created.Should().BeTrue();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts
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.SingleAsync(a => a.AlertType == AlertType.WarningRespRate);
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alert.Details.Should().Contain("morphine");
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alert.Details.Should().Contain("min ago");
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alert.Details.Should().Contain("note:");
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}
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}
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