A production-quality clinical backend built with ASP.NET Core 8, PostgreSQL, Apache Kafka, RabbitMQ, Elasticsearch, Redis, and MinIO. The domain models the observe-alert-acknowledge lifecycle at the center of any clinical monitoring system: patient encounters, continuous vital sign and lab result ingest, real-time sepsis and NEWS2 scoring, and clinician notification with automatic escalation.
**Implementation status:** Twenty-nine planned phases are complete through Phase 31 (plus Phases 20–22) — from schema and CRUD through Kafka, Elasticsearch CQRS, sepsis detection, RabbitMQ paging with DLQ escalation, reconciliation jobs, Prometheus/Grafana observability, the MinIO Parquet data lake, clinical data model expansion, warning alerts and orders, the NEWS2 composite scoring engine, trend detection with alert suppression, qSOFA bedside screening, medication administration with alert correlation annotations, the console replay simulator, the **Vue 3 ward dashboard**, clinician feedback mode, **Glasgow Coma Scale (GCS) scoring**, **SOFA organ-dysfunction scoring with baseline tracking and delta sepsis alerts**, the **Sepsis-3 clinical refactor** (SIRS removed, qSOFA repositioned as screening, SOFA delta ≥ 2 triggers bundles), **frontend GCS entry and SOFA display**, **expanded simulator scenarios with clinical validation**, the **Site & Gateway Registry** with dual authentication, shared clinical sync contracts, and fleet health Prometheus gauges, the **Ward Gateway Service** (local-first clinical path with offline buffering and central sync), the **FHIR R4 Inbound Facade** for EHR integration, **Role-Based Access Control (RBAC) with clinical audit logging**, the **Dashboard Gap Analysis Fixes** (SOFA/GCS/qSOFA history charts, patient banner, encounter timeline, medication markers on vital charts), and the **Enhanced Dashboard** (department overview, sepsis bundle board, critical alert notifications, shift handoff reports, vitals entry form, sortable/filterable ward table). Post-phase hardening includes health check endpoints, Kafka poison pill protection, outbox dead-letter with retry tracking, data lake partial-commit safety, MRN sequence-based generation, FHIR bundle transaction rollback, **FHIR R4 read/search endpoints** (Patient and Encounter), **alert threshold deletion with audit trail**, **FHIR API key rotation** (constant-time multi-key validation), **authorization failure logging** with Prometheus metrics, **JWT signing key validation** at startup, and **concurrency hardening** (transactional sepsis bundle creation, unique active encounter constraint). See [Implemented Phases](#implemented-phases) for the full breakdown. Guides: [dashboard-guide.md](docs/dashboard-guide.md) (technical), [clinical-testing-guide.md](docs/clinical-testing-guide.md) (doctors & nurses).
**Implementation status:** Thirty-one planned phases are complete through Phase 33 (plus Phases 20–23) — from schema and CRUD through Kafka, Elasticsearch CQRS, sepsis detection, RabbitMQ paging with DLQ escalation, reconciliation jobs, Prometheus/Grafana observability, the MinIO Parquet data lake, clinical data model expansion, warning alerts and orders, the NEWS2 composite scoring engine, trend detection with alert suppression, qSOFA bedside screening, medication administration with alert correlation annotations, the console replay simulator, the **Vue 3 ward dashboard**, clinician feedback mode, **Glasgow Coma Scale (GCS) scoring**, **SOFA organ-dysfunction scoring with baseline tracking and delta sepsis alerts**, the **Sepsis-3 clinical refactor** (SIRS removed, qSOFA repositioned as screening, SOFA delta ≥ 2 triggers bundles), **frontend GCS entry and SOFA display**, **expanded simulator scenarios with clinical validation**, the **Site & Gateway Registry** with dual authentication, shared clinical sync contracts, and fleet health Prometheus gauges, the **Ward Gateway Service** (local-first clinical path with offline buffering and central sync), the **FHIR R4 Inbound Facade** for EHR integration, **Role-Based Access Control (RBAC) with clinical audit logging**, the **Dashboard Gap Analysis Fixes** (SOFA/GCS/qSOFA history charts, patient banner, encounter timeline, medication markers on vital charts), the **Enhanced Dashboard** (department overview, sepsis bundle board, critical alert notifications, shift handoff reports, vitals entry form, sortable/filterable ward table), **Degraded Operations Visibility** (gateway fleet operations panel, stale gateway auto-detection, discharge summary API, admin panels for user/threshold/audit/reconciliation management, degraded-mode banner), and **Alert Quality Analytics** (server-side clinician feedback with `AlertFeedback` entity, `AlertQualityAggregatorService` background metrics, quality metrics API, Grafana alert quality dashboard). Post-phase hardening includes health check endpoints, Kafka poison pill protection, outbox dead-letter with retry tracking, data lake partial-commit safety, MRN sequence-based generation, FHIR bundle transaction rollback, **FHIR R4 read/search endpoints** (Patient and Encounter), **alert threshold deletion with audit trail**, **FHIR API key rotation** (constant-time multi-key validation), **authorization failure logging** with Prometheus metrics, **JWT signing key validation** at startup, and **concurrency hardening** (transactional sepsis bundle creation, unique active encounter constraint). See [Implemented Phases](#implemented-phases) for the full breakdown. Guides: [dashboard-guide.md](docs/dashboard-guide.md) (technical), [clinical-testing-guide.md](docs/clinical-testing-guide.md) (doctors & nurses).
## Domain Model — How It Maps to a Real Clinical System
@@ -72,10 +72,10 @@ An `OutboxEvent` is written in the same transaction as any observation or alert,
- **Medication Administration** — `POST /encounters/:id/medications` records drug administrations (name, dose, route, timestamp, administered-by); `GET /encounters/:id/medications` lists with optional `since` filter; `GET /medications/:id` detail; active-encounter guard; FluentValidation on request DTOs
- **Medication Correlation Annotations** — `MedicationCorrelationHelper` appends medication context to warning and NEWS2 alert details when a mapped drug was administered within the correlation window (default 90 min); drug-to-vital mappings in `MedicationCorrelation` config (`appsettings.json`); annotates rather than suppresses — alerts still fire; sepsis, trend, and critical sync-path alerts are never annotated; design rationale in `docs/decisions/medication-correlation-design.md`
- **Ward Dashboard APIs** — `GET /encounters` returns paginated `WardEncounterSummary` rows (patient name/MRN, room/bed, department, status, latest NEWS2 score, live qSOFA criteria count from Redis, sepsis bundle status, open alert count, SOFA score/delta, GCS score/classification, attending physician, admitted-at, last observation time); filterable by `status` and `department`; `GET /encounters/:id/qsofa/current` exposes Redis-backed qSOFA state; `GET /sepsis-bundles` lists bundles hospital-wide with optional `status` filter (returns `SepsisBundleSummary` with patient demographics, elements, and deadlines); CORS policy `Dashboard` allows configured origins (default `http://localhost:5173`)
- **Ward Dashboard Frontend** — Vue 3 SPA (`vigilcare-dashboard/`) with virtual ward table (multi-column sortable, patient search, quick-filters for critical/alerts/sepsis), patient detail (vitals, scores, alerts, orders, sepsis bundle, GCS entry form, SOFA score panel, patient banner with demographics/allergies/emergency contact, encounter timeline, vitals entry form for manual observation recording), alert center (global acknowledge/resolve with role-aware modal and acknowledgment note preview), department overview (unit-level snapshot cards with acuity bars, patient/alert/bundle counts per department), sepsis bundle board (real-time countdown timers, on-track/at-risk/overdue urgency sorting), critical alert banner with browser notifications and audible tone, shift handoff report generator (SBAR format with ward summary, exportable via print/PDF), vital sign trend charts with medication administration markers and local replay scrubbing, NEWS2 history chart, SOFA history chart with organ-system breakdown, GCS history chart with component tracking, qSOFA evaluation history, alert reasoning with optional medication context, and clinician feedback on every alert; polls API every 5–10 s; guides in `docs/dashboard-guide.md` and `docs/clinical-testing-guide.md`
- **Ward Dashboard Frontend** — Vue 3 SPA (`vigilcare-dashboard/`) with virtual ward table (multi-column sortable, patient search, quick-filters for critical/alerts/sepsis), patient detail (vitals, scores, alerts, orders, sepsis bundle, GCS entry form, SOFA score panel, patient banner with demographics/allergies/emergency contact, encounter timeline, vitals entry form for manual observation recording, discharge summary panel), alert center (global acknowledge/resolve with role-aware modal and acknowledgment note preview), department overview (unit-level snapshot cards with acuity bars, patient/alert/bundle counts per department), sepsis bundle board (real-time countdown timers, on-track/at-risk/overdue urgency sorting), critical alert banner with browser notifications and audible tone, shift handoff report generator (SBAR format with ward summary, exportable via print/PDF), vital sign trend charts with medication administration markers and local replay scrubbing, NEWS2 history chart, SOFA history chart with organ-system breakdown, GCS history chart with component tracking, qSOFA evaluation history, alert reasoning with optional medication context, clinician feedback on every alert, admin panels (threshold management, user management, audit log viewer, reconciliation viewer), gateway operations dashboard with degraded-mode banner, and alert quality analytics with quality charts; role-aware sidebar navigation; polls API every 5–10 s; guides in `docs/dashboard-guide.md` and `docs/clinical-testing-guide.md`
- **FHIR R4 Inbound Facade** — `POST /fhir/R4/{Patient,Encounter,Observation,MedicationAdministration}` accepts FHIR R4 JSON resources (`application/fhir+json`); `POST /fhir/R4` processes transaction Bundles (Patient → Encounter → Observation in dependency order); `GET /fhir/R4/metadata` returns a CapabilityStatement; LOINC-to-internal code mapping (19 observation codes + SNOMED CT fallbacks); Fahrenheit-to-Celsius unit conversion; `ExternalResourceIdentifier` table links hospital MRNs and visit numbers to internal UUIDs for idempotent upserts; `FhirApiKeyOrJwtMiddleware` authenticates via JWT bearer or `X-Api-Key` header (supports multiple keys via `Fhir:ApiKeys` array for zero-downtime rotation; constant-time comparison via `CryptographicOperations.FixedTimeEquals`); `FhirExceptionFilter` returns FHIR `OperationOutcome` on errors; configurable identifier systems, department codes, and encounter class mappings via `Fhir` config section; Prometheus `fhir_ingest_total` and `fhir_mapping_errors_total`; integration guide for Mirth Connect HL7v2→FHIR channels in `docs/integration/mirth-fhir-channels.md`
- **FHIR R4 Read/Search** — `GET /fhir/R4/Patient/{id}` reads a Patient by internal ID; `GET /fhir/R4/Patient` searches by `identifier` (system|value) or lists all patients; `GET /fhir/R4/Encounter/{id}` reads an Encounter by internal ID; `GET /fhir/R4/Encounter` searches by `patient` (UUID) and/or `status` (`in-progress`, `finished`, `cancelled`); all return FHIR R4 JSON (`application/fhir+json`); search endpoints return `Bundle.type=searchset`; requires `fhir:read` permission (Admin and Integration roles); internal resources mapped back to FHIR via `PatientFhirMapper.ToFhirResponse` / `EncounterFhirMapper.ToFhirResponse` with hospital identifier resolution; Prometheus `fhir_read_total` counter with `resource_type`, `interaction`, `outcome` labels
- **Role-Based Access Control (RBAC)** — JWT bearer authentication (`POST /auth/login`); four clinical roles (`Nurse`, `Physician`, `Admin`, `Integration`) with 17 granular permissions (`patients:read`, `alerts:acknowledge`, `thresholds:write`, `fhir:ingest`, `fhir:read`, `audit:read`, etc.); `AuthorizePermission` attribute on every controller action; `PermissionAuthorizationHandler` resolves role → permission at runtime from `ClinicalRolePermissionMap` and logs authorization failures with structured details (user, role, permission, endpoint) plus `authorization_failures_total` Prometheus counter; `CurrentUserService` exposes authenticated identity (user ID, display name, role, IP address) to services; nurses and physicians get clinical read/write permissions; admins additionally get `thresholds:write`, `fhir:read`, `audit:read`, and `users:admin`; integration accounts get FHIR ingest and read access; FHIR endpoints accept both JWT and `X-Api-Key` authentication via `FhirApiKeyOrJwtMiddleware`; alert `acknowledgedBy` is set from the authenticated user identity, not the request body; startup validates JWT signing key is at least 256 bits (HMAC-SHA256 minimum); four seeded demo users (`nurse.demo`, `physician.demo`, `admin.demo`, `integration.mirth`); frontend login page with `localStorage` token persistence and automatic `Authorization: Bearer` header injection
- **Role-Based Access Control (RBAC)** — JWT bearer authentication (`POST /auth/login`); four clinical roles (`Nurse`, `Physician`, `Admin`, `Integration`) with 18 granular permissions (`patients:read`, `alerts:acknowledge`,`alerts:feedback`,`thresholds:write`, `fhir:ingest`, `fhir:read`, `audit:read`, etc.); `AuthorizePermission` attribute on every controller action; `PermissionAuthorizationHandler` resolves role → permission at runtime from `ClinicalRolePermissionMap` and logs authorization failures with structured details (user, role, permission, endpoint) plus `authorization_failures_total` Prometheus counter; `CurrentUserService` exposes authenticated identity (user ID, display name, role, IP address) to services; nurses and physicians get clinical read/write permissions; admins additionally get `thresholds:write`, `fhir:read`, `audit:read`, and `users:admin`; integration accounts get FHIR ingest and read access; FHIR endpoints accept both JWT and `X-Api-Key` authentication via `FhirApiKeyOrJwtMiddleware`; alert `acknowledgedBy` is set from the authenticated user identity, not the request body; startup validates JWT signing key is at least 256 bits (HMAC-SHA256 minimum); four seeded demo users (`nurse.demo`, `physician.demo`, `admin.demo`, `integration.mirth`); frontend login page with `localStorage` token persistence and automatic `Authorization: Bearer` header injection
- **Clinical Audit Logging** — append-only `clinical_audit_logs` table records clinical write actions with user identity, entity type/ID, before/after state (JSONB), reason, IP address, and correlation ID; ten audit actions (`THRESHOLD_CREATED`, `THRESHOLD_UPDATED`, `THRESHOLD_DELETED`, `ALERT_ACKNOWLEDGED`, `ALERT_RESOLVED`, `ENCOUNTER_STATUS_CHANGED`, `PATIENT_REGISTERED`, `SUPPRESSION_WINDOW_SET`, `USER_LOGIN`, `AUTHORIZATION_DENIED`); `AuditService` writes log entries inline with domain operations; `GET /audit-logs` admin-only query endpoint with filters by entity type, entity ID, user ID, action, and time range; indexed on entity type, entity ID, user ID, and timestamp
- **Site & Gateway Registry** — `ClinicalSite` and `WardGateway` domain entities model ward edge nodes that buffer clinical data during connectivity loss; `POST /sites` creates clinical sites; `POST /sites/{siteId}/gateways` registers gateways under a site; `PATCH /gateways/{gatewayId}/heartbeat` (gateway API key auth) updates status (`ONLINE`, `DEGRADED`, `OFFLINE`) and reported buffer depth; `GET /sites/{siteId}/gateways` lists gateways with optional `?department=` filter; dual authentication — JWT + RBAC (`users:admin`) for admin CRUD, `GatewayApiKeyAuthenticationHandler` (`X-Api-Key` + `X-Gateway-Id`) for gateway heartbeat and future sync upload; constant-time key comparison via `CryptographicOperations.FixedTimeEquals`; `VigilCare.ClinicalContracts` shared class library with sync DTOs (`ClinicalSyncBatchRequest`, `SyncedObservation`, `SyncedAlertEvent`, `GatewayHeartbeatRequest`) consumed by both central API and ward gateway projects; Prometheus `ward_gateways_offline_gauge` and `ward_gateway_buffer_depth` via `WardGatewayMetricsCollector` (60s periodic); `GatewayRegistrySeeder` provides demo site and gateway for Docker Compose and tests; FluentValidation on all request DTOs; `GatewayRegistryTests` and `ClinicalContractsTests` integration tests
- **Ward Gateway Service** — `VigilCare.WardGateway` (`http://localhost:5081`) is a standalone ASP.NET Core 8 deployable with its own PostgreSQL, Redis, and RabbitMQ; ingests observations locally via `POST /encounters/:id/observations` with plausibility validation, Redis-cached threshold evaluation, and synchronous critical alert creation; `LocalWarningEvaluator` creates warning-range alerts; `BufferedSyncWriter` writes all clinical events to `buffered_sync_items` for central upload; `EncounterReplicaSyncService` pulls patient/encounter data from central API; `ThresholdCacheLoader` fetches thresholds from central into local Redis; `CentralReachabilityService` tracks central API connectivity; `GatewayHeartbeatService` reports status and buffer depth; `SyncUploaderService` batches and uploads buffered items when online; local RabbitMQ paging and escalation queues; `GET /encounters` ward list and `GET /encounters/:id` detail; `GET /health/live` and `GET /health/ready` (Redis, RabbitMQ, encounter replica readiness); Docker Compose `ward-gateway` profile
@@ -86,7 +86,11 @@ An `OutboxEvent` is written in the same transaction as any observation or alert,
- **ThresholdCacheLoader Resilience** — retries Redis connection up to 3 times with exponential backoff (2s, 4s, 8s); if Redis remains unavailable, the application starts without the cache and observation ingest falls back to PostgreSQL queries for threshold lookups
- **MRN Sequence Generation** — MRN numbers are generated via a PostgreSQL sequence (`mrn_seq`) instead of MAX+1 queries; eliminates race conditions under concurrent patient registration; configurable prefix and digit count via `PatientOptions`
- **FHIR Bundle Transaction Rollback** — `FhirBundleProcessor` wraps all bundle entry processing in a database transaction; on any entry failure, the transaction is rolled back and the response includes the `OperationOutcome` for the failed entry; prevents partial state from orphaned Patient/Encounter records
- **Clinician Feedback Mode** — six quick ratings per alert (useful, too early, too late, false positive, missing context, would act); optional notes; Feedback Summary with aggregate stats and JSON/CSV export; client-side persistence for product research
- **Clinician Feedback Mode** — six quick ratings per alert (useful, too early, too late, false positive, missing context, would act); optional notes; server-side `AlertFeedback` entity persisted per user per alert (`POST /alerts/{id}/feedback`); `alerts:feedback` permission for Nurse, Physician, and Admin roles; Feedback Summary with aggregate stats and JSON/CSV export; client-side persistence for product research
- **Degraded Operations Visibility** — `GatewayStaleDetectorService` auto-marks gateways OFFLINE when heartbeat exceeds configurable `StaleThresholdMinutes`; `OperationsController` (`GET /operations/gateways`, `GET /operations/gateways/{id}`, `GET /operations/sites/{siteId}/summary`) provides fleet management API; `DischargeSummaryService` with `GET /encounters/{id}/discharge-summary` (info) and `GET /encounters/{id}/discharge-summary/content` (MinIO PDF download); `DischargeSummaryPanel.vue` on patient detail; `DegradedModeBanner.vue` warns when gateways are offline; `GatewayOperations.vue` operations dashboard
- **User Management** — `UsersController` (`GET /users`, `POST /users`, `PATCH /users/{id}`) for admin user account CRUD; `UserService` with BCrypt password hashing; `UserManagementView.vue` with `UserFormModal.vue` (create/edit users, role assignment, active toggle)
- **Admin Dashboard Panels** — `ThresholdManagementView.vue` with `ThresholdFormModal.vue` (create/edit alert thresholds); `AuditLogView.vue` (filterable audit log viewer with action/entity/user/date filters); `ReconciliationView.vue` (safety finding viewer); sidebar navigation with role-aware admin section; `CollapsibleSection.vue` and `SeverityBadge.vue` UI components
- **Console Replay Simulator** — standalone `VigilCare.Simulator` .NET console app replays JSON scenario files against the live API with configurable speed (`--speed 0` instant, `60` = 60× faster); commands: `replay`, `replay-all`, `validate`, `dry-run`; optional `--poll` shows alerts, NEWS2, GCS, SOFA, and sepsis bundle state during replay; `--gateway` targets the ward gateway (`http://localhost:5081`) with `--encounter-id`, `--skip-setup`, and `--gateway-token`; `alert_ack` events poll for open alerts on central before acknowledging (handles async alert pipeline at `--speed 0`); twelve sample scenarios in `VigilCare.Simulator/Scenarios/List/` (including ward outage reconnect, GCS neurological decline, SOFA sepsis progression, and SpO₂/FiO₂ fallback); user guide in `docs/simulator-guide.md`
- **RabbitMQ Notification Workers** — `NotificationPublisherService` reads `alert.generated` from Kafka and publishes paging jobs to `alerts.paging.queue`; `PagingWorkerService` sends the page and waits for acknowledgment; if no ack arrives before timeout it NACKs to `alerts.paging.dlq` with `x-message-ttl = 300000ms`; if the host is stopping, in-flight paging messages are NACKed with `requeue=true` so they are retried after restart and do not false-escalate; `EscalationWorkerService` pages the on-call backup and sets alert status to `escalated`; `DischargeSummaryWorkerService` reads `encounter.status.changed`, generates a discharge summary, and stores it in MinIO under `/discharge-summaries/{encounterId}/summary.pdf`
- **Data Lake Writer** — `DataLakeWriterService` (consumer group `data-lake-writer`) buffers `observation.recorded`, `alert.generated`, and `encounter.status.changed` events, flushes date-partitioned Parquet files to MinIO (`/observations/`, `/alerts/`, `/encounters/`), and commits Kafka offsets only for topic-partitions where all uploads succeeded; failed partition buffers are retained in memory and retried on the next flush cycle (prevents data loss from partial upload failures); shutdown flush uses an uncanceled token so MinIO writes complete on Ctrl+C; `kafka_partition` and `kafka_offset` columns provide audit lineage
@@ -140,7 +144,9 @@ IHostedServices (background):
OutboxPendingCollector → polls outbox every 30s → outbox_pending_events
KafkaConsumerLagCollector → polls four consumer groups every 30s → kafka_consumer_lag
| `kafka_poison_pills_skipped_total` | Counter | `consumer_group`, `topic` | `PoisonPillGuard` — messages skipped as permanently un-processable (malformed JSON, format errors, or transient failures exceeding MaxPoisonRetries) |
| `alert_quality_useful_rate` | Gauge | `alert_type` | `AlertQualityAggregatorService` — proportion of feedback rated "useful" per alert type |
| `alert_quality_false_positive_rate` | Gauge | `alert_type` | `AlertQualityAggregatorService` — proportion of feedback rated "false positive" per alert type |
| `alert_feedback_total` | Counter | `feedback_type` | `AlertService` — feedback submissions by type |
Prometheus scrapes the API via `infra/prometheus/prometheus.yml` (`job: vigilcare_api` → `host.docker.internal:5270`). Grafana loads the clinical dashboard from `infra/grafana/dashboards/vigilcare.json`.
@@ -1051,6 +1098,8 @@ Error response:
| GET | `/encounters/{id}` | Encounter detail with recent observations and open alerts |
| PATCH | `/encounters/{id}/status` | Advance encounter status |
| GET | `/encounters/{id}/timeline` | Merged chronological view: status changes, observations, alerts |
| GET | `/encounters/{id}/discharge-summary` | Discharge summary info (status, availability) |
| GET | `/encounters/{id}/discharge-summary/content` | Download discharge summary PDF from MinIO |
| GET | `/encounters/{id}/qsofa/current` | Current qSOFA active criteria count (0–3) from Redis |
| GET | `/encounters/{id}/qsofa/history` | Cursor-paginated qSOFA evaluation history |
@@ -1185,6 +1234,7 @@ Uses cursor pagination on `(recorded_at DESC, id DESC)` — offset pagination wo
| GET | `/alerts/{id}` | Alert detail |
| POST | `/alerts/{id}/acknowledge` | Acknowledge with clinician ID and optional note |
| POST | `/alerts/{id}/resolve` | Resolve (must be acknowledged first) |
| POST | `/alerts/{id}/feedback` | Submit clinician feedback (one per user per alert); requires `alerts:feedback` |
**Alert lifecycle:**
@@ -1410,6 +1460,7 @@ When a correlated drug was given within the `MedicationCorrelation.CorrelationWi
| `alerts:read` | yes | yes | yes | — |
| `alerts:acknowledge` | yes | yes | yes | — |
| `alerts:resolve` | yes | yes | yes | — |
| `alerts:feedback` | yes | yes | yes | — |
| `thresholds:read` | yes | yes | yes | — |
| `thresholds:write` | — | — | yes | — |
| `analytics:read` | yes | yes | yes | — |
@@ -1434,6 +1485,66 @@ All endpoints except `POST /auth/login` and `GET /fhir/R4/metadata` require auth
Each audit log entry includes `action`, `entityType`, `entityId`, `userId`, `userDisplayName`, `previousValueJson` (JSONB), `newValueJson` (JSONB), `reason`, `ipAddress`, `correlationId`, and `createdAt`.
### Users
| Method | Path | Auth | Description |
|---|---|---|---|
| GET | `/users` | JWT + `users:admin` | List all clinical user accounts |
| POST | `/users` | JWT + `users:admin` | Create a new clinical user account |
| PATCH | `/users/{id}` | JWT + `users:admin` | Update role, display name, or active status |
All FHIR endpoints are under `/fhir/R4`, accept `application/fhir+json`, and return FHIR R4 JSON responses. Authentication is via JWT bearer token or `X-Api-Key` header (configured in `Fhir:ApiKey` or the `Fhir:ApiKeys` array for zero-downtime key rotation; disabled when blank). API key validation uses `CryptographicOperations.FixedTimeEquals` to prevent timing attacks. When a valid JWT is present, the API key check is skipped — this allows both integration engines (API key) and authenticated admin users (JWT) to access FHIR resources. Write endpoints (`POST`) require `fhir:ingest` permission; read endpoints (`GET`) require `fhir:read` permission. Errors return a FHIR `OperationOutcome` with appropriate issue codes.
**Enhanced Dashboard (post-Phase 22):** Major dashboard feature expansion addressing clinical workflow gaps. **Department Overview** (`/departments`) — unit-level snapshot cards showing patient count, critical/alert/bundle totals per department with acuity distribution bars; click-through to ward filtered by department. **Sepsis Bundle Board** (`/sepsis`) — real-time bundle compliance tracking with countdown timers to 1-hour deadline, urgency-sorted (overdue → at-risk → on-track), live 1-second tick updates. **Critical Alert Notifications** — `CriticalAlertBanner` surfaces new critical alerts from polling cycle with audible 880Hz two-tone alert, browser title flash, and native `Notification` API integration; mute toggle persisted in settings. **Shift Handoff Report** — `HandoffReport.vue` generates SBAR-format (Situation, Background, Assessment, Recommendation) structured reports for all ward patients, enriched with latest vitals, open alerts, pending orders, and sepsis bundle status; ward summary with department stats; print/PDF export. **Vitals Entry Form** — `VitalsEntryForm.vue` on patient detail page enables manual observation recording (7 vital parameters with AVPU dropdown) with client-side plausibility validation matching server-side ranges. **Ward Table Enhancements** — multi-column sorting (room, patient, department, NEWS2, qSOFA, sepsis, alerts) with sortable column headers, debounced patient search (name/MRN), quick-filter toggles (critical, has alerts, active sepsis), clear-all filters. **Acknowledge Modal** — role-aware acknowledgment with clinician identity pre-populated from JWT, role-specific guidance text, and acknowledgment note preview. Backend additions: `GET /sepsis-bundles` paginated hospital-wide list with `SepsisBundleSummary` (patient demographics, elements, deadlines); `WardEncounterSummary` extended with `sofaScore`, `sofaDelta`, `gcsScore`, `gcsClassification`, `lastObservationAt`, `attendingPhysician`, `admittedAt`.
@@ -2101,11 +2253,15 @@ Twenty-nine phases from the project roadmap are implemented and verified, includ
**Scoring pipeline (Phases 25–26):** GCS components → `gcs_scores` + `gcs.scored` → SOFA CNS organ system; SOFA lab/vital observations → `sofa_scores` with baseline tracking → delta sepsis alerts when organ dysfunction worsens.
**Sepsis-3 refactor (Phases 27–29):** SIRS removed; qSOFA repositioned as bedside screening (`QSOFA_SCREEN`); SOFA delta ≥ 2 triggers `SOFA_SEPSIS` → sepsis bundle. Frontend gains GCS entry form and SOFA score panel. Eleven simulator scenarios validate the full clinical pipeline end-to-end.
**Sepsis-3 refactor (Phases 27–29):** SIRS removed; qSOFA repositioned as bedside screening (`QSOFA_SCREEN`); SOFA delta ≥ 2 triggers `SOFA_SEPSIS` → sepsis bundle. Frontend gains GCS entry form and SOFA score panel. Twelve simulator scenarios validate the full clinical pipeline end-to-end.
**FHIR R4 integration (Phase 30):** Inbound facade accepts FHIR R4 JSON from integration engines (Mirth Connect, Rhapsody). Supports per-resource endpoints and transaction Bundles for ADT admit workflows. LOINC/SNOMED code mapping, Fahrenheit conversion, and external identifier linking enable drop-in EHR integration without changing the internal clinical pipeline.
**RBAC + audit logging (Phase 31):** JWT authentication with role-based permission gating on every endpoint. Four clinical roles with granular permissions. Append-only audit logging records who did what, when, and why — with before/after state snapshots for compliance and incident review. Frontend login page with token-based session management.
**RBAC + audit logging (Phase 31):** JWT authentication with role-based permission gating on every endpoint. Four clinical roles with 18 granular permissions. Append-only audit logging records who did what, when, and why — with before/after state snapshots for compliance and incident review. Frontend login page with token-based session management.
**Degraded Operations Visibility (Phase 23):** Gateway fleet operations panel with stale gateway auto-detection (`GatewayStaleDetectorService`), discharge summary API with MinIO PDF retrieval, admin panels for user management, threshold management, audit log browsing, and reconciliation viewing. Frontend adds role-aware sidebar navigation, degraded-mode banner for offline gateways, and comprehensive admin CRUD views.
**Alert Quality Analytics (Phase 33):** Server-side clinician feedback persisted as `AlertFeedback` entities (one per user per alert, six feedback types). `AlertQualityAggregatorService` periodically computes per-alert-type quality metrics (acknowledgement rate, false positive rate, useful rate, would-act rate, response times). REST API exposes quality metric snapshots and aggregate summaries. Grafana dashboard visualizes alert quality trends. Frontend analytics view with quality charts.
**Post-phase hardening (after Phase 31):**
- **FHIR R4 read/search** — `FhirReadController` adds `GET /fhir/R4/Patient/{id}`, `GET /fhir/R4/Patient` (search by `identifier`), `GET /fhir/R4/Encounter/{id}`, `GET /fhir/R4/Encounter` (search by `patient`/`status`); new `fhir:read` permission for Admin and Integration roles; CapabilityStatement updated to advertise `read` and `searchType` interactions for Patient and Encounter
### Scenario E — Ward isolation during infrastructure failure
A typhoon damages the hospital uplink. ICU bedside monitoring continues on the ward server; critical values still alert the charge nurse; acknowledgments are recorded locally. When connectivity returns, the ward backlog syncs to central with a full audit trail — no duplicate pages, no lost observations.
**What we bring:** Ward gateway architecture (`VigilCare.WardGateway`), idempotent clinical sync batch engine, ops fleet visibility for degraded gateways, and six documented chaos experiments proving the design.
**What the hospital brings:** UPS-backed ward server, network partition procedures, clinical policy for local-only mode (who owns escalation when composite scores are unavailable).
### 29. Why split Tier 1 safety onto a ward gateway instead of relying on hospital datacenter HA?
Datacenter HA protects against server failure, not ward-to-datacenter link failure. Typhoons, construction, and router failures isolate the ward LAN from upstream. Colocating critical threshold evaluation with the ward keeps the observe-alert-acknowledge loop on the ward LAN. Central adds NEWS2, SOFA scoring, Elasticsearch, and Parquet when the link returns.
### 30. How does clinical sync batch processing differ from POS offline sync?
Same mechanical pattern: `batchReference` idempotency, async processor, partial conflicts, server-authoritative resolution. Clinical adds ordering dependencies (ack before alert → `ALERT_NOT_YET_SYNCED` conflict), preserved `recorded_at` timestamps for audit timeline, and paging suppression policy to avoid duplicate critical pages after reconnect. POS conflicts are inventory; clinical conflicts are temporal ordering and duplicate device retries.
### 31. What happens to NEWS2 and sepsis detection during a 4-hour ward outage?
Tier 1 thresholds and warnings run locally. NEWS2, SOFA, qSOFA, trend, and sepsis bundle require the Kafka multi-consumer pipeline on central — intentionally deferred. When sync uploads observations, `observation.recorded` events replay through Kafka; scoring engines catch up with correct timestamps. SOFA delta ≥ 2 sepsis confirmation and the hour-1 bundle activate after replay, not during the outage. Trade-off: composite scores lag during outage but critical single-value breaches (potassium, glucose) still fire locally.
### 32. How do you prove the climate resilience design works in an interview without production deployment?
Six documented chaos experiments with Grafana before/after snapshots in `docs/resilience/climate/`; `ward-outage-reconnect-01` scenario replay against gateway; `ClimateResilienceTests` for idempotency and ordering conflicts; live demo via `scripts/demo-network-partition.sh` showing DEGRADED → buffer → ONLINE → buffer 0. Evidence is measured failure modes, not slide claims.
Blocking a user prevents them from interacting with repositories, such as opening or commenting on pull requests or issues. Learn more about blocking a user.
voltsrage