feature: Schema, Migrations, Core CRUD, and Redis Threshold Cache
This commit is contained in:
voltsrage
@@ -0,0 +1,20 @@
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using Microsoft.EntityFrameworkCore;
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public class AppDbContext : DbContext
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{
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public AppDbContext(DbContextOptions<AppDbContext> options) : base(options) { }
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public DbSet<Patient> Patients => Set<Patient>();
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public DbSet<Encounter> Encounters => Set<Encounter>();
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public DbSet<AlertThreshold> AlertThresholds => Set<AlertThreshold>();
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public DbSet<Observation> Observations => Set<Observation>();
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public DbSet<ClinicalAlert> ClinicalAlerts => Set<ClinicalAlert>();
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public DbSet<Order> Orders => Set<Order>();
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public DbSet<OutboxEvent> OutboxEvents => Set<OutboxEvent>();
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public DbSet<ReconciliationAlert> ReconciliationAlerts => Set<ReconciliationAlert>();
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protected override void OnModelCreating(ModelBuilder modelBuilder)
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{
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modelBuilder.ApplyConfigurationsFromAssembly(typeof(AppDbContext).Assembly);
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}
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}
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@@ -0,0 +1,22 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class AlertThresholdConfiguration : IEntityTypeConfiguration<AlertThreshold>
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{
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public void Configure(EntityTypeBuilder<AlertThreshold> builder)
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{
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builder.ToTable("alert_thresholds");
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builder.HasKey(t => t.Id);
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builder.Property(t => t.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(t => t.ObservationCode).HasColumnName("observation_code").HasMaxLength(50).IsRequired();
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builder.Property(t => t.DisplayName).HasColumnName("display_name").HasMaxLength(200).IsRequired();
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builder.Property(t => t.Unit).HasColumnName("unit").HasMaxLength(20).IsRequired();
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builder.Property(t => t.CriticalLow).HasColumnName("critical_low").HasColumnType("decimal(10,3)");
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builder.Property(t => t.WarningLow).HasColumnName("warning_low").HasColumnType("decimal(10,3)");
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builder.Property(t => t.WarningHigh).HasColumnName("warning_high").HasColumnType("decimal(10,3)");
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builder.Property(t => t.CriticalHigh).HasColumnName("critical_high").HasColumnType("decimal(10,3)");
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builder.Property(t => t.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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builder.HasIndex(t => t.ObservationCode).IsUnique();
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}
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}
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@@ -0,0 +1,61 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class ClinicalAlertConfiguration : IEntityTypeConfiguration<ClinicalAlert>
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{
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public void Configure(EntityTypeBuilder<ClinicalAlert> builder)
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{
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builder.ToTable("clinical_alerts", t =>
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{
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t.HasCheckConstraint("chk_clinical_alerts_severity",
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"severity IN ('WARNING', 'CRITICAL')");
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t.HasCheckConstraint("chk_clinical_alerts_status",
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"status IN ('OPEN', 'ACKNOWLEDGED', 'RESOLVED', 'ESCALATED')");
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t.HasCheckConstraint("chk_clinical_alerts_alert_type",
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"alert_type IN ('SEPSIS_WARNING', 'CRITICAL_HEART_RATE', 'CRITICAL_TEMP_C', " +
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"'CRITICAL_POTASSIUM_MEQ_L', 'CRITICAL_SPO2', 'CRITICAL_RESP_RATE', 'CRITICAL_WBC_K_UL')");
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});
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builder.HasKey(a => a.Id);
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builder.Property(a => a.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(a => a.EncounterId).HasColumnName("encounter_id");
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builder.Property(a => a.PatientId).HasColumnName("patient_id");
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builder.Property(a => a.ObservationId).HasColumnName("observation_id");
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builder.Property(a => a.AlertType)
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.HasColumnName("alert_type")
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.HasMaxLength(50)
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.HasConversion(
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v => v.ToDbString(),
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v => AlertTypeExtensions.FromDbString(v))
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.IsRequired();
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builder.Property(a => a.Severity)
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.HasColumnName("severity")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => AlertSeverityExtensions.FromDbString(v))
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.IsRequired();
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builder.Property(a => a.Details).HasColumnName("details").IsRequired();
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builder.Property(a => a.Status)
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.HasColumnName("status")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => AlertStatusExtensions.FromDbString(v))
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.HasDefaultValueSql("'OPEN'")
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.HasSentinel((AlertStatus)(-1));
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builder.Property(a => a.AcknowledgedAt).HasColumnName("acknowledged_at");
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builder.Property(a => a.AcknowledgedBy).HasColumnName("acknowledged_by").HasMaxLength(200);
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builder.Property(a => a.ResolvedAt).HasColumnName("resolved_at");
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builder.Property(a => a.TriggeredAt).HasColumnName("triggered_at").HasDefaultValueSql("NOW()");
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builder.HasOne(a => a.Encounter)
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.WithMany(e => e.Alerts)
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.HasForeignKey(a => a.EncounterId)
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.OnDelete(DeleteBehavior.Restrict);
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builder.HasIndex(a => new { a.EncounterId, a.TriggeredAt });
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builder.HasIndex(a => new { a.PatientId, a.TriggeredAt });
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builder.HasIndex(a => new { a.Severity, a.TriggeredAt })
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.HasFilter("status = 'OPEN'");
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}
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}
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@@ -0,0 +1,48 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class EncounterConfiguration : IEntityTypeConfiguration<Encounter>
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{
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public void Configure(EntityTypeBuilder<Encounter> builder)
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{
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builder.ToTable("encounters", t =>
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{
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t.HasCheckConstraint("chk_encounters_encounter_type",
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"encounter_type IN ('INPATIENT', 'OUTPATIENT', 'EMERGENCY')");
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t.HasCheckConstraint("chk_encounters_status",
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"status IN ('SCHEDULED', 'ACTIVE', 'DISCHARGED', 'CANCELLED')");
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});
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builder.HasKey(e => e.Id);
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builder.Property(e => e.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(e => e.PatientId).HasColumnName("patient_id");
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builder.Property(e => e.EncounterType)
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.HasColumnName("encounter_type")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => EncounterTypeExtensions.FromDbString(v))
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.IsRequired();
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builder.Property(e => e.Status)
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.HasColumnName("status")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => EncounterStatusExtensions.FromDbString(v))
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.HasDefaultValueSql("'SCHEDULED'")
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.HasSentinel((EncounterStatus)(-1));
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builder.Property(e => e.Department).HasColumnName("department").HasMaxLength(100).IsRequired();
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builder.Property(e => e.AttendingPhysician).HasColumnName("attending_physician").HasMaxLength(200).IsRequired();
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builder.Property(e => e.AdmittedAt).HasColumnName("admitted_at").HasDefaultValueSql("NOW()");
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builder.Property(e => e.DischargedAt).HasColumnName("discharged_at");
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builder.Property(e => e.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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builder.HasOne(e => e.Patient)
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.WithMany(p => p.Encounters)
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.HasForeignKey(e => e.PatientId)
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.OnDelete(DeleteBehavior.Restrict);
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builder.HasIndex(e => new { e.PatientId, e.AdmittedAt });
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builder.HasIndex(e => new { e.Status, e.AdmittedAt })
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.HasFilter("status = 'ACTIVE'");
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}
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}
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@@ -0,0 +1,44 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class ObservationConfiguration : IEntityTypeConfiguration<Observation>
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{
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public void Configure(EntityTypeBuilder<Observation> builder)
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{
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builder.ToTable("observations", t =>
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{
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t.HasCheckConstraint("chk_observations_source",
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"source IN ('MANUAL', 'DEVICE', 'LAB')");
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});
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builder.HasKey(o => o.Id);
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builder.Property(o => o.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(o => o.EncounterId).HasColumnName("encounter_id");
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builder.Property(o => o.ObservationCode).HasColumnName("observation_code").HasMaxLength(50).IsRequired();
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builder.Property(o => o.Value).HasColumnName("value").HasColumnType("decimal(10,3)").IsRequired();
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builder.Property(o => o.Unit).HasColumnName("unit").HasMaxLength(20).IsRequired();
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builder.Property(o => o.Source)
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.HasColumnName("source")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => ObservationSourceExtensions.FromDbString(v))
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.HasDefaultValueSql("'MANUAL'")
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.HasSentinel((ObservationSource)(-1));
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builder.Property(o => o.IdempotencyKey).HasColumnName("idempotency_key").HasMaxLength(100);
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builder.Property(o => o.RecordedAt).HasColumnName("recorded_at");
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builder.Property(o => o.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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builder.HasOne(o => o.Encounter)
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.WithMany(e => e.Observations)
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.HasForeignKey(o => o.EncounterId)
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.OnDelete(DeleteBehavior.Restrict);
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// Partial unique index — only non-null idempotency keys are checked for uniqueness.
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// Devices that do not send a key are not subject to deduplication.
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builder.HasIndex(o => o.IdempotencyKey)
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.IsUnique()
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.HasFilter("idempotency_key IS NOT NULL");
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builder.HasIndex(o => new { o.EncounterId, o.ObservationCode, o.RecordedAt });
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}
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}
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@@ -0,0 +1,38 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class OrderConfiguration : IEntityTypeConfiguration<Order>
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{
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public void Configure(EntityTypeBuilder<Order> builder)
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{
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builder.ToTable("orders", t =>
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{
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t.HasCheckConstraint("chk_orders_order_type",
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"order_type IN ('LAB', 'IMAGING', 'MEDICATION', 'PROCEDURE')");
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});
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builder.HasKey(o => o.Id);
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builder.Property(o => o.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(o => o.EncounterId).HasColumnName("encounter_id");
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builder.Property(o => o.OrderType)
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.HasColumnName("order_type")
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.HasMaxLength(20)
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.HasConversion(
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v => v.ToDbString(),
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v => OrderTypeExtensions.FromDbString(v))
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.IsRequired();
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builder.Property(o => o.Description).HasColumnName("description").IsRequired();
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builder.Property(o => o.OrderedBy).HasColumnName("ordered_by").HasMaxLength(200).IsRequired();
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builder.Property(o => o.Status).HasColumnName("status").HasMaxLength(20).HasDefaultValue("pending");
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builder.Property(o => o.OrderedAt).HasColumnName("ordered_at").HasDefaultValueSql("NOW()");
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builder.Property(o => o.ResultedAt).HasColumnName("resulted_at");
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builder.HasOne(o => o.Encounter)
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.WithMany(e => e.Orders)
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.HasForeignKey(o => o.EncounterId)
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.OnDelete(DeleteBehavior.Restrict);
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builder.HasIndex(o => new { o.EncounterId, o.OrderedAt });
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builder.HasIndex(o => new { o.Status, o.OrderedAt })
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.HasFilter("status IN ('pending', 'in_progress')");
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}
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}
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@@ -0,0 +1,19 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class OutboxEventConfiguration : IEntityTypeConfiguration<OutboxEvent>
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{
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public void Configure(EntityTypeBuilder<OutboxEvent> builder)
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{
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builder.ToTable("outbox_events");
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builder.HasKey(o => o.Id);
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builder.Property(o => o.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(o => o.Topic).HasColumnName("topic").HasMaxLength(200).IsRequired();
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builder.Property(o => o.Payload).HasColumnName("payload").HasColumnType("jsonb").IsRequired();
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builder.Property(o => o.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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builder.Property(o => o.ProcessedAt).HasColumnName("processed_at");
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builder.HasIndex(o => o.CreatedAt)
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.HasFilter("processed_at IS NULL");
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}
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}
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@@ -0,0 +1,26 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class PatientConfiguration : IEntityTypeConfiguration<Patient>
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{
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public void Configure(EntityTypeBuilder<Patient> builder)
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{
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builder.ToTable("patients");
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builder.HasKey(p => p.Id);
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builder.Property(p => p.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(p => p.Mrn).HasColumnName("mrn").HasMaxLength(20).IsRequired();
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builder.Property(p => p.FirstName).HasColumnName("first_name").HasMaxLength(100).IsRequired();
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builder.Property(p => p.LastName).HasColumnName("last_name").HasMaxLength(100).IsRequired();
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builder.Property(p => p.DateOfBirth).HasColumnName("date_of_birth");
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builder.Property(p => p.Gender).HasColumnName("gender").HasMaxLength(10).IsRequired();
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builder.Property(p => p.Status).HasColumnName("status").HasMaxLength(20).HasDefaultValue("active");
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builder.Property(p => p.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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// MRN uses exact-match unique index — MRN lookups are always equality checks,
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// never LIKE/ILIKE. A B-tree unique index satisfies O(log n) point lookup.
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// Name search uses ILIKE on first_name/last_name — a prefix scan, not an
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// equality match — so no index here; full ILIKE is intentionally unindexed
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// at this scale (pg_trgm GIN would be warranted at >500k patients).
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builder.HasIndex(p => p.Mrn).IsUnique();
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}
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}
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@@ -0,0 +1,31 @@
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using Microsoft.EntityFrameworkCore;
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using Microsoft.EntityFrameworkCore.Metadata.Builders;
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public class ReconciliationAlertConfiguration : IEntityTypeConfiguration<ReconciliationAlert>
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{
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public void Configure(EntityTypeBuilder<ReconciliationAlert> builder)
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{
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builder.ToTable("reconciliation_alerts", t =>
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{
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t.HasCheckConstraint("chk_reconciliation_alerts_check_type",
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"check_type IN ('UNACKNOWLEDGED_CRITICAL_ALERT', 'PENDING_ORDER_NO_RESULT', 'ACTIVE_INPATIENT_NO_OBSERVATION')");
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});
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builder.HasKey(r => r.Id);
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builder.Property(r => r.Id).HasColumnName("id").HasDefaultValueSql("gen_random_uuid()");
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builder.Property(r => r.CheckType)
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.HasColumnName("check_type")
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.HasMaxLength(50)
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.HasConversion(
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v => v.ToDbString(),
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v => ReconciliationCheckTypeExtensions.FromDbString(v))
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.IsRequired();
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builder.Property(r => r.EncounterId).HasColumnName("encounter_id");
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builder.Property(r => r.PatientId).HasColumnName("patient_id");
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builder.Property(r => r.Details).HasColumnName("details").IsRequired();
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builder.Property(r => r.ResolvedAt).HasColumnName("resolved_at");
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builder.Property(r => r.CreatedAt).HasColumnName("created_at").HasDefaultValueSql("NOW()");
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builder.HasIndex(r => new { r.CheckType, r.EncounterId })
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.HasFilter("resolved_at IS NULL");
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}
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}
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@@ -0,0 +1,104 @@
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using System.Text.Json;
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using Microsoft.EntityFrameworkCore;
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using StackExchange.Redis;
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public static class DataSeeder
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{
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public static async Task SeedAsync(AppDbContext db, IConnectionMultiplexer redis)
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{
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if (await db.Patients.AnyAsync()) return;
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// Two patients
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var patient1 = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-000001", FirstName = "Jane", LastName = "Smith",
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DateOfBirth = new DateOnly(1975, 4, 12), Gender = "F",
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CreatedAt = DateTimeOffset.UtcNow
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};
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var patient2 = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-000002", FirstName = "Robert", LastName = "Chen",
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DateOfBirth = new DateOnly(1962, 9, 3), Gender = "M",
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.AddRange(patient1, patient2);
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// One active inpatient encounter per patient
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var encounter1 = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient1.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = "ICU",
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AttendingPhysician = "Dr. Osei", AdmittedAt = DateTimeOffset.UtcNow.AddHours(-6),
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CreatedAt = DateTimeOffset.UtcNow.AddHours(-6)
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};
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var encounter2 = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient2.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = "General Medicine",
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AttendingPhysician = "Dr. Patel", AdmittedAt = DateTimeOffset.UtcNow.AddHours(-12),
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CreatedAt = DateTimeOffset.UtcNow.AddHours(-12)
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};
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db.Encounters.AddRange(encounter1, encounter2);
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// Four alert thresholds
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var thresholds = new List<AlertThreshold>
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{
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new() {
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Id = Guid.NewGuid(), ObservationCode = "HEART_RATE", DisplayName = "Heart Rate",
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Unit = "bpm", CriticalLow = 30, WarningLow = 50, WarningHigh = 100, CriticalHigh = 150,
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CreatedAt = DateTimeOffset.UtcNow
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},
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new() {
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Id = Guid.NewGuid(), ObservationCode = "TEMP_C", DisplayName = "Body Temperature",
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Unit = "°C", CriticalLow = 35.0m, WarningLow = 36.0m, WarningHigh = 38.3m, CriticalHigh = 40.0m,
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CreatedAt = DateTimeOffset.UtcNow
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},
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new() {
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Id = Guid.NewGuid(), ObservationCode = "POTASSIUM_MEQ_L", DisplayName = "Serum Potassium",
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Unit = "mEq/L", CriticalLow = 2.5m, WarningLow = 3.5m, WarningHigh = 5.0m, CriticalHigh = 6.5m,
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CreatedAt = DateTimeOffset.UtcNow
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},
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new() {
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Id = Guid.NewGuid(), ObservationCode = "SPO2", DisplayName = "Oxygen Saturation",
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Unit = "%", CriticalLow = 88, WarningLow = 92, WarningHigh = null, CriticalHigh = null,
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CreatedAt = DateTimeOffset.UtcNow
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}
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};
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db.AlertThresholds.AddRange(thresholds);
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// Observations spanning normal, warning, and critical ranges for encounter1
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var now = DateTimeOffset.UtcNow;
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var observations = new List<Observation>
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{
|
||||
// Normal heart rate
|
||||
new() { Id = Guid.NewGuid(), EncounterId = encounter1.Id, ObservationCode = "HEART_RATE",
|
||||
Value = 78, Unit = "bpm", Source = ObservationSource.Device, RecordedAt = now.AddMinutes(-30), CreatedAt = now.AddMinutes(-30) },
|
||||
// Warning heart rate
|
||||
new() { Id = Guid.NewGuid(), EncounterId = encounter1.Id, ObservationCode = "HEART_RATE",
|
||||
Value = 104, Unit = "bpm", Source = ObservationSource.Device, RecordedAt = now.AddMinutes(-15), CreatedAt = now.AddMinutes(-15) },
|
||||
// Critical potassium (low)
|
||||
new() { Id = Guid.NewGuid(), EncounterId = encounter1.Id, ObservationCode = "POTASSIUM_MEQ_L",
|
||||
Value = 2.3m, Unit = "mEq/L", Source = ObservationSource.Lab, RecordedAt = now.AddMinutes(-10), CreatedAt = now.AddMinutes(-10) },
|
||||
// Normal SpO2
|
||||
new() { Id = Guid.NewGuid(), EncounterId = encounter1.Id, ObservationCode = "SPO2",
|
||||
Value = 97, Unit = "%", Source = ObservationSource.Device, RecordedAt = now.AddMinutes(-5), CreatedAt = now.AddMinutes(-5) },
|
||||
// Normal temp for encounter2
|
||||
new() { Id = Guid.NewGuid(), EncounterId = encounter2.Id, ObservationCode = "TEMP_C",
|
||||
Value = 37.1m, Unit = "°C", Source = ObservationSource.Manual, RecordedAt = now.AddMinutes(-20), CreatedAt = now.AddMinutes(-20) }
|
||||
};
|
||||
db.Observations.AddRange(observations);
|
||||
|
||||
await db.SaveChangesAsync();
|
||||
|
||||
// Populate Redis cache with the seeded thresholds
|
||||
var cache = redis.GetDatabase();
|
||||
foreach (var t in thresholds)
|
||||
{
|
||||
var json = JsonSerializer.Serialize(new
|
||||
{
|
||||
t.ObservationCode, t.CriticalLow, t.WarningLow, t.WarningHigh, t.CriticalHigh
|
||||
});
|
||||
await cache.StringSetAsync($"threshold:{t.ObservationCode}", json);
|
||||
}
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user