chore: update readme and clinical testing guide
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voltsrage
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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.
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**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**, and the **Dashboard Gap Analysis Fixes** (SOFA/GCS/qSOFA history charts, patient banner, encounter timeline, medication markers on vital charts). 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).
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**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).
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## Domain Model — How It Maps to a Real Clinical System
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@@ -71,8 +71,8 @@ An `OutboxEvent` is written in the same transaction as any observation or alert,
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- **Alert Suppression Windows** — acknowledging a suppressible alert (`WARNING_*`, `NEWS2_WARNING`) sets a Redis key `suppress:{encounterId}:{alertType}` with a configurable TTL (default 30 min from `AlertSuppression` config; optional per-code override via `alert_thresholds.suppression_window_minutes`); `WarningEvaluator` and `News2Detector` check suppression before creating new warning alerts; critical alerts (`CRITICAL_*`, `NEWS2_EMERGENCY`, `SEPSIS_WARNING`, `RAPID_DETERIORATION`) are never suppressed; observations and NEWS2 scores continue to persist during suppression; Prometheus `alert_suppressions_total`
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- **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
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- **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`
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- **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); filterable by `status` and `department`; `GET /encounters/:id/qsofa/current` exposes Redis-backed qSOFA state; CORS policy `Dashboard` allows configured origins (default `http://localhost:5173`)
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- **Ward Dashboard Frontend** — Vue 3 SPA (`vigilcare-dashboard/`) with virtual ward table (NEWS2-sorted), patient detail (vitals, scores, alerts, orders, sepsis bundle, GCS entry form, SOFA score panel, patient banner with demographics/allergies/emergency contact, encounter timeline), alert center (global acknowledge/resolve), 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`
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- **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`)
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- **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`
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- **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`
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- **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
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- **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
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vigilcare-dashboard/ # Phases 17–19, 22, 27–28, 31 — Vue 3 ward dashboard SPA
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├── src/
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│ ├── api/ # HTTP client (auto Bearer header), encounters, clinical (GCS, SOFA, qSOFA history), alerts, normalize
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│ ├── components/ # charts (SofaHistory, GcsHistory, QsofaHistory, VitalChart with medication markers), replay, alerts, feedback, patient (GcsEntryForm, SofaScorePanel, PatientBanner, EncounterTimeline), ward, layout, ui
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│ ├── composables/ # useChartData, useReplayControls, usePolling, useFeedback, useGcs, useSofa, chartFormat, patientFormat, timelineFormat, chartMedications
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│ ├── api/ # HTTP client (auto Bearer header), encounters, clinical (GCS, SOFA, qSOFA history), alerts, analytics, sepsis, normalize
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│ ├── components/
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│ │ ├── alerts/ # AlertCard, AcknowledgeModal (role-aware), CriticalAlertBanner (browser notifications + audible tone)
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│ │ ├── charts/ # SofaHistory, GcsHistory, QsofaHistory, VitalChart with medication markers
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│ │ ├── departments/ # DepartmentCard, AcuityBar (unit-level snapshot)
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│ │ ├── feedback/ # FeedbackButtons, FeedbackSummary
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│ │ ├── layout/ # AppShell, AppHeader, AppSidebar
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│ │ ├── patient/ # GcsEntryForm, SofaScorePanel, PatientBanner, EncounterTimeline, VitalsEntryForm, VitalsPanel, AlertsList
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│ │ ├── replay/ # ReplayControls
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│ │ ├── sepsis/ # SepsisBundleTable, SepsisBundleRow, SepsisBundleCard (countdown timer)
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│ │ ├── ward/ # WardTable (sortable headers), PatientRow, PatientCard, WardToolbar, SortableHeader, HandoffReport (SBAR + print)
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│ │ └── ui/ # Button, Card, Badge, Skeleton, EmptyState
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│ ├── composables/ # useChartData, useReplayControls, usePolling, useFeedback, useGcs, useSofa, chartFormat, patientFormat, timelineFormat, chartMedications, wardSort, wardFilter, departmentFormat, sepsisFormat, alertAcknowledge, criticalAlertDetect, useAlertNotification, useCriticalAlertPolling, handoffReport, vitalsForm
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│ ├── plugins/ # medicationMarkerPlugin (Chart.js plugin for medication administration markers on vital charts)
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│ ├── stores/ # Pinia — ward, alerts, settings, feedback, scoring, auth (localStorage token + user)
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│ ├── views/ # LoginView, WardDashboard, PatientDetail, AlertCenter, FeedbackSummary
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│ └── __tests__/ # Vitest — tests (store, feedback, replay, charts, alerts, ward, GCS, SOFA, qSOFA, PatientBanner, EncounterTimeline, patientFormat, timelineFormat, chartMedications)
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│ ├── stores/ # Pinia — ward (sort + filter + search), alerts (banner + polling), settings (sort prefs + sound mute), feedback, scoring, auth, departments, sepsis
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│ ├── views/ # LoginView, WardDashboard, PatientDetail, AlertCenter, FeedbackSummary, DepartmentOverviewView, SepsisBoardView
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│ └── __tests__/ # Vitest — tests (store, feedback, replay, charts, alerts, ward, GCS, SOFA, qSOFA, PatientBanner, EncounterTimeline, patientFormat, timelineFormat, chartMedications, wardSort, wardFilter, departmentFormat, sepsisFormat, alertAcknowledge, criticalAlertDetect, HandoffReport, handoffReport, VitalsEntryForm, vitalsForm, useAlertStore, useWardStore, DepartmentOverviewView, SepsisBoardView, AcknowledgeModal, CriticalAlertBanner)
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├── vite.config.js
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└── README.md # Dev quick start → docs/dashboard-guide.md
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**GET `/encounters` query params:** `status` (DB literal, e.g. `ACTIVE`), `department` (DB literal, e.g. `ICU`), `page`, `pageSize`
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**Ward summary fields:** `encounterId`, `patientId`, `mrn`, `firstName`, `lastName`, `roomBed`, `department`, `status`, `news2Score`, `news2RiskLevel`, `qsofaScore`, `sepsisActive`, `sepsisBundleStatus`, `openAlertCount`
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**Ward summary fields:** `encounterId`, `patientId`, `mrn`, `firstName`, `lastName`, `roomBed`, `department`, `status`, `news2Score`, `news2RiskLevel`, `qsofaScore`, `sepsisActive`, `sepsisBundleStatus`, `openAlertCount`, `sofaScore`, `sofaDelta`, `gcsScore`, `gcsClassification`, `lastObservationAt`, `attendingPhysician`, `admittedAt`
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**Encounter status machine:**
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| Method | Path | Description |
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| GET | `/sepsis-bundles` | Paginated list of bundles hospital-wide; optional `status` filter (`IN_PROGRESS`, `COMPLIANT`, `NON_COMPLIANT`); returns `SepsisBundleSummary` with patient demographics, elements, and deadlines |
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| GET | `/encounters/{id}/sepsis-bundle/current` | Current (most recent) sepsis bundle for an encounter (404 if none) |
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| GET | `/sepsis-bundles/{id}` | Bundle detail with all elements and linked orders |
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@@ -2034,7 +2045,7 @@ Observation history uses cursor pagination on `(recorded_at DESC, id DESC)`. Off
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## Implemented Phases
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Twenty-nine phases from the project roadmap are implemented and verified, including the **Site & Gateway Registry** (Phase 20), the **Ward Gateway Service** (Phase 21), the **Dashboard Gap Analysis Fixes** (Phase 22), the **Sepsis-3 clinical refactor** (Phases 27–29), the **FHIR R4 Inbound Facade** (Phase 30), and **RBAC with clinical audit logging** (Phase 31). Integration tests (`dotnet test`) and per-phase verification scripts cover Phases 8–15, 20–22, 25–31. Phases 17–19 add the Vue dashboard and clinician feedback (Vitest in `vigilcare-dashboard/`).
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Twenty-nine phases from the project roadmap are implemented and verified, including the **Site & Gateway Registry** (Phase 20), the **Ward Gateway Service** (Phase 21), the **Dashboard Gap Analysis Fixes** (Phase 22), the **Sepsis-3 clinical refactor** (Phases 27–29), the **FHIR R4 Inbound Facade** (Phase 30), **RBAC with clinical audit logging** (Phase 31), and the **Enhanced Dashboard** (department overview, sepsis bundle board, critical alert notifications, shift handoff reports, vitals entry, sortable/filterable ward table). Integration tests (`dotnet test`) and per-phase verification scripts cover Phases 8–15, 20–22, 25–31. Phases 17–19 add the Vue dashboard and clinician feedback (Vitest in `vigilcare-dashboard/`).
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| Phase | Feature | Status |
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| 30 | **FHIR R4 Inbound Facade** — `FhirIngestController` (`POST /fhir/R4/{Patient,Encounter,Observation,MedicationAdministration}`); `FhirMetadataController` (CapabilityStatement); `FhirBundleProcessor` (transaction Bundles in dependency order); `LoincCodeMapper` (19 LOINC + 3 SNOMED CT → internal codes); `FhirUnitConverter` (°F→°C); `ExternalResourceIdentifier` table + `ExternalIdentifierService` for hospital MRN/visit number ↔ internal UUID linking; `FhirApiKeyMiddleware` (`X-Api-Key` auth); `FhirExceptionFilter` (→ OperationOutcome); `PatientFhirMapper`, `EncounterFhirMapper`, `ObservationFhirMapper`, `MedicationAdministrationFhirMapper`, `FhirReferenceResolver`; idempotent patient/encounter upserts (`RegisterOrUpdateByIdentifierAsync`, `OpenOrUpdateByIdentifierAsync`); configurable identifier systems, department codes, encounter class maps (`FhirOptions`); Prometheus `fhir_ingest_total`, `fhir_mapping_errors_total`; Mirth Connect integration guide; `FhirIngestTests`; `run-phase30-verification.sh` | Done |
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| 31 | **RBAC + Clinical Audit Logging** — JWT bearer authentication (`AuthService`, `AuthController`); four clinical roles (`Nurse`, `Physician`, `Admin`, `Integration`) with 17 granular permissions; `AuthorizePermission` attribute on all controller actions; `PermissionAuthorizationHandler` + `PermissionPolicyProvider` resolve `perm:*` policies; `CurrentUserService` extracts identity from JWT claims; `ClinicalUser` entity with BCrypt password hashing; `ClinicalAuditLog` append-only table with before/after JSONB, user identity, IP, and correlation ID; `AuditService` writes log entries on clinical write actions (10 audit actions); `AuditLogsController` admin-only query with filters; `FhirApiKeyOrJwtMiddleware` dual auth for FHIR routes (JWT or X-Api-Key with multi-key rotation); alert `acknowledgedBy` set from authenticated user, not request body; four seeded demo users; frontend `LoginView` + `auth` Pinia store with `localStorage` token persistence; Vue router auth guard; `RbacTests`; `run-phase31-verification.sh` | Done |
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**Ward dashboard:** backend APIs (`GET /encounters` ward list, `GET /qsofa/current`, `GET /qsofa/history`, `GET /gcs/history`, CORS) and frontend SPA — `EncountersListTests`, `QsofaCurrentTests`, `GapAnalysisFixTests`, `vigilcare-dashboard` Vitest suite (replay scrubbing, feedback store, FeedbackButtons, FeedbackSummary, alert components, charts, ward table, GCS entry/history, SOFA panel/history, qSOFA history, scores panel, alert labels, PatientBanner, EncounterTimeline, medication chart markers).
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**Ward dashboard:** backend APIs (`GET /encounters` ward list with extended summary fields including SOFA/GCS/attending/admitted-at, `GET /qsofa/current`, `GET /qsofa/history`, `GET /gcs/history`, `GET /sepsis-bundles` hospital-wide list, CORS) and frontend SPA — `EncountersListTests`, `QsofaCurrentTests`, `GapAnalysisFixTests`, `vigilcare-dashboard` Vitest suite (replay scrubbing, feedback store, FeedbackButtons, FeedbackSummary, alert components, charts, ward table, ward sort, ward filter, department format, sepsis format, alert acknowledge, critical alert detect, handoff report, vitals form, GCS entry/history, SOFA panel/history, qSOFA history, scores panel, alert labels, PatientBanner, EncounterTimeline, medication chart markers, AcknowledgeModal, CriticalAlertBanner, DepartmentOverviewView, SepsisBoardView, VitalsEntryForm, useAlertStore, useWardStore).
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**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`.
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**Site & Gateway Registry (Phase 20):** Central API manages clinical sites and ward edge nodes (gateways). Gateways authenticate via API key for heartbeat and sync upload. Shared `VigilCare.ClinicalContracts` class library defines sync DTOs consumed by both central API and ward gateway projects. Prometheus fleet health gauges track offline gateways and buffer depth per site.
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