feature: MIMIC-IV Replay Scenario Generator
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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:** Thirty-two planned phases are complete through Phase 34 (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), **Alert Quality Analytics** (server-side clinician feedback with `AlertFeedback` entity, `AlertQualityAggregatorService` background metrics, quality metrics API, Grafana alert quality dashboard), and **Explainable Alerts** (immutable JSONB `explanation` on composite alerts with score contributors, trend context, structured medication context, and bedside `NarrativeSummary`; `AlertResponse` DTO on GET/list/acknowledge/resolve; dashboard `AlertReasoning.vue`; ES indexer and data lake propagation; ward gateway sync). 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:** Thirty-three planned phases are complete through Phase 35 (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), **Alert Quality Analytics** (server-side clinician feedback with `AlertFeedback` entity, `AlertQualityAggregatorService` background metrics, quality metrics API, Grafana alert quality dashboard), **Explainable Alerts** (immutable JSONB `explanation` on composite alerts with score contributors, trend context, structured medication context, and bedside `NarrativeSummary`; `AlertResponse` DTO on GET/list/acknowledge/resolve; dashboard `AlertReasoning.vue`; ES indexer and data lake propagation; ward gateway sync), and **MIMIC-IV Replay Scenario Generator** (offline CLI tool converting real de-identified ICU data from MIT PhysioNet into VigilCare scenario JSONs; streaming CSV parser for 668K-row chartevents; 17 chart + 8 lab item ID mappings to VigilCare observation codes; GCS text-to-numeric conversion; Fahrenheit-to-Celsius; blood pressure deduplication preferring non-invasive over arterial; 10-observation cluster limit enforcement; `mimic-list` and `mimic-generate` CLI commands with Spectre.Console output; 100 patients / 140 ICU stays available for replay through NEWS2, SOFA, GCS, qSOFA, trend detection, and alerting). 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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@@ -92,7 +92,8 @@ An `OutboxEvent` is written in the same transaction as any observation or alert,
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- **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
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- **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)
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- **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
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- **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`); `ExpectedOutcomeValidator` validates alert `narrativeContains` on key scenarios; 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`
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- **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`, `mimic-list`, `mimic-generate`; 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`); `ExpectedOutcomeValidator` validates alert `narrativeContains` on key scenarios; twelve sample scenarios in `VigilCare.Simulator/Scenarios/List/` (including ward outage reconnect, GCS neurological decline, SOFA sepsis progression, and SpO₂/FiO₂ fallback); MIMIC-IV scenario generation from real ICU data; user guide in `docs/simulator-guide.md`
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- **MIMIC-IV Scenario Generator** — offline CLI tool that reads MIMIC-IV CSV files (`docs/MIMIC-IV/`, 100 patients, 140 ICU stays, 668K chart events, 107K lab events) and generates VigilCare scenario JSONs; `mimic-list <dir>` displays a Spectre.Console table of available stays with demographics, care unit, LOS, and outcome; `mimic-generate <dir> --stay-id <id>` produces a scenario with options for `--max-hours`, `--no-medications`, `--no-labs`, `--validate`; streaming CSV parser (`MimicCsvReader`) filters 668K-row chartevents by stay_id and item ID set at the string level before allocating records; `MimicItemMap` maps 17 chart event items (vitals, GCS, FiO₂, PaO₂, labs) and 8 lab event items to VigilCare observation codes; GCS text labels ("Obeys Commands" → 6, "To Speech" → 3) resolved from `valuenum` with text-to-numeric fallback dictionary; Fahrenheit temperature converted to Celsius; blood pressure deduplication prefers non-invasive (NBP) over arterial (ABP); 10-observation-per-cluster limit enforced by priority-based splitting (vitals first, labs spill to next offset); medications from prescriptions with dose parsing; generated scenarios pass `ScenarioValidator` and replay through the standard `replay` command
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- **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`
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- **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
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- **Reconciliation Jobs** — three scheduled checks: (1) unacknowledged CRITICAL alerts older than 30 minutes, (2) pending orders without results after 4 hours, (3) active inpatients with no observation in 2 hours; each finding creates a `reconciliation_alerts` row and publishes to RabbitMQ
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@@ -569,8 +570,8 @@ VigilCare.WardGateway.Tests/ # Phase 21 — ward gateway i
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├── WardGatewayLocalPathTests.cs # Local observation ingest, warning alerts, buffered sync items
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└── WardGatewayPartitionTests.cs # Network partition simulation — offline buffering and sync upload
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VigilCare.Simulator/ # Phase 16, 29, 34 — console replay simulator (HTTP-only, no direct DB/Kafka)
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├── Program.cs # CLI: replay, replay-all, validate, dry-run
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VigilCare.Simulator/ # Phase 16, 29, 34, 35 — console replay simulator (HTTP-only, no direct DB/Kafka)
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├── Program.cs # CLI: replay, replay-all, validate, dry-run, mimic-list, mimic-generate
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├── Commands/ # System.CommandLine command handlers
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├── Client/
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│ ├── VigilCareApiClient.cs # Typed HTTP client for all API endpoints (incl. GCS, SOFA)
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├── Engine/ReplayEngine.cs # Scenario replay with speed multiplier + event logging
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├── Output/SimulatorConsole.cs # Colored output with GCS/SOFA score + explanation display
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├── Polling/ApiPoller.cs # Optional post-event alert/score/bundle/GCS/SOFA polling
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├── Mimic/ # Phase 35 — MIMIC-IV scenario generator
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│ ├── MimicCsvReader.cs # Streaming CSV parser with header-index lookup and filter predicate
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│ ├── MimicItemMap.cs # MIMIC item ID → VigilCare observation code mappings (17 chart + 8 lab)
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│ ├── MimicCareUnitMap.cs # ICU care unit → department + tag mapping
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│ ├── MimicDataLoader.cs # Data access layer with streaming filters for chartevents/labevents
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│ ├── MimicScenarioBuilder.cs # Core algorithm: BP dedup, cluster limits, offset conversion
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│ ├── MimicListCommand.cs # CLI: mimic-list — Spectre.Console table of available stays
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│ └── MimicGenerateCommand.cs # CLI: mimic-generate — produces scenario JSON from a stay ID
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├── Scenarios/ # schema.json, ScenarioLoader, ScenarioValidator, ExpectedOutcomeValidator
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└── Scenarios/List/ # Twelve sample scenarios (sepsis, GCS, SOFA, NEWS2, stable, ward outage, …)
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└── Scenarios/List/ # Twelve sample scenarios + MIMIC-generated scenarios
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vigilcare-dashboard/ # Phases 17–19, 22, 23, 27–28, 31, 33–34 — Vue 3 ward dashboard SPA
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├── src/
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@@ -830,6 +839,21 @@ dotnet run --project VigilCare.Simulator -- replay \
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Other commands: `validate <file>`, `dry-run <file>`, `replay-all <directory>`. See `docs/simulator-guide.md` for the full user guide.
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**MIMIC-IV real patient data (Phase 35):** generate and replay scenarios from de-identified ICU records:
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```bash
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# List 140 available ICU stays across 100 patients
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dotnet run --project VigilCare.Simulator -- mimic-list docs/MIMIC-IV/
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# Generate a 24-hour scenario from a CVICU patient
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dotnet run --project VigilCare.Simulator -- mimic-generate docs/MIMIC-IV/ \
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--stay-id 32604416 --max-hours 24 --validate
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# Replay the generated scenario
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dotnet run --project VigilCare.Simulator -- replay \
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VigilCare.Simulator/Scenarios/List/mimic-s32604416.json --speed 0 --poll
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```
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**Ward outage reconnect (Phase 24):** scenario `ward-outage-reconnect-01.json` exercises critical hyperkalemia alerting and nurse acknowledgment during a central outage, then sync back to central when connectivity returns. Manual procedure in `docs/simulator-guide.md` §10; automated end-to-end check:
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```bash
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@@ -2226,7 +2250,7 @@ Observation history uses cursor pagination on `(recorded_at DESC, id DESC)`. Off
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## Implemented Phases
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Thirty-two 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 **Degraded Operations Visibility** (Phase 23), the **Sepsis-3 clinical refactor** (Phases 27–29), the **FHIR R4 Inbound Facade** (Phase 30), **RBAC with clinical audit logging** (Phase 31), the **Alert Quality Analytics** (Phase 33), the **Explainable Alerts** (Phase 34), 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, 20–23, 25–31, 33–34. Phases 17–19 add the Vue dashboard and clinician feedback (Vitest in `vigilcare-dashboard/`).
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Thirty-three 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 **Degraded Operations Visibility** (Phase 23), the **Sepsis-3 clinical refactor** (Phases 27–29), the **FHIR R4 Inbound Facade** (Phase 30), **RBAC with clinical audit logging** (Phase 31), the **Alert Quality Analytics** (Phase 33), the **Explainable Alerts** (Phase 34), the **MIMIC-IV Replay Scenario Generator** (Phase 35), 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, 20–23, 25–31, 33–35. 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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|---|---|---|
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@@ -2262,6 +2286,7 @@ Thirty-two phases from the project roadmap are implemented and verified, includi
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| 23 | **Degraded Operations Visibility** — `GatewayStaleDetectorService` background service auto-marks gateways OFFLINE when heartbeat exceeds configurable `StaleThresholdMinutes`; `OperationsController` exposes gateway fleet listing (`GET /operations/gateways` with status/site filters), gateway detail (`GET /operations/gateways/{id}`), and site summary (`GET /operations/sites/{siteId}/summary`); `DischargeSummaryService` with `GET /encounters/{id}/discharge-summary` (info) and `GET /encounters/{id}/discharge-summary/content` (MinIO PDF download); `UsersController` (`GET /users`, `POST /users`, `PATCH /users/{id}`) for admin user account management; frontend: `GatewayOperations.vue` operations dashboard, `DegradedModeBanner.vue` warning banner, `DischargeSummaryPanel.vue` on patient detail, `ThresholdManagementView.vue` with `ThresholdFormModal.vue`, `UserManagementView.vue` with `UserFormModal.vue`, `AuditLogView.vue`, `ReconciliationView.vue`; role-aware admin sidebar navigation; `roleAccess.js` composable; `useChartTheme.js`, `useFocusTrap.js`, `useApiMode.js` composables; `CollapsibleSection.vue`, `SeverityBadge.vue` UI components; `OperationsApiTests`; `run-phase23-verification.sh` | Done |
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| 33 | **Alert Quality Analytics** — `AlertFeedback` entity with per-user-per-alert constraint; `POST /alerts/{id}/feedback` server-side feedback submission with `alerts:feedback` permission (Nurse, Physician, Admin); `AlertQualityMetric` entity stores per-alert-type quality snapshots (acknowledgement rate, false positive rate, useful rate, would-act rate, avg seconds to acknowledge/resolve); `AlertQualityAggregatorService` background service computes metrics periodically; `AlertQualityMetricsController` exposes `GET /alerts/quality-metrics` (time-range + alert type filter) and `GET /alerts/quality-metrics/summary`; `AlertFeedbackConfiguration` and `AlertQualityMetricConfiguration` EF Core configs; `SubmitAlertFeedbackRequestValidator`; Prometheus `alert_quality_useful_rate` and `alert_quality_false_positive_rate` gauges; Grafana `alert-quality-dashboard.json`; frontend `AlertQualityAnalytics.vue` with `AlertQualityChart.vue` and `alertQuality` Pinia store; `AlertQualityAnalyticsTests`; `run-phase33-verification.sh` | Done |
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| 34 | **Explainable Alerts** — `AlertExplanation` value object (`ScoreContributor`, `TrendContext`, `MedicationContext`, `NarrativeSummary`); JSONB `ClinicalAlert.Explanation` column (immutable at creation); contributor builders for NEWS2, SOFA, GCS; `TrendContextBuilder`; `AlertExplanationBuilder` + `ClinicalAlertFactory`; NEWS2, SOFA, GCS, and `TrendDetector` wire explanation and include `explanation` in `alert.generated` outbox; `MedicationCorrelationHelper.TryGetContextAsync()` for structured medication context; `AlertResponse` DTO + `AlertResponseMapper`; GET/list/acknowledge/resolve return `AlertResponse`; ES indexer projects `NarrativeSummary`; data lake Parquet `explanation_json`; ward gateway `LocalClinicalAlert.ExplanationJson` + sync; dashboard `AlertReasoning.vue` + `alertExplanation.js`; simulator `ExpectedOutcomeValidator` with `narrativeContains`; `ExplainableAlertsTests`; `run-phase34-verification.sh` | Done |
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| 35 | **MIMIC-IV Replay Scenario Generator** — offline CLI tool in `VigilCare.Simulator/Mimic/` that reads MIMIC-IV CSV files (100 patients, 140 ICU stays, 668K chart events, 107K lab events from `docs/MIMIC-IV/`) and generates standard VigilCare scenario JSONs; `MimicCsvReader` streaming CSV parser with header-index lookup and filter predicate (memory-efficient for large files); `MimicItemMap` maps 17 chart event items (vitals, GCS, FiO₂, PaO₂, labs) and 8 lab event items to VigilCare observation codes with GCS text-to-numeric fallback dictionary, Fahrenheit-to-Celsius conversion, and blood pressure priority (non-invasive preferred over arterial); `MimicCareUnitMap` maps care units to departments and generates tags; `MimicDataLoader` streams chartevents/labevents/prescriptions filtered by stay_id + item ID set; `MimicScenarioBuilder` deduplicates BP, enforces 10-observation-per-cluster limit with priority-based splitting, computes offsetMinutes, parses medication doses; `MimicListCommand` (`mimic-list`) displays Spectre.Console table of available stays; `MimicGenerateCommand` (`mimic-generate`) produces scenario JSON with `--max-hours`, `--no-medications`, `--no-labs`, `--validate` options; generated scenarios pass `ScenarioValidator` and replay through the standard `replay` command | Done |
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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, `GET /operations/gateways` fleet management, `GET /users` user management, `GET /alerts/quality-metrics` alert quality, `GET /alerts/{id}` with structured explanation, CORS) and frontend SPA — `EncountersListTests`, `QsofaCurrentTests`, `GapAnalysisFixTests`, `OperationsApiTests`, `AlertQualityAnalyticsTests`, `ExplainableAlertsTests`, `vigilcare-dashboard` Vitest suite (replay scrubbing, feedback store, FeedbackButtons, FeedbackSummary, alert components, AlertReasoning, 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, roleAccess, ThresholdManagementView, DischargeSummaryPanel, GatewayOperations, alertQuality).
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@@ -2287,6 +2312,8 @@ Thirty-two phases from the project roadmap are implemented and verified, includi
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**Explainable Alerts (Phase 34):** Composite alerts (NEWS2, SOFA, GCS, rapid deterioration) carry an immutable JSONB `explanation` snapshot at creation — score contributors with raw values and normal ranges, trend context (percent change, duration, direction), structured medication context, and a bedside `NarrativeSummary`. `AlertResponse` exposes explanation on GET/list/acknowledge/resolve. Downstream consumers (Elasticsearch indexer, data lake Parquet, ward gateway sync, Kafka `alert.generated`) propagate explanation without breaking legacy consumers. Dashboard `AlertReasoning.vue` renders structured reasoning. Simulator validates `narrativeContains` on key scenarios.
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**MIMIC-IV Replay Scenario Generator (Phase 35):** Offline CLI tool that converts real de-identified ICU data from MIT's MIMIC-IV dataset into VigilCare scenario JSONs. `mimic-list` browses 140 ICU stays across 100 patients with demographics, care unit, LOS, and outcome. `mimic-generate` produces a scenario from a specific stay ID with options for duration capping, medication/lab exclusion, and inline validation. The streaming CSV parser handles 668K-row chartevents efficiently by filtering at the string level before allocating records. Item mappings cover 17 chart event items (vitals, GCS text-to-numeric, FiO₂, PaO₂, ICU labs) and 8 lab event items (creatinine, platelets, bilirubin, lactate, WBC, potassium, glucose, PaO₂). Blood pressure deduplication prefers non-invasive over arterial readings. The 10-observation-per-cluster limit is enforced by priority-based splitting (vitals first, labs spill to the next offset). Generated scenarios are structurally identical to hand-crafted ones and replay through the existing `replay` command, driving NEWS2, SOFA, GCS, qSOFA, trend detection, and alerting on real patient trajectories.
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**Post-phase hardening (after Phase 31):**
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- **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
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- **Alert threshold deletion** — `DELETE /alert-thresholds/{id}` with `THRESHOLD_DELETED` audit action and Redis cache invalidation
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