feature: Observation Ingest, Synchronous Alert Detection, and Alert Lifecycle
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voltsrage
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using System.Net;
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using System.Net.Http.Json;
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using System.Text.Json;
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using FluentAssertions;
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using Microsoft.EntityFrameworkCore;
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using Microsoft.Extensions.DependencyInjection;
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using StackExchange.Redis;
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[Collection("Integration")]
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public class ObservationIngestTests : IAsyncLifetime
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{
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private readonly ApiFixture _fixture;
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private readonly HttpClient _client;
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private Guid _patientId;
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private Guid _encounterId;
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public ObservationIngestTests(ApiFixture fixture)
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{
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_fixture = fixture;
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_client = fixture.CreateClient();
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}
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public async Task InitializeAsync()
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{
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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await DbResetHelper.ResetAsync(db);
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// Seed one patient, one active encounter, and the four thresholds
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var patient = new Patient
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{
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Id = Guid.NewGuid(), Mrn = "MRN-T001", FirstName = "Test", LastName = "Patient",
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DateOfBirth = new DateOnly(1970, 1, 1), Gender = "F", CreatedAt = DateTimeOffset.UtcNow
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};
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var encounter = new Encounter
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{
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Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
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Status = EncounterStatus.Active, Department = "ICU",
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AttendingPhysician = "Dr. Test", AdmittedAt = DateTimeOffset.UtcNow,
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CreatedAt = DateTimeOffset.UtcNow
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};
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db.Patients.Add(patient);
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db.Encounters.Add(encounter);
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db.AlertThresholds.AddRange(
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new AlertThreshold { Id = Guid.NewGuid(), ObservationCode = "HEART_RATE",
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DisplayName = "Heart Rate", Unit = "bpm",
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CriticalLow = 30, WarningLow = 50, WarningHigh = 100, CriticalHigh = 150,
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CreatedAt = DateTimeOffset.UtcNow },
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new AlertThreshold { Id = Guid.NewGuid(), ObservationCode = "POTASSIUM_MEQ_L",
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DisplayName = "Serum Potassium", Unit = "mEq/L",
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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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await db.SaveChangesAsync();
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// Pre-load thresholds into Redis (replicates what ThresholdCacheLoader does at startup)
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var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
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var cache = redis.GetDatabase(1);
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await cache.StringSetAsync("threshold:HEART_RATE",
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"""{"ObservationCode":"HEART_RATE","CriticalLow":30,"WarningLow":50,"WarningHigh":100,"CriticalHigh":150}""");
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await cache.StringSetAsync("threshold:POTASSIUM_MEQ_L",
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"""{"ObservationCode":"POTASSIUM_MEQ_L","CriticalLow":2.5,"WarningLow":3.5,"WarningHigh":5.0,"CriticalHigh":6.5}""");
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_patientId = patient.Id;
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_encounterId = encounter.Id;
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}
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public Task DisposeAsync() => Task.CompletedTask;
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// Test 1: normal observation — no alert created
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[Fact]
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public async Task NormalObservation_NoAlert_Created()
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{
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var resp = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 78, "bpm", ObservationSource.Device, DateTimeOffset.UtcNow, null)
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}));
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resp.StatusCode.Should().Be(HttpStatusCode.Created);
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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body!.RootElement.GetProperty("data").GetProperty("alertGenerated").GetBoolean()
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.Should().BeFalse();
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body.RootElement.GetProperty("data").GetProperty("duplicate").GetBoolean()
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.Should().BeFalse();
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alertCount = await db.ClinicalAlerts.CountAsync();
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alertCount.Should().Be(0, "a normal value must not create an alert");
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// Outbox event should still be written for the Kafka consumer (warning detection)
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var outboxCount = await db.OutboxEvents.CountAsync();
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outboxCount.Should().Be(1, "observation.recorded outbox event must be written for every observation");
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var outboxTopic = await db.OutboxEvents.Select(e => e.Topic).FirstAsync();
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outboxTopic.Should().Be("observation.recorded");
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}
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// Test 2: critical threshold breach — alert and outbox event in same transaction
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[Fact]
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public async Task CriticalBreach_AlertCreated_InSameTransaction()
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{
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// Potassium 2.1 mEq/L is below critical_low of 2.5 — immediately life-threatening
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var resp = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("POTASSIUM_MEQ_L", 2.1m, "mEq/L", ObservationSource.Lab, DateTimeOffset.UtcNow, "key-critical-001")
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}));
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resp.StatusCode.Should().Be(HttpStatusCode.Created);
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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body!.RootElement.GetProperty("data").GetProperty("alertGenerated").GetBoolean()
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.Should().BeTrue();
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alert = await db.ClinicalAlerts.SingleAsync();
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alert.Severity.Should().Be(AlertSeverity.Critical);
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alert.Status.Should().Be(AlertStatus.Open);
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alert.EncounterId.Should().Be(_encounterId);
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alert.PatientId.Should().Be(_patientId);
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// Both outbox events must exist: alert.generated AND observation.recorded
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var topics = await db.OutboxEvents.Select(e => e.Topic).OrderBy(t => t).ToListAsync();
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topics.Should().BeEquivalentTo(new[] { "alert.generated", "observation.recorded" });
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}
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// Test 3: warning threshold breach — no alert created; only observation.recorded outbox event
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[Fact]
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public async Task WarningBreach_NoAlertCreated_OnlyObservationOutboxEvent()
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{
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// Heart rate 104 bpm is above warning_high (100) but below critical_high (150)
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var resp = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 104, "bpm", ObservationSource.Device, DateTimeOffset.UtcNow, null)
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}));
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resp.StatusCode.Should().Be(HttpStatusCode.Created);
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var alertCount = await db.ClinicalAlerts.CountAsync();
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alertCount.Should().Be(0, "warning detection is deferred to the Kafka consumer in Phase 3");
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var topics = await db.OutboxEvents.Select(e => e.Topic).ToListAsync();
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topics.Should().ContainSingle().Which.Should().Be("observation.recorded");
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}
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// Test 4: duplicate idempotency key — returns 201 with original observation, no duplicate
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[Fact]
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public async Task DuplicateIdempotencyKey_Returns201_NoDuplicateRow()
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{
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var payload = new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 78, "bpm", ObservationSource.Device, DateTimeOffset.UtcNow, "device-key-abc123")
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});
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var resp1 = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations", payload);
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var resp2 = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations", payload);
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resp1.StatusCode.Should().Be(HttpStatusCode.Created);
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resp2.StatusCode.Should().Be(HttpStatusCode.Created);
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var body2 = await resp2.Content.ReadFromJsonAsync<JsonDocument>();
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body2!.RootElement.GetProperty("data").GetProperty("duplicate").GetBoolean()
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.Should().BeTrue("the second call must be identified as a duplicate");
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var count = await db.Observations.CountAsync();
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count.Should().Be(1, "only one observation row must exist despite two identical requests");
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}
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// Test 5: discharged encounter — 409 returned, no observation written
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[Fact]
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public async Task DischargedEncounter_Returns409_NoObservationWritten()
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{
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// Discharge the encounter
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var patchResp = await _client.PatchAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/status",
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new { status = "Discharged" });
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patchResp.StatusCode.Should().Be(HttpStatusCode.OK);
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// Attempt to ingest against a discharged encounter
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var resp = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 78, "bpm", ObservationSource.Device, DateTimeOffset.UtcNow, null)
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}));
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resp.StatusCode.Should().Be(HttpStatusCode.Conflict);
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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body!.RootElement.GetProperty("error").GetProperty("code").GetString()
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.Should().Be("ENCOUNTER_NOT_ACTIVE");
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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var count = await db.Observations.CountAsync();
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count.Should().Be(0, "no observation must be written when encounter is not active");
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}
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// Test 6: plausibility violation — 422 returned, no rows written
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[Fact]
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public async Task ImplausibleValue_Returns422_NoRowsWritten()
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{
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// Heart rate of 350 bpm: above plausibility ceiling of 300
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var resp = await _client.PostAsJsonAsync(
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$"/api/v1/encounters/{_encounterId}/observations",
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new BatchIngestRequest(new List<IngestObservationRequest>
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{
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new("HEART_RATE", 350, "bpm", ObservationSource.Device, DateTimeOffset.UtcNow, null)
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}));
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resp.StatusCode.Should().Be(HttpStatusCode.UnprocessableEntity);
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var body = await resp.Content.ReadFromJsonAsync<JsonDocument>();
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body!.RootElement.GetProperty("error").GetProperty("code").GetString()
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.Should().Be("OBSERVATION_OUT_OF_PLAUSIBLE_RANGE");
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using var scope = _fixture.Services.CreateScope();
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var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
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(await db.Observations.CountAsync()).Should().Be(0);
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(await db.OutboxEvents.CountAsync()).Should().Be(0);
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}
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}
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