vigilcare-clinical/VigilCareClinicalAPI.Tests/MedicationCorrelationTests.cs

using FluentAssertions;
using Microsoft.EntityFrameworkCore;
using Microsoft.Extensions.DependencyInjection;
using StackExchange.Redis;

[Collection("Integration")]
public class MedicationCorrelationTests : IAsyncLifetime
{
    private readonly ApiFixture _fixture;
    private Guid _patientId;
    private Guid _encounterId;

    public MedicationCorrelationTests(ApiFixture fixture) => _fixture = fixture;

    public async Task InitializeAsync() => await ResetAndSeedAsync();

    public Task DisposeAsync() => Task.CompletedTask;

    private async Task ResetAndSeedAsync()
    {
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        await DbResetHelper.ResetAsync(db);

        var patient = new Patient
        {
            Id = Guid.NewGuid(), Mrn = "MRN-CORR-001", FirstName = "Correlation", LastName = "Test",
            DateOfBirth = new DateOnly(1970, 6, 10), Gender = "M", CreatedAt = DateTimeOffset.UtcNow
        };
        var encounter = new Encounter
        {
            Id = Guid.NewGuid(), PatientId = patient.Id, EncounterType = EncounterType.Inpatient,
            Status = EncounterStatus.Active, Department = Department.Icu,
            AttendingPhysician = "Dr. Correlation", AdmittedAt = DateTimeOffset.UtcNow,
            CreatedAt = DateTimeOffset.UtcNow
        };
        db.Patients.Add(patient);
        db.Encounters.Add(encounter);

        db.AlertThresholds.Add(new AlertThreshold
        {
            Id = Guid.NewGuid(), ObservationCode = "SYSTOLIC_BP",
            DisplayName = "Systolic BP", Unit = "mmHg",
            CriticalLow = 70, WarningLow = 90, WarningHigh = 180, CriticalHigh = 220,
            CreatedAt = DateTimeOffset.UtcNow
        });
        db.AlertThresholds.Add(new AlertThreshold
        {
            Id = Guid.NewGuid(), ObservationCode = "RESP_RATE",
            DisplayName = "Respiratory Rate", Unit = "breaths/min",
            CriticalLow = 5, WarningLow = 8, WarningHigh = 25, CriticalHigh = 35,
            CreatedAt = DateTimeOffset.UtcNow
        });
        await db.SaveChangesAsync();

        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
        var cache = redis.GetDatabase(1);
        await cache.StringSetAsync("threshold:SYSTOLIC_BP",
            """{"ObservationCode":"SYSTOLIC_BP","CriticalLow":70,"WarningLow":90,"WarningHigh":180,"CriticalHigh":220}""");
        await cache.StringSetAsync("threshold:RESP_RATE",
            """{"ObservationCode":"RESP_RATE","CriticalLow":5,"WarningLow":8,"WarningHigh":25,"CriticalHigh":35}""");

        _patientId = patient.Id;
        _encounterId = encounter.Id;
    }

    [Fact]
    public async Task MetoprololThenLowBp_AnnotatedDetails()
    {
        await ResetAndSeedAsync();

        using var scope = _fixture.Services.CreateScope();
        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
        await medService.CreateAsync(_encounterId,
            new CreateMedicationAdministrationRequest(
                "metoprolol", 25m, "mg", "PO",
                DateTimeOffset.UtcNow.AddMinutes(-45), "nurse-1"));

        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);

        created.Should().BeTrue();

        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts
            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
        alert.Details.Should().Contain("metoprolol");
        alert.Details.Should().Contain("min ago");
        alert.Details.Should().Contain("note:");
    }

    [Fact]
    public async Task LowBpWithoutMedication_Unannotated()
    {
        await ResetAndSeedAsync();

        using var scope = _fixture.Services.CreateScope();
        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);

        created.Should().BeTrue();

        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts
            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
        alert.Details.Should().NotContain("note:");
    }

    [Fact]
    public async Task UnrelatedDrug_NoAnnotation()
    {
        await ResetAndSeedAsync();

        using var scope = _fixture.Services.CreateScope();
        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
        // Insulin maps to GLUCOSE_MG_DL, not SYSTOLIC_BP
        await medService.CreateAsync(_encounterId,
            new CreateMedicationAdministrationRequest(
                "insulin", 10m, "units", "SubQ",
                DateTimeOffset.UtcNow.AddMinutes(-30), "nurse-1"));

        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);

        created.Should().BeTrue();

        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts
            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
        alert.Details.Should().NotContain("note:");
        alert.Details.Should().NotContain("insulin");
    }

    [Fact]
    public async Task MedicationOutsideWindow_NoAnnotation()
    {
        await ResetAndSeedAsync();

        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        // Metoprolol administered 2 hours ago — outside 90-min window
        db.MedicationAdministrations.Add(new MedicationAdministration
        {
            Id = Guid.NewGuid(),
            EncounterId = _encounterId,
            DrugName = "metoprolol",
            Dose = 25m,
            DoseUnit = "mg",
            Route = "PO",
            AdministeredAt = DateTimeOffset.UtcNow.AddMinutes(-120),
            AdministeredBy = "nurse-1"
        });
        await db.SaveChangesAsync();

        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "SYSTOLIC_BP", 85m);

        created.Should().BeTrue();

        var alert = await db.ClinicalAlerts
            .SingleAsync(a => a.AlertType == AlertType.WarningSystolicBp);
        alert.Details.Should().NotContain("note:");
        alert.Details.Should().NotContain("metoprolol");
    }

    [Fact]
    public async Task MorphineThenLowRespRate_Annotated()
    {
        await ResetAndSeedAsync();

        using var scope = _fixture.Services.CreateScope();
        var medService = scope.ServiceProvider.GetRequiredService<IMedicationService>();
        await medService.CreateAsync(_encounterId,
            new CreateMedicationAdministrationRequest(
                "morphine", 4m, "mg", "IV",
                DateTimeOffset.UtcNow.AddMinutes(-20), "nurse-1"));

        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "RESP_RATE", 7m);

        created.Should().BeTrue();

        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
        var alert = await db.ClinicalAlerts
            .SingleAsync(a => a.AlertType == AlertType.WarningRespRate);
        alert.Details.Should().Contain("morphine");
        alert.Details.Should().Contain("min ago");
        alert.Details.Should().Contain("note:");
    }
}