vigilcare-clinical/VigilCareClinicalAPI.Tests/AlertSuppressionTests.cs

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

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

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

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

    public Task DisposeAsync() => Task.CompletedTask;

    private async Task ResetAndSeedThresholdAsync()
    {
        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-SUP-001", FirstName = "Suppress", LastName = "Test",
            DateOfBirth = new DateOnly(1982, 8, 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. Suppress", AdmittedAt = DateTimeOffset.UtcNow,
            CreatedAt = DateTimeOffset.UtcNow
        };
        db.Patients.Add(patient);
        db.Encounters.Add(encounter);
        db.AlertThresholds.Add(new AlertThreshold
        {
            Id = Guid.NewGuid(), ObservationCode = "HEART_RATE",
            DisplayName = "Heart Rate", Unit = "bpm",
            CriticalLow = 30, WarningLow = 50, WarningHigh = 100, CriticalHigh = 150,
            CreatedAt = DateTimeOffset.UtcNow
        });
        await db.SaveChangesAsync();

        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
        await redis.GetDatabase().StringSetAsync("threshold:HEART_RATE",
            """{"ObservationCode":"HEART_RATE","CriticalLow":30,"WarningLow":50,"WarningHigh":100,"CriticalHigh":150}""");

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

    [Fact]
    public async Task AcknowledgeWarning_SetsSuppressionKey()
    {
        await ResetAndSeedThresholdAsync();

        var alertId = await SeedAlertAsync(AlertType.WarningHeartRate, AlertSeverity.Warning);

        using var scope = _fixture.Services.CreateScope();
        var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();

        await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));

        var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.WarningHeartRate);
        (await redis.GetDatabase().KeyExistsAsync(key)).Should().BeTrue();
    }

    [Fact]
    public async Task SuppressedWarning_SkipsAlertCreation()
    {
        await ResetAndSeedThresholdAsync();

        var alertId = await SeedAlertAsync(AlertType.WarningHeartRate, AlertSeverity.Warning);

        using var scope = _fixture.Services.CreateScope();
        var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();

        await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));
        await alerts.ResolveAsync(alertId);

        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);

        created.Should().BeFalse();
        (await db.ClinicalAlerts.CountAsync()).Should().Be(1,
            "suppressed warning must not create a new alert after resolve");
    }

    [Fact]
    public async Task CriticalAlert_NotSuppressible()
    {
        await ResetAndSeedThresholdAsync();

        var alertId = await SeedAlertAsync(AlertType.CriticalHeartRate, AlertSeverity.Critical);

        using var scope = _fixture.Services.CreateScope();
        var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();

        await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("dr-1", "treating"));

        var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.CriticalHeartRate);
        (await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
    }

    [Fact]
    public async Task News2Emergency_NotSuppressible()
    {
        await ResetAndSeedThresholdAsync();

        var alertId = await SeedAlertAsync(AlertType.News2Emergency, AlertSeverity.Critical);

        using var scope = _fixture.Services.CreateScope();
        var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();

        await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("dr-1", "reviewed"));

        var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.News2Emergency);
        (await redis.GetDatabase().KeyExistsAsync(key)).Should().BeFalse();
    }

    [Fact]
    public async Task News2Warning_Suppressible()
    {
        await ResetAndSeedThresholdAsync();

        var alertId = await SeedAlertAsync(AlertType.News2Warning, AlertSeverity.Warning);

        using var scope = _fixture.Services.CreateScope();
        var alerts = scope.ServiceProvider.GetRequiredService<IAlertService>();
        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();

        await alerts.AcknowledgeAsync(alertId, new AcknowledgeAlertRequest("nurse-1", "monitoring"));

        var key = AlertSuppressionService.SuppressionKey(_encounterId, AlertType.News2Warning);
        (await redis.GetDatabase().KeyExistsAsync(key)).Should().BeTrue();
    }

    [Fact]
    public async Task SuppressionExpires_AllowsNewAlert()
    {
        await ResetAndSeedThresholdAsync();

        using var scope = _fixture.Services.CreateScope();
        var suppression = scope.ServiceProvider.GetRequiredService<IAlertSuppressionService>();
        var evaluator = scope.ServiceProvider.GetRequiredService<WarningEvaluator>();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();

        await suppression.SetSuppressionAsync(
            _encounterId, AlertType.WarningHeartRate, TimeSpan.FromSeconds(1));

        var blocked = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);
        blocked.Should().BeFalse();

        await Task.Delay(1500);

        var created = await evaluator.EvaluateAsync(
            Guid.NewGuid(), _encounterId, _patientId, "HEART_RATE", 105m);
        created.Should().BeTrue();

        var alert = await db.ClinicalAlerts.SingleAsync();
        alert.AlertType.Should().Be(AlertType.WarningHeartRate);
    }

    private async Task<Guid> SeedAlertAsync(AlertType alertType, AlertSeverity severity)
    {
        using var scope = _fixture.Services.CreateScope();
        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();

        var alert = new ClinicalAlert
        {
            Id = Guid.NewGuid(),
            EncounterId = _encounterId,
            PatientId = _patientId,
            AlertType = alertType,
            Severity = severity,
            Details = $"Test {alertType.ToDbString()} alert.",
            Status = AlertStatus.Open,
            TriggeredAt = DateTimeOffset.UtcNow
        };
        db.ClinicalAlerts.Add(alert);
        await db.SaveChangesAsync();
        return alert.Id;
    }
}