fixes: PromoteAsync (retry path) does not create clinical entities + Patient deduplication by exact name + DOB is fragile + Batch assignment creates inconsistent interim state
This commit is contained in:
@@ -73,21 +73,8 @@ public class PromotionService : IPromotionService
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"Separation of duties: the verifier cannot also approve the same batch.",
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"SEPARATION_OF_DUTIES_VIOLATION");
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// --- Validate draft data completeness (corrections reuse the linked live patient) ---
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if (!batch.SupersedesBatchId.HasValue)
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{
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if (batch.DraftPatient is null)
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throw new ValidationException("Batch has no draft patient data.", "MISSING_DRAFT_PATIENT");
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if (string.IsNullOrWhiteSpace(batch.DraftPatient.FullName))
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throw new ValidationException("Draft patient must have a full name.", "INVALID_DRAFT_PATIENT");
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}
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else if (!batch.PatientId.HasValue)
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{
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throw new ValidationException(
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"Correction batch has no linked patient.",
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"MISSING_PATIENT");
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}
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// --- Validate draft data completeness ---
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ValidateDraftDataForPromotion(batch);
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// --- Begin atomic transaction ---
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await using var transaction = await _db.Database.BeginTransactionAsync();
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@@ -96,92 +83,21 @@ public class PromotionService : IPromotionService
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{
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var now = DateTimeOffset.UtcNow;
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// === Step 1: Create or update Patient ===
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Patient patient;
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if (batch.SupersedesBatchId.HasValue)
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{
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patient = await _db.Patients.FirstOrDefaultAsync(p => p.Id == batch.PatientId!.Value)
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?? throw new NotFoundException(
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$"Patient {batch.PatientId.Value} not found.",
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"PATIENT_NOT_FOUND");
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}
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else
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{
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patient = await CreateOrUpdatePatientAsync(batch.DraftPatient!, now);
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}
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// === Step 2: Create or match Encounter (reuse original encounter for corrections) ===
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var encounter = await ResolveClinicalEncounterAsync(batch, patient.Id, now);
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await EnsureLiveEncounterAsync(encounter, now);
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// === Step 3: Insert each DraftObservation as live Observation ===
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var (observationIds, outboxCount) = await PromoteObservationsAsync(
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batch, patient.Id, encounter.Id, enableRetroactiveAlerts, now);
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// === Step 3b: Mirror to live_observations for supersession / digitization history ===
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PromoteLiveObservationsAsync(batch, patient.Id, encounter.Id, now);
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SupersessionResult? supersessionResult = null;
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if (batch.SupersedesBatchId.HasValue)
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{
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supersessionResult = await SupersedeOriginalBatchAsync(
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batch.SupersedesBatchId.Value, batchId, approverUserId, now);
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}
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// === Step 4: Update batch status to Promoted ===
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batch.Status = BatchStatus.Promoted;
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batch.ApprovedByUserId = approverUserId;
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batch.PatientId = patient.Id;
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batch.PromotedAt = now;
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batch.PromotionEncounterId = encounter.Id;
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batch.EnableRetroactiveAlerts = enableRetroactiveAlerts;
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batch.UpdatedAt = now;
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// === Step 5: Write DigitizationEvent ===
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var promotionMetadata = new Dictionary<string, object>
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{
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["patientId"] = patient.Id,
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["mrn"] = patient.Mrn,
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["encounterId"] = encounter.Id,
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["observationCount"] = observationIds.Length,
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["outboxEventsWritten"] = outboxCount,
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["enableRetroactiveAlerts"] = enableRetroactiveAlerts,
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["track"] = batch.Track.ToDbString(),
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["isCorrection"] = batch.SupersedesBatchId.HasValue
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};
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var core = await ExecutePromotionCoreAsync(
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batch, approverUserId, enableRetroactiveAlerts, now);
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if (supersessionResult is not null)
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{
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promotionMetadata["supersession"] = new
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{
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originalBatchId = supersessionResult.OriginalBatchId,
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observationsSuperseded = supersessionResult.ObservationsSuperseded,
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observationsReplaced = supersessionResult.ObservationsReplaced
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};
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}
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_db.DigitizationEvents.Add(new DigitizationEvent
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{
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Id = Guid.NewGuid(),
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BatchId = batchId,
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EventType = batch.SupersedesBatchId.HasValue
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? DigitizationEventType.CorrectionPromoted
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: DigitizationEventType.Promoted,
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ActorUserId = approverUserId,
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OccurredAt = now,
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MetadataJson = JsonSerializer.Serialize(promotionMetadata)
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});
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// === Step 6: Store idempotency record (within same transaction) ===
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// === Store idempotency record (within same transaction) ===
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var result = new PromotionResultResponse(
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BatchId: batchId,
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Status: BatchStatus.Promoted.ToDbString(),
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PatientId: patient.Id,
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Mrn: patient.Mrn,
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EncounterId: encounter.Id,
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ObservationIds: observationIds,
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PatientId: core.Patient.Id,
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Mrn: core.Patient.Mrn,
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EncounterId: core.Encounter.Id,
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ObservationIds: core.ObservationIds,
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PromotedAt: now,
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OutboxEventsWritten: outboxCount
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OutboxEventsWritten: core.OutboxCount
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);
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if (!string.IsNullOrWhiteSpace(idempotencyKey))
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@@ -191,7 +107,7 @@ public class PromotionService : IPromotionService
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200, result, TimeSpan.FromHours(24));
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}
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// === Step 7: Commit ===
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// === Commit ===
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await _db.SaveChangesAsync();
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await transaction.CommitAsync();
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@@ -201,8 +117,8 @@ public class PromotionService : IPromotionService
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_logger.LogInformation(
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"Batch {BatchId} promoted in {ElapsedMs}ms: Patient {PatientId} (MRN {Mrn}), " +
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"Encounter {EncounterId}, {ObsCount} observations, {OutboxCount} outbox events",
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batchId, stopwatch.ElapsedMilliseconds, patient.Id, patient.Mrn, encounter.Id,
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observationIds.Length, outboxCount);
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batchId, stopwatch.ElapsedMilliseconds, core.Patient.Id, core.Patient.Mrn,
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core.Encounter.Id, core.ObservationIds.Length, core.OutboxCount);
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return result;
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}
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@@ -263,22 +179,133 @@ public class PromotionService : IPromotionService
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// Private helpers
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// ──────────────────────────────────────────────────
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private record PromotionCoreResult(
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Patient Patient,
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Encounter Encounter,
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Guid[] ObservationIds,
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int OutboxCount,
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SupersessionResult? Supersession);
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private static void ValidateDraftDataForPromotion(DigitizationBatch batch)
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{
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if (!batch.SupersedesBatchId.HasValue)
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{
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if (batch.DraftPatient is null)
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throw new ValidationException("Batch has no draft patient data.", "MISSING_DRAFT_PATIENT");
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if (string.IsNullOrWhiteSpace(batch.DraftPatient.FullName))
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throw new ValidationException("Draft patient must have a full name.", "INVALID_DRAFT_PATIENT");
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}
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else if (!batch.PatientId.HasValue)
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{
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throw new ValidationException(
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"Correction batch has no linked patient.",
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"MISSING_PATIENT");
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}
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}
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private async Task<PromotionCoreResult> ExecutePromotionCoreAsync(
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DigitizationBatch batch, Guid actorUserId, bool enableRetroactiveAlerts, DateTimeOffset now)
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{
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// === Step 1: Create or update Patient ===
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Patient patient;
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if (batch.SupersedesBatchId.HasValue)
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{
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patient = await _db.Patients.FirstOrDefaultAsync(p => p.Id == batch.PatientId!.Value)
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?? throw new NotFoundException(
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$"Patient {batch.PatientId!.Value} not found.",
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"PATIENT_NOT_FOUND");
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}
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else
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{
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patient = await CreateOrUpdatePatientAsync(batch.DraftPatient!, now);
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}
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// === Step 2: Create or match Encounter + LiveEncounter ===
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var encounter = await ResolveClinicalEncounterAsync(batch, patient.Id, now);
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await EnsureLiveEncounterAsync(encounter, now);
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// === Step 3: Insert clinical Observations + OutboxEvents ===
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var (observationIds, outboxCount) = await PromoteObservationsAsync(
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batch, patient.Id, encounter.Id, enableRetroactiveAlerts, now);
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// === Step 4: Mirror to LiveObservations ===
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PromoteLiveObservationsAsync(batch, patient.Id, encounter.Id, now);
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// === Step 5: Handle supersession for correction batches ===
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SupersessionResult? supersessionResult = null;
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if (batch.SupersedesBatchId.HasValue)
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{
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supersessionResult = await SupersedeOriginalBatchAsync(
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batch.SupersedesBatchId.Value, batch.Id, actorUserId, now);
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}
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// === Step 6: Update batch status to Promoted ===
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batch.Status = BatchStatus.Promoted;
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batch.PatientId = patient.Id;
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batch.PromotedAt = now;
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batch.PromotionEncounterId = encounter.Id;
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batch.EnableRetroactiveAlerts = enableRetroactiveAlerts;
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batch.UpdatedAt = now;
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// === Step 7: Write DigitizationEvent ===
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var promotionMetadata = new Dictionary<string, object>
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{
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["patientId"] = patient.Id,
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["mrn"] = patient.Mrn,
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["encounterId"] = encounter.Id,
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["observationCount"] = observationIds.Length,
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["outboxEventsWritten"] = outboxCount,
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["enableRetroactiveAlerts"] = enableRetroactiveAlerts,
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["track"] = batch.Track.ToDbString(),
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["isCorrection"] = batch.SupersedesBatchId.HasValue
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};
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if (supersessionResult is not null)
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{
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promotionMetadata["supersession"] = new
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{
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originalBatchId = supersessionResult.OriginalBatchId,
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observationsSuperseded = supersessionResult.ObservationsSuperseded,
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observationsReplaced = supersessionResult.ObservationsReplaced
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};
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}
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_db.DigitizationEvents.Add(new DigitizationEvent
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{
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Id = Guid.NewGuid(),
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BatchId = batch.Id,
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EventType = batch.SupersedesBatchId.HasValue
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? DigitizationEventType.CorrectionPromoted
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: DigitizationEventType.Promoted,
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ActorUserId = actorUserId,
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OccurredAt = now,
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MetadataJson = JsonSerializer.Serialize(promotionMetadata)
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});
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return new PromotionCoreResult(patient, encounter, observationIds, outboxCount, supersessionResult);
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}
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private static string NormalizePatientName(string name) =>
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string.Join(" ", name.Trim().Split((char[]?)null, StringSplitOptions.RemoveEmptyEntries))
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.ToUpperInvariant();
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private async Task<Patient> CreateOrUpdatePatientAsync(DraftPatient draft, DateTimeOffset now)
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{
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// Attempt to match existing patient by name + DOB (simple dedup)
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var normalizedName = NormalizePatientName(draft.FullName!);
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Patient? existing = null;
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if (draft.DateOfBirth.HasValue)
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{
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existing = await _db.Patients
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.FirstOrDefaultAsync(p =>
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p.FullName == draft.FullName &&
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EF.Functions.ILike(p.FullName, normalizedName) &&
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p.DateOfBirth == draft.DateOfBirth);
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}
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if (existing is not null)
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{
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// Update fields that may have new information
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existing.Sex = draft.Sex ?? existing.Sex;
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existing.BloodType = draft.BloodType ?? existing.BloodType;
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existing.EmergencyContact = draft.EmergencyContact ?? existing.EmergencyContact;
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@@ -287,20 +314,43 @@ public class PromotionService : IPromotionService
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existing.UpdatedAt = now;
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_logger.LogInformation(
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"Matched existing patient {PatientId} (MRN {Mrn}) by name + DOB",
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"Matched existing patient {PatientId} (MRN {Mrn}) by normalized name + DOB",
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existing.Id, existing.Mrn);
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return existing;
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}
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// Create new patient with generated MRN
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// No exact normalized match — check for fuzzy near-misses on same DOB
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if (draft.DateOfBirth.HasValue)
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{
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var sameDobPatients = await _db.Patients
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.Where(p => p.DateOfBirth == draft.DateOfBirth)
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.Select(p => new { p.Id, p.Mrn, p.FullName })
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.ToListAsync();
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foreach (var candidate in sameDobPatients)
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{
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var distance = LevenshteinDistance(
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normalizedName, NormalizePatientName(candidate.FullName));
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if (distance > 0 && distance <= 3)
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{
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_logger.LogWarning(
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"Fuzzy patient match: new name '{NewName}' is {Distance} edits from " +
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"existing patient {PatientId} (MRN {Mrn}, name '{ExistingName}') with same DOB. " +
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"Creating new patient — consider merging if these are the same person",
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normalizedName, distance, candidate.Id, candidate.Mrn, candidate.FullName);
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}
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}
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}
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var mrn = await _mrnGenerator.GenerateNextMrnAsync();
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var patient = new Patient
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{
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Id = Guid.NewGuid(),
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Mrn = mrn,
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FullName = draft.FullName!,
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FullName = normalizedName,
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DateOfBirth = draft.DateOfBirth,
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Sex = draft.Sex,
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BloodType = draft.BloodType,
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@@ -320,6 +370,33 @@ public class PromotionService : IPromotionService
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return patient;
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}
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private static int LevenshteinDistance(string a, string b)
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{
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if (a.Length == 0) return b.Length;
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if (b.Length == 0) return a.Length;
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var prev = new int[b.Length + 1];
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var curr = new int[b.Length + 1];
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for (var j = 0; j <= b.Length; j++)
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prev[j] = j;
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for (var i = 1; i <= a.Length; i++)
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{
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curr[0] = i;
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for (var j = 1; j <= b.Length; j++)
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{
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var cost = a[i - 1] == b[j - 1] ? 0 : 1;
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curr[j] = Math.Min(
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Math.Min(curr[j - 1] + 1, prev[j] + 1),
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prev[j - 1] + cost);
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}
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(prev, curr) = (curr, prev);
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}
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return prev[b.Length];
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}
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private async Task<Encounter> ResolveClinicalEncounterAsync(
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DigitizationBatch batch, Guid patientId, DateTimeOffset now)
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{
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@@ -536,7 +613,6 @@ public class PromotionService : IPromotionService
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try
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{
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// Load the batch with all draft data
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var batch = await _db.DigitizationBatches
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.Include(b => b.DraftPatient)
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.Include(b => b.DraftEncounter)
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@@ -551,76 +627,13 @@ public class PromotionService : IPromotionService
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$"Only approved batches can be promoted. Batch is in '{batch.Status.ToDbString()}' status.",
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"ILLEGAL_STATUS_TRANSITION");
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// Resolve or create the live encounter
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var encounterId = await ResolveEncounterAsync(batch);
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ValidateDraftDataForPromotion(batch);
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// Promote draft observations to live observations
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var now = DateTimeOffset.UtcNow;
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var liveObservations = batch.DraftObservations.Select(draft => new LiveObservation
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{
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Id = Guid.NewGuid(),
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EncounterId = encounterId,
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PatientId = batch.PatientId,
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SourceBatchId = batch.Id,
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ObservationCode = draft.ObservationCode,
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Value = draft.Value,
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Unit = draft.Unit,
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RecordedAt = draft.RecordedAt,
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Note = draft.Note,
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CreatedAt = now,
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IsSuperseded = false,
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SupersededByBatchId = null,
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SupersededAt = null
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}).ToList();
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var enableRetroactiveAlerts = batch.EnableRetroactiveAlerts;
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_db.LiveObservations.AddRange(liveObservations);
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// Handle supersession if this is a correction batch
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SupersessionResult? supersessionResult = null;
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if (batch.SupersedesBatchId.HasValue)
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{
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supersessionResult = await SupersedeOriginalBatchAsync(
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batch.SupersedesBatchId.Value,
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batch.Id,
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actorUserId,
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now);
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}
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// Update batch status to Promoted
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batch.Status = BatchStatus.Promoted;
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batch.PromotedAt = now;
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batch.PromotionEncounterId = encounterId;
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batch.UpdatedAt = now;
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// Record promotion event on the correction batch
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var promotionMetadata = new Dictionary<string, object>
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{
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["encounterId"] = encounterId,
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["observationsPromoted"] = liveObservations.Count,
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["isCorrection"] = batch.SupersedesBatchId.HasValue
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};
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if (supersessionResult is not null)
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{
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promotionMetadata["supersession"] = new
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{
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originalBatchId = supersessionResult.OriginalBatchId,
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observationsSuperseded = supersessionResult.ObservationsSuperseded,
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observationsReplaced = supersessionResult.ObservationsReplaced
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};
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}
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_db.DigitizationEvents.Add(new DigitizationEvent
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{
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Id = Guid.NewGuid(),
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BatchId = batch.Id,
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EventType = batch.SupersedesBatchId.HasValue
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? DigitizationEventType.CorrectionPromoted
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: DigitizationEventType.Promoted,
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ActorUserId = actorUserId,
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OccurredAt = now,
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MetadataJson = JsonSerializer.Serialize(promotionMetadata)
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});
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var core = await ExecutePromotionCoreAsync(
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batch, actorUserId, enableRetroactiveAlerts, now);
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|
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await _db.SaveChangesAsync();
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await transaction.CommitAsync();
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@@ -629,20 +642,21 @@ public class PromotionService : IPromotionService
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DiagnosticsMetrics.PromotionDuration.Observe(stopwatch.Elapsed.TotalSeconds);
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_logger.LogInformation(
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"Batch {BatchId} promoted in {ElapsedMs}ms (correction={IsCorrection}, " +
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"observations={ObservationCount}, superseded={SupersededCount})",
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batchId,
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stopwatch.ElapsedMilliseconds,
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batch.SupersedesBatchId.HasValue,
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liveObservations.Count,
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||||
supersessionResult?.ObservationsSuperseded ?? 0);
|
||||
"Batch {BatchId} promoted via retry in {ElapsedMs}ms: Patient {PatientId} (MRN {Mrn}), " +
|
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"Encounter {EncounterId}, {ObsCount} observations, {OutboxCount} outbox events",
|
||||
batchId, stopwatch.ElapsedMilliseconds, core.Patient.Id, core.Patient.Mrn,
|
||||
core.Encounter.Id, core.ObservationIds.Length, core.OutboxCount);
|
||||
|
||||
return new PromotionResult(
|
||||
batch.Id,
|
||||
encounterId,
|
||||
liveObservations.Count,
|
||||
core.Patient.Id,
|
||||
core.Patient.Mrn,
|
||||
core.Encounter.Id,
|
||||
core.ObservationIds,
|
||||
core.ObservationIds.Length,
|
||||
core.OutboxCount,
|
||||
batch.SupersedesBatchId.HasValue,
|
||||
supersessionResult);
|
||||
core.Supersession);
|
||||
}
|
||||
catch
|
||||
{
|
||||
@@ -714,52 +728,4 @@ public class PromotionService : IPromotionService
|
||||
now);
|
||||
}
|
||||
|
||||
/// <summary>
|
||||
/// Resolves the live encounter for promotion. For correction batches, reuses the
|
||||
/// encounter from the original batch to maintain continuity. For new batches,
|
||||
/// creates or resolves the encounter from draft data.
|
||||
/// </summary>
|
||||
private async Task<Guid> ResolveEncounterAsync(DigitizationBatch batch)
|
||||
{
|
||||
// For correction batches, reuse the encounter from the original promoted batch
|
||||
if (batch.SupersedesBatchId.HasValue)
|
||||
{
|
||||
var originalBatch = await _db.DigitizationBatches
|
||||
.FirstOrDefaultAsync(b => b.Id == batch.SupersedesBatchId.Value);
|
||||
|
||||
if (originalBatch?.PromotionEncounterId.HasValue == true)
|
||||
{
|
||||
_logger.LogInformation(
|
||||
"Correction batch {CorrectionBatchId} reusing encounter {EncounterId} " +
|
||||
"from original batch {OriginalBatchId}",
|
||||
batch.Id, originalBatch.PromotionEncounterId.Value, originalBatch.Id);
|
||||
|
||||
return originalBatch.PromotionEncounterId.Value;
|
||||
}
|
||||
}
|
||||
|
||||
// For non-correction batches, create or find the encounter from draft data
|
||||
if (batch.DraftEncounter is null)
|
||||
throw new ValidationException(
|
||||
"Batch has no draft encounter data for promotion.",
|
||||
"MISSING_ENCOUNTER_DATA");
|
||||
|
||||
var encounter = new LiveEncounter
|
||||
{
|
||||
Id = Guid.NewGuid(),
|
||||
PatientId = batch.PatientId
|
||||
?? throw new ValidationException("Patient ID is required for promotion.", "MISSING_PATIENT_ID"),
|
||||
AdmissionDate = batch.DraftEncounter.AdmissionDate
|
||||
?? throw new ValidationException("Admission date is required.", "MISSING_ADMISSION_DATE"),
|
||||
Department = batch.DraftEncounter.Department,
|
||||
RoomBed = batch.DraftEncounter.RoomBed,
|
||||
AdmissionReason = batch.DraftEncounter.AdmissionReason,
|
||||
DischargeDiagnosis = batch.DraftEncounter.DischargeDiagnosis,
|
||||
Status = batch.DraftEncounter.Status ?? "active",
|
||||
CreatedAt = DateTimeOffset.UtcNow
|
||||
};
|
||||
|
||||
_db.LiveEncounters.Add(encounter);
|
||||
return encounter.Id;
|
||||
}
|
||||
}
|
||||
Reference in New Issue
Block a user