feature: Live Capture (Track B)

2026-06-27 04:23:51 +08:00
parent 01000a2489
commit 88e70b3dbe
30 changed files with 4547 additions and 23 deletions
@@ -8,12 +8,13 @@ public static class DbResetHelper
    {
        await db.Database.ExecuteSqlRawAsync(@"
            TRUNCATE TABLE live_observations, live_encounters,
-                       clinical.outbox_events, clinical.observations,
-                       clinical.encounters, clinical.patients,
-                       idempotency_records,
-                       digitization_events, draft_observations,
-                       draft_encounters, draft_patients,
-                       scanned_documents, digitization_batches, users
+                    clinical.clinical_alerts, clinical.alert_thresholds,
+                    clinical.outbox_events, clinical.observations,
+                    clinical.encounters, clinical.patients,
+                    idempotency_records,
+                    digitization_events, draft_observations,
+                    draft_encounters, draft_patients,
+                    scanned_documents, digitization_batches, users
            RESTART IDENTITY CASCADE;
        ");
    }
@@ -0,0 +1,630 @@
+using System.Net;
+using System.Net.Http.Headers;
+using System.Net.Http.Json;
+using System.Text.Json;
+using FluentAssertions;
+using Microsoft.EntityFrameworkCore;
+using Microsoft.Extensions.DependencyInjection;
+using StackExchange.Redis;
+
+[Collection("Database")]
+public class LiveCaptureIntegrationTests : IAsyncLifetime
+{
+    private readonly ApiFixture _fixture;
+    private HttpClient _client = null!;
+
+    public LiveCaptureIntegrationTests(ApiFixture fixture) => _fixture = fixture;
+
+    public async Task InitializeAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        await DbResetHelper.ResetAsync(db);
+        await DataSeeder.SeedAsync(db);
+        _client = _fixture.CreateClient();
+    }
+
+    public Task DisposeAsync() => Task.CompletedTask;
+
+    // ───────────────────────────────────────────────
+    // Happy path: normal observations, no alert
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_NormalValues_PromotesSynchronouslyWithNoAlert()
+    {
+        // Arrange — create patient and encounter via setup
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (patientId, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null),
+                new("TEMP_C", 36.8m, "C", DateTimeOffset.UtcNow, null),
+                new("SPO2", 98m, "%", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        // Act
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        // Assert
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+        Assert.True(body!.Success);
+        Assert.Equal(encounterId, body.Data!.EncounterId);
+        Assert.Equal(3, body.Data.Observations.Count);
+        Assert.Equal(0, body.Data.CriticalAlertCount);
+
+        // Verify all observations have live IDs
+        foreach (var obs in body.Data.Observations)
+        {
+            Assert.NotEqual(Guid.Empty, obs.LiveObservationId);
+            Assert.NotEqual(Guid.Empty, obs.DraftObservationId);
+            Assert.Null(obs.CriticalAlert);
+        }
+
+        // Verify batch exists in database with Promoted status
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var batch = await db.DigitizationBatches.FindAsync(body.Data.BatchId);
+        Assert.NotNull(batch);
+        Assert.Equal(BatchStatus.Promoted, batch!.Status);
+        Assert.Equal(BatchTrack.LiveCapture, batch.Track);
+        Assert.True(batch.ClinicianAttestation);
+        Assert.NotNull(batch.PromotedAt);
+    }
+
+    // ───────────────────────────────────────────────
+    // Critical path: alert fires BEFORE response returns
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_CriticalPotassium_AlertFiresBeforeResponseReturns()
+    {
+        // Arrange
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (patientId, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        // Seed a critical threshold for potassium:
+        // critical_low = 2.5, warning_low = 3.5, warning_high = 5.0, critical_high = 6.5
+        await SeedPotassiumThresholdAsync();
+
+        // Value of 2.1 is below critical_low of 2.5 — life-threatening
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("POTASSIUM_MEQ_L", 2.1m, "mEq/L", DateTimeOffset.UtcNow,
+                    "Bedside iSTAT result")
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        // Act
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        // Assert — response contains the alert inline
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+        Assert.True(body!.Success);
+        Assert.Equal(1, body.Data!.CriticalAlertCount);
+        Assert.Single(body.Data.Observations);
+
+        var obsResponse = body.Data.Observations[0];
+        Assert.NotNull(obsResponse.CriticalAlert);
+        Assert.Equal("CRITICAL", obsResponse.CriticalAlert!.Severity);
+        Assert.Equal("CRITICAL_LOW", obsResponse.CriticalAlert.ThresholdBound);
+        Assert.Equal(2.5m, obsResponse.CriticalAlert.ThresholdValue);
+        Assert.Contains("below critical low", obsResponse.CriticalAlert.Message);
+
+        // Verify the alert exists in the database BEFORE we read anything else —
+        // the alert was committed in the same transaction as the observation
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var alert = await db.ClinicalAlerts.FindAsync(obsResponse.CriticalAlert.AlertId);
+        Assert.NotNull(alert);
+        Assert.Equal(AlertStatus.Open, alert!.Status);
+        Assert.Equal(AlertSeverity.Critical, alert.Severity);
+        Assert.Equal(AlertType.CriticalPotassiumMeqL, alert.AlertType);
+        Assert.Contains("below critical low", alert.Details);
+
+        // Verify outbox event for alert was written in the same transaction
+        var alertOutbox = await db.OutboxEvents
+            .Where(e => e.EventType == "alert.generated" &&
+                        e.AggregateId == obsResponse.CriticalAlert.AlertId)
+            .FirstOrDefaultAsync();
+        Assert.NotNull(alertOutbox);
+        Assert.Contains(obsResponse.CriticalAlert.AlertId.ToString(), alertOutbox!.PayloadJson);
+    }
+
+    // ───────────────────────────────────────────────
+    // Critical high: value above critical_high threshold
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_CriticalHighPotassium_AlertWithCorrectBound()
+    {
+        // Arrange
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+        await SeedPotassiumThresholdAsync();
+
+        // Value of 7.2 is above critical_high of 6.5
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("POTASSIUM_MEQ_L", 7.2m, "mEq/L", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        // Act
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        // Assert
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+
+        var alert = body!.Data!.Observations[0].CriticalAlert;
+        Assert.NotNull(alert);
+        Assert.Equal("CRITICAL_HIGH", alert!.ThresholdBound);
+        Assert.Equal(6.5m, alert.ThresholdValue);
+        Assert.Contains("above critical high", alert.Message);
+    }
+
+    // ───────────────────────────────────────────────
+    // Mixed batch: one critical, two normal
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_MixedBatch_OnlyCriticalObservationGetsAlert()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+        await SeedPotassiumThresholdAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 80m, "bpm", DateTimeOffset.UtcNow, null),
+                new("POTASSIUM_MEQ_L", 2.1m, "mEq/L", DateTimeOffset.UtcNow, null),
+                new("TEMP_C", 37.0m, "C", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+
+        Assert.Equal(1, body!.Data!.CriticalAlertCount);
+        Assert.Null(body.Data.Observations[0].CriticalAlert); // heart rate — normal
+        Assert.NotNull(body.Data.Observations[1].CriticalAlert); // potassium — critical
+        Assert.Null(body.Data.Observations[2].CriticalAlert); // temp — normal
+    }
+
+    // ───────────────────────────────────────────────
+    // Open encounter + vitals in one request
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task OpenEncounterWithVitals_CreatesEncounterAndPromotesObservations()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var patientId = await CreateTestPatientAsync();
+
+        var request = new OpenEncounterWithVitalsRequest(
+            PatientId: patientId,
+            Department: "Outpatient Clinic",
+            RoomBed: "OPD-3",
+            AdmissionReason: "Follow-up consultation",
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 68m, "bpm", DateTimeOffset.UtcNow, null),
+                new("BP_SYSTOLIC", 120m, "mmHg", DateTimeOffset.UtcNow, null),
+                new("BP_DIASTOLIC", 80m, "mmHg", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            "/api/v1/live-capture/encounters", request);
+
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+
+        Assert.True(body!.Success);
+        Assert.NotEqual(Guid.Empty, body.Data!.EncounterId);
+        Assert.Equal(3, body.Data.Observations.Count);
+        Assert.Equal(0, body.Data.CriticalAlertCount);
+
+        // Verify encounter was created in VigilCareClinical
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var encounter = await db.Encounters.FindAsync(body.Data.EncounterId);
+        Assert.NotNull(encounter);
+        Assert.Equal("active", encounter!.Status);
+        Assert.Equal(Department.OutpatientClinic, encounter.Department);
+    }
+
+    // ───────────────────────────────────────────────
+    // Authorization: non-clinician role rejected
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_NonClinicianRole_Returns403()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "entry1");
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{Guid.NewGuid()}/observations", request);
+
+        Assert.Equal(HttpStatusCode.Forbidden, response.StatusCode);
+    }
+
+    // ───────────────────────────────────────────────
+    // Attestation: false attestation rejected
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_AttestationFalse_Returns422()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: false, // Must be true
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.UnprocessableEntity, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<object>>();
+        Assert.Equal("ATTESTATION_REQUIRED", body!.Error!.Code);
+    }
+
+    // ───────────────────────────────────────────────
+    // Attestation: wrong password rejected
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_WrongPassword_Returns422()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "wrong-password" // Incorrect
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.UnprocessableEntity, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<object>>();
+        Assert.Equal("PASSWORD_CONFIRM_INVALID", body!.Error!.Code);
+    }
+
+    // ───────────────────────────────────────────────
+    // Edge case: discharged encounter rejected
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_DischargedEncounter_Returns409()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndDischargedEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.Conflict, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<object>>();
+        Assert.Equal("ENCOUNTER_NOT_ACTIVE", body!.Error!.Code);
+    }
+
+    // ───────────────────────────────────────────────
+    // Edge case: duplicate active encounter
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task OpenEncounterWithVitals_PatientHasActiveEncounter_Returns409()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (patientId, _) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new OpenEncounterWithVitalsRequest(
+            PatientId: patientId,
+            Department: Department.EmergencyDepartment.ToDbString(),
+            RoomBed: "ER-1",
+            AdmissionReason: "Chest pain",
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 90m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            "/api/v1/live-capture/encounters", request);
+
+        Assert.Equal(HttpStatusCode.Conflict, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<object>>();
+        Assert.Equal("ACTIVE_ENCOUNTER_EXISTS", body!.Error!.Code);
+    }
+
+    // ───────────────────────────────────────────────
+    // Edge case: empty observations rejected
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_EmptyList_Returns422()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>(),
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.UnprocessableEntity, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<object>>();
+        Assert.Equal("EMPTY_OBSERVATIONS", body!.Error!.Code);
+    }
+
+    // ───────────────────────────────────────────────
+    // Audit trail: verify digitization events written
+    // ───────────────────────────────────────────────
+
+    [Fact]
+    public async Task RecordObservations_WritesAttestationAndPromotionEvents()
+    {
+        _client = await AuthHelper.LoginAsync(_fixture, "clinician1");
+
+        var (_, encounterId) = await CreateTestPatientAndEncounterAsync();
+
+        var request = new RecordObservationsRequest(
+            Observations: new List<LiveCaptureObservationRequest>
+            {
+                new("HEART_RATE", 72m, "bpm", DateTimeOffset.UtcNow, null)
+            },
+            ClinicianAttestation: true,
+            PasswordConfirm: "password"
+        );
+
+        var response = await _client.PostAsJsonAsync(
+            $"/api/v1/live-capture/encounters/{encounterId}/observations", request);
+
+        Assert.Equal(HttpStatusCode.Created, response.StatusCode);
+        var body = await response.Content
+            .ReadFromJsonAsync<ApiResponse<LiveCaptureResponse>>();
+
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var events = await db.DigitizationEvents
+            .Where(e => e.BatchId == body!.Data!.BatchId)
+            .OrderBy(e => e.OccurredAt)
+            .ToListAsync();
+
+        Assert.Equal(2, events.Count);
+        Assert.Equal(DigitizationEventType.LiveCaptureAttested, events[0].EventType);
+        Assert.Equal(DigitizationEventType.Promoted, events[1].EventType);
+
+        // Verify metadata contains clinician info
+        Assert.Contains("clinicianName", events[0].MetadataJson!);
+        Assert.Contains("LIVE_CAPTURE", events[0].MetadataJson!);
+    }
+
+    // ───────────────────────────────────────────────
+    // Helpers
+    // ───────────────────────────────────────────────
+
+    private async Task<Guid> CreateTestPatientAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(),
+            Mrn = $"MRN-{Guid.NewGuid():N}"[..12],
+            FullName = "Test Patient",
+            DateOfBirth = new DateOnly(1985, 3, 15),
+            Sex = "M",
+            BloodType = BloodType.OPos,
+            CreatedAt = DateTimeOffset.UtcNow,
+            UpdatedAt = DateTimeOffset.UtcNow
+        };
+
+        db.Patients.Add(patient);
+        await db.SaveChangesAsync();
+        return patient.Id;
+    }
+
+    private async Task<(Guid patientId, Guid encounterId)> CreateTestPatientAndEncounterAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(),
+            Mrn = $"MRN-{Guid.NewGuid():N}"[..12],
+            FullName = "Test Patient",
+            DateOfBirth = new DateOnly(1985, 3, 15),
+            Sex = "M",
+            BloodType = BloodType.OPos,
+            CreatedAt = DateTimeOffset.UtcNow,
+            UpdatedAt = DateTimeOffset.UtcNow
+        };
+
+        var encounter = new Encounter
+        {
+            Id = Guid.NewGuid(),
+            PatientId = patient.Id,
+            Department = Department.InternalMedicine,
+            RoomBed = "IM-201A",
+            AdmissionReason = "Observation",
+            Status = "active",
+            AdmissionDate = DateTimeOffset.UtcNow,
+            CreatedAt = DateTimeOffset.UtcNow,
+            UpdatedAt = DateTimeOffset.UtcNow
+        };
+
+        db.Patients.Add(patient);
+        db.Encounters.Add(encounter);
+        await db.SaveChangesAsync();
+
+        return (patient.Id, encounter.Id);
+    }
+
+    private async Task<(Guid patientId, Guid encounterId)> CreateTestPatientAndDischargedEncounterAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+
+        var patient = new Patient
+        {
+            Id = Guid.NewGuid(),
+            Mrn = $"MRN-{Guid.NewGuid():N}"[..12],
+            FullName = "Discharged Patient",
+            DateOfBirth = new DateOnly(1970, 7, 20),
+            Sex = "F",
+            BloodType = BloodType.ANeg,
+            CreatedAt = DateTimeOffset.UtcNow,
+            UpdatedAt = DateTimeOffset.UtcNow
+        };
+
+        var encounter = new Encounter
+        {
+            Id = Guid.NewGuid(),
+            PatientId = patient.Id,
+            Department = Department.Surgery,
+            RoomBed = "SURG-105",
+            AdmissionReason = "Post-op recovery",
+            Status = "discharged",
+            AdmissionDate = DateTimeOffset.UtcNow.AddDays(-3),
+            CreatedAt = DateTimeOffset.UtcNow.AddDays(-3),
+            UpdatedAt = DateTimeOffset.UtcNow
+        };
+
+        db.Patients.Add(patient);
+        db.Encounters.Add(encounter);
+        await db.SaveChangesAsync();
+
+        return (patient.Id, encounter.Id);
+    }
+
+    private async Task SeedPotassiumThresholdAsync()
+    {
+        using var scope = _fixture.Services.CreateScope();
+        var db = scope.ServiceProvider.GetRequiredService<AppDbContext>();
+        var redis = scope.ServiceProvider.GetRequiredService<IConnectionMultiplexer>();
+
+        // Only seed if not already present
+        var existing = await db.AlertThresholds
+            .FirstOrDefaultAsync(t => t.ObservationCode == "POTASSIUM_MEQ_L");
+
+        if (existing is null)
+        {
+            var threshold = new AlertThreshold
+            {
+                Id = Guid.NewGuid(),
+                ObservationCode = "POTASSIUM_MEQ_L",
+                DisplayName = "Serum Potassium",
+                Unit = "mEq/L",
+                CriticalLow = 2.5m,
+                WarningLow = 3.5m,
+                WarningHigh = 5.0m,
+                CriticalHigh = 6.5m,
+                CreatedAt = DateTimeOffset.UtcNow
+            };
+
+            db.AlertThresholds.Add(threshold);
+            await db.SaveChangesAsync();
+
+            // Pre-warm Redis cache with ThresholdCacheEntry (same shape as LiveCaptureService)
+            var cache = redis.GetDatabase();
+            await cache.StringSetAsync(
+                "threshold:POTASSIUM_MEQ_L",
+                JsonSerializer.Serialize(new ThresholdCacheEntry(
+                    threshold.ObservationCode,
+                    threshold.CriticalLow,
+                    threshold.WarningLow,
+                    threshold.WarningHigh,
+                    threshold.CriticalHigh)),
+                TimeSpan.FromMinutes(30));
+        }
+    }
+}