Rebuild CCS case workflow

2026-07-23 04:43:02 -05:00
parent 489b9c3d7c
commit 8e216eac32
13 changed files with 1374 additions and 690 deletions
@@ -115,16 +115,22 @@ public sealed class CcsStore
            CaseExternalId = definition.ExternalId,
            CaseRevisionId = definition.Id ?? "",
            CaseVersion = definition.Version,
-            Mode = request.Mode,
+            Mode = CcsAttemptModes.Timed,
+            OpeningCompleted = false,
            Location = definition.PresentingLocation,
            CurrentVitals = new Dictionary<string, string>(definition.InitialChart.Vitals),
+            VitalHistory =
+            [
+                new CcsVitalSnapshot { SimulatedMinute = 0, Values = new Dictionary<string, string>(definition.InitialChart.Vitals) }
+            ],
            ActiveOrderCodes = definition.InitialChart.InitialOrderCodes.Distinct(StringComparer.OrdinalIgnoreCase).ToList(),
-            DeadlineUtc = request.Mode == CcsAttemptModes.Timed ? now.AddMinutes(definition.RealTimeMinutes) : null,
-            RatingEligible = request.Mode == CcsAttemptModes.Timed,
+            DeadlineUtc = now.AddMinutes(ActivePhaseMinutes(definition.RealTimeMinutes)),
+            HardDeadlineUtc = now.AddMinutes(definition.RealTimeMinutes),
+            RatingEligible = true,
            Chart =
            [
-                new CcsChartEntry { Category = "progress", Text = definition.InitialChart.ReasonForEncounter },
-                new CcsChartEntry { Category = "progress", Text = definition.InitialChart.Appearance }
+                new CcsChartEntry { Category = CcsChartCategories.Progress, Code = "reason_for_encounter", Title = "Reason for encounter", Text = definition.InitialChart.ReasonForEncounter },
+                new CcsChartEntry { Category = CcsChartCategories.Progress, Code = "initial_appearance", Title = "Initial appearance", Text = definition.InitialChart.Appearance }
            ]
        };
        try { await _attempts.InsertOneAsync(attempt); }
@@ -173,7 +179,12 @@ public sealed class CcsStore
        if (attempt.State == CcsAttemptStates.Active && attempt.DeadlineUtc <= DateTime.UtcNow)
        {
            attempt.State = CcsAttemptStates.FinalOrders;
-            attempt.FinalOrdersDeadlineUtc = DateTime.UtcNow.AddMinutes(2);
+            attempt.FinalOrdersDeadlineUtc = FinalOrdersDeadline(DateTime.UtcNow, attempt.HardDeadlineUtc);
+            attempt.Chart.Add(new CcsChartEntry
+            {
+                Category = CcsChartCategories.Progress, Code = "case_end", Title = "Case-end instructions",
+                SimulatedMinute = attempt.SimulatedMinute, Text = "Finalize patient care orders."
+            });
            attempt.Revision++;
            await SaveAsync(attempt);
        }
@@ -206,9 +217,16 @@ public sealed class CcsStore
            case "advance": Advance(attempt, definition, command.Minutes); break;
            case "interval_history":
                attempt.Actions.Add(Action("interval_history", "interval_history", attempt.SimulatedMinute, now));
-                attempt.Chart.Add(new CcsChartEntry { Category = "progress", SimulatedMinute = attempt.SimulatedMinute, Text = "The patient was reassessed for interval change." });
+                attempt.Chart.Add(new CcsChartEntry
+                {
+                    Category = CcsChartCategories.Progress, Code = "interval_history", Title = "Interval history",
+                    SimulatedMinute = attempt.SimulatedMinute, Text = "The patient was reassessed for interval change."
+                });
                Advance(attempt, definition, 1);
                break;
+            case "acknowledge_opening":
+                attempt.OpeningCompleted = true;
+                break;
            case "end_case": EnterFinalOrders(attempt); break;
            case "exit_case": await CompleteAsync(attempt); break;
        }
@@ -220,6 +238,63 @@ public sealed class CcsStore
        return attempt;
    }

+    public async Task<CcsAttempt> ApplyBatchCommandAsync(CcsAttempt attempt, CcsBatchCommandRequest request)
+    {
+        var validation = CcsCaseValidator.ValidateBatch(request);
+        if (validation is not null) throw new ArgumentException(validation);
+        if (attempt.ProcessedCommandIds.Contains(request.CommandId, StringComparer.Ordinal)) return attempt;
+        if (attempt.Revision != request.ExpectedRevision) throw new InvalidOperationException("Attempt revision is stale.");
+        if (attempt.State is CcsAttemptStates.Completed or CcsAttemptStates.Abandoned)
+            throw new InvalidOperationException("The CCS attempt is closed.");
+        if (attempt.State == CcsAttemptStates.FinalOrders && request.Commands.Any(value => value.Type is not ("order" or "cancel_order")))
+            throw new InvalidOperationException("Only final orders may be changed now.");
+
+        var definition = await DefinitionAsync(attempt);
+        var now = DateTime.UtcNow;
+        if (request.Commands.Any(value => value.Type is "exam" or "interval_history"))
+        {
+            var selected = request.Commands.Where(item => item.Type == "exam").Select(item =>
+                definition.Exams.FirstOrDefault(value => value.Code.Equals(item.Code, StringComparison.OrdinalIgnoreCase))
+                ?? throw new ArgumentException($"Unknown examination component: {item.Code}.")).ToList();
+            var includeHistory = request.Commands.Any(item => item.Type == "interval_history");
+            var startingMinute = attempt.SimulatedMinute;
+            foreach (var exam in selected)
+                attempt.Actions.Add(Action("exam", exam.Code, startingMinute, now));
+            if (includeHistory)
+                attempt.Actions.Add(Action("interval_history", "interval_history", startingMinute, now));
+            Advance(attempt, definition, selected.Sum(value => Math.Max(1, value.DurationMinutes)) + (includeHistory ? 1 : 0));
+            if (includeHistory)
+                attempt.Chart.Add(new CcsChartEntry
+                {
+                    Category = CcsChartCategories.Progress, Code = "interval_history", Title = "Interval history",
+                    SimulatedMinute = attempt.SimulatedMinute, Text = "The patient was reassessed for interval change."
+                });
+            foreach (var exam in selected)
+                attempt.Chart.Add(new CcsChartEntry
+                {
+                    Category = CcsChartCategories.Progress, Code = exam.Code, Title = exam.Name,
+                    SimulatedMinute = attempt.SimulatedMinute, Text = exam.Finding
+                });
+        }
+        else
+        {
+            foreach (var item in request.Commands)
+            {
+                if (item.Type == "order") await ApplyOrderAsync(attempt, definition, item.Code, now, false);
+                else CancelOrder(attempt, item.Code, now);
+            }
+            ProcessDue(attempt);
+        }
+
+        attempt.ProcessedCommandIds.Add(request.CommandId);
+        if (attempt.ProcessedCommandIds.Count > 100)
+            attempt.ProcessedCommandIds.RemoveRange(0, attempt.ProcessedCommandIds.Count - 100);
+        attempt.Revision++;
+        attempt.UpdatedUtc = now;
+        await SaveAsync(attempt);
+        return attempt;
+    }
+
    public async Task<CcsHistoryPage> HistoryAsync(string userId, int limit, string status = "all", string sort = "newest", string? cursor = null)
    {
        limit = Math.Clamp(limit, 1, 50);
@@ -314,19 +389,49 @@ public sealed class CcsStore
    {
        var definition = await DefinitionAsync(attempt);
        var completed = attempt.State == CcsAttemptStates.Completed;
+        List<CcsOrderDefinition> activeCatalog = attempt.ActiveOrderCodes.Count == 0
+            ? []
+            : await _orders.Find(value => attempt.ActiveOrderCodes.Contains(value.Code)).ToListAsync();
+        var activeOrders = activeCatalog.Select(order =>
+        {
+            var orderedMinute = attempt.Actions.LastOrDefault(value =>
+                value.Type == "order" && value.Code.Equals(order.Code, StringComparison.OrdinalIgnoreCase))?.SimulatedMinute ?? 0;
+            var pending = attempt.PendingResults.FirstOrDefault(value =>
+                value.OrderCode.Equals(order.Code, StringComparison.OrdinalIgnoreCase));
+            var reported = attempt.Chart.LastOrDefault(value =>
+                value.Code.Equals(order.Code, StringComparison.OrdinalIgnoreCase)
+                && value.Category is not CcsChartCategories.Orders);
+            return new CcsActiveOrder
+            {
+                Code = order.Code, Name = order.CanonicalName, Category = order.Category,
+                Route = order.DisplayRoute, Frequency = order.DisplayFrequency, OrderedMinute = orderedMinute,
+                ReportMinute = pending is not null ? null : reported?.SimulatedMinute,
+                IsPending = pending is not null, HasResult = reported is not null
+            };
+        }).OrderBy(value => value.OrderedMinute).ThenBy(value => value.Name).ToList();
+        List<CcsVitalSnapshot> vitalHistory = attempt.VitalHistory.Count > 0
+            ? attempt.VitalHistory
+            : [new CcsVitalSnapshot { SimulatedMinute = attempt.SimulatedMinute, Values = new Dictionary<string, string>(attempt.CurrentVitals) }];
        return new CcsAttemptResponse
        {
            Id = attempt.Id ?? "", CaseExternalId = attempt.CaseExternalId,
            CaseTitle = completed ? definition.Title : $"CCS Case {attempt.CaseExternalId}",
            Mode = attempt.Mode, State = attempt.State, Revision = attempt.Revision,
-            SimulatedMinute = attempt.SimulatedMinute, Location = attempt.Location,
-            DeadlineUtc = attempt.DeadlineUtc, FinalOrdersDeadlineUtc = attempt.FinalOrdersDeadlineUtc,
+            SimulatedMinute = attempt.SimulatedMinute, SimulatedStartUtc = definition.InitialChart.SimulatedStartUtc,
+            OpeningCompleted = attempt.OpeningCompleted ?? true, Location = attempt.Location,
+            DeadlineUtc = attempt.DeadlineUtc, HardDeadlineUtc = attempt.HardDeadlineUtc,
+            FinalOrdersDeadlineUtc = attempt.FinalOrdersDeadlineUtc,
            CreatedUtc = attempt.CreatedUtc, RealTimeMinutes = definition.RealTimeMinutes,
            ElapsedSeconds = Math.Max(0, (int)Math.Round(((attempt.CompletedUtc ?? DateTime.UtcNow) - attempt.CreatedUtc).TotalSeconds)),
            PatientSummary = definition.InitialChart.PatientSummary, ReasonForEncounter = definition.InitialChart.ReasonForEncounter,
            Appearance = definition.InitialChart.Appearance, History = definition.InitialChart.History,
+            HistorySections = definition.InitialChart.HistorySections,
            Vitals = attempt.CurrentVitals, Chart = attempt.Chart, ActiveOrderCodes = attempt.ActiveOrderCodes,
-            PendingResults = attempt.PendingResults.Select(value => new CcsPendingResult { OrderCode = value.OrderCode, DueMinute = value.DueMinute }).ToList(),
+            ActiveOrders = activeOrders, VitalHistory = vitalHistory,
+            PendingResults = attempt.PendingResults.Select(value => new CcsPendingResult
+            {
+                OrderCode = value.OrderCode, DueMinute = value.DueMinute, Category = value.Category, Title = value.Title
+            }).ToList(),
            AvailableExams = attempt.State == CcsAttemptStates.Active ? definition.Exams : [],
            AllowedLocations = attempt.State == CcsAttemptStates.Active ? definition.AllowedLocations : [],
            Score = completed ? attempt.Score : null, Rating = completed ? attempt.Rating : null,
@@ -342,7 +447,7 @@ public sealed class CcsStore
        await SaveAsync(attempt);
    }

-    private async Task ApplyOrderAsync(CcsAttempt attempt, CcsCaseRevision definition, string code, DateTime now)
+    private async Task ApplyOrderAsync(CcsAttempt attempt, CcsCaseRevision definition, string code, DateTime now, bool processImmediately = true)
    {
        code = code.Trim().ToLowerInvariant();
        var catalog = await _orders.Find(value => value.Code == code).FirstOrDefaultAsync() ?? throw new ArgumentException("Unknown order code.");
@@ -352,17 +457,30 @@ public sealed class CcsStore
        if (!attempt.ActiveOrderCodes.Contains(code, StringComparer.OrdinalIgnoreCase)) attempt.ActiveOrderCodes.Add(code);
        var response = definition.OrderResponses.FirstOrDefault(value => value.OrderCode.Equals(code, StringComparison.OrdinalIgnoreCase));
        var delay = response?.TurnaroundMinutes ?? catalog.DefaultTurnaroundMinutes;
+        var resultCategory = ResultCategory(response?.ResultSection, catalog.ResultSection, catalog.Category);
        if (response is not null && (!string.IsNullOrWhiteSpace(response.Result) || response.VitalPatches.Count > 0))
-            attempt.PendingResults.Add(new CcsPendingResult { OrderCode = code, DueMinute = attempt.SimulatedMinute + delay, Result = response.Result, VitalPatches = response.VitalPatches });
-        attempt.Chart.Add(new CcsChartEntry { Category = "orders", SimulatedMinute = attempt.SimulatedMinute, Text = $"Ordered: {catalog.CanonicalName}" });
-        if (delay == 0) ProcessDue(attempt);
+            attempt.PendingResults.Add(new CcsPendingResult
+            {
+                OrderCode = code, Category = resultCategory, Title = catalog.CanonicalName,
+                DueMinute = attempt.SimulatedMinute + delay, Result = response.Result, VitalPatches = response.VitalPatches
+            });
+        attempt.Chart.Add(new CcsChartEntry
+        {
+            Category = CcsChartCategories.Orders, Code = code, Title = catalog.CanonicalName,
+            SimulatedMinute = attempt.SimulatedMinute, Text = $"Ordered: {catalog.CanonicalName}"
+        });
+        if (delay == 0 && processImmediately) ProcessDue(attempt);
    }

    private static void ApplyExam(CcsAttempt attempt, CcsCaseRevision definition, string code, DateTime now)
    {
        var exam = definition.Exams.FirstOrDefault(value => value.Code.Equals(code, StringComparison.OrdinalIgnoreCase)) ?? throw new ArgumentException("Unknown examination component.");
        attempt.Actions.Add(Action("exam", exam.Code, attempt.SimulatedMinute, now));
-        attempt.Chart.Add(new CcsChartEntry { Category = "exam", SimulatedMinute = attempt.SimulatedMinute, Text = $"{exam.Name}: {exam.Finding}" });
+        attempt.Chart.Add(new CcsChartEntry
+        {
+            Category = CcsChartCategories.Progress, Code = exam.Code, Title = exam.Name,
+            SimulatedMinute = attempt.SimulatedMinute, Text = exam.Finding
+        });
        Advance(attempt, definition, Math.Max(1, exam.DurationMinutes));
    }

@@ -371,7 +489,11 @@ public sealed class CcsStore
        attempt.Actions.Add(Action("cancel_order", code, attempt.SimulatedMinute, now));
        attempt.ActiveOrderCodes.RemoveAll(value => value.Equals(code, StringComparison.OrdinalIgnoreCase));
        attempt.PendingResults.RemoveAll(value => value.OrderCode.Equals(code, StringComparison.OrdinalIgnoreCase));
-        attempt.Chart.Add(new CcsChartEntry { Category = "orders", SimulatedMinute = attempt.SimulatedMinute, Text = $"Canceled: {code}" });
+        attempt.Chart.Add(new CcsChartEntry
+        {
+            Category = CcsChartCategories.Orders, Code = code, Title = Humanize(code),
+            SimulatedMinute = attempt.SimulatedMinute, Text = $"Canceled: {Humanize(code)}"
+        });
    }

    private static void ChangeLocation(CcsAttempt attempt, CcsCaseRevision definition, string location, DateTime now)
@@ -379,7 +501,11 @@ public sealed class CcsStore
        if (!definition.AllowedLocations.Contains(location, StringComparer.OrdinalIgnoreCase)) throw new ArgumentException("Unsupported location.");
        attempt.Location = location;
        attempt.Actions.Add(Action("location", location, attempt.SimulatedMinute, now));
-        attempt.Chart.Add(new CcsChartEntry { Category = "progress", SimulatedMinute = attempt.SimulatedMinute, Text = $"Patient moved to {location}." });
+        attempt.Chart.Add(new CcsChartEntry
+        {
+            Category = CcsChartCategories.Progress, Code = "location", Title = "Location change",
+            SimulatedMinute = attempt.SimulatedMinute, Text = $"Patient moved to {Humanize(location)}."
+        });
    }

    private static void Advance(CcsAttempt attempt, CcsCaseRevision definition, int minutes)
@@ -403,13 +529,20 @@ public sealed class CcsStore
    private static void ProcessDue(CcsAttempt attempt)
    {
        var due = attempt.PendingResults.Where(value => value.DueMinute <= attempt.SimulatedMinute).ToList();
+        var vitalsChanged = false;
        foreach (var result in due)
        {
            if (!string.IsNullOrWhiteSpace(result.Result))
-                attempt.Chart.Add(new CcsChartEntry { Category = "results", SimulatedMinute = attempt.SimulatedMinute, Text = result.Result });
+                attempt.Chart.Add(new CcsChartEntry
+                {
+                    Category = string.IsNullOrWhiteSpace(result.Category) ? CcsChartCategories.OtherTest : result.Category,
+                    Code = result.OrderCode, Title = result.Title, SimulatedMinute = attempt.SimulatedMinute, Text = result.Result
+                });
            foreach (var patch in result.VitalPatches) attempt.CurrentVitals[patch.Key] = patch.Value;
+            vitalsChanged |= result.VitalPatches.Count > 0;
            attempt.PendingResults.Remove(result);
        }
+        if (vitalsChanged) SnapshotVitals(attempt);
    }

    private static bool ProcessEvents(CcsAttempt attempt, CcsCaseRevision definition)
@@ -419,13 +552,20 @@ public sealed class CcsStore
            && value.TriggerMinute <= attempt.SimulatedMinute
            && value.RequiresOrderCodes.All(activeOrders.Contains)
            && (value.RequiresAnyOrderCodes.Count == 0 || value.RequiresAnyOrderCodes.Any(activeOrders.Contains))).ToList();
+        var vitalsChanged = false;
        foreach (var item in events)
        {
            attempt.ProcessedEventIds.Add(item.Id);
            foreach (var patch in item.VitalPatches) attempt.CurrentVitals[patch.Key] = patch.Value;
-            if (!string.IsNullOrWhiteSpace(item.Message)) attempt.Chart.Add(new CcsChartEntry { Category = "progress", SimulatedMinute = attempt.SimulatedMinute, Text = item.Message });
+            vitalsChanged |= item.VitalPatches.Count > 0;
+            if (!string.IsNullOrWhiteSpace(item.Message)) attempt.Chart.Add(new CcsChartEntry
+            {
+                Category = CcsChartCategories.Progress, Code = item.Id, Title = "Clinical update",
+                SimulatedMinute = attempt.SimulatedMinute, Text = item.Message
+            });
            if (item.EndCase) EnterFinalOrders(attempt);
        }
+        if (vitalsChanged) SnapshotVitals(attempt);
        return events.Any(value => !string.IsNullOrWhiteSpace(value.Message) || value.EndCase);
    }

@@ -433,9 +573,21 @@ public sealed class CcsStore
    {
        if (attempt.State != CcsAttemptStates.Active) return;
        attempt.State = CcsAttemptStates.FinalOrders;
-        var remaining = attempt.DeadlineUtc is null ? TimeSpan.FromMinutes(2) : attempt.DeadlineUtc.Value - DateTime.UtcNow;
-        attempt.FinalOrdersDeadlineUtc = DateTime.UtcNow.Add(remaining < TimeSpan.FromMinutes(2) ? TimeSpan.FromSeconds(Math.Max(0, remaining.TotalSeconds)) : TimeSpan.FromMinutes(2));
-        attempt.Chart.Add(new CcsChartEntry { Category = "progress", SimulatedMinute = attempt.SimulatedMinute, Text = "Case-end instructions: finalize patient care orders." });
+        if (attempt.HardDeadlineUtc is not null)
+        {
+            attempt.FinalOrdersDeadlineUtc = FinalOrdersDeadline(DateTime.UtcNow, attempt.HardDeadlineUtc);
+        }
+        else
+        {
+            var remaining = attempt.DeadlineUtc is null ? TimeSpan.FromMinutes(2) : attempt.DeadlineUtc.Value - DateTime.UtcNow;
+            attempt.FinalOrdersDeadlineUtc = DateTime.UtcNow.Add(
+                remaining < TimeSpan.FromMinutes(2) ? TimeSpan.FromSeconds(Math.Max(0, remaining.TotalSeconds)) : TimeSpan.FromMinutes(2));
+        }
+        attempt.Chart.Add(new CcsChartEntry
+        {
+            Category = CcsChartCategories.Progress, Code = "case_end", Title = "Case-end instructions",
+            SimulatedMinute = attempt.SimulatedMinute, Text = "Finalize patient care orders."
+        });
    }

    private async Task CompleteAsync(CcsAttempt attempt)
@@ -489,12 +641,44 @@ public sealed class CcsStore
        };
    }

+    public static int ActivePhaseMinutes(int totalMinutes) => Math.Max(1, totalMinutes - 2);
+
+    public static DateTime FinalOrdersDeadline(DateTime now, DateTime? hardDeadline)
+    {
+        var proposed = now.AddMinutes(2);
+        return hardDeadline is null || proposed <= hardDeadline ? proposed : hardDeadline.Value;
+    }
+
    public async Task<CcsCaseRevision> DefinitionAsync(CcsAttempt attempt) =>
        await _cases.Find(value => value.Id == attempt.CaseRevisionId).FirstOrDefaultAsync()
        ?? throw new InvalidOperationException("The case revision is unavailable.");

    private Task SaveAsync(CcsAttempt attempt) => _attempts.ReplaceOneAsync(value => value.Id == attempt.Id, attempt);
    private static CcsAttemptAction Action(string type, string code, int minute, DateTime now) => new() { Type = type, Code = code, SimulatedMinute = minute, RealUtc = now };
+    private static void SnapshotVitals(CcsAttempt attempt)
+    {
+        if (attempt.VitalHistory.Count > 0
+            && attempt.VitalHistory[^1].SimulatedMinute == attempt.SimulatedMinute
+            && attempt.VitalHistory[^1].Values.OrderBy(value => value.Key).SequenceEqual(attempt.CurrentVitals.OrderBy(value => value.Key)))
+            return;
+        attempt.VitalHistory.Add(new CcsVitalSnapshot
+        {
+            SimulatedMinute = attempt.SimulatedMinute,
+            Values = new Dictionary<string, string>(attempt.CurrentVitals)
+        });
+    }
+    private static string ResultCategory(string? responseSection, string catalogSection, string catalogCategory)
+    {
+        var explicitSection = string.IsNullOrWhiteSpace(responseSection) ? catalogSection : responseSection;
+        if (!string.IsNullOrWhiteSpace(explicitSection)) return explicitSection;
+        return catalogCategory.ToLowerInvariant() switch
+        {
+            "laboratory" => CcsChartCategories.Lab,
+            "imaging" => CcsChartCategories.Imaging,
+            "medication" or "procedure" or "monitoring" => CcsChartCategories.Treatment,
+            _ => CcsChartCategories.OtherTest
+        };
+    }
    private static string Humanize(string value) => string.Join(' ', value.Split('_', StringSplitOptions.RemoveEmptyEntries).Select(word => char.ToUpperInvariant(word[0]) + word[1..]));
    private static string DescribeExpected(CcsScoringCriterion criterion, List<string> targets)
    {