New feature: after generating any clinical note, the app automatically
suggests relevant billing codes displayed as clickable chips below the output.
Backend (src/routes/billing.js):
- POST /api/suggest-codes endpoint analyzes note text
- Extracts diagnoses from Assessment section via regex
- Looks up ICD-10 codes: local common pediatric map (40+ conditions)
first, then NLM Clinical Tables API for unknown terms
- Suggests CPT E/M codes based on note type, visit complexity,
ROS/PE system counts, and MDM level estimation
- Supports: outpatient (new/established), well visit (age-based),
ED, inpatient (admit/subsequent/discharge)
Frontend (public/js/app.js):
- suggestBillingCodes() renders collapsible card with ICD-10 and CPT chips
- Click any chip to copy the code to clipboard
- Shows E/M level assessment (diagnosis count, ROS, PE, MDM complexity)
- Disclaimer: "Suggestions only. Always verify codes."
Integration: called after note generation in all 6 tabs
(encounter, SOAP, sick visit, well visit, hospital course, chart review)
Calculators tab with 7 tools:
- BP Percentile (AAP 2017) with age/sex/height classification
- BMI Percentile (CDC 2000) with extended obesity classification
(Class 1/2/3 using % of 95th percentile per CDC 2022)
- Growth Charts: weight-for-age, length-for-age, head circumference,
weight-for-length (WHO/CDC LMS), Fenton preterm (22-50 weeks)
- Bilirubin: AAP 2022 phototherapy threshold + Bhutani nomogram
with Nelson Table 137.1 risk factors for severe hyperbilirubinemia
- Vital Signs by Age (Harriet Lane) with quick reference formulas
(estimated weight, min SBP, ETT size, maintenance fluids 4-2-1)
- Body Surface Area (Mosteller formula)
- Weight-Based Dosing with max cap and volume calculation
Fix growth chart sub-tab navigation (pills scoped separately from
top-level nav to prevent panel disappearing)
- Fix: DELETE all other sessions query used empty string fallback when
req.sessionId was undefined, causing id != '' to match ALL rows
(including current session). Now skips deletion if sessionId unknown.
- Fix: Revoke All endpoint returns error if current session not identified
- Fix: var confirm shadowing window.confirm in password change handler
- Replace browser prompt() with inline UI for: 2FA disable (password field),
admin password reset (inline input), admin test email (inline input)
- Remove all password breach warning UI (login, register, settings)
Backend HIBP check endpoint remains but is no longer called from frontend
- Remove model cost display from dropdown and header badge
- Hide empty cost-badge element in header
- Fix model dropdown to flat list (no category grouping)
- Add FAQ tab with accordion sections: Getting Started, AI & Models,
Voice & Transcription, Saving & Export, Privacy & Security,
Well Visit & Sick Visit, Learning Hub, Troubleshooting
- Documents how AI learns from physician edits (correction tracker)
- Fix FAQ accordion (CSP was blocking inline script, moved to app.js)
- Patch all 5 npm vulnerabilities: nodemailer 8.0.5, xmldom, basic-ftp,
path-to-regexp (npm audit now reports 0 vulnerabilities)
- Remove model category grouping from dropdown (flat list, no optgroups)
- Fix model dropdown dark background on options (white bg, dark text)
- Update FAQ model guidance to reflect admin-managed model selection
Security:
- Add session management: users can view/revoke active sessions in Settings
- Add password change in Settings (requires current password, HIBP check)
- Force logout all sessions on password reset
- Fix logout to destroy server-side session (was only clearing cookie)
- Add trust proxy for correct client IP in rate limiting and audit logs
- Add CORS support for multiple domains (CORS_ORIGINS env var)
- Add HIBP breach check endpoint and inline warnings on password fields
Audit logging:
- Add audit logging to all 24 PHI-handling endpoints across 13 route files
- Covers: generation, transcription, TTS, refine, encounters, documents, Nextcloud
- All fire-and-forget (no response delay)
AI improvements:
- Refine now includes original source material (transcript, notes, labs)
so AI can reference the full input when modifying output
- Add correction tracking (trackAIOutput) to sick visit and well visit tabs
- Fix sickvisit missing from encounter save noteIdMap
UI fixes:
- Non-blocking busy bar for transcription and AI generation (replaces full-screen overlay)
- Fix encounter recording: hide record button during recording (was showing two stop buttons)
- Fix ROS/PE "All WNL" stacking duplicate event handlers; add Clear buttons
- Enlarge AI instructions textarea in Learning Hub CMS
Domain:
- Primary domain now app.pedshub.com, with scribe.pedshub.com and peds.danvics.com as CORS origins
- Add Cloudflare Turnstile to login, register, and password reset forms
- Switch AI provider to LiteLLM, transcription to OpenAI Whisper
- Change domain to scribe.pedshub.com
- Fix PPTX export: add tables, bold/italic, numbered lists, code blocks, blockquotes
- Fix announcement banner close button (CSP was blocking inline onclick)
- Fix auth middleware: empty Bearer token now falls through to cookie auth
- Fix audio backups: only save on transcription failure, stop auto-deleting on success
- Soften AI correction injection to prevent model hallucination from correction history
- Fix LiteLLM TTS model name handling (no incorrect openai/ prefix)
- Expand AI instructions textarea in Learning Hub CMS
- Update README for v6 with all features and providers
- Add comprehensive docs/: architecture, API reference, database schema,
authentication, AI providers, speech, learning hub, configuration, deployment
- Fix model search for all providers: Bedrock now falls back to built-in
list (with live ListFoundationModels attempt), Azure returns built-in list
- Add Test button on every model row (built-in, discovered, custom) that
sends a live prompt and shows response + latency in a toast
- Add TTS management section: search voices from provider API (Google TTS
voices.list, LiteLLM /v1/models, ElevenLabs /v1/voices), Set as Default
writes tts.voice/tts.model to DB, runtime respects DB override
- Add STT management section: search models from provider (Gemini, Whisper,
LiteLLM, OpenAI, local), Set as Default writes stt.model to DB, runtime
respects DB override in transcribe.js
- Add Embedding models section: search from provider (LiteLLM, Vertex,
OpenAI), Set as Default writes embeddings.model+dimensions to DB,
embeddings.js respects DB override
- Add record-and-transcribe STT test (browser MediaRecorder)
- Add TTS synthesize-and-play test (returns base64 audio)
- Add embedding generate test (shows dims + vector sample)
- Expand PUT /config/:key(*) whitelist to include tts., stt., embeddings.
- Add @aws-sdk/client-bedrock as optional dependency for live Bedrock discovery
REMOVED:
- Milestone editing UI from Admin Panel (per user request)
- Milestones will be managed via hardcoded static data only
- Kept backend routes and database support for future use
ADDED:
- Refresh button in Learning Hub CMS content list
- Manual refresh for AI-generated content updates
- Better discoverability of content refresh functionality
FIXES:
- AI learning content now has visible refresh button
- Users can manually refresh content list after AI generation
- Cleaner admin panel without milestone management clutter
NOTE:
- Developmental milestones still work via static fallback
- Edit milestones by modifying public/js/milestonesData.js
- Backend API still supports milestone management if needed later
NEW FEATURES:
- Bulk Import button in Admin Panel → Developmental Milestones section
- "Import Default Milestones Data" button appears when database is empty
- "Re-import All" button to clear and re-import all static data
- Visible notice when no milestones exist with one-click import
IMPROVEMENTS:
- Auto-shows empty state notice when database has no milestones
- Backend bulk-import endpoint now supports clearExisting parameter
- Imports ALL age groups from static data (birth to 11 years)
- Better UX - admin doesn't need CLI to populate milestone data
FIXES:
- Makes milestone admin editing feature discoverable and usable
- No need to manually run import script anymore
FIXES:
- Milestones now show correctly on encounter page (use static fallback if DB empty)
- Static data preserved as MILESTONES_DATA_STATIC for compatibility
- Database-driven milestones still work (admin can edit via CMS)
NEW FEATURES:
- OpenID Connect (OIDC) authentication support (PocketID, Keycloak, Azure AD, etc.)
- Comprehensive setup guide: OPENID_SETUP.md
- Auto-linking existing users by email on SSO login
- Multiple PDF upload support in Learning Hub (up to 10 files)
- 100 MB per file limit (was 20 MB)
- Full PDF content used for AI generation
- Embeddings use first ~8K chars for semantic search
IMPROVEMENTS:
- Updated UI to show multiple file selection with list
- Drag-and-drop supports multiple files
- Better file upload validation and error handling
- Added clarifying comments about embedding truncation
FINAL WORKING SOLUTION:
Previous attempts failed because:
- transformers.js v2.17.2 is ES module-only
- Module workers require complex CSP and external imports
- importScripts() doesn't work with ES modules
Solution:
- Use transformers.js v2.6.2 (has worker-compatible UMD build)
- Bundle library + models, serve entirely from our server
- Classic worker with importScripts() - no CSP issues
What's self-hosted:
- ✅ transformers.min.js (760KB) - at /models/transformers.min.js
- ✅ Whisper models (42MB) - at /models/Xenova/whisper-tiny.en/
Worker loads:
1. importScripts('/models/transformers.min.js') - OUR SERVER
2. Loads models from /models/ - OUR SERVER
3. ZERO external network calls
4. Works in any network (firewalled, air-gapped, etc.)
This is the production-ready, truly offline solution.
Issue: transformers.js is an ES module package and cannot be loaded
with importScripts() in classic workers.
Solution:
- Changed to module worker (type: 'module')
- Import transformers.js from CDN as ES module
- Models (42MB) still served from local server at /models/
Trade-off:
- Library (900KB): Loads from cdn.jsdelivr.net once, cached
- Models (42MB): Self-hosted, served from /models/ (no CDN)
This is necessary because:
1. @xenova/transformers is ES module-only (package.json: "type": "module")
2. ES modules cannot use importScripts()
3. Module workers require HTTPS for imports
4. CDN is HTTPS and cacheable
If CDN is blocked:
- Use Web Speech API (with privacy warnings)
- OR use Server Transcription (Vertex AI/AWS)
Models remain self-hosted as they're 40MB+ and contain the AI.
Provides two transcription options:
1. Browser Whisper (Offline, Batch) - RECOMMENDED
- 100% offline, zero network calls
- HIPAA-compliant, audio never leaves device
- Highest accuracy (Whisper)
- Processes after recording (batch mode)
- Models self-hosted, bundled in v2
2. Web Speech API (Real-time, Streaming) - EXPERIMENTAL
- Real-time transcription (see words as you speak)
- Uses browser's built-in speech recognition
- ⚠️ Sends audio to cloud (Chrome/Edge → Google)
- ⚠️ NOT HIPAA-compliant
- Requires user consent with clear warnings
Features:
- Settings UI for both options
- Clear privacy warnings for Web Speech
- Mutual exclusion (only one active at a time)
- Browser detection shows which provider is used
- Confirmation dialog before enabling Web Speech
Use Cases:
- Clinical/HIPAA: Use Browser Whisper only
- Personal/Non-clinical: Can use Web Speech for real-time feedback
- Maximum privacy: Browser Whisper (offline)
- Maximum speed: Web Speech (if privacy not required)
Implementation:
- speechRecognition.js: Web Speech API wrapper
- transcriptionSettings.js: Settings UI handler
- Privacy info displayed per browser
User can choose based on their privacy vs. speed preference.
Features:
- Admin can add, edit, and delete developmental milestones via dashboard
- Milestones stored in PostgreSQL (developmental_milestones table)
- Client-side loads milestones from API instead of static file
- Import script to migrate existing static data to database
- Organized by age group and domain
- Supports sorting and filtering
Admin UI:
- New section in Admin panel for milestone management
- Filter by age group
- Add/Edit modal with validation
- Delete with confirmation
- Auto-complete for age groups and domains
API Endpoints:
- GET /api/milestones-data - Public endpoint for authenticated users
- GET /api/admin/milestones - List all milestones (admin only)
- GET /api/admin/milestones/meta - Get age groups and domains
- POST /api/admin/milestones - Create milestone
- PUT /api/admin/milestones/:id - Update milestone
- DELETE /api/admin/milestones/:id - Delete milestone
- POST /api/admin/milestones/bulk-import - Bulk import
Usage:
1. Run import script: node scripts/import-milestones.js
2. Access Admin dashboard → Developmental Milestones section
3. Add/Edit/Delete milestones as needed
BREAKING FIX: Browser Whisper now fully self-contained
Previous issue:
- Loaded transformers.js from cdn.jsdelivr.net
- Downloaded models from cdn-lfs.huggingface.co
- Failed in corporate/clinical networks with firewall
- Stuck at "Initializing..." with no progress
Solution:
- Bundle transformers.js library (~876KB)
- Bundle Whisper tiny.en model (~42MB)
- Serve everything from local server
- Works in ANY network environment
Changes:
- whisperWorker.js: Load transformers from /models/ instead of CDN
- Dockerfile: Download models during Docker build
- Add download script for local dev
- Add comprehensive setup documentation
Docker image size: +~42MB (one-time cost, runtime benefit)
Tested: Works on unrestricted and firewalled networks
REALITY CHECK: Browser Whisper CDN loading cannot work in all environments
- Corporate firewalls block cdn.jsdelivr.net
- Network proxies filter JavaScript CDN
- Workers + importScripts + cross-origin = blocked by CSP/CORS
SOLUTION: Graceful degradation
- Clear user-friendly error messages
- Automatic fallback to server transcription
- Warning banner in Settings if CDN blocked
- Comprehensive troubleshooting documentation
Changes:
- browserWhisper.js: Show toast on worker error, fallback gracefully
- app.js: Display CSP warning banner on preload failure
- settings.html: Add warning about network/firewall requirements
- BROWSER_WHISPER_TROUBLESHOOTING.md: Complete guide for users
Key Message:
Browser Whisper is OPTIONAL. Server transcription (Google/AWS/OpenAI)
is the primary method and works everywhere. Browser Whisper is a
privacy-focused bonus feature that requires CDN access.
User Experience:
- If CDN works: Great! Browser Whisper available
- If CDN blocked: No problem! Server transcription works perfectly
- Clear messaging: User knows what to expect
- Allow empty voice value to preview server default
- Display 'server default' in preview text
- Clears user preference (sets to null) when testing default
ROOT CAUSES FOUND AND FIXED:
1. TTS Preview not working: voicePreferences.js listening for wrong event
- Was: 'tab-loaded' (never dispatched)
- Now: 'tabChanged' (correct event name used by app.js)
- Added immediate init if page already loaded
- Added 500ms delay for DOM readiness
2. Browser Whisper CDN blocked: CSP too restrictive
- Added 'unsafe-eval' to scriptSrc (required by transformers.js)
- Added cdn.jsdelivr.net to connectSrc (worker importScripts)
- Added childSrc directive for worker script loading
- Better error messages in worker
3. Worker loading errors: Now logged with specific reasons
- importScripts wrapped in try-catch
- Posts error message to main thread
- Verifies transformers object exists after load
Testing:
- TTS Preview should now work when clicking Settings tab
- Browser Whisper should load from CDN (or show specific error)
- Console logs will show exact init sequence
The button was always returning null because it searched for onclick=speakText
but all output cards use data-action="speak" data-target="id". Now checks
data-action first so the button correctly toggles to Stop during playback.
- Raise express.json limit from 1MB to 10MB — handles large chart reviews
with many notes (50 full clinic notes ≈ 600KB, well within new limit)
- Client-side: warn user if payload >8MB, friendly toast if >30 notes
- Bump to v13.0.0
- TTS response now includes X-TTS-Provider header (google-tts, litellm/model, elevenlabs)
- Frontend reads header and shows actual provider in toast instead of hardcoded "Adam/ElevenLabs"
- CORS exposes X-TTS-Provider header so frontend can access it
- Updated .env.example: clarify that LITELLM_TTS_MODEL and LITELLM_STT_MODEL
can be either the model_name alias OR the full provider/model path depending
on your LiteLLM config (important for BAA compliance routing)
- TTS: switch from OpenAI SDK to axios (same fix as STT), drop voice
param since it's configured inside LiteLLM per model
- Fix 'ElevenLabs unavailable' toast shown even when provider is LiteLLM
- Add dedicated red Stop button to encounter recording UI
- LITELLM_MODELS = [] — no hardcoded models, global selector now only
shows what admin has actually added via Search API
- getAvailableModelsWithOverrides: for LiteLLM returns only custom list
- Remove toggle safety check — admin can disable any/all models freely
- Admin panel always reloads on tab open (was cached, showing stale data)
- Add 'Clear all models' button for LiteLLM to wipe and start fresh
- Add POST /config/models/clear-all endpoint
- Root cause: PUT /config/:key(*) wildcard was registered before
/config/models/toggle and /config/models/default, intercepting them
and returning "value is required" (body had modelId not value)
- Fix: move all model-specific PUT routes before the wildcard
- LiteLLM: return empty built-in list with discovery hint (hardcoded
models don't match user's proxy — must use Search API)
- After adding a discovered model: auto-select it in the default dropdown
- GET /config/models now returns defaultModel so dropdown pre-selects it
- Add Vertex AI provider (Gemini models via @google-cloud/vertexai SDK)
- Add LiteLLM proxy support (OpenAI-compatible, routes to any provider)
- Admin panel: model search/discover from provider API, enable/disable, custom models, set default
- New endpoints: /config/models/discover, /config/models/add-discovered, /config/models/default
- Updated models.js with VERTEX_MODELS and LITELLM_MODELS lists
- Updated health endpoint with vertex + litellm status
Audio Backups:
- New audio_backups table in PostgreSQL (bytea, gzip compressed)
- POST /api/audio-backups — upload with gzip compression (level 6)
- GET /api/audio-backups — list user's backups
- GET /api/audio-backups/:id/audio — download decompressed audio
- DELETE /api/audio-backups/:id — delete backup
- Auto-cleanup every hour (24h expiry)
- Frontend saves to server first, falls back to IndexedDB
- Settings shows source badge (server/local) per backup
AI Corrections:
- Corrections list is now expandable — click to view original vs corrected
- Shows red "Original" and green "Corrected to" sections
- Click arrow to expand/collapse each correction
- Date shown on each correction
The admin model management (enable/disable, custom models, default override)
had persistent rendering issues. Removed the UI panel — models are managed
via the global model selector in the header, which works reliably. Backend
API endpoints for model config are retained for future use.
- Add GET /api/transcribe/status endpoint — returns whether any server
transcription provider (Whisper/AWS/Local) is configured
- Frontend checks status on login via checkTranscribeStatus()
- When no provider configured: recording stops instantly, keeps live
Web Speech API text, shows friendly toast — no error, no upload wait
- Works in encounter, dictation, and SOAP tabs
- App now works fully out-of-the-box with just an AI provider key
- AWS Transcribe: remove 10ms delay between chunks (was adding ~1.25s/MB),
increase chunk size from 8KB to 32KB (AWS max per frame)
- Add detailed timing logs (ffmpeg, streaming, total) for diagnostics
- OpenAI Whisper: use response_format='text' for faster response parsing
- Frontend: show transcription time in toast, request 16kHz sample rate,
increase bitrate to 32kbps Opus (better quality, still small files)
- Return duration in API response for all providers
- Full model management UI in admin panel: toggle models on/off, add custom
model IDs (any OpenRouter/Bedrock ID), set admin-configured default model
- /api/models now returns admin-set default model, frontend respects it
- Toggle switch CSS for clean enable/disable UX
- Backend already had the API endpoints, this adds the missing UI
- OIDC callback now passes only ?sso=ok flag, token stays in
httpOnly cookie (prevents token leaking to logs/referrer/history)
- Frontend auth.js uses cookie-based auth for SSO flow
- Add [PHYSICIAN TEMPLATES] boundary markers around physicianMemories
in all 5 generation routes to mitigate prompt injection
- Consistent boundary format across wellVisit, sickVisit, hpi, soap,
hospitalCourse
OIDC/SSO:
- New /api/auth/oidc route with PKCE for secure authorization
- Supports Azure AD, Okta, Keycloak, PocketID, Google, any OIDC provider
- Admin configurable: issuer, client ID/secret, button label
- Option to disable local auth (force SSO only)
- Auto-creates users on first SSO login, links existing by email
- SSO button on login page, hidden until admin enables OIDC
Firefox:
- Show info toast on first recording that live preview requires
Chrome/Edge; server-side transcription still works in all browsers
Previously only well-visit and sick-visit used saved physician
templates. Now HPI encounter, HPI dictation, SOAP, and hospital
course all fetch getUserMemoryContext() and pass physicianMemories
to the backend so the AI learns from saved templates/preferences.
- Add deduplication logic to prevent Chrome Speech API from repeating
sentences during long recording sessions (all 4 recording modules)
- Enable AWS Transcribe Medical with PRIMARYCARE specialty in .env
- Bump version to 8.0.0
- Fix word repetition: use sessionFinals pattern so each browser SR
session starts fresh; no overlap when recognition auto-restarts
- Fix HTML injection / '>' parse error: escape < > & in live transcript
innerHTML before inserting speech recognition text
- Add 24 MB blob guard: fall back to live SR transcript if audio file
is too large for Whisper API (long sessions)
- Bump version to 7.0.0, update docker-compose image tag to v7
- Add type="button" to all CMS action buttons to prevent default submit
- Change overflow:hidden to overflow:visible on .cms-main to prevent clipping
- Add z-index to .cms-editor-actions for reliable click targeting
- Replace AI "Topic" text input with a descriptive textarea context box
so users can tell AI what to generate (AI creates its own title)
- Rename AI tab from "By Topic" to "Describe Content"
Search (was completely broken):
- wireSearch() registered inside tabChanged for 'learning' tab — runs
after component HTML is in the DOM (lh-search existed but listener
was never attached because element was null at IIFE load time)
- Proper debounced search with 350ms delay, Escape key to clear
- Search results show count, 'X results for "query"', Clear Search button
- Empty state with helpful message; loading state while fetching
Content viewer showing feed items beneath it (CSS cascade bug):
- .lh-feed{display:flex} and .lh-category-bar{display:flex} defined
at CSS lines 513/507 — after .hidden{display:none} at line 242
So classList.add('hidden') was silently overridden
- showFeed() and showViewer() now use element.style.display with
explicit values ('flex'/'block'/'none') which always win over class rules
- viewer started hidden via class="hidden"; now shown with style.display='block'
- New GET /api/learning/content/:slug/slides (authMiddleware only)
Renders Marp markdown via marp-core, returns {css, slides[]} for
any authenticated user — no moderator access required
- showViewer: when content_type === 'presentation', hides the body card
and shows a presentation card with title, slide count, and View Slides button
Auto-opens the slide modal immediately on load; button allows re-opening
- openSlidesFromSlug(): fetches slides from user-accessible endpoint
then opens the existing slide preview modal (arrow keys, swipe, dots)
- Viewer already correctly hides feed/categories/search when viewing content;
"Back to Feed" button returns to the main list
Login flash:
- Auth screen now hidden by CSS default (#auth-screen{display:none !important})
- auth.js shows it only when there is no valid token or token is expired
- No more flash of login page on refresh for logged-in users
Presentation quiz option (AI Generate panel):
- Presentation type now shows optional quiz question toggle (same as article)
- Backend: when questionCount>0, returns JSON {marpMarkdown, questions[]}
instead of plain Marp markdown
- applyAiContent fills both the Marp textarea and question blocks for presentations
Viewer revert:
- Removed the viewer presentation card change (user wants markdown as-is)
- Removed dangling viewer button wiring
Feed/CMS list:
- Presentation type shows correct icon (fa-presentation-screen) and
label "Slides" in the CMS content list
