New top-level tab positioned after Physical Exam Guide. Per-user
directory of hospital phone extensions and pagers — grouped by location
then type, searchable, soft-deleted.
Data:
- New table user_phone_extensions (id, user_id, location, name, number,
type CHECK (extension|pager), notes, trashed_at, timestamps).
Partial indexes on active vs trashed rows for fast filtering.
- Not PHI — hospital internal phone directory. Plaintext.
API (all user-scoped, all params validated):
- GET /api/extensions?trash=1&q=text — list active or trash, optional search
- POST /api/extensions — create
- PUT /api/extensions/:id — update (requires all three core fields)
- DELETE /api/extensions/:id — soft-delete (sets trashed_at)
- POST /api/extensions/:id/restore — un-trash
- DELETE /api/extensions/:id/purge — hard-delete (only if trashed)
All :id params parsed + validated (positive integer) before query.
All queries parameterized, every WHERE includes user_id scoping.
UI (public/js/extensions.js + components/extensions.html):
- Search bar with 200ms debounce, server-side LIKE on location/name/number/notes
- Add button expands inline form — location (with datalist of existing
locations for autocomplete), name/dept, number, type, optional notes
- Each entry renders as a card: big monospace number, dept, type badge,
edit + delete inline
- Grouped by location → type (Extensions / Pagers subheaders)
- Trash view: toggle shows trashed items with Restore + Purge actions
- Trash count badge on the Trash button updates after every delete/restore
- Delete requires confirm() dialog, then soft-delete (easy to undo)
- Purge from trash requires a second confirm() ("cannot be undone")
- Esc closes the form; form resets between Add and Edit
New top-level tab (positioned after Catch-Up Schedule) combining two
functions:
1. Study reference — for each (age group, system) shows OSCE-style
components with technique, expected normal finding, and abnormal-
feature watch-list.
2. Documentation generator — physician marks each component
Normal / Abnormal (with free-text detail) / Skip; AI produces a
two-section report (Technique + Findings), narrative or structured
list format.
Scope v1: MSK + Neuro × 6 age groups (newborn, infant, toddler,
preschool, school-age, adolescent). More systems can be added to the
embedded PE_DATA in peGuide.js without route changes.
Files:
- src/routes/peGuide.js — POST /api/generate-pe-narrative (mirrors
milestone-narrative pattern: AppRole-level
injection guard, clinical audit category,
PHI redaction upstream already in place)
- src/utils/prompts.js — peGuideNarrative + peGuideList prompts,
structured two-section output
- public/components/pe-guide.html — demographics bar + sub-pills + cards
- public/js/peGuide.js — embedded PE_DATA (all clinical content),
render + state + AI call
- public/index.html — tab button, section, script include
- server.js — mount route at /api
No schema change. No PHI stored — findings live in memory only, exported
via existing copy/read-aloud/Nextcloud actions.
ES module script tags (<script type="module">) always send an Origin
header on fetch, even for same-origin requests. The global cors()
middleware was rejecting /js/bedside/index.js with 500 in the e2e
harness because the container's internal origin
(http://pediatric-ai-scribe:3000) is not in APP_URL/CORS_ORIGINS.
Production was unaffected (real users hit APP_URL, which is allowed),
but the fix is architecturally correct either way: CORS belongs on
the API boundary, not on static file serving. All protected routes
are under /api/*.
Unblocks the bedside smoke suite — now 26/26 green.
Safety net for upcoming refactors:
- 26 Playwright smoke tests via @playwright/test 1.50.0 in an official
Playwright container (no host Node needed). Covers every Bedside sub-pill,
the age→weight estimator, dose calculators (seizure/sepsis/anaphylaxis/
burns/airway), and interactive widgets (lightbox, vent SVG).
- `npm run e2e` wrapper runs tests inside mcr.microsoft.com/playwright:v1.50.0-noble
on the ped-ai_default Docker network so no host port mapping is needed.
- public/e2e-harness.html + public/js/e2e-bootstrap.js load the calculators
component without the SPA auth wall (scripts external to satisfy CSP).
Server:
- server.js now re-reads public/index.html on mtime change instead of
caching at boot. Fixes the "edit HTML, restart container" friction.
- CSP upgradeInsecureRequests disabled in helmet config; Caddy still
enforces HTTPS at the reverse-proxy layer in production.
1. Build-ID cache busting (server.js):
- Compute a BUILD_ID at boot: git HEAD short hash if available,
else /app/BUILD_ID file, else random-on-boot.
- On first request for /, rewrite every local /js/*.js and
/css/*.css reference in index.html to include ?v=BUILD_ID.
Cached once at startup so subsequent renders are free.
- X-Build-Id response header + GET /api/build expose it for
debugging.
- Eliminates the "works after hard-refresh" class of bugs: every
deploy gets a new build ID, so browsers fetch fresh JS/CSS on
the very next page load.
2. Optimistic encounter locking wired into the client
(public/js/encounters.js):
- On resumeEncounter(): stash enc.version into
window._encounterVersions[id]
- On saveEncounter(): send expected_version in the POST body
when we have one.
- Server returns 409 if another tab/device wrote first → user
sees "Someone else edited this encounter. Reload to see the
latest version." instead of silently clobbering the prior save.
- On success, remember the new server-assigned version for the
next save.
Age parser (src/routes/billing.js):
- Now sums year + month + week + day matches so "4 yr 11 mo"
(59 months) correctly maps to the 5-11y billing bracket instead
of being billed as 1-4y. Added bounds sanity check.
Graceful SIGTERM shutdown (server.js):
- Closes the HTTP listener first, then drains batched audit queues,
then ends the Postgres pool. 9-second hard deadline to beat
Docker's 10-second SIGKILL. Previously an in-flight note save
during a container restart could truncate the write.
Explicit LLM fallback opt-in (src/utils/ai.js):
- The OpenRouter / LiteLLM silent fallback now requires admin
setting `ai.allow_model_fallback = true` (default: false). If
primary fails and fallback is disabled, the error is surfaced
to the caller. Prevents silent spillover from a BAA-covered
primary to a non-covered fallback.
Prompt injection delimiters (src/utils/promptSafe.js):
- Wraps user transcripts, dictations, refine-instructions, and
pasted documents in <UNTRUSTED_*>...</UNTRUSTED_*> tags and
appends an explicit system instruction telling the model to
treat the wrapped content as data rather than commands.
- Applied to soap.js, hpi.js, refine.js. Extend to other AI
routes incrementally.
Cross-tab logout sync (public/js/authFetch.js, auth.js):
- BroadcastChannel('pedscribe-auth') — logout in one tab posts
a message; all sibling tabs clear state and reload, dropping
any PHI-containing UI immediately.
Backup code race-free consumption (src/routes/auth.js):
- tryConsumeBackupCode() now uses a Postgres transaction with
SELECT ... FOR UPDATE so concurrent login attempts using the
same code serialize. First wins, second sees the already-
shortened array.
Optimistic encounter locking (migrations/...add-encounter-version):
- saved_encounters.version INTEGER NOT NULL DEFAULT 1
- POST /api/encounters/saved accepts an expected_version and
rejects with 409 if the row has advanced. Falls back to
last-write-wins if the client doesn't pass one (backward compat).
Audit log batching (src/utils/auditQueue.js):
- Audit / api_log / access_log writes are buffered in memory and
flushed every 1s or every 50 entries via one multi-row INSERT.
Under load this reduces DB pressure by ~50x. On SIGTERM the
shutdown path drains the queue before exiting.
- App-layer AES-256-GCM crypto helper (src/utils/crypto.js)
- Nextcloud tokens encrypted at rest; transparent migration on next use
- Audio backups encrypted at rest (version byte 0x01 envelope); legacy
rows still decrypt as-is until overwritten
- argon2id password hashing via src/utils/passwords.js with bcrypt
fallback; bcrypt hashes rehashed to argon2id on next successful login.
argon2 package is optional — server keeps running with bcrypt only
until npm install adds the native dep
- PHI redactor for audit log details (src/utils/redact.js) — strips SSN,
phone, email, DoB, long IDs; caps at 500 chars; detects note bodies
- DOMPurify (cdnjs, SRI-pinned) replaces custom regex sanitizer in
Learning Hub content rendering
- SRI integrity hashes added for Font Awesome CSS and Chart.js
- Magic-byte file-type verification on document uploads
(src/utils/fileType.js)
- Generic 500 error responses via src/utils/errors.js applied to
nextcloud and audioBackups; full detail still logged server-side
- DATA_ENCRYPTION_KEY env documented in .env.example
Deploy: requires rebuild of the container image to pick up the new
files and `npm install` (adds argon2). Existing users keep working
because bcrypt stays available and crypto helpers pass through
plaintext when the key is not yet set in dev.
- JWT_SECRET fails fast at startup in production
- CORS fails closed if APP_URL + CORS_ORIGINS are both missing
- Explicit HSTS (1y, includeSubDomains, preload)
- Rate limit sensitive auth endpoints (change-password, 2FA)
- /api/health now returns {ok:true}; details gated behind admin auth
- Login enumeration removed — generic 401 + dummy bcrypt on miss
- ReDoS guard: 20KB input cap on /suggest-codes
- showToast uses textContent, no innerHTML
- clearSession() clears service worker caches on logout
- OIDC state is now HMAC-signed and stateless (survives restart)
- SSRF guard on admin-set OIDC issuer (blocks private IPs, requires HTTPS)
Adds docs/mobile-build.md covering APK build, release, git push,
keystore, and troubleshooting for both PedScribe and PedsHub apps.
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)
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
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
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
- 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)
- TRANSCRIBE_PROVIDER=litellm routes audio to LiteLLM /audio/transcriptions
- TTS_PROVIDER=litellm routes to LiteLLM /audio/speech
- Both auto-detect when LITELLM_API_BASE is set (no extra config needed)
- LITELLM_STT_MODEL (default: whisper-1), LITELLM_TTS_MODEL (default: tts-1)
- LITELLM_TTS_VOICE (default: alloy) — alloy/echo/fable/onyx/nova/shimmer
- ElevenLabs still works if ELEVENLABS_API_KEY is set and TTS_PROVIDER=elevenlabs
- Health endpoint now reports tts provider
- 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
- APK: Add WAKE_LOCK, BOOT_COMPLETED, ACCESS_NETWORK_STATE permissions
- APK: Disable allowBackup for medical data security
- APK: AudioRecordingService now acquires wake lock, has stop action in notification
- Serve /.well-known/assetlinks.json for TWA domain verification
- Service worker: cache app shell, stale-while-revalidate for assets, network-first for API
- Admin model management: validate model ID format, prevent built-in conflicts, audit toggle actions, prevent disabling all models
- Bump version to v9.0.0, Docker tag to v9
- 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/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
pdf-parse (was v2, broken API):
- Downgraded to v1.1.1 — default export is a function again
- pdfParse is not a function error fixed
WebDAV file selection (style.display bug, same cascade issue):
- lh-ai-webdav-selected had inline style="display:flex" always visible
- selectWebdavFile() / deselectWebdavFile() now use element.style.display
- On select: browser div hides, selected indicator shows with file name + X
- On deselect (X): indicator hides, browser shows again
Topic context for Upload and Nextcloud tabs:
- Both tabs now have optional "Topic / context" field
- Sent to backend as 'topic' param to help AI focus the generated content
Inline refine bar (replaces window.prompt):
- Refine Body button shows/hides an amber inline input bar below generate buttons
- Enter instructions, press Apply — no browser dialog, works in all contexts
CSP: remove unsafe-inline from scriptSrc (security issue #2):
- Converted all 26 onclick= handlers in component HTML files to
data-action / data-target / data-label attributes
- Added delegated click handler in app.js for copy/speak/nc-export actions
- script-src now 'self' only; script-src-attr 'none'
WebDAV path endpoint (security issue #5):
- New POST /api/user/webdav-path (authMiddleware only, not moderator)
- nextcloud.js updated to use new endpoint
nodemailer: already at 6.10.1 (vulnerability fixed).
Backend (src/routes/learningAI.js):
- POST /api/admin/learning/ai-generate
* Accepts: topic text, uploaded file (PDF/TXT/MD/HTML), or Nextcloud WebDAV path
* Extracts text from PDFs via pdf-parse; plain text read directly
* Fetches WebDAV files using stored Nextcloud credentials
* Prompts AI to return structured JSON: title, subject, body (HTML), questions[]
* Strips code fences, falls back to regex JSON extraction if needed
- POST /api/admin/learning/ai-refine — refine existing body with instructions
- GET /api/admin/learning/webdav-browse — PROPFIND-based Nextcloud file browser
- POST /api/admin/learning/webdav-path — save user's default browse path
Frontend:
- AI Generate button in CMS editor header (gradient purple→blue)
- Panel with 3 source tabs: By Topic / Upload File / Nextcloud
- Drag-and-drop file dropzone with DataTransfer API support
- WebDAV file browser: navigate folders, select files, breadcrumb path
- Options: question count, content type (article/quiz/pearl), model selector, instructions
- Refine Current Body: prompt-driven AI rewrite of existing content
- Generated content auto-fills title, subject, type, Tiptap body, quiz questions
Settings:
- Nextcloud section: "Learning Hub Default Browse Path" field (shown when connected)
- Saves to webdav_learning_path column via /api/admin/learning/webdav-path
DB: ALTER TABLE users ADD COLUMN IF NOT EXISTS webdav_learning_path TEXT
Only serve index.html for GET /; all other unknown paths return HTTP 404
with a custom branded error page (stethoscope SVG illustration, matches
app design, links back to /).
- New Learning Hub under Pediatric menu with content feed, category browsing,
search, content viewer, and interactive quizzes (MCQ, true/false)
- Quiz system with per-option wrong-answer explanations and general explanations
- Admin CMS for creating/editing categories, content (articles, pearls, quizzes),
and inline question builder with answer options
- 3-role system: admin (full access), moderator (can manage Learning Hub content),
user (all clinical features + learning hub read access)
- 5 new database tables: learning_categories, learning_content, learning_questions,
learning_options, learning_progress
- User progress tracking with score history per quiz
- Moderators see "Content Manager" tab instead of full Admin panel
- Wrap save-bar + popover in .save-bar-wrap (position:relative) so the
absolute-positioned popover anchors correctly below the Load button
(previously popovers were outside the save-bar, so had no positioned
ancestor and appeared at the wrong place on screen)
- Remove confirm() dialog from deleteEncounter — encounter disappears
immediately from the popover list after deletion
- ICD-10 diagnoses: replace static-only lookup with live NLM Clinical
Tables API search (clinicaltables.nlm.nih.gov) with 280ms debounce;
results appear in a dropdown below the search input; Enter/click selects
- Add clinicaltables.nlm.nih.gov to CSP connect-src
- Drop unused position:relative from .save-bar (now on .save-bar-wrap)
Helmet 8 adds script-src-attr: 'none' by default which blocks ALL
inline event attribute handlers (onclick, onchange, etc.) regardless
of script-src unsafe-inline. This silently broke every onclick button:
copy, read aloud, nextcloud upload, generate, record, etc.
- CSP connectSrc was blocking service worker re-fetches to cdnjs.cloudflare.com
causing Font Awesome icons to go blank (settings, logout, nextcloud buttons)
- Add cdnjs, googleapis, gstatic, google to connectSrc to fix icon rendering
and Chrome Web Speech API (which connects to Google servers for TTS voices)
- Add vendor model Opus 4.6 and vendor model Sonnet 4.6 to all three provider lists
(OpenRouter, Bedrock, Azure-compatible); Sonnet 4.6 now default for Bedrock
- Enable Helmet CSP (scripts/styles/fonts/connect restricted to self + CDNs)
- Lock CORS to APP_URL origin in production (open in dev)
- Reduce JSON body limit from 50mb to 1mb
- Add per-route rate limits: login 10/15min, register 5/hr, forgot-pw 5/hr
- Add README with full setup, Docker Hub, provider switching, env reference
- Bump version to 3.0.0
