Three concurrent themes from this session:
═══════════════════════════════════════════════════════════════════
ED ENCOUNTERS — per-stage cards + consolidate→MDM finalize
═══════════════════════════════════════════════════════════════════
UX redesign per Daniel's feedback ("every stage note should be shown,
if AI is told to modify that particular note then the modified version
is used in final mdm"):
- Each generated stage stays on screen as its own editable card with
its own embedded "Don't Miss" panel. No more single rolling note
element that gets replaced on each generation.
- gatherCurrentNotes() reads contenteditable text from each stage card
before any operation (advance, finalize, persist) so inline edits
flow into the next AI call and the final consolidate.
- Stage badge is now state-accurate. "Stage N (recording)" with yellow
background after Add-more before generation; "Stage N" with gray
after generation. Fixes the bug where the badge flipped to Stage 2
the moment Add-more was clicked.
- Save & Done now runs TWO server-side AI calls in /finalize:
1. edConsolidate (new prompt) → polished single final note that
integrates every stage chronologically (HPI / ROS / PE / ED Course /
A&P with disposition).
2. edFinalize (rewritten with full inline 2023 AMA E/M element
rubric — problems / data / risk definitions, level mapping with
concrete examples) → MDM JSON.
- Two new cards render after finalize: blue-bordered Final Consolidated
Note + green-bordered MDM. Stage cards become read-only.
- partial_data on the saved row now stores {stages, finalNote, mdm,
finalized} so resume re-renders the full state.
Why two-call finalize: a single combined prompt makes the model cut
corners on one task. Two focused calls cost ~2× latency at the very end
of an encounter — acceptable since finalize is a one-time terminal
action, not a per-stage hot path.
Files: public/components/ed-encounter.html, public/js/ed-encounters.js,
src/routes/edEncounters.js, src/utils/prompts.js (edConsolidate added,
edFinalize rewritten).
═══════════════════════════════════════════════════════════════════
EXTENSIONS / PAGERS — visual polish
═══════════════════════════════════════════════════════════════════
Multiple iterations based on Daniel's feedback:
- Layout: align-items:flex-start so action buttons stay pinned top-right
when long numbers wrap (was align-items:center → buttons drifted into
the text area, causing visible overlap).
- Number: word-break:break-all + min-width:0 + font-feature-settings:tnum
so long numbers wrap within their column instead of pushing under the
buttons. Click-to-copy with a 0.55s green flash + ✓ copied badge.
- Phone/pager Font Awesome icon next to the number in the type color —
at-a-glance type signal (replacing an earlier 3px left stripe that
Daniel found visually bulky).
- Name: font-weight 700, font-size 14.5px, color g900, letter-spacing
-0.012em — scan-target headline typography for long lists.
- Alternating subtle backgrounds by index (white vs #fafbfc) so a long
list reads as distinct rows.
- Hover: card lifts 1px with a soft shadow; action buttons fade from
55% to 100% opacity. Cubic-bezier transition on transform.
- Entrance: staggered fade-up animation per card (35ms × index, capped
at 12). prefers-reduced-motion media query disables motion.
- Empty state: 48px FA icon + heading instead of plain gray text.
Files: public/js/extensions.js, public/css/styles.css.
═══════════════════════════════════════════════════════════════════
DOCS REORGANIZATION + APPLICATION-LOGIC DOCS + ADMIN VIEWER
═══════════════════════════════════════════════════════════════════
Document moves (preserving git history via git mv):
BROWSER_WHISPER_SETUP.md → docs/browser-whisper-setup.md
BROWSER_WHISPER_TROUBLESHOOTING.md → docs/browser-whisper-troubleshooting.md
DEVELOPER_GUIDE.md → docs/developer-guide-extended.md
EMBEDDINGS_SETUP.md → docs/embeddings-setup.md
FEATURES_EXPLAINED.md → docs/features-explained.md
IMPROVEMENTS.md → docs/improvements.md
OPENID_SETUP.md → docs/openid-setup.md
TRANSCRIPTION_OPTIONS.md → docs/transcription-options.md
README.md updated with the new paths + a Documentation section that
links to docs/logic/ at the top.
New application-logic doc series (~8,300 lines total) at docs/logic/.
Built with 5 parallel doc-writing agents per Daniel's "use multiple
agents" directive. Each doc explains how a part of the app actually
works — application logic, data flow, design decisions, sacred zones,
how-to-extend recipes — at a depth that lets a new dev (or an AI
assistant) modify the code confidently.
docs/logic/README.md — index + recommended reading order
docs/logic/architecture.md (2166 L) — frontend IIFE pattern, lazy tab
load, backend route convention,
schema, encryption, deployment
docs/logic/clinical-notes.md (1546L) — every note tab + helper trio
docs/logic/bedside-and-calculators.md (1373L) — bedside ES module
pocket + calculators + PE Guide
+ suture selector
docs/logic/auth-admin-learning.md (1281L) — auth (local+OIDC+2FA) +
admin panel + Learning Hub
(Quiz engine logic at sub-detail
only — TODO follow-up)
docs/logic/ai-and-voice.md (1128 L) — callAI 5-provider routing,
prompts, voice/STT, helper trio
docs/logic/ed-encounters.md (821 L) — multi-stage ED + MDM (this
session's worked example)
Admin-only docs viewer:
- New route /api/admin/docs/{tree,file}: recursively walks docs/, returns
the tree as JSON; /file?path=X validates path stays inside docs/ and
renders markdown via marked. Both gated by req.user.role==='admin'.
- New tab "Docs" (book icon) in the sidebar, hidden by default and
revealed in auth.js when user.role==='admin' (same pattern as the
existing Admin and CMS tabs).
- New component public/components/admin-docs.html: split-pane layout
with a tree sidebar + filter input + a markdown reader pane.
- New module public/js/admin-docs.js: lazy-loads the tree on first tab
activation, renders collapsible folders, persists expanded state and
last-opened path via UIState. Server-rendered HTML so no client
markdown parser needed.
- CSS for the viewer (responsive split-pane, code-block styling, table
scrolling, etc.).
- Mounted at /api/admin/docs (NOT /api) — important: mounting a router
with router.use(authMiddleware) at /api accidentally 401s every other
/api/* path (caught and fixed during testing — /api/health was 401'ing).
Files: docs/* (moved + new), README.md, public/components/admin-docs.html
(new), public/js/admin-docs.js (new), src/routes/adminDocs.js (new),
public/index.html (tab + section + script), public/js/auth.js (admin
gate + logout cleanup), public/css/styles.css (viewer styles), server.js
(mount).
═══════════════════════════════════════════════════════════════════
KNOWN GAPS (TODO follow-ups)
═══════════════════════════════════════════════════════════════════
- Learning Hub quiz engine (MCQ / multi-select / T-F scoring + attempt
tracking + progress dashboard) is covered at the architectural level
in docs/logic/auth-admin-learning.md but not drilled into the quiz
data model and scoring flow. Worth a focused follow-up doc.
- ED finalize: if MDM step JSON parse fails, server returns 502 with
the consolidated finalNote in the error payload, but client doesn't
surface the partial result. Add a "MDM failed, retry" affordance.
- No e2e Playwright coverage for ED encounters or the new docs viewer.
#2 — Don't-miss tooltip (encounters HPI + sick visit, max 5)
- New POST /api/dont-miss returning {points: [{point, why}]} capped at 5
(cap defended both in the prompt and server-side .slice(0,5))
- New dontMissTooltip prompt in prompts.js
- New suggestDontMiss() helper in app.js mirroring suggestBillingCodes;
inserts an orange-bordered card next to the note output, silent on empty
- Wired into liveEncounter.js (encounter HPI) and sickVisit.js. Not added
to wellvisit/soap/hospital/chart per spec.
#1 — Bedside suture selector
- New ES module public/js/bedside/sutures.js (~300L) following the
burns.js pattern: site × age × tension × cosmetic × contamination ×
hours-since-injury → material, size, technique, removal day range,
glue/Steri-strip alternative, warnings, tetanus reminder.
- 15 anatomic sites covered (face, eyelid, lip vermilion, intraoral,
ear, scalp, neck, trunk, upper/lower ext, hand, foot, joint surface,
genitalia, fingertip).
- Bites: cat/human → don't-close-primarily warning; dog bite to hand →
loose-approximation note. Heavy contamination → delayed primary
closure. >12h non-face/scalp → judgment call note.
- Removal days shown as ranges (3–5, 7–10, 10–14) per source norms,
not single midpoints.
- Subungual hematoma trephination guidance corrected: any painful
hematoma with intact nail and no displaced fracture (especially if
25–50% or more), per current UpToDate guidance.
- Inline citation: Roberts & Hedges 7e (2019), Fleisher & Ludwig 8e,
AAP Section on EM, UpToDate (Pope JV).
- Pill registered in sub-nav SECTIONS + bedside/index.js. Persists
active state via existing UIState helper.
All 46 tests pass.
Four changes batched:
1. ED Encounters tab (new) — multi-stage emergency note with don't-miss
tooltips and 2023 E/M MDM finalize. New route /api/ed-encounters
(generate per-stage + finalize MDM), new ed-encounters.js owning all
client logic, new ed-encounter.html component, new template_ed memory
category. Persists draft to localStorage every keystroke and to
saved_encounters on stage advance. encounters.js touched only to
register the new tab in sessionStorage restore + tabMap (save and
idempotency code untouched).
2. Notes model selector — /notes/from-voice now accepts a client-supplied
model (validated by the existing callAI allow-list); falls back to the
admin default. Added <select class="tab-model-select"> to notes.html
so the existing app.js populator handles options + default.
3. Remove AI-learning-from-corrections — deleted correctionTracker.js,
POST /memories/correction, the corrections branch in
/memories/context, the settings UI section, the FAQ entry, and all
dead trackAIOutput/saveCorrection guards in callers. Legacy
correction_* DB rows are filtered (NOT LIKE) rather than dropped, so
no destructive migration.
4. Fix notes AI framing — /notes/from-voice prompt no longer assumes
"physician dictation". Plain notes (shopping lists, reminders,
ideas) now match the dictation tone instead of being forced into
clinical structure.
All 46 tests pass.
Replaces the generic one-line-per-component format with a step-level
checklist. Each exam component now contains 3–13 discrete steps, each
with its own Normal/Abnormal/Skip toggle and optional abnormal note.
Physician ticks the exam off step-by-step; report generation
summarises at the component level but knows exactly which steps were
performed.
Example — previously the adolescent "Cranial nerves (II–XII)" was a
single row: "How to perform: Full formal adult-pattern exam. Expected:
All cranial nerves intact." That's unhelpful. Now it's 14 discrete
steps: CN I, CN II acuity, CN II fields, CN II fundoscopy, CN II/III
pupils, CN III/IV/VI EOM, CN V sensation V1/V2/V3, CN V motor, CN V
corneal, CN VII forehead/eye-close/smile/puff, CN VIII, CN IX/X, CN
XI, CN XII — each with specific method and expected finding. Same
depth for MSK: scoliosis = 5 discrete steps (standing inspection,
Adam forward-bend, rib-hump check, scoliometer, plumb-line), joint
stability = 8 named tests (Lachman, anterior drawer, varus/valgus,
McMurray, apprehension, Neer/Hawkins, anterior drawer ankle, talar
tilt), Beighton = 5 per-joint measurements, etc.
Sources cited in code header: Bates' Guide 13th ed, Nelson Textbook
22nd ed, Hutchison's Clinical Methods 25th ed, Fenichel Clinical
Pediatric Neurology 8th ed.
Backend route accepts the flat step array (grouped by component on
the server), passes structured text to the AI with methods and
expected findings per step. Prompts updated to summarise at the
component level rather than step-by-step, so output is clinically
readable.
Scope: MSK + Neuro × 6 age groups (newborn, infant, toddler, preschool,
school-age, adolescent). More systems follow the same pattern —
append to PE_DATA.
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.
- WNL/Normal systems now expand to 1-3 specific pertinent negatives instead of
just "WNL" — varies each time, relates to chief complaint and differential
(e.g., Skin: "no rash, no petechiae, no bruising" instead of "WNL")
- Abnormal systems: AI expands physician's brief note into clinical description
favoring most common presentation, adds only 1-2 related pertinent negatives
(e.g., "pimples on face" → "inflammatory papules on bilateral cheeks...")
- Format function now passes system domain details for context
- Rules applied to well visit (full + short) and sick visit prompts
- Growth reference data by age (newborn through 21y): expected weight/length/HC
gains per day/month/year, puberty growth spurt details
- Feeding/nutrition guidance by age: formula amounts, breastfeeding frequency,
solid food introduction timeline, juice limits, milk transitions, calorie needs
- BMI/obesity classification per AAP 2023 CPG + CDC Extended BMI:
Underweight, Healthy, Overweight, Obesity Class I/II/III with action items
(≥120% and ≥140% of 95th percentile thresholds)
- Weight-for-length guidance for children <2 years
- "By Visit" panel now shows growth reference + feeding guidance + BMI table
- Well visit AI prompt updated to include growth assessment, BMI classification,
and feeding counseling in generated notes
- Backend injects age-appropriate growth/nutrition data into AI context
Replace checkmark/X symbol format with plain numbered sentences:
achieved → 'Can walk independently'
not achieved → 'Cannot walk' / 'Does not yet use 2-word sentences'
