# Ped-AI

Ped-AI is a pediatric clinical documentation, education, and bedside decision-support app. This fork has moved well beyond the original scribe app: it now combines encounter documentation, clinical workflows, Learning Hub CMS, admin controls, MCP-backed clinical assistant integration, Redis-backed operational state, and hardened deployment defaults.

The app runs as an authenticated Express/Postgres service with a browser frontend and optional integrations for LiteLLM, Vertex/Gemini, AWS, OpenAI-compatible APIs, Nextcloud WebDAV, S3-compatible storage, OpenBao, Redis, OIDC, TOTP, and Cloudflare Turnstile.

## Current Scope

### Clinical Documentation

- Live encounter capture with structured pediatric HPI generation.
- Dictation cleanup for narrative notes.
- SOAP, sick visit, well visit, hospital course, chart review, precharting, and ED encounter workflows.
- Parent-facing education handouts generated from clinician notes, with diagnosis, medication, emergency-care guidance, and preferred-language support.
- Pediatric developmental milestone tooling.
- Templates, physician memory, and per-tab model overrides.
- Server-side speech-to-text routing through configured providers.

### Bedside Tools

- Pediatric calculators and emergency dosing helpers.
- PE guide and clinical reference content.
- Vaccines, catch-up schedules, growth/vitals, bilirubin, BSA, GCS, equipment, and resuscitation helpers.
- Mobile-friendly PWA layout for bedside use.
- Per-user phone extension and pager directory with soft-delete, search, ZIP export, and JSON/ZIP import for handoff between users.

### Learning Hub

- CMS for articles, clinical pearls, quizzes, and presentations.
- Tiptap article editor, quiz builder, category management, and draft/publish flow.
- AI-assisted content generation from topic text, uploaded files, or connected Nextcloud WebDAV files.
- Marp slide editing with preview and PPTX export.
- Keyword, semantic, and hybrid search using Postgres/pgvector where configured.

### Clinical Assistant

- Optional MCP-backed clinical assistant integration.
- Prompt suggestions backed by Redis operational cache.
- No clinical answer response caching.
- Designed to retrieve from indexed clinical material while keeping provider selection explicit.

### Admin And Security

- Local auth, role-based access, TOTP 2FA, OIDC/SSO, email verification, and optional Turnstile.
- Admin panel for users, settings, prompts, models, logs, and Learning Hub content.
- Audit, API, access, and client-error logs with redaction hardening.
- OpenBao secret loading support at container startup.
- S3-compatible document storage support.

## Removed Browser STT

Browser Whisper has been removed from the runtime. The app should not ship browser Whisper workers, browser-local Whisper model downloads, Transformers.js browser STT, or Browser Whisper setup docs.

Speech-to-text is handled server-side through configured providers such as Google/Gemini, AWS Transcribe, LiteLLM, or OpenAI Whisper. Browser-native Web Speech remains gated behind an explicit user setting when present in the browser.

## Quick Start

```bash
cp .env.example .env
docker compose up -d --build
```

The default compose exposes the app on `127.0.0.1:3552` and starts:

- `pediatric-ai-scribe` for the Node app.
- `pedscribe-db` for Postgres with pgvector.
- `ped-ai-redis` for operational Redis state.

Health check:

```bash
curl -fsS http://127.0.0.1:3552/api/health
```

Prometheus metrics are exposed at `GET /metrics` with the `ped_ai_` metric prefix.

The first registered user becomes an admin unless registration has already been configured differently.

## Core Environment

Set real values in `.env` before production use.

```env
APP_URL=https://your-domain.example
JWT_SECRET=<64-char-random-secret>
DB_PASSWORD=<strong-database-password>

AI_PROVIDER=litellm
LITELLM_API_BASE=https://your-litellm.example/v1
LITELLM_API_KEY=<key>

TRANSCRIBE_PROVIDER=litellm
LITELLM_STT_MODEL=whisper-1

REDIS_URL=redis://ped-ai-redis:6379
```

Supported text AI providers include LiteLLM, OpenRouter, AWS Bedrock, Azure OpenAI, and Google Vertex AI. Supported STT routing includes Google/Gemini, AWS Transcribe, OpenAI Whisper, and LiteLLM. Supported TTS routing includes Google Cloud TTS, LiteLLM/OpenAI-compatible audio, and ElevenLabs where configured.

## Admin CLI

```bash
docker exec pediatric-ai-scribe node admin-cli.js list-users
docker exec pediatric-ai-scribe node admin-cli.js create-admin admin@example.com password123 "Dr. Admin"
docker exec pediatric-ai-scribe node admin-cli.js make-admin user@example.com
docker exec pediatric-ai-scribe node admin-cli.js reset-password user@example.com newpassword
docker exec pediatric-ai-scribe node admin-cli.js toggle-registration
docker exec pediatric-ai-scribe node admin-cli.js stats
```

## Maintenance

The app checks Postgres collation drift on startup and can reindex text indexes after image or OS-library changes.

```bash
docker exec pediatric-ai-scribe npm run maint:check
docker exec pediatric-ai-scribe npm run maint:reindex
```

Run the reindex command after major Postgres image changes, restoring a dump from another distro, or seeing lookup behavior that suggests collation/index drift.

## Testing

Run the Node test suite:

```bash
npm test
```

Run syntax checks for touched files when doing focused backend work:

```bash
node --check server.js
node --check src/routes/transcribe.js
```

Run the Playwright smoke suite against the e2e compose stack:

```bash
docker compose -f docker-compose.yml -f docker-compose.e2e.yml up -d pediatric-scribe-e2e
npm run e2e
```

## Deployment Notes

- Put the app behind HTTPS before clinical use.
- Use only AI/STT/TTS providers covered by your BAA and data-processing requirements.
- Configure OIDC/SSO and 2FA for production users.
- Keep `JWT_SECRET`, database credentials, provider keys, S3 keys, SMTP credentials, and OpenBao tokens out of git.
- Treat logs as sensitive operational data even with redaction enabled.
- Use the Caddy/reverse-proxy layer to expose only intended public routes.

## Documentation

Primary references:

- `docs/ARCHITECTURE.md` for the current system map and service boundaries.
- `docs/DEVELOPMENT.md` for day-to-day code-change workflow.
- `docs/SCALING.md` for scaling priorities and readiness work.
- `docs/CLINICAL_ASSISTANT.md` for MCP-backed assistant behavior and safety rules.
- `docs/MODULE_CONVENTIONS.md` for CommonJS, ESM, globals, and rendering rules.
- `docs/architecture.md` for high-level architecture.
- `docs/api-reference.md` for API routes.
- `docs/authentication.md` for auth, OIDC, and security configuration.
- `docs/ai-providers.md` for model/provider setup.
- `docs/speech.md` for server-side STT/TTS setup.
- `docs/learning-hub.md` for the CMS and education workflow.
- `docs/configuration.md` for environment variables.
- `docs/deployment.md` for production deployment.
- `docs/mobile-build.md` for the Capacitor wrapper and app-store build notes.
- `docs/logic/README.md` for the deeper code walkthrough.

Some deep `docs/logic/` files still describe historical implementation details. Prefer runtime code and tests when documentation conflicts with current behavior.

## Clinical Safety

Ped-AI is documentation and education support software. It does not replace clinical judgment, local policy, medication verification, or attending review. Validate generated notes, calculations, and recommendations before use in patient care.