216 lines
9.3 KiB
JavaScript
216 lines
9.3 KiB
JavaScript
// ============================================================
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// WELL VISIT ROUTES — SSHADESS assessment + note generation
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// ============================================================
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var express = require('express');
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var router = express.Router();
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var { callAI } = require('../utils/ai');
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var PROMPTS = require('../utils/prompts');
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var { authMiddleware } = require('../middleware/auth');
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var logger = require('../utils/logger');
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var { wrapUserText, INJECTION_GUARD } = require('../utils/promptSafe');
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// Load growth reference and BMI classification data from the same JSON used by the browser.
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var scheduleData;
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try {
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scheduleData = require('../../public/data/well-visit/schedule.json');
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} catch(e) {
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scheduleData = {};
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}
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var GROWTH_REFERENCE = scheduleData.growthReference || {};
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var BMI_CLASSIFICATION = scheduleData.bmiClassification || {};
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// Map visit age text to GROWTH_REFERENCE keys
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function getGrowthRefForAge(ageStr) {
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if (!ageStr) return null;
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var a = ageStr.toLowerCase().trim();
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// Direct key matches
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var directKeys = ['newborn', '1mo', '2mo', '4mo', '6mo', '9mo', '12mo', '15mo', '18mo', '24mo', '30mo', '3y', '4y', '5y'];
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for (var i = 0; i < directKeys.length; i++) {
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if (a.indexOf(directKeys[i]) !== -1) return GROWTH_REFERENCE[directKeys[i]] || null;
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}
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// Age-based range matching
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var ageMatch = a.match(/(\d+)\s*(month|mo|year|y|yr)/i);
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if (ageMatch) {
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var num = parseInt(ageMatch[1]);
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var unit = ageMatch[2].toLowerCase();
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if (unit === 'month' || unit === 'mo') {
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if (num <= 1) return GROWTH_REFERENCE['1mo'];
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if (num <= 3) return GROWTH_REFERENCE['2mo'];
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if (num <= 5) return GROWTH_REFERENCE['4mo'];
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if (num <= 8) return GROWTH_REFERENCE['6mo'];
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if (num <= 11) return GROWTH_REFERENCE['9mo'];
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if (num <= 14) return GROWTH_REFERENCE['12mo'];
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if (num <= 17) return GROWTH_REFERENCE['15mo'];
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if (num <= 23) return GROWTH_REFERENCE['18mo'];
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if (num <= 29) return GROWTH_REFERENCE['24mo'];
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if (num <= 35) return GROWTH_REFERENCE['30mo'];
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}
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if (unit === 'year' || unit === 'y' || unit === 'yr') {
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if (num <= 3) return GROWTH_REFERENCE['3y'];
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if (num <= 4) return GROWTH_REFERENCE['4y'];
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if (num <= 5) return GROWTH_REFERENCE['5y'];
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if (num <= 10) return GROWTH_REFERENCE['6y_to_10y'];
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if (num <= 14) return GROWTH_REFERENCE['11y_to_14y'];
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return GROWTH_REFERENCE['15y_to_21y'];
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}
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}
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if (a.indexOf('newborn') !== -1 || a.indexOf('birth') !== -1) return GROWTH_REFERENCE['newborn'];
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return null;
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}
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// ── POST generate SSHADESS assessment summary ────────────────────────────
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router.post('/well-visit/shadess', authMiddleware, async function(req, res) {
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var start = Date.now();
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try {
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var { domains, patientAge, patientGender, dictationText, model } = req.body;
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if (!domains && !dictationText) {
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return res.status(400).json({ error: 'Provide domain responses or dictation text' });
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}
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// Build structured input text
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var inputText = 'PATIENT: ' + (patientAge || 'Adolescent') + ', ' + (patientGender || 'Unknown gender') + '\n\n';
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inputText += 'SSHADESS SCREENING DATA:\n\n';
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if (dictationText) {
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inputText += 'PHYSICIAN DICTATION:\n' + dictationText + '\n\n';
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}
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if (domains) {
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var domainOrder = ['strengths', 'school', 'home', 'activities', 'drugs', 'emotions', 'sexuality', 'safety'];
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var domainNames = {
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strengths: 'STRENGTHS',
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school: 'SCHOOL',
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home: 'HOME',
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activities: 'ACTIVITIES',
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drugs: 'DRUGS/SUBSTANCES',
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emotions: 'EMOTIONS/EATING',
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sexuality: 'SEXUALITY',
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safety: 'SAFETY'
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};
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domainOrder.forEach(function(key) {
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var d = domains[key];
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if (!d || d.skipped) return;
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inputText += domainNames[key] + ':\n';
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if (d.questions) {
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d.questions.forEach(function(q) {
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if (q.answer !== null && q.answer !== undefined && q.answer !== '') {
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inputText += ' - ' + q.text + ': ' + (q.answer === true || q.answer === 'yes' ? 'YES' : (q.answer === false || q.answer === 'no' ? 'NO' : q.answer)) + '\n';
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}
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});
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}
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if (d.comment && d.comment.trim()) {
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inputText += ' Comments: ' + d.comment + '\n';
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}
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if (d.concern) {
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inputText += ' *** CONCERN FLAGGED ***\n';
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}
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inputText += '\n';
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});
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}
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var result = await callAI([
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{ role: 'system', content: PROMPTS.shadessAssessment + INJECTION_GUARD },
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{ role: 'user', content: wrapUserText('sshadess_answers', inputText) }
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], { model });
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var dur = Date.now() - start;
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logger.apiCall(req.user.id, '/api/well-visit/shadess', {
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model: result.model, tokensInput: result.usage?.input_tokens,
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tokensOutput: result.usage?.output_tokens, duration: dur, statusCode: 200
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});
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res.json({ success: true, assessment: result.content, model: result.model });
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logger.audit(req.user.id, 'generate_shadess', 'Generated SSHADESS assessment', req, { category: 'clinical' });
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} catch (e) {
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logger.error('[WellVisit] SHADESS generation failed', e.message);
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res.status(500).json({ error: 'Request failed' });
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}
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});
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// ── POST generate full well visit encounter note ─────────────────────────
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router.post('/well-visit/note', authMiddleware, async function(req, res) {
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var start = Date.now();
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try {
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var {
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patientAge, patientGender, visitAge,
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vitals, measurements,
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transcript, dictation,
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screenings, vaccines,
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shadessAssessment,
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parentConcerns,
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ros, physicalExam, diagnoses,
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physicianMemories,
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noteStyle, // 'full' | 'short'
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model
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} = req.body;
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if (!patientAge && !visitAge) {
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return res.status(400).json({ error: 'Patient age or visit age required' });
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}
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// Assemble context
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var context = 'WELL CHILD VISIT\n';
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context += 'Patient: ' + (patientAge || visitAge) + ', ' + (patientGender || 'Unknown') + '\n\n';
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if (vitals) context += 'VITAL SIGNS:\n' + wrapUserText('vitals', vitals) + '\n\n';
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if (measurements) context += 'MEASUREMENTS/GROWTH:\n' + wrapUserText('measurements', measurements) + '\n\n';
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if (parentConcerns) context += 'PARENT/PATIENT CONCERNS:\n' + wrapUserText('concerns', parentConcerns) + '\n\n';
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if (transcript) context += 'ENCOUNTER TRANSCRIPT/DICTATION:\n' + wrapUserText('transcript', transcript) + '\n\n';
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else if (dictation) context += 'PHYSICIAN DICTATION:\n' + wrapUserText('dictation', dictation) + '\n\n';
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if (screenings) context += 'SCREENINGS COMPLETED:\n' + wrapUserText('screenings', screenings) + '\n\n';
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if (vaccines) context += 'IMMUNIZATIONS TODAY:\n' + wrapUserText('vaccines', vaccines) + '\n\n';
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if (shadessAssessment) context += 'SSHADESS PSYCHOSOCIAL ASSESSMENT:\n' + wrapUserText('sshadess', shadessAssessment) + '\n\n';
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if (ros) context += wrapUserText('ros', ros) + '\n\n';
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if (physicalExam) context += wrapUserText('physical_exam', physicalExam) + '\n\n';
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if (diagnoses) context += wrapUserText('diagnoses', diagnoses) + '\n\n';
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if (physicianMemories) {
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context += '[STYLE HINTS (low priority — only apply if relevant to the current note, never copy content from these examples)]\n'
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+ wrapUserText('style_hints', physicianMemories) + '\n[END STYLE HINTS]\n\n';
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}
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// Add growth reference and feeding guidance for this age
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var growthRef = getGrowthRefForAge(patientAge || visitAge);
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if (growthRef) {
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context += 'GROWTH/NUTRITION GUIDANCE (AAP reference for this age):\n';
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if (growthRef.weight) context += 'Expected weight gain: ' + growthRef.weight + '\n';
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if (growthRef.length) context += 'Expected length/height gain: ' + growthRef.length + '\n';
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if (growthRef.headCirc) context += 'Expected head circumference gain: ' + growthRef.headCirc + '\n';
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if (growthRef.feeding && growthRef.feeding.length) {
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context += 'Feeding guidance:\n';
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growthRef.feeding.forEach(function(f) { context += ' - ' + f + '\n'; });
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}
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if (growthRef.bmiClassification && BMI_CLASSIFICATION.categories) {
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context += 'BMI Classification (AAP 2023 / CDC Extended BMI):\n';
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BMI_CLASSIFICATION.categories.forEach(function(c) {
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context += ' - ' + c.label + ': ' + c.range + ' → ' + c.action + '\n';
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});
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}
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context += '\n';
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}
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var prompt = (noteStyle === 'short') ? PROMPTS.wellVisitShort : PROMPTS.wellVisitNote;
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var result = await callAI([
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{ role: 'system', content: prompt + INJECTION_GUARD },
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{ role: 'user', content: context }
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], { model });
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var dur = Date.now() - start;
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logger.apiCall(req.user.id, '/api/well-visit/note', {
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model: result.model, tokensInput: result.usage?.input_tokens,
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tokensOutput: result.usage?.output_tokens, duration: dur, statusCode: 200
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});
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res.json({ success: true, note: result.content, model: result.model });
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logger.audit(req.user.id, 'generate_well_visit', 'Generated well visit note', req, { category: 'clinical' });
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} catch (e) {
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logger.error('[WellVisit] Note generation failed', e.message);
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res.status(500).json({ error: 'Request failed' });
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}
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});
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module.exports = router;
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