pediatric-ai-scribe-v3/src/routes/wellVisit.ts

// ============================================================
// WELL VISIT ROUTES — SSHADESS assessment + note generation
// ============================================================

import express = require('express');
import type { Request, Response } from 'express';
const { callAI } = require('../utils/ai');
const PROMPTS = require('../utils/prompts');
const { authMiddleware } = require('../middleware/auth');
const logger = require('../utils/logger');
const { wrapUserText, INJECTION_GUARD } = require('../utils/promptSafe');

const router = express.Router();

// Load growth reference and BMI classification data
let scheduleData: any;
try {
  scheduleData = require('../data/pediatric-schedule-data');
} catch (e) {
  scheduleData = {};
}
const GROWTH_REFERENCE: Record<string, any> = scheduleData.GROWTH_REFERENCE || {};
const BMI_CLASSIFICATION: any = scheduleData.BMI_CLASSIFICATION || {};

// Vaccine full names — sourced from public/js/wellVisit.js where they were
// inlined. Mirrored here so a single backend response can power the React
// vax schedule page without a second round trip.
const VACCINE_FULL_NAMES: Record<string, string> = {
  HepB: 'Hepatitis B (HepB)',
  RV: 'Rotavirus (RV)',
  DTaP: 'DTaP (Diphtheria, Tetanus, Pertussis)',
  Hib: 'Hib (Haemophilus influenzae type b)',
  PCV: 'Pneumococcal (PCV)',
  IPV: 'Polio (IPV)',
  Flu_IIV: 'Influenza (IIV)',
  MMR: 'MMR (Measles, Mumps, Rubella)',
  VAR: 'Varicella (VAR)',
  HepA: 'Hepatitis A (HepA)',
  Tdap: 'Tdap (Tetanus, Diphtheria, Pertussis booster)',
  HPV: 'HPV (Human Papillomavirus)',
  MenACWY: 'Meningococcal ACWY (MenACWY)',
  MenB: 'Meningococcal B (MenB)',
  RSV_mAb: 'RSV Monoclonal Antibody (Nirsevimab/Beyfortus)',
  COVID: 'COVID-19',
  Dengue: 'Dengue (DEN4CYD / Dengvaxia)',
  Mpox: 'Mpox (JYNNEOS)',
};

// ── GET schedule data — used by the React client to render vaccine
// ── + catch-up tables without duplicating the 2000-line schedule module.
router.get('/schedule-data', authMiddleware, function (_req: Request, res: Response) {
  res.json({
    success: true,
    visitAges: scheduleData.VISIT_AGES || [],
    periodicity: scheduleData.PERIODICITY || {},
    catchUpSchedule: scheduleData.CATCH_UP_SCHEDULE || {},
    vaccineFullNames: VACCINE_FULL_NAMES,
  });
});

// Map visit age text to GROWTH_REFERENCE keys
function getGrowthRefForAge(ageStr?: string): any {
  if (!ageStr) return null;
  const a = ageStr.toLowerCase().trim();
  const directKeys = ['newborn', '1mo', '2mo', '4mo', '6mo', '9mo', '12mo', '15mo', '18mo', '24mo', '30mo', '3y', '4y', '5y'];
  for (let i = 0; i < directKeys.length; i++) {
    if (a.indexOf(directKeys[i]) !== -1) return GROWTH_REFERENCE[directKeys[i]] || null;
  }
  const ageMatch = a.match(/(\d+)\s*(month|mo|year|y|yr)/i);
  if (ageMatch) {
    const num = parseInt(ageMatch[1]);
    const unit = ageMatch[2].toLowerCase();
    if (unit === 'month' || unit === 'mo') {
      if (num <= 1) return GROWTH_REFERENCE['1mo'];
      if (num <= 3) return GROWTH_REFERENCE['2mo'];
      if (num <= 5) return GROWTH_REFERENCE['4mo'];
      if (num <= 8) return GROWTH_REFERENCE['6mo'];
      if (num <= 11) return GROWTH_REFERENCE['9mo'];
      if (num <= 14) return GROWTH_REFERENCE['12mo'];
      if (num <= 17) return GROWTH_REFERENCE['15mo'];
      if (num <= 23) return GROWTH_REFERENCE['18mo'];
      if (num <= 29) return GROWTH_REFERENCE['24mo'];
      if (num <= 35) return GROWTH_REFERENCE['30mo'];
    }
    if (unit === 'year' || unit === 'y' || unit === 'yr') {
      if (num <= 3) return GROWTH_REFERENCE['3y'];
      if (num <= 4) return GROWTH_REFERENCE['4y'];
      if (num <= 5) return GROWTH_REFERENCE['5y'];
      if (num <= 10) return GROWTH_REFERENCE['6y_to_10y'];
      if (num <= 14) return GROWTH_REFERENCE['11y_to_14y'];
      return GROWTH_REFERENCE['15y_to_21y'];
    }
  }
  if (a.indexOf('newborn') !== -1 || a.indexOf('birth') !== -1) return GROWTH_REFERENCE['newborn'];
  return null;
}

// ── POST generate SSHADESS assessment summary ────────────────────────────
router.post('/well-visit/shadess', authMiddleware, async function (req: Request, res: Response) {
  const start = Date.now();
  try {
    const { domains, patientAge, patientGender, dictationText, model } = req.body;

    if (!domains && !dictationText) {
      return res.status(400).json({ error: 'Provide domain responses or dictation text' });
    }

    let inputText = 'PATIENT: ' + (patientAge || 'Adolescent') + ', ' + (patientGender || 'Unknown gender') + '\n\n';
    inputText += 'SSHADESS SCREENING DATA:\n\n';

    if (dictationText) {
      inputText += 'PHYSICIAN DICTATION:\n' + dictationText + '\n\n';
    }

    if (domains) {
      const domainOrder = ['strengths', 'school', 'home', 'activities', 'drugs', 'emotions', 'sexuality', 'safety'];
      const domainNames: Record<string, string> = {
        strengths: 'STRENGTHS',
        school: 'SCHOOL',
        home: 'HOME',
        activities: 'ACTIVITIES',
        drugs: 'DRUGS/SUBSTANCES',
        emotions: 'EMOTIONS/EATING',
        sexuality: 'SEXUALITY',
        safety: 'SAFETY',
      };

      domainOrder.forEach((key) => {
        const d = domains[key];
        if (!d || d.skipped) return;

        inputText += domainNames[key] + ':\n';
        if (d.questions) {
          d.questions.forEach((q: any) => {
            if (q.answer !== null && q.answer !== undefined && q.answer !== '') {
              inputText += '  - ' + q.text + ': ' + (q.answer === true || q.answer === 'yes' ? 'YES' : (q.answer === false || q.answer === 'no' ? 'NO' : q.answer)) + '\n';
            }
          });
        }
        if (d.comment && d.comment.trim()) {
          inputText += '  Comments: ' + d.comment + '\n';
        }
        if (d.concern) {
          inputText += '  *** CONCERN FLAGGED ***\n';
        }
        inputText += '\n';
      });
    }

    const result = await callAI([
      { role: 'system', content: PROMPTS.shadessAssessment + INJECTION_GUARD },
      { role: 'user', content: wrapUserText('sshadess_answers', inputText) },
    ], { model });

    const dur = Date.now() - start;
    logger.apiCall(req.user!.id, '/api/well-visit/shadess', {
      model: result.model, tokensInput: result.usage?.input_tokens,
      tokensOutput: result.usage?.output_tokens, duration: dur, statusCode: 200,
    });

    res.json({ success: true, assessment: result.content, model: result.model });
    logger.audit(req.user!.id, 'generate_shadess', 'Generated SSHADESS assessment', req, { category: 'clinical' });
  } catch (e: any) {
    logger.error('[WellVisit] SHADESS generation failed', e.message);
    res.status(500).json({ error: 'Request failed' });
  }
});

// ── POST generate full well visit encounter note ─────────────────────────
router.post('/well-visit/note', authMiddleware, async function (req: Request, res: Response) {
  const start = Date.now();
  try {
    const {
      patientAge, patientGender, visitAge,
      vitals, measurements,
      transcript, dictation,
      screenings, vaccines,
      shadessAssessment,
      parentConcerns,
      ros, physicalExam, diagnoses,
      physicianMemories,
      noteStyle,
      model,
    } = req.body;

    if (!patientAge && !visitAge) {
      return res.status(400).json({ error: 'Patient age or visit age required' });
    }

    let context = 'WELL CHILD VISIT\n';
    context += 'Patient: ' + (patientAge || visitAge) + ', ' + (patientGender || 'Unknown') + '\n\n';

    if (vitals) context += 'VITAL SIGNS:\n' + wrapUserText('vitals', vitals) + '\n\n';
    if (measurements) context += 'MEASUREMENTS/GROWTH:\n' + wrapUserText('measurements', measurements) + '\n\n';
    if (parentConcerns) context += 'PARENT/PATIENT CONCERNS:\n' + wrapUserText('concerns', parentConcerns) + '\n\n';
    if (transcript) context += 'ENCOUNTER TRANSCRIPT/DICTATION:\n' + wrapUserText('transcript', transcript) + '\n\n';
    else if (dictation) context += 'PHYSICIAN DICTATION:\n' + wrapUserText('dictation', dictation) + '\n\n';
    if (screenings) context += 'SCREENINGS COMPLETED:\n' + wrapUserText('screenings', screenings) + '\n\n';
    if (vaccines) context += 'IMMUNIZATIONS TODAY:\n' + wrapUserText('vaccines', vaccines) + '\n\n';
    if (shadessAssessment) context += 'SSHADESS PSYCHOSOCIAL ASSESSMENT:\n' + wrapUserText('sshadess', shadessAssessment) + '\n\n';
    if (ros) context += wrapUserText('ros', ros) + '\n\n';
    if (physicalExam) context += wrapUserText('physical_exam', physicalExam) + '\n\n';
    if (diagnoses) context += wrapUserText('diagnoses', diagnoses) + '\n\n';
    if (physicianMemories) {
      context += '[STYLE HINTS (low priority — only apply if relevant to the current note, never copy content from these examples)]\n'
        + wrapUserText('style_hints', physicianMemories) + '\n[END STYLE HINTS]\n\n';
    }

    const growthRef = getGrowthRefForAge(patientAge || visitAge);
    if (growthRef) {
      context += 'GROWTH/NUTRITION GUIDANCE (AAP reference for this age):\n';
      if (growthRef.weight) context += 'Expected weight gain: ' + growthRef.weight + '\n';
      if (growthRef.length) context += 'Expected length/height gain: ' + growthRef.length + '\n';
      if (growthRef.headCirc) context += 'Expected head circumference gain: ' + growthRef.headCirc + '\n';
      if (growthRef.feeding && growthRef.feeding.length) {
        context += 'Feeding guidance:\n';
        growthRef.feeding.forEach((f: string) => { context += '  - ' + f + '\n'; });
      }
      if (growthRef.bmiClassification && BMI_CLASSIFICATION.categories) {
        context += 'BMI Classification (AAP 2023 / CDC Extended BMI):\n';
        BMI_CLASSIFICATION.categories.forEach((c: any) => {
          context += '  - ' + c.label + ': ' + c.range + ' → ' + c.action + '\n';
        });
      }
      context += '\n';
    }

    const prompt = noteStyle === 'short' ? PROMPTS.wellVisitShort : PROMPTS.wellVisitNote;

    const result = await callAI([
      { role: 'system', content: prompt + INJECTION_GUARD },
      { role: 'user', content: context },
    ], { model });

    const dur = Date.now() - start;
    logger.apiCall(req.user!.id, '/api/well-visit/note', {
      model: result.model, tokensInput: result.usage?.input_tokens,
      tokensOutput: result.usage?.output_tokens, duration: dur, statusCode: 200,
    });

    res.json({ success: true, note: result.content, model: result.model });
    logger.audit(req.user!.id, 'generate_well_visit', 'Generated well visit note', req, { category: 'clinical' });
  } catch (e: any) {
    logger.error('[WellVisit] Note generation failed', e.message);
    res.status(500).json({ error: 'Request failed' });
  }
});

export = router;