pediatric-ai-scribe-v3/src/routes/encounters.js
Daniel 241c376750 feat(security): AES-256-GCM at-rest encryption for encounters and memories
Extends the existing crypto helper (already used for audio backups and the
Nextcloud token) to cover every column that can hold PHI:

- saved_encounters.transcript, .generated_note, .partial_data
- user_memories.content (templates + Dragon-style corrections)
- user_memories.name (auto-derived from original snippet on corrections,
  so effectively PHI)

Reads decrypt transparently. Legacy plaintext rows continue to work —
decryptString passes non-enc1: values through unchanged — so no migration
is required; rows re-encrypt on their next save.

The encounters list query previously used LEFT(transcript, 200) for a
preview. With ciphertext that slice is meaningless, so the route now
fetches the full columns, decrypts in Node, then slices. At 7-day auto-
delete the row count is bounded and the cost is a handful of GCM
decrypts per list call.

user_memories ORDER BY moved from (category, name) to (category, id)
since SQL can no longer order on encrypted names.

Closes the HHS breach-notification safe-harbor gap on at-rest PHI.
2026-04-22 01:01:00 +02:00

175 lines
8.9 KiB
JavaScript

// ============================================================
// ENCOUNTERS ROUTES — Save/resume/pause encounter progress
// ============================================================
var express = require('express');
var router = express.Router();
var db = require('../db/database');
var { authMiddleware } = require('../middleware/auth');
var logger = require('../utils/logger');
var cryptoUtil = require('../utils/crypto');
router.use(authMiddleware);
// Normalise partial_data to a string before encrypting so JSON objects and
// raw strings round-trip identically. Decryption returns the original string.
function partialToString(partial_data) {
if (partial_data == null) return '{}';
if (typeof partial_data === 'object') return JSON.stringify(partial_data);
return partial_data;
}
// ── GET all saved encounters for current user ────────────────────────────
router.get('/encounters/saved', async function(req, res) {
try {
// transcript/generated_note are encrypted at rest, so we can't slice on
// the server with LEFT(..,200). Fetch full columns, decrypt in Node, then
// preview. With a 7-day auto-delete the row count is small; the cost is
// a handful of AES-GCM decrypts per list call.
var rows = await db.all(
"SELECT id, label, enc_type, status, created_at, updated_at, expires_at, transcript, generated_note FROM saved_encounters WHERE user_id = $1 AND expires_at > NOW() ORDER BY updated_at DESC",
[req.user.id]
);
var out = rows.map(function (r) {
var t = '', n = '';
try { t = cryptoUtil.decryptString(r.transcript) || ''; } catch (e) {}
try { n = cryptoUtil.decryptString(r.generated_note) || ''; } catch (e) {}
return {
id: r.id,
label: r.label,
enc_type: r.enc_type,
status: r.status,
created_at: r.created_at,
updated_at: r.updated_at,
expires_at: r.expires_at,
transcript_preview: t.substring(0, 200),
note_preview: n.substring(0, 200)
};
});
res.json({ success: true, encounters: out });
} catch (e) { logger.error('GET /encounters/saved', e.message); res.status(500).json({ error: 'Request failed' }); }
});
// ── GET single saved encounter ───────────────────────────────────────────
router.get('/encounters/saved/:id', async function(req, res) {
try {
var row = await db.get(
'SELECT * FROM saved_encounters WHERE id = $1 AND user_id = $2 AND expires_at > NOW()',
[req.params.id, req.user.id]
);
if (!row) return res.status(404).json({ error: 'Encounter not found or expired' });
try { row.transcript = cryptoUtil.decryptString(row.transcript); } catch (e) {}
try { row.generated_note = cryptoUtil.decryptString(row.generated_note); } catch (e) {}
try { row.partial_data = cryptoUtil.decryptString(row.partial_data); } catch (e) {}
logger.audit(req.user.id, 'encounter_load', 'Loaded encounter: ' + (row.label || 'unlabeled') + ' (id:' + req.params.id + ')', req, { category: 'clinical' });
res.json({ success: true, encounter: row });
} catch (e) { logger.error('GET /encounters/saved/:id', e.message); res.status(500).json({ error: 'Request failed' }); }
});
// ── POST save/update encounter progress ─────────────────────────────────
router.post('/encounters/saved', async function(req, res) {
try {
var { id, label, enc_type, transcript, generated_note, partial_data, status, idempotency_key } = req.body;
var autoDeleteDays = parseInt(await db.getSetting('site.auto_delete_days') || '7', 10);
if (id) {
// Update existing — optimistic locking via `version` column.
// Client passes req.body.expected_version (from the last GET). If
// it doesn't match, another tab/user wrote first and we reject
// with 409. If client doesn't send a version, we fall back to the
// old behaviour (last-write-wins) for backwards compat.
var existing = await db.get('SELECT id, version FROM saved_encounters WHERE id = $1 AND user_id = $2', [id, req.user.id]);
if (!existing) return res.status(404).json({ error: 'Not found' });
var expected = req.body.expected_version;
if (expected != null && Number(expected) !== Number(existing.version || 1)) {
return res.status(409).json({ error: 'Encounter was modified in another tab or session. Reload to see the latest.', currentVersion: existing.version, yourVersion: expected });
}
var newVersion = (Number(existing.version) || 1) + 1;
var upd = await db.run(
'UPDATE saved_encounters SET label=$1, transcript=$2, generated_note=$3, partial_data=$4, status=$5, version=$6, updated_at=NOW() WHERE id=$7 AND user_id=$8 AND (version = $9 OR $9::int IS NULL)',
[
label || 'Untitled',
cryptoUtil.encryptString(transcript || ''),
cryptoUtil.encryptString(generated_note || ''),
cryptoUtil.encryptString(partialToString(partial_data)),
status || 'active',
newVersion,
id, req.user.id,
expected != null ? Number(expected) : null
]
);
if (upd.changes === 0) {
// Someone else wrote between our SELECT and UPDATE
return res.status(409).json({ error: 'Encounter changed under you. Reload and retry.' });
}
res.json({ success: true, id: id, version: newVersion });
logger.audit(req.user.id, 'encounter_save', 'Saved encounter: ' + (label || 'unlabeled'), req, { category: 'clinical' });
} else {
// Enforce unique label per user (within active/non-expired encounters)
if (label && label.trim()) {
var labelDup = await db.get(
"SELECT id FROM saved_encounters WHERE user_id = $1 AND LOWER(label) = LOWER($2) AND expires_at > NOW()",
[req.user.id, label.trim()]
);
if (labelDup) {
return res.status(409).json({ error: 'An encounter with this label already exists. Use a unique label or load the existing one.' });
}
}
// Check for duplicate via idempotency_key
if (idempotency_key) {
var dup = await db.get(
'SELECT id FROM saved_encounters WHERE user_id = $1 AND idempotency_key = $2',
[req.user.id, idempotency_key]
);
if (dup) {
// Update existing instead of creating duplicate
await db.run(
'UPDATE saved_encounters SET label=$1, transcript=$2, generated_note=$3, partial_data=$4, status=$5, updated_at=NOW() WHERE id=$6 AND user_id=$7',
[
label || 'Untitled',
cryptoUtil.encryptString(transcript || ''),
cryptoUtil.encryptString(generated_note || ''),
cryptoUtil.encryptString(partialToString(partial_data)),
status || 'active',
dup.id, req.user.id
]
);
logger.audit(req.user.id, 'encounter_save', 'Saved encounter: ' + (label || 'unlabeled'), req, { category: 'clinical' });
return res.json({ success: true, id: dup.id });
}
}
// Create new
var result = await db.run(
'INSERT INTO saved_encounters (user_id, label, enc_type, transcript, generated_note, partial_data, status, idempotency_key, expires_at) VALUES ($1,$2,$3,$4,$5,$6,$7,$8, NOW() + ($9 || \' days\')::INTERVAL)',
[
req.user.id,
label || 'Untitled',
enc_type || 'encounter',
cryptoUtil.encryptString(transcript || ''),
cryptoUtil.encryptString(generated_note || ''),
cryptoUtil.encryptString(partialToString(partial_data)),
status || 'active',
idempotency_key || null,
autoDeleteDays
]
);
res.json({ success: true, id: result.lastInsertRowid });
logger.audit(req.user.id, 'encounter_save', 'Saved encounter: ' + (label || 'unlabeled'), req, { category: 'clinical' });
}
} catch (e) { logger.error('POST /encounters/saved', e.message); res.status(500).json({ error: 'Request failed' }); }
});
// ── DELETE saved encounter ───────────────────────────────────────────────
router.delete('/encounters/saved/:id', async function(req, res) {
try {
var result = await db.run(
'DELETE FROM saved_encounters WHERE id = $1 AND user_id = $2',
[req.params.id, req.user.id]
);
if (result.changes === 0) return res.status(404).json({ error: 'Not found' });
res.json({ success: true });
logger.audit(req.user.id, 'encounter_delete', 'Deleted encounter ' + req.params.id, req, { category: 'clinical' });
} catch (e) { logger.error('DELETE /encounters/saved/:id', e.message); res.status(500).json({ error: 'Request failed' }); }
});
module.exports = router;