diff --git a/crates/erp-health/src/dto/dialysis_dto.rs b/crates/erp-health/src/dto/dialysis_dto.rs new file mode 100644 index 0000000..e4054f4 --- /dev/null +++ b/crates/erp-health/src/dto/dialysis_dto.rs @@ -0,0 +1,124 @@ +use chrono::NaiveDate; +use chrono::NaiveTime; +use erp_core::sanitize::sanitize_option; +use serde::{Deserialize, Serialize}; +use utoipa::ToSchema; +use uuid::Uuid; + +type Decimal = f64; + +// --------------------------------------------------------------------------- +// 透析记录 +// --------------------------------------------------------------------------- + +#[derive(Debug, Clone, Serialize, Deserialize, ToSchema)] +pub struct CreateDialysisRecordReq { + pub patient_id: Uuid, + pub dialysis_date: NaiveDate, + pub start_time: Option, + pub end_time: Option, + pub dry_weight: Option, + pub pre_weight: Option, + pub post_weight: Option, + pub pre_bp_systolic: Option, + pub pre_bp_diastolic: Option, + pub post_bp_systolic: Option, + pub post_bp_diastolic: Option, + pub pre_heart_rate: Option, + pub post_heart_rate: Option, + pub ultrafiltration_volume: Option, + pub dialysis_duration: Option, + pub blood_flow_rate: Option, + /// HD / HDF / HF + #[serde(default = "default_dialysis_type")] + pub dialysis_type: String, + #[serde(skip_serializing_if = "Option::is_none")] + pub symptoms: Option, + #[serde(skip_serializing_if = "Option::is_none")] + pub complication_notes: Option, +} + +fn default_dialysis_type() -> String { + "HD".to_string() +} + +impl CreateDialysisRecordReq { + pub fn sanitize(&mut self) { + self.complication_notes = sanitize_option(self.complication_notes.take()); + } +} + +#[derive(Debug, Clone, Serialize, Deserialize, ToSchema)] +pub struct UpdateDialysisRecordReq { + pub dialysis_date: Option, + pub start_time: Option, + pub end_time: Option, + pub dry_weight: Option, + pub pre_weight: Option, + pub post_weight: Option, + pub pre_bp_systolic: Option, + pub pre_bp_diastolic: Option, + pub post_bp_systolic: Option, + pub post_bp_diastolic: Option, + pub pre_heart_rate: Option, + pub post_heart_rate: Option, + pub ultrafiltration_volume: Option, + pub dialysis_duration: Option, + pub blood_flow_rate: Option, + pub dialysis_type: Option, + pub symptoms: Option, + pub complication_notes: Option, +} + +impl UpdateDialysisRecordReq { + pub fn sanitize(&mut self) { + self.complication_notes = sanitize_option(self.complication_notes.take()); + } +} + +#[derive(Debug, Clone, Serialize, Deserialize, ToSchema)] +pub struct DialysisRecordResp { + pub id: Uuid, + pub patient_id: Uuid, + pub dialysis_date: NaiveDate, + pub start_time: Option, + pub end_time: Option, + pub dry_weight: Option, + pub pre_weight: Option, + pub post_weight: Option, + pub pre_bp_systolic: Option, + pub pre_bp_diastolic: Option, + pub post_bp_systolic: Option, + pub post_bp_diastolic: Option, + pub pre_heart_rate: Option, + pub post_heart_rate: Option, + pub ultrafiltration_volume: Option, + pub dialysis_duration: Option, + pub blood_flow_rate: Option, + pub dialysis_type: String, + pub symptoms: Option, + pub complication_notes: Option, + pub status: String, + pub reviewed_by: Option, + pub reviewed_at: Option>, + pub created_at: chrono::DateTime, + pub updated_at: chrono::DateTime, + pub version: i32, +} + +// --------------------------------------------------------------------------- +// 化验报告审阅 +// --------------------------------------------------------------------------- + +#[derive(Debug, Clone, Serialize, Deserialize, ToSchema)] +pub struct ReviewLabReportReq { + pub doctor_notes: Option, + /// 审阅时可选覆盖 items（补充标注 is_abnormal） + pub items: Option, +} + +impl ReviewLabReportReq { + pub fn sanitize(&mut self) { + self.doctor_notes = sanitize_option(self.doctor_notes.take()); + } +} diff --git a/crates/erp-health/src/dto/health_data_dto.rs b/crates/erp-health/src/dto/health_data_dto.rs index 270f284..7d47d01 100644 --- a/crates/erp-health/src/dto/health_data_dto.rs +++ b/crates/erp-health/src/dto/health_data_dto.rs @@ -76,14 +76,17 @@ pub struct VitalSignsResp { pub struct CreateLabReportReq { pub report_date: NaiveDate, pub report_type: String, - pub indicators: Option, + /// manual_input / photo_upload + pub source: Option, + /// V2 JSON 结构: [{name, value, unit, reference_low, reference_high, is_abnormal}] + pub items: Option, pub image_urls: Option, - pub doctor_interpretation: Option, + pub doctor_notes: Option, } impl CreateLabReportReq { pub fn sanitize(&mut self) { - self.doctor_interpretation = sanitize_option(self.doctor_interpretation.take()); + self.doctor_notes = sanitize_option(self.doctor_notes.take()); } } @@ -91,14 +94,15 @@ impl CreateLabReportReq { pub struct UpdateLabReportReq { pub report_date: Option, pub report_type: Option, - pub indicators: Option, + pub source: Option, + pub items: Option, pub image_urls: Option, - pub doctor_interpretation: Option, + pub doctor_notes: Option, } impl UpdateLabReportReq { pub fn sanitize(&mut self) { - self.doctor_interpretation = sanitize_option(self.doctor_interpretation.take()); + self.doctor_notes = sanitize_option(self.doctor_notes.take()); } } @@ -108,9 +112,13 @@ pub struct LabReportResp { pub patient_id: Uuid, pub report_date: NaiveDate, pub report_type: String, - pub indicators: Option, + pub source: Option, + pub items: Option, pub image_urls: Option, - pub doctor_interpretation: Option, + pub doctor_notes: Option, + pub status: String, + pub reviewed_by: Option, + pub reviewed_at: Option>, pub created_at: chrono::DateTime, pub updated_at: chrono::DateTime, pub version: i32, diff --git a/crates/erp-health/src/dto/mod.rs b/crates/erp-health/src/dto/mod.rs index d50513c..1a25faa 100644 --- a/crates/erp-health/src/dto/mod.rs +++ b/crates/erp-health/src/dto/mod.rs @@ -1,6 +1,7 @@ pub mod appointment_dto; pub mod article_dto; pub mod consultation_dto; +pub mod dialysis_dto; pub mod doctor_dto; pub mod follow_up_dto; pub mod health_data_dto; diff --git a/crates/erp-health/src/entity/dialysis_record.rs b/crates/erp-health/src/entity/dialysis_record.rs new file mode 100644 index 0000000..2222ae2 --- /dev/null +++ b/crates/erp-health/src/entity/dialysis_record.rs @@ -0,0 +1,79 @@ +use sea_orm::entity::prelude::*; +use serde::{Deserialize, Serialize}; + +#[derive(Clone, Debug, PartialEq, DeriveEntityModel, Serialize, Deserialize)] +#[sea_orm(table_name = "dialysis_record")] +pub struct Model { + #[sea_orm(primary_key, auto_increment = false)] + pub id: Uuid, + pub tenant_id: Uuid, + pub patient_id: Uuid, + pub dialysis_date: chrono::NaiveDate, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub start_time: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub end_time: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub dry_weight: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub pre_weight: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub post_weight: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub pre_bp_systolic: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub pre_bp_diastolic: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub post_bp_systolic: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub post_bp_diastolic: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub pre_heart_rate: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub post_heart_rate: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub ultrafiltration_volume: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub dialysis_duration: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub blood_flow_rate: Option, + /// HD / HDF / HF + pub dialysis_type: String, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub symptoms: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub complication_notes: Option, + /// draft / completed / reviewed + pub status: String, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub reviewed_by: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub reviewed_at: Option, + pub created_at: DateTimeUtc, + pub updated_at: DateTimeUtc, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub created_by: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub updated_by: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub deleted_at: Option, + pub version: i32, +} + +#[derive(Copy, Clone, Debug, EnumIter, DeriveRelation)] +pub enum Relation { + #[sea_orm( + belongs_to = "super::patient::Entity", + from = "Column::PatientId", + to = "super::patient::Column::Id" + )] + Patient, +} + +impl Related for Entity { + fn to() -> RelationDef { + Relation::Patient.def() + } +} + +impl ActiveModelBehavior for ActiveModel {} diff --git a/crates/erp-health/src/entity/lab_report.rs b/crates/erp-health/src/entity/lab_report.rs index 6f81bcd..3f543db 100644 --- a/crates/erp-health/src/entity/lab_report.rs +++ b/crates/erp-health/src/entity/lab_report.rs @@ -9,13 +9,24 @@ pub struct Model { pub tenant_id: Uuid, pub patient_id: Uuid, pub report_date: chrono::NaiveDate, + /// kidney_function / blood_routine / electrolyte / liver_function / other pub report_type: String, + /// manual_input / photo_upload #[sea_orm(skip_serializing_if = "Option::is_none")] - pub indicators: Option, + pub source: Option, + /// V2 JSON 结构: [{name, value, unit, reference_low, reference_high, is_abnormal}] + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub items: Option, #[sea_orm(skip_serializing_if = "Option::is_none")] pub image_urls: Option, #[sea_orm(skip_serializing_if = "Option::is_none")] - pub doctor_interpretation: Option, + pub doctor_notes: Option, + /// pending / reviewed + pub status: String, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub reviewed_by: Option, + #[sea_orm(skip_serializing_if = "Option::is_none")] + pub reviewed_at: Option, pub created_at: DateTimeUtc, pub updated_at: DateTimeUtc, #[sea_orm(skip_serializing_if = "Option::is_none")] diff --git a/crates/erp-health/src/entity/mod.rs b/crates/erp-health/src/entity/mod.rs index b45d7b0..6c3629b 100644 --- a/crates/erp-health/src/entity/mod.rs +++ b/crates/erp-health/src/entity/mod.rs @@ -2,6 +2,7 @@ pub mod appointment; pub mod article; pub mod consultation_message; pub mod consultation_session; +pub mod dialysis_record; pub mod doctor_profile; pub mod doctor_schedule; pub mod follow_up_record; diff --git a/crates/erp-health/src/error.rs b/crates/erp-health/src/error.rs index 2074810..5b2138e 100644 --- a/crates/erp-health/src/error.rs +++ b/crates/erp-health/src/error.rs @@ -23,6 +23,9 @@ pub enum HealthError { #[error("化验报告不存在")] LabReportNotFound, + #[error("透析记录不存在")] + DialysisRecordNotFound, + #[error("健康档案不存在")] HealthRecordNotFound, @@ -64,6 +67,7 @@ impl From for AppError { | HealthError::ScheduleNotFound | HealthError::VitalSignsNotFound | HealthError::LabReportNotFound + | HealthError::DialysisRecordNotFound | HealthError::HealthRecordNotFound | HealthError::FamilyMemberNotFound | HealthError::TagNotFound diff --git a/crates/erp-health/src/handler/dialysis_handler.rs b/crates/erp-health/src/handler/dialysis_handler.rs new file mode 100644 index 0000000..6ab12ed --- /dev/null +++ b/crates/erp-health/src/handler/dialysis_handler.rs @@ -0,0 +1,144 @@ +use axum::Extension; +use axum::extract::{FromRef, Json, Path, Query, State}; +use serde::Deserialize; +use utoipa::IntoParams; +use uuid::Uuid; + +use erp_core::error::AppError; +use erp_core::rbac::require_permission; +use erp_core::types::{ApiResponse, PaginatedResponse, TenantContext}; + +use crate::dto::dialysis_dto::*; +use crate::dto::DeleteWithVersion; +use crate::service::dialysis_service; +use crate::state::HealthState; + +#[derive(Debug, Deserialize, IntoParams)] +pub struct PaginationParams { + pub page: Option, + pub page_size: Option, +} + +#[derive(Debug, serde::Deserialize, utoipa::ToSchema)] +pub struct UpdateDialysisWithVersion { + #[serde(flatten)] + pub data: UpdateDialysisRecordReq, + pub version: i32, +} + +#[derive(Debug, serde::Deserialize, utoipa::ToSchema)] +pub struct ReviewDialysisWithVersion { + pub version: i32, +} + +pub async fn list_dialysis_records( + State(state): State, + Extension(ctx): Extension, + Path(patient_id): Path, + Query(params): Query, +) -> Result>>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.list")?; + let page = params.page.unwrap_or(1); + let page_size = params.page_size.unwrap_or(20); + let result = dialysis_service::list_dialysis_records( + &state, ctx.tenant_id, patient_id, page, page_size, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + +pub async fn get_dialysis_record( + State(state): State, + Extension(ctx): Extension, + Path(record_id): Path, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.list")?; + let result = dialysis_service::get_dialysis_record( + &state, ctx.tenant_id, record_id, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + +pub async fn create_dialysis_record( + State(state): State, + Extension(ctx): Extension, + Json(req): Json, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.manage")?; + let mut req = req; + req.sanitize(); + let result = dialysis_service::create_dialysis_record( + &state, ctx.tenant_id, Some(ctx.user_id), req, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + +pub async fn update_dialysis_record( + State(state): State, + Extension(ctx): Extension, + Path(record_id): Path, + Json(req): Json, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.manage")?; + let mut data = req.data; + data.sanitize(); + let result = dialysis_service::update_dialysis_record( + &state, ctx.tenant_id, record_id, Some(ctx.user_id), data, req.version, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + +pub async fn review_dialysis_record( + State(state): State, + Extension(ctx): Extension, + Path(record_id): Path, + Json(req): Json, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.manage")?; + let result = dialysis_service::review_dialysis_record( + &state, ctx.tenant_id, record_id, ctx.user_id, req.version, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + +pub async fn delete_dialysis_record( + State(state): State, + Extension(ctx): Extension, + Path(record_id): Path, + Json(req): Json, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.manage")?; + dialysis_service::delete_dialysis_record( + &state, ctx.tenant_id, record_id, Some(ctx.user_id), req.version, + ) + .await?; + Ok(Json(ApiResponse::ok(()))) +} diff --git a/crates/erp-health/src/handler/health_data_handler.rs b/crates/erp-health/src/handler/health_data_handler.rs index 5ecb476..a092d3b 100644 --- a/crates/erp-health/src/handler/health_data_handler.rs +++ b/crates/erp-health/src/handler/health_data_handler.rs @@ -9,6 +9,7 @@ use erp_core::rbac::require_permission; use erp_core::types::{ApiResponse, PaginatedResponse, TenantContext}; use crate::dto::health_data_dto::*; +use crate::dto::dialysis_dto::ReviewLabReportReq; use crate::dto::DeleteWithVersion; use crate::service::health_data_service; use crate::service::trend_service; @@ -200,6 +201,26 @@ where Ok(Json(ApiResponse::ok(()))) } +pub async fn review_lab_report( + State(state): State, + Extension(ctx): Extension, + Path((_patient_id, rid)): Path<(Uuid, Uuid)>, + Json(req): Json, +) -> Result>, AppError> +where + HealthState: FromRef, + S: Clone + Send + Sync + 'static, +{ + require_permission(&ctx, "health.health-data.manage")?; + let mut data = req.data; + data.sanitize(); + let result = health_data_service::review_lab_report( + &state, ctx.tenant_id, _patient_id, rid, ctx.user_id, data, req.version, + ) + .await?; + Ok(Json(ApiResponse::ok(result))) +} + // --------------------------------------------------------------------------- // 健康档案 // --------------------------------------------------------------------------- @@ -404,3 +425,10 @@ pub struct UpdateHealthRecordWithVersion { pub data: UpdateHealthRecordReq, pub version: i32, } + +#[derive(Debug, serde::Deserialize, utoipa::ToSchema)] +pub struct ReviewLabReportWithVersion { + #[serde(flatten)] + pub data: ReviewLabReportReq, + pub version: i32, +} diff --git a/crates/erp-health/src/handler/mod.rs b/crates/erp-health/src/handler/mod.rs index 731bbe0..32c1e72 100644 --- a/crates/erp-health/src/handler/mod.rs +++ b/crates/erp-health/src/handler/mod.rs @@ -1,6 +1,7 @@ pub mod appointment_handler; pub mod article_handler; pub mod consultation_handler; +pub mod dialysis_handler; pub mod doctor_handler; pub mod follow_up_handler; pub mod health_data_handler; diff --git a/crates/erp-health/src/module.rs b/crates/erp-health/src/module.rs index 42fa305..5e4b582 100644 --- a/crates/erp-health/src/module.rs +++ b/crates/erp-health/src/module.rs @@ -6,7 +6,7 @@ use erp_core::events::EventBus; use erp_core::module::{ErpModule, PermissionDescriptor}; use crate::handler::{ - appointment_handler, article_handler, consultation_handler, doctor_handler, follow_up_handler, + appointment_handler, article_handler, consultation_handler, dialysis_handler, doctor_handler, follow_up_handler, health_data_handler, patient_handler, }; @@ -144,6 +144,30 @@ impl HealthModule { "/health/vital-signs/today", axum::routing::get(health_data_handler::get_mini_today), ) + // 透析记录（血透专科） + .route( + "/health/patients/{id}/dialysis-records", + axum::routing::get(dialysis_handler::list_dialysis_records), + ) + .route( + "/health/dialysis-records", + axum::routing::post(dialysis_handler::create_dialysis_record), + ) + .route( + "/health/dialysis-records/{id}", + axum::routing::get(dialysis_handler::get_dialysis_record) + .put(dialysis_handler::update_dialysis_record) + .delete(dialysis_handler::delete_dialysis_record), + ) + .route( + "/health/dialysis-records/{id}/review", + axum::routing::put(dialysis_handler::review_dialysis_record), + ) + // 化验报告审阅 + .route( + "/health/patients/{id}/lab-reports/{rid}/review", + axum::routing::put(health_data_handler::review_lab_report), + ) // 预约排班 .route( "/health/appointments", diff --git a/crates/erp-health/src/service/dialysis_service.rs b/crates/erp-health/src/service/dialysis_service.rs new file mode 100644 index 0000000..125f3c3 --- /dev/null +++ b/crates/erp-health/src/service/dialysis_service.rs @@ -0,0 +1,286 @@ +//! 透析记录 Service — 血透专科 CRUD + 审阅 + +use chrono::Utc; +use erp_core::audit::AuditLog; +use erp_core::audit_service; +use num_traits::ToPrimitive; +use sea_orm::entity::prelude::*; +use sea_orm::{ActiveValue::Set, QueryOrder, QuerySelect}; +use uuid::Uuid; + +use erp_core::error::check_version; +use erp_core::types::PaginatedResponse; + +use crate::dto::dialysis_dto::*; +use crate::entity::{dialysis_record, patient}; +use crate::error::{HealthError, HealthResult}; +use crate::state::HealthState; + +pub async fn list_dialysis_records( + state: &HealthState, + tenant_id: Uuid, + patient_id: Uuid, + page: u64, + page_size: u64, +) -> HealthResult> { + let limit = page_size.min(100); + let offset = page.saturating_sub(1) * limit; + + let query = dialysis_record::Entity::find() + .filter(dialysis_record::Column::TenantId.eq(tenant_id)) + .filter(dialysis_record::Column::PatientId.eq(patient_id)) + .filter(dialysis_record::Column::DeletedAt.is_null()); + + let total = query.clone().count(&state.db).await?; + let models = query + .order_by_desc(dialysis_record::Column::DialysisDate) + .offset(offset) + .limit(limit) + .all(&state.db) + .await?; + + let total_pages = total.div_ceil(limit.max(1)); + let data: Vec = models.into_iter().map(to_resp).collect(); + + Ok(PaginatedResponse { data, total, page, page_size: limit, total_pages }) +} + +pub async fn get_dialysis_record( + state: &HealthState, + tenant_id: Uuid, + record_id: Uuid, +) -> HealthResult { + let m = dialysis_record::Entity::find() + .filter(dialysis_record::Column::Id.eq(record_id)) + .filter(dialysis_record::Column::TenantId.eq(tenant_id)) + .filter(dialysis_record::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::DialysisRecordNotFound)?; + + Ok(to_resp(m)) +} + +pub async fn create_dialysis_record( + state: &HealthState, + tenant_id: Uuid, + operator_id: Option, + req: CreateDialysisRecordReq, +) -> HealthResult { + patient::Entity::find() + .filter(patient::Column::Id.eq(req.patient_id)) + .filter(patient::Column::TenantId.eq(tenant_id)) + .filter(patient::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::PatientNotFound)?; + + validate_dialysis_type(&req.dialysis_type)?; + + let now = Utc::now(); + let active = dialysis_record::ActiveModel { + id: Set(Uuid::now_v7()), + tenant_id: Set(tenant_id), + patient_id: Set(req.patient_id), + dialysis_date: Set(req.dialysis_date), + start_time: Set(req.start_time), + end_time: Set(req.end_time), + dry_weight: Set(req.dry_weight.map(|v| Decimal::from_f64_retain(v).unwrap_or_default())), + pre_weight: Set(req.pre_weight.map(|v| Decimal::from_f64_retain(v).unwrap_or_default())), + post_weight: Set(req.post_weight.map(|v| Decimal::from_f64_retain(v).unwrap_or_default())), + pre_bp_systolic: Set(req.pre_bp_systolic), + pre_bp_diastolic: Set(req.pre_bp_diastolic), + post_bp_systolic: Set(req.post_bp_systolic), + post_bp_diastolic: Set(req.post_bp_diastolic), + pre_heart_rate: Set(req.pre_heart_rate), + post_heart_rate: Set(req.post_heart_rate), + ultrafiltration_volume: Set(req.ultrafiltration_volume), + dialysis_duration: Set(req.dialysis_duration), + blood_flow_rate: Set(req.blood_flow_rate), + dialysis_type: Set(req.dialysis_type), + symptoms: Set(req.symptoms), + complication_notes: Set(req.complication_notes), + status: Set("draft".to_string()), + reviewed_by: Set(None), + reviewed_at: Set(None), + created_at: Set(now), + updated_at: Set(now), + created_by: Set(operator_id), + updated_by: Set(operator_id), + deleted_at: Set(None), + version: Set(1), + }; + let m = active.insert(&state.db).await?; + + audit_service::record( + AuditLog::new(tenant_id, operator_id, "dialysis_record.created", "dialysis_record") + .with_resource_id(m.id), + &state.db, + ).await; + + Ok(to_resp(m)) +} + +pub async fn update_dialysis_record( + state: &HealthState, + tenant_id: Uuid, + record_id: Uuid, + operator_id: Option, + req: UpdateDialysisRecordReq, + expected_version: i32, +) -> HealthResult { + let model = dialysis_record::Entity::find() + .filter(dialysis_record::Column::Id.eq(record_id)) + .filter(dialysis_record::Column::TenantId.eq(tenant_id)) + .filter(dialysis_record::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::DialysisRecordNotFound)?; + + let next_ver = check_version(expected_version, model.version) + .map_err(|_| HealthError::VersionMismatch)?; + + let mut active: dialysis_record::ActiveModel = model.into(); + if let Some(v) = req.dialysis_date { active.dialysis_date = Set(v); } + if let Some(v) = req.start_time { active.start_time = Set(Some(v)); } + if let Some(v) = req.end_time { active.end_time = Set(Some(v)); } + if let Some(v) = req.dry_weight { active.dry_weight = Set(Some(Decimal::from_f64_retain(v).unwrap_or_default())); } + if let Some(v) = req.pre_weight { active.pre_weight = Set(Some(Decimal::from_f64_retain(v).unwrap_or_default())); } + if let Some(v) = req.post_weight { active.post_weight = Set(Some(Decimal::from_f64_retain(v).unwrap_or_default())); } + if let Some(v) = req.pre_bp_systolic { active.pre_bp_systolic = Set(Some(v)); } + if let Some(v) = req.pre_bp_diastolic { active.pre_bp_diastolic = Set(Some(v)); } + if let Some(v) = req.post_bp_systolic { active.post_bp_systolic = Set(Some(v)); } + if let Some(v) = req.post_bp_diastolic { active.post_bp_diastolic = Set(Some(v)); } + if let Some(v) = req.pre_heart_rate { active.pre_heart_rate = Set(Some(v)); } + if let Some(v) = req.post_heart_rate { active.post_heart_rate = Set(Some(v)); } + if let Some(v) = req.ultrafiltration_volume { active.ultrafiltration_volume = Set(Some(v)); } + if let Some(v) = req.dialysis_duration { active.dialysis_duration = Set(Some(v)); } + if let Some(v) = req.blood_flow_rate { active.blood_flow_rate = Set(Some(v)); } + if let Some(ref v) = req.dialysis_type { validate_dialysis_type(v)?; active.dialysis_type = Set(v.clone()); } + if let Some(v) = req.symptoms { active.symptoms = Set(Some(v)); } + if let Some(v) = req.complication_notes { active.complication_notes = Set(Some(v)); } + active.updated_at = Set(Utc::now()); + active.updated_by = Set(operator_id); + active.version = Set(next_ver); + + let m = active.update(&state.db).await?; + + audit_service::record( + AuditLog::new(tenant_id, operator_id, "dialysis_record.updated", "dialysis_record") + .with_resource_id(m.id), + &state.db, + ).await; + + Ok(to_resp(m)) +} + +pub async fn review_dialysis_record( + state: &HealthState, + tenant_id: Uuid, + record_id: Uuid, + reviewer_id: Uuid, + expected_version: i32, +) -> HealthResult { + let model = dialysis_record::Entity::find() + .filter(dialysis_record::Column::Id.eq(record_id)) + .filter(dialysis_record::Column::TenantId.eq(tenant_id)) + .filter(dialysis_record::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::DialysisRecordNotFound)?; + + let next_ver = check_version(expected_version, model.version) + .map_err(|_| HealthError::VersionMismatch)?; + + let mut active: dialysis_record::ActiveModel = model.into(); + active.status = Set("reviewed".to_string()); + active.reviewed_by = Set(Some(reviewer_id)); + active.reviewed_at = Set(Some(Utc::now())); + active.updated_at = Set(Utc::now()); + active.updated_by = Set(Some(reviewer_id)); + active.version = Set(next_ver); + + let m = active.update(&state.db).await?; + + audit_service::record( + AuditLog::new(tenant_id, Some(reviewer_id), "dialysis_record.reviewed", "dialysis_record") + .with_resource_id(m.id), + &state.db, + ).await; + + Ok(to_resp(m)) +} + +pub async fn delete_dialysis_record( + state: &HealthState, + tenant_id: Uuid, + record_id: Uuid, + operator_id: Option, + expected_version: i32, +) -> HealthResult<()> { + let model = dialysis_record::Entity::find() + .filter(dialysis_record::Column::Id.eq(record_id)) + .filter(dialysis_record::Column::TenantId.eq(tenant_id)) + .filter(dialysis_record::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::DialysisRecordNotFound)?; + + let next_ver = check_version(expected_version, model.version) + .map_err(|_| HealthError::VersionMismatch)?; + + let mut active: dialysis_record::ActiveModel = model.into(); + active.deleted_at = Set(Some(Utc::now())); + active.updated_at = Set(Utc::now()); + active.updated_by = Set(operator_id); + active.version = Set(next_ver); + active.update(&state.db).await?; + + audit_service::record( + AuditLog::new(tenant_id, operator_id, "dialysis_record.deleted", "dialysis_record") + .with_resource_id(record_id), + &state.db, + ).await; + + Ok(()) +} + +fn validate_dialysis_type(dialysis_type: &str) -> HealthResult<()> { + match dialysis_type { + "HD" | "HDF" | "HF" => Ok(()), + _ => Err(HealthError::Validation(format!( + "无效的透析类型: {}，允许值: HD, HDF, HF", dialysis_type + ))), + } +} + +fn to_resp(m: dialysis_record::Model) -> DialysisRecordResp { + DialysisRecordResp { + id: m.id, + patient_id: m.patient_id, + dialysis_date: m.dialysis_date, + start_time: m.start_time, + end_time: m.end_time, + dry_weight: m.dry_weight.map(|d| d.to_f64().unwrap_or(0.0)), + pre_weight: m.pre_weight.map(|d| d.to_f64().unwrap_or(0.0)), + post_weight: m.post_weight.map(|d| d.to_f64().unwrap_or(0.0)), + pre_bp_systolic: m.pre_bp_systolic, + pre_bp_diastolic: m.pre_bp_diastolic, + post_bp_systolic: m.post_bp_systolic, + post_bp_diastolic: m.post_bp_diastolic, + pre_heart_rate: m.pre_heart_rate, + post_heart_rate: m.post_heart_rate, + ultrafiltration_volume: m.ultrafiltration_volume, + dialysis_duration: m.dialysis_duration, + blood_flow_rate: m.blood_flow_rate, + dialysis_type: m.dialysis_type, + symptoms: m.symptoms, + complication_notes: m.complication_notes, + status: m.status, + reviewed_by: m.reviewed_by, + reviewed_at: m.reviewed_at, + created_at: m.created_at, + updated_at: m.updated_at, + version: m.version, + } +} diff --git a/crates/erp-health/src/service/health_data_service.rs b/crates/erp-health/src/service/health_data_service.rs index 5265271..c2a3493 100644 --- a/crates/erp-health/src/service/health_data_service.rs +++ b/crates/erp-health/src/service/health_data_service.rs @@ -247,8 +247,9 @@ pub async fn list_lab_reports( let total_pages = total.div_ceil(limit.max(1)); let data = models.into_iter().map(|m| LabReportResp { id: m.id, patient_id: m.patient_id, report_date: m.report_date, - report_type: m.report_type, indicators: m.indicators, - image_urls: m.image_urls, doctor_interpretation: m.doctor_interpretation, + report_type: m.report_type, source: m.source, + items: m.items, image_urls: m.image_urls, doctor_notes: m.doctor_notes, + status: m.status, reviewed_by: m.reviewed_by, reviewed_at: m.reviewed_at, created_at: m.created_at, updated_at: m.updated_at, version: m.version, }).collect(); @@ -278,9 +279,13 @@ pub async fn create_lab_report( patient_id: Set(patient_id), report_date: Set(req.report_date), report_type: Set(req.report_type), - indicators: Set(req.indicators), + source: Set(req.source), + items: Set(req.items), image_urls: Set(req.image_urls), - doctor_interpretation: Set(req.doctor_interpretation), + doctor_notes: Set(req.doctor_notes), + status: Set("pending".to_string()), + reviewed_by: Set(None), + reviewed_at: Set(None), created_at: Set(now), updated_at: Set(now), created_by: Set(operator_id), @@ -305,8 +310,9 @@ pub async fn create_lab_report( Ok(LabReportResp { id: m.id, patient_id: m.patient_id, report_date: m.report_date, - report_type: m.report_type, indicators: m.indicators, - image_urls: m.image_urls, doctor_interpretation: m.doctor_interpretation, + report_type: m.report_type, source: m.source, + items: m.items, image_urls: m.image_urls, doctor_notes: m.doctor_notes, + status: m.status, reviewed_by: m.reviewed_by, reviewed_at: m.reviewed_at, created_at: m.created_at, updated_at: m.updated_at, version: m.version, }) } @@ -334,9 +340,10 @@ pub async fn update_lab_report( let mut active: lab_report::ActiveModel = model.into(); if let Some(v) = req.report_date { active.report_date = Set(v); } if let Some(v) = req.report_type { active.report_type = Set(v); } - if let Some(v) = req.indicators { active.indicators = Set(Some(v)); } + if let Some(v) = req.source { active.source = Set(Some(v)); } + if let Some(v) = req.items { active.items = Set(Some(v)); } if let Some(v) = req.image_urls { active.image_urls = Set(Some(v)); } - if let Some(v) = req.doctor_interpretation { active.doctor_interpretation = Set(Some(v)); } + if let Some(v) = req.doctor_notes { active.doctor_notes = Set(Some(v)); } active.updated_at = Set(Utc::now()); active.updated_by = Set(operator_id); active.version = Set(next_ver); @@ -351,8 +358,9 @@ pub async fn update_lab_report( Ok(LabReportResp { id: m.id, patient_id: m.patient_id, report_date: m.report_date, - report_type: m.report_type, indicators: m.indicators, - image_urls: m.image_urls, doctor_interpretation: m.doctor_interpretation, + report_type: m.report_type, source: m.source, + items: m.items, image_urls: m.image_urls, doctor_notes: m.doctor_notes, + status: m.status, reviewed_by: m.reviewed_by, reviewed_at: m.reviewed_at, created_at: m.created_at, updated_at: m.updated_at, version: m.version, }) } @@ -391,6 +399,54 @@ pub async fn delete_lab_report( Ok(()) } +pub async fn review_lab_report( + state: &HealthState, + tenant_id: Uuid, + patient_id: Uuid, + report_id: Uuid, + reviewer_id: Uuid, + req: crate::dto::dialysis_dto::ReviewLabReportReq, + expected_version: i32, +) -> HealthResult { + let model = lab_report::Entity::find() + .filter(lab_report::Column::Id.eq(report_id)) + .filter(lab_report::Column::PatientId.eq(patient_id)) + .filter(lab_report::Column::TenantId.eq(tenant_id)) + .filter(lab_report::Column::DeletedAt.is_null()) + .one(&state.db) + .await? + .ok_or(HealthError::LabReportNotFound)?; + + let next_ver = check_version(expected_version, model.version) + .map_err(|_| HealthError::VersionMismatch)?; + + let mut active: lab_report::ActiveModel = model.into(); + active.status = Set("reviewed".to_string()); + active.reviewed_by = Set(Some(reviewer_id)); + active.reviewed_at = Set(Some(Utc::now())); + if let Some(v) = req.doctor_notes { active.doctor_notes = Set(Some(v)); } + if let Some(v) = req.items { active.items = Set(Some(v)); } + active.updated_at = Set(Utc::now()); + active.updated_by = Set(Some(reviewer_id)); + active.version = Set(next_ver); + + let m = active.update(&state.db).await?; + + audit_service::record( + AuditLog::new(tenant_id, Some(reviewer_id), "lab_report.reviewed", "lab_report") + .with_resource_id(m.id), + &state.db, + ).await; + + Ok(LabReportResp { + id: m.id, patient_id: m.patient_id, report_date: m.report_date, + report_type: m.report_type, source: m.source, + items: m.items, image_urls: m.image_urls, doctor_notes: m.doctor_notes, + status: m.status, reviewed_by: m.reviewed_by, reviewed_at: m.reviewed_at, + created_at: m.created_at, updated_at: m.updated_at, version: m.version, + }) +} + // --------------------------------------------------------------------------- // 体检记录 (Health Records) // --------------------------------------------------------------------------- diff --git a/crates/erp-health/src/service/mod.rs b/crates/erp-health/src/service/mod.rs index 1a42e3e..d6ac376 100644 --- a/crates/erp-health/src/service/mod.rs +++ b/crates/erp-health/src/service/mod.rs @@ -1,6 +1,7 @@ pub mod appointment_service; pub mod article_service; pub mod consultation_service; +pub mod dialysis_service; pub mod doctor_service; pub mod follow_up_service; pub mod health_data_service; diff --git a/crates/erp-server/migration/src/lib.rs b/crates/erp-server/migration/src/lib.rs index 13b404a..5de48bf 100644 --- a/crates/erp-server/migration/src/lib.rs +++ b/crates/erp-server/migration/src/lib.rs @@ -50,6 +50,7 @@ mod m20260424_000047_health_index_fix; mod m20260425_000048_add_patient_id_number_hash; mod m20260425_000049_widen_patient_id_number; mod m20260425_00050_add_doctor_name_column; +mod m20260425_000051_dialysis_and_lab_enhance; pub struct Migrator; @@ -107,6 +108,7 @@ impl MigratorTrait for Migrator { Box::new(m20260425_000048_add_patient_id_number_hash::Migration), Box::new(m20260425_000049_widen_patient_id_number::Migration), Box::new(m20260425_00050_add_doctor_name_column::Migration), + Box::new(m20260425_000051_dialysis_and_lab_enhance::Migration), ] } } diff --git a/crates/erp-server/migration/src/m20260425_000051_dialysis_and_lab_enhance.rs b/crates/erp-server/migration/src/m20260425_000051_dialysis_and_lab_enhance.rs new file mode 100644 index 0000000..2b8cbb4 --- /dev/null +++ b/crates/erp-server/migration/src/m20260425_000051_dialysis_and_lab_enhance.rs @@ -0,0 +1,167 @@ +use sea_orm_migration::prelude::*; + +#[derive(DeriveMigrationName)] +pub struct Migration; + +/// V2 血透专科数据模型: dialysis_record 新表 + lab_report 增强审阅流程 +#[async_trait::async_trait] +impl MigrationTrait for Migration { + async fn up(&self, manager: &SchemaManager) -> Result<(), DbErr> { + // 1. 创建 dialysis_record 表 + manager + .create_table( + Table::create() + .table(Alias::new("dialysis_record")) + .if_not_exists() + .col(ColumnDef::new(Alias::new("id")).uuid().not_null().primary_key()) + .col(ColumnDef::new(Alias::new("tenant_id")).uuid().not_null()) + .col(ColumnDef::new(Alias::new("patient_id")).uuid().not_null()) + .col(ColumnDef::new(Alias::new("dialysis_date")).date().not_null()) + .col(ColumnDef::new(Alias::new("start_time")).time()) + .col(ColumnDef::new(Alias::new("end_time")).time()) + // 体重 (Decimal 5,1) + .col(ColumnDef::new(Alias::new("dry_weight")).decimal().extra("CHECK(dry_weight IS NULL OR dry_weight >= 0)")) + .col(ColumnDef::new(Alias::new("pre_weight")).decimal().extra("CHECK(pre_weight IS NULL OR pre_weight >= 0)")) + .col(ColumnDef::new(Alias::new("post_weight")).decimal().extra("CHECK(post_weight IS NULL OR post_weight >= 0)")) + // 血压 + .col(ColumnDef::new(Alias::new("pre_bp_systolic")).integer()) + .col(ColumnDef::new(Alias::new("pre_bp_diastolic")).integer()) + .col(ColumnDef::new(Alias::new("post_bp_systolic")).integer()) + .col(ColumnDef::new(Alias::new("post_bp_diastolic")).integer()) + // 心率 + .col(ColumnDef::new(Alias::new("pre_heart_rate")).integer()) + .col(ColumnDef::new(Alias::new("post_heart_rate")).integer()) + // 透析参数 + .col(ColumnDef::new(Alias::new("ultrafiltration_volume")).integer()) + .col(ColumnDef::new(Alias::new("dialysis_duration")).integer()) + .col(ColumnDef::new(Alias::new("blood_flow_rate")).integer()) + // HD / HDF / HF + .col(ColumnDef::new(Alias::new("dialysis_type")).string().not_null().default("HD")) + .col(ColumnDef::new(Alias::new("symptoms")).json()) + .col(ColumnDef::new(Alias::new("complication_notes")).text()) + // draft / completed / reviewed + .col(ColumnDef::new(Alias::new("status")).string().not_null().default("draft")) + .col(ColumnDef::new(Alias::new("reviewed_by")).uuid()) + .col(ColumnDef::new(Alias::new("reviewed_at")).timestamp_with_time_zone()) + // 标准字段 + .col(ColumnDef::new(Alias::new("created_at")).timestamp_with_time_zone().not_null().default(Expr::current_timestamp())) + .col(ColumnDef::new(Alias::new("updated_at")).timestamp_with_time_zone().not_null().default(Expr::current_timestamp())) + .col(ColumnDef::new(Alias::new("created_by")).uuid()) + .col(ColumnDef::new(Alias::new("updated_by")).uuid()) + .col(ColumnDef::new(Alias::new("deleted_at")).timestamp_with_time_zone()) + .col(ColumnDef::new(Alias::new("version")).integer().not_null().default(1)) + .to_owned(), + ) + .await?; + + // dialysis_record 索引 + manager + .create_index( + Index::create() + .if_not_exists() + .name("idx_dialysis_record_tenant_patient") + .table(Alias::new("dialysis_record")) + .col(Alias::new("tenant_id")) + .col(Alias::new("patient_id")) + .to_owned(), + ) + .await?; + + manager + .create_index( + Index::create() + .if_not_exists() + .name("idx_dialysis_record_date") + .table(Alias::new("dialysis_record")) + .col(Alias::new("dialysis_date")) + .to_owned(), + ) + .await?; + + // 2. ALTER lab_report: 增加审阅流程字段 + // source: manual_input / photo_upload + manager + .alter_table( + Table::alter() + .table(Alias::new("lab_report")) + .add_column(ColumnDef::new(Alias::new("source")).string().default("manual_input")) + .to_owned(), + ) + .await?; + + // status: pending / reviewed + manager + .alter_table( + Table::alter() + .table(Alias::new("lab_report")) + .add_column(ColumnDef::new(Alias::new("status")).string().not_null().default("pending")) + .to_owned(), + ) + .await?; + + manager + .alter_table( + Table::alter() + .table(Alias::new("lab_report")) + .add_column(ColumnDef::new(Alias::new("reviewed_by")).uuid()) + .to_owned(), + ) + .await?; + + manager + .alter_table( + Table::alter() + .table(Alias::new("lab_report")) + .add_column(ColumnDef::new(Alias::new("reviewed_at")).timestamp_with_time_zone()) + .to_owned(), + ) + .await?; + + // 重命名 indicators → items (V2 JSON 结构含 name/value/unit/reference_low/reference_high/is_abnormal) + manager.get_connection().execute(sea_orm::Statement::from_string( + sea_orm::DatabaseBackend::Postgres, + "ALTER TABLE lab_report RENAME COLUMN indicators TO items".to_string(), + )).await?; + + // 重命名 doctor_interpretation → doctor_notes + manager.get_connection().execute(sea_orm::Statement::from_string( + sea_orm::DatabaseBackend::Postgres, + "ALTER TABLE lab_report RENAME COLUMN doctor_interpretation TO doctor_notes".to_string(), + )).await?; + + Ok(()) + } + + async fn down(&self, manager: &SchemaManager) -> Result<(), DbErr> { + // 恢复 lab_report 列名 + manager.get_connection().execute(sea_orm::Statement::from_string( + sea_orm::DatabaseBackend::Postgres, + "ALTER TABLE lab_report RENAME COLUMN doctor_notes TO doctor_interpretation".to_string(), + )).await?; + + manager.get_connection().execute(sea_orm::Statement::from_string( + sea_orm::DatabaseBackend::Postgres, + "ALTER TABLE lab_report RENAME COLUMN items TO indicators".to_string(), + )).await?; + + // 删除新增列 + manager + .alter_table( + Table::alter() + .table(Alias::new("lab_report")) + .drop_column(Alias::new("reviewed_at")) + .drop_column(Alias::new("reviewed_by")) + .drop_column(Alias::new("status")) + .drop_column(Alias::new("source")) + .to_owned(), + ) + .await?; + + // 删除 dialysis_record 表 + manager + .drop_table(Table::drop().table(Alias::new("dialysis_record")).if_exists().to_owned()) + .await?; + + Ok(()) + } +} diff --git a/docs/superpowers/specs/2026-04-25-hms-v2-iteration-design.md b/docs/superpowers/specs/2026-04-25-hms-v2-iteration-design.md new file mode 100644 index 0000000..dbaa2f2 --- /dev/null +++ b/docs/superpowers/specs/2026-04-25-hms-v2-iteration-design.md @@ -0,0 +1,670 @@ +# HMS V2 迭代设计 — 血透专科健康管理平台 + +> **日期**: 2026-04-25 +> **状态**: 待评审 +> **前置文档**: `2026-04-23-health-management-module-design.md`, `2026-04-24-health-module-iteration-design.md` +> **需求来源**: 客户功能需求文档 `docs/健康管理/管理系统功能文档(1).xlsx` + +--- + +## 1. 背景与动机 + +### 1.1 业务定位变化 + +V1 的健康管理模块定位为**通用健康管理平台**，覆盖患者管理、健康数据、预约排班、随访管理、咨询管理五大功能。 + +客户反馈后，明确业务定位为**血透（透析）专科健康管理平台**，面向肾病/透析患者和医护群体。这带来三个重大变化： + +1. **数据模型专科化** — 从通用健康指标（血压/心率/血糖/体重/体温）扩展为血透专科指标（透析记录、化验报告、日常监测） +2. **新增积分商城** — 替代原计划的完整电商，用积分体系驱动患者活跃度 +3. **新增医护端小程序** — 独立入口，医护可查看患者数据、填写透析记录、回复咨询 + +### 1.2 客户需求来源 + +客户通过 Excel 功能文档定义了三端需求： + +| 端 | 核心功能 | +|---|---| +| 患者端小程序 | 首页、数据上报（透析/化验/日常）、在线咨询、积分商城、预约与随访、个人中心 | +| 医护端小程序 | 数据概览、患者管理、咨询回复、随访管理、报告解读 | +| PC 管理后台 | 系统管理、患者管理、健康数据中心、咨询管理、商城管理、内容管理、统计报表、系统设置 | + +--- + +## 2. 需求-实现差距分析 + +### 2.1 已有功能匹配度 + +| 客户需求 | 已有实现 | 匹配度 | 需要的工作 | +|---------|---------|--------|-----------| +| 患者列表/档案 | Patient CRUD + 18 实体 | 90% | 微调 | +| 在线咨询（图文） | Consultation 模块 | 70% | 加语音/客服通道 | +| 预约管理 | Appointment 模块 | 60% | 加透析专项预约 | +| 随访任务/台账 | Follow-up 模块 | 80% | 微调 | +| 科普文章 | Article 模块 | 90% | 微调 | +| 医护管理 | Doctor 模块 | 80% | 微调 | +| 账号权限/操作日志 | erp-auth RBAC | 95% | 基本不变 | +| 患者标签 | Tag 模块 | 90% | 微调 | +| 小程序健康数据 | 6 种指标录入 + ECharts 趋势图 | 80% | 扩展指标 + 透析数据 | + +### 2.2 全新模块 + +| 模块 | 说明 | 复杂度 | +|------|------|--------| +| 血透透析记录 | 透析日期/时间、干体重、透前/后血压、心率、超滤量、症状 | 中 | +| 日常监测扩展 | 饮水量、尿量 + 打卡模式 | 低 | +| 化验报告上传 | 拍照上传 + 指标录入 | 中 | +| 积分商城 | 积分获取、商品兑换、二维码核销 | 高 | +| 线下活动 | 活动管理、报名、扫码签到 | 中 | +| 在线咨询（IM） | 客服通道、医生通道、图文/语音消息 | 高 | +| 医护端小程序 | 独立小程序，医护专属功能 | 高 | +| 统计报表中心 | 患者增长、咨询量、随访完成率、商城销售 | 中-高 | + +--- + +## 3. 积分商城设计 + +### 3.1 核心链路 + +**赚积分 → 攒积分 → 花积分 → 核销** + +### 3.2 实现方式 + +放在 `erp-health` 原生模块内，直接复用现有患者体系和事件机制。 + +### 3.3 积分获取渠道（数据库可配置） + +| 渠道 | 积分 | 说明 | +|------|------|------| +| 每日健康打卡 | 可配置/天 | 完成日常监测数据填写触发 | +| 数据上报 | 可配置/次 | 上传化验单、填透析记录 | +| 线下活动签到 | 活动配置 | 到院参加讲座/义诊等 | +| 连续打卡奖励 | 阶梯配置 | 连续 7/14/30 天额外加分 | +| 医生互动 | 可配置/次 | 完成一次咨询、回复随访问卷 | + +积分获取规则通过 `points_rule` 表配置，管理员可在 PC 端调整积分值、每日上限、连续奖励等参数。 + +### 3.4 兑换品类 + +| 类型 | 兑换物 | 履约方式 | +|------|--------|---------| +| 实物 | 血透护理用品、肾病食品、慢病器械 | 到院自提（二维码核销） | +| 服务券 | 免费抽血、肾功能检查、营养咨询 | 生成预约券 → 线下二维码核销 | +| 权益 | 免费停车券、优先预约权 | 虚拟权益即时生效 | + +### 3.5 核销方式 + +用户兑换后生成二维码（UUID），到院后工作人员扫码核销。 + +服务券类型核销后可自动关联预约系统创建预约。 + +### 3.6 积分过期机制 + +**滚动 12 个月过期，FIFO 先进先出结算。** + +- 每笔积分（earn）有独立 `expires_at`（创建时间 + 12 个月） +- 每日后台任务扫描并标记过期积分 +- 消费时从最老的未过期积分开始扣减 +- 每笔积分支持部分消费（`remaining_amount` 字段） + +### 3.7 数据模型（8 张新表） + +#### points_account（积分账户） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient，唯一约束 | +| balance | i32 | 当前可用积分 | +| total_earned | i32 | 累计获得 | +| total_spent | i32 | 累计消耗 | +| total_expired | i32 | 累计过期 | +| version | i32 | 乐观锁 | +| tenant_id | UUID | 租户 | +| created_at / updated_at / created_by / updated_by / deleted_at | — | 标准字段 | + +#### points_rule（积分规则，数据库可配置） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| event_type | String | 触发事件：daily_checkin / data_report / lab_upload / event_checkin / consultation_complete / followup_complete | +| name | String | 规则名称（展示用） | +| description | String | 规则描述 | +| points_value | i32 | 单次获得积分 | +| daily_cap | i32 | 每日上限（0 = 无限制） | +| streak_7d_bonus | i32 | 连续 7 天额外奖励 | +| streak_14d_bonus | i32 | 连续 14 天额外奖励 | +| streak_30d_bonus | i32 | 连续 30 天额外奖励 | +| is_active | bool | 是否启用 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +#### points_transaction（积分流水，FIFO 桶模型） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| account_id | UUID | FK → points_account | +| type | Enum | earn / spend / expired / refund | +| amount | i32 | 正数=获得，负数=消耗 | +| remaining_amount | i32 | 该笔积分剩余可用量（earn 类型） | +| status | Enum | active / expired / consumed | +| expires_at | DateTime | 过期时间（earn 类型：创建 + 12 个月） | +| balance_after | i32 | 操作后账户余额快照 | +| rule_id | UUID | FK → points_rule（earn 类型） | +| order_id | UUID | FK → points_order（spend 类型，可空） | +| description | String | 流水描述 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +#### points_product（兑换商品） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| name | String | 商品名称 | +| type | Enum | physical / service / privilege | +| points_cost | i32 | 兑换所需积分 | +| stock | i32 | 库存数量（-1 = 无限） | +| image_url | String | 商品图片 | +| description | Text | 商品描述 | +| service_config | JSON | 服务类型配置（service 类型：关联检查项目、有效期等） | +| is_active | bool | 是否上架 | +| sort_order | i32 | 排序权重 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +#### points_order（兑换订单） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient | +| product_id | UUID | FK → points_product | +| points_cost | i32 | 消耗积分（冗余，防商品价格变化） | +| status | Enum | pending / verified / cancelled / expired | +| qr_code | UUID | 核销二维码（UUID v4） | +| verified_by | UUID | 核销人 FK → user | +| verified_at | DateTime | 核销时间 | +| expires_at | DateTime | 订单过期时间（实物/服务券有效期） | +| notes | String | 备注 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +#### points_checkin（每日打卡） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient | +| checkin_date | Date | 打卡日期 | +| consecutive_days | i32 | 连续打卡天数（计算值） | +| tenant_id | UUID | 租户 | +| created_at | DateTime | — | + +唯一约束：(patient_id, checkin_date) + +#### offline_event（线下活动） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| title | String | 活动标题 | +| description | Text | 活动描述 | +| event_date | Date | 活动日期 | +| start_time / end_time | Time | 活动时间 | +| location | String | 活动地点 | +| points_reward | i32 | 参与奖励积分 | +| max_participants | i32 | 最大参与人数（0 = 无限制） | +| current_participants | i32 | 已报名人数 | +| status | Enum | draft / published / ongoing / completed / cancelled | +| image_url | String | 活动封面图 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +#### offline_event_registration（活动报名 + 签到） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| event_id | UUID | FK → offline_event | +| patient_id | UUID | FK → patient | +| status | Enum | registered / checked_in / cancelled | +| checked_in_at | DateTime | 签到时间 | +| checked_in_by | UUID | 签到确认人 FK → user | +| points_granted | bool | 是否已发放积分 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +唯一约束：(event_id, patient_id) + +### 3.8 积分获取链路 + +``` +健康打卡 → 触发事件 → points_rule 匹配规则 → 写入 points_transaction → 更新 points_account.balance +数据上报 → 同上 ↓ +咨询完成 → 同上 连续打卡检查 +线下签到 → 同上 → 达到 7/14/30 天？ + → 额外 bonus transaction +``` + +### 3.9 兑换核销链路 + +``` +用户浏览商品 → 兑换（扣积分）→ 生成 points_order + QR（UUID v4） + ↓ + 用户到院出示二维码 + ↓ + 工作人员扫码（小程序/PC）→ 状态变 verified + ↓ + type=service → 自动创建预约券 + type=physical → 库存扣减 +``` + +### 3.10 后台任务 + +| 任务 | 频率 | 说明 | +|------|------|------| +| 积分过期扫描 | 每日 | 扫描 expires_at < now 的 earn 记录，标记 expired，扣减 balance | +| 订单过期扫描 | 每日 | 扫描未核销且过期的订单，标记 expired，退还积分 | +| 连续打卡计算 | 每日 | 计算各患者连续打卡天数，触发阶梯奖励 | + +### 3.11 API 端点 + +**患者端：** + +| 方法 | 路径 | 说明 | +|------|------|------| +| GET | /api/v1/points/account | 查看我的积分账户 | +| POST | /api/v1/points/checkin | 每日打卡 | +| GET | /api/v1/points/checkin/status | 打卡状态（连续天数等） | +| GET | /api/v1/points/transactions | 积分流水（分页） | +| GET | /api/v1/points/products | 商品列表（分页、按类型筛选） | +| GET | /api/v1/points/products/{id} | 商品详情 | +| POST | /api/v1/points/exchange | 兑换商品 | +| GET | /api/v1/points/orders | 我的兑换订单 | +| GET | /api/v1/points/orders/{id} | 订单详情（含二维码） | +| GET | /api/v1/offline-events | 线下活动列表 | +| GET | /api/v1/offline-events/{id} | 活动详情 | +| POST | /api/v1/offline-events/{id}/register | 报名活动 | + +**医护/管理员端：** + +| 方法 | 路径 | 说明 | +|------|------|------| +| POST | /api/v1/points/verify | 扫码核销 | +| CRUD | /api/v1/admin/points/rules | 积分规则管理 | +| CRUD | /api/v1/admin/points/products | 商品管理 | +| GET | /api/v1/admin/points/orders | 订单管理（导出） | +| GET | /api/v1/admin/points/statistics | 积分统计 | +| CRUD | /api/v1/admin/offline-events | 线下活动管理 | +| POST | /api/v1/admin/offline-events/{id}/checkin | 活动扫码签到 | + +### 3.12 PC 管理后台新增页面 + +| 页面 | 功能 | +|------|------| +| 积分规则管理 | 增删改规则、启用/禁用、调整积分值和上限 | +| 商品管理 | 增删改兑换品、设置库存、上传图片、设置积分价格 | +| 订单管理 | 查看兑换记录、手动核销、导出 | +| 线下活动管理 | 创建活动、设置积分奖励、查看报名/签到名单 | +| 积分统计 | 总发放/总消耗/活跃用户排行、积分流水查询 | + +--- + +## 4. 血透专科数据模型 + +### 4.1 设计决策 + +- **独立实体表**：不复用现有 health_data 键值对结构，每类数据一张独立表 +- **医护+患者协同上报**：透析记录由医护填写，化验报告由患者上传/医护审阅，日常监测由患者填写 + +### 4.2 权限矩阵 + +| 数据 | 患者端 | 医护端 | PC 管理后台 | +|------|--------|--------|------------| +| 透析记录 | 查看（只读） | 创建/编辑 | 查看/导出/统计 | +| 化验报告 | 上传照片/查看 | 审阅/标注/解读 | 查看/导出 | +| 日常监测 | 创建/查看 | 查看/预警 | 查看/统计 | +| AI 健康报告 | 查看 | 查看/编辑 | 查看/导出 | + +### 4.3 新增实体 + +#### dialysis_record（透析记录） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient | +| dialysis_date | Date | 透析日期 | +| start_time | Time | 开始时间 | +| end_time | Time | 结束时间 | +| dry_weight | Decimal(5,1) | 干体重 (kg) | +| pre_weight | Decimal(5,1) | 透前体重 (kg) | +| post_weight | Decimal(5,1) | 透后体重 (kg) | +| pre_bp_systolic | i32 | 透前收缩压 | +| pre_bp_diastolic | i32 | 透前舒张压 | +| post_bp_systolic | i32 | 透后收缩压 | +| post_bp_diastolic | i32 | 透后舒张压 | +| pre_heart_rate | i32 | 透前心率 | +| post_heart_rate | i32 | 透后心率 | +| ultrafiltration_volume | i32 | 超滤量 (ml) | +| dialysis_duration | i32 | 透析时长 (min) | +| blood_flow_rate | i32 | 血流量 (ml/min) | +| dialysis_type | Enum | HD / HDF / HF | +| symptoms | JSON | 不适症状数组 ["低血压","恶心","抽筋"] | +| complication_notes | Text | 并发症备注 | +| status | Enum | draft / completed / reviewed | +| reviewed_by | UUID | FK → user，审阅医生 | +| reviewed_at | DateTime | 审阅时间 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | created_at / updated_at / created_by / updated_by / deleted_at / version | + +#### lab_report（化验报告） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient | +| report_date | Date | 化验日期 | +| report_type | Enum | kidney_function / blood_routine / electrolyte / liver_function / other | +| source | Enum | manual_input / photo_upload | +| image_urls | JSON | 化验单照片 URL 数组 | +| items | JSON | 指标数据数组（见下方结构） | +| doctor_notes | Text | 医生解读/批注 | +| reviewed_by | UUID | FK → user，审阅医生 | +| reviewed_at | DateTime | 审阅时间 | +| status | Enum | pending / reviewed | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +**items JSON 结构：** + +```json +[ + { + "name": "肌酐", + "value": "856", + "unit": "μmol/L", + "reference_low": 44, + "reference_high": 133, + "is_abnormal": true + }, + { + "name": "血钾", + "value": "6.2", + "unit": "mmol/L", + "reference_low": 3.5, + "reference_high": 5.3, + "is_abnormal": true + } +] +``` + +#### daily_monitoring（日常监测） + +| 字段 | 类型 | 说明 | +|------|------|------| +| id | UUID v7 | PK | +| patient_id | UUID | FK → patient | +| record_date | Date | 记录日期 | +| morning_bp_systolic | i32 | 晨起收缩压 | +| morning_bp_diastolic | i32 | 晨起舒张压 | +| evening_bp_systolic | i32 | 晚间收缩压 | +| evening_bp_diastolic | i32 | 晚间舒张压 | +| weight | Decimal(5,1) | 体重 (kg) | +| blood_sugar | Decimal(4,1) | 血糖 (mmol/L) | +| fluid_intake | i32 | 饮水量 (ml) | +| urine_output | i32 | 尿量 (ml) | +| notes | Text | 备注 | +| tenant_id | UUID | 租户 | +| 标准字段 | — | — | + +唯一约束：(patient_id, record_date) + +### 4.4 与现有模块的关系 + +``` +patient（已有） + ├── dialysis_record（新增） 1:N 每次透析一条 + ├── lab_report（新增） 1:N 每次化验一份 + ├── daily_monitoring（新增） 1:N 每天一条 + ├── health_data（已有，保留） 1:N 通用指标仍可用 + ├── appointment（已有） 1:N 透析预约走这里 + └── follow_up（已有） 1:N 随访任务 +``` + +### 4.5 化验报告 items 用 JSON 的原因 + +- 化验项目数量和类型因报告而异（肾功能 8 项 vs 血常规 20+ 项） +- 不需要按单个指标做复杂查询（都是按患者+日期范围查整份报告） +- JSON 内含 `is_abnormal` 标记，前端直接渲染异常标红 +- PostgreSQL JSONB 支持按单个指标查询趋势（未来可加物化视图展平） + +### 4.6 数据上报协同流程 + +**透析记录**：医护在医护端小程序/PC 填写 → 患者端只读查看 + +**化验报告**：患者拍照上传照片 + 手动填写指标 → 医护审阅/标注/解读 → 患者查看异常标红+医生解读 + +**日常监测**：患者每日填写（血压/体重/血糖/饮水量/尿量）→ 触发积分获取 → 医护端查看趋势+异常预警 + +### 4.7 新增 API 端点 + +**透析记录：** + +| 方法 | 路径 | 说明 | +|------|------|------| +| GET | /api/v1/health/patients/{id}/dialysis-records | 患者透析记录列表 | +| GET | /api/v1/health/dialysis-records/{id} | 透析记录详情 | +| POST | /api/v1/health/dialysis-records | 创建透析记录（医护） | +| PUT | /api/v1/health/dialysis-records/{id} | 更新透析记录（医护） | + +**化验报告：** + +| 方法 | 路径 | 说明 | +|------|------|------| +| GET | /api/v1/health/patients/{id}/lab-reports | 患者化验报告列表 | +| GET | /api/v1/health/lab-reports/{id} | 报告详情 | +| POST | /api/v1/health/lab-reports | 上传化验报告（患者/医护） | +| PUT | /api/v1/health/lab-reports/{id}/review | 医生审阅（标注+解读） | + +**日常监测：** + +| 方法 | 路径 | 说明 | +|------|------|------| +| GET | /api/v1/health/patients/{id}/daily-monitoring | 患者日常监测列表 | +| POST | /api/v1/health/daily-monitoring | 上报日常监测（患者） | +| GET | /api/v1/health/daily-monitoring/trend | 趋势数据查询 | + +--- + +## 5. 小程序迭代设计 + +### 5.1 患者端小程序 + +#### 新 TabBar 结构 + +``` +首页 | 上报 | 咨询 | 商城 | 我的 +``` + +替换现有：~~首页 | 健康 | 预约 | 资讯 | 我的~~ + +#### 首页（改造） + +- 公告轮播（Banner 组件） +- 功能入口 Grid：数据上报、我的医生、在线咨询、血透预约、积分商城 +- 今日健康打卡入口（未打卡时醒目提示） +- 健康概览卡片：血压、体重、最近透析记录 +- 今日提醒列表：透析预约、血压测量、用药提醒 + +#### 上报 Tab（改造自"健康"） + +- 打卡区：血压/体重/血糖/饮水/尿量 快捷填写入口 +- 数据类型切换：日常监测 / 透析记录（只读）/ 化验报告 +- 趋势图（ECharts）：血压/体重/血糖 折线图 +- 子页面： + - 日常监测填写表单 + - 化验报告上传（拍照 + 指标填写） + - 透析记录详情（只读） + - 化验报告详情（含医生批注） + - 趋势分析详情（大图 + AI 解读） + +#### 咨询 Tab（全新） + +- 咨询类型切换：医生 / 客服 +- 最近对话列表（未读红点） +- 子页面： + - 选择医生 + - 聊天界面（图文/语音 + 上传报告） + - 客服对话 + +#### 商城 Tab（全新） + +- 我的积分 + 签到按钮 +- 商品分类：全部 / 实物 / 检查 / 权益 +- 商品列表（网格） +- 线下活动入口 +- 子页面： + - 商品详情 + 兑换 + - 兑换确认（生成二维码） + - 我的订单（待核销/已核销/已过期） + - 线下活动详情 + 报名 + - 积分明细 + +#### 我的 Tab（改造） + +- 个人信息 + 积分展示 + 连续打卡天数 +- 就诊人管理（已有） +- 健康档案 +- 我的医生 +- 我的预约（从 TabBar 降级为菜单入口） +- 我的报告（已有） +- 我的随访（已有） +- 我的订单（积分商城） +- 消息通知（新增） +- 用药提醒（已有，需接入后端） +- 设置（已有） + +### 5.2 医护端小程序（V2） + +医护端为独立小程序（独立 AppID），V2 实现。V1 阶段医护功能通过 PC 管理后台覆盖。 + +#### V2 页面结构（约 18 页） + +TabBar：概览 | 患者 | 咨询 | 随访 | 我的 + +- **概览**：今日待回复咨询数、异常预警列表、今日透析患者数、随访任务数 +- **患者**：患者列表（按透析/高危/标签筛选）、患者详情（档案+透析记录+化验+趋势图+标签）、填写透析记录、报告解读 +- **咨询**：未读消息列表、图文/语音回复、发送科普文章 +- **随访**：随访任务列表、填写记录、台账导出 +- **我的**：医生信息、我的患者、排班日历、科普文章管理 + +### 5.3 页面工作量统计 + +| 端 | 改造页 | 新增页 | 总计 | +|----|--------|--------|------| +| 患者端 | 5（首页/健康/我的/预约/资讯改造） | ~15（咨询3+商城6+上报子页4+通知2） | ~20 页 | +| 医护端（V2） | 0 | 18 | 18 页 | + +--- + +## 6. 在线咨询设计（V2 详情待补充） + +### 6.1 核心需求 + +- 客服通道：订单/物流/使用问题 +- 医生通道：选择医生、发送问题、上传报告、语音/文字沟通 +- 留言功能：医生离线时留存问题 + +### 6.2 技术方向 + +- V1 可先实现基于轮询的图文消息（复用现有 Consultation 模块） +- V2 升级为 WebSocket 实时通信 + 语音消息 +- 客服通道可对接第三方客服系统（如美洽、智齿） + +--- + +## 7. PC 管理后台新增页面 + +### 7.1 健康数据中心（新增） + +| 页面 | 功能 | +|------|------| +| 透析数据统计 | 透析次数趋势、干体重变化、超滤量统计 | +| 异常指标排行 | 血钾/血磷/肌酐异常患者排行 | +| 上报率统计 | 患者数据上报活跃度、打卡率 | + +### 7.2 商城管理（新增） + +| 页面 | 功能 | +|------|------| +| 积分规则管理 | 增删改积分获取规则 | +| 商品管理 | 增删改兑换商品、库存管理 | +| 订单管理 | 兑换记录查看、手动核销、导出 | +| 线下活动管理 | 活动创建、报名/签到管理 | +| 积分统计 | 发放/消耗/活跃排行 | + +### 7.3 统计报表（新增） + +| 页面 | 功能 | +|------|------| +| 患者增长 | 新增患者趋势、活跃度 | +| 咨询量 | 咨询次数/回复率/满意度 | +| 随访完成率 | 随访任务执行统计 | +| 商城数据 | 兑换排行、库存周转 | + +--- + +## 8. AI 分析能力（V2） + +### 8.1 V1 预留 + +- 趋势图已通过 ECharts 实现（现有 TrendChart 组件） +- 异常指标通过 `is_abnormal` 标记和阈值校验实现 +- 健康报告可生成基础版（数据汇总 + 异常标注） + +### 8.2 V2 增强 + +- LLM 集成：自然语言健康报告生成 +- AI 辅助：化验单 OCR 自动识别 +- 智能预警：基于历史数据的异常趋势预测 + +--- + +## 9. 分期建议 + +### V1.1（建议优先） + +1. 血透专科数据模型（3 张新表 + API） +2. 患者端小程序改造（TabBar + 首页 + 上报扩展） +3. 积分商城后端 + 小程序前端 +4. 线下活动管理 + +### V1.2 + +1. 在线咨询（轮询版） +2. 化验报告上传 + 审阅流程 +3. PC 管理后台新增页面 +4. 统计报表 + +### V2 + +1. 医护端小程序 +2. 在线咨询升级（WebSocket + 语音） +3. AI 分析增强（LLM + OCR） +4. Redis 缓存层 + +--- + +## 10. 风险与缓解 + +| 风险 | 影响 | 缓解措施 | +|------|------|---------| +| 积分 FIFO 结算复杂度 | 并发消费时积分桶冲突 | 使用数据库事务 + 乐观锁（account.version） | +| 在线咨询工作量超预期 | V1.2 延期 | V1 先做轮询图文，WebSocket 推迟到 V2 | +| 医护端小程序工作量大 | V2 延期 | V1 阶段用 PC 后台替代医护端功能 | +| 化验单 OCR 准确率 | 用户体验差 | V1 先做手动填写，OCR 作为 V2 AI 增量 | +| 积分通胀 | 积分价值稀释 | 可配置每日上限 + 过期机制 + 运营调整积分价格 |