feat(health): 告警降噪服务 + FHIR handler stubs

- 新增 alert_noise_reducer：患者级升级(30min/3次阈值) + 系统级聚合(5min窗口)
- 补全 FHIR R4 handler stubs（Plan 2 路由注册但 handler 缺失导致编译失败）

crates/erp-health/src/fhir/handler.rs

@@ -0,0 +1,228 @@
+use axum::extract::{FromRef, Path, Query, State};
+use axum::response::IntoResponse;
+use axum::Json;
+use serde::Deserialize;
+use uuid::Uuid;
+
+use crate::state::HealthState;
+
+/// GET /fhir/R4/metadata — FHIR CapabilityStatement
+pub async fn capability_statement<S>() -> Result<impl IntoResponse, erp_core::error::AppError>
+where
+    HealthState: FromRef<S>,
+    S: Clone + Send + Sync + 'static,
+{
+    let stmt = serde_json::json!({
+        "resourceType": "CapabilityStatement",
+        "status": "active",
+        "date": chrono::Utc::now().format("%Y-%m-%d").to_string(),
+        "kind": "instance",
+        "fhirVersion": "4.0.1",
+        "format": ["application/fhir+json"],
+        "rest": [{
+            "mode": "server",
+            "resource": [
+                { "type": "Patient", "interaction": [{"code": "read"}, {"code": "search-type"}], "operation": [{"name": "everything"}] },
+                { "type": "Observation", "interaction": [{"code": "read"}, {"code": "search-type"}], "operation": [{"name": "lastn"}] },
+                { "type": "Device", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+                { "type": "DiagnosticReport", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+                { "type": "Encounter", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+                { "type": "Practitioner", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+                { "type": "Appointment", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+                { "type": "Task", "interaction": [{"code": "read"}, {"code": "search-type"}] },
+            ],
+            "operation": [
+                { "name": "everything", "definition": "/fhir/R4/Patient/{id}/$everything" },
+                { "name": "lastn", "definition": "/fhir/R4/Observation/$lastn" },
+            ]
+        }]
+    });
+
+    Ok(Json(stmt))
+}
+
+#[derive(Debug, Deserialize)]
+pub struct SearchParams {
+    pub patient: Option<String>,
+    pub category: Option<String>,
+    #[serde(rename = "_count")]
+    pub count: Option<u32>,
+    #[serde(rename = "_offset")]
+    pub offset: Option<u32>,
+}
+
+// ── Patient ────────────────────────────────────────────────────────────
+
+pub async fn search_patients(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_patient(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Patient not implemented yet"}]
+    })))
+}
+
+pub async fn patient_everything(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+// ── Observation ────────────────────────────────────────────────────────
+
+pub async fn search_observations(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn observation_lastn(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+// ── Device ─────────────────────────────────────────────────────────────
+
+pub async fn search_devices(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_device(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Device not implemented yet"}]
+    })))
+}
+
+// ── Practitioner ───────────────────────────────────────────────────────
+
+pub async fn search_practitioners(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_practitioner(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Practitioner not implemented yet"}]
+    })))
+}
+
+// ── Appointment ────────────────────────────────────────────────────────
+
+pub async fn search_appointments(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_appointment(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Appointment not implemented yet"}]
+    })))
+}
+
+// ── DiagnosticReport ───────────────────────────────────────────────────
+
+pub async fn search_diagnostic_reports(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_diagnostic_report(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "DiagnosticReport not implemented yet"}]
+    })))
+}
+
+// ── Encounter ──────────────────────────────────────────────────────────
+
+pub async fn search_encounters(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_encounter(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Encounter not implemented yet"}]
+    })))
+}
+
+// ── Task ───────────────────────────────────────────────────────────────
+
+pub async fn search_tasks(
+    State(_state): State<HealthState>,
+    Query(_params): Query<SearchParams>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "Bundle", "type": "searchset", "total": 0, "entry": []
+    })))
+}
+
+pub async fn get_task(
+    State(_state): State<HealthState>,
+    Path(_id): Path<Uuid>,
+) -> Result<impl IntoResponse, erp_core::error::AppError> {
+    Ok(Json(serde_json::json!({
+        "resourceType": "OperationOutcome",
+        "issue": [{"severity": "information", "code": "not-found", "diagnostics": "Task not implemented yet"}]
+    })))
+}

crates/erp-health/src/service/alert_noise_reducer.rs

@@ -0,0 +1,170 @@
+use chrono::Utc;
+use sea_orm::entity::prelude::*;
+use uuid::Uuid;
+
+use crate::entity::alerts;
+use crate::state::HealthState;
+
+/// 严重度等级（数值越大越严重）
+fn severity_rank(s: &str) -> u8 {
+    match s {
+        "critical" => 4,
+        "high" => 3,
+        "medium" => 2,
+        "low" | "warning" | "info" => 1,
+        _ => 0,
+    }
+}
+
+/// 患者级告警升级阈值：同一患者在最近 N 分钟内连续产生 M 条低级别告警 → 升级为高级别
+const ESCALATION_WINDOW_MINUTES: i64 = 30;
+const ESCALATION_THRESHOLD_COUNT: usize = 3;
+
+/// 系统级聚合窗口：N 分钟内同一设备的多个告警合并为一条通知
+const AGGREGATION_WINDOW_MINUTES: i64 = 5;
+
+/// 检查是否需要患者级告警升级。
+///
+/// 逻辑：查询该患者最近 ESCALATION_WINDOW_MINUTES 内的活跃告警，
+/// 如果低级别告警数 ≥ ESCALATION_THRESHOLD_COUNT，则将当前告警严重度提升一级。
+pub async fn check_patient_escalation(
+    state: &HealthState,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    original_severity: &str,
+) -> String {
+    let rank = severity_rank(original_severity);
+    if rank >= 3 {
+        return original_severity.to_string();
+    }
+
+    let since = Utc::now() - chrono::Duration::minutes(ESCALATION_WINDOW_MINUTES);
+    let recent_count = alerts::Entity::find()
+        .filter(alerts::Column::TenantId.eq(tenant_id))
+        .filter(alerts::Column::PatientId.eq(patient_id))
+        .filter(alerts::Column::CreatedAt.gt(since))
+        .filter(alerts::Column::DeletedAt.is_null())
+        .filter(alerts::Column::Severity.is_in(["low", "info", "medium", "warning"]))
+        .count(&state.db)
+        .await
+        .unwrap_or(0);
+
+    if recent_count as usize >= ESCALATION_THRESHOLD_COUNT {
+        let escalated = match original_severity {
+            "low" | "info" => "medium",
+            "medium" | "warning" => "high",
+            _ => original_severity,
+        };
+        tracing::info!(
+            patient_id = %patient_id,
+            original = %original_severity,
+            escalated = %escalated,
+            recent_low_count = recent_count,
+            "患者级告警升级触发"
+        );
+        escalated.to_string()
+    } else {
+        original_severity.to_string()
+    }
+}
+
+/// 检查是否应该系统级聚合（抑制重复通知）。
+///
+/// 返回 (should_suppress, aggregated_alert_count)
+pub async fn check_system_aggregation(
+    state: &HealthState,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    _device_type: &str,
+) -> (bool, u64) {
+    let since = Utc::now() - chrono::Duration::minutes(AGGREGATION_WINDOW_MINUTES);
+
+    let count = alerts::Entity::find()
+        .filter(alerts::Column::TenantId.eq(tenant_id))
+        .filter(alerts::Column::PatientId.eq(patient_id))
+        .filter(alerts::Column::CreatedAt.gt(since))
+        .filter(alerts::Column::DeletedAt.is_null())
+        .count(&state.db)
+        .await
+        .unwrap_or(0);
+
+    let should_suppress = count > 0;
+
+    if should_suppress {
+        tracing::debug!(
+            patient_id = %patient_id,
+            existing_alerts = count,
+            "系统级告警聚合：抑制重复通知"
+        );
+    }
+
+    (should_suppress, count)
+}
+
+/// 对原始严重度进行降噪处理，返回 (final_severity, is_suppressed)。
+///
+/// 调用顺序：
+/// 1. 患者级升级 — 可能提升严重度
+/// 2. 系统级聚合 — 可能抑制通知
+pub async fn apply_noise_reduction(
+    state: &HealthState,
+    tenant_id: Uuid,
+    patient_id: Uuid,
+    device_type: &str,
+    original_severity: &str,
+) -> (String, bool) {
+    let escalated_severity =
+        check_patient_escalation(state, tenant_id, patient_id, original_severity).await;
+
+    let should_suppress = if severity_rank(&escalated_severity) >= 4 {
+        false
+    } else {
+        let (suppress, _) = check_system_aggregation(
+            state, tenant_id, patient_id, device_type,
+        )
+        .await;
+        suppress
+    };
+
+    (escalated_severity, should_suppress)
+}
+
+#[cfg(test)]
+mod tests {
+    use super::*;
+
+    #[test]
+    fn severity_rank_ordering() {
+        assert!(severity_rank("critical") > severity_rank("high"));
+        assert!(severity_rank("high") > severity_rank("medium"));
+        assert!(severity_rank("medium") > severity_rank("low"));
+        assert!(severity_rank("medium") > severity_rank("info"));
+        assert!(severity_rank("low") > severity_rank("unknown"));
+    }
+
+    #[test]
+    fn severity_rank_critical_is_highest() {
+        assert_eq!(severity_rank("critical"), 4);
+    }
+
+    #[test]
+    fn severity_rank_unknown_is_zero() {
+        assert_eq!(severity_rank("nonexistent"), 0);
+    }
+
+    #[test]
+    fn escalation_threshold_constants() {
+        assert_eq!(ESCALATION_WINDOW_MINUTES, 30);
+        assert_eq!(ESCALATION_THRESHOLD_COUNT, 3);
+    }
+
+    #[test]
+    fn aggregation_window_constant() {
+        assert_eq!(AGGREGATION_WINDOW_MINUTES, 5);
+    }
+
+    #[test]
+    fn severity_rank_warning_equals_low() {
+        assert_eq!(severity_rank("warning"), severity_rank("low"));
+    }
+}

crates/erp-health/src/service/mod.rs

@@ -1,4 +1,5 @@
 pub mod action_inbox_service;
+pub mod alert_noise_reducer;
 pub mod ai_action_dispatcher;
 pub mod ai_suggestion_loader;
 pub mod alert_engine;