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+# 架构反思实施计划
+
+> **For agentic workers:** REQUIRED: Use superpowers:subagent-driven-development (if subagents available) or superpowers:executing-plans to implement this plan. Steps use checkbox (`- [ ]`) syntax for tracking.
+
+**Goal:** 落地架构反思三个结论 — WASM 评估量表插件、透析模块独立、P1 事件消费者补全。
+
+**Architecture:** 三条独立工作线可并行推进。WASM 插件遵循 erp-plugin-test-sample 模式；透析模块拆分参照 erp-points 拆 crate 模式；事件消费者补全遵循现有 subscribe_filtered + tokio::spawn 模式。
+
+**Tech Stack:** Rust/SeaORM/Axum/WASM（wit-bindgen 0.55）
+
+**Spec:** `docs/discussions/2026-04-28-architecture-retrospective.md`
+
+---
+
+## Chunk 1: WASM 评估量表插件（PHQ-9）
+
+### Task 1: 创建插件 crate 骨架
+
+**Files:**
+- Create: `crates/erp-plugin-assessment/Cargo.toml`
+- Create: `crates/erp-plugin-assessment/src/lib.rs`
+- Create: `crates/erp-plugin-assessment/plugin.toml`
+
+- [ ] **Step 1: 创建 Cargo.toml**
+
+参照 `crates/erp-plugin-test-sample/Cargo.toml`：
+
+```toml
+[package]
+name = "erp-plugin-assessment"
+version = "0.1.0"
+edition = "2024"
+
+[lib]
+crate-type = ["cdylib"]
+
+[dependencies]
+wit-bindgen = "0.55"
+serde = { version = "1", features = ["derive"] }
+serde_json = "1"
+```
+
+- [ ] **Step 2: 创建 plugin.toml**
+
+```toml
+[metadata]
+id = "assessment"
+name = "评估量表"
+version = "0.1.0"
+description = "标准化医学评估量表（PHQ-9、GAD-7 等）"
+author = "HMS"
+min_platform_version = "0.1.0"
+
+[[permissions]]
+code = "assessment_scale.list"
+name = "查看评估量表"
+description = "查看评估量表列表和详情"
+
+[[permissions]]
+code = "assessment_scale.manage"
+name = "管理评估量表"
+description = "创建、编辑、删除评估量表"
+
+[[permissions]]
+code = "assessment_response.list"
+name = "查看评估结果"
+description = "查看患者评估答卷"
+
+[[permissions]]
+code = "assessment_response.manage"
+name = "管理评估结果"
+description = "提交、编辑评估答卷"
+
+[[schema.entities]]
+name = "assessment_scale"
+display_name = "评估量表"
+
+[[schema.entities.fields]]
+name = "scale_code"
+field_type = "string"
+required = true
+display_name = "量表编码"
+unique = true
+ui_widget = "select"
+options = ["PHQ-9", "GAD-7", "SF-36", "MMSE", "ADL", "IADL"]
+
+[[schema.entities.fields]]
+name = "title"
+field_type = "string"
+required = true
+display_name = "量表名称"
+searchable = true
+
+[[schema.entities.fields]]
+name = "description"
+field_type = "string"
+display_name = "描述"
+ui_widget = "textarea"
+
+[[schema.entities.fields]]
+name = "questions_json"
+field_type = "json"
+required = true
+display_name = "题目定义（JSON）"
+
+[[schema.entities.fields]]
+name = "scoring_rules_json"
+field_type = "json"
+required = true
+display_name = "评分规则（JSON）"
+
+[[schema.entities.fields]]
+name = "status"
+field_type = "string"
+required = true
+display_name = "状态"
+default = "active"
+ui_widget = "select"
+options = ["active", "inactive"]
+
+[[schema.entities]]
+name = "assessment_response"
+display_name = "评估答卷"
+
+[[schema.entities.fields]]
+name = "scale_id"
+field_type = "uuid"
+required = true
+display_name = "量表"
+ui_widget = "entity_select"
+ref_entity = "assessment_scale"
+ref_plugin = "assessment"
+
+[[schema.entities.fields]]
+name = "patient_id"
+field_type = "uuid"
+required = true
+display_name = "患者 ID"
+
+[[schema.entities.fields]]
+name = "answers_json"
+field_type = "json"
+required = true
+display_name = "答案（JSON）"
+
+[[schema.entities.fields]]
+name = "total_score"
+field_type = "integer"
+required = true
+display_name = "总分"
+
+[[schema.entities.fields]]
+name = "severity_level"
+field_type = "string"
+required = true
+display_name = "严重程度"
+ui_widget = "select"
+options = ["normal", "mild", "moderate", "severe"]
+
+[[schema.entities.fields]]
+name = "assessed_by"
+field_type = "uuid"
+display_name = "评估人"
+
+[[schema.entities.fields]]
+name = "status"
+field_type = "string"
+required = true
+display_name = "状态"
+default = "completed"
+ui_widget = "select"
+options = ["draft", "completed", "reviewed"]
+
+[[schema.entities.relations]]
+entity = "assessment_scale"
+foreign_key = "scale_id"
+on_delete = "restrict"
+name = "scale"
+type = "belongs_to"
+display_field = "title"
+
+[[trigger_events]]
+name = "assessment_completed"
+display_name = "评估完成"
+description = "患者完成评估量表，触发评分计算和后续流程"
+entity = "assessment_response"
+on = "create"
+
+[[ui.pages]]
+type = "crud"
+label = "评估量表"
+icon = "FormOutlined"
+```
+
+- [ ] **Step 3: 创建 src/lib.rs**
+
+```rust
+// crates/erp-plugin-assessment/src/lib.rs
+//! 评估量表插件 — 标准化医学评估（PHQ-9, GAD-7 等）
+
+wit_bindgen::generate!({
+    path: "../../crates/erp-plugin/src/wit/plugin.wit",
+    world: "plugin-world",
+});
+
+use crate::exports::erp::plugin::plugin_api::Guest;
+use crate::erp::plugin::host_api::*;
+
+struct AssessmentPlugin;
+
+impl Guest for AssessmentPlugin {
+    fn init() -> Result<(), String> {
+        log_write("info", "AssessmentPlugin initialized");
+        Ok(())
+    }
+
+    fn on_tenant_created(tenant_id: String) -> Result<(), String> {
+        log_write("info", &format!("AssessmentPlugin: tenant {} created", tenant_id));
+        // 可以为新租户插入默认量表（PHQ-9、GAD-7）
+        Ok(())
+    }
+
+    fn handle_event(
+        event_type: String,
+        _event_id: String,
+        _tenant_id: String,
+        _payload: String,
+    ) -> Result<(), String> {
+        log_write("debug", &format!("AssessmentPlugin received: {}", event_type));
+        Ok(())
+    }
+}
+
+export!(AssessmentPlugin);
+```
+
+- [ ] **Step 4: 注册到 workspace**
+
+在根 `Cargo.toml` 的 `workspace.members` 中添加 `"crates/erp-plugin-assessment"`。
+
+- [ ] **Step 5: 编译验证**
+
+```bash
+cargo check -p erp-plugin-assessment
+```
+
+- [ ] **Step 6: 提交**
+
+```bash
+git add crates/erp-plugin-assessment/ Cargo.toml
+git commit -m "feat(plugin): 评估量表插件骨架 — assessment_scale + assessment_response"
+```
+
+---
+
+### Task 2: PHQ-9 默认量表数据 + 评分逻辑
+
+**Files:**
+- Modify: `crates/erp-plugin-assessment/src/lib.rs`（on_tenant_created 插入默认量表）
+
+- [ ] **Step 1: 在 on_tenant_created 中插入 PHQ-9 默认数据**
+
+PHQ-9 的 9 道题（每题 0-3 分）和评分规则：
+
+```json
+// questions_json
+[
+  {"id": 1, "text": "做事时提不起劲或没有兴趣", "options": [{"label": "完全不会", "score": 0}, {"label": "好几天", "score": 1}, {"label": "一半以上的天数", "score": 2}, {"label": "几乎每天", "score": 3}]},
+  // ... 共 9 题
+]
+
+// scoring_rules_json
+[
+  {"min": 0, "max": 4, "level": "normal", "label": "无抑郁症状"},
+  {"min": 5, "max": 9, "level": "mild", "label": "轻度抑郁"},
+  {"min": 10, "max": 14, "level": "moderate", "label": "中度抑郁"},
+  {"min": 15, "max": 19, "level": "moderate_severe", "label": "中重度抑郁"},
+  {"min": 20, "max": 27, "level": "severe", "label": "重度抑郁"}
+]
+```
+
+通过 `db_insert` host API 在 `on_tenant_created` 中插入。
+
+- [ ] **Step 2: 编译 + 验证**
+
+- [ ] **Step 3: 提交**
+
+```bash
+git commit -m "feat(plugin): PHQ-9 默认量表数据 + 评分规则"
+```
+
+---
+
+### Task 3: 编译 WASM + 注册到 erp-server
+
+**Files:**
+- Modify: `crates/erp-server/src/main.rs`（插件注册，如需手动加载）
+- Verify: WASM 编译输出
+
+- [ ] **Step 1: 编译为 WASM Component**
+
+```bash
+cd crates/erp-plugin-assessment
+cargo build --target wasm32-unknown-unknown --release
+# 或使用项目内的 WASM 编译脚本
+```
+
+- [ ] **Step 2: 验证插件加载**
+
+启动后端，确认插件系统识别 assessment 插件，动态表创建成功。
+
+- [ ] **Step 3: 通过 API 测试评估量表 CRUD**
+
+```bash
+# 创建量表
+curl -X POST /api/v1/plugin/assessment/assessment_scale \
+  -H "Authorization: Bearer $TOKEN" \
+  -d '{"scale_code": "PHQ-9", ...}'
+
+# 提交答卷
+curl -X POST /api/v1/plugin/assessment/assessment_response \
+  -d '{"scale_id": "...", "patient_id": "...", "answers_json": [...]}'
+```
+
+- [ ] **Step 4: 提交**
+
+```bash
+git commit -m "feat(plugin): 评估量表 WASM 编译 + 端到端验证"
+```
+
+---
+
+## Chunk 2: 透析模块拆分为 erp-dialysis
+
+### Task 4: 创建 erp-dialysis crate 骨架
+
+**Files:**
+- Create: `crates/erp-dialysis/Cargo.toml`
+- Create: `crates/erp-dialysis/src/{lib,module,state,error}.rs`
+- Modify: `Cargo.toml`（workspace members）
+
+- [ ] **Step 1: 创建 Cargo.toml**
+
+```toml
+[package]
+name = "erp-dialysis"
+version.workspace = true
+edition.workspace = true
+
+[dependencies]
+erp-core.workspace = true
+sea-orm.workspace = true
+tokio.workspace = true
+serde = { workspace = true, features = ["derive"] }
+serde_json.workspace = true
+uuid.workspace = true
+chrono.workspace = true
+axum.workspace = true
+utoipa.workspace = true
+validator.workspace = true
+async-trait.workspace = true
+tracing.workspace = true
+rust_decimal.workspace = true
+```
+
+- [ ] **Step 2: 创建标准模块文件**
+
+```rust
+// crates/erp-dialysis/src/lib.rs
+pub mod dto;
+pub mod entity;
+pub mod error;
+pub mod event;
+pub mod handler;
+pub mod module;
+pub mod service;
+pub mod state;
+
+pub use module::DialysisModule;
+pub use state::DialysisState;
+```
+
+```rust
+// crates/erp-dialysis/src/module.rs
+//! ErpModule trait 实现
+
+use async_trait::async_trait;
+use erp_core::module::{ErpModule, ModuleContext, ModuleType, PermissionDescriptor};
+use erp_core::events::EventBus;
+use crate::state::DialysisState;
+
+pub struct DialysisModule {
+    state: DialysisState,
+}
+
+impl DialysisModule {
+    pub fn new(db: sea_orm::DatabaseConnection, event_bus: EventBus) -> Self {
+        Self { state: DialysisState { db, event_bus } }
+    }
+}
+
+#[async_trait]
+impl ErpModule for DialysisModule {
+    fn name(&self) -> &str { "透析管理" }
+    fn id(&self) -> &str { "erp-dialysis" }
+    fn version(&self) -> &str { "0.1.0" }
+    fn module_type(&self) -> ModuleType { ModuleType::Builtin }
+
+    fn permissions(&self) -> Vec<PermissionDescriptor> {
+        vec![
+            PermissionDescriptor { code: "dialysis.record.list".into(), name: "查看透析记录".into() },
+            PermissionDescriptor { code: "dialysis.record.manage".into(), name: "管理透析记录".into() },
+            PermissionDescriptor { code: "dialysis.prescription.list".into(), name: "查看透析处方".into() },
+            PermissionDescriptor { code: "dialysis.prescription.manage".into(), name: "管理透析处方".into() },
+        ]
+    }
+
+    fn on_startup(&self, ctx: &ModuleContext) {
+        crate::event::register_handlers_with_state(self.state.clone());
+    }
+
+    fn as_any(&self) -> &dyn std::any::Any { self }
+}
+```
+
+- [ ] **Step 3: 注册到 workspace**
+
+在根 `Cargo.toml` 的 members 中添加 `"crates/erp-dialysis"`。
+
+- [ ] **Step 4: 编译验证**
+
+```bash
+cargo check -p erp-dialysis
+```
+
+- [ ] **Step 5: 提交**
+
+```bash
+git commit -m "feat(dialysis): 创建 erp-dialysis crate 骨架 + ErpModule 实现"
+```
+
+---
+
+### Task 5: 迁移透析 Entity + Service + Handler + DTO
+
+**Files:**
+- Move: 6 个文件从 `erp-health` → `erp-dialysis`
+- Modify: `crates/erp-health/src/{entity,service,handler,dto}/mod.rs`（删除透析导出）
+- Modify: 迁移文件中的 `crate::` 引用改为 `erp_core::` 或 erp-dialysis 内部引用
+
+**待迁移文件清单：**
+
+| 来源 | 目标 | 行数 |
+|------|------|------|
+| `erp-health/src/entity/dialysis_record.rs` | `erp-dialysis/src/entity/` | 82 |
+| `erp-health/src/entity/dialysis_prescription.rs` | `erp-dialysis/src/entity/` | 78 |
+| `erp-health/src/service/dialysis_service.rs` | `erp-dialysis/src/service/` | 333 |
+| `erp-health/src/service/dialysis_prescription_service.rs` | `erp-dialysis/src/service/` | 274 |
+| `erp-health/src/handler/dialysis_handler.rs` | `erp-dialysis/src/handler/` | 145 |
+| `erp-health/src/handler/dialysis_prescription_handler.rs` | `erp-dialysis/src/handler/` | 120 |
+| `erp-health/src/dto/dialysis_dto.rs` | `erp-dialysis/src/dto/` | 125 |
+| `erp-health/src/dto/dialysis_prescription_dto.rs` | `erp-dialysis/src/dto/` | 107 |
+
+- [ ] **Step 1: 复制文件到 erp-dialysis**
+
+```bash
+# Entity
+cp crates/erp-health/src/entity/dialysis_record.rs crates/erp-dialysis/src/entity/
+cp crates/erp-health/src/entity/dialysis_prescription.rs crates/erp-dialysis/src/entity/
+# Service
+cp crates/erp-health/src/service/dialysis_service.rs crates/erp-dialysis/src/service/
+cp crates/erp-health/src/service/dialysis_prescription_service.rs crates/erp-dialysis/src/service/
+# Handler
+cp crates/erp-health/src/handler/dialysis_handler.rs crates/erp-dialysis/src/handler/
+cp crates/erp-health/src/handler/dialysis_prescription_handler.rs crates/erp-dialysis/src/handler/
+# DTO
+cp crates/erp-health/src/dto/dialysis_dto.rs crates/erp-dialysis/src/dto/
+cp crates/erp-health/src/dto/dialysis_prescription_dto.rs crates/erp-dialysis/src/dto/
+```
+
+- [ ] **Step 2: 更新 crate 内引用**
+
+全局替换：
+- `crate::state::HealthState` → `crate::state::DialysisState`
+- `crate::error::{HealthError, HealthResult}` → `crate::error::{DialysisError, DialysisResult}`
+- `crate::entity::` → 保持不变（同 crate 内）
+- `crate::dto::` → 保持不变
+- `crate::service::` → 保持不变
+
+- [ ] **Step 3: 创建 error.rs**
+
+```rust
+// crates/erp-dialysis/src/error.rs
+use erp_core::error::AppError;
+use thiserror::Error;
+
+#[derive(Error, Debug)]
+pub enum DialysisError {
+    #[error("透析记录未找到: {0}")]
+    RecordNotFound(uuid::Uuid),
+    #[error("处方未找到: {0}")]
+    PrescriptionNotFound(uuid::Uuid),
+    #[error("状态转换无效: {0} → {1}")]
+    InvalidStatusTransition(String, String),
+    #[error("版本冲突")]
+    VersionConflict,
+}
+
+impl From<DialysisError> for AppError {
+    fn from(e: DialysisError) -> Self { AppError::Business(e.to_string()) }
+}
+
+pub type DialysisResult<T> = Result<T, DialysisError>;
+```
+
+- [ ] **Step 4: 从 erp-health 删除透析代码**
+
+从以下 mod.rs 中移除透析相关 `pub mod` 声明：
+- `crates/erp-health/src/entity/mod.rs`
+- `crates/erp-health/src/service/mod.rs`
+- `crates/erp-health/src/handler/mod.rs`
+- `crates/erp-health/src/dto/mod.rs`
+
+- [ ] **Step 5: 在 erp-server 注册新模块**
+
+在 `crates/erp-server/src/main.rs` 中：
+- 添加 `use erp_dialysis::DialysisModule;`
+- 在 registry 链中 `.register(dialysis_module)`
+- 在路由 merge 中 `.merge(erp_dialysis::DialysisModule::protected_routes())`
+
+- [ ] **Step 6: 编译 + 全链路验证**
+
+```bash
+cargo check --workspace
+# 启动后端，验证透析相关 API 正常
+```
+
+- [ ] **Step 7: 提交**
+
+```bash
+git commit -m "refactor: 透析模块拆分为独立 erp-dialysis crate（2 Entity + 2 Service）"
+```
+
+---
+
+## Chunk 3: P1 事件消费者补全
+
+### Task 6: patient.created → 欢迎消息 + 默认随访
+
+**Files:**
+- Modify: `crates/erp-health/src/event.rs`（添加消费者）
+
+- [ ] **Step 1: 在 register_handlers_with_state 中添加 patient.created 消费者**
+
+```rust
+// 在 register_handlers_with_state() 中新增:
+let (mut patient_rx, _) = state.event_bus.subscribe_filtered("patient.".to_string());
+let patient_db = state.db.clone();
+tokio::spawn(async move {
+    loop {
+        match patient_rx.recv().await {
+            Some(event) if event.event_type == PATIENT_CREATED => {
+                if erp_core::events::is_event_processed(&patient_db, event.id, "patient_welcome").await.unwrap_or(false) {
+                    continue;
+                }
+                let patient_id = event.payload.get("patient_id")
+                    .and_then(|v| v.as_str())
+                    .and_then(|s| Uuid::parse_str(s).ok());
+                if let Some(pid) = patient_id {
+                    // 1. 发布欢迎消息事件（消息模块消费后发送站内通知）
+                    let welcome_event = DomainEvent::new(
+                        "message.send",
+                        event.tenant_id,
+                        erp_core::events::build_event_payload(serde_json::json!({
+                            "template": "patient_welcome",
+                            "recipient_type": "patient",
+                            "recipient_id": pid,
+                        })),
+                    );
+                    // 2. TODO: 创建默认随访计划（后续迭代）
+                    tracing::info!(patient_id = %pid, "新患者欢迎流程触发");
+                }
+                let _ = erp_core::events::mark_event_processed(&patient_db, event.id, "patient_welcome").await;
+            }
+            Some(_) => {}
+            None => break,
+        }
+    }
+});
+```
+
+- [ ] **Step 2: 编译验证**
+
+```bash
+cargo check -p erp-health
+```
+
+- [ ] **Step 3: 提交**
+
+```bash
+git commit -m "feat(health): patient.created 消费者 — 新患者欢迎消息"
+```
+
+---
+
+### Task 7: appointment.confirmed/cancelled → 通知 + 号源
+
+**Files:**
+- Modify: `crates/erp-health/src/event.rs`
+
+- [ ] **Step 1: 添加 appointment 事件消费者**
+
+```rust
+let (mut appt_rx, _) = state.event_bus.subscribe_filtered("appointment.".to_string());
+let appt_db = state.db.clone();
+tokio::spawn(async move {
+    loop {
+        match appt_rx.recv().await {
+            Some(event) if event.event_type == "appointment.confirmed" => {
+                if erp_core::events::is_event_processed(&appt_db, event.id, "appointment_notifier").await.unwrap_or(false) {
+                    continue;
+                }
+                // 通知医生
+                let doctor_id = event.payload.get("doctor_id").and_then(|v| v.as_str());
+                let patient_id = event.payload.get("patient_id").and_then(|v| v.as_str());
+                if let (Some(did), Some(pid)) = (doctor_id, patient_id) {
+                    tracing::info!(doctor_id = did, patient_id = pid, "预约确认通知触发");
+                    // 发布通知事件
+                }
+                let _ = erp_core::events::mark_event_processed(&appt_db, event.id, "appointment_notifier").await;
+            }
+            Some(event) if event.event_type == "appointment.cancelled" => {
+                // 释放号源 + 通知排队患者
+                tracing::info!(event_id = %event.id, "预约取消，号源释放");
+            }
+            Some(_) => {}
+            None => break,
+        }
+    }
+});
+```
+
+- [ ] **Step 2: 编译 + 提交**
+
+```bash
+cargo check -p erp-health
+git commit -m "feat(health): appointment 事件消费者 — 预约确认/取消通知"
+```
+
+---
+
+### Task 8: follow_up.overdue → 升级通知
+
+**Files:**
+- Modify: `crates/erp-health/src/event.rs`
+
+- [ ] **Step 1: 添加 follow_up.overdue 消费者**
+
+```rust
+// 在 register_handlers_with_state 中：
+// 注意：follow_up 事件的前缀是 "follow_up."
+let (mut fu_rx, _) = state.event_bus.subscribe_filtered("follow_up.".to_string());
+let fu_db = state.db.clone();
+tokio::spawn(async move {
+    loop {
+        match fu_rx.recv().await {
+            Some(event) if event.event_type == FOLLOW_UP_OVERDUE => {
+                if erp_core::events::is_event_processed(&fu_db, event.id, "follow_up_escalator").await.unwrap_or(false) {
+                    continue;
+                }
+                let task_id = event.payload.get("task_id").and_then(|v| v.as_str());
+                let assigned_to = event.payload.get("assigned_to").and_then(|v| v.as_str());
+                if let (Some(tid), Some(uid)) = (task_id, assigned_to) {
+                    // 通知随访负责人 + 科室主管
+                    tracing::warn!(task_id = tid, assigned_to = uid, "随访逾期升级通知");
+                }
+                let _ = erp_core::events::mark_event_processed(&fu_db, event.id, "follow_up_escalator").await;
+            }
+            Some(_) => {}
+            None => break,
+        }
+    }
+});
+```
+
+- [ ] **Step 2: 编译 + 提交**
+
+```bash
+cargo check -p erp-health
+git commit -m "feat(health): follow_up.overdue 消费者 — 逾期随访升级通知"
+```
+
+---
+
+## 执行摘要
+
+| Chunk | Tasks | 内容 | 预估 |
+|-------|-------|------|------|
+| 1 | T1-T3 | WASM 评估量表插件（PHQ-9） | 1-2 天 |
+| 2 | T4-T5 | 透析模块拆 erp-dialysis | 1 天 |
+| 3 | T6-T8 | P1 事件消费者补全（3 个） | 0.5-1 天 |
+
+**总计 8 个 Task，预估 2.5-4 天。**
+
+**依赖关系：**
+- T1→T2→T3 串行（WASM 插件逐层构建）
+- T4→T5 串行（先骨架再迁移）
+- T6/T7/T8 可并行（独立消费者）
+- Chunk 1/2/3 相互独立，可完全并行
+
+**与技术债计划的关系：**
+- 本计划的 Chunk 3（事件消费者）应在技术债批次 B（EventBus dead-letter）之后执行
+- Chunk 2（透析拆分）应在技术债批次 A（安全修复）之后执行，避免合并冲突
+- Chunk 1（WASM 插件）完全独立，随时可执行