Add AI provenance to assisted entry saves

alopezo · alopezo · commit aa8aff7f6421 · 2026-03-30T16:04:51.000-03:00
diff --git a/src/app/benefits-demo/ai-assisted-entry/ai-assisted-entry.component.ts b/src/app/benefits-demo/ai-assisted-entry/ai-assisted-entry.component.ts
@@ -278,90 +278,66 @@ export class AiAssistedEntryComponent implements OnInit, OnDestroy {
           }) || null;
         }
       }
-
-      if (this.patientService.getCurrentPersistenceMode() === 'fhir') {
-        const transactionResult = await this.patientService.saveAiAssistedEntryTransaction(this.patient.id, {
-          encounter,
-          conditions: conditionsToSave,
-          procedures: procedureToSave ? [procedureToSave] : [],
-          medications: medicationsToSave,
-          allergies: []
-        });
-
-        if (existingProcedureToLink && transactionResult.encounter) {
-          existingProcedureToLink.encounter = {
-            reference: `Encounter/${transactionResult.encounter.id}`,
-            display: `Encounter ${transactionResult.encounter.id}`
-          };
-          this.patientService.updatePatientProcedure(this.patient.id, existingProcedureToLink.id, existingProcedureToLink);
-
-          this.snackBar.open(
-            `Procedure "${this.selectedProcedure?.name}" already existed and was linked to the new encounter.`,
-            'Close',
-            {
-              duration: 4000,
-              horizontalPosition: 'center',
-              verticalPosition: 'top',
-              panelClass: ['info-snackbar']
-            }
-          );
-        } else if (this.selectedProcedure && !procedureToSave && !existingProcedureToLink) {
-          this.snackBar.open(
-            `Procedure "${this.selectedProcedure.name}" already exists for this patient.`,
-            'Close',
-            {
-              duration: 4000,
-              horizontalPosition: 'center',
-              verticalPosition: 'top',
-              panelClass: ['warning-snackbar']
-            }
-          );
-        }
-
-        this.transactionSaved.emit(transactionResult);
-      } else {
-        conditionsToSave.forEach(condition => this.conditionAdded.emit(condition));
-
-        if (procedureToSave) {
-          this.procedureAdded.emit(procedureToSave);
-        } else if (existingProcedureToLink && encounter) {
-          existingProcedureToLink.encounter = {
-            reference: `Encounter/${encounter.id}`,
-            display: `Encounter ${encounter.id}`
-          };
-          this.patientService.updatePatientProcedure(this.patient!.id, existingProcedureToLink.id, existingProcedureToLink);
-
-          this.snackBar.open(
-            `Procedure "${this.selectedProcedure?.name}" already exists and has been linked to this encounter.`,
-            'Close',
+      const aiDerivedProvenance = encounter
+        ? [
+            ...conditionsToSave,
+            ...(procedureToSave ? [procedureToSave] : []),
+            ...medicationsToSave
+          ].map((resource: any) => this.patientService.createAiDerivedProvenance(
+            this.patient!.id,
+            resource,
             {
-              duration: 4000,
-              horizontalPosition: 'center',
-              verticalPosition: 'top',
-              panelClass: ['info-snackbar']
+              reference: `Encounter/${encounter.id}`,
+              display: encounter.reasonCode?.[0]?.text || `Encounter ${encounter.id}`
             }
-          );
-        } else if (this.selectedProcedure) {
-          this.snackBar.open(
-            `Procedure "${this.selectedProcedure.name}" already exists for this patient (duplicate SNOMED CT code detected).`,
-            'Close',
-            {
-              duration: 4000,
-              horizontalPosition: 'center',
-              verticalPosition: 'top',
-              panelClass: ['warning-snackbar']
-            }
-          );
-        }
+          ))
+        : [];
+
+      const transactionResult = await this.patientService.saveAiAssistedEntryTransaction(this.patient.id, {
+        encounter,
+        conditions: conditionsToSave,
+        procedures: procedureToSave ? [procedureToSave] : [],
+        medications: medicationsToSave,
+        allergies: [],
+        provenance: aiDerivedProvenance
+      });
 
-        medicationsToSave.forEach(medication => this.medicationAdded.emit(medication));
+      if (existingProcedureToLink && transactionResult.encounter) {
+        existingProcedureToLink.encounter = {
+          reference: `Encounter/${transactionResult.encounter.id}`,
+          display: `Encounter ${transactionResult.encounter.id}`
+        };
+        this.patientService.updatePatientProcedure(this.patient.id, existingProcedureToLink.id, existingProcedureToLink);
 
-        if (encounter) {
-          this.encounterAdded.emit(encounter);
-        }
+        this.snackBar.open(
+          `Procedure "${this.selectedProcedure?.name}" already existed and was linked to the new encounter.`,
+          'Close',
+          {
+            duration: 4000,
+            horizontalPosition: 'center',
+            verticalPosition: 'top',
+            panelClass: ['info-snackbar']
+          }
+        );
+      } else if (this.selectedProcedure && !procedureToSave && !existingProcedureToLink) {
+        this.snackBar.open(
+          `Procedure "${this.selectedProcedure.name}" already exists for this patient.`,
+          'Close',
+          {
+            duration: 4000,
+            horizontalPosition: 'center',
+            verticalPosition: 'top',
+            panelClass: ['warning-snackbar']
+          }
+        );
       }
 
-      const totalSaved = conditionsToSave.length + medicationsToSave.length + (procedureToSave ? 1 : 0) + (encounter ? 1 : 0);
+      this.transactionSaved.emit(transactionResult);
+
+      const totalSaved = transactionResult.conditions.length
+        + transactionResult.medications.length
+        + transactionResult.procedures.length
+        + (transactionResult.encounter ? 1 : 0);
       if (totalSaved > 0) {
         this.snackBar.open(
           `Successfully saved ${totalSaved} clinical resources.`,
diff --git a/src/app/benefits-demo/clinical-timeline/clinical-timeline.component.html b/src/app/benefits-demo/clinical-timeline/clinical-timeline.component.html
@@ -25,7 +25,7 @@ <h4>Overview</h4>
 @if (sortedEvents.length > 0) {
   <div class="vertical-timeline">
     <div class="timeline-line"></div>
-    @for (event of sortedEvents; track event; let i = $index) {
+    @for (event of sortedEvents; track event.type + ':' + event.id; let i = $index) {
       <div class="timeline-item"
         [class.left]="i % 2 === 0"
         [class.right]="i % 2 === 1"
diff --git a/src/app/services/patient-fhir-storage.service.ts b/src/app/services/patient-fhir-storage.service.ts
@@ -503,6 +503,9 @@ export class PatientFhirStorageService implements PatientStorageBackend {
     const encounterFullUrl = payload.encounter ? this.createTransactionFullUrl('encounter') : null;
     const conditionReferenceMap = new Map<string, string>();
     const resourceReferenceMap = new Map<string, string>();
+    if (payload.encounter?.id && encounterFullUrl) {
+      resourceReferenceMap.set(`Encounter/${payload.encounter.id}`, encounterFullUrl);
+    }
     const conditionEntries = payload.conditions.map((condition) => {
       const fullUrl = this.createTransactionFullUrl('condition');
       if (condition.id) {
@@ -790,6 +793,13 @@ export class PatientFhirStorageService implements PatientStorageBackend {
         reference: targetReferenceMap.get(target.reference) || (target.reference === provenanceWithoutId.patient?.reference
           ? patientReference
           : target.reference)
+      })),
+      entity: (provenanceWithoutId.entity || []).map((entity) => ({
+        ...entity,
+        what: {
+          ...entity.what,
+          reference: entity.what.reference ? (targetReferenceMap.get(entity.what.reference) || entity.what.reference) : entity.what.reference
+        }
       }))
     };
   }
diff --git a/src/app/services/patient.service.ts b/src/app/services/patient.service.ts
@@ -47,6 +47,8 @@ export class PatientService {
   public static readonly ICD10_SYSTEM = 'http://hl7.org/fhir/sid/icd-10';
   private static readonly EHR_LAB_LOCATION_SYSTEM = 'http://ehr-lab.demo/location';
   private static readonly PERSISTENCE_MODE_STORAGE_KEY = 'ehr_persistence_mode';
+  private static readonly AI_PROVENANCE_TECHNICAL_AGENT_DISPLAY = 'AI/NLP pipeline';
+  private static readonly AI_PROVENANCE_HUMAN_REVIEWER_DISPLAY = 'Human reviewer';
   private readonly FHIR_PATIENT_PAGE_SIZE = 20;
   private readonly ANATOMICAL_ANCHOR_POINTS: Array<{ id: string; ancestors: string[] }> = [
     {
@@ -2121,6 +2123,81 @@ export class PatientService {
     };
   }
 
+  createAiDerivedProvenance(
+    patientId: string,
+    targetResource: { resourceType: string; id: string; code?: { text?: string }; medicationCodeableConcept?: { text?: string } },
+    sourceReference: { reference: string; display?: string },
+    recorded: string = new Date().toISOString()
+  ): Provenance {
+    const targetDisplay = targetResource.code?.text
+      || targetResource.medicationCodeableConcept?.text
+      || `${targetResource.resourceType} ${targetResource.id}`;
+
+    return {
+      resourceType: 'Provenance',
+      id: `provenance-${Date.now()}-${Math.random().toString(36).slice(2, 11)}`,
+      recorded,
+      patient: {
+        reference: `Patient/${patientId}`,
+        display: `Patient ${patientId}`
+      },
+      activity: {
+        text: 'AI-derived clinical entity under active human review'
+      },
+      target: [
+        {
+          reference: `${targetResource.resourceType}/${targetResource.id}`,
+          display: targetDisplay
+        },
+        {
+          reference: `Patient/${patientId}`,
+          display: `Patient ${patientId}`
+        }
+      ],
+      agent: [
+        {
+          type: {
+            text: 'assembler'
+          },
+          role: [
+            {
+              text: 'technical agent'
+            }
+          ],
+          who: {
+            display: PatientService.AI_PROVENANCE_TECHNICAL_AGENT_DISPLAY
+          }
+        },
+        {
+          type: {
+            text: 'author'
+          },
+          role: [
+            {
+              text: 'human reviewer'
+            }
+          ],
+          who: {
+            display: PatientService.AI_PROVENANCE_HUMAN_REVIEWER_DISPLAY
+          }
+        }
+      ],
+      entity: [
+        {
+          role: 'derivation',
+          what: {
+            reference: sourceReference.reference,
+            display: sourceReference.display
+          }
+        }
+      ],
+      text: {
+        status: 'generated',
+        div: '<div xmlns="http://www.w3.org/1999/xhtml"><p>Derived by AI from persisted source text and approved under active human supervision.</p></div>'
+      }
+    };
+  }
+
   private normalizeAllergyForPersistence(allergy: AllergyIntolerance): AllergyIntolerance {
     const normalizedCategories = Array.isArray(allergy.category)
       ? allergy.category
@@ -2687,16 +2764,72 @@ export class PatientService {
     patientId: string,
     payload: AiAssistedEntryTransactionPayload
   ): Promise<AiAssistedEntryTransactionResult> {
-    if (this.getCurrentPersistenceMode() !== 'fhir') {
-      throw new Error('AI-assisted entry transactions are only available in FHIR mode.');
-    }
-
     await Promise.all([
       ...payload.conditions.map((condition) => this.enrichCondition(condition)),
       ...payload.procedures.map((procedure) => this.enrichProcedure(procedure)),
       ...payload.medications.map((medication) => this.enrichMedication(patientId, medication))
     ]);
 
+    if (this.getCurrentPersistenceMode() !== 'fhir') {
+      const savedEncounter = payload.encounter && this.addPatientEncounter(patientId, payload.encounter)
+        ? payload.encounter
+        : null;
+      const savedConditions: Condition[] = [];
+      const savedProcedures: Procedure[] = [];
+      const savedMedications: MedicationStatement[] = [];
+      const savedAllergies: AllergyIntolerance[] = [];
+
+      for (const condition of payload.conditions) {
+        if (this.addPatientCondition(patientId, condition)) {
+          savedConditions.push(condition);
+        }
+      }
+
+      for (const procedure of payload.procedures) {
+        if (this.addPatientProcedure(patientId, procedure)) {
+          savedProcedures.push(procedure);
+        }
+      }
+
+      for (const medication of payload.medications) {
+        if (this.addPatientMedication(patientId, medication)) {
+          savedMedications.push(medication);
+        }
+      }
+
+      for (const allergy of payload.allergies) {
+        if (this.addPatientAllergy(patientId, allergy)) {
+          savedAllergies.push(allergy);
+        }
+      }
+
+      const savedTargetReferences = new Set<string>([
+        ...savedConditions.map((resource) => `Condition/${resource.id}`),
+        ...savedProcedures.map((resource) => `Procedure/${resource.id}`),
+        ...savedMedications.map((resource) => `MedicationStatement/${resource.id}`),
+        ...savedAllergies.map((resource) => `AllergyIntolerance/${resource.id}`)
+      ]);
+
+      const savedProvenance: Provenance[] = [];
+      for (const provenance of payload.provenance || []) {
+        const hasSavedTarget = (provenance.target || []).some((target) => savedTargetReferences.has(target.reference));
+        if (!hasSavedTarget) {
+          continue;
+        }
+        savedProvenance.push(await this.createPatientProvenance(patientId, provenance));
+      }
+
+      this.notifyPatientDataChanged(patientId);
+      return {
+        encounter: savedEncounter,
+        conditions: savedConditions,
+        procedures: savedProcedures,
+        medications: savedMedications,
+        allergies: savedAllergies,
+        provenance: savedProvenance
+      };
+    }
+
     const result = await this.patientFhirStorageService.saveAiAssistedEntryTransaction(patientId, payload);
 
     this.setResourceCache(
