From 6a0fab97aea850df8ef7e7a6da1993144d8342be Mon Sep 17 00:00:00 2001 From: Khalid Abdi Date: Tue, 9 Jun 2026 19:51:17 +0300 Subject: [PATCH] backend: per-doctor patient visibility, transfer, provider picker & scoped activity - Add patients.primary_provider_id (FK to user) + migration; persist it through create/update and surface it on the Patient shape. - Scope patient list/get for the `doctor` role to their own panel (with a createdBy fallback for legacy rows); admin/owner/member/reception/viewer keep seeing every patient. - Add POST /api/patients/:fileNumber/transfer to reassign a chart (updates the provider link + PCP label, records activity, notifies the clinic). - Add GET /api/staff/providers (any member) listing clinical-capable members for the PCP picker and transfer dialog. - Scope the activity feed: non-admins see only their own actions; owners/admins see the whole clinic. Co-Authored-By: Claude Opus 4.8 --- backend/drizzle/0009_melted_puck.sql | 2 + backend/drizzle/meta/0009_snapshot.json | 2485 +++++++++++++++++++++++ backend/drizzle/meta/_journal.json | 7 + backend/src/db/schema/patients.ts | 6 + backend/src/lib/patient-validation.ts | 5 + backend/src/routes/activity.ts | 12 +- backend/src/routes/patients.ts | 82 + backend/src/routes/staff.ts | 32 +- backend/src/services/activity.ts | 17 +- backend/src/services/patients.ts | 54 +- backend/src/types/patient.ts | 3 +- 11 files changed, 2697 insertions(+), 8 deletions(-) create mode 100644 backend/drizzle/0009_melted_puck.sql create mode 100644 backend/drizzle/meta/0009_snapshot.json diff --git a/backend/drizzle/0009_melted_puck.sql b/backend/drizzle/0009_melted_puck.sql new file mode 100644 index 0000000..47dda18 --- /dev/null +++ b/backend/drizzle/0009_melted_puck.sql @@ -0,0 +1,2 @@ +ALTER TABLE "patients" ADD COLUMN "primary_provider_id" text;--> statement-breakpoint +ALTER TABLE "patients" ADD CONSTRAINT "patients_primary_provider_id_user_id_fk" FOREIGN KEY ("primary_provider_id") REFERENCES "public"."user"("id") ON DELETE set null ON UPDATE no action; \ No newline at end of file diff --git a/backend/drizzle/meta/0009_snapshot.json b/backend/drizzle/meta/0009_snapshot.json new file mode 100644 index 0000000..8efc8c9 --- /dev/null +++ b/backend/drizzle/meta/0009_snapshot.json @@ -0,0 +1,2485 @@ +{ + "id": "0f52e156-3afe-48d3-83c4-9e232afe8d49", + "prevId": "0ce438e7-5c83-40d2-9833-d1e19866f94a", + "version": "7", + "dialect": "postgresql", + "tables": { + "public.account": { + "name": "account", + "schema": "", + "columns": { + "id": { + "name": "id", + "type": "text", + "primaryKey": true, + "notNull": true + }, + "account_id": { + "name": "account_id", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "provider_id": { + "name": "provider_id", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "user_id": { + "name": "user_id", + "type": "text", 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true, + "default": false + }, + "created_by": { + "name": "created_by", + "type": "text", + "primaryKey": false, + "notNull": false + }, + "created_at": { + "name": "created_at", + "type": "timestamp", + "primaryKey": false, + "notNull": true, + "default": "now()" + }, + "updated_at": { + "name": "updated_at", + "type": "timestamp", + "primaryKey": false, + "notNull": true, + "default": "now()" + } + }, + "indexes": { + "conversations_org_idx": { + "name": "conversations_org_idx", + "columns": [ + { + "expression": "organization_id", + "isExpression": false, + "asc": true, + "nulls": "last" + } + ], + "isUnique": false, + "concurrently": false, + "method": "btree", + "with": {} + } + }, + "foreignKeys": { + "conversations_organization_id_organization_id_fk": { + "name": "conversations_organization_id_organization_id_fk", + "tableFrom": "conversations", + "tableTo": "organization", + "columnsFrom": [ + "organization_id" + ], + "columnsTo": [ + "id" + ], + "onDelete": "cascade", + "onUpdate": "no action" + }, + "conversations_created_by_user_id_fk": { + "name": "conversations_created_by_user_id_fk", + "tableFrom": "conversations", + "tableTo": "user", + "columnsFrom": [ + "created_by" + ], + "columnsTo": [ + "id" + ], + "onDelete": "set null", + "onUpdate": "no action" + } + }, + "compositePrimaryKeys": {}, + "uniqueConstraints": {}, + "policies": {}, + "checkConstraints": {}, + "isRLSEnabled": false + }, + "public.messages": { + "name": "messages", + "schema": "", + "columns": { + "id": { + "name": "id", + "type": "uuid", + "primaryKey": true, + "notNull": true, + "default": "gen_random_uuid()" + }, + "conversation_id": { + "name": "conversation_id", + "type": "uuid", + "primaryKey": false, + "notNull": true + }, + "sender_id": { + "name": "sender_id", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "body": { + "name": "body", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "created_at": { + "name": "created_at", + "type": "timestamp", + "primaryKey": false, + "notNull": true, + "default": "now()" + } + }, + "indexes": { + "messages_conv_idx": { + "name": "messages_conv_idx", + "columns": [ + { + "expression": "conversation_id", + "isExpression": false, + "asc": true, + "nulls": "last" + }, + { + "expression": "created_at", + "isExpression": false, + "asc": true, + "nulls": "last" + } + ], + "isUnique": false, + "concurrently": false, + "method": "btree", + "with": {} + } + }, + "foreignKeys": { + "messages_conversation_id_conversations_id_fk": { + "name": "messages_conversation_id_conversations_id_fk", + "tableFrom": "messages", + "tableTo": "conversations", + "columnsFrom": [ + "conversation_id" + ], + "columnsTo": [ + "id" + ], + "onDelete": "cascade", + "onUpdate": "no action" + }, + "messages_sender_id_user_id_fk": { + "name": "messages_sender_id_user_id_fk", + "tableFrom": "messages", + "tableTo": "user", + "columnsFrom": [ + "sender_id" + ], + "columnsTo": [ + "id" + ], + "onDelete": "cascade", + "onUpdate": "no action" + } + }, + "compositePrimaryKeys": {}, + "uniqueConstraints": {}, + "policies": {}, + "checkConstraints": {}, + "isRLSEnabled": false + }, + "public.notifications": { + "name": "notifications", + "schema": "", + "columns": { + "id": { + "name": "id", + "type": "uuid", + "primaryKey": true, + "notNull": true, + "default": "gen_random_uuid()" + }, + "organization_id": { + "name": "organization_id", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "user_id": { + "name": "user_id", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "type": { + "name": "type", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "text": { + "name": "text", + "type": "text", + "primaryKey": false, + "notNull": true + }, + "read": { + "name": "read", + "type": "boolean", + "primaryKey": false, + "notNull": true, + "default": false + }, + "entity_type": { + "name": "entity_type", + "type": "text", + "primaryKey": false, + "notNull": false + }, + "entity_id": { + "name": "entity_id", + "type": "text", + "primaryKey": false, + "notNull": false + }, + "actor_name": { + "name": "actor_name", + "type": "text", + "primaryKey": false, + "notNull": false + }, + "actor_initials": { + "name": "actor_initials", + "type": "text", + "primaryKey": false, + "notNull": false + }, + "created_at": { + "name": "created_at", + "type": "timestamp", + "primaryKey": false, + "notNull": true, + "default": "now()" + } + }, + "indexes": { + "notifications_org_user_read_idx": { + "name": "notifications_org_user_read_idx", + "columns": [ + { + "expression": "organization_id", + "isExpression": false, + "asc": true, + "nulls": "last" + }, + { + "expression": "user_id", + "isExpression": false, + "asc": true, + "nulls": "last" + }, + { + "expression": "read", + "isExpression": false, + "asc": true, + "nulls": "last" + } + ], + "isUnique": false, + "concurrently": false, + "method": "btree", + "with": {} + } + }, + "foreignKeys": { + "notifications_organization_id_organization_id_fk": { + "name": "notifications_organization_id_organization_id_fk", + "tableFrom": "notifications", + "tableTo": "organization", + "columnsFrom": [ + "organization_id" + ], + "columnsTo": [ + "id" + ], + "onDelete": "cascade", + "onUpdate": "no action" + }, + "notifications_user_id_user_id_fk": { + "name": "notifications_user_id_user_id_fk", + "tableFrom": "notifications", + "tableTo": "user", + "columnsFrom": [ + "user_id" + ], + "columnsTo": [ + "id" + ], + "onDelete": "cascade", + "onUpdate": "no action" + } + }, + "compositePrimaryKeys": {}, + "uniqueConstraints": {}, + "policies": {}, + "checkConstraints": {}, + "isRLSEnabled": false + } + }, + "enums": {}, + "schemas": {}, + "sequences": {}, + "roles": {}, + "policies": {}, + "views": {}, + "_meta": { + "columns": {}, + "schemas": {}, + "tables": {} + } +} \ No newline at end of file diff --git a/backend/drizzle/meta/_journal.json b/backend/drizzle/meta/_journal.json index 3a662db..d25888d 100644 --- a/backend/drizzle/meta/_journal.json +++ b/backend/drizzle/meta/_journal.json @@ -64,6 +64,13 @@ "when": 1780937195597, "tag": "0008_luxuriant_blue_blade", "breakpoints": true + }, + { + "idx": 9, + "version": "7", + "when": 1781022080228, + "tag": "0009_melted_puck", + "breakpoints": true } ] } \ No newline at end of file diff --git a/backend/src/db/schema/patients.ts b/backend/src/db/schema/patients.ts index d853fa4..89c142a 100644 --- a/backend/src/db/schema/patients.ts +++ b/backend/src/db/schema/patients.ts @@ -44,6 +44,12 @@ export const patients = pgTable( vitalsTakenAt: text("vitals_taken_at").notNull(), vitalsTrend: jsonb("vitals_trend").$type().notNull(), labTrend: jsonb("lab_trend").$type().notNull(), + // The clinician responsible for this chart (the patient's "PCP"). Used to + // scope what each doctor sees and to transfer a patient between providers. + // Nullable: legacy/unassigned rows and patients registered by reception. + primaryProviderId: text("primary_provider_id").references(() => user.id, { + onDelete: "set null", + }), createdBy: text("created_by").references(() => user.id, { onDelete: "set null", }), diff --git a/backend/src/lib/patient-validation.ts b/backend/src/lib/patient-validation.ts index de4e158..b786a93 100644 --- a/backend/src/lib/patient-validation.ts +++ b/backend/src/lib/patient-validation.ts @@ -55,6 +55,11 @@ export const patientInputSchema = z.object({ age: z.number().int().min(0).max(150), sex: z.enum(["M", "F"]), pcp: z.string(), + // Optional link to the responsible clinician (user id). Empty string ⇒ null. + primaryProviderId: z.preprocess( + (v) => (v === "" ? null : v), + z.string().nullable().optional(), + ), status: z.enum(["active", "inpatient", "discharged"]), initials: z.string().trim().min(1).max(4), allergies: z.array(allergySchema).default([]), diff --git a/backend/src/routes/activity.ts b/backend/src/routes/activity.ts index 68c294e..88dae62 100644 --- a/backend/src/routes/activity.ts +++ b/backend/src/routes/activity.ts @@ -8,9 +8,19 @@ export const activityRouter = Router(); // The audit feed is readable by any clinic member. activityRouter.use(requireAuth, requireOrg); +// Whether the caller runs the clinic (owner/admin) and may therefore see the +// whole feed. Everyone else is scoped to their own actions. +function isClinicAdmin(memberRole: string | undefined): boolean { + return String(memberRole ?? "") + .split(",") + .map((s) => s.trim()) + .some((r) => r === "owner" || r === "admin"); +} + activityRouter.get("/", async (req, res, next) => { try { - res.json(await service.listActivity(req.organizationId!)); + const actorId = isClinicAdmin(req.memberRole) ? undefined : req.user!.id; + res.json(await service.listActivity(req.organizationId!, { actorId })); } catch (err) { next(err); } diff --git a/backend/src/routes/patients.ts b/backend/src/routes/patients.ts index f1112b1..3a9b1c8 100644 --- a/backend/src/routes/patients.ts +++ b/backend/src/routes/patients.ts @@ -1,5 +1,9 @@ +import { and, eq } from "drizzle-orm"; import { Router } from "express"; +import { z } from "zod"; +import { db } from "../db/index.js"; +import { member, user } from "../db/schema/auth.js"; import { HttpError } from "../lib/http-error.js"; import { patientInputSchema } from "../lib/patient-validation.js"; import { @@ -15,6 +19,29 @@ import * as service from "../services/patients.js"; export const patientsRouter = Router(); +const transferInputSchema = z.object({ + providerId: z.string().trim().min(1), +}); + +// Only the `doctor` role is scoped to its own panel of patients. Any elevated +// clinical role (owner / admin / member) sees the whole clinic, so scoping never +// applies when the caller also holds one of those. Returns the user id to scope +// by, or undefined for "see everything". +function providerScope( + memberRole: string | undefined, + userId: string, +): string | undefined { + const names = String(memberRole ?? "") + .split(",") + .map((s) => s.trim()) + .filter(Boolean); + if (!names.includes("doctor")) return undefined; + if (names.some((r) => ["owner", "admin", "member"].includes(r))) { + return undefined; + } + return userId; +} + // The `reception` role is scoped to scheduling + registration: it sees and // writes patient demographics only, never clinical PHI. True only when the // caller's role set is reception without any clinical-capable role. @@ -66,6 +93,7 @@ patientsRouter.get( await service.listPatients( req.organizationId!, isReceptionOnly(req.memberRole), + providerScope(req.memberRole, req.user!.id), ), ); } catch (err) { @@ -83,6 +111,7 @@ patientsRouter.get( req.organizationId!, req.params.fileNumber as string, isReceptionOnly(req.memberRole), + providerScope(req.memberRole, req.user!.id), ); if (!patient) throw new HttpError(404, "Patient not found."); res.json(patient); @@ -161,6 +190,59 @@ patientsRouter.put( }, ); +// Reassign a patient to another clinician ("transfer"). Gated on patient:write +// like any edit; the new provider must be a member of the same clinic. +patientsRouter.post( + "/:fileNumber/transfer", + requirePermission({ patient: ["write"] }), + async (req, res, next) => { + try { + const { providerId } = transferInputSchema.parse(req.body); + const [provider] = await db + .select({ name: user.name }) + .from(member) + .innerJoin(user, eq(user.id, member.userId)) + .where( + and( + eq(member.organizationId, req.organizationId!), + eq(member.userId, providerId), + ), + ); + if (!provider) { + throw new HttpError(400, "Selected provider is not a member of this clinic."); + } + + const updated = await service.transferPatient( + req.organizationId!, + req.params.fileNumber as string, + providerId, + provider.name, + providerScope(req.memberRole, req.user!.id), + ); + if (!updated) throw new HttpError(404, "Patient not found."); + + await recordActivity({ + orgId: req.organizationId!, + actor: { id: req.user!.id, name: req.user!.name }, + action: `Transferred patient ${updated.name} to ${provider.name}`, + entityType: "patient", + entityId: updated.fileNumber, + patientName: updated.name, + patientFileNumber: updated.fileNumber, + }); + await notifyClinic( + req.organizationId!, + { id: req.user!.id, name: req.user!.name }, + `${req.user!.name} transferred ${updated.name} to ${provider.name}`, + updated.fileNumber, + ); + res.json(updated); + } catch (err) { + next(err); + } + }, +); + patientsRouter.delete( "/:fileNumber", requirePermission({ patient: ["delete"] }), diff --git a/backend/src/routes/staff.ts b/backend/src/routes/staff.ts index 74edbd0..8ca3601 100644 --- a/backend/src/routes/staff.ts +++ b/backend/src/routes/staff.ts @@ -1,4 +1,4 @@ -import { asc, eq } from "drizzle-orm"; +import { and, asc, eq, inArray } from "drizzle-orm"; import { Router } from "express"; import { z } from "zod"; @@ -45,6 +45,36 @@ const staffInputSchema = z.object({ staffRouter.use(requireAuth, requireOrg); +// Clinical-capable roles that can be a patient's primary provider. Reception +// (front desk) and viewer (read-only) are excluded. +const PROVIDER_ROLES = ["owner", "admin", "doctor", "member"] as const; + +// List clinicians who can be assigned as a patient's primary provider. Readable +// by ANY clinic member (no `member:create` gate) so doctors and reception can +// pick a provider when registering/transferring a patient. Returns user ids. +staffRouter.get("/providers", async (req, res, next) => { + try { + const rows = await db + .select({ + userId: member.userId, + name: user.name, + role: member.role, + }) + .from(member) + .innerJoin(user, eq(user.id, member.userId)) + .where( + and( + eq(member.organizationId, req.organizationId!), + inArray(member.role, PROVIDER_ROLES as unknown as string[]), + ), + ) + .orderBy(asc(user.name)); + res.json(rows); + } catch (err) { + next(err); + } +}); + // List the clinic's members with their usernames (the org client's // getFullOrganization doesn't expose username). Owner/admin only. staffRouter.get( diff --git a/backend/src/services/activity.ts b/backend/src/services/activity.ts index 132a863..2f91069 100644 --- a/backend/src/services/activity.ts +++ b/backend/src/services/activity.ts @@ -1,4 +1,4 @@ -import { desc, eq } from "drizzle-orm"; +import { and, desc, eq } from "drizzle-orm"; import { db } from "../db/index.js"; import { activityLog } from "../db/schema/activity.js"; @@ -54,14 +54,25 @@ export async function recordActivity(params: { } } +// Lists the clinic's audit feed. When `actorId` is given, only that user's own +// actions are returned (each employee sees their own activity); admins/owners +// call without it to see the whole clinic. export async function listActivity( orgId: string, - limit = 100, + options: { actorId?: string; limit?: number } = {}, ): Promise { + const { actorId, limit = 100 } = options; const rows = await db .select() .from(activityLog) - .where(eq(activityLog.organizationId, orgId)) + .where( + actorId + ? and( + eq(activityLog.organizationId, orgId), + eq(activityLog.actorId, actorId), + ) + : eq(activityLog.organizationId, orgId), + ) .orderBy(desc(activityLog.createdAt)) .limit(limit); return rows.map(toEntry); diff --git a/backend/src/services/patients.ts b/backend/src/services/patients.ts index 46c8ee7..9dade0e 100644 --- a/backend/src/services/patients.ts +++ b/backend/src/services/patients.ts @@ -1,4 +1,5 @@ -import { and, asc, eq, inArray } from "drizzle-orm"; +import { and, asc, eq, inArray, isNull, or } from "drizzle-orm"; +import type { SQL } from "drizzle-orm"; import { db } from "../db/index.js"; import { @@ -46,6 +47,7 @@ function toPatient(row: PatientRow, children: Children): Patient { age: row.age, sex: row.sex, pcp: row.pcp, + primaryProviderId: row.primaryProviderId, status: row.status, initials: row.initials, allergies: children.allergies, @@ -106,6 +108,7 @@ function patientColumns(orgId: string, input: PatientInput, createdBy?: string) age: input.age, sex: input.sex, pcp: input.pcp, + primaryProviderId: input.primaryProviderId ?? null, status: input.status, initials: input.initials, alerts: input.alerts, @@ -135,6 +138,7 @@ function demographicColumns( age: input.age, sex: input.sex, pcp: input.pcp, + primaryProviderId: input.primaryProviderId ?? null, status: input.status, initials: input.initials, alerts: [] as string[], @@ -158,11 +162,23 @@ function demographicUpdateColumns(input: PatientInput) { age: input.age, sex: input.sex, pcp: input.pcp, + primaryProviderId: input.primaryProviderId ?? null, status: input.status, initials: input.initials, }; } +// Scope clinical reads to a single provider's panel: their own patients plus any +// legacy/unassigned rows they created (so a freshly scoped doctor isn't left +// with an empty list). Returns undefined when no scoping should apply. +function providerScopeFilter(providerId?: string): SQL | undefined { + if (!providerId) return undefined; + return or( + eq(patients.primaryProviderId, providerId), + and(isNull(patients.primaryProviderId), eq(patients.createdBy, providerId)), + ); +} + // Loads and groups child rows for a set of patients in one round-trip each. async function loadChildren( patientIds: string[], @@ -280,11 +296,15 @@ function isUniqueViolation(err: unknown): boolean { export async function listPatients( orgId: string, demographicsOnly = false, + providerId?: string, ): Promise { + const scope = providerScopeFilter(providerId); const rows = await db .select() .from(patients) - .where(eq(patients.organizationId, orgId)) + .where( + scope ? and(eq(patients.organizationId, orgId), scope) : eq(patients.organizationId, orgId), + ) .orderBy(asc(patients.name)); const children = await loadChildren(rows.map((r) => r.id)); return rows.map((r) => { @@ -297,7 +317,9 @@ export async function getPatient( orgId: string, fileNumber: string, demographicsOnly = false, + providerId?: string, ): Promise { + const scope = providerScopeFilter(providerId); const [row] = await db .select() .from(patients) @@ -305,6 +327,7 @@ export async function getPatient( and( eq(patients.organizationId, orgId), eq(patients.fileNumber, fileNumber), + ...(scope ? [scope] : []), ), ); if (!row) return null; @@ -313,6 +336,33 @@ export async function getPatient( return demographicsOnly ? redactClinical(patient) : patient; } +// Reassign a patient to another clinician. Updates both the machine link +// (primaryProviderId — drives per-doctor visibility) and the display string +// (pcp). Org-scoped; returns null when the patient isn't in this clinic. +export async function transferPatient( + orgId: string, + fileNumber: string, + providerId: string, + providerName: string, + scopeProviderId?: string, +): Promise { + const scope = providerScopeFilter(scopeProviderId); + const [row] = await db + .update(patients) + .set({ primaryProviderId: providerId, pcp: providerName }) + .where( + and( + eq(patients.organizationId, orgId), + eq(patients.fileNumber, fileNumber), + ...(scope ? [scope] : []), + ), + ) + .returning(); + if (!row) return null; + const children = await loadChildren([row.id]); + return toPatient(row, children.get(row.id) ?? emptyChildren()); +} + export async function createPatient( orgId: string, userId: string, diff --git a/backend/src/types/patient.ts b/backend/src/types/patient.ts index 0f39618..3b8c971 100644 --- a/backend/src/types/patient.ts +++ b/backend/src/types/patient.ts @@ -57,7 +57,8 @@ export type Patient = { name: string; age: number; sex: Sex; - pcp: string; // primary care provider + pcp: string; // primary care provider (display name) + primaryProviderId?: string | null; // user id of the responsible clinician status: PatientStatus; initials: string; // for AvatarFallback allergies: Allergy[];