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feat: patient rollup + nested patients payload (plan 02, P3)

Browse source 
core/rollup.py implements the locked truth table: worst gradeable line wins;
a Plan Type Needed line caps the patient at Action Needed; non-gradeable
lines are displayed but never touch the light; no-graded-lines patients carry
None (no label invented). /api/upload gains additive patients[] (one entry
per patient, nested device lines with doc checklists, citations, timing
flags, dedup display fields) and patient_stats (counts patients, not rows).
Flat records payload untouched until P6. Independent audit: SHIP; its LOW
findings fixed (date coercion on timing keys, empty-rollup guard, severity
divergence documented). 151 tests green.

Co-Authored-By: Claude Fable 5 <noreply@anthropic.com>
This commit is contained in:
Kisa 2026-07-07 05:20:45 -04:00
parent d24340c47a
commit bd92126384
4 changed files with 518 additions and 26 deletions
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174
python-backend/api/main.py
View file

@ -185,6 +185,36 @@ class ReadinessItemOut(BaseModel):
rule_id: Optional[str] = None
class LineOut(BaseModel):
"""One coverage line (patient x device x plan type) in the nested payload."""
device_type: str
device_display: str
plan_type: Optional[str] = None # None = plan type needed (never guessed)
gradeable: bool
line_status: Optional[str] = None # LineStatus verbatim; None = ungraded
timing_flag: Optional[str] = None # CoverageFlag of the current shipment
doc_items: Optional[list[ReadinessItemOut]] = None
# Display fields per the locked dedup design (section 6)
order_numbers: list[str] = []
hcpcs_codes: list[str] = []
total_quantity: int = 0
shipment_date: Optional[str] = None # current shipment DOS
payer: Optional[str] = None
prior_shipment_count: int = 0
class PatientOut(BaseModel):
"""One patient in the nested payload; tabs count these, not rows (P6)."""
patient_id: str
rollup_status: Optional[str] = None # None = no graded gradeable lines
plan_type_needed: bool = False
cgm_line_count: int = 0
total_line_count: int = 0
lines: list[LineOut] = []
class RecordOut(BaseModel):
patient_id: str
device_type: str
@ -234,6 +264,10 @@ class UploadResponse(BaseModel):
mapping_summary: dict
batch_id: str | None = None
readiness_stats: dict | None = None
# Nested patient payload (P3, additive). The flat `records` list stays
# untouched until P6 switches the UI (locked migration strategy).
patients: list[PatientOut] | None = None
patient_stats: dict | None = None
def _build_reason(
@ -333,6 +367,24 @@ class DocStatusRequest(BaseModel):
expiry_date: Optional[str] = None
def _readiness_items_out(readiness) -> Optional[list[ReadinessItemOut]]:
"""Serialize a ReadinessVerdict's doc items (shared by rows and lines)."""
if not readiness:
return None
return [
ReadinessItemOut(
doc_type=i.doc_type,
required_state=i.required_state.value,
input_state=i.input_state.value,
quality=i.quality.value,
value=i.value,
satisfied=i.satisfied,
rule_id=i.rule_id,
)
for i in readiness.doc_items
]
def _to_record_out(
r,
record=None,
@ -422,20 +474,7 @@ def _to_record_out(
else None,
plan_type=getattr(record, "plan_type", None) if record else None,
readiness_status=readiness.line_status.value if readiness else None,
readiness_items=[
ReadinessItemOut(
doc_type=i.doc_type,
required_state=i.required_state.value,
input_state=i.input_state.value,
quality=i.quality.value,
value=i.value,
satisfied=i.satisfied,
rule_id=i.rule_id,
)
for i in readiness.doc_items
]
if readiness
else None,
readiness_items=_readiness_items_out(readiness),
)
@ -461,6 +500,104 @@ def _compute_stats(records: list[RecordOut]) -> dict:
}
def _build_patients_payload(index, reachable_line_keys, results):
"""Assemble the nested patients payload (P3) from the lines reachable in
THIS response, so patients/lines always reconcile with the flat records.
Rollup rules are locked in core/rollup.py (worst gradeable line; PTN caps
at Action Needed; non-gradeable lines excluded from the light)."""
from core.dedup import UNKNOWN_PLAN_TYPE
from core.rollup import rollup_patients
reachable = {
k: index.lines[k] for k in reachable_line_keys if k in index.lines
}
if not reachable:
return [], {"patients_total": 0}
from core.dedup import _as_date
# Line-level timing flag = the worst-urgency row of the line's CURRENT
# shipment group (twin rows can differ; worst wins, fail-safe).
flag_by_group: dict = {}
for r in results:
gk = (r.patient_id, r.device_type, _as_date(r.last_shipment_date))
flag_val = r.flag.value if hasattr(r.flag, "value") else str(r.flag)
prev = flag_by_group.get(gk)
if prev is None or r.priority_score > prev[1]:
flag_by_group[gk] = (flag_val, r.priority_score)
# DISPLAY ordering, intentionally different from rollup.SEVERITY: the
# worklist queues At Risk above Plan Type Needed (urgency), while the
# rollup's capping rule treats PTN as the worst LINE state. Do not unify.
severity = {
"At Risk": 4,
"Plan Type Needed": 3,
"Action Needed": 2,
"On Track": 1,
"Clear to Ship": 0,
}
patients = []
for pid, ru in rollup_patients(reachable).items():
lines_out = []
for line in sorted(
ru.lines,
key=lambda l: (
-(severity.get(l.line_status, -1)),
l.device_type,
),
):
line_key = (line.patient_id, line.device_type, line.plan_type)
verdict = index.by_line.get(line_key)
cur = line.current_shipment
timing = flag_by_group.get(
(line.patient_id, line.device_type, _as_date(cur.shipment_date))
)
lines_out.append(
LineOut(
device_type=line.device_type,
device_display=DEVICE_DISPLAY.get(
line.device_type, line.device_type
),
plan_type=None
if line.plan_type == UNKNOWN_PLAN_TYPE
else line.plan_type,
gradeable=line.gradeable,
line_status=line.line_status,
timing_flag=timing[0] if timing else None,
doc_items=_readiness_items_out(verdict),
order_numbers=cur.order_numbers,
hcpcs_codes=cur.hcpcs_codes,
total_quantity=cur.total_quantity,
shipment_date=cur.shipment_date.isoformat(),
payer=cur.payer or None,
prior_shipment_count=len(line.prior_shipments),
)
)
patients.append(
PatientOut(
patient_id=pid,
rollup_status=ru.rollup_status.value
if ru.rollup_status
else None,
plan_type_needed=ru.plan_type_needed,
cgm_line_count=ru.cgm_line_count,
total_line_count=ru.total_line_count,
lines=lines_out,
)
)
# Worklist order: worst patients first, stable by patient_id.
patients.sort(
key=lambda p: (-(severity.get(p.rollup_status, -1)), p.patient_id)
)
stats: dict = {"patients_total": len(patients)}
for p in patients:
key = p.rollup_status if p.rollup_status else "ungraded"
stats[key] = stats.get(key, 0) + 1
return patients, stats
@app.get("/health")
def health():
return {"status": "ok", "service": "signal-api", "version": "1.0.0"}
@ -551,10 +688,13 @@ async def upload_csv(
out = []
used_lines = {}
reachable_line_keys = set()
for r in results:
verdict, line_key, merged = resolve_group(
index, r.patient_id, r.device_type, r.last_shipment_date
)
if line_key is not None:
reachable_line_keys.add(line_key)
if verdict is not None and line_key is not None:
used_lines[line_key] = verdict
# Exact row match first (byte-identical legacy path). CoverageResult
@ -610,6 +750,10 @@ async def upload_csv(
clerk_org_id=clerk_org_id,
)
patients_out, patient_stats = _build_patients_payload(
index, reachable_line_keys, results
)
return UploadResponse(
records=out,
total=len(out),
@ -622,6 +766,8 @@ async def upload_csv(
# reconcile with the records beside them (a record calculate_batch
# skipped cannot leave a phantom line in the counts).
readiness_stats=readiness_stats(used_lines),
patients=patients_out,
patient_stats=patient_stats,
)

101
python-backend/core/rollup.py Normal file
View file

@ -0,0 +1,101 @@
"""
rollup.py
Signal — STTIL Solutions
Patient-level rollup of coverage-line readiness verdicts (build plan 02, P3).
Design locked in readiness-model-brief section 4 and the phase-2 design Item 3:
- The light = worst gradeable line. Severity (worst first):
Plan Type Needed > At Risk > Action Needed > On Track > Clear to Ship.
- Any gradeable Plan Type Needed line caps the patient no greener than
Action Needed (the patient IS being served; one unmapped plan type must not
read as the whole patient being ungradeable).
- Non-gradeable lines (non-CGM) never participate in the light or the counts.
- Tabs count patients, not rows.
A patient with no graded gradeable lines has rollup_status None — the UI
treatment is an open Kisa question; no label is invented here.
PHI CONTRACT: operates on patient_id only; this module logs nothing.
"""
from __future__ import annotations
from collections import defaultdict
from dataclasses import dataclass
from typing import Optional
from core.dedup import CoverageLine
from core.readiness import LineStatus
# Higher = worse. Plan Type Needed ranks worst for LINE severity ordering;
# its patient-level effect is the capping rule below, not raw worstness.
SEVERITY = {
LineStatus.CLEAR_TO_SHIP: 0,
LineStatus.ON_TRACK: 1,
LineStatus.ACTION_NEEDED: 2,
LineStatus.AT_RISK: 3,
LineStatus.PLAN_TYPE_NEEDED: 4,
}
@dataclass
class PatientRollup:
patient_id: str
lines: list[CoverageLine] # all lines, incl. non-gradeable
rollup_status: Optional[LineStatus] # None = no graded gradeable lines
cgm_line_count: int # gradeable lines
total_line_count: int # all lines
plan_type_needed: bool # any gradeable line in PTN
def rollup_patient(lines: list[CoverageLine]) -> PatientRollup:
"""Roll one patient's coverage lines into a single verdict, per the
locked truth table (plan 02 P3):
| gradeable statuses present | rollup_status |
| none | None |
| all Plan Type Needed | Plan Type Needed |
| some PTN + others | worse of (Action Needed, worst other)|
| no PTN | worst by severity |
"""
if not lines:
raise ValueError("rollup_patient requires at least one CoverageLine")
graded = [
l for l in lines if l.gradeable and l.line_status is not None
]
statuses = [LineStatus(l.line_status) for l in graded]
ptn = [s for s in statuses if s == LineStatus.PLAN_TYPE_NEEDED]
if not statuses:
status: Optional[LineStatus] = None
elif len(ptn) == len(statuses):
status = LineStatus.PLAN_TYPE_NEEDED
elif ptn:
worst_other = max(
(s for s in statuses if s != LineStatus.PLAN_TYPE_NEEDED),
key=SEVERITY.get,
)
status = max(worst_other, LineStatus.ACTION_NEEDED, key=SEVERITY.get)
else:
status = max(statuses, key=SEVERITY.get)
return PatientRollup(
patient_id=lines[0].patient_id,
lines=lines,
rollup_status=status,
cgm_line_count=sum(1 for l in lines if l.gradeable),
total_line_count=len(lines),
plan_type_needed=bool(ptn),
)
def rollup_patients(lines: dict) -> dict[str, PatientRollup]:
"""Group CoverageLines (any keying) by patient and roll each up."""
by_patient: dict[str, list[CoverageLine]] = defaultdict(list)
for line in lines.values():
by_patient[line.patient_id].append(line)
return {
patient_id: rollup_patient(patient_lines)
for patient_id, patient_lines in by_patient.items()
}

13
python-backend/core/worklist_readiness.py
View file

@ -36,6 +36,7 @@ from typing import Optional
from core.coverage_calculator import ShipmentRecord
from core.dedup import (
UNKNOWN_PLAN_TYPE,
CoverageLine,
MergedShipment,
_as_date,
assign_to_coverage_lines,
@ -54,11 +55,13 @@ class ReadinessIndex:
"""Dedup-derived resolution index for one upload batch.
by_line: verdicts per gradeable coverage line
lines: every CoverageLine (graded ones carry line_status)
line_by_group: dedup group -> the line that group's shipment belongs to
merged_by_group: dedup group -> its MergedShipment (display-field truth)
"""
by_line: dict[LineKey, ReadinessVerdict] = field(default_factory=dict)
lines: dict[LineKey, "CoverageLine"] = field(default_factory=dict)
line_by_group: dict[GroupKey, LineKey] = field(default_factory=dict)
merged_by_group: dict[GroupKey, MergedShipment] = field(default_factory=dict)
@ -93,11 +96,12 @@ def build_readiness_index(
index = ReadinessIndex()
for key, line in lines.items():
line_key = (key.patient_id, key.device_type, key.plan_type_id)
index.lines[line_key] = line
if not line.gradeable:
continue
cur = line.current_shipment
index.by_line[(key.patient_id, key.device_type, key.plan_type_id)] = (
evaluate_readiness(
verdict = evaluate_readiness(
line.plan_type if line.plan_type != UNKNOWN_PLAN_TYPE else None,
csv_swo_status=cur.csv_swo_status,
csv_visit_date=cur.csv_visit_date,
@ -108,7 +112,10 @@ def build_readiness_index(
csv_pa_status=cur.csv_pa_status,
csv_diagnosis_on_file=cur.csv_diagnosis_on_file,
)
)
index.by_line[line_key] = verdict
# The grading step owns line_status (dedup leaves it None) — the
# rollup (P3) reads it from the line.
line.line_status = verdict.line_status.value
for m in merged:
gkey: GroupKey = (m.patient_id, m.device_type, m.shipment_date)

238
tests/test_rollup.py Normal file
View file

@ -0,0 +1,238 @@
"""
Tests for the patient rollup (build plan 02, P3).
Rollup rules locked in readiness-model-brief section 4 / phase-2 design Item 3:
worst gradeable line; any gradeable Plan Type Needed line caps the patient no
greener than Action Needed; non-gradeable lines never touch the light; a
patient with no graded gradeable lines has rollup_status None (no label
invented).
PHI CONTRACT: synthetic patient_ids only.
"""
import io
import sys
from datetime import date, timedelta
from pathlib import Path
import pytest
sys.path.insert(0, str(Path(__file__).parent.parent / "python-backend"))
from core.dedup import CoverageLine, MergedShipment # noqa: E402
from core.readiness import LineStatus # noqa: E402
from core.rollup import rollup_patient, rollup_patients # noqa: E402
TODAY = date.today()
def make_line(patient_id="PT-1", device="dexcom_g7", plan="medicare",
status=None, gradeable=True):
shipment = MergedShipment(
patient_id=patient_id,
device_type=device,
shipment_date=TODAY - timedelta(days=5),
total_quantity=3,
components=["sensor"],
order_numbers=[],
hcpcs_codes=[],
payer="Medicare Part B",
plan_type=None if plan == "unknown" else plan,
)
return CoverageLine(
patient_id=patient_id,
device_type=device,
plan_type=plan,
gradeable=gradeable,
current_shipment=shipment,
prior_shipments=[],
line_status=status,
timing_flag=None,
)
def test_patient_rollup_single_line():
ru = rollup_patient([make_line(status="On Track")])
assert ru.rollup_status == LineStatus.ON_TRACK
assert ru.cgm_line_count == 1
assert ru.total_line_count == 1
def test_patient_rollup_mixed_statuses():
ru = rollup_patient([
make_line(device="dexcom_g7", status="Clear to Ship"),
make_line(device="freestyle_libre_2", status="At Risk"),
])
assert ru.rollup_status == LineStatus.AT_RISK
def test_patient_rollup_plan_type_needed_capping():
# PTN + Clear to Ship = Action Needed (capped, not PTN)
ru = rollup_patient([
make_line(device="dexcom_g7", status="Clear to Ship"),
make_line(device="freestyle_libre_2", plan="unknown",
status="Plan Type Needed"),
])
assert ru.rollup_status == LineStatus.ACTION_NEEDED
assert ru.plan_type_needed is True
# PTN + At Risk = At Risk (the worse of the two)
ru2 = rollup_patient([
make_line(device="dexcom_g7", status="At Risk"),
make_line(device="freestyle_libre_2", plan="unknown",
status="Plan Type Needed"),
])
assert ru2.rollup_status == LineStatus.AT_RISK
def test_patient_rollup_all_lines_plan_type_needed():
ru = rollup_patient([
make_line(device="dexcom_g7", plan="unknown", status="Plan Type Needed"),
make_line(device="freestyle_libre_2", plan="unknown",
status="Plan Type Needed"),
])
assert ru.rollup_status == LineStatus.PLAN_TYPE_NEEDED
def test_patient_rollup_non_cgm_excluded():
ru = rollup_patient([
make_line(device="dexcom_g7", status="Clear to Ship"),
make_line(device="omnipod_5", gradeable=False, status=None),
])
assert ru.rollup_status == LineStatus.CLEAR_TO_SHIP # pod changes nothing
assert ru.cgm_line_count == 1
assert ru.total_line_count == 2
def test_patient_rollup_no_gradeable_lines():
ru = rollup_patient([make_line(device="omnipod_5", gradeable=False)])
assert ru.rollup_status is None
assert ru.total_line_count == 1
assert ru.cgm_line_count == 0
def test_rollup_patients_groups_by_patient():
lines = {
("A", "dexcom_g7", "medicare"): make_line("A", status="Clear to Ship"),
("A", "freestyle_libre_2", "medicare"): make_line(
"A", device="freestyle_libre_2", status="Action Needed"),
("B", "dexcom_g7", "unknown"): make_line(
"B", plan="unknown", status="Plan Type Needed"),
}
rollups = rollup_patients(lines)
assert set(rollups) == {"A", "B"}
assert rollups["A"].rollup_status == LineStatus.ACTION_NEEDED
assert rollups["B"].rollup_status == LineStatus.PLAN_TYPE_NEEDED
# --- API level ---------------------------------------------------------------
httpx = pytest.importorskip("httpx", reason="httpx required for TestClient")
from fastapi.testclient import TestClient # noqa: E402
import api.main as api_main # noqa: E402
client = TestClient(api_main.app)
SHIP = (TODAY - timedelta(days=5)).isoformat()
VISIT = (TODAY - timedelta(days=30)).isoformat()
HEADER = (
"patient_id,device_type,shipment_date,quantity,payer,plan_type,"
"swo_status,visit_date,pecos_verified,pa_status,diagnosis_on_file"
)
def _upload(csv_text: str):
return client.post(
"/api/upload",
files={"file": ("fixture.csv", io.BytesIO(csv_text.encode()), "text/csv")},
)
def test_upload_response_contains_patients_nested():
csv_text = (
HEADER
+ f"\nPT-N-1,Dexcom G7,{SHIP},3,Medicare Part B,medicare,"
+ f"On File,{VISIT},Yes,,Yes"
+ f"\nPT-N-1,Libre 2,{SHIP},1,Medicare Part B,medicare,"
+ "On File,,Yes,,Yes"
)
resp = _upload(csv_text)
assert resp.status_code == 200
body = resp.json()
patients = body["patients"]
assert len(patients) == 1
p = patients[0]
assert p["patient_id"] == "PT-N-1"
assert p["rollup_status"] == "Action Needed" # worst line (Libre 2 no visit)
assert len(p["lines"]) == 2
by_dev = {l["device_type"]: l for l in p["lines"]}
assert by_dev["dexcom_g7"]["line_status"] == "Clear to Ship"
assert by_dev["freestyle_libre_2"]["line_status"] == "Action Needed"
items = {i["doc_type"]: i for i in by_dev["freestyle_libre_2"]["doc_items"]}
assert items["visit"]["satisfied"] is False
assert items["visit"]["rule_id"] == "R101"
# Worst line renders first
assert p["lines"][0]["device_type"] == "freestyle_libre_2"
def test_patient_stats_count_patients_not_rows():
csv_text = (
HEADER
+ f"\nPT-S-1,Dexcom G7,{SHIP},3,Medicare Part B,medicare,"
+ f"On File,{VISIT},Yes,,Yes"
+ f"\nPT-S-1,Libre 2,{SHIP},1,Medicare Part B,medicare,"
+ f"On File,{VISIT},Yes,,Yes"
+ f"\nPT-S-2,Dexcom G6,{SHIP},3,Medicaid - GA,,"
+ f"On File,{VISIT},,,Yes"
)
resp = _upload(csv_text)
assert resp.status_code == 200
stats = resp.json()["patient_stats"]
assert stats["patients_total"] == 2 # 2-device patient counts once
assert stats["Clear to Ship"] == 1
assert stats["Plan Type Needed"] == 1
def test_flat_records_untouched_by_nested_payload():
csv_text = (
HEADER
+ f"\nPT-F-1,Dexcom G7,{SHIP},3,Medicare Part B,medicare,"
+ f"On File,{VISIT},Yes,,Yes"
)
resp = _upload(csv_text)
body = resp.json()
assert body["total"] == 1
assert len(body["records"]) == 1 # flat path byte-identical (P6 switches UI)
assert body["records"][0]["readiness_status"] == "Clear to Ship"
def test_non_gradeable_only_patient_has_null_rollup():
csv_text = (
HEADER
+ f"\nPT-P-1,Omnipod 5,{SHIP},1,Highmark BCBS,commercial,"
+ f"On File,{VISIT},Yes,Approved,Yes"
)
resp = _upload(csv_text)
body = resp.json()
p = body["patients"][0]
assert p["rollup_status"] is None
assert p["cgm_line_count"] == 0
assert p["lines"][0]["gradeable"] is False
assert p["lines"][0]["line_status"] is None
assert body["patient_stats"]["ungraded"] == 1
def test_rollup_patient_empty_raises():
with pytest.raises(ValueError):
rollup_patient([])
def test_line_timing_flag_populated():
csv_text = (
HEADER
+ f"\nPT-T-1,Dexcom G7,{SHIP},3,Medicare Part B,medicare,"
+ f"On File,{VISIT},Yes,,Yes"
)
resp = _upload(csv_text)
line = resp.json()["patients"][0]["lines"][0]
assert line["timing_flag"] == "RESUPPLY_READY"