The insights alert cards computed medication compliance with the naive
`schedules.length × days` denominator, so a fully-adherent weekly
injectable read ~14% and fired a false low-compliance alert (and a paused
medication mis-fired the same way). Route the alert path through the
canonical `calculateCompliance` engine like every other compliance
surface — pause eras, schedule revisions and dose windows honoured.
Document confirm: committing a numeric observation against an existing
biomarker silently replaced the stated unit with the catalog's, with no
conversion — a stated "6.1 mmol/L" against a mg/dL marker committed
"6.1 mg/dL". Reject on a unit mismatch (fail closed) so the user
reconciles on the review screen, the same posture as the unit-required
guard.
Wire grip strength, waist (with waist-to-height) and pain into the
briefing feature set and the grounding allow-set so the clinical-depth
signals reach the daily narrative; the mental-health screeners stay
excluded by construction.
Biomarker detail: fall back to a generic description for catalog-less
markers, and keep the heading + description with a retry on the error
state. Collapse the medication External-API and Lifecycle groups by
default. Re-enable the insights scroll-to-top regression and assert the
shipped main-content reset.
Align the EN haemoglobin/haematocrit display names to British spelling.
Drop the redundant `(userId, deletedAt)` index on inbound documents — a
strict prefix of the new three-column index. Trim the dead
MedicalDisclaimer variants to the one live `dataPosture`. Move the
crisis-resources card off the retired amber tint to a calm
destructive-subtle border. Add a registry invariant asserting every
biomarker signal key resolves to a real catalog slug.
The inbound-document store encrypts the raw upload
(`inbound_documents.content_encrypted`) because it is sensitive clinical
data, but the per-fact staging columns persisted the same class of data in
the clear: `extracted_facts.data_json` held the transcribed clinical values
(diagnosis text, lab values, medication names, stated codes) and
`provenance_json` held the verbatim source span (up to 2000 chars copied
straight out of the report). The at-rest guarantee was defeated for staged
facts, which persist through PENDING and are retained after the decision.
Convert both columns to the AES-256-GCM `*_encrypted` BYTEA convention shared
with the note columns, going through the same Bytes codec. The upload and
fact-edit paths encrypt on write; the confirm path decrypts at commit time to
write into the normal structured stores, so the review-then-confirm flow is
unchanged. Reads are fail-closed (a bad key id throws).
Register both columns in the encrypted-columns registry and the key-rotation
script so a dropped legacy key cannot strand them (the guard test enforces
both). Migration 0220 swaps the plaintext JSONB columns for the encrypted
BYTEA columns; pre-confirm staged rows are ephemeral and cannot be
re-encrypted in SQL, so any left by a pre-release build are dropped rather
than retained as plaintext (their parent document keeps its encrypted
original).
Ingest an uploaded doctor report / discharge letter through the existing
dedicated OCR/vision provider rails (the v1.22 document-scan provider/key,
reused — no new provider) and transcribe structured facts into staging.
The safety line is extract, never interpret: the prompt frames the document
as untrusted data to reproduce verbatim. Diagnoses map to Condition,
measured values to Observation, medications to MedicationStatement — with
STATED status only. A code survives only when the document writes it and its
system matches the resource (SNOMED/ICD-10 for a diagnosis, LOINC for a
value, RxNorm/ATC for a medication); nothing is inferred, no value is
range-flagged, no condition is linked to a medication. Every fact carries
per-field provenance and a confidence score; a fact below the confidence
floor fails closed — it cannot be approved until the user edits it.
Routes (apiHandler + Zod + session-narrowed userId, opt-in module-gated):
- POST/GET /api/documents/inbound — upload+extract (vision or local-OCR
text), and list. The raw document is stored encrypted at rest.
- GET/DELETE /api/documents/inbound/[id] — review detail; soft-delete.
- PATCH .../facts/[factId] — correct a staged fact before approval.
- POST .../confirm — the only write path: approved facts flow into the
labs / conditions / medications stores through their normal create paths;
rejected facts are discarded; low-confidence facts are refused.
Marc-André Bombeck