Clinical Insights API

POST /api/ai/clinical-insights

{
  "insights": [
    {
      "type": "risk",
      "priority": "high",
      "title": "Diabetic Ketoacidosis Risk",
      "description": "The combination of polyuria/polydipsia, lethargy, and dehydration in a senior dog suggests diabetes mellitus. Immediate blood glucose and ketone testing recommended to rule out DKA, which requires emergency treatment.",
      "confidence": 0.85
    },
    {
      "type": "diagnosis",
      "priority": "high",
      "title": "Chronic Kidney Disease Likely",
      "description": "PU/PD with dehydration and pale mucous membranes in a 10-year-old Labrador is highly suggestive of CKD. Recommend full renal panel including creatinine, BUN, phosphorus, and urine specific gravity. SDMA testing may detect early kidney disease.",
      "confidence": 0.78
    },
    {
      "type": "suggestion",
      "priority": "medium",
      "title": "Blood Pressure Monitoring",
      "description": "Given the differential diagnoses (DM, CKD, Cushing's), systemic hypertension is common. Recommend blood pressure measurement as hypertension can cause secondary organ damage.",
      "confidence": 0.72
    },
    {
      "type": "suggestion",
      "priority": "medium",
      "title": "Retinal Examination",
      "description": "Both diabetes and hypertension (secondary to CKD) can cause retinal changes. Ophthalmoscopic exam recommended to check for hemorrhages or detachment.",
      "confidence": 0.65
    },
    {
      "type": "suggestion",
      "priority": "low",
      "title": "Consider ACTH Stimulation Test",
      "description": "While less likely than DM or CKD, Cushing's disease should remain on the differential list for PU/PD in an older dog. Consider ACTH stimulation or low-dose dexamethasone suppression test if initial workup is inconclusive.",
      "confidence": 0.55
    }
  ]
}

{
  "type": "risk",
  "priority": "high",
  "title": "Gastric Dilatation-Volvulus Risk",
  "description": "Large breed dog with acute onset bloating and non-productive retching. GDV is life-threatening and requires immediate radiographic confirmation and surgical intervention if positive.",
  "confidence": 0.92
}

{
  "type": "diagnosis",
  "priority": "high",
  "title": "Feline Hyperthyroidism",
  "description": "Senior cat presenting with weight loss despite increased appetite, plus tachycardia on exam. These are classic signs of hyperthyroidism. Recommend total T4 measurement.",
  "confidence": 0.88
}

{
  "type": "suggestion",
  "priority": "medium",
  "title": "Pain Management",
  "description": "Patient showing signs of orthopedic pain (reluctance to jump, stiff gait). Consider multimodal pain management including NSAIDs and joint supplements.",
  "confidence": 0.75
}

interface ClinicalInsight {
  id: string;
  type: 'risk' | 'diagnosis' | 'suggestion';
  priority: 'high' | 'medium' | 'low';
  title: string;
  description: string;
  confidence: number;
  status: 'pending' | 'accepted' | 'rejected';
}

// Accept an insight
const acceptInsight = (insightId: string) => {
  setInsights(prev => prev.map(insight => 
    insight.id === insightId 
      ? { ...insight, status: 'accepted' }
      : insight
  ));
  
  // Add to SOAP plan
  const insight = insights.find(i => i.id === insightId);
  if (insight) {
    appendToPlan(`- ${insight.description}`);
  }
};

// Reject an insight
const rejectInsight = (insightId: string) => {
  setInsights(prev => prev.map(insight =>
    insight.id === insightId
      ? { ...insight, status: 'rejected' }
      : insight
  ));
};

const InsightCard = ({ insight }: { insight: ClinicalInsight }) => {
  const priorityColor = {
    high: 'border-red-500 bg-red-50',
    medium: 'border-amber-500 bg-amber-50',
    low: 'border-green-500 bg-green-50'
  }[insight.priority];

  const typeIcon = {
    risk: <AlertTriangle />,
    diagnosis: <FileText />,
    suggestion: <Lightbulb />
  }[insight.type];

  return (
    <div className={`border-l-4 p-4 rounded-lg ${priorityColor}`}>
      <div className="flex items-center justify-between">
        <div className="flex items-center gap-2">
          {typeIcon}
          <h4 className="font-medium">{insight.title}</h4>
        </div>
        <Badge>{Math.round(insight.confidence * 100)}%</Badge>
      </div>
      <p className="text-sm mt-2">{insight.description}</p>
      
      {insight.status === 'pending' && (
        <div className="flex gap-2 mt-3">
          <Button onClick={() => acceptInsight(insight.id)}>
            <ThumbsUp /> Accept
          </Button>
          <Button variant="outline" onClick={() => rejectInsight(insight.id)}>
            <ThumbsDown /> Dismiss
          </Button>
        </div>
      )}
    </div>
  );
};

import { supabase } from '@/lib/supabase';

// Generate insights for a medical record
const generateInsightsForRecord = async (recordId: string) => {
  // Fetch record
  const { data: record } = await supabase
    .from('medical_records')
    .select('*')
    .eq('id', recordId)
    .single();

  if (!record) return;

  // Generate insights
  const response = await fetch('/api/ai/clinical-insights', {
    method: 'POST',
    headers: { 'Content-Type': 'application/json' },
    body: JSON.stringify({
      soap: {
        subjective: record.soap_subjective,
        objective: record.soap_objective,
        assessment: record.soap_assessment,
        plan: record.soap_plan
      },
      patientName: record.pet_name,
      species: record.species,
      breed: record.breed
    })
  });

  const { insights } = await response.json();

  // Store insights with record
  await supabase
    .from('medical_records')
    .update({
      insights: insights
    })
    .eq('id', recordId);

  return insights;
};

const getHighConfidenceInsights = (insights: ClinicalInsight[]) => {
  return insights.filter(i => i.confidence >= 0.75);
};

const prioritizeInsights = (insights: ClinicalInsight[]) => {
  return insights.sort((a, b) => {
    // Sort by priority first, then confidence
    const priorityOrder = { high: 0, medium: 1, low: 2 };
    if (priorityOrder[a.priority] !== priorityOrder[b.priority]) {
      return priorityOrder[a.priority] - priorityOrder[b.priority];
    }
    return b.confidence - a.confidence;
  });
};