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const express = require("express");
const http = require("http");
const path = require("path");
const multer = require("multer");
const fs = require("fs").promises;
const { Server } = require("socket.io");
const { ChatGroq } = require("@langchain/groq");
const { HumanMessage, SystemMessage } = require("@langchain/core/messages");
const mammoth = require("mammoth");
const pdf = require("pdf-parse");
const Tesseract = require("tesseract.js");
const sharp = require("sharp");
const cors = require("cors");
const app = express();
const server = http.createServer(app);
const io = new Server(server, {
cors: { origin: "*" },
maxHttpBufferSize: 1e8
});
app.use(cors());
app.use(express.json());
app.use(express.static(path.resolve("./public")));
app.use("/uploads", express.static(path.join(__dirname, "uploads")));
// Configure file upload
const storage = multer.diskStorage({
destination: async (req, file, cb) => {
const uploadDir = path.join(__dirname, "uploads");
await fs.mkdir(uploadDir, { recursive: true });
cb(null, uploadDir);
},
filename: (req, file, cb) => {
const uniqueName = `${Date.now()}-${file.originalname}`;
cb(null, uniqueName);
}
});
const upload = multer({
storage,
limits: { fileSize: 50 * 1024 * 1024 }
});
// Initialize Groq LLM
const llm = new ChatGroq({
model: "llama-3.3-70b-versatile",
temperature: 0.7,
maxTokens: 2000,
maxRetries: 2,
apiKey: process.env.GROQ_API_KEY
});
// Data structures
let rooms = {};
let users = {};
// π¨ FEATURE 4: Emergency keywords detection
const EMERGENCY_KEYWORDS = [
'chest pain', 'heart attack', 'can\'t breathe', 'breathless', 'severe bleeding',
'unconscious', 'stroke', 'paralysis', 'severe headache', 'suicide',
'overdose', 'seizure', 'choking', 'anaphylaxis', 'severe pain'
];
// π― FEATURE 1: Dynamic Dual-Persona AI Safety Engine
const PATIENT_AI_PROMPT = `You are an AI Medical Assistant helping a PATIENT. Your role:
**SAFETY-FIRST APPROACH**
1. **Empathetic Support**: Be warm, reassuring, and supportive
2. **Simple Language**: Avoid medical jargon, explain in simple terms
3. **Symptom Clarification**: Ask ONE focused question at a time
4. **No Premature Conclusions**: Never diagnose or interpret lab results
5. **Safety Boundaries**: If critical values detected, advise immediate medical attention
6. **Respond Only When**:
- Patient asks direct questions
- Patient is alone and needs guidance
- Someone mentions @ai
**RISK CONTROL**: Never share detailed medical analysis. Acknowledge uploads and reassure.`;
const DOCTOR_AI_PROMPT = `You are an AI Medical Assistant helping a DOCTOR. Your role:
**CLINICAL-GRADE ANALYSIS**
1. **Detailed Insights**: Provide comprehensive medical analysis
2. **Critical Findings**: Highlight abnormal values, red flags with clinical context
3. **Medical Terminology**: Use appropriate professional language
4. **Evidence-Based**: Reference standard clinical thresholds
5. **Explainable AI**: Always explain WHY a finding is significant
6. **Respond Only When**:
- Doctor asks about files/reports
- Doctor mentions @ai
- Doctor needs clinical summary
**TRANSPARENCY**: Provide clear reasoning for all flagged findings with confidence levels.`;
// π¬ FEATURE 3: Explainable AI Layer
async function analyzeFileWithXAI(content, fileName, previousReports = []) {
const analysisPrompt = `Analyze this medical report with EXPLAINABLE AI principles:
File: ${fileName}
Content: ${content.substring(0, 3000)}
${previousReports.length > 0 ? `
**TEMPORAL CONTEXT** (Previous Reports):
${previousReports.map((r, i) => `Report ${i+1} (${r.date}): ${r.keyFindings}`).join('\n')}
` : ''}
Provide analysis in this EXACT format:
**CLINICAL SUMMARY**
β’ Main diagnosis/finding (1 line)
**CRITICAL FINDINGS**
β’ [Value/Finding]: [Normal Range] β [Current Value] β [Deviation %]
Reason: [Clinical explanation]
Confidence: [High/Medium/Low]
**TEMPORAL TRENDS** (if previous data available)
β’ [Parameter]: [Previous β Current] β [Trend Analysis]
**IMMEDIATE CONCERNS**
β’ [Priority level]: [Specific concern]
**RECOMMENDATIONS**
β’ [Actionable next steps]
Be concise, clinical, and ALWAYS explain the "why" behind findings.`;
try {
const analysis = await llm.invoke([
new SystemMessage("You are a clinical AI analyzer specializing in explainable medical insights."),
new HumanMessage(analysisPrompt)
]);
return analysis.content;
} catch (error) {
console.error("XAI Analysis error:", error);
return "Unable to analyze with full explainability.";
}
}
// π FEATURE 2: Temporal Health Intelligence
function extractTemporalData(room) {
if (!room.files || room.files.length < 2) return [];
return room.files.map(f => ({
name: f.name,
date: f.uploadedAt,
keyFindings: f.analysis ? f.analysis.substring(0, 200) : "No analysis",
content: f.content.substring(0, 500)
}));
}
async function performTemporalAnalysis(currentContent, fileName, room) {
const previousReports = extractTemporalData(room);
if (previousReports.length === 0) {
return await analyzeFileWithXAI(currentContent, fileName, []);
}
const temporalPrompt = `Perform TEMPORAL HEALTH INTELLIGENCE analysis:
**CURRENT REPORT**: ${fileName}
${currentContent.substring(0, 2000)}
**HISTORICAL DATA**:
${previousReports.map((r, i) => `
Report ${i+1} - ${new Date(r.date).toLocaleDateString()}:
${r.keyFindings}
`).join('\n')}
Analyze:
1. **Longitudinal Trends**: Compare current vs historical values
2. **Progression/Deterioration**: Identify gradual changes over time
3. **Early Warning Signs**: Flag subtle patterns that indicate future risk
4. **Clinical Significance**: Is this progression normal or concerning?
Format as structured clinical analysis with temporal context.`;
try {
const analysis = await llm.invoke([
new SystemMessage("You are a temporal medical intelligence analyzer specializing in longitudinal health trends."),
new HumanMessage(temporalPrompt)
]);
return analysis.content;
} catch (error) {
console.error("Temporal analysis error:", error);
return await analyzeFileWithXAI(currentContent, fileName, previousReports);
}
}
// π¨ FEATURE 4: Emergency Detection and Escalation
async function detectEmergency(message, userRole) {
const messageLower = message.toLowerCase();
// Check for emergency keywords
const hasEmergencyKeyword = EMERGENCY_KEYWORDS.some(keyword =>
messageLower.includes(keyword)
);
if (!hasEmergencyKeyword) return { isEmergency: false };
// Enhanced AI-based emergency detection
const emergencyPrompt = `Analyze this message for medical emergency indicators:
Message: "${message}"
Classify emergency level:
- CRITICAL: Immediate life threat (chest pain, can't breathe, severe bleeding, stroke symptoms)
- HIGH: Urgent medical attention needed within hours
- MODERATE: Medical evaluation needed soon
- LOW: Non-emergency concern
Respond ONLY with JSON:
{
"level": "CRITICAL|HIGH|MODERATE|LOW",
"reasoning": "brief explanation",
"urgentAdvice": "immediate action to take"
}`;
try {
const response = await llm.invoke([
new SystemMessage("You are an emergency medical triage AI. Respond ONLY with valid JSON."),
new HumanMessage(emergencyPrompt)
]);
const result = JSON.parse(response.content.replace(/```json|```/g, '').trim());
return {
isEmergency: result.level === "CRITICAL" || result.level === "HIGH",
level: result.level,
reasoning: result.reasoning,
urgentAdvice: result.urgentAdvice
};
} catch (error) {
console.error("Emergency detection error:", error);
return { isEmergency: hasEmergencyKeyword, level: "HIGH", reasoning: "Keyword detected" };
}
}
// π FEATURE 5: Doctor Co-Pilot Documentation
async function generateClinicalDocumentation(roomId) {
const room = rooms[roomId];
if (!room) return null;
const conversationHistory = room.messages
.filter(m => m.role === 'Patient' || m.role === 'Doctor')
.map(m => `${m.role}: ${m.content}`)
.join('\n');
const filesSummary = room.files
.map(f => `- ${f.name}: ${f.analysis || 'No analysis'}`)
.join('\n');
const docPrompt = `Generate structured clinical documentation from this consultation:
**CONVERSATION**:
${conversationHistory}
**UPLOADED FILES**:
${filesSummary}
Generate SOAP NOTE format:
**SUBJECTIVE**
- Chief Complaint: [main issue]
- History of Present Illness: [brief narrative]
- Review of Systems: [relevant findings]
**OBJECTIVE**
- Vital signs/Reports: [from uploaded files]
- Physical findings: [mentioned in chat]
**ASSESSMENT**
- Primary diagnosis: [clinical impression]
- Differential diagnoses: [alternatives]
**PLAN**
- Investigations: [tests ordered]
- Treatment: [medications/interventions]
- Follow-up: [next steps]
Keep concise and clinically accurate.`;
try {
const documentation = await llm.invoke([
new SystemMessage("You are a medical documentation AI specializing in SOAP notes and clinical summaries."),
new HumanMessage(docPrompt)
]);
return documentation.content;
} catch (error) {
console.error("Documentation generation error:", error);
return null;
}
}
// Helper: OCR for images
async function extractTextFromImage(imagePath) {
try {
console.log("Starting OCR:", imagePath);
const processedPath = imagePath + "_processed.jpg";
await sharp(imagePath)
.greyscale()
.normalize()
.sharpen()
.toFile(processedPath);
const { data: { text } } = await Tesseract.recognize(processedPath, 'eng');
try { await fs.unlink(processedPath); } catch (e) {}
console.log("OCR completed, text length:", text.length);
return text.trim();
} catch (error) {
console.error("OCR Error:", error);
return "";
}
}
// Helper: Extract text from files
async function extractFileContent(filePath, mimeType) {
try {
console.log("Extracting:", filePath, mimeType);
if (mimeType === "application/pdf") {
const dataBuffer = await fs.readFile(filePath);
const pdfData = await pdf(dataBuffer);
return pdfData.text;
} else if (mimeType.includes("word") || mimeType.includes("document")) {
const result = await mammoth.extractRawText({ path: filePath });
return result.value;
} else if (mimeType.includes("text")) {
return await fs.readFile(filePath, "utf-8");
} else if (mimeType.includes("image")) {
const ocrText = await extractTextFromImage(filePath);
return ocrText.length > 10 ? ocrText : "[Image - no text detected]";
}
return "[Unsupported format]";
} catch (error) {
console.error("Extraction error:", error);
return "[Extraction failed]";
}
}
// Helper: AI Response with risk-aware disclosure control
async function getAIResponse(roomId, userMessage, userRole, isFileQuery = false, emergencyContext = null) {
const room = rooms[roomId];
if (!room) return "Room not found";
// FEATURE 1: Dynamic persona selection
const systemPrompt = userRole === "doctor" ? DOCTOR_AI_PROMPT : PATIENT_AI_PROMPT;
const roleMessages = room.messages.filter(m =>
!m.forRole || m.forRole === userRole || (!m.forRole && m.role !== 'AI Assistant')
);
let context = `Room: ${roomId}
User Role: ${userRole}
Patient: ${room.patient || "Waiting"}
Doctor: ${room.doctor || "Not yet joined"}
${emergencyContext ? `π¨ EMERGENCY CONTEXT: ${emergencyContext.reasoning}\nLevel: ${emergencyContext.level}` : ''}
Recent messages (last 5):
${roleMessages.slice(-5).map(m => `${m.role}: ${m.content}`).join("\n")}`;
// FEATURE 1: Risk-based information disclosure
if (userRole === "doctor" && isFileQuery && room.files.length > 0) {
context += `\n\n**CLINICAL FILES** (with XAI explanations):\n${room.files.map((f, i) =>
`${i+1}. ${f.name}\n Analysis: ${f.analysis}\n Key content: ${f.content.substring(0, 400)}`
).join("\n\n")}`;
} else if (userRole === "patient" && room.files.length > 0) {
// Patients get minimal, safe information
context += `\n\n**FILES UPLOADED**: ${room.files.map(f => f.name).join(', ')}
Note: Detailed medical analysis is being reviewed by your doctor.`;
}
const messages = [
new SystemMessage(systemPrompt),
new SystemMessage(context),
new HumanMessage(`[${userRole}]: ${userMessage}`)
];
try {
const response = await llm.invoke(messages);
return response.content;
} catch (error) {
console.error("AI Error:", error);
return "I'm having trouble responding. Please try again.";
}
}
// File upload endpoint with TEMPORAL ANALYSIS
app.post("/upload", upload.single("file"), async (req, res) => {
try {
const { roomId, uploadedBy, uploaderRole } = req.body;
const file = req.file;
if (!file || !roomId) {
return res.status(400).json({ error: "File and roomId required" });
}
console.log("Upload:", file.originalname, "by", uploadedBy, "in", roomId);
const content = await extractFileContent(file.path, file.mimetype);
console.log("Content extracted, length:", content.length);
// FEATURE 2 & 3: Temporal analysis with XAI
let analysis = "";
if (content && content.length > 20 && !content.includes("no text detected")) {
if (rooms[roomId]) {
analysis = await performTemporalAnalysis(content, file.originalname, rooms[roomId]);
} else {
analysis = await analyzeFileWithXAI(content, file.originalname, []);
}
}
const fileInfo = {
name: file.originalname,
path: file.path,
url: `/uploads/${file.filename}`,
type: file.mimetype,
content: content.substring(0, 5000),
analysis: analysis,
uploadedAt: new Date().toISOString(),
uploadedBy: uploadedBy || "Unknown"
};
if (rooms[roomId]) {
rooms[roomId].files.push(fileInfo);
// Broadcast file upload to everyone in room
const fileMessage = {
role: uploadedBy || "User",
nickname: uploadedBy,
content: `π Uploaded: ${file.originalname}`,
timestamp: new Date().toISOString(),
fileData: {
name: file.originalname,
url: fileInfo.url,
type: file.mimetype,
analysis: analysis
},
isFile: true
};
rooms[roomId].messages.push(fileMessage);
io.to(roomId).emit("chat-message", fileMessage);
// Emit file list update to all users in the room
io.to(roomId).emit("files-updated", { files: rooms[roomId].files });
// FEATURE 1: Role-specific AI responses (PRIVATE - not visible to other role)
if (content && content.length > 20) {
setTimeout(() => {
const doctorSocketId = Object.keys(users).find(
sid => users[sid].roomId === roomId && users[sid].role === "doctor"
);
if (doctorSocketId && rooms[roomId].doctor) {
const doctorAiMessage = `π¬ **Clinical Analysis** (with XAI)\n\n${analysis}`;
io.to(doctorSocketId).emit("ai-message", {
message: doctorAiMessage,
isPrivate: true,
forRole: "doctor"
});
}
}, 1000);
}
if (uploaderRole === "patient") {
setTimeout(() => {
const patientSocketId = Object.keys(users).find(
sid => users[sid].nickname === uploadedBy && users[sid].roomId === roomId
);
if (patientSocketId) {
const patientAiMessage = `β
I've received "${file.originalname}". Your doctor will review it shortly.`;
io.to(patientSocketId).emit("ai-message", {
message: patientAiMessage,
isPrivate: true,
forRole: "patient"
});
}
}, 500);
}
}
res.json({ success: true, file: fileInfo });
} catch (error) {
console.error("Upload error:", error);
res.status(500).json({ error: "Upload failed: " + error.message });
}
});
// FEATURE 5: Generate clinical documentation endpoint
app.post("/generate-documentation", async (req, res) => {
try {
const { roomId } = req.body;
if (!roomId || !rooms[roomId]) {
return res.status(400).json({ error: "Invalid room ID" });
}
const documentation = await generateClinicalDocumentation(roomId);
res.json({ success: true, documentation });
} catch (error) {
console.error("Documentation error:", error);
res.status(500).json({ error: "Documentation generation failed" });
}
});
// Socket.IO
io.on("connection", (socket) => {
console.log("Connected:", socket.id);
socket.on("join-room", async ({ roomId, nickname, role }) => {
socket.join(roomId);
users[socket.id] = { nickname, role, roomId };
if (!rooms[roomId]) {
rooms[roomId] = {
patient: null,
doctor: null,
messages: [],
files: [],
patientData: {},
emergencyMode: false
};
}
if (role === "patient" && !rooms[roomId].patient) {
rooms[roomId].patient = nickname;
} else if (role === "doctor" && !rooms[roomId].doctor) {
rooms[roomId].doctor = nickname;
}
socket.emit("room-history", {
messages: rooms[roomId].messages.filter(m => !m.forRole),
files: rooms[roomId].files
});
io.to(roomId).emit("user-joined", {
nickname,
role,
patient: rooms[roomId].patient,
doctor: rooms[roomId].doctor
});
// Role-specific greeting (PRIVATE - only to this user)
let greeting = "";
if (role === "patient") {
greeting = `Hello ${nickname}! π I'm here to help guide you. What brings you in today?`;
} else if (role === "doctor") {
greeting = `Welcome Dr. ${nickname}! π¨ββοΈ Clinical analysis tools ready. Use "Generate SOAP Note" for documentation.`;
// FEATURE 5: Doctor briefing
if (rooms[roomId].messages.length > 0 || rooms[roomId].files.length > 0) {
setTimeout(async () => {
const briefing = await getAIResponse(
roomId,
"Provide a 3-point clinical summary: chief complaint, temporal trends from files, critical findings.",
"doctor",
true
);
socket.emit("ai-message", {
message: `π **Clinical Briefing**:\n${briefing}`,
isPrivate: true,
forRole: "doctor"
});
}, 1000);
}
}
if (greeting) {
socket.emit("ai-message", {
message: greeting,
isPrivate: true,
forRole: role
});
}
});
socket.on("chat-message", async ({ roomId, message }) => {
const user = users[socket.id];
if (!user || !rooms[roomId]) return;
// Check if this is an @ai request
const isAIRequest = message.toLowerCase().includes('@ai');
// FEATURE 4: Emergency detection
const emergencyCheck = await detectEmergency(message, user.role);
// If NOT an @ai request, broadcast message to everyone
if (!isAIRequest) {
const chatMessage = {
role: user.role === "patient" ? "Patient" : "Doctor",
nickname: user.nickname,
content: message,
timestamp: new Date().toISOString(),
isEmergency: emergencyCheck.isEmergency
};
rooms[roomId].messages.push(chatMessage);
io.to(roomId).emit("chat-message", chatMessage);
}
// FEATURE 4: Emergency escalation
if (emergencyCheck.isEmergency) {
rooms[roomId].emergencyMode = true;
// Alert patient immediately
if (user.role === "patient") {
const urgentMessage = `π¨ **URGENT MEDICAL ATTENTION NEEDED**\n\n${emergencyCheck.urgentAdvice}\n\nCall emergency services (911) immediately if symptoms worsen.`;
socket.emit("ai-message", {
message: urgentMessage,
isPrivate: true,
forRole: "patient",
isEmergency: true
});
}
// Alert doctor
const doctorSocketId = Object.keys(users).find(
sid => users[sid].roomId === roomId && users[sid].role === "doctor"
);
if (doctorSocketId) {
const doctorAlert = `π¨ **EMERGENCY ALERT**\n\nPatient: ${user.nickname}\nLevel: ${emergencyCheck.level}\nReason: ${emergencyCheck.reasoning}\n\nMessage: "${message}"\n\nImmediate evaluation required.`;
io.to(doctorSocketId).emit("ai-message", {
message: doctorAlert,
isPrivate: true,
forRole: "doctor",
isEmergency: true
});
}
return; // Don't process normal AI response in emergency
}
// Handle @ai requests - PRIVATE response only to requester
if (isAIRequest) {
const messageText = message.toLowerCase();
const isFileQuery =
messageText.includes("report") ||
messageText.includes("file") ||
messageText.includes("result") ||
messageText.includes("test") ||
messageText.includes("value") ||
messageText.includes("finding") ||
messageText.includes("trend");
setTimeout(async () => {
const aiResponse = await getAIResponse(roomId, message, user.role, isFileQuery);
// Send ONLY to the user who requested (not broadcast)
socket.emit("ai-message", {
message: aiResponse,
isPrivate: true,
forRole: user.role
});
}, 1500);
} else {
// Auto-respond logic for non-@ai messages
const messageText = message.toLowerCase();
const isFileQuery =
messageText.includes("report") ||
messageText.includes("file") ||
messageText.includes("result") ||
messageText.includes("test") ||
messageText.includes("value") ||
messageText.includes("finding") ||
messageText.includes("trend");
const shouldAIRespond =
(user.role === "patient" && !rooms[roomId].doctor && message.endsWith("?")) ||
(user.role === "doctor" && isFileQuery);
if (shouldAIRespond) {
setTimeout(async () => {
const aiResponse = await getAIResponse(roomId, message, user.role, isFileQuery);
socket.emit("ai-message", {
message: aiResponse,
isPrivate: true,
forRole: user.role
});
}, 1500);
}
}
});
// FEATURE 5: Generate documentation on request
socket.on("request-documentation", async ({ roomId }) => {
const user = users[socket.id];
if (!user || user.role !== "doctor") return;
const documentation = await generateClinicalDocumentation(roomId);
if (documentation) {
socket.emit("documentation-generated", { documentation });
}
});
socket.on("typing", ({ roomId }) => {
const user = users[socket.id];
if (user) {
socket.to(roomId).emit("user-typing", { nickname: user.nickname });
}
});
socket.on("disconnect", () => {
const user = users[socket.id];
if (user) {
const { roomId, nickname, role } = user;
if (rooms[roomId]) {
if (role === "patient") rooms[roomId].patient = null;
if (role === "doctor") rooms[roomId].doctor = null;
io.to(roomId).emit("user-left", {
nickname,
role,
patient: rooms[roomId].patient,
doctor: rooms[roomId].doctor
});
}
delete users[socket.id];
}
});
});
const PORT = process.env.PORT || 7860;
server.listen(PORT, "0.0.0.0", () =>
console.log(`π₯ Enhanced Medical Chat Server running on port ${PORT}`)
);
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