backend/comprehensive_medical_prompt_engineering.py

"""
COMPREHENSIVE MEDICAL ANALYSIS PROMPT ENGINEERING FRAMEWORK
Creates meaningful clinical insights across ALL medical categories

This file provides enhanced prompt templates and structured output schemas for:
- Cardiology/ECG Analysis
- Radiology (X-ray, CT, MRI, Ultrasound)
- Laboratory Medicine
- Pathology (Biopsies, Cytology)
- Clinical Documentation
- General Medical Analysis

Each prompt includes:
1. Domain-specific clinical context
2. Structured diagnostic framework
3. Professional medical terminology
4. Evidence-based recommendations
5. Clinical correlation requirements
"""

import json
from typing import Dict, Any, List
from datetime import datetime

class ComprehensiveMedicalPromptEngine:
    """
    Enhanced medical prompt engineering for meaningful clinical insights
    across all medical categories
    """
    
    def __init__(self):
        self.medical_domains = self._initialize_medical_domains()
        self.output_schemas = self._initialize_output_schemas()
    
    def _initialize_medical_domains(self) -> Dict[str, Dict[str, Any]]:
        """Initialize comprehensive medical analysis domains with enhanced prompts"""
        return {
            # ===== CARDIOLOGY/ECG ANALYSIS =====
            "cardiology_ecg": {
                "clinical_context": """You are a board-certified cardiologist specializing in electrocardiography and cardiac electrophysiology. 
Provide comprehensive ECG analysis with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Comprehensive Electrocardiogram Analysis
Patient Context: {patient_info}
ECG Data: {ecg_data}

Provide detailed cardiac electrophysiology assessment including:

1. **RHYTHM ANALYSIS & CARDIAC RATE**
   - Primary rhythm identification with confidence assessment
   - Heart rate analysis with normal/abnormal range determination
   - Sinus rhythm characteristics and any arrhythmic patterns

2. **CONDUCTION SYSTEM ASSESSMENT**
   - P wave morphology, duration, and timing analysis
   - PR interval interpretation (normal, prolonged, shortened)
   - QRS complex analysis (duration, morphology, axis determination)
   - QT/QTc interval measurement with clinical significance

3. **MYOCARDIAL ISCHEMIA/INFARCTION DETECTION**
   - ST-segment elevation/depression analysis with lead distribution
   - T wave abnormalities and their clinical significance
   - Q wave presence indicating prior infarction territory
   - Pathological Q waves vs physiological variants

4. **CLINICAL CORRELATION & RECOMMENDATIONS**
   - Risk stratification based on ECG findings
   - Correlation with clinical presentation and cardiac biomarkers
   - Evidence-based management recommendations
   - Follow-up testing requirements (stress test, echo, catheterization)

Provide professional cardiac electrophysiology interpretation.""",
                
                "domain_expertise": "Cardiology, Electrophysiology, Clinical Medicine",
                "critical_elements": ["rhythm", "intervals", "ischemia", "axis", "recommendations"]
            },
            
            # ===== RADIOLOGY ANALYSIS =====
            "radiology_xray": {
                "clinical_context": """You are a board-certified radiologist specializing in diagnostic imaging interpretation.
Provide comprehensive radiological analysis with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Comprehensive Radiological Analysis
Imaging Study: {imaging_study}
Patient Context: {patient_context}
Radiological Data: {image_data}

Provide detailed radiological interpretation including:

1. **TECHNICAL ASSESSMENT**
   - Imaging modality and acquisition parameters
   - Image quality and technical adequacy
   - Anatomical coverage and positioning

2. **ANATOMICAL & PATHOLOGICAL FINDINGS**
   - Systematic review of anatomical structures
   - Primary pathological findings with specific descriptions
   - Differential diagnosis considerations based on imaging patterns
   - Critical findings requiring urgent attention

3. **CLINICAL SIGNIFICANCE & INTERPRETATION**
   - Correlation with clinical presentation and symptoms
   - Severity assessment and prognostic implications
   - Disease progression or treatment response indicators
   - Comparison with prior imaging when available

4. **MANAGEMENT RECOMMENDATIONS**
   - Additional imaging studies if indicated
   - Clinical correlation requirements
   - Treatment implications and monitoring needs
   - Follow-up imaging recommendations

Provide expert radiological consultation with clinical correlation.""",
                
                "domain_expertise": "Radiology, Diagnostic Imaging, Clinical Medicine",
                "critical_elements": ["findings", "differential", "severity", "recommendations"]
            },
            
            "radiology_ct": {
                "clinical_context": """You are a board-certified radiologist specializing in CT imaging and cross-sectional anatomy.
Provide comprehensive CT analysis with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Comprehensive CT Scan Analysis
CT Study: {ct_study}
Clinical Indication: {indication}
Patient Context: {patient_context}

Provide detailed CT interpretation including:

1. **TECHNICAL ASSESSMENT**
   - CT protocol and imaging parameters
   - Contrast enhancement status
   - Image quality and diagnostic adequacy

2. **SYSTEMATIC ORGAN REVIEW**
   - Brain/nervous system (if head CT)
   - Chest (lung parenchyma, mediastinum, pleural spaces)
   - Abdomen/pelvis (solid organs, bowel, vasculature)
   - Musculoskeletal structures as applicable

3. **PATHOLOGICAL FINDINGS & INTERPRETATION**
   - Primary lesion characterization (size, location, enhancement)
   - Secondary findings and metastatic assessment
   - Inflammatory, infectious, or neoplastic processes
   - Vascular abnormalities and perfusion deficits

4. **CLINICAL CORRELATION & RECOMMENDATIONS**
   - Findings correlation with clinical presentation
   - Differential diagnosis with probability assessment
   - Tissue sampling recommendations if indicated
   - Treatment planning and monitoring protocols

Provide expert CT interpretation with clinical management guidance.""",
                
                "domain_expertise": "Radiology, Cross-sectional Imaging, Clinical Medicine",
                "critical_elements": ["systematic_review", "pathology", "differential", "management"]
            },
            
            # ===== LABORATORY MEDICINE =====
            "laboratory_chemistry": {
                "clinical_context": """You are a board-certified clinical pathologist specializing in laboratory medicine.
Provide comprehensive laboratory interpretation with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Comprehensive Laboratory Analysis
Laboratory Data: {lab_data}
Patient Context: {patient_context}
Clinical Indication: {indication}

Provide detailed laboratory interpretation including:

1. **NORMAL & ABNORMAL VALUE ASSESSMENT**
   - Reference range comparison with flagging of abnormal values
   - Critical value identification requiring immediate attention
   - Trending analysis for serial measurements
   - Hemolysis, lipemia, or other specimen quality issues

2. **CLINICAL SIGNIFICANCE & CORRELATION**
   - Clinical interpretation of abnormal findings
   - Correlation with patient symptoms and medical history
   - Drug-induced laboratory abnormalities
   - Organ-specific findings (hepatic, renal, cardiac markers)

3. **DIAGNOSTIC & PROGNOSTIC IMPLICATIONS**
   - Disease diagnosis support based on laboratory patterns
   - Prognostic indicators and risk stratification
   - Treatment monitoring and therapeutic drug levels
   - Baseline and follow-up testing requirements

4. **RECOMMENDATIONS & CLINICAL ACTION**
   - Repeat testing requirements or confirmatory studies
   - Additional laboratory testing for diagnosis/monitoring
   - Clinical correlation with other diagnostic modalities
   - Specialist consultation recommendations

Provide expert clinical pathology interpretation.""",
                
                "domain_expertise": "Laboratory Medicine, Clinical Pathology, Clinical Medicine",
                "critical_elements": ["reference_ranges", "abnormalities", "significance", "recommendations"]
            },
            
            # ===== PATHOLOGY ANALYSIS =====
            "pathology_biopsy": {
                "clinical_context": """You are a board-certified pathologist specializing in histopathology and molecular pathology.
Provide comprehensive pathological analysis with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Comprehensive Pathology Analysis
Specimen Type: {specimen_type}
Anatomical Site: {site}
Clinical Information: {clinical_info}
Histopathological Data: {path_data}

Provide detailed pathological interpretation including:

1. **MORPHOLOGICAL ASSESSMENT**
   - Specimen adequacy and diagnostic quality
   - Histological pattern analysis and architectural features
   - Cellular morphology, nuclear characteristics, and cytoplasmic features
   - Staining characteristics and immunohistochemical profile

2. **DIAGNOSTIC INTERPRETATION**
   - Primary diagnosis with confidence level
   - Differential diagnosis considerations
   - Grading and staging information when applicable
   - Molecular/immunohistochemical markers and their significance

3. **CLINICAL CORRELATION & PROGNOSIS**
   - Correlation with clinical presentation and imaging findings
   - Prognostic factors and risk stratification
   - Treatment response prediction and therapeutic targets
   - Genetic/molecular alterations with clinical implications

4. **CLINICAL MANAGEMENT RECOMMENDATIONS**
   - Surgical margin assessment and adequacy
   - Additional staining or molecular testing recommendations
   - Treatment planning implications
   - Follow-up protocols and surveillance recommendations

Provide expert pathological consultation with clinical management guidance.""",
                
                "domain_expertise": "Pathology, Histopathology, Molecular Pathology, Clinical Medicine",
                "critical_elements": ["morphology", "diagnosis", "prognosis", "management"]
            },
            
            # ===== CLINICAL DOCUMENTATION =====
            "clinical_notes": {
                "clinical_context": """You are an experienced clinical physician reviewing medical documentation.
Provide comprehensive clinical assessment with medical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Clinical Documentation Review
Medical Document: {document_data}
Document Type: {doc_type}
Patient Context: {patient_context}

Provide comprehensive clinical analysis including:

1. **DOCUMENT STRUCTURE & CONTENT ASSESSMENT**
   - Chief complaint and presenting problem analysis
   - History of present illness extraction and analysis
   - Past medical, surgical, and social history review
   - Physical examination findings and documentation quality

2. **CLINICAL ASSESSMENT & DIAGNOSTIC REASONING**
   - Primary assessment and clinical impression extraction
   - Differential diagnosis considerations and reasoning
   - Problem prioritization and clinical decision-making
   - Evidence-based diagnostic approach assessment

3. **TREATMENT PLAN & MANAGEMENT**
   - Therapeutic interventions and medication orders
   - Diagnostic testing recommendations and rationale
   - Follow-up care and monitoring protocols
   - Patient education and discharge planning

4. **CLINICAL QUALITY ASSURANCE**
   - Documentation completeness and accuracy
   - Clinical reasoning adequacy and decision-making quality
   - Standard of care compliance and best practice adherence
   - Areas for improvement and education recommendations

Provide professional clinical assessment and quality review.""",
                
                "domain_expertise": "Clinical Medicine, Internal Medicine, Medical Documentation",
                "critical_elements": ["assessment", "reasoning", "management", "quality"]
            },
            
            # ===== EMERGENCY MEDICINE =====
            "emergency_medicine": {
                "clinical_context": """You are an emergency medicine physician specializing in acute care assessment.
Provide comprehensive emergency medicine evaluation with clinical expertise.""",
                
                "prompt_template": """CLINICAL SCENARIO: Emergency Medicine Assessment
Emergency Presentation: {emergency_data}
Patient Context: {patient_context}
Clinical Scenario: {scenario}

Provide comprehensive emergency medicine evaluation including:

1. **ACUTE PRESENTATION ASSESSMENT**
   - Chief complaint and triage priority assessment
   - Vital signs analysis and stability determination
   - Acute symptom progression and severity
   - Risk stratification and immediate threats

2. **EMERGENCY CLINICAL FINDINGS**
   - Critical diagnostic findings requiring immediate attention
   - Organ system dysfunction assessment
   - Pain assessment and management needs
   - Environmental and trauma considerations

3. **EMERGENCY MANAGEMENT PROTOCOL**
   - Immediate life-saving interventions required
   - Diagnostic testing priorities (CT, labs, ECG)
   - Specialist consultation requirements
   - Admission vs discharge decisions

4. **DISPOSITION & FOLLOW-UP**
   - Admission criteria and level of care determination
   - Outpatient follow-up requirements
   - Patient education and discharge instructions
   - Emergency re-evaluation triggers

Provide expert emergency medicine consultation with acute care protocols.""",
                
                "domain_expertise": "Emergency Medicine, Acute Care, Critical Care",
                "critical_elements": ["triage", "critical_findings", "management", "disposition"]
            }
        }
    
    def _initialize_output_schemas(self) -> Dict[str, Dict[str, Any]]:
        """Initialize structured output schemas for each medical domain"""
        return {
            "cardiology_ecg": {
                "required_fields": [
                    "rhythm_analysis", "heart_rate", "conduction_intervals", 
                    "ischemia_findings", "clinical_significance", "recommendations"
                ],
                "output_structure": {
                    "rhythm_analysis": "Primary rhythm identification and characteristics",
                    "heart_rate": "Rate analysis with clinical interpretation",
                    "conduction_intervals": "PR, QRS, QT intervals with significance",
                    "ischemia_findings": "ST-T changes, Q waves, infarct location",
                    "clinical_significance": "Risk assessment and correlation",
                    "recommendations": "Evidence-based management and follow-up"
                }
            },
            
            "radiology_xray": {
                "required_fields": [
                    "technical_assessment", "anatomical_findings", "pathological_lesions",
                    "differential_diagnosis", "clinical_correlation", "recommendations"
                ],
                "output_structure": {
                    "technical_assessment": "Image quality, positioning, adequacy",
                    "anatomical_findings": "Systematic review of structures",
                    "pathological_lesions": "Primary findings with descriptions",
                    "differential_diagnosis": "List of possibilities with rationale",
                    "clinical_correlation": "Symptom correlation and significance",
                    "recommendations": "Additional imaging, treatment, follow-up"
                }
            },
            
            "laboratory_chemistry": {
                "required_fields": [
                    "normal_values", "abnormal_values", "critical_values",
                    "clinical_significance", "trending_analysis", "recommendations"
                ],
                "output_structure": {
                    "normal_values": "Results within reference range",
                    "abnormal_values": "Out of range results with interpretation",
                    "critical_values": "Life-threatening values requiring action",
                    "clinical_significance": "Interpretation of abnormalities",
                    "trending_analysis": "Pattern recognition and changes",
                    "recommendations": "Repeat testing, additional studies"
                }
            },
            
            "pathology_biopsy": {
                "required_fields": [
                    "morphological_assessment", "diagnostic_interpretation",
                    "grading_staging", "prognosis_factors", "treatment_implications"
                ],
                "output_structure": {
                    "morphological_assessment": "Histological pattern and cellular features",
                    "diagnostic_interpretation": "Primary diagnosis and differential",
                    "grading_staging": "Severity assessment and classification",
                    "prognosis_factors": "Risk factors and outcome prediction",
                    "treatment_implications": "Therapeutic targets and monitoring"
                }
            },
            
            "clinical_notes": {
                "required_fields": [
                    "chief_complaint", "assessment_plan", "clinical_reasoning",
                    "diagnostic_approach", "treatment_recommendations", "documentation_quality"
                ],
                "output_structure": {
                    "chief_complaint": "Primary problem and presentation",
                    "assessment_plan": "Clinical impression and assessment",
                    "clinical_reasoning": "Diagnostic logic and decision-making",
                    "diagnostic_approach": "Testing and evaluation strategy",
                    "treatment_recommendations": "Therapeutic interventions",
                    "documentation_quality": "Completeness and accuracy assessment"
                }
            }
        }
    
    def generate_enhanced_prompt(self, domain: str, data: Dict[str, Any]) -> str:
        """Generate enhanced medical prompt for specific domain"""
        if domain not in self.medical_domains:
            return self._generate_general_medical_prompt(data)
        
        domain_config = self.medical_domains[domain]
        prompt_template = domain_config["prompt_template"]
        
        # Format the prompt with available data
        formatted_prompt = prompt_template.format(**data)
        
        # Add structured output requirements
        if domain in self.output_schemas:
            schema = self.output_schemas[domain]
            formatted_prompt += f"""

STRUCTURED OUTPUT REQUIREMENTS:
Provide your analysis in the following structured format:

"""
            for field in schema["required_fields"]:
                formatted_prompt += f"• **{field.replace('_', ' ').title()}**: [Detailed analysis]\n"
        
        # Add clinical correlation requirement
        formatted_prompt += """

CLINICAL CORRELATION REQUIREMENTS:
1. Correlate all findings with patient presentation and medical context
2. Use professional medical terminology and clinical expertise
3. Provide evidence-based recommendations with clinical justification
4. Include risk stratification and management priorities
5. Suggest appropriate follow-up and monitoring protocols

Professional medical analysis with clinical correlation required."""
        
        return formatted_prompt
    
    def _generate_general_medical_prompt(self, data: Dict[str, Any]) -> str:
        """Generate general medical prompt for unspecified domains"""
        return f"""CLINICAL SCENARIO: Comprehensive Medical Document Analysis
Medical Information: {data.get('text', 'N/A')}

Provide comprehensive medical analysis including:

1. **CLINICAL FINDINGS**
   - Key medical findings and interpretations
   - Diagnostic considerations with clinical significance
   - Correlation with medical standards and guidelines

2. **CLINICAL ASSESSMENT**
   - Overall clinical impression and interpretation
   - Risk factors and prognostic indicators
   - Clinical decision-making guidance

3. **MANAGEMENT RECOMMENDATIONS**
   - Evidence-based treatment considerations
   - Follow-up protocols and monitoring requirements
   - Specialist consultation recommendations

4. **CLINICAL CORRELATION**
   - Integration with patient presentation and medical history
   - Quality assessment and clinical standards compliance

Provide expert medical consultation with clinical correlation and professional medical interpretation."""

    def get_domain_expertise(self, domain: str) -> str:
        """Get domain-specific medical expertise context"""
        return self.medical_domains.get(domain, {}).get("domain_expertise", "Clinical Medicine")
    
    def get_critical_elements(self, domain: str) -> List[str]:
        """Get critical analysis elements for domain"""
        return self.medical_domains.get(domain, {}).get("critical_elements", ["findings", "significance", "recommendations"])

# Global instance for medical analysis
medical_prompt_engine = ComprehensiveMedicalPromptEngine()

def generate_medical_analysis_prompt(domain: str, data: Dict[str, Any]) -> str:
    """Generate enhanced medical analysis prompt"""
    return medical_prompt_engine.generate_enhanced_prompt(domain, data)

def get_medical_domain_expertise(domain: str) -> str:
    """Get medical domain expertise context"""
    return medical_prompt_engine.get_domain_expertise(domain)