Aula 2: Sistema de Saúde Inteligente

// Sistema de Triagem Médica Automatizada
class AutomatedTriageSystem {
  constructor() {
    this.nlpProcessor = new MedicalNLPProcessor();
    this.symptomClassifier = new SymptomClassifier();
    this.urgencyCalculator = new UrgencyCalculator();
    this.emergencyDetector = new EmergencyDetector();
    this.specialtyRouter = new SpecialtyRouter();
    this.questionGenerator = new QuestionGenerator();
  }

  // Processamento principal de triagem
  async processTriageInterview(patientInput, patientHistory) {
    const session = await this.initializeTriageSession(patientHistory);
    
    const analysisResults = {
      symptom_extraction: await this.extractSymptoms(patientInput),
      severity_assessment: await this.assessSeverity(patientInput, patientHistory),
      urgency_classification: await this.classifyUrgency(patientInput, patientHistory),
      emergency_detection: await this.detectEmergency(patientInput, patientHistory),
      differential_diagnosis: await this.generateDifferentialDiagnosis(patientInput, patientHistory),
      next_questions: await this.generateFollowUpQuestions(patientInput, session.conversation_history)
    };

    const triageDecision = await this.makeTriageDecision(analysisResults, patientHistory);
    
    return {
      session_id: session.id,
      analysis: analysisResults,
      decision: triageDecision,
      confidence_score: await this.calculateConfidenceScore(analysisResults),
      recommended_actions: await this.generateRecommendedActions(triageDecision),
      escalation_requirements: await this.checkEscalationRequirements(triageDecision)
    };
  }

  // Extração inteligente de sintomas
  async extractSymptoms(patientInput) {
    const medicalEntities = await this.nlpProcessor.extractMedicalEntities(patientInput);
    
    const symptomAnalysis = {
      primary_symptoms: {
        identified_symptoms: medicalEntities.symptoms,
        body_systems_affected: await this.mapToBodySystems(medicalEntities.symptoms),
        symptom_severity_indicators: await this.extractSeverityIndicators(patientInput),
        temporal_patterns: await this.extractTemporalPatterns(patientInput)
      },
      associated_factors: {
        pain_scale: await this.extractPainScale(patientInput),
        duration: await this.extractDuration(patientInput),
        frequency: await this.extractFrequency(patientInput),
        triggers: await this.extractTriggers(patientInput),
        relieving_factors: await this.extractRelievingFactors(patientInput)
      },
      context_indicators: {
        recent_activities: await this.extractRecentActivities(patientInput),
        medication_timing: await this.extractMedicationTiming(patientInput),
        environmental_factors: await this.extractEnvironmentalFactors(patientInput),
        stress_indicators: await this.extractStressIndicators(patientInput)
      }
    };

    return this.enhanceSymptomAnalysis(symptomAnalysis);
  }

  // Classificação de urgência baseada em IA
  async classifyUrgency(symptoms, patientHistory) {
    const urgencyFactors = {
      symptom_severity: await this.assessSymptomSeverity(symptoms),
      risk_stratification: await this.stratifyRisk(symptoms, patientHistory),
      time_sensitivity: await this.assessTimeSensitivity(symptoms),
      complication_risk: await this.assessComplicationRisk(symptoms, patientHistory),
      resource_requirements: await this.assessResourceRequirements(symptoms)
    };

    const urgencyScore = await this.calculateUrgencyScore(urgencyFactors);
    
    const urgencyLevels = {
      emergency: { score_range: [0.9, 1.0], response_time: 'immediate', color: 'red' },
      urgent: { score_range: [0.7, 0.89], response_time: '15_minutes', color: 'orange' },
      semi_urgent: { score_range: [0.5, 0.69], response_time: '60_minutes', color: 'yellow' },
      standard: { score_range: [0.3, 0.49], response_time: '4_hours', color: 'green' },
      non_urgent: { score_range: [0.0, 0.29], response_time: '24_hours', color: 'blue' }
    };

    const assignedLevel = Object.entries(urgencyLevels).find(([level, config]) => 
      urgencyScore >= config.score_range[0] && urgencyScore <= config.score_range[1]
    );

    return {
      urgency_level: assignedLevel[0],
      urgency_score: urgencyScore,
      response_requirements: assignedLevel[1],
      contributing_factors: urgencyFactors,
      confidence_interval: await this.calculateConfidenceInterval(urgencyScore),
      review_requirements: await this.determineReviewRequirements(urgencyScore)
    };
  }

  // Detecção de emergências médicas
  async detectMedicalEmergency(symptoms, patientData) {
    const emergencyPatterns = {
      cardiac_emergency: {
        indicators: ['chest_pain', 'shortness_of_breath', 'arm_pain', 'jaw_pain', 'sweating'],
        risk_factors: ['age_over_50', 'diabetes', 'hypertension', 'smoking_history'],
        threshold: 0.8,
        actions: ['call_911', 'aspirin_if_not_allergic', 'monitor_vitals']
      },
      stroke_indicators: {
        indicators: ['facial_drooping', 'arm_weakness', 'speech_difficulty', 'sudden_confusion'],
        risk_factors: ['age_over_65', 'atrial_fibrillation', 'previous_stroke'],
        threshold: 0.75,
        actions: ['immediate_emergency_transport', 'note_symptom_onset_time']
      },
      respiratory_emergency: {
        indicators: ['severe_difficulty_breathing', 'blue_lips', 'inability_to_speak'],
        risk_factors: ['asthma', 'copd', 'allergies', 'recent_illness'],
        threshold: 0.85,
        actions: ['emergency_services', 'upright_position', 'remove_triggers']
      },
      severe_allergic_reaction: {
        indicators: ['swelling', 'difficulty_breathing', 'rapid_pulse', 'dizziness'],
        risk_factors: ['known_allergies', 'recent_exposure', 'previous_reactions'],
        threshold: 0.9,
        actions: ['epinephrine_if_available', 'emergency_services', 'remove_allergen']
      }
    };

    const emergencyDetection = await Promise.all(
      Object.entries(emergencyPatterns).map(async ([type, pattern]) => {
        const score = await this.calculateEmergencyScore(symptoms, patientData, pattern);
        return {
          emergency_type: type,
          detection_score: score,
          meets_threshold: score >= pattern.threshold,
          immediate_actions: score >= pattern.threshold ? pattern.actions : [],
          confidence_level: await this.calculateDetectionConfidence(score, pattern)
        };
      })
    );

    const highestRiskEmergency = emergencyDetection
      .filter(detection => detection.meets_threshold)
      .sort((a, b) => b.detection_score - a.detection_score)[0];

    return {
      emergency_detected: !!highestRiskEmergency,
      primary_emergency: highestRiskEmergency,
      all_detections: emergencyDetection,
      immediate_protocol: highestRiskEmergency?.immediate_actions || [],
      escalation_required: !!highestRiskEmergency,
      emergency_contacts: highestRiskEmergency ? await this.getEmergencyContacts(patientData) : []
    };
  }
}

// Gerador Inteligente de Perguntas Clínicas
class ClinicalQuestionGenerator {
  constructor() {
    this.medicalKnowledgeBase = new MedicalKnowledgeBase();
    this.conversationAnalyzer = new ConversationAnalyzer();
    this.informationGapDetector = new InformationGapDetector();
    this.questionOptimizer = new QuestionOptimizer();
  }

  // Geração de perguntas de follow-up
  async generateFollowUpQuestions(currentSymptoms, conversationHistory, patientProfile) {
    const informationGaps = await this.identifyInformationGaps(
      currentSymptoms, 
      conversationHistory, 
      patientProfile
    );

    const questionCategories = {
      clarification_questions: await this.generateClarificationQuestions(informationGaps.unclear_symptoms),
      severity_assessment: await this.generateSeverityQuestions(informationGaps.severity_gaps),
      timeline_questions: await this.generateTimelineQuestions(informationGaps.temporal_gaps),
      associated_symptoms: await this.generateAssociatedSymptomQuestions(informationGaps.system_gaps),
      history_questions: await this.generateHistoryQuestions(informationGaps.history_gaps),
      medication_questions: await this.generateMedicationQuestions(informationGaps.medication_gaps)
    };

    const prioritizedQuestions = await this.prioritizeQuestions(questionCategories, currentSymptoms);
    
    return {
      next_question: prioritizedQuestions[0],
      question_sequence: prioritizedQuestions.slice(0, 5),
      question_rationale: await this.explainQuestionRationale(prioritizedQuestions[0]),
      estimated_completion: await this.estimateInterviewCompletion(informationGaps),
      alternative_questions: await this.generateAlternativeFormulations(prioritizedQuestions[0])
    };
  }

  // Geração de perguntas específicas por sintoma
  async generateSymptomSpecificQuestions(symptom, severity, patientAge) {
    const symptomQuestionMaps = {
      chest_pain: {
        location: [
          "Pode me mostrar exatamente onde é a dor no peito?",
          "A dor fica só em um lugar ou se espalha para outros locais?"
        ],
        character: [
          "Como você descreveria essa dor? É como uma pressão, queimação, facada ou aperto?",
          "A dor é constante ou vem em ondas?"
        ],
        radiation: [
          "A dor se espalha para o braço, pescoço, mandíbula ou costas?",
          "Você sente algum desconforto em outros lugares além do peito?"
        ],
        triggers: [
          "Havia alguma atividade específica quando a dor começou?",
          "A dor piora com movimento, respiração profunda ou ao tocar o local?"
        ]
      },
      headache: {
        location: [
          "Onde exatamente é a dor de cabeça? Frente, lado, atrás ou toda a cabeça?",
          "A dor fica sempre no mesmo lugar ou muda de local?"
        ],
        character: [
          "A dor é latejante, constante, em pontadas ou como uma pressão?",
          "Numa escala de 0 a 10, como você classificaria a intensidade?"
        ],
        associated_symptoms: [
          "Você tem enjoo, vômito ou sensibilidade à luz junto com a dor?",
          "Está com visão embaçada, tonturas ou outros sintomas?"
        ],
        pattern: [
          "É a primeira vez que tem uma dor de cabeça assim?",
          "Costuma ter dores de cabeça? Esta é diferente das habituais?"
        ]
      },
      abdominal_pain: {
        location: [
          "Pode apontar onde é a dor na barriga? É em cima, no meio, embaixo ou do lado?",
          "A dor começou em um lugar e depois se moveu para outro?"
        ],
        character: [
          "A dor é tipo cólica, queimação, pontada ou uma dor constante?",
          "A intensidade da dor varia ou permanece igual?"
        ],
        associated_symptoms: [
          "Tem enjoo, vômito, diarréia ou constipação junto com a dor?",
          "Notou mudanças no apetite, inchaço ou gases?"
        ],
        timing: [
          "A dor tem relação com as refeições? Piora ou melhora depois de comer?",
          "Quando foi a última vez que conseguiu evacuar normalmente?"
        ]
      }
    };

    const questions = symptomQuestionMaps[symptom] || {};
    const selectedQuestions = await this.selectOptimalQuestions(questions, severity, patientAge);
    
    return {
      primary_questions: selectedQuestions.primary,
      follow_up_questions: selectedQuestions.follow_up,
      age_appropriate_language: await this.adaptLanguageForAge(selectedQuestions, patientAge),
      cultural_considerations: await this.addCulturalConsiderations(selectedQuestions)
    };
  }

  // Adaptação de linguagem para diferentes perfis
  async adaptQuestionLanguage(question, patientProfile) {
    const adaptationFactors = {
      age_group: patientProfile.age_group, // pediatric, adult, elderly
      education_level: patientProfile.education_level, // basic, intermediate, advanced
      primary_language: patientProfile.primary_language,
      health_literacy: patientProfile.health_literacy_level,
      cultural_background: patientProfile.cultural_background,
      communication_preferences: patientProfile.communication_style
    };

    const adaptedVersions = {
      medical_terminology: await this.adjustMedicalTerminology(question, adaptationFactors),
      complexity_level: await this.adjustComplexity(question, adaptationFactors),
      cultural_sensitivity: await this.applyCulturalSensitivity(question, adaptationFactors),
      age_appropriateness: await this.makeAgeAppropriate(question, adaptationFactors),
      language_translation: await this.translateIfNeeded(question, adaptationFactors)
    };

    return {
      adapted_question: adaptedVersions.final_version,
      adaptation_reasoning: adaptedVersions.reasoning,
      alternative_formulations: adaptedVersions.alternatives,
      expected_comprehension_level: adaptedVersions.comprehension_score
    };
  }
}

// Workflow de Triagem Completa
class TriageWorkflowManager {
  constructor() {
    this.workflowEngine = new WorkflowEngine();
    this.decisionTree = new DecisionTree();
    this.protocolManager = new ProtocolManager();
    this.escalationManager = new EscalationManager();
  }

  // Workflow principal de triagem
  async executeTriageWorkflow(patientContact) {
    const workflow = {
      initial_assessment: {
        step: 1,
        action: 'collect_chief_complaint',
        next_step: 'symptom_analysis',
        timeout: '300_seconds',
        fallback: 'human_escalation'
      },
      symptom_analysis: {
        step: 2,
        action: 'analyze_symptoms_with_ai',
        next_step: 'urgency_classification',
        timeout: '60_seconds',
        fallback: 'symptom_analysis_fallback'
      },
      urgency_classification: {
        step: 3,
        action: 'classify_urgency_level',
        next_step: 'emergency_check',
        timeout: '30_seconds',
        fallback: 'default_urgent_classification'
      },
      emergency_check: {
        step: 4,
        action: 'detect_emergency_conditions',
        next_step: 'routing_decision',
        timeout: '15_seconds',
        fallback: 'emergency_protocol_activation'
      },
      routing_decision: {
        step: 5,
        action: 'determine_care_pathway',
        next_step: 'appointment_scheduling',
        timeout: '45_seconds',
        fallback: 'manual_routing'
      },
      appointment_scheduling: {
        step: 6,
        action: 'schedule_appropriate_care',
        next_step: 'confirmation_and_instructions',
        timeout: '120_seconds',
        fallback: 'waitlist_management'
      },
      confirmation_and_instructions: {
        step: 7,
        action: 'provide_care_instructions',
        next_step: 'monitoring_setup',
        timeout: '60_seconds',
        fallback: 'basic_instructions'
      },
      monitoring_setup: {
        step: 8,
        action: 'setup_patient_monitoring',
        next_step: 'workflow_completion',
        timeout: '30_seconds',
        fallback: 'manual_monitoring_setup'
      }
    };

    const executionResult = await this.executeWorkflowSteps(workflow, patientContact);
    
    return {
      workflow_id: executionResult.workflow_id,
      completion_status: executionResult.status,
      execution_time: executionResult.total_time,
      decision_points: executionResult.decisions,
      escalations: executionResult.escalations,
      final_recommendations: executionResult.recommendations,
      follow_up_requirements: executionResult.follow_up,
      quality_metrics: await this.calculateQualityMetrics(executionResult)
    };
  }

  // Integração com N8N para automação
  async integrateWithN8N() {
    const n8nWorkflows = {
      emergency_alert_workflow: {
        trigger: 'emergency_detected',
        actions: [
          'notify_emergency_team',
          'call_ambulance_if_needed',
          'alert_family_contacts',
          'prepare_emergency_room',
          'document_emergency_response'
        ]
      },
      routine_triage_workflow: {
        trigger: 'standard_triage_completion',
        actions: [
          'schedule_appointment',
          'send_confirmation',
          'add_to_patient_record',
          'setup_reminders',
          'notify_assigned_provider'
        ]
      },
      follow_up_workflow: {
        trigger: 'post_triage_monitoring',
        actions: [
          'monitor_symptom_progression',
          'send_check_in_messages',
          'escalate_if_worsening',
          'schedule_follow_up_if_needed',
          'update_care_plan'
        ]
      }
    };

    return this.setupN8NIntegration(n8nWorkflows);
  }
}

// Sistema de Agendamento Médico Inteligente
class IntelligentMedicalScheduling {
  constructor() {
    this.resourceManager = new ResourceManager();
    this.scheduleOptimizer = new ScheduleOptimizer();
    this.appointmentMatcher = new AppointmentMatcher();
    this.waitlistManager = new WaitlistManager();
    this.conflictResolver = new ConflictResolver();
    this.capacityPredictor = new CapacityPredictor();
  }

  // Agendamento principal otimizado
  async scheduleOptimalAppointment(patientRequest, triageResults) {
    const schedulingContext = {
      patient_profile: await this.getPatientProfile(patientRequest.patient_id),
      medical_requirements: this.extractMedicalRequirements(triageResults),
      urgency_level: triageResults.urgency_classification.urgency_level,
      specialty_needed: triageResults.specialty_recommendation,
      preferred_scheduling: patientRequest.preferences,
      insurance_constraints: await this.getInsuranceConstraints(patientRequest.patient_id)
    };

    const availabilityAnalysis = await this.analyzeAvailability(schedulingContext);
    const optimalSlots = await this.findOptimalTimeSlots(availabilityAnalysis, schedulingContext);
    
    if (optimalSlots.immediate_availability.length > 0) {
      return await this.bookImmediateAppointment(optimalSlots.immediate_availability[0], schedulingContext);
    } else {
      return await this.handleNoImmediateAvailability(optimalSlots, schedulingContext);
    }
  }

  // Análise de disponibilidade multi-dimensional
  async analyzeAvailability(schedulingContext) {
    const availabilityFactors = {
      provider_availability: await this.getProviderAvailability(
        schedulingContext.specialty_needed,
        schedulingContext.urgency_level
      ),
      resource_availability: await this.getResourceAvailability(
        schedulingContext.medical_requirements.equipment_needed,
        schedulingContext.medical_requirements.room_type
      ),
      capacity_constraints: await this.analyzeCapacityConstraints(
        schedulingContext.urgency_level,
        schedulingContext.specialty_needed
      ),
      insurance_network: await this.filterByInsuranceNetwork(
        schedulingContext.insurance_constraints
      ),
      patient_constraints: await this.analyzePatientConstraints(
        schedulingContext.patient_profile,
        schedulingContext.preferred_scheduling
      )
    };

    const compositeAvailability = await this.calculateCompositeAvailability(availabilityFactors);
    
    return {
      availability_score: compositeAvailability.score,
      bottleneck_analysis: compositeAvailability.bottlenecks,
      optimization_opportunities: compositeAvailability.opportunities,
      alternative_options: await this.generateAlternativeOptions(availabilityFactors),
      capacity_forecast: await this.forecastCapacityChanges(availabilityFactors)
    };
  }

  // Otimização de slots baseada em múltiplos critérios
  async findOptimalTimeSlots(availabilityAnalysis, schedulingContext) {
    const optimizationCriteria = {
      urgency_compliance: {
        weight: 0.4,
        requirement: this.getUrgencyTimeRequirement(schedulingContext.urgency_level)
      },
      provider_specialization_match: {
        weight: 0.25,
        requirement: this.getSpecializationRequirements(schedulingContext.specialty_needed)
      },
      patient_preference_alignment: {
        weight: 0.15,
        requirement: schedulingContext.preferred_scheduling
      },
      resource_optimization: {
        weight: 0.1,
        requirement: this.getResourceOptimizationGoals()
      },
      operational_efficiency: {
        weight: 0.1,
        requirement: this.getOperationalEfficiencyTargets()
      }
    };

    const timeSlotCandidates = await this.generateTimeSlotCandidates(
      availabilityAnalysis,
      schedulingContext,
      optimizationCriteria
    );

    const scoredSlots = await Promise.all(
      timeSlotCandidates.map(async (slot) => {
        const score = await this.scoreTimeSlot(slot, optimizationCriteria, schedulingContext);
        return { ...slot, optimization_score: score };
      })
    );

    const rankedSlots = scoredSlots
      .sort((a, b) => b.optimization_score.total_score - a.optimization_score.total_score)
      .slice(0, 10);

    return {
      immediate_availability: rankedSlots.filter(slot => slot.availability_type === 'immediate'),
      short_term_availability: rankedSlots.filter(slot => slot.availability_type === 'short_term'),
      future_availability: rankedSlots.filter(slot => slot.availability_type === 'future'),
      waitlist_opportunities: await this.identifyWaitlistOpportunities(rankedSlots),
      alternative_locations: await this.suggestAlternativeLocations(schedulingContext)
    };
  }

  // Gestão inteligente de lista de espera
  async manageIntelligentWaitlist(patientRequest, unavailableSlots) {
    const waitlistStrategy = {
      priority_calculation: await this.calculateWaitlistPriority(
        patientRequest.urgency_level,
        patientRequest.patient_profile,
        patientRequest.medical_requirements
      ),
      slot_monitoring: await this.setupSlotMonitoring(
        patientRequest.preferred_slots,
        patientRequest.acceptable_alternatives
      ),
      predictive_availability: await this.predictSlotAvailability(
        patientRequest.specialty_needed,
        patientRequest.urgency_level
      ),
      automated_notifications: await this.setupAutomatedNotifications(
        patientRequest.patient_id,
        patientRequest.communication_preferences
      )
    };

    const waitlistEntry = {
      patient_id: patientRequest.patient_id,
      request_timestamp: new Date().toISOString(),
      priority_score: waitlistStrategy.priority_calculation.score,
      monitoring_criteria: waitlistStrategy.slot_monitoring,
      expected_wait_time: waitlistStrategy.predictive_availability.estimated_wait,
      alternative_options: waitlistStrategy.predictive_availability.alternatives,
      notification_preferences: waitlistStrategy.automated_notifications,
      escalation_rules: await this.setupEscalationRules(patientRequest)
    };

    await this.addToWaitlist(waitlistEntry);
    await this.activateAutomatedMonitoring(waitlistEntry);

    return {
      waitlist_position: await this.getWaitlistPosition(waitlistEntry),
      estimated_availability: waitlistEntry.expected_wait_time,
      monitoring_active: true,
      alternative_recommendations: waitlistEntry.alternative_options,
      next_update_schedule: await this.calculateNextUpdateTime(waitlistEntry)
    };
  }
}

// Otimização de Recursos Médicos
class MedicalResourceOptimizer {
  constructor() {
    this.capacityManager = new CapacityManager();
    this.resourceAllocator = new ResourceAllocator();
    this.efficiencyAnalyzer = new EfficiencyAnalyzer();
    this.demandPredictor = new DemandPredictor();
  }

  // Otimização de capacidade em tempo real
  async optimizeCapacityAllocation(currentSchedule, demandForecast) {
    const resourceAnalysis = {
      current_utilization: await this.analyzeCurrentUtilization(),
      capacity_bottlenecks: await this.identifyBottlenecks(),
      demand_patterns: await this.analyzeDemandPatterns(),
      resource_constraints: await this.getResourceConstraints(),
      optimization_opportunities: await this.identifyOptimizationOpportunities()
    };

    const optimizationStrategies = {
      dynamic_scheduling: {
        flex_appointment_slots: await this.createFlexibleSlots(resourceAnalysis),
        overflow_capacity: await this.setupOverflowCapacity(resourceAnalysis),
        cross_training_utilization: await this.optimizeCrossTrainedStaff(resourceAnalysis),
        telemedicine_integration: await this.optimizeTelemedicineSlots(resourceAnalysis)
      },
      predictive_adjustments: {
        demand_based_scaling: await this.setupDemandBasedScaling(demandForecast),
        seasonal_capacity_planning: await this.planSeasonalCapacity(demandForecast),
        emergency_reserve_management: await this.manageEmergencyReserves(demandForecast),
        resource_pooling: await this.optimizeResourcePooling(demandForecast)
      },
      efficiency_improvements: {
        appointment_duration_optimization: await this.optimizeAppointmentDurations(),
        no_show_prediction_mitigation: await this.mitigateNoShows(),
        cancellation_recovery: await this.optimizeCancellationRecovery(),
        workflow_streamlining: await this.streamlineWorkflows()
      }
    };

    return this.implementOptimizationStrategies(optimizationStrategies, resourceAnalysis);
  }

  // Previsão de demanda por IA
  async predictMedicalDemand(timeframe = '30_days') {
    const demandFactors = {
      historical_patterns: await this.analyzeHistoricalDemand(),
      seasonal_factors: await this.identifySeasonalFactors(),
      external_factors: await this.analyzeExternalFactors(),
      demographic_trends: await this.analyzeDemographicTrends(),
      health_trends: await this.analyzeHealthTrends()
    };

    const predictionModels = {
      time_series_model: await this.runTimeSeriesAnalysis(demandFactors),
      machine_learning_model: await this.runMLPrediction(demandFactors),
      epidemiological_model: await this.runEpidemiologicalAnalysis(demandFactors),
      economic_impact_model: await this.analyzeEconomicImpacts(demandFactors)
    };

    const ensemblePrediction = await this.createEnsemblePrediction(predictionModels);

    return {
      demand_forecast: ensemblePrediction.prediction,
      confidence_intervals: ensemblePrediction.confidence,
      key_drivers: ensemblePrediction.drivers,
      risk_scenarios: await this.generateRiskScenarios(ensemblePrediction),
      capacity_recommendations: await this.generateCapacityRecommendations(ensemblePrediction),
      strategic_planning: await this.generateStrategicRecommendations(ensemblePrediction)
    };
  }

  // Gestão de conflitos de agendamento
  async resolveSchedulingConflicts(conflictingAppointments) {
    const conflictResolutionStrategies = {
      priority_based_resolution: {
        medical_urgency: (apt1, apt2) => this.compareUrgencyLevels(apt1, apt2),
        patient_vulnerability: (apt1, apt2) => this.compareVulnerabilityScores(apt1, apt2),
        appointment_age: (apt1, apt2) => this.compareAppointmentAge(apt1, apt2),
        insurance_priority: (apt1, apt2) => this.compareInsurancePriority(apt1, apt2)
      },
      alternative_solutions: {
        provider_substitution: await this.findAlternativeProviders(conflictingAppointments),
        time_slot_adjustment: await this.findAlternativeTimeSlots(conflictingAppointments),
        service_modification: await this.modifyServiceDelivery(conflictingAppointments),
        location_alternatives: await this.findAlternativeLocations(conflictingAppointments)
      },
      compensation_strategies: {
        expedited_scheduling: await this.offerExpeditedRescheduling(conflictingAppointments),
        additional_services: await this.offerAdditionalServices(conflictingAppointments),
        preference_accommodation: await this.accommodateSpecialPreferences(conflictingAppointments),
        follow_up_prioritization: await this.prioritizeFollowUp(conflictingAppointments)
      }
    };

    const resolutionPlan = await this.developResolutionPlan(
      conflictingAppointments,
      conflictResolutionStrategies
    );

    return {
      resolution_strategy: resolutionPlan.chosen_strategy,
      affected_appointments: resolutionPlan.appointment_changes,
      patient_communications: resolutionPlan.communication_plan,
      compensation_offers: resolutionPlan.compensation_package,
      future_conflict_prevention: resolutionPlan.prevention_measures
    };
  }
}

// Integração com Sistemas Hospitalares
class HospitalSystemIntegration {
  constructor() {
    this.hisConnector = new HISConnector();
    this.ehrIntegrator = new EHRIntegrator();
    this.billingSystem = new BillingSystemConnector();
    this.inventoryManager = new InventoryManager();
  }

  // Integração com HIS (Hospital Information System)
  async integrateWithHIS() {
    const hisIntegration = {
      patient_management: {
        patient_registration: await this.setupPatientRegistrationSync(),
        demographic_updates: await this.setupDemographicSync(),
        insurance_verification: await this.setupInsuranceVerificationSync(),
        medical_record_access: await this.setupMedicalRecordAccess()
      },
      scheduling_integration: {
        appointment_synchronization: await this.setupAppointmentSync(),
        provider_schedule_sync: await this.setupProviderScheduleSync(),
        resource_availability_sync: await this.setupResourceSync(),
        waiting_room_management: await this.setupWaitingRoomSync()
      },
      clinical_workflows: {
        order_management: await this.setupOrderManagementSync(),
        result_delivery: await this.setupResultDeliverySync(),
        care_team_coordination: await this.setupCareTeamSync(),
        clinical_documentation: await this.setupClinicalDocumentationSync()
      },
      billing_integration: {
        charge_capture: await this.setupChargeCaptureSync(),
        insurance_claims: await this.setupInsuranceClaimsSync(),
        payment_processing: await this.setupPaymentProcessingSync(),
        financial_reporting: await this.setupFinancialReportingSync()
      }
    };

    return this.activateHISIntegration(hisIntegration);
  }

  // Sincronização de dados em tempo real
  async setupRealTimeSync() {
    const syncConfiguration = {
      data_streams: {
        appointment_updates: {
          source: 'whatsapp_scheduling_system',
          destination: 'hospital_his',
          frequency: 'real_time',
          conflict_resolution: 'hospital_his_priority'
        },
        patient_communications: {
          source: 'whatsapp_bot',
          destination: 'patient_portal',
          frequency: 'real_time',
          privacy_filters: 'hipaa_compliant'
        },
        clinical_updates: {
          source: 'hospital_ehr',
          destination: 'whatsapp_system',
          frequency: 'triggered',
          triggers: ['new_results', 'care_plan_updates', 'medication_changes']
        },
        resource_availability: {
          source: 'resource_management_system',
          destination: 'whatsapp_scheduling',
          frequency: 'every_5_minutes',
          cache_strategy: 'intelligent_caching'
        }
      },
      error_handling: {
        retry_policies: await this.setupRetryPolicies(),
        fallback_mechanisms: await this.setupFallbackMechanisms(),
        data_integrity_checks: await this.setupIntegrityChecks(),
        audit_logging: await this.setupAuditLogging()
      }
    };

    return this.implementRealTimeSync(syncConfiguration);
  }

  // N8N workflow para automação hospitalar
  async setupHospitalAutomationWorkflows() {
    const n8nWorkflows = {
      appointment_lifecycle: {
        trigger: 'appointment_scheduled',
        workflow: [
          'validate_insurance_eligibility',
          'check_provider_availability',
          'reserve_required_resources',
          'send_appointment_confirmation',
          'create_hospital_record',
          'setup_reminder_schedule',
          'prepare_clinical_workspace'
        ]
      },
      pre_appointment_preparation: {
        trigger: 'appointment_24_hours_before',
        workflow: [
          'send_preparation_instructions',
          'verify_insurance_status',
          'check_medication_list',
          'prepare_clinical_documentation',
          'alert_care_team',
          'prepare_equipment_if_needed'
        ]
      },
      post_appointment_followup: {
        trigger: 'appointment_completed',
        workflow: [
          'capture_clinical_notes',
          'process_billing_charges',
          'schedule_follow_up_if_needed',
          'send_care_instructions',
          'update_care_plan',
          'trigger_medication_reminders',
          'setup_monitoring_protocols'
        ]
      },
      emergency_escalation: {
        trigger: 'emergency_detected_in_triage',
        workflow: [
          'alert_emergency_team',
          'prepare_emergency_bay',
          'notify_family_contacts',
          'activate_emergency_protocols',
          'coordinate_with_ambulance',
          'prepare_necessary_equipment',
          'alert_specialist_if_needed'
        ]
      }
    };

    return this.deployN8NWorkflows(n8nWorkflows);
  }
}

// Sistema de Lembretes Médicos Inteligentes
class IntelligentMedicalReminders {
  constructor() {
    this.reminderEngine = new ReminderEngine();
    this.personalizationEngine = new PersonalizationEngine();
    this.adherenceTracker = new AdherenceTracker();
    this.behaviorAnalyzer = new BehaviorAnalyzer();
    this.notificationOptimizer = new NotificationOptimizer();
    this.escalationManager = new EscalationManager();
  }

  // Sistema principal de lembretes personalizados
  async initializePatientReminderSystem(patientProfile, treatmentPlan) {
    const reminderConfiguration = {
      patient_context: await this.analyzePatientContext(patientProfile),
      treatment_requirements: await this.extractTreatmentRequirements(treatmentPlan),
      behavior_patterns: await this.analyzeBehaviorPatterns(patientProfile.id),
      communication_preferences: await this.getCommuncationPreferences(patientProfile),
      adherence_history: await this.getAdherenceHistory(patientProfile.id),
      risk_factors: await this.assessRiskFactors(patientProfile, treatmentPlan)
    };

    const reminderTypes = {
      medication_reminders: await this.setupMedicationReminders(reminderConfiguration),
      appointment_reminders: await this.setupAppointmentReminders(reminderConfiguration),
      lifestyle_reminders: await this.setupLifestyleReminders(reminderConfiguration),
      monitoring_reminders: await this.setupMonitoringReminders(reminderConfiguration),
      preventive_care_reminders: await this.setupPreventiveCareReminders(reminderConfiguration),
      follow_up_reminders: await this.setupFollowUpReminders(reminderConfiguration)
    };

    return this.activatePersonalizedReminderSystem(reminderTypes, reminderConfiguration);
  }

  // Lembretes de medicação com adaptação comportamental
  async setupAdaptiveMedicationReminders(medicationSchedule, patientBehavior) {
    const medicationContext = {
      medication_details: await this.analyzeMedicationComplexity(medicationSchedule),
      timing_optimization: await this.optimizeMedicationTiming(medicationSchedule, patientBehavior),
      adherence_barriers: await this.identifyAdherenceBarriers(patientBehavior),
      motivation_factors: await this.identifyMotivationFactors(patientBehavior),
      social_support: await this.assessSocialSupport(patientBehavior)
    };

    const adaptiveStrategies = {
      personalized_timing: {
        optimal_windows: await this.calculateOptimalTimeWindows(medicationContext),
        lifestyle_integration: await this.integrateWithLifestyle(medicationContext),
        reminder_frequency: await this.optimizeReminderFrequency(medicationContext),
        flexibility_rules: await this.createFlexibilityRules(medicationContext)
      },
      behavioral_reinforcement: {
        positive_reinforcement: await this.setupPositiveReinforcement(medicationContext),
        habit_formation: await this.supportHabitFormation(medicationContext),
        barrier_mitigation: await this.mitigateBarriers(medicationContext),
        social_accountability: await this.leverageSocialSupport(medicationContext)
      },
      adaptive_messaging: {
        tone_adaptation: await this.adaptMessageTone(medicationContext),
        content_personalization: await this.personalizeContent(medicationContext),
        urgency_calibration: await this.calibrateUrgency(medicationContext),
        channel_optimization: await this.optimizeChannels(medicationContext)
      }
    };

    return this.implementAdaptiveMedicationReminders(adaptiveStrategies, medicationContext);
  }

  // Sistema de escalação inteligente
  async setupIntelligentEscalation(patientId, reminderType, missedReminders) {
    const escalationContext = {
      patient_risk_profile: await this.assessPatientRisk(patientId),
      adherence_history: await this.getAdherenceHistory(patientId),
      support_network: await this.getSupportNetwork(patientId),
      clinical_consequences: await this.assessClinicalConsequences(reminderType, missedReminders),
      intervention_options: await this.getInterventionOptions(patientId, reminderType)
    };

    const escalationLevels = {
      level_1_gentle_nudge: {
        trigger: 'first_missed_reminder',
        actions: [
          'send_gentle_reminder',
          'offer_alternative_time',
          'provide_easy_action_button',
          'share_motivational_content'
        ],
        timing: 'immediate_to_2_hours'
      },
      level_2_increased_engagement: {
        trigger: 'second_missed_reminder',
        actions: [
          'send_personalized_message',
          'highlight_health_benefits',
          'offer_support_resources',
          'suggest_habit_linking'
        ],
        timing: '2_to_6_hours'
      },
      level_3_support_activation: {
        trigger: 'third_missed_reminder',
        actions: [
          'notify_care_team',
          'engage_family_support',
          'offer_pharmacy_consultation',
          'schedule_adherence_counseling'
        ],
        timing: '6_to_12_hours'
      },
      level_4_clinical_intervention: {
        trigger: 'critical_adherence_failure',
        actions: [
          'alert_prescribing_physician',
          'schedule_urgent_consultation',
          'activate_case_management',
          'consider_medication_adjustment'
        ],
        timing: '12_to_24_hours'
      }
    };

    return this.activateEscalationProtocol(escalationLevels, escalationContext);
  }
}

// Otimização de Notificações por IA
class AINotificationOptimizer {
  constructor() {
    this.timingOptimizer = new TimingOptimizer();
    this.contentPersonalizer = new ContentPersonalizer();
    this.channelSelector = new ChannelSelector();
    this.engagementPredictor = new EngagementPredictor();
    this.fatigueDetector = new FatigueDetector();
  }

  // Otimização de timing baseada em comportamento
  async optimizeNotificationTiming(patientId, notificationType) {
    const behaviorAnalysis = {
      activity_patterns: await this.analyzeActivityPatterns(patientId),
      response_patterns: await this.analyzeResponsePatterns(patientId),
      device_usage_patterns: await this.analyzeDeviceUsage(patientId),
      lifestyle_rhythm: await this.analyzeLifestyleRhythm(patientId),
      work_schedule: await this.analyzeWorkSchedule(patientId),
      sleep_patterns: await this.analyzeSleepPatterns(patientId)
    };

    const timingStrategies = {
      circadian_alignment: {
        morning_peak: await this.identifyMorningOptimalWindow(behaviorAnalysis),
        afternoon_peak: await this.identifyAfternoonOptimalWindow(behaviorAnalysis),
        evening_peak: await this.identifyEveningOptimalWindow(behaviorAnalysis),
        weekend_patterns: await this.identifyWeekendPatterns(behaviorAnalysis)
      },
      context_awareness: {
        work_hours_avoidance: await this.identifyWorkHoursToAvoid(behaviorAnalysis),
        meal_time_integration: await this.integrateMealTimes(behaviorAnalysis),
        commute_time_utilization: await this.utilizeMobilityWindows(behaviorAnalysis),
        social_activity_consideration: await this.considerSocialActivities(behaviorAnalysis)
      },
      adaptive_learning: {
        response_time_analysis: await this.analyzeResponseTimes(behaviorAnalysis),
        engagement_correlation: await this.correlateEngagementWithTiming(behaviorAnalysis),
        seasonal_adjustments: await this.makeSeasonalAdjustments(behaviorAnalysis),
        life_event_adaptations: await this.adaptToLifeEvents(behaviorAnalysis)
      }
    };

    const optimalTiming = await this.calculateOptimalTiming(timingStrategies, notificationType);

    return {
      recommended_times: optimalTiming.primary_windows,
      backup_times: optimalTiming.fallback_windows,
      timing_confidence: optimalTiming.confidence_score,
      adaptation_triggers: optimalTiming.adaptation_rules,
      monitoring_metrics: optimalTiming.success_metrics
    };
  }

  // Personalização de conteúdo adaptativa
  async personalizeNotificationContent(patientProfile, notificationContext) {
    const personalizationFactors = {
      communication_style: await this.identifyCommuncationStyle(patientProfile),
      motivation_drivers: await this.identifyMotivationDrivers(patientProfile),
      health_literacy_level: await this.assessHealthLiteracy(patientProfile),
      cultural_considerations: await this.analyzeCulturalFactors(patientProfile),
      emotional_state: await this.assessEmotionalState(patientProfile),
      stress_levels: await this.assessStressLevels(patientProfile)
    };

    const contentStrategies = {
      tone_adaptation: {
        formal_vs_casual: this.selectToneFormality(personalizationFactors),
        encouraging_vs_directive: this.selectMotivationalApproach(personalizationFactors),
        detailed_vs_brief: this.selectInformationDensity(personalizationFactors),
        technical_vs_simple: this.selectComplexityLevel(personalizationFactors)
      },
      message_structure: {
        opening_personalization: await this.craftPersonalizedOpening(personalizationFactors),
        core_message_framing: await this.frameCoreMeesage(personalizationFactors, notificationContext),
        call_to_action_optimization: await this.optimizeCallToAction(personalizationFactors),
        emotional_appeal_integration: await this.integrateEmotionalAppeal(personalizationFactors)
      },
      content_enrichment: {
        relevant_examples: await this.addRelevantExamples(personalizationFactors),
        visual_elements: await this.selectVisualElements(personalizationFactors),
        interactive_components: await this.addInteractiveElements(personalizationFactors),
        gamification_elements: await this.addGamificationIfAppropriate(personalizationFactors)
      }
    };

    return this.generatePersonalizedContent(contentStrategies, notificationContext);
  }

  // Detecção e prevenção de fadiga de notificação
  async manageNotificationFatigue(patientId) {
    const fatigueAnalysis = {
      notification_volume: await this.analyzeNotificationVolume(patientId),
      response_rate_trends: await this.analyzeResponseTrends(patientId),
      engagement_quality: await this.analyzeEngagementQuality(patientId),
      opt_out_signals: await this.detectOptOutSignals(patientId),
      feedback_indicators: await this.analyzeFeedbackIndicators(patientId)
    };

    const fatigueIndicators = {
      declining_response_rate: fatigueAnalysis.response_rate_trends.slope < -0.1,
      increasing_response_delay: fatigueAnalysis.response_rate_trends.delay_increase > 0.2,
      negative_feedback: fatigueAnalysis.feedback_indicators.negative_score > 0.3,
      reduced_engagement: fatigueAnalysis.engagement_quality.score < 0.5,
      high_volume_exposure: fatigueAnalysis.notification_volume.daily_count > 8
    };

    const antiFeatureStrategies = {
      volume_optimization: {
        intelligent_consolidation: await this.consolidateRelatedNotifications(patientId),
        priority_filtering: await this.implementPriorityFiltering(patientId),
        timing_spacing: await this.optimizeTimingSpacing(patientId),
        channel_diversification: await this.diversifyChannels(patientId)
      },
      engagement_recovery: {
        content_refresh: await this.refreshContentApproach(patientId),
        format_variation: await this.varyNotificationFormats(patientId),
        personalization_enhancement: await this.enhancePersonalization(patientId),
        break_periods: await this.scheduleEngagementBreaks(patientId)
      },
      feedback_integration: {
        preference_updates: await this.updateBasedOnPreferences(patientId),
        timing_adjustments: await this.adjustBasedOnFeedback(patientId),
        content_modifications: await this.modifyContentBasedOnFeedback(patientId),
        proactive_surveys: await this.conductPreferenceSurveys(patientId)
      }
    };

    return this.implementAntiFatigueStrategy(antiFeatureStrategies, fatigueAnalysis);
  }
}

// Integração com Workflows de Saúde
class HealthWorkflowIntegration {
  constructor() {
    this.workflowOrchestrator = new WorkflowOrchestrator();
    this.careTeamNotifier = new CareTeamNotifier();
    this.patientEngagementTracker = new PatientEngagementTracker();
    this.outcomesMeasurer = new OutcomesMeasurer();
  }

  // Workflows de lembretes integrados com N8N
  async setupN8NHealthReminderWorkflows() {
    const healthWorkflows = {
      medication_adherence_workflow: {
        trigger: 'medication_time_reached',
        workflow_steps: [
          'check_patient_availability',
          'send_personalized_reminder',
          'track_response_status',
          'escalate_if_missed',
          'update_adherence_record',
          'analyze_patterns',
          'adjust_future_reminders'
        ],
        success_criteria: 'medication_taken_confirmation',
        failure_handling: 'escalation_protocol_activation'
      },
      appointment_preparation_workflow: {
        trigger: 'appointment_24h_before',
        workflow_steps: [
          'send_preparation_checklist',
          'confirm_insurance_validity',
          'remind_required_documents',
          'provide_location_directions',
          'offer_transportation_assistance',
          'send_final_confirmation_request'
        ],
        success_criteria: 'preparation_completed_confirmation',
        failure_handling: 'care_coordinator_notification'
      },
      chronic_disease_monitoring_workflow: {
        trigger: 'monitoring_schedule_due',
        workflow_steps: [
          'request_vitals_measurement',
          'provide_measurement_instructions',
          'collect_patient_data',
          'analyze_values_against_baselines',
          'alert_if_abnormal_values',
          'schedule_follow_up_if_needed',
          'update_clinical_record'
        ],
        success_criteria: 'values_recorded_and_normal',
        failure_handling: 'clinical_team_immediate_alert'
      },
      preventive_care_workflow: {
        trigger: 'preventive_care_due',
        workflow_steps: [
          'identify_due_screenings',
          'send_educational_content',
          'offer_scheduling_assistance',
          'provide_insurance_coverage_info',
          'send_preparation_instructions',
          'confirm_appointment_completion'
        ],
        success_criteria: 'preventive_care_completed',
        failure_handling: 'rescheduling_assistance_offer'
      }
    };

    return this.deployHealthWorkflows(healthWorkflows);
  }

  // Monitoramento de aderência em tempo real
  async implementRealTimeAdherenceMonitoring(patientId) {
    const monitoringSystem = {
      data_collection: {
        self_reported_adherence: await this.setupSelfReporting(patientId),
        pharmacy_refill_tracking: await this.trackPharmacyRefills(patientId),
        device_integration: await this.integrateSmartDevices(patientId),
        care_team_observations: await this.collectCareTeamObservations(patientId)
      },
      real_time_analysis: {
        adherence_scoring: await this.implementAdherenceScoring(patientId),
        pattern_recognition: await this.setupPatternRecognition(patientId),
        risk_stratification: await this.implementRiskStratification(patientId),
        intervention_triggering: await this.setupInterventionTriggers(patientId)
      },
      adaptive_interventions: {
        micro_interventions: await this.setupMicroInterventions(patientId),
        personalized_coaching: await this.setupPersonalizedCoaching(patientId),
        social_support_activation: await this.activateSocialSupport(patientId),
        clinical_escalation: await this.setupClinicalEscalation(patientId)
      },
      outcome_tracking: {
        clinical_outcomes: await this.trackClinicalOutcomes(patientId),
        quality_of_life: await this.trackQualityOfLife(patientId),
        healthcare_utilization: await this.trackHealthcareUtilization(patientId),
        cost_effectiveness: await this.trackCostEffectiveness(patientId)
      }
    };

    return this.activateRealTimeMonitoring(monitoringSystem);
  }

  // Integração com equipe de cuidados
  async integrateCareTeamNotifications(patientId, reminderEvents) {
    const careTeamIntegration = {
      team_identification: await this.identifyCareTeam(patientId),
      notification_preferences: await this.getCareTeamPreferences(patientId),
      escalation_hierarchies: await this.defineCareTeamHierarchies(patientId),
      communication_protocols: await this.establishCommunicationProtocols(patientId)
    };

    const notificationTypes = {
      adherence_alerts: {
        recipients: ['primary_care_physician', 'case_manager'],
        triggers: ['missed_medications', 'declined_adherence_trend'],
        urgency: 'medium',
        required_actions: ['patient_outreach', 'adherence_assessment']
      },
      clinical_concern_alerts: {
        recipients: ['prescribing_physician', 'clinical_pharmacist'],
        triggers: ['adverse_effects_reported', 'contraindication_detected'],
        urgency: 'high',
        required_actions: ['immediate_review', 'medication_adjustment']
      },
      engagement_alerts: {
        recipients: ['care_coordinator', 'patient_educator'],
        triggers: ['low_engagement_score', 'communication_breakdown'],
        urgency: 'low',
        required_actions: ['engagement_strategy_review', 'communication_optimization']
      },
      outcome_alerts: {
        recipients: ['care_team_lead', 'quality_improvement_team'],
        triggers: ['poor_clinical_outcomes', 'quality_metrics_decline'],
        urgency: 'medium',
        required_actions: ['care_plan_review', 'intervention_adjustment']
      }
    };

    return this.implementCareTeamIntegration(careTeamIntegration, notificationTypes);
  }
}

// Sistema de Telemedicina Integrada via WhatsApp
class IntegratedTelemedicineSystem {
  constructor() {
    this.consultationManager = new ConsultationManager();
    this.secureVideoEngine = new SecureVideoEngine();
    this.digitalPrescriptionSystem = new DigitalPrescriptionSystem();
    this.vitalSignsMonitor = new VitalSignsMonitor();
    this.clinicalDocumenter = new ClinicalDocumenter();
    this.qualityAssurance = new QualityAssurance();
  }

  async initializeTelemedicinePlatform() {
    const platformConfiguration = {
      security_framework: {
        encryption_standards: 'FIPS-140-2-Level-3',
        authentication: 'multi_factor_with_biometrics',
        session_management: 'zero_trust_architecture',
        audit_logging: 'comprehensive_hipaa_compliant',
        data_sovereignty: 'jurisdiction_aware'
      },
      clinical_capabilities: {
        video_consultation: await this.setupSecureVideoSessions(),
        digital_stethoscope_integration: await this.integrateDigitalDevices(),
        prescription_management: await this.setupDigitalPrescriptions(),
        vital_signs_monitoring: await this.setupRemoteMonitoring(),
        clinical_photography: await this.setupSecureClinicalImaging()
      }
    };

    return this.activateTelemedicinePlatform(platformConfiguration);
  }

  async manageSecureVirtualConsultation(consultationRequest) {
    const consultationSetup = {
      pre_consultation: {
        identity_verification: await this.verifyPatientIdentity(consultationRequest.patient_id),
        consent_validation: await this.validateTelemedicineConsent(consultationRequest.patient_id),
        technical_readiness: await this.assessTechnicalReadiness(consultationRequest.patient_id)
      },
      during_consultation: {
        secure_communication: await this.establishSecureCommunication(consultationRequest),
        clinical_documentation: await this.enableRealTimeDocumentation(consultationRequest),
        diagnostic_tools: await this.provideDigitalDiagnosticTools(consultationRequest)
      },
      post_consultation: {
        documentation_completion: await this.completeConsultationDocumentation(consultationRequest),
        prescription_delivery: await this.deliverDigitalPrescriptions(consultationRequest),
        follow_up_scheduling: await this.scheduleFollowUpIfNeeded(consultationRequest)
      }
    };

    return this.executeSecureConsultation(consultationSetup);
  }
}

// Sistema de Prescrição Digital Segura
class DigitalPrescriptionSystem {
  constructor() {
    this.prescriptionEngine = new PrescriptionEngine();
    this.drugInteractionChecker = new DrugInteractionChecker();
    this.pharmacyNetworkConnector = new PharmacyNetworkConnector();
    this.insuranceValidator = new InsuranceValidator();
    this.complianceManager = new ComplianceManager();
  }

  async generateSecureDigitalPrescription(prescriptionData, consultationContext) {
    const prescriptionValidation = {
      prescriber_verification: await this.verifyPrescriberCredentials(prescriptionData.prescriber_id),
      patient_verification: await this.verifyPatientIdentity(prescriptionData.patient_id),
      medication_validation: await this.validateMedicationDetails(prescriptionData.medications),
      interaction_analysis: await this.analyzeInteractions(prescriptionData, consultationContext),
      allergy_screening: await this.screenForAllergies(prescriptionData, consultationContext)
    };

    const prescriptionGeneration = {
      digital_signature: await this.applyDigitalSignature(prescriptionData, prescriptionValidation),
      blockchain_verification: await this.recordOnBlockchain(prescriptionData),
      tamper_protection: await this.applyTamperProtection(prescriptionData),
      encryption: await this.encryptPrescriptionData(prescriptionData)
    };

    const pharmacyIntegration = {
      preferred_pharmacy: await this.identifyPreferredPharmacy(prescriptionData.patient_id),
      insurance_coverage: await this.validateInsuranceCoverage(prescriptionData),
      alternative_medications: await this.identifyAlternatives(prescriptionData),
      delivery_options: await this.identifyDeliveryOptions(prescriptionData)
    };

    return this.generateAndDeliverPrescription(
      prescriptionData,
      prescriptionValidation,
      prescriptionGeneration,
      pharmacyIntegration
    );
  }

  async setupMedicationAdherenceMonitoring(prescriptionId, patientId) {
    const adherenceSystem = {
      smart_packaging_integration: {
        smart_pill_bottles: await this.integrateSmartBottles(prescriptionId),
        blister_pack_sensors: await this.integrateBlisterPackSensors(prescriptionId),
        medication_dispensers: await this.integrateAutomatedDispensers(prescriptionId)
      },
      behavioral_monitoring: {
        refill_pattern_analysis: await this.analyzeRefillPatterns(patientId),
        timing_adherence: await this.monitorTimingAdherence(patientId),
        side_effect_reporting: await this.setupSideEffectReporting(patientId)
      }
    };

    return this.activateAdherenceMonitoring(adherenceSystem);
  }
}

// Sistema de Garantia de Qualidade em Telemedicina
class TelemedicineQualityAssurance {
  constructor() {
    this.qualityMetricsCollector = new QualityMetricsCollector();
    this.outcomeTracker = new OutcomeTracker();
    this.satisfactionAnalyzer = new SatisfactionAnalyzer();
    this.clinicalAuditor = new ClinicalAuditor();
    this.continuousImprovement = new ContinuousImprovement();
  }

  async setupClinicalQualityMonitoring() {
    const qualityFramework = {
      clinical_outcome_metrics: {
        diagnostic_accuracy: await this.trackDiagnosticAccuracy(),
        treatment_effectiveness: await this.trackTreatmentEffectiveness(),
        patient_safety_incidents: await this.trackSafetyIncidents(),
        medication_errors: await this.trackMedicationErrors()
      },
      process_quality_metrics: {
        consultation_completion_rate: await this.trackConsultationCompletion(),
        technical_issue_frequency: await this.trackTechnicalIssues(),
        appointment_adherence: await this.trackAppointmentAdherence(),
        documentation_completeness: await this.trackDocumentationQuality()
      },
      patient_experience_metrics: {
        satisfaction_scores: await this.trackSatisfactionScores(),
        ease_of_use_ratings: await this.trackEaseOfUse(),
        technical_support_satisfaction: await this.trackSupportSatisfaction(),
        communication_quality: await this.trackCommunicationQuality()
      }
    };

    return this.implementQualityMonitoring(qualityFramework);
  }

  async performAutomatedConsultationAudit(consultationId) {
    const auditCriteria = {
      clinical_documentation: {
        completeness_score: await this.assessDocumentationCompleteness(consultationId),
        accuracy_score: await this.assessDocumentationAccuracy(consultationId),
        timeliness_score: await this.assessDocumentationTimeliness(consultationId)
      },
      clinical_decision_making: {
        evidence_based_decisions: await this.assessEvidenceBasedDecisions(consultationId),
        guideline_adherence: await this.assessGuidelineAdherence(consultationId),
        treatment_appropriateness: await this.assessTreatmentAppropriateness(consultationId)
      },
      technical_performance: {
        video_quality: await this.assessVideoQuality(consultationId),
        audio_quality: await this.assessAudioQuality(consultationId),
        connection_stability: await this.assessConnectionStability(consultationId)
      }
    };

    const auditResults = await this.generateAuditReport(auditCriteria, consultationId);
    
    return {
      audit_score: auditResults.overall_score,
      detailed_assessment: auditResults.detailed_scores,
      improvement_areas: auditResults.areas_for_improvement,
      recommendations: await this.generateImprovementRecommendations(auditResults)
    };
  }
}