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feat: mode hybride Ollama — gemma3:27b pour CPAM, 12b pour codage

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Le pipeline utilise désormais gemma3:12b (rapide) pour le codage CIM-10
et gemma3:27b (meilleur raisonnement) pour la contre-argumentation CPAM.
Configurable via OLLAMA_MODEL_CPAM et OLLAMA_TIMEOUT_CPAM.

Inclut aussi : traçabilité source/page DAS, niveaux CMA ATIH, sévérité,
page tracker PDF, améliorations fusion et filtres DAS.

Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>
This commit is contained in:
dom
2026-02-17 17:53:53 +01:00
parent 4ef42dd3d3
commit 01d47f3c4b
20 changed files with 1025 additions and 98 deletions
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20
src/medical/fusion.py
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@@ -17,6 +17,8 @@ from ..config import (
Sejour,
Traitement,
)
from ..medical.das_filter import is_valid_diagnostic_text, apply_semantic_dedup
from ..medical.cim10_extractor import _is_dp_family_redundant
logger = logging.getLogger(__name__)
@@ -163,6 +165,14 @@ def merge_dossiers(dossiers: list[DossierMedical]) -> DossierMedical:
if len(dossiers) == 1:
result = dossiers[0].model_copy(deep=True)
result.source_files = [result.source_file]
# Appliquer la dédup famille DP + sémantique même pour un seul dossier
dp_code = result.diagnostic_principal.cim10_suggestion if result.diagnostic_principal else None
if dp_code:
result.diagnostics_associes = [
d for d in result.diagnostics_associes
if not d.cim10_suggestion or not _is_dp_family_redundant(d.cim10_suggestion, dp_code)
]
result.diagnostics_associes = apply_semantic_dedup(result.diagnostics_associes)
return result
merged = DossierMedical()
@@ -181,23 +191,29 @@ def merge_dossiers(dossiers: list[DossierMedical]) -> DossierMedical:
for d in dossiers:
all_das.extend(d.diagnostics_associes)
# Si le DP de ce dossier est différent du DP fusionné, l'ajouter comme DAS
# mais seulement si le texte est un diagnostic valide (filtre artefacts OCR)
if (
d.diagnostic_principal
and merged.diagnostic_principal
and d.diagnostic_principal.cim10_suggestion
!= merged.diagnostic_principal.cim10_suggestion
and is_valid_diagnostic_text(d.diagnostic_principal.texte)
):
all_das.append(d.diagnostic_principal)
merged.diagnostics_associes = _dedup_diagnostics(all_das)
# Retirer les DAS dont le code est identique au DP (violation règle PMSI)
# Retirer les DAS redondants avec le DP (même code, famille, parent/enfant)
dp_code = merged.diagnostic_principal.cim10_suggestion if merged.diagnostic_principal else None
if dp_code:
merged.diagnostics_associes = [
d for d in merged.diagnostics_associes if d.cim10_suggestion != dp_code
d for d in merged.diagnostics_associes
if not d.cim10_suggestion or not _is_dp_family_redundant(d.cim10_suggestion, dp_code)
]
# Redondances sémantiques entre DAS
merged.diagnostics_associes = apply_semantic_dedup(merged.diagnostics_associes)
# Actes CCAM
all_actes: list[ActeCCAM] = []
for d in dossiers: