feat: méthode TIM experte CPAM + moteur de règles étendu
CPAM — Méthode TIM (mémoire en défense) : - Réécriture CPAM_ARGUMENTATION avec raisonnement 5 passes TIM (contexte admin → motif réel → confrontation bio → hiérarchie → validation défensive) - _BIO_THRESHOLDS (19 entrées) + _build_bio_confrontation() pour confrontation biologie/diagnostic avec seuils chiffrés et verdicts - _format_response() dual format : nouveau TIM (moyens numérotés, tableau bio, codes non défendables, conclusion dispositive) + rétrocompat legacy - CPAM_ADVERSARIAL mis à jour pour vérifier honnêteté intellectuelle - Tests adaptés + 12 nouveaux tests (bio confrontation, format TIM) Moteur de règles : - Nouvelles règles YAML : demographic, diagnostic_conflicts, procedure_diagnosis, temporal, parcours - Bio extraction FAISS (synonymes vectoriels) - Veto engine enrichi (citations, Trackare skip, règles démographiques) - Decision engine : _apply_bio_rules_gen() + matchers analytiques Co-Authored-By: Claude Opus 4.6 <noreply@anthropic.com>
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dom
@@ -67,6 +67,24 @@ def dossier_complet() -> DossierMedical:
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)
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@pytest.fixture
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def dossier_trackare_dp() -> DossierMedical:
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"""Dossier Trackare : DP pré-codé sans preuve RAG (source d'autorité)."""
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return DossierMedical(
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source_file="trackare-TEST.pdf",
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document_type="trackare",
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sejour=Sejour(sexe="F", age=72, duree_sejour=3),
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diagnostic_principal=Diagnostic(
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texte="Pancréatite aiguë biliaire",
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cim10_suggestion="K85.1",
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cim10_confidence="high",
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source="trackare",
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# Pas de source_excerpt, sources_rag, preuves_cliniques
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# → c'est normal pour un Trackare
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),
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)
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@pytest.fixture
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def controle_cpam() -> ControleCPAM:
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"""Contrôle CPAM de test avec codes contestés."""
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@@ -19,10 +19,12 @@ from src.config import (
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)
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from src.control.cpam_response import (
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_assess_dossier_strength,
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_build_bio_confrontation,
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_build_bio_summary,
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_build_correction_prompt,
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_build_cpam_prompt,
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_build_tagged_context,
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_BIO_THRESHOLDS,
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_check_das_bio_coherence,
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_extraction_pass,
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_format_response,
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@@ -138,14 +140,18 @@ class TestBuildPrompt:
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assert "CIM-10 FR 2026" in prompt
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assert "page 64" in prompt
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def test_prompt_contains_three_axes(self):
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def test_prompt_contains_tim_passes(self):
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"""Le prompt TIM contient les 5 passes de raisonnement."""
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dossier = _make_dossier()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "AXE MÉDICAL" in prompt
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assert "AXE ASYMÉTRIE D'INFORMATION" in prompt
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assert "AXE RÉGLEMENTAIRE" in prompt
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assert "PASSE 1" in prompt
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assert "PASSE 2" in prompt
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assert "PASSE 3" in prompt
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assert "PASSE 4" in prompt
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assert "PASSE 5" in prompt
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assert "MÉMOIRE EN DÉFENSE" in prompt
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def test_prompt_contains_traitements_imagerie_when_present(self):
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dossier = _make_dossier_complet()
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@@ -181,39 +187,44 @@ class TestBuildPrompt:
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assert "ÉLÉMENTS DU DOSSIER NON TRANSMIS À LA CPAM" not in prompt
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def test_prompt_json_format_new_fields(self):
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def test_prompt_json_format_tim_fields(self):
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"""Le format JSON demandé inclut les champs TIM."""
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dossier = _make_dossier()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "contre_arguments_medicaux" in prompt
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assert "contre_arguments_asymetrie" in prompt
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assert "contre_arguments_reglementaires" in prompt
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assert "moyens_defense" in prompt
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assert "confrontation_bio" in prompt
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assert "conclusion_dispositive" in prompt
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assert "codes_non_defendables" in prompt
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assert "rappel_faits" in prompt
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def test_prompt_contains_cite_exacts(self):
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"""Le prompt renforcé demande des preuves exactes."""
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def test_prompt_contains_honesty_rules(self):
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"""Le prompt TIM contient les règles d'honnêteté intellectuelle."""
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dossier = _make_dossier()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "HONNÊTETÉ INTELLECTUELLE" in prompt
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assert "CITE" in prompt
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assert "EXACTS" in prompt
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assert "JAMAIS" in prompt
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def test_prompt_contains_interdiction(self):
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"""Le prompt interdit les références inventées."""
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def test_prompt_contains_redaction_consignes(self):
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"""Le prompt TIM contient les consignes de rédaction numérotées."""
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dossier = _make_dossier()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "INTERDICTION ABSOLUE" in prompt
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assert "MOYENS DE DÉFENSE NUMÉROTÉS" in prompt
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assert "N'invente AUCUN tag" in prompt
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def test_prompt_contains_preuves_dossier_field(self):
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"""Le format JSON demandé inclut preuves_dossier."""
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dossier = _make_dossier()
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def test_prompt_contains_bio_confrontation(self):
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"""Le prompt TIM inclut la section confrontation biologie."""
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dossier = _make_dossier_complet()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "preuves_dossier" in prompt
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assert "CONFRONTATION BIOLOGIE" in prompt
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@patch("src.control.cpam_context.validate_code", return_value=(True, "Iléus paralytique et obstruction intestinale"))
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@patch("src.control.cpam_context.normalize_code", return_value="K56.0")
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@@ -365,6 +376,96 @@ class TestFormatResponse:
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assert "AVERTISSEMENT" in text
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assert "Manuel Imaginaire 2025" in text
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# --- Tests nouveau format TIM ---
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def test_tim_format_memoire_defense(self):
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"""Le format TIM produit un mémoire en défense structuré."""
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parsed = {
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"objet": "Contestation DAS — OGC 17 — Mémoire en défense",
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"rappel_faits": "Patient M, 65 ans, hospitalisé 5j pour cholécystite aiguë.",
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"moyens_defense": [
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{
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"numero": 1,
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"titre": "Le DP K81.0 est justifié par la biologie",
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"argument": "CRP à 180 mg/L confirme l'inflammation aiguë.",
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"preuves": [
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{"ref": "[BIO-1]", "fait": "CRP = 180 mg/L [norme < 5]", "signification": "inflammation sévère"}
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],
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"source_reglementaire": "[Guide Méthodologique MCO 2026 - p.45] citation",
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}
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],
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"confrontation_bio": [
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{"diagnostic": "K81.0", "test": "CRP", "valeur": 180, "seuil": "> 5", "verdict": "CONFIRMÉ"}
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],
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"asymetrie_information": "Bio non transmise à l'UCR",
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"reponse_points_cpam": "La CPAM a raison sur X, mais...",
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"codes_non_defendables": [],
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"references": [
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{"document": "Guide Méthodologique MCO 2026", "page": "45", "citation": "Le DAS doit..."}
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],
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"conclusion_dispositive": "Par conséquent, nous demandons le MAINTIEN du codage.",
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}
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text = _format_response(parsed)
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assert "MÉMOIRE EN DÉFENSE" in text
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assert "RAPPEL DES FAITS" in text
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assert "MOYEN N°1" in text
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assert "K81.0" in text
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assert "Preuve" in text
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assert "Source" in text
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assert "CONFRONTATION BIOLOGIE" in text
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assert "CONFIRMÉ" in text
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assert "ASYMÉTRIE D'INFORMATION" in text
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assert "RÉPONSE AUX POINTS DE LA CPAM" in text
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assert "RÉFÉRENCES RÉGLEMENTAIRES" in text
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assert "CONCLUSION" in text
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assert "MAINTIEN" in text
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def test_tim_format_codes_non_defendables(self):
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"""Les codes non défendables apparaissent dans le format TIM."""
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parsed = {
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"moyens_defense": [],
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"codes_non_defendables": [
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{"code": "D50.9", "raison": "Hb = 13.5, valeur NORMALE", "recommandation": "Retrait recommandé"}
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],
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"conclusion_dispositive": "Nous reconnaissons...",
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}
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text = _format_response(parsed)
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assert "CODES NON DÉFENDABLES" in text
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assert "D50.9" in text
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assert "Retrait recommandé" in text
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def test_tim_format_confrontation_table(self):
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"""Le tableau de confrontation bio est formaté en grille."""
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parsed = {
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"moyens_defense": [],
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"confrontation_bio": [
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{"diagnostic": "N17.8 IRA", "test": "Créatinine", "valeur": 280, "seuil": "> 130", "verdict": "CONFIRMÉ"},
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{"diagnostic": "E87.1 HypoNa", "test": "Sodium", "valeur": 138, "seuil": "< 135", "verdict": "NON CONFIRMÉ"},
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],
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"conclusion_dispositive": "Conclusion...",
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}
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text = _format_response(parsed)
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assert "N17.8" in text
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assert "Créatinine" in text
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assert "CONFIRMÉ" in text
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assert "NON CONFIRMÉ" in text
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assert "┌" in text # table border
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def test_tim_retrocompat_legacy_format(self):
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"""L'ancien format (sans moyens_defense) utilise le rendu legacy."""
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parsed = {
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"analyse_contestation": "Analyse...",
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"contre_arguments_medicaux": "Arguments médicaux...",
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"conclusion": "Conclusion...",
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}
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text = _format_response(parsed)
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assert "CONTRE-ARGUMENTS MÉDICAUX" in text
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assert "MÉMOIRE EN DÉFENSE" not in text
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class TestValidateReferences:
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def test_valid_reference_no_warning(self):
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@@ -1061,6 +1162,81 @@ class TestCheckDasBioCoherence:
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assert "NORMAL" in prompt
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class TestBioConfrontation:
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"""Tests pour la confrontation biologie/diagnostic TIM."""
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def test_confrontation_with_matching_bio(self):
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"""Code avec bio disponible et pathologique → CONFIRMÉ."""
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dossier = DossierMedical(
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source_file="test.pdf",
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sejour=Sejour(sexe="M", age=65),
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diagnostic_principal=Diagnostic(texte="IRA", cim10_suggestion="N17.8"),
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biologie_cle=[
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BiologieCle(test="Créatinine", valeur="280 µmol/L", anomalie=True),
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],
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)
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controle = ControleCPAM(
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numero_ogc=1, titre="Test", arg_ucr="Test",
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decision_ucr="Rejet", dp_ucr=None, da_ucr=None,
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)
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result = _build_bio_confrontation(dossier, controle)
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assert "N17" in result
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assert "Créatinine" in result
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assert "280" in result
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assert "CONFIRMÉ" in result
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def test_confrontation_normal_value(self):
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"""Code avec bio NORMALE → NON CONFIRMÉ."""
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dossier = DossierMedical(
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source_file="test.pdf",
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sejour=Sejour(sexe="F", age=70),
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diagnostic_principal=Diagnostic(texte="Hyponatrémie", cim10_suggestion="E87.1"),
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biologie_cle=[
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BiologieCle(test="Sodium", valeur="138 mmol/L", anomalie=False),
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],
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)
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controle = ControleCPAM(
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numero_ogc=1, titre="Test", arg_ucr="Test",
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decision_ucr="Rejet", dp_ucr=None, da_ucr=None,
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)
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result = _build_bio_confrontation(dossier, controle)
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assert "E87.1" in result
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assert "NON CONFIRMÉ" in result
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def test_confrontation_missing_bio(self):
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"""Code avec bio absente → NON DISPONIBLE."""
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dossier = DossierMedical(
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source_file="test.pdf",
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sejour=Sejour(sexe="M", age=50),
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diagnostic_principal=Diagnostic(texte="IRA", cim10_suggestion="N17.8"),
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biologie_cle=[],
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)
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controle = ControleCPAM(
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numero_ogc=1, titre="Test", arg_ucr="Test",
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decision_ucr="Rejet", dp_ucr=None, da_ucr=None,
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)
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result = _build_bio_confrontation(dossier, controle)
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assert "NON DISPONIBLE" in result
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def test_confrontation_no_threshold(self):
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"""Code sans seuil dans _BIO_THRESHOLDS → message par défaut."""
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dossier = DossierMedical(
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source_file="test.pdf",
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sejour=Sejour(),
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diagnostic_principal=Diagnostic(texte="Fracture", cim10_suggestion="S72.0"),
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)
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controle = ControleCPAM(
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numero_ogc=1, titre="Test", arg_ucr="Test",
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decision_ucr="Rejet", dp_ucr=None, da_ucr=None,
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)
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result = _build_bio_confrontation(dossier, controle)
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assert "Aucun seuil" in result
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class TestPatientContext:
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"""Tests pour le contexte patient dans le prompt."""
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@@ -1103,14 +1279,14 @@ class TestPatientContext:
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assert "ADMISSION EN URGENCE" in prompt
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def test_context_consigne_in_prompt(self):
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"""Le prompt contient une consigne sur le contexte clinique."""
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"""Le prompt TIM contient les consignes sur le contexte patient."""
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dossier = _make_dossier()
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controle = _make_controle()
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prompt, _ = _build_cpam_prompt(dossier, controle, [])
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assert "CONTEXTE CLINIQUE" in prompt
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assert "ÂGE" in prompt
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assert "MODE D'ENTRÉE" in prompt
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assert "CONTEXTE ADMINISTRATIF" in prompt
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assert "pédiatrie" in prompt.lower() or "Pédiatrie" in prompt
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assert "urgence" in prompt.lower()
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class TestExtractionPass:
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