Intelligent therapeutic monitoring platform for polymedicated patients. Centralizes treatments, detects drug interactions in real time using official ANSM data, and orchestrates clinical alerts.

A polymedicated patient sees 3 specialists. Each prescribes without knowing the full treatment picture. MediGuard automatically cross-checks all of a patient's medications against the official ANSM Interaction Thesaurus and raises clinical alerts when a contraindication or inadvisable combination is detected.

The system resolves the complete chain: brand name → BDPM → active substance → salt form → normalized INN → therapeutic classes → interactions. Without this resolution, most interactions remain invisible.

Event Sourcing is not a gratuitous technical choice — it's a domain requirement.

In pharmacovigilance, every mutation must be traceable: who added this treatment, when, who stopped it, why, which interactions were detected at that point, who acknowledged the alert, with what justification. A simple CRUD with updated_at columns loses this information.

With Event Sourcing, the patient's event stream tells the complete story:

TherapeuticRecordCreated          → 2026-04-06 10:00
TreatmentAdded (Warfarin)         → 2026-04-06 10:01
InteractionAnalysisCompleted (0)  → 2026-04-06 10:01
TreatmentAdded (Fluconazole)      → 2026-04-06 10:05
InteractionAnalysisUpdated (1 PE) → 2026-04-06 10:05
TreatmentAdded (Domperidone)      → 2026-04-06 10:10
InteractionAnalysisUpdated (2)    → 2026-04-06 10:10
NewCriticalInteractionFound (CI)  → 2026-04-06 10:10
AlertRaised (PENDING)             → 2026-04-06 10:10
AlertAcknowledged                 → 2026-04-06 10:15
AlertOverridden (justification)   → 2026-04-06 10:20

Every event is immutable, timestamped, and replayable. The patient's state can be reconstructed at any point in time.

┌─────────────────────────────────────────────────────────────────┐
│                     Frontend React 18 + MUI 7                   │
└──────────────────────────────┬──────────────────────────────────┘
                               │ REST API (10 endpoints)
┌──────────────────────────────▼──────────────────────────────────┐
│                   Symfony 7.4 — PHP 8.5                         │
│           command.bus (sync) / query.bus (sync)                  │
│                event.bus (async — RabbitMQ)                      │
├────────────┬────────────┬────────────┬──────────────────────────┤
│ Therapeutic│ Interaction│  Alert &   │      Drug Catalog        │
│   Record   │  Analysis  │  Decision  │    (supporting ctx)      │
│    (ES)    │   (ES)     │    (ES)    │    batch import          │
├────────────┴────────────┴────────────┴──────────────────────────┤
│                    PostgreSQL 16 — Event Store                   │
│               append-only, optimistic concurrency               │
└─────────────────────────────────────────────────────────────────┘

Therapeutic Record — Patient's therapeutic assessment. ES aggregate with addTreatment, stopTreatment (reason + author required), modifyPosology. Every mutation carries a UserId for traceability.

Interaction Analysis — Core domain. InteractionEngine (Domain Service) with multi-level detection algorithm: direct lookup → via class A → via class B → via both classes, with deduplication by symmetric key. PatientInteractionReport (ES aggregate) persists the analysis history.

Alert & Decision — State machine: PENDING → ACKNOWLEDGED → OVERRIDDEN → RESOLVED. An override requires a justification of at least 50 characters. Alerts are raised automatically via EventSubscriber on critical interactions.

Drug Catalog — Supporting context. Batch import of BDPM (15,033 drugs) and ANSM Thesaurus (3,220 interactions). Isolated from the core by an Anti-Corruption Layer.

• command.bus (sync) — mutations: AddTreatmentCommand, StopTreatmentCommand, AcknowledgeAlertCommand...
• query.bus (sync) — reads: GetActiveTreatmentsQuery, GetPatientInteractionsQuery...
• event.bus (async, RabbitMQ) — cross-BC propagation: TreatmentAdded triggers analysis, NewCriticalInteractionFound raises an alert

Adding a medication
  → TreatmentAdded (async)
    → AnalyzePatientInteractions (sync)
      → InteractionEngine detects CI
        → NewCriticalInteractionFound (async)
          → RaiseAlert (sync)
            → ClinicalAlert PENDING

Hybrid substance normalization: official ANSM FT (priority) → regex fallback for salts → ICU transliterator for diacritics (2,234 substances affected).

• Docker & Docker Compose
• Node.js 18+ and npm

git clone https://github.com/Drkilla/mediguard.git
cd mediguard
docker compose up -d

docker compose exec php php bin/console doctrine:migrations:migrate --no-interaction
docker compose exec php php bin/console drug-catalog:import-bdpm
docker compose exec php php bin/console drug-catalog:import-thesaurus

# Async worker (terminal 1)
docker compose exec -e APP_DEBUG=0 php php bin/console messenger:consume async -vv --env=prod

# Frontend (terminal 2)
cd frontend && npm install && npm run dev

• Frontend: http://localhost:5173
• Swagger UI: http://localhost:8080/api/doc

docker compose exec php vendor/bin/phpunit       # 243 tests, 630 assertions
docker compose exec php vendor/bin/phpstan analyse  # level 8, 0 errors

src/
├── SharedKernel/          # Event Sourcing, shared Value Objects
├── TherapeuticRecord/     # BC — Therapeutic assessment (ES)
├── InteractionAnalysis/   # BC — Interaction engine (ES)
├── AlertDecision/         # BC — Clinical alerts (ES)
├── DrugCatalog/           # BC — Drug reference catalog
└── UI/Http/Controller/    # REST API
frontend/                  # React 18 + TypeScript + MUI 7
docs/                      # Detailed project documentation

This project is a technical demonstrator. It is not a medical device and must not be used to make therapeutic decisions.

• @Drkilla