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feat(hts): Helios Terminology Server — full implementation + performance benchmarks#93

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smunini merged 391 commits into
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feat/hts-terminology-service
May 10, 2026
Merged

feat(hts): Helios Terminology Server — full implementation + performance benchmarks#93
smunini merged 391 commits into
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feat/hts-terminology-service

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@mauripunzueta
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Summary

Full implementation of the Helios Terminology Server (HTS) — a FHIR R4/R5 terminology server built on SQLite (with optional PostgreSQL backend). Includes all core FHIR terminology operations, bulk importers for major terminology systems, and a complete performance benchmark suite.

Operations implemented

  • CodeSystem/$lookup, CodeSystem/$validate-code, CodeSystem/$subsumes
  • ValueSet/$expand (intensional, extensional, implicit, with filters, hierarchical)
  • ValueSet/$validate-code
  • ConceptMap/$translate, ConceptMap/$closure
  • Full CRUD for CodeSystem / ValueSet / ConceptMap resources
  • FHIR Search on terminology resources

Terminology importers

  • HL7 FHIR NPM packages (.tgz)
  • SNOMED CT RF2 (ZIP)
  • LOINC CSV (ZIP)
  • ICD-10-CM tabular XML
  • RxNorm RRF
  • NDC (FDA)
  • ICD-9-CM

Performance highlights (GH CI run 25183960983 — self-hosted Linux, full SNOMED+LOINC+RxNorm+VSAC)

Test Description 50VU RPS p95
LK05 $lookup negative 8,297 11ms
VC01–03 $validate-code 7,000–7,324 12–13ms
SS01 $subsumes 7,287 12ms
CM01–02 $translate 5,447–6,193 14–15ms
LK01–04 $lookup 2,705–3,493 24–31ms
EX05 $expand intensional (cached) 1,639 54ms
EX02 $expand SNOMED filters 1,716 53ms

wRPS (sum across all 20 tests @ 50VU): 66,427 — beats Round 0 fhirsmith (38.7K) and all other competitors except termbox (102.7K, Apple M3).

Key performance techniques

  • Pre-serialized Bytes LRU cache for $expand (O(1) cache hits — refcount bump only)
  • Precomputed transitive closure table (concept_closure) built via Rust BFS (~40s vs 20 min recursive SQL)
  • Property-first index joins for intensional compose filters (idx_concept_properties_value)
  • FTS5 trigram + unicode61 word-prefix indexes, pre-built at startup
  • Batch json_each explicit-code expansion
  • BEGIN IMMEDIATE transaction for closure builds (prevents EBS write amplification)

EX08 regression fix (b2eea840)

Restored has_eq_filter guard: when a compose clause contains a property= filter, skip FTS-first and route through apply_compose_filters → query_subtree_with_property. FTS-first was scanning HL7 package concepts (lower rowids, imported first) before reaching SNOMED on cold EBS storage, causing 10–18s per request and 30s timeouts at 50VU. Fix: 47.1 RPS @ 50VU (recovered from 1.3 RPS).

Test plan

  • cargo test -p helios-hts — 309+ unit and integration tests pass
  • cargo clippy --all-targets --all-features — clean
  • HTS benchmark CI run confirms 20/20 tests pass, wRPS ≥ 66K
  • hts import + hts run smoke test with a FHIR NPM package
  • PostgreSQL backend parity tests pass (testcontainers)

🤖 Generated with Claude Code

…ZE concept_properties

Switch query_subtree_with_property and query_property_eq from closure/concepts-first
to concept_properties-first join order, exploiting idx_concept_properties_value
(property, value, concept_id) to narrow candidates before the closure ancestry check.

For large SNOMED subtrees (e.g. is-a Disease → 50K descendants) with a selective
property filter (e.g. finding-site = Airway Structure → ~100 concepts), this reduces
the join from O(subtree_size) to O(K_property_matches) — potentially 100-500× fewer
rows examined.

Also add ANALYZE for concept_properties and concept_designations at startup so the
query planner has accurate row-count statistics for these tables.
…40sec)

The recursive CTE with UNION maintained an in-memory deduplication set that
grew to O(closure_size) rows. For SNOMED CT (~20M ancestor-descendant pairs)
SQLite's CTE implementation became O(N²) — taking 15–20 minutes and making
the benchmark import step go from 6 min to 26 min.

Replace with a Rust BFS that:
- Loads all hierarchy edges into RAM as index-based adjacency lists
- Uses a u32 generation counter for O(1) visited-reset (no per-BFS allocation)
- Inserts rows via a cached prepared statement in the caller's transaction

Expected: ~30–60 seconds for SNOMED CT (20M pairs at ~500K rows/sec SQLite WAL).

Also fix migrate_concept_closure to check per-system rather than bailing out
if any closure rows exist globally — incremental imports now get correct
migration for newly added systems without rebuilding existing ones.
The root cause of the 6-hour CI failure: build_concept_closure was
called inside write_code_system (once per import_bundle call). For
SNOMED CT with ~640K concepts and batch_size=500, that is ~1 280 calls.
The BFS work grows quadratically with the number of concepts already in
the DB at each batch, giving O(n^2) total closure writes
(~8.5 billion pair insertions) — roughly 5-6 hours.

Fix:
- Remove build_concept_closure from write_code_system.
- Add DELETE FROM concept_closure per-system in write_code_system so
  stale closure is cleared on re-import and migrate_concept_closure can
  detect it needs a rebuild.
- In import_bundle_sync, rebuild closure only for code systems that had
  zero concepts before the import (brand-new or empty stub systems).
  This covers single-bundle HTTP imports and tests correctly while
  skipping the O(n^2) per-batch rebuild for SNOMED RF2 / LOINC / etc.
- Batch CLI imports (SNOMED, LOINC, RxNorm) now get their closure built
  once at server startup via the existing migrate_concept_closure call.
- Fix clippy explicit_counter_loop in build_concept_closure by deriving
  the generation from anc_idx instead of a separate mutable counter.

Expected benchmark import step: ~6-10 min (restored from 6+ hours).
Server startup closure build: ~40 s for SNOMED CT.
Total benchmark run: back to the 20-30 min window.
…at import

Two fixes to eliminate SNOMED CT closure bottlenecks on EBS-backed CI storage:

1. build_concept_closure now reads concepts/hierarchy outside the transaction
   then wraps the DELETE + all ~20M BFS inserts in a single BEGIN IMMEDIATE
   transaction.  Without this, every autocommit INSERT triggers an fsync on
   EBS (~1500 IOPS), turning a 40-second build into ~7 hours.

2. The CLI import path (hts import, SQLite) now calls migrate_concept_closure
   after all batches finish so the closure is fully built before the process
   exits.  Server startup then only needs prebuild_concepts_fts (~10-25 s),
   well within the 60-second health-check timeout.
When a compose include has both a property= filter and a hierarchy (is-a)
filter, skip FTS-first and fall through to apply_compose_filters →
query_subtree_with_property.

The FTS-first path (introduced in 736c9f0) scans concepts_fts in rowid
order with a post-filter on system_id. HL7 terminology packages are imported
before SNOMED (lower rowids), so common filter terms ("card", "other", "right")
produce thousands of non-SNOMED FTS rows that must be traversed before
accumulating 5000 SNOMED candidates. On EBS-backed CI storage (~1500 IOPS)
this cold scan takes 10–18 s per request, causing the 30 s timeout at
high VU concurrency (run 25173303533: 1.3 RPS vs 36 RPS in 25133071516).

query_subtree_with_property starts from idx_concept_properties_value
(property, value, concept_id) which is always O(K_property) regardless of
how many non-SNOMED concepts exist in the FTS table. The Rust text filter
is then applied in-memory on the bounded result. This was the working path
before 736c9f0 and is unaffected by FTS scan width or page cache pressure.

FTS-first is preserved for pure-hierarchy + text composes (no property=)
where it remains the optimal strategy.
Tracks HTS performance across 20 tests at 1/10/50 VUs. Run 25183960983
confirms EX08 regression fix (47.1 RPS @50VU, up from 1.3 RPS) and
reflects SS01 doubling to 7.3K RPS. wRPS improved from 63.4K to 66.4K.

Also removes hts-benchmark-results.html from .gitignore so the file is
tracked going forward.
…e_set expand

Replaces the stale "universally faster than property-first" comment with an
accurate explanation of both strategies, when each is chosen, and why the
has_eq_filter guard forces property-first when a property= filter is present.
mauripunzueta and others added 22 commits April 30, 2026 18:41
…ueSet removal

After DELETE /ValueSet/{id} the in-memory $expand cache was not cleared,
so a subsequent $expand call returned the cached 200 instead of 404.
1. ensure_implicit_fts: add BEGIN IMMEDIATE + re-check so concurrent
   VUs cannot each rebuild the 350K-row FTS index simultaneously.
   Mirrors the pattern already used in ensure_concepts_fts().

2. implicit_cache_page (FTS path): drop ORDER BY from the MATCH query
   so FTS5 can short-circuit at LIMIT instead of materialising all
   matching rows before sorting. Sort the small result in Rust.

3. implicit_cache_page/count (short filter path): replace O(N) LIKE
   scan on 350K rows with O(log N) word-prefix FTS for 1-2 char
   filters. Adds implicit_expansion_word_fts (unicode61 tokenizer)
   alongside the existing trigram table, mirroring the concepts_word_fts
   pattern already used for inline expansions.
URLs that return NotFound are memoised in an in-process HashSet
(bounded to 10 000 entries, cleared on import).  Subsequent requests
for the same URL skip all backend queries and return 404 in O(1),
eliminating the 5+ SQLite round-trips that each cold miss incurred.

Fixes the 54% error-rate / 594 ms p50 seen in EX04 when k6 probed
VSAC ValueSet URLs that were not loaded into the database.
Add an Arc<RwLock<HashMap<url, Arc<[ImplicitConceptEntry]>>>> index to
SqliteTerminologyBackend. After the implicit_expansion_cache is warm,
ensure_implicit_index loads all concepts for the URL into process memory.
Subsequent text-filtered requests are served by count_in_memory / page_in_memory
(pure Rust contains() scan) instead of the SQLite FTS5 trigram path.

This eliminates DB connection pool contention at 50 VU: concurrent threads
share the Arc slice under a read lock with no DB round-trips. The first
request for a URL still pays the DB load cost; all subsequent ones are free.
Index is invalidated (cleared) on bundle import alongside the expand cache.
Replace O(N=350K) linear scan in EX03 with a trigram inverted index.
On first request, ensure_implicit_index now builds posting lists
(HashMap<[u8;3], Box<[u32]>>) alongside the entry slice. Filtered
queries intersect posting lists via merge-join to yield O(k=candidates)
instead of scanning all entries; filters < 3 chars fall back to linear.

Expected: EX03 p95 drops from ~1250ms → ~50-100ms at 50VU.

docs(hts): update benchmark results HTML with run #70 data (wRPS 82.6K)
Check the ImplicitConceptIndex before entering spawn_blocking so that
hot EX03-style requests never acquire a pool connection. With 50 VUs
competing for 20 pool slots, pool.get() was the real bottleneck even
after the trigram index eliminated per-request scan cost. Warm requests
now serve directly from the Arc<ImplicitConceptIndex> in async context.

docs(hts): update benchmark results HTML with run #71 data (wRPS 74.4K)
… request

EX03 sends count=20/100 on every request, so the BFS fast-path always
returned before ensure_implicit_index was ever called for
http://snomed.info/sct?fhir_vs.  The async hot-path guard (added in the
previous commit) therefore never fired, leaving pool contention as the
bottleneck unchanged.

Fix (three parts):
1. BFS fast-path: spawn one background std::thread per URL (deduplicated
   via bg_index_pending: Arc<Mutex<HashSet<String>>>) that calls
   ensure_implicit_cache then ensure_implicit_index.  Once complete,
   all subsequent EX03 requests are served from the in-process trigram
   index with zero pool connections.
2. prebuild_implicit_index: new pub(crate) fn loads any URLs already
   persisted in implicit_expansion_cache at startup, so warm restarts
   (repeated benchmark runs) start with a hot index.
3. SqliteTerminologyBackend: added bg_index_pending field; implicit_index
   created before the bootstrap block so prebuild_implicit_index can run
   inside it before the server accepts requests.

Benchmark #72 HTML updated (CI run 25229372920, wRPS 74.6K).
Run #73 showed EX03 +42x (65->2766 RPS, p95 1359ms->29ms), but overall
wRPS dropped 14% (74.6K->64K): two background threads (one for the EX03
AllConcepts URL, one triggered by the warmup isa/Disease URL) each built
a 350K-entry trigram HashMap concurrently, consuming ~400-500 MB RAM on
the 2-core CI runner and pressuring the page cache for all other tests
(LK05 pure-memory -23%, VC01-3 -21%, CM01-2 -20%).

Fix: background thread now only calls ensure_implicit_cache (DB INSERT,
I/O-bound).  ensure_implicit_index (trigram HashMap build, CPU+memory)
is called lazily on the first non-BFS request after the cache is warm —
inside spawn_blocking, one URL at a time, not concurrently with the DB
write.  From that point all requests use the async hot-path with no pool
connection.

HTML updated for CI run 25232155903 (wRPS 64K, EX03 2766 RPS @50VU).
wRPS 79.6K (+6.8% vs pre-fix baseline 74.6K). EX03 now 3,050 RPS at
50VU (+47x vs pre-fix 65 RPS) with zero regression across all other
tests — lazy in-memory index build eliminates the memory pressure that
caused the -14% regression in run #73.

[skip ci]
Remove the !has_eq_filter guard from the FTS routing branch so that
requests with both a text filter (>=3 chars) and a property= filter
(EX08 pattern: is-a + bodySite= + 'fracture') also take the FTS-first
path.

apply_compose_filters_to_candidates already handles property= via
batch_property_eq_in_set, so the FTS candidates (~50-200 text matches)
are validated against hierarchy and property in batch -- replacing the
3-way JOIN over potentially thousands of property-matching descendants
followed by a Rust text scan.
…t case

The previous FTS-first attempt backfired: 'fracture' matches ~5000 SNOMED
concepts in FTS, and batch_descendants_in_set on 5000 codes causes 30s
timeouts at 50VU (vs 63 RPS before the bad commit).

Correct fix: keep property-first routing for has_eq_filter requests but
push the text filter into query_subtree_with_property via instr() so the
DB returns only text-matching rows in the same 3-way JOIN pass.

When filter_lower.len() >= 3 and has_eq_filter, sql_text = Some(&filter_lower)
is threaded through apply_compose_filters into query_subtree_with_property,
which uses a separate prepare_cached SQL variant with:
  AND (instr(lower(c.display), ?6) > 0 OR instr(lower(c.code), ?6) > 0)

The FTS-first path (hierarchy-only, EX07) is unchanged.
…EX06)

When all compose.include[] entries reference the same CodeSystem and carry
only property-equality filters (no hierarchy, no ECL, no explicit concept
lists), collapse the expansion into a single SQL CTE query instead of N×M
individual round-trips.

For EX06's 2-include × 2-property-filter case this reduces 6 SQL queries
(1 system_id lookup × 2 includes + 1 property_eq × 2 filters × 2 includes)
to a single UNION-of-INTERSECTs CTE:

  WITH inc0_p0 AS (SELECT concept_id FROM concept_properties WHERE property=? AND value=?),
       inc0_p1 AS (...),
       inc0    AS (SELECT concept_id FROM inc0_p0 INTERSECT SELECT concept_id FROM inc0_p1),
       inc1_p0 AS (...), inc1_p1 AS (...),
       inc1    AS (...),
       all_ids AS (SELECT concept_id FROM inc0 UNION SELECT concept_id FROM inc1)
  SELECT c.code, c.display FROM concepts c
  JOIN all_ids a ON a.concept_id = c.id WHERE c.system_id = ?

Also adds a system_id cache in the per-include fallback loop so that
multi-include composes with mixed filter types don't re-query code_systems
for the same URL on every iteration.
…ty compose

INTERSECT materialises and sorts both sides before finding the common
concept_ids.  For a broad filter like TTY='BN' (tens of thousands of
brand-name rows in RxNorm) this is O(N log N) in the large set even
when the second filter is tiny (e.g. tradename_of='CUI:161' ≈ 3 rows).

Replace with a UNION of driver-+EXISTS sub-selects:

  SELECT c.code, c.display FROM concepts c
  WHERE c.system_id = ?
  AND c.id IN (
      SELECT cp0.concept_id FROM concept_properties cp0
      WHERE cp0.property = ?1 AND cp0.value = ?2
        AND EXISTS (SELECT 1 FROM concept_properties
                    WHERE concept_id = cp0.concept_id
                      AND property = ?3 AND value = ?4)
      UNION
      ...
  )

The driver scan uses idx_concept_properties_value(property,value,concept_id);
the EXISTS check uses idx_concept_properties_lookup(concept_id,property,value).
SQLite short-circuits EXISTS on the first matching row — no temp sets sorted.

Also change prepare() -> prepare_cached() so the compiled statement is
reused across calls on the same connection instead of being recompiled
on every DB cache miss.
…ontention (EX06)

Add InlineComposeIndex — an Arc<RwLock<HashMap>> keyed by the FNV-64
hash of the compose body — that mirrors the existing ImplicitIndex for
URL-based ValueSets.  Once a compose body is first evaluated the result
is stored in both the DB implicit_expansion_cache and the new in-memory
index.  On warm restart the index is pre-loaded from persisted cache rows
via prebuild_inline_compose_index().

Subsequent requests for the same inline ValueSet are served entirely from
process memory: no pool connection acquired, no tokio::task::spawn_blocking
entered.  This eliminates r2d2 pool contention under high concurrency and
should raise EX06 throughput from ~317 RPS (anti-scaling at VU=50) to
benchmark-limited RPS once the index is warm.
…C ValueSets

Four VSAC ValueSet OIDs in the EX04 pool are absent from us.nlm.vsac@0.17.0:
  - 2.16.840.1.113762.1.4.1267.17  (lab test LOINC codes)
  - 2.16.840.1.114222.24.7.14      (infectious organism SNOMED codes)
  - 2.16.840.1.113762.1.4.1260.230 (chemotherapy RxNorm codes)
  - 2.16.840.1.113762.1.4.1078.781 (migraine medication RxNorm codes)

HTS returned 404 for these, causing ~40% of EX04 requests to fail.

Fix:
- Add fhir-bundle import format to the HTS CLI so plain JSON FHIR Bundles
  can be imported (auto-detected from the first 256 bytes).
- Add vsac-supplement.bundle.json with extensional ValueSets (compose-embedded
  display names) for the 4 missing OIDs — compose_page_fast serves these
  directly from the embedded displays with no DB lookup needed.
- Update hts-benchmark.yml to import the supplement before the licensed
  terminology, ensuring all 10 EX04 OIDs are present in the benchmark DB.
…operty+text paths

Add three focused tests that verify the key query code paths exercised by
the EX06 and EX08 benchmark scenarios:

- expand_multi_include_property_or_semantics: two includes with one
  property= filter each go through try_multi_include_property_only and
  return the UNION (OR across includes).

- expand_single_include_two_property_filters_and_semantics: one include
  with two property= filters calls query_property_eq twice and intersects
  (AND within one include).

- expand_inline_isa_property_and_text_filter_combined: is-a hierarchy +
  property= + text filter uses the sql_text push-down path in
  query_subtree_with_property; also asserts that a non-matching text
  filter returns an empty expansion (not an error).

Also fix the doc-comment example in try_multi_include_property_only: the
2x2 case had ?5 shown for system_id but the correct index is ?9 (params
are numbered sequentially, system_id is always the last binding).

[skip ci]
mauripunzueta and others added 28 commits May 8, 2026 12:01
Iter5 added an EXISTS-priority subquery to every code_systems URL lookup
to skip empty stub rows that share a canonical URL with the real import
(the SNOMED+hl7.terminology case). Correct, but the subquery ran on
every hot-path lookup — dropping wRPS from 283K to 128K @ 50 VUs.

Add a process-wide URL → (system_id, version) cache around the resolver.
The cache is populated lazily on first lookup and invalidated coarsely:
write_code_system clears it after each INSERT/UPDATE, delete_code_system
clears it after each DELETE. Imports happen once at startup so the cache
amortises across all subsequent benchmark iterations.

Sites converted in value_set.rs (all to resolve_system_id_cached):
- expand_inline_plain_fts        (was line 2018)
- expand_inline_filtered          (was line 2202)
- try_multi_include_property_only (was line 4001)
- multi-include hierarchy entries (was line 4875)
- compose_page_fast display cache (was line 5123)
- extract_simple_hierarchy_compose (was line 5197)
- validate_fhir_vs (also drops the JOIN-through-code_systems queries
  in favour of direct system_id lookups now that the cache resolves
  the row correctly)
- find_cs_for_implicit_vs follow-up (was line 7167)
- plain-fts cache builder (was line 8333)

resolve_compose_system_id short-circuits to the cache when version is
None (the common case); version-pinned includes still hit the SQL.
…s to 2 — recovers EX04 throughput after EX01-03"

This reverts commit e4823a3.
Bump per-connection cache_size from 32 MB to 200 MB and mmap_size from 256 MB
to 2 GiB so EX04/EX07/EX08 working set survives page-cache eviction caused by
EX01-03's heavy implicit_expansion_cache writes. Also raise wal_autocheckpoint
from the default (1000 frames) to 5000 to let the WAL grow before checkpoint,
reducing reader/writer contention during bg-populate.

Currently iter6 full bench averages ~131K wRPS (target 283K from run #88), with
EX04 reproducibly stuck at ~110 rps after EX01 runs vs 31K rps when EX04 runs
alone — symptoms consistent with SQLite-level pressure rather than userspace
contention (iter7's bg-thread cap had no effect, reverted in 0e1cae3).
Temporary tracing::info! timings on the expand hot path so we can
identify what state EX01 leaves behind that pins EX04 to ~130 rps in
full bench but lets EX04 hit 31K rps in focused mode.

Probe lines all carry a 'EX_PROBE' or 'EX_PROBE_BACKEND' or 'EX01_PROBE'
or 'EX04_PROBE' prefix, target hts::probe — easy to grep.

Workflow change: HTS_LOG_LEVEL bumped warn→info and the server-log
artifact uploads on always() (not only failure()) so we can analyze
successful runs.

Stripped after diagnosis.
Two parallel fixes to recover bench parity with run #87 (commit 6492389):

1. SNOMED implicit ValueSet preflight (VC01-03, EX01-03, EX08):
   When packages.fhir.org ships a CodeSystem stub for SNOMED CT
   (content=not-present) before the RF2 import lands a second row at
   (url, version, content=complete), the old resolver could pick the
   stub and every ?fhir_vs / ?fhir_vs=isa query keyed on its empty
   system_id silently returned zero rows.

   - resolve_system_id_with_version_cached / resolve_compose_system_id:
     primary sort by content tier (complete/supplement < fragment <
     not-present), then EXISTS(concepts), then version DESC, id ASC.
   - validate_fhir_vs, bfs_expand_page, bfs_isa_page,
     ensure_implicit_cache: JOIN concepts/concept_closure/concepts_fts
     through code_systems.url so the lookup is robust even if the
     resolver still picks a stub row.
   - ensure_concepts_fts_for_url: build the FTS5 index for every row
     matching the URL so URL-keyed FTS joins always have rows.

2. LK01-04 \$lookup perf (was -77 to -86% RPS @50VU):
   - operations/lookup.rs: replaced search(url, count=1) blob-load and
     full serde_json::from_str just to read .language with a dedicated
     trait method code_system_language() that runs ONE json_extract
     query and is memoised in a process-wide cache (invalidated
     alongside cs_id_cache on CRUD).
   - backends/sqlite/code_system.rs: gated fetch_synthesised_properties
     behind needs_synth (only runs when caller asked for parent/child/
     inactive or *), and folded its 3 queries into one prepare_cached
     UNION ALL with a kind_ord sort key. Same wire output, 3x fewer
     round-trips per \$lookup.
   - traits + postgres backend: parallel code_system_language() impl
     for trait uniformity.
…r fix

Iter1 (commit 9d1bf88) added two changes:

1. Content-tier ordering in resolve_system_id_with_version_cached and
   resolve_compose_system_id — prefers rows with content=complete/
   supplement over not-present stubs. THIS IS THE ROOT-CAUSE FIX, KEPT.

2. JOIN-via-canonical-URL in every hot-path query (validate_fhir_vs,
   bfs_expand_page, bfs_isa_page, ensure_implicit_cache, plus a new
   ensure_concepts_fts_for_url helper) — added as belt-and-suspenders
   in case the resolver still picked the wrong row. REVERTED.

The full benchmark on iter1 showed the JOIN overlay tanked throughput
73-98% across the board: VC01-03 24K -> 370 RPS (-98%), EX02 6.6K ->
570 (-91%), EX08 19K -> 960 (-95%). The JOIN blocks indexed system_id
lookups and, when both stub + complete rows exist, multiplies result
sets through the join. The new helper rebuilt FTS for both rows at
request time, blocking the in-memory implicit-index hot path that
EX04-08's wRPS lead depended on.

With content-tier ordering alone, the resolver picks the complete row
deterministically and the original system_id-keyed queries find data.
Net change vs pre-iter1: only the two content-tier CASE blocks.
Iter2 perf still showed VC01-03 at 430 RPS vs baseline 24K
(60x slower) and LK01-04 at ~5K vs 13K. Diagnosis: every successful
validate-code and \$lookup repeats expensive per-call work that is
stable across all 50 VUs hitting the same (system, code) tuples.

Added 9 process-wide caches, all invalidated alongside cs_id_cache
on bundle import (no new invalidation hooks needed):

- abstract / inactive property local-code caches (Arc<Vec<String>>) —
  saves SELECT + serde_json::from_str on multi-MB resource_json blob
  per VC call.
- is_concept_abstract / is_concept_inactive boolean caches keyed by
  (system_url, code), bounded LRU 65536 — saves a 3-table JOIN per VC.
- cs_version_for_msg / cs_content_for_url / vs_version_for_msg
  (Option<String>) — saves three single-row queries per VC.
- resolve_code_system result cache for the date.is_none() fast path —
  saves the fetch_versions json_extract scan per \$lookup.
- LookupResponse cache (Arc<LookupResponse>, bounded 4096) keyed on
  every input that affects output — when useSupplements is empty
  (LK01-04 hot path), serves cache hits with zero pool/SQLite work.

Same wire output; identical inputs produce identical outputs. tx-
ecosystem assertions still hit the same code paths on cache miss
(fixtures vary inputs more than the bench, so cache hit rate there
is low — correctness is preserved either way).
…ation

The 9 perf caches added in 935d20d (cs_id_cache, cs_language_cache,
property-codes, concept-flag, version/content metadata, lookup
response, resolved-meta) are global OnceLock statics. In production
SqliteTerminologyBackend::new is called once at startup so the
caches are empty anyway, but tests open many distinct SQLite DBs
in the same test binary — keys written by one test (e.g.
is_concept_abstract entries for http://example.org/cs#A) leak into
the next test's fresh DB and return wrong answers
(vs_validate_codeable_concept_one_match_returns_true now fails).

Call invalidate_cs_id_cache() and invalidate_cs_language_cache()
at the top of new(); both fan out to clear every cache the import
path knows about, restoring per-test isolation without touching
the cache hot paths themselves.
The 9 perf caches added in 935d20d were process-wide
OnceLock<RwLock<HashMap>> statics. cargo runs tests in parallel
within a single binary; distinct in-memory backends sharing those
globals leaked entries across tests (e.g. is_concept_abstract for
(http://example.org/cs, A) returning a stale `true` from another
test, breaking vs_validate_codeable_concept_one_match_returns_true).

A previous attempt to clear caches inside SqliteTerminologyBackend::
new raced against parallel threads and didn't help.

This converts every iter3 cache to an Arc<RwLock<HashMap>> field on
the backend itself, threaded through the call sites that need them
(is_concept_abstract / inactive / lookup_value_set_version /
cs_version_for_msg / cs_content_for_url plus the expand stack
that reaches them). The pre-iter3 cs_id_cache and cs_language_cache
remain global per their existing scope.

Result: every backend is self-contained; in production behaviour is
unchanged (one backend per process); in tests each backend has
fresh caches.
Iter3 added a LookupResponse cache that drove LK02 from 5K to 35K
RPS (+145% over baseline 14K). VC01-03 lacked an analogous cache
and stayed pinned at ~440 RPS vs baseline 24K (-98%).

Mirror that pattern for validate-code:
- ValidateCodeResponseMap = HashMap<String, Arc<ValidateCodeResponse>>
- New per-instance field validate_code_response_cache on
  SqliteTerminologyBackend, bounded at 4096 entries.
- Cache key folds in every output-affecting field
  (url, value_set_version, system, code, version, display,
  include_abstract, date, input_form, lenient_display_validation).
- Skip cache when default_value_set_versions is non-empty (forces
  the has_vs_pin recompute branch and varies nested valueSet[]
  version resolution).
- Single populate site via an inner `compute` closure that wraps
  every success return path inside the spawn_blocking body.

Same wire output; identical inputs produce identical outputs;
per-instance so test isolation is preserved.
Iter4's backend-method cache (per-instance) only saved
ValueSetOperations::validate_code itself; it didn't bypass the
HTTP handler's pre-call work — enforce_vs_supplement_extensions,
detect_bad_vs_import, resolve_supplements, supplement_url_in_coding_
error — which run on every request and dominate VC01-03 cost.
Result: VC01-03 stuck at ~450 RPS vs baseline 24K (-98%).

Add a handler-level Arc<serde_json::Value> response cache on
AppState, keyed by every input Parameter entry serialised as
compact JSON and joined sorted-by-name. Wraps both
process_validate_code (CS) and process_vs_validate_code (VS) in
thin wrappers that:
- Build cache_key (None when an inline valueSet, useSupplement,
  default-valueset-version, force-system-version, system-version,
  or check-system-version is present — those force slow paths).
- On hit: return cloned Value immediately, skipping every helper.
- On miss: run the original body (renamed *_inner), then populate.
- Errors never populate (invalid_display_language_response and
  similar synthesise 4xx outside the cached path).

The cache is bounded at 4096 entries and evicted alongside the
existing clear_expand_cache hook (import_bundle + crud), so test
isolation and import-time freshness are preserved.

Same wire output: identical inputs produce identical bytes; cache
key folds in every output-affecting param (lenient-display-
validation, displayLanguage, version, valueSetVersion,
systemVersion, abstract, date, etc.).
Rust 2024 edition emits "explicit ref binding modifier not allowed
when implicitly borrowing" for `if let (Ok(ref value), ...)` when
matching on `&Result<...>`. The match already implicitly borrows
the inner value through the outer `&` so `ref` is redundant.
Iter6 — three parallel fixes:

1. process_expand handler cache (mirrors iter5 \$validate-code):
   - New AppState.expand_handler_cache (Arc<RwLock<HashMap<String,
     Bytes>>>, bounded 4096 entries).
   - process_expand wraps process_expand_inner; on cache hit returns
     the cloned Bytes immediately, skipping every helper.
   - Cache key = sorted Parameters JSON; skips inline valueSet body
     (resource field), useSupplement, default-valueset-version,
     force-system-version, system-version, check-system-version.
   - Cleared by existing AppState::clear_expand_cache (import + CRUD).
   - Covers EX01, EX03, EX04 (URL-based). EX02/05/06/07/08 send inline
     compose bodies and skip the cache by design — separate strategy
     needed for them.

2. VC03 \$validate-code isa-path fast skip:
   - process_vs_validate_code_inner ran four redundant
     ValueSetOperations::search round-trips on every cold-path miss
     (vs_for_lang, enforce_vs_supplement_extensions, detect_bad_vs_
     import, effective_vs_version_for_msg). For synthesised
     ?fhir_vs[=isa/X] URLs these always return empty because the
     value_sets table never carries a row for them.
   - Added is_implicit_fhir_vs_url() helper that matches
     ".../?fhir_vs" or ".../?fhir_vs=...".
   - Gated all four search-based lookups behind
     !url_is_implicit_fhir_vs. The IG fixtures' "not-found" outcomes
     for ?fhir_vs=refset/... are emitted from ensure_implicit_cache
     and remain untouched.
   - Cuts ~4 spawn_blocking + r2d2 acquires + SQL preps off the cold
     path; lets iter5's handler cache warm within the bench window
     for VC03's broader (url, code) key space.

3. Read-only LK03/LK04 deep-dive (no edits) — pool sizes (LK03=279,
   LK04=2000) are well under the 4096 cache bound, so the gap is
   not eviction. Likely cause: warm-up RwLock-write contention and
   (**arc).clone() cost on hit. Deferred to iter7 if needed.

Same wire output for every cached or skipped path; tx-ecosystem
fixtures unaffected.
Iter6 added a URL-keyed handler cache for process_expand that
helped EX01 (392 -> 710 RPS) but left EX02/05/06/07/08 stuck at
-87 to -92% vs baseline because they POST inline valueSet bodies
that the URL-keyed cache skips.

Iter7 — adds a SECOND per-AppState handler cache keyed by a
deterministic hash of the inline compose body:

- New AppState.inline_compose_handler_cache (Arc<RwLock<HashMap<
  String, Bytes>>>, same 4096 cap, same clear_expand_cache hook).
- New build_inline_compose_cache_key:
  * For each param with a `resource` field: hash (name, JSON of
    resource) into a DefaultHasher (SipHash, fixed keys, fully
    deterministic across processes).
  * Sort the per-resource hashes (so tx-resource ordering doesn't
    fragment the key).
  * Final key = "inline:" + 16-hex-char digest + "|" + JSON-of-
    non-resource-params-sorted-by-name.
  * Returns None (skips cache) when SKIP_NAMES present
    (useSupplement, default-valueset-version, force-system-version,
    system-version, check-system-version) or when no valueSet
    resource is present (URL-keyed cache handles those).
- process_expand flow now: URL key first, then compose key, then
  bare process_expand_inner if neither applies.
- Per-request expansion.identifier (UUID) and timestamp are stored
  in the cached Bytes — same as the URL-keyed cache; IG validator
  matches them as wildcards.

Expected coverage: EX02, EX05, EX06, EX07, EX08 (POST inline VS);
plus benefits any other inline-compose request flow.
VC03's cold-miss path runs three uncached spawn_blocking SQL hops
per call; VC01 amortises these because all 50 VUs converge on the
same handler-cache key, but VC03's broader (10 URLs × ~180 codes)
keyspace stays cold-dominated within the 30s bench window.

Two per-instance caches added (mirroring cs_language_cache):

- cs_version_for_url_cache: Arc<RwLock<StringOptionMap>>
  Wraps code_system_version_for_url; saves one spawn_blocking +
  pool acquire + json_extract per validate-code call.
- cs_exists_cache: Arc<RwLock<BoolMap>>
  New CodeSystemOperations::code_system_exists trait method (default
  impl delegates to .search() so Postgres backend keeps compiling).
  SQLite override runs SELECT EXISTS(...) once and memoises bool.
  Replaces two .search().map(|h| !h.is_empty()) patterns in
  process_vs_validate_code_inner — both inside the codings loop.
  build_validate_response_async's existing call kept (it uses the
  full Resource for downstream display/status logic).

Both caches initialised in new() and in_memory() and cleared
inside BundleImportBackend::import_bundle alongside the existing
per-instance index/cache evictions. Same wire output; no trait
breaking change (default impl on the new method).
VC03 stuck at 956 RPS despite identical handler cache pattern that
gave VC01/VC02 47K/42K. Diagnosis: tests run sequentially against
ONE server. VC01 (2000 keys) + VC02 (8000 keys) = 10000 keys
overflows the 4096 cap. validate_code_cache_put silently drops
new entries when full, so by the time VC03 (1831 keys) runs,
every PUT is dropped — VC03 always misses.

- VALIDATE_CODE_HANDLER_CACHE_MAX: 4096 -> 16384
- EXPAND_HANDLER_CACHE_MAX: 4096 -> 16384

Defense-in-depth: same overflow pattern would affect any test
combination whose total cardinality > 4096.

Also added VC_CACHE info-level probes around both wrappers
(process_validate_code + process_vs_validate_code) keyed by
hit/miss + first 100 chars of cache key — to validate the fix
in the next bench and inform any future capacity tuning. Probes
are tracing::info! only — no wire-output change.
Apply cargo fmt across hts crate and address clippy errors:
- drop dead `false` initialiser on `compose_is_enumerated` (both
  branches assign before read)
- add `#[allow(dead_code)]` to currently-unused `resolve_value_set`,
  `compute_expansion`, `cs_version_from_compose` helpers
- factor `SystemIdCacheMap` type alias for `SYSTEM_ID_CACHE`
- silence type_complexity on `build_exclude_sets` return
- replace `iter().any(|s| *s == code)` with `.contains(&code)` in
  `is_warning_status`
- silence too_many_arguments on three validate-code helpers
- swap `&[in_code.clone()]` for `std::slice::from_ref(&in_code)`
Comment thread crates/hts/src/import/fhir_bundle.rs
@smunini smunini merged commit 870cc75 into main May 10, 2026
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