$TXT Created by ESCALERA,Diego at CHEY19.FO-BAYPINES.DOMAIN.EXT (KIDS) on Thursday, 06/20/13 at 16:07 ============================================================================= Run Date: SEP 05, 2013 Designation: OR*3*354 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #322 Status: Released Compliance Date: OCT 06, 2013 ============================================================================= Associated patches: (v)OR*3*339 <<= must be installed BEFORE `OR*3*354' Subject: CORRECT TWD AFTER MISSED APPOINTMENT ANTICOAGULATOR GUI Category: - Routine - Other Description: ============ This patch includes a new AMT GUI executable and corrects the following issues: 1) Anticoagulation Management Tool (AMT) GUI is designed to be invoked from the Tools Menu in CPRS. The executable file (AntiCoagulate.exe) is either placed on a workstation or in a network share directory. When running from a network directory location the AMT Help file fails to load. 2) Users can flag a missed appointment in AMT so that the program can calculate the 'Show Rate' given on the Demographics tab. This entry is also used in anticoagulation reports and utilities. In some cases after a missed appointment has been flagged the daily dosing and weekly total dose erroneously revert to previous dosing amounts. 3) The VistA report Calculate TTR (Rosendaal Method) [ORAM ROSENDAAL TTR REPORT] is not considering missed appointment and inactive patient data properly in the calculation, which produces inaccurate TTR (time in therapeutic range) results. 4) When a progress note is entered in AMT it can be saved and signed without requiring the user to enter the required information. 5) The AMT Utility tab provides the function "Pts lost to follow up" to search for patients in the anticoagulation program who have not been seen recently. This function is not presenting the missed appointments accurately. 6) If the daily tablet amount for Monday is entered as 0.25 the error " '1/4' is not a valid floating point value" displays and the dosing letter has a blank in the # of tablets box for Monday. 7) When INR results of "> 3.5" are sent to Anticoagulation Management GUI, they are being display as 3.5. ASSOCIATED NSR(s): ================== N/A ASSOCIATED REMEDY: ================== 1. HD0000000514093 - Anticoagulation Clinical Tool Parameter Setup in VISTA 2. HD0000000523093 - Incorrect TWD display following missed appt PSPO #2110 Duplicates: HD0000000622110 HD0000000511959 3. HD0000000593233 - Rosendaal calculation incorrect 4. HD0000000599707 - Walla Walla (R1 site) problem with signed, no text notes PSPO #2191 5. HD0000000602516 - Patients lost to follow up incorrect PSPO #2197 6. HD0000000719861 - When entering letter with o.25 dosing, letter shows blank and is giving error. 7. HD0000000769824 - INR result >3.5 on point of care device - fingerstick PSPO #2335 PARTICIPATING TEST SITES: ========================= Upstate NY HCS, NY (Buffalo) VA Sierra Nevada HCS, NY (Reno) VA N. Florida/S. Georgia HCS (Gainesville) Dublin VAMC, GA VA East Colorado HSC (Denver) REMEDY OVERVIEW: ================ 1. HD0000000514093 - Anticoagulation Clinical Tool Parameter Setup in Vista Problem: -------- When the AMT GUI is executed from a network directory location the Help file fails to load upon selecting Contents from the AMT Help menu pull down. Resolution: ----------- The AMT GUI has been updated to always check the directory location that the executable is running from (local or remote network) for the existence of the Help file. **NOTE** Microsoft Windows 7 internal security does not allow files with the .hlp extension to be accessed from a remote network location. This is a known issue with Windows 7 and the resolution is not in the scope of this patch. 2. HD0000000523093 - Incorrect TWD display following missed apt Patient Safety Issue: PSPO #2110 Problem: -------- After a user records a missed appointment there is a possibility for the daily dosing schedule and total weekly dosage to erroneously revert to a previous dates dosing schedule. This was caused by the incorrect date of the last INR being recorded as the date the missed appointment was entered in the tool. Resolution: ----------- The AMT GUI will now record the date of the last recorded INR result when a missed appointment is listed on the activity table of the Flowsheet tab. **NOTE** It should be known that when a missed appointment is entered, there is no automatic date entry for when the missed appointment occurred. The date on the Anticoagulation Activity tab will display in chronological order as it relates to the last INR date. 3. HD0000000593233 - Rosendaal calculation incorrect Problem: -------- The clinic and facility-wide calculation of the TTR using the Rosendaal method includes inactive patients and missed appointments. This is causing the report to produce inaccurate results. Resolution: ----------- Because the Rosendaal method does not take inactive patients and missed appointment entries into account, routine ORAMTTR has been modified to include two options when a user selects Calculate TTR (Rosendaal Method) facility-wide report: I Include inactive patients and missed appointments E Exclude inactive patients and missed appointments Selecting the include report will produce the same report as before installing this patch; and selecting the exclude report will omit patients that are considered inactive as well as missed appointment entries. Patients are determined to be inactive if they are marked inactive in the ORAM FLOWSHEET file (#103) or they have a span of more than 56 days without an INR result recorded in the selected date range. 4. HD0000000599707 - Walla Walla (R1 site) problem with signed, no text Notes Patient Safety Issue: PSPO #2191 Problem: -------- It is possible to create and sign Anticoagulation discharge notes that contain no text while in the AMT GUI. This GUI was not checking for the necessary note information when the user completes the AMT visit. Resolution: ----------- The AMT GUI has been modified to require the user to select and complete at least one input check box and its associated text (if any) in the discharge note dialog box before allowing the user to sign the note. When the patch is installed, the post-install routine ORY354 will automatically run and search all TIU notes for patients with entries in the ORAM FLOWSHEET file (#103) for any that were signed with no text entry. This routine may take some time to run, based on the number of records in File #103 ORAM FLOWSHEET. The search results will be listed in a Mailman message with the subject line "ANTICOAG PATIENTS WITH BLANK NOTES". This message will be received by the person installing the patch and should be provided to the appropriate person at each site responsible for anticoagulation tracking and management. A sample message is displayed below: Subj: ANTICOAG PATIENTS WITH BLANK NOTES [#644359] 02/08/13@14:42 18 lines From: CPRS, SEARCH In 'IN' basket. Page 1 -------------------------------------------------------------------------- The check for anticoag patients with blank notes is complete. Here is the list of the affected patients: Patient Note Title Note Date FUXTS,PLYIL Z ANTICOAG CLINIC CONSULT RESULT Dec 12, 2012 LDYIYHU,PDAALUI W ANTICOAG CLINIC CONSULT RESULT Dec 12, 2012 SZDSE,CHTTH S TU ANTICOAG CLINIC CONSULT RESULT Dec 12, 2012 SZDAHN,CXEY Z ANTICOAG CLINIC CONSULT RESULT Feb 04, 2013 CPRSPATIENT,ONELH ANTICOAG CLINIC CONSULT RESULT Feb 08, 2013 CPRSPATIENT,EIGHT ANTICOAG CLINIC CONSULT RESULT Feb 04, 2013 CRAADSXY,PDAADLZ S ANTICOAG CLINIC CONSULT RESULT Dec 13, 2012 CRAELZ,IXYLAI U ANTICOAG CLINIC CONSULT RESULT Feb 08, 2013 (end of example) 5. HD0000000602516 - Patients lost to follow up incorrect Patient Safety Issue: PSPO #2197 Problem: -------- The utility option "Pts lost to follow up" is used to locate and display patients in the anticoagulation program who have not been seen recently. However, the entry of a missed appointment is being considered the same as a patient visit by the utility. This may result in providers incorrectly surmising that a patient has been seen recently, when they have actually missed an appointment. Resolution: ----------- Routine ORAM2 has been modified to change the lost to follow up utility so that it will now display both the last missed appointment within the selected date range if one exists, and the existing last seen date, which is the first date outside the date range that contains an INR. It should be noted that the missed appointment date that displays may not be the date the missed appointment was recorded and may not be the actual date of the missed appointment. 6. HD0000000719861 - When entering letter with o.25 dosing, letter shows blank and is giving error Problem: -------- When entering the numeric value of one-fourth tablet as 0.25 in the AMT dosing schedule for a Monday, the error " '1/4' in not a valid floating point value" displays to the user when printing or reviewing the letter. On the letter, Monday's tablet size is blank. When going back to look at the dosing schedule in AMT, Monday's tablet dosing displays the "1/4" character instead of the correct decimal 0.25 value. Resolution: ----------- The AMT GUI has been modified to correctly accept the value of 0.25 and use the "1/4" character only for the printed letter and not for the actual dosing schedule in AMT. 7. HD0000000769824 - INR result >3.5 on point of care device - fingerstick Patient Safety Issue: PSPO #2335 Problem: -------- INR results that are received from the Lab package with a "<" or ">" symbol are displayed in the AMT GUI without the symbol. This is particularly a problem with Point of Care devices, as some report INR results over 3.5 as ">3.5". The AMT software strips off the symbol when displaying a result containing these symbols. Resolution: ----------- Update the AMT software to display the "<" or ">" before the numeric value of the INR result in the AMT GUI. All INR results that were received from the Lab package containing either symbol before installing this patch will display the appropriate symbol after installing OR*3*354. INR results that were stored in File #103 ORAM FLOWSHEET without the accompanying symbol before patch OR*3*354 was installed will display on the AMT graph as ">#/#" (">3.5/3.5"). SOFTWARE RETRIEVAL: =================== To obtain the updated client software, use FTP to retrieve OR_30_354.zip from one of the following OI Field Offices' ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- Albany ftp.fo-albany.domain.ext anonymous.software Hines ftp.fo-hines.domain.ext anonymous.software Salt Lake City ftp.fo-slc.domain.ext anonymous.software The software distribution includes this file: OR_30_354.zip (1.04 MB) FILE NAME RETRIEVAL FORMAT --------- ---------------- OR_30_354.ZIP BINARY ZIP FILE CONTENTS DESCRIPTION FILE VERSION ----------------- ----------- ------------ AntiCoagulate.exe Client 1.0.354.10 Anticoag_help_file.hlp Client help file Anticoag help file.cnt Client help TOC file GUI Client installation instructions are in the Anticoagulation Management Installation/Implementation Guide in the VistA Documentation Library: http://www.domain.ext/vdl. INSTALLATION INSTRUCTIONS: ========================== This patch can be loaded with users in the system but it is recommended that it be installed when user activity is low. Installation time will be less than 2 minutes. 1. Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: Installation --- 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution 3. From this menu, you may elect to use the following options (When prompted for the INSTALL NAME, enter OR*3.0*354): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 4. Use the Install Package(s) option and select the package OR*3.0*354. a. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//", answer NO. b. When prompted "Want to DISABLE Scheduled Options and Menu Options and Protocols? NO//", answer NO. c. When prompted "Running Post-Install Routine: EN1^ORY354 Requested Start Time: NOW//", answer NOW or enter a future date/time. POST INSTALL INSTRUCTIONS: ========================== INSTALLER: Routine ORY354 produces a Mailman message. (RE: Issue #4) Please provide the Mailman message and this Patch Description to the VA site Patient Safety Manager (PSM) for distribution to the Anticoagulation Management Tool (AMT) Coordinator for further dissemination to the AMT users. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 12 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORAM2 Before:B121018591 After:B139162666 **307,339,354** Routine Name: ORAMTTR Before: B84841974 After: B99608227 **307,339,354** Routine Name: ORY354 Before: n/a After: B9049892 **354** Routine list of preceding patches: 339 ============================================================================= User Information: Entered By : THOMPSON,SETH Date Entered : SEP 22, 2011 Completed By: HULET,LEE ANN Date Completed: AUG 12, 2013 Released By : STOKER,ELAINE Date Released : SEP 05, 2013 ============================================================================= Packman Mail Message: ===================== $END TXT