============================================================================= Run Date: MAY 24, 2016 Designation: OR*3*269 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #366 Status: Released Compliance Date: JUN 24, 2016 ============================================================================= Associated patches: (v)PSJ*5*281 install with patch `OR*3*269' (v)GMRA*4*46 install with patch `OR*3*269' (v)OR*3*286 <<= must be installed BEFORE `OR*3*269' (v)OR*3*306 <<= must be installed BEFORE `OR*3*269' (v)OR*3*311 <<= must be installed BEFORE `OR*3*269' (v)OR*3*346 <<= must be installed BEFORE `OR*3*269' (v)OR*3*352 <<= must be installed BEFORE `OR*3*269' (v)PSO*7*411 <<= must be installed BEFORE `OR*3*269' (v)OR*3*395 <<= must be installed BEFORE `OR*3*269' Subject: ADD SIGN/SYMPTOMS TO ALLERGY-DRUG INTERACTION ORDER CHECK MESSAGE Category: - Routine - Data Dictionary - Enhancement (Mandatory) Description: ============ This patch is part of the Medication Order Check Healthcare Application (MOCHA) Enhancements 2 group of patches. A host file was created to simplify installation at Veterans Health Administration (VHA) facilities. The host file MOCHA_ENH_2_GMRA_OR_PSJ_PSO.KID contains: PSJ*5*281, PSO*7*411, OR*3*269 and GMRA*4*46. Additionally there is the stand alone patch PSS*1*175 which must be installed before the combined build. Important: Recently released patch GMRA*4*48 contains an Allergy Assessment Clean Up utility tool that produces a report that identifies discrepancies between the ADVERSE REACTION ASSESSMENT file (#120.86) and the PATIENT ALLERGIES file (#120.8). It is imperative that GMRA*4*48 be installed prior to the installation of OR*3*269 and its associated patches, and that all data discrepancies identified by GMRA*4*48 have been corrected. If not, then installing OR*3*269 and its associated patches may result in drug allergy order checks not displaying in Computerized Patient Record System (CPRS) and pharmacy during the medication order entry processes. The following functionality changes are introduced in this patch: 1. This patch will enable the Computerized Patient Record System (CPRS) to display the sign/symptom and the severity of an adverse reaction to a medication in its ALLERGY-DRUG INTERACTION order check messages. It will also update the Remote Data Interoperability (RDI) component within CPRS to retrieve the sign/symptom, severity, and observed/historical data values from the Health Data Repository (HDR) for adverse reactions. 2. During testing of an unrelated patch, it was discovered that order checks performed during the AudioCare renewal process were stored in the ORDER CHECK INSTANCES (#100.05) file using the user who processed the refills, rather than the proxy user. Since the routine required to correct this issue is already included in this patch, the correction was added to this patch. Patch Components ================ Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- ORDER CHECK INSTANCES ORDER (#.01) Modified (#100.05) STATUS (#1) Modified OCCURRENCE (#2) Modified USER (#3) Modified OCCURRENCE Modified DATE/TIME (#4) ORDER CHECK (#5) Modified CLINICAL DANGER Modified LEVEL (#6) OVERRIDE REASON (#7) Modified PHARMACIST OVERRIDE Modified COMMENTS (#13) PHARMACIST (#14) Modified PHARMACIST COMMENTS Modified DATE/TIME (#14.1) MONOGRAPH TERM (#16) Modified DRUG ALLERGIES (#17) Modified DISPENSE DRUGS (#50) New GROUP ONE PHARMACY New ORDERS (#60) GROUP TWO PHARMACY New ORDERS (#70) INTERVENTION (#81) New CLOZAPINE DISPENSING New FREQUENCY (#82) DRUG INTERACTION New SEVERITY (#83) DATABASE (#84) New CLOZAPINE LAB New RESULTS (#90) CLINICAL EFFECTS New (#100) DRUG ALLERGIES SUB-FIELD INTERACTING Deleted (#100.517) MEDICATION (#.01) REACTANT (#.01) New LOCATION (#1) Deleted CAUSATIVE AGENT (#2) Modified VA DRUG CLASSES (#3) Modified DRUG INGREDIENTS Modified (#4) SIGNS/SYMPTOMS (#5) Modified REMOTE LOCATION Deleted (#6) LOCATION TYPE (#6) New INTERVENTION (#7) Deleted REMOTE LOCATION New (#7) DATABASE (#8) Deleted ORIGINATION DATE/ New TIME (#8) OBSERVED/HISTORICAL Modified (#9) SEVERITY (#10) Modified Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A New Service Requests (NSRs) ---------------------------- 20100825 Drug-Allergy Order Check Enhancements and Improved Detail The following features are introduced by this patch: 1. Add signs/symptoms and severity data to the drug-allergy order check message. 2. Replace the site designation (local/remote) with the name of the site that documented the allergy and the date and time of when the documentation was entered. 3. Populate the DRUG ALLERGIES field (#17) in the ORDER CHECK INSTANCES file (#100.05) for drug-allergy order checks. 20080334 CCDSS (CPRS) PSI mandated work 2009 A Clinical decision Support System is being requested to further enhance drug order checking to improve patient care and reduce costs. This request is to address work mandated as determined by Patient Safety Incident (PSI) evaluation. Patient Safety Issues (PSIs) ----------------------------- PSPO 2069 When a provider is shown an adverse reaction order check message, the provider has to cancel the order and then navigate to the coversheet to review both the severity and the signs and symptoms of the reaction. This patch addresses this issue by including the reaction's severity and its signs and symptoms in the order check message. For example, Previous MODERATE adverse reaction to IODINE resulted in VOMITTING (ANN ARBOR VAMC entered on 01/14/2013@14:27). PSPO 2099 When a provider is shown an adverse reaction order check message with (LOCAL) at the end of the message, providers have misinterpreted this to mean the patient experienced a localized reaction (such as a rash) instead of the fact that the reaction was documented locally. This patch addresses this issue by replacing the site designation (local/remote) with the name of the site that documented the allergy and the date and time of when the documentation was entered. For example, (ANN ARBOR VAMC entered on 01/14/2013@14:27). PSPO 457/2072 The wrong reactant is displayed in the adverse reaction order check message. The ordered drug is displayed as the causative agent. See associated remedy tickets 130757, 173383 and 510151 for resolution. PSPO 281 The adverse reaction order check message displays the ordered drug instead of the causative agent in the adverse reaction order check message. See associated remedy tickets 130757 and 536052. Remedy Ticket(s) & Overview --------------------------- 1. HD130757 1 Wrong reactant displayed in allergy check pop-up window HD173383 pt with sulfa allergy received HCTZ HD510151 1 Misleading adverse reaction if order for Furosemide and pt has allergy to Sulfa Drugs Problem: ------- The wrong reactant is displayed in the adverse reaction order check message. The ordered drug is displayed as the causative agent. Resolution: ---------- The adverse reaction order check message is modified to correctly display the causative agent from the PATIENT ALLERGIES file (#120.8). 2. HD536052 Ofloxacin allergy entry does not prompt for Order checks Problem: ------- The adverse reaction order check message displays the ordered drug instead of the causative agent in the adverse reaction order check message. Resolution: ---------- The adverse reaction order check message is modified to correctly display the causative agent from the PATIENT ALLERGIES file (#120.8). Test Sites: ---------- VA Maryland Health Care System Sioux Falls VA Health Care System Orlando VA Medical Center Documentation Retrieval Instructions ------------------------------------ Updated documentation describing the new functionality introduced by this patch is available. The preferred method is to retrieve the files from the ANONYMOUS.SOFTWARE directory on download.vista.domain.ext using secure file transfer protocol (SFTP). This transmits the files from the first available SFTP server. Sites may also elect to retrieve the files directly from a specific server as follows: Albany ftp.domain.ext Hines ftp.domain.ext Salt Lake City ftp.domain.ext Documentation can also be found on the VA Software Documentation Library at: http://www4.domain.ext/vdl/ Title File Name FTP Mode ----------------------------------------------------------------------- CPRS User Guide: GUI Version CPRSGUIUM.PDF Binary CPRSGUIUM.DOC Binary MOCHA Enhancements 2 Release PSS_1_PSJ_5_PSO_7_RN_R0416.PDF Binary Notes MOCHA Enhancements 2 PSS_1_PSJ_5_PSO_7_MOCHA_E2_CB_IG.PDF Installation Guide Binary Patch Installation: Pre/Post Installation Overview ------------------------------ The post installation routine will execute the following tasks: 1. Add a REMOTE DATA UNAVAILABLE entry to the ORDER CHECKS file (#100.8). 2. Update the Allergy-Contrast Media Interactions order check in the CPRS Expert System to use the new allergy order check application programming interface (API). 3. Convert existing data within the ORDER CHECK INSTANCES file (#100.05) to conform with the new data dictionary. After the patch is successfully installed, KIDS will automatically delete the main post-install routine ORY269. Pre-Installation Instructions ----------------------------- This patch may be installed with users on the system although it is strongly recommended that it be installed during non-peak hours when CPRS usage is at a minimum, particularly medication activities and entering or editing adverse reaction data to minimize potential disruption to users. The amount of time needed to complete the installation is dependent upon the number of entries in the ORDER CHECK INSTANCES (#100.05) file that need conversion and could range from 5 to 30 minutes. Installation Instructions ------------------------- Refer to the MOCHA Enhancements 2 Installation Guide for installation instructions. Install Order: 1. PSS_1_175.KID 2. MOCHA_ENH_2_GMRA_OR_PSJ_PSO.KID Post-Installation Instructions ------------------------------ After the patch is successfully installed, KIDS will automatically delete the main post-install routine ORY269. Sites may safely delete the following remaining post-install routines using the Delete Routines [XTRDEL] option: ORY2690 ORY26901 ORY26902 ORY26903 ORY26904 ORY26905 ORY2691 ORY2692 ORY2693 ORY2694 ORY269ES 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 84 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORCHECK Before:B120029142 After:B120466042 **7,56,70,94,141,215,243,293, 280,346,357,352,345,311,269** Routine Name: ORCSAVE Before: B98247986 After: B98204455 **7,56,70,73,92,94,116,141,163, 187,190,195,243,303,293,280, 306,286,269** Routine Name: ORCSAVE2 Before: B84601504 After: B85557974 **4,27,56,70,94,116,190,157, 215,265,243,293,280,346,269** Routine Name: ORKCHK5 Before: B46374630 After: B87020125 **6,32,74,94,123,190,280,357, 345,269** Routine Name: ORKCHK6 Before: B31183287 After: B28204591 **6,32,74,87,94,123,162,190, 249,280,272,346,345,269** Routine Name: OROCAPI1 Before: B44544805 After: B59785777 **293,346,345,269** Routine Name: ORQQAL Before: B28169891 After: B15654998 **9,85,162,190,216,232,243,269** Routine Name: ORRDI1 Before:B113704699 After:B165641370 **232,294,306,269** Routine Name: ORWDXC Before: B69940726 After: B72504942 **10,141,221,243,280,346,345, 311,395,269** Routine Name: ORY269 Before: n/a After: B18452228 **269** Routine Name: ORY2690 Before: n/a After: B15650231 **269** Routine Name: ORY26901 Before: n/a After: B70829648 **269** Routine Name: ORY26902 Before: n/a After: B80510090 **269** Routine Name: ORY26903 Before: n/a After: B60307349 **269** Routine Name: ORY26904 Before: n/a After: B65797598 **269** Routine Name: ORY26905 Before: n/a After: B54406345 **269** Routine Name: ORY2691 Before: n/a After: B40554138 **269** Routine Name: ORY2692 Before: n/a After: B26767922 **269** Routine Name: ORY2693 Before: n/a After: B13000330 **269** Routine Name: ORY2694 Before: n/a After: B13530470 **269** Routine Name: ORY269ES Before: n/a After: B12638325 **269** Routine list of preceding patches: 286, 395 ============================================================================= User Information: Entered By : Date Entered : NOV 06, 2006 Completed By: Date Completed: MAY 19, 2016 Released By : Date Released : MAY 24, 2016 ============================================================================= Packman Mail Message: ===================== No routines included