$TXT Created by SCM.FO-BIRM.DOMAIN.EXT (KIDS) on Friday, 04/05/19 at 08:43 ============================================================================= Run Date: APR 22, 2019 Designation: OR*3*444 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #423 Status: Released Compliance Date: MAY 23, 2019 ============================================================================= Associated patches: (v)OR*3*350 <<= must be installed BEFORE `OR*3*444' (v)OR*3*441 <<= must be installed BEFORE `OR*3*444' (v)OR*3*456 <<= must be installed BEFORE `OR*3*444' (v)OR*3*471 <<= must be installed BEFORE `OR*3*444' Subject: CPRS MODIFICATION UNIFIED ACTION PROFILE Category: - Routine - Data Dictionary Description: ============ **Note: This functionality is delivered with an On/Off switch parameter. (OR UNIFIED ACTION PROFILE OFF). The default setting is Off. Do not switch this feature On until CPRS v.32 (OR*3.0*405) has been released and successfully installed. OR*3.0*444 enables a clinician to view existing inpatient and outpatient medication orders from the local site on a single page when preparing to discharge a patient. This order information is displayed on a new Unified Action Profile (UAP) form available from the View menu on the Computerized Patient Record System (CPRS) Orders tab. Duplicate orders can occur because outpatient orders remain in the system after a patient is admitted, and new inpatient orders are created after admission. When discharging a patient, a clinician must review all orders to avoid duplication, while ensuring the correct medication orders are continued for patient safety and care. The clinician must take the appropriate action for each medication order, deciding whether to continue, change, renew, or discontinue the order prior to discharge. Previously, when preparing to discharge a patient, a clinician had to switch between forms in order to review all medication orders. OR*3.0*444 enables the clinician to review all medication orders at one time from the new UAP form. This change both simplifies order reconciliation and reduces the time and effort required from the clinician when making decisions on each active inpatient and outpatient order. The UAP sorts orders by the first orderable item name from the Orderable Items file (#101.43), so that inpatient and outpatient medications are grouped together. Sorting orders by the orderable item name ensures that the clinician sees all existing orders for each drug when making decisions during reconciliation. Note: The Order Text field (#100.0081) in the Order file (#100) is a word processing field that is generated when an order is created. Additional Order Text fields are added each time the order is modified. When working with an order in CPRS, the content of the most recent Order Text field is displayed. UAP checks the first line of the Order Text field against the orderable item name. If this check detects that the first line of the Order Text field does not match the orderable item name, then the order is sorted based on the first line of the most recent Order Text field. In the UAP view, Infusions are sorted alphabetically by the first orderable item identified as an additive; solutions are ignored for the purpose of sorting. The orderable items that display are reorganized based on the orderable additive item used for sorting. This change supports alphabetical sorting by a meaningful additive in the UAP, but does not change the original order in the ORDER file (#100). Infusions usually have more than one orderable item and sorting by the first additive ensures a consistent alphabetized display of infusion orders in the UAP view. Infusion orders cannot be continued, changed, or renewed using UAP because CPRS does not convert inpatient infusion orders to an outpatient order when preparing for discharge. To prevent issues with discharge medication orders, these options are grayed when performing UAP medication reconciliation for an inpatient Infusion order. Note: When an order is modified by a pharmacist during prescription processing, the order is marked with an asterisk when displayed in CPRS. In the UAP view, this asterisk is hidden when displaying orders; this preserves the alphabetical sorting critical to the reconciliation process. The UAP includes a Reviewed column that displays the decision made by the clinician during review. A new "UAP Reviewed?" field (#.61) is added to the order record in the ORDER file (#100). This field denotes whether an order was reviewed ("1") or not reviewed ("0"). Two additional fields store information about previous reviews: the "UAP Last Reviewed" field (#.62) stores the date an order was last reviewed using the UAP form; the "UAP Last Reviewed By" field (#.63) stores identification information for the last person to perform a review of the order using the UAP view. This enhancement also adds a Discharge Meds Review form, which provides a summary of all medications being continued for the patient upon discharge. This form is accessed by selecting the Discharge Meds view from the Orders tab. The Discharge Meds Review form enables a clinician to see the full list of medications prescribed for a discharged patient after the UAP review is completed. This modification includes a new PHARMACY UAP Display Group, which includes the display members INPATIENT MEDICATIONS, OUTPATIENT MEDICATIONS, and NON-VA MEDICATIONS. If expected orders do not display in the UAP view, additional display members can be added to the group. For example, Supply orders are omitted from the UAP view by design, but they can be displayed if the SUPPLY Display Group is added as a member of the PHARMACY UAP Display Group. To add additional display group members to the PHAMACY UAP Display Group, contact OIT for assistance; access to VistA programmer mode and FileMan are required to modify display group members. A new parameter (OR UNIFIED ACTION PROFILE OFF) in VistA enables sites to turn the UAP functionality On/Off. This parameter is set at the facility level and is located in the PARAMETER DEFINITION file (#8989.51). Initially, this parameter is set to OFF ("0"). When the parameter is set to OFF, the two options used to access the Unified Action Profile functionality (Unified Action Profile (UAP) and Discharge Meds) are not displayed on the CPRS View menu. To enable this functionality, set the parameter to ON ("1") using the Edit Parameter Values function accessible from the XPAR MENU TOOLS option in VistA. **Note: In addition to turning this new parameter ON, enabling UAP requires changing two settings for the Discharge Release Event using the CPRS Configuration (Clin Coord) menu in VistA. Both settings are accessible from the Event Delayed Orders option. First, activate the DISCHARGE Release Event by changing the Activate/Inactivate [AI] setting to ACTIVATE. Second, disable Copy Active Orders by changing the Copy Active Orders setting to NO. The medication reconciliation performed by UAP will not function as intended until the parameter is turned ON and these settings are configured. Refer to the Post-Installation Instructions in this document for an example of how to modify these settings. BLOOD BANK Clearance: EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3.0*444 contains changes to a package referenced in ProPath standard titled: BBM Team Review of VistA Patches. This patch does not alter or modify any VistA Blood Bank software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch OR*3.0*444 have no effect on Blood Bank software functionality, therefore RISK is none. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------------------ -------------------- ORDER (#100) UAP Reviewed? (#100,.61) NEW ORDER (#100) UAP Last Reviewed (#100,.62) NEW ORDER (#100) UAP Last Reviewed By (#100,.63) NEW 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 Parameters Associated: Parameter Name New/Modified/Deleted ----------------------------- -------------------- OR UNIFIED ACTION PROFILE OFF New Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Remote Procedures(RPC)s Associated: RPC Name ROUTINE TAG New/Modified/Deleted ------------- ------- -------- -------------------- ORTO SET UAP FLAG ORTOULT4 SETUAPF NEW ORTO GETRVW ORTOULT4 GETRVW NEW ORTO SETRVW ORTOULT4 SETRVW NEW ORTO UAPOFF ORTOULT4 UAPOFF NEW ORTO DGROUP ORTOULT4 DGROUP NEW Additional Information: N/A New Service Requests (NSRs): ---------------------------- NSR20130714 CPRS Modification Unified Action Profile Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- N/A Problem: ------- N/A Resolution: ---------- N/A Test Sites: ---------- VA Portland Health Care System, Portland, OR Milwaukee VA Medical Center, Milwaukee, WI Software and Documentation Retrieval Instructions: ---------------------------------------------------- The software is released as a PackMan message and is distributed from FORUM. Documentation associated with the new functionality introduced by this patch is available for downloading. The preferred method is to retrieve files from download.vista.domain.ext. This transmits the files from the first available server. Sites may also elect to retrieve files directly from a specific server. Sites may retrieve the documentation directly using Secure File Transfer Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following OI Field Offices: Hines: domain.ext Salt Lake City: domain.ext Title File Name FTP Mode ----------------------------------------------------------------------- CPRS User Guide: GUI Version cprsguium.pdf Binary CPRS User Guide: GUI Version cprsguium.doc Binary CPRS Technical Manual GUI Version cprsguitm.pdf Binary CPRS Technical Manual GUI Version cprsguitm.doc Binary The documentation may also be found in the VA Software Document Library (VDL) at: https://www.domain.ext/vdl/ Patch Installation: Pre/Post Installation Overview: ------------------------------- Review the Pre-Installation Instructions provided before beginning installation of the patch. The post-installation routine ORUA444P runs automatically and is deleted after installation. This routine: - Adds the new DISCHARGE MEDS and PHARMACY UAP display groups to the DISPLAY GROUPS file (#100.98); these groups are used during UAP processing. Refer to the Post-Installation Instructions in this document for information about adding new display group members to the PHARMACY UAP display group. - Registers new Remote Procedure Calls (RPCs) ORTO SET UAP FLAG, ORTO GETRVW, ORTO SETRVW, ORTO UAPOFF, and ORTO DGROUP to the OR CPRS GUI CHART option. Pre-Installation Instructions: ------------------------------ This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 minutes to install. Installation Instructions: -------------------------- To install the patch: 1. Choose the PackMan message containing this patch. 2. Choose the INSTALL/CHECK MESSAGE PackMan option. 3. From the Kernel Installation and Distribution System (KIDS) menu, select the Installation Menu. From this menu, you may elect to use the following options. When prompted for the INSTALL NAME, enter the patch number OR*3.0*444. a. Verify Checksums in Transport Global - This option will help ensure the integrity of the routines that are in the transport global. b. Print Transport Global - This option will enable viewing the components of the KIDS build. c. Compare Transport Global to Current System - This option will enable viewing all changes that will be made when this patch is installed. It compares all components of this patch (routines, data dictionaries, templates, etc.). d. Back up a Transport Global - This option will create a backup message of any routines exported with this patch. It will not back up any other changes such as data dictionaries or templates. 4. From the Installation Menu, select the Install Package(s) option and choose the patch to install. 5. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', press . 6. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', press . 7. If prompted 'Delay install (Minutes): (0-60): 0//', press . 8. If prompted 'Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// HOME (CRT)', press . Post-Installation Instructions: -------------------------------------------------------------- **Note: This functionality requires CPRS v.32. Do not perform the following configuration steps until CPRS v.32 (OR*3.0*405) has been released and successfully installed. The functionality enabled by this patch requires that the feature Copy Active Orders is disabled and the Discharge Release Events is Activated. Both configuration settings are controlled using the CPRS Clinical Coordinator's menu in VistA. From the CPRS Clinical Coordinator's menu in VistA: 1. At the prompt, type "PE" to display CPRS Configuration (Clin Coord) options. 2. At the prompt, type "DO" to display the Event Delayed Orders Menu. 3. At the prompt, type "DO" to display Delayed Orders/Auto-DC Set-up options. 4. Select option 2, Release Events, to display a list of available Release events. 5. At the prompt, type "DD" from the list of actions to open the Detailed Display. 6. Select option 10, DISCHARGE, as the Release Event. 7. At the prompt, type "AI" to Activate/Inactivate the Discharge Event. Confirm the selection to ACTIVATE at the "Are you sure you want to ACTIVATE this entry? NO//YES" prompt by pressing Enter. 8. At the prompt, type "AE" to ADD/EDIT the Discharge event. 9. Press Enter to move through the remaining prompts until the COPY ACTIVE ORDERS prompt displays. Enter "NO" to disable Copy Active Orders. Verify Copy Active Orders is set to NO. 10. The Write Orders List by Event options display, followed by the "Enter selection:" prompt. This selection determines which users are affected by the change. For example, to apply this setting to all CPRS users at a particular site, type "System" at the prompt. Limit how broadly this setting applies by selecting an alternate choice of User, Location, Service, Division, instead of System. Note: The PHARMACY UAP Display Group is delivered with the members INPATIENT MEDICATIONS, OUTPATIENT MEDICATIONS, and NON-VA MEDICATIONS. If additional members must be added to this display group, contact OIT for assistance. The OIT representative must add new display group members to the PHARMACY UAP Display Group file (#100.98) using the following steps: 1. Log in to VistA in programmer mode and then navigate to FileMan. 2. Select the ENTER OR EDIT FILE ENTRIES option. 3. At the "Input to what File: OPTION//" prompt, type DISPLAY GROUP. 4. At the "EDIT WHICH FIELD: /ALL" prompt, type MEMBER. 5. At the EDIT WHICH MEMBER SUB-FIELD: /ALL" prompt, press Enter. 6. At the "Select DISPLAY GROUP NAME:" prompt, type PHARMACY UAP. 7. At the "Select MEMBER: NON-VA MEDICATIONS//" prompt, type the name of the Display Group to add to the PHARMACY UAP Display Group. For example, type CLINIC MEDICATIONS to add the CLINIC MEDICATIONS member to the PHARMACY UAP Display Group. 8. At the "Are you adding 'CLINIC MEDICATIONS' as a new MEMBER? No//" prompt, type Y (Yes). 9. At the MEMBER SEQUENCE: 4//" prompt, press Enter to accept the default. Note: The member sequence is not used by the UAP code modification. 10. Repeat these steps to add each required display group to the PHARMACY UAP Display Group file. Backout Procedure: ------------------ Backout of this patch will be performed only with the concurrence and participation of the appropriate VA site/region personnel. The decision to back out the patch will be a joint decision between VA site/region personnel and other appropriate VA personnel. Note: Due to the complexity of this patch, it is not recommended for backout, and a restore from a backup of the Transport Global should not be attempted. However, in the event that a site decides to back out this patch, the site should contact the National Service Desk (NSD) to submit a help desk ticket. The development team will need to issue one or more follow-on patches in order to comprehensively back out this patch, after coordination with the VA Project Manager and COR. Validation of Backout Procedure: -------------------------------- The Backout procedure can be verified by printing the first two lines of the OR routines contained in this patch using the option First Line Routine Print [XU FIRST LINE PRINT]. Once the OR routines have been backed out, the first two lines of the routines will no longer contain the designation of patch OR*3.0*444 on line 2 in the patch list section. Note: This validation procedure only verifies that routine changes have been backed out; it does not confirm that other patch component changes have been backed out. 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 48 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORQ1 Before: B10080837 After: B12018675 **27,72,78,141,190,215,444** Routine Name: ORQ11 Before: B65899286 After: B86143021 **7,27,48,72,78,99,94,148,141, 177,186,190,195,215,243,295, 322,350,444** Routine Name: ORQ12 Before: B41144852 After: B44346271 **12,27,78,92,116,190,220,215, 243,356,441,444** Routine Name: ORTOULT4 Before: n/a After: B55857069 **444** Routine Name: ORUA444P Before: n/a After: B6132340 **444** Routine Name: ORWORR Before: B81663175 After: B88246015 **10,92,116,110,132,141,163, 189,195,215,243,280,306,471, 444** Routine Name: ORWORR1 Before: B9884468 After: B14089076 **141,243,456,444** Routine list of preceding patches: 350, 441, 456, 471 ============================================================================= User Information: Entered By : Date Entered : NOV 10, 2016 Completed By: Date Completed: APR 17, 2019 Released By : Date Released : APR 22, 2019 ============================================================================= Packman Mail Message: ===================== $END TXT