$TXT Created by ALVIN JR at CLN1S1.AAC.DOMAIN.EXT (KIDS) on Tuesday, 03/16/21 at 10:41 ============================================================================= Run Date: APR 20, 2021 Designation: YS*5.01*175 Package : YS - MENTAL HEALTH Priority: Mandatory Version : 5.01 SEQ #132 Status: Released Compliance Date: MAY 04, 2021 ============================================================================= Associated patches: (v)YS*5.01*149 <<= must be installed BEFORE `YS*5.01*175' Subject: CLOZAPINE HL7 WARRANTY Category: - Routine Description: ============ This patch is a warranty patch for Clozapine HL7 patch YS*5.01*149. The Mental Health (YS) Clozapine HL7 software enables the Department of Veterans Affairs (VA) to maintain compliance with federal mandates for tracking Clozapine prescriptions and dispensing. This patch addresses an issue with the nightly transmission of Clozapine Health Level 7 (HL7) messages to the National Clozapine Registry (NCR) database. The Veterans Data Integration and Federation (VDIF) Enterprise Platform is responsible for delivering the HL7 messages from each Vista facility to the NCR SQL database table HL7MessageDumps, which serves as an inbound HL7 queue. The NCR web application is responsible for parsing, validating, and processing the HL7 messages out of the HL7MessageDumps table and into permanent NCR tables. Defect Summary Defect INC16902503: Missing WBC/ANC Labs Older Than 7 Days ----------------------------------------------- Clozapine HL7 messages are missing White Blood Cell Count (WBC) and Absolute Neutrophil Count (ANC) lab results when there are greater than 7 days between the specimen collection date/time and the clozapine order finish date/time. Description ------------ Clozapine orders require valid WBC and ANC lab results collected no more than 7 calendar days prior to the order becoming active. For example, lab results collected at 10/01/2020@0001 will authorize clozapine orders through 10/08/2020@2359. However, the clozapine HL7 process is evaluating the time portions of both the specimen collection date/time and the clozapine order's finishing date/time to exclude lab results collected 7 days prior to the finishing date, when the specimen was collected at an earlier time of day than the order finishing time of day. For example, lab results collected in the morning will not be sent in the clozapine ADT HL7 message (as they should be) if the order is finished in the afternoon of the 7th day following the specimen collection, even though the pharmacy order entry process allows the order because number of calendar days between the specimen collection date and the order finishing date is not more than 7. Solution --------- Send WBC and ANC lab result information in clozapine HL7 ADT messages when there are 7 days or less between the specimen collection date and the date the order's status is changed to active, regardless of the time values of the collection date/time and the order activation date/time. Using this logic, a specimen collected in the morning on January 1st will authorize clozapine orders up to midnight on January 8th. Technical Solution ------------------ Change routine YSCLHLGT to strip the time value from the FINISHDT variable prior to passing as a parameter to routine CL^YSCLHLAB. This will ensure that all lab results that were collected on the 7th calendar day will be returned, regardless of the time. Two different OBX segments in the HL7 ADT^A05 message are affected: the OBX segment containing the WBC lab results (SetID=3, or OBX|3), and the OBX segment containing the ANC lab results (SetID=4, or OBX|4). The incorrectly excluded lab information results in data missing from the HL7 fields listed below: HL7 ADT segment.field affected (SetID=3 and SetID=4): --------------------------------------------------------- OBX.5 - Observation Value OBX.14 - Date/Time of Observation Example of OBX|3 and OBX|4 HL7 ADT segments missing data: OBX|3|CE|^WBC||||||F|| OBX|4|CE|^ANC||||||F|| Example of OBX|3 and OBX|4 HL7 ADT segments containing data: OBX|3|CE|^WBC||30000||||F||20201202110337-0500 OBX|4|CE|^ANC||100000||||F||20201202110337-0500 Defect INC16903299: Missing Overrides for Inpatient Complex Orders -------------------------------------------------- Clozapine HL7 missing override information for Complex Inpatient Medications clozapine orders. Description ------------ When a complex Inpatient Medications V.5.0 clozapine order requires an override due to expired WBC/ANC lab results or Discontinued clozapine status, the clozapine override information is not included in the clozapine HL7 message sent to the National Clozapine Coordinating Center (NCCC). Solution --------- Ensure Inpatient Complex order clozapine override information is sent, when it exists, in clozapine HL7 RDE messages by correctly retrieving Inpatient Complex clozapine override information from the CLOZAPINE MEDICATION OVERRIDES file (#53.8). Technical Solution ------------------ Change routine YSCLHLGT to retrieve Inpatient clozapine override information from the CLOZAPINE MEDICATION OVERRIDES file (#53.8) using a numeric (integer) format for the CPRS order number (i.e., without a semicolon suffix). The numeric order number format is stored in the CLOZAPINE MEDICATION OVERRIDES file (#53.8) and must be used to find previously filed entries. The change will ensure Complex Inpatient clozapine override information is sent in clozapine HL7 RDE messages, in fields RXE.7 and RXE.14 (details below). HL7 RDE message segment.field affected: ---------------------------------------- RXE.7 - Provider's Administration Instructions RXE.14 - Pharmacist/Treatment Supplier's Verifier ID Example of HL7 segment containing data: RXE||^^^00378-0860-01^CLOZAPINE 100MG (MYLAN) TAB^NDC|100||MG||94^PRESCRIBER APPROVED 4 DAY SUPPLY^^4^IP Order Override with Outside Lab Results|||1|^EA|||^DOC^NAME^^^^^^^^^^DEA ~ZZ1111111 ^^^^^^^^^^^^PN|1111111;1|||||||||||||||||||||||||1111111 Example of HL7 segments missing data: RXE||^^^00378-0860-01^CLOZAPINE 100MG (MYLAN)TAB^NDC|100||MG||^^^^ |||1|^EA|||^^^^^^^^^^^^DEA~^^^^^^^^^^^^PN|1111111;1||||||||||||||| ||||||||||1111111 Patch Components: ---------------- Files & Fields Associated: N/A Forms Associated: N/A Protocols Associated: N/A Security Keys Associated: N/A Templates Associated: N/A Remote Procedures Associated: N/A Parameter Definitions Associated: N/A Additional Information: ----------------------- New Service Requests (NSRs): N/A Patient Safety Issues (PSIs): N/A Test Sites: ----------- TBD Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. Documentation can be found at https://download.vista.domain.ext/index.html/SOFTWARE/ as well as at the Mental Health (YS) link in the Clinical Section of the VA Software Documentation Library (VDL) at https://www.domain.ext/vdl/. Documentation Title File Name ---------------------------------------- ------------------------ Patch YS*5.01*175 Deployment, Installation YS_5_01_175_dibrg.docx Backout, Rollback Guide YS_5_01_175_dibrg.pdf Patch Installation: ------------------------------------------------ Installation Overview: Pre-Installation Instructions: VistA Patch YS*5.01*175 will be distributed as a standard KIDS build. Prior to installing, routine CHECK1^XTSUMBLD should be run to capture pre-patch checksums. The patch contains one routine: YSCLHLGT. Installation Instructions: The YS*5.01*175 patch will be installed by local or regional OIT staff. 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: 1. Choose the PackMan message containing this build. Then select the INSTALL/CHECK MESSAGE PackMan option to load the build. 2. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter YS*5.01*175. B. Select the Backup a Transport Global option to create a backup message of any routines exported with this patch. It will not backup any other changes such as DDs or options. C. Other options available: i. Print Transport Global - This option allows viewing of the components of the KIDS build. ii. Compare Transport Global to Current System - This option allows viewing of all changes that will be made when this patch is installed. It compares all of the components of this patch, such as routines, DDs, templates, etc. D. From the Installation Menu, select the Install Package(s) option and choose YS*5.0*175 to install. i. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' answer NO. ii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' answer . Post-Installation Instructions: -------------------------------- N/A Back-Out/Roll Back Plan: ------------------------ The modified routines can be restored from the backup message created in installation step B above. See the YS*5.01*175 Deployment, Installation, Backout, Roll-Back Guide for more details. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.01;MENTAL HEALTH;**[Patch List]**;Dec 30, 1994;Build 7 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: YSCLHLGT Before:B184903686 After:B187481843 **149,175** Routine list of preceding patches: 149 ============================================================================= User Information: Entered By : Date Entered : DEC 11, 2020 Completed By: Date Completed: APR 20, 2021 Released By : Date Released : APR 20, 2021 ============================================================================= Packman Mail Message: ===================== $END TXT