$TXT Created by THOMPSON,SETH at DAYT17.FO-BAYPINES.MED.VA.GOV (KIDS) on Monday, 04/11/11 at 07:10 ============================================================================= Run Date: JUN 27, 2011 Designation: OR*3*339 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #291 Status: Released Compliance Date: JUL 28, 2011 ============================================================================= Associated patches: (v)OR*3*307 <<= must be installed BEFORE `OR*3*339' Subject: ANTICOAGULATION TOOL FIXES Category: - Other - Routine Description: ============ The Anticoagulation Management Tool (AMT), released in patch OR*3*307, is a tool within the Computerized Patient Record System Graphical User Interface (CPRS GUI) which enables the user to enter, review, and continuously update all information connected with patient anticoagulation management. OR*3.0*339 is the first maintenance patch for the Anticoagulation Management Tool and resolves the following 9 issues: 1. When a non-Provider (e.g., Student, Pharmacy Tech, etc.) is exiting the Anticoagulation module, the system no longer prompts for them to identify the primary provider for the encounter. 2. The ICD-9 code is not displayed for patients who have had the ICD-9 code entered on a previous visit. 3. Anticoagulation Consult requests with the status of Scheduled are not completed when an Initial Note is filed. 4. When the user modifies the Current Daily Dosing and modifies the Pill Strength, it is possible that the daily doses will be incorrectly recalculated. 5. When the user attempts to enroll a patient in the Anticoagulation module and the patient's most recent International Normalized Ratio (INR) was cancelled, an error is encountered. 6. When the user edits the number of tablets in Current Daily Dosing, it is possible to have a zero appended to the end of the number, significantly changing the desired dosage. 7. INR results may cause a error in the Rosendaal Report in VistA. 8. Changes to the Clinic Name for a patient visit in the Anticoagulation module are not saved if this is the only change made and the user clicks on the Save/Exit button. 9. The Anticoagulation module does not allow a Draw date on weekends. ASSOCIATED NSR(S): ================== N/A ASSOCIATED REMEDY TICKETS: ========================== 1. HD0000000392179 - Wrong name submit as Primary Duplicate: HD0000000406932 - New student not a billable student to Austin 2. HD0000000396046 - Other Dx not saving ICD 9 code 3. HD0000000404437 - Scheduling Consult Issue 4. HD0000000418906 - Problem with auto calculation 5. HD0000000420035 - Anticoagulation - a tech is trying to add a patient for a next week app but errors out. 6. HD0000000424310 - Changing Tablets in Daily Dosaging 7. HD0000000439690 - Rosendaal Report gets Error Under Certain Conditions 8. HD0000000439776 - Changes to Patient Location not Saved Unless Complete Visit is Recorded 9. HD0000000439782 - Can't Order INRs or CBCs for Weekend Collection PARTICIPATING TEST SITES: ========================= VA East Colorado HCS VA West Los Angeles HCS VA Western NY HCS Tomah VAMC VA Sierra Nevada HCS - Reno REMEDY OVERVIEW: ================ 1. HD0000000392179 - Wrong name submit as Primary Problem: -------- When a non-Provider (e.g., Student, Intern, Technician, etc.) uses the Anticoagulator to document their encounter, the resulting Visit in PCE is left with an invalid Primary Provider (i.e., the Student) and data transmitted to Austin errors off due to the missing Primary Provider. Resolution: ----------- The client- and server-side code were modified to assure that the provider identified by the student/intern as cosigner on the note or provider for the orders is also sent to the PCE API as the Primary Provider for the encounter. 2. HD0000000396046 - Other Dx not saving ICD 9 code Problem: -------- When the user selects "Other" for the "Add'l Indication" field and manually enters the "ICD-9 code", the visit is properly credited and the diagnostic code is properly stored. However, it is not retrieved and presented correctly when the patient returns for subsequent visits, which then causes the data sent to Austin to be rejected due to an incomplete encounter. Resolution: ----------- The client-side code was modified to assign the ICD-9 code stored on a prior encounter to the appropriate variable when the indication for care was "Other." Note: This Remedy ticket has 2 parts; The first part is addressed by this patch and the second part is addressed in patch OR*3*330, released 10/18/2010. 3. HD0000000404437 - Scheduling Consult Issue Problem: -------- Anticoagulation Consult requests with the status of 'Scheduled' are not completed when an Initial Note is filed like requests with a status of 'Pending' or 'Active' are. Resolution: ----------- Modified the server-side code that retrieves the list of consult requests to match with an initial anticoagulation note to include requests with a status of 'scheduled' in addition to 'pending' or 'active' consults. 4. HD0000000418906 - Problem with auto calculation Patient Safety Issue: PSPO #1813 Problem: -------- If the user is modifying the daily dosing on the Enter Information tab and elects to change the pill strength, without clicking OK or Cancel, the daily doses will be incorrectly recalculated when the user tabs or clicks away from the pill strength edit box. Resolution: ----------- The anomaly results from the interaction between the code that gets executed on exit from the pill strength edit box and the code that gets invoked when the contents of the daily dosing edit boxes change. This can only occur when both the Pill Strength and the Daily Dosing edit boxes are enabled (i.e., editable). The solution which was implemented is to toggle the enabled property of the Pill Strength edit box off when the user is changing the daily dosing, and back on when the user either submits or cancels the changes. 5. HD0000000420035 - Anticoagulation - a tech is trying to add a patient for a next week app but errors out. Problem: -------- If the user attempts to enroll a patient in the AMT whose most recent INR was cancelled, the following error will occur: $ZE= COMPTEST+6^ORAM1 *X The AMT remains open, but its connection is lost, and the session can't be recovered. Resolution: ----------- The error above occurred in DT^DILF, which accepts an internal-format FileMan date/time and returns the external-format date/time. In the case above, the input string to DT^DILF was empty so it returned an empty string which caused the UNDEFINED error. The code was modified to accommodate an empty string for the draw date/time, allowing the code to proceed without error. 6. HD0000000424310 - Changing Tablets in Daily Dosaging Patient Safety Issue: PSPO #1823 Problem: -------- If the user deletes the number of tablets in the Change Daily Dosing function of the AMT of CPRS, the field is populated with a zero and the cursor is positioned in front of the zero. If the user then enters a number, the zero remains appended to the number, significantly changing the value of the number (i.e., '2' becomes '20'). Resolution: ----------- Modified the OnChange event handler for the dosing grid to assure that a zero would only be left for the number of tablets if the user entered nothing else. 7. HD0000000439690 - Rosendaal Report gets Error Under Certain Conditions Problem: -------- When a patient has two consecutive INRs which are identical, one in-range and one out-range, due to goal range change, a division by zero error occurs in the Rosendaal Report in VistA. Resolution: ----------- Logic in routine ORAMTTR has been modified to account for the difference of two INRs being zero and calculate accordingly. 8. HD0000000439776 - Changes to Patient Location not Saved Unless Complete Visit is Recorded Problem: -------- Changes to the Clinic Name for a patient visit in the AMT are not saved if this is the only change made and the user clicks on the Save/Exit button. Resolution: ----------- The code on both the client and server was modified to accommodate saving the patient location when the Save & Exit button is clicked. 9. HD0000000439782 - Can't Order INRs or CBCs for Weekend Collection Problem: -------- Some sites have asked for the ability to specify a Draw Date on weekends. Currently, the Anticoagulation module does not allow the user to specify a Draw Date on a Saturday or Sunday for INR or CBC (complete blood count ) orders. If the user attempts to do so, the application will automatically increment the collection date to the following Monday. Resolution: ----------- The application was modified to inform the user that the date they have selected for the Draw Date is a Saturday or Sunday, and allow them to leave it or change it, as they deem appropriate. SOFTWARE RETRIEVAL: =================== To obtain the current client software, use FTP to retrieve OR_30_339.zip from one of the following OI Field Offices' ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- Albany ftp.fo-albany.med.va.gov anonymous.software Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake City ftp.fo-slc.med.va.gov anonymous.software The software distribution includes this file: OR_30_339.zip (1.07 MB) FILE NAME RETRIEVAL FORMAT --------- ---------------- OR_30_339.ZIP BINARY ZIP FILE CONTENTS DESCRIPTION FILE VERSION ----------------- ----------- ------------ AntiCoagulate.exe Client 1.0.1.1 GUI Client installation instructions are in the Anticoagulation Management Installation/Implementation Guide in the VistA Documentation Library: http://www.va.gov/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*339): 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*339. 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. 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 7 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORAM1 Before:B159543113 After:B161086526 **307,339** Routine Name: ORAM2 Before:B120270114 After:B121018591 **307,339** Routine Name: ORAMTTR Before: B84948729 After: B84841974 **307,339** Routine Name: ORAMX Before:B147643525 After:B153727620 **307,339** Routine list of preceding patches: 307 ============================================================================= User Information: Entered By : THOMPSON,SETH Date Entered : SEP 29, 2010 Completed By: WERNER,GARY Date Completed: JUN 07, 2011 Released By : STOKER,ELAINE Date Released : JUN 27, 2011 ============================================================================= Packman Mail Message: ===================== $END TXT