$TXT Created by CPRS28.DOMAIN.EXT (KIDS) on Thursday, 01/21/16 at 12:22 ============================================================================= Run Date: AUG 17, 2016 Designation: GMPL*2*40 Package : GMPL - PROBLEM LIST Priority: Mandatory Version : 2 SEQ #43 Status: Released Compliance Date: SEP 17, 2016 ============================================================================= Associated patches: (v)GMPL*2*42 <<= must be installed BEFORE `GMPL*2*40' Subject: Erroneous Problem File Cleanup Category: - Routine - Other Description: ============ This patch will correct several types of erroneous Problem File entries. One of these include entries that contain a SNOMED CT (SCT) concept code in the Diagnosis (#.01) field. This is caused by updating problems with inactive ICD-9 diagnoses via the Diagnosis tab of the encounter form dialog of CPRS v30A. When this occurs the SCT concept code is incorrectly stored into the Diagnosis field. As a result, the corresponding details display and audit history are also rendered incorrectly. This particular issue will be resolved in CPRS GUI v30B. This patch will perform a file scan and cleanup of these erroneous entries. Once these tasks have completed and errors have been found, two separate MailMan messages will be generated to the installer with instructions on how to access both the error and cleanup reports. Sample Error Scan Complete message: Subj: Problem File Error Scan Complete [#151756] 07/01/15@12:56 14 lines From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 *New* -------------------------------------------------------------------------- A scan of your system's Problem file #9000011 has been performed for possible errors. There are 9 record entries that contain a SNOMED CT concept code in the Diagnosis field #.01. To see a report of these records, please access the SNOMED in Diagnosis Field Error Report [GMPL DIAG ERROR REPORT] which is attached to the Problem List Mgt Menu [GMPL MGT MENU]. These record entries will initially be corrected with the installation of GMPL*2.0*40 or by running the Generate SNOMED in Diagnosis Field Err/Cleanup Rpt [GMPL GENERATE DIAG RPTS] menu option off the Problem List Mgt Menu. Once the cleanup is complete, a separate MailMan message will be sent to the installer containing instructions on how to access the cleanup report. Sample Cleanup Complete message: Subj: SNOMED Error Cleanup Complete [#151757] 07/01/15@12:56 7 lines From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 *New* ------------------------------------------------------------------------ A cleanup of the Problem file has been performed and 9 record entries have been corrected. These entries no longer contain a SNOMED CT concept code in the Diagnosis field #.01. To see a report of these corrected records, please access the SNOMED in Diagnosis Field Cleanup Report [GMPL DIAG CLEANUP REPORT] which is attached to the Problem List Mgt Menu [GMPL MGT MENU]. If no errors are found by the scan, then the following example message will be generated to the installer: Subj: Problem File Error Scan: No Errors Found [#68471] 07/09/15@14:04 From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 -------------------------------------------------------------------------- A scan of your system's Problem file #9000011 has been performed on: Jul 09, 2015@14:04:24 No errors were found that contain a SNOMED CT concept code in the Diagnosis field #.01. Three new menu options are exported and attached to the Problem List Mgt Menu [GMPL MGT MENU]: 1. SNOMED in Diagnosis Field Error Report [GMPL DIAG ERROR REPORT] 2. SNOMED in Diagnosis Field Cleanup Report [GMPL DIAG CLEANUP REPORT] 3. Generate SNOMED in Diagnosis Field Err/Cleanup Rpt [GMPL GENERATE DIAG RPTS] The first two provides a user access to both the error and cleanup reports respectively. The third option allows a user to rerun the file scan and cleanup tasks for any potential new errors. Sample Error Report: Erroneous Problem File Record Entries Report **NOTE**: This report is retroactive as of the last Problem file scan runtime: Jul 09, 2015@13:00:32. This report will expire and be purged from the system in 30 days. If the Generate SNOMED in Diagnosis Field Err/Cleanup Rpt [GMPL GENERATE DIAG RPTS] menu option is run prior to the 30 days, then this report will expire on the date/time the option is run. Whichever comes first. A scan of your system's Problem file #9000011 has been performed for possible errors. The following 9 record entries contain a SNOMED CT concept code in the Diagnosis field #.01. This report contains 4 columns. Please scroll to the right to see a full display of the Problem text. These record entries will be corrected and upon completion, a separate MailMan message will be sent to the installer containing instructions on how to access the cleanup report. DATE LAST IEN MODIFIED DIAGNOSIS PROBLEM --------------- ------------ ------------------ -------------------- 285 MAY 28, 2015 443694000 Unresolved 400 MAY 28, 2015 88805009 Chronic Systolic... 730 MAY 28, 2015 1201005 Hypertension 851 MAY 28, 2015 267434003 Hyperlipidemia 1075 MAY 28, 2015 63480004 Bronchitis 1077 MAY 28, 2015 68449006 Arthritis, Rhemat... 1079 MAY 28, 2015 25702006 Alcohol Dependence 1080 MAY 28, 2015 193031009 1177 JUN 10, 2015 230572002 Unresolved Sample Cleanup Report: Problem File Cleanup Report **NOTE**: This report is retroactive as of the last Problem file cleanup runtime:Jul 09, 2015@13:00:32. This report will expire and be purged from the system in 30 days. If the Generate SNOMED in Diagnosis Field Err/Cleanup Rpt [GMPL GENERATE DIAG RPTS] menu option is run prior to the 30 days, then this report will expire on the date/time the option is run. Whichever comes first. A cleanup of the Problem file has been performed and the following 9 record entries have been corrected. This report contains 7 columns. Please scroll to the right for more information. These entries no longer contain a SNOMED CT concept code in the Diagnosis field #.01. The correct primary ICD diagnosis and secondary diagnosis code(s) is now stored in the appropriate fields. The corresponding SNOMED CT concept and designation codes have also been correctly filed in their respective fields. The provider narrative and problem fields were also updated accordingly as well. DATE LAST PRIMARY SNOMED C IEN MODIFIED DIAGNOSIS SECONDARY DIAGNOSIS CONCEPT --------------- ------------ --------- ------------------- ------- 285 MAY 28, 2015 250.02 44369... 400 MAY 28, 2015 428.0 88805... 730 MAY 28, 2015 401.1 12010... 851 MAY 28, 2015 272.2 26743... 1075 MAY 28, 2015 491.9 63480... 1077 MAY 28, 2015 716.60 68449... 1079 MAY 28, 2015 305.00 25702... 1080 MAY 28, 2015 339.00 19303... 1177 JUN 10, 2015 250.60 355.9 23057... Consequently the details display and audit history will be corrected as well and no longer display the erroneous messages respectively: No Code Selected and Invalid coding system specified. The other erroneous Problem File entries that will be corrected originate from a Patient Safety issue (PSPO 2868) where it was determined that the SNOMED mapping for the term,"History of polyp of colon" was incorrectly mapped. The SCT code 428283002 was mapped to the incorrect ICD-9 diagnosis code V15.89. The description for this V code, "Other specified personal history presenting hazards to health" did not correspond with the above SNOMED description. It was determined that the ICD-9 code of V12.72 (Personal History of Colonic Polyps) was more appropriate for this mapping. This caused the Colonoscopy reminders to fail to trigger correctly. With the Clinical Reminders ICD-10 project, clinical reminders was updated to allow the use of ICD-10-CM and SNOMED CT codes in taxonomies. After ICD-10-CM and SNOMED CT codes have been added to taxonomy, they will be included in the list of codes to search for during reminder evaluation. For example, in order to search the Problem List for an ICD-9 diagnosis code or a SNOMED CT code, both of the codes have to be in the taxonomy. This enhancement was completed in PXRM*2.0.26 which is part of a multi-package build containing DG*5.3*862, GMPL*2.0*44, and PXRM*2.0*26. This build was released July 24, 2015 so it should be installed at all sites. CAC's will need to verfiy that the SNOMED CT codes are added to the taxonomies so that the linked colonoscopy reminders are triggering correctly even with an incorrect ICD-9 code or mapping. This was a workaround that could have been utilized. This patch scans the Problem File for these incorrect mappings and performs any necessary corrections. If any incorrect mappings are found, a mapping report will be generated to the installer via a MailMan message. Sample Mapping Report: Subj: Incorrect Mapping Report [#160093] 01/14/16@14:32 21 lines From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 -------------------------------------------------------------------------- Problem file scan runtime: Jan 14, 2016@14:32:58 A scan of your system's Problem file #9000011 has been performed for possible errors. There are 5 record entries that contain an incorrect SNOMED CT 428283002 to ICD-9-CM V15.89 code mapping for the term "History of polyp of colon". As a result the V15.89 code is incorrectly stored in the Diagnosis field #.01. This report contains a list of these erroneous record entries which will be corrected after the installation of GMPL*2.0*40. Once the cleanup is complete, the correct V12.72 code will be stored in the Diagnosis field. **ATTENTION CACs!!**: Once the cleanup is complete, please also review the Colonoscopy clinical reminders for the corresponding patients and verify that the corrections have been updated appropriately for those as well. IEN PATIENT PROVIDER NARRATIVE Subj: Incorrect Mapping Report [#160093] Page 2 -------------------------------------------------------------------------- ------- -------------------- -------------------------- 1243 CPRSPATIENT,FIVE History of polyp of colon 1244 CPRSPATIENT,ELEVEN History of colonic polyp 1245 CPRSPATIENT,FOUR History of colonic polyp 1246 CPRSPATIENT,TEN History of polyp of colon 1247 CPRSPATIENT,TWENTY History of polyp of colon If no incorrect mappings are found, the following sample message is generated to the installer: Subj: Incorrect Mapping Scan: No Errors Found [#160096] 01/14/16@14:51 5 lines From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 -------------------------------------------------------------------------- A scan of your system's Problem file #9000011 has been performed on: Jan 14, 2016@14:51:35 No incorrect SNOMED CT 428283002 to ICD-9-CM V15.89 code mappings for the term "History of polyp of colon" were found. If any corrections are made, the following sample cleanup complete message is generated to the installer: Subj: Incorrect Mapping Cleanup Complete [#160094] 01/14/16@14:32 5 lines From: GMPL*2.0*40 INSTALL In 'IN' basket. Page 1 -------------------------------------------------------------------------- A cleanup of the Problem file has been performed and 5 record entries have been corrected. These entries no longer contain an incorrect mapping and a V15.89 code in the Diagnosis field #.01. The correct code of V12.82 is now stored in this field. Additionally once the corrections have completed, the audit history of the corresponding problems will also be updated appropriately under the Details display. ---------- Audit History ---------- 1/14/16: DIAGNOSIS changed by CPRSPROVIDER,ONE from (ICD-9-CM V15.89) to (ICD-9-CM V12.72) Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- N/A 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 ----------- ---- -------------------- GMPL DIAG ERROR REPORT Action New GMPL DIAG CLEANUP REPORT Action New GMPL GENERATE DIAG RPTS Action New GMPL MGT MENU Menu Use as link for menu items 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 Additional Information: N/A New Service Requests (NSRs): ---------------------------- N/A Patient Safety Issues (PSIs): ----------------------------- 1. PSPO 2868: The ICD-9-CM code for the diagnosis of "History of colonic polyp" in CPRS incorrectly corresponds to V15.89 "Other specified personal history presenting hazards to health". This caused the Colonoscopy reminders to not function correctly. Resolution: Correct the entries in the Problem File so that it is mapped to the correct ICD-9 code of V12.72. Remedy Ticket(s) & Overview: ---------------------------- 1. INC000001219700: An ICD-9 code is incorrect in CPRS but shows up correct in VistA. Resolution: Correct the entries in the Problem File so that it is mapped to the correct ICD-9 code of V12.72. Test Sites: ---------- Detroit Hines Providence Software and Documentation Retrieval Instructions: ------------------------------------------------- Software and/or documentation describing the new functionality introduced by this patch are available. Since this patch is released via a packman message, it can be retrieved using the 'Forward a Released Patch message' option under the Patch User Menu in FORUM. Documentation files can be retrieved 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&T Field Offices: Albany: domain.ext Hines: domain.ext Salt Lake City: domain.ext The documentation will be in the form of Adobe Acrobat files. Documentation can also be found on the VA Software Documentation Library at: http://www4.domain.ext/vdl/ File Description File Name FTP Mode ---------------------------------------------------------------------- Technical Manual gmpl_2_0_40_tm.pdf (binary) User Manual gmpl_2_0_40_um.pdf (binary) Patch Installation: Pre/Post Installation Overview: ------------------------------- There are no special considerations for pre-installation. However there is a post-installation routine (GMPLY40) included. This routine will be automatically deleted once installation has completed. Pre-Installation Instructions: ------------------------------ N/A Installation Instructions: -------------------------- This patch loads several routines and may be installed with users on the system although it is STRONGLY recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 1 minute to install. **NOTE: Users should stay out of the Problem List Application entirely during the installation of this patch as a file scan and cleanup is potentially performed. Utilizing the Problem List during the file scan & cleanup tasks could lock up certain records and prevent them from being successfully corrected. If this should occur, a MailMan message will be generated to the installer identifying those records. 1. Choose the PackMan message containing this patch. 2. Choose the INSTALL/CHECK MESSAGE PackMan option. 3. From the Kernel Installation and Distribution System 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 #(ex. GMPL*2.0*40): 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 DDs 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, DDs, 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. From the Installation Menu, select the Install Package(s) option and choose the patch to install. 5. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', respond with NO. KIDS will automatically attach the new menu options to the designated menu tree during the installation process. There is no need to rebuild the menu trees upon completion of installation. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', response with NO. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', respond with YES. Disable all GMPL* options and protocols. NOTE: GMPL MGT MENU option may not disable due to the build configuration. This is ok as the new menu options should be attached as sub-items during installation. Post-Installation Instructions: ------------------------------- The post-install routine will call an API that will queue the file scan and cleanup tasks for the Problem file. It is imperative that users stay out of the Problem List until the installer has received messages that these tasks have completed. Backout Plan: ------------- If for some reason this patch needs to be backed out, the following are the instructions. 1) If a backup of the routines have been created using the "Backup a Transport Global" option in Step 3 of the Patch Installation, then the original routines can be restored by installing the Backup Packman (MailMan) message. Subj: Backup of GMPL*2.0*40 install on May 16, 2016 [#70907] 05/16/16@12:07 933 lines From: INSTALLER,ONE In 'IN' basket. Page 1 -------------------------------------------------------------------------- $TXT PACKMAN BACKUP Created on Monday, 5/16/16 at 12:07:41 by INSTALLER,ONE at XXXXX.DOMAIN.EXT $ROU GMPLUTL (PACKMAN_BACKUP) ... Enter message action (in IN basket): Ignore// Xtract PackMan Select PackMan function: 6 INSTALL/CHECK MESSAGE Warning: Installing this message will cause a permanent update of globals and routines. Do you really want to do this? NO// Y Routines are the only parts that are backed up. NO other parts are backed up, not even globals. You may use the 'Summarize Message' option of PackMan to see what parts the message contains. Those parts that are not routines should be backed up separately if they need to be preserved. Shall I preserve the routines on disk in a separate back-up message? YES// NO No backup message built. Line 467 Message #70907 Unloading Routine GMPLUTL (PACKMAN_BACKUP) Line 678 Message #70907 Unloading Routine GMPLX (PACKMAN_BACKUP) 2) The three new menu options can be removed via FileMan: VA FileMan 22.2 Select OPTION: ENTER OR EDIT FILE ENTRIES Input to what File: OPTION// EDIT WHICH FIELD: ALL// Select OPTION NAME: GMPL DIAG ERROR REPORT SNOMED in Diagnosis Field Error Report NAME: GMPL DIAG ERROR REPORT Replace @ SURE YOU WANT TO DELETE THE ENTIRE 'GMPL DIAG ERROR REPORT' OPTION? Y (Yes) SINCE THE DELETED ENTRY MAY HAVE BEEN 'POINTED TO' BY ENTRIES IN THE 'AUDIT' FILE, ETC., DO YOU WANT THOSE POINTERS UPDATED (WHICH COULD TAKE QUITE A WHILE)? No// Y (Yes) WHICH DO YOU WANT TO DO? -- 1) DELETE ALL SUCH POINTERS 2) CHANGE ALL SUCH POINTERS TO POINT TO A DIFFERENT 'OPTION' ENTRY CHOOSE 1) OR 2): 1 DELETE ALL POINTERS? Yes// (Yes) (DELETION WILL OCCUR WHEN YOU LEAVE 'ENTER/EDIT' OPTION) Select OPTION NAME: GMPL DIAG CLEANUP REPORT SNOMED in Diagnosis Field Cleanup Report NAME: GMPL DIAG CLEANUP REPORT Replace @ SURE YOU WANT TO DELETE THE ENTIRE 'GMPL DIAG CLEANUP REPORT' OPTION? Y (Yes) SINCE THE DELETED ENTRY MAY HAVE BEEN 'POINTED TO' BY ENTRIES IN THE 'AUDIT' FILE, ETC., DO YOU WANT THOSE POINTERS UPDATED (WHICH COULD TAKE QUITE A WHILE)? No// Y (Yes) WHICH DO YOU WANT TO DO? -- 1) DELETE ALL SUCH POINTERS 2) CHANGE ALL SUCH POINTERS TO POINT TO A DIFFERENT 'OPTION' ENTRY CHOOSE 1) OR 2): 1 DELETE ALL POINTERS? Yes// (Yes) (DELETION WILL OCCUR WHEN YOU LEAVE 'ENTER/EDIT' OPTION) Select OPTION NAME: GMPL GENERATE DIAG RPTS Generate SNOMED in Diagnosis Field Err/Cleanup Rpt NAME: GMPL GENERATE DIAG RPTS Replace @ SURE YOU WANT TO DELETE THE ENTIRE 'GMPL GENERATE DIAG RPTS' OPTION? Y (Yes) SINCE THE DELETED ENTRY MAY HAVE BEEN 'POINTED TO' BY ENTRIES IN THE 'AUDIT' FILE, ETC., DO YOU WANT THOSE POINTERS UPDATED (WHICH COULD TAKE QUITE A WHILE)? No// Y (Yes) WHICH DO YOU WANT TO DO? -- 1) DELETE ALL SUCH POINTERS 2) CHANGE ALL SUCH POINTERS TO POINT TO A DIFFERENT 'OPTION' ENTRY CHOOSE 1) OR 2): 1 DELETE ALL POINTERS? Yes// (Yes) (DELETION WILL OCCUR WHEN YOU LEAVE 'ENTER/EDIT' OPTION) Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;Problem List;**[Patch List]**;Aug 25, 1994;Build 9 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMPLCLN Before: n/a After:B143436186 **40** Routine Name: GMPLCLNP Before: n/a After: B88965830 **40** Routine Name: GMPLUTL Before: B62326591 After: B62818534 **3,6,8,10,16,26,35,39,36,42,40** Routine Name: GMPLX Before:B101606054 After:B102602938 **7,23,26,28,27,36,42,40** Routine Name: GMPLY40 Before: n/a After: B38628 **40** Routine list of preceding patches: 42 ============================================================================= User Information: Entered By : Date Entered : JUN 09, 2009 Completed By: Date Completed: AUG 16, 2016 Released By : Date Released : AUG 17, 2016 ============================================================================= Packman Mail Message: ===================== $END TXT