============================================================================= Run Date: MAY 24, 2016 Designation: GMRA*4*46 Package : GMRA - ADVERSE REACTION TRACKING Priority: Mandatory Version : 4 SEQ #46 Status: Released Compliance Date: JUN 24, 2016 ============================================================================= Associated patches: (c)OR*3*269 install with patch `GMRA*4*46' (c)PSO*7*411 install with patch `GMRA*4*46' (c)PSJ*5*281 install with patch `GMRA*4*46' (v)GMRA*4*10 <<= must be installed BEFORE `GMRA*4*46' (v)GMRA*4*44 <<= must be installed BEFORE `GMRA*4*46' Subject: ALLERGY ORDER CHECK SIGNS/SYMPTOMS Category: - Routine - 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 GMRA*4*46 and its associated patches, and that all data discrepancies identified by GMRA*4*48 have been corrected. If not, then installing GMRA*4*46 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. This patch will enable the Adverse Reaction Tracking package to return sign/symptom data with the medication order check message to the Computerized Patient Record System (CPRS) and Pharmacy. It will also update the EN1^GMRADPT Application Programming Interface (API) to return adverse reaction data from the Health Data Repository (HDR) along with data stored locally. 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 ----------- ---- -------------------- 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) ---------------------------- 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 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 2383 During the drug-allergy order check process, the ordered drug's VA CLASSIFICATION value is examined to determine if a patient will have a reaction to the drug. This examination looks at the first four characters for non-analgesics and all five characters for analgesics. For non-analgesics, if a patient's profile lists multiple drug classes with the same first four characters as the ordered drug, only the last drug class listed is returned. Many times, the returned class is less clinically important than the other classes on the list. See associated Remedy tickets 823464 and 453615 for resolution. Remedy Ticket(s) & Overview --------------------------- 1. HD823464 Adverse Reaction Tracking - Alerts Issue: HD453615 4 Alert not being displayed with third drug added Problem: ------- During the drug-allergy order check process for a non-analgesic, when the VA CLASSIFICATION value is examined, only one drug class is returned. Many times, the returned class is less clinically important than the other classes on the list. Resolution: ---------- The code is modified to return all drug classes that are matched. 2. 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). 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://www.domain.ext/vdl/ Title File Name FTP Mode ----------------------------------------------------------------------- Technical Manual GMRA_4_TM_R0416.pdf Binary User Manual GMRA_4_UM_R0416.pdf 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 delete the ^XTMP("GMRAOC") global node. This data cache is no longer used by the order check component. After the patch is successfully installed, KIDS will automatically delete the post-install routine GMRAY46. 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 Routine Information: ==================== The second line of each of these routines now looks like: ;;4.0;Adverse Reaction Tracking;**[Patch List]**;Mar 29, 1996;Build 61 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRADPT Before: B17553287 After: B83164261 **2,10,46** Routine Name: GMRADSP0 Before: B2907720 After: B2615214 **46** Routine Name: GMRAHDR Before: B23798281 After: B21589009 **18,24,26,42,46** Routine Name: GMRAOR Before: B60802991 After:B151697530 **2,13,26,37,41,42,44,46** Routine Name: GMRAOR0 Before: B763825 After: B35767706 **4,46** Routine Name: GMRAOR1 Before: B7165118 After: B6022298 **21,41,46** Routine Name: GMRAOR2 Before: B11000982 After: B14577566 **21,41,46** Routine Name: GMRAPENC Before: B4933029 After: B5910833 **41,46** Routine Name: GMRAY46 Before: n/a After: B247357 **46** Routine list of preceding patches: 4, 10, 44 ============================================================================= User Information: Entered By : Date Entered : SEP 13, 2012 Completed By: Date Completed: MAY 19, 2016 Released By : Date Released : MAY 24, 2016 ============================================================================= Packman Mail Message: ===================== No routines included