$TXT Created by T at CLE623.FO-BAYPINES.DOMAIN.EXT (KIDS) on Monday, 10/24/22 at 14:22 ============================================================================= Run Date: JAN 30, 2023 Designation: GMRC*3*184 Package : GMRC - CONSULT/REQUEST TRACKING Priority: Mandatory Version : 3 SEQ #160 Status: Released Compliance Date: FEB 06, 2023 ============================================================================= Associated patches: (v)GMRC*3*58 <<= must be installed BEFORE `GMRC*3*184' (v)GMRC*3*154 <<= must be installed BEFORE `GMRC*3*184' (v)GMRC*3*176 <<= must be installed BEFORE `GMRC*3*184' Subject: IFC ORDER RESPONSE FOR VDIF/CERNER AND ORDER COMMENTS Category: - Routine - Data Dictionary Description: ============ ======================================================================== Version 11: Modified ADD2OBR in GMRCIUTL so OBR-4.2 populated with either REQUEST SERVICES file (#123.5) IFC REMOTE NAME (field #133) or GMRC PROCEDURE file (#123.3), IFC REMOTE PROC NAME (field #127). Version 10: Changes made for Prosthetics interface: --------------------------------------- Created field #508 Cerner Placer Field 1 in the REQUEST/CONSULTATION file (#123). In GMRCIACT, extracted data from OBR-19 on incoming Cerner orders and saved it in field #508. Enhanced ADD2OBR function in GMRCIUTL to populate OBR-19 with saved data for IFC consults where VistA is the filler. In GMRCRFC0, removed NPI from OBR-16.1, shifting name from OBR-16.2,3,4 to OBR-16.1,2,3. This was previously done by VDIF and is required by Prosthetics code. Version 9: Removed code setting status to "P" for non-Prosthetics IFCs when activity would set it to "F". Version 8: Restored comment generation functionality for Prosthetics IFCs only. Removed calls that generated cumulative comments for Prosthetics IFCs (CRNROBX^GMRCIEV1) and restored use of previous calls (OBXWP^GMRCISEG). Version 7: Bug fix. Version 6: Bug fix. Version 5: 1. When cumulative comments are produced for a Prosthetics IFC, the status field (OBX-11) is changed from P (Preliminary) to F (Final) for all activities from Complete/Update (10) or Cancelled (19) forward in time. 2. When determining if HL7 messages for an IFC are routed to a converted site, use the station number not the IEN in the Institution file (#4) as they are not always synonymous. ======================================================================== Inter-Facility Consults (IFCs) are initiated by the placer site sending a Health Level Seven (HL7) order message to the filler site. The filler site, upon receipt of the order message, evaluates it and determines if it will access the order. The site then returns an HL7 message acknowledgement either accepting or rejecting the order. Subsequent actions at the filler site - resulting, commenting, order discontinuation, etc. - also trigger generation of HL7 messages that are sent to the placer site. Issue #1 ======== Problem: When the placer site uses Cerner Millennium, HL7 messages must include PID and OBR segments or Cerner will ignore/reject them. VistA does not require either segment and so does not include them. When the filler site uses Cerner Millennium, it requires that the placer site include the patient account number on the PID segment when messaging it. Currently, Veterans Data Integration and Federation (VDIF) is inserting PID and OBR segments from the original order message if it still retains them. However, VDIF does not have long-term storage for messages. Many of the order messages have been purged from its orders database. Accordingly, Cerner is receiving HL7 messages without PID or OBR segments. Solution: 1) When an order message is received by a VistA filler site, extract the Cerner patient account number from PID-18 and save it in the REQUEST/CONSULTATION file (#123) in a new Patient Account Number field (#502) so that it can be returned in the PID segment of response messages. 2) When generating an HL7 message that is routed to Cerner, add a PID and an OBR segment to the HL7 message. In the PID segment, add Integration Control Number (ICN) and Electronic Data Interchange Personal Identifier (EDIPI) to PID-3 and add patient account number to PID-18. Field #502 Patient Account Number was added to the REQUEST/CONSULTATION file (#123) to store the Cerner patient account number. Field #507 Cerner Ordering Provider was also added to file #123 to store the ordering provider field (OBR-16) of the original placer order so it can be returned in order responses. NW^GMRCIACT and ORRIN^GMRCIMSG were modified to extract the patient account number from the PID segment of a Cerner order message or order acknowledgement and to store it in field #502. RESP^GMRCIUTL was modified to add PID and OBR segments if a patient account number is present in file #123. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. GENUPD^GMRCIEVT was modified to add PID and OBR segments if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. NW^GMRCIEVT was modified to add a PID segment if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. RSLT^GMRCIEVT was modified to add a PID segment if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. RESUB^GMRCIEV1 was modified to add a PID segment if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. SF^GMRCIEV1 was modified to add PID and OBR segments if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. FWD^GMRCIEV1 was modified to add a PID segment if the consult is routed to a converted site. The contents of PID-3 was modified to include the patient's ICN and EDIPI. PID-18 is populated with the patient account number. ADD2PID^GMRCIUTL was added to re-format the PID segment and to populate the patient account number in PID-18. EDIPI^GMRCIUTL was added to return the patient's EDIPI number from the Treatment Facility List file (#391.91). ADD2OBR^GMRCIUTL was added to enhance the contents of the OBR segment to make it Cerner-compliant. Issue #2 ======== Problem: Serious patient safety issues emerged with comments on IFCs where a non-converted site placed an order to a converted site or where a converted site placed an order to a non-converted site. IFC consult comments sent by VistA are being overwritten in Cerner Millenium. An example is when a comment was placed as a Significant Finding and then right after that the referral was cancelled by the VistA site with another comment, Cerner only sent the comment associated with the cancel and NOT the Significant Finding as an alert to the provider or the nurse. Solution: This patch fixes the issue as follows: When a comment is added in VistA to an IFC by means of Request Received, Add Comment, Discontinued, Scheduled, Completed, Significant Findings, Forwarded or Cancelled, and the comment needs to be sent to a converted site, instead of just sending the new comment, all comments including the new one will be transmitted to Cerner. The HL7 message will contain either an OBX segment or an NTE segment containing the comments. Each comment in the OBX stream will have a sub-heading as follows: Entered at Location: VAMC SITE NAME Entered By: GMRCUSER,ZZONE 05/12/2021 10:28:14 PM Activity: (where 'Activity' would be one of those listed above) ... FOLLOWED BY THE COMMENT ... Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- REQUEST/CONSULTATION (#123) Patient Account Number NEW (#502) Cerner Ordering Provider NEW (#507) Cerner Placer Field 1 NEW (#508) REQUEST PROCESSING ACTIVITY (#40) SENT FROM CERNER NEW SITE (#.32) CERNER FACILITY NEW SENDING (#.33) Forms Associated: Form Name File Number 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 Remote Procedures Associated: Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A Additional Information: ----------------------- Blood Bank Team Coordination: N/A New Service Requests (NSRs): N/A Patient Safety Issues (PSIs): N/A Defect Tracking System Ticket(s) & Overview: N/A Test Sites: ----------- Biloxi, MS Fargo, ND Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. Other Software Files: This release also includes other software files. They can be obtained at location: /srv/vista/patches/SOFTWARE Other software files can also be obtained by accessing the URL: https://download.vista.domain.ext/index.html/SOFTWARE File Title File Name Format --------------------------------------------------------------------- N/A Documentation describing the new functionality is included in this release. Documentation can be found on the VA Software Documentation Library at: https://www.domain.ext/vdl/. Documentation can also be obtained at https://download.vista.domain.ext/index.html/SOFTWARE. Documentation Title File Name --------------------------------------------------------------------- Electronic Health Modernization IFC response gmrc_3_184_dibr.docx Deployment, Installation, Backout and Rollback Guide Consult/Request Tracking Technical Manual constm.docx Patch Installation: ------------------- 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: 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 the patch or build name GMRC*3.0*184. B. Select the Backup a Transport Global option to create a backup message. You must use this option for each patch contained in the Host File. For each patch you can specify what to backup; the entire Build or just Routines. The backup message can be used to restore just the routines or everything that will restore your system to pre-patch condition. C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. 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 of the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install. i. If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', answer NO. ii. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. iii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', answer NO. Post-Installation Instructions: N/A Back-Out/Roll Back Plan: ------------------------ Removing patch GMRC*3.0*184 from a site can be done by installing the backup created during patch installation. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;CONSULT/REQUEST TRACKING;**[Patch List]**;DEC 27, 1997;Build 22 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRCIAC2 Before: B65203764 After: B66788923 **22,28,35,66,154,184** Routine Name: GMRCIACT Before: B85863477 After: B95663299 **22,47,58,66,73,121,154,176,184** Routine Name: GMRCIEV1 Before: B47368373 After:B152302428 **22,28,31,154,184** Routine Name: GMRCIEVT Before:B137504904 After:B211927861 **22,28,31,121,154,184** Routine Name: GMRCIMSG Before: B55595174 After: B60850283 **22,28,51,44,154,184** Routine Name: GMRCIUTL Before: B32825849 After: B86167861 **22,58,184** Routine Name: GMRCRFC0 Before: B10011172 After: B11530799 **154,184** Routine list of preceding patches: 176 ============================================================================= User Information: Entered By : Date Entered : NOV 18, 2021 Completed By: Date Completed: JAN 26, 2023 Released By : Date Released : JAN 30, 2023 ============================================================================= Packman Mail Message: ===================== $END TXT