$TXT Created by T at CLE623.FO-BAYPINES.DOMAIN.EXT (KIDS) on Tuesday, 07/11/23 at 11:57 ============================================================================= Run Date: NOV 29, 2023 Designation: GMRC*3*185 Package : GMRC - CONSULT/REQUEST TRACKING Priority: Mandatory Version : 3 SEQ #163 Status: Released Compliance Date: DEC 30, 2023 ============================================================================= Associated patches: (v)GMRC*3*193 <<= must be installed BEFORE `GMRC*3*185' Subject: LOAD CERNER DATA FOR IFCS AND ADD TRIGGERS FOR CUMULATIVE COMMENTS Category: - Routine - Other - Data Dictionary Description: ============ VERSION 4 CHANGES/ADDITIONS --------------------------- Code change made so pre-prod environments can access the IFC data file. Post-installation report sent to OR CACS mail group as well as patch installer. VERSION 3 CHANGES/ADDITIONS --------------------------- Code to populate station number in OBR-2.2 returned IEN of Institution file (#4) instead of 3 digit station number. VERSION 2 CHANGES/ADDITIONS --------------------------- Code changes made to address problems #3 and #4 described below. =========================== Inter-Facility Consults (IFCs) are initiated by the requesting (placer) site sending a Health Level Seven (HL7) order message to the consulting (filler) site. The consulting site, upon receipt of the order message, evaluates it and determines if it will process the order. VistA sites return an HL7 message acknowledgement either accepting or rejecting the order. Cerner sites return an HL7 message acknowledgement regardless of their intent to process the order. Subsequent actions at the consulting site - resulting, commenting, order discontinuation, etc. - also trigger generation of HL7 messages that are sent to the requesting site. The requesting site may also add comments or may cancel/discontinue the order. These actions also trigger transmission of HL7 messages. Problem #1: When the requesting site has been converted to Cerner Millennium, HL7 messages must include PID and OBR segments or Cerner will acknowledge but ignore them. VistA at non-converted sites does not require either segment and so does not include them. When the consulting site has been converted to Cerner Millennium, it requires that the non-converted requesting site include the patient account number (aka FIN) on the PID segment (PID-18) when messaging it. In addition, Cerner requires that ordering physician data be included in the OBR segment (OBR-16) and that the ordering description be present in OBR-19. As part of the first site conversion, Veterans Data Integration and Federation (VDIF) stored the PID and OBR segments sent by converted sites that were included in HL7 messages initiating IFCs (as requesting site) or accepting IFC orders (as consulting site). For all follow up HL7 messages for these IFCs, VDIF inserted the saved PID and OBR segments to make them Cerner-compliant. VDIF does not, however, have long-term storage capacity for these message segments. A purge of the segments was required in July of 2021 to maintain VDIF's stability. This purge meant that numerous HL7 messages for IFCs could not be populated with PID and OBR segments. These messages were ignored by Cerner, and IFCs failed. Solution: Patch GMRC*3.0*184 saves and stores patient account numbers, ordering physician and ordering description data from Cerner orders in the REQUEST/CONSULTATION file (#123). The patch also generates PID and OBR segments for HL7 messages sent to Cerner for converted sites. It ensures that HL7 messages are Cerner-compatible for all IFCs entered after installation of the patch. GMRC*3.0*184, however, cannot generate Cerner-compliant HL7 messages for IFCs entered prior to installation of that patch. The patient account numbers that Cerner requires to be in PID-18, the ordering physician data that Cerner requires to be in OBR-16 and the ordering description it requires in OBR-19 are not present in the REQUEST/CONSULTATION files on non-converted sites that either initiated IFCs to converted sites (requesting site) or that received IFC orders from converted sites (consulting site) for older IFCs. GMRC*3.0*185 loads the patient account numbers, ordering physician and ordering description data for IFCs placed before the installation of patch GMRC*3.0*184 into the REQUEST/CONSULTATION file on the affected non-converted site. Data provided by Cerner - Cerner order number, placer site, filler site, patient account number, ordering provider, ordering description - was put into a host file that is loaded during execution of the patch's post-install routine. The data is scanned at each installation site and loaded into the REQUEST/CONSULTATION file (#123) if the VistA site's number matches the placer or filler site number provided by Cerner. Problem #2: Cumulative comments are generated and transmitted to Cerner by GMRC*3.0*184 for the following consult activities: 1) ADDED COMMENT 2) DISCONTINUED 3) CANCELLED 4) RECEIVED 5) REMOTE REQUEST RECEIVED 6) SCHEDULED 7) SIG FINDING UPDATE 8) FORWARDED FROM 9) COMPLETE/UPATE 10) FWD TO REMOTE SERVICE The following consult activities should also trigger cumulative comment generation: 1) STATUS CHANGE Solution: One (1) additional activity added as a trigger for cumulative comments in GMRCIEV1. Problem #3: Prosthetics IFCs require that OBR-20 (OPT IN FOR FINAL STATUS) and OBR-27.4 (PERFORMED DATE/TIME) be populated when VistA sends IFC HL7 messages to Cerner. These fields originate in Cerner and must be returned to Cerner. When GMRC*3*184 began generating OBR segments instead of VDIF inserting saved OBR segments, the data in these two fields were missing. Solution: GMRC*3*185 added 2 fields to the REQUEST/CONSULTATION file (#123) where these values can be stored upon receipt of a new HL7 order and retrieved for inclusion in outing OBR segments. Field #511 OPT IN FOR FINAL STATUS and field #512 PERFORMED DATE/TIME are populated when a Prosthetics order is received from Cerner. Their contents are inserted into the OBR segment generated by VistA that is then transmitted to Cerner. GMRC*3*185 also backloads data into the two new fields in the Consult file for IFCs that pre-date the release of the patch. Problem #4: When generating OBR segments, GMRC*3*184 inserted the ordering station (field #.05 ORDERING FACILITY) from the REQUEST/CONSULTATION file (#123) into OBR-2.2. After go-live, it was determined that the station number of the VistA instance should go in OBR-2.2 instead. Solution: GMRC*3*185 replaced the ordering station number with the VistA instance station number when generating OBR segments. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- REQUEST/CONSULTATION OPT IN FOR FINAL STATUS (#511) NEW PERFORMED DATE/TIME (#512) NEW 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 ----------- ---- -------------------- GMRC185 BACKOUT ROUTINE NEW 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 Portland Spokane 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_185_DIBR.DOCX Deployment, Installation, Backout and Rollback GMRC_3_185_DIBR.PDF Guide Consult/Request Tracking Technical Manual CONSTM.DOCX CONSTM.PDF 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. Note: If the installation is done on a test or pre-production (not a production) site, the installer will be prompted as follows: Select one of the following: D DEVELOPMENT T IST TEST P PRE-PROD Installation environment: Select the type of site appropriate for the installation. 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*185. 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: *** Installer: please forward the post-installation report to: *** padma.bodduluri@domain.ext rhonda.goldsmith@domain.ext A sample of the post-installation report titled "GMRC*3.0*185 LOAD REPORT" is shown below. It is sent to the installer and to the OR CACS MailMan mail group. Subj: GMRC*3.0*185 LOAD REPORT [#72952043] 04/05/22@09:38 12 lines From: SMITH, MRY (IRM) In 'IN' basket. Page 1 -------------------------------------------------------------------------- ========================================================================== 2 CONSULTS UPDATED. ========================================================================== 4 ORDERS NOT FOUND. PLACER ORDER NUMBER SITE ACCOUNT NUMBER ----------------------- ----------- -------------- 2233445566 FILLER: 541 123456789 ORDERING PHYSICIAN: 1234567890^CERNER^CERNER^JUNIOR CERNER PLACER FIELD 1: IFC Request - Columbus OPT IN FOR FINAL STATUS: N PERFORMED DATE/TIME: 203204251334+0400 6655443322 FILLER: 541 987654321 ORDERING PHYSICIAN: 1234567890^CERNER^CERNER^JUNIOR CERNER PLACER FIELD 1: IFC Request - Columbus -------------------------------------------------------------------------- There is no site action required to be taken on this report. The functionality that attempts to match the old orders between the site and a Cerner-converted site uses every possible algorithm to find a match. During site testing, the unmatched orders were determined to be not fixable, i.e. test patients, etc. If sites have questions, a Service Now ticket can be entered and assigned to the SPM.HEALTH.APP.VADCLIN.Triage Group. Back-Out/Roll Back Plan: ------------------------ The data loaded by this patch can be backed out by running the GMRC185 BACKOUT option. The patch can then be backed out by installing the backup patch created in step 2B above. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;CONSULT/REQUEST TRACKING;**[Patch List]**;DEC 27, 1997;Build 16 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRC185 Before: n/a After: B84504881 **185** Routine Name: GMRCIACT Before:B103344683 After:B105576202 **22,47,58,66,73,121,154,176, 184,193,185** Routine Name: GMRCIEV1 Before:B152302428 After:B162874990 **22,28,31,154,184,185** Routine Name: GMRCIUTL Before: B86167861 After: B90121709 **22,58,184,185** Routine list of preceding patches: 193 ============================================================================= User Information: Entered By : Date Entered : NOV 29, 2021 Completed By: Date Completed: NOV 28, 2023 Released By : Date Released : NOV 29, 2023 ============================================================================= Packman Mail Message: ===================== $END TXT