$TXT Created by CPRS28.DOMAIN.EXT (KIDS) on Tuesday, 12/22/15 at 07:46 ============================================================================= Run Date: DEC 28, 2015 Designation: GMRC*3*85 Package : GMRC - CONSULT/REQUEST TRACKING Priority: EMERGENCY Version : 3 SEQ #72 Status: Released Compliance Date: DEC 30, 2015 ============================================================================= Associated patches: (v)GMRC*3*73 <<= must be installed BEFORE `GMRC*3*85' (v)GMRC*3*75 <<= must be installed BEFORE `GMRC*3*85' Subject: CONSULT ORDER REJECTION Category: - Enhancement () - Routine Description: ============ This patch addresses two urgent issues in the Consult/Request Tracking package. 1. Order rejection upon signature 2. Diagnosis codes missing from consult transmissions to the Healthcare Claims Processing System (HCPS). Issue #1 -------- In GMRC*3.0*33, the Consult/Request Tracking package implemented Code Set Versioning (CSV). Part of that change was to validate the diagnosis code contained in any consult or procedure requests. With the activation of ICD-10, this diagnosis validation logic is the root cause of numerous orders being rejected by Consults with the message: "Provisional DX code rejected: code not valid for the Coding System unable to file request". This patch, GMRC*3.0*85, removes the CSV logic from the new order and edit/resubmit processes in VistA. When an order is signed and released to the Consult/Request Tracking package, Consults will no longer validate the ICD code being placed with that order. Therefore, Consult/Request Tracking will now accept an order that contains an ICD-9 diagnosis code while ICD-10 is the active coding system. This patch does nothing to alter the ICD code validation that is done in CPRS GUI. That logic will still be in effect if a user selects a consult quick order (QO) where an ICD-9 code has been saved for the Provisional Diagnosis prompt. **The consult order can still be saved and signed. It will not be rejected by Consults.** In this scenario, the user may see a popup dialog entitled "Inactive ICD Code" that states: "The provisional diagnosis is not active as of today's date. Another code must be selected before the order can be saved." Upon clicking OK in the popup dialog, the user is taken to the consult (or procedure) order dialog so that the provisional diagnosis value can be changed (if a diagnosis is required) or omitted entirely. To avoid this quick order scenario, sites may use the Review Quick Orders for Inactive ICD9 Codes [ORCM GMRC CSV CHECK] option found on the Order Menu Management [ORCM MGMT] menu. This option produces a list of all consult quick orders that contain inactive diagnosis codes. These quick orders may be reviewed for continued use and subsequently edited to update them with active diagnosis codes. The following are the known scenarios in which a consult can be ordered with an ICD-9 diagnosis code despite ICD-10 being active. These scenarios apply to outpatient orders. 1. When a user interacts with a patient chart and the date/time set for current activities predates ICD-10 activation and the user then proceeds to enter a consult for today where a provisional dx is required/entered, the Lexicon search will return ICD-9 codes. 2. If a user selects a consult quick order that is configured for AUTO-ACCEPT QUICK ORDER=YES and that quick order has an ICD-9 code saved for the provisional diagnosis prompt. Previously, in all scenarios above, upon signing the consult order, the user would receive the rejection message. With the installation of GMRC*3.0*85, these orders will no longer be rejected and consults will continue to be processed as usual. Issue #2 After the transition to ICD-10, the HCPS began receiving consult requests that did not contain a diagnosis code. This creates a delay in processing these requests as the consult must be manually edited in the Referral and Authorization System (RAS) to re-enter the diagnosis code. The root cause for this was found to be a bug in the consults code with how the diagnosis code was being extracted from an array of data before transmission to the HCPS. Previously, the code was trying to extract the diagnosis code from the provisional diagnosis text, and it was discovered that the extracted code was often a SNOMED code instead of the actual ICD code. E.g. If the diagnosis was: Amyotrophy due to type 1 diabetes mellitus (SNOMED CT 427571000) (250.61) The routine was extracting the diagnosis code as "SNOMED CT 427571000" And the diagnosis text was extracted as: "Amyotrophy due to type 1 diabetes mellitus" After the installation of GMRC*3.0*85, the actual ICD diagnosis code will now be extracted, such as "250.61" in the above example. The diagnosis text will remain unaffected. 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): ---------------------------- N/A Patient Safety Issues (PSIs): ----------------------------- N/A Remedy/CA SDM Ticket(s) & Overview: ---------------------------- CPRS-related Tickets Remedy #1304169, 1305953: Code not valid for Coding System Problem: ------- After the ICD-10 implementation, a consult order has been created that uses an ICD-9 code in the provisional diagnosis. Consults attempts to validate that the submitted ICD code is active and subsequently rejects the order because it cannot find an ICD-9 code in the active coding system (ICD-10). Resolution: ---------- When an order is signed and released to the Consult/Request Tracking package, Consults will no longer validate the ICD code being placed with that order. Therefore, orders placed in these scenarios will no longer be rejected by Consults. VistA Imaging-related Tickets I5944836FY16 Text Gateway Keeps Crashing from Bad HL 7 Message I5937620FY16 HL7 Data Error is stopping Worklist I5904476FY16 Text Gateway receiving HL7 error. Worklist stopping. I5903426FY16 HL7 error on Dicom gateway I5903370FY16 User is Reporting the Error *** DICOM TEXT GATEWAY... I5902854FY16 DICOM TEXT GATEWAY -- HL7 DATA ERROR I5900787FY16 Imaging Issue I5900130FY16 Text Gateway Issue I5897962FY16 Text Gateway Issue Problem: ------- After the ICD-10 implementation, a consult order has been created that uses an ICD-9 code in the provisional diagnosis. Consults attempts to validate that the submitted ICD code is active and subsequently rejects the order because it cannot find an ICD-9 code in the active coding system (ICD-10). Provider may submit several consult orders not realizing that each rejected order is creating downstream issues for VistA Imaging. VistA Imaging is unable to handle the rejected order. Resolution: ---------- When an order is signed and released to the Consult/Request Tracking package, Consults will no longer validate the ICD code being placed with that order. This change removes the condition that caused downstream issues where other packages cannot handle the rejected order. Prosthetics-related Tickets I5916375FY16 Duplicate prosthetics consults with nothing to display; manual suspense Problem: ------- After the ICD-10 implementation, a consult order has been created that uses an ICD-9 code in the provisional diagnosis. Consults attempts to validate that the submitted ICD code is active and subsequently rejects the order because it cannot find an ICD-9 code in the active coding system (ICD-10). Provider may submit several consult orders not realizing that each rejected order is creating downstream issues for Prosthetics. Prosthetics is unable to handle the rejected order. Resolution: ---------- When an order is signed and released to the Consult/Request Tracking package, Consults will no longer validate the ICD code being placed with that order. This change removes the condition that caused downstream issues where other packages cannot handle the rejected order. HCPC/RAS-related Ticket R6063960FY16 - Consult diagnosis code no longer transmitting to Healthcare Claims Processing System(HCPS) Problem: -------- After the implementation of ICD-10, consult orders transmitted to the HCPS were arriving without a diagnosis code. This created a need to manually edit these requests to add the diagnosis code back in. Resolution: ----------- The GMRC routine that processes these transmissions was obtaining the diagnosis code from an incorrect location in a data array. That code has been updated to reference the correct location in the array. Test Sites: ---------- Coatesville Dayton Detroit Houston Wilmington Software & Documentation Retrieval Instructions: ------------------------------------- There is no updated documentation provided with this patch. This patch is a PackMan build. Therefore the software may be obtained by forwarding the released patch message to the target system. Patch Installation: ------------------- Pre/Post Installation Overview: ------------------------------- This patch contains a simple pre-install routine that will prompt the installer for names of recipients for a post-install generated MailMan message. The post-install routine will create a tasked job to search the ORDER file (#100) for a particular subset of orders and then send a MailMan report containing the findings to the recipients specified during the pre-install. Pre-Installation Instructions: ------------------------------ The post-install will create a tasked job to search the ORDER file (#100) and generate a MailMan message containing the search results. IT installers MUST contact and coordinate with site staff to learn the names of recipients BEFORE installing the patch. Do NOT install the patch until you have names to specify as recipients. These recipients should be site staff who will be tasked with reviewing Consult orders that were rejected upon signature with the message: "Provisional DX code rejected: code not valid for the Coding System unable to file request". These recipients may be local Clinical Applications Coordinators (CACs) or other staff identified by the site. The installer must work with the site to identify recipients before installing the patch. When discussing this issue with sites, referencing the rejection message above and the associated trouble tickets should help provide context for the issue and assist with identifying recipients. Installers are also strongly encouraged to add themselves as recipients for the post-install report as well. Doing so will allow the installer to notice when the tasked job has completed and the MailMan message has been sent. No options need to be disabled for the pre-install 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. The tasked job started by the post-install will likely take more time to complete. It could be up to 30 minutes or more before the job completes and the recipients receive the specified MailMan message. Installation Instructions: -------------------------- The installation will update the routines associated with the diagnosis code validation checks. 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 GMRC*3.0*85: 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//' A menu rebuild is not necessary. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' Inhibiting logons is not necessary. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' Disabling any options or protocols is not necessary Post-Installation Instructions: ------------------------------- No special post-installation steps are necessary. If installers add themselves as recipients for the post-install message, they should verify that the message was generated and received. As no options were disabled during the pre-install, there is no need to re-enable any options. If the tasked job exits before completion, the installer will receive a MailMan message stating such along with directions on how to restart the task. The task may be restarted by running RESTART^GMRCP85 from the programmer prompt. Post-Install Tasked Job Details: -------------------------------- The recipients gathered during the pre-install are stored in the following ^XTMP array: ^XTMP("GMRCP85RECIPS") Any orders found during the tasked job search are stored in the following ^XTMP array: ^XTMP("GMRCP85_ORDERS") If the tasked job exits before completion, the following ^XTMP array contains the reference point used when the task is requeued: ^XTMP("GMRCP85") The tasked job searches the ORDER file (#100). The start date for the search is 9/01/2015 and moves forward chronologically from that date. The orders of interest are limited to Consults and Procedure orders where the NATURE OF DC (100,61) is REJECTED and the DC REASON TEXT (100,66) contains the phrase "Code not valid for Coding System". The output of the report is the patient's name + last four; the intended consult service; the date the order was placed; and the order number (IEN from file 100). The last line of the report will be the total number of orders found. Two abbreviated examples of the post-install generated message follow. The first where orders of interest were found, and the second where no orders were found. Subj: PATCH GMRC*3.0*85 ORDER SEARCH STATUS [#157238] 11/04/15@09:32 From: GMRC*3.0*85 INSTALL@CPRS28.DOMAIN.EXT In 'IN' basket. Page 1 -------------------------------------------------------------------------- The file #100 search process from GMRC*3.0*85 was successfully completed. PATIENT SERVICE ORDER DATE ORDER # -------------------------------------------------------------------------- CPRS,EIGHT III (0008) CONTACT LENS REQUEST 10/14/15 22326 CARDIOLOGY 10/15/15 22344 PHYSICAL THERAPY 10/15/15 22350 CPRS,TWO-PATIENT (0001) DIABETES NUTRITION 10/07/15 21722 DIABETES NUTRITION 10/07/15 21728 TOTAL ORDERS FOUND: 5 Enter message action (in IN basket): Ignore// Subj: PATCH GMRC*3.0*85 ORDER SEARCH STATUS [#157239] 11/04/15@09:35 From: GMRC*3.0*85 INSTALL@CPRS.TEST.DOMAIN.EXT In 'IN' basket. Page 1 ----------------------------------------------------------------------- The file #100 search process from GMRC*3.0*85 was successfully completed. No CONSULT or PROCEDURE orders found with the 'Code not valid for Coding System' rejection message. Enter message action (in IN basket): Ignore// Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;CONSULT/REQUEST TRACKING;**[Patch List]**;DEC 27, 1997;Build 3 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRCEDT1 Before: B70113386 After: B69360979 **1,5,12,15,22,33,47,66,73,85** Routine Name: GMRCEDT2 Before: B17559466 After: B16802448 **1,5,12,15,22,33,66,46,73,85** Routine Name: GMRCEDT4 Before: B85583529 After: B85518879 **1,5,12,15,22,33,66,73,85** Routine Name: GMRCGUIC Before: B69004877 After: B68517845 **4,12,20,15,22,33,66,73,85** Routine Name: GMRCHL7B Before: B29886300 After: B26855576 **1,5,12,21,17,22,33,66,46,73,85** Routine Name: GMRCHL7H Before:B129894392 After:B130038973 **75,85** Routine Name: GMRCP85 Before: n/a After: B77500247 **85** Routine list of preceding patches: 73, 75 ============================================================================= User Information: Entered By : Date Entered : OCT 09, 2015 Completed By: Date Completed: DEC 23, 2015 Released By : Date Released : DEC 28, 2015 ============================================================================= Packman Mail Message: ===================== $END TXT