============================================================================= Run Date: JAN 12, 2017 Designation: LA*5.2*90 Package : LA - AUTOMATED LAB INSTRUMENTS Priority: Mandatory Version : 5.2 SEQ #68 Status: Released Compliance Date: FEB 12, 2017 ============================================================================= Associated patches: (v)LA*5.2*74 <<= must be installed BEFORE `LA*5.2*90' (v)LA*5.2*88 <<= must be installed BEFORE `LA*5.2*90' Subject: MICROBIOLOGY ENHANCEMENTS Category: - Enhancement (Mandatory) - Data Dictionary - Routine Description: ============ The build for this patch is distributed as part of a multi-package build that contains LR*5.2*474 and LA*5.2*90 and contains functionality that will allow Microbiology instrumentation to utilize the Lab Universal Interface. By utilizing the Universal interface and middleware sites will be able to interface microbiology devices to a UI standard interface. New functionality will be applied that will allow for a "MI" subscripted test to be added to the Auto Instrument file. There will also be enhanced result processing and verify/release functions (see LR*5.2*474 patch descriptions for additional details). This patch is distributed in support of the VistA Laboratory Enhancement (VLE) Microbiology/Data Innovations interface utilizing the Laboratory Universal Interface. The patch contains a modification to the AUTO INSTRUMENT (#62.4) file that will change the name of the "CHEM TESTS" (#30) field to "LABORATORY TESTS" and modify the input screen to allow "MI" subscripted tests to be added to an Auto Instrument entry. The trigger on the TEST (#.01) field was also modified so that only tests with a value in the LOCATION (DATA NAME) (#5) will set the ROUTINE STORAGE (#11) field. Additional Information: ----------------------- This patch contains an enhancement to the antibiotic susceptibility result processing to accommodate the need for laboratories to report/document variations in susceptibility testing related to differences between in vitro susceptibility testing and in vivo action. An example is extended-spectrum_Beta-lactamases (ESBL). Susceptibility results received as coded entries can be from the SNOMED CT code system or a site-designated local code (L). The interface supports the following SNOMED CT codes to report susceptibility to antimicrobial agents. 131196009 susceptible 260357007 moderately susceptible 264841006 intermediately susceptible 30714006 resistant 10828004 positive 260385009 negative Local codes in the role of answers can be entered on an interface specific basis using the option Add/Edit Local Identifier [LA7V 62.47 LOCAL IDENTIFIER] An example of reporting ESBL status is the following HL7 OBX segment fragment. OBX|1|CWE|6984-9^ESBL:SUSC:PT:ISLT:ORDQN:AGAR DIFFUSION^LN^^^^2.19^^ESBL||ESBL^ESBL^L^^^^20160721^^+|||+ Routines related to this enhancement are: LA7VIN2A LA7VIN7 LA7VIN7A LA7VIN7B LA7VHLU6 Blood Bank Review: ================== EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LA*5.2*90 does not contain any changes to the VISTA BLOOD BANK Software as defined by ProPath standard titled: BBM Team Review of VistA Patches. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LA*5.2*90 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LA*5.2*90 have no effect on Blood Bank software functionality, therefore RISK is none. VALIDATION REQUIREMENTS BY OPTION: Because of the nature of the changes made, no specific validation requirements exist as a result of installation of this patch. Patch Components: ----------------- None Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- AUTO INSTRUMENT (#62.4) LABORATORY TESTS (#30 Modified 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 Below shows the Data Dictionary as modified with the installation of this Patch for the Auto Instrument File. STANDARD DATA DICTIONARY #62.41 -- LABORATORY TESTS SUB-FILE JUN 8,2016@12:37:17 PAGE 1 STORED IN ^LAB(62.4,D0,3, SITE: TEST.CHEYENNE.DOMAIN.EXT UCI: VISTA,ROU DATA NAME GLOBAL DATA ELEMENT TITLE LOCATION TYPE -------------------------------------------------------------------------- 62.41,.01 TEST 0;1 POINTER TO LABORATORY TEST FILE ( #60) (Required) (Multiply asked) INPUT TRANSFORM: S DIC("S")="I $D(^LAB(60,Y,.2))!(""MI""[$P (^LAB(60,Y,0),U,4))" D ^DIC K DIC S DIC=DI E,X=+Y K:Y<0 X LAST EDITED: JUN 07, 2016 HELP-PROMPT: Enter the name of a test for which the instrument will send data. DESCRIPTION: This contains the test names for this instrument. SCREEN: S DIC("S")="I $D(^LAB(60,Y,.2))!(""MI""[$P (^LAB(60,Y,0),U,4))" EXPLANATION: Allow CH atomic test or Microbiology subsc ript test FIELD INDEX: AD (#867) MUMPS IR ACTION Short Descr: Set "ROUTINE STORAGE" field with CH subscripted test data name number Description: This trigger cross reference will only populate the "ROUTINE STORAGE" field with 63.04 data location file number for CH (Chemistry) atomic subscripted test having data name field populated. See example below. MI (Microbiology) subscripted test have no data name, therefore the "AUTO INSTRUMENT" file # 62.4, "TEST" field #30, (#62.41), subfile #62.41, "ROUTINE STORAGE" file #11 will NOT be set. EXAMPLE: CH subscripted test having DATA NAME will populate the ROUTINE STORAGE field with: TV(#,1) MI subscripted test will NOT set the ROUTINE STORAGE field. Set Logic: S $P(^LAB(62.4,DA(1),3,DA,1),U)="TV("_X2(3 )_",1)" Set Cond: S X=(X2(2)="CH")&(X2(3)'="") Kill Logic: S $P(^LAB(62.4,DA(1),3,DA,1),U)="" X(1): TEST (62.41,.01) (Subscr 1) (Len 10) (forwards) Transform (Display): X(2): Computed Code: S X=$P($G(^LAB(60,X(1),0)), U,4) (Subscr 2) X(3): Computed Code: S X=$P($G(^LAB(60,X(1),.2)) ,U) (Subscr 3) FILES POINTED TO FIELDS LABORATORY TEST (#60) TEST (#.01) New Service Requests (NSRs): ---------------------------- NSR #20131213 Carbapenem Resistant Enterobacteriaceae (CRE) Naming Conventions Electronic Interfacing of Automated Identification and Susceptibility Testing Instruments NSR #20140801 Tracking Multi-Drug Resistant Organisms Patient Safety Issues (PSIs): ----------------------------- N/A Remedy Ticket(s) & Overview: ---------------------------- N/A Problem: ------- N/A Resolution: ---------- N/A Test Sites: ---------- James A. Haley Veterans Hospital Iowa City VA Healthcare System Lexington VA Medical Center Software and Documentation Retrieval Information ================================================ VistA Laboratory patch LR*5.2*474 software is distributed by Host File, along with LA*5.2*90. Software is available on the SOFTWARE.DIR directory at one of the following Office of Information (OI) Field Offices. The preferred method is to retrieve the file using Secure File Transfer Protocol (SFTP) from download.vista.domain.ext, which transmits files from the first available SFTP server. Albany ftp.domain.ext Hines ftp.domain.ext Salt Lake City ftp.domain.ext File Name Contents Retrieval Format ------------------ -------------------- ---------------- LAB_MICRO_INTERFACE_ Host File containing ASCII RELEASE_1_0.KID KIDS software distribution LAB_MICRO_INTERFACE_RELEASE_1_0_DOCS.ZIP, which contains both .pdf and .docx formatted files of the following documents. Retrieval format is BINARY: VLE Micro_Lab_Micro_Interface_Release_1.0_Technical_Manual VLE Micro_Lab_Micro_Interface_Release_1.0_User_Guide VLE Micro_Deployment_Installation_Roll Back_Back Out_Guide The VistA Documentation Library (VDL) web site will also contain the above referenced documents. This website is usually updated within 1-3 days of the patch release date. The VDL web address for Laboratory Universal Interface user documentation is: http://www.domain.ext/vdl/application.asp?appid=120 Note: These previously released documents contain configuration and mapping information that is useful to the implementation of the Universal Interface for Microbiology tests. ------------------------------------------------------------------------ LEDI IV Installation Guide LAB_LEDI_IV_IG.PDF binary LEDI IV User Manual LAB_LEDI_IV_UM.PDF binary LEDI IV Update AP/MICRO LEDI_IV__AP__MICRO_ binary Configuration Guide CONFIGURATION_GUIDE.PDF binary Patch Installation: Pre/Post Installation Overview: ------------------------------- This patch install must be coordinated with the Laboratory ADPAC to ensure that all Lab Interface related activities are halted. Pre-Installation Instructions: ------------------------------ Ensure that all Lab Interface activity has been halted !! This would include: -Editing of an Auto Instrument file entry, -Turn off the Auto Downloading process to prevent the building and downloading of a Load/Worklist to the Instrument Manager. -Shut down all LA7UI logical links and any other HL7 process (HLZTCP or HLLP processes) to prevent the processing of result messages from the IM. This patch may be installed with users on the system as long as the above process controls have been followed. 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. This installation will modify the CHEM TESTS field (#30) in the AUTO INSTRUMENT file (#62.4) by changing the following: The name of the field will be changed to LABORATORY TESTS The screen on the field will now allow "MI" subscripted tests The ROUTINE STORAGE (#11) value set by the trigger on the TESTS (#.01) field will not happen for "MI" subscripted tests The original ROUTINE STORAGE trigger code has been replace with a new style AD cross-reference. 1. DOWNLOAD HOST KIDS FILE ---------------------- Download the KIDS file LAB_MICRO_INTERFACE_RELEASE_1_0.KID from the ANONYMOUS.SOFTWARE directory of Albany, Hines, or the Salt Lake OIFO to the appropriate directory on your system. 2. LOAD DISTRIBUTION ----------------- Use the 'LOAD A DISTRIBUTION' option on the KIDS INSTALLATION menu, and enter: the directory onto which you have downloaded the host file, followed by LAB_MICRO_INTERFACE_RELEASE_1_0.KID, the host file name. 3. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: Installation ------------- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global 4. Select Installation Menu Option: ------------------------------------------ a. Use the Load a Distribution and select Host File: LAB_MICRO_INTERFACE_RELEASE_1_0.KID b. 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. c. 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.). d. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. From the KIDS Installation menu: Select option #6: Install Package(s) At the Select INSTALL NAME: Respond: LA*5.2*90 When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//' Respond: NO When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' Respond: NO When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' Respond: NO If prompted 'Delay Install (Minutes): (0 - 60): 0//' Respond: 0. Post-Installation Instructions: ------------------------------- Below is an example of how an micro instrument might be defined in the Auto Instrument file. Refer to the Install. We recommend that the Install and User manuals be followed for more completely documented instructions. AUTO INSTRUMENT (#62.4: NUMBER: 3 NAME: BAC-TEC LOAD/WORK LIST: BAC-TEC ENTRY for LAGEN ROUTINE: Accession cross-reference CROSS LINKED BY: IDE MESSAGE CONFIGURATION: LA7UI2 METHOD: BACTEC DEFAULT ACCESSION AREA: BLOOD CULTURE OVERLAY DATA: YES STORE REMARKS: YES NUMBER: 1 TEST: BLOOD CULTURE UI TEST CODE: BLD CX ACCESSION AREA: MICROBIOLOGY FILE BUILD ENTRY: EN FILE BUILD ROUTINE: LA7UID AUTO DOWNLOAD: NO WKLD METHOD: BACT/ALERT WKLD CODE METHOD NAME: BACT/ALERT WKLD CODE SUFFIX: .7086 Routine Information: ==================== The second line of each of these routines now looks like: ;;5.2;AUTOMATED LAB INSTRUMENTS;**[Patch List]**;Sep 27, 1994;Build 17 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LA7VHLU6 Before: B56093217 After: B58736241 **74,90** Routine Name: LA7VIN2A Before: B34119950 After: B34485992 **74,88,90** Routine Name: LA7VIN7 Before: B81438195 After: B83943151 **74,90** Routine Name: LA7VIN7A Before: B55259468 After: B61187996 **74,90** Routine Name: LA7VIN7B Before: B59079752 After: B65792075 **74,90** Routine Name: LA90A Before: n/a After: B5670536 **90** Routine list of preceding patches: 88 ============================================================================= User Information: Entered By : Date Entered : OCT 06, 2015 Completed By: Date Completed: JAN 11, 2017 Released By : Date Released : JAN 12, 2017 ============================================================================= Packman Mail Message: ===================== No routines included