============================================================================= Run Date: SEP 02, 2009 Designation: LEX*2*55 Package : LEX - LEXICON UTILITY Priority: Mandatory Version : 2 SEQ #61 Status: Released Compliance Date: OCT 02, 2009 ============================================================================= Associated patches: (v)LEX*2*43 <<= must be installed BEFORE `LEX*2*55' (v)LEX*2*56 <<= must be installed BEFORE `LEX*2*55' Subject: Adding BI-RADS and AAA codes Category: - Routine - Enhancement (Mandatory) Description: ============ This is a multi-package Kernel Installation and Distribution System (KIDS) distribution consisting of the following two builds: Build Package Subject Comment ---------- --------- -------------------- -------------------------- LEX*2.0*55 Lexicon BI-RAD Codes install name is LEX*2.0*55 RA*5.0*97 Radiology BI-RAD and AAA Codes NOTE: This message is neither KIDS nor Packman and contains no KIDS build, no routines and no data, and is not installable. The installable KIDS distribution can be obtained using the FTP instructions found later in this patch description. This patch exports the Mammography Assessment Categories from the Breast Imaging Reporting and Data System (BI-RADS) for the Lexicon Utility in support of the Radiology Outside Reporting project and makes minor changes to the Lexicon lookup to access these BI-RADS terms. It also adds BI-RADS and Abdominal Aortic Aneurysm (AAA) codes to the DIAGNOSTIC CODES file #78.3, using internal entry numbers 1100 thru 1106 and 1200 thru 1202, respectively. ENHANCEMENTS: ============ Lexicon Enhancements -------------------- BI-RADS and MQSA terms and codes have been added to the Expression file 757.01 and Codes file 757.02. These terms and codes are taken from the American College of Radiology (ACR) Breast Imaging Reporting and Data System (BI-RADS) and the Mammography Quality Standards Act of 1992 (MQSA). BI-RADS Breast Imaging Reporting and Data System 0 Incomplete, need additional imaging evaluation and/or prior Mammograms for comparison 1 Negative 2 Benign Finding(s) 3 Probably Benign Finding, Initial Short-Interval Follow-Up Suggested 4 Suspicious Abnormality, Biopsy should be considered 5 Highly Suggestive of Malignancy, appropriate action should be taken 6 Known Biopsy, Proven Malignancy, appropriate action should be taken Mammography Quality Standards Act of 1992 (MQSA) 0 Incomplete: Need Additional Imaging Evaluation 1 Negative 2 Benign 3 Probably Benign 4 Suspicious 5 Highly Suggestive of Malignancy 6 Known Biopsy Proven Malignancy Two new special lookup variables are implemented with this patch (see Lexicon Technical Manual, Special Variables, Variables affecting the Lookup). Added: LEXSRC The documented source of terminology (from the Lexicon Source file 757.14) LEXCAT If a source is divided into categories, this is the category/sub-category within the source (from the Lexicon Source Category file 757.13) Radiology Enhancements --------------------- BI-RADS and Abdominal Aortic Aneurysm (AAA) codes are added to the DIAGNOSTIC CODES file #78.3, using internal entry numbers 1100 thru 1106 and 1200 thru 1202, respectively. It also adds the display of the MQSA coding text next to the BI-RADS code for file look up and all reports and API's that currently display diagnostic codes. It checks if a BI-RADS diagnostic code is required for an outside report, and if so, would display a warning message if the required BI-RADS diagnostic code wasn't entered during the use of the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option. The maintenance portion fixes routine RABWORD1 and two print templates so that they use APIs to retrieve CPT modifiers and ICD9 codes, instead of reading directly from old fields that are scheduled for deletion. ROUTINE ENHANCEMENTS: ==================== Lexicon Routine Enhancements ---------------------------- LEXA This routine has been modified by adding two new parameters (Source and Category) to the entry point LOOK^LEXA. If defined, terms associated with the Source and/or Category will be placed on the list of terms found in the ^TMP("LEXFND") global array. The two extrinsic functions $$SRC and $$CAT have been added to resolve the two new parameters to files 757.14 and 757.13 respectively. LEXA1 This is the Lexicon Special Lookup routine. It has been modified to look for the variables LEXSRC and LEXCAT and pass them to LOOK^LEXA. It has also been modified to look for special characters (control characters and apostrophes, see Remedy Tickets). LEXAL This routine builds the list of terms found during the lookup. It has been modified to utilized the Source and Category fields in 757.01 to place source specific terminology on the search list in ^TMP("LEXFND"). LEXAR This routine gets the response from the user and is called by special lookup ^LEXA1. It has been modified to leave the lookup defaults found in global array ^TMP("LEXSCH") for subsequent lookups. See Remedy Tickets below. LEXAR4 This routine provides information about a term and is called by INFO^LEXA. It has been modified to allow the source and category of an expression to be saved in the LEX("SEL") array. LEXAR5 This routine provides additional information about a term. It has been modified to allow the BI-RADS codes to be saved in the LEX("SEL") array. LEXTOLKN This routine takes a string (term) and parses it into words. It has been modified to process apostrophe "s" as both a word and a plural word to facilitate various forms of user input during lookup. It has also been modified to remove control characters. Term Cross-Referenced as BIRAD'S BIRAD BIRADS Radiology Routine Enhancements ------------------------------ RA97PST This is a new routine used to add BI-RADS and AAA records into the DIAGNOSTIC CODES file (#78.3). It is also used to add the display of the MQSA coding system's text alongside the BI-RADS code during user selection lookup. It resets the record counter for file #78.3 after the patch installation. RA97PST1 This is a new routine used during the patch installation to retrieve BI-RADS codes from the Lexicon application's EXPRESSIONS file (#757.01). RABIRAD This is a new routine used for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option. It checks if a case should require a BI-RADS code. If the case is missing a required BI-RADS code, then a warning message will be displayed. It also displays extra fields after BI-RADS and AAA records whenever the user enters a "?" or "??" at the DIAGNOSTIC CODES prompt. The extra field displayed for BI-RADS is the MQSA coding system's text from the Lexicon's EXPRESSIONS file (#757.01). The extra field displayed for AAA is the DESCRIPTION from the DIAGNOSTIC CODES file (#78.3). RABWORD1 This routine has been modified to convert a direct read of the ICD DIAGNOSIS file (#80) to a supported code set versioning API: $$ICDDX^ICDCODE( ). RADLQ1 This routine has been modified to display the correct report status for an electronically filed report in the 'Delinquent Status Report' [RA DELINQUENT] option. It is also modified to add a screen pause at the end of the last screen so the display won't scroll off the screen. RAEDCN This routine has been modified to disallow the use of the 'Diagnostic Code and Interpreter Edit by Case No.' [RA DIAGCN] option for a case that doesn't have a report yet or has a stub report or an electronically filed report. RAO7PC2 This routine has been modified to output the MQSA coding system's text next to the BI-RADS diagnostic code. This is a routine that is used by other applications to display a Radiology report. RAPRINT These routines have been modified for the 'Abnormal Exam RAPRINT1 Report' [RA ABNORMAL] option to allow the user to select data by VA radiologist only, Electronically Filed only, or both. RAPRINT1 was also modified to display the MQSA coding system's text beneath the BI-RADS code and correct a bug found during development testing. The bug occurred when a case had two abnormal diagnostic codes, and the case # displayed under the first abnormal diagnostic code but not under the second abnormal diagnostic code. This was due to the case being the last case with the first abnormal diagnostic code and the first case with the second abnormal diagnostic code. RART This routine has been modified for the 'Display a Rad/Nuc Med Report' [RA RPTDISP] option to display the MQSA coding system's text next to the BI-RADS diagnostic code. RARTE5 This routine has been modified for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option to use routine RABIRAD to check for a required BI-RADS code. RARTE7 This routine has been modified for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option to generate an "Imaging Results" alert when an outside report has been entered the first time and it doesn't have an abnormal diagnostic code. (The wording of this alert is changed to "Imaging Results,Non Critical" by the released patch RA*5*93.) Previously, only abnormal diagnostic codes would cause an alert to be generated from this option. RARTR1 This routine has been modified for options: 'Draft Report (Reprint)' [RA REPRINT], 'Select Report to Print by Patient' [RA RPTPAT] and the background processing that sends a verified report to the requesting physician. This modification adds the display of the MQSA coding system's text alongside the BI-RADS code in the output. FILE ENHANCEMENTS: ================= Lexicon Files ------------- Patch LEX*2.0*55 writes to the following files: File Name File # File Root Action ---------------- -------- ------------ ---------- MAJOR CONCEPT MAP #757 ^LEX(757, Data Added CONCEPT USAGE #757.001 ^LEX(757.001, Data Added EXPRESSIONS #757.01 ^LEX(757.01, Data Added CODES #757.02 ^LEX(757.02, Data Added CODING SYSTEMS #757.03 ^LEX(757.03, Data Added SEMANTIC MAP #757.1 ^LEX(757.1, Data Added SEMANTIC CLASS #757.11 ^LEX(757.11, Data Added SEMANTIC TYPE #757.12 ^LEX(757.12, Data Added SOURCE CATEGORY #757.13 ^LEX(757.13, Data Added SOURCE #757.14 ^LEX(757.14, Data Added SUBSET DEFINITIONS #757.2 ^LEXT(757.2, Data Added Before installing this patch, make a backup copy of the ^LEX and ^LEXT globals. Radiology Files --------------- Patch RA*5.0*97 includes the following files and fields: File Name File # File Root Field/Action ---------------- -------- ------------ ----------------------- DIAGNOSTIC CODES #78.3 ^RA(78.3, .001 NUMBER Blocked 999 and higher Changed Help Prompt Changed Field Description DIAGNOSTIC CODES #78.3 ^RA(78.3, .01 DIAGNOSTIC CODE Made Un-Editable DIAGNOSTIC CODES #78.3 ^RA(78.3, 6 EXPRESSION New and Un-Editable PRINT TEMPLATE ENHANCEMENTS: =========================== Radiology Print Templates ------------------------- The following print templates have been modified to use $$MOD^ICPTMOD to retrieve the names of CPT modifiers. RA IMAGE LOC LIST RA PROCEDURE LIST REMEDY TICKETS: ============== Lexicon Remedy Tickets ---------------------- Ticket Problem HD0000000070373 Lookup with apostrophe 's' HD0000000219980 Default values deleted causing inconsistency HD0000000251024 PTX+25^LEXTOLKN error (control characters) DOCUMENTATION RETRIEVAL: ======================= Updated documentation describing the functionality introduced by this patch is available in the [ANONYMOUS.SOFTWARE] directories at the following Internet addresses: Files: File Name Document File Description FTP Protocol ------------- ------------------------------- ------------ RA5_0UM.PDF Radiology User Manual binary RA5_0TM.PDF Radiology Technical Manual binary RA5_0RN_P97.PDF Released Notes binary FTP Servers: The documentation may be downloaded directly from the following FTP servers: FTP Server Internet address ---------------------- ------------------------- * Preferred Server download.vista.med.va.gov <-- Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov * The preferred server download.vista.med.va.gov will transmit the file from the first available FTP server. Files are available in the ANONYMOUS.SOFTWARE directory. Internet: After this patch is released, the updated manuals may also be retrieved from the Internet at: http://www.va.gov/vdl In the "Browse" box, select "Clinical" On the Clinical Page, select "Radiology/Nuclear Medicine" On the Radiology/Nuclear Medicine download the files listed above FTP SOFTWARE RETRIEVAL: ======================= Filename: LEX_RA_BIRADS_97.KID The file may be downloaded directly from the following FTP servers: FTP Server Internet address ---------------------- ------------------------- * Preferred Server download.vista.med.va.gov <-- Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov * The preferred server download.vista.med.va.gov will transmit the file from the first available FTP server. Files are available in the ANONYMOUS.SOFTWARE directory. Test Sites ---------- 1. Martinez, CA 2. Bronx, NY 3. Charleston, SC 4. Bay Pines, FL 5. Puget Sound, OR INSTALLATION INSTRUCTIONS: ========================= 1) Radiology users should be off the system during the installation of this host file but other users may be on the system. It is recommended that this host file be installed during non-peak hours. The global backup (step 2) may take up to 30 minutes. The KIDS installation should take less than 5 minutes. 2) Create a backup of the following global files before continuing: Lexical Files #757-757.41 ^LEX Sub-Set Definition #757.2 ^LEXT These backup files may get as large as 1.17 gigabytes. Make sure space is available before proceeding. It should take from 15 to 40 minutes to create the backup files. When you are creating a backup of non-subscripted globals, you are saving the entire global. You should use the utility ^%GO for non-subscripted globals, and when prompted for a global, enter the global root (global name only, no open parenthesis, no file number and no commas, as shown below). Example: Enter To create a Backup copy of: ------ -------------------------- ^LEX Lexical Files ^LEXT Sub-Set Definition File 3) Set up user and IO variables (D ^XUP) for programmer access. 4) Distribution Load: Load the KIDS Distribution from the host file LEX_RA_BIRADS_97.KID which you obtained via FTP. 5) KIDS Installation: Use the KIDS Installation Menu. a) Pre-Install Options: From the KIDS Installation Menu, you may choose the following options prior to installing this patch: 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global For each of the above options, respond "LEX*2.0*55" only at the "Select INSTALL NAME:" prompt. Do *NOT* enter the Radiology patch name. These options will automatically bring in the Radiology patch for you. b) Install Option: From the KIDS Installation Menu, use the following option to install the contents of the host file: 6 Install Package(s) Respond "LEX*2.0*55" only at the "Select INSTALL NAME:" prompt. Do *NOT* enter the Radiology patch name. Do *NOT* reload the host file to install the Radiology patch. The Install file LEX*2.0*55 will automatically install both LEX*2.0*55 and RA*5.0*97, creating individual entries in both the BUILD and INSTALL files for both the Lexicon and Radiology patches. Respond "NO" at the "Want KIDS to INHIBIT LOGONs during the install?" prompt. Respond "YES" at the "Want to DISABLE Schedule Options, Menu Options, and Protocols?" prompt. Respond "RA*" at the "Enter options you wish to mark as 'Out Of Order'" prompt to disable RA namespaced options. Respond "RA*" at the "Enter protocols you wish to mark as 'Out Of Order'" prompt to disable RA namespaced protocols. Respond "0" at the "Delay Install (Minutes)" prompt proceed with the install immediately after the options and protocols have been disabled. 6) Cleanup The Post-Install routine LEX2055P should be deleted using the KERNEL option 'Delete Routines' [XTRDEL] upon completion of the installation. Routines LEX2055A, LEX2055B, LEX2055C, LEX2055D, LEX2055E, LEX2055F, LEX2055G, LEX2055H and LEX2055I will be deleted by the post-install routine LEX2055P. The Post-Install routines RA97PST and RA97PST1 may be deleted if the patch processing displayed : *** 10 of 10 BI-RADS and Abdominal Aortic Aneurysm codes have been successfully added to the DIAGNOSTIC CODES file #78.3. *** 7) Post Installation Overview Post LEX*2.0*55 The post installation routine LEX2055P will generate an install message and send it to G.LEXINS@FO-SLC.MED.VA.GOV and a copy to the installer. If an error is encountered in the install of the Lexicon patch it will be reflected in this message, else it will simply list the install times of the components. Post RA*5.0*97 1. For sites that will use the exported BI-RADS and AAA codes from Voice Recognition (VR) systems, such as PowerScribe or TalkStation, the VR systems manager must add the BI-RADS and AAA codes exported from Patch RA*5*97 into the diagnostic file of the VR system. The exported BI-RADS and AAA field values are described in item 2. It is known that PowerScribe has an inactivation feature and TalkStation does not. For sites that will not use the exported BI-RADS and AAA codes from VR systems with the inactivation feature, the VR systems manager can add the exported codes into the diagnostic file of the VR system and inactivate the codes. This keeps the diagnostic codes in VistA in sync with the diagnostic codes on the VR system. 2. The post installation routines RA97PST and RA97PST1 will add the following records to the DIAGNOSTIC CODES file (#78.3): [Field Number] : Stored value -> Displayed value [.001]: 1100 [.01] : BI-RADS CATEGORY 0 [2] : Incomplete: Need Additional Imaging Evaluation [3] : Y -> YES [4] : y -> YES [6] : 80 -> Incomplete: Need Additional Imaging Evaluation [.001]: 1101 [.01] : BI-RADS CATEGORY 1 [2] : Negative [3] : N -> NO [4] : n -> NO [6] : 82 -> Negative [.001]: 1102 [.01] : BI-RADS CATEGORY 2 [2] : Benign [3] : N -> NO [4] : n -> NO [6] : 84 -> Benign [.001]: 1103 [.01] : BI-RADS CATEGORY 3 [2] : Probably Benign [3] : Y -> YES [4] : y -> YES [6] : 86 -> Probably Benign [.001]: 1104 [.01] : BI-RADS CATEGORY 4 [2] : Suspicious [3] : Y -> YES [4] : y -> YES [6] : 88 -> Suspicious [.001]: 1105 [.01] : BI-RADS CATEGORY 5 [2] : Highly Suggestive of Malignancy [3] : Y -> YES [4] : y -> YES [6] : 90 -> Highly Suggestive of Malignancy [.001]: 1106 [.01] : BI-RADS CATEGORY 6 [2] : Known Biopsy Proven Malignancy [3] : Y -> YES [4] : y -> YES [6] : 92 -> Known Biopsy Proven Malignancy [.001]: 1200 [.01] : ABDOMINAL AORTIC ANEURYSM NOT PRESENT [2] : The maximum width of the infrarenal aorta is less than three centimeters. [3] : N -> NO [4] : n -> NO [.001]: 1201 [.01] : ABDOMINAL AORTIC ANEURYSM PRESENT [2] : The maximum width of the infrarenal aorta is greater than three centimeters. [3] : Y -> YES [4] : y -> YES [.001]: 1202 [.01] : DOES NOT SATISFY SCREEN FOR AAA [2] : Exam is not technically adequate for AAA screening. [3] : N -> NO [4] : n -> NO If your site already has data in the range 1100-1106 and/or 1200-1202, then the post installation will not add any of the ten records to the DIAGNOSTIC CODES file #78.3. Instead, it will send a mail message to the patch installer and an Outlook message to the "VA OIT VHIT Radiology Facility Level Application Issues" mail group to notify them that your facility has a conflict with one or more internal entry numbers (IENS) in file #78.3. If there is no conflict with the IENs, then the post installation will reset the third piece of ^RA(78.3,0) to the highest IEN under 999 and also display the following message: *** 10 of 10 BI-RADS and Abdominal Aortic Aneurysm codes have been successfully added to the DIAGNOSTIC CODES file #78.3. *** 3. The description of the diagnostic code from the 'Diagnostic Code List' [RA DIAGP] option is taken from the Description field of the DIAGNOSTIC CODES file (#78.3). But the MQSA coding system's text of BI-RADS from the following options and features is taken from the EXPRESSIONS file (#757.01) of the Lexicon application: Display a Rad/Nuc Med Report [RA RPTDISP] Draft Report (Reprint) [RA REPRINT] Select Report to Print by Patient [RA RPTPAT] CPRS Report tab Email message of a verified report sent to the requester The description and the MQSA coding system's text from the options will remain identical as long as there are no local changes made to the Description field in the DIAGNOSTIC CODES file (#78.3) or national changes made to the Displayable Text field in the EXPRESSIONS file (#757.01). MULTI-PACKAGE DISTRIBUTION ROUTINE SUMMARY: ========================================== LEX*2.0*55 ========== The second line of each of these routines will look like: ;;2.0;LEXICON UTILITY;**[PATCH LIST]**;Sep 23, 1996 The following checksums were created using CHECK1^XTSUMBLD Checksums Checksums Routine Before Patch After Patch Patch List (2nd Line) -------- ------------- ----------- --------------------- LEX2055P 22882820 55 LEX2055A 55248924 55 LEX2055B 66701747 55 LEX2055C 53113878 55 LEX2055D 68192938 55 LEX2055E 68482263 55 LEX2055F 71730942 55 LEX2055G 75516224 55 LEX2055H 72557384 55 LEX2055I 125880515 55 LEXA 31301237 42625550 3,4,6,19,25,36,38,43,55 LEXA1 30130787 28014387 3,4,6,11,15,38,55 LEXAL 25956299 37971689 6,55 LEXAR 18400371 17442980 3,19,25,55 LEXAR4 9380127 9905737 4,5,6,25,55 LEXAR5 25100906 25098898 14,25,26,38,55 LEXTOLKN 11678633 16578878 4,55 RA*5.0*97 ========== The second line of each of these routines will look like: ;;5.0;Radiology/Nuclear Medicine;**[PATCH LIST]**;Mar 16, 1998 The following checksums were created using CHECK1^XTSUMBLD Checksums Checksums Routine Before Patch After Patch Patch List (2nd Line) -------- ------------ ----------- --------------------- RA97PST 30429917 97 RA97PST1 11847551 97 RABIRAD 7783867 97 RABWORD1 20761340 21044448 41,57,70,97 RADLQ1 28026450 28970876 15,97 RAEDCN 57573116 69681618 5,13,10,18,28,31,34,45,85,97 RAO7PC2 45083529 47517488 1,11,14,16,22,27,45,75,56,95,97 RAPRINT 22198588 31817816 97 RAPRINT1 25798821 27115956 34,97 RART 23124716 24437904 2,5,15,18,43,82,56,97 RARTE5 93390991 100088941 56,95,97 RARTE7 23668703 23848565 56,95,97 RARTR1 46270637 53930536 8,18,56,97 Routine Information: ==================== Routine Name: LEX2055A Routine Name: LEX2055B Routine Name: LEX2055C Routine Name: LEX2055D Routine Name: LEX2055E Routine Name: LEX2055F Routine Name: LEX2055G Routine Name: LEX2055H Routine Name: LEX2055I Routine Name: LEX2055P Routine Name: LEXA Routine Name: LEXA1 Routine Name: LEXAL Routine Name: LEXAR Routine Name: LEXAR4 Routine Name: LEXAR5 Routine Name: LEXTOLKN ============================================================================= User Information: Entered By : ROWE,KIMBALL Date Entered : JAN 26, 2008 Completed By: BASKETT,BARBARA J Date Completed: SEP 02, 2009 Released By : SCHWARTZ,VIKIE Date Released : SEP 02, 2009 ============================================================================= Packman Mail Message: =====================