$TXT Created by at MNTVBB.DOMAIN.EXT (KIDS) on Monday, 12/10/18 at 16:10 ============================================================================= Run Date: FEB 13, 2019 Designation: LR*5.2*504 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #417 Status: Released Compliance Date: MAR 16, 2019 ============================================================================= Subject: MISSING ANATOMIC PATHOLOGY ALERTS Category: - Routine - Other Description: ============ This patch addresses one (1) VistA Laboratory Anatomic Pathology issue: Alerts might not be generated after Anatomic Pathology cases are verified. Patch Components: ================= Options Associated: Option Name Type New/Modified/Deleted ----------- ----------- -------------------- Missing AP Alert Search run routine New LRAPSUPER menu Modified Parameter Definition Associated: Parameter Definition Name New/Modified/Deleted ------------------------- -------------------- LR AP ALERT SEARCH END New New Service Requests (NSRs): =========================== N/A Patient Safety Issues (PSIs): ============================ PSPO 3681 Blood Bank Review: ================== EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*504 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 LR*5.2*504 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LR*5.2*504 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. Participating Test Sites: ======================== WHITE RIVER JUNCTION VA (VERMONT) ST.CLOUD VA FARGO VA Defect Tracking System Ticket(s) & Overview: =========================================== R18600337FY18: Missing Anatomic Pathology Alerts R19264009FY18 (d) Problem: ------- Alerts might not be generated after Anatomic Pathology cases are verified. Several sites are finding that alerts are not generating after some cases are verified. The issue is not reproducible except by forcing a session disconnect after electronically signing a case but before specifying whether additional alerts should be sent. It is unknown whether this is the scenario causing missing alerts at sites. Resolution: ---------- The root cause of this issue is not yet known. In the meantime, this patch provides a routine and option which will search for missing Anatomic Pathology alerts as well as other issues known to occur along with missing alerts such as fields in the ORDERS (#100) file which are set incorrectly. After the routine executes, alert(s) and a MailMan message are sent to the"LMI" mail group as well as the user who manually invoked the option "Missing AP Alert Search". Recipients of the alerts and MailMan messages will then determine whether to manually generate an alert for the cases using the already existing option "Send an AP Alert" which is under the menu "Verify/release menu, anat path". The option included in this patch, "Missing AP Alert Search", is placed under the "Supervisor, anat path" menu. The option may be invoked manually and/or defined to be executed automatically by TaskMan. Various information gathered about issues found is sent in alerts and MailMan messages as well as stored in an ^XTMP("LR AP ALERT TRACE... global. The information in the ^XTMP subscript will automatically purge after 90 days. The information is kept for a period of time in the event that future research will need to be performed on the Anatomic Pathology cases. NOTE: It is strongly recommended this option be scheduled to run daily. See the Post-Installation Instructions. If the option is executed by TaskMan, alert(s) and a MailMan message are sent to the user who defined the option in TaskMan as well as members of the "LMI" MailMan group. Routine: LRAPUALT ^XTMP Example (top level only): ------------------------------ ^XTMP("LR AP ALERT TRACE 3181207.1434",0) = purge date, etc. The search option may be executed manually and/or through TaskMan. Sites can determine how often the search routine should run. Manual Execution: ---------------- The option included in this patch, "Missing AP Alert Search", is placed under the "Supervisor, anat path" menu. The option will ask the user which starting and end date should be searched. The date range pertains to the date that Anatomic Pathology cases are verified. After the routine executes, alert(s) and a MailMan message are sent to members of the "LMI" mail group as well as the user who manually invoked the option "Missing AP Alert Search". Recipients of the alerts and MailMan messages will then determine whether to manually generate an alert for the cases using the already existing option "Send an AP Alert" which is under the menu "Verify/release menu, anat path". If no issues are found, an alert and MailMan message are generated indicating "No issues found". TaskMan Execution: ----------------- If the option is executed by TaskMan, alert(s) and a MailMan message are sent ONLY to members of the "LMI" MailMan group and ONLY if issues are found. Only "new" verified Anatomic Pathology cases with missing alerts and/or related issues will be included in the MailMan messages each time the option is invoked. This enables the recipients to quickly ascertain which cases need attention. The ending date/time when the search option last finished is stored in the parameter "LR AP ALERT SEARCH END". Manually invoking option "Missing AP Alert Search" will not affect the parameter setting. The parameter is only referred to and set by TaskMan execution. MailMan Message Example - Issues Found: -------------------------------------- Subj: Anatomic Pathology Alert Search Issues Found [#277918] 12/07/18@14:34 65 lines From: Anatomic Pathology Missing Alert Search In 'IN' basket. Page 1 -------------------------------------------------------------------------- Anatomic Pathology Alert Search Issues Found Date/Time Range Searched: Dec 06, 2018@14:30 to: Dec 07, 2018@14:30 SP 18 15: - is missing package reference for order 5598085. - has incorrect status of 6 for order 5598085. - has no results date/time for order 5598085. - *** did not generate an alert. *** MailMan Message Example - No Issues Found: ----------------------------------------- Note: TaskMan executions run for a specified date/time range. Manual executions run for a date range. Subj: No Anatomic Pathology Alert Search Issues Found [#277926] 12/07/18@18:02 4 lines From: Anatomic Pathology Missing Alert Search In 'IN' basket. Page 1 *New* -------------------------------------------------------------------------- No missing Anatomic Pathology alert issues found on Dec 07, 2018@18:02. Date Range Searched: Dec 01, 2018 to: Dec 07, 2018 Documentation Update -------------------- The Laboratory Anatomic Pathology (AP) Version 5.2 User Guide has been updated in the section titled "Supervisor, Anat Path [LRAPSUPER]". The manual is located in the VA Document Library (VDL) at: https://www.domain.ext/vdl/application.asp?appid=72 ==================== Installation Instructions ==================== This patch may be loaded with users on the system. You may wish to Install it during non-peak hours. Installation will take less than 1 minute. NOTE: Kernel patches must be current on the target system to avoid problems loading and/or installing this patch. 1. Use the 'INSTALL/CHECK MESSAGE' option of the PackMan menu. This option will load the KIDS patch onto your system. 2. The patch has now been loaded into a Transport global on your system. You now need to use KIDS to install the transport global. 3. On the 'Kernel Installation & Distribution System' Menu (KIDS), select the 'Installation' menu. 4. Use the 'Verify Checksum in Transport Global' option and verify that all routines have the correct checksums. 5. On the KIDS menu, under the 'Installation' menu, use the following options: Print Transport Global Compare Transport Global to Current System Backup a Transport Global If you wish to preserve a copy of the routines exported in this patch prior to installation, you should use the 'Backup a Transport Global' option at this time. You may also compare the routines in your production account to the routines in the patch by using the 'Compare a Transport Global to Current System' option. NOTE: Since the routine in this patch is new, there should be no routines to back up. However, it's a good idea to back up anyway in case a routine with the same name unexpectedly happens to reside on the system. 6. Use the 'Install Package(s)' option under the 'Installation' menu and select the package 'LR*5.2*504'. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', choose 'NO'. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', choose 'NO'. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', choose 'NO'. Installation Verification ========================= 1. Compare the checksum of the routine LRAPUALT to the "After" checksum listed in the patch description. 2. Verify that the option "Missing AP Alert Search" is available under the LRAPSUPER menu: AL Missing AP Alert Search 3. Perform a FileMan Inquiry on the PARAMETER DEFINITION (#8989.51) file for "LR AP ALERT SEARCH END": VA FileMan 22.2 Select OPTION: 5 INQUIRE TO FILE ENTRIES Output from what File: PARAMETER DEFINITION// (1001 entries) Select PARAMETER DEFINITION NAME: LR AP ALERT SEARCH END LR AP Alert Search End Date/Time Another one: Standard Captioned Output? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// BOTH Computed Fields and Record Number (IEN) NUMBER: 933 NAME: LR AP ALERT SEARCH END DISPLAY TEXT: LR AP Alert Search End Date/Time MULTIPLE VALUED: No INSTANCE TERM: LR AP Alert Search End Date/Time VALUE TERM: LR AP Alert Search End Date/Time PROHIBIT EDITING: No VALUE DATA TYPE: date/time VALUE DOMAIN: ::T VALUE HELP: This value equals the last time that TaskMan ran option Missing AP Alert Search. INSTANCE DATA TYPE: date/time INSTANCE DOMAIN: ::T DESCRIPTION: This parameter only applies to a search initiated by Taskman when the option "Missing AP Alert Search" is defined to run automatically in TaskMan. Users may manually run the search using the option "Missing AP Alert Search" without affecting the date/time set in this parameter. The value for this parameter equals the last date/time that was searched in order to find verified Anatomic Pathology cases which did not have an alert generated. Some sites are finding that alerts do not generate at times. The issue cannot be reproduced at will. A suspected cause is that a session is disconnected after verification but before the alert is queued. PRECEDENCE: 1 ENTITY FILE: SYSTEM Post-Installation Instructions: ------------------------------- 1. Verify there is at least one member in the mail group LMI. It is recommended that the LIM and at least one other person be a member of this group. 2. Use the option Schedule/Unschedule Options (XUTM SCHEDULE) to schedule the option Missing AP Alert Search (LRAPALERT) to run DAILY. Back-out Procedures =================== Option: ------ The option "Missing AP Alert Search" can be removed from the LRAPSUPER menu through FileMan. 1. Make sure the option has not been scheduled in TaskMan. If it has, delete the TaskMan entry following established protocols for your site. 2. Delete the option as an item under the LRAPSUPER menu: VA FileMan 22.2 Select OPTION: 1 ENTER OR EDIT FILE ENTRIES Input to what File: OPTION// (13653 entries) EDIT WHICH FIELD: ALL// MENU 1 MENU (multiple) 2 MENU TEXT CHOOSE 1-2: 1 MENU (multiple) EDIT WHICH MENU SUB-FIELD: ALL// ITEM THEN EDIT MENU SUB-FIELD: THEN EDIT FIELD: Select OPTION NAME: LRAPSUPER Supervisor, anat path Select ITEM: LRAPALERT// @ SURE YOU WANT TO DELETE THE ENTIRE ITEM? Y (Yes) Select ITEM: LRAP ESIG SWITCH// ^ 3. Delete the option: VA FileMan 22.2 Select OPTION: 1 ENTER OR EDIT FILE ENTRIES Input to what File: OPTION// (13653 entries) EDIT WHICH FIELD: ALL// Select OPTION NAME: LRAPALERT Missing AP Alert Search NAME: LRAPALERT// @ SURE YOU WANT TO DELETE THE ENTIRE 'LRAPALERT' OPTION? Y (Yes) SINCE THE DELETED ENTRY MAY HAVE BEEN 'POINTED TO' BY ENTRIES IN THE 'AUDIT' FILE, ETC., DO YOU WANT THOSE POINTERS UPDATED (WHICH COULD TAKE QUITE A WHILE)? No// (No) Routine: ------- The routine LRAPUALT may be deleted using the Delete Routines option under the Programmer Options menu: Select Routine Tools Option: DELETE Routines ROUTINE DELETE All Routines? No => No Routine: LRAPUALT Routine: 1 routine 1 routines to DELETE, OK: NO// YES Use this option cautiously so as to not accidentally delete a routine which is needed due to a typo when specifying the routine. It does not cause harm to keep the routine on the system since the option has been deleted. Parameter Definition: -------------------- Deleting the PARAMETER DEFINITION (#8989.51) file entry of "LR AP ALERT SEARCH END" is not recommended. Cross-references may exist in other VistA files, and the downstream effects of possible remaining cross references are unknown. There is no harm in allowing the PARAMETER DEFINITION (#8989.51) file entry of "LR AP ALERT SEARCH END" to remain on the system. Instead, the FileMan description field could be edited to state that the parameter definition is not used. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.2;LAB SERVICE;**[Patch List]**;Sep 27, 1994;Build 33 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LRAPUALT Before: n/a After:B158177199 **504** ============================================================================= User Information: Entered By : Date Entered : APR 17, 2018 Completed By: Date Completed: FEB 12, 2019 Released By : Date Released : FEB 13, 2019 ============================================================================= Packman Mail Message: ===================== $END TXT