$TXT Created by UNDERHILL,GARDNER at DAYT17.FO-BAYPINES.MED.VA.GOV (KIDS) on Wednesday, 11/28/07 at 18:01 ============================================================================= Run Date: JAN 28, 2008 Designation: LR*5.2*377 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #293 Status: Released Compliance Date: FEB 28, 2008 ============================================================================= Associated patches: (v)LR*5.2*289 <<= must be installed BEFORE `LR*5.2*377' Subject: NEW CONSTANT VALUE FOR EGFR FORMULA Category: - Routine - Informational Description: ============ EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*377 does not contain any changes to the VISTA BLOOD BANK Software as defined by VHA DIRECTIVE 2004-053 titled VISTA BLOOD BANK SOFTWARE VERSION 5.2. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*377 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LR*5.2*377 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. ************************************************************************** This patch is a follow-up to patch LR*5.2*289 which was released on 7/23/2003 and introduced the estimated Glomerular Filtration Rate (eGFR) Delta Check. This patch will add a new Delta Check containing an updated formula used to calculate the eGFR with a constant of 175 instead of 186 in the previous formula. ASSOCIATED REMEDY TICKET(S): ============================ HD145899 - Concern about the eGFR delta check Duplicates: ----------- HD152150 - LR*5.2*289 Edit eGFR formula HD217266 - DAY - eGFR HD218640 - Need to make eGFR change in calculation because of Creatinine standardization. HD221531 - status of LR*372 for EGFR changes HD222321 - wrong calculation for eGFR PARTICIPATING TEST SITES: ========================= Bay Pines VAMC Dayton VAMC New Jersey HCS Hudson Valley HCS REMEDY OVERVIEW: ================ Problem: -------- Some site are starting to use a new methodology for the formula used to calculate the eGFR when using the new ultra sensitive Creatinine. Solution: --------- A new routine (LREGFR2) will be used for this purpose to calculate the eGFR with the new constant of 175. The old routine (LREGFR) will still be available to those sites still using the old methodology (constant of 186). A new Delta Check will need to be created (or an existing one edited) to call the new routine. See Post-Installation Instructions for more information. The Creatinine record in the LABORATORY TEST file (file #60) will need to be edited to use this new Delta Check. Sites will need to change TYPE OF DELTA CHECK (field # 7) in the multivalued field SITE/SPECIMEN (field #100). Keep in mind that any existing delta checks for eGFR will not be deleted or altered by the installation of LR*5.2*377. See Post-Installation Instructions for more information. INSTALLATION INSTRUCTIONS: ========================== This patch can be loaded with users in the system. Installation time will be less than two minutes. 1. Choose the PackMan message containing this patch and invoke the INTALL/CHECK MESSAGE Packman option. 2. Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: Installation 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution 3. From this menu, it is highly recommended that you use the following options (When prompted for the INSTALL NAME, enter LR*5.2*377): a. Verify Checksums in Transport Global - This option will verify the checksums of routines included in this patch. b. Print Transport Global - This option will print out a list of all the components exported in this patch. 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, DD's, templates, etc.). d. Backup a Transport Global - This option will back up the current versions of the routines in this patch before it is installed. 4. Use the Install Package(s) option and select the package LR*5.2*377. a. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//", answer NO. b. When prompted "Want to DISABLE Scheduled Options and Menu Options and Protocols? YES//", answer NO. POST-INSTALLATION INSTRUCTIONS: =============================== If/when the sites want to use the new eGFR methodology (LREGFR2), they will need to create a new delta check (or edit an existing one) and edit the Creatinine record in the LABORARTORY TEST file (file #60). Sites will need to update TYPE OF DELTA CHECK (field #7) in the multivalued field SITE/SPECIMEN (field #100) to point to the new (or newly edited) Delta Check. **NOTE: Sites which use mutilple versions of the eGFR Delta Check will need to create new (or edit existing) versions for each eGFR Delta Check. Example of the new delta check: ------------------------------- NAME: EGFR2 XECUTABLE CODE: D STRT^LREGFR2(DFN,X) DESCRIPTION: Created to support the new methodology for calculating the eGFR in patch LR*5.2*377. This is an update patch for LR*5.2*289. TEST NAME FOR INPUT VALUE 1: CREATININE TEST NAME FOR OUTPUT VALUE 1: EGFR Example of the session to create the new delta check: ----------------------------------------------------- VA FileMan 22.0 Select OPTION: ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE: DELTA CHECKS// EDIT WHICH FIELD: ALL// .01 NAME THEN EDIT FIELD: 10 XECUTABLE CODE THEN EDIT FIELD: 60.1 TEST NAME FOR INPUT VALUE 1 THEN EDIT FIELD: 61.1 TEST NAME FOR OUTPUT VALUE 1 THEN EDIT FIELD: Select DELTA CHECKS NAME: EGFR2 Are you adding 'EGFR2' as a new DELTA CHECKS (the 45TH)? No// Y (Yes) XECUTABLE CODE: D STRT^LREGFR2(DFN,X) TEST NAME FOR INPUT VALUE 1: CREATININE 1 CREATININE 2 CREATININE CLEARANCE 3 CREATININE(INCLUDES EGFR) CHOOSE 1-3: 1 CREATININE TEST NAME FOR OUTPUT VALUE 1: EGFR Example of the session to edit the Creatinine record: ----------------------------------------------------- VA FileMan 22.0 Select OPTION: ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE: LABORATORY TEST// (1912 entries) EDIT WHICH FIELD: ALL// SITE/SPECIMEN (multiple) EDIT WHICH SITE/SPECIMEN SUB-FIELD: ALL// TYPE OF DELTA CHECK THEN EDIT SITE/SPECIMEN SUB-FIELD: THEN EDIT FIELD: Select LABORATORY TEST NAME: CREATININE 1 CREATININE 2 CREATININE CLEARANCE 3 CREATININE(INCLUDES EGFR) CHOOSE 1-3: 1 CREATININE Select SITE/SPECIMEN: SERUM 0X500 ...OK? Yes// (Yes) TYPE OF DELTA CHECK: EGFR// EGFR2 Routine Information: ==================== The second line of each of these routines now looks like: ;;5.2;LAB SERVICES;**[Patch List]**;Sep 27, 1994;Build 4 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LREGFR2 Before: n/a After: B12034100 **377** ============================================================================= User Information: Entered By : UNDERHILL,GARDNER D Date Entered : NOV 14, 2007 Completed By: WERNER,GARY Date Completed: JAN 28, 2008 Released By : MURCH,CLAUDETTE Date Released : JAN 28, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT