============================================================================= Run Date: AUG 20, 2008 Designation: LR*5.2*365 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #297 Status: Released Compliance Date: OCT 06, 2008 ============================================================================= Associated patches: (v)LR*5.2*311 <<= must be installed BEFORE `LR*5.2*365' (v)OR*3*210 <<= must be installed BEFORE `LR*5.2*365' (v)LR*5.2*317 <<= must be installed BEFORE `LR*5.2*365' (v)LR*5.2*324 <<= must be installed BEFORE `LR*5.2*365' (v)LR*5.2*369 <<= must be installed BEFORE `LR*5.2*365' Subject: AP ALERTS AND CPRS REPORT CHANGES Category: - Routine - Enhancement (Mandatory) - Other - Informational Description: ============ This patch is being released in conjunction with CPRS GUI v27. CPRS GUI version 27 consists of two host files: OR_PSJ_PSO_27.KID and CPRS_BUNDLE_GUI_27_REQ_REL.KID. These two host files contain software patches that support CPRS GUI v27 functionality. The host files were created to simplify installation at Veterans Health Administration (VHA) facilities. Please refer to the "CPRS GUI v.27 and Associated Patches Installation Guide" for installation sequence information. This document is exported as OR_30_243IG.doc and OR_30_243IG.pdf and is included in OR_30_243.ZIP. Installation and set-up information specific to LR*5.2*365 is included in this patch description. OR_PSJ_PSO_27.KID includes the CPRS and Pharmacy patches required for CPRS GUI v27. It includes builds for the following patches: OR*3*243 PSJ*5*134 PSO*7*225 CPRS_BUNDLE_GUI_27_REQ_REL.KID includes the related and required patches needed to support CPRS GUI v27 functionality. It includes builds for the following patches: GMRA*4*38 GMPL*2*35 GMTS*2.7*80 LR*5.2*365 TIU*1*219 WV*1*23 Installation of the two CPRS host files should be coordinated among the packages affected since these host files will install the majority of the software needed to implement CPRS GUI v27. Blood Bank Clearance: ===================== EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*365 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*365 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LR*5.2*365 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. =========================== VistA Laboratory Anatomic Pathology (AP) Alerts and Computerized Patient Record System (CPRS) Report Changes Patch LR*5.2*365 software release addresses 7 Patient Safety Issues (PSIs). Individual reports are displayed as one continuous scrolling display. A single row of the equal (=) sign is used to separate one report from the next. Additionally, the text "Next SURGICAL PATHOLOGY Specimen..." is also used to separate reports. However, with multiple reports and the use of single dashed lines in each report, it can be difficult to distinguish the separation between AP reports. A new API has been created (EN^LR7OSAP4) for retrieving a detailed report for an individual Anatomic Pathology Specimen. This helps resolve the PSI by allowing a package interface, like CPRS, to present each accession and related specimens to the user and then display the related report for the accession/specimens. Patches OR*3*210 and LR*5.2*311 implemented informational alerts generated for AP pathology results. Recipients of VA view alerts for Anatomic Pathology complained that clicking on the alert did not open up or display the report to them in the same manner as other lab alerts are displayed. Once the recipients click on the alert, it is gone from view. If they did not make a note as to who the patient was, they can not get the alert back. Providers can easily erase the alerts without recording the patient's name. A potential malignancy report could be missed. Problem was identified from complaints of surgeons and oncologists/hematologists. To correct this issue the new action alert is provided to display AP reports. The Anatomic Pathology informational alerts are now modified into action alerts that upon processing will direct the user to the associated report in the Clinical Reports section under the Reports tab of the CPRS GUI or to a List manager display of the associated report results. This patch provides action alerts for Anatomic Pathology tests including Electron Microscopy (EM), Surgical Pathology (SP), Cytology (CY), and Autopsy (AU) results. These action alerts are sent automatically to the Ordering Provider, Primary Physician, or Primary Care Provider at the time the report is released. If requested, alerts may be sent to additional person(s) and mail group(s). These additional alerts are also action alerts. This functionality is now the same whether electronic signature (ES) is turned ON or OFF. Before this patch, additional alerts could not be requested with electronic signature (ES) turned OFF. This patch provides the new Send an AP Alert [LRAP ALERT] option that is available on the Verify/release menu, anat path [LRAPVR] which allows a pathologist to send an action alert to a provider, other individuals, or mail group(s) after the report has been released. Before this software release if the user did not answer YES to the prompt to send an alert after a report was released, an alert could not be sent unless the AP report was reopened and re-released. 1) PSI-05-027 and PSI-07-135 identified a patient safety issue using the CPRS Graphic User Interface (GUI) Lab Tab, Laboratory Results- Anatomic Pathology (AP). The individual reports are displayed as one continuous scrolling display. A single row of equal (=) signs is used to separate one report from the next. Additionally, the text- "Next SURGICAL PATHOLOGY Specimen..." is also used to separate reports. However, with multiple reports and the use of single dashed lines in each report, it can be difficult to distinguish the separation between AP reports. Resolution: A new API has been created (EN^LR7OSAP4) for retrieving a detailed report for an individual Anatomic Pathology Specimen. This resolves the PSI by allowing a package interface, like CPRS, to present each specimen to the user and then get the report on the specimen. 2) PSI-06-068, PSI-07-014, PSI-05-001, PSI-06-134, and PSI-07-031 identified a patient safety issue with the Anatomic Pathology notification alerts. Patches OR*3*210 and LR*5.2*311 implemented informational alerts generated for pathology results. Recipients of VA view alerts for Anatomic Pathology have complained that clicking on the alert does not open up or display the report to them in the same manner as other lab alerts do (CH subscripted). Once they click on the alert, it's gone from view. If they didn't make a note as to who the patient was, they can't get it back. It would be helpful to have an action alert for these results. Providers can easily erase them without recording the patient's name. A potential malignancy report could be missed. Problem was identified from complaints of surgeons and oncologists/hematologists. Resolution: The Anatomic Pathology informational alerts are now modified into action alerts that upon processing will direct the user to the associated report in the Clinical Reports section under the Reports tab of the CPRS GUI or to a List manager display of the associated report results. This patch provides action alerts for Anatomic Pathology reports including Electron Microscopy (EM), Surgical Pathology (SP), Cytology (CY), and Autopsy (AU) reports. These action alerts are sent automatically to the ordering provider and the primary care physician (PCP) at the time the report is released. If requested, alerts may be sent to additional person(s). These additional alerts are also action alerts. This functionality is now the same whether electronic signature (ES) is turned ON or OFF. Before this patch, additional alerts could not be requested with electronic signature (ES) turned OFF. The Supplementary report release, anat path [LRAPRS] option now sends action alerts automatically to the ordering provider and the PCP at the time the supplementary report is released. If requested, alerts may be sent to additional person(s). These additional alerts are also action alerts. These alerts are sent whether electronic signature is turned ON or OFF. Modified options: ================ NAME: LRAPR MENU TEXT: Verify/release reports, anat path TYPE: run routine LOCK: LRVERIFY DESCRIPTION: This option is used to verify/release pathology reports. The user is prompted for the accession number of the report to be released. If electronic signature is not activated, the user is asked if the report is to be released, yes or no. If electronic signature has been activated, the option is used to electronically sign and store pathology reports. It also allows CPT coding to be performed regardless of the release status of the chosen report. Another feature is the ability to print SNOMED codes for the given accession/report. Action alerts are sent automatically to the ordering provider and the primary physician or PCP at the time the report is released. If requested, alerts may be sent to additional person(s) and/or mail group(s). These additional alerts are also action alerts. ROUTINE: LRAPR NAME: LRAPRS MENU TEXT: Supplementary report release, anat path TYPE: run routine DESCRIPTION: Releases supplementary reports for Surgical Pathology, Cytopathology, Electron Microscopy, or Autopsy. If all supplementary reports that exist for the chosen accession have already been released or if no supplementary reports exist for the accession, the user will be notified. If electronic signature is not activated, the user is asked if the report is to be released, yes or no. If electronic signature has been activated, the option is used to sign and store the supplementary report. Action alerts are sent automatically to the ordering provider and the primary physician or PCP at the time the supplementary reports are released. If requested, alerts may be sent to additional person(s) and/or mail group(s). These additional alerts are also action alerts. These alerts are sent whether electronic signature is on or off. ROUTINE: EN^LRAPR 3) This patch provides a new option, Send an AP Alert [LRAP ALERT] available on the Verify/release menu, anat path [LRAPVR] menu which allows a pathologist to send an action alert to a provider or other person(s) or mail group(s) after the case has been released. The use of this option requires the LRVERIFY key. Before, if they did not answer YES to the prompt to send an alert after a report was released, an alert could not be sent unless the case was reopened and re-released. New Option: =========== NAME: LRAP ALERT MENU TEXT: Send an AP Alert TYPE: run routine LOCK: LRVERIFY DESCRIPTION: This option allows a pathologist to send an action alert to a provider or other person(s) or mail group(s) after the case has been released. ROUTINE: LRAPALRT The following option was modified to include the new option, Send an AP Alert [LRAP ALERT] on the Verify/release menu, anat path [LRAPVR] menu. Modified Option: ================ NAME: LRAPVR MENU TEXT: Verify/release menu, anat path TYPE: menu DESCRIPTION: Anatomic pathology verify and release option menu. ITEM: LRAPR SYNONYM: RR DISPLAY ORDER: 1 ITEM: LRAPV SYNONYM: LU DISPLAY ORDER: 3 ITEM: LRAPRS SYNONYM: RS DISPLAY ORDER: 2 ITEM: LRCAPES SYNONYM: CPT DISPLAY ORDER: 4 ITEM: LRAP ALERT SYNONYM: SA Associated E3R: =============== 19879 18132 19040 19516 19106 Associated Remedy: ================== HD0000000087038 HD0000000145148 HD0000000175194 HD0000000071165 HD0000000175887 Duplicate Remedy: ================= HD0000000200282 HD0000000161040 HD0000000117241 HD0000000131803 HD0000000159885 Associated PSI: =============== PSI-05-027 PSI-07-135 PSI-05-001 PSI-06-134 PSI-06-068 PSI-07-031 PSI-07-014 Test Sites: =========== Charleston, SC - Large Cleveland, OH - Large Heartland-East HCS - Large/Integrated Hudson Valley HCS - Medium/Integrated Loma Linda, CA - Large Northern California HCS - Large Palo Alto HCS - Large/Integrated Philadelphia, PA - Large San Diego, CA - Large Tampa, FL - Large Software Retrieval ================== VistA Laboratory AP Alerts and CPRS Report Changes Patch LR*5.2*365 software is exported as part of CPRS_BUNDLE_GUI_27_REQ_REL.KID : File Name Contents Retrieval Format --------- -------- ---------------- CPRS_BUNDLE_GUI_27_REQ_REL.KID KIDS Build ASCII CPRS_BUNDLE_GUI_27_REQ_REL.KID may be obtained via FTP. The preferred method is to FTP the files from: download.vista.med.va.gov This transmits the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: CIO FIELD OFFICE FTP ADDRESS DIRECTORY ---------------- ------------------------- -------------------- Albany ftp.fo-albany.med.va.gov [anonymous.software] Hines ftp.fo-hines.med.va.gov [anonymous.software] Salt Lake City ftp.fo-slc.med.va.gov [anonymous.software] Documentation Retrieval ======================= VistA AP Alerts and CPRS Report Changes Patch LR*5.2*365 User Guide is available at the following Office of Information Field Offices (OIFOs) ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- ALBANY ftp.fo-albany.med.va.gov [ANONYMOUS.SOFTWARE] HINES ftp.fo-hines.med.va.gov [ANONYMOUS.SOFTWARE] SALT LAKE CITY ftp.fo-slc.med.va.gov [ANONYMOUS.SOFTWARE] Documentation Retrieval Formats =============================== VistA AP Alerts and CPRS Report Changes Patch LR*5.2*365 User Guide files are exported in the following retrieval formats: File Name Contents Retrieval Formats --------- -------- ----------------- LAB_LR_52_365_UG.doc AP Alerts and CPRS Report Changes Patch LR*5.2*365 User Guide BINARY LAB_LR_52_365_UG.pdf AP Alerts and CPRS Report Changes Patch LR*5.2*365 User Guide BINARY VistA Website Locations: ======================== VistA AP Alerts and CPRS Report Changes Patch LR*5.2*365 User Guide is accessible in MS Word (.doc) and Portable Document Format (.pdf) at the following VistA locations: Laboratory Version 5.2 Home Page -------------------------------- http://vista.med.va.gov/ClinicalSpecialties/lab/ VistA Documentation Library (VDL) --------------------------------- www.va.gov/vdl/ Installation Instructions: ========================== This patch may be installed with users on the system; however, it should be installed at a non-peak time to minimize disruption to the users. Installation of this patch should take less than 1 minute. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan Menu. 2. From the Kernel Installation and Distribution System (KIDS) Menu, select the Installation menu. 3. From the Installation menu, you may select to use the following options (when prompted for INSTALL NAME, enter LR*5.2*365): a. Backup a Transport Global b. Compare Transport Global to Current System c. Print Transport Global d. Verify Checksums in Transport Global 4. Use the Install Package(s) option and select the package LR*5.2*365. 5. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//', respond YES. Responding "Yes" to this prompt can significantly increase install time. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', respond NO. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond NO. Note: Routine LR365 will be deleted after successful patch installation Routine Information: ==================== The second line of each of these routines now looks like: ;;5.2;LAB SERVICE;**[Patch List]**;Sep 27, 1994;Build 9 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LR365 Before: n/a After: B3322693 **365** Routine Name: LR7OSAP2 Before: B59162352 After: B59966352 **230,256,259,317,365** Routine Name: LR7OSAP4 Before: n/a After: B2801060 **365** Routine Name: LRAPALRT Before: n/a After: B3310137 **365** Routine Name: LRAPDA Before: B76606340 After: B81540087 **72,73,91,121,248,259,295,317,365** Routine Name: LRAPR Before: B84430863 After: B88035016 **72,248,259,317,365** Routine Name: LRAPRES1 Before: B43595923 After: B43214564 **259,336,369,365** Routine Name: LRWOMEN Before: B1458269 After: B1173687 **231,248,311,324,365** Routine list of preceding patches: 317, 324, 369 ============================================================================= User Information: Entered By : ANZALDUA,CAROL Date Entered : AUG 29, 2006 Completed By: ELIJAH,VICKEY Date Completed: AUG 07, 2008 Released By : GAWRONSKI,ROXANNE Date Released : AUG 20, 2008 ============================================================================= Packman Mail Message: =====================