============================================================================= Run Date: JAN 26, 2018 Designation: MAG*3*183 Package : MAG - IMAGING Priority: Mandatory Version : 3 SEQ #146 Status: Released Compliance Date: FEB 26, 2018 ============================================================================= Associated patches: (v)MAG*3*166 <<= must be installed BEFORE `MAG*3*183' Subject: ADT MESSAGING FOR PACS Category: - Routine - Other - Data Dictionary Description: ============ The VA has a variety of commercial departmental imaging systems: Picture Archiving and Communication System (PACS) in Radiology and Cardiology, imaging systems in clinical specialties like Eye Care, Endoscopy, and Dentistry, and Digital Pathology System (DPS) in Anatomic Pathology. All of these systems are interfaced to VistA Imaging to receive study order information via HL7 messages and to send DICOM images back to VistA for long term storage. In order to operate properly, it is crucial that the departmental imaging systems keep patient demographics (name, birthdate, patient identifier, gender, etc.) in sync with the local VistA database. If a name change occurs on VistA and is not communicated to the departmental imaging system, then order processing is delayed at the departmental imaging system because of the name mismatch. Subsequently, when the images with the old name sent are back to VistA, processing is delayed because of the name mismatch. Manual procedures are then required to resolve these issues. These manual procedures are inefficient and slow, interrupt patient care, and are error prone. Not communicating patient demographic changes on VistA to the departmental imaging systems can be a major patient safety issue (see patient safety PSPO(s) #3115, & #3428). The goal of this patch is to have local VistA send HL7 patient demographic update messages to the departmental imaging systems. This is accomplished by using the ADT A08 Patient Information Update and ADT A47 Change Patient Identifier List messages. This follows the established practice in the industry. The Integrating the Healthcare Enterprise (IHE) Technical Framework documents the use of the ADT A08 message to communicate patient demographic updates from an ADT system (VistA PIMS) to a departmental imaging system: The Update Patient transaction is an HL7 ADT message. The message shall be generated by the system that performs the update whenever an error is resolved or a change occurs in patient demographics. An A08 message is the only method that may be used to update patient demographic and visit information. However Patient ID cannot be updated with an A08 message. It is expected that after receiving Patient Information Update message (A08) the receiving system will update its local patient demographic, visit, allergy, and/or insurance information. Any information received as null in the new A08 message shall be removed locally. The IHE also documents the use of the ADT A47 to change patient identifier information: The Patient Demographics Supplier notifies the change of a patient identifier list for a patient. That is, a single PID-3-patient identifier list value has been found to be incorrect and has been changed. This message is not used to update other patient demographics information. The receiver shall correct the identifier in its database, and shall report the result of this operation (success / error) in an acknowledgment message returned to the sender. The IHE specified these two transactions many years ago and has tested them with PACS at international Connectathons for more than a decade. This patch will enable VistA Imaging to send real-time ADT A08 and ADT A47 HL7 messages to the departmental imaging systems so that they can automatically update their patient information. This will eliminate the problems caused by the lack of communications of patient demographic changes. Departmental imaging systems will automatically be able to keep patient demographics in sync with the local VistA system. Problems caused by patient name changes will be virtually eliminated and a major patient safety concern will be resolved. Patient Safety Issue(s): ======================== PSPO: 3115 PSPO: 3428 Associated Tickets(s): ================== R12079614FY17 R7240632FY16 I7642061FY16 Associated NSR(s): ================== 20080924 HL7 IHE Interface to PACS Systems for Patient Demographics Changes Participating Test Sites: PACS at time of testing ========================= ======================= Baltimore, MD McKesson PACS Washington, DC McKesson PACS Memphis, TN GE PACS Boston, MA Carestream PACS Long Beach, CA Agfa PACS and Bayer Radimetrics St. Louis, MO Philips PACS Ann Arbor, MI Leica Cerebro Madison, WI Apollo Enterprise Imaging Patch Installation: =================== Installation Planning --------------------- MAG*3.0*183 must be installed on the VistA System and on legacy VistA Imaging DICOM Gateways. This patch must be installed by the compliance date to conform to VHA Directive 2001-023. All sites running VistA Imaging 3.0 must install the KIDS portion of this patch. This patch can be loaded while the VistA Imaging System is active and users are on the system. Installing the MAG*3.0*183 KIDS takes 2-5 minutes. Pre-Installation Instructions: ------------------------------ Verify that the patches listed in the Associated Patches section of this document have been previously installed. Note: All released VistA Imaging patches must be installed on the VistA system before installing MAG*3.0*183. VistA System (KIDS) Installation -------------------------------- - Installation Steps The actual KIDS installation will take less than one minute. 1) On the VistA system, access the Kernel Installation and Distribution System Menu [XPD MAIN]. 2) Run the Installation option [XPD INSTALLATION MENU]. 3) Load the KIDS file by performing the following steps: a. Run the Load a Distribution option [XPD LOAD DISTRIBUTION] to load the KIDS distribution. b. When prompted, enter the path and file name (MAG3_0P183.KID) of the Patch 183 KIDS file. c. When prompted to continue with the load, enter "YES". A Distribution OK! message will be displayed when the load is complete. 4) After loading the KIDS file, use the following options to verify the contents of the patch and to back up any affected routines. a. Verify Checksums in Transport Global [XPD PRINT CHECKSUM] - Run this option if you want to ensure the integrity of the routines in the patch. b. Compare Transport Global to Current System [XPD COMPARE TO SYSTEM] - Run this option if you want to view all changes that will be made when the patch is installed. All components (routines, options, and so on) in the patch will be compared. c. Backup a Transport Global [XPD BACKUP] - Run this option if you want to create a backup message of any routines exported with the patch. It will NOT back up any of the other changes 5) After performing the load and any optional verification steps, install the KIDS file by performing the following steps: a. Run the Install Package(s) [XPD INSTALL BUILD] option. b. When prompted for the install name, enter "MAG*3.0*183". c. Answer "NO" to the following prompts: Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO// Want KIDS to INHIBIT LOGONs during the install? NO// Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO// 6) When installation is finished, an Install Complete message will be displayed. KIDS Installation Example ------------------------- This example shows the output when the KIDS file is installed for the first time. If you have already installed the patch and are installing the KIDS file in a namespace on which it has previously been installed, your output may be different. Select OPTION NAME: xpd main Kernel Installation & Distribution System Edits and Distribution ... Utilities ... Installation ... Patch Monitor Main Menu ... 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 Select Installation Option: 1 Load a Distribution Enter a Host File: C:\...\MAG3_0P183.KID KIDS Distribution saved on Jan 02, 2018@15:43:30 Comment: ADT messages for PACS This Distribution contains Transport Globals for the following Package(s): MAG*3.0*183 Distribution OK! Want to Continue with Load? YES// Loading Distribution... Build MAG*3.0*183 has an Environmental Check Routine Want to RUN the Environment Check Routine? YES// MAG*3.0*183 Will first run the Environment Check Routine, MAGIP183 Use INSTALL NAME: MAG*3.0*183 to install this Distribution. 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 Select Installation Option: 6 Install Package(s) Select INSTALL NAME: MAG*3.0*183 1/2/18@15:49:57 => ADT messages for PACS ;Created on Jan 02, 2018@15:43:30 This Distribution was loaded on Jan 02, 2018@15:49:57 with header of ADT messages for PACS ;Created on Jan 02, 2018@15:43:30 It consisted of the following Install(s): MAG*3.0*183 Checking Install for Package MAG*3.0*183 Will first run the Environment Check Routine, MAGIP183 Install Questions for MAG*3.0*183 Incoming Files: 2006.1 IMAGING SITE PARAMETERS (Partial Definition) Note: You already have the 'IMAGING SITE PARAMETERS' File. Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO// Want KIDS to INHIBIT LOGONs during the install? NO// Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO// Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// HERE Install Started for MAG*3.0*183 : Jan 02, 2018@15:50:07 Build Distribution Date: Jan 02, 2018 Installing Routines:.......................... Jan 02, 2018@15:50:07 Installing Data Dictionaries: .. Jan 02, 2018@15:50:08 Installing PACKAGE COMPONENTS: Installing HL LOGICAL LINK.. Installing PROTOCOL........................... Installing OPTION... Installing HLO APPLICATION REGISTRY... Jan 02, 2018@15:50:09 Running Post-Install Routine: POS^MAGIP183.. "MAGD PATHOLOGY" already exists in the HLO SUBSCRIPTION REGISTRY. Updating DISPLAY ORDER for IHE on MAG HL7 MAINT menu -- SUCCESS. Setting DICOM Text Gateway to use Radiology HL7 V2.4 protocols -- PASS 1 This option is used to set the Radiology HL7 version for the DICOM Text Gateway. The HL7 v2.4 is the default and is recommended because it provides more data. MAGD SEND ORM protocol found... MAGD SEND ORU protocol found... RA CANCEL protocol found... MAGD SEND ORM subscribed RA EXAMINED protocol found... MAGD SEND ORM subscribed RA REG protocol found... MAGD SEND ORM subscribed RA RPT protocol found... MAGD SEND ORU subscribed RA CANCEL 2.3 protocol found... RA EXAMINED 2.3 protocol found... RA REG 2.3 protocol found... RA RPT 2.3 protocol found... RA CANCEL 2.4 protocol found... RA EXAMINED 2.4 protocol found... RA REG 2.4 protocol found... RA RPT 2.4 protocol found... Subscribing to HL7 version 2.4 Radiology HL7 protocols... Protocol RA CANCEL has been unsubscribed from... Protocol RA EXAMINED has been unsubscribed from... Protocol RA REG has been unsubscribed from... Protocol RA RPT has been unsubscribed from... Protocol RA CANCEL 2.3 is not currently subscribed to, no action taken... Protocol RA EXAMINED 2.3 is not currently subscribed to, no action taken... Protocol RA REG 2.3 is not currently subscribed to, no action taken... Protocol RA RPT 2.3 is not currently subscribed to, no action taken... Protocol RA CANCEL 2.4 has been subscribed to... Protocol RA EXAMINED 2.4 has been subscribed to... Protocol RA REG 2.4 has been subscribed to... Protocol RA RPT 2.4 has been subscribed to... Setting DICOM Text Gateway to use Radiology HL7 V2.4 protocols -- PASS 2 This option is used to set the Radiology HL7 version for the DICOM Text Gateway. The HL7 v2.4 is the default and is recommended because it provides more data. MAGD SEND ORM protocol found... MAGD SEND ORU protocol found... RA CANCEL protocol found... RA EXAMINED protocol found... RA REG protocol found... RA RPT protocol found... RA CANCEL 2.3 protocol found... RA EXAMINED 2.3 protocol found... RA REG 2.3 protocol found... RA RPT 2.3 protocol found... RA CANCEL 2.4 protocol found... MAGD SEND ORM subscribed RA EXAMINED 2.4 protocol found... MAGD SEND ORM subscribed RA REG 2.4 protocol found... MAGD SEND ORM subscribed RA RPT 2.4 protocol found... MAGD SEND ORU subscribed Subscribing to HL7 version 2.4 Radiology HL7 protocols... Protocol RA CANCEL is not currently subscribed to, no action taken... Protocol RA EXAMINED is not currently subscribed to, no action taken... Protocol RA REG is not currently subscribed to, no action taken... Protocol RA RPT is not currently subscribed to, no action taken... Protocol RA CANCEL 2.3 is not currently subscribed to, no action taken... Protocol RA EXAMINED 2.3 is not currently subscribed to, no action taken... Protocol RA REG 2.3 is not currently subscribed to, no action taken... Protocol RA RPT 2.3 is not currently subscribed to, no action taken... Protocol RA CANCEL 2.4 is already subscribed to, no action taken... Protocol RA EXAMINED 2.4 is already subscribed to, no action taken... Protocol RA REG 2.4 is already subscribed to, no action taken... Protocol RA RPT 2.4 is already subscribed to, no action taken... Post Install Mail Message: Jan 02, 2018@15:50:10 Updating Routine file...... Updating KIDS files....... MAG*3.0*183 Installed. Jan 02, 2018@15:50:10 Back-out/Rollback Strategy ========================== In the event of a catastrophic failure, the Facility CIO may make the decision to back-out the patch. It is imperative that you have performed a backup of the VistA routines included in this patch prior to installation. (The VistA routines are listed below.) The back-out plan for VistA is to restore the routines from this backup. To verify the back-out completed successfully, ensure the checksum matches the pre-patch checksum from the routine information below. There is a new Imaging subscriber to PROTOCOL file (#101) VAFC ADT-A08 SERVER. The MAGD PACS VAFC ADT-A08 CLIENT subscriber protocol should be removed. There were two changes to the FileMan Data Dictionary for the IMAGING SITE PARAMETERS file (#2006.1), SEND ANATOMIC PATHOLOGY HL7field (#204) and ENABLE TELEPATH WORKLIST field (#205). These are minor changes to the names and descriptions and do not require changing back. Similarly, there were changes to descriptions in 18 protocol files and six new ones created. These are listed above in the Protocols Associated section and do not need to be removed. The back-out plan for the DICOM Gateway is to uninstall MAG*3.0*183 and install the previous version (MAG*3.0*166). Routine Information: ==================== VistA KIDS Checksums: This section lists modified routines for the VistA KIDS build. For each routine, the second line will contain the following information: ;;3.0;IMAGING;**[Patch List]**; Mar 19, 2002;Build 5;[Date] CHECK1^XTSUMBLD is used to generate the checksums. Routine Checksum Before Checksum After Patch List ------- --------------- -------------- ---------- MAG7UP 34875703 35026309 **11,51,183** MAGDHL7 23868283 8379265 **11,30,86,54,183** MAGDHLE 10197843 19989150 **54,49,183** MAGDHLI 5220582 8285914 **49,183** MAGDHLL 8663546 9309805 **49,110,183** MAGDHLS 78648405 78973085 **49,123,141,138,183** MAGDHLT 5153872 5902737 **49,183** MAGDHLTA 23848932 52475695 **49,183** MAGDHLTC 20360006 19165831 **49,183** MAGDHOW2 48253924 50817205 **138,156,183** MAGDHOWA 36363777 42474842 **138,183** MAGDHPS 35750729 62305390 **49,183** MAGIP183 N/A 16977771 **183** MAGT7MA 124464922 133779882 **138,173,166,183** MAGT7S 33454697 31666917 **138,183** MAGT7SI 13003738 13457996 **138,183** MAGTP005 12863512 13949061 **138,166,183** Legacy DICOM Gateway Routine Checksum Before Checksum After Patch List ------- --------------- -------------- ---------- MAG7UP 34875703 35026309 **11,51,183** MAGDHRC2 24123084 25348186 **11,49,110,138,183** MAGDHRC3 127214354 127795528 **11,30,102,49,123,87 ,110,183** MAGDHRC7 16576779 19766889 **11,51,49,110,183** MAGDHRCA 64012465 16270996 **138,183** MAGDHRCP 41946326 44418147 **11,54,49,110,183** MAGDWLPA 76942046 78343810 **11,51,49,110,174,183** Routine MAGIP183 is an installation routine that is automatically deleted after the KIDS installation. The following routines are deleted by this patch. Routine Checksum Before Patch List ------- --------------- ---------- MAG7RS 54913363 **11,40,30,123,138,166** MAG7RSD 12010159 **11** MAG7RSO 6903355 **11** MAG7RSR 7799977 **11** MAG7UDR 7350925 **11** MAGDHL7T 3762716 - none - MAGT7SP 40182060 **138** MAGT7SV 12817677 **138** Routine Information: ==================== No routines included. ============================================================================= User Information: Entered By : Date Entered : JAN 23, 2017 Completed By: Date Completed: JAN 26, 2018 Released By : Date Released : JAN 26, 2018 ============================================================================= Packman Mail Message: ===================== No routines included