============================================================================= Run Date: DEC 19, 2018 Designation: MAG*3*208 Package : MAG - IMAGING Priority: Mandatory Version : 3 SEQ #165 Status: Released Compliance Date: JAN 18, 2019 ============================================================================= Associated patches: (v)MAG*3*180 <<= must be installed BEFORE `MAG*3*208' (v)MAG*3*183 <<= must be installed BEFORE `MAG*3*208' Subject: CLINICAL PROCEDURE AND DICOM CONSULT REQUEST TRACKING Category: - Routine Description: ============ Patches MAG*3.0*208 and MD*1.0*60 work together and should be installed back to back. The two patches improve interoperability for the Clinical Procedures DICOM modalities by using the VistA Imaging accession number ("sss-GMR-nnnnnnnn") as the CP Instrument Order Number. This allows the DICOM objects generated during a Clinical Procedure to be automatically processed by VistA Imaging. These patches also optimize the availability of the VistA Imaging DICOM Modality Worklist by putting the Clinical Procedures order on the worklist at check-in time, as opposed to when the order is released. Furthermore, these patches can provide the VistA Imaging HL7 order message to instruments that need more information than available in the current Clinical Procedures HL7 order message. *** Note - MD*1*60 is distributed separately, please see that patch description for more details and installation instructions. *** Details ======= Clinical Procedures (CP) and VistA Imaging (VI) CPRS Consult Request Tracking DICOM are two very successful applications. Clinical Procedures primarily uses HL7 for its communications. It has two kinds of devices: unidirectional instruments and bidirectional instruments. Both send examination results to Clinical Procedures via HL7. A large variety of document types can be handled, with PDF being the most popular. Unidirectional instruments are not capable of receiving HL7 orders and require manual entry of the patient and study information. Bidirectional instruments can receive HL7 order information prior to the examinations. Some bidirectional Clinical Procedures instruments include DICOM modalities. VistA Imaging CPRS Consult Request Tracking uses an accession number that has the format "sss-GMR-nnnnnnnn", where "sss" is the three-digit VA Station Number and "nnnnnnnn" is the internal entry number of the study in the REQUEST / CONSULTATION file (#123). Automatic association of DICOM images in the VistA electronic health record (EHR) requires exact matches for the patient name, medical record number (SSN in VA), and accession number. The Clinical Procedures Instrument Order Number is derived from the check-in date and time. The Instrument Order Number is mapped to the DICOM Accession Number (0008,0050) in the DICOM modalities that are in use with Clinical Procedures. The DICOM objects created with this accession number cannot be automatically processed by VistA Imaging. These patches improve interoperability by using the VistA Imaging consult accession number (in the format "sss-GMR-nnnnnnnn") as the Clinical Procedures Instrument Order Number. This results in the correct value for the DICOM Accession Number (0008,0050) and allows Clinical Procedures' DICOM objects to be automatically processed by VistA Imaging and inserted into the EHR. DICOM instruments follow the established workflow of obtaining patient and study information from a Modality Worklist provider, acquiring DICOM objects, storing the patient and study data into the headers of the DICOM objects, and sending the DICOM objects to VistA. The DICOM Text Gateway processes VistA Imaging HL7 order messages and puts the studies on the worklist. Some DICOM instruments for Clinical Procedures use DICOM Modality Worklist. These patches improve the timing of the DICOM Modality Worklist information for Clinical Procedures. Previously the VistA Imaging HL7 order message for Clinical Procedures was generated when the order is released (i.e., "signed") which resulted in the study being put on the worklist well in advance of the examination. With these patches, the VistA Imaging HL7 order message is generated when the clinical procedure order is checked in. As a result, the study is put on the worklist just when it is needed to provide the patient and study information for the modality. With these patches, at check-in time, both the Clinical Procedures and VistA Imaging HL7 messages are created. Some instruments require fields that are not present in the Clinical Procedures HL7 order message. The VistA Imaging HL7 message body provides these fields and can be used by Clinical Procedures instead. Note that if the Clinical Procedure uses DICOM instruments, the DICOM Encapsulated PDF SOP Class is recommended for computer-generated PDF reports. DICOM Encapsulated PDFs are more suitable for storage in an EHR than raw PDFs because they contain patient and study identification information and can be managed by the whole suite of DICOM services (storage, display, query/retrieve, export, etc.). Overview of the New Capabilities ================================ The new capabilities in these two patches only apply to bidirectional CP instruments. There are no changes for unidirectional CP instruments. CP Can Use VI Accession Number as Instrument Order Number ========================================================= For designated CP instruments that generate DICOM objects, the VistA Imaging consult / procedure accession number "sss-GMR-nnnnnnnn" can be used as the Clinical Procedure Instrument Order Number. This permits DICOM objects created by the CP instrument to be automatically associated with the clinical procedure in VistA. CP Check-in Triggers the VistA Imaging HL7 Generation ===================================================== Check-in of a Clinical Procedure triggers the generation of the VistA Imaging HL7 order (ORM) message. The VistA Imaging HL7 message will no longer be generated prematurely when the order is released. The VistA Imaging DICOM Modality Worklist is populated with information from the VistA Imaging HL7 order message. Since the CP study shall be put on the worklist at check-in instead of when the order was released, the DICOM Modality Worklist will provide much more timely information. Note: The clinical procedure must have an entry in the CLINICAL SPECIALTY DICOM & HL7 file (#2006.5831) to have DICOM Modality Worklist and HL7. This is an existing requirement going back to MAG*3.0*10 DICOM - CONSULT AND PROCEDURES INTERFACE (2003). CP Can Use VistA Imaging's HL7 Order Message Body ================================================= The VistA Imaging HL7 order (ORM) message contains many more data fields than the CP order message. The VistA Imaging HL7 order (ORM) message for a Clinical Procedure is also backwards-compatible with the CP HL7 order (ORM) message - all the fields in the Clinical Procedure HL7 order message are present in the VistA Imaging HL7 order message and contain the same data. Some VI HL7 ORM fields have additional components, however. For designated CP instruments that need this additional information, the VistA Imaging HL7 order message body can be used instead of the CP order message. The content of the CP HL7 order message will be replaced by the VI HL7 order message, but the CP message transport mechanism will remain the same: the same MSH message header segment is used, the same Logical Link, and the same 1.6 HL7 communications package. New CP INSTRUMENT file (#702.09) CP - DICOM INTEROPERABILITY field (#.19) ========================================================================= MD*1.0*60 adds the new CP - DICOM INTEROPERABILITY field (#.19) to the CP INSTRUMENT file (#702.09). This field is used to identify Clinical Procedure instruments that (1) will use the VistA Imaging consult/procedure accession number sss-GMR-nnnnnnnn as the Clinical Procedure Instrument Order Number, and (2) will use the VistA Imaging HL7 message body instead of the Clinical Procedure HL7 message body. The values for the field are , 0, 1, or 2 accordingly. Associated Ticket(s): ===================== Associated NSR(s): ================== N/A Participating Test Sites: ========================= VA Heartland East (ST. Louis) Maryland HCS (Baltimore) Eastern Colorado HCS (Denver) Software and Documentation Retrieval Instructions ================================================= Software being released as a host file and/or documentation describing the new functionality introduced by this patch is available. The preferred method is to SFTP the files from: Download.vista.domain.ext The preferred method is to retrieve MAG*3.0*208 files from download.vista.domain.ext. This transmits the files from the first available server. Sites may retrieve the software and/or documentation directly using Secure File Transfer Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following OI Field Offices: Hines: domain.ext Salt Lake City: domain.ext Documentation can also be found on the VA Software Documentation Library at: http://www4.domain.ext/vdl/ Note: Information about last-minute changes to these patches will be provided in the readme file. If present, this file will also be in the MAG3_0P208 directory. File Name: Description: Protocol: ========== ============ ========= MAG3_0P208.KID KERNEL DISTRIBUTION ASCII MAG3_0P208_PD.PDF PATCH DESCRIPTION BINARY MAG3_0P208_Cookbook.docx COOKBOOK BINARY Installation Instructions: ========================== MAG*3.0*208 must be installed on the VistA System followed by patch MD*1.0*60 (see patch 60 for installation instructions). There is no component for the legacy VistA Imaging DICOM Gateways. This patch must be installed by the compliance date to conform to VHA Directive 2001-023. The MAG*3.0*208 patch can be loaded while the VistA Imaging System and Clinical Procedures are active and users are on the system. The actual KIDS installations 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_0P208.KID) of the Patch MAG*3.0*208 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 files 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*208". 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. 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. Routine Information: ==================== Routine Name: MAGDHLS Routine Name: MAGDHOW1 Routine Name: MAGDHOW2 Routine Name: MAGDHOW3 Routine Name: MAGDHOWC Routine Name: MAGDHOWP Routine Name: MAGDHOWS Routine Name: MAGHOW4 Routine Name: MAGIP208 ============================================================================= User Information: Entered By : Date Entered : APR 09, 2018 Completed By: Date Completed: DEC 19, 2018 Released By : Date Released : DEC 19, 2018 ============================================================================= Packman Mail Message: ===================== No routines included