============================================================================= Run Date: NOV 14, 2012 Designation: MAG*3*122 Package : MAG - IMAGING Priority: Mandatory Version : 3 SEQ #82 Status: Released Compliance Date: DEC 15, 2012 ============================================================================= Associated patches: (v)MAG*3*49 <<= must be installed BEFORE `MAG*3*122' (v)MAG*3*104 <<= must be installed BEFORE `MAG*3*122' (v)MAG*3*108 <<= must be installed BEFORE `MAG*3*122' (v)MAG*3*117 <<= must be installed BEFORE `MAG*3*122' Subject: ANNOTATIONS Category: - Routine - Data Dictionary - Enhancement (Mandatory) - Other Description: ============ MAG*3.0*122 Overview: ===================== This document describes MAG*3.0*122, the VistA Imaging Annotations patch for Clinical Applications. The Department of Veterans Affairs (VA) has more than two billion medical images stored in its database and available online. Images are collected, captured, stored, and displayed using VistA Imaging applications. Each month, VistA Imaging serves more than 1.3 million patients, captures more than 39 million new images, and displays nine to eleven million images for review and diagnosis. Image annotations highlight features, details, and points of interest within an image. Annotations provide clinicians with tools to transcribe inscriptions, callouts, symbols, and words and place them adjacent to areas of interest. Annotations become part of the patient's medical record. VistA Imaging includes a tool to annotate medical diagrams but not medical images, and VistARad provides functionality to annotate RAD package images. This patch expands Clinical Capture and Clinical Display to annotate images and save them. The diagram annotation tool will continue to be distributed but is not part of the scope of MAG*3.0*122 and will not be discussed further in this document. Major features of MAG*3.0*122 are summarized below: =================================================== * Allows annotating of images during the capture process in Clinical Capture. * Allows annotating of images and viewing of images with their annotations in Clinical Display, in both the full resolution viewer and the radiology viewer. * Clinical Display provides a notification when viewing a radiology image or radiology group that has been annotated in VistARad. * Supports remote image view functionality. Annotated images can be viewed from remote VA sites (a remote site must have MAG*3.0*122 installed). Annotations can be added to remote VA images if annotation permissions are granted. * An indicator is displayed on abstracts, group abstracts, and in other summary areas to alert the clinician of images that have associated annotations. * The following image formats can be annotated: - Bitmap - DICOM (single image and multi-frame) - JPEG - PDF (single page and multi-page) - TGA - TIFF (single page and multi-page) * Annotations are image overlays and are stored only in VistA. They are not burned into the image, but they do remain a permanent part of the patient record. In addition, annotations are not exportable. * By default, users are restricted from creating annotations. Site administrators can alter permissions to allow users to create annotations according to system, division, service, and user parameters. * Saved annotations cannot be modified or deleted except with the MAG ANNOTATE MGR key. * The MAG ANNOTATE MGR key allows a designated user to change or delete saved annotations. * An annotation audit trail is created and stored. It tracks annotations by user, date created, and the user's service. * Annotations can be added before and after a progress note is signed or consult resulted, according to TIU business rules. * Annotations can be printed with images. * Measurements can be created on images by using the ruler and protractor tools in both the full resolution viewer and the radiology viewer. * Annotation global settings are stored with the user's preferences. Clinical Capture and Clinical Display have their own settings in the user's preferences. * DICOM and PDF images can now be viewed in the Clinical Capture viewer when in Annotation Mode. MAG*3.0*122 adds functionality to support the Indian Health Services (IHS) ========================================================================== program: ======== * Allows searching for a patient by IHS Health Record Number (HRN) when the Agency Code is set to IHS in the Kernel System Parameters file. * Displayed screens and printed reports will use the IHS HRN as the patient ID. Distribution of Software: ========================= This patch can be downloaded from: ftp.imaging.med.va.gov/Software/Released_Software/Mag3_0P122 Installation instructions are included in this document. NOTE Any late-breaking news about this patch will be found in a readme file. If present, this file will also be located in the MAG3_0P122 directory. Patch Contents: =============== This patch includes the following files: Software: ========= MAG3_0P122.KID - KIDS (Kernel Installation & Distribution System) package to be installed on the VistA System. MAG3_0P122_Install.exe - Installation file for Clinical Display, Clinical Capture, and TeleReader client software. Mag3_0P122_Install.msi - Installation file for sites using SMS or similar software. Mag3_0P122_VIX_Setup.msi - Installation file to set up the MAG*3.0*122 VIX. NOTE You must upgrade your VIX to the MAG*3.0*122 VIX immediately after installing the MAG*3.0*122 KIDS and before installing the client software. MagAUShare.zip - Zip file containing files used by Auto-update sites. Contains MagASet.exe, MagSetup, and magnet.ini. Documentation: ============== MAG3_0P122_Patch_Description.pdf - Patch Description. MAG3_0P122_Technical_Manual_Changes.pdf - VistA Imaging Technical Manual MAG3_0P122_Installation_Guide_Changes.pdf - MAG*3.0*122 Installation Instructions MAG3_0P122_Security_Guide_Changes.pdf - VistA Imaging Security Guide MAG3_0P122_Clinical_Capture_Changes.pdf - VistA Imaging System Clinical Capture User Manual MAG3_0P122_Clinical_Display_Changes.pdf - VistA Imaging System Clinical Display User Manual MAG3_0P122_VIX_Installation_Guide.pdf - VistA Imaging System VIX Service Installation Guide NOTE Refer to Fact Sheet for MAG*3.0*122 VistA Imaging Annotations for more information. (URL = http://vaww.vhaco.va.gov/him/docscanning.html) Before MAG*3.0*122 is installed, the following patches must be installed: MAG*3.0*104 MAG*3.0*108 MAG*3.0*117 MAG*3.0*49 For a list of all released Imaging (MAG) patches, refer to the patch_list.txt file available on the Imaging FTP server (go to ftp://ftp.imaging.med.va.gov, then navigate to the \Docs\Imaging_Docs_Latest folder). Test Sites: =========== The following sites are test sites for this patch: Fayetteville, NC (Large) Mountain Home, TN (Medium) St. Louis, MO (Integrated, Large) VISN 2 (Integrated, Large) West Haven, CT (Integrated, Large) West Palm Beach, FL (Large) Remedy Calls: ============= This patch addresses the following Remedy help desk calls: Tickets 488697, 484208, and 596007 The QA Review query in VI Clinical Display will use a new cross reference. This will allow a much faster QA review. Tickets 528992 and 530491 Restore the Cache Images function in Clinical Display that allows users to manually cache images in the background while the user views other images which take more time to retrieve. Ticket 529824 Clinical Display queries the local treating facility list for the sites at which the patient has been seen. Previous versions of the client would query the DoD for any site entry that contains 200 including entries that do not represent the DoD. MAG*3.0*122 changes this to only query the DoD for patient data when the patient has been seen at site 200 and no other variation of site 200 in the treating facility list. Ticket 533466, 477116, 740194 Fix the 'Use Alternate PDF Viewer' preference in Clinical Display such that the functionality is restored and the PDF file will open in Adobe Reader or the viewer they use for PDFs. Tickets 531950, 531487, 530326, 531108 An Access Violation error message displays in Vista Imaging Capture (in module MagImageCapture.exe). Tickets 527026,533757,619468 MAG*3.0*122 sets the pointer in Clinical Capture to the BIG file only if the BIG file exists. Ticket 539861,540859, 716678 MAG*3.0*122 uses the primary site station number when retrieving images from remote VA sites with the VIX. This allows the CAPRI remote login method to work when the BSE method fails. Ticket 528654 MAG*3.0*122 corrects the failure of Clinical Capture to maintain the Convert to DICOM setting during a drag and drop import. Tickets 530056, 555163, 555768, 583850, 610256, 526399 MAG*3.0*122 eliminates the error BRK+20^MAGGTRPT in the error log when a user selects a deleted image to view with Preview Report enabled. Ticket 626390 On some servers in the VA domain, applying a DENY ACL to the system drive root directory (usually c:\) will cause an exception to be thrown. The VIX installer has been modified to catch and log the exception, allowing the VIX installation to continue. Tickets 716685, 717384, 717734, 718170 A problem was discovered in the field with Patch 104 where a VIX server would not be able to communicate with other VIX servers. Eventually the listener threads on the VIX are all used up and no longer respond to requests. The fix in Patch 122 resolves this issue. Tickets 612929, 722131 This ticket requests to upgrade the EKG viewer to use the new MUSE 8 interface. New Service Requests: ===================== 20080404 - Teledermatology Enhancements 20090511 - Telehealth and Telepathology Enhancements Patient Safety Issues: ====================== There are no Patient Safety Issue (PSI) reports associated with this patch. MAG*3.0*122 Changes: ==================== Summary: ======== MAG*3.0*122 enables users with annotation permission to draw annotations directly on the image they are viewing in Clinical Capture or Clinical Display. Although annotations are kept in an annotation layer and stored in VistA as an overlay, they are a permanent part of the patient record. By default, annotations always display when an image is viewed. A clinician can choose to hide and show annotations as needed. MAG*3.0*122 provides flexible user controls to draw, arrange, and present annotations. Annotations made to an image associated with a Text Integration Utility (TIU) note before the note is signed are visually different from annotations made after the note is signed. Annotations made before the note is signed have solid lines and normal text; annotations made after the note is signed have dashed lines and underlined text. For printing of images, annotations can be printed along with the image if desired (the user can determine if all or some or none of the annotations should be included in a print job). Clinical Display provides a notification when radiology images have been annotated in VistARad. NOTE Users cannot annotate non-radiology images viewed from the Department of Defense (DoD). DoD radiology images can have temporary measurement annotations created (i.e., rulers and protractors). Annotation Permissions: ======================= Creating Annotations: ===================== By default, when MAG*3.0*122 is installed, users cannot annotate images. Site Administrators can update kernel parameter definitions to allow users to annotate images. Using these parameters, the site administrator has the flexibility to grant and deny annotation permission to individual users at the site, to all users of a particular service at that site, to an entire division associated with that site, or to all users at the site. For more information about the parameters and how to set them, see Annotation Permissions section. Viewing Annotations: ==================== Clinical Display users are able to view annotations associated with an image when the image is displayed. Editing and Deleting Annotations: ================================= Only users who have the MAG ANNOTATE MGR key can edit or delete saved annotations. The MAG ANNOTATE MGR key is reserved for users who have an oversight role, for example, quality control. The MAG ANNOTATE MGR key is not intended for general distribution. Users who use remote image views and need to modify the annotations made by other users at a remote site must have the MAG ANNOTATE MGR key at the remote site. NOTE Please delete annotated images with care. It is recommended that annotated images destined for deletion be marked "Needs Review" for further QA consideration, since to delete an image permanently will also disassociate annotations and the annotation history from the deleted image. Even though an image may be recoverable, annotations and annotation history are not. Annotating Images at Remote Sites: ================================== Users can annotate images at a remote site if the remote Site Administrator grants the appropriate annotation permission. Audit History: ============== An annotation audit history is kept in VistA for each image when annotations are added during a session and saved. The audit history keeps a record of each annotation and stores the user name, date and time, and the user's service with the audit entry. Clinical Capture Changes: ========================= (For more information on the FIGURE samples please refer to the Patch Description document distributed with this patch). A new Annotations button has been added to Clinical Capture as shown in Figure 1. The Annotations Button becomes enabled when an image is viewable and the user has annotation permission. When the user clicks the button a new Annotation Toolbar becomes visible. The toolbar will indicate that the user is in Annotation Mode. Annotations will be associated with an image when capture is completed and the image saved. When an image is saved with annotations, the annotations are stored in a separate file in VistA, apart from the image file. Annotations become a part of the permanent medical record and cannot be modified or deleted except by a user with the MAG ANNOTATE MGR Key. DICOM and PDF images can now be viewed in the Clinical Capture viewer when in Annotation Mode. The Annotations Button appears in the toolbar only if the user has annotation permissions. Figure 1 - Annotations Button (For more information about the annotation figures please refer to the Patch Description distributed with this patch) The Annotation Toolbar, shown in Figure 2 appears when the capture session is in Annotation Mode. Annotation Mode begins after pressing the Annotations button shown above. Figure 2 - Annotation Toolbar in Clinical Capture The Clinical Capture Annotation Toolbar button functions are as follows: Select Annotation button Line button Freehand button Rectangle button Text button Ellipse button Arrow button Highlighter button Ruler button Protractor button Annotation Property Editor button Global Annotation Attributes button Delete Annotations button Exit Annotation Mode button Annotations are drawn directly on the image as shown in Figure 3. The use of magnification and rotation tools will cause the annotation(s) to zoom and translate with the image. Annotation coordinates and aspect stay locked with the image. Figure 3 - Imported Image with Annotations Clinical Display Changes: ========================= Image annotation is now an integrated feature of the full resolution viewer and the radiology viewer. When the Annotations Button is pressed, the Annotation Toolbar becomes visible and the image goes into Annotation Mode. On the full resolution viewer, Annotation Mode is started by clicking the Annotations Button on the toolbar or on the image title bar as seen in Figure 4. Figure 4 - Full Resolution Viewer Showing Annotations Buttons On the radiology viewer, Annotation Mode is started by clicking the Annotations Button on the image title bar as seen in Figure 5. Figure 5 - Radiology Viewer Showing the Annotations Button Annotation Mode is active until the Annotation toolbar is closed. While in Annotation Mode the image responds to drawing commands based on the tool selected or to other annotation commands based on the user selection. When annotations are created and the Annotation Toolbar is closed, the user will be prompted to save or abandon the changes or to continue annotating. When annotations are saved they form an annotation history layer. The annotation history layer is part of the audit history and is useful when a clinician wants to see how annotations were presented at a point in time. When an image is first opened and it has annotations, the most recently saved history layer becomes the current view which can be further annotated and then saved as a new layer. Use of external viewers like the Adobe Acrobat Reader will display only the image, even if annotations are part of the image. The radiology viewer supports annotation in a single or dual stack mode. Annotating is not supported in the radiology viewer's layout mode. DICOM multi-frame cine loops can be annotated one frame at a time. In both the full resolution and radiology viewers, the image can be rotated, zoomed, inverted, and flipped and annotations will translate with the image. Clinical Display Annotation Toolbar: ==================================== When the Annotations Button is clicked in the full resolution or radiology viewer, the Annotation Toolbar will be displayed as shown in Figure 6, and the image will be in Annotation Mode until the Annotation Toolbar is closed. While the Annotation Toolbar is visible it can be moved to any location on the screen. If more than one image is displayed in a viewer, the Annotation Toolbar will be associated with the image that has focus. Figure 6 - Clinical Display Annotation Toolbar Following is a table of the annotation tools available in the Annotation Toolbar. Edit Annotations button View Annotations button Select Annotation button Line button Freehand button Rectangle button Text button Ellipse button Arrow button Highlighter button Ruler button Protractor button Annotation Property Editor button Global Annotation Attributes button Audit History Annotation Information The User Information line in Figure 6 provides the following information (as setup by the current annotation session): 1. Read-only indicator (not shown in the illustration, but when it is shown, it is on the left side of the User Information line). This indicator tells the user that a selected annotation is read-only (i.e., created by someone else). If a group of annotations are multi-selected and one or more of them in the group belong to someone else, the indicator will appear. This indicator will also appear when viewing RAD package images, DoD radiology images, or when the user does not have annotation permission. 2. The user permission setting a. Read Only b. Read/Write Permission c. Master Key Permission d. RAD Package e. DoD 3. The count of annotations on the page and the count of hidden annotations on the page. If the image is multi-paged, both counts span all of the pages. The Status line will display the session state except when an annotation in the image is selected. Then it will display the annotator's name, annotator's service, and date/time when the annotation was last saved. When a name is displayed the user can hover over it and get a full listing. If the hover over information needs to be displayed longer, the user can click the Annotation Information button (be sure to select one or more or all of the annotations before clicking the button). The Edit Annotations button Error! Reference source not found., pops up a submenu with the following choices: Figure 7 - Edit Annotations Button The View Annotations button Figure 8, pops up a submenu with the following choices: Figure 8 - View Annotation Button for Hide and Show When the View Annotations button Hide or Show option is selected, a Choices Available popup list box will appear as shown in Figure 9. The figure below shows a series of dates for the annotations on the image. This example list appeared after selecting Hide/By Date. By clicking on a date entry, the annotations on the image that have the selected date will hide. The inverse is true for Show/By Date. Figure 9 - Choices Available Popup Selector The Annotation Property Editor button changes the properties of an individually selected annotation. After an annotation is placed on the image, the owner of the annotation can select it and change items like line width, color, opacity, etc. The Global Annotation Attributes button lets the user adjust settings for all of the annotation types (ellipses, lines, etc.). This affects all annotations placed on the image after the global settings are changed and saved. It will not affect annotations already drawn. To do that the user will need to use the Annotation Property Editor button. Global changes are saved to the user's preference settings. The Audit History button will expand the Annotation toolbar window to display a tree view showing every annotation session that was saved. Except for the current annotation session, the Audit History layers are read-only. If one or more annotations were hidden rior to saving, the user can view the way the last annotator saved the session by selecting "As Last Viewed" when that node appears. If the "As Last Viewed" node is not available for an Audit History layer, the previous annotator did not save the session with hidden annotations. Clicking the Annotation Information button displays information about the session state. The example below shows information for all of the annotations on the page (Select All was used in this example prior to pressing the Annotation Information button). User Preference Setting Changes: ================================ User Preferences has a new Annotation tab shown in Figure 10. The tab has a button to open the Global Annotation Attributes screen for Clinical Display, as shown in Figure 11. Figure 11 can also be accessed by selecting the Global Annotation Attributes button on the Annotation toolbar. Figure 10 - User Preferences Annotation Tab Figure 11 - Global Annotation Attributes Selections made in the Global Annotation Attributes screen are stored as part of the user's preference settings. These settings will be applied as annotations are initially created. Changes made to global settings, at the time they are made, will not affect pre-existing annotations. Even though default global settings are in effect when annotations are drawn, they can be individually modified at any point later. Clinical Capture and Clinical Display have their global settings kept in the Capture user preference file and in the Display user preference file, respectively. Automatically Showing Annotations: ================================== Annotations, by default, are always shown if they exist for an image when the image is displayed. This is controlled by the checkbox as illustrated in Figure 12 below. The user can uncheck this option to not show annotations upon displaying an image. When this option is unchecked the user can manually show annotations. Whether this option is checked or not, the icon is always visible on abstracts, the tree view, and list view. If the option is unchecked and an annotated image is displayed, the user can selectively show existing annotations. This is done by entering Annotation Mode (click the Annotations button), clicking the View Annotations button in the Annotation toolbar and then choosing to show all of the annotations as desired. Figure 12 - Show Annotations Option Clinical Display Image List Changes: ==================================== The Clinical Display Image List window, shown in Figure 13, will display an annotation indicator to notify the user that annotations exist for the image. Figure 13 - Image List Window Annotation Indicators In the abstract pane the icon indicates that annotations exist for the image. If the abstract is for a group, the icon indicates that one or more images in the group abstract window have annotations. In the tree view and in the list view the indicates that annotations exist for the single image while the icon indicates that a group has one or more images with annotations. When a group is selected and the group abstract window opens, the individual images of the group will display an annotation indicator when appropriate as shown in Figure 14. Figure 14 - Group Abstract Window Annotation Indicators The image information window will indicate if annotations exist for an image as shown in Figure 15. Figure 15 - Image Information Window QA Review Window Changes: ========================= The QA Review window allows annotating as shown below in Figure 16. Figure 16 - QA Review Window Changes Figure 17 shows the QA Review window in Annotation Mode with the Annotation toolbar visible. Figure 17 - QA Review Window in Annotation Mode Clinical Display Radiology Viewer Changes: ========================================== Annotations cannot been drawn on images associated with the RAD package with one exception: measurements can be made on RAD package images with the MAG*3.0*122 ruler and protractor tools, but not saved. These measurements are temporal measurements which do not get saved to VistA. RAD package images must be annotated in the VistARad application. RAD package image annotations must be viewed in the VistARad application. In Clinical Display, RAD package images are always viewable, but without annotations if present. However, Clinical Display does provide the clinician with notification that an image has been annotated in VistARad. Notification is provided through a hover-over hint when moving the mouse over the image in the abstract, tree, or list view. It is also available in the Image Information window when hovering over the abstract. When printing images in Clinical Display, a notification is printed along with the image if the image contains VistARad annotations. DICOM and TGA images that are displayed in the Radiology Viewer but are associated with other types of packages (e.g., MED, NOTE), can be annotated in Clinical Display and saved. Remote radiology images from the Department of Defense cannot be annotated with permanent annotations. However, temporary measurements can be created with the ruler and protractor tools. Annotations that may have been drawn on a DoD image by a DoD application are not available to the VA for display and Clinical Display does not provide notification to VA clinicians of their existence. The Radiology Viewer toolbar has been modified to harmonize MAG*3.0*117 measurement toolbar buttons and measurement submenu items to work with MAG*3.0*122. Three toolbar buttons have been removed from the Radiology Toolbar as shown in Figure 18. In MAG*3.0*122, access to the three removed buttons are available in the Annotation Toolbar. Figure 18 - MAG*3.0*117 Radiology Toolbar Three submenu items shown in Figure 19 have been replaced by a single button to the Annotation Toolbar as shown in Figure 17. Figure 19 - MAG*3.0*117 Submenu Figure 20 - MAG*3.0*122 Submenu Deleting Images with Associated Annotations: ============================================ Starting with MAG*3.0*122 and going forward, the concept of the "image" in the medical record is expanded. Prior to MAG*3.0*122 an image was a singular object consisting of the image and its image metadata (metadata describes characteristics and properties of the image). MAG*3.0*122 adds an annotation overlay and annotation history to theimage. The image is now a paired object and breaking them apart should be avoided to maintain medical record integrity. Deleting an annotated image or deleting a group containing annotated images will disassociate the image from the annotation information. A deleted image is moved from IMAGE file (#2005) to IMAGE AUDIT file (#2005.1) and can be resurrected if necessary if the image is mistakenly deleted. However the annotation information cannot be easily or accurately reconstructed. For this reason HIMs has required that users who have the right to delete images be given an option to place an annotated image into a "Needs Review" status as shown in Figure 21. This gives HIM staff an opportunity to discuss the loss of annotation information with the annotation author. The "Needs Review" button will only show up when deleting an annotated image or an annotated group. Figure 21 - Delete an Annotated Image Dialog An authorized user can choose to put an annotated image in "Needs Review" state, delete the annotated image from VistA, or cancel. Printing Images with Annotations: ================================= Images with annotations can be printed in two ways. The first method is by using the Print Image. option which is available from the File menu as shown in Figure 22 - Print Image Option. Figure 22 - Print Image Option The image will print with the annotations showing. The user can elect to print all the annotations as is, or customize a view by selecting annotations to hide and show before printing. Printing in this manner is What You See is What You Get (WYSIWYG). If annotations are part of the image, the printed page will include a line of information as shown in Figure 23 - Print Image Example. Annotated images will print a second line at the top of the printed page detailing the number of annotations, the number of hidden annotations that did not print because the user decided to hide some, and date the annotated image was printed. On radiology images, printing will also notify the user if there are annotations that must be viewed in VistARad. It will also tell the user if temporal measurements were printed on the paper but not stored in VistA. Figure 24 shows a printed radiology image with temporary measurements that were drawn in Clinical Display. NOTE When printing Radiology (DICOM) images to paper it must be understood that this product is not necessarily adequate for clinical purposes. Figure 23 - Print Image Example Figure 24 - Radiology Image with Temporary Measurement Annotations The second method of printing is through the Release of Information (ROI) feature of Clinical Display. In ROI, images that are selected for printing will always print with annotations. The annotation layer that prints with the image is the latest annotation layer stored in VistA. Radiology images, even with annotations, do not print when creating pages through ROI. VistA System Changes: ===================== Data Dictionary: ================ The following files and fields are included in this patch: IMAGING ANNOTATION file (#2005.002) - New This file contains an entry for each annotated image. The information includes the detail about each annotation, that is: annotator, date/time saved, tool version, source and XML data, and so on. FIELDS IMAGE (#.01) This is the image being annotated. ANNOTATION GROUP (#1) - Multiple field These fields store the user annotations to the image. ANNOTATOR (#.01) This field stores the ID of the user who made the annotation. ANNOTATION SAVED DATE/TIME (#1) Date and time the image was annotated /stored. ANNOTATION VERSION (#2) The annotation tool version used to create the annotated image. SOURCE (#3) The source of the annotation being created, for example: Imaging Clinic. ANNOTATION LAYER DELETION (#4) Indicates that an annotation layer has been marked as deleted. ANNOTATION IMAGE LAYER (#5) The field contains annotation XML raw data. TIU NOTE COMPLETION (#6) The completion status of the TIU document when saving a TIU image annotation. SERVICE (#7) Service/Section of annotator when the annotation was made. SITE (#8) The site/division at which the annotator logged in and annotated the image. IMAGING USER PREFERENCE file (#2006.18) - New Fields ANNOTATION CAPTURE FONT (#250) This field defines the text font of the Capture annotation tools. The default is "Arial". ANNOTATION CAPTURE FONT STYLE (#251) This defines the text font style of the Capture annotation tools. The default is 'Regular'. ANNOTATION CAPTURE FONT SIZE (#252) This defines the text font size in points of the Capture annotation tools. Each point is 1/72nd of an inch. A font size of 72 results in letters 1 inch high. The default is 36. ANNOTATION CAPTURE LINE WIDTH (#253) This defines the line width of the Capture annotation tools The default is 5. ANNOTATION CAPTURE COLOR (#254) This defines the color of the Capture annotation tools. The default is 32768 (GREEN). ANNOTATION CAPTURE OPACITY (#255) This defines the opacity of the Capture annotation tools. The default is 159. It is the degree to which light is not allowed to travel through Opaque context. ANNOTATION CAPTURE ARROW STYLE (#256) This defines the arrow style of the Capture annotation tools. The default is 0 (Pointer). ANNOTATION CAPTURE ARROW LENGTH (#257) This defines the arrow length of the Capture annotation tools. The default is 35. ANNOTATION CAPTURE ARROW ANGLE (#258) This defines the arrow angle of the Capture annotation tools (10-60 degrees). The default is 35 degrees. ANNOTATION CAPTURE G WIN LEFT (#259) This defines the global setting of the Capture annotation window left position on the screen (dot pixel). ANNOTATION CAPTURE G WIN TOP (#260) This defines the global setting of the Capture annotation window top position on the screen (dot pixel). ANNOTATION DISPLAY FONT NAME (#270) This field defines the text font of the Display annotation tools. The default is "Arial". ANNOTATION DISPLAY FONT STYLE (#271) This defines the text font style of the Display annotation tools. The default is 'Regular'. ANNOTATION DISPLAY FONT SIZE (#272) This defines the text font size in points of the Display annotation tools. Each point is 1/72nd of an inch. A font size of 72 results in letters 1 inch high. The default is 36. ANNOTATION DISPLAY LINE WIDTH (#273) This defines the line width of the Display annotation tools. The default is 5. ANNOTATION DISPLAY COLOR (#274) This defines the color of the Display annotation tools. The default is 32768 (Green). ANNOTATION DISPLAY OPACITY (#275) This defines the opacity of the Display annotation tools. The default is 159. It is the degree to which light is not allowed to travel through Opaque context. ANNOTATION DISPLAY ARROW STYLE (#276) This defines the arrow style of the Display annotation tools. The default is 0 - Pointer. ANNOTATION DISPLAY ARROW LENGTH (#277) This defines the arrow length of the Display annotation tools. The default is 35. ANNOTATION DISPLAY ARROW ANGLE (#278) This defines the arrow angle of the Display annotation tools (10-60 degrees). The default is 35 degrees. ANNOTATION DISPLAY G WIN LEFT (#279) This defines the global setting of the Display annotation window left position on the screen (dot pixel). ANNOTATION DISPLAY G WIN TOP (#280) This defines the global setting of the Display annotation window top position on the screen (dot pixel). ANNOTATION DISPLAY AUTO SHOW (#281) This defines the auto-show annotation of Display image. Controlling Permissions to Annotate Images: =========================================== The kernel parameter Definition MAG IMAGE ALLOW ANNOTATE is a new parameter in MAG*3.0*122. It is used to control the ability of users at a specific site to create annotations based on the following hierarchical levels: * User * Service * Division * System By default, when MAG*3.0*122 is installed, users at the site cannot create annotations (the MAG IMAGE ALLOW ANNOTATE value for the SYSTEM is NO). The VistA administrator or Information Resources Management (IRM) personnel can allow users to create annotations by changing the value of the parameter MAG IMAGE ALLOW ANNOTATE for an individual user account, for the users of a specific service at the site, for the user accounts that are part of a division, or for the entire site. Authorized users can access the MAG IMAGE ALLOW ANNOTATE parameter through the VistA menu option [XPAR EDIT PARAMETER]. Mail Groups: ============ This patch contains no new or modified mail groups. Forms: ====== This patch contains no new forms. Security Keys: ============== The following security keys are included in this patch: MAG ANNOTATE MGR - New. This security key grants the key holder full annotation access at the local site to change and delete annotations made by someone else. This key is intended to support quality assurance checking. Changes made to any annotation will have the identification of the key holder kept with the annotation for audit purposes. Remote Procedures: ================== This patch contains the following new remote procedure calls: MAG ANNOT GET IMAGE Gets the list of annotations for a particular image (given an image IEN). Returns the annotations in sorted order by saved date. MAG ANNOT GET IMAGE DETAIL Returns the details of image annotations. MAG ANNOT STORE IMAGE DETAIL Stores the annotation detail/XML into the IMAGING ANOTATION file (#2005.002). MAG ANNOT IMAGE ALLOW Checks if the annotation feature is allowed or if the user has the MAG ANNOTATE MGR key. MAG DICOM GET AGENCY Checks if the site is VA or IHS agency to allow searching for a patient by IHS Health Record Number (HRN). Menu Options: ============= This patch contains no new menu options. Protocols: ========== This patch contains no new or modified protocols. Templates: ========== This patch contains no new or modified templates. Installation: ============= This patch is to be installed on the VistA System and on the clinical workstations. This patch must be installed by the compliance date to conform with VHA Directive 2001-023. This patch may be loaded while users are on the system. Installation will take less than one minute. Installation Prerequisites: =========================== Before installing this patch, you will need to download the MAG*3.0*122 files from the Imaging FTP site to a local storage location. Verify that the patches listed in the section Patch Contents on page 3 have been installed. VistA System (KIDS) Installation: ================================= Installation Steps: 1. 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_0P122.KID) of the MAG*3.0*122 KIDS file that you downloaded from the Imaging FTP server. 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. At this point it is a good idea to ensure there is an existing back up of the working version of affected routines. c) Backup a Transport Global [XPD BACKUP] - Run this option if you want to create a backup of any routines exported with the patch. The option 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*122. c) Answer NO to the following prompts: Want KIDS to Rebuild Menu Trees Upon Completion of Install? No//NO Want KIDS to INHIBIT LOGONs during the install? No//NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? No//NO 6. When installation is finished, an Install Complete message will be displayed. KIDS Installation Example: ========================== This sample 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 Installation Option: INStall Package(s) Select INSTALL NAME: MAG*3.0*122 8/27/12@15:17:26 => VistA Imaging V3.0 - Patch 122 - 08/02/2012 08:06AM ;Created This Distribution was loaded on Aug 27, 2012@15:17:26 with header of VistA Imaging V3.0 - Patch 122 - 08/02/2012 08:06AM ;Created on Aug 02, 2012@08:06:41 It consisted of the following Install(s): MAG*3.0*122 Checking Install for Package MAG*3.0*122 Install Questions for MAG*3.0*122 Incoming Files: 2005.002 IMAGING ANNOTATION 2006.18 IMAGING USER PREFERENCE (Partial Definition) Note: You already have the 'IMAGING USER PREFERENCE' File. 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// TELNET Complete Install Started for MAG*3.0*122 : Aug 27, 2012@15:19:20 Build Distribution Date: Aug 02, 2012 Installing Routines: Aug 27, 2012@15:19:20 Installing Data Dictionaries: Aug 27, 2012@15:19:21 Installing PACKAGE COMPONENTS: Installing SECURITY KEY Installing REMOTE PROCEDURE Installing PARAMETER DEFINITION Aug 27, 2012@15:19:21 Running Post-Install Routine: POST^MAGIP122 Turn off MAG IMAGE Annotation by default - EDIT PARAMETER VALUES(OPTION NAME) Updating MAG WINDOWS: RPCs ****** Post Install Mail Message: Aug 27, 2012@15:19:21 Updating Routine file... Updating KIDS files... MAG*3.0*122 Installed. Aug 27, 2012@15:19:21 Install Completed VIX Installation: ================= Installation of the VIX is required and allows users at your site to view images from the DoD and to more efficiently view remote VA images. Installation of the MAG*3.0*122 VIX must be done after installing the KIDS but before installing the client. For instructions on how to install the VIX refer to the MAG_VIX_installation_guide.pdf. Annotation Permissions: ======================= Authorized users can access the MAG IMAGE ALLOW ANNOTATE parameter through the VistA menu option [XPAR EDIT PARAMETER]. The following shows an example of how to set up the parameter definitions. Select OPTION NAME: XPAR ED 1 XPAR EDIT BY TEMPLATE Edit Parameter Values with Template 2 XPAR EDIT KEYWORD Edit Parameter Definition Keyword 3 XPAR EDIT PARAMETER Edit Parameter Values CHOOSE 1-3: 3 XPAR EDIT PARAMETER Edit Parameter Values Edit Parameter Values --- Edit Parameter Values --- Select PARAMETER DEFINITION NAME: MAG IMAGE ALLOW ANNOTATE MAG IMAGE ALLOW ANNOTATE MAG IMAGE ALLOW ANNOTATE may be set for the following: 1 User USR [choose from NEW PERSON] 2 Service SRV [choose from SERVICE/SECTION] 3 Division DIV [choose from INSTITUTION] 4 System SYS [IMGDEM01.MED.VA.GOV] Enter selection: SERV Service SERVICE/SECTION Select SERVICE/SECTION NAME: CARD 1 CARDIOLOGY 111A MEDICINE 2 CARDIOLOGY MEDICINE 111 CHOOSE 1-2: 1 CARDIOLOGY 111A MEDICINE --------- Setting MAG IMAGE ALLOW ANNOTATE for Service: CARDIOLOGY --------- Value: ? Allow User, Service, Division or System to annotate the image. Value: YES Clinical Display and Clinical Capture Installation: =================================================== The Clinical Imaging client software (Display, Capture, and TeleReader) can be updated using one of the methods outlined below: * Manual Installation * Autoupdate Installation using VIIS (VistA Imaging Installation Service) * Automatic Installation using other methods (SMS, PSexec, etc.) After client installation is complete, log in to an updated workstation and use the Help | About menu option to verify that the version number is 3.0.122.15. Manual Installation: ==================== The Mag3_0P122_install.exe file can be installed manually on workstations as described in Section "Single Workstation Installation" in the Clinical Imaging Installation Guide. Autoupdate Installation: ======================== These steps assume Autoupdate has already been implemented. For information about setting up Autoupdate, see Section "Setting Up and Using Autoupdate" in the Clinical Imaging Installation Guide. 1. Download MagAUShare.zip and magInstall.exe from the Imaging FTP server to a local storage location. 2. Rename Mag3_0P122_install.exe to MagInstall.exe. 3. Copy the new Mag3_0P122_install.exe file to the location specified in magautoupdate.bat. (magautoupdate.bat is typically stored in Program Files\VistA\Imaging\InstallationService on the system where VIIS is installed). 4. Perform the following steps to allow the new software to be pushed to designated test workstations: a) Extract the contents of the MagAUShare.zip file to the UPDATE\TEST folder. b) In the UPDATE\TEST folder, open magnet.ini and change the placeholder for "InstallService" to reflect the server (or cluster name) where VIIS is installed. [update_mode] ForceUpdateAll=FALSE InstallFile=MagSetup.exe InstallService=http:///imaging/install.asmx =TRUE 5. Run Clinical Display and Clinical Capture on the test workstations for a period of time to ensure there are no problems with the software at your site. 6. When it is verified that the software is running properly, extract the contents of the MagAUShare.zip file to the UPDATE\DISTRIB folder. 7. In the UPDATE\DISTRIB folder, open magnet.ini and change the placeholder for "InstallService" to reflect the server (or cluster name) where VIIS is installed. All workstations will be updated the next time Clinical Display or Clinical Capture is run. Other Automatic Installation Methods (SMS, PSexec, etc.): ========================================================= The following methods are available to push updated software to multiple workstations: * Remote push of Mag3_0P122_install.exe using PSexec and an administrator's account: For details, see section "Remote Push Installation using PSExec" in the current Clinical Imaging Installation Guide. * Remote push using Microsoft SMS or similar remote installation software: Either Mag3_0P122_install.exe or Mag3_0P122_install.msi can be used for this. Installation specifics will vary from site to site. Routines: ========= For each routine, the second line will contain the following information. ;;3.0;IMAGING;**[patch list]**;Mar 19, 2002; Build 92;Aug 02, 2012 New and modified routines for the VistA System are listed below. Please note that the "before" checksum may differ if any test software has been installed. MAGIP122 routine is a post install routine and is deleted after the KIDS install. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: MAGDRPC1 Before: B46610398 After: B48033690 **11,30,51,50,54,49,122** Routine Name: MAGGA03Q Before: B73673627 After: B82673839 **117,122** Routine Name: MAGGAII Before:B120962526 After:B177433198 **93,94,122** Routine Name: MAGGI12 Before: B36188951 After: B97013744 **93,94,122** Routine Name: MAGGI13 Before: B43871753 After: B65233516 **93,117,122** Routine Name: MAGGNTI Before: B68648040 After: B77235042 **10,8,59,93,108,122** Routine Name: MAGGTPT1 Before: B43431536 After: B51976467 **16,8,92,46,59,93,117,122** Routine Name: MAGGTRPT Before: B43638944 After: B43148529 **8,48,93,122** Routine Name: MAGGTU4C Before: B4896018 After: B5095269 **93,94,106,117,122** Routine Name: MAGGTU4D Before: B4901823 After: B5101074 **93,94,106,117,122** Routine Name: MAGGTU4L Before: B4896099 After: B5095350 **93,94,106,117,122** Routine Name: MAGGTU4T Before: B4896171 After: B5095422 **93,94,106,117,122** Routine Name: MAGGTUP Before: B24946997 After: B26333617 **7,8,48,45,59,93,94,117,122** Routine Name: MAGIP122 Before: n/a After: B8703636 **122** Routine Name: MAGSANNO Before: n/a After: B90488683 **122** Routine Name: MAGSPID Before: n/a After: B3911091 **122** Routine list of preceding patches: 49, 108, 117 ============================================================================= User Information: Hold Date : NOV 01, 2012 Entered By : TROMBETTA,KATHY Date Entered : MAR 15, 2011 Completed By: CASUGAY,ELSIE G Date Completed: OCT 02, 2012 Released By : DILORENZO,JOHN Date Released : NOV 14, 2012 ============================================================================= Packman Mail Message: ===================== No routines included