Introduction

CP provides features that can be used across clinical departments such as general medicine, cardiology, pulmonary, women’s health, neurology, and rehabilitation medicine. CP uses the procedure order function that is included with the Consults/Procedures package.  For example, a clinician places an order for a procedure, such as an EKG, in the Consults/Procedures application.

If the procedure is performed on a bi-directional instrument, the patient demographics are automatically transmitted to the instrument.  When the procedure is complete, the result is then transmitted back to VistA.  The result is stored in VistA Imaging and associated with a TIU document.  The result and the TIU document are then associated with the original Consults order.

If the procedure is performed on a uni-directional instrument, then the clinician must use the CP User application to match the instrument results to the procedure order.  Then the clinician submits the results to Imaging and creates the TIU document.  Once the TIU document is in place, standard Consults functionality is used to complete and sign the TIU document.


Adding an Automated Instrument

If a site has an instrument that needs to interface with CP, and that instrument is not exported with the Clinical Procedures package, you need to add the instrument. A warning screen displays when you attempt to add a new instrument. This warning screen informs you that you should make sure CP supports the instrument interface you are attempting to add. If you are adding a new instrument (bi-directional or uni-directional) that is not supported by CP, then you must enter a NOIS/Remedy help ticket. Keep in mind that adding unsupported instruments is a complex task and may cause some image quality problems.

In most cases, you can edit an existing automated instrument and not add a new one because several automated instruments are installed with Clinical Procedures.  Check for the existence of an automated instrument that would satisfy your needs before adding a new automated instrument.  To view the names of devices, click the Instruments folder.   A list of automated instruments is displayed on the left side of the Clinical Procedures Manager window.

Indicates active instruments.

Indicates non-active instruments.

1.	Select File > New > Instrument.  The New Instrument screen is displayed.

2.	Enter a name that can be used to identify the automated instrument.  If you are adding a new instrument that is already supported by CP, do one of the following:

- If the device is bi-directional, you can enter a name of your own choice, such as Muse EKG (Tampa), (3-30 characters).  The name does not have to be the vendor’s name.

- If the device is uni-directional, enter a CP defined name.  In this case, you can contact TSO or NVS for the correct instrument name.

If you are adding a new instrument (bi-directional or uni-directional) that is not supported by CP, then you must you must enter a NOIS/Remedy help ticket.  Keep in mind that adding unsupported instruments is a complex task and may cause some image quality problems.

This field must be filled in for an active instrument to work properly.

3.	Click OK.  The Edit screen is displayed.  The Automated Instrument Name that you just entered is displayed.

4.	Enter data for each field as applicable.

5.	Click Save when you are done.

6.	Click Print if you want to print an Automated Instrument report.

Use the Instrument Analyzer to see if an automated instrument is ready to use with CP.

View the list of Field Descriptions for Automated Instruments.


About Automated Instruments

In most cases, you can edit an existing automated instrument.  The Clinivision, Muse, Olympus, and Sensormedics automated instruments are exported with Clinical Procedures.  You must edit all the automated instruments that you want to implement with necessary information.

The following list of fields applies to automated instruments:

*  Indicates fields that must be filled in for an active instrument to work properly.

BOLD indicates fields that are already populated when an automated instrument is exported.

∗ Instrument Name

∗ Printable Name

Description

∗ M Routine

∗ Pkg. Code

∗ Valid Attachment Types

If Bi-Directional Instrument is checked:

∗HL7 Inst ID

∗HL7 Link

∗ Notification Mailgroup

∗ Active

Serial Number (Optional)

Delete When Submitted (Optional)

Default Extension (Optional)

IP Address  (Optional)

Port  (Optional)

HL7 Unv Svc ID  (Optional)

Server Name  (Optional)

Share Name  (Optional)

Path Name  (Optional)

Executable Name  (Optional)

Instructions on Adding or Editing an Automated Instrument.

View the list of Field Descriptions for Automated Instruments.


Editing an Automated Instrument

1.	View the list of automated instruments.

2.	Click on an automated instrument.  The edit screen is displayed on the right side of the Clinical Procedures Manager window.

3.	Enter the fields that apply to the instrument you selected.

4.	Click Save when you are done.

5.	Click Print if you want to print an Automated Instrument report.

Use the Instrument Analyzer to see if an automated instrument is ready to use with CP.

View the list of Field Descriptions for Automated Instruments.


Field Descriptions for Automated Instruments

Here is a list of fields for automated instruments.

General:  This section contains general information about the instrument.

Instrument Name:  If you are editing an instrument, the name is filled in.

If you are adding a new instrument that is already supported by CP, do one of the following:

- If the device is bi-directional, you can enter a name of your own choice, such as Muse EKG (Tampa), (3-30 characters). The name does not have to be the vendor’s name.

- If the device is uni-directional, you need to enter a CP defined name. In this case, you can contact TSO or NVS for the correct instrument name.

If you are adding a new instrument (bi-directional or uni-directional) that is not supported by CP, then you must enter a NOIS/Remedy help ticket. Keep in mind that adding unsupported instruments is a complex task and may cause some image quality problems.

This field must be filled in for an active instrument to work properly.

Printable Name:  Enter a name for the instrument report (3 to 30 characters). You can use the same name as the instrument name. This name is used as the printable name on reports. Must be filled in for an active instrument to work properly.

Notification Mailgroup:  Enter the name of a local VistA mailgroup that contains a list of people, who will be notified if a problem arises with this automated instrument.

CP also exports a mailgroup called "MD DEVICE ERRORS" that can be used to populate this field.   Enter MD and the field fills in with "MD DEVICE ERRORS’. The coordinator of this group is assigned during package installation.  Must be filled in for an active instrument to work properly.

Description:  Enter a description of the automated instrument (1-50 characters). Optional.

Serial Number:  Enter the serial number of the automated instrument (1-50 characters).  The serial number is used for documentation purposes. Optional.

Active:  Select this option if you want to make the instrument active and able to transmit results.   Do not select if the package coordinator wants to prevent data from a specific automated instrument from being processed. A package coordinator may want to enter the basic information for an automated instrument and not make it active.  Must be selected to make this instrument active.

Attachment Processing:  This section contains information about attachments.

Delete when Submitted:  Select this option if the medical center does not want to store a duplicate report outside of Imaging, or if the vendor wants to delete files because of storage issues.  The vendor determines whether or not the report files can be deleted.  This information is found in the vendor’s setup instructions.  Optional.

Default Ext.:  Enter a default file extension that is exported by the vendor, such as .html, .jpg, and .pdf.  This information should be obtained from the vendor or will be exported with future patches. Optional.

M Routine:  Indicates the M routine used to process the HL7 message from the automated instrument (1-8 characters).  Enter an M routine if the site is entering a new device.  The routine must have a namespace of MDHL7* for any nationally released interfaces.  This field also is automatically populated when an instrument interface patch is installed.  If a local M routine is developed, use the local namespace.  Must be filled in for an active instrument to work properly.

Pkg. Code:  Indicates which package is to process the instrument results.  Must be filled in for an active instrument to work properly.

Medicine:	Select if your study data is stored in the Medicine package.  If a site is currently running Medicine and has an instrument used for Medicine, you can still send the result to Medicine by selecting this field.

CP V1.0	Select if your study data is stored as a final report (in the format of an Imaging document) in Clinical Procedures.

Valid Attachment Types:  Data types let CP know what kind of data output to expect from the automated instrument so that the data can be processed by the interface routines.  The vendor setup instructions provide this information, or Clinical Procedures automatically exports this information. Must be filled in for an active instrument to work properly.

Here is a list of valid attachment types:

UNC (Universal Naming Convention or Uniform Naming Convention) - A PC format for specifying the location of resources on a local-area network (LAN).

UUENCODE (Unix-to-Unix ENCODE) - A set of algorithms for converting files into a set of ASCII characters that can be transmitted over a network.

Text - Text stored as ASCII codes.

XML (eXtensible Markup Language) - A specification developed by the World Wide Web Consortium (W3C), the organization that sets standards for the web.  XML is a pared-down version of SGML.  Designed especially for Web documents.

URL (Uniform Resource Locator) - The global address of documents and other resources on the World Wide Web.

XMS - An XML Style Sheet.

DLL (Dynamic Link Library) - A library of executable functions or data that can be used by a Windows application.

Bi-Directional Capabilities:  This section contains specifics on the bi-directional capabilities of the instrument.

Bi-Directional Instrument: Select this option if this instrument supports a bi-directional interface.

IP Address:  Enter the IP address for the instrument (7-15 characters).  This field is for documentation purposes only.  Optional.

Port:  Enter the port number for the instrument (a number between 1000 and 99999).  This field is for documentation purposes only.  Optional.

HL7 Inst ID:  Enter the name of the actual device as provided by the vendor. This field is used to ID the device (3-30 characters).  You can contact TSO or NVS for the correct ID. Must be filled in for an active instrument to work properly.

HL7 Unv Svc ID:  This field defines what type of procedure the device can perform if the device can perform more than one procedure (1-48 characters). Optional.

HL7 Link:  There is one unique link for each instrument.  Select the appropriate link to the instrument from the dropdown list. Must be filled in for an active instrument to work properly.

Server Executable:  The following fields make up the path for the automated instrument server (http://servername/servershare/serverpath/server.exe).  Some devices do not produce reports that can be saved. Enter these fields if you want to capture a report from that type of device.

Server Name:  The network name of the automated instrument (1-30 characters).

Server Share:  The name of the share drive on the automated instrument server (1-30 characters).

Server Path:  The full directory path on the automated instrument share (1-150 characters).

Server Executable:  The name of the executable that produces the report on the automated instrument (1-30 characters).  Browse to find the path where the server.exe program resides.

Instructions on Adding or Editing an Automated Instrument.


Adding a Procedure

Before you add a procedure, you can check to see if an appropriated titled procedure already exists that meets your needs.  To view the names of procedures, select Procedures and then the appropriate treating specialty folder.  A list of procedures is displayed.

 - Identifies an active procedure

 - Identifies a inactive procedure

If you decide that you do need to add a procedure, follow these instructions:

1.	Select File > New > Procedure.

2.	Enter the name of the procedure that you want to add. It is recommended that you enter the name in uppercase with a minimum of 3 characters and a maximum of 30 characters.

3.	Click OK. The Edit screen is displayed.  The Procedure Name that you just entered is displayed in the left side of the CP Manager window in the Unassigned folder.

4.	Enter data for each field as applicable.

5.	Click Save when you are done.  After you complete the edits, if you entered the name in upper case, the procedure name that you just entered is displayed in title case.

6.	Click OK.  The new procedure appears in the list on the left side of the CP Manager window. Check that the procedure is placed in the correct treating specialty folder.

7.	Click Print if you want to print a Procedure report.

View the list of Field Descriptions for Procedures.


Editing a Procedure

•	Double-click the procedure.  Now you can edit the procedure, complete the necessary fields, and make the procedure active.

•	To activate the procedure, be sure to select the Active field, and then fill in the following fields to ensure that the procedure works properly

Treating Specialty

TIU Note Title

Hospital Location

To edit a procedure:

1.	View the list of procedures.

2.	Click a procedure name.  The edit screen is displayed on the right side of the Clinical Procedures Manager window.

3.	Enter the fields as applicable.

4.	Click Save when you are done.

5.	If you selected a different treating specialty folder, a confirmation message is displayed. Click OK to confirm that the procedure is in the correct treating specialty folder.

6.	Click Print if you want to print a Procedure report.

Note: A procedure can only be deleted through the main menu bar.  If a procedure has been assigned through Consults, it cannot be deleted.

View the list of Field Descriptions for Procedures.


Field Descriptions for Procedures

Here is a list of fields for Procedures.

General:  This section contains general information about the procedure.

Procedure Name:  Enter a name used to uniquely identify the procedure (3-30 characters). It is recommended that you enter the name in uppercase, such as PACEMAKER FOLLOWUP.

After you complete the edits, if you entered the name in upper case, the procedure name that you just entered is displayed in title case, Pacemaker Followup, (the first letter of every word is capitalized), in the left side of the CP Manager window.

Active:  Select if you want the procedure to be mapped to Consults.  Only active procedures can be selected and linked to the Consults package.  Be sure to fill in the Treating Specialty, TIU Note Title, and Hospital Locations fields. Do not select if you do not want procedures to display. Must be selected to make this procedure active.

Treating Specialty:  Enter at least two letters of a treating specialty, such as CA for CARDIOLOGY, and then click the down arrow to select an appropriate match from the list.  This list comes from the Treating Specialty (#45.7) file.  Must be filled in for an active procedure to work properly.

TIU Note Title:  Enter at least two letters of a TIU Note Title, such as CP CARD for CP CARDIOLOGY NOTE or CARD for CARDIOLOGY, and then click the down arrow to select an appropriate match from the list, which comes from the 8925.1 file. This title must be in the CLINICAL PROCEDURES CLASS.   Must be filled in for an active procedure to work properly.

Hospital Location:  Enter at least two letters of a hospital location, such as CA for Cardiac Clinic, and then click the down arrow to select an appropriate match from the list, which comes from the #44 file. The Hospital Location file is the location where the workload credit for the procedure is tracked and is needed so CPRS can display the appropriate encounter form when prompted. Must be filled in for an active procedure to work properly.

If the Medical Administrative Service (MAS) schedules appointments for patients who are having clinical procedures, enter a NON-COUNT clinic for the location.  (A hospital location can be defined as a Non-Count clinic in the Scheduling packaging. A NON-COUNT clinic is used only for scheduling purposes and not for workload reporting.)

Auto Submit to VistA Imaging:  Select if a procedure is processed by a bi-directional instrument and additional data does not need to be matched. The study is automatically submitted to VISTA Imaging. If this field is not selected, the study will be in the Ready to Complete status.  Optional.

Require External Data:  Select if you want this procedure to allow external attachments.  For example, you might want to attach an independent report from a VA or non-VA health care facility. If you want to manually select external attachments, you must select this field.

Be sure the Allow Non-Instrument Attachments checkbox is selected in CP Manager > System Parameters. There is no default for this field.

External Attachment Directory:  If you select Require External Data, enter the path where the data is located, or browse to locate a directory (3-150 characters).  There is no default on this field.  You can locate any directory on the LAN. This is the directory that CP User accesses to find attachments. This directory must be a network share directory that the VistA Imaging Background Processor can access.

Allowable Instruments:  Select each automated instrument that provides results for this procedure.  You can select more than one instrument for a procedure. If you only want to use external attachments, do not select any instruments.

You can select both Allowable Instruments and Require External Data. For example, you can have a pathology report from an endoscopy and you can attach the report to the procedure.

Instructions on Adding or Editing a Procedure.


Finding a Parameter

Use this option when you want to find a specific automated instrument or procedure.

1.	Select Tools > Find a Parameter.

2.	Enter a partial or complete name of the instrument or procedure.

3.	Click OK to begin the search.

4.	If you find the parameter that you are searching for, click Yes on the confirmation window.  The edit window for the parameter is displayed.


Printing Reports

You can print a listing of automated instruments, procedures, or system parameters.  You can also print a detailed report of a selected instrument or procedure.

To print a list of instruments, procedures or system parameters, do the following:

1.	Select File > Print.

2.	Select Automated Instruments, Procedures, or System Parameters.  If you previously selected a specific instrument or procedure, you can also select that instrument or procedure name.

3.	Click OK to print.

To print a report of a selected instrument or procedure:

1.	Select the instrument or procedure name.

2.	Select File > Print.

3.	From the list of available reports, select the procedure or instrument. You may have to enter a report title.

4.	Click OK to print.


Setting Up System Parameters

System parameters are system-wide and affect all procedures and instruments. You must select Clinical Procedure On-Line, and fill in the CP/BGP Transfer Directory and the VistA Scratch HFS Directory fields for CP to work properly.  You can edit the other parameters as required for your site.

Here is a list of the system parameters:

*  Indicates fields that must be filled in for CP to work properly.

Allow non-instrument attachments

Bypass CRC Checking

Clinical Procedures Home Page

* Clinical Procedures On-Line

* CP/BGP Transfer Directory

CRC Values

Days to keep instrument data

Imaging File Types

Offline Message

Version Compatibility

* VistA Scratch HFS Directory

1.	Click System Parameters, which is displayed under the Clinical Procedures folder.  The System Parameters Edit window is displayed.

2.	Enter information in the necessary fields and in the optional fields as needed by your site.


Deleting an Automated Instrument or Procedure

Use this option to delete an automated instrument or procedure.

1.	Display the list of automated instruments or procedures on the CP Manager window.

2.	Click the name of the instrument or procedure that you want to delete.

3.	Select File > Delete.

4.	Click Yes to confirm the deletion.

Note:  If the procedure is linked to the Consults package, it cannot be deleted.


Calculating a Files CRC Value

You can calculate a file’s CRC (Cyclical Redundancy Check) value to determine if the file is the exact same file as the one that was distributed.  CRC values are recalculated every time an application is compiled.

1.	Select Tools > Calculate a file’s CRC Value.

2.	Select the file.

3.	You can copy the CRC value and paste it into a text file for reference purposes.


Using the Instrument Analyzer

Use the Instrument Analyzer to see if an automated instrument is ready to use with CP.

1.	Select Tools > Instrument Analyzer.

2.	Select the instrument that you want to analyze.  Click Analyze.  The window that is displayed indicates the ready status of the instrument and lists other information as well.

•	Ready Status - Pass or Fail.  If the Ready Status is Fail, a list of missing fields for that automated instrument is displayed.

•	If an Imaging share directory has not been configured, the following message is displayed "No Imaging Share indicated in the System Parameters."

•	If the M Routine (processing routine) is not in the MD or MC namespace, a warning is displayed indicating that the M Routine is not in the package namespace.

3.	Click Print or Close.


Bypass CRC Checking

Select if you want to bypass CRC (Cyclical Redundancy Check) during startup. When a CP application starts up, it can check with the server to be sure that the checksum of the application that is running is the same as the checksum of the application that was distributed.  If the checksum values do not match, a message displays stating that the values do not match.  You can continue using the application or exit.


CRC Values

A site can check that a specific build of the application is running on the client.  This level of checking is not mandatory and you can use the Bypass CRC Checking parameter if the site does not want this level of security.

If a site is running more than one version of the application or is testing a new patch, this field can contain multiple entries.  Each entry contains the name of the application with extension (no directory path) followed by a colon ‘:’ and the executable version number ‘#.#.#.#’.  Each of these entries contains the CRC value for that particular version of the executable.  You can also obtain CRC values for a version of an executable from the About menu or by selecting CP Manager > Tools >  Calculate a File’s CRC Value.  See Calculate a File's CRC Value.

Note: The MDPOST routine in the KIDS build sets this field during installation. The data in the parameter is predefined. Do not modify this parameter unless the site is performing local modifications to the client software


Days to keep Instrument Data

Enter the number of days (0-365) to save data from auto-instruments, after the data has been associated with a Clinical Procedures study.  If the data has not been associated with a study, the data is not purged from the temporary storage area.  Enter 0 or leave the field empty if you want the data to be retained forever

Note:  CP Gateway purges data daily.  This purge only deletes the raw data that comes from the instrument.  CP Gateway keeps data for a specified number of days based on the entry in "Days to keep Instrument Data".  Data older than this purged.  The data in Item Value field (#.1) and Item Text field (#.2) of the Upload Item multiple in the CP Results file (#703.1) are purged.


Imaging File Types

Verifies that a file type submitted by an instrument or user is acceptable and can be sent to the VistA Imaging RAID.  The Open a Study option in CP User uses this system parameter to determine if a file is an acceptable file type.

Note: The MDPOST routine in the KIDS build sets this field during installation. The data in the parameter is predefined. Do not modify this parameter unless the site is performing local modifications to the client software


VistA Scratch HFS Directory

Clinical Procedures uses the Host File Server (HFS) functionality in the VA Kernel to create reports.  VISTA broker processes require full read, write, and delete access to this directory.  (Check with IRM about this directory.)  If this directory is not filled in, CP tries to use the broker environment directory. Must be filled in for CP to work properly.


CP/BGP Transfer Directory

Enter the shared directory that is accessed by the Imaging Background  Processor (BGP) and CP Gateway.  Reports generated from text need to be placed in a location that can be accessed by the BGP.  The Network share must not reside physically on the Imaging RAID.  You can also use Browse to select the directory.  Must be filled in for CP to work properly.


Offline Message

Enter a message that users see when they try to activate CP User and Clinical Procedures is offline.  This message only displays when the Clinical Procedures On-line parameter is not checked.


Clinical Procedures On-Line

Must select if you want to use CP User and CP Gateway.  If this parameter is not selected, a warning message is displayed. (If a message has been entered into the Offline Message parameter, that message is displayed when the user tries to access CP User.)

This parameter is only effective when the VistA system is functioning and it is useful if you want to restrict access to Clinical Procedures. For example, you can set this field to offline if you are loading a newer version of CP.


Version Compatibility

Displays a list of client versions, identified by their executable name and windows file version, which are compatible with the currently running server version.  More than one version of the software may be flagged as compatible for backward compatibility.

To check the client version number:

1.	Open Windows Explorer and locate the Clinical Procedures folder.

2.	Right-click CPGateway.exe, or CPUser.exe., or CPManager.exe.

3.	Select Properties, and then click the Version tab. The version number, such as 1.0.0.17, is displayed.

4.	Go back to CP Manager. Double-click Clinical Procedures, and then click System Parameters.

5.	In the Version Compatibility tab, select each version that is compatible with the current server version.

Note: The MDPOST routine in the KIDS build sets this field during installation. The data in the parameter is predefined. Do not modify this parameter unless the site is performing local modifications to the client software

If an executable version is not compatible, a message is displayed when you try to use a Clinical Procedures application.

If the application is CP Manager, the user is allowed to continue.   If the application is CP User, the user needs to contact IRM because the client needs to be upgraded to the current version.


Clinical Procedures Home Page

Displays the Clinical Procedures home page and directs the browser to this page when accessed.

This parameter is used by the client application in the Help menu when the user selects the option Clinical Procedures on the Web.

Note: The MDPOST routine in the KIDS build sets this field during installation. The data in the parameter is predefined. Do not modify this parameter unless the site is performing local modifications to the client software.


Allow Non-Instrument Attachments

Select if you want to let users attach files from the network to studies.  If selected, the +Files icon displays in the Study window in CP User and lets the user select attachments. Indicates if external attachments (documents) are allowed including when an instrument has not created data.

Be sure to select Allow non-instrument attachments if you selected the Require External Data field in CP Manager for a specific procedure. If you do not select Allow non-instrument attachments, you will not be able to attach files to a procedure.