$TXT Created by VIPDEV11.AAC.DOMAIN.EXT (KIDS) on Wednesday, 10/10/18 at 12:35 ============================================================================= Run Date: NOV 07, 2018 Designation: OR*3*441 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: Mandatory Version : 3 SEQ #413 Status: Released Compliance Date: DEC 08, 2018 ============================================================================= Associated patches: (v)OR*3*311 <<= must be installed BEFORE `OR*3*441' (v)OR*3*356 <<= must be installed BEFORE `OR*3*441' (v)OR*3*434 <<= must be installed BEFORE `OR*3*441' Subject: EPIP OR REMEDIATION 2.0 Category: - Routine - Data Dictionary - Print Template - Other Description: ============ OR*3.0*441 provides the following enhancements to VistA: - Modifies the display of flagged Order comments and Ward comments to make them readily available on the Computerized Patient Record System (CPRS) Orders tab where Clinical staff can plainly see them. Currently, the clinician must double-click the order and search through activity details to find the flagged Order comment or Ward comment. Not only is this search time-consuming, but it requires that the clinician recognize the need to actively search. This can result in comments being overlooked and not addressed in a timely manner, thus impacting patient safety and care. The Flagged and Ward comments modification comes with an On/Off switch. The default position is OFF. To enable the modification, use the XPAR MENU TOOLS option to set the OR FLAGGED & WARD COMMENTS parameter to ON. This parameter is stored in the PARAMETER DEFINITION file (#8989.51). - Enables support for tracking antimicrobial medication quick orders by adding a tracking hook to enhance auditing of those orders. Sites that do not wish to track antimicrobial prescribing practices using quick orders, or do not use the VISN 23 Antimicrobial Clinical Decision Support System (CDSS), do not need to perform the setup steps for using the antimicrobial hooks and reporting features described in the supporting documentation for this patch. The Antimicrobial Decision Tree Hook functionality is enabled by two new TIU Objects (hooks) added to the TIU DOCUMENT DEFINITION file (#8925.1). The |OR QUICK ORDER AUDIT| hook tracks clinically preferred antimicrobial drug quick orders; the |OR QUICK ORDER AUDIT(ALT)| hook tracks quick orders that prescribe an alternative to a clinically preferred antimicrobial drug. This enhancement does not provide any preconfigured quick orders; the quick orders must be set up and added to CPRS by a Clinical Application Coordinator (CAC) or Office of Information and Technology (OIT) staff member. When creating an antimicrobial drug quick order, either the |OR QUICK ORDER AUDIT| or the |OR QUICK ORDER AUDIT(ALT)| hook must be added to the order Comments field to enable quick order audit capabilities. Note: When setting up Antimicrobial Quick Orders, respond YES at the "Verify Order" prompt and NO at the "Auto-Accept" prompt. If a YES response is made at the "Auto-Accept" prompt, then two pharmacy confirmation numbers will appear in the new antimicrobial quick order tracking file and subsequent Quick Order Audit reports. This does not result in the creation of multiple drug orders. When an antimicrobial drug quick order containing one of the Quick Order Audit hooks is created from the CPRS Orders tab, a pharmacy confirmation number is displayed with other order information such as the medication, dose, schedule, and special instructions. When the medication order is accepted by the clinician, an order number is assigned; this number serves as verification that the order was completed. Six VistA quick order auditing options are provided with this enhancement: OR Quick Order Nightly Background Task [OR QUICK ORDER NIGHTLY BG], OR Quick Order Audit Menu [OR QUICK ORDER AUDIT MENU], OR Quick Order Audit Inquiry [OR QUICK ORDER AUDIT INQUIRY], OR Quick Order Audit Print [OR QUICK ORDER AUDIT PRINT], OR Quick Order Audit Monthly [OR QUICK ORDER AUDIT MONTHLY], and OR Quick Order Division Groups Edit [OR QUICK ORDER DIVISION GROUPS]. These options enable the various auditing and reporting features associated with antimicrobial quick orders. The OR Quick Order Nightly Background Task is scheduled to run by TaskMan. This option adds the order number to the QUICK ORDER AUDIT file (#100.95) if the order is accepted. The background job scheduling is set to YES and is preset to run at 23:01 and then to re-run at 24-hour intervals. These default settings can be modified by OIT staff. The OR Quick Order Audit Menu option displays the OR Quick Order Audit Inquiry, OR Quick Order Audit Print, OR Quick Order Audit Monthly, and OR Quick Order Division Groups Edit options. - The OR Quick Order Audit Inquiry option uses the pharmacy confirmation number to retrieve order details for individual antimicrobial quick orders from the QUICK ORDER AUDIT file. The pharmacy confirmation number is displayed in the order Comments field in CPRS when the order is created; it is also included in the report generated using the OR Quick Order Audit Print option. - The OR Quick Order Audit Print option provides information about antimicrobial quick order usage. Date range fields are provided to limit the report output to a specific time period. The information in this report reflects provider medication decision trends because a pharmacy confirmation number is recorded any time an antimicrobial quick order containing one of the Quick Order Audit hooks is created, even if the order is not accepted. If the order is accepted, an order number is also included. This report uses a Print template and a Sort template, each named [OR QUICK ORDER AUDIT REPORT], to display information from the QUICK ORDER AUDIT file. - The OR Quick Order Audit Monthly option generates a report that includes details on all antimicrobial drug orders placed during a user-specified reporting period. The monthly report can be run for any period of up to 31 days for which data is present in the system. This report separates antimicrobial orders into those placed using a quick order and those placed using a method other than a quick order. This report is intended to be exported in a delimited format to an HFS (HOST FILE DEVICE) at the standard device prompt "DEVICE:" for import into Excel. Before the standard prompt is presented, the new prompt "Do you want a delimited report to a printer or home device ? NO//" is presented to facilitate those sites that do not have access to an HFS (HOST FILE DEVICE). If a user selects the default NO response, then the standard "DEVICE:" prompt will display and the user can choose to send a delimited report to the HFS (HOST FILE DEVICE) or to have a non-delimited report sent to the screen or other printer. If the user responds "YES" at the new prompt, then a modified device prompt, "DELIMITED REPORT DEVICE: HOME//," is presented. From this prompt, the user can send a delimited report to the screen or to a printer, but will have to use other methods (for example, turning on logging) to capture the delimited report so that it can be imported into Excel the same way that an HFS (HOST FILE DEVICE) would deliver the report. The user can additionally choose to include orders that are missing a location by responding "YES" at the "Do you want to print orders with MISSING LOCATIONS? NO//" prompt. Before using this report, it must be configured using the OR Quick Order Division Groups Edit option. - The OR Quick Order Division Groups Edit option enables editing of the QUICK ORDER DIVISION GROUPS file (#100.953). This file allows large facilities to filter the OR Quick Order Audit Monthly report into groups of Medical Center divisions to be included in separate reports. The selected divisions are stored in the MEDICAL CENTER DIVISIONS field (#100.9531). This field only supports selecting from existing entries found in the MEDICAL CENTER DIVISION file (#40.8). Proper configuration requires each site to create one or more group names and then add all subordinate divisions to include in the group. When a group is added, the user is prompted for the divisions to include; a different subset of divisions may be selected for each group. Sites desiring only one report must include all of the Medical Center divisions associated with their facility in a single group. Note: The Quick Order Audit Inquiry [OR QUICK ORDER AUDIT INQUIRY] report may not accurately record antimicrobial quick orders in the QUICK ORDER AUDIT file (#100.95) when processing multiple delayed orders at one time. Due to an issue with legacy delayed order processing of quick orders, the system does not transmit all the required variables for antimicrobial quick order tracking. This may result in inaccuracies when using the inquiry report. However, the Quick Order Audit Monthly [OR QUICK ORDER AUDIT MONTHLY] report provides accurate information for all orders and can be used in its place. This report retrieves information from the Order file (#100) and provides real-time data on all antimicrobial orders. The report separates Quick Orders and Non-Quick Orders and can be used to identify antimicrobial quick orders for verification and auditing purposes. Those individuals assigned the Quick Order Audit Menu [OR QUICK ORDER AUDIT MENU] have access to all of the new user options associated with this patch, including the monthly report. The patch functionality is turned ON by adding one of the two new hooks to antimicrobial quick orders defined for the site. The functionality is turned OFF by removing the hook from the Comments section of any quick orders previously configured with either hook. To completely turn off the Antimicrobial Decision Tree Hook functionality, the scheduled OR Quick Order Nightly Background Task [OR QUICK ORDER NIGHTLY BG] must also be turned off. Note: Sites that are utilizing an existing CDSS to select quick orders associated with antimicrobial drugs can continue using the CDSS without interruption following implementation of this enhancement. During patch installation, Quick Orders preconfigured with a |ZZ QUICK ORDER AUDIT|, |ZZ QUICK ORDER AUDIT (CI)|, or |ZZ QUICK ORDER AUDIT (NE)| hook will be automatically converted to the new |OR QUICK ORDER AUDIT| hook. Quick Orders preconfigured with the |ZZ QUICK ORDER AUDIT (ALT)|, |ZZ QUICK ORDER AUDIT (CI-ALT)|, or |ZZ QUICK ORDER AUDIT (NE-ALT)| hook will be automatically converted to the new |OR QUICK ORDER AUDIT(ALT)| hook. BLOOD BANK Clearance: -------------------- EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3.0*441 contains changes to a package referenced in ProPath standard titled: BBM Team Review of VistA Patches. This patch does not alter or modify any VistA Blood Bank software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch OR*3.0*441 have no effect on Blood Bank software functionality, therefore RISK is none. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- QUICK ORDER AUDIT NEW (#100.95) QUICK ORDER DIVISION MEDICAL CENTER NEW GROUPS (#100.953) DIVISIONS (#100.9531) TIU DOCUMENT DEFINITION MERGE/ ADDED TWO OBJECTS (#8925.1) PARAMETER DEFINITION MERGE/ ADDED A PARAMETER (#8989.51) Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ------------------------------ ---- -------------------- OR QUICK ORDER AUDIT MONTHLY RUN ROUTINE NEW OR QUICK ORDER AUDIT INQUIRY INQUIRE NEW OR QUICK ORDER AUDIT MENU MENU NEW OR QUICK ORDER AUDIT PRINT PRINT NEW OR QUICK ORDER NIGHTLY BG RUN ROUTINE NEW OR QUICK ORDER DIVISION MULTIPLE NEW GROUPS EDIT Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Parameters Associated: Parameter Name New/Modified/Deleted -------------- -------------------- OR FLAGGED & WARD COMMENTS New Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted --------------- ---- ----------------- -------------------- OR QUICK ORDER PRINT QUICK ORDER AUDIT NEW AUDIT REPORT (#100.95) OR QUICK ORDER SORT QUICK ORDER AUDIT NEW AUDIT REPORT (#100.95) Additional Information: N/A New Service Requests (NSRs): ---------------------------- NSR20150103 Display Flagged and Ward Comments NSR20160613 Anti-Microbial Decision Tree Interface Hook Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- N/A Problem: ------- N/A Resolution: ---------- N/A Test Sites: --------- Milwaukee VA Medical Center, Milwaukee, WI Minneapolis VA Health Care System, Minneapolis, MN VA Nebraska-Western Iowa Health Care System, Omaha, NE Software and Documentation Retrieval Instructions: ---------------------------------------------------- The software is released as a PackMan message and is distributed from FORUM. Software documentation describing the new functionality introduced by this patch is available for downloading. The preferred method is to retrieve files from download.vista.domain.ext. This transmits the files from the first available server. Sites may also elect to retrieve files directly from a specific server. Sites may retrieve the 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 in the VA Software Document Library (VDL) at: https://www.domain.ext/vdl/. Title File Name FTP Mode ----------------------------------------------------------------------- CPRS User Guide: GUI Version cprsguium.doc Binary CPRS User Guide: GUI Version cprsguium.pdf Binary CPRS Technical Manual: GUI Version cprsguitm.doc Binary CPRS Technical Manual: GUI Version cprsguitm.pdf Binary Patch Installation: Pre/Post Installation Overview: ------------------------------- Review the Pre-Installation Instructions provided before beginning installation of the patch. Pre-Installation Instructions: ------------------------------ This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 minutes to install. Installation Instructions: ------------------------------ To install the patch: 1. Choose the PackMan message containing this patch. 2. Choose the INSTALL/CHECK MESSAGE PackMan option. 3. From the Kernel Installation and Distribution System (KIDS) menu, select the Installation Menu. From this menu, you may elect to use the following options. When prompted for the INSTALL NAME, enter the patch number OR*3.0*441. a. Verify Checksums in Transport Global - This option will help ensure the integrity of the routines that are in the transport global. b. Print Transport Global - This option will enable viewing the components of the KIDS build. c. Compare Transport Global to Current System - This option will enable viewing all changes that will be made when this patch is installed. It compares all components of this patch (routines, data dictionaries, templates, etc.). d. Back up a Transport Global - This option will create a backup message of any routines exported with this patch. It will not back up any other changes such as data dictionaries or templates. 4. From the Installation Menu, select the Install Package(s) option and choose the patch to install. 5. If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', press . 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', press . 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', press . 8. If prompted 'Delay install (Minutes): (0-60): 0//', press . 9. If prompted '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// HOME (CRT)', press . Post-Installation Instructions: ------------------------------ The Post-Installation routine ORQO441P will schedule the OR Quick Order Nightly Background Task [OR QUICK ORDER NIGHTLY BG] option to run every 24 hours at 23:01 on the next calendar day. If this is not an optimal time to run the option, then a member of the OIT staff must manually reschedule this option. This routine also creates two new objects in the TIU DOCUMENT DEFINITION file (#8925.1) - |OR QUICK ORDER AUDIT| and |OR QUICK ORDER AUDIT(ALT)|. Sites with quick orders containing the |ZZ QUICK ORDER AUDIT|, |ZZ QUICK ORDER AUDIT (CI)|, or |ZZ QUICK ORDER AUDIT (NE)| hook in the order Comments field must convert those orders to use the |OR QUICK ORDER AUDIT| hook. Sites with quick orders containing the |ZZ QUICK ORDER AUDIT (ALT)|, |ZZ QUICK ORDER AUDIT (CI-ALT)|, or |ZZ QUICK ORDER AUDIT (NE-ALT)| hook must convert those orders to use the |OR QUICK ORDER AUDIT(ALT)| hook. A utility in the post-installation routine automatically performs this conversion. Each quick order that the utility converts is displayed on the screen as the routine executes. No conversion is needed at sites that do not have previously configured antimicrobial quick orders using a "ZZ" prefixed hook. Routine ORQO441P is automatically deleted at the end of the installation. Backout Procedure: ------------------ Backout of this patch will be performed only with the concurrence and participation of the appropriate VA site/region personnel. The decision to back out the patch will be a joint decision between VA site/region personnel and other appropriate VA personnel. Note: Due to the complexity of this patch, it is not recommended for backout, and a restore from a backup of the Transport Global should not be attempted. However, in the event that a site decides to back out this patch, the site should contact the National Service Desk (NSD) to submit a help desk ticket. The development team will need to issue one or more follow-on patches in order to comprehensively back out this patch, after coordination with the VA Project Manager and COR. Validation of Backout Procedure: -------------------------------- The Backout procedure can be verified by printing the first two lines of the OR routines contained in this patch using the option First Line Routine Print [XU FIRST LINE PRINT]. Once the OR routines have been backed out, the first two lines of the routines will no longer contain the designation of patch OR*3.0*441 on line 2 in the patch list section. Note: This validation procedure only verifies that routine changes have been backed out; it does not confirm that other patch component changes have been backed out. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 52 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORQ12 Before: B37558185 After: B41144852 **12,27,78,92,116,190,220,215, 243,356,441** Routine Name: ORQO441P Before: n/a After: B21266113 **441** Routine Name: ORQOAUIA Before: n/a After: B6757048 **441** Routine Name: ORQOAUIB Before: n/a After: B45897882 **441** Routine Name: ORQOAUIC Before: n/a After: B15051497 **441** Routine Name: ORWDXM3 Before:B118361960 After:B120942767 **10,85,131,132,141,185,187, 190,195,215,243,303,296,280, 350,434,441** Routine Name: ORWPT Before: B64148022 After: B77269918 **10,85,132,149,206,187,190, 215,243,280,306,311,441** Routine list of preceding patches: 311, 356, 434 ============================================================================= User Information: Entered By : Date Entered : OCT 17, 2016 Completed By: Date Completed: NOV 05, 2018 Released By : Date Released : NOV 07, 2018 ============================================================================= Packman Mail Message: ===================== $END TXT