============================================================================= Run Date: JUN 10, 2013 Designation: PSO*7*391 Package : PSO - OUTPATIENT PHARMACY Priority: Mandatory Version : 7 SEQ #355 Status: Released Compliance Date: NOV 04, 2013 ============================================================================= Associated patches: (v)PSO*7*194 <<= must be installed BEFORE `PSO*7*391' (v)PSO*7*257 <<= must be installed BEFORE `PSO*7*391' (v)PSO*7*340 <<= must be installed BEFORE `PSO*7*391' (v)PSO*7*377 <<= must be installed BEFORE `PSO*7*391' (v)PSO*7*390 <<= must be installed BEFORE `PSO*7*391' (v)XU*8*580 <<= must be installed BEFORE `PSO*7*391' (v)PSS*1*166 <<= must be installed BEFORE `PSO*7*391' (v)PSO*7*400 <<= must be installed BEFORE `PSO*7*391' (v)PSD*3*76 <<= must be installed BEFORE `PSO*7*391' Subject: DEA E-PRESCRIBING FOR CS (CPRS V29) Category: - Routine - Enhancement (Mandatory) - Data Dictionary - Other Description: ============ Computerized Patient Record System (CPRS) v29 is an enhancement release with modifications for the Drug Enforcement Agency (DEA) electronic prescribing (ePCS) of controlled substances, Problem List changes for the use of SNOMED CT codes, and the display of Mental Health Treatment Coordinator (MHTC) information entered through the Primary Care Management Module. In addition to these enhancements, software changes are being made to correct several PSIs, Section 508 issues, and additional miscellaneous defect fixes. CPRS GUI version 29 consists of several host files, updated CPRS GUI and several Help files; too many to list (which will be located in a single directory named HELP): HDI_1_11.KID CONTAINS HDI*1*11 PATCH PSS_1_166.KID CONTAINS PSS*1*166 PATCH CPRSV29_PSO_PSD.KID CONTAINS PSO*7*391 AND PSD*3*73 PATCHES OR_GMPL_GMTS_XU_29.KID CONTAINS XU*8*609, GMPL*2*36, GMTS*2.7*86 AND OR*3.0*306 PATCHES CPRSChart.exe OR_30_371.KID CONTAINS OR*3.0*371 PATCH PSO_7_426.KID CONTAINS PSO*7*426 PATCH The host files were created to simplify installation and also to control the phased implementation of CPRS V29 at the Veterans Health Administration (VHA) facilities. To see the current status and target dates for Sites/VISN/Regions, please refer to the following site: http://go.usa.gov/TfvW Then open the document "CPRS GUI v29 Deployment Schedule.xslx". Patch information: HDI_1_11 supports CPRS v29 functionality by adding data for the Problem List Domain to the HDIS DOMAIN file (#7115.1). PSS*1*166, PSO*7*391, PSD*3*73 and PSO*7*426 supports the DEA ePCS functionality. GMPL*2*36 is an extension to accommodate SNOMED-CT. GMTS*2.7*86 supports the Problem List Standardization. XU*8*609 ePCS Support OR*3*306 New CPRS version 29 which contains several Remedy ticket fixes and enhances the Primary Care button by adding the Mental Health Treatment Coordinator and the Associate Provider. Adds a new Bulletin "OR PROBLEM NTRT BULLETIN" and reissues Mail Group OR CACS. By default, this bulletin will be delivered to the OR CACS Mail Group. It may be configured to be delivered to separate local mail groups for each Medical Center Division by setting the new OR PROBLEM NTRT BY DIVISION parameter. OR_30_371 includes support for CPRS v.29. Please refer to the "CPRS GUI v.29 Installation Guide" for installation and set-up information. This document is exported as OR_30_306_IG.doc and OR_30_306_IG.pdf and is included in OR_30_306.ZIP. Installation of these host files must be coordinated among the personnel affected because these host files will be installed in one installation session. Note: A new security key named "PSDRPH", has been sent out in the Controlled Substances patch PSD*3*76, which is a required patch for this patch (PSO*7*391). This key authorizes pharmacists to finish/verify digitally signed Schedule II-V CS orders placed via CPRS and should be assigned to registered pharmacists working with Schedule II-V drugs. The following modifications and enhancements are included in this patch (PSO*7*391): 1. When processing a digitally signed pending order, the integrity of the original order placed in CPRS is now being checked to ensure that the data fields listed below are not altered from the time the order is signed in CPRS and later selected for processing in backdoor pharmacy. This is done by passing the data elements listed below to a Kernel Application Programming Interface (API), Integration Control Registration (ICR) #3539, along with the CPRS hash count, provided by ICR #5709. The Kernel API compares these two hash values and returns an "OK" if the pending order is unaltered or otherwise, returns a "-1^error code^error message." Example: "-1^89802016^Mismatched digital signature hash values." These are the fields used in the hash check: Date of Issuance Full Name and Address of the Patient Drug Name Quantity Prescribed Directions for Use Prescriber Name Prescriber Address (site address) Prescriber DEA / VA Registration Number Order Number (CPRS) The Kernel API will also check for the validity of the DEA certificate. If the certificate is revoked or expired then the API will return the appropriate error code. If the error code is related to hash mismatch or the DEA certificate is revoked then the following events will be triggered during pending order processing: The order will be auto discontinued. First line of the pending order screen will have the message "Digital Signature Failed: Corrupted (Hash mismatch)" or "Certificate revoked" concatenated with "Order Auto Discontinued", and the message will be highlighted in reverse video. The status bar of the screen will have the message "Signature Failed: Corrupted (Hash mismatch)" or "Certificate revoked." A mail message will be generated to the holders of the PSDMGR key notifying that the order has been auto discontinued (similar to the example listed below). If the discontinuation is due to a hash mismatch as a result of altering one of the fields listed above then the mail message will show the altered fields with the discrepancies. Here is an example: Subj: DIGITALLY SIGNED NEW ORDER AUTO DISCONTINUED [#196353] 03/20/12@17:1024 lines From: POSTMASTER In 'IN' basket. Page 1 *New* ----------------------------------------------------------------------- Following order was auto discontinued when finishing a pending order due to Corrupted (Hash mismatch) - 89802016 Division : GREELEY CLINIC CPRS Order # : 5587651 Issue Date : MAR 7,2012 Patient : TEST,PATIENT (0908) Address : P.O. BOX 31 LAPORTE, CA 95981 Drug : CODEINE SULFATE 60MG TAB Dosage Ordered: 120(MG) Dosage Form : TABLETS Quantity : 54 Provider : TEST,PROVIDER DEA# : TA1234563 Site Address : 2360 E PERSHING BLVD 2360 East Pershing Boulevard CHEYENNE Differences in CPRS and Pharmacy Pending File Data Name CPRS File Pharmacy Pending File --------- --------- --------------------- QTY PRESCRIBED 15 30 If the error code is related to 'certificate expired', the pending order will be processed (will not be auto discontinued) and a notification will be sent to the provider with the message, "DEA certificate expired. Renew your certificate." 2. When finishing a pending CS order, if the user does not hold the new PSDRPH security key, the order will be marked as 'Non-Verified'. 3. To verify a 'Non-Verified' CS order, PSDRPH security key is now required. 4. To discontinue a pending CS order, PSDRPH security key is now required. 5. The pending order screen will now display the provider's DEA/VA #, the DETOX# (if available) and the site address. 6. When finishing a new pending CS order, the orderable item, dosage, provider name, or the number of refills will not be allowed to be edited. Also, if the changes to the dispense drug would result in a new order being created, this will not be allowed for digitally signed orders. The user WILL be allowed to select other dispense drugs for the same Orderable Item as long as it does not change the prescribed dosage. 7. When finishing a new pending CS order, the days supply or the quantity will not be allowed to increase, but can be decreased. If the days supply is decreased, the number of refills will also be adjusted accordingly depending on the drug setup (maximum refills, not refillable etc). (The quantity may be auto-calculated to a higher quantity by the system only when the dosage remains the same, but the dispense drug strength is changed - i.e. 2mg tablets #30 is changed to 1mg tablets, the Sig is updated and the system changes the quantity to 60. A manual change to a higher quantity is not allowed.) 8. In patch PSO*7*99, a change was made for pending orders not to recalculate the quantity for CS drugs on selecting a different strength of the same drug and resulting in the same prescribed dosage. This change is removed in this patch. 9. When finishing a pending CS order or verifying a CS order by the PSDRPH key holder, any edit to some of the key fields like dispense drug, dosage, dispense units, issue date, day's supply, quantity or number of refills, will now be captured and stored in the activity log. 10. In the Complete Orders From OERR [PSO LMOE FINISH] option, a new sort selection, 'CS' is included to select digitally signed CS orders separately. 11. A new field BACKDOOR SIGNATURE STATUS (#311) is being added to the PRESCRIPTION file (#52) and will be set to '1' to indicate that the CS order was entered via pharmacy backdoor and was not digitally signed. 12. A new field, DIRECTIONS FOR USE (#120) is being added to the PENDING OUTPATIENT ORDERS file (#52.41) to store the raw HEALTH LEVEL SEVEN (HL7) dosage data as sent from CPRS. This will be used to validate the integrity (hash count) against the CPRS digitally signed orders. 13. Currently, the pending order screen displays only the number of refills ordered by the provider. For digitally signed orders, this is modified to include the days supply and the quantity. Here is a screen capture: (6) Issue Date: SEP 17,2012 (7) Fill Date: SEP 17,2012 (8) Days Supply: 45 (9) QTY ( ): 45 Provider ordered: days supply 45, quantity 45 & refills 1 (10) # of Refills: 1 (11) Routing: WINDOW 14. The protocols PSO LM ACCEPT and PSO LM RENEW MENU are being modified to add code to the SCREEN field (#24) and the HEADER field (#26) of the PROTOCOL file (#101) to ensure users are limited to ListMan actions based on their security key. 15. As part of this project, Kernel patch XU*8*580 introduced the following new fields to the NEW PERSON file (#200). Apart from the DEA#/VA# requirement, DEA further classifies what CS schedule a provider is authorized to write. 55.1 SCHEDULE II NARCOTIC (S), [PS3;1] 55.2 SCHEDULE II NON-NARCOTIC (S), [PS3;2] 55.3 SCHEDULE III NARCOTIC (S), [PS3;3] 55.4 SCHEDULE III NON-NARCOTIC (S), [PS3;4] 55.5 SCHEDULE IV (S), [PS3;5] 55.6 SCHEDULE V (S), [PS3;6] If any one of the above fields are populated for a provider then when placing a new order in backdoor pharmacy, the software will now check for the drug schedule with the provider privileges. If the provider does not have the credentials to write such orders then the software will display a message (as shown below) and will not allow the selection of that provider. Example: When the provider does not have schedule 2 privileges, this message is displayed: "Provider not authorized to write Federal Schedule 2 prescriptions." 16. When placing an order for a CS Detoxification drug, the software will now check for a valid Detoxification number for the provider. If the provider does not have a Detoxification number then the software will display a message "Provider must have a DETOX# to order this drug." 17. The Released and Unreleased Prescription Report [PSO RELEASE REPORT] is being modified to include CS as a selection to the input. The drug name and CS schedule is being added to the output. Here are the changes: You are currently logged in under the CHEYENNE VAM&ROC division. Do you want to select a different division? NO// Do you want ONLY Unreleased Prescriptions? NO// Include (C)S Rx only, (N)on CS Rx only, or (B)oth (C/N/B): B// Controlled Substances Rxs Only Select controlled substance schedules Select one of the following: 1 SCHEDULES I - II 2 SCHEDULES III - V 3 SCHEDULES I - V Select Schedule(s): 3// The report currently shows the count of unreleased and copay prescriptions, but not the count of released prescriptions. The report is modified with this patch to include the count of released prescriptions. 18. The following options are being modified to include the DETOX/MAINTENANCE ID NUMBER field (#53.11) and the DEA EXPIRATION DATE field (#747.44) of the NEW PERSON file (#200) as part of the screen. The DEA EXPIRATION DATE field will be prompted only if the PROVIDER TYPE field (#53.6) of the NEW PERSON file (#200) is marked as "FEE BASIS". Add New Providers [PSO PROVIDER ADD] Edit Provider [PSO PROVIDER EDIT] View Provider [PSO PROVIDER INQUIRE] 19. Currently, the default days supply for all drugs is set from the DAYS SUPPLY field (#3) of the RX PATIENT STATUS file (#53) up to a maximum of 90. With this project, the default for CS schedule II-V drugs will be set to 30 or from the DAYS SUPPLY field (#3) of the RX PATIENT STATUS file (#53) if it is less than 30. Also, the Integration Control Registration #3278 that returns days supply (DSUP^PSOSIGDS) to CPRS is modified to return 30 or from the DAYS SUPPLY field (#3) of the RX PATIENT STATUS file (#53) if it is less than 30 for CS schedule II-V drugs. 20. The pharmacy release slip portion of the Laser Label is being modified to include the text "(DSIG)" or "(NOT DSIG)" after the patient's name to indicate that the prescription is digitally signed or not digitally signed. 21. This patch addresses the issue reported in REMEDY ticket #595795, to ensure that when editing an orderable item/dispensed drug, the instruction field is displayed only when editing the pending order and not when editing an active or non-verified order. 22. The Expire Prescriptions [PSO EXPIRE PRESCRIPTIONS] option that currently runs as a nightly job is being modified to check for the Institutional DEA 'expiration date'. If the expiration date is within 30 calendar days or past expiration then a mail message will be generated and sent to PSDMGR key holders. Here is an example when the expiration date is within 30 days: Subj: 500:Institutional DEA Expiration Date is about to expire [#140331] 03/20/12@11:57 3 lines From: POSTMASTER In 'IN' basket. Page 1 *New* ----------------------------------------------------------------------- Please update Institutional DEA Certification Date. Will expire on 3/24/12. ****************************** Here is an example when the DEA Expiration Date is past expiration date: Subj: 500:Institutional DEA Expiration Date has expired [#140333] 03/20/12@12:08 3 lines From: POSTMASTER In 'IN' basket. Page 1 *New* ---------------------------------------------------------------------- Please update Institutional DEA Certification Date. Expired on 2/19/12. ********************************** Patch Components ================ Files & Fields Associated: File Name (#) Field Name (#) New/Mod/Del ------------- -------------- ----------- PRESCRIPTION (#52) BACKDOOR SIGNATURE STATUS (#311) New PENDING OUTPATIENT ORDERS (#52.41) DIRECTIONS FOR USE (#120) New PENDING OUTPATIENT ORDERS (#52.41) DRUG INCLUDED (#118) New Forms Associated: Form Name File # New/Mod/Del --------- ------ ----------- N/A Mail Groups Associated: Mail Group Name New/Mod/Del --------------- ----------- N/A Options Associated: Option Name Type New/Mod/Del ----------- ---- ----------- PSO LMOE FINISH MENU Modified PSO EXPIRE PRESCRIPTIONS MENU Modified Protocols Associated: Protocol Name New/Mod/Del ------------- ----------- PSO LM ACCEPT Modified PSO LM RENEW MENU Modified Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (#) New/Mod/Del ------------- ---- ------------------ ----------- N/A Additional Information: N/A New Service Requests (NSRs): ----------------------------- 20080702 Patient Safety Issues (PSIs): ------------------------------ N/A Remedy Ticket(s) & Overviews: ----------------------------- 483789 - Inconsistency in the process of a tech finishing a pending order. 595795 - Changing orderable item on verified order gives incorrect information to user. Test Sites: ----------- CHARLESTON, SC CLEVELAND, OH HEARTLAND-EAST HCS HEARTLAND-WEST HCS HINES, IL LOMA LINDA, CA PALO ALTO HCS SAN DIEGO, CA TAMPA, FL Documentation Retrieval Instructions: ------------------------------------- Updated documentation describing the new functionality introduced by this patch is available. The preferred method is to FTP the files from ftp://download.vista.med.va.gov/. This transmits the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov The documentation will be in the form of Adobe Acrobat files. Documentation can also be found on the VA Software Document Library at: http://www4.va.gov/vdl/ File Description File Name FTP Mode -------------------------------------------------------------------------- Outpatient Pharmacy V. 7.0 Manager's PSO_7_MAN_UM_R0513.PDF (binary) User Manual Outpatient Pharmacy V. 7.0 Manager's PSO_7_P391_MAN_UM_CP.PDF (binary) User Manual Change Pages Outpatient Pharmacy V. 7.0 Pharmacist's PSO_7_PHAR_UM_R0513.PDF (binary) User Manual Outpatient Pharmacy V. 7.0 Pharmacist's PSO_7_P391_PHAR_UM_CP.PDF (binary) User Manual Change Pages Outpatient Pharmacy V. 7.0 Technician's PSO_7_TECH_UM_R0513.PDF (binary) User Manual Outpatient Pharmacy V. 7.0 Technician's PSO_7_P391_TECH_UM_CP.PDF (binary) User Manual Change Pages Outpatient Pharmacy V. 7.0 Technical PSO_7_TM_R0513.PDF (binary) Manual/Security Guide Outpatient Pharmacy V. 7.0 Technical PSO_7_P391_TM_CP.PDF (binary) Manual/Security Guide Change Pages Patch Installation: Pre/Post Installation Overview ------------------------------ CPRSV29_PSO_PSD.KID includes patches PSO*7*391 and PSD*3*73. The host file was created to simplify installation at Veterans Health Administration (VHA) facilities and to assist in the phased implementation release method for CPRS GUI v29. The software will be distributed in a controlled process due to the phased implementation. During each implementation phase, the Implementation Team will provide each site the instructions and location to obtain the software. File Name Contents Retrieval Format ---------------------------- -------- ---------------- CPRSV29_PSO_PSD.KID PSD*3*73 ASCII PSO*7*391 Installation Instructions ------------------------- Do not install this patch while Outpatient Pharmacy users are on the system or when Outpatient orders are being entered and signed through Computerized Patient Record System. Installation will take no longer than 5 minutes. Pre-Installation Instructions ----------------------------- 1. Download CPRSV29_PSO_PSD.KID into your local directory. 2. From the Kernel Installation & Distribution System (KIDS) menu, select the Installation menu. 3. Select the Load a Distribution and enter the directory that you FTP'ed the host file to and CPRSV29_PSO_PSD.KID. Example: USER$:[ABC]CPRSV29_PSO_PSD.KID 4. From the Kernel Installation & Distribution System (KIDS) menu, you may select to use the following options (when prompted for INSTALL NAME, enter PSO_PSD_V29 1.0 a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DD's, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 5. Use the Install Package(s) option and select the package PSO_PSD_V29 1.0. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' respond NO. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO// respond NO. Post-Installation Instructions ------------------------------ N/A Routine Information: ==================== The second line of each of these routines now looks like: ;;7.0;OUTPATIENT PHARMACY;**[Patch List]**;DEC 1997;Build 13 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSOCAN4 Before: B47636509 After: B49357876 **20,24,27,63,88,117,131,259, 268,225,358,385,391** Routine Name: PSODGDGP Before: B57788736 After: B66741905 **251,387,379,391** Routine Name: PSODIR Before: B28488189 After: B34162228 **37,46,111,117,146,164,211, 264,275,391** Routine Name: PSODIR1 Before: B86466009 After: B94639325 **23,46,78,102,121,131,146,166, 184,222,268,206,266,340,391** Routine Name: PSODISP Before: B55745559 After: B53119721 **15,71,131,156,185,148,247, 200,385,391** Routine Name: PSODISP1 Before: B43577126 After: B49194938 **15,9,33,391** Routine Name: PSOHLEXP Before: B14786719 After: B22400492 **10,22,36,73,148,257,391** Routine Name: PSOHLNE1 Before: B73330251 After: B74363469 **1,9,46,71,98,111,117,131,157, 181,143,235,239,225,391** Routine Name: PSOHLNE2 Before: B64195087 After: B64216422 **1,7,59,46,225,305,391** Routine Name: PSOHLNEW Before: B83121604 After: B86108957 **1,7,15,46,71,98,111,124,117, 131,146,132,143,223,235,148, 239,249,225,324,251,387,379, 391** Routine Name: PSOLLL2 Before: B16255333 After: B16898415 **120,138,141,161,200,391** Routine Name: PSON52 Before: B65058460 After: B86376192 **1,16,23,27,32,46,71,111,124, 117,131,139,157,143,219,148, 239,201,268,260,225,303,358, 251,387,379,390.391** Routine Name: PSONFI Before: B9036524 After: B8543831 **46,94,131,225,391** Routine Name: PSOORED4 Before: B52076927 After: B54971624 **46,91,78,99,111,117,133,159, 148,251,391** Routine Name: PSOOREDT Before: B69885568 After: B72615864 **4,20,27,37,57,46,78,102,104, 119,143,148,260,281,304,289, 298,379,377,391** Routine Name: PSOORFI1 Before: B74027837 After: B83482862 **7,15,23,27,32,44,51,46,71, 90,108,131,152,186,210,222,258, 260,225,391** Routine Name: PSOORFI4 Before: B81736847 After: B81023299 **46,74,78,99,117,131,207,258, 274,300,308,251,384,391** Routine Name: PSOORFI5 Before: B19521565 After: B46664581 **225,315,266,391** Routine Name: PSOORFIN Before: B62133110 After: B63039564 **7,15,27,32,44,46,84,106,111, 117,131,146,139,195,225,315, 266,338,391** Routine Name: PSOORNE2 Before: B68864998 After: B69776712 **11,21,23,27,32,37,46,84,103, 117,131,146,156,210,148,222, 238,264,281,289,251,379,391** Routine Name: PSOORNE3 Before: B66896129 After: B68130643 **11,9,39,59,46,103,124,139, 152,194,391** Routine Name: PSOORNE4 Before: B85067804 After: B94257859 **11,27,32,36,46,75,96,103,99, 117,131,225,386,390,391** Routine Name: PSOORNE5 Before: B60780567 After: B68801944 **11,27,32,46,78,99,117,131, 146,171,180,210,222,268,206, 225,391** Routine Name: PSOORNEW Before: B81591143 After: B92744719 **11,23,27,32,55,46,71,90,94, 106,131,133,143,237,222,258, 206,225,251,386,390,391** Routine Name: PSOORNW1 Before: B43950828 After: B44718806 **23,46,78,117,131,133,172,148, 222,268,206,251,379,391** Routine Name: PSOPKIV1 Before: B24905517 After: B98820890 **131,146,223,148,249,391** Routine Name: PSOPKIV2 Before: n/a After: B23465178 **391** Routine Name: PSOPRVW Before: B37841346 After: B40061242 **11,146,153,263,268,264,398,391** Routine Name: PSORN52C Before: B50785936 After: B68196793 **1,7,11,27,46,75,87,100,111, 124,117,131,146,148,200,225, 251,387,379,391** Routine Name: PSORXVW Before: B70126239 After: B77494288 **14,35,46,96,103,88,117,131, 146,156,185,210,148,233,260, 264,281,359,385,400,391** Routine Name: PSOSIG Before: B63218715 After: B70011572 **46,99,114,391** Routine Name: PSOSIGDS Before: B62109134 After: B68186224 **46,222,391** Routine Name: PSOVER Before: B75971956 After: B81192424 **16,21,27,117,131,146,251,375, 387,379,391** ============================================================================= User Information: Entered By : ANWER,MOHAMED Date Entered : MAY 25, 2011 Completed By: BANGRAKULUR,KRISHNA Date Completed: JUN 05, 2013 Released By : BLOCH,JACULYN Date Released : JUN 10, 2013 ============================================================================= Packman Mail Message: ===================== No routines included