$TXT Created by DEVRAD.DOMAIN.EXT (KIDS) on Thursday, 09/05/24 at 08:56 ============================================================================= Run Date: NOV 20, 2024 Designation: RA*5*218 Package : RA - RADIOLOGY/NUCLEAR MEDICINE Priority: Mandatory Version : 5 SEQ #199 Status: Released Compliance Date: DEC 20, 2024 ============================================================================= Associated patches: (v)RA*5*165 <<= must be installed BEFORE `RA*5*218' (v)RA*5*207 <<= must be installed BEFORE `RA*5*218' Subject: RA HL7 MAINTENANCE: INBOUND RESULTS DATA VERIFICATION Category: - Routine Description: ============ There are three issues to be addressed in patch RA*5.0*218: 1) INC34284530: The radiology staff at the Lexington Kentucky VAMC reported that HL7 inbound ORU results caused the VistA Radiology/Nuclear Medicine (RIS) application to broadcast a negative acknowledgement (NAK) that identifies the accession number as the reason for the NAK. The accession number was not the reason for the NAK, it was a corrupted (a missing or invalid) patient identifier from the Patient Identifier segment. 2) INC34499034: The current VistA RIS negatively acknowledged (NAK'd) inbound HL7 ORU result messages identifies the reason behind the NAK but it does not identify the report associated with the error. This adds an unfortunate degree of difficulty to debugging the event. 3) INC34906899: Update to National Teleradiology Program (NTP) protocols to handle Enhanced Mode /Two-Phased Acknowledgements. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- N/A Forms Associated: Form Name File Number New/Modified/Deleted --------- ----------- -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A New Service Requests (NSRs): ---------------------------- N/A Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- 1) INC34284530: Radiology Nuance PowerScribe reporting program getting errors when sending HL7 files to Vista HL7 report server. Reported by: Lexington, KY VAMC. Problem: -------- Lexington VAMC radiology personnel reported the RIS would return a NAK in response to an inbound HL7 ORU results message from voice recognition/PACS. Analysis has shown that this issue is not due to corrupted accession number. The issue was due to missing or corrupted patient identifier data from the following fields of the PID segment: * Patient ID (PID-2) * Patient Identifier List (PID-3) The first check is on PID-3; specifically, the patient's SSN. If that lookup fails, the RIS checks PID-2. The PID-2 data is corrupted but is not checked for data integrity by the RIS. The bad patient identifier data was not identified as the reason behind the NAK received. Resolution: ----------- When an inbound HL7 ORU result message is received, identify the PID segment. Get the data used to validate the patient from PID-3 then if necessary, PID-2. If the data in both fields cannot identify the patient, NAK the inbound HL7 ORU results message and gracefully exit the VistA HL7 server-side application. 2) INC34499034: 'Report already on file' NAK missing accession number. Reported by: Iowa City, IA VAMC. Problem: -------- VistA RIS negatively acknowledged (NAK'd) inbound result HL7 messages do not identify the result's accession number in their NAK'd response. Three conditions that generate a NAK without an accession number are checked: 1. Report already on file. 2. Cannot add addendum to a non-verified report. 3. Duplicate Addendum. All three have the accession number appended at the front of the warning message. I've chosen 'Report already on file.' as the condition I'll use in my examples. Example: ------------------- MSH|^~\&|RA-VOICE-SERVER|ANYVAMC|RA-NTPTST-TCP|623|20240726095643-0500||A CK^R01|623906139291|T|2.4|||||USA MSA|AE|6184|Report already on file 'Report already on file' <-- The ask is to prepend the accession number of the report to this text. Resolution: ----------- The radiology staff ask if the NAK's message can append the result's accession number to the NAK'd acknowledgement to better identify the report record in our RAD/NUC MED REPORTS (#74) file. We have honored that request in RA*5.0*218. Example: -------- MSH|^~\&|RA-VOICE-SERVER|ANYVAMC|RA-NTPTST-TCP|623|20240726095643-0500||A CK^R01|623906139291|T|2.4|||||USA MSA|AE|6184|623-122923-52: Report already on file Note: I am using Site Specific Accession Numbers (SSANs) in these examples. Not all sites enabled SSANs. I that case, the legacy accession number (w/o the site prefix) would be displayed in the NAK description. This is the new format of the error text: '623-122923-52: Report already on file'. The accession number of the report, '623-122923-52', has been prepended to the original error text. 3) INC34906899 - Update to NTP protocols to handle Enhanced Mode /Two-Phased Acknowledgements. Problem: -------- An update to NTP protocols to handle Enhanced Mode/Two-Phased Acknowledgements. Resolution: ------------ After RA*5.0*218, with post-install routine RAIPS218 having successfully completed, the logical link 'RA-NTPV2', will be associated with the server-side subscriber protocol 'RA NTPV2 TCP REPORT'. Test Sites: ----------- Central Alabama Veterans Health Care System (Montgomery, AL) Minneapolis VA Medical Center (Minneapolis, MN) SNOW Change Order #: -------------------- Central Alabama Veterans Health Care System: CHG0531720 Minneapolis VA Medical Center: CHG0531893 Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. There are no documentation updates associated with this patch. Patch Installation: ------------------- Pre-Installation Instructions: This patch may be installed with users on the system although it is recommended that the resulting of radiology reports using voice recognition and/or PACS should be halted while installing this patch. It is also recommended that RA*5.0*218 be installed during non-peak hours to minimize potential disruption to users. This patch should take less than five minutes to install. Note: There are no options or protocols that need to be disabled for this patch installation. Installation Instructions: 1. Choose the PackMan message containing this build. Then select the INSTALL/CHECK MESSAGE PackMan option to load the build. 2. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter RA*5.0*218. B. Select the Backup a Transport Global option to create a backup message. You must use this option and specify what to backup; the entire Build or just Routines. The backup message can be used to restore the routines and components of the build to the pre-patch condition. When prompted for the following, enter "B" for Build. Select one of the following: B Build R Routines Enter response: Build C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. 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 the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install. i. If prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//', answer NO ii. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. iii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', answer NO. a. When prompted 'Delay Install (Minutes): (0 ): 0//', answer 0. Post-Installation Instructions: N/A Back-out/Rollback Strategy: --------------------------- Back-out will be done only with the concurrence and participation of development team and appropriate VA site/region personnel. The decision to back-out or rollback software will be a joint decision between development team, VA site/region personnel and other appropriate VA personnel. A national help desk ticket should be logged before attempting any backout procedures. Prior to installing an updated KIDS package, the site/region should have saved a backup of the routines in a mail message using the Backup a Transport Global [XPD BACKUP] menu option (this is done at time of install). The message containing the backed-up routines can be loaded with the "Xtract PackMan" function at the Message Action prompt. The Packman function "INSTALL/CHECK MESSAGE" is then used to install the backed up routines onto the VistA System. If the new backup build option was used, after Xtracting the patch message use the KIDS Installation menu and enter RA*5.0*218b at the INSTALL NAME prompt. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0;Radiology/Nuclear Medicine;**[Patch List]**;Mar 16, 1998;Build 1 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: RAHLO Before: B55646905 After: B57100578 **4,8,27,55,66,84,94,106,144, 162,165,218** Routine Name: RAHLTCPX Before:B121573389 After:B127047715 **47,114,129,141,144,157,195, 207,218** Routine Name: RAIPS218 Before: n/a After: B15854742 **218** Routine list of preceding patches: 165, 207 ============================================================================= User Information: Entered By : Date Entered : JUL 26, 2024 Completed By: Date Completed: NOV 20, 2024 Released By : Date Released : NOV 20, 2024 ============================================================================= Packman Mail Message: ===================== $END TXT