============================================================================= Run Date: SEP 02, 2009 Designation: RA*5*97 Package : RA - RADIOLOGY/NUCLEAR MEDICINE Priority: Mandatory Version : 5 SEQ #87 Status: Released Compliance Date: OCT 02, 2009 ============================================================================= Associated patches: (v)RA*5*70 <<= must be installed BEFORE `RA*5*97' (v)RA*5*85 <<= must be installed BEFORE `RA*5*97' (v)LEX*2*55 <<= must be installed BEFORE `RA*5*97' (v)RA*5*95 <<= must be installed BEFORE `RA*5*97' Subject: BI-RADS and AAA codes Category: - Routine - Enhancement (Mandatory) - Data Dictionary Description: ============ This patch is released together with the LEX*2.0*55 patch in a host file, LEX_RA_BIRADS_97.KID, which has LEX*2.0*55 as the first patch and RA*5.0*97 as the second patch. The instructions for retrieval of this host file and for installation of this patch are in the LEX*2.0*55 patch. The LEX*2.0*55 must be first in the host file because it provides the APIs that are needed by RA*5.0*97 to add the MQSA coding system's BI-RADS records to the DIAGNOSTIC CODES file (#78.3) during the installation. This patch includes enhancements and maintenance fixes. The enhancement portion adds BI-RADS and Abdominal Aortic Aneurysm (AAA) codes to the DIAGNOSTIC CODES file #78.3, using internal entry numbers 1100 thru 1106 and 1200 thru 1202, respectively. It also adds the display of the MQSA coding text next to the BI-RADS code for file look up and all reports and API's that currently display diagnostic codes. It checks if a BI-RADS diagnostic code is required for an outside report, and if so, would display a warning message if the required BI-RADS diagnostic code wasn't entered during the use of the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option. The maintenance portion fixes routine RABWORD1 and two print templates so that they use APIs to retrieve CPT modifiers and ICD9 codes, instead of reading directly from old fields that are scheduled for deletion. Radiology Components from the host file --------------------------------------- The following changed fields are in the host file: FILE # FIELD FIELD NAME NEW/MODIFIED # item(s) -------- ----- ---------------------------- --------------- 78.3 .001 NUMBER blocked 999 and higher changed Help Prompt changed Field Description 78.3 .01 DIAGNOSTIC CODE made un-editable 78.3 6 EXPRESSION new and un-editable The following is a list of print templates included in the host file. They are modified to use $$MOD^ICPTMOD to retrieve the names of CPT modifiers. Print Template Name ------------------- RA IMAGE LOC LIST RA PROCEDURE LIST Routine Information: ==================== These routines are in the host file, not in this patch message: The second line of the routines now look like : CHECK1^XTSUMBLD results Name Before After Patch List Patch Patch ---------------------------------------------------------------- RA97PST (NEW) 30429917 **97** RA97PST1 (NEW) 11847551 **97** RABIRAD (NEW) 7783867 **97** RABWORD1 20761340 21044448 **41,57,70,97** RADLQ1 28026450 28970876 **15,97** RAEDCN 57573116 69681618 **5,13,10,18,28,31,34,45,85,97** RAO7PC2 45083529 47517488 **1,11,14,16,22,27,45,75,56,95,97** RAPRINT 22198588 31817816 **97** RAPRINT1 25798821 27115956 **34,97** RART 23124716 24437904 **2,5,15,18,43,82,56,97** RARTE5 93390991 100088941 **56,95,97** RARTE7 23668703 23848565 **56,95,97** RARTR1 46270637 53930536 **8,18,56,97** Summary of changes to the routines above ------------------------------------------------------------------ Routine RA97PST is new and is used to add BI-RADS and AAA records into the DIAGNOSTIC CODES file (#78.3). It is also used to add the display of the MQSA coding system's text alongside the BI-RADS code during user selection lookup. It resets the record counter for file #78.3 after the patch installation. Routine RA97PST1 is new and is used during the patch installation to retrieve BI-RADS codes from the Lexicon application's EXPRESSIONS file (#757.01). Routine RABIRAD is new and is used for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option. It checks if a case should require a BI-RADS code. If the case is missing a required BI-RADS code, then a warning message will be displayed. It also displays extra fields after BI-RADS and AAA records whenever the user enters a "?" or "??" at the DIAGNOSTIC CODES prompt. The extra field displayed for BI-RADS is the MQSA coding system's text from the Lexicon's EXPRESSIONS file (#757.01). The extra field displayed for AAA is the DESCRIPTION from the DIAGNOSTIC CODES file (#78.3). Routine RABWORD1 is modified to convert a direct read of the ICD DIAGNOSIS file (#80) to a supported code set versioning API : $$ICDDX^ICDCODE( ). Routine RADLQ1 is modified to display the correct report status for an electronically filed report in the 'Delinquent Status Report' [RA DELINQUENT] option. It is also modified to add a screen pause at the end of the last screen so the display won't scroll off the screen. Routine RAEDCN is modified to disallow the use of the 'Diagnostic Code and Interpreter Edit by Case No.' [RA DIAGCN] option for a case that doesn't have a report yet or has a stub report or an electronically filed report. Routine RAO7PC2 is modified to output the MQSA coding system's text next to the BI-RADS diagnostic code. This is a routine that is used by other applications to display a Radiology report. Routines RAPRINT and RAPRINT1 are modified for the 'Abnormal Exam Report' [RA ABNORMAL] option to allow the user to select data by VA radiologist only, Electronically Filed only, or both. RAPRINT1 was also modified to display the MQSA coding system's text beneath the BI-RADS code and correct a bug found during development testing. The bug occurred when a case had two abnormal diagnostic codes, and the case # displayed under the first abnormal diagnostic code but not under the second abnormal diagnostic code. This was due to the case being the last case with the first abnormal diagnostic code and the first case with the second abnormal diagnostic code. Routine RART is modified for the 'Display a Rad/Nuc Med Report' [RA RPTDISP] option to display the MQSA coding system's text next to the BI-RADS diagnostic code. Routine RARTE5 is modified for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option to use routine RABIRAD to check for a required BI-RADS code. Routine RARTE7 is modified for the 'Outside Report Entry/Edit' [RA OUTSIDE RPTENTRY] option to generate an "Imaging Results" alert when an outside report has been entered the first time and it doesn't have an abnormal diagnostic code. (The wording of this alert is changed to "Imaging Results,Non Critical" by the released patch RA*5*93.) Previously, only abnormal diagnostic codes would cause an alert to be generated from this option. Routine RARTR1 is modified for options: 'Draft Report (Reprint)' [RA REPRINT], 'Select Report to Print by Patient' [RA RPTPAT] and the background processing that sends a verified report to the requesting physician. This modification adds the display of the MQSA coding system's text alongside the BI-RADS code in the output. Documentation Retrieval ----------------------- Updated documentation describing the functionality introduced by this patch is available in the [ANONYMOUS.SOFTWARE] directories at the following Internet addresses: Preferred or Specific Server Internet address ---------------------------- ------------------------- First available ftp server download.vista.med.va.gov <-- preferred Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov Below is a list of the documentation files related to this patch and available via the FTP sites listed above. Document File Description File Name FTP Mode ------------------------------- ------------- -------------- Radiology User Manual RA5_0UM.PDF binary Radiology Technical Manual RA5_0TM.PDF binary Released Notes RA5_0RN_P97.PDF binary After this patch is released, the updated manuals may also be retrieved from the Internet at http://www.va.gov/vdl Test Sites ---------- 1. Martinez, CA 2. Bronx, NY 3. Charleston, SC 4. Bay Pines, FL 5. Puget Sound, OR INSTALLATION INSTRUCTIONS ========================= Please refer to the patch description for LEX*2.0*55 for instructions for retrieving the host file and installing this patch. Post Installation Overview ------------------------------ 1. For sites that will use the exported BI-RADS and AAA codes from Voice Recognition (VR) systems, such as PowerScribe or TalkStation, the VR systems manager must add the BI-RADS and AAA codes exported from Patch RA*5*97 into the diagnostic file of the VR system. The exported BI-RADS and AAA field values are described in item 2. It is known that PowerScribe has an inactivation feature and TalkStation does not. For sites that will not use the exported BI-RADS and AAA codes from VR systems with the inactivation feature, the VR systems manager can add the exported codes into the diagnostic file of the VR system and inactivate the codes. This keeps the diagnostic codes in VistA in sync with the diagnostic codes on the VR system. 2. The post installation routines RA97PST and RA97PST1 will add the following records to the DIAGNOSTIC CODES file (#78.3): [Field Number] : Stored value -> Displayed value [.001]: 1100 [.01] : BI-RADS CATEGORY 0 [2] : Incomplete: Need Additional Imaging Evaluation [3] : Y -> YES [4] : y -> YES [6] : 80 -> Incomplete: Need Additional Imaging Evaluation [.001]: 1101 [.01] : BI-RADS CATEGORY 1 [2] : Negative [3] : N -> NO [4] : n -> NO [6] : 82 -> Negative [.001]: 1102 [.01] : BI-RADS CATEGORY 2 [2] : Benign [3] : N -> NO [4] : n -> NO [6] : 84 -> Benign [.001]: 1103 [.01] : BI-RADS CATEGORY 3 [2] : Probably Benign [3] : Y -> YES [4] : y -> YES [6] : 86 -> Probably Benign [.001]: 1104 [.01] : BI-RADS CATEGORY 4 [2] : Suspicious [3] : Y -> YES [4] : y -> YES [6] : 88 -> Suspicious [.001]: 1105 [.01] : BI-RADS CATEGORY 5 [2] : Highly Suggestive of Malignancy [3] : Y -> YES [4] : y -> YES [6] : 90 -> Highly Suggestive of Malignancy [.001]: 1106 [.01] : BI-RADS CATEGORY 6 [2] : Known Biopsy Proven Malignancy [3] : Y -> YES [4] : y -> YES [6] : 92 -> Known Biopsy Proven Malignancy [.001]: 1200 [.01] : ABDOMINAL AORTIC ANEURYSM NOT PRESENT [2] : The maximum width of the infrarenal aorta is less than three centimeters. [3] : N -> NO [4] : n -> NO [.001]: 1201 [.01] : ABDOMINAL AORTIC ANEURYSM PRESENT [2] : The maximum width of the infrarenal aorta is at least three centimeters. [3] : Y -> YES [4] : y -> YES [.001]: 1202 [.01] : DOES NOT SATISFY SCREEN FOR AAA [2] : Exam is not technically adequate for AAA screening. [3] : N -> NO [4] : n -> NO If your site already has data in the range 1100-1106 and/or 1200-1202, then the post installation will not add any of the ten records to the DIAGNOSTIC CODES file #78.3. Instead, it will send a mail message to the patch installer and an Outlook message to the "VA OIT VHIT Radiology Facility Level Application Issues" mail group to notify them that your facility has a conflict with one or more internal entry numbers (IENS) in file #78.3. If there is no conflict with the IENs, then the post installation will reset the third piece of ^RA(78.3,0) to the highest IEN under 999 and also display the following message: *** 10 of 10 BI-RADS and Abdominal Aortic Aneurysm codes have been successfully added to the DIAGNOSTIC CODES file #78.3. *** 3. The description of the diagnostic code from the 'Diagnostic Code List' [RA DIAGP] option is taken from the Description field of the DIAGNOSTIC CODES file (#78.3). But the MQSA coding system's text of BI-RADS from the following options and features is taken from the EXPRESSIONS file (#757.01) of the Lexicon application: Display a Rad/Nuc Med Report [RA RPTDISP] Draft Report (Reprint) [RA REPRINT] Select Report to Print by Patient [RA RPTPAT] CPRS Report tab Email message of a verified report sent to the requester The description and the MQSA coding system's text from the options will remain identical as long as there are no local changes made to the Description field in the DIAGNOSTIC CODES file (#78.3) or national changes made to the Displayable Text field in the EXPRESSIONS file (#757.01). Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: RA97PST Before: n/a After: B30429917 **97** Routine Name: RA97PST1 Before: n/a After: B11847551 **97** Routine Name: RABIRAD Before: n/a After: B7783867 **97** Routine Name: RABWORD1 Before: B20761340 After: B21044448 **41,57,70,97** Routine Name: RADLQ1 Before: B28026450 After: B28970876 **15,97** Routine Name: RAEDCN Before: B57573116 After: B69681618 **5,13,10,18,28,31,34,45,85,97** Routine Name: RAO7PC2 Before: B45083529 After: B47517488 **1,11,14,16,22,27,45,75,56,95,97** Routine Name: RAPRINT Before: B22198588 After: B31817816 **97** Routine Name: RAPRINT1 Before: B25798821 After: B27115956 **34,97** Routine Name: RART Before: B23124716 After: B24437904 **2,5,15,18,43,82,56,97** Routine Name: RARTE5 Before: B93390991 After:B100088941 **56,95,97** Routine Name: RARTE7 Before: B23668703 After: B23848565 **56,95,97** Routine Name: RARTR1 Before: B46270637 After: B53930536 **8,18,56,97** Routine list of preceding patches: 70, 85, 95 ============================================================================= User Information: Hold Date : SEP 02, 2009 Entered By : MO,SELINA Date Entered : NOV 03, 2008 Completed By: MUNIPALLI,YAMINI Date Completed: SEP 02, 2009 Released By : BLACK,KATHLEEN Date Released : SEP 02, 2009 ============================================================================= Packman Mail Message: ===================== No routines included