$TXT Created by MCNEILE,KEN at DEV.DEV.FO-HINES.MED.VA.GOV (KIDS) on Tuesday, 06/09/09 at 09:25 ============================================================================= Run Date: SEP 28, 2009 Designation: RA*5*94 Package : RA - RADIOLOGY/NUCLEAR MEDICINE Priority: Mandatory Version : 5 SEQ #88 Status: Released Compliance Date: OCT 28, 2009 ============================================================================= Associated patches: (v)RA*5*65 <<= must be installed BEFORE `RA*5*94' (v)RA*5*84 <<= must be installed BEFORE `RA*5*94' Subject: REMOVE GMT OFFSET FROM D/T STAMP & FIX LOCK ISSUE Category: - Routine Description: ============ This patch will correct the following issues: 1. After the installation of patch RA*5*84, some voice recognition systems are experiencing an issue in the form of date/time being recorded as 00/00/00 00:00:00. 2. Removal of Patch 81 from the 2nd line in Routine RAUTL1. 3. Correct the locking issues following the installation of patch RA*5*84. 4. PRIMARY DIAGNOSTIC CODE field was not properly being updated. 5. The Reason for Study field becomes a required field in CPRS v27. Some sites utilizing voice recognition cannot accept Reason for Study from the HL7 message. Associated Remedy tickets: ========================== 1. HD0000000258383 - RA*5*84 and Talk Issue Duplicate: HD0000000261230 - Report already on file message generated each time 2. HD0000000258531 - Remove patch 81 from the second line of routine RAUTL1 3. HD0000000259589 - TalkStation locking case numbers Duplicate: HD0000000264155 - TALK dropping message body 4. HD0000000259432 - Palo Alto: A non-teleradiology report event occurs in PowerScribe (PS) and that report is broadcast to VistA. VistA fails to file the Diagnostic Code associated with the report. 5. HD0000000272792 - Reason for Study can not be displayed in Agfa Talkstation Duplicates: HD0000000276071 Reason for Study Field not transmitting HD0000000275790 CPRS patch V.27 issue HD0000000275936 Reason for Study issue due to CPRS V27 HD0000000276276 Clinical History vs Reason For Study HD0000000277346 New Imaging Order in Ver 27 Associated NSR(s): ================== N/A Participating Test Sites: ========================= Tampa Atlanta Salisbury Palo Alto Remedy Overview: ================ Problem #1: ----------- After Patch RA*5*84 is installed, VistA will send the date/time in OBR-7 to the Voice Recognition products with a GMT offset of a dash and 4 numbers (-9999). Some versions of the Voice Recognition products cannot process this offset and causing a data problem. Resolution #1: -------------- A modification will be made in routine RAHLR to strip off the GMT offset from the data before sending it to subscribers. Problem #2: ----------- Patch 81 was inadvertently included in the second line patch list of routine RAUTL1 and needs to be removed. Resolution #2: -------------- Patch 81 will be removed from the 2nd line patch list in routine RAUTL1. Problem #3: ----------- After installation of patch RA*5*84, sites began to receive HL7 errors relating to exam being locked. Report data is showing up in VistA without report or impression text. When the sites attempt to resend reports from voice recognition they are receiving an HL7 error 'Accession locked within VistA'. Resolution #3: -------------- - RAHLO has had the lock of the report moved from inside this routine and placed within the scope of RAHLO1. This change was made in order to lock a record within a single component and not across components. Centrally locating the lock and unlock events makes testing and supporting these types of events much easier. - RAHLO1 has been edited to lock and unlock the report record from the same routine. The filing of data into the RAD/NUC MED REPORT file was done in the past by calling the traditional VA FileMan data filing utility DIE. Due to the nature of this interface (a TCP/IP background process), a far more efficient way of filing the data into the RAD/NUC MED REPORT file was to utilize the silent Database Server call UPDATE^DIE to create a new report and FILE^DIE to file data into the existing report record. RAHLO1 introduces the function NEWIEN^RAHLTCPU() which is called whenever a new report is created. - RAHLTCPU has been edited to include the new NEWIEN() function. This function finds the next available Internal Entry Number (IEN) from the RAD/NUC MED REPORT file and locks the new record. In this way our record number is unique to this particular process. The lock executed in the new NEWIEN() function is released in RAHLO1. - RAHLRPTT has been edited to kill the variable RATELE in the TELE subroutine if the report was not signed by a teleradiologist. This issue was identified by Palo Alto. (Remedy 259432: Failure to file a Dx Code for non-teleradiology reports with a report status of RELEASED/NOT VERIFIED) Problem #4: ----------- PRIMARY DIAGNOSTIC CODE field was not properly being updated. As a result, the "AD" cross-reference was inaccurate. Other issues with the definition of this field include WRITE statements in the data dictionary (see NODEL^RADD1 prior to the installation of RA*5.0*94) and the use of an IF statement in the PDC^RADD1 function. Resolution #4: -------------- - RADD1 has been edited to change the following in the PDC^RADD1() function: REPLACE ------- I $P(^RA(78.3,+Y,0),U,5)="Y" Q 0 I $D(^RADPT(DA(2),"DT",DA(1),"P",DA,"DX","B",+Y)) Q 0 WITH ---- Q:$P(^RA(78.3,+Y,0),U,5)="Y" 0 Q:$D(^RADPT(DA(2),"DT",DA(1),"P",DA,"DX","B",+Y)) 0 for the NODEL^RADD1() function: REPLACE ------- I RASECCHK W " Required" WITH ---- I RASECCHK D EN^DDIOL(" Required","","?0") - RA94PST has been created to correct the issue where the whole file traditional "AD" cross-reference on the PRIMARY DIAGNOSTIC CODE (70.03, 0;13) field was not deleted and the new style "AD" cross-reference on the PRIMARY DIAGNOSTIC CODE field was not created. To correct this issue, RA94PST takes three direct actions: * If it exists, the traditional "AD" cross-reference on the PRIMARY DIAGNOSTIC CODE field is deleted. The indexed cross-reference '^RADPT("AD"' is also killed. * If it exists, the new style "AD" cross-reference on the PRIMARY DIAGNOSTIC CODE field is deleted. The indexed cross-reference '^RADPT("AD"' is also killed (because we cannot assume the existing "AD" index is accurate). * Create the new style "AD" cross-reference on the PRIMARY DIAGNOSTIC CODE field and generate the "AD" index '^RADPT("AD",Dx Code IEN,DA(2),DA(1),DA)' for all the appropriate PRIMARY DIAGNOSTIC CODE data on file. Note: 'DA(2)' is the top level IEN of the RAD/NUC MED PATIENT (#70) file, 'DA(1)' is the second level IEN of a record in file 70, and 'DA' is the third level ('EXAMINATIONS') IEN of a record in file 70. The creation of the new style "AD" cross-reference does not remove any locally created cross-references on the PRIMARY DIAGNOSTIC CODE field. Be aware that locally created cross-references may be incompatible with the new style "AD" cross-reference. Problem #5: ----------- With the installation of CPRS v27, Reason for Study field becomes a required field and, currently, sites running Agfa Talkstation can not accept 'Reason for Study' from the HL7 message (OBR31) because it has a limit as to the length (245) of segment it can accept. Resolution #5: -------------- Routine RAHLR is being modified to add the 'Reason for Study' (as a prefix) in the text for Clinical History in OBX11. Reason for Study will still be sent in OBR31 as well. This will allow Talkstation to display the 'Reason for Study' field. Installation Instructions: ========================== If installed during the normal workday, it is recommended that the the Radiology users be off the system. Other VISTA users will not be affected. Install Time - less than 5 minutes SPECIAL NOTE: Users may experience an XINDEX error after the installation of this patch. This XINDEX error occurs because a line of code has been added for handling a future version of HL7 (2.3). This line of code is checked to determine if HL7 (2.3) is being used and then checks for the presence of routine RAHLR1. If both are true it will call routine RAHLR1. This XINDEX error does not affect the software in this patch. 1. Shut down the specific voice recognition system HL7 message receipt and broadcast services 2. Shut down the specific VistA Radiology/Nuclear Medicine logical links used to broadcast and receive HL7 messages. Use the following menu path to accomplish this task: Select OPTION NAME: HL7 MAIN MENU HL MAIN MENU HL7 Main Menu Event monitoring menu ... Systems Link Monitor Filer and Link Management Options ... Message Management Options ... Interface Developer Options ... Site Parameter Edit HLO HL7 (Optimized) MAIN MENU ... Select HL7 Main Menu Option: Filer and Link Management Options SM Systems Link Monitor FM Monitor, Start, Stop Filers LM TCP Link Manager Start/Stop SA Stop All Messaging Background Processes RA Restart/Start All Links and Filers DF Default Filers Startup SL Start/Stop Links PI Ping (TCP Only) ED Link Edit ER Link Errors ... Select Filer and Link Management Options Option: SL Start/Stop Links This option is used to launch the lower level protocol for the appropriate device. Please select the node with which you want to communicate Select HL LOGICAL LINK NODE: 1. Load Transport Global Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. Start Up KIDS Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global 3. Select the 'Verify Checksums in Transport Global' option. If there are discrepancies then do not install RA*5.0*94. 4. Select the 'Backup a Transport Global' option. This is a requirement that should not be bypassed. Note: The following options are optional but should be exercised for the benefit of the facility installing the patch: a. Print Transport Global - This option lets you compare the components of a Transport Global, that is currently loaded in the XTMP global, to your current system. b. Compare Transport Global to Current System - This option will verify checksums for the components of a Transport Global and will report any checksums that are incorrect. 5. Select the 'Install Package(s)' option. This option starts the install process for all Packages in a Transport Global that are part of a distribution. Note that you must load the distribution before you can use this option to install it. **This is the step to start the installation of this KIDS patch** a. Choose the Install Package(s) option to start the patch install. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' answer NO c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' answer YES When prompted "Enter options you wish to mark as 'Out of Order':", enter the following to disable all Rad/Nuc Med options: RA* When prompted "Enter protocols you wish to mark as 'Out of Order':", enter the following to disable all Rad/Nuc Med protocols: RA* 5. Verify that the patch installation completed correctly by using the KIDS 'Utilities...' [XPD UTILITY] option 'Install File Print' [XPD PRINT INSTALL FILE] and selecting this patch (RA*5.0*94). 6. The post-installation routine, RA94PST, can be deleted. 7. Enable HL7 communication between VistA and COTS applications. a. Start the HL7 message receipt and broadcast services of the voice recognition system in use at your facility. b. Start the specific VistA Radiology/Nuclear Medicine logical links used to broadcast and receive HL7 messages. Use the menu path outlined above for the VistA side logical link shutdown to execute the 'SL' (Start/Stop Links) to accomplish this task: 8. All radiology, and those users utilizing CPRS to place radiology orders, can resume their normal activities. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.0;Radiology/Nuclear Medicine;**[Patch List]**;Mar 16, 1998;Build 9 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: RA94PST Before: n/a After: B39745362 **94** Routine Name: RADD1 Before: B18784553 After: B20320820 **1,5,10,65,94** Routine Name: RAHLO Before: B47630507 After: B46090166 **4,8,27,55,66,84,94** Routine Name: RAHLO1 Before: B58238892 After: B64407342 **4,5,12,17,21,27,48,55,66,87,84,94** Routine Name: RAHLR Before: B54233244 After: B58728135 **2,12,10,25,71,82,75,80,84,94** Routine Name: RAHLRPTT Before: B17479415 After: B17860544 **84,94** Routine Name: RAHLTCPU Before: B2063802 After: B5185299 **84,94** Routine Name: RAUTL1 Before: B52485172 After: B52864092 **5,9,18,71,82,84,94** Routine list of preceding patches: 65, 84 ============================================================================= User Information: Entered By : MCNEILE,KEN Date Entered : JUL 03, 2008 Completed By: CRICHLOW,SHERRY Date Completed: AUG 25, 2009 Released By : REGA,ANNE Date Released : SEP 28, 2009 ============================================================================= Packman Mail Message: ===================== $END TXT