$TXT Created by MONOSKY,ALAN at CINP.FO-BIRM.MED.VA.GOV (KIDS) on Monday, 03/03/08 at 14:07 ============================================================================= Run Date: APR 07, 2008 Designation: SR*3*166 Package : SR - SURGERY Priority: Mandatory Version : 3 SEQ #160 Status: Released Compliance Date: MAY 08, 2008 ============================================================================= Associated patches: (v)SR*3*151 <<= must be installed BEFORE `SR*3*166' (v)SR*3*164 <<= must be installed BEFORE `SR*3*166' Subject: NSQIP-CICSP ENHANCEMENTS 2008 Category: - Enhancement (Mandatory) - Data Dictionary - Routine - Input Template Description: ============ This patch updates the Surgery Risk Assessment software of the Veterans Health Information Systems and Technology Architecture (VistA) Surgery application as requested by the Executive Board of the National Surgical Quality Improvement Program (NSQIP) and by the Cardiac Surgery Consultants Board of the Continuous Improvement in Cardiac Surgery Program (CICSP). The updates include the addition of new data fields, changes to existing data fields, changes to data entry screens, changes to reports used in Surgery Risk Assessment management process and changes to the Surgery Risk Assessment transmissions. Non-Cardiac Assessment Modifications ------------------------------------ - List of Surgery Risk Assessment [SROA ASSESSMENT LIST] option o When printing the List of Transmitted Assessments to screen or printer, the user is prompted to view/print assessed cases only, excluded cases only or both. Additionally, the user is prompted to view/print the list by date of operation or by date of transmission. o When printing the List of Eligible Cases to screen or printer, the user is prompted to view/print assessed cases only, excluded cases only, non-assessed cases only or all cases. o A new list, the List of Cases With No CPT Codes is added. This list displays all completed cases that have not been coded with CPT codes. o A new list, the Summary List of Assessed Cases is added. This report displays the total count of incomplete, complete and transmitted risk assessments and the count of excluded cases. This report may be printed for all or for selected surgical specialties and for all divisions or for a selected division. - M&M Verification Report [SRO M&M VERIFICATION REPORT] option This report is modified to display additional information as available, including the case number, final CPT codes and review of death comments. - Clostridium Difficile Colitis (C. difficile) definition updated o In the SURGERY file (#130), the description for the CLOSTRIDIUM DIFFICILE COLITIS field (#446) is updated. o In the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5), the description for the CLOSTRIDIUM DIFFICILE COLITIS (C-DIFFICILE) category is updated. - In the SURGERY file (#130), the description for the PREOP FUNCT. HEALTH STATUS field (#492) is updated. - Risk Model Lab Test (Enter/Edit) [SROA LAB TEST EDIT] option This new option is added to the Surgery Risk Assessment Menu [SROA RISK ASSESSMENT] to assist the nurse reviewers in mapping entries in the RISK MODEL LAB TEST file (#139.2) to the LAB DATA file (#63). - REGIONAL Anesthesia Technique added o REGIONAL is added to the list of choices when entering the ANESTHESIA TECHNIQUE field (#.37) in the SURGERY file (#130). o The Anesthesia AMIS [SROAMIS] option is inactivated and removed from the Anesthesia Menu [SROANES1] and from the Anesthesia Reports [SR ANESTH REPORTS] menu options. - Preoperative Information (Enter/Edit) [SROA PREOP DATA] option updated o The following items are no longer required and are removed from the input screens: > On Page 1, under GENERAL E. Pack/Years I. Pre-illness Funct Status > On Page 2, under CENTRAL NERVOUS SYSTEM H. Paraplegia I. Quadriplegia o The following changes are made relating to the capture of height from the Vitals software: > The 1 year date range limitation is removed from the height capture process so that the most recent height measurement is returned regardless of when it was taken. > If the height capture process returns a height measurement from the Vitals software, the date of the measurement will be stored and displayed on the data input screen. - Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option If the user responds YES to batch printing for a specific date range, the user will be allowed to print for a single surgical specialty or for all surgical specialties. - Surgery Consult Dates added The Patient Demographics (Enter/Edit) [SROA DEMOGRAPHICS] option is updated to include 2 additional date fields: o Surgery Consult Date o Date Surgery Consult Requested Cardiac Assessment Modifications ------------------------------------ - Clinical Information (Enter/Edit) [SROA CLINICAL INFORMATION] The HEIGHT field (#236) and the WEIGHT field (#237) will no longer accept an entry of NS for "No Study". System will only accept numeric values in the field. - Operative Risk Summary Data (Enter/Edit) [SROA CARDIAC OPERATIVE RISK] This option is modified to allow users to enter a value of NS (No Study) into the Physician's Preoperative Estimate of Operative Mortality field. Upon entry of NS, the system will automatically populate the Date/Time of Estimate of Operative Mortality field with a value of NS (No Study). - Update Assessment Status to 'COMPLETE' [SROA COMPLETE ASSESSMENT] This option is modified to list items missing from the assessment based upon the order in the field number in SURGERY file (#130). An enhancement to this option shall list missing items in the same order as the standard assessment screens. - Cardiac Procedures Operative Data (Enter/Edit) [SROA CARDIAC PROCEDURES] The system is modified to initially prompts user to "Select Operative Information to Edit." A new entry of "N" shall allow the user to "Set All to No" for the 22 Cardiac Procedures fields. A verification prompt will follow to ensure that user understands entry. Fields that do not have YES/NO responses will be updated as follows: Items #1-#5 are numeric and their values will be set to 0. #9 Valve Repair will be set to NONE #13 Maze Procedure will be set to NO MAZE PERFORMED - Laboratory Test Results (Enter/Edit) [SROA LAB-CARDIAC] If the lab values entered into the screen are out of range, they will be flagged as high or low during data entry. - Resource Data [SROA CARDIAC RESOURCE] o When editing the D/T PATIENT DISCH FROM ICU field (#471), the software is modified to provide the user with a select option to allow user to pull date/time from existing list of possible entries or manually enter a date/time o Postop Extubation Hours If the extubation time is entered, the software will display the number of hours between the time the patient left the operating room and the time the patient was extubated. o PRIMARY CAUSE FOR DELAY field (#515) If a Cardiac patient's surgery is greater than 30 days from initial VA Cardiothoracic Surgery Consultation (as calculated between the CT CONSULT DATE to DATE OF SURGERY), user is requested to enter cause as defined in the field. If date is less than or equal to 30 days, system shall automatically default entry to NONE. General Surgery Items --------------------- 1. The following fields in the SURGERY file (#130) are updated to utilize VistA Pharmacy supported API's in reference to the DRUG file (#50): - MEDICATIONS field (#.01, sub-file #130.33) - ANESTHESIA AGENTS field (#.01, sub-file #130.47 of sub-file #130.06) - TEST DOSE field (#.01, sub-file #130.48 of sub-file #130.06) 2. Remedy Ticket #HD0000000203815 When making an operation request, a site parameter controls whether preoperative risk assessment information can be entered. If set to YES, there are occasions within two screens delete variables causing an undefined error. This patch fixes this problem. 3. Remedy Ticket #HD0000000231157 The problem reported in this Remedy ticket is corrected by this patch. In the SURGERY file (#130), lookups on the DRUG file (#50) are modified to use only the GENERIC NAME field (#.01) and the SYNONYM field (#9). 4. The following date/time fields in the SURGERY file (#130) are modified to assume a past date if the user enters a date without a year: SURGICAL PRIORITY, DATE field (#414.1) HOSPITAL ADMISSION DATE field (#418) HOSPITAL DISCHARGE DATE field (#419) ADMISSION/TRANSFER DATE field (#420) DISCHARGE/TRANSFER DATE field (#421) OBSERVATION ADMISSION DATE field (#452) OBSERVATION DISCHARGE DATE field (#453) Associated Remedy Ticket(s): ============================ HD0000000203815 HD0000000231157 New Service Request (NSR): ========================== N/A Test Sites: =========== BAY PINES, FL CLEVELAND, OH LITTLE ROCK, AR MEMPHIS, TN NEW YORK HCS, NY PALO ALTO HCS, CA PITTSBURGH HCS, PA Documentation Retrieval: ======================== Sites will retrieve VistA software and documentation from the following FTP addresses. The preferred method is to FTP the files from 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: OI FIELD OFFICE FTP ADDRESS DIRECTORY Albany ftp.fo-albany.med.va.gov anonymous.software Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake City ftp.fo-slc.med.va.gov anonymous.software FILE NAME DESCRIPTION/TITLE FORMAT SR_3_UM_R0408.PDF Surgery V. 3.0 User Manual BINARY SR_3_P166_UM_CP.PDF Surgery V. 3.0 User Manual Change Pages BINARY SR_3_TM_R0408.PDF Surgery V. 3.0 Technical Manual/ BINARY Security Guide SR_3_P166_TM_CP.PDF Surgery V. 3.0 Technical Manual/ BINARY Security Guide Change Pages SR_3_P166_RN.PDF Surgery V. 3.0 Release Notes BINARY Once released, documentation can also be retrieved from the VistA Documentation Library (VDL) on the Internet at the following address, http://www.va.gov/vdl. Installation Instructions: ========================== This patch should be installed during a period of low system activity with Surgery users off the system. It should be installed at a time when the Surgery Nightly Cleanup and Updates [SRTASK-NIGHT] option is not running. No options need to be placed out of service. Installation time is expected to be less than 5 minutes. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation & Distribution System menu, select the Installation menu. 3. From this menu, you may elect to use the following options (when prompted for the INSTALL NAME, enter SR*3.0*166): (a) Backup a Transport Global - this option will create a backup message of any routines exported with the patch. It will NOT backup any other changes such as DDs or templates. (b) Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, 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. (d) Print Transport Global - this option will allow you to view the components of the KIDS build. 4. Use the Install Package(s) option and select the package SR*3.0*166. 5. When prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//" respond YES. 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. NOTE: This patch includes pre-installation and post-installation processes within the routine SR166UTL. - The pre-installation process performs the following actions: o Adds normal ranges to the cardiac tests in the RISK MODEL LAB TEST file (#139.2) o Deletes the existing data from the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5.) o Deletes the option Anesthesia AMIS option [SROAMIS] as a menu item from the following two menu options: (1) Anesthesia Menu [SROANES1] (2) Anesthesia Reports [SR ANESTH REPORTS] o Removes the CPT code 47135 from the CPT EXCLUSIONS file (#137) o Removes the "AE" cross reference from the SURGERY CONSULT DATE field (#513) - The post-installation process sets up the "AT" cross reference in the SURGERY file (#130). The routine SR166UTL is deleted at the end of patch installation. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.0; Surgery ;**[Patch List]**;24 Jun 93;Build 6 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: SR166UTL Before: n/a After: B2958392 **166** Routine Name: SROABCH Before: B5698870 After: B9293045 **77,166** Routine Name: SROACAR Before: B10623143 After: B13335693 **38,71,93,95,100,125,142,153,166** Routine Name: SROACMP Before: B26064813 After: B34040143 **47,50,127,143,166** Routine Name: SROACMP1 Before: B33541933 After: B28325936 **47,68,77,50,166** Routine Name: SROACOM Before: B21181819 After: B15296750 **38,55,63,65,88,93,95,102,100, 125,134,142,160,166** Routine Name: SROACOM1 Before: n/a After: B19655415 **166** Routine Name: SROACOP Before: B23673971 After: B24468418 **38,47,71,88,95,107,100,125, 142,153,160,166** Routine Name: SROACPM Before: B47007615 After: B57221658 **71,93,95,99,100,125,142,160, 164,166** Routine Name: SROACPM1 Before: B14126949 After: B18300862 **125,153,166** Routine Name: SROACR2 Before: B15772524 After: B15979431 **125,153,160,166** Routine Name: SROALEC Before: B22392220 After: B24984327 **160,166** Routine Name: SROALM Before: B22043209 After: B22101707 **38,50,88,142,153,160,166** Routine Name: SROALNC Before: n/a After: B19389319 **166** Routine Name: SROALOG Before: B18199636 After: B26759607 **38,55,62,77,50,153,160,166** Routine Name: SROALSL Before: n/a After: B11594141 **166** Routine Name: SROALT Before: B10668793 After: B13907550 **38,50,142,153,160,166** Routine Name: SROALTP Before: B10029019 After: B12785479 **32,50,142,153,160,166** Routine Name: SROALTS Before: B12998435 After: B15655356 **38,50,142,153,160,166** Routine Name: SROALTSP Before: B12106234 After: B14316603 **32,50,142,153,160,166** Routine Name: SROAMEAS Before: B451481 After: B683336 **38,125,153,166** Routine Name: SROAMIS Before: B16993820 After: B17586751 **22,34,38,77,50,86,166** Routine Name: SROAOP Before: B17150014 After: B19700758 **19,38,47,63,67,81,86,97,100, 125,142,153,160,166** Routine Name: SROAPAS Before: B27516322 After: B28963323 **38,47,81,88,111,112,100,125, 153,166** Routine Name: SROAPCA1 Before: B30711274 After: B30576973 **38,63,71,88,95,125,142,153,166** Routine Name: SROAPCA3 Before: B20996510 After: B22548966 **38,71,95,101,125,160,164,166** Routine Name: SROAPM Before: B42791462 After: B46797280 **47,81,111,107,100,125,142,160,166** Routine Name: SROAPRE Before: B20305987 After: B18131652 **38,47,55,88,100,125,142,166** Routine Name: SROAPRE1 Before: B12243504 After: B9700130 **38,47,125,135,141,166** Routine Name: SROAPRE2 Before: B8990080 After: B8926868 **38,47,125,153,166** Routine Name: SROAPRT1 Before: B15011288 After: B13596603 **38,47,125,153,166** Routine Name: SROAPRT2 Before: B11956199 After: B10962875 **38,125,137,153,160,166** Routine Name: SROAPRT4 Before: B6368116 After: B6182812 **38,125,153,160,166** Routine Name: SROAPRT5 Before: B5810182 After: B5757110 **38,88,153,166** Routine Name: SROAPS1 Before: B19811405 After: B23125324 **38,47,125,153,166** Routine Name: SROAPS2 Before: B18374164 After: B16963957 **38,47,125,153,160,166** Routine Name: SROASS Before: B19053232 After: B19270585 **38,47,64,94,121,100,160,166** Routine Name: SROASSP Before: B4481417 After: B5254158 **38,94,166** Routine Name: SROATCM3 Before: B12614187 After: B12747087 **125,135,153,164,166** Routine Name: SROATM1 Before: B24222970 After: B24970386 **27,38,47,60,62,81,88,93,95, 125,153,160,166** Routine Name: SROATMNO Before: B27561878 After: B28046675 **27,38,47,62,68,79,83,81,88, 93,95,97,129,125,142,153,160, 166** Routine Name: SROAUTL Before: B41379689 After: B41172793 **38,46,47,63,81,88,95,112,100, 125,134,142,153,160,166** Routine Name: SROAUTL1 Before: B18991431 After: B17536014 **38,47,81,125,153,160,166** Routine Name: SROAUTL3 Before: B12857590 After: B13024362 **38,47,63,77,142,163,166** Routine Name: SROAUTL4 Before: B40778268 After: B50847568 **38,71,95,125,153,160,164,166** Routine Name: SROAUTLC Before: B27522259 After: B27748931 **38,71,90,88,95,97,102,96,125, 153,163,164,166** Routine Name: SROCODE Before: B6616214 After: B6396921 **72,41,114,151,166** Routine Name: SROLABS Before: n/a After: B8161872 **166** Routine Name: SROMED Before: B19949445 After: B20688417 **21,44,79,100,151,166** Routine Name: SROXR4 Before: B6379114 After: B8185921 **62,83,100,153,166** ============================================================================= User Information: Entered By : MONOSKY,ALAN Date Entered : NOV 02, 2007 Completed By: ALEXANDER,DAVID Date Completed: MAR 26, 2008 Released By : MUSGROVE,STEVE Date Released : APR 07, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT