$TXT Created by ROWLANDS,ELMER at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 01/03/08 at 08:50 ============================================================================= Run Date: FEB 01, 2008 Designation: TIU*1*231 Package : TIU - TEXT INTEGRATION UTILITIES Priority: Mandatory Version : 1 SEQ #222 Status: Released Compliance Date: MAR 03, 2008 ============================================================================= Associated patches: (v)TIU*1*236 <<= must be installed BEFORE `TIU*1*231' Subject: ANALYZE POTENTIAL PROBLEMS CAUSED BY PATCH TIU*1.0*215 Category: - Routine Description: ============ *****PRE - INSTALLATION STEP **** ***IF patch TIU*1*215 was installed and then backed out - please get start date from the install file as you will be asked for it during installation of this patch. Notification to back out patch was sent 7/19/2007, check your records to see when it was backed out. If you did not install TIU*1.0*215 answer NO to the question "Did you install patch TIU*1.0*215?", and the install will run to completion.*** Description: =========== A problem has been found with VistA patch TIU*1.0*215, released June 28, 2007. One of the intents of this patch was to only allow editing/amending etc. from the Surgery package to keep the Surgery file (#130) and TIU files in sync. This was for the Nurse Intraoperative Report(NIR) and the Anesthesia Report only. However, if surgery personnel made changes to a surgery case using one of the case editors such as OSS Operation (Short Screen) [SROMEN-OUT], they were asked if they wanted to create an addendum. After installation of TIU*1.0*215, the addendum was not created for viewing via the Surgery Tab in CPRS, however, the data was being updated in the Surgery application files. PSI-07-124 Patch TIU*1.0*236, which was an emergency patch released 11/15/2007, restored the routines to the pre TIU*1.0*215 versions. Surgery does not have any type of audit trail or time stamp of any changes. Therefore, cases displayed on this report need to be compared MANUALLY (TIU to Surgery) to each other. For cases where the TIU note has an addendum, this does not necessarily indicate the existence of a discrepancy. This is due to the difference in the way the Surgery record is stored vs. the TIU record. Edits in Surgery change the contents of the Surgery record, while the corresponding TIU note an addendum created. A new option TIU 215 ANALYSIS is set up with installation of this patch and is being added as sequence 14 to the TIU MAIN MENU MGR option. TIU MAIN MENU MGR Text Integration Utilities (MIS Manager) TIU 215 ANALYSIS ... A ANALYZE POTENTIAL SURGERY TIU PROBLEMS V VIEW SINGLE SURGERY CASE USING CASE # T SEND ANALYSIS OUTPUT TO TEXT FILE The install routine asks for a start date to begin searching for Surgery cases. This date should be determined by the Surgery ADPAC, and will be sometime before TIU*1.0*215 was loaded. This is because a Surgery case could have been started well before TIU*1.0*215 was loaded, but edited during the timeframe that TIU*1.0*215 was installed in production. An end date is then asked for, which would be the date TIU*1.0*215 was backed out. The install routine will run upon installation and send a mailman message to the installer with a list of Surgery cases that need to be reviewed. The installer should forward the Mailman message (MM) to the Surgery ADPAC, Chief Health Information Management (HIM) or other appropriate personnel, and the IRM person that will work with the ADPAC to fix any problems. The post-install instructions should be followed at this point. Associated Remedy: ================== HD197407 Duplicate: HD198838 Participating Test Sites: ========================= NY HARBOR SALISBURY,NC CHARLESTON,SC DOCUMENTATION DISTRIBUTION: =========================== Sites may retrieve the User Manual directly via FTP (using BIN mode) from the ANONYMOUS.SOFTWARE directory at: Albany: ftp.fo-albany.med.va.gov Hines: ftp.fo-hines.med.va.gov Salt Lake City: ftp.fo-slc.med.va.gov Files available: tiuum.pdf The complete and updated manual will be posted to the VDL immediately after the release of the patch. INSTALLATION: ============= ***IF patch TIU*1*215 was installed and then backed out - please get start date from the install file as you will be asked for it during installation of this patch. Notification to back out patch was sent 7/19/2007, check you records to see when it was backed out. If you did not install TIU*1.0*215 answer NO to the question "Did you install patch TIU*1.0*215?", and the install will run to completion*** This patch can be loaded with users on the system. The installation time will vary but it should be less than 15 minutes. 1. Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: Installation 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution 2. From this menu, you may elect to use the following options (When prompted for the INSTALL NAME, enter TIU*1.0*231): 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. 3. Use the Install Package(s) option and select the package TIU*1.0*231. a. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO. b. When prompted 'Want to DISABLE Scheduled Options and Menu Options and Protocols? YES// Enter options you wish to mark as 'Out Of Order': TIU MAIN MENU MGR Text Integration Utilities (MIS Manager) Enter options you wish to mark as 'Out Of Order': Enter protocols you wish to mark as 'Out Of Order': Delay Install (Minutes): (0-60): 0// SAMPLE INSTALL: =============== Select Installation Option: 6 Install Package(s) Select INSTALL NAME: TIU*1.0*231 Loaded from Distribution 8/3/07@14:18:44 => TIU*1.0*231 This Distribution was loaded on Aug 03, 2007@14:18:44 with header of TIU*1.0*231 It consisted of the following Install(s): TIU*1.0*231 Checking Install for Package TIU*1.0*231 Will first run the Environment Check Routine, TIU215F Install Questions for TIU*1.0*231 Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO// Did you install patch TIU*1.0*215? YES Enter a date equal or prior to the date patch was installed: (1/1/2007 - 8/3/2007): 7/2/2007 (JUL 02, 2007) Enter date patch was backed out: (7/2/2007 - 8/3/2007): 7/25/2007 (JUL 25, 2007) Want KIDS to INHIBIT LOGONs during the install? NO// Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// Enter options you wish to mark as 'Out Of Order': TIU MAIN MENU MGR Text Integration Utilities (MIS Manager) Enter options you wish to mark as 'Out Of Order': Enter protocols you wish to mark as 'Out Of Order': Delay Install (Minutes): (0-60): 0// Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// TELNET TERMINAL TIU*1.0*231 -------------------------------------------------------------------------- Install Started for TIU*1.0*231 : Aug 03, 2007@14:20:33 Build Distribution Date: Aug 03, 2007 Installing Routines: Aug 03, 2007@14:20:33 Running Post-Install Routine: INS^TIU215F Updating Routine file... Updating KIDS files... TIU*1.0*231 Installed. Aug 03, 2007@14:20:34 Install Message sent #29571 -------------------------------------------------------------------------- +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed A mailman message will be generated after the installation of this patch. The subj line reads: "ANALYSIS OF POTENTIAL PROBLEMS CAUSED BY PATCH TIU*1.0*215 POST-INSTALL: ============= The install routine will run upon installation and send a mailman message to the installer with a list of Surgery cases that need to be reviewed. The installer should forward the Mailman message (MM) to the Surgery ADPAC, Chief Health Information Management (HIM)or other appropriate personnel and the IRM person that will work with the ADPAC to fix any problems. Reminder: Make sure the Surgery ADPAC Health Information Management (HIM), and/or other designated persons are involved in this process. The purpose of the post-install is to identify and correct any information that may be out of sync between Surgery and TIU concerning NIR and Anesthesia reports. It should be kept in mind that the Surgery record contains the correct and updated information, while the TIU record may not. A new option (14 TIU 215 ANALYSIS) will be set up with the installation of this patch. TIU MAIN MENU MGR Text Integration Utilities (MIS Manager) 14 TIU 215 ANALYSIS ... A ANALYZE POTENTIAL SURGERY TIU PROBLEMS V VIEW SINGLE SURGERY CASE USING CASE # T SEND ANALYSIS OUTPUT TO TEXT FILE Option A - ANALYZE POTENTIAL SURGERY TIU PROBLEMS Allows for the analysis process (which was run during the installation of this patch) to be run again. Surgery cases will be analyzed within a particular date range and the information from NIR and/or Anesthesia reports will be compared to their corresponding TIU notes. If the information does not match, the case number will be recorded as one that needs to be reviewed. The information generated by this option should be printed, either by cutting and pasting the results into a text file, or you can simply print the MM that was generated during installation. It can be used to identify which TIU records have addenda and which do not. This is extremely important as how a comparison is handled depends directly on if the TIU record has addenda. It can also be used as a checklist, to make sure that every record in question is examined. *Note: The MM from the install does not contain patient names, only the first character of the last name followed by the last 4 of the social security number. When the utility is run from the menu, however, it prints the full patient name. ***Options V and T are available to assist with comparison and cleanup*** Option V - VIEW THE CONTENTS OF A SURGERY CASE USING CASE # Views the content ofa Surgery Case file (#130). NIR data will be displayed followed by the Anesthesia data. Option T - SEND OUTPUT TO TEXT FILE Sends output to a Host text file on your production account's server. This will be very useful for sites that have a large number of cases to review. Microsoft Word can then be used to compare the text files, which is extremely helpful because discrepancies are automatically highlighted, thus expediting the comparison process. Option T overview: ================== Option T will send data from both Surgery and TIU to respective output files. First, the user is prompted for a path to send output files to which should look something like this: USER$:[] . You may need to coordinate with your local IRM VistA system administrator to determine exactly what the path should be. The user is then prompted for three filenames; one for Surgery output, one for TIU output, and one for associated TIU addenda. If the path and/or filenames are invalid you will be prompted to enter them again. Option T will use the same analysis technique as Option A does. Instead of just listing cases that need review, it will write the contents of the associated reports to text files. For each case, what is on record in Surgery will be written to one file, and what is on record in TIU will be written to another file. Also, if there are any associated TIU addenda with the case, these addendums will be written to a separate file. Multiple cases will be written to a single file, with the user pre-defining the maximum limit. When this limit is encountered, a new set of output files will be created. For instance, if there are a total of 50 cases found with possible discrepancies, and the user sets a maximum of 25 cases per file, then 2 Surgery output files will be created, two TIU output files, and x number of addenda output files. Note: The number of Surgery and TIU files will always be the same; the number of addenda files may not. This is due to the fact not every Surgery case will have an associated TIU addenda). Let's say the names "Surgery", "TIU", and "ADDENDA" are used for the output filenames, you would then have: Surgery1.txt, Surgery2.txt, TIU1.txt, TIU2.txt, and ADDENDA1.txt (and possibly ADDENDA2.txt), each with 25 cases per file. ***IMPORTANT*****************IMPORTANT****************IMPORTANT******* NOTE!!!! The host files created in option T contains Patient Information and should only be sent to a server within the system boundary of the VA. The directory must be password protected. If you are going to download to a pc for the Microsoft Word Compare for analysis it must be a VA approved encrypted PC. Both the host files and the files downloaded to the pc must be destroyed by an approved means when analysis/correction is complete. When the files are destroyed the systems manager, official, or the ISO should be notified they have been destroyed. ***IMPORTANT******************IMPORTANT******************IMPORTANT***** IMPORTANT!!!! READ THESE INSTRUCTIONS The compare feature in Word may not give the desired results. If this is the case, you will have to switch the order in which you open the files for comparison. 1) Open up your TIU .txt file as plain text **Note: You may have to set 'Files of type' to All Files (*.*) or Text Files (*.txt) to see text files in your directory browser. 2) Go to the Tools menu option and select 'Compare and Merge Documents' 3) A file browser window will open up. Select the Surgery .TXT file as plain text. IT IS IMPORTANT THAT YOU SELECT 'MERGE INTO NEW DOCUMENT' IN THE DROP-DOWN BOX! Simply double-clicking on the file, or just hitting the Merge button can show an erroneous compare. You can tell if your compare is correct by first finding a Surgery case where the corresponding TIU note DOES NOT CONTAIN any addenda. Look at what data is underlined vs. what is crossed out (or marked as deleted). If you see a pattern where items are crossed out, yet you know they are what is currently in the Surgery record, THIS IS BACKWARDS. These items should be underlined, while a crossed out item should represent what is in the original TIU note and not in Surgery. If you encounter this situation, simply close Word and start over. This time open your Surgery output file first, then the TIU one, with the Merge and Compare option under the Tools menu. 4) You should now see the compared documents as one (hereafter referred to as the compare document), with underlined highlighted text indicating information not present in the original TIU note. Information that has been edited is shown one of two ways: either in an outlined box or with a strikethrough. The outlined box will contain what was originally in the TIU record pointing to what is currently contained in the Surgery record (outlined boxes have the caption 'Deleted' in them). For information that has a strikethough, it is simply right next to the information that is in the Surgery record. Interpreting your compared documents: ==================================== As mentioned before, Surgery cases where the TIU notes have addenda need to be treated differently than ones that do not. Use the list printed from Option 1 (or MM message generated during the installation) to determine if the note has addenda. The two processes are outlined below: **TIU records WITHOUT addenda - The discrepancies listed in the compare document generated by Word need to be added to the TIU record by the process described in the CORRECTION PROCESS section. **TIU records WITH addenda - This process is a bit more complex. The way Surgery edits are handled in TIU, the presence of an addenda automatically causes the records not to match when doing a checksum compare. Therefore, some cases may be legitimate (information is in sync with the supporting addenda) while others are not. Every individual discrepancy in the compare document needs to be examined, and if the information is not present in an addendum of the TIU note, it needs to be added using the process described in the CORRECTION PROCESS section. The addenda output file can help with this, as all addenda associated with their corresponding TIU case will be included in that file. Detail on NIR: ============= When entering the NIR it allows you to enter Anesthesia Technique data. If the data is present when the note is signed, the NIR is created in TIU with the data. If it was not added prior to signing and is entered after signing, an addendum will be created. If you go back into Surgery after the Anesthesia Technique data created the addendum, and change or enter additional data other than the Anesthesia Technique, it does not create an addendum to the NIR. Another addendum will only be created if the Anesthesia Technique is changed. According to Surgery developers this is by design as technically only the Anesthesia Technique is a part of the NIR. Data added after the Anesthesia technique was completed and sent to TIU will put the case on the review list. *Note: If the site does use the Anesthesia report and the Anesthesia technique data is changed, an addendum is created in TIU. CORRECTION PROCESS: =================== The following manual fix process is provided by the Surgery Enterprise Product Support(EPS) personnel: ========================================================================== The Surgery ADPAC should review the reports. Health Information Management (HIM) personnel should also be involved in this process. If the programmer feels comfortable in restoring the data in the Surgery package to what it was originally, then the programmer can with the help of the Surgery ADPAC do it, but we would encourage the site to enter a Surgery Remedy ticket, and we will step the site through the process. The programmer would edit the fields in the Surgery Case file (#130) that should be restored to their original data using FileMan enter/edit. For the NIR, once the cases that need fixing are restored to their original data set(see examples one and two), one of the circulating nurses listed in the case, with the assistance of the Surgery ADPAC, should use the Surgery package to put the changes back into the cases and sign the addenda (see Options used to reenter the data in Surgery). Similarly for the Anesthesia Report, once the cases that need fixing are restored to their original data set (see examples one and two), the anesthetist with the assistance of the Surgery ADPAC, should use the Surgery package to put the changes back into the cases and sign the addenda (see Options used to reenter the data in Surgery). ========================================================================== Example one using fileman: =============================== INPUT TO WHAT FILE: SURGERY// EDIT WHICH FIELD: ALL// ANESTHESIA TECHNIQUE (multiple) EDIT WHICH ANESTHESIA TECHNIQUE SUB-FIELD: ALL// THEN EDIT FIELD: Select SURGERY PATIENT: `30536 GLTLPLN,TJXSS HAIXY 08-18-07 TOE 7- 24-69 XXXXXXXXX YES SC VETERAN GJ Select ANESTHESIA TECHNIQUE: GENERAL// @ SURE YOU WANT TO DELETE THE ENTIRE 'G' ANESTHESIA TECHNIQUE? Y (Yes) Select ANESTHESIA TECHNIQUE: THEN IN SURGERY ADD THE GENERAL ANESTHESIA TECHNIQUE BACK IN USING ONE OF THE OPTIONS UNDER USED TO RE-ENTER DATA IN SURGERY. Example two using fileman: ================================================================= TIU HAS CLEAN FOR WOUND CLASSIFICATION BUT SURGERY HAS CONTAMINATED Select OPTION: 1 ENTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE: SURGERY// EDIT WHICH FIELD: ALL// WOUND CLASSIFICATION THEN EDIT FIELD: Select SURGERY PATIENT: `30506 NANNIE,ETHAN HAIXY 12-31-06 BAD FINGER 7-24-69 101043279 YES SC VETERAN GJ WOUND CLASSIFICATION: CONTAMINATED// CLEAN 1 CLEAN 2 CLEAN/CONTAMINATED Choose 1-2: 1 CLEAN NOW REENTER 'CONTAMINATED' IN SURGERY USING ONE OF THE OPTIONS USED TO RE-ENTER DATA INTO SURGERY AND IT WILL GENERATE AN ADDENDUM FOR TIU ================================================================== Options used to reenter the data in Surgery. NIR REPORT OSS Operation (Short Screen) NR Nurse Intraoperative Report ANESTHESIA REPORT AR Anesthesia Report PAC Enter PAC(U) Information M Medications (Enter/Edit) =================================================================== For those sites that use the Anesthesia Report, the following list of fields create an addendum to the NIR> Sub-file Field -------- ----- Other Scrubbed Assistant(s) - Other Scrubbed Assistant Other Scrubbed Assistant(s) - Comments O.R. Circulating Nurse(s) - O.R. Circulating Nurse O.R. Circulating Nurse(s) - Educational Status O.R. Scrub Nurse(s) - O.R. Scrub Nurse O.R. Scrub Nurse(s) - Educational Status Other Persons in O.R. - Other Person in O.R Other Persons in O.R. - Title/Organization Position(s) - Position Position(s) - Placed Restraints and Position Aids - Restraint/Position Aid Restraints and Position Aids - Applied By Restraints and Position Aids - Comment Principal CPT Modifier - CPT Modifier Other Procedures Performed - Other Procedure Other Procedures Performed - CPT Code Other Procedures Performed - CPT Modifier Tourniquet - Time Applied Tourniquet - Time Released Tourniquet - Site Applied Tourniquet - Pressure Applied (in TORR)- Tourniquet - Applied By Thermal Unit - Thermal Unit Thermal Unit - Temperature Thermal Unit - Time On Thermal Unit - Time Off Prosthesis Installed - Item Prosthesis Installed - Sterility Checked Prosthesis Installed - Sterility Expiration Date Prosthesis Installed - RN Verifier Prosthesis Installed - Vendor Prosthesis Installed - Model Prosthesis Installed - Lot/Serial Number Prosthesis Installed - Sterile Resp Prosthesis Installed - Size Prosthesis Installed - Quantity Medications - Medication Medications - Time Administered Medications - Route Medications - Dose Medications - Ordered By Medications - Administered By Medications - Comments Irrigation Solution(s) - Irrigation Solution Irrigation Solution(s) - Time Utilized Irrigation Solution(s) - Amount Irrigation Solution(s) - Provider Blood Replacement Fluids - Replacement Fluid Type Blood Replacement Fluids - Quantity (ml)- Blood Replacement Fluids - Source Identification Blood Replacement Fluids - VA Identification Blood Replacement Fluids - Comments Laser Unit(s) - Laser Unit/ID Laser Unit(s) - Duration Laser Unit(s) - Wattage Laser Unit(s) - Operator Laser Unit(s) - Plume Evacuator Laser Unit(s) - Comments Cell Saver(s) - Cell Saver ID Cell Saver(s) - Operator Cell Saver(s) - Amount Salvaged (ml)- Cell Saver(s) - Amount Reinfused (ml)- Cell Saver(s) - Comments Cell Saver(s) - Disposables Name Cell Saver(s) - Lot Number Cell Saver(s) - Quantity Anesthesia Technique(s) - Anesthesia Technique Anesthesia Technique(s) - Principal Technique Anesthesia Technique(s) - Anesthesia Agent Anesthesia Technique(s) - Dose (mg)- Routine Information: ==================== The second line of each of these routines now looks like: ;;1.0;TEXT INTEGRATION UTILITIES;**[Patch List]**;Jun 20, 1997;Build 63 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: TIU215F Before: n/a After: B46816253 **231** Routine Name: TIU215R Before: n/a After: B65000557 **231** ============================================================================= User Information: Entered By : ROWLANDS,ELMER Date Entered : JUL 30, 2007 Completed By: HEFFERNAN,COREY Date Completed: JAN 30, 2008 Released By : SCHMIT,BECKY Date Released : FEB 01, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT