============================================================================= Run Date: SEP 02, 2020 Designation: YS*5.01*166 Package : YS - MENTAL HEALTH Priority: EMERGENCY Version : 5.01 SEQ #127 Status: Released Compliance Date: SEP 09, 2020 ============================================================================= Associated patches: (v)YS*5.01*154 <<= must be installed BEFORE `YS*5.01*166' Subject: CLOZAPINE OVERRIDE DEFECT FIXES Category: - Routine - Enhancement () - Data Dictionary Description: ============ The Health Integration & Modernization (HI&M) CLOZAPINE NCCC OVRD COVID-19 multi-build is an emergency patch to the National Clozapine Registry (NCR) software to correct defects to Clozapine National Clozapine Coordinating Center (NCCC) Override functionality. The NCR is maintained by the NCCC. The NCCC is responsible for VA's compliance with the clozapine Risk Evaluation and Mitigation Strategy (REMS), which is mandated by the Food and Drug Administration (FDA) for tracking clozapine patients. The multi-build contains the Mental Health patch YS*5.01*166 and the Outpatient Pharmacy patch PSO*7.0*612. The list of defects and their resolution is below. This patch is also being released with informational patch PSJ*5*403 that documents changes to Inpatient Medications' processing of clozapine overrides that are a result of the defect fixes in PSO*7.0*612 and YS*5.01*166. This patch addresses one enhancement to the Clozapine drug dispensing program: 1) Allows automatic update of the Clozapine Registration Number between Mental Health and Pharmacy Files. Additionally, this patch addresses these defects to the Clozapine drug dispensing program: 1) Resolves an issue where a National Override fails for a patient with more than one entry in the Clozapine Patient List file (#603.01). 2) Resolves an issue where a National Override from NCCC was not honored after issuing a Local Temporary Registration Number or Local Special Condition Override. Defect Tracking System Ticket(s) & Overview: -------------------------------------------- * Defect and Enhancement ID's listed below are internal identifiers and do not map to any external system. Patch YS*5.01*166 contains the following changes: 1. Requirement 1 Enhancement - Automate the Pharmacy Registration of NCCC Clozapine Authorizations. Problem: -------- Currently, national clozapine authorization numbers are sent by the National Clozapine Coordinating Center (NCCC) and filed into the CLOZAPINE PATIENT LIST file (#603.01). Later, a pharmacy user must manually execute Vista option Register Clozapine Patient [PSOL REGISTER PATIENT] (for new patients), or Edit Data for a Patient in the Clozapine Program PSOL [EDIT] (for previously registered patients). Resolution: ---------- Automate the clozapine registration process by automatically updating the patient's clozapine registration number and status when a new National Clozapine number is received from the NCCC. Technical Resolution: --------------------- A new Pharmacy API has been created that accepts Patient DFN and NCCC Clozapine Authorization number as input and files the number into the CLOZAPINE REGISTRATION NUMBER field (#53) in the PHARAMCY PATIENT file (#55), and updates the CLOZAPINE STATUS field (#54) to 'A' for Active. This API is executed when a new clozapine authorization is filed into the CLOZAPINE PATIENT LIST (#603.01) file via a mumps action cross reference. 2. Requirement 1 Defect 2 - National Override Date update fails for patient with more than one clozapine authorization. Problem: ----------- When a National Override is requested for a patient that has more than one entry in 603.01, the YSCL Server code performs a defective lookup into 603.01. If the patient has more than one entry in 603.01, the server code retrieves the older clozapine number and compares it to the clozapine number in the incoming override. Since the override is usually (if not always) performed on the most recent clozapine number, the override fails and generates the error message, "SSN (PATIENT,NAME) has multiple Clozapine Numbers at nnn". Resolution: ----------- The Mental Health Clozapine Server's NCCC Override patient lookup into file 603.01 shall be corrected when processing an incoming NCCC Override so that it looks in file 603.01 for the specific patient and NCCC Clozapine number from the incoming message. Only the file 603.01 entry matching the incoming NCCC clozapine number and patient shall be updated with the incoming NCCC Override Date. Technical Resolution: --------------------- Correct routine YSCLSRV2 from failing to find a match in the CLOZAPINE PATIENT LIST file (#603.01) for the incoming clozapine authorization number and patient when attempting to file an NCCC Override Date in the OVERRIDE field (#3). Prior to the patch, the code compared clozapine number associated with the incoming NCCC override with the first (earliest) clozapine authorization number on file for the patient. If the patient had only one clozapine number on file, the match was successful. If the patient had more than one clozapine number on file, the match failed as the most recent clozapine number was ignored. Routine OVVRID^YSCLSRV2 was changed to look through all clozapine authorization numbers associated with the patient to find a match for the clozapine number associated with the incoming NCCC override. 3. Requirement 2 Defect 1 - Patient with Temp Registration and an NCCC Authorization and NCCC Override Date, but day supply limited to 4. INC9951972: COVID-19 VistA PSO defect - Clozapine National Override patient's prescription limited to 4 days. Problem: -------- A Patient initially receives a 4-day emergency authorization, and later an NCCC Authorization and an NCCC Override Date. While the NCCC Override Date is still active, the Day Supply (for Outpatient Pharmacy) or Order Duration (for Inpatient Medications) continues to be limited to 4 days. Inpatient Medications Order Duration is defined as the number of days between the order's Start Date/Time and Stop Date/Time. Resolution: ----------- If a NCCC Authorized National Override Date is in effect following an initial local override, the system shall process an active clozapine patient's clozapine prescription under national override processes allowing the patient to be provided with the approved quantity associated with their individual dispensing frequency from the DISPENSE FREQUENCY field (#2) in the CLOZAPINE PATIENT LIST file (#603.01). The approved quantity is determined by the order's Days Supply for Outpatient Pharmacy orders, and the Order Duration (days between Start Date/Time and Stop Date/Time) for Inpatient Medications orders. Technical Resolution: --------------------- The correct patient dispense frequency is now retrieved by changing CL1^YSCLTST4 to find the dispense frequency associated with the patient's registered clozapine authorization number. 4. Requirement 2 Defect 2 - Patient with NCCC Authorization receives a Special Condition Fill, and later an NCCC Authorization and Override Date, but day supply limited to 4. INC9951972: COVID-19 VistA PSO defect - Clozapine National Override patient's prescription limited to 4 days Problem: -------- A patient with an initial NCCC Authorization receives a Special Condition override, followed by an NCCC override, is limited to a Day Supply (Outpatient Pharmacy orders) or an Order Duration (Inpatient Medications orders) limited to 4 for clozapine orders. The NCCC national clozapine override and the patient's regular clozapine dispense frequency are ignored. Resolution: ----------- A patient with an initial NCCC clozapine authorization receiving a Special Condition override, followed by an NCCC override, shall be processed under national override rules allowing the patient to be provided with the approved quantity associated with their individual dispensing frequency from the DISPENSE FREQUENCY field (#2) in the CLOZAPINE PATIENT LIST file (#603.01). The approved quantity is reflected in the order's Days Supply for Outpatient Pharmacy orders, and the Order Duration (days between Start Date/Time and Stop Date/Time) for Inpatient Medications orders. Technical Resolution: --------------------- Routine OVRRID^YSCLTST2 changed to kill ^XTMP("PSJ4D-"_DFN) and ^XTMP("PSO4D-"_DFN) after an NCCC override is successfully filed. This removes a patient's local clozapine override information when it is replaced by an NCCC override. Patch Components ================ Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ---------------------- -------------------- CLOZAPINE PATIENT CLOZAPINE REGISTRATION Modified* (Mumps X-Ref) LIST (#603.01) NUMBER (#.01) CLOZAPINE PATIENT(#1) Modified* (Mumps X-Ref) *New style "AC" mumps cross reference added to these two fields in file 603.01. New routine TRGR^PSOCLADD(DFN,PSOCLZNW) is invoked when a new entry is filed. New Integration Control Registration (ICR) #7175 has been created to document the new cross application interaction. Forms Associated: Form Name File # 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 New/Modified/Deleted ---------------------- -------------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A * * * * * * Test Sites: ---------- New Jersey Health Care System (561) VA Connecticut Health Care System (689) Boise VA Medication Center (531) Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released as a host file. The host file PSO_YS_CLOZ_COVID.KID contains patches PSO*7.0*612 and YS*5.01*166 and is available on the VA VistA download server at https://download.vista.domain.ext/index.html/SOFTWARE/. Documentation can also be found on the VA Software Documentation Library at: https://www.domain.ext/vdl/. Other software files can also be obtained by accessing the URL: https://download.vista.domain.ext/index.html/SOFTWARE. ------------------------------------------------------------------------- Title File Name ------------------------------------------------------------------------- MHA Security Technical YS_MHA_TM.pdf Manual/Guide Deployment Installation Back-Out pso_7_p612_ys_501_p166_dibr.docx and Rollback Guide - HI&M pso_7_p612_ys_501_p166_dibr.pdf Clozapine Overrides Release Notes - HI&M Clozapine pso_7_p612_ys_501_p166_rn.docx Overrides pso_7_p612_ys_501_p166_rn.pdf Patch Installation: Pre/Post Installation Overview: ------------------------------- There are no tasks to be performed before the installation of this multi-build. Note that the routines should be backed up to a PackMan message before installing the build. Pre-Installation Instructions: ------------------------------ This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 minutes to install. It should not be installed when the YSCL DAILY TRANSMISSION option is running. If unsure when that is check the OPTION SCHEDULING file (#19.2) using FileMan: Select VA FileMan Option: Inquire to File Entries Output from what File: OPTION SCHEDULING// (17 entries) Select OPTION SCHEDULING NAME: YSCL DAILY TRANSMISSION Another one: Standard Captioned Output? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// - No record number (IEN), no Computed Fields NAME: YSCL DAILY TRANSMISSION QUEUED TO RUN AT WHAT TIME: OCT 05, 2019@01:30 RESCHEDULING FREQUENCY: 1D TASK ID: 2577736 Installation Instructions: -------------------------- 1. Place the KIDS multi-build file into a local directory and use the KIDS option Load a Distribution option to load it into the transport global. 2. Choose the INSTALL/CHECK MESSAGE PackMan option. 3. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, you may elect to use the following options. When prompted for the INSTALL NAME enter: PSO*7.0*612 a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. 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, DDs, templates, etc.). c. Verify Checksums in Transport Global - This option allows you to ensure the integrity of the routines that are in the transport global. 4. From the Installation Menu, select the Install Package(s) option and choose the patch to install (PSO*7*612). 5. Accept the default when prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? NO//' 6. Accept the default when prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' 7. Accept the default when prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//' 8. If prompted 'Delay Install (Minutes): (0 - 60): 0// enter 0 (zero). Backout /Rollback Strategy: --------------------------- Backout will be done only with the concurrence and participation of development team and appropriate VA site/region personnel. The decision to backout the software will be a joint decision between development team, VA site and regional personnel, and other appropriate VA personnel. Rollback applies to data only and is not applicable to this multi-build. Prior to installing the KIDS multi-build, the site/region should have saved a backup of the routines in a PackMan 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. The new "AC" mumps cross reference for the CLOZAPINE PATIENT LIST file (#603.01) must be manually deleted vi FileMan prior to restoring the backed up routines. The steps to delete the cross reference: 1. Access VA FileMan option Cross-Reference A Field via the VA FileMan Utility Functions [DIUTILITY] menu. 2. At the prompt, "What type of cross-reference (Traditional or New)?" enter NEW. 3. At the prompt, "Modify What File:" enter 603.01. 4. The new "AC" cross reference should be selected by default. 5. At the prompt "Choose E (Edit)/D (Delete)/C (Create):" enter DELETE. 6. At the prompt "Are you sure you want to delete the index definition? NO// YES" Example deletion of new "AC" index if backout is required: VA FileMan 22.2 Select OPTION: UTILITY FUNCTIONS Select UTILITY OPTION: CROSS-REFERENCE A FIELD OR FILE What type of cross-reference (Traditional or New)? Traditional// NEW Modify what File: REMOTE PROCEDURE// 603.01 CLOZAPINE PATIENT LIST (74 entries) Current Indexes on file #603.01: 1589 'AC' index Choose E (Edit)/D (Delete)/C (Create): DELETE Which Index do you wish to delete? 1589// AC Are you sure you want to delete the index definition? NO// YES Index definition deleted. Validation of Backout Procedure ------------------------------- The backout Procedure can be verified by printing the first 2 lines of the PSO* routines contained in the PSO*7*612 build using the option First Line Routine Print [XU FIRST LINE PRINT]. Once the old routines listed in the multi-build patch have been restored, the first two lines of the Routines will no longer contain the designation of patch 612 in the patch list section on line 2 of the routines. The backout of the new "AC" cross reference on the CLOZAPINE PATIENT LIST file (#603.01) can be verified by repeating the backout steps and verifying that there is no longer a selectable "AC" cross reference to delete. Routine Information: ==================== The second line of each of these routines now looks like: ;;5.01;MENTAL HEALTH;**[Patch List]**;Dec 30, 1994;Build 24 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: YSCLSRV2 Before: B39436709 After: B46125256 **69,90,92,154,166** Routine Name: YSCLTST2 Before:B118550569 After:B130797741 **18,22,26,47,61,69,74,90,92, 122,166** Routine Name: YSCLTST4 Before: B20061166 After: B23499494 **92,122,166** Routine list of preceding patches: 122, 154 ============================================================================= User Information: Entered By : Date Entered : MAY 15, 2020 Completed By: Date Completed: SEP 01, 2020 Released By : Date Released : SEP 02, 2020 ============================================================================= Packman Mail Message: ===================== No routines included