============================================================================= Run Date: MAR 18, 2004 Designation: DG*5.3*508 Package : DG - REGISTRATION Priority: Mandatory Version : 5.3 SEQ #502 Status: Released Compliance Date: APR 18, 2004 ============================================================================= Associated patches: (v)DG*5.3*415 <<= must be installed BEFORE `DG*5.3*508' (v)DG*5.3*484 <<= must be installed BEFORE `DG*5.3*508' (v)DG*5.3*489 <<= must be installed BEFORE `DG*5.3*508' (v)DG*5.3*527 <<= must be installed BEFORE `DG*5.3*508' (v)DG*5.3*555 <<= must be installed BEFORE `DG*5.3*508' Subject: Messaging for HIPAA Confidential Address and IEMM changes. Category: - Routine Description: ============ NOTE: Patches DG*5.3*508 and SD*5.3*293 are being released in a single distribution. Because of this, patch descriptions for DG*5.3*508 and SD*5.3*293 are identical and contain routine summaries for both sets of routines. NOTE: It is recommended that this patch NOT be installed less than seven days before Amb Care's monthly close-out. In May 2003, the Department of Veterans Health Administration (VHA) issued VHA Directive 2003-025, "Confidential Communications," which establishes a new policy concerning a patient's rights to receive confidential communications pertaining to health information by an alternative means or at an alternative location other than the permanent address of record. The objective of the Health Insurance Portability and Accountability Act (HIPAA) Confidential Communication Project is to develop and deploy enhancements to the Veterans Health Information System and Technology Architecture (VistA) software to comply with HIPAA rules for Confidential Communication 45 CFR 164.552. A previous patch (DG*5.3*489) provided the means for a patient to provide an alternative mailing address to be used for confidential communication at a designated Veterans Administration (VA) facility, communication of Protected Health Information (PHI) by alternative means or alternative location. This patch provides additional functionality to include the confidential address in the PID segment of an HL7 message, to validate the confidential address fields in the Incomplete Encounter Management Module (IEMM) and to correct problems found in the screen handling in the Load/Edit Patient Data, Register a Patient options. 1. HL7 messaging functionality: --------------------------- Scheduling and Registration software will be modified to include the confidential address information in the transmissions to Austin Automation Center (AAC) for storage in the National Patient Care Database (NPCD). The PID segment building routines will be modified to build the segment with this additional information when requested by the calling application. DG*5.3*508 distributes a post-init routine DG53508 that changes the name of the "NPTF-484" application in the HL7 APPLICATION PARAMETER (#771) file to "NPTF-508". SD*5.3*293 distributes a post-init routine SD53293 that changes the name of the "AMBCARE-DH239" application in the HL7 APPLICATION PARAMETER file (#771) to "AMBCARE-DH293". This change prevents the processing of acknowledgements for encounters that were transmitted using AMBCARE-DH239 and the encounters will be resent because AmbCare automatically retransmits encounters that have not been acknowledged. Since acknowledgements are typically received within a day, this should only affect one day's worth of encounters. SD*5.3*293 distributes a post-init routine SD53293 that changes the name of the "PCMM-213" application in the HL7 APPLICATION PARAMETER file (#771) to "PCMM-293". This change prevents the processing of acknowledgements for PCMM patient records that were transmitted using PCMM-213 and the records will be resent because PCMM automatically retransmits records that have not been acknowledged. Since acknowledgements are typically received within a day, this should only affect one day's worth of PCMM records. To ensure proper purging, the status of all unacknowledged AmbCare and PCMM-213 messages which have been successfully completed [in the HL7 MESSAGE TEXT file (#772)] will be changed to SUCCESSFULLY COMPLETED. This process is automatically queued to run at the current date/time so that patch installation can complete in a timely manner. Two messages are sent to the installer upon completion of the task, regarding the updating of the HL7 Messaging Text file (#772) (one for AmbCare, the other for PCMM, though no identifying information). An example of the mail message follows: Subj: Updating of HL7 Message Text file [date & time] 3 lines From: PATCH SD*5.3*293 In 'IN' basket. Page 1 *New* --------------------------------------------------------------- Updating of HL7 Message Text file (#772) began on [date & time] Updating of HL7 Message Text file completed on [date & time] [x] entries were updated. Modifications to $$EN^VAFHLPID and $$EN^VAFCPID: Currently, the Patient Address field in the PID segment contains the permanent address. The modifications in this patch will add the confidential address to the PID segment when requested by the calling application. The first repetition will include the permanent address. The confidential address information will be included in the second through sixth repetitions of this sequence. If the confidential address category is not an active category for the patient, the category will be included in the repetition but all other fields will contain the null indicator. The calling application must provide a list of sequences to be included in the PID segment to the VAFHLPID or VAFCPID API. For example, VAFSTR="1,2,3,4,5,6,7,8,9,10,11". The confidential address is optional and may be requested by appending an additional parameter(s) to the sequence number. The valid parameters are as follows: "" - For backward compatibility if nothing is appended, no changes to what is currently returned (permanent address only) "11P" - Permanent address only "11C" - Confidential address only "11PC" - Permanent and Confidential addresses The Patient Address (sequence #11) of the PID segment will contain the following data: Component Data element --------- ------------ 1 Street address Line 1 2 Street address Line 2 3 City 4 State 5 Zip Code 6 Not used 7 Address type (Component will be populated if P and/or C contained in the VAFSTR passed to the PID segment builder call) P - Permanent VACAA - Appointment/Scheduling VACAE - Eligibility/Enrollment VACAC - Copayments/Veteran Billing VACAM - Medical Records VACAO - All Others 8 Street address Line 3 9 County 10 Not used 11 Not used 12 Confidential Start/End Dates (Component will be populated if the address type is one of the Confidential Address categories - VACAA, VACAE, VACAC, VACAM, VACAO) Modifications to the existing building logic will be made to assure the 245 character limit is not exceeded when building the segment. A new routine, VAFHLPI2, has been added and VAFHLU modified for this purpose. Modifications to SCDXMSG1, VAFCMSG4, VAFCADT2, and VAFCA04: "PC" will be appended to the VAFSTR variable to include both the permanent and confidential address information in the HL7 messages transmitted to the Austin Automation Center (AAC). 2. Changes to the Incomplete Encounter Management Module (IEMM): ----------------------------------------------------------- New entries will be added to the Transmitted Outpatient Encounter Error Code (#409.76) file to validate the Confidential Address fields. The new codes are as follows: New TRANSMITTED OUTPATIENT ENCOUNTER ERROR CODES Code Error Code Description Code ---------------------------------------------------------------------- 240 Conf. Address - Line 1 contains all numbers NPCD 241 Conf. Address - Line 2 contains all numbers NPCD 242 Conf. Address City is missing or invalid NPCD 243 Conf. Address State code is missing or invalid NPCD 244 Conf. Address Zip code is missing or invalid NPCD 245 Conf. Address County code is invalid NPCD 246 Conf. Address Inactive State/County code NPCD 247 Conf. Address Category is missing or invalid NPCD 248 Conf. Address Start Date is missing or the Start/End Dates are invalid NPCD 2400 Conf. Address line 1 is missing or invalid VISTA 2410 Conf. Address line 2 is invalid VISTA 2420 Conf. Address City is missing or invalid VISTA 2430 Conf. Address State code is missing or invalid VISTA 2440 Conf. Address Zip code is missing or invalid VISTA 2450 Conf. Address County Code is invalid VISTA 2470 Conf. Address Category is missing or invalid VISTA 2480 Conf. Address Start Date is missing or the Start/End Dates are invalid VISTA Modifications to SCMSVPID,SCMSVUT2, and SCMSVUT5: The process used to validate the PID segment in the HL7 message builds the segment, parses it and validates the data. This patch modifies the process to break the address into smaller components before validating the data. The following Confidential Address fields will be validated using the existing criteria currently used to validate the permanent address fields: Field Name Field Number ======================================================== CONFIDENTIAL STREET [LINE 1] .1411 CONFIDENTIAL STREET [LINE 2] .1412 CONFIDENTIAL ADDRESS CITY .1414 CONFIDENTIAL ADDRESS STATE .1415 CONFIDENTIAL ADDRESS ZIP CODE .1416 CONFIDENTIAL ADDRESS COUNTY .14111 New validation and correction logic has been added for the following fields: Field Name Field Number ======================================================== CONFIDENTIAL START DATE .1417 CONFIDENTIAL END DATE .1418 CONFIDENTIAL ADDRESS CATEGORY (multiple) 2.141 CONFIDENTIAL ADDRESS CATEGORY .01 CONFIDENTIAL CATEGORY ACTIVE 1 Modifications to SCMCHLS: Modified to make correct call into SETMAR^SCMSVUT0 for validation purposes, and to provide for correct transmission of RACE codes and Ethnicity in PCMM patient messages sent to AAC. These changes address problems reported in NOISes including the following: NOL-0603-71185 PCMM 240M ERRORS (PATIENT RACE CODE INVAL CTX-0203-70395 RACE ERRORS ON PCMM TRANSMISSION 3. Modifications to routine DGRPP1: ------------------------------- Users may jump from one screen to another in several Registration options including Load/Edit Patient Data, [DG LOAD PATIENT DATA], Register a Patient, [DG REGISTER PATIENT], and Eligibility Verification, [DG ELIGIBILITY VERIFICATION] options. However, an error occurs if the user enters a non-existent screen number with a decimal point (.i.e. 1.4). This problem was found during the development of this patch and the modifications in DGRPP1 correct the problem. Test Site(s): ========== Lexington Iron Mountain Big Spring ROUTINE SUMMARY - REGISTRATION: ============================== The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;5.3;Registration;**[patch list]**;Aug 13, 1993 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== DG53508 N/A 795155 508 DGRPE 24690575 24713474 32,114,139,169,175 247,190,343,397,342 454,415,489,506,244 547,522,528,555,508 DGRPP1 3516530 3649793 489,508 DGRPU1 2738282 2769172 139,169,415,527,508 VAFCA04 5710533 5744261 91,209,149,261,298 415,484,508 VAFCADT2 5238148 5270712 91,179,209,415,494 484,508 VAFCMSG4 4123672 4159728 91,209,149,415,484 508 VAFCPID 3564275 3741323 91,149,190,415,508 VAFHLPI2 N/A 3133979 508 VAFHLPID 3153380 3205152 68,94,415,508 VAFHLU 872343 1060630 415,508 ROUTINE SUMMARY - SCHEDULING: ============================ The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;5.3;Scheduling;**[patch list]**;AUG 13, 1993 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== SCDXMSG1 9645949 9617034 44,55,70,77,85,66,143, 142,162,172,180,239, 245,254,293 SCMCHLS 1640979 1626749 177,210,212,293 SCMSVPID 3522345 4732219 44,66,162,254,293 SCMSVUT0 6602857 5073216 44,55,66,132,245 254,293 SCMSVUT2 3255774 3872060 66,180,254,293 SCMSVUT5 1130452 1766333 254,293 SD53293 N/A 5462883 293 SOFTWARE RETRIEVAL: ================== This patch is not being distributed through the National Patch Module. The distribution file DG_53_P508.KID (which contains DG*5.3*508 and SD*5.3*293) may be obtained using FTP from the ANONYMOUS.SOFTWARE directory at DOWNLOAD.VISTA.MED.VA.GOV or from specific servers at: Albany: ftp.fo-albany.med.va.gov Hines: ftp.fo-hines.med.va.gov Salt Lake City: ftp.fo-slc.med.va.gov Host file name: DG_53_P508.KID Builds: DG*5.3*508 SD*5.3*293 INSTALLATION INSTRUCTIONS: ========================== NOTE: It is recommended that this patch NOT be installed less than seven days before Amb Care's monthly close-out. This patch can be installed with users on the system, however it should be installed during off hours to minimize disruption to users. Installation will take less than 5 minutes. This patch affects Registration, PTF, the check-out process and must be installed when the SCDX AMBCAR NIGHTLY XMIT background job is not running. 1. Use the LOAD A DISTRIBUTION option on the KIDS INSTALLATION Menu, and enter DG_53_P508.KID 2. Review your mapped set. If any of the routines listed in the ROUTINE SUMMARY section are mapped, they should be removed from the mapped set at this time. 3. From the Kernel Installation and Distribution System Menu, select the Installation menu. 4. From this menu, you may elect to use the following options (when prompted for INSTALL NAME, enter DG*5.3*508): 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 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. 5. Use the Install Package(s) option and select the package DG*5.3*508 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//',respond NO. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond YES. When prompted to select the options you would like to place out of order, enter the following: DG DISPOSITION APPLICATION Disposition an Application DG ELIGIBILITY VERIFICATION Eligibility Verification DG LOAD PATIENT DATA Load/Edit Patient Data DG REGISTER PATIENT Register a Patient DG NPTF XMIT ADMISSION Retransmit Admission Data DG NPTF XMIT DEMOGRAPHICS Retransmit Patient Demographics DG NPTF XMIT PIVOT Retransmit Entry in ADT/HL7 PIVOT File PXCE ENCOUNTER DATA ENTRY PCE Encounter Data Entry PXCE ENCOUNTER ENTRY & DELETE PCE Encounter Data Entry & Delete PXCE ENCOUNTER ENTRY NO DELETE PCE Encounter Entry Without Delete PXCE ENCOUNTER ENTRY SUPER PCE Encounter Data Entry - Supervisor SCDX AMBCAR NIGHTLY XMIT Ambulatory Care Nightly Transmission to NPCDB SCENI IEMM ERROR CORRECTION Correct Incomplete Encounters SCMC PCMM HL7 TRANSMIT PCMM HL7 Transmission SDAM APPT CHECK IN/OUT Appointment Check-in/Check-out SDAM APPT MGT Appointment Management VAFC BATCH UPDATE UPDATE BATCH JOB FOR HL7 v2.3 8. If routines were unmapped as part of step 2, they should be returned to the mapped set once the installation has run to completion. 9. Routines DG53508 (post installation routine for DG*5.3*508) and SD53293 (pre and post installation routine for SD*5.3*293) should be deleted after successful installation of this patch. Routine Information: ==================== Routine Name: - DGRPP1 Routine Checksum: Routine Name: - DGRPU1 Routine Checksum: Routine Name: - VAFCPID Routine Checksum: Routine Name: - VAFHLPID Routine Checksum: Routine Name: - VAFHLPI2 Routine Checksum: Routine Name: - VAFHLU Routine Checksum: Routine Name: - VAFCA04 Routine Checksum: Routine Name: - VAFCMSG4 Routine Checksum: Routine Name: - VAFCADT2 Routine Checksum: Routine Name: - DG53508 Routine Checksum: Routine Name: - DGRPE Routine Checksum: ============================================================================= User Information: Entered By : FISHER,BRAD Date Entered : APR 01, 2003 Completed By: MARKS,MARY Date Completed: MAR 17, 2004 Released By : FITCH,DONNA Date Released : MAR 18, 2004 ============================================================================= Packman Mail Message: ===================== No routines included