$TXT Created by NABER,DAVID A at DEVCUR.FO-SLC.MED.VA.GOV (KIDS) on Friday, 10/24/03 at 11:40 ============================================================================= Run Date: DEC 08, 2003 Designation: GMRA*4*17 Package : GMRA - ADVERSE REACTION TRACKING Priority: Mandatory Version : 4 SEQ #16 Status: Released Compliance Date: JAN 08, 2004 ============================================================================= Associated patches: (v)GMRA*4*6 <<= must be installed BEFORE `GMRA*4*17' (v)GMRA*4*8 <<= must be installed BEFORE `GMRA*4*17' (v)GMRA*4*14 <<= must be installed BEFORE `GMRA*4*17' Subject: Free text utility Category: - Routine - Data Dictionary Description: ============ A utility is introduced in this patch that will help sites identify and fix allergy entries that have free text reactants. Previously, users were allowed to add free text reactants, which are undesirable as they often do not include all the required information for order checking, etc. Release notes, contained in file GMRA_4_17_RN.pdf, are available for download. 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: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.go The documentation can also be found on the System Design and Development Web page:(http://vista.med.va.gov/vdl/). With this patch, free text entries will no longer be allowed from within the allergy tracking package. A subsequent patch to CPRS will stop the ability to add free text entries from within CPRS as well. However, in an effort to let sites begin the clean up process the utility is being sent out ahead of the scheduled changes for the CPRS interface. A new mail group, GMRA REQUEST NEW REACTANT, will be added with this patch. Sites should populate this mail group with the people responsible for addressing requests to add new reactants. If a user attempts to enter a reactant that is not found during the look up process they are asked if they would like to send an email requesting the addition of the new reactant. The request can then be reviewed for accuracy and new, local entries can added if appropriate. Previously, the user was asked if they wanted to add the new entry and it was immediately available in the patient's record. Under the new system, the new reactant would need to be reviewed prior to being added to the patient's record. Lower case entries are no longer allowed. Previously, lower case entries could be added to the GMR ALLERGIES file (120.82). A post-installation routine will identify any local entries and update the entries to upper case. Synonyms will also be checked and converted to uppercase if required. The post-installation routine will also clean up erroneous entries in the PATIENT ALLERGIES file caused by previous package problems. Also, the AODT cross reference will be reviewed and updated if necessary. Due to a problem with date conversion it was possible to have fileman dates with trailing zeros. This caused the cross reference to be incorrectly built. From within the allergy tracking package, when selecting a reactant, the user will now be shown the file that is being searched. This should aid the user in selecting the best reactant to associate with the patient's allergy entry. Currently, the allergy tracking package allows users to leave entries in a "not signed off" state. The allergy, though not complete, will be part of the patient's record even though the user is told that it will not be. Depending on how the entry was made, an alert may not be sent indicating that the entry needs to be signed off. Ultimately, an unfinished entry may never be finished but may still appear in the patient's record. A change has been made so that no new entry can be left in a "not signed off" state. Upon entering a new allergy, if the user enters an "^" at any point during the data gathering process, the entry will be deleted. Upon completing the new entry the user will be asked if the entry is ok. If the user enters no then they'll be given the opportunity to edit or delete the entry. The entry must then be deleted or accepted before exiting this process. As a result, no new entries will be allowed to be in an unsigned state. **NOTE** Sites should run the "Patient Allergies Not Signed Off" option to identify all existing entries that have not yet been completed. Each entry should be reviewed and marked as entered-in-error or completed by entering the required information. Once these entries are cleaned up then no unsigned entries should appear in the patient's chart. You are not required to update these entries as data may not be available but you should review them and take action if possible. The post-installation routine will also list any allergies that are observed, have been signed off, but are missing either an observed date or a sign/symptom. These entries should also be reviewed and updated if possible. This patch also fixes a problem where signs/symptoms could be erroneously stored as "-1" rather than the correct numerical representation. This has been fixed and the post-installation routine will identify and delete any erroneous sign/symptom entries from the associated files. NOIS ==== PUG-0503-50846 PROTOCOL PSO EDIT ALLERGY FAILS TO CLEANUP GMRAOUT BAY-0103-31601 Unable to Enter Allergy/ADR When a user enters an "^" to escape from a prompt a variable is set indicating that you exited using an "^". In a number of places in the allergy tracking code this value is not cleared upon exiting from the option. The value is now cleared and users may continue to process normally. HIN-0800-41504 ODD AODT XREF Before a kernel patch was distributed to fix a problem with the conversion of HL7 formatted dates to file manager formatted dates it was possible to have dates with trailing zeros. Dates with trailing zeros are treated as strings rather than numbers. Cross references do not build correctly when the date/time is a string rather than a number. The post-install routine will identify all existing "string date/time" entries and will convert them to correct file manager format. OKL-1001-73363 ART entries in lower case CON-0700-11467 Provider allowed to put in lower case letters WRJ-0200-10423 CAN'T edit an allergy that is in lowercase letters ALX-0100-71981 Can't edit allergies entered in lower case CMO-0100-40317 Allergies Entered in Lowercase POR-1299-50568 Can't edit allergy entries MON-0999-51189 CPRS entered allergens STC-0599-41575 RECORDS FLAGGED - NO KNOWN ALLERGY WBP-0499-20346 LOWER CASE ALLERGY ENTRY WPB-0498-30034 CPRS entry of ART in lower case Previously, it was possible to add lower case reactants either as free text entries or as local entries into the GMR ALLERGIES file. A change has been made so that entries into the GMR ALLERGIES file will be in upper case. In addition, a change was made in the ART package so that lowercase free text entries can no longer be allowed. Lower case entries may still be added via the List manager interface in CPRS, but this will be fixed in a subsequent patch to CPRS. All lowercase free text entries need to be reviewed and either marked as entered in error or updated to an existing reactant from one of the files that allergies points to. In order to accomplish this a utility has been developed that will find all existing free text entries. This utility will then allow you to either update the entries or mark them as entered in error. The utility will be added to the Enter/Edit Site Configurable Files menu in the allergy tracking package. ISA-1297-10002 Creation of Progress Note w/o Electronic Signature SBY-1099-32649 Reinstate editing/signing PN through ART Prior to the installation of OE/RR when entering a reaction you were taken to the progress notes package and allowed to modify the progress note that was filed. With the installation of this patch, this functionality is restored. When appropriate, the user is taken to the TIU package to modify the progress note that would be filed due to changes made to the patient's allergy. SDC-0399-62721 VIEW ALERT FOR NOT SIGNED OFF ALLERGY GOES AWAY ANYWAY HUN-0998-20735 ALLERGIES NOT SIGNED OFF HUN-0998-20737 UNSIGNED ALLERGIES ENTERED Alerts are sent when an allergy is entered and left unsigned (incomplete). Prior to this patch, it was possible to exit the entry of an allergy in such a way that the alert was never sent. It was also possible for the alert to go away without ever signing off on the allergy. After installation of patch 17, you will no longer be allowed to leave an allergy in a "not signed off" state. Required information must be entered or the allergy will be deleted and the user will have to re-enter the information when they have everything they need. Sites will need to review their unsigned allergies and either complete them or mark them as entered in error. The option GMRA PRINT-NOT SIGNED OFF can be used to obtain a listing of allergies that need to be reviewed. In addition, the post-install routine will also list all observed allergies that have been signed off that do not have the required information of observed date/time and sign/symptoms. These allergies should also be reviewed and either completed or marked as entered in error. ALB-1299-52704 SIGN+8 GMRADSP1 undef variable MWV-0401-20238 Error - $ZE= SIGN+8^GMRADSP1:1, PUG-1201-50760 SIGN+8~GMRADSP1:1 When entering reaction information (signs/symptoms) for an allergy via the list manager interface in CPRS it was possible for the system to send a -1 when a non-existent sign/symptom was entered at the same time as an existing entry. For example, if the user entered hives, anziety (mis-spelled on purpose for this example), the system would have sent a -1 for the incorrect entry. Invalid reaction entries are now ignored. The post-installation routine will also identify and delete any existing entries. PROTOCOL SUMMARY: ================= The following protocols are added in support of the free text utility: GMRA FIX ADD/EDIT ALLERGY FILE GMRA FIX ADD/EDIT ALLERGY FILE IN DETAIL GMRA FIX DETAIL IN DETAIL GMRA FIX DETAIL LIST GMRA FIX DETAIL MENU GMRA FIX ENTERED IN ERROR GMRA FIX ENTERED IN ERROR IN DETAIL GMRA FIX FREE TEXT LIST GMRA FIX UPDATE REACTANT GMRA FIX UPDATE REACTANT IN DETAIL GMRA FIX PATIENT A/AR EDIT IN DETAIL LIST TEMPLATES: =============== GMRA FIX and GMRA FIX DETAIL are added in support of the free text utility. OPTION: ======== The option GMRA FREE TEXT UTILITY has been added to the GMRA SITE FILE MENU option. MAIL GROUP: =========== The mail group GMRA REQUEST NEW REACTANT has been added. Requests for new allergy entries will be sent to the members of this group. Members must be added to this group. FILES: ====== The GMR ALLERGIES (#120.82) file has been updated so that entries are stored in upper case. This includes any synonyms as well. ROUTINE SUMMARY: ================ 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: ;;4.0;Adverse Reaction Tracking;**[patch list]**;Mar 29, 1996 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== GMRAFX N/A 29943036 17 GMRAFX1 N/A 13606085 17 GMRAFX2 N/A 13058727 17 GMRAFX3 N/A 14437876 17 GMRAOR6 1825026 1989086 17 GMRAOR7 1356308 1525209 4,17 GMRAPED0 13519042 14150599 17 GMRAPEM0 8281139 14054587 2,5,17 GMRAPEO0 4242971 4362542 8,17 GMRAPES0 15729385 27112804 13,17 GMRAPES1 5625701 5627244 13,14,17 GMRAPET0 6614863 7048876 6,17 GMRASIG1 5985745 6039446 2,17 GMRASIGN 8182730 14414875 17 GMRAUTL 6845848 6969746 17 GMRAY17 N/A 13568415 17 INSTALLATION ============ Users may be on the system during installation of this patch, though this patch should be loaded during non-peak hours to minimize disruption to users. Installation will take less than 5 minutes. *NOTE: A routine will be queued to run in the background that will fix a number of issues with the existing allergy data. A mail message will be sent upon completion of the review. The message may include allergies that are observed and signed off that are missing required data. You may wish to review those entries for possible updating. *NOTE: A new mail group GMRA REQUEST NEW REACTANT has been added with this patch. You must populate this mail group in order for information to be sent when users attempt to add 'free text' reactants. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 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 GMRA*4.0*17): a. Backup a Transport Global b. Compare Transport Global to Current System c. Verify Checksums in Transport Global 5. Use the Install Package(s) option and select the package GMRA*4.0*17. 6. When prompted Enter the Coordinator for Mail Group 'GMRA REQUEST NEW REACTANT':, you may hit return and leave it blank. 7. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//', you may respond NO and rebuild at a later time, depending on your site's preferences. 8. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', you may respond NO. 9. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond NO. 10. If routines were unmapped as part of step 2, they should be returned to the mapped set once the installation has run to completion. 11. Populate new mail group GMRA REQUEST NEW REACTANT will local members. 12. Upon receipt of the post-installation message you may delete routine GMRAY17 Routine Information: ==================== Routine Name: - GMRAFX Routine Checksum: Routine Name: - GMRAFX1 Routine Checksum: Routine Name: - GMRAFX2 Routine Checksum: Routine Name: - GMRAFX3 Routine Checksum: Routine Name: - GMRAPES1 Routine Checksum: Routine Name: - GMRAPES0 Routine Checksum: Routine Name: - GMRAY17 Routine Checksum: Routine Name: - GMRAPET0 Routine Checksum: Routine Name: - GMRASIGN Routine Checksum: Routine Name: - GMRAPEM0 Routine Checksum: Routine Name: - GMRAUTL Routine Checksum: Routine Name: - GMRASIG1 Routine Checksum: Routine Name: - GMRAPEO0 Routine Checksum: Routine Name: - GMRAOR6 Routine Checksum: Routine Name: - GMRAOR7 Routine Checksum: Routine Name: - GMRAPED0 Routine Checksum: ============================================================================= User Information: Entered By : NABER,DAVID A Date Entered : JUL 28, 2003 Completed By: ASKEW,DENEEN Date Completed: DEC 04, 2003 Released By : HEMBREE,SUSAN Date Released : DEC 08, 2003 ============================================================================= Packman Mail Message: ===================== $END TXT