$TXT Created by NABER,DAVID A at DEVCUR.FO-SLC.MED.VA.GOV (KIDS) on Thursday, 02/01/07 at 13:50 ============================================================================= Run Date: MAR 20, 2007 Designation: GMRA*4*36 Package : GMRA - ADVERSE REACTION TRACKING Priority: Mandatory Version : 4 SEQ #32 Status: Released Compliance Date: APR 20, 2007 ============================================================================= Associated patches: (v)GMRA*4*23 <<= must be installed BEFORE `GMRA*4*36' (v)GMRA*4*25 <<= must be installed BEFORE `GMRA*4*36' Subject: Remove ability to delete allergy records Category: - Routine - Data Dictionary - Other Description: ============ Due to potential updates to the HDR it is highly recommended that this patch be installed during off-hours. Users may remain on the system but an off-hours installation is highly encouraged. Clear Quest/Remedy/PSIs ----------------------- CQ 6683 - ID BAND marked question asked multiple times. This question is now asked only one time per allergy entered. CQ 8690 - ALLERGY TYPE (3.1) field in PATIENT ALLERGIES (120.8) file is not updated when the associated entry in the GMR ALLERGIES (120.82) file is changed. Code has been modified so that when the ALLERGY TYPE (1) field in the GMR ALLERGIES (120.82) file is updated so is the same field in the PATIENT ALLERGIES (120.8) file. In addition, the post-install routine GMRAY36 will make sure all GMR ALLERGIES (120.82) file entries are in synch. CQ 12731 - An allergy assessment message is sent to the HDR when a user enters an up-arrow or blank return when prompted with the "does this patient have any allergies" prompt in the roll and scroll environment. The system currently creates an entry in the ADVERSE REACTION ASSESSMENT file (120.86) before the user enters their response to the question. If the user enters an up-arrow or hits return then the entry is deleted, which causes the HL7 message to be sent to the HDR. The entry will now only be created after the user answers the question. Files Updated ------------- 120.82 - GMR ALLERGIES, updated to have a new cross-reference so changes to the ALLERGY TYPE (1) field propagate through all allergy entries. Also, the DRUG INGREDIENTS (4) multiple is modified so only primary ingredients can be chosen. Test Sites ---------- Palo Alto Biloxi Minneapolis Fargo Tomah Previously, if a user edited an existing allergy in VISTA that had the ORIGINATOR SIGN OFF (15) field in the PATIENT ALLERGIES (120.8) file set to no, the user would be given the option to delete the entry. With the Health Data Repository (HDR) now in place for allergies, deletions of data that are already part of the HDR cannot be allowed. As a result, any existing allergy that hasn't been "signed off" will be marked entered in error if the user chooses to "delete" the entry. In a previously released patch, a post-installation routine identified allergy entries that should have been auto-verified but weren't due to a logic issue. Those entries were then auto-verified as they should have been. When those entries were auto-verified the ORIGINATOR SIGN OFF (15) field in the PATIENT ALLERGIES (120.8) file should have been set to yes. A post-install routine, GMRAY36, has been added to this patch to identify and fix any auto-verified allergies that have the ORIGINATOR SIGN OFF (15) field set to no. The post-install will also review existing allergy entries to make sure that the ALLERGY TYPE (3.1) field in the PATIENT ALLERGIES (120.8) file is consistent with its corresponding entry in the GMR ALLERGIES (120.82) file. Prior to this patch, any changes to the ALLERGY TYPE (1) field in GMR ALLERGIES (120.82) file made by the standardization team would not have updated existing patient allergies. The ALLERGY TYPE (1) field in the GMR ALLERGIES (120.82) file has also been updated to include a new style cross-reference that will now update existing patient allergies should the value change. The new style cross-reference will be added during the post-install. The post-install will also make sure that the name of the reactant that is stored in the PATIENT ALLERGIES (120.8) file matches the name of the reactant from the GMR ALLERGIES (120.82) file. Prior to standardization it was possible for a site to change the name of a locally entered allergy without that change updating existing allergies. The post install will check existing allergies associated with the GMR ALLERGIES (120.82) file and make sure the reactant field matches the name of the allergy. The post-install will also identify any patient allergies that are associated with an entry from the GMR ALLERGIES (120.82) file that is inactive and convert it to a free text entry. Finally, the post-install will check for patient allergies that are associated with the DRUG (50) file. While the DRUG (50) file may no longer be selected from, there are pre-standardization entries that may be pointing to locally created entries in the DRUG (50) file that did not have ingredient and/or drug class information. In cases where the entry doesn't have appropriate drug information the allergy will be converted to a free text entry. A mail message will be sent to the installer indicating the total number of entries that were converted to free text. When patch GMRA*4*29, currently in testing, is installed most of the entries that were converted to free text will be automatically updated to a standardized term. As a result, you do not need to take any action on the newly created free text entries at this time. This patch updates the GMR ALLERGIES (120.82) file so that the DRUG INGREDIENTS (4) multiple will only allow primary ingredients to be selected. The DRUG INGREDIENTS (2) multiple in the PATIENT ALLERGIES (120.8) file has had this restriction for quite some time. This update will get them in synch. As the GMR ALLERGIES (120.82) file is standardized, this change has effectively been in place since standardization but this will assure compliance. This patch also fixes the problem where a user may have been asked the "have the ID BANDS been marked" question more than once when entering or verifying allergies in the roll and scroll environment. During internal testing, it was noted that in the roll and scroll package, when the user is asked "does the patient have any known allergies or adverse reactions" an entry is created in the ADVERSE REACTION ASSESSMENT (120.86) file before the question is asked. If the user hits return or enters an ^ the entry is then deleted from the file. This causes unnecessary traffic to the HDR. The entry is now created after the question is answered by the user. INSTALLATION ============ NOTE: ************************************************************************ A mail message will be sent to the installer indicating the total number of entries that were converted to free text. When patch GMRA*4*29, currently in testing, is installed most of the entries that were converted to free text will be automatically updated to a standardized term. As a result, you do not need to take any action on the newly created free text entries at this time. ************************************************************************ This patch may be installed with users on the system although it is highly recommended that it be installed during non-peak hours to minimize potential disruption to users entering allergy information during the installation process. This patch should take less than 2 minutes to install. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation and Distribution System Menu, select the Installation menu. 3. From this menu, you may elect to use the following options (when prompted for INSTALL NAME, enter GMRA*4.0*36): a. Backup a Transport Global b. Compare Transport Global to Current System c. Verify Checksums in Transport Global 4. Use the Install Package(s) option and select the package GMRA*4.0*36. 5. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', you may respond NO. 6. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond NO. 7. If prompted 'Delay Install (Minutes): (0-60): 0//; respond '0'. 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 ============ ============ =========== ========== GMRADEL 2952383 4238070 36 GMRAGUI1 17409478 17480835 21,25,36 GMRAMCB 6502842 6919400 21,36 GMRANKA 6768620 6543144 2,21,36 GMRAPEM0 14463993 14058325 2,5,17,21,36 GMRAPEM3 2212104 2418313 36 GMRASIG1 8238942 8507536 2,17,21,36 GMRASIGN 14487255 14910364 17,19,36 GMRAUTL2 24232551 25261796 23,36 GMRAY36 N/A 10907615 36 GMRAY36A N/A 1203129 36 Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: GMRADEL Before: B8878805 After: B12620688 **36** Routine Name: GMRAGUI1 Before: B56901114 After: B56993804 **21,25,36** Routine Name: GMRAMCB Before: B10298543 After: B10933598 **21,36** Routine Name: GMRANKA Before: B15425405 After: B12980471 **2,21,36** Routine Name: GMRAPEM0 Before: B44377298 After: B43826251 **2,5,17,21,36** Routine Name: GMRAPEM3 Before: B2842314 After: B3076909 **36** Routine Name: GMRASIG1 Before: B15349456 After: B16149250 **2,17,21,36** Routine Name: GMRASIGN Before: B37583197 After: B40714673 **17,19,36** Routine Name: GMRAUTL2 Before: B71296835 After: B79798893 **23,36** Routine Name: GMRAY36 Before: n/a After: B23667730 **36** Routine Name: GMRAY36A Before: n/a After: B1688077 **36** ============================================================================= User Information: Entered By : NABER,DAVID A Date Entered : MAR 20, 2006 Completed By: SCHLEHUBER,PAM Date Completed: MAR 14, 2007 Released By : HEMBREE,SUSAN Date Released : MAR 20, 2007 ============================================================================= Packman Mail Message: ===================== $END TXT