$TXT Created by PAJERSKI,JAN at DEVVII.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 03/20/06 at 13:25 ============================================================================= Run Date: MAY 16, 2006 Designation: LR*5.2*291 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #268 Status: Released Compliance Date: JUN 16, 2006 ============================================================================= Associated patches: (v)LR*5.2*224 <<= must be installed BEFORE `LR*5.2*291' (v)LR*5.2*272 <<= must be installed BEFORE `LR*5.2*291' (v)LR*5.2*274 <<= must be installed BEFORE `LR*5.2*291' (v)LA*5.2*64 <<= must be installed BEFORE `LR*5.2*291' (v)LR*5.2*286 <<= must be installed BEFORE `LR*5.2*291' (v)LR*5.2*290 <<= must be installed BEFORE `LR*5.2*291' (v)LA*5.2*67 <<= must be installed BEFORE `LR*5.2*291' (v)LR*5.2*299 <<= must be installed BEFORE `LR*5.2*291' Subject: LAB CLINICAL INDICATOR DATA CAPTURE Category: - Data Dictionary - Routine - Enhancement (Mandatory) Description: ============ This patch is the Laboratory part of Clinical Indicator Data Capture (CIDC) project. There are no NOIS messages or E3Rs associated with this patch. Required: ========= Before installing patch LR*5.2*291, site IRM personnel are directed to coordinate with the site's Laboratory Automated Data Processing Application Coordinator (ADPAC) or Laboratory Information Manager (LIM). With the install of LR*5.2*291 the RESPONSIBLE OFFICIAL(#.1) field of the ACCESSION (#68) file is changed from a free text field to a pointer to the NEW PERSON (#200) file. This new field when populated will be utilized to specify the rendering provider of the PCE workload rather than the PCE DEFAULT PROVIDER (#617)field of the LABORATORY SITE(#69.9)file as is currently the case. This allows sites to specify down to the Accession Area level for PCE encounter data. To assist sites with populating this field, an Environment Check LR291 routine will loop through each Accession Area prompting the installer to specify the Responsible Official. During the process the software displays the current 'OLD' free text value and does a look up on the New Person (#200) file based on the free text and valid active person class entries. If the routine finds more than one potential match the installer is presented a list of all matching entries to select one. Since the field is optional the installer may not answer these additional prompts were no Responsible Official specified. The Environment Check routine stops and the installer is able to continue the installation. Laboratory personal are able to review and update the Accession Area RESPONSIBLE OFFICIAL at a later time. IRM should consult with the site Laboratory ADPAC or Laboratory LIM for names of RESPONSIBLE OFFICIALS to specify. EXAMPLE: ACCESSION AREA: CHEMISTRY Old Responsible Official: XXXXX, XXX X New Responsible Official: YYYYY, YYY Y Chief, Pathology & Laboratory It is crucial that the Laboratory ADPAC or LIM be available immediately after the installation of this patch to flag billable lab panels to prevent them from unbundling. Should billable panels unbundle, a large amount of otherwise unnecessary work will be required because of the high volume of certain billable panels. The medical coders will be required to identify large numbers of individual unbundled tests, recognize them as billable panels, and then manually rebundle them for billing. A list of billable panels for reference can be found on the CIDC Website at http://vaww.vistau.med.va.gov/VistAU/CIDC/doc/lab-suppdoc/LABPANELCPTANDDE SCRIPTIONS.xls Overview ======== BACKGROUND: The Laboratory Clinical Indicator Data Capture (CIDC) project is part of the larger CIDC project under Management Systems service line. The VistA Laboratory application is one of several clinical applications requiringmodifications to meet the necessary data capture requirements for CIDC. HIGHLIGHTS: There will be additional calls created to applications outside the Laboratory package (primarily PCE) to retrieve or store data, but most of these changes occur in the background and will not directly impact the user. This phase of the development effort requires passing of collected CIDC data elements to PCE for patients with an outpatient status. Due to the addition of several new fields, primarily associated with the internal order process, once this release is installed the user will see additional data entry fields. BENEFITS AND GOALS: The primary goal of this release is to capture CIDC information within the Laboratory application to store the clinical reason and any indications associated with the reason for the lab test rendered. Functional Description ====================== Blood Bank Clearance ==================== EFFECT ON BLOOD BACK FUNCTIONAL REQUIREMENTS:Patch LR*5.2*291 does not contain any changes to the VISTA BLOOD BANK Software as defined by VHA DIRECTIVE 99-053 titled VISTA BLOOD BANK SOFTWARE VERSION 5.2 EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS:Patch LR*5.2*291 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS:Changes made by patch LR*5.2*291 have no effect on Blood Bank software functionality, therefore RISK is none. ==================================================== The following identifies the modifications to the VistA Laboratory software. An attempt is made to identify those changes that may require involvement of the end-user (laboratory staff), as opposed to software processes that will occur in response to current data entry (or data entry from external applications such as CPRS). 1. Service Connected Indicator* - This is a data element that currently exists but is not currently used by the Laboratory application. This data element is available from an outside source such as CPRS. In the case of internal Lab order entry, there will be additional fields displayed during specimen receipt. 2. Environmental Indicator* - This is a data element that currently exists but is not currently used by the Laboratory application. It is available from an outside source such as CPRS. In the case of internal Lab order entry, there will be additional fields displayed during specimen receipt. 3. Changes to Existing Orders - This involves capturing CIDC information when a test is an add-on, reflex, or deleted. The CIDC information will be sent to CPRS and PCE. 4. CPT association - The Laboratory system currently unbundles service requests to a level that allows result reporting. The software will store procedures (CPT codes) at the reportable level for transmission to PCE at the time of result release. 5. CPT Coding - The Laboratory application currently allows tests (individual or panels) to link to CPT codes via NLT. The current system was designed for workload capture and may not be suitable for proper clinical indicator data capture purposes. Modifications to the association of test to procedure code will be handled in the background. 6. Coded Diagnosis* - This is a data element that currently exists but is not currently used by the Laboratory application. For clinical laboratory and microbiology, this information will be made available from an outside source such as CPRS. Additional fields will be presented to accommodate entry of one or more diagnoses in ICD-9 format in the case of internal Lab order entry accessioning. 7. External Services - Laboratory service requests, which are performed at an external location, will be identified. These send-outs will be identified with the use of CPT modifiers. 8. Date sent to PCE - This involves capturing all billing information and sending to PCE. The software will identify the information needed to be sent to PCE. 9. Rendering Physician Name - This data element represents the individual responsible for result reporting. The application may require a data input field to allow identification of the reporting individual responsible for resulting or result interpretation. 10. CPRS Alerts - This function alerts the ordering provider in CPRS that an order may be missing associated diagnosis, SC/EI information or require an electronic signature. * NOTE: These prompts will only be available, whether from an outside source such as CPRS or the internal lab order entry, if the user user has the PROVIDER key and the CIDC switch and the patient's insurance permit these prompts to appear. Further information is provided in the supporting documentation. Technical Description ====================== The routines LR7OB3, LR7OB69, LR7OF0, LR7OF1 are modified to parse the DG1 and ZCL segments being sent from CPRS. The data is stored in the LAB ORDER ENTRY FILE (#69) file. The routines LRFAST, LRORD, LRORDST, LROW, LROW2A are modified to prompt the provider (or holder of the PROVIDER key) with the diagnosis question. The Service Connected and Environmental Indicators (SC/EI) questions will also be asked. The data is stored in the LAB ORDER ENTRY FILE (#69) file. The routines LRTSTJAM and LRTSTSET are modified to allow proper association of diagnosis and SC/EI for tests added to accessions. The routines LRVER1, LRVER3, LRVR1, LRVR3 are modified to collect the CIDC information stored in the LAB ORDER ENTRY FILE (#69) file. The data is sent to PCE and CPRS. The routine LRNIGHT is modified to check the need to send unbundled AMA/Billable panels to PCE on the Panel Process Date in the LABORATORY SITE (#69.9) file. The routine LRCAPPH3 is modified to send a new report to the LMI Mail Group during nightly Lab cleanup. This new report identifies entries in the LABORATORY TEST (#60) file that are associated with inactive CPT Codes. The routines LRBEBA, LRBEBA2, LRBEBA3, LRBEBA31, LRBEBA4, LRBEBAO are a collection of APIs that handle all the collection and distribution of CIDC information. The APIs are called by the order entry and resulting routines. The routine LRBEBA5 is called by the nightly cleanup task to check the Panel Process Date, and to unbundle AMA/Billable panels as needed. The routine LRBEPEND provides a new report on the Lab liaison menu that lists AMA/Billable panels from the preceding calendar month that are still pending completion. It is used by the Print AMA CPT Panel Pending List [LRBE PENDREP] menu option. ***************************** IMPORTANT ********************************* AMA/Billable Panels ------------------- After install of LR*5.2*291 all Lab panels will be sent to PCE 'unbundled' as their individual atomic tests. It is important that each site review their Lab panels for proper coding, identify their AMA/Billable panels for billing, and mark them as such in the new field AMA COMPLIANT/BILLABLE PANEL (#508) of the LABORATORY TEST file (#60). A valid CPT or HCPCS Code must be associated with the AMA/Billable panel test in order to send a panel-level (i.e., 'bundled') CPT code to PCE for billing. Sites will use the new option Test/Specimen/CPT Link [LRED CPT] to flag their AMA/Billable panels. This option is not included in the Laboratory DHCP Menu [LRMENU]. It must be added to the secondary menu in the NEW PERSON (#200) file of the user that will be entering panel CPT codes for Laboratory. To assist in review of proper CPT coding, the new menu option Lab Tests and CPT Report [LRBE PANEL CPT REPORT] provides a report of Lab tests and their associated CPT codes. This new report option is located in the Lab Liaison menu [LRLIAISON]. CPT codes for panel tests flagged as AMA/Billable are not sent to PCE until all 'required' atomic tests within the panel have been verified. Once all required atomic tests are verified, the 'bundled' CPT code is sent to PCE (i.e., the CPT or HCPCS Code associated with the AMA/Billable panel). If any required atomic test is cancelled during verification, then the remaining tests on the panel will be unbundled as they are verified. In that case, PCE will receive a CPT code for each individual atomic test. Marking a required atomic test on an AMA/Billable panel as 'Not Performed' by deleting the atomic test from the accession after result verification also causes the panel to be unbundled. But since data only passes to PCE upon verification, the accession would need to be re-verified in order for the unbundling to occur immediately. This may happen whenever it is necessary to change a previously verified result, verify a new result for another test in the accession, or add a comment. If there is no reason to re-verify the accession, then the unbundled CPT Codes will not pass to PCE until the date specified in the PANEL PROCESS DATE field (#620) of the LABORATORY SITE PARAMETERS file (#69.9). As stated above, a valid CPT or HCPCS Code must be associated with the AMA/Billable panel. If this requirement is not satisfied, the panel is not sent to PCE even though all required component tests have been verified. Again, the transmission to PCE will be delayed until the date specified in the PANEL PROCESS DATE field (#620). Pending AMA/Billable Panels to PCE ---------------------------------- The PANEL PROCESS DATE field (#620) in file #69.9 should be set after consultation with HIMS personnel at your site. This field should be set to a date preceding the date of PCE's monthly data roll-up to the Austin Automation Center. Typically, the PANEL PROCESS DATE is set to at least one day, but no more than 5 days, before the PCE roll-up date. Each night when the scheduled Nightly Cleanup [LRTASK NIGHTY] task runs, the date in field #620 of file #69.9 is checked. If that date is equal to or less than the current date, then the roll-up of pending AMA/Billable panels is started. Pending AMA/Billable panels from the prior month, not previously sent to PCE because either (1) not all required atomic tests were verified or (2) the panel did not have a valid CPT/HCPCS Code, will be sent to PCE at this time. If all required atomic tests are still not verified or if a valid CPT/HCPCS Code for the panel is still not present, then the panel will be unbundled and PCE will receive a CPT code for each verified atomic test. A report is sent via MailMan to the LMI Mail Group with details of the pending AMA/Billable panel roll-up to PCE. The Subject header of the message is "Report on Roll-up to PCE for ". The PANEL PROCESS DATE must be set initially via the FileMan Enter/Edit option. Each month when the roll-up of AMA/Billable panels occurs, this date is automatically re-set for the next month. Example: The site's PCE Roll-up to AAC occurs on the 19th of each month. If the site installs LR*5.2*291 in May, 2006, they could then set the PANEL PROCESS DATE field to June 17, 2006. On June 17 the Nightly Cleanup will start the roll-up of pending AMA/Billable panels to PCE. Only panels with a collection date on or before May 31, 2006, are processed. When the process concludes, the PANEL PROCESS DATE field is re-set to July 17, 2006. Lab personnel may request a report of pending AMA/Billable panel tests that may be included in an upcoming roll-up to PCE. The new menu option Print AMA CPT Panel Pending List [LRBE PENDREP] will list pending AMA/Billable panel tests, collected in the calendar month prior to the PANEL PROCESS DATE, that have no valid CPT/HCPCS Code and/or still have atomic tests pending. The report is sent to the requesting user via MailMan with a Subject header of "AMA/Billable Panel Pending List ". The new report option is located in the Lab Liaison menu [LRLIAISON]. Panels within Panels -------------------- If a panel test is included as a component test within another panel, it is the AMA COMPLIANT/BILLABLE PANEL field (#508) of the top-level panel that controls the transmission of CPT codes to PCE. All atomic tests contained in the sub-panel(s) are treated as if they were individual atomic tests of the top-level panel. If the top-level panel is flagged as AMA/Billable, then all required atomic tests contained in each sub-panel must be verified before the CPT/HCPCS Code (i.e., the 'bundled' CPT code) of the top-level panel can be sent to PCE. If any one of the required atomic tests within either the top-level panel or a sub-panel is cancelled/not performed, then a CPT code for each verified atomic test will be sent to PCE (i.e., the top-level panel and each sub-panel will be 'unbundled'). The AMA/Billable status of the sub- panel has no effect on this process. If the top-level panel is not flagged as AMA/Billable, then the CPT/HCPCS code for each individually verified atomic test is sent to PCE (i.e., panels are 'unbundled'). This is true even for the atomic tests on a sub- panel flagged as AMA/Billable. Exploded Panels --------------- Existing LAB functionality dictates that any panel test which does not have an assigned ACCESSION AREA for the INSTITUTION at which it is being performed is 'exploded' during accessioning. (These are fields within the ACCESSION AREA multiple (#6) of the LABORATORY TEST file (#60).) Components of an exploded panel are processed as if they were ordered and accessioned as separate entities. If the exploded panel contains sub-panels, the AMA/Billable status of the top-level panel will have no effect on whether CPT codes for atomic tests within a sub-panel are bundled or unbundled. Each sub-panel will be processed according to its own AMA/Billable status. If the top-level panel itself contains atomic tests, then they will be sent to PCE as individual CPT Codes (i.e., unbundled) as they are verified, regardless of the AMA/Billable status of the parent panel. ************************************************************************ ROUTINE SUMMARY =============== The following routines are included in this patch. The second line of each of these routines now looks like: ;;5.2;LAB SERVICE;**[Patch List]**;Sep 27, 1994 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List --------- ------------ ----------- ---------------------------- * LR291 n/a 6179512 **291** LR7OB3 12535845 12668397 **121,187,272,291** LR7OB69 4964747 4993129 **121,187,224,291** LR7OF0 21173052 21386021 **121,187,223,230,256,291** LR7OF1 12846415 12938587 **121,187,223,256,299,291** LRBEBA n/a 13852638 **291** LRBEBA2 n/a 17646164 **291** LRBEBA21 n/a 9131499 **291** LRBEBA3 n/a 9047328 **291** LRBEBA31 n/a 3432619 **291** LRBEBA4 n/a 12064856 **291** LRBEBA5 n/a 12195219 **291** LRBEBAO n/a 10958610 **291** LRBEECP1 n/a 1338151 **291** LRBEECPT n/a 13295281 **291** LRBEPEND n/a 12133481 **291** LRBEPRPT n/a 7979192 **291** LRCAPPH1 11352750 12066626 **127,136,138,158,263,264 274,291** LRCAPPH3 6642885 9674857 **263,291** LRFAST 18799737 19472230 **100,121,201,286,291** LRNIGHT 3012542 3063158 **291** LRORD1 9190513 9656882 **1,8,121,153,201,286,291** LRORDST 12502665 12904359 **100,107,121,153,202,290,291** LROW 7256064 7680398 **100,121,291** LROW2A 7988346 8205944 **20,40,100,107,121,291** LRTSTJAM 12720248 12901084 **121,153,291** LRTSTSET 12775322 12783733 **65,100,121,153,201,202, 263,291** LRVER1 7330679 7385270 **42,153,201,215,239,240,263, 232,286,291** LRVER3 13055299 13252395 **42,100,121,140,171,153,221, 286,291** LRVR1 11667912 11819149 **42,153,221,286,291** LRVR3 11176919 11379575 **42,121,153,286,291** LRWU1 4042564 3390492 **153,272,291** List of preceding patches: 224, 272, 274, 286, 290, 299 Sites should use CHECK^XTSUMBLD to verify checksums. Total number of routines - 32 * Note: LR291 is automatically deleted when the installation completes. DATA DICTIONARY SUMMARY ======================== UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # NAME DD CODE W/FILE DATA PTS RIDE ----------------------------------------------------------------------------- 60 LABORATORY TEST YES NO NO NO Partial DD: subDD: 60 fld: 506 fld: 507 fld: 508 subDD: 60.196 DATA SCREEN: 68 ACCESSION YES NO NO NO Partial DD: subDD: 68 fld: .1 fld: 12 DATA SCREEN: 69 LAB ORDER ENTRY YES NO NO NO Partial DD: subDD: 69.03 fld: 22 fld: 22.1 subDD: 69.05 DATA SCREEN: 69.9 LABORATORY SITE YES NO NO NO Partial DD: subDD: 69.9 fld: 620 DATA SCREEN: DOCUMENTATION RETRIEVAL ======================== The documentation for this patch can be found in the following [ANONYMOUS.SOFTWARE] directories: Preferred Address ------------------------- First available FTP server download.vista.med.va.gov Specific Field Office FTP Address --------------------- ------------------------ Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov File Name Description Format FTP Protocol -------------- ------------- ------- ------------ LR_52_291RN.pdf Release Notes PDF Binary LR_52_291TM.pdf Technical Manual PDF Binary LR_52_291UM.pdf User Manual PDF Binary Test Sites: ========== Boston HCS Dayton VAMC Loma Linda VAMC INSTALLATION INSTRUCTIONS ========================= This patch should not be installed during normal business hours. Install during a period of low LABORATORY activity and preferably with Lab users off the system for the brief time required for installation. Please coordinate the installation with the site's Laboratory Automated Data Processing Application Coordinator (ADPAC) or Laboratory Information Manager (LIM). Install Time - less than 5 minutes 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global Select Installation Option: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter LR*5.2*291): 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. 4. Select Installation Option: Install Package(s) ---------------- **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. b. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' answer NO. c. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO. d. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer NO. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LR291 Before: n/a After: B21675343 **291** Routine Name: LR7OB3 Before: B23426692 After: B24033857 **121,187,272,291** Routine Name: LR7OB69 Before: B8682133 After: B8923375 **121,187,224,291** Routine Name: LR7OF0 Before: B39264678 After: B40209802 **121,187,223,230,256,291** Routine Name: LR7OF1 Before: B24069320 After: B24442487 **121,187,223,256,299,291** Routine Name: LRBEBA Before: n/a After: B62512443 **291** Routine Name: LRBEBA2 Before: n/a After: B81298476 **291** Routine Name: LRBEBA21 Before: n/a After: B34208057 **291** Routine Name: LRBEBA3 Before: n/a After: B24961895 **291** Routine Name: LRBEBA31 Before: n/a After: B6240256 **291** Routine Name: LRBEBA4 Before: n/a After: B57653585 **291** Routine Name: LRBEBA5 Before: n/a After: B50227072 **291** Routine Name: LRBEBAO Before: n/a After: B68648424 **291** Routine Name: LRBEECP1 Before: n/a After: B2583804 **291** Routine Name: LRBEECPT Before: n/a After: B83809805 **291** Routine Name: LRBEPEND Before: n/a After: B47036238 **291** Routine Name: LRBEPRPT Before: n/a After: B37091351 **291** Routine Name: LRCAPPH1 Before: B42645479 After: B49109396 **127,136,138,158,263,264,274,291** Routine Name: LRCAPPH3 Before: B22721141 After: B41949665 **263,291** Routine Name: LRFAST Before: B27602884 After: B29732413 **100,121,201,286,291** Routine Name: LRNIGHT Before: B3406356 After: B3519006 **291** Routine Name: LRORD1 Before: B21032923 After: B22670416 **1,8,121,153,201,286,291** Routine Name: LRORDST Before: B28541612 After: B30093835 **100,107,121,153,202,290,291** Routine Name: LROW Before: B10364832 After: B11672894 **100,121,291** Routine Name: LROW2A Before: B11381802 After: B11789915 **20,40,100,107,121,291** Routine Name: LRTSTJAM Before: B16911767 After: B17412817 **121,153,291** Routine Name: LRTSTSET Before: B17772964 After: B18867118 **65,100,121,153,201,202,263,291** Routine Name: LRVER1 Before: B30450805 After: B31119261 **42,153,201,215,239,240,263, 232,286,291** Routine Name: LRVER3 Before: B48071171 After: B49207018 **42,100,121,140,171,153,221,286,291** Routine Name: LRVR1 Before: B35974824 After: B36555743 **42,153,221,286,291** Routine Name: LRVR3 Before: B36944972 After: B37947077 **42,121,153,286,291** Routine Name: LRWU1 Before: B6453701 After: B7097286 **153,272,291** ============================================================================= User Information: Entered By : YOUNG,TIM Date Entered : AUG 23, 2002 Completed By: LYNCH,MARY F. Date Completed: MAY 12, 2006 Released By : LECLAIR,RAY Date Released : MAY 16, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT