$TXT Created by ANZALDUA,CAROL K at CHLVSS.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 10/30/06 at 16:26 ============================================================================= Run Date: JUN 14, 2007 Designation: LR*5.2*317 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #285 Status: Released Compliance Date: JUL 15, 2007 ============================================================================= Associated patches: (v)LR*5.2*259 <<= must be installed BEFORE `LR*5.2*317' (v)LR*5.2*295 <<= must be installed BEFORE `LR*5.2*317' Subject: AP MODIFICATIONS/ENHANCEMENTS TO ADDRESS PSI-04-025 Category: - Routine - Enhancement (Mandatory) - Data Dictionary Description: ============ ************************************ ************************************************************************* SPECIAL NOTE: Installation of this patch MUST be coordinated with Laboratory personnel. The Pre-Installation instructions within the Installation Section below, MUST be followed and completed before installation can begin. ************************************************************************* ************************************ BLOOD BANK CLEARANCE ==================== VISTA Laboratory Package patch LR*5.2*317 contains changes to software controlled by VHA DIRECTIVE 2004-053, titled VISTA BLOOD BANK SOFTWARE. Changes include: File Sub-file Field Field Name Action ---- -------- ----- ---------- ------ 63 63.207 .03 RELEASE SUPP REPORT MODIFIED New Field 63 63.324 .03 RELEASE SUPP REPORT MODIFIED New Field 63 63.817 .03 RELEASE SUPP REPORT MODIFIED New Field 63 63.907 .03 RELEASE SUPP REPORT MODIFIED New Field All of the above changes have been reviewed by the VISTA Blood Bank Developer and found to have no impact on the VISTA BLOOD BANK SOFTWARE control functions. RISK ANALYSIS: Changes made by patch LR*5.2*317 have no effect on Blood Bank software functionality, therefore RISK is none. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*317 does not alter or modify any software design safeguards or safety critical elements functions. POTENTIAL IMPACT ON SITES: This patch contains changes to 0 routines and 1 file identified in Veterans Health Administration (VHA) Directive 2004-053, group B listing. The changes have no effect on Blood Bank functionality or medical device control functions. There is no adverse potential to sites. VALIDATION REQUIREMENTS BY OPTION: There are no validation requirements associated with this patch. MINIMAL TEST CASE SCENARIOS BY OPTION, INCLUSIVE OF ALL CONTROL FUNCTIONS: There are no test case scenarios associated with this patch. ================= VistA Laboratory Anatomic Pathology (AP) Modifications/Enhancements patch LR*5.2*317 addresses two patient safety issues (PSI) reported in PSI-04-025 that arose from the release and implementation of the VistA Laboratory Anatomic Pathology Electronic Signature Patch LR*5.2*259. The patient safety issues are described as follows: 1. Users that should not be allowed to modify an Anatomic Pathology SF515 or Autopsy Protocol released report are given access to the Modify released report [LRAPMRL] option in order to allow the user to add supplementary reports. 2. The original Anatomic Pathology SF515 or Autopsy Protocol report is not viewable in the Computer Patient Records System (CPRS) during the time a supplementary report is underway. Personnel are unable to view the report during this time. The VistA Laboratory Anatomic Pathology Electronic Signature Patch LR*5.2*259 changed the location and the method by which supplementary reports are added. The Modify released report [LRAPMRL] option is used to add supplementary reports to the original report. Laboratory personnel allowed to add supplementary reports to Anatomic Pathology released reports must have access to the Modify released report [LRAPMRL] option. This access opened up the potential for errors in which the report could be accidentally modified when a supplementary report was added. Patch LR*5.2*317 resolves this problem by removing the supplementary report addition functionality from the Modify released reports [LRAPMRL] option and placing the functionality back to the Supplementary Report, Anat Path [LRAPDSR] option for Cytology, Electron Microscopy, and Surgical Pathology released reports and the Autopsy supplementary report [LRAPAUSR] option for Autopsy released reports. Another concern had to do with the addition of a supplementary report to a released Anatomic Pathology report, which unreleased the original report and made it unavailable for viewing in Computerized Patient Record System (CPRS). The time span in which the original report remained unavailable for viewing by the Providers could be crucial. It was considered a major patient safety issue if a doctor, who was with a patient, was not able to view the report at that time. Patch LR*5.2*317 resolves this problem by leaving the original report in released status during the time a supplementary report is being added. The original report remains available for viewing in CPRS during this time. Enhancements to LAB DATA file (#63): ------------- A new field, RELEASE SUPP REPORT MODIFIED (#.03), has been added to the SUPPLEMENTARY REPORT SUB-FILE for the anatomic pathology sections Cytopathology, Electron Microscopy, and Surgical Pathology; and to the AUTOPSY SUPPLEMENTARY REPORT for Autopsy. The field is a flag, when set to '1', indicates a released supplementary report is being modified, and has not yet been released. 63.207,.03 RELEASE SUPP REPORT MODIFIED 0;3 SET '1' FOR YES; '0' FOR NO; LAST EDITED: SEP 08, 2004 DESCRIPTION: This flag will be set to '1' when a released supplementary report is modified. It is removed when the modified supplementary report is released. 63.817,.03 RELEASE SUPP REPORT MODIFIED 0;3 SET '1' FOR YES; '0' FOR NO; LAST EDITED: SEP 08, 2004 DESCRIPTION: This flag will be set to '1' when a released supplementary report is modified. It is removed when the modified supplementary report is released. 63.907,.03 RELEASE SUPP REPORT MODIFIED 0;3 SET '1' FOR YES; '0' FOR NO; LAST EDITED: SEP 08, 2004 DESCRIPTION: This flag will be set to '1' when a released supplementary report is modified. It is removed when the modified supplementary report is released. 63.324,.03 RELEASE SUPP REPORT MODIFIED 0;3 SET '1' FOR YES; '0' FOR NO; LAST EDITED: SEP 08, 2004 DESCRIPTION: This flag will be set to '1' when a released supplementary report is modified. It is removed when the modified supplementary report is released. Modifications: -------------- The following options have been modified. Please refer to the User Guide distributed with this patch for detailed information and examples. Supplementary Report, Anat Path [LRAPDSR] option Supplementary report release, anat path [LRAPRS] option Autopsy supplementary report [LRAPAUSR] option Modify released pathology report [LRAPMRL] option Print all reports on queue [LRAP PRINT ALL ON QUEUE] option Print single report only [LRAP PRINT SINGLE] option Print final path reports by accession # [LRAPFICH] option This patch addresses the following E3R's: ======================================== N/A This patch addresses the following NOIS / Remedy Ticket: ======================================================= BRX-0704-11083 / HD0000000070862 CPH-0904-40215 / HD0000000070983 MIA-0604-31201 / HD0000000070788 PRO-0604-10213 / HD0000000070762 SLC-0604-50484 / HD0000000070766 SLC-0604-50594 / HD0000000070769 SLC-0604-51082 / H00000000070778 Overview of NOIS / Remedy Tickets: ================================= BRX-0704-11083 / HD0000000070862 Problem: Pathologists are complaining about changes in procedure done by the Electronic Signature patch. When a supplemental report is added the system un-verifies the parent report. This unverified report becomes available for other Pathologists and transcriptionists to edit it. Before once a report was verified it could not be changed. The Chief Pathologist is very concerned with the legal and clinical ramifications of this change. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. CPH-0904-40215 / HD0000000070983 - Problem: Our pathologists are concerned that post patch 259, addition of supplemental reports (additional information) must be added under MM Modify option, thus un-releasing the original report, and necessitating the re-release of both original and supplemental reports. They feel modified reports should be reserved for edition/correction of previous released reports. They feel this is a patient safety issue. The post 259 options [LRAPDSR] and [LRAPDSS] are redundant when they are operable only with un-released reports. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. MIA-0604-31201 / HD0000000070788 - Problem: According to our lab folks in Anatomic path they used to go in to an option called Supplementary Report, Anat Path to make a correction to the original after it is released. They don't want to go under the edit modify to reopen the report any ideas on how they can go into the supplementary to attach to the original accession report or something like that. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. PRO-0604-10213 / HD0000000070762 - Problem: Our LAB Service Chief does not want IRM to install patch LR*5.2*259 for the following Patient Safety, integrity, and additional keystrokes reasons. For example the Surgical Pathology Reports, the new patch, takes the Supplemental report feature away (ie. For a special stain), it's replaced with a modified report feature, which allows you to make changes to the original report in addition to adding. Also, while using the modify report feature, while your in it, it makes the original report unavailable for the Providers to view. He feels that this is a Major Patient Safety issue, that if a Doctor is with the patient, he won't be able to view the report. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. SLC-0604-50484 / HD0000000070766 - Problem: I've just reviewed the NOIS MEM-0504-71296, and we are struggling with the same issues of supplementary reports that they are. (Post install of patch LR*5.2*259). We currently do not have the electronic signature turned on. The concern is, that once a report is unreleased, the previously released portion of the report is not viewable on CPRS, and the way we operate here is that the secretaries transcribe the report, and the pathologist signs them sometime later. We have only had the patch installed for a couple of days, and the path lab has already received calls that reports have "disappeared" on CPRS ... are there any suggestions for a process change that could help with this? Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. SLC-0604-50594 / HD0000000070769 - Problem: Post installation of LA*5.2*259 we have encountered the usual problems with any software install that changes the daily routine of workflow, but there is a problem that we feel does affect patient care . We now have to "unrelease" a report prior to adding a supplementary report, the secretaries then transcribe the supplemental report, then the pathologists must review/correct and sign it prior to the secretaries re-releasing the report. This leaves a window of several hours during which the original report is not viewable on the computer, we have already received calls about "disappearing" path reports. Our pathologists feel that a supplemental report should truly be regarded as an addendum to the original report, and should not make the original report unviewable while the supplemental report is being processed. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. SLC-0604-51082 / H00000000070778 - Problem: We have found a problem with the electronic signature patch. Our transcriptionist mistakenly selected the field to add a date to the supplementary report field (thru edit/modify), but didn't add text to the free text field. He was unable to sign a supplementary report (the computer says it doesn't exist), but when he tries to release the original report, it says that the supplementary needs to be released first. The lab figured out a way to release this, but it is an issue. Resolution: The resolution of this issue is contained in the section above that describes the resolution to patient safety issues #1 and #2. TEST SITES ========== Ann Arbor VAMC - CACHE/VMS, large site Boston HCS - CACHE/VMS, large integrated site Long Beach VAMC - CACHE/VMS, large site Providence VAMC - CACHE/VMS, medium site Salem VAMC - CACHE/VMS, medium site ROUTINE SUMMARY: ================ The following is a list of the routines included in this patch. The second line of each of these routines now look like: ;;5.2;LAB SERVICE;**;Sep 27, 1994 CHECK^XTSUMBLD results Routine Before After Name Patch Patch Patch List ----------- -------- --------- ---------------------------- LR317 N/A 6221288 **317** (DELETED BY KIDS) LR7OSAP 16576063 17166196 **121,187,230,256,259,317** LR7OSAP1 8012437 8222916 **121,227,230,259,317** LR7OSAP2 17315095 18146154 **230,256,259,317** LRAPAUSR 7980343 8097532 **1,173,248,259,317** LRAPBR1 8346961 8691424 **259,317** LRAPBR4 5636439 5950657 **259,317** LRAPD1 5673315 5050395 **41,91,248,259,317** LRAPDA 11977101 13331988 **72,73,91,121,248,259,295,317** LRAPDSR 4820936 5708731 **248,259,295,317** LRAPMRL 8314291 8358357 **259,295,317** LRAPMRL1 4140484 5097223 **259,317** LRAPR 12791716 12536700 **72,248,259,317** LRAPR1 N/A 5253992 **317** LRAPRES 10849835 10161024 **259,295,317** LRAPV 3996189 4248185 **72,201,259,317** LRSPRPT 12082607 12449414 **1,72,248,259,317** NOTE: LR317 will be deleted after successful patch installation. SOFTWARE RETRIEVAL: =================== Software Retrieval ------------------ VistA Laboratory Anatomic Pathology Modifications/Enhancements to Address PSI-04-025 Patch LR*5.2*317 software is distributed by Packman. Documentation Retrieval ----------------------- VistA Laboratory Anatomic Pathology (AP) Modifications/Enhancements to Address PSI-04-025 Patch LR*5.2*317 User Guide is available at the following Office of Information Field Offices (OIFOs) ANONYMOUS.SOFTWARE directories: OI Field Office FTP Address Directory --------------- ----------- --------- ALBANY ftp.fo-albany.med.va.gov [ANONYMOUS.SOFTWARE] HINES ftp.fo-hines.med.va.gov [ANONYMOUS.SOFTWARE] SALT LAKE CITY ftp.fo-slc.med.va.gov [ANONYMOUS.SOFTWARE] Documentation Retrieval Formats ------------------------------- VistA Laboratory Anatomic Pathology Supplementary Report Enhancements Patch LR*5.2*317 User Guide files are exported in the following retrieval formats: File Name Contents Retrieval Formats --------- -------- ----------------- LAB_52_317_UG.doc VistA Laboratory Anatomic Pathology (AP) Modifications/Enhancements to Address PSI-04-025 Patch LR*5.2*317 User Guide BINARY LAB_52_317_UG.pdf VistA Laboratory Anatomic Pathology (AP) Modifications/Enhancements to Address PSI-04-025 Patch LR*5.2*317 User Guide BINARY VistA Website Locations: ----------------------- VistA Laboratory Anatomic Pathology (AP) Modifications/Enhancements to Address PSI-04-025 Patch LR*5.2*317 User Guide is accessible in MS Word (.doc) and Portable Document Format (.pdf) at the following VistA locations: Laboratory Version 5.2 Home Page -------------------------------- http://vista.med.va.gov/ClinicalSpecialties/lab/ VistA Documentation Library (VDL) --------------------------------- www.va.gov/vdl/ INSTALLATION INSTRUCTIONS ========================= This patch can be installed with users on the system. However, it is recommended that installation occur when there is no Anatomic Pathology activity or activity is at a minimum. This will prevent 'Cannot return to source routine' errors. The Anatomic Pathology menu will be disabled automatically by this patch and re-enabled after installation. Install Time - less than 5 minutes. PRE-INSTALLATION INSTRUCTIONS ============================= *************************************************************************** *** IT IS VERY IMPORTANT THAT YOU FOLLOW THE PRE-INSTALLATION *** *** INSTRUCTIONS BEFORE INSTALLING THE PATCH. *** *** *** *** All outstanding (unreleased) supplementary reports from July 23, *** *** 2003, the date LR*5.2*259 Anatomic Pathology Electronic Signature *** *** patch was first installed in a production account, until the present*** *** MUST be released before installing this patch. If there are *** *** unverified supplementary reports, THE PATCH WILL NOT INSTALL. *** *** *** *** The appropriate Laboratory personnel should check for unverified *** *** supplementary reports and make sure all are reviewed and released *** *** before proceeding with this installation. The following option *** *** can be used to check for outstanding unreleased supplementary *** *** reports: List of unverified pathology reports [LRAPV] option. *** *** Selection #2 will create a listing of unverified supplementary *** *** reports. *** *************************************************************************** 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 ---- 1 Load a Distribution 2 Verify Checksums in Transport Global 3 Print Transport Global 4 Compare Transport Global to Current System 5 Backup a Transport Global 6 Install Package(s) Restart Install of Package(s) Unload a Distribution DD DD, 2nd Line Comparison Select Installation Option: 3. Select Installation Option: ------------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter LR*5.2*317): 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. (When prompted for the INSTALL NAME, enter LR*5.2*317.) b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO (unless otherwise indicated) c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer NO (unless otherwise indicated) 5. If you have any unreleased supplementary reports from July 23, 2003 until the present, the install will abort. To print the unreleased supplementary reports, you can print the install file. Here's an example: Select Kernel Installation & Distribution System Option: utilities Select Utilities Option: install File Print Select INSTALL NAME: lr*5.2*317 Loaded from Distribution 8/25/06@14:37:36 DEVICE: HOME// ;;1000 UCX/TELNET PACKAGE: LR*5.2*317 Aug 25, 2006 2:39 pm PAGE 1 COMPLETED ELAPSED --------------------------------------------------------------------------- INSTALLED BY: IRM,PERSON NATIONAL PACKAGE: LAB SERVICE INSTALL STARTED: ROUTINES: PRE-INIT CHECK POINTS: XPD PREINSTALL STARTED XPD PREINSTALL COMPLETED FILES: LAB DATA POST-INIT CHECK POINTS: XPD POSTINSTALL STARTED XPD POSTINSTALL COMPLETED MESSAGES: Sending transport global loaded alert to mail group G.LMI Unreleased supplemental report(s) from July 23,2003 until present- must be released before install. Name: TEST,PATIENT Accession: NSP 04 2 --- Install Environment Check FAILED --- LR*5.2*317 Build will not be installed Aug 25, 2006@14:38:55 Select Utilities Option: ** NOTE: Routine LR317 will be deleted after successful patch installation. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: LR317 Before: n/a After: B18182916 **317** Routine Name: LR7OSAP Before: B34114559 After: B37919526 **121,187,230,256,259,317** Routine Name: LR7OSAP1 Before: B24974232 After: B26109314 **121,227,230,259,317** Routine Name: LR7OSAP2 Before: B52834321 After: B59162352 **230,256,259,317** Routine Name: LRAPAUSR Before: B34065623 After: B34793694 **1,173,248,259,317** Routine Name: LRAPBR1 Before: B54673575 After: B58834636 **259,317** Routine Name: LRAPBR4 Before: B30127062 After: B32957954 **259,317** Routine Name: LRAPD1 Before: B24077474 After: B22198195 **41,91,248,259,317** Routine Name: LRAPDA Before: B64317056 After: B76606340 **72,73,91,121,248,259,295,317** Routine Name: LRAPDSR Before: B17788838 After: B25438900 **248,259,295,317** Routine Name: LRAPMRL Before: B66524711 After: B65434742 **259,295,317** Routine Name: LRAPMRL1 Before: B15484610 After: B21952067 **259,317** Routine Name: LRAPR Before: B89817361 After: B84430863 **72,248,259,317** Routine Name: LRAPR1 Before: n/a After: B19317428 **317** Routine Name: LRAPRES Before:B103360947 After: B94733481 **259,295,317** Routine Name: LRAPV Before: B13932043 After: B15077938 **72,201,259,317** Routine Name: LRSPRPT Before: B88845330 After: B92562557 **1,72,248,259,317** ============================================================================= User Information: Entered By : LYON,KAREN Date Entered : JUN 14, 2004 Completed By: ELIJAH,VICKEY Date Completed: JUN 12, 2007 Released By : MURCH,CLAUDETTE Date Released : JUN 14, 2007 ============================================================================= Packman Mail Message: ===================== $END TXT