$TXT Created by MCCORMACK,JOHN J at FS.ISC-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 04/13/04 at 09:52 ============================================================================= Run Date: JUN 14, 2004 Designation: LR*5.2*313 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #238 Status: Released Compliance Date: JUL 15, 2004 ============================================================================= Associated patches: (v)LR*5.2*289 <<= must be installed BEFORE `LR*5.2*313' Subject: EGFR DELTA CHECK AND AUTOMATED INSTRUMENT INTERFACES Category: - Routine Description: ============ Description =========== This patch corrects several defects reported with the eGFR delta check released in patch LR*5.2*289 DELTA CHECK FOR EGFR TEST. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*313 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*313 does not alter or modify any software design safeguards or safety critical elements functions. RISK ANALYSIS: Changes made by patch LR*5.2*313 have no effect on Blood Bank software functionality, therefore RISK is none. VALIDATION REQUIREMENTS BY OPTION: Because of the nature of the changes made, no specific validation requirements exist as a result of installation of this patch. 1. NOIS DUR-0803-30566 and NYH-1203-10526 reported the eGFR calculation delta check was not triggered when processing creatinine results via option Enter/verify data (autoinstrument) [LRVR]. The delta check will be triggered when the creatinine value is entered and/or changed or when the eGFR has not been calculated. If the eGFR is a required test and the result is 'pending' then the delta check will attempt to calculate the eGFR. 2. The comment "MISSING PARAMETER" generated when the patient's race is 'Undeclared' or 'Unanswered' is changed to "For eGFR: Race unknown, if African American multiply result by 1.210". 3. The delta check will determine the patient's race using the following criteria: a. If specimen for a PATIENT file (#2) patient, the race is determine using supported API VADPT. b. If specimen for a REFERRAL PATIENT file (#67) patient, the race is determined based on RACE field (#.06) in REFERRAL PATIENT file. c. All other patient types will not use race as a parameter in the calculation. These patient types will generate the 'race unknown' comment. 4. During patch development it was determined that the lock placed on the accession being verified could be prematurely released. This defect could allow two or more users to edit the accession concurrently. The delta check has been changed to eliminate the releasing of the lock. The lock will now be released by the lab verifying options. 5. During patch testing a potential safety issue was identified with the delta check with regards to display of abnormal/critical creatinine values. The delta check displayed eGFR exception messages as part of the display of creatinine abnormal/critical flags. These eGFR exception messages will be added as accession comments and not displayed as part of the creatinine result display. The eGFR exception messages that will be added as comments are. Condition Comment --------- ------- no patient age - "For eGFR: **eGFR not Calculated - No Age Recorded**" no patient sex - "For eGFR: **eGFR not Calculated - No Sex Recorded**" race unknown - "For eGFR: Race unknown, if African American multiply result by 1.210" delta check incorrectly configured - "For eGFR: **eGFR not Calculated - Delta check not configured**" Note: this comment generated when field TEST NAME FOR OUTPUT VALUE 1 (#61.1) is blank for the eGFR delta check entry in DELTA CHECKS file (#62.1). creatinine changed and eGFR not in editing profile - "For eGFR: **eGFR not in test editing profile - Creatinine Changed**" When no patient age or sex is identified, "canc" will be entered as the eGFR test result. 6. NOIS FGH-0304-32518 reported the eGFR calculation was being performed and the result added to the accession when there was no ordered test for the eGFR. This prevents user from verifying and releasing test results. The eGFR delta check will check for the eGFR test in the test editing profile selected by the user. If the eGFR test is not in the editing profile then it will not be calculated. If the creatinine value is changed, the eGFR test is not in the editing profile and there is a previous eGFR result then the exception message "For eGFR: **eGFR not in test editing profile - Creatinine Changed**" will be generated 7. When the eGFR delta check is called by option Group data review (verified & EM) [LRGVP] the delta check will quit with no action taken. 8. See patch LR*5.2*289 DELTA CHECK FOR EGFR TEST for instructions on setting up and configuring the eGFR delta check. ASSOCIATED E3R -------------- None ASSOCIATED NOIS --------------- DUR-0803-30566 FGH-0304-32518 NYH-1203-10526 TEST SITES ---------- Albuquerque VAMC - VMS/DSM Durham VAMC - VMS/DSM Iron Mountain VAMC - VMS/Cache Maryland HCS - VMS/DSM Milwaukee VAMC - VMS/DSM North Florida/South Georgia HCS - VMS/DSM Shreveport VAMC - VMS/DSM Tomah VAMC - VMS/Cache Upstate New York HCS - VMS/DSM 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;;Sep 27, 1994 Checksum Checksum Routine Name Before Patch After Patch Patch List ------------ ------------ ----------- ------------ LR313 N/A 4332118 **313** (Deleted by KIDS) LREGFR 2490467 3964631 **289,313** List of preceding patches: 289 Sites should use CHECK^XTSUMBLD to verify checksums. INSTALLATION INSTRUCTIONS ------------------------- The install time for this patch is less than 5 minute. This patch can be installed when Laboratory users are on the system. However these users should not be using any of the Laboratory's package verifying options. Suggested time to install: non-peak requirement hours. NOTE: Kernel patches must be current on the target system to avoid problems loading and/or installing this patch. Patch installation needs to be coordinated with the Laboratory Information Manager (LIM/ADPAC). 1. If any of the above routines are mapped, disable mapping for them. 2. Use the 'INSTALL/CHECK MESSAGE' option of the PackMan menu. This option will load the KIDS patch onto your system. 3. On the 'Kernel Installation & Distribution System' Menu (KIDS), select the 'Installation' menu. 4. Use the 'Verify Checksum in Transport Global' option and verify that all routines have the correct checksums. 5. On the KIDS menu, under the 'Installation' menu, use the following options: Print Transport Global Compare Transport Global to Current System Backup a Transport Global 6. Use the 'Install Package(s)' option under the 'Installation' menu and select the package 'LR*5.2*313'. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES// choose 'NO'. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', choose 'NO' unless site has additional local laboratory verifying options that should be disabled during install. The install will automatically disable the following options: Accession order then immediately enter data LR ACC THEN DATA Batch data entry (chem, hem, tox, etc.) LRSTUF Bypass normal data entry LRFAST Enter/verify data (Load list) LRVRW2 Enter/verify data (Work list) LRVRW Enter/verify data (auto instrument) LRVR Enter/verify/modify data (manual) LRENTER Fast Bypass Data Entry/Verify LRFASTS Group data review (verified & EM) LRGVP Group verify (EA, EL, EW) LRGV 7. On a mapped system, rebuild your map set. Note: Routine LR313 will be deleted after successful patch installation. INSTALLATION EXAMPLE ==================== Select Installation Option: 6 Install Package(s) Select INSTALL NAME: LR*5.2*313 Loaded from Distribution 1/26/04@11:22:51 => LR*5.2*313 This Distribution was loaded on Jan 26, 2004@11:22:51 with header of LR*5.2*313 It consisted of the following Install(s): LR*5.2*313 Checking Install for Package LR*5.2*313 Will first run the Environment Check Routine, LR313 Sending install started alert to mail group G.LMI --- Environment Check is Ok --- Install Questions for LR*5.2*313 Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES// NO Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// NO Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// TELNET VIRTUAL Install Started for LR*5.2*313 : Jan 26, 2004@11:26:28 Build Distribution Date: Jan 26, 2004 Installing Routines:... Jan 26, 2004@11:26:28 Running Pre-Install Routine: PRE^LR313. *** Pre install started *** *** No action required *** *** Pre install completed *** Installing PACKAGE COMPONENTS: Installing OPTION........... Jan 26, 2004@11:26:28 Running Post-Install Routine: POST^LR313. *** Post install started *** *** No action required *** *** Post install completed *** Sending install completion alert to mail group G.LMI Updating Routine file...... Updating KIDS files....... LR*5.2*313 Installed. Jan 26, 2004@11:26:28 Install Message sent #xxxxx Routine Information: ==================== Routine Name: - LREGFR Routine Checksum: Routine Name: - LR313 Routine Checksum: ============================================================================= User Information: Entered By : MCCORMACK,JOHN Date Entered : DEC 09, 2003 Completed By: HSU,YUI LI Date Completed: MAY 20, 2004 Released By : BELSCHWINDER,MICHAEL Date Released : JUN 14, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT