============================================================================= Run Date: DEC 17, 2004 Designation: LR*5.2*286 Package : LR - LAB SERVICE Priority: Mandatory Version : 5.2 SEQ #245 Status: Released Compliance Date: JAN 17, 2005 ============================================================================= Associated patches: (v)LR*5.2*121 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*153 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*187 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*201 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*202 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*220 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*221 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*222 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*230 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*232 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*256 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*261 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*263 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*269 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*271 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*282 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*283 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*285 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*287 <<= must be installed BEFORE `LR*5.2*286' (v)LR*5.2*312 <<= must be installed BEFORE `LR*5.2*286' Subject: VA/DOD LAB INTEROPERABILITY Category: - Enhancement (Mandatory) - Data Dictionary - Routine - Informational Description: ============ VISTA Laboratory Package patch LR*5.2*286 contains changes to software controlled by VHA DIRECTIVE 99-053, titled VISTA BLOOD BANK SOFTWARE VERSION 5.2. Change includes: The addition of the "USE FOR REFERENCE TESTING" field (#13) to the "SITE/SPECIMEN SUB-FIELD" (#60.01) of the LABORATORY TEST file (#60). The addition of the "USE FOR REFERENCE TESTING" field to the "LR ATOMIC TESTS" Input Template. The above change has been reviewed by the VISTA Blood Bank Developer and found to have no impact on the VISTA BLOOD BANK SOFTWARE version 5.2 control functions. RISK ANALYSIS: Changes made by patch LR*5.2*286 have no effect on Blood Bank software functionality, therefore RISK is none. EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch LR*5.2*286 does not alter or modify any software design safeguards or safety critical elements functions. POTENTIAL IMPACT ON SITES: This patch contains changes to a Data Dictionary identified in Veterans Health Administration (VHA) Directive 99-053. The changes have no effect in Blood Bank functionality or medical device control functions. There is no adverse potential to sites. VALIDATION REQUIREMENTS BY OPTION: There are no required validation scenarios to be completed by sites after installing LR*5.2*286. ======================================== Patch LR*5.2*286 VA/DOD LAB INTEROPERABILITY will be distributed and installed with patch LA*5.2*64 VA/DOD LAB INTEROPERABILITY This patch adds support for sending/receiving Laboratory Electronic Data Interchange (LEDI) orders/results with Department of Defense (DoD) facilities. Laboratory result verification has been enhanced to allow the designation of a performing laboratory and the use of the performing laboratory's units, normals, and normalcy status in results reporting. 1. User during the verification process is able to specify the performing laboratory. The performing laboratory is selected from the list of available entries in the site's INSTITUTION file (#4). The selection of entries is screened as follows: a. User can select the division they are logged on. b. User can select an institution that is configured in the LAB SHIPPING CONFIGURATION file (#62.9) as a host facility with their division as the collecting facility. 2. During acceptance and verification of results received from a reference laboratory via an HL7 interface (LEDI), the performing laboratory, results, units, normals and normalcy status contained in the HL7 message are stored "as is". 3. Receipt of amended reports from a reference laboratory will generate a MailMan bulletin containing the particulars of the amended report. This bulletin is sent to the members of the mail group specified for "New Result" alerts in LA7 MESSAGE PARAMETER file (#62.48) for the interface. 4. Amended reports received via a LEDI HL7 interface can be processed via the Enter/verify/modify data (manual) option [LRENTER]. 5. Users using the Enter/verify/modify data (manual) option [LRENTER] to enter results manually from a reference laboratory can use the units and normals specified in LABORATORY TEST file (#60) by configuring USE FOR REFERENCE TESTING field (#13) within the SITE/SPECIMEN subfile (#100). If this field is not enabled for reference laboratory result data entry, then the user is prompted for units, normals, high and low reference ranges to store with the results. The Edit atomic tests option [LRDIEATOMIC] allows Labortory Information Manager (LIM) to designate this functionality for affected tests. 6. NOIS DEN-1299-52099, NYH-0700-11942, PHI-0803-21507, TAM-0400-31033, and WPB-0900-32221 reported the defect of normalcy status (low/high/critical low/critical high) being incorrectly evaluated when the test result is zero (0). Evaluation of normalcy status will properly deal with test results of zero (0). 7. Changing normalcy status and units will trigger the generation of audit trail comments. 8. During verification, the ordering provider's phone and pager information is displayed. 9. Display of lab results in the Computerized Patient Record System Graphical User Interface (CPRS GUI) and Laboratory Interim Reports has been modified to display units and normals associated with results at time of verification. Results that are derived from a Set of Codes will be reported using the external form of the code. 10. Display of performing laboratory has been added to CPRS GUI display of results. 11. NOIS DAY-0303-40775 reported a defect in display of lab results with embedded spaces. When lab results contained embedded spaces these spaces were being removed prior to the display of the lab result. The removal of theses spaces resulted in corruption of the result. Routines LR7OB63 and LR7OR2 have been corrected to trim leading and trailing spaces but leave embedded spaces. 12. Enter/verify data (auto instrument) [LRVR] and Enter/verify/modify data (manual) [LRENTER] options will display patient information from PAT. INFO. field (#.091) in LAB DATA file (#63) during result verification. (E3R #13408) 13. Alignment of test results during verification process has been adjusted to avoid display of previous and current test results together. Results will be displayed right-justified under the date/time of each specimen. 14. NOIS ALB-0100-50284, FAV-1103-70892 reported a failure of UID creation and storage when creating a non-daily accession that is in common with another accession area. The failure occurs on the creation of the first accession for a given accession area and date. After the first accession for an accession date is created and stored in ACCESSION file (#68) subsequent accessions have the UID stored properly. Failure was due to missing subfile zeroth nodes for the ACCESSION DATE multiple (#68.01) and ACCESSION NUMBER multiple (#68.02) of the ACCESSION file (#68) when calling FileMan to store the UID. Routine LRWLST1 will now check and set the subfile's zeroth nodes before calling FileMan. FileMan calls have been converted from classic FileMan DIE calls to FileMan Database Server calls (DBS). When an error condition is encountered during a FileMan DBS call, the Laboratory package will generate a mail message with the subject "FileMan DBS call failed during accessioning in routine LRWLST1". This message will be sent to the local mail group "LMI". It will contain debugging information to assist site and National VistA Support in resolving the condition that produced the error. 15. NOIS BON-0196-71728 reported a problem with storing the appropriate treating specialty associated with an accession. A bad or incorrect pointer to FACILITY TREATING SPECIALTY file (#45.7) could be stored in the TREATING SPECIALTY (#6.6) field within the ACCESSION NUMBER field (#68.02) multiple within the ACCESSION DATE field (#68.01) multiple of the ACCESSION file (#68). When a specimen is accessioned for a non-inpatient and the user selects an inpatient ordering location the software would use the specialty from SPECIALITY file (#42.4) that is associated with the WARD LOCATION file (#42) entry linked to the HOSPITAL LOCATION file (#44). Routine LRWLST1 will determine treating specialty based on the associated TREATING SPECIALTY field (#9.5) in the HOSPITAL LOCATION file (#44) when the patient is not an inpatient. When a patient is an inpatient then treating specialty will be determined from the PATIENT file (#2), TREATING SPECIALTY field (.103). Treating specialty will only be stored in ACCESSION file (#68) when the patient is from PATIENT file (#2). 16. The following defects were identified during the software review as part of patch development. a. Ordering location and ordering provider will not be stored on accessions that are related to LAB CONTROL NAME file (#62.3) entries. b. During accessioning if accession area is locked by another process, the message displayed to user was "Accession area is locked by another user." Message will now include the name of the accession area that the software is waiting on lock. c. Interim report options and displays will display month portion of date/times using the three letter abbreviation instead of the two number designation to eliminate potential confusion with day portion of dates. Time is displayed using 24 hour time format. d. Interim report could display the wrong ordering and collecting site when the specimen was received from an integrated facility. Report will display the correct ordering and collecting site. e. Referral Patient Multi-purpose Accession option [LR LEDI] was prompting the user for CPRS Nature of Order which is not used during accessioning of non-PATIENT file (#2) patients. Routine LROW3 is modified to only prompt the user for CPRS Nature of Order when accessioning a patient from the PATIENT file (#2). f. Previous test versions of previous LEDI versions may have installed two versions of the "D" cross reference in LAB PENDING ORDERS ENTRY file (#69.6). The post-install will delete and reindex the "D" cross reference on file #69.6. g. Entering of accession number during lab results verification will check for invalid values or numbers out of range (1-999999). 17. Referral Patient Multi-purpose Accession option [LR LEDI] will check for pending orders when performing accessioning without a bar code scanner. It will display to the user and store order comments that accompanies electronic orders with order in LAB ORDER ENTRY file (#69). 18. When using the Enter/verify/modify data (manual) option [LRENTER] to amend previously released results user can now enter their verifying initials in mixed case. 19. NOIS CHS-0303-40534 reported a defect which prevented results for reflex tests added to a LEDI order at the host laboratory being returned electronically to the collecting laboratory. Routine LRWLST11 was storing the collecting site as both the collecting site and ordering site in the order created in LAB ORDER ENTRY file (#69). When a collecting site is a member of an integrated facility the collecting site is the site collecting the specimen and the ordering site is the primary facility of the integrated institution. Reflex test added by the host site would have the incorrect ordering site assigned which prevents the LEDI software from returning the results of the reflex test to the collecting facility. Defect has been corrected to store the correct ordering and collecting sites on LEDI accessions. 20. NOIS BRK-0499-10720, MAR-0603-21152 reported a defect during lab result verification using option Enter/verify/modify data (manual) [LRENTER] which caused the previous patient demographics to be displayed when entering results on an accession. If the previous selected accession was in an uncollected state, the option was skipping the uncollected accession and incrementing the default accession number to the next available accession. If the user selects this or another accession, the patient demographics of the selected accession were not being displayed. Instead, the patient demographics of the uncollected accession were displayed. Routine LRVER will now display the patient demographics of the currently selected accession. 21. NOIS SFC-1103-60132 reported a defect during display of lab results in the CPRS GUI. When a critical flag becomes part of the data for a patient in CPRS, the line of data containing the flag becomes split after the * following the high or low flag, and the units along with the reference range gets bumped to the next line down. Routine LR7OGMP increases the space allocated to display this information from 37 to 38 characters to display units/normals on same line. 22. When displaying results that are a Set of Codes data type, the result will be displayed using the external value for the set of codes. 23. NOIS NYH-0700-11942 reported a defect with critical value flag not being triggered when entering a value of 0. Value of 0 will be evaluated when performing high/low/critical value checks. 24. When verifying results from a reference laboratory using Enter/verify data (auto instrument) option [LRVR], any test results that have not been verified will be displayed to the user after verification. The display will list the test names, results, abnormal flags and units if available. This display will list the test(s) as not reviewed. This may indicate that additional or reflex testing has been added by the reference laboratory. These additional tests may need to be added to the accession to process these results. 25. During verification of laboratory results, comments for a previous result are displayed along with the previous result when entering results manually or by automated instrument for user selected tests (E3R #18490). Users can indicate which tests should have previous test comments displayed during verification by flagging the test using General Lab User Parameters option [LR USER PARAM] located on the Information-help menu [LRHELP]. 26. NOIS SDC-0904-61304 Reported a defect with the display of text results in CPRS when using the Laboratory Results-All Test By Date and Laboratory Results-Selected Tests By Date. When a text result was displayed that exceeded 10 characters and the test has no units or normals specified, the display of the result was corrupted with inserted into the text. Test results will be displayed without corruption. Units, reference ranges, and site codes will be displayed on the following line when test results print in area usually reserved for these parameters. 27. NOIS IND-0498-42538 reported a defect in display of test comments during lab test result verification when encountering an 'end-of-page' condition. All test comments will now be displayed. PATIENT SAFETY ISSUES RESOLVED IN THIS PATCH: ============================================ PSI-040260/NOIS HVH-0604-10572 - "Not Performed test Resulted - No Alert Generated" This patch corrects defects in software used to set laboratory tests to a Not-Performed (NP) state. The NP state was introduced by patch LR*5.2*221 in 1999. The functionality introduced by this patch replaced the "delete-a-test" functionality. Instead of deleting tests, tests are now set to a not-performed state. However, tests in the NP state could still be edited such that the NP state is replaced with an actual result. Results entered into NP tests were not treated in the same manner as results entered through the normal results entry pathways. File updates to ACCESSION file (#68), LAB ORDER ENTRY file (#69), and ORDER file (#100) as well as alerts were not generated. This situation was documented in NOIS HVH-0604-10572 - "Not Performed test Resulted - No Alert Generated". This was identified as a potential patient safety risk. With concurrence from the Pathology & Laboratory Medicine Program Office, the appropriate mechanism for handling the situation is to disable editing of NP tests. If the test is designated as NP and the user wants to edit the test result, they will now have to order the test(s) in a new accession. ASSOCIATED E3R -------------- E3R #13408, ADDING INFECTION WARNING TO PROCESS DATA OPTIONS E3R #16060, CORRECT ALIGNMENT PROBLEM E3R #17904, LEDI BETWEEN VA AND DOD SITES E3R #18490, COMMENTS DISPLAY FORPRVIOUS RESULTS ASSOCIATED NOIS --------------- ALB-0100-50284 BRK-0499-10720 BON-0196-71728 CHS-0303-40534 DAY-0303-40775 DEN-1299-52099 FAV-1103-70892 HVH-0604-10572 IND-0498-42538 MAR-0603-21152 NYH-0700-11942 PHI-0803-21507 SDC-0904-61304 SFC-1103-60132 TAM-0400-31033 WPB-0900-32221 TEST SITES ---------- Albuquerque VAMC - VMS/DSM and VMS/Cache Boston HCS - VMS/DSM and VMS/Cache El Paso HCS - NT/Cache and VMS/Cache Hines VAMC - VMS/DSM and VMS/Cache Honolulu VAMC - NT/Cache Manchester VAMC - NT/Cache NT and VMS/Cache Milwaukee VAMC - VMS/DSM North Chicago VAMC - VMS/DSM Salt Lake City VAMC - VMS/DSM San Diego VAMC - VMS/DSM and VMS/Cache Upstate New York HCS - VMS/DSM and VMS/Cache INSTALLATION FILES: ================== The following software and documentation files are exported as part of this patch: File Name Contents Retrieval Format --------- -------- ---------------- LAB_LEDI_III.KID LA*5.2*64 KIDS build ASCII LR*5.2*286 KIDS build LAB_LEDI_III_IG.PDF LABORATORY ELECTRONIC DATA BINARY INSTALLATION GUIDE LAB_LEDI_III_IMP_UG.PDF LABORATORY ELECTRONIC DATA BINARY IMPLEMENTATION AND USER GUIDE The files listed above may be obtained via FTP. 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: CIO 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] 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 ------------ ------------ ----------- ------------ LR286 N/A 5465218 **286** (Deleted by KIDS) LR7OB63 9973912 9132350 **121,187,286** LR7OGM 8016197 8279122 **187,220,312,286** LR7OGMC 5100174 5463477 **187,230,312,286** LR7OGMG 3593445 3973477 **187,230,286** LR7OGMP 5548341 6065382 **187,246,282,286** LR7OR2 9125008 8919494 **121,187,219,285,286** LR7OSUM1 12883059 12868699 **121,187,256,286** LR7OSUM6 7911216 5450631 **121,201,187,286** LRAFUNC 5202410 5809534 **286** LRDIDLE0 5463932 6544739 **140,171,153,286** LRDPAREF 5111405 7469302 **153,222,286** LRDPAREX 7190033 6456580 **153,286** LREVENT 3678954 2907416 **153,286** LRFAST 19691126 18799737 **100,121,201,286** LRFASTS 6423167 6524547 **30,95,121,271,286** LRGP1 3988622 4165501 **112,269,286** LROE 14550901 11534796 **100,121,201,221,263,286** LRORD 12009917 12806626 **100,121,153,286** LRORD1 9848796 9190513 **1,8,121,153,201,286** LRORDB 3782224 7231598 **153,222,286** LROW3 7497722 6459972 **33,121,286** LRRP 11838355 9427993 **195,221,283,286** LRRP1 8015031 6556852 **153,221,283,286** LRRPU N/A 3220194 **286** LRSTUF1 13209134 11668378 **153,286** LRVER 17228890 15441873 **153,286** LRVER1 8587449 7330679 **42,153,201,215,239,240, 263,232,286** LRVER3 14311842 13055299 **42,100,121,140,171,153, 221,286** LRVER4 19639169 14489554 **14,42,112,121,140,171, 153,188,279,283,286** LRVER5 14564045 14854455 **42,153,283,286** LRVERA 690805 5764794 **153,271,286** LRVR 13316120 11130012 **42,153,263,286** LRVR1 11269859 11667912 **42,153,221,286** LRVR3 10486080 11176919 **42,121,153,286** LRVR4 8885642 9645653 **14,42,121,153,221,263, 279,283,287,286** LRVR5 11950773 4666781 **1,42,153,263,283,286** LRWLST1 18457202 12664045 **48,65,121,153,261,286** LRWLST11 21393713 16883055 **121,128,153,202,286** List of preceding patches: 187, 202, 222, 230, 232, 256, 261, 269, 271 282, 283, 285, 287, 312 Sites should use CHECK^XTSUMBLD to verify checksums. INSTALLATION INSTRUCTIONS ========================= See LABORATORY ELECTRONIC DATA INTERCHANGE III (LEDI III) INSTALLATION GUIDE LA*5.2*64/LR*5.2*286 Routine Information: ==================== Routine Name: - LRDPAREF Routine Checksum: Routine Name: - LROE Routine Checksum: Routine Name: - LRRP Routine Checksum: Routine Name: - LRRPU Routine Checksum: Routine Name: - LRVER Routine Checksum: Routine Name: - LRVER3 Routine Checksum: Routine Name: - LRVER4 Routine Checksum: Routine Name: - LRVER5 Routine Checksum: Routine Name: - LRVERA Routine Checksum: Routine Name: - LRVR Routine Checksum: Routine Name: - LRVR1 Routine Checksum: Routine Name: - LRVR3 Routine Checksum: Routine Name: - LRVR4 Routine Checksum: Routine Name: - LRVR5 Routine Checksum: Routine Name: - LRWLST1 Routine Checksum: Routine Name: - LRWLST11 Routine Checksum: Routine Name: - LR286 Routine Checksum: Routine Name: - LRRP1 Routine Checksum: Routine Name: - LRDIDLE0 Routine Checksum: Routine Name: - LR7OSUM1 Routine Checksum: Routine Name: - LR7OSUM6 Routine Checksum: Routine Name: - LR7OGMC Routine Checksum: Routine Name: - LR7OGMG Routine Checksum: Routine Name: - LR7OR2 Routine Checksum: Routine Name: - LR7OB63 Routine Checksum: Routine Name: - LR7OGMP Routine Checksum: Routine Name: - LROGM Routine Checksum: Routine Name: - LRGP1 Routine Checksum: Routine Name: - LRSTUF1 Routine Checksum: Routine Name: - LRORD Routine Checksum: Routine Name: - LRORDB Routine Checksum: Routine Name: - LRVER1 Routine Checksum: Routine Name: - LRDPAREX Routine Checksum: Routine Name: - LRFAST Routine Checksum: Routine Name: - LRFASTS Routine Checksum: Routine Name: - LRORD1 Routine Checksum: Routine Name: - LREVENT Routine Checksum: Routine Name: - LRAFUNC Routine Checksum: Routine Name: - LROW3 Routine Checksum: ============================================================================= User Information: Entered By : STALLING,FRANK Date Entered : JUN 12, 2002 Completed By: ELIJAH,VICKEY Date Completed: NOV 19, 2004 Released By : LECLAIR,RAY Date Released : DEC 17, 2004 ============================================================================= Packman Mail Message: ===================== No routines included