============================================================================= Run Date: JAN 23, 2007 Designation: OR*3*270 Package : OR - ORDER ENTRY/RESULTS REPORTING Priority: EMERGENCY Version : 3 SEQ #240 Status: Released Compliance Date: FEB 06, 2007 ============================================================================= Associated patches: (v)OR*3*258 <<= must be installed BEFORE `OR*3*270' Subject: CPRS GUI - PSI-06-145 CCOW Fixes Category: - PATCH FOR A PATCH - Routine - Other Description: ============ Test Sites ============== Dayton Heartland West (Kansas City/ Columbia, MO/Eastern Kansas Topeka/Leavenworth)/Wichita) Miami Northern California Health Care (NCHC) San Diego ************************************************************************** *** This patch addresses one patient safety issue and must be *** *** installed by the compliance date, which is 14 days from release *** *** date. It may be installed with users on the system. *** ************************************************************************** Patch OR*3.0*270, CPRS GUI version 26.69, resolves one patient safety issue, related to CCOW patient context. PATIENT SAFETY ISSUES RESOLVED BY THIS PATCH: ============================================= PSI-06-145 - HD 162746, 163113, 166913 - Information on patient name button does not match demographics and other information in chart. PROBLEM: Under certain circumstances, it is possible to arrive at a situation where the patient named on the patient button (upper left of toolbar) is a different patient from the data shown in the rest of CPRS. This is not made clear to the user in any way, and has been recognized in the field only by vigilant users noticing that the data shown was not for the selected patient. This could very easily lead to orders being unintentionally placed for the wrong patient. SCENARIO #1: A CCOW-enabled application is also running on the desktop alongside CPRS (BCMA, Vitals, CCR, second linked copy of CPRS, etc), and the user is processing alerts in CPRS. The other application in the background is unable to process a patient change caused by selection of a particular alert without certain consequences (items will be left unsigned, current process will be left incomplete, etc). Standard CCOW behavior is to alert the user to the inability of that application to change patients, and to provide 3 choices to the user. The user can choose "OK", and continue with the patient change in both applications, despite the known consequences. The user can choose "Cancel", and leave both applications in the existing patient, with no change occurring. Or the user can choose "Break link". The correct behavior in that case would be to leave the CCOW context, change to the newly selected patient, show a broken link, and not affect the background application, which remains linked in context with the existing patient. Currently, in v26.68 and all earlier released versions, clicking "Break link" is malfunctioning, but only while processing alerts with another application linked to context in the background. While it appears that CPRS has indeed changed to the newly selected patient, only the information on the patient name button has actually been changed. All other information in the chart remains that of the previously selected patient. "Break link" is already functioning correctly on a patient change initiated by "File/Select patient", or by the "Select new patient" button on the patient demographics screen. SCENARIOS #2 and #3: If a CCOW connectivity error occurs between the Vergence Locator on the desktop and the CCOW vault, when and only when the patient selection screen is visible, CPRS v26.68 does not respond correctly to this error condition after the usual CCOW error message is displayed to the user. - SCENARIO #2: If this is the first patient being selected on startup and such an error occurs, the patient name button will fail to display the selected patient's information, remaining in a "no patient selected" state, despite the population of all other chart information for that patient. - SCENARIO #3: If an error occurs at this point while selection of a second or subsequent patient is in progress, the patient name button will still contain the information for the previous patient. All other chart information will be that of the newly selected patient. - RELATED MENU DEFECT: When any CCOW connectivity error results in the error message to the user advising that CCOW will be unavailable for the remainder of the session, the "File/Break link" and "File/Rejoin" menus should remain disabled as advertised. In v26.68, selection of each new patient following this error would inadvertently reenable these menus, even though CCOW may not be available. Clicking on either of these menu items in that situation would very likely only cause further CCOW error messages to display, and could lead to other unpredictable behavior. RESOLUTION: SCENARIO #1: The alert processing code in CPRS has been corrected to respond as it should to any user choice on the "Problem changing clinical context" screen. SCENARIOS #2 and #3: CPRS error processing code has been corrected to reflect the correct patient after one of these patient selection errors occurs. RELATED MENU DEFECT: These menus are no longer reenabled on every patient change, if a prior CCOW error condition for the session is still in effect. KNOWN CCOW ISSUE: Although unrelated to the issues corrected here, and common to all VistA CCOW-enabled applications, users should also be aware of the following behavior, recently discovered in internal testing. If a user uses CTRL-ALT-DEL to open Windows Task Manager, and then uses the "End Task" button to terminate a participating CCOW application, the information in the CCOW vault is NOT cleared when that application terminates. A timeout setting in the vault itself determines how long this information remains active, but a typical value is 20 to 40 minutes. Starting a subsequent application following such a shutdown can result in that application utilizing both the existing user and patient contexts if present, and linking automatically to those items on startup. There is no possible correction to VistA GUI applications to address this Sentillion vault behavior. One possible action would be to reboot the workstation, which will establish a new connection with the vault. REQUIRED BUILDS: ================ OR*3.0*258 The KIDS portion of the installation will simply update the version number of the OR CPRS GUI CHART option to be 1.0.26.69. The .ZIP file contains an updated CPRS executable. NOTE: Internet Explorer 4.0 (IE4) or later is REQUIRED in order for GUI version 26.69 to run. However IE 5.5 or later with 128-bit encryption is required for PKI functionality. 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: ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[patch list]**;Dec 17, 1997 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== ORY270 N/A 903607 270 INSTALLATION FILES: ================== The following software files are exported as part of this patch: File Name Contents Retrieval Format --------- -------- ---------------- OR_30_270.ZIP File(s) indented below BINARY - CPRSChart.exe CPRS Executable - OR_30_270RN.pdf Release Notes (Adobe Acrobat version) - OR_30_270RN.doc Release Notes (Word version) OR_30_270_SRC.ZIP CPRSChart Source BINARY OR_30_270.KID KIDS build ASCII 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: 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] INSTALLATION REQUIREMENTS/NOTES: ================================ -- Required Patches: OR*3.0*258 -- Installation Compliance Date: OR*3.0*270 must be installed within 14 days of its national release date. -- Internet Explorer: NOTE: Internet Explorer 4.0 (IE4) or later is REQUIRED in order for GUI version 26.69 to run. However IE 5.5 or later with 128-bit encryption is required for PKI functionality. -- Build components: The KIDS portion of the installation will simply update the version number of the OR CPRS GUI CHART option to be 1.0.26.69 with routine ORY270. The .ZIP file contains an updated CPRS executable. INSTALLATION INSTRUCTIONS: ========================== Users should not be on the system during installation of this patch. This patch should be installed during non-peak hours to minimize disruption. Installation should take approximately 1 minute. 1. Read the above section "INSTALLATION REQUIREMENTS/NOTES" and take appropriate actions. 2. Obtain the file OR_30_270.KID. 3. From the Kernel Installation and Distribution System (KIDS) Menu, select the Installation menu. 4. Use Load a Distribution using OR_30_270.KID when prompted to Enter a Host File name. You may need to prepend a directory name. 5. From this menu, you may then elect to use the following options (when prompted for the INSTALL NAME, enter OR*3.0*270): a. Backup a Transport Global b. Compare Transport Global to Current System c. Verify Checksums in Transport Global 6. When ready, select the Install Packages option (when prompted for the INSTALL NAME, enter OR*3.0*270). 7. When prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? Yes//", respond "YES." 8. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', respond "YES." 9. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond YES. When prompted to select the options you would like to place out of order, enter the following: OR OE/RR MENU CLINICIAN CPRS Clinician Menu OR OE/RR MENU NURSE CPRS Nurse Menu OR OE/RR MENU WARD CLERK CPRS Ward Clerk Menu OR CPRS GUI CHART 10. When prompted 'Delay Install (Minutes): (0-60): 0//; respond '0.' 11. Move the routines to other CPUs if appropriate. 12. Following successful installation, the post-install routine ORY270 may be deleted. 13. Retrieve and open the file OR_30_270.ZIP. 14. Note the file date/time inside the ZIP for CPRSChart.EXE. Move this file to the appropriate directory where it can be accessed by all CPRS workstations. After moving the files, compare the file date/time of the extracted copy to that contained in the ZIP. They should be the same. Some ZIP extraction utilities may produce extracted files with the current date/time. If this is the case, the CPRSUpdate application may not function correctly. 15. In National Center for Patient Safety (NCPS) Alert #AL07-03 (http://vaww.ncps.med.va.gov/Guidelines/alerts/Docs/CPRSCCOWAL07-03.pdf), sites were previously instructed to edit the BCMA desktop shortcut parameters on all applicable workstations to disable CCOW. A follow-up informational BCMA patch, PSB*3*34, will provide instructions for enabling CCOW and notification of the patch s availability will be posted to the NCPS Patient Safety Log: http://vaww.ncps.med.va.gov/Dialogue/pslog/default.asp Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: ORY270 Before: n/a After: B1830696 **270** ============================================================================= User Information: Entered By : VERTIGAN,RICHARD E Date Entered : NOV 16, 2006 Completed By: OLINGER,BRIAN Date Completed: JAN 17, 2007 Released By : SCHMIT,BECKY Date Released : JAN 23, 2007 ============================================================================= Packman Mail Message: ===================== No routines included