============================================================================= Run Date: AUG 31, 2005 Designation: PSO*7*143 Package : PSO - OUTPATIENT PHARMACY Priority: Mandatory Version : 7 SEQ #188 Status: Released Compliance Date: OCT 01, 2005 ============================================================================= Associated patches: (v)PSO*7*119 <<= must be installed BEFORE `PSO*7*143' (v)PSO*7*132 <<= must be installed BEFORE `PSO*7*143' (v)PSO*7*133 <<= must be installed BEFORE `PSO*7*143' (v)PSO*7*157 <<= must be installed BEFORE `PSO*7*143' (v)PSO*7*181 <<= must be installed BEFORE `PSO*7*143' (v)PSO*7*185 <<= must be installed BEFORE `PSO*7*143' Subject: CLINICAL INDICATOR DATA CAPTURE (CIDC) - OUTPATIENT PHARMACY Category: - Enhancement (Mandatory) - Routine - Data Dictionary Description: ============ This patch is part of the Clinical Indicator Data Capture (CIDC) Master Build and should be installed in conjunction with Computerized Patient Record System (CPRS) Version 25. There are no NOIS messages or E3Rs associated with this patch. OVERVIEW ======== **************************** N O T E ***************************** Outpatient Pharmacy has no interface with CoreFLS and can be safely installed on all VistA accounts. ****************************************************************** ----------- N O T E ----------------- Note: If your site uses the Composite Health Care Systems (CHCS) External Interface which is an interface between a Department of Defense (DoD) CHCS system and VistA that is used to process prescriptions prescribed by Non-VA providers, it is suggested that you test the external order process before installing this patch in the live account. The order segments passed to and from CPRS have changed as noted below in the technical description section. While testing was performed, none of the test sites use this function. -------------------------------- This patch modifies Outpatient Pharmacy to collect and store required data elements not currently being collected for clinical indicator data capture (I.e., ICD-9 diagnosis code, Service Connected (SC) 0-100%, and Environmental Indicators (EI)). The application must capture all data elements to track clinical indicator determination. Functional Description ====================== ICD-9 Diagnosis Code Entry: During backdoor orders, a new diagnosis code prompt will ask for up to eight ICD-9 codes. The prompts will be displayed during the following functions: 1. After the drug is entered during a new order. 2. If the drug or orderable item is edited during a copy of a prescription. 3. If an orderable item or drug is edited. 4. If the Verification parameter in the OUTPATIENT SITE file (#59) is on, the new diagnosis prompt will also be displayed during verification should the user choose to edit the orderable item or drug during the verification process in the Patient Prescription Processing option [PSO LM BACKDOOR ORDERS]. These new ICD-9 diagnosis code prompts will only be asked when the person entering the prescription holds the PROVIDER key and when the IBB CIDC Insurance and Switch API (CIDC^IBBAPI) indicates to do so. The ICD-9 diagnosis prompts are not required entry. The prompt will allow the user to inquire into the ICD DIAGNOSIS file (#80) by typing a question mark at the prompt to find a desired diagnosis code, by typing a partial code, or by typing a partial name. Data entered into this field will be stored in the Outpatient Pharmacy package within the new ICD nodes defined in PRESCRIPTION file (#52) and PENDING OUTPATIENT ORDERS file (#52.41). In the existing circumstance where a CPRS alert is sent due to the nature of order being verbal or telephone, the user will be required to enter ICD-9 diagnosis codes during the CPRS sign order process. When prescriptions are copied, edited or renewed, the ICD-9 Diagnosis codes from the prescription that these functions are performed on will be carried forward as default answers. Service Connected and Environmental Indicators: All users will be prompted for SC 0-100% and EI's based on the veteran's information in the Enrollment package. The prompts for SC/EI will remain in it's current location and will remain as mandatory fields. The EI prompts will be asked regardless of the response to the SC question and without affecting copayment (copay) functionality. The prompts have been changed to the following format: Was treatment for a Service Connected condition? Was treatment related to Combat Vet? Was treatment related to Agent Orange exposure? Was treatment related to Ionizing Radiation exposure? Was treatment related to Environmental Contaminant exposure? Was treatment related to Military Sexual Trauma? Was treatment related to Head and/or Neck Cancer? For prescriptions that are copied or renewed, the SC/EI's from the prescription that these functions are performed on will be carried forward as default answers. When SC/EI's are modified using the Reset Copay Status/Cancel Charges [PSOCP RESET COPAY STATUS] option, the new ICD node will be modified to reflected the changes to these fields using this option. CPRS/Order Entry Results Reporting (OERR)/Outpatient Pharmacy Application Program Interface (API): Outpatient Pharmacy has been modified to tell OERR to ask all SC/EI's based on the veteran's enrollment. This change is evident in the sign order process within OERR in Vista. Data passed back and forth between Outpatient Pharmacy and CPRS has been modified to pass ICD-9 Diagnosis Codes, SC, and EI's in a new format. This processing occurs in the background. When prescriptions are signed in the CPRS Graphical User Interface (GUI), the ICD-9 codes are required entry before e-sig. Once the prescription is signed, a new transaction will be sent to Outpatient Pharmacy to update the DIAGNOSIS multiple (#52311) with the new ICD-9 Diagnosis Codes, SC and EI's. Also, if the copay status changes from copay to no copay as a result of edited SC/EI information and the prescription has been released, the copay charges are automatically cancelled in the background and are notated in the copay activity log as RX EDITED. No additional action to the current process is taken if the copay status is changed from no copay to copay. For transactions passed from CPRS to Outpatient Pharmacy, an activity log entry will be defined on the prescription after the update has been completed. This entry will be an EDIT showing the date and time that the prescription was updated from CPRS. The second entry below is an example of the comment that will be displayed: Activity Log: # Date Reason Rx Ref Initiator Of Activity ===================================================================== 1 05/18/04 X-INTERFACE ORIGINAL Comments: Label sent to external interface. 2 05/18/04 EDIT ORIGINAL Comments: Clinical Indicators were updated from a CPRS Edit at 10:55. Currently, CPRS only allows for four ICD-9 Diagnosis Codes, and Outpatient Pharmacy allows for up to eight. CPRS will import only the first four ICD-9 diagnosis codes. TECHNICAL DESCRIPTION ===================== ICD-9 Diagnosis Codes: The ICD-9 Diagnosis prompts will be asked when the user holds the PROVIDER key and the IBB API call indicates that the questions should be asked. The IBB API call (CIDC^IBBAPI) evaluates whether the CIDC switch is on/off and evaluates the patient's insurance to determine whether the diagnosis questions should be asked. It returns either 1 to ask the question or 0 to not ask the diagnosis questions. Storage of diagnosis codes will be in the ICD DIAGNOSIS sub-field (#.01) of the DIAGNOSIS multiple (#52311) of PRESCRIPTION file (#52) and in the DIAGNOSOS sub-field (#.01) of the new ICD DIAGNOSIS multiple (#311) of the PENDING OUTPATIENT ORDERS file (#52.41). The first node will always be the primary diagnosis code and all others secondary. Service Connected and Environmental Indicators: For SC<50%, data will continue to be stored on the IBQ node and copay functionality will remain as is. SC and EI's must be associated with ICD-9 diagnosis codes. This along with the necessity of not affecting copay processing, SC 0-100% and all EI's that apply will be stored with each ICD-9 diagnosis code entered in the new DIAGNOSIS multiple (#52311) of PRESCRIPTION file (#52) and in the new ICD DIAGNOSIS multiple (#311) in the PENDING OUTPATIENT ORDERS file (#52.41). Only when SC<50%, will SC/EI's be stored on the existing IBQ nodes in both of the files. If no ICD-9 diagnosis code is entered, one entry in the new ICD node will be stored and will contain any SC/EI information. On this single node, the ICD DIAGNOSIS sub-field (#.01) of the PRESCRIPTION file (#52) and the DIAGNOSIS sub-field (#.01) of the PENDING OUTPATIENT ORDERS file (#52.41) will be null, and there will be no cross-references defined for these multiples until an ICD-9 diagnosis code is entered. Copay functionality has not been changed in this patch. When the SC/EI flags are changed using the Reset Copay Status/Cancel Charges [PSOCP RESET COPAY STATUS] option, the ICD node in the prescription file will be updated to reflect those changed answers. No changes were made to the existing copay functionality. CPRS/Outpatient Pharmacy API: For CPRS orders, the ICD-9 diagnosis codes, Environmental Indicators, and Service Connection will continue to be passed into the PENDING OUTPATIENT ORDERS file (#52.41) and will be stored in the manner stated above. The API's between Outpatient Pharmacy and CPRS has been modified to use the new DG1 and ZCL Health Level 7 (HL7) segments. These segments replace the ZSC segment. The DG1 segment is used to send/receive ICD-9 diagnosis codes and the ZCL segment is used to send/receive SC and EI's as well as the linkage to the DG1 segment. There can be up to eight DG1 segments and there will be a set of ZCL segments for each DG1 segment. The following is an example of the new segments: Definition: DG1|Sequence#||ICD IEN^ICD Name^file#^ICD Code#^Name^ICD9||||||||||||| Where: DG1 = Identifies the segment as DG1 for diagnosis codes Sequence # = sequence of 1-8 order of ICD-9 codes ICD IEN = Internal entry number (IEN) from the file the ICD-9 code was retrieved ICD Name = Diagnosis name/description File# = File number that Diagnosis information came from ICD Code# = Code for the diagnosis Name = Diagnosis name/description ICD9 - literal Example: DG1|1||80^CLONORCHIASIS^80^121.1^CLONORCHIASIS^ICD9||||||||||||| There will be seven ZCL segments per DG1 segment, and piece one of both segments is the Set ID which links the set of ZCL segments to the DG1 segment. The Set Id in the ZCL segment will be the same as the Sequence# in the DG1 segment. Definition: ZCL|Set ID|Clinical Indicator Code (CIC)|Clinical Indicator Response Where: ZCL = identifies the segment as ZCL Set ID = linkage to the DG1 segment CIC = code that identifies SC/EI's Clinical Indicator Response - 1=yes, 0=no, or null=not asked/doesn't apply Example: ZCL|1|1|1 where CIC 1 = Agent Orange ZCL|1|2|0 where CIC 2 = Ionizing Radiation ZCL|1|3|1 where CIC 3 = Service Connected ZCL|1|4|0 where CIC 4 = Environmental Contaminants ZCL|1|5|0 where CIC 5 = Military Sexual Trauma ZCL|1|6|0 where CIC 6 = Head and/or Neck Cancer ZCL|1|7|0 where CIC 7 = Combat Veteran A new API (PSOHLNE3) between CPRS and Outpatient Pharmacy has been added to update the Prescription file (#52) when SC/EI/ICD's are edited during the e-sig process in the CPRS GUI. Any previously entered ICD/SC/EI data entered will be replaced with the new data. Also, if the copay status changes from copay to no copay as a result of edited SC/EI information and the prescription has been released, the copay charges are automatically cancelled in the background. All prescriptions with a copay change will always state RX EDITED in the copay activity log and will reflect the user name who made the change in the CPRS GUI. No additional action to the current process is taken if the copay status is changed from no copay to copay. This patch addresses the following New Service Request (NSR): ============================================================= There is no NSR associated with this patch. This patch addresses the following NOIS/Remedy Ticket(s): ========================================================= There are no NOIS/Remedy tickets associated with this patch. Associated E3Rs: ================ N/A TEST SITES: ========== LOMA LINDA, CA CLEVELAND, OH DAYTON, OH BOSTON, MA MEMPHIS, TN CHARLESTON, SC ROUTINE SUMMARY =============== The second line now reads as follows: ;;7.0;OUTPATIENT PHARMACY;**[patch list]**;DEC 1997 CHECK^XTSUMBLD results: Routine Before Patch After Patch Patch List ========================================================================== PSOBKDED 31015882 31060350 11,46,91,78,99,117,133,143 PSOCP 20178669 21661953 20,46,71,85,137,157,143 PSOCPA 13674694 15060347 9,71,85,137,143 PSOCPB 29777446 31027202 72,71,85,185,143 PSOCPC 25365048 25435754 10,9,71,85,114,157,143 PSODIAG N/A 21941710 143 PSOHLINC 5229499 5362858 111,143 PSOHLNE1 24431194 25813314 46,71,98,111,117,131,157,181,143 PSOHLNE3 N/A 20707004 143 PSOHLNEW 35562858 36071257 98,111,124,117,131,146,132,143 PSOHLSN1 32008887 32112613 55,46,71,101,99,121,139,157,181,143 PSOHLSN2 N/A 2427990 143 PSOHLSNC 17086440 18875016 111,157,143 PSOMLLD2 N/A 13355955 143 PSOMLLDT 33319253 35516592 71,157,143 PSON52 23311220 23955816 71,111,124,117,131,139,157,143 PSONEW1 6699671 6918067 46,104,117,143 PSONEW2 13009435 12525042 32,37,46,71,94,124,139,157,143 PSONEWF 12417539 23064279 71,157,143 PSONEWG 10932930 12548314 71,157,143 PSOORED6 21213128 21715596 78,104,117,133,143 PSOOREDT 26416171 28006347 27,37,57,46,78,102,104,119,143 PSOORNEW 33900028 33951326 32,55,46,71,90,94,106,131,133,143 PSOPTPST 14412045 14424813 7,71,88,146,157,143 PSORENW1 23659551 25063940 20,37,51,46,71,117,157,143 PSORN52 27909127 28512387 27,37,46,79,71,100,117,157,143 PSORN52D N/A 26941168 143 DATA DICTIONARY SUMMARY ======================= UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # NAME DD CODE W/FILE DATA PTS RIDE -------------------------------------------------------------------------- 52 PRESCRIPTION YES NO NO NO Partial DD: subDD: 52.052311 DATA SCREEN: 52.41 PENDING OUTPATIENT ORDERS YES NO NO NO Partial DD: subDD: 52.41311 DATA SCREEN: SOFTWARE AND DOCUMENTATION RETRIEVAL ==================================== The software for this patch is being distributed in host file PX_CLINICAL_INDICATOR_DATA_CAPTURE.KID. The host file will contain six KIDS builds. The builds contained in the CIDC multi-package distribution are: Package Patch ------- --------- PCE PATIENT CARE ENCOUNTER PX*1.0*124 INTEGRATED BILLING IB*2.0*260 RADIOLOGY/NUCLEAR MEDICINE RA*5.0*41 SURGERY SR*3.0*119 PROSTHETICS RMPR*3.0*78 OUTPATIENT PHARMACY PSO*7.0*143 Please refer to the 'Software and Documentation Retrieval' section of the PX*1.0*124 patch description for instructions on how to acquire the patch software and install instructions. 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 -------------- ------------- ------ ----------- PX_CLINICAL_INDICATOR_DATA_CAPTURE.KID KIDS ASCII PSO_7_P143_RN.PDF Release Notes PDF Binary PSO_7_P143_UM_CP.PDF User Manual Change Pages PDF Binary PSO_7_P143_TM_CP.PDF Technical Manual Change Pages PDF Binary Routine Information: ==================== Routine Name: - PSON52 Routine Checksum: Routine Name: - PSORN52 Routine Checksum: Routine Name: - PSONEW1 Routine Checksum: Routine Name: - PSONEW2 Routine Checksum: Routine Name: - PSONEWF Routine Checksum: Routine Name: - PSONEWG Routine Checksum: Routine Name: - PSOHLNEW Routine Checksum: Routine Name: - PSOHLSNC Routine Checksum: Routine Name: - PSOBKDED Routine Checksum: Routine Name: - PSOHLSN1 Routine Checksum: Routine Name: - PSOHLSN2 Routine Checksum: Routine Name: - PSOCP Routine Checksum: Routine Name: - PSOORED6 Routine Checksum: Routine Name: - PSOORNEW Routine Checksum: Routine Name: - PSOOREDT Routine Checksum: Routine Name: - PSOHLNE1 Routine Checksum: Routine Name: - PSOPTPST Routine Checksum: Routine Name: - PSORENW1 Routine Checksum: Routine Name: - PSOCPB Routine Checksum: Routine Name: - PSOMLLDT Routine Checksum: Routine Name: - PSORN52D Routine Checksum: Routine Name: - PSOHLINC Routine Checksum: Routine Name: - PSOHLNE3 Routine Checksum: Routine Name: - PSOMLLD2 Routine Checksum: Routine Name: - PSODIAG Routine Checksum: Routine Name: - PSOCPC Routine Checksum: Routine Name: - PSOCPA Routine Checksum: ============================================================================= User Information: Entered By : ELLZEY,LINDA Date Entered : MAY 29, 2003 Completed By: LYNCH,MARY F. Date Completed: AUG 30, 2005 Released By : CONSENTINO,ALBERT Date Released : AUG 31, 2005 ============================================================================= Packman Mail Message: ===================== No routines included