============================================================================= Run Date: MAY 10, 2005 Designation: RA*5*45 Package : RA - RADIOLOGY/NUCLEAR MEDICINE Priority: Mandatory Version : 5 SEQ #49 Status: Released Compliance Date: JUN 10, 2005 ============================================================================= Associated patches: (v)RA*5*51 <<= must be installed BEFORE `RA*5*45' Subject: Contrast studies in Radiology - Orderable Items inconsistency Category: - Input Template - Routine - Data Dictionary - Print Template - Enhancement (Mandatory) Description: ============ Patch RA*5*45 is one of two patches that work together; in order of install, they are: OR*3*211 RA*5*45 These two patches will be released as a multi-build named: 'RA_OR_45_CONTRAST_MEDIA.KID'. The functional changes included in OR*3*211 can be viewed by executing the 'Display a Patch' option for that patch. Description of RA*5*45 ====================== This patch answers a registered Patient Safety Issue [PSI-03-047] by addressing two contrast media related issues and a Rad/Nuc Med request print/display issue [HEH-1103-40959 (Heartland-East HCS)]. The first is the problem of a parent procedure's descendent procedures not being checked for contrast media during ordering. Also, a parent procedure is not flagged as having contrast media in the ORDERABLE ITEMS file (#101.43) when one or more of its descendent procedures have contrast media. This can lead to complications when treating patients. Please note that during order entry, an Allergy-Contrast Media order check will only occur if: 1. The imaging procedure uses contrast and 2. The patient has one of the following active allergies from the VA Drug Class (#50.605) file: IONIC CONTRAST MEDIA RADIOLOGICAL/CONTRAST MEDIA The second is the use of AMIS codes in determining whether contrast media is associated with the procedure. This is no longer an acceptable way to associate contrast media to a procedure, because an AMIS code may include procedures with and without contrast media. The association of contrast media with procedure is more accurately made with CPT codes. As a result of tying CPT code to contrast media, the [RA PROCEDURE] option does not allow editing of the CPT code for existing procedures. This new feature prevents patient treatment misrepresentation that can be caused by changing the definition of the procedure. The request issue deals with how the pregnancy status of the female patient is displayed to the user. Since a substantial amount of time may pass from the time the order is placed to the time the order is registered, if the patient wasn't pregnant at the time of the order, instead of not displaying a pregnancy status, the "Patient not pregnant at time of order" will be displayed. Prior to installing the combined build, contrast media definitions were associated with AMIS codes. The value of the AMIS code for the radiology nuclear medicine procedure indicated the contrast media used. AMIS CODES is a multiple (#71.03) field in the RAD/NUC MED PROCEDURES (#71) file. The following types of contrast media existed prior to RA_OR_45_CONTRAST_MEDIA.KID: 'B' for 'Barium' 'C' for 'Cholecystogram' 'M' for 'unspecified contrast media' After the installation of RA_OR_45_CONTRAST_MEDIA.KID, a CONTRAST MEDIA multiple field will be added to the following files: RAD/NUC MED PATIENT (#70) file (sub-file: 70.3225) and the RAD/NUC MED PROCEDURES (#71) file (sub-file: 71.0125). The following contrast media types will replace the three above: 'I' for 'Ionic Iodinated' 'N' for 'Non-ionic Iodinated' 'L' for 'Gadolinium' 'C' for 'Cholecystographic' 'G' for 'Gastrografin' 'B' for 'Barium' 'M' for 'unspecified contrast media' (backwards compatibility) After the patch is installed, a post-init will check every Rad/Nuc Med orderable item (OI) in CPRS' ORDERABLE ITEMS (#101.43) file for contrast media (CM) definitions. If an OI has a CM definition, then the post-init will designate the associated Rad/Nuc Med procedure in the RAD/NUC MED PROCEDURES (#71) as having the same CM definition. The user will be informed, via email, which Rad/Nuc Med procedures have been updated either successfully or unsuccessfully. A second post-init will then run which will initiate a whole-file update between the RAD/NUC MED PROCEDURES and the ORDERABLE ITEMS files. This second post-init ensures: a) That all OI non-parent procedures are defined exactly as Rad/Nuc non-parent procedures. b) That Rad/Nuc Med parent procedures having descendents with CM associations update the parent orderable item by indicating the parent has CM associations. Note: The OI file does not recognize parent/descendent relationships; that is why OI parents are allowed a contrast media associations. The user will be informed, via email, which Rad/Nuc Med procedures have been updated either successfully or unsuccessfully. After the patch is installed and the post-inits complete, procedures associated with contrast media when ordered or registered for patients who had contrast media allergic reactions in the past will display the contrast media causing the allergic reaction to the user. Options Changed =============== Procedure related: ------------------ * Active Procedure List (Long) [RA PROCLONG] * Active Procedure List (Short) [RA PROCSHORT] * Alpha Listing of Active Procedures [RA ALPHALIST] * Inactive Procedure List (Long) [RA INACPRCLONG] * List of Inactive Procedures (Short) [RA INACPRCSHORT] * Parent Procedure List [RA PROCPARENT] * Series of Procedures List [RA PROCSERIES] * List of Procedures with Contrast [RA PROCMEDIA] * Display Rad/NM Procedure Contrast Media History [RA CMAUDIT HISTORY] * Procedure Enter/Edit [RA PROCEDURE] * Rad/Nuc Med Procedure Information Look-Up [RA DISPLAY IMAGPROCINFO] * Procedure File Listings [RA PROCLISTS] Request related: ---------------- * Detailed Request Display [RA ORDERDISPLAY] * Print Rad/Nuc Med Requests by Date [RA ORDERPRINTS] * Print Selected Requests by Patient [RA ORDERPRINTPAT] Exam related: ------------- * Exam Profile (selected sort) [RA PROFSORT] * Profile of Rad/Nuc Med Exams [RA PROFQUICK] * Case No. Exam Edit [RA EDITCN] * Edit Exam by Patient [RA EDITPT] * Status Tracking of Exams [RA STATRACK] * View Exam by Case No. [RA VIEWCN] * Exam Deletion [RA DELETEXAM] Report related: --------------- * Display a Rad/Nuc Med Report [RA RPTDISP] * Draft Report (Reprint) [RA REPRINT] * On-line Verifying of Reports [RA RPTONLINEVERIFY] * Report Entry/Edit [RA RPTENTRY] * Resident On-line Pre-Verification [RA RESIDENT PRE-VERIFY] * Select Report to Print by Patient [RA RPTPAT] * Unverify a Report for Amendment [RA UNVERIFY] * Access Uncorrected Reports [RA UNCORRECTED REPORTS] Options created for this patch: ------------------------------- * List of Procedures with Contrast [RA PROCMEDIA] * Display Rad/NM Procedure Contrast Media History [RA CMAUDIT HISTORY] Data Dictionary =============== File RAD/NUC MED PATIENT (#70) sub dictionary: 70.03, field: BARIUM USED? (#5) **deleted by post-init** sub dictionary: 70.03, field: CONTRAST MEDIA USED (#10) sub dictionary: 70.03, field: CONTRAST MEDIA ACTIVITY LOG (#250m) sub dictionary: 70.16, field: DATE/TIME EDITED (#.01) PRIOR CONTRAST MEDIA VALUE (#2) USER WHO EDITED CONTRAST (#3) sub data dictionary: CONTRAST MEDIA (#225m) sub dictionary: 70.3225, field: CONTRAST MEDIA (#.01) File RAD/NUC MED PROCEDURES (#71) sub dictionary: 71, field: CONTRAST MEDIA USED (#20) sub dictionary: 71, field: CONTRAST MEDIA (#125m) sub dictionary: 71.0125, field: CONTRAST MEDIA (#.01) sub dictionary: 71, field: AMIS CODE (#175m) sub dictionary: 71.03, field: AMIS CODE (#.01) Description only sub dictionary: 71, field: CONTRAST MEDIA ACTIVITY LOG (#250m) sub dictionary: 71.06, field: DATE/TIME EDITED (#.01) PRIOR CONTRAST MEDIA VALUE (#2) USER WHO EDITED CONTRAST (#3) File MAJOR RAD/NUC MED AMIS CODES (#71.1) sub dictionary: 71.1, field: MAJOR AMIS CODE (#.001) Description only sub dictionary: 71.1, field: DESCRIPTION (#.01) "DEL" node Print Templates =============== RA ALPHA LIST OF ACTIVES (#71) RA PARENT PROCEDURE LIST (#71) RA PROCEDURE LIST (#71) RA PROCEDURE SHORT LIST (#71) Input Templates =============== RA EXAM EDIT (#70) RA PROCEDURE EDIT (#71) RA STATUS CHANGE (#70) Related Site/Remedy/NOIS references =================================== Richmond Remedy # HD0000000067478 NOIS: RIC-0502-20827 Northern California Remedy # HD0000000067724 NOIS: MAC-0903-61801 Heartland-East HCS Remedy # None NOIS: HEH-1103-40959 Mountain Home VAMC Remedy # HD0000000068440 NOIS: None Documentation and Host File Retrieval: ====================================== This patch is available via ftp in a KIDS distribution. The host file is named RA_OR_45_CONTRAST_MEDIA.KID and is located in the [ANONYMOUS.SOFTWARE] directory of the following OI Field Offices: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov The documentation and software distribution includes: File Name Description ========= =========== RA_OR_45_CONTRAST_MEDIA.KID Host file containing KIDS software distribution ra5-0ag.pdf The ADPAC Guide in .pdf format ra5-0tm.pdf The Technical Manual in .pdf format ra5-0um.pdf The User Manual in .pdf format Once released, documentation may also be retrieved from VISTA Documentation Library (VDL) on the Internet at the following address, http://www.va.gov/vdl Test Sites ========== Northern California (Martinez), CA White River Junction, VT VA Health Care Upstate New York (Buffalo) The second line of the routine now looks like: ;5.0;Radiology/Nuclear Medicine;**[patch number]**;Mar 16, 1998 CHECK^XTSUMBLD results Name Before Patch After Patch Patch List ---------------------------------------------------------------- RA45PST N/A 3865185 45 RA45PST1 N/A 6858003 45 RA45PST2 N/A 9056793 45 RACMHIS N/A 7690691 45 RADEM1 8939570 10680172 45 RAEDCN 28242867 24022873 5,13,10,18,28,31,34,45 RAEDCN1 2948642 7924594 18,45 RAEDPT 6004419 6424730 10,18,28,45 RAMAIN2 11467456 13024121 45 RAMAINP1 3356556 9396499 3,45 RAMAINU N/A 6604102 45 RAMAINU1 N/A 4267425 45 RAO7MFN 10033679 9909094 1,6,10,18,45 RAO7PC1 4988201 4988201 1,16,18,26,36,45 RAO7PC1A 13362260 13401859 1,10,26,31,36,45 RAO7PC2 12546577 13303812 1,11,14,16,22,27,45 RAO7PC4 12829193 13713291 28,32,31,45 RAO7UTL 4993295 6235271 18,45 RAORD1 19192472 19206033 10,45 RAORD2 15522254 16592047 5,10,51,45 RAORD3 13362556 14044719 5,15,21,27,45 RAORD5 13837177 14010598 8,10,15,31,45 RAORD6 20456866 16690655 5,10,15,18,27,45 RAORD61 N/A 5157089 45 RAPINFO 6544230 8150810 10,45 RAPROD 16571532 17091996 10,35,45 RAPROD1 18529710 18723570 15,18,45 RAPROD2 4015870 6030670 45 RART3 9260244 9929650 8,10,18,27,35,45 RARTE 12455147 13233809 18,34,45 RARTR3 7227526 8374182 8,10,19,27,35,45 RASTED 20445380 21073275 1,10,18,28,45 RAUTL2 12821191 16596455 10,26,45 RAUTL21 3596173 5107529 26,45 RAUTL8 9923944 11287595 45 Installation Instructions: ========================== The install time for this patch may be more than 5 minutes because Menu Trees are rebuilt during the installation. Please check with your IRM supervisor regarding rebuilding Menu Trees. The installation of this patch should be coordinated with the Radiology ADPAC due to menu structure changes and the added capability of associating contrast media to Rad/Nuc Med procedures. This patch should be installed when there are no Rad/Nuc Med users on the system. NOTE: MailMan and Kernel patches must be current on the target system to avoid problems loading and installing this patch. 1. Review your mapped set. If the routines are mapped, they should be removed from the mapped set at this time. 2. From the Kernel Installation & Distribution System menu, select the Installation menu. a. From this menu, select the option Load a Distribution. When prompted for a file name, type in the directory where you have stored the host file, followed by the file name. 3. From this menu, you may select to use the following options (when prompted for INSTALL NAME, enter RA_OR_CONTRAST MEDIA 1.0) a. Backup a Transport Global - this option will create a backup message of any routines exported with the patch. b. Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. c. Verify Checksums in Transport Global - this option will ensure the integrity of the routines that are in the transport global. 4. Use the 'Install Package(s)' option under the 'Installation' menu. When prompted for INSTALL NAME, enter: RA_OR_CONTRAST MEDIA 1.0 When prompted "Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//, respond YES. When prompted "Want KIDS to INHIBIT LOGONs during the install? YES//", respond NO. When prompted "Want to DISABLE Scheduled Options and Menu Options? YES//", respond YES. When prompted "Enter options you wish to mark as 'Out of Order':", enter the following to disable all Rad/Nuc Med options: RA* When prompted "Enter protocols you wish to mark as 'Out of Order':", enter the following to disable all Rad/Nuc Med protocols: RA* 5. Verify that the patch installation completed correctly by using the KIDS 'Utilities...' [XPD UTILITY] option 'Install File Print' [XPD PRINT INSTALL FILE] and selecting this patch (RA*5.0*45). 6. On a mapped system, rebuild your map set. 7. After the post-installation has completed successfully, the following two actions should be taken: 1. Delete following routines used in the 'RA_OR_CONTRAST MEDIA 1.0' multi-build patch installation process. These routines are in the ORY211* namespace: ORY2110 ORY21101 ORY21102 ORY21103 ORY21104 ORY21105 ORY21106 ORY21107 ORY21108 ORY2111 ORY2112 ORY2113 ORY2114 ORY211ES 2. It is REQUIRED that the Radiology service ADPAC run the menu option: 'Active Procedure List (Short)' [RA PROCSHORT] This option will list, by imaging type, all active procedures and the current contrast media associations for detailed procedures. The Radiology ADPAC must thoroughly review this list and make appropriate corrections/additions of contrast media associations to any detailed procedure that uses contrast using the 'Procedure Entry/Edit' [RA PROCEDURE] menu option. Parent procedures will automatically inherit contrast media associations from their descendent procedures. **IMPORTANT NOTE** Not performing this step could result in absent or unexpected CPRS Order checks at the time of physician order entry which could lead to patient complications when contrast procedures are performed. Routine Information: ==================== Routine Name: - RA45PST Routine Checksum: Routine Name: - RA45PST1 Routine Checksum: Routine Name: - RA45PST2 Routine Checksum: Routine Name: - RACMHIS Routine Checksum: Routine Name: - RADEM1 Routine Checksum: Routine Name: - RAEDCN Routine Checksum: Routine Name: - RAEDCN1 Routine Checksum: Routine Name: - RAEDPT Routine Checksum: Routine Name: - RAMAIN2 Routine Checksum: Routine Name: - RAMAINP1 Routine Checksum: Routine Name: - RAMAINU Routine Checksum: Routine Name: - RAMAINU1 Routine Checksum: Routine Name: - RAO7MFN Routine Checksum: Routine Name: - RAO7PC1 Routine Checksum: Routine Name: - RAO7PC1A Routine Checksum: Routine Name: - RAO7PC2 Routine Checksum: Routine Name: - RAO7PC4 Routine Checksum: Routine Name: - RAO7UTL Routine Checksum: Routine Name: - RAORD1 Routine Checksum: Routine Name: - RAORD2 Routine Checksum: Routine Name: - RAORD3 Routine Checksum: Routine Name: - RAORD5 Routine Checksum: Routine Name: - RAORD6 Routine Checksum: Routine Name: - RAORD61 Routine Checksum: Routine Name: - RAPINFO Routine Checksum: Routine Name: - RAPROD Routine Checksum: Routine Name: - RAPROD1 Routine Checksum: Routine Name: - RAPROD2 Routine Checksum: Routine Name: - RART3 Routine Checksum: Routine Name: - RARTE Routine Checksum: Routine Name: - RARTR3 Routine Checksum: Routine Name: - RASTED Routine Checksum: Routine Name: - RAUTL2 Routine Checksum: Routine Name: - RAUTL21 Routine Checksum: Routine Name: - RAUTL8 Routine Checksum: ============================================================================= User Information: Entered By : CEBELINSKI,GREGORY Date Entered : SEP 26, 2003 Completed By: PATRICK,PAT Date Completed: MAY 10, 2005 Released By : HINES,RICK Date Released : MAY 10, 2005 ============================================================================= Packman Mail Message: ===================== No routines included