$TXT Created by MCCLENAHAN,MARGARET E E at DEVCUR.FO-SLC.MED.VA.GOV (KIDS) on Thursday, 03/06/03 at 15:11 ============================================================================= Run Date: MAY 28, 2003 Designation: TIU*1*144 Package : TIU - TEXT INTEGRATION UTILITIES Priority: Mandatory Version : 1 SEQ #145 Status: Released Compliance Date: JUN 28, 2003 ============================================================================= Associated patches: (v)TIU*1*131 <<= must be installed BEFORE `TIU*1*144' (v)TIU*1*142 <<= must be installed BEFORE `TIU*1*144' Subject: CONSULTS WITH MISMATCHED PATIENTS Category: - Routine - Other Description: ============ I. DESCRIPTION: ============ This patch aids sites in cleaning up old Consult documents with mismatched patients. After generating a list of mismatches, sites are asked to resolve the mismatches manually. So far as we know, no NEW mismatches are being generated, so this clean up task should not need to be redone once existing mismatches are dealt with. The patch provides an option which generates a list of Consult documents with mismatched patients. The new option replaces a similar option provided in patch TIU*1*131. In some cases, the new option lists documents which were missed by the old option. The new option also provides additional information on each mismatch. The new option, in contrast to the old, does NOT include documents which are Progress Notes and not Consults. When the option is run it sends a message with a summary of results to the local PATIENT SAFETY NOTIFICATIONS mailgroup. The list of mismatches includes any Consult document whose associated Consult Request is for a patient other than the patient of the document. After printing the list, sites should examine each document in the list and determine whether the document needs to be reassigned to a different patient, or re-linked to a different Consult Request. Sites should then proceed to reassign or re-link the document as appropriate. The patch also fixes several TIU VistA document management actions. NOIS: ===== CIN-0802-41924 PRO-0200-12597 UNY-0802-10960 TAM-1202-32252 BUT-1002-20036 II. TECHNICAL COMPONENTS: ===================== 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: ;;1.0;TEXT INTEGRATION UTILITIES;**[patch list]**;Jun 20, 1997 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== TIU144 N/A 16169202 144 TIUCNSLT 5971238 6031905 4,31,109,131,142,144 Routine TIU131 is deleted at the site, upon installation of this patch. TIU DOCUMENT MANAGEMENT ACTION FIXES: ===================================== 1. If a TIU Consult document had a Requesting Package Reference (field 1405) value beginning with -1 or 0, and if a user attempted to correct the problem using action "Link with Request", the action quit prematurely, failing to present the user with the list of Consult Requests to select from, or if the patient had no requests to select, failing to so inform the user. The action no longer quits prematurely. NOTE: Consult documents with a Requesting Package Reference value beginning with -1 or 0, do not involve patient mismatches, and have not been included in the mismatch list for this patch. They will be dealt with in a future TIU patch. Such documents probably involve patients who have no Consult Requests to select, and should therefore probably have their title changed to a Progress Note rather than being re-linked to a different result. The action is fixed in this patch since it involves a routine already included in this patch. This problem was discovered by the developer, there are no known NOIS for it. 2. If a user used List Manager action "Change Title" for a document, changed the title from a Progress Note title to a Consult title, and, after changing the title, up-arrowed out instead of selecting a Consult Request to link the document to, the title remained changed instead of the change being rolled back. The action now rolls back the title change. This problem is reported in NOIS TAM-1202-32252. 3. If a user used List Manager action "Link with Request" to re-link a Consult document to a different Consult Request, and if the document had addenda, the addenda were not updated to reflect the new request. So far as we know, this was not evident to the user in any VistA or CPRS GUI displays, but an inconsistency was created in the addendum entries in the TIU DOCUMENT file (#8925), where the request for the addendum failed to match the request for the original document. Addenda are now updated appropriately in VistA when an original document is re-linked to a different request. Even if the document is re-linked to the SAME request, the addenda are now updated with that request. This means that re-linking an original document to the same request now provides a way of correcting addenda which were previously not linked to the same request as the original. This problem was discovered by the developer, there are no known NOIS for it. OPTIONS: ======== Enhanced Mismatched Consults List [TIU144 ENHANCED MISMATCH LIST] This option replaces option "Consult Results with Mismatched Patients" [TIU131 LIST CONSULT MISMATCHES], which is deleted at the site upon installation of patch TIU*1*144. The option lists Consult documents which have mismatched patients. A document appears on the list if the patient for the REQUEST associated with the document does not match the patient for the DOCUMENT. This option should be run at all sites which have Consults in the TIU DOCUMENT file (#8925). It should be queued to run at a non-peak time since it will take some time. For an electronic copy of the list, sites can elect to print it to a spool device. NOTE: The report took 2 hours to run at a site with 9,600,000 documents in the TIU DOCUMENT file (#8925). Your time may vary; time to run actually depends on the number of CONSULT documents the site has in the TIU DOCUMENT file. The option must be run from the programmer prompt: >D ^XUP Setting up programmer environment Terminal Type set to: C-VT220 Select OPTION NAME: TIU144 ENHANCED MISMATCH LIST Enhanced Mismatched Consults List action Enhanced Mismatched Consults List Searching for mismatched Consults could take some time. Please remember to queue this option. DEVICE: HOME// QUEUE TO PRINT ON DEVICE: HOME// HP4$PRT - 80 Printer room Requested Start Time: NOW//T@11P (MAR 04, 2003@23:00:00) Request Queued! Here is an example of the list which is generated: ********************* Consult Documents with Mismatched Patients 1361 documents processed 10 mismatched documents found In listed mismatches, the patient for the request associated with the document does not match the patient for the document. See the description for patch TIU*1*144 in the National Patch Module for further explanation of this display and for instructions on how to correct listed entries. ========================================================================== Division: SALT LAKE CITY HCS ========================================================================== 1. Note Title: PULMONARY CS CONSULT #: 25413 Capt: O Pt: BABBITT,G F (B8829) Rf Date: 12/22/98 Cnslt To Serv: RHEUMATOLOGY Cnslt #: 15 Pt: NIVEK,A (N8796) Date: 03/04/92 . . . ================ 10 Mismatches Found. ================= ********************* When the option is run, a message is automatically sent to the person running the option, if their DUZ is defined, and to local mail group PATIENT SAFETY NOTIFICATIONS. Here is an example of that message: ********************* Subj: TIU*1*144 Mismatched TIU Consult Documents [#36589] 03/04/03@12:20 9 lines From: PATCH TIU*1*144 MISMATCHED CONSULTS SEARCH OPTION In 'IN' basket. Page 1 *New* -------------------------------------------------------------------------- TIU Consult Documents Linked to Different Patient's Request Search completed successfully on Mar 04, 2003@12:20:53 Number of TIU documents processed: 1361 Number of mismatched documents found: 10 These documents should be cleaned up manually, using TIU Document Management options. For more information, see patch TIU*1*144 in the National Patch Module on FORUM, or contact XXX [user who ran the option]. ********************* The site should examine each document on the list and manually correct it, if possible, using TIU VistA document management options. III. INSTALLATION INSTRUCTIONS: ========================== NOTE: This patch requires patch TIU*1*131 in order to ensure that all known problems causing patient mismatches in Consults have been fixed BEFORE sites attempt to clean up old mismatches. NOTE: Installing this patch deletes old option "Consult Results with Mismatched Patients", and its routine, TIU131, at the site where it is installed. Installation of this patch will take less than 2 minutes. Users need not be off the system when applying this patch. 1. Use the INSTALL/CHECK MESSAGE option on the Packman Menu, to load the KIDS Transport Distribution global. 2. From the Kernel Installation and Distribution System (KIDS) Menu, select the Installation menu. 3. From the installation menu, you may elect to use the following options (when prompted for INSTALL NAME, enter TIU*1.0*144): a. Backup a Transport Global b. Compare Transport Global to Current System c. Verify Checksums in Transport Global 4. Use the Install Package(s) option and select the package TIU*1.0*144. 5. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//', respond 'NO'. 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', respond 'NO'. 7. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', respond 'NO'. 8. When prompted 'Delay Install (Minutes): (0-60): 0//' respond '0'. IV. POST-INSTALLATION INSTRUCTIONS: =============================== 1. After installing the patch, sites should run option, "Enhanced Mismatched Consults List" [TIU144 ENHANCED MISMATCH LIST]. Sites should then proceed to correct listed mismatches. See below for further information on correcting mismatches. The patch should be queued to run at a non-peak time, since it will take some time to run. Don't delete the option; you will want to run it again later to confirm that all mismatches have been corrected. When the list comes up empty, indicating that no mismatches remain after cleanup, you may delete the option if you wish. V. RESOLVING MISMATCHES: ===================== Please begin this process by looking through the generated list of patient mismatches. If any entries contain the line, "Consult # XXXX is ALSO linked to this document on the Consults side", you will need to do some special cleanup. Please contact National Vista Support (NVS) for help before resolving those entries. See section VI. SPECIAL CLEANUP INSTRUCTIONS, at the end of the patch description. We recommend the following 6-step approach to resolving mismatches: 1. Read through this entire patch description. 2. Browse the entire list of mismatches. 3. If a title needs to be changed for a document that also needs re-linking, plan to change the title BEFORE re-linking. This is more efficient since the Change Title action itself brings up the re-link action. 4. Don't worry about cleaning up addenda on the first printout of the list. Clean up original documents first. 5. After resolving original documents, reprint the list and then deal with any remaining original documents and remaining addenda. In many cases, cleaning up the original (parent) will automatically resolve addenda. 6. When all mismatches have been resolved, reprint the list one last time. If all documents have indeed been resolved, this should generate a list with the message: "No Mismatches found." This will also serve to notify the Patient Safety Notifications Mailgroup that all mismatches have been resolved. The following comments describe documents expected to appear on the list and offer suggestions for dealing with them. These comments assume that the person correcting the mismatches is familiar with actions such as "Link with Request", "Reassign", and "Change Title". Test sites found it helpful to have several sessions running concurrently during cleanup. Although this document deals with most situations a site is likely to encounter, unforeseen situations may well arise. If sites experience difficulties or have questions on how to correct documents, they should request help from National VistA Support. Resolving Mismatches: ===================== Three Software Errors: ---------------------- Three separate software errors are known to have caused patient mismatches on Consult documents. Mismatches occurred under certain conditions: 1) through the upload process when the dictated/transcribed Consult Request number was incorrect. 2) during direct entry (VistA) when using Consult Tracking to complete Consult Requests. 3) when resulting consults from View Alerts. There may be other software problems, unknown to us, which also generated patient mismatches on Consults. The known problems have been corrected, and, so far as we know, no NEW mismatches are occurring. (Exception: if an addendum is made to a mismatched document, the mismatch is perpetuated in the addendum. This is not a software error, and must be dealt with by correcting the source of the problem, the mismatched original document.) The error which created mismatches when Consults were uploaded with incorrect Consult Request numbers was fixed in patch TIU*1*131, which was released on 7/25/02. Mismatches which occurred because of this error should be corrected by re-linking the document to the correct Consult Request. Such re-linking will remove them from the list of mismatches. Documents created via upload have Capture Method "U". See below for an example of re-linking a document to the correct request. The second software error occurred when a user completed a Consult in VistA, using Consult Tracking, and switched back and forth between Appointment Management and Consult Tracking options. A variable used to identify the patient to TIU was not cleaned up between options, and as a result, although the Consult was completed for the correct patient, the new TIU document was sometimes created for a different patient. Mismatches which occurred in this way should be corrected by reassigning the document to a different patient, the patient matching the associated request. Reassigning the document to the correct patient will remove the document from the list of mismatches. This error was fixed in patch OR*3*72, which was released on 2/25/00. (A work-around was suggested earlier, in 11/99, in NOIS calls.) Documents created in VistA (as opposed to being uploaded or created in the CPRS GUI) have Capture Method "D". See below for an example of reassigning a document to the correct patient. The third error occurred when a user resulted consults from View Alerts, and several Consults variables were not cleaned up. As in the second problem, above, the consult was completed for the correct patient, but the new TIU document was sometimes created for a different patient. This error was fixed in patch GMRC*3*4, which was released on 7/1/99. These documents probably have Capture Method "D", and should be corrected as above, by reassigning the document to a different patient, the patient matching the associated request. Deleting Documents: ------------------- A site may determine that certain documents should simply be deleted. If the "Delete" action is used to delete an UNSIGNED document, the document no longer exists and no longer appears on the list of mismatches. If a SIGNED document is deleted, the document is changed to status RETRACTED, and is hidden from view. Retracted documents do not appear on the list of mismatches. Changing the document to an "ERRONEOUS NOTE" title, or to a test patient does NOT remove the document from the list. Now that the "Delete" action maintains a hidden copy of the document, the "Delete" action should be used rather than moving the document to an "ERRONEOUS NOTE" title, or to a test patient. Addenda: -------- Addenda, as well as original notes, may appear on the mismatch list. If so, they appear as separate items, not under their parent document. We suggest ignoring these addenda until after all original documents have been corrected. Then reprint the mismatch list and deal with remaining addenda. Most addenda will have been corrected automatically when the parent was corrected, and will no longer appear on the list. Mismatched addenda were created when an addendum was made to a document with a mismatched patient: the addendum evidences the same mismatch as the original. There may be other circumstances as well which created mismatched addenda. If the site determines that an addendum still applies and should remain attached to the same, original document, then re-linking the parent will automatically also re-link the addendum, or reassigning the parent will automatically also reassign the addendum. Either action will remove both original and addendum from the mismatch list. As an alternative, if the addendum no longer applies, the site may choose to delete it. Deleting the addendum will remove it from the mismatch list. If a document which should be reassigned to a different patient has an UNSIGNED addendum which should be deleted, the addendum should be deleted before the document is reassigned. However, if a document which should be reassigned to a different patient has a COMPLETED addendum which should be deleted, it is best to reassign the document first, and then delete the unsigned addendum which is copied to the new patient. Deleting a completed addendum BEFORE reassigning a document will necessitate an additional deletion: if a document with a retracted addendum is reassigned, the retracted addendum is still copied to the new patient, and will need to be deleted again, for the new patient. If, on the other hand, the site determines that the addendum still applies, but should be moved to a different document, then the addendum should be reassigned, using action "Move", under action "Reassign". The "Move" action does not update the addendum's Consult Request, and it may be necessary to re-link the new parent document in order to update the request for the newly moved addendum. Changing Consults to Progress Notes: ------------------------------------ The site may decide that certain documents should be changed from Consults to Progress Notes. The "Change Title" action is available for such changes and SHOULD clean-up Consults links when a Consult is changed to a Progress Note. Unfortunately, the "Change Title" action FAILS TO REMOVE THE LINK in the TIU DOCUMENT FILE (#8925). This is a known TIU problem and will be fixed. (Action "Change Title" DOES remove the link in the REQUEST/CONSULTATION FILE (#123), as it should.) Until this is fixed, changing the title of a Consult to a Progress Note does not entirely clean up a patient mismatch. Changing the title to a Progress Note does, however, ensure that the erroneous link in the TIU DOCUMENT FILE is not invoked: TIU VistA screen action "Print" for the given document will not display Standard Form 513 for the wrong Consult Request on a different patient. Instead, screen action "Print" will print the document just like any other Progress Note. Since the list of mismatches contains only Consult documents, changing the title of a Consult to a Progress Note DOES remove the document from the mismatch list. TIU plans to provide an option to clean up Consult links in file 8925 on Progress Note documents at some point in the future. That option will then clean up these remaining elements of the mismatch. Other: ------ There may be documents on the list which do not fit any of these descriptions. In such cases, the site will need to use its judgment in deciding how to correct them; we cannot make a recommendation. Questions should be addressed to National VistA Support. Confirming Corrections: ----------------------- Sites should re-run option "Enhanced Mismatched Consults List" after making corrections, to confirm that mismatches have been corrected. Documents which have been corrected by re-linking, reassigning, deletion, or changing title to a Progress Note will no longer appear on the list. Sites should not delete option "Enhanced Mismatched Consults List", along with its routine TIU144, until all the documents on the list have been cleaned up, and the list contains no mismatches. Examples of Resolving Mismatches: ================================= In this section we take several documents from a simulated mismatch list and show how to correct the documents. NOTE: Capture Method is abbreviated as follows: 'D' for direct (i.e. VistA), 'C' for converted (from an older package), 'R' for remote procedure (i.e. CPRS GUI), 'O' for copy (TIU List Manager options have an action to copy a note to a different patient), 'U' for upload. Example 1: Linking a Document to a Different Consult Request: ============================================================= 5. Note Title: MEDICINE CS CONSULT #: 5138 Capt: U Pt: CONTFORT,A (C1432) Rf Date: 01/11/99 Cnslt To Serv: CARDIOLOGY Cnslt #: 1272 Pt: BUCHALTER,W (B8833) Date: 12/22/98 This is the fifth document in the mismatch list. It is a Consult document entitled MEDICINE CS CONSULT, with internal file number 5138, written on patient CONTFORT, with Reference Date 01/11/99. This document was created by the upload process (Capture Method is U.) It is linked in the TIU DOCUMENT FILE with Consult Request #1272. Consult Request #1272 is for patient BUCHALTER, with To Service CARDIOLOGY. The request is dated 12/22/98. The patient for the TIU document doesn't match the patient for the Consult Request, so the document needs correction. All corrections involving TIU documents must be done from the TIU side, using VistA actions intended for such corrections. Since this document was created via upload, it was probably dictated/transcribed with the wrong Consult Request number. The note pre-dates patch TIU*1*131 (released on 7/25/02), which smartened up the upload code to prevent patient mismatches, so the date of the note is consistent with this explanation. If this explanation is correct, the document should be re-linked to a different Consult Request. To make the correction, we use the TIU Manager Menu and locate the document: *********************** --- MIS Managers Menu --- 1 Individual Patient Document 2 Multiple Patient Documents 3 Print Document Menu ... 4 Search for Selected Documents 5 Statistical Reports ... Select Text Integration Utilities (MIS Manager) Option: Search for Selected Documents Select Status: UNVERIFIED// ALL undictated untranscribed unreleased unverified unsigned uncosigned completed amended purged deleted retracted Select CLINICAL DOCUMENTS Type(s): Progress Notes// Progress Notes Select SEARCH CATEGORIES: AUTHOR// Patient Select PATIENT: CONTFORT,ARNIE 3-1-34 239331432 MILITARY RETIREE Start Reference Date [Time]: T-7// 01/11/99 (JAN 11, 1999) Ending Reference Date [Time]: NOW// 01/11/99 (JAN 11, 1999) -------------------------------------------------------------------------- ALL Documents Dec 17, 2002@11:51:11 Page: 1 of 1 by PATIENT (CONTFORT,ARNIE) from 01/11/99 to 01/11/99 1 documents Patient Document Ref Date Status 1 CONTFORT,A (C1432) MEDICINE CS CONSULT 01/11/99 completed + Next Screen - Prev Screen ?? More Actions >>> Find Delete Document Browse On Chart Reassign Interdiscipl'ry Note Edit Link with Request Change View Verify/Unverify Send Back Print Amend Document Display... Quit Select Action: Quit// -------------------------------------------------------------------------- *********************** If we need additional information on this document, action "Browse" will display the document, action "Display"/"Detailed Display" will show document details, including the file number of the document, and action "Print" will display Standard Form 513 for Consult Request #1272. The same information is available under the Consults Tab for patient CONTFORT, Consult Request #1272, in the CPRS GUI. When we have gathered enough information on the document to be sure it is the document we are trying to correct from the mismatch list, and are convinced that it should be linked to a different Consult Request (rather than reassigned to a different patient), then we use action "Link with Request". This action lists Consult Requests for the patient of the document, CONTFORT: *********************** Select Action: Quit// Link with Request You must link this Result to a Consult Request... The following CONSULT REQUEST(S) are available: 1> Sep 18, 2001 C#1996 CAR pr 1 note 2> Dec 22, 1998 C#1273 MEDICINE a 0 notes CHOOSE 1-2 TO CONTINUE OR '^' TO QUIT: 2 1273 Refreshing the list... -------------------------------------------------------------------------- ALL Documents Dec 17, 2002@12:10:48 Page: 1 of 1 by PATIENT (CONTFORT,ARNIE) from 01/11/99 to 01/11/99 1 documents Patient Document Ref Date Status 1 CONTFORT,A (C1432) MEDICINE CS CONSUL 01/11/99 completed ** Item 1 reassigned. ** >>> Find Delete Document Browse On Chart Reassign Interdiscipl'ry Note Edit Link with Request Change View Verify/Unverify Send Back Print Amend Document Display... Quit Select Action: Quit// -------------------------------------------------------------------------- *********************** NOTE: If the appropriate request to link a document to has been discontinued or cancelled, that request will not appear among the choices, above. In such a case, the site may wish to use FileMan to edit the status of the request back to pending. This will ensure that the request appears on the list. For help, contact NVS. NOTE: In some cases, there may be no appropriate request at all to link a document to. In that case, the site may wish to change the title of the note to a Progress Notes title. See section "Changing Consults to Progress Notes," above. When the document has been re-linked, action "Print" will display Standard Form 513 for Consult Request #1273, enabling me to verify that the document has been linked to the new request. After refreshing patient data, the Consults Tab for patient CONTFORT in the CPRS GUI will also display the new information for Consult Request #1273. It is important to examine the old Consult Request #1272, as well, and to verify that it has been properly cleaned up on the Consults side. In this case, the Consults Tab for patient BUCHALTER in the CPRS GUI for Consult Request #1272 will show that TIU document 5138 has been dissociated from the request. Please also check the STATUS of the request; in some cases a request may be erroneously reactivated when a document is dissociated. In particular, if a note is linked to a Consult Request with status "Discontinued," and the note is re-linked to a different request, the Discontinued request may become "Active" when the note is dissociated. This may also happen for documents completed administratively. If this occurs, please discontinue (or complete) the request again. This should be done promptly after the re-linking so that the request does not remain erroneously active any longer than necessary. Example 2: Reassigning a Document to a Different Patient: ========================================================= 3. Note Title: PULMONARY CS CONSUL #: 25413 Capt: D Pt: BABBITT,T (B8832) Rf Date: 12/22/98 Cnslt To Serv: PULMONOLOGY Cnslt #: 1570 Pt: NIVEK,A (N8796) Date: 12/03/98 This is the third document in the mismatch list. It is a Consult document entitled PULMONARY CS CONSULT, with internal file number 25413, written on patient BABBITT, with Reference Date 12/22/98. This document was created in VistA (Capture Method is D for Direct). It is linked in the TIU DOCUMENT FILE with Consult Request #1570. Consult Request #1570 is for patient NIVEK, with To Service PULMONOLOGY. The request is dated 12/03/98. The patient for the TIU document doesn't match the patient for the Consult Request, so the document needs correction. All corrections involving TIU Consult documents must be done from the TIU side, using VistA actions intended for such corrections. Since this document was created directly in VistA, it may have been created for the wrong patient when a user completed a consult using Consult Tracking and switching back and forth between Appointment Management and Consult Tracking options. That error was fixed in patch OR*3*72 which was released on 2/25/00, so the date of the note is consistent with this explanation. Alternately, it may have been created for the wrong patient when a user completed a consult from View Alerts. These errors were fixed in patch OR*3*72 (released on 2/25/00), and in patch GMRC*3*4 (released on 7/1/99), so the date of the note is consistent with either explanation. In either case, the document should be reassigned to a different patient, the patient associated with Consult Request #1570. To make the correction, we use the TIU Manager Menu option, as above, and locate the document: *********************** Select Text Integration Utilities (MIS Manager) Option: Search for Selected Documents Select Status: UNVERIFIED// ALL undictated untranscribed unreleased unverified unsigned uncosigned completed amended purged deleted retracted Select CLINICAL DOCUMENTS Type(s): Progress Notes// Progress Notes Select SEARCH CATEGORIES: AUTHOR// Patient Select PATIENT: BABBITT,THEODORE 5-19-46 448668832 YES SC VETERAN Start Reference Date [Time]: T-7// 12/22/98 (DEC 22, 1998) Ending Reference Date [Time]: NOW// 12/22/98 (DEC 22, 1998) -------------------------------------------------------------------------- ALL Documents Dec 17, 2002@13:58:41 Page: 1 of 1 by PATIENT (BABBITT,THEODORE) from 12/22/98 to 12/22/98 2 documents Patient Document Ref Date Status 1 BABBITT,T (B8832) PATIENT EDUCATION 12/22/98 completed 2 BABBITT,T (B8832) PULMONARY CS CONSULT 12/22/98 completed + Next Screen - Prev Screen ?? More Actions >>> Find Delete Document Browse On Chart Reassign Interdiscipl'ry Note Edit Link with Request Change View Verify/Unverify Send Back Print Amend Document Display... Quit Select Action: Quit// -------------------------------------------------------------------------- *********************** Document number 2, above, appears to be the document from the mismatch list. If we need additional information on this document, action "Browse" will display the document, action "Display"/"Detailed Display" will show document details, including the file number of the document, and action "Print" will display Standard Form 513 for Consult Request # 1570. The same information is available under the Consults Tab for patient BABBITT, Consult Request # 1570, in the CPRS GUI. When we have gathered enough information on the document to be sure it is the document we are trying to correct from the mismatch list, and are convinced that it should be reassigned to a different patient (rather than linked to a different Consult Request), then we use action "Reassign": *********************** Select Action: Quit// Reassign=2 Reassign Processing Item #2... Opening PULMONARY CS CONSULT record for review... -------------------------------------------------------------------------- Reassign Document Dec 17, 2002@14:07:59 Page: 1 of 1 PULMONARY CS CONSULT BABBITT,T *********** CARDIOLOGY Visit Date: 12/22/1998 09:15 DATE OF NOTE: DEC 22, 1998@09:15 ENTRY DATE: DEC 23, 1998@10:16:32 AUTHOR: SNOW,CHARLES R EXP COSIGNER: URGENCY: STATUS: COMPLETED Pt is doing fine, he will heal well. /es/ CHARLES R. SNOW MD Signed: 12/22/1998 09:17 + Next Screen - Prev Screen ?? More actions Find Reassign Print Quit Select Action: Reassign// -------------------------------------------------------------------------- *********************** The document is displayed, and we again select action "Reassign": *********************** Select Action: Reassign// Reassign Are you sure you want to REASSIGN this PULMONARY CS CONSULT? NO// YES The status of this document is: COMPLETED Enter your Current Signature Code: SIGNATURE VERIFIED Please choose the correct PATIENT and CARE EPISODE: Select PATIENT NAME: NIVEK,ALPHA 12-4-49 234438796 SC VETERAN Moving signed document to another Patient...A RETRACTED copy will be retained. Removing RETRACTED PULMONARY CS CONSULT from original Visit... Enter/Edit PROGRESS NOTE... Patient Location: 1A(1&2) Date/time of Admission: 09/07/02 12:42 Date/time of Note: 12/22/98 09:15 Author of Note: MCCLENAHAN,MARGARET E ...OK? YES// NO Correct VISIT? YES// NO Is this note for INPATIENT or OUTPATIENT care? OUTPATIENT// The following SCHEDULED VISITS are available: 1> SEP 13, 2000@13:00 INPATIENT APPOINTMENT 1 CARY'S CLINIC 2> SEP 01, 2000@11:30 INPATIENT/CHECKED IN 1 CARY'S CLINIC 3> SEP 01, 2000@11:00 CANCELLED BY PATIENT 1 CARY'S CLINIC 4> SEP 01, 2000@10:45 CANCELLED BY PATIENT 1 CARY'S CLINIC 5> DEC 21, 1998@10:30 INPATIENT/CHECKED OUT PULMONARY CLINIC CHOOSE 1-5, or NSCHEDULED VISITS, UTURE VISITS, or EW VISIT TO CONTINUE OR '^' TO QUIT: 5 DEC 21, 1998@10:30 Enter/Edit PROGRESS NOTE... Patient Location: PULMONARY CLINIC Date/time of Visit: 12/21/98 10:30 Date/time of Note: 12/22/98 09:15 Author of Note: SNOW,CHARLES R ...OK? YES// AUTHOR/DICTATOR: SNOW,CHARLES R // You must link this Result to a Consult Request... The following CONSULT REQUEST(S) are available: 1> Oct 03, 2001 C#2024 CAR ATRIAL LEA p 0 notes 2> Dec 03,1998 C#1570 PUL MONOLOGY p 0 notes CHOOSE 1-2 TO CONTINUE OR '^' TO QUIT: 2 1570 PULMONARY CS CONSULT Reassigned. You may now clean up the encounter data for the ORIGINAL Visit... BABBITT,T *********** CARDIOLOGY Visit Date: 12/21/1998 10:30 Patient: BABBITT,T Visit: DEC 21, 1998 to CARDIOLOGY Do you wish to do this now? NO// <==== Sites must use their own judgment here. See below. *********************** If the Consult document contains clinical data, and the encounter data for Babbit's original Cardiology visit contains data obviously intended for Nivek's Pulmonology visit, it should be cleaned up, if possible. If, on the other hand, the Consult Result does not contain clinical data but concerns appointment management only, then it is not appropriate to clean up the encounter data for the original visit. Here again, questions may be addressed to National VistA Support. *********************** Rebuilding the list... -------------------------------------------------------------------------- ALL Documents Dec 17, 2002@13:58:41 Page: 1 of 1 by PATIENT (BABBITT,THEODORE) from 12/22/98 to 12/22/98 2 documents Patient Document Ref Date Status 1 BABBITT,T (B8832) PATIENT EDUCATION 12/22/98 completed ** Item reassigned, no longer in list. ** >>> Find Delete Document Browse On Chart Reassign Interdiscipl'ry Note Edit Link with Request Change View Verify/Unverify Send Back Print Amend Document Display... Quit Select Action: Quit// -------------------------------------------------------------------------- *********************** Example 3: Mismatched Addenda: ============================== An addendum entry in the mismatch list might look like: 8. Note Title: Addendum #: 25517 Capt: D Pt: BABBITT,T (B8832) Rf Date: 12/24/98 Cnslt To Serv: PULMONOLOGY Cnslt #: 1570 Pt: NIVEK,A (N8796) Date: 12/03/98 Parent Title: PULMONARY CS CONSULT #: 25413 Rf Date: 12/22/98 This is an addendum to the note from Example 2. See section Addenda, under section Resolving Mismatches, above. If the site determines that the addendum still applies and should remain attached to the same, original document, then re-linking the parent will automatically also re-link the addendum, or reassigning the parent will automatically also reassign the addendum. For this reason, we suggest ignoring addenda until after all original documents have been corrected. VI. SPECIAL CLEANUP INSTRUCTIONS: ============================= Some sites have attempted to correct patient mismatches using Fileman instead of using TIU document management options. This has sometimes resulted in documents being linked on the Consults side to the correct request, while remaining linked on the TIU side to an incorrect request, and possibly remaining linked on the Consults side to an incorrect request AS WELL AS to the correct request. If TIU document management options are used to correct such documents, the Last Action on the Consult Request the document is re-linked to may incorrectly indicate that an addendum was added to the document when in fact the last action was a complete/update action or some other action: Status: COMPLETE Last Action: ADDENDUM ADDED TO (This is not a software error; it results from the inconsistency created when Consult links were changed, using FileMan, but TIU links were NOT changed.) This incorrect Last Action is undesirable. Entries on the mismatch list which may generate this undesirable Last Action when re-linked are marked in the mismatch list by the presence of an additional line of the form, "Consult # XXXX is ALSO linked to this document on the Consults side." If your mismatch list includes entries containing such a line, please contact NVS for help in correcting them. Routine Information: ==================== Routine Name: - TIU144 Routine Checksum: Routine Name: - TIUCNSLT Routine Checksum: ============================================================================= User Information: Entered By : MCCLENAHAN,MARGARET Date Entered : AUG 27, 2002 Completed By: CONDIE,KENNY Date Completed: MAY 27, 2003 Released By : KREUZ,SHERI B Date Released : MAY 28, 2003 ============================================================================= Packman Mail Message: ===================== $END TXT