# Presentation: 678614

## Welcome to VEHU 2007

- Class #135
- The CPRS Version Bunny

## VeHU Class 135

- This “energized” CIS-sponsored class will cover the CPRS current release and planned development for future release(s), including blood product ordering.

## Questions

- Please hold all questions until the end, and use the 3x5 question cards provided.
- All questions and answers will be posted on the VeHU web page for this session.

## VeHU Class 135

- Disclaimer – The readers digest version
- V27 web sites
**V27 Web Site**
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html
- Project notebook
- http://tspr.vista.med.va.gov/warboard/anotebk.asp?proj=1114&Type=Active
- Version 28  (web page not yet available)

**Notes:**
Disclaimer:  This class will be the readers digest version of information for version 27 and beyond.
The class is 90 minutes long and we cannot tell everyone about everything.
But we can direct you to resources that you can investigate on your own that will help understand what is happening in the development of CPRS.

A vast amount of information is published on the two websites you see here.  

[next slide]

## Slide 5

**Notes:**
In addition to what you see here, there is:
CPRS Update scripts.
a listing of Installation Instructions, Test Item Spreadsheet, and Test Scripts
A spreadsheet of Remedy tickets to be resolved
Training information 
Test site contacts
Current issues
Other presentations 

## VeHU Class 135

- Disclaimer – The readers digest version
- V27 web sites
**V27 Web Site**
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html
- Project notebook
- http://tspr.vista.med.va.gov/warboard/anotebk.asp?proj=1114&Type=Active
- Version 28  (web page not yet available)

**Notes:**
Next is the project notebook site.  [next slide]

## Slide 7

**Notes:**
This site differs in that it’s orientation is from the project perspective not the application. It contains information required for the project in a single place and resource.

This site contains:
A listing of the development team.
Project Background Information & Documentation 
Linked New Service Requests
Test site listings
Project status and updates in a table format
Also a table on Narrative updates

[next slide]

## VeHU Class 135

- Disclaimer – The readers digest version
- V27 web sites
**V27 Web Site**
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html
- Project notebook
- http://tspr.vista.med.va.gov/warboard/anotebk.asp?proj=1114&Type=Active
- Version 28  (web page not yet available)

**Notes:**
Next is the project notebook site.  [next slide]

## Presenters	

- Mike Belschwinder - EPS – Clin. 2
- Rich Vertigan - CPRS GUI Developer
- Jamie Crumley – Pharmacy Developer
- Tom Saunders – EPS - Clin. 2

**Notes:**
Me:
Med tech by education.
Started at the VA in August 1980 ... BD  (before DHCP).
Became the second lab ADPAC in the Albany VAMC in late 80’s.  
Was hired at the Troy ISC in June of 1992.
Am the only charter member of Clin2. team.

Rich has been a CPRS GUI developer since 1997, and is a frequent presenter at VeHU.  During that time, he has worked on a wide variety of CPRS functionality, both new and corrective.  Prior to CPRS, Rich's federal career included mail delivery, a DoD internship in military transportation, training and support for the original IBM-PC, a supervisory position in an IBM mainframe keypunch and scheduling shop, a stint as an information security officer, and a programmer position with VHA's Mental Health Informatics office.  Rich is located at the Albany OI Field Office.

Jamie:
She is a valued EDS partner who works out of Plano Texas.  She has 26 years experience in the health-care IT industry. 7+ years spent working in development of VistA Inpatient Medications.

Tom
Has been with the VA since 1978 where he was hired at Mile City VAMC. 
His primary background is Lab, and was involved with Miles City computer install in 1985.  Tom was basically a jack of all trades in Mile City.  He joined the Clin2 team in 1995 as one of our earliest hires. 

Claudette
Began working as a Medical Technologist for the Togus VAMC in 1980, 
served as blood bank/hematology supervisor
Later became LIM and also served as a National Laboratory Practicum Site Instructor. 
In 1994 she moved to the Lab  Program Office as a developer and support the Blood Bank/Anatomic Pathology modules of the Laboratory package. 
Later on this position became part of SD&D and her duties were focused on the blood bank modernization project. She joined the Clin2 team in September, 2003.

Intro Tom and Claudette here

## VBECS & CPRS

- VistA Blood Establishment Computer Software
- Tom Saunders
- Claudette Murch (consultant)
- Clin2 – Enterprise Product Support

## Blood Bank Orders for VBECS

- Blood Bank Orders will be electronic through CPRS
- VBECS order dialog was part of CPRS version 26 but should not be utilized until v27
- Won’t be activated until OR*3*212
- Part of the VBECS bundle
- Changes to Dialog can only happen in CPRS v27
- Additional text order for administration instructions needs to be built by Clinical Application Coordinator
- Orders need to be accessioned in Lab Package in order to be available in the VBECS package

## Blood Bank Orders for VBECS

- The VBECS Order Dialog must be placed by the CAC appropriately in the sites Order menus
- VBEC BLOOD BANK
-  DESCRIPTION:   This dialog creates an order for blood components to be made available by the VBECS system, as well as any supporting diagnostic tests
- 6 components
- 5 diagnostic tests
- There is a new Display Type that is added with VBECS/CPRS
- Blood Products
- Diagnostic Tests

**Notes:**
This new VBEC BLOOD BANK order dialog is an important aspect.  This is the only way to create quick orders, “can not” use the file 60 to create Blood Bank tests

## Blood Bank Orders for VBECS

- The VBECS Order Dialog that is released is a unique structure
- During use, it has direct communication with the VBECS Package
- HL7 & Vista Link
- The Dialog has 3 parts to it
- Patient information tab – displays Blood Bank information
- Orders tab – ordering dialogs
- Lab results tab – displays lab results defined in the parameters

## VBECS Blood Bank Order Dialog

**Notes:**
A copy of the VBEC BLOOD BANK order dialog in its collective state, 3 tabs

## VBECS Blood Bank Order Dialog

- Patient information tab of VBEC Order Dialog

## VBECS Blood Bank Order Dialog

- Blood Bank Orders (Tab)

**Notes:**
This is broken 3 section, Blood Components, Diagnostic Tests and the Personal Quick Orders

## VBECS Blood Bank Order DialogBlood Bank Orders (tab)

- Two sides
- Components
- Diagnostic tests

**Notes:**
This is a capture of the Blood Component and Diagnostic Test Order form, which is the Blood Bank Orders Tab of the VBECS order dialog.  The capture shows a dotted line down the middle of the dialog showing that there are 2 sections of the ordering process, the Blood Components and the Diagnostic Test

## Blood Bank Orders for VBECS

- Diagnostic tests and components are added to the Selected Components and Test box separately.
- Certain components cannot be ordered alone if there isn’t an available specimen.
- Accomplished by communications between CPRS order dialog and VBECS system

**Notes:**
I like to think of the Selected Components and Test Box as the Blood Bank Shopping Cart, similar to the shopping carts that you fill on-line

## Blood Bank Orders (tab)Blood Components

**Notes:**
VBECS order dialog is component centric – that is, physicians will be able to focus on what blood products they actually want.  VBECS will indicate if the provider needs to a TAS

These 6 components are what are listed in the VBEC BLOOD BANK order dialog, and it how a CAC will create quick orders for components

## Blood Bank Orders (tab)Blood Components

- Based on the component that is being ordered and the configurations that have been setup in VBECS
- The 3rd tab may be active/available with laboratory data
- The user will be alerted to this by the change on the tab it self
- The provider can review that tab to review the laboratory results without leaving the order dialog process

## Blood Bank Orders (tab)Diagnostic Tests

**Notes:**
This is a capture of the VBECS order dialog, with the Lab Results Available Tab highlighted.  It is showing the laboratory results that are indicated based on the components that are being ordered

## Blood Bank Orders (tab)Blood Components

**Notes:**
This is a capture of the VBECS order dialog, with the Blood Bank Orders Tab highlighted and the listing of the Modifiers  that are available for selection for the component order

## Blood Bank Orders (tab)Blood Components

**Notes:**
This is a capture of the VBECS order dialog, with the Blood Bank Orders Tab highlighted, showing the rest of the component order section and the ADD button on the bottom right portion of the order dialog, which adds the component to the order or the start of a "shopping cart" 

## Blood Bank Orders (tab)Blood Components

**Notes:**
Because there is a connection between Vista and VBECS, when a component that is ordered that requires a specimen, it will communicate back to order dialog that the particular component needs a specimen for testing.

This is a capture of the Blood Component and Diagnostic Test Order Form, of the Blood Bank Order tab of the VBECS order tab.  This is indicating that after the component Red Blood Cells have been ordered that there is communication between CPRS and VBECS, letting the provider know that a Type & Screen must be added to the order.   If a specimen had been on file in the VBECS system and was still with-in the time limits this message would not have been displayed.

## Blood Bank Orders (tab)Diagnostic Tests

## Blood Bank Orders (tab)Diagnostic Tests

**Notes:**
This is a capture of the VBECS order dialog, with the Blood Bank Orders Tab highlighted and the section highlighting the Diagnostic Tests, and the other information needed for that section of the order.  Collection date/time, Collection Type , and the Urgency.  It the patient has any surgery scheduled, it will allow the order to associated to that surgery to check the MSBOS.

The Add button is also highlighted for adding the diagnostic tests to the order

## Blood Bank Orders (tab)Components & Diagnostic Tests	

**Notes:**
This is a capture of the VBECS order dialog, with the Blood Bank Orders Tab show the compiled order of the component and diagnostic tests.  The Accept Order button is also highlighted, which when selected will put the order on the orders tab.

## Text Order Requirement

**Notes:**
It is planned that this automatic display will be a parameter that can be turned off if the site has added in the administration order as part of either the quick order, order set

## The VBECS order dialog can used to create
Order Sets
Quick Orders
Personal Quick Orders

- Order Sets
- Quick Orders
- Personal Quick Orders

- Blood Bank Orders

## Blood Bank Orders

- VBECS Quick Orders
- TYPE OF QUICK ORDER
- BLOOD PRODUCTS
- Component or Test
- Choose from Blood Components:
-    CRYOPRECIPITATE
-    FRESH FROZEN PLASMA
-    OTHER
-    PLATELETS
-    RED BLOOD CELLS
-    WHOLE BLOOD
- or Diagnostic Tests:
-    ABO/RH
-    ANTIBODY SCREEN
-    DIRECT ANTIGLOBULIN TEST
-    TRANSFUSION REACTION WORKUP
-    TYPE & SCREEN

## Add Order Menu example

## VBECS and Personal Quick Orders

**Notes:**
This is a capture of the Blood Component and Diagnostic Test Order Form.  The Blood Bank Orders tab has been selected.  There is a box that is highlighting the Personal Quick Orders drop down box.

This will only be populated after a practitioner has created their own personal quick order 

## VBECS and Personal Quick Orders

- VBECS Personal Quick orders
- Must have the component or Diagnostic test fields entered
- Must be added to the “Selected Component and Test” window of the VBECS order dialog
- Using CPRS Options Pull-down menu
- Save as Quick Order

## VBECS and Personal Quick Orders

- Adding Blood Bank Personal Quick Order

## VBECS and Personal Quick Orders

- As Personal Quick Orders get created they will be added to the drop down box

**Notes:**
This is a capture of the Blood Component and Diagnostic Test Order Form.   The Personal Quick Orders drop down box is highlighted showing the 4 personal quick orders that have been created.

## Order gets signed
No SF518
Specimen gets collected by lab 
In the laboratory package
Specimen get accepted into VBECS system

- No SF518
- Specimen gets collected by lab
- In the laboratory package
- Specimen get accepted into VBECS system

- Blood Bank Orders

## CPRS v27Project Initiatives

- Rich Vertigan
- CPRS Developer, Albany OIFO

## CPRS v27

- Patch OR*3*243 currently being tested
- Targeted for Dec 2007 release
- CPRS v27 Web page:
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html

## CPRSUpdate

- OR*3*252 – first release since OR*3*10
- Corrects “Range Check” error
- Corrects miscellaneous directory path formatting issues
- Distributes updated BORLNDMM.DLL
- Formal documentation provided as part of updated CPRS Installation Guide

## Delphi 2006

- CPRS v27 updated and compiled with Delphi 2006, vs. Delphi 6
- More compatible with Windows XP – should eliminate most  “hidden window” problems
- Local use of V27 source code now requires Delphi 2006 – not compatible with Delphi 6
- New BORLNDMM.DLL is required for CPRS v27 to run at all
- Provided both in OR*3*252 and OR*3*243

## Health Data Repository 

- Address RDV Incompatibility Issues with HDR
- Not displaying all SIG 1 fields for Clinical Reports/Orders/Current Orders on the Reports Tab from Vista.
- embedded HL7 delimiters in SIG causing truncation
- Allergy NKA status stored in HDR-HX continues to display after NKA is deleted by GMRA user
- Standardize Display of Pulse Oximetry Information for CPRS Cover Sheet, RDV and VistAWeb
- O2 sat (%); amount (Liters for NC, % O2 for mask and vent); delivery system, flow rate/concentration

## Patient Demographic Updates

- 2nd Next of Kin (NOK)
- as additional emergency contact information
- Patient cell phone number
- to facilitate more timely appointment rescheduling

## Radiology

- Add "Reason for Study" field for Radiology Orders.
- PACS messaging and Voice Recognition interface needs 'Reason for Study’ split out from ‘Clinical History’.
- ‘Clinical History’ currently a catch-all
- unlimited text including both clinical history and reason for study.
- Project:  "Radiology Voice Recognition Interface."
- Dependent upon Radiology patch RA*5.0*75
- Health Summary patch GMTS*2.7*84 will address one additional report issue

## Mental Health GUI

- Mental Health Assistant 3.0
- converts national MH tests to new GUI tool and file structure
- allows users to create own MH tests
- Impacted Clinical Reminder evaluation logic and several national reminders
- CPRS v27
- includes changes to support modified Reminder Definitions and Reminder Dialogs

## 508 Compliance

- Visually impaired users met with CPRS developers in Salt Lake City in February 2007
- one-on-one usability testing
- problem areas identified
- numerous recommendations included in CPRS v27

## 508 Compliance

- *Encounter Form
- *Order Menus
- Resizing Retention
- Display Consistency after Font Changes
- Clinical Reminder Keyboarding Navigation
- *Must-do work in OR*3*243 (CPRS GUI v27) based on response to 508 complainant

## 508 Compliance

- Possible solution created for all Vist*A* GUI applications to enable use of JAWS and Window Eyes screen readers
- Installation of several additional files will be required for user workstations requiring support for these tools

## Miscellaneous Fixes

- Remedy tickets
- 67 as of mid-July 2007
- v26 ~ 200
- Better v26 SQA = fewer site-reported problems?
- Patient Safety Issues (PSI)
- 35 as of mid-July 2007
- v26 ~ 36

## Deferred ClearQuest Tickets

- Adverse Reaction Tracking
- Clinical Reminders
- Encounters
- Non-VA Meds
- Notes
- Orders

- Parameters
- Patient Record Flags
- Templates
- Vitals
- Other
- 1154 total as of mid-July, including deferred and new (v26 ~ 1000)

**Notes:**
During the testing of CPRS GUI v26, several ClearQuest tickets were deferred for resolution in v27.  The nature of testing/reporting will result in more ClearQuest tickets that must be resolved in v27.  V26 resolved approximately 1000 ClearQuest tickets and 200 Remedy tickets.  The list above reflects the current ClearQuest tickets, but does not represent the final number of tickets that will be addressed by v27.

## CPRS v27 Project Initiatives

- Pharmacy – Jamie Crumley

## FDA Regulatory Changes

- Disallow Clozapine order processing, without override, if:
- 3500/mm3>WBC>3000/mm3
- 2000/mm3>ANC>1500mm3
- Requires twice-weekly monitoring until WBC stabilizes above 3500/mm3 and ANC above 2000/mm3 with no signs of infection.

## FDA Regulatory Changes (cont.)

- For a long-term patient with consistent lab results, prescriptions can be written for up to a month
- 7 days with 3 refills
- 14 days with 1 refill
- 28 days with no refills

## Mental Health

- Mental Health Package patch YS*5.01*90
- provides API to CPRS and Outpatient Pharmacy
- NCCC has authorized the medication
- Ok to dispense (lab results timing and values are within limits)
- Indicator of whether prescription can be written for weekly, bi-weekly, or monthly
- Returns all WBC and Neutrophil (ANC) results in a date range

**Notes:**
NCCC – Department of Veterans Affairs National Clozapine Coordinating Center

## Mental Health (cont.)

- Weekly roll-up to NCCC
- Sent to local G.PSOCLOZ mail group
- Shows date of most recent WBC and Neutrophil Count
- Shows date of most recent prescription
- API provides override reason, if applicable
- Laboratory ADPAC should be assigned to the Link Multiple Tests to Clozapine [CLOZAPINE MULTI TEST LINK] option

## CPRS

- Patch OR*3*243 will utilize the new Mental Health API to determine
- Whether Clozapine can be ordered
- How many weeks can be ordered

## CPRS (cont.)

## Outpatient Pharmacy

- Outpatient Pharmacy patch PSO*7*222
- New field to store ANC results
- New prompt for override – based on returns from Mental Health API

## Inpatient Medications

- At this time Clozapine is not prescribed in Inpatient Medications.
- Dosage not transmitted to NCCC
- If needed for an inpatient, it is ordered from Outpatient Pharmacy.

## Project 112/Shad

- New environmental indicator
- Outpatient Pharmacy modifications
- CPRS modifications
- CMOP modifications

## What is it?

- Required by **VHA Directive 2004-016 **“Provision of Health Care Services to Veterans involved in Project 112/Shipboard Hazard and Defense (SHAD) Testing”.
- A new classification used in Copay and 3rd Party billing determinations

## How does it work?

- Depending on the patient’s eligibility in enrollment, the Project 112/SHAD environmental indicator prompt will be displayed for a required yes or no answer.
- Used to determine billing status for the prescription fill at finish and release.  Same type of evaluation made for the other environmental indicators.

## CPRS

- Add a checkbox to the Visit Type tab
- New API for CPRS to determine if new checkbox should be active
- Add checkbox to encounters, orders and problems

## Review/Sign Changes

## Problem Form

## Encounter Form

## Outpatient Pharmacy

- PSO*7*225 adds new prompt when applicable for:
- New Order
- Complete orders from OERR
- Renew
- Copying existing orders
- Editing an order that creates a new order
- Reset Copay Status/Cancel Charges

## Other features

- During label print:  If a prescription is deemed copay exempt, “NO COPAY” will be printed on the label.
- If the SHAD indicator question applies and is unanswered at release of the fill, a “PRESCRIPTION QUESTIONS REVIEW NEEDED” MailMan message is generated.

## Example MailMan Message

**Below shows the top portion of the Mailman message:**
- Subj: PRESCRIPTION QUESTIONS REVIEW NEEDED (500)  [#96941] 03/22/06@16:41
- 34 lines
- From: OUTPATIENT PHARMACY PACKAGE  In 'IN' basket.   Page 1
- -------------------------------------------------------------------------------
- PSOPATIENT,FOUR (XXXX)    ALBANY
- Eligibility: NSC     SC%:
- Disabilities:
- Rx# 100004663 (0)    COPAY
- LANSOPRAZOLE 15MG SA CAP
- Due to a change in criteria, additional information listed below is needed
- to determine the final VA copay and/or insurance billable status for this Rx
- so that appropriate action can be taken by pharmacy personnel.
**Is this Rx related to treatment of PROJ 112/SHAD?**
- This message has been sent to the provider of record, the pharmacist who
- finished the prescription order, and all holders of the PSO COPAY key.
- Enter RETURN to continue or '^' to exit:

## Combat Vet

- Currently no default
- Default changed to YES

## Order Dialog Changes

- Add administration time display
- Updates to infusion dialog
- Intermittent infusions require schedule
- Continuous infusions need infusion rate

## Admin Time on Simple

## Admin Time on Complex

## Continuous Infusion Dialog

## Intermittent Infusion Dialog

## Medication OrderingPatient Safety Issues

- Jamie Crumley

## PSI-05-006 / PSI-06-023

- Discontinue of pending IV renewal
- Order renewed
- creates a new pending order
- original order changes to ‘renewed’ status
- Provider discontinued pending order
- original order becomes active
- provider is not notified

## PSI-05-006 / PSI-06-023 (cont.)

## PSI-05-006 / PSI-06-023 (cont.)

- Solution:
- Add a pop-up box when discontinuing the pending order
- Message: This order is in a pending status.  If this pending order is discontinued, the original order will still be active.
- Give provider option to discontinue pending, both or neither

## PSI-05-007

- Provider receiving ‘Invalid Pharmacy Order Number’ error when attempting to discontinue order
- Order ‘pending’ in CPRS, active in Pharmacy
- Had to be dc’d in Pharmacy
- Break between CPRS and Pharmacy

## PSI-05-007 (cont.)

- Current error:

## PSI-05-007 (cont.)

- Add the following text to the text box:
- 		The changes to this order have not 	been saved.  You must contact 	Pharmacy to complete any action on 	this order.

## PSI-05-026

- Problems with Expected First Dose (EFD):
- Day-of-Week schedules with no admin times
- On-call schedules
- One-time schedules
- IV Orders

## PSI-05-026 (cont.)

- Solution:
- PSJ*5*157
- Adds EFD for IV orders
- Removes display (in backdoor) of EFD for on-call schedules
- PSJ*5*134 and PSS*1*94
- Removes display (in backdoor) of EFD for one-time schedules
- Additional validation on schedules to improve displays
- OR*3*243
- remove display of EFD for on-call and one-time orders
- Require time associated with Day-of-Week schedules

## PSI-05-026 (cont.)

## PSI-05-116

- Synonyms in CPRS medication ordering
- Synonym is displayed for selection
- Never appears again in ordering
- Solution
- Display full medication name when ordering by synonym

## PSI-05-116 (cont.)

## PSI-06-014

- Order was for epidural infusion
- Only option to enter in provider comments
- Missed in finishing process so the default of ‘IV’ route was shown in BCMA

## PSI-06-014 (cont.)

- Solution
- CPRS will add a new field for med route on the Infusion dialog
- Inpatient Meds – use the med route from CPRS
- BCMA
- Display full med route rather than abbreviation
- Add med route to scan IV dialog
- Add med route to ‘unable to scan’ box

## PSI-06-015

- Leading 0 in BCMA
- Order was for .4 mg of hydromorphone
- Patient received 4 mg
- CPRS will be modified to require leading 0

## CPRS v27 PSIsOther Applications

- Mike Belschwinder

## PSI’s – Other applications

- How many are there... really...
- Which applications ?
- CPRS Test Site page
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html
- Test scripts for PSI’s

**Notes:**
42 PSI’s
6 repeated
---
32 unique PSI issues being covered in V27
Alerts, Consults, CPRS, Lab, Pharmacy, Clinical Reminders and TIU related areas.
Majority are Pharmacy related in functionality. Which is why we had Jamie first.. 

## Top 5 PSI issues

**PSI-05-001 plus: **Make Anatomic Pathology Notifications Action Alerts
**PSI-05-027**: Changes to the Anatomic Pathology Report
**PSI-05-103**: Order check overrides not transmitted to ancillary service, parts 1, 3, and 4
**PSI-05-048**: System changes the order from LC to WC
**PSI-06-104**: RDV Health Summaries via CPRS

## Slide 93

## Top 5 PSI issues

**PSI-05-001 plus: **Make Anatomic Pathology Notifications Action Alerts
**PSI-05-027**: Changes to the Anatomic Pathology Report
**PSI-05-103**: Order check overrides not transmitted to ancillary service, parts 1, 3, and 4
**PSI-05-048**: System changes the order from LC to WC
**PSI-06-104**: RDV Health Summaries via CPRS

## PSI-05-027  AP report fix 

## Top 5 PSI issues

**PSI-05-001 plus: **Make Anatomic Pathology Notifications Action Alerts
**PSI-05-027**: Changes to the Anatomic Pathology Report
**PSI-05-103**: Order check overrides not transmitted to ancillary service, parts 1, 3, and 4
**PSI-05-048**: System changes the order from LC to WC
**PSI-06-104**: RDV Health Summaries via CPRS

## PSI-05-103

## CPRS OR*3.0*243 test site web page

- http://vista.med.va.gov/cprs/html/v27_test_site_page.html

## Top 5 PSI issues

**PSI-05-001 plus: **Make Anatomic Pathology Notifications Action Alerts
**PSI-05-027**: Changes to the Anatomic Pathology Report
**PSI-05-103**: Order check overrides not transmitted to ancillary service, parts 1, 3, and 4
**PSI-05-048**: System changes the order from LC to WC
**PSI-06-104**: RDV Health Summaries via CPRS

## Slide 101

## Top 5 PSI issues

**PSI-05-001 plus: **Make Anatomic Pathology Notifications Action Alerts
**PSI-05-027**: Changes to the Anatomic Pathology Report
**PSI-05-103**: Order check overrides not transmitted to ancillary service, parts 1, 3, and 4
**PSI-05-048**: System changes the order from LC to WC
**PSI-06-104**: RDV Health Summaries via CPRS

## DoD View

- “Camera 1”

## Health Summary View

- “camera 2”

## Patches

**Who or what was MOAB ?? **
**Released before V27 is released**
**Applications**
**GMPL, LR, OR, PSJ, PSS, PSO, TIU and YS**
**Required vs. Related**
**Compliance dates**

## CPRS v28Project Initiatives

- Rich Vertigan
- CPRS Developer, Albany OIFO

## Disclaimer

- CPRS v28 Project Manager’s Statement:
- “We are still seeking approval from IDMC or whatever governing body to officially do this work.”  (June 2007)
- Functionality you see here is anticipated and tentative, pending those approvals.

## Anatomic Pathology Ordering

- LEDI IV (LDSI Phase II, aka LA*5.2*74/LR*5.2*350) will implement creation of an order in the Lab Order file (#69) when AP orders are accessioned
- When that occurs CPRS should start seeing the creation of corresponding CPRS orders
- CPRS requirements gathering to start summer of  2007

## Consults

- Reference
- NSR 20051008
- Add “Appropriate” Dates to Consult Software
- Add earliest and latest appropriate dates to the Consults and Interfacility Consults software packages to monitor the electronic closure of consults in CPRS.
- Requires Consults patch.  Probably also requires Health Summary patch

## ART Order Checks

- Order checks for newly entered allergies currently only trigger when future orders are being placed.
- Planned order checks would also evaluate currently active orders against new allergy/adverse reactions entered.

## Remote order check resolution

- Facility information will be included in remote order check text
- This will facilitate a better ability to follow-up in resolving that order check

## Data Standardization

- Standardization of immunization and skin test files, and others to follow
- Dropped from v27 and added to v28.
- Impacts CPRS encounter form
- “Other” button on each of those tabs - only active entries will be available for selection
- Impacts reminder dialogs
- questions remain related to historical entries and active/valid immunizations as of those dates

## Service Connected Encounter Data Can Not be Modified in CPRS

- PCE made an underlying change in the data required to store service-connected information.
- User’s editing changes appear to be made in CPRS, but fail to be stored in PCE.
- CPRS changes are required to provide this information.

## Pulse Oximetry

- Value entered from Notes tab (Nursing Shift Assessment) not displayed anywhere in CPRS

## Problem List

- Replace the ICD9 Problem List selection list with a new SNOMED CT-based list also from the Lexicon
- Lexicon patch will allow lookup of terms by SNOMED code

## VistA Imaging Integration

- Implement Patient Photo in CPRS
- Add Image Indicator to Surgery Rpt
- Add Image Indicator to Consults Rpt
- Add Image Indicator to Anatomic Pathology Rpt

## Surgery tab enhancements

- Rename CPRS Surgery tab to Procedures tab
- Move procedure info from Consults tab to new Procedures tab
- Modify Procedures tab so that a hierarchy separates surgical procedures from medical procedures

## CPRS v28 Project Initiatives

- Pharmacy – Jamie Crumley

## Clinic Orders

- Expand existing IMO functionality
- Not just for Medications
- Ability to do BCMA for all Inpatient orders

## Med Order Button

- Provider-administered medications
- Mark med administered as it is entered

## Clozapine for Inpatients

- May be independent of GUI v28 if no GUI changes are required.
- Will include order checks in backdoor Inpatient Medications
- National Roll-up will occur for Inpatients
- Will use BCMA administration information for total dosage administered
- Will no longer require both Inpatient and Outpatient order.

## Miscellaneous

- Restriction of dangerous abbreviations
- Enhanced drug interaction order checks
- Enhanced narcotic order checks
- Non-VA meds enhancements
- Questionnaire/standard form

## CPRS v28 PSIs

- Pharmacy – Jamie Crumley

## PSI-07-092

- Free-text dosage on Outpatient order
- Entered in CPRS
- Root Cause Analysis suggested that this resulted in the patient safety issue

## PSI-06-067

- Inpatient Meds ordered during an admission
- Did not use event or time-delayed
- Orders appeared correctly in Pharmacy and BCMA
- Appeared as Outpatient orders on the Orders tab

## PSI-06-097

- Active Outpatient orders transferred to Inpatient
- Finished as Inpatient
- Appeared as Outpatient on Orders Tab

## CPRS v28 PSIs

- Other Applications
- Rich Vertigan

## CPRS v28 Patient Safety Issues

- Approximately 10 to date, but number will increase to 21 if not included in v27
- Number tends to double during normal version development cycle
- Conservative estimate would be approximately 30 by release date

## PSI-06-005

- Report received that a cosigner was able to edit a signed document
- TIU*1.0*220 – released Dec 2006
- allows CAC to change expected cosigner without having access to associated note text
- TIU*1.0*229
- TIU “amend” function will be modified to maintain audit trail (VistA only)
- Extent of CPRS GUI changes not yet clear
- another TIU patch with v28 to address GUI issues

## Other Late-Breaking News

- Previous lists for both CPRS v27 and v28 were complete when this presentation “went to press”.
- No slides for these, but...
- Late-breaking additions
- Late-breaking deferrals
- CPRS v27 Web page:
- http://vista.med.va.gov/cprs/html/v27_test_site_page.html
- CPRS v28 Web page (not yet active):
- http://vista.med.va.gov/cprs/html/v28_test_site_page.html

## CPRS v28 and Beyond

- Remember, all of the foregoing is tentative at this time.
- CPRS v27 due for release at end of CY07
- CPRS v28 currently projected for release early in CY09
- v29?  Nothing firm yet, but it seems likely.

## Questions?

- It just keeps going and going and going......