VistA Patch Display                                                   Page: 1
=============================================================================
Run Date: JUN 28, 2016                      Designation: OR*3*427  TEST v
Package : ORDER ENTRY/RESULTS REPORTING     Priority   : MANDATORY
Version : 3                                 Status     : UNDER DEVELOPMENT
=============================================================================

Associated patches: (v)OR*3*243    <<= must be installed BEFORE `OR*3*427'
                    

Subject:  MENTAL HEALTH NCC PROJECT 5.01

Category:  ROUTINE
           ENHANCEMENT

Description:
===========
 
This patch will add enhancements to the Inpatient Order Entry routines for
the National Clozapine T4 project.  Below is a list of all the applications
involved in this project along with their patch number:
 
   APPLICATION/VERSION                                   PATCH
   ---------------------------------------------------------------
   MENTAL HEALTH (MH) V. 5.01                          YS*5.01*122
   OUTPATIENT PHARMACY (OP) V. 7.0                     PSO*7*457 
   INPATIENT MEDICATIONS (IP) V. 5.0                   PSJ*5*327
   ORDER ENTRY/RESULTS REPORTING (OR) V. 3.0           OR*3*427
 
The patches (YS*5.01*122, PSO*7*457, PSJ*5*327, and OR*3*427) are 
being released  in the Kernel Installation and Distribution System
(KIDS) multi-build distribution MENTAL HEALTH NCC PROJECT 5.01.
 
The purpose of this software package is to maintain compliance with 
legislative and federal mandates and to add Clozapine Order Checking 
to the Inpatient Pharmacy application.  It also adds real-time updating
functionality of the data sent to the National Clozapine Server.
 
This specific patch contains the following functionality:
---------------------------------------------------------
The ORDER CHECK RULE file (#860.2) and the ORDER CHECK ELEMENT file (#860.3)
need to be modified to meet the new FDA Clozapine reporting guidelines.  
1. The CLOZAPINE entry in the ORDER CHECK RULE file (#860.2) will be 
   modified to:
   a. Remove the WBC order checks
   b. Modify the ANC order check values to meet new FDA guidelines
2. Add new entries to the ORDER CHECK ELEMENT file (#860.3)
   a. ELEMENT NAME: CLOZAPINE ANC >= 1.0 & < 1.5
   b. LABEL: 1.0 >= ANC < 1.5
   c. ELEMENT NAME: CLOZAPINE ANC < 1.0
   d. ANC < 1.0
3. Modify the ^ORALWORD routine to display the appropriate order check
   message based on:
   a. The new ANC (Absolute Neutrophil Count) values
   b. Outpatient
  
     *** Permission to dispense clozapine has been denied based on the
     available lab tests related to the clozapine treatment program. ***
 
     For a National Override to dispense at the patient's normal
     frequency, contact the NCCC.
 
     A local override for an Outpatient can be approved for: (1)
     weather-related conditions, (2) mail order delays of clozapine,or (3)
     inpatient going on leave.
 
     For an Outpatient Special Conditions Local Override, a written 
     prescription from the provider with documentation to the pharmacist
     is required to dispense a one-time emergency 4-day supply.
 
   c. Inpatient
 
     *** Permission to dispense clozapine has been denied based on 
     the available lab tests related to the clozapine treatment program.
     ***
 
     For a National Override to dispense at the patient's normal
     frequency, contact the NCCC.
 
     A local emergency override for an Inpatient can be approved for:
     IP Order Override with Outside Lab Results.
 
     For a Special Conditions Local Override, a written order
     from the provider with documentation to the pharmacist
     is required to dispense a one-time emergency 4-day supply. 
   
     The provider must record the ANC from another facility including 
     date/time in both the Provider Progress Note and Comment field in
     CPRS.
 
 
   Message will be added  and enforce a hard stop on the order.
 
Before:
ORDER CHECK RULE LIST                          FEB 16,2016  14:29    PAGE 1
-----------------------------------------------------------------------------
NUMBER: 57                              NAME: CLOZAPINE
LABEL: NO WBC W/IN 7 DAYS
  ELEMENT NAME: CLOZAPINE NO WBC W/IN 7 DAYS
  TYPE: SIMPLE DEFINITION
LABEL: WBC < 3.0                        ELEMENT NAME: CLOZAPINE WBC < 3.0
  TYPE: SIMPLE DEFINITION
LABEL: ANC < 1.5                        ELEMENT NAME: CLOZAPINE ANC < 1.5
  TYPE: SIMPLE DEFINITION
LABEL: 3.0 <= WBC < 3.5
  ELEMENT NAME: CLOZAPINE WBC >= 3.0 & < 3.5
  TYPE: SIMPLE DEFINITION
LABEL: NO ANC W/IN 7 DAYS
  ELEMENT NAME: CLOZAPINE NO ANC W/IN 7 DAYS
  TYPE: SIMPLE DEFINITION
LABEL: CLOZAPINE                        ELEMENT NAME: CLOZAPINE DRUG SELECTED
  TYPE: SIMPLE DEFINITION
LABEL: ANC >= 1.5                       ELEMENT NAME: CLOZAPINE ANC >= 1.5
  TYPE: SIMPLE DEFINITION
LABEL: WBC >= 3.5                       ELEMENT NAME: CLOZAPINE WBC >= 3.5
  TYPE: SIMPLE DEFINITION
LABEL: 1.5 <= ANC < 2.0
  ELEMENT NAME: CLOZAPINE ANC >= 1.5 & < 2.0
  TYPE: SIMPLE DEFINITION
  STATUS: ACTIVE
RELATION INDEX: 1                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND (NO WBC W/IN 7 DAYS OR NO ANC W/IN 7 DAYS)
  ORDER CHECK MESSAGE: Clozapine orders require a CBC/Diff within past 7 days.  
                       Please order CBC/Diff with WBC and ANC immediately.
                       Most recent results - |CLOZ LAB RSLTS|
RELATION INDEX: 2                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND (WBC < 3.0 OR ANC < 1.5)
  ORDER CHECK MESSAGE: WBC < 3.0 and/or ANC < 1.5 - pharmacy cannot fill
                       clozapine  order. Most recent results - |CLOZ LAB RSLTS|
RELATION INDEX: 3                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND 3.0 <= WBC < 3.5 AND ANC >= 1.5
  ORDER CHECK MESSAGE: WBC between 3.0 and 3.5 with ANC >= 1.5 - please repeat
                       CBC/Diff including WBC and ANC immediately and twice
                        weekly.  Most recent results - |CLOZ LAB RSLTS|
RELATION INDEX: 4                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND 1.5 <= ANC < 2.0
  ORDER CHECK MESSAGE: ANC between 1.5 and 2.0 - please repeat CBC/Diff
                       including WBC and ANC immediately and twice weekly.
                       Most recent results - |CLOZ LAB RSLTS|
 
AFTER:
ORDER CHECK RULE LIST                          FEB 16,2016  14:29    PAGE 1
-----------------------------------------------------------------------------
NUMBER: 57                              NAME: CLOZAPINE
LABEL: ANC < 1.0                        ELEMENT NAME: CLOZAPINE ANC < 1.0
  TYPE: SIMPLE DEFINITION
LABEL: NO ANC W/IN 7 DAYS
  ELEMENT NAME: CLOZAPINE NO ANC W/IN 7 DAYS
  TYPE: SIMPLE DEFINITION
LABEL: CLOZAPINE                        ELEMENT NAME: CLOZAPINE DRUG SELECTED
  TYPE: SIMPLE DEFINITION
LABEL: 1.0 >= ANC < 1.5
  ELEMENT NAME: CLOZAPINE ANC >= 1.0 & < 1.5
  TYPE: SIMPLE DEFINITION
  STATUS: ACTIVE
RELATION INDEX: 1                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND (NO ANC W/IN 7 DAYS)
  ORDER CHECK MESSAGE: Clozapine orders require a CBC/Diff within past 7 days.  
                       Please order CBC/Diff with WBC and ANC immediately.
                       Most recent results - |CLOZ LAB RSLTS|
RELATION INDEX: 2                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND ANC < 1.0
  ORDER CHECK MESSAGE: Moderate/Severe Neutropenia - please repeat CBC/Diff
                       including WBC and ANC tests immediately and Daily until
                       ANC stabilizes to greater than or equal to 1000. Most
                       recent results - |CLOZ LAB RSLTS|
RELATION INDEX: 3                       ORDER CHECK: CLOZAPINE APPROPRIATENESS
  RELATION EXPRESSION: CLOZAPINE AND (1.0 >= ANC < 1.5)
  ORDER CHECK MESSAGE:  Mild Neutropenia - please repeat CBC/Diff including
                        WBC  and ANC tests immediately and 3X weekly until ANC
                        stabilizes to greater than or equal to 1500. Most
                        recent results - |CLOZ LAB RSLTS|
 
Patch Components
================
Files & Fields Associated:
 
File Name (Number)      Field Name (Number)              New/Modified/Deleted
------------------      -------------------              --------------------
N/A
 
Forms Associated:
 
Form Name             File #       New/Modified/Deleted
---------             ------       --------------------
N/A
 
Mail Groups Associated:
 
Mail Group Name          New/Modified/Deleted
---------------          --------------------
N/A
 
Options Associated:
 
Option Name                   Type           New/Modified/Deleted
-----------                   ----           --------------------
N/A
 
Protocols Associated:
 
Protocol Name                     New/Modified/Deleted
-------------                     --------------------
N/A
 
Security Keys Associated:
 
Security Key Name                 New/Modified/Deleted
----------------------            --------------------
N/A
 
Templates Associated:
 
Template Name      Type      File Name (Number)  New/Modified/Deleted
-------------      ----      ------------------  --------------------
N/A
 
Additional Information:
 
New Service Requests (NSRs)
----------------------------
Request Name: National Clozapine Coordination Project
  Request ID: 20100703
 
Patient Safety Issues (PSIs)
-----------------------------
N/A
 
Remedy Ticket(s) & Overview
---------------------------
N/A
 
Test Sites:
----------
TBD
 
Documentation Retrieval Instructions
------------------------------------
Updated documentation describing the new functionality introduced by this
patch is available.
 
The preferred method is to SFTP the files from
ftp://download.DNS   med.DNS   . This transmits the files from the first
available SFTP server. Sites may also elect to retrieve software directly from
a specific server as follows:
 
 Albany         ftp.DNS      .med.DNS     <ftp://ftp.DNS      .med.DNS   >
 Hines          ftp.DNS     .med.DNS      <ftp://ftp.DNS     .med.DNS   >
 Salt Lake City ftp.DNS   .med.DNS        <ftp://ftp.DNS   .med.DNS   >
 
Documentation can also be found on the VA Software Documentation Library at:
http://www.DNS   /vdl/
 
Title                                 File Name                   FTP Mode
-------------------------------------------------------------------------
TBD
 
Patch Installation:
 
Pre/Post Installation Overview
------------------------------
N/A
 
Installation Instructions
-------------------------
This patch should take up to 20 minutes to install.
DO NOT QUEUE the installation of this patch.
 
To avoid disruptions, these patches should be installed during non-peak
hours when there is minimal activity on the system.  Avoid times when 
 
Pre-Installation Instructions
-----------------------------
 
1.  OBTAIN PATCHES
    --------------
    Obtain the host file MH_NCC_PROJECT_5_01.KID, which contains the
    following patches:
 
        YS*5.01*122
        PSO*7*457
        PSJ*5*327
        OR*3*427
 
     Sites can retrieve VistA software from the following SFTP addresses.
     The preferred method is to SFTP the files from:
 
                    download.DNS   med.DNS   
 
     This will transmit the files from the first available SFTP server.
     Sites may also elect to retrieve software directly from a specific
     server as follows:
 
       Albany                  ftp.DNS      .med.DNS   
       Hines                   ftp.DNS     .med.DNS   
       Salt Lake City          ftp.DNS   .med.DNS   
 
     The MH_NCC_PROJECT_5_01.KID host file is located in the
     anonymous.software directory. Use ASCII Mode when downloading the
     file.
 
2.  START UP KIDS
    -------------
    Start up the Kernel Installation and Distribution System Menu option
    [XPD MAIN]:
 
         Edits and Distribution ...
         Utilities ...
         Installation ...
 
    Select Kernel Installation & Distribution System Option: INStallation
                                                             ---
         Load a Distribution
         Print Transport Global
         Compare Transport Global to Current System
         Verify Checksums in Transport Global
         Install Package(s)
         Restart Install of Package(s)
         Unload a Distribution
         Backup a Transport Global
 
    Select Installation Option:
 
3.  LOAD TRANSPORT GLOBAL FOR MULTI-BUILD
    -------------------------------------
    From the Installation menu, select the Load a Distribution option.
 
    When prompted for "Enter a Host File:", enter the full directory path
    where you saved the host file MH_NCC_PROJECT_5_01.KID (e.g.,
    SYS$SYSDEVICE:[ANONYMOUS] MH_NCC_PROJECT_5_01.KID)
 
    When prompted for "OK to continue with Load? NO//", enter "YES."
 
    The following will display:
 
      Loading Distribution...
 
        MENTAL HEALTH NCC PROJECT 5.01
        YS*5.01*122
        PSO*7*457
        PSJ*5*327
        OR*3*427
      Use INSTALL NAME: MENTAL HEALTH NCC PROJECT 5.01 to install this
      Distribution.
 
4.  RUN OPTIONAL INSTALLATION OPTIONS FOR MULTI-BUILD
    -------------------------------------------------
    From the Installation menu, you may select to use the following
    options (when prompted for the INSTALL NAME, enter
    YS*5.01*122):
 
    a.  Backup a Transport Global - This option will create a backup
        message of any routines exported with this patch.  It will not
        backup any other changes such as DD's or templates.
    b.  Compare Transport Global to Current System - This option will
        allow you to view all changes that will be made when this patch
        is installed.  It compares all components of this patch
        (routines, DD's, templates, etc.).
    c.  Verify Checksums in Transport Global - This option will allow
        you to ensure the integrity of the routines that are in the
        transport global.
 
5.  INSTALL MULTI-BUILD
    -------------------
    This is the step to start the installation of this KIDS patch.  This
    will need to be run for the MENTAL HEALTH NCC PROJECT 5.01.
 
    a. Choose the Install Package(s) option to start the patch install.
    b. When prompted for the "Select INSTALL NAME:", enter YS*5.01*122  
 
    This Distribution was loaded on Mar 10, 2016@13:46:45 with header of 
    MENTAL HEALTH NCC PROJECT 5.01  ;Created on Mar 09, 2016@08:27:27
    It consisted of the following Install(s):
    YS*5.01*122    PSO*7.0*457    PSJ*5.0*327     OR*3.0*427
    Checking Install for Package YS*5.01*122
 
    Install Questions for YS*5.01*122
 
    Checking Install for Package PSO*7.0*457
 
    Install Questions for PSO*7.0*457
 
    Incoming Files:
 
    52.52     CLOZAPINE PRESCRIPTION OVERRIDES  (Partial Definition)
    Note:  You already have the 'CLOZAPINE PRESCRIPTION OVERRIDES' File.
 
    52.54     CLOZAPINE OVERRIDE REASONS  (including data)
 
    Checking Install for Package PSJ*5.0*327
 
    Install Questions for PSJ*5.0*327
 
    Incoming Files:
 
    53.8      CLOZAPINE MEDICATION OVERRIDES
 
    Checking Install for Package OR*3.0*427
 
    Install Questions for OR*3.0*427
 
    c. When prompted "Want KIDS to Rebuild Menu Trees Upon Completion of
    d. Install? YES//", enter YES unless your system does this in a nightly
       TaskMan process.
    e. When prompted "Want KIDS to INHIBIT LOGONs during the install?
       YES//", enter NO.
    f. When prompted " Want to DISABLE Scheduled Options, Menu Options,
       and Protocols? NO//", enter NO.
    g. When prompted "Device: HOME//", respond with the correct device 
       but do not queue this install.
 
     DEVICE: HOME//   HOME  (CRT)
     ----------------------------------------------------------------------
 
     YS*5.01*122 Already Installed 
 
     PSO*7.0*457 Already Installed 
 
     PSJ*5.0*327 Already Installed 
 
     Install Restarted for OR*3.0*427 at Mar 10, 2016@16:28:45
 
     Build Distribution Date: Mar 09, 2016
 
     Routines already installed.
 
     Pre-Install already finished.
 
     Running Post-Install Routine: ^ORY427ES .
 
     Order Check Expert System Rule Transporter
     Created: FEB 23,2016 at 15:22  at  NCCLAB1.AAC.DNS   
     Current Date: MAR 10,2016 at 16:28  at  NCCLAB3.AAC.DNS   
 
     Loading Data  . . . . . . . .
     Installing '863.8  OCX MDD PARAMETER' records...............
     . . . . . . .. . . . . . .. . .
     Installing '864.1  OCX MDD DATATYPE' records...  . . .. .
     Installing '863.7  OCX MDD PUBLIC FUNCTION' records...........
     Installing '863.9  OCX MDD CONDITION/FUNCTION' records..........
     .
     Installing '863.4  OCX MDD ATTRIBUTE' records...............
     Installing '863.2  OCX MDD SUBJECT' records....
     Installing '863.3  OCX MDD LINK' records..................
     Installing '860.9  ORDER CHECK NATIONAL TERM' records..........
     . . . . .. . . . .
     Installing '860.8  ORDER CHECK COMPILER FUNCTIONS' records......
     . .. .. . .. . .. .... . ..
     Installing '860.6  ORDER CHECK DATA CONTEXT' records.......
     Installing '860.5  ORDER CHECK DATA SOURCE' records.........
     Installing '860.4  ORDER CHECK DATA FIELD' records............
     ..
     Installing '860.3  ORDER CHECK ELEMENT' records..........
     Installing '860.2  ORDER CHECK RULE' records.....
 
      No data filing errors.
 
     Transport Finished...
 
    ---Creating Order Check Routines-----------------------------------.
 
    Build list of Active Rules, Elements and Datafields....
 
     94 DATA FIELDS
 
     77 ELEMENTS
 
     39 RULES.
 
    Compile DataField Navigation code....
 
     99 DataField Navigation Code Arrays.
 
    Compile Element Evaluation code....
 
     71 Event Evaluation Code Arrays.
 
    Compile Element MetaCode....
 
     77 Element Metacode Arrays.
 
    Get Compiler Function Code....
 
     51 Compiler Include Functions.
 
    Compile Rule Element Relation code....
 
     56 Rule Element Relation Code Arrays.
 
    Construct Decision Tree....
 
    692 Sub-Routines.
 
    Optimize Sub-Routines....
 
    278 Sub-Routines
 
    59.9% Optimization.
 
    Assemble Routines....
 
     39 OCXOZ* Routines.
 
Post-Installation Instructions
------------------------------
N/A


Routine Information:
====================


Routine Name: ORALWORD
    Checksum:
  Before: 47499175   After: 89588397 **243,427**
Routine Name: ORY4270
    Checksum:
  Before: N/A   After: 15569729  **427**
Routine Name: ORY42701
    Checksum:
  Before: N/A   After: 71551106  **427**
Routine Name: ORY42702
    Checksum:
  Before: N/A   After: 79020863  **427**
Routine Name: ORY42703
    Checksum:
  Before: N/A   After: 78683867  **427**
Routine Name: ORY42704
    Checksum:
  Before: N/A   After: 81471478  **427**
Routine Name: ORY42705
    Checksum:
  Before: N/A   After: 60288831  **427**
Routine Name: ORY42706
    Checksum:
  Before: N/A   After: 65663010  **427**
Routine Name: ORY42707
    Checksum:
  Before: N/A   After: 69514019  **427**
Routine Name: ORY42708
    Checksum:
  Before: N/A   After: 18751543  **427**
Routine Name: ORY4271
    Checksum:
  Before: N/A   After: 40435115  **427**
Routine Name: ORY4272
    Checksum:
  efore: N/A   After: 26767346  **427**
Routine Name: ORY4273
    Checksum:
  efore: N/A   After: 12998366  **427**
Routine Name: ORY4274
    Checksum:
  efore: N/A   After: 13528386  **427**
Routine Name: ORY427ES
    Checksum:
  Before: N/A   After: 12600854  **427**


=============================================================================
User Information:  
  Entered By  :   WIPERT,RANDY T       Date Entered  :   JAN  6,2016
  Completed By:                        Date Completed:   
  Released By :                        Date Released :   
=============================================================================


