$TXT Created by WIPERT,RANDY T at DNS   12.AAC.VA.GOV  (KIDS) on Saturday, 01/05/19 at 22:16
=============================================================================
Run Date: JAN 08, 2019                     Designation: OR*3*444
Package : OR - ORDER ENTRY/RESULTS REPORTING  Priority: Mandatory
Version : 3                                     Status: Under Development
=============================================================================

Associated patches: (v)OR*3*350    <<= must be installed BEFORE `OR*3*444'
                    (v)OR*3*441    <<= must be installed BEFORE `OR*3*444'
                    (v)OR*3*456    <<= must be installed BEFORE `OR*3*444'
                    (v)OR*3*471    <<= must be installed BEFORE `OR*3*444'

Subject: CPRS MODIFICATION UNIFIED ACTION PROFILE

Category: 
  - Routine
  - Data Dictionary

Description:
============

 Description:
 ------------
 **Note: This functionality is delivered with an On/Off switch parameter. 
 (OR UNIFIED ACTION PROFILE OFF). The default setting is Off. Do not switch
 this feature On until CPRS v.32 (OR*3.0*405) has been released and 
 successfully installed.
  
 OR*3.0*444 enables a clinician to view existing inpatient and outpatient
 medication orders from the local site on a single page when preparing to
 discharge a patient. This order information is displayed on a new Unified
 Action Profile (UAP) form available from the View menu on the Computerized
 Patient Record System (CPRS) Orders tab.
  
 Duplicate orders can occur because outpatient orders remain in the system 
 after a patient is admitted, and new inpatient orders are created after 
 admission. When discharging a patient, a clinician must review all orders 
 to avoid duplication, while ensuring the correct medication orders are 
 continued for patient safety and care. The clinician must take the 
 appropriate action for each medication order, deciding whether to 
 continue, change, renew, or discontinue the order prior to discharge.
  
 Previously, when preparing to discharge a patient, a clinician had to 
 switch between forms in order to review all medication orders. OR*3.0*444 
 enables the clinician to review all medication orders at one time from the
 new UAP form. This change both simplifies order reconciliation and reduces
 the time and effort required from the clinician when making decisions on
 each active inpatient and outpatient order. The UAP sorts orders by drug 
 name so that inpatient and outpatient medications are grouped together. 
 Sorting drugs by medication name ensures that the clinician sees all 
 existing orders for each drug when making decisions during reconciliation.
  
  
 In the UAP view, Infusions are sorted alphabetically by the first 
 orderable item identified as an additive; solutions are ignored for the 
 purpose of sorting. The orderable items that display are reorganized based
 on the orderable additive item used for sorting. This change supports
 alphabetical sorting by a meaningful additive in the UAP, but does not
 change the original order in the ORDER file (#100). Infusions usually have
 more than one orderable item and sorting by the first additive ensures a
 consistent alphabetized display of infusion orders in the UAP view.
  
 Infusion orders cannot be continued, changed, or renewed using UAP because
 CPRS does not convert inpatient infusion orders to an outpatient order
 when preparing for discharge. To prevent issues with discharge medication
 orders, these options are grayed when performing UAP medication
 reconciliation for an inpatient Infusion order.
  
 Note: When an order is modified by a pharmacist during prescription 
 processing, the order is marked with an asterisk when displayed in CPRS. 
 In the UAP view, this asterisk is hidden when displaying orders; this 
 preserves the alphabetical sorting critical to the reconciliation process.
  
 The UAP includes a Reviewed column that displays the decision made by the 
 clinician during review. A new "UAP Reviewed?" field (#.61) is added to
 the order record in the ORDER file (#100). This field denotes whether an
 order was reviewed ("1") or not reviewed ("0"). Two additional fields
 store information about previous reviews: the "UAP Last Reviewed" 
 field (#.62) stores the date an order was last reviewed using the UAP
 form; the "UAP Last Reviewed By" field (#.63) stores identification
 information for the last person to perform a review of the order using the
 UAP view.
  
 This enhancement also adds a Discharge Meds Review form, which provides a 
 summary of all medications being continued for the patient upon discharge.
 This form is accessed by selecting the Discharge Meds view from the Orders
 tab. The Discharge Meds Review form enables a clinician to see the full
 list of medications prescribed for a discharged patient after the UAP
 review is completed.
  
 This modification includes a new PHARMACY UAP Display Group, which 
 includes the display members INPATIENT MEDICATIONS, OUTPATIENT 
 MEDICATIONS, and NON-VA MEDICATIONS. If expected orders do not display in 
 the UAP view, additional display members can be added to the group. For 
 example, Supply orders are omitted from the UAP view by design, but they 
 can be displayed if the SUPPLY Display Group is added as a member of the 
 PHARMACY UAP Display Group. To add additional display group members to the
 PHAMACY UAP Display Group, contact OIT for assistance; access to VistA
 programmer mode and FileMan are required to modify display group members.
  
 A new parameter (OR UNIFIED ACTION PROFILE OFF) in VistA enables sites to 
 turn the UAP functionality On/Off. This parameter is set at the facility 
 level and is located in the PARAMETER DEFINITION file (#8989.51). 
 Initially, this parameter is set to OFF ("0"). When the parameter is set 
 to OFF, the two options used to access the Unified Action Profile 
 functionality (Unified Action Profile (UAP) and Discharge Meds) are not
 displayed on the CPRS View menu. To enable this functionality, set the
 parameter to ON ("1") using the Edit Parameter Values function accessible
 from the XPAR MENU TOOLS option in VistA.
  
 **Note: In addition to turning this new parameter ON, enabling UAP 
 requires changing two settings for the Discharge Release Event using the 
 CPRS Configuration (Clin Coord) menu in VistA. Both settings are 
 accessible from the Event Delayed Orders option. First, activate the 
 DISCHARGE Release Event by changing the Activate/Inactivate [AI] setting 
 to ACTIVATE. Second, disable Copy Active Orders by changing the Copy 
 Active Orders setting to NO. The medication reconciliation performed by 
 UAP will not function as intended until the parameter is turned ON and 
 these settings are configured. 
  
 BLOOD BANK Clearance:
  
 EFFECT ON BLOOD BANK FUNCTIONAL REQUIREMENTS: Patch OR*3.0*444 contains 
 changes to a package referenced in ProPath standard titled: BBM Team 
 Review of VistA Patches. This patch does not alter or modify any VistA 
 Blood Bank software design safeguards or safety critical elements 
 functions.
  
 RISK ANALYSIS: Changes made by patch OR*3.0*444 have no effect on Blood 
 Bank software functionality, therefore RISK is none.
  
 Patch Components:
 -----------------
  
 Files & Fields Associated:
  
 File Name (Number)  Field Name (Number) New/Modified/Deleted
 ------------------  ------------------- --------------------
 ORDER (#100)        UAP Reviewed? (#100,.61)            NEW         
 ORDER (#100)        UAP Last Reviewed (#100,.62)       NEW         
 ORDER (#100)        UAP Last Reviewed By (#100,.63)    NEW         
  
  
 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
  
 Parameters Associated:                        
                  
 Parameter Name                                      New/Modified/Deleted
 -----------------------------                       --------------------
 OR UNIFIED ACTION PROFILE OFF                       New
  
  
 Security Keys Associated:
  
 Security Key Name
 -----------------
 N/A
  
  
 Templates Associated:
  
 Template Name   Type    File Name (Number)  New/Modified/Deleted 
 -------------   ----    ------------------  --------------------
 N/A
  
 Remote Procedures(RPC)s Associated:
  
 RPC Name        ROUTINE   TAG         New/Modified/Deleted 
 -------------   -------    --------    --------------------
 ORTO SET UAP FLAG  ORTOULT4   SETUAPF     NEW
 ORTO GETRVW        ORTOULT4   GETRVW      NEW
 ORTO SETRVW        ORTOULT4   SETRVW      NEW 
 ORTO UAPOFF        ORTOULT4   UAPOFF      NEW 
 ORTO DGROUP        ORTOULT4   DGROUP      NEW
  
 Additional Information:
 N/A
  
  
 New Service Requests (NSRs):
 ----------------------------  
 NSR20130714 CPRS Modification Unified Action Profile
  
  
 Patient Safety Issues (PSIs):
 -----------------------------
 N/A
  
 Defect Tracking System Ticket(s) & Overview:
 --------------------------------------------
 N/A
  
 Problem:
 -------
 N/A
  
 Resolution:
 ----------
 N/A
  
 Test Sites:
 ----------
 VA Portland Health Care System, Portland, OR
 Milwaukee VA Medical Center, Milwaukee, WI
 VA Northern California Health Care System, Mather, CA
  
  
 Software and Documentation Retrieval Instructions:
 ---------------------------------------------------- 
 The software is released as a PackMan message and is distributed from
 FORUM.
  
 Software documentation describing the new functionality introduced by 
 this patch is available for downloading.
  
 The preferred method is to retrieve files from download.DNS      .DNS   .
 This transmits the files from the first available server. Sites may 
 also elect to retrieve files directly from a specific server. 
  
 Sites may retrieve the documentation directly using Secure File Transfer
 Protocol (SFTP) from the ANONYMOUS.SOFTWARE directory at the following OI
 Field Offices:
  
 Hines:  DNS     .URL         
 Salt Lake City:       .URL       
  
 The following documentation can be found in the VA Software Document
 Library (VDL) at http://www.DNS   /vdl/.
  
 Title         File Name FTP Mode
 -----------------------------------------------------------------------
 CPRS User Guide: GUI Version        cprsguium.pdf             Binary
 CPRS User Guide: GUI Version        cprsguium.doc             Binary
 CPRS Technical Manual GUI Version   cprsguitm.pdf             Binary
 CPRS Technical Manual GUI Version   cprsguitm.doc             Binary
  
  
 Patch Installation:
  
 Pre/Post Installation Overview:
 -------------------------------
 Review the Pre-Installation Instructions provided before beginning 
 installation of the patch.
  
 The post-installation routine ORUA444P runs automatically and is deleted 
 after installation. This routine:
  
 - Adds the DISCHARGE MEDS and PHARMACY UAP display groups to the DISPLAY
 GROUPS file (#100.98); these groups are used during UAP processing. Refer
 to the Post-Installation Instructions in this document for information
 about adding new display group members to the PHARMACY UAP display group.
 - Registers new Remote Procedure Calls (RPCs) ORTO SET UAP FLAG, ORTO 
 GETRVW, ORTO SETRVW, ORTO UAPOFF, and ORTO DGROUP to the OR CPRS GUI 
 CHART option.
  
 Pre-Installation Instructions:
 ------------------------------
 This patch may be installed with users on the system although it is 
 recommended that it be installed during non-peak hours to minimize
 potential disruption to users. This patch should take less than 5 minutes
 to install.
  
 Installation Instructions:
 --------------------------
 To install the patch:
  
 1.      Choose the PackMan message containing this patch.
  
 2.      Choose the INSTALL/CHECK MESSAGE PackMan option.
  
 3.      From the Kernel Installation and Distribution System (KIDS) menu, 
 select the Installation Menu. From this menu, you may elect to use the
 following options. When prompted for the INSTALL NAME, enter the patch
 number OR*3.0*444.
  
 a.      Verify Checksums in Transport Global - This option will help 
 ensure the integrity of the routines that are in the transport global.
  
 b.      Print Transport Global - This option will enable viewing the 
 components of the KIDS build.
  
 c.      Compare Transport Global to Current System - This option will 
 enable viewing all changes that will be made when this patch is 
 installed. It compares all components of this patch (routines, data 
 dictionaries, templates, etc.).
  
 d.      Back up a Transport Global - This option will create a backup 
 message of any routines exported with this patch. It will not back up any 
 other changes such as data dictionaries or templates.
  
 4.      From the Installation Menu, select the Install Package(s) option 
 and choose the patch to install.
  
 5.      When prompted 'Want KIDS to INHIBIT LOGONs during the install? 
 NO//', press <Enter>.
  
 6.      When prompted 'Want to DISABLE Scheduled Options, Menu Options, 
 and Protocols? NO//', press <Enter>.
  
 7.      If prompted 'Delay install (Minutes): (0-60): 0//', press <Enter>.
  
 8.      If prompted 'Enter the Device you want to print the Install 
 messages. You can queue the install by enter a 'Q' at the device prompt. 
 Enter a '^' to abort the install. DEVICE: HOME//   HOME  (CRT)', press 
 <Enter>.
  
  
 Post-Installation Instructions:
 --------------------------------------------------------------
 The functionality enabled by this patch requires that the feature Copy 
 Active Orders is disabled and the Discharge Release Events is Activated.
 Both configuration settings are controlled using the CPRS Clinical
 Coordinator's menu in VistA.
  
 From the CPRS Clinical Coordinator's menu in VistA:
  
 1. At the prompt, type "PE" to display CPRS Configuration (Clin Coord) 
 options.
  
 2. At the prompt, type "DO" to display the Event Delayed Orders Menu.
  
 3. At the prompt, type "DO" to display Delayed Orders/Auto-DC Set-up 
 options.
  
 4. Select option 2, Release Events, to display a list of available Release
 events.
  
 5. At the prompt, type "DD" from the list of actions to open the Detailed
 Display.
  
 6. Select option 10, DISCHARGE, as the Release Event.
  
 7. At the prompt, type "AI" to Activate/Inactivate the Discharge Event.
 Confirm the selection to ACTIVATE at the "Are you sure you want to
 ACTIVATE this entry? NO//YES" prompt by pressing Enter.
  
 8. At the prompt, type "AE" to ADD/EDIT the Discharge event. 
  
 9. Press Enter to move through the remaining prompts until the COPY ACTIVE
 ORDERS prompt displays. Enter "NO" to disable Copy Active Orders. Verify
 Copy Active Orders is set to NO.
  
 10. The Write Orders List by Event options display, followed by the "Enter
 selection:" prompt. This selection determines which users are affected by
 the change. For example, to apply this setting to all CPRS users at a
 particular site, type "System" at the prompt. Limit how broadly this
 setting applies by selecting an alternate choice of User, Location,
 Service, Division, instead of System.
  
 Note: The PHARMACY UAP Display Group is delivered with the members 
 INPATIENT MEDICATIONS, OUTPATIENT MEDICATIONS, and NON-VA MEDICATIONS. If 
 additional members must be added to this display group, contact OIT for 
 assistance.
  
 The OIT representative must add new display group members to the PHARMACY 
 UAP Display Group file (#100.98) using the following steps:
  
 1.      Log in to VistA in programmer mode and then navigate to FileMan.
  
 2.      Select the ENTER OR EDIT FILE ENTRIES option.
  
 3.      At the "Input to what File: OPTION//" prompt, type DISPLAY GROUP.
  
 4.      At the "EDIT WHICH FIELD: /ALL" prompt, type MEMBER.
  
 5.      At the EDIT WHICH MEMBER SUB-FIELD: /ALL" prompt, press Enter.
  
 6.      At the "Select DISPLAY GROUP NAME:" prompt, type PHARMACY UAP.
  
 7.      At the "Select MEMBER: NON-VA MEDICATIONS//" prompt, type the 
 name of the Display Group to add to the PHARMACY UAP Display Group. 
 For example, type CLINIC MEDICATIONS to add the CLINIC MEDICATIONS member 
 to the PHARMACY UAP Display Group.
  
 8.      At the "Are you adding 'CLINIC MEDICATIONS' as a new MEMBER? 
 No//" prompt, type Y (Yes).
  
 9.      At the MEMBER SEQUENCE: 4//" prompt, press Enter to accept the 
 default. 
 Note: The member sequence is not used by the UAP code modification.
  
 10.     Repeat these steps to add each required display group to the 
 PHARMACY UAP Display Group file.
  
  
 Backout Procedure:
 ------------------
 Backout of this patch will be performed only with the concurrence and 
 participation of the appropriate VA site/region personnel. The decision to
 back out the patch will be a joint decision between VA site/region 
 personnel and other appropriate VA personnel.
  
 Note: Due to the complexity of this patch, it is not recommended for 
 backout, and a restore from a backup of the Transport Global should not be
 attempted. However, in the event that a site decides to back out this
 patch, the site should contact the National Service Desk (NSD) to submit a
 help desk ticket. The development team will need to issue one or more 
 follow-on patches in order to comprehensively back out this patch, 
 after coordination with the VA Project Manager and COR.
  
 Validation of Backout Procedure:
 --------------------------------
 The Backout procedure can be verified by printing the first two lines of 
 the OR routines contained in this patch using the option First Line
 Routine Print [XU FIRST LINE PRINT]. Once the OR routines have been backed
 out, the first two lines of the routines will no longer contain the
 designation of patch OR*3.0*444 on line 2 in the patch list section.
  
 Note: This validation procedure only verifies that routine changes have 
 been backed out; it does not confirm that other patch component changes 
 have been backed out.

Routine Information:
====================
The second line of each of these routines now looks like:
 ;;3.0;ORDER ENTRY/RESULTS REPORTING;**[Patch List]**;Dec 17, 1997;Build 44

The checksums below are new checksums, and
 can be checked with CHECK1^XTSUMBLD.

Routine Name: ORQ1
    Before: B10080837   After: B12018675  **27,72,78,141,190,215,444**
Routine Name: ORQ11
    Before: B65899286   After: B85321272  **7,27,48,72,78,99,94,148,141,
                                           177,186,190,195,215,243,295,
                                           322,350,444**
Routine Name: ORQ12
    Before: B41144852   After: B45394513  **12,27,78,92,116,190,220,215,
                                           243,356,441,444,377**
Routine Name: ORTOULT4
    Before:       n/a   After: B54802084  **444**
Routine Name: ORUA444P
    Before:       n/a   After:  B6132340  **444**
Routine Name: ORWORR
    Before: B81663175   After: B96506113  **10,92,116,110,132,141,163,
                                           189,195,215,243,280,306,471,
                                           444,405**
Routine Name: ORWORR1
    Before:  B9884468   After: B15874108  **141,243,456,444,405**
 
Routine list of preceding patches: 350, 377, 405

=============================================================================
User Information:
Entered By  : WERTH,WARREN                  Date Entered  : NOV 10, 2016
Completed By:                               Date Completed: 
Released By :                               Date Released : 
=============================================================================
