The Veterans Health Information Systems and Technology Architecture
 (VistA) Immunizations Enhancements (VIMM) 2.0 project, Increment 3, builds
 upon the file structures and standardized data introduced in Increments 1
 and 2 by adding functional enhancements to the existing VistA Patient Care
 Encounter (PCE) package.
  
 This patch provides the following new features:
  
 1) This patch creates Remote Procedure Calls (RPCs) for use by the
    Enterprise Health Management Platform (eHMP) project, the 
    Computerized Patient Record System (CPRS) software, Data Access Service
    (DAS) and others. These RPCs retrieve immunization information from the
    following files:
    - VACCINE INFORMATION STATEMENT (#920)
    - IMMUNIZATION INFO SOURCE (#920.1)
    - IMM ADMINISTRATION ROUTE (#920.2)
    - IMM ADMINISTRATION SITE (BODY) (#920.3)
    - IMM CONTRAINDICATION REASONS (#920.4)
    - IMM REFUSAL REASONS (#920.5)
    - V IMM CONTRA/REFUSAL EVENTS (#9000010.707)
    - IMM MANUFACTURER (#9999999.04)
    - IMMUNIZATION (#9999999.14)
    - IMMUNIZATION LOT (#9999999.41)
  
 2) This patch introduces functionality for capturing the reason(s) an 
    immunization was not given by documenting immunization 
    contraindications and/or refusal events. This functionality includes 
    the following:
    - Creation of the V IMM CONTRA/REFUSAL EVENTS file (#9000010.707)
    - A WARNING UNTIL DATE may be stored for temporary 
    contraindications/refusals. This is the date until which the 
    contraindication/refusal is valid.
    - When an immunization for a patient is associated with valid 
    contraindications/refusals (WARNING UNTIL DATE is not a past date), 
    the software will display a warning and the user will be required to 
    acknowledge the warning and enter a justification reason before 
    continuing with administration.
  
 3) This patch inactivates the PCE CODE MAPPING file (#811.1). The file
    will still exist, but the mappings in the file will no longer be used
    to determine which related entries in the V IMMUNIZATION (#9000010.11),
    V SKIN TEST (#9000010.12), and V CPT (#9000010.18) files need to
    reflexively be recorded. From now on, the mappings in the CODING SYSTEM
    multiple of the IMMUNIZATION (#9999999.14) and SKIN TEST (#9999999.28)
    files will be used for this purpose. There are a few differences with
    this new approach:
      a) The PCE CODE MAPPING file was managed locally, while the CODING
         SYSTEM multiple of the IMMUNIZATION and SKIN TEST files are
         standardized and managed nationally. 
      b) We will now support mappings to ICD-10 codes. If an immunization
         or skin test is mapped to an ICD-10 code, when that immunization
         or skin test is documented, we will reflexively file the mapped
         ICD-10 code to the V POV file (#9000010.07). 
      c) We will stop the practice of reflexively recording an immunization
         or skin test when a corresponding CPT code is filed. The mappings
         will only be used to reflexively file the corresponding codes (CPT
         and ICD-10) when an immunization or skin test is documented.
         However, in the reverse scenario, when a CPT code is documented,
         we will not reflexively record the corresponding immunization or
         skin test.
      d) Codes will only reflexively be filed when a VA-administered
         (non-historical) immunization or skin test is documented.
  
 4) This patch includes functionality to enable a documenting provider to 
    view some immunization prompts with default values to accept and to 
    edit the responses if need be. This functionality includes:
    - Creation of the IMM DEFAULT RESPONSES file (#920.05) to store 
    facility specific default values by immunization type for ROUTE OF 
    ADMINISTRATION, SITE OF ADMINISTRATION, DOSE, DOSE UNITS, and COMMENTS.
    - Creation of the Immunization Default Responses Enter/Edit menu option
    [PXV EDIT DEFAULT RESPONSES] to allow authorized users to enter or 
    update information in the IMM DEFAULT RESPONSES file (#920.05).
  
 5) This patch updates the NDC CODE (VA) field (#.18) in the IMMUNIZATION
    LOT file (#9999999.41) so that access to information in the NDC/UPN
    file (#50.67) is controlled by application programmer interfaces
    (APIs).