MC*2.3*48 automatically adds a Patient Care Encounter (PCE) entry in VistA after an electrocardiogram (EKG) reading is verified in the MUSE web service. Currently, staff cardiologists must manually enter the information from each EKG reading, which is time consuming and prone to data errors and omissions.

To create the automated PCE entry, each EKG cart is assigned a unique identifier to designate an inpatient or outpatient location. After an EKG is performed, transmitted to MUSE, and manually confirmed by the cardiologist, MUSE generates a Health Link 7 (HL7) message that includes the cardiologist's identification, the EKG location, date/time of the EKG, and patient identification. This data is automatically filed in the ELECTROCARDIOGRAM (EKG) file (#691.5) and the visit is created in the VISIT file (#9000010). If the EKG data is not successfully transferred to a PCE, a Mail Alert is sent to the MCM4 MUSE mail group.

Note: Information Resource Management (IRM) staff can view visits in the PCE Encounter Viewer [PXCE ENCOUNTER VIEWER] option in the PCE Coordinator Menu [PX PCE COORDINATOR MENU]. Visits do not display in the PCE Clinician Menu [PX PCE CLINICIAN MENU] to prevent the editing of the transmitted data.

The new option Set XPAR Values for EKG/MUSE [MCM4 XPAR] in the existing ECG Menu [MCARECG] option is used to configure the five new XPAR MUSE system-level parameters used to pass the EKG data from MUSE to a PCE. The MCM4 MUSE parameter template calls the five parameters.
- The MCM4 MUSE INTERFACE STATUS parameter in the PARAMETER DEFINITION file (#8989.51) is used to turn the functionality On/Off. Initially, this parameter is set to OFF (No).
- The MCM4 MUSE STD INPATIENT LOC parameter is used to set the default inpatient location.
- The MCM4 MUSE DEFAULT OUTPT LOC parameter maps the default outpatient location.
- The MCM4 MUSE LOC ID parameter is used to define the EKG cart number(s) that identify the MUSE location(s).
- The MCM4 MUSE LOC INPATIENT OOS parameter is used to set the inpatient Occasion of Service (OOS) location.

The patch also adds two new options that generate reports that can be printed to a Cardiology department printer. Both of these reports are configured in Taskman. It is recommended that these reports be run weekly, but the site can set the schedule to meet its needs. The EKG Action Required Report [MCM4 EKG OUTPATIENT ENC] option creates a report listing outpatients with a status of “ACTION REQUIRED” in the OUTPATIENT ENCOUNTER file (#409.68). The EKG Action Required Report is generated using the new print template MC EKG ACTION REQ and the new sort template MC EKG ACTION REQ. The sort template must be set up using the Template Edit option in the FileMan Utility Functions menu [DIUTILITY] to establish the clinic that will be used for this report. The Missing EKG Report Interpreted By [MCM4 MISSING EKG REPORT] option creates a report listing the patient records that need a physician name to be entered in the INTERPRETED BY field (#12)in the ELECTROCARDIOGRAM (EKG) file (#691.5). The Missing EKG Report Interpreted By report is generated using the new print template MC MISSING INTERPRETED BY and the new sort template MC MISSING INTERPRETED BY.

GMTS*2.7*123 creates the new Health Summary Object "EKG (LAST) (TIU)" that can be used to display data in the CPRS Notes tab when creating a TIU Object. The EKG (LAST) (TIU) Object displays the following patient data from the Medicine Package ELECTROCARDIOGRAM (EKG) file (#691.5): the Procedure Date/Time, Procedure Name, Report Summary, and Auto-Instrument Diagnosis. The HEALTH SUMMARY OBJECTS file (#142.5) contains a new Health Summary Type called OBJ EKG (LAST), which was created by filing a record named OBJ EKG (LAST) into the HEALTH SUMMARY TYPE file (#142). The Health Summary Type uses the new Health Summary Component "EKG" in the HEALTH SUMMARY COMPONENT file (#142.1) to call the VistA routine GMTSKGHS to display the data when the TIU Object is created.

The post-installation routine GMTSP123 creates the new EKG Health Summary Component at IEN=263. If this IEN is already in use, the system will notify the installer to move the conflicting Component to another IEN and then reinstall.