1. OR*3*243 CPRS GUI V27 Functional Training
Medication Order Changes
BHIE
VBECS
All Other CPRS GUI Changes
9/22/2018

2. OR*3*243 (CPRS GUI v27) Functionality
CPRS GUI v27 Functionality includes:
Project Initiatives (6 projects)
Patient Safety Issues (47)
Remedy Tickets (100+)
ClearQuest tickets deferred from v26 to v27 (approximately 200)
Total ClearQuest ticket resolution (1040)
508 Compliance Modifications (approximately 200)
9/22/2018

3. Medication Order Changes
9/22/2018

4. Issues Covered Administration Times
Changes to Infusion Order Dialog (PSI ,PSI ,PSI , PSI )
Meds Tab Sorts
Meds Tab Display
Pending Renewals (PSI )
Day-Of-Week Schedule Builder
Expected First Dose (PSI )
Schedule Type
Provider/Pharmacy Hold
Provider Comments (PSO , PSI )
Clozapine Orders
Patient Safety Changes
9/22/2018

5. Administration Times
CPRS now displays administration times when writing inpatient medication orders in the unit dose and infusion order dialogs.
CPRS will display the Administration times associated with the defined schedule or the Day-of-Week Schedule builder in the Unit Dose and Infusion Order Dialogs.
CPRS will display “Not Defined” if an Administration Time is not defined in VistA.
When changing or copying to a new order, CPRS will display the administration time according to the CURRENT location of the patient.
When changing or copying Inpatient Medications for Outpatients (IMO)/other clinic order or delayed orders:
The administration time will be brought forward from the order being copied.
The administration time will not display in the dosage and complex tabs.
When a provider is writing a Delayed Order using Day-of-Week schedule, where the administration time would have been displayed, To Be Determined will be displayed.
When a provider is writing an IMO/other orders at an outpatient (OPT) location using the Day-of-Week schedule, where the administration time would have been displayed, the text Not defined for Clinic Locations will be displayed.
The Administration Time Column on IMO and Clinic order dialogs will be removed.
CPRS will provide a new parameter called OR ADMIN TIME HELP TEXT to allow sites to configure a text message to display when the user clicks on the administration times on the complex dosage tab or the text will appear in a hover hint on the Dosage Tab.
The administration time associated with a schedule is return from a pharmacy API when the list of possible schedules are built in CPRS. The Administration times follow these rules
If there exists a duplicate named schedule in the ADMINISTRATION SCHEDULE FILE (#51.1), and if one of the duplicates has ward-specific administration times for the ward the patient is currently admitted to, the schedule sent back to CPRS in the selection list will be the schedule with the ward-specific admin times.
If none of the duplicates have ward-specific admin times for the ward the patient is admitted to, then the current functionality will be retained, and the schedule with the lowest IEN number in the ADMINISTRATION SCHEDULE FILE (#51.1) will be returned to CPRS.
If more than one duplicate schedule has ward-specific admin times for the ward the patient is admitted to, then the schedule with the lowest IEN number in the ADMINISTRATION SCHEDULE FILE (#51.1) will be returned
9/22/2018

6. Administration Times
CPRS will provide a new parameter called OR ADMIN TIME HELP TEXT to
allow sites to configure a text message to display when the user clicks on the
administration times on the complex dosage tab.
9/22/2018

7. Changes to Infusion Dialog
Added IV Type selection field
Added Medication Route selection field
Added Schedule selection field
Added Give Additional Dose Now field
Added Infuse Over Time field
Added Administration Time display
Added Expected First Dose
IV Type can be either Continuous or Intermittent.
For Continuous and Intermittent orders, Duration must be a whole number.
Nothing is displayed in the Route Combo Box before a selection is made.
9/22/2018

8. New IV Medication Route Field
CPRS added a new required field called Medication Route to the Infusion Order Dialog screen.
Nothing is displayed in the Route Combo Box before a selection is made.
For the initial IV selection, CPRS will display the default med route for the selected Pharmacy Orderable Item.
Determination of Default Med Route – One Orderable Item
If there is one and only one orderable item in the IV order, the Pharmacy Orderable Item file (#50.7) will be checked to see if there is a default med route.
Any med route defined for the dosage form of the orderable item will be checked.
Duplicate entries will be filtered by inpatient pharmacy.
The list of possible med routes sent back to CPRS will include the default med route (if defined), as well as any other med routes defined for the dosage form.
Determination of Default Med Route – More than one Orderable Item
If there is more than one orderable item on the IV order, the Pharmacy Orderable Item file (#50.7) will be checked for each orderable item to see if a default is defined.
This default will be pooled with the other possible med routes for each dosage form for each orderable item.
Duplicates will be filtered by inpatient pharmacy.
Regardless of whether all orderable item defaults match or not, a default med route will NOT be marked as a default if there is more than one orderable item on the order.
The list of possible med routes returned to CPRS will include ONLY those med routes that every orderable item in the order shares in common.
9/22/2018

9. New IV Medication Route Field
Multiple Orderable Items will not display a default route.
For multiple Pharmacy Orderable Items, users must select a route from the combined list of the medication routes associated with the selected Pharmacy Orderable Items. Duplicates will be filtered out.
Each time additives and solutions change, by addition or deletion, if the available medication routes change, the route must be reselected.
To get an extended list of routes, the user may click Expanded Med Route List or select OTHER from the Route combo box.
Entries selected from the Expanded Med Route List form will populate in the small Route Combo Box and be retained throughout the ordering session.
Users must select from the list provided by Pharmacy. Free-text entries will not be allowed.
9/22/2018

10. New IV Medication Route Field
When processing a QO or using the Change Order action, the Route field in the order dialog will return blank if the route is invalid.
When using the renew actions, users will see the following message if the route is invalid:
9/22/2018

11. Continuous IV Type
When an IV type of Continuous is selected, the Schedule box is inactive.
Continuous IV infusion Rate must be entered in ml/hour or of labels.
Continuous IV infusion Rate is required.
For Continuous IV orders, entry of a fractional infusion Rate (one decimal point) is allowed.
When Continuous is selected, the Give Additional Dose Now check box will not appear.
Quick Order setup allows entry of a fractional number for a pre-defined infusion Rate for continuous orders.
Quick Orders allow entry of a fractional number for an infusion Rate for Continuous orders.
9/22/2018

12. Intermittent IV Type
Intermittent IV infusion rate is allowed in hours or minutes.
A solution is not required when processing an Intermittent Infusion Order
The Intermittent IV patient instructions block contains the words Infuse Over Time.
Infuse Over Time cannot start with a “0” (zero).
Renewal of an order that contains titrate in the Infuse Over Time field is prevented.
Display of the order dialog with Copy and Change when the order contains titrate in the Infuse Over Time field is forced.
When “titrate” is entered in Infuse Over Time, minutes will be blank.
Intermittent IV Schedule is a required field.
When Intermittent IV is selected, the Day–of-Week Schedule builder will be available.
When Intermittent IV is selected, Duration will allow the entry of number of doses.
The Duration field cannot start with a “0” (zero).
CPRS allows schedule to be set as PRN for Intermittent IVs.
CPRS allows the user the option to give an additional dose now for inpatient Intermittent orders.
Intermittent IVs may not have a fractional number for an infusion rate.
Quick Orders setup does not allow entry of a fractional number for a pre-defined infusion rate on Intermittent orders.
Quick Orders do not allow entry of a fractional number for an infusion rate on Intermittent orders.
CPRS will display the expected first dose to the user for inpatient Intermittent orders.
9/22/2018

13. Meds Tab Sorts
CPRS will remember the value selected by the provider for the Meds tab sort. This value is store in a new parameter OR MEDS TAB SORT. The first time a user signs into CPRS 27 the Meds tab will default to the original sort. The sort name will be display on the meds tab.
The first format is the existing functionality and is sorted by Location, then by Status Group, then by Stop Date/Expiration Date. The existing functionality uses the following status groups:
Pending
NON VERIFIED
NON-VERIFIED
PENDING
Active/Hold
ACTIVE
ON CALL
REFILL
REINSTATED
RENEWED
SUSPENDED
HOLD
PROVIDER HOLD
DONE
DRUG INTERACTIONS
Expired
EXPIRED
Discontinued/Deleted
DATE OF DEATH ENTERED
DELETED
DISCONTINUED
DISCONTINUED (EDIT)
DISCONTINUED (RENEWAL)
DISCONTINUED BY PROVIDER
PURGE
The first new view is sorted by Status Group, then by Status, then by Location, then by Drug Name. The first new view uses the following Status Groups:
Active
Refill
Hold
Suspended
Provider Hold
On Call
Non-verified
Drug Interactions
Incomplete
Done
Discontinued
Deleted
Discontinued By Provider
Discontinued (Edit)
Reinstated
Renewed
The second new Meds tab view within CPRS is sorted alphabetically by Drug:
Sort by drug name
Status active
Status recent expired (using ORCH context meds stop date)
Medications will sort Inpatient, Outpatient, and Non-VA meds. Each group will sort in their own section on the CPRS Meds tab.
9/22/2018

14. Meds Tab Display
The Recently Expired Orders view available from the Orders tab will no longer display the DC/Edit status of orders. Displays of order status of Expired on both the Meds tab view and the Orders tab are the same.
If the provider should select the DC/Edit version of an order from the
custom order view, and try to renew the order, the following message
will be displayed:
9/22/2018

15. Pending Renewals
CPRS provides the user an option to DC the pending renewal and/or the original order.
When a pending renewal is discontinued, it will return to its original status.
The following message will display if the original order has not expired:
9/22/2018

16. Day-Of-Week Schedule Builder
CPRS Day-of-Week schedule builder will have the ability of assigning a schedule for specific days:
Schedules will have a frequency >0 and <1440.
Users will be able to select a schedule or time, but not both.
9/22/2018

17. Expected First Dose Modifications
Inpatient meds will not display expected first dose for a schedule of One Time or On Call.
Inpatient meds will accept the schedule format from CPRS
Expected first dose will not show if “Give Additional Dose Now” is checked.
9/22/2018

18. Schedule Type
The “Give Additional Dose Now” box is removed for Delayed orders and Schedule type of Once or One Time.
Duration cannot be assigned to an Intermittent IV Order if the schedule has a Schedule Type of Once.
Administration times will not show for the following schedule types: PRN, One time, On Call.
CPRS will store the schedule type of the finished order from pharmacy for Unit Dose Orders. Infusion Order will not store the schedule type with the order.
9/22/2018

19. Provider Comments
Potential of inappropriate or misleading provider comments automatically included on new medication. orders. PSI
Provider comments will display in the Sig until the order is finished, then only if copied into the patient instructions.
If an order is later edited, copied or renewed, the finished patient instruction text will be retained in the new order instead of the original provider comment.
The Transfer action will allow provider comments to roll over into the order dialog for review by the new ordering provider.
CPRS will continue to include both the provider comments and the patient instructions of the original order text in an audit trail.
9/22/2018

20. Provider /Pharmacy Holds
Provider held orders will expire when the stop date has passed.
A Pharmacy held order will expire when the stop date has passed.
Discontinued overrides expired so users are aware a medications has been affirmatively discontinued.
9/22/2018

21. Clozapine Orders Outpatient Clozapine orders
Patients set up weekly are allowed 7 days supply no refills.
Patients set up biweekly are allowed 14 days, or 7 days and one refill.
Patients set up Monthly are allowed 28 days, 14 days and 1 refill, or 7 days and 3 refills.
CPRS GUI will apply the FDA regulatory checks on all clozapine order actions.
CPRS will not allow renewal of inpatient clozapine orders.
CPRS will allow delayed clozapine orders:
CPRS will apply the FDA regulatory check and clozapine order check when the order is accepted.
CPRS will apply the FDA regulatory check and clozapine order check when the order is signed.
New clozapine parameter OR CLOZ INPT MSG:
The purpose of this system level parameter is to broadcast site policies related to management of inpatient clozapine orders.
OR CLOZ INPT MSG will be available on OR PARAM COORDINATOR MENU CPRS Configuration (Clin Coord)
The new parameter will allow sites to define text that will be displayed:
When a new clozapine order is entered.
When clozapine is transferred from an outpatient to an inpatient order.
CPRS will retrieve the text for the new parameter at the initiation of a CPRS session:
If no text is defined, CPRS will check the value of the parameter each time a clozapine order is entered.
If text is defined, CPRS will check the value of the parameter once during the CPRS session.
9/22/2018

22. Clozapine Orders
Days supply checks will be apply when writing a new Outpatient orders written from:
Order Dialogs
Quick Orders
Auto-Accept Quick Orders
Changes Orders
Copy from an existing outpatient orders
Transfer to an outpatient order from an existing inpatient order
Renewal will not be allowed by CPRS
9/22/2018

23. Clozapine Orders Inpatient Clozapine Orders done in CPRS:
CPRS GUI will apply the FDA regulatory checks on all clozapine order actions.
CPRS will not allow renewal of inpatient clozapine orders.
CPRS will allow delayed clozapine orders:
CPRS will apply the FDA regulatory check and clozapine order check when the order is accepted.
CPRS will apply the FDA regulatory check and clozapine order check when the order is signed.
New clozapine parameter OR CLOZ INPT MSG:
9/22/2018

24. Clozapine Orders
Inpatient message for Clozapine if defined in the OR CLOZ INPT parameter and the patient passes the Clozapine order checks.
This message appears if the provider does not YSCL Authorized security key and/or does not have a DEA number or a VA number.
9/22/2018

25. Clozapine Orders
This message appears if the patient is not registered for the Clozapine treatment program
This message appears if the patient does not have a White Blood Count or an Absolute Neutrophil Count within 7 days of placing the Clozapine order.
9/22/2018

26. Clozapine Orders
This order checks appears after placing the clozapine order and a local override is needed to finish the order.
This message appears if a national override is needed to order the clozapine order.
Local Override are needed if
ANC 1.5 and 2.0 K/cmm and/or WBC K/cmm.
Patients must have these levels checked twice weekly until WBC stabilizes > 3.5 K/cmm and ANC stabilizes > 2.0 K/cmm.
Local overrides are performed in pharmacy:
By a local pharmacist who has been given the PSOLOCKCLOZ (Clozapine Manager) key.
The person authorizing the override and the pharmacist entering the override cannot be the same person.
National Override are needed if:
ANC< 1.5 K/cmm and/or WBC< 3.0 K/cmm
Most current WBC and ANC results are not within 7 days
National overrides are performed by the NCCC:
Override is initiated by faxing a progress note from the patient chart which includes: Date of the WBC test, the WBC result, the ANC result, and the suspected reason for the lockout condition.
If blood test values are outside FDA limits, physician approval for the override is required.
NCCC override only remains active for one day.
9/22/2018

27. Patient Safety
A patient order remained active, although numerous attempts were made to discontinue the order. (PSI ). The order is active in pharmacy and pending in CPRS.
The following error message was added.
9/22/2018

28. Patient Safety CPRS Order Entry use of Synonym. (PSI-05-116)
Synonym text will appear at the top of each ordering dialog.
Synonyms will not appear in the order text.
Synonyms will not appear in Quick Order text
An IV fluid order with controlled substance ( CS) additives may be entered without a VA# or a DEA. (PSI )
CPRS now prevents ordering of an IV with a CS without a VA# or a DEA.
User may give additional dose now in the inpatient medication dialog box when they have a medication of Once or One-Time.
(PSI )
The Give Additional Dose Now check box for IV and Unit Dose orders with a schedule of Once or One-Time is now disabled/removed.
The Give Additional Dose Now check box for delayed orders is now disabled/removed.
9/22/2018

29. Patient Safety Order check overrides were not transmitted to the
ancillary service (PSI )
A new message appears upon signature for order
checks marked high.
A new API will be added to allow other packages to read Order Checking data.
A new option will be attached to the Order Checking Mgmt Menu [ORK ORDER CHK MGMT MENU].
9/22/2018

30. Pharmacy/Provider Flags PSI-06-041
Pending orders can be flagged in CPRS, IPM or OPT - Users may flag orders and have updates sent to Outpatient Pharmacy.
Order must be pending.
FL option shows up on Outpatient Pharmacy menu. Upon selection, pharmacy can view flag and reason.
Comments can be entered by pharmacy which display in the order detail and unflag the order in CPRS.
Flag can be initiated and unflagged from either side:
9/22/2018

31. Patient Safety
Schedule Missing from Clinical Reports/pharmacy PSI
Add a new Schedule column in the CPRS Reports.
Rearrange the existing column sequence to: Additives, Solutions, Rate, Schedule, Start Date/Time, Stop Date/Time, [+]Flag
All IV
Active IV
9/22/2018

32. VA/DoD Bi-Directional Health Information Exchange (BHIE) REPORTS
9/22/2018

33. Simplified representation of the FHIE/BHIE architecture:
The VA gets information from multiple DoD sources while DoD gets information from one source - VA Vista. 
9/22/2018

34. BHIE Data Domain
DoD Data Source
CHCS
CDR▼
DMSS
CIS
TMDS
PDTS
Allergy Information X
Consultation Reports
Discharge Summaries
Anatomic Pathology
Cytology (New Source - DoD CDR)
Surgical Pathology (New Source - DoD CDR)
Chemistry Reports
Hematology
Microbiology
Laboratory Orders
Outpatient Pharmacy
Outpatient Visits
Radiology Text Reports
Pre/Post Deployment Health Assessments
Post Deployment Health Reassessments
Problem Lists
Inpatient Progress Notes
Outpatient Progress Notes
Standard Ambulatory Data Record
Admission, Discharge and Transfer
Non-Government Medications (e.g. CVS, Walgreen's)
Vital Signs (New w/CPRS GUI V27)
This chart details the source of data available to VA via CPRS RDV and VistaWeb. Items in blue are new in CPRS GUI V27 (i.e. blue indicates which source (DoD CDR) and information domains (APs and Vitals) that are added or updated in CPRS GUI V27 and related BHIE Release 3a)
9/22/2018

35. CPRS V27 adds Vital Signs to the DoD Data Tree in RDV
CPRS V27 presents DoD remote data only – no longer contains local or other VA data
CPRS V27 adds Vital Signs to the DoD Data Tree in RDV
9/22/2018

36. CPRS V27 Clinical Reports “Anatomic Pathologies” present local and other VA remote data only – no longer contains DoD remote data
9/22/2018

37. In Summary – CPRS V27 changes to assist VA/DoD sharing include:
The addition of Vital Signs to the DoD tree of Remote Data Views
The addition of the DoD CDR (Clinical Data Repository) as a data source for Vital Signs, Surgical Pathology and Cytology reports
CPRS V27 presents DoD remote data only for Surgical Pathology and Cytology reports in the DoD tree of Remote Data Views – no longer contains local or other VA data
CPRS V27 presents Surgical Pathology and Cytology reports contain Local and Other VA data only in the Clinical Reports tree of Remote Data Views – no longer contains DoD data
9/22/2018

38. VBECS/CPRS
Comprehensive CPRS/VBECS Functional Training will be provided when VBECS is nationally released in the fall of 2008.
There are three CPRS GUI v27 VBECS test sites:
Philadelphia (March 29, 2008)
Heartland-East (July 19, 2008)
San Diego (August 9, 2008)
9/22/2018

39. All Other CPRS GUI v27 Changes
Cancelled on Discharge from Observation (PSI )
Order Checks
Accidental Signing of Old Orders (PSI )
Reason for Flag Changes
Quick Order
Dietetic Order Changes
Original Verbal Orders Signature
Patient Inquiry
Patient Record Flag
Patient Selection
Project 112/SHAD
Reports
Remote Data Displays
Team Lists
Section 508 Changes
Alerts
Allergies
Clinical Reminders
Conflict between encounter location and inpatient location Schedule Type
Consults
Current Activities Form
Discharge Summary
Labs Tab
Notes
Radiology Order Changes
Lab Order Changes
9/22/2018

40. SECTION 508 CHANGES
Huge effort has been made in CPRS GUI v27 to improve usability and accessibility.
Framework developed that directly communicates with screen readers. Currently only implemented for JAWS 7.1 or higher. Numerous screen reader issues resolved using framework.
Many font issues addressed.
Many Keyboard navigation issues addressed.
Alternate color scheme support added.
Other miscellaneous 508 changes.
9/22/2018

41. REASON FOR FLAG to Display When Processing Flagged Order Alert
ALERTS
REASON FOR FLAG to Display When Processing Flagged Order Alert
REASON FOR FLAG to Display When Processing Flagged Order Alert
When a user is processing a flagged order alert, the REASON FOR FLAG did not display in the order text on the Orders tab.
Resolution: When a user processes the Flagged Order alert, the REASON FOR FLAG will now display on the Orders tab. It will not display there when not processing notifications. In both cases, the reason will still be included in the order details as it currently is. This functionality now matches CPRS List Manager
9/22/2018

42. ALERTS Flagged Order Alert Processing
Problem
If a user flags an order and adds another recipient the order shows a red flag for both users and a notification for both users. If the first user unflags the order, the notification and the flag disappears from both users. The second user's notification (and flag) do not operate independently.
Solution
Now when the first user unflags the order (which clears his notification) the second user’s flagged order alert remains because that user still has a flagged order to view
9/22/2018

43. ALERTS Improved Surrogate Validation and Forwarded Comments Button
Previously, surrogate validation was done by CPRS’s own internal method. Comments were only displayed in a hover hint.
Resolution: Developers standardized the surrogate validation code (Tools/Options/Notifications) to use a new supported Kernel API. Developers also added a Show Comments button to patient selection screen that allows users to display comments added by forwarder when forwarding an alert.
9/22/2018

44. ALERTS
Remedy #215189, NSOC ticket #VA Sensitive record check bypassed when using CPRS GUI to process alerts. This has never worked correctly, but is now fixed in v27. There are 2 known issues remaining, both only when an alert can't be processed at all because viewing that patient is denied:
If that alert is the first in the list to be processed, then following the "access denied" message, the patient selection screen will open, and any subsequent alerts that were previously selected will need to be selected again.
In any other sequence, alerts up to and including the "access denied" message will process correctly. At that point, the user cannot continue processing alerts using the NEXT button or menu, and must go back to the patient selection screen to continue, or reselect additional alerts.
9/22/2018

45. ALERTS Make Anatomic Pathology, Pap Smear, Mammogram Notifications Action Alerts
Modify the following three notifications, making them action alerts rather than informational alerts
o        MAMMOGRAM RESULTS
o        PAP SMEAR RESULTS
o        ANATOMIC PATHOLOGY RESULTS
Clicking on the alert should take the user to the related report on the Reports tab.
9/22/2018
PSI /PSI /PSI /PSI-07-14/PSI

46. TEAM LISTS Personal Team Lists Exclusions from GUI Applications
Exclude from GUI Applications
Previously, when a team list was created, it was visible to all users. This created clutter and could cause a breach of confidentiality if all patients on the list had HIV or some similar disease. Simply seeing the list might allow users to know more than they should about a patient.
Resolution: Developers added a new option to the ORLP TEAM MENU named ORLP TEAM LIST VISIBILITY. Team lists can be updated singly or in batch. Visibility options are: NOBODY or ALLUSERS. OPTIONS ARE OWNER OR ALLUSERS.
Some team/personal lists may be sensitive based on their name and the patients they contain. Now with CPRS 27, a new field VISIBILITY has been added to the OE/RR LIST file
This field can be set to OWNER or ALLUSERS for a specific patient list. If it is set to OWNER only the owner can view it in CPRS. If set to ALLUSERS then it is visible to all users in CPRS. Option ORLP TEAM LIST VISIBILITY on the ORLP TEAM MENU allows users to manage the visibility of Team Lists
9/22/2018

47. ALLERGIES Remove Default for Value for Observed/Historical (E3R 19668)
Previously, the allergy dialog had a default for whether an allergy was observed or historical. User might not check to ensure that the correct value was selected.
Resolution: Developers removed the default value for the “Observed/Historical” radio button group, and the user will need to select one or the other to complete the entry of the allergy or adverse reaction.
9/22/2018

48. ALLERGIES Users Can No Longer Change the “Originator”
Previously, on the Allergy Entry dialog, the “Originator” defaulted to the user who was logged in, but the user could change the “Originator” to another user. This was not consistent with the List Manager version of the Adverse Reaction Tracking package.
Resolution: Developers changed CPRS so that the “Originator” selection continues to default to current user, but is no longer editable.
9/22/2018

49. ALLERGIES
Cannot Add the New Allergy Entry/Edit Dialog to the Write Orders List (Remedy #189377)
Resolution: User can now add the new allergy entry/edit dialog because developers changed the parameter ORWOR WRITE ORDERS LIST to accept entries of type ACTION in file
9/22/2018

50. Clinical Reminder Enhancements & Mental Health Assistant
YS*5.01*85
PXRM*2.0*6
GMTS *2.7*77
Nationally Released January 7, 2008
9/22/2018

51. MHA dll-- YS_MHA.dll Distributed with patch YS*5.01*85
Must be placed in Common Folder, same location as vitals dll
Will be utilized in CPRS v27 for reminders to present MHA instruments in reminder dialogs
Enhances functionality of MH Instruments used in Reminder Dialogs
Users need option YS BROKER1 to be able to use MHA instruments in reminder dialogs with CPRS v27
Instruments with free text responses can only be used in reminder dialogs once the dll is activated
BOMC,
TBI 2nd level evaluation
9/22/2018

52. New YS Option
YS Broker1
This needs to be assigned as a secondary menu option to users who will do the following
Process MH tests in the new MHA3 executable
Have access to reminder dialogs in CPRS
Consider the same as the OR CPRS GUI CHART option
9/22/2018

53. Use of MH DLL Parameter
OR USE MH DLL is a new parameter that is set to “Y” when CPRS 27 is installed.
This is a system level parameter
This parameter determines if CPRS should try to use the MH DLL when processing a MH Test from a Reminder Dialog.
This parameter can be set to No to have CPRS default to processing the MH test the old way
We want sites to use the MH DLL, because this contains all the functionality needed to support the changes in the New National Reminder Dialogs.
9/22/2018

54. Changes to Reminder Dialogs
Result groups must point to a MH test and a valid scale for the MH test
Multiple result groups can be used for a MH test (CPRS 27 and MH DLL)
Informational pop-up message with result elements (CPRS 27 and MH DLL)
MH test required functionality has been changed (CPRS 27)
9/22/2018

55. Pop-Up Informational Text
NAME: PXRM PHQ2 RESULT ELEMENT 2
RESULT CONDITION: I SCORE>2//
PROGRESS NOTE TEXT:
A PHQ-2 screen was performed. The score was |SCORE| which is a positive screen for depression.
INFORMATIONAL MESSAGE TEXT:
The PHQ-2 is positive. A PHQ-9 and also a suicide risk evaluation should be performed for any positive PHQ-2.
9/22/2018

56. Informational Pop-up with patches and CPRS v27
9/22/2018

57. Reminder Dialog Changes seen with CPRS v27
MHA dll can be used (can also be disabled)
With CPRS 27 and MH dll active
Progress note text has no extra instruction text
Can use the new features in dialogs
Pop up informational message for MH tests, MH test required, require all elements in a group
9/22/2018

58. PHQ-9 with patches and v27 with dll
No drop down lists; type the number for each question; Q10 is included
9/22/2018

59. Conflict between encounter location and inpatient location
Scenarios
Patient is an inpatient and is being seen at an outpatient location
Patient is admitted while being seen at an outpatient location and the provider is in CPRS.
9/22/2018

60. Conflict between encounter location and inpatient location
Old Forms in CPRS 26
Non-IMO location
IMO location
9/22/2018

61. Conflict between encounter location and inpatient location
Changes for CPRS 27
Standard form for both IMO and Non-IMO clinics.
Allows location to be assigned to individual orders.
Allows provider to determine encounter location when refreshing the chart instead of CPRS automatically going back to the inpatient location.
9/22/2018

62. Conflict between encounter location and inpatient location
When the patient location is different than the order location, the Order Location Switching box will activate when signing orders
Every order must have a location defined.
To complete the form, a continue processing data location must be selected.
If printing is set up, the order will print to the selected location for each order.
9/22/2018

63. Conflict between encounter location and inpatient location
When leaving a patient chart and the patient location is different than the order location, the Where would you like to continue processing patient data? section will be inactive.
9/22/2018

64. Conflict between encounter location and inpatient location
When the patient and encounter locations are different and no current orders have been written, select File/Refresh patient information to bring up the Refresh Encounter Location Form and choose the desired location.
This can also happen when the patient location changes during an ordering session and the user has the Order Location Switching From open. The user can get to the new location by finishing the current order and refreshing the patient information. The new location will appear on the Refresh Encounter Location form.
9/22/2018

65. CONSULTS Add/Remove buttons have been added to the Consult Actions Send Alert Dialog
9/22/2018

66. Consults Complete Consults without Viewing Reason for Request
Consults completed without viewing reason for consult
Added right-click option to note editing menu to display details of consult being completed while editing a consults-titled note
9/22/2018
PSI (Part 4):

67. Direct Edit or Skip Reason for Request Field When Using Templates
CONSULTS
Direct Edit or Skip Reason for Request Field When Using Templates
Users Could Directly Edit or Skip Reason for Request Field When Using Templates
Previously, when a user was ordering a consult, cancelling a template dialog linked to a Reason for Request allowed this field to be edited directly, instead of requiring the entries on the template.
Resolution: In this version, cancelling out of a template dialog will also abort that order, following user confirmation.
9/22/2018

68. CONSULTS Alert Changes
Consults Alert Changes (Remedy #151414)
When sending alerts on addition of a comment to a consult request, no distinction was made between service update users defined at the service level and update users defined as “unrestricted access” for that service. Alerts were being sent incorrectly or not sent at all as a result of this.
Resolution: CPRS developers made the necessary changes to support patch GMRC*3.0*55
PSI
9/22/2018

69. CONSULTS Alert Changes (cont)
When a user takes an action on a consult that generates an alert, that individual should not receive the alert.
If an ordering provider, that is a member of a consult team, takes an action on a consult, the alert should be sent to the consult team and not to the ordering provider.
If an unrestricted access user, that is not the ordering provider or a member of the consult team, acts on a consult, the alert should be sent to both the consult team and the ordering provider.
PSI
9/22/2018

70. CONSULTS Text Wrapping Problem in Consult/Procedure Reason for Request
When a user entered a consult or procedure, the text for the consult/procedure Reason for Request was correctly wrapping at 74 characters, as required to maintain List Manager and File Manager editor compatibility, but hard returns were being inappropriately inserted. This caused the text to break up and have a choppy appearance when saved.
Resolution: Developers corrected the problem so that the text correctly flows into paragraphs that are still 74 characters wide.
9/22/2018

71. CURRENT ACTIVITIES Focus defaults to the “Encounter Provider” list box
Modified to default to the Encounter provider when user is a
non-provider.
Modified to default to the Encounter provider when the user is a non-provider.
PSI
9/22/2018

72. CURRENT ACTIVITIES Additional click in the Visit Location field no longer required.
9/22/2018

73. DATE/TIME SELECTION Users Can Select an Invalid Time (Remedy #153432)
From the CPRS date/time chooser dialog, the user can choose 00:00 from the time columns. Since it’s unclear what that means in terms of a date, CPRS currently changes it to 00:00:01. (Similarly, clicking “midnight” enters a time of 23:59.) But then, back on whatever form called this dialog, those seconds are stripped from the time, leaving the time at 00:00, and that’s the time that gets used.
Resolution: Developers changed CPRS so that selecting an hour of “00” will cause the minutes of “00” to change to “01”, making the selection of a “00:00” time impossible. Typing in a “00:00” will result in a value of "00:01" being returned to the calling date box when OK is selected.
9/22/2018

74. DISCHARGE SUMMARY
Discharge Summary attending physicians now respect user classes
Discharge Summary attending physicians now respect user classes
They must be in the PROVIDER user class, or one of it’s descendent user classes.
They must be in a user class that does not require a cosigner, based on the selected document title. And document definition has to set USERS REQUIRING COSIGNATURE.
Only users that meet the above criteria will display in the list of providers that can be selected as attending physicians.
9/22/2018

75. LABS TAB Most Recent Labs/Worksheet
Caption on the Most Recent Labs Shows 00:00 when No Time Is Entered (Remedy #123277)
For the caption on the Labs tab for the “Most Recent Labs” grid and Worksheet, if a lab result had a date but no associated specific time, CPRS was displaying “00:00” if no time was present for those results.
Resolution: If no specific time is entered for an unknown time), CPRS will display only the date. This change applies to the Most Recent Labs and Worksheet views.
PSI
9/22/2018

76. NOTES User Able to Add Disallowed Author or Cosigner
On the “additional signers” screen, when a user clicked on the selection list for either the current author or cosigner, or for an already selected additional signer, CPRS correctly displayed an error message that the selection was not allowed. However, if the user then clicked the “Add” button immediately after the error message, CPRS would still add the disallowed selection to the list.
Resolution: Developers corrected this problem; CPRS will not add the inappropriate selection.
9/22/2018

77. Radiology Orders Added Reason for Study field
Removed default value for Desired Date Default field (E3R 19834)
The Radiology package is implementing a PACS messaging and Voice Recognition interface that needs “Reason for Study” split out from “Clinical History”. Prior to this version, “Clinical History” had been a catch-all; it collected unlimited text. The users have been accustomed to entering both the clinical history of the patient and the reason for the study.
Resolution: Developers added a new “Reason for Study” prompt to the Radiology ordering dialog. CPRS still prompts for “Clinical History”, but it is no longer required, while “Reason for Study” is a required entry, 64 characters maximum.
Developers also added validity checking to CPRS for the optional “Clinical History” field. Following Radiology’s validation rules, if something is entered in this field, CPRS will validate that this field contains at least one occurrence of two consecutive alphanumeric non-space characters. If it does not find them, CPRS will display a warning message and will not accept the order.
Remove Desired Date Default (E3R 19834)
Previously, when a user placed a radiology order, the prompt for Date Desired defaulted to TODAY.
Resolution: Developers removed this default as requested. This field remains required, but is now displayed with no default.
9/22/2018

78. ORDERS Lab Collect vs. Ward Collect
System changes the order from lab collect to ward collect
Previously, for inpatient lab orders that are of type “lab collect” or “immediate collect”, if a continuous schedule was selected (such as QD or QWEEKLY) and a child order falls on a day when the lab cannot perform the collection (for example, weekends or holidays), the collection type was automatically changed to “ward collect” but CPRS did not warn to the user.
Resolution: Developers added an advisory window that initially appears when the user selects “Accept” for that order, advising of any such changes to child orders. If these orders are left unsigned, the same advisory window will also appear at the point when they are signed or released at some future date.
PSI
9/22/2018

79. Cancelled on Discharge from Observation
Delayed Orders Entered for Transfer to Surgery Cancelled on Discharge from Observation (Remedy #180390, E3R #20065)
When an inpatient was in a ward with an observation treating specialty and the patient was transferred, the delayed orders were inappropriately cancelled.
Resolution: Developers changed CPRS so that transfer events will no longer be selectable from the delayed orders event selection list for patients in an observation treating specialty.
PSI
9/22/2018

80. IV / Infusion Orders GUI v27 IV/Infusion order changes will result in:
All orders finished as ‘IV’ in Inpatient Medications will now be displayed in the Infusion display group
These orders will be edited using the Infusion dialog
Must be marked as ‘USED IN IV FLUID ORDER ENTRY’ as YES.
9/22/2018

81. IV / Infusion Orders File 52.6 – IV ADDITIVES File 52.7 – IV SOLUTIONS
If these items are not marked as YES, then an attempt to CHANGE, RENEW, etc. in CPRS will result in the following error box:
9/22/2018

82. IV / Infusion Orders
9/22/2018

83. IV / Infusion Orders To update the IV Solutions file:
Select OPTION NAME: PSSJI SOLN PRimary Solution File (IV)
PRimary Solution File (IV)
Select IV SOLUTIONS PRINT NAME: DEX DEXTROSE 10% ML
NATL FORM; 500ML SOLN IN 1000ML BAG
PRINT NAME: DEXTROSE 10%//
PRINT NAME {2}:
GENERIC DRUG: DEXTROSE 70% 500ML IN 1000ML BAG//
VOLUME: 500 ML//
Select ELECTROLYTES:
Select SYNONYM: D10W//
DRUG INFORMATION:
No existing text
Edit? NO//
AVERAGE DRUG COST: 7.45//
INACTIVATION DATE: JUN 21,1989//
USED IN IV FLUID ORDER ENTRY: NO//  This prompt should be evaluated and set to YES if the entry is used as an IV Solution.
9/22/2018

84. IV / Infusion Orders To update the IV Additives file:
Select OPTION NAME: PSSJI DRUG
1 PSSJI DRUG ADditives File
2 PSSJI DRUG INQUIRY Drug Inquiry (IV)
CHOOSE 1-2: 1 PSSJI DRUG ADditives File
ADditives File
Select IV ADDITIVES PRINT NAME: DEXDEXAMETHASONE
NATL FORM (NDC)
PRINT NAME: DEXAMETHASONE//
GENERIC DRUG: DEXAMETHASONE 4MG/ML 1ML INJ//
USED IN IV FLUID ORDER ENTRY: YES//  This prompt should be evaluated and set to YES if the entry is used as an IV Additive.
9/22/2018

85. Order Checks
Order Check Override Text Not Transmitted to Ancillary Services (PSI )
Order checking screen (dialog) can now be resized.
A "Return to Orders" button was added. Pressing the button does not cancel the order, only the signature process
Extra informative text above the critical order check justification was added
Order Check Override Text Not Transmitted to Ancillary Services
Ordering provider may assume service receives this information
Only contained within detailed display of order, which is not visible via ancillary service’s software application.
Resolution – current system
Include short description of purpose of override reason in pop up box for CPRS user.
Critical order check override reasons must be included with orders released to ancillary services.
Provide utilities to review critical order check override reasons. Allow for reports to be extracted and sorted by division, display group and other appropriate data fields
Ancillary services must make provisions to have order check override reasons viewable via their VistA applications.
PSI PART 3: Provide utilities that enable facilities to review critical order check override reasons.  Allow for reports to be extracted and sorted by division, display group and other appropriate data fields.
Option:
There is one new option being exported with the OR*3*243 patch. It will be attached to the Order Checking Mgmt Menu [ORK ORDER CHK MGMT MENU]:
Order Check Override Reason Report [ORK ORD CHK OVERRIDE REPORT]
The reporting utility will be accessible via the above menu option and tree.
Summary of Resolution & Features:
This reporting utility will allow the user to review the critical order check override reasons by extracting reports and filtering them by search criteria such as the DATE/TIME ORDERED, DIVISION, DISPLAY GROUP, ORDER CHECK, & OVERRIDDEN BY fields.
The report will be sorted in ascending order by any combination of these fields depending on what search option is chosen. For example, the following sort orders will be applied in correspondence to the chosen search options:
Select one of the following:
DATE/TIME ORDERED & OVERRIDDEN BY
DATE/TIME ORDERED & ORDER CHECK
DATE/TIME ORDERED & DIVISION
DATE/TIME ORDERED & DISPLAY GROUP
DATE/TIME ORDERED, DIVISION, & DISPLAY GROUP
FILTER SEARCH by: 1//
1) Date/Time Ordered, Division, Display Group, Order Check, & Order #.
2) Order Check, Division, Display Group, Date/Time Ordered, & Order #.
3) Division, Display Group, Order Check, Date/Time Ordered, & Order #.
4) Display Group, Division, Order Check, Date/Time Ordered, & Order #.
5) Date/Time Ordered, Division, Display Group, Order Check, & Order #.
***Please see the test plan for PSI : Order check overrides not transmitted to ancillary service, part 3 on the CPRS GUI v27 test site webpage for more information.
9/22/2018

86. ORDER CHECKS
9/22/2018

87. Accidental Signing of Old Orders
Accidental Signing of Old Orders in CPRS. The review/sign order form will be changed to group orders together by the current session, previous session and by all other user orders written in a previous session.
The section that appears in this form are based off the value assigned to this parameter OR UNSIGNED ORDERS ON EXIT.
NEW ORDERS ONLY will only show the first group.
MY UNSIGNED ORDERS will only show the first two groups.
ALL UNSIGNED ORDERS will show all three groups.
PSI
9/22/2018

88. Accidental Signing of Old Orders
When canceling orders that are unsigned, orders that are canceled outside of the session will no longer be deleted but actually canceled and retained.
Old unsigned orders will now be lapsed based on the OR LAPSE ORDERS and OR LAPSE ORDERS DFLT parameter values.
A nightly task job will flag lapsed orders.
Option OR LAPSED ORDERS will be added under the OR PARAM COORDINATOR MENU. This is a utility to pull up reports on orders that have been lapsed due to provider’s failure to sign the order before the lapse period expires.
PSI
9/22/2018

89. ORDERS
REASON FOR FLAG Field Changed from Free-Text to Drop-Down List with Free-text Allowed
Resolution: When a user flags an order, the REASON FOR FLAG field has been changed from a free-text entry to a selection of standard reasons defined by the site in parameter (OR FLAGGED ORD REASONS). Users can append additional free-text to the selected reason, or enter a free-text reason of their own instead of selecting from the list. The field limit is 80 characters.
9/22/2018

90. ORDERS Duplicate Personal Quick Order Names
It was possible for a user to enter a new personal quick order name that is a duplicate of an existing quick order name in the same display group type.
Resolution: Developers corrected this problem. Users can no longer enter a duplicated quick order name for a quick order in the same display group type. CPRS will also prohibit renaming an existing personal quick order to a name that matches an existing entry, regardless of upper/lower case.
9/22/2018

91. ORDERS Dietetics
Sequence Problem with Delayed NPO at Midnight and Other Diet Orders
For inpatient delayed diet orders, if an “NPO at Midnight” were ordered, followed by any other diet with a start date prior to midnight and no expiration date, the NPO order will be discontinued on release and replaced by the second order. If placed in the reverse sequence, both orders are released correctly and remain in effect.
Resolution: User is now prompted about the possible conflict, and instructed on how to prevent it from happening by entering explicit start and stop date/times for any diet orders defined for that same release event. Developers also added code to check for auto-accept diet quick orders, immediate and delayed, that would auto-DC because of overlapping start/stop times.
For event-delayed, auto-accept diet quick orders, CPRS checks for conflicting orders for the same release event, and if the user answers NO to the prompt about having adjusted the start/stop dates, CPRS displays the diet order dialog with that quick order pre-loaded so date adjustments can be made.
PSI
9/22/2018

92. ORDERS Original Verbal Orders Signature
Problem
A verbal order is entered by a nurse and the receiving service makes a service correction and fills the order. Because of this the ordering provider is not getting a chance to sign anything related to the order because of the service correction.
Resolution
The original verbal order will stay in need of a signature despite the service correction and will show on the ordering provider's unsigned orders list.
9/22/2018

93. PATIENT INQUIRY Patient Demographic Updates
2nd Next of Kin (NOK)
as additional emergency contact information
Patient cell phone number
to facilitate more timely appointment rescheduling
9/22/2018

94. PATIENT RECORD FLAGS Date, author, etc
PATIENT RECORD FLAGS Date, author, etc.. can now be changed from a PRF note title.
9/22/2018

95. PATIENT RECORD FLAGS Category I Flags stand out from Category II flags.
9/22/2018

96. PATIENT SELECTION
Provider selecting wrong patient with same first/last name
Remove highlight of the first entry in a possible list of patient names
PSI
9/22/2018

97. Project 112/SHAD Added a checkbox to the Visit Type tab
Added checkbox to encounters, orders and problems
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.
9/22/2018

98. Review/Sign Changes
9/22/2018
Project 112/SHAD

99. REPORTS Viewing Multiple Anatomic Pathology Reports
Problem:
It is difficult to distinguish the separation between multiple Anatomic Pathology (AP) reports for a single patient on the CPRS GUI Labs Tab and certain Reports Tab formats.  The individual reports currently present as one continuous scrolling display and a single row of the equal sign (=) is used to separate one report from the next.  Additionally, the text – ‘Next <AP SECTION NAME> Specimen…’ is also used to separate AP sections in the report. 
Resolution:
Cytology, Surgical Pathology, & Electron Microscopy reports are separated out & listed individually in a grid type display.
Upon selection each report can be viewable in the textbox area underneath the grid display helping to distinguish the different reports.
Pending Issue
AP Reports under DOD still use the old text format.  Any changes to this need to be coordinated with FHIE development.
9/22/2018
PSI and PSI

100. REPORTS Viewing Multiple Anatomic Pathology Reports
Labs Tab
The Labs Tab has been redesigned to have the same look and feel as the Reports Tab.  The list of reports on the left side of the screen is now a treeview rather than a listbox.  A grid control has been added so that reports can be displayed in a grid format, like what is used on the Reports Tab.
PSI and PSI
9/22/2018

101. REPORTS Viewing Multiple Anatomic Pathology Reports
Resolution: EM Report
--Electron Microscopy report format changed from a text only report to a grid type display.
PSI and PSI
9/22/2018

102. REPORTS Viewing Multiple Anatomic Pathology Reports
PSI and PSI
9/22/2018

103. REPORTS Remote Data Displays
DoD Data do not display in Remote Health Summaries, even when data are available (and viewable via DoD tree or Clinical Reports)
PROBLEM: When using the CPRS Reports tab, if a patient has Remote DOD data available and the user attempts to retrieve a Health Summary report via the DOD tab (with Dept. of Defense checked in the Remote Data button), the report does not populate.
PSI
9/22/2018

104. REPORTS Remote Data Displays
This has been resolved by providing ‘cognitive’ information when data is excluded on a report query.  For text reports only, a comment, showing the problem is added where the report would normally be.  For ‘grid’ type reports, the error comment is put in the first column (after the facility name) of the report.  Here are some examples of the comments that could show up, depending on the type of query and what the user has selected:
PSI
9/22/2018

105. REPORTS Remote Data Displays
Resolution Error Messages
<No HDR Data Included> - Use "HDR Reports" menu for HDR Data.
<No HDR Data> This site is not a source for HDR Data.
<No DOD Data> - Use "Dept. of Defense Reports" Menu to retrieve data from DOD.
<ERROR>- Unable to communicate with Remote site
PSI
9/22/2018

106. REPORTS Remote Data Displays
Resolution: Error Message on Blue Button
In addition to this text, error messages will also be shown after each remote site listed under the (blue) Remote Data View button, when appropriate.
PSI
9/22/2018

107. REMOTE Data Displays Resolution: OE/RR Reports File
Additional data has been added to the OE/RR REPORTS file (#101.24) to resolve this problem, which means that this file will be re-exported, with data, in patch OR*3.0*243.  As part of the pre-init process, entries in this file with internal numbers greater than 999 will be deleted and re-installed.  This is a pretty common occurrence with all releases of the CPRS GUI.
PSI
9/22/2018

108. REPORTS Remote Data Displays--HDR Data
Clinical Reports ->Allergies: Notice the error message <No HDR Data Included> - Use “HDR Reports” menu for HDR Data
PSI
9/22/2018

109. REPORTS Remote Data Displays--HDR Data
PSI
9/22/2018

110. REPORTS Remote Data Displays--DoD Data
Note the error message: <No DOD Data> - Use “Dept. of Defense Reports” Menu to retrieve data from DOD
PSI
9/22/2018

111. REPORTS Remote Data Displays—Error Messages
PSI
9/22/2018

112. CPRS v27 RDV changes
Enhancements in CPRS 27 have the following advantages from previous functionality:
Easier access to VistaWeb and RDV.
Both methods for accessing remote data are always available.
No longer necessary to change Remote Data Tool Settings when changing users Remote Data tool default.
Time savings for Clinical Coordinators.  No longer need to help providers reset their default back to RDV.
More intuitive interface to Remote Data.
Simplifies user training for use of Remote Data Tools.
VistaWeb access is always available regardless of patient’s presence in Master Patient Index (MPI).
9/22/2018

113. Additional Information
Links to CPRS GUI v27 website
Installation Instructions
Test Scripts
Training Presentations and other Training Materials
Spreadsheet of Resolved Remedy Tickets
Test Sites and Points of Contact
Functional Item Spreadsheet
9/22/2018

114. QUESTIONS
9/22/2018