SURGERY (127)    PACKAGE (9.4)

Surgery patch SR*3*58, SURGERY INTERFACE TO PCE.

Surgery patch SR*3*66 includes modifications specifically for Imaging.

1. The Surgery-Tracking Prosthesis Items project enhances the Surgery
 
2. Unrelated to the Prosthesis features, the trigger event for
   discontinuing orders will be moved from the TIME PAT OUT OR field
   (#.232) of the SURGERY file (#130) to the TIME PAT IN OR field (#.205)
   of the SURGERY file (#130). This enhancement is required as part of
   the Documenting Preoperative Antibiotics (Gainesville Solution)
   project.
 
3. On the Nurse Intraoperative Report, replace references to CORRECT
   SURGERY COMMENTS to TIME OUT VERIFIED COMMENTS, IMAGING CONFIRMED
   software, adding new fields to the PROSTHESIS INSTALLED sub-file
   COMMENTS, and MARKED SITE COMMENTS, as appropriate.
   (#130.01) in the SURGERY file (#130). These new fields will
   function to mark the prosthesis item as sterile and record the
   expiration date of the sterile implant. The information entered into
   these fields will display on the Nurse Intraoperative Report. As an
   added safety/quality measure, the new fields will be mandatory for
   signing the Nurse Intraoperative Report. The report cannot be signed
   until all documentation is completed.

This patch updates the Surgery Risk Assessment software of the Veterans
 
Cardiac Risk Assessment Modifications
-------------------------------------
- The software is modified to expand the answer options of the PREOP
  CIRCULATORY DEVICE field (#474) to include "ARTIFICIAL HEART" and to 
  transmit "A" to CICSP for new raw value of this answer option.
 
- This patch modifies all Lab fields under the Laboratory Test Results
  (Enter/Edit) [SROA LAB-CARDIAC] option to assume a past date if the user
  enters a date without a year.
 
Non-Cardiac Assessment Modifications
- Reinstitute the default functionality of the CARDIAC SURG PERFORMED 
  NON-VA field (#472) in the SURGERY file (#130), so that it defaults to
  "NO". 
 
- The description is updated and/or other data dictionary changes are made
  for the following items:
   o CONGESTIVE HEART FAILURE field (#207)
   o ON VENTILATOR >48 HOURS field (#285)
   o PERIOPERATIVE MI field (#385)
   o PREOP CIRCULATORY DEVICE field (#474)
------------------------------------
   o AORTIC STENOSIS field (#477)
 
- Data Quality Queries
  The data entry that does not meet the criteria is permitted, but would 
  cause a warning message to check the data for accuracy.
   o The D/T PATIENT EXTUBATED field (#470) should be later than the TIME
     PAT OUT OR field (#.232).
   o The D/T PATIENT EXTUBATED field (#470) should be earlier than the D/T
     PATIENT DISCH FROM ICU field (#471).
   o The D/T PATIENT DISCH FROM ICU field (#471) should be later than the
 * Note: All fields named below are in the SURGERY file (#130) unless 
     D/T PATIENT EXTUBATED field (#470).
   o D/T PATIENT DISCH FROM ICU field (#471) be equal to or earlier than
     the HOSPITAL DISCHARGE DATE field (#419).
   o The SURGICAL PRIORITY, DATE field (#414.1) should be earlier than
     the TIME PAT IN OR field (#.205).
   o The ESTIMATE OF MORTALITY, DATE field (#364.1) should be earlier than
     the TIME PAT IN OR field (#.205).
   o If TOTAL CPB TIME field (#451) > 0, the CONVERT FROM OFF PUMP TO CPB
     field (#469) should not be answered "NO, began off/stayed off".
 
         otherwise indicated.
 
General Surgery Items
---------------------
- Remedy Ticket #HD0000000152814
  This patch addresses two issues related to the Update Assessment Status
  to 'COMPLETE' [SROA COMPLETE ASSESSMENT] option missing items list:
  (1) For the NUM OF PRIOR HEART SURGERIES field (#352) in the SURGERY
      file (#130), the field is corrected to display "Number of Prior
      Heart Surgeries" instead of "Prior Heart Surgery (Y/N)".
  (2) For the field "PRIOR HEART SURGERIES" field (#485) in the SURGERY 
 
      file (#130), the data input functionality is modified to use the
      same controlled data input functionality used by the Clinical
      Information (Enter/Edit) [SROA CLINICAL INFORMATION] option. 
 
- Remedy Ticket #HD0000000177807
  After installing this patch, if procedure and diagnosis coding is not
  complete at the time the Update Assessment Status to 'COMPLETE' [SROA
  COMPLETE ASSESSMENT] option is run, the software will display "The
  coding for Procedure and Diagnosis is not complete" immediately before
  asking, "Are you sure you want to complete this assessment ?".
- These updates include functionality for selecting cases for risk
 
- Remedy Ticket #HD0000000185045
  When using the Outcome Information (Enter/Edit) [SROA CARDIAC-OUTCOMES] 
  option to edit the OPERATIVE DEATH field (#384), entering YES or NO 
  causes the NEW MECHANICAL CIRCULATORY field (#467) to be changed to the 
  same value. Editing the NEW MECHANICAL CIRCULATORY field (#467) field 
  does not change the OPERATIVE DEATH field (#384).
 
- Short LOCK Timeouts
  This patch updates the 1 second LOCK timeouts in the routine SROUTL to 
  assessment based upon case Current Procedural Terminology (CPT) codes,
  use the VA FileMan variable DILOCKTM if it exists.
  replacing the use of the Major or Minor surgery definition.
   o When selecting a case to be assessed, the software will check the 
Health Information Systems and Technology Architecture (VistA) Surgery
     case CPT codes and display an informational statement if no CPT codes
     have been assigned to the case or if the case should be excluded from
     assessment.
   o A new report called "List of Eligible Cases" is added to the reports 
     contained in the List of Surgery Risk Assessments [SROA ASSESSMENT 
     LIST] option.
   o The MAJOR/MINOR field (#.03) is removed from NSQIP input options and 
     from the Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] 
     option.
 
application as requested by the Executive Board of the National Surgical
- A new field called INTRAOPERATIVE ASCITES (#446) is created:
   o Added to the Operation Information (Enter/Edit) [SROA OPERATION DATA]
     option
   o Added to the Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] 
     option
   o Added to data set transmitted to the national database
 
- A new field called CLOSTRIDIUM DIFFICILE COLITIS (#447) is created:
   o Added to the Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] 
     option
Quality Improvement Program (NSQIP) and by the Cardiac Surgery Consultants
   o Added to the PERIOPERATIVE OCCURRENCE CATEGORIES section of the 
     Surgery Quarterly Report
   o CLOSTRIDIUM DIFFICILE COLITIS is added as a new occurrence category 
     to the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5)
 
- The description is updated and/or other data dictionary changes are made
  for the following items:
   o SURGERY SPECIALTY field (#.04)
   o WOUND CLASSIFICATION field (#1.09)
   o REASON FOR NO ASSESSMENT field (#102)
Board of the Continuous Improvement in Cardiac Surgery Program (CICSP).
   o HISTORY OF COPD field (#203)
   o WEIGHT LOSS > 10% field (#215)
   o BLEEDING DISORDERS field (#216)
   o OPEN WOUND field (#218)
   o PREOPERATIVE SEPSIS field (#218.1)
   o PREVIOUS PCI field (#220)
   o SYSTEMIC SEPSIS field (#250) and the SYSTEMIC SEPSIS occurrence 
     category in the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5)
   o PNEUMONIA field (#251) and the PNEUMONIA occurrence category in the 
     PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5)
The updates include the addition of new data fields, changes to existing 
   o PULMONARY EMBOLISM field (#252) and the PULMONARY EMBOLISM occurrence
     category in file (#136.5)
   o ACUTE RENAL FAILURE field (#254) and the ACUTE RENAL FAILURE
     occurrence category in file (#136.5)
   o PREGNANCY field (#269)
   o PERIPHERAL NERVE INJURY field (#287) and the PERIPHERAL NERVE INJURY 
     occurrence category in the PERIOPERATIVE OCCURRENCE CATEGORY file 
     (#136.5)
   o DYSPNEA field (#325)
   o CURRENT PNEUMONIA field (#326)
data fields, changes to data entry screens, changes to reports used in 
   o REST PAIN/GANGRENE (Y/N) field (#330)
   o CHEMOTHERAPY IN LAST 30 DAYS field (#338.1)
   o QUADRIPLEGIA (Y/N) field (#398)
   o TUMOR INVOLVING CNS (Y/N) field (#401)
   o INTRAOP DISSEMINATED CANCER field (#443)
   o DATE COMP NOTED field (#2, sub-file #130.22)
   o SEPSIS CATEGORY field (#7, sub-file #130.22)
 
- Hemoglobin A1c is added to the set of preoperative lab test results.
 
Surgery Risk Assessment management process and changes to the Surgery Risk
- This patch modifies all Lab fields under the Laboratory Test Results
  (Enter/Edit) [SROA LAB] option to assume a past date if the user enters
  a date without a year.
 
- The DATE OF DEATH field (#342) is modified to allow the entry of time as
  well as date and is added to the Patient Demographics (Enter/Edit) [SROA
  DEMOGRAPHICS] option.
 
- Airway Trauma, Mallampati Scale and Airway Index are removed from the
  set of information collected and transmitted to NSQIP.
Assessment transmissions.
 
- The letter produced by the Print 30 Day Follow-up Letters [SROA REPRINT 
  LETTERS] option is modified to display the date of operation and the 
  local surgical specialty.
 
- The Monthly Surgical Case Workload Report [SROA MONTHLY WORKLOAD REPORT]
  option is modified to replace references to major/minor with eligible or
  excluded.
 
  

This patch addresses the following problems:
a RESIDNET
 
2.  HD175983   SROCON   Error - <UNDEFINED>HELP+1^SROCON
When entering Anesthesia data for a surgical case, ^SROCON routine errors 
at the
"Do you want to store this information in the concurrent case ?  YES//" 
prompt if 
a "?" is entered and concurrent cases exist.
 
3.  HD177449  SROREQ4   UNDEF ERROR
 
When running the : Operation Requests for a Day  [SROP REQ] option the 
report 
generates an error <UNDEFINED>PRINT+2^SROREQ4
 S S(0)=^SRF(SRTN,0),DFN=$P(S(0),"^"),CNT=CNT+1
 
4.  HD153358  SROCDX1   Error - <UNDEFINED>PADD1+4^SROCDX1
An <UNDEFINDED> error was encountered when trying to verify some ICD-9 
codes or Procedure codes.
1.  HD136616  SROPCEP  Primary and Secondary Provider incorrect from 
Surgery pkg
The information  passed from the surgical package to PCE when received in 
PCE the 
SURGEON is listed as the PRIAMRY PROVIDER and the ATTENDING is listed as 
the 
SECONDARY PROVIDER.  Claims are being rejected if the PRIMARY PROVIDER is 

1. This patch changes the Environmental Indicator ENVIRONMENTAL 
  ENVIRONMENTAL CONTAMINANTS the mnemonic "SWAC:" will be displayed. The 
  user dialog "Treatment related to Environmental Contaminants (Y/N)" 
  will be changed to "Treatment related to SW Asia (Y/N)".
 
2. This patch modifies the Surgery software to always use a YES default 
when initially prompting for "Treatment related to Combat (Y/N)".
 
3. This patch modifies the Surgery software so that when entering or 
editing a waiting list entry, service connected and environmental 
indicator questions will be asked if appropriate for the patient 
CONTAMINANTS name to SOUTHWEST ASIA CONDITIONS.
regardless of the patient's admission status.
 
  - The Surgery package data dictionaries for ENVIRONMENTAL CONTAMINANTS 
  will be changed to SOUTHWEST ASIA CONDITIONS. The field help text will 
  be updated with the new name. Other field cross references will be
  updated with the new name.
 
  - In user dialog where the mnemonic "EC:" is used to display the 

This patch makes changes to the Surgery software following the 
assessment information when entering or updating a surgery request if the 
ASK FOR RISK PREOP INFO field (#17) in the SURGERY SITE PARAMETERS file 
(#133) is set to YES is updated so that this functionality works 
correctly with the updated code for CARDIAC SURGERY in the SURGICAL 
SPECIALTY FILE (#45.3).
 
3. The logic executed when editing the CASE SCHEDULE TYPE field (#.035) 
in the SURGERY file (#130) is updated so that this logic works correctly 
with the updated code for CARDIAC SURGERY in the SURGICAL SPECIALTY file 
(#45.3) to populate the CARDIAC SURGICAL PRIORITY field (#414) in the 
installation of patch DG*5.3*757 (SURGICAL SPECIALTY FILE CHANGES) for 
SURGERY file (#130).
the PTF Fields No Longer Needed Project:
 
1. The Quarterly Report - Surgical Service [SRO QUARTERLY REPORT] option 
is updated to correspond with the codes and specialties that exist in the 
updated SURGICAL SPECIALTY file (#45.3).
 
2. The functionality that allows the input of preoperative risk 

1. This patch adds the SURGERY CONSULT DATE field (#513) to the SURGERY 
updated to display the SURGERY CONSULT DATE field (#513) when printing a 
cardiac risk assessment.
 
4. The missing information functionality for cardiac risk assessments is 
updated to include the SURGERY CONSULT DATE field (#513) for surgical
cases after September 30, 2007. This functionality is used by the Update
Assessment Status to 'COMPLETE' [SROA COMPLETE ASSESSMENT] option and the
List of Surgery Risk Assessments [SROA ASSESSMENT LIST] option.
 
5. The SURGERY CONSULT DATE field (#513) is added to the cardiac risk 
file (#130) for use by the Cardiac Risk Assessment module to document the 
assessment transmission data set.
 
6. This patch adds the WAIT TIME START field (#21) to the SURGERY file 
(#130). This field will be auto-populated when the SURGERY CONSULT DATE 
field (#513) is entered. There are no plans to build additional functions 
for this field at this time.  
date that the patient was notified that Surgery was needed, effectively 
documenting the start of the patient's wait time. 
 
2. The Resource Data [SROA CARDIAC RESOURCE] option is updated to include 
the SURGERY CONSULT DATE field (#513) for input.
 
3. The Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option is 

Correct multiple Surgery tickets

This patch updates the Surgery Risk Assessment software of the Veterans
 
  enhancement to this option shall list missing items in the same order as
  the standard assessment screens.
 
- Cardiac Procedures Operative Data (Enter/Edit) [SROA CARDIAC PROCEDURES]
  The system is modified to initially prompts user to "Select Operative 
  Information to Edit." A new entry of "N" shall allow the user to "Set
  All to No" for the 22 Cardiac Procedures fields. A verification prompt
  will follow to ensure that user understands entry.
  
  Fields that do not have YES/NO responses will be updated as follows:
Non-Cardiac Assessment Modifications
    Items #1-#5 are numeric and their values will be set to 0.
    #9 Valve Repair will be set to NONE
    #13 Maze Procedure will be set to NO MAZE PERFORMED
 
- Laboratory Test Results (Enter/Edit) [SROA LAB-CARDIAC]
  If the lab values entered into the screen are out of range, they will be
  flagged as high or low during data entry.
 
- Resource Data [SROA CARDIAC RESOURCE]
  o When editing the D/T PATIENT DISCH FROM ICU field (#471), the software
------------------------------------
    is modified to provide the user with a select option to allow user to
    pull date/time from existing list of possible entries or manually
    enter a date/time
 
  o Postop Extubation Hours
    If the extubation time is entered, the software will display the 
    number of hours between the time the patient left the operating room 
    and the time the patient was extubated.
 
  o PRIMARY CAUSE FOR DELAY field (#515)
- List of Surgery Risk Assessment [SROA ASSESSMENT LIST] option
    If a Cardiac patient's surgery is greater than 30 days from initial VA
    Cardiothoracic Surgery Consultation (as calculated between the CT
    CONSULT DATE to DATE OF SURGERY), user is requested to enter cause as
    defined in the field. If date is less than or equal to 30 days, system
    shall automatically default entry to NONE.
 
 
General Surgery Items
---------------------
1. The following fields in the SURGERY file (#130) are updated to utilize 
  o When printing the List of Transmitted Assessments to screen or
   VistA Pharmacy supported API's in reference to the DRUG file (#50):
    - MEDICATIONS field (#.01, sub-file #130.33)
    - ANESTHESIA AGENTS field (#.01, sub-file #130.47 of sub-file #130.06)
    - TEST DOSE field (#.01, sub-file #130.48 of sub-file #130.06)
 
2. Remedy Ticket #HD0000000203815
   When making an operation request, a site parameter controls whether 
   preoperative risk assessment information can be entered. If set to YES,
   there are occasions within two screens delete variables causing an
   undefined error. This patch fixes this problem.
    printer, the user is prompted to view/print assessed cases only,
 
3. Remedy Ticket #HD0000000231157 
   The problem reported in this Remedy ticket is corrected by this patch.
   In the SURGERY file (#130), lookups on the DRUG file (#50) are modified
   to use only the GENERIC NAME field (#.01) and the SYNONYM field (#9).
  
4. The following date/time fields in the SURGERY file (#130) are modified 
   to assume a past date if the user enters a date without a year:
   SURGICAL PRIORITY, DATE field (#414.1)
   HOSPITAL ADMISSION DATE field (#418)
    excluded cases only or both. Additionally, the user is prompted to
   HOSPITAL DISCHARGE DATE field (#419) 
   ADMISSION/TRANSFER DATE field (#420)
   DISCHARGE/TRANSFER DATE field (#421)
   OBSERVATION ADMISSION DATE field (#452)
   OBSERVATION DISCHARGE DATE field (#453)
    view/print the list by date of operation or by date of transmission.
  o When printing the List of Eligible Cases to screen or printer, the 
    user is prompted to view/print assessed cases only, excluded cases 
Health Information Systems and Technology Architecture (VistA) Surgery
    only, non-assessed cases only or all cases.
  o A new list, the List of Cases With No CPT Codes is added. This list 
    displays all completed cases that have not been coded with CPT codes.
  o A new list, the Summary List of Assessed Cases is added. This report 
    displays the total count of incomplete, complete and transmitted risk
    assessments and the count of excluded cases. This report may be 
    printed for all or for selected surgical specialties and for all 
    divisions or for a selected division.
    
- M&M Verification Report [SRO M&M VERIFICATION REPORT] option
application as requested by the Executive Board of the National Surgical
  This report is modified to display additional information as available,
  including the case number, final CPT codes and review of death comments.
  
- Clostridium Difficile Colitis (C. difficile) definition updated
  o In the SURGERY file (#130), the description for the CLOSTRIDIUM
    DIFFICILE COLITIS field (#446) is updated.
  o In the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5), the 
    description for the CLOSTRIDIUM DIFFICILE COLITIS (C-DIFFICILE)
    category is updated.
 
Quality Improvement Program (NSQIP) and by the Cardiac Surgery Consultants
- In the SURGERY file (#130), the description for the PREOP FUNCT. HEALTH
  STATUS field (#492) is updated.
    
- Risk Model Lab Test (Enter/Edit) [SROA LAB TEST EDIT] option
  This new option is added to the Surgery Risk Assessment Menu [SROA RISK
  ASSESSMENT] to assist the nurse reviewers in mapping entries in the 
  RISK MODEL LAB TEST file (#139.2) to the LAB DATA file (#63).
  
- REGIONAL Anesthesia Technique added
  o REGIONAL is added to the list of choices when entering the ANESTHESIA
Board of the Continuous Improvement in Cardiac Surgery Program (CICSP).
    TECHNIQUE field (#.37) in the SURGERY file (#130).
  o The Anesthesia AMIS [SROAMIS] option is inactivated and removed from
    the Anesthesia Menu [SROANES1] and from the Anesthesia Reports [SR
    ANESTH REPORTS] menu options.
    
- Preoperative Information (Enter/Edit) [SROA PREOP DATA] option updated
  o The following items are no longer required and are removed from the
    input screens:
    > On Page 1, under GENERAL
      E. Pack/Years
The updates include the addition of new data fields, changes to existing 
      I. Pre-illness Funct Status
    > On Page 2, under CENTRAL NERVOUS SYSTEM
      H. Paraplegia 
      I. Quadriplegia
  o The following changes are made relating to the capture of height from
    the Vitals software:
    > The 1 year date range limitation is removed from the height capture 
      process so that the most recent height measurement is returned 
      regardless of when it was taken.
    > If the height capture process returns a height measurement from the 
data fields, changes to data entry screens, changes to reports used in 
      Vitals software, the date of the measurement will be stored and 
      displayed on the data input screen.
 
- Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option
  If the user responds YES to batch printing for a specific date range,
  the user will be allowed to print for a single surgical specialty or for
  all surgical specialties.
 
- Surgery Consult Dates added
  The Patient Demographics (Enter/Edit) [SROA DEMOGRAPHICS] option is 
Surgery Risk Assessment management process and changes to the Surgery Risk
  updated to include 2 additional date fields:
  o Surgery Consult Date
  o Date Surgery Consult Requested
 
Cardiac Assessment Modifications
------------------------------------
- Clinical Information (Enter/Edit) [SROA CLINICAL INFORMATION]
  The HEIGHT field (#236) and the WEIGHT field (#237) will no longer   
  accept an entry of NS for "No Study". System will only accept numeric
  values in the field.
Assessment transmissions.
 
- Operative Risk Summary Data (Enter/Edit) [SROA CARDIAC OPERATIVE RISK]
  This option is modified to allow users to enter a value of NS (No Study)
  into the Physician's Preoperative Estimate of Operative Mortality field.
  Upon entry of NS, the system will automatically populate the Date/Time
  of Estimate of Operative Mortality field with a value of NS (No Study).
 
- Update Assessment Status to 'COMPLETE' [SROA COMPLETE ASSESSMENT] 
  This option is modified to list items missing from the assessment based 
  upon the order in the field number in SURGERY file (#130). An

The CPT EXCLUSIONS file (#137) stores CPT codes that have been identified
by the National Surgical Quality Improvement Program (NSQIP) as procedures
that should not be risk assessed. This patch updates this file with data
for fiscal year 2008.

This patch modifies the Blood Product Verification [SR BLOOD PRODUCT 
New Service Request (NSR):
==========================
N/A
 
Test Sites:
===========
HEARTLAND-EAST HCS
PHILADELPHIA, PA
SAN DIEGO, CA
 
VERIFICATION] option to accept the manually entered eye-readable code as 
 
Documentation Retrieval:
========================
No new documents or changes to existing documents are included in this 
patch.
 
 
Installation Instructions:
==========================
This patch can be installed at any time with users on the system.
well as the scanned bar code for Codabar labels.
Installation should take less than two minutes.
 
 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu.
 
 2. From the Kernel Installation & Distribution System menu, select
    the Installation menu.
 
 3. From this menu, you may elect to use the following options (when
    prompted for the INSTALL NAME, enter SR*3.0*168):
 
 
    (a) Backup a Transport Global - this option will create a backup
        message of any routines exported with the patch. It will NOT
        backup any other changes such as DDs or templates.
 
    (b) Compare Transport Global to Current System - this option will
        allow you to view all changes that will be made when the patch is
        installed. It compares all components of the patch (routines,
        DDs, 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.
 
    (d) Print Transport Global - this option will allow you to view the
        components of the KIDS build.
 
 4. Use the Install Package(s) option and select the package SR*3.0*168.
 
 5. When prompted "Want KIDS to INHIBIT LOGONs during the install? NO//"
    respond NO.
Associated Remedy Ticket(s):
 
 6. When prompted "Want to DISABLE Scheduled options, Menu options, and
    Protocols? NO//" respond NO.
 
 
Routine Summary:
================
The following is a list of the routine(s) included in this patch. The
second line of each of these routine(s) will look like:
 
============================
    <TAB>;;3.0; Surgery ;**[patch list]**;24 Jun 93;Build 2
 
 Routine Name  Before Patch  After Patch  Patch List
 ------------  ------------  -----------  ----------
 SRBL          8388831       8708447      148,168
N/A
 

Surgery patch SR*3*69 - Surgery/PCE/NPCD Reporting

This patch adds the Transplant Assessment module to the Surgery software.
     This option is used to enter and update the information required for
     the transplant assessments. This option also allows the assessment
     to be completed and transmitted.
 
 (2) Print Transplant Assessment [SRTP PRINT ASSESSMENT]
     This option is used to print a single Surgery Transplant Assessment.
 
 (3) List of Transplant Assessments [SRTP ASSESSMENT LIST]
     This option is used to print the List of Transplant Assessments. It
     provides summary information for assessments within the sort
This enhancement provides the ability to create assessments for lung,
     parameters selected.
 
 (4) Transplant Assessment Parameters (Enter/Edit) [SR TRANSPLANT
     PARAMETER]
     This option is used to update local site parameters for the Surgery
     Transplants Assessment module. Sites that are transplant centers must
     designate the types of organ transplants performed or assessed in
     order to streamline the transplant selection process when entering
     data.
 
liver, kidney and heart transplants.
- The collected transplant assessments data will be stored in the SURGERY
  TRANSPLANT ASSESSMENTS file (#139.5).
 
- Transplant Assessments Transmissions
  When editing an individual transplant assessment, upon leaving the
  final page, the software allows the user to transmit the assessment to
  the national database.
 
  o The data of the non-cardiac transplant assessments (lung, liver, and
    kidney) will be transmitted to national NSQIP database in Chicago,
 
    Illinois.
 
  o The data of the heart transplant assessments (cardiac) will be
    transmitted to national NSQIP database in Chicago, Illinois, as well
    as to national CICSP database in Denver, Colorado.
 
- Followup to patch SR*3*169
  This patch includes a pre-installation process that removes the
  following CPT codes from the CPT EXCLUSIONS file (#137) that were
  overlooked in the NSQIP - CPT EXCLUSION update patch for fiscal year
A new menu, Transplant Assessment Menu [SR TRANSPLANT ASSESSMENT], is
  2008 (SR*3*169).
  
   33945   TRANSPLANTATION OF HEART 
   47135   TRANSPLANTATION OF LIVER
   47136   TRANSPLANTATION OF LIVER
added to the Surgery Menu [SROMENU] option. This new menu includes the
following four options:
 
 (1) Enter/Edit Transplant Assessments [SR TRANSPLANT ENTER/EDIT]

This patch addresses one minor issue, updates the CPT Exclusion List for 
In October 2003, under the Code Set Versioning Project, the code names,
descriptions, inactive flags and dates were replaced by versioned data
elements, each with an effective date of use. Additionally, VA software
packages who utilize the ICD/CPT files were provided with Code Set
Application Programmer Interfaces (APIs) to retrieve the new data and
instructed to discontinue the use of the old un-versioned data elements.
 
This patch modifies the routine SROCMPED to make use of one of the Code 
Set APIs to retrieve and display versioned data.
 
NSQIP, and modifies a data element collected by NSQIP and CICSP. Each is 
2. The CPT EXCLUSIONS file (#137) stores CPT codes that have been  
identified by the National Surgical Quality Improvement Program (NSQIP) as
procedures that should not be risk assessed. This patch updates this file
with data for fiscal year 2009.
 
3. The lower range for HEIGHT field (#236) in the SURGERY file (#130)
collected by the National Surgical Quality Improvement Program (NSQIP) and
Continuous Improvement in Cardiac Surgery Program (CICSP) has been lowered
to account for post amputation height of patients with both legs
amputated.
explained in more detail.
  
1. The Health Insurance Portability and Accessibility Act (HIPAA) 
stipulated that diagnostic and procedure codes and terms used for billing 
purposes must be the codes and terms that were applicable at the time the 
service was provided.
 

There are two fixes in this patch: The first issue concerns an
a PRINC. ANESTHESIA TECHNIQUE for their patients.
UNDEFINED error occurring when trying to enter a DISCHARGE
FROM PACU (DPACU) time that is earlier than the PATIENT IN ROOM
(PIR) time even though the date is for the next day under the
OPERATION INFORMATION option of the NON-CARDIAC ASSESSMENT
INFORMATION. The second issue is under the same NON-CARDIAC 
ASSESSMENT INFORMATION option OPERATION INFORMATION and an 
UNDEFINED error is being generated due to an expected variable
DA(1) not being set. This prevents users from being able to enter 

This patch provides the annual updates to the Veterans Health Information 
- The frequency of transmission of 1-liner cases is changed from the 45th 
  o PREOP CIRCULATORY DEVICE field (#474)
  o ENDOVASCULAR REPAIR field (#505)
  o D/T PATIENT DISCH FROM ICU field (#471)
 
- Corrections are made to the list of missing items functionality for the
  following fields in the SURGERY file (#130):
  o ANGINA field (#267)
  o CONVERT FROM OFF PUMP TO CPB field (#469)
 
- TIME OPERATION BEGAN field (#.22) and TIME OPERATION ENDS field (#.23) 
  day past the end of the quarter to the 45th day past the end of the
  are moved from the Operative Risk Summary Data (Enter/Edit) [SROA 
  CARDIAC OPERATIVE RISK] option to the Resource Data [SROA CARDIAC
  RESOURCE] option.
 
- The list of missing items functionality is updated to remove deleted 
  variables and to include the new variables.
 
- The SURGERY CONSULT DATE field (#513) and the PRIMARY CAUSE FOR
  DELAY field (#515) are removed from the Resource Data [SROA CARDIAC 
  RESOURCE] option.
  month.
 
- Patient gender is added to the information transmitted on 1-liner cases.
 
- New fields added to SURGERY file (#130):
  o ASSESSMENT COMPLETED BY field (#272.1)
    When a non-cardiac assessment is completed, the user who completed the
    assessment will be identified in this field and the name of the user 
Systems and Technology Architecture (VistA) Surgery package in support of
    will be transmitted with the assessment.
  o PREOPERATIVE SLEEP APNEA field (#237.1)
    This field is added to the Preoperative Information (Enter/Edit) [SROA
    PREOP DATA] option, the assessment printout, assessment transmission
    and the list of missing items functionality.
 
- The SURGERY CONSULT DATE field (#513) and the SURGERY CONSULT REQUESTED 
  field (#516) are eliminated as non-cardiac assessment variables.
 
- This patch updates the CPT EXCLUSIONS file (#137) with data for fiscal 
the VA Surgery Quality Improvement Program (VASQIP). The updates include
  year 2010.
 
- Field descriptions are modified in the following fields in SURGERY file 
  (#130):
  o HEIGHT field (#236)
    The description and the input transform are modified.
  o WEIGHT field (#237)
    The description and the input transform are modified.
  o HISTORY OF COPD field (#203)
  o ASCITES field (#212)
the addition of new data fields, changes to existing fields, changes to 
  o DISSEMINATED CANCER (Y/N) field (#338)
  o INTRAOP DISSEMINATED CANCER field (#443)
  o BLEEDING DISORDERS field (#216)
  o OTHER PROCEDURE field (#.01 of OTHER PROCEDURES multiple field #.42)
  o INTRAOPERATIVE ASCITES field (#446)
  o DVT/THROMBOPHLEBITIS field (#263)
    Note: The description of DVT/THROMBOPHLEBITIS in the PERIOPERATIVE 
    OCCURRENCE CATEGORY file (#136.5) is updated as well.
 
- On the Operation Information (Enter/Edit) [SROA OPERATION DATA] option:
data entry screens, changes to reports, and changes to the Surgery Risk 
  o When selecting item #3, CPT Codes (view only), the following note is 
    added to the screen:
       CPT Codes should be verified. If need be, report discrepancies to
       the official CPT coder for surgery.
  o When selecting item #5, Concurrent Procedure, the following note is 
    added to the screen:
       Concurrent Procedure: An additional operative procedure performed
       by different surgical team (i.e., a different specialty/service)
       under the same anesthetic which has a CPT code different from that
       of the Principal Operative Procedure (e.g., fixation of a femur
Assessment transmissions.
       fracture in a patient undergoing a laparotomy for trauma). This
       field should be verified and, if need be, report discrepancies to
       the official CPT coder for surgery.
       
- A new entry, N - NONE ASSIGNED, is added to the ASA CLASS file (#132.8).
  The output transform on ASA CLASS field (#1.13) in SURGERY file (#130)
  is modified to allow the display of the new entry.
 
- The list of missing items functionality is updated to remove deleted 
  variables and to include the new variables.
 
 
Cardiac Assessment Modifications:
---------------------------------
- The SURGERY CONSULT DATE field (#513) and the PRIMARY CAUSE FOR DELAY 
  field (#515) are eliminated as cardiac assessment variables.
 
- New fields added to SURGERY file (#130) as new cardiac variables:
  o PREOP ATRIAL FIBRILLATION field (#509)
    This field is added to the Clinical Information (Enter/Edit) [SROA 
    CLINICAL INFORMATION] option.
Non-Cardiac Assessment Modifications:
  o PULMONARY VALVE PROCEDURE field (#493)
    This field is added to the Cardiac Procedures Operative Data 
    (Enter/Edit) [SROA CARDIAC PROCEDURES] option.
  o BNP field (#507)
    This field is added to the Laboratory Test Results (Enter/Edit) [SROA 
    LAB-CARDIAC] option.
  o BNP DATE field (#507.1)
    This field is added to the Laboratory Test Results (Enter/Edit) [SROA 
    LAB-CARDIAC] option.
  o POSTOP ATRIAL FIBRILLATION field (#448)
-------------------------------------
    This field is added to the Outcome Information (Enter/Edit) [SROA 
    CARDIAC-OUTCOMES] option. Associated with this yes/no field is a new 
    entry, POSTOPERATIVE ATRIAL FIBRILLATION, in the PERIOPERATIVE 
    OCCURRENCE CATEGORY file (#136.5).
 
- The following fields in SURGERY file (#130) are modified:
  o AORTIC VALVE PROCEDURE field (#367)
  o MITRAL VALVE PROCEDURE field (#368)
  o TRICUSPID VALVE PROCEDURE field (#369)
  o FUNCTIONAL HEALTH STATUS field (#240)

This patch addresses the following problems:
 
2.  HD238998 - FGH - service block issue on 5th week of month
When a monthly service block is set for a day in the 4th week, users are
unable to set a service block for that day in the 5th week of a month.
 
1.  HD194156 - Input transform for CPT Modifier 51 in Surgery
The Lexicon package has been working to update the CPT code ranges for 
the CPT Modifier 51. Part of this update is to include all Surgical 
Procedures with the exception of those listed in Appendix E of the CPT
Manual.  During the analysis phase for this project, it was discovered 
that this unique CPT Modifier carries with it the stipulation that it 
can not be used in conjunction with the principal procedure.

This patch provides the VASQIP 2011 Increment 1 to the Veterans Health
I. General Surgery Updates:
     ANESTHESIA AGENTS Multiple (#130.47) of the ANESTHESIA TECHNIQUE
     Multiple (#130.06)
   - DOSE field (#.1) of the TEST DOSE Multiple (#130.48) of the
     ANESTHESIA TECHNIQUE Multiple (#130.06)
 
9. The Clean Wound Infection Summary Report is updated to include
   the ORGAN/SPACE SSI field (#488) in the algorithm for calculating the
   clean wound infection rates. For cardiac assessed cases, 
   ENDOCARDITIS field (#386) and MEDIASTINITIS field (#388) will be
   included in the algorithm for calculating the clean wound infection
--------------------------
   rates.
 
10. The Perioperative Occurrences Report, under the Morbidity & Mortality 
    Reports [SROMM] option, will be modified to allow three selections as 
    follows:
        1-Intraoperative Occurrences
        2-Postoperative Occurrences 
        3-Intraoperative and Postoperative Occurrences 
 
 
1. All options under the Quarterly Report Menu [SROQ MENU] are retired
II. Non-Cardiac Module Updates:
--------------------------------
1. A new 30 DAY DEATH field (#342.1) has been added to the
   SURGERY file (#130). This field is added to the Patient 
   Demographics (Enter/Edit) [SROA DEMOGRAPHICS] option and it will 
   indicate operative death has occurred within 30 days of surgery. This
   field will be auto populated based on an entry into the DATE OF DEATH 
   field (#342). If Date of Death occurs within 30 days or less of
   the date in the DATE OF OPERATION field (#.09), then this field is
   automatically updated to "Yes" when the Date of Death is saved. If the
   except the Admissions Within 14 Days of Outpatient Surgery [SROQADM]
   Date of Death is greater than 30 days from the Date of Operation then
   this field is automatically updated to "No" when the Date of Death is
   saved.
 
2. The data dictionary of the PREOPERATIVE SLEEP APNEA field (#237.1)
   of the SURGERY file (#130) has been changed to allow for an entry of
   "N" for "NONE" on the Preoperative Information (Enter/Edit)
   [SROA PREOP DATA] option. 
 
3. Update the printed Assessment to now include the field ASSESSMENT
   option, the Report of Missing Quarterly Report Data [SROQ MISSING DATA]
   COMPLETED BY field (#272.1) of the SURGERY file (#130).
 
                                                            
III. Cardiac Module Updates:
---------------------------
1. The field name "Myectomy for IHSS" is changed to "Myectomy" in the
   option for the Cardiac Procedures Operative Data (Enter/Edit)
   [SROA CARDIAC PROCEDURES] option and the the Print Assessment Report.
 
2. The data dictionary of the BRIDGE TO TRANSPLANT/DEVICE field
   option and Deaths Within 30 Days of Surgery [SROQD], which are
   (#481) is modified from the current values of "Yes" and "No" to "None",
   "Bridge to Transplant", and "Destination Therapy"
 
3. The existing field, WOUND CLASSIFICATION (#1.09), is added to the
   Operative Risk Summary Data (Enter/Edit) [SROA CARDIAC OPERATIVE RISK] 
   option. This field has been added to the Cardiac Print Assessment
   Report.
 
4. The current WOUND DISRUPTION field (#404) of the Surgery file (#130)
   is added to the Outcome Information (Enter/Edit)[SROA CARDIAC-OUTCOMES]
   relocated under the Management Reports [SRO-CHIEF REPORTS] menu.
   option. This information will appear on the Printed Assessment
   Report and added to the Cardiac Transmission.
 
5. The Clinical Information (Enter/Edit)[SROA CLINICAL INFORMATION] option
   is updated to allow a response of "N" or "NO" at the prompt to update
   all the fields to a negative value except Height, Weight, FEV1, 
   Functional Status, Angina, and CHF.
 
 
IV. Transplant Module Updates:
 
-------------------------------
1. HLA Typing fields in the SURGERY TRANSPLANT ASSESSMENTS file (#139.5)
   across all four organ types are updated to allow entry of 4 digits 
   (#,#,#,#). The Transplant Transmission is also updated.
 
2. The C-PEPTIDE AT TIME OF LISTING field (#136) of the SURGERY 
   TRANSPLANT ASSESSMENTS file (#139.5) has been changed to allow for a
   value less than 1. When the value is less than 1, it will be displayed
   with a leading zero (i.e., 0.6). 
 
2. Remove references to "NSQIP" and "CICSP" in field labels and field 
3. The POST-TX PROPHYLAXIS - TB field (#92) of the SURGERY TRANSPLANT
   ASSESSMENTS file (#139.5) has been updated to allow a value to be
   entered of "N/A". This information is added to the Transmission.
 
4. The COLD ISCHEMIA TIME FOR ORGAN field (#87) and WARM ISCHEMIA TIME FOR
   ORGAN field (#85) of the SURGERY TRANSPLANT ASSESSMENTS file (#139.5)
   has been added to page #1 of the Enter/Edit Transplant Assessments [SR
   TRANSPLANT ENTER/EDIT] option and to the Print Transplant Assessment
   [SRTP PRINT ASSESSMENT] option for VA and Non-VA heart transplants.
   definitions. When the text is not in the header of a definition, the 
Information Systems and Technology Architecture (VistA) Surgery package in
   terms "NSQIP" and "CICSP" are replaced with "VASQIP".
 
   The complete list of these fields is listed in the Release Notes 
   manual.
 
3. Addition of Scheduling Date fields
   The following new fields are added to the SURGERY file (#130):
  - ORIGINAL DESIRED PROCEDURE DATE field (#612)
  - D/T OF DESIRED PROCEDURE DATE ENTRY field (#613)
  - ORIGINAL SCHEDULED DATE field (#614)
support of the VA Surgery Quality Improvement Program (VASQIP). The
  - D/T OF SCHEDULED DATE ENTRY field (#615)
  - DESIRED PROCEDURE DATE field (#616)
  - SCHEDULED DATE field (#617)
 
4. Add Time Out Verified Utilizing Checklist
 (a) The following new fields are added to the SURGERY file (#130):
   - CONFIRM PATIENT IDENTITY field (#600)
   - PROCEDURE TO BE PERFORMED field (#601)
   - SITE OF PROCEDURE field (#602)
   - VALID CONSENT FORM field (#603)
updates include the addition of new data fields, changes to existing
   - CONFIRM PATIENT POSITION field (#604)
   - MARKED SITE CONFIRMED field (#605)
   - PREOPERATIVE IMAGES CONFIRMED field (#606)
   - CORRECT MEDICAL IMPLANTS field (#607)
   - ANTIBIOTIC PROPHYLAXIS field (#608)
   - APPROPRIATE DVT PROPHYLAXIS field (#609)
   - BLOOD AVAILABILITY field (#610)
   - AVAILABILITY OF SPECIAL EQUIP field (#611)
   - CHECKLIST COMMENT field (#85)
     
fields, changes to data entry screens, changes to reports, changes to the
 (b) The VALID ID/CONSENT CONFIRMED BY field (#.69) has been renamed to
     CHECKLIST CONFIRMED BY.
 
 (c) All the above new fields are added to the new Time Out Verified
     Utilizing Checklist option [SROMEN-VERF], which has been added to the
     Operation Menu [SROPER].
 
 (d) The existing ensuring correct surgery fields (MARKED SITE CONFIRMED
     field (#73), PREOPERATIVE IMAGING CONFIRMED field (#72), TIME OUT
     VERIFIED field (#71), MARKED SITE COMMENTS field (#84), IMAGING
Surgery Risk Assessment transmissions, and changes to Transplant
     CONFIRMED COMMENTS field (#83), TIME OUT VERIFIED COMMENTS field 
     (#82), and VALID ID/CONSENT CONFIRMED BY field (#.69)) will be
     removed from the following Operation Menu options:
 
     - Operation Startup [SROMEN-START]
     - Operation [SROMEN-OP]
     - Operation (Short Screen) [SROMEN-OUT]
     - Nurse Intraoperative Report [SRONRPT]
 
 (e) The existing ensuring correct surgery fields in the Nurse
components of the VistA Surgery application.
     Intraoperative Report are replaced with the new Time Out Verified
     Utilizing Checklist fields (the fields listed in item "a" and "b" of
     this section are added).
 
5. OR Cancellation Report
  - The pre-existing reasons have been inactivated and will not be 
    editable but can be viewed.
  - A new selection list for Cancellation Reasons has been added.
  - The SURGERY CANCELLATION REASON file (#135) will be locked with 
    this patch so it will no longer be editable at sites.
 
  - The Update Site Configurable Files [SR UPDATE FILES] option has been 
    updated to remove the Surgery Cancellation Reasons from the Site 
    Configurable Files.
 
6. The CPT Code Exclusion list for 2011 has been updated so that the
   surgical package can accurately calculate the VASQIP eligible list
   (affecting the CPT EXCLUSIONS file (#137) and the Workload Report/List
   #9).
 
7. Two pre-existing fields for the SURGERY file (#130), PRINC
 
   ANESTHETIST field (#.31) and ANESTHESIOLOGIST SUPVR field (#.34), have
   been added to the Non-OR Procedure report.
 
8. This patch updates the Anesthesia Report and the Nurse Intraoperative
   Report to display values of less than 1 for the fields below with a
   leading zero in reports they are displayed.
 
   - DOSE field (#1) of the MEDICATIONS multiple (#130.33)
   - TIME ADM field (#1) of the TIME ADM multiple (#130.34)
   - DOSE field (#1) and the ANESTHESIA AGENTS field (#.01) of the

In support of the VA Surgery Quality Improvement Program (VASQIP), this 
   a. Surgery cancellation functionality is modified so that any surgery 
    References to ICD9 are replaced with ICD in the following menu 
    options:
     - CPT/ICD9 Coding Menu [SRCODING MENU]
     - CPT/ICD9 Update/Verify Menu [SRCODING UPDATE/VERIFY MENU]
     - Update/verify Procedure/Diagnosis Codes [SRCODING EDIT]
    
 9. Remove Quarterly Report References
   a. References to "Quarterly Report" are removed from the Deaths Within
      30 Days of Surgery [SROQD] option.
 
      case that is placed on the surgery schedule and then cancelled will 
   b. The routines that provided the Surgery Quarterly Report
      functionality are removed. Those routines are SROQ1, SROQ1A, SROQ2,
      SROQM, SROQM0, SROQM1 and SROQT.
 
10. Add Superficial Incisional SSI to Cardiac Outcomes
    The SUPERFICIAL INCISIONAL SSI field (#248) in the SURGERY file 
    (#130) is added to the Outcome Information (Enter/Edit) [SROA 
    CARDIAC-OUTCOMES] option, the cardiac assessment transmission and to 
    the cardiac assessment printout.
 
      be retained in the SURGERY file (#130) as a cancelled case
11. The following routines associated with obsolete functionality are 
    removed: SROAC, SROAC1, SROAC2, SROACCR, SROACRC, SROACS, SROASWAP,
    SROASWP, SROASWP0, SROASWP1, SROASWP2, SROAWSP3, SROASWPD, SRSLOOK,
    and SRSLOOK1.
    
12. This patch fixes the issue reported by Remedy ticket #528445, where 
    the PREOPERATIVE IMAGES CONFIRMED field (#606) displays the same data
    as MARKED SITE CONFIRMED field (#605).
 
13. This patch updates the CPT EXCLUSIONS file (#137) with data for 
      regardless of when the case is cancelled. Also, a cancellation
    fiscal year 2012.
      reason is required for every cancellation. Any scheduled case that
      is cancelled will be counted as a cancellation on the Report of
      Cancellations generated by the Report of Cancellations [SROCAN]
      option.
 
   b. The Report of Cancellations, generated by the Report of 
patch provides the VASQIP Increment 2 update to the Veterans Health 
      Cancellations [SROCAN] option, is modified to group patient data 
      together within specialty so that all cases for a single patient
      will be shown together. The report will also order based on 
      operations so the same operation descriptions will show next to each
      other for the same patient.  
 
 2. Miscellaneous Additions to Risk Assessment Transmissions
   a. The name of the operating room as defined in the HOSPITAL LOCATION 
      file (#44) is added to each cardiac and non-cardiac risk assessment 
      transmission and to each 1-liner case transmission.
Information Systems and Technology Architecture (VistA) Surgery package.
 
   b. The following four fields in the SURGERY file (#130) are added to
      each 1-liner case transmission and to the list of items checked for
      by the List of 1-Liner Cases Missing Information which is one of the
      reports generated by the List of Surgery Risk Assessments [SROA
      ASSESSMENT LIST] option:
       - TIME OPERATION BEGAN (#.22)
       - TIME OPERATION ENDS (#.23)
       - TIME PAT IN OR (#.205)
       - TIME PAT OUT OR (#.232)
The updates include the addition of new data fields, changes to existing
 
 3. Positive Drug Screening
    A new POSITIVE DRUG SCREENING  field (#618) is added to the SURGERY 
    file (#130). This field is added to the Preoperative Information 
    (Enter/Edit)[SROA PREOP DATA] option, the Clinical Information 
    (Enter/Edit)[SROA CLINICAL INFORMATION] option and the Print a Surgery
    Risk Assessment [SROA PRINT ASSESSMENT] option. This field is also
    added to the cardiac and non-cardiac risk assessment transmissions and
    is added to the list of missing items functionality.
 
fields, changes to data entry screens, changes to reports, changes to the
 4. Consolidation of Shared Cardiac, Non-Cardiac and Transplant Fields
    This patch updates various fields in the SURGERY file (#130) and in
    the SURGERY TRANSPLANT ASSESSMENTS file (#139.5) as well as various
    occurrence category descriptions in the PERIOPERATIVE OCCURRENCE
    CATEGORY file (#136.5) so that common items share common definitions.
    This patch also replaces various fields with new fields in order to
    enhance and refine certain data elements that are in common with
    cardiac and non-cardiac risk assessments and transplant assessments.
    All the associated data input options, assessment printouts and
    transmissions are updated accordingly.
Surgery Risk Assessment transmissions, and changes to transplant
    
    The complete list of updated fields, new fields and replaced 
    fields is in the patch release notes.
    
 5. Add Serial Number for Prosthesis Items
     - Two new fields, LOT NUMBER (#11) and SERIAL NUMBER (#12) are 
       added to the PROSTHESIS INSTALLED multiple field (#.47, sub-file 
       #130.01) to replace the existing LOT/SERIAL NO field (#2.5). The 
       Operation [SROMEN-OP] option and the Nurse Intraoperative Report 
       [SRONRPT] option are updated to allow editing and display of these
components of the VistA Surgery application.
       two new fields.
     - LOT NUMBER field (#8) and SERIAL NUMBER field (#9) are added to
       the PROSTHESIS file (#131.9). The Update Site Configurable Files
       [SR UPDATE FILES] option is modified to allow editing of these new
       fields and to disallow editing of the LOT/SERIAL NO field (#4) and
       the STERILE CODE field (#3).
       
 6. Flash Sterilization
    Six new fields are added to the SURGERY file (#130) to document the
    number of episodes of each type of flash sterilization that happened
 
    for an operation:
     - FLASH-CONTAMINATION (#619)
     - FLASH-SPD/OR MGT ISSUE (#620)
     - FLASH-EMERGENCY CASE (#621)
     - FLASH-NO BETTER OPTION (#622)
     - FLASH-LOANER INSTRUMENT (#623)
     - FLASH-DECONTAMINATION (#624)
       
    The Post Operation [SROMEN-POST] option and the Nurse Intraoperative
    Report [SRONRPT] option are updated to allow editing and display of
 1. Surgery Cancellation Modifications
    these two new fields.
    
 7. 30-Day Readmission
    This patch creates a transmission report that lists inpatient 
    surgery cases which were followed by the patient being readmitted 
    within 30 days of discharge. This report is run by the Surgery 
    Nightly Cleanup and Updates [SRTASK-NIGHT] option and will transmit to
    the VASQIP database automatically each quarter.
    
 8. Update ICD9 to ICD

 
This patch addresses the following issues:
 
(1) Users are receiving an UNDEFINED error at SRHLXTMP+7^SRHLXTMP when
their system runs the nightly task SRTASK-NIGHT option. (2) A user 
reported that addendums created in VistA are not always being 
transmitted to CPRS. The reason being it appears that TIU BUSINESS RULES
for certain document types or user classes are being created which can
cause unforeseen issues.

The International Classification of Diseases, Tenth Revision (ICD-10) 
characters. This value does not include the decimal point, which follows 
the third character for the ICD-10-CM code set. There is no decimal point 
in the ICD-10-PCS code set. 
These code sets have the potential to reveal more about quality of care, 
so that data can be used in a more meaningful way to better understand 
complications, better design clinically robust algorithms, and better 
track the outcomes of care. ICD-10-CM also incorporates greater 
specificity and clinical detail to provide information for clinical 
decision making and outcomes research.
 
Class 1 Software Remediation project replaces the 30-year-old set of 
The only noticeable difference users may see will occur when a specific 
ICD diagnosis code descriptor changes based on the date of operation for 
the case.
diagnosis and procedure codes (ICD-9-CM) that medical personnel use. 
Dates of service, or dates of discharge for inpatients, that occur on or 
after October 10, 2013 will use the ICD-10 code set. Clinical Modification
(ICD-10-CM) diagnosis codes increase from about 13,000 ICD-9 codes to 
more than 68,000. Procedure Coding System (ICD-10-PCS) procedure codes 
increase from about 3,800 ICD-9 codes to nearly 87,000. Both systems also 
expand the number of characters allotted to seven alpha-numeric 

  This patch will correct the following issues currently occurring in
  Next, the FIELD field (#2) for the ATTENDING CODE entry of the Surgery
  Interface Parameter file (#133.2) points to the ATTENDING CODE field
  (#.165) of the SURGERY file (#130) which is no longer used.  It should
  point to ATTENDING CODE field (#.166) of the SURGERY file.
 
 
  Finally, when printing the 'LONG' form version of an operation request
  for a particular surgical specialty in the Operation Requests for a
  Day [SROP REQ] option in the Surgery Menu, a site noticed the Case
  Order number is not displaying correctly.
  the VistA Surgery application:
 
  In the Surgery option Exclusion Criteria (Enter/Edit) [SR NO
  ASSESSMENT REASON] when users try to enter exclusion criteria
  beginning with 'EXCEEDS' at the 'Reason an Assessment was not
  Created:' prompt, the response 'EXCEEDS MAX ASSMNTS' is always
  always displaying no matter what the user has entered/selected.
 

Surgery patch SR*3*68 - July 97 Fixes and Updates

The description of this build can be found in the National Patch Module 
under SR*3*182.

The description of this build can be found in the National Patch Module 
under SR*3*184.

The patch addresses two (2) issues:
     values have been added to the SET of allowable choices ("1" FOR 
     SAME DAY, "2" FOR ADMISSION, "3" FOR HOSPITALIZED).
 
1.   During transmission of Surgery Risk Assessments, an UNDEF error 
     occurs when routine SROATMNO calls routine ADM1^SROAPIMS without
     initializing the needed local variable SRSOUT.
 
2.   Routines that generate the Report of Non-O.R. Procedures [SRONOR]
     need to be modified to recognize recent modifications to the 
     IN/OUT-PATIENT field (#.011) in the SURGERY FILE (#130): three (3)

The patch addresses two (2) issues:
     caret ("^") to escape the edit session prior to completion, the
     application erroneously adds a field delimiter to the selected
     category record in the SURGERY INTERFACE PARAMETER File (#133.2).
 
1.   When a user edits the PROSTHESIS INSTALLED data for a completed
     surgery case using the Operation option [SROMEN-OP] of the
     Operation Menu option [SROPER] of the Surgery Menu option
     [SROMENU] and answers "NO" when prompted to create an addendum,
     an application error occurs.
 
2.   When a user edits Surgery Flag Interface Fields and enters a

The patch addresses three (3) issues:
3.   Users are unable to enter a D Code (Dental) in the PLANNED 
     PRINCIPAL PROCEDURE field (#27) of the SURGERY file (#130) using
     the Non-O.R. Procedure option [SRONOP] in the Surgery package.
 
1.   Cases aborted prior to the release of SR*3.0*184 are displayed as 
     "CANCELLED" in the Operation Menu option [SROPER].
 
2.   Nurses are unable to sign their Nurse Intraoperative Report (NIR) 
     in the Surgical Package when the case has been aborted using the 
     Abort/Cancel Operation option [SROABRT].
 

The patch addresses four (4) issues:
3. Surgery Post Operation and CPT/ICD Update/Verify options incorrectly
   allow CPT Modifier 51 to be entered on the Principle Procedure.
4. The Surgery Schedule of Operations report truncates the patient 
   name inappropriately when its length is great than 23 characters.
 
1. When Surgery sends HL7 (Health Level-7) DG1 (Diagnosis) Segments to
   Ancillary systems, messages with other preoperative diagnoses have
   an incorrect value for the ICD diagnosis code.
2. When a Wound Classification Report is generated at an institution 
   that has only one (1) Active surgery site and the Active site isn't 
   the installation's default institution, the report displays no data 
   regardless of the date range selected.

Patch SR*3.0*189 addresses the following Surgery issue:
 
  1. The SURGERY file (#130) ADT and ARS cross references do not merge 
during a patient merge.

The patch addresses one (1) issues:
 
1.   Under certain conditions, the transplant/donor section is not
     displayed on the Nurse Intraoperative Report (NIR)

Preoperative CVD data fields assigned invalid values

HOSPITAL ADMISSION STATUS field defaults to an inactive code

National Surgical Quality Improvement Program (NSQIP) enhancements patch.

The description of this build can be found in the National Patch Module 
under SR*3*195.

The patch addresses one (1) issue:
 
1.   When the MAKE OPERATION REQUEST [SROOPREQ] option is used to 
     delete an outstanding surgery request with a concurrent case 
     request, the user is asked if they want to delete the concurrent
     case and defaults to "yes". If the user accepts the default the
     outstanding request AND concurrent cases are deleted regardless
     whether the concurrent case is completed case.

The patch addresses two (2) issue:
     schedule the same case for different times or rooms and block 
     those resources from other users.
 
1.   When a POSTOP OCCURRENCE for "OUT-OF-OR UNPLANNED INTUBATION 
     W/IN 30 DAYS" is entered and then deleted, the printed risk 
     assessment improperly displays "NO DATE" rather than "NO" for
     the occurrence.
 
2.   When two (2) users accidently attempt to schedule or reschedule
     an operation for the same patient, they can inadvertently 

Backup of SR*3.0*202 on Jun 23, 2021
 
Warning:  Installing this backup patch message will install older versions
of routines and Build Components (options, protocols, templates, etc.).
Please verify with the Development Team that it is safe to install.

The patch will address the following issue: 
 
The CPT EXCLUSIONS file (#137) needs to be updated for fiscal year 2021 
(FY21).

This enhancement to the VISTA Surgery package includes a new field 
(137.45).  If defined for a local specialty, the software will
automatically enter NO in the ROBOTIC ASSISTANCE (Y/N) field when
a surgery case is created for the selected specialty.
 
Update to transmission code to restrict date/time field 613 to 12 
characters.
 
Update to Nurse Intraoperative report to have Laser Duration notes as 
seconds (not minutes).  Update to file #130.11, field #14 to reflect this 
change.
ROBOTIC ASSISTANCE (Y/N) for tracking whether robotic assistance was used 
 
Update to include a search for any height for the patient, not just a 
height in the past year.
when completing a surgery procedure. The new field is included on the 
Operation, Operation Short Screen, and Nurse Intraoperative Report 
options within the Operation Menu and is required to be entered prior to 
signing the Nurse Intraoperative Report. The field is also included on 
Non-Cardiac and Cardiac Risk Assessment data entry options.  This 
indicator is transmitted to VASQIP for all cases. A new field, ROBOTIC 
DEFAULT (#12) has been added to the LOCAL SURGICAL  SPECIALTY file

The patch addresses two (2) issues: 
    DELIVERED field (#9) in the LASER PERFORMED multiple (#135) in the 
    SURGERY FILE (#130). Specifically: the request is to increase the 
    largest allowable value to 99999.9.
 
1.  One Liner (1-Liner) cases are not transmitting to the National Risk
    Assessment database because the SURGERY FILE (#130) AQ XREF is being 
    killed and not reset when the TIME PAT OUT OR field (#.232) in the 
    SURGERY FILE (#130) is edited for a surgery case with a signed Nurse
    Intraoperative Report with coding complete.
 
2.  A request is to increase the numeric upper limit of the TOTAL JOULES

The patch addresses one (1) issue: 
 
The patch will address the following issue: the CPT EXCLUSIONS file (#137)
needs to be updated for fiscal year 2022 (FY22).

The patch addresses three (3) issue: 
    Abnormally terminated, the Operating Room schedule is blocked. If 
    the VistA session times out at the same prompt, the Operating Room
    schedule is not blocked.
 
3.  The Cardiac Assessment option only captures the height if entered 
    into the Vitals package in the past year instead of  capturing height 
    regardless of when the measurement was taken like the Non-Cardiac 
    Assessment option.
 
1.  When using the "Scheduled Unrequested Operations" [SROSRES] option
    at the PRIMARY SURGEON prompt and the VistA session is terminated,
    the Operating Room schedule is blocked. If the VistA session times
    out at the same prompt, the Operating Room schedule is not blocked.
 
2.  When using the "Schedule Unrequested Concurrent Cases" [SRSCHDC] 
    Option at the PRIMARY SURGEON prompt and the VistA session is

The patch addresses one (1) issue: 
 
1.  Under certain circumstance, completed concurrent surgical cases (the 
TIME PAT OUT OR field {#.232} in the SURGERY FILE {#130} is entered) are 
allowed to be deleted from the VistA Surgery package.

Surgery patch SR*3*70 - September 97 Fixes

The patch addresses one (1) issue: 
 
1.  The National Surgery Office requests that the help text for wound 
classification information in VistA Surgery be updated so that 2018 CDC 
Wound Classification definitions are displayed rather than the current 
definitions (2007).

The patch addresses one (1) issue: 
 
The patch will address the following issue: the CPT EXCLUSIONS file (#137)
needs to be updated for fiscal year 2023 (FY23).

The patch addresses one (1) issue: 
 
The CONCURRENT CASE field (#35) in the SURGERY FILE (#130) in a completed 
concurrent case is cleared however the CONCURRENT CASE field is not 
cleared in a cancelled concurrent case.

The patch addresses one (1) issue: 
 
Under certain circumstances, the CULTURES title/data does not display on 
the Nurse Intraoperative Report using the VistA Nurse Intraoperative 
Report display/print option or on the SURGERY tab in CPRS.  This occurs 
when the NURSE INTRAOP REPORT field (#29) in the SURGERY SITE PARAMETERS 
FILE (#133) is set to "PRINT TITLES WITH INFO ONLY" and the CULTURES 
field (#64) in the SURGERY FILE (#130) contains data and the SPECIMENS 
field (#49) does not.

The patch addresses one (1) issue: 
 
Under certain circumstances, the CVD REPAIR/OBSTRUCT field (#521) value 
in the SURGERY File (#130) is not displaying/printing for a NON-CARDIAC 
RISK ASSESSMENT using the "Print a Surgery Risk Assessment" [SROA PRINT 
ASSESSMENT] option.

The patch addresses one (2) issues: 
erroneously instead of the field name/title when adding a new entry to 
several multiples in the SURGERY file (#130) when entering a new surgery 
case using the "Operation Menu".  The multiples are: OTHER PROCEDURES 
(#.42), OTHER PREOP DIAGNOISIS (#.72)
SURGERY POSITION (#65), REQ BLOOD KIND (#1.05), SPECIAL EQUIPMENT (#680), 
PLANNED IMPLANTS (#681), SPECIAL SUPPLIES (#682), SPECIAL INSTRUMENTS 
(#683), PHARMACY ITEMS (#684), and REFERRING PHYSICIAN (#23).
 
1. In certain circumstances if a value is entered in the REFERRING
PHYSICIAN field (#23) of the SURGERY FILE (#130) in a surgery case the
value is carried over and DISPLAYS in the SPECIAL EQUIPMENT (#680),
PLANNED IMPLANTS (#681), SPECIAL SUPPLIES (#682), SPECIAL INSTRUMENTS
(#683) or PHARMACY ITEMS (#684) fields.
 
2. In certain circumstances "Select Surgical Specialty:" displays 

This enhancement to the VistA Surgery package includes:
 
STORED IN ^SRF(  (XX ENTRIES)   SITE: XXXXXXX                UCI: XXXXXXX
                                                              (VERSION 3)
DATA          NAME                  GLOBAL        DATA
ELEMENT       TITLE                 LOCATION      TYPE
-------------------------------------------------------------------------
 
130,665       DONOR VESSEL DISPOSITION VER1;16 SET
 
              Donor Vessel Disposition if not used   
 
                                'N' FOR NO DONOR VESSELS RECEIVED; 
                                'D' FOR DISCARDED; 
                                'R' FOR RETURNED TO OPO; 
                                'S' FOR STORED; 
                               *'NA' FOR NOT APPLICABLE; <--
              LAST EDITED:      MAY 18, 2022 
              HELP-PROMPT:      Enter disposition of donor vessels. 
              DESCRIPTION:
                                Document disposition of donor vessels.
 
1. An update to the SET OF CODES for the DONOR VESSEL DISPOSITION (#665)
2. Input template (order of menu options) realignment
 
The SRONRPT, SRONRPT1, and SRONRPT2 input templates that are executed when
the Nurse Intraoperative Report [SRONRPT] option is selected have been
updated to follow the order of menu options requested by the National
Surgery Office (NSO).
 
3. Deactivation of the POSSIBLE ITEM RETENTION (#630) field in the SURGERY
(#130) file
 
field in the SURGERY (#130) file
The POSSIBLE ITEM RETENTION (#630) field has been marked as 
UNEDITABLE in the SURGERY (#130) file and will no longer be included in
any VistA Surgery input templates for entry or editing. This field will
also no longer be required to electronically sign the Nurse Intraoperative
report. It will, however, continue to display in completed Nurse
Intraoperative Reports for historical cases.
 
4. Correction of spelling for GLASSES/GOOGLES to GLASSES/GOGGLES in the 
PATIENT PRECAUTIONS (#15) subfield of the LASER PERFORMED (#130.11)
multiple in the SURGERY (#130) file for display/print in the Nurse
 
Intraoperative Report.
'NA - NOT APPLICABLE' has been added to the set of codes that can be
selected for the DONOR VESSEL DISPOSITION (#665) field in the SURGERY 
(#130) file.  Surgery Risk Assessment transmissions have been modified to
accommodate the new 2 character code.

The patch addresses one (1) issue: 
 
The patch will address the following issue: the CPT EXCLUSIONS file (#137)
needs to be updated for fiscal year 2024 (FY24).

Please review FORUM's Patch Module description and installation 
instructions before installing this patch.

This patch removes the SURGEON'S OPERATION TIMES file (#131.2) from your
system. This file has been obsolete since the release of Surgery V. 3.0 in
1993.

This patch modifies the routine ^SROCODE used for flagging anesthesia
enhanced to create a background task for performing this function.
agents. With the release of Pharmacy Data Management V. 1.0, existing
calls to the Inpatient Medications routine ^PSGIU will be replaced by
the Pharmacy Data Management routine ^PSSGIU.  This modification allows
the function to work with or without the installation of Pharmacy
Data Management V. 1.0.
 
This patch also modifies the routine ^SROXR1 which is used for canceling
IV orders upon start of a surgical procedure. This routine has been

This patch contains modifications to routines used to file information to
between Surgery and Order Entry/Results Reporting will be reestablished. A
future patch will be necessary when that time comes.
OE/RR. Changes will allow the software to function in it's current form
when using Order Entry/Results Reporting V2.5, but will inactivate the
interface for sites using CPRS and Order Entry/Results Reporting V3.0. The
interface for Surgery used within Order Entry/Results Reporting V2.5 is
not supported with CPRS and Order Entry/Results Reporting V3.0, causing
errors when using the Surgery software.
 
At the time of release of this patch, it is unclear when the interface

Surgery patch SR*3*75 - DELAYED OP REPORT COMMENTS ERROR

This patch modifies the routines SROCON and SROCON1 used in creating the
data to be stored in Concurrent Cases. A problem was discovered when a
free text field contained a semi colon (;). The patch resolves this
problem.

Patch SR*3*77 provides software renovations related to Y2K (Year 2000)
compliance.

 This patch contains a new option [SR BLOOD PRODUCT VERIFICATION] within
 selected product is not associated with the patient identified, the
 warning message will be displayed.
 
 A new option called [SR BLOOD PRODUCT VERIFY AUDIT] is included to allow
 auditing of the option above. It has been placed on the "Chief of Surgery
 Menu" on the "Management Reports Menu".
 
 After installing this patch, IRM needs to turn on the KERNEL Audit Option
 by invoking the option, [XUAUDIT] for the new option exported with this
 patch [SR BLOOD PRODUCT VERIFICATION]. The expiration date for the audit
 the VistA Surgery package which will be used for transfusion error risk
 should be set to a date 100 years into the future.
 management. The new option is contained on the Surgery "Operations Menu".
 The option performs the following function; after scanning the blood unit
 ID, the software will check for an association with the patient
 identified. If there are multiple entries with the Unit ID scanned, these
 entries will be listed along with the Blood Component, Patient
 Associated, and Expiration Date. The user will then be prompted to select
 the one that matches the blood product about to be administered.  If the

The Surgery Interface is a generic interface that sends and receives
Surgery and Patient information by way of the VistA HL7 package.  The
interface consists of QRY (Query), ORU (Observation Results Unsolicited),
and ZIU (Scheduling Information Unsolicited) messages.  Certain specified
information is sent from the interface based on trigger events in the
VistA Surgery package.

 This patch adds "ORAL" as a medications route to the set of codes within
 This patch modifies the routine SROXR1 to correct a problem at entry
 point IV with an undefined variable 'Y' and converts a read/write at
 entry point IV1 to a FileMan call.
 Surgery file (#130) and modifies the routine SROMED to reflect this
 addition.
 
 This patch also changes the definition of the field Major/Minor
 per Dr. Gerald McDonald, Acting Director, Surgical Service, VACO and the 
 National Surgical Quality Improvement Program (NSQIP) Executive
 Committee.
 

This is Surgery patch SR*3*83.

This patch modifies one Surgery routine, SROQM, which is used to transmit
mail messages related to the Quarterly Report.  Current code, while it
works properly, needs to be updated based on guidance received from the
MailMan development team.  The changes included in this patch should be
transparent.

This patch corrects an undefined variable condition when the OERR Task
Order Purge option [ORTASK PURGE] runs after installing patch SR*3*41.
This patch also reinstalls the protocols included in patch SR*3*41.  The
install process for SR*3*41 did not properly update HL7 related fields for
these protocols in virgin installs.

This is Surgery patch SR*3*50, REPORTS BY DIVISION & OTHER FIXES.

Surgery Patch SR*3*84 - XQUIT Processing

Surgery patch SR*3*81 - NSQIP/VHA Directive 98-025

This patch modifies one Surgery routine, SRBLOOD.  This routine is used by
the Blood Product Verification option [SR BLOOD PRODUCT VERIFICATION].
It is possible, but rare, that this routine could result in a software
error when reading the Blood Unit ID. This patch eliminates the potential
hole in the logic.

This is Surgery patch SR*3*86.

The changes included in this patch are described in the description
of patch SR*3*87 in the National Patch Module.

This patch enhances the API written for the Imaging software. It updates
the data to use a 4-digit year format when sending the DATE OF OPERATION
field (#.09) from the SURGERY file (#130).  Changes have also been made to
provide the total number of images associated with the surgery case.

 Under some circumstances, incorrect nursing personnel were appearing on
 the Operation Report when using the option Batch Print Transcripted
 Operation Notes [SRSTRANS PRINT]. The problem occurs when a previous case
 in the batch has more entries for the fields OR SCRUB SUPPORT (#.112) or
 OR CIRC SUPPORT (#.111) of the SURGERY file (#130).

1. Information from the STROKE/CVA field (#256) of the SURGERY file (#130)
$J.
 
3. The list of station numbers that identify medical centers that perform
cardiac surgery is updated in the routine SROAUTLC, replacing 525
(Brockton/West Roxbury) with 523 (Boston).  This routine is further
modified updating several reads and writes with calls to ^DIR and
EN^DDIOL.
was not correctly extracted for cardiac risk assessments. This patch
corrects the problem.  The patch also provides a post-installation routine
to retransmit missing information for all surgical cases in which the
STROKE/CVA field (#256) was answered "YES".
 
2. This patch updates the cardiac assessment transmission routines
(SROATCM, SROATCM1 and SROATCM2) so that in references to the global ^TMP
the first two subscripts are a package namespaced subscript followed by

Surgery patch SR*3*88 provides the ability to enter CPT modifiers and
provides for displaying these CPT modifiers on screens and reports that
display CPT codes within the Surgery package.  The patch also includes
several software updates related to NSQIP and multi-division facilities.

1. The cardiac risk assessment transmission routines SROATCM, SROATCM1 and
 
This patch includes a post-install process that will transmit the added
pieces of information for all cardiac assessments that have already
transmitted.
 
2. For cardiac assessments, when using the Resource Data [SROA CARDIAC
RESOURCE] option or the Update Assessment Status to 'COMPLETE' [SROA
COMPLETE ASSESSMENT] option, if the admission date is later than the
discharge date, the following message will be displayed on the screen:
 
SROATCM2 are modified by this patch to do the following:
  ***  NOTE: Discharge Date precedes Admission Date!!  Please check.  ***
 
Similarly, when using the Cardiac Procedures Requiring CPB (Enter/Edit)
[SROA CARDIAC PROCEDURES] option or the Update Assessment Status to
'COMPLETE' [SROA COMPLETE ASSESSMENT] option, if the ischemic time is
greater than the CPB (cardiopulmonary bypass) time, the following message
will be displayed on the screen:
 
  ***  NOTE: Ischemic Time is greater than CPB Time!!  Please check.  ***
 
 
These changes require modifications to the routines SROACAR, SROACPM,
SROACR1 and SROACOM.
 
3. The non-cardiac transmission routines SROATM1 and SROATMNO are modified
by this patch to add to the transmissions the entry in the INTUBATED ?
(Y/N) field (#42) for the principal anesthesia technique defined in the
ANESTHESIA TECHNIQUE multiple field (#.37) in SURGERY file (#130).
 
This patch includes a post-install process that will transmit this added
piece of information for all FY2000 cases that have already transmitted.
   a. For both the admission and the discharge movements associated with
 
4. The routine SRSUP1 is modified to correct the problem described in NOIS
DAY-0200-41350.
   the assessed operation, the entry in the TRANSFER FACILITY field (#.05)
   in the PATIENT MOVEMENT file (#405) is added to the transmission.
 
   b. The patient's address, including street address, city and state, and
   the patient's phone number are added to the transmission.

1. When using the option Print Surgery Waiting List [SRSWL2] to print the
 
3. The options Operation Requests for a Day [SROP REQ] and Report of Missing
Quarterly Report Data [SROQ MISSING DATA] are updated to make the reports
print by division.  This change requires that the following routines be
modified: SROPREQ, SROQN, SROREQ, SROREQ1, SROREQ2, SROREQ3 and SROREQ4.
 
4. When entering a request for an operation, if the normal request deadline
falls on a holiday, the method used by the software to recalculate the
deadline to allow for the holiday is problematic.  (See NOIS BAY-0100-31625.)
This patch modifies the routines SRSCAN2 and SRSREQ.  After installing this
brief form by tentative date of operation, entering "^" to quit may not work.
patch, if the normal request deadline falls on a holiday, the software will
use the deadline for the closest valid scheduling date prior to the operation
request date.
(See NOIS ALB-1199-52220.)  This patch modifies the routines SRSWL12 and
SRSWL14 to correct the problem.
 
2. The Monthly Surgical Case Workload Report [SROA MONTHLY WORKLOAD REPORT]
option may generate an error if the report is run for a month prior to
October 1995.  (See NOIS TAM-1299-31004.)  The routine SROAWL1 is modified to
correct the problem.

1. This patch modifies the routine SROASSP adding the call to %ZISC to close
3. The routines SROREST and SROIRR are modified to correct the problem
described in NOIS V02-0400-N0176.  When using the option Enter Irrigation and
Restraints [SROMEN-REST], if the number of active entries in the IRRIGATION
file (#133.6) or in the RESTRAINTS AND POSITIONAL AIDS file (#132.05) is
greater than 36, items will be displayed on multiple screen pages with no
more than 36 items per page.                                              
 
4. Before installing this patch, if the nurse reviewer used the option
Non-Cardiac Assessment Information (Enter/Edit) [SROA ENTER/EDIT] or the
option Cardiac Risk Assessment Information (Enter/Edit) [SROA CARDIAC
the printer device.  This change fixes the problem described by NOIS
ENTER/EDIT] to update a risk assessment that was already transmitted, the
software required the nurse reviewer to go to the option Update Assessment
Completed/Transmitted in Error [SROA TRANSMITTED IN ERROR] to change the
assessment status to incomplete before updating was allowed.  After installing
this patch, if the nurse reviewer attempts to update a risk assessment using
the option Non-Cardiac Assessment Information (Enter/Edit) [SROA ENTER/EDIT]
or the option Cardiac Risk Assessment Information (Enter/Edit) [SROA CARDIAC
ENTER/EDIT], the option will allow the nurse reviewer to change the assessment
status to incomplete without having to go to another option first.  The
routine SROASS is modified to provide this change.
TAM-0300-32135 and NOIS ALB-0200-51214.
 
5. Obsolete code used originally to check for old Surgery Risk Assessment data
was removed from the routine SROASS.  This code was called by the entry action
of 6 options whose entry actions are also updated by this patch.  Those 6
options are listed below.
 
   Exclusion Criteria (Enter/Edit) [SR NO ASSESSMENT REASON]
   List of Surgery Risk Assessments [SROA ASSESSMENT LIST]
   Non-Cardiac Assessment Information (Enter/Edit) [SROA ENTER/EDIT]
   Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT]
 
   Print 30 Day Follow-up Letters [SROA REPRINT LETTERS]
   Update Assessment Completed/Transmitted in Error [SROA TRANSMITTED IN ERROR]
 
6. This patch modifies the routines SRODLAY, SRODLA1, SRODLA2, SROREAS,
SROREA1, SROREA2, SRODLT, SRODLT0, SROCAN, SROCAN0, SROCRAT, SRORAT1 and
SRORAT2 allowing the following report options to print reports for all
divisions or for a selected division:
   Report of Delayed Operations [SRODELA]
   Report of Delay Reasons [SROREAS]
   Report of Delay Time [SRO DELAY TIME]
2. The routine SRSDISP is modified to allow the display of the first 8
   Report of Cancellations [SROCAN]
   Report of Cancellation Rates [SROCRAT]
 
7. This patch updates the data dictionary for the following fields in
SURGERY file (#130) to require the inclusion of at least one space in
every 31 characters of input.  See NOIS HVH-0500-10303.  
 
   OTHER PREOP DIAGNOSIS multiple field (#.72, sub-file #130.17)
       OTHER PREOP DIAGNOSIS field (#.01)
   OTHER POSTOP DIAGS multiple field (#.74, sub-file #130.18)
characters of the name of the operating room on the operating room
       OTHER POSTOP DIAGS field (#.01)
   PRINCIPAL PRE-OP DIAGNOSIS field (#32)
   PRINCIPAL DIAGNOSIS field (#33)
   PRINCIPAL POST-OP DIAGNOSIS field (#34)
availability display graph.  This change is made in response to NOIS
GNH-0300-42659
 

This patch installs the SURGERY DISPOSITION file (#131.6), converts the
three disposition fields to point to this file and updates reports that
access disposition data.

This patch provides enhancements in support of the Continuous Improvement
in Cardiac Surgery Program Expansion (CICSP-X). 
See Patch SR*3*95 in the National Patch Module for description of the
Build.

See Patch SR*3*97 in the National Patch Module for description of the
Build.

See patch SR*3*98 in the National Patch Module for description of this
build.

1. The input screen of the Cardiac Procedures Requiring CPB (Enter/Edit)
   expands to "RI-Remains in ICU at 30 days" when entered for D/T PATIENT
   EXTUBATED field (#470) in the SURGERY file (#130). Actually, it should
   expand to "RI-Remains intubated at 30 days". This patch fixes this
   problem.
   [SROA CARDIAC PROCEDURES] option, for the BATISTA PROCEDURE USED field
   (#439) the screen displays what is in the MISC. CARDIAC PROCEDURES
   field (#375) of the SURGERY file (#130). This patch fixes this problem.
 
2. The cardiac assessment transmission is modified to include the
   patient's date of birth.
 
3. On the Resource Data [SROA CARDIAC RESOURCE] option, the code "RI"

1. On the Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option,
   this patch rewords the message to read "Today's date exceeds the blood
   product expiration date.".
   the code "RI" expands to "RI-Remains in ICU at 30 days" when entered
   for D/T PATIENT EXTUBATED field (#470) in the SURGERY file (#130).
   Actually, it should expand to "RI-Remains intubated at 30 days". This
   patch fixes this problem.
 
2. On the Blood Product Verification [SR BLOOD PRODUCT VERIFICATION]
   option, if the blood unit is expired the system displays the worning
   message "Blood Product Expiration Date is later than today's date.",

1. This patch modifies the RISK ASSESSMENT IN USE (Y/N) field (#15) in the
   controls access based upon the sites default institution station number.
 
2. This patch fixes the problem reported in NOIS SDC-0301-62902 to prevent
   the undefined variable error that may occur when completing a
   non-cardiac risk assessment.
   SURGERY SITE PARAMETERS file (#133), changing the name of the field to
   CARDIAC RISK ASSESSMENT IN USE(Y/N).  After installing this patch, the
   entry action on the Cardiac Risk Assessment Information (Enter/Edit)
   [SROA CARDIAC ENTER/EDIT] menu will check this parameter field to
   determine if menu access is allowed. This parameter may be edited using
   the Surgery Site Parameters (Enter/Edit) [SROPARAM] option on the Surgery 
   Package Management Menu [SRO PACKAGE MANAGEMENT].  This change enables
   local control of menu access and replaces the current function that 

1. As reported in NOIS DUR-0501-32617, the value in the DATE/TIME OR
2. NOIS CPH-0601-41315 reported that the Surgery Quarterly Report is
continuing to use inactive CPT codes in the Index Procedures section of
the report.  This patch modifies the routine SROQ0A, replacing the 3
inactive CPT codes (56340, 56341 and 56342) with the 3 replacement codes
(47562, 47563 and 47564).  The post-install process will task the
Quarterly Reports for the past reporting periods of FY 2001 to transmit
again.
REQUEST MADE field (#1.098) in SURGERY file (#130) occasionally includes
trailing zeros that cause the exclusion of such values when sorting by a
date range.  This patch modifies the routines SRSCAN0, SRSCAN2, SRSCHUN,
SRSDT and SRSRQST so that trailing zeros will be removed before the value
is stored.  A post-install process will loop through SURGERY file (#130)
and remove any trailing zeros in the DATE/TIME OR REQUEST MADE field
(#1.098).
 

1. This patch modifies routine SROPRPT, adding the call to HOME^%ZIS to
   fix the error "DEVICE OR FILE NOT OPEN" that occurs occasionally due to
   the printer device not being closed prior to running the Operation
   Report [SROSRPT] option.
 
2. This patch fixes the problem reported in NOIS PUG-0701-50135, of an
   extrinsic function call in routine SROAUTLC which quits without a
   value.

1. This patch fixes the Undefined Error reported on NOIS LAH-0901-60445.
   The error is generated as a result of not killing variable DR before
   calling Surgery screen server routine SRCUSS.
 
2. When using the Delete Service Blockout [SRSBDEL] option at a
   multi-division facility, it was reported that this option displays all
   operations, where as it should display only those operations for the
   selected division. This patch fixes this problem.

1. This patch corrects the problem described in NOIS UNY-1101-11002 and NOIS 
 
This patch adds the following new fields to store responses to the MST and 
HNC classification questions that will be passed to PCE with the other 
surgical encounter information:
 - File: SURGERY (#130)
   Field: MILITARY SEXUAL TRAUMA  (#.022)      SET
   Description: This field will be used to indicate if this surgery or non-OR
                procedure is treating a VA patient for a problem that is
                related to Military Sexual Trauma.  This information may be 
                passed to the VISIT file (#9000010) for use by PCE.
HAM-1101-21180.
 
   Field: HEAD AND/OR NECK CANCER (#.023)         SET
   Description: This field will be used to indicate if this surgery or non-OR
                procedure is treating a VA patient for a problem that is 
                related to Head and/or Neck Cancer.  This information may be 
                passed to the VISIT file (#9000010) for use by PCE.
 
 - File: SURGERY WAITING LIST (#133.8)
   Field: PATIENT (#1) (Multiple, sub-file #133.801)
   Sub-Field: MILITARY SEXUAL TRAUMA (#21)     SET
 
   Description: This field will be used to indicate if this surgery is 
                treating a VA patient for a problem related to military 
                sexual trauma.  This information may be passed to the VISIT
                file (#9000010) to be used by PCE.
 
   Sub-Field: HEAD AND/OR NECK CANCER (#22)       SET
   Description: This field will be used to indicate if this surgery is 
                treating a VA patient for a problem related to Head and/or
                Neck Cancer.  This information may be passed to the VISIT
                file (#9000010) to be used by PCE.
2. This patch modifies the Surgery software to include the Military Sexual 
Trauma (MST) classification question and the Head and/or Neck Cancer (HNC) 
classification question on the list of potential classification questions 
that must be answered on ambulatory surgeries that are passed to PCE if the 
Surgery interface to PCE is turned on and the ASK CLASSIFICATION QUESTIONS 
field (#19) in SURGERY SITE PARAMETERS file (#133) is set to YES.

Surgery Patch SR*3*62.

1. It was reported that, when using the Report of Unscheduled Admissions
   characters, but no spaces in the  next 80 or more  characters after the
   last space, the software would loop, causing the job to hang. This
   patch fixes this problem.
   to ICU [SROICU] option, if the site is a multi-division facility, this
   report populates the data from all the divisions. This patch modifies
   the routines SROICU, SROICU1, and SROICU2 to enhance printing of this
   report to be a division specific.
 
2. When using the Nurse Intraoperative Reprot [SRONRPT] option, there is a
   problem which causes the job to hang.  If the NURSING CARE COMMENTS
   field (#.29) of the SURGERY file (#130) contains spaces in the first 78

1. The calls to the Imaging (MAG) V 1.0 package software that are in the
   patch fixes this problem.
 
3. It was observed that when editing any multiple fields via the Surgery
   Screen Server Utility it's currently not allow editing of any multiple
   fields if those fields have only the top level field (.01) in the Input
   Template. This patch will ensure that such fields are editable.
   Surgery routines were added to those routines by patch SR*3*66 to
   facilitate the use of the Imaging software. These calls are obsolete,
   any reference to those calls will cause the software to generate an
   error.  This patch removes all of these references.
 
2. It was reported that the REQ FROZ SECT field (#1.02) in the SURGERY
   file (#130) is not printed when generating the Operating Room
   Schedule report using the Schedule of Operations [SROSCH] option. This

This patch exports a new "AOE" cross-reference to the TIME PAT OUT OR
field (#.232) in the SURGERY file (#130). The new cross-reference will
allow the Computerized Patient Record System (CPRS) to automatically
discontinue or release orders when patient leaves the Operating Room.

In preparation for the VistA Blood Establishment Computer Software 
post-install routine. A mail message will be sent to the person who 
started the installation to let them know the conversion is complete and 
any problems that were encountered. The subject of the message will be: 
SURGERY POINTER CONVERSION COMPLETED. Please note: if problems were 
encountered, the message will contain information on correcting the 
problems and re-running the conversion. However, it is not required to do 
this. Just be aware that these entries will now simply display as a 
number.
(VBECS), changes are necessary in the Surgery V. 3.0 package. Any 
reference to the blood bank information needs to be modified to prepare 
for the VBECS release. This patch makes these modifications.
 
As a part of these changes, it is necessary to convert the existing data. 
Pointers from the SURGERY SITE PARAMETERS file (#133) and the SURGERY 
file (#130) that reference the BLOOD PRODUCT file (#66) will be changed 
to actually contain the name of the product. This process will run as a 

This patch contains modifications to the Surgery package to include new
    Ethnicity and multiple Races display on the report.  These fields are 
    not editable through the Surgery package options.
 
3.  Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT].  Ethnicity 
    and multiple races appear on the report.
 
4.  Queue Assessment Transmissions [SROA TRANSMIT ASSESSMENTS].
        a.  Non-Cardiac Risk Assessment transmission.  Old Race 
            information is retained on node 7.  New Ethnicity and multiple
            Races are transmitted on node 13.
Ethnicity and multiple Race fields in four Surgery options as listed 
        b.  Cardiac Risk Assessment transmission.  Old Race information is
            retained on node 24.  New Ethnicity and multiple Races 
            are transmitted on node 6.
below. The new fields comply with the new Race and Ethnicity Standards as
set forth by the Office of Management and Budget.
 
1.  Tissue Examination Report [SROTRPT].  Ethnicity and multiple Races 
    appear in the report footer.
 
2.  Non-Cardiac Assessment Information (Enter/Edit) [SROA ENTER/EDIT].

This is an enhancement patch to the Surgery V. 3.0 software. It will
 
1. The new SPD COMMENTS field (#80) of the SURGERY file (#130) is added to
   the following options:
 
  - Make Operation Requests [SROOPREQ]
  - Delete or Update Operation Requests [SRSUPRQ]
  - Make a Request from the Waiting List [SRSWREQ]
  - Make a Request for Concurrent Cases [SRSREQCC]
  - Schedule Unrequested Operations [SROSRES]
  - Schedule Unrequested Concurrent Cases [SRSCHDC]
replace the existing Surgery interface with the Integrated Funds
  - Reschedule or Update a Scheduled Operation [SRSCHUP]
 
2. The new AUTOMATED CASE CART ORDERING field (#37) will be added to the
   SURGERY SITE PARAMETERS file (#133) input template SRPARAM so that
   this field may be edited using the Surgery Site Parameters (Enter/Edit)
   [SROPARAM] option. This field will be checked to determine if the
   CoreFLS interface for Surgery is in use at the facility before sending
   the Surgery data to the CoreFLS package.
 
3. This patch modifies all options used to create or schedule a Surgery
Distribution, Control Point Activity, Accounting, and Procurement (IFCAP)
   case so that information can be provided to SPD for the creation of
   Surgery case carts.
 
4. This patch modifies the Surgery software to send updates to SPD
   whenever any of the information provided on the messages has been
   modified using any data entry option.
 
5. This patch enhances the following options to initiate HL7 update
   messages if the Surgery Health Level 7 (HL7) interface is in use at
   the facility for the following options:
with a new interface to the Core Financial and Logistics System (CoreFLS).
 
   - Enter PAC(U) Information [SROMEN-PACU]
   - Patient Demographics (Enter/Edit) [SROA DEMOGRAPHICS]
   - Operative Risk Summary Data (Enter/Edit) [SROA CARDIAC OPERATIVE
     RISK]
   - Exclusion Criteria (Enter/Edit) [SR NO ASSESSMENT REASON]
   - Update 1-Liner Case [SROA ONE-LINER UPDATE]
Functionally, the new interface expands the features provided in the
existing interface. The interface will provide Surgery case information to
Supply Processing and Distribution (SPD) so that the specific Surgery
case carts needed for the case can be created. The modifications include
the following items:

This patch provides the ability to display a new confidential 
communication address when using the Print 30 Day Follow-up Letters [SROA 
REPRINT LETTERS] option within VISTA Surgery if the Confidential 
Communication Types contain "All Others".

This patch is created in support of directive 2002-070, ENSURING CORRECT
SURGERY.
 
The patch adds two new fields in the SURGERY file (#130).  They are
needed to document that the operating room team performed a "time out" to
ensure that the correct surgery is being done.  The new fields are:
  1. TIME OUT VERIFIED (#71)
  2. IMAGING CONFIRMED (#72)

1. This patch fixes the "NULLSUBSCR" error generated when using the PRINT
2. This patch adds the description to the Data Dictionary of the
   DEFAULT BLOOD COMPONENT field (#41) in the SURGERY SITE PARAMETERS file
   (#133).
 
3. When updating a Risk Assessment Status to "COMPLETE", the software
   checks for missing information and provides the ability to update it.
   This option was overlooked when doing the Race & Ethnicity changes
   (patch SR*3*111). This patch removes the current checking for the RACE 
   field (#417) in the SURGERY file (#130).
 
   FILE ENTRIES FileMan option to print one or more of the following
4. When using the Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT]
   option, there is a possibility of getting an undefined error if the
   length of the race data is found to be more than forty characters.
   This patch fixes this problem.
   fields in the SURGERY file (#130) if these fields contain no data:
 
   - OTHER RESPIRATORY OCCURRENCE field (#253)
   - OTHER URINARY TRACT OCCURRENCE field (#286)
   - OTHER CNS OCCURRENCE field (#343)
   - OTHER CARDIAC OCCURRENCE field (#344)
 

1. Surgery is using the Flag Drugs for Use as Anesthesia Agents [SROCODE] 
   If the user quits using the up-arrow ("^"), the software does not
   respond correctly and subsequently errors out. This patch fixes this
   problem.
 
3. It was reported that if the Surgery case was in a requested state 
   and if an entry is made in the TIME PAT IN OR field (#.205) of the 
   SURGERY file (#130), it is found that the time gets appended to the
   DATE OF OPERATION field (#.09) of the SURGERY file (#130). This is
   causing the time to appear in the scheduling grid and prevents the case
   scheduling. This entry should be made only if the case is in a
   option to flag drugs in the DRUG file (#50) for use as anesthesia 
   scheduled state or entered via the Operation Menu [SROPER] option. This
   patch provides the user the option to delete any of the following
   entered date fields as a pre-condition for scheduling such cases:
 
    - ANES CARE START TIME field (#.21), TIME OPERATION BEGAN 
      field (#.22), TIME OPERATION ENDS field (#.23), ANES CARE END TIME
      field (#.24), TIME PAT IN OR field (#.205), and TIME PAT OUT OR
      field (#.232)
 
   This functionality is added to the following options:
   agents. This patch modifies this option to call Pharmacy Data
    - Delete or Update Operation Requests [SRSUPRQ] option
    - Schedule Requested Operations [SRSCHD1] option
    - Reschedule or Update a Scheduled Operation [SRSCHUP] option
   Management V. 1.0 (PDM) package so that PDM possibly generates an HL7
   outgoing drug message.
 
2. When canceling a concurrent case using the Cancel Scheduled Operation 
   [SRSCAN] option, the software prompts, "There is a concurrent case 
   associated with this operation. Do you want to cancel it also? YES//".

Surgery patch SR*3*63, Fixes and Enhancements.

As a follow-up enhancement to Surgery patch SR*3*115, this patch adds a 
CONFIRMED field (#72). A surgical case is counted as compliant with the 
documentation process for ensuring correct surgery if the TIME OUT 
VERIFIED field (#71) is YES and if the IMAGING CONFIRMED field (#72) is 
either YES or NOT APPLICABLE.
 
This report includes two parts, either of which may be printed separately 
or combined: 
 1. Compliance Summary - This part shows the number of cases with each of
    the possible data scenarios for the two fields in question and their
    percentage of the total cases performed.
new report option to assist in reviewing compliance with the process 
 2. List of Non-Compliant Cases - This part provides a list of surgical
    cases that are not compliant (as defined above).
defined by directive 2002-070, ENSURING CORRECT SURGERY. Ensuring Correct 
Surgery Compliance Report [SRO ECS COMPLIANCE] option is added to the 
Management Reports [SRO-CHIEF REPORTS] menu on the Chief of Surgery Menu
[SROCHIEF] option. 
 
This report checks the two fields added to SURGERY file (#130) by Surgery 
patch SR*3*115, the TIME OUT VERIFIED field (#71) and the IMAGING 

Please see the National Patch Module for details of the enhancements
included in this patch.

As a follow-up enhancement to Surgery patch SR*3*115 (released April 8, 
after November 13, 2003, the Quarterly Report for the fourth quarter of
Fiscal Year 2003 will also be automatically transmitted by a post-install
process.
2003), this patch updates the Quarterly Report by adding the Compliance 
Summary portion of the Ensuring Correct Surgery Compliance Report (made 
available by patch SR*3*120) to the end of the existing Quarterly Report.
This additional information will be transmitted as part of the Quarterly
Report that goes to Surgical Service, Central Office.
 
A post-install process will automatically transmit the Quarterly Report 
for the third quarter of Fiscal Year 2003. If this patch is installed

This is an enhancement patch to the Surgery V. 3.0 software. It will
 - Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT]
 - Update Assessment Completed/Transmitted in Error
    [SROA TRANSMITTED IN ERROR]
 - Print 30 Day Follow-up Letters [SROA REPRINT LETTERS]
 - Exclusion Criteria (Enter/Edit) [SR NO ASSESSMENT REASON]
 - Update 1-Liner Case [SROA ONE-LINER UPDATE]
allow assessment lookups by assessment (case) number, in addition to the
lookups by patient. The following options under the Surgery Risk
Assessment Menu [SROA RISK ASSESSMENT] option has this functionality
incorporated:
 
 - Non-Cardiac Assessment Information (Enter/Edit) [SROA ENTER/EDIT]
 - Cardiac Risk Assessment Information (Enter/Edit)
    [SROA CARDIAC ENTER/EDIT]

This patch corrects two problems. It corrects the problem in the 
display when entering "Other Procedures" in the Operation [SROMEN-OP]
Option. The display is limited to 15 entries, and sometimes more
than 15 "Other Procedures" entries are needed. The patch also corrects
a problem that occurs when printing the PCE Filing Status report. 
Long names should list the initial for the patient's first name.  
Currently, the report drops the first name completely.

This patch corrects the null subscript error in SROPRPT routine.

This patch updates the PROTOCOL file(#101) and HL LOGICAL LINK file(#870) 
for the Surgery interface.  HL LOGICAL LINK file(#870) does not contain 
any site specific data.

This patch is an enhancement to the Surgery software providing additional
   type field.
 
This patch modifies the following four existing fields in the SURGERY
file (#130):
 - A minor change is made to the description of the "NO" choice in
   the TIME OUT VERIFIED field (#71).
 
 - The PREOPERATIVE IMAGING CONFIRMED field (#72) will have three
   choices: "Y, YES", "I, IMAGING NOT REQUIRED FOR THIS PROCEDURE" and
   "N, NO - IMAGING REQUIRED BUT NOT VIEWED (see CORRECT SURGERY
changes related to Ensuring Correct Surgery. This patch is Phase I of the
   COMMENTS)"
 
 - The description of the different choices of the ATTENDING CODE
   field (#.165) is modified.
 
 - The maximum number of years of surgical residency (post graduate)
   of the PGY OF PRIMARY SURGEON field (#214) is changed from 10 to 12.
 
This patch also exports the following new date/time fields that will be
used to time-stamp when the three correct Surgery fields (TIME OUT
enhancement.
VERIFIED (#71), PREOPERATIVE IMAGING CONFIRMED (#72), and MARKED SITE
CONFIRMED (#73)) of the SURGERY file (#130) are entered or edited, and
they are not editable fields:
 - TOV TIMESTAMP field (#75)
 - IMAG TIMESTAMP field (#76)
 - SITE MARK TIMESTAMP field (#77)
 
These fields MARKED SITE CONFIRMED (#73), PREOPERATIVE IMAGING CONFIRMED
(#72), and CORRECT SURGERY COMMENTS (#74) are found under the following
menu options:
 
 - Operation [SROMEN-OP] option
 - Operation (Short Screen) [SROMEN-OUT] option
 - Operation Startup [SROMEN-START] option
 
This patch will disable the Ensuring Correct Surgery Compliance Report
[SRO ECS COMPLIANCE] option. Also, the compliance section of the
Quarterly Report - Surgical Service [SRO QUARTERLY REPORT] option will be
disabled until Correct Surgery Enhancements 2004 Phase II is released,
targeted date is June 2004.
This patch exports the following new fields in the SURGERY file (#130):
 - The MARKED SITE CONFIRMED field (#73) will have three choices:
   "Y, YES", "M, MARKING NOT REQUIRED FOR THIS PROCEDURE" and "N, NO -
   MARKING REQUIRED BUT NOT DONE (see CORRECT SURGERY COMMENTS)".
 - The CORRECT SURGERY COMMENTS field (#74) which is a word processing

This patch provides the ability to electronically sign operative reports 
Features provided by this patch are described in the Surgery Electronic 
Signature for Operative Reports Release Notes and in the Surgery 
Electronic Signature for Operative Reports Implementation Guide.
contained within the VISTA Surgery V. 3.0 application. These reports
include the Operation Report, the Nurse Intraoperative Report, the
Anesthesia Report and the Procedure Report (Non-O.R.). This patch provides
the ability to view these signed reports through the Computerized Patient
Record System (CPRS) by storing them in the Text Integration Utilities
(TIU) V. 1.0 application. Tools provided by the TIU software will be used
to sign and manage the electronic documents.
 

This patch addresses follow-up issues related to the Surgery Electronic 
**DRAFT COPY - DRAFT COPY -- ABOVE NOTE IS UNSIGNED-- DRAFT COPY - DRAFT COPY**
 
   This patch modifies the routine SROESPR1 to prevent the display of this
   line if the document has a status of COMPLETED. See NOIS
   FAR-0104-40622.
 
2. The input template SROARPT is used by the Anesthesia Report [SROARPT] 
   option to edit fields that are part of the Anesthesia Report. This 
   patch modifies this input template to remove the INTRAOPERATIVE
   OCCURRENCES field (#1.14) and the POSTOP OCCURRENCE field (#1.16) since
Signature for Operative Reports patch (SR*3*100).
   these two fields do not appear on the Anesthesia Report.
 
1. Converted documents for historical surgical/non-OR cases are stored in 
   the TIU DOCUMENT file (#8925) with a status of COMPLETED, but they 
   have no signature date. Therefore, when one of these converted
   documents is printed, the following line is printed at the end of the
   document text:
 

The information contained in this KIDS Build relates to the Surgery patch
SR*3*64.

******************************* N O T E **********************************
   procedures. This patch implements the new levels of resident 
     comment field.
     At the end of the conversion process, this patch will delete the data
     dictionary of the CORRECT SURGERY COMMENTS field (#74) in the SURGERY
     file (#130), which was exported in phase I of the Ensuring Correct
     Surgery patch SR*3.0*126.
 
3. SURGEON PRESENT TIME ON NURSE INTRAOPERATIVE REPORT
   Patch SR*3*25 modified the Nurse Intraoperative Report so that it 
   displayed the SURG PRESENT TIME field (#.206) only if data was entered.
   This functionality, omitted unintentionally by patch SR*3*100, is
   supervision in the Surgery software and includes the following
   restored by this patch.
 
4. DOCUMENTS PRINTED FROM TIU
   This patch modifies the routine SROESPR to correct a possible problem 
   if no print group is defined when a document is printed.
   features:
 
 (a) A new file, ATTENDING CODES file (#132.9), is created to store all 
     attending codes used by the Surgery software. These codes include 
     both sets of Levels 0 to 3 (before and after patch SR*3*126, all
     flagged as inactive codes) and the latest codes for Levels A to F
     (active codes).
 
There is no conflict between this patch and the CoreFLS software.
 (b) The name of the existing ATTENDING CODE field (#.165) in the SURGERY
     file (#130) is changed to *ATTENDING CODE - NOT USED and a new
     ATTENDING CODE field (#.166) is created that points to the ATTENDING
     CODES file (#132.9).
 
 (c) The patch includes a post-install conversion that loops through all 
     the cases in the SURGERY file (#130) and matches the attending code
     in the old field (#.165) with the equivalent code in the new
     ATTENDING CODE field (#.166), storing the equivalent code in the new
     field. The content of the old field is not changed by the conversion.
Installation of this patch by the CoreFLS sites will not cause any 
 
 (d) The following data entry options are updated to use the new ATTENDING
     CODE field (#.166): 
     - Post Operation [SROMEN-POST] 
     - Operation (Short Screen) [SROMEN-OUT] 
     - Surgical Staff [SROMEN-STAFF] 
     - Edit Non-O.R. Procedure [SRONOP-EDIT] 
     - Update 1-Liner Case [SROA ONE-LINER UPDATE]
 
 (e) The following report and display options are updated to use the new 
problems.
     ATTENDING CODE field (#.166): 
     - Attending Surgeon Reports [SROATT] 
     - View Patient Perioperative Occurrences [SROMEN-M&M] 
     - Operation Information [SROMEN-OPINFO] 
     - Quarterly Report - Surgical Service [SRO QUARTERLY REPORT] 
       Note: The Perioperative Occurrence Categories on this report are
       updated to reflect the categories used by the National Surgical
       Quality Improvement Program (NSQIP) and the Continuous Improvement
       in Cardiac Surgery Program (CICSP). Some of these categories may
       not be immediately available for selection, but will be included
**************************************************************************
       later in the NSQIP/CICSP ENHANCEMENTS 2004 patch (SR*3*125).
     - List of Operations Included on Quarterly Report [SROQ LIST OPS] 
     - Report of Missing Quarterly Report Data [SROQ MISSING DATA]
 
 (f) The patch updates the transmission of Quarterly Report data to the 
     national database to use the new ATTENDING CODE field (#.166).  
 
2. ENSURING CORRECT SURGERY PHASE II
   Phase II of the Ensuring Correct Surgery Enhancement Project provides
   the following enhancements:
 
 
 (a) The following new fields are added to the SURGERY file (#130):
     - TIME OUT VERIFIED COMMENTS field (#82)
     - IMAGING CONFIRMED COMMENTS field (#83)
     - MARKED SITE COMMENTS field (#84)
 
     These fields are added to capture the comments corresponding to the
     following:
     - TIME OUT VERIFIED field (#71)
     - PREOPERATIVE IMAGING CONFIRMED field (#72)
1. RESIDENT SUPERVISION
     - MARKED SITE CONFIRMED field (#73)
 
 (b) The following data entry options will be modified to include
     the new comment fields noted in item (a):
     - Operation [SROMEN-OP]
     - Operation (Short Screen) [SROMEN-OUT]
     - Nurse Intraoperative Report [SRONRPT]
 
     Entry of "NO" in any of the three Correct Surgery fields will prompt
     the user to enter the associated comment field. Entry of "NO" in
   The Veterans Health Administration (VHA) Handbook 1400.1, dated May 3, 
     any of the three Correct Surgery fields will not automatically force
     entry into the respective comment field.
 
 (c) Nurse Intraoperative Report Changes
     If any of the three Correct Surgery fields are not answered, the
     nurse will not be able to electronically sign the Nurse
     Intraoperative Report. If any of the three Correct Surgery fields is
     answered "NO" but does not have information in the corresponding
     comments field, the nurse will not be able to electronically sign the
     Nurse Intraoperative Report. The nurse will be able to update this
   2004, changed the levels of resident supervision for operating room 
     information at time of signature without leaving the option.
 
 (d) The compliance reports, which were disabled in phase I are 
     reactivated and are modified to display the new formats for the three
     Correct Surgery fields.
 
 (e) Convert Existing Comments
     For each of the three Correct Surgery fields answered with a "NO" 
     response, the information in the CORRECT SURGERY COMMENTS field (#27)
     of the SURGERY file (#130) will be replicated in the corresponding

******************************* N O T E *********************************
dictated summary, if present. After patch SR*3*100, the Procedure Report 
(Non-OR) includes only the provider's dictated summary since only the 
provider's dictated summary is electronically signed. The only way to 
review the information entered into the data fields documenting the 
procedure in the SURGERY file (#130) is by way of the data entry options 
on the Non-O.R. Procedures (Enter/Edit) [SRONOP-ENTER] menu.
 
This patch adds the Non-OR Procedure Information [SR NON-OR INFO] option, 
to the Non-O.R. Procedures (Enter/Edit) [SRONOP-ENTER] menu and to the 
CPT/ICD9 Update/Verify Menu [SRCODING UPDATE/VERIFY MENU]. This option 
There is no conflict between this patch and the CoreFLS software.
will display the "op-top" information that formerly was part of the 
Procedure Report (Non-OR). The output from this option may be viewed on 
the user's screen or may be printed.  
 
A future enhancement is planned that will incorporate the "op-top"
information into an electronically signed document and thus be viewable in
the Computerized Patient Record System (CPRS). At this time, the details
of this enhancement and schedule for release are not known.
Installation of this patch by the CoreFLS sites will not cause any 
problems.
*************************************************************************
 
Prior to patch SR*3*100, the Procedure Report (Non-OR) included an 
"op-top" section that included many of the data fields documenting the 
procedure in the SURGERY file (#130) in addition to the provider's 

******************************* N O T E **********************************
   VA's NSQIP module more in line with the data collected in the private
   sector. This patch also include updates to the Continuous Improvement
   in Cardiac Surgery Program (CICSP) module. 
   
   Modifications to the Surgery V. 3.0 software include:
   - the addition of 22 new fields to SURGERY file (#130)
   - the update of approximately 120 field descriptions for NSQIP and 
     CICSP data elements in the SURGERY file (#130)
   - the update of data input screens to allow the input of additional
     data elements as well as to delete some data elements no longer 
There is no conflict between this patch and the CoreFLS software.
     needed
   - the addition of two new data input options, Laboratory Test Results 
     (Enter/Edit) [SROA LAB-CARDIAC] and Outcome Information (Enter/Edit) 
     [SROA CARDIAC-OUTCOMES], on the Cardiac Risk Assessment Information 
     (Enter/Edit) [SROA CARDIAC ENTER/EDIT] menu
   - the removal of the option Update Operations as Unrelated/Related to 
     Death [SRO DEATH RELATED] from Surgery Risk Assessment Menu [SROA
     RISK ASSESSMENT]
   - the update of assessment transmissions to reflect the current 
     set of NSQIP and CICSP data elements
Installation of this patch by the CoreFLS sites will not cause any 
   - the update of occurrence categories in the PERIOPERATIVE OCCURRENCE
     CATEGORY file (#136.5)
 
2. This patch will enhance the lookup by case/assessment number feature
   introduced in patch SR*3*121. Within the Surgery Risk Assessment Menu 
   [SROA RISK ASSESSMENT] option, at the "Select Patient" prompt, lookup
   by case/assessment number is allowed by entering the case number
   preceded by #, e.g., enter #6785 to go to case #6785.
problems.
**************************************************************************
 
1. This patch updates the Surgery Risk Assessment software of the VISTA 
   Surgery V. 3.0 application as requested by the National Surgical
   Quality Improvement Program (NSQIP) Executive Committee to bring the

1. NON-CARDIAC PREOP INFORMATION SCREEN, PAGE 1
   in the SURGERY file (#130), the word aneurysectomy is changed to
   aneurysmectomy.
 
3. REPEAT VENTILATOR W/IN 30 DAYS
   This patch modifies the cardiac assessment creation process to set the 
   default value of the REPEAT VENTILATOR W/IN 30 DAYS field (#490) in 
   the SURGERY file (#130) to NO if null.
 
4. CPB STATUS
   This patch updates how the cardiopulmonary bypass status associated 
   When editing all the GENERAL items on the first page of the
   with a repeat cardiac surgical procedure outcome is updated and
   transmitted for cardiac assessments.
   Preoperative Information (Enter/Edit) [SROA PREOP DATA] option, the
   last two items are not presented for editing in the same order they
   appear on the main screen. This patch changes the order of presentation
   for editing to match the order on the main screen.
 
2. SPELLING CORRECTION
   In the field description of the PREVIOUS CARDIAC SURGERY field (#266)

Office of Information Assurance, Office of Information, Veterans Health
time service was provided. Four code sets, (ICD-9-CM, CPT, CPT modifiers,
DRG) for this project were modified as required under HIPAA legislation to
be date-sensitive under the first phase of the project.
 
At the time that CSV was developed, a request was made to defer
applicable text versioning to the next iteration. This deferment of the
short and long-text versions from the CSV project makes up the scope of
this Code Text Descriptor (CTD) project. This follow-up project, CTD,
intends to add the functionality of date-sensitive versioning
for all applicable code text descriptors for the four code sets, effective
Administration (VHA), requested modifications to the VHA Information
with all textual changes occurring since October 1, 2002.
 
This patch addresses the changes done within the Surgery V. 3.0 software
in compliance with the CTD project.
 
The only noticeable difference users may see will occur when a specific
CPT, CPT modifier or ICD9 code descriptor changes base on the date of
operation for the case.
Systems and Technical Architecture (VistA) Patient Information Management
System (PIMS) package that would allow for the use of multiple versions of
the code sets employed in financial transactions. This work was completed
in 2003 in the Code Set Versioning (CSV) project that was deployed in
October of 2003. CSV included the Health Information Portability and
Accessibility Act (HIPAA) stipulation that diagnosis and procedure codes
used for billing purposes must be the codes that were applicable at the

THIS PATCH WILL ALLOW SURGERY USERS TO ENTER MORE THEN 15 LINE ITEMS FOR
ALL MULTIPLE FIELDS.

This patch prevents the infinite loop condition described in NOIS 
ISW-0904-20140 when the Imaging software attempts to display an Operation
Report that is not complete.

This patch corrects the problem reported in NOIS WRJ-1004-10891 in which 
ORGAN/SPACE SSI occurrence categories were not appearing on the 
non-cardiac assessment printout.

This patch will clean up old variables after the call to EN^DIQ1.
It will also replace the Anesthesia Agent Dose that was removed during 
the install of SR*3*100.

1. LOCKING OF SURGICAL CASES FOR EDITING
   signed while the case or a concurrent case is open for editing. If a
   case is locked and another user attempts to open the same case for
   editing, a message will appear on the screen indicating the name of the
   user that has the case locked. Likewise, if a user attempts to sign 
   the Nurse Intraoperative Report or the Anesthesia Report while the 
   case is open for editing, a message will appear on the screen 
   indicating the name of the user that has the case open for editing.
   
2. ALLOW CHART PRINT OUTSIDE MAS
   This patch modifies the software responsible for printing
   Patch SR*3*100 introduced locking of a surgical case when a user opens
   electronically signed surgery reports to honor the ALLOW CHART PRINT
   OUTSIDE MAS parameter defined in the TIU DOCUMENT PARAMETERS file
   (#8925.95). If this parameter is set to YES or is null, users will be
   allowed to choose between printing a work copy or a chart copy. If this
   parameter is set to NO, only users in MAS will be allowed to print a
   chart copy and all other users will be allowed to print a work copy
   only.
 
3. QUARTERLY REPORT ARRAY CLEANUP
   This patch updates the software that generates the Surgery Quarterly 
   the case for editing, allowing only one user at a time to edit the same
   Report to kill a variable array that may cause problems when the
   Surgery Quarterly Report is transmitted from multidivisional
   facilities.
 
4. DATE/TIME OUTPUT TRANSFORM CORRECTION
   This patch corrects the output transform used to display the external 
   format of several date/time fields modified by patch SR*3*125. Also, an
   update is made to the way admission, transfer and discharge date/times 
   are retrieved and stored for Surgery Risk Assessment.
 
   case. This patch alters how surgical cases are locked and allows
5. DOCUMENTATION ERROR CORRECTION
   The patch SR*3*100 documentation problem described in NOIS
   PUG-0604-51225 is corrected in documentation distributed with this
   patch.
 
6. FIELD DESCRIPTION UPDATE
   In the SURGERY file (#130), the CONGESTIVE HEART FAILURE field (#207) 
   field description is updated with the 2004 definition.
 
7. PATIENT NAME/ID ON CARDIAC ASSESSMENT PRINTOUT
   multiple users to open the same case for editing up until the time that
   This patch corrects a problem with the cardiac assessment printout in 
   which the patient ID is truncated if the patient's name is more than 
   16 characters in length.
 
8. NOIS SHR-0904-71756
   This patch corrects the problem described in NOIS SHR-0904-71756 so
   that the printer is closed after printing the assessment upon
   assessment completion.
 
9. CARDIAC TRANSMISSION UPDATE
   either the Nurse Intraoperative Report or the Anesthesia Report is
   The cardiac assessment transmission is modified by this patch to 
   update the formatting of the date of death, if present.
 
10. NOIS SBY-0904-31547
   Application of this patch prevents the problem described in NOIS
   SBY-0904-31547.
 
11. ATTENDING REQUIRED BEFORE COMPLETING CASE
   To prevent possible cosigner problems with the Operation Report and 
   the Procedure Report (Non-OR), this patch will require the attending 
   signed. When a user enters the function to sign either report and after
   surgeon/provider to be entered before the case can be completed. 
   
   When a user enters the TIME PAT OUT OR field (#.232) in the SURGERY 
   file (#130), to complete a surgical case, if the ATTEND SURGEON field 
   (#.164) is blank, the software will prompt the user to enter the 
   attending surgeon. For non-OR procedures, when a user enters the TIME 
   PROCEDURE ENDED field (#122), if the ATTEND PROVIDER field (#124) is 
   blank, the software will prompt the user to enter the attending 
   provider.
   
   either report is signed, the software will again allow only one user at
   If the SURGICAL RESIDENTS (Y/N) field (#33) in the SURGERY SITE 
   PARAMETERS file (#133) is set to NO, when a surgeon is entered in the 
   SURGEON field (#.14) in the SURGERY file (#130), the software will 
   enter the surgeon in the ATTEND SURGEON field (#.164). For non-OR 
   procedures, when the provider is entered in the PROVIDER field (#123), 
   the software will enter the provider in the ATTEND PROVIDER field 
   (#124).
   a time to open the case for editing. Neither report for a case can be

Variables not printing correctly in Risk Assessment report

1. This patch fixes the problem reported in NOIS BAY-0105-30051. The 
   PREOP DATA] on the menu Non-Cardiac Assessment Information 
   (Enter/Edit) [SROA ENTER/EDIT] on the menu Surgery Risk Assessment 
   Menu [SROA RISK ASSESSMENT] to edit items under GENERAL on page 1, 
   entering a caret (^) to exit at one of the sub-item prompts does 
   not work correctly. This patch corrects this problem.
   problem was introduced by patch SR*3*134.
 
2. This patch fixes the problem reported in NOIS CLA-0105-20215. This 
   problem occurs only at facilities with multiple divisions defined in
   the SURGERY SITE PARAMETERS file (#133) with all but one division 
   flagged as inactive.
 
3. When using the option Preoperative Information (Enter/Edit) [SROA 

This patch enables the user to delete surgery images.

1. In support of the Surgical Infection Project (SIP), this patch 
     Medication Comments
 
2. The Morbidity & Mortality Reports [SROMM] option and the M&M 
   Verification Report [SRO M&M VERIFICATION REPORT] option are 
   modified to display the sepsis category for SYSTEMIC SEPSIS
   occurrences.
 
3. This patch modifies the DYSPNEA field (#325) in the SURGERY file 
   (#130) changing MINIMAL EXERTION in the set of choices to MODERATE 
   EXERTION. This change makes the set of codes agree with the field 
   modifies the Nurse Intraoperative Report [SRONRPT] option to display
   description.
   and to allow editing of the following additional information related
   to medications:
     Time Administered
     Route
     Dosage
     Ordered By
     Administered By

CLINICAL INDICATOR DATA CAPTURE - SURGERY

In Remedy HD 94190, when using the Patient Demographics (Enter/Edit) [SROA
DEMOGRAPHICS] option, an undefined error occurs if the length of the race
data is found to be more than 72 characters.

1. For CPRS-R (ReHosting), a cache of patient data will be maintained for
   (#.12) in the SURGERY file (#130). The field is renamed "PREOP HAIR
   CLIPPING BY" and the title and description of this field are updated.
   The field titles on the Nurse Intraoperative Report are changed as
   well.
   the duration of his/her inpatient stay (or outpatient visit) for ease
   of searching and sorting within the new Java client; rather than making
   frequent calls back to each application's database. To this end, this
   patch contains modifications that will allow the Surgery software to
   update the CPRS-R (ReHosting) cache of patient data when a case is
   created or edited.
 
2. This patch updates the data dictionary of the PREOP SHAVE BY field

THIS PATCH WILL INSERT "N SRX" TO THE BEGINNING OF SEVERAL SURGERY
FILE (#130) INPUT TRANSFORMS.

THIS PATCH CORRECTS FOUR ISSUES RELATED TO CIDC.

This patch modifies the Blood Product Verification [SR BLOOD PRODUCT 
VERIFICATION] option to reference the VistA Blood Establishment Computer 
Software (VBECS) if installed. This change allows the option to maintain 
its current functionality before and after VBECS is installed.

This is Surgery patch SR*3*67.

As existing pharmacy software modules are being re-engineered through
'behind-the-scenes' process to enable exchange of medication data.
new development and the purchase of commercial off-the-shelf products
(COTS). Transition to the new Pharmacy Re-Engineered system eliminates the
VistA Pharmacy files currently referenced. Therefore, all Surgery existing
references (direct global reads/writes, VA FileMan reads/writes) to all
pharmacy application files must be replaced with Application Programmer
Interfaces (APIs).
 
This enhancement does not entail any user functionality change, only a

This patch is a follow up patch for SR*3*151. It fixes the undefined
error reported by Dublin when using the Anesthesia Provider Report
[SROADOC] option.

This patch is part of the Patient Financial Services System (PFSS) project.
system. The project consists of the implementation of the billing
     o Quarterly Report - Surgical Service [SRO QUARTERLY REPORT] option
     o Report of Missing Quarterly Report Data [SROQ MISSING DATA] option
       Note: The Other CPT Codes no longer affect this report and 
       references to Other CPT Codes are removed. The display of "I" in 
       the footer of this report is removed.
     o Annual Report of Non-O.R. Procedures [SRONOP-ANNUAL] option
     o List of Invasive Diagnostic Procedures [SROQIDP] option
   - The following Surgery reports and options are modified to remove CPT 
     and/or ICD codes from the display.
     o Update Status of Returns within 30 Days [SRO UPDATE RETURNS] option
replacement system, business process improvements, and enhancements to
     o Update Operations as Unrelated/Related to Death [SRO DEATH RELATED]
       option
     o Non-OR Procedure Information [SR NON-OR INFO] option
     o Deaths Within 30 Days of Surgery [SROQD] option
     o Admissions Within 14 Days of Outpatient Surgery [SROQADM] option
     o List of Operations Included on Quarterly Report [SROQ LIST OPS]
       option
 
3. Modified Risk Assessment Options
   - Surgery case CPT and/or ICD codes used in the following options are 
VistA to support integration with the COTS billing replacement system.
     displayed from the SURGERY PROCEDURE/DIAGNOSIS CODES file (#136):
     o Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option
     o List of Surgery Risk Assessments [SROA ASSESSMENT LIST] option 
     o Exclusion Criteria (Enter/Edit) [SR NO ASSESSMENT REASON] option
       Note: The new CPT code fields will not be editable from this
       option.
     o Update 1-Liner Case [SROA ONE-LINER UPDATE] option
       Note: The new CPT code fields will not be editable from this
       option.
     o Queue Assessment Transmissions [SROA TRANSMIT ASSESSMENTS] option
Significant changes to VistA legacy systems and ancillary packages are
   - In the following options CPT codes are removed from the screen
     headings:
     o Preoperative Information (Enter/Edit) [SROA PREOP DATA] option 
     o Laboratory Test Results (Enter/Edit) [SROA LAB] option
     o Operation Information (Enter/Edit) [SROA OPERATION DATA] option
       Note: The CPT code and Postoperative Diagnosis fields will not be 
       editable from this option. 
     o Patient Demographics (Enter/Edit) [SROA DEMOGRAPHICS] option
     o Intraoperative Occurrences (Enter/Edit) [SRO INTRAOP COMP] option
     o Postoperative Occurrences (Enter/Edit) [SRO POSTOP COMP] option
necessary.
     o Clinical Information (Enter/Edit) [SROA CLINICAL INFORMATION]
       option
     o Laboratory Test Results (Enter/Edit) [SROA LAB-CARDIAC] option
     o Enter Cardiac Catheterization & Angiographic Data [SROA 
       CATHETERIZATION] option 
     o Operative Risk Summary Data (Enter/Edit) [SROA CARDIAC OPERATIVE 
       RISK] option
       Note: The CPT code fields will not be editable from this option.
     o Cardiac Procedures Operative Data (Enter/Edit) [SROA CARDIAC 
       PROCEDURES] option
 
     o Outcome Information (Enter/Edit) [SROA CARDIAC-OUTCOMES] option
     o Resource Data [SROA CARDIAC RESOURCE] option
   - The Update Assessment Status to 'COMPLETE' [SROA COMPLETE ASSESSMENT]
     option is modified to remove the ability to edit CPT and ICD codes 
     from this option.
 
4. Functions that are currently part of the Surgery Nightly Cleanup and 
   Updates [SRTASK-NIGHT] option are modified as follows:
   - Store Operation Times function uses the CPT code fields in the 
     SURGERY PROCEDURE/DIAGNOSIS CODES file (#136).
Some of the PFSS software components are not operational until the PFSS 
   - File Surgery Data in PCE function is removed.
 
5. The Surgery to PCE interface is modified to send coding data from the 
   SURGERY PROCEDURE/DIAGNOSIS CODES file (#136). The interface now passes
   data to PCE in real time when the coder completes the coding process
   for a case. After a case is filed with PCE, if certain data passed to 
   PCE is changed within the Surgery software, the Surgery to PCE
   interface sends an update to PCE immediately. ICD coding related data 
   is updated through the Update/Verify Procedure/Diagnosis Codes
   [SRCODING EDIT] option.
On/Off Switch, distributed with patch IB*2*260, is set to "ON". The ability
for the local site to set the switch to "ON" will be provided at the
appropriate time with the release of a subsequent Integrated Billing patch.
PFSS patches are being released on various schedules. Some patch
 
For more information about the PFSS project, review the documentation 
accompanying this patch and refer to the following website: 
http://vista.domain.ext/billreplace/
 
Features of patch SR*3*142 are listed below:
 
1. Modified Surgery Coding Option
   Coders currently use the Update/Verify Procedure/Diagnosis Codes 
   [SRCODING EDIT] option, which updates coded data directly in the 
functionality will not be active until a new PFSS switch is activated
   SURGERY file (#130). However, the SURGERY file (#130) does not
   currently make a distinction between procedure and diagnosis data
   entered by clinicians and that entered by coders. Today, coding a
   surgical case impacts the clinical data for the patient and causes an
   addendum to be generated because each code is directly associated with
   a free-text procedure or diagnosis entry. This patch separates final
   coded procedures and diagnoses from the clinically captured procedures
   and diagnoses.
 
   A new file, the SURGERY PROCEDURE/DIAGNOSIS CODES file (#136), is
during final implementation. PFSS will initially be implemented at select
   created to store coded procedure and coded diagnosis data for a Surgery
   case. Data entered into this file will be the new source coding data
   sent by the Surgery package to PCE. In the SURGERY file (#130), the
   existing PRINCIPAL CPT Code field (#27), PRIN DIAGNOSIS CODE field 
   (#66), OTHER PROCEDURE CPT CODE field (#3 of sub-file #130.16) and ICD
   DIAGNOSIS CODE field (#3 of sub-file #130.18) are modified to include
   the word "PLANNED" in the field labels and titles.
   
   The Update/Verify Procedure/Diagnosis Codes [SRCODING EDIT] option is 
   modified to allow entry of final billing Current Procedural 
pilot sites ONLY.
   Terminology (CPT) codes for surgical procedures and International
   Classification of Disease (ICD) diagnosis codes in the SURGERY
   PROCEDURE/DIAGNOSIS CODES file (#136).
 
   Modified features of the Update/Verify Procedure/Diagnosis Codes
   [SRCODING EDIT] option are listed below:
   - Upon record creation for a case in the SURGERY PROCEDURE/DIAGNOSIS
     CODES file (#136), the record will be auto-populated with clinician
     entered coding data, if any, from the SURGERY file (#130).
   - A principal ICD code and a principal CPT code are initial
 
     requirements for coding a surgical case. 
   - An unlimited number of ICD codes may be entered for other diagnoses
     and an unlimited number of CPT codes may be entered for other
     procedures performed.
   - Each CPT code entered must be assigned the associated ICD code(s)
     related to the procedure performed.
   - An unlimited number of CPT modifiers may be entered for each CPT code
     entered.
   - For every ICD code entered, the following questions must be answered
     as appropriate for the patient based upon enrollment indicators:
The purpose of the PFSS project is to prepare the Veterans Health 
     o Treatment related to Service Connected condition?
     o Treatment related to Agent Orange Exposure?
     o Treatment related to Ionizing Radiation Exposure?
     o Treatment related to Environmental Contaminant Exposure?
     o Treatment related to Military Sexual Trauma?
     o Treatment related to Head and/or Neck Cancer?
     o Treatment related to Combat?
   - Upon completion of coding for a case, the coder is allowed to mark
     the record as complete and to send the record immediately to PCE.
   - Before allowing the record to be marked as complete, the option
Information Systems and Technology Architecture (VistA) environment for the
     checks to see if a specific code, 065.0 CRIMEAN HEMORRHAGIC FEV, is
     entered as a diagnosis code. If it is entered, the software prompts
     the user to make sure that the code is correct for the case. This
     check is added to prevent the inadvertent assignment of code 065.0
     when "CHF" is entered for the Principal or Other ICD Diagnosis
     codes.
   
2. Modified Surgery Reports and Other Options
   - The following Surgery reports and options as modified to use the
     coder entered CPT and/or ICD codes from the SURGERY 
implementation of a commercial off-the-shelf (COTS) billing replacement
     PROCEDURE/DIAGNOSIS CODES file (#136):
     o Cumulative Report of CPT Codes [SROACCT] option
     o Report of CPT Coding Accuracy [SR CPT ACCURACY] option
     o List Completed Cases Missing CPT Codes [SRSCPT] option
       Note: The option descriptions are updated to read "The List
       Completed Cases Missing CPT Codes option generates a report of
       completed cases that are missing the Principal CPT code for a
       specified date range."
     o Annual Report of Surgical Procedures [SROARSP] option
     o PCE Filing Status Report [SRO PCE STATUS] option

1. At many sites the Risk Assessment Nurse Reviewers are involved with the
   [SROA ENTER/EDIT] and Cardiac Risk Assessment Information (Enter/Edit) 
   [SROA CARDIAC ENTER/EDIT] menus.
 o The Alert Coder Regarding Coding Issues [SROA CODE ISSUE] option will
   not check the PFSS On/Off switch.
 o The Alert Coder Regarding Coding Issues [SROA CODE ISSUE] option will
   display basic surgery case information including Patient, Case Number,
   Surgery Date, and Procedure.
 o The Alert Coder Regarding Coding Issues [SROA CODE ISSUE] option will
   display the following coded information:  the PRINCIPAL CPT CODE, OTHER
   CPT CODE, and PRINCIPAL DIAGNOSIS CODE.
Health Information Management Systems (HIMS) staff in determining the
 o The Alert Coder Regarding Coding Issues [SROA CODE ISSUE] option will
   allow the Reviewer to enter a free text comment field to send coding
   concerns to the coder, as well as to members of a predefined mail group
   identified in the CODE ISSUE MAIL GROUP parameter.
 o Values for the CODING COMPLETED BY field (#.01) of the CODING 
   COMPLETED BY multiple (#136.011) of the SURGERY PROCEDURE/DIAGNOSIS
   CODES file (#136) or the CODE ISSUE MAIL GROUP will be present when the
   user selects the Alert Coder Regarding Coding Issues [SROA CODE ISSUE]
   option. If neither are valued, the user will be notified that the
   message cannot be sent without one of these two items defined.
final codes for a Surgery case. An Alert Coder Option will allow the Risk
 o The CODE ISSUE MAIL GROUP field (#43) is added in the SURGERY SITE
   PARAMETERS file (#133) to allow the site to create a designated mail
   group for the Alert Coder Regarding Coding Issues [SROA CODE ISSUE]
   option.
 o The Surgery Site Parameters (Enter/Edit) [SROPARAM] option within
   the Surgery Package Management Menu [SRO PACKAGE MANAGEMENT] option is 
   modified to allow entry and editing of the new CODE ISSUE MAIL GROUP.
 
2. When creating a request from a waiting list entry, the Surgery screen 
server incorrectly displays "SCHEDULING" in the screen header. This patch 
Assessment Nurse Reviewer to alert the coder if there is a question on the
makes a modification to display "REQUEST" instead.
 
3. This patch corrects problems with the two trigger cross references that
were added to the SITE field (#.01) of the SURGERY SITE PARAMETERS file
(#133) by patch SR*3*150.
 
Note: This patch includes a post-installation process that updates each
entry in the SURGERY SITE PARAMETERS file (#133) as follows:
 - UPDATES TO PCE field (#18) is set to ALL CASES.
 - ASK CLASSIFICATION QUESTIONS field (#19) is set to YES.  
Current Procedural Terminology (CPT) or International Classification of
Diseases (ICD) codes on a Surgery case.
 
 o The new Alert Coder Regarding Coding Issues [SROA CODE ISSUE] option
   will appear on both the Non-Cardiac Assessment Information (Enter/Edit)

Project 112/SHAD (Shipboard Hazard and Defense) is a new environmental 
 
   The Project 112/SHAD information will be forwarded to Patient Care 
   Encounter (PCE) as part of the normal case coding activities.
 
2. This patch will prevent the PRIN PRE-OP ICD DIAGNOSIS CODE field
   (#32.5) of the SURGERY file (#130) from being sent to PCE.
   
3. This patch adds the Alert Coder Regarding Coding Issues [SROA CODE 
   ISSUE] option to the Surgery Risk Assessment Menu [SROA RISK 
   ASSESSMENT] option.
indicator added to VistA as part of the Enrollment System Redesign (ESR) 
project.
 
1. This patch provides the ability to enter and edit Project 112/SHAD
   Environmental Indicator information in the Surgery package. The 
   patient's Project 112/SHAD enrollment status is displayed when creating
   or editing a surgical case, and the user will be prompted to answer the
   Project 112/SHAD questions with "yes" or "no".

This patch is part of the Patient Financial Services System (PFSS) 
replacement system. The project consists of the implementation of the 
billing replacement system, business process improvements, and 
enhancements to VistA to support integration with the COTS billing 
replacement system. Significant changes to VistA legacy systems and 
ancillary packages are necessary.
 
Some of the PFSS software components are not operational until the PFSS 
On/Off Switch, distributed with patch IB*2*260, is set to "ON". The 
ability for the local site to set the switch to "ON" will be provided at 
the appropriate time with the release of a subsequent Integrated Billing 
project. PFSS patches are being released on various schedules. Some patch
patch.
 
For more information about the PFSS project, review the documentation 
accompanying this patch and refer to the following website: 
http://vista.domain.ext/billreplace/
 
Features of patch SR*3*144 are listed below:
 
1. The VistA Surgery software will be enhanced to request an account
   number for every Surgery Request Consult. This activity will support
functionality will not be active until a new PFSS switch is activated
   the Revenue Office's need to pre-certify with insurance companies the
   requested Surgery. A national guideline will be issued defining the
   minimum format for creating a Surgery Request Consult within the VistA
   Consults package that will collect the data required by PFSS. The
   Surgery Request Consult will not create a Surgery case. This guideline
   does not require that sites use the Consults package for creating
   Surgery requests. Sites using VistA Surgery Request options can
   continue to use that approach.
 
   VistA Surgery will be enhanced to also request a PFSS ACCOUNT
during final implementation. PFSS will initially be implemented at select
   REFERENCE, and it will be stored in the PFSS ACCOUNT REFERENCE field
   (#500) of the SURGERY file (#130). The association to a PFSS ACCOUNT
   REFERENCE is obtained when the Surgery case is created and is sent to
   the PATIENT CARE ENCOUNTER (PCE) application upon completion of coding.
 
2. This patch changes the List Completed Cases Missing CPT Codes [SRSCPT]
   option to list only those completed cases that do not have a final CPT 
   code entered in the PRINCIPAL PROCEDURE CODE field (#.02) of the
   SURGERY PROCEDURE/DIAGNOSIS CODES file (#136).
pilot sites ONLY.
 
The purpose of the PFSS project is to prepare the Veterans Health 
Information Systems and Technology Architecture (VistA) environment for 
the implementation of a Commercial Off-The-Shelf (COTS) billing 

1. The Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option for
   Non-Cardiac assessments is corrected to display the PRIN POSTOP
   DIAGNOSIS CODE field (#.03) stored in the SURGERY PROCEDURE/DIAGNOSIS
   CODES file (#136).
 
2. The Print a Surgery Risk Assessment [SROA PRINT ASSESSMENT] option for
   Non-Cardiac assessments is corrected to display the PRINCIPAL PROCEDURE
   CODE field (#.02) stored in the SURGERY PROCEDURE/DIAGNOSIS CODES file
   (#136) when referencing CPT Codes for Returns within 30 Days.

An undefined error occurs when two users attempt to access the 
same record at the same time.  One user is creating a surgery request and 
the other is attempting to delete that same user request.

After installing patch SR*3*144, if the SURGICAL RESIDENTS (Y/N) field 
correctly. This patch includes a post-installation process that will check
each surgical case and correct any textual entries that may exist in the
ATTEND SURG field (#.164) in the SURGERY file (#130).
(#33) in the SURGERY SITE PARAMETERS file (#133) is NO, surgical cases for
that division created using the Schedule Unrequested Operations [SROSRES]
option will contain the textual name of the attending surgeon instead of 
the pointer value in the ATTEND SURG field (#.164) in the SURGERY file
(#130).
 
This patch modifies the Schedule Unrequested Operations [SROSRES] option 
so that the ATTEND SURG field (#.164) in the SURGERY file (#130) is set

his patch updates the Surgery Risk Assessment software of the Veterans
 
 o Modification to some of the user entries of fields that allow text to
   be entered to accept lower case or all CAPS
  - The NUM OF PRIOR HEART SURGERIES field (#352) is modified to allow the
    entry of lowercase letter "N" to represent "0 - NONE". Any existing
    N's will be converted to '0' for NONE by he post install routine.
  - The ESTIMATE OF MORTALITY field (#364) is modified to allow the entry
    of lowercase letter "ns" to represent "NO STUDY".
 
 o Modifications to the List of Surgery Risk Assessments [SROA ASSESSMENT
   LIST] option
NOTE: All fields listed below are in the SURGERY file (#130) unless
  - Each report is modified to display the final CPT codes from the case
    coding record in the SURGERY PROCEDURE/DIAGNOSIS CODES file (#136).
  - List of 1-Liner Cases Missing Information (list #8) is added.
 
General Surgery Items
---------------------
 o The PREOP HAIR CLIPPING BY field (#.12) is renamed HAIR REMOVAL BY.
 
 o The HAIR REMOVAL METHOD field (#506) and the HAIR REMOVAL COMMENTS
   field (#508) are added to the Operation Startup [SROMEN-START] option
otherwise indicated.
   and the Operation (Short Screen) [SROMEN-OUT] option. Those two fields
   and the HAIR REMOVAL BY field (#.12) are added to the Nurse
   Intraoperative Report and became a mandatory documentation field to
   satisfy the record review process for quality measurement purposes.
 
Cardiac Risk Assessment Modifications
-------------------------------------
 o Modifications to the Clinical Information (Enter/Edit) [SROA CLINICAL
   INFORMATION] option
  - The software is modified to auto-populate the HEIGHT field (#236) and
    the WEIGHT field (#237) as documented in the Vitals software.
Health Information Systems and Technology Architecture (VistA)
  - The Current Smoker item under this option is modified to reference to
    the new CURRENT SMOKER (CARDIAC) field (#510) instead of the old field
    CURRENT SMOKER field (#202), which will be utilized by the NSQIP
    options.
 
 o Modifications to the Laboratory Test Results (Enter/Edit) [SROA
   LAB-CARDIAC] option
  - The HEMOGLOBIN A1C field (#504) and the HEMOGLOBIN A1C, DATE field
    (#504.1) are added to the list of preoperative lab results.
  - The software is modified to use a date range of 1000 days prior to the
Surgery application as requested by the Executive Board of the National
    date of operation when searching for the most recent preoperative lab
    test result for the HDL (CARDIAC) field (#457), the LDL (CARDIAC)
    field (#461), the TOTAL CHOLESTEROL (CARDIAC) field (#462), the SERUM
    TRIGLYCERIDE (CARDIAC) field (#458), and the HEMOGLOBIN A1C field
    (#504).
 
 o The Enter Cardiac Catheterization & Angiographic Data [SROA CARDIAC
   PROCEDURES] option is modified to allow all fields to be
   auto-populated with 'NS' (NO STUDY) when 'NS' is entered in the
   PROCEDURE TYPE field (#476).
Surgical Quality Improvement Program (NSQIP) and by the Cardiac Surgery
 
 o Modifications to the Cardiac Procedures Operative Data (Enter/Edit)
   [SROA CARDIAC PROCEDURES] option
  - The GREAT VESSEL REPAIR (Y/N) field (#372) is moved to screen #1 under
    this option as item #20.
  - The ENDOVASCULAR REPAIR field (#505) is added in screen #1 as item
    #21.
  - The OTHER CT PROCEDURE field (#484) in the first screen is now
    replaced by the OTHER CARDIAC PROCEDURES (Y/N) field (#502). If this
    field value is "YES" the software will prompt the user for the OTHER
Consultants Board of the Continuous Improvement in Cardiac Surgery
    CARDIAC PROCEDURES-LIST field (#484).
  - The OTHER NON-CT PROCEDURES field (#491) is removed from the second
    screen and a blank line is added before "Other Operative Data
    details" header.
  - The software is modified so that entering "N" for the VALVE REPAIR
    field (#370) shall result in "5. None". The existing N's will be
    converted to '5' upon patch installation.
  - This option is updated to reference the new MAZE PROCEDURE field
    (#512) as item 13 in the first data entry screen.
 
Program (CICSP). These updates include the addition of new data fields,
 o A new occurrence category REPEAT VENTILATOR SUPPORT W/IN 30 DAYS is
   created in the PERIOPERATIVE OCCURRENCE CATEGORY file (#136.5). This
   occurrence category will be selectable only for cardiac assessed cases.
 
 o The following fields on the Resource Data [SROA CARDIAC RESOURCE]
   option are modified to assume a default of "past date" when no year is
   specified:
  - ESTIMATE OF MORTALITY, DATE field (#364.1)
  - D/T PATIENT EXTUBATED field (#470)
  - D/T PATIENT DISCH FROM ICU field (#471)
changes to existing data fields, changes to data entry screens, changes
 
 o This patch will allow the retransmission of a cardiac risk assessment.
 
Non-Cardiac Assessment Modifications
------------------------------------
 o Modifications to the Preoperative Information (Enter/Edit) [SROA PREOP
   DATA] option
  - The software is modified to auto-populate the HEIGHT field (#236) and
    the WEIGHT field (#237) as documented in the Vitals software.
  - The PREGNANCY field (#269) is added to the NUTRITIONAL/IMMUNE/OTHER
to reports used in Surgery Risk Assessment management process and changes
    section.
 
 o Modifications to the Laboratory Test Results (Enter/Edit) [SROA LAB]
   option
  - The PREOPERATIVE ANION GAP field (#444) and the PREOP ANION GAP, DATE
    field (#444.1) are added to the list of preoperative lab results.
  - The HIGHEST ANION GAP field (#445) and the HIGH ANION GAP, DATE field
    (445.1) are added to the list of postoperative lab results.
 
 o The Operation Information (Enter/Edit) [SROA OPERATION DATA] option is
to the Surgery Risk Assessment transmissions.
   modified to add the INTRAOP DISSEMINATED CANCER field (#443).
 
Other Risk Assessment Modifications
-----------------------------------
 o The Print a Surgery Risk Assessment [SROA Print Assessment] option is
   modified to include the new data elements.
 
 o The transmissions to the national databases are modified to include the
   new fields.