| DESCRIPTION OF ENHANCEMENTS |
The Health Integration & Modernization (HI&M) CLOZAPINE NCCC OVRD
used as an initial test to allow the patient to be selected for
registration; existing code will still prevent the patient from being
selected due to previous registration, but the correct message will now
display regarding the patient's registration status.
3. Requirement 2 Defect 1 - Patient with Temp Registration and an NCCC
Authorization and NCCC Override Date, but day supply limited to 4.
INC9951972: COVID-19 VistA PSO defect - Clozapine National Override
The multi-build contains the Mental Health patch YS*5.01*166 and the
patient's prescription limited to 4 days.
Problem:
--------
A Patient initially receives a 4-day emergency authorization, and later
an NCCC Authorization and an NCCC Override Date. While the NCCC Override
Date is still active, the Day Supply (for Outpatient Pharmacy) or Order
Duration (for Inpatient Medications) continues to be limited to 4 days.
Inpatient Medications Order Duration is defined as the number of days
between the order's Start Date/Time and Stop Date/Time.
Outpatient Pharmacy patch PSO*7.0*612. The list of defects and their
Resolution:
-----------
If a NCCC Authorized National Override Date is in effect following an
initial local override, the system shall process an active clozapine
patient's clozapine prescription under national override processes
allowing the patient to be provided with the approved quantity associated
with their individual dispensing frequency from the DISPENSE FREQUENCY
field (#2) in the CLOZAPINE PATIENT LIST file (#603.01). The approved
quantity is determined by the order's Days Supply for Outpatient Pharmacy
resolution is below.
orders, and the Order Duration (days between Start Date/Time and Stop
Date/Time) for Inpatient Medications orders.
Technical Resolution:
---------------------
A change was made in several routines to look in the PHARMACY PATIENT
file (#55) for the patient's active clozapine authorization number before
searching for the value in the patient's DISPENSE FREQUENCY field (#3) of
the CLOZAPINE PATIENT LIST file (#603.01). This enables the clozapine
processing logic to any temporary initial local authorization on file
that have been replaced by a permanent NCCC authorization numbers.
- To address backdoor entry of outpatient orders, routine DAYSEN^PSODIR1
was changed to find the patient's registered clozapine
authorization number.
- To address backdoor entry of inpatient orders, routine ^PSOCLO1
was changed to find the patient's registered clozapine authorization
number.
This patch is also being released with informational patch PSJ*5*403 that
- To properly calculate days supply during the finishing of pending
orders, routine CLOZ^PSOORFI2 was changed to find the patient's
registered clozapine authorization number.
- To properly calculate days supply during the back door editing of
active orders, routine ACT^PSOORNE2 was changed to find the patient's
registered clozapine authorization number.
- To properly calculate default Days Supply in CPRS, change
DSUP^PSOSIGDS was changed to find the patient's registered clozapine
documents changes to Inpatient Medications' processing of clozapine
authorization number. This changed routine is used by the ORWDPS1
DFLTSPLY Remote Procedure Call (RPC) to calculate default Days Supply.
4. Requirement 2 Defect 2 - Patient with NCCC Authorization receives a
Special Condition Fill, and later an NCCC Authorization and Override
Date, but day supply limited to 4.
INC9951972: COVID-19 VistA PSO defect - Clozapine National Override
patient's prescription limited to 4 days
overrides that are a result of the defect fixes in PSO*7.0*612 and
Problem:
--------
A patient with an initial NCCC Authorization receives a Special Condition
override, followed by an NCCC override, is limited to a Day Supply
(Outpatient Pharmacy orders) or an Order Duration (Inpatient Medications
orders) limited to 4 for clozapine orders. The NCCC national clozapine
override and the patient's regular clozapine dispense frequency are
ignored.
YS*5.01*166.
Resolution:
-----------
A patient with an initial NCCC clozapine authorization receiving a
Special Condition override, followed by an NCCC override, shall be
processed under national override rules allowing the patient to be
provided with the approved quantity associated with their individual
dispensing frequency from the DISPENSE FREQUENCY field (#2) in the
CLOZAPINE PATIENT LIST file (#603.01). The approved quantity is reflected
in the order's Days Supply for Outpatient Pharmacy orders, and the Order
Duration (days between Start Date/Time and Stop Date/Time) for Inpatient
Medications orders.
Technical Resolution:
---------------------
To address backdoor entry of outpatient orders, routine DAYSEN^PSODIR1
was changed to find the patient's registered clozapine authorization
number.
To address backdoor entry of inpatient orders, routine ^PSOCLO1 was
changed to find the patient's registered clozapine authorization
COVID-19 multi-build is an emergency patch to the National Clozapine
Defect Tracking System Ticket(s) & Overview:
number.
5. Requirement 2 Defect 3 - Local Special Condition Override followed
by valid lab results limits orders to 4-day supply.
Problem:
--------
When a patient with an active NCCC clozapine registration and no
current clozapine lab results receives a Local Special Condition
--------------------------------------------
override, followed by the entry of valid clozapine lab results,
subsequent pharmacy orders continue to be limited to a 4-day supply.
Resolution:
-----------
When a patient with an active NCCC clozapine registration and no
current clozapine lab results receives a Local Special Condition
override, followed by the entry of valid clozapine lab results,
the Local Special Condition override is no longer in effect and should
be ignored for new orders. New pharmacy orders should be processed
using the days supply associated with their individual dispense
frequency. The patient's dispense frequency is reflected in the order's
Days Supply for Outpatient Pharmacy orders, and the Order Duration
(days between Start Date/Time and Stop Date/Time) for Inpatient
Medications orders.
Technical Resolution:
---------------------
Routine ^PSOCLO1 was modified to KILL the ^XTMP globals associated
with the patient's local override when an active NCCC clozapine
Patch PSO*7.0*612 contains the following changes:
registration and valid clozapine lab results exist. This prevents the
obsolete Local Special Condition override from interfering with the
patient's regular clozapine dispense frequency.
6. Requirement 2 Defect 4 - Emergency Temp Override followed by new
NCCC authorization limits orders to 4-day supply.
Problem:
--------
When a patient with a discontinued clozapine registration and current
valid lab results receives a Local Emergency Temp Override, followed
by a new NCCC clozapine authorization number and registration,
subsequent pharmacy orders continue to be limited to a 4-day supply.
Resolution:
-----------
When a patient with a discontinued clozapine registration and current
valid lab results receives a Local Emergency Temp Override, followed
by a new NCCC clozapine authorization number and registration, the Local
1. Requirement 1 Enhancement - Automate the Pharmacy Registration of NCCC
Emergency Temp override is no longer in effect and should
be ignored for new orders. New pharmacy orders should be processed
using the days supply associated with the patient's dispense frequency.
The patient's dispense frequency is reflected in the order's Days
Supply for Outpatient Pharmacy orders, and the Order Duration (days
between Start Date/Time and Stop Date/Time) for Inpatient Medications
orders.
Technical Resolution:
---------------------
Clozapine Authorizations.
Modify routines PSOCLUTL and PSOCLADD to KILL the ^XTMP globals
associated with the patient's local override at the time an NCCC
clozapine authorization number is registered to the patient. This
prevents an obsolete local override from interfering with order entry
routines' calculation of the days supply based on the patient's regular
clozapine dispense frequency.
Patch Components
================
Files & Fields Associated:
File Name (Number) Field Name (Number) New/Modified/Deleted
------------------ ---------------------- --------------------
N/A (See YS*5.01*166 Patch Description related for Files/Fields)
Forms Associated:
Form Name File # New/Modified/Deleted
--------- ------ --------------------
N/A
Problem:
Mail Groups Associated:
Mail Group Name New/Modified/Deleted
--------------- --------------------
N/A
Options Associated:
Option Name Type New/Modified/Deleted
----------- ---- --------------------
N/A
--------
Protocols Associated:
Protocol Name New/Modified/Deleted
------------- --------------------
N/A
Security Keys Associated:
Security Key Name New/Modified/Deleted
---------------------- --------------------
N/A
Registry (NCR) software to correct defects to Clozapine National
Currently, national clozapine authorization numbers are sent by the
Templates Associated:
Template Name Type File Name (Number) New/Modified/Deleted
------------- ---- ------------------ --------------------
N/A
* * * * * * * * * * *
Test Sites:
----------
National Clozapine Coordinating Center (NCCC) and filed into the
New Jersey Health Care System (561)
VA Connecticut Health Care System (689)
Boise VA Medication Center (531)
Software and Documentation Retrieval Instructions:
--------------------------------------------------
The software for this patch is being released as a host file.
The host file is available at the following location:
CLOZAPINE PATIENT LIST file (#603.01). Later, a pharmacy user must
/srv/vista/patches/SOFTWARE/PSO_YS_CLOZ_COVID.KID
Documentation describing the new functionality is included in this
release. Documentation can be found on the VA Software Documentation
Library at: https://www.domain.ext/vdl/
-------------------------------------------------------------------------
Title File Name
-------------------------------------------------------------------------
Technical Manual/Security Guide pso_7_p612_tm.docx
manually execute Vista option Register Clozapine Patient [PSOL REGISTER
- Outpatient Pharmacy V.7.0 pso_7_p612_tm.pdf
User Manual - Manager - Outpatient pso_7_man_um.docx
Pharmacy V.7.0 pso_7_man_um.pdf
Deployment Installation Back-Out pso_7_p612_ys_501_p166_dibr.docx
and Rollback Guide - HI&M pso_7_p612_ys_501_p166_dibr.pdf
Clozapine Overrides
Release Notes - HI&M Clozapine pso_7_p612_ys_501_p166_rn.docx
PATIENT] (for new patients), or Edit Data for a Patient in the Clozapine
Overrides pso_7_p612_ys_501_p166_rn.pdf
Patch Installation:
Pre/Post Installation Overview:
-------------------------------
There are no tasks to be performed before the installation of this
multi-build. Note that the routines should be backed up to a PackMan
message before installing the build.
Program PSOL [EDIT] (for previously registered patients).
Pre-Installation Instructions:
------------------------------
This patch may be installed with users on the system although it is
recommended that it be installed during non-peak hours to minimize
potential disruption to users. This patch should take less than 5
minutes to install. It should not be installed when the YSCL DAILY
TRANSMISION option is running. If unsure when that is check the OPTION
SCHEDULING file (#19.2) using FileMan:
Select VA FileMan Option: Inquire to File Entries
Output from what File: OPTION SCHEDULING// (17 entries) Select OPTION
SCHEDULING NAME: YSCL DAILY TRANSMISSION Another one: Standard Captioned
Output? Yes// (Yes) Include COMPUTED fields: (N/Y/R/B): NO// - No
record
number (IEN), no Computed Fields
NAME: YSCL DAILY TRANSMISSION
QUEUED TO RUN AT WHAT TIME: OCT 05, 2019@01:30
Resolution:
RESCHEDULING FREQUENCY: 1D TASK ID: 2577736
Installation Instructions:
--------------------------
1. Place the KIDS multi-build file PSO_YS_CLOZ_COVID.KID into a
local directory and use the KIDS option Load a Distribution option to
load it into the transport global.
2. Choose the INSTALL/CHECK MESSAGE PackMan option.
----------
3. From the Kernel Installation and Distribution System Menu, select
the Installation Menu. From this menu, you may elect to use the
following options. When prompted for the INSTALL NAME enter:
PSO*7.0*612
a. Backup a Transport Global - This option will create a backup message
of any routines exported with this patch.
b. Compare Transport Global to Current System - This option will (allow
you to view all changes that will be made when this patch
Automate the clozapine registration process by automatically updating the
is installed. It compares all components of this patch
(routines, DDs, templates, etc.).
c. Verify Checksums in Transport Global - This option allows you to
ensure the integrity of the routines that are in the transport
global.
4. From the Installation Menu, select the Install Package(s) option and
choose the patch to install (PSO*7*612).
Clozapine Coordinating Center (NCCC) Override functionality.
patient's clozapine registration number and status when a new National
5. Accept the default when prompted 'Want KIDS to Rebuild Menu Trees
Upon Completion of Install? NO//'
6. Accept the default when prompted 'Want KIDS to INHIBIT LOGONs during
the install? NO//'
7. Accept the default when prompted 'Want to DISABLE Scheduled Options,
Menu Options, and Protocols? NO//'
8. If prompted 'Delay Install (Minutes): (0 - 60): 0// enter 0 (zero).
Clozapine number is received from the NCCC.
Backout /Rollback Strategy:
---------------------------
Backout will be done only with the concurrence and participation of
development team and appropriate VA site/region personnel. The decision
to backout the software will be a joint decision between development
team, VA site and regional personnel, and other appropriate VA personnel.
Rollback applies to data only and is not applicable to this multi-build.
Prior to installing the KIDS multi-build, the site/region should have
saved a backup of the routines in a PackMan message using the Backup a
Transport Global [XPD BACKUP] menu option (this is done at time of
install). The message containing the backed-up routines can be loaded
with the "Xtract PackMan" function at the Message Action prompt. The
PackMan function "INSTALL/CHECK MESSAGE" is then used to install the
backed up routines onto the VistA System.
The new "AC" mumps cross reference for the CLOZAPINE PATIENT LIST file
(#603.01) must be manually deleted via FileMan prior to restoring the
backed up routines.
Technical Resolution:
The steps to delete the cross reference:
1. Access VA FileMan option Cross-Reference A Field via the VA FileMan
Utility Functions [DIUTILITY] menu.
2. At the prompt, "What type of cross-reference (Traditional or New)?"
enter NEW.
3. At the prompt, "Modify What File:" enter 603.01.
4. The new "AC" cross reference should be selected by default.
5. At the prompt "Choose E (Edit)/D (Delete)/C (Create):" enter DELETE.
6. At the prompt "Are you sure you want to delete the index
---------------------
definition? NO// YES"
Example deletion of new "AC" index if backout is required:
VA FileMan 22.2
Select OPTION: UTILITY FUNCTIONS
Select UTILITY OPTION: CROSS-REFERENCE A FIELD OR FILE
What type of cross-reference (Traditional or New)? Traditional// NEW
Modify what File: REMOTE PROCEDURE// 603.01 CLOZAPINE PATIENT LIST
New Pharmacy API PSOCLADD has been created that accepts Patient DFN and
(74 entries)
Current Indexes on file #603.01:
1589 'AC' index
Choose E (Edit)/D (Delete)/C (Create): DELETE
Which Index do you wish to delete? 1589// AC
Are you sure you want to delete the index definition? NO// YES
Index definition deleted.
NCCC Clozapine Authorization number as input and files the number into
Validation of Backout Procedure
-------------------------------
The backout Procedure can be verified by printing the first 2 lines of
the PSO* and YS* routines contained in the HI&M CLOZAPINE NCCC OVRD
COVID-19 multi- build using the option First Line Routine Print [XU FIRST
LINE PRINT]. Once the old routines listed in the multi-build patch have
been restored, the first two lines of the Routines will no longer contain
the CLOZAPINE REGISTRATION NUMBER field (#53) in the PHARAMCY PATIENT
the designation of patch 612 in the patch list section on line 2 of the
routines.
The backout of the new "AC" cross reference on the CLOZAPINE PATIENT
LIST file (#603.01) can be verified by repeating the backout steps and
verifying that there is no longer a selectable "AC" cross reference to
delete.
file (#55), and updates the CLOZAPINE STATUS field (#54) to 'A' for
Active. This API is executed when a new clozapine authorization is filed
into the CLOZAPINE PATIENT LIST (#603.01) file via a mumps action cross
reference.
2. Requirement 1 Defect 1 - Incorrect Messages Displayed in Clozapine
Vista Options
Problem:
--------
When more than one clozapine authorization number exists for a patient,
The NCR is maintained by the NCCC. The NCCC is responsible for VA's
the "Register Clozapine Patient" option currently displays the incorrect
message, "Patient,Name has not been authorized for Clozapine by the NCCC
(National Clozapine Coordinating Center). This option is only available
for known NCCC-registered patients." when more than one entry in file
603.01 for the patient. This message displays regardless of patient's
Clozapine Status in file 55.
When more than one clozapine authorization number exists for a patient,
the "Edit Data for a Patient in the Clozapine Program" option currently
displays the incorrect message, "Patient,Name has not been authorized for
compliance with the clozapine Risk Evaluation and Mitigation Strategy
Clozapine by the NCCC in Dallas. Contact the NCCC in Dallas for
authorization." The patient cannot be selected.
Resolution:
-----------
The code associated with the 'Register a Clozapine Patient' option and
the "Edit Data for a Patient in the Clozapine Program" shall be modified
to display correct information about the patient's Clozapine registration
status regardless of the number of clozapine numbers on file for the
patient.
(REMS), which is mandated by the Food and Drug Administration (FDA) for
The "Register Clozapine Patient" option shall display "Patient,Name is
already registered with number CL99999. Use the edit option to change
registration data, or contact your supervisor" when more than one entry
in file 603.01 for the patient. No other change in functionality to this
option.
The "Edit Data for a Patient in the Clozapine Program" option shall
not display the incorrect message "Patient,Name has not been authorized
for Clozapine by the NCCC in Dallas. Contact the NCCC in Dallas for
tracking clozapine patients.
authorization". The option will allow the selection of a patient with
more than one entry in file 603.01. No other change in functionality to
this option.
Technical Resolution:
---------------------
Correct routine PSOCLUTL's lookups by patient into the CLOZAPINE PATIENT
LIST file (#603.01) from $$FIND1^DIC, which fails when there is more than
one clozapine authorization number on file for a patient, to D FIND^DIC,
which finds all clozapine authorization numbers. The defective lookup is
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