| DESCRIPTION OF ENHANCEMENTS |
The Health Integration & Modernization (HI&M) CLOZAPINE NCCC OVRD
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.
The multi-build contains the Mental Health patch YS*5.01*166 and the
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
Outpatient Pharmacy patch PSO*7.0*612. The list of defects and their
orders, and the Order Duration (days between Start Date/Time and Stop
Date/Time) for Inpatient Medications orders.
Technical Resolution:
---------------------
The correct patient dispense frequency is now retrieved by changing
CL1^YSCLTST4 to find the dispense frequency associated with the patient's
registered clozapine authorization number.
resolution is below.
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
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.
Resolution:
-----------
A patient with an initial NCCC clozapine authorization receiving a
Special Condition override, followed by an NCCC override, shall be
This patch is also being released with informational patch PSJ*5*403 that
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:
---------------------
documents changes to Inpatient Medications' processing of clozapine
Routine OVRRID^YSCLTST2 changed to kill ^XTMP("PSJ4D-"_DFN) and
^XTMP("PSO4D-"_DFN) after an NCCC override is successfully filed. This
removes a patient's local clozapine override information when it is
replaced by an NCCC override.
Patch Components
================
Files & Fields Associated:
overrides that are a result of the defect fixes in PSO*7.0*612 and
File Name (Number) Field Name (Number) New/Modified/Deleted
------------------ ---------------------- --------------------
CLOZAPINE PATIENT CLOZAPINE REGISTRATION Modified* (Mumps X-Ref)
LIST (#603.01) NUMBER (#.01)
CLOZAPINE PATIEN T(#1) Modified* (Mumps X-Ref)
*New style "AC" mumps cross reference added to these two fields in file
603.01. New routine TRGR^PSOCLADD(DFN,PSOCLZNW) is invoked when a new
entry is filed. New Integration Control Registration (ICR) #7175 has
been created to document the new cross application interaction.
YS*5.01*166.
Forms Associated:
Form Name File # New/Modified/Deleted
--------- ------ --------------------
N/A
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
COVID-19 multi-build is an emergency patch to the National Clozapine
Security Keys Associated:
Security Key Name New/Modified/Deleted
---------------------- --------------------
N/A
Templates Associated:
Template Name Type File Name (Number) New/Modified/Deleted
------------- ---- ------------------ --------------------
N/A
Defect Tracking System Ticket(s) & Overview:
* * * * * *
Test Sites:
----------
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:
/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/
* Defect and Enhancement ID's listed below are internal identifiers and
-------------------------------------------------------------------------
Title File Name
-------------------------------------------------------------------------
MHA Security Technical YS_MHS_TM.pdf
Manual/Guide
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
do not map to any external system.
Release Notes - HI&M Clozapine pso_7_p612_ys_501_p166_rn.docx
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.
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
Patch YS*5.01*166 contains the following changes:
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
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.
1. Requirement 1 Enhancement - Automate the Pharmacy
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.
Registration of NCCC Clozapine Authorizations.
b. Compare Transport Global to Current System - This option will (allow
you to view all changes that will be made when this patch
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.
Registry (NCR) software to correct defects to Clozapine National
4. From the Installation Menu, select the Install Package(s) option and
choose the patch to install (PSO*7*612).
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,
Problem:
Menu Options, and Protocols? NO//'
8. If prompted 'Delay Install (Minutes): (0 - 60): 0// enter 0 (zero).
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.
Currently, national clozapine authorization numbers are sent by the
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.
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.
National Clozapine Coordinating Center (NCCC) and filed into the
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
CLOZAPINE PATIENT LIST file (#603.01). Later, a pharmacy user
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
(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
must manually execute Vista option Register Clozapine Patient [PSOL
Index definition deleted.
Validation of Backout Procedure
-------------------------------
The backout Procedure can be verified by printing the first 2 lines of
the PSO* routines contained in the PSO*7*612 build using the option
REGISTER PATIENT] (for new patients), or Edit Data for a Patient in the
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 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.
Clozapine Program PSOL [EDIT] (for previously registered patients).
Clozapine Coordinating Center (NCCC) Override functionality.
Resolution:
----------
Automate the clozapine registration process by automatically updating the
patient's clozapine registration number and status when a new National
Clozapine number is received from the NCCC,
Technical Resolution:
---------------------
A new Pharmacy API has been created that accepts Patient DFN and
NCCC Clozapine Authorization number as input and files the number into
the CLOZAPINE REGISTRATION NUMBER field (#53) in the PHARAMCY PATIENT
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 2 - National Override Date update fails
for patient with more than one clozapine authorization.
The NCR is maintained by the NCCC. The NCCC is responsible for VA's
Problem:
-----------
When a National Override is requested for a patient that has more
than one entry in 603.01, the YSCL Server code performs a defective
lookup into 603.01. If the patient has more than one entry in 603.01, the
server code retrieves the older clozapine number and compares it to the
clozapine number in the incoming override. Since the override is usually
(if not always) performed on the most recent clozapine number, the
override fails and generates the error message, "SSN (PATIENT,NAME) has
multiple Clozapine Numbers at nnn".
compliance with the clozapine Risk Evaluation and Mitigation Strategy
Resolution:
-----------
The Mental Health Clozapine Server's NCCC Override patient lookup
into file 603.01 shall be corrected when processing an incoming NCCC
Override so that it looks in file 603.01 for the specific patient and
NCCC Clozapine number from the incoming message. Only the file 603.01
entry matching the incoming NCCC clozapine number and patient shall be
updated with the incoming NCCC Override Date.
(REMS), which is mandated by the Food and Drug Administration (FDA) for
Technical Resolution:
---------------------
Correct routine YSCLSRV2 from failing to find a match in the
CLOZAPINE PATIENT LIST file (#603.01) for the incoming clozapine
authorization number and patient when attempting to file an NCCC Override
Date in the OVERRIDE field (#3). Prior to the patch, the code compared
clozapine number associated with the incoming NCCC override with the
first (earliest) clozapine authorization number on file for the patient.
If the patient had only one clozapine number on file, the match was
successful. If the patient had more than one clozapine number on file,
tracking clozapine patients.
the match failed as the most recent clozapine number was ignored. Routine
OVVRID^YSCLSRV2 was changed to look through all clozapine authorization
numbers associated with the patient to find a match for the clozapine
number associated with the incoming NCCC override.
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
|
