| DESCRIPTION OF ENHANCEMENTS |
This patch will address the following issues:
beginning of a Pending Order or an Active prescription. This problem happens
only for incoming eRx records where the SSN contains '-' (dashes).
Resolution:
-----------
The size of the eRx field SSN was expanded to display the entire SSN when it
contains '-'.
Technical Resolution:
---------------------
4. INC19419044 - Acknowledge option deficiency within RxRenewal and RxChange
The size of the field SSN was changed from 15 to 20 in the line of code at
DERX1+72^PSOERXU1, which should accommodate an SSN with '-' in it.
4. INC19419044 - Acknowledge option deficiency within RxRenewal and RxChange
Request and Response messages
Problem:
--------
Meds-by-Mail (MbM) reported that users were able to choose the ACK
(Acknowledge) action multiple times on the same record, which in some cases
would trigger a 'Verify' message to be sent back to the eRx prescriber
Request and Response messages
multiple times.
Resolution:
-----------
A change was made to the ACK action to block the execution if the eRx record
is in one of the following status (already acknowledged):
CAA CANCEL REQUEST ACKNOWLEDGED
CXA RXCHANGE RESPONSE ACKNOWLEDGED
ICA INBOUND RXCHANGE ERROR ACKNOWLEDGED
IEA INBOUND ERROR ACKNOWLEDGED
IRA INBOUND RXRENEWAL ERROR ACKNOWLEDGED
RXA RXRENEWAL RESPONSE ACKNOWLEDGED
The following message will be displayed if the user now tries to acknowledge
an eRx record twice:
Record already acknowledged!
Type <Enter> to continue or '^' to exit:
5. INC19287772 - HAC VistA eRx 4.0 sorting issue
Technical Resolution:
---------------------
Added the line of code below at CANACK+7^PSOERXU5:
I ",CAA,CXA,ICA,IEA,IRA,RXA,"[ERXSTAT W !!,"Record already acknowledged!"
,!,$C(7) D DIRE^PSOERXX1 Q
5. INC19287772 - HAC VistA eRx 4.0 sorting issue
Problem:
-------
Meds-by-Mail (MbM) reported that the SO (SORT ENTRIES) action did not work
after selecting a patient and trying to sort by drug name. After selecting to
sort by drug name the software lost previous patient selection and would
display all patients on the list.
Resolution:
-------------
Changed the software to preserve the previously selected patient after the
6. INC19647182 - Refill 6 shows as Partial in ECME log
user selects to sort the patient's records by a different sort criteria (e.g.,
drug name).
Technical Resolution:
--------------------
Added the line of code below at SORT+10^PSOERX:
I $D(SRCH) D EN(.SRCH,STYP,1) Q
6. INC19647182 - Refill 6 shows as Partial in ECME log
Problem:
--------
The Marion VA Medical Center (IL) reported that entries in the ECME Log
related to Refill #6 displayed in Patient Prescription Processing [PSO LM
BACKDOOR ORDERS] option wrongly showed as 'PARTIAL' fills (Rx Ref column).
Resolution:
------------
Correct the display of the entry for Refill #6 to show as 'REFILL #6' instead
7. INC20086630 - Pharmacists are blocked from editing conjunction and duration
of 'PARTIAL' in the under the Rx Ref column in the ECME Log.
Technical Resolution:
---------------------
Move the code for the Output Transform for the RX REFERENCE field (#.04) in
the ACTIVITY LOG (#52.3) sub-file in the PRESCRIPTION file (#52) to
ALFILNUM^PSOUTLA and included an exception for ECME entries to not interpret
value 6 as a PARTIAL fill.
7. INC20086630 - Pharmacists are blocked from editing conjunction and duration
prompts for complex orders on eRx holding queue screen
prompts for complex orders on eRx holding queue screen
Problem:
-------
There is no functionality in the eRx Holding Queue (Complete Orders from eRx
PSO ERX FINISH]) to allow the user to create a complex order dosage. This
creates a problem particular for processing Controlled Substance (CS) Complex
eRx prescriptions because they cannot be edited on the Pharmacy Backdoor
Pending Queue or even after they become an Active prescription because of the
restrictions for editing CS prescription. The receiving of CS eRx prescription
have been recently enabled by PSO*7*617, which did not include this
functionality. Furthermore, when entering the dosage information for an eRx in
the eRx Holding queue the user is not automatically presented with a default
value for the ROUTE field. This requires the pharmacist to always type and
chose the appropriate medication route for the dispense drug selected which
may lead to a mistake that could be easily mitigated by the addition of a
default value.
Resolution:
-------------
8. INC20420672 - Audit Log (AU) option in eRx holding queue fails to capture
This patch adds the ability for the user to create a Complex dosage for any
prescription in the eRx Holding Queue option [PSO ERX FINISH]. When entering
a dosage information the users will be prompt with two new fields: LIMITED
DURATION and CONJUNCTION after the Schedule Prompt:
...
Schedule: QD//
Now searching ADMINISTRATION SCHEDULE (#51.1) file...
QD EVERY DAY
...OK? Yes// (Yes)
original eRx SIG
LIMITED DURATION (IN DAYS, HOURS OR MINUTES): 10 (DAYS)
CONJUNCTION: THEN
There are 2 Available Dosage(s):
1. 15MG
2. 30MG
...
Select from list of Available Dosages (1-1), Enter Free Text Dose
or Enter a Question Mark (?) to view list: 7.5//
An addition functionality was added to provide a default value for the ROUTE
prompt to assist the user in selecting the appropriate medication route for
the medication on the prescription while reducing the chance for
administration errors by the patient.
Technical Resolution:
---------------------
Complex Order:
The routine PSOERXD2 was changed to add two new fields: LIMITED DURATION
(line tag DUR) and CONJUNCTION (line tag CON). Data dictionary fields
9. INC20842304 - EPCS software detox# validation capability fails
already existed to accommodate complex dosages so no new DD fields were
necessary to be created.
Default Med Route:
A new function called DEFROUTE that returns a default medication route for
an specific Orderable Item was added to the routine PSOERXUT and a call to
this function was added to RTE2^PSOERXD2. If the function returns a value
and there is no previous value entered for the ROUTE the returned value is
used as the default value for the ROUTE field.
8. INC20420672 - Audit Log (AU) option in eRx holding queue fails to capture
original eRx SIG
Problem:
--------
Meds-by-Mail (MbM) reported that the AU (Audit Log) action did not show the
eRx value for the SIG field after the SH (Show/Hide eRx Value) action was
selected.
Resolution:
------------
The Audit Log functionality introduced by the patch PSO*7*617 did not take
10.INC20591567 - RxRenewalRequest messages are blocked at hub due to missing
into account that after the patch PSO*7*581 was released to upgrade the NCPDP
version from 10.6 to 2017 the SIG was stored in a different field. The code
was changed to first check the NCPDP version for the record and then retrieve
the eRx SIG information from the correct field.
Technical Resolution:
---------------------
For eRx records with NCPDP version 10.6 (received before PSO*7*581) the eRx
SIG is stored in the DIRECTIONS field (#7) in the ERX HOLDING QUEUE file
(#52.49). For eRx records with NCPDP version 2017 (received after PSO*7*581)
Pharmacy Data
the eRx SIG is stored in the SIG TEXT field (#8) within the 2017 MEDICATIONS
sub-file (#52.49311) in the ERX HOLDING QUEUE file (#52.49). A new API
$$ERXSIG was added to the PSOERXUT routine to return the eRx SIG. It will
check whether the eRx record is NCPDP version 2017 by checking the
field SCRIPT VERSION NUMBER (#312.1). If so, it will retrieve the value from
the SIG TEXT field (#8) otherwise it will retrieve it from the DIRECTIONS
field (#7). Then, the routine PSOERXAU was changed to use this new API
instead of retrieving it from the DIRECTIONS field (#7).
9. INC20842304 - EPCS software detox# validation capability fails
Problem:
--------
Central Texas VAMC reported a problem when trying to validate the provider
for an eRx prescription for BUPRENORPHINE (Detox Drug). Although the VistA
provider had a valid DETOX # on file (e.g., VX1234567) the user got the
message below:
VistA Provider XXXXX,XXXXXXXX X does not have a valid DETOX #.
11.INC20591582 - RxRenewalRequest blocked at VA routing hub due to missing
It was determined that the software was checking for "X" as the first letter
on the DETOX # in order to consider it valid, which is incorrect. This issue
affected also other actions for internal VA outpatient prescriptions. If the
user tried copy or renew a VA prescription for BUPRENORPHINE and the VA
Provider did not have a Detox # that started with an "X".
Resolution:
------------
The DETOX # validation code was changed to remove the requirement for the
first letter to be an "X". It will now only look for 2 letters followed by
1. INC19910756 - Duplicated entries of drug code number in VistA NDC file
Observation
a 7-digit number.
Technical Resolution:
---------------------
The validation code at PRVDETOX+4^PSOUTIL, PRDRVAL+43^PSOERXUT and
PRDRVAL+94^PSOERXUT were changed from ...?1"X"1A7N... to ...?2A7N...
10.INC20591567 - RxRenewalRequest messages are blocked at hub due to missing
Pharmacy Data
Problem:
--------
Meds-by-Mail (MbM) reported that outbound Renewal or Change Request messages
were being dropped by the eRx Hub because they were missing the Pharmacy
address and/or the communication number. A sample XML message from the Hub
confirmed that the Pharmacy address was missing, as seen below:
...
<Pharmacy>
<Identification>
<NCPDPID>5204437</NCPDPID>
<NPI>1538421110</NPI>
12.INC20730418 - Non-Controlled Substance eRx was blocked from being edited by
</Identification>
<BusinessName>MEDS BY MAIL CHAMPVA</BusinessName>
<Address>
<CountryCode>US</CountryCode>
</Address>
<<< <CommunicationNumbers> segment was missing here
</Pharmacy>
...
Resolution:
Electronic Prescribing for Controlled Substance mechanism
------------
When the new NCPDP version (2017) was implemented by patch PSO*7*581 it did
not keep existing 'failsafe's' mechanism from 10.6 version at the time the
user requested a Change or Renewal Request to the outside provider. One of
them retrieved address information from the OUTPATIENT SITE file (#59) in
case the ERX EXTERNAL PHARMACY file (#52.47) record did not contain a valid
address. The other one was to send "0000000000" as a Primary Telefone number
if one could not be found for the pharmacy. This patch adds these
'failsafe's' for NCPDP v2017 eRx records.
Technical Resolution:
---------------------
Address
-------
New code was added at OPHARM+31^PSOERXOD to check if the ADDRESS LINE 1 field
in the ERX EXTERNAL PHARMACY file (#52.47) for the eRx record being renewed/
changed was blank. If so, it will retrieve the complete address from the
corresponding pharmacy record in the OUTPATIENT SITE file (#59).
Communication Number
13.INC21240944 - received eRX type CS for non-CS drug
--------------------
New code was added at OCOMM+3^PSOERXOU to make sure that the
<CommunicationNubmers> XML segment is always included in the outbound eRx
Renewal or Change request messages.
11.INC20591582 - RxRenewalRequest blocked at VA routing hub due to missing
Observation
Problem:
--------
Meds-by-Mail (MbM) reported that outbound Renewal or Change Request messages
were being dropped by the eRx Hub because the Observation/Measurement segment
did not contain the required <ObservationDate> field. A sample XML message
from the Hub confirmed that the problem, as seen below:
<Observation>
<Measurement>
<VitalSign>29463-7</VitalSign>
<LOINCVersion>2.42</LOINCVersion>
<Value>178.4</Value>
<UnitOfMeasure>[lb_av]</UnitOfMeasure>
14.INC22031884 - eRx pending order screen does not display original
<UCUMVersion>1.8.2</UCUMVersion>
<<< <ObservationDate> segment was missing here
</Measurement>
</Observation>
Resolution:
------------
For an unknown reason some incoming Observation/Measurement records saved to
the 2017 OBSERVATION sub-file (#52.49306) in the ERX HOLDING QUEUE file
(#52.49) failed to save a valid date in the OBSERVATION DATE field (#6). Since
physician's instruction and relevant drug dose strength
it cannot be determined the cause of the incomplete Observation/Measurement
information stored it was decided to not include such information in the
Change or Renewal request messages if the Observation Date value is not
populated.
Technical Resolution:
---------------------
New code was added at OBSERVE+2^PSOERXOB to make sure that the in order for
and Observation/Measurement to be included in the outbound eRx Renewal or
Change request it must have a valid Observation Date value, otherwise it is
skipped.
12.INC20730418 - Non-Controlled Substance eRx was blocked from being edited by
Electronic Prescribing for Controlled Substance mechanism
Problem:
--------
Meds-by-Mail (MbM) reported that the users were unable to edit a Digitally
Signed eRx Pending Order record even if the drug selected for the prescription
is not marked as a Controlled Substance (non-CS). When the CS eRx Project was
caused erroneous drug auto-match
Defect Tracking System Ticket(s) & Overview:
released with patch PSO*7*617 it included functionality to prevent any
field in a CS eRx Pending Order record from being edited before the order was
finished. The reason is because DEA (Drug Enforcement Agency) requires all
Pharmacy software applications to audit all edits to a CS prescription record
and the Pending Queue edits are not audited. However, a few incoming Digitally
Signed eRx records will be matched with a dispense drug that is not considered
to be a Controlled Substance by the VA and in such cases the edit should be
permitted.
Resolution:
--------------------------------------------
------------
Instead of checking whether the eRx record was digitally signed or not to
determine if the eRx Pending Order record can be edited or not the software
will now check if the dispense drug in the Pending Order is marked as a CS or
non-CS. If the drug is not marked as CS the editing of the eRx Pending Order
record will be allowed. In addition, the messages "Processing Digitally
Signed eRx Order" displayed at the top of the Pending eRx as well as the DEA
note (see below) at the end of the order will not display the dispense drug in
the Pending Order is not marked as CS.
1. INC19910756 - Duplicated entries of drug code number in VistA NDC file
This prescription meets the requirements of the Drug Enforcement
Administration (DEA) electronic prescribing for controlled substances rules
(21 CFR Parts 1300, 1304, 1306, & 1311).
Technical Resolution:
---------------------
The code at CSERX+1^PSOORNEW was changed from checking whether the CONTROLLED
SUBSTANCE INDICATOR field (#95.1) in the ERX HOLDING QUEUE file (#52.49) was
set to check if the dispense drug associated with the Pending order is marked
as CS by calling the local $$CSDRG API. In addition, the line tag DERX1+66 in
caused erroneous drug auto-match
the PSOERXU1 routine was changed to add a check if the dispense drug is marked
as CS before setting the variable PKIE with the message that the eRx was
digitally signed. And the code at PST+48 in the routine PSOORFI1 was also
modified not display the DEA message above unless the drug is marked as CS.
13.INC21240944 - received eRX type CS for non-CS drug
Problem:
--------
West Palm Beach VA Medical Center (FL) reported that the users were unable to
Problem:
accept a Digitally Signed eRx Pending Order record even if the drug selected
for the prescription is not marked as a Controlled Substance (non-CS). When
the CS eRx Project was released with patch PSO*7*617 it assumed that a
digitally signed order would certainly translate into a CS VistA prescription.
However, in some cases, digitally signed prescription are for medications not
considered by the VA to be controlled substance. A good example is GABAPENTIN
medication, which in some states is classified as a controlled substance but
not by the Drug Enforcement Agency (DEA). So, a prescriber in such states will
digitally sign prescriptions before transmitting prescriptions for this
medication to the VA however the VA will not process such eRx prescriptions as
--------
controlled substances. Therefore it will not require that the VistA provider
assigned to the eRx prescription has a valid DEA# on file.
Resolution:
------------
Instead of checking whether the eRx record was digitally signed or not to
determine if the eRx can be accepted the software will now check if the
dispense drug associated with the eRx order is marked as a CS or non-CS.
If the drug is not marked as CS the accepting of the eRx order will be
permitted even though the provider does not have a valid DEA# on file. A
Meds-by-Mail (MbM) encountered a problem with eRx auto-matching functionality
warning message will still be displayed.
Technical Resolution:
---------------------
The code at PRDRVAL+49^PSOERXUT was changed to check solely whether the VistA
drug selected for the prescription is marked as CS or not. If not marked as CS
and the Accept functionality will only warn the user about not assigning a CS
drug to a digitally signed order but it will not block them from proceeding.
14.INC22031884 - eRx pending order screen does not display original
performed by the eRx Hub web-application. For the incoming NDC 000185060510
physician's instruction and relevant drug dose strength
Meds-by-Mail (MbM) reported that the users were unable to view the eRx SIG
in the "Instructions" field (above the VistA SIG) while processing a pending
order. Furthermore, they requested that the eRx Drug is also displayed in the
line above the "Instructions" field. This change would only impact eRx pending
orders.
Resolution:
------------
the software was wrongly auto-matching to CHLORDIAZEPOXIDE HCL 5MG CAP and
In order to address this issue the software was changed to save the eRx SIG
in the PROVIDER COMMENTS field (#9) in the PENDING ORDERS file (#52.41) when
the record is crated after the eRx is accepted. In Addition, when displaying
the "Instructions" field for eRx pending order the field will now be
displayed as "eRx Instructions" and the a new field called "eRx Drug" will be
added above this "eRx Instructions" field and it will display the original
eRx drug name that was sent it by the outside provider software.
Technical Resolution:
---------------------
pre-populating the matched VistA Drug for the incoming eRx record.
Replaced the code at ADD+67^PSOERX1F to use the eRx SIG information in the
field mentioned above. Additionally, changed the routines PSOORFI1 (PST+5)
and PSOORNEW (PT+4) to add the word "eRx" in front of "Instructions" field
for eRx originated Pending orders. Also, added a line above for such orders
to display the actual eRx Drug sent in by the outside prescriber.
Resolution:
-----------
The eRx dispense drug auto-matching functionality was changed to skip Inactive
NDC/UPN entries while trying to match the eRx incoming NDC with an existing
VistA dispense drug.
Technical Resolution:
---------------------
The existing code at DRGMTCH+29^PSOERXA0 was reading the first NDC/UPN entry
2. INC17880583 - Pharmacist cannot process e-prescribers' RXRENEWALRESPONSE
that matched the incoming NDC to find a match in the DRUG file (#50) without
checking whether the entry was Inactive or not. The code was changed to loop
through all the entries in the "NDC" cross-reference in the NDC/UPN file
(#50.67), skipping Inactive entries, until it can find a unique match to a
dispense drug. If more than one possible match is found then it will not
auto-match the dispense drug.
2. INC17880583 - Pharmacist cannot process e-prescribers' RXRENEWALRESPONSE
Problem:
--------
Meds-by-Mail (MbM) reported a problem with certain incoming RxRenewalResponse
records that were assigned an RXN (RXRENEWAL RESPONSE - NEW) status but could
not be processed because they did not have a corresponding eRx record. This
caused this records to remain on their 'to-do' eRx Queue until they 'aged out'.
The ACK (Acknowledge) action is not available for such records. MbM referred
to such records as 'orphaned' records.
Resolution:
-----------
3. INC19246636 - eRx SSN gets truncated on vistA screen (OERR and pharmacy
The processing of incoming eRx records was changed to automatically assign a
status of RXF (RXRENEWAL RESPONSE FAILED) to records without a corresponding
eRx record. In addition it automatically adds the following comment to the
Status History for the 'orphaned' record: Response received was 'Denied' -
No corresponding eRx Record found.
Technical Resolution:
---------------------
Introduced new code at REFRESP+20^PSOERXA5 to check whether the incoming eRx
response record has a corresponding eRx record. If not, the status of the
backdoor)
incoming response record will be changed to RXF and a comment will be logged
to Status History log.
3. INC19246636 - eRx SSN gets truncated on vistA screen (OERR and pharmacy
backdoor)
Problem:
--------
Meds-by-Mail (MbM) reported a problem with the patient SSN (Social Security
Number) last digit being truncated in the Patient Prescription Processing [PSO
LM BACKDOOR] option. The problem is with in the eRx information listed at the
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