OR*3*243 CPRS GUI V27 Functional Training

1. OR*3*243 CPRS GUI V27Functional Training Medication Order Changes BHIE VBECS All Other CPRS GUI Changes

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

3. Medication Order Changes

4. Administration Times Changes to Infusion Order Dialog (PSI-05-065,PSI-06-014,PSI-06-045, PSI-06-066) Meds Tab Sorts Meds Tab Display Pending Renewals (PSI-06-023) Day-Of-Week Schedule Builder Expected First Dose (PSI-05-026) Schedule Type Provider/Pharmacy Hold Provider Comments (PSO-07-057, PSI-07-203) Clozapine Orders Patient Safety Changes Issues Covered

5. Administration Times CPRS now displays administration times when writing inpatient medication orders in the unit dose and infusion order dialogs.

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

7. Changes to Infusion Dialog • Added IV Type selection field • Added Medication Route selection field • Added Schedule selection field • Added Give Additional Dose Now field • Added Infuse Over Time field • Added Administration Time display • Added Expected First Dose

8. New IV Medication Route Field

9. New IV Medication Route Field

10. New IV Medication Route Field

11. Continuous IV Type

12. Intermittent IV Type

13. Meds Tab Sorts

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

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

16. Day-Of-Week Schedule Builder

17. Expected First Dose Modifications • Inpatient meds will not display expected first dose for a schedule of One Time or On Call. • Inpatient meds will accept the schedule format days@schedule from CPRS (Tuesday@BID). • Expected first dose will not show if “Give Additional Dose Now” is checked.

18. Schedule Type • The “Give Additional Dose Now” box is removed for Delayed orders and Schedule type of Once or One Time. • Duration cannot be assigned to an Intermittent IV Order if the schedule has a Schedule Type of Once. • Administration times will not show for the following schedule types: PRN, One time, On Call.

19. Provider Comments • Potential of inappropriate or misleading provider comments automatically included on new medication. orders. PSI-07-057 • Provider comments will display in the Sig until the order is finished, then only if copied into the patient instructions. • If an order is later edited, copied or renewed, the finished patient instruction text will be retained in the new order instead of the original provider comment. • The Transfer action will allow provider comments to roll over into the order dialog for review by the new ordering provider. • CPRS will continue to include both the provider comments and the patient instructions of the original order text in an audit trail.

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

21. Clozapine Orders • Outpatient Clozapine orders • Patients set up weekly are allowed 7 days supply no refills. • Patients set up biweekly are allowed 14 days, or 7 days and one refill. • Patients set up Monthly are allowed 28 days, 14 days and 1 refill, or 7 days and 3 refills.

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

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

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

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

26. Clozapine Orders This order checks appears after placing the clozapine order and a local override is needed to finish the order. This message appears if a national override is needed to order the clozapine order.

27. Patient Safety • A patient order remained active, although numerous attempts were made to discontinue the order. (PSI -05-007). The order is active in pharmacy and pending in CPRS. • The following error message was added.

28. Patient Safety • CPRS Order Entry use of Synonym. (PSI-05-116) Synonym text will appear at the top of each ordering dialog. • Synonyms will not appear in the order text. • Synonyms will not appear in Quick Order text • An IV fluid order with controlled substance ( CS) additives may be entered without a VA# or a DEA. (PSI-06-173) CPRS now prevents ordering of an IV with a CS without a VA# or a DEA. • User may give additional dose now in the inpatient medication dialog box when they have a medication of Once or One-Time. (PSI-06-192) • The Give Additional Dose Now check box for IV and Unit Dose orders with a schedule of Once or One-Time is now disabled/removed. • The Give Additional Dose Now check box for delayed orders is now disabled/removed.

29. Patient Safety • Order check overrides were not transmitted to the ancillary service (PSI-05-103) A new message appears upon signature for order checks marked high. • A new API will be added to allow other packages to read Order Checking data. • A new option will be attached to the Order Checking Mgmt Menu [ORK ORDER CHK MGMT MENU].

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

31. Patient Safety • Schedule Missing from Clinical Reports/pharmacy PSI -07-063 • Add a new Schedule column in the CPRS Reports. • Rearrange the existing column sequence to: Additives, Solutions, Rate, Schedule, Start Date/Time, Stop Date/Time, [+]Flag • All IV • Active IV

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

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

34. This chart details the source of data available to VA via CPRS RDV and VistaWeb. Items in blue are new in CPRS GUI V27 (i.e. blue indicates which source (DoD CDR) and information domains (APs and Vitals) that are added or updated in CPRS GUI V27 and related BHIE Release 3a)

35. CPRS V26 CPRS V27 CPRS V27 presents DoD remote data only – no longer contains local or other VA data CPRS V27 adds Vital Signs to the DoD Data Tree in RDV

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

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

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

39. Section 508 Changes Alerts Allergies Clinical Reminders Conflict between encounter location and inpatient location Schedule Type Consults Current Activities Form Discharge Summary Labs Tab Notes Radiology Order Changes Lab Order Changes All Other CPRS GUI v27 Changes • Cancelled on Discharge from Observation (PSI-07-046) • Order Checks • Accidental Signing of Old Orders (PSI-05-106) • Reason for Flag Changes • Quick Order • Dietetic Order Changes • Original Verbal Orders Signature • Patient Inquiry • Patient Record Flag • Patient Selection • Project 112/SHAD • Reports • Remote Data Displays • Team Lists

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

41. ALERTS REASON FOR FLAG to Display When Processing Flagged Order Alert

42. ALERTSFlagged Order Alert Processing

43. ALERTS Improved Surrogate Validation and Forwarded Comments Button

44. ALERTS Remedy #215189, NSOC ticket #VA08853 - Sensitive record check bypassed when using CPRS GUI to process alerts. This has never worked correctly, but is now fixed in v27. There are 2 known issues remaining, both only when an alert can't be processed at all because viewing that patient is denied: • If that alert is the first in the list to be processed, then following the "access denied" message, the patient selection screen will open, and any subsequent alerts that were previously selected will need to be selected again. • In any other sequence, alerts up to and including the "access denied" message will process correctly. At that point, the user cannot continue processing alerts using the NEXT button or menu, and must go back to the patient selection screen to continue, or reselect additional alerts.

45. ALERTSMake Anatomic Pathology, Pap Smear, Mammogram Notifications Action Alerts PSI-05-001/PSI-06-068/PSI-06-134/PSI-07-14/PSI-07-031

46. TEAM LISTSPersonal Team ListsExclusions from GUI Applications

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

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

49. ALLERGIES Cannot Add the New Allergy Entry/Edit Dialog to the Write Orders List (Remedy #189377) • Resolution: User can now add the new allergy entry/edit dialog because developers changed the parameter ORWOR WRITE ORDERS LIST to accept entries of type ACTION in file 101.41.

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