rpms - ehr v1.1 techie class september 2007 really powerful at measuring stuff
TRANSCRIPT
RPMS - EHR v1.1 Techie Class
September 2007
Really Powerful at Measuring Stuff
Student Questions
• Questions posed during the class
• Answers from the presenters and students
Can’t Log into RPMS While in EHR
Question– I have EHR users that have correct class keys,
BGO keys, but cannot log into RPMS while they are in EHR.
– Would this be resolved with the VueCentric updates service file? I have been told this is a permissions issue. How would this be resolved?
Can’t Log into RPMS While in EHR
Answer– Most likely the user doesn’t have multiple sign-on
allowed.– Inspect/correct the user account
• User option: Edit an Existing User• On page 2, field Multiple Sign-on should be “Allowed” and
Multiple Sign-on limit should be at least 2 or 3.
Can’t Log into RPMS While in EHR
CCOW Version Supported?
Answer– Specification version 1.1 is currently supported.
Electronic Signature?
Question– Is there an electronic signature for the EHR Demo?
Answer– Vuecentric
Launching Demo RPMS
Question– How do we get into RPMS?
Launching Demo RPMS
Answer– Via Windows Start > Programs > Cache >
Cacheweb > Terminal • Access Code: user123• Verify Code: user321$
– Or, via clicking on the Communication tab in EHR and then clicking the RPMS link from the left menu
• Username: RPMS• Password: <enter> no password required• Access Code: user123• Verify Code: user321$
Adding Components
Question– Can the education and health factors objects be
added to another tab such as the Prob/POV tab if the Categories tab of the Object Registration is blank in vcManager?
Adding Components
Answer– First, when the Categories tab initially appears, only previously
checked items are visible. To see all possible entries, right-click on the tab and select Show All Categories from the popup menu. Categories determine the placement of an object in the tree view control within the Add Object dialog of the Visual Interface Manager.
Adding Components
Answer– Second, the Special Settings tab of Object Registration will show you
whether a given object can be placed in multiple tabs. If the Allow Multiple Instances checkbox is selected (checkmark shown) then that object may be placed in multiple locations. Both the education and health factors objects permit multiple instances.
Pick List....still side to side…
Question– Can scroll bar be placed on side to scroll up and
down?
Answer– The splitter bar has a vertical orientation, meaning it
visually is top to bottom. The scroll bar can only move left or right.
Templates stored?
Question– Where are the templates stored- local computer or
server? – Can they be backed up as part of the backup
program the windows admin runs?
Templates stored?
Answer– The templates are stored in the database you’re
logged into. So, if you’re on a local RPMS database (located on your PC), then the templates are stored on your PC. In most production instances, the users will be logged onto a server database, so the templates would be stored on the server.
– Yes, the databases can be backed up, just include the Cache folders in the backup plan.
VueCentric.ini
Question– Are all the files in the bin folder (master copy)
supposed to be listed in the VueCentric.ini?
Answer– No
EHR Failover?
Question– If default server (EHR local...ie its down) is not
available will it failover to EHR -Remote server on application startup?
Answer– No. This is not a standard setup. However, a
failsafe/failover solution is technically feasible as part of a business continuity program.
Communications Tab… Design Mode…
Question– After adding a new node in the communication tab,
in the design mode, can you change the name of the node?
Answer– Right-click on item and select Properties– Click node editor button– Click on item in list and click pencil tip icon (rename
operator)– Type in the desired new name and click OK button
Communications Tab… Design Mode…
IE Component
Question– How do you pass security context to new IE window (web
outlook) so that it does not prompt the user for a password/user name?
Answer– The IE component operates in a similar fashion as the Internet
Explorer application on your PC. Consequently, it will use the Windows IE settings and cookies, cached pages, etc, but is limited in it’s navigational abilities.
– As far as using autofill field values, this is website specific. In the case of Web Outlook, you must enter your credentials. Other sites, like the New York Times, will automatically log you in.
Cover Sheet Kernel Alert
Question– Advantage of Cover Sheet Kernel Alert: Provider
seeing patient can easily see if this patient has any alerts/notifications.
– Why isn’t the Kernel Alerts component used at most EHR sites?
Answer– The Kernel Alerts was the VA component and is
display only.– It has been superceded by the Notifications
component.
Updating Problem List
Question– How are problems entered and updated in CPRS
(BEH) Problem List?
Answer– The BEH problem list is only used for viewing.
Problems are entered/edited on the Prob/POV tab.
Patient Detail
Question– Can "Patient Detail" content be adjusted?
Answer– Yes, you can use a Health Summary in place of the
program presently being used,– or if you are a MUMPS programmer, you may write
your own program to replace the one present.
Patient Home Directions
Question– Out PHNs would like to have the directions to the
patients home (which is included in the "Patient Registration" Package. Can we do this?
Answer– Yes, you can use a Health Summary in place of the
program presently being used,– or if you are a MUMPS programmer, you may write
your own program to replace the one present.
Problem List
Question– Why aren’t we using the VA version of Problem List
so that clinicians can manage their problem lists?
Answer– The BGO (IHS) version of the Problem List is being
utilized. You could use the VA version by incorporating the BEH component… On the Prob/POV tab.
Lab Results Component
Question– What is the parameter to set the “# of days back” for
the Lab Results component on the cover sheet?
Answer– To set, use the new RPMS-EHR CONFIGURATION
MENU• Choose LAB and then • CVR Days of Lab Results to Retrieve (Cover Sheet)
– The parameter is BEHOLRCV DATE RANGE
VA CPRS and EHR v1.1
Question– What version of the VA's CPRS is included in EHR
Versions 1.1?
Answer– CPRS 20
VA CPRS and EHR v1.1
Question– What CPRS version will be utilized with the next
Version of EHR?
Answer– That will be determined by IHS
National Reminder Templates
Question– The VA has begun to develop national "Reminder
Dialog" templates. Do we need CPRS Version 26 to do the same within IHS?
Answer– Not necessarily version 26 but higher than 20.
Reminders version 2.0 must be present, which cannot be installed until after the Code Set Versioning Update project is completed in early 2008.
BEH Notifications
Question– Are BEH Notifications sorted? Can we track
notification responses? Example One: Provider is sent notification by coding department that an error in the patient record needs to be clarified. Provider deletes notification and makes change to patient record but coding department does not know that change has been made. Example Two: Documentation that provider has viewed the laboratory results notification.
BEH Notifications
Answer– Are BEH Notifications sorted? Yes.– Can we track notification responses? Yes.– There are two types of notification files.
• The file that contains notifications is purged every 14 days.• The notification tracking file is purged every 30 days.• However, in the EHR on the Notification Setup Menu is an
option Archive (delete) after <x> Days where you can setup an individual notification to be tracked for up to 220 years.
BEH Notifications (cont.)
Answer– There is also an alert management menu which has
reporting options: SURO Alerts - Set/Remove Surrogate for User
Delete Old (>14 d) Alerts Make an alert on the fly Report Menu for Alerts ... <== Several reports are here Set Backup Reviewer for Alerts Surrogate for which Users?
"Where are all the macro’s documented at?"
Question– Where are the different macro's listed with usage?
For example, we were shown ($user.name) in class.
Answer– We believe you are referencing the replaceable
parameters feature. This functionality is described in the ReplaceParams section of the EHR v1.1 Technical Manual.
BEH Visits - Appointment Component
Question– No configuration parameters?– What determines the date range for appointments
that are displayed on the coversheet?
Answer– Two parameters are available:
• ORQQAP SEARCH RANGE START• ORQQAP SEARCH RANGE STOP
Lab Component
Question– What determines the date range for labs that are
displayed?
Answer– Two Parameters:
• ORQQLR DATE RANGE OUTPT• ORQQLR DATE RANGE INPT
Employee Data Viewing Protocol
Question– Could you please send the protocol on employee
records or employee health records viewing by other employees.
Employee Data Viewing Protocol
Answer: Business Rules:– If you place a Document Class called EMPLOYEE HEALTH under
Progress Notes and create the title(s) for Employee Health in that class, then these rules should do what you need. The other appropriate actions should be covered by rules in the Progress Notes class:
1 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by an EMPLOYEE
HEALTH2 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS3 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by an EMPLOYEE
HEALTH4 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by a CHIEF, MIS5 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by an EMPLOYEE
HEALTH6 An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by a CHIEF, MIS7 A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by an EMPLOYEE
HEALTH8 A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS9 A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE PRINTED by an EMPLOYEE
HEALTH10 A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE PRINTED by a CHIEF, MIS
Available Reports Not Visible
Question– In following along the creation steps for the Reports
tab from the Design Mode class, the resulting template did not show any Available Reports. The template that I am using is the same template that Mary had the class modify. I compared this template with the %PROVIDER and updated to match the Design properties including the selections for Required Services and still no Available Reports were visible.
Available Reports Not Visible
Answer– The condition that you produced is a known defect
when exiting Design Mode for the object in question.
– Simply exit completely from the EHR, launch EHR and log into the system as usual.
– Clicking on the Reports Tab (with a patient selected) will now reveal the available reports, as expected, and any relevant patient data.
Last # of Meds… Med Class…
Question– We can do last med or last med class, will we ever
be able to do last # of meds or med class? For example, I have a patient who is currently on warfarin 2mg tabs (MoWeFr) *and* warfarin 3mg tabs (TuThSaSu). If I use the existing objects, I'll only get one of them (whichever was filled last, even if by a nanosecond). I really need a way to get both of the current warfarin strengths in this object. This could happen with other drugs, too (i.e. phenytoin).
Last # of Meds… Med Class…
Answer– You can create a HS for that particular med that
brings 3 occurrences or more…– then create a TIU object with this HS.
TaskMan Jobs…
Question– What TaskMan jobs need to be running in order to
keep the EHR well maintained? What other procedures (if any) are needed to keep the EHR healthy?
Answer– The TIU Nightly Task and PSO Expire Prescriptions
jobs should be scheduled daily.
MS Windows Vista Supported?
Question– Will RPMS EHR GUI work on machines with
Windows Office Vista?
Answer– Using MS Windows Vista has been tested in a very
preliminary fashion and plans for a full evaluation have not been formed yet.
– Windows Vista is not currently supported by the VueCentric framework.
Power User
Question– Don't all EHR users need "Power User" rights to run
EHR?
Answer– Prior to the introduction of the VueCentric Updater
service, the Power User rights were necessary. With the deployment of the updater service, with its permissions to maintain the components locally, the individual EHR user does not need the Power User rights setting.
Question– Why do I not appear in the list of available providers in the
encounter dialog?
Answer– The parameter BEHOENCX PROVIDER controls who can be
a provider on a visit. Contact your Application Coordinator to set this parameter for you.
– This also can happen if the provider has a status of Disuser, which can happen in those sites who have outside providers set up in the EHR for use by Pharmacy, Lab, and Radiology orders, or if the given provider works intermittently.
Available Providers List
Question– Explain "Improperly Terminates" statement in locked
patient record message.
Answer– Anytime that the connection to the RPMS server is
abruptly lost… That is, whenever the user has not properly logged off.
Improper Terminations
Statement– IHS contention for identifying "demo patients" in the
Demo database is as follows: • Demo, Patient Father• Demo, Patient John• Demo, Patient Gillian
IHS Demo Patients
Import Key on Personal List Under Patient
Question– Under the patient, on the personal list how do you
use the import key? Is that similar to template importing/exporting?
Answer– The import on the personal list is a way to import a selection of
patients from a ward or clinic list. It is not am import similar to template importing/exporting.
Import Key on Personal List Under Patient
Personal List Under Patient
Question– Personal list under the patient – how can others see
it?
Answer– You can’t. This list is a private list and cannot be
shared.
Flagging Orders
Question– Flagging Orders- for example your parameter is set
to clear off completed orders in 24 hours. And you flag an order and un-flag it – will disappear. a) If you leave it flagged on the order tab will it stay there or
is it cleared with the same parameter?
b) How can you retrieve the MD signature of acknowledging a critical lab value?
Answer – 2 places to check
• In RPMS, under the notification menu
• Choose item 15• This will show you
who got each notification and what they did with it.
Answer (cont.)
Consult Team
Question– Consult Team – in RPMS when one team member
views the alert will it disappear for the whole team in RPMS? How does this affect the notifications tab in EHR?
Consult Team - Answer
• RPMS notifications are the same as EHR notifications. The deletion parameters should work the same way.
• This is a parameter on the notifications menu
• Use option 4 – Set deletion parameters
Answer (cont.)
• Set up each notification
Inpatient Diet Orders
Question– Inpatient diet orders what is the parameter for that?
Inpatient Diet Orders
Answer– The Dietary package is not yet supported
by IHS.– You can remove the diet orders from the
Orders tab by making your own list (don't overwrite the package values) using the parameter ORWOR WRITE ORDERS LIST or by making your own menu for the parameter ORWDX WRITE ORDERS LIST.
Inpatient Diet Orders
Answer (cont.)– You can remove the dietary items from the
Reports tab using the parameter ORWRP REPORT LIST. Set up the system level with the items you want to use.
– In the VA, there are no dietary parameters• You will make Dietary Quick orders• There is a generic dietary order menu called
FHW1
System Package
Inpatient Diet Orders - Answer (cont.)
IHS Patient Inquiry
Question– Why are we not using the IHS Patient Inquiry for
the Patient Detail display? Appears the VA Patient Inquiry is being used which contains items we don’t need and is missing IHS items.
IHS Patient Inquiry
Answer– This is a parameter setting– The package setting is: Value: D PTINQB~BEHOPTCX(DFN)
– You can use a different programEnter as D entry pt ~ routine (Parameters)
– Or a health summary:
Value: S APCHSTYP=26,APCHSPAT=DFN D EN~APCHS
Format S APCHSTYP=ien of HS type,APCHSPAT=DFN D EN~APCHS
Deleting TIU Objects
Question– Can you delete TIU objects? If so…how?
Answer– Yes, but be really careful. If this object is in ANY
TIU TEMPLATE, it will cause an error since it will not warn you before you delete it that it is being used in the EHR GUI.
– In general, it is safer to simply inactive the object. However, you delete them from the Create Objects option, then edit the object, make it inactive, and then choose the action of delete.
Personal Health Component
Question– Does the provider also need the "Asthma Registry"
(BAT) keys in order to document asthma related data?
– Should the "Asthma Registry" be setup prior to using the asthma personal health component?
Personal Health Component
Answer– Yes, you should set up the Asthma registry first.
Otherwise, data will still go into the files, which exist already, but it may cause unusual results.
– The provider needs the Asthma registry key to add anyone to the registry. I (Mary) think that you can add the other data but I am not sure.
EHR Component Updating
Question– Each user runs the updates every time they use
another computer even if the computer is up to date from another user running EHR.
– How are you able to push these updates out with admin tools? A failure here gives us “load failure” on EHR startup.
– We load EHR from a desktop shortcut, perhaps this causes the above constant update issues?
EHR Component Updating
Answer– The updating process at each startup time is by
design. When the EHR icon is double-clicked, the VueCentric Updater runs and checks to see if any executables or libraries need to be updated. VIM is then scheduled. When VIM loads the template, VIM pulls any updated components from the Object Repository to the local bin directory.
– The VueCentric Updater is the only automated method of updating a local client machine.
Communications Tab
Question– Communications Tab: "Where do, or how do, you
put an IP address"?Answer– If you are referring to the use of the Telnet
component, it permits connecting to the character-based (“roll-and-scroll”) interface of the host system that was specified when the EHR session was launched. The user is not able to telnet to a different host.
– The Internet Explorer browser component permits entering a site name or an IP address.
Notifications from Doctors to Data Entry
– re: Data Entry receiving notifications back from doctors when the (PCC) return visit for corrections/additions so they are aware it's been addressed.
– PCC Data Entry edits occur within RPMS not EHR. Therefore, once a provider has altered a visit in any manner, an automatic regeneration of that visit is transmitted back to Data Entry for editing. The visit is the notification. This visit remains on the Data Entry Edit List until the data entry clerk has designated it "complete" in RPMS. That should not happen until the provider has completed the task that was returned to him/her.
Exams
Question– Can we edit exams to add for exam: colo-rectal
exam?– Or, do we have to make an enhancement for
additions?
Answer– No, exams are distributed nationally by IHS – IHS is moving more toward ICD9 and CPT codes
and not using exams
Notifications
Question– When a group/team receives notifications, is it possible that
once one member of group receives them, they disappear from the other team members notification page?
– Example: a consult to the Anticoag Clinic; once one member schedules appt or results consults, the other members really don't need to see the notification any longer.
– If so, does this also apply to Lab Result Notifications? If the entire team receives them, and one member reviews them, would they disappear from the others notification page? If so, what if more than one team (or an individual receiver-the ordering doctor, maybe - and a team) receive results...and one team member reviews them...would they remain on the ordering doctor's notification page?
Notifications
Answer• On the notifications setup menu, use this option – Set
Deletion Parameters for Notifications• In this parameter, you can select the individual
notification and decide how it should be deleted BUT this is a system-wide setting, not different for different locations.
TIU Objects and Components
Question– Is it possible to begin with a TIU object and create
a Health Summary component from it. The training as Mary presented it demonstrated the method of bringing a HS Component over into TIU.
Answer– No, HS type –> HS object –? TIU object is
the way it works. You cannot go the other way.
Multiple Divisions Set Up
Question– What parameters do we need to set up with multiple division
sites? Anything techies need to know before allowing users to access all the divisions? Does duplicate work take place, etc.?
Answer– Duplicate activity is not common. Sites can set up the
parameters differently per division.– The site must be setup to be multi-divisional and must have a
site number for each division.– Users must be assigned access rights to each division they
plan to access. When these users log on they will be presented a choice of the division to enter.
Question– As we continue with our EHR setup, we are at the point of
trying to demonstrate how the EHR works at our site.– We can log into EHR and we can select a patient, then we can
create a New Visit; BUT when we go to try to fill in information on the Triage sheet or some other area to add text to that Visit, the attached WORD doc. has screen shots describing the problem. This happens all the time for every patient for every provider/user - we have not had a Visit opened and closed successfully, yet. It may be a basic setup issue? Not sure.
Answer– Set the associated parameter at the System level to YES
Visit Updating Problem
Order Signing
Question– DC orders generated for Pharmacy, Radiology, and
Lab have to be signed by a nurse or clerk. How is this turned off?
Answer– If the order is being discontinued by a nurse or a
clerk in response to a verbal or written order, then it is appropriate that they sign the order.
– If they are being asked to sign orders that are edited by a service such as Pharmacy, this needs to be configured as Service Correction so that a signature is not necessary.
Question– We have one IP address with several different databases. They don't share
mgr global or rtn. Do we need to load EHR on site?
Answer– The implementation of EHR will still rely on pulling the EHR application files
from a shared bin folder (the VueCentric application repository). A local copy, or copies, of EHR on site is not needed, nor recommended.
– Each database to be accessed from EHR will need to have a unique TCP port #. To enable EHR to communicate with these databases, a listener process should be initiated from each database using its designated port.
– During the installation process, or subsequently if a site is adding a new database, an entry for each database that is to be accessed by EHR should be inserted in the vcBroker.ini file. (See how to use the vcIniConfig Utility in the EHR v1.1 Technical Manual and/or the EHR v1.1 Installation Guide)
– When a user launches EHR, they will be requested to select the database they wish to connect.
Host with Multiple Databases
RPMS - EHR v1.1 Techie Class
Conclusion
Really Powerful at Measuring Stuff