CSI for CIS 310H VEHU 2008

1. 1 CSI for CIS � 310HVEHU 2008 Investigation to a Higher Degree

2. 2 FACULTY Sheri Kreuz, EPS/Clin2 SLC OIFO Debbie Swayngim, CAC Asheville VAMC Kristian Johnson, CAC Minneapolis VAMC Jason Hawsey, CPRS Developer Bay Pines OIFO

3. 3 Overview You each have your own personal VistA and CPRS account (CPRS GUI V27) Each is �broken� in a variety of ways ~10 minutes per problem, with successive hints provided during each time period After making any changes, you need to logoff/logon for those changes to take effect Several of the problems have multiple parts to solve/fix the problem. Please follow along as each solution is explained, and raise your hand if stuck.

4. 4 �Friendly Competition� Each problem will have 2-3 hints If you solve the problem before the 1st hint, you get 5 points. If you solve the problem after 1st hint, you get 3 points. If you solve the problem after 2 or 3 hints, you get 1 point. Keep track of your points � the winner will take home a valuable prize!!!!!!!!!!

5. 5 Signing ON Please locate your desktop shortcuts for CPRS (v27) and Reflection Your login: Access: ##VEHU (188VEHU) Verify: VEHU## (VEHU188) ESig: VEHU## Remember that each SCENARIO may provide a specific user and/or specific patient name that you�ll be investigating.

6. 6 Problem #1 User VEHU,ONEHUNDREDEIGHTYEIGHT cannot enter new DOM REHAB NOTE on NINETYNINE,PATIENT (N0099) located on the DOMICILLARY ward.

7. 7 Problem #1 User VEHU,ONEHUNDREDEIGHTYEIGHT cannot enter new DOM REHAB NOTE on NINETYNINE,PATIENT (N0099) located on the DOMICILLARY ward. HINT #1: Have rules been obeyed?

8. 8 Problem #1 User VEHU,ONEHUNDREDEIGHTYEIGHT cannot enter new DOM REHAB NOTE on NINETYNINE,PATIENT (N0099) located on the DOMICILLARY ward. HINT #1: Have rules been obeyed? HINT #2: Is there an �unruly� class?

9. 9 Problem #1 User VEHU,ONEHUNDREDEIGHTYEIGHT cannot enter new DOM REHAB NOTE on NINETYNINE,PATIENT (N0099) located on the DOMICILLARY ward. HINT #1: Have rules been obeyed? HINT #2: Is there an �unruly� class? HINT #3: Do �parents� have control?

10. 10 Solution #1 MEDICAL TITLES document class (doc class for DOM REHAB NOTE title) parameter does not allow more than one record per visit <CJJ> Select TIU Parameters Menu Option: 3 Document Parameter Edit First edit Institution-wide parameters: Select DOCUMENT DEFINITION: MEDICAL TITLES DOCUMENT CLASS ...OK? Yes// (Yes) DOCUMENT DEFINITION: MEDICAL TITLES// MEDICAL TITLES REQUIRE RELEASE: REQUIRE MAS VERIFICATION: REQUIRE AUTHOR TO SIGN: ROUTINE PRINT EVENT(S): STAT PRINT EVENT(S): MANUAL PRINT AFTER ENTRY: ALLOW CHART PRINT OUTSIDE MAS: ALLOW >1 RECORDS PER VISIT: NO// ?

11. 11 Problem #2 Patient ONEHUNDREDTHREE,PATIENT is currently admitted to the NHCU, however the ADMISSION TO NHCU orders did not release upon ADMISSION movement. Make your change/correction (manual release is not an option). Run ADMISSION (specific name) macro from the desktop. Validate that your change worked by checking if the orders on ONEHUNDREDFOUR,PATIENT released upon ADMISSION movement. If you need another few patients, use ONEHUNDREDFIVE,PATIENT and/or ONEHUNDREDSIX,PATIENT.

12. 12 Problem #2 Patient ONEHUNDREDTHREE,PATIENT is currently admitted to the NHCU, however the ADMISSION TO NHCU orders did not release upon ADMISSION movement. Make your change/correction (manual release is not an option). Run ADMISSION (specific name) macro from the desktop. Validate that your change worked by checking if the orders on ONEHUNDREDFOUR,PATIENT released upon ADMISSION movement. If you need another few patients, use ONEHUNDREDFIVE,PATIENT and/or ONEHUNDREDSIX,PATIENT. HINT #1: Are we in TX or are we in FL?

13. 13 Problem #2 Patient ONEHUNDREDTHREE,PATIENT is currently admitted to the NHCU, however the ADMISSION TO NHCU orders did not release upon ADMISSION movement. Make your change/correction (manual release is not an option). Run ADMISSION (specific name) macro from the desktop. Validate that your change worked by checking if the orders on ONEHUNDREDFOUR,PATIENT released upon ADMISSION movement. If you need another few patients, use ONEHUNDREDFIVE,PATIENT and/or ONEHUNDREDSIX,PATIENT. HINT #1: Are we in TX or are we in FL? HINT #2: Is there �division� between TX & FL?

14. 14 Problem #2 Patient ONEHUNDREDTHREE,PATIENT is currently admitted to the NHCU, however the ADMISSION TO NHCU orders did not release upon ADMISSION movement. Make your change/correction (manual release is not an option). Run ADMISSION (specific name) macro from the desktop. Validate that your change worked by checking if the orders on ONEHUNDREDFOUR,PATIENT released upon ADMISSION movement. If you need another few patients, use ONEHUNDREDFIVE,PATIENT and/or ONEHUNDREDSIX,PATIENT. HINT #1: Are we in TX or are we in FL? HINT #2: Is there �division� between TX & FL? HINT #3: Can you �admit to division� between the NHCU and the ADMISSION TO NHCU?

15. 15 Solution #2 Change ADMISSION TO NHCU release event to TAMPA, FL division to match the INSTITUTION for the NHCU hospital location To TEST/VALIDATE � run ADMISSION macro on ONEHUNDREDFOUR,PATIENT to NHCU. If you need another few patients, use ONEHUNDREDFIVE,PATIENT and/or ONEHUNDREDSIX,PATIENT (run the corresponding ADMISSION macro found on your desktop).

16. 16 Problem #3 User VEHU,THIRTYTHREE is trying to mark NINETY,PATIENT�s allergy to CHOCOLATE as entered in error; patient is NOT allergic to CHOCOLATE and desperately needs it removed from the coversheet.

17. 17 Problem #3 User VEHU,THIRTYTHREE is trying to mark NINETY,PATIENT�s allergy to CHOCOLATE as entered in error; patient is NOT allergic to CHOCOLATE and desperately needs it removed from the coversheet. HINT #1: Is the user allergic to chocolate too?

18. 18 Problem #3 User VEHU,THIRTYTHREE is trying to mark NINETY,PATIENT�s allergy to CHOCOLATE as entered in error; patient is NOT allergic to CHOCOLATE and desperately needs it removed from the coversheet. HINT #1: Is the user allergic to chocolate too? HINT #2: Does the user have any �class� at all??

19. 19 Problem #3 User VEHU,THIRTYTHREE is trying to mark NINETY,PATIENT�s allergy to CHOCOLATE as entered in error; patient is NOT allergic to CHOCOLATE and desperately needs it removed from the coversheet. HINT #1: Is the user allergic to chocolate too? HINT #2: Does the user have any �class� at all?? HINT #3: �OR� is the �ALLERGY ENTERED IN ERROR� really an issue?

20. 20 Solution #3 OR ALLERGY ENTERED IN ERROR parameter is set; need to review settings and make changes so that user VEHU,THIRTYTHREE can mark allergies entered in error

21. 21 Problem #4 User VEHU,ONEHUNDRED (Provider) is trying to comply with medication reconciliation. In April, he entered a Non-VA medication on FIFTYTWO,PATIENT. Patient is back today and VEHU,ONEHUNDRED does not see his Non-VA order on the medication tab, but he can see it on the orders tab. Why can the nurses see the Non-VA medications on both tabs and VEHU,ONEHUNDRED can not?

22. 22 Problem #4 User VEHU,ONEHUNDRED (Provider) is trying to comply with medication reconciliation. In April, he entered a Non-VA medication on FIFTYTWO,PATIENT. Patient is back today and VEHU,ONEHUNDRED does not see his Non-VA order on the medication tab, but he can see it on the orders tab. Why can the nurses see the Non-VA medications on both tabs and VEHU,ONEHUNDRED can not? HINT #1: Ouch!

23. 23 Problem #4 User VEHU,ONEHUNDRED (Provider) is trying to comply with medication reconciliation. In April, he entered a Non-VA medication on FIFTYTWO,PATIENT. Patient is back today and VEHU,ONEHUNDRED does not see his Non-VA order on the medication tab, but he can see it on the orders tab. Why can the nurses see the Non-VA medications on both tabs and VEHU,ONEHUNDRED can not? HINT #1: Ouch! HINT #2: What is different from April to today?

24. 24 Problem #4 User VEHU,ONEHUNDRED (Provider) is trying to comply with medication reconciliation. In April, he entered a Non-VA medication on FIFTYTWO,PATIENT. Patient is back today and VEHU,ONEHUNDRED does not see his Non-VA order on the medication tab, but he can see it on the orders tab. Why can the nurses see the Non-VA medications on both tabs and VEHU,ONEHUNDRED can not? HINT #1: Ouch! HINT #2: What is different from April to today? HINT #3: Hmmmm� what is that parameter�..?

25. 25 Solution #4 Walk the user through Tools/Options/General/Other Parameters and �reset� using Set Date Range for Meds Tab Display - or � Edit from General Parameters using Edit Parameter Values EP Edit Parameter Values for ORCH CONTEXT MEDS for the USER Setting ORCH CONTEXT MEDS for User: VEHU,ONEHUNDRED Value: T;T//

26. 26 Problem #5 A new physician, VEHU,TEN, at the Clermont Ohio CBOC calls to say that his order menu is not the same as the other providers at his CBOC.

27. 27 Problem #5 A new physician, VEHU,TEN, at the Clermont Ohio CBOC calls to say that his order menu is not the same as the other providers at his CBOC. HINT #1: There seems to be a troublesome �assignment� in his HOMEwork.

28. 28 Problem #5 A new physician, VEHU,TEN, at the Clermont Ohio CBOC calls to say that his order menu is not the same as the other providers at his CBOC. HINT #1: There seems to be a troublesome �assignment� in his HOMEwork. HINT #2: There seems to be some DIVISION between VEHU,TEN and his co-workers.

29. 29 Problem #5 A new physician, VEHU,TEN, at the Clermont Ohio CBOC calls to say that his order menu is not the same as the other providers at his CBOC. HINT #1: There seems to be a troublesome �assignment� in his HOMEwork. HINT #2: There seems to be some DIVISION between VEHU,TEN and his co-workers. HINT #3: Perhaps someone should EDIT this existing user to reflect where he really belongs.

30. 30 Solution #5 The order menus have been assigned at the DIVISION level. This user was assigned to the wrong division. EEU Edit an Existing User ? Enter VEHU, TEN Tab down to the Select Division field. @ sign to delete CINCINNATI. Now add a division of CLERMONT CBOC. Logout/Login required after change. User should now see the order menu assigned to his CBOC.

31. 31 Problem #6 You get a call from VEHU,EIGHT. He is having difficulty ordering Atenolol tabs. He says that for some reason when he uses the inpatient medication dialog box and types in Atenolol, he is unable to find that medication. NOTE: When you think that you have this problem solved, run ORMTime on your main menu before verifying your fix.

32. 32 Problem #6 You get a call from VEHU,EIGHT. He is having difficulty ordering Atenolol tabs. He says that for some reason when he uses the inpatient medication dialog box and types in Atenolol, he is unable to find that medication. NOTE: When you think that you have this problem solved, run ORMTime on your main menu before verifying your fix. HINT #1: There is nothing �QUICK� about how he is trying to order Atenolol.

33. 33 Problem #6 You get a call from VEHU,EIGHT. He is having difficulty ordering Atenolol tabs. He says that for some reason when he uses the inpatient medication dialog box and types in Atenolol, he is unable to find that medication. NOTE: When you think that you have this problem solved, run ORMTime on your main menu before verifying your fix. HINT #1: There is nothing �QUICK� about how he is trying to order Atenolol. HINT #2: What do you think is �RESTRICTING� him?

34. 34 Problem #6 You get a call from VEHU,EIGHT. He is having difficulty ordering Atenolol tabs. He says that for some reason when he uses the inpatient medication dialog box and types in Atenolol, he is unable to find that medication. NOTE: When you think that you have this problem solved, run ORMTime on your main menu before verifying your fix. HINT #1: There is nothing �QUICK� about how he is trying to order Atenolol. HINT #2: What do you think is �RESTRICTING� him? HINT #3: Atenolol seems like an ITEM you would want to see ORDERABLE.

35. 35 Solution #6 The Orderable Item ATENOLOL TAB has been restricted to Quick Orders only. OE CPRS Manager Menu ..., ? PE CPRS Configuration (Clin Coord) ? MM Order Menu Management ? OI Manage orderable items ? QO Enter/edit QO restriction ? Enter ATENOLOL TAB as the orderable item At Usage prompt, type in UNIT DOSE At QO Only prompt, type in @ Confirm that you wish to delete � YES Perform ORMTIME RUN option. CPRS Logout/Login required after change.

36. 36 Problem #7 User VEHU, EIGHT calls in saying that he has "Order flagged for clarification" alerts and that after processing them, he tries to unflag the orders but CPRS gives an error saying he cannot unflag because the orders are already unflagged. However the orders tab shows the orders with a flagged status.

37. 37 Problem #7 User VEHU, EIGHT calls in saying that he has "Order flagged for clarification" alerts and that after processing them, he tries to unflag the orders but CPRS gives an error saying he cannot unflag because the orders are already unflagged. However the orders tab shows the orders with a flagged status. HINT #1: Lets get detailed about this

38. 38 Problem #7 User VEHU, EIGHT calls in saying that he has "Order flagged for clarification" alerts and that after processing them, he tries to unflag the orders but CPRS gives an error saying he cannot unflag because the orders are already unflagged. However the orders tab shows the orders with a flagged status. HINT #1: Lets get detailed about this HINT #2: It would be nice if I had an AUTO fixing tool

39. 39 Problem #7 User VEHU, EIGHT calls in saying that he has "Order flagged for clarification" alerts and that after processing them, he tries to unflag the orders but CPRS gives an error saying he cannot unflag because the orders are already unflagged. However the orders tab shows the orders with a flagged status. HINT #1: Lets get detailed about this HINT #2: It would be nice if I had an AUTO fixing tool HINT #3: It is probably just some dumb �Miscellaneous Parameter�

40. 40 Solution #7 Look at detailed display of the order (shows that it was auto unflagged Turn off Auto Unflag in option: Miscellaneous Parameters [OR PARAM ORDER MISC]

41. 41 Problem #8 User VEHU,EIGHT calls in and says that recently when going to the reports tab and expanding the Health Summary option, there are only a few reports underneath of it when there were previously many.

42. 42 Problem #8 User VEHU,EIGHT calls in and says that recently when going to the reports tab and expanding the Health Summary option, there are only a few reports underneath of it when there were previously many. HINT #1: A Health Summary Coordinator could probably figure this out

43. 43 Problem #8 User VEHU,EIGHT calls in and says that recently when going to the reports tab and expanding the Health Summary option, there are only a few reports underneath of it when there were previously many. HINT #1: A Health Summary Coordinator could probably figure this out HINT #2: I think a new METHOD is needed

44. 44 Problem #8 User VEHU,EIGHT calls in and says that recently when going to the reports tab and expanding the Health Summary option, there are only a few reports underneath of it when there were previously many. HINT #1: A Health Summary Coordinator could probably figure this out HINT #2: I think a new METHOD is needed HINT #3: This problem we need to amend, so there is something we must Append

45. 45 Solution #8 The method of compilation has been turned to overwrite Use option "Method of compiling 'Health Summary Types List' [GMTS GUI HS LIST METHOD]" to set it back to (A)ppend

46. 46 Problem #9 Recently a local staff IRM programmer has written the latest and greatest Health Summary Component � �310H Component.� Up until now everyone has had to use the Ad Hoc Report on the reports tab to get to this component. You have been given the task to add this component to the Reports Tab so the users don't have to use the Ad Hoc Report.

47. 47 Problem #9 Recently a local staff IRM programmer has written the latest and greatest Health Summary Component � �310H Component.� Up until now everyone has had to use the Ad Hoc Report on the reports tab to get to this component. You have been given the task to add this component to the Reports Tab so the users don't have to use the Ad Hoc Report. HINT #1: Only the best TYPEs of HS Components make it to the Reports Tab

48. 48 Problem #9 Recently a local staff IRM programmer has written the latest and greatest Health Summary Component � �310H Component.� Up until now everyone has had to use the Ad Hoc Report on the reports tab to get to this component. You have been given the task to add this component to the Reports Tab so the users don't have to use the Ad Hoc Report. HINT #1: Only the best TYPEs of HS Components make it to the Reports Tab HINT #2: There is definitely a specific SEQUENCE of events

49. 49 Problem #9 Recently a local staff IRM programmer has written the latest and greatest Health Summary Component � �310H Component.� Up until now everyone has had to use the Ad Hoc Report on the reports tab to get to this component. You have been given the task to add this component to the Reports Tab so the users don't have to use the Ad Hoc Report. HINT #1: Only the best TYPEs of HS Components make it to the Reports Tab HINT #2: There is definitely a specific SEQUENCE of events HINT #3: Maybe we should include this TYPE in a LIST

50. 50 Solution #9 First users have to create a Health Summary Type and include this component in it. Then they need to use option "Edit 'Health Summary Types List' Parameters [GMTS GUI HS LIST PARAMETERS]" to add the new Health Summary Type at the System Level to the reports tab.

51. 51 Problem #10 A Nurse (NURSE,ONE) from Boise, Idaho calls just a �bit heated� to ask why he continually receives �Flagged� alerts from VEHU,FIFTYTWO? Today�s example is FIFTYTWO, PATIENT. PROVIDER,ELEVEN ordered the medication in May 2008. VEHU,FIFTYTWO flagged the order for PROVIDER,ELEVEN. What is NURSE,ONE suppose to do?

52. 52 Problem #10 A Nurse (NURSE,ONE) from Boise, Idaho calls just a �bit heated� to ask why he continually receives �Flagged� alerts from VEHU,FIFTYTWO? Today�s example is FIFTYTWO, PATIENT. PROVIDER,ELEVEN ordered the medication in May 2008. VEHU,FIFTYTWO flagged the order for PROVIDER,ELEVEN. What is NURSE,ONE suppose to do? HINT #1: Whew�Who�s Who in Idaho?

53. 53 Problem #10 A Nurse (NURSE,ONE) from Boise, Idaho calls just a �bit heated� to ask why he continually receives �Flagged� alerts from VEHU,FIFTYTWO? Today�s example is FIFTYTWO, PATIENT. PROVIDER,ELEVEN ordered the medication in May 2008. VEHU,FIFTYTWO flagged the order for PROVIDER,ELEVEN. What is NURSE,ONE suppose to do? HINT #1: Whew�Who�s Who in Idaho? HINT #2: Is it bakE time?

54. 54 Problem #10 A Nurse (NURSE,ONE) from Boise, Idaho calls just a �bit heated� to ask why he continually receives �Flagged� alerts from VEHU,FIFTYTWO? Today�s example is FIFTYTWO, PATIENT. PROVIDER,ELEVEN ordered the medication in May 2008. VEHU,FIFTYTWO flagged the order for PROVIDER,ELEVEN. What is NURSE,ONE suppose to do? HINT #1: Whew�Who�s Who in Idaho? HINT #2: Is it bakE time? HINT #3: Or is it Potato time?

55. 55 Solution #10 7 Set Provider Recipients for Notifications Notification: FLAG ORDER FOR CLARIFICATION// Value: PATOE <<<<< REMOVE the �E� E (Entering User): deliver notification to the user/provider who entered the order's most recent activity.

56. 56 Problem #11 You get another call from a pharmacist saying that when she was finishing a CIPROFLOXACIN TAB for SEVENTYFIVE,PATIENT she sees that there was an order check for a previous adverse reaction, but there is no override.

57. 57 Problem #11 You get another call from a pharmacist saying that when she was finishing a CIPROFLOXACIN TAB for SEVENTYFIVE,PATIENT she sees that there was an order check for a previous adverse reaction, but there is no override. HINT #1: DANGER, DANGER Will Robinson

58. 58 Problem #11 You get another call from a pharmacist saying that when she was finishing a CIPROFLOXACIN TAB for SEVENTYFIVE,PATIENT she sees that there was an order check for a previous adverse reaction, but there is no override. HINT #1: DANGER, DANGER Will Robinson HINT #2: Why would a justification be necessary? It must be of HIGH importance

59. 59 Problem #11 You get another call from a pharmacist saying that when she was finishing a CIPROFLOXACIN TAB for SEVENTYFIVE,PATIENT she sees that there was an order check for a previous adverse reaction, but there is no override. HINT #1: DANGER, DANGER Will Robinson HINT #2: Why would a justification be necessary? It must be of HIGH importance HINT #3: If the CLINICAL DANGER is high, a JUSTIFICATION you must apply.

60. 60 Solution #11 Only order checks that are considered HIGH require a justification The clinical danger level of the ALLERGY-DRUG REACTION order check was set to low at the SYSTEM level.

61. 61