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

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 HEALTH 2    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS 3    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by an EMPLOYEE HEALTH 4    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE EDITED by a CHIEF, MIS 5    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by an EMPLOYEE HEALTH 6    An UNSIGNED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE SIGNED by a CHIEF, MIS 7    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by an EMPLOYEE HEALTH 8    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE VIEWED by a CHIEF, MIS 9    A COMPLETED (DOCUMENT CLASS) EMPLOYEE HEALTH may BE PRINTED by an EMPLOYEE HEALTH 10   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.

Available Providers List 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.

Improper Terminations 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.

IHS Demo Patients Statement IHS contention for identifying "demo patients" in the Demo database is as follows: Demo, Patient Father Demo, Patient John Demo, Patient Gillian

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. If you leave it flagged on the order tab will it stay there or is it cleared with the same parameter? 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 program Enter 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.

Visit Updating Problem 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

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.

Host with Multiple Databases 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.

RPMS - EHR v1.1 Techie Class Conclusion Really Powerful at Measuring Stuff