OR3243 CPRS GUI V 27 Functional Training Medication

OR*3*243 CPRS GUI V 27 Functional Training Medication Order Changes BHIE VBECS All Other CPRS GUI Changes 9/17/2021 1

OR*3*243 (CPRS GUI v 27) Functionality CPRS GUI v 27 Functionality includes: Project Initiatives (6 projects) n Patient Safety Issues (47) n Remedy Tickets (100+) n Clear. Quest tickets deferred from v 26 to v 27 (approximately 200) n Total Clear. Quest ticket resolution (1040) n 508 Compliance Modifications (approximately 200) n 9/17/2021 2

Medication Order Changes 9/17/2021 3

Issues Covered n n Administration Times Changes to Infusion Order Dialog (PSI-05 - 065, PSI-06 -014, PSI-06 -045, PSI 06 -066) n n n Meds Tab Sorts Meds Tab Display Pending Renewals (PSI-06 -023) n n -026) n n n Schedule Type Provider/Pharmacy Hold Provider Comments (PSO-07 -057, PSI-07 -203) n n 9/17/2021 Day-Of-Week Schedule Builder Expected First Dose (PSI-05 Clozapine Orders Patient Safety Changes 4

Administration Times CPRS now displays administration times when writing inpatient medication orders in the unit dose and infusion order dialogs. 9/17/2021 5

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. 9/17/2021 6

Changes to Infusion Dialog Added IV Type selection field n Added Medication Route selection field n Added Schedule selection field n Added Give Additional Dose Now field n Added Infuse Over Time field n Added Administration Time display n Added Expected First Dose n 9/17/2021 7

New IV Medication Route Field 9/17/2021 8

New IV Medication Route Field 9/17/2021 9

New IV Medication Route Field 9/17/2021 10

Continuous IV Type 9/17/2021 11

Intermittent IV Type 9/17/2021 12

Meds Tab Sorts 9/17/2021 13

Meds Tab Display n n 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 the provider 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: 9/17/2021 14

Pending Renewals n n n 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: 9/17/2021 15

Day-Of-Week Schedule Builder 9/17/2021 16

Expected First Dose Modifications Inpatient meds will not display expected first dose for a schedule of One Time or On Call. n Inpatient meds will accept the schedule format days@schedule from CPRS (Tuesday@BID). n Expected first dose will not show if “Give Additional Dose Now” is checked. n 9/17/2021 17

Schedule Type n n n 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. 9/17/2021 18

Provider Comments n Potential of inappropriate or misleading provider comments automatically included on new medication. orders. PSI-07 -057 n n 9/17/2021 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. 19

Provider /Pharmacy Holds Provider held orders will expire when the stop date has passed. n A Pharmacy held order will expire when the stop date has passed. n Discontinued overrides expired so users are aware a medications has been affirmatively discontinued. n 9/17/2021 20

Clozapine Orders n Outpatient Clozapine orders Patients set up weekly are allowed 7 days supply no refills. n Patients set up biweekly are allowed 14 days, or 7 days and one refill. n Patients set up Monthly are allowed 28 days, 14 days and 1 refill, or 7 days and 3 refills. n 9/17/2021 21

Clozapine Orders n Days supply checks will be apply when writing a new Outpatient orders written from: n n n n 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 9/17/2021 22

Clozapine Orders n Inpatient Clozapine Orders done in CPRS: n n n 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: n n n 9/17/2021 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: 23

Clozapine Orders 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. 9/17/2021 24

Clozapine Orders 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. 9/17/2021 25

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. 9/17/2021 26

Patient Safety n n 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. 9/17/2021 27

Patient Safety CPRS Order Entry use of Synonym. (PSI-05 -116) Synonym text will appear at the top of each ordering dialog. n Synonyms will not appear in the order text. n 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. n n n 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) n 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. n The Give Additional Dose Now check box for delayed orders is now disabled/removed. 9/17/2021 28

Patient Safety n Order check overrides were not transmitted to the ancillary service (PSI-05 -103) A new message appears upon signature for order checks marked high. n n 9/17/2021 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]. 29

Pharmacy/Provider Flags PSI-06 -041 n n n 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: 9/17/2021 30

Patient Safety n Schedule Missing from Clinical Reports/pharmacy PSI -07 - 063 n 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 n Active IV n n 9/17/2021 31

VA/Do. D Bi-Directional Health Information Exchange (BHIE) REPORTS 9/17/2021 32

Simplified representation of the FHIE/BHIE architecture: The VA gets information from multiple Do. D sources while Do. D gets information from one source - VA Vista. 9/17/2021 33

BHIE Data Domain Do. D Data Source DMS S CHCS CDR▼ Allergy Information X X Consultation Reports X X Discharge Summaries X X Anatomic Pathology X X Cytology (New Source - Do. D CDR) X X Surgical Pathology (New Source - Do. D CDR) X X Chemistry Reports X X X Hematology X X X Microbiology X Laboratory Orders X X Outpatient Pharmacy X X Outpatient Visits X X Radiology Text Reports X X X Post Deployment Health Reassessments X X Inpatient Progress Notes X X Standard Ambulatory Data Record X Admission, Discharge and Transfer X Non-Government Medications (e. g. CVS, Walgreen's) 9/17/2021 This chart details the source of data available to VA via CPRS RDV and Vista. Web. Items in blue are new in CPRS GUI V 27 (i. e. blue indicates which source (Do. D CDR) and information domains (APs and Vitals) that are added or updated in CPRS GUI V 27 and related BHIE Release 3 a) X X Outpatient Progress Notes Vital Signs (New w/CPRS GUI V 27) PDTS X X X TMDS X Pre/Post Deployment Health Assessments Problem Lists CIS X X 34

CPRS V 26 9/17/2021 CPRS V 27 adds Vital Signs to the Do. D Data Tree in RDV CPRS V 27 presents Do. D remote data only – no longer contains local or other VA data 35

CPRS V 27 Clinical Reports “Anatomic Pathologies” present local and other VA remote data only – no longer contains Do. D remote data 9/17/2021 36

In Summary – CPRS V 27 changes to assist VA/Do. D sharing include: 1. The addition of Vital Signs to the Do. D tree of Remote Data Views 2. The addition of the Do. D CDR (Clinical Data Repository) as a data source for Vital Signs, Surgical Pathology and Cytology reports 3. CPRS V 27 presents Do. D remote data only for Surgical Pathology and Cytology reports in the Do. D tree of Remote Data Views – no longer contains local or other VA data 4. CPRS V 27 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 Do. D data 9/17/2021 37

VBECS/CPRS Comprehensive CPRS/VBECS Functional Training will be provided when VBECS is nationally released in the fall of 2008. n There are three CPRS GUI v 27 VBECS test sites: n Philadelphia (March 29, 2008) n Heartland-East (July 19, 2008) n San Diego (August 9, 2008) n 9/17/2021 38

All Other CPRS GUI v 27 Changes n n n 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 n n n n 9/17/2021 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 39

SECTION 508 CHANGES Huge effort has been made in CPRS GUI v 27 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. n Many font issues addressed. n Many Keyboard navigation issues addressed. n Alternate color scheme support added. n Other miscellaneous 508 changes. n 9/17/2021 40

ALERTS REASON FOR FLAG to Display When Processing Flagged Order Alert 9/17/2021 41

ALERTS Flagged Order Alert Processing 9/17/2021 42

ALERTS Improved Surrogate Validation and Forwarded Comments Button 9/17/2021 43

ALERTS Remedy #215189, NSOC ticket #VA 08853 - Sensitive record check bypassed when using CPRS GUI to process alerts. This has never worked correctly, but is now fixed in v 27. There are 2 known issues remaining, both only when an alert can't be processed at all because viewing that patient is denied: n n 9/17/2021 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. 44

ALERTS Make Anatomic Pathology, Pap Smear, Mammogram Notifications Action Alerts 9/17/2021 PSI-05 -001/PSI-06 -068/PSI-06 -134/PSI-07 -14/PSI-07 -031 45

TEAM LISTS Personal Team Lists Exclusions from GUI Applications 9/17/2021 46

ALLERGIES Remove Default for Value for Observed/Historical (E 3 R 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. n 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. n 9/17/2021 47

ALLERGIES Users Can No Longer Change the “Originator” n n 9/17/2021 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. 48

ALLERGIES Cannot Add the New Allergy Entry/Edit Dialog to the Write Orders List (Remedy #189377) n 9/17/2021 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. 49

Clinical Reminder Enhancements & Mental Health Assistant YS*5. 01*85 PXRM*2. 0*6 GMTS *2. 7*77 Nationally Released January 7, 2008 9/17/2021 50

MHA dll-- YS_MHA. dll n n n Distributed with patch YS*5. 01*85 Must be placed in Common Folder, same location as vitals dll Will be utilized in CPRS v 27 for reminders to present MHA instruments in reminder dialogs Enhances functionality of MH Instruments used in Reminder Dialogs Users need option YS BROKER 1 to be able to use MHA instruments in reminder dialogs with CPRS v 27 Instruments with free text responses can only be used in reminder dialogs once the dll is activated n n 9/17/2021 BOMC, TBI 2 nd level evaluation 51

New YS Option YS Broker 1 n This needs to be assigned as a secondary menu option to users who will do the following n Process MH tests in the new MHA 3 executable n Have access to reminder dialogs in CPRS n 9/17/2021 Consider the same as the OR CPRS GUI CHART option 52

Use of MH DLL Parameter n n OR USE MH DLL is a new parameter that is set to “Y” when CPRS 27 is installed. This is a system level parameter This parameter determines if CPRS should try to use the MH DLL when processing a MH Test from a Reminder Dialog. This parameter can be set to No to have CPRS default to processing the MH test the old way 9/17/2021 53

Changes to Reminder Dialogs Result groups must point to a MH test and a valid scale for the MH test n Multiple result groups can be used for a MH test (CPRS 27 and MH DLL) n Informational pop-up message with result elements (CPRS 27 and MH DLL) n MH test required functionality has been changed (CPRS 27) n 9/17/2021 54

Pop-Up Informational Text NAME: PXRM PHQ 2 RESULT ELEMENT 2 RESULT CONDITION: I SCORE>2// PROGRESS NOTE TEXT: A PHQ-2 screen was performed. The score was |SCORE| which is a positive screen for depression. INFORMATIONAL MESSAGE TEXT: The PHQ-2 is positive. A PHQ-9 and also a suicide risk evaluation should be performed for any positive PHQ-2. 9/17/2021 55

Informational Pop-up with patches and CPRS v 27 9/17/2021 56

Reminder Dialog Changes seen with CPRS v 27 MHA dll can be used (can also be disabled) n With CPRS 27 and MH dll active n Progress note text has no extra instruction text n Can use the new features in dialogs n n Pop up informational message for MH tests, MH test required, require all elements in a group 9/17/2021 57

PHQ-9 with patches and v 27 with dll 9/17/2021 58

Conflict between encounter location and inpatient location n Scenarios Patient is an inpatient and is being seen at an outpatient location n Patient is admitted while being seen at an outpatient location and the provider is in CPRS. n 9/17/2021 59

Conflict between encounter location and inpatient location n Old Forms in CPRS 26 n Non-IMO location n IMO location 9/17/2021 60

Conflict between encounter location and inpatient location n Changes for CPRS 27 Standard form for both IMO and Non-IMO clinics. n Allows location to be assigned to individual orders. n Allows provider to determine encounter location when refreshing the chart instead of CPRS automatically going back to the inpatient location. n 9/17/2021 61

Conflict between encounter location and inpatient location 9/17/2021 62

Conflict between encounter location and inpatient location 9/17/2021 63

Conflict between encounter location and inpatient location 9/17/2021 64

CONSULTS Add/Remove buttons have been added to the Consult Actions Send Alert Dialog 9/17/2021 65

Consults Complete Consults without Viewing Reason for Request 9/17/2021 PSI-04 -012 (Part 4): 66

CONSULTS Direct Edit or Skip Reason for Request Field When Using Templates 9/17/2021 67

CONSULTS Alert Changes Consults Alert Changes (Remedy #151414) When sending alerts on addition of a comment to a consult request, no distinction was made between service update users defined at the service level and update users defined as “unrestricted access” for that service. Alerts were being sent incorrectly or not sent at all as a result of this. n Resolution: CPRS developers made the necessary changes to support patch GMRC*3. 0*55 n PSI-06 -088 9/17/2021 68

CONSULTS Alert Changes (cont) n n n When a user takes an action on a consult that generates an alert, that individual should not receive the alert. If an ordering provider, that is a member of a consult team, takes an action on a consult, the alert should be sent to the consult team and not to the ordering provider. If an unrestricted access user, that is not the ordering provider or a member of the consult team, acts on a consult, the alert should be sent to both the consult team and the ordering provider. PSI-06 -088 9/17/2021 69

CONSULTS Text Wrapping Problem in Consult/Procedure Reason for Request n n 9/17/2021 When a user entered a consult or procedure, the text for the consult/procedure Reason for Request was correctly wrapping at 74 characters, as required to maintain List Manager and File Manager editor compatibility, but hard returns were being inappropriately inserted. This caused the text to break up and have a choppy appearance when saved. Resolution: Developers corrected the problem so that the text correctly flows into paragraphs that are still 74 characters wide. 70

CURRENT ACTIVITIES Focus defaults to the “Encounter Provider” list box Modified to default to the Encounter provider when user is a non-provider. PSI 07 -025 9/17/2021 71

CURRENT ACTIVITIES Additional click in the Visit Location field no longer required. 9/17/2021 72

DATE/TIME SELECTION Users Can Select an Invalid Time (Remedy #153432) n n 9/17/2021 From the CPRS date/time chooser dialog, the user can choose 00: 00 from the time columns. Since it’s unclear what that means in terms of a date, CPRS currently changes it to 00: 01. (Similarly, clicking “midnight” enters a time of 23: 59. ) But then, back on whatever form called this dialog, those seconds are stripped from the time, leaving the time at 00: 00, and that’s the time that gets used. Resolution: Developers changed CPRS so that selecting an hour of “ 00” will cause the minutes of “ 00” to change to “ 01”, making the selection of a “ 00: 00” time impossible. Typing in a “ 00: 00” will result in a value of "00: 01" being returned to the calling date box when OK is selected. 73

DISCHARGE SUMMARY Discharge Summary attending physicians now respect user classes 9/17/2021 74

LABS TAB Most Recent Labs/Worksheet Caption on the Most Recent Labs Shows 00: 00 when No Time Is Entered (Remedy #123277) n n For the caption on the Labs tab for the “Most Recent Labs” grid and Worksheet, if a lab result had a date but no associated specific time, CPRS was displaying “ 00: 00” if no time was present for those results. Resolution: If no specific time is entered (“T@U” for an unknown time), CPRS will display only the date. This change applies to the Most Recent Labs and Worksheet views. PSI-05 -118 9/17/2021 75

NOTES User Able to Add Disallowed Author or Cosigner n n 9/17/2021 On the “additional signers” screen, when a user clicked on the selection list for either the current author or cosigner, or for an already selected additional signer, CPRS correctly displayed an error message that the selection was not allowed. However, if the user then clicked the “Add” button immediately after the error message, CPRS would still add the disallowed selection to the list. Resolution: Developers corrected this problem; CPRS will not add the inappropriate selection. 76

Radiology Orders • Added Reason for Study field • Removed default value for Desired Date Default field (E 3 R 19834) 9/17/2021 77

ORDERS Lab Collect vs. Ward Collect System changes the order from lab collect to ward collect Previously, for inpatient lab orders that are of type “lab collect” or “immediate collect”, if a continuous schedule was selected (such as QD or QWEEKLY) and a child order falls on a day when the lab cannot perform the collection (for example, weekends or holidays), the collection type was automatically changed to “ward collect” but CPRS did not warn to the user. n Resolution: Developers added an advisory window that initially appears when the user selects “Accept” for that order, advising of any such changes to child orders. If these orders are left unsigned, the same advisory window will also appear at the point when they are signed or PSI-05 -048 released at some future date. n 9/17/2021 78

Cancelled on Discharge from Observation Delayed Orders Entered for Transfer to Surgery Cancelled on Discharge from Observation (Remedy #180390, E 3 R #20065) n When an inpatient was in a ward with an observation treating specialty and the patient was transferred, the delayed orders were inappropriately cancelled. n Resolution: Developers changed CPRS so that transfer events will no longer be selectable from the delayed orders event selection list for patients in an observation treating specialty. PSI-07 -046 9/17/2021 79

IV / Infusion Orders n GUI v 27 IV/Infusion order changes will result in: All orders finished as ‘IV’ in Inpatient Medications will now be displayed in the Infusion display group n These orders will be edited using the Infusion dialog n Must be marked as ‘USED IN IV FLUID ORDER ENTRY’ as YES. n 9/17/2021 80

IV / Infusion Orders File 52. 6 – IV ADDITIVES n File 52. 7 – IV SOLUTIONS n If these items are not marked as YES, then an attempt to CHANGE, RENEW, etc. in CPRS will result in the following error box: n 9/17/2021 81

IV / Infusion Orders 9/17/2021 82

IV / Infusion Orders n To update the IV Solutions file: Select OPTION NAME: PSSJI SOLN PRimary Solution File (IV) Select IV SOLUTIONS PRINT NAME: DEXTROSE 10% 500 ML NATL FORM; 500 ML SOLN IN 1000 ML BAG PRINT NAME: DEXTROSE 10%// PRINT NAME {2}: GENERIC DRUG: DEXTROSE 70% 500 ML IN 1000 ML BAG// VOLUME: 500 ML// Select ELECTROLYTES: Select SYNONYM: D 10 W// DRUG INFORMATION: No existing text Edit? NO// AVERAGE DRUG COST: 7. 45// INACTIVATION DATE: JUN 21, 1989// USED IN IV FLUID ORDER ENTRY: NO// This prompt should be evaluated and set to YES if the entry is used as an IV Solution. 9/17/2021 83

IV / Infusion Orders n To update the IV Additives file: Select OPTION NAME: PSSJI DRUG 1 PSSJI DRUG ADditives File 2 PSSJI DRUG INQUIRY Drug Inquiry (IV) CHOOSE 1 -2: 1 PSSJI DRUG ADditives File Select IV ADDITIVES PRINT NAME: DEXDEXAMETHASONE NATL FORM (NDC) PRINT NAME: DEXAMETHASONE// GENERIC DRUG: DEXAMETHASONE 4 MG/ML 1 ML INJ// USED IN IV FLUID ORDER ENTRY: YES// This prompt should be evaluated and set to YES if the entry is used as an IV Additive. 9/17/2021 84

Order Checks n n Order Check Override Text Not Transmitted to Ancillary Services (PSI-05 -103) Order checking screen (dialog) can now be resized. A "Return to Orders" button was added. Pressing the button does not cancel the order, only the signature process Extra informative text above the critical order check justification was added 9/17/2021 85

ORDER CHECKS 9/17/2021 86

Accidental Signing of Old Orders in CPRS. The review/sign order form will be changed to group orders together by the current session, previous session and by all other user orders written in a previous session. PSI-05 -106 9/17/2021 87

Accidental Signing of Old Orders n n When canceling orders that are unsigned, orders that are canceled outside of the session will no longer be deleted but actually canceled and retained. Old unsigned orders will now be lapsed based on the OR LAPSE ORDERS and OR LAPSE ORDERS DFLT parameter values. A nightly task job will flag lapsed orders. Option OR LAPSED ORDERS will be added under the OR PARAM COORDINATOR MENU. This is a utility to pull up reports on orders that have been lapsed due to provider’s failure to sign the order before the lapse period expires. PSI-05 -106 9/17/2021 88

ORDERS REASON FOR FLAG Field Changed from Free-Text to Drop-Down List with Free-text Allowed n 9/17/2021 Resolution: When a user flags an order, the REASON FOR FLAG field has been changed from a free-text entry to a selection of standard reasons defined by the site in parameter (OR FLAGGED ORD REASONS). Users can append additional free-text to the selected reason, or enter a free-text reason of their own instead of selecting from the list. The field limit is 80 characters. 89

ORDERS Duplicate Personal Quick Order Names It was possible for a user to enter a new personal quick order name that is a duplicate of an existing quick order name in the same display group type. n Resolution: Developers corrected this problem. Users can no longer enter a duplicated quick order name for a quick order in the same display group type. CPRS will also prohibit renaming an existing personal quick order to a name that matches an existing entry, regardless of upper/lower case. n 9/17/2021 90

ORDERS Dietetics Sequence Problem with Delayed NPO at Midnight and Other Diet Orders n n n For inpatient delayed diet orders, if an “NPO at Midnight” were ordered, followed by any other diet with a start date prior to midnight and no expiration date, the NPO order will be discontinued on release and replaced by the second order. If placed in the reverse sequence, both orders are released correctly and remain in effect. Resolution: User is now prompted about the possible conflict, and instructed on how to prevent it from happening by entering explicit start and stop date/times for any diet orders defined for that same release event. Developers also added code to check for auto-accept diet quick orders, immediate and delayed, that would auto-DC because of overlapping start/stop times. For event-delayed, auto-accept diet quick orders, CPRS checks for conflicting orders for the same release event, and if the user answers NO to the prompt about having adjusted the start/stop dates, CPRS displays the diet order dialog with that quick order pre-loaded so date adjustments can be made. PSI-07 -212 9/17/2021 91

ORDERS Original Verbal Orders Signature Problem n A verbal order is entered by a nurse and the receiving service makes a service correction and fills the order. Because of this the ordering provider is not getting a chance to sign anything related to the order because of the service correction. Resolution n The original verbal order will stay in need of a signature despite the service correction and will show on the ordering provider's unsigned orders list. 9/17/2021 92

PATIENT INQUIRY Patient Demographic Updates n 2 nd Next of Kin (NOK) n n Patient cell phone number n 9/17/2021 as additional emergency contact information to facilitate more timely appointment rescheduling 93

PATIENT RECORD FLAGS Date, author, etc. . can now be changed from a PRF note title. 9/17/2021 94

PATIENT RECORD FLAGS Category I Flags stand out from Category II flags. 9/17/2021 95

PATIENT SELECTION n Provider selecting wrong patient with same first/last name n Remove highlight of the first entry in a possible list of patient names PSI-04 -057 9/17/2021 96

Project 112/SHAD Added a checkbox to the Visit Type tab n Added checkbox to encounters, orders and problems n 9/17/2021 97

Review/Sign Changes 9/17/2021 Project 112/SHAD 98

REPORTS Viewing Multiple Anatomic Pathology Reports 9/17/2021 PSI-05 -027 and PSI-07 -135 99

REPORTS Viewing Multiple Anatomic Pathology Reports PSI-05 -027 and PSI-07 -135 9/17/2021 100

REPORTS Viewing Multiple Anatomic Pathology Reports Resolution: EM Report n --Electron Microscopy report format changed from a text only report to a grid type display. PSI-05 -027 and PSI-07 -135 9/17/2021 101

REPORTS Viewing Multiple Anatomic Pathology Reports PSI-05 -027 and PSI-07 -135 9/17/2021 102

REPORTS Remote Data Displays Do. D Data do not display in Remote Health Summaries, even when data are available (and viewable via Do. D tree or Clinical Reports) n PROBLEM: When using the CPRS Reports tab, if a patient has Remote DOD data available and the user attempts to retrieve a Health Summary report via the DOD tab (with Dept. of Defense checked in the Remote Data button), the report does not populate. PSI-06 -104 9/17/2021 103

REPORTS Remote Data Displays n This has been resolved by providing ‘cognitive’ information when data is excluded on a report query. For text reports only, a comment, showing the problem is added where the report would normally be. For ‘grid’ type reports, the error comment is put in the first column (after the facility name) of the report. Here are some examples of the comments that could show up, depending on the type of query and what the user has selected: PSI-06 -104 9/17/2021 104

REPORTS Remote Data Displays Resolution Error Messages n <No HDR Data Included> - Use "HDR Reports" menu for HDR Data. n <No HDR Data> This site is not a source for HDR Data. n <No DOD Data> - Use "Dept. of Defense Reports" Menu to retrieve data from DOD. n <ERROR>- Unable to communicate with Remote site PSI-06 -104 9/17/2021 105

REPORTS Remote Data Displays Resolution: Error Message on Blue Button n In addition to this text, error messages will also be shown after each remote site listed under the (blue) Remote Data View button, when appropriate. PSI-06 -104 9/17/2021 106

REMOTE Data Displays Resolution: OE/RR Reports File n Additional data has been added to the OE/RR REPORTS file (#101. 24) to resolve this problem, which means that this file will be re-exported, with data, in patch OR*3. 0*243. As part of the pre-init process, entries in this file with internal numbers greater than 999 will be deleted and re-installed. This is a pretty common occurrence with all releases of the CPRS GUI. PSI-06 -104 9/17/2021 107

REPORTS Remote Data Displays--HDR Data PSI-06 -104 9/17/2021 108

REPORTS Remote Data Displays--HDR Data PSI-06 -104 9/17/2021 109

REPORTS Remote Data Displays--Do. D Data PSI-06 -104 9/17/2021 110

REPORTS Remote Data Displays—Error Messages PSI-06 -104 9/17/2021 111

CPRS v 27 RDV changes 9/17/2021 112

Additional Information Links to CPRS GUI v 27 website n n n Installation Instructions Test Scripts Training Presentations and other Training Materials Spreadsheet of Resolved Remedy Tickets Test Sites and Points of Contact Functional Item Spreadsheet http: //vista. med. va. gov/CPRS/html/v 27_test_site_page. html#training 9/17/2021 113

QUESTIONS 9/17/2021 114