Pharmacy Issues
This page will contain notes to work out pharmacy programming issues.
Initiated by K. Toppenberg 4/2005
Contents
- 1 Keys Needed for Pharm. Setup
- 2 Files and Relationships
- 3 Example of Data
- 4 Example Entry
- 5 Other Important Pharmacy Files and Relationships
- 6 Steps to Adding One Drug / Making Available in CPRS
- 7 Relevent Menu Options
- 8 Emails Regarding Adding Drugs
- 9 Instructions for entering a drug through menus
- 10 RPC Calls
- 11 Completion of CPRS drug orders
- 12 HUI Prescription Auto-Finishing
Keys Needed for Pharm. Setup
We searched pharmacy routines and found keys that were needed for some of the pharmacy setup routines. Here are the keys that were found: PSA ORDERS, PSAMGR, PSJ RPWARN, PSB MANAGER, PSB CPRS MED BUTTON, PSB INSTRUCTOR, PROVIDER, PSD TECH, PSDMGR, PSD BUMGR, PSD ERROR, PSD PARAM, PSD TRAN
Files and Relationships
- VA PRODUCT file (file #50.68, ^PSNDF(50.68,*)) holds ALL possible drugs. Some people refer to this as the National Drug File. File Info: 50dot68
- VA GENERIC file (file #50.6, ^PSNDF(50.6))
- DRUG file (file #50, ^PSDRUG(*)) holds all the drugs in the local formulary. This links to above. File Info: 50
- PHARMACY ORDERABLE ITEM file (file #50.7, ^PS(50.7,*)) holds things that can be ordered from the pharmacy. This links to above. File Info 50dot7
- ORDERABLE ITEM file (file #101.43, ^ORD(101.43,*)) holds things that can be ordered, including labs and drugs. This links to above. File Info 101dot43
- ORDER QUICK VIEW file (file #101.44, ^ORD(101.44,*)) holds "quick order" entries. This links to above. File Info 101dot44
- PENDING OUTPATIENT ORDERS file (file #52.41, ^PS(52.41,*)) holds prescription requests entries, to be approved by pharmacist File Info 52dot41
- PRESCRIPTION FILE file (file #52, ^PSRX(*)) holds prescriptions File Info 52
Summary of Pharmacy File Linkages
What I Have Learned so Far
1. File 50.7 (PHARMACY ORDERABLE ITEM):
**A record in this file should be created first.
.01 field should be the generic name of the drug.
When the record is created, an entry in fle 101.43 (ORDERABLE ITEM) will automatically be made.
Also, a record in in ORDER QUICK VIEW will also be created (but it is incomplete--see below.)
Note: new drugs may not be added unless PSEDITNM>0. So to setup a drug in fileman,
set PSEDITNM=1 from the command-line, then DO D^DI to get into Fileman with vars intact.
In the MED ROUTE field, the input transform does not allow an input of "ORAL". (If left
blank ORAL will be shown in CPRS)
This file can hold the synonyms of a drug etc.
When this record is created, for some reason it is automatically given the current
date in the INACTIVE DATE field--meaning it is created in an inactive state. One must
go back and edit the record a second time to remove the entry from this field.
File 101.43 (ORDERABLE ITEM), field ID holds a text pointer to this file, e.g.
"10;99PSP" <---- 10 is IEN in file #50.7
There is no pointer field from file 50.7 up to file 50. The link is FROM file #50
TO #50.7 (via file #50's field 2.1(PHARMACY ORDERABLE ITEM)). HOWEVER, File #50's
"ASP" cross-reference for the field "PHARMACY ORDERABLE ITEM (#2.1) i.e.
^PSDRUG("ASP",IEN_in_50.7,*), contains list of linked records in file #50
2. In file# 50 (DRUG, ^PSDRUG):
This file will hold a separate record for every different medication/tablet size. For example, there will be one for AMOXICILLIN 250, and another for AMOXICILLIN 500. Both of the above records would be linked to one record in the PHARMACY ORDERABLE ITEM, i.e. an AMOXICILLIN record. The link should be in field 2.1 (the PHARMACY ORDERABLE ITEM field), which will hold a pointer to file 50.7 (PHARMACY ORDERABLE ITEM file)
3. In file 101.43 (ORDERABLE ITEM) an entry for the drug must exist like this:
This entry should have been made automatically when the PHARMACY ORDERABLE ITEM was
created.
file 101.43
record: .01 NAME = LISINOPRIL
2 ID = "Unique identifier, created from primary key passed in the
Orderable Items update message from each package; it will be
in the form of 'package code;99XXX' where XXX indicates the
package table originating this item (i.e. RAP,LRT,etc.)
[e.g. in my system, then entry for DILTIAZEM TAB is 1;99PSP]
"Package code" should be the IEN on the PHARMACY ORDERABLE ITEM (#50.7)
4. 101.44 (ORDER QUICK VIEW) For meds to show up in the dialog box in CPRS, it must have a entry like this:
Again, this entry should have been created automatically when the PHARMACY ORDERABLE ITEM was created. But for some reason, the DISPLAY TEXT field is not filled in. Without this, the drug will not appear in CPRS. So this must be manually supplied.
file: 101.44 (ORDER QUICK VIEW);
record: ORWDSET O RX;
subfile: SET MEMBER (101.442)
record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM) ... a drug would go here
DISPLAY TEXT: "A name to appear in CPRS appears here.
record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM) ... a drug would go here
DISPLAY TEXT: "A name to appear in CPRS appears here.
record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM) ... a drug would go here
DISPLAY TEXT: "A name to appear in CPRS appears here.
record: SET MEMBER: _IEN_ pointer to 101.43 (ORDERABLE ITEM) ... a drug would go here
DISPLAY TEXT: "A name to appear in CPRS appears here.
Example of Data
File 101.44 (ORDER QUICK VIEW)
.01-NAME : ORWDSET O RX
6-LAST UPDATE : 60414,61441
20-SET MEMBER :
-snip-
Multiple Entry #15 <--- notice that there are no doses
.01-SET MEMBER : SILDENAFIL TAB <-- pointer to 101.43
2-DISPLAY TEXT : SILDENAFIL TAB
-snip-
Multiple Entry #17 <--- notice that there are no doses
.01-SET MEMBER : SILDENAFIL TAB <-- pointer to 101.43
2-DISPLAY TEXT : VIAGRA <SILDENAFIL TAB>
-snip-
||
||
\/
File 101.43 (ORDERABLE ITEM)
.01-NAME : SILDENAFIL TAB
1-SYNONYMS :
Multiple Entry #1
.01-SYNONYM : VIAGRA
1.1-PACKAGE NAME : SILDENAFIL TAB
2-ID : 4;99PSP <--- pointer to IEN=4 in 50.7
5-DISPLAY GROUP : PHARMACY
9-SET MEMBERSHIP :
Multiple Entry #1
.01-SET : RX
-snip-
||
||
\/
File 50.7 (PHARMACY ORDERABLE ITEM)
.01-NAME : SILDENAFIL
.02-DOSAGE FORM : TAB
.05-DAY (nD) or DOSE (nL) LIMIT : 2L
.07-SCHEDULE TYPE : FILL ON REQUEST
2-SYNONYM :
Multiple Entry #1
.01-SYNONYM : VIAGRA <-- free text
7-PATIENT INSTRUCTIONS : [Do not take with nitroglycerin]
||
||
\/
ASP index in file 50 allows link from 50.7 --> 50
^PSDRUG("ASP",4,7118) = IEN# 4 in 50.7 --> IEN# 7118 in 50
||
||
\/
File 50 (DRUG file) (some noncontributory fields edited)
.001-NUMBER : 7118
.01-GENERIC NAME : SILDENAFIL (Viagra) 50MG TAB
2.1-PHARMACY ORDERABLE ITEM : SILDENAFIL
9-SYNONYM :
Multiple Entry #2
.01-SYNONYM : VIAGRA
1-INTENDED USE : TRADE NAME
14.5-DISPENSE UNIT : TAB
20-NATIONAL DRUG FILE ENTRY : SILDENAFIL
21-VA PRODUCT NAME : SILDENAFIL CITRATE 50MG TAB
22-PSNDF VA PRODUCT NAME ENTRY : SILDENAFIL CITRATE 50MG TAB
101-MESSAGE : Use for 25mg dose only
215-QUANTITY DISPENSE MESSAGE : MAX 4 DOSE/MO-CONTRAINDICATED WITH NITRATES
901-STRENGTH : 50
902-UNIT : MG
903-POSSIBLE DOSAGES :
Multiple Entry #1
.01-DISPENSE UNITS PER DOSE : 1
2-PACKAGE : IO
Multiple Entry #2
.01-DISPENSE UNITS PER DOSE : .5
2-PACKAGE : O
Multiple Entry #3
.01-DISPENSE UNITS PER DOSE : 1
1-DOSE : 50
2-PACKAGE : IO
Multiple Entry #4
.01-DISPENSE UNITS PER DOSE : 2
1-DOSE : 100
2-PACKAGE : IO
Example Entry
Here is an example of entering the drug the "proper" way, via menu options: Drug Entry Edit Example
Here is a sample inquirery of one successfuly added drug: furosemide (NOTICE: in this system, there is only 1 orderable drug from CPRS)
OUTPUT FROM WHAT FILE: NEW PERSON// 50.7 PHARMACY ORDERABLE ITEM
(1 entry)
(NOTE: reformatted for easier reading)
Select PHARMACY ORDERABLE ITEM NAME: ?
Answer with PHARMACY ORDERABLE ITEM NAME, or SYNONYM, or OI-DRUG TEXT ENTRY:
FUROSEMIDE FUROSEMIDE TAB
Select PHARMACY ORDERABLE ITEM NAME: furOSEMIDE TAB
ANOTHER ONE:
STANDARD CAPTIONED OUTPUT? Yes// (Yes)
Include COMPUTED fields: (N/Y/R/B): NO// b BOTH Computed Fields and Record Number (IEN)
NUMBER: 1
NAME: FUROSEMIDE
SYNONYM: LASIX
DOSAGE FORM: TAB
Select PHARMACY ORDERABLE ITEM NAME:
OUTPUT FROM WHAT FILE: 101.43 ORDERABLE ITEMS//
(NOTE: reformatted for easier reading)
Select ORDERABLE ITEMS NAME: furose
1 FUROSEMIDE
2 FUROSEMIDE TAB
CHOOSE 1-2: 1 FUROSEMIDE
ANOTHER ONE: furo
1 FUROSEMIDE
2 FUROSEMIDE TAB
CHOOSE 1-2: 2 FUROSEMIDE TAB
ANOTHER ONE:
STANDARD CAPTIONED OUTPUT? Yes// (Yes)
Include COMPUTED fields: (N/Y/R/B): NO// b BOTH Computed Fields and Record Number (IEN)
NUMBER: 774
NAME: FUROSEMIDE
ID: 828;99LRT
DISPLAY GROUP: LABORATORY
PACKAGE NAME: FUROSEMIDE
SYNONYM: LASIX
SET: LAB
TYPE: both
NUMBER: 1659
NAME: FUROSEMIDE TAB
ID: 1;99PSP <---- x;99PSP x=IEN in file# 50.7 (PHARMACY ORDERABLE ITEM)
DISPLAY GROUP: PHARMACY
PACKAGE NAME: FUROSEMIDE TAB
SET: RX
SET: UD RX
SET: O RX
INPATIENT MED: YES
OUTPATIENT MED: YES
IV BASE: NO
IV ADDITIVE: NO
SUPPLY: NO
NON-FORMULARY: NO
NON-VA MEDS: NO
Select ORDERABLE ITEMS NAME:
OUTPUT FROM WHAT FILE: 101.44 ORDER QUICK VIEW
(2 entries)
(NOTE: reformatted for easier reading)
Select ORDER QUICK VIEW NAME: ?
Answer with ORDER QUICK VIEW NAME
Choose from:
ORWDQ PKG35 DO
ORWDSET O RX
Select ORDER QUICK VIEW NAME: orwdset O RX
ANOTHER ONE:
STANDARD CAPTIONED OUTPUT? Yes// (Yes)
Include COMPUTED fields: (N/Y/R/B): NO// b BOTH Computed Fields and Record Number (IEN)
NUMBER: 2
NAME: ORWDSET O RX
LAST UPDATE: 60201,74282
SET MEMBER: FUROSEMIDE TAB
DISPLAY TEXT: FUROSEMIDE TAB
Select ORDER QUICK VIEW NAME:
Other Important Pharmacy Files and Relationships
Steps to Adding One Drug / Making Available in CPRS
GTM>set PSEDITNM=1
GTM>D D^DI
VA FileMan 22.0
Select OPTION: enter OR EDIT FILE ENTRIES
INPUT TO WHAT FILE: DRUG// 50.7 PHARMACY ORDERABLE ITEM
(3 entries)
EDIT WHICH FIELD: ALL//
Select PHARMACY ORDERABLE ITEM NAME: VIAGRA
Are you adding 'VIAGRA' as a new PHARMACY ORDERABLE ITEM (the 4TH)? No// Y
(Yes)
PHARMACY ORDERABLE ITEM DOSAGE FORM: tab
1 TAB
2 TAB,BUCC,SA
3 TAB,BUCCAL
4 TAB,CHEWABLE
5 TAB,CHEWG GUM
Press <RETURN> to see more, '^' to exit this list, OR
CHOOSE 1-5: 1 TAB
PHARMACY ORDERABLE ITEM INACTIVE DATE:
DOSAGE FORM: TAB// (No Editing)
IV FLAG:
INACTIVE DATE:
DAY (nD) or DOSE (nL) LIMIT: ??
Type a whole number between 0 and 99, 0 decimal digits, followed by either
a "D" (for NUMBER OF DAYS) or an "L" (for DOSE LIMIT).
DAY (nD) or DOSE (nL) LIMIT: 2L
MED ROUTE:
SCHEDULE TYPE: r FILL ON REQUEST
SCHEDULE:
SUPPLY:
Select SYNONYM: VIAGRA
Are you adding 'VIAGRA' as a new SYNONYM (the 1ST for this PHARMACY ORDERABLE ITEM)? No// Y (Yes)
Select SYNONYM:
Select OI-DRUG TEXT ENTRY:
PATIENT INSTRUCTIONS: [Do not take with nitroglycerin]
[Do not take with nitroglycerin]
OTHER LANGUAGE INSTRUCTIONS:
NON-VA MED:
Select PHARMACY ORDERABLE ITEM NAME:
Select OPTION:
Note: You have to go back and edit the INACTIVE DATE, and delete the value.
Now create link from #50, field 2.1 --> 50.7
Select OPTION: eNTER OR EDIT FILE ENTRIES INPUT TO WHAT FILE: DRUG// 50 DRUG (5173 entries) EDIT WHICH FIELD: ALL// pharmACY ORDERABLE ITEM THEN EDIT FIELD: Select DRUG GENERIC NAME: viagra 1 VIAGRA SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only 2 VIAGRA SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED CHOOSE 1-2: 1 SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only PHARMACY ORDERABLE ITEM: viagra TAB 04-25-2005 <--- Date is an INACTIVE data. Delete value in 50.7 Select DRUG GENERIC NAME: viag 1 VIAGRA SILDENAFIL (Viagra) 50MG TAB GU900 Use for 25mg dose only 2 VIAGRA SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED CHOOSE 1-2: 2 SILDENAFIL (Viagra) 100MG TAB GU900 ONLY 4 DOSES PER MONTH ALLOWED PHARMACY ORDERABLE ITEM: viagra TAB 04-25-2005 <--- Date is an INACTIVE data. Delete value in 50.7 Select DRUG GENERIC NAME: Select OPTION:
... to be continued later.....
Relevent Menu Options
Here is a pharmacy option/menu setup I gathered:
ADD Drug Enter/Edit [PSS DRUG ENTER/EDIT]
cv Protocol Conversion Utilities ... [ORCM CONVERSION UTILITIES]
EOI Edit Orderable Items [PSS EDIT ORDERABLE ITEMS]
Mgr Pharmacy Data Management ... [PSS MGR]
NDF National Drug File Menu ... [PSNMGR]
Out Outpatient Pharmacy Manager ... [PSO MANAGER]
xxx Enter/Edit a Drug [PSA DRUG ENTER/EDIT] <--- don't use this one
Drug Accountability Menu ... [PSA DRUG ACCOUNTABILITY MENU]
Drug Receipt History Review [PSA DRUG HISTORY]
Drug Transaction History [PSA DRUG DISPLAY]
Inquire/Compare DRUG file/ITEM MASTER file [PSA DRUG INQUIRE]
Emails Regarding Adding Drugs
Moved here: Pharmacy Setup Emails
Helpful post here: Instructions for New Drug Entry
RPC Calls
ORWUL^FVSUB -- gets the list of drugs to display in the box.
ORWDXA ISACTOI
ORWDPS1 FAILDEA
ORWOR PKISITE
When a drug is selected in the new medicine dialog, the following RPC's are called:
ORWDPS2 OISLCT example params: 1158,0,1,Y,N
Remote procedure file details for this: OISLCT^ORWDPS2(LST,OI,PSTYPE,ORVP,NEEDPI,PKIACTIV)
This returns defaults for ordering
Example:
Params ------------------------------------------------------------------
literal 1158
literal O
literal 1
literal Y
literal N
Results -----------------------------------------------------------------
~Medication
d1158^ACYCLOVIR CAP,ORAL
~Verb
dTAKE
~Preposition
dBY
~PtInstr
~AllDoses
i200MG^5671^200&MG&1&CAPSULE&200MG&5671&200&MG
i400MG^5671^400&MG&2&CAPSULES&400MG&5671&200&MG
NOTE: format-- iDrugName^Strength^NF^TDose&Units&U/D&Noun&LDose&Stren^
DoseText^CostText^MaxRefills^DispUnits^CanSplit
~Dosage
iACYCLOVIR 200MG^200MG^^200&MG&1&CAPSULE&200MG&5671&200&MG^200MG^^11^CAP
iACYCLOVIR 200MG^200MG^^400&MG&2&CAPSULES&400MG&5671&200&MG^400MG^^11^CAP
NOTE: format-- iDrugName^Strength^NF^TDose&Units&U/D&Noun&LDose&Stren^
DoseText^CostText^MaxRefills^DispUnits^CanSplit
~Dispense
i5671^200^MG^ACYCLOVIR 200MG^0
NOTE: format-- DrugIEN^Strength^Units^Name^Splict
~Route
i1^ORAL^PO^MOUTH^0
~Schedule
~Guideline
~Message
~DEASchedule
d
Completion of CPRS drug orders
The menu option for completing a medication order entered in CPRS is PSO LMOE FINISH
This menu option causes execution of code: DO ^PSOORFIN The code for PSOORFIN.m in my VOE folder has a copyright GNU GPL WorldVista. This is different from the one in my older server setup.
File 52.41 holds PENDING OUTPATIENT ORDERS And after the order is "finished" via the above order, it is removed from this file.
older stuff below------------
This is a debug trace. First, I entered a drug in CPRS, but didn't sign it....
CPRS gets name of drug order (unsigned) via ORWORR GETTXT Params: "239;1" Results: PENICILLIN TAB 250MG TAKE ONE TABLET BY MOUTH TWICE A DAY Quantity: 20 Refills: 0 *UNSIGNED* Above, 239;1 is the link to the drug order. It comes from: ORWORR AGET Params: "70774", "2^0", "1", "0", "0", "" Results ----------------------------------------------------------------- 10^2^ 239;1^4^3080202.1616^^ <----- the drug order 229;1^43^3080201.1208^^ ... I then signed the order in CPRS. It is now displayed on the medications tab. Here is the RPC that got that:
ORWPS ACTIVE Params "70774" Results ~OP^44P;O^PENICILLIN TAB 250 MG^^^^^^239^PENDING^^^20^^0 PENICILLIN TAB 250 MG Qty: 20 \ Sig: TAKE ONE TABLET BY MOUTH TWICE A DAY After a drug is entered in CPRS, it is put into: file 52.41 - PENDING OUTPATIENT ORDERS
Now, to complete the prescription, must go to Terminal mode.
menu options:
PSO MANAGER --> PSO RX --> PSO LM BACKDOOR ORDERS
From there I am taken into a screenman form where I can view and update the patient information. I press ENTER twice, and then I am shown the prescription that is pending (i.e. signed in CPRS).
I am able to edit the prescription. And then I enter FN to finish the prescription.
From there I am prompted:
Select New Rx # for TEST,KEVIN: ??
ENTER A VALID PRESCRIPTION NUMBER
OR BARCODE PRESCRIPTION NUMBER
OR 'P' TO GET A PATIENT PROFILE
(works only if in the OUTPATIENT package)
This is the prescription number.
Select New Rx # for TEST,KEVIN:
Initially I had a problem, but then got this working, after fixing a bug in my version of the PSO code. I kept getting a crash at ACP+6^PSOORNEW when I would enter a prescription number. I stepped through it and found that PSONEW("QFLG") was not being set, which then caused a "variable-doesn't-exist" error. I wrapped this in a $G() and the code was able to continue and complete the prescription. ... Another problem was that I didn't have the setting correct regarding automatically numbering prescriptions. I needed to set that the YES, and then give an upper and lower range and a last-prescribed value into a fields 27000...
Tracing through the code, I find the following stack (order of execution) (earliest calls on the bottom) when I break at the first prompt after launching a FN finish.
EN^PSON52 <-- create new entry in prescription file ACP+10^PSOORNEW <-- Module: display orders from oerr LOOP+6^XQOR1 <-- listman code STAK+3^XQOR1 <-- listman code ASK+1^VALM <-- listman code EN+8^VALM <-- listman code EN+1^PSOLMPO <-- starts listman session to allow FN to be chosen PST+42^PSOORFI1 <-- shows order ORD+14^PSOORFIN <-- Module: finish cprs orders OK^PSOORNE5 NEWSEL+2^PSOORNE2 NEWSEL+1^PSOORNE2 NEWSEL+1^PSOLMUTL ...
My goal was to see if I could create an API out of this process, so that the launching of completion of the FN could be done programatically.
I did find that EN^PSON52(PSOX) seems to be a key entry point. It is called from ACP^PSOORNEW
Starting in ACP^PSOORNEW, I found that PSONEW is modified. Then it is passed as PSOX into EN^PSON52. So the question is, what is setup prior to this call?
PSODRUG seems to contain the info for the drug that has been prescribed.
PSODRUG("CLN")=269
PSODRUG("COST")=""
PSODRUG("DEA")=""
PSODRUG("EXPIRATION DATE")=""
PSODRUG("OIN")="A-HYDROCORT INJ"
PSODRUG("SIG")="USE AS DIRECTED"
PSODRUG("UNIT")=""
PSODRUG("VA CLASS")="HS051"
PSONEW contains other info
PSONEW("# OF REFILLS")=0
PSONEW("CHCS NUMBER")=""
PSONEW("CLERK CODE")=73
PSONEW("CLINIC")=6
PSONEW("DAYS SUPPLY")=30
PSONEW("DFLG")=0
PSONEW("DOSE",1)="54;14"
PSONEW("DOSE ORDERED",1)=1
PSONEW("DURATION",1)=""
PSONEW("ENT")=1
PSONEW("EXTERNAL SYSTEM")=""
PSONEW("FILL DATE")=3090404
PSONEW("ISSUE DATE")="APR 4,2009"
PSONEW("MAIL/WINDOW")="W"
PSONEW("NOUN",1)=""
PSONEW("PATIENT STATUS")=20
PSONEW("PROVIDER")=73
PSONEW("PROVIDER NAME")="TOPPENBERG,KEVIN S"
PSONEW("QFLG")=0
PSONEW("QTY")=60
PSONEW("REMARKS")=""
PSONEW("ROUTE",1)=1
PSONEW("SCHEDULE",1)="BID"
PSONEW("UNITS",1)=1391
PSONEW("VERB",1)="TAKE"
By the end of ACP, PSONEW has had the following fields added:
PSONEW("NEWCOPAY")=0
PSONEW("OLD LAST RX#",8)=22
PSONEW("POE")=1
PSONEW("RX #")=23
After passed as PSORX into EN^PSON52, the values are as below. Notice that drug name is still missing, so I think that PSODRUG is also still required.
PSOX("# OF REFILLS")=0
PSOX("CHCS NUMBER")=""
PSOX("CLERK CODE")=73
PSOX("CLINIC")=6
PSOX("DAYS SUPPLY")=30
PSOX("DFLG")=0
PSOX("DOSE",1)="5;30;100"
PSOX("DOSE ORDERED",1)=1
PSOX("DURATION",1)=""
PSOX("ENT")=1
PSOX("EXTERNAL SYSTEM")=""
PSOX("FILL DATE")=3090403
PSOX("ISSUE DATE")="APR 3,2009"
PSOX("MAIL/WINDOW")="W"
PSOX("NEWCOPAY")=0
PSOX("NOUN",1)=""
PSOX("OLD LAST RX#",8)=22
PSOX("PATIENT STATUS")=20
PSOX("POE")=1
PSOX("PROVIDER")=73
PSOX("PROVIDER NAME")="TOPPENBERG,KEVIN S"
PSOX("QFLG")=0
PSOX("QTY")=5
PSOX("REMARKS")=""
PSOX("ROUTE",1)=1
PSOX("RX #")=23
PSOX("SCHEDULE",1)="NOW"
PSOX("UNITS",1)=967
PSOX("VERB",1)="TAKE"
After creating the new entry, the pending entry is deleted here
DCORD+1^PSONEW2
So the next question is, how can I populate PSONEW given an IEN in the pending orders file?
After the drug is completed in the Terminal, it is removed from File 52.41 holds PENDING OUTPATIENT ORDERS.
However, from CPRS, it is still the same RPC call [ORWPS ACTIVE] that gets the list of active medications--both those Pending (await terminal-mode completion, meaning that they are in the PENDING OUTPATIENT ORDERS) and those that are completed.
HUI Prescription Auto-Finishing
This section will hold information as I investigate the HUI autoprescription code that I was given at one point. I will note that this was beta code, and there are likely better versions now.
This is a list of modified files:
ORWDX PSOCAN4 PSODRDUP PSODRG PSOLBLN PSOLBLN2 PSOLMPO PSONEW PSOORFI1 PSOORFI2 PSOORFI4 PSOORFIN PSOORNE4 PSOORNEW (was older than my system --> changes merged in) PSOORRNW PSORXL PSOZHUIF PSOZLSET (PSOTPCAN NOTE: not in the HUI package, but required mod, see below) (PSODGAL NOTE: not in the HUI package, but required mod, see below) (PSORX1 NOTE: not in the HUI package, but required mod, see below)
I went through these files, and all were OK to overwrite by files (except 1)
... OK. I have copied the above files into my routines folder. I then have stepped through the RPC code and found a hang-up. --first, pick a drug that is a non-va drug. On my system, Abilify TAB is such a drug. Order the drug. Then look at the RPC calls for SAVE ORWDX. Find the order number at piece 1 in the results.
Then on the server setup as follows: x="do SEND^ORWDX(.list,70685,73,6," (U?Ec%U{,",.array)" set array(1)=1945;1^1^1^E" (replace 1945 with the order number from above) Then trace into: xecute x
I have this to SPAT+12 (the line that starts with "S ORD"), to the place where the message is given, and "press return to continue" is encountered. I think in the loop a D ORD is the culprit. I need to finish tracing through this to find the exact spot.
... OK. Found it. Rather than tracing through the code, I called this manually as above, and let it run to the point where it stopped and asked for a prompt. I then used ^ZJOB to examine the process, and looked at it's variable table ("V"), and got the stack, showing the path of execution.
The culprit is in DISPL^PSOTPCAN
I am going to put in a code guard to not do this, as follows:
DSPL+8^PSOTPCAN
. . I $G(HUIFIN)="Y" Q ;vf //kt
DSPL+15^PSOTPCAN
. I $G(HUIFIN)="Y" Q ;vf //kt
I also changed ABORT^PSOORNEW from
ABORT S VALMBCK="Q",DIR(0)="E",DIR("A")="Press Return to Continue" D ^DIR,CLEAN^PSOVER1,KV
Q
To:
ABORT ;"//kt S VALMBCK="Q",DIR(0)="E",DIR("A")="Press Return to Continue" D ^DIR,CLEAN^PSOVER1,KV
S VALMBCK="Q"
I $G(HUIFIN)'="Y" D
. S DIR(0)="E",DIR("A")="Press Return to Continue" D ^DIR
D CLEAN^PSOVER1,KV
Q
I also changed the line at ACP+12&PSOORNEW to ensure non-interactive. I had not encountered this as a problem, but thought it was a potential one.
I $G(PSOCPZ("DFLG")) DO QUIT ;"//kt added HUIFIN guard to ensure non-interactive
. I $G(HUIFIN)'="Y" DO
. . W !!,"No action taken!",! K DIR S DIR(0)="E",DIR("A")="Press Return to continue" DO ^DIR
. D KV K PSOCPZ("DFLG"),DRET,PSOANSQD S VALMBCK="Q" Q
I then found that the auto-completion code was trying to act on ALL orders, including for example, text-only WP orders. So I added the following to prevent this. It will only work on orders pointing to an ORDERABLE ITEM marked as coming from the PSxxx package.
EN^PSOZHUIF (at the beginning of the routine)
;"//kt start mod ------------ 4/8/09
KILL HUIFIN,HUIDUZ,HUIDFN
NEW TMGOIY,TMGI,TMGPKG
;"NOTE: I am only checking the first entry in this multiple. I don't know
;" what it would mean if the order referred to multiple orderable items.
SET TMGOIY=$ORDER(^OR(100,+ORDERID,.1,"B","")) ;"Ptr to 101.43 ORDERABLE ITEM
QUIT:(+TMGOIY'>0)
SET TMGPKG=$PIECE($GET(^ORD(101.43,TMGOIY,0)),"^",2)
QUIT:(TMGPKG'["PS") ;"Only auto-complete package PSxxx Orderable Items
if '$get(TMGDEBUG) quit; "TEMP!!!!! -- disable for now.
;"//kt end mod ------------
I also changed the following to ignore drug interactions (i.e. not prompt for user response):
DSPLY+7^PSODGAL...
.;//kt orig-> S DIR(0)="SA^1:YES;0:NO",DIR("A")="Do you want to Intervene? ",DIR("B")="Y" W ! D ^DIR
.I $G(HUIFIN)'="Y" S DIR(0)="SA^1:YES;0:NO",DIR("A")="Do you want to Intervene? ",DIR("B")="Y" W ! D ^DIR ;"//kt
.I $G(HUIFIN)="Y" SET Y=0 ;"Force 'NO' if Autofinishing ;"//kt
and
CLASS+11^PSODGAL..
..;"//kt orig-> S DIR(0)="SA^1:YES;0:NO",DIR("A")="Do you want to Intervene? ",DIR("B")="Y" W ! D ^DIR
..I $G(HUIFIN)'="Y" S DIR(0)="SA^1:YES;0:NO",DIR("A")="Do you want to Intervene? ",DIR("B")="Y" W ! D ^DIR ;"//kt
..I $G(HUIFIN)="Y" SET Y=0 ;"Force 'NO' if Autofinishing ;"//kt
I also changed the following to automatically set up a PHARMACY PATIENT record stubb for those without one. Again, to avoid user queries
OERR+14^PSORX1
.L +^PS(55,PSODFN):0 I '$T W $C(7),!!,"Patient Data is Being Edited by Another User!",! S POERR("QFLG")=1 S:$G(PSOFIN) PSOQUIT=1 Q
.IF $GET(HUIFIN)="Y" DO QUIT ;"//kt mod (entire block)
. . NEW TMGFDA,TMGMSG,TMGIEN
. . SET TMGFDA(55,"+1,",.01)=PSODFN
. . SET TMGFDA(55,"+1,",3)=20 ;"Force NON-VA as status.
. . SET TMGIEN(1)=PSODFN
. . DO UPDATE^DIE("S","TMGFDA","TMGIEN","TMGMSG")
. . IF $DATA(TMGMSG) SET POERR("QFLG")=1
. . L -^PS(55,PSODFN)
.S PSOXFLG=1,SSN=$P(^DPT(PSODFN,0),"^",9) W !!?10,$C(7),PSORX("NAME")_" ("_$E(SSN,1,3)_"-"_$E(SSN,4,5)_"-"_$E(SSN,6,9)_")",! K SSN
.S DIE=55,DR=".02;.03;.04;.05;1;D ELIG^PSORX1;3;50;106;106.1",DA=PSODFN W !!,?5,">>PHARMACY PATIENT DATA<<",! D ^DIE L -^PS(55,PSODFN)
Below if from the accompanying documentation. I will make comments below.
Processing Overview
The AutoFinish process starts by a call in ORWDX after a medication orders has had a provider sign with a valid e-signature and the prescription exists in file 52.41. The call in ORWDX goes to PSOZHUIF
This is found at SEND+19^ORWDX (or line 171 from top of file) in new ORWDX file.
which determines the status of the AUTOFINISH RX field of the associated OUTPATIENT SITE, if “YES” the AutoFinish and printing process will be executed. The user AUTOFINISH,RX must also be able to be identified in the NEW PERSON(File#200) in order to initiate the AutoFinishing functionality. If these conditions are not satisfied the normal provider signing functionality continues without AutoFinishing (i.e., the CPRS prescription will be left in a signed, ‘pending’ status). If these conditions are met and AutoFinishing takes place, the CPRS prescription will be left in signed; ‘active’ status and a hard copy patient prescription will be printed.
PSOZHUIF sets up an environement, then calls D ^PSOORFIN
PSOZHUIF will set the variable HUIFIN equal to “Y” if the medication order is to be AutoFinished, the modified routines have lines that begin with either, I $G(HUIFIN)="Y" or “I $G(HUIFIN)’="Y". If the line in the routine begins with I $G(HUIFIN)’="Y" and AutoFinishing is turned OFF the routines will work and behave with the original functionality. If the line in the routine begins with I $G(HUIFIN)’="Y" and AutoFinishing is turned ON the routines will not execute this line of code. If the line in the routine begins with I $G(HUIFIN)="Y" and AutoFinishing is turned ON and the routines will AutoFinish and print the prescription. These lines either automate the points in the finishing process where normally a pharmacist will respond to prompts or if the line of the code is to display prompts to the screen the line removes the display function.
PSOZLSET is a modified version of PSOLSET that sets up the normal variables that are needed in the PSO* routines. It removes all prompts for data input and provides the appropriate values to the routine.
It is important to NOTE that one part of the code that is bypassed in the AutoFinish process is all the interacting checking, allergy checking, drug duplication checking, laboratory prompts and other checks that a pharmacist normally process in the manual finish process. All of the checks processed in the CPRS medication order process are still processed by the provider entering the order.
Comments can be found throughout all the routines describing functionality and variables. Lines changed in the routines by this patch are ended with the comment “;vfa*” where * is a single letter.
When the AUTOFINISHING functionality is turned on existing Class I audit trails are preserved. In addition the Class 1 “Method of Pickup” field will be populated with the phrase “AutoFinished for Rx Printing”. The Class 1 “Finished by” or “Finishing Person” field will be populated with the user name “AUTOFINISH, RX” AND the prescription label log will populate the Class 1 “Printed by” field with the user name “AUTOFINISH, RX”. The date/time stamp for label printing can be found by using FileMan to look at the label log for a prescription in PRESCRIPTION(File #52).
Patients who are processed with the AutoFinish process must have a STATUS assigned to them, if they do not the code can not process the medications orders. The AutoFinish Rx routines check to see if a patient has a status assigned to them, if no status exists the routine will print a message to the printer and not AutoFinish the medication order. See below for an example of the message printed.
