Difference between revisions of "Pharmacy Issues"

Revision as of 23:08, 27 April 2009

This page will contain notes to work out pharmacy programming issues.

Initiated by K. Toppenberg 4/2005

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

Instructions for entering a drug through menus

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.

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.

Prescription Auto-Finishing

This section got too long. So moved to a separate page.

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
 
 for patient 70772, use " /)Bv@})H%"
 3 --> " *6tLxj68."

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.