Prescription Auto-Finishing

Intro
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.

Modified Files
This is a list of modified files, from the originial HUI patch:

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)

Below are the files modified with the newer PSO-7-0-280 patch for autocompletion.

(ORWDX) -- missing PSOCAN4.m -- old    --> no signif change from old patch. PSODRDUP.m -- old   --> no signif change from old patch. PSODRG.m -- old     --> +/- no signif change from old patch. PSOLBLN.m -- old    --> new changes copied into TMG code. PSOLBLN2.m -- old   --> +/- no signif change from old patch. PSOLMPO.m -- old    --> no signif change from old patch. PSONEW.m -- old     --> no signif change from old patch. PSOORFI1.m -- old   --> new changes copied into TMG code. PSOORFI2.m -- old   --> no signif change from old patch. PSOORFI4.m -- old   --> new changes copied into TMG code. PSOORFIN.m -- old   --> new changes copied into TMG code. PSOORNE4.m -- old   --> no signif change from old patch. PSOORNEW.m -- old   --> new changes copied into TMG code. PSOORRNW.m -- old   --> no signif change from old patch. PSORXL.m -- old     --> new changes copied into TMG code. (PSOZHUIF) -- missing (i.e. not present in new patch) (PSOZLSET) -- missing (i.e. not present in new patch) (PSODGAL) -- missing (i.e. not present in new patch) PSOLSET.m -- old    --> new changes copied into TMG code.

PSOAFIN.m new   <-- copied into TMG codebase PSOAFPT1.m new  <-- copied into TMG codebase PSOAFPTL.m new  <-- copied into TMG codebase (Makes use of custom fields) PSOAFPTS.m new  <-- copied into TMG codebase (Makes use of custom fields) PSOAFRP1.m new  <-- copied into TMG codebase PSOAFRPT.m new  <-- copied into TMG codebase PSOAFSET.m new  <-- copied into TMG codebase PSODISP.m  new  <-- copied into TMG codebase PSODISPS.m new  <-- copied into TMG codebase PSON52.m  new   <-- copied into TMG codebase PSONEWF.m  new  <-- copied into TMG codebase (introduces new calls also) PSOOREDT.m  new <-- copied into TMG codebase (introduces new calls also) PSOORFI3.m  new <-- copied into TMG codebase (little changed) PSOORFI5.m  new <-- copied into TMG codebase PSOORNW2.m  new <-- copied into TMG codebase (little changed) PSOREF.m  new   <-- copied into TMG codebase (little changed) PSORN52.m  new  <-- copied into TMG codebase PSORX1.m  new   <-- copied into TMG codebase (prior changes merged in) PSORXPA1.m  new <-- copied into TMG codebase PSORXRP1.m  new <-- copied into TMG codebase PSORXRP2.m  new <-- copied into TMG codebase PSORXRPT.m  new <-- copied into TMG codebase PSOTPCAN.m  new <-- copied into TMG codebase (prior changes merged in)

Notes on HUI Code
First I started with the older HUI code. Notes on newer PSO-7-0-280 below.

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)

Notes on Newer PSO Autocompletion code
NOTES: I took the patch, and manuall extracted each of the separate .m files. I then compared them to my local system. See notes about each comparison above. I then took the patch (PSO-7-0-208.KID) for autofinish and cut out all the files and installed just the part that contained the data dictionary entries and installed that. Below are instructions from the patch.

This patch for Auto-Finish Rx (AutoRx) and Auto Prescription Printing adds the functionality for automatically finishing a medication order entered via the medication ordering process in CPRS. Then it prints a prescription based on the order entered by the physician to give to the patient.

Installation instructions are in the multi-build containing this build.

The following section describes the technical components of this patch.

1. The following FIELDS will be added to OUTPATIENT SITE (#59)

Added Fields: ===============

Field #  Field Name                            Field Type ---  --                        --    22900     AUTOFINISH  RX                 Set of Codes 22901    AUTOFINISH DEFAULT PAT STATUS  Pointer to RX PATIENT STATUS 22902    AUTO-FINISH ELIGIBILITY        Multiple (#59.022902) .01    -AUTO-FINISH ELIGIBILITY       Pointer to ELIGIBILITY CODE 22903    AUTOFINISH ES                  Set of Codes 22904    AUTOFINISH HEADER LINE         Free Text 22905    AUTOFINISH TRADE NAME PRINT    Set of Codes 22906    AUTOFINISH WET SIG ON CSII     Set of Codes 22907    AUTOFINISH DOB                 Set of Codes 22908    AUTOFINISH DIAGNOSIS           Set of Codes 22909    AUTOFINISH LINE 1-2-3          Set of Codes 22910    AUTOFINISH FAX SERVER LOCATION Free Text 22911    AUTOFINISH FAXED FROM NUMBER   Free Text

(Note: I entered these values) 22900-AUTOFINISH RX : YES 22901-AUTOFINISH DEFAULT PAT STATUS : NON-VA 22903-AUTOFINISH ES : YES 22904-AUTOFINISH HEADER LINE : K.Toppenberg TN30xxxxxx 22906-AUTOFINISH WET SIG ON CSII : YES 22907-AUTOFINISH DOB : YES 22908-AUTOFINISH DIAGNOSIS : YES 22910-AUTOFINISH FAX SERVER LOCATION : /tmp/tempfaxes 22911-AUTOFINISH FAXED FROM NUMBER : 423-787-xxxxxxx 459001-AUTOFINISH RX : YES (continuing)

2. The following FIELDS will be added to PRESCRIPTION (#52)

Added Fields: ===============

Field #  Field Name                      Field Type ---  --                 --   22900     AUTOFINISH COMPLEX ORDER        Free Text

(No entry needed)

3. The following new file will be added

PSO AUTOFINISH PHARMACY file 22900

.01      NAME                      Free Text 2        STREET ADDRESS 1          Free Text 3        STREET ADDRESS 2          Free Text 4        STREET ADDRESS 3          Free Text 5        CITY                      Free Text 6        STATE                     Pointer to State file 7        ZIP CODE                  Free Text 8        BILLING NUMBER            Free Text 9        PRIMARY CONTACT PERSON    Free Text 10       PHARMACIST IN CHARGE      Free Text 11       VOICE PHONE DIRECT TO RPH Free Text 12       VOICE PHONE TO PHARMACY   Free Text 13       FAX PHONE                 Free Text 14       IP ADDRESS                Free Text

(I am not going to enter these for now, as I plan to NOT fax scripts)

4. The following PROTOCOLS will be addded.

Name                 Item Text           Entry Action Exit Action ==============      ==================  ========================  =======

PSO AF REPRINT      Autofinish Reprint  S POERR=1 D BCK^PSOAFRPT  K POERR PSO AF SPEED REPRINT AF REPRINT         D ^PSOAFRP1               NA

5. The following PROTOCOLS will be USE AS LINK FOR MENU ITEMS for the above two Protocols, respectively.

PSO HIDDEN ~|ActionACTIONS PSO HIDDEN ActionS #2

NOTE: From looking at the code there is supposed to be a new field at ^SC(IEN,"AFRXSITE") This plays the same role as ^SC(IEN,"HUIAUTOSITE").. After I installed the patch, I don't have the newer field. So I have modified the code to first look at AFRXSITE, and then HUIAUTOSITE for the info.

From Docs
Below if from the accompanying documentation from the HUI code. I haven't found docs for the PSO-7-0-208 patch yet. 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.