User:Hydenseek/Here

As a new user and proponent of the WorldVistA Electronic Health Record, I will document on this page my personal experience using the software on a test system in my home.

How I became interested:

I suppose I am like the majority of people, I have always been in good health, had medical insurance and had very limited contact with the Health Care System, yet assumed I knew "how it all worked" if I did need to use it.

A recent health issue left me reeling with disbelief with regard to the lack of patient health information being readily available to the very health care providers who needed it. Every visit to a hospital, doctor, or clinic seemed as though I were visiting an island known only to itself. I would fill out the same paperwork over and over: Name, address, wife's name, allergies, past surgeries, and on and on. Most places did not use a computer but relied on a paper record system to keep track of my information. I thought to myself this is the most inefficient system I have ever seen. I mean we live in an age where I can buy a widget at WalMart in Syracuse, fly to Chicago and the WalMart clerk there can tell me what I bought, where I bought it and how much I paid for it in seconds.

This prompted me to begin searching for the reason things were the way they were. I came across Google Health and immediately began a health record for myself. If I went to a new doctor I printed out my Google Health record and they were amazed at what I had done in so short a time. But the health record information is for them to gather not me,(fortunately I was still healthy enough to be able to build the record) so I looked further and soon found WorldVistaEHR.

Now here was a free piece of software that ran the VA, one of the largest health care systems in the world and I became an immediate fan. But why wasn't everyone using it? It turns out that WorldvistA is too good, too complete, and too not Windows. Everyone wants a point and click interface and WV is far from that, except for CPRS of course.

I have known for a long time that a piece of software will never learn how you want it to behave, you MUST learn how it behaves so I set about learning how it functions. Enter HardHats, a dedicated group of individuals whose goal is to further the acceptance of VistA and its derivatives in applications outside the VA. If not for these HardHats, VistA would be dead and buried never to see life outside the VA. What they are trying to accomplish is akin to moving a mountain, they number perhaps a few hundred strong yet have turned the heads of many people.

How I began:

Initially I was overwhelmed with the capability of the program from what I read. I wanted to learn a program that would help the small clinic or doctor's office, not run St. Judes Hospital. But the more I read the more I realized that this program could scale to any level of complexity with its modular architecture. I decided to download the demo from the Worldvista.org website to kick the tires a bit. Installation was straight forward and the demo ran flawlessly. After a week I decided to try a client server test setup using Ubuntu Jaunty and Windows Vista HP. It seemed that the Astronaut Installer was the quickest and most reliable way to setup the system. It was a breeze to install both server and TMG-CPRS with Astronaut. Now the fun begins.....

My first hurdle was to log on to the server. To do this required changing the Access/ Verify codes for an existing doctor, in my case Doctor,One

Follow these steps to do this:

Open a terminal

enter choice 3 in Vista Commander

VA FileMan 22.0

Select OPTION NAME: Select OPTION NAME:1 ENTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: REMOTE PROCEDURE// 200 NEW PERSON (74 entries) EDIT WHICH FIELD: ALL// Access CODE Want to edit ACCESS CODE (Y/N) THEN EDIT FIELD: verify 1  VERIFY CODE  Want to edit VERIFY CODE (Y/N) 2  VERIFY CODE never expires CHOOSE 1-2: 1 Want to edit VERIFY CODE (Y/N) THEN EDIT FIELD:

Select NEW PERSON NAME: DOCTOR,ONE

You are then at Doctor, One's entry and can change his login codes. As soon as he logs in he will have to change to a new access and verify code for security reasons.

You can now login using CPRS (Computerized Patient Record System) as Doctor,One

To make the system more realistic go back to a terminal and press 3 as before.

then press 1 when asked for the Option Name

INPUT TO WHAT FILE: 200 NEW PERSON//

EDIT WHICH FIELD: ALL//

Select NEW PERSON NAME: DOCTOR,ONE

Now press enter until you get down to the e Sign entry and enter a new e sign code for the good doctor. This will let you sign orders etc. for patients, just like a real doctor!!

Time to PuTTY:

I discovered that it was a pain to keep running into the other room where the server is located to open a terminal and use the roll and scroll interface. To use one computer just download the PuTTY terminal emulator to your windows machine and use it to connect to a terminal on the server--much more convenient!

Next I wanted to pretend to be a small clinic, keeping in mind that most interaction with Vista is done through CPRS, I needed to let CPRS know about this new clinic. This post from John Leo Zimmer explains how:

Dear hydelake,

You want to add an outpatient site so CPRS sees two sites as opposed to just the default "Dr Office".

In FileMan you want to edit the HOSPITAL LOCATION file, #44. First look at the existing DR OFFICE entry. Then you can add another similar to it.

An easy way to accomplish that is with the FileMan function:
 * Transfer Entries:*

Select TRANSFER OPTION: *1 *(TRANSFER FILE ENTRIES) Input to what File: *HOSPITAL LOCATION* TRANSFER FROM FILE: *HOSPITAL LOCATION*// TRANSFER DATA INTO WHICH HOSPITAL LOCATION: *NEW CLINIC* Are you adding 'NEW CLINIC' as a new HOSPITAL LOCATION (the 6TH)? No// y (Yes) HOSPITAL LOCATION TYPE: *C *      CLINIC TRANSFER FROM HOSPITAL LOCATION: *DR OFFICE* WANT TO DELETE THIS ENTRY AFTER IT'S TRANSFERRED? No// * (No)*

Give that a try, have a look with CPRS, and you should now have two clinics, DR OFFICE and NEW CLINIC. (Edit NEW CLINIC to have its own abbreviation, perhaps "NC", instead of "DR")

jlz

There are probably references to proper clinic setup somewhere in the VDL and perhaps a menu option that should be used. But try this for now. Let us know when you get stuck. (count on it.) :-)

That allowed the creation of "River Clinic" so I could see patients.

Next I needed patients. The easiest, quickest way to get a patient into the system is to use the "add patient" feature in TMG-CPRS. This will get you a sick person to treat. If you want to enter a lot of personal info after using "add patient" you'll need to use PuTTy and edit the Patient File. Now as it turns out editing the Patient File is not as simple as firing up FileMan and telling it to edit the Patient File and then select a patient. If you try you'll get this screen:

Prompt> 3

VA FileMan 22.0

Select OPTION: 1 ENTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: LABORATORY TEST// patient 1  PATIENT                          (8 entries) 2  PATIENT ALLERGIES                (5 entries) 3  PATIENT APPOINTMENT INFO LOG     (0 entries) 4  PATIENT CONSCIOUSNESS            (7 entries) 5  PATIENT DATA ELEMENT             (0 entries) Press  to see more, '^' to exit this list, OR CHOOSE 1-5: 1 PATIENT                    (8 entries) EDIT WHICH FIELD: ALL//

Unable to proceed. DUZ(2) is undefined.

And believe me you will not proceed! Nancy Anthracite provides the key in this post:

Are you first setting your DUZ and then running and exiting from D ^XUP before entering fileman? That is always SOP if you come in with nothing but setting the DUZ because it populates the symbol table.

For example:

nancy@owl:~$ gtm

GTM>S DUZ=9 (use your real DUZ here, 9 is the DUZ of COORDINATOR,FIVE)

GTM>ZWR DUZ=9

GTM>D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

You have 46 new messages. Select OPTION NAME: GTM>ZWR

DILOCKTM=3 DISYS=19 DT=3090823 DTIME=9999 DUZ=9 DUZ(0)="@" DUZ(1)="" DUZ(2)=67 DUZ("AG")="E" DUZ("BUF")=1 DUZ("LANG")="" IO="/dev/pts/5" IO(0)="/dev/pts/5"

IO(1,"/dev/pts/5")=""

IO("ERROR")=""

IO("HOME")="50^/dev/pts/5"

IO("ZIO")="/dev/pts/5"

IOBS="$C(8)"

IOF="#,$C(27,91,50,74,27,91,72)"

IOM=80

ION="TELNET"

IOS=50

IOSL=24

IOST="C-VT100"

IOST(0)=9

IOT="VTRM"

IOXY="W $C(27,91)_((DY+1))_$C(59)_((DX+1))_$C(72)"

U="^"

X="5;DIC(4.2,"

XPARSYS="5;DIC(4.2,"

XQXFLG="^^XUP"

GTM> NOW GO INTO FILEMAN

On Saturday 22 August 2009, hydelake wrote:

> This has worked in the past but now refuses.

> I enter Fileman and choose edit file entries

> Edit which file > Patient > which fields//All

> unable to proceed DUZ(2) is undefined

> what is Fileman telling me?

> Thanks > Tim

-- Nancy Anthracite

Now Fileman will let you edit the Patient File normally.

To find your DUZ:

Prompt> 1

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT320

Select OPTION NAME: eve 1  EVE       Systems Manager Menu 2  EVENT CAPTURE (ECS) EXTRACT AU  ECX ECS SOURCE AUDIT     Event Capture (ECS) Extract Audit 3  EVENT CAPTURE DATA ENTRY  ECENTER     Event Capture Data Entry 4  EVENT CAPTURE EXTRACT  ECXEC     Event Capture Extract 5  EVENT CAPTURE MANAGEMENT MENU  ECMGR     Event Capture Management Menu Press  to see more, '^' to exit this list, OR CHOOSE 1-5: 1 EVE     Systems Manager Menu

Core Applications ...         Device Management ...          Menu Management ...          Programmer Options ...          Operations Management ...          Spool Management ...          Information Security Officer Menu ...          Taskman Management ...          User Management ...   FM     VA FileMan ...          Application Utilities ...          Capacity Planning ...          HL7 Main Menu ...          Manage Mailman ... MAS Parameter Entry/Edit

Select Systems Manager Menu Option: user Management

Add a New User to the System Grant Access by Profile Edit an Existing User Deactivate a User Reactivate a User List users User Inquiry Switch Identities File Access Security ... **> Out of order: ACCESS DISABLED Clear Electronic signature code Electronic Signature Block Edit Manage User File ...         OAA Trainee Registration Menu ... Person Class Edit Reprint Access agreement letter

Select User Management Option: list users

START WITH NAME: FIRST//

DEVICE:  TELNET



This lists all people in the New Person #200 file on your screen and the USER LIST NUMBER is the DUZ for that person, it never changes so write down your DUZ.

I had a problem a couple days ago. When I started CPRS the program would not load my clinical reminders or recent lab results stating that it was "retrieving in background". A post to Hardhats confirmed it was a TaskMan issue and the report from D ^XUP,EVE,TAS,TAS,MON said that the TaskMan job limit had been reached. My initial solution was simply to increase the job limit from 100 to 200 then Skip Ormsby provided this bit of insight:

Sounds to me like what is happening is instead of a hard crash, is what I would call a soft crash, that is TaskMan is not being Stopped before GT.M is shut down. I remembered there was a message about the hard crash and there was a node that needed fixing. I searched on "xusys" with the quotes and found the message, "Taskman active jobs" In the message Rick suggests setting ^XUTL("XUSYS","CNT") equal to one. You also might like to consider this (and here is a good reason for using the menu, rather than calling something direct): Select OPTION: ENTER OR EDIT FILE ENTRIES

INPUT TO WHAT FILE: INSTALL// 19 OPTION  (9907 entries) EDIT WHICH FIELD: ALL// ENTRY ACTION THEN EDIT FIELD:

Select OPTION NAME: RESTART TASK MANAGER XUTM RESTART     Restart Task Manager ENTRY ACTION: S:$E(^%ZOSF("OS"),1,2)="GT" ^XUTL("XUSYS","CNT")=1

Select OPTION NAME:

TST>D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

You have 106 new messages. Select OPTION NAME: TASKMAN MAN 1  TASKMAN MANAGEMENT  XUTM MGR     Taskman Management 2  TASKMAN MANAGEMENT UTILITIES  XUTM UTIL     Taskman Management Utilitie s CHOOSE 1-2: 2 XUTM UTIL     Taskman Management Utilities

MTM   Monitor Taskman Check Taskman's Environment Edit Taskman Parameters ... Restart Task Manager Place Taskman in a WAIT State Remove Taskman from WAIT State Stop Task Manager Taskman Error Log ... Clean Task File Problem Device Clear Problem Device report. SYNC flag file control

Select Taskman Management Utilities Option:

I would be something somebody could try and check out, if this is a good idea or not.

He was right because lately I had been unwittingly "soft crashing" Taskman through an improper shut down procedure I had adopted and TaskMan jobs were continuing to run and not being tagged as completed each time I shutdown. I believe I have cured this by shutting down TaskMan cleaning the jobs queue and restarting TaskMan. I then reset the job limit back to 100 and all seems fine. From now on I will shutdown TaskMan manually then quit GTM when I shutdown the server.