Episode13

Ordering Configuration

The Intracare Implementation Log Episode12 (Back to Log Homepage) Episode14 nn

The Problem
Ignacio Valdes  	Date: Tue, 16 Sep 2008 16:38:42 -0500
 * Original thread on Hardhats

Let the ordering Configuration begin! This looks like it will be by far the most complicated part of all this.

I have uploaded to the files section a copy of our admission order form: for RTF and as .doc just in case.
 * http://groups.google.com/group/Hardhats/web/ICH-118%20Revised%2007-06.rtf
 * http://groups.google.com/group/Hardhats/web/ICH-118%20Revised%2007-06.doc

What is the best way to proceed in getting this into ordering so that one does not have to go to multiple sub-headings to do a set of orders. I am aware of 'Order Sets' but not if they can be sub-selectable like for instance one does not normally enter urine pregnancy test on males.

The first part, Admitting diagnosis will be a DSM IV Axis I diagnosis. Inpatient, partial and outpatient are covered elsewhere so they are not an issue. I do not know what to do about 'Programs:' as that is a local bed control issue to be done.

So that leaves Precautions which should definitely be executable orders in effect for a certain period and possibly canceled after a period of time, for instance Suicide precautions. How/where should I add the different Precautions into ordering? Same with Restrictions.

When one enters a generic consult, how do consultantee's know that they are being consulted?

How does one 'bundle' Vital signs Pulse, Respriation, BP?

Probably many more questions to come...

-- IV ivaldes		Date: Wed, 17 Sep 2008 11:51:05 -0700 (PDT)

Seems like I am getting into little trodden territory. Is there a CAC manual for defining order sets? If so, can anyone furnish a link to the right manual? -- IV

First Answer, be sure to read the manual
Sam Habiel 		Date: Wed, 17 Sep 2008 19:41:46 -0700

Both the VA and IHS have good manuals on how to do this sort of thing, but you will fumble a little at the beginning.

Go to manual. Or
 * http://www.va.gov/vdl, look for CPRS, and look for the CPRS set-up
 * http://www.ihs.gov/cio/ehr.

Here are the steps:

1.Admitting Diagnosis:         (ICD in Encounter; DSM not available in CPRS)

2. Allergies: (Allergies Component) Height:         Weight:                (vitals) 3.  Admit to:  ÿ Inpatient                    ÿ Partial Hospital Program     ÿ Intensive Outpatient Program (Generic Order; part of an order set possibly)

4.  Programs:  ÿ PICU (Adult)                 ÿ Adolescent Program   □  D.A.P.A.                  ÿ Adult General Program                ÿ Children's Program             □  Other ______________________ (Generic Order etc.)

5.  Precautions:       ÿ Seizure                      ÿ Assault                      ÿ Fall             ÿ Homicidal ÿ Detox                       ÿ Elopement            ÿ Suicide       ÿ Other ____________________ ÿ Sexual Acting Out           ÿ May go off unit to smoke with staff escort & at staff discretion. ÿ Unit restriction first 24 hours       ÿ May go off unit for recreation therapy (Generic Order) 6. Restrictions:       ÿ No Restriction of Telephone and/or Visitors. ÿ Restriction of Telephone, Requires Clinical Justification: ÿ Restriction of Visitors, Requires Clinical Justification: ÿ Complete Personal/Body Search, Requires Clinical Justification ÿ Search personal belongings and pat search, Requires Clinical Justification (Generic Order) 7.  Vital Signs:       ÿ Routine : Q 4 hours while awake X 24 hours ÿ Other: ________________________________________________________________________________________ (Generic Order) 8.  Diet:              ÿ Regular      ÿ Other: _______________________________________________________________________ (Dietetics Order if you use the package; otherwise, Generic Order) 9.  Lab:               ÿ Routine Admit Panel (CMP, CBC, RPR,TSH, T4 FREE) ÿ Urine Pregnancy Test ÿ UDS          ÿ U/A ÿ Other: (Lab order) 10. Tuberculosis Screen:       ÿ PPD  (0.1cc intradermal)     ÿ Chest X-Ray, Clinical Justification: (Text order or Radiology order)

11. Contract Physician or other: ______________________________ for: ________________ (notes; part of history) ÿ History & Physical      ÿ Other: (notes; part of history) 12. Medications:               Children                                                Adults and Adolescents ÿ Maalox 15cc p.o. q 4 h. prn indigestion             ÿ Maalox 30cc p.o. q 4 h. prn indigestion ÿ Tylenol         mg. p.o. q 4 h. prn headache/pain/temp      ÿ Tylenol 650mg. p.o. q 4 h. prn headache/pain/temp (pharmacy orders) AGE 4-5 years 6-8 years 9-10 years 11 years Weight 36-47 LB 48-59 LB 60-71 LB 72-95 LB Tylenol 240 mg. 320 mg. 400 mg. 480 mg. 13. ÿ Psychosocial History 14. ÿ Individual Therapy      ÿ Unit Staff   ÿ Affiliate Staff  (Name of Affiliate Staff) 15. ÿ Family Therapy  ÿ Unit Staff   ÿ Affiliate Staff  (Name of Affiliate Staff) 16. ÿ Chemical Dependency Assessment 17. ÿ Recreation Therapy (14-17: notes) ÿ A.M. ÿ P.M. DATE ORDERED    TIME ORDERED

The way I would do it is as follows, assuming you have lab, pharmacy, and radiology running (if not, you will have to use generic orders).

Create individual generic orders for all your items. There's a steep learning curve, but you eventually get the hang of it. Create quick orders for labs, pharmacy, radiology

Create an order set, possibly several of them depending on the circumastances (e.g. males don't get hcg because... well... because...)

After ordering and signing, create a note template that will include the rest of the information, and that pulls in all orders automatically into the note text.

Your workflow may look like this:
 * 1) Initial evaluation note, saved, not signed.
 * 2) Vitals, Allergies, etc.
 * 3) Order Set.
 * 4) Complete note.
 * 5) Encounter information

- Sam

This is the manual
ivaldes		Date: Thu, 18 Sep 2008 10:23:59 -0700 (PDT)

Is this the right manual?
 * http://www.va.gov/vdl/documents/Clinical/Comp_Patient_Recrd_Sys_(CPRS)/cprssetup.pdf

Sam Habiel 		Date: Thu, 18 Sep 2008 18:03:57 -0700

Yes.

DSM IV Axis I psychiatric diagnoses are in fact available
I, Valdes  		Date: Fri, 19 Sep 2008 09:30:43 -0700 (PDT)

FYI everyone, the Diagnosis dialog DOES have access to apparently all DSM IV Diagnostic and Statistic Manual of Mental Disorders Axis I, however, you have to go to the Other Diagnosis dialog and search for them. It looks good enough for what we do. The mental leap is that the default Psychiatric Diagnosis set has only very basic diagnosis but it seems that all or most with qualifiers ARE available through the Other Diagnosis search.

-- IV I, Valdes 		Date: Thu, 25 Sep 2008 11:14:39 -0700 (PDT)

Try it out
Okay, I tried to put in some text orders into CPRS but when I try to save them as quick orders, it says that the text orders dialog box does not support quick orders. I looked at the CPRS manual setup it looks daunting. -- IV I, Valdes 		Date: Thu, 25 Sep 2008 13:35:41 -0700 (PDT)

Is anyone willing to talk me through creating order sets by phone? If so, please contact me offline. -- IV

I, Valdes  		Date: Fri, 26 Sep 2008 11:45:14 -0700 (PDT)

I spoke to Sam today and we got through much of defining an order set. The full terminal session for this is below. However, the new order set menu did not show up because the system is not 'christened'? Per Sam, the menu below shows the problem which is that system is pointing at BETA.VISTA-OFFICE.ORG and not INTRACARE HOSPITAL INSTITUTION? He said to please post this to Hardhats on how to christen the system.

Select PARAMETER DEFINITION NAME:   ORWOR WRITE ORDERS LIST   Write Orders (Inpatient)

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [BETA.VISTA-OFFICE.ORG] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Full terminal session for creating an order set menu that consists of CBC, TSH and RPR:

Script started on Fri 26 Sep 2008 12:54:09 PM CDT [vista@vista ~]$ gtm

GTM>S DUZ=60 D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: OR PARAM 1  OR PARAM ADD MENU       Assign Primary Order Menu 2  OR PARAM CHART COPY       Chart Copy Parameters 3  OR PARAM COORDINATOR MENU       CPRS Configuration (Clin Coord) 4  OR PARAM IRM MENU       CPRS Configuration (IRM) 5  OR PARAM ORDER MISC       Miscellaneous Parameters Press  to see more, '^' to exit this list, OR CHOOSE 1-5: 3 OR PARAM COORDINATOR MENU     CPRS Configuration~}Configuration (Clin Coord)

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select CPRS Configuration (Clin Coord) Option: ?

AL    Allocate OE/RR Security Keys KK    Check for Multiple Keys DC    Edit DC Reasons GP    GUI Parameters ... GA    GUI Access - Tabs, RPL MI    Miscellaneous Parameters NO    Notification Mgmt Menu ...   OC     Order Checking Mgmt Menu ...   MM     Order Menu Management ...   LI     Patient List Mgmt Menu ... FP    Print Formats PR    Print/Report Parameters ... RE    Release/Cancel Delayed Orders US    Unsigned orders search EX    Set Unsigned Orders View on Exit NA    Search orders by Nature or Status CM    Care Management Menu ...   DO     Event Delayed Orders Menu ... PM    Performance Monitor Report

Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text.

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select CPRS Configuration (Clin Coord) Option: MM Order Menu Management

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option: ?

OI    Manage orderable items ... PM    Enter/edit Prompts GO    Enter/edit generic orders QO    Enter/edit quick orders QU    Edit personal quick orders by user ST    Enter/edit order sets AC    Enter/edit Actions MN    Enter/edit order menus AO    Assign Primary Order Menu CP    Convert protocols SR    Search/replace components LM    List Primary Order Menus DS    Disable/Enable order dialogs CS    Review Quick Orders for Inactive ICD9 Codes

Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text.

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option: QO Enter/edit quick orders Select QUICK ORDER NAME: LRZ CBC NOW Are you adding 'LRZ CBC NOW' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: ? Answer with DISPLAY GROUP NAME Do you want the entire DISPLAY GROUP List? ? TYPE OF QUICK ORDER: LAB LABORATORY NAME: LRZ CBC NOW// DISPLAY TEXT: CBC VERIFY ORDER: N NO DESCRIPTION: No existing text Edit? NO// ENTRY Action:

Lab Test: CBC 1  CBC 2  CBC & MORPHOLOGY (NO DIFF) 3  CBC & MORPHOLOGY (WITH DIFF) 4  CBC PROFILE CHOOSE 1-4: 1   CBC

This is just a test...

SEND TO LAB - Means the patient is ambulatory and will be sent to the Laboratory draw room to have blood drawn. WARD COLLECT - Means that either the physician or a nurse will be collecting the sample on the ward. LAB BLOOD TEAM - Means the phlebotomist from Lab will draw the blood on the ward. This method is limited to laboratory defined collection times.

SP       Send patient to lab WC       Ward collect & deliver LC       Lab blood team Collected By: LC Lab blood team There are no lab collection times defined! Collected By: Collection Sample: BLOOD // Collection Date/Time: N (SEP 26, 2008@13:00) Urgency: Routine How often: once      1600

---                   Lab Test: CBC Collection Sample: BLOOD Specimen: BLOOD Collection Date/Time: NOW Urgency: ROUTINE How often: ONCE ---

(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Select QUICK ORDER NAME: RPR Are you adding 'RPR' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: lab LABORATORY NAME: RPR// DISPLAY TEXT: RPR VERIFY ORDER: N NO DESCRIPTION: No existing text Edit? NO// ENTRY Action:

Lab Test: RPR

SEND TO LAB - Means the patient is ambulatory and will be sent to the Laboratory draw room to have blood drawn. WARD COLLECT - Means that either the physician or a nurse will be collecting the sample on the ward. LAB BLOOD TEAM - Means the phlebotomist from Lab will draw the blood on the ward. This method is limited to laboratory defined collection times.

SP       Send patient to lab WC       Ward collect & deliver LC       Lab blood team Collected By: LC Lab blood team There are no lab collection times defined! Collected By: Collection Sample: BLOOD // Collection Date/Time: N (SEP 26, 2008@13:02) Urgency: Routine How often: once      1600

---                   Lab Test: RPR Collection Sample: BLOOD Specimen: SERUM Collection Date/Time: NOW Urgency: ROUTINE How often: ONCE ---

(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Select QUICK ORDER NAME: TSH Are you adding 'TSH' as a new ORDER DIALOG? No// Y (Yes) TYPE OF QUICK ORDER: lab LABORATORY NAME: TSH// DISPLAY TEXT: TSH VERIFY ORDER: N NO DESCRIPTION: No existing text Edit? NO// ENTRY Action:

Lab Test: TSH The input value contains control characters. Enter a lab test to be ordered for this patient.

Lab Test: rsh ?? Enter a lab test to be ordered for this patient.

Lab Test: tsh     TSH

SEND TO LAB - Means the patient is ambulatory and will be sent to the Laboratory draw room to have blood drawn. WARD COLLECT - Means that either the physician or a nurse will be collecting the sample on the ward. LAB BLOOD TEAM - Means the phlebotomist from Lab will draw the blood on the ward. This method is limited to laboratory defined collection times.

SP       Send patient to lab WC       Ward collect & deliver LC       Lab blood team Collected By: LC Lab blood team There are no lab collection times defined! Collected By: Collection Sample: BLOOD // Collection Date/Time: Now (SEP 26, 2008@13:03) Urgency: Routine How often:

---                   Lab Test: TSH Collection Sample: BLOOD Specimen: SERUM Collection Date/Time: NOW Urgency: ROUTINE ---

(P)lace, (E)dit, or (C)ancel this quick order? PLACE// Auto-accept this order? NO//

Select QUICK ORDER NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option: ST Enter/edit order sets Select ORDER SET NAME: ORZ Routine Admit Panel Are you adding 'ORZ Routine Admit Panel' as   a new ORDER DIALOG? No// Y (Yes) Do you wish to copy an existing order set? YES// NO NAME: ORZ Routine Admit Panel Replace DISPLAY TEXT: Routine Admit Panel DESCRIPTION: No existing text Edit? NO// ENTRY Action: EXIT Action: Select COMPONENT SEQUENCE#: 10 SEQUENCE: 10// ITEM: LRZ CBC NOW

Select COMPONENT SEQUENCE#: 20 SEQUENCE: 20// ITEM: LRZ TSH?? Enter an order dialog; a dialog that is an ancestor may not also be a    sub-item. ITEM: TSH

Select COMPONENT SEQUENCE#: 30 SEQUENCE: 30// ITEM: RPR

Select COMPONENT SEQUENCE#:

Select ORDER SET NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option: MN Enter/edit order menus Select ORDER MENU: ? Answer with ORDER DIALOG NAME Do you want the entire ORDER DIALOG List? ??       You may enter a new ORDER DIALOG, if you wish This is the name of the dialog; entries that were converted from the Protocol file will retain the same name. Namespacing is not required, but still encouraged.

Select ORDER MENU: ??

Choose from: FHWMENU GMRVORMENU OR ADD MENU CLINICIAN OR GMENU ACTIVITY ORDERS OR GMENU ORDER SETS OR GMENU OTHER ORDERS OR GMENU PATIENT CARE ORDERS OR GXMOVE PATIENT MOVEMENT

You may enter a new ORDER DIALOG, if you wish This is the name of the dialog; entries that were converted from the Protocol file will retain the same name. Namespacing is not required, but still encouraged.

Select ORDER MENU: OR ADD MENU CLINICIAN Menu Editor                  Sep 26, 2008@13:09:44          Page: 1 of   3 Menu: OR ADD MENU CLINICIAN                                   Column Width: 26 Sep 26, 2008@13:09:44 +4 Allergies              34 Dressing Change        74 CBC w/Diff 113 I & O                 43 NPO at Midnight        79 LDH Suscept ORDERS... +23 Bed Rest / BRP                                  91 EKG: Portable Order
 * 0 ORDER SETS...          30 PATIENT CARE...        70 LABORATORY...
 * 1 Patient Movement       31 Condom Catheter        71 Chem 7
 * 2 Diagnosis              32 Guaiac Stools          72 T&S
 * 3 Condition              33 Incentive Spirometer   73 Glucose
 * 75 PT
 * 10 PARAMETERS...         40 DIETETICS...           76 PTT
 * 11 TPR B/P               41 Regular Diet           77 CPK
 * 12 Weight                42 Tubefeeding            78 CPK
 * 14 Call HO on                                      80 Urinalysis
 * 50 IV FLUIDS...          81 Culture &
 * 20 ACTIVITY...           51 OUTPATIENT MEDS...
 * 21 Ad Lib                55 INPATIENT MEDS...      90 OTHER
 * 24 Ambulate TID          60 IMAGING ...
 * 25 Up in Chair TID       61 Chest 2 views PA&LAT   99 Text Only

+        + Next Screen  - Prev Screen  ?? More Actions                     >>>

EXIT is not a valid selection. Select Action: Next Screen// q  Q

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select CPRS Configuration (Clin Coord) Option:

Do you really want to halt? YES//

Logged out at Sep 26, 2008 1:12 pm

GTM> GTM>S DUZ=60 D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: XPAR MENU TOOLS      General Parameter Tools

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: LV List Values for a Selected Parameter Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST    Write Orders (Inpatient)

Values for ORWOR WRITE ORDERS LIST

Parameter                     Instance             Value

PKG: ORDER ENTRY/RESULTS REPOR 20                  GMRAOR Allergy ENTER/EDIT PKG: ORDER ENTRY/RESULTS REPOR 55                  PSO OERR PKG: ORDER ENTRY/RESULTS REPOR 60                  LR OTHER LAB TESTS PKG: ORDER ENTRY/RESULTS REPOR 70                  RA OERR EXAM PKG: ORDER ENTRY/RESULTS REPOR 80                  GMRCOR CONSULT PKG: ORDER ENTRY/RESULTS REPOR 85                  GMRCOR REQUEST PKG: ORDER ENTRY/RESULTS REPOR 90                  GMRVOR PKG: ORDER ENTRY/RESULTS REPOR 99                  OR GXTEXT WORD PROCESSING OR

Enter RETURN to continue or '^' to exit: EP

Enter either RETURN or '^'.

Enter RETURN to continue or '^' to exit:

Enter either RETURN or '^'.

Enter RETURN to continue or '^' to exit: ^

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: EP Edit Parameter Values --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME:   ORWOR WRITE ORDERS LIST   Write Orders (Inpatient)

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [BETA.VISTA-OFFICE.ORG] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: 2.7 Division   INTRACARE HOSPITAL INSTITUTION

Setting ORWOR WRITE ORDERS LIST for Division: INTRACARE HOSPITAL INSTITUTION Select Sequence: 10 Are you adding 10 as a new Sequence? Yes//  YES

Sequence: 10//   10 Order Dialog: ? Answer with ORDER DIALOG NAME, or DISPLAY TEXT Do you want the entire ORDER DIALOG List? Y (Yes) Choose from: 1300  FHW OP MEAL FHW SPECIAL MEAL FHW1 FHW2 FHW3 FHW4 FHW7 FHW8 FHWMENU FHWN1 FHWN2 GMRCOR CONSULT GMRCOR REQUEST GMRCR NEUROLOGY INPATIENT GMRVOR GMRVORADMIT V/M GMRVORB/P GMRVORHT GMRVORMENU '^' TO STOP:

GMRVORPULSE GMRVORRESP GMRVORTEMP GMRVORTPR GMRVORTPR B/P GMRVORWT IRON LR OTHER LAB TESTS LRTZ GLUCOSE SERUM SP TODAY LRZ CBC NOW LRZ HEMOGLOBIN AIC LRZ HGB TODAY LRZ LIPID PROFILE LRZ MICROALBUMIN LRZ OCCULT BLOOD LRZ PLATELET TODAY LRZ PT/PTT TODAY LRZ WBC TODAY NUTRITION Neurology Inpatient OR ADD MENU CLINICIAN OR GMENU ACTIVITY ORDERS '^' TO STOP:

OR GMENU ORDER SETS OR GMENU OTHER ORDERS OR GMENU PATIENT CARE ORDERS OR GWCOND CONDITION OR GWDIAG DIAGNOSIS OR GWINST DNR OR GXACTV AD LIB OR GXACTV AMBULATE OR GXACTV AMBULATE TID OR GXACTV BATHROOM PRIVILEGES OR GXACTV BED REST OR GXACTV BED REST / BRP OR GXACTV HOB UP  OR GXACTV MAY LEAVE WARD OR GXACTV OTHER ACTIVITY ORDER OR GXACTV OUT OF BED OR GXACTV PROVIDE TRAPEZE OR GXACTV ROM EXERCISE OR GXACTV TURN PATIENT OR GXACTV UP IN CHAIR OR GXACTV UP IN CHAIR TID OR GXHEMO ARTERIAL LINE '^' TO STOP:

OR GXHEMO ARTERIAL SHEATH OR GXHEMO CARDIAC OUTPUT OR GXHEMO HEMODYNAMICS ITEM OR GXHEMO SWAN GANZ CATHETER OR GXHEMO VENOUS SHEATH OR GXMISC GENERAL OR GXMOVE ADMIT PATIENT OR GXMOVE DISCHARGE OR GXMOVE EVENT OR GXMOVE PATIENT MOVEMENT OR GXMOVE TRANSFER OR GXMOVE TREATING SPECIALTY OR GXNURS CHEST TUBE OR GXNURS GLASCOW COMA OR GXNURS GUAIAC ASPIRATE OR GXNURS GUAIAC EMESIS OR GXNURS GUAIAC STOOLS OR GXNURS NEURO CHECK OR GXNURS NURSING ITEM OR GXNURS PUSH FLUIDS OR GXNURS URINE PH  OR GXNURS URINE SPEC GRAV '^' TO STOP:

OR GXOXGN MASK 35 PER CENT OR GXOXGN MASK 40 PER CENT OR GXOXGN MASK 50 PER CENT OR GXOXGN O2 3 LT NASAL CANNUL OR GXOXGN O2 4 LT NASAL CANNUL OR GXOXGN OXYGEN THERAPY ITEM OR GXOXGN VENTILATOR OR GXPARM CALL HO ON  OR GXPARM I AND O   OR GXRESP CHEST PT   OR GXRESP INCENTIVE SPIROMETER OR GXRESP RESPIRATORY ITEM OR GXRESP SUCTION OR GXRESP TCDB OR GXRESP TRACH CARE OR GXSKIN AIR MATTRESS OR GXSKIN COLD PACKS OR GXSKIN DRESSING CHANGE OR GXSKIN SHEEPSKIN OR GXSKIN SKIN AND WOUND ITEM OR GXSKIN WARM PACKS OR GXSKIN WARM SOAKS '^' TO STOP: ^

Select Sequence:

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [BETA.VISTA-OFFICE.ORG] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: ---

Select PARAMETER DEFINITION NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option:

Do you really want to halt? YES//

Logged out at Sep 26, 2008 1:17 pm

GTM> GTM>S DUZ=60 D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: OR PARAM 1  OR PARAM ADD MENU       Assign Primary Order Menu 2  OR PARAM CHART COPY       Chart Copy Parameters 3  OR PARAM COORDINATOR MENU       CPRS Configuration (Clin Coord) 4  OR PARAM IRM MENU       CPRS Configuration (IRM) 5  OR PARAM ORDER MISC       Miscellaneous Parameters Press  to see more, '^' to exit this list, OR CHOOSE 1-5: 3 OR PARAM COORDINATOR MENU     CPRS Configuration (Clin Coord)

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select CPRS Configuration (Clin Coord) Option: MM Order Menu Management

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option: MN Enter/edit order menus Select ORDER MENU: OR ADD MENU CLINICIAN Menu Editor                  Sep 26, 2008@13:18:27          Page: 1 of   3 Menu: OR ADD MENU CLINICIAN                                   Column Width: 26 Sep 26, 2008@13:18:59 2 +1 Patient Movement       31 Condom Catheter        71 Chem 7 + 3
 * 0 ORDER SETS...          30 PATIENT CARE...        70 LABORATORY...

+        + Next Screen  - Prev Screen  ?? More Actions                     >>> Menu Items               Text or Header            Row

Add: Menu  Menu Items ITEM: ORZ Routine Admit Panel ROW: 20 COLUMN: 1 DISPLAY TEXT: MNEMONIC:

ITEM:

Rebuilding menu display ... Menu Editor                  Sep 26, 2008@13:20:11          Page: 2 of   3 Menu: OR ADD MENU CLINICIAN                                   Column Width: 26 Sep 26, 2008@13:23:07 3 4 + 5

+ Next Screen - Prev Screen  ?? More Actions                     >>>

Select Action: Quit//   QUIT

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select Order Menu Management Option:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select CPRS Configuration (Clin Coord) Option:

Do you really want to halt? YES//

Logged out at Sep 26, 2008 1:23 pm

GTM>h [vista@vista ~]$ exit exit

Script done on Fri 26 Sep 2008 01:23:20 PM CDT [vista@vista ~]$

Christen a new Domain
Sam Habiel Date: Fri, 26 Sep 2008 19:26:50 -0700

I.e. A domain was not created and/or was not pointing to the right institution.

Sam I, Valdes 		Date: Tue, 30 Sep 2008 09:46:56 -0700 (PDT)

Can anyone please guide me as how to rectify this problem? -- IV Nancy Anthracite 		Date: Tue, 30 Sep 2008 14:00:29 -0400

See http://www.hardhats.org/projects/VistA_Install/Vista_Install.html Step 41 or the wiki I, Valdes  		Date: Tue, 30 Sep 2008 14:22:25 -0700 (PDT)

I did steps 41-48 and it worked somehow. However, I had to go back and re-constitute the Routine Admit Panel menu as it did not recognize it immediately then I restarted CPRS and it appeared. An un-wanted side effect is that all of the default Order menu items like labs and such disappeared. Sam says I will have to re-constitute all of that myself unless there is another way to get them back along with the menu I just created?

-- IV

The bad news
Sam Habiel		Date: Thu, 2 Oct 2008 17:01:40 -0700

"Sam says I will have to re-constitute all of that myself unless there is another way to get them back along with the menu I just created?"

Sorry to break the bad news to you: the fact is sites take at least 6 months to get ready for EHR, and a lot of that time (at least 2 months FTE) gets spent on configuring the pharmacy package, the lab package, the radiology package, creating all the quick orders, the menus, hanging the quick orders on the menus, hanging the menus on CRPS, configuring note titles, configuring Allergy tracking, configuring consults and list goes on... To speak nothing of creating TIU Templates, which takes forever depending on how many templates you want to create.

Sam

Restore default ordering menus
I, Valdes  	Date: Fri, 3 Oct 2008 06:43:02 -0700 (PDT)

That's about what I expected, however, I'm still trying to understand why creating a single order set made all the useful default WorldVistA ordering menus disappear? -- IV Sam Habiel		Date: Fri, 3 Oct 2008 11:52:57 -0700

It's done so that you can customize the ordering by division, service, user class etc. Once you set a list at a lower level, it overrides what is set at a higher level. Initially, this didn't work because you didn't have your system set up correctly.

To reconstitute the list, look at orwor write orders list for system, and copy the menus that you see. It should less than take 5 minutes.

Sam

I, Valdes 		Date: Fri, 10 Oct 2008 09:44:51 -0700 (PDT)

So here is the terminal session done with Sam Habiel for how one brings back the default WorldVistA ordering menus after adding a custom order set. I miskeyed a few things such as XBAR instead of XPAR so just note and probably ignore the mistakes I made. This also shows how to change the order such as adding an inpatient medication item. You do the following, then restart CPRS and the menus are all back. I will show in the next note how to remove the inpatient medication list that I have as sequence 5 using the apparently commonly used @

[vista@vista ~]$ gtm

GTM>S DUZ=60 D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: XBAR MENU TOOLS ??

Select OPTION NAME: XBAR MENU TOOLS ??

Select OPTION NAME: XBAR ??

Select OPTION NAME: XPAR MENU TOOLS      General Parameter Tools

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ORWOR WRITE ORDERS LIST ??

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: LV List Values for a Selected Parameter Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST    Write Orders (Inpa tient)

Values for ORWOR WRITE ORDERS LIST

Parameter                     Instance             Value

SYS: VISTA.ICH.LOCAL          10                   ORZ Routine Admit Panel PKG: ORDER ENTRY/RESULTS REPOR 20                  GMRAOR Allergy ENTER/EDIT PKG: ORDER ENTRY/RESULTS REPOR 55                  PSO OERR PKG: ORDER ENTRY/RESULTS REPOR 60                  LR OTHER LAB TESTS PKG: ORDER ENTRY/RESULTS REPOR 70                  RA OERR EXAM PKG: ORDER ENTRY/RESULTS REPOR 80                  GMRCOR CONSULT PKG: ORDER ENTRY/RESULTS REPOR 85                  GMRCOR REQUEST PKG: ORDER ENTRY/RESULTS REPOR 90                  GMRVOR PKG: ORDER ENTRY/RESULTS REPOR 99                  OR GXTEXT WORD PROCESSING OR

Enter RETURN to continue or '^' to exit:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: EDIT 1   Edit Parameter Definition Keyword 2   Edit Parameter Values 3   Edit Parameter Values with Template CHOOSE 1-3: 2 Edit Parameter Values --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME:   ORWOR WRITE ORDERS LIST   Write Orders (Inpatient)

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: 3 System   VISTA.ICH.LOCAL

Setting ORWOR WRITE ORDERS LIST for System: VISTA.ICH.LOCAL

Select Sequence: ?

Sequence Value - 10       ORZ Routine Admit Panel

Select Sequence: 20 Are you adding 20 as a new Sequence? Yes//  YES

Sequence: 20//   20 Order Dialog: PSO OERR Select Sequence: 30 Are you adding 30 as a new Sequence? Yes//  YES

Sequence: 30//   30 Order Dialog: LR OTHER LAB TESTS Select Sequence: 40 Are you adding 40 as a new Sequence? Yes//  YES

Sequence: 40//   40 Order Dialog: GMRAOR Allergy ENTER/EDIT ?? Order Dialog: GMRAOR Allergy The input value contains control characters. Order Dialog: GMRAOR Allergy ?? Order Dialog: GMRAOR ?? Order Dialog: GMRAOR ?? Order Dialog: RA OERR EXAM Select Sequence: 50 Are you adding 50 as a new Sequence? Yes//  YES

Sequence: 50//   50 Order Dialog: GMRCOR CONSULT Select Sequence: 60 Are you adding 60 as a new Sequence? Yes//  YES

Sequence: 60//   60 Order Dialog: GMRCOR REQUEST Select Sequence: 70 Are you adding 70 as a new Sequence? Yes//  YES

Sequence: 70//   70 Order Dialog: GMRVOR 1  GMRVOR 2  GMRVORADMIT V/M 3  GMRVORB/P 4  GMRVORHT 5  GMRVORMENU Press  to see more, '^' to exit this list, OR CHOOSE 1-5: 1 GMRVOR Select Sequence: 80 Are you adding 80 as a new Sequence? Yes//  YES

Sequence: 80//   80 Order Dialog: OR GTEXT WORD PROCESSING ?? Order Dialog: OR GXTEXT 1  OR GXTEXT TEXT ONLY ORDER 2  OR GXTEXT WORD PROCESSING ORDER CHOOSE 1-2: 2 OR GXTEXT WORD PROCESSING ORDER Select Sequence:

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: ---

Select PARAMETER DEFINITION NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ORWOR WRITE ORDERS ??

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ORWOR ??

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: LV List Values for a Selected Parameter Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST    Write Orders (Inpa tient)

Values for ORWOR WRITE ORDERS LIST

Parameter                     Instance             Value

SYS: VISTA.ICH.LOCAL          10                   ORZ Routine Admit Panel SYS: VISTA.ICH.LOCAL          20                   PSO OERR SYS: VISTA.ICH.LOCAL          30                   LR OTHER LAB TESTS SYS: VISTA.ICH.LOCAL          40                   RA OERR EXAM SYS: VISTA.ICH.LOCAL          50                   GMRCOR CONSULT SYS: VISTA.ICH.LOCAL          60                   GMRCOR REQUEST SYS: VISTA.ICH.LOCAL          70                   GMRVOR SYS: VISTA.ICH.LOCAL          80                   OR GXTEXT WORD PROCESSING OR PKG: ORDER ENTRY/RESULTS REPOR 20                  GMRAOR Allergy ENTER/EDIT PKG: ORDER ENTRY/RESULTS REPOR 55                  PSO OERR PKG: ORDER ENTRY/RESULTS REPOR 60                  LR OTHER LAB TESTS PKG: ORDER ENTRY/RESULTS REPOR 70                  RA OERR EXAM PKG: ORDER ENTRY/RESULTS REPOR 80                  GMRCOR CONSULT PKG: ORDER ENTRY/RESULTS REPOR 85                  GMRCOR REQUEST PKG: ORDER ENTRY/RESULTS REPOR 90                  GMRVOR PKG: ORDER ENTRY/RESULTS REPOR 99                  OR GXTEXT WORD PROCESSING OR

Enter RETURN to continue or '^' to exit:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ?

LV    List Values for a Selected Parameter LE    List Values for a Selected Entity LP    List Values for a Selected Package LT    List Values for a Selected Template EP    Edit Parameter Values ET    Edit Parameter Values with Template EK    Edit Parameter Definition Keyword

Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text.

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: EP Edit Parameter Values --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST The input valu e contains control characters. Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST    Write Orders (Inpa tient)

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: 3 System   VISTA.ICH.LOCAL

Setting ORWOR WRITE ORDERS LIST for System: VISTA.ICH.LOCAL

Select Sequence: 5 Are you adding 5 as a new Sequence? Yes//  YES

Sequence: 5//   5 Order Dialog: PSJ 1  PSJ OR PAT OE     2   PSJI OR PAT FLUID OE     3   PSJQ1 EPINEPHRINE 4  PSJZ AMINOPN 1GM CHOOSE 1-4: 1 PSJ OR PAT OE Select Sequence:

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: ---

Select PARAMETER DEFINITION NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option:

Do you really want to halt? YES//

Logged out at Oct 10, 2008 11:30 am GTM>h

Remove an ordering menu with the @ sign
I, Valdes 	Date: Fri, 10 Oct 2008 09:46:40 -0700 (PDT)

Here is how you remove a ordering menu item with use of the @ sign. Pretty simple. Please ignore the few times I went off into the weeds. -- IV

[vista@vista ~]$ gtm

GTM>S DUZ=60 D ^XUP

Setting up programmer environment This is a TEST account.

Terminal Type set to: C-VT100

Select OPTION NAME: XPAR 1  XPAR EDIT BY TEMPLATE       Edit Parameter Values with Template 2  XPAR EDIT KEYWORD       Edit Parameter Definition Keyword 3  XPAR EDIT PARAMETER       Edit Parameter Values 4  XPAR LIST BY ENTITY       List Values for a Selected Entity 5  XPAR LIST BY PACKAGE       List Values for a Selected Package Press  to see more, '^' to exit this list, OR CHOOSE 1-5: ^

Select OPTION NAME: XPAR MENU TOOLS      General Parameter Tools

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ?

LV    List Values for a Selected Parameter LE    List Values for a Selected Entity LP    List Values for a Selected Package LT    List Values for a Selected Template EP    Edit Parameter Values ET    Edit Parameter Values with TemplateSelect PARAMETER DEFINITION NAME:    ORWOR WRITE ORDERS LIST   Writ EK    Edit Parameter Definition Keyword

Enter ?? for more options, ??? for brief descriptions, ?OPTION for help text.

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option: ED   1    Edit Parameter Definition Keyword 2   Edit Parameter Values 3   Edit Parameter Values with Template CHOOSE 1-3: 2 Edit Parameter Values --- Edit Parameter Values ---

Select PARAMETER DEFINITION NAME: ??

Choose from: ANRV GUI VERSION     Active ANRV Executable BPS USRSCR     Display claims for ONE or ALL users DENTV CPT QUICK LIST DENTV CVISION     CVision Setup Parameters DENTV DATE RANGE     Dental Date Range Parameter DENTV DRM ADMINISTRATOR DENTV DRM BOILERPLATE Prompt DENTV DRM DAS TURNOFF     Turn off sending data to DAS (file 221) DENTV DRM DEF ENC TAB DENTV DRM DEF STARTUP TAB     Default DRM Startup Tab DENTV DRM DEF TEMP FOLDER     Temporary Folder Location for PC   DENTV DRM DEF TX TAB      Default Treatment tab display DENTV DRM DIVISION DENTV DRM EXCEL EXTRACT DENTV DRM EXTRACT FOLDER     Default history extract folder DENTV DRM EXTRACT IP  DENTV DRM EXTRACT PORT DENTV DRM EXTRACT SERVER     Excel Extract Server Name DENTV DRM NOTE WIDTH     Progress note wordwrap width DENTV DRM USER CHAR ACCESS DENTV ICD9 QUICK LIST DENTV PAGE SETUP     Printing Page Setup Param DENTV TP CODE BOILERPLATE     CODE BOILERPLATE (COMPREHENSIVE EXAM) DENTV TP DX Prompt     USER OPTION TO ADD DX TO PLANNED ITEMS DENTV TP NOTE OBJECTS     DRM Treatment SYSTEM NOTE DATA OBJECTS DENTV TP NOTE SEQUENCE     NOTE SEQUENCE DENTV TP TREEVIEW DEFAULT     DEFAULT TREEVIEW DISPLAY DENTV TX CODELINKS     Treatment Planning Personal Code Links DENTV TX HNPRESETS     Common Head & Neck Findings DENTV TX SPEEDCODES     Tretment Planning Personal Speed Codes DG PT DIRECTORY CALL CENTER     Enable Patient Directory Call Center DGMT MAPR 0 DEPENDENTS     Max. Ann. Rate - 0 Dependents DGMT MAPR 1 DEPENDENTS     Max. Ann. Rate - 1 Dependents DGMT MAPR GLOBAL RATE     Allowable Medical Expense Rates DGMT MAPR N DEPENDENTS     Max. Ann. Rate - 1+n Dependents DGPF QUERY TRY LIMIT     Patient Record Flags Query Try Limit DGQE VIC REQUEST EXPIRATION     VIC Request Expiration DGQE VIC REQUEST PURGE     VIC Request Purge DGRR PL GENDER     Gender DGRR PL MAX NUM PATIENTS RET     Maximum Number of Patients Returned DGRR PL NUM PATIENTS PER PAGE     Number of Patients per Page ^ Select PARAMETER DEFINITION NAME: EP ??

Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDER LISTS ??

Select PARAMETER DEFINITION NAME: ORWOR WRITE ORDERS LIST    Write Orders (Inpa tient)

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: 3 System   VISTA.ICH.LOCAL

Setting ORWOR WRITE ORDERS LIST for System: VISTA.ICH.LOCAL

Select Sequence: 5

Sequence: 5// @ ...deleted

ORWOR WRITE ORDERS LIST may be set for the following:

1  User          USR    [choose from NEW PERSON] 2  Location      LOC    [choose from HOSPITAL LOCATION] 2.3 Service      SRV    [choose from SERVICE/SECTION] 2.7 Division     DIV    [INTRACARE HOSPITAL INSTITUTION] 3  System        SYS    [VISTA.ICH.LOCAL] 4  Package       PKG    [ORDER ENTRY/RESULTS REPORTING]

Enter selection: ---

Select PARAMETER DEFINITION NAME:

You have PENDING ALERTS Enter "VA to jump to VIEW ALERTS option

Select General Parameter Tools Option:

Do you really want to halt? YES//

Logged out at Oct 10, 2008 11:36 am GTM>h

Woodhouse Gregory 		Date: Fri, 10 Oct 2008 10:26:12 -0700

On Oct 10, 2008, at 9:44 AM, I, Valdes wrote:

> Select OPTION NAME: XBAR MENU TOOLS ??

So, you're a traditional Chomskian at heart? (Look up "X bar theory" in linguistics.)

I, Valdes		Date: Fri, 10 Oct 2008 11:13:30 -0700 (PDT)

I'd say I am an accidential Chomskian but it is a good read on wikipedia. It answers the eternal question as to why o why I had to do all of that sentence diagramming in grade and high school. -- IV

Once again, RTFM
I, Valdes 		Date: Mon, 1 Dec 2008 13:01:11 -0800 (PST)

Sam is there any particular vdl or other document for setting up order sets and pharmacy? -- IV Sam Habiel 		Date: Mon, 1 Dec 2008 14:20:53 -0800

http://www.va.gov/vdl/documents/Clinical/Comp_Patient_Recrd_Sys_(CPRS)/cprssetup.pdf

You need to read this manual from the first page to the end. It's the bible.

Sam

Nurses get ORES key
I, Valdes 		Date: Wed, 3 Dec 2008 13:37:14 -0800 (PST)

The default Nurse ID's in WVEHR have Security Key ORES vs ORELSE. The nurses in admissions frequently take orders by phone (especially late night) from the physicians and sign them on behalf of the physician which the physician then signs later. Is ORES what they should have in this situation?

Per CPRSsetup guide:


 * ORES
 * Assigned to users authorized to write and sign orders.
 * Typically assigned to licensed physician.
 * Allows holders to electronically sign orders.
 * ORELSE
 * Assigned to users authorized to release physician’s orders.
 * Typically assigned to RN’s.
 * OREMAS
 * Assigned to users authorized to release patient orders as signed on chart.
 * Typically assigned to Ward Clerks.

-- IV David Whitten 		Date: Wed, 3 Dec 2008 18:03:50 -0600

I suspect it depends on the practice at the site. If you expect the nurses in admissions to write and sign orders, then you need to give them ORES. I did a search through the code and found that there are two PROTOCOLs which specify Actions for the separate keys:

They look mostly alike, the ORELSE protocol has ORC VERIFY MENU and ORC ALERT RESULTS whereas the ORES one doesn't.

I expect that CPRS can be used to enforce whatever policy your site has.

Best Regards, David

Select OPTION: INQUIRE TO FILE ENTRIES

OUTPUT FROM WHAT FILE: 101  PROTOCOL Select PROTOCOL NAME: ORC ORES ORDER ActionS      Order Action menu for ORES key holders ANOTHER ONE: ORC ORELSE ORDER ActionS      Order Action menu for ORELSE key holders ANOTHER ONE: STANDARD CAPTIONED OUTPUT? Yes//  (Yes) Include COMPUTED fields: (N/Y/R/B): NO// BOTH Computed Fields and Record Number (IEN)

NAME: ORC ORES ORDER [ACTION~|Action]]S ITEM TEXT: Order Action menu for ORES key holders TYPE: menu COLUMN WIDTH: 20                     MNEMONIC WIDTH: 2 ITEM: ORC CHANGE ORDERS                SEQUENCE: 11 ITEM: ORC RENEW ORDERS                 SEQUENCE: 12 ITEM: ORC SIGN ORDERS                  SEQUENCE: 21 ITEM: ORC WARD COMMENTS                SEQUENCE: 34 ITEM: ORC DETAILED DISPLAY             SEQUENCE: 41 ITEM: ORC DISCONTINUE ORDERS           SEQUENCE: 14 ITEM: ORC HOLD ORDERS                  SEQUENCE: 23 ITEM: ORC FLAG ORDERS                  SEQUENCE: 32 ITEM: ORC PRINT ORDERS                 SEQUENCE: 44 ITEM: ORC UNHOLD ORDERS                SEQUENCE: 24 ITEM: ORC UNFLAG ORDERS                SEQUENCE: 33 ITEM: ORC ALERT RESULTS                SEQUENCE: 43 ITEM: ORC COMPLETE ORDERS              SEQUENCE: 22 ITEM: ORC DELAY EVENT                  SEQUENCE: 31 ITEM: ORC REWRITE ORDERS               SEQUENCE: 13 ITEM: ORC RESULTS DISPLAY              SEQUENCE: 42 EXIT Action: D DESELECT^ORCHART(ORNMBR):'$G(OREBUILD) ENTRY Action: S XQORM(0)="1AD\",(XQORM("?"),XQORM("??"))="D ITEMHELP^ORCHART", VALMBCK="",ORNMBR=$P(XQORNOD(0),"=",2) D SELECT^ORCHART(ORNMBR) HEADER: W ""                         MENU Prompt: Select Action:

NAME: ORC ORELSE ORDERActionS ITEM TEXT: Order Action menu for ORELSE key holders TYPE: menu COLUMN WIDTH: 20                     MNEMONIC WIDTH: 2 ITEM: ORC CHANGE ORDERS                SEQUENCE: 11 ITEM: ORC RENEW ORDERS                 SEQUENCE: 12 ITEM: ORC SIGN ORDERS                  SEQUENCE: 21 DISPLAY NAME: Sign/On Chart ITEM: ORC WARD COMMENTS                SEQUENCE: 34 ITEM: ORC DETAILED DISPLAY             SEQUENCE: 42 ITEM: ORC DISCONTINUE ORDERS           SEQUENCE: 14 ITEM: ORC VERIFY MENU                  SEQUENCE: 31 ITEM: ORC HOLD ORDERS                  SEQUENCE: 23 ITEM: ORC FLAG ORDERS                  SEQUENCE: 32 ITEM: ORC PRINT ORDERS                 SEQUENCE: 44 ITEM: ORC UNHOLD ORDERS                SEQUENCE: 24 ITEM: ORC UNFLAG ORDERS                SEQUENCE: 33 ITEM: ORC COMPLETE ORDERS              SEQUENCE: 22 ITEM: ORC DELAY EVENT                  SEQUENCE: 41 ITEM: ORC REWRITE ORDERS               SEQUENCE: 13 ITEM: ORC RESULTS DISPLAY              SEQUENCE: 43 EXIT Action: D DESELECT^ORCHART(ORNMBR):'$G(OREBUILD) ENTRY Action: S XQORM(0)="1AD\",(XQORM("?"),XQORM("??"))="D ITEMHELP^ORCHART", VALMBCK="",ORNMBR=$P(XQORNOD(0),"=",2) D SELECT^ORCHART(ORNMBR) HEADER: W ""                         MENU Prompt: Select Action

Nancy Anthracite 		Date: Wed, 03 Dec 2008 20:32:33 -0500

In the VA, as I understand it, the nurses can write nursing orders and they can take verbal orders that later need to be signed. They do not get the ORES key.

Nancy Anthracite 		Date: Wed, 03 Dec 2008 20:34:13 -0500

Except Nurse Practitioners do get ORES. -- Nancy Anthracite

Episode12 Log Homepage Episode14