CPRS GUI v.30A (Patch OR*3.0*385)
Department of Veterans Affairs
Office of Information & Technology (OI&T)
Product Development (PD)
Table of Contents
Below is a list of patches that you must verify are properly installed on your system before OR*3.0*385 can be installed:
Although not required for the patch to install, there are many other patches that will need to be installed so that this version of the CPRS GUI will run properly. Please see the CPRS GUI 30.A Installation Guide for further instructions.
CPRS GUI v.30A consists of patch OR*3.0*385 and a GUI executable (cprschart.exe). It is part of the larger effort to change from using ICD-9 codes to using ICD-10 codes. The ICD-10 project requires a large number of patches from numerous packages to make the change from the ICD-9 coding system to the ICD-10 coding system.
The ICD-10 program will oversee the release of all patches on a schedule that enables the complete change to ICD-10 prior to the official implementation date. The patches will be released in groups so that sites are not overwhelmed with more than 30 patches that must be installed all at once. All of the necessary patches will be installed on the affected VA systems, but will not start using ICD-10 codes until the specified ICD-10 activation date arrives. On the specified date, the change should happen seamlessly.
CPRS GUI v.30.A will have a deployment schedule in which groups of sites (sometimes called "waves") will install according to a schedule. Grouping sites for installation ensures that the CPRS development team can appropriately support sites that installing during the specified time period. The CPRS Deployment Manager will contact each site with further details at the time for national release and deployment approach.
For specific information on the CPRS GUI v.30.A installation, please see the CPRS GUI version 30.A Installation Guide.
Delay when First Launching CPRS after Installation
When the user first runs the executable after the CPRS 30.A installation, it may take several minutes for CPRS to come up. With CPRS GUI v.30.A, CPRS configures itself when the user double-clicks the icon, which is a change from past versions. Unfortunately, there is no indicator to tell the user that CPRS is getting ready to run the new version. Users must be patient and let CPRS run through the set up for the new version. If the user continues to click on the icon, multiple CPRS sessions could be launched and the machine may not be able to handle all the sessions.
ICD-10 Coding System Implementation
The Department of Veterans Affairs in compliance with a mandate from the federal government is implementing the new International Classification of Diseases, Tenth Revision (ICD-10) coding system for diagnoses relating to billing purposes and other data capture. The new ICD-10 revision is a much more detailed coding system with new codes, new definitions, and more detailed concepts of medical treatment, such as whether items are a follow-up visit and if the patient is progressing in their treatment or not.
The change to the new ICD-10 system is mandated currently to occur on October 1, 2015. The change will affect any codes related to billing of medical expenses. It is a huge undertaking and there are over 30 patches involved in making this change.
In CPRS, users will see changes in the areas where ICD codes are displayed or entered—especially in encounters and how it relates to the problem list.
Cover Sheet Active Problems Pane
On the Active Problems pane, the hash symbol or pound sign (#) for inactive codes is no longer used. The information will still be available in the detailed display, but CPRS no longer displays this symbol as an identifier in the list of problems.
ICD-10 codes if linked to problems display in the detailed display when the user selects a problem from the Cover Sheet.
- In CPRS GUI v.29, the Problem List was changed to use only SNOMED codes for newly entered problems, but the coding system for billing purposes was still ICD-9.
Prior to the ICD-10 implementation date (October 1, 2015), the Problem List software within CPRS GUI 30.A will function as it currently does in CPRS v.29. However, once the ICD-10 implementation date becomes active, the ICD features of the Problem List will be enabled. New problems added to the Problems List by default are assigned an ICD-10 code of R69, which is equivalent to the 799.9 code in ICD-9. If the provider assigns a more specific code to a problem during Encounter checkout, the specified ICD-10 code will display in the Detail view of the problem. There is no direct mapping of SNOMED codes by which problems are defined on the Problem List and ICD-10 codes that are used for encounter checkout and billing purposes. The provider will have to manually assign the ICD-10 code to the problem during Encounter checkout.
- Other Diagnosis… - On the Diagnosis tab, providers can select the Other Diagnosis… button to search the Lexicon and select a specific ICD-10 code. The search results will be displayed in a tree view format.
- Assigning a Problem an ICD-10 Code
- Unspecified (R69) ICD-10 Codes - On the Encounters' Diagnosis tab, there is a pane on the left of the dialog that shows categories (Problem List Items and Encounter forms) that providers can use to select the diagnosis for the encounter. When the Problem List Items category is selected, CPRS displays in the pane to the right all problems from the Problem List. CPRS v.29 filtered some items from the Problem List Items category, but CPRS GUI v.30.A shows all items from the Problem List.
Providers can select one or more problems from the Problem List as a diagnosis for the visit, but if the problem is expressed as a SNOMED term and code, the provider must select an ICD-10 code for the diagnosis. All new problems entered on the Problem List are expressed as SNOMED terms and codes and given a default ICD-10 code of R69 (illness, unspecified), which is equivalent to the 799.9 code in ICD-9. The R69 code must be changed to a more specific ICD-10 code. When the user selects a SNOMED code, CPRS brings up the Lexicon Look Up dialog so that the provider can look up and select a specific ICD-10 code for the diagnosis.
- Problems with an Inactive ICD-9 Code – Because all problems from the Problem List display when the provider selects the Problem List Items category, a provider may select problem that has an inactive ICD-9 code that will need to be updated to use an ICD-10 code. Problems with inactive ICD-9 codes will have a hash (#) symbol by them in the Encounters display. If the user selects a problem with an inactive code, CPRS brings up the Lexicon Look Up dialog so that the provider can look up and select a specific ICD-10 code for the diagnosis.
After the provider selects and ICD-10 code, CPRS again brings up the Lexicon Look Up dialog so that the provider can look up and select a specific SNOMED code for the problem so that the Problem List is updated with the new ICD-10 code.
- Adding a Diagnosis Back to the Problem List – After selecting an ICD-10 diagnosis, the provider has the option to add it back to the Problem List by highlighting the diagnosis and checking the Add to Problem List check box. However, now that the Problem List uses SNOMED codes, CPRS brings up the Lexicon Look Up dialog so that the provider can look up and select a specific SNOMED code for the problem.
- Display of Diagnoses for the Encounter – On the Encounters' Diagnosis tab, the selected diagnosis is displayed in a pane below the categories and specific items. If a SNOMED problem is selected for Encounter checkout, the associated mapped ICD description, coding system, and diagnosis code will be displayed.
On the Consults tab, providers often use the Lexicon search to look up a provisional diagnosis. After the ICD-10 activation date, those Lexicon searches will now use ICD-10.
On some Clinical Reminder dialogs, providers can make selections that will use diagnosis codes. After the ICD-10 activation date, those codes will now be ICD-10 codes.
Some Health Summary components display ICD codes. As new codes are added in the new coding system, those codes will display in health summaries with the ICD description, the coding system, and the code.
- Discontinuing Existing Orders Creates Duplicate Order with Right Click Sign Option in CPRS Orders Tab (CQ 21308) – In CPRS v.29, a problem occurred when a provider selected orders to discontinue and then did a right-click sign action. The orders were displayed twice on the Orders tab.
Resolution: CPRS developers corrected the problem and the order is displayed correctly only once.
- Unsigned Order Alert Doesn't Fire if User Aborts before Entering PIV PIN Number (CQ 21289) – In CPRS v.29, a defect was found that involved an unsigned order alert not firing if the provider began the process but aborted the signing process before entering their PIV PIN.
Resolution: CPRS developers corrected this problem. If the user begins the signature process but does not enter their PIV PIN, the orders requiring the PIN will not be signed and the unsigned order alert will now be generated correctly.
- View Icon Legend Displays Error Message (CQ 21241) – In CPRS v.29, the Icon Legend dialog did not work correctly. A change in the code inadvertently created a situation in which when the user selected View | Icon Legend, CPRS displayed an error message.
Resolution: Developers correctly the problem and the Icon Legend now displays correctly. If your site chose to use the workaround and put an item on the Tools menu to reach the web page with the icon legends, you may want to remove the items from the tools menu. Instructions for this can be found in the CPRS Technical Manual: GUI Version.