Computerized Patient Record System (CPRS)
Patch# OR*3.0*270 Release Notes
January 2007



Department of Veterans Affairs
Health Data Systems
Computerized Patient Record System Product Line
Revision History
The most recent entries in this list are linked to the location in the manual they describe. Click on a link or page number to go to that section.

Date

Patch

Page

Change

Project Manager

Technical Writer

1/16/07

OR*3.0*270

6

Revised link to the patient safety alert and altered some language concerning the BCMA patch release.

M. Braithwaite

T. Robinson

1/11/07

OR*3.0*270

6

Added an action that might address the Sentillion known issue.

M. Braithwaite

T. Robinson

1/8/07

OR*3.0*270

6

Added a statement about reactivating CCOW for BCMA.

M. Braithwaite

T. Robinson

12/7/06

OR*3.0*270

n/a

Initial version.

M. Braithwaite

T. Robinson


Table of Contents
Purpose
Installation Requirements
Required Patches
Patient Safety Issue (PSI)
Reactivating CCOW with BCMA
Known Sentillion CCOW Issue
Purpose
OR*3.0*270 is a patch to address one patient safety issue, PSI-06-145 in CPRS GUI v.26.
Installation Requirements
Required Patches
Before you can install OR*3.0*270, you must install the following required patches:

  • OR*3.0*258


Note:Internet Explorer 4.0 (IE4) or later is REQUIRED in order for GUI version 26.69 to run. However IE 5.5 or later with 128-bit encryption is required for PKI functionality.
Patient Safety Issue (PSI)

  • PSI-06-145: Mismatched Patient Name and Data with CCOW Error (Remedy 166913, 163113, 162746) – Under certain circumstances when using CPRS in context with another application or CPRS session, it is possible that the patient named on the Patient Inquiry button (upper left of toolbar) is a different patient from the patient whose data is displayed in the rest of CPRS. The user has no way of knowing this. This error has been produced in the following scenarios:
  • Scenario 1: This scenario can occur under the following conditions
  • The user is processing alerts in CPRS
  • A CCOW-enabled application, such as Bar Code Medication Administration (BCMA), Vitals, Clinical Case Registries (CCR), a second linked copy of CPRS, etc., is running on the desktop alongside CPRS
  • The applications are sharing context with CPRS so the patients in the applications are synchronized while the user is processing alerts in CPRS.
  • The other application in the background is unable to process a patient change caused by selection of a particular alert without certain consequences (items will be left unsigned, current process will be left incomplete, etc).


When the application cannot handle the patient change, standard CCOW behavior is to alert the user to the inability of that application to change patients, and to provide 3 choices to the user:

  • The user can choose OK, and continue with the patient change in both applications, despite the known consequences.
  • The user can choose Cancel to leave both applications in the existing patient. No changes occur.
  • The user can choose Break link. In this case, the correct behavior would be to leave the CCOW context, change to the newly selected patient, show a broken link, and not affect the background application, which remains linked in context with the existing patient.


Currently, in v26.68 and all earlier released versions, choosing Break link is malfunctioning, but only while processing alerts with another application linked to context in the background. If the user chooses Break Link, it appears that CPRS has indeed changed to the newly selected patient, but only the information on the Patient Inquiry button has actually been changed. All other information in the chart remains that of the previously selected patient. Break Link is already functioning correctly on a patient change initiated by the menu item "File/Select patient", or by the "Select new patient" button on the patient demographics screen.

  • Scenario 2: If a CCOW connectivity error occurs between the Vergence Locator on the desktop and the CCOW vault, when and only when the patient selection screen is visible, CPRS v26.68 does not respond correctly to this error condition after the usual CCOW error message is displayed to the user.
  • If this is the first patient being selected on startup and this error occurs, the selected patient's information will not display on Patient Inquiry button; the button remains in a "no patient selected" state, despite the population of all other chart information for that patient.
  • If a CCOW error while the selection of a second or subsequent patient is in progress, the Patient Inquiry button will still contain the information for the previous patient. All other chart information will be that of the newly selected patient.


  • Related Menu Defect: If a CCOW error is encountered at any time while using CPRS, the user receives a message that CCOW encountered an error, and will be disabled for the remainder of the current session. The "File/Break Link" and "File/Rejoin Link" menu items are greyed out and disabled after this error occurs. In v26.68, selecting a new patient after one of these errors inadvertently results in these menus being completely or partially re-enabled.


Resolution:

  • Scenario 1: The alert processing code in CPRS has been corrected to respond as it should to any user choice on the "Problem changing clinical context" dialog.
  • Scenario 2: CPRS error processing code has been corrected to reflect the correct patient after either of these patient selection errors occurs.
  • Related Defect: These menus are no longer reenabled on every patient change, if a prior CCOW error condition for the session is still in effect.




Reactivating CCOW with BCMA
In National Center for Patient Safety (NCPS) Alert #AL07-03 (http://vaww.ncps.med.va.gov/Guidelines/alerts/Docs/CPRSC COWAL07-03.pdf), sites were previously instructed to edit the BCMA desktop shortcut parameters on all applicable workstations to disable CCOW. A follow-up informational BCMA patch, PSB*3*34, will provide instructions for enabling CCOW and notification of the patch's availability will be posted to the NCPS Patient Safety Log: http://vaww.ncps.med.va.gov/Di alogue/pslog/default.asp.
Known Sentillion CCOW Issue
Although unrelated to the issues corrected here, and common to all VistA CCOW-enabled applications, users should also be aware of the following behavior, recently discovered in internal testing. If a user uses CTRL-ALT-DEL to open Windows Task Manager, and then uses the "End Task" button to terminate a participating CCOW application, the information in the CCOW vault is NOT cleared when that application terminates. A timeout setting in the vault itself determines how long this information remains active, but a typical value is 20 to 40 minutes. Starting a subsequent application following such a shutdown can result in that application utilizing both the existing user and patient contexts if present, and linking automatically to those items on startup.
There is no possible correction to VistA GUI applications to address this Sentillion vault behavior.
Workaround: One possible action would be to reboot the workstation, which will establish a new connection with the vault.