S02_Attachment_22_Laboratory_Implementation_Manual_VISTA.pdf

LABORATORY

PLANNING AND IMPLEMENTATION

GUIDE

Version 5.2

October 1994

(Revised November 2016)

Department of Veterans Affairs

Office of Information and Technology (OI&T)

Attachment 22 - 36C24919R0003

Revision History Date Page

Number(s) Description Author

November 2016 Pages 35, 44, Patch LR*5.2*465 - This patch enables multidivisional facilities to customize the number of labels required for each site in LABORATORY TEST File (#60) by adding two new fields that can be configured for a specific lab test at a specific facility: The INSTITUTION EXTRA LABELS field (#60.15,.01) and the NUMBER OF LABELS subfield (#60.15,1).

L. Behuniak, PM; N.

Muller, TW

June 9, 2005 494-495 Patch LR*5.2*257- The Microbiology Trend Report [LRMITS] option is enhanced to sort the ‘Antimicrobial Trend Report’ by DIVISION.

Marge Norris ii Laboratory V. 5.2 October 1994 Planning and Implementation Guide

Preface

The Laboratory Planning and Implementation Guide (PIG) Version 5.2 is designed to provide the Department of Veterans Affairs Medical Center (VAMC), Information Resources Management Services (IRM), and the Laboratory Information Manager (LIM) with the necessary information required to efficiently and effectively implement, maintain, and manage Laboratory Version 5.2 software package.

This documentation provides sufficient information about the software package for IRM personnel and the LIM to operate and maintain the software without additional assistance from software package developers. This Planning and Implementation Guide V. 5.2 was created to fulfill that requirement.

October 1994 Laboratory V. 5.2 iii

Preface iv Laboratory V. 5.2 October 1994

Table of Contents

INTRODUCTION

PURPOSE

Area of Application Organization of Manual Functional Description Laboratory Module Work Flow

ORIENTATION

PACKAGE SPECIFIC NOTATIONS

SIGNING ON

SIGNING OFF

IF YOUR TERMINAL WILL NOT WORK

IMPLEMENTATION AND MAINTENANCE

SYSTEM INTEGRITY CHECKS

Check files for inconsistencies [LRCKFILES] Check patient and lab data cross pointers [LRCKPTR]

LABORATORY PACKAGE ROUTINE INTEGRITY MENU

Lab Routine Integrity Menu Loop thru LR Integrity [LR Integrity Loop] Load Integrity File [LR Integrity Load] Check a Single Routine Size [LR Integrity Single] Other Laboratory Configurable Files Laboratory Files Not To Be Edited Add a new data name File Structure/Interaction Editing The Files Laboratory Files Field Descriptions

GENERAL LABORATORY

Menu Description Menu Management Laboratory Options List Distribution Of Menus List of Menus with Entry or Exit Action

October 1994 Laboratory V. 5.2 v

Laboratory Security Keys Workflow/Procedures Implementation/User Hints Collection of Specimens Organizing Your Workload Data Entry, Review, and Verification Data Modification (General Laboratory) Record-Keeping Lab Labels Implementation/User Hints Workload Implementation (General Laboratory)

ANATOMIC PATHOLOGY

AP Implementation Microfiche of Path Reports

BLOOD BANK

Implementation Objectives Supervisor Menu Adapting the Blood Bank Menu to Fit Your Needs Bar code Readers Training Information Blood Bank Workload Implementation Meeting American Association of Blood Bank (AABB) Accreditation Requirements - VA Decentralized Hospital Computer Program

MICROBIOLOGY

Setting Up Your Files References Storage Of Antimicrobial Results Comments on Reports Reports Microbiology Workload Implementation Microbiology LMIP/Workload

MULTIDIVISIONS IMPLEMENTATION

Preliminary Preparation Setting Up The Files Accessioning in a Multidivision Facility Automating An Ancillary Test Site

UPLOADING AND DOWNLOADING WITH A PC

Uses vi Laboratory V. 5.2 October 1994

Equipment Needed Software Needed Direct Connects Modem Connects Speed of Transmission Protocols Security Upload Sequence Download Sequence

PREVENTATIVE MAINTENANCE

TROUBLESHOOTING

Labels Test Missing Delta Check Entry/Verification problems Load/Worklist Ward Order Entry Reports FileMan problems Collection list

CUMULATIVE REPORT

Further Cumulative Functionality (Version 5.2) TaskManager Device Parameters Structure Formatting of the Cumulative Relationship to Files #64.5 and #60 Cumulative Reprint Options Updating the Cumulative Report

INTERIM REPORTS

Menu Options (Manual) Tasking the Interim

SUPERVISOR’S REPORT

INTERFACE GUIDE FOR OE/RR PACKAGE

PURGING AND ARCHIVING

FORCE CUMULATIVE DATA TO PERMANENT PAGE [LRAC FORCE]

PURGE OLD ORDERS AND ACCESSIONS [LROC]

October 1994 Laboratory V. 5.2 vii

ARCHIVING DATA

GLOSSARY

INDEX

viii Laboratory V. 5.2 October 1994

INTRODUCTION

October 1994 Laboratory V. 5.2 1

Introduction

2 Laboratory V. 5.2 October 1994

Purpose

The purpose of the Laboratory Planning and Implementation Guide (PIG) V. 5.2 is to provide Information Resources Management Service (IRM) and Laboratory Information Manager (LIM) with a description of the package setup, special capabilities, files, security, and data dictionaries.

Familiarity with the fundamentals of VA FileManager, Laboratory User Manual, Blood Bank User Manual, Anatomic Pathology User Manual, and the Laboratory Technical Manual is assumed.

Area of Application

The Laboratory V. 5.2 package covers every functional area of the Clinical Laboratory:

• Anatomic Pathology • Results Reporting

• Blood Bank • Serology

• Chemistry • Surgical Pathology

• Coagulation • Test Accessioning/Ordering

• Hematology • Toxicology

• Microbiology • Urinalysis

• Phlebotomy • Auto Instrument

• Quality Control • Workload Recording

Organization of Manual

This manual is organized into major chapters plus an Introduction and a Glossary for the complete guide. The chapters represent functional content areas or issues to be addressed in package implementation and maintenance.

Other manuals relevant to the Laboratory package are:

• Anatomic Pathology User Manual*

• Blood Bank User Manual*

• Laboratory User Manual*

• Laboratory Technical Manual*

• VA FileManager User Manual*

• VA FileManager Programmer Manual

• Users Guide To Computing*

• MailMan User Manual*

• Kernel Systems Manual

• Kernel Technical Manual

Functional Description

October 1994 Laboratory V. 5.2 3

• What is the Laboratory Package?

The Laboratory package is part of the integrated Decentralized Hospital Computer Program (DHCP) Core Package and a clinically oriented system designed to provide data to health care providers as well as to other health care personnel. Its primary function is to assist the Pathology & Laboratory Medicine Service in managing and automating the workload and reporting process. The Laboratory package includes software for all major functional areas; selected examples of software modules are illustrated in this section.

• Who does the Laboratory package serve?

Health Care Providers/Other Health Care Providers:

The Laboratory package is a clinically oriented application, designed to provide data to health care providers as well as to other health care personnel. For this reason, it is a multifaceted package with many spin off advantages for other hospital services. Its primary function is to assist the Pathology & Laboratory Medicine Service in managing and automating workload generated by the Medical Center primary mission.

• Who can use the Laboratory Package and for what purpose?

The Health Care Provider:

The Laboratory package provides a method for Health Care Providers to place requests into the system for collection and analysis of patient’s specimens. It also provides a means of tracking work activities to completion and reporting. When results become available, users may view the results in a variety of formats.

The Clinical Pathology & Laboratory Medicine Service:

The package provides methods of identifying and processing workload.

Test result values are accepted from manual input and/or automated instruments and test data is displayed for review before verification.

After verification, the results may be automatically distributed to appropriate locations throughout the institution.

Data is provided for management reports and administrative support.

• What are the benefits of the Laboratory Package?

Lab test information is more accurate, timely, and accessible.

Status of orders is more accessible to lab and hospital personnel.

Abnormal and critical values can be flagged to assist in verification and review of data.

Quality control data can be collected, automatically performed, and reported.

Delta checks can be made on a series of data to establish trends or significant clinical variations in value.

4 Laboratory V. 5.2 October 1994

Functionality

• Phlebotomy/Ordering

Supports ward order entry

Reports status and transactions of tests

Prints collection lists/labels

Tracks the laboratory accession numbers and order numbers

Provides maximum ordering frequency (number per day, daily, user defined limits)

Flag duplicate orders

Processes special ward instructions at time of ordering.

• Specimen Processing

Provides worklists by urgency and accession number (instrument specific)

Produces incomplete lists

Produces workload/data capture reports

Produces review lists for verification of data

• Verification/Release of Data

Provides Delta Checks, flagging high/low/critical results

Provides customized input checking

Provides automatic calculations (e.g., LDL)

Supports review/verification by group or individuals accessions

Unidirectional and Bidirectional Auto Instrument Support

• Reports

Produces supervisory management reports, audit trail reports, system integrity reports, and quality assurance and utilization review reports

Produces discharge summaries and cumulative and discrete episode reports

Produces automatic transmission of data at time of verification to the ordering location

Provides quality control

October 1994 Laboratory V. 5.2 5

Provides search capabilities (SNOMED criticals, HI-LO)

Provides Antimicrobial Trend Reports

Provides Infection Control Reports

Provides Health Department Reports

Provides multiple reports of microbial interpretation

Provides searches for cytological agents with defined antimicrobial patterns.

6 Laboratory V. 5.2 October 1994

Laboratory Module Work Flow

Multipurpose Accessioning or Send Patient

Creation of Collection List

Accession Test Ordered by WOE

Enter/verify data Manual/Auto

Results Reporting

Interim Reports General Reports Collected Tests

Cumulative Reports

Management Reports

Quality Control/ Quality Assurance

Ward Collect

OE/RR

Receipt/accession Routine Lab Collect

Phlebotomy Collection

October 1994 Laboratory V. 5.2 7

8 Laboratory V. 5.2 October 1994

ORIENTATION

October 1994 Laboratory V. 5.2 9

Orientation

10 Laboratory V. 5.2 October 1994

Package Specific Notations

This section describes symbols used to indicate terminal dialogues or user responses in this manual.

Special Commands, Keys and Conventions

The keyboard you will work on is similar to that of a typewriter. However, there are some additional keys and functions you will be using. Here is a list of the common ones that you will use.

COMMANDS:

Continue Entered at any point, it will terminate your session immediately, but the computer remembers what you were doing when you terminated.

When you log on again, you will be asked if you want to continue at that same point. Some systems have not activated this functionality.

Check with your LAC or IRM.

Halt Enter halt at any menu level will terminate your session immediately.

Press Press indicates 1 keystroke.

Example: Press the RETURN key.

KEYS:

Control (CTRL) The CONTROL key is like a second shift key. It is held down while pressing another key.

CTRL/C gains the attention of the computer. It interrupts current activity at that terminal.

CTRL/S stops the printing. Useful when viewing a listing longer than your screen length. Some terminals have HOLD Screen or SCROLL/NO SCROLL for stopping scrolling.

CTRL/Q causes printing or scrolling to resume after CTRL/S has been used.

CTRL/U deletes current input line if <RET> has not t been pressed.

Enter or Return There are three uses for the RETURN or ENTER key (denoted in this manual as <RET>):

• Entering information each time you respond to a prompt, you must press <RET>.

• Accepting a default just press <RET>

October 1994 Laboratory V. 5.2 11

• Skipping a prompt will allow you not to enter any information in response to a prompt. You may press <RET> and the next prompt will appear if the previous prompt was not mandatory.

Delete or Backspace This key will deletes previous characters one at a time.

Up-arrow ^ Up-arrow “^” is (shift 6). This key will terminates the line of questioning you are in and returns you to the previous level in the routine. If you continue to enter “^” you can exit the menus and the Laboratory package.

PROMPTS:

Device A device prompt allows you to select a device for printing output. You may always enter Q for QUEUE when you are asked for a device, and then you will be asked to specify the device name and the time to print.

Press ^ To Exit This process will terminate within the selected option. The screen will return to the menu you selected the option from.

NOTE: You must respond to some prompts in order to use the rest of an option. These prompts are called mandatory prompts. In these cases, the system supplies a message indicating that you MUST enter a response before continuing. You can use ^ to escape from the prompt but you will lose all information previously entered.

Deleting an entry

If you wish to delete the answer, enter @ (upper case 2) following the slashes:

Temporary Address: 888 Fifth St, Ogden, Utah// @

You will be asked “Do you really want to delete?”

If you answer “YES”, this leaves the temporary address value blank.

12 Laboratory V. 5.2 October 1994

Space bar convention

On a Select question, if you wish to enter the same answer just previously used for that question, you may respond with a space bar and <RET> for that question. The computer will enter the same response for that question as was most recently entered for it.

Example: You may wish to do a series of procedures for one patient. Each time (after the first) you are asked for Patient Name, you may enter a space bar and <RET> and the computer will select the same patient name.

Date And Time Format

Date and time can be entered in a variety of ways: (Your response is in the bold letters).

October 10, 1950

OCT 50

TODAY or T (today) T-1 (yesterday) T+1 (tomorrow) T-4W (4 weeks ago) NOW or N (Now)

10OCT@10AM (October 10 at 10: AM; current year is assumed if not entered) 3/10 (March 10 of the current year)

How To Go Back To A Previous Question Or Exit Option

To terminate a series of questions, enter “^” (shift 6) in response to the displayed question. Since this returns you to a previous level, you may need to enter “^” several times to exit the program or return to the level you wish. If you want to return, or go forward enter “^” and the name of the desired question.

Example:

YEAR OF BIRTH: 1950

SSN: 123456789

ADDRESS: ^YEAR

YEAR OF BIRTH: 1950// 1951

SSN: 123456789// <RET>

In this sequence, you needed to change the date of birth when you were at the address question. By entering ^ and the first few letters of the desired question, you returned and entered the correct date of birth.

October 1994 Laboratory V. 5.2 13

Help

If in doubt as to possible answers to what is being asked, or the correct format to use, always enter ?

and the computer will respond with an explanation and then repeat the question to you.

Prompts/Cursor

A prompt is an instruction the computer gives you on your terminal screen, followed by a colon (:)

and a cursor. The prompt tells you what kind of information the computer is looking for (such as, Select NAME:), and the cursor tells you the computer is ready for you to type the information on your keyboard and send it to the computer (by pressing the enter or return key). The most common cursor is a flashing rectangle, but it may be a flashing or steady line or rectangle.

Select Option:Select Option:

The entries you type into the computer are always indicated in this manual by bolded letters. The bolded parts of the entry are the letters that must be typed in so that the computer can identify the response. In most cases you need enter only the first few letters. This increases both speed and accuracy. A different font type (Courier, 10 point) is used to indicate “computer dialogue.”

This arrangement will look like the following example where LABPATIENT, ONE is the name that the user types in response to the “Select PATIENT:” prompt.

Select PATIENT: LABPATIENT, ONE

14 Laboratory V. 5.2 October 1994

Types of prompts

The package uses prompts to ask questions. Several types of prompts may be used to supply the information.

• Basic Prompt

Most prompts in the package ask a question or indicate the type of information to be supplied, followed by a colon.

Example: The computer asks for date of birth.

You enter October 10, 1950.

Date of Birth: October 10, 1950

• YES/NO Prompt

If the question requires a “YES” or “NO” answer, it may end with a question mark.

Are you sure you wish to delete? YES

You may just type a “Y” or a “N”.

• Select Prompt

If the question you are asked involves an answer chosen from a list, then the word Select may be used:

Select PATIENT:

If you need the list of valid answers, enter ? and the computer will respond with instructions and/or a list, and then asks you the same question again:

Select PATIENT: ?

Choose from:

LABPATIENT, ONE

LABPATIENT, TWO

LABPATIENT, THREE

Select PATIENT: LABPATIENT, ONE

October 1994 Laboratory V. 5.2 15

If the list is long, you will be asked if you want to see the entire list. The list presented to you will stop when the CRT screen is filled. To continue press <RET>, to stop the list enter “^” (shift 6).

If your answer is not on the list, sometime you may be allowed to add it:

Select PROVIDER NAME: LABPROVIDER, ONE

The computer beeps and asks you:

Are you adding LABPROVIDER, ONE as a new provider name: YES

Answer “YES” and the computer will enter LABPROVIDER, ONE into the valid answer list. If you had answered with anything but “YES”, it would disallow the addition of the provider and repeat the question.

If you enter the first few letters of a response and there are multiple responses starting with that letter or combination of letters, the computer will respond and ask for a choice:

CHOOSE FROM: 1. PRINT

2. PROFILE

Select 1 Thru 2: 1

• Default Prompt

Some questions have a most probable answer or default answer:

IS IT OKAY TO DELETE? NO// <RET>

In this case, if you press <RET>, you agree with the probable answer of “NO”. If you enter “YES”, that answer will be accepted instead of the current entry “NO”. The most probable answer is always followed by two slashes. If you are editing a question which already has an answer, the two slashes ask if the answer is still okay. If not, you may enter the new answer following the slashes:

SSN: 123456789// 000000001

16 Laboratory V. 5.2 October 1994

Signing On

Turn on the terminal using the on/off switch (unless your terminal is left on at all times). Some terminals turn off the display if no keystroke has been received for a few minutes. Touching any key will restore the display. After turning on the terminal, press the Return key to get the attention of the computer (a blinking cursor will appear).

You must have a personal access and verify codes before the computer will respond to you. These are to provide security for computer data. Your site manager or LIM will give you access and verify codes, which you must memorize and keep to yourself.

The ACCESS CODE and VERIFY CODE will not be displayed on the screen, to protect the security of the system.

After turning on the terminal, press <RET> to get the attention of the computer (a blinking cursor will appear).

If there is no cursor on the screen after you have turned the terminal on, check all power connections and connections between the keyboard and CRT. If you still get no response, contact your LIM.

If you do get a blinking cursor, press <RET> and you should see the access code prompt. If you are unable to get a response after you press <RET>, press CTRL/Q, and <RET> again. If the cursor still does not move, contact your LIM.

If you do get the proper response, you should see a screen that looks like the following example.

Example:

ACCESS CODE: ACCUSER (these responses will not show) VERIFY CODE: VERUSER (up on the screen)

GOOD AFTERNOON, LABUSER, TWO

Select LABORATORY OPTION: M

If access is denied, re-enter your codes. (especially checking for misspellings or typos).

If you receive the message:

DEVICE LOCKED

You must wait a minute or so before trying to sign on again. This message means that an incorrect code has been entered. As a security precaution, the number of consecutive SIGN ON tries is limited.

October 1994 Laboratory V. 5.2 17

Signing Off

Once you have completed your work, it is important to sign off, so that someone else can not do work in your name.

If Your Terminal Will Not Work

Check to make sure the <CAPS LOCK> is on. Occasionally the computer does not recognize small letters.

Check to see if the <NO SCROLL> has been pressed. Press <NO SCROLL> again.

Check to see if <CTRL S> has been pressed. Press <CTRL Q>.

If none of these works, check with your application coordinator or site manager.

If the computer is very busy because of many users working on it at the same time, it frequently will become very slow, even coming to a standstill at times. Just be patient, or try to arrange your time at the terminal for when there won t be so many users.

Warning Symbol

*WARNING: The warning symbol indicates that the action to be performed is critical. This symbol is used in the documentation to alert you to a critical action.

Note Box

NOTE: The note box indicates that a special action maybe required or that the documentation is trying to call your attention to a significant point.

18 Laboratory V. 5.2 October 1994

IMPLEMENTATION AND MAINTENANCE

October 1994 Laboratory V. 5.2 19

Implementation and Maintenance

20 Laboratory V. 5.2 October 1994

System Integrity Checks

Check files for inconsistencies [LRCKFILES]

This option includes the check from LRCKPTR plus additional checks on potential inconsistencies in various files. The following is a list of some of the messages that might be generated if there are discrepancies or problems. There are several routines that run when this option is called up. This option is most useful when you are initially setting up your files.

NOTE: Only the first 20 errors are totaled for the section, but a total error count is provided with the group.

Messages: Messages are labeled either: F (fatal) or W (warning).

NOTE: Fatal indicates potential problems with various software functions. Consult your IRM and then your Regional ISC if necessary.

From File #60 check: The user can choose not to check tests that are defined as NEITHER in the TYPE field when the option is selected.

F - A test can not be Atomic and Cosmic at the same time.

W - Atomic test has no site/specimen; therefore, no units or range F - Test must have a HIGHEST URGENCY value F - The data name field must be re-entered to set up location and field F - BAD Data name F - Needs a print name entered W - Does not have a print order F - BAD pointer to the ACCESSION file (#68) F - BAD lab collection sample pointer to the COLLECTION SAMPLE file F - BAD pointer to the PROCEDURE file (#61.5) F - BAD Edit code pointer to the EXECUTE CODE file (#62.07) F - BAD Batch data code pointer to the EXECUTE CODE file (#62.07) F - BAD pointer in panel F - Test is on its own panel (infinite loop) F - BAD entry in Specimen/Site subfile F - BAD Specimen/Site subfile pointer to TOPOGRAPHY FIELD file (#61) F - BAD type of pointer to DELTA CHECKS file (#62.1) F - BAD collection sample pointer to COLLECTION SAMPLE file (#62) F - BAD required comment pointer to EXECUTE CODE file (#62.07)

October 1994 Laboratory V. 5.2 21

From File #68:

F - Missing the LR subscript W - Missing the print order F - Has no abbreviation F - BAD common accession # pointer to the ACCESSION file (#68) F - BAD accession transform pointer to the EXECUTE CODE file (#62.07) F - Accession transform field and EXECUTE CODE file (#62.07) not match F - BAD verification code pointer to the EXECUTE CODE file (#62.07) F - Verification code and EXECUTE CODE file (#62.07) don t match F - Does not have an accession W - Does not have an order number F - Does not have an Order on file F - BAD pointer to test LABORATORY TEST file (#60) F - BAD pointer to URGENCY file (#62.05) F - BAD pointer to the specimen COLLECTION SAMPLE file (#62) F - BAD pointer to COLLECTION SAMPLE file (#62) F - BAD instrument pointer to the AUTO INSTRUMENT file (#62.4) F - BAD control name pointer to the LAB CONTROL NAME file (#62.3)

From File #69:

F - Entry LRDFN in ^LR( is missing F - Does not have an ORDER number F - BAD pointer to COLLECTION SAMPLE file (#62) F - BAD pointer to the USER file (#) F - BAD pointer to the LABORATORY TEST file (#60) F - BAD pointer to the URGENCY file (#62.05) F - BAD pointer to the ACCESSION file (#68) F - BAD pointer to the specimen TOPOGRAPHY file (#61)

From Files # 68.2 and 62.4

F - MISSING ZERO NODE

F - Has duplicate routine entry F - SYSTEM MUST have a device to get the data from F - Has no program name. This will prevent data processing F - MUST have a LOAD/WORK LIST entry F - Enter a number has a BAD test pointer W - A sequence/batch should have 0 cups/tray F - BAD pointer in the LOAD transform field F - BAD pointer in the INITIAL setup field F - Does not have a profile defined F - Has a BAD test pointer F - At least one test of the panel MUST NOT be build name only F - BAD accession area pointer

NOTE: Warnings are not critical and in most situations can be ignored. However, if you are experiencing problems with a particular item, please investigate. Consult your respective IRM if uncertain of the impact.

22 Laboratory V. 5.2 October 1994

All of the F or W messages give you a place to start looking within each file mentioned. Most of them you can fix by making required field changes. Some will have to be fixed by using some of the utility functions of VA FileMan or re-cross referencing certain fields within files. If the “fix” is not evident to you, ask your IRM for help.

You should run this check every three months and after any unscheduled downtimes.

Check patient and lab data cross pointers [LRCKPTR]

This option should probably be run on some kind of routine basis (monthly would probably be more than adequate). This could be part of a laboratory quality assurance program to verify the internal consistency of the laboratory data files. The program goes through each file to see if there is an LR pointer. If there is, it then looks to see if that pointer is correct. The program then goes through the lab data file to see what file is being pointed to and makes sure there is a corresponding entry in that file.

October 1994 Laboratory V. 5.2 23

LAB TEST CYCLE CHART

Phlebotomy Collection

Receipt of Specimens

Orders & Accessions created in

Lab

Processing of Specimens

(worklists, Accessions, etc.)

Ward Orders

Verification of results

Test Results

Other Reports

Globals Removed by Purg (^LRO, ̂ LAM, ^LAC), Archiving (̂ LR)

^LRO(69,DATE,1,LRSN

^LRO(68 & ^LRO(69 Updated

^LR(LRDFN,LRSS,LRIDT Created ^LRO(68 & ^LRO(69 Updated

^LA,^LAH,^LRO(68.2 CREATED (opt.)

^LR & ̂ LRO(68 &

^LRO(69 Updated

(x-ref for reporting set)

LRNIGHTY BUILDS

^LRO(67.9 workload

^LAM ( WKLD

^LAC( BUILT

for cumulative

Lab Test Cycle Chart

24 Laboratory V. 5.2 October 1994

Laboratory Package Routine Integrity Menu

Lab Routine Integrity Menu

This menu is designed for Site Managers to provide the means to load LR ROUTINE INTEGRITY CHECKER file (#69.91) with data after the Laboratory package installation. This menu also provides a method to view data on a single routine. The Lab Routine Integrity Menu loops through File #69.91 to determine if any routines have been changed/edited. The Lab Routine Integrity Menu [LR INTEGRITY] is composed of three options:

1) [LR Integrity Load]

2) [LR Integrity Loop]

3) [LR Integrity Single]

This menu is also designed for support persons to determine the integrity of the laboratory routines, by determining the routine size and the ASCII value of the characters that are in the routines. By using these values, you can determine:

• If the routine has been altered or edited.

• The size of the routine (used in determining routine map space.)

• A double check on patch application. (This is not foolproof.)

• The total number of routines (excluding all INITs).

• Options that have been deleted or renamed. These are used in the post INITs.

NOTES:

1. LR ROUTINE INTEGRITY CHECKER file (#69.91) is based upon versions. If a version is no longer in use, that version can be deleted from the file.

2. The Lab Routine Integrity Menu [LR INTEGRITY] is distributed on the Lab liaison [LRLIAISON] menu.

3. You must delete all INITs before loading these routines.

4. Many LIM will not have this level of access.

This file is not exported with routines. The site must load the routines into the global/file. Option LR Integrity Load is provided for that purpose.

October 1994 Laboratory V. 5.2 25

Loop thru LR Integrity [LR Integrity Loop]

This option will loop through the entire LR ROUTINE INTEGRITY CHECKER file (#69.91) to determine if any of the loaded routines in the file have been changed or edited.

Load Integrity File [LR Integrity Load]

This option will load the LR ROUTINE INTEGRITY CHECKER file (#69.91) with lab routines which have the correct version number in the second line. Those routines which do not match (e.g., LRINITs) will not be loaded.

The option should be done as soon as possible. Users can be logged on during this process.

If there are local routines in the LRZ namespace and you wish these to be included in the LR ROUTINE INTEGRITY CHECKER file (#69.91), they must have the correct second line format and version number.

Second line format ;;xx.xx;LAB SERVICE;**pn**;date/time where xx.xx = Version Number pn = Patch Number

Check a Single Routine Size [LR Integrity Single]

This option allows you to review stored data about a single routine. After entering the routine name, the option will show you the current data and compare this data with values stored in LR ROUTINE INTEGRITY CHECKER file (#69.91). It then indicates if the routine has been changed/edited. This option will also allow you to determine if a patch has been applied correctly. To get a complete listing, use the VA FileMan Print option.

26 Laboratory V. 5.2 October 1994

File Editing

Editing file entries may be performed by the LIM if they have VA FileMan access. File attributes generally may NOT be edited.

There are certain files and or fields which require great caution when editing or entering data. Some of these fields may contain mumps codes. A FileMan access code of programmer is required to edit these files/fields. The assignment of programmer access codes is a local issue. Therefore, certain files and fields may not accessible by the LIM.

NOTE: Deletion from most files is strongly discouraged. It can be done in certain instances, but use caution. If there is any uncertainty, do not delete entries until advised by your IRM or Regional ISC.

If file entries are edited (either initially or after system implementation), they must be done in this order:

1. TOPOGRAPHY FIELD file (#61)

2. COLLECTION SAMPLE file (#62)

3. ACCESSION file (#68)

4. LAB DATA file (#63)

5. LABORATORY TEST file (#60)

6. ACCESSION TEST GROUP file (#62.6)

7. LABORATORY SITE file (#69.9)

It is recommended that before adding entries to the above files, you run [LRCHKFILES] to find any inconsistencies. Correct any Fatal responses listed. When this is completed, you will be ready to add new entries.

After the above files are finished, other files may be changed in any order. The above seven files must be changed in that order because of the interdependence of the files.

October 1994 Laboratory V. 5.2 27

Other Laboratory Configurable Files

• MORPHOLOGY FIELD file (#61.1)

• ETIOLOGY FIELD file (#61.2)

• FUNCTION FIELD file (#61.3)

• DISEASE FIELD file (#61.4)

• PROCEDURE FIELD file (#61.5)

• OCCUPATION FIELD file (#61.6)

• URGENCY file (#62.05)

• ANTIMICROBIAL SUSCEPTIBILITY file (#62.06)

• EXECUTE CODE file (#62.07)

• DELTA CHECKS file (#62.1)

• LAB SECTION file (#62.2)

• LAB CONTROL NAME file (#62.3)

• AUTO INSTRUMENT file (#62.4)

• LAB DESCRIPTIONS file (#62.5)

• AGGLUTINATION STRENGTH file (#62.55)

• WKLD CODE file (#64)

• WKLD LOG file (#64.03)

• NON WKLD PROCEDURES file (#64.05)

• WKLD CODE LAB SECT file (#64.21)

• LAB REPORTS file (#64.5)

• INTERIM REPORTS file (#64.6)

• BLOOD INVENTORY file (#65)

• BLOOD BANK UTILITY file (#65.4)

• BLOOD DONOR file (#65.5)

• LAB LETTER file (#65.9)

28 Laboratory V. 5.2 October 1994

• BLOOD PRODUCT file (#66)

• BLOOD BANK VALIDATION file (#66.2)

• OPERATION (MSBOS) file (#66.5)

• BLOOD COMPONENT file (#66.9)

• REFERRAL PATIENT file (#67)

• RESEARCH file (#67.1)

• STERILIZER file (#67.2)

• ENVIRONMENTAL file (#67.3)

• LOAD/WORK LIST file (#68.2)

• WORKLIST HEADINGS file (#68.4)

• LAB JOURNAL file (#95)

Laboratory Files Not To Be Edited

• ARCHIVED LR DATA file (#63.9999)

• WKLD SUFFIX CODE file (#64.2)

• WKLD ITEM FOR COUNT file (#64.22)

• WKLD INSTRUMENT MANUFACTURER file (#64.3)

• CUMULATIVE file (#64.7)

• NON PATIENT WORKLOAD file (#67.4)

• LAB MONTHLY WORKLOADS file (#67.9)

• LAB ORDER ENTRY file (#69)

October 1994 Laboratory V. 5.2 29

Add a new data name

In the LABORATORY TEST file (#60), each test entry with a CH subscript and a type of BOTH or OUTPUT has a location or data name. See the location Data Name field of File #60. This data name points to a unique field in the LAB DATA file (#63) where the data for that test is to be stored. This unique field also defines what type of value can be entered as a result for the test (free-text, numeric or a set of codes).

NOTE: Panels, profiles, and tests with subscripts other than CH do not have data name entries.

The exported version of the LAB DATA file (#63), subfield #4 contains subfield entries called data names, most of which are associated with corresponding presupplied entries in the LABORATORY TEST file. These data names determine the type of response allowable when entering a result for a laboratory test. You should print a list of possible subfields to determine if additional entries must be added. The addition of data names must be done by using the Add a new data name [LRWU5] option.

Using Add a new data name option

Select Supervisor menu Option: LAB LIAison menu

ANT Add a new internal name for an antibiotic DATA Add a new data name MOD Modify an existing data name Add a new WKLD code to file AP Microfiche Archive Archive lab data ...

Check files for inconsistencies Check patient and lab data cross pointers Diagram Menus Download Format for Intermec Printer Edit atomic tests Edit cosmic tests File list for lab

LAB ROUTINE INTEGRITY MENU ...

LIM workload menu ...

Manually compile WKLD and workload counts OE/RR interface parameters ...

Outline for one or more files Press 'RETURN' to continue, '^' to stop: <RET> Re-index Antimicrobial Suscept File (62.06) Turn on site workload statistics Turn on workload stats for accession area User selected lab test/patient list edits ...

VA FileMan ...

Select Lab liaison menu Option: DATA Add a new data name This option will add a new data name to the lab package.

DATA NAME: GLUCOSE-TIMED

30 Laboratory V. 5.2 October 1994

ARE YOU ADDING GLUCOSE-TIMED (SUBFIELD # 7022001) AS A NEW DATA NAME? NO// Y

(YES)

Enter data type for test: (N)umeric, (S)et of Codes, or (F)ree text? F Minimum length: 2 Maximum length: 30

GLUCOSE-TIMED added as a new data name

Data Name: GLUCOSE-TIMED Subfield #: 7022001 Type: FREE TEXT Input Transform: K:$L(X)>30!($L(X)<2) X Minimum length: 2 Maximum length: 30

You must now add a new test in the LABORATORY TEST file and use GLUCOSE-TIMED as the entry for the DATA NAME field.

Using VA FileMan

Select VA FileMan Option: 4 Modify File Attributes

MODIFY WHAT FILE: // 63 LAB DATA

Select FIELD: 4 CHEM, HEM, TOX, RIA, SER, etc. (Multiple LABEL: CHEM, HEM, TOX, RIA, SER, etc. Replace <RET>

READ ACCESS (OPTIONAL) <RET>

WRITE ACCESS (OPTIONAL):<RET>

SOURCE: <RET>

Select DESTINATION: <RET> Select GROUP: <RET>

Select CHEM, HEM, TOX, RIA, SER, etc. SUB-FIELD: 555001 (enter the sub-field number = station # + entry # in the format of “555001”, “555002”, “555003”, etc.)

ARE YOU ADDING A NEW CHEM, HEM, TOX, RIA, SER, etc. SUB-FIELD NUMBER (THE

800TH)? Y//<RET>(YES)

LABEL: SERUM MAYONNAISE

CHEM, HEM, TOX, RIA, SER, etc. SUB-FIELD NUMBER: 555001// <RET>

DATA TYPE OF SERUM MAYONNAISE: FREE TEXT

MINIMUM LENGTH: 1

MAXIMUM LENGTH: 10

(OPTIONAL) PATTERN MATCH (IN X ): <RET>

WILL SERUM MAYONNAISE FIELD BE MULTIPLE ? NO// <RET>

SUBSCRIPT: 49// 555001 (***NOTE: this must always match the sub-field number!!!)

-POSITION: 1// <RET> (***NOTE: this answer must always be 1 )

IS SERUM MAYONNAISE ENTRY MANDATORY (Y/N): NO// <RET> (NO)

HELP - PROMPT: ANSWER MUST BE !-!) CHARACTERS IN LENGTH Replace

EXECUTABLE HELP : <RET>

Select CHEM, HEM, TOX, RIA, SER, etc. SUB-FIELD: ^

You now have a new data name for the test SERUM MAYONNAISE. When you enter SERUM MAYONNAISE as a new test in File #60, be sure to fill in the Data Name field with the number 555001. The test name will then point to the correct new data name.

October 1994 Laboratory V. 5.2 31

File Structure/Interaction

Before you begin the process of reviewing and editing the lab package files (also known as site configuring), it is important to note which of the files should be edited prior to going live and the sequence in which they should be modified.

The database for the lab package is composed of a series of files. These files contain all the information that is needed by the system to process or interpret test data and are the basis for storage, organization and retrieval of that data.

The files and the data they contain form the backbone of a comprehensive network that is used on three levels:

1. within files

2. between files in the lab package

3. among files in the lab package and other package files.

Information within a file may in some ways be dependent upon other elements stored in the same file. When this occurs, it is said that the file points to, or references itself. Similarly, data contained in one file may point to another separate file or a group of files. Finally, files within the lab package can be pointers to files found in other packages in the system (i.e., ADT or PHARMACY). This occurs when the lab file information is drawn from data contained in an outside file or when the lab file information points to an outside file.

Based on the relationships which exist between the files, the sequence of events during file modification becomes very important. Files which must be edited or modified in sequence are:

1. TOPOGRAPHY file (#61)

2. COLLECTION SAMPLE file (#62)

3. ACCESSION file (#68)

4. LAB DATA file (#63)

5. LABORATORY TEST file (#60)

6. ACCESSION TEST GROUP file (#62.6)

7. LABORATORY SITE file (#69.9)

These seven files are also known as Day one files, although editing of other files in addition to those listed above MUST be done in order to bring up a fully functional laboratory package.

32 Laboratory V. 5.2 October 1994

We are classifying them as primary or pre-implementation files, which include the following:

1. TOPOGRAPHY file (#61)

2. COLLECTION SAMPLE file (#62)

3. ACCESSION file (#68)

4. LAB DATA file (#63)

5. LABORATORY TEST file (#60)

6. ACCESSION TEST GROUP file (#62.6)

7. LABORATORY SITE file (#69.9)

8. LAB CONTROL NAME file (#62.3)

9. AUTO INSTRUMENT file (#62.4)

10. LAB REPORTS file (#64.5)

11. INTERIM REPORTS file (#64.6)

12. LOAD/WORK LIST file (#68.2)

NOTE: Remember that the first seven files must be reviewed/edited in that order. These are Day One files. Files #8 thru #12 are pre-implementation files.

We have included review here, since in most cases you will only have to review the entries in the TOPOGRAPHY file (#61) to make sure the site/specimens you need are there. If you have to add an entry, do it first. The remaining primary files can be modified in any order you wish, with a few exceptions. If you want to put controls on a load or worklist, the entry must be made in the LAB CONTROL NAME file (#62.3) first. In order to specify what load or worklist is run on a particular instrument, you have to build the LOAD/WORK LIST file (#68.2) entry first and then associate it with the correct instrument in the AUTO INSTRUMENT file (#62.4).

To better understand the interrelationships of the files and their corresponding field characteristics, one of the first things you should do is use VA FileManager to obtain a list of file attributes (otherwise known as a data dictionary) for each and every laboratory package file. These listings will provide the information on type of field, length of field, number of decimals allowed, whether a field requires an entry, input transforms, output transforms, cross references, and identifiers, as well as pointers which exist between the files.

A good understanding of the files, what information they contain, and how they interrelate is important in the implementation process.

If you have lots of extra time, feeling ambitious, or a stickler for details, you can also modify the other lab package files prior to going live, although the package initially will be fully functional without extensive editing. Three exceptions here are Microbiology, Anatomic Pathology, and Blood Bank related files. These files should be reviewed and modified before bringing up those portions of the lab package. Specific information about those pre-implementation files can be found in the Microbiology, Anatomic Pathology, and Blood Bank sections in this manual.

October 1994 Laboratory V. 5.2 33

Editing The Files

Listed below are some suggested steps you should take when adding to, editing, modifying, or otherwise changing any entries in the laboratory package files before and after implementation:

1. FAMILIARIZE YOURSELF WITH THE FILES - list the entries (if any); obtain a printout of the data dictionary for the file; figure out what type of information goes into the file. Use the option, Outline for One or More files [LRUFILE].

2. GATHER APPROPRIATE INFORMATION - compile and organize the necessary information for editing the file, consult existing lab documentation, and procedures; consult with department personnel from each area of the lab.

3. EDIT THE FILE - add new entries or modify existing entries; DO NOT DELETE existing entries unless absolutely necessary; consult with your site manager or regional ISC for any questions or problems. BE CAREFUL!

4. DOCUMENT YOUR WORK - obtain new copies of any and all file listings and printouts for reference after making any changes.

5. CHANGES AFTER GOING LIVE - determine what other file(s) (if any) will be affected by the change; ALWAYS make any changes to the day one files in the specified order. Document your changes (what fields and files, as well as the date).

34 Laboratory V. 5.2 October 1994

Laboratory Files Field Descriptions

LABORATORY TEST file (#60)

The LABORATORY TEST file (#60) contains all specific information related to each individual test (also known as an atomic test) or laboratory tests grouped into panels or profiles (or cosmic tests). It is pointed to by several other files. Entries may be added or modified, but none of the supplied entries should be deleted. It is used to define the site specific parameters for each test, including synonym(s), accession area, collection sample(s), site/specimen(s), normal values, and interpretive remarks, or special instructions unique to the test.

Field List

(.01) NAME

(1) TEST COST

(2) SYNONYM (Subfile 60.1) (.01) Synonym

(3) TYPE

(4) SUBSCRIPT

(5) LOCATION (DATA NAME)

(6) ACCESSION AREA (Subfile 60.11) (.01) Institution

(1) Accession Area

(7) UNIQUE ACCESSION #

(8) UNIQUE COLLECTION SAMPLE

(9) LAB COLLECTION SAMPLE

(10) REQUIRED TEST

(13) FIELD

(14) PROCEDURE (SNOMED)

(15) *QUICK INDEX

(16) EXTRA LABELS

(16.1) INSTITUTION EXTRA LABELS

(.01)INSTITUTION EXTRA LABELS

(1) NUMBER OF LABELS

(17) HIGHEST URGENCY ALLOWED

(18) FORCED URGENCY

(51) PRINT NAME

(52) Reserved

(53) PRINT CODE

(54) PRETTY PRINT ENTRY

(55) PRETTY PRINT ROUTINE

(56) PRINT ORDER

(98) EDIT CODE

(99.1) *BATCH DATA CODE

(99.2) EXECUTE ON DATA REVIEW

(100) SITE/SPECIMEN (Subfile #60.01) (.01) Site/Specimen

(1) Reference Low

(2) Reference High

(3) Critical Low

(4) Critical High (5.5) Interpretation (Subfile #60.07) (.01) Interpretation

(6) UNITS

(7) TYPE OF DELTA CHECK

October 1994 Laboratory V. 5.2 35

(8) DELTA VALUE

(9) DEFAULT VALUE

(9.2) THERAPEUTIC LOW

(9.3) THERAPEUTIC HIGH

(10) *AMIS/RCS 14-4 (Subfile #60.06)

(.01) AMIS/RCS 14-4

(20) FOREIGN COMPUTER SYSTEM

(.01) FOREIGN COMPUTER SYSTEM

(1) FOREIGN ITEM #

(2) INTERGER

(3) UNIT CONVERSION

(110) GENERAL PROCESSING INST. (Subfile #60.09) (.01) General Processing Inst.

(200) LAB TEST INCLUDED IN PANEL (Subfile #60.02) (.001) Number (.01) Lab Test (.02) AP Multiply Factor

(300) COLLECTION SAMPLE (Subfile #60.03) (.01) Collection Sample

(1) Form Name/Number

(2) Container

(3) Min Vol (In Mls.)

(4) Max. Order Freq.

(4.5) Single Day Max Order Freq

(5) Ward Remarks (Subfile #60.04) (.01) Ward Remarks

(6) Lab Processing Instructions (Subfile #60.05) (.01) Lab Processing Instructions

(7) Required Comment

(500) SAMPLE WKLD CODE (Subfile #60.14) (.01) Sample WKLD Code

(1) Sample WKLD Code #

(2) Test Multiply Factor

(310) GENERAL WARD INSTRUCTIONS (Subfile 60.08) (.01) General Ward Instructions

(320) REQUIRED COMMENT

(400) DATA NAME

(410) INPUT TRANSFORM

(411) DATA TYPE

(412) CULTURE ID PREFIX

(500) VERIFY WKLD CODE (Subfile 60.12) (.01) Verify WKLD Code

(1) Verify WKLD Code #

(2) Test Multiply Factor

(3) Protect Suffix (500.1)ACCESSION WKLD CODE (Subfile 60.13) (.01) Accession WKLD Code

(1) Accession WKLD Code #

(2) TEST MULTIPLY FACTOR

(501) *ASK AMIS/CAP CODES

(502) DISPLAY GROUP

(503) COMBINE TEST DURING ORDER

(504) CIS TEST CODE

(505) SITE NOTES DATE (Subfile 60.0505)

(.01) SITE NOTES DATE

(1) TEXT

Fields Description

36 Laboratory V. 5.2 October 1994

(.01) NAME: This is the name of the laboratory test you are defining/editing. It has to be between 3 and 30 characters in length, and must be unique. The current version contains over 1000 entries, so it would be useful to get a printout of the file to see how the names are listed BEFORE editing or adding test names. This name is used for verification of test results and is the name displayed on the interim reports (if shorter than 20 characters). It is displayed during test ordering and accessioning.

The name of the laboratory test can also be displayed by inquiry type options such as the Test Description Information [LREV] option.

Hints

• You may decide to use an abbreviated familiar name for a test in this field, such as MCV instead of

MEAN CORPUSCULAR VOLUME.

• The importance of using the sort and print options of VA FileMan to help you organize the information in this file CANNOT be stressed enough! (There are a lot of tests in this file and lots of fields for each test!) Use these lists to keep track of what you have edited, changed, or added, and always remember to include the date! Give copies of sorted groups of information (test name, reference ranges, units, type of collection sample and ward instructions, for example) to the people in the lab so they can verify that the correct data has been entered. Update and reprint the listings regularly, so that you will always have a current copy to use for reference. If you need help with using FileManager to print these lists, ask your Site Manager or contact your regional ISC. You can also use the printouts as a sort of check list to make sure you do not have any conflicting field entries. (Refer to the earlier part of this chapter for instructions on how to use the system option known as Check files for inconsistencies to help you with this.)

October 1994 Laboratory V. 5.2 37

• Some of the more basic conflicts you should check for are:

° All tests to be placed on a routine phlebotomy collection list should have a Lab Collection Sample entry.

° All single, CH subscripted tests type OUTPUT or BOTH should have a Data Name and Site/Specimen entry.

° All panel type tests should have at least one Lab Tests To Be Included entry.

° All tests must have a Print Name entry.

° The number of Collection Sample entries should match the number of Site /Specimen entries.

Example: A test has two site/specimen types defined, both serum and plasma, then the test should also have two collection sample names defined, BLOOD (red top) and BLOOD (green top), or some other collection tube yielding plasma. There may also be times when one site specimen (plasma) relates to several acceptable collection samples.

• Should there be a test that your lab will no longer be using, or that came with the exported version of File #60 and you have chosen not to use, you will be able to deactivate the test name by prefixing the existing name with zz- as well as specifying the type of NEITHER for that test. Remember, it is a big “NO-NO” to delete any of the test names from this file!

° The prefix of zz- is chosen for the fact that it is at the end of the alphabet (will appear at the end of the list of the 1000 or so test names in the file) and also because there are few valid test names performed in the lab which begin with the letter Z (like Zinc).

° Remember, if you zz tests in File #60 and those tests have had previous results stored under their names, adding zz can make it very difficult for users to look up old results and test descriptions information. When old results are displayed, the zz will print in front of the test name. This looks strange and causes confusion for some users. It may be more efficient to change the name to something like SEROTONIN (BEFORE 1/20/90) instead of ZZSEROTONIN.

(1) TEST COST: This field allows for the entry of a cost of the particular test, which may be used by local software for cost accounting calculations and reports. Currently, this field is not used in any available lab package software program.

NOTE: This field will be superseded by the cost field in WKLD CODE file (#64). This field is still available for local use.

(2) SYNONYM (Subfile): This multiple field allows entry of additional names for each test name listed above (add new entry without asking). These synonyms may be alternate names, abbreviations, common misspellings of the test, etc.