Session

1
Session 134H CSI for CIS Rookies
Vikie Schwartz IT Specialist, Clin 2 Elaine
Stoker IT Specialist, Clin 2 Chajuana Vance CAC,
Cleveland VAMC
2
Overview

• You each have your own personal VistA and CPRS
  account.
• Each is broken in a variety of ways
• 7 minutes per problem, with successive hints
  provided during each time period, if needed

3
Overview (contd)

• Always try to re-create the problem for yourself
  as your first step in trouble shooting!
• After making any changes, you need to use the
  File/refresh or logoff/logon for those changes to
  take effect.
• CSI TIP If you make a PATIENT related change,
  you can usually just refresh. When the change
  is related to a USER, MENU, KEY, or PARAMETER,
  you will need to log off/log on to test the
  resolution!

4
Overview (contd)

• Please locate your desktop shortcuts for CPRS and
  KEA
• Your login
• Access nnVEHU
• Verify VEHUnn
• ESig VEHUnn
• Your patient
• - Use your default patient nn,Patient

5
Friendly Competition

• Each problem will have 2-3 hints
• If you solve the problem before the 1st hint, you
  get 5 points.
• If you solve the problem after 1st hint, you get
  3 points.
• If you solve the problem after 2 or 3 hints, you
  get 1 point.
• Keep track of your points the winner will take
  home a valuable prize!!!!!!!!!!

6
Problem 1

• Provider,OneHundred left you a message stating
  that they can only see 3 notes on every patient
  even though they KNOW there are more. This User
  is being held captive in the CBOC dungeon and not
  reachable by phone so the CAC needs to fix the
  problem!

7
Problem 1

• Provider,Onehundred left you a message stating
  that they can only see 3 notes on every patient
  even though they KNOW there are more. This User
  is being held captive in the CBOC dungeon and not
  reachable by phone so the CAC needs to fix the
  problem!
• Hint 1 It isnt always DE FAULT of the
  software!
• Try to replicate the problem for yourself.
• ?? Is it just one patient ??
• ?? Is it just one user ??

8
Problem 1

• Provider,Onehundred left you a message stating
  that they can only see 3 notes on every patient
  even though they KNOW there are more. This User
  is being held captive in the CBOC dungeon and not
  reachable by phone so the CAC needs to fix the
  problem!
• Hint 1 It isnt always DE FAULT of the
  software!
• Hint 2
• Option A Negotiate and pay the ransom.
• Option B Take a peek at those pesky note
  parameters.

9
Problem 1

• Provider 100 left you a message stating that
  they can only see 3 notes on every patient even
  though they KNOW there are more. This User is
  being held captive in the CBOC dungeon and not
  reachable by phone so the CAC needs to fix the
  problem!
• Hint 1 It isnt always DE FAULT of the
  software.
• Hint 2 Take a peek at those pesky note
  parameters.
• Hint 3 Parameter ORCH CONTEXT NOTES looks like
  it allows settings for system, package and user.

10
Problem 1 SOLUTION

• CSI TIP The parameter ORCH CONTEXT NOTES
  contains information used to limit or customize
  the list of notes displayed to the user. This
  parameter can be set by SYSTEM and by USER.
• If you first use LV to list the values for this
  parameter, you will see
• Parameter                              
  Instance        Value
• ------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  -- ----------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  --------------------------------------------------
  ---
• PKG ORDER ENTRY/RESULTS REPOR 1 1100
• SYSCDD.FO-ALBANY.MED.VA.GOV 1 131R00
  
• USR PROVIDER,ONEHUNDRED 1
  131R00
• Now Edit values in Parameter ORCH CONTEXT NOTES
  at the User and System levels. Type _at_ to remove
  the coded value for
• the USER
• ---Setting ORCH CONTEXT NOTES for User
  PROVIDER,ONEHUNDRED ---
• Value 131R00// _at_ ...deleted
• and edit the SYSTEM to show 100 instead of 3.
  You can easily do this by copying the value for
  PACKAGE and pasting it to System
• ---Setting ORCH CONTEXT NOTES for System
  CDD.FO-Albany.Med.VA.GOV ---

11
Problem 2

• You try to enter a new order and cant select
  yourself (VEHU,NN) as the provider!! No one else
  can select you as the provider, either!!

12
Problem 2

• You try to enter a new order and cant select
  yourself (VEHU,NN) as the provider!! No one else
  can select
• you as the provider, either!!
• Hint 1 May we suggest the KEY lime pie?

13
Problem 2

• You try to enter a new order and cant select
  yourself (VEHU,NN) as the provider!! No one else
  can select you as the provider, either!!
• Hint 1 May we suggest the KEY lime pie?
• Hint 2 Can you prove youre a provider?

14
Problem 2

• You try to enter a new order and cant select
  yourself (VEHU,NN) as the provider!! No one else
  can select
• you as the provider, either!!
• Hint 1 May we suggest the key lime pie?
• Hint 2 Can you prove youre a provider?
• Hint 3 How do you compare to Provider,Eighteen
  (User Inquiry)?

15
Problem 2 SOLUTION

• Assign the Provider key to yourself in VISTA
• Select Menu Option KY Allocation of
  Security Keys
• Allocate key PROVIDER start a search for key choices
• 1 PROVIDER
• 2 PROVIDER ID EDIT IB PROVIDER EDIT
• CHOOSE 1-2 1 PROVIDER
• Another key
• Holder of key VEHU,NN ? Type your name (VEHU,
  )
• And press to assign the key to yourself.
• Log Off/Log On to CPRS GUI and confirm that
  you can now select your name as a Provider.

16
Problem 3

• User calls stating the system will not allow them
  to sign the Nursing Procedures Note. When they
  attempt to sign the note, the Insufficient
  Authorization error keeps popping up! So they
  ask youWhats so insufficient about my
  authorization? The User class, keys, rules,
  etc. are good can you recreate the problem?

17
Problem 3

• User calls stating the system will not allow them
  to sign the Nursing Procedures Note. When they
  attempt to sign the note, the Insufficient
  Authorization error keeps popping up! So they
  ask youWhats so insufficient about my
  authorization? User class, keys, rules, etc.
  are goodcan you recreate the problem?
• Hint 1 Free text or Template?

18
Problem 3

• User calls stating the system will not allow them
  to sign the Nursing Procedures Note. When they
  attempt to sign the note, the Insufficient
  Authorization error keeps popping up! So they
  ask youWhats so insufficient about my
  authorization? User class, keys, rules, etc. are
  goodcan you recreate the problem?
• Hint 1 Free text or Template?
• Hint 2 This could have multiple fixes

19
Problem 3

• User calls stating the system will not allow them
  to sign the Nursing Procedures Note. When they
  attempt to sign the note, the Insufficient
  Authorization error keeps popping up! So they
  ask youWhats so insufficient about my
  authorization? User class, keys, rules, etc. are
  goodcan you recreate the problem?
• Hint 1 Free text or Template?
• Hint 2 This could have multiple fixes
• Hint 3 DUH

20
Problem 3 Solution

• (1) Have the user right-click in the body of the
  note and select FIND, type DUH in word
  processing block and check both Match boxes,
  click FIND NEXT button and the instance of this
  will be highlighted in your note for editing and
  then signing.
• (2) Because this template is linked to a note you
  also will
• Go to the Template Editor Document Titles
• Nursing Procedure Note and edit the
  misspelling.
• (3) To change the Blank Character String text
• Go to Basic TIU Parameters and edit the three
  character string for the appropriate INSTITUTION.
  
• example
• BLANK CHARACTER STRING DUH// -- most sites
  have this set to either _at__at__at_ or _ _ _.

21
Problem 4

• Everyone is complaining they only see the
  DISCONTINUED orders on the Orders Tab.

22
Problem 4

• Everyone is complaining they only see the
  DISCONTINUED orders on the Orders Tab.
• Hint 1 Betcha cant say
• Look Ma, no Hands!

23
Problem 4

• Everyone is complaining they only see the
  DISCONTINUED orders on the Orders Tab.
• Hint 1 Betcha cant say
• Look Ma, no Hands!
• Hint 2 Need to tune into THE VIEW!

24
Problem 4

• Everyone is complaining they only see the
  DISCONTINUED orders on the Orders Tab.
• Hint 1 Betcha cant say
• Look Ma, no Hands!
• Hint 2 Need to tune into THE VIEW!
• Hint 3 Check out the ORCH CONTEXT ORDERS
  Parameter

25

Problem 4
CSI Tip The covering hands icon
26
Problem 4 Solution

• Solution A
• The CAC can guide the USER in making the edit
  themselves by doing the following
• ? On the Orders tab, click on View,
• select Active Orders.
• ? Again go to VIEW and click Save as Default
  View.

27
Problem 4 Solution

• Solution B
• The CAC can edit for ALL USERS by editing via
  the XX General Parameter Tools option. You can
  first LIST VALUES for the ORCH CONTEXT ORDERS
  parameter to see current setting values.
• Parameter Instance
  Value
• -------------------------------------------------
  --------------------------------------------------
  -----------
• USR VEHU,ZERO ZERO 1 3ALLLR1
• USR CLINCOORDINATOR,THREE 1 3ALLLR1
• PKG ORDER ENTRY/RESULTS REPOR 1 2ALLL
• SYS CDD.FO-ALBANY.MED.VA.GOV 1 3ALLLR1
• Now use EP to Edit the values at the SYSTEM
  level looking at the settings will show that
  the 3 value should be changed to 2.
• ? Setting ORCH CONTEXT ORDERS for User
  VEHU,ZERO ZERO
• Value 3ALLLR1// _at_ ...deleted
• ? Setting ORCH CONTEXT ORDERS for System
• Value 3ALLLR1// ? Change this to
  2ALLL
• Remember to check your work by logging into CPRS
  GUI to see your orders VIEW.

28
Problem 5

• Users are calling to say they cant order a Chem
  7 lab test from the Laboratory orders menu.

29
Problem 5

• Users are calling to say they cant order a Chem
  7 lab test from the orders menu.
• Hint 1 Wonder whats restricting them?

30
Problem 5

• Users are calling to say they cant order a Chem
  7 lab test from the orders menu.
• Hint 1 Wonder whats restricting them?
• Hint 2 Can we quickly resolve this ordering
  problem?

31
Problem 5 Solution

• In VISTA, you need to remove the restriction to
  quick order only for the orderable item Chem
  7.
• Select Menu Option OE CPRS Manager Menu
• Select PE CPRS Configuration (Clin
  Coord) ...
• Select MM Order Menu Management ...
• Select OI Manage orderable items ...
• Select QO Enter/edit QO restriction
• Select an ORDERABLE ITEM (meds or labs only)
  CHEM 7 ? type the orderable item
  that is restricted here
• Now Select the type of usage for which you wish
  to restrict ordering of this item.
• (Choice is LABORATORY or CHEMISTRY for this
  item)
• Usage LABORATORY ? select Laboratory since the
  orderable item was restricted on the Laboratory
  menu!
• QO ONLY YES// _at_ ? type _at_ to delete the
  restriction.
• Check your work by clicking on Laboratory from
  your Write Orders list in CPRS GUI and typing
  CHEM 7 in the Available Lab Tests block.

32
Problem 6

• User calls to say that an Ophthalmology consult
  was ordered for EIGHTYTHREE, PATIENT but seems to
  have Disappeared! It shows on the Orders tab
  but not on the Consults tab. Also, wonder how
  they placed the order?

33
Problem 6

• User calls to say an Ophthalmology consult was
  ordered for EIGHTYTHREE, PATIENT but seems to
  have Disappeared! It shows on the Orders tab
  but not on the Consults tab. Also wonder how they
  placed the order?
• Hint 1 Was the order signed using disappearing
  ink?

34
Problem 6

• User calls to say an Ophthalmology consult was
  ordered for EIGHTYTHREE, PATIENT but seems to
  have Disappeared! It shows on the Orders tab
  but not on the Consults tab. Wonder how they
  placed the order?
• Hint 1 Was the order signed using disappearing
  ink?
• Hint 2 HI ARCHIE! SET UP straight, no
  slouching!

35
Problem 6

• User calls to say an Ophthalmology consult was
  ordered for EIGHTYTHREE, PATIENT but seems to
  have Disappeared! It shows on the Orders tab
  but not on the Consults tab. Wonder how they
  placed the order?
• Hint 1 Was the order signed using disappearing
  ink?
• Hint 2 HI ARCHIE! SET UP straight, no
  slouching!
• Hint 3 Remember the Musketeer motto ALL for
  one and one for ALL

36
Problem 6 Solution

• In VISTA, go to the CONSULT MANAGER menu.
• Use the option LH - List Consult Service
  Hierarchy to view the current Hierarchy.
• Select option SS - Set Up of Consult Services,
  for ALL SERVICES grouper.
• At the Select SUB-SERVICE/SPECIALTY prompt add
  Ophthalmology as a sub-specialty.
• User must have used a Quick Order!
• Check your work to see if you can now see the
  Ophthalmology Consult on the Consult tab!

37
Problem 7

• No one can run the Search for Selected
  Documents report by Expected Cosigner, for
  Provider,Ninetynine.
• The date range to search is within the last 90
  days.

38
Problem 7

• No one can run the Search for Selected
  Documents report by expected cosigner
  Provider,Ninetynine. The date range to search is
  within the last 90 days.
• Hint 1 Try to recreate the problem.
• This is sticky but it is not GUI!
• Select TIU (MIS Manager) Option search for
  Selected Documents
• Select Status COMPLETED// UNCOSI uncosigned
• Select CLINICAL DOCUMENTS Type(s) Progress
  Notes// ALL
• Select SEARCH CATEGORIES AUTHOR// exp Expected
  Cosigner
• Select EXPECTED COSIGNER Provider,Ninetynine ??
• Select EXPECTED COSIGNER Provider,Onehundred ??
• Hmmmit will not accept ANY Expected Cosigner
  name!

39
Problem 7

• No one can run the Search for Selected
  Documents report by expected cosigner
  Provider,Ninetynine. The date range to search is
  within the last 90 days.
• Hint 1 Try to recreate the problem.
• This is sticky but it is not GUI!
• Hint 2 If you think a PROVIDER would expect to
  be a Cosigner of notes go to the head of the
  CLASS.

40
Problem 7

• No one can run the Search for Selected
  Documents report by expected cosigner
  Provider,Ninetynine. The date range to search is
  within the last 90 days.
• Hint 1 Try to recreate the problem.
• Hint 2 If you think a PROVIDER would expect to
  be a Cosigner of notes go to the head of the
  CLASS.
• Hint 3 Am I seeing STARS or has someone been
  monkeying around with those user class names??

41
Problem 7 Solution

• CSI Tip The Expected Cosigner screens all users
  to ensure they are members of the PROVIDER user
  class. Someone renamed the PROVIDER user class to
  PROVIDER CLASS HEADER ONLY. Since there was
  no longer a PROVIDER user classes, it could not
  find ANY provider you were searching for. You
  need to change the name back to PROVIDER.
• Solution
• In VISTA, use the TIU USER CLASS MANAGEMENT menu
  look at the User Class Definition of all active
  user classes. Return until you get to the
  PROVIDER user class screen
• Select Action Next Screen// ed Edit User Class
  
• Select Class(s) ? enter item number for
  PROVIDER User Class
• Edit the PROVIDER CLASS HEADER ONLY to change
  it to
• NAME PROVIDER
• DISPLAY NAME Provider
• Test your success by trying again to run the
  Search for Selected Documents report by expected
  cosigner!

42
Problem 8

• Youre getting numerous calls that users cannot
  see the clinical reminders that are DUE NOW from
  the clock menu or the reminders drawer.

43
Problem 8

• Youre getting numerous calls that users cannot
  see the clinical reminders that are DUE NOW from
  the clock menu or the reminders drawer.
• Hint 1 Think it through from A to?

44
Problem 8

• Youre getting numerous calls that users cannot
  see the clinical reminders that are DUE NOW from
  the clock menu or the reminders drawer.
• Hint 1 Think it through from A to?
• Hint 2 Parameters can spell it out for you.

45
Problem 8 Solution

• To fix this for ALL USERS you would use VISTA,
• Select Menu Option XX General
  Parameter Tools
• First you can use option LV to list the
  values for the parameter
• Values for ORQQPX REMINDER FOLDERS
• Parameter Instance
  Value
• -------------------------------------------------
  --------------------------------------
• SYS CDD.FO-ALBANY.MED.VA.GOV 1
  A,N,E,O
• CSI TIP Visible Folders - DDue, AApplicable,
  NNot Applicable, EEvaluated, OOther
• Now Select Edit Parameter Values to edit the
  SYSTEM level value.
• Enter ORQQPX REMINDER FOLDERS as the parameter
  name
• --- Setting ORQQPX REMINDER FOLDERS for System
  ---
• Visible Reminder Folders A,N,E,O// ? Type
  D,A,N,E,O
• to include the DUE folder in
  your reminders view!

46
Problem 8 Solution

• To fix this for the one USER, instruct the user
  to
• Click on the Reminder Clock in CPRS GUI
• Click VIEW, and then simply click on DUE to
• add this folder to your Reminder View.

Check your work by confirming you now see DUE
reminders!
47
Problem 9

• A new Comprehensive Med List Health Summary
  has recently been created. JCAHO is in town and
  the they want a quick look at the patients
  reconciled meds. A user calls for helpIt was
  there just this morning where did it go?

48
Problem 9

• A new Comprehensive Med List Health Summary has
  recently been created. JCAHO is in town and the
  they want a quick look at the patients
  reconciled meds. A user calls for helpIt was
  there just this morning where did it go?
• Hint1 Weve got to get this thing in line.

49
Problem 9

• A new Comprehensive Med List Health Summary has
  recently been created. JCAHO is in town and the
  they want a quick look at the patients
  reconciled meds. A user calls for helpIt was
  there just this morning where did it go?
• Hint 1 Weve got to get this thing in line.
• Hint 2 Could it be those darn parameters again
  ? ? ?

50

• A new Comprehensive Med List Health Summary has
  recently been created. JCAHO is in town and the
  they want a quick look at the patients
  reconciled meds. A user calls for helpIt was
  there just this morning where did it go?
• Hint 1 Weve got to get this thing in line.
• Hint 2 Could it be those darn parameters
• again ? ? ?
• Hint 3 It was under education just this
  morning!

51
Problem 9 Solution

• Go to the Health Summaries Coordinators menu
• Use option 5 to edit CPRS Reports Tab 'Health
  Summary Types List' Parameters then option 4
  Edit 'Health Summary Types List' Parameters.
• Notice that 6 is missing from the sequence
• (just under the Education HS ?).
• Add the Comprehensive Med List to the sequence.
  OR
• Edit the ORWRP Health Summary Type List system
  parameter and add the Comprehensive Med List HS
  to the sequence.

52
Problem 10

• User calls stating the system will not allow them
  to complete the Patient Record Flag Category II
  Infectious Disease note for EIGHTYEIGHT, PATIENT.

53
Problem 10

• User calls stating the system will not allow them
  to complete the Patient Record Flag Category II
  Infectious Disease note for EIGHTYEIGHT, PATIENT.
• Hint 1 You askedWhat prompted you to write
  this note anyhow?

54
Problem 10

• User calls stating the system will not allow them
  to complete the Patient Record Flag Category II
  Infectious Disease note for EIGHTYEIGHT, PATIENT.
• Hint 1 You askedWhat prompted you to write
  this note anyhow?
• Hint 2 Do I need to give you A SIGN?

55
Solution 10

• Using the Patient Record Flag assignment menu
  option you must FIRST assign the flag THEN write
  the Patient Record Flag class note.
• From the notes tab, associate the PRF note with
  the Active flag. Similar to completing consults.

56
Congratulations!
You are now a certified CPRS Help Desk
Troubleshooter!
57

• Questions?