Pirates of VeHU: Unlocking the Secrets of Notifications

1
Pirates of VeHU Unlocking the Secrets of
Notifications
Session 236

• Patricia Akerly
• Larry Schoppe
• Ray LeClair

2
Overview

• Alert setup
• Processing
• Parameters
• Surrogates
• Technical aspects
• Troubleshooting
• Common problems
• Questions write on note card

3
History

• Phone Calls
• Pagers
• Stickers
• Hall talk
• Papers
• Notebooks
• Monitoring

4
Clinician Viewpoints

• Are electronic alerts an
• advantage or disadvantage?

5
Disadvantage

• Overwhelming
• Redundancy
• Multiple alerts for same test
• Can not separate urgency of TIU alerts
• Alerts sent to wrong person

6
Advantage

• Patient safety
• Read at own time
• Less interruptions
• Less paper sorting
• Real time
• Customization
• Easy chart availability
• Quicker Processing

7
Notifications/Alerts
Sort alerts by selecting column heading
Choices are available for processing Notifications
8
Grouping Alerts
Notifications in sequence can be selected by
pressing the SHIFT Key and then click on the
beginning and end of the list.
Processing alerts can be simplified by selecting
Multiple notifications at a time and clicking
the PROCESS button
9
To select disparate notifications, press and hold
the Control (Ctrl) key, then click on each
Notification you want to process
10
Forwarding Alerts
To forward an alert with a comment Highlight
the alert and select FORWARD button. To view a
forwarded alert hover over the text of the alert
and the comment will appear.
11
Renew alerts
Once alert is opened it can be renewed by right
clicking the NEXT button in the lower right
corner of the chart
12
Personal Notification set up
13
Key Notifications

• Lab
• Imaging
• Orders
• Consults
• Pharmacy
• Patient information/movement
• Dietetics
• Results
• Flags
• TIU alerts

14
Lab Results

• Lab Results
• Abnormal Lab Results (Action)
• Abnormal Lab Result (Info)
• Critical Lab results (Action)
• Critical Lab Result (Info)
• Lab Threshold exceeded
• Lab Order Cancelled
• STAT Lab Results

15
Consults

• Consult/Request Resolution
• New Service Consult/Request
• Consult/Request Cancel/Hold
• Consult Request Updated
• Consult/Proc Interpretation

16
Orders

• Flag Order for Clarification
• Order Requires Elec Signature
• Order Requires Chart Signature
• Flagged OI Order INPT
• Flagged OI Order OUTPT
• Flagged OI Expiring INPT
• Flagged OI Expiring - OUTPT
• STAT Order
• New Order
• DC Order
• Expiring Order

17
Imaging

• Imaging Patient Examined
• Imaging Results
• Abnormal Imaging Results
• Imaging Request Cancel/Held
• STAT Imaging Request
• Urgent Imaging Request
• Imaging Results Amended
• Imaging Request Changed

18
TIU

• Unsigned
• Un-Cosigned
• Additional Signature

19
OE/RR Notifications

• FREE TEXT
• MEDICATIONS EXPIRING - INPT
• UNVERIFIED MEDICATION ORDER
• NEW ORDER
• STAT IMAGING REQUEST
• URGENT IMAGING REQUEST
• IMAGING RESULTS AMENDED
• ORDER CHECK
• FOOD/DRUG INTERACTION
• ERROR MESSAGE
• CRITICAL LAB RESULTS (ACTION)
• ABNORMAL LAB RESULT (INFO)
• UNVERIFIED ORDER
• FLAGGED OI RESULTS - OUTPT
• FLAGGED OI ORDER - OUTPT
• DC ORDER
• CONSULT/REQUEST UPDATED
• FLAGGED OI EXPIRING - INPT
• FLAGGED OI EXPIRING - OUTPT

• LAB RESULTS
• ORDER REQUIRES CHART SIGNATURE
• FLAG ORDER FOR CLARIFICATION
• ORDER REQUIRES ELEC SIGNATURE
• ABNORMAL LAB RESULTS (ACTION)
• ADMISSION
• UNSCHEDULED VISIT
• DECEASED PATIENT
• IMAGING PATIENT EXAMINED
• IMAGING RESULTS
• CONSULT/REQUEST RESOLUTION
• CRITICAL LAB RESULT (INFO)
• ABNORMAL IMAGING RESULTS
• IMAGING REQUEST CANCEL/HELD
• NEW SERVICE CONSULT/REQUEST
• SERVICE ORDER REQ CHART SIGN
• CONSULT/REQUEST CANCEL/HOLD
• NPO DIET MORE THAN 72 HRS
• FLAGGED OI RESULTS - INPT

20
Notification Management

• Notification Mgmt Menu ...
• ORB NOT COORD MENU
• General Parameters

21
Parameter Mapping
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Enable/Disable Notifications

• Processing Flag may be set for the following
• 1 User USR choose from NEW
  PERSON
• 2 Team (OE/RR) OTL choose from OE/RR
  LIST
• 3 Service SRV choose from
  SERVICE/SECTION
• 4 Location LOC choose from
  HOSPITAL LOCATION
• 5 Division DIV choose from
  INSTITUTION
• 6 System SYS ERIE.MED.VA.GOV
• Enter selection 6 System ERIE.MED.VA.GOV
• ------------ Setting Processing Flag for
  System ERIE.MED.VA.GOV ------------
• Select Notification CRITICAL LAB RESULTS
  (ACTION)
• Notification CRITICAL LAB RESULTS (ACTION)//
  CRITICAL LAB RESULTS (ACTION)
• CRITICAL LAB RESULTS (ACTION)
• Value Mandatory//

23
Erase Notifications

• 1. Erase all notifications for a User
• 2. Erase all notifications for a Patient
• 3. Erase all instances of a notification
  (regardless of Patient or User)
• 4. Erase specific notifications for a User
• 5. Edit Erase All Notifications parameter
  for a User

24
More Parameters

• Set Urgency for Notifications
• Set Deletion Parameters for Notification
• Set Default Recipients for Notification
• Set Default recipient Device(s) for Notifications
• Set Provider Recipients for Notifications
• Archive(delete) after ltxgt days -
• Set Delays for Unverified Orders

25
Hierarchical Relationship
Corrections to above Matrix Mandatory setting
at the System Level overrides ALL other settings
except when inpatient settings are set to
Disable
26
NOTIFICATIONSPart DuexTREASURE IF YOU KNOW THE
RULES
Notifications Part Two
27
Context IS Important
Arrgggg!
Ye Best Know To Read the Shoals to Avoid Danger
Matey!!
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Confusion Possible!
Arrgggg!
29
Receiving Notifications
NOT GETTING NOTIFICATIONS will NOT be your main
problem.
Must get to CORRECT PERSON or persons
Must be seen in TIMELY MANNER
ABSOLUTELY MUST AVOID OVERLOAD
Confusion
Terrible compliance (use) of alerts
Irritation and dissatisfaction of the Providers
Creation of alert irrelevance or complacency
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PATOMERS
P (Primary Provider) deliver notification to
the patient's Primary Provider. A (Attending
Physician) deliver notification to the patient's
Attending Physician. T (Patient Care Team)
deliver notification to the patient's primary
care Team. O (Ordering Provider) deliver
notification to the provider who placed the order
which trigger the notification. M (PCMM Team)
deliver notification to users/providers linked to
the patient via PCMM Team Position
assignments. E (Entering User) deliver
notification to the user/provider who entered the
order's most recent activity. (Not used much _at_
Dayton) R (PCMM Primary Care Practitioner)
deliver notification to the patient's PCMM
Primary Care Practitioner. S (PCMM Associate
Provider) deliver notification to the patient's
PCMM Associate Provider.
31
Options Of Interest

• ORB FORWARDING
• Forward Notifications ... ORB3 FORWARD NOTIFS
  MENU

• ORB EXPIRING
• Medications Expiring - Inpt.
• Medications Expiring - Outpt

• ORB FLAGGED ORDERS
• Orb Oi Expiring - Inpt Pr Flag Items For Inpt
  Expiring Prov Recip
• Orb Oi Expiring - Outpt Pr Flag Items For
  Outpt Expiring Prov Recip
• Orb Oi Ordered - Inpt Pr Flag Items For
  Inpt Order Providr Recip
• Orb Oi Ordered - Outpt Pr Flag Items For
  Outpt Order Providr Recip
• Orb Oi Results - Inpt Pr Flag Items For
  Inpt Result Provid Recip
• Orb Oi Results - Outpt Pr Flag Items For
  Outpt Result Provid Recip

• BACK UP REVIEWER PROCESS - Patch XU8285
  enhancements
• Set Backup Reviewer for Alerts XQAL SET
  BACKUP REVIEWER
• XQAL BACKUP REVIEWER Mailgroup

32
ORB Forwarding
Forward Notifications ... ORB3 FORWARD NOTIFS
MENU
Notification Mgmt Menu Option 10 Forward
Notifications Select Forward Notifications
Option 1 Forward Unprocessed
Notification to Supervisor 2 Forward
Unprocessed Notification to Surrogates 3
Forward Unprocessed Notification to Bkup Reviewer
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ORB Forward Supervisor
Forward Unprocessed Notification to Supervisor
ORB3 FORWARD SUPERVISOR
Number of days before a notification is forwarded
to a recipient's supervisor
Only available at the division and system Levels
Maximum is 30 days
Determination of recipients who have not
processed the notification and who their
supervisors are is made by the Kernel Alert
Utility
Value of this parameter is zero or non-existent,
the alert/notification will never be forwarded
Will not be forwarded to surrogates of
recipients who have processed the alert within
indicated days.
Supervisor is identified as the recipient's
service/ section chief
34
ORB Forward Surrogates
Forward Unprocessed Notification to Surrogates
ORB3 FORWARD SURROGATES
Number of days to hold before a notification is
forwarded to a recipient's surrogates.
Only available at the division and system Levels
Maximum is 30 days.
Determination of recipients who have not
processed the notification and who their
surrogates are is made by the Kernel Alert
Utility.
Not indicated or zero notification will not be
forwarded.
Will not be forwarded to surrogates of
recipients who have processed the alert within
indicated days.
Surrogate(s) are identified as the recipient's
MailMan surrogate(s).
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ORB Forward Backup Reviewer
Forward Unprocessed Notification to Bkup Reviewer
ORB3 FORWARD BACKUP REVIEWER
Number of days before a notification is forwarded
to recipient's backup alert reviewer.
Only available at the division and system Levels
Maximum is 30 days
Determination of recipients who have not
processed the notification and their backup alert
reviewer is made by the Kernel Alert Utility
Value of this parameter is zero or non-existent,
the alert/notification will never be forwarded
Will not be forwarded to surrogates of
recipients who have processed the alert within
indicated days.
Backup Reviewers identified individually using
Set Backup Reviewer for Alerts XQAL SET BACKUP
REVIEWER
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ORB OI Expiring
E3R 12229 Requested separation of notifications
for inpatient and outpatient expiring Orders
Resolved with OR3215 (CPRS GUI v26)

• MEDICATION EXPIRING - INPT
• MEDICATION EXPIRING - OUTPT

37
ORB OI Flagged
E3R 16709, 14381 Requesting additional
parameters be developed to build on OR3.074 to
send be able to control alerts to provider
recipients
Resolved with OR3220
Expands flagged orderable item functionality to
send alerts to PROVIDER RECIPIENTS.
ORB OI EXPIRING - INPT PR Flag Items for
INPT EXPIRING Prov Recip ORB OI EXPIRING -
OUTPT PR Flag Items for OUTPT EXPIRING Prov
Recip ORB OI ORDERED - INPT PR Flag Items
for INPT ORDER Providr Recip ORB OI ORDERED -
OUTPT PR Flag Items for OUTPT ORDER Providr
Recip ORB OI RESULTS - INPT PR Flag
Items for INPT RESULT Provid Recip ORB OI
RESULTS - OUTPT PR Flag Items for OUTPT RESULT
Provid Recip
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Provider Recipients
Flag Orderable Item(s) to Send Notifications
ORB3 FLAG ORDERABLE ITEMS
Only available at the division and system levels
Notification Mgmt Menu Option 8 Flag Orderable
Item(s) to Send Notifications
Delivered to a user based upon that user's
relationship to the patient as defined by PATOMERS
Used to trigger a notification/alert when a
specific orderable item is ordered for an
inpatient (or outpatient)
Flag INPATIENT orderable items to send
Notifications/Alerts 1. Flag Inpatient
ORDERS. 2. Flag Inpatient ORDERS for PROVIDER
RECIPIENTS 3. Flag Inpatient RESULTS. 4. Flag
Inpatient RESULTS for PROVIDER RECIPIENTS 5.
Flag Inpatient EXPIRING orders. 6. Flag
Inpatient EXPIRING orders for PROVIDER RECIPIENTS
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Flagged DNR Example
  Flag ORDERABLE ITEMS to send Notifications   1. 
Flag INPATIENT orders/results/expiring
orders.             Flag INPATIENT orderable
items to send Notifications/Alerts   2.  Flag
Inpatient ORDERS for PROVIDER RECIPIENTS.   Flag
Items for INPT ORDER Providr Recip may be set for
the following        1   Division      DIV   
choose from INSTITUTION      2   System       
SYS    YOURSITE.MED.VA.GOV    Setting Flag
Items for INPT ORDER Providr Recip  for System
YOURSITE..MED.VA.GOV Orderable
Item                                  
Value --------------                              
             ----- DO NOT RESUSCITATE
(DNR)           A   Orderable Item DO NOT
RESUSCITATE (DNR)//   DO NOT RESUSCITATE (DNR)  
DO NOT R ESUSCITATE (DNR) Provider Recipients
A// ? PATOMERS Selection for Attending
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Order Expiration Rules
Allows flagged orderable items to send a
notification/alert when an order for that
orderable item is about to expire Expiring
orders are those with a stop date/time before
midnight on the next working day On Saturday
through Thursday, medication orders expiring
within the next 24 hours trigger the alert On
Friday, medication orders expiring within 72
hours trigger the alert Next working day is a
holiday Next Actual Working Day
    Alert is not triggered, IF Patient is
deceased An outpatient Order is a one
time medication Medication is not renewable.
41
Patch XU8285
Patch XU8285 - Correct Alert Processing for
Inactive User
This patch address a patient safety issue in
which alerts sent to an inactive user were not
received by anyone
No specified BACKUP REVIEWERS entries the Alert
will be sent to members of the XQAL UNPROCESSED
ALERTS mailgroup
If no users specified in XQAL UNPROCESSED ALERTS
mailgroup the alerts will go to G.Patch mail group
OR3.0200 Remove Inactive User Alert Screen
42
XQAL Unprocessed Alerts
PATCH XU3285 XQAL UNPROCESSED ALERTS is a
mailgroup Place to send unprocessed alerts if
no other mechanism Persons placed on the list
can vary considerably Dayton Patient safety
(QMS) and HIMs.
Note no users specified in XQAL UNPROCESSED
ALERTS mailgroup the alerts will go to G.Patch
mail group
43
Backup Reviewer System
Resident rotation ends and the Resident clears
and sails away.
See Ya! Yo Ho, Yo Ho, Yo Ho
44
The Resident now departed gets notification for
alerts for Abnormal Imaging or Critical Lab but
will obviously not get them.
The alert is never seen clinically though the
result is available.
45
Alerts were (of course) no longer viewable
Residents were no longer with the facility but
would have been present for a period of time the
alert was generated.
Impossible to determine if they had seen them or
even prove that the alert was generated Our
system setting was enabled and neither user had
disabled it per looking at their alerts in ORB3
RECIP NOTIFICATIONS. There was no indication
that any other provider was provided the
information or had knowledge of the alerts.
46
The Shotgun Approach
THE SHOTGUN APPROACH to no longer have this
occur by Abnormal Imaging and Critical Lab
notification set USING ORB3 PROVIDER RECIPIENTS
to ALL AVAILABLE providers (PATOMERS)
BAD IDEA..
AND A REALITY CHECK!
47
Hold Days before Forward to Backup
OPTION ORB FORWARD BACKUP REVIEWER
SYSTEM LEVEL ABNORMAL IMAGING RESULTS 3
Days CRITICAL LAB RESULTS (ACTION) 3 Days
48
Enable/Disable Notification
OPTION ENABLE/DISABLE NOTIFICATION ORB3
PROCESSING FLAG
ABNORMAL IMAGING RESULTS MANDATORY CRITICA
L LAB RESULTS (ACTION) MANDATORY
49
Provider Recipients
OPTION Provider Recipients for Notifications
ORB3 PROVIDER RECIPIENTS
Provider Recipients may be set for the
following 1 Division DIV
choose from INSTITUTION 2 System
SYS DAYTON.MED.VA.GOV --------- Setting
Provider Recipients for System
YOURPLACE.MED.VA.GOV --------- Notification
Value ------------
----- ABNORMAL IMAGING RESULTS
PAORT CRITICAL LAB RESULTS (ACTION) PAORT
Each of these are set at P (Primary
Provider) A (Attending Physician) T (Patient
Care Team O (Ordering Provider) R (PCMM Primary
Care Practitioner)
50
Backup Reviewer For Alerts
OPTION Set Backup Reviewer for Alerts XQAL SET
BACKUP REVIEWER
Allows Selection of a Backup Reviewer, then
select parameter cases (User, Service, Division,
System could make a case for adding a team to
this) for this Backup Reviewer.
The option then allows selection for another
Backup Reviewer for additional parameter cases if
necessary.
Select NEW PERSON entry to be BACKUP REVIEWER
CHIEF,DOCTOR PCL CHIEF PRIMARY CARE
Select one of the following 1
User 2 Service 3
Division 4 System Enter
response 2 Service Select SERVICE to set
GIVEME,ALERTS as BACKUP REVIEWER for primARY
CARE LINE 11C There is currently 1 instance
for this entity 1 OTHER, CLINICAL
REVIEWER ? This service also has another
Backup Reviewer Select one of the
following a Add an instance
r Replace an instance d
Delete an instance q
Quit Select Action a
51
Backup Reviewer Schemes
Critical Lab (Action)
Abnormal Imaging (Action)
Flexibility of Backup Reviewer Schemes
Receiving Provider (Surgical Service)
Most Instances goes to the receiving provider
3 Days Alert Not Processed
Resident Provider
SURGICAL HSS/ADPAC
3 Days Alert Not Processed
Forward to Correct Provider By Case (Usually
Surgical Attending)
3 Days Alert Not Processed
Clinical Service Chief or Clinical Service
Clinical Reviewer
Asst. Program Director, Internal Medicine
Residency Program/Chief Resident
52
ORB Delete Mechanism
OPTION Set Deletion Parameters for Notifications
ORB3 DELETE MECHANISM
Only available at the division and system Levels
Set of codes used to determine how a notification
will be deleted at a site
Caution They can be confusing and really mess up
routing
I (Individual Recipient) delete the
notification for an individual recipient when
a) that individual completes the
follow-up action on
notifications with associated actions. A (All
Recipients) delete the notification for all
recipients when a) any recipient
completes the follow-up action on notifications
with follow-up actions.
b) any recipient reviews notifications
without follow-up actions.
53
ORB Erase All
OPTION ORB ERASE ALL - Access to erase all my
alerts option
General Parameter Tools ... XPAR MENU TOOLS
option we set to NO to disallow Removing
Pending Notifications
Set at User, Division or System ours is set at
the System Level
Not without controversy - initially
54
GUI Remove Button Enabled
OPTION GUI Remove Button Enabled ORWORB REMOVE
Sets flag to indicate if a CPRS OR notification /
alert can be deleted without processing via the
GUI alert Remove button
A Yes" value indicates the notification / alert
can be removed
If a notification / alert has a blank value or a
No" value, the notification/alert cannot be
deleted without processing
Critical to allow providers control of alerts if
the ORB ERASE ALL is set to No
Critical Lab Result (Action) and Abnormal Imaging
Results are set to No so they can not be
deleted without processing
55
Setting Surrogates In CPRS
56
(No Transcript)
57
Ray LeClair
Unearthing the Alert/Notification Mystery
58
NOTIFICATIONS
VS
ALERTS
59
WHAT MAKES NOTIFICATIONS DIFFERENT FROM ALERTS?

• CPRS (OERR) SPECIFIC CONTROL
• File 100.9
• ORB options routines
• Triggering, Recipients, Follow-up Action,
  Controlled by PARAMETERS

60
Alerts

• VistA Generic Origin
• XQAL Options Routines
• Kernel Control
• Delivery
• Storage
• Deletion
• View Alerts VA

61
How Notification is Createdand How It Becomes An
Alert
ORB NOTIFICATION RESOURCE DEVICE
TRIGGER EVENT

• Taskman

?
NOTIFICATION PROCESSING
ALERT
Kernel Alerts
62
How Alert Is Created
D SETUPXQALERT D SENDTIUALRT Coded in the
routines
63
NOTIFICATION PROCESSING RECIPIENTS DETERMINED
ACCORDING TO PARMETER SETTINGS
ALERT DELETED
ACTION TAKEN
ALERT
RECIPIENT(S) SURROGATE
NO ACTION TAKEN
Backup Reviewer Supervisor Mail Surrogate Back
Review Group Regenerated (TIU)
D SETUPXQALERT RECIPIENTS DETERMINED FROM FILE
SETTINGS OR ENTRY MADE DURING EXECUTION OF ROUTINE
64
Secrets To Successful Alerts/Notifications
In Real Estate Its LOCATION, LOCATION, LOCATION
In VISTA Its CONFIGURATION, CONFIGURATION,
CONFIGURATION
Most Applicable to NOTIFICATIONS Much of ALERT
Configuration is Hard Coded
65
Notification Configuration
KEY PARAMETERS
ORB PROCESSING FLAG - CAN IT BE GOT? ORB
PROVIDER RECIPIENTS WHO GETS IT? ORB DELETE
MECHANISM HOW DOES IT GET REMOVED?
66
Notification Management Barrier 1
OE/RR TEAM/LIST CONFIGURATION
USERS ON MULTIPLE TEAMS PATIENT MEMBERS ON
MULTIPLE TEAMS PERSONAL PATIENT
LISTS USERS/PATIENTS ON DEFUNCT TEAMS TEAM USERS
WITH SURROGATES
67
Notification Management Barrier 2
SURROGATES
Inactive Surrogates Surrogates w/
Aliases Surrogates w/ Surrogates Surrogates on
Teams Surrogate Deletion
68
Notification Management Barrier 3
CONFLICTING PARAMETER SETTINGS
ORB PROCESSING FLAG PACKAGE LEVEL
DISABLED SYSTEM LEVEL NO SETTING DIVISION LEVEL
ENABLED SERVICE LEVEL NO SETTING TEAM LEVEL
MANDATORY USER LEVEL DISABLED ORB PROVIDER
RECIPIENT O ORB DELETE MECHANISM A
69
Notification Troubleshooting 101
FIRST LEVEL Options Available in Notification
Management Menu 14 Determine Recipients for
a Notification 15 Display Patient Alerts and
Alert Recipients 17 Display the Notifications
a User Can Receive
LIMITATIONS Option 14 lists everyone who could
have or did receive notification making finding
one individual difficult Option 15 list every
notification generated for a given patient for a
selected time period, can be extensive
70
NOTIFICATION TROUBLESHOOTING Contd
USER DID NOT RECEIVE NOTIFICATION / ALERT

• MAKE SURE ALERT GENERATED OPTION 15
• CHECK TO SEE IF USER LISTED AS RECIPIENT
  OPTION 14
• MAKE SURE SAME NOTIFICATION ENABLED AND BEING
  DELIVERED TO OTHER RECIPIENTS
• CHECK IF USER HAS SURROGATES
• CHECK IF OTHER RECIPIENTS AND IF DELETE
  MECHANISM IS ALL
• MAKE SURE USER HAS DIVISION SETTING
• CHECK FOR BACKUP REVIEWER AND/OR FORWARDING
  SETTINGS

71
Notification Troubleshooting Contd
USER RECEIVED UNWANTED NOTIFICATION

• CHECK TO SEE IF/WHY USER IS RECIPIENT OPTION
  14
• IS USER A DESIGNATED ATTENDING OR PRIMARY
  PROVIDER?
• IS USER A SURROGATE?
• IS USER A SERVICE SUPERVISOR?
• IS USER A BACKUP REVIEWER?
• IS USER A DEFAULT RECIPIENT?
• IS USER A MEMBER OF TEAM?
• IS USER A MAIL SURROGATE TO A RECIPIENT?
• DOES USER HAVE AN ALIAS?

72
Notification Troubleshooting Contd
NOTIFICATION NOT BEING DELIVERED TO ANY USER

• DETERMINE ORB PROVIDER RECIPIENT STATUS ALL
  LEVELS
• MAKE SURE ORB RESOURCE DEVICE FUNCTIONING
• MAKE SURE ORMTIME CURRENT AND WORKING
• SET SELF AS DEFAULT RECIPIENT

73
General Rule 1 Notification Troubleshooting
If you hear hoof beats
It is not necessarily zebras
74
General Rule 2 Notification Troubleshooting
Once Software Is Broken, It Does Not Fix Itself
If an alert/notification is not working properly
for only one or a few while functioning as
expected for the majority, it usually reflects a
configuration or process problem.
75
General Rule 3 Notification Troubleshooting
If It Cant Be Reproduced - It Cant Be Prevented
Or Fixed

• Rattle In Car Analogy
• Separates Process From Functionality Issues
• Some Errors Best Addressed With Training
• Fixing Something Using Speculation May Induce
  More Significant Errors
• Developers/Maintenance Coders Seldom Are
  Familiar With Field Application/Functionality

76
Little Known Facts

• If a surrogate is defined for a user, the
  alert/notification goes directly to the
  surrogate, intended recipient never gets alert.
• Under certain conditions alerts/notifications
  can be forwarded to Service Chiefs.
• Under certain conditions alerts/notifications
  can be forwarded to Mailman surrogates.
• Deleting an alert does not mean it has been
  deleted from the system. Information related to
  an alert can remain in ALERT TRACKING file for
  weeks, months, years.

77
Little Known Facts
Several notifications only generate one instance
of the notification even if multiple orders are
involved and created at the same time. DC
ORDER DNR EXPIRING FLAG ORDER FOR
CLARIFICATION MEDICATIONS EXPIRING NEW
ORDER NPO DIET MORE THAN 72 HRS ORDER REQUIRES
ELEC SIGNATURE UNVERIFIED MEDICATION
ORDER UNVERIFIED ORDER
78
Little Known Facts

• Users Must Be Associated With The Order/Patient
  To Receive Original Notifications For Same
• All Notifications For Expiring Items Use Same
  Algorithm
• Automated Forwarding to Backup Reviewers,
  Supervisors, Surrogates Works Only If XQADELETE
  OLD is tasked.
• Zeros Set In Timed Events (forwarding) Can Be
  Source Of Errors

79
Techie Tip 1A
USING FILEMAN TO FIND NOTIFICATION IN 8992.1
ALERT TRACKING FILE
At Select ALERT TRACKING NAME Enter OR for ID
OR, Then Enter DFN of Patient OR,100040 Then
Enter Notification Internal Entry Number from
100.9 OR,100040,12 THIS WILL RETURN A LIST OF
CHOICES WITH THE FOLLOWING FORMAT e.g. Select
ALERT TRACKING NAME OR,100040,12 1
OR,100040,12100000001163070508.173003 2
OR,100040,12100000001163070514.200001 The
number after the first semicolon is DUZ of who
created entry. The number after second semicolon
is date/time entry generated.
80
Techie Tip 1B
USING FILEMAN TO FIND TIU ALERT IN 8992.1 ALERT
TRACKING FILE
At Select ALERT TRACKING NAME Enter TIU for ID
TIU Then Merge Entry Number of Document in 8925
TIU7246 THIS WILL RETURN A LIST OF CHOICES WITH
THE FOLLOWING FORMAT e.g. Select ALERT TRACKING
NAME TIU7246 Select ALERT TRACKING NAME
TIU7246 1 TIU7246117433070505.001001
2 TIU7246117433070506.001001 3
TIU7246117433070507.001001 The number after
the first semicolon is DUZ of who created entry,
usually the author of the note. The number after
second semicolon is date/time entry generated.
81
Techie Tip 2
DETERMINE ORB PROCESSING FLAG PARAMETER SETTINGS
USING AC CROSS REFERENCE
Using General Parameter Tools To Determine
Settings ORB PROCESSING FLAG settings for several
entities can be cumbersome
Select CPRS Configuration (IRM) Option XX
General Parameter Tools 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
82
Techie Tip 2 (Continued)
The Parameter Definition ORB PROCESSING FLAG is
internal entry number (IEN) 48 in File
8989.51 Using the AC cross reference of 48 and
the internal entry number (ORBIFN) of a specific
notification in the following global expression
will return a concise listing of all settings for
this parameter XTV(8989.5,"AC",48,,ORBIFN)
e.g. Global XTV(8989.5,"AC",48,,47) ltlt
47MEDICATION EXPIRING XTV(8989.5,"AC",48,"11747
VA(200,",47)E user value XTV(8989.5,"AC",48,"11
754VA(200,",47)D XTV(8989.5,"AC",48,"170DIC(9.
4,",47)D package value XTV(8989.5,"AC",48,"217
SC(",47)E location value XTV(8989.5,"AC",48,"26
2DIC(4.2,",47)M system value XTV(8989.5,"AC",4
8,"94OR(100.21,",47)E team value
83
Troubleshooting Notifications and Alerts Is Often
More Difficult Than Teaching A Cat To Swim