Overview of CPRS
CPRS provides clinicians, managers, support staff, researchers, and others an integrated patient Record] system. VISTA software for Pharmacy, Lab, Radiology, Allergy Tracking, Consults, Dietetics, Progress Notes, Problem List, Scheduling, MAS (A/D/T), Kernel, FileManager, Vitals, PCMM, PCE, TIU, ASU and Clinical Lexicon packages was written or modified to support and communicate with CPRS. OE/RR was completely re-written. Together, these clinical components of VISTA provide a single interface for physicians to manage patient care and Records, as well as an efficient means for others to access and use patient information.
Smooth transition from OE/RR
When a VAMC installs CPRS, a fully automated process converts existing orders, order dialogs, orderable items, medications, labs, consults, clinical notifications and other components into CPRS. No patient data is lost and little or no manual conversion is required. Installation of CPRS only requires 1-2 hours of system downtime, with little impact on users and patient care. Because of its “user-friendly” design, most VA clinicians can use CPRS with minimal training.
OE/RR core module.
All basic CPRS tasks occur within the M environment. Tasks relegated to the GUI workstation include those necessary to communicate with the server and to present and obtain data. Specific components of the core M module for OE/RR include:
Order processing and storage.
Processing orders in CPRS includes: 1) order dialog presentation, 2) order checking, 3) appropriate holding/processing/status assignment related to user credentials, order signature status, and filling package, 4) HL7 formatting, and 5) event posting for filling package and other interested parties, 6) receiving order status messages from filling package, and 7) updating the appropriate data files. Order storage in CPRS includes a complete, date/time-stamped history of all events related to the order including status changes, ordering, requesting, and signatory personnel, related order checks, and override reason, flagged order data, and various components related to the filling package.
Mechanism for clinical orderable items.
Orderable items are phrased in physician-friendly terms, centrally stored and can be updated at individual VAMCs. Updating is coordinated between OE/RR core and ancillary packages via HL7 messages.
An order can be flagged when it requires special attention. A notification regarding the flagged order is sent to appropriate caregivers assigned to the patient.
Orderable items can be assigned varying degrees of electronic signature requirements. Unsigned orders trigger a notification to appropriate patient caregivers.
Orders are linked with specific patient encounters, facilitating point-of-care management and data exchange with encounter-oriented management processes.
Extensive patient selection capabilities allow physicians to build patient lists based on ward, room-bed, clinic appointment, patient’s primary provider/Attending Physician, team and individual patient. Once created, providers’ preferred patient lists are automatically loaded when they access CPRS. For example, a provider can set up a patient list based on each day’s clinic appointments. This list is built automatically each day and displayed to facilitate easier patient selection.
List Manager Interface.
Non-GUI, ANSI terminals use the CPRS List Manager interface. Designed with a great deal of clinician usability feedback, this interface displays allergies, lab results, medications, existing orders, consults, and other clinical data in a format conducive to decision making. The order entry process has been streamlined to gather the most pertinent information necessary to fill the order.
Clinical workstations in the Windows environment access CPRS through a Delphi-based Graphical User Interface (GUI). Based on years of prototyping, usability studies, and actual clinical use, the CPRS GUI is a full implementation of results reporting and order entry. It communicates with CPRS server processes through the Kernel Broker client-server utility. Data is exchanged via an extensive list of remote procedure calls.
HL7 Messaging/Event Processing.
Communication between VISTA packages participating in CPRS is accomplished primarily through event-driven HL7 messaging. This approach allows multiple processes to subscribe to a single CPRS event. The structure and content of the HL7 message provides consistent data for processes subscribing to an event. Additional Application programmer interfaces (APIs) exist between OE/RR and ancillary packages to provide data not supported by HL7.
VAMC Parameters and Defaults.
Every VAMC has specialized needs regarding CPRS functionality and processing. To allow variation and modification among VAMCs, CPRS provides a hierarchically structured set of parameters. Each parameter can have a user, team, service/section, patient location, division, system, and package value. The extensive set of parameters exported with CPRS allows VAMC administrators and CPRS users to fine-tune the functionalities and processes specific to their needs.
Remote Procedure Calls.
A fully functional consulting package is exported with CPRS. Integrated tightly with CPRS, consults provides consult ordering/requesting, tracking, and resulting. Consulting events such as requesting and resulting trigger notifications to appropriate health care providers, who can then quickly react to the request or result.
Patient and Team List functionality in CPRS provides several methods for linking health care providers with patients. Team relationships can be based on ward, room-bed, provider, specialty, and/or clinic. Membership is updated automatically when patients are admitted, discharged, transferred, or assigned to a clinic.
The CPRS Expert System is a modular, rule-oriented, knowledge-based system. It supports CPRS as the basis for real-time order checking (e.g. critical drug interactions, duplicate orders) and background notifications (e.g. critical lab results, expiring medications.) Components include: a Meta-Dictionary for linking discrete medical concepts with data located in files, messages and dialogs; a Rule Editor for creating and editing medical logic modules (MLMs) or rules which relate meta-dictionary concepts in logical expressions; an Inferencing Engine for processing the rules against data; and a Router for distributing results or messages.
The Notifications component generates patient-specific clinical alerts regarding order entry, consult, radiology, lab, pharmacy, dietetics, and A/D/T information.Alerts are displayed to VISTA users when they sign onto the computer. They can also be delivered to printers, files, and terminals. Many alerts allow recipients to take related follow-up Actions. For example, a patient’s unsigned order triggers an alert to appropriate health care providers. When a recipient selects the alert, the follow-up Action displays the patient’s unsigned orders and Prompts for electronic signature. Via parameters, VAMCs can disable or enable notifications for users, teams, patient locations, services, divisions, and systems.
Order Checks are messages interactively displayed to the ordering provider during an ordering session. They occur in real-time and are driven by responses entered by the ordering provider in conjunction with existing patient data. Order Checks are rated according to potential clinical danger level. Order check messages with a low or moderate clinical danger level can be ignored. High clinical danger level order checks require the entry of a reason if they are overridden. This information is passed on to the filling package (e.g. pharmacy) as part of the order. All order check messages include a Prompt to cancel or change the order. Via parameters, VAMCs can adjust order check clinical danger levels and disable or enable order checks for users, teams, patient locations, services, divisions, and systems.
Online CPRS Demo
Adding Remote Procedures for Use with CPRS
GTM>D P^DI VA FileMan 22.0
Select OPTION: 1 ENTER OR EDIT FILE ENTRIES
INPUT TO WHAT FILE: OPTION
1 OPTION (9906 entries) 2 OPTION SCHEDULING (18 entries)
CHOOSE 1-2: 1 OPTION (9906 entries) EDIT WHICH FIELD: ALL// RPC (multiple)
EDIT WHICH RPC SUB-FIELD: ALL//
THEN EDIT FIELD: