5. Miscellaneous Set Up Items:

• One way to ensure the INVISION pathways are ready to receive interfaced orders is to place a med/IV order on INVISION using model pathways. INVISION orders could be placed using model pathways to test order creation/entry independent of the interface (even if no order entry is expected to be performed directly on INVISION). Although this does not test the RTIF interface, it will assure the essential profiles and Service Master components are in place.
• The model Rx document groups (RXDOCS01-9, 99) need to be in place on INVISION. These document groups are necessary for the successful creation of an INVISION order.
• Add %OMBEDID=1 in the visit create pathway for all outpatients. This will allow INVISION to create "IP like" orders. Otherwise, when placing an order on an outpatient on SMS Rx with the Take Home Ind = NO, the system will try to create an OP order on INVISION, resulting in the error ‘Rx Est Days Supply Req Field Missing’.
• Key back into the SM all Record Type 22 IV Skeleton services (e.g., ‘PHM000001’ thru ‘PHM000012’ from model), including the ‘PHM999’ undefined ingredient skeleton.

6. NURSE SET-UP IMPLICATIONS:

• For nursing to scrutinize the INVISION Rx order placed by Rx via SMS Rx and the interface, and to note their review of the order, place the order on INVISION as pending countersignature. Value %ORCSAUT=0 in T-RXIFGE01. This will cause all orders via the interface to be placed pending countersignature (C1763=Y). Nursing should be given a standalone Countersign Orders function. The nurse sign-on TCL should contain %ORCSAUT=3 (countersign authority). The nurse sign-on and date can be stored in C2715/C2716 and can be place on appropriate documents (Worklist/MAR) and screens (Display Orders, Charting).
• Nursing may desire the order to come over the interface and be placed as unverified (verified on SMS Pharmacy). This way nursing can "verify" the order as a means of checking pharmacy’s interpretation and order entry process. They may not want the order to be active for charting and MARs, etc., until the order is scrutinized by nursing. To accomplish this, value %ORVERIF=0 or 1 in T-RXIFEO12. You should consider building a display/verify of unverify orders as a front end to the charting function for nursing. Additionally, nursing would need the display/verify features as a standalone function.

• How can nursing chart for orders written after the pharmacy closes at night?

RESPONSE: One suggestion is to allow nursing to enter a once/once order on INVISION using a generic "dummy" service. Build Nursing a one-time med/iv order pathway (same pathway used for meds and IVs) allowing the nurse to change the name and enter relevant order information in the direction fields. Pharmacy inputs the order in the morning on SMS Pharmacy starting with the second dose (nursing should note on the order sheet if one dose was entered and charted ahead of time) and performs a miscellaneous charge for the first dose given by nursing.

• At Beta client site, nursing enters their own plain IV orders (via a non-Rx pathway) on INVISION. The hospital created a new entry in PRPRI using the ‘6’ (PRN) entry, but changed the text to some other non-PRN specific name. Nursing will choose this priority and enter the order as a ‘PRN’ order. Doing this will allow nursing to chart the plain IV without worrying about occurrence times. Charging is accommodated through a daily room charge. The plain IV order does not get entered on SMS Rx.

7. MISCELLANEOUS INFORMATION:

• Order number processing:
• The SMS Pharmacy PMP number will be sent over the interface and stored in the 3field, 3RTIFORD. The PMP number can be accessed and viewed by users on INVISION.
• The INVISION order number will go across the interface and get stored on SMS Pharmacy, but will not be accessible to the end user.
• When revising an order on SMS Pharmacy, the INVISION order number will display. A warning is issued if the INVISION order number cannot be found.
• The interface does take advantage of the Med/IV Orders Install Model, Orders As Written feature. Therefore Display Orders using C127F can be used. Nursing could be given the conventional display (using C1202) or the install model display, with a ‘toggle’ key to go back and forth between the displays.
• The glossary indicates the ‘Unspecified’ Sig Type is not supported on INVISION and therefore is not supported by the interface. How should a user enter a PRN order since ‘Unspecified’ is used for PRN orders on SMS Rx?

RESPONSE: PRN orders are allowed on SMS Rx and the interface. What is not supported is a ‘scheduled unspecified’ order, i.e., a scheduled (routine) order with no specified TOAs. The purpose of these orders (e.g., some oncology orders or pre-op order) is to create an order that acts like a PRN (i.e., no occurrences or TOAs), but appears with other scheduled/routine orders on MARs, etc. This type of order is not supported on INVISION and is therefore scoped out of the interface project. There are two recommendations for entering this type of order:

• Enter the order as PRN (unspecified) order. No TOAs will be created, although the order will appear with other non-scheduled (PRN) orders on reports.
• Enter the order as a scheduled order. This will build a TOA; however, the order will be grouped with other scheduled orders.

• Why is Dispense Unit not valued on the interface specs table mapping on the INVISION side of the document?

RESPONSE: For formulary (i.e., items found on the PDM and SM) orders, the Dispense Unit does not need to be sent across the interface. The Dispense Unit is unloaded from the SM on the INVISION side and is therefore not needed in the interface. Non-Formulary orders will use this field in the interface to send the Dispense Unit, if entered, on the SMS Rx side.

• How does the daily vs weekly frequency work on the interface; e.g., how does the interface know to pull weekly frequency vs. daily frequency if 10MWF is used on SMS Rx?

RESPONSE: The INVISION TCL, RXIFEO08, examines and values the following data coming over from SMS Rx:

• %RXIF001 = Sig Code
• %RXIF002 = Type Sig Code
• %RXIF003 = Type Sig Data
• %RXIF004 = Priority Code
• non-standard times of administration (C3701 thru C3708)

Depending on the values, the daily/weekly frequencies, C1215/C1219 are valued using the following logic:

Where C3701 is valued (non standard order) then
    $TRXIFEO28 (set non standard times)
Else
Where %RXIF004=‘OT’ (one-time order), ‘ES’, ‘OS’, ‘EX’ then
    C1215=‘Once’
    C1215=‘Once’
Else
Where C1486 (Ord IV Method Type) is valued (IV Order) and %RXIF001 is unvalued (continuous IV) then
    use ‘SMSRXHRS’ expression in PRALC
Else
Where C1486 is valued and %RXIF001 equals ‘ ‘ then
    use ‘SMSRXHRS’ expression in PRALC
Else
Where %RXIF001 is valued and %RXIF002 in (R,D) and %RXIF003 is valued then
    C1215=%RXIF001
    C1219=%RXIF003
Else
Where %RXIF001 is valued and %RXIF002=‘H’ and %RXIF003 is valued then
    use ‘SMSRXHRS’ expression in PRALC’
Else
Where %RXIF001 is valued then
    C1215=%RXIF001
    C1219=‘Daily’
Else issue $MSG=120225

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