• What is the ‘PHM999’ undefined ingredient used for?

RESPONSE: This "skeleton" ingredient service is necessary to process Alternating IV orders on INVISION. It is the same existing "skeleton" ingredient services used to process complex meds with no ingredients (INVISION only). Mostly transparent to the user, the interface processing was designed to define all alternating IV bottles up front, then place the IV as a non-verified (reviewed) order. The interface processes then reprocesses each ingredient, updates each bottle with the ingredient, and then verifies the order. Creating the initial, interfaced, reviewed order before defining the specific ingredients, creates a bottle with one ingredient. This one ingredient is comprised of the PHM999 skeleton service.

• How will the interface accommodate the following message fields:
• Order Messages (POM) and Expanded Order Message (POME) text fields #213 and 214: The SMS Rx’s Order Message and Expanded Order Message features are not accommodated by the interface. These message text files are designed to provide additional information to the order entry person. The messages are not stored with the order and, therefore, there is no need to pass this information across the interface to INVISION. The comparable feature on INVISION is the Service Master Message, or using the Online Architecture (OAS) to create service-specific message text screens. Dual maintenance will need to be performed on the POM/POME file on SMS Rx and the SM Message file on INVISION.
• Pharmacy Order Comments will be placed in INVISION’s order comment 3fields, 3RXCMNT1-4. The original value on SMS Rx (2 x 60 characters) is a field used by Rx only to internally communicate order related information; e.g., internal comments associated with
• the order to the technician for cart filling (e.g., ‘tape two tablets together’). These comments are usually not displayed to non-pharmacy users.
• Sig Aux will be place in INVISION’s 3fields, 3SIGAUX1-4. The original value on SMS Rx (3 x 17 characters - 51 total) are automatic precautions or instructions to patient or nursing (e.g., ‘shake well’, ‘rotate insulin vial’) and are available for printing on the MAR and labels.
• Additional Sig will be placed in INVISION’s Additional Directions, C1286-8. The original value on SMS Rx (3 x 30 characters) come from either the Latin file or can be typed in as free text.
• How does the interface accommodate the non-scheduled IVs (i.e., titratable IVs)? Will the Adjust Select function to dispense subsequent bags on SMS Rx result in a refilled, dispensed occurrence on INVISION?

RESPONSE: PRN/Titratable IV order entry is supported by the interface. Currently, the interface does not support the Adjust Select function for PRN (titratable) IVs. The ‘refill’ function may not be necessary as dispensed, refilled occurrence may not be necessary on INVISION.

• To check the Transaction File (comsub) to see the fields sent over the interface:

!PF20 - Online Architecture
!PF99 - OAS Admin Menu
!PF10 - Interface Control
!PF4 - RTIF
!PF2 Display RTRNFile
!PF2 - Comsub Subsystem Function
!PF10 - SMS Pharmacy Receive
!PF6 - Display COMQFILE Records

• Does all VSAM need to be a PROD status for the interface to recognize it? Is there a way to test a VSAM item at TEST status in the interface?

RESPONSE: The interface will only read enabled VSAM items; no test status VSAM would be recognized.

As with any implementation, you will find yourself customizing the pharmacy interface process to accommodate your customers’ unique situations. While the Med/IV Orders interface does not utilize the customary INVISION pathways, you may be able to modify the order as it is placed via the interface on INVISION. You should acquaint yourself with the new INVISION Med/IV Orders Interface pathways before attempting any customization. Below are a few examples gleaned from the initial installs showing how the INVISION OAS can be used to customized order placement on INVISION.

1. SCENARIO: Hospital is charging on INVISION (charge on chart for IVs and unit dose meds; charge on dispense for tradition meds) for all orders placed on SMS Pharmacy. Hospital needs to figure out how to suppress charge for traditional meds on INVISION during enter order and refill after the interface is turned on, but before the charting Live date.

SOLUTION: Set Dispense Unit Qty=0 (after T-RXIFEO16 in T-RXIFEO01 add custom T-RXTRAD01 that sets C1314=0 if C1396=2). This will create a traditional order during the back load (charge on dispense) but will not charge for it. To prevent the Refill function from charging before live on Charting, create T-RXREFIL1 that does a $GO=label when %RXINTCC=RF and %SYSDATE is < the live on charge on chart. Place T-RXREFIL1 early in T-RXIFEO01 and add a $L=label stack command at the end of list of stack commands in T-RXIFGE01???. T-RXREFIL1 can be removed at LIVE.

2. SCENARIO: The hospital wishes to set PRN order start time (C1214) default back by 8 hours on INVISION. This will allow nursing to chart a dose up to eight hours prior to Rx entering the order on SMS Rx (allowing for natural delays in order entry). This set back step assumes the interface places the order start D/T into C1213/C1214.

RESPONSE: Created T-RXPRN8H1 (WHERE ALL OF C1220 IS VAL AND C1220 EQ ‘PRN’ AND C1214 GT 0800 THEN C1214=C1214 - 00480 ELSE WHERE ALL OF C1220 IS VAL AND C1220 EQ PRN THEN C1213=C1213 - 00001, C1214=C1214 - 00480) and place in T-RXIFEO01 after the T-RXIFEO08 (the TCL that values C1215 in the interface pathway). T-RXPRN8H1 calls T-RXPRN8H2 which evaluates the set-back start D/T in lieu of the patient’s Admit D/T (C0809/C0810) and move Admit D/T into Start D/T if the 8 hour setback D/T is < Admit D/T (WHERE ALL OF C0809 IS VAL AND C1213 IS VAL AND C1213 LT C0809 THEN C1213=C0809, C1214=C0810 ELSE WHERE ALL OF C0809 IS VAL AND C1213 IS VAL AND C1213 IS EQ C0809 AND C1214 IS VAL AND C0810 IS VAL AND C1214 LT C0810 THEN C1214=C0810).

3. SCENARIO: The Latin Sig Description is not supported on the interface. Pharmacy depends on the Latin Sig Description for all pharmacy orders and expects the text to be used on INVISION.

RESPONSE: Redundantly store the text in PRDFQ and unload the text into a 3field as the interface places the order. To cause the PRDFQ description to default in a 3field (3LATSIGD):

• First, check to make sure this is a valid frequency found in PRDFQ. If it is a nonstandard frequency (C3701 valued with a time) then just move C1215 into the 3field, or if there is no frequency (e.g., continuous IV) then skip out. Create T-RXLATSI1 with the condition WHERE "C3701" IS VALUED THEN "3LATSIGD"="C1215" ELSE WHERE "C1215 IS UNVALUED THEN $R=1 ELSE $T=RXLATSI2.
• Set "PCDFQKEY"=‘PHM xxxxxxxx’ where ‘xxxxxxxx’ is the daily frequency found in C1215. To do this, create T-RXLATSI2 which contains "PCALCID"=‘RXLATSIG’ and $PE=PCALCID, $P=CHPPDVAL, $D=PCAL????, $T=RXLATSI3.
• Create an ‘RXLATSIG’ entry in PRALC containing the "PCDFQKEY"=‘PHM’||’ ‘||"C1215" expression. Note:  An alternative to using Data Evaluator is to use the Concatenation utility (AKA ‘Orders As Written’) to concatenate the above expression.
• Place T-RXLATSI1 in T-RXIFEO01 after T-RXIFEO08 (the TCL that values C1215 in the interface pathway).
• Create T-RXLATSI3 containing the following condition: WHERE ALL OF "PCDFQKEY" IS VALUED AND "PCDFQKEY" IN (PE=PCDFQKEY) THEN $PE=PCDFQKEY, $T=RXLATSI4 ELSE "3LATSIGD"="C1215". This will unload PCDFQDSC (PRDFQ Description) in the AUDA. If it cannot locate an entry in PRDFQ, then just move C1215 into the 3field.
• Create T-RXLATSI4 which DVA’s "3LATSIGD"="PCDFQDSC".
• The "3LATSIGD" should replace C1215 on INVISION (i.e., Charting displays, etc.)