Adding new drugs in VistA

[Tony Perry]

Hi,

I am trying to add a drug to VistA that isn't in the formulary (meropenam 500mg injection).

I have read the Pharmacy Management manual (http://www.va.gov/vdl/documents/Clinical/Pharm-Data_Mgmnt_(PDM)/pss_1_um_r0312.pdf)   but am not having much luck.

I am adding new drugs using the "Orderable Items" table via FileMan, which seems to be the best way of ensuring that the drug appears in CPRS.  (I know that the Enter/Edit Drug function in the Pharmacy Data Management (PSS MGR) is another option, but drugs entered through here don't appear as orderable in CPRS.  This also seems to use a different table, as a drug I added in Orderable Items did not appear when I tried entering it in PSS MGR).

Also, in neither case can I specify in CPRS that meropenam is administered via an injection.  Based on the Orderable Items table, the default response in CPRS seems to be as a nasal spray; I saw no field in either PSS MGR or the Orderable Items table for the method of administering the drug.  The closest I found was in PSS MGR (Enter/Edit Drug) for the "dispense unit", but even this requires an assumption (e.g. tablets could be found in a 'carton' or a 'box' of medication).

I've tried looking in "Medication Route File Enter/Edit" in PSS MGR, but this seems to apply to medication routes as a generic concept (rather than for a specific drug).

 Does anyone have any thoughts?  (I tried looking on the Vistapedia site but it seems to be down at the moment).

Any guidance would be most appreciated!

Tony

[David Whitten]

A very general overview:

The DRUG file #50 keeps track of drugs that can be FILLED by the pharmacy.
The ORDERABLE ITEM File #101.43 specifies everything that can be ORDERed with CPRS.
The PHARMACY ORDERABLE ITEM file #50.7 specifies the links between the two files.
The National Drug files specify information about the medications that might be included in the DRUG file.

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[Sanchu Shanmugam]

Tony

I will have my team member send you the steps to add this specific drug along with the associated route.

Should be reaching you within 12 hours, hope this should be okay for you..

Regards

Sanchu S

OHUM Healthcare

Skype: sanchu.shanmugam

[Sam Habiel]

http://vistapedia.net/index.php/Enter_A_Drug

Written by yours truly. Includes a section on how to add drugs not
marketed in the US.

Sam

[Nasir Mahmood]

vistapedia.net is reportedly being identified as a malware site and my browser always warns me to not to go for it.

Nasir Mahmood

[tony2468]

Thanks Sam, David and Sanchu!

 

David, thanks for clarifying the purposes of the different tables -- it does sound like one has to enter medication details into the system twice (one for ordering, the other for fulfilling orders).

 

Sanchu, thank you for having your team member send us instructions that you've used for adding medications and the mode of delivery.  I look forward to receiving these!

 

Sam, thanks also for posting your instructions on Vistapedia --- like Nasir (my colleague working on our project in Pakistan), I can't get onto the Vistapedia site without risk of malware.  (I've had this problem beefore on vistapedia, which is a great shame given the treasure trove of information it contains).

 

Best regards,

 

Tony

On Wednesday, July 4, 2012 9:05:41 AM UTC+1, Sam Habiel wrote:

http://vistapedia.net/index.php/Enter_A_Drug

Written by yours truly. Includes a section on how to add drugs not
marketed in the US.

Sam

On Tue, Jul 3, 2012 at 11:45 PM, Sanchu Shanmugam

wrote:
> Tony
>
> I will have my team member send you the steps to add this specific drug
> along with the associated route.
>
> Should be reaching you within 12 hours, hope this should be okay for you..
>
> Regards
> Sanchu S
> OHUM Healthcare
> Skype: sanchu.shanmugam
>
> On Wed, Jul 4, 2012 at 2:57 AM, Tony Perry

>> To unsubscribe, send email to Hardhats+unsubscribe@googlegroups.com
>
>
> --
> http://groups.google.com/group/Hardhats
> To unsubscribe, send email to Hardhats+unsubscribe@googlegroups.com

[David Whitten]

Both VistApedia.net and VistApedia.com are now hosted on a different machine than was identified as a malware site.

The software has been reviewed to verify that no malware is being hosted, and the new machine is under our control, as opposed to the previous machine, which we could not control, and which was exploited by a PHP worm.

[tony2468]

Hi David,

I had another go at vistapedia.com and all worked well...  (Sam, thanks for the link!  http://www.vistapedia.com/index.php/Enter_A_Drug)

I followed the instructions and somehow managed to get the drug to appear using the Drug Enter/Edit option.  I don't know whether my earlier issue was related to security keys (and so not seeing questions?), but I didn't get a warning about this when I was updating via the WorldVistA server.  The Enter/Edit Drug now shows questions both for the drug itself and then the drug ordering options.  I will try a couple of other drugs as well to see if I can do this more confidently.

I do have a related problem, though -- for some reason, I can't get VistA to prompt me on strength and dosages.  So, for merapenam, for example, I can type in "500 MG" as part of the generic drug name, but I don't see where I can put this into the system so it can be selected using the Medications order form in CPRS.  (This will be particularly an issue for drugs with more than one possible dosage (e.g. 500 MG, 1000 MG).  

I see the option of "Local Possible dosages", but it simply shows "strength" and "unit" as unpopulated (and doesn't give me an option to populate them).

Does anyone have any thoughts on how to do this?

I've attached the putty log as reference.  (Please let me know if I've mis-answered a question, which could be causing the problem!).

Thanks!

Tony

PS. Happy 4th to those in the States!

On Wednesday, July 4, 2012 5:14:46 PM UTC+1, David Whitten wrote:

Both VistApedia.net and VistApedia.com are now hosted on a different machine than was identified as a malware site.

The software has been reviewed to verify that no malware is being hosted, and the new machine is under our control, as opposed to the previous machine, which we could not control, and which was exploited by a PHP worm.

On Wed, Jul 4, 2012 at 4:20 AM, Nasir Mahmood < wrote:

vistapedia.net is reportedly being identified as a malware site and my browser always warns me to not to go for it.

On Wed, Jul 4, 2012 at 1:05 PM, Sam Habiel > wrote:

http://vistapedia.net/index.php/Enter_A_Drug

Written by yours truly. Includes a section on how to add drugs not
marketed in the US.

Sam

On Tue, Jul 3, 2012 at 11:45 PM, Sanchu Shanmugam

<> wrote:
> Tony
>
> I will have my team member send you the steps to add this specific drug
> along with the associated route.
>
> Should be reaching you within 12 hours, hope this should be okay for you..
>
> Regards
> Sanchu S
> OHUM Healthcare
> Skype: sanchu.shanmugam
>
> On Wed, Jul 4, 2012 at 2:57 AM, Tony Perry <>

--
Nasir Mahmood

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[JohnLeo Zimmer]

Tony,

From your putty.log:

Select LOCAL POSSIBLE DOSAGE: 500

  Are you adding '500' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? 

No//   (No) ??

Select LOCAL POSSIBLE DOSAGE: YES

  Are you adding 'YES' as a new LOCAL POSSIBLE DOSAGE (the 1ST for this DRUG)? 

No// Y  (Yes)

LOCAL POSSIBLE DOSAGE: YES// 

PACKAGE: IO  Both

It looks like you said (No) to "500", and then (Yes) to

a LOCAL POSSIBLE DOSAGE of "YES"

This is the sort of thing I can stare at for an hour and never see.

regards,

jl.z

--
Not sent from anyone's Ipad

[Chris Edkins]

Most common tasks like this have an existing menu function to do the the needful steps in one go.  Drug entry is no exception.  Use the character based menu option "Drug Enter/Edit" in the Pharmacy Data Manager menu.  This will enter the the drug, cross map it to the national drug file, set up doasage forms and create the orderable item. All in one step.

[Kevin Toppenberg]

This has been a previous thread.  Search archives.

Kevin

[tony2468]

Hi All,

Thanks again for your help with the process of adding drugs -- I've now got a related challenge, in that I was able to add a drug in my local (test) site for VistA, but cannot get it to add at the hospital.  I'm using the Enter/Edit drug option in PSS MGR and following Sam Habiel's instructions (http://www.vistapedia.com/index.php/Enter_A_Drug)  to add an injectable form of vancomycin (500mg).  All of my settings seem to match with the instructions, but this form of vancomycin still isn't showing up in the CPRS order list.  

I then tried to go to the Orderable Item Management option in PSS MGR.  Here it does match again between the dispense and order items and I can't see any sign of a problem here.

I then had another go at the Drug Enter/Edit option but again could not see what might be causing the drug not to appear.

I finally looked through the ORDERABLE ITEMS table in FileMan -- there were two possible issues that I could see:

1) "Set" was set to NV RX.  (Where I had gotten this to work on my local system, I had selected RX.  Unfortunately, I can't find any information on what the different "set" options mean (I've looked in the Pharmacy Data Manual and tried a search on Hardhats)).

2) "Supply" was set to "No".  I changed this to "Yes", as the explanation noted that this was used to indicate whether the drug "is selectable for a medication supply order", which I gather means it can be selected in CPRS? 

I changed this to "Yes", but it still did not appear in the CPRS list.

I've attached a copy of the PuTTY log and am hoping I haven't missed anything obvious (as I did with drug strength in an earlier post in this thread).  I would be most grateful for any feedback you might be able to provide, so that we can add these into the hospital system.

Thanks!

Tony

[tony2468]

Following on my last message, I wanted to confirm that the user adding the drugs has the following security keys as noted in Sam Habiel's instructions:

• PSNMGR (to match the drug)
• PSORPH (to mark drugs for outpatient and non-VA)
• PSJU MGR (to mark drugs for Unit Dose)
• PSJI MGR (to mark drugs for IV)

[tony2468]

Hi All,

I just wanted to note that we've made a bit more progress, and I can now consistently get drugs to appear in CPRS...  However, the process that worked for me is slightly different from Sam's instructions.

I basically did the following:

* Follow Sam's instructions for entering meds in the Drug Enter/Edit menu in PSS MGR

* Go into the ORDERABLE ITEMS table (FileMan), call up the drug I added and change the following settings:

    SET -> RX

    QO -> YES

    SUPPLY -> YES

When I do this, the drug does appear in CPRS (I don't know why these menus--or equivalents--don't get prompted in the Drug Enter/Edit menu in PSS MGR, though...)

We're still having trouble getting dosages and drug forms to appear correctly, unfortunately...  For example, our hospital uses an injectable form of clarithromycin, but the orderable items prompts in "Drug Enter/Edit" insists in a tablet dosage.  This dosage form is pre-populated and I don't see where I can change it.  

Does anyone have any thoughts on how to do this?

 

On Saturday, July 7, 2012 4:08:27 PM UTC+1, tony2468 wrote:

[Sam Habiel]

I will let others help you on the dosages front.

Quick hint1: there is not Injectible Clarithromycin in the US. You
should match Clarithromycin to Azithromycin Injectible and go from
here. The dosage form comes from the one from the National Drug File
the drug is matched to, not the original drug, unless it is unmatched.

But a couple of things scream for a comment:

DO NOT USE FILEMAN TO EDIT ORDERABLE ITEMS. EVER! YES, ALL CAPS IS INTENDED!
They can only be changed from the appropriate menu options. In
general, if you modify a user-land item using Fileman (all of CPRS
set-up belongs in User-land, not programmer/sys admin land), you
should stop and ask yourself: how come I am doing that? All packages
are designed to maintain their files from within the package.
Exceptions are rare. The manual will tell you if you have to change
something through Fileman. A word of advice: always log-in as a user
with limited privileges when working with the system. (Limited
Priviliges = minimum keys to get job done + no fileman access codes).
This will prevent you from doing bad things to the system, like
editing the Orderable Item file.

CPRS has a very strange algorithm for updating the Orderable Items.
When you make a change to the Pharmacy Orderable Item file through
Drug Enter/Edit or Edit Orderable Item, it updates the Orderable Item
List immediately via a call to an entry to the protocol file. However,
CPRS DOES NOT look at the Orderable Item file. It looks at the ORDER
QUICK VIEW file. The orderable item and the order quick view file have
to be kept in sync. That's done using taskman when the user browses
the orderable items from CPRS. Which means, after you make the change,
the first time you look, you won't find the change made. Wait a few
moments (depending on how long taskman takes) and open it again. Now
you will find the drug you added.

FYI: None of your changes to the Orderable Item file through Fileman
made any difference. What you saw was an artifact of the strange way
that CPRS updates ORDER QUICK VIEW file.

Sam

[tony2468]

Hi Sam,

Thanks very much for your reply -- I thought it a bit odd to have to go through both the menu option and a FileMan edit, and I'm relieved to know that all should work in PSS MGR.  It definitely makes life easier not having to get into FileMan for this (as the person doing this on a day-to-day basis will be a pharmacist).

What confused me was that I entered in the new drug details (using PSS MGR alone) with CPRS off.  I then logged on and went to Meds and then Action->New Medication.  My concern was that the drug didn't appear in the list.  If I wait (e.g. a few minutes?), then it should appear?  In essence, then, taskman goes behind the scenes and changes the 'supply' and 'set' variables to make the drug activate?  Is that right?

Thanks also for letting me know about azithromycin being an equivalent.  Do you know whether there is a source (e.g. like a Physicians Desk Reference) that has an international equivalent to drug names?  I'm not sure whether the pharmacist at the hospital in Pakistan will be familiar with US drug names, so something like this would be helpful for matching drugs!  Meropenam was another drug I came across, but I'm not sure what (if any) the US equivalent to this might be.

Tony

> To unsubscribe, send email to Hardhats+unsubscribe@googlegroups.com

[tony2468]

Hi Sam,

I just wanted to let you know I seem to have sorted it -- drugs are now appearing as Orderable Items in CPRS.  I just needed to be patient for TaskMan to update the ORDER QUICK VIEW file.  Thanks for helping me make sense of what was going on!

As for the dosages -- I believe I've gotten to the bottom of this, too.  I looked at Orderable Line Management (under PSS MGR) and pulled a report of all orderable drugs.  This gave a detailed view of all drugs in my system, which showed that there were inpatient dosages--but no outpatient dosages--for vancomycin and clarithromycin.  As I was working with a 'dummy' patient who was an outpatient, no dosages appeared for these drugs.  I did get a dosage option for omeprazole, but this was because there was an outpatient dosage associated with this drug as an Orderable Item.

My next challenge is to see whether it's possible to add these as being available for use on an outpatient basis.  The doctors and pharmacist there will have to confirm that these are indeed used for outpatients, but I just want to make sure that--if they are--we can update the system to reflect that.

I look forward to any thoughts others might have on this!

Thanks again to all for your help!

Tony

On Sunday, July 8, 2012 8:33:04 PM UTC+1, Sam Habiel wrote:

> To unsubscribe, send email to Hardhats+unsubscribe@googlegroups.com

[Sam Habiel]

"In essence, then, taskman goes behind the scenes and changes the
'supply' and 'set' variables to make the drug activate? Is that
right?"

No. What you did has nothing to do with what Taskman does. The fact
that you saw a result in the end is a pure accident of you having
finished after taskman was done updating the order view file. Read my
email again on what really happens.

"Do you know whether there is a source (e.g. like a Physicians Desk
Reference) that has an international equivalent to drug names?"

Azithromycin is the chemical name, as is Clarithromycin. A pharmacist
should be able to find that information. I gave you a workaround;
which perhaps I shouldn't have done. In any case, the answer for you
perhaps is MIMS India. MIMS provides drug information for various
countries.

You are running up the problem that the VISTA implementations in
Jordan, India and Thailand have come up against. The National Drug
Files are US only. Drugs are very variable from country to country. To
date, there is no good solution with VISTA, as VISTA relies on the
National Drug Files.

Sam

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