Jim Gray
----- Original Message ----- From: "Nancy Anthracite" <[EMAIL PROTECTED]>
To: <hardhats-members@lists.sourceforge.net>
Sent: Thursday, April 21, 2005 5:45 AM
Subject: Re: [Hardhats-members] IHS system???
Tantalized and becoming less confused would describe me, and hoping someone
would be willing to help us document how to implement this for the WorldVistA
Wiki.
BTW, it sure is nice to see posts coming from IHS folks. The experience you
all have had with adapting VistA for the "Real World" certainly can help
those of us struggling with the issues for the first time a whole lot! You
have dealt with the small to large implementations and a non-veteran
population with characteristics that are more generalizable to the whole
world than what VA FOIA VistA needs to support, such as no SS number, Peds
and OBGYN, so you have a lot of valuable information that many of this list's
readers could use, for sure. You could probably also tell us what worked and
what didn't with the solutions you found.
So, besides the SS numbers, what are some of the other big issues you IHS folks have had to tackle that those of use looking at VistA from the VA have been blissfully unaware of the need to address?
On Thursday 21 April 2005 02:37 am, Floyd Dennis wrote:
There appears to be some confusion on the nature of the IHS patient fileıs Health Record Number. I donıt know if clarification is possible, but Iıll give it a shot. :>
1. Like many of the initial RPMS modules, the IHS Patient Registration
system is ³piggybacked² onto the VAıs registration system. Much of the
patient demographic information resides in File #2 (referenced in RPMS as
the VA PATIENT file). Additional patient data captured by the RPMS patient
registration system is stored in File #9000001 (the RPMS systemıs PATIENT
file referred to as PATIENT/IHS by VistA), which maintains a DINUM
relationship with File #2. Examples of such additional data are patientıs
tribe of membership, level of eligibility for IHS services, etc.
2. The RPMS deals with IHS-specific mods to VA standard dictionaries in a
similar fashion; DINUM-related RPMS correspondent dictionaries are
established; and the IHS-specific mods dealt with in the corresponding
dictionary. One example of this is the IHSıs method of identifying
facilities. The VAıs standard dictionary of facilities is maintained in
file #4 (INSTITUTION); IHS has its own standard method of facility ID
coding, however, for which (to the best of my knowledge) there is no
corresponding VA code. The RPMS solution to this was to create a LOCATION
file #9999999.06 which (a) has a DINUM relation with file #4 and (b)
contains the IHS standard 6-digit ASUFAC ID code for the facility. Simple,
huh? :)
3. When looking at using the VAıs DHCP software, one of the very first
hurdles IHS had to overcome was the problem of patient identification. The
VAıs patient registration system uses SSN as its primary patient
identifier. IHS cannot base its patient identification on SSN, however,
because many of its patients (especially on the larger Southwestern U.S.
reservations) have never applied for nor been issued a Social Security
number.
4. The IHS solution was/is the health record number (HRN), a number which
uniquely identifies a patient within a given healthcare facility. There is
no relationship between the HRN and the SSN; the two are apples and
oranges. For facility-external references, the HRN can be concatenated onto
the end of the facilityıs ASUFAC code. In IHS, the HRN is limited to 6
digits; YMMV.
5. The RPMSıs PATIENT file #9000001 incorporates multiple field #4101
which contains (a) a LOCATION file pointer reference to each facility at
which a patient has been registered, and (b) the patientıs HRN at that
facility. This (theoretically) allows coherent management of demographic
information for patients registered at more than one IHS facility. In
Annaıs example entries, the HEALTH RECORD FAC field is the pointer
reference to the registering LOCATION file entry, and the HEALTH RECORD NO.
field is the patientıs HRN at that facility. Annaıs #3 entry represents a
patient TEST PATIENT,PATIENT who has been registered with chart number
000001234 at the SOFTWARE SERVICE healthcare facility.
6. Unsurprisingly, the earlier standard FileMan lookups did not deal well with the notion of using several data items from a multiple field as a unique patient lookup identifier (this *was* back in the days of FileMan v16.60, after all). The AUPNLK* routines perform that patient lookup function, as well as providing increased security on patient lookups.
7. Since the VistA software does not acknowledge or use the RPMS #9000001
PATIENT file, this HRN-identifier lookup would not be available on the
VistA side of the house without some rewriting of a given packageıs patient
lookup modules. This is not an insurmountable problem; as a momentıs
reflection will reveal, IHS has performed this rewrite on every VistA
package that has been adapted for use in the RPMS environment.
8. Along the same lines as #7 since the AUPNLK* patient lookup routines are IHS-developed software, they would be unlikely to pop up in a VA software distribution.
NOW is everybody sufficiently confused? :)
--------------------------------------------------- Doubt is uncomfortable; Certainty is ridiculous.
- Voltaire
Floyd Dennis [EMAIL PROTECTED]
On 4/20/05 10:59 AM, "James Gray" <[EMAIL PROTECTED]> wrote:
> I believe the input transform on the HRN field is for a max of 6 digits.
> I thought that some version of the AUPNLK* routines were included in the
> VistA FOIA. The lastest can be obtained from the IHS FOIA. It would be
> possible for a hospital to put their own patient id's into the HRN field
> as long as they are numbers no more than 6 digits long.
>
> If you have Cache installed on a Windows machine you should be able to
> load it onto Cache. I do not know about untaring (if that is the right
> term) without Unix or Linux.
>
> I was trying to say that IHS uses unmodified versions of VA Fileman and
> Kernel.
>
> Jim Gray
>
>> ----- Original Message -----
>>
>> From: Anna Joseph <mailto:[EMAIL PROTECTED]>
>>
>> To: hardhats-members@lists.sourceforge.net
>>
>> Sent: Wednesday, April 20, 2005 12:39 AM
>>
>> Subject: Re: [Hardhats-members] IHS system???
>>
>>
>>
>>
>> From: James Gray <mailto:[EMAIL PROTECTED]>
>>
>> To: hardhats-members@lists.sourceforge.net
>>
>> Sent: Wednesday, April 20, 2005 3:30 AM
>>
>> Subject: Re: [Hardhats-members] IHS system???
>>
>>> >I don't either, but I recall some things about it. If you use the >>> >VA
>>> > FOIA
>>>
>>> there is cross reference on the SSN that stuffs the SSN into the HRN.
>>> The interesting thing is >that it violates the input transform on the
>>> HRN field.
>>
>> what is the input transform on the HRN Field? I mean does it
>> increase/decrease the number of digits, a specific logical
>> transformation...?
>>
>>> >If you are not going use SSN you need a different way to keep files >>> >2
>>> > and
>>>
>>> 9000001 in synch. The cross reference (something like PX09) is how
>>> the VA software keeps >the two files in synch. If you make the SSN
>>> optional or do not use it then the two files will not stay in synch.
>>> IHS does it a different way. They keep the two files in >synch with
>>> the file 2 look up routines (the routines with the names AUPNLK*).
>>
>> Tried to locate the routine (AUPNLK ) could not find anything of that
>> sort in the OpenVista SemiViva 4.0 which we are using. We presume that
>> this contains all the FOIA routines. In which case the routines are
>> only available in the IHS system.
>>
>>
>>
>> So that means that the SSN will have to be maintained (to play it
>> safe), though it may not be used by a hospital, which would use the
>> HRN. In such a case, can we generate the HRN using a M routine
>> (Generally Hospitals like to have their own sequence for patients
>> numbers with respect to their status i.e. private patient, general
>> patient, etc.) or are there other criteria for gernerating the HRN?
>>
>>> >To refer back to an earlier question, if you do not have Mumps
>>> > programmers
>>>
>>> available it will be difficult to impossible to meld RPMS and Vista.
>>> But they are quite similar >and I do not think the isssue would be
>>> very difficult for a Mumps programmer. I do not know if anyone has
>>> gotten RPMS to run on a GT.M system. RPMS uses >essentially vanilla
>>> VA Fileman and Kernel.
>>
>> I wish we can have a local implementation of RPMS. I have tried to
>> look at the page www.ihs.gov/Cio/RPMS/index.cfm
>> <http://www.ihs.gov/Cio/RPMS/index.cfm> provided by Marc Aylesworth. >> I
>> have not understood how one can go about the installation of RPMS? I
>> mean, you can only download the .zip/.tar files as per your module
>> selection from the site. How do we proceed then?
>>
>>
>> RPMS apparently has not been implemented on GT.M. How does one install
>> it on Cache? Does one have to use UNIX (again which flavor of UNIX) or
>> can it be installed using Cache on Linux or Windows?
>>
>>
>>
>> What is the meaning of Vanilla VA Fileman and Kernel? This is
>> apparently needed for RPMS installation. If so how does one get hold of
>> it?
>>
>>
>>
>> Is there any way of atleast going thru a demo of the IHS system if I
>> can't have it setup here locally?
>>
>>
>>
>> Anna
>>
>>> ----- Original Message -----
>>>
>>> From: Aylesworth Marc A Contr AFRL/IFSE
>>> <mailto:[EMAIL PROTECTED]>
>>>
>>> To: 'hardhats-members@lists.sourceforge.net'
>>>
>>> Sent: Tuesday, April 19, 2005 9:59 AM
>>>
>>> Subject: RE: [Hardhats-members] IHS system???
>>>
>>>
>>>
>>>
>>>
>>> Unfortunately I do not work with RPMS anymore. I believe that the
>>> record number can be different from the SSN but am unsure how to
>>> achieve it SORRYY !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
>>>
>>>
>>>
>>>
>>>
>>> Thanks,
>>>
>>> Marc Aylesworth
>>>
>>>
>>>
>>> C3I Associates AFRL/IFSE Joint Battlespace Infosphere Team
>>>
>>>
>>>
>>> 525 Brooks Rd
>>>
>>> Rome, NY 13441-4505
>>>
>>>
>>>
>>> Tel:315.330.2422
>>>
>>> Fax:315.330.7009
>>>
>>> Email:[EMAIL PROTECTED] <mailto:[EMAIL PROTECTED]>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> From: [EMAIL PROTECTED]
>>> [mailto:[EMAIL PROTECTED] On Behalf Of
>>> Kevin Toppenberg
>>> Sent: Tuesday, April 19, 2005 10:46 AM
>>> To: hardhats-members@lists.sourceforge.net
>>> Subject: Re: [Hardhats-members] IHS system???
>>>
>>>
>>>
>>>
>>>
>>> Anna,
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> I don't know how this system works. I wonder if Marc A., who I
>>> believe works with the IHS system, could explain this.
>>>
>>>
>>>
>>>
>>>
>>>
>>>
>>> Kevin
>>>
>>> Anna Joseph <[EMAIL PROTECTED]> wrote:
>>>> That's just the captioned output of some patients in the
>>>> implementation we have here. These patients we had entered (not
>>>> sasmple patients).
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> STANDARD CAPTIONED OUTPUT? Yes// (Yes)
>>>> Include COMPUTED fields: (N/Y/R/B): NO// BOTH Computed Fields and
>>>> Record Number
>>>> (IEN)
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> NUMBER: 5 NAME: PATIENT,SURGERY
>>>> HEALTH RECORD FAC: SOFTWARE SERVICE HEALTH RECORD NO.: >>>> 789654123
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> NUMBER: 3 NAME: TEST PATIENT,PATIENT
>>>> HEALTH RECORD FAC: SOFTWARE SERVICE HEALTH RECORD NO.: >>>> 000001234
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>>
>>>> Anna
>>>>
>>>>> ----- Original Message -----
>>>>>
>>>>>
>>>>>
>>>>> From: Kevin Toppenberg <mailto:[EMAIL PROTECTED]>
>>>>>
>>>>>
>>>>>
>>>>> To: hardhats-members@lists.sourceforge.net
>>>>>
>>>>>
>>>>>
>>>>> Sent: Monday, April 18, 2005 6:56 PM
>>>>>
>>>>>
>>>>>
>>>>> Subject: Re: [Hardhats-members] IHS system???
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> Are these patients that you entered, or are they sample patients?
>>>>> What number do they have entered? Is it a SSN?
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>>
>>>>> Kevin
>>>>>
>>>>> Anna Joseph <[EMAIL PROTECTED]> wrote:
>>>>>> Kevin
>>>>>> Yes did just check out the file. Surprising to find that all
>>>>>> patients have a
>>>>>> health record number assigned to them! Does this then mean that to
>>>>>> have an
>>>>>> implementation of the IHS software you need to apply their patches
>>>>>> to a VistA core?Can that be done on the GT.M database itself?
>>>>>> Wonder if anyone here has ever tried it or has an idea of how we
>>>>>> can install
>>>>>> it and how it works?
>>>>>> Anna
>>>>>>
>>>>>> ----- Original Message -----
>>>>>> From: "Kevin Toppenberg"
>>>>>> To:
>>>>>> Sent: Monday, April 18, 2005 5:21 PM
>>>>>> Subject: Re: [Hardhats-members] IHS system???
>>>>>>
>>>>>>> > Anna,
>>>>>>> >
>>>>>>> > See if your system has a file# 9000001
>>>>>>> >
>>>>>>> > This is the PATIENT/IHS file. Here are the fields as
>>>>>>> > reported by VPE's DD
>>>>>>> >
>>>>>>> > File: PATIENT/IHS
>>>>>>> > Branch: 1
>>>>>>> > REF NODE;PIECE FLD NUM FIELD NAME
>>>>>>
>>>>>> ====================================================================
>>>>>>===== ===
>>>>>> ===
>>>>>>
>>>>>>> > 1 0;1 .01 NAME
>>>>>>> > <-Pntr [RP2'X]
>>>>>>> > 12;0 1201 LOCATION OF HOME
>>>>>>> > <-WP [9000001.12]
>>>>>>> > 2 -0;1 .01 -LOCATION OF HOME
>>>>>>> > [W]
>>>>>>> > 41;0 4101 HEALTH RECORD NO.
>>>>>>> > <-Mult [9000001.41IPA]
>>>>>>> > 3 -0;1 .01 -HEALTH RECORD FAC
>>>>>>> > <-Pntr [P9999999.06'X]
>>>>>>> > 4 -0;2 .02 -HEALTH RECORD NO.
>>>>>>> > [RFX]
>>>>>>> > 5 -0;3 .03 -DATE
>>>>>>> > INACTIVATED/DELETED [D]
>>>>>>> > 6 -0;5 .05 -RECORD STATUS
>>>>>>> > [S]
>>>>>>> > 7 -0;6 .06 -STOP INTEGRATION
>>>>>>> > [S]
>>>>>>> > <> <> <>
>>>>>>> >
>>>>>>> > I think it is fairly well integrated into the VA
>>>>>>> > system. But I don't know if VistA depends on it. I
>>>>>>> > don't think CPRS can use it to look up a patient by
>>>>>>> > their HEALTH RECORD NO. however.
>>>>>>> >
>>>>>>> > Another option would be to use just name and DOB.
>>>>>>> > There is a key that allows entry of patients WI THOUT a
>>>>>>> > SSN. Or, you can just enter "P" for a SSN, and they
>>>>>>> > will be given a pseudo-SSN.
>>>>>>> >
>>>>>>> > Kevin
>>>>>>> >
>>>>>>> > --- Anna Joseph wrote:
>>>>>>>> > > Indian Health Service runs a system similar to
>>>>>>>> > > VistA.. With the little I
>>>>>>>> > > know about it, seems like they do not use an SSN
>>>>>>>> > > number to identify the
>>>>>>>> > > patient but they have record number... which caught
>>>>>>>> > > my attention!
>>>>>>>> > > Has anyone worked with this system? Was trying to
>>>>>>>> > > have a local
>>>>>>>> > > implementation of it to explore it. Any idea of
>>>>>>>> > > where i can get the sources
>>>>>>>> > > from? how the installation etc. is to be done?
>>>>>>>> > > Anna
>>>>>>> >
>>>>>>> > -------------------------------------------------------
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-- Nancy Anthracite
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