Problem: If mixed-case names were entered during manual registration of a patient. If an HL7 patient record uses uppercase names, this can result in the creation of duplicate patient records.

Solution: The VAPALS-ELCAP HL7 interface was changed to a case-insensitive matching process. Names are temporarily converted to uppercase to ensure matches are found, to avoid creating duplicates when HL7 brings over a patient who ought to match an existing patient.

Problem: HL7 was registering patients without the Suffix field, which caused later HL7 messages involving those patients to fail to match, because the incoming HL7 message included Suffix, but the patient’s entry in the VAPALS-ELCAP graphstore did not.

Solution: VAPALS-ELCAP HL7 interface now handles Suffix.

Problem: On Intake Form, in the Clinical Indications text box, HL7 does not transmit some text after a line break.

Solution: Fixed.

Problem: On Intake Form, Shared Decision Making should either be done or N/A. If N/A, the Intake Note should say Shared decision making is not applicable.

Solution: The checkboxes were converted to radio buttons, and the functionality fixed.

Problem: New wording desired: include . . . In addition, the Veteran has been educated today about the imporance of adhering to annual lung screening, the possible . . . 

Solution: Updated.

Problem: One of the Comment fields causes extra line breaks in the export.

Solution: Fixed.

Problem: If a text field has a quote in it, this quote is passed through to the output unescaped. This in turn causes problems for other programs that import the file (e.g., Excel). The CSV specifiction requests for embedded quotes to be double quoted.

Solution: Fixed.

Problem: Prior Scans field should be pre-filled with prior dates, but also be editable to enter scans not in system. Prior Scans, Most Recent, and Comparison Scan need to be editable even for baseline. If there is no baseline CT form, then the Baseline CT, Most Recent Comparative Study, and Prior Scans fields should be empty. In some cases, the baseline CT scan will not be the first CT scan.

Solution: Fixed.

Problem: In the Reconstructed Thickness drop-down field, 1.25 mm needs to be an option for slice thickness.

Solution: Added.

Problem: In CT Protocol field, set default to Low-dose.

Solution: Done.

Problem: In Image Number field, only require the lower image number rather than both lower and upper. Most radiologists only provide a single image number.

Solution: Fixed.

Problem: Remove Coronary Artery Calcification radio options for ELCAP users.

Solution: Removed.

Problem: Need to be able to enter additional small nodules if participant doesn’t have a nodule 1. Unable to enter Additional Calcified Nodules or Additional Non-calcified Nodules without first entering a nodule. We need a way to enter those two items without a nodule (for example, if a veteran has a lot of very small nodules but none are big enough to note on the grid).

Solution: Moved the Additional . . .Nodules checkboxes outside the nodule grid. Removed the word Additional.

Problem: When copying the nodule grid forward from a previous form to a new form, if a nodule status is set to Prev Seen, Resolved or Prev Seen, Resected or Not a Nodule, the nodule grid should only keep the Is It New, Nodule Status, and Likely Location fields. The rest should be cleared in the new form.

At present, copy-forward requires all the additional nodule info. If previous report had a nodule, then when copying forward to the new form, if you select Prev Seen, Resolved, we want to zero out most of the values and just keep Nodule Status and Likely Location interactively while working on the nodule grid. This change must be made to the HTML grid and to the copy-forward. This rule should only apply from one CT Evaluation form to another CT Evaluation form.

Solution: Implemented.

Problem: When CT Evaluation form field Calcified/Non-calcified Nodules if checked, the CT Report incorrectly says no . . . nodule. It should say small calcified/non-calcified nodules are present.

Solution: Fixed.

Problem: When Low-dose CT Follow-up is set to Annual Repeat, typing a date into its Date field resets Low-dose CT Follow-up to Other.

Solution: Fixed.

Problem: In cases where non-CT interventions are recommended (such as PET, biopsy, etc.), the follow-up Date should be now. It should be able to be the only recommendation in the impression.

Solution: Fixed.

Problem: Under Cardiac and Aorta, Ascending Aorta Width is forced to be a whole number. It should allow decimals. (The Pulmonary Artery Width already works this way.)

Solution: Fixed.

Problem: On the CT and Intervention forms, three fields (Pulmonary Artery Width, Ascending Artery Width, and a third field) should be moved from Cardiac and Aorta to Emphysema/Coronary Calcifications.

Solution: Moved.

Problem: The intervention date on the Case Review Page uses the date the form was created, but it should use the date of the intervention, or if not filled out, the date of the first intervention.

Solution: Fixed.

Problem: The nodule grid copy-forward isn’t working.

Solution: Fixed.

Problem: The PET and Biopsy dates on the Case Review Page use the date the form was created, but it should use the date of the PET scan or biopsy, respectively, or if not filled out, the date of the first PET scan or biopsy.

Solution: Fixed.

Problem: The Baseline CT Date and Most Recent CT Date fields are not automatically filled in when creating a new PET or Biopsy form.

Solution: Fixed.

Problem: PET and Biopsy form copy-forward aren’t working.

Solution: Fixed.

Problem: On the PET and Biopsy forms, follow-up is required, but it should not be.

Solution: Fixed.

Problem: On the Case Review Page, in the New Form drop-down field list, move PET Evaluation ahead of Biopsy, and move Follow-up ahead of CT Evaluation.

Solution: Reordered.

Problem: In the Enrollment Report, patient names are out of order in a case-sensitive way. Uppercase letters come before lowercase letters, e.g., GZ comes before Ga.

Solution: Re-sorted to be case-insensitive.

Problem: On the Enrollment Report, the Gender and Race fields are empty. At least Gender should be filled in; we may not have a source for Race.

Solution: Gender now consistently filled in for Enrollment Report. Race reserved until we have a data source.

Problem: VAPALS-ELCAP users would like a report that shows which patients are inactive or have withdrawn from the program.

Solution: Created.

Problem: The Last Exam field seems to be redundant if it follows the Recommended Follow-up. The fields should exchange places.

Solution: Re-ordered.

This step assumes you type a sudo command to do this. If your configuration is different, please adjust this step to match your configuration:

Create install and backup directories:

Back up existing www files that will be overwritten by this install. Do this by copying the www directory to the install backup directory:

At the Unix prompt, enter the M environment in direct mode, using the csession command on Caché or the mumps command on YottaDB/GT.M:

At the M prompt, call Vista’s direct-mode interface, enter your access code, and then just press return at the OPTION NAME prompt to return to direct mode. This sets up your authentication variables. Here’s a sample capture of this step:

Back up existing VAPALS-ELCAP routines that will be overwritten by this install. Do this by calling direct-mode interface ^%RO (routine out), selecting the list of routines to save, selecting sami-18.11.back.ro to save to, and answering any other additional prompts.

The prompts vary between M implementations, so be sure to follow the correct dialog for yours. The routine names to save are listed below under each implementation; copy the list and paste it at the Routine prompt. At the final Routine prompt, press return to indicate the list of routines is done.

To return to your normal account, exit the M environment, and then the osehra shell session.

You may safely download the archive file (sami-18.11.zip) in advance of the actual install.

Once the file is on the VAPALS-ELCAP instance server, use sudo to move the archive file from whatever directory it’s in (here referred to as $WHATEVERDIR, which should be replaced with the actual directory where the archive file is stored) to the osehra user install directory, change the ownership of the file to osehra, and then assume the osehra user identity and change directories to that install directory:

Change directories to the install directory, and expand the archive file, using the Unix unzip command:

Select option 1 and press return at the Continue prompt.

Select option 6, enter the space bar at the INSTALL NAME prompt, and press return at the next three prompts.

At the Select . . . Option prompt, select the halt option, and at the M prompt enter the halt command.

At this point in the install process, the VAPALS-ELCAP routines have been updated, but the corresponding www files have not. Those www files must first be installed.

VA VAPALS-ELCAP sysadmins should follow the For VA VAPALS-ELCAP systems step. Non-VA sysadmins should follow the For Non-VA VAPALS-ELCAP systems step.

Both the VAPALS-ELCAP routines and www files have been updated at this point, but the routines are using cached copies of the www files. This step refreshes that cache to activate the www files.