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Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Electronic Health Record (EHR)  

EHR Patches & Enhancements

RPMS EHR is not a finished product. Development continues on a number of fixes and enhancements, many of which have been recommended by clinicians who use EHR on a daily basis for patient care.

To submit an Enhancement Request please visit the Resources and Patient Management System (RPMS) Feedback page.

EHR Version 1.1 patch 14 – Controlled Release Starts June 2015

Information on the release of EHRv1.1 Patch 14 and other associated patches can be found at: https://www.ihs.gov/ICD10/ or contact your area office.

Overview of Changes

ICD-10 updates

  • EHR components updated to transition to ICD-10 after the changeover date. Integrated Problem List will re-map to ICD-10 on the changeover date. Look ups for visit related data are context aware and will store ICD-9 and ICD-10 based on visit date.

Enhancements and fixes

  • Integrated problem list – priority and POV display columns added, SNOMED CT-ICD-10 map advice exposed via hover, SNOMED CT search is executed with or clicking ellipsis, care planning fields Tiu template functionality delivered
  • Integrated Problem List – care planning template functionality improved
  • Pharm Ed (Medication Counseling) – POV information may now be added
  • Pick Lists – may now select synonym for Pick List selection, pick lists now have option to allow pick list selections to store as POV, now honors settings in pick list manager
  • POV dialog – E&M documentation for office visits, provider text column renamed “Alternate POV provider text” for clarity, Primary diagnosis dropdown now honors user selection, care planning fields Tiu template functionality delivered
  • Prenatal Issues and Problem List (PIP) – Updated application to synchronize with IPL (requires BJPNv2 and BJPNv2p1)
  • Reproductive factors – allows deletion (entered in error) of family planning methods
  • Superbill – Diagnosis (SNOMED CT) associations added
  • Stroke Component – new feature
  • AMI Component – new feature

EHRv1.1p14 and related application release notices

  • RPMS Program Release Notice_EHRv1.0 patch 14
  • RPMS Program Release Notice_GMRC v3 Patch 1005
  • RPMS Program Release Notice_BHS
  • RPMS Program Release Notice_BJPN v2.
  • RPMS Program Release Notice_GMRC v3 Patch 1005
  • RPMS Program Release Notice_GMRV
  • RPMS Program Release Notice_TIU patch 1013
  • RPMS Program Release Notice_PXRM v2.0 patch 1003

Associated Links and Documents

Please read all documentation associated with the general release of EHRv1.1 p14 and related applications on the RPMS Clinical Applications webpage under the following sections:

  • Electronic Health Record (EHR)
  • VA Clinical Reminders (PXRM)
  • Adverse Reactions (GMRA)
  • Health Summary Components BHS
  • Prenatal Care Module (BJPN)

Please read all documentation associated with general release of TIU and related applications on the RPMS Administrative Applications under the following section:

  • Text Integration Utility (TIU)

Additional Training

Training dates and times can be found at: https://www.ihs.gov/ICD10/index.cfm/training/

EHR Version 1.1 patch 13 – September 2014

Enhancements/New Features

  • New non-redundant SNOMED CT® based Integrated Problem List (IPL) replaces the Problem List
    • Treatment/Regimen
    • Goals
    • Care Planning
    • Visit Instructions
  • Picklists
  • New Family History SNOMED CT® based Component
  • Orders - Clinical indications will now be presented in SNOMED CT® for Lab, Med and Consult orders
  • CCDA Component replaces C32 Component to generate Transition of Care and Clinical Summary Documents for Visits and Referrals
  • CIR (Clinical Information Reconciliation) Component
    • Displays incoming CCDA, CCDA and C32 documents
    • Provides tool to reconcile outside facility Meds, Allergies and Problems or reconcile data from patient or caregiver

EHRv1.1p13 and related application release notices

  • EHRp13v1.0p13
  • BHSv1.0p9 Release Notice
  • TIU 1011 and 1012 Release Notice
  • Reminders 2.0, Patches 1001/1002 Release Notice
  • BSTSv1.0

Associated Links and Documents

Please read all documentation associated with the general release of EHRv1.1 p13 and related applications on the RPMS Clinical Applications webpage under the following sections:
  • Electronic Health Record (EHR)
  • Health Summary Components (BHS)
  • VA Clinical Reminders (PXRM)

Please read all documentation associated with general release of TIU and related applications on the RPMS Administrative Applications under the following section:

  • Text Integration Utility (TIU)

Additional Training

EHR Version 1.1 patch 12 – December 2013

Enhancements/New Features

  • Designated Provider - Users may now add, edit, delete designated providers from the new EHR component.
  • eRx Enhancements

Problem fixes/Routine updates (see patch notes for complete list)

  • Community Alert Splash Screen – Synced with iCare
  • Inpatient Meds for Outpatient (IMO) – Infusions now display as “Clinic Orders” in IMO designated clinics
  • Reminder Dialog – Skin test site and Volume prompts added
  • Service – HCPCS search fixed
  • Skin Test – Date applied now populated when entered skin test
  • Visits – Inpatient ancillary lab and pharmacy visits are not displayed or selectable

EHR v1.1 Patch 11 Fixes

ICD-10 and Meaningful Use

It’s time to start prepping your databases for the coming updates and patches for meeting the mandatory change to ICD-10 and meeting Meaningful Use. EHRv1.1p10 includes some infrastructure to support the near future upgrades.

EHR Version 1.1 patch 11 – Controlled Release available June 2013

Patch 11 is a controlled release patch. Please see the RPMS Website and EHRv1.1 Patch 11 FTP site for more information on pre-install instructions, scheduling an appointment for support, prerequisites/dependencies and Office Hours materials.

RPMS Clinical Applications Website

EHR Version 1.1 patch 10 - Released July 2012

Patch 10 includes enhancements/new features/updates/fixes to the following functions:

  • Asthma Action Red/Yellow Zone component (New)
  • Immunizations:
    • Ability to enter inactive vaccine as historical immunization
    • Display of invalid doses in EHR
  • Measurements:
    • EGA - Estimated Gestational Age
    • MMSE - Mini Mental Status Exam
  • Medication orders – default pick up locations enhanced
  • Patient Goals Component (New)
  • Personal History – ability to enter CPT refusals
  • Quick notes – added ability for user to assign co-signer
  • Reminder Dialog Prompts added:
    • Asthma Control
    • EGA - Estimated Gestational Age
    • MMSE - Mini Mental Status Exam
  • Reproductive History Component – major changes to reflect updates to the Reproductive Factors file including addition of Lactation Status, ability to enter different Estimated Due Dates for pregnant women based in method used to calculate, ability to enter multiple concurrent contraceptive methods, age at menarche, age at coitarche, age at menopause.
  • eRx: Support for eRx refill request messaging (infrastructure for future upgrades – nothing visible for EHR user)

Associated links and documents:

Associated patch releases:

  • APSP v7.0 P1013 (required for EHRv1.1p10)
  • TIU 1.0 p1009

EHR Version 1.1 patch 9 - Released January 2012

The majority of patch 9 updates and fixes are to meet ePrescribing requirements. Patch 9 includes updates/fixes to the following functions:
    1. Enhancements

    Medication prescribing:

    • Much more flexible configurability facilitating sites with on-site pharmacies to implement electronic prescribing (requires separate configuration and deployment of Surescripts®).
    • Medication order dialog enhanced for improved usability.
    • Auto-finish and printing behavior configurable by facility type and may be used in advance of electronic prescribing.
    • Printing functionality is now highly configurable and streamlined for user.
    • Clinical indication now required for each medication order.
    • Electronic prescribing now requires ICD-9 code for transmission

    2. Problem fixes/Routine updates (see patch notes for complete list)

    • Allergy/ADR: now filters out "Other Reaction" for both reactant and signs/symptoms.
    • CCD Viewer: hanging with VPN session, PDF generation with Internet Explorer 9 resolved.
    • Chart Review: Adding problem from Visit Diagnosis or Historical Diagnosis now stores Reviewed and Updated.
    • CSV: ICD-9 look up now returns long narrative text.
    • Immunizations: No longer populates CPT codes, Education now stores properly when "Patient/Family Counseled by provider" checked.
    • Notifications: Flagged expiring notifications now work properly.
    • Order checks: Height and weight limits now honored for CT and MRI orders.
    • Outside Med details: Documented by now displays logged in user who entered information
    • Patient Education: Text now wraps properly when viewing standards.
    • Reminder dialogs: Measurements "done elsewhere" now store the correct date/time.
    • Requestor no longer displays on Outside Medication entries.
    • Suicide form: Updated to current Behavioral Health GUI.
    • Visit Context: Now excludes ancillary visits on inpatients.
    • Windows 7: Superbill and Patient Education check box behavior resolved.
    • Patient Context: Accessing a patient chart from notifications will now honor the BEHOPTCX REQUIRES HRN parameter. Users will see notifications for patients from all divisions but if this parameter is set, the user will need to log into the division in which the patient is registered to access the patient's record.
Associated links and documents:
Associated patch releases:
  • APSP v7.0 P1011, 1012 (required for EHRv1.1p9)
  • BHS v1.0 p6

EHR Version 1.1 patch 8 - Released June 2011

The majority of patch 8 updates and fixes are to meet certification and Meaningful Use requirements. Patch 8 includes updates/fixes to the following functions:
  • Problem List
  • Attach Images fix
  • Allergy enhancements
  • Help menu fixes for Windows 7
  • Patient detail
  • Chart Review component
  • Patient education
  • Summary of care document and viewer
  • This patch includes GMRA v4.0 P1002

Associated links and documents:

There will be associated patches released between patches 7 and 8 to include the following updates/fixes: New "missing text" report and clean up utility for TIU notes, new reassigned document report, new/fixed data objects, health summary components, CPT modifiers, vitals entered in error, Patient Education - allow more than one entry per topic per day, Work/chart copy printing, Restore ability to select rows in Lab tab, Pharmacy package - additional updates for e-Prescribing, multi-divisional drug file, new drug file maintenance reports, Adverse Reaction package

EHR Version 1.1 patch 7 - Released February 2011

Patch 7 includes updates/fixes the following functions:
  • Vital Measurement
  • "Clear" Function - correctly clears reproductive history and infant feeding data
  • Skin tests
  • Historical Services
  • POC Lab - NEW parameter to allow either for ordering provider to be visit provider, or to have user select the provider each time
  • Patient Detail
  • Medication Ordering
  • DM Registry
  • Notes - NEW Quick Note Module
  • POV narrative
  • Suicide Form

EHR Version 1.1 patch 6 - Released August 2010

EHR Version 1.1 patch 5 - Released July 2009

EHR Version 1.1 patch 4 (EHR License file) - Released in November 2008

The License file in patch 4 will not expire.

EHR Version 1.1 patch 3 (EHR License file) - Released in August 2008

EHR Version 1.1 patch 1 - Released April 2008

EHR Version 1.1 - Released in October, 2007

EHR Well Child Module

Behavioral Health

Behavioral Health providers who are co-located at primary care facilities that have deployed the EHR can now enter their individual behavioral health encounters into RPMS using the EHR. These behavioral health records will populate both the Behavioral Health System (AMH) database and the Patient Care Component (PCC) database. This functionality supports the integration of primary and behavioral health care and offers behavioral health providers access to features available in the EHR that are also critical to the provision of behavioral health care, including electronic order entry of medications. Additionally, behavioral health providers now have the convenience and security of template-based TIU notes that are developed to meet their unique business needs. The applications required to support this functionality in the EHR are AMH Behavioral Health System v3.0 patch 10, BPC IHS Patient Chart v1.5 patch 05 and BGU IHS RPC Broker v1.5 patch 04. Visit the Integrated Behavioral Health website.

Clinical Reminders

Clinical Reminders patch 1007 - Released in April 2010
Patch 1007 will provide new and revised reminders with updated resolution logic. In addition, this patch will include newly formatted dialogs.

Clinical Reminders patch 1006 - Expected release with EHR Version 1.1 patch 5 Released in July 2009
Patch 1006 will update the Clinical Reminders with the new Patient Education codes that will be released at the same time.

Clinical Reminders patch 1005 - Released in September 2008
Patch 1005 includes a set of National Reminders with dialogs.

For additional information and documentation on Clinical Reminders please click here

VistA Imaging - Utilized in IHS since 2005

VistA Imaging system integrates clinical images and documents and other non-textual data into the patient's electronic health record. Facilities can scan documents and upload images into the patient's chart. Vista Imaging also functions as a PACS (Picture Archiving and Communication System) for Radiology. VistA Imaging deployment is being managed by the IHS Vista Imaging Coordinator in conjunction with the Area Offices. More information about Vista Imaging can be found at the VA VistA Imaging SharePoint Exit Disclaimer: You Are Leaving www.ihs.gov site.

iCare Population Management GUI v1.1 - Released June 26, 2008

iCare is a software tool that helps you manage the care of your patients. The ability to create multiple panels of patients with common characteristics (e.g., age, diagnosis, community) allows you to personalize the way you view patient data. Visit the iCare website.

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