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Use of the SoftwareTraining MaterialsRefer to the following attachment (Cat I MP PRF Guidance-Nov-2013.pdf) for additionalbackground and training information for Missing Patient - Patient Record Flag.redactedReaders who wish to learn more about PRF operations, features, files, options, and userinformation can view the VistA VA Software Document Library (VDL) at the following link.http://www.va.gov/vdl/Patient Record Flag ManualsManual NameFile NamePatient Record Flag HL7 Interface Specificationprfhl7is.pdfPatient Record Flag Phase I Release NotesPrfrn.pdfPatient Record Flag Phase II Release NotesPrfi rn.pdfPatient Record Flag Phase III Release NotesPrfii rn.pdfPatient Record Flags User GuidePatient Record Flags UserGuide.pdfUSH PRF Legal Solution Release NotesGeneral SupportFor support, site questions, and problems with the Patient Record Flag software packages, pleaseenter a National Remedy ticket to Patient Information Management System (PIMS)-PatientRecord Flags or call the National Service Desk-Tuscaloosa at 1-888-596-4357 for assistance.Patient Records Flags (PRF) User Guide3March 2019

Use of the SoftwareThis section of the PRF User Guide provides instructions for the end-Users to successfully usethe software with little or no assistance. It also lists and describes the menus/options withexamples to implement and use the software.New FunctionalityPatch DG*5.3*951 – Suicide High Risk Patient EnhancementsProject UpdatesPatch DG*5.3*951 makes several enhancements to PRFs to provide support to the VA to help:reduce Patient suicides, ensure patient and healthcare worker safety, and make the process ofmanaging ownership of flags and flag data, more efficient and timely.Patch DG*5.3*951; Adds in new fields to track and maintain DBRS (Disruptive Behavior Reporting System)data on National Category 1 Behavioral PRFs Provides a corresponding PRF DBRS Historical Report which shows who added/editedthe DBRS data on a single Behavioral PRF Includes a new PRF action to request Ownership Transfer of active PRFs and takeownership of inactive PRFs, complete with a corresponding new action to Approve orReject the Ownership Transfer requests Includes a new option to refresh PRF data to all sites where the Patient is registered Includes updates made to the CO-Change Ownership action and new FT-OwnershipTransfer action to recalculate the ‘Review Date’ value upon ownership transferImportant: Users must be assigned the DGPF ASSIGNMENT security key AND programmermode access (“@”) to utilize the new Refresh option.Patch DG*5.3*960 – Updates to Assignment Action NotLinked, Flag Assignment and Record Flag TransmissionError ReportPatch DG*5.3*960 updates the existing report selection criteria and report outputs for the PatientRecord Flag (PRF) Assignment Action Not Linked, Flag Assignment and Transmission Errorreports.The Assignment Action Not Linked report has been updated; To include new report selection criteria which allows the report to be generated for asingle Category I OR Category II PRF To include new report selection criteria which allows the report to be generated forInactive as well as a combination of Active and Inactive PRFsPatient Record Flags (PRF) User Guide4March 2019

Use of the Software To include new report selection criteria which allows the report to be generated for PRFswith actions performed on the PRF by their local facility, by other facilities or by allfacilities.Changed report selection criteria so that if report is generated only for Category II PRFs,the ‘Ownership Type’ criteria is no longer presented to the user.Changed report selection criteria so that if report is generated for either ‘Category I’ or‘Both’ Category I and II PRFs, the prompt to the user now states: “Choose Type ofHistory Record”Changed report selection criteria so that if report is generated for either ‘Category I’ or‘Both’ Category I and II PRFs, the “Choose Type of History record” selection criteriachoices have been changed to;o “Actions performed by Local Facility Onlyo Actions performed by Other Facilitieso Actions performed by All Facilities”In the report output, the header contains “Action By” and then a truncated version of theuser’s choice made; i.e. “Other Facilities”In the report output, the Patient’s Social Security Number has been truncated fromdisplaying all 8 numbers, to displaying a combination of last initial of Last Name last 4digits of the Patient’s SSN.The Flag Assignment report has been updated; The report output has been re-configured for correct display at 132 column width The report header has been updated to include report selection criteria selected by theuser To include new report selection criteria which allows the report to be generated forActive, Inactive or a combination of both Active and Inactive status PRFs To include new report selection criteria which allows the report to be generated for PRFsonly owned by the user’s local Facility, those owned by Facilities other than the user’slocal Facility, or those owned by all Facilities. Changed report selection criteria so that if report is generated only for Category II PRFs,the ‘Ownership Type’ criteria is no longer presented to the user. In the report output, the Patient’s Social Security Number has been truncated fromdisplaying all 8 numbers, to displaying a combination of last initial of Last Name last 4digits of the Patient’s SSN. If the report was generated for Inactive flags only, the ‘Review On’ and ‘Overdue’columns and data are replaced with ‘Inactivated Date’ (most recent date of PRFinactivation). To include a new column in the report output ‘Orig AssignDate’ displaying the originaldate the PRF was assigned to the Patient To include a new column in the report output ‘Activated On’displaying the most recentdate this PRF was assigned to/activated for the Patient To include a new column in the report output ‘Days Active’displaying the total numberof days since this assignment was active OR if the assignment was still active at the endof the user input date range, then the number of days active calculates up to the report endPatient Records Flags (PRF) User Guide5March 2019

Use of the Software To include a new column in the report output ‘Review On’ if the assignment is currentlyactive, this is next date for review.To include a new column in the report output ‘Overdue?’displayingY - if the review is past its due dateN – if the review is not yet past its due dateN/A – if no review date is present for the PRFTo include a new column in the report output ‘# Times Activated’displaying a numericalvalue showing how many times this particular PRF has been activated for this Patientduring the date range selectedTo include a new column in the report output ‘Current Owning Site’ this is the value ofthe OWNER SITE field on the PRFTo include the report header information so that if the report was generated for a singlePRF, the PRF name is included in the header details.Note: For a single flag assignment to show in this report, there must be at least oneHistory record recorded within the report date range.The Record Flag Transmission Error report has been updated; So that it only returns Transmission Errors for Locally-Owned, currently Active NationalCategory I PRFs To include new report selection criteria which allows the report to be generated for aSingle PRF specified by the user or all PRFs To include new report selection criteria which prompts the User to enter a Single PRFtitle/name if they chose to generate the report for a Single PRF The report title has been updated to include report selection criteria selected by the user By changing the ‘Received’column title in the report output to be ‘Error On’ By totally removing the ‘Owner Site’ column and data The ‘Item Number’ column/field was changed from 6 characters/spaces to 3 The ‘Transmitted To’ column/field will show 29 characters (of 30)Patch DG*5.3*869 - Missing Patient, Patient Record FlagPatch DG*5.3*869 installs a NEW National Category I Patient Record Flag (PRF), MISSINGPATIENT and creates a new mail group, DGPF MISSING PT FLAG REVIEW. Members of thismail group will receive messages when the patient’s flag needs to be reviewed, followingexisting PRF review processes of continue, inactivate or delete.The Missing Patient, Patient Record Flag will identify a missing patient from a VA facility. Thisshort term Flag will identify a missing patient while in a missing status, so should the patientappear elsewhere in the system, it is immediately known that they are missing from anotherfacility.The addition of the Missing Patient PRF includes the following. Creates National Category I Missing Patient, Patient Record Flag.Patient Record Flags (PRF) User Guide6March 2019

Use of the Software Creates mail group, DGPF MISSING PT FLAG REVIEW.Updates file #.84 (field #4), Dialog Number 261132-Patient has local ICN, to changethe message that is displayed when there is an attempt by a user to assign anyNational, CAT I PRF to the record of a patient that does not have a National ICN.This component updates the Text (field #4) so that it does not reference any specificNational, Category I PRF (i.e. BEHAVIORAL) to be assigned.Updates the following reports to reflect the new Missing Patient, Patient Record Flag(*Note: See the Record Flag Reports Menu section for more details on each report. Assignment Action Not Linked Report Flag Assignment Report Patient Assignments Report Assignments Due For Review Report Assignments Approved by Report.Important: Users must be assigned the DGPF ASSIGNMENT security key to assign theMissing Patient PRF.Patient Records Flags (PRF) User Guide7March 2019

Use of the SoftwarePatch TIU*1*279 – New Progress Note TitlePatch TIU*1*279 includes the following updates. Creates and installs a new TIU Note Title, PATIENT RECORD FLAG CATEGORY I MISSING PATIENT. This flag will have the MENTAL HEALTH PATIENT RECORDFLAG Enterprise Standard Title, and PATIENT RECORD FLAG CAT I DocumentClass. Creates a new entry in the TIU DOCUMENT DEFINITION File #8925.1 to create thenew TIU Note Title.DG*5.3*864 - DGPF New Category I Flag PatchPatch DG*5.3*864 installs a new national Category I patient record flag, URGENTADDRESS AS FEMALE PRF, and associates the new PATIENT RECORD FLAGCATEGORY I – URGENT ADDRESS AS FEMALE progress note title with the new flag.This Patient Record Flag was established to ensure that a transgender Veteran is addressed asFemale per a court order agreement. This flag cannot be used without approval of the UnderSecretary for Health.The ability to assign the new URGENT ADDRESS AS FEMALE PRF will be limited to oneidentified IRM staff member with programmer access, or an identified clinician with temporaryprogrammer access assigned by IRM staff at one pre-determined site. The identified person withprogrammer access at the pre-determined site will assign the URGENT ADDRESS ASFEMALE PRF to a pre-determined patient, identified by Under Secretary of Health (USH). Thetext used during the assignment will be based on very specific pre-defined text provided by theOffice of the Under Secretary of Health.Once the USH-specified patient is assigned the URGENT ADDRESS AS FEMALE flag, thePRF cannot be inactivated for the patient. NOTE: Only one site will be assigning this flag tothe patient. There will be no Review frequency for this flag assignment.The patch also includes a change to the Register a Patient [DG REGISTER PATIENT] optionand the Load/Edit Patient Data [DG LOAD PATIENT DATA] option to ensure Category IPatient Record Flags are updated when a patient registers at a new facility. The updates areprovided from the existing VistA treating facility where the patient has been seen. This changeis required to address a Patient Safety Issue (PSPO #2365) and Remedy Ticket #801785 –Category I Flag.DG*5.3*864 is part of a bundle that includes TIU*1.0*275 and DG*5.3*864. PatchTIU*1*275 installs one new Progress Note Title: PATIENT RECORD FLAG CATEGORY I –URGENTADDRESS AS FEMALE and links the title to the existing document class,PATIENT RECORD FLAG CAT I. This title will be automatically linked to the URGENTADDRESS AS FEMALE Patient Record Flag during the install of DG*5.3*864. PatchGMTS*2.7*103 provides two new Health Summary Types: VA-PT RECORD FLAG STATUSfor local display of active and inactive patient record flags and REMOTE PT RECORD FLAGSTATUS for use from Remote Data Views to see another treating facilities active and inactivepatient record flags. Both of these Health Summary Types include a new Health SummaryPatient Record Flags (PRF) User Guide8March 2019

Use of the SoftwareComponent, CAT I PT RECORD FLAG STATUS, which displays the active and inactiveCategory I Patient Record Flags assigned to a given patient.ExampleredactedPatient Records Flags (PRF) User Guide9March 2019

Use of the SoftwareUse DF (Display Flag Action) to see the flag definition.redactedDG*5.3*849 - DGPF New Category I Flag and ConversionPatchThe DG*5.3*849 DGPF NEW CAT I FLAG AND CONVERSION patch supports the ImproveVeteran Mental Health (IVMH) Initiative #5, High Risk Mental Health (HRMH) NationalReminder & Flag. This patch implements the following new functionality. National Patient Record Flag (PRF) for suicide prevention (HIGH RISK FOR SUICIDE) Convert Local HRMH PRF to National [DGPF LOCAL TO NATIONAL CONVERT]Option DGPF CLINICAL HR FLAG REVIEW mail group.Patient Record Flags (PRF) User Guide10March 2019

Use of the SoftwareNew National Patient Record Flag (PRF) for Suicide Prevention (HIGHRISK FOR SUICIDE)The purpose of this National Category I Patient Record Flag is to alert Veterans HealthAdministration (VHA) Mental Health staff regarding patients who have a high risk for suicidethat may pose a threat to themselves.The process to generate the new National Patient Record Flag (PRF) for suicide prevention(HIGH RISK FOR SUICIDE) (Category I) from a local (Category II) Patient Record Flag (PRF)will take the existing, active, local PRFs for high risk for suicide and determine whether anational PRF can be created. If there is an issue with generating a national PRF, an errormessage will be logged, or the record will be flagged for manual action by appropriate staff. Inthis case no national PRF is created and the local PRF will remain intact.When creating the new national PRF, the information from the local PRF will be used in the newnational PRF. Upon successful creation of the new national PRF, the local PRF will beinactivated with a comment indicating a new national PRF has been created.Upon creation of the new national PRF, the existing Health Level 7 (HL7) messagingfunctionality will be used to transmit the national PRF information to other known treatingfacilities as is currently done when a National PRF is created through the Record FlagAssignment [DGPF RECORD FLAG ASSIGNMENT] option.The new national flag record entry (HIGH RISK FOR SUICIDE) is added in the PRFNATIONAL FLAG file (#26.15).New DGPF CLINICAL HR Flag Review Mail GroupDGPF CLINICAL HR FLAG REVIEW mail group receives reports

create, assign, inactivate, edit, produce reports, and view patient record flag alerts. Patient record flags are divided into Category I (National) and Category II (Local) flags. Category I flags are nationally approved