HistoTrac Software Release Notes Version

Transcription

1 HistoTrac Software Release Notes Version NOTE: This HistoTrac Version 2.52 Release Notes document is organized by menu, as presented in the application. It includes updates that affect the Core software, any affected modules and some reagent vendor interface functions. This document presents changes from version to Version NOTE: To install the latest setup file, please refer to the Client Installation and Database Connection Instructions provided separately. Remove the previously installed client and Install the new client. Software Update Process 1. To make the software update process easier for the customer, the setup file that installs the new client software will also make any changes to the database necessary for the upgrade. The person who first logs into the software will be presented with update messages, beginning with the appropriate message based on the software version presently in use oldest version to the current version Update message to expect based on currently installed version are described here. Answer Yes to all messages. a. If the present version is , , or , the Update to the database for version 52 message will appear. Page 1 of 67

2 b. If upgrading from version , the and messages will be displayed before the upgrade to c. If upgrading from , the update to version 51 message will appear first, followed by the messages described in 2a and 2b above. d. If upgrading from a version prior to 2.50, check first with your software consultant. When skipping more than two versions, assistance with upgrading may be desirable. 3. Choose Yes to each message and the database will be updated with the appropriate scripts for use with version The software will open. Proceed as usual to each menu. 4. If you choose No, the software will open but may display various error messages as the database is not updated for the requirements of the new application. (Not recommended.) Page 2 of 67

3 Table of Contents Software Update Process... 1 Patient Menu... 5 My Patients and Patients Folder... 5 Virtual XM button... 5 Other Features on the Patient Menu... 8 General Information... 9 Antibody History DSA History Specificity/Antigen Folder UNOS Audit History Sample Menu Log folder Sample record Orders DNA Extraction Batch Accessioning Work Management Menu Test Batches Results/Review/Signoff Menus Results Menu Antibody Tests with Imported Single Antigen Bead Data HLA Fusion Imported Data MatchIt Imported Data Create Text File Test level CPRA Other Features Review Menu By Report Sign Off Menu By Work Area, Test, Patient, Batch By Report Inventory Menu Ad Hoc Query Administration Patient Dictionary Ethnicity Table Death Cause Codes User-defined Patient Fields Patient Audit History Sample Dictionary DNA Extraction fields Test Dictionary Test Definitions Antibody Tests Test Definitions Crossmatch Tests Page 3 of 67

4 User-Defined Test Fields Test Batteries Molecular Allele and NMDP Code tables Test Classifications Tray Dictionary Trays Security Dictionary Users Roles Report Dictionary Send Preliminary Report Tools/Options System Test UNOS Regional Date Settings Sticky Notes DSA New Test Classification Test Dictionary Test Classifications Test Definitions Sample Menu Results Menu Review and Sign Out menus CPRA Management Multiple Medical Record Numbers for a Patient From the Patient Record From the Sample Record From the Billing Menu Page 4 of 67

5 Patient Menu Changes to folders and screens on the Patient Menu are described here. My Patients and Patients Folder Virtual XM button Virtual XM button on the Tool bar provides a feature to assist with donor selection based on matching with selected donor based on the antibody history of the patient. This feature was introduced in Version Some new functionality and some repairs are included in version New Functionality: 1. When using the Virtual XM button for the first time after installing version 52, some additional setup will be required before viewing test detail data. There are now threshold setting per vendor product used for testing. (There is more detail on this new feature provided under the Results menu/antibody Testing and under the Test Dictionary/Test Definitions.) 2. When the Virtual XM screen opens, first enter threshold values from the Default Virtual XM settings button. Enter values based on the vendor s products in use. 3. To update the Threshold settings, press the Default Virtual XM Settings button. The Virtual XM Settings screen opens. a. If using single antigen bead data from HLA Fusion, enter threshold values on the Normal and/or Raw tabs. b. If using single antigen bead data from MatchIt!, enter threshold values on the AD- BCR, BCR, and/or BCM tabs. c. If using mulitple vendors, complete the treshold setting on all tabs that apply. Virtual XM Settings screen Page 5 of 67

6 4. When selecting test code(s) in the Patient Antibody HistoTrac window, the test data on the right will display using column headers based on the vendor s test data selected. In this example the test data are from MatchIt and the threshold settings for AD-BCR, BCR, and/or BCM have not yet been entered. Incomplete Data to Display the Bead Detail 5. In this example, the HLA Fusion threshold has been established for the Normal field. The tests under analysis are checked. Press the Refresh button to display color coding based on the threshold settings for the Normal values. Bead Detail Filtered for selected antibody data against donor phenotype a. Values above the threshold setting will appear in red. b. Values below the threshold but within the variance will appear in black. The Raw threshold is set at 5000 with a variance of 500. Page 6 of 67

7 Corrections/Repairs 1. For the highlighted donor with serological equivalent HLA typings (no serology typings), the DRw fields did not populate correctly. This has been fixed. 2. When changing the Default settings, the Refresh button now reloads the bead detail, changing the colors of each bead according to the settings. 3. When entering a new donor manually, the tab sequence in the HLA Typing fields was out of order. This has been changed to move through each locus from left to right. 4. The donor s ABO has been added to the Donors frame. 5. The display of B locus specificities in the Bead Detail window was suppressed for some users. A script was included in the new release to allow specificities that included the Bw value to be displayed. Virtual XM Screen Page 7 of 67

8 Other Features on the Patient Menu 1. The DOB field has been added to the Find screen on the Patient and Donor folders. Find Screen with DOB 2. The SSN field can be masked to display only the last 4 digits on the Patient and Donor list views. The full SSN remains visible when the patient/donor screen is open. See Tools/Options/System (page 45) for instructions on the setting. List View Displaying Masked SSN field 3. For the Proficiency patient type, the Survey Number field has been increased from 10 to 20 characters. Proficiency Name screen showing the Survey Number Page 8 of 67

9 4. With version 2.51+, the pending tests on each of the Test History screens can be opened. Previously, only signed out tests could be opened. With this change, the user can take a pending test through the Result, Review, and Sign Off process while on the Patient or Donor record. At the completion of signing out a Typing test, the General Information screen is now updated with the typing results. The user would complete the sign out of the typing test, close and reopen the patient/donor record. The current typing fields will be populated with the test results. 5. The Restrict Field Access feature has been enhanced. Access to Add or Edit individual Patient and Sample field content can be determined by Role. These restricted fields may be on the General Information screen or on other folders of the patient/donor record. The settings for this feature are described under the Security Dictionary/Security/Role section. Example of Restricted Patient Field Edit 6. Restricted Function Access, also available with Restricted Field Access under the Security Dictionary, provides a way to limit access to Add and Delete functions on the various folders of the patient s record such as Delete Sample, Delete Report, Delete Extraction. The settings for this feature are described under the Security Dictionary/Security/Role section. General Information 1. The Cause of Death dropdown next to DOD (Date of Death) has not had a table in the Patient Dictionary. (The field is unlabeled and is positioned to the right of the DOD field.) The table is now available. Add values to the table to populate the dropdown. See Patient Dictionary/Death Cause Codes. Section of the General Information screen showing the Cause of Death Dropdown Page 9 of 67

10 2. A new field has been added to the Patient and Donor screens. The Ethnicity field appears below the Race field. A new table in the Patient Dictionary loads the dropdown. See the Patient Dictionary/Ethnicity section. Ethnicity Field with Drop Down Antibody History 1. Signed off antibody tests can be edited by selected people. When changes are made to the Specificity field, a new message alerts the user to also update the Unacceptable field on the Specificity/Antigen folder and/or the UNOS Unacceptable field on the UNOS folder. This is helpful for wait listed patients when Unacceptables are exported to UNOS. The export file can then be consistent with the edited test result. Message presented when the Specificity field of a Signed Out Test has been changed DSA History 1. A new Test Classification is included with this upgrade the DSA Test Classification. The DSA History folder is displayed on the Patient record. See the Section on DSA Test Classification for full explanation of this new feature. DSA History Folder Page 10 of 67

11 Specificity/Antigen Folder 1. The Specificity checkboxes available from the several antibody specificity fields are loaded from the Test Dictionary, Serology tables. More recently, DQA, DPA, and DPB were added to the Serology tables in order to facilitate the loading of the checkbox screen. There has been some incorrect display in the DP and DPA fields. This has been corrected. Checkbox Specificity screen showing entries at all loci 2. Proper nomenclature for the serological label for DRB345 should be DR, not the previously labeled DRw. The screen label will remain DRw. The software relies on that differential label to distinguish DR from DRw in properly placing specific alleles in the correct position in several places throughout the application. Adjustments can be made to properly display the label when reporting. UNOS 1. On the UNOS folder of the Patient screen, a scroll bar has been added to the right side of the UNOS Unacceptables window when a patient s UNOS Unacceptables values exceed the space in the window. UNOS folder on patient screen showing scroll bars 2. A cpra calculator was added on the UNOS folder in version The software upgrade to 2.51 added the UNOS frequency tables to the database. After version 2.51 Page 11 of 67

12 was released, UNOS changed the loci included in the calculation of the cpra. The previous calculation included A, B, DR, and DQ loci. C locus is now included. The new design of the table provides a more flexible means of changing the calculation in the future, should UNOS policy change to include other loci in the calculation or should other frequency tables be used. a. An additional setup file is included with the version 2.52 upgrade. This application will load the current frequency tables. See the CPRA Management section for full details. b. Until the CPRA Management application is run, an error message will present when using the CPRA calculator. 3. The UNOS Patient Name and HIC number fields can be updated when changes are made to the Patient s Last Name, First Name, and SSN on the General Information screen. When making changes to those fields on the GI screen, the user would be asked Do you want to Update the UNOS Patient Name field? Since these fields are rarely used, the message has been removed and the fields are updated without confirmation from the user. Audit History 1. When the General Information typing grid is updated manually, the changes are logged in the Audit History folder (if these fields are turned on for Audit in the Patient Dictionary). The changes when Typing tests are signed out will now be tracked as well. The Audit Type will be recorded as Patient Typing. Audit History folder showing Patient Typing changes Page 12 of 67

13 Sample Menu Changes to folders and screens on the Sample Menu are described here. Log folder Sample record 1. The Sample Search screen was not accurately searching the Logged Date. This has been corrected. 2. The Restrict Field Access feature has been enhanced. Access to Add or Edit individual Patient and Sample field content can be determined by Role. The settings for this feature are described under the Security Dictionary/Security or Role folder. Example of Restriced Sample Field Edit Orders 1. When ordering tests in a battery the priority of the test in the battery was not used when the test was displayed in the Items to Order window. The Priority on the Order screen was used. This has been corrected. Items to Order window with correct Priority when using a Battery Page 13 of 67

14 2. When tests that have been billed are canceled, the test was reappearing in the billing queue. This has been corrected. 3. Automatic Label printing is now available when ordering tests using a Test Battery. The setup for the Label Report and the Label Printer are available on the Test Battery screen in the Test Dictionary. See the Test Dictionary/Test Batteries section. 4. The Test Priority, when ordering a battery, was previously pulled from the Default Priority field on the Order Tests screen. This instruction has been changed. a. The Priority displayed when ordering tests in a battery will be the Priority from the Test Definition. Tests within a battery could have different priorities. b. If the tests priorities are not appropriate for the order, they can be changed on the Order Test screen, in the Items to Order window. c. If the Priority field on the test definition is empty, the Default Priority on the Order Tests screen will be used. Items to Order window showing different priorities of tests within a battery 5. When editing the financial account number of tests previously ordered, the drop down is populated only when one individual test is selected for editing. It was blank when selecting multiple tests to be edited. This has been corrected to allow the Editing of multiple tests at one time. 6. Also when editing account information, the drop down now contains both code and description of the account number information allowing for more accurate account selection. 7. The Cancel Reason feature was added to the software with version With a new setting under Tools/Options/Test, the Cancel Reason field can be required. a. A Message is displayed when pressing OK without entering a Cancel Reason. b. Answering Yes will close this screen without canceling. c. Answering No will return to the Cancel Test screen for entry of a reason. Page 14 of 67

15 Cancel Test screen Message with No Reason Entered DNA Extraction 1. When ordering multiple extractions on the same sample, the separate extractions can now be identified in the inventory system by displaying the Concentration with the sample identification. Two Extractions Ordered on One Sample Two extractions in inventory, showing the DNA Concentration of each 2. To accomplish the above display of the concentration, the workflow steps require saving the Extraction data prior to selecting the Inventory location. a. Enter Extraction data, including Concentration. Page 15 of 67

16 b. Check the Save Data box (but not Extraction Complete). c. Save and Close. d. Highlight the Extraction records to be placed into Inventory and reopen the Extraction records. e. Press the Place Sample into Inventory button. Continue with placement of samples as usual. f. The DNA Concentration will be visible within the grid location. (In necessary, widen the row by pulling the line between rows farther apart.) 3. The Extractor and Spectrophotometer fields previous required manual entry each time a record was to be completed. These two fields are now populated from new tables in the Sample Dictionary. See Administration/Sample Dictionary for instructions on entering values into these tables. If these fields have not been previously added to the Extraction record, they are available to add under Tools/Options/Sample. Dropdowns for Extractor and Spectrophotometer fields Batch Accessioning 1. On the Batch Accessioning screen, the Physician must be entered, whether using the Tools/Options/Test setting requires Physician setting or not. This has been corrected. 2. The Physician drop-down displays the Physician Code or the Physician Name based on a setting under Tools/Options/Patient. Choose accordingly for the desired value when Batch Accessioning. Setting under Tools/Options/Patient Page 16 of 67

17 Work Management Menu Test Batches 1. Build a Tray from a Batch tray-building wizard now includes the Test Code in the tray map with Version This will provide on-the-screen information when moving the samples to positions based on test code. However, when using Copy/Paste, the test code did not move to the new location. This has been corrected. 2. Some test batches would remain Active when using the Inactivate Batch after sign out box, even if all tests are signed out. If tests are removed or reassigned from one batch to another, the batch would remain open. This has been corrected. When all tests remaining in the batch have been signed out, the batch will be made inactive when using this setting. 3. The Review Cycle for a Test Batch has previously been defaulted to one step of review. There is now a setting under Tools/Options/Test to establish the Default Batch Review Cycle. See the Tools/Options/Test section. Page 17 of 67

18 Results/Review/Signoff Menus Changes to folders and screens on the Results, Review, and Sign Off Menus are described here. Results Menu Antibody Tests with Imported Single Antigen Bead Data Imported Single Antigen Bead data has been managed using Thresholds for the Normal value when using the Apply to Test button for data imported from One Lambda s HLA Fusion database. Data from the MatchIt! have different criteria for differentiating levels of antibody and could not be managed using thresholds for Normal. New functionality with version 52 provides the same features for the two vendor s differing data analysis. 1. Data from HLA Fusion will import with these columns for Test Details. 2. Data from MatchIt! will import with these columns for Test Details. 3. Differentiation into the 4 levels of antibody Specificity, Moderate Risk, Low Risk, and Negative Specificity can be accomplished using the appropriate data fields from each vendor. (OL Normal and Raw, Immucor BCR, AD-BCR, and BCM) NOTE: When importing data, the software will know the vendor s data format and will display the appropriate threshold settings and columns of data. 4. Additional features included in the View Details display are as follows. Check the View Cutoff Thresholds to display these settings. a. Threshold levels per locus, per test, per patient category. See Administration/Test Dictionary/Test Definitions for details on establishing the default values. b. Exclusion of Self Antigens when applying specificities to the test c. Viewing only Self Antigens d. Analysis of Class I B locus beads with and without the Bw4/6 associated specificities. An option on the HLA Fusion interface provides for separation of Bw4/6 from the B specificities. This setting is not needed with MatchIt! as the Bw4/6 associations are displayed with the Specificity Allele, not with the Abbr. Specificity. Page 18 of 67

19 New Threshold fields and Filter Settings under View Details e. This portion of the screen is hidden from view when unchecking the View Cutoff Thresholds box. 5. Default Threshold settings are associated with each test that is ordered based on the Manage Threshold Settings entered with the test definition. When the test data are imported and the user opens the View Details screen, the thresolds associated to the Test Code and the Patient s Category will be displayed. Changes to these values made when reviewing the test will be saved with each test and will be displayed through each test s Review and Sign out process and from Antibody History. 6. To assist with allele level antibody analysis, the patient s molecular typing at each locus can be seen by hovering the mouse over the field for the serological equivalent. HLA Fusion Imported Data 1. Steps taken prior to analyzing the data on the screen shot below. a. Establish Default Threshold settings on the Test Definition for each test code used with One Lambda Antibody Identification products. b. Order the test codes and proceed with test batches, Sample ID export, testing on the Luminex instrument, analysis in HLA Fusion, and import to HistoTrac using the HLA Fusion Interface application. Settings in the Interface appliction should include all the choices for data import. See HLA Fusion Interface instructions. c. Open the test and check the View Details setting. d. Check View Cutoff Thresholds to display the Threshold value fields at each locus, for Normal or Raw values. i. Threshold settings established in the test definition can be changed for this test. View Cutoff Thresholds for Normal Page 19 of 67

20 ii. When settings are adjusted, press the Apply Thresholds button to save these settings for this test and to see the thresholds applied to the bead detail. Thresholds applied for Normal values 2. Two settings are used to identify Self Antigens. a. Check the Exclude Self Antigens to mark the specific bead(s) with black. These specificities will not be included when pressing the Apply to Test button. Exclude Self Antigens b. Check the View Only Self Antigens to filter self antigen beads from the total bead detail. Each bead will be colored according to the Threshold values. View Only Self Antigens Page 20 of 67

21 3. If importing using the Split Bead Detail setting under the HLA Fusion interface Import Settings button, use the Exclude Bw4/6 when applying to test if the patient s antibody is NOT Bw4 or Bw6. Bead Detail with Bw4/6 Split from B Locus Specificity 4. Following analysis with the several settings, use the Apply to Test button to move the specificities, based on Thresholds and Exclusions, into the test fields. Test Fields following Apply to Test 5. The steps are the same if using the Raw values instead of the Normal values. 6. This example has been for Class I Single Antigen Bead. Complete the same steps for Class II. Send the tests through the Review and Sign Off process. MatchIt Imported Data 1. Steps taken prior to analyzing the data on the screen shot below. a. Establish Default Threshold settings on the Test Definition for each test code used with Immucor Antibody Identification products. b. Order the test codes and proceed with test batches, Sample ID export, testing on the Luminex instrument, analysis in MatchIt!, and import to HistoTrac using the MatchIt Interface application. Settings in the Interface appliction should include all the choices for data import. See MatchIt! Interface instructions. c. Open the test and check the View Details setting. d. Check View Cutoff Thresholds to display the Threshold value fields at each locus, for BCR, AdBCR, and BCM values. Page 21 of 67

22 i. Threshold settings established in the test definition can be changed for this test. View Cutoff Thresholds for AD-BCR ii. When settings are adjusted, press the Apply Thresholds button to save these settings for this test and to see the thresholds applied to the bead detail. Thresholds applied for AD-BCR values 2. Two settings are used to identify Self Antigens. a. Check the Exclude Self Antigens to mark the specific bead(s) with black. These specificities will not be included when pressing the Apply to Test button. Exclude Self Antigens b. Check the View Only Self Antigens to filter self antigen beads from the total bead detail. Each bead will be colored according to the Threshold values. Page 22 of 67

23 View Only Self Antigens 3. If importing NOT using the Include Bw4/6 setting under the MatchIt! interface Import Settings button, use the Exclude Bw4/6 when applying to test if the patient s antibody is NOT Bw4 or Bw6. MatchIt Test Detail with Bw4/6 Split from B Locus Specificity 4. Following analysis with the several settings, use the Apply to Test button to move the specificities, based on Thresholds and Exclusions, into the test fields. Test Fields following Apply to Test 5. The steps are the same if using the BCM and BCR values instead of the AD-BCR values. 6. This example has been for Class I Single Antigen Bead. Complete the same steps for Class II. Send the tests through the Review and Sign Off process. Page 23 of 67

24 Create Text File 1. From the Results menu, the Create Text File function, available using the right click of the mouse, has been updated to include additional options. a. Users have asked for specific export choices not associated with the ability to use the import interface (Last Name, First Name, Sample Nbr, Sample Date). This choice has been added. b. The csv file choice has had the Test Name added to the export. c. Sample Number Patient ID Name has been added to the choices. Create Text File export choices 2. To accommodate the limitation of the Sample ID field to 30 characters by the xponent software on the Luminex instrument, a Sample ID max length feature has been added to the Create Text File feature available from the right click of the mouse on the Results menu. The length of the sample identification record will be limited to the value in the Max Length field. Export Text File screen with Max Length feature Test level CPRA 1. The CPRA field has been available at the test level for some time. The field can be imported from the HLA Fusion analysis program using the Import CPRA setting under the Fusion Import Settings button. Often, the user does not have appropriate data in Page 24 of 67

25 Fusion to make this calculation. The CPRA field in HistoTrac will now calculate the CPRA for the test based on the values that are posted in the Specificity field of the test. a. Update the specificity field in the test. b. With mouse in the CPRA field, a browse button becomes available. Press the button. NOTE: The CPRA Management application is required to load the frequency tables. This must first be completed for this calculator to become functional. An error message will appear until functional. See the CPRA Management section for full details. CPRA Field with Browse Button to activate the calculator Other Features 1. The View Image and View Details features are available on each test, beginning during Results entry. Some centers use these features regularly and would prefer not to select the setting each time a test is opened. For that reason, when the View Image/Detail setting is checked on a previous test and remains checked when closing or moving to the next test, the View Image/Detail will remain checked for the next test, whether using Save and Close or Next Test buttons. a. This setting is per user, not across all users. b. If it is not desirable to have this setting remain for the next test, uncheck the setting before moving to the next test. 2. For a user without Edit Test History permission, it is sometimes useful for that individual to have Copy access to remarks that have been entered into previously signed out tests. One can now enter the mouse into a View Only signed off tests and copy the comments to another location, without changing the content of the field in the signed out test. Copy from a View Only Signed Out Test 3. The Notes and Reportable Comments fields have access to the Canned Comments tables in the Report Dictionary. When selecting a comment from the list, the placement of the comment relative to other remarks already in the field was inconsistent. The Comments will now load at the position of the cursor. Page 25 of 67

26 Review Menu By Report NOTE: This feature applies to users with an Outbound Results Interface. Reports can be sent to the HL7 queue from the Review menu for the purpose of providing a Preliminary report. The report that is sent can have the term preliminary included. The mechanism for this is determined individually by client. Turn on the setting under Report Dictionary to activate this feature only for reports that will have a preliminary version. See page 44 for further instructions to complete the setup. 1. For a report with the Preliminary setting, a PDF will be created when the Report Complete button is pressed. Look for the Exporting message that appears briefly. 2. The report will move on to the Sign Out menu for completion. A second PDF will be created, but without the term Preliminary on the report or in the HL7 message. Sign Off Menu By Work Area, Test, Patient, Batch 1. When signing out tests, a new color change is available, per classification, to assist in the recognition that a test(s) is ready to report. These color choices are established in the Test Dictionary/Test Classifications. See the Test Dictionary/Test Classifications section for details. Color changes and example are displayed there. The previous feature Christmas Green when the last test on a sample is signed out remains available. By Report 1. When pressing the Report Complete during Report Sign Off, a message has been added asking for confirmation of the sign out process. This message will appear when using the setting under Tools/Options/System. Confirmation Message when Report Complete 2. The Canned Comments table is available when making remarks for the Comments sections of reports during Report Review and Sign Out. The Canned Comment type that uses the automatic Date and Name feature did not load correctly. This has been corrected. 3. The Report Date on the patient s Report History folder will update when the Report Completed button is pressed. The PDF is generated at this time. Page 26 of 67

27 Inventory Menu 1. A mysterious Type Mismatch Error has been corrected. Randomly, when a sample would be placed into Inventory, the coordinates would be recorded incorrectly in the database, giving the user a Type Mismatch error when attempting to open a Location for further sample entry. Ad Hoc Query 1. Two fields have been added to the Patient table in the Ad Hoc query. They are the Other ID and UNOS Unacceptable fields. 2. In the Test table, all the fields in the new DSA Test Classification have been added. Query Tables with Additional Fields Page 27 of 67

28 Administration Changes to tables in the Dictionaries are described below. Patient Dictionary Ethnicity Table 1. The Ethnicity field has been added to the Patient and Donor records. TheEthnicity table is now available in the Patient Dictionary, positioned just below the Race table. a. To activate the table, first go to the Security Dictionary/Security folder. Open the Administrator Role (and additional roles that should have access to the table). b. Highlight Patient Dictionary in the left frame and Etnicity Codes in the center frame. Check all the boxes in the right frame for the Administrator. For other roles, check the appropriate permissions according to the role. Activate the Ethnicity Table c. Return to the Patient Dictionary. Ethnicity is positioned between Race and Gender. Use Customize View on the list view on the right side to add column headers to the screen. Page 28 of 67

29 d. To add records to the Ethnicity table, press New on the Tool bar. Add records using a Code and Description. Ethnicity Table Death Cause Codes 1. The Death Cause Codes field has been added to the Patient and Donor records. The Death Cause Codes table is now available in the Patient Dictionary, positioned just below the Sensitizing Event table near the bottom of the Patient Dictionary folder list. a. To activate the table, first go to the Security Dictionary/Security folder. Open the Administrator Role (and additional roles that should have access to the table). b. Highlight Patient Dictionary in the left frame and Etnicity Codes in the center frame. Check all the boxes in the right frame for the Administrator. For other roles, check the appropriate permissions according to the role. Activate the Death Cause Codes Table Page 29 of 67

30 c. Return to the Patient Dictionary. Use Customize View on the list view on the right side to add column headers to the screen. d. To add records to the Death Cause Codes table, press New on the Tool bar. Add records using a Code and Description. Death Cause Codes Table User-defined Patient Fields 1. Patient User-defined fields can now be made Inactive. An Inactive field will no longer display on the Custom Attributes folder of the Patient or Donor record, but the data previously entered into the field can be searched from the UserPatient table in the Ad Hoc query. User-defined Patient record with Active Checkbox Patient Audit History 1. The UNOS Unacceptable field has been added to the list of fields that can be tracked under Patient Audit History. Sample Dictionary DNA Extraction fields 1. Two new tables are available for entry of the Extractor and the Spectrophotometer on the DNA Extraction record. a. To activate each table, first go to the Security Dictionary/Security folder. Open the Administrator Role (and additional roles that should have access to these tables). b. Highlight Sample Dictionary in the left frame and Extractor and Spectrophotometer Codes in the center frame. Check all the boxes in the right frame for the Page 30 of 67

31 Administrator. For other roles, check the appropriate permissions according to the role. Activate Extractor and Spectrophotometer c. Return to the Sample Dictionary. The new tables are available at the bottom of the list of folders. Use Customize View on the list view on the right side to add column headers to the screen. Extractor Table List View d. To add records to these two tables, press New on the Tool bar. Add records using a Code and Description. Page 31 of 67

32 Extractor Table e. Repeat for the Spectrophotometer. Test Dictionary Test Definitions Antibody Tests 1. The View Details feature for imported Single Antigen Bead data provided a single threshold for all loci, all patient types, and all test codes. A new feature will provide default threshold values per patient category, per test code, per locus, per threshold division (Unacceptable, Moderate, Low, and Negative Specificity). 2. Each test where the Test Classification is Antibody has a Manage Specificity Thresholds button on the bottom left corner. a. Use this button to add Threshold MFI/Raw/BCR/Ad-BCR/BCM values for all Single Antigen Bead test definitions. i. If using the same test codes when reporting single antigen bead results from multiple product vendors, all Threshold settings can be entered on each test. ii. If using different test codes when reporting single antigen beach results from different vendors, complete only the settings appropriate for the vendor s analysis. b. This button is not used for tests that do not have imported Bead Details such as Screens, IDs, and CDC test types. Page 32 of 67

33 Test Definition with Manage Specificity Thresholds Button 3. Press the Manage Specificity Thresholds button to open the Manage Test Specificity Thresholds screen. a. The Category Codes window on the left displays Default. This set of Thresholds would be used if the patient s Category field were empty or is not a category with threshold definitions. b. Complete the appropriate High, Moderate, and Low Risk settings on each tab as appropriate for the products in use and the desired settings per level of antibody. i. Use Normal and/or Raw for data analyzed using HLA Fusion. ii. Use AD-BCR, BCR, and/or BCM for data analyzed using MatchIt!. Manage Test Specificity Thresholds screen 4. Add Categories as needed for each type of patient being tested with single antigen bead test codes. a. Press the Add Category button on the bottom left. b. The Category drop-down provides all active entries in that table. Page 33 of 67

34 Select Category 5. Examples of Threshold Settings by Category Code and data analysis values: Completed Threshold Values for the Default Category (Normal tab) Completed Threshold Values for the Default Category (AD-BCR tab) Page 34 of 67

35 Completed Threshold Values for the Kidney Category (Normal tab) Completed Threshold Values for the Heart Category (Normal tab) 6. These default threshold values per category, per test code, will be immediately displayed for newly ordered tests when using View Details to observe imported data. The values can still be changed per patient s test. The threshold settings, if changed during test analysis, are now saved per patient s test. 7. See Results Menu/Antibody Tests with Imported Single Antigen Bead Data for further details on using these threshold settings. Test Definitions Crossmatch Tests 1. When entering Default values on the Components of a Crossmatch Test, the Dilution field was not saved and then loaded by default when the test was ordered. This has been corrected. Tests ordered after the Dilution values are added will display the default values. Page 35 of 67

36 Default Values for the Dilution field Crossmatch Test ordered showing the Dilution Field Default values User-Defined Test Fields 1. User-defined test fields can now have functionality similar to the Notes and Reportable Comments fields that are included in all test definitions. a. From the User-Defined Test Fields screen, press New on the Tool bar. b. Complete the Field Name, Label Name, Data Type, Test Classification and Maximum Length. c. If this field is to have access to the Canned Comments tables in the Report Dictionary, click the Allow Comments Pop-up Box. User-defined Test field with New Comments format Page 36 of 67

37 d. Add the field to the Test Definition. e. From the Results menu, open the test for results. The new field contains a browse button that opens the larger Test Comments field. New Antibody Comments Field with Access to Canned Comments 2. User-defined fields with data type = Date can now populate with Today s Date by default. Enter <NOW> in the Default field of the Field definition. User-defined field with Today s Date as the default value. Date field populated with the current date by default Test Batteries 1. Under Test Batteries, a label printing function has been added. The setup mimics the same feature present from the Sample Log when 1) saving a new sample or 2) ordering a test. This feature will send a message to the label printer when a Test Battery is ordered. Page 37 of 67

38 Test Batteries showing setup for Label Printing Molecular Allele and NMDP Code tables 1. The molecular allele tables can be updated with a current list of alleles from the IMGT website. A message has been added to acknowledge that the file containing the alleles has been completely loaded, ready for update into the HistoTrac tables. 2. The Last Loaded Date has been added to the screen. The field will show UNKNOWN until the table has been updated when the current date will be added. The date field is updated as soon as the table has been loaded. Import of Data Complete Page 38 of 67

39 3. Over time, this list of alleles has grown. The HistoTrac database can manage 2000 alleles at each locus. The Class I loci lists exceed this number. An alert message will appear for each locus with >2000 alleles. a. On the screen below, the allele spreadsheet has completed the loading process onto the import screen. This message appears, warning of list that is over 2000 records. b. To manage this lengthy list, a recommendation is to review the spreadsheet prior to loading, removing alleles that are of such low frequency as to not be found in the user s patient population. Any allele that is found but has not been included in the HistoTrac allele table by this upload process can be entered manually. c. If only the Class II allele tables require updating, select the Load checkbox for only those loci, avoiding the A, B, and C loci, each of which has over 2000 alleles. d. If the allele table presently contains low resolution alleles not in the IMGT file, choose the Append checkbox to add the new alleles, not overwrite the table. Load Molecular Alleles screen with Allele file ready to Load 4. The NMDP code table can be updated with a current file downloaded from the NMDP website. a. The codes have been extended to 5 characters. The code field in the database has been enlarged to manage the new codes. b. The downloaded file may contain code translations that are greater than 2000 characters. c. After the text file of codes has been loaded, press the Apply to System button to update the NMDP table. i. The message appears to tally the number of records in the file. ii. A progress bar has been added to monitor the loading of the file. iii. A message will appear when the loading of the codes is complete. Page 39 of 67

40 Load NMDP Codes d. To assist with the update process, the Last Loaded Date is not populated on the bottom left corner of the Load NMDP Codes screen. When the software is first updated, this field will display UNKNOWN until an upload has been done. Test Classifications 1. The new feature to display a different color per test classification for the last test signed out is set up in the Test Dictionary/Test Classification. Open each classification and chose the color that will be displayed. a. Open the classification. b. Click in the color block on the left side. A color grid appears. c. Make the color selection and Save. Color Selection for Crossmatch Tests Page 40 of 67

41 Last Crossmatch Test on the patient s Sample Color Selection for Molecular Tests Last Molecular Test on the Patient s Sample d. If this new feature is not to be used leaving in place only the current feature of Christmas Green for the last test on the sample make no color selections for individual test classifications and check the No Specific Color for Test Classification. All Classifications will have this checkbox selected with the upgrade. If using color, make the color changes as described above for all and uncheck this box. No Color Selection Page 41 of 67

42 Tray Dictionary Trays 1. The list of trays may become lengthy over time. Maintaining Trays in the system is not necessary. They can be made inactive or they can be deleted. Highlight multiple trays and press the Delete button on the Tool bar. 2. When saving a tray map, the user was prompted to enter an expiration date because of a Tray Type and Subtype connection with the HistoScope software. This has been corrected for non-histoscope Tray Types. The user should use Tray Types such as Luminex or PCR to avoid the Expiration Date requirement. This change is in place on the Work Management Test Batch Tray wizard and from the Tray Dictionary. Security Dictionary Users 1. The Password field on the User Record has been increased from 10 to 12 characters. Roles 1. The Restricted Field feature has been enhanced to provide settings to differentiate the restriction between adding new values versus editing existing values in most fields on the patient and sample records. a. To access the Restricted Field choices, open the desired Role and press the Restrict Field Access button. Technologist Role Showing Restrict Field Access button b. The Restrict Edit screen opens. There are three panes. Page 42 of 67

43 i. Restricted Add Fields when checked, this Role will not be allowed to make entries to this field. ii. Restricted Edit Fields when checked, this Role will not be allowed to make changes to existing entries in this field. Restricted Patient Fields Set up Screen Restricted Sample Fields Set up Screen c. The pane of the right is labeled Restricted Functions. These are Add, Edit, View, Delete functions in various areas of the patient record. In the example above, this role would not have access to the Delete feature on several screens Patient Reports, Patient Cases, Patient Extraction History, and Patient Sample History. Page 43 of 67

44 Report Dictionary NOTES: 1. The feature described here is available for users with the HL7 Outbound Results interface. 2. Consult with your report development contact to add logic to the report if the report should include the word Preliminary in the title or near the signature area. 3. Contact your IT representatives (both SystemLink and customer) to make configuration changes to the outbound results transactions. The transaction can include the term preliminary. Send Preliminary Report 1. From the Report Dictionary, open the report that will have a preliminary version sent through the interface. 2. If the report has been set for one step of review, change the Review Cycle setting to 2 steps of review. The report will then appear first under the Review menu, by Reports. 3. The Send Report Through the Results Interface (blue frame) should have been checked previously. 4. Check the Send Preliminary Report through Results Interface (red frame). A PDF will be created when pressing Report Complete on the Review menu, By Report. Report Definition with Preliminary Setting Page 44 of 67

45 Tools/Options Changes on tabs under the Tools/Options screen are described here. System 1. The setting to display only a portion of the SSN has been added to the System tab. This setting will display ***** plus the last 4 digits of the SSN. This applies to the list views on the Patient, Sample log, Results, Review and Sign Off menus. The full SSN will be displayed on the patient or sample record when open. Tools/Options/System screen Test The position of some settings on the Test tab of Tools/Options has been rearranged, allowing for the addition of new settings. 1. Require Physician When Ordering was added in version The use of the setting has been corrected for ordering done under Batch Accessioning. (See Blue below). 2. (Version ) The ability to delete a billed test was removed in version and returned with a setting under Tools/Options/Test. (See Blue below). 3. Require Cancellation Reason when Cancelling a Test is described under the Sample menu/sample Record/ Orders above. This provides a setting that will require the reason for cancellation. If the setting is not checked, the Reason For Cancellation message screen will appear, but can be ignored prior to cancellation of the test. (See Red on Test tab.) 4. The Default Review Cycle on a Test Batch has been one step of review. The user could change to either zero or two. If the review cycle consistently required Page 45 of 67

46 changing, the user can now select a different Default Review Cycle. (See Red on Test tab.) 5. Some users requested the ability to enter a non-numeric value into the %PRA field. For example, the result of the PRA to be reported may be NT for Not Tested. A new setting on the Test tab will Allow non-numeric PRA% (See Red on Test tab.) Tools/Options/Test screen a. When saving this setting, an alert message will appear concerning reports that use the PRA% field. The data type of the field was changed to allow nonnumeric values. A report change may be necessary to display this new data type. When choosing Allow non-numeric PRA%, this message alerts to the data type of the field when using the PRA field on a report Page 46 of 67

47 b. If the new setting is checked and then returned to unchecked, the following message will appear. Removal of any non-numeric values will be necessary before completing this reversal see the second message. Messages presented when returning the non-numeric setting to the original data type UNOS 1. The UNOS tab has been updated to remove the settings related to the Export Unacceptables Module. These settings are now available on the Export Unacceptable application. 2. The remaining settings relate to the Wait List Management module. They provide the Cross-reference tables for updating values from the Wait List to the Patient record UNOS tab with Export Settings removed Page 47 of 67

48 Regional Date Settings HistoTrac displays dates throughout the software based on the regional setting chosen for the workstation. When the US date format (MM/DD/YYYY) is the setting, the date fields are displayed correctly according to that setting. When an international date format (DD/MM/YYYY) is chosen, many, but not all, date fields are displayed in that format. Corrections have been made to display international dates in every date field throughout the software. Known issues corrected are as follows: Search fields on the Patient Find screen for Date of Birth Search fields on the Sample Log Find screen for Sample Date, Logged Date. Inventory menu grid display of sample dates Crossmatch Test Donor s Cell dropdown with Sample Dates When returning a report using RQSO, the date format inconsistency caused an error. When using this setting under Tools/Options/Sample, an error message was generated after the 12 th of the month. The setting could not be used. When using the Ad Hoc Query, dates must be entered in US date format but will be returned in international date format. Page 48 of 67

49 Sticky Notes The Sticky Notes feature provides a messaging mechanism used for individual Patient notes and for System notes. The feature is designed to alert the user of specific situations that affect a patient s testing or to provide alerts to all users for an activity not related to a patient. 1. A bothersome feature about Sticky Notes has been that the alert appeared with each opening of the Patient, then Sample, then Test record. This has been changed. The alert will appear only one time, when the first record is opened, whether that record is the patient or the sample or the test. 2. Individual users can now be granted permission to dismiss a note. When creating the Note, an additional tab provides the list of Users or Roles that are Allowed to Dismiss the Note. a. Check the user(s) or Role(s) on the Allowed to Dismiss tab. b. If any user is allowed to dismiss for him/herself, use the setting at the top Allow User to Dismiss Alert. Notes screen with the new Allowed to Dismiss tab Page 49 of 67

50 DSA New Test Classification Pre and post-transplant testing for antibody specific to a donor has been part of the HLA lab s routine testing for some time now. HistoTrac s ability to properly identify the donor and the donor s HLA type in the context of antibody analysis and to report donor specific antibody will be improved with a new feature. The Core software is provided with 4 test classifications Serology, Molecular, Antibody, and Crossmatch. All Core software users will now have a new/additional Test Classification DSA. The DSA test will be ordered in conjunction with/addition to Single Antigen Bead tests. Workflow would normally involve ordering a DSA test at the same time new samples are tested with a single antigen product. The DSA test will be updated following the completion of Single Antigen test results from either One Lambda s product or Immucor s product. Results will reside on the DSA History folder, newly added to the Patient record. DSA tests ordered over time can be viewed and reported with MFI values per donor antigen/allele. Test Dictionary Test Classifications 1. The new classification will appear in the Test Dictionary when the version upgrade is done. The user is not required to add this manually. Additional DSA Test Classification 2. With each Test Classification, a test History folder is added to the Patient record. Page 50 of 67

51 Patient Record showing DSA History folder Test Definitions 1. To create a new DSA test, press New on the Tool bar from the Test Definition folder. 2. Select DSA from the Test Classification dropdown. The Available Fields window will populate with the fields that are available for this definition. Test Definition showing the new DSA Classification 3. Based on reporting needs, a Class I, Class II or combined Class I/II definition can be created. The best choice is likely to be the combined definition as it is most common to report DSA to the donor s full typing. Page 51 of 67

52 Example List of DSA Test Definitions 4. The following definition contains fields for reporting the Donor antigens (2 at each locus) and the patient s MFI value to each antigen. The MFI values are based on selected single antigen bead test data on the patient. Example of a DSA Class I and II Antibody Test Sample Menu Following is a description of using this new test classification. 1. From the Log screen, accession a sample on the patient. 2. From the Orders screen, select the DSA I/II test code. a. As with a Crossmatch Test, the Relate To screen opens, offering the ability to associate this test to a specific donor. Also, like the Crossmatch Test To screen, a case can be created on the patient (if not already available) and a donor added to the case. b. Make the selection of the donor whose typing this patient s antibody will be compared to. Page 52 of 67

53 Relate To Screen when Ordering a DSA Test DSA Test ready to Order Page 53 of 67

54 Results Menu 1. The DSA test will move through the workflow based on assignment either to a Work Area or later to a Batch. This example uses a Batch. The batch includes the DSA test(s) and the Single Antigen Bead Class I and II tests that will be used to update the DSA tests. Maintaining the DSA and SAB tests in the same batch may/may not be helpful. a. If using the Build a Tray wizard from the Test Batch screen, first assign the SAB tests to the batch and build the tray. b. Then return to the Results menu and assign the DSA tests to the batch. This is not a requirement, only a suggestion. The DSA tests could remain in a separate batch or not be batched at all. DSA Tests in a Batch 2. Double click to open the test. The top portion of the screen offers the following: a. Donor identification in the upper left. b. A list of Antibody tests from the patient in the window on the right. c. The fields of the DSA test across the screen. DSA Test 3. The donor s phenotype must first be added to the antigen fields of the test. a. Depending on whether the donor s typing is located in the Serology or the Serological Equivalent fields, select the appropriate radio button. b. Press the Apply Typing to Test button. Page 54 of 67

55 Apply to Test button to load Donor Typing c. The donor typing fields can also be edited/entered manually. If looking for allele level antibody, the donor s allele level typing can be entered into each or selected fields. Edited typing to enter an allele typing on the donor 4. The Antibody Data frame presents the patient s Antibody test from which a Class I and a Class II test will be selected to populate the MFI values in the DSA test. a. Place a Check to the left of the Class I SAB test. b. The MFI value per specificity (Abbr. Specificity) from that SAB test will load the locus and position specific field of the DSA test. When doing so, the Abbr. Specificity will be loaded based on the Average, Minimum, or Maximum values if there are multiple beads with the same Abbr. Specificity. Choose the radio button for Use Avg, Use Max, Use Min. c. From the Determine Using dropdown, select the bead value that will be used for the Avg, Max, or Min calculation. d. Normal and Raw are bead values for HLA Fusion data. e. AD-BCR, BCM, and BCR are bead values for MatchIt. Antibody Data Frame Page 55 of 67

56 f. Press the Apply button to add the MFI values, per matching donor antigen, to the DSA test. Class I SAB MFI loaded to DSA Test 5. Repeat for the Class II SAB test. (Both Class I and Class II SAB tests can be selected initially.) Class II SAB MFI loaded to DSA Test 6. Check the View Details box at the bottom of the test to view the donor specific MFI data from the Highlighted test in the Antibody Data frame. a. The Bead data viewed under View Details is selected based on the vendor used for Single Antigen Bead antibody identification. The columns of data will change accordingly. i. Choose Test Details for HLA Fusion data. ii. Choose MatchIt Test Detail for MatchIt data. Test Details choice of Vendor data 7. Use the View Only Donor Specificities checkbox to display bead detail for the highlighted SAB test. Page 56 of 67

57 a. Data viewed can be compared to the values that were updated to the test. b. Column headers can be clicked to sort data by column for improved analysis. View Details Showing all Bead Detail for the Highlighted Class I SAB Test c. Highlight the Class II SAB test to view the SAB bead details for Class II. View Details Showing all Bead Detail for the Highlighted Class II SAB Test Page 57 of 67

58 8. If allele level data is desired, the MFI value for the individual bead can be updated manually to the DSA MFI field. Allele-level Data entered manually 9. To view DSA trends, check the View DSA Trends checkbox. This checkbox toggles the screen between DSA Trends and Donor Specificities. Uncheck the Hide DSA Trends to return to Donor Specificities. a. The two tests displayed under DSA Trends in this example are previously signed out DSA tests. b. The Trend will display all tests over a period of time. DSA Trends Review and Sign Out menus 1. DSA tests move through the Review and Sign out process like other test classifications. 2. Report creation to display DSA data will be managed with each HistoTrac customer individually. Talk with your software consultant. Page 58 of 67

59 CPRA Management With Version , the CPRA calculator feature has been updated. For users who wish to use the calculator, an additional installation step is necessary. Your software consultant will provide the link to download the CPRAManagement.exe. This is a small program that will add functionality to the database, including the UNOS frequency tables. The design of the CPRA calculator is flexible to accommodate frequency data using other formats than provided in the US by the UNOS system. NOTE: This application requires permission to write to the database. This does not require administrative rights, but DDL-Admin permission in the SQL database. Typically, all HistoTrac users have the appropriate permission. Download the CPRA Management application. Place in a directory available to the user who will run the update. This is application will be run once in the Test environment during the upgrade validation process and once again in the Production environment when validation is complete. Placement in the shared folder where other utility applications reside will enable easy installation as a utility. The application contains a Review Frequency feature which may be used after the calculator is functional. To install the CPRA functionality: 1. Double click on the CPRAManagement.exe. A log in screen appears. Enter the User Name and Password for the Test environment. CRPA Update Log in Screen 2. The CPRA Management screen opens. Page 59 of 67

60 CPRA Management Screen 3. Press the Create/Recreate HistoTrac CPRA Tables button. a. The following message confirms this action and explains the database changes. Confirm Creation of Tables b. Answer Yes. Once the tables are created, the frequency data are added. Populate Frequency Data Page 60 of 67

61 c. A progress bar will display. Population of the CPRA Tables 4. Press the Create/Recreate HistoTrac CPRA Calculator Database Function button. Press Yes. Create CPRA Database Functions Confirmation of task 5. In the Frequency Data frame, press the Populate Default Frequency Table Data button. NOTE: If version 2.51 has been previously installed, the CPRA tables and Frequency data were loaded with that version. The message will describe that the data will be replaced. Page 61 of 67

62 Confirmation of Populating the Frequency Data a. A progress bar will display as the tables are updated. Progress Bar as Tables are Updated Update is Complete 6. To review the Frequency Data, either by individual antigen or by haplotype, the Review Existing Frequency Data button will open a screen with a filter mechanism. This feature may be desirable to access for a number of reasons. The CPRA Management application may be installed as a Utility for easy access. a. In this example, A2, B44 search shows the frequency data for four races (Caucasian, African American, Hispanic, and Asian.) Page 62 of 67

63 Review Frequency Data Screen 7. Press the Exit button to close the application. Page 63 of 67

64 Multiple Medical Record Numbers for a Patient HistoTrac has always used a single MRN identifier for each patient, making the assumption that each patient would be managed at a single center with that center s medical record number. Current HistoTrac users who do testing for patients from multiple centers because of multi-organ transplant listings have had to create work-arounds to track proper identification and proper billing when samples arrive from that patient s different center locations. For users with this issue, there is now a solution. The new feature available will track multiple MRN s per patient, per category, per hospital, per UNOS center. The MRN will now be associated with the Sample record in addition to the patient record. This will accommodate billing records to the correct MRN/center. single-center patients who are listed for multiple organs multi-center patients who are listed for multiple organs Each patient will have a primary record completed with all demographic and identifying fields on the General Information screen. That patient can then have additional MRN s stored associated with a Category, Hospital, and UNOS Center. When accessioning a sample, any of the patient s MRN values will locate the main patient record. From the Patient Record 1. From the Patient Menu, create a new patient record, completing all the General Information fields required for proper identification. Save. Patient Record with initial MRN 2. Then click the blue MRN link. a. The Patient MRN Screen opens. b. Press the Add button to add a second MRN. Page 64 of 67

65 Patient MRNs Screen c. The Maintain Multiple MRN screen opens. Maintain Multiple MRN screen d. Enter the additional MRN and make selections for the category, UNOS Center, and Hospital. This example is an additional organ at the same center. Press Save. Second MRN Entry e. If the patient has additional associations, create a third entry. This example is a different organ at a second hospital and UNOS center. Save and Close. Page 65 of 67

66 Third MRN Entry f. This screen will always display the MRN associations for this patient. When opening the patient record, press the MRN link to open this screen. Patient MRNs Screen showing all MRNs From the Sample Record 1. To accession a sample on a patient with multiple MRN values, enter an alternate MRN in the MRN field of the Sample Record. 2. The secondary MRN will be recognized and will populate the patient fields with the primary patient data with the exception of the Category, UNOS Center and Hospital. These fields will fill with the values associated with the secondary MRN. 3. Tests ordered with this secondary MRN will move to the billing queue with the secondary MRN Category, Hospital, and UNOS Center. Sample record with a Secondary MRN Page 66 of 67