NOTE: This guide is NOT to replace the patch install notes or installation guides for each patch listed below,
please use this as an additional guide to help you complete patch installs/package configuration.
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
(will vary
depending on
speed of
machine)
BXT IHS Kernel Toolkit Extensions v1.0
kids + post
install
YES
2 min
(Must have XT Kernel Toolkit v7.3 patch 1017)
 Post install for Site Mgrs./IT support staff (to implement the Parameter Audit system):
o BXPAMENU option will need to be added to the local Kernel menu structure at a menu location
accessible to appropriate staff
o Allocate security keys to appropriate staff
 BXPAZMENU – general access to parameter audit
 BXPAZMGR – manager access to parameter audit
AVA IHS VA Support Files v93.2 patch 22
(Must have AVA*93.2*21)

kids only
YES
2 min
Install notes: If you receive any prompts, “Shall I overwrite your file? Y”, Answer YES
AUPN IHS Dictionaries (Patient) v99.1 patch 23
(Must have AUPN*99.1*22 and AUT*98.1*25)
kids only
2 min
AG Patient Registration v7.1 patch 11
kids + post
install
2- 6 min
(Must have AG*7.1*10, AVA*93.2*22,AUPN*99.1*23)
 Save off AG* routines, install kids
 Post install notes:
 Review ag__0710.110.pdf Installation/Setup/User Guide
 See setup/user manual for post-installation instructions regarding the IHS Eligibility Letter
 Sites using RPMS Lab package may be impacted by addition of ‘unknown’ pat sex, possibility of false
alerts on lab tests for patients w/ an ’unknown’ sex
 Needs to be FM search on Lab test (#60) file’s REFERENCE LOW, REFERENCE HIGH, CRITICAL
LOW, AND CRITICAL HIGH to determine if any code uses the SEX variable
 If not done and code not corrected, possibility of false alerts
 New security keys:
 AGZPHROPT – provides access to new MENU option: PHR Update patient’s Personal Health
Record Access (AGPHR)
 AGZACA PRINT – provides access to new MENU option: Print IHS Eligibility Letter (AGACA PRINT)
 AGZACA VERIFY – provides access to new MENU option: Verify IHS Eligibility Letter (AGACA
VERIFY)
 AGZACA SIGN – assigned to service unit director or chief executive officer of facility whose name
will appear as the author of the printed IHS Eligibility letters
1
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
BMW Practice Management Application Suite v2.0 patch 5
no kids, application server setup
Server Pre-reqs:
- Windows Server 2008 64 bit
- IIS 7.0 (avail with Windows 2008 server)
- .NET Framework 4
- 5 GB min free disk space
- 7-zip software to extract installation files from BMW installation pkg
YES
30 - 60 min
RPMS Server:
- Ensemble v 2012.2.x
- CACHE.DAT file specific to Ensemble version
Workstation pre-reqs:
- 20 GB free disk space
- Windows 7 (or Windows XP)
- IE 9.0 or IE 8
- Microsoft Silverlight 5.0 plugin for IE
RPMS patch pre-reqs:
- PIMS v5.3 patch 1015
- AG v7.1 patch 11
- AUT v98.1 patch 26
- XU v8.0
- BJPC v2.0 patch 10
- AVA v93.2 patch 22
- AUPN v99.1 patch 23
First time install notes:
 Acquire SSL Certificate (IHS domain/non-IHS domain)
 BMW Application Server installation and configuration
o .NET framework verification
o .NET framework 4.0 installation
o Run Windows update utility to check for and install any .NET Framework updates (if available)
o IIS 7.0 Installation
o Windows Communication Foundation (WCF) Activation
o Adding MIME Types
o HTTP Compression Configuration
o Moonwalk Web Site Setup
 Add the Application Pool
 Create a Moonwalk folder (to aid in setting up the Moonwalk web site)
 Add the New Site
o Install the SSL Certificate
o Configure the SSL Certificate
 Visit the website via an HTTPS connection – using the domain name, not the IP address – to verify installation
 BMW Database Server Installation & Configuration
o Setup
 Create a /BMW folder under the default database directory on your RPMS server
 Windows Server – substitute appropriate drive letter and folder name
 AIX Server – mkdir /usr3/cachedata/bmw/ (or your default db directory)
2


Unzip the BMW zip file, using 7-zip software
 Windows Server – bmw_0250db_win_nnnn.7z
 AIX Server – bmw_0250db_aix_nnnn.7z
 This file contains the BMW database named CACHE.DAT
 Unzip this file on a workstation or other local machine, not on database server itself
 Move CACHE.DAT to the Database Server
 Move the CACHE.DAT file to the /BMW folder
o Windows – move directly through the network or via Remote Desktop
Connection
o AIX – move using FTP or similar file transfer program
 Set File and Folder Permissions
 Windows – setup by default
 AIX – use these commands to change:
o $cd /usr3/cachedata/
o $chmod 770 /usr3/cachedata/bmw
o $chmod 775 /usr3/cachedata/bmw/CACHE.DAT
 Setup the BMW database using Ensemble system management portal
 Mount the BMW database
 Create the new namespace called BMW
o Add BMW Global Mapping to your RPMS database
 Using SMP, browse to Namespaces and select your production RPMS namespace
 Select “Global Mappings” and add a “New Global Mapping”
 Select BMW as the ‘Global Database Location’ and type BMW as the ‘Global Name’, click “OK”
when done
 Click “Save Changes” in the confirmation window to complete the global mapping
o Add BMW Package Mapping to your RPMS database
 Using SMP, browse to Namespaces and select your production RPMS namespace
 Select “Package Mappings” and add a “New Package Mapping”
 Select BMW as the ‘Package Database Location’ and select ‘BMW’ as the ‘Package Name’, click
“OK” when done
 Click “Save Changes” in the confirmation window to complete the package mapping
o Import BMW XML file (bmw_nnnn.xml)
 Disable Read only on BMW database, set ‘Read Only’ field to “NO”
 Once patch is installed, you can re-enable ‘Read Only’, set ‘Read Only’ to “YES”
 You may select “Run import in the background” checkbox on Import Classes window
 Confirm “Load finished successfully” message appears
o Setup Package Mapping in your RPMS database using SMP
 Package Mapping Verification, execute SQL query
 If no results or previous installation, select Browse SQL Schemas and select Purge Queries
 Verify Ensemble version is compatible with BMW Cache classes, YOU WILL NEED TO KNOW
FACILITY IEN # FOR YOUR SITE TO RUN THIS TEST. This can be found in the INSTITUTION FILE
for your facility.
 Access/Verify prompt will appear on screen, if sharing session using adobe connect you will
want to stop sharing to run this test
o Cache User Creation
 Create the Moonwalk user
 Assign user roles
Application Deployment to the Web Server
o Deploy the BMW application
 Browse to location where the BMW Application Installer File (bmw_0250.msi) is stored
3


Double-click the bmw_0250.msi file to run the BMW application installer. (If you cannot install,
you may have to install from the command line with administrator privileges).
 See BMW Installation Guide, section 7.0 for further details on installation
 Port should be set to 80-83 (http://) or SSL port 443 (https://) under Moonwalk site bindings
 If needed to associate one or more additional databases to the BMW application suite, add
additional database after initial BMW client installation
 There are no package-specific security keys associated with BMW
o Open BMW application
 From IE, enter IP address of your Windows application server using this form:
http://nnn.nnn.nnn.nnn
 If Microsoft Silverlight is not installed, follow the prompts to install Silverlight on the computer
 If you receive this error, “Your current security settings do not allow this file to be
downloaded” when installing Silverlight, try this:
http://www.symantec.com/docs/TECH164780
 BMW Log In screen is displayed
 Type Access / Verify codes
 Select your RPMS database
o Refer to the separate BMW User Manuals for additional information about using the BMW modules
OPTIONAL: Follow these steps to install BMW in “Out of Browser” mode
o Start BMW in browser mode
o Click Install in upper right corner of the browser window
o After a few moments of processing, the installation is complete and the “out of browser” BMW Login
screen is displayed
o After installation, BMW can be accessed from the user’s desktop by double-clicking the IHS Practice
Management icon on the user’s desktop
If you have already installed BMW at your site and are now installing a patch or updated version, follow these steps:
 Stop the BMW Web Site on the Application Server
 Uninstall the BMW Application
 Install the new version of the BMW Application
o Browse to location where the BMW Application Installer File (bmw_0250.msi) is stored
o Double-click the bmw_0250.msi file to run the BMW application installer. (If you cannot install, you
may have to install from the command line with administrator privileges).
o See BMW Installation Guide, section 9.3 for further details on installation
 Import the new BMW CACHE.DAT file
o Dismount the BMW Database on the Database Server
o Unzip the BMW zip file
o Move the new CACHE.DAT file
o Mount the BMW database
 Check the BMW Global Mapping to your RPMS database
o If you need to add, follow these steps:
 Using SMP, browse to Namespaces and select your production RPMS namespace
 Select “Global Mappings” and add a “New Global Mapping”
 Select BMW as the ‘Global Database Location’ and type BMW as the ‘Global Name’, click “OK”
when done
o Click “Save Changes” in the confirmation window to complete the global mapping
 Check the BMW Package Mapping to your RPMS database
o If you need to add, follow these steps:
 Using SMP, browse to Namespaces and select your production RPMS namespace
 Select “Package Mappings” and add a “New Package Mapping”
4




Select BMW as the ‘Package Database Location’ and select ‘BMW’ as the ‘Package Name’, click
“OK” when done
o Click “Save Changes” in the confirmation window to complete the package mapping
Import the new BMW XML File
o Disable Read only on BMW database, set ‘Read Only’ field to “NO”
o Once patch is installed, you can re-enable ‘Read Only’, set ‘Read Only’ to “YES”
o Import BMW XML file (bmw_nnnn.xml)
o You may select “Run import in the background” checkbox on Import Classes window
o Confirm “Load finished successfully” message appears
Purge the Previous SQL Queries
o There are 2 ways to do this:
 From SMP: click System Explorer, SQL, Browse SQL Schemas, and select Purge Queries
 From programmer prompt: D $SYSTEM.SQL.Purge()
Start the BMW Web Site on the Application Server
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
BUSA IHS User Security Audit v1.0
kids + addtl
YES
Ensemble
Config
(pre and post)
YES
30 – 60 min

Required Resources:
o Ensemble 2012.2.0 or later
o VA Fileman (DI) v22.0 patch 1003 or later
o VA Kernel (XU) v8.0 patch 1015 or later
o BMW v1.0 patch 2 or later

Key Installation issues to be aware of
 BMW v1.0 patch 2 installation verification
 The BMW global must be properly mapped in the RPMS environment or installation of the BUSA
application will not be permitted to continue.
 If BMW mapping has not been done, please see Appendix C of the BMW Practice Management
Application Suite Version 1.0 patch 2 Installation Guide and Release Notes
 BUSA Reporting Tool – Authorized Users
 During the kids installation process, the installer will be prompted to enter a list of users who are
approved to use the reporting tool included with the BUSA package
 Develop this list of approved users prior to installing this package
 This new reporting tool shows patient related activity, provide access only to appropriate users
 BUSA Package – CPU Capacity: BUSA API calls should not have any noticeable impact on CPU capacity
 BUSA Package – Disk Usage
 The BUSA application logs all user patient related activity and consumes a large amount of disk
space
 Develop a detailed plan to account for this need on your RPMS database server
Perform these instructions BEFORE installing the initial BUSA patch
 Pre-Kids installation configuration
o Locate and create a “BUSA<namespace>” folder under the default database directory on
your RPMS server
 Windows Server – substitute appropriate drive letter and folder name (i.e.,
I:\E2012\BUSAGOLD4)
 AIX Server – mkdir /usr3/cachedata/busa<namespace>/ (or your default db
directory)

5
o



Select a name for the new database that includes “BUSA” and the RPMS
namespace/database name that it is associated with
o Ensemble setup (for detailed instructions refer to Section 3.0 of the BUSA IHS User Security
Audit Installation Guide and Release Notes v1.0)
 Create a new database
 Make sure that this directory path is included in your site’s backup procedures to
backup database on a regular basis
 Map the BUSA globals to the new BUSA database
 Map 2 BUSA globals called BUSAD and BUSAS
 Using SMP, browse to Namespaces and select your production RPMS
namespace
 Select “Global Mappings” and add a “New Global Mapping”
 Select the BUSA database as the ‘Global Database Location’ and type BUSAD
as the ‘Global Name’, click “Apply” when done
 Change the ‘Global Name’ to BUSAS
 Click “OK”
 Click “Save Changes” in the confirmation window to complete the global
mapping
 Verify BUSAD and BUSAS global mapping are visible in the Global Mapping
List
KIDS Installation
o This is a new package with new routines so there isn’t anything to backup or compare
o Do not queue the installation to run in the background since you have to enter the user (or
users) who will be given access to the reporting tool
Configuring the IHS User Security Audit Web Application –
o Recommended for site to use a standalone IIS or Apache web server with SSL configuration,
not the private web server provided by Intersystems
o The instructions included in Section 5.0 of the BUSA IHS User Security Audit Installation
Guide and Release Notes v1.0 are meant for testing purposes only
o Additional Ensemble SMP configuration to complete Web application portion and security
setup
 Enable System Authentication Options
 Create New Web Application
 Update Ensemble’s Unknown User
Cache Server Page (CSP) Web Gateway Installation
o Instructions in Section 6.0 of the BUSA IHS User Security Audit Installation Guide and Release
Notes v1.0 assume the site is running IIS (version 7 or higher) with a valid installed SSL
certificate. Installation of IIS and SSL certificates are outside scope of BUSA installation
guide.
o Install Cache shell
o Configure IIS
o Configure CSP Web Gateway
 While connected to the sever where the CSP Web Gateway was installed, enter the
following link in a web browser:
http://localhost:PORT/csp/bin/Systems/Module/cxw
(Where PORT should be set to the appropriate assigned port number)
o Test connection to BUSA Reporting page from a workstation:
If using a secure connection:
https://<IPAddressofCSP Gateway Server>:444/csp/busa/BUSA.MainReportPage.cls
(If using a non-standard port for the https protocol handled by IIS such as 444, modify the
URL you used accordingly).
6
RPMS Name:
Install type:
BSTS IHS Standard Terminology v1.0
(Must have Ensemble 2012 or later)
kids + RPMS YES
BSTS menu
Configuration
(pre and post)


NEW? Users off? New DB? Est install time?
YES
20 – 30 min
Perform these instructions BEFORE installing the initial BSTS patch
o Pre-Kids installation configuration
 It is recommended a minimum of 100 MB of space be allocated for this release
 Review bsts010t.pdf Version 1.0 Technical Manual
 Increase the site’s Ensemble 2012 maximum per process memory setting to be at minimum
131072 (if existing values are greater than this value, leave as is)
o All classes are imported and compiled as part of the KIDS installation
Perform these instructions AFTER installing the BSTS patch
o Post-installation configuration.
 From Ensemble System Management Portal, follow instructions to add SSL/TLS Configuration
for: SNOMEDServer
 Assign Area IT support, local IT support, and CACs the BSTSZMENU key. If this is overlooked, you
will get a message stating, “Sorry, your Primary Menu is locked” when trying to access BSTS
menu options
Define your Web Service Endpoint
 From BSTS WEB SERVICE menu, enter these values
o BSTS WEB SERVICE ENDPOINT NAME: PRODUCTION
o URL ROOT: https://dtsservices.ihs.gov
o PORT NUMBER: 443
o TYPE: DTS4
o TIMOUT OVERRIDE: 60
o USERNAME: DTSUser
o PASSWORD: DTSPW!
o SERVICE PATH: /dtsserverws//
o SSL/TLS CONFIGURATION: SNOMEDServer
 Editing your site parameters
 After the Web Service Endpoint is complete, add to site parameters
o BSTS SITE PARAMETERS NAME: <enter site name>
o WEB SERVICE: PRODUCTION
o PRIORITY: 1
o DAYS TO KEEP RESPONSE: 5
 Test the Web Service Endpoint from BSTS TEST WEB SERVICE menu option
o BSTS WEB SERVICE ENDPOINT NAME: PRODUCTION
o Display DTS connection log (Y/N): Y
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
BCQM IHS Code Mapping v1.0
kids only
YES
3 min
(Must have Kernel 8.0 or greater and Fileman 22.0 or greater)
 Save off BCQM* routines, install kids. Note: If this is a first time install, there will be no routines in this
namespace
BJPC IHS PCC Suite v2.0 patch 10
kids only
(Please refer to patch checklist to see list of patch requirements)
7
3 min
RPMS Name:
Install type:
PXRM Clinical Reminders v2.0
kids + pre
and post
install steps


NEW? Users off? New DB? Est install time?
20 min
Key Installation issues to be aware of
o Make sure that PXRM indexing has been completed and indexes are built as specified in
PXRM*1.5*patch 1009 Clinical Index and Reminder setup document (pxrm0150.1009o.pdf). The
indexes are required to be built before Reminders 2.0 can be installed. They are also required for
graphing changes which are delivered EHR*1.1*11
 Globals to be indexed are:
 LABORATORY TEST (CH, Anatomic Path, Micro)
 ORDER
 PTF
 PHARMACY PATIENT
 PRESCRIPTION
 PROBLEM LIST
 RADIOLOGY
 V CPT
 V EXAM
 V HEALTH FACTORS
 V IMMUNIZATION
 V PATIENT ED
 V POV
 V SKIN TEST
 V MEASUREMENT
 V PROCEDURE
o EHR should be off-line or clinical reminders turned OFF while the build is completed. Install during off
hours or at night. During the install process Clinical Reminders users should not be accessing the Clinical
Reminders software.
o Immediately following installation of Clinical Reminders v2.0, PXRM v2.0 patch 1001 needs to be
installed. If PXRM*2.0*1001 is not immediately installed, clinical reminders will create a large # of errors
and will not run correctly. YOU WILL NOT BE ABLE TO USE CLINICAL REMINDERS UNTIL PATCH 1001 IS
INSTALLED.
o New PXRM Menu Options:
 Reminder Patient List Menu
 PXRM PATIENT LIST MENU – this menu contains options for creation of term-based list
rules that can be used in both extract processing and patient list creation
 Reminder Extract Menu
 PXRM EXTRACT MENU – this menu contains options that allow display and edit of
extract finding rules used in the extract process and of extract parameters for use in
extract processing
 New menu options on the Reminder Dialog Management menu
 PXRMCS INACTIVE DIALOG CODES  PXRM DIALOG TOOLS MENU – dialog reports
o Computed Findings Review
 Locally created computed findings may need to be updated. Any sites experiencing computed
finding errors with CRv1.5, should identify and fix the problems prior to installing CR v2.0
Installation notes
o Remove All Items from Reminder Exchange (EHR -> REM -> RX)
8
o
o

Turn off clinical reminders – reminders should NOT be running during this conversion
Make sure the iCare nightly task job which runs reminders is not running during this time these patches
are installed
o RPMS menu path will be EHR -> BEH -> REM -> PAR -> ACT, turn off reminders at the system level by
setting “REMINDERS ACTIVE:” field to “NO”
o Load and Install Kids patch
o At Legacy system, accept the default of NO
o This build has an environment check to see if the Index Global was installed and built. If the indexes are
not built, you cannot load Clinical Reminders v2.0
o At Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//, type YES to rebuild menus
o IMMEDIATELY after installing Clinical Reminders v2.0 install pxrm0200.1001k
 Check Fileman to make sure that the current version matches the installed version and is filled
in or the patch will not install for:
 Lexicon v2.0
 ICD Update v12.0
 ICD Grouper v18.0
 ICPT v6.0
 Overwrite Files – Answer YES to all file overwrite questions, the patches will ask you about
overwriting many files
 Mail Groups – Enter yourself or the CAC at your site, you will be asked to enter a name for mail
groups that RPMS does not use:
 IHD SEND
 GEC2 NATIONAL ROLLUP
 Errors – you may see a few error messages regarding VA national reminders during the install of
patch 1001. These error are normal since we are not installing these reminders into RPMS
Post-installation notes
o Review mailman messages.
o Test Reminders. Validate that the reminders still work after conversion, especially any locally created
reminders that will not have been reviewed by anyone else
o After verifying reminders are working correctly, reactivate reminders from the “REMINDERS ACTIVE”
parameter
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
PXRM Clinical Reminders v2.0 patch 1001
kids only
10 min
 Post-install notes
o Provide notes file for this patch to your CAC for review.
o A post-init routine will be run to inactivate taxonomies used as reminder dialogs and it will remove any
ICD FINDINGS. The report will be sent to the mail group PXRM ERRORS. Please review what has been
removed at your site. Share information with your CAC to review if they are not part of this mail group.
TIU Text Integration Utilities v1.0 patch 1011
kids only
6 min
 Pre-install notes
o IMPORTANT CHECK: Check TIU installed patch listing to see if your site has installed TIU*1*215. If you
did not install TIU*1.0*215 answer NO to the question, “Did you install patch TIU*1.0*215?” and the
install will run to completion. ****If patch TIU*1*215 was installed and then backed out, please get
start date from the install file as you will be asked for it during installation of this patch. Notification to
back out was sent 7/19/2007, check your records to see when it was backed out
 Installation notes
o MENU REBUILD: YES
This will install the new reports on the menus
o When it asks if you have installed patch 215, Say NO. ***This is very important***
9
Did you install patch TIU*1.0*215? NO
Patch 225 will ask for mail group coordinator, ENTER the Coordinator for Mail Group ‘TIU CACS’: <you
may want to enter your site CAC>
Post-install notes
o Please see the tiu_0100.1011o.pdf document for mapping note titles to national titles or setting up form
letters
o Please rebuild menus since the menu options have changed, if you did not do this during the patch
install
o

RPMS Name:
Install type:
APSP IHS Pharmacy Modification v7.0 patch 1017
(Must have APSP*7.0*1016)
kids only

NEW? Users off? New DB? Est install time?
8 min
Installation notes
o Remove Pharmacy users from the system
o Load apsp0700.zipcode.17k.zip file first. When you load the file, globals will be installed
o Load and install zpsp0700.17k
o At “Tasking DRUG File #50 RXCUI field update….”, Requested Start Time: NOW//, select Enter
 You will receive message, “The update for DRUG File field RXCUI is tasked #xxxxxx”
o At “Tasking MEDICATION ROUTE #51.2 SNOMED CODE update”, Requested Start Time: NOW//, select
Enter
 You will receive message, “The task number is xxxxxx.”
GMRA Adverse Reaction Tracking v4.0 patch 1007
kids only
(Must have GMRA*4.0*1006, XU*8.0*1016, IHS STD TERM 1.0)

Rx users only
no, load
during
Non-peak hrs.
2 min
Installation notes
o At “Running Post-Install Routine: POST^GMRA1007, Requested Start Time: NOW//, select Enter
 You will receive message, “A task has been queued in the background. The task number is
xxxxxxx.”
 To check on the status of the task, in programmer mode type D STATUS^GMRA1007
GMRC CONSULT/REQUEST TRACKING v3.0 patch 1004 kids only
(Must have GMRC*3.0*1003, XU*8.0*1016)
no, load
during
Non-peak hrs.
12 min
GMRV GEN. MED. REC. – VITALS v5.0 patch 1002
kids only
(Must have GMRV*5.0*1001, BJPC*2.0*10, XU*80*1016)
no, load
during
Non-peak hrs.
3 min
BEPR e-Prescribing Productions v2.0
BEH IHS-EHR v1.1 patch 13

kids + EHR server
Update + CAC setup
In EHR
2 min
Installation notes
o Self-Extracting Archive
o Kids install
o At “Enter the Coordinator for Mail Group ‘BEHOCCD HIMS TOC’:” prompt, enter site CAC
o At “Restoring local object registry settings…Setting up default site parameters…”, Requested Start Time:
NOW//, select Enter
10


You will receive message, “A task has been queued in the background. The task number is
xxxxxx.”
 To check on the status of the task, in programmer mode type D STATUS^BEHOVMIN
o You will see a message for “The update for BUSA AUDIT RPC DEFINITIONS FILE is tasked #xxxxxx”
o Sites may wish to print out the install log for review of errors (several pages)
Post-installation notes
o Review Patch 13 Meaningful Use Setup Guide v1.0. – this document provides the information required
to setup and use the components in the P13 Meaningful Use (MU) release, most of this setup may be
done by the CAC (will vary by site)
 Adding New Components to EHR
 Configuring the Components
 Configuring the CCDA Component – may need to help with setup of CCDA parameters
 Setting up the CCDA BEHOCCD Direct Email Server Address XPAR Parameters
 Setting up the CCDA BEHOCCD Port XPAR Parameters
 Setting up the CCDA Generator BEHOCCD URL XPAR Parameter
 Setting the CCDA Mail Group
 Setting the Server IP Address and Port for CCDA VistA Broker
 Creating a New User for Storage of a CCDA to VistA Imaging
 Configuring the CIR Component
 Configuring the Consults Component
 Configuring the Education Component
 Configuring the Immunizations Component
 Configuring the Integrated Problem List (IPL) Component
 Configuring RxNorm for Drugs
 Secondary Menu – must be assigned for users to launch the SNOMED search tool for use in the
Integrated Problem List (IPL), Patient Education, and the Consult Order Clinical Indication
components
 ***RPC option
 BSTSRPC
 BMXRPC - the Apelon tool utilizes the BMXNet
 Education Information Button
 Clinical Decision Support Button
 IHS Image Viewer
o Refer to the ehr_0110.13o.doc RPMS-Electronic Health Record Patch 13 Release Notes for fixes and
modification details.
RPMS Name:
Install type:
TIU Text Integration Utilities v1.0 patch 1012
(Must have TIU*1.0*1011, BJPC*2.0*10)
kids only
RA Radiology v5.0 patch 1005
(Must have RA*5.0*1004)
kids only
no, load
when minimal
activity in rad
2 min
LR Lab Service v5.2 patch 1033
kids + pre
and post
install steps
lab users only
15 min

NEW? Users off? New DB? Est install time?
2 min
Pre-install notes
o Ensure a database backup is performed before installing this patch. NOTE: THE ONLY
BACKOUT/RESTORE STRATEGY IS TO RESTORE THE ENTIRE DATABASE FROMBACKUP.
11
o
o



All LAB users must be logged off before installing this patch
The Lab to PCC Link must be stopped prior to installing this patch, be sure to do this for all BLR MASTER
CONTROL sites. Refer to patch notes for details on how to do this from the BLRMENU option
o Provide a copy of lr__0520.33o.doc LR*5.2*1033 User Guide to the site Lab Manager to read and review
BEFORE installing this patch update. There are MAJOR changes that the patch installs into the RPMS Lab
Module. The Lab Manager must become familiar with them.
o If <EDIT> errors occur during the install, the patch will NOT have been installed correctly. The patch will
need to be reinstalled.
o Log the patch install to ensure a printed audit trail will exist if any problems should arise
o Make sure there is at least 30 MB of free space on the Cache disk
o IMPORTANT: 3 LAB MAIL GROUPS MUST EXIST AND HAVE AT LEAST ONE MEMBER WHOSE LAST
SIGN-ON DATE/TIME FIELD IN THE NEW PERSON (#200) FILE HAS A DATE WITHIN THE PAST YEAR. The
installation of LR*5.2*1033 WILL NOT complete until ALL 3 Mail Groups exist. It will also fail if ANY of
the 3 mail groups DOES NOT have at least one member whose LAST SIGN-ON DATE/TIME in the NEW
PERSON (#200) file has a date within the past year. The Mail Groups are:
 LMI
 Lab Messaging
 BLRLINK
o It is highly recommended that the Lab Supervisor be a member of all 3 mail groups
Installation notes
o Install will take approx. 10 min to install
o Will have to respond to question, “Has a SUCCESSFUL backup been performed??” during install with a
“SUCCESSFUL system backup CONFIRMED by:” prompt immediately following
o Review lr__0520.33ob for a detailed listing of an example of LR*5.2*1033 patch install
Post-install notes
o Restart the Lab to PCC Link from the BLRMENU option for appropriate BLR MASTER CONTROL sites
previously stopped
o Any environment errors will be sent to members of the LMI Mail Group, review for errors. After the
issue is corrected, the install process will have to start again from the beginning
o Add the BLR REFLAB REFILE LEDI MESSAGE option to the main Ref Lab menu (BLRREFLABMENU), if the
site has a LEDI/Ensemble Reference Laboratory interface. See patch notes for how to.
o It is strongly recommended that the BLR LRAS MICRO REPORT option with the LRAS synonym be added
to the Microbiology Menu (the LRMI option) after patch 1033 install. See patch notes for how to.
o It is strongly recommended that the BLR MU2 MICRO REPORT option with the IHSM synonym be added
to the Microbiology Menu (the LRMI option) after patch 1033 install. See patch notes for how to.
o The FILE 60 ‘SEX’ REF RANGE CHECK routine (BLRLTRRR) will run during the post-install phase. Review
report that is sent to LMI Mail Group when this completes. This report is explained in the LR*5.2*1033
User Guide.
Documentation
o lr__0520.33o.pdf - details concerning various aspects of the patch are included in this user guide
o lr__0520.33ot.pdf - technical details concerning the patch are included in this guide
o blr_0520.33o.pdf – details concerning GUI Monitoring are included in the GUI Monitor Guide
o lr__0520.33va.zip – copies of the VA documentation for the included VA patches
RPMS Name:
Install type:
BMC Referred Care Info System v4.0 patch 8
kids + post
Install


NEW? Users off? New DB? Est install time?
Installation notes
o Is the Facility using PCC? YES
o Is the Facility using EHR? YES
Post install for Site Mgrs. /IT support staff (to capture TOC information):
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5-10 min
o
o
o
o
RPMS Name:
Refer to bmc_0400.08i.pdf – RCIS/EHR Component Installation Guide and Release Notes to install the
following EHR files:
 Add 2 dll files to the lib folder on the EHR network share
 IHSReferredCare.PatientReferral.dll – EHR component
 IHSReferredCare.Referral.dll – EHR component
 Import 2 .vor files to VueCentric Object Registry
 IHSReferredCare.PatientReferral.vor – EHR registry
 IHSReferredCare.Referral.vor – EHR registry
 NOTE: For Citrix and Terminal Server setups, ensure that the shared files on the server are
updated. Desktop setups will need the local files updated on each workstation.
 Perform installation verification by logging on to EHR as a provider to test
Menu option: BMC MOD TOC Add/Edit Transition of Care Information – this option will be located in
RPMS under Referral EDIT menu option
 Security key: BMCZTOC
 Allocate security key to appropriate staff
Menu option: BMC RPT-APPRV REF TOC PENDING Approved Referrals Pending TOC Document – this
report prints out a list of all approved referrals for which the status of the transition of care document is
pending. Report will include Primary and Secondary referrals. It is located in RPMS under ADM –
Administrative Reports
 Security key: BMCZTOCR
 Allocate security key to appropriate staff
Provide patch notes to RCIS staff to notify of multiple important changes for MU Stage 2 requirements
Install type:
BJMD C32 v1.0 patch 4
kids + pre
*** INSTALL ONLY IF PATCH 3 INSTALLED ****
and post,
(Must have BJMD*1.0*3, BEH COMPONENTS v1.1
if prompted
Patch 001010 – this is part of the EHR patch 13 install) to do so

NEW? Users off? New DB? Est install time?
10 min
Installation notes
o Unschedule the nightly C32 job (required only if your site has C32 nightly job scheduled)
 Must sign on to RPMS as a user with %All role to do this
 Will do this from C Messaging Menu -> Edit C Messaging Parameters menu option
 Delete value from “TIME TO RUN NIGHTLY TASK:”, “SURE YOU WANT TO DELETE?” YES
 Check to see that C Messaging processing task is not running, if it is, stop it
o Install kids file
 If unable to perform certain steps during install, you will be prompted to perform additional preinstallation and/or post-installation steps
 Pre-installation steps, follow these instructions ONLY if the pre-installation routine of the KIDS
build instructs you to do so:
 Stop the BJMD.Prod.Production ensemble production in Ensemble System Management
portal, make sure to select C32 namespace
 Post-installation steps, follow these instructions ONLY if the post-installation routine of the KIDS
build instructs you to do so:
 From RPMS programmer mode, switch to C32 namespace to recompile the Ensemble
production by typing: do
$System.OBJ.Compile(“BJMD.Prod.Production”,”ck/journal=0/lock=0”)
 Disable “Auto Start Production” setting for C32 namespace from Ensemble -> Manage ->
Auto-Start Productions menu. Because this patch disables the C32 application, it is not
necessary to restart C32 after installing the patch
13
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
BCCD Consolidated Clinical Document Architecture (CCDA) v1.0
(Must have Ensemble 2012.2 or greater, BMW classes, and
Additional patch requirements listed in patch checklist)
Kids + Ensbl
YES
YES
YES
19 min
config
 Make sure to READ Section 3.0 of the BCCD Installation Guide and Release Notes v1.0. This lists installation
issues to be aware of related to architectural issues
 Installation of BCCD package consists of the following activities
o Calculate additional disk space required for the BCCD package and allocate disk space, see section 3.2 of
the installation guide for instructions on estimating how much disk space will be needed to
accommodate the new CCDA database(s). The installation process will make sure that the directory has
at least 500 MB of free space
o Perform pre-installation steps, including enabling Long Strings, verifying access to OS configuration file,
designating a directory where the new CCDA database will reside (one for each RPMS Database),
mapping BMW globals, and stopping the CCDA (if this is a reinstall of CCDA 1.0)
o Install KIDS build bccd0100.k, which will install the CCDA software and the new CCDA Ensemble
production
o Perform the post-install steps, including setting up optional encryption, optional email notifications,
disabling journaling in the CCDA database, configuring the CCDA CSP Application, setting up site-specific
BCCD parameters and starting the CCDA messaging. May have to wait for onboarding at site to
complete.
 Need to review all test and demo patients in RPMS database and make sure social security numbers start with 5
zeroes. This will ensure that CCDA documents are not generated for test/demo patients
 Ensure that the site manager accounts used to restart TaskMan manually have the Ensemble role %All. If this is
not done, CCDA will not run whenever TaskMan is restarted manually
 If you have to Enable Long Strings in Ensemble, then the new settings will not take effect until after you restart
Ensemble. In that case, you will not be able to install CCDA until you restart Ensemble.
 Recommended naming for directory and namespace is: CCDA<namespace>, creates namespace for you
 Installation process creates the CCDA database in the specified directory, be sure to add the CCDA database to
the list of backed up databases
o At the “Specify the name of the BMW Database” prompt, enter the local database name for the BMW
database used by that RPMS instance. If BMW was installed per the BMW installation guide, this will be
BMW
o At the “Specify Full Directory path for the database for new namespace CCDAPRD” prompt (where PRD
stands for the name of your RPMS namespace), enter the name of the directory that you created in
Section 4.4 of the installation guide. Once you enter the directory name, the system will create a new
database file in it and configure all necessary settings and mappings.
 You will need to perform directory setup and kids install for every RPMS namespace that you have if you have
multiple RPMS namespaces
 The installation process automatically performs certain steps before and after the KIDS installation. If your site
configuration prevents the installation process from performing these steps automatically, the installation
process will display a message instructing you to perform the steps manually. Detailed instructions may be
found in Appendix B: Manual Pre-Installation Steps and Appendix C: Manual Post-Installation Steps
14



The output from installation generates several pages of messages (about 75-80) and may take a few minutes to
complete
There are post-installation steps that must be followed. Proceed to Section 6.0 of the installation guide for
further information and setup instructions.
New RPMS Menu and Security Key:
o BCCD Menu – CCDA Menu, locked by security key XUMGR, which you should have as a site manager
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
APCL IHS PCC Reports (ILI Surveillance/Syndromic Surveillance Patch) v3.0 patch 29
(Must have APCL*3.0*28)
kids only
2 min
 On the install you will be asked to indicate whether the system you are installing on is a PRODUCTION system or
a TEST/TRAINING system, please answer appropriately
BQI iCare Management System v2.3 patch 3
kids + client
10 – 15 min
GUI update
(Please refer to patch checklist to see list of patch requirements)
 Installation notes
o The iCare client PC installation program will check for Microsoft .NET 4.0 Framework on the client PC,
and if it has not been previously installed, it will assist with the download and installation as part of the
iCare setup
o Different facilities that use the same RPMS database are considered to be “multi-divisional” sites. Once
installed the KIDS on the RPMS Server, all facilities will be affected
o Coordinate with all iCare users when the KIDS is going to be installed with the GUI so the GUI is ready to
go when the KIDS is installed
o Ensure that the BMX system is installed and that a BMX monitor process is running. BMX’s Integrated
Security feature allows connection to RPMS without having to re-specify access and verify codes every
time. For this feature to work, the integrated security field of the BMX monitor port must be set to Yes.
See the BMX user and installation manuals for details on BMX.
o After installing KIDS, the post-installation job needs to run to initialize the Meaningful Use (MU) data,
see Section 6.0 Post Installation Configuration instructions of the installation guide for details
o See the iCare Population Management GUI Installation Guide and Release Notes for client workstation
specification and client installation details. A Sample GUI Client installation is included.
APCM IHS MU Performance Reports (2014) v1.0 patch 4
(Must have apcm*1.0*3, bjpc*2.0*10)
kids only
2 min
BHS Health Summary Components (VA) v1.0 patch 8
(Must have BHS*1.0*7, BJPC*2.0*10, TIU*1.0*1012)
2 min

kids + post
Install
Post-installation notes
o If you wish to use any new components included in this patch with EHR, you can either add them to a VA
health summary type, or add them to the ad hoc health summary type. See patch notes for details on
how to do this or provide to your CAC
15
RPMS Name:
Install type:
NEW? Users off? New DB? Est install time?
PXRM Clinical Reminders v2.0 patch 1002
kids only
2 min
 Pre-install notes
o Remove all national reminders from reminder exchange file. This should have been done before
reminders 2.0 was installed but this file should now be empty
o DO NOT OVERWRITE THE ROUTINES OR COMPUTED FINDINGS *** ALWAYS SELECT SKIP WHEN
INSTALLING COMPUTED FINDINGS *****
 Post-install notes
o Provide notes file for this patch to your CAC for review.
o 4 components inactivated, please go into the GUI dialog to edit cover sheet reminder list and remove
from the display list:
 IHS-ANTICOAG CBC 2013
 IHS-ANTICOAG UA 2013
 IHS-ANTICOAG OCCULT BLOOD 2013
 IHS-PRD
o From the reminder exchange, install the 2013 reminders your site wishes to use
o Remove and inactivate any 2013 or 2013 reminders that were replaced by 2013 reminders. This is very
important since iCare evaluates all active reminders
o See patch 1002 notes for list of reminders
o There is one taxonomy that contains a CPT code of which there are 2 in the CPT file, you will need to
work with CAC to re-check and make sure correct code (j1050) is applied for IHS-DEPO PROVERA
ADMIN-2013. See patch notes for example of how to do this.
AMER Emergency Room System-Inpatient Only v3.0 patch 5
(Must have AMER*3.0*4, BUSA v1.0 in order for
kids only
ERS users
Activity logging to occur for the AMER app)
 Installation notes
o Do routine saves of AMER* (can be removed 14 – 21 days after install if no problems)
o Do global saves of AMER* (can be removed 14-21 days after install if no problems)
2 min
BCER EHR Environment Checker v2.0
kids only
2 min
(Need Ensemble 2012.2.5 or later)
 This package examines RPMS EHR software packages to verify that the version and patch level is at the minimum
level required to meet the 2014 “Certified EHR” requirement of Meaningful Use (MU) 2014.
 If any requirements are missing, the load will fail. Install the missing requirements and run again until the
installations succeeds. You may have to use the option “Unload a Distribution” before running BCER again.
 After the environment checker installs successfully, contact your MU Consultant or coordinator
16