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Resident Information Technology Services Manual

1. cccccccccccssssseeeecccceeccaaeseeeccccceeesaaaeseeeeeeees 21 Persistence of Confidentiality Obligations cc eessesssesseeeeeeceeeeeeeeeeeeeeaaeseeeeeseeees 21 Poel Be LAL C1 art etrae ce teeth ced E hea aoeant teen S 21 CES ACCESS PONCY odin ioc cased eeose oiiaee decease a Eae ssscecasdasdeaedeeessacdees uses ssacceastuesentdesel eons 22 ACCESS ACMI SOA OI rete tat et neti a ea a ida estdsle a T 23 Resident Information Technology Services Manual Rev 06 11 JHS ACCE SGU 1A G06 BAGH 0 PRN eRe eRe TER Re a a Mm NSTOIn Se Hun TINT MUSTER RW a Ten Omar tEn Senta an tmnt te 23 ACCESS Fe SCA IIS AMEI eren e E S E 23 Access ModiiCaNo Meisie e eto vlaavelsentaiaeaeeten 24 Oer SCOUT Feature teeatae tebe ctolva oudidotchencavetelatssectimoitu tebe 24 Monitoring of User Activity within the Clinical Information System cccsessssseeeeeeeeees 25 TACT al AUd Sres ection ud eae rtaei wt eel aer iin elles 25 Other IOSD alS V SUCIIS 6 cies cutct on Sateen teenie ates a E E 26 ips eh a 802 pre 0 ALE 1 eee erp een roe yen nE ArT Rey Cn DEES ED Rey eoann ne nE Iv nTY Fenn DEE en oor eon er anny foment re 26 Photography and Digital Imaging occssssseccccccsssssecccocosssssececocosssseseeceossssssececcssssssssseecsssssssssee 27 Taking Disita MaL eS a a a a a E 27 Naming Convention for Digital Image Files 0 0 0 0 cccccccccccecceceeceseeeesesseeeeeeeeeeeeeees 28 Namme Convention for Tmia ee Piles aie accented ari
2. CERNER This product is licensed to Yale Pathology Department Agatha P Daley is currently logged User ID on to the TEST Yale Pathology PTEST System Password Exit 2 4 2 70 ic 1994 2003 Cemer DHT Inc This computer program is protected by copyright lay Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maxinoum extent under law This system contains protected healthcare information By logging into the system I understand that my activities may be monitored and audited I also understand that I am responsible for any activities performed under my user id The CoPath Sign On window appears This sign on window differs from the sign on window when you first enter the system in that the default button label reads Return instead of Sign On Enter your User ID and password and click the Return button When in the break mode only the original user can log back in Pressing the Exit button logs the user off but any unsaved changes are lost As a precaution you should always save changes before you leave your workstation unattended If you do not save changes before you take a break you will lose your changes if a co worker signs you off the system while you are gone Automatic Time Out The CoPath system times out after a pre determined period of idle time has elap
3. Displaying Histology Asset Tracking Information The Stain Process and Block Edit activity can also be used to obtain detailed tracking information about the blocks and slides This is accessed from the Asset Tracking tab lt 510 13896 Stain Process and Block Edit Patient O OO O MR M HH Spec Class SR 008 D Age 24 F Client YNHH isit fec Date 5 28 2010 Status Signed Out Histology Asset Tracking Histology Block and Slide Tracking Information Part 1 KIDHEY BIOPSY FORMALIN Block 1 KID No Description Status Filed on 05 290 07 29 t Block Events Slide 1 H amp E Initial INIT Status Verified on 05 2610 18 46 Slide 2 Periodic Acid Schiff SPEC Status Verified on 06 01 10 09 11 Slide 3 H amp E Initial INIT Status Verified on 05 2610 18 46 Slide 4 Trichrome Klatskin SPEC Status Verified on 06 02 10 08 24 Slide 5 H amp E Initial INIT Status Verified on 05 2610 18 46 Slide 6 Jones SPEC Status Verified on 06 0210 08 24 Slide 7 Unstained Initial INIT Status Cut on 05 2610 16 52 Slide 8 Periodic Acid Schiff SPEC Status Verified on 06 0140 09 11 Slide 9 Hematoxylin Phloxine B Safran SPEC Status Verified on 06 020 08 24 Slide 10 Unstained Initial INIT Status Cut on 05 2610 16 52 Slide 11 Unstained Initial INIT Status Cut on 05 2610 16 52 Slide 12 Unstained Initial INIT Status Cut on 05 2610 16 52 Slide 13 Unstained Initial INIT Status Cut on 05 2610 16 53 S
4. Select Specimen window Highlighting the cases in this window will display the patient s name associated with that specimen directly above the specimen list Once you find the case you are looking for select an activity and click on the OK button The window associated with the specimen activity you have chosen will appear If you wish to view another case click on the yellow folder in the menu at the top of the screen Your search criteria will re display and the cases that have already been reviewed will be highlighted Switching Between Specimen Activities After you have selected an existing specimen to work on you can switch specimen activities for this specimen without having to return to the Select Specimen window The specimen activities that you can switch to are dependent upon your security access the specimen class that has been assigned to the specimen and what activities are relevant for that specimen To switch between specimen activities you can click on the menu tool bar button with the file folders and arrow symbols or select Options Activities from the menu A menu with the activities relevant for the specimen will appear Highlight the activity you wish to go to and click the OK button Resident Information Technology Services Manual Rev 06 11 JHS WJ VV ILVLI L AVLI VILVO IVUIL Working on Specimens in CoPath CoPath Client Server PTEST i Fie Edit Options Window Help Oecd
5. 507 5097 OSR 03 28 07 ACC endometrial biopsy Detail oe Print Report Activity field Pint Report Clear Everything Cancel sooty mna Hep Selecting a Specimen by Patient Name In the Select Specimen window tab or click into the Patient Name or MRN Field It is neither necessary nor recommended to enter the patient s entire name into this field The system will search the database with a partial last name and first name separated with a comma e g BLO CHE The system will open the Select a Patient window and display all matches Identify the correct patient by verifying age date of birth and medical record number s The Details button also displays the patient s address and social security number if available Highlight the appropriate patient and click the OK button to return to the Specimen Selection window where there will be a list of all specimens accessioned to that patient Highlight the desired specimen select the desired Activity from the dropdown list as described and click the OK button or hit lt Enter gt Select Specimen x Search z earc Specimen or Patient Name or MRN BLOSSOM CHERRY 9988777 a Sach of Search Criteria or Encounter Number Baa Hansal Next Specimen Select Specimens for BLOSSOM CHERRY New Specimen Specimen Acc Date Status Tissue Source VYorklists CcO7 10122 O42707 Acc STANDARD PAP SMEAR
6. need to have the correct part type specified Part description Free text entry of how the surgeon or other submitting physician labeled the specimen Protocols There are three types of protocols cytology accessioning protocols histology block stain protocols and stain group protocols For this discussion we will be mostly concerned with Histology Data Entry Edit Page 59 histology block stain protocols For appropriate specimen parts usually biopsies or other small specimens specifying a protocol will make available to you at the time you enter blocks a group or multiple groups of stains which are typically ordered for specimens of that type For example the Kidney Biopsy protocol automatically orders 3 H amp E slides a PAS x 2 a Trichrome a Jones a HPS and Unstained x 6 all in the proper order Protocols also include proper block designations which should be used to identify blocks See below for more details Block designation Uniquely identifies the block It consists of block number followed by a single space followed by the sectioning site designation See below for formatting conventions The block designation prints on the slide labels Block description Translates the designation into an understandable explanation of what the tissue is or where in the specimen the tissue came from Block descriptions print in the report along side their respective block designations thereby creating not only a code table for tra
7. Brian Paquin Resident Information Technology Services Manual 203 785 3837 203 785 2828 203 737 5204 203 785 3691 Cell 860 853 8803 Cell 203 530 9018 Beeper 203 370 1780 203 370 4041 Beeper 203 370 4905 203 370 1374 203 370 4041 Rev 06 11 JHS Desktop Computer Use and Support One of the reasons for the existence of the Pathology Information Technology Services Unit is to provide members of the Department of Pathology with more timely service and in many cases a higher level of service than would otherwise be available through the University s ITS department Departments at the medical school other than pathology purchase ITS services from the University To a large extent the Pathology department subsidizes departmental access to ITS services by subsidizing Pathology ITS which maintains the department s network and provides many of these services Thus members of the pathology department are NOT charged for many ITS service activities However pathology department resources are not unlimited and the equipment must be used responsibly by all users Philosophy ITS Support Services Support is provided by the Pathology ITS Unit for all departmentally purchased computers The chart below defines support by user title and support category This table refers to both desktop and laptop computer ITS only purchases computers for pathology faculty and staff Computer Support C
8. Standard Pap Smear Standard Pap Smear Bpt SurePath Pap Smear SurePath Pap Smear Bpt Thin Prep Pap Vag Wall Scrap Vaginal and Introitus Part Types for Cytology Specimen Class CF OCF BPCF Breast Fine Needle Aspirate Breast FNA Cytotech Assist Breast FNA Fellow Perform Breast FNA Pathologist Perform Breast FNA Wash Common Bile Duct FNA Common Bile Duct FNA Cytotech Cyst Ovarian Cytology Eye Conjunctiva Vitreous Fluid Fine Needle Aspirate NOS FNA Lymph Node Cytotech FNA Lymph Node Fellow FNA Lymph Node Pathol FNA Lymph Node FNA FNA NOS Cytotech Assisted FNA NOS Fellow Performed FNA NOS Pathologist Performed Head Neck Salivary FNA Head Neck Salivary FNA Cytotech Head Neck Salivary FNA Fellow Head Neck Salivary FNA Pathol Introitus Kidney FNA Cytotech Kidney FNA Fellow Kidney FNA Pathologist Kidney FNA Wash Liver FNA Resident Information Technology Services Manual Liver FNA Cytotech Liver FNA Fellow Liver FNA Pathol Lung FNA Pathologist Performed Lung Fine Needle Aspirate Lung FNA Cytotech Assisted Lung FNA Fine Needle Asp Wash Miscellaneous Pancreas FNA Pancreas FNA Cytotech Pancreas FNA Fellow Pancreas FNA Pathol Parotid Fine Needle Aspiration Parotid Fine Needle Asp Wash Peritoneal Fluid Peritoneal Wash Pelvic Wash Pleura Soft Tissue amp Bone FNA Cytotech Soft Tissue am
9. edit or add a new stain process to a different part either use the Previous Part and Next Part buttons or click on the Select Part button A pop up window will display the associated parts for the specimen Select the part type you wish to edit and click the OK button oxi File Edit Options Window Help R D EH SOBX Ph DW a 507 5104 Histology Data Entry Edit Patient BLOSSOM CHERRY 04531939 MR 9988777 YNHH Spec Class SR DOB 061941943 Age 63 F Client NHH sisit 56042591 fec Date 06 07 07 Status Final Complete Specimen Tissue Blocks StainProcess Text Stain Process Info f Description k Received 4 1 Colon Resection Not COLON EXCISION 06 07 07 09 54 O6 07 07 09 54 gt 1 HE Initial 2 2 Small Intestine Not tut SMALL INTESTINE 0607 07 09 54 0640707 11 43 2 H amp E Initial 3 H amp E Initial 4 H amp E Initial 5 H amp E Initial 6 H amp E Initial P Stain Process StainProcess Detail You can now add or edit an existing stain process If you wish to add a stain process to another part click on the Select Part Previous Part or Next Part button When you are finished be sure to save your work by clicking the Save Next Specimen button in the lower right side of the window Resident Information Technology Services Manual Rev 06 11 JHS Stain Process and Block Edit Activity Stain information and requests can be obtained and made
10. if while performing a drop and drag maneuver you attempt to drop on a spot of the screen that will not accept it The mouse pointer turns to an hourglass while the system is working on the task which it was told to perform e g Save Taking Breaks and Time Out CoPath has two security features which users will use or encounter at some point Take a Break allows the user to leave their current work session without exiting the system Time Out automatically closes the current window and displays the CoPath Sign On window after a predetermined period of idle time has elapsed Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 39 Take a Break The Take a Break feature lets you leave your current work session without exiting the system When you are ready to resume working you re enter your password and CoPath returns to the point at which you left off This feature is used if you have to step away from the workstation for a brief period Locking the session prevents other users from doing things in CoPath using your user account To take a break from your current work session ePress the coffee cup icon on the toolbar or select File Take a Break on the menu bar CoPath displays a message asking if you want to take a break Press OK NOTE If you have made changes and have not saved your work CoPath prompts you to save changes before you leave your current work session
11. letters from the last name and first name separated by a comma Three letters of each name are the Resident Information Technology Services Manual Rev 06 11 JHS Case Intake Close File Icon Page 52 recommended choice e g POP CHE Click on the Search button A list of possible patients will appear for you to choose from If the patient does not currently exist in the CoPath system they will need to be registered Click on the New Patient button The Registration Entry Edit screen will appear Select Patient l x oe E Patient POP CHE Name Last First Middle search C Medical Record Number ears Exact Match C Social Security Number _ New Patient Encounter Number C Universal Number HIS Other Number _ Select Filter Clear Filter Current Medical Records Gender Birth Date Age Number Client Edit Patient SWIMMER CHERYL 064084959 47 1530006 aka POPE CHERYL Detail POPE CHERYL 11474962 POPELKA CHERYL 06 06957 1413520 POPOYICH CHERYL 06 221 966 1298116 Cancel Help In all cases enter as much information as is available However the system requires only that patient name and gender be entered 2 CoPath Client Server PTEST l o x File Edit Window Help 2 O me Id eh h l amp Me CHERRY POPSICLE Registration Entry cdit Patient Encounters Last Name First Name Middle Name Suffix POPSICLE HERRY E Aliases Medical Reco
12. 1n the Accession Client YNHH isit 56042391 fec Date 06 0707 Status Hew Accession Entry Edit screen and must lismo T Part Type s Label Description aken eceive complete the first two tab forms of or Recessored focon excision err oss4 psorar 7 a this screen to finish the case intake process Each field on the first screen is a required field and the system will not allow the case to A Frozen Section Pathologist Grossing Resident s Pathologist s be saved if any information is a ppor ane wa E d EE missing from this screen Order Procedures Spec Req Deficiencies Frozen Label Requisition Labels SaveNew Specimen Client VNHH Path Serv Gastrointestinal v Priority Ja THER EXC v Using the Tab key to advance through the fields enter the specimen information and change the default client if necessary Click on the Accession Data tab to get to the next screen Enter the submitting physician and hit the Tab key This will open a window which will allow you to choose the correct physician Repeat the same process in the Additional Physician s field to enter additional physicians as indicated on the specimen requisition form who should receive a copy of the report The system will automatically populate the Specimen Data field if the specimen is associated with an encounter If the specimen is from an outreach client then there will be no encounter number exception Shore
13. 2x2x4 mm J MICROSCOPIC DESCRIPTION There is digitated epidermal hyperplasia hypergranulosis vacuolated granular layer cells and compact hyperorthokeratosis Final Diagnosis performed by Shaum Cover M D Case Flags Results Correlate SNOMED Results Log Signout du tamapp PowerPath The case information 1s now visible On a MAC Shift CMD 4 and draw a box around the complete case information screen A document will be created on your desktop titled Picture 1 and you can repeat for any additional cases and each time you Shift CMD 4 a new document will be created in sequential order Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 100 Picture 5 Double click on the created document and it will open You can not print the document as normal Note If a case is large two pages you might need to take two pictures You can use the arrow down the side of the Case information to get the additional information Resident Information Technology Services Manual Rev 06 11 JHS
14. 507 5097 03 2807 ACC COLON EXCISION Detail COF 10121 OCG 024907 5 0 CYTYC THIN PREP PAP SMEAR Print Report Clear Everything Cancel Activity Gross Description Entry Edit Help Selecting a Specimen by Patient Medical Record Number In the Select Specimen window tab or click into the Patient Name or MRN Field Enter the patient s medical record number leading zero s may be omitted If there are multiple matches the Select Patient window will appear as described above If there is only one match the patient s name and list of specimens will appear in the Select Specimen window Proceed as described above Selecting a Specimen Using Other Criteria There may be times when you are trying to retrieve a case but cannot remember either the patient s name or case number On the Select Specimen window directly below the specimen field is a button called Search Criteria Clicking once on this button will access the Select Specimen Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath 4 Page 47 Criteria window It is through this window that other search criteria may be used to facilitate your search The accession date range will default in at 30 days These fields may be changed but may not extend beyond 90 days Any additional information known about the case should be entered into the appropriate fields Please note that the primary resid
15. As defined above under Definitions the description should clearly identify the tissue source in a way understandable to anyone Descriptions should be in upper and lower case and should not exceed the space provided in the data entry window Blocks with the same sectioning site designation should have the same description to avoid confusion don t use a designation of L for Lesion and elsewhere in the same part use a designation of L for Left margin Block category Roughly equivalent to the color of the cassette into which you are placing the tissue the block category determines how the tissue will be routed through the histology laboratory In general all of the tissue blocks from a given specimen will have the same block category but this is not necessarily required for example for a large case one might put most of the tissue in blue cassettes but one representative section in a pink cassette so that a provisional diagnosis can be made earlier in the day If standard blocks have previously been entered for the part the block category will default to the category most recently used Otherwise if this is the first block it will default to a value as previously specified by the selected part type For critical technologies blocks the block category appropriate for the CT class code used will automatically be selected Request class The request class is an assessment of why you are having the tissue block m
16. Click the Connect button Enter YNHH VPN username and password provided by Pathology ITS Agree to warning about access to YNHH network Do NOT close the VPN connection window it can be minimized Open CoPath Citrix Client will start up Login to CoPath 10 When done log out of CoPath 11 Return to the VPN Client window and click the Disconnect button SO HNIDARWNS SOON DMA Resident Information Technology Services Manual Rev 06 11 JHS Page 81 Obtaining Access to Clinical Applications YNHH Clinical Applications Access to all YNHH Clinical Applications requires a Network ID Incoming residents are automatically provided with a Network ID and access to the following systems by the hospital during new employee orientation Synapse SCM Sunrise Clinical Management Chartview Navicare and Centricity If a user does not log into an application within a certain time period their access is inactivated To reactivate your account contact the YNHH Help Desk at 688 4357 You will be asked to fax a copy of your ID to the Help Desk before your password will be reset New faculty and attendings must request a Network ID and access to these clinical systems through Path ITS either by sending an e mail to PathITS yale edu or calling the Help Desk at 785 3691 Additional Clinical Applications CoPath access to the department s clinical information system is provided by the clinical system administrator after rec
17. Digital Imaging Page 33 Viewing the Images for a Case When a case with images has been selected a summary of the number of images of each image type will be displayed Image types are also indicated by icons for convenience Click on the link for the image type desired or on All Images to display thumbnails of all of the images for a case Once thumbnails are displayed use the mouse to pass the cursor over each image The full name for that image will be displayed in the status bar Clicking on a thumbnail of an image will open another window with the full size image displayed You may need to use the scroll bars to see the entire image Printing Thumbnails of the Images The interface to the image repository allows printing out thumbnails for the selected images for a case This is done using the standard Print function of the browser To ensure that the thumbnail frame is printed and not one of the other frames be sure to click in the thumbnail frame although not on an image before selecting Print Use the Print Preview to be sure Printing takes a while so be patient Extracting Images from the Image Repository Because the image repository is a type of medical record no images can be modified once they have been filed in the image repository If you want to manipulate an image or include it in a presentation you must make a local copy of it and work with the copy Making a copy of the image onto your local drive is very ea
18. Entry Edit Page 60 by the Informatics Unit in the department of pathology at Yale uses barcoded labels which uniquely identify assets such as paperwork blocks and slides as they move through the laboratory A barcode and barcode reader are simply a rapid and accurate way of entering information into a computer system Barcodes themselves do not trigger any particular action any and all resulting actions are determined solely by the software into which the barcoded information is scanned However the rapid and accurate entry provided by barcodes allows information to be entered into the computer system at many points during its processing and it 1s this scanning entry at multiple points which enables tracking of the assets which in turn enables better control of the workflow in the laboratory To maximize patient safety whenever possible cases should be specified to the computer system by scanning a barcode rather than manually entering a case number The complete solution designed and implemented at Yale allows entire cases to be processed without ever having to type a case number The process starts with accessioning the point at which the case number accession number is initially assigned Labels are printed containing a barcode representation of the case number and affixed to each sheet of paperwork for the case The barcode on the paperwork is then used to generate barcoded cassettes to call up the cases at the grossing stations and
19. Physician Print copies E Mail d 4 M Case and billing information Revenue center Enterprise facility E E G A Party to bill Fee schedule Case priority ee Select the TAB Results to be able to print and view a report Only reports that are Final can be printed S Case Information D99028593 Imported Accession no Case type Patient name Age Medical rec no Case status D99028593 PLab Derm History Smith John ea Final General Req Data Specimens Charges Patient History Results Notes Sex Male Total blocks 0 Total slides 0 EE e amp o fio Case Report Clinical Data ACT CHEILITIS R O LP Specimen A Diagnosis MID LOWER LIP LICHEN PLANUS Gross Description 7x6x1 mm bisected Microscopic Text There is a lichenoid infiltrate of lymphocytes which obscures the of gt 4 Case Flags Results Correlate SNOMED Results Log Finalize Select Results Log to print fax or view a report Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 97 S Results Log for DOO040874 Report Log Report History Step Completed by Date D Final 2 22 2000 Clinical Data A NEVUS ATYPICAL B amp C BCC Specimen A Diagnosis BACK MID When finished select Close then X to exit the case or you can search another case by reselecting the Binocular or F
20. Program Files Tamtron PowerPath Client PowerPathClient exe Sz PowerPath File View Tools Help Jae PowerPatn System Login PowerPath Client Version 8 3 27 3 Server I User name Po Password Po Database Poo I Change password none Z The first time you will need to add the following information to the login The next time you sign in the Server and Database information will be there Server tamapp User name your NetID Password enter your PowerPath password default password for first log in is Password1 Database Select PowerPath from drop down NOT PowerPath Test 009 4 C Program Files Tamtron PowerPath Client PowerPathClient exe S7 PowerPath Fie view Tools Help ae PowerPatu System Login PowerPath Client Version 8 3 27 3 Server ftamapp User name fjab223 Password p Database linonel 2 If this is the first time you are going into the application you will be requested to change your password Once you change your password it will not expire The following screens show how to change your password and the requirements Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath O OO 7 C Program Files Tamtron PowerPath Client PowerPathClient exe PowerPath a x File view Tools Help Please enter a new password by entering it in the two fields below NOTE Your new password must be different from your current password
21. Rush by the attending clinician Stat tan Stat biopsy on urgent material slides out same day Biopsy ovrnt white lavender Small biopsy received after 5 00 p m or a larger biopsy received prior to 5 00 p m which can be processed on a medium length cycle Bridgeport which can be processed on a short cycle Long Cycle white For biopsy priority material which requires a full length processing cycle This is used for brain biopsies lymph node biopsies bone bone marrow biopsies and frozen section controls Routine blue orange All other surgical specimens Fatty specimens e g breast should be placed in orange cassettes to direct to a customized processing cycle Autopsy green Cytology Kelly green Research yellow Tissue specific to research protocols These may be placed in cassettes and processed in Research Histology Frozen Clinical Diagnostic tissue blocks kept frozen for special studies Crit Tech Additional tissue for tissue banking CT Bulk Frozen purposes CT Ethanol CT Formalin CT OCT Resident Information Technology Services Manual Rev 06 11 JHS CoPath from Home via VPN VPN stands for Virtual Private Network It works by using your existing internet connection to connect to another network in a secure manner This connection is often referred to as a tunnel Once a tunnel has been created ALL network related traffic e mail web browsing file sharing will get passed to the remote netwo
22. Use the Tab key to advance through the tab windows and the Shift Tab keys to go back to a previous window You may also use your mouse to maneuver through the tab fields CoPath Client Server PTEST Ee x File Edit Options Window Help HETEREN Z 507 5104 Inquiry Patotoo Patient BLOSSOM CHERRY 04531939 MR 9968777 YNHH Spec Class SR DOB 0619 1943 Age 63 F Client NHH sisit 56042391 foc Date 06 0707 Status Final Complete Summary Everts Source Staff Procedures Biling Codes Demographics Text ier Location 4 7 EP Surgery Submitting Physician Jack J Chuong M D Service Surgery General Primary Pathologist Marie E Robert M D Final Diagnosis Hot Signed Out COLON SIGMOID RESECTION DIVERTICULOSIS WITH MURAL THICKENING CONSISTENT WITH CLINICAL HISTORY OF STRICTURE SURROUNDING COLON WITHOUT SIGNIFICANT ABNORMALITIES ONE SURGICAL RESECTION MARGIN WITH A DIVERTICULUM SIXTEEN BENIGN LYMPH NODES 0 16 Part Description s Image Gallery Other Case Numbers Description of Tabs Summary This window provides information on the major components of the case e g clinician pathologist location service final diagnosis if available part type and worklist status Information on a case amendment will also display in this window Events This tab lists in chronological order the main events of the case and the individual responsible for the event Clicking on
23. a SOExX PH a e Patient BLOSSOM CHERRY 04531939 MR 9988777 Y Client Digestive Dis Assoc sit Text StaftiParts Biling 4DT Images Amendment Entry Attachments Entry Edit Billing Entry Edit Consut Review Container Label Reprint Diagnosis Coding Entry Edit Final Diagnosis Entry Edit Gross Description Entry Edit Histology Data Entry Edit Hot Seat Diagnosis Entry Ecit Inquiry Clinician Inquiry Pathology Intraop Diagnosis Entry Ecit Patient Report Single Print Post Signout Edit Procedure Postsignout Review Procedure Addendum Entry Ecit QA Diagnosis Review Signout Electronic Signout Manual Slides Send Out Staff Entry Edit StainProcess and Block Edit Select a text field and edit the text below lr Clinical History Impression Frozen Intraor Clinical History Impression Insert Pari ee Allows you to switch to another specimen telated activity for the cu 07 5097 Gross Description Entry Edit Specimen Activities Selecting the Activity First Page 48 As an alternative approach you may elect to choose your activity first and then select the desired specimen You can choose an activity from the Application Manager window by clicking on an activity in your Personal Menu or by selecting Browse Items from the File menu and choosing a specimen activity from the list on the right If you choose New Specimen then obviously ther
24. additional devices to the computer without ITS approval iii Do not obstruct the air vents on any device iv Clean LCD panels with a soft cloth and a cleaner made for LCD screens or eyeglasses Do not use Windex or harsh cleaners Do not put tape or post its on the screen b Software precautions are somewhat less obvious but equally important i It is inappropriate for individual users to alter the appearance or functionality of any machine which is used by other users This compromises the utility of the machine for other members of the department and makes desktop support more time consuming and expensive The more people who use a particular desktop machine the more restrictive are the rules for proper use of that machine For the purposes of this discussion desktop computers are classified into one of four categories Multi User Desktop Machines e g sign out room gross room cytotech computers case intake histology The setup of these machines should be changed ONLY by ITS personnel Any unauthorized changes will be reversed and any unauthorized files will be deleted without notice Users should NOT e install any software or download any files from the internet e change the appearance of the desktop including the screen resolution or add or remove any icons on the desktop e store any files or patient identifiable clinical information anywhere on the local machine Semi Private Desktop Machines Limited sco
25. all of the necessary filing of the images In brief the process works like this A digital picture is taken usually as a JPEG image file That file has to be named correctly so that it 1s associated with the case A naming convention is used which indicates not only the case number but also the image type gross photo photomicrograph radiograph etc A Macintosh program ImgUpload can assist in this naming process Then the image file is moved to the Image Drop folder on the department s main file server From there a background process will find the image and place it both into the Clinical Image Repository and into CoPath Users can access the images from either location although accessing from the Image Repository is usually faster and allows for easier downloading ALL CASE RELATED IMAGES WHETHER TAKEN FOR CLINICAL DOCUMENTATION PRESENTATION AT A CONFERRENCE OR PUBLICATION SHOULD BE FILED IN THE CLINICAL IMAGE REPOSITORY This will not only assure that the image is backed up but will make the images available to others If a case is presented at multiple conferences it will only need to be photographed once Taking Digital Images It is often difficult to predict when doing a case what the level of clinical interest will be in that case or what interesting findings may later turn up or what legal proceedings may arise perhaps years later There are few things more intellectually embarrassing than being asked to pre
26. all the histology information currently entered for a specimen choose a part or block and order additional stains or edit the existing histology information e g delete or cancel a block or stain Acting on Specimens To perform any of the activities on a specimen the user must specify both the specimen to be acted upon and the activity desired These can be done in either order you can choose the specimen first and then the activity or you can select the activity first and then the specimen A specimen can be selected either by specimen number by patient name by patient medical record number or by performing a search of recent specimens Selecting a Specimen by Specimen Number From the Application Manager click once on the Specimens button at the top of the screen This will open the Select Specimen window Select Specimen l Specimen or Patient Name or MRM E search oF Search Criteria or Encounter Number aoe Gene Next Specimen Select New Specimen Worklists Detaj x Specimens for Acc Date Status Tissue Source Print Rep Report Clear Everything Activity v Help The cursor will be flashing in the Specimen field Type the case number into this field using the appropriate specimen number wheel e g A for autopsy cases S OS SB or SM for surgical cases etc The 2 digit year is not necessary if the speci
27. and press the space bar This will advance you to the next tab page in the window From the last tab page your will return to the first tab page e To easily switch from open window to open window press Ctrl Tab to move forward or Shitf Ctrl Tab to reverse direction The keys can be kept pressed to speed switch between all your open windows Release the Tab key and the other keys when you arrive at the window you want Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 38 CoPath provides access keys for many of its command buttons and shortcut keys for many of its menu commands Keyboard equivalents to mouse commands are provided in the Appendix of this user guide Using Access Keys Many of the buttons in CoPath have access keys Access keys allow you to use the keyboard instead of the mouse to execute commands while in a CoPath window An access key is a combination of the Alt key and the underlined letter of a button By holding the Alt key the option key on the Macintosh keyboard and then typing the underlined letter the appropriate command will be selected For example by holding down Alt S when on the Select Patient window Search is selected Using Shortcut Keys Shortcut keys are associated with menu commands and usually involve the use of the Ctrl key the Shift or one of the standard Function keys F1 F2 can also be used along with another key or character from the keyboa
28. any specimen Location 4 7 EP Surgery Service Surgery General Submitting Physician Jack J Chuong M D Primary Pathologist Marie E Robert M D Final Diagnosis COLON SIGMOID RESECTION f Hot Signed Out DIVERTICULOSIS WITH MURAL THICKENING CONSISTENT WITH CLINICAL HISTORY OF STRICTURE SURROUNDING COLON WITHOUT SIGNIFICANT ABNORMALITIES ONE SURGICAL RESECTION MARGIN WITH A DIVERTICULUM SIXTEEN BENIGN LYMPH NODES 0 1 6 Part Description s Image Gallery Other Case Numbers Ready activities window in the application will bring you to the Other Specimens window The Other Specimens window can also be accessed through the F4 key or by selecting CoPath Client Server PTEST S File Edit Window Help from the menu bar Options Other Specimens The Other Specimens for Patient OSP window displays in lol x R Me Other Specimens for BLOSSOM CHERRY 507 5104 3 Other Specimens for BLOSSOM CHERRY QA Specimen Class COo 10122 CG 507 5097 OSR co7 10121 OCG Acc Date 04 27 07 03 26 07 024 9 07 Status ACC Abnormal Source STANDARD PAP SMEAR COLON EXCISION CYTYC THIN PREP PAP SMEAR 07 5097 Specimen Status Accessioned Signed Out Final Report Not Signed Out Source COLON EXCISION Page 1 of 1 Final Diagnosis ENDOMETRIAL BIOPSY ACUTE INFLAMMATION ENDOMETRIOSIS SQUAMOUS ATYPIA Print Print AIl
29. is more prone to error than using the Block Wizard so use this method only when necessary CoPath Client Server PTEST 5 x File Edit Options Window Help R Deda SOCBX Pr o w e Z S07 5104 Histology DataEntry edt Patient BLOSSOM CHERRY 04531939 MR 9988777 YNHH Spec Class SR DOB 061941943 Age 63 F Client NHH sisit 56042391 fec Date 06 0707 Status Final Complete Specimen Tissue Blocks StainProcess Text Description Part Type gt 1 1 COLON EXCISION Colon Resection Not Tumor A 4 E ol Block Vizard Block Detail SaveMext Specimen Histology Data for Part 1 1 of 1 COLON EXCISION Blk Dsq Description Block Category Request Class Histology Lab argin 1 black ink Routine blue orange Y f Clinical YNHH Histology v Sd tO argin 2 blue ink Routine blue orange Y f Clinical Y UY NHH Histology v jui toutinelblue orange Y f Clinical utine blueforange Y Clinical YNHH Histology w toutinelblue orange Y f Clinical wF MHH Histology outine blue orange Y f Clinic YNHH Histology ange Y f Clinical wf YNHH Histology 1 Select the correct part type This is important for all of the reasons described above see Definitions 2 Enter the block information using the conventions described below 3 Enter any additional histology information For each non critical technologies block entered a single H amp E slide is ordered To specify additional H amp E slides or to orde
30. on the images As each image is selected it will be transferred to the display of selected images on the right Do NOT select images which are of poor quality 7 For each selected image set the appropriate image type from the drop down list under the selected image The initial value will be the type selected in step 5 Adjust any which need to be changed Enter appropriate Titles for the images such as the organ or site This 1s especially important if the specimen had multiple parts and you want to identify which part the image came from 8 To preview an image at full resolution click on the image thumbnail in either the left or right display and then press the Preview button 9 If you want the source image files to be deleted automatically after moving the images to the image drop folder be sure the check box marked Delete Source Files when Saving is selected Only the selected images will be deleted and only after they have been saved to the destination location Unselected images will NOT be deleted 10 Click on the Save Selected Images button Another window will appear indicating the planned new name for each selected source image Click the Save button to initiate the saving 11 After the image files have been saved and if you requested to have the source image files deleted another dialog box will appear asking you to confirm the delete Either confirm or cancel the delete 12 Close the Save S
31. only one PID however there can be duplicate entries of the same patient with different PIDs Definition of Terms and Required Fields Encounter This term is synonymous to the term visit number and is the number that is associated with a patient s stay in or encounter with the hospital either as an inpatient or an outpatient A specimen can have only one encounter number However an encounter number can be associated with more than one specimen Currently an encounter number is used for only one outreach client s specimens Specimen class It is in the case intake process that the specimen class is defined As stated previously the specimen class determines the workflow process for that specimen the default number wheel for a specimen part of the specimen number what windows or activities are available for the specimen and the type and format of the report that will be generated Part type In the case intake process the part type is always entered as accessioned In most instances this process is done by non medical personnel who are not equipped to make the appropriate decision as to correct part type It is the resident s responsibility to enter the appropriate part type during the histology entry edit process This is discussed in further detail Label description This 1s a free text entry and 1s taken directly from the specimen requisition form Taken Received These fields are system generated and consist of the
32. policies will not be tolerated Inappropriate access use or disclosure of protected health information is a major violation of employee conduct and may result in immediate termination of employment Persistence of Confidentiality Obligations Even after voluntary or involuntary termination of employment or other relationship with the department you remain obligated both by professional ethics and federal regulations to maintain the privacy and confidentiality of protected health information acquired during your relationship with the department Violations may be subject to criminal and or civil proceedings Safeguards A number of physical technical and procedural safeguards have been implemented to protect patient information Patient data is stored on the departmental clinical servers located in a highly secure physical environment in the hospital data center Access into the main facility is through secured ID magnetic stripped as is access into the computer room Desktop machines are provided throughout the department to allow departmental personnel to effectively do their jobs These machines are all in restricted areas of the hospital and university not generally accessible to non employees and are for use by departmental personnel ONLY If you see anyone you don t know using a departmental machine they may be trying to inappropriately access patient information Report this immediately to a supervisor Resident Information Tech
33. quickly move from field to field Press the Tab key to move forward or the Shift Tab to reverse direction The keys can be kept pressed to speed tab through the fields Release the Tab key when you arrive at the field you want e To quickly move from data group to data group on a tab page Press the F7 key to move forward to the first field of a data group or Shift F7 to reverse direction A data group contains a set of logically related and or arranged fields F7 only works for data groups that contain fill in fields It does not work with check box or radio button fields CoPath Client Server PTEST k Oj x File Edit Window Help R DOSA ww Me CHERRY BLOSSOM Registration Entry Edit Patient Encounters Last Name First Name Middle Name BLOSSOM CHERRY A a Aliases Medical Record Client Pathology ID 04531939 gt 1 18988777 YNHH Ba D ee 222 Gender Female xl Title Ms Street MAIN STREET Birth Date 05 19 1943 63 Years Age v State Postal Code City ASHINGTON pe af Race Country e To easily move from tab page to tab page press the F5 key to move forward or Shift F5 to reverse direction The keys may be kept pressed to speed from tab to tab within the window you have opened Release the key s when you arrive at the tab page you want e Click on the Next Tab button turned up page symbol at the bottom right hand corner of each tab page or tab to the button
34. sign on window CoPath Client Server CERNER This product is licensed to Yale Pathology Department Welcome to the Yale Pathology PLIVE System c 1994 2005 Cemer DHT Inc at ENS 5 Das PST 3 s E i FF seven lt CoPathPl us om a a ie ms User ID Password Exit 2 5 1 83 This computer program is protected by copyright lay Unauthorized reproduction or distribution of this program or any portion of it may result in severe civil and criminal penalties and will be prosecuted to the maximum extent under law This system contains protected healthcare information By logging into the system I understand that my activities may be monitored and audited I also understand that I am responsible for any activities performed under my user id After entering a valid user ID and password the main CoPath Window with the Application Manager will appear The Application Manager is the gateway to the CoPath system It contains the command buttons and the user s personal menu Main CoPath Window CoPath Client Server PLI E 15 x File Window Help Rojok iks lt Application Manager Specimens Inquiry Patients Reports i i ig Dictionaries Menu for Test User x Accession Entry Edit Active Case List by Resident E Change Password w Final Diagnosis Entry Edit Gross Description Entry Edit x Histology Data Entry Edit xZ New Sp
35. specimens originating from clients affiliated with the department s outreach program OCN outreach cytology non gynecological This specimen class is used for cytological specimens of a medical nature e g bronchial washings gastric brushings voided urine It is to be used for specimens received from clients affiliated with the department s outreach program OCP outreach cytology procedure only This specimen class is used for a cytological stand alone procedure e g no routine processing of the case is to be performed Examples of a cytological procedure include HPV testing Chlamydia Gonorrhea testing or molecular diagnostics This specimen class should be used for specimens received from clients affiliated with the department s outreach program e BPA Bridgeport Pathology autopsy This specimen class is used for all autopsies where the patient originated at Bridgeport Hospital BPCG Bridgeport Pathology cytology gynecologic Cytology gynecologic specimens more commonly known as Pap smears that originate from Bridgeport Hospital inpatients and outpatients e BPCF Bridgeport Pathology cytology fine needle aspirations This specimen class is used for all fine needle aspirates performed at Bridgeport Hospital BPCN Bridgeport Pathology cytology non gynecological Medical cytology specimens e g bronchial brushings sputum CSF performed at Bridgeport Hospital BPLM Bridgeport Pathology
36. the part and block numbers will change to bold font and the Designation Description and Stain entry fields will be shown If two different color cassettes block category have been printed with the same part and block number there will be a dropdown list in the category column for that block The most recently printed block category will be defaulted in If you are using a different color cassette be sure to select the correct block category Depending upon the part type and protocol selected certain values may default in for the block designation description and stains If multiple default designations are typically used for the part type they will be available in the drop down list of blocks for that part Selecting the desired value will fill in both the Desig nation and Description fields Once you are familiar with the standard designations simply entering a standard designation using the keyboard will default in the corresponding description in the description field If you are using non standard designations not available in the drop down list be sure to enter a description manually Once you have done this Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 64 using the same designation for another block will cause the same description previously used to default in saving entry time Barcoded Block Wizard 510 6 3 parts BLOSSOM CHERRY A Scan Barcoded Cassette J Def
37. used to register a patient accession a specimen enter additional specimen activities such as gross description final diagnosis SNOMED and ICD 9 codes sign out a case and print final reports While in CoPath and before the case is final other activities can be performed on a specimen For example a procedure can be ordered a status inquiry can be performed and the specimen can be referred for quality assurance review Once a patient specimen has been accessioned the system tracks who has dealt with the specimen and when e g who performed and entered the gross description and when who made the final diagnosis and signed out the case and when The system can also produce statistical reports such as the number of cases waiting pathologist review and specimen turnaround time CoPath can also produce retrospective and historical reports how many cytology specimens were accessioned in 1999 how many cases were signed out by a particular pathologist CoPath is based on the architecture of the client server model which enables a wide variety of users within an organization to access share and distribute information across systems and functional boundaries This model allows efficient use of the huge amounts of data that are received and produced within an anatomic pathology environment Here at Yale CoPath is accessed from the Macintosh using a Citrix client to create a virtual Windows application session on the Mac This allows us t
38. user s password expires and access 1s denied Restoring access requires contacting the Clinical Systems Manager Since many of the Attending Pathologists and residents may be off service for periods of greater than one week and be unaware that their password will expire until after it has expired a daily e mail is sent to the attending beginning 5 days prior to the password expiration date informing them of the upcoming expiration date The system also provides a two day grace period before inactivating the user s account Monitoring of User Activity within the Clinical Information System The YPDCIS monitors access to patient information and records details of that access for future retrieval All users of the Yale Pathology Department Clinical Information System understand and agree that their activities within the system are being audited and monitored and that they are responsible for all activities performed under their userid An automatic audit trail is kept at a specimen level of all activities which result in a change to user data or printing of a patient report Additional activity audits may be added without notice at any time Internal Audits In addition to the automatic audit trails maintained by the system the Clinical Systems Manager performs regular audits of user access looking for suspicious activities Any such findings are reported immediately to the Director of Pathology Informatics Internal audits inc
39. using the Stain Process and Block Edit activity While stains can also be ordered using the Histology Data Entry Edit activity using the Stain Process and Block Edit activity is more useful outside of the gross room since it allows for greater flexibility in ordering stains and determining the status of stains already ordered CoPath Client Server PLIYE File Edit Options Window Help R DEAE El ook 10 13896 Stain Process and Block Edit Paene I Re HH Spec Class SR DOB MMM Age 24 F Client YNHH asit 4 cc Date 5 28 2010 Status Signed Out Histology Asset Tracking Click on a part block or stain sprocess to select it Part 1 KIDHEY BIOPSY FORMALIN Taken 5 28 2010 14 41 Received 5 28 2010 14 41 All Pieces Used N Block Pcs Comment Stain Process Date Ordered By Comment 1 KID H amp E x 1 5 28 2010 14 56 GM Add Block PAS x1 5 28 2010 14 56 GM H amp E x 1 5 28 2010 14 56 GM Klat x 1 5 28 2010 14 56 GM H amp E x 1 5 26 2010 14 56 GM Jones x 1 5 28 2010 14 56 GM Unst x 1 5 28 2010 14 56 GM PAS x1 5 26 2010 14 56 GM HPS x 1 5 28 2010 14 56 GM Unst x 1 5 28 2010 14 56 GM v Individual Labels SlidePrinter Individual Labels Label Printer Staff Billing Savelet Specimen Edit Block Ready Mh On entering the Stain Process and Block Edit activity you will get a list of the blocks and stains for the case In this scrollable list select a part or bl
40. with similar attributes workflow Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 42 and reporting requirements Each specimen is assigned to one and only one specimen class Depending on the specimen class that 1s chosen during the accessioning process the system responds in a certain way and triggers a host of reactions within CoPath for that particular specimen Because it defines the workflow process for that specimen specimen classes also determine the default number wheel for a specimen part of the specimen number what windows or activities are available for the specimen and the type and format of the report that will be generated for the specimen Because of these attributes once a specimen has been assigned a specimen class the specimen class cannot be changed and if an error has been made the existing specimen must be deleted from the system and re accessioned using the correct specimen class There are separate specimen classes for Yale New Haven Hospital and University based clinics Bridgeport Hospital Milford Hospital and the Yale Pathology Laboratory Below is a brief description of the CoPath system s specimen classes e AUT autopsy This is the specimen class that is used when accessioning a Yale New Haven Hospital YNHH autopsy eSR surgical routine This specimen class is used for surgical specimens that originate from YNHH or a Yale University based clini
41. 1 JHS Desktop Computer Use and Support Page 12 No Expectation of Privacy The Yale Pathology Department workforce is provided with computers and Internet access to assist them in the performance of their jobs With the exception of faculty machines in private offices users of departmental computers should have no expectation of privacy in anything they create store send or receive using departmental computer equipment The computer equipment and all contents are the property of the Yale Pathology Department Supported Software The Pathology Department provides the following software free to any departmental user at the request of a manager or faculty Software other than the following requires charging instructions Pathology ITS supports many popular software packages including Office and Adobe Suite Computers are grouped by use and user software on these computers varies depending on their function Pathology ITS does not allow users to freely download or install software on any of the department computers At the approval of the Director of the Residency Program residents may request ITS to install additional software Department Software Supplied MS Office Symantec AntiVirus and CoPath via Citrix ICA Client YNHH Clinical applications VPN Web browsers Safari Firefox and Internet Explorer Windows only Express dictate and Express scribe For a fee Endnote Adobe products OS licenses when applicable FileMaker and sp
42. 1 JHS Desktop Computer Use and Support Page 8 Software It is simply not possible for ITS personnel to be well versed in the operation of all versions of all software packages available or of potential interest to the members of the department The ITS unit will maintain a list of currently supported software This list 1s developed and maintained with ongoing input from the departmental faculty and chairman as well as the experiences of the ITS unit personnel The current list is included in the Supported Software section of this manual Additional software purchased at the request of a supervisor will be installed and then its original disks serial numbers and documentation will be handed to the requestor to keep for future needs Updates follow the same procedures Support for this software is limited The user is responsible for reading the manual and learning the features Support for most software is available via the web or in its supporting documentation ITS will address interface and connectivity issues For site licensed software installation disks are kept by ITS documentation 1s installed as part of the set upIn some instances the department will decide to absorb the cost of a particular version of software for a particular class of users In all other cases charging instructions must be provided at the time the software is requested The user is responsible for abiding by the software agreement Installation of the sam
43. C Accession no Case type Patient name Age Medicalrec no Case status Ce oOo 3p Hoo General Req Data Specimens Charges Patient History Referring physicians Delivery locations Code Referring Physician EMail amp E Case and billing information Revenue center Enterprise facility Party to bill Fee schedule Case priority 3 31 du tamapp PowerPath 7 On this screen select the Binocular or Find record Ctrl F Resident Information Technology Services Manual Page 94 Rev 06 11 JHS Using PowerPath Page 95 vur VIRW Reon rans winnnw nein Criteria Set None 7 im Pa Search Criteria Advanced Criteria Results by Patient Results by Case Patient Last name First name Middle name Suffix Search type Medical record no Visit no Social security no Date of birth EE ee eee eee Case Accession no from Accession no to Received from Received to eee T Include imported cases Case type Maximum records fi 0000 Referring physician Clear Form Cancel Help To find your patient Put in Last name First name and 1f it is a common name put in the date of birth to narrow the search ENTER or select Find Criteria Set None x 2 OX Search Criteria Advanced Criteria Results by Patient Results by Case Patients 18 Patient name or alias Sex Date of birth Cases Current name Smith Jo
44. Class SR OSR BPS ainesse 76 Part Types for Specimen Classes AUT and BPA 00000nooonnnnneeennnnnssssesnsssssssseeen qT Part Types for Cytology Specimen Class CG OCG BPCG 0 eeeceeeeeeeeeeeeeees 77 Part Types for Cytology Specimen Class CF OCF BPCF ccceeeeseeeeseeeeees oe Valid Part Types for Cytology Specimen Class CN OCN BPCN ceeeeeeee 78 Block Category Dale ossis acess i niusa oen eea a Tee a aeara Eseo TROA aaa 79 CoPathirom Home via VP Nresecesctiseedetdidccteteeescactateeecetereesetasccascksvesietaddenecetbvesdetdedeadstecbedinissdstsee 80 Accessing CoPath via VPN from a MAC ccccccsssssseseseeeeeeeceeeeeeeeeeeeeaaaaeseeeeeeeess 80 Accessing CoPath vid VPN Tom a PC nesicieoutrniiii nee 80 Obtaining Access to Clinical Applications eecoocsssssecccocosssseseccoooosssssceccososssssececsoosssssseeeesssssoe 81 Chiieal A pplication ICOMS wfsutndisscsaahect A uted ane weeen eran 81 Accessing the YNHH Clinical Applications ccccccccssssssssssscccccssssssssssccccssscsessssssscccssseseeees 83 Usine C eniricit y reoot rine a AE IN a Ee a aeS EGEREN aaa 84 Usine Sunrise Chnical Manager sscccccccsacesccetecucccudacacesiievaceoec dio scceseauenceddecccuiitvsdetedeas aED ivuenduddeiiews 85 Usine Synapse oron ieor aara N OCN RENAN AEAEE NOOO ETEN 88 Usine Chart yie W ansioissa ieiesettabaesets vriese ce ledecclsavic
45. Disc Intervertebral Duodenum biopsy Ear Endocervix biopsy Endometrium bx curett Esophagus biopsy Esophagus Resection Eye NOS Eyelid Biopsy Fallopian tube excision Foot amputation Foreign Body Foreskin Gallbladder excision Globe Enucleation Globe Evisceration Gross Diagnosis Only NOS Hardware Prosthesis Heart Bx Medical Heart Bx Transplant Heart Resection Resident Information Technology Services Manual Heart valve Hemorrhoids Hernia sac Hydrocele Spermatocele Ileum biopsy Jeyunum biopsy Kidney Needle Biopsy Kidney Nephrectomy Not tumor Kidney Nephrectomy Tumor Larynx Pharynx Larynx biopsy Leg amputation Lens Lipoma Liver Needle Bx Medical Liver Needle Bx Transplant Liver Needle Bx Tumor Liver Nontumor Hepatectomy Liver Tumor hepatectomy Liver Wedge biopsy Lung Bx Bronchial Transbronch Lung Bx Open or Wedge Lung Resection Lymph node Bx Lymph node Sentinel Bx Margin Meniscus Metabolic Bone Biopsy Muscle Biopsy Neck dissection Nerve biopsy Nerve Not Biopsy Node Dissection NOS biopsy NOS Major Surgical NOS small surgical Omentum Orbit Biopsy Orbit Exenteration Ovary fallopian tube no tumor Ovary fallopian tube tumor Pancreas biopsy Pancreas resection Parathyroid Penis Biopsy Penis Excision Pericardium Pharynx Bx Pituitary tumor Placenta multiple Placenta single Plaque Products
46. Discharge Summaries that were signed electronically are available All others must be viewed using Chartview SoftMed gt The Document tab allows you to view patient documents by date Click on the document you wish to view and it will display below The Documents tab lets you view all patient results gt To view a different patient s results click on the Find Pt button and enter the patient s name gt To exit the system click on the red Exit button at the top of the screen This will bring you back to the Centricity log on screen Click on the exit button to disconnect from the system Note The department has limited licenses to the Centricity system It is important that individuals log out of the system when they have completed a patient inquiry Resident Information Technology Services Manual Rev 06 11 JHS Using Sunrise Clinical Manager Training website www ynhhslearning com Click on the Sunrise Clinical Manager icon SCM p You will need to enter your Network ID and password At the Sunrise Clinical Manager Logon screen enter your SCM userid and password and click OK Ki Sunrise Clinical Manager Logon Sunrise Clinical Manager User eat Password Congratulations to Yale New Haven Psychiatric Hospital for piloting SCM Order Entry and Documentation Dial 8 HELP 8 4357 for assistance scm 45PROD Workgroup You are now at the main screen of t
47. Help chronological order starting with the most current any other specimens associated with the patient The top part of the OPS window contains a list of other specimens The bottom portion of the window will display the final diagnosis for the selected specimen An abnormal cytology specimen will display a Y in the abnormal field column in the upper portion of the display The buttons on the right allow the user to print one the highlighted one or all Allows you to view other specimens for the current patient of the prior reports The Return button will take the user back to the specimen activity window from which the OSP feature was accessed Other Specimens and the Working Draft Page 57 Working Draft The working draft is a report that 1s viewed by both the resident and attending pathologist during the rendering of a diagnosis The report contains the information available on the patient and their current specimen including clinical history gross description of the specimen histology data and a CPT 4 grid to facilitate with billing The total number of other specimens for the patient also displays on this report This is shown on the first page directly beneath the billing grid If any prior material is present the message is displayed in bold font At the end of the working draft report there is a listing in reverse chronological order of all the other specimens on that patient including the c
48. NESS KEWIN Save Selected Visit s Show Active You are now in the patient s account and have access to lab results documents etc by clicking into the field of your choice at the top of the chart e g Orders Results Patient Info etc The Results tab will display laboratory radiology cardilogy and surgical pathology reports Resident Information Technology Services Manual Rev 06 11 JHS Logoff Page 87 Ox HOLNESS KEYIN Sunrise Clinical Manager File Registration Edit wiew GoTo Actions Preferences Tools Help lt P OARS Slap lo 22 pf a Patient list Orders MESHES PatientInfo Summary Documents Clinical Summary CCSS Centricity EMR on ares Petfomed since 0318 2008 fall Available Ma Mar 19 Mar 25 08 Mar 26 Apr 1 08 1 ane Received Performed Clin Neuro meas E ESSN Two weeksago di Chemistr Eanna A Fee ee ee Two weeks ago Hematology Hoo9o A Benen _ Microbiology gt Blood Gases p Blood Bank Immunology Ad Virology Prenatal Lab SM Labs DIAGNOSTIC RADIOLOGY Radiology p p gt p gt p gt p gt pe pe p gt p gt ET jo Nuc Med Card Annotations EchoAdult cho Adult Echo Pedi Special Procedures p Breast Imaging The Since information box will allow you to refine the range of your search by either choosing a received or performed date drop down arrow will pop up a calendar to assist with date entry or by cli
49. Pathology Department Access will be provided only to those whose clinical information needs cannot be adequately met by the routine reporting methods of the Pathology Department e Employees of other YNHH Yale Medical School departments whose activities include reporting of clinical information to government agencies as required by law e On very unusual occasions access may be provided to researchers with HIC approval for access to information on the YPDCIS The level of access will be limited to that necessary to obtain the approved information Access Administration Access Authorization Access to the YPDCIS can only be authorized by the Clinical Systems Manager following established departmental policies and practices or by the Director of Pathology Informatics Any requests which are unusual or involve non departmental employees must be approved by the Director of Pathology Informatics Authorization requires completion of the steps detailed below under Access Establishment Authorization will be documented by the authorizer signing the Confidentiality Agreement Form signed by the user Access Establishment As detailed in Department s Informatics Section Policy and Procedure manual requests for access to the clinical information system must be made in writing by the unit manager responsible for the person requesting access The request can be made by e mail to the Clinical Systems Manager The request must document the necessity
50. Resident Information Technology Services Manual Department of Pathology Yale University School of Medicine Yale New Haven Hospital Bridgeport Hospital 2011 2012 Resident Information Technology Services Manual Department of Pathology Yale University School of Medicine Yale New Haven Hospital Bridgeport Hospital John H Sinard M D Ph D Director Pathology Informatics Brian M Daley System Manager Clinical Information System July 2011 Table of Contents Table OFC Ontents siessen a esis i General Inora iO Mossin siden Saeesdavenve as casos N a 1 Scope ANG Str ct re OF TiS osc csceisiossececssccedvesssteadessccetselaeseisenve eNe a E E oiiae S esaea aan 2 Clinical Information Systems CIS arrere ninnaa E eee eee ee 2 T Infrastructure and Core HardWare moronieeini n caret ada O 3 User SET VICES and SUNDOI ecne n EE E A eee 4 MAMMOT CONIC YC ON CACUS sieve vacicescucssesnacactvecsusessauswacsaassuessesnatastceceusesseusvaceoessuassxenstactceceuesssesvasssesacecacsose gt 5 Desktop Computer Use and Supp OM Crcssccscvessecaesscccceucnedectcccsuessssesseconsesvessecnndestoecousssescsvacdasssuctsaeenes 6 PROSO secrete satiate eae A en aie 6 ITS SUPPO Sel VICES peii E aeeeeeuaees 6 SOEN Oaa A A A EA EE A 8 DSW Oe a ag ses ee etn eae T A tenes aanecasate eee 8 User Responsio UE Sesaro aa eene o aee ao a ne ea a e A E 9 Multi User Desktop Machine Serseri saan anae AA E E OEE OET 9 Semi Private Deskt p Machines rahi
51. Rev 06 11 JHS Using Synapse Page 89 File View Favorites Tools Help Back fe Asea ee 3 A A Be Address ja Synapse ns oes w Name S ASC PACS SSL gt Be sure to logout when you finish working in Synapse If you do not logout the next person who uses the computer will have access to Synapse without logging in which is a HIPAA violation gt To logout click File Logout Resident Information Technology Services Manual Rev 06 11 JHS Using Chartview Training website www ynhhslearning com Please see the next page for basic instructions provided by YNHH Medical Records for using Charview or you can take their web based tutorial 3M course formerly known as SoftMed at the above training website Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Click the PowerPath icon either on your desktop or Dock The following screen will open Remote Desktop Connection Enter your credentials These credentials will be used to connect to dermterm yu yale edu Password Domain yale _ Add user information to your keychain Gree GOD Enter the following User name NetID Password NetID password Domain Leave as yale Click OK or press ENTER Once you click OK or press ENTER the PowerPath application will open Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 92 AAA z C
52. access to these systems is broad enough and the policies of the administrators of those systems so permit Pathology employees access these systems only to retrieve ancillary data useful in rendering diagnostic interpretations or to meet the business needs of the department Since the department often will have a limited number of licenses users are instructed to exit the systems immediately upon completion of their query For access to a system for which departmental coordination has been arranged the Clinical Systems Manager is responsible for requesting accounts and ensuring that the appropriate confidentiality statements are signed and delivered to the System Manager of the appropriate system It is also the responsibility of the Clinical Systems Manager to ensure that the managers of such systems are notified when a departmental employee with access privileges is terminated or for any other reason no longer requires access External Software All computers in the Residents room and the Sign out area have a ClinApps folder in the dock This folder contains shortcuts to all of the Pathology and YNHH clinical applications One of these shortcuts is to the YNHH Clinical Desktop A list of the clinical applications and instructions on their use may be found in the Appendix section of this manual beginning with Obtaining Access to Clinical Applications Resident Information Technology Services Manual Rev 06 11 JHS Photography and Digital I
53. ad our advice on selecting a strong password New Password Retype New Password Change Password Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 18 Password Guidelines What NOT to Use e Do not use your login name in any form as is reversed capitalized doubled etc Do not use proper names especially not your own nor that of your significant other mother or child This includes all first and last names as well as geographical locations Do not use your initials or those of anyone close to you e Do not use other information easily obtained about you This includes your phone social security Yale ID license plate VISA credit card number your birth date the brand of your automobile the name of the street you live on etc e Do not use a word contained in English or foreign language dictionanes spelling lists or other lists of words including Klingon and Elvish e Do not attempt to be clever and make your password a derivation reversed as is shifted by a few characters a simple substitution code doubled etc of your NetID account name or your first or last name Do not use a password that is so difficult for you to remember that you will forget it if you do not write it down Do not reuse any passwords that you have used previously at Yale Use different passwords on different systems Guidance on keeping your NetID and other passwords safe e Do not give out you
54. ade It can be one of Clinical Autopsy Personal Educational Research or Recut Repeat For the most part you will use Clinical for surgical material and Autopsy for autopsy material Only blocks of these request classes are listed in the report as having been used in the diagnostic evaluation of the case For Critical Technologies blocks the request class is always Research Histology Laboratory This field allows support for multiple histology laboratories and will default in based on specimen class For example YNHH specimen classes will default in YNHH Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 68 Histology whereas Bridgeport Hospital specimen classes will default in BH Histology On rare occasions you may need to change this value Block Comment This additional field allows entry of comments to appear on the histology embedding log perhaps with special instructions for histology To access this field you need to press the Block Detail button Stain Process Edit Entry The Stain Process tab window of the Histology Data Entry Edit activity allows you to view the information automatically entered through the histology entry edit activity via protocols the block wizard or manual entry and to edit or add a new stain process When you select this tab the stains processes for the part most recently selected in either of the first two tabs will be displayed To
55. ale NYUC New York University Cytopathology This specimen class is used for technical processing of gynecological specimens received from NYU Specimen Number Wheel Every specimen in CoPath receives a specimen accession number This number is composed of three parts an alphabetical prefix or number wheel determined by specimen class year and case number The system assigns case numbers sequentially within each number wheel depending on the Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 44 designated specimen class The prefixes currently used by the CoPath system and their associated specimen classes are as follows Number Wheel Specimen Classes A YNHH Autopsy Bridgeport Hospital Autopsy S YNHH Surgical Routine Surgical Procedure Surgical Consult Bridgeport Surgical Consult OS Outreach Surgical Routine Outreach Surgical Procedure C YNHH Cytology GYNs Cytology Consult Cytology Gyn Procedure Outreach GYNs Outreach Cytology Gyn Procedure HPV Chlamydia etc N YNHH Cytology Non GYNs Fine Needle Aspirate Cytology Procedure Outreach Cytology Non GYNs Outreach Fine Needle Aspirate Outreach Cytology Procedure SB Bridgeport Pathology surgical routine and surgical procedure CB Bridgeport Pathology cytology gyn NB Bridgeport Pathology cytology non gyn medical fine needle aspirate and cytology procedures LB Bridgeport Pathology clinical pathology specimen
56. and meet the PowerPath password complexity requirements Server tamapp Database PowerPath User Name iab223 New Password Po Confirm Password O none 7 o0e e d C Program Files Tamtron PowerPath Client PowerPathClient exe Ez PowerPath File View Tools Help ag Please enter a new password by entering it in the two fields below NOTE Your new password must be different from your current password and meet the PowerPath password complexity requirements PowerPath Client x New passwords must contain characters From three of the Following Four categories 1 Uppercase characters 4 through Z 2 Lowercase characters a through z 3 Number characters 0 through 9 4 Non alphabetic characters for example Con Click OK and your Desktop screen will open Resident Information Technology Services Manual Page 93 Rev 06 11 JHS Using PowerPath AOA S PowerPath y C Program Files Tamtron PowerPath Client PowerPathClient exe File Edit View Tools Window Help BA m E Favorites J 6 te xT oa g S Desktop of Demo User Tol Favorites Contents of Desktop Favorites Startup du tamapp PowerPath 7 Double click on Cases ORK 4 C Program Files Tamtron PowerPath Client PowerPathClient exe S3 PowerPath File Edit view Record Tools Window Help Ja Sila O S s HBl AcM rH Sia Se a ew S Case Information No Cases Iof x
57. ase specimen class status of the case diagnosis and attending pathologist The text of any procedures and or addenda is also included A sample working draft is shown Surgical Pathology Working Draft High Priority Other Specimens on EA O secession S01 Wead Rac w Gent County OBAS YN Tean M pogiageex ME Age 44 F Location Outside Recehred M coi Specimen Casa CG Accessed B Statue Signed Out Pabholocr ct B Semice Outside Service Reporte High Risk Specimen woo O O fa CYTYC THIN PREP PAP SMEAR Ehe pa Penker LOW GRADE SQOUAMOLS INTRAEPITHELIAL LESION career Preys oe THIS SPECIMEN IS SATISFACTORY FOR EVALUATION Copy To duged is ENDOCERVICAL COLUMNAR EPITHELIAL CELLS ARE PRESENT RECOMMEND REPEAT PAP SMEAR IN 470 6 WONTHS Decal FS isl FS Add 35300 5837 p804 BROS 99307 38209 6611 SEH BRIS I l l i I l l l l l l Proc dures Addenda for CO4 l l i l I l i l thy Molecular Studie need D fenced D Pathog st i oop ee mil een Peg ail co pad nrabas Jet ABOE CUTOFF FOR HF Y PROSE A k 1 FT 7 pi 1 AF of Other Specimens on this Patient in the System 4 SPECIMEN IS POSITIVE FOR ONE OR MORE HPW TYPES 16 18 31 33 35 39 45 51 52 58 58 59 AND 68 Clinical History RESEARCH DATA SPECIMEN CONTAINS A MODERATE VIRAL LOAD March 2007 LGSIL Jangary 2004 LGSIL Gross Description cot mz Specimen Gess CG iow Ei Saws Signed Out 1 Received in formalin labalad with the p
58. at the patient 1s correct by using additional patient criteria e g birth date Clicking on the Details button will also provide you with the patient s address and social security number if available Highlight the appropriate patient and click on the OK button Please see the Registering a New Patient section below if the patient does not currently exist in the CoPath system Select Patient x Taar L R Patient BLO CHE Name Last First Middle OC Search C Medical Record Number es Exact Match C Social Security Number _New Patient Encounter Number C Universal Number C HIS Other Number _ Select Filter Clear Filter Current Medical Records Name Gender Birth Date Age Number Client Edit Patient BLOM UIST CHESTER h 06444926 80 0736718 YNHH BLOSSOM CHERRY 06491943 63 9988777 YNHH AC Detail Cancel Help The next screen will display any previous specimens received on the patient Click on the New Specimen button The New Specimen window will display It is from this window that the specimen class and a temporary specimen number will be assigned The specimen number is not assigned to the case until the case has been Filed or Saved If available an encounter visit number will default into the encounter number field Verify this number against the specimen requisition form for accuracy To view additional encounters for a patient click on the butt
59. atient s name and F o clock ie a firm tan to brown fragment of tissue Patiobsit O OO i KU i h l STANDARD PAP SMEAR measuring 0 4 x 0 3 x 0 3 cm Part 1 is oriented in agar and submitled entirely in one cassette LOW GRADE SOUAMOUS INTRAEPITHELIAL LESION THIS SPECIMEN IS SATISFACTORY F OF EVALUATION ENDOCERVICAL COLUMNAR EPITHELIAL CELLS ARE PRESENT RECOMMEND REPEAT PAP SMEAR IN 4 TO 6 MONTHS coo Specimen Cieza CS _ STANDARD PAP SHEAR SATISFACTORY FOR INTERPRETATION BUT CYTOLOGIC DETAIL PARTIALLY OBSCURED BY INFLAMMATION MEGATIVE FOR DYSPLASTIC OR MALIGNANT CELLS ENDOCERVICAL COLUMNAR EPITHELIAL CELLS ARE PRESENT FRESH BLOOD PRESENT Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Data storage in the CoPath system is centered around a hierarchical arrangement of several main entities Those entities involved in the storage of histology information are from top to bottom patient specimen parts blocks and slides stains These exist in a strictly unidirectional branching hierarchy Thus although a patient may have many specimens a specimen can belong to only one patient Likewise although a part may have several blocks each block must belong to one and only one part All the information about a specimen is stored at the appropriate level in this chain and applies to all information stored below it in the chain For example specimen priority is stored at the specimen l
60. ault in designation if only one JV Fitter used designations from insert list READY to scan Require sequential entry Io skipping Part Block Category Desig Description Insert standard designation Stains 4 1 Routine blue orar No Unused Designations 2 1 Routine blue orar i 2 Routine blue orar 3 41 Routine blue orar 3 2 Routine blue orar 3 3 Routine blue orar 53 4 Routine blue orar 3 Routine blue orar 3 6 Routine blue orar No Existing Blocks Cancel Create 1 Block Histo Lab YNHH Histology Pay particular attention to the stains For the majority of non biopsy specimens only a single H amp E stain will be ordered For parts for which a protocol has been specified however a variety of stain combinations may be available A single H amp E slide will always be an option Be sure to select the group of stains appropriate for each block Barcoded Block Wizard 510 6 3 parts BLOSSOM CHERRY A Scan Barcoded Cassette J Default in designation if only one V Fitter used designations from insert list READY to sean Require sequential entry Mo skipping Part Block Category Desig Description Insert standard designation Stains 1 1 Routine blue orar No Unused Designations 2 1 Routine blue orar No Unused Designations H amp E 2 2 Routine blue orar No Unused Designations H amp E 113 1 Routine blueiorar J JM Selecta Standard Desig v H amp E 3 2 Routine blue orar 3 3 Routine blue o
61. be remembered and restored the next time you open the Barcode Block Wizard After all of the cassettes you plan to use have been activated and all of the designations descriptions have been entered and the correct stain sets have been chosen click on the Create Blocks button This will initiate the automatic creation of the blocks and ordering of the stains This process will also mark all of the activated cassettes as used so that they will not be available the next time you go into the Barcode Block Wizard Alternatively clicking Cancel will close the block Wizard without creating any blocks or ordering any stains Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 66 If you wish to add additional stains not available in the stain sets in the Block Wizard run the block wizard to create the standard H amp E stain and then afterward add the additional stains manually using the manual data entry process described below You can also edit the block information manually delete unwanted blocks or enter block comments Manual Entry of Histology Block Stains Information This method although more time consuming gives the user complete control of the histology information entered for each part Manual block data entry is done from the Tissue Blocks tab of the Histology Data Entry Edit activity Manual stain data entry is done from the Stain Process tab Manual entry
62. cimen Accession number Bottom Level Individual image files ImgRep 2001 2002 2003 A2001 C2001 2001 2001 000001 000099 S2001 000100 000199 S2001 000200 000299 2001 000100 2001 000123 2001 000149 2001 000198 Sf 2001 000123g01 jpg ET S2001 000123g02 jpg Sf S2001 000123m01 jpg EP S2001 000123m02 klat jpg SP S2001 000123m03 cd20 jpg Access to the image repository is via the department s intranet site Any computer in the department can access the images Since the image display includes protected patient information you must log into the repository using your CoPath username and password Once in the image repository images can be accessed in one of two ways e Entering the Accession Number Simply enter the accession number at in the box at the top of the window and press the search button Standard shortcuts such as leaving out the year for the current year should work The lower part of the display will immediately jump to the case requested e Navigate through the directory structure One can also get to a case by proceeding through the directory structure to the desired case Only cases for which images are present in the repository will be listed To go deeper into the repository click on the path to the desired case To back out to a lower level click on links in the Path chain at the top of the frame Resident Information Technology Services Manual Rev 06 11 JHS Photography and
63. cking on the down area of the next field which will display date ranges e g two weeks ago one month ago start of this chart etc Double clicking into a results field will allow you to view tests results or access a report Double click on a report to review the expanded text To return to the Results tab click on Summary in the Display Format box Please remember to log off of SCM by clicking on the logoff icon or go to File Logoff You will be returned to the SCM Logon screen click the Exit button to exit the application Resident Information Technology Services Manual Rev 06 11 JHS Using Synapse gt Double click on the Synapse icon Synapse gt The following login screen will appear Back A Search C Folders S Q ah X Address a Synapse Pao w Name Enter Network Password cI x Please type your user name and password Site yalepacs ynhh org User Name Password Domain I Save this password in your password list tos 4 a D gt Enter you User Name and Password The Domain is always ynhh gt DO NOT check the Save this password in your personal list checkbox gt A second login screen will appear use the same User Name Password and Domain This appears because you are logging in to two systems gt Once you login you will see the screen below To get help click on Help Synapse Help Resident Information Technology Services Manual
64. clinical pathology This specimen class is used for clinical pathology specimens requiring a professional evaluation at Bridgeport Hospital BPS Bridgeport Pathology surgicals This specimen class is used for surgical specimens that originate from Bridgeport Hospital BPSCO Bridgeport Pathology consults This specimen class is used for cases sent to the Bridgeport Pathology either because the patient will received continued care at this institution or for a second opinion BPSP Bridgeport Pathology procedure only This specimen class is used for specimens where procedures will be ordered e g molecular diagnostics electron microscopy and will receive no routine processing MFCF Milford Pathology cytology fine needle aspirations This specimen class is used for fine needle aspirates performed at Milford Hospital but currently processed at Yale MFCN Milford Pathology cytology non gynecological Medical cytology specimens taken and Milford Hospital but currently processed at Yale s cytology lab e MFS Milford Pathology surgicals This specimen class is used for surgical specimens that originate from Milford Hospital but are currently being processed at Yale eMFSP Milford Pathology procedure only This specimen class is used for specimens where procedures will be ordered e g molecular diagnostics electron microscopy and will receive no routine processing These are currently being processed at Y
65. cs eSCO surgical consult This specimen class is used for cases that are sent to our department either because the patient is being referred to this institution for continued care or for a second or expert opinion In most instances the specimen consists of glass slides and or radiographs eSP surgical procedure only This specimen class is chosen when the specimen to be processed will receive no routine processing and only a procedure or procedures e g electron microscopy immunohistochemistry or estrogen receptors will be ordered It 1s to be used when the specimen originates from YNHH or a Yale University based clinic eCG cytology gynecologic This specimen class is chosen for cytology gynecologic specimens more commonly known as Pap smears It is to be used for specimens received from YNHH or Yale University based clinics eCF cytology fine needle aspirates All fine needle aspirates whether cytotechnologist or pathologist assisted are assigned this specimen class for specimens originating from YNHH or Yale University based clinics eCN cytology non gynecological This specimen class is used for cytological specimens of a medical nature e g bronchial washings gastric brushings voided urine which originate from YNHH or Yale University based clinics CCO cytology consults Like its surgical counterpart this specimen class is used for cases sent to the department either because the patient will
66. ct of printing the frozen section labels which notifies FSLink of the frozen section so you must do this even if you do not plan to use the labels Resident Information Technology Services Manual Rev 06 11 JHS Tab Forms Specimen Inquiry At any time during the processing of a case you may need to review the case status or specimen results information The Inquiry option allows you to view the current information entered on a case To begin this process from the Application Manager click once on the Inquiry button at the top of the screen This will open the Select Specimen window From this window select the desired specimen either by specimen number patient name patient medical record number or by performing a search of recent specimens For details on this process see the section entitled Working on Specimens in CoPath Once you have selected the specimen and the Inquiry activity the available information about the case will be displayed The inquiry activity provides a multi tab form window that displays the specimen information The tab headings are self explanatory and will help direct you to the appropriate tab window for your review The information available will depend upon the specimen class assigned to the specimen For example the gross description text for a specimen will be available on the text tab in the inquiry window but would not be available for a cytology gyn specimen that has no gross description
67. cted to Microsoft Exchange 2010 Microsoft Corporation All rights reserved e You will be able to read and delete mail that is on the server e Follow the Webmail directions for other options such as creating mailboxes and address books e When done be sure to logout of your email account or the next person sitting down at that computer will also be able to read and delete your e mail E mail and Security Because e mail travels from the sender s computer to the recipient s computer via the Internet it is generally not possible to predict the route that the message will take Therefore it is possible for sniffer programs to intercept and read the e mail For this reason e mail is not generally considered a secure form of communication unless encrypted This needs to be kept in mind when composing an e mail message In particular e mail messages should not contain any personally identifiable protected health information about patients Indirect references to a patient with information which is sufficiently vague as to make it impossible to determine the patient in question is acceptable Resident Information Technology Services Manual Rev 06 11 JHS Getting a Net ID PIN There are two ways to get a PIN for your Net ID 1 You can contact the Pathology Help Desk Telephone 203 785 3691 We will contact the Med School Client Access for a PIN 2 Go to the Med School Walk in Help Desk at SHM B25 in the Cushing Whitney Med
68. date and time the specimen was taken and received into the Unit Client The client is the institution of practice from where the specimen originates YNHH is the system default for the client field A pop up list of current clients 1s available by clicking on the button to the right of the client field Priority Specimen priority places certain expectations for specimen turn around time It is the resident s responsibility to ensure that the appropriate priority is set for the specimen at the histology entry edit process this will be discussed in further detail in this section Some specimen priorities include 1 Rush Bx 3 Excisional Bx and Autopsy Grossing Resident The name of the resident assigned the case 1s entered into this field A drop down list is available for this field Pathologist The name of the pathologist responsible for the case is entered into this field A drop down list is available for this field Creating a New Specimen This process should be done in UPPER CASE Case Intake Page 50 Access the CoPath system From the Application Manager click once on the Specimen command button The Select Specimen window will appear Enter the patient s name using a combination of letters from the last name and first name separated by a comma Three letters of each name are the recommended choice e g POP CHE Click on the Search button A list of possible patients will appear for you to choose from Verify th
69. des for possible additional studies are selected and ordered up front speeding the evaluation of the case To enter the Barcode Block Wizard click on the button at the bottom of the Specimen tab of the Histology Data Entry Edit activity Do this only after you have entered correct part types for each part of the case that you plan to gross in and after you have printed the cassettes you feel you will need for the case If you have not entered a valid part type for any of the parts of the case those parts will not be available to you in the block wizard and you will receive a message notifying you of that In addition if you have not printed cassettes for the case using the Cassette Labeling application no cassettes will be available for entry and you will not be able to enter the block wizard Once in the block wizard you will be presented with a list of all of the cassettes which have been printed for the case but not yet used scanned into the Barcode Block Wizard Each cassette part Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 63 number and block number is in italics because at this point it is only a potential block If cassettes have been printed for a block which already exists in CoPath a warning will be listed next to that part and block number indicating that you cannot use that cassette since it would result in a duplicate block A complete list of any existi
70. dress ee aE secuny Question 2 ep Answer i Security Question 25 Answer i Security Question O O Security Questioni Oo O O Answer 4 Security Question 85 a Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 17 Yale University Change Your NetID Security Info Important You may be asked for some or all of the information below if you forget your password Store this information in a safe place NetID ew44 Change Email Address Email Address Retype Email Address VeriSign Secured VERIFY Change Secu Question and Answer Security Question What is your mother s maiden name What is your dream car What was the name of your first pet a Where was your first job Answer In what year was your father born What is the name of the high school from which you graduated Security Question What was your childhood best friend s first name Who is your favorite author What was the model of your first car ire Security Question Where do you want to retire Answer Answer Answer 4 Security Questions OO O Answer 5 Examples of security questions above Requirements for the NetID password Password must have 8 14 characters Must contain at least 2 letters Must contain at least 2 non letters Must NOT contain Illegal characters lt gt amp less than greater than ampersand backslash comma apostrophe and quotation marks Please re
71. e single user software on multiple machine is software piracy and will not be supported by ITS Some software allow for the installation of a laptop and work copy for one user please read your software usage policy Installation of illegal copies of software on departmentally maintained machines is strictly forbidden ITS does not support the installation or use of software which does not promote the departmental missions As such utilities for music and movies games and other such entertainment software 1s specifically not supported Network Pathology ITS will assign network settings for all departmental systems ordered by ITS and these should never be changed or altered by the user without consultation with Pathology ITS No computer or electronic device should ever be connected to the department s ethernet network without specific consultation with Pathology ITS This is crucial to maintaining the integrity and security of the network The department s network is a subnet of the hospital s network and as such is behind the firewall protecting the patient information stored on hospital computers from access by the general public Any direct remote connection into a desktop machine on the network represents a hole in the firewall and a potential major breach of security Authorized remote connection to the hospital network is possible through the use of Virtual Private Network VPN software VPN enables a
72. e accessioned by the support staff in the department However the most common situation in which a resident may be expected to accession a specimen into CoPath would be an after hours frozen section or rush biopsy If you are on call and have received a specimen for frozen section or for stat processing the specimen MUST be accessioned into CoPath BEFORE it is worked on This is not only a good idea it is a State law but it assures that any blocks or slides generated from the specimen can be properly labeled and thus identified as coming from the particular patient Since the need to do this accessioning may come at a time when there is pressure to being the evaluation process on the specimen quickly it is a good idea to be familiar with the accessioning process in advance Additionally a new system has been create to manage and track frozen section diagnoses This in house system called FSLink is described in detail elsewhere in the manual For the FSLink application to even be aware of the existence of the frozen section the specimen MUST be accessioned into CoPath and the Frozen Section Labels MUST BE PRINTED for any specimen part which is to be evaluated by frozen section On the Case Intake tab of the specimen accessioning window click on the Frozen Section Labels button Select the correct part from the part drop down list and press print Labels will print which can be used to label the containers for the frozen section It is the a
73. e slide e g T for Tumor DM for Distal Margin APP for appendix etc Using the block wizard see below will help you learn standard designations Critical Technologies Blocks Critical technologies now called Yale Pathology Tissue Services is the unit in the department which promotes research by making human tissue available to investigators Critical technology blocks also contain two parts a three letter critical technologies code followed by a space followed by a sectioning site designation The two parts must both be present and together must form a unique block designation Critical technologies blocks can only be entered by the manual method e g the block wizard cannot be used to create critical technologies blocks When a proper critical technologies block code is entered the appropriate block category and request class will default in The three letter critical technologies code specifies the type of block and must be one of CTB bulk frozen tissue CTO tissue frozen in OCT CTF formalin fixed for paraffin embedding CTE ethanol fixed for paraffin embedding The designation must be present must be unique within a given CT class e g cannot have two blocks labeled CTB Tum1 but can have a CTB Tum1 and a CTO Tum1 should be from 1 to 10 characters long should generally identify the tissue as Tumor or Normal Block description Every block should have a block description
74. e will not be an existing specimen to select Proceed as described in Case Intake elsewhere in this manual If you select a specimen activity that applies to an existing specimen the Select Specimen window will appear just as described above except that the activity you selected will be already selected in the Activity dropdown list near the bottom of the window Select a specimen by one of the methods described above and proceed Resident Information Technology Services Manual Rev 06 11 JHS Case Intake Before any specimen related activities can be performed on a specimen it will need to be accessioned into the CoPath system Accessioning a surgical specimen into the CoPath system requires entering data into the appropriate fields prior to saving the case Once the case is saved it is assigned a specimen accession number and becomes available for further processing In some instances the lab may receive a specimen for a patient that does not exist in the system This will require that the patient be registered in the CoPath system prior to entering the specimen The patient registration process is a simple process that involves entering all available patient demographics e g last name first name medical record number and associated client address social security number if available gender and birth date Once a patient is registered the system assigns a patient ID number PID which is a unique number A patient can have
75. ecialty programs Resident Information Technology Services Manual Rev 06 11 JHS Electronic Mail Electronic Mail Services Residents email accounts are paid for by the hospital These accounts are housed on the Yale School of Medicine server named YaleConnect and are thus termed Yale Connect e mail accounts These accounts support a friendly e mail address in the format firstname lastname yale edu calendaring and tasks There is a 5GB disk quota for YaleConnect email accounts Users will be notified when they are approaching this limit but mailboxes that have reached the 5GB quota will no longer be able to receive mail These accounts also support SPAM filtering and vacation auto reply Getting an E mail Account Yale New Haven Hospital automatically requests the email accounts for all residents General User Information about E mail Accounts A basic understanding of electronic mail is helpful in allowing you to more effectively manage your e mail account Electronic mail travels around the world via the internet An e mail account is an actual account on a server that is connected to the internet This is responsible for sending your messages to their addressees and for receiving and holding messages addressed to you until you can read them Other computers known as name servers allow the various e mail servers around the world to translate your e mail address into the address of the e mail server on wh
76. ecimen Inquiry Pathology Patient Report Single Print Quick Entry Functions 5 Schedule Manager 5 Spelling Files 5 System Session Utilities StainProcess and Block Edit 060607 11 35 Patient Specimen MrgeMove Del The options available to each user depend upon his or her job responsibilities within the department so your Application Manager window may appear different from that shown here To view all the options available to you click on the File menu and select Browse Items All of the options available to you will be listed on the right The menu on the left is your Personal Menu You can customize this by dragging options from the list on the right to the window on the left You can also re order the options listed in your personal menu To remove an item simply drag it off the window Your personal menu will appear every time you log in or return to the main Application Manager window Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Tab Pages Name Data Page 37 Group Navigating in CoPath The windows and fields within CoPath can be navigated using a keyboard a mouse or a combination of the two Navigating using the Keyboard You can navigate in CoPath by using the keyboard Most selections that can be done with a mouse can be accompdishedathrough the kayboardhiwithttkowse of the menu bar access keys shortcut keys and the arrow Tab and Enter keys e To
77. ed user and then inactivated Individuals with the person type of Pathologist or Resident who are leaving the department are kept as active entries but their person type is changed to Clinician This will allow them to be selected as submitting physician for future consults etc Other Security Features Automatic Log off All users are expected to log off of any workstation at which they have established connection to a secure system prior to leaving that workstation However to further protect against unauthorized access any session established into the YPDCIS will automatically place itself into a suspended mode after a period of inactivity Re entry of the user s username and password will return the user to where they were prior to the session suspension If the session remains suspended for 15 minutes the session is terminated and any unsaved changes are lost Password Complexity All user passwords must be at least 6 characters long and include at least one number Shorter passwords will not be accepted Passwords may not be reused for 180 days Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 25 Password Expiration The YPDCIS requires users to change their passwords every 60 days The user will receive automatic warning messages during the week preceding the expiration prompting them to change their password If a password is not changed within a defined period of time the
78. eipt of a signed confidentiality form Although usually provided at employee orientation the CIS confidentiality form may also be obtained by calling the Path ITS Help desk at 785 3691 The completed form may be faxed to ITS at 785 2403 however the original copy of the confidentiality form must be sent to Path ITS BB50 BML PowerPath Path ITS will request access to the Dermatopathology s clinical information for incoming residents Flow cytometry access to flow cytometry is required for a year residents during their hemepath rotation Path ITS will request access for the 2 year residents at the beginning of the academic year Clinical Application Icons The following are icons to help you identify the clinical applications you will be using ey Clinical Applications folder This folder contains shortcuts to the applications listed below also be found in the Dock of all general use computers in the sign out area and all CoPath eS Access the Pathology Department s clinical information system This icon will Residents room computers A Synapse This is the hospital system where radiology reports may be viewed ify PowerPath Dermatopathology s system that provides access to dermatopathology reports rz SCM Sunrise Clinical Manager A hospital and community based system that is Resident Informat A nology Services Manual Rey 6 1 TS Page 82 available to all physicians On line training is avai
79. elected Images window You can now select a new case and or a new source location and save additional images 13 After all of the desired images have been saved from the source location leaving only undesired and or bad images behind delete the remaining source images by pressing the Delete ALL Source Images button NOTE When images are deleted from within the ImgUpload application they are COMPLETELY deleted they are not simply moved into the Trash Clinical Image Repository The Yale Pathology Department Clinical Image Repository is a collection of clinical images arranged in a hierarchical directory structure which allows all of the images for a particular case to be stored together in one location and still be uniquely identified thereby preventing accidental image overwriting or loss Each of the image files is a standard non proprietary file format most commonly JPEG which allows easy view ability and incorporation into presentations The structure of the image repository is shown in the diagram Basically the repository is a hierarchical tiered structure grouping together cases for easier navigation The various levels of image storage are Root Level 0 Year 4 digits Resident Information Technology Services Manual Rev 06 11 JHS Photography and Digital Imaging Page 32 Level I Prefix and Year Level II Case range by 100 first from 1 to 99 rest from 100 199 200 299 etc Level III Prefix Year Spe
80. elephone PINs e Arrange for and administer electronic pagers e Set up install and manage electronic mail services Graphics and Imaging Services e Provide graphic design scanning illustration and poster services for departmental research teaching and clinical activities e Design and produce departmental public relations materials World Wide Web Services e Maintain the department s presence on the worldwide web www yalepath org e Design and maintain the department s intranet site for secure access to departmental services e Develop and maintain web delivered databases Resident Information Technology Services Manual Rev 06 11 JHS Emergency Contacts For before and after normal working hours and on weekends report emergencies to the responsible individual based on the system you are using Please note that names are listed in primary order Please make every effort to contact the first individual on the list before moving on to the next person Since the Autopsy Unit is staffed every weekend the individual on call for the weekend will access the Clinical Information System each day and report any problems to the Clinical Systems Manager This will help to ensure that problems are resolved prior to the start of the work week Clinical Information System CoPath Plus Name Work Brian M Daley Janos Lobb Network Hardware Problems Name Work 203 737 5339 203 737 5204 Sophia Gyory Katie Henderson Janos Lobb
81. elp Enter your current password enter a new password and verify the new password Click the OK button Your password has now been changed and will be effective for sixty days Passwords must be between 6 and 15 characters include one number and may not be reused for 180 days Exiting CoPath When you are done with what you need to do in CoPath it 1s important to exit the system For one thing this prevents others from doing things in the system under your user account actions for which you will be held responsible In addition the system is limited by our licensing agreement to a Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 41 maximum number simultaneous users Your being in the system may be preventing someone else from logging in 1 Press the Exit button on the toolbar the Exit CoPath Client Server message box appears 2 Press the Yes button Another message box will appear if you have not already performed a Save function on any item that you may still have open S gt Exit CoPath Client Server PLIYE STOP Do you want to exit CoPathPlus now Working on Specimens in CoPath Work on specimens within CoPath requires understanding some commonly used terms Specimen Classes The specimen classes that are used in the CoPath system form one of the major foundations of the system s data structure Specimen classes help to categorize cases
82. emembers which block numbers have been used and defaults to next consecutive block number Printing a second cassette with the same case part and block number requires an override authorization Only cassettes printed with this application are available for entry into CoPath Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 62 Histology Block Stain Protocols CoPath allows for the entry of Histology Protocols which permit specifying default blocks block designations and descriptions and stain sets routine and special stains for each block of a specimen part These are useful in speeding data entry and assuring that the specimen part is handled consistently and appropriately Yale does not use protocols to order blocks because there is no double check to assure that those blocks actually exist However we do use the information within the protocols to build default block designations and descriptions as well as stain sets used by the barcode block wizard Therefore it can be important to select the correct protocol 1f it exists for a part before entering the block wizard The Barcode Block Wizard The Barcode Block Wizard is a portion of the CoPath code which is unique to Yale It integrates the cassette labeling application into the CoPath system and begins the process of integrating CoPath with the Histology Asset Tracking software used throughout the histology laboratory The Ba
83. ent field is not a valid field in this type of search because the system will search for the primary resident in the primary pathologist field At Yale we do not store the primary resident in this field It is stored in the gross pathologist table Therefore do not attempt to search for your cases in this manner for you will come up with nothing Indicating the specimen class and or parts appropriate to the search will hasten the search process Specimen Search Criteria x Specify the criteria to use to limit the search From Accession Date psa7a7 0 00 oo Primary Pathologist fo To Accession Date pEMBO7161200 0C i C S Primary Resident fo Specimen Client fo xh Physician o Encounter Client PO Retrieval Flag poo Ctrl Click to select multiple entries or to de select an entry Specimen Classes Parts Abbreviation Name Outreach Cytology Procedure Only OSP Outreach Surgical Procedure Only Colon Resection Not Tumor COLNT OSR Outreach Surgical Routine al Colon Resection Tumor COLT SCO Surgical Consult Common Bile Duct FNA CBB Common Bile Duct FNA Cytotech CBDCYT Composite Resection COMP Abbreviation a pame SP Surgical Procedure Only Surgical Routine Clear Cancel Help After entering the search criteria click on the OK button at the bottom of the screen A list of the possible cases that meet your search criteria will display in the
84. erver to which access 1s restricted In some cases 1t may be determined that it is appropriate for certain single user machines Resident Information Technology Services Manual Rev 06 11 JHS Desktop Computer Use and Support Page 11 or research machines to store some patient information In such cases those desktop machines must meet one of two requirements 1 The machine is in a secure location which is ALWAYS locked or attended Everyone who has access to the machine must also be authorized to access the clinical information stored on that machine 2 The information stored on the local machine is password protected either in a password protected database file folder or storage device Security Configuration Management The Director of Pathology Informatics and the Senior ITS Manager with assistance from the three ITS Managers are responsible for maintaining the appropriate departmental policies and procedures to maintain the security of the central systems and desktop machines These policies and procedures are represented in the Policy and Procedure manual and are outlined in the Clinical Information System Confidentiality Form and the Pathology Server Confidentiality Form Security violations will be assessed individually by the Director of Pathology Informatics and sanctions will be recommended to the Chair and Clinical Administrator of the Department who will be responsible for the final determination on what disciplinary actio
85. es Menai a een 29 Ime Upload Program and Image Pale erorii a a E A ONO risen 30 Clinical Imac KR EDOSIOLy arieni eano a E E E eee a 31 Viewing the mages for a Case miircsssan enna E ETE A 33 Primtine Thumonals of the Ima ees aii ssiaast cateiieicingeeesinielccdoanuienansseaserea eee 33 Extracting Images from the Image RepOSiItOry cceceeeessseeeececcceeeeeeeeeeaaaaeeeeeeeeeees 33 COP ati Users Mantal oessa e E S 34 General Introduction to CoPath PIUS sississacsscsncstascsisssistaadacsscsanassnssuccdascstissistaddacdscsavcssnssdsacaseaaccss 35 Logone NTO SOP AU hoen E a a a a 35 Navicatno 110 OP AEN porion E O E E seueeotenianaaewnaeraenees 37 Navigating using the Keyboard osuneen na EE E ESO 37 IN VA AU NDE MOUS anea E E aa oa octane 38 Takime Breaks and DOR Ob casara a a a a A A 38 Take a Break etn a a a da Aswad coed geGolsA asec eee 39 Antom Me OUl ersen A A 39 Forced Log O tsereaserie uneen a a a a 40 Channoine Your Passworde oraaa dylan E E N ty lal ioe alee dl tata ied 40 EA a E 0 A E AEE S E AEE E EAE A E E EET 40 Wo rkmo on SPECIMENS m COP AU vesesccesccssscscedsdcessssscsccsccsseedassevssesededscesssscancsedsnesbendsesdesodenceeases es 41 Specimene ASSES ioa e A E AEN 41 SPECIMEN NUMDEE W IOE Drnekisieia a Niet dthshemsdebetehaduatiunla es Wetiivds 43 CC IIG NC ULI Sahat a tit eat tndies tute eel cence ate trata ed yaa detach akaa sue tetecaealetsaeastoutetents 44 PICU SOM S PCCM SIS sessen ei cos oaae dlemsuoiu Oa O 45 Selec
86. ess to the subset of options which you need to do your job As such your access level may be different than a co worker and therefore you should never allow someone else to access the system from a session that you are logged in to Individual user activity within the Clinical Information System is monitored and audited CoPath Plus provides an audit trail with the identity of the responsible data entry person for specimen activity Other activities are also monitored You will be held responsible for any data access or alteration that occurs under your username This is another reason to make sure no one else ever accesses the system using your account In addition the system manager regularly monitors the system for unusual activity We also monitor for active accounts that have not been used for some time These are automatically inactivated Emergency Access to the Clinical Information System is not allowed All users must complete a confidentiality agreement and be assigned a unique user account before access 1s allowed The system does not store information that might need to be otherwise retrieved for a critical situation The department s data network is a sub net off the hospital network which is protected behind a PICS firewall Remote access into the departmental network is only allowed through the hospital s Secure ID portal Modem connections into desktop machines except to receive a fax are strictly forbidden Fi
87. evel and this priority applies to all of the parts blocks and stains for that specimen Block category e g cassette color 1s a block level data element and can theoretically be different for each block even blocks of the same part Histology data entry begins at the specimen level When the specimen is accessioned it is assigned to a patient One or more parts are defined and these are given a part number a temporary part type a part description and a date time taken The parts should be pre defined prior to your using the Histology Data Entry Edit activity and additional parts cannot be added during this activity Your major objective will be to gross in the specimens generating a textual gross description which the transcriptionists will type into the case later and then to enter into the computer system the appropriate information about the tissue blocks which are being submitted for histological examination and the stains required for that examination Definitions of Terms Specimen Priority The priority of the overall specimen not for each part This places certain expectations upon turn around time Possible values for Specimen Priority are 1 Rush Biopsies 2 Small Biopsy 3 Excisional Biopsies 4 Therapeutic Excision S5 Surgical Validation and 6 Gross Only Part type Each part of each specimen must be given an appropriate part type This is important for a number o
88. f reasons A list of currently available part types is included as an appendix Selecting the appropriate part type is a medical assessment of not only what was removed but often why it was removed Some part types are simple and based only on the tissue of origin e g Tonsils Adenoids Cyst Prostate biopsy whereas others require knowing why the tissue was removed e g Uterus Fibroids Uterus Endometrial Cancer Uterus Cervical Cancer Since the people entering the specimens into the computer are often not in a position to correctly assign the part type they have been instructed to enter Accessioned with the understanding that the resident PA will correct this later Selection of the correct part type is important for a number of reasons Many behaviors in the system are driven by the part type chosen what default protocols appear what default sectioning sites appear in the block wizard the default block category for the tissue blocks and possibly default billing codes In addition when cases need to be later retrieved for research or educational purposes the most common criteria provided is I want to find all the thyroidectomies or I need to find a particular case it was a uterus with endometrial cancer Departmental workload statistics are also calculated off the part type field Thus do not simply pick any part type to stick in this field Even cases which are for gross only exam
89. formation D06 001234 Accession no Case type Patient name Age Medical rec no Ce D06 001234 Dermpath X Hunt Earl E General Req Data Specimens Charges Patient History Results Notes Referring physicians Delivery locations Referring Physician Moyer D 0 Stephen 85 Seymour Street Suite 815 Hartford CT M Case and billing information Revenue center Enterprise facility YALE DERM YALE DERMATOLOGY LABOR aa YALE YALE DERMATOPATHOLOGY LABORATORY aa Party to bill Place of service Patient billing account Patient v Independent Lab E Defaut z Fee schedule Case priority Global Global Fee Schedule Routine du tamapp PowerPath 7 Once the case is open select the Results TAB Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 99 OOO y C Program Files Tamtron PowerPath Client PowerPathClient exe 4 PowerPath File Edit View Record Tools Window Help A m 6 s BelMollk drm BI BS la e ee imini S Case Information D06 001234 E zigi xi Accession no Case type Patient name Age Medical rec no Case status Ce D06 001 234 z Hunt Earl E Final General Req Data Specimens Charges Patient History Results Notes Sex Male Total blocks 1 Total slides 3 6B e amp a fo 7 DIAGNOSIS CENTRAL FOREHEAD VERRUCA VULGARIS CLINICAL IMPRESSION Wart SCC GROSS DESCRIPTION
90. hart Computer Purchase Categor Pathology Pathology Non pathology Lab computers purchased purchased Purchase moved with at home used for work only incoming new faculty Faculty Faculty Residents Fellows Faculty Secondary Appointment Staff Departments Support limitations e ITS will diagnosis the problem to the best of our ability This may take several days depending on our schedule and the amount of calls required to technical support services Clinical and department support computers take priority over research and others e It is assumed that all computers have an up to date data backup ITS is not responsible for loss of data Resident Information Technology Services Manual Rev 06 11 JHS Desktop Computer Use and Support Page 7 e If parts are required ITS will contact you for approval and charging instructions e If software needs installing and the computer is a personal purchase the user must provide ITS with the disks ITS does not provide system disks ITS observes and adheres to all licensing laws Pathology purchased computers for home use e Computers must be brought into ITS to be looked at For internet connection problems ITS can only verify that the computer connection hardware works ITS cannot troubleshoot ISP settings Network specific settings are the user s responsibility to troubleshoot with their ISP ITS does not make calls to ISP providers Advice e ITS will spend 15 m
91. he application To access a patient s record click on the find patient icon in the toolbar Access to CCSS Sunrise Clinical Manaczr ions Preferences Tools Help GP OR Q GLI io B22 Fe AccesstoCCSS AAAAAAAAA 000058 Other zzSunrise 7000 Access File Registration Edit Yiew GoTo Patient list MCAS Results Patient Info Summary Documents Clinical Summary CCSS Centricity EMR Current List Access to CCSS 7 Select All Patients 1 Visit s Save Selected Patients The Find Patient popup window will appear Enter the patient s last and first name and click on the Search button A list of possible choices will display in the lower portion of the Find Patient window Resident Information Technology Services Manual Rev 06 11 JHS Page 86 Name iit ite le ce tea ee a Seach Enter full or partial criteria then start Search Last holness Given kevin I Find similar sounding last names T Include patients with highest privacy level Name Gender Birth Date Deceased Date HOLNESS KEVIN Male 11 25 1936 C ShowViete Create Viet ae oe ao Double click on the correct patient s name or after highlighting the correct patient click on the Show Visits button The following window will appear Highlight a visit to engage the OK button Once engaged click OK Admit Date T ype Care Level Location Visit Status Name 03 03 2008 Inpatient Inpatient WP3 CTICU 312 4 ADM HOL
92. he physical technical and procedural safeguards used to prevent unauthorized access to protected health information stored either electronically or in any other format Security 1s breached when someone who is NOT authorized to have access to information seeks to obtain it Privacy confidentiality and security are inter related To protect a patient s privacy one must keep information about them confidential To maintain confidentiality one must make sure information about the patient is kept secure Departmental Privacy Confidentiality and Security Policy Every member of the department is obligated both by professional ethics and now by federal regulations to do everything possible to protect the privacy and confidentiality of patient information without compromising the quality of care delivered to our patients Policies and procedures to protect this information are collectively referred to as the Department s Privacy Confidentiality and Security Policies and are detailed in the Informatics Policy and Procedure Manual Constant vigilance by every member of the department to assure that their behavior and that of their co workers is appropriate is an essential element of the departmental policies The essence of those policies 1s described here Net ID Page 21 Examples of Inappropriate Behavior The following are examples of behaviors which violate departmental policies because they can directly or indirectly compromise
93. history of the patient Once the specimen priority is correctly set it is then important to enter the correct part type for each of the specimen parts to be grossed This is done from the Specimen tab of the Histology Data Entry Edit activity See the description of Part Type above under Definition of terms Block information CANNOT BE ENTERED for a part until a part type is specified Specifying the part type will set the default histology protocol and or default block designations which will facilitate the data entry process It also makes case retrieval at a later date possible Once the part type is specified it is time to examine the specimen dictate the gross description decie what tissue needs to be examined microscopically and enter the histology information into the computer Details of the digital dictation system are described elsewhere Histology block information should be entered into CoPath only by scanning barcoded cassettes A manual method 1s available but that should be used only under unusual circumstances since it bypasses several consistency checks and therefore is not as safe Cassette Labeling Application Before any cassettes can be entered they need to be printed Tissue cassettes are printed with the specimen accession number part number and block number both printed in a readable format on the cassette and encoded in the barcode Details of the operation of the Cassette Labeling Software i
94. hn M 08 12 1947 030 38 0257 Smith John M 07 11 1937 267 48 0258 2Y Smith John M 03 04 1965 Tr Smith John M 05 27 1921 130 05 6146 3Y Smith John M 12 31 1937 031 30 1312 10 Y Smith John M 02 25 1924 049 12 8570 1Y Smith John M 03 22 1928 080 20 6886 2Y Smith John Mo 09 01 1950 042 42 5640 3Y Smith John M 02 02 71947 04 42 4206 1Y Smith John M 11214 1941 048 32 6374 1Y Smith John M 12203 1959 044 64 5813 1Y Smith John M 09 14 1943 04 34 9966 4 Y Smith John M 12 13 1925 TY Smith John Mo 07 25 1930 288 26 1930 1Y Patient cases 31 Case status I D00040874 BACK MID 12 20 2000 Final I D01005298 RIGHT TIP NOSE 02 16 2001 Final I D01010792 SHOULDER LEFT POSTERI 04 10 2001 Final I D01013262 LEFT CALF 05 02 2001 Final I D01026462 LEFT LATERALUPPER ARM 08 15 2001 Final oe 4 b Cases C Demographics Cancel Help Double click on the patient and the cases for that patient will show below Double click on a case and it will open to check the patient s information and reports Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 96 S Case Information D99028593 Imported _ Accession no Case type Patient name Age Medical rec no Case status P99028593 PLab Derm History Smith John E9 Final General Req Data Specimens Charges Patient History Results Notes Referring physicians Delivery locations Referring
95. ially c A one letter code for the image type Should be in LOWER case Valid image codes are g gross photograph includes in situ autopsy photos specimen photos etc m tissue light photomicrograph H amp E histochemical special stain or immunostain c cytology light photomicrograph includes smears thin preps FNAs touch preps i immunofluorescence photomicrograph e electron micrograph r radiology study including plain films CT MRI etc f FISH fluorescence in situ hybridization study d diagram document eg sectioning diagrams etc Does NOT include requisitions w whole slide image x external report y Yale pathology final report Z requisition image a additional study Pretty much anything that doesn t fit into one of the above Use for cytogenetics gels etc If there is an image type which is used frequently but does not have its own letter designation please contact ITS about obtaining an official image type designation NN Sequential image number as a two digit number 01 02 03 Start at O1 for each image type code dddd Optional 0 4 character description used to qualify the image type selected For example for a photomicrograph this could be used to identify a special stain or which antibody an immunostain represents For a gross photograph it might identify which organ is represented For a FISH study it could indicate tumor or normal tissue Use LOWER case letters and separate from the
96. ical Library also called LE 25 You will need to bring your ID with you Their hours are from 9 00 AM to 4 30 P M Monday through Friday telephone number 203 737 1244 The Walk in Help Desk can also help you activate your Net ID Once you have a PIN you need to activate your Net ID by using a Web browser and connecting to the following URL www yale edu netid Instructions for account activation are on the web page see following screenshots Yale University Activate Your NetiD Activate Your NetID Type Auth Setup Confirm Please select the option below that describes your current relationship with Yale University O Faculty or Staff OUndergraduate Student OGraduate Student Alumnus Dependent NetIDs Other Clear Form Cancel Continue Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 16 Yale University Activate Your NetID 090 0 Auth Setup Confirm This process will activate a user s NetID given a pre assigned 8 character PIN and the user s birth date The PIN is not a password and cannot be used to any computer system Once your NetID is activated the PIN is no longer valid 8 Character PIN g oo e Birth Date C OO A E Yale University Rr Change Your NetID Security Info Important You may be asked for some or all of the information below if you forget your password Store this information in a safe place NetID ew44 Change Email Ad
97. ich you have your e mail account Your e mail account is accessed using a web browser program on any desktop computer connected to the internet This program communicates with the e mail server Examples of web browsers are Safari and FireFox they have the ability to access your e mail account on the pantheon server Outlook Web Access OWA Yale ITS has set up web based access to the YaleConnect e mail server so that account holders can check their e mail This web access does NOT download your e mail so unless you specifically delete read messages they will still be available the next time you check your mail To use Outlook Web Access you must know the username and password for your e mail account on the mail server These are your Yale NetID and corresponding password If you do not know these you can have Path ITS get you a PIN from Yale Client Access to help you reset you NetID password To use OWA e In a web browser go to http connect yale edu e Enter your user name and Yale Net ID using the following format Resident Information Technology Services Manual Rev 06 11 JHS E Mail Page 14 Yale University ITS YaleConnect YaleConnect Support HelpDesk System Status E mail Address yale NetID e g yale NetID or first last yale edu Password eecccccece Security show explanation This is a public or shared computer This is a private computer E Use the light version of Outlook Web App amp 3 Conne
98. ide 12 stainer tis IRNT 3 Matic Mido SMSin1e6 s2 The information in the Asset Tracking tab is displayed in an explodable tree structure The hierarchy is Part Block Slide Event In front of each item in the tree is a or symbol This is Resident Information Technology Services Manual Rev 06 11 JHS Stain Process Entry Edit Page 71 a disclosure control A symbol means there is information under this level and it can be revealed by clicking on the sign A symbol means the information is currently being shown but can be hidden by clicking the sign The first item listed under each block will be Block Events Disclosing the information under this header will display all of the tracking events for that block Similarly clicking on the disclosure control for any of the slides associated with that block will display detailed tracking information about that slide Histology Asset Tracking Histology Block and Slide Tracking Information Part 1 KIDNEY BIOPSY FORMALIN Block1 KID No Description Status Filed on 05 29 10 07 29 Block Events 05 2610 14 56 04 Ordered by TRAMMEL JESSICA STAT tan 05 2610 15 05 09 Received by COLLINS CHRISTINE 05 2610 15 05 09 On Batch by COLLINS CHRISTINE 26831 1 05 2610 16 23 59 Embedded by COLLINS CHRISTINE 05 29 10 07 29 54 Filed by DAVIS PHILIP Slide 1 H amp E Initial INIT Stat
99. ift N will keep this same formatting Any new paragraphs created will keep this same formatting Ctrl T Ctrl Shift T Home End Cirle Cerit Ctrl Home Ctrl End Backspace Ctrl Backspace Ctrl Shift Spacebar Access the next text field in a set of option buttons Ctrl Q Access the previous text field in a set of option buttons Ctrl Shift Q the tab page on the tab page Zoom a text field Zoom the text field Shift F8 Initiate Preview mode when in a text field using this Ctrl 8 combination zooms the text field and displays it in 5 o Preview mode If the text field is already zoomed it is in Preview mode Preview mode displays the text field very closely as it will appear on the report Resident Information Technology Services Manual Rev 06 11 JHS Valid Part Types by Specimen Class Part Types for Surgical Specimen Class SR OSR BPS Adrenal Gland Excision Amputation non tumor NOS Aneurysm Contents Appendix Bile duct Bx Bladder Biopsy TURBT Bladder Cystectomy Bone Marrow biopsy Bone fracture Bone Not tumor Bone osteoarthritis Bone Stapes Bone tumor Brain Breast Mastectomy Breast Needle biopsy Breast Open biopsy Breast Reduction mammoplasty Bursa Cartilage Nasal Cervix biopsy Cervix Cone Bx Colon biopsy Colon Resection Not Tumor Colon Resection Tumor Composite Resection Conjunctiva Biopsy Conjunctiva Resection w Margins Cornea Cyst NOS
100. image number with a dash If no description is used the dash should not be used either ATT Standard file extension identifying the image file format in LOWER case Use the following standard extensions Jpg Joint Photographic Experts Group JPEG file RECOMMENDED tif Tagged Image Format TIFF file not currently used jp2 JPEG 2000 Used for whole slide images Examples A2001 000012g01 jpg S2002 005233m03 cd20 jpg Resident Information Technology Services Manual Rev 06 11 JHS Photography and Digital Imaging Page 30 C2000 094820c12 jpg N2002 000013c02 fna jpg ImgUpload Program and Image Filing The ImgUpload utility is designed to facilitate the renaming of clinical digital image files according to the naming convention needed to direct the images into the Yale Pathology Clinical Image Repository and eventually into the CoPath laboratory information system Features include e Thumbnail display of images in a source file e Full resolution preview of images e Easy mouse click selection of images to be filed e Drop down menu assignment of image types e Specimen accession number entry and lookup e Automatic renaming of image files as they are transferred to the image drop folder e Automatic numbering of image files within an image type class preventing accidental use of duplicate numbers e Optional automatic deletion of images from the source location after they have been filed e Optional easy deletion of remaining bad q
101. in Process Request Class Similar to the block request class the stain process request class indicates why the stain process was ordered The choice made here determines whether or not the patient is billed for the stain a request class of Clinical will result in a bill to the patient even if it 1s ordered days weeks or years after the case has been signed out Do NOT use the Clinical request class for personal educational or research related stains Stain Process Histology Department Indicates which histology laboratory will perform the stain Provides support for multiple laboratories using the same clinical information system Stain Process comment Optional free text field to provide special instructions to the histology department Barcode based Histology Asset Tracking System The YNHH histology lab processes hundreds of blocks and slides collectively referred to as assets every day Each block and slide has to be correctly identified and labeled The opportunities for error are many and the implications to the patients of a lost or mislabeled block or slide can be enormous the wrong patient could have unnecessary surgery To promote patient safety and to facilitate the workflow in the histology laboratory a computerized tracking system has been designed and written in house specifically for our laboratory The tracking system developed Resident Information Technology Services Manual Rev 06 11 JHS Histology Data
102. ind record Ctrl F U O U X amp Progialll Fires aAamNUON rOwerratn CHEML rOWEIrdalnivient exe 24 PowerPath File Edit View Tools Window Help S Desktop of Demo User Favorites Contents of Desktop Fayvorites Startup To Log Out of the PowerPath select File Logout then exit the system by selecting Cancel OR select File Exit to completely exit the system Resident Information Technology Services Manual Rev 06 11 JHS Using PowerPath Page 98 Printing from PowerPath from a MAC Double click Cases icon to open PowerPath Case Information OOA 2 C Program Files Tamtron PowerPath Client PowerPathClient exe File Edit View Record Tools Window Help Ja SllA O S 4 BB Molla dr HW s jos a 23 Case Information No Cases Accession no Case type Patient name Medical rec no Cc l General Reg Data Specimens Charges Patient History Referring physicians 7 Delivery locations Case and billing information Revenue center Enterprise facility re B eee hs ot Party to bill Fee schedule Case priority 3 du tamapp Powe Type in Accession number or use the search option either by clicking on the binocular or CTRL F to find patient by name 00608 y C Program Files Tamtron PowerPath Client PowerPathClient exe File Edit Yiew Record Tools Window Help Aee ma se Mol MPM BlIS Dlo amp 3 Case In
103. inutes looking at the computer and provide our opinion of the situation per incident applies to each new non related issue We may refer you to web sites that may help you further troubleshoot the computer such as instructions for rebuilding your system or we can recommend where to take it for repair e ITS will also help or provide instructions to this category of user to set up printers for use in pathology access internal wireless networks and minor settings ITS does not support personal items such as non Yale e mail accounts music videos for personal use or other non essential non work related software or network issues Support includes a Ordering hardware and related software b Basic consultation for equipment purchase c Equipment installation and set up including 1 E mail 1i Pathology server access iu Network set up iv Software installation v Software updates vi Phone based support vil User training sessions d Maintenance and relocation of the equipment e Custom software development 3 ITS does not provide a Hard disk management b Support for specialty equipment or software 4 Fees may be charged for the following see computer support chart above Computer maintenance Repairs Diagnostics Researching specialized systems Damage to the computer due to unauthorized use or software installation Software upgrades moa Ts Resident Information Technology Services Manual Rev 06 1
104. l Rev 06 11 JHS Scope and Structure of ITS Page 3 e Customizations to the clinical information system as needed to meet the needs of the department This includes custom reports window painting trouble shooting and other specific modifications e Control and monitor all access to the clinical information system e Coordinate compliance with regulatory requirements imposed by the Federal Government the College of American Pathologists the Joint Commission for the Accreditation of Healthcare Organizations and other regulatory agencies e Administer access to extra departmental information systems to facilitate patient care The CIS Manager is the contact person for coordinating access to information systems in other departments within the Hospital Healthcare Network and Medical School e With appropriate approval the pathology clinical information system can be used to identify cases for research purposes Details of this process are discussed elsewhere in this manual IT Infrastructure and Core Hardware Manager Janos Lobb Much of the usefulness of the many computers seen on desktops throughout the department is made possible by the cable coming out of the back of the computer plugged into a jack on the wall labeled data This is the computer s network connection which allows communication with other departmental desktop computers the central servers in the department including those housing the department s clinical informati
105. lable at http www ynhhslearning com Chartview This system is part of the SoftMed application SSIMenu where operative WY notes can be viewed Navicare This system provides real time OR status 23 a Centricity The outpatient system used for YNHR s primary care clinics and physician s specialty clinics In addition to pathology reports this system has laboratory medicine results diagnostic imaging results and operative notes Resident Information Technology Services Manual Rev 06 11 JHS Accessing the YNHH Clinical Applications You will need a Network ID and password to access the YNHH Clinical Applications Please contact the Pathology ITS Help Desk at 785 3691 or PathITS yale edu for assistance with ID and password assignment To access YNHH Clinical Applications click on the ClinApps folder in the dock and select the icon for the required application 8 Resident Information Technology Services Manual Rev 06 11 JHS Using Centricity Training website www ynhhslearning com gt Double click on the Centricity icon gt There will be a delay of 5 500 seconds Please be patient you will get a log in screen gt Enter your userid If this is your first log in click new password Enter your old password your new password and verify your new password Click OK Otherwise press Tab and enter your password and click on OK Location of Care
106. line Ob Gyn For outreach specimens Service is not a required field and location is used for multi practice sites only As with the submitting physician field the tab key will open a window which will allow you to choose the appropriate location The location should match the client s practice site as listed on the specimen requisition Billing Type should be entered as Lab Outreach The case is now complete Click on the Save New Specimen button Ready ioi x Fie Edit Options Window Help R Da Mat oX al 507 5104 Accession Entry Edit Patient BLOSSOM CHERRY 04531939 MR 9988777 YNHH Spec Class SR DOB 0649 1943 Age 63 F Client YNHH sit 56042391 fec Date 0607 07 Status New Accession Intake Accession Data Text Specimen Data m Other Data Submitting Physician Visit Number 56042391 u Other Case Numbers CHUONG JACK J OTHER 5 SpecReq Deficiencies Location h 7 EP Surgery Ef ain Ser Burgery General M Retrieval Flags Additional Physician s in Serv Surgery General eee O Billing Type YNHH In x Fee Codes Also Send To gt Edit Patient Info SaveNext Specimen Case Intake of a Specimen that Requires Registering a New Patient Access the CoPath system From the Application Manager click once on the Specimen command button The Select Specimen window will appear Enter the patient s name using a combination of
107. lude 90 Day Login Report This report retrieves the names of individuals who have not accessed the YPDCIS for the past ninety days The System Manager validates the user s continued employment and need for access If the user has left the department or if job responsibilities are no longer clinically related access is inactivated This report is run quarterly e Active Users Report This report retrieves the name of all active users and the date of their last entry into the system The System Manager reviews the report for unusual lapses of time in user activity Access is inactivated for those individuals who have left the department or whose job responsibilities no longer require access to the System This report is run semi annually Evening Activity Report This report retrieves the names of individuals who access the system between 7 00 p m 7 00 a m daily The report is reviewed by the System Manager for any unusual activity This report is run monthly Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 26 Other Hospital Systems Pathology Department staff may be granted privileges to access other hospital medical school information systems based on job related needs Access authorization privileges and terms are determined by the managers and policies of the respective systems Access to non pathology YNHH diagnostic related systems is coordinated through the Pathology ITS Help Desk if the need for
108. maging With the increasing acceptance and use of digital imaging as a routine method for documenting clinical information it is necessary to have a standardized mechanism for storage of these images to allow appropriate security and ready retrieval and to prevent the duplication of efforts associated with re photographing already photographed cases A standardized storage location and format also allows archiving of the many images currently being taken for case presentation conferences so that they are not subsequently lost simply because there is no appropriate place to store them The pathology department switched to digital imaging several years ago Digital images offer several advantages over traditional 35mm photography For example image quality can be immediately assessed at capture time and the images are immediately available for use Images cannot get lost because a roll of film does not develop correctly Images can be duplicated indefinitely without loss of image quality Yale Pathology has developed a unique and custom solution to meet its clinical digital imaging needs Digital images for any clinical case need to be stored in two different places one copy 1s stored in the Clinical Image Repository and a second copy is imported into CoPath to allow incorporation into patient reports However users only have to create one copy of the image label it correctly and place it in the correct place and background software will handle
109. men is from the current year Then enter the case number For example entering S5097 will retrieve the current year s surgical case SX X 5097 If one wanted to view the surgical case 5097 from 2002 you would need to enter S02 5097 Click on the Search button or hit the lt Enter gt key on your keyboard The bottom portion of the Select Specimen window will display the specimen information You can now select an activity from the dropdown list at the bottom of the window Then click on the OK button or hit the lt Enter gt key to start that activity on the chosen specimen If you click the OK button without selecting an activity an activity selection pop up box will pop up box will appear Select the desired activity from this list and press OK Specimen activities were described above Specimen Activities Amendment Edi Amendment Entry Cancel Attachments Entry Edit Billing Entry Edit Help Resident Information Technology Services Manual Seat eed Rev 06 11 JHS Container Label Reprint Diagnosis Coding Entry Edit Final Niannnsis FrtrvsF edit Working on Specimens in CoPath Page 46 Select Specimen x Search z z Specimen 207 5097 or Patient Name or MRN a __Search oF Search Criteria or Encounter Number _Same Patient Hsads Next Specimen Select Specimen for BLOSSOM CHERRY New Specimen Specimen Class Acc Date Status Tissue Source m T Worklists
110. n Stain Process Group Save Stain Process Group In contrast in the second approach below the Keratin stain is being ordered on Unstained slide level 12 This is done simply by changing the Unstained stain to the Keratin stain This will not result in a deeper cut into the block Rather the histology lab will locate slide level 12 and relabel it for Keratin staining lt Stain Process Entry Edit Histology Data for Part 1 1 of 3 KIDNEY BIOPSY FORMALIN Stain Process Blk Desig Count Level Request Class Comment Ordered By Histology Lab s heem Jo zh s Ena eI _ IMOECKEL GLBERT NHHHistoogy z fines J M zh Je JOE e S Histology 7 e a At 7 a A a A Fistolooy a Peroac aca Schl 1O zh e finca J NOEcKEL Geen wHHistomgy z tafinstained mta J 1KO h 10 Erica OOOO MOECKEL GLBER VNHHFistolooy z 1 insted mai Jao st 11 Eea OOOO MOECKEL GLBERT NHHHistobogy z b 12 feran aerees aao h 12 nca A SINARD JORN H Q YNRH Histology z 1a pnstanea mtia Jaf zh 13 fica OEKE GLBER NHHHstoogy E YNHH Histology v 14 Linstained Initial KD vh J14 Cinca eff ECKL GILBERT Stain Process Detail Run Stain Process Group Save Stain Process Group Resident Information Technology Services Manual Rev 06 11 JHS APPENDIX Keyboard Shortcut Keys Shortcut keys involve the use of the Ctrl Shift or Alt key along with another key or characte
111. nally remember that printed patient information must be protected as tightly as electronic information Patient records of any form are not to be taken from the premises All printouts or other documents containing patient information are to be disposed of only in specific waste containers designated for shredding or are to be directly shredded before disposal CIS Access Policy Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 23 The Yale Pathology Department Clinical Information System YPDCIS contains confidential patient information As such access to this system is restricted Access is provided only to those individuals within the department whose daily responsibilities are directly related to clinical care Interdepartmental usage is limited to areas with State reporting requirements or functions necessary to meet the department s business needs Although each potential user will be individually evaluated the following criteria will be employed when deciding whether or not access privileges will be granted e Employees faculty staff of the Yale Department of Pathology whose daily activities require access to the YPDCIS The level of access will be appropriate for the required activities e Clinicians on the YNHH Yale Medical School staff or associate staff providing direct patient care services either as a primary care giver or as a clinical consultant to patients whose specimens are evaluated by the Yale
112. ng blocks can be shown by clicking on the button in the lower left corner of the window Barcoded Block Wizard 510 6 3 parts BLOSSOM CHERRY A Scan Barcoded Cassette i Defaut in designation if only one Iv Fiter used designations from insert list READY to sean Require sequential entry No skipping Fart Block Category Desig Description Inset standard designation Stains 7 49 Rouwtine bluesorar 2 4 Routinelblueforar 2 2 Routine blueforar 3 47 Routinetbluesorar 3 2 Routine bluesorar 3 9 Routine blueforar 3 4 Routine blueforar 3 Routine blueforar a 6 Routinelbluesorar Cancel No Existing Blocks Create Blocks Hista Lab Y MHH Histology ka The first thing to do is to verify that the correct histology lab is selected This is driven by the specimen class assigned at the time of accessioning and will usually be correct except perhaps for cases which are from Bridgeport Hospital The checkboxes in the upper right control the behavior of the wizard Typically you will want the configuration shown above These settings will be discussed in more detail below The Wizard will be in it s standard entry mode the focus will be on the entry box in the upper left Scan Barcoded Cassette and the text READY to scan will be shown in blue below the box If this is NOT the case simply click in this entry box to reset the focus here for scanning As each cassette is scanned it is activated
113. nology Services Manual Rev 06 11 JHS Net ID Page 22 As a resident of the Department of Pathology you will be provided with an IronKey encrypted flash drive The IronKey flash drive should be used for all storage and transfer of EPHI Access to the Clinical Information System via any of these desktop machines is via session emulator software Citrix Metaframe in which a user session is established on a server in the hospital data center and only the screen output is displayed on the desktop machine No clinical data is EVER transferred to local storage devices It is a MAJOR violation of departmental policy to copy paste or otherwise download any protected health information to a local document or non password protected device Signed confidentiality statement forms are required before access is granted to the Pathology Clinical Information System Access to the system requires a unique user identifier and password of sufficient complexity and is limited to those individuals whose job responsibilities are directly related to departmental activities and or clinical care Your password should never be shared with anyone and you should never use or attempt to learn another person s password If you feel the secrecy of your password has been compromised at any time change it and contact the Clinical Systems Manager immediately You are required to change your password every 60 days Access privileges are role based meaning you will only have acc
114. ns are to be taken If appropriate institutional and local law enforcement officials will also be notified Appropriate Use of Electronic Systems Please refer to Yale University Policy 1607 Information Technology Appropriate Use Policy and the YNHH Policy B16 1 Electronic Communications Policy for guidelines in the use of the department s electronic communications systems see Appendix Appropriate use includes all activities which are related to job responsibilities accessing business patient records when appropriate or for approved professional development The following are some examples of inappropriate behavior and may result in disciplinary action up to and including termination and prosecution when the infraction involves criminal activity Since all types of inappropriate conduct cannot be contemplated this list 1s not intended to be complete Unauthorized attempts to break into any internal or external computer system Use of electronic systems for personal gain Use of electronic systems for unlawful activities eSending threatening prejudicial or sexually harassing messages Use of objectionable language in messages eTheft or copying electronic files without permission eRevealing to unauthorized persons confidential information such as patient or employee information eAccessing sites featuring gambling activities pornography or non work related chat rooms Resident Information Technology Services Manual Rev 06 1
115. nslation of the block designations but also an understandable list of the tissue submitted for histological examination Block category This is used to route the flow of work in the histology laboratory The block category is essentially equivalent to the color of the cassette into which the tissue is placed Different types of specimens are processed differently in histology and the cassette color is used to route those tissue blocks For example rush specimens go on a shorter processor cycle and are cut first so the slides are available earlier Routine cases with more than 5 tissue blocks are generally cut later in the day More details about the block category are provided below under manual entry instructions Block Request Class An assessment of why the tissue block was submitted for processing This determines whether or not the block appears on the final report in the summary of sections Block Histology Department Indicates which histology laboratory will process the block Provides support for multiple laboratories using the same clinical information system Block comment Optional free text field to provide special instructions to the histology department Stain Process Each time a tissue block is cut and a section is placed on a glass slide something needs to be done to that slide Most commonly this is an H amp E stain but could also be a histochemical stain or an immunohistochemical stain Recut is also a stain process Sta
116. o cut into the block For example the standard prostate biopsy stain protocol is H amp E Unst H amp E Unst H amp E that is cut five slides but stain only levels 1 3 and 5 If one finds a suspicious focus which one wants to investigate further by ordering a PIN 4 stain how to best proceed will be determined by where the suspicious focus is located If it is present on slide 1 and 3 but getting smaller on slide 5 it is likely to be gone if one recuts the block Therefore one should order the PIN 4 stain on the already cut level 2 In contrast if the suspicious lesion is not present on slides 1 and 3 but is seen on slide 5 then it would probably be more advisable to cut a new slide for the PIN 4 stain because it may show the lesion better A new approach has been programmed into CoPath to allow the pathologist to direct which of these procedures should be followed while still preserving the tracking functionality and information If you add a new stain row to the case this will result in a deeper level being cut from the block Please note that THE FORMER PRACTICE OF WRITING PLEASE USED UNSTAINED SLIDE WILL NO LONGER prevent a new slide from being cut Adding a new slide order to the list of slides requires that that order be tracked A slide number needs to be assigned to that slide If the next Resident Information Technology Services Manual Rev 06 11 JHS Stain Process Entry Edit Page 72 sequential number were assigned bu
117. o features of the CoPath system that assist with continuity of patient care are the Other Specimens for Patient OSP window and the Working Draft report These are designed to inform the pathology staff of previous specimens which have been received from the same patient This information is helpful in filling in gaps in the history providing case numbers for slides which might warrant reviewing in conjunction with the current case and identifying other specimens which might have been received by the department perhaps in Cytology for example Other Specimens for Patient OSP Window This feature allows direct viewing of all of the patient s previous reports on the computer screen and also permits printing of one or all of the specimen reports for this patient CoPath Client Server PT Ele Ect Options Window GP a 0 a A at S OBX k DB o Me Patient BLOSSOM CHERRY 04531939 Client YNHH Help MR 9988777 CYNHH Spec Class SR sit 56042391 DOB 061941943 Age 63 F fcc Date 0607 07 Status Final Complete Summary Events Source Statt Procedures Billing Codes Demographics Text SSO Other CoPath makes it easy to determine whether there are other specimens associated with a patient A light bulb exists on the toolbar which is present within all of the specimen activities This light bulb will be lit if other specimens exist for the patient Clicking on this icon from
118. o obtained during the process of providing that care for example in the form of test results This information must be kept protected In the course of your work activities all full time and casual employees as well as volunteers working in the Department of Pathology will have either direct or indirect access to protected health information or PHI PHI is defined as any individually identifiable health information that is information about a person s health that can be linked back to that person in some way PHI can be electronic or paper documents or verbal communication PHI is kept protected by preserving privacy confidentiality and security Privacy the right of an individual to freedom from unauthorized intrusion simply stated your right to be left alone Privacy is violated when for example a physician or employee contacts a patient to obtain information for a purpose other than the health care of that patient such as for a research study Confidentiality the right of an individual to have personal information about them either provided or otherwise obtained during the process of health care delivery kept private and not disclosed or used for any purpose other than to provide health care Confidentiality is breached when a person authorized to have access to information either uses that information for a purpose other than that for which it was provided or discloses it to a person NOT authorized to have access to it Security t
119. o provide access to a Windows only application on the Macintosh or any other platform This architecture also facilitates the process of workstation updates and maintenance CoPath features a graphical user interface consistent with the look and feel of other Microsoft Windows applications Like Windows CoPath uses the desktop metaphor CoPath can run while other applications e g a word processing package a spreadsheet an electronic mail function are also open in other individual windows on your desktop One can easily switch from one application to another cut or copy and paste data between applications and perform functions using a mouse or a keyboard Logging in to CoPath To access CoPath you log in using an account which has been previously established specifically for you To begin the process you must establish a connection to the Citrix server This is done from any of the Macintoshes in the clinical areas by double clicking on the desktop or dock icon named CoPath Access CoPath Access The Log in screen shown below will appear Enter your assigned User ID and your Password Use the tab key to maneuver between the two fields Click the Sign On button or hit the lt enter gt key If lool Bar Working on Specimens in CoPath Page 36 you enter either your user ID or password i StreMtY an error message will appear Try again After five unsuccessful attempts CoPath will automatically exit you from the
120. ock and click on the Add Stain Process button A complete list of the stains ordered for that part will be displayed Stain Process Entry Edit X Histology Data for Part 1 1 of 3 KIDNEY BIOPSY FORMALIN Stain Process BlkiDesig Count Level Request Class Comment Ordered By Histology Lab apem ao 1 SEL HoecreL oueeny rtitistoouy 2 Periodic aca sonjo zh 2 finica J MOECnEL GLAER _ YNFE Histoiogy z 4 ichrome Kats KIO fi_ 4 Cina MOEcwEL GLeR A Histology S Fee ntia T fi_ 5 cincar MOE CkeL OLeR Yeti Hstoouy 8 8 PME CKELOLBERT VINHH Histology x 2 emetoryin Phiod 10 fi_ 9 Cinicar MOECKEL OLeR YH Hstoouy 10 10 A MOECKEL GLEER VNHH Histology 12 12 fines A MOECKEL GLEER NH Hstotouy gt E Ee A ef 13 Eines J ____________Moecxe ouper yirwiristoigy r Stain Process Detail Run Stain Process Group Save Stain Process Group Stain Process Entry Edit Page 70 Most of the fields displayed are intuitively obvious what stain was ordered what block it was ordered on how many were ordered who ordered the stain and what lab is to perform it Request Class for stains is similar to that for blocks but has billing implications for the stain Clinical defaults into this field for active cases and will automatically generate a billing charge for the patient To ensure that the patient is billed appropriately it is imperative that the correct req
121. of Conception Prostate needle biopsy Prostate prostatectomy Prostate TURP Rectal biopsy Rectum Hirschprung s Salivary Gland excision Sinus contents Skin excision Skin punch biopsy Skin shave biopsy Small bowel biopsy Small Intestine Not tumor Small Intestine Tumor Soft Tissue Debridement Soft Tissue Mass Special Procedure Spinal Cord Spleen Stomach gastrect nontumor Stomach gastrectomy cancer Stomach biopsy Stone calculus Synovium Teeth Temporal artery biopsy Tendon Testis Biopsy Testis Not tumor Testis Tumor Thrombus Thymus resection Thyroid resection Toe s amputation Tongue Biopsy Tonsils Adenoids Ureter Urethral Biopsy Uterus Cervical cancer Uterus Endometrial cancer Uterus Myomectomy Uterus Simple Hyst No Cancer Uvula Vagina Biopsy Vagina Not biopsy Varicose veins Vas Deferens Vocal cord biopsy Vulva vulvectomy Vulva biopsy Rev 06 11 JHS Part Types by Specimen Class Page 77 Part Types for Specimen Classes AUT and BPA Autopsy Adult gt 18 yrs Autopsy Brain Autopsy Child 6 mos 18 yrs Autopsy Fetus Perinatal lt 6 mos Autopsy Heart Autopsy Tissue Consult Part Types for Cytology Specimen Class CG OCG BPCG Autocyte Prep Pap Smear Miscellaneous Nonstandard Pap amp MI Nonstandard Pap Vaginal Nonstandard Pap Vulva Pelvic Washing Standard Pap amp MI Standard Pap amp MI Bpt
122. of the access based on the employee s job responsibilities Non pathology department employees desiring access must complete the Client Application Form before requests will be considered All users must sign a Confidentiality Agreement Form before an access account will be set up In brief this Form documents that the user agrees among other things e not to access clinical or demographic patient information except as required for patient care activities e not to release any clinical or demographic patient information to any person except as required for patient care activities Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 24 e passwords must meet certain minimal requirements of complexity e not to release their password to any person for any reason e to notify the system manager immediately if they suspect their password may be compromised e to take full responsibility for any use or misuse of their account to access patient information The confidentiality form contains a place for the authorizer to approve access Once signed by both the user and the authorizer an account to access the system can be set up This is routinely done by the Clinical Systems Manager but in the event of the absence of that person may be done by other ITS personnel The signed confidentiality form will be kept on file in the ITS department Role based Access The level of access granted to the user will be determined by
123. on system and the rest of the world The pathology local area network LAN is a subnet off the YNHH network which itself is protected behind a firewall preventing unauthorized access from the outside world The pathology network currently supports over 400 connections Our department is rather unique among the departments at the medical school and the hospital in that we maintain our own network and maintain our own central servers This 1s the main responsibility of the Infrastructure and Core Hardware group of the Pathology Information Technology Services unit Activities of this team include e Maintain the wiring in the network closets including the patch panels which connect the wall outlets to active ports on the network switches This includes as needed coordinating new line drops e Manage assignment of IP addresses for ALL computers and printers connected to the department s network e Coordinate all electronic communications between equipment on our network and any systems outside our network e Maintain and administer all of the central servers which support clinical data storage deployment of the clinical information system peer to peer file sharing networked printing and communication with other systems This currently represents more than a dozen server level machines e Maintain and manage regular back up of the central servers e Explore investigate and develop new connectivity and application delivery to support depa
124. on to the right of the encounter field A pop up list will display all of the encounters assigned to the patient Highlight the correct encounter number if necessary 4 Encounter numbers are only x aed Tor ooi eaten DOB 06 19 1943 Current Age 63 MRN 9988777 p p Gender F Client NHH and are not required if from an outpatient service or Encounter Number 6042391 w Same Patient most outreach clients with the exception of Shoreline Specimenciass R Surgical Routine 1l Obstetrics and Gynecology TETS The specimen class is also wheel Year Number P Specimen Number s ai 2007 5104 assigned to the specimen from this screen You may Recent Specimens for this Number Wheel Specimen type in the specimen class Parts abbreviation e g SCO SR S07 5098 ENDOMETRIAL BIOPSY 507 5101 endometrial biopsy CG or use the pop up 507 5102 Consult window by clicking on the 507 5103 endometrial bio Cancel button to the right of the aie e oeno specimen class field The system will now assign a temporary specimen number using the appropriate number wheel based on the specimen class designation Click on the OK button Help Resident Information Technology Services Manual Rev 06 11 JHS Sissies in x File Edit Options Window Help R O ea SOBX Pr a w e Patient BLOSSOM CHERRY 04531939 MR 9988777 YNHH Spec Class SR DOB 06 19 1943 Age 63 F You are NOW
125. orners are a good place for these The size reference should be in the same plane of focus as the lesion being photographed e For irregular specimens it is often helpful to use wet paper towels behind portions of the specimen out of sight to bring the lesion and surrounding tissue into the same plane of focus e Do NOT photograph both halves of a cut specimen the open book photograph Both cut surfaces contain the same information simply mirrored As a result you loose half of the field and gain nothing However it is perfectly acceptable to photograph both halves of for example a bisected kidney if one half is placed to show the cut surface and the other placed to show the external surface e Lesions should be routinely photographed at two magnifications a low power shot to see where the lesion is in the organ and then a zoomed in photograph showing the detail of the lesion Don t assume that one can always blow up the low power shot the image quality is generally too poor especially for digital photographs e Don t forget to photograph significant lesions identified on external examination The camera can be removed from the copy stand for this purpose remember keep the camera clean Naming Convention for Digital Image Files To assure that images are uniquely identified associated with the correct case and readily located a naming and storage standard has been developed for these files This section describe
126. p Bone FNA Fellow Soft Tissue amp Bone FNA Pathol Soft Tissue and Bone FNA Thyroid FNA Thyroid FNA Cytotech Thyroid FNA Fellow Thyroid FNA Pathologist Rev 06 11 JHS Part Types by Specimen Class Page 78 Valid Part Types for Cytology Specimen Class CN OCN BPCN Ascites Anal Smear Bile Fluid Biliary fluid drainage Bladder Brush Bladder Washing Blood Breast FNA Wash Breast Nipple Discharge Bronchial Aspirate Bronchial Brush Bronchial Wash Bronchoalveolar Lavage Brushing NOS Brushing Common Bile Duct Cisternal Tap Colon Brush Colon Wash CSF CSP Lumbar Tap Cyst NOS Cytology Cyst Ovarian Cytology Cyst Pancreas Cytology Duodenal Brush Duodenal Touch Prep Duodenal Wash Esophageal Brush Esophageal Wash Eye Conjunctiva Vitreous Fluid Resident Information Technology Services Manual Gastric Brush Gastric Wash GI Touch Prep Introitus Miscellaneous Pancreatic Brush Pancreatic Brush Tip Paracolic Wash Pericardial Fluid Peritoneal Fluid Peritoneal Wash Pelvic Wash Pleura Pleural Fluid Research Histology Sputum Sputum Induced Stool Tracheal Brush Tracheal Wash Ureteral Brush Ureteral Wash Urine NOS Urine Catherization Instrumentation Urine Kidney Urine Voided Vitreous Fluid Rev 06 11 JHS Block Category Table Rush pink Any urgent material for which a rapid diagnosis is needed for treatment usually specified as
127. pe of users e g resident s room transcription case accessioning These machines can adopt a non standard setup but only at the request of the manager or administrative chief resident responsible for the work area in which the machine is used Users should NOT e install any software without consulting with pathology ITS ITS can help assess whether or not the new software will result in any incompatibilities with existing software Resident Information Technology Services Manual Rev 06 11 JHS Desktop Computer Use and Support Page 10 e download any executable files from the internet this is a primary source of computer viruses e add or remove any icons on the desktop except as agreed to by all users of the desktop machine e store ANY protected health information or any other information about specific patients This includes correspondence about patients Users SHOULD e store personal files ONLY in an appropriately folder Within this should be folders named with the last name of the user and ALL of that user s files should be stored in that folder e develop their own mechanism for the regular backup of personal data Single User Desktop Machines e g faculty faculty support managers other machines in offices Since these are single user machines the user is free to adapt the machine to best meet their productivity needs However the user must understand that installation or downloading of software alway
128. pplications Organizationally ITS is divided into three areas of focus each with a manager Dr Peter Gershkovich a faculty member and senior manager of ITS oversees the coordination of these focus areas and manages the extensive overlap in their responsibilities to provide integrated services to the department This policy describes the overall structure of ITS and the major goals of each of the areas of focus Organization Chart Title Associate Director of Informatics Peter Gershkovich IT Infrastructure and Core Hardware Janos Lobb Clinical Information Systems CIS Manager Brian M Daley User Services and Support Katie Henderson Yale Pathology uses CoPath Plus a product of Cerner DHT as its clinical information system but performs extensive customizations on a regular basis to better meet the needs of the department Details of the CoPath Plus system are described elsewhere in this manual However the CoPath system 1s involved in every aspect of the processing of clinical material by the department including specimen tracking histology processing specimen reporting and patient billing There is an average of 11 345 log ins into the CoPath system each month Activities responsibilities of the CIS group include e Daily dictionary maintenance daily monitoring of backups interfaces fax server and report chutes user training user access and data integrity Resident Information Technology Services Manua
129. r from the keyboard The combination of these keys helps to quickly navigate through CoPath C S The following table explains the shortcut keys available in CoPath C S Function Keys Function Key Function Help Shift F1 Context Help Ke Application Manager eS Switch Activities Es Other Specimens el Next Tab Prior Tab Move Row Down Move Row Up Next Group Prior Group Lookup Zoom Date 1 Da Date 1 Da Time 10 minutes Time 10 minutes Control Key Combinations Ctrl A Adds row or select all Ctrl C Copy Ctrl D Delete Row Ctrl N Creates a new entity e g specimen encounter patient etc Ctrl O Open an existing entity from within the current activity Ctrl S Save Ctrl V Paste Ctrl W Close the activity you are in Ctrl X Cuts Ctrl Z Undo Using Keyboard Equivalents to Navigate through Specimen Activities The following table lists keyboard equivalents for buttons on the TxText text editor as well as other keyboard combinations that can be used within the TxText editor CtrltA Shift Shif Cirit Shift Ctrl Shift GirltC or Girl Insert Ctrl X or Shift Delete Ctrl V or Shift Insert Ctrl Z Apply Attributes to Text Press these combinations to turn on or off each attribute for selected text or for text that you are about to type Resident Information Technology Services Manual Rev 06 11 JHS Shortcut Keys Page 75 Ctrl B Ctrl I Ctrl K Ctrl Shift Ctr Ctrl U Ctri L Ctrl R Ctrl Sh
130. r password to anyone including IT staff or your supervisor Do not share your account with anyone or let anyone else use your account Do not write down your password on paper nor store it on a computing device It can be a help to write down your password for a few days when you have just changed it keep any such copy in your wallet or purse and discard it as soon as you have memorized your new password e Do not use your NetID password as a password for another computer system such as your ATM card PIN number or as your password to a website on the Internet Do not let anyone see you type in your password Stop typing if you notice someone watching you Make sure your password is not being displayed on your screen as you type Do not save or store your NetID password in a dialup PPP or VPN script Be wary of any program or web page that asks you for your NetID password Secure Yale web pages that ask you for your NetID password will have URLs that begin with https 7 Your browser e g IE Firefox Mozilla should visually indicate icon of a closed padlock that you are on a secure page If you are being prompted for your NetID password from a particular web page that you do not recognize or if the page appears different from the screen you are familiar with contact ITS to verify the authenticity of the page Do not enter your passwords when using insecure protocols e g programs that transmit user account and password information
131. r special stains up front use the Stain Process tab Block designation Two types of blocks can be entered standard blocks used for all of the submission of tissue for clinical purposes and Critical Technologies blocks used specifically to set aside additional tissue for potential research purposes The format for the block designation is different for these two block types Standard blocks Standard block designations contain two parts a unique block number and an alphanumeric sectioning site designation These parts are separated by a single space The space and alphanumeric designation may be omitted but this should only be done if all of the tissue is submitted and each tissue block is equivalent to the others Use the following conventions Numeric Part must be a unique number two blocks in the same part cannot have the same number should be sequential numbers 1 2 3 etc but need not be in order Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 67 Alphanumeric Part should begin with a letter not a number but may contain a number should be in full capital letters should be from 1 to 6 characters long whenever possible should be a standard representation for the sectioning site Avoid arbitrary use of complex designations Designations are printed on the slide label Use of standard conventions will allow immediate identification of the content of th
132. rar 3 4 Routine blue orar 3 Routine blue orar 3 6 Routine blue orar No Existing Blacks Cancel Create 4 Blocks Histo Lab YNHH Histology x After the information has been entered for a block the focus should return to the Scan Barcoded Cassette entry field If it does not you can simply click on that field to select it However the Wizard has been designed to detect the accidental scan of a block into a designation or description field If this occurs it will be handled appropriately The checkboxes in the upper right hand part of the window control the behavior of the Wizard Default in designation if only one If selected scanning a block for a part for which the associated part type or protocol has only one standard designation will cause that designation and description to default in Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 65 Filter used designations from the insert list This option facilitates data entry by removing from the drop down list cassette designations which have already been used for that part For example if the standard designations for the part suggest that you submit five slides designated T for Tumor two designated R for Random and one each of VM Vascular Margin and BDM Bile Duct Margin the behavior of the drop down list will be different based on the setting of this option Checked The list will contain 9 entries five T
133. rcode Block Wizard was designed to allow for rapid but safe entry of histology information into CoPath It collects information from the scanning of barcoded cassettes and user entry and then uses that information to automatically insert into CoPath all the histology and slide stain information needed to continue the processing of the case As with all of the other components of the asset tracking solution data entry is facilitated with appropriate defaults while at the same time performing consistent double checks to assure that the information entered is accurate Patient safety and patient care features include Setting the correct part type determines what block designations and stain sets will be available for data entry Block information cannot be entered into the Block Wizard until a part type is specified The histology department defaults in based on the specimen class routing the histology information to the correct laboratory Blocks are entered by scanning the barcodes printed on the cassettes This assures that Only cassettes for the current specimen can be entered Two cassettes with the same part and block number cannot be entered duplicate cassettes are rejected Optional flags can assure that Blocks are entered sequentially preventing mixing up of parts Blocks are entered without numerical gaps preventing omission of parts Necessary stains for the proper work up of the case including cutting unstained sli
134. rd Client Pathology ID 1 8876543 NHH T E O O Gender Femae xl Street Title fis j VERYSWEET WAY Birth Date 07 14 1940 Age l 66 Years tad City State Postal Code BOLTON jet x fos043 af Race j v CET Expired sl ee Date Time Expired Edit Morgue Info z FieiClose Ready Once complete clicking on the Save Close button will allow the patient information to be filed and will return you to the new specimen window where you can continue with the case intake process as described above Clicking on the Close File icon will also take you back to the case intake process The system will prompt you to save the new registration Alternative Method to Beginning the Case Intake Process As with most activities in the CoPath system there are multiple ways to enter a specimen activity The New Specimen window can also be accessed by placing the New Specimen activity in your personal menu and double clicking on its icon To find the New Specimen activity click File Resident Information Technology Services Manual Rev 06 11 JHS Case Intake Page 53 Browse Items on the menu bar of the Application Manager A list of activities in alphabetical order will appear on the right side of the screen Click and drag the New Specimen item to the left side of the screen your personal menu Frozen Sections and the Case Intake Process The vast majority of the specimens ar
135. rd Sample shortcut keys in CoPath include the Ctrl Tab to move from one open window to another F5 to go to the next tab page and Shift F5 to go back to the previous tab page Shortcut keys display to the right of their pull down menu commands on the menu bar You can execute shortcut keys as long as the menu command is available e g you cannot use the shortcut keys Ctrl V to paste something 1f there is nothing to paste Navigating with the Mouse The mouse pointer is an outline of a left angled arrowhead eTo use a mouse to activate or press something a button an icon position the pointer over the item and press and release the button You may also have to double click in which case you would press and release the button twice in quick succession over the item you wish to open eTo use the drag and drop maneuver to move an item position the mouse pointer over the item press the mouse button and while holding the button down drag move the mouse pointer the item to where you want it to appear on the screen Then drop the item release the mouse button Within CoPath during the drag and drop maneuver the mouse pointer may change to reflect an appropriate image For example when dragging and dropping something to your Personal Menu list the pointer changes to a hollow rectangular box When the mouse pointer is clicked within a field the arrow becomes an I beam cursor eThe mouse pointer appears as the symbol for no
136. received continued care at this institution or for a second opinion eCP cytology procedure only This specimen class is used for a cytological stand alone procedure e g no routine processing of the case is to be performed Examples of a cytological procedure include HPV testing Chlamydia Gonorrhea testing or molecular diagnostics This specimen class should be used for YNHH or Yale University clinics OSR outreach surgical routine This specimen class is used for surgical specimens originating from a client affiliated with the department s outreach program OSP outreach surgical procedure only This specimen class is chosen when the specimen to be processed will receive no routine processing and only a procedure or procedures e g electron microscopy immunohistochemistry or estrogen receptors will be ordered It 1s to be used when the specimen originates from a client affiliated with the department s outreach program OCG outreach cytology gynecologic This specimen class is chosen for cytology gynecologic specimens more commonly known as Pap smears when the specimen is Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 43 received from a client affiliated with the department s outreach program This specimen class comprises the bulk of our cytology specimens OCF outreach fine needle aspirates Fine needle aspirates are assigned this specimen class for
137. rk If you are interested in using VPN please contact the Pathology ITS Helpdesk at 5 3691 or PathITS yale edu Two steps are required to obtain access You will need to fill out the YNHH Web Remote Access Request Form and sign the YNHH Confidentiality and Responsibility Agreement Form and return to Path ITS for the ITS Director s approval The paperwork will then be forwarded to YNHH for processing You will be notified via e mail from the YNHH MIS Help Desk when your account has been set up Inform Path ITS when you receive e mail notification We will provide you with instructions for installing the two programs VPN and Citrix that you will need on your home computer Accessing CoPath via VPN from a MAC Connect to the Internet Open the VPNclient application Select YSM VPN CLIENT TO ACCESS YNHH NETWORK Click Connect upper left hand corner of window Enter YNHH VPN username and password Agree to warning about access to YNHH network Do NOT close the VPN connection window it can be minimized Open CoPath Citrix Client will start up Login to CoPath 10 When finished with your CoPath session log out of CoPath 11 Return to the VPNClhient window and click Disconnect Accessing CoPath via VPN from a PC 1 Connect to the internet 2 Open the VPN Client application 3 Select the YSM VPN CLIENT TO ACCESS YNHH NETWORK profile then choose Set as Default Connection Entry under the Connection Entries menu
138. rtmental operations Resident Information Technology Services Manual Rev 06 11 JHS Scope and Structure of ITS Page 4 User Services and Support Manager Katie Henderson This group of the Information Technology Services unit provides direct user services to the members of the pathology department Yale Pathology is again unique among the departments at both the hospital and university in the level of services provided intra departmentally most departments rely upon central institutional support for these activities Because of growing overlap in services provided and to take fuller advantage of their computer expertise the department s Graphics and Imaging unit was merged into the IT Unit in 2001 and now represents a component of this larger team Activities responsibilities of the User Services and Support group include Desktop Support e Purchase set up trouble shoot repair and maintenance of desktop computers printers and peripherals e Installation and upgrading of departmental issued software e Systems and equipment inventory Personal Laptop Support ITS will provide limited diagnostic help to trouble shoot laptops owned by Pathology Residents This service is to help guide Residents to an appropriate outside service vendor ITS does not provide repair service or extensive diagnostics unless instructed by the Director of the Residency program to do so Telecommunications e Arrange for and administer telephone and fax lines t
139. s NM Milford Pathology cytology non gyn medical fine needle aspirate SM Milford Pathology surgical routine and surgical procedure TN New York University gynecological specimens Specimen Activities The specimen activities that can be performed are determined by the specimen class that has been assigned to the specimen during the accessioning process For example the cytotech review activity would not be available for a specimen that has been assigned the specimen class SR surgical routine Likewise one would not be able to enter a gross description for a specimen assigned the specimen class of CG cytology gynecological or enter a gross description on a specimen assigned the SCO surgical consult specimen class Possible activities which might be available include Accession Entry Edit this 1s the activity that is used for accessioning a new specimen into the system and editing the accessioning data for an existing specimen Although you may view accession data you cannot edit accession data on a specimen that has been signed out Diagnosis Coding Entry Edit this activity allows you to enter or edit the SNOMED codes assigned to a case through the automatic coder or by manually assigning the codes Final Diagnosis Entry Edit this activity is used to enter or edit the final diagnosis for a specimen after it has been accessioned or before it has been signed out This activity also allows for the editing of any selected information that ma
140. s two R s one VM and one BDM As each of these are used subsequent blocks for this part will have the used values removed When all nine have been used the drop down list will disappear and there will be a message that there are no unused designations Unchecked The list will contain 4 entries one each of T R VM and BDM As each is used it remains in the list for subsequent blocks for the same part so you may use any designation as many times as desired Barcoded Block Wizard 510 6 3 parts BLOSSOM CHERRY A Scan Barcoded Cassette JV Default in designation if only one JV Filter used designations from insert list 7 Require sequential entry Mo skipping Barcoded Block Wizard 510 6 3 parts BLOSSOM CHERRY A Scan Barcoded Cassette JV Default in designation if only one Fitter used designations from insert list J Require sequential entry Mo skipping Part Block Category Desig Description Insert standard designation Part Block Category Desig Description Insert standard designation Stains Routine blue orar No Description No Unused Designations H amp E H amp E H amp E v Routine blue orar No Description Select a Standard Desig vi JH amp E H amp E H amp E nd Routine blue orar No Unused Designations H amp E Routine blue orar Select a Standard Desig v H amp E l Routine blue orar No Unused Designations H amp E Routine blue orar Select a Standard Desig v H amp E Routine bl
141. s available elsewhere In brief however one enters the case accession number typically by scanning in the barcode on the paperwork for the case The patient name will then be displayed for verification and the parts of the case will be listed Select the number of cassettes desired for each part the block category cassette color and the printing hopper bin specified in the dropdown lists Cassettes MUST be printed using this application to be available for the next step in the cassette entry process Note that the application remembers any previous cassettes printed for the case and will default to the next consecutive block number for each part This helps to prevent creation of two cassettes with the same designation However there will be times when it is necessary to re make a cassette the cassette gets damaged or the printing on the cassette 1s damaged or the flash to make the ink permanent does not fire the cassette is lost the cassette is printed in the wrong color etc In these instances the duplicate cassette prevention can be overridden by entering your initials Be sure that all but one of the cassettes with a given part and block number are discarded Summary of patient safety features Case is selected by scanning a barcode placed on the specimen requisition form Will not allow printing of cassettes for cases which do not exist in CoPath Will not allow printing of cassettes for parts which do not exist in CoPath R
142. s carries risks of incompatibility and any work required by ITS to restore the system to a prior functional state will be considered a billable activity Users should NOT e install illegal or pirated copies of any software e modify any of the network settings e set up any form of remote access to a machine which is on the department network Users SHOULD e develop their own mechanism for the regular backup of data e keep installation disks and instructions for any software which is not on the departmental software support list Research Machines These are computers designated for use by research laboratories The PI of the laboratory is responsible for complying with ITS policy ITS will order and set up computers Clinical and department computers always take priority in receiving ITS support Users should NOT e install illegal or pirated copies of any software e modify any of the network settings e set up any form of remote access to a machine which is on the department network Users SHOULD e develop their own mechanism for the regular backup of data e keep installation disks and instructions for any software which is not on the departmental software support list Patient Information In general protected health information and any other patient information should NOT BE STORED LOCALLY on any desktop machine within the department This includes patient specific correspondence Space is provided for this on the departmental file s
143. s that standard ALL CLINICAL IMAGES STORED IN THE DEPARTMENT IMAGE REPOSITORY MUST FOLLOW THE STANDARD DESCRIBED IN THIS DOCUMENT The standard was developed specifically with the following goals in mind e All of the images for a single case should be in one location e The image name should have all necessary identifying information so that it can be positively identified even if its location is changed e g copied to a local device for use or manipulation e The image name should identify e The accession number unambiguously e The image type gross photo micrograph radiology etc e A unique identifier e A brief description e g for immunostains which antibody does this represent e The image file format e g jpg e Sorting of the images by name should group images into a readily identifiable order e Once stored in the image repository an image should never be deleted or altered Resident Information Technology Services Manual Rev 06 11 JHS Photography and Digital Imaging Page 29 Naming Convention for Image Files Image file names are between 19 to 25 characters in length as follows PPYY Y Y AAAAAACNN dddd fff PP 1 or 2 letter number wheel prefix just as used in the accession number e g S A C N SB OS etc Should be in UPPER case YYYY Year of accession using 4 digit year a dash AAAAAA Accession number as a 6 digit with leading zeros as necessary This will allow proper sorting of cases folders sequent
144. sed e g no one is using the workstation that is signed on When the Time Out feature is applied CoPath closes the current window and the CoPath sign on window displays As in the example above the sign on window will have the Return button and will work as described above When you return to your workstation you can either sign back on by entering your userid and password and pressing Return or exit CoPath by pressing Exit Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 40 Forced Log Out If your session remains timed out for an additional 15 minutes after the automatic time out feature the session is terminated and any unsaved changes are lost Changing Your Password The CoPath system requires you to change your password every sixty days The system will begin prompting you to change your password for 7 days prior to expiration and will continue to do so until the change is made However on the 8 day if your password has not been changed you will no longer be able to access the system and you will need to contact the pathology ITS help desk To change your password log into the CoPath system and from the Application Manager click once on the Task button Open the yellow folder entitled System Session Utilities Double click on the change password feature Change Password User ID Daley Old Password New Password Cancel Verity Password H
145. sent a case at a clinical conference and having no gross photographs to show Document your cases well photographically Most large surgical specimens should be photographed EVERY MALIGNANT TUMOR RESECTION must be photographed EVERY AUTOPSY CASE must be well photographed e Know how the camera works Know what all the little buttons do If you are not sure don t assume that they are all set right ask Since the cameras in use in the department will Photography and Digital Imaging Page 28 vary these instructions do not attempt to explain the particulars of each camera Instructions for each specific camera should be available near the camera e KEEP THE CAMERA CLEAN The cameras are sometimes used for other purposes within the department They need to be kept clean This is particularly important for the digital camera e When cutting through an organ don t saw through it with a short knife Use the longest knife available and make long smooth slices e Dissect off extraneous fat from the specimen before photographing e Align the long axis of the specimen with the long axis of the photograph and zoom in so the specimen fills the field Do not leave a lot of blank space surrounding the specimen e Be sure the background is clean and free of blood or other fluid e Include a size reference in the photograph usually a ruler but wherever possible it should NOT overlap the specimen so that it can be cropped out later if needed The c
146. should default to SurgPath gt To access a patient chart click on the Chart icon Then enter a patient s partial or full name Format is last name first name Hit the enter key or click on the Search key If searching by MRN use five leading zeros before the MRN Highlight the appropriate patient and click OR gt You are now viewing the patient summary screen which provides an overview of the chart Patient demographics are displayed here and using the mouse you can click on tabs to view different parts of the chart From the patient summary screen in the flowsheet and document sections you can view laboratory values and documents by double clicking on the flowsheet or document which you wish to view gt The Flowsheet tab allows you to view patient lab data by date A green dot next to a value means that there is more than one value for that time period Click on the box to display the other value s A yellow up arrow next to the value indicates that the value is too high a yellow down arrow indicates that the value is too low A single click on a results will provide more details time of result normal range and units will be displayed To see a particular subset of clinical data 1 e hematology click the Organize button under the Patient Banner on the Flowsheet page and select the appropriate flowsheet Extended Microbiology and Virology results are not yet available Operative Reports and
147. sy from a Macintosh Simply click on the image in either the thumbnail display or in the full size image display and holding down the mouse drag the image to the desktop A file will be created which will be the same name as the file stored in the image repository Another way to accomplish this is to click on the image and keep holding down the mouse button until a menu pops up One of the choices should be something like Save Image to Disk Select that and then specify a name and location to save the image Once saved locally you can open the image up in either PhotoShop GraphicConverter or some other image editing program and modify it as desired To include an image in a PowerPoint presentation create a local copy of the image by one of the methods described above and then from PowerPoint select Insert gt Picture gt From File Alternatively if no editing of the image is required you can simply drag the image directly from the browser window onto your PowerPoint window and the image will be transferred Resident Information Technology Services Manual Rev 06 11 JHS CoPath User s Manual General Introduction to CoPath Plus CoPath Plus is a comprehensive computer system that supports the automation of the processing managing analyzing and reporting of complex anatomic pathology information Throughout this guide CoPath Plus will be more commonly referred to as CoPath In the pathology laboratory setting CoPath is
148. t a previous level were used then the level number would no longer correspond to the order in which the slides were cut or even the number of slides which actually exist Therefore to order a stain on a previous unstained slide find in the list of slides the Unstained slide of the desired level number and CHANGE the stain from Unstained to whatever stain is desired Make sure the Ordering By and Histology Lab information are correct and Save That is all that needs to be done The figures below demonstrate these two approaches In the first instance a new row row 15 is added for the Keratin stain Note that this row does not yet have a level number assigned to it This will trigger histology to CUT A NEW LEVEL from the block Stain Process Entry Edit Xx Histology Data for Part 1 1 of 3 KIDNEY BIOPSY FORMALIH Stain Process BlkDesig Count Level Request Class Comment Ordered By Histology Lab 3 Feet 3 Ginics A EE A E 4 firichrome Kistsh 1KiD Ft 4 oinica A E A vr Ora 5 fincas A E _v spos Jao 6 Ena AO Jhore seer MNHH Histology J Ae T e A a A YNHHHistology J i a 11 einica A E A vr 12 nstanea nta Ko zh 12 MOE e gt 13 pnstanea mia Jao ft 13 eines J iMOECKEL GLBER VNHHHstology z 14 pUnstained Initial KID ft 14 Clinical Il MO ECKEL GILBERT YNHH Histology v vas Kp ere BENARD JONA i Serre ae Stain Process Detail Ru
149. t ns ees Sars a ieee atest arth ate na tutta ea ateea ete Hate ee bed ahaa eta enatees aes 57 Histology Data Entry Editssrcisusesnieoisuno a eecsestabenceuisteesebeateee 58 PDENMAONS OET ONS a E E ene ee See ae 58 Barcode based Histology Asset Tracking System ccccccccccccccceceeeeeeeeeeeaseessseseeeeeeeeeeeees 59 Histology Block Information Data Entry Process cccccccccccccccceeeeeeeceeaaeeeeeeesseseeeeeceeeeeees 60 Cassette Labeling Applicat OM sepesi r e E E ATES 6l Histology Block Stain Protocol is cissticeiessctteciot n e eindctaabiwonece laugh oles Sno eakeawiad eels 62 MTG Barcode Blok War as iS tae cance aie ate Soateee RN 62 Manual Entry of Histology Block Stains Information ccccccccccccsssssseeeeeeeeeees 66 DENT PTOS S EU E AU Vera E re nae eer hee anne ar E O an 68 Stain Process and Block Edit Activity ssssssssssssssssscccccsssscccssssssssssccsssssssscccccssssssssscsssseees 69 Displaying Histology Asset Tracking Information ccccccccccceeeeeeeeseeeeeeeeeeeeeees 70 Ordering Additional Stains and Ordering on Unstained Slides eeeeeeeeeseeeeeees 71 PAB INDEX orsoni uii D R EAE E E EE 73 Keypoard SMONCCUIT Cy 6 scsisccessieisscdiedi cp seexeveccdbscetsssesetescd ned issiasereicedbecebledetetetied daaa ra 74 Valid Part Types Dy Specimen Class ce ccccceessvaciccccdidecscsmecttcccuasevseadecsascctaseveveincttecceucecsceveciveccdedesocs 76 Part Types for Surgical Specimen
150. the Details button in the lower right side corner of the window will provide a detailed accounting of all the events for the specimen Histology Provides histology tracking information for blocks and stains All of the tracking events for every block and slide can be reviewed here Specimen Inquiry Page 55 Staff Provides the names of the clinician additional physicians pathologist s assigned to the case and the names of outside institutions that have requested a copy of the final report Procedures This window displays any procedures ordered on the specimen and the procedure text fields if available Billing Codes This window displays the specimen billing type CPT 4 billing codes ICD 9 codes and SNOMED codes assigned to the specimen Demographics Includes patient and specimen demographic information Text The window displays all the text by text field type e g clinical history gross description final diagnosis etc that are associated with the specimen SSO Other This window displays slide sent out and other information that might be associated with the specimen For example specimen requisition deficiencies resolutions or any retrieval flags that have been set for the specimen will display here Resident Information Technology Services Manual Rev 06 11 JHS Indicates Other Specimens Exist for Patient Sample Other S for Patient Window ample Other Specmepy VOUS Material from the Same Patient Tw
151. the Clinical Systems Manager in consultation with the employee s supervisor The Yale Pathology Department uses role based access Specifically this means that an individual user s level of access once logged into the clinical information system will be determined by the role they serve within the department Features activities reports and even specimen classes available to a histology technician for example will be different from those available to a transcriptionist or a pathologist The capabilities of each role will be set up by the Clinical Systems Manager in consultation with the Director of Pathology Informatics and will be reviewed as new capabilities are added to the system Access Modification ITS personnel are to be notified in advance of any employee termination or significant change in job responsibilities Access to confidential patient information will be terminated or modified appropriately before the end of the last day of employment or beginning of new job responsibilities When an employee is terminated the person s userid and password are removed from the system thereby disabling login capability If the individual leaving the department has a person type designation of unspecified user their entry in the Person Dictionary is also inactivated Employees leaving the department whose person type designation is of a technical nature e g cytotech PA diener etc are changed to person type unspecifi
152. the integrity or security of protected heath information on our patients This is only a partial list e Providing information on a patient to anyone not involved in the care of that patient e g a friend neighbor relative e Looking up or otherwise accessing information on a friend or neighbor if you are not involved in their care e Looking up information on a patient at the request of anyone for a non health care related activity e Giving out protected health information over the phone or in person to anyone who might not be authorized to receive that information e Accessing patient information for a research study without first obtaining Institutional Review Board approval e Leaving a copy of a patient report in a conference room cafeteria or public location e Discarding a copy of a patient report in a trash can in a conference room cafeteria or public location e Discussing a patient in an identifiable way in any public location e Sharing your user ID or password with another employee e Attempting to learn another s user ID or password e Leaving a terminal on which you are logged in unattended e Down loading protected health information from the clinical information system onto the local machine where it might be accessed without requiring a username and password Sanctions for Inappropriate Behavior The department takes patient privacy very seriously and as such any violations of the department s Privacy Confidentiality or Security
153. ting a Specimen by Specimen Numbet cccccccccccccceececeeeeesssssseeeseeeeeeeeeees 45 selecting a Specimen by Patent Nami ge sicins chert r oatverenanreeeeaie earner es 46 Selecting a Specimen by Patient Medical Record Numbet cccccceeeeeeeeeeeeees 46 Selecting a Specimen Using Other Criteria cccccccccccccccccceeeceeeeeeeesssseeeeeeeeeeeeeeees 46 Switching Between Specimen ACctivities cccccccccccccccceeeeeeceseaeeeessssseeeeeeeeeeeeeeees 47 Solene TS ACU Vy FISE yoko cso assets waste assess E EE O E EO 48 Case TCA irois oe a panded nec aE O EE A E E Sar eaa 49 Definition of Terms and Required Fields ceccccccccccccsssssseeecccceeeceaeeeeeececceeeeaaaeeeees 49 Creatine a NEw Specie Misese aa a A a 49 Case Intake of a Specimen that Requires Registering a New Patient eee 51 Alternative Method to Beginning the Case Intake Process ceccececceeeeeeeeeeeeeeeeees 52 Frozen Sections and the Case Intake Process ccccccssssssesssseeeececeeeeeeeeeeeeaaaaeeeeeeeeees 53 Resident Information Technology Services Manual Rev 06 11 JHS SPECIMEN NOUIN y rrena arae EER EEE EA ERSE EESE SAA I ESE AENEIS 54 DESPO ONOT TaD T nese eee 54 Previous Material from the Same Patient ccccccccccsssssssssssscccccsssssssssssccccscsssssssssssccssssseeees 56 Other Specimens tor Patient OSP W midOw sasticisciccesicshen cise e A Geld 56 I OMI ANB Shh haa clench cis
154. tion Data Entry Process The main goals of grossing a specimen is to thoroughly examine the specimen received generate a dictated gross description determine what tissue needs to be examined microscopically place that tissue in appropriate cassettes for processing and then enter all the appropriate histology information into the computer system so that the histology lab knows what blocks to expect and what stains are to be performed on which blocks One will typically begin the grossing process by calling up the case in both the CoPath system and the digital dictation system This can be done by scanning the barcode placed on the requisition form Resident Information Technology Services Manual Rev 06 11 JHS Histology Data Entry Edit Page 61 Before entering the histology information it 1s important to verify the Specimen Priority that has been assigned to the specimen This is on the Specimen tab of the Histology Entry Edit Activity window As mentioned above the priority applies to the specimen as a whole Possible choices for specimen priority include 1l Rush Bx 3 Excisional Bx 6 Gross Only and Autopsy All stat specimens should be prioritized as 0 Stat All rush specimens should be prioritized as 1 Rush Small biopsies should be prioritized as 2 Small Bx The remainder of the specimens should be prioritized from 3 6 based on the type of specimen and clinical
155. to identify the case to the dictation system The barcodes on the cassettes are used to enter the cassettes into CoPath to track the cassette through histology and to generate the barcoded labels for the slides The barcodes on the slides are used to track the slides through the histology lab Barcodes on the working drafts are used to call up the cases at the time of final diagnosis dictation and signout Of course for each of these steps manual entry of a case block or slide identifier is possible in case the barcode has been damaged or the asset is not immediately available you can t scan the barcode on a missing cassette to get it s tracking information One of the key safety and productivity features built into the barcode based software solution is that at each step along the way wherever possible the most common correct values for any situation are automatically defaulted in minimizing the amount of manual data entry In most cases minimal use of the keyboard will be required At each data entry point the application s automatically send the focus to the next most likely field for the next data entry and in some instances detects when data is entered incorrectly into the wrong field and redirects that entry to the correct field Invalid entries are signaled by screen flashes to audible tones to allow heads down operation it is not necessary to watch the screen directly while scanning assets Histology Block Informa
156. toctsbeeseussteeseteaentee 90 Usine Power P atin oscinina eriase usb eeenls ictoctsbewceriiteesstea teste 91 Printing from PowerPath from a MAC eressero naen na EAE AAEN ECE RAKELI TEN 98 Resident Information Technology Services Manual Rev 06 11 JHS General Information Resident Information Technology Services Manual Rev 06 11 JHS Scope and Structure of ITS The Yale Pathology Informatics Program is a hybrid unit consisting of an academic component with faculty resident fellows and support staff and a service support component Both components are under the direction of John Sinard M D Ph D The service support component often referred to as the Operations Unit or the Information Technology Services ITS Unit provides a broad range of computer telecommunications and electronic technology support for the department The Mission of the ITS Unit includes e To provide a pathology clinical information system including ongoing enhancements that facilitates patient care instruction and research e To provide in house expertise for the procurement management and maintenance of information technologies e To support systems to gather organize and integrate information for use in patient care research teaching and the management of the Department s programs e To provide support and continuing education to our staff in the advancements of medical imaging and information design e To explore the utility and deployment of new a
157. ty questions from the lists below and provide an answer for them in the box provided You must select 5 separate questions and provide answers to them You will be asked to answer some of these questions if you forget your password and need to have it reset E A 3 E Your password may be stored in multiple locations or devices Before changing your password first identify where you may have your NetID password stored This process may take up to 15 minutes to propagate throughout the Yale systems e Please log out of all other applications and other machines prior to changing your password Requirements for the NetID password Password must have 8 14 characters Must contain at least 2 letters Must contain at least 2 non letters Must NOT contain Illegal characters lt gt amp less than greater than ampersand backslash comma apostrophe and quotation marks Please read our advice on selecting a strong password New Password Retype New Password Change Password If you have any questions call the Pathology Help Desk at 5 3691 The Pathology Help Desk hours are from 8 30 A M to 5 00 P M Monday through Friday Resident Information Technology Services Manual Rev 06 11 JHS Introduction to PHI Definitions of Terms In order to receive proper medical care patients have to share personal information about themselves with their health care providers Additional personal information about the patient is als
158. uality and or unwanted images from the source location e Setting of workstation specific defaults to facilitate repeated use for similar purposes The ImgFiler application is built around the concept of moving images from a Source location to a Destination location In the process the images are renamed based on the pathology case accession number The Source location 1s usually where the images are originally acquired This is commonly a digital camera the mounted flash memory card from a digital camera or a temporary storage location folder on a computer hard disk drive The names of the image files in the source location are usually set by the image capture device and are relatively meaningless The Destination location 1s where the renamed image files are to be stored This should ALWAYS be the Image Drop folder for the departmental Image Repository Image files must be properly named before being placed into the Image Drop folder to be sure they are filed correctly A background process the Image Filing Engine will periodically remove images from the Image Drop folder and file them into the Image Repository The process of saving images involves selecting appropriate Source and Destination locations selecting the images to be saved setting the proper image type for each image and entering the pathology case accession number for the group of selected images The ImgUpload application
159. ue orar sid Select a Standard Desig vi H amp E Routine blue orar r umr dh Select a Standard Desig vi H amp E Routine blue orar al Routine blue orar Routine blue orar Routine blue orar Routine blue orar Routine blue orar Select a Standard Desig Routine blue orar Routine blue orar Routine blue orar Routine blue orar VM Vascular Margin BDM Bile Duct Margin wWwowwwwW Nh RAR WOM Dw wOwowowoWwW NN DRoahRONM N R Random 2 Cancel Create 4 Blocks Histo Lab YNHH Histology v Require Sequential Entry When checked this option requires that cassettes be scanned activated sequentially from the top of the list downward This is useful for multipart biopsies to assure that they are processed in sequence and thus entered correctly If this option is selected an additional suboption No skipping may also be selected No Skipping Checked Cassettes must be scanned sequentially from the top of the list of available cassettes downward without skipping any cassettes This is most useful for multipart biopsies where each part is a single cassette No Skipping Unchecked Cassettes can be skipped when scanning such as might be the case if three cassettes were printed for a part but only two are needed but once skipped you cannot go back Thus a cassette cannot be activated if any cassette below it in the list has already been activated Each user s settings for these options will
160. uest class be entered The drop down arrow displays a list of request classes to choose from and include Autopsy Clinical Educational Personal Recut Repeat and Research If you are ordering a stain which is not needed for diagnosis eg for a conference or research project it is not appropriate to bill the patient for that stain In that case be sure the request class is something other than Clinical Level is a new field which warrants some explanation As the tissue block is cut and slides are generated the Histology Asset Tracking software assigns each successive slide a sequential level number This unique number allows tracking the slide through the histology laboratory but also makes it possible to place the slides in the order in which they were cut from the block which can be useful when tracking a small lesion or a suspicious focus through subsequent slides Level numbers are not assigned until the slide is cut so newly ordered stains will not have a level number If a Stain Process name is not dimmed out and there is no slide level assigned to that block the slide has not yet been cut so you can change the stain or delete the order However once the slide has been cut the Stain Process name will be dimmed out and you cannot change the stain requested an exception to this is Unstained slides for the reasons described below Similarly the block selection cannot be changed once the slide has been cut
161. unencrypted over unsafe networks o Configure your email software to use secure protocols e g TLS SSL for both sending and receiving email o If you use your NetID password in an insecure manner or from an insecure location you should change your password as soon as possible e If your NetiD password has been compromised contact the Information Security Office ITS The first security measure the Information Security Office ISO will usually recommend will be to change your password but ISO will also want to determine how the account and password was compromised the impact of the exposure and whether to investigate file a complaint or prosecute Resident Information Technology Services Manual Rev 06 11 JHS Net ID Page 19 Changing Your Net ID Password If you wish to change your Net ID password you can do so by using a Web browser and connecting to the following URL www yale edu netid Follow the instructions on the web page feel Yale University Rees Change Your NetiD Password NetID ew44 Important You may be asked for some or all of the information below if you forget your password Store this information in a safe place Email Address It is recommended that you enter a non Yale email address The NetID system will send confirmation notification emails to this address whenever a password change or a Security Information change is processed for your NetID Address Retype Address Please select 5 securi
162. us Yerified on 05 2610 18 46 Slide 2 Periodic Acid Schiff SPEC Status Verified on 06 0140 09 11 by MOECKEL GILBERT 05 2610 16 51 06 Cut by TAYLOR ANTHONY 06 0140 07 35 12 Collected by FLETCHER GARY 06 0140 09 09 45 Stained by FLETCHER GARY 06 0110 09 11 19 Verified by FLETCHER GARY Slide 3 H amp E Initial INIT Status Yerified on 05 2610 18 46 Ordering Additional Stains and Ordering on Unstained Slides Frequently after the initial slides for a case have been reviewed there will be a need to order additional stains to further evaluate the case Typically this means that histology has to relocate the block and cut an additional slide from the block on which to perform the stain Cutting new sections from a block requires re facing the block the process of cutting slightly into the block to obtain sections which include the entire block surface If done multiple times this can exhaust the tissue in the block Therefore for small biopsy specimens many of the histology staining protocols include cutting unstained slides at the time the block is initially cut If unstained slides exist for a block they can be used for the additional stain s Whether the block is cut into again for the new stain or whether the stain 1s performed on an unstained slides depends entirely on how the stain is ordered In fact there will be times when it will be desirable to cut into the block again and other times when one would not want t
163. uthorized users to have remote access to computing resources of the Pathology Department Individuals desiring VPN remote access should contact the Pathology ITS Help Desk and abide by the VPN policy found on the ITS website Specifications on all research printers computers and systems that require network connections should send networking specifications to ITS for approval before purchase as well as data connection specifications If additional lines or cards need to be installed the requestor should send an e mail to Resident Information Technology Services Manual Rev 06 11 JHS Desktop Computer Use and Support Page 9 pathits yale edu with a description of where the line needs to be installed and specifically why it is needed ITS will review the request and get authorization from the Business Office User Responsibilities Departmental machines must remain operational to support the activities of the department As such users are expected to be responsible in their use of departmental computers and abide by the responsibilities defined in the Yale University Policy 1607 Information Technology Appropriate Use Policy found elsewhere in this manual Certain precautions should be taken to protect the hardware and software of each desktop machine a Protection of the hardware 1s rather obvious i Do not eat or drink around the computers as liquid spilled into the keyboard can cause a tremendous amount of damage 1i Do not attach
164. will then do the rest 1 Mount the SOURCE location for the image files This usually means connecting the digital camera or inserting the memory card into the card reader It should appear on the desktop 2 Mount the DESTINATION location for the image file This usually means clicking on the ImgDrop icon in the dock If a short cut icon is not present log into the Reptile server and select the ImageDrop volume 3 Start the ImgUpload application If the appropriate settings have been predefined source and destination locations will be indicated at the bottom left and right respectively of the ImgUpload Resident Information Technology Services Manual Rev 06 11 JHS Photography and Digital Imaging Page 31 window and thumbnails for all the images in the image acquisition location should appear in the scrollable window at the left If necessary set the appropriate source and destination locations 4 Enter the specimen accession number corresponding to the images to be saved and press the Search button The part description s for that specimen should be displayed to verify the correct case number 5 At the lower left select the most appropriate Default Image Type from the drop down list Select the image type which will be correct for most of the images which will be selected 6 In the thumbnail display on the left click on each image to be saved for the case and press the Select button or simply double click
165. xo dsndadsice tat uieitandstebaeewsedandedhcetebeeeendtonaeeraes 9 Si Sle User Desktop IMAC hiie Sienssne niout e a A adage mcateadaumoste 10 Rescdrc EMic HGS ra E E A ene eee 10 PATE MT ormanla a a a e a R 10 Security Configuration Management s ssessseceseeeeeecceccsscnnnasssssseseescssereesecccecessenenas 11 Appropriate Use of Electronic Syst mS siciccicscvcdis ccasdecnnnddeleswaeebunnsadaebeiccnstuannnedadecwansbenaendaethleees 11 NOExpectatoir OL PLY ACY ects hasnt E E T 12 SUPPO O 8 GE ds een er E Re eee Te eT ee EE eer ee 12 Electronic Maiksi aeaa esoe aaae aa ar E ea Eea Sioe r airat 13 Ecto Mail SSIViCe Soeren E iaeceicauiaceeuiwisweaseneia tear 13 Getine an Beall AC COUN izsenis aenn A 13 General User Information about E mail Accounts 0 0 cecccccccccceccsseeeeeeccceeeesaeeeeeeeeeeeeeeaas 13 Bt AI SECUN y eei icin tutes A A O doi islets TEE E E EAE 14 Gettin a Ne ID PIN csan etchensontelees tse teseten races bensceiedescteieteas 15 There are two ways to get a PIN for your Net ID ou eeeeccesseeeeeceeeeeeeeeeeeeeeaaaees 15 Chancine Your Net ID Pass word vision ete o en E TA 19 Introduccion COP EAD win riie eA EOAR a 20 DEMMHONS OT EOM S kiore E A Meer mn eee Re Ce a eee 20 Departmental Privacy Confidentiality and Security Policy ccccsssseeeessseeeeeeeeeeeeeees 20 Examples of Inappropriate Behavior cc cc ceeeeccccccceccceeeseseecccceeeceaaseeececceeeeaaanesees 21 Sanctions for Inappropriate Behavior
166. y have or may not have been entered during the accession or gross description process Gross Description Entry Edit this activity is used to enter or edit a gross description of the tissue received This activity also allows for the editing of any selected information that may or may not have been entered during the accessioning process Histology Data Entry Edit this activity records the part types blocks stains and processes ordered for a specimen Itis what is used in the gross room to enter histology information for a case Inquiry Pathology this activity allows you to review the status of the case and to view the information entered to date Patient Report Single Print this activity allows you to print or view a single patient s report s for a particular specimen The following reports available through this activity are final reports working drafts and procedure reports Resident Information Technology Services Manual Rev 06 11 JHS Working on Specimens in CoPath Page 45 Procedure Addendum Entry Edit this activity allows you to order a procedure e g flow cytometry immunohistochemistry for a specimen either before or after it has been signed out This activity also allows for entering diagnostic information or for editing the procedure Staff Entry Edit this activity allows you to edit the staff associated with a specimen prior to the case being signed out Stain Process and Block Edit this activity allows you to review

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