Laboratory of Pathology - Staff

Downtime Procedure:

Although it is unlikely that we will experience an extended down-time after the new system is stable, common sense and a variety of regulatory agencies require that we have procedures to follow in case of emergency.

The procedures to follow depend both on the actual system which is down and on the length of actual or anticipated downtime.  In the case of a major failure that occurs in the evening, we will probably not be the ones to discover or report the problem.

This first table describes the various systems that might fail.

Here are some possible scenarios and what internal procedures will be used as work-arounds until the problem(s) is/are solved

Condition 1. 

A system is down for an extended period during off-hours (evenings, weekends, holidays).

LIS Down – Processing work will only be done on stat cases.  If it is necessary to accession a new case, a paper log record will be kept and cases entered after the system comes back up.  Phone calls should be made as necessary to report results but, of course, no results will be entered into the system during the downtime.

CRIS Down – Clinicians will not be able to enter new orders or view results.  Stat specimens should be accepted using a paper requisition form (use either the form for Medical Consultations used as the Frozen section form or the Submitted specimen form).  Stat orders can continue to be entered directly into the LIS.  New NIH patients whose biographical information is not yet in the LIS should be entered as non-patients and given dummy medical record number.  These patients can be merged later to the correct record.  Other processing steps as well as result entry may continue to be done as necessary.

CRIS-LIS Interface Down – The main impediment here is that orders and results will not be able to cross between the two computer systems.  New CRIS orders will be saved in the CRIS until the interface is fixed.  Once the interface is restored, the orders will flow normally into the LIS where accessioning can take place as usual.  Other processing and resulting should take place as usual.

Network Down – If the problem is local, accessioning of new cases can take place on a part of the network which is still up.  On weekends and evenings this should only be necessary for emergency cases.  If the network problem is widespread, this should be treated the same way as a “LIS Down”.

The remaining situations have to do with down time during regular working hours.

Condition 2

The system down is anticipated to be less than 2 hours.

LIS down – Accessioning of new cases and other LIS activities will be delayed until the system comes back up.  Stat cases will be handled as under Condition 1.

CRIS down – LIS activities will occur normally.  Tissues, slides and blocks received during the CRIS down time will be held until the CRIS is back up.  Stat cases will be handled as under Condition 1.

CRIS-LIS interface down – This situation should be treated the same as an CRIS down.

Network Down – This problem should be handled as under Condition 1.

Condition 3

The system down is anticipated to be from 2 hours to 1 working day.

LIS down – Paper accession logs should be created to log cases in by hand during the down time.  This activity will be coordinated section by section, with Histology responsible for logging of surgical type specimens from Surgical pathology and Hematopathology.  Case processing should occur as usual, with actual transcription of results delayed until the LIS is up again.  All final results should be called to clinical staff.  New orders may continue to be entered into the CRIS.

CRIS down – Clinical staff should use the Submitted specimen form to request pathology services.  These orders may be entered into the LIS so that processing is not delayed.  Other LIS functions will continue as usual. A log should be kept of cases electronically signed-out during the down time in case results need to be re-sent. All final results should be called to clinical staff.

CRIS-LIS interface down – CRIS orders should be entered as usual and then re-entered directly into the LIS.  Other LIS functions should be continued as usual.  A log should be kept of cases electronically signed-out during the down time in case results need to be re-sent.  All final results should be called to clinical staff.

Network down – Depending on the portion of the network affected, business may be able to continue on other workstations.  In the case of a widespread down, this should be treated like an “LIS down”.

Condition 4

The system down is anticipated to last more than one working day.

The system administrator will first determine the total anticipated delay in cooperation with the Information Systems Department.  Arrangements should be made to alert clinical staff of any changes in procedure for requesting pathology services during the emergency.

LIS down - An emergency meeting of clinical section chiefs, the laboratory chief and the LIS administrator will convene to decide whether the anticipated down time warrants moving to a manual report preparation method.  Other down time procedures will be as for condition #3.

CRIS down – Alert clinical staff to use paper requisition forms for anatomic pathology services. Other down time procedures will be as for condition #3.

CRIS-LIS interface down – Down time procedures will be as for condition #3.

Network down – In the case of a widespread network failure, down time procedures will be as for the “LIS down” case, otherwise, LIS activities will continue as usual.

Picking up the Pieces

After a period of down time where paper accession logs were created, cases need to be entered into the LIS in an organized fashion.  These should be done by “Accession Group” which is a group of cases linked into a single number wheel.  In order to do this in an organized way, one person should enter the information for each accession group.  The table that follows lists the different accession groups and the individual or section responsible for entering cases logged on paper during the down time.  Once the cases are entered, other case information may by entered by multiple individuals simultaneously.  This activity should take place before new cases are accessioned.

Accession Group                             Responsible Party

AU, AN                                            Autopsy Resident

CG, CM                                           Cytopathology Section

SI, SS, SJ, SM, SB                           Histology

SF                                                     Flow Cytometry Unit

GN                                                   Cytogenetics Section

HH, HK                                            Hematology Section, CPD

Basic Trouble-Shooting and Emergency Contact Information

Whenever you encounter a problem with the LIS, make note of the circumstances. Always try these basic things:

• Log off and back on the system
• Try the function on a different piece of hardware (printer, workstation, etc.)
• If you received an LIS error message or some other screen weirdness occurs, press F11 to print the screen to the nearest printer
• If the problem is with something you don’t know how to do, before calling the LIS administrator, look in the SoftPath User Manual and in the LIS Procedure Manual for the answer.
• If you have exhausted all other resources, contact your LIS administrator or their back-up.  If it is during off-hours, decide whether the problem can wait until normal working hours.  If it can’t you should certainly feel free to contact the LIS administrator.

LIS Administrator:  Earle Barnes

Work: 301-480-7187, Home 301-529-1309, Blackberry 240-645-3210
e-mail: barnese@mail.nih.gov

LIS Back-up:  David Kleiner, M.D., Ph.D.
Work: 301-480-8487, Home 301-946-8976, Page 102-10333
e-mail: dkleiner@helix.nih.gov

If the problem is a local hardware/software problem that is not fixable by our laboratory (such as the installation of new terminal emulation software) our contact is the NIH helpdesk 301-496-4357.  http://support.cit.nih.gov

These problems should only be dealt with during normal working hours. 

POLICY FOR GRANTING ACCESS TO THE CRIS/LIS

Access to the CRIS and SoftPath LIS is restricted to those individuals who have a medical or research need to access computerized patient information and who have agreed to abide by the patient confidentiality and security policies of the Laboratory of Pathology (see Memo on Access to the CRIS/LIS by Laboratory of Pathology Personnel).  Access to each system is gained through the use of an individual password.  The password for the CRIS is a unique alphanumeric string, which is assigned to individuals by the Department of Clinical Research Informatics division of the Warren Grant Magnuson Clinical Center.  The SoftPath password is the same as your NIH login/email password.

1. The password is 8 characters in length and must use a combination of upper and lower case letters, numbers and special characters.
2. The password is not a name or dictionary word, and is not based on easily guessed personal information such as a birthday.

Use of these passwords and system access in general is subject to the following restrictions.

1. The user has signed the Patient Confidentiality Agreement.
2. The user does not allow others to use or gain knowledge of their password.
3. The password is not recorded in a location or in a manner that would allow others to discover the password (e.g., posting the password on or near a computer terminal).
4. If the user suspects a security breach involving their password, that such suspicions are reported immediately to their section chief (supervisor) or to the LIS Administrator.
5. Users log off terminals after completing work so that others cannot use their log-on to gain access to the system.  Users should not rely on the system time-out to log them off of the system.
6. When employees leave their positions within the Laboratory of Pathology, they are responsible for notifying the LIS administrator of the date of their termination so that their password may be inactivated.  As a back up for this notification, section chiefs should also report employee turnover to the LIS Administrator

The LIS Administrator as a final check on password assignments shall review the list of personnel having passwords at least annually.  Documentation of this review will be available in the Master Procedure Manual for the LIS/CRIS.  The LIS administrator shall maintain records pertaining to personnel access to the SoftPath LIS.

Annual Review of Personnel Access to the CRIS/LIS is required.

ARCHIVING RECORDS OF INFORMATION SUBMITTED WITH
OUTSIDE SUBMITTED CASES (SCANNING REPORTS)

The Department of Surgical Pathology scans submitted consult additional (i.e. outside pathology reports, submitted requests) using the SoftPath Image Repository system.

Adding Images to SoftMedia

1. From Query, or any other place in the system that you see it, click the Image Repository button.
   
   
2. When it opens, the upper left vertical selection bar will display. Click on the button for the desired function: Add File. Other options available:, Search, Video, Scanning, and Audio.
   
   
3. To upload an image, click on the Add File button. A dialogue box will appear. Click on the file folder icon to select your image file(s)
   
   
4. Once you have your images all imported, select the Template (Path Image Upload) and click the Green Check at the top of the Add File Dialogue to confirm or click the Red X to remove them. Note: There is no need to name the files as they will import with the image file name.
   
   
5. You can add various attributes to them by clicking the Attributes button at the bottom of the page. Select your image from the list of files on the left to set the attributes. Note: In order to have image hyperlinks cross to the CRIS, you must put a check mark in the Report to HIS with Final/Revised box and you must click the small blue save icon for each image.
   
   
6. When you are done adding attributes and saving, you can simply close the Image Repository window.

Scanning into SoftMedia

1. From Query, or any other place in the system that you see it, click the Image Repository button.
   
   
2. When it opens, the upper left vertical selection bar will display. Click on the button for the desired function: Scanning. Other options available:, Search, Video, Audio, and Add File.
   
   
3. From the Scanning dialogue box select the appropriate scanning template (Path_Duplex_BW_Scan , Path_Duplex_Color_Scan, , Path_Non-Duplex_Color_Scan, or Path_Non-Duplex_BW_Scan), category (Path and Outside Material typically) and the scanner (Canon 4010).
   
   
4. Load your documents to be scanned on your document feeder and click the Green Checkmark.
   
   
5. Your files will be scanned and imported into SoftMedia. Once you look them over and make sure everything is ok, you can close the Image Repository window.

Other information to note

Along the bottom of the window you will find more tabs:

• • Info Tab – Display info about the document including User that scanned, when it was scanned and into what system.
  • Attributes Tab – This will be mainly used for images that are being put into SoftMedia. There are other options at the bottom which when checked will allow the document to be sent to the CRIS system.  If your order is from the CRIS please put a check in the box Report to HIS with Final/revised report.
  • Categories Tab – In order to do reports later from SoftMedia, please click on this tab to select the Outside Material Checkbox.
  • History Tab – Displays the history of the SoftMedia document/image.
  • Versions Tab – If there are multiple versions of a document or image after annotations have been added for example, here you will see the different versions of the file.