Innovative Pathology Services - 4Medica Standard Operating Procedures

In order to use 4Medica, IPS recommends:

Description
Personal Computer	IBM Compatible
Processor	Pentium IV 1.6 GHZ or better
Memory	512 MB
Hard Disk	6 GB
Monitor	Color XGA (1024 x 768 pixels)
Operating System	Windows XP SP2
Internet Connection	DSL, Cable Modem, ISDN, T-1 or other broad band connections
Web Browser	Microsoft Internet Explorer v 6.0 SP1 (or higher) with 128-bit encryption
Printer	Any laser or ink jet printer supported by Windows
Other Software	Adobe Acrobat Reader 6.0 or higher

Determine who can login on the computer. The following Internet explorer settings must be set for each user account.
Verify that the client does not have any Pop up blocker software installed. Any Pop up Blocker software will need to be disabled before each login to 4Medica or setup to allow 4Medica as an allowed site.
Open Internet Explorer and click on Tools. Then, click on Internet Options. Contained on the General tab, click on the "Settings" button.

The check for newer versions of stored pages option should be set to Automatically.

Select the "Advanced" tab, scroll down to the "Printing" section and verify that there is a check mark next to "Print background colors and images".

Clients using Windows XP and Internet Explorer 6.0 Service Pack 2 (SP2) will be required to add 4Medica to their trusted sites. Click on the "Security" tab and verify the "Trusted Sites".

Click on the "Sites" button and add https://www.4medica.net or https://www.4medica.com. Remove the check mark for "require server verification (https) for all sites in this zone".

Close the "Internet Options" menu by pressing "OK".
Click on the "File" menu, select the "Page Setup" option. Remove the "Footer" information and change all the "Margins" settings to "0.5".

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Open Microsoft Internet Explorer, and type 4Medica.com into the address bar at the top of the screen.

Enter user name and password in the red areas as shown in the figure above.

The desktop screen is a screen you will become quite familiar with as you use 4Medica. There is a navigation screen on the left hand side of the screen which will allow you to use the different functions in the 4Medica application.

Each of the functions in the "Navigate" bar in the figure above, will each have its own Section in this document, to explain how each function is used.

In addition to this document you are reading, 4Medica also has a help system you can access online. In this document, IPS has attempted to provide a clear, concise, picture of how to use the 4Medica application. However, if something in this document is not clear, you can take a look at the 4Medica help by clicking on "Help" as shown in the figure below. Before you click on "Help" in the menu, you should first select "Test Results" on the left side of the screen. For some reason, all of the "Help" options are not available in the "Desktop" view.

The "Quick Reference Guide" has a lot of information about the features available to 4Medica users. After you click on "Quick Reference Guide", you are presented with a table of contents of the help topics available.

The "FAQ" section contains a list of frequently asked questions. Clicking on "FAQ" will present you with a pop-up window that looks like the figure below.

If you prefer, your IPS Technical Support Specialist is just a phone call away. Please feel free to contact your IPS Technical Support Specialist with any questions you may have about 4Medica.

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When you select the "Test Results" menu item, your screen will change and will look similar to the following display.

The default option is to show you all test results reported within the last 7 days. If the patient you are looking for is in this list, you simply click on the patients name and the report will open at the bottom of the screen.

Of course, in this view it is very difficult to read the report. In order to obtain a better view of the report click on the "Printer Icon" which will open the report in a new window. You can proceed to just view the report on the screen, or actually print it out on a printer.

In Section 3.1 we showed you how you can view and print a report. However, the only reports available in the default view are reports "Reported Last 7 Days". In many instances you may wish to view a report that is older than 7 days. 4Medica provides many options of which you can use to search for patient reports. In the screen displayed below, you can see the types of options available to you.

Reported is when the case was "signed out" by the pathologist, and the report was made available in the 4Medica web application. Obtained is the date the specimen was collected from the patient. In the drop down list, you have the option to search for reports by date. If you select the option "Reported from ... to ...." or "Obtained from... to..." you will be presented with a dialog box. It is important to note, you cannot select "All Dates" unless you have typed a name in the patient name search box.

You can type in the date, or click on the icons, and a calendar will pop up. In the calendar you select your date by clicking on it.

The Sources selection is for 4Medica clients who may be using 4Medica with more than one lab. For example, your practice utilizes the services of IPS for pathology. Your practice utilizes AAA Labs for your blood work. If:

You need to find ALL reports for a specific patient, then select "All Sources".
You only need the blood work report for a specific patient, then you would select "AAA Labs" for your source.
You only need the pathology report for a specific patient, then you would select "IPS" for your source.

If your practice is a larger practice, then you most likely have several physicians providing services in your practice. This filter will allow you to filter results by the physician who rendered the services to the patient. For example, if your practice has a Dr. Smith, and a Dr. Jones, you can use this filter to search for patients treated by both of them, or strictly for patients treated by Dr. Smith, or by Dr. Jones.

If you do not know the patient's name, then you may type in the partial name, and 4Medica will provide a list of names that match what you typed. Here are some tips to help you when searching for a patient:

If you type:	Your results will include:
sm	Last Name starting with Sm
john,mi	Last Name starting with john, and first name starting with mi
,k	First Name starting with k
*ith,k	Last Names ending with ith, and first names starting with k
??ith	Last Names with EXACTLY 2 letters in front of ith
#AO12345	Patient ID found on report starting with A012345
A012345	Accession number starting with A012345

Note: These tips are available in the 4Medica application. Just click on the Icon

icon to view these tips. In Section 3.2, there is a screen shot of 4Medica indicating where the patient name (or the partial name) should be typed. After typing in the patient name, just click on the Icon

icon to start the search.

You are still having problems finding the report after reading through sections 3.1 - 3.5.

Use the least restrictive search options. Make sure you have selected, "All Patients", "All Providers", "All Sources (or IPS if you are just looking for Pathology reports), and "Obtained from... to ...". This will provide you with an alphabetized list of the patients with reports.
Make sure you have scrolled through all the results. If there are more than 20 results returned, you will press the blue arrow in the upper right hand corner of the screen to proceed to the next page.

3.7.1. Details

4Medica has the capability of automatically printing patient reports for you. The software allows you to set the days of the week, and the time of the day you would like for the reports to print. It is imperative you monitor your printer to insure it has plenty of paper and toner so the printing of your reports is successful. If you are interested in utilizing the Automatic Report Printing, please contact your IPS Technical Support Specialist. The Technical Support Specialist will arrange an onsite visit with you which is necessary for the software installation.

3.7.2. Requirements

High speed "always on" internet connection
At the very minimum, the computer and printer should be on at the scheduled print time. IPS recommends the computer and printer should never be turned off.
Administrator level access to the PC is required to install the required software

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In order to open up the test menu, you must first click the "Test Orders" icon in the navigation menu on the left.

Clicking on this will expand the menu which now contains two sub menus, "Test Orders", and "Order Log".

If you would like to order a test, you would click on "Test Orders". If you would like to view a list of tests that have been ordered in the past, click on "Order Log"

After clicking on "Test Orders" (shown in section 4.1), you must enter the patient's name. There are several scenarios in this situation:

The patient's chart is already in the system.
The patient's chart needs to be entered into the system.

4.2.1. Finding an existing patient (by name, chart or SSN)

Type the patient's last name in the text box underneath "Last or ID". Then use the mouse to left click the "GO" button (or you can just press enter). A list of patients with the last name you entered will appear in the pull down box. The following picture illustrates how this works.

Now you can click on the patients name, and a list of tests available will appear in the window which currently has "No Data Available". If you know the patient's chart number, you can enter that in the "Last Name" box, and the patient will be found. 4Medica also offers the ability to find a patient using their Social Security Number. In order to access this feature, you must click on the Screen Shot

icon. After the icon is clicked, a window will pop up which will allow you to search by Social Security Number. In this dialog there are even more advanced search options which are beyond the scope of this document.

4.2.2. Creating a new patient

If the patient does not exist, then you will need to create a new patient. To do this, click on "New Chart" as shown in the screen shot below. The fields marked with red triangles are all required, and 4Medica will not let you proceed until all those fields are filled. The "Practice" field is a required field, but it is also automatically filled in for you with your practice name. After entering the patient information, you should click "Apply" so you can proceed with entering the insurance information.

After you click apply, the menu will change to look like the screen image shown below. To enter patient insurance information, click on the "List of Responsible Parties" tab.

You will now be presented with fields for insurance information. First, you must click "New Guarantor/Policy" located in the lower right of the window. After clicking "New Guarantor/Policy", you can enter the insurance information into the fields as shown in the image below.

In the insurance panel, you can click the button with the three "periods" to open up the "Insurance Company" selection pop up display. In the "Insurance Company" selection pop up, you can select insurance companies from a "Global" list, or a "Practice List", a list specifically used at your practice. After you select an insurance company from the "Global" list, it is automatically added to your own "Practice" list.

If the patient has more than one insurance policy, you can enter the second one after saving the first one. The first one, will now be listed at the top of the screen. To begin entering the new one, just click "New Guarantor/Policy" in the lower right side of the screen. After all insurance information has been entered, you can press "OK" and the "Patient Information" window will close, returning you to the main 4Medica screen.

After selecting a patient (4.2.1) or creating a new patient (4.2.2) 4Medica will present you with a list of tests as shown in the figure below.

The list of tests that first appears may vary from what is seen here. In this example the default test list is "IPS OB/GYN". If the test you require is presented on the screen, you can select it. If the test you require is NOT on the screen you need to select a different test list.

The test lists are completely customizable. If you would like tests added to or removed from the test list you can contact your IPS Technical Support Specialist.

If your practice has more than one provider (physician) you must select the physician who treated the patient before you can proceed.

After the provider is selected, the "Ordering Provider" is automatically selected. In most cases, the "Ordering Provider" will be the same as the "Practice Provider". In most IPS practices, "Copy To" is not used. This option can be used if you want another provider to be informed of the tests being ordered.

The "Bill To" field should be "Provider", the physician ordering the test. If you would like for the patient to be billed, you can select "Patient". After completing these fields, you are ready to order a test.

4.4.1. Thin Prep Pap Smear

This section will describe how to order a Thin Prep Pap Smear. If you would like to order a Thin Prep Pap Smear with an HPV test, you should review one of the following sections. Section 4.4.2, 4.4.3, and 4.4.4 describe how to order Pap Smears which include HPV tests.

In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. To order a Thin Prep Pap Smear you should select the first choice, Thin Prep Pap Smear. After selecting Thin Prep Pap Smear, a pop-up window will appear as in the figure below.

The options in the pop-up window are exactly the same as on the "paper" requisitions. For this test, you will want to select "Thin Prep", and DO NOT select any HPV testing. Please ensure you take care in filling out this information as a patient's medical history is very important for the processing of a Pap Smear. After providing the required information you can select "Save".

4.4.2. Thin Prep Pap Smear and HPV (regardless of DX)

This section will describe how to order a Thin Prep Pap Smear with an HPV test, regardless of the Pap Smear diagnosis. If you would like to order a Thin Prep Pap Smear with reflex to an HPV test, you should review one of the following sections. Section 4.4.3, and 4.4.4 describe how to order Pap Smears which include reflex to HPV tests. If you would like to order a Thin Prep Pap Smear without an HPV test you should refer to section 4.4.1.

In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. To order a Thin Prep Pap Smear with an HPV test regardless of diagnosis you should select the second choice, Thin Prep Pap and HPV (regardless of DX). After selecting Thin Prep Pap Smear and HPV (regardless of DX), a pop-up window will appear as in the figure below.

The options in the pop-up window are exactly the same as on the "paper" requisitions. For this test, you will want to select "Thin Prep", and YOU MUST select one of the HPV testing options. It is possible to submit this form WITHOUT selecting one of the HPV options, which will require us to contact you and may delay the receipt of your test results. Please ensure you take care in filling out the information on the form as a patient's medical history is very important for the processing of a Pap Smear. After providing the required information you can select "Save".

4.4.3. Thin Prep Pap Smear with reflex to HPV if ASCUS

This section will describe how to order a Thin Prep Pap Smear with an HPV test, if the pap smear diagnosis is ASCUS. If you would like to order a Thin Prep Pap Smear without an HPV test you should review section 4.4.1. If you would like to order a Thin Prep Pap Smear with an HPV test regardless of the Pap Smear diagnosis you should review section 4.4.2. If you would like to order a Thin Prep Pap Smear with reflex to HPV if the Pap Smear Diagnosis is ASCUS or LGSIL you should refer to section 4.4.4.

In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. To order a Thin Prep Pap Smear with reflex to an HPV test if the Pap Smear diagnosis is ASCUS you should select the third choice in the "Test List", Thin Prep Pap Smear with reflex to HPV if ASCUS. After selecting Thin Prep Pap Smear with reflex to HPV if ASCUS, a pop-up window will appear as in the figure below.

The options in the pop-up window are exactly the same as on the "paper" requisitions. For this test, you will want to select "Thin Prep", and YOU MUST select one of the HPV testing options. It is possible to submit this form WITHOUT selecting one of the HPV options, which will require us to contact you and may delay the receipt of your test results. Please ensure you take care in filling out the information on the form as a patient's medical history is very important for the processing of a Pap Smear. After providing the required information you can select "Save".

4.4.4. Thin Prep Pap Smear with reflex to HPV if ASCUS or LGSIL

This section will describe how to order a Thin Prep Pap Smear with an HPV test, if the pap smear diagnosis is ASCUS or LGSIL. If you would like to order a Thin Prep Pap Smear without an HPV test you should review section 4.4.1. If you would like to order a Thin Prep Pap Smear with an HPV test regardless of the Pap Smear diagnosis you should review section 4.4.2. If you would like to order a Thin Prep Pap Smear with reflex to HPV if the Pap Smear Diagnosis is ASCUS you should refer to section 4.4.3.

In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. To order a Thin Prep Pap Smear with reflex to an HPV test if the Pap Smear diagnosis is ASCUS or LGSIL you should select the fourth choice in the "Test List", Thin Prep Pap w/reflex to HPV (if ASCUS or LGSIL). After selecting Thin Prep Pap Smear with reflex to HPV if ASCUS or LGSIL, a pop-up window will appear as in the figure below.

The options in the pop-up window are exactly the same as on the "paper" requisitions. For this test, you will want to select "Thin Prep", and YOU MUST select one of the HPV testing options. It is possible to submit this form WITHOUT selecting one of the HPV options, which will require us to contact you and may delay the receipt of your test results. Please ensure you take care in filling out the information on the form as a patient's medical history is very important for the processing of a Pap Smear. After providing the required information you can select "Save".

4.5.1. HPV Testing on Tissue/Biopsy

This section will describe how to order a HPV test from Tissue/Biopsy. In order to proceed you should refer to the figure in section 4.3. There should be a customized test list for your site which is similar to the test list in figure 4.3. To order an HPV test on Tissue/Biopsy you should select HPV Test on Tissue/Biopsy. After making this selection a pop-up window will appear as in the figure below.

You must fill out the fields which are enclosed within the "red" boxes. You must also click the check box next to "HPV in situ hybridization (ISH) on tissue biopsy." After you have typed in the necessary information, you can select "Save".

4.5.2. Gynecology Tissue/Biopsy (Colposcopy, ECC, LEEP, Cone Biopsy, etc.)

This section will describe how to order a Gynecology Tissue Biopsy. In order to proceed you should refer to the figure in section 4.3. There should be a customized test list for your site which is similar to the test list in figure 4.3. To order a Gynecology Biopsy you should select "Gynecology/Tissue Biopsy" from the test list. After making this selection a pop-up window will appear as in the figure below.

The fields in this pop-up are the same as the fields on the current paper requistions. 4Medica REQUIRES that information is ENTERED for each of these fields. In many cases, a "Post-Op" diagnosis may not be available, in which case, you can put "Same".

Tips:

In many cases, "Colposcopy" can be entered for the "Operation".
In many cases, the Post-Op diagnosis is not known. You can put "Same".
Examples of Pre-Op diagnosis - ASCUS Pap Smear, LSIL, Dysplasia, etc.

To proceed, click "Next". The next screen that will appear is shown below. You do need to click on "Cervix" in order to bring up the diagram of the Cervix.

Next, click (left mouse button) on the red "X" (Biopsy). Keep the left mouse button held down, and drag the circle to the place on the diagram where the specimen was collected.

In this example, I have changed Endocervical Biopsy to ECC. If you need to remove a "Biopsy", double click on the numbered circle to remove it.

After you have finished entering your specimens, click "Next". DO NOT CLICK "Skip".

Click "Save".

4.6.1. HPV Only (No Pap Smear)

This section will describe how to order a HPV test from a Thin Prep Pap Smear. The specimen type is a Thin Prep Pap Smear, but if this test is ordered, IPS does not process a pap smear from the sample. IPS will only process an HPV Test. If you would like a Thin Prep Pap Test along with an HPV test you should refer to sections, 4.4.2, 4.4.3, 4.4.4.

In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. You should select HPV Only (No Pap Smear) which is the fifth choice in the "Pap and HPV" test section. After selecting this a pop-up window will appear as shown in the figure below.

For this test, you must select the specimen type. Valid specimen types for the HPV test include: Thin Prep, Sure Path, and Digene Cervical Sampler. After selecting the specimen type, all you need to do is click "Save" at the bottom of the form.

4.6.2. Herpes Simplex Virus Type 1 and 2 by PCR

This section will describe how to order a Herpes Simplex Virus Type 1 and 2 by PCR. In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. You should select Herpes Simplex Virus Type 1 and 2 by PCR which is the first choice in the "Additional Tests" section. After selecting this a pop-up window will appear as shown in the figure below.

For this test, you must select the specimen type. Valid specimen types for the HSV test include: Thin Prep, Sure Path, and Swab/M4. After selecting the specimen type, all you need to do is click "Save" at the bottom of the form.

4.6.3. GC/Chlamydia by PCR

This section will describe how to order a GC/Chlamydia by PCR. In order to proceed you should refer to the figure in section 4.3. There should be a customized "Test List" for your site which is similar to the test list in figure 4.3. You should select GC/Chlamydia by PCR which is the second choice in the "Additional Tests" section. After selecting this a pop-up window will appear as shown in the figure below.

For this test, you must select the specimen type. Valid specimen types for the GC/Chlamydia test include: Thin Prep, Sure Path, Swab/M4, and Urine. After selecting the specimen type, all you need to do is click "Save" at the bottom of the form.

4.6.4. IPap5 (Pap Smear, GC/Chlamydia, HSV Type 1&2, HPV(High Risk/Low Risk)

This section will describe how to order the IPap5 test. The IPap5 is a comprehensive test which includes a Thin Prep Pap Smear, GC/Chlamydia test, HSV Type 1&2 test, and HPV (High Risk/Low Risk). In order to proceed, you should refer to the figure in section 4.3. There should be a customized "Test list" for your site which is similar to the test list in figure 4.3. You should select IPap5 which is the last test in the "Pap and HPV" column. After selecting this a pop-up window will appear as shown in the figure below.

The options in the pop-up window are exactly the same as on the "paper" requisitions. For the IPap5, you will want to select "Thin Prep", and YOU MUST select one of the HPV testing options. It is possible to submit this form WITHOUT selecting one of the HPV options, which will require us to contact you and may delay the receipt of your test results. Please ensure you take care in filling out the information on the form as a patient's medical history is very important for the processing of a Pap Smear. After providing the required information you can select "Save".

4.6.5. Cystic Fibrosis

This section will describe how to order the Cystic Fibrosis test. Informed Consent IS required for the Cystic Fibrosis test. It is imperative this form has been reviewed and signed by the patient. A copy of the signed form must remain with the patient's records.

Innovative Pathology Services Cystic Fibrosis testing can be conducted from the following specimen types:

A ThinPrep Vial
A SurePath Vial
A Buccal Swab (Please select "Other" and type in Buccal Swab)

In the "Clinical History" box, please type the ethnicity of the patient. You may select from:

European Caucasian
Ashkenazi Jewish
Hispanic
African
Asian
Other

After you have filled out the form, please click "Save".

After you have selected a test, and you have clicked "Save", 4Medica will return you to the "Test Orders" screen. The test you have ordered is displayed in the bottom half of the screen as shown in the figure below.

If you would like to order another test, you can click on the test you would like to order. In this example, a GC/Chlamydia test is also being ordered for this patient. To order the GC/Chlamydia, you just click on GC/Chlamydia by PCR in the test menu. After completing the GC/Chlamydia order, there are now two tests shown at the bottom of the screen.

After you have completed ordering the tests, you must click the "Diagnoses" tab. This will allow you to enter the correct ICD9 codes for each of the tests ordered. In this example the previous pap was abnormal, so 795.00 is the code that will be used for the Thin Prep Pap test. To select 795.00 you first must search for it and then you can click on it to select. Please review the following screen shot for details on how to proceed. Follow the numbered list of instructions included at the bottom of the screen.

After you press "Submit", you will be presented with a screen asking for the specimen collection date as shown in the figure below.

You can type in the date and time or you can click Icon to bring up the calendar so you can select a date. If you have just collected the specimen you can choose "Now and Close". If you do not select "Now and Close" you need to click "OK" after you have entered the date.

After the specimen collection date has been entered, a pop-up window appears which is the requisition. If you have ordered multiple tests, several pop-up windows may appear, each with a requisition for a different test. To "Print" the requisition you need to click the "Print" button.

After clicking print, a printer dialog box should appear. In most cases, it should work if you just click "Print". If this does not work, or you need to change the settings to print to a different printer you should contact your IPS Technical Support Specialist.

After you have selected a test, and you have clicked "Save", 4Medica will return you to the "Test Orders" screen. The test you have ordered is displayed in the bottom half of the screen as shown in the figure below. In the example shown in the image, there are two tests that have been ordered, a Thin Prep Pap and HPV(regardless of dx) and a GC/Chlamydia by PCR.

If you need to review the specimen requirements you can do so, by clicking on the "Specimen Requirements" tab.

When the screen first appears, you will receive a message that says "No Data Available". In order to view the "Specimen Requirements", click the button that says, "Get Requirements", which will display the specimen requirements for you to review.

Complete service manuals with specimen requirements are also available at our web site, www.gowithips.com

In certain cases, you may need to edit or cancel an order after the order has been placed. First you must go to the "Order Log" screen as described in Section 4.1.

To cancel an entire order, you would first click on the order you would like to cancel. Next you would click the red "X" labeled as "Cancel Order". If the requisition and specimen have already been sent to I.P.S. you must also contact I.P.S. via phone or fax to ensure the order is cancelled. If you DO NOT contact I.P.S. the order WILL NOT be cancelled!

If you need to edit an order, you would first click on the order you would like to edit. Next, you click the icon marked as "Edit Order", which will bring up the "Order Tests" screen as shown in the screen shot below.

In this example, a "Liquid Based Pap Smear with HPV (regardless of diagnosis)" has been ordered. If you need to add another test to this, you would simply select another test just like you would do when you were ordering the tests initially, including entering the diagnoses codes. After finishing, you would click "Submit".

If you wanted to change the test to a "Liquid Based Pap Smear", you would click the yellow highlighted area "Liquid Based Pap Smear with HPV (regardless of diagnosis)", which would remove the highlighting, and remove the test. Then you could add a "Liquid Based Pap Smear" by selecting "Liquid Based Pap Smear", fill out the pop-up window correctly, "Save" and then "Submit". If the requisition and specimen have already been sent to I.P.S. you must also contact I.P.S. via phone or fax to ensure the order is CHANGED. If you DO NOT contact I.P.S. the order WILL NOT be changed!

If you need to change the ICD9 Diagnoses Code, you must select the test in the bottom "Window Pane". If you would like to use the same Diagnoses for all tests you can select all the tests so they are all highlighted yellow.

The real power of editing is becoming familiar with how the "highlighting" works. After you play with the interface for a while, you will become somewhat more familiar on how to edit orders. This short section was just a quick guide to help you get started.

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