ANATOMIC PATHOLOGY
PROCEDURE MANUAL.
INTRODUCTORY REMARKS
FOR THE INTERNET USER.
DRAFT COPY ONLY.
(Procedure I).
G. William Moore, MD, PhD.
http://www.netautopsy.org/axsop/axsopint.htm



United States Government Work, uncopyrighted, public-domain, DRAFT COPY ONLY. This document does not necessarily represent the views or policies of any United States Government agency. This document is provided "as is", without warranty of any kind, express or implied, including but not limited to the warranties of merchantability, fitness for a particular purpose and non-infringement. In no event shall the authors be liable for any claim, damages or other liability, whether in an action of contract, tort or otherwise, arising from, out of, or in connection with the document or the use or other dealings made with the document.


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This document is an approximate copy of some sections in the ANATOMIC PATHOLOGY PROCEDURE MANUAL of the Baltimore Veterans Affairs Maryland Health Care System. The document is uncopyrighted, public-domain, draft copy, and has no official status. The document may be copied freely. It is offered as a model electronic document, in a spirit of cooperation with other pathology laboratories worldwide, who are considering developing an electronic pathology manual at their medical institutions. Obviously, institutions that are developing their own manuals must make local modifications on the document. The authors assume no responsibility for any damages that might arise from the use of the present document.

Electronic documentation has several advantages over paper documents in a modern medical institution. If the institution has an in-house INTRANET, with appropriate cyber-security, then the document may be made available to all authorized viewers.
  • Many off-hours calls to pathology personnel are questions on how to submit a specimen to pathology or how to find a pathology report. The appropriate paper manual may not be readily available when needed. The caller may appreciate the opportunity to locate the information rapidly in an appropriate on-line manual, rather than tracking down the required pathology staff.

  • We have sought to make the electronic manual richly interlinked, so that if a particular comment in one procedure refers to another procedure in the manual, or even to an outside PubMed reference or other internet document, the reader can immediately link to it.

  • A modern pathology laboratory offers hundreds, perhaps thousands of different laboratory tests, and is constantly bombarded by new test requirements, safety regulations,..... Nowadays, the appropriate information is provided electronically by the manufacturer, but must be customized to meet local laboratory requirements......

  • This is an amateur document, not requiring a professional publication staff, that can be prepared and modified by a pathologist with modest personal computing and internet skills, and an appropriate Internet editor (we recommend Dreamweaver®). Thus, the document can be kept current by the pathology department as new situations arise.

  • Finally, this document uses a pathology reporting system that runs on the VistA® and CPRS® electronic medical record (EMR) systems. The VistA® and CPRS® software systems are United States Government products, that may be obtained cost-free. (Of course, these cost-free products do not come with technical assistance for installation or maintenance.) These systems currently function at 172 U. S. Veterans Affairs medical centers, and provide EMR support for 85,000 employees caring for five million patients. Details at URL:
    http://www.hardhats.org

    For a free, single-user demo version of VistA/MUMPS, go to the above website. At the top of the home webpage, you will see:
    Search | HOME | MUMPS | Fileman | .......
    Click on MUMPS. Scroll down to:
    Learn M and FM v21 for free.
    Click on Download, and save the file, fm_ws.zip. Use PKUNZIP.EXE, in order to UNZIP the ZIPped file, fm_ws.zip. 
     Directory:
                  
 02/23/2005  11:03 AM              .
 02/23/2005  11:03 AM              ..
 01/26/1999  09:34 AM        10,240,000 FILEMAN.M
 01/24/1999  02:29 AM           159,744 FM.EXE
 02/23/2005  11:00 AM         3,210,667 fm_ws.zip
 01/25/1999  03:13 PM         2,450,704 MSMWS002.DLL
 02/01/1993  01:04 AM            28,959 PKUNZIP.EXE
 01/26/1999  09:49 AM               287 README.TXT
                6 File(s)     16,090,361 bytes
    type readme.txt The FM.EXE file runs the VA's File Manager program from the data stored in the Fileman.m file. A limitation of this current edition, is that the three files (msmws002.dll, fm.exe and Fileman.m) must be stored in the following path:
    C:\Program Files\Micronetics\MSMWS\Program\

    • Standards:
    1. Procedure Manual written according to National Committee for Clinical Laboratory Standards (NCCLS) specifications, as follows:
    1.1. Procedure Number.
    1.2. Title.
    1.3. Principle of the test.
    1.4. Specimen required.
    1.5. Reagents, instrumentation.
    1.6. Step-by-step description.
    1.7. References.
    1.8. Author and effective date.
    Hoeltge GA, Dynek DA, Delahunty DC, McClatchey KD, Rabinovitch A, Robinowitz M, Travers EM.
    National Committee for Clinical Laboratory Standards (NCCLS). Clinical Laboratory Technical Procedure Manuals. Third Edition.
    Approved Guideline GP2-A3. December, 1996. vol 16, no 15.

    2. Procedure Manual prepared in Hypertext MarkUp Language (HTML), the publication language of the Internet.

    3. All specimens submitted to the pathology department by:
    3.1. Tissue Examination Form. (U. S. Standard Form 515, USSF515).
    3.2. Gynecologic Cytology. (U. S. Standard Form 541, USSF541).
    3.3. Request for Postmortem Examination. (U. S. Standard Form 523, USSF523).
    3.4. VistA® order-entry.

    4. Paper documents are mirrored in VistA®/CPRS® electronic records.

    5. Open-source data structure:
    5.1. CPRS® on a platform of VistA®.
    5.2. VistA® on a platform of VistA® Kernel.
    5.3. VistA® Kernel on a platform of VistA® File Manager.
    5.4. VistA® File Manager on a platform of MUMPS®.
    5.5. MUMPS® on a platform of C.


    6. All reports electronically signed by technologist/pathologtist.

    7. HIPAA-secure VistA® email for patient information and notifications.

    8. Electronic tracking of notification, billing, turnaround-time (TAT).

    9. Collection of monthly statistics with spreadsheet and database.

    10. Monthly QA reports to P&LMS staff meeting.

    11. Monthly QA reports to IPRC meeting.

    12. In surgical pathology, large resections: TNM staging according to AJCC/UICC, 6th edition.

    13. Annual CAP inspection.

    14. Triennial JCAHO inspection.

    15. Biennial OSHA inspection.

    16. Other regulatory agencies: FDA, .....

    17. TEMPO/Continuing education/CME,.....

    18. Electronic re-credentialing of medical staff.


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