Meditech Policies & Procedures

July, 2000

MOUNT AUBURN HOSPITAL INFORMATION SYSTEMS POLICIES AND PROCEDURES

SUMMARY:

The Information Systems Department provides hardware and software support for Hospital Information System (HIS). In addition, the department implements, develops, modifies and tests software, routines, menus and reports within MEDITECH and other vendor applications software. Information Systems gives advice to end-users on the capabilities and functions of the HIS software and hardware and consults with departments to integrate HIS into his/her daily operations. Personal computer support for IBM and compatible hardware and software is also available.

Location: 330 Mount Auburn Street, Clark Building
Operations Staff (Clark Basement) 617-499-5600
Office Staff (Clark 3rd floor) 617-499-5602
(Note: Individuals on the Mount Auburn campus can dial the 4 digit extension to reach the above numbers.)
Fax: 617-868-1458
Hours: 24-hours daily, Sunday through Saturday

Guide to Information:

Toner Cartridge Replacement
Passwords
Terminating Passwords
Employees Holding Multiple Positions
Downtime
Help Desk
Trouble Shooting
Maintaining Printer
Loading Paper
Paper Jams
Labels
Site Visits
Custom Reports
Password Application Form
Contacts in Information Systems

PROCEDURES:

Toner Cartridge Replacements for Laser Printers:

The toner cartridges for the laser printers will be replaced and recycled by the Information Systems Department. If a user requires a replacement cartridge, it will take two shifts before a new cartridge is installed.

To order the toner, enter the request on the MEDITECH Order Entry system. Using the routine ENTER REQUISITIONS (Stock and Work), note the Information Systems (IS) category. The procedure will be TONER - Toner Cartridge Replacement. Please call Information Systems at 617-499-5600 for access to this routine. A supply of cartridges is maintained by the Information Systems Department.

Passwords:

The use of a unique computer password identifies each user in the computer system and acts as his/her signature. The password also links a user to a menu of functions designed specifically for that individual's job or class.

In addition, passwords are important because they help to maintain confidentiality of hospital information, including patient, employee, and financial information, and they preserve the integrity of the Hospital data. It is extremely important that passwords not be shared with anyone.

New Employees:

When a new employee accepts a job at the Hospital, the department manager will fill out a Password Application Form (1157B) for that employee as soon as his/her starting date is confirmed.

Managers should submit this form at least a week in advance of an employee's scheduled starting date to ensure that a password is available in time for the employee's first day of work.

A password will be assigned by Information Systems and the confidential packet will be sent to the requesting manager/supervisor, who will deliver the password to the employee. Information Systems will include the MOX Quick Reference and the Quick Reference Card for MOX, PCI, and Scientific American Medicine along with the passwords for all physicians and P.A.'s.

The password application will be maintained on file in the Information Systems Department. At the time of Sign-In, conducted by Employee Education, the new employee will sign a Confidentiality Statement, which can be found in the BULLETIN BOARD cabinet in MOX, in a drawer called HUMAN RESOURCES QUICK STOP. The new employee will bring this document to his/her supervisor, where it will be filed in the department's employee file.

Non-Employees:

This category includes employees from other companies in the Foundation, board members, physicians, clergy, volunteers, CRNA's, surgical houseofficers and staff from physicians' offices.

Requests for computer access for non-employees may be made by the supervisor, i.e.:

The vice president associated with the non-employee's department or service
The physician if he/she is active or courtesy staff
Mount Auburn's chaplain for other clergy
Director of Volunteer Services for volunteer staff
Physician or office manager for physician's office staff
Authorized personnel in the Medical Staff Office for Residents,
Interns, and medical students
Authorized personnel in Patient Care Services or Nursing instructors for student nurses

The Password Application Form (1157B), as well as the Confidentiality Statement for Non-employees, which may be found in the BULLETIN BOARD cabinet in MOX, in a drawer called HUMAN RESOURCES QUICK STOP, must be completed and forwarded to the Information Systems department for processing.

PASSWORD APPLICATIONS REQUIRE THE SIGNATURE OF THE USER'S SUPERVISOR.

A password will be assigned by Information Systems and the confidential packet will be sent to the requesting manager/supervisor, who will deliver the password to the new user. Information Systems will include the MOX Quick Reference and the Quick Reference Card for MOX, PCI, and Scientific American Medicine along with the passwords for all physicians, P.A.'s, and medical students.

Revisions, Changes:

When there is a change of status involving a Meditech user, such as a change of name, department, position or menu, the user's supervisor must complete a Password Application Form (1157B) indicating the changes and then forward the form to the Information Systems department for processing.

Verbal Requests for Passwords:

In extenuating circumstances, (i.e. a fax machine is not available) a password may be verbally requested by a department head for immediate use. Positive identification of the requesting department head must be obtained before the release of the password. The password will be given only to the prospective user, who must sign a Confidentiality Statement, which is available in the MOX library file BULLETIN BOARD, in a drawer called HUMAN RESOURCES QUICK STOP.

A Password Application Form (1157B) must be completed by the user's supervisor as soon as possible after the password has been issued. The completed Password Application Form should be forwarded to the Information Systems department, along with the signed Confidentiality Statement if the user is a non-employee. The Confidentiality Statement for employees should be retained and filed in the department's personnel file.

Temporary Passwords:

Temporary passwords may be issued to non-employees who work in positions that require the use of the information system. A Password Application Form (1157B) and the Confidentiality Statement for Non-employees must be completed and signed by the individual's supervisor and then forwarded to Information Systems.

Forgotten Passwords:

If a password is lost or forgotten, the user may request the password by calling the Information Systems Department. Identity will be verified by:

Positive confirmation of the requester through the identification of some unique item of information, and

A "co-requester" or "verifier"; e.g. someone on site with the requestor who "co-signs" the request by successfully entering his/her own password into the system.

After successful verification, the Information Systems Department representative will only reveal the password to the identified user. The Information Systems Department representative will complete a report on the situation and identify the user's name and department. This report will be reviewed by the Director of Information Systems and may be forwarded to the individual's supervisor, as well as the "verifier's supervisor," if there are repeated occasions of forgotten passwords by the same user.

In the case of lost passwords, that is, if the user's password has been physically lost, a new password should be issued to prevent unauthorized access to the computer system by a possible finder of the lost password.

Passwords associated with employees who have VIP routines will only be revealed by the Director of Information Systems.

Terminating Passwords:

Passwords terminated by the system: In order to maintain security, all passwords will be automatically terminated every six months, beginning with the first six months after a password is issued.

On the expiration date, when a user first signs on to the computer system, a message will appear that "sign on" may be attempted three more times using the current password before having to accept the new system-assigned password. If the user is ready to accept, the new password should be quickly written down and then, at the prompt, typed in to verify it. If the accepted password is typed incorrectly, and the three chances to accept have not been used up, the system reverts back to the user's old password, allows entry, and then prompts to accept a new password at the next "sign-on." If three more "sign-on's" have been used without a new password being accepted, access to the system cannot be gained until the user accepts and verifies a new password.

On-demand terminations: A supervisor or department head may call Information Systems to request immediate termination of an employee's password. Employees' and non-employees' password terminations: Supervisors must notify Information Systems immediately after termination of employment for immediate password deactivation.

Transfer of an Employee: When an employee/non-employee is transferring to another department, the individual's current supervisor should notify the Information Systems department in advance of the effective date of the transfer, so that arrangements can be made to transfer any important MOX files from that user to another appropriate person and so that the old password can be deactivated in a timely manner. The new supervisor must complete the Password Application Form (1157B) to request computer access for the new position.

Employees Holding Multiple Positions:

If an employee holds positions in more than one department, he/she will have a different password for each department in which computer access is needed.

Downtime Procedures:

Downtime at Mount Auburn Hospital is defined as anything that inhibits the flow or accessibility of information in the hospital information system. The Information Systems Department will notify the switchboard of the downtime. The switchboard will announce the anticipated length of downtime through the Hospital intercom.

Areas that do not have an intercom system will be notified by the Information Systems Department. These areas include:

Laboratory
Parsons Recovery Room
Operating Room
Clark Building
Transport
ICU
Pharmacy
Dietary
CCU
South 1
Day Surgery
Medical Records
Admitting
Cast Room
Dialysis
DOB 512
Neurology

Computer Help Desk:

All computer problems should be directed to the Information Systems Computer Trouble-Shooting Line at extension 617-499-5600.

Trouble-Shooting the Terminal:

Black Screen:

Check to be sure that the green light next to the On/Off switch is lit;
Press the "Shift" to refresh the screen;
Make sure that the wires in the back of the terminal are plugged in securely;
Make sure that the phone-type line is secured into the wall port;
If the screen is still black, press and hold the "Alt." A small white box will appear. Check the speed, it should always be 9600. If it is not 9600, call 617-499-5600.

If the terminal screen remains black after trying the procedures outlined above, call 617-499-5600.

Question Marks On the Screen:

If a question mark (?) or a dollar sign ($) appears on the screen and pressing "Enter" causes more question marks, type:

H(0) {that is zero} then hit "Enter."

This should bring the screen back to the Good-Bye screen. Press "Enter" to continue.

A Password That Does Not Allow An Employee Access To The System:

If the password was typed in at the USER prompt and the computer will not allow the user onto the system, enter the password again. If the system continues to deny access, confirm that the correct password is being used. The third unsuccessful attempt will lock the keyboard for 60 seconds. Do not attempt to enter the password again until the message "Keyboard Locked For 60 Seconds" disappears.

Screen Is Frozen - Cursor Will Not Move:

If a user is scrolling a report on the screen and it freezes and cannot return to the scroll, press "CTL" and "Q" to unfreeze the screen. If an attempt is made to print something and the cursor freezes, check the printer for adequate paper supply and to determine if it is "On Line."

HP Laser Jet Printer Care:

NEVER TURN OFF THE PRINTER UNLESS INSTRUCTED TO DO SO BY AN INFORMATIONS SYSTEMS EMPLOYEE.

CONTROL PANEL:

Display:

Status messages to keep a user aware of the printer's current condition.

Attendance messages to tell a user to perform a necessary task before the printer continues to print.

Error or service messages to let a user know when the printer encounters difficulties

Menu items and his/her associated values or choices that a user can select

Flashing Indicators:

Printer is either receiving data, printing information, or the operation is pending.

Ready Indicator:

The green ready indicator is lit when the printer is ready to print. When the ready light indicator is off, an error or attendance message appears in the display. In order for the printer to receive the information, it must be both "On Line" and "Ready."

Manual Feed Indicator:

The amber Manual Feed indicator is lit when the manual paper feed is selected.

On Line Indicator:

The amber On Line indicator is lit when the printer is On Line. The printer can be switched between on line and off line by pressing the On Line button. To print, the printer must be on line. To use the other keys on the control panel, the printer must be off line.

Form Feed Indicator:

The amber Form Feed indicator is lit whenever page data is stored in the printer's memory.

NOTE: When the printer is actively receiving data, the Form Feed indicator is lit and the Ready light is flashing. When the printer is finished processing the data, the Ready light will remain lit. If the Form Feed indicator remains lit, there is still a page of data in the printer's memory that has not been printed. Take the printer off line and press the Form Feed button to print the stored data.

DO NOT TURN OFF THE PRINTER WHEN THE FORM FEED INDICATOR IS LIT BECAUSE THE DATA THAT HAS BEEN STORED IN MEMORY WILL BE LOST.

Other Control Panel Features:

Most of the features on the control panel are for the Information Systems' department use only. Two features that users may use are "Continue/Reset."

Briefly pressing "Continue" clears most errors and returns the printer to the On Line status. To use the reset feature, hold in the "Continue" button for 3 to 5 seconds. This will reset all of the internal printer settings to the control panel settings.

CHECK WITH INFORMATION SYSTEMS (617-499-5600) BEFORE RESETTING THE PRINTER.

Cleaning And Maintaining The HP Laser Jet III Printer:

Low Toner:

The low toner message will appear in the display when the toner level in the toner cartridge is low. The print on the page will get lighter and light streaks may appear as the toner level becomes low.

To redistribute the toner:

Open the printer's top by pressing the rectangular button on the top of the printer.

Remove the toner cartridge by pulling straight away from the printer.

Rotate the cartridge from side to side to redistribute the toner.

Re-insert the cartridge and close the top of the printer. To order a new toner cartridge, notify Information Systems.

Call 617-499-5600 for further help.

Loading Paper:

Grasp both sides of the paper tray firmly and pull straight out away from the printer.

Lift off the plastic cover to the paper tray.

Load the paper (arrow side up) into the tray. Note that one side of the tray has a silver bar over one corner to serve as a guide for not overfilling the tray. Do not load above the silver guide. Replace the plastic cover and insert the tray back into the printer. Be sure to insert the tray at a level angle, and insert the tray completely. LOAD LETTER should now read READY. If the printer does not return to the On Line and Ready status, press the Continue/Reset button once to continue the printing process.

The LOAD LETTER message will appear on the display when the paper holder cartridge is out of paper. The printer will store in memory the data that has not been printed. It is important to add paper to the tray as soon as possible so that the information will not be be delayed, causing the system to back up.

NOTE: The paper should not be creased, folded or damaged.

Do not add small amounts of paper on top of paper that is already in the tray. This will increase the chance of two pages feeding at once, and may lead to a paper jam.

If the photocopy paper package has an arrow on the packing label, load the paper with the arrow pointing up.

Clearing A Paper Jam:

The PAPER JAM Message will appear in the display when the paper has not fed properly through the printer.

To clear the paper jam:

Open the printer cover by pressing the rectangular button on the top of the printer.

Look for the jammed paper. If the jam has occurred in the fuser assembly area, pull the paper toward the front of the printer (toward the paper tray). If the jam occurs in the paper pick-up or the transfer guide area, gently pull the paper toward the back of the printer.

Gently and firmly close the printer cover. Press continue/reset as necessary.

External Care:

As with all of the hardware (terminals, printers, etc.) associated with the hospital information system, the printers need to be dusted periodically. Food or beverages should not be consumed near any computer hardware.

Each device connected to the hospital information system (personal computer, printer, or terminal) will have two stickers attached. One sticker is the assigned device name, and the other is the telephone extension for the Help Desk. Please do not remove these stickers.

Do not place anything on top of the printer.

Employee Labels:

All requests for labels printed from the Payroll/Human Resources Module must be cleared through the Director of Compensation and Benefits. Information Systems requires two weeks' notice for all employee labels. Employees in Human Resources have a separate "Labels" menu from the sub-menu on his/her Custom Reports options. A Human Resource employee will contact the Information Systems Department through the Help Desk (617-499-5600) to provide details on the request.

Site Visits:

All requests for site visits, whether initiated by our software vendor, another hospital, new account, or MEDITECH consultant, must be coordinated through the Information Systems Department. These requests will be channeled through the Marketing Representative at MEDITECH. MEDITECH's Marketing Representative will contact the Director of Information Systems for approval and coordination. Once approved by the Director, the Information Systems managers will determine a schedule acceptable to the department(s) involved, the visitor, and the Information Systems department representative. Mount Auburn Hospital will accrue "credits" from MEDITECH for each visitor.

Custom Reports:

To request custom reports from the Information Systems Department:

Submit all requests to the Information Systems Department on the Request NPR/DSR Custom Report Form. An employee may call the contact in the Information Systems Department for the form. An analyst will review the request and determine if there is any standard report that resembles the request and may meet the needs of the request. Requests for reports not already available on the system will be entered into the Report Queue in the Information Systems log.

The report will be written by the Information Systems staff and tested in the Test system. An employee will be contacted to test the report to ensure that the new report meets the needs. This step must take place before Information Systems will move the report Live.

An employee will sign off on the request sheet when the report is satisfactory. The report will then be added to the appropriate menus.

INSTRUCTIONS FOR PASSWORD APPLICATION FORM

1. Check a box to indicate whether the application is for an employee, non-employee, volunteer or temporary. If two categories apply, check both boxes.

2. Check off the correct box to indicate the requesting facility.

3. Check the correct box(es) to indicate if the application is for a New User, Rehire or Menu Change. Fill in the beginning date and ending date (if temporary).

4. If the application is for a name, department, or position change, fill in the old and the new information.

5. LAST NAME; FIRST NAME; MID.INIT: Fill in the last name, first name, and middle initial, if any, of the applicant. If the application is for a name change, fill in the person's new name.

6. Check off the appropriate title, if any, or check off OTHER for a title not listed.

7. POSITION: Fill in applicant's working position and/or OTHER title.

8. PHONE/BEEPER: Fill in the applicant's work phone number/extension and beeper number, if applicable. If the applicant does not have an assigned number, fill in the main department number. This information will be used for an on-line telephone directory.

9. 4PER DIEM?; IS USER A SUPERVISOR?: Check off Y or N.

10. DEPT & LOCATION OR ADDRESS IF OFF SITE: Fill in the name of the applicant's department, the building and the floor, or the off-site address, if applicable.

11. REPLACING TERMINATED USER? Check off Y or N. Fill in NAME OF TERMINATED USER.

12. SUPERVISOR' NAME: Print name of applicant's supervisor.

13. PHONE/BEEPER: Fill in the supervisor's phone and/or beeper number.

14. Fill in the name of a person in the applicant's department who has the exact computer access required for this user - usually someone with the same position.

15. MOX FAXING CAPABILITY? INTERNET E-MAIL ACCESS? Check off Y or N.

16. DOES APPLICANT CURRENTLY HAVE A MEDITECH PASSWORD? Check off Y or N.

UNDER WHAT DEPT? Name any other department in which the applicant is currently working.

WILL APPLICANT RETAIN THAT POSITION? Check off Y or N

WHICH DEPT IS PRIMARY POSITION? If answer to above question is Y, fill in applicant's main department.

17. SPECIAL INSTRUCTIONS: Supply any additional information necessary to complete password

18. ACCESS TO MOX: Check off whether applicant needs access to Mail and Messages only or to Mail, Messages, and Word Processing. Mail and Messages allows the user to send and receive mail, create cabinets into which mail can be transferred and access library files. Word Processing access allows the user to create documents and is restricted to Mount Auburn Hospital employees, except under special circumstances. Users with more than one password will have access to MOX on their primary password only.

19. ADD TO MOX DISTRIBUTION LISTS: Name any distribution lists currently existing in MOX to which the applicant should be added.

20. AUTHORIZED BY: The applicant's supervisor or manager must sign here and return the form to the Information Systems department, either by FAX or through the mail. If applicant is a non-employee of MAH, a confidentiality statement signed by the applicant should be submitted with the password application.

THE REMAINDER OF THE FORM WILL BE COMPLETED BY INFORMATION SYSTEMS.

PRIMARY INFORMATION SYSTEMS CONTACTS (REVISED JULY 2000)

Below are the current Information Systems contacts for each of the Hospital Information Systems' applications. If you are in a situation in which you need assistance with a specific application, you may want to phone or MOX the contact directly versus dialing 617-499-5600.

As always, general computer problems (hung terminal, toner cartridges, etc.) can be addressed by the I.S. Help Desk at extension 5600 or via an outside line at 617-499-5600.

GENERAL CONTACT NUMBERS: