The Main Line Health (MLH) system can be accessed through the Internet using the MLH Extranet Portal. The Extranet Portal gives users access to the MLH Intranet, PACS Horizon RadStation Distributed (HRS-d), PACS ejacket, and Physicians Workstation. Users must have an assigned SecurID fob to pass the security measures in place. Please contact the Information Services Help Desk for assistance at 610-993-2332 or internally at 59-2332. McKesson s PACS HRS-d and ejacket products can be accessed by using the MLH Extranet Portal to the MLH Network. This software is intended for image viewing capabilities only and is not to be used in any diagnostic format. The quality of your PC monitor will directly affect the quality of the images displayed via the Web. Recommended Settings for PACS HRS-d/eJacket via Remote Access Display settings: - 1024 x 768 1600 x 1200 pixels screen resolution - 24-bit screen bit depth (To determine if your monitor supports 24-bit color click on Start Settings Control panel Display Settings tab and see if one of the options for number of colors to display either says True Color, 24-bit or 32-bit.) Hardware: Required software: - Pentium III 500 MHZ - Microsoft Internet Explorer version 6.0-256 MB RAM (for viewing reports and images) - Adobe Reader v 6 or later (for viewing reports) - 100 MB free disk space (more space may be necessary) - Single color monitor - Mouse with scroll wheel Internet Connection: Operating system: - Cable Modem or DSL - Windows 2000 or Windows XP - Main Line Health SecurID (for Remote Access) To Login 1. Enter https://www2.mlhs.org (Note: notice the letter S after http) 2. Enter your six-character username in lowercase. Press <Tab> The username is usually the first five characters of your last name and the first character of your first name. 3. Enter your four-digit PIN, followed by the SecurID number on the display 4. Click the Sign In button 1
Note: If you have requested access to HRS-d (i.e., the version currently used within the MLH hospitals), then you will see the following set of WSAM screens. If you have not requested this access, please skip to the Extranet Portal Menu on page 6 and follow the instructions for the Main Line Health Enterprise PACS link. WSAM Client To use HRS-d, you must first install a WSAM client (a small application that allows you to connect to MLH) on to your PC. When you sign on to the extranet portal, you will see the following screen. In order to complete the kick-off you will need to allow the ActiveX object installation. The following dialog will appear: Notice the security bar across the top of the Internet Explorer window in the graphic below. You ll need to click on this bar and select Install ActiveX Control. This security bar is a function of Internet Explorer Service Pack 2 and was designed by Microsoft to help prevent the automated installation of unwanted spyware and malware by third parties. Unfortunately that design now requires that you explicitly allow the installation, requiring you to click and select Install ActiveX Control. 2
The ActiveX object is designed to help facilitate the installation of the WSAM client. As depicted below you ll be prompted to install the actual WSAM client (NeoterisSetup.cab). You should select Install in order to continue Please Note: If you are running Additional Virus Protection or Personal Firewall you may receive an additional message box. The verbiage of this dialog will differ depending on software. Please permit this action by selecting Install, Allow or Run to ensure the ActiveX Control is downloaded. After selecting Install you will see the client get downloaded from the Juniper appliance. The download dialog will disappear when the download is complete. The following Setup Dialog presents while the application is loading. 3
You have now completed the installation of the Juniper Windows Secure Application Manager (WSAM) Client. If you have run into unexpected problems while following the steps above please refer to the Firewall/Antivirus section located on page 18 near the end of this document. The WSAM manager can be located by an Icon the lower right hand corner of your desktop) in windows task tray (the group of icons in Once the initial download and installation are complete the WSAM Client will automatically launch itself and bring you to the Extranet portal at login. You do not need to go through the download process each time you use PACS. You should see a page similar to the graphic attached below. 4
When finished it is very important to Log Out of PACS and most importantly Sign Out the WSAM session. There are two ways to Sign Out 1) Click the Button in the upper Right portion of the portal screen. 2) Right click on and choose End Session. This icon will be located in task tray on the bottom left portion of the screen. Bank of icons should look like this... MLH cannot support the installation of this application beyond the instructions provided in this document because of the considerable variations of hardware and software that exist on home/office PCs. If you are not successful following the instructions in this document for installing the Windows Secure Application Manager (WSAM) client, please contact MLH Help Desk (610-993-2332). If your issue can not be resolved by the MLH Help Desk, you have two options: 1) Use ejacket as your remote PACS solution 1 or 2) Contact a third-party vendor to assist you with the installation If you choose option 2) you will be responsible for any costs associated with using the third-party. 1 This option requires Main Line Health Information Services to remove you from the WSAM User Group. Please contact the MLH Help Desk at 610-993-2332 or inside tie line 59-2332 to have yourself removed from this group. 5
Extranet Portal Menu After you have successfully logged into MLH, you will see the portal page as seen below. You have several choices one of them is Main Line Health Enterprise PACS (HRS-d) and another is Main Line Health Enterprise PACS (ejacket). If you select the Main Line Health Enterprise PACS (ejacket) link, you will be able to use a feature limited PACS Web application. While this version lacks many features, it does provide basic image review capabilities and more importantly is designed to run in the IE browser without any downloads as a standard Web page. If you have difficulties installing and/or using the more advanced HRS-d application, you can always use this version. If you select the Main Line Health Enterprise PACS (HRS-d) link, you will be able to use the latest version of HRS-d, the more advanced PACS viewer. This is the version that is currently available from any MLH PC within the MLH hospitals. Please note that this version requires an application installation on your PC unlike the ejacket application. If you need instructions on using or installing this version of the Web application, follow the Main Line Health Enterprise PACS (HRS-d) instructions that begin on page 13 of this document. MLH cannot support the installation of this application beyond the instructions provided in this document because of the considerable variations of hardware and software that exist on personal PCs. If you cannot install this version of the Web application based on the instructions provided in this document, you have two options: 1) Use the ejacket application or 2) use a third-party to assist you with the installation. If you choose option 2) you will be responsible for any costs associated with using the third-party. 6
Main Line Health Enterprise PACS (ejacket) Below are instructions on using the ejacket application. Enter your PACS User ID and Password Enter your PACS user name and password. Locating a patient or study Enter Patient Name, CID, Accession Number, or Exam Date and hit Enter or click on Search to locate a study. A list of studies will be returned that match the selection criteria. Once you locate the study you want to view, double click on the study in the list using the left mouse button to view the images. 7
Viewing Images The first image in the study will display automatically. To view the next image in the study click on Next. To view the next series, click on Next Series. To go back, click on Previous or Previous Series. You can click on the Other Studies for This Patient drop down box in the upper right corner of the screen to view other studies for the particular patient for whom the current study is open. Studies with a significant number of images (e.g., CT, MR, US) will display four images per screen. If you would like to make any of these images larger, click on the image with the mouse and this will launch High Resolution Mode, which displays the images across the entire screen. Click on the Exit High Resolution Mode link at the top of the screen to return to the normal display. The icons in the upper right corner of the screen have the following functions: Search for another patient Help Exit the application 8
Main Line Health Enterprise PACS (HRS-d) Note: If you are running HRS-d for the first time on a particular PC, you will need to install the software on your PC prior to using the application. This will only need to be run one time per PC. See instructions on page 13 of this document for the setup process. From the main extranet portal page show below click on the HRS-d link as shown below (Note: if you are not running the WSAM client this will not run). If you have already installed the HRS-d client you will see the following screen. Enter your PACS username and password here. 9
1. Click on the arrow next to the Study List icon and then click on Find Studies to search for a patient study. 2. Enter the patient name then click Find. 3. Double click on the study you wish to open on the list. Images automatically load. To view other images/series, click on the thumbnail for that image/series and drag it to the active window while holding down the mouse button or double click on the thumbnail. If images are compressed, it will be indicated on the image. To remove or change compression, click on the compression icon. 10
Prior studies will automatically load along top toolbar. To compare studies, drag series thumbnails from different studies into active parts of the screen. Clicking on the documents icon (shown at left) in the toolbar will display any results available for the study in a separate window (shown below). To review reports for older studies, click on the study details in the list at the left of the window. 11
Below is a list of all icons available in HRS-d and their functions. Items are also available via a right mouse click on an image. Click on the Preferences icon in the toolbar to change the items that appear in the toolbar. You can also change the items that appear in your Right-Click Menu. Click Apply to save changes. 12
Installing HRS-d MLH provides the following instructions as a guide to help you with installation of HRS-d, but MLH makes no guarantees that you will be able to successfully install this on your PC. Furthermore, MLH takes no responsibility for any damage you or any third-party does to your PC or any application or data on your PC as a result of trying to install this application. There are a number of steps involved to successfully install HRS-d on your PC. In addition, depending on the OS (e.g., Windows XP, Windows 2003) and third-party applications (e.g., antivirus, firewalls, pop-up blockers), some or all of the following steps may be blocked by your PC. Because of the considerable variations of hardware and software that exist on personal PCs MLH cannot support the installation of this application beyond the instructions provided in this document. If you contact the MLH Help Desk for assistance with installing HRS-d, they will refer you to this document or to a third-party. If you are unable to install this application on your PC, you have the option to use ejacket (see page 6 for more details) or you can use a third-party to assist you with the installation of the application. If you choose to use a third-party you will be responsible for any costs associated with using the third-party. To begin the installation, click on the Main Line Health Enterprise PACS (HRS-d Software Download) link as shown below. Please note that firewalls, antivirus applications, and pop-up blockers may prevent the successful installation of HRS-d. For more information on configuring to your firewall or antivirus application see page 18. For more information on configuring your pop-up blocker see page 19. 13
When the following pop up window appears, click on the Run button. (Note: Depending on your system, you may need to click on Open instead of Run.) You will see the following window appear. The percentage at the top of the window will count up to 100% as the application downloads to your PC. You will then see the following window click on Run. 14
Click on the Next button. Click on the Next button. 15
Click on the Install button. The software will install automatically (If you have a firewall or antivirus application installed on your PC, this may block the installation. See the note on page 18 if this occurs.). Please note that this step may take several minutes as indicated on the screen and even if nothing appears to be happening the application is still installing in the background. 16
After the PACS installation completes you will see the following window. Click on Finish. After the PACS installation completes go back to the Main Line Health extranet menu to launch the application (see page 6 for more details). 17
Firewall/Antivirus Issues If you have a Person Firewall (e.g., Windows Firewall, Windows Defender, McAfee Personal Firewall Plus, Symantec Norton Personal Firewall) or Anti Virus application (e.g., McAfee VirusScan, Symantec Norton AnitVirus) installed on your PC, it may block the installation of the WSAM and HRS-d clients. If you receive an alert from your firewall or Anti Virus package (typically identified by an additional dialog on the windows tool bar) during the installation of the WSAM or HRS-d client you will need to select this dialog and MANULLY choose to Allow or Unblock or Permit these clients to install. Below are some sample dialog windows for common firewall and Anti Virus applications. (Note: the names of the blocked applications may differ from those shown below as these are just representative examples) Click on Allow entire script this time. Click on Unblock. 18
Pop-Up Blockers With virtually hundreds of pop-up blockers on the market today it is impossible to provide an allinclusive manual. Below are some configurations for common pop-up blockers. For instructions on other pop-up blockers, refer to your pop-up blocker manufacturer's manual. Configuring the Windows XP Service Pack 2 Pop-up Blocker Open an Internet Explorer window 1. Click Tools (on the upper menu) 2. Choose Internet Options 3. Select the Privacy tab 4. Click the Settings button (see the picture below) 5. In the box for Address for Web Site to Allow type https://www2.mlhs.org 6. Click the Add button (see the picture below) 7. Click Apply and OK 19
You can also Go to Tools>Pop-Up Blocker>Pop-Up Blocker Settings. Type https://www2.mlhs.org in Address of Web Site to allow and click Add. As Illustrated below... Type web address and click Add to allow Pop-Ups for Secure Session. 20
Configuring the Google toolbar Pop-up Blocker If you are using Internet Explorer with the Google toolbar, ensure that the Google Toolbar says "Site pop-ups allowed" when you are on the Main Line Health SSL (https://www2.mlhs.org). To accomplish this, go to the https://www2.mlhs.org and click the button on the Google Toolbar that says " # blocked" (e.g., 377 blocked in the picture below). The button will turn into Site pop-ups allowed". Click to allow Pop-Ups for session. Find more information about Google's Pop-up Blocker look at http://toolbar.google.com/popup_help.html. Configuring the Yahoo toolbar Pop-up Blocker Turn Pop-Up Blocker off using the Pop-Up Blocker menu Add the source of the pop-up window to your Allowed List by clicking the Pop-Up Blocker menu and selecting Always Allow Pop-Ups From... button. Then select https://www2.mlhs.org from the Sources of Recently Blocked Pop-Ups list and click Allow. Find more information about Yahoo's Pop-up Blocker look at http://help.yahoo.com/help/us/companion/pub/pub-07.html Configuring the MSN toolbar Pop-up Blocker Click the down arrow next to Pop-ups Blocked Choose Allow Pop-ups from this Site from the drop down menu. Add https://www2.mlhs.org to the list of sites to allow pop-ups. Click Add>OK. 21
Configuring the AOL toolbar Pop-up Blocker AOL Toolbar appears in the browser as follows... The following icon is the Pop-Up Blocker: Click on this icon. The icon should now look like this: Configuring Pop-up Stopper Professional Pop-Up Blocker One of the more popular Pop-Up Blockers available, this software is designed solely for preventing Pop-Ups. It will install an icon in the lower right corner of your Start Menu Toolbar This Icon will look like this: To disable Pop-Up Blocking, right-click on the icon and a Pop- Up menu will appear with a list of options: Uncheck the option Block pop-up ad windows. 22
Configuring the Pop-Up Cop Pop-up Blocker Another popular Pop-Up Blocker, this software is also designed solely for preventing Pop-Ups. It installs the following toolbar within the browser: Click on the down arrow next to the shield to display options... Click on Allow popups from... type the address https://www2mlhs.org Click OK 23
Configuring the Norton Internet Security/Firewall Pop-up Blocker 1. Open Norton Internet Security's/Firewall s main window (you may click the firewall icon on the system tray or use Start->Programs->Norton Firewall( 2. Click the Ad Blocking line 3. Click the Turn Off button 24