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Contributor: David Cooper Date: Aug 29-2016

Telemedicine Facilitation Course –

Sheridan College

Telemedicine Equipment Technical Resource Guide -

Version 1

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Table of Contents

Telemedicine Cart Hardware ……………………………................ 3

General Overview …………………………………………………… 4

Simulation Devices …………………………………………………. 6

Startup Process ……………………………………………………… 7

Telemedicine Workflow …………………………………………….. 10

Troubleshooting …………………………………………………….. 37

Important Contacts …………………………………………………. 49

Technical Requirements/Specs …………………………………..... 50

Appendix A – Telus EMR Config ……………….………………..... 52

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TELEMEDICINE CART HARDWARE

Surface 3 Computer

and Docking Station

DELL 24” External

Monitor

OphthoSim (Eye) Base

Unit

Logitech BCC950

Camera + Remote

Control

Avizia HorusScope

↓

TF Cart Base + Storage

3M Littmann Tele-

Stethoscope

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(a) General Overview

The Telemedicine Equipment for the Telemedicine Facilitation Course

consists of a Telemedicine Facilitator (herein referred to as “TF”) Station (or

cart) and a Doctor Station (or cart). There are various software, electronic and

conventional components that comprise the stations.

The TF station consists of the following items:

Telemedicine Devices, Software and Accessories

» Luxor Industrial Locking Cart with Monitor Mount » Microsoft Surface 3 Computer running Windows 10 with a docking station

» DELL 24” LCD Monitor

» Logitech BCC950 Conference Camera/Mic with Remote Control

» Avizia Electronic HorusScope with Charging Cradle, General Attachment and Otoscope Attachment

» 3M Littmann 3200 Electronic Tele-Stethoscope with Case

» OphthoSim Eye Simulation Device and Case from OtoSim » Anker 7 Port USB3 Hub

» Wireless Mouse

» MD Matrix Telemedicine Software

» TELUS Med Access Electronic Medical Record (EMR) Software

The Doctor station consists of the following items:

Telemedicine Devices, Software and Accessories

» Luxor Industrial Locking Cart with Monitor Mount

» Microsoft Surface 3 Computer running Windows 10 with a docking station » DELL 24” LCD Monitor

» Logitech C920 HD Pro Webcam

» Jabra Speak 410 Hands-Free Speakerphone » 3M Littmann 3200 Electronic Tele-Stethoscope with Case

» OtoSim Ear Simulation Device and Case from OtoSim

» Anker 7 Port USB3 Hub

» Wireless Mouse » MD Matrix Telemedicine Software

» TELUS Med Access Electronic Medical Record (EMR) Software

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Conventional Medicine Devices

» OMRON Blood Pressure Monitor

» BRAUN Digital Ear Thermometer

» Urinalysis Dipstick

The Microsoft Surface 3 computers are the main computers running the

software and hardware. They are currently running Windows 10 Home

operating system. The other 2 important software components are the MD

Matrix Telemedicine Software and the TELUS Med Access EMR software

(accessed through Internet Explorer Browser running remotely on the Telus

Cloud server).

The majority of the telemedicine peripherals are connected via Universal Serial

Bus – commonly known as “USB” (either directly at the back of the Surface 3

docking station or through the 7 port USB Hub in the base of the carts). The

DELL 24” external monitors are connected to the Surface 3 computers via a

“Mini-display to Display Port” cable using the “DP” input on the monitors.

The Surface 3 displays and DELL 24” monitor displays can either be

configured for “duplicate” mode (which means to display the same video on

both screens) or in “extended” mode (which means the Surface 3 can display a

different image/video compared to the DELL monitors). The “extended”

mode can be useful for displaying the Telemedicine Software session on one

screen and the EMR software on another screen.

The external Logitech cameras, Jabra speakerphone and Avizia HorusScope

are connected via USB. The Logitech BCC950 Conference Camera on the TF

cart is a motorized camera with a remote control. The 3M Littmann Tele-

Stethoscope is connected via Bluetooth/USB dongle.

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(b) Simulation Devices

There are 2 OtoSim Simulation devices used for teaching and training that are

physically located on the carts…but would not part of the typical Telemedicine

equipment in real-life. One device for the ear (OtoSim) and one for the eye

(OphthoSim). They are mainly used as a teaching tool for the instructor to help

minimize the risk of injury by teaching the students how to examine the ear

and eye first before practicing on a human. The carts are currently

installed/configured to run the Ear Simulator on the Doctor Cart and the Eye

Simulator on the TF Cart. They are connected to the Surface 3 computers via 2

USB cables – one cable for the large Base Unit and 1 cable for the smaller

Interface Box – and currently the video is displayed on the Surface 3 screens

and the 24” DELL monitors on the carts.

If the Simulation devices are connected to a standalone laptop on the TF or

Doctor Cart, then the video can be displayed on the DELL monitors via an

HDMI cable (the cable is roughed-in on the carts and is currently connected

to the monitor on one end and loose on the other end stored in the base of the

cart). In order to view the simulator software on the DELL 24” monitor, you

would need to switch the input on the DELL monitor to “MHL/HDMI input”

by pushing the input button on the bottom right of the monitor.

If the OtoSim hardware and software is being run on a separate laptop

independent of the Telemedicine stations, then it can be hooked up via a VGA

or an HDMI cable to the Sheridan Classroom Projector Interface Module to

display the simulator software on the large projector screens.

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(c) Startup Process

Referencing the basic Startup Flowchart above, the portable Telemedicine

carts require power to function and have a long master power cord that needs

to be plugged into a grounded electrical outlet to function.

NOTE: The Surface 3 Computers have an internal LI-ION rechargeable battery and can run

without AC power for several hours when fully charged.

The carts have a black main power bar at the back of the cart and a second

power bar in the base of the lockable cabinet (which all of the devices are

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plugged into – except for the external DELL monitor which is plugged into the

external black power bar at the back).

Once the master power cord is plugged in, the Surface 3 computers need to be

powered on. The removable Surface 3 computers are stored in the base of the

cabinet and need to be installed in the external docking station on the

keyboard pull-out tray. In order to dock them, this needs to be completed by

lining up the 2 Surface 3 ports on the top right side with the Docking station

ports and then carefully sliding the computers from LEFT to RIGHT. Once

fully pushed to the right gently pushed back on the bottom left to lock them in

place (the reverse needs to occur when removing the computers from the

docking stations). It may be easier to remove the magnetic detachable

keyboard when doing this but it is not necessary. The power switch is on the

top left of the Surface 3 screen. The switch needs to be pushed and held for

approximately 4 -5 seconds in order to turn on. The computers power up with

a Surface logo and will boot to directly to the Windows Desktop screen

because the option to login first to Windows has been disabled. If this auto-

login option become disabled, then the computers will boot up to a Windows

10 landing screen.

By clicking on the mouse, touchpad or swiping up the Surface 3

Touchscreen…this will take you to a login screen.

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A 4 digit quick login PIN has been enabled for ease of login. The password is

“1234” (you do not have the press the “enter” or “return” key). Once you are

logged in and fully operational, the monitors should display the main Windows

Desktop screen.

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(d) Telemedicine Workflow

MD Matrix Telemedicine Software takes the traditional in-person physician

visit and makes it truly virtual – without impacting the quality of care. By

providing patients with secure technology and the ability to access a physician

through a high-speed Internet connection, quality healthcare can be offered

that is convenient, accurate and easy with typically no waiting room.

There are 3 types of users: Patient, Doctor and Healthcare Professional (the

Healthcare Professional user is synonymous with the Telemedicine Facilitator

role at Sheridan). Depending on user credentials entered on the login screen,

the software will display the corresponding user interface (UI) to the type of

user.

In order to initiate a Telemedicine session, the first thing you want to check is

whether or not the computers are connected to the Sheridan WI-FI network.

After the initial WI-FI connection, normally when they boot up within the

Sheridan network they will automatically connect. However, this is not always

the case and sometimes they won’t be connected on WI-FI. Please check the

WI-FI connection icon in the “system tray” on the bottom right corner of the

display. The picture below shows a good connection.

If they are connected then you can continue. If not, then the picture will look

like one of 2 icons:

If not connected, click on the icon and choose “Sheridan Secure Network” and

ensure the check box “connect automatically” is enabled in order to connect.

For the purpose of this section, we will assume that they are connected (if they

will not connect right away then proceed to the WI-FI troubleshooting section

later in the manual).

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The next step is to launch the MD Matrix Telemedicine Software. You do this

by clicking on the small icon with the orange capital “M” in the Quick Launch

Toolbar on the bottom…or alternatively you can double click on the icon on

the desktop.

This will prompt you for a login.

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The login credentials are as follows:

TF STATION:

UNAME – scfacilitator

PW - scfacilitator

DOCTOR STATION:

UNAME – scdoctor

PW - scdoctor

NOTE: Make sure the “Remember” radio button is enabled. Then click “LOGIN”.

Telus Med Access EMR

To enter information in the Electronic Medical Record, manually launch the

Telus EMR software by clicking on the Internet Explorer icon in the Quick

Launch toolbar or double clicking on the Desktop icon. Internet Explorer is

currently configured to launch the Telus Med Access EMR software as the

home page and will take you to the login screen.

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The Telus Med Access login is a 2 step login. If you click “Remember my

credentials” on the 1st login, then on subsequent logins the UNAME and PW

will auto-populate and you can just click on “ok”. The login process from

scratch is as follows for the 1st step login:

To logon to Med Access EMR:

1. Open any internet browser (including Google Chrome, Internet Explorer, or Firefox) and then, at the top of the window, in the address field, enter: https://brasco.med-access.net You are prompted to enter the authentication/validation and the username/password.

2. Enter the following credentials:

Username: brasco

Password: 6PYNOoT1dAMr3eYA0r7x

(Please note that O is a capital o and o is a lowercase o, while 0 is a zero)

The Med Access EMR login screen should open.

Tip: If the computer you are using is secure (i.e. you have a unique Windows username and

password that no other users have access to, you can save the password. This way, you don’t

have to enter your external credentials every time.

This next screen is expecting a particular user login in order to setup the

permissions and credentials. The instructor login is as follows:

Username: abose

Password: Sheridan0426tf

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Note: All users have the same password (Time2change) when they first login; however,

you are prompted to change your password upon first logon.

Any and all applicable EMR information should be entered real-time in the

Telus Med Access software during the registration and intake of the patient.

Telemedicine Facilitator Station

Once you login then the Telemedicine Software is launched. An EMR

Authentication Window will pop up…leave this blank and then click “ok”.

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This will bring you to a landing window where you will initiate the

telemedicine session with the Remote Doctor. The 1st step is to register and

intake the patient. In order to do this, you will need to capture information in

the Electronic Medical Record as described above.

To start the Telemedicine session, both the Facilitator station and the Doctor

station require a green circle icon beside the names in order to be online and

ready for the call. If the connection is not good, there will be no green circle

and the names will be greyed out. See below:

If the connection is good, then the display should look like the one below:

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On the TF station, once you click on the applicable Remote Doctor Station

that you want to connect with, an Avatar or picture will be displayed and a

Green “Register New Session” Icon will be displayed. There will also be a

message at the bottom left of the window indicating the status.

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By clicking on this icon, this will confirm that the TF has completed the initial

intake and registered the patient. This will then prompt the next step to

confirm that the patient is now in the Exam Room by clicking on the Green

“Patient in Chair” icon.

Once this icon is clicked, then a Green “Request a Session” Phone Icon will

be displayed.

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By clicking on the Green Phone icon, this will initiate the call with the Remote

Doctor.

Remote Doctor Station

On the Remote Doctor side, the MD Matrix Telemedicine software will need

to be launched in the same way as described above for the TF station….except

of course with different login credentials (as indicated earlier). Once logged in,

there is a landing screen and it should show the Telemedicine Facilitator name

with a Green Icon which means they are online and ready to initiate a call.

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Depending on the status of the patient being communicated within the

software by the TF, the doctor will see different messages on their screen.

When the TF registers the patient and clicks the Green “Register New

Session” Icon, then the following message will be displayed on the bottom left

of the Doctor Telemedicine Window – “Patient Registered”.

Once the patient is in the room and the TF clicks on “notify Patient is in

Room” Icon, then the following message will be displayed on the bottom left

of the Doctor Telemedicine Window – “Patient in Room”.

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Once the Green “Request a Session” Phone Icon is clicked by the TF to

initiate the call with the remote Doctor, no message is displayed but the 3

Green/Red/Yellow icons will be displayed…as well the Doctor should hear an

audible ringing to indicate that a call is being initiated by the TF.

Green Phone Icon - Accept call

Red Phone Icon - Reject Call

Orange Message Icon - Reject Call with Message

If the Doctor accepts the call, then the green icon will be clicked and the

remote telemedicine session is confirmed. The audio/video streaming will

begin and will come up on the displays (just like a “Facetime” or “Skype”

call). The Doctor station would see the Facilitator/Patient in the large Video

window and they would see what they are transmitting in the small Video

window in the bottom right hand corner. The TF on their end should see the

image of the Doctor as the large display…and the image that is being

transmitted from the TF/Patient to the doctor will be a small video in the

bottom right corner. The green circle icons beside the names then change to

yellow to indicate that a call is in session and both the TF and Doctor are busy.

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IMPORTANT: Currently, the call can only be initiated by the Telemedicine Facilitator…but once

connected, the call can be terminated by either party.

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Once the AV streaming session is activated, then the streaming audio and

video is displayed in the right side of the window and several camera icons will

be displayed in the video screen on the left (2 green and 1 yellow icon) and

several medical device streaming icons will also be displayed under the video

area on the right side (greyed out).

The active camera will be displayed in yellow (busy) while the inactive

cameras are displayed in green (idle). The cameras on both the TF and Doctor

Stations default to the Surface 3 front camera, so the TF and Doctor (if

applicable) will need to choose the external Logitech camera by clicking on

the Green camera icon on the left side of the screen below the yellow face

camera icon. Another visual indication to let you know whether the external

camera are active or not is that they display a small blue LED on the TF

Camera and a blue LED outline on both sides of the Doctor camera. The TF

should adjust the camera using the base or remote controls to ensure that the

best view of the patient and TF is being transmitted.

NOTE: You will encounter feedback from the computer microphones if the carts are close to each

another. This would not be an issue that would occur in a real-life situation, but it is a reality in the

classroom setting. If there is feedback, then you can mute the audio by hitting the F1 key and/or

separating the carts from one another.

There are 2 other options (and icons) for the doctor regarding the original

incoming call. They can decide to reject the call by clicking on the red icon. If

this is done, the Telemedicine session is aborted and the TF should proceed to

try and connect with another available doctor. They will receive the following

message back on their screen:

If they click on the Orange Message Icon then this will abort the call but it

gives the opportunity to send a message back to the TF explain why. The

doctor can use one of the auto-populated messages or can type in a custom

message. Once they do this then they will need to click on the “send message”

icon. The TF will see a message similar to one below:

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Depending on the nature of the visit and patient (as well as the clinic’s policy),

the TF will need to then either wait for the same doctor or decide to engage a

different doctor.

Notes:

+ Required bandwidth of the video call function for HD resolution at 30fps is 2.5 Mbps, if lower,

video quality will be automatically degraded. If network connectivity of an end point degrades to a

degree that bandwidth is not enough for video and audio streaming, the video is dropped on that end

point (without affecting the other end), and the end point receives audio only. If connectivity improves,

the video returns.

+ USB video devices should not be unplugged from its attaching machine when it is in use, users

should switch to other cameras before unplugged it from the machine.

Medical Devices Streaming

Once the Telemedicine session has started, the doctor will provide guidance

and direction on patient care. There will most likely be some further questions

for the TF and/or patient which will be communicated by the audio and video

within the MD Matrix software. Depending on the clinic/doctor/protocols

established, there may have been some further information/images that would

have been uploaded to the EMR system depending on the symptoms

communicated by the patient (i.e. Flu-like symptoms may require the TF to

take initial pictures of the ears/throat to be ready for the doctor to view).

The doctor most likely will require further diagnostic information which may

require video from the HorusScope or audio from the digital Tele-Stethoscope.

As a good practice, the TF should be organized and prepared by connecting

the HorusScope and Tele-Stethoscope in advance in order to be better

prepared to provide this information efficiently to the doctor. This will also be

helpful if there is any issue connecting the devices so the TF can try and rectify

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these issues before the session begins with the doctor. The process for

connecting and streaming the devices is provided below.

CONNECTING/STREAMING HORUS SCOPE

The Avizia HorusScope, designed specifically for telemedicine, is an easy-to-

use hand-held video system used for capturing images of the body. Optional

interchangeable lenses make it ideal for multi-discipline medical applications.

There are several attachments available including one designed for ear nose &

throat, dermatology, ophthalmology, audiology, women’s health, and general

examinations. The device used in the Sheridan Telemedicine program has 2

lenses – a General lens and an Otoscope lens.

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As mentioned above, the MD Matrix telemedicine software needs to be

running in order to be able to connect and stream the video from the

HorusScope. Once the Telemedicine software is connected, the icons appear

on the right side under the streaming video for the HorusScope and

Stethoscopes. These appear in grey as they are not instantly and automatically

connected. The first step is to ensure that the HorusScope is turned on and

connected properly. The power on button is located on the top left side of the

HorusScope screen. This needs to be held for 1-2 seconds to power on. If there

is no attachment on the HorusScope, then the display on the HorusScope

screen will just show Avizia name with a blue background. See below:

Also, if you try and connect the HorusScope with a proper lens attached, then a

message will pop up instructing you to connect Otoscope.

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Depending on what the doctor requires to see, this will determine whether the

General Attachment (for general use) or the Otoscope Attachment (for

ear/nose/throat use) is used. Regardless, both attachments are installed and

removed the same way onto the HorusScope. See below a step by step

diagram showing how to properly install a lens:

Once the lens is attached properly, the video will be shown on the HorusScope

LCD screen. The next step is to connect the device in order to stream the

Video within the Telemedicine Software. This is done by clicking on the grey

“hammer-like” icon. This will start the video streaming and a Video streaming

window will pop up on the Left Quadrant of the telemedicine software screen.

This does not automatically show up on the Doctors screen. The doctor would

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need to do the same thing as the TF by clicking on the grey “hammer-like”

icon. If everything is connected and working properly, the grey icon will turn

to green and a Video screen will appear on the left quadrant showing the Video

that is being transmitted from the HorusScope at the TF station. See below a

typical screen shot showing this connection:

Both the TF and Doctor can control the Video streaming box independently.

They can maximize the video to full screen and back by double-clicking on the

top bar of the video window. They can also “stretch” the screen and maximize

it within the left while still seeing the patient video on the right side. If the

doctor asks to see a different part of the patients’ anatomy which requires the

TF to change the lens, then this can be done real time by turning the current

lens counter-clockwise to remove and then turning the new lens clockwise

(ensuring first that the black alignment dots are aligned) ¼ turn until it locks

in place. In the spirit of open and transparent communication, The TF should

always remember to communicate clearly and fully regarding the tasks they are

performing. In order to stop the HorusScope streaming, this is done by closing

the steaming window (as opposed to clicking on the green hammer icon).

Note: Always remember to install the protective covers on the lenses and HorusScope attachment

window when not in use.

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CONNECTING/STREAMING STETHOSCOPE

The compatible stethoscope model which can be used with MD Matrix

software is 3M™ Littmann® Electronic Stethoscope Model 3200. The 3M

Littmann Model 3200 Electronic Stethoscope brings you the very latest in

advanced auscultation and wireless electronics technology in a highly

ergonometric and easy-to-use format. It is useful for auscultating infant,

pediatric or adult patients, in quiet or noisy environments, or picking up

difficult-to-hear heart and body sounds.

The Model 3200 detects and displays an acoustic-based heart rate when

presented with consistent heart sounds (heart rate variation < 10%). It takes

five seconds to compute the initial heart rate and updates are provided every

two seconds. The heart rate will then be displayed for 10 seconds after removal

of the chestpiece from the patient. Prior to the initial reading, the display

shows two dashes (--). For heart rates outside a range of 30-199 bpm, the

display will also show two dashes (--). The acoustic-based heart rate display

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functions best when the Model 3200 is placed near the apex of the patient’s

heart and can be monitored while using any filter mode and/or volume level. If

the heart rate changes from consistent to inconsistent or if there is excessive

ambient noise, patient movement or lung sounds during auscultation, the

heart rate display number will display two dashes (--).

As mentioned above, the MD Matrix telemedicine software needs to be

running in order to be able to connect and stream audio sounds from the

Stethoscope. The stethoscopes work with MD Matrix software via Bluetooth

2.0 connectivity. Make sure Bluetooth interface is enabled on the machine

running MD Matrix software before pairing/connecting stethoscopes.

Using stethoscope streaming function, heartbeat and lung sound collected

from the patient is sent over the Internet and can be heard by the doctor

through his stethoscope.

BLUETOOTH MANAGER WINDOW

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The Bluetooth Manager window is a component of MD Matrix software, it

helps users to pair and connect stethoscopes.

(1) List of paired stethoscopes

(2) Name box, used to name stethoscopes. Naming stethoscopes helps a user

to decide which stethoscope to connect easier in case he has more than one

stethoscope.

(3) Status text

(4) Remove button, used to remove (unpair) a device.

(5) Pair button, used to start the pairing process.

(6) Connect button, used to connect a stethoscope to the software.

Naming Stethoscopes

By default, each paired stethoscope is represented by its Serial Number ID in

the stethoscope list of the Bluetooth Manager window.

Follow these steps to name a stethoscope

Step 1: Select a stethoscope which need to be named, its ID is now shown in

the Name box.

Step 2: Type the new name to the name box, the name will be remembered for

later use after the Bluetooth Manager window is closed.

PAIRING

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Before MD Matrix software can connect a stethoscope via Bluetooth, the

stethoscope must be paired with the machine running MD Matrix software.

There are two ways to pair a stethoscope to a PC.

Method 1: Using the Bluetooth Manager window of MD Matrix software

Step 1: When a healthcare professional is in a call, he can pair a stethoscope

using the Bluetooth Manager window of MD Matrix software. To open the

Bluetooth Manager window, click the stethoscope button when there is no

stethoscope connected (the button’s background is grey).

Step 2: Turn the stethoscope to pairing mode:

On the stethoscope, depress and release the (M) button. The MAIN menu will

be displayed. Use the (-) button to scroll down to the PAIR option. Select this

option by pressing and releasing the (M) button. The LCD screen will signal

that pairing is in progress with the following animated display:

Step 3: Press “Pair Stethoscopes” button in the Bluetooth Manager window,

the software will try to pair the stethoscope device. The status text on the

Bluetooth Manager window shows “Pairing…”.

Step 4: If the MD Matrix software successfully paired the stethoscope, its Id is

shown in the stethoscope list of the Bluetooth Manager window and the LCD

display of the stethoscope will show a flashing Bluetooth icon (Connect mode)

and the stethoscope will be ready for wireless operations.

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Method 2: Using Windows Bluetooth Settings program (applies to Windows

8/8.1/10)

To open the Windows Bluetooth Manager, press Start on your keyboard, then

type “Bluetooth settings”, then press Enter, the Bluetooth Settings window

will show up.

Step 2: Turn the stethoscope to pairing mode (same as above)

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Step 3: The stethoscope Id will show up in the device list of Bluetooth Settings

program and its status is “Ready to pair”, click on the device Id and press the

Pair button.

A pop up will appear for the user to enter the PIN code (displayed in the

stethoscope’s LCD).

Enter the PIN code and press Next button to proceed pairing.

If pairing process is success, the status of the stethoscope Id will be shown as

“Paired” and the LCD display of the stethoscope will show a flashing

Bluetooth icon (Connect mode) and the stethoscope will be ready for wireless

operations.

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CONNECTING

To send stethoscope data to the doctor during a call, a stethoscope has to be

connected first, follow the steps below

Step 1: Turn the stethoscope to Connect mode: depress and release the (M)

button. Select the CONNECT option by again pressing and releasing the (M)

button. The LCD screen will signal that the Bluetooth link is active, the

stethoscope is ready to connect.

Step 2: On MD Matrix software, press the grey “Stethoscope Connect” icon.

The software will try to connect to a previous connected stethoscope first,

therefore, if the waiting stethoscope was connected to the software in the last

running, the software will connect it automatically. If no stethoscope is

connected previously, the Bluetooth Manager window will show up for the user

to select a stethoscope to connect.

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On the Bluetooth Manager window, select a desired stethoscope by click on its

Id and then press “Connect” button. If success, the Bluetooth Manager will be

closed automatically and the Stethoscope turns green. Stethoscope data

streaming function is started automatically (Stream button turns green) on

stethoscope connected if it was not stopped previously.

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When the stethoscope is connected, the streaming should start automatically

and the grey “stethoscope streaming” icon should be green. The nice feature is

the fact that you can click on the green streaming icon to stop the

streaming…but still have the Stethoscopes “connected” The advantage of this

is the fact that you can start and stop the streaming depending on the doctors

instructions…but still keep the stethoscope connected.

To disconnect the stethoscope from the software, press the Stethoscope button

again, if the stethoscope is disconnected successfully, the Stethoscope and

Stream button turn grey, and the software status text will show “Stethoscope

disconnected”.

Notes:

+ The limitation of the distance between the stethoscope and its connecting machine varies depending

on the Bluetooth Adapter used on the connecting machine. In case of the Littmann USB Bluetooth

dongle is used (found in the box of Littmann Stethoscope 3200 model), the maximum distance is 10

meters. If integrated Bluetooth interface (of the machine) is used, the maximum distance should be

lower. On Microsoft Surface machines, internal Bluetooth interfaces should NOT be used.

+ If the stethoscope is turned off while it’s still connected to the software, it should take up to 30

seconds for the software to be aware of this event.

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(e) Troubleshooting

The one thing you can count on for any type of electronic/computer/software

component is that things will not always work properly. Many things have to

occur in the right order and several components have to “talk” or “handshake”

with each other successfully to ensure optimal functioning. In light of the

environment you are working in and the fact that most patients will feel

somewhat anxious and/or vulnerable visiting a clinic or doctor, you want to

remain calm and in control when problems arise with the Telemedicine

equipment. The key is to remain calm and communicate courteously and

professionally!

For the most part, by remaining calm and using common sense, most issues

can be handled efficiently and effectively. If the problem is minor and can be

resolved quickly, you don’t necessarily need to communicate this to the

patient. However, if the problem is taking longer to resolve and/or will result

in delays, then please be transparent and communicate clearly and confidently

(not negatively) to the patient and/or doctor if applicable that there is a minor

issue and that you are trying to rectify it…but there will be slight delay. Try not

to be intimidated by the technology and the problem, use your observation

skills as well as the material in this document, and escalate problems when

necessary to resolve the issue at hand.

TIPS:

1. It is useful to have a notebook and write down your observations and/or error messages when

issues arise.

2. When initiating the troubleshooting scenarios for students to test their ability to calmly and

efficiently figure out the issue while maintaining professional and courteous behavior in front of

the patient/doctor, it is recommended for the student (and/or teacher if applicable) to always

test the functionality of the system before going to the next scenario. It is easy to forget to re-

attach a cable or correct an intentional software bug which can then lead to confusion as well

as potential extra time or further support that may be unnecessary.

Troubleshooting Table for Instructor

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ISSUE STEPS TO CORRECT Cart will not power up

1. Check to insure master power is plugged in 2. Check to insure AC outlet is working 3. Check to see if DELL external monitor is working as

this is the only device plugged into black power bar at back of cabinet.

4. Check power bar in bottom of cabinet is plugged into main power bar at back

5. Check for power indicator lights on Power Bar (RED) and USB hub (GREEN) in base of cart

6. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

Cart has power but Surface 3 Computer will not turn on

1. Check Docking station power indicator light on top right of docking station (white LED)

2. Ensure Power on button is held for 5 seconds 3. Computer Battery Dead – recharge battery for at

least 10 minutes and check again 4. If battery not charging, plug Surface 3 into separate

standalone power adapter (located in base of cabinet)

5. Check for solution online - https://www.microsoft.com/surface/en-ca/support/warranty-service-and-recovery/surface-wont-turn-on?os=windows-10&=undefined

6. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

Surface 3 Computer turns on but will not boot to Windows

1. Power off Surface 3 and reboot 2. Remove Surface 3 from docking station and try to

boot standalone 3. Check online for solution -

https://www.microsoft.com/surface/en-ca/support/warranty-service-and-recovery/surface-wont-turn-on-windows-wont-start?os=windows-10&=undefined

4. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

Computer not connected to WI-FI network

1. Check WI-FI icon status to ensure it is a WI-FI connection issue (hold mouse over WI-FI icon)

2. Ensure WI-FI is enabled

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3. Ensure that you are selecting “Sheridan Secure Access” as the WI-FI name and that it is in range.

4. Uncheck the box “Connect automatically” and re-enter Sheridan WI-FI credentials.

5. Power Down and reboot system 6. Check online for solution -

https://www.microsoft.com/surface/en-ca/support/networking-and-connectivity/cant-connect-to-a-wireless-network?os=windows-10&=undefined

7. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

Mouse not working

1. Check to make sure the power switch is in the on position on the bottom of the mouse.

2. Make sure the battery is good. Replace battery. 3. Since the mice are identical, they 4. The mice used on the carts go into sleep mode and

can only be woken up by clicking on the button (just moving the mouse around will not wake it up).

5. Isolate problem to external mouse by making sure the Surface 3 trackpad and touchscreen are still operational.

MD Matrix Telemedicine Software not connecting (users

1. Check WI-FI connection and correct 2. If issue was a WI-FI issue and is now corrected, wait

patiently for 30 seconds as the Telemedicine software will try and reconnect automatically

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are greyed out and no green light)

3. Close MD Matrix and re-launch 4. Power Down and reboot system…try logging in again 5. Call Sheridan IT Support – Ryan Green - 905-459-7533

ext 5602 or ext 2510 6. Escalate to MD Matrix Technical Support – Basil

Rafikalli – 647-882-9230

Avizia HorusScope not functioning or powering up

1. Check to make sure unit is powering up by holding down power button on top left of HorusScope screen.

2. If unit not powering up and there is no light on front to indicate battery level, then recharge battery by plugging in unit.

3. If unit is plugged in properly at both ends (plug cable in directly to handle instead of charging cradle) and is still not charging, remove and re-insert LI-ION battery. Refer to HorusScope manual for instructions.

4. If battery still not charging, battery may require replacing. Call Avizia Technical Support for warranty status before replacing. Battery type is

Rechargeable Lithium Ion Battery - 3.7V / 2600mAh. NOTE: It is recommended to remove the battery if the Horus Scope is stored more than 2 weeks.

5. Replace Battery and make sure to charge for at least 5 hours before first use.

6. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

7. Escalate to Avizia Technical Support – 1-888-637-7605 or online - https://www.avizia.com/contact/

Avizia HorusScope not connecting and streaming within Telemedicine Software

1. Ensure HorusScope is powered on. Recycle power on HorusScope.

2. Ensure that the Video Streaming Display is not “hidden” by clicking on the MD Matrix Quick Launch Icon.

3. Check to make sure that there is either the General or Otoscope attachment is correctly installed. Remove be turning counter clockwise, line up alignment dots, and re-attach accessory. Ensure the accessory is turned a full ¼ turn clockwise.

4. Close the Telemedicine Software and re-launch.

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5. Shutdown and reboot system. Relaunch Telemedicine software and try re-connecting.

6. Check the cable connections on computer and device ends. Remove and re-attach. Use a different USB port.

7. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

8. Escalate to Avizia Technical Support – 1-888-637-7605 or online - https://www.avizia.com/contact/

Camera(s) not working within MD Matrix Telemedicine Software

1. Shutdown and reboot system. Reconnect and launch telemedicine software.

2. Verify which cameras are/not functional (i.e. internal front and rear Surface cameras and external Telemedicine cameras). Use “Camera App” on Quick Launch Toolbar.

3. If internal cameras are functional within Windows but external camera is not, check and re-connect connections on computer and device end. Use a different USB port.

4. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

Computer Audio not working

1. Make sure audio is not muted by toggling F1 key. 2. Adjust/increase audio by pressing F1 and

adjusting…or by clicking on the volume control icon in the system tray. You should hear a confirmation tone at or above 50%.

3. Shutdown and reboot system. Reconnect and launch telemedicine software.

4. Test both internal and external audio sources to determine if it is a software or device problem.

5. If problem is isolated to external Jabra or Logitech audio devices, check and re-connect connections on computer and device end. Use a different USB port.

6. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

3M Littmann Tele-Stethoscopes not powering on

1. Ensure mater power switch is pushed fully and held for 1-2 seconds

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2. Check battery level indicator. If low, replace battery with AA Alkaline battery (not rechargeable battery). Refer to manual for removing and replacing battery.

3. Recheck to make sure that the battery handle is fully turned and locked into place by experiencing a “lock” and checking alignment arrows.

4. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

5. Escalate to 3M Littmann Technical Support - 1-800-228-3957 or 1-800-563-2921 – or online at http://www.littmann.ca/wps/portal/3M/en_CA/3M-Littmann-CA/stethoscope/customer-service/contact-us/

3M Littmann Tele-Stethoscopes unable to connect or not working optimally within Telemedicine Software

1. Check and ensure power is on and battery is ok. 2. Make sure the Stethoscope is positioned correctly. It

will only work if the flat diaphragm face is towards your chest.

3. Power off and re-connect Stethoscope by powering on and going into Stethoscope Menu (hit “M” twice) …and then reconnect within the MD Matrix software by clicking on the Stethoscope “Connect” icon.

4. Close and re-launch Telemedicine software. Try re-connecting.

5. Make sure you are connecting the correct stethoscope. The software recognizes the stethoscope by name or serial number that is etched on the left side of the device.

6. Shutdown and reboot system. Launch telemedicine software and try re-connecting.

7. Try removing and re-pairing device (hitting “M” once, arrowing down to “PAIR”, then hitting “M” again)…and then re-connect device.

8. Try the other stethoscope from the other station to determine if it is the actual device…or a software problem.

9. If device is connecting but is losing the connection or audio is not clear, make sure the Network connection is strong. Re-locate telemedicine cart if necessary and try again.

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10. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

11. Escalate to 3M Littmann Technical Support - 1-800-228-3957 or 1-800-563-2921 – or online at http://www.littmann.ca/wps/portal/3M/en_CA/3M-Littmann-CA/stethoscope/customer-service/contact-us/

“OtoSim” Devices not connecting

1. Verify which device has the problem. If small Interface Box is connected properly, then there should be a message “OtoSim (or OphthoSim) Peripheral Version: 3.0” displayed the bottom center of the window. If large base unit is connected properly, then there should be message “Monitors:1” displayed at the bottom left of the screen.

2. Check the cable connections on computer and device ends. Remove and re-attach. Use a different USB port.

3. Shutdown and reboot system. Launch OtoSim software to see if devices connect.

4. Call Sheridan IT Support – Ryan Green - 905-459-7533 ext 5602 or ext 2510

5. Escalate to OtoSim Technical Support – Brian Carrillo at (647) 717-5182 or Vito Forte at (416) 813-6846

Telus EMR Software not functioning properly

1. Test the functionality on both Telemedicine stations to determine if problem is the Telus software itself or with a particular Telemedicine cart

2. If problem is not just happening on one cart and related to the general functionality of the Telus software, try closing the browsers and restarting the browsers. If this does not correct the problem, try shutting down and restarting the computers

3. If problem is not resolved and still is common to both carts, then escalate to Sheridan IT – Ryan Green - 905-459-7533 ext 5602 or ext 2510

4. Escalate to Telus Technical Support - 1-888-781-5553, option 1 or online - https://www.telushealth.co/health-solutions/electronic-medical-records/support/?solution=med-access-emr

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5. If problem seems to be unique to one station, make sure the web address and all username and passwords are correct, try another username and password, and then try shutting down the particular system and restarting.

6. If not resolved, follow steps 3 & 4 above

IT/3rd Party Remote Technical Support

In case technical support is required from Sheridan IT and/or 3rd party

suppliers (i.e. MD Matrix, OtoSim), they may want to connect remotely to the

carts for troubleshooting. A program to support this functionality is installed

which is called TeamViewer. They will need the TeamViewer ID’s of the carts.

The software is launched by clicking on the TeamViewer icon in the Quick

Launch toolbar and the ID’s will be displayed. These are as follows:

TF CART – 519 694 511

DOCTOR CART – 519 702 586

Troubleshooting Scenarios for Students

SCENARIO OBSERVATIONS SOLUTION 1. Plug main power

cord into wall just lightly to simulate “no power” situation

No power or lights on cart or devices…but Surface 3 will still turn on and boot up if battery is charged. Nothing else will work

Check and Fully insert main power cable

2. Turn off breaker on power bar in base of cabinet to

Surface 3 will still turn on and boot up (if battery is charged) and

Turn on breaker on power bar in bottom of

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simulate devices not connecting

external DELL monitor will still work. All other devices will not work

cabinet. Test functionality

3. Unplug USB hub power cord in base of cabinet to simulate some devices not working

Surface 3 will still turn on and boot up (if battery is charged) and external DELL monitor will still work. Mouse and trackpad don’t work but touchscreen does work. Only USB devices plugged into the USB hub will not work

Re-connect power adaptor to USB hub. Test functionality

4. Disconnect WI-FI from Sheridan Secure Access Network on either or both carts by clicking on Wi-Fi Icon to simulate network connection problem

In general, everything looks fine except that the Wi-Fi icon will have a “not connected” status.

Reconnect WI-FI to Sheridan Secure Access Network. Test functionality

5. Unplug power cord from DELL external monitor to simulate no video display on DELL monitor

No power or display on Dell monitor. Everything else with still function normally and you can actually use the Telemedicine stations as normal. The video will only be displayed on the Surface 3 monitor

Reconnect power cord at back of monitor. Test functionality

6. Unplug “mini-display” port cable from the back of Surface 3 docking station to simulate

No display on Dell monitor but the monitor still has power. The display will indicate that the monitor is searching for

Reconnect min-display cable at back of docking station. Test functionality

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no video display on DELL monitor

the signal. Everything else with still function normally and you can actually use the Telemedicine stations as normal. The video will only be displayed on the Surface 3 monitor

7. Remove Surface 3 from docking station and place it loosely on docking station stand to simulate an incorrect dock. This can be done with or without power on

Surface 3 will still turn on and boot up if battery is charged. No video will be displayed on 24” monitor. Nothing else will work.

Place Surface 3 properly in docking station. This can be done while powered up and the stations should recover and function normally without the need to restart. If not, shutdown, restart and test functionality

8. Plug HorusScope cable into the cradle instead of the handle to simulate HorusScope unable to connect

Everything will work fine except for the HorusScope. When you try and connect HorusScope, it will not connect and will display a message to connect OtoScope

Plug cable directly into HorusScope handle and test functionality

9. Put HorusScope streaming video in background to simulate HorusScope connected and streaming but cannot see the video

Everything will be working but you will not be able to see the HorusScope video

Click on MD Matrix Quick Launch icon and click on HorusScope image to bring the HorusScope streaming video into the foreground window

10. Don’t connect General or Ear HorusScope attachment fully to

No video in HorusScope small LCD screen. The HorusScope will

Fully turn lens ¼ turn and then disconnect and reconnect HorusScope by

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simulate HorusScope connection issue

connect but will not stream any video

clicking on icon. Test functionality

11. While in Telemedicine Session, disconnect Doctors station from network to simulate a network connection end on the remote doctors side

This problem may not be immediately obvious….but the first thing that you will notice is no audio. The next thing that happens is that the video will stop streaming and then the Telemedicine session will be disconnected

Reconnect Doctor station to Wi-Fi. In real life situation, ask Doctor to observe messages on his screen and to check his/her Wi-Fi connection. Test functionality

12. Disconnect USB cables from either or both OtoSim base unit and interface box to simulate bad connection on OtoSim devices

All Telemedicine and other devices will function normally. There will be a message at the bottom middle of the OtoSim screen when you open the software that “device is waiting to connect”. Also, the Monitors:1 message on the left will now state Monitors:0

Reconnect USB cables, verify error messages go away, and retest OtoSim software.

13. Turn off power switch on bottom of mouse to indicate faulty mouse

Mouse will not work but touchpad and touchscreen will work normally. System functionality will be ok

Turn on switch on bottom of mouse

14. Switch off Bluetooth on Surface 3 via Bluetooth settings to simulate unpaired Stethoscope

Telemedicine software will still connect. Neither Stethoscope will show up. Everything else will look ok until you try and connect Stethoscope. An error message will come up

Turn on Bluetooth via Bluetooth settings. Test functionality

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stating that the “system could not Bluetooth antenna and to check and ensure Bluetooth is enabled

15. Remove or “unpair” 3M Stethoscope to simulate Stethoscope not paired.

Telemedicine software will still connect. Everything else will look ok until you try and connect Stethoscope. The other Stethoscope will show up in the Stethoscope manager window

Go through Stethoscope pairing and connecting process in 3M Littmann manual. Test functionality

16. Disconnect external camera from either system

The video will still work fine as it will be using the Surface 3 camera. The external camera icon will not come up in the Telemedicine window

Reconnect USB cable and test functionality

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(f) Important Contacts

CONTACT CONTACT INFO FUNCTION Marcela Velez-Pulgarin

905-8459430 x4057 or marcela.velezpulgarin@sheridancollege.ca

Program Manager - Telemedicine Facilitation Program – Sheridan College

Alicia Bose 647-299-9306 or alicia.bose@sheridancollege.ca aliciabose@gmail.com

Telemedicine Facilitation Instructor - Sheridan College

Hayley White 905-459-7533 ext 32273 or hayley.white@sheridancollege.ca

Program Officer – Technology, Health and Culture - Sheridan College

Ryan Green 905-459-7533 ext 5602 (direct) or ext 2510 (main IT helpdesk) or ryan.green2@sheridancollege.ca

Tier 2 Support Specialist – Sheridan College

Ashley Misurka 905-459-7533 or ashley.misurka@sheridancollege.ca

Nursing lab Leader – Sheridan College

David Cooper 647-242-8994 or david.cooper@rogers.com david.cooper1@sheridancollege.ca

Telemedicine Equipment Specialist – Sheridan College

Dr. Nayyar Razvi 905-330-9828 or nayyar@md-matrix.com Chief Medical Officer – MD Matrix

Basil Rafikalli 647-822-9230 or basil@md-matrix.com basil.rafikalli@gmail.com

Technical Support – MD Matrix

Mike Redekop 587-990-3436 or mike.redekop@telus.com Project Manager/Trainer – Telus Health

Telus Technical Support

1-888-781-5553, option 1 or online – https://www.telushealth.co/health-solutions/electronic-medical-records/support/?solution=med-access-emr

Telus Technical Support Hotline/Chat

Vito Forte (416) 813-6846 or vito.forte@sickkids.ca CTO – OtoSim Inc.

Brian Carrillo (647) 717-5182 or brian.carrillo@sickkids.ca R&D/Technical Support – OtoSim Inc.

Robert May

416-697-7017 or rmay@cbcitelecom.com Director of Sales – CBCI Telecom (Avizia HorusScope)

Avizia Technical Support

1-888-637-7605 or online – https://www.avizia.com/contact

Avizia Technical Support Hotline/Chat

3M Littmann Technical Support

1-800-228-3957 or 1-800-563-2921 – or online at http://www.littmann.ca/wps/portal/3M/en_CA/3M-Littmann-CA/stethoscope/customer-service/contact-us/

3M Littmann Technical Support Hotline Chat

Robbie Kennedy (905) 470-6665 or robbie@kennedysalesparts.com Fore Tenn Marketing Sales (Luxor Telemedicine Carts)

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(g) Technical Requirements/Specs

MD Matrix (MD Matrix has standardized on the Microsoft Surface

Platform)

Minimum system requirements

CPU: Intel® Pentium® Dual Core 1.2 GHz or faster

RAM: 2 GB

Free of hard disk space: 200 MB

OS: Windows 7/8/8.1/10

Internet access with Up Link and Down Link bandwidth from 2 Mbps or

higher.

Telus Med Access EMR

Reliable and High Speed Secure internet connection

Telus Med Access Web EMR: Citrix receiver software has to be installed.

MD Matrix Local EMR: EMR Advantage Tablet software has to be installed.

51

Equipment Model and Serial Number Info

52

(h) Appendix A – Telus EMR Config

In order for the Telus EMR to function optimally, there are browser settings

for configuring Med Access. Configuring these settings will allow Med Access

to perform successfully.

For the Sheridan Telemedicine setup, we have only IE installed. However, the

settings for Google and Firefox are listed here for future reference or

configuration.

Internet Explorer

Settings-130116-1444-16.pdf IE 11 Opening links

from other programs.pdf Google Chrome

Settings-130116-1444-14.pdf Mozilla Firefox

Settings-130116-1445-18.pdf