CHP User Guide V1 FINAL

Cisco HealthPresence User GuideV 1.0 April 21, 2011

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Text Part Number: OL-23353-07

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Any Internet Protocol (IP) addresses and phone numbers used in this document are not intended to be actual addresses and phone numbers. Any examples, command display output, network topology diagrams, and other figures included in the document are shown for illustrative purposes only. Any use of actual IP addresses or phone numbers in illustrative content is unintentional and coincidental.

Cisco HealthPresence is intended for use by licensed healthcare professionals with those certain independent third party medical devices listed as compatible in the Cisco Health Presence Instructions for Use. The user is to refer to the third party instructions for use concerning any further information about the use of those certain medical devices. Cisco HealthPresence is not intended to perform real-time, active, or online patient monitoring, and does not transmit or display any real-time data that is intended to alert the user of alarms or other conditions that require immediate action or response. The user is advised that Cisco Systems makes no representations or warranties concerning jurisdictional requirements related to the licensed practice of medicine or healthcare using Cisco HealthPresence.

Cisco HealthPresence User Guide © 2010 Cisco Systems, Inc. All rights reserved.

C O N T E N T S

C H A P T E R 1 Understanding Cisco HealthPresence 1-1

Objectives and Audience 1-1

Cisco HealthPresence Overview 1-1

Intended Uses 1-3

Understanding the Cisco HealthPresence Solution 1-4

Cisco HealthPresence Terminology 1-4

Attendant Site Components 1-5

Provider Site Components 1-6

Browser Terminology 1-6

Internet Browser 1-6

Url or Hyperlink 1-6

Using Tabs to Toggle between Browser Windows 1-7

Browser Window Partitions 1-7

Unlocking your PC 1-8

Three User Profiles 1-9

C H A P T E R 2 Cisco HealthPresence Scheduling Tasks 2-1

Overview 2-1

Logging into the Scheduling Application 2-1

Booking a Conference Reservation 2-4

Reserving the Provider Site 2-6

Reserving the Attendant Site(s) 2-8

Verifying Conference Readiness 2-8

Verifying All Sites are Reserved 2-8

Verifying Participants Have Accepted 2-9

Deleting Reservations 2-10

Logging Out 2-11

Workflow Considerations 2-11

C H A P T E R 3 Cisco HealthPresence Attendant Tasks 3-1

Overview 3-1

Logging into Cisco HealthPresence 3-1

Checking Your Calendar 3-2

iiiCisco Health Presence User Guide

Contents

Patient Appointments 3-4

Opening the Telemedicine Appointment Window 3-5

Opening the Telemedicine Window from your Calendar 3-5

Opening the Telemedicine Window from the CHP Home Page 3-6

Attending to Patients 3-7

Getting Vitals 3-7

Starting a Telemedicine Appointment 3-9

Sharing Vitals 3-10

Joining a Conference 3-10

Starting Medical Devices 3-12

Ending an Appointment 3-14

Other Operational Responsibilities 3-15

Verifying that Medical Telemetry is Operational 3-15

Calendar Maintenance 3-17

Accepting Invitations 3-17


Refreshing your Calendar 3-17

CHP Endpoint Maintenance 3-18

C H A P T E R 4 Cisco HealthPresence Provider Tasks 4-1

Overview 4-1

Logging into Cisco HealthPresence 4-1

Checking Your Calendar 4-2

Patient Appointments 4-5

Opening the Telemedicine Appointment Window 4-6

Opening the Telemedicine Window from your Calendar 4-6

Opening the Telemedicine Window from the CHP Home Page 4-6

Getting Vitals 4-7

Joining a Conference 4-8

Accessing Content from Medical Devices 4-10

Viewing Video from an Exam Camera 4-10

Viewing Video from a Scope (ENT Scope, Dermascope, or Ophthalmoscope) 4-11

Using a Telephonic Stethoscope 4-11

Ending an Appointment 4-12

Calendar Maintenance 4-13

Accepting Invitations 4-13


Refreshing Your Calendar 4-14

ivCisco Health Presence User Guide

Contents

C H A P T E R 5 Administration and Problem Solving 5-1

Overview 5-1

Account Management 5-1

Administrative Rules 5-2

Addressing Conference Problems 5-3

Addressing Scheduling Problems 5-3

Addressing Vitals or Streaming Problems 5-4

Provider Cannot Access Medical Data 5-4

Attendant Cannot View Video or Vitals 5-4

Addressing Telemetry Problems 5-5

Checking Welch Allyn Vital Signs Monitor Status 5-5

Contacting Cisco Support 5-7

A P P E N D I X A Checklists 6-1

Cisco HealthPresence Attendant Checklists 6-1

Start of Day 6-1

Appointment Checklist 6-2

Close of Day 6-3

Cisco HealthPresence Appointment Checklist for Providers 6-3

G L O S S A R Y

vCisco Health Presence User Guide

Contents

viCisco Health Presence User Guide

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C H A P T E R 1
Understanding Cisco HealthPresence
Revised: April 21, 2011, OL-23353-07

Objectives and AudienceThis user guide is for health professionals who will use the Cisco HealthPresence™ device and for medical office staff who will make Cisco HealthPresence appointments and reserve HealthPresence rooms.

This guide describes the terminology and components of Cisco HealthPresence and explains how to use the Cisco components in the Cisco HealthPresence device. After reading this manual, you should be able to:

• access the scheduling application,

• retrieve medical data from the telemetry devices and forward it to remote sites, and

• join TelePresence™ conferences.

This document does not describe how to use the medical telemetry.

Cisco HealthPresence OverviewCisco HealthPresence enables a health-care provider (physician, specialist, etc.) to evaluate patients regardless of their physical location. It replicates the in-person experience for both patient and provider, with life-sized images and no voice delay. Physicians can see images from an ear, nose and throat (ENT) scope just as they would if they were in the same room as the patient. A special camera zooms in to allow the physician to get close ups of a patient’s throat. A stethoscope can be placed on a patient’s chest in one location and a physician can hear the heartbeat using headphones in a remote location. Finally, HealthPresence allows specialists to be consulted without requiring additional patient travel. Optionally the specialist can participate in the same patient conference as the attending physician.

Figure 1-1 shows a view of the Cisco HealthPresence solution in a clinical setting.

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Chapter 1 Understanding Cisco HealthPresence Cisco HealthPresence Overview

Figure 1-1 Cisco HealthPresence Solution

From a process perspective, there are similarities and differences as described below and illustrated in Figure 1-2.

• Patients still have appointments with their doctor, but their appointments include a Telemedicine component, where medical data is transmitted from the patient site to the doctor site, and a conference, where the doctor and patient view each other via teleconference.

• There is a separate scheduling tool used to book HealthPresence conferences.

• The attendant (a licensed health care professional such as a nurse or nurse practitioner) gathers the patient’s vitals before the doctor arrives, but shares this data electronically instead of on a paper chart. Alternatively, the attendant may be the primary care physician, consulting with a specialist.

• The doctor still sees the patient, but via teleconference instead of face to face.

Figure 1-2 The Cisco HealthPresence Appointment

Patient calls for appointment.

Scheduler reserves CHP pods.

Attendant takes patient’s vitals and joins Telemedicine appointment with a mouse click.

Remote doctor sees patient in high-definition video and views data from medical devices (approved for use with CHP) in streaming video


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Chapter 1 Understanding Cisco HealthPresence Intended Uses

Intended UsesCisco HealthPresence consists of patient stations referred to as attendant endpoints; provider workstations referred to as provider endpoints; and the Cisco HealthPresence-Connect software.

The Cisco HealthPresence-Connect software provides a communications link between HealthPresence endpoints over private or virtual private network connections having securement. Utilizing the network connections with securement, the Cisco HealthPresence-Connect software transmits data acquired from third-party medical devices at an attendant endpoint to doctor endpoints located at remote facilities.

Compatible Third Party Devices include:

• digital stethoscope (AMD-3700)

• camera and illumination system (AMD-400) and supported scopes:

– digital ear, nose, and throat (ENT) video scope (AMD-2015)

– digital direct ophthalmoscope (AMD-2020)

– digital dermascope (AMD-2030)

• digital examination camera (AMD-2500)

• vital sign capture and measurement device (AMD-8221)

Additional network connections with securement, separate from those used to transmit the data from medical devices, provide video conferencing capabilities between a endpoints.

The Cisco HealthPresence-Connect software transmits data to a doctor workstation for viewing on a personal computer according to the intended uses of the third party medical devices.

Note The Cisco HealthPresence-Connect software is not intended to perform real-time, active, or online patient monitoring, and does not transmit or display any real-time data that is intended to alert a physician of alarms or other conditions that require a physician's immediate action or response.

The user’s infrastructure must meet the basic minimum specified requirements in order for Cisco HealthPresence to perform as intended. This includes, but is not limited to:

• adequate bandwidth

• appropriate capacity routing and switching equipment

• proper software levels

• correct room design

• adequate physical and network security

Cisco HealthPresence PC Configuration

Note The Cisco HealthPresence PC at both the attendant and the provider endpoints must not be changed in any way, as this can impact the performance of the solution. No software packages may be added and existing software packages must not be modified (either by configuration changes or service level changes).


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Chapter 1 Understanding Cisco HealthPresence Understanding the Cisco HealthPresence Solution

The Cisco HealthPresence PC is an HP Slimline 8000. Table 1-1 shows the off-the-shelf software that is used by Cisco HealthPresence and is installed with the HP Slimline 8000 during the solution installation.

Table 1-1 Cisco HealthPresence PC Configuration

Understanding the Cisco HealthPresence SolutionThe Cisco HealthPresence solution combines Cisco TelePresence™, scheduling software, specialized HealthPresence software, medical telemetry devices and network components. Components reside at an attendant site, a provider site, and a data center. Before describing the components, it is useful to understand some terminology.

Cisco HealthPresence TerminologyTelepresence refers to Cisco’s solutions for video conferencing and remote collaboration.

Telemedicine refers to providing medical care remotely using medical telemetry.

Medical Telemetry allows remote measurement and reporting of medical information. For Cisco HealthPresence, the medical information includes vitals, video imaging from the AMD 2500 examination camera and the AMD 400 camera and illumination device with its attached medical scopes, and stethoscopic audio.

An attendant is a licensed medical professional who attends to a patient. The attendant greets the patient, takes their vitals, and uses the medical telemetry to assist a physician in evaluating the patient. An attendant can also be a physician who is consulting with a specialist.

A provider is a licensed medical professional who provides medical evaluations from a remote site.

The term attendant endpoint refers to the location containing the medical telemetry, an attached TelePresence or video conferencing system, the PC running the Cisco HealthPresence-Connect software and optionally, the Cisco HealthPresence furniture, referred to as a patient pod.

Figure 1-3 illustrates this terminology.

Cisco HealthPresence PC Component Specification

PC Model HP Compaq 8000 Elite Small Form Factor PC

Operating System Windows 7 Professional 64 bit

Processor Intel Core 2 Duo CPU E8400@ 3.00 GHz 3.

Anti Virus version/type McAfee Total Protection Service - 5.00.811

PC Browser version/type Internet Explorer Version 8 (8.0.7600.16385)

Media Player Audio Windows Media Player 12 (12.0.7600.16415)

Media Player Video Silverlight 4 (4.0.50826.0)

PC Audio Card Realtek HD Audio Output

PC Audio Driver Realtek Audio Driver 6.00.0001.5886

PC Video Card Intel Q35/Q43 Express Chipset

PC Video Driver Intel Video Driver 8.15.10.1855


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Figure 1-3 Cisco HealthPresence Terminology

Attendant Site ComponentsThe attendant is the licensed medical professional at the attendant endpoint. The components at the attendant site include:

• TelePresence or video conferencing system (monitor, speakers, phone etc.) – these components enable a teleconference among sites.

• CHP PC and monitor - this runs the Cisco HealthPresence-Connect software and provides access to the scheduling application (which resides elsewhere). The software also collects vitals data, enables Telemedicine appointments and initiates Telepresence1 conferences.

• Device Aggregator – this device connects to all of the medical devices, monitors their status, and upon request, sends the medical data to the CHP PC, either as static information or streaming video/audio.

• Medical telemetry devices approved for use with Cisco HealthPresence, including:

– AMD 400 Image and Illumination System and it’s related components

AMD-2015 ENT Scope

AMD-2030 Dermascope

AMD-2020 Direct Ophthalmoscope

– AMD 8221 Welch Allyn Spot Vital Signs LXi (which includes an oximeter, a blood pressure monitor and a thermometer)

– AMD 2500 General Exam Camera

– AMD 3700 Telephonic Stethoscope

Attendant Endpoint

Telepresence TeleMedicine

Attendant Provider Medical Telemetry

1.


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Provider Site ComponentsComponents at the provider site include:

• TelePresence or video conferencing system (monitor, speakers, etc.).

• CHP PC and monitor.

• HeadPhones, which physicians use to listen to the telephonic stethoscope remotely.

Browser TerminologyMuch of what you will learn in this manual relates to accessing the Cisco HealthPresence Scheduler and interfacing with the Cisco HealthPresence application. Both are accessed through a browser interface. If you are unfamiliar with using browsers to access information, some additional terminology is useful.

Internet Browser

You will access the Cisco HealthPresence application the same way you access any other browser-based application: by opening your browser. The browser icon is on the desktop of your PC and you open the browser by clicking on the browser icon. Since Cisco HealthPresence is your home page, opening your browser causes the Cisco HealthPresence login window, illustrated in Figure 1-4, to display.

Figure 1-4 Cisco HealthPresence Login Window


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Url or Hyperlink

As you will learn in another chapter, to open the Telemedicine Window with the appointment ID filled in, you will click on a url or hyperlink2. You have probably clicked on a url before without knowing what they are called. When you click on a url, your browser is automatically directed to a new browser window. Figure 1-5 shows an example of a url.

Figure 1-5 Example of a url

Using Tabs to Toggle between Browser Windows

You can have multiple browser windows open at one time. To toggle between them, click on tabs. Figure 1-6 illustrates the Cisco HealthPresence and Cisco HealthPresence Scheduler tabs.

Figure 1-6 Cisco HealthPresence Quick Link Tabs

Browser Window Partitions

Finally, it may be beneficial to understand that a browser window can be subdivided into partitions with each partition responsible for a different function. Figure 1-7 shows the Cisco HealthPresence Telemedicine window, which is divided into 5 different partitions (separated with red rectangles in this figure for purposes of illustration). Each rectangle has a specific function. These functions are:

• Appointment

• TelePresence2. For the purposes of this manual, the terms url and hyperlink are used interchangeably, even though their

technical definitions are different.


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• Vitals

• Video

• Stethoscope

Understanding that this window is divided up into partitions will make this page easier to navigate. For example, whenever you want to do something related to video images, all the related buttons are in the video partition. Likewise, if you want to perform a function related to Vitals, all the related buttons are in the Vitals partition.3

Figure 1-7 Browser Window Partitions

Unlocking your PC

When your PC is left unattended for a period of time, the screen will lock and you must unlock it using your Windows password. Click chpuser4 as illustrated in Figure 1-8 and type in the Windows password provided to you when the solution was installed.

3. The only exception to this is “Not Ready” in the Vitals partition which ends the TelePresence conference as well as the Telemedicine appointment.

4. Some sites use a site-specific Windows user name, not chpuser.


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Chapter 1 Understanding Cisco HealthPresence Three User Profiles

Figure 1-8 Unlocking your PC

Three User ProfilesThere are three types of users of the Cisco HealthPresence solution:

• The scheduler manages the appointment calendar and is the only one who can add or delete appointment reservations. The scheduler does not have to be a specific person, but to perform the scheduling task, he or she must log in using the scheduler’s user id and password.

• The attendant is a licensed medical professional who meets with patients and takes their vitals information. The attendant is responsible for accepting appointment invitations, gathering vitals data, joining conferences, and sharing medical data with the provider (typically a doctor). The attendant may also be a primary care physician who meets with a patient and consults with a remote specialist.

• The provider is typically a doctor or physician’s assistant who meets with the patient and attendant in a teleconference and views and analyzes medical data. The providers (or their staff) also have the responsibility to accept appointment invitations and join conferences.

This document describes the roles and responsibilities of each of these types of users.

chpuser

Select chpuser;Enter password


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Chapter 1 Understanding Cisco HealthPresence Three User Profiles


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C H A P T E R 2
Cisco HealthPresence Scheduling Tasks
Revised: April 21, 2011, OL-23353-07

Overview When a scheduler receives a call from a patient who needs to see a remote doctor, the scheduler logs in to the scheduling application and finds a day and time when both the doctor and the patient’s attendant/facility are available. They first reserve the provider location and select all participating locations. Then they reserve the attendant location.When done, the scheduler logs out of the scheduling application.

The following is a summary of the steps required to schedule a conference:

• Log into the Scheduling Application

• Book a Conference Reservation

• Schedule doctor/provider location and select participants

• Schedule patient/attendant location

• Log out

This chapter details the scheduling tasks.

Logging into the Scheduling Application

Note Your PC may be locked to prevent unauthorized access. In this case, you will need to click chpuser and type in the Cisco HealthPresence user password.

Log into the scheduling application from the PC in either the patient endpoint or the doctor’s endpoint1. Ensure that no one else is logged into the calendar.

Note On a single PC, the scheduler calendar cannot be open at the same time as the provider or attendant calendar.

1. In some configurations, the scheduler can log in to the scheduling application from a different PC, but that requires the Cisco HealthPresence network to be connected to the office network.


Chapter 2 Cisco HealthPresence Scheduling Tasks Logging into the Scheduling Application

Step 1 Ensure no one is logged into the scheduling application.

If a browser is open (for example, if you see the Telemedicine window), you can do one of two things, close the browser(s) or verify that no one else is logged in to the scheduler.

• Closing the browser(s) is the easiest way to make sure no one is logged into the Scheduling Application, but it requires the attendant or provider to log into Cisco HealthPresence an additional time.

• To leave the Cisco HealthPresence browser window up but verify that no one else is logged into the scheduler, do this:

– If the scheduling application is displayed on any browser, click Logout.

– If the scheduling application is not displayed, navigate to View Calendar on the Home page. That takes you to the scheduling application. Log out if necessary.

Step 2 Open the Internet Explorer browser. The Cisco HealthPresence Login window displays. You only need the calendar function, so click the Scheduler Quick link at the top left of the page, as shown in Figure 2-1. This opens the Login window for the calendar.

Figure 2-1 Logging in to the Scheduling Application

Step 3 Enter your logon name and password. The Control Panel window displays, as shown in Figure 2-2.

Use Quick link to Scheduler

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Chapter 2 Cisco HealthPresence Scheduling Tasks Logging into the Scheduling Application

Figure 2-2 Understanding the Control Panel Window

In the Control Panel window, notice the tool bar labeled “My Quick Links” on the left hand side of the window. You only need to use Bookings, Schedule Calendar, and Log Out. The remainder of this window includes a number of items. The only ones relevant to the scheduler are My Reservations and My Permissions. The following explains the relevance of each item.

• Under My Quick Links on the left of the window:

– Bookings takes you to the calendar used to schedule appointments.

– Schedule Calendar shows all scheduled appointments.

– Click Log Out whenever you are done with the Scheduling application.

– All other tools are for a Cisco Administrator or do not apply to the Scheduler.

• On the center/right of the window:

– My Reservations are those made by the scheduler.

– My Permissions refers to the resources for which you can schedule reservations.

– My Invitations refers to the reservations for which you have been invited. It will be empty because the scheduler login is not for a HealthPresence site, but simply for managing the calendar.

– My Reservation Participations refers to the reservations for which you will participate. Again, this will be empty.

Reservations you have booked

Resources you have permission to book

Click to Book a Reservation

Click to View the Reservation

Calendar

Quick Links


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Chapter 2 Cisco HealthPresence Scheduling Tasks Booking a Conference Reservation

Booking a Conference Reservation To book a reservation for a conference, click Bookings from the Control Panel window as shown in Figure 2-3. This causes the bookings calendar to appear.

Figure 2-3 Accessing the Bookings Calendar


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The Bookings calendar starts on Sunday of the current week. Figure 2-4 illustrates the Bookings calendar. Notice that today’s date is highlighted in dark blue. The rest of the week is a lighter blue/gray. Any prior days have the participants grayed out, indicating that you cannot schedule a conference on a prior day.

To navigate to the date you want to schedule, you can either use the month calendars at the top (just click the date) or specify a specific date at the bottom.

Figure 2-4 Navigating the Bookings Calendar

Calendar grays out days that cannot be scheduled

Jump to specific day

Today

Past days

Future days


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Reserving the Provider Site

Tip As a matter of consistency, it helps to always schedule the Provider or Physician location first and to always send invitations from there. In the example in Figure 2-5, the provider site is Long Beach.

Step 1 Click on an open time slot in the provider’s row. The time slot fills in with green and the New Reservation window appears.

Step 2 In the new window, click Check Availability. If the time slot is open, you will see the green bar labeled Reservation Available.

Figure 2-5 Reserving the Provider Site

Step 3 Add Participants. To do this:

a. Click the Participants tab and select the names of the participants for this conference.

b. Click on the >> arrows to move the names to the box Invited Users, as shown in Figure 2-6.

Note Unless you add participants, the conference will not occur, even if you reserve both sides. When you add participants, an invitation appears on the Control Panel window for each of the participants. The participants at each of those sites must then accept the invitation, which causes the reservation to appear on their calendar.

1

2


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Figure 2-6 Selecting Participants

Step 4 Click Save. A window displays asking you if you want to close this dialog. Click Close. Your main calendar displays.

Note If you do not explicitly save the reservation, the conference is not scheduled.

4

3a

3b


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Reserving the Attendant Site(s) The scheduler must reserve each additional site that needs to participate. In the last example, we reserved Long Beach. Next we will reserve Sacramento, as shown in Figure 2-7.

Again, when you click the box, it turns green and the New Reservation window opens. Click Check Availability, click Save, and then click Close. You do not need to add the participants again.

Figure 2-7 Reserving the Attendant Site(s)

Verifying Conference ReadinessThere are two things you can check to ensure the conference calendar is ready for the day:

• Verify that all sites are reserved.

• Verify that all participants have accepted.

Verifying All Sites are Reserved

As a sanity check, in your booking calendar, every reservation should have at least two boxes. In the Control Panel window, there should be at least two sites listed for every conference.

1

2

3


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It is possible to have more than two sites. For example, training sessions could include all sites. Also, if you have multiple provider sites, you could have conferences involving multiple doctors (for example, a general practitioner and a specialist.)

Figure 2-8 shows how you can verify at a glance that there are at least two sites reserved for a conference.

Figure 2-8 Verifying All Sites Are Reserved

Verifying Participants Have Accepted

Prior to patient appointments, you might want to verify that all parties have accepted their invitations. To do that, click the appointment reservation in either the Control Panel window or the Schedule Calendar window and then click the Participants tab. All participants should be illustrated under Participating Users. In Figure 2-9, you see that Long Beach is a participating user. That implies the participant in Long Beach has accepted the reservation and that the conference is therefore on their calendar. However, the participant in Sacramento has been invited but has not accepted.


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If all parties are not listed as participants, contact the missing participants and request them to accept their invitation.

Figure 2-9 Verifying Participants Have Accepted

Deleting ReservationsIf an attendant or provider chooses to not participate in a scheduled conference after accepting an invitation, or if they choose not to accept an invitation, they should contact the scheduler and inform him/her. Only the scheduler can delete a conference in such a way that it is removed from all of the participants’ calendars.

You might receive a request to delete a reservation or you might notice a problem when you attempt to validate that all participants have accepted. In either case, if you find out you need to delete a reservation, click Delete, as shown in Figure 2-10. If there are only two participating sites in a conference and you delete one end, delete the other end as well.

Long Beach has accepted

Sacramento has been

invited but has not accepted


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Chapter 2 Cisco HealthPresence Scheduling Tasks Workflow Considerations

The participants might attempt to delete the conference themselves using the End Participation button. This can cause problems because it only deletes the meeting on their calendar. Other participants would still have the meeting on their calendar. Hence, the best solution is always to have the scheduler delete both instances of the meeting.

Figure 2-10 Deleting Reservations

Logging OutWhen you have completed all your scheduling tasks (added conferences, validated participation, and deleted cancelled conferences), log out of the scheduling application.

Note If you do not log out and another user logs in to the scheduler using the same PC, both open calendars no longer list the calendar owner. No existing scheduling is lost, but your ability to schedule or accept invites might be impacted. Just close all the browsers and start over.

Workflow ConsiderationsWhen scheduling Telemedicine appointments, allow time between appointments for other activities.

• Leave breaks in the appointments for the scheduler to enter the room with the CHP endpoint and update the calendar2. These breaks can be early in the day, at the end of the day, and perhaps when the attendant is at lunch.

• Leave additional time at the beginning of the day for the attendant to verify that the CHP endpoint is ready for patients.

2. In many environments, the Cisco HealthPresence network is isolated from the office network. Therefore the Scheduler and Attendant must both use the same PC.


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Chapter 2 Cisco HealthPresence Scheduling Tasks Workflow Considerations

• Allow time in between Telemedicine appointments for activities that must occur with each appointment but do not require a doctor. The attendant needs time to greet the patient and take vitals before a appointment, and record vitals and clear the work space after the patient leaves.

• Take into consideration that the doctor does not require as much time between Telemedicine appointments. While a doctor might be able to have 2-4 appointments in an hour, the attendant might have no more than 1-2 appointments.

• Decide on a process to prevent open slots between Telemedicine appointments from getting scheduled (for example, by setting a minimum amount of time between Telemedicine appointments).


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C H A P T E R 3
Cisco HealthPresence Attendant Tasks
Revised: April 21, 2011, OL-23353-07

OverviewThe following list summarizes the key responsibilities of the attendant. A complete checklist is in the Appendix.

• Ensure medical devices are operational and that the CHP endpoint is ready for patients. This topic is covered towards the end of the chapter, but should be the first thing done every morning, at a minimum.

• Maintain the calendar. Attendants should check their calendar at the beginning of the day, accept any open invitations, and determine when their first appointment is. Periodically throughout the day, they should refresh their calendar and check for new invitations.

• Attend to patients. As patients arrive for an appointment, the attendant gathers personal data and vitals information about that patient, shares vitals data with the provider/physician and then joins a conference with the provider. The attendant then gathers additional medical data as required using an examination camera, one of the three supported medical scopes, the digital stethoscope or other medical device approved for use with Cisco HealthPresence.

• At the conclusion of the appointment, the attendant records the medical data and prepares for the next appointment. At the end of the day, the attendant turns off the medical telemetry, closes all browsers and secures the room.

This chapter describes each step in detail.

Logging into Cisco HealthPresenceThe first thing you will do each morning is to log into Cisco HealthPresence.

Note Your PC may be locked to prevent unauthorized access. In this case, you will need to click chpuser1 and type in the Cisco HealthPresence user password.

Follow the step by step directions below.



Chapter 3 Cisco HealthPresence Attendant Tasks Checking Your Calendar

Step 1 Close any open browsers. This guarantees that you are the only user logged into the scheduling application when it is time for you to check your calendar.2

Step 2 Open the Internet Explorer browser. The Cisco HealthPresence Login window displays, as shown in Figure 3-1.

Step 3 Enter your user name and password and click Login. The Cisco HealthPresence Home Page displays.

Figure 3-1 Logging into Cisco HealthPresence

Checking Your CalendarFirst thing in the morning and periodically throughout the day, you should check your calendar for appointments and accept any invitations. From the Cisco HealthPresence Home Page, do the following:

Step 1 Click View Appointments at the top left of the Telemedicine window. This opens an additional window3 with the scheduling application displayed, as illustrated in Figure 3-2.

Step 2 Log into the scheduling application using your assigned user name and password. The Control Panel window appears, which lists your invitations and your reservations.

2. Two different user profiles (for example, the scheduler and the attendant) should not log in to the scheduler on the same PC at the same time.

CHP Login Window

CHP Home Page

3. Notice there are now two tabs at the top of your browser - one for the scheduler and one for the Cisco HealthPresence application. You can toggle between them by clicking on the tabs.


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Chapter 3 Cisco HealthPresence Attendant Tasks Checking Your Calendar

Figure 3-2 Checking Your Calendar

Step 3 From the Control Panel window, find My Invitations. If you have any invitations, either accept them, as shown in Figure 3-3, or contact your scheduler to have the conference rescheduled.

Figure 3-3 Accepting Invitations

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Chapter 3 Cisco HealthPresence Attendant Tasks Patient Appointments

Step 4 View your calendar. To view your calendar, click My Calendar from the menu to the left of the Control Panel window. The default is a monthly view. You can also use either a daily view or a weekly view4. The top overlay in Figure 3-4 shows the daily view.

Figure 3-4 Viewing Your Calendar

Note If you leave your calendar open all day, occasionally refresh the page; otherwise, the calendar you are viewing may have appointments that have been cancelled. Also refresh your home page on occasion to assure you always see new invitations.

Patient AppointmentsThe following is a summary of the steps involved in a patient appointment. There is also a checklist in the appendix that you can use as a reminder of these steps. The details of each bulleted item are covered in this section.

4. The daily view allows more appointments to be visible without scrolling.

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• Start the Telemedicine appointment by opening the Telemedicine window.

• Welcome the patient and take their vitals. Transfer the vitals information to your CHP PC.

• Click Ready. This indicates that you are ready for the doctor to participate in the appointment - much like putting the patient’s chart outside an examining room.

• Share the vitals with the doctor and join a conference with the doctor.

• Gather medical data using the medical telemetry.

• Transcribe vitals information and end the appointment.

Opening the Telemedicine Appointment WindowThere are two ways to open the Telemedicine Appointment window. You can either enter an appointment ID by hand or click on the appointment url in you calendar.

Opening the Telemedicine Window from your Calendar

Step 1 Click on the appointment in your calendar. This opens the reservation, as shown in Figure 3-5.

Step 2 Click on the url below the word Summary. This displays the Appointment with the appointment ID filled in.

Step 3 Enter the patient’s name and ID. Click Start Appointment. The Telemedicine window appears, as shown in Figure 3-5.

Note On the Telemedicine window, if you need to change any patient data (for example, correct the spelling of the patient’s name), enter the new information and click Update.


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Figure 3-5 Opening the Telemedicine Window from Your Calendar

Opening the Telemedicine Window from the Cisco HealthPresence Home Page

If you already have your appointment ID, there is another way to access your Telemedicine window.

Click Enter Appointment ID from your home page. A window will open where you can enter the ID and if appropriate, the patient name and ID. When you click Start Appointment, the Telemedicine window displays, as illustrated in Figure 3-6.

This second method is quicker, but it requires that you accurately enter a long appointment ID5. Either method works.

5. The CHP solution-provided appointment IDs are l0+ digits long, and as such, provide a level of security for health care appointments. If you are using the system for Cisco HealthPresence training or testing purposes, you can bypass the scheduler-created appointment IDs and enter a simpler ID such as your user name. As long as both ends use the same ID, you will be able to connect.


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Figure 3-6 Opening the Telemedicine window from the Cisco HealthPresence Home Page

Attending to PatientsBefore you attend to your first patient, verify that everything is operational. (See the section Verifying that Medical Telemetry is Operational, page 3-15.) Then navigate to the Telemedicine window, using the procedures illustrated in either Figure 3-5 or Figure 3-6.

Note The Cisco TelePresence microphone can transmit ambient noise in the surrounding area, such as audible conversations in or near the same area. Try to reduce or eliminate background noise before beginning a patient appointment.

Getting Vitals

Step 1 When a patient arrives, greet the patient, obtain your patient’s weight and height6 and enter it into the Vitals partition in the Telemedicine window.

Step 2 Have the patient sit in front of the TelePresence camera and adjust the seat height, if necessary, so that the patient’s head is about a 6-12 inches below the top of the TelePresence video display.

6. This may be done outside of the Cisco HealthPresence room if necessary.


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Note To maximize the effectiveness of the HealthPresence appointment, it is best if the patient sits in a chair in front of the TelePresence camera. If the patient needs to lie down during the exam for medical reasons, the physician and patient can still see each other, but since you might be putting the patient outside of the optimal CTS-500 camera focal range, the patient will appear smaller in the physician's TelePresence screen. Also, patient facial expressions and true skin color may be harder for the physician to see, and eye contact may not be possible.

Step 3 Take the patient’s vitals using the Welch Allyn Vital Signs Monitor (VSM).

a. Turn on the VSM and check for the green status light.

b. Take the patient’s temperature, pulse and blood pressure.

c. When you have all the readings on the VSM, remove the oximeter from the patient’s finger and thermometer from the patient’s mouth and wait for the VSM display to stop blinking. Then click Get and verify that vitals appear on Cisco HealthPresence screen as shown in Figure 3-7. (If any readings are missing, you can either click Get again or simply type them in.)

Figure 3-7 Getting Vitals

Note To clear the Vitals data on the Welch Allyn VSM for any reason, use the Reset button on the lower middle of the Vitals section of the page. This will clear the information from the Welch Allyn device as well as from your Telemedicine window.


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Starting a Telemedicine Appointment

Once you have successfully gathered the Vitals data on your PC, click Ready on the lower right of the Appointment area in the Telemedicine window as illustrated in Figure 3-8. This causes your name to appear in the participant list on both your Telemedicine window and the Telemedicine windows of any other participants who have entered the same appointment ID. It is similar to putting the patient’s chart outside an examining room. It lets the physician know that the patient is ready to be seen.

When the Provider starts the appointment on their end, their name will appear on all participant windows. At this point, attendants have the ability to share patient vitals data with a provider or join a TelePresence session with them.

• If the provider wants to view the vitals before they see the patient, you can Share the vitals and then Join the TelePresence session. In this case, to protect patient privacy, do not Share the vitals until you see the provider’s name in the “Participants” section of the Appointment partition.

• If the provider would prefer to see the patient first, you can Join the TelePresence session and then Share the vitals. In this case, you can Join as soon as you click Ready. You will not see the provider until the provider clicks Join. Once you see the provider, you can click Share.

Figure 3-8 Starting a Telemedicine Appointment


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Sharing Vitals

Note Do not share vitals until you see the name of the provider in the participant list.

For the provider/physician to see the Vitals data, two actions must occur:

1. The attendant must Share the Vitals. This action makes the data available to the provider but does not display it on the screen.

2. The provider must Get the Vitals. This step displays the Vitals data in the Vitals area of the provider’s Telemedicine window.

Figure 3-9 illustrates how the Share / Get combination works.

Figure 3-9 Sharing Vitals

Joining a Conference

Both the attendant and the provider must click Join in the TelePresence partition to see each other on the TelePresence monitor. Once both have joined, you can see the provider/physician on your TelePresence monitor and the provider/physician can see the patient and attendant on their TelePresence monitor as shown in Figure 3-10.


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Figure 3-10 Joining a Conference

Once you are in the teleconference, use the volume button on the phone (or the remote control if using a Tandberg Edge 95 MXP) to adjust the volume. This is illustrated in Figure 3-11.

Note The phone is only connected to the Cisco HealthPresence system and cannot be used for dialing 911 or making outside calls.7

Wait for Doctor to appear

Click Join

7. Should the TelePresence system be unavailable, it is possible to use the IP phone to communicate between endpoints. However, you cannot use the phone for a voice call if you have “Joined” a TelePresence session. You must first “End” the TelePresence call. Conversely, you cannot “Join” a TelePresence session if you are using the phone for a voice call. If you lift the receiver, you can only make a voice call.


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Figure 3-11 Adjusting the Volume

Starting Medical Devices

Cisco HealthPresence supports streaming video and audio to enable medical telemetry used at the attendant side to be viewed or heard at the provider site.

Cisco HealthPresence is only to be used with those medical devices approved for use with the Cisco HealthPresence system and described in Attendant Site Components, page 1-5.

Transmitting Video from an Exam Camera

To transmit video from an exam camera, use the drop-down menu shown in Figure 3-12 and click Exam Camera. Then click Start. This causes the video image to be displayed on your PC. For the provider to view it, they click Exam Camera and click View. When you are done with the exam camera, click Stop.

Transmitting Video from a Scope (ENT, Dermascope, or Ophthalmoscope)

To transmit video from any video device other than an exam camera, click Otoscope. There are several devices that you can attach to the AMD 400 Image and Illumination system, as described in Attendant Site Components, page 1-5. It does not matter which one you have attached to the camera. Clicking Otoscope displays the image captured by the AMD 400 video camera (through any of these scopes) on the PC. Again, after you click Otoscope, click Start. When you are done, click Stop.

Using a Telephonic Stethoscope

To use the telephonic stethoscope, click Start in the Stethoscope partition at the bottom right of the Telemedicine window. Both the attendant and provider can listen to the heartbeat using the headphones at each site.

To adjust the volume, use the PC volume controls on the lower right hand side of your PC as shown in Figure 3-13. Volume adjustments only affect the headphones attached to the local PC. In other words, if the physician wants to increase the volume of the stethoscope, the physician needs to adjust the volume controls on his/her PC.

Note Rarely will volume be an issue with the telephonic stethoscope, but to be on the safe side, assure that the volume on the PC is set to the lower third of its range when you first begin to listen through the headphones.

When you are done, click Stop.

Volume Control


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Figure 3-12 Starting and Stopping Medical Devices

Figure 3-13 Adjusting the Volume on the Stethoscope

Otoscope or camera image displayed

here

Drop down menu


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Ending an Appointment

There are several options for discontinuing a portion or all of an appointment.

1. Click Leave to end the TelePresence conference. This does not erase the vitals or end the Telemedicine appointment (attendants and providers can still share video, audio, and vitals).

2. Click Not Ready to end the Telemedicine appointment and the TelePresence session. This does not erase the vitals.

3. Click End to end the entire appointment. This erases all vital signs data and returns your screen to the Home page.

Figure 3-14 illustrates the locations of all three buttons.

Note Do not click End until you have transcribed the patient’s vitals data to their chart8. You might also want to request the doctor’s notes to add to the charts (this is not done by the Cisco HealthPresence solution).

Figure 3-14 Ending an appointment

8. When Cisco HealthPresence is integrated with EMR, you will be able to click Publish to automatically record patient vitals in your EMR data base.

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Chapter 3 Cisco HealthPresence Attendant Tasks Other Operational Responsibilities

Note When not at the patient endpoint, the attendant should log out and close all browsers to prevent unauthorized access. If the PC is idle for an hour (this is a configurable time period), you will see a warning message. Five minutes after the warning message is displayed, you will automatically be logged off the system.

Note For subsequent patients, you need to access your calendar again to get the conference ID. There are two ways to do that. You can either click View Appointments from the top left corner of the Telemedicine window or you can click the Cisco HealthPresence Scheduler quick link, as illustrated in Figure 3-15.

Figure 3-15 Accessing Your Calendar

Other Operational Responsibilities

Verifying that Medical Telemetry is OperationalAccess the Cisco HealthPresence home page, either by ending your current appointment, or, if you do not have the Cisco HealthPresence browser open, opening Cisco HealthPresence and logging in. Follow the steps below to verify that the medical equipment is operational and is communicating properly to the Cisco HealthPresence application on your PC.

Step 1 Open the Telemedicine Window from the home page by doing the following:

a. Click Enter Appointment ID.

b. Enter your Cisco HealthPresence user name as an appointment ID9.

c. Click Start Appointment. This opens the Telemedicine window.

Step 2 Test the Welch Allyn Vital Signs Monitor (VSM).

a. Turn on the VSM - check for a green status light at the top right-hand side of the Telemedicine window, as illustrated in Figure 3-16. If you see a green light, proceed to test the Vitals telemetry. If not, see the chapter titled, “Administration and Problem Solving”.

Quick link to Scheduler

- OR -

9. Any appointment ID will work, but to keep appointment IDs unique, use your Cisco HealthPresence user ID.


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b. Test the VSM using yourself as a patient. Put the oximeter on your index finger, attach the blood pressure cuff, and check your temperature. Start the blood pressure test by pressing on the blood pressure button on the VSM. Wait for your blood pressure to register on the VSM screen.

c. Remove the oximeter from your finger and the thermometer from your mouth. The readings for these devices on the VSM will be blinking. Wait for the blinking to stop.

d. Click Get and verify that vitals appear on Cisco HealthPresence screen.

e. Click Ready.

Figure 3-16 Checking Medical Device Status

Step 3 Test the otoscope.

a. Connect the scope body to either the ENT scope or the Dermascope.

b. Turn on the AMD 400; optionally focus the ENT scope in your fist.

c. Set the white balance by holding the scope ½ inch from a white surface for 5 seconds.

d. Select Otoscope in the drop-down menu and click Start in the video partition of the Telemedicine window.

e. Verify that the video image appears on the Cisco HealthPresence screen.

f. Click Stop.

Step 4 Test the exam camera.

a. Turn the exam camera power on. Turn the exam camera light on.

b. Set the white balance by holding the camera 5 inches from a white surface for 5 seconds.

c. Select Exam Camera in the drop-down menu and click Start in the video partition of the Telemedicine window.

d. Verify that camera image appears on Cisco HealthPresence screen.

e. Click Stop.

Step 5 Test the stethoscope.

a. Put the headphones on.

No devices are available

Some devices are available

All devices are available

What the status code means:


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b. Put the stethoscope on your chest.

c. Click Start in the Stethoscope window.

d. Verify that you can hear your heartbeat; adjust the volume using your PC's volume controls.

e. Click Stop.

Step 6 Click End. This returns you to the Cisco HealthPresence Home Screen.

Calendar Maintenance

Accepting Invitations

Regularly check your control panel in the Cisco HealthPresence Scheduler to ensure that you do not have any outstanding invitations.

Deleting Reservations

If you need to change or delete scheduled reservations, contact the scheduler. Do no use the End Participation button.

Refreshing your Calendar

If you log into the scheduling application and stay logged in all day, changes can occur to your calendar without your knowledge. For example, a reservation might have been deleted and still display on your calendar. Figure 3-17 shows what happens if you try to open a reservation that has been deleted. An error message appears that tells you there is no record of that reservation.

To verify that you are always looking at the most recent calendar, refresh your page by clicking the double curved arrow symbol at the top right-hand side of your Internet Explorer page.


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Figure 3-17 Refreshing Your Calendar

Cisco HealthPresence Endpoint MaintenanceAdhere to these regular maintenance recommendations to ensure your Cisco HealthPresence endpoint and the components in it are in optimal working condition.

• Turn off the cameras when not in use. Replace protective covers on lenses.

• At the end of every work day:

– log out of Cisco HealthPresence and the Scheduling application.

– Close all browsers.

– Leave power strip turned on.

– Leave PC powered on.

– Turn off the exam camera and ENT scope (if they are not already off).

Click on the refresh arrows

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Reservations Removed

2Reservations appear on schedule, but when clicked, an error occurs

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C H A P T E R 4
Cisco HealthPresence Provider Tasks
Revised: April 21, 2011, OL-23353-07

OverviewThe following list summarizes the key responsibilities of the provider.

• At the beginning of each day, log in to the Cisco HealthPresence (CHP) application and view your calendar. The office staff can accept invitations for you, but you should check for invitations that have come in since your staff checked your calendar. Accept any outstanding invitations unless you have a conflict (in which case, have your office staff contact the scheduler to resolve).

• To evaluate and assist patients, start a Telemedicine appointment to access patient medical data and join a conference to view the patient and attendant.

• If required, ask the attendant to use medical instruments to gather additional data. Click View or Listen on your end to view the video or hear the audio.

This chapter describes each step in detail.

Logging into Cisco HealthPresence

Note Your PC may be locked to prevent unauthorized access. In this case, you will need to click chpuser1 and type in the Cisco HealthPresence user password.

Step 1 Close any open browsers. This guarantees that you are the only user logged into the scheduling application when it is time for you to check your calendar.2

Step 2 Open the Internet Explorer browser. The Login window displays as shown in Figure 4-1.

Step 3 Enter your user name and password and click Login. The Cisco HealthPresence Home Page displays.


2. Two different user profiles (for example the scheduler and the attendant) should not log in to the scheduler on the same PC at the same time.


Chapter 4 Cisco HealthPresence Provider Tasks Logging into Cisco HealthPresence

Figure 4-1 Logging into Cisco HealthPresence

Checking Your CalendarStart the day by checking your calendar and getting the conference ID for the first appointment. To do that, follow these steps:

Step 1 Click View Appointments at the top left of the Cisco HealthPresence Home Page. This opens an additional window with the scheduling application displayed, as illustrated in Figure 4-2.

Step 2 Log in to the scheduling application using your assigned user name and password.This brings you to the Control Panel window which lists your invitations and your reservations.

Login Screen

Home Screen

4-2Cisco HealthPresence user Guide

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Figure 4-2 Checking Your Calendar

Step 3 In the Control Panel window, find My Invitations. If you have any invitations, click Accept, as shown in Figure 4-3, or if required, contact your scheduler to have the conference rescheduled.

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Figure 4-3 Accepting Invitations

Step 4 View your calendar. Click My Calendar from the Quick Links area of the Control Panel window. The default is a month view. You can also use either a daily view or a weekly view. The top overlay in Figure 4-4 shows an example of a daily calendar.

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Chapter 4 Cisco HealthPresence Provider Tasks Patient Appointments

Figure 4-4 Viewing Your Calendar

Note If you leave your calendar open all day, occasionally refresh the page; otherwise, the calendar you are viewing may have appointments that have been cancelled. Also refresh your home page on occasion to assure you always see new invitations.

Patient AppointmentsThe following is a summary of the steps involved in a patient appointment. There is also a checklist in the appendix that you can use as a reminder of these steps. The details of each bulleted item are covered in this section.

• Start the Telemedicine appointment by opening the Telemedicine window.

• Get vitals data.

• Join a TelePresence conference with the patient and attendant.

• Gather additional medical data required for your evaluation of the patient.

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• Transcribe vitals information and End the appointment.

Opening the Telemedicine Appointment WindowThere are two ways to open the Telemedicine Appointment window. You can either enter an appointment ID on the Cisco HealthPresence home page or click on the appointment url in you calendar.

Opening the Telemedicine Window from your Calendar

Step 1 Click on the appointment in your calendar. This opens the reservation.

Step 2 Click on the url below the word Summary. This opens the Telemedicine window with the appointment ID filled in, as shown in Figure 4-5.

Figure 4-5 Accessing the Telemedicine Window From Your Calendar

Opening the Telemedicine Window from the Cisco HealthPresence Home Page

If you already have your appointment ID, there is another way to access your Telemedicine window.

Click Enter Appointment ID from your home page. A window will open where you can enter the ID and if appropriate, the patient name and ID. When you click Start Appointment, the Telemedicine window displays, as illustrated in Figure 4-6.

This second method is quicker, but it requires that you accurately enter a long appointment ID3. Either method works.

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Figure 4-6 Accessing the Telemedicine Window from the Cisco HealthPresence Home Page

You should now have the Telemedicine window open and your name along with the participants’ names and the patient’s name in the Appointment area of the window4. As a next step, you can either Join a TelePresence conference (so you can see the patient and attendant) or Get vitals (if you would prefer to view the vitals before you see the patient.)

Getting VitalsThe Cisco HealthPresence solution allows you to view electronically the vitals data the attendant has collected. To view the vitals data, click Get from the Telemedicine window as illustrated in Figure 4-7. (If the attendant has not yet shared vitals, clicking Get will display an error message. Wait for the attendant to Share the vitals and click Get again.)

3. The Cisco HealthPresence solution-provided appointment IDs are l0+ digits long, and as such, provide a level of security for health care appointments. If you are using the system for Cisco HealthPresence training or testing purposes, you can bypass the scheduler-created appointment IDs and enter a short ID such as 1234. As long as both ends use the same ID, you will be able to connect.

Click Enter Appointment ID

Enter Appointment IDClick Start Appointment

Telemedicine window

4. If you do not see any other names in the participants window, that means the attendant is not yet ready and you are the first person to start the Telemedicine appointment.


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Figure 4-7 Getting Vitals Data

Joining a ConferenceTo join a conference, click Join in the TelePresence area of the Telemedicine window. Both the attendant and the provider must join the conference. Once both have joined, the patient and attendant display on your TelePresence monitor, as shown in Figure 4-8. The patient and attendant can now see you on their TelePresence monitor.

Note When you look directly at the camera, the patient perceives that you are making eye contact. If you look at the image of the patient on the monitor, the patient perceives that you are looking at their neck or chest (depending on your eye level in relationship to the camera and screen). You will be more effective when making key comments to the patient if you look directly at the camera.


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Figure 4-8 Joining a Conference

Once you are in the teleconference, use the volume button on the phone (or the remote control if you are using a Tandberg Edge 95 MXP) to adjust the volume, as shown in Figure 4-9.

Note The phone is only connected to the Cisco HealthPresence system and cannot be used to dial 911 or to make outside calls.5

5. Should the TelePresence system be unavailable, it is possible to use the IP phone to communicate between endpoints. However, you cannot use the phone for a voice call if you have “Joined” a TelePresence session. You must first “End” the TelePresence call. Conversely, you cannot “Join” a TelePresence session if you are using the phone for a voice call. If you lift the handset, you can only make an audio call.


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Figure 4-9 Adjusting the Volume

Accessing Content from Medical DevicesThe Cisco HealthPresence solution also supports streaming video and audio to enable medical devices to be used at the attendant side and viewed or heard at the provider site.

The list of approved medical devices can be found at Attendant Site Components, page 1-5 and includes the following types of devices:

• ENT scope

• dermascope

• ophthalmoscope

• exam camera

• telephonic stethoscope.

Note The attendant must first turn on these devices, use them to view or listen to whatever area you request, and then start the streaming of the video or audio from these devices.

Viewing Video from an Exam Camera

To view the video from the exam camera listed for use with Cisco HealthPresence, do the following:

Step 1 Confirm that the attendant has started the devices at their end.

Step 2 Use the drop-down menu and click Exam Camera.

Step 3 Click View, as shown in Figure 4-10. This action displays the video image on your PC. You can request the attendant to freeze an image at any time, but remember there is a slight delay, so you may request that the attendant freeze the image as soon as they get a crisp image of what it is you want to see.

Step 4 When you are done viewing the image, click Stop Viewing.

Volume Control


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Figure 4-10 Viewing and Listening to Medical Devices

Viewing Video from a Scope (ENT Scope, Dermascope, or Ophthalmoscope)

To view video from any approved video device other than an exam camera, do the following:

Step 1 Confirm that the attendant has started the devices at their end.

Step 2 Use the drop-down menu and click Otoscope.

Step 3 Click View, as shown in Figure 4-10. This action displays the video image on your PC.

Step 4 When you are done viewing the image, click Stop Viewing.

Note There are several devices that you can attach to the AMD 400 Image and Illumination System, including an ENT scope, a dermascope or a direct ophthalmoscope. It does not matter which scope you attach to the camera. Clicking Otoscope displays the image, seen by the AMD 400 camera through any of these scopes, on the PC.

Using a Telephonic Stethoscope

To use the telephonic stethoscope, put on your headphones and click Listen on the Stethoscope bar at the bottom of your window, as shown if Figure 4-10.

Otoscope or camera image

displayedhere

Drop down menu


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To adjust the volume, use the PC volume controls on the lower right hand side of your PC as shown in Figure 4-11. Volume adjustments only affect the headphones attached to the local PC. In other words, if the physician wants to increase the volume of the stethoscope, the physician needs to adjust the volume controls on his/her PC.

When you are done, click Stop Listening.

Figure 4-11 Adjusting the Volume on the Stethoscope

Ending an AppointmentWhen you are done with the appointment, click Leave to end the TelePresence conference. This does not clear the vitals or end the Telemedicine appointment (attendants and providers can still share video, audio, and vitals).

When you no longer need to see the vitals data or any images on the Telemedicine window, click End to end the entire appointment and return to the Home page.

Figure 4-12 illustrates the locations of the Leave and End buttons.

Note If you need to transcribe any of the patient’s vitals information, do not click End until you have done so6. This data is not stored on the Cisco HealthPresence PC after an appointment ends.

Note If the Cisco HealthPresence PC is left unattended, the provider should log out and close all browsers to prevent unauthorized access. If the PC is idle for an hour (this is a configurable time period), you will see a warning message. Five minutes after the warning message is displayed, you will automatically be logged off the system.

6. When Cisco HealthPresence is integrated with EMR, you will be able to click Publish to automatically record patient vitals in your EMR data base.


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Chapter 4 Cisco HealthPresence Provider Tasks Calendar Maintenance

Figure 4-12 Ending an appointment

Calendar Maintenance

Accepting InvitationsYou (or your office staff) should regularly check the Control Panel window in the Cisco HealthPresence Scheduling application to ensure there are no outstanding invitations to be accepted.

There are two ways to access your calendar:

• Click View Appointments from the top left corner of the Home page.

• Click the Cisco HealthPresence Scheduler quick link,

These are illustrated in Figure 4-13.


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Figure 4-13 Accessing Your Calendar

Deleting ReservationsIf you need to change or delete scheduled reservations, contact the scheduler. Do no use the End Participation button.

Refreshing Your CalendarIf you log in to the scheduling application and stay logged in all day, changes can occur to your calendar without your knowledge. For example, a reservation could have been deleted and still show up on your calendar. Figure 4-14 shows the result if you try to open a reservation that has been deleted. An error message pops up that tells you there is no record of that reservation.

To verify that you are always looking at the most recent calendar, refresh your page by clicking the double curved arrow symbol at the top right-hand side of your Internet Explorer page.

Quick link to Scheduler

- OR -


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Figure 4-14 Refreshing Your Calendar

Click on the refresh arrows

1

Reservations Removed

2Meetings appear on schedule, but

when clicked, an error occurs

3


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C H A P T E R 5
Administration and Problem Solving
Revised: April 21, 2011, OL-23353-07

Overview This section covers administrative options for account management. It also covers administrative rules that can help you avoid problems and discusses how to address problems with either the teleconferencing equipment or the Cisco HealthPresence (CHP) solution.

Account ManagementTo manage your account, click Manage Account from the home page. This takes you to the Account Management window, illustrated in Figure 5-1. The following describes the options available on this window.

• Change your password. Enter your current password. Then enter a new password in the Password field and the same password in the Confirm Password field. Click Save.

• Change the name that is displayed on the Telemedicine window when you are in an appointment. This name is visible to the patient.

• When you have completed your changes, click Save and then click Close.


Chapter 5 Administration and Problem Solving Administrative Rules

Figure 5-1 Account Management

Administrative RulesAdhere to the following rules to enable the solution to minimize problems.

• Only one user (either the scheduler or the attendant/ provider) can be logged into a given PC at a given time to use the scheduling application

– The scheduler must log off when done.

– The provider/attendant must log off the scheduling calendar if the scheduler needs access.

• If you need to cancel a reservation, contact the scheduler (or log in as the scheduler).

– Do NOT use End Participation button.

• Understand the consequences of a conference running over its allotted time.

– Conferences do not end when scheduled time elapses. If your patient requires more time than anticipated, the conference remains active.

– However, any conference with the same participant(s) cannot start.

• You cannot be idle for more than 60 minutes, or you will be logged out of the application. You will get a warning 5 minutes before you are logged out as illustrated in Figure 5-2.


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Chapter 5 Administration and Problem Solving Addressing Conference Problems

Note Whenever you leave Cisco HealthPresence PC unattended, you should log out and close all browsers for security reasons.

Figure 5-2 Inactivity Warning Window

Addressing Conference ProblemsIf you attempt to join a conference and the TelePresence screen is blank:

• Verify that the video display has power (a green light is visible).

• Contact your scheduler and verify the appointment is on the calendar for both parties.

• Call the other site to verify they know about the appointment and have accepted the invitation.

• Try logging out of Cisco HealthPresence and logging in again.

• If none of the above address the problem, contact Cisco Support as described in Contacting Cisco Support, page 5-7.

If you start a conference and you cannot hear the attendees, adjust the volume using the Cisco phone.

Note The phone is only connected to the Cisco HealthPresence system and cannot be used for outside calls.

Note You can hold a TeleMedicine conference without a TelePresence conference. You will not be able to see the other participants, but if you use a speakerphone to communicate, you can still walk through sharing vitals, video and audio.

Addressing Scheduling ProblemsIf you cannot access the scheduler, or if clicking on the summary url does not cause the appointment window to open:

• Try closing all browsers and logging in again.


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Chapter 5 Administration and Problem Solving Addressing Vitals or Streaming Problems

• Ensure you are using the correct scheduler login ID.

• If necessary, select a random 8-10 digit appointment ID, communicate the appointment ID securely to all the participants, and start the TeleMedicine appointment and TelePresence session using the selected appointment ID.

Addressing Vitals or Streaming ProblemsBefore you use the system for the first time, Cisco verifies that all devices are properly connected and working. Cisco verifies that the exam camera and ENT scope send video to both ends of a conference, the stethoscope can be heard at the Provider end, and the Vitals data is transmitted to the local PC and remote location. If you have a problem at a later time, it might be user-error or a loose connection.

The following guidelines help eliminate user error before you call Cisco for assistance.

Provider Cannot Access Medical Data

Vitals

If the provider clicks Get and no Vitals appear, verify that the attendant has clicked Share.

Camera Output

If the provider clicks View to see the output of the exam camera or otoscope and no video appears on the PC:

• Verify that the attendant can see the video on the video area of their Telemedicine window.

• Ensure the attendant has started the device and the Provider is viewing the same device.

• If neither of the above actions addresses the problem, contact Cisco support as described in Contacting Cisco Support, page 5-7.

Stethoscope Output

If the provider clicks Listen to hear the stethoscope and no sound is coming from the headphones:

• Verify that the attendant has started the stethoscope and has it in position.

• Verify that the volume is properly adjusted using the PC’s volume controls at the provider site.

• If neither of the above actions address the problem, contact Cisco Support as described in Contacting Cisco Support, page 5-7.

Attendant Cannot View Video or Vitals

• If the attendant clicks Get and no Vitals appear on the Vitals area of their Telemedicine window:

– Verify that the vitals data is visible on the Welch Allyn monitor.

– Check the Device Status. See Addressing Telemetry Problems, page 5-5.

– Contact Cisco as described in Contacting Cisco Support, page 5-7, if necessary.

• Attendant Starts the exam camera or otoscope and no video appears on the video area of their Telemedicine window.

– Verify that the camera is operational. See Addressing Telemetry Problems, page 5-5.


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Chapter 5 Administration and Problem Solving Addressing Telemetry Problems

– Contact Cisco as described in Contacting Cisco Support, page 5-7, if necessary.

• Video streaming stops at Attendant PC and an error message is displayed indicating that streaming has stopped.

– Verify that the camera is properly connected to the Device Aggregator.

– Try to restart streaming using the Start button.

If this resolves the problem, tell the provider to click View to re-start viewing at the provider endpoint.

If the problem is not resolved, contact Cisco as described in Contacting Cisco Support, page 5-7.

• Camera image is blurry or unclear:

– Verify that lens are clean and intact.

– Refer to AMD documentation for further problem isolation.

Addressing Telemetry Problems

Checking Welch Allyn Vital Signs Monitor Status

Before patients arrive, the attendant turns on all medical devices and then verifies that the Vital Signs Monitor is available by looking at the Device Status notification at the top right-hand side of the Cisco HealthPresence home page, as illustrated in Figure 5-3.

Figure 5-3 Checking Medical Device Status

The status bar provides status for the oximeter, blood pressure monitor, and thermometer.

• The red octagon with an X in the middle means that no devices are available.

• The yellow square with a ! in the middle means that some devices are available and some are not.

What the status code means:

No devices are available

Some devices are available

All devices are available


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Chapter 5 Administration and Problem Solving Addressing Telemetry Problems

• The green square with a check mark in the middle means that all devices are available.

Obtaining Detailed Status

For details, click the Device Status bar. The detailed status displays, as shown in Figure 5-4.

• A red circle with an X in it means the Device Aggregator (DA) is reporting an error or unknown status for the device. Try turning off the device and turning it back on. Close this window and reopen it to see the updated device status.

• A red box with a dash in it means the device is powered off. Check these devices and either turn on the device power or make sure the power cord is correctly attached to both the device and the wall outlet.

• A green box with a check mark in it means the device is powered on and available.

• No device status implies a problem with the DA and an error message displays as shown in Figure 5-5.

If you have problems with the devices, ensure they are powered on and connectors are inserted properly. If they are powered on and properly connected and you still do not have a green check, call for assistance.

Figure 5-4 Understanding the Detailed Status Window


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Chapter 5 Administration and Problem Solving Contacting Cisco Support

Figure 5-5 No Device Status

Contacting Cisco SupportIf you are unable to resolve problems on your own, contact Cisco support:

http://www.cisco.com/en/US/support/tsd_cisco_worldwide_contacts.html

Reference your Cisco HealthPresence support contract number and use the keyword “HealthPresence”.


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Chapter 5 Administration and Problem Solving Contacting Cisco Support


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A
P P E N D I X A Checklists
Revised: April 21, 2011, OL-23353-07

Cisco HealthPresence Attendant Checklists

Start of Day

Note Your PC may be locked to prevent unauthorized access. In this case, you will need to click CHP User and type in the Cisco HealthPresence user password.

1. Open Browser.

2. Log in to Cisco HealthPresence (CHP).

3. Click Enter Appointment ID.

a. Enter your Cisco HealthPresence user ID as the appointment ID1.

b. Click Start Appointment. This opens the Telemedicine window.

4. Test Welch Allyn Vital Signs Monitor (VSM).

a. Turn on VSM - check for a green status light.

b. Test devices using yourself as a patient: oximeter, pulse, blood pressure and temperature.

c. Click Get and verify that vitals appear on Cisco HealthPresence screen.

d. Click Ready.

5. Test Otoscope.

a. Connect the scope body to ENT scope or Dermascope.

b. Set white balance - ½" for 5 seconds

c. Turn on AMD 400; Focus the ENT scope. One way to do this is make a fist (tight at the little finger, loose at the index finger), aim the ENT scope through the loose part of your fist and focus on your curled small finger inside of your fist (to emulate an ear drum).

d. Select Otoscope on the drop-down menu and click Start.

e. Verify that the video image appears on the Cisco HealthPresence screen.

1. Any appointment ID will work, but this guarantees that the appointment ID is unique.

A-1Cisco HealthPresence User Guide

Appendix A Checklists Cisco HealthPresence Attendant Checklists

f. Click Stop.

6. Test Exam Camera.

a. Turn exam camera power on. Turn exam camera light on.

b. Set white balance - 5" for 5 sec.

c. Select Exam Camera on the drop-down menu and click Start.

d. Verify that camera image appears on Cisco HealthPresence screen.

e. Click Stop.

7. Test Stethoscope.

a. Put headphones on.

b. Put stethoscope on chest.

c. Click Start in the Stethoscope window.

d. Verify that you can hear your heartbeat; adjust volume using PC's volume controls.

e. Click Stop.

8. Click End. This returns you to the Cisco HealthPresence Home Screen.

9. Click View Appointments.

10. Log into Calendar.

11. Accept invitations if required.

12. Click My Calendar.

13. Click on first appointment of the day. When ready to start this appointment, click on the Summary hyperlink (url).

Appointment Checklist1. Open browser (if it is not already open.) Log into the Cisco HealthPresence application.

2. Click View Appointments. Log into Calendar.

3. Click My Calendar. Click on the upcoming appointment.

4. Click on the Summary hyperlink (url). The Appointment window opens.

5. Fill in the patient’s name and ID. Click Start Appointment. The Telemedicine window opens with appointment ID filled in.

6. Fill in patient’s weight and height in the Vitals partition.

7. Have the patient sit in front of the TelePresence screen and adjust the chair height, if possible.

8. Turn on the Welch Allyn vitals monitor and take blood pressure, temperature, and pulse. Remove thermometer and oximeter and wait for blinking on the VSM to stop.

9. Click Get. Verify that the vitals data now appears on the Cisco HealthPresence screen and is correct.

10. Click Ready. Your name will appear in the participant window.

11. When you see the doctor's name appear in the participant window, click Share and then Join. Share lets the doctor see the vitals; Join lets the doctor see you and the patient.

12. Use any telemetry requested by the doctor. For video, select the correct device (Exam camera or otoscope) in the drop-down menu and click Start. For the stethoscope, click Start in the stethoscope box. Click Stop when instructed to by the doctor.


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Appendix A Checklists Cisco HealthPresence Appointment Checklist for Providers

13. When the appointment is over, click Leave to end the TelePresence conference only or Not Ready to end the TelePresence and Telemedicine appointment.

14. Transcribe vitals into the Patient records.

15. Click End to end this appointment, clear the vitals, and return to the Cisco HealthPresence home screen.

Close of Day1. Turn off the exam camera light and power.

2. Turn off the AMD 400.

3. Turn off Vital Signs Monitor to clear memory.

4. Close any browsers on the PC.

5. Leave the PC turned on and the power strip turned on.

Cisco HealthPresence Appointment Checklist for Providers

Note Your PC may be locked to prevent unauthorized access. In this case, you will need to click CHP User and type in the Cisco HealthPresence user password.

1. Open browser (if it is not already open.) Log into the Cisco HealthPresence application.

2. Click View Appointments. Log into Calendar.

3. Click My Calendar. Click on the upcoming appointment.

4. Click on the Summary hyperlink (url). The Telemedicine window opens with appointment ID filled in.

5. When you see the attendant's name appear in the participant window, click Get. This lets you view the vitals (as soon as the Attendant Shares them.)

6. When you are ready to join the TelePresence session, click Join. This lets the patient and attendant view you on their TelePresence monitor. Look at the camera to make “eye contact” with the patient.

7. You can ask the attendant to use any telemetry available.

a. Exam Camera or Otoscope: After the attendant has started one of these devices, select the correct device in the drop-down menu and click View. When you are done viewing, you can click Stop Viewing.

b. Stethoscope: After the attendant has started the stethoscope, click Listen in the stethoscope box. Click Stop Listening when done.

8. When the appointment is over, click Leave to end the TelePresence conference. If necessary, transcribe vitals into the Patient records.

9. After you have transcribed vitals, click End to end this appointment, erase the vitals, and return to the Cisco HealthPresence home screen.


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Appendix A Checklists Cisco HealthPresence Appointment Checklist for Providers


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OL-23353-07

G L O S S A R Y

Revised: April 21, 2011, OL-23353-07

A

Attendant A licensed medical professional who meets with patients, takes their vitals information, and then joins conferences with a provider.

B

browser A user interface on a computer that allows you to access files and applications. An example is Internet Explorer.

C

CHP See Cisco HealthPresence Solution.

Cisco

HealthPresence

Solution

The solution that combines video, telemetry, computer networking and a graphical user interface to enable providers to offer physical health, mental health, or advisory services to patients seeking remote access to clinical services.

O

Otoscope In this manual, the term otoscope is used as a shorthand way of describing the AMD 400 Image and Illumination System used with any of the three snap on scopes: ENT scope AMD-2015, Dermascope AMD-2030 and Ophthalmoscope AMD-2020.

P

Provider A doctor or physician’s assistant who meets with a patient and attendant in a teleconference, and views and analyzes medical data.

R

refresh To reread the source data for a computer window and update the window as required.

GL-1Cisco HealthPresence User Guide

Glossary

S

Scheduler The person who manages the appointment calendar and adds or deletes appointment reservations. The scheduler does not have to be a specific person, but to perform the scheduling task, he or she must log in using the scheduler’s user ID and password.

T

Telemetry A technology that allows remote measurement and reporting of information.

Telemedicine

Appointment

The portion of a CHP medical appointment where the attendant can share and the provider can receive patient Vitals, video streams and audio streams.

U

URL Uniform Resource Locator. An address of documents or resources on the World Wide Web. When a URL is clicked, your web page is redirected to that location.

GL-2Cisco HealthPresence User Guide

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