Cisco HealthPresence User Guide

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1 Cisco HealthPresence User Guide V 1.0 April 21, 2011 Americas Headquarters Cisco Systems, Inc. 170 West Tasman Drive San Jose, CA Tel: Support: or Web portal: Text Part Number:

2 THE SPECIFICATIONS AND INFORMATION REGARDING THE PRODUCTS IN THIS MANUAL ARE SUBJECT TO CHANGE WITHOUT NOTICE. ALL STATEMENTS, INFORMATION, AND RECOMMENDATIONS IN THIS MANUAL ARE BELIEVED TO BE ACCURATE BUT ARE PRESENTED WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. USERS MUST TAKE FULL RESPONSIBILITY FOR THEIR APPLICATION OF ANY PRODUCTS. THE SOFTWARE LICENSE AND LIMITED WARRANTY FOR THE ACCOMPANYING PRODUCT ARE SET FORTH IN THE INFORMATION PACKET THAT SHIPPED WITH THE PRODUCT AND ARE INCORPORATED HEREIN BY THIS REFERENCE. IF YOU ARE UNABLE TO LOCATE THE SOFTWARE LICENSE OR LIMITED WARRANTY, CONTACT YOUR CISCO REPRESENTATIVE FOR A COPY. The following information is for FCC compliance of Class A devices: This equipment has been tested and found to comply with the limits for a Class A digital device, pursuant to part 15 of the FCC rules. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment. This equipment generates, uses, and can radiate radio-frequency energy and, if not installed and used in accordance with the instruction manual, may cause harmful interference to radio communications. Operation of this equipment in a residential area is likely to cause harmful interference, in which case users will be required to correct the interference at their own expense. The following information is for FCC compliance of Class B devices: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If the equipment causes interference to radio or television reception, which can be determined by turning the equipment off and on, users are encouraged to try to correct the interference by using one or more of the following measures: Reorient or relocate the receiving antenna. Increase the separation between the equipment and receiver. Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. Consult the dealer or an experienced radio/tv technician for help. Modifications to this product not authorized by Cisco could void the FCC approval and negate your authority to operate the product. The Cisco implementation of TCP header compression is an adaptation of a program developed by the University of California, Berkeley (UCB) as part of UCB s public domain version of the UNIX operating system. All rights reserved. Copyright 1981, Regents of the University of California. NOTWITHSTANDING ANY OTHER WARRANTY HEREIN, ALL DOCUMENT FILES AND SOFTWARE OF THESE SUPPLIERS ARE PROVIDED AS IS WITH ALL FAULTS. CISCO AND THE ABOVE-NAMED SUPPLIERS DISCLAIM ALL WARRANTIES, EXPRESSED OR IMPLIED, INCLUDING, WITHOUT LIMITATION, THOSE OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT OR ARISING FROM A COURSE OF DEALING, USAGE, OR TRADE PRACTICE. IN NO EVENT SHALL CISCO OR ITS SUPPLIERS BE LIABLE FOR ANY INDIRECT, SPECIAL, CONSEQUENTIAL, OR INCIDENTAL DAMAGES, INCLUDING, WITHOUT LIMITATION, LOST PROFITS OR LOSS OR DAMAGE TO DATA ARISING OUT OF THE USE OR INABILITY TO USE THIS MANUAL, EVEN IF CISCO OR ITS SUPPLIERS HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. CCDE, CCENT, CCSI, Cisco Eos, Cisco HealthPresence, Cisco IronPort, the Cisco logo, Cisco Nurse Connect, Cisco Pulse, Cisco SensorBase, Cisco StackPower, Cisco StadiumVision, Cisco TelePresence, Cisco Unified Computing System, Cisco WebEx, DCE, Flip Channels, Flip for Good, Flip Mino, Flipshare (Design), Flip Ultra, Flip Video, Flip Video (Design), Instant Broadband, and Welcome to the Human Network are trademarks; Changing the Way We Work, Live, Play, and Learn, Cisco Capital, Cisco Capital (Design), Cisco:Financed (Stylized), Cisco Store, Flip Gift Card, and One Million Acts of Green are service marks; and Access Registrar, Aironet, AllTouch, AsyncOS, Bringing the Meeting To You, Catalyst, CCDA, CCDP, CCIE, CCIP, CCNA, CCNP, CCSP, CCVP, Cisco, the Cisco Certified Internetwork Expert logo, Cisco IOS, Cisco Lumin, Cisco Nexus, Cisco Press, Cisco Systems, Cisco Systems Capital, the Cisco Systems logo, Cisco Unity, Collaboration Without Limitation, Continuum, EtherFast, EtherSwitch, Event Center, Explorer, Follow Me Browsing, GainMaker, ilynx, IOS, iphone, IronPort, the IronPort logo, Laser Link, LightStream, Linksys, MeetingPlace, MeetingPlace Chime Sound, MGX, Networkers, Networking Academy, PCNow, PIX, PowerKEY, PowerPanels, PowerTV, PowerTV (Design), PowerVu, Prisma, ProConnect, ROSA, SenderBase, SMARTnet, Spectrum Expert, StackWise, WebEx, and the WebEx logo are registered trademarks of Cisco Systems, Inc. and/or its affiliates in the United States and certain other countries. All other trademarks mentioned in this document or website are the property of their respective owners. The use of the word partner does not imply a partnership relationship between Cisco and any other company. (0910R) 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 Systems, Inc. All rights reserved.

3 CONTENTS CHAPTER 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 CHAPTER 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 CHAPTER 3 Cisco HealthPresence Attendant Tasks 3-1 Overview 3-1 Logging into Cisco HealthPresence 3-1 Checking Your Calendar 3-2 Cisco Health Presence User Guide iii

4 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 Deleting Reservations 3-17 Refreshing your Calendar 3-17 CHP Endpoint Maintenance 3-18 CHAPTER 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 Deleting Reservations 4-14 Refreshing Your Calendar 4-14 iv Cisco Health Presence User Guide

5 Contents CHAPTER 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 APPENDIX 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 LOSSARY Cisco Health Presence User Guide v

6 Contents vi Cisco Health Presence User Guide

7 CHAPTER 1 Understanding Cisco HealthPresence Revised: April 21, 2011, Objectives and Audience This 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 Overview Cisco 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. 1-1

8 Cisco HealthPresence Overview Chapter 1 Understanding Cisco HealthPresence 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 1-2

9 Chapter 1 Understanding Cisco HealthPresence Intended Uses Intended Uses Cisco 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). 1-3

10 Understanding the Cisco HealthPresence Solution Chapter 1 Understanding Cisco HealthPresence The Cisco HealthPresence PC is an HP Slimline 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 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 3.00 GHz 3. Anti Virus version/type McAfee Total Protection Service PC Browser version/type Internet Explorer Version 8 ( ) Media Player Audio Windows Media Player 12 ( ) Media Player Video Silverlight 4 ( ) PC Audio Card Realtek HD Audio Output PC Audio Driver Realtek Audio Driver PC Video Card Intel Q35/Q43 Express Chipset PC Video Driver Intel Video Driver Understanding the Cisco HealthPresence Solution The 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 Terminology Telepresence 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. 1-4

11 Chapter 1 Understanding Cisco HealthPresence Understanding the Cisco HealthPresence Solution Figure 1-3 Cisco HealthPresence Terminology Attendant Endpoint Telepresence TeleMedicine Attendant Provider Medical Telemetry Attendant Site Components The 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 Telepresence 1 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

12 Understanding the Cisco HealthPresence Solution Chapter 1 Understanding Cisco HealthPresence Provider Site Components Components 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 Terminology Much 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 1-6

13 Chapter 1 Understanding Cisco HealthPresence Understanding the Cisco HealthPresence Solution 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 hyperlink 2. 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 TelePresence 2. For the purposes of this manual, the terms url and hyperlink are used interchangeably, even though their technical definitions are different. 1-7

14 Understanding the Cisco HealthPresence Solution Chapter 1 Understanding Cisco HealthPresence 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 chpuser 4 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. 1-8

15 Chapter 1 Understanding Cisco HealthPresence Three User Profiles Figure 1-8 Unlocking your PC Select chpuser; Enter password chpuser Three User Profiles There 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. 1-9

16 Three User Profiles Chapter 1 Understanding Cisco HealthPresence 1-10

17 CHAPTER 2 Cisco HealthPresence Scheduling Tasks Revised: April 21, 2011, 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 endpoint 1. 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. 2-1

18 Logging into the Scheduling Application Chapter 2 Cisco HealthPresence Scheduling Tasks Step 1 Step 2 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. 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 Use Quick link to Scheduler Step 3 Enter your logon name and password. The Control Panel window displays, as shown in Figure Cisco Health Presence User Guide

19 Chapter 2 Cisco HealthPresence Scheduling Tasks Logging into the Scheduling Application Figure 2-2 Understanding the Control Panel Window Quick Links Click to Book a Reservation Reservations you have booked Click to View the Reservation Calendar Resources you have permission to book 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. 2-3

20 Booking a Conference Reservation Chapter 2 Cisco HealthPresence Scheduling Tasks 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 2-4 Cisco Health Presence User Guide

21 Chapter 2 Cisco HealthPresence Scheduling Tasks Booking a Conference Reservation 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 Past days Jump to specific day Today Future days 2-5

22 Booking a Conference Reservation Chapter 2 Cisco HealthPresence Scheduling Tasks 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 Step 2 Click on an open time slot in the provider s row. The time slot fills in with green and the New Reservation window appears. 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 1 2 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. 2-6 Cisco Health Presence User Guide

23 Chapter 2 Cisco HealthPresence Scheduling Tasks Booking a Conference Reservation Figure 2-6 Selecting Participants 3a 3b 4 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. 2-7

24 Booking a Conference Reservation Chapter 2 Cisco HealthPresence Scheduling Tasks 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 Readiness There 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. 2-8 Cisco Health Presence User Guide

25 Chapter 2 Cisco HealthPresence Scheduling Tasks Booking a Conference Reservation 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. 2-9

26 Booking a Conference Reservation Chapter 2 Cisco HealthPresence Scheduling Tasks 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 Sacramento has been invited but has not accepted Long Beach has accepted Deleting Reservations If 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 If there are only two participating sites in a conference and you delete one end, delete the other end as well Cisco Health Presence User Guide

27 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 Out When 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 Considerations When 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 calendar 2. 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. 2-11

28 Workflow Considerations Chapter 2 Cisco HealthPresence Scheduling Tasks 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) Cisco Health Presence User Guide

29 CHAPTER 3 Cisco HealthPresence Attendant Tasks Revised: April 21, 2011, Overview The 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 HealthPresence The 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 chpuser 1 and type in the Cisco HealthPresence user password. Follow the step by step directions below. 1. Some sites use a site-specific Windows user name, not chpuser. 3-1

30 Checking Your Calendar Chapter 3 Cisco HealthPresence Attendant Tasks Step 1 Step 2 Step 3 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 Open the Internet Explorer browser. The Cisco HealthPresence Login window displays, as shown in Figure 3-1. Enter your user name and password and click Login. The Cisco HealthPresence Home Page displays. Figure 3-1 Logging into Cisco HealthPresence CHP Login Window CHP Home Page Checking Your Calendar First 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 window 3 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. 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. 3-2

31 Chapter 3 Cisco HealthPresence Attendant Tasks Checking Your Calendar Figure 3-2 Checking Your Calendar 1 2 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 3 3-3

32 Patient Appointments Chapter 3 Cisco HealthPresence Attendant Tasks 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 view 4. The top overlay in Figure 3-4 shows the daily view. Figure 3-4 Viewing Your Calendar 4 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 Appointments The 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. 3-4

33 Chapter 3 Cisco HealthPresence Attendant Tasks Patient Appointments 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 Window There 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 Step 3 Click on the url below the word Summary. This displays the Appointment with the appointment ID filled in. 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. 3-5

34 Patient Appointments Chapter 3 Cisco HealthPresence Attendant Tasks 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 ID 5. 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. 3-6

35 Chapter 3 Cisco HealthPresence Attendant Tasks Patient Appointments Figure 3-6 Opening the Telemedicine window from the Cisco HealthPresence Home Page Attending to Patients Before 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 Step 2 When a patient arrives, greet the patient, obtain your patient s weight and height 6 and enter it into the Vitals partition in the Telemedicine window. 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. 3-7

36 Patient Appointments Chapter 3 Cisco HealthPresence Attendant Tasks Note Step 3 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. 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. 3-8

37 Chapter 3 Cisco HealthPresence Attendant Tasks Patient Appointments 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 3-9

38 Patient Appointments Chapter 3 Cisco HealthPresence Attendant Tasks 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

39 Chapter 3 Cisco HealthPresence Attendant Tasks Patient Appointments Figure 3-10 Joining a Conference Wait for Doctor to appear Click Join 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 Note The phone is only connected to the Cisco HealthPresence system and cannot be used for dialing 911 or making outside calls 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. 3-11

40 Patient Appointments Chapter 3 Cisco HealthPresence Attendant Tasks Figure 3-11 Adjusting the Volume Volume Control Starting Medical Devices Transmitting Video from an Exam Camera 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. 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) Using a Telephonic Stethoscope 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. 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 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. 3-12

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