PACEART SYSTEM. Get Connected III Edition. Paceart System Administrator's Guide

PACEART SYSTEM Get Connected III Edition Paceart System Administrator's Guide Caution: Federal Law (USA) restricts this device to sale by or on the order of a physician (or properly licensed practitioner).

The names of actual companies and products mentioned herein may be the trademarks of their respective owners. The following are trademarks of Medtronic: Medtronic, and Paceart

Paceart System Administrator's Guide Contents i Contents Chapter 1: Introduction to the Paceart System...9 Explanation of symbols...10 Purpose...10 Intended Audience...10 Indications...10 Precautions...11 Contraindications...12 Paceart authorized users...12 Technical Support...13 Chapter 2: Preparing for Paceart...15 Minimum requirements...16 Database...16 Replication...16 SQL Server licensing...17 Determining Database Size...17 Data migration...18 Security...18 Network bandwidth requirements...18 Example...19 Estimating transmission time...19 Configurations...19 Stand-alone Paceart workstation/server...20 Master SQL server only, single database...20 Master SQL server only, multiple databases...21 Master and local SQL servers, single database, full publication...22 Master and local SQL servers, single database, filtered publication...23 Master and local SQL servers, multiple databases...25 Local SQL servers only, multiple databases...26 Chapter 3: Paceart System Installation...29 AutoRun window...30 Paceart System server installation...30 Installation requirements...30 Notes for users of Paceart System 16-bit software...30 Installing the Paceart System server...31 Paceart System client installation...32 Installation requirements...32

ii Paceart System Administrator's Guide Contents Notes for users of Paceart System 16-bit software...32 Installing the Paceart System Client...32 Starting the Paceart System client for the first time...32 Global configuration options overview...33 Accessing the Global configuration options...34 Creating a new global configuration...34 Local configuration options overview...38 Accessing the Local Configuration options window...38 Paceart Device Update CD...45 Starting the Paceart System Device Update...45 Troubleshooting...46 Progress bar moves backward during server installations...46 Select device window appears during client installation...47 Windows logo testing warning appears...47 Chapter 4: Paceart Database Manager...49 Starting the Paceart Database Manager...50 Creating your first Paceart System Database...50 Sample data...50 Publications...51 Setting up a new publication...52 Maintaining existing publications...54 Subscriptions...55 Creating and configuring a new subscription...55 Maintaining existing subscriptions...56 Bulk copy...57 Performing a bulk copy...57 BCP export...58 BCP import...58 MDB import...58 Performing an MDB import...59 Script schema...60 Creating a script schema...60 Changing the compatibility level for a SQL Server 2008 database...60 Delete strips...61 Deleting strips...61 Rename database...61 Renaming a database...61 Run script...62 Delete patients...62 Deleting patients...62 Users...63 Changing the compatibility level for a SQL Server 2008 database...63 Creating a new user...63

Paceart System Administrator's Guide Contents iii Maintaining existing users...64 Roles...65 Changing the compatibility level for a SQL Server 2008 database...65 Creating a new role...65 Maintaining roles...66 Enable or disable auditing...66 Enabling auditing...66 Disabling auditing...67 Tools...67 Server Active Connections Management Window...68 Database Active Connections Management...69 Command Line Interface...69 Command Line Switches...69 Running the Paceart Database Manager from Command Line...71 Creating Shortcuts to the Paceart Database Manager...71 Troubleshooting...71 Chapter 5: Database Replication...73 When to use replication...74 Replication topologies...74 Central publisher...74 Publishing subscriber...75 Central subscriber...75 Replication security...76 SQLServerAgent service...76 Publisher/distributor security...76 Subscriber security...77 Setting up replication...77 SQL server synchronization...79 Synchronization using the Paceart Database Manager...79 Synchronization with SQL Server Enterprise Manager...80 Synchronization with Windows Synchronization Manager...80 Getting subscriptions to appear in Windows Sychronization Manager...80 Performing on-demand synchronization...80 Configuring sychronization on log on/log off...81 Configuring scheduled synchronization...81 Synchronization management and replication conflicts...82 Microsoft Replication Conflict Viewer...82 Troubleshooting...83 Chapter 6: Paceart System Security and Privacy...85 Paceart System security...86 Paceart Login Profile Manager...87

iv Paceart System Administrator's Guide Contents Setting up Paceart System security...89 Paceart System privacy...90 Access and authorization control...90 Audit control...91 Entity Authentication...92 Data authentication...93 Performing a batch print of reports for a given patient...93 HL7 export and PHI...93 BCP data export and PHI...93 Chapter 7: Paceart System Maintenance...95 System backup...96 Backup software...97 Backup hardware...97 Backup media...98 Paceart SQL Server backup VB script...100 MSSQLServer service backup...101 SQL Server backup...102 Checking the backup integrity...102 System recovery...102 Paceart recovery script...103 SQL Server restore...104 Database maintenance planner...104 Accessing the Database Maintenance Planner Wizard...105 Updates to the Paceart System...105 Paceart System software update...105 Paceart database structure updates...105 Structure revision update type...105 No structure revision change update...106 Decimal update...106 Integer update upgrade process...107 Updating the structure revision level...107 Paceart Customer-Specific Configurations (PCSC)...108 Applying Microsoft Service Packs/Updates and other updates...108 Chapter 8: Device Data Import/Export from the Programmer...109 Biotronik Programmer...110 Serial cable import...110 CD or memory card Import...111 Supported devices...111 Troubleshooting and known issues...112 ELA Programmer...112 Performing an import using removable media (such as floppy disks)...112

Paceart System Administrator's Guide Contents v Supported devices...113 Troubleshooting and known issues...113 Guidant Programmer...113 Performing an import using removable media (such as floppy disks)...113 Supported devices...114 Troubleshooting and known issues...114 Intermedics Programmer...114 Hardware connections...114 Configuring the Programmer...115 Performing an import...115 Supported devices...116 Troubleshooting and known issues...116 Medtronic Programmer...116 Saving device data to a floppy disk...116 Saving device data using SessionSync...117 Supported devices...117 Troubleshooting and known issues...117 Pacesetter Programmer...118 Hardware connections...118 Performing an import...119 Supported devices...119 Troubleshooting and known issues...119 St. Jude Medical Programmer...119 Saving device data to a floppy from the Programmer...120 Performing an import using removable media (such as floppy disks)...120 Serial cable import...120 Supported devices...121 Troubleshooting and known issues...121 Data export from Paceart to the Programmer...121 Saving the programming information to disk from a patient's Follow-Ups folder...121 Chapter 9: Paceart System Printing...123 Report Queue server...124 Running multiple Report Queue servers...124 Configuring Paceart clients to use the Report Queue sever...124 Configuring the Report Queue server...125 Starting and stopping the Report Queue server...128 Report Queue Server Maintenance...128 Patient Carry card lamination...130 Laminating patient carry cards...130 Troubleshooting Printing...130 Chapter 10: Paceart Web Access...133

vi Paceart System Administrator's Guide Contents Architecture...134 Configurations...135 Common Server Configuration...135 Multiple Server Configuration...136 Multiple Server Configuration with Multiple Report Queue Servers...137 Configuration file: Custom.dat...137 Installation...141 Paceart Web Access security...143 Secured Sockets Layer (SSL)...143 Automatic redirection...144 Custom error handling...144 Account administration...145 SQL Server login...146 Requesting passwords...146 Changing user passwords...147 Monitoring services and limiting access to reports...147 Chapter 11: CardioVoice TTM Assistant...149 Installation requirements...150 CardioVoice Installation...150 Installing a new 32-bit system...150 Upgrading from a 16-bit system to a 32-bit system...152 CardioVoice Account Management...154 Patient CardioVoice IDs...154 Physician CardioVoice IDs...155 CardioVoice Configuration Options...155 Opening the CardioVoice Configuration Options Window...155 Options Tab...155 Fax Options Tab...156 Prompts Tab...156 Call Script Tab...157 External Notifications...158 Faxing...158 Paging...158 Emailing...158 Patient and Physician Voice Messages...159 Troubleshooting CardioVoice...161 Chapter 12: Paceart Gateway Services...163 Installation requirements...164 Paceart Gateway Services application...164 Paceart System Database tab...164 Remote Acquisition Service tab...165

Paceart System Administrator's Guide Contents vii Local Acquisition Service tab...167 Services Configuration options...169 Enabling the Remote Acquisition service...169 Enabling the Local Acquisition service...169 Services log on...169 Administrative maintenance...170 Windows Event Viewer...170 Configuring the Event Log file size...170 Data Exchange Log Viewer...171 Accessing the Data Exchange Log Viewer...171 Search criteria...171 Buttons...171 Results...172 Troubleshooting...172 Configuring Windows Vista for SessionSync...172 Configuring the Windows firewall...173 "Host not Found" error message...173 Configuring the proxy server...174 Configuring the HTTP SSL service...174 System lockup accompanied by an error dialog from virus checker program...174 Chapter 13: Paceart Export Module...175 Installation...176 Installing the Export Module...176 Configuration...176 Configuring the Export Module global options...176 Event data export...179 Exporting event data...179 Paceart XML Schema Definition (XSD)...179 Troubleshooting...180 Chapter 14: Paceart Satellite Services Client...181 Installing the Paceart Satellite Services client on the terminal server...182 Installing Terminal Services client on workstations...182 Starting a Satellite Services Client session...182 Running Satellite Services in Administrative Mode...182 Logging off sessions...183 Purchasing Satellite Services licenses...183 Appendix A: Appendix A: HIPAA...185 Product use and technical features...186 Potential security exposures...186 Paceart System security features...187

viii Paceart System Administrator's Guide Contents Important notes...190 Additional information...190 Appendix B: Appendix B: Unassisted Update Guide...191 Unassisted Update Guide...192 Before you begin...192 Synchronizing local data with the network database...193 Backing up the Paceart System database...193 Checking the MDAC version information...193 Uninstalling Paceart Gateway Services...194 Deleting Publications from the Server and Subscriptions from Workstations...194 Installing the Paceart System - Get Connected III Edition Software...194 Installing the documentation CD...195 Installing the Paceart System Database Manager software...195 Updating the structure revision level...195 Configuring replication on the publishing server...196 Configuring replication on the subscribing workstation(s)...196 Installing the Paceart System Client...196 Installing Paceart Customer-Specific Configuration software...196 Installing the Paceart Gateway Services software...197 Installing the Connected Systems Gateway...197 Installing the CardioVoice TTM Assistant...198 Installing the Export Module...199 Installing the Paceart Satellite Services client on the terminal server...199 Completing the update...200

Chapter 1 Introduction to the Paceart System Topics: The Paceart System is a clinic management tool that organizes patient, device, and programmer information and provides access to trend analysis, Explanation of symbols aiding a physician or clinician in their evaluation of a patient s condition. Purpose The Paceart System supports cardiac rhythm devices from most Intended Audience manufacturers. Indications You ll find the Paceart System adaptable. You can configure it to meet Precautions your present needs, adding new devices, patients or physicians. It works Contraindications within the processes of varied clinical environments. Paceart authorized users Technical Support The Paceart System supports most cardiac rhythm devices from most manufacturers. So whatever device or programmer you re looking at, you ll see the information presented in a similar way. The Paceart System: Stores programmed device parameters Summarizes patient session data into concise reports Keeps a history of patient device tests Offers TTM technologies, such as CardioVoice, designed to work with pacemaker transmitters and cardiac event recorders Creates correspondence documents Schedules patient follow-up appointments Speeds records processing Assists in charge and billing management Offers integration with your hospital's or clinic's HL7-compatible system Provides import of data from pacemakers, programmers, and other storage media If you have any questions about the contents of this manual or need assistance with your Paceart System, contact Paceart Technical Support.

10 Paceart System Administrator's Guide Introduction to the Paceart System Explanation of symbols Consult instructions for use Conformité Européenne (European Conformity). This symbol means that the device fully complies with European Directive MDD 93/42/EEC. For US audiences only Authorized Representative in the European Community Manufacturer Lot number Reorder number Date of Manufacture Purpose This manual, the Paceart System Administrator's Guide, is intended as a companion to the Paceart System Online Help. This guide deals with the technical aspects of deploying, managing, maintaining, and administrating your Paceart System. Intended Audience The information contained in this manual is intended for: New or advanced Paceart users who are tasked with maintaining their Paceart System. Hospital and clinic information technology staff responsible for administering and maintaining a Paceart System at their hospital or clinic. Medtronic Paceart technical support staff. Indications The Paceart System is intended for use as a 12-lead electrocardiograph, pacemaker artifact analyzer, and transtelephonic ECG receiving station. It also acts as a database for cardiac patients with or without pacemakers or implantable cardioverter defibrillators.

Paceart System Administrator's Guide Introduction to the Paceart System 11 Precautions Storage and installation Avoid moisture or contact with water. Avoid excessive or extreme air pressure. Avoid vibration and mechanical shock while moving. Place on a level floor. Use AC power that corresponds in frequency, voltage, and allowable current capacity. Use the isolation transformer as the source of AC power during in-clinic follow-ups. Use a grounded 3-wire AC power plug. The outside of the Paceart Module can be cleaned with a clean, dry cloth. Use the isolation transformer as the source of AC power and plug it directly into a grounded wall outlet. Use a grounded 3-wire AC power cable to connect the PC to the isolation transformer. Ensure there is no condensed moisture on the Paceart software CD-ROMs. Paceart software CD-ROMs must be stored within the following conditions: Storage Environment Temperature Relative Humidity -20 C to +50 C 5% to 90% System operation Before system operation: Check that the system components are working properly. Check that the cords are connected to the system correctly. Ensure that the system is not being used with other instruments that may result in misdiagnosis or other problems. Check to be sure that there is no damage to the circuitry that connects directly to the patient. Ensure there is no condensed moisture on the Paceart software CD-ROMs. Paceart software CD-ROMs must be operating in an environment within the following conditions: Operating Environment Temperature Relative Humiditiy -25 C to +70 C 10% to 95% During system operation: Maintain constant observation of the patient to ensure that significant events are detected immediately. The system can be switched off when necessary to ensure the patient's safety. After system operation: The system and all the accessories should be carefully cleaned after use to prepare them for the next session. Additional precautions Do not modify the original system in any way. This includes adding any software product.

12 Paceart System Administrator's Guide Introduction to the Paceart System The system and its components should undergo regular maintenance inspections. If the system is stored for a long period of time without use, make sure that the system is in perfect condition prior to operation. Use only ECG disposable electrodes in proper working condition. Use electrode gel or electrolytic pads to ensure that good electrode contact is obtained. Ensure that the proper lead colors are connected to the correct electrode sets. Do not use the equipment in an explosive atmosphere. Do not use liquid on top of the equipment. Ensure that all patient records are updated and permanently stored before turning the PC power off. Do not use the instrument in an environment with excessive temperature and humidity. Double-check the data before typing the data into the system. Call customer service or your biomedical department for service and repairs. Ensure that the report to be printed reflects the proper leads. The operator selects which leads will be shown in the printed report. The operator should not touch the computer and patient simultaneously when the patient is connected to the ECG electrodes. ECG electrodes should not contact other conductive parts, including earth. The Paceart ECG module is not suitable for direct cardiac applications. Transmission and transmitter settings The transmitter transmission speed must match the transmit speed setting in Paceart. The transmitter transmit format must match the transmit format setting in Paceart. Discrepancies between the transmission speed or the transmission format will result in incorrect measurements that may lead to incorrect ECG interpretations. The Date Given field must have a date that is the same or prior to the date the transmission is recorded. A patient may only have one active transmitter. The Paceart operator is responsible for setting the speed and format settings. ECG noise The following may cause noise affecting artificial pacemaker spikes: Pacemaker programmers Poor electrode contact Electrical interference due to grounding problems Caution: Make sure that the PC used to record pacemaker clinic ECGs is connected to AC power using an isolation transformer and a grounded three-wire power cable. Contraindications No known contraindications. Paceart authorized users Medtronic representatives provide the Paceart System orientation and training materials at the time of the installation. All users should be familiar with the Paceart documents, including the online Help, before using

Paceart System Administrator's Guide Introduction to the Paceart System 13 the Paceart System. The designated system administrator should also read the Paceart System Administrator's Guide for information on using the Paceart System software user interface for function and control. An authorized person, preferably a physician, must verify the implantable device and electrode specifications entered into the database or modified in the database. An authorized person, preferably a physician, must verify the test results that are automatically entered into the database by the instrument. The data obtained from this device must be interpreted in conjunction with other clinical data and the results of other independent tests. Technical Support For technical support contact your local Medtronic office. In the US and Canada, call 1-800-PACEART.

Chapter 2 Preparing for Paceart Topics: The intent of this chapter is to help you as a system administrator prepare for an installation of the Paceart System at your site. It should answer Minimum requirements many of the questions you may have about how the Paceart System can Database utilize your existing network infrastructure. This chapter should also help Network bandwidth requirements you decide the preparations you will need to make for deploying the Configurations Paceart System.

16 Paceart System Administrator's Guide Preparing for Paceart Minimum requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. Power Distribution An isolation transformer is required on all Paceart Systems on which you will be performing in-clinic ECG acquisitions. If you are using a laptop computer, an isolation transformer is needed if the laptop or any device connected to the laptop is acquiring power from a wall outlet. Connect the Paceart computer, printer, monitor, Paceart modules (if using the external AC power adapter), and any additional AC-powered equipment that you have connected to the Paceart computer directly to the isolation transformer. Contact Paceart Technical Support if you need to purchase isolation transformers. Database Which version of SQL server? The Paceart System uses a Microsoft SQL Server database for the storage of data. Paceart will run against any of the 32-bit editions of SQL Server 2000, 2005, and 2008. This includes the MSDE Edition of SQL Server 2000 and the Express editions of SQL Server 2005 and 2008, provided the conditions listed under Full editions vs. Express are met. SQL Express and MSDE cannot be used as publishers in a replicated environment. Full editions vs. Express The express editions are a limited version of SQL Server. They are limited to 4 GB of data storage and are optimized for a low number of concurrent users. Because of these limitations, the Paceart System restricts the scenarios where Express editions can be deployed with the Paceart System. If you meet all three of the following conditions, the Paceart System allows you to use an Express edition: You will store less than 4 GB of data. You will have no more than two client workstations. You will not be performing replication. If you exceed any of the above conditions, a full edition of SQL Server is required. Note: MSDE 2000 has a limit of 2 GB. If you have been using MSDE 2000, you may wish to upgrade to SQL Server 2008 Express to avoid hitting this limit. SQL Server 2008 Express is provided on the installation CD. Note: The client and server do not need to be installed on separate computers. Replication If your deployment will utilize SQL Server replication, your publishing server must have either the Enterprise or Standard edition of SQL Server installed. Your Paceart System workstations that will be participating in database replication as subscribers also require their own local version of Microsoft SQL Server. SQL Server Express and MSDE cannot be used as publishers in a replicated environment.

Paceart System Administrator's Guide Preparing for Paceart 17 SQL Server licensing Depending on the configuration selected for your installation, the cost of SQL Server licenses will vary. SQL Server 2008 Express is provided on the installation CD, and can be used without the need to purchase a SQL Server license. Full editions of SQL Server require the purchase of a license or licenses. If you require SQL Server licenses, contact your Paceart Sales Representative. If your computers will be configured by Medtronic Paceart staff, and you are not purchasing SQL Server through Medtronic Paceart, ensure that all licenses and installation media are available for the Paceart Technical Service Specialist performing your installation. Determining Database Size The majority of the database is composed of ECG data, programmer data transfers, and auditing. When determining the size of the database, you must estimate the number of patients that will be maintained in the database, the number of seconds of ECG stored per follow-up, and if you will be utilizing the programmer data import or auditing features. Paceart estimates that the average transtelephonic recording requires 150 bytes / second. The average clinical ECG recording requires 250 to 300 bytes / second. 1. To compute an estimate of the average growth of your database size each year, complete the following: a) Enter the average length of clinic follow-up ECG recordings: a= Seconds b) Enter the average length of Pacemaker TTM follow-up ECG recordings: b= Seconds c) Enter the average length of Arrhythmia TTM follow-up ECG recordings: c= Seconds d) Enter the average number of clinic follow-ups per day: d= Follow-ups e) Enter the average number of Pacemaker TTM follow-ups per day: e= Follow-ups f) Enter the average number of Arrhythmia TTM follow-ups per day: f= Follow-ups g) Enter the number of days follow-ups performed each year: g= Days h) Will you transfer data from programmers for clinic follow-ups? If yes, h= 25000. If no, h=0 i) Will you utilize the Auditing feature of the Paceart database? If yes, i=2 If no, i=1 2. Enter your numbers in the following formula and compute: Bytes per year = G*I(275*A*D)+(H*D)+(150*B*E)+(150*C*F) 3. Use the formula's result to calculate the following estimates: Divide Bytes per year by 1,024 to find your estimated growth in kilobytes divide Bytes per year 1,048,576 to find your estimated growth in megabytes divide Bytes per year by 12 to find your estimated average monthly growth divide Bytes per year by 4 to find your estimated average quarterly growth.

18 Paceart System Administrator's Guide Preparing for Paceart Note: These numbers should only be used as rough estimates as you determine your disk storage space needs. As new features are released for the Paceart System, these features may require additional disk space that is not accounted for in this formula. The Paceart Database Manager provides the option of deleting patients and ECG strips from your Paceart database to maintain the size of the database. You can delete patients based on their status code or affiliation code. You can delete ECG strips based on their recorded date, size, or type. Note: The option to delete patients is only available in Paceart System Database Manager version 3.30 and greater. If you have a license for the full edition (Enterprise or Standard) of SQL Server, you can maintain the size of your database by using tools in SQL Server Enterprise Manager. For more information, consult SQL Server Books Online or Paceart Technical Support. Data migration The Paceart System comes with utilities for migrating legacy data that is contained in 16-bit versions of the Paceart System. Paceart may also be able to migrate data from your existing computerized systems, including your legacy test data systems, scheduling systems, or billing systems. This data can include: Legacy arrhythmia monitoring data Legacy TTM data Legacy ICD and pacemaker follow-up data Patient demographic data Doctor demographic data Event recorder, pacemaker, ICD, or lead device data Paceart may be able to migrate some or all of your legacy data, including migration from other competitor's data or third party electronic medical record systems. Contact your Paceart Sales Representative if you wish to have a data migration consultation. Security As you plan a Paceart System installation, you will also have to consider the type and level of security you wish to implement. The Paceart System builds upon existing Microsoft security models. You can choose to use Windows authentication or SQL Server authentication with your Paceart System. Note: If your operating system is Windows Vista, then you must use Windows authentication. Another feature of the Paceart System is the ability to add role-based access to your Paceart data. You can set up roles to grant or deny permissions to users or groups of users to different types of Paceart data. Note: Role-based security is only available with Paceart Systems version 3.30 and greater. Network bandwidth requirements If you will be running your Paceart System in a client-server configuration on multiple machines, you must consider network bandwidth requirements. A minimum 384 Kbps link should be used for the Paceart System, running over a networked environment such as a WAN. This bandwidth will allow you to view ECG strips and achieve reasonable interactive synchronization times. All bandwidth recommendations are based on past experience with other Paceart installations. You should estimate the amount of data that will need to be stored and maintained at any one time to help estimate bandwidth requirements for use with replication to ensure that initialization of subscriptions and ongoing replication can be performed in a reasonable amount of time.

Paceart System Administrator's Guide Preparing for Paceart 19 Determining reasonable response times can be very subjective. What may be acceptable for one user or for one type of application may not work for other users or applications. Example Replicating clinic follow-up ECG strips The following example should give you a good method for determining the amount of bandwidth that your Paceart System will require. You have just performed 10 clinic follow-ups at a remote clinic, and you want to synchronize your data with the central database at your central clinic. For each follow-up, you recorded an average of 30 seconds of ECG. This means that you have 5 minutes of ECG to transmit, or about 81 kilobytes (645 kilobits) of data. To send 645 kilobits of data at 384 Kbps, it would take you approximately 1.7 seconds. At 128 Kbps (Dual ISDN), it would take approximately 5 seconds. If you were to transmit over a 56 Kbps modem, it would take approximately 12 seconds. Estimating transmission time The following table can be used to estimate the transmission time for a given amount of in-clinic ECG across a particular network bandwidth, assuming you will be utilizing the entire bandwidth. Amount of Data 56k Modem Dual ISDN 384 Kbps T1 10Base-T Ethernet T3 30 sec 1.2 sec 0.52 sec 0.17 sec 0.04 sec 0.006 sec 0.001 sec 1 min 2.4 sec 1 sec 0.34 sec 0.09 sec 0.01 sec 0.003 sec 5 min 12 sec 5.2 sec 1.7 sec 0.43 sec 0.07 sec 0.015 sec 10 min 24 sec 10 sec 3.4 sec 0.85 sec 0.13 sec 0.030 sec 30 min 1.2 min 31 sec 10 sec 2.6 sec 0.40 sec 0.089 sec 1 hr 2.4 min 62 sec 21 sec 5.1 sec 0.80 sec 0.17 sec Configurations The Paceart System can be configured in multiple ways to support the needs of each installation. When deciding on the configuration most appropriate for your installation, you must take the following items into consideration: Number of clinical ECG-acquisition stations needed Number of TTM-acquisition stations needed Number of data entry terminals needed Availability of a local area network (LAN) and support Availability of a wide area network (WAN) and support Need for multiple geographic locations Number of places and locations for report retrieval Need for 24/7 TTM-acquisition Need for remote, disconnected data access Paceart System is scalable and configurable, providing a number of options to best suit your installation.

20 Paceart System Administrator's Guide Preparing for Paceart Stand-alone Paceart workstation/server This scenario is the most basic and most limited Paceart System configuration option. It involves a single computer, with no network connection, running both the Paceart server and client software. Paceart Hardware, such as the 12-Lead ECG/TTM ECG Module for in-clinic and transtelephonic ECG acquisition, or the Paceart Sound Card Interface for transtelephonic-only ECG acquisition, is added to capture ECG signals. This configuration most likely will not need a full version of SQL Server, because an Express edition will suffice. The only time a full version of SQL Server would be required is if the database would need to store more than 4 GB of data. Master SQL server only, single database Description This scenario is the most typical Paceart System scenario in use today. In this scenario, there is one Paceart Server with a single SQL Server database containing the data from all of the workstations. These workstations could be all within the same facility, sending the data across a local area network (LAN) or in different geographies, sending data on a wide area network (WAN). Complexity This configuration has a low degree of complexity. There is only one database to maintain, and no replication is needed. Pros Centralized security and maintenance at the master location, including a central repository for backups. For server software upgrades, only one database needs to be updated if the database structure changes during a Paceart System upgrade. All patient data is stored in one database and is accessible from any location on the LAN or WAN. Cons No local copy of data at local locations if LAN or WAN fails. Higher bandwidth requirements as individual locations will be saving all data, including large ECG strips, across the LAN or WAN. Client software upgrades must be upgraded across multiple locations simultaneously if the database structure changes. Queries must contain extra criteria if remote locations only wish to see local patients. Lookup tables will contain information from all locations and will require special maintenance to ensure uniform data entry.

Paceart System Administrator's Guide Preparing for Paceart 21 Diagram Figure 1: Master SQL Server and a single Paceart Database Master SQL server only, multiple databases Description In this scenario, there is one Paceart Server running an instance of SQL Server that has multiple databases, one for each department or remote location. Each workstation can be configured to connect to any of the databases on the Paceart Server over the LAN or WAN. This scenario is not typically used. The most common reason for implementing it is to segregate patient populations for confidentiality purposes. Often, monitoring services will use this scenario with their Paceart System to keep separate databases for separate clients. Complexity This configuration has a low degree of complexity. There are multiple databases to maintain, but all databases are located at a single site, meaning no replication. Users can set up shortcuts to access each database from each workstation. Pros Centralized security and maintenance at the master location, including a central repository for backups. If the database structure changes during a Paceart System upgrade, individual workstations can update their client software at convenient times, and database structure changes can be applied separately to each database at convenient times. Autonomy of data entry at each location. Each location can maintain separate lookup tables. Extra filter criteria are not needed to generate queries and reports for one department or remote locations. Cons No local copy of data on the workstation if LAN or WAN fails. Higher bandwidth requirements, as individual locations will be saving all data, including large ECG strips, across the LAN or WAN. If the database structure changes during a Paceart System upgrade, a workstation will not be able to access data in the other databases until all database structures have been upgraded to the same revision level. No ability to perform queries and reports across multiple databases.

22 Paceart System Administrator's Guide Preparing for Paceart If a patient moves from one remote location to another, their history will need to be manually re-entered into the new database. Diagram Figure 2: Master SQL Server and multiple databases Master and local SQL servers, single database, full publication Description This is the first scenario where we introduce replication. In this scenario, there is a master Paceart Server running an instance of SQL Server with a single database. This database contains all of the data from all of the remote locations. Each remote location has its own local Paceart Server running an instance of SQL Server with a single database. This database contains a replicated copy of all of the data from the master database. Workstations at the remote locations would run against their local SQL Server database. The remote databases would synchronize with the master database on a scheduled basis. This scenario is one that is commonly used by Paceart customers who wish to use replication. For example, a customer may have a satellite clinic with no high-speed WAN connection to the central clinic. They want to work off a local copy of the Paceart database and connect only occasionally to the master database to synchronize changes. They can do this by setting up replication between the satellite clinic(s) and the central office. Complexity This configuration introduces a high degree of complexity. Replication must be used, which increases the complexity of software upgrades when there is a database structure change. However, it is the simplest replication configuration as only one publication is created that serves all subscribers. Pros Centralized maintenance at the master location, including a central repository for backups. Local copy of data at all remote locations in the event of WAN failure. Only one database needs to be updated at each location if the database structure changes during a Paceart System upgrade.

Paceart System Administrator's Guide Preparing for Paceart 23 All patient data is stored in one database. If patients move from one remote location to another, they can be found automatically at the new location. Queries of data can be done easily across all locations. Cons If security is desired, security information must be maintained at each location. Higher bandwidth requirements, as all remote locations must replicate their data, including large ECG strips, across the WAN. If the database structure changes during a Paceart System upgrade, all remote locations will need to update all software simultaneously to access the new database. If the change is a major structure change, replication will need to be removed before the update is made and re-established after the update. Queries and reports for individual remote locations will need extra criteria to filter for patients only at that location. Lookup tables will be combined for all locations and will require special maintenance to ensure uniform data entry. Diagram Figure 3: Master and local SQL Servers, a single database, and full publication Master and local SQL servers, single database, filtered publication Description In this scenario, there is a master Paceart Server running an instance of SQL Server with a single database. This database contains the data from all of the remote locations. Each remote location has its own local Paceart Server running an instance of SQL Server with a single database. However, instead of having a complete copy of all of the data on the master database, only a portion of the data is replicated to the remote location. With a copy of only its own patients from the single database on the master SQL Server. Workstations at the remote locations would run against their local SQL Server database. The remote databases would synchronize with the master database on a scheduled basis. This scenario is very similar to the Master and Local SQL Servers, Single Database, Full Publication scenario. The difference is that separate publications for each remote location will be created on the master SQL Server. Separate publications are created to reduce the amount of data that needs to be transferred between sites. This reduces network bandwidth requirements while still giving the flexibility of having all patient data stored

24 Paceart System Administrator's Guide Preparing for Paceart in the same database at a master location. Many filters can be created on the publication, including limiting the amount of ECG data that is published or filtering the patients that are published to each location. Complexity This configuration introduces a high degree of complexity. Replication must be used, which increases the complexity of software upgrades when the database structure changes. It also requires the creation and maintenance of multiple publications and subscriptions. Pros Centralized maintenance at the master location, including a central repository for backups. Better delegates what data is published to meet your subscriber needs. Lower network bandwidth requirements since only a subset of the data is replicated across the WAN. Each remote site has a copy of their data in the event of WAN failure. Only one database needs to be updated at each location if the database structure changes during a Paceart System upgrade. All patient data is stored in a single, master database. If a patient moves from one location to another, the patient's affiliation code can be changed. After synchronizations are performed, the patient's data will be transferred to the new location. Queries of data can be done easily across all locations. Cons If security is desired, security information must be maintained at each location. If the database structure changes for a particular software upgrade, all remote locations will need to update all software simultaneously to access the new database. If the change is a major structure change, replication will need to be removed before the update is made and re-established after the update. Queries and reports for individual remote locations will need extra criteria to filter for patients only at that location, if run from the master database. Lookup tables will be combined for all locations and will require special maintenance to ensure uniform data entry. Diagram

Paceart System Administrator's Guide Preparing for Paceart 25 Figure 4: Master and Local SQL Servers, a single database, and filtered publication Master and local SQL servers, multiple databases Description This scenario is not used very often. In this scenario, there is a master Paceart Server running an instance of SQL Server with multiple databases, one for each remote location. Each remote location has its own local Paceart Server running an instance of SQL Server, which would contain a replicated copy of the database specific to that location. Workstations at the remote locations would run against their local SQL Server database. The remote databases would synchronize with their counterpart database on the master SQL Server on a scheduled basis. If a particular remote location needs to review data from another remote location, they can connect to the desired database on the master SQL Server using the WAN. Complexity This configuration presents the highest degree of complexity. Replication must be used, which increases the complexity of software upgrades when there is a database structure change. A publication is needed for each database on the master SQL Server, and a subscription is needed on each remote database. Users can create shortcuts to access either the local database or remote master databases on their workstations. Pros Centralized maintenance at the master location, including a central repository for backups. Lower bandwidth requirement due to the fact that only patient data for a single site must be replicated across the WAN. Local copy of data at all remote locations in the event of WAN failure. If the database structure changes during a Paceart System upgrade, individual locations can update their database structure and client software as time allows. Autonomy of data at each location. Each location can maintain separate lookup tables and will not need extra filter criteria to generate queries and reports for their patients. Cons If security is desired, security information must be maintained at each location. If the database structure changes during a Paceart System upgrade, a location will not be able to access other locations' data until all databases are brought to the same structure revision level. Multiple databases will need to be updated at the master location. No ability to perform queries and reports across databases from all locations. If a patient moves from one location to another, their data will need to be manually re-entered.

26 Paceart System Administrator's Guide Preparing for Paceart Diagram Figure 5: Master and Local SQL Servers and multiple databases Local SQL servers only, multiple databases Description This scenario is not frequently used. In this scenario, there is a local Paceart Server running an instance of SQL Server at each individual remote location with one database. This database contains patient data only for that particular location. Workstations at each location would work against their local SQL Server. If a particular location needs to review data from another remote location, they would connect to the remote location's database on the remote location's SQL Server via the WAN. Complexity This configuration presents a medium degree of complexity. Multiple databases need to be maintained, but maintenance can be delegated to individual locations. No replication is used. Users will need shortcuts to access the database at all locations. Individual SQL Servers need to be addressable from all other SQL Servers to give access at all locations. Pros Autonomy of maintenance at each location. Individual remote locations can determine backup and maintenance schedules. Low bandwidth requirement due to the fact that the majority of data access is performed locally, with only infrequent requests being sent over the WAN. Local copy of an individual remote location's data in the event of a WAN failure. If the database structure changes during a Paceart System upgrade, individual locations can update their database structure and client software as time allows. Autonomy of data entry at each location. Each location can maintain separate lookup tables and will not need extra filter criteria to generate queries and reports for their patients.

Paceart System Administrator's Guide Preparing for Paceart 27 Cons If security is desired, security information must be maintained at each location. If the database structure changes during a Paceart System upgrade, a location will not be able to access other locations' data until they are brought up to the same structure revision level. No ability to perform queries and reports across databases from all locations. If a patient moves from one remote location to another, their data will need to be manually re-entered. Diagram Figure 6: Local SQL Servers only and multiple databases

Chapter 3 Paceart System Installation Topics: This section describes the installation process for the Paceart System. Call Paceart Technical Support at 1-800-PACEART before attempting AutoRun window any installation or reinstallation. Reinstalling and the copying of the Paceart Paceart System server installation System software may breach your end-user license agreement. Paceart System client installation The Paceart System is divided into two required modules: Global configuration options overview The server component Local configuration options The client component overview The server component performs several database tasks, including the Paceart Device Update CD Troubleshooting creation of a Paceart System database for information storage, conversion of databases from Paceart System16-bit versions, and all tasks required for replication of a Paceart System database. The client component allows you to access any Paceart System Database via a graphical user interface. Optional modules can also be installed. CardioVoice TTM Assistant Paceart Web Access Paceart Export Module Paceart Gateway Services Connected Systems Gateway Satellite Services The installation instructions for the optional modules are contained in each module's respective chapter or the documentation provided with the software CDs.

30 Paceart System Administrator's Guide Paceart System Installation AutoRun window The Paceart System Installation autorun window will appear when you insert your Paceart System installation CD into your computer. Note: If this screen does not appear, AutoRun has been disabled for your CD or DVD drive. You can manually bring up the window by clicking Autorun.exe on the Paceart System installation CD. From this window, you can select from the following options: Install Client Components: Starts the Paceart System client installation. Install Server Components: Starts the Paceart System server installation. View ReadMe: Displays the ReadMe.txt file, which contains installation notes. Browse CD: Displays the contents of the CD in Windows Explorer. Exit: Closes the window. Paceart System server installation The Paceart System server installation will install all necessary components for a local Paceart System database. The Paceart System server requires that a version of the Microsoft SQL Server database be installed (although not necessarily on the same computer). The main component installed by the Paceart System server installation is the Paceart Database Manager. By default, no empty or sample database is initially created with the Paceart System Server Installation. The initial Paceart System database must be created using the Paceart Database Manager. For customers upgrading from a 16-bit version, the Paceart Database Manager includes a utility to convert data from a Paceart System 16-bit database into a Paceart System 2000 database. You can run this utility after you perform the Paceart System Server Installation. Not every computer in your Paceart System deployment will need the Paceart System server installed. The Paceart System server installation must be performed on at least one computer in your Paceart network to give you the ability to create a Paceart System database. Medtronic Paceart recommends that the Paceart System server software is installed on every computer running an SQL Server with a Paceart database. In some deployments, this is the central server. In deployments with replication, this would be the publisher server and all subscribing servers. However, Medtronic Paceart does not require you to install the server software on your SQL Server if your deployment policies prohibit you from doing this. The Paceart Database Manager is able to connect remotely to an SQL Server. All that is required is that you install the Paceart System server software on a computer that has network connectivity to all SQL Servers hosting Paceart databases in your deployment. Installation requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. Notes for users of Paceart System 16-bit software Data storage In the 16-bit version of the Paceart System, database storage was done with Microsoft Access. Data was stored in an Access database file called CPTSFile.mdb. The MDB file limited data storage to 2 GB. The 16-bit version

Paceart System Administrator's Guide Paceart System Installation 31 also gave the option of storing ECG data separately from all other patient data in a binary file called Strips.dat, which was also limited to 2GB of data. The current Paceart System database storage is performed with Microsoft SQL Server, and ECG data is stored together with all other patient data in a single database. Move program In the 16-bit version of the Paceart System, data could be stored in separate databases on several different computers and merged together periodically via one of several different proprietary move programs, e.g., via a LAN or via Symantec pcanywhere. With the current Paceart System, the same effect is achieved using SQL Server's built-in replication technology. Utilities are provided in the Paceart Database Manager to set up replication on both the server (publisher) and the client (subscriber). Any computer participating in replication must have the Paceart System Server installation performed on it. Installing the Paceart System server Close all Paceart software and any other running programs on your server before starting an installation. Note: If you are using Windows Vista, you must select Do not install the MSDE on this computer. 1. Run the setup.exe program located in the Paceart System Server directory on your Paceart System CD. This will start the Paceart Database Manager setup program. 2. Click Next. 3. You may choose to use the default destination folder (recommended), or click Browse to choose a different destination folder. 4. Click Next. 5. If you do not have a version of SQL Server installed on the computer, the Microsoft Desktop Engine Installation Required window will appear. Read the message and click Next. 6. On the Choose Microsoft Desktop Engine Installation Location window, you must select the version of the Microsoft SQL Server Desktop Engine you would like to install. If you select SQL Server 2000 Compatible the Microsoft SQL Server 2000 Desktop Engine (MSDE 2000) will be installed. If you do not wish to install the MSDE, select Do not install the MSDE on this computer. You should select this option if your system is using Windows Vista or you will be using a full version of SQL Server. 7. Click Browse if you want to change the default installation program and data folders. 8. Click Next after you have selected the correct version of MSDE and installation folders. 9. If you will be using replication in your Paceart System configuration, specify an account for your SQL Server services to use. 10. Read through the windows, then click Next. Note: If the MSDE installation prompts you to reboot the computer, wait until the Paceart System Server installation has completed before rebooting your computer. 11. Click Finish to exit the installation. If you were prompted to reboot the computer during the installation, you may restart now. After completing the server installation, you will need to create a Paceart Database.

32 Paceart System Administrator's Guide Paceart System Installation Paceart System client installation The Paceart System Client installation must be run on all of your Paceart workstations. This will install the Paceart System client application containing the client user interface, including data entry forms and data reporting. Installation requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. Notes for users of Paceart System 16-bit software Program file In the 16-bit version of the Paceart System, all forms, reports, and utilities that you run are contained in a Microsoft Access database named WinCPTS.mdb. In addition, ECG acquisition and playback was done using two different Visual Basic executables, WinTTM.exe and WinECG.exe. With the Paceart System, all graphical user interface elements, including those used for ECG acquisition and playback, are contained in a Microsoft Access database project called WinCPTS 2000.adp. Installing the Paceart System Client Close all Paceart software before starting an installation. 1. Select Install Client Components from the main menu that appears when you insert the Paceart installation CD in your CD drive. If the menu does not automatically appear, run Autorun.exe on the CD. 2. This will start the Paceart System client application setup program. Click Next. 3. You may choose to use the default destination folder (recommended), or click Browse to choose a different destination folder. 4. Click Next. 5. The Choose Parallel Port Module window will appear. If this Paceart System client computer will ever use a Paceart Parallel Port module for ECG acquisition, select This computer will use a parallel module on port and select the parallel port in the drop-down list that the module will use. If the computer will be using a Paceart USB Module or not using a module, select This computer will not use a parallel port module. 6. Click Next. 7. The Paceart System client application is ready to be installed. If you need to make any modifications to your previous selections, click Back. Otherwise, click Next to continue. 8. When the Paceart System Client Installation is complete, click Finish to exit the installation. 9. If you receive a message to restart, click OK to restart the computer and complete the installation. Starting the Paceart System client for the first time To start the Paceart System client application for the first time, power on the workstation. If you are using external Paceart hardware, make sure that the hardware is turned on and connected before turning the computer on. The computer will boot to the Windows desktop. Click the Paceart System icon on the desktop to start the Paceart System.

Paceart System Administrator's Guide Paceart System Installation 33 Figure 7: Paceart System icon The login screen will prompt you to enter login profile, operator name, and password. Figure 8: Paceart System login window The Login Profile Manager is accessed by clicking the System main screen will appear. button. After passing authentication, the Paceart Global configuration options overview The Paceart System client has Global configuration options that you can modify. Global configuration options are stored in your Paceart database and are used by all Paceart System clients that connect to the database and that use the same configuration. Because Global configurations are stored in the database, they can be set once and used by all Paceart System users. From the Configurations tab, you can maintain and modify different global configuration profiles and select which configuration profile to use. From the Report Options tab, you can change the report heading, letter closing, Physician signature label, graphing options, PaceCard options, and enable signature graphics. From the E-mail Options tab, you can configure the email option, the email message, and the HIPAA disclaimer. From the Fax Options tab, you can configure the cover page and HIPAA disclaimer. From the HIPAA tab, you can configure the default HIPAA disclaimer. From the Miscellaneous 1 tab, you can configure customer-specific configuration files and other miscellaneous settings. From the Miscellaneous 2 tab, you can configure Patient CardioVoice ID defaults, Report Queue options, and Card Guard Event Recorder options.

34 Paceart System Administrator's Guide Paceart System Installation If you have the Paceart Export Module installed you have the Export Options tab. From this tab you can configure the default export status, the file location, and other export options. Accessing the Global configuration options 1. Click the Main tab, then click the Utilities tab from the Paceart System main screen. 2. Select the Tools folder, click Global configuration options, and then click Open. The Global Configuration Options window appears. Creating a new global configuration Global configuration options can be set once and automatically stored in your Paceart database. The configurations are used by all Paceart System clients that connect to the database. All changes made to the global configuration options are saved under a configuration profile. The initial configuration is the Default profile. You may add new configurations (profiles) for satellite or internal clinics with more than one location and/or workstation. 1. Click the Configurations tab. 2. Click Add. 3. Enter a name for the new configuration and click OK. 4. At the prompt, enter the name of an existing configuration from which you want to pre-load values. Then click OK. 5. With the new configuration highlighted, enter the appropriate changes on each tab within the global configuration option. 6. Click Save. Note: Use the Rename button to change the name of an existing configuration. The Delete button allows you to delete the selected configuration. Report options The Report Options tab is used to set up or change global report headings, letter closings, physician signature labels, graphing options, PaceCard options, and to enable e-signatures. The boxes on the Report Options menu are described below. Report Heading Letter Closing Physician Signature Label Graphing Options The Report Heading box is used to enter the information that you want to display at the top of each report. The Letter Closing box is used to enter information that you wish to print on the last two lines on specific letters or reports. The Physician Signature Label applies to TTM reports only. This is used to customize the label that precedes signature lines that allow for a physician signature. The Graphing Options menu provides options for setting the minimum and maximum number of months displayed on all graphs. If the Prefer fixed duration for threshold graphs option is selected, the y-axis on capture threshold graphs will default to voltage as opposed to duration, if no variation in either variable

Paceart System Administrator's Guide Paceart System Installation 35 PaceCard Options Signature can be found across the patient's test history. The variable not used for the y-axis, either voltage or duration, will be displayed in the graph title. However, if the Paceart System can determine whether duration or voltage was held constant across the patient's test history, the y-axis will use the parameter that varied among the tests and place the constant value in the graph title. Select Prefer fixed duration for threshold graphs when the duration and amplitude are equal. The PaceCard Options are used to make fine adjustments to printing offsets to correctly align PaceCards on the bottom of 8.5" x 11" letter reports. Select Enable Signature to indicate to the system that a signature graphic can be placed on the report for a follow-up physician. This option must be selected to make use of digital signatures. E-mail options The E-mail Options tab contains settings for emailing reports directly from your local system. In order to email reports from your Paceart System, you must have an email program installed along with a connection to an outgoing email server. With your Paceart System, you can choose to email directly from your local system, or have all of your clients send their requests to a Paceart Report Queue Server that will send the email. If you wish to send email directly from your local computer, choose the Paceart E-mail driver output device. If you wish to send email through a Paceart Report Queue Server, use the Paceart E-mail server output device. Configuration Message HIPAA Disclaimer The Configuration option allows you to enable or disable the email option by clicking the Enable e-mail option check box. The Message option contains two text boxes that can be filled in with text to place as the default body and footer of the message The HIPAA Disclaimer option allows you to use a default HIPAA disclaimer or specify a custom disclaimer. Fax options Cover Page HIPAA Disclaimer The Cover Page option allows you to use either a simple cover page or specify a custom page by selecting a file using the browse function. The HIPAA Disclaimer option allows you to specify a default disclaimer or specify a custom disclaimer. Miscellaneous 1 Path & DB name The button is used to search for the path to the appropriate customization.mdb file. Customization files contain customer requested modifications to the Paceart System.

36 Paceart System Administrator's Guide Paceart System Installation Maximum ECG length (TTM) Maximum ECG length (Clinic) Multiple text lookup formatting Max number of patients displayed Disable billing screens Idle minutes before AutoLockout Save projected appointments Enable Elapsed Time Detection when saving variable size ECG strips Pre-fill Brady and Tachy programming data automatically Require user to unlock patients before editing Number of days before considering remote follow-up appointments as missed This option allows you to select the maximum transtelephonic ECG recording from 7.5, 15, 30, and 60 minutes. The default value is 30 minutes. The maximum length is 60 minutes. This option allows you to select the maximum in-clinic ECG recording from 4, 8, 16, or 32 minutes. The default value is 32 minutes. Text lookups can be inserted into various boxes (for example, commentary boxes) by pressing the F9 key. When adding multiple comments, use this option to Keep lookups on the same line, Start additional lookups on the next line, or Skip a blank line between lookups. Any number between 1 and 5 is valid to specify the maximum number of patients that can be open at one time in the Paceart System. The default is 0, which allows up to 5 concurrent patient records to be open. Billing is enabled by default. Use this option to turn off all billing features AutoLockout is set to 0 (disabled) by default. A user is logged out of the system if no mouse or keyboard movement occurs during the number of minutes that are set in this box. AutoLockout can be set from 1 to 180 minutes. Projected appointments are not saved by default. Run the "Projected Schedule Report" to save projected appointments under the Schedule tab. Elapsed time detection is enabled by default. Use this option to store ECG strips by the date and time they were recorded by the patient, as opposed to received by the Paceart System. This feature is only available on event recorders that support the elapsed time feature. This is also the date and time that appear on the Multi-Lead report. If your event recorders do not have this feature, leave this option disabled. This feature is off by default. Select the check box to automatically fill-in Pacemaker and ICD clinic follow-up data with the device programming data from the previous test. This feature is off by default. This feature can be used to prevent users from accidentally making changes to all data entry forms within a saved patient record. In order to make changes to a patient record, you must select the Lock/Unlock Patient button on the menu bar. The default value is 0, and appointments appear as missed if they are not fulfilled by midnight of the day they are scheduled. This value is used to set the amount of elapsed time before a remote follow-up

Paceart System Administrator's Guide Paceart System Installation 37 Enforce patient ID number uniqueness appointment is set to missed as well as affecting the scheduling letters. The default value is off. This option is used to prevent duplicate patient ID numbers. If the Paceart System in your clinic or hospital is integrated with another HL7 HIS or EMR system, you must select this check box to enforce patient number uniqueness. Miscellaneous 2 The Miscellaneous 2 tab is used to set CardioVoice ID number defaults, Report Queue defaults, and Card Guard Event Recorder defaults. Patient CardioVoice ID Default This option allows you to set the default method for assigning CardioVoice IDs. IDs can be set to use the last x digits of the primary phone # where x is the number of digits in the Patient s Phone 1 on the Patient demographics screen, or use the last 10 digits of the Patient ID. If you do not wish to have a default CardioVoice ID created, select Do not default patients CardioVoice IDs. Note: CardioVoice is a separately purchased software option. Report Queue Card Guard Event Recorders Save only the ECG data Embed Elapsed Time Markers This option contains check boxes to Enable Print Server, Enable Fax Server, and Enable E-mail Server. By default, these report queue servers are disabled. Select Enable Print Server to allow client computers to send reports to a designated print server instead of directly to a printer. Select Enable Fax Server to send reports to a fax server. Select Enable E-mail Server to send an email to a designated email server. This section provides configuration options specific to receiving ECGs from event recorders manufactured by Card Guard. When this option is enabled, it will create a strip with the comment Original cardiogram x Event(s) ECG data only, where x indicates the number of events in the strip. This strip will contain only the ECG data will all calibration signals removed. The original strip, including the calibration signals, will also be saved to allow for future re-parsing of the strip. This option allows you to automatically insert an elapsed time marker into transmissions sent from Card Guard event recorders. These event recorders do not have elapsed time markers included in their transmissions, but rather send this data as part of the FSK digital data. When this feature is enabled, saved Card Guard strips will have an elapsed time marker inserted into the ECG, signifying the time that the record button was pressed on the event recorder by the patient. The elapsed time marker looks very similar to those sent by Instromedix event recorders. Note: Refer to the Paceart Technical Requirements document for specific software requirements for these options.

38 Paceart System Administrator's Guide Paceart System Installation Export options If you have installed the Paceart Export Module, an additional Export Options tab is displayed in the Global Configuration Options window. Local configuration options overview The Paceart System client has local configuration options that you can modify. From the Miscellaneous tab, you can configure paging settings, printing settings, and other system options. Other system options include hardware options, access options, dialing properties, and AutoCorrect options. Accessing the Local Configuration options window 1. Click the Main tab, then click the Utilities tab from the Paceart System main screen. 2. Select the Tools folder, click Local configuration options, and then click Open. The Local Configuration Options window appears. Miscellaneous tab The Paging section The Paging section contains options related to the sending alphanumeric or numeric pages to doctors in CardioVoice or directly from the doctor's record. Field name Maximum Number of Retries Modem Port Number Numeric Delay in Seconds Modem Baud Rate What the field is for This field specifies the number of times CardioVoice tries to resend the page when it is unsuccessful. The sending of a page could be unsuccessful for a variety of reasons (e.g., busy signal, no answer, no dial-tone, no carrier). This field specifies the port to which your modem is connected for sending pages. Possible values include COM1 through COM99, TAPI, TAPI1 through TAPI99, and TAPIA through TAPIZ. If multiple applications share the same modem, use the value TAPI, which will search through all available TAPI devices and try to send the page. If you wish to only send pages on a specific device, you must specify it with TAPIx, where x is a number from 1 to 99, or letter from A to Z. The default modem port number is TAPI (Telephony Application Program Interface). This field specifies the number of seconds to wait before touch-toning the digits to leave on a numeric pager. This is only used when sending a numeric message page (e.g., a phone number) to a pager directly, without going through a Pager Service. If no delay is specified, the Paceart System will default to a six second delay This field specifies the baud rate of the paging service's alpha access port. This can be any of the following

Paceart System Administrator's Guide Paceart System Installation 39 Field name Modem Initialization String What the field is for values: 300, 1200, 2400, 4800, 9600, 19200. By default, the port settings will be set to E,7,1 (Even parity, 7 data bits, 1 stop bit). If your paging service requires N,8,1 (No parity, 8 data bits, 1 stop bit), precede your baud rate with the letter N (e.g., N300). The default modem baud rate is 2400. This field allows you to input any special setup string that your modem needs. The default value is an empty string, which will send your modem the string AT and a carriage return. If you use the string AUTO, the setup string specified in your modem's Windows INF file will be used. You can only use AUTO when your Modem Port Number is set to use TAPI. If you will be entering your own initialization string, remember the following: To create a carriage return, use the tilde (~) character. To create a pause, the hat character (^) will give you a one second pause. To enter a modem termination string, place a bar ( ) between the initialization string and termination string. The maximum length of the modem initialization string is 80 characters. The Printing section The Printing section contains boxes to enable printing features. Field name Enable Color Printing by Default Enable Report Queue Server What the field is used for This field sets the default report output to color. This field allows the report queue server to run on the local computer. The System section The System section allows the configuration of the hardware and software subsystems of the Paceart System application. To access these options, click the Hardware Options window The Hardware Options section button. Clicking the Hardware Options button opens the Hardware Configuration window. This window contains options for configuring the Paceart hardware to run with the Paceart System. The window has two tabs, Transtelephonic and Clinic. The Transtelephonic tab The Hardware section is used to select the Paceart transtelephonic hardware that is connected to the local system.

40 Paceart System Administrator's Guide Paceart System Installation The check box name None Paceart Parallel Port TTM Paceart ISA TTM Board Paceart USB TTM Sound Card What the check box is for Select this check box if no transtelephonic ECG receiving hardware is installed. If this is selected, TTM ECG acquisition will be disabled. Select this check box if a Paceart Parallel Port Module is connected to the computer's parallel port. This allows the telephone line input on the module to be used for TTM ECG acquisition. Select this check box if the internal Paceart transtelephonic board is inserted into the ISA bus of the computer. The RJ-11 telephone line input of the ISA TTM board is used for TTM ECG acquisition. Select this check box if a Paceart USB Module is connected to the computer's USB port. The Paceart USB Module must be either a TTM or TTM/Clinic model. This allows the telephone line input on the module to be used for TTM ECG acquisition. Select this check box if the Paceart Sound Card Interface is connected to the computer's sound card input. This allows the telephone line input on the Paceart Sound Card Interface to be used for TTM ECG acquisition. Note: The Sound Card option is not available in all versions of the Paceart System. Note: If the Sound Card option is selected, the Auto Dialer feature and Patient Alert feature will be disabled. Voice Board Select this check box if a modem is installed with voice features will allow the acquisition of TTM ECG from the RJ-11 telephone line input on the modem. Note: Voice Board is not a recommended hardware option for TTM acquisition because of its low sampling rate and bandpass. Voice board compression algorithms can also adversely affect TTM ECG recording. Voice Board + Sound Card Select this check box if a modem with voice features is installed that is connected to the sound card line-in input. This configuration is used if the voice board's compression algorithm adversely affects TTM ECG recording when the Paceart System software is processing the voice digital signal. The sound card driver allows a higher band pass and therefore a better analog signal resolution. When this option is selected, the voice board will be used for controlling the telephone line (pick-up, dialing, hang-up) and the sound card will be used to record the TTM ECG.

Paceart System Administrator's Guide Paceart System Installation 41 The Hardware Settings section dynamically changes depending on the selection made in the hardware section. It contains additional parameter settings from Paceart hardware. Field name Paceart Parallel Port TTM Hardware Paceart ISA TTM Board Paceart USB TTM Sound Card Voice Board Voice Board + Sound Card What the field is for If this hardware is selected, the option to select the Parallel Port appears. The port can be set to LPT1, LPT2, or LPT3. The default parallel port is LPT1. If this hardware is selected, the option to select the Interrupt appears. The Interrupt can be set to 2, 3, 4, 5, or 7. The default interrupt is 5. The jumper switch on the TTM board must match the interrupt that is selected. If this hardware is selected, the option to select the input appears. Select Phone Line Input if using a POTS analog phone line, or PBX Handset Input if using a PBX digital phone line. If this hardware is selected, the Sound Card and Audio Input drop-down lists appear. The Sound Card drop-down list displays the sound cards automatically detected by the Windows operating system. Select the sound card that is being used for TTM acquisition. The Audio Input drop-down list displays the sound card input ports automatically detected by the Windows operating system. Select the audio input that is used for TTM acquisition. The default audio input is Microphone. If this hardware is selected, the Voice Board drop-down list will appear. The Voice Board drop-down list displays voice boards automatically detected by the Windows operating system. Select the voice board that is being used for TTM acquisitions. If this hardware is selected, the Voice Board, Sound Card, and Audio Input drop-down lists will appear. The Voice Board and Sound Card drop-down lists will display the voice boards and sound cards automatically detected by the Windows operating system. Select the voice board used for telephone line control and the sound card used for TTM acquisition. Select the audio input used for TTM acquisition on your sound card. The Defaults section contains default parameter settings for TTM ECG acquisition. These parameters can also be changed for a one-time use at the time of acquisition. Field name Gain What the field is for The Gain setting is used to control the ECG gain on acquisition. The parameter can be set to 5, 10, 20, 40, or 80 mm/mv. The default setting is 20 mm/mv. The default setting is only used if a previous strip has not been recorded. Otherwise, the settings from the previous strip are used.

42 Paceart System Administrator's Guide Paceart System Installation Field name Filter Speed Invert Polarity Leave High Pass Filter On After Recording What the field is for The Filter setting is used to set the lower cutoff frequency of the software-based low-pass filter. The parameter can be set to None, 35 Hz, 25 Hz, or 10 Hz. The default setting is 35 Hz. The Speed setting changes the ECG graphing resolution on the x-axis. The parameter can be set to 12.5, 25, or 50 mm/sec. The default setting is 25 mm/sec. The Invert Polarity setting flips the sign on the ECG samples, effectively flipping the ECG on its x-axis. The Leave High Pass Filter On After Recording setting, when enabled, will leave the Motion Filter on after recording TTM ECG. By default, this option is not enabled, giving you the chance to see the raw, unfiltered ECG after recording. The Clinic tab The Clinic tab in the Hardware Configuration window contains parameter settings related to the hardware necessary to acquire ECG from a patient in-clinic, namely via 12-Lead ECG. The Hardware section is used to select the Paceart in-clinic hardware that is connected to the local system. Field name None Paceart Parallel Port 12 Lead Module Paceart USB 12 Lead Module What the field is for Select None if no transtelephonic ECG receiving hardware is installed. Select Paceart Parallel Port 12 Lead Module if a Paceart Parallel Port Module is connected to the computer s parallel port. Select Paceart USB 12 Lead Module if a Paceart USB Module is connected to the computer s USB port. The Paceart USB Module must be either a Clinic or TTM/Clinic model. The Hardware Settings section dynamically changes depending on the selection made in the hardware section. It contains additional parameter settings for Paceart hardware. Field name Paceart Parallel Port 12 Lead Module What the field is for If Paceart Parallel Port 12 Lead Module hardware is selected, the option to select the Parallel Port appears. The port can be set to LPT1, LPT2, or LPT3. The default parallel port is LPT1. The Defaults section contains default parameter settings for in-clinic ECG acquisition. These parameters can also be changed for a one-time use at the time of acquisition. Field Name Gain What the field is for The Gain setting is used to control the ECG gain on acquisition. The parameter can be set to 2.5, 5, 10, 20, or 40 mm/mv. The default setting is 10 mm/mv.

Paceart System Administrator's Guide Paceart System Installation 43 Field Name Filter Speed What the field is for The Filter setting is used to set the cutoff frequency of the ECG low-pass filter. The parameter can be set to None, 30 Hz, or 40 Hz. The default setting is 40 Hz. The Speed setting changes the ECG graphic resolution on the x-axis. The parameter can be set to 12.5, 25, or 50 mm/sec. The default setting is 25 mm/sec. Dialing Properties window Clicking Dialing Properties from the Local Configuration Options window opens the Auto Dialer window. The Auto Dialer window The Auto Dialer window contains configuration options for Auto Dial, a feature of the Paceart System that allows you to automatically call your TTM patients. This window gives you the ability to configure your Paceart System to work with your phone system s prefix and/or suffix requirements. Fill in your local area code, and necessary number prefixes and suffixes. For example, if your phone system requires you to dial 9 to access an outside line, type 9 in the local calls prefix text box and 9,1 in the long distance prefix text box. If your dialing scheme requires a pause before continuing with the dialing, enter a comma or sequence of commas to pause the dialing process. This can be useful if you have to enter an authorization code before placing a long distance call. Patients with the same area code as the local area code that you enter on the Auto Dialer Configuration screen will be dialed as a local call. In some areas of the country, all calls to the local area code are not local calls. If your local area code is like this, follow these procedures to allow calls in your local area code to be treated as both long distance and local calls: Leave the local area code blank on the Auto Dialer Configuration window. For patients that have the same local area code, but should be dialed as a long distance call, fill in the area code on their Patient Demographics screen. For patients that have the same local area code, but should be dialed as a local call, leave the area code blank on their Patient Demographics screen. Access Options window Clicking Access Options from the Local Configuration Options window will open the Microsoft Access Options window, which allows you to customize the default options for the Microsoft Access environment. For more information on Access Options, consult the Microsoft Access Online Help. Note: Microsoft Access Online Help is only available on computers that have a full version of Microsoft Access installed. It is not available for Paceart Systems utilizing only the Microsoft Access Runtime. Keyboard tab The options that most Paceart System users may want to change appear on the Keyboard tab. After you have made changes, click OK.

44 Paceart System Administrator's Guide Paceart System Installation Feature Move after enter Arrow key behavior Behavior entering field Cursor stops at first/last field What the feature is for This option changes what happens to your insertion point (cursor) after pressing the ENTER key. Don't move - Keep the insertion point in the current field after you press the ENTER key. Next field - Move the insertion point to the next field after you press the ENTER key. Next record - Does not apply to the Paceart System. This option changes what happens to your insertion point (cursor) after pressing either the RIGHT ARROW or LEFT ARROW key. Next field - Move the insertion point to the next or previous field when you press the RIGHT or LEFT ARROW key. Next character - Move the insertion point to the next or previous character when you press the RIGHT or LEFT ARROW key. This option changes the behavior of the ENTER, TAB, and ARROW keys when used to move between fields in the Paceart System. Select entire field - Select the entire text in a field when you enter it. Go to start of field - Places the insertion point at the start of the field when you enter it. Go to end of field - Places the insertion point at the end of the field when you enter it. Not used by the Paceart System. AutoCorrect Options Clicking AutoCorrect Options from the Local Configuration Options window will open the Microsoft Office AutoCorrect window. AutoCorrect is a Microsoft Office feature that automatically detects and corrects typos, misspelled words, grammatical errors, and incorrect capitalization. The following is a list of features that can be used. After you have made changes, click OK. Feature Correct TWo INitial CApitals Capitalize first letter of sentence Capitalize names of days What the feature is for If you type two capital letters at the beginning of a word, this feature, when enabled, will cause the second letter to be lowercase. Click Exceptions to enter acronyms with two initial capital letters that you don't want AutoCorrect to change. This feature, when enabled, will automatically capitalize the first letter of sentences. This feature, when enabled, will automatically capitalize the first letter of days of the week.

Paceart System Administrator's Guide Paceart System Installation 45 Feature Correct accidental use of caps LOCK key Replace text as you type What the feature is for This feature, when enabled, will automatically change a word typed in reverse caps to initial caps. For example, caps will become Caps. This feature, when enabled, will automatically replace the text in the Replace column with the corresponding entry in the With column. Paceart Device Update CD A Paceart System Device Update CD will be shipped to your clinic periodically. The update CD is used to update the device listings and clean up the Paceart database device library. It also updates the Paceart Import component, which is used by the Paceart System to import data from device programmers. Important things to know before starting the update process: You do not need to run the Device Update as part of the Paceart System installation. You can run the update at any time. Depending on your device library, the update may take a significant amount of time to complete. The update process does not need to be finished in one session. You can exit from the update wizard at any time and re-launch the wizard any number of times until the update is complete. You do not need to add or update all of the devices that the wizard finds. The Device Update can be run from the server on which your Paceart database resides, or any workstation that has access to the Paceart database. You must close Paceart, Paceart Database Manager, Paceart Gateway Services, and Connected Systems Gateway; and stop all services associated with these applications, including Paceart Remote Acquisition, Paceart Programmer Acquisition, and Connected System Gateway. If you use replication on your Paceart database, replication must be complete before starting the update. Once the update process starts, do not use the Back button. Note: If you choose to replace an existing device with a device listing from the wizard, the wizard will overwrite ALL device parameters. Starting the Paceart System Device Update 1. Insert the Paceart System Device Update CD in the disk drive. The CD automatically starts the update wizard. 2. On the Welcome to the Paceart System Device Update Wizard screen, click Next. 3. Check the Update Device Listing and Update Device Import Wizard boxes to perform the corresponding updates. 4. Click Next on the Select Update Options screen. 5. On the Database Location screen, click the SQL Server drop-down list, select the name of the server where the Paceart database is located. 6. Choose an authentication method that has administrative privilege to update the Paceart database. The Windows account must have administrative rights to the database. The SQL account must have System Administrator or Database Owner access rights. Note: If your operating system is Windows Vista, then you must use Windows authentication. 7. In the Database Name drop-down list, select the name of the Paceart database.

46 Paceart System Administrator's Guide Paceart System Installation 8. Click Next. 9. On the Device Update screen, double-click the device you would like to add or update. This opens the Compare Devices dialog box. 10. On the Compare Devices dialog box, select an update action from Select update action section. If this is a new device that is not already in the Paceart database, choose the Create New Device option. Choose Replace Device in Database with New Device if you would like to override the device currently in the Paceart database with the device information shown in the New Device column. If the device already exists in the Paceart database, but not as an exact match, the wizard will attempt to find a similar device, which is shown in the Device in Database column. Note: If you choose to replace an existing device with a device listing from the wizard, the wizard will overwrite ALL device parameters. Choose Keep Device in Database to keep the existing device in the Paceart database and not override the data. Note: In order to ensure proper matching of incoming transmissions, Create New Device or Replace Device in Database must be selected. If the wizard does not find a match and you know that one does exist in the Paceart database, click Available Devices to manually select the device. In the Select Device From the Database dialog box, select the device and click Select. 11. Click OK after the desired selection is made. This process must be repeated for each device in the Device Update list. 12. Click Next on the Device Update screen to accept the changes. 13. Click Next on the Update Process screen. 14. To review the results of the device import, click Click here to open the import log file. 15. Click Finish on the Completing the Paceart System Device Update Wizard screen. The log is saved to the desktop. Troubleshooting Progress bar moves backward during server installations When installing the Paceart System Server on a computer running Windows 2000 Professional, you may notice the installation progress bar begin to move backward during installation. This is caused by a rollback of the Microsoft Data Engine installation. This occurs when the File and Printer Sharing for Microsoft Networks service component has not been installed and enabled for use by your network connection. Perform the following steps to install the service before reattempting to install the Paceart System Server. 1. Right-click My Network Places on your Windows Desktop and select Properties. 2. From the Network and Dial-up Connections screen, right-click your network connection (e.g., Local Area Connection) and select Properties. 3. Click Install. 4. Select the Service network component type and click Add. 5. Select Microsoft from the Manufacturers list, select File and Printer Sharing for Microsoft Networks from the Network Services list, and click OK.

Paceart System Administrator's Guide Paceart System Installation 47 After the component is installed, make sure that the File and Printer Sharing for Microsoft Networks icon appears in the components list, and that it is checked. Select device window appears during client installation During a Paceart System Client installation, a Select Device window may appear. 1. Select the Paceart 12 Lead USB Module. 2. Click OK to continue the installation. Windows logo testing warning appears When installing the Paceart System client software on a computer running the Windows XP Professional operating system, you may receive the following warning while running the installation: The software you are installing has not passed Windows Logo testing to verify its compatibility with this version of Windows. (Tell me why this testing is important.) Continuing your installation of this software may impair or destabilize the correct operation of your system either immediately or in the future. Microsoft strongly recommends that you stop this installation now and contact the software vendor for software that has passed Windows Logo testing. If you receive this message while installing Paceart System software, click Continue Anyway.

Chapter 4 Paceart Database Manager Topics: Starting the Paceart Database Manager Creating your first Paceart System Database Publications Subscriptions Bulk copy MDB import Script schema Delete strips Rename database Run script Delete patients Users Roles Enable or disable auditing Tools Command Line Interface Creating Shortcuts to the Paceart Database Manager Troubleshooting The Paceart Database Manager is a tool for performing the most common tasks of managing your Paceart System databases. This tool makes it easy to complete advanced database administration tasks through the use of wizards. Some of the tasks performed by the Paceart Database Manager could also be performed through more sophisticated database management software, such as Microsoft SQL Server Enterprise Manager.

50 Paceart System Administrator's Guide Paceart Database Manager Starting the Paceart Database Manager Note: Use the System Administrator (sa) login when using the Paceart Database Manager. Many of the features require this login. 1. Click the Paceart Database Manager icon on the desktop. The Connect to SQL Server login screen is displayed. 2. Select the SQL Server instance you want to connect to. Select from the most recently used servers from the drop-down list or by clicking the button to pick from a list of all SQL Servers known to be running on your network or aliased using the SQL Server Client Network Utility. 3. Enter the appropriate credentials and click OK to connect. Note: If you want to login to a different instance of SQL Server, you can click the Paceart Database Manager. button from within Creating your first Paceart System Database 1. To create a new Paceart database on the SQL Server, click New Database. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next to continue the Paceart System New Database Wizard. 3. Enter both the Database Name, which is defaulted to Paceart Database, and the Database Location. It is recommended to accept the default values, but you can modify the values if necessary. 4. Click Next. 5. Set the initial size of the Paceart database. Your Paceart System can run more efficiently if the database size is allocated correctly. However, the database will continue to grow size in increments of 50 MB if you exceed the initial database. The initial size of the database must be between 50 MB and 2,000 MB. The wizard gives you the option of either estimating the size of your database according to the size of your patient population, or by specifying the initial size directly. If you are estimating based on patient population, fill in the number of Pacemaker patients, the number of arrhythmia patients, and click Next. If you are specifying the size directly, slide the bar to the appropriate size and click Next. 6. When a wizard window shows the choices you have selected to create the new database, review the attributes for accuracy and click Next. The wizard may take several minutes to complete creating the database, initializing the database structure, and loading the sample data. 7. Click Finish to close. Sample data All new Paceart databases are loaded with sample data. This data can be used to train your users on how to use the Paceart System. The following ten patients are sample patients that will appear in your database: Alice R. Roth Charles P. Ireland Edward N. Paulson

Paceart System Administrator's Guide Paceart Database Manager 51 George E. Martin George U. Ironwing Ivan N. Marcus II Kathleen D. Reynolds Samuel J. Morse Stan J. Maslaski Vivian T. Diamond These patients have sample events associated with them. The following physicians are added as sample physicians: Ahmed Kasimir Belinda Morgan Chris Snow David Fishman Gary Johnson George Wilson Gerald Brown Harlen J. DuBois James Jensen Kay H. Stanford Naomi Clous Omar Cordoza Phillip Armadin Raymond Fischer Raymond Fisher Shiela Cross Victoria L. Brenner Wanda Claybourne Data is also loaded into your Paceart Database for CPT Codes, Devices, Diagnoses, Insurance Companies, Medications, and Pager Services. This data can be used as your initial lookup table information, to which you can add as you collect more information. Publications A publication is a set of data that is made available on an SQL Server that is set up to be a Publisher. Data is published to make it available to other computers, including Pocket PCs. Other computers access this data through subscriptions. Publications can be configured to publish all data, or it can be limited through filtering only certain patients, or not publishing ECG strips.

52 Paceart System Administrator's Guide Paceart Database Manager All publishing is configured using the Paceart Database Manager. To access publications and publication utilities, select a specific database, and then click the Publications icon. Note: This feature is only available when the user logged in to the Paceart Database Manager is a member of the System Administrators server role on the SQL Server Setting up a new publication 1. To set up a new publication, click the New Publication icon. 2. Click Next. 3. The PocketPC Option window is used to configure your new publication for use with a PocketPC handheld device. If you are using a PocketPC to access your Paceart data while disconnected from the main database, select the This publication is for use with a PocketPC check box. When this option is selected, ECG strip data and spoken data files from CardioVoice will not be part of the subscription. This data is very large in size and is not available for viewing on the PocketPC. Note: Do not select this option unless you are certain you will be performing replication with PocketPCs. By selecting this option, future updates to the Paceart database structure may not be able to be applied without recreating your entire Paceart database. 4. Click Next. 5. The Status and Affiliation Code Filters window allows you to filter the data that is published. Filtering data is useful if you don't need all of your data available on the remote client computer. The wizard gives you the option to filter on both the Patient Status Code and the Patient Affiliation Code. The Patient Status Code is called Status on the patient information screen in the Paceart System client application. The Patient Affiliation Code is called Code on the patient information screen in the Paceart System client application. 6. Click Next. 7. The Physician Filter window allows you to publish only a certain physician's patients. This option can be useful if a physician will subscribe to your publication and only wants to view his or her own patient data. It can also be useful if you are using a PocketPC handheld device and wish to limit the amount of data that is published to the PocketPC. 8. To filter based on a physician, click the button. To view all of the physicians in your Paceart database, enter a "*" in the Enter Physician Name text box. Press the TAB key and the Results window will populate with a list of all of the physicians in the database. Highlight the physician and press Select. The Select physician type list allows you to further refine which patients you want included in your publication. You can choose from the following: All physician types Referring physician #1 Referring physician #2 Referring physician #3 Follow-up physician Selecting All physician types will include all patients where the selected physician is in any of the physician fields (one of the three referring physicians or follow-up physician). Selecting one of the other options will include only patients where the selected physician is listed as the physician in that specific physician field. 9. If you do not wish to filter on a physician, leave the Select physician and Select physician type fields empty. Click Next. 10. The ECG Strip Filter window allows you to choose if you want to publish ECG strips. The wizard gives you three options: All strips: Select this option to publish all of the ECG strip data. No strips: Select this option to not publish ECG strip data.

Paceart System Administrator's Guide Paceart Database Manager 53 Front page strips only: Select this option to only publish the three 6-second strips that appear on the front page of Paceart reports. If your client is on a slow network or does not have a large amount of free disk space, do not publish ECG strip data unless it is critical that the client see ECG strip data. Not publishing ECG strip data will significantly cut down on the amount of time needed to synchronize the data between the client and server. 11. Click Next. 12. The Large Data Field Filters window is used to further filter the size of the publications by excluding data items that can make up a significant size of the database. You can choose to include or not include CardioVoice recordings, attachments, and physician signatures. These fields are a large part of the database, and if the subscriber has little disk space or a slow connection to the publisher, data from these fields should not be published. Note: The options Include CardioVoice recordings and Include physician signatures should only be cleared if absolutely necessary, for example if you are a CardioVoice user with subscribers who synchronize over a slow network link. If you clear these options, future updates to the Paceart database structure may not be able to be applied without recreating your entire Paceart database. 13. Click Next. 14. On the Auditing Filter window, specify if you want to include the data stored in the audit log in the publication. The audit log can become large, and may not need to be published. It can also contain Protected Health Information (PHI) and should not be included if your subscribers are restricted in viewing PHI. Even though you do not include auditing data in your publication, you can still capture your subscribers' audit data if auditing is enabled on both the publication and subscription databases. Whether or not you choose to publish your auditing information, audit data from your subscribers will be transferred back to the publisher if auditing is enabled. 15. Click Next. 16. On the Name the Publication window, give a name to your publication or accept the default. By default, a name is given sequentially based on the number of publications currently existing in the database. It is recommend that you give the publication a descriptive name. For example, if a publication is created for patients with a status of "A" and no ECG strips are published, a descriptive publication name could be "Patients with Status=A, No ECGs". 17. Click Next. 18. The Snapshot Location window is used to specify the location to store the initial snapshot of the published data. The snapshot data is used when a new subscription is created in order to give the subscriber an initial set of data from the publisher. This page of the wizard is only shown the first time a publication is created on a given SQL Server. All subsequent publications will use the location that you specify. The snapshot must be stored in a Windows shared directory that will be visible from all subscribing computers. To share the directory, open Windows Explorer and navigate to the location of your snapshot. Right-click the folder and select Sharing. The Sharing tab of the folder properties window will open. Select the Share this folder option. After you have shared the folder, it will appear when you click the button. The Snapshot Location must be specified in UNC (universal naming convention) format. For example, use \\ServerName\ReplData, where the D:\Program Files\Microsoft SQL Server\MSSQL\ReplData directory on the ServerName computer is shared as 'ReplData'. When using SQL Server Version 2000 we recommend that snapshot data be stored in C:\Program Files\Microsoft SQL Server\MSSQL\ReplData. If your publication has a large amount of data and your subscribers will be connecting over a slow network connection, you may choose to copy the contents of the snapshot folder to external media and send the media to your subscribers. When your subscribers initialize their subscription to your publication, they have the option of pulling the snapshot data over the direct connection on the network, or loading from a snapshot folder location, for example a CD-ROM drive.

54 Paceart System Administrator's Guide Paceart Database Manager 19. Click Next. The Distributor Replication Agent Login window will appear if your SQL Server has not yet been set up to act as a distributor and publisher participating in replication. 20. The Distributor Replication Agent Login window allows you to select the login used for your distribution database to connect to your publication database on your Publication/Distribution computer. You can choose: Impersonate the SQL Server Agent Account of the Publisher: This option will use the Windows Authentication of the current login properties of the SQLServerAgent service on the Publisher server. Use SQL Server Authentication: Use this option to use a specific SQL Server authenticated login on the SQL Server containing the distribution database. You will have to specify the login name, password, and confirm the password for the account you wish to use. This account must exist as a login on the Publication/Distribution SQL Server. Note: If your operating system is Windows Vista, then you must use Windows authentication. 21. After you create your publication you must give your subscribers a login and password to use when connecting to the Publisher/Distributor database. When the subscription is created using the wizard, this information must be provided. You must ensure that this login has access to both the Distribution and Publication databases. 22. Click Next. 23. The Create Publication window summarizes the selections that you have made with the Paceart System New Publication Wizard. It is your last chance to review your selections and go back and change them if necessary. Click Next. Depending on the size of your Paceart database and the speed of your database server, publication creation can take several minutes or hours. If you wish to manually copy the snapshot data to external media to transfer to remote computers, click the shortcut. 24. Click Finish. After you create your publication, you must give your subscribers a login and password to use when connecting to the Publisher/Distributor database. You can do this by either giving your subscribers a specific SQL Server login, or by changing the login properties of the SQLServerAgent to an account that has access to the Publication and Distribution databases. When the subscription is created using the Paceart System New Subscription Wizard, this login information must be provided. Maintaining existing publications Highlighting the icon of an existing publication in the Paceart Database Manager will display information about the publication in the left-hand side of the window. The following information is displayed: ECGs: Shows if the publication has been set to publish all ECG strips, no ECG strips, or front-page ECG strips only. Affiliation: Shows the filters applied to the affiliation code field, or All if no filter is applied to this publication. Status: Shows the filters applied to the status code field, or All if no filter is applied to this publication. Physician: Shows the filters applied to the physician name and physician type fields for this publication. CardioVoice: Shows whether or not the publication has been configured to publish CardioVoice recordings. Attachments: Shows whether or not the publication has been configured to publish attachments. MD Signatures: Shows whether or not the publication has been configured to publish physician signatures. PocketPC: Shows whether or not the publication has been configured for use with a PocketPC. Auditing Data: Shows whether or not auditing data is included in the publication. Clicking on the icon of an existing publication will open the Publication Information window. This window displays synchronization and conflict information for the publication.

Paceart System Administrator's Guide Paceart Database Manager 55 Subscriptions Subscriptions are set up on database servers to receive replicated data that has been published on a remote database server. Using the replication that is offered in the Paceart Database Manager wizards, subscribers are also able to make changes to the data that are propagated back to the publishers. To access the options to create and manage subscriptions, click the Subscriptions icon. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. Creating and configuring a new subscription You must have a publication configured before you can configure a subscription. Note: You can only have one subscription created on each database. If you already have a subscription created, the New Subscription icon will be disabled. 1. Click the New Subscription icon to start the Paceart System New Subscription Wizard. 2. Click Next. 3. The Choose Publishing Server window allows you to specify the server that contains the publication to which you wish to subscribe. You need to specify the connection properties to connect to the Publication server. This connection information is not stored permanently in your subscription; it is only used to return a list of publications. Select the Publishing Server that contains the publication. If necessary, click the button for a list of SQL Servers running on your network. Next, specify to connect using Windows Authentication or SQL Server Authentication. If you choose SQL Server Authentication, you must also specify a Login Name and Password of a valid login on the Publication SQL Server. Note: If your operating system is Windows Vista, then you must use Windows authentication. Note: You must have a publication configured before you can configure a subscription. 4. Click Next. 5. The Choose Publication window is used to select the publication from the Publishing database. The list shows all of the publications available. Only publications matching the same database structure revision level of the subscription database will be shown. You can see all of the publication attributes in the window on the right-hand side. 6. Click Next. 7. The Initialize Subscription window allows you to specify whether the subscription needs to be loaded with an initial snapshot of the published data, and if so, how to initialize the publication data on the subscribing computer. Before a new subscriber can receive incremental changes from a publisher, the subscriber's database must contain tables with the same schema and data as the tables in the publication's database. The initial snapshot contains the complete initial database, including tables and data. When setting up a new subscription, it is possible to load the initial snapshot into the subscriber's database manually instead of sending it over a network. This is done if the publication is very large or the network bandwidth is very small. Sometimes it is more efficient to copy the initial snapshot to a tape or other storage device, express courier the external media to the subscriber, and reload the database instead of sending it over a slow network connection. The following three options are available in the Paceart System New Subscription Wizard: Initialize the data directly from the publisher: The initial snapshot is sent over the established connection directly from the snapshot folder on the publisher. This option should be selected if there is

56 Paceart System Administrator's Guide Paceart Database Manager a fast network connection between the subscriber and publisher, or there is only a small amount of patient data being published. Initialize the data from a bulk copy of the initial snapshot: Select this option if the initial snapshot has already been copied to the subscribing computer and is available locally on the computer. This option should be used if there is a slow network connection between the publisher and subscriber and there is a large amount of patient data being published. In this case, the user will need to specify the location of the snapshot folder by clicking the button. Note: You cannot choose the Initialize the data from a bulk copy of the initial snapshot option if you are using the MD Signature or CardioVoice filter. Do not initialize the subscription, the subscriber already has the data: Select this option if the publishing and subscribing databases are initially the same, or if the initial snapshot of the published data has already been imported into the subscribing database by other means. This option is for advanced users only. If the publishing and subscribing databases do not contain the same data or schema the first time synchronization is run, the databases will not synchronize properly. 8. Click Next. 9. The Subscriber Login window allows you to specify the permanent connection properties of the subscription to the subscription database. This connection is used during synchronization. You can choose: Impersonate the SQL Server Agent Account of the Subscriber: This option will use the Windows Authentication of the current login properties of the SQLServerAgent service on the subscription server. Use SQL Server Authentication: Use this option to use a specific SQL server authenticated login on the SQL server containing the subscription database. You will have to specify the login name, password, and confirm the password for the account you wish to use. This account must exist as a login on the subscription SQL server. 10. Click Next. 11. The Publisher/Distributor Login window allows you to specify the permanent connection properties of the subscription to the publication and distribution databases. This connection is used during synchronization. You can choose: Impersonate the SQL Server Agent Account of the Publisher/Distributor: This option will use the Windows Authentication of the current login properties of the SQLServerAgent service on the publication/distribution server. Use SQL Server Authentication: Use this option to use a specific SQL server authenticated login on the SQL server containing the publication and distribution databases. You will have to specify the login name, password, and confirm the password for the account you wish to use. This account must exist as a login on the publication/distribution SQL server. Note: The Paceart Database Manager assumes that the publication database and distribution database are contained on the same physical SQL server. If you have a Remote Distributor, you must use Microsoft SQL Server Enterprise Manager. 12. Click Next through the wizard. 13. Click Finish. Maintaining existing subscriptions The Paceart Database Manager gives you the ability to maintain existing subscriptions. Clicking the icon of an existing subscription in Paceart Database Manager will open the Synchronize Subscription window.

Paceart System Administrator's Guide Paceart Database Manager 57 Synchronize subscription The Synchronize Subscription window allows you to synchronize your subscription with the publication. For more information on synchronization, refer to the SQL Server Synchronization section in the Database Replication chapter. Change publisher/distributor password From the Synchronize Subscription window, you can update your password for the connection to the Publisher/Distributor by clicking Publisher Login. Use this feature if your publisher changes their publisher/distributor password. From this window, you can change the logins that the subscription uses to connect to the distribution and publication databases. You can choose: Impersonate the SQL Server Agent Account of the Subscriber: This option will use the Windows Authentication of the current login properties of the SQLServerAgent service. Use SQL Server Authentication: Use this option to use a specific SQL Server authenticated login on the SQL Server containing the publication and distribution databases. You will have to specify the login name, password, and confirm the password for the account you wish to use. This account must exist as a login on the publication/distribution SQL server. Note: The Paceart Database Manager assumes that the publication database and distribution database are contained on the same physical SQL Server. If you have a Remote Distributor, you must use Microsoft SQL Server Enterprise Manager. Bulk copy The Bulk Copy Wizard, available in the Paceart Database Manager, gives you the ability to bulk copy data into and out of the database. When you bulk copy data out of the database, you can specify filters, including removing protected health information from the exported data. Note: The Bulk Copy Wizard is first available in Paceart System Version 3.30. This wizard combines the functionality of two wizards available in previous versions of the Paceart Database Manager: Bulk Copy Import and Bulk Copy Export. It also adds the ability to remove PHI. The Bulk Copy Wizard exports or imports Microsoft SQL Server data to or from a data file using native format. It does this by using the SQL Server utility called BCP. Since the exported data file is saved in native format, it can only be read by the Bulk Copy Wizard import function, or by calling the BCP application directly. No other application will be able to read it. Performing a bulk copy 1. Click the Bulk Copy icon Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next. 3. Choose either Import or Export. If you choose Export, read the BCP Export section. If you choose Import, read the BCP Import section. BCP Export allows you to bulk copy data out of your Paceart database into a data file. BCP Import allows you to import data into an SQL Server database from a data file that was created using BCP Export. You cannot perform a BCP Import on a database that has current publications or

58 Paceart System Administrator's Guide Paceart Database Manager subscriptions. If you have publications or subscriptions already configured, cancel the wizard, delete them, and re-run the wizard. After you import the BCP data, you will be able to reestablish replication. 4. Click Next. BCP export Note: When you perform a BCP Export, you must be the only person logged into the database at the time of export. If you are not, you will be prompted to run the Active Connections tool. 1. Select Export from the Import/Export Option window. This window gives you the option of placing a filter on the data that is exported. The two filters available are Status Code and Affiliation Code. The export will only contain records of patients that have the Status Code or Affiliation Code that you enter. If you leave these filters blank, all patients in the database will be exported. 2. Click Next. 3. To remove protected health information or PHI, select Remove protected health information. 4. Click Next. 5. Choose a folder where the exported data will be stored. You can accept the default location or click the button to navigate to a folder location. 6. Click Next. 7. Review your settings and then click Next. The BCP Export may take several minutes to complete, depending on the amount of data in your database. 8. Click Finish. The BCP files will be located in the directory you specified. BCP import Note: You cannot perform a BCP Import on a database participating in replication. If the database has current publications or subscriptions, cancel the Bulk Copy Wizard and delete all existing publications and subscriptions. Note: When you perform a BCP Import, you must be the only person logged into the database at the time of import. If you are not, you will be prompted to run the Active Connections tool. 1. Select Import from the Import/Export Option window. 2. Select the folder where the data to be imported resides. You can accept the default location or click the button to navigate to a folder location. 3. Click Next. 4. Review your settings and then click Next. The BCP Import may take several minutes to complete, depending on the amount of data in your database. 5. Click Finish. The database now contains the data contained in the BCP files that you imported. MDB import The Paceart System 16-bit Import Wizard, available in the Paceart Database Manager, is used by customers upgrading from a 16-bit Paceart System to a 32-bit Paceart System. The wizard converts the data in your Paceart 16-bit database, stored as an MDB file, into your new SQL Server database.

Paceart System Administrator's Guide Paceart Database Manager 59 Performing an MDB import 1. Click the MDB Paceart System 16-bit Import icon. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next. 3. The 16-bit Paceart System MDB File Location window allows you to select the file location of your MDB file. If you already have a 16-bit Paceart System installed on the same computer on which you are running the wizard, the file location should automatically be filled with the correct location. If it is not the correct location of your MDB file, click the file was named CPTSFile.mdb. 4. Click Next. button to navigate to the correct folder and file. By default, the MDB 5. If your MDB file was configured to store ECG strip data in an external file, but that file cannot be found, the 16-bit Paceart System DAT File Location window will appear. Enter the correct file location for your external ECG strip data file. By default, the ECG strip data file is named Strips.dat. Click the to the correct location. 6. Click Next. button to navigate 7. The CardioVoice Option window allows you to configure CardioVoice options. If you are not a CardioVoice user, you may skip this page by clicking Next. 8. If you are a CardioVoice user, select options to determine CardioVoice IDs of your patients, and the location of your pager services file. In the 16-bit Paceart System, CardioVoice patients were identified by their phone number. Paceart System now has a new field, called CardioVoice ID, which stores an identifier for each CardioVoice patient. On this window, you can select the method for populating the CardioVoice ID field: using the last digits of the patient's phone number, using the patient's ID, or leaving the CardioVoice ID field blank. Select one of the options. The bottom text box is for specifying the file location of the pager services file. This file contained a list of pager services that were displayed in the 16-bit Paceart System. The wizard will import the data found in your pager services file into your new Paceart System database. Type the location of your Services.lst file, or navigate to its location by clicking the paging feature of CardioVoice, you may leave the text box blank. 9. Click Next. button. If you do not use the 10. The Log File and Work Folder Location window allows you to enter locations for both the log file and work folder. The log file will store a history of the operations performed during the conversion. The default location is on your desktop in a file called Paceart System16-bit Import Wizard Log.txt. You can accept the default or click to navigate to a different file location. 11. The work folder that you specify is the location where a temporary copy of your MDB file is made. The default folder location is your temporary path. If you wish to place the temporary MDB file in another location, you can either enter directly or click to navigate to the location. Note: You will only have to specify a work folder if the structure of your database needs to be updated before performing the import. If the structure requires no update, this option will be grayed out. 12. Click Next. 13. The window allows you to set two options for MDB import, ECG strip compression verification, and strict date validation. ECG strip compression allows your ECG strips to take up half as much disk space without loss of data. When you perform an MDB import, your ECG strips will be compressed into your Paceart System database. If you select Verify ECG Compression, the import wizard will compare each imported, compressed ECG strip to the original ECG strip to verify that they are identical. Paceart System uses stricter date checking than that available in the 16-bit Paceart System. Because of this, you will be prompted to fix all dates that fall before January 1, 1753. You can apply even stricter date checking by selecting the Use Strict Date Validation check box. If you do this, you will be prompted for patient birth dates occurring

60 Paceart System Administrator's Guide Paceart Database Manager before January 1, 1860, event recorder dates before January 1, 1980, device implant and explant dates before January 1, 1960, and patient events occurring before January 1, 1980. 14. Click Next. 15. If you select Use Strict Date Validation and invalid dates were found you must verify or enter corrections. Make changes to the entry by highlighting it and either pressing the F2 key or by double-clicking the entry. 16. Click Next. 17. Confirm that you wish to modify the invalid dates in your MDB Database, click Yes. 18. Click Next to start the import. 19. Click Yes. 20. When the MDB import is finished, click Next. 21. Your Paceart System SQL Server database now contains the data contained in your MDB file. If you wish to view the import log file, click the Click here to open the import log file hyperlink at the bottom of the window. 22. Click Finish. Script schema The Paceart Database Manager gives you the ability to create an SQL Server script. With this script, you can recreate the schema of your Paceart System database on another database. If you are using SQL Server 2008 with the Paceart Database Manager you will need to change the compatibility level for the database before you create a script schema. Creating a script schema 1. To create a schema script, click the Script Schema icon. This will open the Script Schema window. 2. You can enter directly or click the button to navigate to the location where your script will be saved. By default, this is in the schema's folder for the current version of your Paceart System database. If you select to script the Roles and Users, the file will be called Create Roles And Users.sql. If you select to script the Database, the file will be called Create XX.X.sql, where XX.X is your current database structure revision level. 3. Use the Roles and Users option to create a backup script of your Paceart database's users, logins, and roles. This script will allow you to re-create your user, logins, and roles in the event that you need to restore your database. Users, logins, and roles are not backed up when performing a database backup, so it is important that you run this script if you are using roles and users on your Paceart database. To maintain security, passwords are not written to the script file. 4. The Database option should only be used if you are instructed to do so by Paceart Technical Support. Use the Database option to create a script that will re-create your Paceart database tables, stored procedures, triggers, views, and foreign keys. 5. Click OK. Changing the compatibility level for a SQL Server 2008 database 1. Open SQL Server Management Studio. 2. Run the following command: ALTER DATABASE <database name> SET COMPATIBILITY_LEVEL = 80;

Paceart System Administrator's Guide Paceart Database Manager 61 Delete strips The Delete Strips function of the Paceart Database Manager allows you to permanently delete ECG strips from the Paceart database. ECG strips usually use the most disk space of any item in the database. By deleting unnecessary strips, you can decrease the size of your Paceart database. Deleting strips 1. To permanently delete ECG strips in the Paceart Database Manager, click the Delete Strips icon. This starts the Strip Deletion Utility. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. This window allows you to apply two filters to the strips stored in your database to determine which strips will be deleted, the type of strip, and the date the strip was recorded. To set the Type of Strip filter, select from the following choices: All strips - All recorded strips will be deleted Front page strips - Only strips selected in the Paceart System client application to print on the front page of the report will be deleted. Second page strips - Only strips selected in the Paceart System client application to print on pages other than the front page will be deleted. Six second strips - Only strips equal to or less than six seconds will be deleted. Large strips - Only strips longer than six seconds will be deleted. 3. To set the Strip Record Date filter, type the date in the date field in the following format: MM/DD/YYYY. Strips recorded before this date that also meet the selected strip type criteria will be deleted. Note: You must be the only user logged into the database before proceeding to delete ECG strips. If you are not, you will be prompted to run the Active Connections tool. 4. When you have set your two filters, click Delete. The utility will calculate the number of strips that will be deleted, and you will be prompted with a window asking if you want to delete the strips. Click Yes. Rename database The Rename Database function of the Paceart Database Manager allows you to change the name of your Paceart System database. Renaming a database Note: You must be the only person logged into your Paceart database before attempting to change the name of the database. If you are not, you will be prompted to run the Active Connections tool. Note: All publications and subscriptions must be deleted on a database before you can rename it. 1. To change the name of your database in Paceart Database Manager, click the Rename Database icon. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server.

62 Paceart System Administrator's Guide Paceart Database Manager 2. Type the new name of your database into the text box. Your Paceart database name cannot contain spaces. 3. Click OK. Run script The Paceart Database Manager gives you a convenient way to run a script on a database. The Run Script window allows you to run an SQL script on your database. To run a script on your database in the Paceart Database Manager, click the Run Script icon. The script window will appear. Load or enter your SQL Script into the upper text window. The results will be displayed in the lower text window. Button Load Script Save Commands Clear Commands Execute Clear Results Save Results Close Function Loads a SQL Script from a file. Saves the SQL Script in the upper text window to file. Erases all text in the upper text window. Runs the SQL Script in the upper text window. Erases all text in the lower text window. Saves the results in the lower text window to a file. Exits the Run Script Window. Delete patients Note: The Delete Patients feature is only available in Paceart Database Manager version 3.30 and greater. Note: You must be the only person logged into your Paceart database before attempting to delete patients. If you are not, you will be prompted to run the Active Connections tool. The Delete Patient Wizard allows you to delete patients and their associated events from your Paceart System Database. This feature allows you to decrease the number of patients in your database to meet licensing requirements or database size requirements. Deleting patients 1. Click Delete Patients. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next. 3. Select the status and affiliation code filters for the patients you want to delete. You must enter a status code, an affiliation code, or both. If you enter a status code, all patients in your Paceart Database with the status code you specify will be deleted. If you enter an affiliation code, all patients in your Paceart Database with the affiliation code you specify will be deleted. If you make it a practice to give your patients status codes of "D" when they are deceased, or "L" if they are lost to follow-up, it will be very easy to remove these groups of patients periodically from your database. 4. Click Next.

Paceart System Administrator's Guide Paceart Database Manager 63 5. The Review Patients for Deletion window lists the patients that match the criteria of the filter. The patients that will be deleted are listed. You may click Back if you want to change the status or affiliation code. The Print button will bring up a print preview window that allows you to print a report containing information about the patients to be deleted. The Save button allows you to save the information contained in the form on this screen to a comma-separated value (CSV) file. The CSV file containing the patients to be deleted can be opened in a spreadsheet application, such as Microsoft Excel. 6. Click Next. 7. The Backup Patients for Deletion window allows you to choose a folder where the data of the patients you wish to delete will be exported before deletion. The data is exported in a format called BCP. In the event that you need to retrieve the deleted data, you can recover the data into a new database. It is important that you not only back up the data to a backup folder, but also back up the selected folder as part of your system backup procedures. Although it is not recommended, if you do not wish to back up the deleted patient data, check the Do not backup data option. Note: If you delete patients often and use the same folder, it is important to know that the BCP data will be overwritten. Go back and change your backup folder, or move the BCP data out of the selected backup folder before continuing. 8. Click Next. 9. Review your selections. Click Back if you want to change any selections. Then click Next. 10. Click Finish. Users Note: The Users feature is only available in Paceart Database Manager version 3.30 and greater. The Paceart Database Manager gives you the ability to create new users and maintain existing users in your Paceart database. To access this feature in the Paceart Database Manager, click Users. If you are using SQL Server 2008 with the Paceart Database Manager you will need to change the compatibility level for the database before you create users. Changing the compatibility level for a SQL Server 2008 database 1. Open SQL Server Management Studio. 2. Run the following command: ALTER DATABASE <database name> SET COMPATIBILITY_LEVEL = 80; Creating a new user 1. Click Users > New User. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next. 3. All users have to be associated with a server login. This window allows you to associate your new user with an existing or new login. To associate the user with an existing login, select it from the list. To associate the user with a new login, select <new> from the list.

64 Paceart System Administrator's Guide Paceart Database Manager 4. Click Next. 5. If you selected to create a new login, select which type of authentication you want to use: Windows authentication or SQL Server authentication. Windows: The SQL Server login information is taken from the user's Windows domain user ID and password and validated with Windows authentication. You will specify which account on the next window. This is sometimes referred to as Windows Integrated Security. SQL Server: The SQL Server login information is taken from the account you create directly in the database. The login is validated by SQL Server and does not use Windows Authentication. You will specify the login name and password on the next window. This is sometimes referred to as Standard Security. Note: If your operating system is Windows Vista, then you must use Windows authentication. 6. Click Next. 7. Depending on the authentication you choose, you will get one of the next two windows. If you select Windows authentication, select the Windows login to associate with your new user. If the login is not listed, you can type the name in the Add Name text box. If you add your own, use either of the following formats: Domain\UserName or Domain\GroupName. Note: It may take some time for the window to appear, depending on how many Windows users and groups exist in your domain and on your local Windows system. Note: You will not be able to add a Windows authenticated login if the given login is already a member of a Windows group and the group has already been assigned a login on the SQL Server. If you selected SQL Server on the authentication window, you need to create a new SQL Server login to associate with the new user. 8. Click Next. 9. Assign roles (a set of permissions) to your new user. The roles that appear in the Roles window are those created on your Paceart database. 10. Click Next. 11. Specify the user name for the new user you are creating. Type the user's name in the text box. 12. Click Next. 13. Review the user creation tasks, and then click Next. 14. If you need to create additional new users, click the Click here to create another new user link. If not, click Finish. Maintaining existing users In addition to creating new users, you can use the Paceart Database Manager to maintain your existing users on your Paceart database. Click the User icon in the Paceart Database Manager. On this window, you see can see icons for each user created on your Paceart database. The type of login authentication assigned to each user is shown by the icon (NT or SQL). To maintain a user, click that user's icon. The Maintain User window allows you to change the user's password. It also allows you to assign or un-assign roles for the user. After you have made the necessary changes for the user, click OK. Note: You can only change the user's password from this window if the user is assigned SQL Server authentication. If the user is using Windows Authentication, you must use one of the tools in Windows to change their Windows domain account information.

Paceart System Administrator's Guide Paceart Database Manager 65 Roles Note: The Roles feature is only available in Paceart Database Manager versions 3.30 and greater. The Paceart Database Manager gives you the ability to create new roles and maintain existing roles on your Paceart database. Roles are a group of permissions that can be assigned to users of the Paceart database. To access this feature in the Paceart Database Manager, click Roles. If you are using SQL Server 2008 with the Paceart Database Manager you will need to change the compatibility level for the database before you create roles. Changing the compatibility level for a SQL Server 2008 database 1. Open SQL Server Management Studio. 2. Run the following command: ALTER DATABASE <database name> SET COMPATIBILITY_LEVEL = 80; Creating a new role 1. To create new roles from the Roles wizard in the Paceart Database Manager, click New Role. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. Click Next. 3. Select the initial options for the role you are creating. The role type can be one of the following three options: Read Only: Will not allow update permissions or delete permissions. Update Only: Will allow update permissions but not delete permissions. Customize: Will allow both update and delete permissions. 4. The role type can be applied to one of the following table type options: Both: Role type will initially be applied to both the Base tables and the Lookup tables. Base Table: Role type will only be applied to the Base tables. Base tables store specific information about a patient, such as events, their devices, and their prescriptions. This information is specific to a particular patient. Lookup Table: Role type will only be applied to the Lookup tables. Lookup tables store lists of billing codes, CPT codes, devices diagnoses, doctors, insurance companies, medications, pager services, and text lookups. This information is not related to any specific patient. 5. After you have selected your initial role and table types, click Next. 6. This window breaks down the permissions that will be assigned for your new role on a table-by-table basis. The update and delete permissions are based on your selection in the previous window. You can modify the permissions further by selecting a table from the table list and then click the update or delete permission. When you select a table, a short description of the contents of the table will appear in the table description area. 7. Specify which users should receive the permissions set by your new role. If you are creating your roles before creating your users, you can assign roles to a user when you create the new user. 8. Click Next.

66 Paceart System Administrator's Guide Paceart Database Manager 9. Choose whether you would like the members of the new role to have the permission to view audit log information. The audit log tracks changes to the database. 10. Click Next. 11. Specify a name for your new role. It is good practice to give your role a descriptive name. 12. Click Next. 13. This window describes the tasks that will be performed to create your new role. To create your new role, click Next. 14. Click Finish. Maintaining roles 1. Click Roles in the Paceart Database Manager. 2. Click one of the role names. 3. Click Next. 4. The Table Permissions window allows you to make modifications to the permissions on a table-by-table basis. Select the table you wish to modify, and then change the update and delete permission text boxes. 5. Click Next. 6. Select which users are assigned to the role you are modifying. 7. Click Next. 8. Choose whether you would like the members of the new role to have the permission to view audit log information. The audit log tracks changes to the database. 9. Click Next. 10. This window describes the tasks that will be performed to create your new role. To create your new role, click Next. 11. Click Next. 12. Click Finish. Enable or disable auditing Note: The Auditing feature is only available in Paceart Database Manager versions 3.30 and greater. The Paceart Database Manager enables you to audit your database. In order to audit your database, you must first enable auditing. This will start logging changes to your Paceart database, so that you can run audit reports in the future. One way to quickly determine the state of auditing on your Paceart database is to highlight your database icon in the Paceart Database Manager. One of the database properties displayed in the left side of the window is Auditing Enabled. This property will either display true or false. Depending on the current state of auditing on your Paceart database, you will either be given the option of enabling auditing or disabling auditing. Enabling auditing 1. Click Enable Auditing. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server.

Paceart System Administrator's Guide Paceart Database Manager 67 2. If you wish to enable auditing on your Paceart database, click Yes. Disabling auditing 1. Click Disable Auditing. Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. 2. If you wish to disable auditing on your Paceart database, click Yes. Tools There are four tools that can be accessed from the Tools menu in the Paceart Database Manager: Client network configuration Server network configuration Change sa password Client network configuration Click Client network configuration in the Tools menu to start the Microsoft SQL Server Client Network Utility. This utility allows you to do the following: Create network protocol connections to servers Change the default network protocol Display information about the network libraries installed on the client Show and configure DB-Library information For more information on this utility, click the Help button in the utility to show the Microsoft Client Network Utility online help. Sever network configuration Click Server network configuration in the Tools menu to start the Microsoft SQL Server Network Utility. This utility allows you to do the following: Enable and disable network protocols for a SQL Server instance Force protocol encryption Enable a WinSock proxy Display information about the network libraries installed on the server For more information on this utility, click the Help button in the utility to show the Microsoft Network Configuration online help. Change password Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. SQL Server system administrators can change their password or the passwords of other logins by using the Change Password feature. To access this feature, click Change Password in the Tools menu in the Paceart Database Manager.

68 Paceart System Administrator's Guide Paceart Database Manager Enter the name of the login whose password you wish to change in the Login Name field. Enter the new password in the Password textbox. Confirm the password by typing it again in the Confirm Password textbox. Click OK to set the password. This utility will change the following passwords: The password of the login specified in the Login Name field. The replication agent connection passwords if the login name is used for any of these connections. Specifically, this means the following password changes occur depending on the type of computer you are running the Change Password dialog on. Publisher/Distributor: Changes the replication agent connection to the publisher from the distributor. Subscriber: Changes the replication agent connection to the subscription database and publisher/distributor database. If the password for the replication agent connection is modified on the publisher/distributor computer, all subscriptions to publications on this computer will need to have their publisher/distributor passwords changed. Active connection The Active Connection Management feature allows system administrators using the Database Manager to see all active connections to either the Microsoft SQL Server or the Paceart Database. To see all connections to the SQL Server, select Tools from the Database Manager menu, and then select Active Connections. Server Active Connections Management Window Note: If you are unable to see all of the columns, use the scroll-bar at the bottom of the window to slide horizontally in the table. The Active Connections window has the following columns: Column name SPID Login Database Computer Program Status Command CPU Time Disk I/O Last Batch What is shown in the column The system process identifier. The login name associated with the SPID. The database used by the SPID. The computer name of the client connection used by the SPID. The name of the application or the program that has invoked the SPID. The current status of the SPID. The last command run by the SPID. The cumulative time that the computer has spent processing the SPID. The number of reads and writes the SPID has made to the hard disk. The timestamp of the last activity of the SPID. The Active Connections window also has three buttons: Button name Refresh What the button does Click this button to re-query the SQL Server for the active connections.

Paceart System Administrator's Guide Paceart Database Manager 69 Button name Kill SPID What the button does Click this button to terminate the user process on the highlighted SPID in the table. Note: Use caution when performing a Kill SPID. You cannot kill system processes, and you cannot kill your own process. You should not kill critical processes such as: Awaiting Command Checkpoint Sleep Lazy Writer Lock Monitor Select Signal Handler Note: This feature is only available when the user logged into the Paceart Database Manager is a member of the System Administrators server role on the SQL Server. Close Click this button to close the Active Connections window. Database Active Connections Management There are many functions that the Paceart System Database Manager performs where it needs to be the only connection to the Paceart database. These functions are: Update Schema Rename Database Delete Strips Delete Patients BCP - Bulk Copy Import and Export When you encounter this scenario, you are given the ability to see all of the active connections to the database, and if necessary, the ability to kill the connections. The Active Connections window that you encounter behaves the same as the Active Connections window, with the exception that only connections to the Paceart database are displayed. Command Line Interface The command line interface feature allows you to run the startup functionality of the program from the command line. You can use this feature to create shortcuts that perform very specific tasks. For example, you could set up a command line to start the program, connect to a particular database as a given user, and click on your subscription. You could give this example shortcut the name ''Synchronize My Subscription'' and click this shortcut anytime you needed to execute this task. Command Line Switches The following table lists the command line switches available to you when starting the Paceart Database Manager.

70 Paceart System Administrator's Guide Paceart Database Manager Note: Characters appearing between the brackets ([ and ]) are optional. Switches -S[erver] -U[serID] -P[assword] -D[atabase] -N[oAutoConnect] -C[ommand]1 -C[ommand]2 -M[ultiple] Description Server Name User ID Password Database Forces connection dialog to appear Selects a command to run for the specified database Select sub-command to run Allow multiple instances of Paceart Database Manager to run Notes Will use the local server if not specified Use -U with no User ID to indicate Windows authentication -U and -P options will be ignored -D must also be specified If required by specified -C1 This will disable the MDB Import feature The command switches, C1 and C2, allow you to start the program at a particular point in the Paceart Database Manager by scripting the navigation of the icons. The following table shows the commands you can give for C1 and C2. -C[ommand]1 Publications Subscriptions MDB Import. Bulk Copy Script Schema Delete Strips Rename Database Run Script Delete Patients Users Roles -C[ommand]2 New Publication Any publication name you have set up on the database New Subscription Any subscription name you have set up on the database New User Any user name you have set up on the database New Role Any role name you have set up on the database Enable Auditing The commands are the names of the icon labels in the Paceart Database Manager.

Paceart System Administrator's Guide Paceart Database Manager 71 Examples Open the New Publication wizard on database Paceart_Database on the local server: pacedbm.exe -D Paceart_Database -C1 Publications -C2 New Publication Open the Run Script window on database Paceart_Database on server CORPDB. Connect using user id jdoe and password mysqlpassword: pacedbm.exe -S CORPDB -D Paceart_Database -U jdoe -P mysqlpassword -C1 Run Script Open a second instance of the Paceart Database Manager while one instance is currently running: pacedbm.exe -M Running the Paceart Database Manager from Command Line 1. Click Start > Run. 2. In the Run window, type "C:\Program Files\Medtronic\Paceart System Database Manager\PaceDBM.exe" <your switches here>. Note: If you installed the Paceart Database Manager in a location other than the default click Browse to navigate to your PaceDBM.exe location. 3. Replace <your switches here> with the switches needed to perform your operation. Note: Your switches must be typed outside the quotation marks that surround the path and filename of the Paceart Database Manager. 4. Click OK to run the Paceart Database Manager. Creating Shortcuts to the Paceart Database Manager 1. Right-click with your mouse on an open area on the desktop. Click New, then click Shortcut. 2. Fill in the text box with the same path, filename, and switches that you used in the Run window. If you need to navigate to your location of PaceDBM.exe, click Browse. 3. Click Next. 4. Type a name for the shortcut. It is helpful to name your shortcut with a name descriptive of the action you are performing. 5. Click Finish. Troubleshooting If you get a compatibility error message when you are creating a Script Schema, you need to change the compatibility level by running the following command in SQL Server Management Studio: ALTER DATABASE <database name> SET COMPATIBILITY_LEVEL = 80;

Chapter 5 Database Replication Topics: Your Paceart System has the ability to utilize a feature of Microsoft SQL Server called Database Replication. Replication is a set of technologies When to use replication for copying and distributing data and database objects from one database Replication topologies to another and then synchronizing between databases for consistency. Replication security Using replication, you can distribute data to remote or mobile users over SQL server synchronization a local area network, dial-up connection, or the Internet. Replication also Synchronization management and allows you to enhance application performance, physically separate data replication conflicts Troubleshooting based on how it is used, or distribute database processing across multiple servers.

74 Paceart System Administrator's Guide Database Replication When to use replication Scenarios where replication may be used with your Paceart System include the following: Sites with notebook computers that are periodically logged off the network and run remotely. A multiple-site user with no WAN link between sites. A site where the user would like to use replication as a means of backup to an alternate computer. A site with an unreliable network where the user would like workstations to be able to run locally on demand. Replication topologies There are three possible topologies that can be set up and maintained by the Paceart Database Manager: Central Publisher, Publishing Subscriber, and Central Subscriber. Paceart technical support staff should be consulted in selecting the topology that will best suit the needs of your site. Other more complex topologies exist, but must be set up using Microsoft SQL Server Enterprise Manager, which is only available to clients who purchase full licenses of SQL Server. If you decide that a more complex topology is required at your site, Paceart technical staff should be consulted to determine if the manual setup of the replication topology could be integrated with the built-in utilities for replication found in the Paceart Database Manager. Central publisher The Central Publisher replication topology is the most common. In this scenario, one computer is designated as the Publisher, and one or more computers are acting as Subscribers. The Subscribers can either be computers on a local area network, or computers at a remote site. This scenario would be used at sites that have notebook computers that must be undocked from the network to work remotely, or sites that have multiple locations connected by a slow (or expensive) network link. Figure 9: Central publisher

Paceart System Administrator's Guide Database Replication 75 Publishing subscriber The Publishing Subscriber replication topology is used by customers with multiple sites that are connected by a slow (or expensive) network link. In this scenario, one computer is designated as the main Publisher and Distributor, Publisher A. At the remote site, a second computer, Publisher B, is configured to subscribe to Publisher A. Publisher B is configured to publish its data that it receives from Publisher A, and will act as a Publishing Subscriber. All computers at the remote location can now subscribe to the local copy of the publication stored on Publisher B. This Publishing Subscriber acts as a gateway to Publisher A, and eliminates the need for individual connections from each Subscriber. Figure 10: Publishing subscriber Central subscriber The Central Subscriber replication topology is used by customers who want to maintain multiple Paceart System databases. An example of this is monitoring services that wish to keep client databases separate. In this scenario, each individual client site would publish its data. At the site that will serve as the central repository for all of the data, a separate database will be created for each client, and subscriptions will be created in each database to the corresponding client publication. By making the central computer the Subscriber, it gives that computer more control over when synchronization will take place with the various client sites

76 Paceart System Administrator's Guide Database Replication Figure 11: Central subscriber Replication security Note: Paceart Systems prior to version 3.31 default to using the sa SQL Server authentication login for areas where a login is required for replication. Using logins other than sa require the use of Microsoft SQL Server Enterprise Manager. SQLServerAgent service The SQLServerAgent is a Windows service that executes jobs for your SQL Server, including replication jobs. If you will be performing replication, it is important that you specify an account that the service should use to log in to your system, and not rely on the Local System account. 1. Click Start. 2. Click Settings. 3. Click Control Panel. 4. Double-click Administrative Tools. 5. Double-click Services. 6. Double-click SQLSERVERAGENT. 7. Click the Log on tab. 8. Select the This account option, and then specify the login name and password. You will need to type the password one additional time in the Confirm Password box. 9. Click OK. Publisher/distributor security The Paceart Database Manager configures your Publisher/Distributor security the first time you create a publication on your SQL Server if the SQL Server has not already had its replication enabled through programs outside of the Paceart System. The Paceart System New Publication Wizard will set up the Distributor Replication Agent Login. This is the connection that the distribution database uses to connect to the publication database. You can choose to use

Paceart System Administrator's Guide Database Replication 77 the Windows authenticated login of your SQLServerAgent service running on your Publisher, or specify an SQL Server login and password. Subscriber security Subscriptions under Microsoft SQL Server replication are require three different logins when performing a synchronization. The first login is to the Subscription database, the second login is to the Distribution database, and the third login is to the Publication database. Since the Paceart System assumes local distributors (i.e., the Distribution and Publication databases reside on the same physical SQL Server), the login information for the Distribution and Publication databases is identical. When you run the Paceart System New Subscription Wizard, you are asked to specify the login information for the Subscription Database on the Subscriber Login screen. You are also asked to specify the login information for the Distribution and Publication databases on the Publisher/Distributor Login screen. For these logins, you can choose either Windows Authentication by Impersonating the SQL Server Agent account, or SQL Server Authentication by specifying a login that resides on the SQL Server. If you choose to impersonate the SQL Server Agent account, you will be using the log in information specified in the SQLServerAgent service on the Subscription computer when connecting the Subscription database, or the Publication/Distribution computer when connecting to the Publication and Distribution databases. Note: If your operating system is Windows Vista, then you must use Windows authentication. Setting up replication Setting up replication for use with your Paceart System involves performing the following tasks: Establishing a connection Configuring publishing and distribution Creating publications Creating subscriptions Applying the initial snapshot of data to the Subscriber If you wish to perform advanced replication setups, you can make use of SQL Server tools (Enterprise Manager for SQL Server 2000 and Management Studio for SQL Server 2005 and 2008). Note: Medtronic Paceart requires that all Paceart System deployments using replication must have full versions of SQL Server on every computer participating in replication. SQL Server Express and MSDE cannot be used as publishers in a replicated environment. Establishing the connection The first step in setting up replication is to ensure that you have a connection between your publishing and subscribing computers. When you are finished with this step, you should be able to see the other computer on your network. The connection can be in the form of a permanent network connection, such as an established LAN or WAN. If your Paceart System configuration does not have a permanent LAN or WAN, replication can still be achieved by using Windows Dial-Up Networking. This type of connection should be used as a last resort if other permanent, faster connections do not exist in your Paceart System environment. You must make sure both computers have the appropriate network protocols installed in their Windows Networking Components. Also, you must make sure that the instances of SQL Server that are running on both computers can communicate with each other. Although most SQL Servers will be able to connect to each other using the default settings, special installations that use uncommon network protocols or ports may need to be configured using the Client Network Configuration or Server Network Configuration tools in the Paceart Database Manager. Setting up a Windows Network is beyond the scope of this guide. Please consult your Microsoft Windows Networking documentation or consultant if you have questions on creating and configuring a Windows Network.

78 Paceart System Administrator's Guide Database Replication Replication using the Paceart Database Manager The replication wizards in the Paceart Database Manager make it easy to set up replication. The Paceart Database Manager creates replication with the following features: Merge Replication - Used when subscribers are disconnected for periods of time from the publishing database, data is updated at the subscriber, and conflicts are handled at the row level. Local Distributor - The distributor and publisher are located on the same physical server. In the Paceart Database Manager, when you create a publication on a computer, that computer also becomes a distributor. The opposite of a local distributor is a remote distributor. Pull Subscriptions - The subscriptions are created on the subscriber computer. The subscriber chooses when the data will be synchronized, either by scheduling synchronization or performing it on demand. The opposite of pull subscriptions are push subscriptions. Snapshots Stored In Native SQL Server Format - All publications created in the Paceart Database Manager have snapshots stored in native SQL Server format. This requires that all subscribers must be servers running SQL Server. Anonymous Subscriptions - Detailed information about the subscriptions and subscribers are not stored on the publisher/distributor. In the Paceart Database Manager, all subscriptions are set to anonymous. Synchronization Enabled with Windows Synchronization Manager - All subscriptions created in the Paceart Database Manager will automatically be set up in Windows Synchronization Manager. Subscription Security - All subscriptions created in the Paceart Database Manager are set to login to the publisher/distributor using SQL Server Security and either the specified SQL Server authenticated login, or by impersonating the SQLServerAgent service on the publisher/distributor. If you set up replication using the wizards in the Paceart Database Manager, your replication will be set up as merge replication with a local distributor and pull subscriptions. Configuring publishing, distribution, and publications with Paceart Database Manager In the Paceart Database Manager, publishing and distribution is configured at the same time you create your first publication. The New Publication Wizard will set up a local distributor in addition to creating a publication. To configure publishing, and distribution, and create a publication on your Paceart System Database, click the New Publications icon in the Paceart Database Manager while connected to your publishing database. This starts the New Publication Wizard. Creating subscriptions and applying the initial snapshot with Paceart Database Manager In the Paceart Database Manager, you can create subscriptions to publications on your subscriber database. When creating the subscription, you will also have the opportunity to apply the initial snapshot. To do this, click the New Subscription icon in the Paceart Database Manager while connected to your subscriber database to start. This starts the New Subscription Wizard. Replication using SQL Server Enterprise Manager Note: We recommend that you use the Publication and Subscription wizards in the Paceart Database Manager to set up your initial publications and subscriptions. These wizards perform actions that the replication wizards in SQL Server Enterprise Manager do not provide, including setting the table relationships on the subscriber as NOT FOR REPLICATION and do not publish DRI. Paceart wizards also preserve the security permissions on the subscriber database when it is initialized with the schema from the publisher. Once the initial publications and subscriptions have been set up, if changes to the default settings are required, they can be made with SQL Server Enterprise Manager. As an advanced alternative to using the Paceart Database Manager, you can use Microsoft SQL Server Enterprise Manager to set up your replication. Enterprise Manager gives you advanced functionality when designing your replication topology. Among these advanced features, you can choose different replication methods, including merge, transactional, and snapshot replication. You can set up a remote distributor, where the distributor and publisher are two different computers.

Paceart System Administrator's Guide Database Replication 79 Finally, you can set up your subscriptions to be either push subscriptions or pull subscriptions. These are just some of the many advanced features available in Enterprise Manager that are not available in the Paceart Database Manager. Enterprise Manager gives you access to five replication wizards, four of which are for setting up your replication. To access the wizards in Enterprise Manager, select your database from the tree. Then select Tools > Wizards. Expanding the Replication heading will give you access to the replication wizards. These wizards allow you to configure your publisher and distributor, create publications, and create subscriptions. Choose the wizard you wish to run and click OK. Even the most advanced SQL Server users will find it convenient to use the Paceart Database Manager for performing specific Paceart functions such as creating a Paceart System database, publication, or subscription. After these are created using the Paceart Database Manager, advanced users can switch to the Microsoft SQL Server Enterprise Manager for advanced management of their Paceart databases. For more detailed information on using replication in Microsoft SQL Server Enterprise Manager, consult your SQL Server Books Online. This online help ships with your SQL Server. SQL server synchronization Once you have replication set up on your Paceart database, you will need to perform synchronization. Synchronization is the act of moving data from the publisher to the subscriber, and from the subscriber to the publisher, after the initial snapshot has been applied. Under Merge replication, which is the default replication method in the Paceart Database Manager, synchronization means that data updates made on multiple subscriber computers are merged, any conflicts are detected and resolved, and data converges to the same values in both the publisher and subscriber databases. Using Pull subscriptions, the default subscription method in the Paceart Database Manager, synchronization can either be scheduled to occur at certain times or on-demand. The following sections discuss the three different tools that can be used for synchronization: Paceart Database Manager Microsoft SQL Server Enterprise Manager Windows Synchronization Manager Any of these tools will allow you to perform database synchronization. Certain tools have more advanced features than others. Some of the tools will only work in certain environments, so check to see that the tool you choose will work in your specific Paceart environment. Synchronization using the Paceart Database Manager The Paceart Database Manager can be used to perform synchronizations. It is limited to only performing on-demand synchronizations. 1. Click Subscriptions, and then click the individual subscription icon that you want to synchronize. 2. To initiate synchronization, click Synchronize Now. Note: The update publisher distributor option is only available on Paceart versions 3.30 and greater. 3. You can update your subscription with the new password by clicking Update Password. 4. Enter the new password in each textbox and click OK.

80 Paceart System Administrator's Guide Database Replication Synchronization with SQL Server Enterprise Manager You can use SQL Server Enterprise Manager to synchronize your subscriptions. For more detailed information on using synchronization in Microsoft SQL Server Enterprise Manager, consult your SQL Server Books Online. This online help ships with your SQL Server. 1. Navigate to your subscription folder under your database in the tree. 2. Select the subscription that you want to update. 3. Click Action in the toolbar, and then click Start Synchronizing. Synchronization with Windows Synchronization Manager Windows Synchronization Manager is installed with Microsoft Windows 2000 and anywhere Microsoft Internet Explorer 5.0 or higher is installed. The majority of Paceart installations use Windows Synchronization Manager to manage their database synchronizations. Once your subscriptions appear in Windows Synchronization Manager, you can synchronize your subscriptions manually via on-demand synchronization, automatically at logon or logoff from the network, or automatically via scheduled synchronization. 1. To start Windows Synchronization Manager, click Start. 2. Select Programs. 3. Click Accessories, and then click Synchronize. Getting subscriptions to appear in Windows Sychronization Manager If you created your subscription using the Paceart Database Manager, your subscriptions will automatically appear in Windows Synchronization Manager. If you created your subscriptions using SQL Server Enterprise Manager, you must specify that your subscription appear in Windows Synchronization Manager. 1. Open SQL Server Enterprise Manager. 2. Navigate to your subscription by selecting the SQL Server name, database name, and replication folder. 3. Select the subscription. 4. Click Action - Properties. 5. Select the Synchronization tab. 6. Check the Enable synchronization using Windows Synchronization Manager option. Performing on-demand synchronization On-demand synchronization is a one-time synchronization with the master publication database that is initiated by the user. 1. Open the Windows Synchronization Manager. 2. Select the check boxes next to the subscriptions you want to synchronize. 3. Click Synchronize. 4. When synchronization has finished, click Close.

Paceart System Administrator's Guide Database Replication 81 Configuring sychronization on log on/log off You can configure your subscriptions to automatically synchronize when you log on to your network, log off the network, or both 1. Open the Windows Synchronization Manager. 2. Click Setup. 3. Select the network connection to which this automatic synchronization on log on and/or log off should apply from the list. For example, if you want to set up automatic synchronization when you connect to your local area network, select LAN Connection. 4. Select the check boxes next to the subscriptions you want to set up for automatic synchronization on log on and/or log off. 5. Select the appropriate check boxes to set up automatic synchronization when you log on to your computer, log off of your computer, or both. You can also select the option to have the Synchronization Manager ask you before performing synchronization. 6. Click OK. 7. Click Close. Configuring scheduled synchronization Windows Synchronization Manager has an easy-to-use Scheduled Synchronization Wizard that allows you to set up your synchronization on a schedule. This option is often used if you have replication set up on your network and you wish to synchronize your databases unattended at a specific time, for example, every evening at 11 PM. 1. Open Windows Synchronization Manager. 2. Click Setup. 3. Select the Scheduled tab. 4. Click Add. This will start the Scheduled Synchronization Manager. 5. Click Next. 6. On this page, you must select three items: The network connection that the synchronization will use to transfer the data between the publisher and subscriber. The item to synchronize. Select the subscription or subscriptions from the list that you wish to include in your scheduled synchronization. Choose whether or not you want to automatically connect the network connection if it is not available. 7. Click Next. 8. Select the start time, frequency, and start date of your scheduled synchronization. 9. Click Next. 10. Give your scheduled synchronization a descriptive name and click the Next button. 11. Click Finish. Your scheduled synchronization will appear in the Current Synchronization Tasks window. Current Synchronization Tasks window From the Current Synchronization Tasks window you can perform tasks by clicking the following buttons: Button Add What the button does Add more scheduled synchronizations.

82 Paceart System Administrator's Guide Database Replication Button Remove Edit What the button does Delete the selected scheduled synchronization. Edit the selected scheduled synchronization's options. This will also give you access to advanced scheduled synchronization options not available in the Scheduled Synchronization Wizard. The first time you run a scheduled synchronization, you may see a dialog box allowing you to choose whether you want the scheduled synchronization to run unattended from then on. If you want it to run unattended, select the Do not show me this again check box. From the next window, you can specify the subscriber login, the publisher login, and the distributor login. This information usually will be pre-filled with information that was specified when you created the subscription. Make any necessary changes to this information and click OK. Synchronization management and replication conflicts Once you have set up replication and synchronization, you may want to periodically administer the synchronization, verify that your synchronizations are succeeding, and where necessary, resolve synchronization conflicts. Clicking on an existing publication in the Publications window in the Paceart Database Manager will bring up the Publication Information window. The window displays the Synchronization History for the publication. The topmost node in the tree represents the publication. The child nodes to the publication represent each subscription to the publication. The subscription names are based on the subscribing server name in the format \\ServerName\DatabaseName. The child nodes of each subscription represent each time the subscription was synchronized with the Publisher. These names are based on the date and time the synchronization began and the outcome of the synchronization. The child nodes of the synchronizations represent the individual steps that occurred in the synchronization process. There names are based on the time they occurred and a text description of the action that occurred. The Refresh History button will cause the synchronization history to be updated and displayed in the Synchronization History window. Microsoft Replication Conflict Viewer Resolve Conflicts on the Publication Information window opens the Microsoft Replication Conflict Viewer. This viewer helps you view and resolve conflicts that may have occurred during replication synchronization. Conflicts occur when the same data is modified at two separate servers, for example, at a Publisher and Subscriber, or at two different Subscribers. The following types of conflicts can occur: Update and insert conflicts: This conflict happens when the same data is changed at two locations. One change wins, the other one loses. For these conflicts, you have the option to keep the existing data (the data that won) or overwrite the existing data with the data that conflicted with it (the losing data). If you keep the existing data, it remains in the replica that won and the Microsoft Replication Conflict Viewer adds it to the replica whose update or insert operation initially lost. If you overwrite the existing data with the conflicting data, the replicas are changed to include the data that was originally lost. Delete conflicts: This conflict occurs when the same row is deleted at one location and changed at the other.

Paceart System Administrator's Guide Database Replication 83 Conflicts are automatically resolved using the conflict resolver selected when the publication or subscription article was created. As conflicts are resolved during synchronization, the data from the losing row is written to a conflict table in the database. The Replication Conflict Viewer allows you to review these conflict records and, potentially, modify your data. By default, when the Microsoft Replication Conflict viewer opens, it will be synchronized to the Publisher server, the publication database, and the publication currently being viewed. If there are any data conflicts, each table with conflicts will be listed, along with a count of the conflicts that occurred. To view these conflicts, click View. This will open up a window showing more information about the conflict. When you resolve a conflict using Replication Conflict Viewer, you can choose to accept the original resolution or submit an update to the data based on the winning or losing row. In each instance, the logged conflict row is deleted from the conflict table. Thereafter, you should periodically review conflicts to help reduce the size of the conflict tracking tables. Replication Conflict Viewer options The following options are available in the Replication Conflict Viewer dialog box for merge publications. Option Reason for conflict Show only columns with conflicts Show all columns Show Show or edit for resolution Keep winning change Resolve with this data Postpone resolution Log the details of the conflict for later reference What the option does View the reason for the conflict, including where data modifications occurred. Select to display only those columns where data modifications conflict. Select to show all solumns regardless of whether there is a conflict. Select Conflict Winner or Conflict Loser to view the data modivications made by the winner or loser that caused the conflict. Select Conflict winner or Conflict Loser to view or edit the data modifictions made by the winner or loser that caused the conflict. Select to keep the winning change. The losing change will be disregarded and the winning change will be propagated to the other servers in the replication topology. Select to resolve the conflict with the data listed. This data will be accepted and proopagated to the other servers in the replication topology. Postpones any resolution to the conflict and closes the Replication Conflict Viewer for this table. Logs the details of the conflict in system tables. Troubleshooting If Windows Synchronization Manager cannot be found, search your Windows directory and run the mobsync.exe program. If Windows Synchronization Manager does not appear in your start menu, and you do not have the Mobsync utility, upgrade your version of Internet Explorer to version 5.0 or greater.

Chapter 6 Paceart System Security and Privacy Topics: Your Paceart System data security, integrity, confidentiality, and availability are important. The Health Insurance Portability and Accountability Act Paceart System security (HIPAA) and other laws have brought these topics to the forefront. This Paceart System privacy chapter describes the security and privacy measures that you can deploy with your Paceart System. It describes the many security and privacy features that have been built into the Paceart System. These features can assist you in securing your Paceart System and ensuring the privacy of the data that is contained in your Paceart System.

86 Paceart System Administrator's Guide Paceart System Security and Privacy Paceart System security The Paceart System uses the built-in security provided by an SQL Server or a Windows-based server. Security consists of roles, users, logins, and Paceart login profiles. If you wish to use security on your Paceart System, you must configure the security for your particular environment. Database roles defined A database role is a set of permissions that can be applied to a user or group of users. In the Paceart System, you can create roles that grant or deny update and delete permissions on a table-by-table basis. Read-only roles can also be created by denying both the update and delete permissions. You can create permissions on both the Paceart Database lookup tables and the Paceart Database base tables. The Paceart System New Role Wizard is used to create database roles on an SQL or Windows based server. Note: You can also create roles using Microsoft SQL Server Enterprise Manager, if you have the full version of SQL Server. For more information on this, consult Microsoft SQL Server Books Online. Logins defined Logins are simply login names and passwords. Logins are created on your server at the server level. This means that if you have multiple databases on your server, the logins you create can be used by all of the databases on your server. When you create a login on your server, you can choose the login to use either Windows authentication or server authentication. Note: Windows Authentication is sometimes referred to as 'Windows 2000 Authentication.' We will use the generic term Windows Authentication. If you choose to use Windows authentication, you will use the logins that you have already created on your Windows domain. These logins can be either single user logins or group logins. Because the information about these logins already exists on the Windows domain, there is less setup work and ongoing maintenance than server authentication. You still have to create a login on your server, but you can simply map this login to an existing Windows login, saving you the trouble of creating the login name and password. In addition, when you choose Windows authentication, the user does not have to log in to the database if they have already successfully logged in to Windows. Their authentication information is passed to server automatically. If you choose to use server authentication, you have to specify a login name and password when you create the login on your server. Your Paceart users will have to manually log in to the Paceart database. Note: If your operating system is Windows Vista, then you must use Windows authentication. In the Paceart Database Manager, logins are created and attached to a user account at the same time you create a user in the Paceart System New User Wizard. Note: You can also create logins using Microsoft SQL Server Enterprise Manager, if you have the full version of SQL Server. For more information on this, consult SQL Server Books Online. Users defined A user account is an entity that is set up on your Paceart System database. User accounts are defined on the database level. If your SQL Server has multiple databases, you must define users on each database. User accounts are linked to server logins and can be assigned database roles. You must assign a server login that you have created on your server to each of your users. You also have the option of assigning a database role or multiple roles to your users.

Paceart System Administrator's Guide Paceart System Security and Privacy 87 The Paceart System New User Wizard creates a user, creates or assigns a login, and assigns roles to your new user account. Note: You can also create users using Microsoft SQL Server Enterprise Manager, if you have the full version of SQL Server. For more information on this, consult SQL Server Books Online. Paceart login profiles defined In addition to the security provided by Windows and SQL Server, the Paceart System adds an additional component known as login profiles. A login profile allows you to associate a database connection with a user account and operator name. This is done using the Paceart Login Profile Manager. Paceart Login Profile Manager The purpose of a login profile is to associate a server, login method, database name, and operator name. You can create a one-to-one relationship with your login profiles and users, creating one login profile for each user; or you can create a one-to-many relationship, creating one login profile that is used by many users. The advantage of using a one-to-many strategy is simpler maintenance. You will not have to add additional profiles every time you add a user. The disadvantage of a one-to-many strategy is that your users will have to retype their Operator Name in the text field on the login screen each time they start the Paceart System. Figure 12: Paceart System login screen From the login screen, choose a login profile. To create additional profiles or edit existing profiles, click the button next to the login profile drop-down list. This will open the Paceart Login Profile Manager. When you are finished making changes, click OK.

88 Paceart System Administrator's Guide Paceart System Security and Privacy Figure 13: Paceart Login Profile Manager New Rename Delete Profile Available for All Users SQL Server Login Method Click to create a new login profile. Click to rename a highlighted login profile. Click to delete a highlighted login profile. Click this check box to allow the highlighted login profile to be available to all users on that computer. Select the SQL server that has the database that the highlighted login profile will use. Click the button to start the Microsoft SQL Server Client Network Utility. Select the login method for the highlighted login profile. Use Windows Authentication - Select this option if you want the login profile to be associated with a Windows authentication user account that has been set up on your Paceart Database. The username and password will be passed automatically from Windows, using the information supplied with the user logged in. Use a specific user name and password - Select this option if you want the login profile to be associated with an SQL Server Authentication user account that has been set up on your Paceart Database. You will need to specify the User Name and Password of the SQL Server user account. You can also check the Save Password option if you want the password to be remembered. Note: If your operating system is Windows Vista, then you must use Windows authentication. Database Name Select the Paceart database you want to associate with this login profile.

Paceart System Administrator's Guide Paceart System Security and Privacy 89 Operator Name Enter the name of the person that is associated with the highlighted login profile (optional). This name will be printed on Paceart reports. If more than one user will be associated with the login profile, leave the operator name blank. Setting up Paceart System security The first step is to define your role-based security. Do you want to use role-based security in your organization? Even in smaller organizations, role-based security can give you control over who can modify and delete data. Think of the different permissions that you wish to assign to users or groups of users. For each of these permissions, create a role using the Paceart System New Role Wizard in the Paceart Database Manager. Your next big decision is what type of logins you want your user accounts to use. Your choices are either to create SQL Server authenticated logins or Windows authenticated logins. The deciding factor in this choice should be whether or not you are using a Windows domain and Windows authentication in your current network. If you are, use Windows authenticated logins. If you do not have a Windows domain, use SQL Server authenticated logins. Note: If your operating system is Windows Vista, then you must use Windows authentication. If you will be using Windows authenticated logins, you can save a lot of setup and ongoing maintenance time by setting up Windows group accounts on your domain. Create one group account to correspond to each of the roles you have defined. By doing this, you will only need to create a user in Paceart Database Manager for each Windows group instead of for each of your users. Whether you decide to create user accounts using server authenticated logins or Windows authenticated logins, you will need to create these users with the Paceart Database Manager. If you create server authenticated users, you will have to create the login by specifying a login name and password. If you create Windows authenticated users, you can simply attach an existing Windows domain login to the user. Use the Paceart System New User Wizard to create these users, specify authentication, create or attach logins to the users, and assign roles to the users. The last step is to create your Paceart Login Profiles. If you are using server authenticated user accounts, you will need to create a login profile for each user's account. If you are using Windows user/group accounts, you can either create a profile for each user, or have your users share one profile. If you decide to have your users share one profile, your users will have to type their name in the Operator Name text box each time they log in to the Paceart System client application. This operator name will then be printed on Paceart reports. Local Security Policies During installation of the Paceart System, the installation program will automatically modify security policies in your Windows Security local groups. The installation program will make the following changes: Members of the Everyone group will be granted write access to the two installation directories of the Paceart System. The first directory is C:\Program Files\Common Files\Paceart Shared. The second directory is C:\Program Files\Medtronic\Paceart System. However, this second directory may differ depending on the installation directory chosen in the installation program. Members of the Users group will be granted permission to start and stop the device driver for the Paceart 12-Lead ECG/TTM Parallel Port Module. Members of the Everyone group will be granted write access to keys in the following Windows registry path: HKEY_LOCAL_MACHINE\Software\Paceart. Changing passwords in the Paceart System client application The Paceart System client application allows Paceart System users to change their passwords from the login screen.

90 Paceart System Administrator's Guide Paceart System Security and Privacy Figure 14: Change Password window Note: Users are only allowed to change their password if their login uses SQL Server authentication. Note: If the user is using the 'sa' SQL Server login, they will not be able to change the 'sa' password from this window. The user can only change the 'sa' login password using the Paceart System Database Manager. 1. Make sure that the Login Profile that is selected contains the login name whose password you wish to change, or enter the user name manually. 2. Click the Change Password button to open the Change Password window. 3. The user will enter their old password, new password, and then enter the new password once again in the Confirm Password text box. Paceart System privacy The Paceart System has been designed to assist you in protecting Protected Health Information (PHI), included under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and other laws. The Paceart System has implemented security features to assist you in protecting data integrity, confidentiality, and availability in the following areas: Access and Authorization Control Audit Control Entity Authentication Data Authentication Patient Access Data Export and PHI Note: Many of the following features available in the Paceart System related to PHI are only available if enabled by the end user. Access and authorization control The Paceart System has implemented role-based access and authorization controls. By defining roles in the Paceart Database Manager and assigning these roles to users or groups of users, you can control whether these users are allowed to update or delete certain types of data. Note: The button and form lockout based on role feature is only available on Paceart System versions 3.30 and greater. If a user is not allowed to update or delete data, certain buttons and user interface forms in the Paceart System are disabled. If a user does not have update permissions on a lookup table, Add and Save will be disabled. If a user does not have delete permissions on a lookup table, Delete will be disabled. If a user does not have update permissions on data that is displayed in a user interface form, the user can click on the form, but they

Paceart System Administrator's Guide Paceart System Security and Privacy 91 will not be able to change the data. If a user does not have delete permissions on data that is displayed in a user interface form, they will not be able to delete data in the form. Audit control Paceart can track the following actions: Opening patient records Viewing patient demographic information, device information, medication/prescription information, implant information, and follow-up information Generating reports for printing, faxing, emailing, or exporting Adding, modifying, or deleting information in the Paceart database You can view the tracked information in the Audit Log Viewer. When changes are made to information in the Paceart database, the audit log captures the old value, the new value, the user's name, the user's computer, and the date and time the change was made. Opening the Audit Log Viewer Note: The Audit Log and Audit Log Viewer features are only available on Paceart System versions 3.30 and greater. 1. Make sure that auditing is enabled on your database in the Paceart Database Manager, and that you are not a member of a role that is restricted from seeing audit log information. 2. Click the Paceart System icon to open Paceart. 3. Log in, connecting to the database on which you wish to view the audit log. 4. If you already have patient records open, you will need to click the Main tab. 5. Click the Utilities tab. 6. Select Audit Log Viewer under the Tools folder. The Audit Log Viewer opens. Audit Log Viewer window This window is divided into three parts: Search Criteria - this section is used to enter filters to search for particular audit log events. Results - this table is populated by the events matching the search criteria you specify. Details - clicking an entry in the results table will show detailed information about the event in this section. Search Criteria You can enter search criteria to limit the audit log event results that are returned to you. To return all results, simply leave the search criteria text boxes blank and confirm insert, update, and delete check boxes are checked. To narrow your results, enter one or more of the following search criteria: Name: Select a patient name to only show audit log entries for one patient. Table Name: Select a table name from the drop-down list to limit your results to a particular database table. Column Name: Select a column name from the drop-down list to limit your results to a particular database column. Modified By: Select a login name from the drop-down list to limit your results to modifications made by a particular user. Computer Name: Select a computer name from the drop-down list to limit your results to modifications made from a particular computer. Start Date/Time: If you enter a date and time, audit log entries occurring after this timestamp will be returned in the results.

92 Paceart System Administrator's Guide Paceart System Security and Privacy End Date/Time: If you enter a date and time, audit log entries occurring before this timestamp will be returned in the results. Insert Checkbox: Check this box to include insert database events. Insert events are created when a new entry is added to the database. Update Checkbox: Check this box to include update database events. Update events are created when an existing database entry is modified. Delete Checkbox: Check this box to include delete database events. Delete events are created when an entry is deleted from the database. After entering your search criteria, click Search to search the audit log for entries matching your search criteria. Click Refresh to re-query your audit log and repopulate the search criteria drop-down lists. Results and Details The Results table is populated with the audit log entries matching your search criteria. If you would like more information about an entry in the Results table, highlight it. This will populate the Details section. The following informational fields are shown for an audit log entry in the Results and Details sections: Name: Displays the patient name or doctor name for particular database tables. Description: Gives additional information, where available, for the data that was modified. Table Name: Name of the Paceart database table where the modification occurred. Column Name: Name of the Paceart database column where the modification occurred. Table GUID: Global Unique Identifier (GUID) of the Paceart database table where the modification occurred. Old Value: Value stored in the Paceart database before the modification. New Value: Value stored in the Paceart database after the modification. Operation: The database event type (insert, update, or delete) that caused the event to be logged. Modified By: Login name of the user who performed the modification. Modified Date: Date and time indicating when the modification occurred. Computer: Name of the computer from which the modification occurred. If you wish to have a printed report listing the detailed information for each of the entries in your Results table, click Report. Entity Authentication The Paceart System has implemented entity authentication features. You can configure user identification and passwords for your users. The Paceart System client application also has an automatic logoff feature that will automatically log out users after a certain period of inactivity. Configuring automatic logoff Note: The automatic logoff feature is only available in Paceart System versions 3.30 and greater. In the Paceart System client application, you can configure the number of minutes of inactivity before automatic logoff. 1. Click the Paceart System icon to open Paceart. 2. Log in to connect to your Paceart database. 3. If you already have patient records open, click the Main tab. 4. Click the Utilities tab. 5. Select Global configuration options under the Tools folder. 6. Click the Miscellaneous 1 tab.

Paceart System Administrator's Guide Paceart System Security and Privacy 93 7. Set the Idle Minutes before AutoLockout to the number of minutes of inactivity you want before the Paceart System automatically logs the user off. If the value is set to 0, the Paceart System will never automatically log users off. 8. Click Close. Data authentication The Paceart System has implemented a feature for data authentication. Every time ECG strip data is stored in the database, a cyclic redundancy code (CRC) is calculated and stored with the data. When the ECG strip data is retrieved from the database, the CRC is calculated again and compared to the stored CRC. If the new CRC matches the stored CRC, the ECG data passes authentication and is displayed. If the two CRCs do not match, an error message is displayed on the Paceart System informing the user that the ECG strip data did not pass authentication and is likely corrupt. The CRC ensures that data has not changed from the time it was stored in the database until the time it is displayed. It is a method used to check for errors in transmission between a sender and a receiver. The CRC can identify errors that occurred either in saving the ECG strip data to the Paceart database or in retrieving ECG strip data from the Paceart database. Performing a batch print of reports for a given patient The batch report printing by patient feature allows you to quickly provide your patients with access to all of their reports in the Paceart System. Note: The batch printing of reports by patient is only available on Paceart System version 3.30 and greater. 1. Open the Paceart System client application by clicking the Paceart System icon. 2. Log in to connect to your Paceart database. 3. If you already have patient records open, click the Main tab. 4. Click the Tests tab. 5. Type the name of the patient into the Patient field, or click the button to search for the patient. If you click the button, the Select Patient window will appear. 6. Click the patient whose reports you want to batch print from the list. You can narrow the results by entering a search string in the search string text box. When you have selected your patient, click Select. 7. Click Search to search for all tests for the selected patient. 8. Click Batch ECG Reports to bring up the Batch ECG Reports window. 9. Make any necessary changes to the print options, and then click Print Batch. HL7 export and PHI The Connected Systems Gateway supports standard HL7 protocol for inbound patient administration messages (ADT), inbound scheduling messages (SIU), and outbound observation reporting messages (ORU). HL7 is not a security protocol. It is your clinic's responsibility to ensure that the HL7 functionality is used on a secure network that is based on your clinic's data security policies. BCP data export and PHI Note: The feature to exclude PHI from a BCP data export is only available on Paceart System versions 3.30 and greater.

94 Paceart System Administrator's Guide Paceart System Security and Privacy The Paceart System has a feature to export your Paceart data from your Paceart Database. When performing a BCP data export, you can choose whether or not you wish to include Protected Health Information (PHI). If you choose not to include PHI, the following information will be blanked in the exported data: Patient ID Number Patient First Name, Middle Initial, and Last Name Patient Name and Social Security Number on Primary Insurance Patient Name and Social Security Number on Secondary Insurance Patient Date of Birth Patient Sex Medicare Number Medicaid Number Patient Address, City, State, Zip Code, and Country Patient Phone Number 1 and Phone Number 2 Recorded Sound File of Patient Name Recorded Sound File of Physician Message Patient E-Mail Address Patient's Device Serial Number

Chapter 7 Paceart System Maintenance Topics: This chapter is intended to assist you as you plan and execute system maintenance procedures for your Paceart System. System Backup gives System backup you an introduction to the different backup software, hardware, and media. System recovery It also gives you information on performing system backups. System Database maintenance planner Recovery shows you how to recover the files you have archived using Updates to the Paceart System your system backup. Database Maintenance Planner presents the SQL Server Database Maintenance Planner Wizard, which is included with full Paceart Customer-Specific version of Microsoft SQL Server. Updating the Paceart System discusses Configurations (PCSC) the procedure for updating your Paceart System software when new Applying Microsoft Service software is available. Packs/Updates and other updates

96 Paceart System Administrator's Guide Paceart System Maintenance System backup It is very important to back up your Paceart System database. It is also your responsibility to verify your backup tapes/diskettes. There are two ways to back up your Paceart System database. The first method, available to all Paceart customers, is to use the Paceart Backup and Paceart Restore Visual Basic scripts. The second method, only available to customers using Microsoft SQL Server Enterprise or Standard editions, is to use the built-in backup and restore features of SQL Server Enterprise Manager. Microsoft SQL Server is designed so that running backups has minimal effect on currently running transactions. This allows you to perform backups during normal operation. Why Back up? There are many reasons why you should back up your Paceart System on a regular basis. Any of the following items could cause you to lose vital Paceart data: Hardware failure on your database server Damage to your facility Data is accidentally deleted Data is maliciously deleted Theft Performing a backup of your Paceart System data is the only way to ensure that your data will survive one of these disruptions. Back up Methods The backing up of your system involves three components: the backup software, the hardware used to backup your files, and the backup media that stores the actual backup files. Selecting the backup method that is best for your site depends on many different conditions: Which backup methods are currently used at your location? How much data will you be backing up? This can affect which hardware and media you choose. For example, if you choose 100 MB zip drives as your backup media and you have 1 GB of data to back up, you will have to manually swap the zip disks 10 times during the backup procedure. How fast do you want to be able to retrieve data in the event of a failure? How much data can you afford to lose in the event of a failure one day? one hour? one minute? Do you want your backup to occur manually or automatically? Do you want to have the responsibility of switching backup media? How will you train people responsible for backup and recovery? What is your backup budget? How you answer each of these questions can help you to determine the backup strategy you should implement at your site. Paceart recommends checking with your site's information technology department, if one exists, to see if an enterprise-wide backup strategy exists for your site. If your site has an enterprise backup strategy, work with your IT department backup personnel to include backup of your Paceart System data. If you do not have an enterprise backup strategy, the following sections will help you as you decide the backup strategy that will work best for your site.

Paceart System Administrator's Guide Paceart System Maintenance 97 Backup software The most important question when deciding which backup software to use is what backup hardware does the backup software support. Many times, software packages can only back up files to certain hardware. Often, the best option is to use software that is included with your backup hardware. Another option is to use the Windows Backup utility that ships with Microsoft Windows. Note: Windows Backup does not back up to CD-R, CD-RW, or DVD-R media. Backup hardware There are many different types of backup hardware that will back up data from your Paceart System. These include everything from commonly used tape drives and network drives to web applications. Backup hardware can either be placed internal to the computer or external to the computer. In the past, internal drives had data transfer rates that were much faster than external drives. However, advances in interface technology allow for very fast data transfer rates to external drives. When deciding on backup hardware, look at the interface used by the drive. This is the connection between the drive and your computer. For internal drives, you will find EIDE and SCSI drives. External drives can use Parallel, USB, USB 2.0, and IEEE 1394 FireWire. The interface you choose will directly translate to the transfer speed of the data from your computer to the drive during a backup, or from your drive to your computer during a recovery. Interface EIDE SCSI Parallel USB USB 2.0 IEEE 1394 FireWire Transfer Rate 4 to 16.6 MB/s 4 to 80 MB/s, depending on the variety used 0.15 to 2 MB/s 0.2 to 1.5 MB/s (12 Mbps) Up to 60 MB/s (480 Mbps) Up to 50 MB/s (400 Mbps) The following sections provide descriptions of typical backup hardware. This list does not imply that these are the only backup hardware options for use with the Paceart System. Tape Drives Tape drives are the most widely used method for backing up data. This is because of the high capacity of data storage they offer for a low cost. The capacity of most modern tapes allows for entire high capacity hard disk drives to be backed up to a single tape, getting rid of the need to manually switch media during the backup process. Tape drives come in many formats, including both internal and external, and interfaces such as EIDE, SCSI, USB, and IEEE 1394 FireWire. Select the model that best suits your needs. It is important to look at the type of media that the tape drive supports, as this will dictate your storage capacity and cost. Network Drives Using a network drive as a backup storage location can be one of the easiest ways to back up your Paceart database, as you do not have to deal with backup hardware, software, and media. If your Local Area Network has a network drive that is backed up by your network administrators on a regular basis, you can simply move your backup to the network drive, and make use of your facility's pre-existing backup policies and procedures. Make sure you consult with your network administrators before selecting this option. Find out how often they back up the network drive, and how they manage their backup media. You will also want to find out if there is enough space on the network drive for you to back up your Paceart database.

98 Paceart System Administrator's Guide Paceart System Maintenance Optical Drives with Write Capabilities Optical drives with write capabilities, such as CD-R/RW drives, DVD-RAM drives, DVD-RW drives, and DVD+RW drives have become popular backup storage mechanisms in recent years. Some of these drives write to media that is writable only once, so you may have to purchase many CDs or DVDs. The write speed of the optical drives is usually given as a multiple of the original read speed of the first CD-ROM drive. For example, a 24x CD-R drive will write at approximately 3.6 MB/s. One thing to watch out for is buffer underrun errors, which can happen if your system does not meet the minimum system requirements. Iomega Zip Drives Zip Drives, manufactured by Iomega Corporation, come in three different sizes: 100 MB, 250 MB, and 750 MB. Zip drives only work with proprietary Zip disks. The 100 MB drives come in ATAPI (EIDE) internal and USB external models. The 250 MB drives come in ATAPI (EIDE) internal and Parallel Port, SCSI, and USB external models. The 750 MB drives come in ATAPI (EIDE) internal and USB 2.0 and IEEE 1394 FireWire external models. Castlewood ORB Drives ORB Drives, manufactured by Castlewood Systems, Inc., come in two sizes: 2.2 GB and 5.7 GB. ORB drives only work with proprietary ORB disks. The 2.2 GB drives come in both internal and external formats, and are available in a number of interfaces: EIDE, Ultrawide SCSI, Ultra SCSI, USB, and IEEE 1394 FireWire. The 5.7 GB drive is only available as an internal EIDE drive. These drives have a data transfer rate of up to 12.2 MB/s for the 2.2 GB versions, and 17.35 MB/s for the 5.7 GB model. Backup media Backup media (like tapes or disks) are the storage devices for your data. Often the media that you choose will be directly related to the type of backup hardware that you choose. In addition to selecting backup media, you should also implement a media management plan. This should include who is responsible for getting the correct media into the drive, a schedule for selecting the correct media, a means for determining the lifetime of the media, and a procedure for where to store the media. When choosing media, you must consider the capacity of the media. This will limit or eliminate the manual media changes you need to make during the backup procedure. Also, consider the transfer rate of the hardware and media. This will directly relate to faster backup times. CD Using a compact disc burner for your backup hardware, you can transfer your files to CDs. CDs generally hold up to 650 MB, which may be too small to hold all of your Paceart data on one disc. DAT DAT stands for Digital Audio Tape. DAT is available in two formats: DDS and DataDAT, although DDS is more common than DataDAT. DAT has a higher data capacity than QIC and Travan magnetic tapes, but it is also usually more expensive. DAT drives are only available with SCSI interfaces, which will add to your cost if your computer does not already have a SCSI interface. DLT DLT stands for Digital Linear Tape. It is known for its high storage capacity, high data transfer rates, and high reliability. In 1998, Super DLT was introduced with even higher storage capacity and data transfer rates, by using a combination of magnetic and optical recording techniques.

Paceart System Administrator's Guide Paceart System Maintenance 99 DVD DVD optical discs are available in many different formats, including DVD-RAM, DVD-RW, and DVD+RW. DVDs generally have a capacity of either 4.7 GB or 9.4 GB, depending on the format and whether a single-sided or double-sided disc is used. 8mm 8mm magnetic tape has an extremely high capacity and data transfer rate. It is available in three different formats: standard 8mm, Mammoth, and Advanced Intelligent Tape (AIT). QIC QIC stands for Quarter-Inch-tape Cartridge, and is a standard for magnetic tape drives. QIC comes in many different formats, including longer tape, and wider tape. QIC media is generally divided into two classes: full-size and mini-cartridge. It is important to make sure that your tape drive supports the QIC media that you buy. Travan Travan magnetic tape media is backward compatible with QIC standards. But not all Travan types are compatible with all QIC types. Travan media is known for its high capacity, which is available today at 20GB or 40GB compressed. Transfer rates to Travan media are up to 4MB/second. Backup media rotation procedure Establishing a good rotation of your backup media is crucial to providing the backup data that you need, when you need it. Many times, you will not discover that you need to recover data until many days, weeks, or even months have passed. Rotating your backup media also protects you against accidental data loss during restore procedures or in the case of defective media. With a good backup rotation procedure, you will be able to go back and retrieve data as it existed at many different points in time. If you choose to use reusable media, like tape or CD-RW, Paceart recommends the following rotation procedure. You will be reusing seven pieces of backup media. Label them as follows: 1. Monday 2. Tuesday 3. Wednesday 4. Thursday 5. Friday #1 6. Friday # 2 7. Friday # 3 Reuse the Monday media every Monday, the Tuesday media every Tuesday, etc. These tapes will give you a daily backup copy of your database. If you had to, you could restore to any day in the past week. The numbered Friday media are to be rotated every first, second, and third Friday. Use Friday #1 the first Friday, Friday #2 the second Friday, and Friday #3 the third Friday. You will reuse the Friday #1 media again on the fifth Friday (more on the fourth Friday follows). These three Friday tapes will give you a weekly backup copy of your database. If you had to, you could restore to any week during the past month. Finally, every fourth Friday, you will use new backup media to back up your database. Label this media with the date of backup and archive the media, preferably offsite. This media will never be overwritten, and it gives you a monthly backup copy of your database. If necessary, you could go to your archive and restore your database to its state at any month. If you aren t using reusable media, you may choose to keep all of your backups in your archive, or only keep the media that you would have around had you been using reusable media. Make sure that you label your media correctly, and document your rotation procedure. This will be very helpful information in the event that you need to restore your database to a given point in time.

100 Paceart System Administrator's Guide Paceart System Maintenance Paceart SQL Server backup VB script The Paceart System has a Visual Basic script to assist you in performing your Paceart System backups. The script will perform an SQL Server backup. The script file, called Paceart Backup.vbs, is located in the Paceart System folder, by default C:\Program Files\Medtronic\Paceart System. You can modify the script file by opening the file in a text editor such as Microsoft Notepad. The following configurable variables are found near the top of the file on the lines that start with Private Const: ServerName DatabaseName UserID The name of the computer on which your SQL Server resides. The default value is (local), which should be selected if you are running the script on the same physical computer that your SQL Server resides. The name of the database that you wish to back up. The default is 'Paceart_Database.' The user id of the administrator account of the database. This user must be configured to be a member of the sysadmin fixed server role and the db_owner and db_backupoperator database roles. The default value is 'sa'. If you wish to use Windows authentication (rather than SQL Server authentication), leave the UserID variable blank. The script will then use the account information of the user currently logged into Windows and pass this information to SQL Server. Note: If your operating system is Windows Vista, then you must use Windows authentication. Password BackupDirectory ProgramToRun The password of the administrator account of the database. The default is a blank password. If you wish to use Windows authentication (rather than SQL Server authentication), leave the Password variable blank. The script will then use the account information of the user currently logged into Windows and pass this information to SQL Server. The directory on the file system where the output of the script will be saved. The default is 'D:\mssql7\backup.' Note that there is no final backslash on the path. If you choose to back up to a network drive folder on your Local Area Network, map the network drive to a drive letter on your computer and use this drive as your backup directory. The third-party backup software that can be instantiated automatically to run after the script has created the backup file(s) in the path specified by BackupDirectory. This software can be set up to back up the files to a specific location or media that you specify in the backup software. Specify the entire command line, including any command line parameters that are needed to start the program. The default value for this parameter is blank.

Paceart System Administrator's Guide Paceart System Maintenance 101 If you require any assistance modifying the Paceart Backup.vbs file, contact Paceart Technical Support. The script will perform a full SQL Server database backup, which backs up the entire database including the transaction log. The backup script can be run while clients are logged in and actively using Paceart. If you wish to move the backup file(s) off the disk where the script backup output is placed, you must either configure the script to run third-party backup software or you must run third-party backup software manually. The third-party backup software should be set up to copy and back up all of the files in the directory specified in the script variable BackupDirectory to your backup hardware and backup media. MSSQLServer service backup After you complete the backup VB script, it is important that you also configure your MSSQLServer Service with the correct domain account name and password, if the target directory for the backup data is a network location. The default login account is 'Local Account,' which does not give the system network privileges. The domain account name and password will give the system permission to write the backup information to your target directory. If you do not change this default setting, you will receive an error message when you attempt to back up to a network location. Check with your IT department for domain account names and passwords. Note: If your IT department supplies you with a domain account that has a password with an expiration policy, this password must be updated when the account expires. It is recommended that the IT department create a 'PaceartBackup' user with the minimum privileges needed to perform the backup and with a password that never expires. Manually configuring the MSSQLServer service 1. Click Start and select Settings. 2. Click the Control Panel icon. 3. Double-click the Administrative Tools icon. 4. Double-click Services. 5. Double-click MSSQLSERVER to open the MSSQLSERVER properties window. 6. Click the Log On tab. 7. Select the This account option. 8. In the text fields, enter in the domain account name and password supplied by your IT department. Scheduling the automatic Paceart backup script To schedule the Paceart Backup.vbs script to run automatically, use the Windows Task Scheduler. 1. Click Start. 2. Click Settings. 3. Click Control Panel. 4. Click the Scheduled Tasks icon. 5. From the Scheduled Tasks window, select the Add Scheduled Task icon. 6. Click Next to continue the wizard. 7. Select the program you want to schedule, then click Browse. 8. Navigate to the script, which in most cases is found in the C:\Program Files\Paceart System. 9. Select the Paceart Backup.vbs file and click Open. 10. Give the scheduled task a name and select how often the Paceart Backup script will run. Note: Paceart recommends that you run your backup at least daily.

102 Paceart System Administrator's Guide Paceart System Maintenance 11. Click Next. 12. Select the time and day you want the task to start. 13. Click Next. 14. Enter the Windows username and password of the user that the task should run under. 15. Click Next. 16. The final window gives you the option of opening the Advanced Properties window once the wizard is complete. Select the Open advanced properties for this task when I click Finish check box if you want further configuration options. 17. Click Finish to create the backup job and end the wizard. 18. The Paceart Backup schedule job icon now appears in the Scheduled Tasks window. SQL Server backup Note: This option is only available to customers using Enterprise or Standard editions of Microsoft SQL Server. As an alternative to the Paceart Backup.vbs script file, advanced users can make use of the built-in backup features of SQL Server Enterprise Manager. Checking the backup integrity Check the integrity of your backup often to ensure the backup is working. 1. Create a new database in Paceart System Database Manager. Give it a name like "temp_integrity_check." 2. Restore the data off the backup media to a local drive. 3. Restore the data into SQL Server using the Paceart Recovery.vbs script. Note: Make sure you set the DatabaseName variable of the Paceart Recovery.vbs script to the name you gave to your temporary database in Step 1. Failure to do so may result in overwriting your existing production Paceart database. 4. Start the Paceart System. At login, click the button to create a new login profile that will allow you to connect to the new temporary database. Select the database name that you gave to your temporary database in Step 1. 5. Verify that you can access a few recent records and a few older records to give you confidence in the backup integrity. 6. Close the Paceart System. 7. Start the Paceart System Database Manager and delete your temporary database. System recovery If you have properly planned your Paceart System database backup and have regularly checked the integrity of your backups, you can easily recover your system from failures. Note: Backups created with any version of Microsoft SQL Server cannot be restored to an earlier version of SQL Server.

Paceart System Administrator's Guide Paceart System Maintenance 103 Paceart recovery script The Paceart System has a Visual Basic script to assist you in performing a Paceart System recovery. This script can restore any Paceart database that was backed up using an SQL Server backup. Typically, this would be done by either using the Paceart Backup VB Script, or initiating the backup in SQL Server Enterprise Manager. The Paceart Recovery VB Script file is located in your Paceart System folder, most likely at C:\Program Files\Medtronic\Paceart System. It is called "Paceart Restore.vbs." Before you run the script, you will need to re-install the version of SQL Server that the backup was created from. Once SQL Server is in place, re-install the Paceart System Server on your database server. This will install the Paceart Database Manager. With your SQL Server and Paceart Database Manager in place, you are ready to run your Paceart Recovery VB Script. The script file variables must be modified for your site. Do this by opening the file in a text editor such as Microsoft Notepad. The configurable variables are found near the top of the file on the lines that start with ' Private Const:' ServerName DatabaseName The name of the computer on which your SQL Server resides. The default value is (local), which should be selected if you are running the script on the same physical computer that your SQL Server resides. The name of the database that you wish to restore. The default is Paceart_Database. Note: If a Paceart production database already exists (e.g., when you are performing a backup integrity check), make sure that you do not use the name of your production database, or all of the data in the database will be overwritten and lost. Note: If you wish to restore a database on top of an existing and working production database, back up the production database first in case something goes wrong when you restore the database. UserID The user id of the administrator account of the database. If the database does not yet exist, the user must have CREATE DATABASE permissions. If the database already exists, the user must be a member of the sysadmin and dbcreator server roles and the owner of the database. The default value is sa. If you wish to use Windows authentication (rather than SQL Server authentication), leave the UserID variable blank. The script will then use the account information of the user currently logged into Windows and pass this information to SQL Server. Note: If your operating system is Windows Vista, then you must use Windows authentication. Password The password of the administrator account of the database. The default is a blank password. If you wish to use Windows authentication (rather than SQL Server authentication), leave the Password variable blank.

104 Paceart System Administrator's Guide Paceart System Maintenance BackupDirectory The script will then use the account information of the user currently logged into Windows and pass this information to SQL Server. The directory on the file system where the database backup files reside. The default is 'D:\mssql7\backup.' Note: There is no final backslash on the path. If you back up your data to a mapped network drive, you can directly specify that directory here. If you require any assistance modifying the Paceart Restore.vbs file, contact Paceart Technical Support. Before you execute the Paceart Restore.vbs script, if you backed up your Paceart database to media other than a mapped network drive, you must use your third-party backup software to restore the files to the directory specified in the BackupDirectory variable in the script. If you run the Paceart Restore.vbs script, and a database of the same name already exists on your SQL Server, the existing database will be deleted. A new database will be created and loaded with the data found in your backup files. Also, when you run the Paceart Restore.vbs script, the database cannot be in use. All users must be logged out of Paceart System. SQL Server restore Note: This option is only available to customers using Enterprise or Standard editions of Microsoft SQL Server. You can use the advanced functionality of SQL Server Enterprise Manager to restore a database that was backed up using an SQL Server backup. This backup could have been created with the Paceart Backup VB Script or created from performing a backup using Enterprise Manager. The backup also could have been created by any third-party application that performs full SQL Server backups. To perform a SQL Server restore from inside SQL Server Enterprise Manager, click Tools then click Restore Database. For more information on running the SQL Server Restore feature, click the Help button from within the Restore Database window, or contact Paceart Technical Support. Database maintenance planner Note: This option is only available to customers using Enterprise or Standard editions of Microsoft SQL Server. The Maintenance Plan wizard within SQL Server is a good way to plan and set up maintenance on your Paceart database. The wizard will allow you to set up the following items: Database optimization Database integrity checks Database statistics updates Database backups Transaction log backups The wizard allows you to set up maintenance schedules, allowing the maintenance to occur automatically.

Paceart System Administrator's Guide Paceart System Maintenance 105 For more information on the options presented in the wizard, click the Help button within the wizard. This will take you to the Database Maintenance Plan Wizard Help in the SQL Server Books Online. Or contact Paceart Technical Support for more information. Accessing the Database Maintenance Planner Wizard Before you begin you must start the SQL Server Enterprise manager. 1. Click Tools. 2. Click Database Maintenance Planner Wizard. Updates to the Paceart System From time to time, you may need to update the Paceart or Microsoft software used on your Paceart System computers. Paceart System software update When you decide to perform an update to your Paceart System software, Paceart Technical Service will need to send you a copy of the installation CD. The update process is a re-installation of the software. Note: Contact Paceart Technical Support before attempting a Paceart System software update. The update can be performed in two ways: You can run the installation program directly from the CD. This method works for standalone computers or if your computer does not have access to a network directory. You can run the installation from a copy of the CD located in a network directory. Typically, this would be a directory on the SQL Server computer, because all clients can access this computer. Shortcuts can be created to the client and server installation programs. These shortcuts are typically called Client Update and Server Update, respectively. This method works for sites that have many Paceart workstations that will need to run the update simultaneously. Paceart database structure updates Note: Paceart database whole integer structure updates (and some decimal updates with SQL Server 7) require the deletion of all publications and/or subscriptions configured on the database. Replication can be re-created after the structure update has been applied. All databases that connect to the main database using replication must be synchronized and also have the structure update applied. Please plan accordingly to minimize downtime before starting an upgrade of the Paceart software that requires a Paceart database whole integer structure update. Paceart software upgrades may contain revisions to the Paceart database structure. Paceart classifies structure updates under two types: integer updates and decimal updates. If your upgrade contains an integer update and you have replication setup on your Paceart database, your replication will be affected. In addition, if you use SQL Server 7, decimal updates may also affect your replication. Structure revision update type Before updating your Paceart System software, you must determine whether your upgrade will have no database structure revision update, a decimal update, or an integer update. To do this, you need three pieces of information:

106 Paceart System Administrator's Guide Paceart System Maintenance The version of your current Paceart database. You can get this number by highlighting your Paceart database in Paceart System Database Manager. The version information will be displayed on the left-hand side of the window. The version of Paceart System software you will be installing. This number can be found on your Paceart System installation CD. The version of your SQL Server (SQL Server 2000, 2005, or 2008). With these three pieces of information, contact Paceart Technical Services to ask if the upgrade will update the Paceart database structure, and if so, if it will be a decimal update or an integer update. The following table lists the affect on replication determined by your version of SQL Server and the change in database structure revision level: Integer Decimal No Structure Revision Change Update SQL Server 2000, 2005, 2008 Drop Replication Pulled Update No Impact No structure revision change update If no database structure revision will occur with your upgrade, there will be no impact to your replication. Note: These instructions may not be appropriate if you have a complex Paceart System configuration. Use the following instructions as a general guideline for the upgrade process. 1. Copy the contents of the CD to a network location accessible by the Paceart server and all Paceart workstations. As an alternative, you can perform the updates by installing directly from the CD on all computers. 2. Have all Paceart users exit Paceart. 3. Back up the Paceart database. 4. On the database server, run the Paceart Server installation. 5. On the workstations, run the Paceart Client installation. 6. On workstations that participate in replication (i.e., they have a local copy of SQL Server or the SQL Server Desktop Engine), run the Paceart Server Installation. When the update is complete, all users can resume using the Paceart System. Decimal update If you are using replication and are updating from 2004 First Edition or later, a decimal update will not require you to drop and rebuild replication. Instead, you will only need to perform a structure revision update to your publishing database. The next time your subscribers synchronize, the structure changes will automatically be transferred to the subscriber and applied to the database. See the instructions on Updating the structure revision level for performing the structure update to just your publishing database. Remember to have all of your subscribers synchronize followed by a backup of the publishing database prior to updating the database structure. 1. Copy the contents of the CD to a network location accessible by the Paceart server and all Paceart workstations. As an alternative, you can perform the updates by installing directly from the CD on all computers. 2. Have all Paceart users exit Paceart. Remote subscribers must synchronize before exiting 3. Back up the Paceart database. 4. On the database server, run the Paceart Server installation. 5. On the workstations, run the Paceart Client installation.

Paceart System Administrator's Guide Paceart System Maintenance 107 6. On workstations that participate in replication (i.e., they have a local copy of SQL Server or the SQL Server Desktop Engine), run the Paceart Server Installation. 7. See the instructions on Updating the Structure Revision Level for performing the structure revision update on all of your SQL Servers (both your central server and all workstations participating in replication). Integer update upgrade process Integer updates require more attention if you are participating in replication. All publications and subscriptions must be deleted on all Paceart databases participating in replication before they can have their structure updates applied. The subscribers should do a final synchronization before the replication is deleted to ensure the central publishing database has all of the current data. Once the update has been applied, synchronization must be reestablished. Reestablishing replication should be done before any new data entry is performed. Consult Paceart Technical Support if you are not able to reestablish replication immediately after the upgrade is performed. Note: These instructions may not be appropriate if you have a complex Paceart System configuration. Use the following instructions as a general guideline for the upgrade process. 1. Copy the contents of the CD to a network location accessible by the Paceart server and all Paceart workstations. You can perform the updates by installing directly from the CD on all computers. 2. Perform a synchronization between all workstations and the publishing database. 3. Start Paceart System Database Manager. Log into each SQL Server participating in your Paceart replication, write down the information for all publication and subscriptions on each computer, and then delete every publication and subscription. 4. Have all Paceart users exit Paceart. 5. Run a backup on your Paceart database. 6. On the database server, run the Paceart Server installation. 7. On all workstations, run the Paceart Client installation. 8. On workstations that participate in replication (i.e., they have a local copy of SQL Server or the SQL Server Desktop Engine), run the Paceart Server Installation. 9. See the instructions on Updating the structure revision level for performing the structure revision update on all of your SQL Servers (both your central server and all workstations participating in replication). 10. Start Paceart System Database Manager on the central database server. Re-create all of the publications that you deleted in Step 3. 11. Using Paceart System Database Manager, log into each workstation that participates in replication and re-create the subscriptions that you deleted in Step 3. 12. If you wish to use automatic or scheduled synchronization, this must be re-configured using Windows Synchronization Manager, or SQL Server Enterprise Manager. When the update is complete, all users can resume using the Paceart System. Updating the structure revision level If your Paceart System software upgrade contains a structure revision level update to your Paceart database, you must apply this update individually to each Paceart database in your Paceart System. If you have replication, this means applying the update to not only your central publishing database, but also to all subscribing databases. You can do this all from one computer by performing the following steps, and when finished, clicking the button to connect to your other SQL Servers. Note: You must have administrative rights to the database to update the database structure. A quick way to determine if you have administrative rights is to click the New Database icon. If the New Database Wizard starts, that means you have sufficient rights to run the database structure update.

108 Paceart System Administrator's Guide Paceart System Maintenance 1. Log into the Paceart Database Manager. 2. Select the database that you want to update (for example, WinCPTS_2000 or Paceart_Database). 3. Click Yes to update your database structure. If your version is earlier than 2004FE, continue with the next step. If you have version 2004FE or later you do not need to continue. 4. If you have existing publications and/or subscriptions configured on the database, you may receive an error message. Before you can proceed with the database structure revision update, you must delete all existing publications and subscriptions configured on the database. You will need to re-create your publications and/or subscriptions after updating the database structure. Take notes on all of your publications and subscriptions before deleting them so they can be easily re-created. Click OK. Paceart Customer-Specific Configurations (PCSC) Paceart develops and provides PCSC files containing customer requested modifications for the Paceart System. PCSC files will only work with the version of the Paceart System for which they were written. If you have applied a PCSC to your Paceart System and you wish to upgrade your Paceart software, you must have Paceart Technical Services redo your PCSC for the new version of the Paceart System. To make this request, contact Paceart Technical Service. Applying Microsoft Service Packs/Updates and other updates Microsoft Service Packs and other software updates can impact the performance of the Paceart System. Please contact Paceart Technical Services prior to applying any Microsoft service packs or other updates to determine if there are any known issues associated with the particular service pack or critical update.

Chapter 8 Device Data Import/Export from the Programmer Topics: Programmers are used in the clinical environment to test patients with medical devices. The programmer utilizes telemetered RF (radio Biotronik Programmer frequency) communication with the implanted medical device to determine ELA Programmer the current programmed values, change the current programmed values, Guidant Programmer and collect diagnostic information stored in the device. Intermedics Programmer Automatic data transfer methods have been developed to interface the Medtronic Programmer Paceart System with certain device manufacturers' programmers that Pacesetter Programmer collect pacemaker and implantable cardioverter defibrillator (ICD) device St. Jude Medical Programmer data. Data export from Paceart to the There are five ways to import device data into Paceart: Programmer Connecting the programmer to the Paceart System via an RS-232 serial cable connection. Saving the device data on removable media (such as floppy disks, CDs, memory cards) then loading the media into the Paceart System. Saving device data to a local hard drive folder or network path. Saving device data to a network location. Saving device data using SessionSync (Medtronic CareLink 2090 programmers only). Note: Not all import options are available for all manufacturers' programmers. Device data can be manually entered into the Paceart System when automatic methods do not exist. This chapter explains data transfer methods for many well-known programmers in use in clinical environments. Important: The programmer import wizard is intended to be a timesaving convenience feature. It is not a substitute for careful examination of the entire follow-up form prior to saving the test and printing a report.

110 Paceart System Administrator's Guide Device Data Import/Export from the Programmer Biotronik Programmer The Paceart System supports data import from the Biotronik EPR 1000 plus programmer, the Biotronik TMS 1000 plus programmer, and the Biotronik ICS 3000 for select Biotronik pacemakers and ICDs. Methods for Importing There are two ways to import device data from the Biotronik programmers into Paceart: Using the Serial Cable Using removable media (such as CDs and memory cards) Serial cable import The Paceart System utilizes the serial cable data transfer capabilities of the Biotronik programmers. You must request the Biotronik serial cable from your Biotronik representative to connect your programmer to the Paceart System. If you are using other programmers that support device data transfer via serial cable, you will also need a Paceart Programmer Interface Kit, available by contacting Paceart Technical Support. Figure 15: Biotronik serial cable connections The drawing illustrates that the serial cable should be connected with the end labeled "PMS " connected to the Biotronik programmer serial port, and the end labeled "SPS " connected to the Paceart System. The connection on the Paceart System can either be the serial port on the back of the Paceart computer, or Position D on the back of the Paceart Programmer Interface Kit. Configuring the Biotronik Programmer Before performing a programmer import from a Biotronik programmer, you must configure the programmer to output device data. 1. Start the Biotronik programmer and select More in the lower right-hand corner of the screen. 2. Select Preferences. 3. Select Print Destination. 4. Change the option to CDM + Printer. Performing a pacemaker import You must configure the Biotronik Programmer before starting this task. If you require additional assistance performing these operations on your Biotronik programmer, consult your Biotronik programmer user manual or your Biotronik representative. 1. Perform the interrogation and necessary programming on the patient's device.

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 111 2. Run the Paceart Programmer Import Wizard by creating a new Pacemaker Clinic event for your patient, clicking the Programming tab, and clicking Retrieve from Programmer. The Programmer Import Wizard will start and guide you through the device data import procedure. 3. Performing the following three steps will give you a complete follow-up transmission. However, you can choose to do a subset of the three. Option On the Biotronik programmer click Parameters in the lower left-hand corner of the main screen and click Print. Description Select to view the parameters information. Click Follow-up in the lower part of the main screen and click Print. Click Tests in the lower part of the main screen. Select Battery/Lead Telemetry and click Print. Select to view follow-up information. Select to view test information. Performing an ICD import You must configure the Biotronik Programmer before starting this task. If you require additional assistance performing these operations on your Biotronik programmer, consult your Biotronik programmer user manual or your Biotronik representative. 1. Perform the interrogation and necessary programming on the patient's device. 2. Run the Paceart Programmer Import Wizard by creating a new ICD Clinic event for your patient, clicking the Programming tab, and clicking the Retrieve from Programmer button. The Programmer Import Wizard will guide you through the device data import procedure. 3. On the Biotronik programmer click Next. 4. From the Export menu on the programmer, click Read ICD Data to interrogate the device. 5. When you are finished with the interrogation, click Export to transfer the data. CD or memory card Import If you are using the Biotronik Programmer model ICS 3000, you have the option of importing device data to Paceart using CDs or Memory cards. Performing a CD or memory card import If you require additional assistance performing these operations on your Biotronik programmer, consult your Biotronik programmer user manual or your Biotronik representative. 1. Insert the removable media into the Paceart System. 2. Run the Paceart Programmer Import Wizard by creating a new clinic event for your patient, clicking the Programming tab, and clicking Retrieve from Programmer. 3. Select Click here to review configuration options on the Programmer Import Wizard. 4. Select the Biotronik tab. 5. Select the Files on removable media option, and then select the location by clicking the button. 6. Click OK. Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia.

112 Paceart System Administrator's Guide Device Data Import/Export from the Programmer If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you encounter a problem importing data from a Biotronik programmer, make sure that you have made all of the hardware connections correctly and the connectors are inserted completely. If you still have difficulty importing the data, contact Paceart Technical Support. If you are using the Paceart Programmer Interface Kit, make sure the switchbox is in the Biotronik position before attempting the automatic programmer import. If you press the Interrogate button on the Biotronik programmer to initiate a manual interrogation and then attempt to transfer the data to the Paceart System, the Paceart System may not receive information from the Parameters page. In order to resolve this issue, press the Transmit button on the Biotronik programmer (while the patient is still present) and then reattempt the data transfer to the Paceart System. This issue can be avoided by only using the Initial Auto-Interrogation function during follow-up. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure how to get this information, contact your Biotronik representative. ELA Programmer The Paceart System supports data import from the ELA Medical Corporation Orchestra programmer for select ELA Medical devices. Method for importing Upon completion of an in-clinic device follow-up, save the device data to a floppy disk in the Orchestra programmer. Then remove the floppy disk from the programmer and place it in the floppy disk drive in the Paceart System computer. Figure 16: ELA Programmer import Performing an import using removable media (such as floppy disks) 1. Insert the removable media into the Paceart System. 2. Run the Paceart Programmer Import Wizard by creating a new Clinic event for your patient, clicking the Programming tab, and clicking Retrieve from Programmer. 3. Select Click here to review configuration options on the Programmer Import Wizard. 4. Select the Files on removable media option, and then select the location by clicking the button. 5. Click OK.

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 113 Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you encounter problems importing data into the Paceart System from your ELA Medical Orchestra programmer, save the floppy disk that will not import and contact Paceart Technical Support. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure how to get this information, contact your ELA Medical representative. Guidant Programmer The Paceart System supports data import from the Guidant 2901 and 2920/ZOOM programmers for select Guidant devices. Method for importing Upon completion of an in-clinic device follow-up, save the device data to a floppy disk in the Guidant programmer. Then remove the floppy disk from the programmer and place it in the floppy disk drive in the Paceart System computer. Figure 17: Guidant programmer import Performing an import using removable media (such as floppy disks) 1. Insert the removable media into the Paceart System. 2. Run the Paceart Programmer Import Wizard by creating a new Clinic event for your patient, clicking the Programming tab, and clicking Retrieve from Programmer. 3. Select Click here to review configuration options on the Programmer Import Wizard. 4. Select the Files on removable media option, and then select the location by clicking the button. 5. Select OK.

114 Paceart System Administrator's Guide Device Data Import/Export from the Programmer Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. The Guidant 2901 programmer only supports floppy disks formatted for the Qnix operating system. The Paceart System is able to read and convert Qnix-based files. The Guidant 2920/ZOOM programmer supports DOS-based disks, which are also supported by the Paceart System. If you are using Qnix disks, your Windows operating system may not recognize that the disk is formatted and may prompt you to format the disk. Do NOT format the disk, as you will lose any data stored in the Qnix format. For single chamber devices, certain atrial chamber parameters appear in their corresponding ventricular chamber parameter fields. This issues occurs because the import wizard was unable to determine the correct chamber in which to place the parameters when the programmer exports the mode in a non-chamber-specific format (such as SST, SSIR, SSI, SOOR, and SOO). If necessary, manually transfer the parameters to the atrial fields. If you are unable to import certain CPI pacemakers, be sure the manufacturer name is set to Guidant or CPI, and that the numeric model number (such as 1124) is contained in the model field in the device lookup table. If you receive an error importing a device data file, save the disk containing the device data file and contact Paceart Technical Support. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure how to get this information, contact your Guidant representative. Intermedics Programmer The Paceart System supports data import from the Intermedics RX5000 programmer for select Intermedics devices. Guidant Corporation supports the Intermedics RX5000 programmer. Method for importing Import device data from the Intermedics programmer into Paceart using a serial cable. Hardware connections The Paceart System utilizes the serial cable data transfer capabilities of the Intermedics RX5000 programmer. To assist with connecting the Intermedics programmer to the Paceart System, Paceart provides the Paceart Programmer Interface Kit, which can be obtained by contacting Paceart Technical Support.

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 115 Figure 18: Intermedics hardware connections The Intermedics RX5000 Programmer utilizes Position B on the Paceart Programmer Interface Switchbox. The Paceart Programmer Interface Kit also comes with a serial cable for connecting your Intermedics RX5000 programmer to the switchbox, and a second serial cable for connecting the switchbox to your Paceart System computer's serial port. Configuring the Programmer The Guidant Intermedics RX5000 Programmer must be set to 9600 baud in order to communicate with the Paceart System. If the baud rate is not set to 9600, contact your Guidant Intermedics representative to make the change. 1. From the programmer's main menu, click RX5000 Functions and then Restricted Functions. 2. Call Guidant at 1-800-CARDIAC and ask for Brady Technical Support. Give the 5-digit code on the screen to the Guidant representative. They will give you the corresponding 5-digit access code. Enter it by clicking on each digit and turning the wheel. When the 5 digits are entered, click Special Function 1. Note: Do not click Return. If you do, you will need to get a new code and re-enter it. 3. Click RAPT Setup. If this option is not on the restricted functions menu, then contact Guidant to have your programmer exchanged for a programmer that has this function or one that already has the baud rate set to 9600. It is possible that the programmer is set to 9600 baud already, even though it cannot be adjusted through the restricted functions menu. 4. Change the BAUD Rate to 9600 and click Start/Change Parameters. 5. Click Return, and then choose Calibrate. 6. Click Calibrate Touch Screen. 7. Click Calibrate and then click on the points on the screen as indicated. 8. Click Return twice to return to the main menu. Performing an import You must configure the Programmer before starting this task. Note: It is very important that the cables and switchbox connecting your Intermedics programmer to the Paceart System are set up correctly before attempting to perform a device data import. If they are not set correctly, you will have to reboot the programmer and redo the interrogation before attempting to import the data again. 1. Perform the interrogation and necessary programming on the patient's device. 2. Verify that the programmer is correctly connected to your Paceart System.

116 Paceart System Administrator's Guide Device Data Import/Export from the Programmer 3. Run the Paceart Programmer Import Wizard by creating a new Pacemaker Clinic event for your patient, clicking the Programming tab and clicking Retrieve from Programmer. The Programmer Import Wizard will guide you through the device data import procedure Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you receive an RS-232 serial communication error, you must reboot your programmer, repeat the interrogation of the device, and re-run the wizard. The following are causes for RS-232 serial communication errors: Baud rate is not set to 9600 Incorrect COM port setting Incorrect switchbox setting Cables are not firmly connected Bad connection cable If your RS-232 serial communication errors persist, contact Paceart Technical Support. If you are using the Paceart Programmer Interface Kit, make sure the switchbox is in the Intermedics position before attempting the automatic programmer import. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure on how to get this information, contact your Guidant representative. Medtronic Programmer The Paceart System supports data import from both the Medtronic 9790 programmer and the Medtronic CareLink 2090 programmer for select Medtronic devices. Methods for importing There are two ways to import device data from Medtronic programmers into Paceart: Saving device data to a floppy disk Saving device data using SessionSync Saving device data to a floppy disk If you are using the Medtronic 9790 programmer or the Medtronic CareLink 2090 programmer you can save data using a floppy disk. Upon completion of an in-clinic device follow-up, save the device data to a floppy disk in the Medtronic programmer. For information on how to save device data to a floppy disk on the Medtronic programmer, consult your Medtronic device manual.

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 117 Figure 19: Medtronic programmer data export using a floppy disk Performing an import using a floppy disk 1. Insert the removable media into the Paceart System. 2. Run the Paceart Programmer Import Wizard by creating a new Clinic (ICD or pacemaker) event for your patient, click the Programming tab, and click Retrieve from Programmer. 3. Select Click here to review configuration options on the Programmer Import Wizard. 4. Select the Files on removable media option, and then select the location of the files you would like to import by clicking the 5. Click OK. button. Saving device data using SessionSync If you are using the Medtronic CareLink 2090 programmer you have the option of saving device data from the programmer directly to Paceart using your clinic's network. For information on how to use SessionSync consult the SessionSync software documentation supplied with the software or contact Paceart Technical Service. Upon completion of an in-clinic device follow-up, the operator saves the device data using SessionSync. The information is sent from the programmer through the clinic's network to Paceart. Downloaded patient data from a single follow-up event is automatically placed as an event in a patient's Follow-ups folder. The event can be opened, and viewed and edited, just like any other follow-up event. Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you are unable to import a Kappa or Sigma pacemaker device data file from the Medtronic programmer, look at the contents of the disk and make sure that the file extension ends in "X" and not "D". Medtronic pacemakers save to disk files may have.mds,.pdd,.07x,.08x, or.09x file extensions. Medtronic ICD device data files all end with a.pdd file extension, with the exception of the 7250 Jewel AF, which has a file extension of.img. If you receive the error message "Output file was not created", it may be due to the length of your TEMP environment variable. This can occur with imports in the Paceart System version 3.29 and earlier. It also

118 Paceart System Administrator's Guide Device Data Import/Export from the Programmer can occur when trying to import the 7218 Jewel ICD, 7220 Jewel Plus ICD, or 7223Cx Micro Jewel II. To fix this, shorten the length of the location of your TEMP system variable: 1. Create a C:\Temp folder. Right-click Start, select Explore, highlight Local Disk (C:), select File, then New Folder, and type "Temp". 2. Right-click My Computer. Select Properties. Select the Advanced tab on the System Properties window. Click Environment Variables. 3. Under the System variables, change the "TEMP" variable to "C:\Temp". Click OK. 4. Restart your PC. If you cannot import from a 7250 Jewel AF ICD, make sure the text "7250" occurs in the model field in the device lookup table. If a patient has a 7253 AT500 pacemaker, and you wish to take advantage of automatic programmer import, the device must be entered into your Paceart System as an ICD. All follow-ups for this device must use the ICD clinic event type. Use the End Session or Save Session option on the Medtronic Programmer to generate the appropriate file type for Paceart. Which option you see depends on which implanted device you are interrogating. Paceart displays the Since-Last-Session atrial and ventricular percent pacing values for ICDs where percent pacing is pertinent. The only exception is the 7276 Gem III AT, where Paceart shows the Since-Last-Cleared atrial and ventricular percent pacing values. Paceart does not currently import manual threshold test information for the following families of Medtronic pacemakers: Sigma, Kappa 400, Kappa 700, Kappa 900, EnPulse, and InSync III. Only Strength Duration, Amplitude Auto Decrement, and Pulse Width Auto Decrement threshold test data is transferred. For other Medtronic pacemakers that support the import of manual threshold test information (e.g., Thera), you must manually save the test information to disk in order for the information to be transferred. If you receive an error importing a device data file, save the disk containing the device data file and contact Paceart Technical Support. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure on how to get this information, contact your Medtronic representative. Pacesetter Programmer Device data can be imported from select devices on the St. Jude Medical Pacesetter Analyzer Programmer System II Model 3003 programmer. Methods for importing The Paceart System utilizes the serial cable data transfer capabilities of the Pacesetter Model 3003 programmer. Hardware connections To assist with connecting the Pacesetter programmer to the Paceart System, Paceart provides the Paceart Programmer Interface Kit, which can be obtained by contacting Paceart Technical Support.

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 119 Figure 20: Pacesetter programmer hardware connections The Pacesetter Model 3003 programmer utilizes Position A on the Paceart Programmer Interface Switchbox. The Paceart Programmer Interface Kit also comes with a serial cable for connecting your Pacesetter Model 3003 programmer to the switchbox, and a second serial cable for connecting the switchbox to your Paceart System computer's serial port. Performing an import 1. Perform the interrogation and necessary programming on the patient's device. 2. Verify that the programmer is correctly connected to your Paceart System. 3. Run the Paceart Programmer Import Wizard by creating a new Pacemaker Clinic event for your patient, clicking the Programming tab and clicking Retrieve from Programmer. The Programmer Import Wizard will guide you through the device data import procedure. Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you are using the Paceart Programmer Interface Kit, make sure the switchbox is in the Pacesetter position before attempting the automatic programmer import. If you encounter a problem importing data from a Pacesetter programmer, make sure that you have made all of the hardware connections correctly and the cords are inserted completely. If you still have difficulty importing the data, contact Paceart Technical Support. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure on how to get this information, contact your St. Jude Medical representative. St. Jude Medical Programmer The Paceart System supports data import from the St. Jude Medical Model 3510 Programmer and the St. Jude Medical PR-3500 Programmer for select St. Jude Medical devices. Note: The St. Jude Medical Model 3510 Programmer was previously marketed as the Pacesetter Systems, Inc. Model 3510 Programmer. Method for importing There are two methods for device data import from the St. Jude Medical Model 3510 and PR-3500 Programmers: Using removable media (such as floppy disks)

120 Paceart System Administrator's Guide Device Data Import/Export from the Programmer Figure 21: St. Jude Medical floppy disk import Using the Serial Cable Figure 22: St. Jude Medical serial cable import Saving device data to a floppy from the Programmer Upon completion of an in-clinic device follow-up, save the device data to a floppy disk in the St. Jude Medical programmer. Note: For more information on how to save device data to a floppy disk on St. Jude Medical programmers, consult your St. Jude Medical programmer user guide or your St. Jude Medical representative. 1. From the main menu, click Operation Preferences. 2. Click Floppy disk. 3. Insert a blank, formatted floppy disk in the programmer disk drive. 4. Click Send Data to Database. Performing an import using removable media (such as floppy disks) 1. Insert the removable media into the Paceart System. 2. Run the Paceart Programmer Import Wizard by creating a new Clinic event for your patient, clicking the Programming tab, and clicking Retrieve from Programmer. 3. Select Click here to review configuration options on the Programmer Import Wizard. 4. Select the Files on removable media option, and then select the location by clicking the button. 5. Click OK. Serial cable import The Paceart System also utilizes the serial cable data transfer capabilities of the St. Jude Medical programmers. If you wish to connect multiple programmers that support device data transfer via serial cable to your Paceart

Paceart System Administrator's Guide Device Data Import/Export from the Programmer 121 System, you will need a Paceart Programmer Interface Kit. You can also connect your St. Jude Medical programmer directly to the serial port on your Paceart System computer by using a serial cable. For a serial cable and the interface kit, contact Paceart Technical Support. Performing a device data import 1. Perform the interrogation and necessary programming on the patient's device. 2. Verify that the programmer is correctly connected to your Paceart System. 3. Run the Paceart Programmer Import Wizard by creating a new Clinic event for your patient, click the Programming tab, and then click Retrieve from Programmer. 4. Select Click here to review configuration options on the Programmer Import Wizard. 5. Select the St. Jude tab. 6. Select the Serial Cable option. 7. Click OK. Supported devices If you have Internet access, point your browser to www.medtronic.com/physician/paceart/cardiacsupport.html. From there, you can view the Medtronic Paceart System Supported Devices list and the Medtronic Pacemaker and ICD Encyclopedia. If you do not have Internet access, refer to the printed Supported Devices document that was included with the software documentation. Troubleshooting and known issues If the button for automatic programmer import is not active in the Paceart System, make sure the proper device manufacturer and model is selected and a device implant date is specified. If you are performing a serial data transfer with the Paceart Programmer Interface Kit, make sure the switchbox is in the New/Paceset position before attempting the automatic programmer import. If you are performing a floppy disk import, and you receive an error importing a device data file, save the device data file and contact Paceart Technical Support. St. Jude Medical Model 3510 Programmer imports device data only from ICDs. If the above steps fail to resolve the issue, make sure your programmer is running the latest version(s) of programmer software. If you are unsure on how to get this information, contact your St. Jude Medical representative. Data export from Paceart to the Programmer Patient follow-up information that has been retrieved or downloaded into Paceart from a programmer can now be saved to a floppy disk, network or local disk drive, or other kinds of removable media. It can then be loaded onto a programmer and viewed. Note: Only ICD and pacemaker clinic, implant, and programming session data can be saved to disk. Remote events cannot be imported. If the Save to Disk menu selection is disabled, there is no downloaded data available. Saving the programming information to disk from a patient's Follow-Ups folder 1. Select the desired event.

122 Paceart System Administrator's Guide Device Data Import/Export from the Programmer 2. Click File, and then click Save To Disk. 3. In the pop-up Browse for Folder window, navigate to the desired floppy disk or a network or local disk drive folder, and click OK. 4. Click OK in the pop-up window.

Chapter 9 Paceart System Printing Topics: Report Queue server Patient Carry card lamination Troubleshooting Printing The Paceart Report Queue server, allows you to consolidate printing from multiple Paceart System workstations. The Report Queue server also gives you the option of faxing and e-mailing Paceart System reports.

124 Paceart System Administrator's Guide Paceart System Printing Report Queue server The Paceart System is equipped with a Report Queue server. This server allows you to centralize the printing, faxing, and e-mailing of Paceart System reports from a centralized server. This feature is beneficial when your client computers don't have access to a printer, fax, or e-mail, or if you want to maintain a log of all reports that are printed or sent from the Paceart System. Figure 23: Multiple clients sending requests to the Report Queue server If your Paceart System configuration includes multiple Paceart databases, you can configure the Report Queue server to connect to multiple databases. Architecture There are two parts to outputting a report using the Paceart Report Queue server. 1. To send a Paceart report you must choose an output device such as the Paceart print server, the Paceart fax server, or the Paceart E-mail server. The report output job is then placed in the ReportQueue table of the Paceart database the client is connected to. 2. The Report Queue server monitors the ReportQueue table (or tables) of the Paceart System database(s). At each polling interval, the Report Queue server queries the table to see if there are any unfulfilled requests. When the server sees an unfulfilled request in the table, it processes the request. Upon completion, the Report Queue server posts a fulfilled timestamp or error information to the database, depending on whether the request completed successfully or failed. Running multiple Report Queue servers The Paceart System Report Queue servers were designed to allow multiple Report Queue servers to run on your network. This is beneficial if you have Paceart System workstations generating different reports, or if you are running Paceart Web Access and handling many incoming report requests. All of the Report Queue servers can be set up to monitor the ReportQueue table(s) of your Paceart database(s), and effectively load-balance the work of generating the reports across multiple servers. Configuring Paceart clients to use the Report Queue sever Paceart clients must be configured to use a Paceart Report Queue server. The configuration is done through the Global configuration options. You only need to modify the Global configuration option configuration

Paceart System Administrator's Guide Paceart System Printing 125 profile(s) your Paceart System clients use. Other clients that use the same configuration profile will see the changes when they restart the Paceart System. 1. Click the Main tab. 2. Click the Utilities tab. 3. Select the Tools folder. 4. Click Global configuration options. 5. Click the Miscellaneous 2 tab of the Global Configuration Options window. You may need to use the scroll arrows at the top of the screen to scroll to the appropriate tab. 6. Select Enable Print Server, Enable Fax Server, and/or Enable E-mail Server. Note: You must log out and log back into Paceart for the changes to take effect. 7. Click Save. 8. Click Close. Configuring the Report Queue server The Paceart Report Queue server is run on a separate Paceart System computer. The computer that you designate as the Report Queue server must have the Paceart System software installed on it. Note: This computer should only be used as the Report Queue server and should not be used to perform other Paceart System tasks. If you use the computer to do other Paceart System tasks, the Report Queue server will stop. 1. Start and login to the Paceart System on the computer that will be the Report Queue server. Connect to the Paceart System database that you will connect to each time you start the Report Queue server. 2. Start and login to the Paceart System on the computer that will be the Report Queue server. Connect to the Paceart System database that you will connect to each time you start the Report Queue server. You must enable the Report Queue server under Local configuration options by completing the following: a) Click the Main tab. b) Click the Utilities tab. c) Select the Tools folder. d) Click Local configuration options. e) Select Enable Report Queue Server. 3. The Report Queue server has many options that must be configured. To access the Report Queue server, click the Report Queue tab. 4. The Database Setup frame on the Report Queue window allows you to select the logins to the Paceart Database(s) you monitor with the Report Queue server. The connections to be monitored must be highlighted. If you need to create new login profiles, or view the connection properties of a login profile, click the View/edit profiles button. Note: You can select multiple login profiles by holding down the CTRL key and clicking each connection you want to monitor. Note: If your operating system is Windows Vista, then you must use Windows authentication for each Paceart Database you monitor. 5. The Maintenance Options pane in the Report Queue window allows you to set the purge options. Requests sent to the Report Queue table from Paceart clients are retained along with their completion status. Purging allows you to erase completed records from the database table, allowing you to maintain the size of your database. You have the option of specifying the interval that requests should be purged from the database. You can also specify to print a report of the requests before they are purged.

126 Paceart System Administrator's Guide Paceart System Printing 6. The Queue Options frame in the Report Queue window allows you to set which type of reports the Report Queue server should process, how often it should process the requests, and how the reports should be signed. a) The Polling interval is used to specify how often the Report Queue server should connect to the Paceart Database(s) to see if there are any new requests to process. The number is entered in milliseconds. b) The Sign By list is used to select the electronic signature to use on the report. You can select from the following options: Option None Specific doctor Manual Referring doctor #1 Referring doctor #2 Referring doctor #3 Follow-up doctor Implanting doctor #1 Description No electronic signature will appear on the report. This option enables the text box just below the Sign by drop-down list, where you can click the button to choose a specific doctor. Selecting this option causes the Signature Capture Tablet window to appear on the Report Queue server each time it processes a report, allowing you to sign the report manually. The electronic signature of the Referring doctor #1 for the report will be used to sign the report. The electronic signature of the Referring doctor #2 for the report will be used to sign the report. The electronic signature of the Referring doctor #3 for the report will be used to sign the report. The electronic signature of the Follow-up doctor for the report will be used to sign the report. The electronic signature of the Implanting doctor #1 for the report will be used to sign the report. Note: The electronic signature is only available if the Enable Signature option is checked on the Report Options tab in the Global Configuration Options window. Configuring the web (PDF) server The web (PDF) server is part of the Paceart Web Access product. This is a separate application. Configuring the print server Make sure your printer is installed and configured. Follow the directions you received with your printer. The print server can be used to consolidate all Paceart System report printer through the Report Queue server. 1. The Report Queue server can only print to the Windows default printer. To se your default printer, complete the following: a) Click the Start menu, click Settings, and then click Control Panel. b) Click the Printers and faxes folders. c) right-click the printer and select Set as Default Printer. 2. You must enable your Report Queue server to process print requests. To do this, perform the following steps: a) Start and login to the Paceart System on the Report Queue server. b) Click the Report Queue tab.

Paceart System Administrator's Guide Paceart System Printing 127 c) Select the Print option in the Queue Options section. The fax server The fax server can be used to consolidate all Paceart System report faxing through the Report Queue server. Note: You must have Symantec WinFax Pro Version 10.01 installed on your Report Queue server. Make sure to select the correct fax modem that your Report queue server will be using. This fax modem must be connected to an analog phone line. Setting the default cover page You can modify the default cover page that WinFax Pro uses when sending faxes. 1. Start the WinFax Pro Message Manager program. 2. Click Cover Pages. 3. You can either choose a pre-existing cover page, or create your own. To choose a pre-existing cover page, browse through the folders and descriptions until you find a suitable cover page. With the cover page selected, click File > Set as Default. 4. To create your own customized cover page, click the Tools menu, and click Cover Page Designer. Use the Cover Page Design wizard to create a new cover page. When you are finished, select File > Save As. Give the cover page a file name and description, and click the Set as default cover page option. Tip: You may want to add your facility's standard patient privacy and confidentiality statements to your fax cover sheet. Configuring the fax server 1. Start and login to the Paceart System on your Report Queue server. 2. Click the Report Queue tab. 3. Select the Fax check box in the Queue Options section. The e-mail server The e-mail server can be used to consolidate all Paceart System report e-mailing through the Report Queue server. Note: The Report Queue server must have an e-mail client installed and have access to an outgoing corporate, workgroup, or Internet e-mail server. The Report Queue server will use the default e-mail account of the user currently logged into Windows when the Report Queue server is started. You may want to modify the default e-mail account properties in your e-mail program to change the outgoing From field from the user's name to a more descriptive name such as Paceart Report Queue Server. You may also want to make sure the Reply-To field address is configured with the appropriate e-mail address. Configuring the global e-mail options 1. Login to the Paceart System on the Report Queue server. Connect to the same Paceart Database that you will connect to when you start the Paceart System and its Report Queue server. 2. To access the Global configurations window, click the Main tab, then click the Utilities tab. 3. Select the Tools > Global configuration options. 4. Click the E-mail Options tab. 5. Modify the default body and footer of the message text boxes. The text you enter here will appear in every e-mail message that is sent by the Report Queue server.

128 Paceart System Administrator's Guide Paceart System Printing Configuring e-mail server 1. Start and login to the Paceart System from the Report Queue server. 2. Click the Report Queue tab. 3. Check the E-mail option. Starting and stopping the Report Queue server 1. To start the Paceart Report Queue sever from the Report Queue window in the Paceart System, click Start. Note: Once the Report Queue server is started, you cannot perform other functions with the Paceart System running on the Report Queue server computer. If you try to switch to other tabs in the Paceart System, the Report Queue server will stop. 2. To stop the Paceart Report Queue server from the Report Queue window in the Paceart System, click Stop. Report Queue Server Maintenance Clicking the Maintenance button from the Report Queue page in the Paceart System will open the Report Queue Maintenance window. Figure 24: Report Queue Maintenance window The Report Queue Maintenance window allows you to search the database(s) from which the Report Queue server processes requests. You can search and filter on particular requests, display properties about these requests, and then delete or create a report of the requests. The Search Criteria section gives you several ways to filter and control the results that are returned: Display Type: This drop-down list allows you to select the detail of information that is returned for each request. Selecting Simple will return 5 parameters for each request. Selecting Full will return 10 parameters for each request.

Paceart System Administrator's Guide Paceart System Printing 129 Parameter Date Requested Requested By Report Description Request Type Patient Name Event Type Event Date Date Retrieved Date Fulfilled Status Display Type Simple, Full Full Simple, Full Full Simple, Full Full Simple, Full Full Full Simple, Full Description Timestamp indicating when the report was requested by the remote client Name of the person who requested the report Name of the report that was requested by the remote client Describes if this was a print, fax, or e-mail request Name of the patient on the report Describes the type of follow-up event Timestamp indicating when the follow-up event occurred Timestamp indicating when the request was retrieved by the Report Queue server Timestamp indicating when the request was completed by the Report Queue server Describes if the request is pending, completed successfully, or failed Date Requested: Allows you to enter start and end dates and times. The values that you enter will filter the results that are returned by only returning Report Queue server events that occurred between the timestamps you specify. If you do not enter any dates or times into the Date Requested fields, the results will not be time-filtered. Request Type: Allows you to filter the types of Report Queue server requests that are returned in the results. You can choose to filter on one or more of the following request types: Web (PDF), Print, Fax, and E-Mail. If no request types are checked, the results will not be filtered on request type. Request Status: Allows you to filter the returned results based on the statuses of Report Queue server requests. You can choose to filter on one or more of the following statuses: Pending, Completed, or Failed. If no request status is checked, the results will not be filtered on request status. The Results section is where the returned results are displayed. Depending on the display type that you selected in the search criteria, different columns will be displayed in the Results pane. The bottom of the Report Queue Maintenance window contains the following buttons: Button name Search Delete Delete All Report Button function Initiates a search based on the criteria entered in the Search Criteria box Deletes the selected report queue result record Deletes all of the report queue result records Prints a report of the results to your default printer. If you selected a Simple display type, a report will print in portrait mode. If you selected a Full display type, a report will print in landscape mode. The Full report will

130 Paceart System Administrator's Guide Paceart System Printing Button name Button function also contain a Report Queue Summary, giving the following details, broken down into the Printer, Fax, E-Mail, and Web (PDF) categories: Completed Requests Failed Requests Avg. time to wait in queue (in sec.) Avg. time to process the request (in sec.) Avg. time to fulfill the request (in sec.) Close Closes the Report Queue Maintenance window Patient Carry card lamination Patient Carry cards are wallet-sized cards that contain pertinent patient information and are convenient for patients to carry. The Patient Carry cards come in three different types: CardioCard for arrhythmia monitoring patients PaceCard for pacemaker patients ICDCard for ICD patients The cards are printed from the Paceart System on special perforated paper that is laminated and given to the patient. Laminating patient carry cards 1. Turn on the lamination machine. When the light is on, the lamination is ready. 2. Open the Paceart System program and select the desired patient. 3. Select event type, then press Report. 4. Select the report format from the available reports: Summary with CardioCard Summary with PaceCard Simplified doctor letter with PaceCard Doctor letter with PaceCard Summary with ICDCard 5. Print to the printer. The printer is usually set to manual feed so have the special Paceart preformatted paper with the Paceart logo, in the printer face down. 6. After printing, remove the PaceCard data portion and insert into the transparent lamination plastic. 7. Insert the lamination plastic into the larger white protective paper and insert into the lamination machine. Troubleshooting Printing Paceart System reports are to be printed by laser printers only. Most inkjet printers have larger margins (non-printable regions) that prevent the entire Paceart System report from printing on the intended number of pages. Paceart System reports are set to have a printable region that is ¼ inch all the way around the page.

Paceart System Administrator's Guide Paceart System Printing 131 HP LaserJet 1100 If you were using a HP LaserJet 4P printer and you switch to a HP LaserJet 1100 printer, you will need to use the HP LaserJet 4P printer driver instead of the HP LaserJet 1100 printer driver. HP customer support states that the HP LaserJet 1100 printer is not supported for peer-to-peer networking. HP LaserJet 1200 The printer drivers for the HP 1200 are not compatible with the Paceart System. Below are some suggestions to avoid potential problems: Remove the HP 1200 drivers using the add/remove option, and then install the HP LaserJet 4P drivers. In Printer Properties, change the spool setting, set printer to print directly to printer and to RAW, adjust or match memory accordingly to the amount of memory that is installed in the printer. Go to Printer properties then select Device Settings tab, and under the Graphics Tab, disable bi-directional support for printing; select Raster graphics, set resolution to 300 DPI. HP LaserJet 4100 Batch mode printing is extremely slow when using the HP LaserJet 4100 driver with the Paceart System. Values are not printed on the graphs on Threshold reports when using the HP LaserJet 4100 printer drivers.

Chapter 10 Paceart Web Access Topics: Paceart Web Access is an optional add-on package for use with the Paceart System. Adding Paceart Web Access to your Paceart System Architecture will allow you access to Paceart reports through an easy-to-use web Configurations interface. Paceart Web Access security In order to a view patient's report using Paceart Web Access, log into the web site using an e-mail address as a user name and your assigned password. From there, you can view the list of events for your patients. Details of each of the tests can be viewed by displaying all of the reports available in the Paceart System. You can to search for a particular report using Paceart Web Access. The search criteria include patient's name, type of test, and date range when the test was recorded. Reports are displayed on the screen in PDF format. These reports can be viewed from within your web browser. Paceart Web Access can be configured to work on either an intranet or on the Internet. Depending on your access requirements, you can restrict Paceart Web Access availability to your internal intranet, or you can access your Paceart reports from any Internet connection in the world. This chapter is intended to serve as background technical information for a facility that will be deploying Paceart Web Access. It addresses product architecture, deployment configurations, and installation procedures.

134 Paceart System Administrator's Guide Paceart Web Access Architecture Overview A Paceart Web Access environment is divided into five separate components: Paceart System Workstations Paceart System Database Paceart Web Access Server Paceart Report Queue Server Paceart Web Access Clients Paceart System Workstations The Paceart System workstations are the computers running the Paceart System software. They are used to collect and review test data and to maintain your patient information. Paceart System Database The Paceart System database stores all of the information needed to run your Paceart System, including patient and test information. It uses a Microsoft SQL Server database. Paceart Web Access Server The Paceart Web Access server runs the Microsoft Internet Information Services Web Server. This is the server that the Paceart Web Access clients connect to for accessing Paceart reports. In addition, the Paceart Web Access application, which is installed from the Paceart Web Access CD-ROM, can reside on this server. Your anticipated usage of Paceart Web Access (e.g., number of simultaneously connected users, number of report requests, etc.) should influence your choice of operating system. It will also affect the processor(s) and memory you install on the server. Paceart Report Queue Server The Paceart Report Queue server is a part of the Paceart System client software. The Report Queue server creates the PDF versions of the Paceart reports. The Paceart Web Access server then serves these reports over the web. Each Paceart Report Queue server requires a separate Paceart workstation license. In order to start the Paceart Report Queue Server, you must start the Paceart System client application, click the Report Queue tab, and click Start. Report caching The Paceart Report Queue Server has a built-in report caching feature. If a report is requested from the Report Queue Server within five minutes, the Report Queue Server will deliver the cached PDF. This feature eases the reporting burden that arises when a Paceart Web Access user navigates back and forth between several reports for comparison purposes. Paceart Web Access clients Paceart Web Access clients are machines running a web browser and Adobe Reader. These clients can be used to view Paceart reports through a local Intranet or the Internet, depending on the configuration of Paceart Web Access.

Paceart System Administrator's Guide Paceart Web Access 135 Configurations When adding Paceart Web Access to your Paceart System, there are many configuration options available. The configuration that you choose for your facility depends upon a number of factors: How many people will be using Paceart Web Access to view reports? When answering this question, think about the number of simultaneous users that will be accessing reports. How many Paceart reports will be requested from Paceart Web Access? Again, think about how many reports will be requested simultaneously. Do you want to only access the Paceart reports within your facility's Intranet, or do you want your reports accessed globally through the Internet? Do you wish to use SSL (Secure Sockets Layer) to secure your report transmissions? Does your facility currently have a web server? If so, does it meet the minimum requirements of the Paceart Web Access Server? What is your budget for servers and software? Physical Configurations Using the answers from the questions above, you are now ready to determine the physical configuration of your Paceart Web Access. You need to decide which computers you wish to place the following applications on: Paceart Web Access Server Paceart Report Queue Server Paceart System Database These three applications can co-exist on the same physical machine if you do not anticipate heavy use of Paceart Web Access. Alternatively, each of these applications may exist on their own dedicated machine if you are anticipating heavy use of Paceart Web Access. You can also deploy Paceart Report Queue Servers to balance the load of creating the Paceart reports in PDF format. Common Server Configuration This configuration is the simplest physical configuration, but also is the weakest configuration in terms of the web traffic it can handle. It uses only one server to host the Paceart Web Access Server, the Paceart Report Queue Server, and the Paceart System Database.

136 Paceart System Administrator's Guide Paceart Web Access Figure 25: Common Server Configuration Multiple Server Configuration The Multiple Server Configuration is more advanced, but gives you the best performance for serving Paceart reports with Paceart Web Access. In this configuration, the Paceart Database Server, Paceart Report Queue Server, and Paceart Web Access Server each reside on separate physical machines. Figure 26: Multiple Server Configuration

Paceart System Administrator's Guide Paceart Web Access 137 Multiple Server Configuration with Multiple Report Queue Servers Some facilities implementing Paceart Web Access may find that even when using multiple physical servers, there is still a noticeable performance bottleneck. The first bottleneck you will encounter when deploying the Multiple Server Configuration is with the Paceart Report Queue Server. This server processes requests to generate Paceart reports as PDFs sequentially, meaning that if multiple requests come in at one time, they will be queued and processed one after the other. Since each report can take on average 0.5 to 1.5 seconds to process, facilities that generate many Paceart report requests may experience delays in the delivery of Paceart reports. For example, if 10 users simultaneously request a single report, the last request may not be delivered for 15 seconds. This can be handled by implementing the Multiple Server Configuration with Multiple Report Queue Servers. Figure 27: Multiple Server Configuration with Multiple Report Queue Servers Configuration file: Custom.dat The Custom.dat file contains configuration settings that can be modified to suit your Paceart Web environment. This file is installed when you install Paceart Web in the root directory of Paceart Web. By default, this location is C:\Program Files\Paceart Web\Custom.dat. The configuration settings can be modified by editing the file in a text editor, like Microsoft Notepad. Configuration setting EnableSecurity What the Configuration does Specifies whether Paceart Web will be secured through SSL protocol. If set to true, users will automatically be redirected to the secure website if they enter "http" instead of "https". The default setting is "false".

138 Paceart System Administrator's Guide Paceart Web Access Configuration setting WebsiteName ServerName What the Configuration does The name displayed in the title bar of the Paceart Web website and used in the message sent to the user requesting password information. The default setting is "Paceart Web". The name of the SQL Server containing the Paceart database used by Paceart Web. The default setting is "(local)". Note: Specify only the name of the server. Omit slashes, backslashes, or other characters not included in the actual name of the server. Parenthesis can be used if specifying "(local)" as a server name. UserName UserPassword DatabaseName DefaultDatabase The SQL Server user assigned to access the database via Paceart Web. This user should be a generic login Paceart Web uses to access the Paceart database. The default setting is "sa". The password used by the SQL Server user specified in the "UserName" option. If the user has a blank password, use empty quotes. The default setting is "". The Paceart Database that will be accessed by Paceart Web. If this is blank, the Database field on the login screen will appear and the user will have to specify the name of the Paceart Database as part of the login. The default setting is "". The default Paceart Database you want to appear in the Database field on the login screen and the Send Password form. The default setting is "Paceart_Database". Note: The default database will not appear if a database name is specified in the configuration option "DatabaseName". RootDirectory The directory path to the folder where the Paceart Web application is deployed. If the application is deployed to the root of the web server, then RootDirectory should be set to "/". If you create a virtual directory alias for your Paceart website, RootDirectory would be the name of the alias. The RootDirectory string should always start and end with a forward slash (i.e., "/"). The default setting is "/PaceartWeb/".

Paceart System Administrator's Guide Paceart Web Access 139 Configuration setting OEMVersion FirstPageText ReturnAddress ContactInfo1 What the Configuration does Indicates whether the installation is running in production or demo mode. Set to True to run in production mode and eliminate references to HeartAccess.com. The default setting is "true". The text displayed on the Paceart Web homepage. This string may contain HTML formatting tags. The default setting is "<p><font face="arial, helvetica" size="5" color="red">paceart Web Access</font><br><font face="arial, helvetica" size="2"><strong>a Paceart Sponsored Service for Physicians</strong><br><br>Welcome to Paceart Web Access, a web-based interactive tool that allows Cardiologists and Referring Physicians to access and store their patient's data. Available 24 x 7, from any location, Cardiologists may access vital patient information and share it instantly with referring Physicians or emergency care providers anywhere on the globe. The site is password protected from unauthorized access and securely treats patient information." The "From" field in an e-mail message containing user's passwords. The default setting is "support@abccardiology.com". Address Line 1 on the contact page. The default setting is "ABC Cardiology". Note: If you do not want to use ContactInfo1, set it to the value of "". Do not remove from the configuration file. ContactInfo2 Address Line 2 on the contact page. The default setting is "123 Some Rd.". Note: If you do not want to use ContactInfo2, set it to the value of "". Do not remove from the configuration file. ContactInfo3 Address Line 3 on the contact page. The default setting is "Some Town, AB 12345". Note: If you do not want to use ContactInfo3, set it to the value of "". Do not remove from the configuration file.

140 Paceart System Administrator's Guide Paceart Web Access Configuration setting ContactInfo4 What the Configuration does The Phone Number on the contact page. The default setting is "(123) 456-7890". Note: If you do not want to use ContactInfo4, set it to the value of "". Do not remove from the configuration file. ContactInfo5 The Fax Number on the contact page. The default setting is "(123) 456-0987". Note: If you do not want to use ContactInfo5, set it to the value of "". Do not remove from the configuration file. ContactInfo6 The e-mail address label on the contact page. The default setting is "Customer Support:". Note: If you do not want to use ContactInfo6, set it to the value of "". Do not remove from the configuration file. ContactInfo7 The e-mail address on the contact page. The default setting is "support@abccardiology.com". Note: If you do not want to use ContactInfo7, set it to the value of "". Do not remove from the configuration file. ResultsPerPage RefreshInSeconds Indicates the number of tests displayed on a page. The default setting is "5". Indicates the delay in seconds between sending the request to the server and checking for the results. This number can be increased if your users connect to the Internet using a slow connection, such as dial-up. The default setting is "5". Note: This setting specifies the refresh delay. The user will always wait the specified number of seconds before viewing the results on the screen, even if the report is printed faster. EnablePhysicianGroup Specifies if physicians are allowed to view data from all patients in the database, or only their own patients in the database. If the value is set to "true", a physician will have the ability to view data from all patients. If the value is set to "false", the physician will be restricted

Paceart System Administrator's Guide Paceart Web Access 141 Configuration setting What the Configuration does to viewing only patients where the physician is the referring or follow-up physician. The default setting is "false". Note: The Physician Group option is not available if using SQL Server logins with Paceart Web. It is only available when using e-mail address logins. ShowResources This setting specifies whether or not the Resources page is displayed on the Paceart Web Access site. The default setting is "true". Installation Paceart Web Access requires many components to be installed and configured, including the Paceart Web Access application and Microsoft Internet Information Services. This section explains the installation and configuration of these applications. Paceart Web Access application installation 1. To install Paceart Web Access, insert the Paceart Web Access installation CD-ROM into the CD-ROM drive of the Paceart Web Access Server. 2. Run Setup.exe on the CD-ROM. 3. Click Next to continue installation. 4. Specify the destination folder of the Paceart Web Access program. The default is C:\Program Files\Paceart Web. If you wish to install the application in a different location, click Browse and choose a location. Click Next. 5. Click Next to continue. The application files will be copied to the destination directory. 6. The setup program will detect if your Paceart Web Access server needs the Microsoft Visual InterDev server components installed. If it does, the application will install the components. 7. The setup program will then detect if your Paceart Web Access server needs the Microsoft Visual Studio Service Pack 4 installed. If it does, the application will install the service pack. 8. Click Finish to end the setup application. 9. The Paceart Web Access installation program may require you to reboot your computer. If the restart message box appears, click OK to restart your computer. Installing and configuring the Microsoft Internet Information Services Microsoft Internet Information Services (IIS) must be installed on your Paceart Web Access Server. Although the server is shipped to you with all Paceart Web Access Server supported operating systems, you may have to manually install it. 1. Open Windows Control Panel. 2. Click Add/Remove Programs. 3. Select Add/Remove Windows Components. 4. Check Internet Information Services (IIS), then Next. Note: If the Internet Information Services (IIS) option is already checked, IIS is already installed on your server.

142 Paceart System Administrator's Guide Paceart Web Access 5. Open Windows Control Panel. 6. Click Administrative Tools. 7. Click Internet Services Manager. 8. If necessary, expand the tree by double-clicking the web server name. Right-click Default Web Site. 9. Select New and Virtual Directory. This starts the Virtual Directory Creation Wizard. 10. Click Next. 11. Type the name of the alias identifying your Paceart Web Access application. This alias will later be used by your clients as part of the URL to reach Paceart Web Access (i.e., http://www.yourdomain.com/<aliasname>). Click Next. 12. Type or browse to the location of your Paceart Web Access directory (the destination directory you specified in the installation). Click Next. 13. This window allows you to access permissions for your virtual directory. Select the Read and Run scripts (such as ASP) options. Click Next. 14. You have successfully created your Paceart Web Access virtual directory. Click Finish. 15. Right-click the virtual directory alias that you created above. It should be located under the Default Web Site tree. 16. Select All Tasks and Permissions Wizard. This will start the IIS Permissions Wizard. 17. Click Next. 18. Choose Select new security settings from a template, then click Next. 19. Click Public Web Site, then click Next. 20. Select Replace all directory and file permissions (recommended), then click Next. 21. This window summarizes the changes that will be made to your Paceart Web Access Server. Read the changes and click Next to apply them. 22. You have successfully applied the permissions to your Paceart Web Access application. Click Finish to end the wizard. 23. Grant permission to your web Server for anonymous e-mailing through the virtual SMTP server by performing the following steps: a) Open Windows Control Panel. b) Click Administrative Tools. c) Click Internet Services Manager. d) Right-click the Default SMTP Virtual Server and select Properties. e) Click the Access tab. f) Click Relay. g) Select Only the list below. h) Click Add. i) Select Single computer. j) Either enter the IP address of your Paceart Web server, or click DNS and enter the name of your Paceart Web Server. After entering the name, click OK. k) Click OK. l) Click OK to close the Relay Restrictions window. m) Click OK to close the Default SMTP Virtual Server Properties window. Microsoft Windows Server 2003 Note: This section applies only to those using the Microsoft Windows Server 2003 operating system. If you are using another Microsoft Windows operating system, you may disregard this section.

Paceart System Administrator's Guide Paceart Web Access 143 If you are using Microsoft Windows Server 2003 as the operating system on your Paceart Web Access Server, there are additional installation steps that you must perform. This is due to the enhanced initial lock down state of Windows Server 2003. Configuring the Microsoft Windows Server 2003 1. Make sure that the Active Server Pages and Server Side Includes Windows components have been installed on your computer by performing the following steps: a) Open the Windows Control Panel. b) Click Add or Remove Programs. c) Click Add/Remove Windows Components. d) If the items are selected in the Windows Components Wizard, then they have been installed. If they are not selected, select them and follow the instructions in the wizard to install them. 2. Enable the Active Server Pages and Server Side Includes Windows components by performing the following steps: a) Open Windows Control Panel b) Click Administrative Tools. c) Click Internet Services Manager. d) Select the Web Service Extensions node. e) Select Active Server Pages and click Allow. f) Select Server Side Includes and click Allow. 3. Enable Parent Paths support by performing the following steps: a) Open Windows Control Panel. b) Click Administrative Tools. c) Click Internet Services Manager. d) Double-click the name of the Paceart Web Access Server. e) Double-click Default Web Site. f) Right-click the alias of the virtual directory that you created for the Paceart Web Access Server and select Properties. g) Click the Home Directory tab. h) Click the Configuration tab. i) Click the Options tab. j) Select Enable parent paths. Paceart Web Access security Note: The information contained in this section should not substitute as advice from a professional Internet security consulting firm. If you require a secure website, seek professional security consulting help. Secured Sockets Layer (SSL) Paceart Web Access is fully compatible with Secured Sockets Layer (SSL) security. SSL incorporates authentication and encryption to ensure message integrity between a web server and a web client. SSL is just one security mechanism that should be employed alongside other security mechanisms and practices. For more information on securing your website, consult the IIS documentation. If you have IIS installed, the documentation can be accessed from the following URL in a web browser: http://localhost/iishelp. Information on security can be accessed by clicking Administration, click Server Administration, and then click Security in the contents tree. A good starting point is to review the IIS Security Checklist.

144 Paceart System Administrator's Guide Paceart Web Access Note: If you require a secure website, Paceart recommends that you seek the assistance of a professional Internet security consulting firm. 1. Obtain a Server Certificate from a third-party certification authority or online certification authority (e.g., Microsoft Certificate Services). 2. When you have a Server Certificate, use the Web Server Certificate Wizard to bind the certificate to your Paceart Web Access website. 3. Make sure that your SSL port is assigned to port 443 by performing the following steps: a) Open Windows Control Panel. b) Click Administrative Tools. c) Click Internet Services Manager. d) Double-click the name of your Paceart Web Access Server. e) Double-click Default Web Site. f) Right-click the alias of the virtual directory that you created for your Paceart Web Access Server and select Properties. g) Click the Web Site tab. h) Click Advanced in the Web Site Identification box. i) In the Multiple SSL identities for this Web Site box, make sure that the IP address is assigned to port 443. This is the default port for secure communications. 4. Configure your website to require a secure channel by performing the following steps: a) Open Windows Control Panel. b) Click Administrative Tools. c) Click Internet Services Manager. d) Double-click the name of your Paceart Web Access Server to expand the Internet services on your server. e) Double-click Default Web Site to expand the list of websites on your sever. f) Right-click the alias of the virtual directory that you created for your Paceart Web Access Server and select Properties. g) Click the Directory Security tab. h) Click Edit in the Secure communications box. i) Configure your website to require a secure channel. Note: If you require 128-bit encryption, make sure that your client's web browsers support 128-bit encryption. j) If necessary, you can enable client certificates and map these certificates to user accounts. For more information, see IIS Help. Automatic redirection Paceart Web Access has implemented a feature with the default.asp file that will allow for automatic redirection to the secure website if the client tries to enter through the unsecured website. This happens if the user specifies the 'http' protocol instead of the 'https' protocol in the URL address of the website. In order to enable this feature, set the EnableSecurity flag to "true" in the custom.dat file. Custom error handling Paceart Web Access ships with a custom error-handling file that can be used when clients receive HTTP error 403;4. This error is the "Forbidden - SSL Required" error that is given when a user tries to access a secure website through an unsecure channel.

Paceart System Administrator's Guide Paceart Web Access 145 The Paceart custom error 403;4 tries to redirect the user through the secure protocol (using https). If this fails the user will get an error message. Installing the custom error handling file 1. Open Windows Control Panel. 2. Click Administrative Tools. 3. Click Internet Services Manager. 4. Double-click the name of your Paceart Web Access Server to expand the Internet services on your server. 5. Double-click Default Web Site to expand the list of websites on your web server. 6. Right-click the alias of the virtual directory that you created for your Paceart Web Access Server and select Properties. 7. Click the Custom Errors tab. 8. Highlight the 403;4 error, then click Edit Properties. 9. Change the Message Type list to URL. 10. Enter "<Paceart Website Alias>/errors/403-4.asp" in the URL box, where "<Paceart Website Alias>" is the name of your virtual Paceart web server directory. Account administration Paceart Web Access requires users to log in before using the system. Figure 28: Login dialog on the Paceart Web Access home page Users of Paceart Web Access can log in using either a valid SQL Server login on the database, or by entering their e-mail address and password. E-Mail Address Login Users of Paceart Web Access can log in using their e-mail account as their username along with a password. Each user must be listed in the Doctors records lookup table on the Paceart System database. The administration of the users, their e-mail addresses, and passwords is all done through the Paceart System client. Accessing the Doctors records lookup table utility 1. In the Paceart application, click the Main tab. 2. Next, click the Utilities tab. 3. Click Forms folder. 4. Click the Lookup tables folder. 5. Click Doctor records, and then click Open.

146 Paceart System Administrator's Guide Paceart Web Access 6. The Doctor window appears. From this window, you can view and modify existing Paceart Web Access accounts, or add new accounts. View or modify an existing account 1. Select a doctor from the Results list. 2. Click the Details tab. 3. The Doctors window, Details tab will appear. 4. You can view or modify the Paceart Web Access login and password by looking at the E-mail and Web Password fields. 5. If you make any changes to the Doctors window, Details tab, click Save. Add a new doctor account If you wish to add a new account, you must add a new doctor to your doctor lookup table. 1. Double-click the Doctors records folder. 2. Click Add. 3. Enter the pertinent information about the doctor, including the doctor's E-mail and Web Password fields. 4. Click Save. SQL Server login You may use valid SQL Server logins when logging into Paceart Web Access. To do this, enter the SQL Server login in the Email Address field and enter the SQL Server login password in the Password field on the Paceart Web Access login form. Requesting passwords Users of Paceart Web Access can request their password from the Paceart Web Access home page. 1. Go to the Paceart Web access home page and click the Forgot your password? link on the login form. The Password Request window will appear.

Paceart System Administrator's Guide Paceart Web Access 147 Figure 29: The Password Request window 2. Complete the Email Address box, and enter the name of the Paceart Database that you access in the Database box. Next, click Submit. If the e-mail address is found in the Paceart database, Paceart Web Access will generate and send an e-mail that contains the user's password. Note: The SMTP Virtual Server must be properly configured in order to send e-mail from Paceart Web Access. Changing user passwords Paceart users can also change their own passwords after logging into Paceart Web Access. 1. Log into Paceart Web Access. 2. Click the Profile tab. 3. Change your password on the Profile form. Any changes made on this page will be used to update the Doctor record in the Paceart System. To change a password, you must enter the current password and new password then confirm the new password. 4. Click Submit after you have updated your information. Monitoring services and limiting access to reports Paceart Web Access uses the same security principle as the main Paceart System client application. All users that have access to a particular Paceart Database have the ability to view all patient reports on that database. If you want to restrict users' access to reports, Paceart recommends that you create separate databases for each of your clients that will be accessing Paceart Web.

Chapter 11 CardioVoice TTM Assistant Topics: Installation requirements CardioVoice Installation CardioVoice Account Management CardioVoice Configuration Options External Notifications Patient and Physician Voice Messages Troubleshooting CardioVoice The CardioVoice TTM Assistant system enables patients and doctors to communication information about cardiac events through an automated voice response system. The Patient's Role Patients call into CardioVoice from their home and are directed through a series of automated prompts. The patient can perform the following actions during a CardioVoice call: Transmit an ECG. Record a message for their doctor. Listen to a message from their doctor. CardioVoice allows patients to communicate with their doctors about cardiac events while not at the clinic. The Doctor's Role Doctors can access CardioVoice from a Paceart station in the clinic or by dialing into CardioVoice remotely. When a patient records a new ECG, notification of the event is sent to the doctor by fax, email, or page. The doctor can perform the following actions within CardioVoice: Record messages for patients. Listen to messages from patients. View ECGs recorded by patients. The doctor can receive and analyze patient cardiac events without the patient being present at the clinic. The System Administatrator's Role The system administrator is responsible for the following tasks in CardioVoice: Installation Configuration Information updates

150 Paceart System Administrator's Guide CardioVoice TTM Assistant Installation requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. CardioVoice Installation If you are installing a new 32-bit system, follow the instructions under Installing a new 32-bit system. Note: If you will be using CardioVoice with the Windows Vista operating system, you must use Windows authentication for logging in to the Paceart System. If you are upgrading from a 16-bit system to a 32-bit system, first call Paceart Technical Support to request device drivers for your ProLine/2V CardioVoice board. Then follow the instructions under Upgrading from a 16-bit system to a 32-bit system. Installing a new 32-bit system Installing the Dialogic D/4PCI and D/4PCIU Boards 1. Unplug the electrical supply to the computer. 2. Remove the outside computer cover (refer to computer owner's manual for instructions on removing the cover). 3. Identify where existing boards are installed. 4. Insert the Dialogic Board into an open PCI slot, and secure it with the included mounting screws. Caution: Avoid over-handling the board. Electrostatic shock could damage the board. 5. Replace the computer cover. 6. Turn the computer power on. 7. Reconnect the electrical supply to the computer. 8. Click Cancel in the Found New Hardware window. Installing the driver 1. Insert the CardioVoice CD into the CD drive. 2. Double-click the My Computer icon to open it. Then double-click the CardioVoice CD icon to open the contents of the CD. 3. Double-click the Dialogic folder. 4. Double-click on setup.exe. Configuring CardioVoice environment variable 1. Right-click the Computer icon on your desktop. If you do not have that icon, click Start, and then right-click Computer. 2. Select Properties from the menu. 3. Click the Advanced system settings link. 4. Click Environment Variables.

Paceart System Administrator's Guide CardioVoice TTM Assistant 151 5. Under the User variables section, click New. 6. Enter DIALOGICDIR in the Variable name field. 7. Enter the path C:\Program Files in the Variable value field. 8. Click OK. 9. Restart your system. Installing CardioVoice Software 1. Make sure the CardioVoice CD is still in the CD drive. 2. Double-click the My Computer icon, then double-click the CardioVoice CD to open the contents of the CD. 3. Double-click Setup.exe to install CardioVoice. Configuring Dialogic Drivers for Dialogic D/4PCI and D/4PCIU boards 1. After the computer has restarted click the Start menu. Click Programs, click Dialogic System Software, and then open the Dialogic Configuration Manager. 2. Click Connect. This will begin the process of detecting the device. 3. In the Configured Devices window you should see the device number and TDM Bus. At the top of the window, click Service, then Startup Mode, and then click Automatic. 4. Click the button to start the configuration process. 5. When the process is completed correctly you will see System Service Status = Running at the bottom of the window. 6. Close the Configuration Manager. Testing CardioVoice installation 1. Create a test patient with a CardioVoice ID number. 2. Call into CardioVoice and record a test ECG for that patient. Creating a test patient To test the CardioVoice installation, first create a test patient with a CardioVoice ID number. 1. Launch Paceart. 2. From the main Paceart screen, click Add to add a new test patient. 3. Select the Miscellaneous tab. 4. In the CardioVoice ID field enter "1111". 5. In the Name field enter "Test" for the first name and "Test" for the last name. 6. Click Save. 7. Click Close. Simulating a CardioVoice call After you have created a test patient, call into CardioVoice and record a test ECG for that patient. Note: You must stop the CardioVoice phone line before adding a new transmitter or changing any device settings. After saving the device settings, you must log out of Paceart, log back into Paceart, then re-start the CardioVoice phone line. 1. Dial into CardioVoice by calling the phone number that is connected to the Dialogic board. 2. When asked by the system, enter your test CardioVoice ID number "1111".

152 Paceart System Administrator's Guide CardioVoice TTM Assistant 3. When prompted, send an ECG or whistle into the phone to simulate an ECG. 4. Exit the CardioVoice call or hang up. 5. You will see a New Event in the Call Log section of the main CardioVoice screen. 6. Click the new event. Then click Open. 7. You should see the test ECG you recorded during the call. If you are able to open and view the ECG, you have properly installed the CardioVoice software. Upgrading from a 16-bit system to a 32-bit system If you are upgrading from a 16-bit system to a 32-bit system you must uninstall the Dialogic DOS drivers and then install new drivers. Contact Paceart Technical Support to request device drivers for your ProLine/2V CardioVoice board. Uninstall drivers If you are upgrading from a 16-bit system to a 32-bit system, you must unistall the Dialogic DOS drivers. 1. Double-click the My Computer icon to open it. 2. Double-click the C drive icon. 3. Right-click the Autoexec.bat file and click Open With. Then click Notepad. This will open a text batch file containing DOS commands. 4. Locate all occurrences of the following lines of code: @echo off rem ----------------- Dialogic setup C: cd\dialogic genload dialogic.cfg d40drv -h3 -i61 -sd000/d000 cd\ rem ----------------- Dialogic setup 5. You must comment them out by putting 'rem' in front of each line as follows: rem @echo off rem ----------------- Dialogic setup rem C: rem cd\dialogic rem genload dialogic.cfg rem d40drv -h3 -i61 -sd000/d000 rem cd\ rem ----------------- Dialogic setup Installing the driver 1. Insert the CardioVoice CD into the CD drive. 2. Double-click the My Computer icon to open it. Then double-click the CardioVoice CD icon to open the contents of the CD. 3. Double-click the Dialogic folder. 4. Double-click on setup.exe. Installing CardioVoice Software 1. Make sure the CardioVoice CD is still in the CD drive.

Paceart System Administrator's Guide CardioVoice TTM Assistant 153 2. Double-click the My Computer icon, then double-click the CardioVoice CD to open the contents of the CD. 3. Double-click Setup.exe to install CardioVoice. Configuring ProLine/2V Board Drivers 1. Under the Start menu, click Programs, and then Dialogic System Software. Then double-click Dialogic Configuration Manager to launch the Dialogic Configuration Manager application. 2. In the main tool bar, click Action, and then click Add Device. This opens the Add Hardware wizard window. 3. Under Family click ProLine, and under Model click ProLine/2V. 4. Click Next. 5. On the Add Hardware wizard Name Board window, enter "1" next to Proline/2V. 6. Click Next. 7. In the Properties window for ProLine/2V - 1 make sure the value for D41Daddress field is d0000 and the value for the D41Dinterrupt field is 3. 8. Click OK. 9. On the main Dialogic Configuration page under Configured Devices you should now see the device name with a green circle next to it. 10. At the bottom of the screen you should see System Service Status = Running when the configuration is successfully completed. 11. Close the Dialogic Configuration program. Testing CardioVoice installation 1. Create a test patient with a CardioVoice ID number. 2. Call into CardioVoice and record a test ECG for that patient. Creating a test patient To test the CardioVoice installation, first create a test patient with a CardioVoice ID number. 1. Launch Paceart. 2. From the main Paceart screen, click Add to add a new test patient. 3. Select the Miscellaneous tab. 4. In the CardioVoice ID field enter "1111". 5. In the Name field enter "Test" for the first name and "Test" for the last name. 6. Click Save. 7. Click Close. Simulating a CardioVoice call After you have created a test patient, call into CardioVoice and record a test ECG for that patient. Note: You must stop the CardioVoice phone line before adding a new transmitter or changing any device settings. After saving the device settings, you must log out of Paceart, log back into Paceart, then re-start the CardioVoice phone line. 1. Dial into CardioVoice by calling the phone number that is connected to the Dialogic board. 2. When asked by the system, enter your test CardioVoice ID number "1111". 3. When prompted, send an ECG or whistle into the phone to simulate an ECG. 4. Exit the CardioVoice call or hang up.

154 Paceart System Administrator's Guide CardioVoice TTM Assistant 5. You will see a New Event in the Call Log section of the main CardioVoice screen. 6. Click the new event. Then click Open. 7. You should see the test ECG you recorded during the call. If you are able to open and view the ECG, you have properly installed the CardioVoice software. CardioVoice Account Management All patients and physicians who dial into the CardioVoice system are required to enter their 4 to 10 digit CardioVoice ID numbers. Patient CardioVoice IDs CardioVoice uses Patient CardioVoice IDs to associate patient tests with a particular patient. If patients do not have their CardioVoice ID numbers, they will still be able to record ECGs, but a new CardioVoice patient will be created with each transmission. The CardioVoice operator will have to manually reassign the test from "New CardioVoice Patient" to the correct patient. You may configure the system to automatically assign a CardioVoice ID number based on a specified patient number (such as the patient's phone number). Or you may enter a patient's CardioVoice ID number manually. Viewing or Modifying a Patient CardioVoice ID 1. Open the Paceart System client application. 2. Search for and open the patient record you wish to view or modify. 3. Select the Miscellaneous tab. 4. The CardioVoice ID number is listed in the CardioVoice ID number field. Configuring the Patient CardioVoice ID Auto-Assign Settings You can automatically assign a patient's CardioVoice ID based on either the last ten digits of their Patient ID number or based on the digits of their phone number. 1. In the Paceart System client application, close all patients. 2. Click the Utilities tab. 3. Click the Tools folder and then click Global Configuration Options. Then click Open. 4. Select the Miscellaneous 2 tab in the Global Configuration Options window. 5. Under the Patient CardioVoice ID Default section, click one of the choices listed. You may choose to use the last digits in a patient's phone number, the last digits of the patient ID number, or the Do Not Default setting. 6. Click Save. After changing your Patient CardioVoice ID Deafult settings, new patients added to your Paceart System will have their CardioVoice ID automatically assigned if you choose one of the following options: Chose to use the last digits of the primary phone number, and then enter the new patient's phone number in the Phone 1 field on the Patient Demographics form. Chose to use the last ten digits of the Patient ID, and then enter the new patient's ID in the Number field on the Patient Demographics form. Note: After changing your Patient CardioVoice ID default settings, your existing patients' CardioVoice IDs will NOT change automatically. If you want to change existing Patient CardioVoice IDs open the patient's record, click the Miscellaneous tab, and delete the exisiting CardioVoice ID. Also make sure if you chose

Paceart System Administrator's Guide CardioVoice TTM Assistant 155 to use the patient's phone number for an ID that there is a phone number listed. If you chose to use the Patient's ID number for the CardioVoice ID make sure there is a number in that field. Physician CardioVoice IDs CardioVoice uses Physician CardioVoice IDs to recognize a physician calling into CardioVoice. Physician CardioVoice IDs must be unique and 4 to10 digits. Viewing or Modifying a Physician CardioVoice ID 1. Open the Paceart System client application. 2. Click Utilities. 3. Double-click the Lookup tables folder. Then click Doctor records. 4. Click Open. 5. From the Doctors window, click the physician's name and click the Details tab. 6. In the CardioVoice ID field, you can see the physician's current CardioVoice ID. You can modify it if you wish. 7. Click Save. CardioVoice Configuration Options The CardioVoice Options window gives you access to many configuration options. The following is an overview of each tab and what it contains: The Options tab allows you to configure default reports, faxing options, and miscellaneous phone options. The Fax Options tab allows you to configure the fax cover page and HIPAA Disclaimer message. The Prompts tab allows you to customize the prompts the user hears when they dial into CardioVoice. The Call Script tab allows you to customize the options the user can select when they dial into CardioVoice. Opening the CardioVoice Configuration Options Window 1. From the main window in the Paceart System client application, click the CardioVoice tab. Note: The CardioVoice tab is only available in the Paceart System client application after CardioVoice has been successfully installed. 2. In the Configuration section, click Options. The CardioVoice Configuration Options window will open. Options Tab Defaults Reports The Default Reports section allows you to specify which report will be sent when a physician requests an arrhythmia or pacemaker report through CardioVoice. This report is then faxed or e-mailed to the physician. Use the drop-down lists to choose one default report for arrhythmia requests and one default report for pacemaker requests. Note: It is not possible to set the default CardioVoice reports to a report group.

156 Paceart System Administrator's Guide CardioVoice TTM Assistant Miscellaneous The Miscellaneous section contains three options: Number of Rings to Answer On - This option specifies the number of rings that will occur before the CardioVoice program picks up the incoming call. This option can be set to a number between 0 and 10. If 0 or 1 ring is specified, CardioVoice will pick up on the first ring. Dialogic Board/Modem Shared Line - Use this option to specify which phone line, if any, is shared with your modem. You may choose to share either line 1 or line 2. International CardioVoice Installation - Select this option if you are using CardioVoice outside the United States. This will allow you to enter a fax number with up to 19 digits. Fax Options Tab The Fax Options tab allows you to configure the fax cover page and HIPAA disclaimer information that would appear on a fax. Cover Page You can choose to use the standard simple cover page or you can specify a custom cover page. A custom cover page should be a CVP file, the file format used by WinFax Pro. You can create a cover page using the WinFax Pro Message Manager program. Open this program and click Tools then Cover Page Designer. After you have created your cover page, save it to a known location and select the file for this option. HIPPAA Disclaimer You can choose Use default disclaimer or you can Specify custom disclaimer. If you select Specify custom disclaimer, type your custom disclaimer in the box below. Prompts Tab The Prompts Tab allows you to select which prompts the caller will hear and in which language. You can use existing prompts, edit existing prompts, or create new prompts. Language Field You may choose from two pre-recorded languages, either English or Spanish. Note: If you would like to add a new language you must record all voice promts for that new language. Name Field This field displays a listing of all the call prompts for CardioVoice. Description Field This field displays a description of a selected call prompt. Click the desired prompt in the Name field to see a description of the prompt. Contents Field This field displays the contents of each voice prompt. Click the desired prompt in the Name field to see the contents of that prompt.

Paceart System Administrator's Guide CardioVoice TTM Assistant 157 Type Field There are two types of messages. The first is the Voice Message Prompt. These are the prompts where a caller is asked to give a response. The second type of message is the System Message Prompt. These are letters, numbers, and words CardioVoice uses to repeat back the information the caller has just entered on the keypad. Adding a language If you would like to add a new language you must record all voice prompts for that new language. 1. In the language field of the Prompts tab, click Add. 2. In the text field, type the name of the language. 3. Click Ok. If you have completed the language addition successfully the new language will appear in the language field of the Prompts tab. Editing and Playing Back Voice Prompts 1. Click the desired language in the Language field. Note: If you select any language other than English or Spanish you must record the voice prompts in the designated language. 2. In the Name field, click the prompt you would like to modify. 3. Click the button. 4. From the PageMessage Player, select which recording device you would like to use. Use the Sound Card setting when recording voice prompts in this location. 5. To record the message, click the button. Then speak into the computer's microphone (if using the recommended Sound Card setting). Note: If you record a new call prompt, the old prompt will be erased. 6. To play back what you have recorded, and click the button. 7. On the PaceMessage Player, click File and then click Exit. 8. Click Save to save the newly recorded call prompt. Call Script Tab When a patient or physician calls into CardioVoice, they are directed by a series of call prompts. The user responds to these prompts by selecting numbers on the phone's keypad, for example the user is asked to select a language by pressing one for English or two for Spanish. The call prompts are organized into a call script. You can customize the call script to fit the needs of your system by activating or deactivating the prompts. Each call prompt in the call script has one of the following icons to the left of it: Call script step is configurable and is currently enabled Call script step is configurable and is currently disabled To disable an enabled step, double-click the icon. To enable a disabled step, double-click the icon.

158 Paceart System Administrator's Guide CardioVoice TTM Assistant External Notifications The CardioVoice TTM Assistant can be configured to automatically fax, page, or e-mail a physician when a patient calls into the CardioVoice system. These external notifications let physicians know that new data is waiting in their Paceart System, and in the case of faxing and e-mailing, actually send the data directly to the physician. To configure system-dialing properties for paging, faxing, and e-mailing see the Installation the Dialing Properties section. Faxing Note: The physician will be faxed only if a patient ECG was successfully recorded. To restore the default Following or Referring Physician setting, highlight the name listed in the Auto Fax to field and press the DELETE key. Then press the TAB key. 1. On the CardioVoice main page under the Configuration section select the Auto Fax to check box. 2. The default setting is Following or Referring Physician with this setting the system will fax the patient's information to the doctor listed in the Referring physician field on the Patient Information page. 3. To fax the information to a doctor other than the one listed in the Demographics tab, click the button. 4. On the Select Doctor to page screen, click the Search tab. 5. Type the doctor's name in the format last name, first name or type * to display all the doctors in the system. Then press the Enter key. 6. The specific name search will bring up the specified doctor's name or all of the doctors listed in the system. 7. Click the desired doctor's name. Then click Select. 8. The doctor's name will appear in the Auto Fax to field. Paging Note: A physician will be paged if the CardioVoice system was able to identify the patient, regardless of whether or not they have successfully transmitted an ECG. To restore the default Following or Referring Physician setting, highlight the name listed in the Auto Page to field and press the DELETE key. Then press TAB. 1. On the CardioVoice main page under the Configuration section select the Auto page to check box. 2. The default setting is Following or Referring Physician with this setting the system will fax the patient's information to the doctor listed in the Referring Physician field on the Patient Information window. 3. To page a doctor other than the one listed on the Demographics tab click the button. 4. On the Select Doctor to page screen click the Search tab. 5. Type the Doctor's name in the format 'ast name, first name or type '*' to display all the doctors in the system. Then press ENTER. The specific name search will bring up the specified doctor's name or all of the doctors listed in the system. 6. Click the desired doctor's name. Then click Select. The doctor's name will appear in the Auto page to field. Emailing Note: The physician will be e-mailed only if a patient ECG was successfully recorded.

Paceart System Administrator's Guide CardioVoice TTM Assistant 159 To restore the default Following or Referring Physician setting, highlight the name listed in the Auto E-mail to field and press the DELETE key. Then press TAB. 1. From the main Paceart screen, click the Utilities tab. 2. Click the Tools folder to open it. 3. Click Global Configuration Options. 4. Click the E-mail Options tab. 5. Select the Enable e-mail option check box. 6. In the Message field, type the default text you would like in the body of the e-mail. 7. In the Footer Message field, type the default text to be included in the footer of the e-mail. 8. Click Save. 9. Click Close. 10. Click the CardioVoice tab. 11. Select the Auto E-mail to check box to enable the e-mailing option. The default setting is Following or Referring Physician, with this setting the system will e-mail the patient's information to the doctor listed in the Referring Physician field on the Patient Information page. 12. To e-mail a doctor other than the one listed under the Demographics tab, click the button. 13. On the Select Doctor to auto e-mail screen, click the Search tab. 14. Type the doctor's name in the format last name, first name or type * to display all the doctors in the system. Then press the ENTER key. 15. The specific name search will bring up the specified doctor's name or all of the doctors listed in the system. Click the desired doctor's name. Then click Select. The doctor's name will appear in the Auto e-mail to field. Patient and Physician Voice Messages Event Messages Overview Event Messages are voice messages recorded by a patient and/or physician relating to a recorded event. For example, a patient may record a message for the physician asking when to record their next ECG. The physician then could record a message for the patient in response. Patient Event Messages The patient is allowed to record only one Event Message for each CardioVoice call and cannot listen to recorded Event Messages. The patient can record an Event Message in one of two locations during the course of a CardioVoice call. The first option is right before the patient records their ECG. The CardioVoice system will ask them to say their name and telephone number and to state their symptoms, and then press the # button when finished. The second option is the Answering Machine Message prompt. If selected the patient will be asked to record their name, telephone number, and message, and then press the # button when finished. Physician Event Messages Physicians are allowed to listen and record Event Messages. Note: Each event can have only one Event Message associated with it. If a physician records a message or evaluation of an event where a patient has already recorded a message, the patient's message will be erased and replaced by the physician's Event Message.

160 Paceart System Administrator's Guide CardioVoice TTM Assistant A physician can listen to Event Messages at two times during a CardioVoice call or from two places in Paceart. During a CardioVoice call select the Play Patient Last Message. In this location the physician can play previous messages also. During a CardioVoice call select Play Patient's Evaluation. This will play the same messages as the previous option but is available in the Patient Evaluation menu. In this location the physician can also play previous messages. From the main Paceart screen select the desired patient. Then select the desired event in the patient information tree. Click the Event Tab. Click Message. From the PaceMessage player click the button. From the main Paceart screen click the CardioVoice tab. In the Call Log window highlight an event. Click Message. From the PaceMessage player click the button. Physicians should use the Sound Card option for the highest quality audio when listening to messages on the PaceMessage player. A physician can record Event Messages in three locations. During a CardioVoice call, select Record Patient's Evaluation. Then select Dictate Evaluation for Patient. From the main Paceart screen select the desired patient. Select the desired event in the patient information tree. Then click the Event Tab. Click Message. From the PaceMessage player click the button. From the main Paceart screen click the CardioVoice tab. Select the desired event from the Call Log window. Then click Message. From the Pace Message player click the button. Physicians should use the Sound Card option for the highest quality audio when recording messages on the PaceMessage player. Patient Message Overview Patient Messages are voicemail messages recorded by the physician about the patient. There can be only one Patient Message for each patient. When a physician records a new message, the old Patient Message is erased. Patient Patient Messages Patients are allowed only to listen to Patient Messages. During a CardioVoice call, select Play Physician Message. Physician Patient Messages Physicians are allowed to record only one Patient Message per patient. Note: If a new Patient Message is recorded, the old message will be erased and replaced. Physicians should use the Sound Card option for the highest quality audio when listening to messages on the PaceMessage player. In the Paceart System select the desired patient. Then select Patient Information from the patient information tree. Next click the Miscellaneous tab. Click Physician Message. Then from the PaceMessage player, click the button. Physicians use the Sound Card option for the highest quality audio when recording messages on the PaceMessage player. In the Paceart should system select the desired patient. Then select Patient Information from the patient information tree. Next click the Miscellaneous tab. Click Physician Message. From the PaceMessage player, click the button.

Paceart System Administrator's Guide CardioVoice TTM Assistant 161 Troubleshooting CardioVoice You receive a Microsoft security popup when trying to use the auto e-mail function. Call Paceart Technical Support if you use one of the following versions of Microsoft Outlook or Outlook Express for your default e-mailing client: Outlook 98 version 8.5.7806 and later Outlook 2000 version 9.0.0.4201 and later Outlook 2002 all versions (10.0.x.x) Outlook 2003 all versions (11.0.x.x) Outlook Express (IE 6.0 and above) CardioVoice Error and Event Logs CardioVoice keeps detailed error and event logs. If the default installation folder was used, the error log is stored in C:\Program Files\Medtronic\Paceart System\CardioVoice\CardioVoice.err. The event log is stored in C:\Program Files\Paceart System\CardioVoice\CardioVoice.log. Auto e-mail configuration option does not turn on Make sure the enable email option is selected. Complete the following steps to activate this feature: 1. From the main Paceart screen, click the Utilities tab. 2. Click the E-mail Options tab. 3. Under Configurations, select the Enable e-mail option check box. Doctor is not given the choice to e-mail a patient record The e-mail option in CardioVoice will not be presented to a doctor when using CardioVoice if the Enable E-mail option has not been selected in the Global Configuration Options window, and if the doctor does not have an e-mail address entered on their doctor record. To enter an e-mail address for a doctor, click the Utilities tab, then click Lookup Tables to expand the list. Select Doctor records. Select the doctor record you wish to add the e-mail address to. You hear "Invalid Data" when entering a patient record date If the physician hears the message 'Invalid Data' after entering a date when searching for a patient record by date, the date has been entered incorrectly. CardioVoice interprets the date based on the short date settings in Windows Regional Options, found in the Windows Control Panel. If your locale specifies the short date format with the month before the day (e.g., English - United States), enter your date into CardioVoice as a two-digit month, two-digit day, and two or four-digit year. For example, January 15, 2001, can be entered either as "011501" or "01152001". If your locale specifies the short date format with the day before the month (e.g., English - Australia), enter your date into CardioVoice as a two-digit day, two-digit month, and two or four-digit year. For example, January 15, 2001, can be entered either as "150101" or "15012001". When entering a patient record date, the date cannot occur in the future. The date must be today's date or a date in the past. CardioVoice also checks the validity of the date you enter. Your month must be a number between 01 and 12 and your day must be a number between 01 and 28, 29, 30, or 31, depending on the month. For example, you cannot enter "093101" because September only has 30 days.

Chapter 12 Paceart Gateway Services Topics: Installation requirements Paceart Gateway Services application Services Configuration options Administrative maintenance Data Exchange Log Viewer Troubleshooting Paceart Gateway Services provides the capability to import patient session data into Paceart from other systems involved in the follow-up care of cardiac patients. The Paceart Gateway Services user interface is divided into three tabbed panels: Paceart System Database Remote Acquisition Service Local Acquisition Service The Paceart System Database tab allows you to configure certain Paceart database connectivity options. On this tab you can specify the SQL server, specify the login method, designate the Paceart database name, and view the connection status. The Remote Acquisition Service tab allows you to configure the service that imports patient session data from remote sources. You can start and stop the service, specify the polling interval, select the service's auto start options, and configure the login information for remote follow-up services. The Local Acquisition Service tab allows you to configure the service that receives patient session data transmitted from local sources (such as a programmer). You can start and stop the service, configure advanced options, and enable or disable transmissions from enabled sources.

164 Paceart System Administrator's Guide Paceart Gateway Services Installation requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. Paceart Gateway Services only needs to be installed once per Paceart database. Most Paceart deployments only have one Paceart database, so in these cases, the Paceart Gateway Services only needs to be installed on one computer. Paceart Gateway Services is tightly integrated with other components of the Paceart System. If you are installing the Paceart Gateway Services, you must first have the current version of the Paceart System client, database, and server components installed. Note: If you wish to enable the connectivity to the Medtronic CareLink Network, you must have an active login account on the Medtronic CareLink Network. Contact Paceart Technical Support for support in activating this feature. Note: The Paceart System can also receive follow-up data from other vendors' remote follow-up services. For specific instructions on how to perform these downloads, contact your Paceart technical support specialist. For vendor-specific instructions, you can also contact the vendor directly. Paceart Gateway Services application The Paceart Gateway Services application is used to configure the connection to the Paceart database, the Remote Acquisition Service, and the Local Acquisition Service. To start the Paceart Gateway Services application, click the Paceart Gateway Services icon located on the desktop (or Start > Paceart). Note: The Paceart Gateway Services application must be run as an Administrator. Figure 30: The Paceart Gateway Services icon There are three tabs in Paceart Gateway Services user interface: Paceart System Database Remote Acquisition Service Local Acquisition Service Paceart System Database tab With this tab you can specify the following options for the Paceart System Database: SQL Server Login Method Database Name After you are finished making changes, click Set Connection to save your database connection settings.

Paceart System Administrator's Guide Paceart Gateway Services 165 Note: You must select either Set Connection or Cancel Changes after modifying database settings. You cannot leave the Database tab until valid database connection information has been entered. SQL Server Enter the name of the SQL Server that contains your Paceart Database. In most installations, you can use the drop-down list to display a list of SQL Servers available on your network. Otherwise, you can type the name of the SQL Server. Note: Both the Remote Acquisition and Programmer Acquisition services use the same SQL Server login information provided here. Login method Specify whether your login authenticates using Windows Authentication or if it uses a specific user name and password (also known as SQL Server Authentication). If you choose the latter, you must specify the login information using the User Name and Password fields. The login you choose must be a valid login on the SQL Server. Note: If your operating system is Windows Vista, then you must use Windows authentication. Note: If you are using the Windows Authentication option, you can only test the validity of your current login ID from the Paceart Gateway Services user interface. The services must be configured to log in with a particular domain user account to use the Windows Authentication option. The domain account used for service login must also be granted access to the Paceart Database on the SQL Server. Database name Select or enter the name of your Paceart Database. The name you enter must be a valid Paceart database on the SQL Server, created using the Paceart Database Manager New Database wizard and must also be at the current revision. If you are upgrading from an earlier version of the Paceart System, make sure to update the structure of your database before attempting to connect to it from Gateway Services. Remote Acquisition Service tab The Remote Acquisition Service tab allows you to configure the following options: Remote Acquisition Service Status Advanced Options Web Services Configuration In addition, the left side of the status bar at the bottom of the window displays the current status of the Remote Acquisition Service. Remote Acquisition Service status This section gives you a visual indication of the Remote Acquisition Service's current status. You can click the buttons to Start/Continue or Stop the service. Advanced options The Advanced Options section gives you the ability to change the following: Polling Interval: This option allows you to set the freqency that the service will poll the Paceart database to determine if there are new remote acquisition jobs to process. You can set this to a value between 1 and 30 sectonds. The default setting is 3 seconds. After you have made your choice, click Set. Lower settings provide greater responsiveness to requests from the Paceart client application, at the expense of increased load on the database server.

166 Paceart System Administrator's Guide Paceart Gateway Services Service Startup Type: This drop-down list allows you to select when you want the service to initiate. You can choose from the following: Automatic - The service starts when Windows starts. Select Automatic if you want the service to automatically resume in case of unscheduled or scheduled server restarts Manual - The service does not start when Windows starts. Web Services configuration This table lists all of the remote device follow-up services that have been configured to use the Paceart Remote Acquisition Service. The following columns are displayed for each service: Service Name: Lists the name of the remote device follow-up service. Currently, only Medtronic CareLink Network is displayed. URL: Shows the URL your Paceart System uses to connect to the CareLink Network. User Name: Lists the user name of the login used to access the remote device follow-up service. Password: Gives a visual indication that a password has been entered for the login. Start Date: Lists the earliest date for which tests on the remote follow-up service should be transmitted to your Paceart System. This setting defaults to the date that the Paceart Gateway Services was first started. Scheduled Batch Downloads: Shows whether or not the system is configured to automatically perform an unattended batch download each evening from the remote follow-up service. This setting defaults to On Last Successful Batch Connection: Shows the date and time of the last successful batch download. To change the settings of a particular remote device follow-up service, highlight the service in the table and click Edit. For example, if you selected the Medtronic CareLink Network the following window would appear: Figure 31: Web Service Details window The name of the remote device follow-up service is displayed at the top of the window. The Service Configuration section allows you to modify the following: URL: Select or enter the URL you use to connect to the CareLink Network. User Name: Enter the user name of the account assigned to you by the remote device follow-up service. Password: Enter the password of the account assigned to you by the remote device follow-up service.

Paceart System Administrator's Guide Paceart Gateway Services 167 Start Date: You can modify the date on which you want to start receiving transmissions from the remote device follow-up service. All transmissions to the remote device follow-up service occurring on or after this date will transfer to your Paceart System. The default date is the date that you installed Paceart Gateway Services software. If you wish to receive all tests from the remote device follow-up service, set this to the date that you started using the service. If you have manually been entering the event data for your remote follow-up events into the Paceart System, you will probably want to set this to the date after you last manually entered your tests, so you do not have duplicate tests in your Paceart System. Enable Scheduled Batch Downloads: When selected the Remote Acquisition Service will automatically download data from the remote device follow-up service every night. The Service Details box shows the following details about the service: Batch Window Start Time: This time is when the Remote Acquisition Service may first try to perform its nightly scheduled batch download. This time is set by the remote device follow-up service and is not user configurable. Batch Window End Time: This time is when the Remote Acquisition Service will have completed its nightly scheduled batch download. This time is set by the remote device follow-up service and is not user configurable. Last Successful Batch Connection: This is the date and time of the last successful nightly batch download. Note: The Remote Acquisition Service will randomly choose a time to download during the batch window. If it cannot connect, the Remote Acquisition Service will auto-retry until a connection is made to the remote device follow-up service. The Test Connection button allows you to test your connection to the remote device follow-up service. Local Acquisition Service tab The Local Acquisition Service tab allows you to view and configure the following options: Local Acquisition Service Status Advanced Options Local Data Import Setup In addition, the right side of the status bar at the bottom of the window gives you the current status of the Local Acquisition Service. Local Acquisition Service status This section gives you a visual indication of the Local Acquisition Service status. You can click the buttons to Start/Continue or Stop the service. Advanced options The Advanced Options section gives you the ability to change the following: Logging Level: This drop-down list allows you to specify which level of detail you would like to have recorded for each data import. This logging information is recorded in the Windows Event Viewer. It is recommended that you leave the logging level at the default value of 1, unless you are debugging connectivity issues. Service Startup Type: This drop-down list allows you to select when you want the service to initiate. You can choose from the following: Automatic - The service starts when Windows starts. Select Automatic if you want the service to automatically resume in case of unscheduled or scheduled server restarts Manual - The service does not start when Windows starts.

168 Paceart System Administrator's Guide Paceart Gateway Services Paceart Gateway Services Server certificate installation The Certificate allows a secure connection to be established between a data import source and the Paceart Gateway. You must complete the Certificate installation before you can import data from other sources. The installation wizard will create a Certificate Request that you will email to Paceart Technical Support. Then Technical Support will email you back the Certificate file that you will import into your system and install. If you have questions please call Paceart Technical Support. Installing the Certificate 1. Double-click the Paceart Gateway Services icon. 2. From the menu bar, click Certificate > Launch Certificate Wizard. 3. In the Customer Information window, enter your information in the following required fields: Customer Number - This number can be found on your Paceart contract or call Paceart Technical Support for the number. Organization Address City & State Zip Code & Country 4. Click Next. 5. In the Contact Information window enter your information in the following required fields: Name - must be more than one word Phone number - must include area code Email - must be in standard email format (the certificate will be emailed to this email address) 6. Click Next. 7. From the Server Addressing window, select how you would like the data import soure to address the Paceart Gateway Services server. Select the check box next to Host Name or IP Address. It is recommend that you select Host Name because it is the most flexible option. You can use either the local host name (default) or enter the fully qualified domain name. 8. Click Next. 9. In the Export the Certificate Request window, click Export Certificate Request to a File. 10. Select the location where you would like to save the Certificate Request file. You must save to a location that can be accessed by a workstation or computer that has email. The default file location is C:\PaceartGatewayCertificateRequest.McertReq. 11. Once the file has been successfully exported, click Next. 12. Send an e-mail with the exported Certificate Request file to technical support at CertSupport@Medtronic.com. 13. Technical Support will then send the Certificate file to the email address you specified. Note: Some days may elapse before you receive the certificate. 14. Save the Certificate file to a location that is accessible from the Paceart Gateway Services computer. The default filename is C:\PaceartGatewayCertificate.MCert. 15. In the Import Certificate window of the Paceart Gateway Services Certificate Installer, click Import Certificate from File. 16. Find and select the file using the standard Windows dialog. 17. When the file has been successfully imported, click Next. 18. From the Certificate Installation window, click Install Certificate. 19. If you have completed the installation successfully, the Installation Status will display Certificate is properly installed. If you receive an error message, call Paceart Technical Support.

Paceart System Administrator's Guide Paceart Gateway Services 169 Enabling a data import source You must install the certificate before you can enable a source for data import. 1. Click on the source ID listed in the Available for Data Import field to select it. 2. Click Add. 3. The source ID will now be in the Enabled for Data Import field. 4. Click Set for the changes to take effect. This source is now able to import data to Paceart. Services Configuration options Paceart Remote Acquisition service and Paceart Programmer Acquisition service (called the Local Acquisition Service in Gateway Services) are background processes that fulfill requests created by the two services or the Paceart System. Paceart Gateway Services, when running, activates the interaction between data import sources (such as device programmers or remote follow-up services) and the Paceart System. The Paceart Remote Acquisition service and the Paceart Programmer Acquisition service (called the Local Acquisition Service in Gateway Services) are Windows services, special long-running processes that may be automatically launched at the time the operating system starts, even if no user is logged onto the system. Enabling the Remote Acquisition service Although it is recommended to configure the Remote Acquisition Service by using the Paceart Gateway Services, you can also access the Paceart Remote Acquisition Service from the Administrative tools. 1. Open the Windows Control Panel. 2. Double-click Administrative tools. 3. Double-click Services. 4. Double-click Paceart Remote Acquisition. Enabling the Local Acquisition service Although it is recommended to configure the Local Acquisition service using the Paceart Gateway Services, you can also access the Local Acquisition service from the Administrative tools. Note: In Windows Services the Local Acquisition service is called Paceart Programmer Acquisition. 1. Open the Windows Control Panel. 2. Double-click Administrative tools. 3. Double-click Services. 4. Double-click Paceart Programmer Acquisition. Services log on One option that you may wish to change on the service is the account that it uses to log on to Windows. This cannot be done from the Paceart Gateway Services application, and must be done from the Windows Services administrative tool. By default, the service will use the Local System account. If you wish to modify the login properties, click the Log On tab on the Paceart Remote Acquisition Service properties window. Select This account and enter the login information.

170 Paceart System Administrator's Guide Paceart Gateway Services For example, you want to control access to your Paceart Database and audit who is accessing the database. In addition, you only use Windows authenticated accounts on your database. In this scenario, you would create a Windows login for the Paceart Remote Acquisition Service. You would add this login to your SQL Server, giving it DBO (database owner) permissions to the Paceart Database. Next, you would configure the Remote Acquisition Manager Database Login to use Windows Authentication (from the Paceart Gateway Services application). Finally, go into the Windows Services administrative tool and modify the Log On properties for both services to use the Windows login you created. When changing the service Log On properties from the Windows Services administrative tool, you should start (or restart) the services to verify that they successfully start with the new login information. If the login information is invalid, an error message dialog will appear. You should also check the Paceart Gateway event log (as described below) to verify that the services have successfully connected to the database. You should see a SuccessAudit event indicating that all connections were properly established. Administrative maintenance Administrative maintenance tools are intended for Paceart System Administrators. If you are not comfortable using the tools, contact Paceart Technical Support to have a Paceart Technical Service Specialist assist you. Windows Event Viewer When you install the Paceart Gateway Services, a Paceart Gateway Services Event Log is created on the computer that hosts the Remote Acquisition Manager. Viewing the Event Log 1. Open the Windows Control Panel. 2. Double-click Administrative Tools. 3. Double-click Event Viewer. 4. Double-click Paceart Gateway in the Event Viewer tree. The Paceart Gateway Services event log will open. All events from the Remote Acquisition Service will have a source of "RemoteAcquisitionService." All events from the Local Acquisition Service will have a source of "ProgrammerAcquistionService." The events log will give you a detailed view into the activity of the Paceart Gateway Services. You can use this log to determine whether the Paceart Gateway Services are working correctly, or it can be used to help troubleshoot issues. Events labeled with yellow Warning or red Error icons are of particular concern, and should be inspected. Note: Events in this log do not automatically refresh. To refresh the event listing, right-click the PaceartGateway icon and select Refresh. Configuring the Event Log file size We recommend that you modify the event log size to 4 MB or larger. If you do not do this, the Event Log may fill up and the services will not be able to write to the log. 1. Right-click the PaceartGateway icon. 2. Select Properties. 3. Select Overwrite events as needed. 4. Change the maximum log size setting to a value of 4000 (or higher).

Paceart System Administrator's Guide Paceart Gateway Services 171 5. Select OK. Data Exchange Log Viewer The Paceart System client has a Data Exchange Log Viewer that shows the status of events received by the Remote Acquisition Service, Local Acquisition Service, and the Connected Systems Gateway. This viewer can be accessed by Paceart users, and can be used by System Administrators to determine the status of the services and troubleshoot issues. Accessing the Data Exchange Log Viewer 1. Start the Paceart System client software. 2. Click the Utilities tab. 3. Click the Forms folder. 4. Double-click Data Exchange Log Viewer to open the log viewer. Search criteria The Search Criteria section of the log viewer allows you to change the events that are displayed. Field Source Date Submitted Import Status Description Use to change the source of events that are returned. Use to set the start and end date and times for the events you want returned. Use to change the type of events that are returned. Buttons There are five buttons on the log viewer. Field Search Match Delete Delete All Save to Disk Close Description Performs a search for events using the filters specified in the Search Criteria section. The results are displayed in the Results section. If you select a result that is an unmatched download, clicking this button will open the window to match the download to a specific patient. Deletes the currently selected result in the Results section. Deletes all results in the Results section. Saves SessionSync events to a floppy disk. Closes the log viewer.

172 Paceart System Administrator's Guide Paceart Gateway Services Results The Results section displays all of the results that match the search criteria when you click the Search button. Field Source Type Status Description Serial Number Time Submitted Description Displays the source of the message (e.g., Medtronic CareLink Network). Describes the type of event (e.g., Event Request, Schedule Batch, etc.). Shows the status of the event (e.g., Completed, Failed). Displays a detailed message about the event. The entire description is displayed in the Description text box below the Results table when a particular event is highlighted in the list. When pertinent, shows the device serial number that is related to the event. Displays the date and time the event was created. Troubleshooting Configuring Windows Vista for SessionSync In order to enable SessionSync to work on Microsoft Windows Vista, you must put in place a group policy that elevates a protocol supported by SessionSync higher than newer Vista protocols, which may not be supported by SessionSync. You can do this by setting a new protocol order using the SSL Cipher Suite Order group policy in Windows Vista. It is only necessary to perform this procedure on the computer running Paceart Gateway Services. In Windows Vista, the group policies defining the prioritized order of protocols can be edited using the Group Policy Editor. The available list of protocols (or "cipher suites") and detailed instructions for changing the order are provided in the tool itself. Note: It is important to note that elevating the RC4 protocols may reduce the overall level of TLS/SSL security for all connections to the server. This will not affect the relative security of the Paceart System when compared to existing SessionSync implementations, but may reduce the absolute security level when used in other contexts. 1. Open the Vista Run dialog. 2. In the Open text box type "gpedit.msc" and click OK. This opens the Local Group Policy Editor window. 3. In the Local Group Policy Editor window, open the Computer Configuration > Administrative Templates > Network > SSL Configuration Settings folder. 4. Double-click SSL Cipher Suite Order. This opens the SSL Cipher Suite Order Properties dialog. 5. Select the Explain tab. The Explain tab displays a scrollable list of cipher suites in a prioritized order. The procedure for reordering the list is provided at the bottom of the list.

Paceart System Administrator's Guide Paceart Gateway Services 173 6. Using the procedure provided under the Explain tab, move the "TLS_RSA_WITH_RC4_128_SHA" cipher suite to the top of the list (the highest priority). 7. Before you click OK, examine the last cipher suite in the string to make sure that it has not been truncated. If it has, then delete the remaining characters of that cipher suite and also delete the final comma that follows the last complete cipher suite. 8. Click OK, and then close the Local Group Policy Editor window. 9. To implement the new protocol priority, stop the Paceart Programmer Acquisition and Paceart Remote Acquisition services and then restart them. Configuring the Windows firewall A common source of connectivity problems is the Microsoft Windows firewall that is part of Windows XP Service Pack 2. This same issue also applies for third-party firewall solutions. To enable communication between Paceart and device programmer in a Windows XP firewall installation, complete the following steps (for other firewall solutions, consult the product documentation). 1. Click Start. 2. Click Settings. 3. Click Control Panel. 4. Click the Windows Firewall icon. 5. Select the Exceptions tab. 6. Click Add Port. 7. In the Name field enter "HTTPS" and in the Port number field enter "443". 8. Select the button next to TCP. 9. Select the OK button. For advanced debugging of issues arising from firewall and TCP port issues, you can use the following sources: In the Event Viewer administrative tool, view the System log for red X Error entries related to service startup failures. There may be details in such entries regarding why the service failed to start, such as contention with another process (e.g. a web server) that is attempting to use the same port. In a Windows command window, type "netstat-a" to view the current state of network port usage. If the programmer Gateway service is properly installed and running, there should be an entry in the listing's Local Address column for either "HTTPS" or "443." If the service is not running, and netstat still shows HTTPS is busy, it's likely that another process is using that port. "Host not Found" error message If you receive a "Host not Found" error when connecting to a secure website, it could be a proxy server issue. Some network environments do not allow outgoing connections on standard network TCP/IP ports such as 80 (http) and 443 (https). Instead, they redirect those requests to a proxy server on a nonstandard port, and the proxy server makes the outgoing requests on the standard ports. This is done for security, filtering of outgoing web requests, and to implement shared caching of web content. Paceart Gateway Services uses port 443 for outgoing requests, but is able to detect any proxy settings in place for the Internet Explorer (version 5.5 or higher) browser, and redirect its requests through a proxy server according to those settings. To enable proxy redirection for the Remote Acquisition Service, you must perform the following steps

174 Paceart System Administrator's Guide Paceart Gateway Services 1. Configure the Paceart Remote Acquisition Service to run from a specific login account. 2. Log into that account on the Paceart Gateway host server and configure proxy settings in Internet Explorer. The service will subsequently detect that account's proxy settings. Configuring the proxy server The steps for configuring proxy settings vary depending on the proxy server product used. For example, Microsoft ISA (Internet Security and Acceleration) Server provides for highly automated configuration through a small toolbar application on the client workstation. 1. Open Internet Explorer. 2. Click Tools. Then click Internet Options in the menu bar. 3. Select the Connections tab. 4. Click LAN Settings. 5. If you are using an auto-proxy setup, click Automatically detect settings. Otherwise click the checkbox next to Use a proxy server to manually configure proxy redirection. For these settings contact your network administrator. 6. To test the proxy settings within Internet Explorer and verify that contact can be made with the CareLink web service, attempt to open the address https://pgw.medtroniccarelink.net/clcwebservices/clcrdi.wsdl If you receive a "Host not found" error, then your proxy configuration is probably not valid. If you get a login prompt, it means that you've made contact with the CareLink server. Note: The output received from the CareLink web service is in XML format, and not intended for human reading. Configuring the HTTP SSL service If Paceart Gateway Services is installed on a system using Windows XP Service Pack 2 or Windows Server 2003, you may need to configure the HTTP SSL Service to automatically start. If the Paceart Gateway event log contains entries from the ProgrammerAcquisitionService that indicate "failure to execute SSL handshake" you will need to complete the following steps. 1. Click Start > Settings > Control Panel. 2. Click Administrative tools, and then click Services. 3. Double-click on HTTP SSL service to open the properties box. 4. Change the startup type to Automatic. 5. Click Apply. 6. Click OK. System lockup accompanied by an error dialog from virus checker program Certain virus checker software can cause a general system lockup. If you use virus checking software we recommend that you set up an exclusion list to avoid this issue. Exclusion lists specify locations on the file system where virus checking is bypassed. Enter C:\Program Files\Common Files\Paceart Shared\AcquistionQueue in the virus checker exclusion list. Check your virus checker software documentation for information on how to set up an exclusion list.

Chapter 13 Paceart Export Module Topics: The Paceart Export Module is an optional add-on component to the Paceart System. It allows you to export data files from your Paceart Installation System. You can then use these data files in your integration projects to Configuration connect your Paceart System with other computer systems, including Event data export Hospital Information Systems (HIS) and Electronic Medical Record (EMR) Paceart XML Schema Definition systems. It also gives you options to control the review workflow of tests (XSD) in your Paceart System. Troubleshooting The Export Module will export all data related to a single test in an XML document or HL7 message. The XML conforms to the Paceart XML Schema Definition (XSD). In addition, you can optionally choose to export Paceart reports in a PDF file format.

176 Paceart System Administrator's Guide Paceart Export Module Installation Contact Medtronic Paceart Technical Service prior to starting the installation of the Paceart Export Module. The trained customer support specialists can assist you with your installation. Installation requirements For information regarding the minimum hardware and software requirements, refer to the Paceart System Technical Requirements document included with your software documentation. The Paceart Export Module must be installed on each Paceart System client PC from which you wish to export data. The Export Module installation is on a separate CD. The version of your Paceart Export Module CD should match the version of the Paceart System client. For example, if your client is running the Get Connected III Edition, install the Paceart Export Module Get Connected III Edition. The computer workstations that the Paceart Export Module is installed on must meet the minimum hardware requirements as specified in the Paceart System Technical Requirements document. Installing the Export Module All Paceart-related applications must be closed prior to loading the Paceart System software. The Export Module CD should be loaded on each workstation where you want to export patient data. Note: This is an optional software component that your clinic may not have. 1. Insert the Paceart Export Module installation CD into a computer that has the Paceart System client installed. The setup program should automatically start. Note: If the setup program does not automatically start you can manually start the installation program by clicking setup.exe on the Paceart System installation CD. If you receive a message about versions not matching, open Paceart to the login screen, close it without logging in, and then retry installing the Export module. 2. Read the copyright warnings. Then click Next through the installation wizard. 3. Click Finish to complete the installation. 4. Click Yes to restart your system. Configuration Once the Paceart Export Module has been installed, you must configure the Export Module. Configuring the Export Module global options Export Module configuration options are stored as global configuration options. Because the configuration is global, you only need to make the configuration changes on one Paceart System client workstation in your Paceart deployment. The options you choose will be available to all your Paceart System computers. Opening the Export Options tab 1. Open the Paceart System client.

Paceart System Administrator's Guide Paceart Export Module 177 2. From the Main tab, click the Utilities tab. 3. Double-click the Tools folder to expand it. 4. Double-click Global configuration options. 5. Click the Export Options tab. Export options tab Export Status field The Export Status field configuration option is used to control your clinic workflow during the review of Paceart System tests. This option allows you to determine the default value of the Export Status field for every new test you create in the Paceart System. The choices available in the drop-down list are as follows: Ready for Export: Select this option if you want all new tests to be ready for export when they are created. This is a good default option for clinics where most tests are considered complete at the time the test is taken. Ready for Review: Select this option if you want all new tests to be ready for review when they are created. Tests that are at a status of Ready for Review cannot be exported until their status is manually changed to Ready for Export. This is a good default option for clinics where a review must take place after a test is taken and before final report generation. Note: These are default options only, and can be manually changed after a test is created. Export Type The Export Type drop-down list allows you to select which type of file to export. You may choose from the following options: XML Export HL7 Export Note: You must have the Paceart Source Adapter, installed, configured and run at least once in order to select the HL7 option from the drop-down list. Export File location This option controls where the Paceart export files (XML or PDF) are placed upon creation. You can select a shared network folder that is accessible to other computers on the network (for example, if distribution of Paceart export files are to be processed from a centralized location for import into another hospital EMR system) or a folder on a local hard drive. Use the browser (accessed with the button) to select the export location, or type the file path in the textbox. This configuration option must be entered in order for the export feature to function. Export options The following three options are available: Export Version: This option allows you to specify the version of the Paceart XML Schema Definition (XSD) that you wish to export. This allows your integration projects to continue working should Paceart develop a new version of the XSD. This gives you time to upgrade your integration project to the latest version to take advantage of new Paceart System features. If you are starting a new integration project, use the latest version of the Paceart XSD in order to take advantage of new features included in the export. Note: If you select HL7 from the Export type drop-down list, the Export Version will not be selectable.

178 Paceart System Administrator's Guide Paceart Export Module PDF Report Options: This option controls whether a copy of the test's Paceart report will be included with the export as a PDF file. Choices for this option are: Don't include PDF report Include link to PDF report Include embedded PDF report Export Type XML HL7 PDF Report Option Include link to PDF report Include embedded PDF report Include link to PDF report Include embedded PDF report Results Two files are created for every export. One file contains the XML textual data. The second file is the PDF copy of the report selected for the test. One XML file is created. The PDF report is embedded in the XML file using a binary format specified by the Paceart XSD. One PDF report file is created for every export. The PDF report is embedded in the HL7 message using base 64 encoding. Exclude Protected Health Information (PHI): This option controls whether protected health information is contained in an exported XML document. This option is disabled if you select the HL7 export type. Note: Note: If you choose to exclude protected health information from the content of the exported file, the XML and PDF file names and properties will still contain the patient's name. By default, all data, including PHI, is exported from the Paceart System. If you wish to exclude PHI, this option can be selected to remove that information. Select this option if you are using the Paceart Export Module to send data to a research database. The following table contains all fields that are currently classified as PHI in the Paceart System and will be removed from the content of the export files if the option is enabled: Field Description Patient ID Number Patient First Name Patient Middle Initial Patient Last Name Primary Insurance Patient Name Secondary Insurance Patient Name Patient Date of Birth Patient Sex Primary Insurance Social Security Number Secondary Insurance Social security Number Medicare Number Medicaid Number Patient Honorific (not currently used)

Paceart System Administrator's Guide Paceart Export Module 179 Field Description Patient Address Line 1 Patient Address Line 2 Patient City Patient State Patient Zip Code Patient Country Patient Phone Number 1 Patient Phone Number 2 Recorded Sound File of Patient Name Recorded Sound file of Physician Message Patient Photo Image (not currently used) Patient E-Mail Address Device Serial number Event data export Once you have successfully installed the Paceart Export Module and configured your settings, you are ready to export event data. Exporting event data 1. Open a patient event in the patient tree. 2. Click the button in the toolbar or click File. Then click Export. 3. Click Yes. Note: Once you have exported the event data, the Event Info tab will display Export Completed in the Event Status drop-down list. If you want to export the event data again, you must select Ready for Export from the Event Status drop-down list. Paceart XML Schema Definition (XSD) The Paceart Export Module will export XML files that conform to a Paceart proprietary schema definition. If you will be integrating the Paceart Export to another computer system, it is essential that you write your integration to the Paceart XSD. The Paceart XSD files can be found in Paceart Installation Drive > Program Files > Common Files > Paceart Shared > XML Schema. Note: The Paceart Installation Drive is usually C: for a typical Paceart System installation.

180 Paceart System Administrator's Guide Paceart Export Module In the XML Schema folder, there are subfolders for each version of the Paceart XML Schema. Open the folder of the version you want to support with your integration project. The XSD file is named Paceart.xsd. You can open this file in a text editor or, preferably, in an application that allows you to work with XSD files. In each schema version folder there are also two.xsl (extensible stylesheet language) files. One file is for upgrading from a previous version of the schema and the other file is for downgrading the schema. When you downgrade the schema you lose the ability to export any new functionality introduced by that schema. Note: Downgrading the schema does not delete any information from the Paceart database. If you downgraded from schema version 6.0 to schema version 5.0 you would lose scheduling integration, which includes Appointment Remote Status and Visit ID. If you downgraded from schema version 5.0 to schema version 4.0 you would have the following results on exported events: Removes remote follow-up tests created using remote follow-up services that were first supported in the Get Connected II Edition. Removes the remote follow-up service from the patient demographics if the remote follow-up service was first supported in the Get Connected II Edition. Removes the remote follow-up service name from appointments if the remote follow-up service was first supported in the Get Connected II Edition (the appointments are not removed). Troubleshooting The remote follow-up sucessfully exported but not all the information appears Verify that you are using the correct XML schema version. For the Get Connected II release use schema version 5.0. If you have questions call Paceart Technical Support. Note: To use new features in Paceart you must use the most up-to-date version of the Paceart XML schema.

Chapter 14 Paceart Satellite Services Client Topics: Installing the Paceart Satellite Services client on the terminal server Installing Terminal Services client on workstations Starting a Satellite Services Client session Running Satellite Services in Administrative Mode Logging off sessions Purchasing Satellite Services licenses The Paceart Satellite Services Client is an optional addition to the Paceart System that allows users to login from multiple workstations onto one server and run Paceart in data-entry mode. The Paceart Satellite Services Client uses Microsoft Terminal Services technology. Terminal Services is an optional upgrade available on all Microsoft Windows servers supported by Paceart. For information on Terminal Services refer to the appropriate website. For Windows 2000 go to http://www.microsoft.com/windows2000/technologies/terminal/default.asp. For Windows 2003 go to http://www.microsoft.com/windows2003/technologies/terminal/default.asp.

182 Paceart System Administrator's Guide Paceart Satellite Services Client Installing the Paceart Satellite Services client on the terminal server The Paceart System client must be installed on your terminal server. Note: This is an optional software component that your clinic may not have. 1. Insert the Paceart Satellite Services Client CD. The setup program should start automatically. Note: If the setup program does not automatically start, AutoRun has been disabled for your CD or DVD drive. You can manually start the installation program by clicking PaceTSC.exe on the installation CD. 2. In the first wizard window click Browse if you want to change from the default location. 3. Click Next through the wizard. 4. Satellite Services initially permits up to five concurrent connections. If you purchased more licenses than five, contact Paceart Technical Support. They will supply you with a licensing code. You may also purchase more licenses after you have completed the installation. 5. If you did not purchase more licenses, click Next. 6. After installation, the administrative shortcut is accessible to all users. To restrict access to this function, you can move it from the All Users folder to the personal folder of the administrator. Installing Terminal Services client on workstations Terminal Services client is a free download from Microsoft. Refer to the Microsoft documentation for information on how to perform the installation. Configuration will vary based on your setup; for example where you are connecting to, how your users are authenticated, or how you configure your visual settings. Starting a Satellite Services Client session 1. After setup, connect to the server using the Terminal Services client. 2. Start Satellite Services by double-clicking on the Paceart System icon on the desktop. Running Satellite Services in Administrative Mode When you run the Satellite Services client in administrative mode you can see the complete list of Terminal Services connections, including PCs running the Paceart System client. 1. Click Start. 2. Click Programs. 3. Click Paceart Satellite Services Client.

Paceart System Administrator's Guide Paceart Satellite Services Client 183 Logging off sessions The Administrator can remotely log off Paceart client sessions. Note: Do not log off users as part of your normal operations, you could loose or corrupt data. 1. Select the desired active session in the Paceart System Satellite Services Client window. 2. Click Logoff session. 3. Click Yes in the pop-up dialog. Purchasing Satellite Services licenses The number of licenses determines how many Paceart System Clients can be executed simultaneously from separate Microsoft Terminal Services connections. By default, the Satellite Services Client comes with five licenses. Note: To purchase more Microsoft Terminal Services licenses you must contact Microsoft. 1. Call Paceart Technical Support to purchase more licenses and receive a license code. 2. Click Options from the taskbar. 3. Then select License. 4. Enter the license code provided by Technical Support. 5. Click OK.

Appendix A HIPAA overview Topics: Product use and technical features Potential security exposures Paceart System security features Important notes Additional information This information describing the security features of the Medtronic Paceart System is provided to help our customers comply with Health Insurance Reform: Security Standards' (Health Insurance Portability and Accountability Act (HIPAA) Security Rule), found at 45 C.F.R. Parts 160, 162, and 164. This information applies to Paceart 2004 First Edition and later software versions. Paceart displays the software version on the user logon screen. Medtronic Paceart engaged an independent security expert to help proactively assess the Paceart System we currently market with respect to the standards and implementation specifications of the Security Rule. The following information describes the security features and potential risks we have identified as a result of our assessment. In addition, it identifies possible administrative, physical and technical safeguards to help you, as a Covered Entity, establish processes and procedures for the use of Medtronic Paceart products that are reasonable and appropriate for your institution. Understanding Paceart's capabilities, using Paceart security features, and implementing recommended procedures can assist you in safeguarding electronic patient data as you use the Paceart System in the management of heart rhythm patients. This information is not intended as an exhaustive list of recommendations. Your organization's particular needs and security requirements may call for additional actions and controls.

186 Paceart System Administrator's Guide HIPAA overview Product use and technical features The Medtronic Paceart System is a computer software application that organizes relevant patient, cardiac device, and programmer information to help clinics manage follow-up of implantable cardiac device patients. Paceart's principle objective is to provide heart data rhythm management solutions. Paceart Systems are installed on Intel-compatible hardware, running Microsoft Windows operating Systems. The System uses Microsoft SQL Server for database hosting. Other components of the technical environment will include Microsoft Internet Information Server (IIS) if the provider has selected Paceart's Web Access option. Patient Data Data Recording The Paceart System creates an electronic patient record, which may contain patient-specific ephi (electronic protected health information) data, including ECG and other monitored parameters and therapy events such as defibrillation and pacing. Patient data stored by the Paceart System can include for each patient: name, address, city and state, postal code, telephone numbers, fax numbers, Social Security number, medical record number, health plan beneficiary numbers, account numbers, certificates and license numbers, device numbers, date of admission and date of service. Data Storage The number of patient records managed by the Paceart System is dependent upon the storage capacity of the computer server hosting the ephi data. Data is stored in a Microsoft SQL Server database. Data Retrieval Clinicians access ephi via the Paceart Systems Windows-based user interface. Paceart allows the clinic's System administrator to create and manage unique user identifications and passwords for each clinician accessing the System. User profiles controlling access to data can be created and assigned to individual user identifications and passwords. Data Transmission For patient care or data archiving purposes, data may be transferred from the Paceart System to another data management tool employed by the clinic. Information is transferred via the Paceart Export Module, which creates an XML-based or HL7-based message that is transmitted by the clinic's network infrastructure. Potential security exposures The following table represents examples of potential information security exposures associated with the Paceart System. Other information security exposures may exist, depending on how this product is used within your organization. Security exposures External Hostile or intentional activities Non-hostile or unintentional activities Theft of a Paceart System-equipped computer from the building results ephi is disclosed to service provider when Paceart System-equipped in ephi being destroyed or hardware is repaired or serviced disclosed. and software support is provided. Physical access to the Paceart System-equipped computer permits ephi is left on Paceart System-equipped computers when

Paceart System Administrator's Guide HIPAA overview 187 Security exposures Internal Hostile or intentional activities the copying of ephi to portable media for removal and later disclosure. The copying of ephi data to portable media for removal and later disclosure. Employee copies ephi to a portable media for removal and later disclosure. Employee intentionally deletes or modifies ephi. Non-hostile or unintentional activities equipment is retired, and a salvage company discovers patient data. Employee spills liquids or causes other accidental damage to the Paceart System-equipped computer, thereby preventing or delaying access to ephi required for delivery of patient care. Employee accidentally deletes ephi from Paceart System database. Paceart System security features These security features and recommended procedures for proper use of the System are intended to facilitate your HIPAA security compliance efforts. Administrative safeguards HIPAA standard Information access management (To implement policies and procedures authorizing access to electronic patient data.) Security issue and feature Recommended action Paceart security features are based To help prevent improper disclosure upon the customer's selection of or loss of ephi, installation of the security model. There are two full version of Microsoft SQL Server options. with use of the Microsoft Windows security model is recommended. The first option uses the Microsoft This will permit the use of Windows SQL Server security model. The event logging to track user activities. second option uses the Microsoft This will also permit the use of Windows security model. Windows groups for role-based Both models provide for controlling administration of user access. access to the Paceart System Clinics should enable Windows application and ephi. Both models event logs for both successful and allow for audit logging capabilities. failed events and implement policies Use of the Microsoft Windows and procedures for backup and protection of audit logs. security model allows for the use of Microsoft Windows security groups and logging. For information on workstation security, refer to the following chapters: Chapter 2 - Preparing for Paceart, Chapter 4 - Paceart Database Manager, and Chapter 6 - Paceart System Security and Privacy

188 Paceart System Administrator's Guide HIPAA overview HIPAA standard Contingency plan (To respond to an occurrence that damages systems containing electronic patient data.) Security issue and feature Paceart provides for the backup and recovery of ephi using either the standard Microsoft SQL Server utilities or the backup capabilities of the Windows server. Data backups can be used to store ephi on portable media or clinic-based storage systems. Recommended action Clinics should establish polices, standards, and procedures for the backup and recovery of ephi. For information on workstation security, refer to the following chapter: Chapter 7 - Paceart System Maintenance Clinics should establish policies, standards, and procedures for the protection of portable media that contain ephi. Protection from malicious software (To implement technology designed to protect ephi from attack from software viruses.) Paceart relies on the security controls implemented for the hosting platform on which it is installed. Customers are responsible for providing a secure platform on which the Paceart System can operate. Clinics should install anti-virus software on the computer used to process and manage ephi used by the Paceart application. The procedure should call for the timely updating of virus definitions. Security updates to the operating System are recommended upon consultation with Paceart Technical Services. Table 1: Physical safeguards HIPAA standard Security issue and feature Recommended Workstation Security (To implement policies and standards to physically secure access to and the integrity of Paceart System managed ephi at the local workstation level.) The Paceart System allows for the Implement policies and standards storage of electronic patient data on for physical security for those either a local workstation or a workstations used to interface with network-enabled server. In either the Paceart database, either on a case, the Paceart System utilizes local workstation or server Microsoft SQL Server to host the environment. data. The Paceart System Implement necessary network workstation client connects via security measures to ensure data ActiveX Data Objects (ADO transmitted via the ADO interface [SQLOLEDB]) to the Microsoft SQL between the Paceart workstation Server database, whether that client and the Microsoft SQL Server database resides directly on the database are secure. local workstation, on the clinic's Implement workstation user authentication policies that manage the access of ephi by user role. network, on a Virtual Private Network (VPN), or on a remote network. Customers are responsible for ensuring that access to Paceart System-managed ephi is secure. Use of a password protected screen saver is recommended. For information on workstation security, refer to the following chapters: Chapter 2 - Preparing for Paceart, Chapter 4 - Paceart

Paceart System Administrator's Guide HIPAA overview 189 HIPAA standard Security issue and feature Recommended Database Manager, Chapter 6 - Paceart System Security and Privacy, and Chapter 7 - Paceart System Maintenance Technical safeguards HIPAA standard Access Controls (To manage access and use of ephi stored in the Paceart System database.) Integrity (To implement policies and procedures designed to protect the integrity of system-managed ephi.) Security issue and feature Recommended action Microsoft SQL Server is used to provide database support for the Clinics should administer user access procedures consistent with Paceart application. The Paceart the customer's policies, procedures application can provide for the use and standards for administration of of unique user accounts and applications and Systems that passwords in conjunction with either maintain ephi. the Microsoft Windows security Clinicians and other users should model or the Microsoft SQL Server be assigned unique user accounts security model. The Microsoft Windows security model provides additional benefits in the form of coordination with Microsoft Windows security groups, Microsoft Windows password policies and Microsoft Windows event logging. and appropriate user access permissions for accessing the Paceart application. For information on establishing access controls, refer to the following chapters: Chapter 2 - Preparing for Paceart, Chapter 4 - Paceart Database Manager, Chapter 6 - Paceart System Security and Privacy, Chapter 10 - Paceart Web Access, and Chapter 11 - CardioVoice TTM Assistant The accuracy and completeness of the Paceart System's data depend Implement policies and standards to secure and protect the host in part on the policies and standards operating System on which the implemented on the host operating Paceart client application is to be System. Risk to Paceart stability can operated. be introduced from weak local Implement policies and standards security policies on the host to secure and protect the host platform. Security patches to the OS operating System on which the should be applied after consultation Paceart database is to be hosted. with Medtronic Paceart Technical These policies and standards Services. should be appropriate for a System that maintains ephi. Use the Microsoft Windows security model. Use an external Uninterruptible Power Supply (UPS) in conjunction with workstations or servers used to connect to or host a Paceart database.

190 Paceart System Administrator's Guide HIPAA overview Important notes This document provides a description of certain security features of the Paceart System. In addition, it provides recommended actions and suggested controls that may help you mitigate or otherwise address the information security risks that are associated with the product's use. However, these security features, recommended actions, and suggested controls may not ensure that all security incidents can be avoided, such as those related to the inadvertent or the unauthorized disclosure, deletion, or modification of a patient's health information. In addition, this document is not intended to provide, and should not be relied upon as, a comprehensive description or an exhaustive list of recommended actions and controls. As a result, depending upon the particular security requirements and needs of your organization, additional actions and controls may need to be implemented by your organization. Additional information For additional information, call Paceart Technical Support.

Appendix B Unassisted Update Guide Topics: Welcome to the Paceart System - Get Connected III Edition. This new version of the Paceart System includes new features and continues to Unassisted Update Guide give you The Power to Transform your arrhythmia patient care. This Before you begin document provides the information and steps necessary to update Paceart Installing the Paceart System - System 2004 First Edition, 2004 Second Edition, 2005 First Edition, 2006 Get Connected III Edition First Edition, or Paceart System - Get Connected II Edition to the latest Software version: Paceart System - Get Connected III Edition. Completing the update The instructions will guide you through the update process. If at any time prior to or during your update you have questions about the process, or if you require assistance, call Paceart Technical Support. If you require full support to perform an update, you will be referred to the Paceart Update Coordinator who will schedule a time to perform the update. For technical support contact your local Medtronic office. In the US and Canada, call 1-800-PACEART. For further information you may: Call Paceart Technical Support Consult the Medtronic website at www.paceart.com Refer to the Paceart System Administrator's Guide PDF included with your Paceart Software on the documentation CD

192 Paceart System Administrator's Guide Unassisted Update Guide Unassisted Update Guide Welcome to the Paceart System - Get Connected III Edition. This new version of the Paceart System includes new features and continues to give you The Power to Transform your arrhythmia patient care. This document provides the information and steps necessary to update Paceart System 2004 First Edition, 2004 Second Edition, 2005 First Edition, 2006 First Edition, or Paceart System - Get Connected II Edition to the latest version: Paceart System - Get Connected III Edition. The instructions will guide you through the update process. If at any time prior to or during your update you have questions about the process, or if you require assistance, call Paceart Technical Support. If you require full support to perform an update, you will be referred to the Paceart Update Coordinator who will schedule a time to perform the update. For technical support contact your local Medtronic office. In the US and Canada, call 1-800-PACEART. For further information you may: Call Paceart Technical Support Consult the Medtronic website at www.paceart.com Refer to the Paceart System Administrator's Guide PDF included with your Paceart Software on the documentation CD Before you begin Before updating to the Get Connected III Edition you must complete the following tasks. Important: When you install server components, the SQL Services will be stopped. Afterwards, the workstation housing the database manager may require a restart. You can cancel out of the restart. If you think you will have to restart, notify your information technology department prior to installing this software. All Updates All updates require that you do the following tasks: Back up the Paceart System database. Ensure that MDAC 2.8 SP1 has been installed on servers and workstations if you are upgrading from something other than 2006 or GCII. If you are upgrading from 2006 or GCII, you do not need to perform this step. Gateway Services If you have Gateway Services, you must also do the following task: Uninstall Paceart Remote Acquisition/Gateway Services if it is currently installed on one of your workstations or servers. Replication If you have replication, you must also do the following tasks: Synchronize local data with the network database. Note: Verify that all replicating laptops/pcs have successfully transferred local data to the network database before starting the update process. If data is not replicated it may be unrecoverable.

Paceart System Administrator's Guide Unassisted Update Guide 193 If your version is earlier than 2004FE, delete the publication(s) from the server, and subscription(s) from the workstation(s). If you have version 2004FE or later you do not need to drop replication. Connected Systems Gateway Module If you have HL7 connectivity, call Paceart Technical Support for assistance with the update. Do not attempt an unassisted update, because it will break your connectivity. Synchronizing local data with the network database This should be done prior to backing up the database. Note: If your Paceart System uses replication, you must verify that all replicating laptops/pcs have successfully transferred local data to the network database before updating the Paceart software. If data has not been replicated before the update, it may be unrecoverable. 1. To start Windows Synchronization Manager, click Start. 2. Select Programs. 3. Click Accessories, and then click Synchronize. Backing up the Paceart System database You must back up the database to ensure faster recovery if you need to reinstall the previous version of Paceart. To back up the database, locate the workstation with the Paceart System Database Manager on it. If you have multiple databases, you must back up each one by repeating the steps for each database. 1. Click the Paceart System Database Manager icon to open the application. 2. Log into the correct SQL Server. 3. Select the database that you want to update (for example, WinCPTS_2000 or Paceart_Database). 4. Click Bulk Copy, and then click Next. 5. Under BCP Direction, click Export. 6. On the remaining pages, click Next or Yes to accept default settings. 7. Click Finish. Checking the MDAC version information Ensure that MDAC 2.8 SP1 has been installed on servers and workstations prior to loading the Paceart System software. If you are upgrading from 2006 or GCII, you do not need to perform this step. Caution: Do not make any changes to the registry settings. Incorrectly editing the registry could severely damage your Windows software system. 1. On the Start menu click Run. 2. In the Run window type "regedit" and then click OK. This starts the Registry Editor. 3. In the left navigation section of the Registry Editor window, click HKEY_LOCAL_MACHINE > Software > Microsoft > DataAccess. 4. In the right section of the Registry Editor window, look for FullInstallVer and Version. Each of these keys will have corresponding version information in the Data column. Ensure that both values start with 2.81. 5. When you are finished, click File > Exit to close the Registry Editor.

194 Paceart System Administrator's Guide Unassisted Update Guide Uninstalling Paceart Gateway Services You must uninstall the Paceart Gateway Prerequisites and the Paceart Gateway Services. Note: The uninstall will only remove the Gateway Services application. All configurations within Gateway Services are stored within the database and will not be affected so this will not affect SessionSync, CareLink, or other remote follow-up services integrations. 1. Verify and write down the Paceart Remote Acquisition and Paceart Programmer Acquisition services "Log On As" information. This information may be needed later in the installation if you have proxy or other Internet/Network security restrictions. 2. Click Start > Settings > Control Panel > Add or Remove Programs. 3. In the Add or Remove Programs dialog box, select Paceart Gateway Prerequisites, click Remove, click Yes, then click Yes for all. 4. Select Paceart Gateway Services, click Remove, click Yes, then click Yes for all. Deleting Publications from the Server and Subscriptions from Workstations Synchronizing local data with the network. Note: If your version is earlier than 2004FE, delete the publication(s) from the server, and subscription(s) from the workstation(s). If you have version 2004FE or later you do not need to drop replication. 1. Open the Database Manager. 2. Log into the correct SQL Server. 3. Open the Publishing Database. a) Click Publications. a) Move the cursor over the active publication and record the filters listed on the left side of the dialog box. These filters are used when re-creating the publication. b) Move the cursor over the publication and press DELETE on the keyboard. 4. Open the Database Manager. 5. Log into the correct SQL Server. 6. Open the Subscribing Database. a) Click Subscriptions. b) Move the cursor over the active subscription and press DELETE on the keyboard. Installing the Paceart System - Get Connected III Edition Software You must install the Get Connected III Edition software pieces in the following order: 1. Get Connected III Edition Documentation CD 2. Paceart System Server Components (Database Manager) software (on the same CD as the Paceart System Client Components software) 3. Paceart System Client Components software (on the same CD as the Paceart System Server Components software that you just installed) 4. Customizations software (if applicable to your system) 5. Paceart Gateway Services software 6. CardioVoice software (if applicable to your system) 7. Export Module software (if applicable to your system)

Paceart System Administrator's Guide Unassisted Update Guide 195 8. Connected Systems Gateway Module software (see installation note in the Before you begin section) 9. Satellite Services software (if applicable to your system) Installing the documentation CD This CD should be installed on all workstations where you want to have this documentation available. 1. Insert the installation CD in the disk drive. The CD automatically starts the installation wizard. If the installation does not automatically start, run Autorun.exe on the CD. 2. Click Install Documentation. 3. Click Finish. Installing the Paceart System Database Manager software All Paceart-related applications must be closed prior to loading this software. Important: When you install Server Components the SQL Services will be stopped. Afterwards, the workstation housing the database manager may require a restart. You can cancel out of the restart. If you think you will have to restart, notify your Information Technology Department prior to installing this software. 1. Locate all workstations with the previous version of the Paceart Database Manager software. 2. Insert the installation CD in the disk drive. The CD automatically starts the installation wizard. If the installation does not automatically start, run Autorun.exe on the CD. 3. Click Install Server Components. 4. Click Next or Yes to accept the default settings. 5. Complete the installation wizard and click Finish. Important: At this point, the workstation housing the database manager may require a restart. If a restart will impact other people's work, notify your Information Technology Department that your update of the Paceart System requires a restart of the server so they can coordinate the server outage with other users. If a restart must be avoided, you can cancel the restart, but you have to restart the SQL Service manually. Updating the structure revision level If your Paceart System software upgrade contains a structure revision level update to your Paceart database, you must apply this update individually to each Paceart database in your Paceart System. If you have replication, this means applying the update to not only your central publishing database, but also to all subscribing databases. You can do this all from one computer by performing the following steps, and when finished, clicking the button to connect to your other SQL Servers. Note: You must have administrative rights to the database to update the database structure. A quick way to determine if you have administrative rights is to click the New Database icon. If the New Database Wizard starts, that means you have sufficient rights to run the database structure update. 1. Log into the Paceart Database Manager. 2. Select the database that you want to update (for example, WinCPTS_2000 or Paceart_Database). 3. Click Yes to update your database structure. If your version is earlier than 2004FE, continue with the next step. If you have version 2004FE or later you do not need to continue. 4. If you have existing publications and/or subscriptions configured on the database, you may receive an error message. Before you can proceed with the database structure revision update, you must delete all existing publications and subscriptions configured on the database. You will need to re-create your publications

196 Paceart System Administrator's Guide Unassisted Update Guide and/or subscriptions after updating the database structure. Take notes on all of your publications and subscriptions before deleting them so they can be easily re-created. Click OK. Configuring replication on the publishing server These steps only need to be completed if your version is earlier than 2004FE and you are using replication. 1. To create the new publication, open the Database Manager, open the publishing database, click Publications, and then click New Publication. 2. Follow the instructions provided by the wizard to configure the filters. If you have questions on the selections within the wizard, refer to the Paceart Database Manager chapter of the Paceart System Administrator's Guide. Configuring replication on the subscribing workstation(s) These steps only need to be completed if your version is earlier than 2004FE and you are using replication. 1. Install the Paceart System Database Manager software. 2. To create a new subscription, open the subscribing database, click Subscriptions, and then click New Subscriptions. 3. Follow the instructions provided by the wizard to create subscriptions. If you have questions on the selections within the wizard, refer to the Paceart Database Manager chapter of the Paceart System Administrator's Guide. Installing the Paceart System Client Close all Paceart software before starting an installation. 1. Select Install Client Components from the main menu that appears when you insert the Paceart installation CD in your CD drive. If the menu does not automatically appear, run Autorun.exe on the CD. 2. This will start the Paceart System client application setup program. Click Next. 3. You may choose to use the default destination folder (recommended), or click Browse to choose a different destination folder. 4. Click Next. 5. The Choose Parallel Port Module window will appear. If this Paceart System client computer will ever use a Paceart Parallel Port module for ECG acquisition, select This computer will use a parallel module on port and select the parallel port in the drop-down list that the module will use. If the computer will be using a Paceart USB Module or not using a module, select This computer will not use a parallel port module. 6. Click Next. 7. The Paceart System client application is ready to be installed. If you need to make any modifications to your previous selections, click Back. Otherwise, click Next to continue. 8. When the Paceart System Client Installation is complete, click Finish to exit the installation. 9. If you receive a message to restart, click OK to restart the computer and complete the installation. Installing Paceart Customer-Specific Configuration software You must update the Paceart Database and Database Manager and install the Paceart System Client before you install the PCSC software.

Paceart System Administrator's Guide Unassisted Update Guide 197 Perform this step only if your system has a Paceart Customer-Specific Configuration (PCSC). If Medtronic Paceart created a PCSC for you, a separate CD titled "PCSC - Paceart Customer Specific Configuration Software" is packaged and shipped separately. You must load new PCSCs for the system to work properly. PCSCs created for previous versions of Paceart do not work with the Get Connected III Edition. 1. Close the Paceart System. 2. Insert the PCSC - Paceart Customer Specific Configuration Software CD into your CD-ROM drive. 3. Browse to the CD. 4. Select and copy the contents of the CD (Backup folder, menus.rst, YourCustomerName####.mdb and WinCPTS 2000.adp) to the C:\Program Files\Medtronic\Paceart System folder. 5. When copying the contents of the CD to the folder you may be asked if you would like to replace the file. Click Yes to All. 6. Click Menus.rst, click the File menu, click Properties. 7. On the Properties window, make sure the Read-only check box is not checked. 8. Repeat steps 6 and 7 for the WinCPTS 2000.adp file and ensure the Read-only check box is not checked. 9. Start and log in to Paceart. Verify your PCSC software is accessible. Installing the Paceart Gateway Services software All Paceart-related applications must be closed prior to loading this software. The Paceart Gateway Services software must be installed on only one workstation. This workstation must have Internet access and must be turned on overnight to take advantage of automated retrieval of remote follow-ups. Note: This is an optional software component that your clinic may not have. 1. Locate the workstation or server you want to install the Paceart Gateway Services on. 2. Insert the Paceart Gateway Services CD in the disk drive. The CD automatically starts the installation wizard. If the installation does not automatically start, run Autorun.exe on the CD. 3. Click Next or Yes to accept the default settings. 4. Click Proceed to the Final Part, and then click Next. 5. Select one of the following: To Limit access to Paceart Gateway Services to yourself or the current user, click Just me. To allow anyone who logs onto the computer to access the Paceart Gateway Services, click Everyone (recommended). 6. Click Next, until you reach the Installation Complete window, and then click Close. To configure Paceart Gateway Services refer to the instructions in the Gateway Services chapter of the Paceart System Administrator's Guide. Note: Open Gateway Services and verify that the services are started and the services start-up type is set to Automatic. Installing the Connected Systems Gateway If you have HL7 integration call Technical Support for assistance with the update. Note: This is an optional software component that your clinic may not have. For information on installing the Connected Systems Gateway refer to the Connected Systems Gateway Connectivity Guide provided with the software.

198 Paceart System Administrator's Guide Unassisted Update Guide Installing the CardioVoice TTM Assistant All Paceart-related applications must be closed prior to loading this software. You will need to copy your.vox files from your previous Paceart version if you want to save your recordings. Note: This is an optional software component that your clinic may not have. 1. Make a copy of the CardioVoice folder located in C:\Program Files\Medtronic\Paceart System\CardioVoice, and then save it to your desktop. This will be your backup copy. 2. Insert the CardioVoice CD in the disk drive, and double-click My computer. 3. Double-click the drive containing the CardioVoice CD. 4. Double-click Setup.exe. 5. Click Next or Yes to accept the default settings. 6. Copy the.vox files, CVPrompts.rst file, the CVLanguages.rst file, and the CVPrompts English.VAP file from the folder on the desktop to C:\Program Files\Medtronic\Paceart System\Cardiovoice. 7. Play the prompts by going to the Cardiovoice tab in Paceart, clicking the Options tab, clicking the Prompts tab, and then playing each of the.vox files. 8. Start the appropriate Cardiovoice lines. 9. Verify that the CardioVoice software is working properly by simulating a CardioVoice call. If the call is completed properly, delete the backup copy of the CardioVoice folder on the desktop. Creating a test patient To test the CardioVoice installation, first create a test patient with a CardioVoice ID number. 1. Launch Paceart. 2. From the main Paceart screen, click Add to add a new test patient. 3. Select the Miscellaneous tab. 4. In the CardioVoice ID field enter "1111". 5. In the Name field enter "Test" for the first name and "Test" for the last name. 6. Click Save. 7. Click Close. Simulating a CardioVoice call After you have created a test patient, call into CardioVoice and record a test ECG for that patient. Note: You must stop the CardioVoice phone line before adding a new transmitter or changing any device settings. After saving the device settings, you must log out of Paceart, log back into Paceart, then re-start the CardioVoice phone line. 1. Dial into CardioVoice by calling the phone number that is connected to the Dialogic board. 2. When asked by the system, enter your test CardioVoice ID number "1111". 3. When prompted, send an ECG or whistle into the phone to simulate an ECG. 4. Exit the CardioVoice call or hang up. 5. You will see a New Event in the Call Log section of the main CardioVoice screen. 6. Click the new event. Then click Open. 7. You should see the test ECG you recorded during the call. If you are able to open and view the ECG, you have properly installed the CardioVoice software.

Paceart System Administrator's Guide Unassisted Update Guide 199 Installing the Export Module All Paceart-related applications must be closed prior to loading the Paceart System software. The Export Module CD should be loaded on each workstation where you want to export patient data. Note: This is an optional software component that your clinic may not have. 1. Insert the Paceart Export Module installation CD into a computer that has the Paceart System client installed. The setup program should automatically start. Note: If the setup program does not automatically start you can manually start the installation program by clicking setup.exe on the Paceart System installation CD. If you receive a message about versions not matching, open Paceart to the login screen, close it without logging in, and then retry installing the Export module. 2. Read the copyright warnings. Then click Next through the installation wizard. 3. Click Finish to complete the installation. 4. Click Yes to restart your system. Installing the Paceart Satellite Services client on the terminal server The Paceart System client must be installed on your terminal server. Note: This is an optional software component that your clinic may not have. 1. Insert the Paceart Satellite Services Client CD. The setup program should start automatically. Note: If the setup program does not automatically start, AutoRun has been disabled for your CD or DVD drive. You can manually start the installation program by clicking PaceTSC.exe on the installation CD. 2. In the first wizard window click Browse if you want to change from the default location. 3. Click Next through the wizard. 4. Satellite Services initially permits up to five concurrent connections. If you purchased more licenses than five, contact Paceart Technical Support. They will supply you with a licensing code. You may also purchase more licenses after you have completed the installation. 5. If you did not purchase more licenses, click Next. 6. After installation, the administrative shortcut is accessible to all users. To restrict access to this function, you can move it from the All Users folder to the personal folder of the administrator. Installing Terminal Services client on workstations Terminal Services client is a free download from Microsoft. Refer to the Microsoft documentation for information on how to perform the installation. Configuration will vary based on your setup; for example where you are connecting to, how your users are authenticated, or how you configure your visual settings.

200 Paceart System Administrator's Guide Unassisted Update Guide Completing the update Create a backup of your installation CDs in a network location. Each CD has an.exe file, make sure to create a separate folder for each CD backup. Contact your information technology support resources for instructions on how to create the backup. Test the replication update by modifying a test patient on the local database, perform a replication, and verify that the changes have transferred to the publishing database. After you have updated all of your workstations, contact Paceart Technical Support. Ask the support specialist to notify the update coordinator that your update to the Paceart System - Get Connected III Edition is complete.

Manufacturer Medtronic, Inc 710 Medtronic Parkway Minneapolis MN 55432-5604 USA Tel. +1-763- 514-4000 Fax +1-763-514-4879 www.medtronic.com Europe/Africa/Middle East Headquarters Medtronic International Trading Sàrl Route du Molliau 31 Case Postale 84 CH-1131 Tolochenaz Switzerland Tel. +41-21-802-7000 Fax +41-21-802-7900 www.medtronic.com Medtronic E.C. Authorized Representative Medtronic B.V. Earl Bakkenstraat 10 6422 PJ Heerlen The Netherlands Tel.: +31-45-566-8000 Fax +31-45-566-8668 Australia Medtronic Australasia Pty. Ltd. 97 Waterloo Road North Ryde NSW 2113 Australia Canada Medtronic of Canada Ltd. 6733 Kitimat Road Mississauga Ontario L5N 1W3 Tel. +905-826-6020 Fax +905-826-6620 Toll-free in Canada: 1-800-268-5346 Medtronic, Inc. 2011 M946717A001 Rev A 2011-08-01 *M946717A001*