“Better Care” platform user manual
Contents
1.2. bce CARE Better Care S L Better Care platform user manual V 1 0 1 584 Rev A EEE Better Care S L Parc Taul 1 Edifici Santa Fe Sabadell 08208 Spain Version control 1 0 0 405A Jaume Montany Daniel Alomar Feb 2012 Added PACS configuration and 1 0 0 532A Jaume Montany Bernat Sales May 2012 the Better Care Client descrip tion Better C cia am 1 0 1 546A Jaume Montany Bernat Sales Jun 2012 da ar bas HUE changes Contents 1 Hardvvare requirements 2 What is Better Care 2 1 Description of the Better Care platform LL lll Better Care Net Server dd Ropo es ss Be gus dda ae oa SE Ree EI 9 2 IVIOMITOMING sarti Sw dw bte ARA E LEPRI 52 Waves Panel Basic se teves E eds 0 2 es Ra EES Es 3 2 2 Waves Panel Advanced rre ra EA A 3 2 2 1 Waveform aspect configuration window 3 2 2 2 Numeric configuration lt 4 dd AA dd a E E eh EA 3 2 2 3 Global configuration of Better Care Net Server look 3 2 2 4 Keyboard and Mouse Events on the Wave Panel Da PROCESS ere aa ane Es x ERO 3 e ute ee da SEES De AA 3 2 3 1 General view of the interface LL LL LL 3 2 3 1 1 Visualization options adu ue a8 AE y Xu 9 2 0 2 Alarm CO Ona cua Li ON soe uox ce 2 A des S q a xpo SE n Soil Interactive buttons o mm amp s Sus uyu a Ab dc aa
3. AIR FLOW Figure 4 10 Drag Drop on waves panel We can also configure the look of all the waves globally or individually In figure 4 11 we can see the menu generated when the mouse right button is pressed on Air Flow The first USER MANUAL Page 35 4 Better Care Client two funcionalities Serie Configuration and Numeric serie configuration are used to con figure the wave and its trend and Chart allows to choose the information to display on the screen AIR FLOW Serie Settings RESP RATE Numeric Representation Settings Chart k 903 2 Figure 4 11 VVave configuration menu 4 3 2 1 Waveform aspect configuration window Checking scale auto adjustment 4 12 will let the system choose the best scale for the corresponding parameter We can also adjust them manually as seen in figure 4 13 When we select manual adjustment we can change the minimum and maximum values and restore scales to their default value At last we can also change the color of the wave AIR FLOW Serie Settings E Parameter Setup Delay ms 7 Autoadjust Scale Min Scale 56 Max Scale Color LightSkyBlue w x Figure 4 12 Auto adjustment active USER MANUAL Page 36 4 Better Care Client AIR FLOW Serie Settings E Parameter Setup Delay ms Autoadjust Scale Min Scale 180 Max Scale 180 Color O LightSkyBlue Figure 4 13 Manual Scale adjustment 4 3
4. ARN SPO2 oT Wat N 3 J V V pP qua TS _ ARA N U 76 PRES ART Va Mi 154 PAM L N L MW LI ANI AIR FEOW 441 4 A A 68 RESP RATE i EN TA A PR ae wi Y 59 21 PAW 273 A A A Q4 PEAK PAW f 7 VT rr FN FX E 974 VT INSP N N q e y W WZ Nj 124 y Y um 50 2 00 02 52 e A Figure 4 8 Waves visualization region USER MANUAL Page 33 4 3 2 Waves Panel Advanced 13 21 06 13 21 08 13 21 10 13 21 12 ECG 13 20 52 13 20 54 13 20 56 13 20 58 13 21 00 13 21 02 Rt ue TE ral ween Jen vi e ECG Il i a a z pri di Le 1 Ed PLETA LJ fi f LA P E E i2 dm ART E BN 154 i i i Il W W un Wi LA i I l i L L l n L a 1 di k he La n 1 La A l 1 i i i T j J d T x u e em a A d L E i A T ad 1 T lew i E be ll con i vl ui j F T S d 49 ni EL a P P AIR FLOW 41 5 PEAK PAW PAW i Mea 2 j ES lo eee aa Y A V E al E zn y E j j i 574 i A j l j i 93 00 02 52 Figure 4 9 Waves panel user interaction capabilities USER MANUAL i L i Li 34 1 i A wey l asl re HN m vm JL rale rea pp pos ae A gp in mh m IT dd o a lo val emm 47 i i Las 4 Better Care Client ce 74 Pf SPO2 76 PAM 12
5. desired checked Servers ICU beds USER MANUAL Page 28 4 Better Care Client Manage Servers 10 24 0 21 80 IP Address Password Servers MI HOSPITAL PARC TAULI BOX 8 HOSPITAL PARC TAULI BOX9 Figure 4 3 Selected servers management 4 2 General vievv of Better Care Client Once configured the ICU beds available vvill be presented as its previev version in a viev that called ICU bed pre selection view Figura 4 4 USER MANUAL Page 29 4 Better Care Client No server selected BOX 8 BOX 9 FG bpm 115 SPO2 100 RESP RATE rpm 15 Figure 4 4 ICU bed pre selection view 4 2 1 ICU bed pre selection view Each box representing a single patient displays the Number name of the ICU Bed the Patient ID from the patient being monitored an Overview of the parameters that are beeing received and the alarm messages in case there s any message to show When an alarm is triggered the background of this preview box will turn blue if silenced all the alarms are deactivated background will turn yellow in the Figure 4 5 we see the detail of a box in the ICU bed pre selection view BOX 8 0 Figure 4 5 Preview of ICU bed 1 Net Server Given Name 2 Numeric parameter Name 3 Numeric parameter Units 4 Numeric parameter Value 5 Alarm messages USER MANUAL Page 30 4 Better Care Client General view of an ICU bed is accessed b
6. 4 Slider Bar 5 Current Time position 6 Trend 24h Mean 7 List of hidden Trends The trends panel is organized and displayed the same way waves panel and review panel are and even parameter drag and drop is exactly the same Navigation through the 24 values can be done with the navigation bar at the bottom of the panel Figure 3 26 the left and right cursor keys or shifting Left Mouse Button Alt Key USER MANUAL Page 23 3 Better Care Net Server 3 3 4 Alarms Alarms panel is shown in Figure 3 27 For each alarm it shows the ocurrence percentage number of times it was detected vs number of times it was calculated 01 02 03 04 05 06 OF 06 09 10 11 12 13 14 15 16 1 18 19 20 21 22 23 00 AS Cycle Time 100 a li i o 0w Per wa I Li WE Exp Asynchronies 100 10 8 dd Extrasystole Index 100 a E aa E sisters o tears e ll i fone po O YA 21 07 2012 06 00 00 07 00 00 E AA A Si A Figure 3 27 Alarms distribution visualization panel With this panel it s very easy to see the most critical hours of the day 3 4 Cameras The camera panel will be visible in case at least one camera is configured in the setup screen This panel contains USER MANUAL Page 24 3 Better Care Net Server 10 10 118 14 i Playing Motion JPEG Zoom 6199 Figure 3 28 Camera control region 1 Selected Camera 2 Real Ti
7. 7 300 mm 50 122 O 0 H 0 0 O 4 0 0 96 0 0 0 Variable without Variable with alarm Categoric Variable Variable in state of alarm limits limits Alarm Figure 4 18 Variable Box different states 4 3 3 1 1 Visualization options All the available variables and alarms its availability depends on the input signals are visible in the alarm panel This can be modified through the visualization menu or by a drag drop action USER MANUAL Page 40 4 Better Care Client e Visualization Menu Clicking with the right button on the empty space of the variables panel it will make the configuration options appear as a toolstrip menu With it it s possible to switch between showing the variables that have an alarm associated or showing all the variables being calculated Figure 4 19 TRAPPED AIR Configure TRAPPED AIR parameter Deactivate Figure 4 19 Mouse right button toolstrip menu clicking with the e Drag and Drop Variable boxes can also be dragged and dropped from the panel to the list at the right of the panel in order to hide them or from the list to the panel in order to be shown again They can also be dragged and dropped in order to sort them Figures 4 20 y 4 21 show the actions of drag and drop respectively Waves Processing T gt ECG ECG PAUSE EXTRASYSTOLE INDEX HR LEADS STATUS 0 63 s 86 78 bpm m 2 50 130 m J j oj 00 om 200 75 30 0 0 96 2 2 0 0 96 0 0 0
8. e Next Alarm Next alarm can be selected by pressing the key Drag and drop can also be used on the list to reach the thumbnail we want to expand e Previous Alarm Previous can be selected by pressing the key Drag and drop can also be used on the list to reach the thumbnail we want to expand e Last Alarm Last alarm can be directly accessed by pressing the push the gt gt button e First Alarm Last alarm can be directly accessed by pressing the push the lt lt button dl TEMTMLESM Ria LS TILA MUELA WES AIR FLOW PAW TRAPPED AIR 15 3 l m lt 5 Figure 4 25 Alarm log 4 4 Review The review tab will contain the past days since the admission until the current date which are stored in PACS Each day study will include the main clinical events the curve visualization Waves the registered trends Trends and the distribution of the events in the 24 hours of the day Alarms This tab will only be enabled if we pre configured the PACS connection USER MANUAL Page 45 4 Better Care Client File Edit Visualization Help Signals Delay 3465 msecs Data Freq 200 hz 2 bytes per sample HOSPITAL PARC TAULI BOX 8 ANON BOX 9 E MONITORING FC bpm 115 TT gt 2012 05 21 1 Waves Alarms OC la 0 O2 G O4 06 Q7 086 09 10 ti 9 2 14 16 16 1718072 22 00 SPO2 Y 99 a TTT Wt 99 64 AL 41 FCT E anes 73 RESP RATE rpm 21 o do N E Legis Status 1
9. o 6 Review off line Figure 2 1 Connection scheme of the Better Care platform USER MANUAL Page 2 2 What is Better Care The system is also powered with medical knowledge by means of parametric alarms based on complex algorithms aimed to improve patient security Functionalities e Simple intuitive and easily customizable interface e Unique and homogeneous interface for a wide heterogeneous range of medical devices e Saving in medical devices integration e Biomedical signals visualization from anywhere in the world with just a simple Internet connection Better Care Client software e Customizable alarms depending on patient and clinician needs software e Offline data and clinical events revision Better Care Review e Ideal for teaching purposes Better Care Review software e Biomedical signals capture and integration with Hospital Information Systems and PACS by using the HL7 standard USER MANUAL Page 3 3 Better Care Net Server 3 Better Care Net Server Net server is the tool placed at the patient side responsible of real time biomedical signals acquisition processing ditribution and storage Net Server contains all the elements needed to monitor and diagnose the patient grouped by tags The elements shown in Figure 3 1 are explained in the following sections UNKNOWN UNKNOWN ANON 8 TRAPPED AIR 13 1 L M lt 5 Processing
10. of times it was detected vs number of times it was calculated 01 02 03 04 05 06 OF 06 09 10 11 12 13 14 15 16 1 18 19 20 21 22 23 00 AS Cycle Time 100 a li i o 0w Per wa I Li WE Exp Asynchronies 100 10 8 dd Extrasystole Index 100 a E aa E sisters o tears e ll i fone po O YA 21 07 2012 06 00 00 07 00 00 E AA A Si A Figure 4 36 Alarms distribution visualization panel With this panel it s very easy to see the most critical hours of the day 4 5 Cameras The camera panel will be visible in case at least one camera is configured in the setup screen This panel contains USER MANUAL Page 54 4 Better Care Client 10 10 118 14 Playing Motion JPEG Zoom 61909 Figure 4 37 Camera control region 1 Selected Camera 2 Real Time Camera image 3 Level of Zoom e Current camera Selection of the current camera e Current camera view Real time video of the current camera e Current camera zoom Zoom selection of the current camera 0 to 100 Pressing the left mouse button no the camera panel will cause it to expand or contract depending on the state it had when pressed resizing also the waves and processing panels USER MANUAL Page 55 5 Better Care Review 5 Better Care Review Coming soon USER MANUAL Page 56 6 Better Care Mobile Server 6 Better Care Mobile Server Coming soon USER MANUAL Page 57
11. 2 2 Numeric configuration We can modify the max scale the min scale and also restore the default scale of the trend attached to a wave We can se this configuration window in figure 4 14 RESP RATE Numeric Representation Setti Parameter Setup Min Scale Max Scale 40 Reset Scale Figure 4 14 Numeric configuration window 4 3 2 3 Global configuration of Better Care Client look If we choose Chart in the serie configuration menu Figura 4 11 we can navigate to Profiles to change the global aspect of the waves panel USER MANUAL Page 37 4 Better Care Client The options load and Manage profiles allows loading and modifying the configuration profiles created with Profile Management that can be accessed through the option Modify in the profile menu and also by clicking the Profiles button to change the colors used the representation environment and configure Better Care Client as desired The window shown when selecting Modify is displayed in figure 4 15 Customization ES Profiles Chart Atinbutes Default a Back Color Parameters color Default Dark L_ white Mi DimGray Refresh Interval Trends periode 125 j 5 Trends repr rea Grid J High Quality Y Force Parameters Color Save Default Cancel Figure 4 15 Profile customization The parameters are e Profiles List of profiles already created By default o
12. Max Scale 40 Figure 3 9 Numeric configuration window 3 2 2 3 Global configuration of Better Care Net Server look If we choose Chart in the serie configuration menu Figura 3 6 we can navigate to Profiles to change the global aspect of the waves panel USER MANUAL Page 10 3 Better Care Net Server The options load and Manage profiles allows loading and modifying the configuration profiles created with Profile Management that can be accessed through the option Modify in the profile menu and also by clicking the Profiles button to change the colors used the representation environment and configure Better Care Net Server as desired The window shown when selecting Modify is displayed in figure 3 10 Customization ES Profiles Chart Atinbutes Default a Back Color Parameters color Default Dark L_ white Mi DimGray Refresh Interval Trends periode 125 j 5 Trends repr rea Grid J High Quality Y Force Parameters Color Save Default Cancel Figure 3 10 Profile modifying The parameters are e Profiles List of profiles already created By default only two profiles appear default and dark profile e Chart attributes Background color Parameter color Text and waves color Refresh interval Refresh time update in milliseconds the lower it is the smoother the waves are drawn Wave
13. configuration On first execution a valid the Server Directory IP address must be specified in order to retrieve real time data from all the ICU beds connected We can access this feature by clicking with the mouse left button on the label with the text No Server Selected and selecting Manage 9 Servers as shown in figure 4 1 Manage Servers Figure 4 1 Better Care Client configuration strip menu 4 1 1 Better Care Client Server Directory configuration When Manage Servers is pressed a Window Form will appear asking for a IP adress and a password Figure 4 2 When introduced pressing the Add button will make the system add the available ICU beds currently connected and sending data to the corresponding Server Directory The IP adress of the Server Directory will be stored for further executions USER MANUAL Page 27 4 Better Care Client Manage Servers E servers Directory IP Address 10 24 0 21 Password EEE Servers Figure 4 2 Manage Servers Window It is possible to add more than one Server directory at once Also in case the service in the server directory is published in a port different than 80 we can specify the port by using the following syntax IP port 4 1 1 1 Servers management Once connected to a Server Directory in the region labeled Servers we can check or uncheck the available servers in order to receive data only from the
14. de ds Dia 3 2 3 3 Alarm Log Alarm Report 225 dass Es ets dE ee dO 3 2 3 3 1 Actions on Alarm Log uw 4 8 pia Ge a a A CHR De Ps OS bela De k fat do ee EE E we dede Event panel uere se attese E dh S S amp b as ne St JOVI ELE Lie S sk w a a pe 58 SE Ge ae A 3 3 2 1 Reproduction options of the waves review panel 3 3 2 2 Keyboard and mouse events on waves panel 555 SiC A RR do let penali e PARA a ds AMICS gt 2d aa ERA es ee A 0 9 ae lata stop e manda e lee ee ee e deo e die ad ven e deu ES R Better Care Client 4 1 Better Care Client configuration 4 1 1 Better Care Client Server Directory configuration 4 1 1 1 Servers management X Gwe Week Ex mde Poda ED ES 4 2 General view of Better Care Client Q a LL LL LL LL 4 2 1 ICU bed pre selection view LL LL LL 4 2 2 General view of ICU bed llle 43 MONTONE ux te puguis A De Ge dee ol Bag ee Ge er ae dea P A 43d Waves Panel Basie oa a rios EE Se Ha ee hd d a patge i pe er EA a 192 Waves Panel Advanced suscita ss pala Ad RESI 4 3 2 1 Waveform aspect configuration window 4 3 2 2 Numeric configuration ria e E qe EE X X03 4 3 2 3 Global configuration of Better Care Client look No O N CU oo Bb 10 10 12 12 13 13 16 17 17 18 18 19 20 21 22 22 24 24 20 4 3 2 4 Keyboard and Mous
15. representation Line or area waves representation Grid Shows hides a grid in the background High quality Turns on off smoothing when drawing waves USER MANUAL Page 11 3 Better Care Net Server Force parameter color if we check this checkbox the texts and waves will be drawn with the color defined by Parameter color if not checked texts and waves will be drawn with the system default color e Save Naming a profile and clicking the Save button we adds the current profile to the stored profiles list to be modified and selected later 3 2 2 4 Keyboard and Mouse Events on the Wave Panel e Drag drop Already seen at the beginning of the chapter e Cntrl Mouse Wheel up Cntrl Mouse Right Button Zoom in e Cntrl Mouse Wheel down Cntrl Mouse Right Button Zoom out 3 2 3 Processing This module performs a real time processing of the selected waves to generate alarms that will rise when they go out of the defined range of normality or when they increase or decrease during a limited timespan This is how this module works Variable1 Alarm3 Variable2 Input Processing Signals Module Variable3 Variable4 Li n Figure 3 11 Processing scheme e Input signals Air flow FLOW Airway pressure PAW Volume VT CO2 CO2 Invasive arterial pressure PRES ART Pulse oximeter SPO2 Electrocardiogram one or more
16. the machines connected to the patient in time This wave is usually presented with a constant trend that helps understanding what s going on with the corresponding wave An example is the heart rate associated with the different ECG channels or the respiratory rate associated with the air flow The name of the constant is drawn in the header and at the center the current value between the minScale and maxScale or if there is not a valid value at the current moment In figure 3 4 we can see at the right side of the waveforms the box where we can drag the waveforms we don t want to see Using the mouse and the drag and drop movement we can drag any of the visible waves to this box so the same area is divided between the current visible waves hidden waves are still being captured and processed It s also possible to sort the waves To do it we just need to drag any wave to the desired location a line will be drawn to easily identify where the wave is about to be dropped We can see in figure 3 5 the effect of Drag and Drop AIR FLOW above the PLETH wave T AIR FLOW Figure 3 5 Drag Drop over Waves Panel We can also configure the look of all the waves globally or individually In figure 3 6 we can see the menu generated when the mouse right button is pressed on Air Flow The first USER MANUAL Page 8 3 Better Care Net Server two funcionalities Serie Configuration and Nu
17. type Each group alarms can be reordered by following the method described before By clicking on the name of the group all corresponding variable boxes will be shown or hidden USER MANUAL Page 42 4 Better Care Client Waves E PAUSE EXTRA TOLE INDEX LEAI TATI n 7 2 5 uu o E mi 0 0 96 3 3 0 i 0 96 0 0 O 120 120 120 o 0 O YCLE TIME DISCONNECTION DOUBLE TRIGGER 101 15 0 200 t JEN jx I 100 122 35 35 0 0 96 0 0 416 416 416 E O 0 0 0 0 0 ENT MODE EXP ASYINCHRONIES PLAT f e 0 2 1 1 0 0 96 16 16 16 HX 0 0 0 Y SECRETIONS STRESS INDEX TRAPPED AIR 2 9 3 2 1 4 l m a 5 Tawa 0 0 0 0 O 0 2 2 0 0 0 4 1 1 14 40 0 0 4 H 28 28 28 Activate All Edit Deactivate All Figure 4 22 Alarms grouping 4 3 3 2 Alarm Configuration Configuration of a variable alarm limitsis done through the form of alarm limit configuration This limits fix the normality minimum and maximum values so when the current value is out of this range the corresponding variable enters in alarm state Access to this form is done by pressing the mouse right button on the variable box we want to configure and selecting Configure parameter X or by clicking on the value bar with the mouse left button In figure 4 22 we can see the Alarm configuration form USER MANUAL Page 43 4 Better Care Client TRAPPED AIR VENT MODE 36 Um DF u Config
18. 13 21 06 13 21 08 13 21 10 13 21 12 EC TET FC NO ANA 77 EC WENN FC ba el 77 PLETH o SPO2 6 fee PRES ART bai 4 154 PAM wy 66 3 m 128 65 80 AIR FEOW 1 Pa 44 1 63 RESP RATE i PAW 27 3 41 PEAK PAW Ps PA i gt nd k aj 5 37 O VT 574 VT INSP a 121 6 x 53 902 00 02 52 Profiles Figure 3 1 Net Server general vievv 1 Secondary selection tabs 2 Main selection tabs 3 Camera region 4 Real Time wave panel 5 Real Time Alarm Label Visible tabs can be in 3 different states e Active and selected Determines the content to show in the elements depending on it In figure 3 1 Monitoring is the main active and selected tab and Waves is the selected depending one Active and selected tabs are drawn with a dark background and white text e Active and not selected Active tabs not selected at the moment but selectable by the user In figure 3 1 Revision is a main active and not selected tab Processing would be the corresponding dependant one Active and not selected tabs are drawn with a bright background and dark text USER MANUAL Page 4 3 Better Care Net Server e Inactive Non selectable tabs In figure 3 1 Report is an inactive tab Inactive tabs are drawn with bright background and text The following scheme shows the visible elements grouped by the three main tabs Report Processing Figure 3
19. 2 Navigability scheme in Better Care Net Server Review 3 1 Report This tab will be enabled if Net Server can access the Hospital Information System it will include patient data at entry as well as clinical data collected day by day 3 2 Monitoring The monitoring tab shows the current session state in real time This includes waves visualization Waves processing or alarm variables Processing and also remote cameras visualization and manipulation panel 3 2 1 Waves Panel Basic Real time configured biomedical waves and constants visualization Together with the waves and constants panels there are 3 interactive buttons Figure 4 8 allowing du 5 e Zoom out USER MANUAL Page 5 3 Better Care Net Server e Profiles Modifies the visual aspect of these regions gt Zoom in Waves Processing 13 21 06 13 21 08 13 21 10 13 21 12 13 20 52 13 20 54 13 20 56 13 20 58 13 21 00 13 21 02 ECG FC AL A ECG Il FC III a E E ELE PLETH do SPO2 ge A Jl n JV 76 PPP LLL UL ELE LLLI m uu f WJ MAR A M n w Jw MA nu 66 3 n AC w INC IW JW w JM ag 128 65 80 AIR VV 44 1 Mm na a 63 RESP RATE l fi af agg Le j V 59 2 1 PAVV 27 3 41 PEAK PAW 1 l fh Ad mat Li jJ TA LL 4 Loa 37 VT IN N N 574 VT INSP 121 6 d V 53 502 00 0
20. 2 2012 06 06 0 ET M nn E 00 8 2012 05 21 2 SPO2 Je 915 40 ECG Pause 2 y 0 81 lt b EXTRASYSTOLE INDEX 71 lt 75 i Profiles 4 Figure 4 26 General View of the Review tab 4 4 1 Study Download By default only the descriptions of the studies stored in the PACS are downloaded For each study it is possible to download the day report only and also the full session that includes the 24 hour waves The study name will be coloured light gray if no data have been downloaded yet 4 4 1 1 Day Report Download To download the Day Report of any of the available studyies in the PACS the corresponding element in the list has to be selected left mouse button click It is possible to download all the Day Reports from all the available studies simultaneously by clicking the right mouse button USER MANUAL Page 46 4 Better Care Client File Edit Visualization Help Signals Delay 3456 msecs Data Freq 200 hz 2 bytes per sample HOSPITAL PARC TAULI BOX 8 ANON MONITORING BOX9 FC bpm 114 SPO2 98 RESP RATE rpm 19 BOX 8 FC bpm 71 SPO2 9e CERTO CO Si PAM mmHg 112 E _ lt gt j Profiles Figure 4 27 Studyies without beeing downloaded Once the download is started its progress will be shown together with the name of the corresponding study Hn Edit Visualization Help Signals Delay 3466
21. 2 52 Figure 3 3 Waves visualization region 1 Wave Panel interactive Buttons USER MANUAL Page 6 3 2 2 VVaves Panel Advanced 13 21 06 13 21 08 13 21 10 13 21 12 13 20 52 13 20 54 13 20 56 13 20 58 13 21 00 13 21 02 ECG Rt ue TE ral ween Jen vi e ECG Il i i gt 5 i F p v P Le Ls p PLETA LJ fi f LA P E E i2 dm ART il I 154 1 ft dy L AA Il W W un Wi LA i I La LE E i L i n L a i di k T La n 1 La A l 1 i i i T j J d r as vu am i ue Fi he Tu i hi d 1 LL e e ET ud is a p soll i j i T E E I A 49 r gt Es 1 P AIR FLOW 41 5 PEAK PAW PAW 27 3 A A A ee q TUBE TR GP m j AA 1 La I mM A MN A f p 574 53 00 02 52 Figure 3 4 User interaction capabilities of Waves Panel USER MANUAL i L Il I n i E T L ad re a e d emm lim Fa LF a rs Lo aT a tt P Mn i n mai dur gi Lage Pi LN ra ail en e N L ge Lal 3 Better Care Net Server SPO 76 PAM 128 65 80 RESP RATE 621 af 902 Page 7 3 Better Care Net Server 1 Drag drop to change waveform s location 2 Waveform name 3 elapsed time 4 current waveform value 5 waveform scales 6 waveform attached numeric 7 list for hidden waveforms A biomedical wave is the continuous representation of a parameter provided by one of
22. 6 16 Y PLAT P PPV SECRETIONS STRESS INDEX TRAPPED AIR 4 8 90 2 1 2 l m 32 15 30 1 20 0 50 0 50 o 100 O 2 25 A 25 0 80 5 0 0 0 0 96 0 0 0 0 96 3 3 96 0 0 02 0 0 0 1 1 15 70 0 0f 28 28 28 E Activate All Edit Deactivate All Figure 3 15 1 Result of dragging Double Trigger Alarm USER MANUAL Page 14 3 Better Care Net Server Waves Processing gt ECG ECG PAUSE EXTRASYSTOLE INDEX HR LEADS STATUS O 0 78s 97 90 71 bpm m 2 50 130 0 4 o Io A ms E 75 30 96 3 3 0 0 98 98 98 0 0 0 DISCONNECTION COMPLIANCE DOUBLE TRIGGER VENT MODE 10 38 4 ml cmH2O 0 T 75 65 EB 100 o o 120 ol 100 0 0 96 0 0 0 0 0 0 0 0 0 EXP ASYNCHRONIES PLATP PPV SECRETIONS STRESS INDEX 0 5 2 45 32 15 30 u 120 0 100 0 50 ol 50 off 100 0 2 0 80 2 2 0 0 0 0 0 0 0 0 96 16 16 16 0 0 0 4 0 0 0 1 1 1 d 0 0 0 TRAPPED AIR 1 2 l m EN 25 3 3 28 28 28 Activate All Edit Deactivate All Figure 3 16 1 Result of dropping Double Trigger Alarm e Alarms grouping Alarms are automatically grouped depending on their type Each group can be reordered by following the method described before By clicking on the name of the group all corresponding variable boxes will be shown or hidden USER MANUAL Page 15 3 Better Care Net Server Waves E
23. 8 65 80 RESP RATE 2 1 3 902 Page 34 4 Better Care Client 1 Drag drop to change waveform s location 2 Waveform name 3 elapsed time 4 current waveform value 5 waveform scales 6 waveform attached numeric 7 list for hidden waveforms A biomedical wave is the continuous representation of a parameter provided by one of the machines connected to the patient in time This wave is usually presented with a constant trend that helps understanding what s going on with the corresponding wave An example is the heart rate associated with the different ECG channels or the respiratory rate associated with the air flow The name of the constant is drawn in the header and at the center the current value between the minScale and maxScale or if there is not a valid value at the current moment In figure 4 9 we can see at the right side of the waveforms the box where we can drag the waveforms we don t want to see Using the mouse and the drag and drop movement we can drag any of the visible waves to this box so the same area is divided between the current visible waves hidden waves are still being captured and processed It s also possible to sort the waves To do it we just need to drag any wave to the desired location a line will be drawn to easily identify where the wave is about to be dropped We can see in figure 4 10 the effect of Drag and Drop AIR FLOW above the PLETH wave T
24. 9 03 lt lt 11 09 05 11 09 07 11 09 10 11 09 34 11 09 40 11 10 03 11 10 10 11 10 15 11 10 18 11 10 33 11 10 35 11 10 39 gt lt gt lt n Figure 4 31 Clinical events panel When a date is selected in the first list Review Trends and Alarmas charts will be filled with the data corresponding to the selected date Navigation to a lower level in the list Date to Event Type or Event Type to Event can be done pressing the right arrow key or pressing the gt button Once in the last level the selection of any single event will make data chart in Revision tab move to the time the selected event was detected Navigation to a higher level can be done with the key left arrow or pressing the lt button 4 4 3 Review When review tab is selected in review waves revision panel shows the stored signals and biomedical constants Three buttons are shown Figure 4 32 allowing USER MANUAL Page 50 4 Better Care Client gt e Performs a zoom out e Profiles Customization of the look and characteristics of the waves and constants e Performs a zoom in w xww rr gt Profiles Figure 4 32 Waves revision panel This panel is shown similarly to the waves panel previously described but also includes a navigation bar similar to a media player 4 4 3 1 Repro
25. 92 92 92 0 0 0 gt INVASIVE VENTILATION CYCLE TIME DISCONNECTION COMPLIANCE VENT MODE EXP ASYNCHRONIES 101 5 38 3 ml cmH20 T 0 75 45 0 m 1300 ol 100 o 120 0 100 122 19 9 0 0 2 2 181 181 181 0 0 0 0 0 0 4 16 16 16 Y PLAT P PPV SECRETIONS STRESS INDEX TRAPPED AIR 4 8 90 2 1 2 l m 32 15 30 1 20 0 50 0 50 o 100 O 2 25 A 25 0 80 5 0 0 0 0 96 0 0 0 0 96 3 3 96 0 0 02 0 0 0 1 1 15 70 0 0f 28 28 28 E Activate All Edit Deactivate All Figure 4 20 1 Result of dragging Double Trigger USER MANUAL Page 41 4 Better Care Client Waves Processing gt ECG ECG PAUSE EXTRASYSTOLE INDEX HR LEADS STATUS O 0 78s 97 90 71 bpm m 2 50 130 0 4 o Io A ms E 75 30 96 3 3 0 0 98 98 98 0 0 0 DISCONNECTION COMPLIANCE DOUBLE TRIGGER VENT MODE 10 38 4 ml cmH2O 0 T 75 65 EB 100 o o 120 ol 100 0 0 96 0 0 0 0 0 0 0 0 0 EXP ASYNCHRONIES PLATP PPV SECRETIONS STRESS INDEX 0 5 2 45 32 15 30 u 120 0 100 0 50 ol 50 off 100 0 2 0 80 2 2 0 0 0 0 0 0 0 0 96 16 16 16 0 0 0 4 0 0 0 1 1 1 d 0 0 0 TRAPPED AIR 1 2 l m EN 25 3 3 28 28 28 Activate All Edit Deactivate All Figure 4 21 1 Result of dropping Double Trigger e Alarms grouping Alarms are automatically grouped depending on their
26. Alarms triggered by the system must be analyzed and interpreted by an expert clinician only 1 Hardware requirements 1 Hardware requirements The minimum requirements to run each Better Care platform component are 1 GHz 32 or 64 bit 1 GHz 32 or 64 bit 1 GHz 32 or 64 bit 4 GB 16 GB RAM 1GB Depending on the 1GB number of NS connected 5 GB Depending on local 50 MB data that are to be kept Microsoft NET Microsoft NET Microsoft NET Other req Framework 3 5 SP1 or Framework 3 5 SP1 or Framework 3 5 SP1 or higher higher higher Lantronix EDS4100 4 LAN 1 Gb starting from Serie Ethernet ports or UDS2100 2 10 connections ports for serial devices y Table 1 1 Net Server Server Directory and Review applications requirements BC Mobile Server BC Client 1 GHz 32 or 64 bit 1 GHz 32 or 64 bit Windows 98 or higher Windows 98 or higher 5 GB Depending on local 5 GB Depending on local data that are to be kept data that are to be kept Microsoft NET Microsoft NET Other req Framework 3 5 SP1 or Framework 3 5 SP1 or higher Lantronix EDS4100 4 Serie Ethernet ports or UDS2100 2 ports for serial devices Table 1 2 Mobile and Client application requirements Note Due to the feature of showing in real time biomedical signals it is recommended con necting through a VLAN network medical devices with computers where Net Server has been installed
27. CG PAUSE EXTRASYSTOLE INDEX Ha EADS STATI n 2 2 5 E mi 0 0 96 3 3 0 i 0 96 0 0 O i 120 120 120 o 0 O E TIME ISCONNECTION ETR 2 101 15 8 200 Ja il 122 35 35 0 0 96 0 0 96 416 416 416 4 O 0 0 0 0 0 MOI P ASYNCHRONIE AT F 2 0 96 2 1 1 96 0 0 96 16 16 16 HX 0 0 0 Y SECRETIONS STRESS INDEX TRAPPED AIR A 25 Wawa 0 0 0 0 0 0 2 2 0 0 O H 1 1 1 8118 0 0 0 4 H 28 28 28 Activate All Edit Deactivate All Figure 3 17 Groups of alarms depending on its kind 3 2 3 2 Alarm Configuration Configuration of a variable alarm limitsis done through the form of alarm limit configuration This limits fix the normality minimum and maximum values so when the current value is out of this range the corresponding variable enters in alarm state Access to this form is done by pressing the mouse right button on the variable box we want to configure and selecting Configure parameter X or by clicking on the value bar with the mouse left button In figure 3 17 we can see the Alarm configuration form USER MANUAL Page 16 3 Better Care Net Server TRAPPED AIR VENT MODE 3 6 lm DF u Configure TRAPPED AIR parameter e Deactrvate 14 14 28 28 28 TRAPPED AIR Configuration Es Value Alarm Parameters W Min Value Limit Max Value Limit Figure 3 18 Trapped Air configuration It is also possible to modify the normality
28. USER MANUAL Page 1 2 What is Better Care 2 What is Better Care 2 1 Description of the Better Care platform Better Care is a software platform that captures biomedical signals from a wide range of medical devices monitors invasive ventilators non invasive ventilators providing an important economical saving for Hospitals and Clinics when integrating and centralizing these data The Better Care platform integrates processes in real time and stores data according to the DICOM standard This allows an offline analysis once data have been saved with the possibility to export data to many different formats TXT XLS CSV XML The Better Care platform is composed of the following elements e Net Server Biomedical signals capture itengration analysis and Server Directory real time data sending e Mobile A Net Server version optimized for mobile vehicles e Server Directory Centralizes data sent by one or more Net Servers and serves them to the Clients asking for them e Client Server Directory data sent by Net Servers real time visualization e Review Offline stored data review and analysis This is a connection scheme of the elements composing the Better Care platform Client LAN gprs ISDN 3 Internet XDSL 56 Client a v Ji Q 2 V 6 Server Directory 5 3 E Satellite x
29. X E ta s e e os a 4 Navigability scheme in Better Care Net Server 5 Waves vVistlalizati n region 5 sl aa da MW ee Lee Us 6 User interaction capabilities of Waves Panel 7 Drag Drop over Waves Panel 3 Rx EI o we 8 Waveform configuration menu 2 ll lll sl 9 Auto adjustment active us mug obere EE Ng e pere a our Rr tv et b A 9 Manual Scale adjustment netos dd de ede de dm om ai 10 Numeric configuration window ascii ok aa PS Aree BE a a 10 PORC modi IP de s zx uix 2 de e De 6 ia h S s ah rat ou nne DD ila 11 Processie SOOO ar is hasa Sau EA e eye AAA SR ee Pe PUR DS 13 Variable Box Variable Container a ra er a ee e es s 13 Variable Box different states a cene a EE RON EEE s r Bot qua Rr ES 15 tool strip menu clicking with the mouse right button 14 1 Result of dragging Double Trigger Alarm 2 14 1 Result of dropping Double Trigger Alarm aaoo 15 Groups of alarms depending on its kind 16 Trapped Air configuration stud X wie koe a e a a l Xu ger E e ani 17 Interactive Buttons 5 aa eu ad a e RAE 17 ALAMOS 2 S z uc dr data Es du ee NQ Eee 18 General view of the review tab LL LL LL LL a a 19 Clmical events panel d dE S up us a Bt e EE eni a 20 Waves Tevisio panel We s ca e rear A ERA 21 Waves reproduction controls a mee Bo Pe bee de e R
30. ame of the full downloaded studies will be drawn blue and review trends and alarms tabs will be selectable Waves of the study will be downloaded in packets of 15 minutes Waves can be reviewed once the first packet is fully downloaded The downloaded percentage will be drawn at the right of the study name until it reaches 100 Figura 4 30 USER MANUAL Page 48 A dg File Edit Visualization Help Signals Delay 3466 msecs Data Freq 200 hz 2 bytes per sample HOSPITAL PARC TAULI BOX 8 ANON BOX 9 MONITORING FC bpm 116 O O 2012 05 21 2 Waves Alarms SPO2 99 Extrasystole index a TT 00 60 0 0 RESP RATE rom 19 o E g E O 2 FC bpm 12 ECG Pause 2 SA e 079 PAM mmHg 106 Profiles Figure 4 30 Downloaded study 2012 05 21 1 4 4 2 Event panel The event panel contains the clinical events list detected during the current or previous monitoring of the patient with the ID specified when session was configured The events are grouped by date and event type every event in every event type is represented by the time of the selected date 1t was detected USER MANUAL Page 49 4 Better Care Client 2011 12 19 2011 12 19 2011 12 19 Exp Asynchronies 16 11 06 53 Extrasystole Index 25 11 07 59 Secretions 1 11 08 14 d Air 28 11 08 20 11 08 26 11 08 32 11 08 35 11 08 41 11 08 49 11 08 52 11 09 01 11 0
31. channels ECG e Variables numeric values generated when applying mathematical algorithms to the input signals These values are continuously updated USER MANUAL Page 12 3 Better Care Net Server e Alarms An alarm is associated to a variable An alarm will be triggered when the variable goes out of range 3 2 3 1 General view of the interface The processing interface can be accessed by pressing the Processing tab It displays the variables being processed at the current moment and its current state and value Variables are displayed as boxes that can also be sorted These boxes display the following information Figure 3 12 EXP ASYNCHRONIES 1 0 96 Af O Do 100 3 44 4 9 e H 16 16 Figure 3 12 Variable Box Variable Container 1 Variable name 2 Value and Units 3 Value Bar 4 last hour event counter and percentage 5 Drawable events last hour 6 24 hour event counter and percentage The Variable Boxes or Variable containers can change its appearance depending on factors such as its type alarm limits and current state A Variable Box can be presented as CYCLE TIME LEADS STATUS CYCLE TIME 101 G 100 200 200 o 300 og so 50 122 0 0 96 0 0 96 H O 0 0 4 0 0 0 Variable without Variable with alarm Variable in state of Categoric Variable alarm limits limits Alarm Figure 3 13 Variable Box different states 3 2 3 1 1 Visualization options All th
32. d during the current or previous monitoring of the patient with the ID specified when session was configured The events are grouped by date and event type every event in every event type is represented by the time of the selected date it was detected USER MANUAL Page 19 3 Better Care Net Server 2011 12 19 2011 12 19 2011 12 19 Exp Asynchronies 16 11 06 53 Extrasystole Index 25 11 07 59 Secretions 1 11 08 14 d Air 28 11 08 20 11 08 26 11 08 32 11 08 35 11 08 41 11 08 49 11 08 52 11 09 01 11 09 03 lt lt 11 09 05 11 09 07 11 09 10 11 09 34 11 09 40 11 10 03 11 10 10 11 10 15 11 10 18 11 10 33 11 10 35 11 10 39 gt lt gt lt n Figure 3 22 Clinical events panel When a date is selected in the first list Review Trends and Alarms charts will be filled with the data corresponding to the selected date Navigation to a lower level in the list Date to Event Type or Event Type to Event can be done pressing the right arrow key or pressing the gt button Once in the last level the selection of any single event will make data chart in Revision tab move to the time the selected event was detected Navigation to a higher level can be done with the key left arrow or pressing the lt button 3 3 2 Review When review tab is selected in review waves revision panel shows the stored
33. duction options of the waves review panel Reproduction options can be accessed by the navigation bar at the bottom of the panel where waves are shown This navigation bar allows the manipulation of the current monitoring similarly to a standard media player Figure 4 33 shows the function of each button in the bar region Figure 4 33 Waves reproduction controls 1 previous event 2 decrease simulation speed 3 Backwards and Normal Play Buttons 4 Zoom buttons 5 Increase and decrease trend sampling period 6 Slider Bar Figure 4 34 shows Current date and time time elapsed current window time and event info in case there s an event detected at the current time USER MANUAL Page 51 4 Better Care Client 19 12 2011 11 39 17 00 33 04 680 of 01 06 59 990 elapsed showing from 00 32 56 380 to 00 33 12 980 Figure 4 34 Waves reproduction information region 4 4 3 2 Keyboard and mouse events on waves panel Keyboard and mouse events on waves review panel are the same described for the waves panel with the addition of e Cntrl 1 Only waves are shown e Cntrl 2 Only trends are shown Cntrl 3 Waves and trends are shown simultaneously e Cntrl N Navigate to next event Cntrl P Navigate to previous event Alt Left Mouse Button shift mode Navigates through the study by moving the mouse left and right 4 4 4 Trends When Trends tab is selected the Trends visualization panel becom
34. e Events on the Wave Panel do FOCOS nerd SEARA SERASA DR ERR 4 3 3 1 General view of the interface 4 3 3 1 1 Visualization options 4 3 3 2 Alarm Configuration 4 3 3 2 1 Interactive buttons 4 3 3 3 Alarm Log Alarm Report 4 3 3 3 1 Actions on Alarm Log A VO 43k sr 9 Q i as ii 4 4 1 Study Download ue xo Des 44 EDS eren 4 4 1 1 Day Report Download 4 4 1 2 Downloading the full session AAD Event panel 3X w o Bee eee W A ee PK Ee i 319 CREVIEW A dw Bk eb b x xxx 5 ORB AR 4 4 3 1 Reproduction options of the waves review panel 4 4 3 2 Keyboard and mouse events on waves panel AAA Ii u 2 Z b p uk oe eee hee mars W NU NQ Q G ee eee ddl ADO igiene 4 CAM ee 259 4433 ele a 5 Better Care Review 6 Better Care Mobile Server USER MANUAL Contents TE ol Page 4 List of Figures el 3 1 3 2 3 3 3 4 3 9 3 6 3 4 3 8 3 9 3 10 3 11 3 12 3 13 3 14 3 15 3 16 3 17 3 18 3 19 3 20 3 21 3 22 3 23 3 24 3 25 3 26 3 27 3 28 3 29 4 1 4 2 4 3 4 4 4 5 4 6 4 7 4 8 4 9 4 10 4 11 4 12 4 13 Connection scheme of the Better Care platform 2 Net server general view 2 352 44 we kw ee V VOR Ax
35. e available variables and alarms its availability depends on the input signals are visible in the alarm panel This can be modified through the visualization menu or by a drag drop action USER MANUAL Page 13 3 Better Care Net Server e Visualization Menu Clicking with the right button on the empty space of the variables panel it will make the configuration options appear as a toolstrip menu With it it s possible to switch between showing the variables that have an alarm associated or showing all the variables being calculated Figure 3 14 TRAPPED AIR i Configure TRAPPED AIR parameter Deactivate Figure 3 14 tool strip menu clicking with the mouse right button e Drag and Drop Variable boxes can also be drag dropped from the panel to the list at the right of the panel in order to hide them or from the list to the panel in order to be shown again They can also be drag dropped in order to sort them Figures 3 15 y 3 16 show the actions of drag and drop respectively Waves Processing T gt ECG ECG PAUSE EXTRASYSTOLE INDEX HR LEADS STATUS 0 63 s 86 78 bpm m 2 50 130 m J j oj 00 om 200 75 30 0 0 96 2 2 0 0 96 0 0 0 92 92 92 0 0 0 gt INVASIVE VENTILATION CYCLE TIME DISCONNECTION COMPLIANCE VENT MODE EXP ASYNCHRONIES 101 5 38 3 ml cmH20 T 0 75 45 0 m 1300 ol 100 o 120 0 100 122 19 9 0 0 2 2 181 181 181 0 0 0 0 0 0 4 16 1
36. e3 Variable4 Li n Figure 4 16 Processing scheme e Input signals Flow FLOW Airway pressure PAW Volume VT the CO2 CO2 invasive arterial pressure PRES ART the pulsoximeter SPO2 Electrocardiogram one or more channels ECG e Variables numeric values generated when applying mathematical algorithms to the input signals These values are continuously updated USER MANUAL Page 39 4 Better Care Client e Alarms An alarm is associated to a variable An alarm vvill be triggered vvhen the variable goes out of range 4 3 3 1 General view of the interface The processing interface can be accessed by pressing the Processing tab It displays the variables being processed at the current moment and its current state and value Variables are displayed as boxes that can also be sorted These boxes display the following information Figure 4 17 EXP ASYNCHRONIES 1 0 96 Af O Do 100 3 44 4 9 9 H 16 16 Figure 4 17 Variable Box Variable Container 1 Variable name 2 Value and Units 3 Value Bar 4 last hour event counter and percentage 5 Drawable events last hour 6 24 hour event counter and percentage The Variable Boxes or Variable containers can change its appareance depending on factors such as its type alarm limits and current state A Variable Box can be presented as CYCLE TIME LEADS STATUS CYCLE TIME 101 100 200 200
37. es a a ds Em a 21 Waves reproduction information region 222 en 22 Trends DOC CC i a ma amp ra bs de AA AA ora ds TE k UR 23 Alarms distribution visualization panel 0 2l ll 24 Camera control PESO cs a ee eas eoo ee ee ae X EU ad ee ek 25 Net Server folder Structure 26 Better Care Client configuration strip menu LL LL LL 2f Manage Servers Window soo ionracan E a a ROS Ln 28 Selected servers management lll ss 20 ICU bed pre selection view 30 Preview of ICU Ded du ww ege e q hl odes d eos ao RE LS Ed E 30 Better Care Client with a selected ICU bed 31 Navigability scheme of Better Care Client LL a 32 Waves visualization region pi dosi Bo oue Eod dee DE dede E nue ee 39 Waves panel user interaction capabilities LL LL 0 34 Dras Drop on waves panel sail A EA 35 Wave configuration menu 2 44 25 ac RL 2648 won ES Bs 36 Auto adjustment active Y kiss E co A IA E a 36 Manual Scale adjustment eds rica EL dl do P LL 37 List of Figures 4 14 Numeric configuration window aoaaa e ee e e s e e e s 37 4 15 Pro le CUSLOIIZALIORN 2244446446482 LR A 38 4 16 Processing scheme 1 ees 39 4 17 Variable Box Variable Container 40 4 18 Variable Box different states oa aoa a a a 40 4 19 Mouse right button toolstrip menu clicking with the 41 4 20 Resu
38. es visible 1t shows the mean values of the trends hour by hour Trends include physiological constatns as well as a selection of the values calculated by the software processing module depending on the signals registered in the selected date Zooming is disabled when viewing trends Zoom is fixed to show always a 24 hour window although other chart characteristics are still enabled This panel automatically updates durnig the monitoring USER MANUAL Page 52 4 Better Care Client 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 Inspiratory Time 1 0 2 Peak Flow Expiratory Time E di e NE sl T 3 r A Min Flow y 46 67 637 Trapped Air J j 4 42 21 07 2012 10 00 00 6 lt Figure 4 35 Trends panel detail 1 Trend Name 2 Current Trend Value 3 Daytime in hours 4 Slider Bar 5 Current Time position 6 Trend 24h Mean 7 List of hidden Trends The trends panel is organized and displayed the same way waves panel and review panel are and even parameter drag and drop is exactly the same Navigation through the 24 values can be done with the navigation bar at the bottom of the panel Figure 4 35 the left and right cursor keys or shifting Left Mouse Button Alt Key USER MANUAL Page 53 4 Better Care Client 4 4 5 Alarms Alarms panel is shown in Figure 4 36 For each alarm it shows the ocurrence percentage number
39. limits without opening the configuration window This can be done by dragging the minimum or maximum limit in the variable box to the desired value 3 2 3 2 1 Interactive buttons The three interactive buttons Figure 3 19 allow e Activate All Activates all the alarms with at least a minimum or a maximum limit set e Edit Initiates edition mode to configure or activate deactivate each variable individually e Disable All Disables all the alarms 0 0 96 0 0 96 12 12 96 HE 1 l 1 F 0 0 O 28 28 28 i Activate All Edit Deactivate All Figure 3 19 Interactive Buttons 3 2 3 3 Alarm Log Alarm Report This window Alarm Log appears when clicking a variable box with one or more alarms occurred during the last hour It displays a region where the alarm is shown as an image and another region with the thumbnails of the different alarms that have also been detected during the last hour ordered by the time they were detected The figure 3 20 show the Alarm Log USER MANUAL Page 17 3 Better Care Net Server 3 2 3 3 1 Actions on Alarm Log The interaction with the alarm log window is done by using the keyboard and the mouse e Next Alarm Next alarm can be selected by pressing the key Drag and drop can also be used on the list to reach the thumbnail we want to expand e Previous Alarm Previous can be selected by pressing the key Drag and drop can also be used on the list to reach
40. lt of dragging P Plat ra a e ee 41 4 21 Result of dropping P Plat 0 20 00 00000002 LL LL n 42 4 22 Alarms grouping ovo xoxo x e deghcR od ox is mox dada Ge A 43 4 23 Trapped Air configuration 44 4 24 Interactive BUON amp sosa a w ooo x W 4 a Q h es RR MELEE wes 44 2 25 SAO IOC Z uut de dox DARE iem A 45 4 26 General View of the Review tab LL a 46 4 27 Studyies without beeing downloaded 47 4 28 Downloading studies ls 47 4 29 Download full session button and advice T LL LL LL 48 4 30 Downloaded study 2012 05 21 1 o o e 49 4 31 Clinical events panel amp aoa sas xo iti 50 4 32 Waves revision panel ll ll LL LL 51 4 33 Waves reproduction controls LL LL 51 4 34 Waves reproduction information region a e e e e a a e en 51 4 35 Trends panel detail LL LL 52 4 36 Alarms distribution visualization panel 53 4 37 Camera control region 2 ees 54 USER MANUAL Page 6 WARNING The Better Care software is not intended to replace the main alarm notification system and must not replace personnel monitoring neither clinicians criterium INTENDED USE The Better Care software provides clinical staff a monitoring support system including clinical parameters generated by monitoring devices remote visualiza tion as well as its storage
41. me Camera image 3 Level of Zoom e Current camera Selection of the current camera e Current camera view Real time video of the current camera e Current camera zoom Zoom selection of the current camera 0 to 100 Pressing the left mouse button no the camera panel will cause it to expand or contract depending on the state it had when pressed resizing also the waves and processing panels 3 5 Local data storage Data are locally stored in folders in My Documents B CARE These folders are first organized by the patient ID and for each patient a folder with the data and time of every patient session is created Figure 3 29 shows how data are organized USER MANUAL Page 25 3 Better Care Net Server Es Mis documentos E tag B CARE e En 120572 c3 2010 03 02 09 04 05 c3 2010 03 02 23 59 59 4 2010 03 03 23 59 59 E Es 177121 a Es 206712 E I 230300 E E 256166 E E 256967 a E 437067 Es 437177 amp 2 2010 04 16 16 13 00 amp 5 2010 04 16 23 59 59 amp ES 2010 04 17 23 59 59 amp c3 2010 04 18 23 59 59 G 2010 04 19 09 51 41 i 2010 04 19 09 52 30 2010 04 19 23 59 59 E E 518183 E E 638085 E Ey 655184 i Ey 708041 866779 El El E Figure 3 29 Net Server folder structure The studies can be opened by selecting the corresponding folder in the Review application USER MANUAL Page 26 4 Better Care Client 4 Better Care Client 4 1 Better Care Client
42. meric serie configuration are used to con figure the wave and its trend and Chart allows to choose the information to display on the screen D AIR FLOW Serie Settings RESP RATE Numeric Representation Settings Chart k rt 903 2 Figure 3 6 Waveform configuration menu 3 2 2 1 Waveform aspect configuration window Checking scale auto adjustment will let the system choose the best scale for the corresponding parameter We can also adjust them manually as seen in figure When we select manual adjustment we can change the minimum and maximum values and restore scales to their default value At last we can also change the color of the wave AIR FLOW Configuraci n de serie Configuraci n del Par metro Retraso ms 7 Autoajuste de escalas Escala min b5 Escala m x 60 LightSkyBlu Figure 3 7 Auto adjustment active USER MANUAL Page 9 3 Better Care Net Server ir AIR FLOW Configuraci n de serie ES Configuraci n del Far net Retraso ms E Autoajuste de escalas Escala m n 100 Escala m x 100 Reiniciar escala Color LightSkyBlu Figure 3 8 Manual Scale adjustment 3 2 2 2 Numeric configuration We can modify the max scale the min scale and also restore the default scale of the trend attached to a wave We can se this configuration window in figure 3 9 RESP RATE Numenc Representation Setti Parameter Setup Min Scale 0
43. msecs Data Freq 200 hz 2 bytes per sample HOSPITAL PARC TAULI BOX 8 ANON BOX 9 Ce MONITORING FC bpm 108 SPO2 100 RESPRATE rpm 16 BOX 8 FO bpm 79 D E E o gt 2012 05 21 1 SPO2 95 PAM mmHg 111 Figure 4 28 Downloading studies Once downloaded the name of the study will be coloured dark gray and it will be possible to select the trends and alarms tabs USER MANUAL Page 47 4 Better Care Client 4 4 1 2 Downloading the full session The full session can be downloaded by clicking the button that appears at the right of a study when placing the mouse over it Once pressed the system will ask for confirmation Figure 4 29 File Edit Visualization Help Signals Delay 3466 msecs Data Freq 200 hz 2 bytes per sample HOSPITAL PARC TAULI BOX 8 ANON BOX 9 7 MONITORING FC bpm 112 16 o 2012 05 21 1 Waves Trends Alarms OC La c Sa C4 cs ce co ce CO 0 z 3 s e 7 5 2 3 22 33 0 i SPO2 99 me T1 FT Y T 4 11 1 1 99 64 RESP RATE rpm 16 RB er E Downloading the full study may take some minutes depending on data i m length and compression Do you want to continue g 2012 06 06 0 Gus 5 73 66 S FC bpm 14 2012 05 21 2 91 5 ECG Pause 2 SPO2 96 E A ns 0 81 T ar gt PAM mmHg 114 EM E lt gt Profiles Figure 4 29 Download full session button and advice The n
44. nly two profiles appear default and dark profile e Chart attributes Background color Parameter color Text and waves color Refresh interval Refresh time update in milliseconds the lower it is the smoother the waves are drawn Wave representation Line or area waves representation Grid Shows hides a grid in the background High quality Turns on off smoothing when drawing waves USER MANUAL Page 38 4 Better Care Client Force parameter color if we check this checkbox the texts and waves will be drawn with the color defined by Parameter color if not checked texts and waves will be drawn with the system default color e Save Naming a profile and clicking the Save button we adds the current profile to the stored profiles list to be modified and selected later 4 3 2 4 Keyboard and Mouse Events on the Wave Panel e Drag drop Already seen at the beginning of the chapter e Cntrl Mouse Wheel up Cntrl Mouse Right Button Zoom in e Cntrl Mouse Wheel down Cntrl Mouse Right Button Zoom out 4 3 3 Processing This module performs a real time processing of the selected waves to generate alarms that will rise when they go out of the defined range of normality or when they increase or decrease during a limited timespan This is how this module works Variable1 Alarm3 Variable2 Input Processing Signals Module Variabl
45. rd and mouse events on waves panel Keyboard and mouse events on waves review panel are the same described for the waves panel with the addition of e Cntrl 1 Only waves are shown e Cntrl 2 Only trends are shown Cntrl 3 Waves and trends are shown simultaneously e Cntrl N Navigate to next event Cntrl P Navigate to previous event Alt Left Mouse Button shift mode Navigates through the study by moving the mouse left and right 3 3 3 Trends When inside Review Trends tab is selected the Trends visualization panel becomes visible it shows the mean values of the trends hour by hour Trends include physiological constatns as well as a selection of the values calculated by the software processing module depending on the signals registered in the selected date Zooming is disabled when viewing trends Zoom is fixed to show always a 24 hour window although other chart characteristics are still enabled This panel automatically updates durnig the monitoring USER MANUAL Page 22 3 Better Care Net Server 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 0 Inspiratory Time 1 0 2 Peak Flow op RN WI u ass a 80 62 Expiratory Time E AA Se E E At e Min Flow 7 O 46 67 637 Trapped Air J j 4 42 21 07 2012 10 00 00 6 lt Figure 3 26 Trends panel detail 1 Trend Name 2 Current Trend Value 3 Daytime in hours
46. signals and biomedical constants Three buttons are shown Figure 3 23 allowing USER MANUAL Page 20 3 Better Care Net Server gt e Performs a zoom out e Profiles Customization of the look and characteristics of the waves and constants e Performs a zoom in w aaa gt Profiles Figure 3 23 Waves revision panel This panel is shown similarly to the waves panel previously described but also includes a navigation bar similar to a media player 3 3 2 1 Reproduction options of the waves review panel Reproduction options can be accessed by the navigation bar at the bottom of the panel where waves are shown This navigation bar allows the manipulation of the current monitoring similarly to a standard media player Figure 3 24 explains the function of each button in the bar region Figure 3 24 Waves reproduction controls 1 previous event 2 decrease simulation speed 3 Backwards and Normal Play Buttons 4 Zoom buttons 5 Increase and decrease trend sampling period 6 Slider Bar Figure 3 25 shows Current date and time time elapsed current window time and event info in case there s an event detected at the current time USER MANUAL Page 21 3 Better Care Net Server 19 12 2011 11 39 17 00 33 04 680 of 01 06 59 990 elapsed showing from 00 32 56 380 to 00 33 12 980 Figure 3 25 Waves reproduction information region 3 3 2 2 Keyboa
47. the thumbnail we want to expand e Last Alarm Last alarm can be directly accessed by pressing the push the gt gt button e First Alarm Last alarm can be directly accessed by pressing the push the lt lt button DUM FEF 44128 EDAD VILA TT 13 AIR FLOW PAW TRAPPED AIR 15 3 l m lt 5 Figure 3 20 Alarm log 3 3 Review The review tab contains the elements showing patient s previous state including a clinical events panel stored waves visualization registered trends per hour and a panel showing clinical events distribution during all day Alarms USER MANUAL Page 18 3 Better Care Net Server 2011 12 19 Trends Alarms Exp Asynchronies 16 M1 11 39 13 11 39 15 11 39 17 11 39 19 11 39 21 11 39 23 11 39 25 11 36 Extrasystole Index 20 ECG FC sesos Li 6s Pl 69 LPLETH n ii SPO2 A veo Lal X AN A V j PRES T PAM K A JM i Ju INN NM NM Ww 126 60 75 406 e RESP RATE IV I 20 PAW Pa A 37 PEAK PAW m L AO OT Lila 33 E VT N Fa N FA 560 VT INSP i x j N Ter b I Vw y I 52 540 00 33 04 gt ON O09 i 11 39 He lt li gt UL OW 00 33 08 680 of 01 06 59 990 elapsed showing from 00 32 58 580 to 00 33 10 780 E E mm gt s a Profiles Figure 3 21 General view of the review tab 3 3 1 Event panel The event panel contains the clinical events list detecte
48. ure TRAPPED AIR parameter e Deactrvate 14 14 H 28 28 28 TRAPPED AIR Configuration Es Value Alarm Parameters W Min Value Limit Max Value Limit Figure 4 23 Trapped Air configuration It is also possible to modify the normality limits without opening the configuration window This can be done by dragging the minimum or maximum limit in the variable box to the desired value 4 3 3 2 1 Interactive buttons The three interactive buttons Figure 4 24 allow e Activate All Activates all the alarms with at least a minimum or a maximum limit set e Edit Initiates edition mode to configure or activate deactivate each variable individually e Disable All Disables all the alarms 0 0 96 0 0 96 12 12 96 HE 1 l 1 F 0 0 O 28 28 28 i Activate All Edit Deactivate All Figure 4 24 Interactive Buttons 4 3 3 3 Alarm Log Alarm Report This window Alarm Log appears when clicking a variable box with one or more alarms occurred during the last hour It displays a region where the alarm is shown as an image and another region with the thumbnails of the different alarms that have also been detected during the last hour ordered by the time they were detected The figure 4 25 show the Alarm Log USER MANUAL Page 44 4 Better Care Client 4 3 3 3 1 Actions on Alarm Log The interaction with the alarm log window is done by using the keyboard and the mouse
49. ut can be selected whenever the user wants In the figure 4 6 Review is a active and non selected main tab and from dependent tabs Processing The active but non selected tabs are light background and dark text e Inactive corresponds to tabs that can not be selected by the user In the Figure 4 6 Report is an inactive tab The inactive tabs are light background and light text USER MANUAL Page 31 4 Better Care Client The visible elements are grouped by the three main tabs Theese element are described next Report Figure 4 7 Navigability scheme of Better Care Client Review 4 3 Monitoring The monitoring tab shows the current session state in real time This includes waves visualization Waves processing or alarm variables Processing and also remote cameras visualization and manipulation panel 4 3 1 Waves Panel Basic Real time configured biomedical waves and constants visualization Together with the waves and constants panels there are 3 interactive buttons Figure 4 8 allowing e Zoom out e Profiles Modifies the visual aspect of these regions e Zoom in USER MANUAL Page 32 4 Better Care Client Waves Processing 13 21 06 13 21 08 13 21 10 13 21 12 13 20 52 13 20 54 13 20 56 13 20 58 13 21 00 13 21 02 ECGI FC 1 A de A ede ee ae re Lo e are alertat 7J T IRURE lo lilo E PLETH E
50. y clicking with the mouse left button on any of the boxes which we have in the pre selection view It is possible to go back to pre selection view clicking the selected ICU bed with the mouse left button again 4 2 2 General view of ICU bed This view shows the detail of the selected ICU bed We can see the waves shown by default when selecting a bed the current alarm messages and the real time video if available and even review clinical data of the corresponding patient In figure 4 6 a selected bed is shown HOSPITAL PARC TAULI BOX 8 ANON ES EXTRASYSTOLE INDEX 72 lt 75 Processin FC PAM mmHg 111 TI ol EXTRASYSTOLE INDEX 72 lt 75 mm A A V L Y al l V N AJ i 11 ECG III 2 FC BOX 9 FC 115 PLETH SPO2 98 5 183 79 111 60 RESP RATE 16 Profiles Figure 4 6 Better Care Client with a selected ICU bed 1 Preview of the Selected ICU Bed Net Server 2 Detailed view of the Selected ICU Bed Net Server the visible tabs can have three different states e Active and selected Depending on the tap which is active and selected the content in the application will change In the figure 4 6 Monitorization is the main tab active and selected and the dependent tabs Waves is the selected The active and selected tabs have dark background and white text e Active and non selected corresponds to active tabs non selected b
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