Administrator Manual
37 Pages
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REF 9515-120-50-ENG REV D1
E-Scribe DATA MANAGEMENT SYSTEM
Administrator Manual
Manufactured by Mortara Instrument, Inc., Milwaukee, Wisconsin U.S.A. CAUTION: Federal law restricts this device to sale by or on the order of a physician.
®
Copyright © 2008 by Mortara Instrument, Inc. 7865 N. 86th Street Milwaukee, Wisconsin 53224
This document contains confidential information that belongs to Mortara Instrument, Inc. No part of this document may be transmitted, reproduced, used, or disclosed outside of the receiving organization without the express written consent of Mortara Instrument, Inc. Mortara is a registered trademarks of Mortara Instrument, Inc. E-Scribe and VERITAS are trademarks of Mortara Instrument, Inc. Microsoft is a registered trademark of Microsoft Corporation. Windows is a trademark of Microsoft Corporation. 8.0.
Technical Support and Service
Headquarters Mortara Instrument, Inc. 7865 North 86th Street Milwaukee, WI 53224 U.S.A. Tel: 414.354.1600 Tel: 800.231.7437 Fax: 414.354.4760 Internet: http://www.mortara.com
Europe Economic Community Representatives Mortara Rangoni Europe, Srl (European Headquarters) Via Cimarosa 103/105 40033 Casalecchio di Reno (BO) Italy Tel: +39.051.298.7811 Fax: +39.051.613.3582
Service/Technical Support Group Mortara Instrument, Inc. 7865 North 86th Street Milwaukee, WI 53224 U.S.A. Tel: 414.354.1600 Service: 888.MORTARA (888.667.8272) Fax: 414.354.4760 E-mail: [email protected]
Sales Support/ Supplies & Accessories Mortara Instrument, Inc. 7865 North 86th Street Milwaukee, WI 53224 U.S.A. Tel: 414.354.1600 Fax: 414.354.4760 E-mail: [email protected] Mortara Instrument Germany Kaninenberghöhe 50 45136 Essen Germany Tel: +49.201.18 55 69 70 Fax: +49.201.18 55 69 77 Mortara Instrument Netherlands Postbus 324 5680 AH Best Randweg 4 5683 CL Best Netherlands Tel: +31.499.377310 Fax: +31.499.377908 Mortara Instrument Australia PO Box 7568 Unit 11, 7 Inglewood Place Baulkham Hills NSW 2153 Australia Tel: +61 2 8824 5499 Fax: +61 2 8814 5399
24-Hour Technical Support Same-Day Shipment of Replacement Parts Biomedical Training Classes Extended Warranties/Service Contracts
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Notices Manufacturer’s Responsibility Mortara Instrument, Inc. is responsible for the effects on safety and performance only if: •
Assembly operations, extensions, readjustments, modifications, or repairs are carried out only by persons authorized by Mortara Instrument, Inc.
•
The electrical installation of the relevant room complies with the requirements of appropriate regulations, and
•
The device is used in accordance with the instructions for use.
Responsibility of the Customer The user of this device is responsible for ensuring the implementation of a satisfactory maintenance schedule. Failure to do so may cause undue failure and possible health hazards. Equipment Identification Mortara Instrument, Inc. equipment is identified by a serial and reference number on the back of the device. Care should be taken so that these numbers are not defaced. Copyright and Trademark Notices This document contains information that is protected by copyright. All rights are reserved. No part of this document may be photocopied, reproduced, or translated to another language without prior written consent of Mortara Instrument, Inc. Other Important Information The information in this document is subject to change without notice. Mortara Instrument, Inc. makes no warranty of any kind with regard to this material including, but not limited to, implied warranties of merchantability and fitness for a particular purpose. Mortara Instrument, Inc. assumes no responsibility for any errors or omissions that may appear in this document. Mortara Instrument, Inc. makes no commitment to update or to keep current the information contained in this document.
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Warranty Information Your Mortara Warranty MORTARA INSTRUMENT, INC. (hereinafter referred to as “Mortara”) hereby warrants that Mortara products (hereinafter referred to as “Product/s”) shall be free from defects in material and workmanship under normal use, service, and maintenance for the warranty period of such Product/s from Mortara or an authorized distributor or representative of Mortara. The warranty period is defined as twelve (12) months following the date of shipment from Mortara. Normal use, service, and maintenance means operation and maintenance in accordance with appropriate instructions and/or information guides. This warranty does not apply to damage to the Product/s caused by any or all of the following circumstances or conditions: a)
Freight damage;
b) Parts and/or accessories of the Product/s not obtained from or approved by Mortara; c)
Misapplication, misuse, abuse, and/or failure to follow the Product/s instruction sheets and/or information guides;
d) Accident; a disaster affecting the Product/s; e)
Alterations and/or modifications to the Product/s not authorized by Mortara;
f)
Other events outside of Mortara’s reasonable control or not arising under normal operating conditions.
THE REMEDY UNDER THIS WARRANTY IS LIMITED TO THE REPAIR OR REPLACEMENT WITHOUT CHARGE FOR LABOR OR MATERIALS, OR ANY PRODUCT/S FOUND UPON EXAMINATION BY MORTARA TO HAVE BEEN DEFECTIVE. This remedy shall be conditioned upon receipt of notice by Mortara of any alleged defects promptly after discovery thereof within the warranty period. Mortara’s obligations under the foregoing warranty will further be conditioned upon the assumption by the purchaser of the Product/s (i) of all carrier charges with respect to any Product/s returned to Mortara’s principal place or any other place as specifically designated by Mortara or an authorized distributor or representative of Mortara, and (ii) all risk of loss in transit. It is expressly agreed that the liability of Mortara is limited and that Mortara does not function as an insurer. A purchaser of a Product/s, by its acceptance and purchase thereof, acknowledges and agrees that Mortara is not liable for loss, harm, or damage due directly or indirectly to an occurrence or consequence therefrom relating to the Product/s. If Mortara should be found liable to anyone under any theory (except the expressed warranty set forth herein) for loss, harm, or damage, the liability of Mortara shall be limited to the lesser of the actual loss, harm, or damage, or the original purchase price of the Product/s when sold. EXCLUDED FROM THE LIMITED WARRANTY SET FORTH ABOVE ARE CONSUMABLE ITEMS SUCH AS PAPER, BATTERIES, ELECTRODES, PATIENT CABLES, LEAD WIRES, AND MAGNETIC STORAGE MEDIUMS. EXCEPT AS SET FORTH HEREIN WITH RESPECT TO REIMBURSEMENT OF LABOR CHARGES, A PURCHASER’S SOLE EXCLUSIVE REMEDY AGAINST MORTARA FOR CLAIMS RELATING TO THE PRODUCT/S FOR ANY AND ALL LOSSES AND DAMAGES RESULTING FROM ANY CAUSE SHALL BE THE REPAIR OR REPLACEMENT OF DEFECTIVE PRODUCT/S TO THE EXTENT THAT THE DEFECT IS NOTICED AND MORTARA IS NOTIFIED WITHIN THE WARRANTY PERIOD. IN NO EVENT, INCLUDING THE CLAIM FOR NEGLIGENCE, SHALL MORTARA BE LIABLE FOR INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES, OR FOR ANY OTHER LOSS, DAMAGE, OR EXPENSE OF ANY KIND, INCLUDING LOSS OF PROFITS, WHETHER UNDER TORT, NEGLIGENCE OR STRICT LIABILITY THEORIES OF LAW, OR OTHERWISE. THIS WARRANTY IS EXPRESSLY IN LIEU OF ANY OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTY OF MERCHANTABILITY AND THE WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE.
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User Safety Information
Warning:
Means there is the possibility of personal injury to you or others.
Caution:
Means there is the possibility of damage to the device.
Note:
Provides information to further assist in the use of the device.
Warning(s) •
Device retrieves and stores transmitted data reflecting a patient’s physiological condition that when reviewed by a trained physician or clinician can be useful in determining a diagnosis; however, data should not be used as a sole means for determining a patient’s diagnosis.
•
User is responsible for performing daily tape backups of all data. In the event of a hardware failure, data can only be recovered if these backups have been reliably performed.
•
To ensure electrical safety is maintained during operation, the device must be plugged into a grounded outlet.
•
To maintain designed operator safety, peripheral equipment and accessories used with the device must be in compliance with UL 60950-1 and IEC 60950-1.
•
To maintain designed operator and patient safety, only use parts and accessories supplied with the device and software available through Mortara Instrument, Inc.
•
Downloading/transmitting of patient ECG data to the device cannot be done while the patient is connected to the electrocardiograph.
•
A possible explosion hazard exists; do not use the device in the presence of flammable anesthetics.
•
Before attempting to use the device for clinical applications, the operator must read and understand the contents of the user manual and any documents accompanying the device.
•
Temperature: Operation 15° to 35° C; Storage: -20° to 65° C; Relative humidity: 25-95%, non-condensing.
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Caution(s) •
To keep the device clean, wipe the exterior surface monthly with a mild cleaner; dry with a clean cloth.
•
The quality of the ECG received by the device may be adversely affected by the use of other medical equipment including, but not limited to, defibrillators and ultrasound machines.
Note(s) •
Interconnect cables should be checked for cracks or breakage prior to use.
•
As defined by IEC 60950-1, the device is classified as follows: – Class I equipment – Type B – Ordinary equipment – Not suitable for use in the presence of flammable anesthetics – Continuous operation
Equipment Symbols and Markings Symbol Delineation
Attention, consult accompanying documents
NOTE: Refer to the manual(s) accompanying the device that pertain to the computer hardware for additional definitions of symbols that may be present.
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Table of Contents INTRODUCTION SECTION 1 1.1 Purpose... 1 1.2 What is E-Scribe? ... 1 1.3 Prerequisites ... 1 1.4 Concepts ... 1
E-SCRIBE ARCHITECTURE SECTION 2 2.1 Server Services... 5 2.2 Communication between Services ... 5 2.3 Workstation Client ... 5 2.4 Direct Serial Communication from Workstations ... 6 2.5 Database Tables ... 6 2.6 E-Scribe Folders ... 6
OS CONFIGURATION SECTION 3 3.1 Environmental Variables ... 7 3.2 Configuration Files ... 7 3.3 PortConfigurations.cfg ... 8 3.3.1 PortConfigurations.cfg Editing Tips ... 9 3.4 Localization ... 9 3.5 Date and Time Format ... 9 3.6 English and Metric Units ... 9 3.7 Fixed ID Format Labels... 9 3.8 User-Interface Text ... 9 3.9 Signatures ... 10 3.10 Installing the AutoPrinting Printer... 10 3.11 Efficient Printer Performance ... 10 3.12 Accounts for E-Scribe Windows Services... 10
BACKUP AND RESTORE SECTION 4 4.1 Backups ... 11 4.2 Default Backup Method... 11 4.3 Custom Backup Method... 11 4.4 Restoring Data ... 11 4.5 Disaster Recovery... 12
ADMINISTRATION TASKS SECTION 5 5.1 Starting E-Scribe ... 13 5.2 Current Logon List ... 13 5.3 System Settings ... 13 5.3.1 General ... 13 5.3.2 Fixed ID Localization ... 15 5.3.3 E-Mail (optional) ... 15
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ADMINISTRATION TASKS SECTION 5 (cont’d.) 5.3.4 Fax (optional)... 15 5.3.5 Logon Authentication... 15 5.3.6 Worklists (optional) ... 16 5.3.7 Reason on Update (optional) ... 16 5.4 Groups ... 16 5.4.1 Group Information... 16 5.4.2 Users ... 17 5.4.3 Physicians ... 17 5.4.4 Acronym List... 17 5.4.5 Measurements (optional)... 17 5.4.6 Median Beat Measurements ... 17 5.4.7 Lead Data Measurements ... 18 5.4.8 Protocol Instructions ... 19 5.5 Custom ID ... 19 5.5.1 Planning the Print Format... 19 5.5.2 Demographic Fields... 19 5.5.3 Creating the Custom ID ... 20 5.5.4 Print: Mortara Eli + Lands... 20 5.5.5 Print: Portrait... 21 5.5.6 Operator Prompts ... 21 5.5.7 LCD: Mortara Eli + Lands ... 21 5.5.8 LCD: Portrait... 22 5.5.9 Downloading Custom ID to All Electrocardiographs ... 22 5.6 Request Codes ... 22 5.7 Sites ... 22 5.7.1 Automatic Processing... 23 5.8 Users... 25 5.9 Physicians ... 26 5.10 Client List/Workstation Licenses... 26 5.10.1 Node-Locked ... 26 5.10.2 Floating ... 26
TROUBLESHOOTING SECTION 6 6.1 Event Logs ... 27 6.2 Barcode Font... 27
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INTRODUCTION SECTION 1
1.1 Purpose This manual is intended for system administrators and those responsible for data security, electronic workflow, and general maintenance of hospital information systems. E-Scribe™ data management system users intending to view and/or edit ECGs should refer to the E-Scribe user manual.
1.2 What is E-Scribe? E-Scribe is a data management system specific to the management of ECGs collected from Mortara Instrument diagnostic ECG devices. Main features include: • • • • • • •
Long-term ECG storage Instant recall of patient ECGs Workflow management for ECG editing, reviewing, measuring, and signing Diverse reporting Protocol-driven ECG study management with measurement and HL7 aECG export Complete security and audit trail solutions Automatic information exchange with other clinical systems
1.3 Prerequisites This manual assumes E-Scribe software is installed, and the administrator has basic network and Microsoft® Windows™ server administration skills.
1.4 Concepts Concept
Description
Acquisition Time
Time when ECG was recorded. Timestamp is recorded by the electrocardiograph. EScribe does not translate time zones; it displays same time as that displayed on the electrocardiograph (i.e., ECG acquired at 10:34:28 CST and transmitted to an E-Scribe in another time zone still displays acquisition time as 10:34:28.)
Custom ID
Allows customization of demographic fields collected and displayed with ECG. If applicable, all ECGs imported into E-Scribe must be acquired using the Custom ID configured at the E-Scribe. The E-Scribe administrator configures the Custom ID according to organizational needs and ensures its download to the ECG devices. All Mortara diagnostic ECG devices have one or more built-in sets of demographics fields. A Custom ID is not normally required unless using the ECG Requests feature.
Confirmation
The act of confirming an ECG (a physician’s interpretation is entered and his name is signed). Also known as “overread”.
Confirmation Time
Time when ECG was last confirmed by a physician.
Customizable Worklists Option
Optional feature allowing the administrator to create custom-named Worklists. See Worklist.
Demographics Status
Status of demographics’ verification. Status is "Unverified" when ECG is received from acquisition device; "Verified" after demographics have been verified. Status can be automatically set to "Skipped" if established workflow rule states verification is not needed. • UNV = Unverified • VER = Verified • SKP = Skipped
Digital Measurement and Annotation Module Option or
Optional feature also known as DMA Module. It is intended for ECG research and allows measurements according to a research protocol. If enabled, provides additional measure view and Rx status for each ECG.
DMA Module
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Concept
Description
ECG Status
Status of the overread by cardiologist or authorized ECG interpreter. Status is "Unconfirmed" when ECG is received from acquisition device, "Transcribed" when interpretation is edited, but not confirmed, or "Confirmed" when ECG is marked confirmed by authorizing party (e.g., physician or authorized transcriptionist). Status can be automatically set to "Skipped" if established workflow rule states overread is not needed. Status is “Deleted” when ECG has been deleted. • UNC = Unconfirmed • TRN = Transcribed • CNF = Confirmed • SKP = Skipped • DEL = Deleted
Group
Mechanism to group a set of patients and sites. Requires each unique patient to have a unique ID within the Group. A Group must have at least one site, and it may have a Custom ID. Unique Groups define the set of protocol measurements needed for each ECG and are used for every ECG research study.
HR
Heart rate; more precisely, Ventricular heart rate. Normally derived from all RR intervals of the ECG.
Interpretation
A series of statements about patient condition based on ECG waveforms. Automatic interpretation is one given by a computer algorithm such as Mortara’s VERITAS™ algorithm. Physician interpretation, or overread, is one given by a trained professional. Physician interpretations may be wholly or partly based on the initial automatic interpretation.
Median Beat
Representation of a patient’s typical cardiac cycle. Created by the VERITAS algorithm in the electrocardiograph, it is used to derive global measurements. Also known as “Median”, “Typical Cycle”, or “Representative Beat”.
QT
QT duration is the time between onset of QRS and offset of T; measured in milliseconds.
QTc
Corrected QT is a QT duration normalized for HR. There are several ways to correct (normalize) for HR; QTc refers to the Mortara linear method.
QTcB
Corrected QT using the Bazett method.
QTcF
Corrected QT using the Fredericia method.
Request
Contains patient demographics for a requested or ordered ECG. Requests can come from external hospital information systems, or entered directly into E-Scribe. When requests are downloaded to the electrocardiographs, demographic re-entry is not necessary. Each Request has a status: • Pending (not claimed by any single electrocardiograph) • Downloaded (claimed by a single electrocardiograph) • Received (ECG taken and received by E-Scribe; ECG is not Confirmed) • Confirmed (ECG Confirmed; requested ECG is complete)
Request Code
Up to 7 characters long, a name given to a set of Requests. Request Codes organize Requests for various hospital departments and care areas. Each Group has its own set of Request Codes. The electrocardiograph operator selects a Request Code when downloading the Requests to the electrocardiograph. Request Codes are created and managed by the E-Scribe Administrator.
RR
The time, measured in milliseconds, between consecutive R-peaks.
Rx Status
Status of protocol measurements. Status is "Unmeasured" when ECG is received from acquisition device, "Measured" once measurements are made but waiting for second quality assurance check, and “Checked” once measurements are finalized. Status can be automatically set to "Skipped" if established workflow rule states measurements are not needed. • UNM = Unmeasured • MES = Measured • CHK = Checked • SKP = Skipped
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Concept
Description
Site
Represents a physical location where ECGs are acquired. In hospitals it often represents a department, care area, wing, or floor. It can also represent remote facilities outside the building where the E-Scribe is housed. For ECG research studies, it usually represents an investigator site.
Transmission Time
Time when the ECG was received from the electrocardiograph. This time is different from the Acquisition Time and is useful for filtering ECG lists based on time received.
Worklist
A list of ECGs that require some work. When enabled, the administrator can configure Worklists to match the organization's ECG workflow. Worklists can list ECGs for a particular person or group of people, or list ECGs needing similar processing (e.g., verification of demographics, confirmation of interpretation, measurement per protocol, etc.).
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E-SCRIBE ARCHITECTURE SECTION 2
2.1 Server Services E-Scribe uses classic client-server architecture. A single computer running E-Scribe services acts as the central server. These services manage the ECG database, automatic processing, and communication with the electrocardiographs. Service Name
Image Name
Description
E-Scribe AthenaInterface
AthenaInterface.exe
Manages communication with Athena (if applicable).
E-Scribe ATHManager
ATHManager.exe
Authentication Manager. Manages authentication of Windows users when using OS Logon Authentication.
E-Scribe CDGInterface
CDGInterface.exe
“Cardiograph” Interface. Manages communication with electrocardiographs; imports UNIPRO files.
E-Scribe DBInterface
DBInterface.exe
Database Interface. Manages all database transactions.
E-Scribe E-Mail Service
ESEMail.exe
Manages automatic e-mail messages triggered by Automatic Processing rules.
E-Scribe RPTManager
RPTManager.exe
Report Manager. Creates offline reports including a complete study dump into XML, and export of FDA XML files.
E-Scribe SendFax
FaxService.exe
Manages automatic fax transmissions triggered by Automatic Processing rules.
E-Scribe TRGManager
TRGManager.exe
Trigger Manager. Processes Automatic Processing rules upon ECG update.
2.2 Communication between Services All E-Scribe services start, stop, and run independently of one another. All services needing database access communicate with DBInterface using a TCP/IP socket. The environment variables DBMNG_HOST_NAME and DBMNG_PORT_NUMBER specify where DBInterface is running. Services performing automatic (offline) processing are informed of work needed by monitoring shared folders. Service
Communication Folder
ESEMail
<ESCRIBE_DIR>ActionEMail
RPTManager
<ESCRIBE_DIR>OfflineReports
FaxService
<ESCRIBEFAXDIRECTORY>
TRGManager
<ESCRIBE_DIR>AutoOutput
2.3 Workstation Client The client software must be installed on the computer from where it will be run. The executable file is named “USRInterface.exe” meaning “User Interface”. The installer for this software will prompt for the host name and port number where DBInterface is running (the E-Scribe server). It will also ask if a local CDGInterface service should be installed.
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2.4 Direct Serial Communication from Workstations Most Mortara electrocardiographs have an RS-232 serial port for direct communication with a host computer. The interface service “CDGInterface” allows electrocardiographs to communicate with EScribe via an RS-232 serial cable connected to the workstation. Install the service on the workstation and edit the PortConfigurations.cfg configuration file to indicate which serial port(s) to monitor.. If needed, CDGInterface can also be configured to monitor UNIPRO file import folders, network transmissions, and modems; however, it cannot be used as an offline receiver of ECGs. CDGInterface must communicate with DBInterface to store the ECGs as they are received from the electrocardiograph.
2.5 Database Tables E-Scribe uses a series of database tables to store information. These tables must be installed as System Data Sources in ODBC. By default, these tables are MDB files (Microsoft JET) and are located in the <ESDB_DIR> folder. ODBC Name
MDB File
Purpose
ecgorders
ecgorders.mdb
ECG Requests.
Esnt_Translog
esnttl_master.mdb
Transaction log.
measurements
measurements.mdb
Protocol measurements.
patient
db1.mdb
ECGs (except waveforms).
worklists
worklists.mdb
Worklists.
If using an Oracle database, the ODBC entries will be the same but will use Oracle drivers. Contact Mortara Technical Support for information about an Oracle installation.
2.6 E-Scribe Folders The following E-Scribe folders are located under the <ESCRIBE_DIR> root installation folder.
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Folder
Purpose
ActionEMail
Used to communicate ECGs to be e-mailed by ESEMail service.
ActionFax
Used to communicate ECGs to be faxed by FaxService service.
AutoOutput
Used to communicate ECGs to be processed by TRGManager service.
Backup
Backup scripts used to backup E-Scribe configuration and database files.
Configuration
Configuration files.
ESDB
Database files.
Executables
Executable files for services, applications, and utilities.
Indexes
Database index files.
LogFiles
Log files.
Messages
Location of ESMessages.txt file containing all user interface text.
Miscellaneous
Miscellaneous files (i.e., barcode font and XML DTDs).
Name
Database name files.
OfflineReports
Used to communicate reports created offline by RPTManager.
PreviousInstallation
Copies of the following folders from a previous installation of E-Scribe: Backup, Configuration, Executables, Messages, Miscellaneous.
Signatures
Physician signature images.
OS CONFIGURATION SECTION 3
3.1 Environment Variables E-Scribe uses several environment variables. Required variables are set by the application installer; other variables can be set by the administrator when required. Variable Name
Default
Description
ESCRIBE_DIR
D:Mortara Instrument IncEScribe D:Mortara Instrument IncEScribeESDB 7000 (name of local computer) D:Mortara Instrument IncEScribeActionFax <Hospital Name> 5000 7
Top-level E-Scribe installation folder.
ESDB_DIR DBMNG_PORT_NUMBER DBMNG_HOST_NAME ESCRIBEFAXDIRECTORY ESCRIBE_ORG_NAME ATHENA_SVR_PORT_NUM DAYS_BEFORE_ACQUISITION PDF_DIR TEA_WAVE OLD_FDAXML_FORMAT
NO_UNIDENTIFIED_TRANSMISSIONS
Folder path to stored E-Scribe database files. TCP/IP port number DBInterface listens on. Host name where DBInterface runs. Folder path where TRGManager and FaxService exchange fax requests. Organization name displayed in logon prompt. TCP/IP port number AthenaInterface listens on. Maximum future date allowed when adding ECG Requests. Folder path where USRInterface will automatically write confirmed ECGs as PDF files. When present, E-Scribe exports TEA (Total Electrical Activity) wave in XML files. When present, E-Scribe uses the “old” FDA XML format. (Used for backward compatibility with early adopters of the XML format.) When present, E-Scribe will decline transmissions without a patient ID.
3.2 Configuration Files E-Scribe uses several configuration files to store system settings. These ASCII text files are located in the <ESCRIBE_DIR>Configuration folder and can be viewed using a regular text editor (e.g., Notepad). As these files are read and written by E-Scribe application software, DO NOT use a text editor to change their contents. The only exception is PortConfigurations.cfg which must be maintained with a text editor. File Name
Edit Method
Purpose
Acronyms.cfg Actions.cfg AutoProcessings.cfg Clients.cfg Conditions.cfg DisplayOptions.cfg ElseActions.cfg Features.cfg
USRInterface USRInterface USRInterface USRInterface USRInterface (automatic) USRInterface (Obtained from Mortara) USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface (text editor, e.g. Notepad)
Acronyms for Groups. Actions for Automatic Processing Items. Automatic Processing Item printing and image conversion settings. Computer names for node-locked workstation licenses. Conditions for Automatic Processing Items. Saved display settings for all E-Scribe users. Else Actions for Automatic Processing Items. License file for E-Scribe server. Locked to network interface card’s MAC address. Fields used in Custom IDs. Custom ID information. Group settings. Physician instructions for measurement protocols. Custom ID information. Custom ID information. Measurement protocol information. Physician names. Lists physician names that can confirm ECGs for each Group. Serial ports, network ports, file import folders, and modems used to communicate with Mortara electrocardiographs.
FormatFields.cfg Formats.cfg Groups.cfg Instructions.cfg LcdFormatFields.cfg LcdFormats.cfg Measurements.cfg Physicians.cfg PhysicianGroups.cfg PortConfigurations.cfg
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File Name
Edit Method
Purpose
ReasonForChanges.cfg Regions.cfg ReqCodes.cfg Sites.cfg Transcribers.cfg Users.cfg UsersGroups.cfg UsersPhysicians.cfg WorklistNames.cfg
USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface USRInterface
List of configured reasons for changing ECGs. System-wide settings. Request Codes. Site information. Lists users who can transcribe for physicians. User account names with encrypted passwords and permissions. Lists Groups that users are allowed to access. Lists users who can confirm for physicians. Worklist names.
3.3 PortConfigurations.cfg The PortConfigurations.cfg file specifies how E-Scribe receives ECGs and communicates with Mortara electrocardiographs. Each line of the file is a record. Lines starting with a hash ‘#’ sign are treated as comments. The starting and ending columns in the table below are as reported by a text editor – the first character on a line is column 1. Note: instructions in the file show field start and end positions three less than the table below (first position is 0, and records are indented by 2 characters). You must use spaces to fill in between the fields, and the last field must use exactly the right number of spaces to complete the row. Each row must be exactly 156 characters long. The last full record must end with a new line, and the last line in the file must be empty. Field Name
Start Column
End Column
Length
Description
Host name
3
34
32
Computer name this record is for. CDGInterface only uses records with the name of the computer it is running on. Use this feature to specify which COM ports the workstations should use for direct serial communication. The value should be left justified within the field boundaries.
Record type
36
39
4
1 = Direct serial communication (RS-232) 2 = Modem communication 3 = Network communication 4 = UNIPRO file import The value should be right justified within the field boundaries.
COM port name
41
56
16
Name of the Windows COM port for direct serial and modem communications. Use the universal naming convention (UNC), i.e., COM1 is “.COM1”. The value should be left justified within the field boundaries. Leave blank for network and file import records.
Baud or port number
58
66
9
Baud rate for direct serial communication. It must match the setting in the electrocardiograph; default is 38400. For network communication, this is the TPC/IP port that the electrocardiograph will connect to. The value should be right justified within the field boundaries. Leave blank for modem and file import records.
Modem “init” command or import directory
68
131
64
For modem records, the initialization command sent to the modem when CDGInterface starts. Important: configure the modem to automatically answer after one or two rings. Such commands usually start with “AT” and end with a carriage return character “015”. The file example is the initialization string tested with the USRobotics Sportster external modem. For file import records, this is the full path to the folder where the UNIPRO files will be placed for import. The value should be left justified within the field boundaries. Leave blank for direct serial and network records.
Modem hang-up command
133
156
24
For modem records, the command sent to hang up after transmission is complete. The file example was tested with the USRobotics Sportster external modem. The value should be left justified within the field boundaries. Leave blank for all other records.
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3.3.1 PortConfigurations.cfg Editing Tips • • • • •
Before opening in a text editor, use the Format menu to turn the word-wrap feature off, and ensure font is “Lucinda Console”, Regular, 10 point. Before editing, make a backup copy of the original file. Restore the original file if the edits don’t work. Do not leave a carriage return where one does not belong. Do not exceed the defined table lengths. To save your changes, use Save in the File menu. Do not let the text editor program add a “txt” extension to your file name.
3.4 Localization Localize dates, units of measure, and user-interface text.
3.5 Date and Time Format Most date and time values will format according to the computer’s Regional and Language Options. As such, one computer may display these values differently from another. Local date formats can be customized, or if a consistent date format is required throughout the enterprise, network administrators can use Windows desktop management tools to set the Regional and Language Options for all computers. Note: dates look best in E-Scribe when leading 0’s are used (‘MM’ for month, ‘dd’ for day); times look best when a 24-hour format is used with leading 0’s (HH:mm:ss). How a patient’s birth date will display depends on whether a fixed ID or a Custom ID format was used for the ECG. With a fixed ID format, the birth date displays according to the E-Scribe system setting (MM/dd/yyyy for English; dd.MM.yyyy for Metric). With a Custom ID, the birth date displays as it comes from the electrocardiograph.
3.6 English and Metric Units E-Scribe displays patient weight and height in either “English” or “Metric”. This display is independent of how the electrocardiograph was configured at the time of ECG acquisition. When set for English, weight will display in pounds, and height in inches. When set for Metric, weight will display in kilograms, and height in centimeters. E-Scribe automatically labels height and weight values for ECGs using one of the fixed ID formats; however, for ECGs using Custom ID formats, E-Scribe will not add its own unit labels. Therefore, if the Custom ID includes unit labels, verify the labels match the system setting.
3.7 Fixed ID Format Labels Mortara electrocardiographs have built-in, fixed ID formats. The demographic labels for these are translated into several languages. Select the appropriate language in E-Scribe system settings.
3.8 User-Interface Text All user-interface text strings are contained in the ESMessages.txt file located in the <ESCRIBE_DIR>Messages folder. Replace this file with one translated into the local language for proper user interface display. Note: each computer running the E-Scribe workstation (USRInterface) software has its own ESMessages.txt file. As such, this file must be updated on all E-Scribe workstation computers.
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SECTION 3
Changing text strings requires caution. The user interface is not designed to accommodate largely varying string lengths; strings must never exceed 512 characters.
3.9 Signatures E-Scribe can display an image of a physician’s handwritten signature. Install signature image files into the <ESCRIBE_DIR>Signatures folder. Files must be in 1-bit-per-pixel BMP format, 1024 pixels wide, and 256 pixels high. Image file names must exactly match the physician names and end with the “.bmp” file extension.
3.10 Installing the AutoPrinting Printer E-Scribe uses a AutoPrinting printer to convert ECGs into TIFF and BMP images. The server must have a printer with this name to create TIFF and BMP images when specified in the Automatic Processing rules. Select any type of printer; though it is recommended to use an “HP LaserJet 5”. The basic steps using the Windows Wizard are listed below. 1. Launch the “Add Printer” wizard under Windows’ Start/Settings/Printers and Faxes menu. 2. Select “Local printer” but do not try to automatically detect the printer. 3. Select “Create a new port” and select “Local Port” for the type. 4. Give the new port a name such as “ES AutoPrint”. 5. Select the manufacturer “HP”, and the printer “HP LaserJet 5”. 6. Give the printer the name “AutoPrinting”. It must have this name or E-Scribe will not find it. 7. Do not make it the default printer. 8. Do not share the printer. 9. Do not print a test page. 10. When done, right click printer and select Properties. Clear the “Enable Advanced Printing Features” option on the Advanced Options tab.
3.11 Efficient Printer Performance Some printer features cause ECGs to print slowly. When possible, right click the printer being used and select Properties. Clear the “Enable Advanced Printing Features” option on the Advanced Options tab.
3.12 Accounts for E-Scribe Windows Services TRGManager and FaxService services potentially use resources on the network. TRGManager may use network printers and write to network folders; FaxService may use a fax server running on another computer. In Properties of the service, you may have to specify a different account in the Log On tab. The account must have permission to use the network resources.
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BACKUP AND RESTORE SECTION 4
4.1 Backups Completely backup the E-Scribe configuration and database every day. E-Scribe’s default server hardware ships with a suitable tape drive (e.g., DAT40). The system also ships with 7 tapes. Label the tapes with the days of the week and insert the appropriate tape into the tape drive every day. Replace the tapes after about 50 uses. Replace the complete set of weekly tapes once a year. Consider regularly rotating the tapes to a secure offsite storage facility in case of facility damage.
4.2 Default Backup Method Backup scripts and related files are located in the <ESCRIBE_DIR>Backup folder. The script “esbackup.cmd” runs the backup. E-Scribe’s default installation will run this script every night at 11:00 p.m. Use Windows’ scheduler to change this time if needed (it is called “At1.job”). The backup can be run while the system is in use; however, a relatively quiet time is recommended. If needed, manually execute in a command window to perform a backup on demand. Backup failures can be reported in several ways: a dialog window on the console session of the server stating the backup failed; a failure notification sent by the backup script to users and computers (add computer and user names in the UsersToWarn.txt file); a failure message sent to a printer (add printer names in the PrintersToWarn.txt file). The file BackupFailedWarning.doc will print as a cover page followed by error messages. A daily backup log is created in the <ESCRIBE_DIR>LogFiles folder. Files are named backupXX.log where XX cycles through 01, 02, 03, …, 09, 10, 01, 02, and so on. The files are reused after 10 backups. These files contain a log of everything backed up. There are also additional files with additional failure information if the backup fails.
4.3 Custom Backup Method To forgo using backup tapes, include E-Scribe in an enterprise-wide backup solution by removing “At1.job” in the Windows scheduler. It is recommended to backup the entire <ESCRIBE_DIR> folder, but the following folders are mandatory: • • • •
<ESCRIBE_DIR>Configuration <ESCRIBE_DIR>Indexes <ESCIRBE_DIR>Name <ESDB_DIR>
If the default JET database is not used, (e.g., Oracle), backup the data in that database.
4.4 Restoring Data Contact Mortara’s Technical Support department before performing a data restore. E-Scribe should be restored from a previous day’s backup tape. To restore data, stop all E-Scribe services. Insert the appropriate tape and launch Windows’ Backup utility under Start / All Programs / Accessories / System Tools menu. Use the wizard to catalog the tape, and then restore the <ESCRIBE_DIR> and <ESDB_DIR> folders. After the restore is complete, restart the E-Scribe services or reboot.
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