3DMP Product Manual

Contents

Notice 2Safety Notice 2

Specifications 3

Technical Support 4

System Requirements 5Overview 9Startup Menu 10

System Administration Menu 11

Network Troubleshooting Menu 13

Patient Testing Guide 16Testing and Lead Placement 16

Reviewing ECG Data Quality 17

Tutorial 22User Management 23

Patient Management 25

Patient Test (ECG) Data 28

Reports 39

Network Troubleshooting 50

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Safety Notice

Follow the normal safety precautions for any office equipment when using the 3DMP machine.• Use only the AC adapter/power supply included with the 3DMP device• To protect against electric shock and to ensure good quality ECG signals, plug the AC adapter into aproperly grounded electrical outlet

•

Avoid using wall outlets controlled by wall switches or shared with other equipment• Do not remove any component from the 3DMP machine, this will void product warranty• Use the equipment only for its intended use, to collect and transmit human ECG data and to display the testresults

Warning

During cable connection and installation, take care not to turn on either the computer or the monitor.

To prevent electrical shock, do not remove cover. No user−serviceable parts are located inside. Referservicing to qualified personnel.

In the unlikely event the computer or the circuit on which it functions is hit by lightning, it may shut down.Before rebooting, take note of the data that may have been lost from the time the computer shut downbefore recommencing testing.

All power cords must be plugged into the surge protector that comes with the device. Furthermore, thesurge protector must be plugged into an isolation transformer.

During setup, try to work in a static−free environment. While testing the patient, the 3DMP system must beinsulated at all times from metal objects, cellular phones, and any device that creates an electro−magneticfield. If the ECG leads or other cable components are touching a metal surface, the extremely sensitiveequipment may pick this up as interference, inducing an artifact in the waveform displayed.

•

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Specifications

Software3DMP Client v 1.0.0

LeadsV5 and II

Environmental Requirements50°F/10°C − 95°F/35°CRelative Humidity <85%

Input ImpedanceTransdermal electrode signal amplifier − A/D Converter

A/D Set2 channel, 12 bit.

Power Requirements100/115 VAC, 50−60Hz

LeakagePatient >2 µAGround, Chassis >10 mA

Frequency Domain Resolution0.2Hz

Input Offset ToleranceProtected: 2.5kV/min ±25V

Equipment Type/SafetyClassificationClass 1, CF

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Technical Support

If a user encounters difficulty during installation or test administration of the 3DMP device, technicalsupport can be accessed via Online Service and Support or via the telephone.

Online Service and Support

Connect with Premier Heart online by visiting our website at http://www.premierheart.com. The websitewill also provide you with the latest updates, downloads and contact information.

Premier Heart Telephone/Fax Support

Premier Heart telephone support services are available to all of our customers. For information or inquiriesplease contact us at (516)883−3383.Use your fax machine to receive/send general product information and fact sheets by dialing(516)883−5812

Support for old and discontinued versions

In the event that a new version of the 3DMP software is released, you will receive updated information viaemail. Telephone support will be also provided for the set up of the latest software.

Service and Support Offices

North America

Premier Heart14 Vanderventer AvePort Washington, NY 11050U.S.ATel: (516)883−3383Fax:(516)883−5812

Manager : Joseph T. Shen, MD (jtshenmd@premierheart.com)Technical Support : support@premierheart.com

Asia/Pacific Rim

Premier Heart (Asia) LtdRoom 1202−3 121FChinachem Johnston Plaza178−186 Chinachem Johnston RoadWan Chai, Hong Kong 040Tel: (852) 9771−5445Fax: (852) 3006−4275Contact : Eric Chien (eric.chien@premierheart.com)

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System Requirements

Outbound TCP Ports

The 3DMP system uses the HTTPS protocol for all normal traffic (e.g. sending patient test data and receivingreports). The HTTPS protocol requires unrestricted access to outbound port 443.

The 3DMP system uses the SSH protocol for all system administration traffic (e.g. updating software, orallowing remote administration). The SSH protocol requires unrestricted access to outbound port 80.

Unrestricted outbound traffic on ports 443 and 80 is required for 3DMP system operation.

Ports 80 and 443 are standard ports for web traffic and should be available from behind all firewalls.

Internet Connection

The 3DMP system must have a direct connection to the internet; that is, an ethernet (or wireless ethernet)connection to a router or gateway server which provides the internet access. There may be any number ofhubs, routers, and switches between the 3DMP system and the gateway/router, but no servers which performany translation of the network traffic (e.g. proxy servers or machines using Windows Internet ConnectionSharing). The connection should be a broadband connection; connections under 128k/s, such as modems, willcause network timeouts and are not supported.

It is recommended that the server or router providing the connection also provide DHCP configuration of the3DMP system IP address, default (gateway) route, and name (DNS) server. Static configuration of the 3DMPmachine is possible, however Premier Heart staff cannot determine whether the static settings for a customer'snetwork are correct, and therefore cannot support static network configuration.

While most network hardware such as routers are preconfigured, or offer simple configuration utilities forservices such as DHCP, such configuration varies widely by manufacturer and cannot be supported byPremier Heart. Similarly, server configuration will vary by operating system, hardware, server software, and

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supplementary network appliances; configuration and management of servers cannot be provided by PremierHeart.

The recommended network configuration is as follows:

a broadband internet connection• a router connected to this internet connection OR a server connected to this internet connection• a switch/hub connected to the router/server• the 3DMP connected to the switch/hub•

Home or Personal Network

A standard home setup would be as follows:

The ISP provides the internet connection and a small router. The router has a hub or switch built in, andprovides DHCP. The 3DMP machine is connected to one of these ports.

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Small Office Network

A standard small office setup would be as follows:

The ISP provides the internet connection and a router. The office provides a firewall and a gateway with twonetwork cards: one connected to the firewall, and one connected to a switch/hub. The gateway providesDHCP to local machines connected to the hub. The 3DMP machine is connected to one of these ports.

Network Hardware

Any standard router, switch, or hub will work with the 3DMP machine. It is recommended that the customeracquire their network hardware from a reputable manufacturer, such as

Linksys• Netgear• Belkin• D−Link•

Standard gateway servers and firewalls will work with the 3DMP machine, provided they allow unrestrictedaccess to outbound TCP ports 443 and 80.

Wireless Networks

Only wireless cards provided by Premier Heart are supported. Any standard 802.11b/g routers and hubs willwork with these cards. It is recommended that the customer obtain their wireless hardware from a reputablevendor, and that the hardware supports WEP encryption and MAC address filtering.

Currently Premier Heart only supports 64−bit and 128−bit WEP security.

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Captive Portals/Networks

Captive networks require that a user authenticate via a web browser in order to gain internet access for themachine.

The 3DMP system has a web browser which can be used for this purpose. The web browser can be accessedby right−clicking on the desktop background (the GUI must be moved or shaded in order to do this) andselecting the "Premier Heart Web Site" option.

Proxy Servers

Outbound connections via proxy servers are unsupported. System administration functions will not work overa proxy server connection, and the Wingate proxy server is known to interfere with the HTTPS trafficrequired for normal operation, even when tunnelled.

Printer Connection

Only printers which are connected directly to the 3DMP machine via parallel port or USB are officiallysupported by Premier Heart.

Networked printers and print servers, such as HP JetDirect, or a server providing access to printers via theLPD or IPP protocols, may work with the system but are officially unsupported.

Printers shared from a Windows system via "printer sharing", or servers providing access to printers via theSMB protocol, are known to not work and are officially unsupported.

Supported Printers

Premier Heart recommends using a printer make and model which is mature and which has a good reputation,such as the HP line of Deskjet and Laserjet printers.

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Overview

3DMP is a non−invasive device for the diagnosis of coronary artery disease (CAD). It mathematicallyanalyzes electrocardiogram (ECG) data from leads II and V5 simultaneously. The results of the mathematicalcalculations are represented graphically as the power spectrum and its variations: impulse response, amplitudehistogram, phase angle shift, coherence, and cross correlation. They represent various aspects of the electricalactivity of the heart.

The complete 3DMP system consists of an application used to gather patient ECG data and to display reports,and a Database Server which automatically analyzes the patient ECG data and generates reports on demand.

This manual contains the documentation for the 3DMP application. The application GUI consists of a menu, atoolbar for common tasks, and dialogs for interacting with the user.

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Startup Menu

When the 3DMP machine first starts you will briefly be presented with the Startup menu.

3DMP ApplicationThe default behavior for the Startup menu is to pause for three seconds and then launch the 3DMPapplication. This standard behavior requires no intervention on behalf of the user for daily use.

System AdministrationThis option provides access to the System Administration Menu, which allows configuration of the network,updating of software and other administration operations. Only a qualified system or network administratorshould choose this option.

Technician's MenuThis option provides access to the Technician Menu, and is for use ONLY by Premier Heart distributors ortechnical staff. Choosing this option could render the system inoperable.

Local RecoveryThis option is for use ONLY by trained Premier Heart technical staff. Choosing this option could doirreparable harm to the 3DMP system.

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System Administration Menu

The System Administration Menu is used for configuring the system and for viewing system information. Itshould only be used by a qualified network or system administrator, or under the direction of trained PremierHeart support staff.

Ethernet LAN configThe ethernet card in the system can be configured with this option; the system supports DHCP and staticconfiguration. Only a qualified network or system administrator should select this option.

Wireless LAN ConfigIf the system has shipped with a wireless networking card, it can be configured with this option. The systemsupports Ad−Hoc and Managed modes, as well as 64−bit and 128−bit WEP encryption. Only a qualifiednetwork or system administrator should select this option.

Add DNS serverThis option will display the DNS servers which the system has been configured to use; it also provides the

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option of adding a DNS server to the existing list of DNS servers. It can be used to manually add DNSservers, in the event that the DHCP server has not provided DNS server information, or the local DNS serversare not adequate.

Display IP addressThis option will display the IP address of the system. If both an ethernet card and a wireless card are present,this option will display the IP address of the interface being used to connect to the internet.

Display WLAN MAC addressThis option will display the MAC address of the wireless card, if one is installed. This is for the convenienceof sites whose wireless networks use MAC address filtering.

Display system statisticsThis option will display various statistics, such as the version of the 3DMP application software, the numberof patients stored locally, and the amount of free disk space on the system.

Set system dateThis option can be used to set the system date and time.

Set timezoneThis option can be used to set the timezone of the system.

Remote Administration ModeThis option should be used only under the direction of Premier Heart support staff. When selected, it displaysthe IP address of the machine, which may be required in order to provide Premier Heart with remote access tothe machine. The system will then start a screensaver while remote administration mode is enabled. To exitthe screensaver and remote administration mode, press the Ctrl, Alt, and Backspace keys simultaneously.

Update softwareThis option is used to obtain the latest versions of the 3DMP application and all system software. PremierHeart will contact all customers when an update is available. Customers should not select this option unlessthey have been informed that updated software is available.

Network troubleshooting menuThis option displays the Network Troubleshooting Menu, which contains operations that can be performed todiagnose network connectivity problems. See the Network Troubleshooting Guide.

ExitThis option exits the System Administration menu and reboots the system.

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Network Troubleshooting Menu

The Network Troubleshooting Menu can be used by system administrators and support personnel to diagnoseproblems connecting the 3DMP system with the Premier Heart database server.

The operations available on this menu only provide information; they do not change the state or configurationof the 3DMP system in any way. More information can be found in the Network Troubleshooting section.

Test database name resolution

This option will use the UNIX host utility to query the A (address) records for the Premier Heart databaseserver. It tests whether the DNS servers used by the 3DMP system can resolve the URL needed for normalGUI operation.

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Test admin name resolution

This option will use the UNIX host utility to query the A (address) records for the Premier Heart adminserver. It tests whether the DNS servers used by the 3DMP system can resolve the URL needed for softwareupdates and remote administration.

Test W3C name resolution

This option will use the UNIX host utility to query the A (address) records for the W3C webserver. It testswhether the DNS servers used by the 3DMP system can resolve well−known internet URLS.

Ping database server

This option will use the UNIX ping utility to connect to the Premier Heart database server. It determines if thedatabase server is up, and if packets from the 3DMP system can reach it.

Ping admin server

This option will use the UNIX ping utility to connect to the Premier Heart admin server. It determines if theadmin server is up, and if packets from the 3DMP system can reach it.

Ping W3C

This option will use the UNIX ping utility to connect to the W3C webserver. It determines if packets from the3DMP system can reach well−known internet sites.

Traceroute database

This option will use the UNIX traceroute utility to connect to the Premier Heart database server. It will listeach gateway or router encountered on the way, and can be used to determine which intervening gateway orrouter is responsible for delays or loss of connectivity during normal GUI operation. NOTE: the routeinformation for the Premier Heart database and admin servers will be identical; this menu item can be used totroubleshoot both.

Traceroute W3C

This option will use the UNIX traceroute utility to connect to the W3C webserver. It will list each gateway orrouter encountered on the way, and can be used to determine which intervening gateway or router isresponsible for delays or loss of connectivity to the internet in general.

Test database port

This option will attempt to connect to port 443 on the Premier Heart database server. It can be used todetermine whether a firewall is properly allowing outbound TCP connections that are required for normalGUI operation.

Test admin port

This option will attempt to connect to port 443 on the Premier Heart admin server. It can be used to determinewhether a firewall is properly allowing outbound TCP connections that are required for software updates andremote administration.

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Test HTTPS connectivity

This option will attempt to fetch a web page from the Premier Heart database server using the HTTPSprotocol. It can be used to determine if the network traffic required for normal GUI operation is possible.

Exit

This option will exit from the Network Troubleshooting Menu.

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Patient Testing Guide

Testing Procedure and Lead Placement

Select a quiet room with minimal foot traffic, away from other heavy diagnostic equipment such asCT or MRI scanners, with a sign on the door: "3DMP testing in progress, please do not enter."

1.

Select an electrical power outlet which is well grounded without other devices sharing with 3DMPdevice power cords.

2.

The examination table should not have any metal surface to avoid interference.3. Be sure the patient turns off all personal electronic devices.4. Let the patient rest comfortably supine on his/her back, completely relaxed for a recommended 20minutes.

5.

During the resting period, use 70% isopropyl alcohol swabs to prepare the skin surfaces for the fivelead placements.

6.

A razor can be used to shave off the excess hair in and around the five sites for better adhesion of thehydro gel electrodes.

7.

Attach the conductive, adhesive hydro gel ECG electrodes to each of the five locations.8. Lead placements: two finger breadth above the distal radial crease of the inner wrists, two fingerbreadth above the medial maleoli of the inner ankles and one at the intersection of anterior axillaryline and the fifth intercostal space (V5).

9.

Lead placements for amputees are demonstrated in the following diagram:

Torso lead placements for amputees

10.

Place the yoke of the ECG lead wires between the patient's legs to allow each wire to fan out to itsdestination in the "Peacock Tail" configuration to avoid crossing over of the lead wires.

11.

The lead wires should not touch any metal surface.12. Enter the patient's demographic data through the GUI according to the instructions in the manual.13. Instruct the patient to remain still and no talking for approximately 82 seconds during each ECGsampling period.

14.

Repeat the tests a minimum of 3 or more times, as the situation allows, to generate good qualitytracings and reproducible test results.

15.

Generate the automatic reports for review and printing according to the instructions in the manual.16.

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Reviewing ECG Data Quality

The 3DMP device is an electrocardiography apparatus that represents patient cardiac electric signals in bothtime and frequency domains. Because of the sensitive diagnostic capabilities of the device, fidelity to a trueelectrocardiograph waveform must be maintained.

This constitutes a relatively artifact−free waveform over the 82−second time span necessary for completewaveform capture. This section describes criteria used to exclude or resample a particular test because ofsome element confounding the tracing (artifact) such as patient movement or noise, for example.

Use the following criteria to determine whether to accept or discard (i.e., resample) ECG data immediatelyafter sampling.

The test should be resampled if the waveforms represented in five or more 5−second segments of ECG datacontain idiopathic extrema that deviate from the baseline by >= 2mm and appear >= 10 times.

The test should be resampled if two or more 5−second segments of ECG data demonstrate idiopathic extremathat deviate from the baseline by >=5mm.

The test should be resampled if, within a 25mm section of waveform in any 5−second segment of the ECGdata, the waveform strays from the baseline by >=3mm

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The test should be resampled if the waveform demonstrates:a radical deviation away from the baseline 80° 10°, at >=2mm, two or more times• a single episode of >= 5mm.•

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Example of a poor quality ECG tracing

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Example of a marginal quality ECG tracing

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Example of a good quality ECG tracing

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How To Use the 3DMP System

How To...

User management

...log in as a user?•

...add a user?•

...delete a user?•

Patient management

...add a new patient?•

...edit an existing patient?•

...find a patient?•

...delete a patient?•

Patient test (ECG) data

...test a patient?•

...review patient test data?•

...send patient test data to the server?•

...find patient test data?•

...delete patient test data?•

Reports

...download a report?•

...view a downloaded report?•

...delete a downloaded report?•

Handling problems and errors

...test the network connection?•

...test the ECG sampling hardware?•

...test report displaying?•

...send a bug report?•

...enable remote administration?•

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User management

...log in as a user?

To log in as a user on startup of the 3dmp machine, select your user name in the scrolldown bar of the Logindialog box and click the OK button

If the 3dmp machine is already running and you wish to switch users select Admin−>User−>Set Active Userfrom the menu bar. This will bring up the Switch User dialog box.

Select your user name and click the OK button to log in.

...add a user?

To add a new user to the system select Admin−>User−>New User from the menu bar. This will bring up theUser Profile dialog box

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Enter in the new user's name in this dialog box. The location field is always set to the name entered in theLocation dialog box can not be changed by the user. You may also input an email address and phonenumber for the user. Once you have input the information click the OK button to finish creating the newuser.

...delete a user?

To delete a user, select Admin−>User−>Delete Current User from the menu bar. A message box will openasking you to confirm that the user should be deleted. Click OK to finish deleting the user. Once the user isdeleted, the Switch User dialog box will open and you may log in as another user.

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Patient management

...add a new patient?

To add a new patient, select Patient−>New Patient from the menu bar. This brings up the Patient dialog box.

The patient's data will be saved when the OK button is pressed, or when the user switches to another tab inthe patient dialog.

...edit an existing patient?

To make changes to an existing patient, first find the patient you wish to make changes for. For informationon how to find a patient click here: Find a patient. Once the patient is selected, the Patient dialog box willappear.

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You may change any of the data on this screen. When you have completed your changes, press the OK buttonand all changes you have made will be saved in the database.

...find a patient?

To find a patient, select Patient−>Find Patient from the menu bar. This brings up the Find dialog box.

Make sure the Patient Name button is selected, then type in the name or partial name of the patient you aretrying to find and press the Search button. This will bring up the Search results dialog box.

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This dialog box contains all possible matches from the search. You can now click on the patient you arelooking for and press the Select button to bring up the Patient dialog box.

If you type nothing in the Find dialog box. and press the Search button it will bring up a list of all patients.

...delete a patient?

To delete a patient, select Patient−>List Patients from the menu bar. This will bring up the Patient List dialogbox.

Click on the patient you wish to delete, then click the Delete button. A message box will open asking you toconfirm that the patient should be deleted. Click OK to finish deleting the patient.

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Patient test (ECG) data

...test a patient?Be sure to read the Patient Testing Checklist before proceeding.

To create a new test, first select the patient you would like to run a test for using either the Patient−>ListPatients or the Patient−>Find Patient menu item. Once you have selected a patient, the Patient dialog box. willappear.

In this screen, select the Tests tab.

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In this tab press New; this will bring up the Patient Test dialog box.

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Select the ECG Sample tab. Connect the ECG leads to the patient and press Record ECG.

This will begin the ECG sampling process. When the sampling is complete (approximately 82 seconds), youmay review the ECG data using the ECG Image Display dialog box. If the quality of the ECG data is poor,check the leads connected to the patient and press Record ECG to obtain a new sample.

When an adequate ECG sample has been obtained, review the ECG data and rate the ECG Tracing Quality.You can then press Send to send the data to the server, or press OK to save the test information to the localmachine and close the dialog box.

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...review patient test data?

To review a test for a patient, select Patient−>Patient List from the menu bar. This will open the Patient Listdialog.

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Select the patient whose test you wish to review, then press the View button. This will open the Patient dialog.Go to the Tests tab.

Select the test you wish to review from the list and press the Edit button. This will open the Test dialog forthat test. Go to the ECG Sample tab and click on the image of the ECG.

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This will open the ECG Image Display dialog, which you can use to review the ECG trace data. The X axisrepresents time in 10 ms intervals, and ranges from 0 to 8192 (that is 81920 ms, or 81.92 seconds); the Y axisrepresents voltage in millivolts.

...send patient test data to the server?

To send a test for a patient to the database server, select Patient−>Patient List from the menu bar. This willopen the Patient List dialog.

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Select the patient whose test you wish to send, then press the View button. This will open the Patient dialog.Go to the Tests tab.

Select the test you wish to send from the list and press the Edit button. This will open the Test dialog for thattest. Go to the ECG Sample tab and press the Send button. Note that the ECG Tracing Quality field must beset to a value other than undescribed or the send will fail.

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A message box will appear confirming that the data has been sent to the server.

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...find patient test data?

To find a test, select Patient−>Find Test Data from the menu bar. This brings up the Find dialog box.

Make sure the "Test Filename" button is selected, then type in the name or partial name of the filename youare trying to find and press the "Search" button. This will bring up the "Search results" dialog box.

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It contains all possible matches from the search and you can now select the test you are looking for byclicking on the test and pressing the "Select" button.

If you type nothing in the "Find" dialog box and press the "Search" button it will bring up a list of all tests.

...delete patient test data?

To delete a test, select Patient−>Patient List from the menu bar. This will bring up the Patient List Dialog.

Click on the patient whose test you wish to delete, then click the View button. This will bring up the PatientDialog.

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Click on the Test tab.

In this screen click on the test that you wish to delete and press the Delete button. A message box will openasking you to confirm that the test should be deleted. Click OK to finish deleting the test.

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Reports

...download a report?

To download a report on the results of a test, select Patient−>Patient List from the menu bar. This will openthe Patient List dialog.

Select the patient whose report you wish to view, then press the View button. This will open the Patientdialog. Go to the Tests tab.

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Select the test you wish to download a report for from the list and press the Report button. This will open theReport List dialog, which contains a list of all reports that have been downloaded for the test.

Press the New button. This will open the Report Download dialog.

Select the Report Type (usually Automatic), then press the Download button.

A message box will be displayed confirming that the report has been downloaded.

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If the report is not yet available, a message box explaining this will be displayed.

The Report Download dialog will close and the Report List dialog will be updated to included thenewly−downloaded report.

The report can be viewed in Adobe Acrobat Reader™ by pressing the View button.

...view a downloaded report?

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To view a downloaded report on the results of a test, select Patient−>Patient List from the menu bar. This willopen the Patient List dialog.

Select the patient whose report you wish to view, then press the View button. This will open the Patientdialog. Go to the Tests tab.

Select the test whose report you wish to view from the list and press the Report button. This will open theReport List dialog, which contains a list of all reports that have been downloaded for the test. If no reportshave been downloaded, use the Download button to download the report.

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Press the View button. This will open the report in Adobe Acrobat Reader™.

...delete a downloaded report?

To delete a downloaded report on the results of a test, select Patient−>Patient List from the menu bar. Thiswill open the Patient List dialog.

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Select the patient whose report you wish to delete, then press the View button. This will open the Patientdialog. Go to the Tests tab.

Select the test whose report you wish to delete from the list and press the Report button. This will open theReport List dialog, which contains a list of all reports that have been downloaded for the test. Select the reportyou wish to delete and press the Delete button. A message box confirming the delete will appear; press theOK button to delete the report.

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Troubleshooting

...test the network connection?

To test the connection to the database server, select File −> Test Connection from the menu bar. The TestConnection Dialog will appear and display the current status of the network connection.

If the connection fails, use the Force DB Reconnection menu item to renew the connection. If this fails, checkthe network cables and ensure that network settings are correct.

...test the ECG sampling hardware?

To test the connection to the database server, select File −> Test Hardware from the menu bar. The TestHardware Dialog will appear and display the current status of the ECG sampling hardware.

...test report displaying?

To test the downloading and displaying of reports, select File −> Test Reporting from the menu bar. A samplereport will be downloaded from the database server and displayed in Adobe Acrobat Reader™.

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...send a bug report?

To send a bug report, select Help −> Send Error Report from the menu bar. This will open the Send ErrorReport dialog box. Enter a description of the problem and the the steps that led up to it, then press OK to sendthe bug report.

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...enable remote administration?

Important: This operation could render the 3DMP system unusable. Only perform this operation under thedirection of Premier Heart support staff.

Reboot the system to get to the System Administration Menu. Select the Remote Administration Mode option.

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The Initiate remote Connection dialog will display, prompting you to press ENTER. Once this is done, thesystem will connect to the Premier Heart remote administration server.

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The system will then display a screensaver while it is in Remote Administration mode. At this point youshould inform Premier Heart support personnel that the system is available for remote administration.

The Premier Heart technician will inform you when work has been completed on your machine; at this timeyou can return to the System Administration Menu by pressing the Ctrl, Alt, and Backspace keyssimultaneously.

The Close Remote Connection will now appear; press ENTER to disconnect the system from the remoteadministration server. This will return you to the System Administration menu; select Exit to reboot thesystem.

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Network Troubleshooting Guide

1.Test internet connectivity

Reboot the system to get the System Administration Menu. Select the Network troubleshooting menu option;this will bring up the Network Troubleshooting Menu.

Select the Ping W3C option; this will send 3 ICMP ECHO packets to the w3.org webserver.

If this test succeeds, then the machine can connect to the internet; test Premier Heart connectivity.

If this test fails, then test DNS resolution.

2. Test Premier Heart connectivity

Select the Ping database server option; this will send 3 ICMP ECHO packets to the Premier Heart databaseserver.

If this test succeeds, then the machine can connect to the database; test outbound port connectivity.

If this test fails, then test DNS resolution.

3. Test name server (DNS) resolution

Select the Test W3C name resolution option; this will attempt to get the internet address record for the hostwww.w3.org.

If this test fails, the DNS server is not working correctly; consult your system administrator, ISP, or systemmanual as appropriate.

If this succeeds, select the Test database name resolution option; this will attempt to get the internet addressrecord for the Premier Heart database server.

If the database test fails, the DNS server does not recognize the Premier Heart domain names; either the DNStables need to be updated, or the Premier Heart DNS server is down. Consult your system administrator, ISP,or system manual to update the DNS tables; contact Premier Heart technical support if the Premier Heartdomain cannot be resolved from other networks.

If the database test succeeds, and there are no routing problems, then this is probably a firewall issue −− forexample, the firewall might not allow outgoing ICMP packets, might only allow outbound traffic to specifichosts, or might not allow outbound traffic from unknown IP addresses. Consult your system administrator,ISP, or system manual as appropriate.

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4. Test outbound port 80/443

Select the Test database port option. This will attempt to open port 443 on the Premier Heart database server.

If this test succeeds, then the machine can connect to the proper port on the database server; test HTTPSconnectivity.

If this test fails, and there are no routing problems, dns resolution problems, or database connectivity issues,then there may be a firewall issue −− the firewall is preventing outbound connections on port 443. Consultyour system administrator, ISP, or system manual as appropriate.

5. Test HTTPS connectivity

Select the Test HTTPS connectivity option. This will attempt to download a page from the Premier Heartdatabase server via the HTTPS (SSL over HTTP) protocol.

If this test succeeds, and the GUI does not connect to the database, then it is likely that the GUI configurationhas become corrupt. Contact Premier Heart technical support.

If this test fails, and there are no routing problems, port connectivity issues, dns resolution problems, ordatabase connectivity issues, then some network component might be interfering with the SSL traffic. Thiscould be a firewall or a proxy server which modifies the packets in transit. Consult your system administrator,ISP, or system manual as appropriate.

6. Identify routing problems

Select the Traceroute database option. This will display all gateways and routers between the system and thePremier Heart database server.

If there are delays or connectivity drops in the traceroute output (e.g., it continuously displays '* * *'), thenthere is a routing issue at the last router or gateway reported by traceroute. Contact the administrator of thatserver or your ISP as appropriate.

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