3M™ Littmann®TeleSteth™ OnlineAuscultation System User ... · • USB 1.1 port to support a...

3M™ Littmann® TeleSteth™ Online AuscultationSystem User Manual ‒ Version 2.6.X

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TABLE OF CONTENTS

1.0 General Information.......................................................................................... 32.0 Getting Started.................................................................................................. 63.0 Hosting & Joining a Real-Time Streaming Session .......................................... 94.0 Streaming Session Features .......................................................................... 105.0 Uploading, Downloading & Reviewing Auscultatory Recordings.................... 126.0 TeleSteth™ Software Account Information ..................................................... 147.0 Methods and Technique for Proper Auscultation ............................................ 158.0 Troubleshooting .............................................................................................. 16

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1.0 General Information

1.1 General Overview of 3M™ Littmann® TeleSteth™ System

3M™ Littmann® TeleSteth™ Online Auscultation System was developed toextend the practice of auscultation (listening with a stethoscope to situations andenvironments where face-to-face encounters are not always convenient or feasible.This platform allows healthcare professionals to share heart, lung and other bodysounds with colleagues located across the globe using the internet or a privatenetwork.

The TeleSteth™ System is designed to be accessed from a user’s PC and iscompatible with the 3M™ Littmann® StethAssist® Heart and Lung SoundVisualization Software. For organizations requiring users to access stethoscopesounds from within their private network, the TeleSteth™ System can be deployedusing the Local Client Server Solution.

1.2 Intended Use

The TeleSteth™ System is intended to provide and control the real time datatransfer of body sounds between two 3M™ Littmann® Electronic Stethoscopes Model3200 over a data network. Patient body sounds may be remotely evaluated in real-time or in store-and-forward mode. The TeleSteth™ Online Auscultation System canbe used on any person undergoing a physical assessment.

1.3 Operator Profile

The TeleSteth™ System is designed to be used by anyone who is familiar with theModel 3200 stethoscope and who wishes to transfer body sounds over a data networkin real time. The TeleSteth™ Online Auscultation System user manual providescomplete information on how to operate the software program; thus no additionaloperating training is required.

1.4 Functional Description

The TeleSteth™ System provides for the real-time transmission of body soundsfrom one Model 3200 stethoscope to another Model 3200 stethoscope over a datanetwork. The sound captured by the stethoscope chestpiece at the Patient site can beheard equivalently at both the Patient and Consulting sites through the Model 3200’sstethoscope’s binaural headset.

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Both site’s 3M™ Littmann® Stethoscope Electronic Model 3200 are connected to aMicrosoft Windows®-based personal computer (PC) via a Bluetooth wireless link.The two PC’s are then connected to each other via a central server over a TCP/IPdata network.

1.5 Safety Information

Consult instructions for use

This user manual provides instructions for use of the 3M™ Littmann® TeleSteth™Auscultation System System and assumes that all users are familiar with theWindows® operating system. It is recommended that all personnel who operate theTeleSteth™ System thoroughly read and understand this user manual. Please retainthese instructions for future reference.

A CAUTION or NOTE used in this user manual will be boxed and will have thefollowing significance:

CAUTION: Indicates a situation in which the software may present inaccurate orincomplete information to the user.

NOTE: Information that is considered important to emphasize.

1.6 Minimum System Requirements

• 1 gigahertz processor• 512 megabytes available hard disk space• 512 megabytes RAM• Network bandwidth of 1.5 megabits/second• Java 1.6.0 through Java 1.8.0• Windows Vista, Service Pack 2 (32 bit)• Windows 7 (32 and 64 bit)• Windows 8 (32 and 64 bit)• Windows 8.1 (32 and 64 bit)• Windows 10 (32 and 64 bit)• USB 1.1 port to support a Bluetooth dongle using the

Microsoft Bluetooth drivers• Microsoft® Internet Explorer® versions 8, 9, 10, or 11• Microsoft Edge

1.7 IT Network Requirements

• A standard TCP/IP based network with DHCP or static IP addressassignment. Connectivity is supported via hardwire (i.e. CAT5) or wireless

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(i.e. 802.11g). The minimum dedicated bandwidth required per activeConsultant/Patient Site connection is 100kbps.

• The 3M™ Littmann® TeleSteth™ Software requires communicationthrough a TCP/IP port assignment. The application uses bidirectionalTCP/IP communication.

• The port utilized by the application is in the range of 1100-1300 (For theLocal Client Server Solution, the port range can be changed using theadministrator application).

• The TeleSteth™ Software incorporates SSL encryption techniques toencrypt the network communications between the Patient Site andConsultant applications.

1.8 Bluetooth USB Dongle Requirements

• Compliant with Bluetooth V1.1• Interface: Compliant with USB 1.1 & 2.0• Working distance: 5-10m

U.S.A. ONLYCAUTION: Federal law restricts this device to sale by or on the order of aphysician.

NOTE: The 3M™ Littmann® TeleSteth™ Online Auscultation Systemshould only be installed on a PC that meets the System Requirements.

NOTE: The 3M™ Littmann® TeleSteth™ Online Auscultation Systemwill only function with the 3M™ Littmann® Stethoscope ElectronicModel 3200.

NOTE: The USB dongle device complies with Part 15 of the FCC Rules.Operation is subject to the following two conditions: 1. This devicemay not cause harmful interference, and 2. This device must accept anyinterference received, including interference that may cause undesiredoperation.

FCC NOTE: THE MANUFACTURER IS NOT RESPONSIBLE FOR ANYRADIO OR TV INTERFERENCE CAUSED BY UNAUTHORIZEDMODIFICATIONS TO THIS EQUIPMENT. SUCH MODIFICATIONSCOULD VOID THE USER’S AUTHORITY TO OPERATE THEEQUIPMENT.

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1.9 Patient Privacy

The 3M™ Littmann® TeleSteth™ Online Auscultation System is not designed toinclude individually identifiable health information in order to function. Records canbe stored and recalled through the use of a timestamp or an arbitrarily assignedidentifier.

If you do use personally identifiable health information with the TeleSteth™System, you should understand that the privacy and security of certain individuallyidentifiable health information may be protected by state, federal, international,and/or foreign laws that regulate and restrict how such information can be used,disclosed, stored and transmitted. In some instances, you may even be prohibitedfrom permitting any third party to access such information without first obtaining priorwritten authorization to do so.

You are solely and fully responsible for determining, understanding, andcomplying with any and all laws that affect how you may store and transmit anyelectronic individually identifiable health information through use of the TeleSteth™System. If you determine that you are not able to comply with a law or restriction thatapplies to your use and disclosure (including transmission) of individually identifiablehealth information through the TeleSteth™ System, then you should not proceed touse the system. By proceeding to use the TeleSteth™ System, you hereby assumeall risks, responsibilities and liabilities associated with using, storing, and/ortransmitting such information, including sound files, electronically or otherwise.

2.0 Getting Started

2.1 Installing the USB Bluetooth Adaptor (Dongle)

A USB dongle allows communication between the PC running the TeleSteth™System and the 3M™ Littmann® Stethoscope Electronic Model 3200. The USBdongle receives and transmits data via the commonly accepted Bluetooth® shortrange wireless connectivity standard. To install the USB dongle, plug the device intoan open USB port on the PC.

NOTE: The TeleSteth™ System was designed and validated using the USBdongle, and therefore it is recommended that you use the USB dongle as opposedto an internal Bluetooth radio. Furthermore, the wireless range will likely be betterwith the external USB dongle.

The USB dongle must be inserted into the PC prior to launching the TeleSteth™Software. If the TeleSteth™ Software tries to connect to the stethoscope but doesnot detect a USB dongle on the PC, the following screen will be displayed:

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USB Dongle Detection Window

2.2 Launching the 3M™ Littmann® TeleSteth™ Software

The 3M™ Littmann® TeleSteth™ System is a web-based software tool that is designedto belaunched through a standard internet browser. The web address (URL) that youenterinto the internet browser will be dependent upon which TeleSteth™ Server you are using(3M Hosted USA, 3M Hosted outside of the USA, or a Local Client). In the USA, you canconnect to 3M Hosted Server by entering http://www.littmann.com/telemedicine/launch inthe address bar. If you are connecting to a 3M Hosted Server outside of the USA, contactyour local 3M Representative for the correct URL. If you are using your institution’s LocalClient Server instead of the 3M Hosted Server, contact your institution’s IT or telemedicinedepartment for the correct URL.

A valid username and password is needed to log into the TeleSteth™ Software. Whenthe application appears, sign in using your username and password.

2.3 Pairing & Connecting the Stethoscope to the TeleSteth™ Software

To connect a 3M™ Littmann® Electronic Stethoscope Model 3200 to the TeleSteth™Software for the first time, it is necessary to “pair” the stethoscope and the software. Toinitiate the pairing process, go to the “Real-Time Streaming Session” tab and make surethat “Add Scope” appears in the field under the “My Stethoscope” heading. Then, clickon the circular stethoscope icon located to the left of “My Stethoscope” and follow theinstructions on the pop-up window that will appear.

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3M™ Littmann® TeleSteth™ Real-Time Streaming Session Tab

The screen below will appear each time a stethoscope is attempting to connect to theTeleSteth™ Software.

Stethoscope Connection Window

NOTE: Prior to pairing or connecting a 3M™ Littmann® StethoscopeModel 3200 to the 3M™ Littmann® TeleSteth™ Software, make sure thestethoscope is not currently connected to any other open Littmann®stethoscope Software such as 3M™ Littmann® StethAssist™ Software.An easy way to ensure this is to simply turn stethoscope off and thenback on again.

Make sure“Add Scope” isselected in thisdrop-down field

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2.4 Connecting Your Stethoscope

Once a 3M™ Littmann® Stethoscope Electronic Model 3200 has been paired tothe 3M™ Littmann® TeleSteth™ Software, that stethoscope can now be connected.To connect the stethoscope, follow these steps:

1. Turn the stethoscope on and click the (M) button on the stethoscope2. Press the (M) button again to select CONNECT3. Make sure the stethoscope’s ID appears in the “My Stethoscope” field

on the “Real-Time Streaming Session” tab, and then click the circularstethoscope icon located to the left of the “My Stethoscope” field.

NOTE: When the stethoscope is connected to the TeleSteth™ Software,

the Stethoscope Connection button will display a green check mark .If the stethoscope is not connected, the Stethoscope Connection button

will display a red X .

3.0 Hosting & Joining a Real-Time Streaming Session

To initiate a real-time streaming session, click the blue “Host a Session” button onthe upper right side of the TeleSteth™ Real-Time Streaming Session Tab. When the“Host a Session” button is clicked, a Session ID for the streaming session will appearbelow the button. This Session ID needs to be provided to the remote site.

To join the streaming session, click the blue “Join a Session” button on the upperright side of the TeleSteth™ Real-Time Streaming Session Tab and enter theSession ID that has been provided by the Patient Site.

NOTE: Multiple stethoscopes can be paired to the TeleSteth™ Software,but only one stethoscope can be actively connected to the TeleSteth™Software.

NOTE: The Patient Site clinician should “Host” the session while the remoteconsultant/specialist should “Join” the session. The acoustic sounds stream fromthe site that hosts the session to the site that joins the session. The site that hostsa session will be referred to as the “Patient Site” while the site that joins a sessionwill be referred to as the “Consultant”.

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If the Patient Site stethoscope is not connected to the 3M™ Littmann® TeleSteth™Software when the “Host a Session” button is clicked, a pop-up window will appearinstructing the user to put the stethoscope in “CONNECT” mode.

The “Session Status” icon indicates the connection status between the PC andthe TeleSteth™ Server. If the Session Status icon is green, the PC is connected tothe TeleSteth™ Server and the session is active. If the Session Status icon is red,the session has not been started or the session has been terminated.

TeleSteth™ Real-Time Streaming Session Tab

4.0 Streaming Session Features

4.1 Shared Waveform Display

During an active streaming session, the rectangular window at the bottom of theReal-Time Streaming Session tab displays the waveform for the incoming signal fromthe Patient Site stethoscope. This waveform is simultaneously visible at both sites. Ablue colored waveform line indicates a good network connection and properoperation. A red colored waveform line indicates that the network connection hasbeen interrupted or stopped.

The streaming session ID will belisted here.

Session Status icon:Green indicatesan active streamingsession.

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4.2 Shared Scale Selector

The Scale Selector, located on the right-hand side of the Shared WaveformDisplay, provides the user the ability to increase or decrease the volume, or theamplitude, of the heart sounds that is both heard and being displayed at theConsultant site. At the Patient site, the Scale Selector will adjust only the display.The Scale Selector can be controlled by both sites. In situations where the signal isfaint, select the “High” setting in order to increase the volume. In situations where thedisplayed signal is exceptionally loud and being clipped on the display, select the“Low” setting. The default setting will be “Mid” for Medium.

4.3 Shared Auscultatory Site Indicator and Patient Posture

During an active streaming session, both sites have the ability to adjust theposition of the white dot on the blue torso image and/or select the patient posture,and any change to these features is seen immediately at both sites. During an activestreaming session, the Patient Site clinician may wish to use these features to informthe Consultant as to patient site and/or posture. Alternatively, the Consultant canuse these features to guide the Patient Site clinician to the proper patient locationand/or posture.

The thumbnail images located beneath the blue torso image can be used by bothsites to change the large image to a back or side view. The blue Preset Sites buttonlocated beneath the thumbnail images can be used to automatically position thewhite dot over any one of a number of standard cardiovascular and pulmonaryauscultatory listening locations. The “Other” Preset Site selection can be used toconvey a listening location that is not available in the provided images.

4.4 Shared Chat Window

The right side of the 3M™ Littmann® TeleSteth™ Real-Time Streaming SessionTab provides an instant messaging chat window for use by both sites.

4.5 Audio Mode Settings

During an active streaming session, the Consultant will see an “Audio Mode”settings box at the top left corner of the Real-Time Streaming Session tab. TheConsultant has the option of using the 3M™ Littmann® Stethoscope Electronic Model3200 to listen to the streaming auscultation, the speaker system inherent to the PC,or speakers connected to the audio jack of the PC, such as headphones, desktopspeakers, etc.

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CAUTION: The audio quality of the sounds played through the PC speakers orPC audio jack may not be a faithful reproduction of the actual sounds due tothe acoustical performance of the PC’s sound card, sound card drivers, and/orthe frequency response of the headphones/speakers, potentially resulting in notbeing able to hear clinically relevant sounds. It is strongly recommended that a3M™ Littmann® Stethoscope Electronic Model 3200 is used to listen to theauscultation session as the sound quality at the remote site will be equivalent towhat is heard at the local site.

NOTE: Aside from the Shared Scale Selector described in Section 4.2, the filtersetting and the volume level are independent for the Patient Site and theConsultant, e.g., a change to the filter setting or the volume level on the PatientSite’s stethoscope during an active streaming session does not affect the soundthe Consultant hears, and a change by the Consultant to the on-screen filtersetting does not impact the filter setting on the Patient Site’s stethoscope.

NOTE: Do not use this software to send or receive any other types of sound otherthan those indicated by this manual and the Intended Use statement. Doing somay result in sounds that are not reproduced as expected.

NOTE: For patient data security purposes, exit or logout of the 3M™ Littmann®TeleSteth™ System at the conclusion of the session.

NOTE: The Uploading and Downloading feature is not available on the HostedTeleSteth™ Server.

The drop-down arrow in the box allows the Consultant to change the filter setting(bell, diaphragm and extended mode) applied to the incoming sounds.

4.6 Shared End Session ButtonBoth sites can terminate a streaming session at any time by clicking the blue End

Session button.

5.0 Uploading, Downloading & Reviewing Auscultatory Recordings

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5.1 Uploading Previously Recorded Files

Auscultatory recordings saved in the 3M™ Littmann® StethAssist™ Heart & LungSound Visualization Software can be uploaded to the 3M™ Littmann® TeleSteth™System. To upload files of this type, go to the “Upload” tab in TeleSteth™ Software(shown below) and follow the four simple listed steps.

TeleSteth™ Upload Tab

5.2 Downloading Previously Recorded Files

To download auscultatory files that have been uploaded to the TeleSteth™System for your access, go to the “Download” tab in TeleSteth™ Software. If files areavailable for download, the files will appear in a list at the top of the window. Use ctrl+ click (or Shift + click) to select the files you wish to download.

NOTE: Files in bold have either never been downloaded or they contain changesthat have not yet been downloaded.

NOTE: Files may become unavailable at a predetermined time following the lastupload.

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3M™ Littmann® TeleSteth™ Download Tab

5.3 Reviewing Previously Recorded Files

3M™ Littmann® StethAssist™ Files downloaded from the 3M™ Littmann®TeleSteth™ System can be opened and reviewed within the StethAssist™ Software.

6.0 TeleSteth™ Software Account Information

The “My Account” tab in TeleSteth™ Software displays the account holder’susername along with the email address to which account-related messages aredelivered. This tab also displays the expiration date for the account. To extend asubscription or to initiate a new account, contact 3M™ Littmann® Stethoscopes at1-800-327-5380 (U.S.A. only).

The My Account tab also contains links to change the account password orsecurity questions, view the end user license agreement, view this user manual, andchange the language within the application.

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Additions or deletions to your contact list can be made on the My Account tab.The contact list stores the usernames of other 3M™ Littmann® TeleSteth™Subscribers (when uploading an auscultatory recording to the TeleSteth™ Softwarefor transfer to another TeleSteth™ Subscriber, you must enter his or her TeleSteth™Username).

7.0 Methods and Technique for Proper Auscultation

When using the 3M™ Littmann® Electronic Stethoscope model 3200, there areseveral techniques that are important to consider that can substantially improve yourauscultation experience.

a. The sound sensor, where all sound acquisition occurs, isquite small and located in the very center of the chestpiece(lift the edge of the diaphragm and look for the indentationunder the white sticker). The area around the soundsensor does not contribute to sound acquisition.Therefore, it is important to focus the point of contact withthe patient on the very center of the chestpiece.

b. Only light contact is necessary with the Model 3200stethoscope. This includes both the handling of thestethoscope and the contact on the patient. Excessive pressure on the patientmay result in artifact sounds.

c. Contact with the patient must remain steady and consistent for optimal soundquality. Movement of the chestpiece against the patient will induce frictionalnoise.

d. It is a best practice to start your auscultation exam at a lower amplification level.Then, if you are trying to listen to a difficult-to-hear sound, adjust the amplificationupward. Using the amplification on an as needed basis will help reducedistracting noises during your exam.

Finally, it is important to recognize the difference in technique betweennonelectronic and electronic stethoscopes. Holding the Model 3200 stethoscopelightly, making light contact with the patient, focusing the point of contact on thecenter of the chestpiece, and remaining steady will assure the highest sound qualityauscultation experience.

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8.0 Troubleshooting

Problem Potential Cause SolutionCannotconnect tostethoscope

No USB dongleinstalled/USB donglenot properly installed

Install USB dongle. See Section 2.1of this user manual titled, “Installingthe USB Bluetooth Adaptor (Dongle)”

USB dongle notdetected

Only one Bluetooth radio can beactive on any one PC at any onetime. Disable the internal Bluetoothradio.

USB dongle notdetected

Update the Bluetooth driver on thePC to the Windows GenericBluetooth Radio

The USB dongle isinserted after theTeleSteth™ Client islaunched

Close the TeleSteth™ Client andrelaunch

Stethoscope notpaired

Pair the stethoscope. See Section2.3 of this user manual titled, “Pairing& Connecting the Stethoscope to theTeleSteth™ Software”

Each uniqueStethoscope ID canonly be connected toone stethoscope

If your office has multiplestethoscopes, make sure you aretrying to connect to the correctStethoscope ID.

Excessivestethoscope motion

Hold the stethoscope with a steadyhand and lightly press against thepatient’s skin while auscultating. SeeSection 7.0 of this user manual titled,“Improving Sound Quality”.

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Problem Potential Cause SolutionUsers see a“BluetoothConnectionError” whenstreaming.

Poor Bluetoothreception. . This canbe caused by:1) Low battery in thestethoscope2) No line-of-sightbetween thestethoscope andthe dongle3) A user coveringthe stethoscopehead (i.e. theantenna) with his/herhand4) Other systemprocesses competingfor limited systemresources on thePC (e.g. WiFi, virusscanner, etc)5) Not running ondedicated hardware(e.g. using a VirtualMachine, Citrix,etc)

Use the external Bluetooth dongle.Ensure clear line of sight from thestethoscope chestpiece andBluetooth dongle. Use a USB elbowadaptor or a USB extender cable toimprove antenna transmission.

Cannotconnect toremote site

No internetconnection

Check the network connection andtry again

TeleSteth™ Server isunavailable

Server is in maintenance mode.Contact the IT department

For questions or concerns regarding to the 3M™ Littmann® TeleSteth™ OnlineAuscultation System or the 3M™ Littmann® Stethoscope Model 3200, please contactour customer service hotline at 1-800-228-3957, or visit www.Littmann.com to findyour local country 3M™ Littmann® Stethoscope website, view Frequency AskedQuestions, or send an email via the Contact Us page.

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3M, Littmann, StethAssist and TeleSteth are registered trademarks of 3M. Windowsis a registered trademark of Microsoft. Bluetooth is a registered trademark of theBluetooth SIG, Inc.

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