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OPERATION MANUAL

1. ssseeeeeseseeeeeeeee nennen eene sene nnne eene nns 40 REVIEWING AND EDITING HOLTER TESTS OVER THE NETWORK eeeee 42 PRS IES BUE DES ae eek eu buie dtes en ios AE bU Devas ee DEP NUN MU ED ae 43 EH Go To Table Of Contents Omark EZ Holter Operation Manual Installing IQmark Network Security Server NSS sesse sesse ees ee ee ee ee ee EE 43 I TEE uuo lb b qx 47 As QPERATIONS AT ACHANCOE iste sesse ei a a ee SE Ge Ee 47 B TROUBLESHOOTING GUIDE cccccccceccsceccsceccscecescecescscecesceceececescscesescucescesescecsesceses 48 Ce CU TON SUPPORT RON 49 Wa e E E E 49 Return Materials AuthorizatlOn eee 49 SDD ea ee GR EE DR oe AD oe EE EE DE De oe Ee EE oe AE A9 DNE CO E ERE 50 Go To Table Of Contents IQmark EZ Holter Operation Manual A Word of Thanks Thank you for purchasing the IQmark EZ Holter Midmark Diagnostics Group has used the latest microelectronic and computer software technology to develop a compact low maintenance and high quality Holter system Our goal 1s to enable healthcare professionals to provide quality and efficient patient care With that in mind our product is designed with intuitive layouts and features that will enable more physicians to conduct office based Holter tests which will result in more timely diagnoses and enhanced patient outcomes We believe you will
2. 21 Go To Table Of Contents Omark EZ Holter Operation Manual Format Important See Note following this table Delete ECG E E B il Full Report the current Holter report contains the complete continuous ECG waveforms or full disclosure On this report you can edit the beat classification view any part of the recorded ECG and more Summary Report the current Holter report does not contain the full disclosure You cannot edit this report except in the Interpretation Comments screen Any Sample Strip not saved in the full report format is lost Full Report format only Click to delete the original Holter ECG waveform full disclosure and any unsaved Sample Strips converting the report format from Full Report to Summary Report see Format above This action is irreversible A Summary Report cannot be converted to a Full Report Full Report format only Click to review details of the Holter recording and its full disclosure and to edit the analysis See Working with the Holter Program in Section III D Full Report format only Click to repeat the Holter scan on the original ECG recording saved in the IQmark Diagnostic Workstation You will not need the original Compact Flash Card The Holter Analysis dialog box appears from which you can Acquire amp Analyze with the same or different analysis settings The Re analyze function does not create a new Holter test but replaces th
3. g I y 2 e i N a i D e a 3 e ite 3t Lr re N a c 9 y a w y e c 0 m ui i y ad p toe oo a uH Bay w w J9 91 UO 285 A ui edols 1 T4 2 RB R 4 RB 4 b 4 eT3eIbE 6 1 6 1 d 4 ER T i 1 El e 4 R i R L q 1 1 rasse hle 4 4 Uu ee eee were rrr T eee ee 4 ee eee a eee eee eee oe eed ee eed ed eee eee eee ee ST Trend Screen a Lan Lad e o G wo 4 s a amp g o I uv 4 N Lee a N a e N WO i e Te N Holter ST James Dean ID 265 ST Tabular Screen 36 Go To Table Of Contents IQmark EZ Holter Operation Manual Viewing and Entering Interpretation Comments When you have reviewed the Holter analysis you may want to enter your interpretation or comments about the test Click Summary on the Holter Main Buttons Bar and select the Interpretation Comments tab Interpretation entered in the top box on this tab also appears in the Interpretation section at the bottom of the Analysis Summary tab Narrative Results and Comments in the lower box are generated automati
4. Under Analyzed Channels you can select one or more of the three available channels to analyze and select one of your selected channels as the primary channel By default all three channels are selected and Channel 1 is the primary channel A NOTE Atrial fibrillation A Fib analysis is not available in the IQmark EZ Holter Please contact our Customer Service for more information Patient Diary If the patient has written notes in his or her patient diary you should enter them in the Holter software On the Holter Analysis dialog box click the Patient Diary button to open the Patient Diary dialog box If the patient has pushed the event button on the 19 EH Go To Table Of Contents IQmark EZ Holter Operation Manual recorder during the recording the Holter software automatically tabulates each event as a Recorder Event Enter any times symptoms and comments as recorded on the patient s diary Once finished click Save to save your entries Click Close to return to the Holter Analysis dialog box Patient Diary Save Insert Row Clear Row Clear All Help Close Patient Diary Screen Completing the Holter Scan In the Holter Analysis dialog box click Acquire amp Analyze The Holter program acquires the ECG data recorded on the Compact Flash Card and analyzes Depending on the speed of your computer 1t will take about a minute for the Holter to complete the analysis The Holter reports are then p
5. editing here is generally not recommended as the Holter program does not automatically update all other sections of the Holter report to agree with these changes 37 EH J Back Go To Table Of Contents Omark EZ Holter Operation Manual Holter Summary Ezzy Holter ID 930 09 2929 DOB 09 18 1933 Recodring Time 07 25 2003 11 25 AM Analysis Results Analysis Summary Interpretation Comments Tabular Summary Cancel Zero Column ORS VE VPsair vRun SVE SV Pair SV Run Pause Bigem Trigem RonT STD NA 5 wae 80 2870 4943 4720 4724 4463 5152 5197 4645 5065 4988 5108 4989 5003 4201 3921 3993 3954 3847 3825 3842 4399 4580 4819 1768 ce e e e e cjojojoiloijojiojojojojojojojojolojoijojojojojjojo c oejojojojojojojojojojojojojojojojojojojojo jo OO OO cccccccccoccccccccccccdc OO OO ODOODODODODODODOODODODODOODODOD DOOD oo OODOODODODODODODOODODODODOODOODODOO ceo jro ceo rejrsjojojojoij jo ro3j s amp rojro o o Tabular Summary Screen Printing Reports Once the Holter test is completed you can print or print preview reports that were pre selected in Holter Settings Click Print on the Main Buttons Bar and click Print All Selected Pages or Preview All Selected Pages You can also choose to print any selected reports Click Print on the Main Buttons Bar and click Select Report Pages amp Print The Holter Settings dialog box appears Select or clear a
6. j Cancel IQmark Network Security Server Installation Completed lt Back 6 A new shortcut icon is added to the desktop You can double click it to start the IQmark Network Security Server Otherwise it will start automatically when the host computer is restarted or turned on the next time IGmark Network Security Server 7 The following screen indicates that the IQmark Network Security Server has started It also identifies the serial number and type of the Security key that is plugged into this computer the name of the computer and its IP Address If someone is reviewing or editing a Holter test on another computer on the network this screen indicates Current Connections as 1 one 44 Go To Table Of Contents IQmark EZ Holter Operation Manual IQmark Network Security Server E x The Security Server has started Server Status Security key type 4040 00007 EZ Holter Server Computer Name Holter PC Server IP Address 172 16 19 288 Current Connections 0 i Stop amp Exit Refresh Help IQmark Network Security Server You can minimize this screen by clicking on Minimize button Clicking the Stop amp Exit button on the IQmark Network Security Server prevents the other computer s from reviewing or editing the Holter reports over the network The first time you attempt to review or edit a Holter report from a different computer over the network the following
7. 118 bpm Avg 104 bpm Min 97 bpm Heart Rate Screen J Next Go To Table Of Contents IQmark EZ Holter Operation Manual Holter Data Review James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution RR Intervals All Beats RR Intervals N N Beats RR Intervals N V Beats Summary Beats Total 105216 Normal 99682 VE 5374 SVE 15 Pause D Quantity bpm ms 0 400 800 1200 1600 200 ms o 400 800 1200 1600 200 ms o 400 800 1200 1600 zooi 2V9 PR E HR 0 150 75 50 37 30 HR 0 150 75 50 37 30 HR 0 150 75 50 37 30 MaxHR 103 RR Ratio All Beats RR Ratio N N Beats RR Ratio N V Beats Min HR 54 Y Quantit 2 2 2 RR RR 1 RRG RR G 1 ST Settings RR Interval Ratio Screen Holter Data Review James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution 404 323 gt ST Settings Events Distribution Screen ST Analysis Results To view ST Trends or ST Tabular results click ST on the Holter Main Buttons Bar Then click the appropriate tab 35 Go To Table Of Contents IQmark EZ Holter Operation Manual 4 Indi e Iz S e 4 5 a amp
8. Flecainide T Inderal B lzordil g Metoprolol 10 M exiletine 11 Phenytoin 12 Pindalal 13 Procainamide 14 Propafenane 15 Prooranalal Figure 2 5 List Management General List Management The ECG Statements setting is not applicable to IQmark Digital Holter product To enter the names of doctors and technicians who use the Workstation select the User Names tab Click the Add button You can type in a user s name and define the user as a physician technician or both 10 Go To Table Of Contents IQmark EZ Holter Operation Manual Local Database List Management x General List Management ECG Statements User Names Double click on an item s test to edit that term Jason Smith RM Robert Wrest MD Tech Susan Terry Jones MD Tina May HM Figure 2 6 List Management User Names Click OK to close the List Management Utility Holter Settings You can change the default settings for Holter tests through the IQmark Workstation Configuration Settings screen or the Settings button inside the Holter program Both methods will provide you with similar options Click the Holter Settings button on the IQmark Workstation Configuration Settings screen to view or change the default settings ECG Strips The ECG Strips tab of the Holter Settings dialog box enables you to specify how you want to view or print ECG strips If RR Interval 1s checked each interval value in millisecond ms will appear on top of th
9. N A VENTRICULAR SUPRAVENTRICULAR Total Ectopics 5374 5 11 of all beats Total Ectopics lt 1 Isolated 5059 166 Interpolated Isolated Pair 67 Pair Bigeminy 55 167 VE beats Run D SVE beats Trigeminy 4 14 VE beats Longest Run 0 0 VE beats Fastest Longest N A Fastest N A Slowest ST SEGMENT OTHERS Pause gt 2 5 sec Minutes of depression Longest Minutes of elevation Average mm i 1 1 Length Depression Elevation Analysis Results Screen The layout of each EZ Holter screen 1s designed for ease of use You can access the major functions by clicking on Holter Main Buttons Bar at the bottom In the Summary Data Review or ST screen more information 1s available with the tabs indicated at the top of the screen Table 3 2 lists the functions you can view or access through the Holter Main Buttons Bar Table 3 2 Functions of the Holter Main Buttons Bar Tab or Submenu Functions Print Print Current Page Print the report s currently displayed on screen 23 Go To Table Of Contents Next Omark EZ Holter Operation Manual Preview Current Page Preview the report printout s currently displayed on screen Print Setup Set or change default printer settings Print All Selected Pages Print all reports selected in the report settings See Printing Reports later in this section Preview All Selected Preview all report printout s selected in the Pages repor
10. The following describes the functions of the buttons located in Page Scan MF Channel 1 F Channel 2 E M Channel 3 EE lt Page Up gt Page Down ik Auto Scan start il Settings Check or clear a channel box to show or hide the ECG for that channel in the page view By default only the primary channel ECG is shown Use the arrow buttons to increase or decrease the amplitude of the ECG by increments of 15 This adjustment affects printouts of the full disclosure only Click Page Up to display the previous page The ECG strip view closes Click Page Down to display the next page The ECG strip view closes Click Start to browse the ECG By default the full disclosure view is refreshed every three seconds To stop Auto Scan click the button again Auto Scan stops whenever the Page Scan screen is clicked and a diagnostic strip appears Resume the Auto Scan by clicking Start button again Click Settings to adjust the Direction of the scan and the Auto Scan Interval seconds 3l EH Go To Table Of Contents J Next Omark EZ Holter Operation Manual Ful Disclosure Click to print a full disclosure report The Print Full Disclosure dialog box appears By default only the primary channel is selected and the entire recording is set to print Optionally you can select Selected Hours and then check the hours you want to print EI Print Full Disclosure P x Channels To Print
11. dialog box will appear Enter the name or the IP address of the host computer where the Network Security Server is installed Then click Search Network to continue Search Security Key x Cannot find a Security Key dongle on this computer Search on the network by Computer Name C IP Address Status Please enter the server s Computer Name or its IP Address Search Network Cancel amp Close Help Search Security Key Dialog Box 45 EH Go To Table Of Contents Omark EZ Holter Operation Manual This page is intentionally left blank 46 Go To Table Of Contents J Next IQmark EZ Holter Operation Manual IV Appendix A Operations at a Glance A quick guide to using the IQmark EZ Holter with Print Reports After Analysis on a new patient 1 Obtain the recorded Compact Flash Card from the IQmark Digital Holter Recorder 2 Insert the Compact Flash Card into the Compact Flash Card Reader in the computer 3 Start the IQmark Diagnostic Workstation program 4 Choose New Patient from the opening screen For an established patient open the Patient List and search by the patient s last name or ID number The Patient Data screen appears 5 Enter as much information as you can on the Patient Data dialog box A patient s name or patient s ID number is required 6 Click on New Test on the Main Buttons Bar 7 Click the Holter button under Test Type Enter the technician n
12. of the screen The program automatically saves 3 strips from each category to print A NOTE When a test is converted to a Summary Report only the strips saved to print are retained All strips not saved for printing are discarded This does not alter the analysis result If Condensed Sample Strips Report is checked you can print up to 30 condensed strips per page If the check box is cleared all sample strips are printed in diagnostic size 25mm sec with a maximum of three strips per page P Back Go To Table Of Contents Omark EZ Holter Operation Manual Holter Data Review James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution Category List Saved Total Display ECG Current Strip High Heart Rate 3 20 AJ Strips Save to Print C Saved Strips Don t Print Instant Update peu EG l Add Comments iv Condensed Sample Strips Report Reject Current Strip Samples sorted by Severity No 1 of 20 103 bpm Iss lt lt sm E Sample Strips Screen Specific arrhythmia events are displayed in different colors You can print the sample strips in color if you are using a color printer and if the Print Color option is selected on the ECG Strips of the Holter Settings dialog box The diagnostic size ECG
13. strips will be printed on red grid You can also choose to display the category code above each beat by checking the Beat Annotation check box See ECG Strips under Holter Settings later in this section Beat Category Color Code Beat Annotation Normal beats Black N Ventricular beats Red V Supraventricular beats Blue S Pause beats Pink P Artifacts Dark yellow Under Current Strip Save to Print and Don t Print indicators show whether the displayed strip is saved You can choose to save or not to save to print by selecting one of these options If Instant Update is checked any single change made to the current displayed strip e g Save to Print Don t Print Add Comments or reclassification will be updated instantly and the next strip in the category will automatically be displayed If you need to make multiple changes to the current strip clear the Instant Update box Use the arrow buttons on the screen to move your view from strip to strip within the selected category 28 EH Go To Table Of Contents Omark EZ Holter Operation Manual Reject Current Strip is available only for the High Heart Rate and Low Heart Rate categories Use this button to quickly reject the current strip if it is incorrectly classified as High or Low Heart Rate probably due to excessive movement artifacts or low ECG amplitude Holter Data Review James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Samp
14. the Windows Taskbar through the following sequence Teel HE 48 Start gt Programs Midmark Diagnostics IQmark Configuration Or double click the following IQmark Configuration icon on the Desktop A l mark Configuration The following dialog box appears Most of these settings are not applicable to the IQmark Digital Holter e IOmark Workstation Configuration Settings x Institution Mame Midmark Medical Group Institution Address 3300 Fujita Street Torrance C 90505 Units i Serial Fort English C Metric Database Settings List Management Time Format 24 Hour Clock ECG Settings C 12 Hour Clock Date Format C DD MM YY MM DDAY C YY MM DD Line Frequency v 60Hz C 50Hz Holter Settings Spirometre Settings Stress Settings Default Help Default Fax Printer EE select Figure 2 2 IQmark Workstation Configuration Settings Complete the Institution Name and Institution Address boxes with information about your own medical practice The IQmark Digital Holter will print your institution name on the Analysis Summary cover page of the reports Enter a name that describes your practice or operation to enable other medical personnel to identify your reports You may choose between International metric and American English units of measurement which will only affect the patient data e g weight and height The IQmark Digital Holter
15. the flash card is contact inserted into the r r properl serted into the reader properly e Verify that the correct Flash Card is inserted in the Message appears after the Acquire Flash Card Reader amp Analyze button is clicked e ject and reinsert the Flash Card Can t successfully save raw The IQmark EZ Holter program cannot copy the raw ECG data ECG data file to the required location Message appears after the Acquire e Verify that the Brentwood Database Holter folder amp Analyze button is clicked exists Create the required folder or call our Customer Support Department All other operational problems Please refer to the online help by clicking the Help button on any screen Please refer to your IQmark Diagnostic Workstation Operation Manual for additional troubleshooting covering the IQmark Workstation For technical support information please see section Customer Support below 48 EH Go To Table Of Contents IQmark EZ Holter Operation Manual C Customer Support For immediate help diagnosing any problems with this product refer to the online help system or the Troubleshooting Guide Otherwise contact our Customer Service at 800 624 8950 Office hours are 6 30 AM to 4 30 PM Pacific Standard Time Warranty All products for Midmark Diagnostics Group are warranted to be free from manufacturing and material defects for 12 months from the date of purchase Any misuse or abuse of a Midm
16. Go To Table Of Contents OPERATION MANUAL Omark EZ Holter Version 8 0 AMIIBI ANS Diagnostics Group Part Number 3 100 1044 Revision 8 0 1B 62007 Brentwood Medical Technology Corp IQmark EZ Holter Operation Manual TABLE OF CONTENTS A WORDOPTIDLANEKS 1ictexeanveesivestevssassaesuvess EE OE HD eueE iii I GENERAL INFORMATION ccccccccccccccccccccccccccccccccccccccccccccccccccccccccccecs 1 D EE Procedure Nee ee eee ee eee ee 1 B NECESSARY COMPUTER SKILLS cccscsceccsceccsceccsceccccscccscesescecescesescscesescesescecesesceees 2 C SYSTEM COMPONENTS cccccsccsceccsceccsceccscecescscescececeececeececscscestecesescecescecscscesescesescecs 3 I INSTALLATION ENE N AE OE EE N EN ER EE N EN 5 A HARDWARE INSTALLATION ccccceccsceccscecccceccsceccscsceccscecescecescscescscesescesescesescecesesceses 5 Minimum Computer Requirements eeesessssssssssseeeeeeeeee eene nnne 9 sod Bio m N EN 6 B SOPDWABRINSTALDATION SS issie ee Ee Ge Ge ee Ge Ge Ge Ge Ge oe ee ed EG Se ee ee ee SG sei ed ee ces 7 Windows Taskball cccccececcccececcccccececececcscecececcececsccesuecsescesescsescnsesescsctcesuecs 7 Installdbton iD EE EE E ns Be ei ee ee DE ee ao 7 C CONFIGURING THE IQMARK EZ HOLTER ees ees sees see ee see ee ee ee ee ee ese ee ese ee ee ee ee ee ee ee ee 7 Database SetU S esse RE EE GR OR AG EENE EG ER ee RE ee 9 List Mana
17. Omark EZ Holter Operation Manual Previous Page Search Time Comment amp Save Save to print Print Current Strip Print Continuous Strips Display the previous page of the ECG strips The page size is determined by the length of the ECG strips in the current view z Page Up This button performs the same function Open the Search Time dialog box to search and view the ECG by time Set the label for the current ECG strip and save the ECG strip to the print queue for batch printing later Save the current ECG strip to the print queue for batch printing later Print the current ECG strip or current report Print continuous ECG strips You can print diagnostic size strips from 8 seconds 1 ECG strip to 96 seconds 12 ECG strips long Print up to 3 strips per page Viewing other results in Data Review Besides viewing the ECG strips you can view additional analysis information on the other Data Review tabs through graphs and tabulated results as shown below Click the Help button on each screen for a detailed description 34 Holter Data Review Wyatt Earp ID 123 95 3333 DOB 12 12 1922 Recodring Time 04 03 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution 24 Hour Scale Auto Scale Select Curves All Iv Maximum Iv Minimum Iv Average Maximum HR JR ANE Minimum HR Status Time 18 00 Max
18. Table Of Contents FOLDER MICROSOFT WINDOWS BASED COMPUTER MY COMPUTER IQmark EZ Holter COMPACT FLASH CARD COMPACT FLASH CARD READER COMPACT FLASH ADAPTER SHORTCUT ICON IQmark EZ Holter Operation Manual Folders which function like the drawers in a filing cabinet are used by Windows to organize files and applications The IQmark Workstation application resides in a folder named Brentwood located on your hard drive Any computer that runs on Microsoft Windows operating system The Midmark IQmark Digital ECG requires a personal computer that runs on Windows 2000 or XP platform for operation A Windows 95 98 Me 2000 NT or Windows XP icon that appears on the desktop in the form of a stylized computer Clicking My Computer allows you to explore your computer s disks printers Control Panels and other functions Midmark Diagnostics Group s medical diagnostic program for performing Holter analysis on a 24 hour ECG recorded from the IQmark Digital Holter Recorder The IQmark EZ Holter is operated through IQmark Workstation software application Also called CF memory card Used inside the IQmark Digital Holter Recorder to record and store the continuous raw ECG waveforms for Holter analysis An internal or external drive that reads the Compact Flash Card so that the recorded data can be retrieved for Holter analysis A sleeve like adapter that accepts a Compact Flash Card This adapter allows yo
19. acemaker ace Report Options v Print Reports After Analysis Report Settings Data Source Flash Card C File Browse ECG File Acquire amp Analyze Analysis Settings Cancel Patient Diary Help Holter Analysis Dialog Box Enter the recording start time and date This time is in 24 hour format 1f the recording was started at 1 00 p m enter 13 00 Use the right arrow key to move from the hour digits to the minute digits A NOTE Pacemaker analysis is not available in the IQmark EZ Holter Please contact our Customer Service for more information Verify that e The Print Reports After Analysis box is checked You can view or select the reports to be printed by clicking the Report Settings button e The recorded Holter Compact Flash Card is inserted into the Card Reader e The default printer is on and ready with enough paper for the report If the Full Disclosure Report is selected in the Report Settings you will need at least 24 sheets of paper 18 J Next Go To Table Of Contents IQmark EZ Holter Operation Manual Holter Settings x Reports General Reports To Print Arrhythmia Report Heart Rate Trend Arrhythmia Distribution RR Interval Ratio Report Narrative Comments v Tabular Summary Patient Events Diary ECG Strips To Print Diagnostic Sample Strips Sample Stip Options Condensed Sample Strips Patien
20. ame and other information as needed Then click OK 8 Enter the recording start time and date Check Print Reports After Analysis 9 Click Patient Diary to enter the patient s notes from his or her diary if available 10 Click the Acquire amp Analyze button to start the Holter analysis 11 Reports are automatically saved and printed 12 Click the Exit button to return to the Workstation opening screen 47 Go To Table Of Contents Omark EZ Holter Operation Manual B Troubleshooting Guide This Troubleshooting Guide provides a comprehensive list of solutions and recommendations to problems you might encounter with the IQmark EZ Holter Before calling Midmark Diagnostics Group for technical support please refer to the following table for help Error messages appear at the center or at the bottom right of your screen A NOTE For errors that occur during analysis or management of test files please refer to the Troubleshooting section in the IQmark Diagnostic Workstation Operation Manual Troubleshooting Guide Error Message or Problem Solution or Recommendation Can t analyze non Midmark The IQmark EZ Holter analyzes only ECG data format ECG files recorded from the IQmark Digital Holter Recorder M Please contact Customer Service for more information essage appears after the Acquire amp Analyze button is clicked Can t find Holter data please The Flash Card is not inserted or not making proper make sure
21. ark product voids all applicable warranties Return Materials Authorization To return any product for repair please obtain an RMA Return Materials Authorization from our Customer Support representative Clearly mark the number on all packaging containing the items to be returned and in any correspondence regarding the return Shipping Before shipping any unit to Midmark Diagnostics Group be certain that an RMA Return Materials Authorization number has been issued and that all guidelines regarding this authorization are followed We highly recommend that you follow all guidelines for the shipment of medical products set forth by the shipping company you choose If a question should arise regarding the appropriate method of shipment please feel free to ask when calling for your RMA number It is ultimately the responsibility of the customer when shipping a product to ensure that all packages and contents get to us safely Midmark Diagnostics Group will not assume responsibility for damage incurred by improper packaging shipment or product use Such actions will void all applicable warranties 49 J Back Go To Table Of Contents IQmark EZ Holter Operation Manual D Glossary ARCHIVING IQMARK DIAGNOSTIC WORKSTATION CLICK DATABASE DESKTOP DIALOG BOX ECG ELECTROCARDIOGRAM 50 Placing data into temporary storage where it cannot be damaged or altered Archived data such as Holter reports prepare
22. ast Name Hackings Date Of Birth 12 12 1961 mm dd yyyy Pen First Name Bill MI p Sex Male C Female View Data ID 121 32 4567 Race Caucasian Edit Smoking History Contact Info Risk Factors Vital Signs Medications History Diagnostic Reports Comments Format Vital Signs Weight 195 Ibs Temp 97 5 deg F Height 68 inches SpO2 29 BMI 29 6 BP 120 90 Pulse 82 BPM New Vital Signs Review Vital Signs Patient Data Screen Starting a New Holter Test When you have completed the patient data entries click New Test on the Main Buttons Bar The New Test dialog box appears New Test x Test Type 7 Technician Tina May RN na C ECG Requesting Physician Robert WestMD x S Indication C Spirometry LA C Stress New Test Dialog Box Select the Holter icon at the left of the dialog box Enter the names of the technician conducting the Holter scan and the reguesting physician in their respective boxes In the Indication box enter the symptomatic reason for performing the Holter test This information 1s optional If you have configured the list management for your practice you can select these entries from the lists 17 EH Go To Table Of Contents IQmark EZ Holter Operation Manual Click OK The Holter Analysis dialog box appears x Recording Start Time amp Date E 00 T 6 18 2003 v P
23. aved Holter test e CD ROM or DVD ROM drive e Intel Pentium class or compatible microprocessor with speed 800M Hz or faster e VGA display accommodating 800x600 1024x768 1280x1024 or higher resolution Minimum 256 colors 16 bit color recommended e 128 megabytes RAM for Windows 2000 XP 512 megabytes for Windows Vista e Microsoft compatible mouse e Keyboard e One Parallel Printer Port or Universal Serial Bus USB Port for the security key e One Universal Serial Bus USB port for the external Compact Flash Card Reader A NOTE The USB port is not required if the computer has a Compact Flash Card Reader installed or has a standard Flash Card Reader PCMCIA drive as do most laptop computers Go To Table Of Contents Omark EZ Holter Operation Manual Set Up l Remove the IQmark EZ Holter from its packaging and verify that you have the following items IQmark Diagnostic Workstation Installation CD IQmark Digital Holter Recorder with patient lead wires and pouch Compact Flash Card Holter USB Sentinel Security Key dongle see note below External USB Compact Flash Card Reader Compact Flash Adapter IQmark Diagnostic Workstation Operation Manual IQmark EZ Holter Operation Manual this manual IQmark Digital Holter Recorder Operation Service Manual Holter Hookup Kit Mouse pad A NOTE You will receive one of the following Sentinel Security Keys These are NOT flash drives Do NOT lose your
24. be pleased with the user friendly operation of our product and with your results As your partner in healthcare we look forward to working with you in the coming years as we develop even more sophisticated diagnostic technology for the cardiopulmonary field Your thoughts questions and comments about our product are welcomed Midmark Diagnostics Group PH 800 624 8950 www midmark com Caution Federal Law restricts this device to sale by or on the order of a physician in Go To Table Of Contents Omark EZ Holter Operation Manual Physician s Responsibility The diagnostic results provided by the Midmark IQmark Digital Holter are for the exclusive use of licensed physicians or personnel under their direct supervision The numerical and graphical results should be examined with respect to the patient s overall clinical condition recording preparation quality and general recorded data quality which can affect the accuracy of reported data Proper administration of the test is the physician s responsibility as is making a diagnosis obtaining expert opinions on the results and implementing the correct treatment if indicated Notice The information in this manual is subject to change without notice Midmark Diagnostics Group shall not be liable for technical or editorial omissions made herein nor for incidental or consequential damages resulting from the furnishing performance or use of this operation manual T
25. c at 05 05 04 SDANN 99 Maximum HR 103 bpm 582 msec at 16 16 08 RMSSD 46 Tachycardia 7120 bpm N A Triangular Index Bradycardia lt 40 bpm N A VENTRICULAR SUPRAVENTRICULAR Total Ectopics 5374 5 11 of all beats Total Ectopics lt 1 Isolated 166 Interpolated Isolated Parr Parr Bigeminy 167 VE beats Run D SVE beats Trigeminy 14 VE beats Longest Run 0 VE beats Fastest Longest Fastest Slowest Report Review Screen The Report Review screen displays the summary of a Holter analysis The table below explains the features of this screen Table 3 1 Features of the Holter Report Review Screen Technician Yes Displays the technician name entered in the New Test dialog box If blank type the name of the technician performing the Holter scan or select the name from the list Reviewed By Yes Enter or select the name of the physician who reviewed the Holter results mc Displays the date when the Reviewed By box is filled Date Of Displays the date of recording as entered in the Holter Recording Analysis dialog box Start Time Displays the time of recording as entered in the Holter Analysis dialog box Indication Displays the symptomatic reason for the ECG from the New For Test Test dialog box If blank type or select an indication Hours No Displays the length of the Holter recording calculated Scanned automatically Displays the scanned channels selected in Analysis Settings
26. cally by the Holter program You can edit them on this tab A NOTE Any changes you make in the Analysis Results screen are saved automatically when you exit the screen If you perform re analysis of the current Holter test any changes you have made in this screen will be lost Holter Summary Ezzy Holter ID 930 09 2929 DOB 09 18 1933 Recodring Time 07 25 2003 11 25 AM Analysis Results Analysis Summary Interpretation Comments Tabular Summary Interpretation cover page Save Cancel Clear Narrative Results Comments second page Save Cancel Clear The patient s Holter monitoring period was 23 hours and 11 minutes There were a total of 105216 QRS complexes detected The average heart rate was 73 BPM with a maximum heart rate of 103 BPM at 16 41 08 and a minimum heart rate of 54 BPM at 05 30 04 Tachycardia heart rate gt 120 BPM was noted 0 of the time Bradycardia heart rate lt 40 BPM was noted 0 of the time No Pauses exceeding 2 5 seconds were noted 5350 Ventricular ectopics which represented 5 08 of the total beat count were noted Yentricular ectopics Analysis Results Interpretation Comments Tab Viewing and Editing the Tabular Summary If your practice relies on hand counting or in extreme cases where hand counting is necessary you can edit the Tabular Summary to match your hand count results only the numerical values displayed in black can be changed However
27. checkbox only affects the printout if a color printer is used A NOTES The Show Normal Templates checkbox is only available in the IQmark Advanced Holter Sample Strips On this tab you can set the maximum number of sample strips up to 9 per category for printing and select to sort Sample ECG strips by time or severity A NOTES 12 The High Heart Rate Low Heart Rate and ST Segment Sample Strips will only be sorted by severity EH Go To Table Of Contents IQmark EZ Holter Operation Manual Holter Settings l x OT Analysis Heart Rate Variability Pacemaker ECG Strips Sample Strips Repots Miscellaneous Sample Strips Report Strips printed per category 0 9 B Sort Sample ECG strips by Time C Severity Note 1 The Holter software will automatically save sample strips into the print queue for printing according to the number and the sorting method specified above 2 Changing those settings will make the Holter software reset saved sample strips Cancel Apply Sample Strips Settings Reports The Reports tab of the Holter Settings dialog box enables you to select the default reports for printing Holter Settings x OT Analysis Heart Rate Variablity Pacemaker ECG Strips Sample Strips Reports Miscellaneous General Reports To Print M Analysis Summary J Arrhythmia Report Narrative Comments Heart Rate Trend v Tabular Summary Arrhythmia Distribu
28. d through the IQmark Workstation can be retrieved at a later date for review Only Holter reports in Summary Report format can be archived The name of the software application you install on your IBM compatible computer in order to use the Midmark IQmark EZ Holter Refer to the IQmark Diagnostic Workstation operation manual In this manual Click refers to pressing the left mouse button once quickly and firmly Double click refers to pressing the button twice in rapid succession and is generally used to start programs Right click refers to pressing the right mouse button A collection of data arranged in methodically organized categories In this manual the term refers to the collection of Holter reports that the IQmark EZ Holter stores on your hard drive The background image that appears on your computer screen behind the application window s An onscreen form you complete to provide the IQmark Workstation with information needed to accomplish tasks an example is the Holter Settings dialog box See electrocardiogram A graphic recording that displays the electrical activities of the heart Promotes the detection of abnormalities in the transmission of the cardiac impulse through the heart muscle and serves as an important aid in the diagnosis of heart ailments During an electrocardiogram the heart s electrical impulses are typically measured through electrodes placed on the chest and limbs J Next Go To
29. dministrator if you do not have this authority e Close all Windows programs before installing this software Do not interrupt the installation program while it is running The installation should take less than five minutes Windows Taskbar The IQmark application 1s designed to run as a full screen program For best results the Windows Taskbar should not be displayed in order to provide maximum display area Place the mouse pointer on the blank portion of the Taskbar on the bottom of the screen then right click and select Properties Ensure Always on top is NOT checked Installation Steps 1 Insert the Installation CD into the CD ROM or the DVD ROM drive The installation starts automatically If the installation does not start automatically double click My Computer on the desktop and double click the CD ROM icon to start 2 Follow the instructions on the screen For detailed installation setup and detailed operation instructions please refer to the IQmark Diagnostic Workstation Operation Manual C Configuring the IQmark EZ Holter Through the IQmark Configuration program you can customize the IQmark Diagnostic Workstation and the IQmark EZ Holter for your operation If you are using the database on your local and network computers the configuration program also enables you to set your default database EH Go To Table Of Contents IQmark EZ Holter Operation Manual The configuration program can be accessed from
30. e Compact Flash Adapter is required on any computer that has a standard Flash Card Reader installed Windows Recorded Compact Laptop or Notebook Compact Flash Flash P Com uter Compatible Printer Card Adapter Figure 1 2 Typical Use of the Compact Flash Adapter with an IQmark Digital Holter System J Next Go To Table Of Contents Omark EZ Holter Operation Manual This page is intentionally left blank Go To Table Of Contents IQmark EZ Holter Operation Manual II Installation A NOTE Please give us a call before you install and set up your IQmark EZ Holter system Computers today are more complex then ever They come with wide variations of hardware and software options making your computer almost unique We want to make sure that your system is installed and configured as quickly and easily as possible Please call 1 800 624 8950 and our technical support will make sure your system is up and running in no time A Hardware Installation The IQmark EZ Holter is a 32 bit Windows based medical software program For successful installation and use of the EZ Holter system make sure that your computer meets the minimum requirements and follow the installation instructions carefully Minimum Computer Requirements e Microsoft Windows based PC running Windows 2000 Windows XP or Windows Vista e Hard disk with at least 500 megabytes of available free space for the program and additional 40 megabytes for each s
31. e ECG strip between every two RR If Heart Rate is checked an instantaneous heart rate value in BPM will appear on top of the ECG strip between every two RR The Grid checkbox only affects the gridlines on display Sample strip printouts will always have gridlines printed If Beat Annotation is checked a letter code will appear above each QRS complex indicating its classification If you have a color printer and the Print Color box is checked the diagnostic ECG strips will be printed with red grid and all ECG beats will be printed with the following designated color codes 11 EH J Back Go To Table Of Contents Omark EZ Holter Operation Manual Beat Category Display Color Beat Annotation Normal beats Black N Ventricular beats Red V Supraventricular beats Blue S Pause beats Pink P Artifacts Dark yellow T xi QT Analysis Heart Rate Variability Pacemaker ECG Strips Sample Strips Reports Miscellaneous Recording Time amp Date ECG Strips M RR interval v Grid Heart Rate BeatAnnotation Print Color Channel s to Display v Channel 1 v Channel 2 MV Channel 3 r Gain Channel 1 I MM 6 1X o Channel 2 E 6 1x C 2X Channel 3 aoe GE 1X es Polarity Channel 1 Normal Invert Channel 2 Normal Invert Channel 3 Normal C Invert Show Normal Templates Never show me the Right Click prompt Cancel ECG Strips Settings Dialog Box Print Color
32. e host computer and the NSS software must be started before you access the Holter software to edit or review Holter reports over the network Database Server Security Key Typical network configuration with IQmark Digital Holter on the Host PC Installing IQmark Network Security Server NSS 1 Insert the IQmark Diagnostic Workstation installation CD into the CD ROM or the DVD ROM drive of the computer that acquires the Holter tests 2 Cancel the auto start installation process 3 Using Windows Explorer navigate to the CD DVD drive and locate the folder NetworkSecurityServer 4 Open the folder and double click on the file NSSetup exe The following screen appears Click Next to install the IQmark Network Security Server 43 J Next Go To Table Of Contents Next IQmark EZ Holter Operation Manual IQmark Network Security Server InstallShield Wizard a x Welcome to the InstallShield Wizard for Qmark Network Security Server Back The InstallShield Wizard will install mark Network Security Server on your computer To continue click Next E Cancel IQmark Network Security Server Installation 5 The next screen will be displayed when the installation is complete Click Finish IQmark Network Security Server InstallShield Wizard j InstallShield Wizard Complete The InstallShield Wizard has successfully installed IGrmark Network Security Server Click Finish to exit the wizard
33. e previous analysis All previously edited information is lost You can use this feature to return to the original unedited analysis Summary Report format only In Summary Report format the Review button replaces the Delete ECG Edit and Re analyze buttons Click the Review button to view the Holter results A NOTE An average full report occupies about 35 megabytes of hard disk space A Summary Report takes up about two megabytes The total number of Holter reports you can store depends on the amount of hard disk space available on your computer 27 EH Go To Table Of Contents Next IQmark EZ Holter Operation Manual D Reviewing And Editing Holter Tests Working with the Holter Program The following Analysis Results screen appears after you click on the Edit button on the Report Review screen amp NOTE fyou did not select Print Reports After Analysis at the beginning of the Holter scan the program will take you directly to this screen after the Holter analysis is completed Holter Summary James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Analysis Results Analysis Summary Interpretation Comments Tabular Summary HEART RATE Total Beats 105216 HEART RATE VARIABILITY Average HR 73 bpm 821 msec SDNN Minimum HR 54 bpm 1111 msec at 05 05 04 SDANN Maximum HR 103 bpm 582 msec at 16 16 08 RMSSD Tachycardia 7120 bpm N A Triangular Index Bradycardia lt 40 bpm
34. his document contains proprietary information protected by copyright No part of this document may be photocopied or reproduced in any form without prior written consent from Midmark Diagnostics Group IQmark is a registered trademark of Midmark Windows is a registered trademark of Microsoft Corporation Pentium is a registered trademark of Intel Corporation 1V J Next Go To Table Of Contents Next IQmark EZ Holter Operation Manual J Back I General Information A Description The IQmark Digital Holter Recorder The IQmark EZ Holter is seamlessly integrated with the IQmark Diagnostic Workstation which is the portal to all of Midmark Diagnostics Group s medical diagnostic utilities including ECG Spirometry Stress and Vital Signs It is designed to scan 24 hours of ECG waveform digitally stored on a Compact Flash Card by the IQmark Digital Holter Recorder and to produce an analytical report on arrhythmic cardiac activity It is a computer based medical diagnostic instrument designed for Microsoft Windows operating systems The IQmark EZ Holter is a true 32 bit Windows program and it runs natively on Windows 2000 and Windows XP The IQmark EZ Holter is intuitive and can be operated with minimal training After the patient s demographics and recording information are entered the program can scan the recorded ECG and generate a report automatically with minimum operator intervention Holter monitoring is perf
35. iary entry Click again to insert more rows When you enter a time in the Time column the corresponding ECG strip is displayed When you have finished making diary entries click Save before you open a different screen 26 J Back Go To Table Of Contents Next IQmark EZ Holter Operation Manual A NOTE Time entered must be in 24 hour format Enter 0945 for 09 45 00 in the morning or 132522 for 13 25 22 or 1 25 22 in the afternoon Holter Data Review James Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution EN 15 14 Recorder Event Unknown 2 13 18 52 Recorder Event 7 Unknown 3 419 12 18 Eating dinner M ain 000434 Wetching TV Bornes lt Lo le E ou WM i dt MED EE d Making Patient Diary Entries in the Data Review Screen Viewing and Editing Sample Strips Select the Sample Strips tab of the Data Review screen see Sample Strips Screen below You can select to view any category in the Category List The numbers in the right column indicate the number of saved strips and total number of beats or runs in each category except for High Heart Rate Low Heart Rate and ST Segment categories which show a maximum of 20 strips Under Display ECG select whether to display all strips or only the saved strips in the selected category displayed at the bottom
36. key Please call Customer Service 1 800 624 8950 if you have any questions about the Security key v Fig 2 0 Holter Sentinel Security Keys If the computer does not have a standard Flash Card PCMCIA Reader or a Compact Flash Card Reader install the external USB Compact Flash Card Reader according to the installation instructions included Unpack the Sentinel Security Key dongle and connect it directly to an USB port of the computer v pow ex Fig 2 1 Example of USB ports on a computer USB Ports J Back Go To Table Of Contents IQmark EZ Holter Operation Manual B Software Installation The IQmark Diagnostic Workstation installation CD includes software for both the IQmark EZ Holter and the IQmark Diagnostic Workstation amp NOTES e Ifyou already have IQmark Diagnostic Workstation installed on your computer and you are now either upgrading or adding a new IQmark product please skip this section and refer to the IQmark Diagnostic Workstation Operation Manual for detailed information on the installation e Ifyou are using Windows 2000 Windows XP or Windows Vista you will need Administrator privileges to install upgrade or remove any Windows software Once the IQmark Diagnostic Workstation software is installed the installation program gives out the read write permission for the installed Brentwood folder to all users in the local machine Please contact your network a
37. l ST Tabular View and edit heart rate and ST statistics in an hourly breakdown Settings Recording Time amp Date Displays the recording start time and date of the See Holter Holter Settings in You can correct the time or date of the recording Section II C if needed ECG Strips View and print RR Interval heart rate grid and beat annotation in color Select channel s to display Select between 1 2X 1X or 2X gain for each channel Select polarity for each channel Disable the right click prompt By default the right click prompt appears when the mouse is moved over any ECG strips Sample Strips Set maximum number of sample strips per category for printing Sort Sample ECG strips by time or severity Reports Select and set various reports to print If you checked the Print Reports After Analysis option in the Holter Analysis Dialog box selected reports are printed See Printing Reports later in this section Miscellaneous Select to print ST and Heart Rate Variability summary results on Cover Page Report Multiple Topics View and print help on various screen topics This 1s a useful tool that explains the features of the screen you are viewing Exit Exit the Holter program and return to IQmark Workstation Entering Patient Events Diary To enter or update patient diary entries click Data Review on the Main Buttons Bar then select the Patient Events Diary tab Click Insert to insert a blank row for each d
38. le Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution Category List Saved Total r Display ECG r Current Strip All Strips Save to Print C Saved Strips C Dont Print Instant Update Print Options AP Carmen Condensed Sample Strips Report Reject Current Strip Samples sorted by Time No 1 of 4893 80 bpm B IPJ aaam Color Coded Sample Strips To reclassify an arrhythmia on the display double click the QRS complex of the beat you want to change The Beat Activity dialog box enables you to reclassify the beat to VE SVE Pause Normal or Artifact The entire Holter report is updated automatically Beat Activity E xj Reclassify Select one of following Categories C VE Ventricular Ectopic SVE Supraventricular Ectopic C Asystole Pause Nomal C Artifact Cancel Help Beat Activity Dialog Box 29 EH Go To Table Of Contents Next Omark EZ Holter Operation Manual Viewing Full Disclosure in Page can The Page Scan tab enables you to review the full disclosure of the Holter recording By default the screen shows the primary channel with 30 seconds per line but you can adjust the density from the menu that appears when you right click the strip See Using the Right Click Menu Options later in this section mes Dean ID 265 969 6699 DOB 11 25 1944 Recodri
39. lick prompt Help Holter Settings ECG Strips Dialog Box EN Go To Table Of Contents IQmark EZ Holter Operation Manual Reports For Jeannie Scotland a E siel ECG RR Variability Holter Spirometry Vitals 1 02 12 03 17 13 40 Report 1 of 2 Technician Tina May RN Date Of Recording 02 11 03 Hours Scanned 23 11 Reviewed By R Patterson MD Patterson MD Start Time 10 00 00 Channels l A S Review Date 02 14 03 Indication For Test Palpitation E Format Summary Report Review Details HEART RATE Total Beats 105216 HEART RATE VARIABILITY Average HR 73 bpm 821 msec SDNN Minimum HR 54 bpm 1111 msec at 04 05 04 SDANN Maximum HR 103 bpm 582 msec at 15 16 08 RMSSD Tachycardia 7120 bpm N A Triangular Index Bradycardia lt 40 bpm N A VENTRICULAR SUPRAVENTRICULAR Total Ectopics 5374 5 11 of all beats Total Ectopics Isolated 166 Interpolated Isolated Pair Bigeminy 167 VE beats D SVE beats Trigeminy 14 VE beats Longest Run 0 VE beats Fastest Longest Fastest Slowest Summary Report Format Through the Workstation you can archive any Holter test and save it in a separate file whether it is in full or summary report format To archive the Holter report click the File button then select Save Selected Reports To File Archive You will be given an option to select Report Only without full disclosure or Archive ECG with full discl
40. n sinus beats without a compensatory pause Isolated ventricular beats Two successive VE beats Three or more successive VE beats No detected beat occurs for an R R interval that exceeds the threshold value Bigeminy pattern for at least 6 beats Trigeminy pattern for at least 9 beats Isolated premature supraventricular beats Two successive premature SVE beats VE within QT of a normal beat
41. ng Time 06 18 2003 11 00 Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution iv Channel 1 m EF Channel 2 isl an Channel 3 nl Auto Scan Start Settings gt Page Down Full Disclosure Page Scan Screen As you move the mouse a redline cursor shows your current position in the Page Scan screen When you click on the screen a diagnostic ECG strip appears either at the top or bottom of the display depending on where you click A green rectangle in the page view indicates which 8 second period is being displayed 30 Go To Table Of Contents IQmark EZ Holter Operation Manual mes Dean ID 265 969 6699 DOB 11 25 1944 Recodring Time 06 18 2003 11 00 ELE TES P i s EE PETES ANASANAT Sample Strips Page Scan Patient Events Diary Heart Rate RR Interval Ratio Events Distribution a T SEE EE EG EE EE Semel amp r ET a s HE RE TREE HU G E M Channel 2 d X Channel 3 a Auto Scan Start E BOER Settings QOIS TVAE TUBAE ERA RSAURBRREEEES i yy LL se ny oe 7 1 492 804 648 648 Gt CUPS peace rome VU i 695 p44 i 1 acon eee Se zs Boca E aud s i zzzi laat sed AE REE EA RA EE EES o EE AA Ed i i 1 i i 1 i i i i 1 i 1 i i i i i i D i i i i 1 ECG Strip View on the Page Scan
42. ny reports as desired click OK and the selected reports will be printed A NOTE 38 These are the same report selections for the automatic Print Reports After Analysis function If you made any changes in this setting remember to readjust the selections to reflect your original report preferences after you have printed the report 1 ow or oo ol oo o o o ai ceo c eojjojoicojojojoj oij ojoc o Ioioioi 1o c OO DO cccccccccoccccccococccz ccc 0 ol Seel e c2 Lem Lem c ce co EN m dee IS IS ER ER ER LS IR LIE CO CO C3 LL ww ee EE EE EF WX io a re co e oljo ctc c ES rc EH Go To Table Of Contents IQmark EZ Holter Operation Manual Holter Settings j x Reports General Reports To Print O S v Analysis Summary Arrhythmia Report Narrative Comments Heart Rate Trend v Tabular Summary Arrhythmia Distribution Patient Events Diary RR Interval Ratio Report ECG Strips To Print Sample Strip Jptiaris Diagnostic Sample Strips Condensed Sample Strips Patient Event Strips Full Disclosure Report First Ful Hour ECG Advanced Reports To Print ST Trend HRV Summary ST Tabular Report Time Domain Analysis GT Interval Trend Time Domain Tabular GT Tabular Report Frequency Analysis Pacemaker Reports T
43. o Print Print All Saved Sample Strips Pacemaker Tabular Report Print Selected Sample Strips Sample Stip Options Select All Clear All Help Cancel Holter Settings Reports Selection Dialog Box Under ECG Strips To Print if the Diagnostic Sample Strips is checked the Sample otrip Options button is available for selecting categories of sample strips for printing See the Sample Strip Options dialog box below ECG Strips To Print v Diagnostic Sample Strips Sampie strip options i x Print Sample Strips from selected categories IV High Heart Rate 3 v Low Heart Rate 3 ST Segment 0 IV VE Isolated 3 v WE Interpolated 3 v VE Pair 3 VE Run 0 v VE Bigeminy 3 v VE Trigeminy 3 Iv SVE 3 SVE Pair 0 SVE Aun 0 Asystole Pause 0 I RonT D Operator Selected 0 NOTE Above selections only affect the next printing job will not be saved for other Holter tests i Cancel Clear All Select All Help Sample Strip Options Dialog Box Correcting The Time and Date of the Holter Recording In the event that you need to change the Recording Time and Date of the Holter test first open the desired test Click Settings button on the Holter Main Buttons Bar Correct the Recording Time and Date as necessary Changing the Recording Time and Date does not reanalyze the Holter All edited results are retained and adjusted appropriately acco
44. oie us se use DEO 9 Foelie Ellie See Ee ei ee He EE De ere eee eee 11 IL OPERATION OO 15 EE PORT ce 15 B BEFORE STARTING A HOLTER SCAN ee ee ee ee ee ee ee ee ee ee ee ee ee ee ee ee ee 15 C PERFORMING A NEW HOLTER SCAN WITH AUTOMATIC PRINT REPORTS AFTER ANALYSIS 16 D Br DID Hi Die ERA see ee S ee ee said Ge ee epee 16 Enter Paucnt DA ao rete dada doe EE EdaUE 17 Starting a New Holter Test ss se see ee de ee ee ee ee ee ee EE ee ee ee ee 17 Completing he Holter SCAN icc ans SEE ed Re EE De Se Se AE De ed RO s Abus oe 20 REVIEWING AND EDITING HOLTER TESTS uses sesse esse esse sedes see sees es ee ee ee ede ee ee ee ede ee ee 23 Working with the Holter Program sesse sees ees sees see ee ee ee ee ed ee ee ee ee EE ee ee 23 Entering Patient Events Diary sesse sesse see ee ee ee ee ee ee ee ee RR RE ee ee ee ee ee ee 26 Viewing and Editing Sample Strips eise sesse sesse EE ee ee ee Re ee ee ee ee EE 2 Viewing Full Disclosure in Page SCAN ss sesse sees ee ee ee ee ee ee ee RE EE 30 Viewing other results in Data RevieW ssesssseeenssssssseserrrssssssseeeeresssssseeeeees 34 54 Analysts ResUl S s sesse Ee RR AE Ge GENRE Eg ER SEA OR AG GR be DE 35 Viewing and Entering Interpretation Commaeents sesse sesse ee ee ee 37 PANS Kers se GE ee D geen 38 Correcting The Time and Date of the Holter Recording 39 Summary Report Format
45. on is to get started with a new Holter scan quickly and obtain a standard Holter report printout with minimal involvement in the various screens and functions Starting the Program Insert the Compact Flash Card from the Digital Holter Recorder into the Compact Flash Card Reader Use a Compact Flash Adapter if necessary see Fig 1 2 Open the IQmark Diagnostic Workstation by double clicking on the IQmark Workstation icon on your desktop I mark Workstation You can also start the IQmark Diagnostic Workstation program from the Windows Taskbar through the following sequence A Start Programs Midmark Diagnostics IQmark Diagnostic Workstation The IQmark Diagnostic Workstation opening screen appears Click the New Patient button mem ore VATI PAN Ed Ed Eed ctm Diagnostic Workstation New Patient Register a new patient 4 STAT ECG Patient List Search the patient database IQmark Products Available Configuration Database Local MS Access Digital ECG Digital Holter Help Digital Spirometry Digital Stress Digital VSM Return To Windows Institution Midmark Diagnostics Group IQmark Diagnostic Workstation Opening Screen 16 EH Go To Table Of Contents IQmark EZ Holter Operation Manual Entering Patient Data In the Patient Data screen enter all necessary information regarding the patient A name or an ID is required to start a Holter test ala xi L
46. ormed for mean heart rate minimum and maximum heart rates isolated premature arrhythmia interpolated ventricular arrhythmia VE pairs VE Pairs runs of three or more VEs VE Runs premature supraventricular isolated ectopic beats SVE coupled SVEs SV Pairs supraventricular runs of three or more SVEs SV Runs pause RonT bigeminy trigeminy and ST segment depressions and elevations for channels 1 2 and 3 Color coded beat identification enhances the operator s ability to scrutinize and validate the computer analysis of the Holter test Important values are presented in tables and graphics for easy overview Go To Table Of Contents IQmark EZ Holter Operation Manual Together with the IQmark Diagnostic Workstation the IQmark EZ Holter makes it easy to scan a Holter recording produce a report archive results for future reference and share them with colleagues via networks or e mail A NOTE The IQmark EZ Holter system is designed to scan only ECG data recorded with the IQmark Digital Holter Recorder Please refer to the Operation Service Manual of the IQmark Digital Holter Recorder for detailed operation patient preparation hookup and maintenance instructions B Necessary Computer Skills This manual assumes that you are already capable of using Microsoft Windows based applications that you have some understanding of how a PC works and that you are familiar with the basic operations of Microsoft Windows If
47. osure The Report Only option will archive the selected report in summary report format While you have full editing printing and viewing options with the full report some operations are not available with the summary report format Table 3 3 lists those operations Table 3 3 Operations Restricted in Summary Report Format Tabs Submenu Remark Tabular Summary No editing available Data Review Sample Strips View only strips that have been saved to print By default only 3 sample strips from each category are saved Others are discarded Page Scan Not available No full disclosure printing Patient Diary User No additional entry Events Saved event strips are retained 4 EH Go To Table Of Contents Omark EZ Holter Operation Manual Heart Rate Only the first High Heart Rate strip is displayed No other strips are available from the Heart Rate Trend screen ST ST Trend Only the first ST Segment sample strip 1s displayed No other ECG strips are available when you click in the ST Trend graph ST Tabular No editing available Settings ECG Strips Recording Time and Date cannot be changed Sample Strips Settings disabled Reports Arrhythmia Report Full Disclosure Report and First Full Hour ECG report are not available E Reviewing And Editing Holter Tests Over The Network If the computer that scans the Holter test is on a Local Area Network LAN you can review or edit the Holter tests from an
48. other computer on the same network To set up for Holter network reviewing and editing you must 1 Install the IQmark Network Security Server NSS on the host computer that scans the Holter tests Instructions follow 2 Configure the other computers to access the database on the host computer that scans the Holter test or on the central network database Please refer to the IQmark Diagnostic Workstation Operation Manual on Working with Peer to Peer Networks ANOTE Acquire and analyze a new Holter test or Re analyze an exiting Holter test can only be performed on the host computer that has the security key A NOTE Midmark Diagnostics Group wants to make sure that your system is installed and configured as quickly and easily as possible If you have any problem with these instructions please call 1 800 624 8950 and our technical support will make sure your system is set up and running in no time 42 EH J Back Go To Table Of Contents IQmark EZ Holter Operation Manual Requirements 1 Windows network using TCP IP protocol The Network Security Server supports only Windows platforms Windows 2000 or Windows XP On Windows 2000 and Windows XP both Home edition and Professional edition systems TCP IP is installed by default 2 AnIQmark Digital Holter Security Key dongle which comes with the IQmark EZ Holter The Holter security key must be connected to the host computer that acquires Holter tests 3 Th
49. r Service for more information Save sample strips for printing Choose condensed or diagnostic sized printouts Page Scan View the original continuous ECG waveforms Note full disclosure Not available if the report Select channel s to view is converted to a Summary Select Auto Scan or manual scan Report format Set Auto Scan direction and interval Print all or selected hours of Full Disclosure Adjust view to 8 seconds per line 30 seconds per line 60 seconds per line or 120 seconds per line Search a time to view Print Current Strip Print Continuous Strips of 8 to 96 seconds Patient Events Diary View and edit a diary of patient recorded events Heart Rate View heart rate trends maximum minimum and average over the entire recording View an 8 second strip of the maximum and minimum heart rate RR Interval Ratio View various beat quantity vs Heart Rate RR intervals and beat quantity vs RR interval ratio histograms These graphs present the distribution of heart rate either by the RR intervals ms or by RRG RR G 1 ratio over the recorded period Events Distribution View hourly bar charts of various events ST ST Trend View average heart rate ST level and ST slope trends over the entire recording Select which channel to view Click on trend graphs to view specific ECG sample strips 23 EH J Back Go To Table Of Contents Next Omark EZ Holter Operation Manua
50. rding to the new recording time Any entry in the Interpretation field will remain as before 39 EH Back Go To Table Of Contents IQmark EZ Holter Operation Manual A NOTE Summary Report Format Depending on the number of arrhythmic events an average 24 hour Holter Full Report format requires about 35 megabytes of hard disk space A Summary Report format on the other hand requires about two megabytes You can manually convert a full Holter report to a summary Holter report format by clicking the Delete ECG button in the IQmark Diagnostic Workstation when viewing the Holter report A NOTE 40 However any changes made in the Narrative Results Comments box will be discarded as the Holter software will regenerate the Narrative Results Converting to a Summary Report format deletes the full disclosure or the 24 hours of recorded ECG for that Holter test This action is not reversible Holter Settings E X ECG Strips Sample Strips Reports Recording Time amp Date 11 00 6 18 2003 ECG Strips v RR interval Grid Heart Rate BeatAnnotation v Print Color Channels to Display MV Channel 1 v Channel 2 v Channel 3 Gain Channel 1 EM 1x I M Channel 2 1 GE 1X I N Channel 3 C 1 2X 8 1X I M Polarity Channel 1 Normal C nvert Channel 2 Normal C Invert Channel 3 Normal C Invert Never show me the Right C
51. rinted automatically Printing time varies with the type of printer you are using the type of reports you select and the Holter analysis results You have now completed the Holter scan for your patient The IQmark Diagnostic Workstation automatically saves the patient information the Holter analysis results and the complete full disclosure in your computer and returns you to the Report Review screen shown below From this screen you can choose to e Perform another Holter scan for a different patient by going to the Patient List e View another ECG RR Variability Spirometry Stress or Vitals test on the same patient by clicking the appropriate tab e Return to the opening screen by clicking the Exit button e Review and edit the Holter results by clicking the Edit button See Working with the Holter Program in Section III D 20 EH Go To Table Of Contents Next IQmark EZ Holter Operation Manual J Back 5 Reports For James Dean l E i amp l x ECG RR Variability Holter Spirometry Vitals E 06 19 03 08 29 14 Report 1 of 1 Technician Tina May RN Date Of Recording 06 18 03 Hours Scanned 28 41 Reviewed By Start Time 11 00 00 Channels UN ME Review Date Indication For Test Chest pain Format Full Report Delete ECG Edit Re analyze HEART RATE Total Beats 105216 HEART RATE VARIABILITY Average HR 73 bpm 821 msec SDNN 111 Minimum HR 54 bpm 1111 mse
52. rk for instance a T1 network Holter Settings x QT Analysis Heart Rate Variability Pacemaker ECG Strips Sample Stips Reports Miscellaneous r Cover Page Report Analysis Summary v Print ST Summary v Print Heart Rate Variability General Copy raw data to local drive for quick editing This option is only recommended when you run Holter across a low bandwidth network e g a T1 line Holter Settings Miscellaneous Tab OT Analysis amp NOTES This option is only applicable to the IQmark Advanced Holter Heart Rate Variability amp NOTES This option is only applicable to the IQmark Advanced Holter Pacemaker A NOTES This option is only applicable to the IQmark Advanced Holter with Pacemaker Analysis option 14 J Next Go To Table Of Contents IQmark EZ Holter Operation Manual III Operation A Purpose This section is written to help you get started and become familiar with the IQmark EZ Holter system While this manual describes features of the IQmark EZ Holter in the operational sequence that most new operators will follow you are not restricted to following this particular sequence Many of the features are interconnected and can be accessed from more than one screen The Holter Main Buttons Bar appears at the bottom of each screen with shortcut buttons to other screens On each screen there may be tabs and buttons you can use to access different function
53. s Because of the extensive list of the Holter features and the flexibility of the program not every possibility 1s described here A more comprehensive explanation of the features and functionalities of each screen are available through the online help system installed within the program Once you are familiar with the basic operation of this product you can operate the Holter program in different ways to meet different purposes Of course there are certain sequences that you must follow such as entering a patient s medical data before performing the Holter scan Overall we believe that you will find this program to be both user friendly and flexible For your convenience we have included a condensed guide to operating the IQmark EZ Holter with new patients in the Appendix under Operations at a Glance in Section IV A B Before Starting A Holter Scan For instructions on preparing a patient and on operating the recorder please refer to the Operation Service Manual of the IQmark Digital Holter Recorder part 3 100 1045 When the patient returns to your office remove the Compact Flash Card from the recorder and insert it into the Compact Flash Card Reader for the EZ Holter to acquire and analyze the data see Figures 1 1 and 1 2 in section I C 15 J Next Go To Table Of Contents Omark EZ Holter Operation Manual C Performing A New Holter Scan With Automatic Print Reports After Analysis Follow this secti
54. selected location is displayed in parenthesis below the Path box List Management The List Management button on the configuration screen Fig 2 2 enables you to add or customize medications history statements race categories and ECG Holter indications You can also enter the names of the doctors and technicians using the Workstation Once these items are entered you can later select them from the appropriate lists in the test without having to retype them Click List Management in the configuration screen Fig 2 2 and choose to configure the lists for your local database or network database If the network database is not setup the Network Database selection will be disabled as shown below J Next Go To Table Of Contents Next Omark EZ Holter Operation Manual El List Management Utility x Select a database then click on Manage Lists Database Selection f Network Database LK Help Figure 2 4 List Management Utility Click Manage Lists and the following dialog box appears You can add edit or delete any item in the Medications History Statements ECG Holter Statements and Race Categories lists Local Database List Management x General List Management ECG Statements User Mames Current List Medications History Statements EC Halter Indications Race Categories Double click on an Acebutolal 1 Amiodarone 2 Digoxin 3 Diltiazem 4 Disopyramide n Ethrazine B
55. t Event Strips Full Disclosure Report First Full Hour ECG r Advanced Reports To Print ST Trend HRY Summary ST Tabular Report Time Domain Analysis OT Interval Trend Time Domain Tabular GT Tabular Report Frequency Analysis Pacemaker Reports To Print Print All Saved Sample Stips Pacemaker Tabular Report Print Selected Sample Strips Sample Strip Options Select All Clear All Help Cancel Holter Settings Reports To view or change the analysis criteria click the Analysis Settings button in the Holter Analysis dialog box The default analysis settings are shown in the screen shot below You can change any of these criteria to better fit your needs For example some offices may choose to use 60bpm as bradycardia limit or 2 0second as asystole pause limit Analysis Settings i ST Segment Threshold FI Depression mm jo v Elevation mm jo v Enable A Fib Detection amp Fib Duration Limit 7 Beats Supraventricular Prematurity Percentage 4U sd Er 4 Tachycardia Limit 120 bpm Analyzed Channels Bradycardia Limit 59 f bpm Tei ecce fme Non amp Fib Duration Limit v Beats Asytole Pause Limit 125 vf second 1 Vv 2 Iv C Irregularity 7 76 ST Point milliseconds after the J point 80 msec 3 iv C Tall Pacing Artifact Pacer Spikes Cancel Save As Default Help Default Analysis Settings
56. t settings See Printing Reports later in this section Select Report Pages amp Select individual reports for printing Changes Print made here will affect the default report settings See Printing Reports later in this section Summary Analysis Summary View a numerical summary of the analysis results and the doctor s interpretation These results are updated automatically when you make changes in the other screens Interpretation View and edit interpretation narrative results Comments and comments All your editing is saved automatically when you leave this screen unless you click the Cancel button Any text entered in the Interpretation box is transferred to the bottom page of the Analysis Summary screen Tabular Summary View and edit a tabulated summary of all events and various statistics in an hourly breakdown of the ECG recording You can edit any numeric result that appears in black but this is not recommended Editing the Tabular Summary does not update the rest of the reports In order to maintain consistency with other parts of the Holter reports edit these results only in the Sample Strips and Page Scan screens 24 J Back Go To Table Of Contents IQmark EZ Holter Operation Manual Data Sample Strips View and edit sample strips for all events Review including events that you selected Note A Fib analysis is not available in the IQmark EZ Holter Please contact our Custome
57. this is true you will have no problem using the product However in the event that you have any technical questions or problems please refer to the Troubleshooting Guide in the Appendix to this manual for immediate assistance Customer Support information is also listed at in the Appendix EH Go To Table Of Contents IQmark EZ Holter Operation Manual C System Components Figures 1 1 and 1 2 illustrate two configurations of the IQmark EZ Holter system The primary components are a Windows based PC a printer and the IQmark Digital Holter Recorder A Holter security key dongle which is not shown in the diagrams connects to the parallel port or an USB port on the computer The Digital Holter Recorder records patient ECG data on a Compact Flash Card For scanning this card is inserted into the Compact Flash Card Reader which is connected to the computer Refer to the IQmark Digital Holter Recorder Operation Manual for detailed instructions on operating the Recorder External Compact Recorded FlashCard Reader Windows based Windows a Computer Compatible Printer ar Figure 1 1 Configuration of the IQmark Digital Holter System This Holter system can also be installed and used on a laptop computer As most laptops come with a PCMCIA drive a Compact Flash Adapter is required Insert the recorded Compact Flash Card into the Compact Flash Adapter and then insert the adapter into the PCMCIA drive on the laptop Th
58. tion Patient Events Diary RR Interval Ratio Report RR Tachogram Report ECG Strips To Print Diagnostic Sample Strips Condensed Sample Strips Patient Event Strips Sample Stip Options Full Disclosure Report First Full Hour ECG Advanced Reports To Print ST Trend HRV Summary ST Tabular Report Time Domain Analysis QT Interval Trend Time Domain Tabular QT Tabular Report Frequency Analysis Pacemaker Reports To Print Print All Saved Sample Strips Pacemaker Tabular Report Print Selected Sample Strips jtri i Select All Clear All Help Cancel Apply Holter Settings Reports Tab amp NOTES The following reports are only applicable to the IQmark Advanced Holter RR Tachogram Report QT Interval Trend QT Tabular Report HRV Summary Time Domain Analysis Time Domain Tabular Frequency Analysis and all Pacemaker reports 13 EH Go To Table Of Contents IQmark EZ Holter Operation Manual Miscellaneous The Miscellaneous tab of the Holter Settings provides you the option to print ST Summary and Heart Rate Variability summary results on the cover page of Holter report If you have a network and the Holter full disclosure is stored remotely on a network drive you can check the box in General to speed up data access across the network during reviewing or editing This option is useful when you operate Holter on a relative low bandwidth netwo
59. u to plug a Compact Flash Card into the standard PCMCIA ATA drive that commonly comes with laptops Generally appearing on the desktop shortcut icons allow you to open a document application or folder simply by double clicking on them 51 EH J Back Go To Table Of Contents START BUTTON TASKBAR TEXT BOX Isolated Ventricular Interpolated Ventricular VE Paired Ventricular VE Pair Ventricular Run V Run Pause Asystole Ventricular Bigeminy Bigeminy Ventricular Trigeminy Trigeminy Isolated Supraventricular SVE Paired Supraventricular SVE Pair RonT 52 IQmark EZ Holter Operation Manual Appears at the left end of the Windows 95 98 2000 NT and Windows XP Taskbar and allows you to start applications open files get to the Control Panel and exit Windows This feature first appeared with Windows 95 Consult your Windows owners manual for more information A gray bar which typically appears at the bottom of your screen In Windows 95 98 2000 NT and Windows XP the Taskbar provides rapid access to the Start Button and applications you have started The IQmark Workstation requires that the taskbar be set to Autohide in order for it to work properly Refer to your Windows owner s manual for more details A box in which you type text required for an application or task Select the text box by clicking in it then start typing Single PVC beat PVC occurring betwee
60. up menu is selected Use this menu to quickly remove the analysis results of a specific period that has excessive artifacts For example if the patient has removed the hookup 20 minutes before the end of the recording and it is full of artifacts you can right click on the last of the good ECG beats before the artifacts select Remove Analysis Results and select To the end of the recording The analysis result and the beat information of the selected period will be deleted but the full disclosure will not be changed Use your mouse to measure the current ECG strip to get the interval between two measurement lines and the amplitudes for all available channels Measurements are given numerically at the bottom of the screen To move both measurement lines together with a fixed interval hold down the Ctrl Control key then click and drag one of the lines Click Close to exit Measurements Specify the number of seconds of ECG strip to display in each line of the ECG strip view You can choose e 8 seconds per line which is the default length for diagnostic ECG strips e 30 seconds per line which is the default length for Page Scan review e 60 seconds per line e 120 seconds per line Display the next page of the ECG strips The page size is determined by the length of the ECG strips in the current view l gt Fage Down This button performs the same function 33 EH J Back Go To Table Of Contents
61. uses both Date and Time Format settings but some part of the Holter screen will always be in 24 hour format The Line Frequency information is irrelevant to Holter EH Go To Table Of Contents IQmark EZ Holter Operation Manual Database Settings Note Refer to the IQmark Diagnostic Workstation operation manual for details on setting up an IQmark Diagnostic Workstation network database The IQmark Diagnostic Workstation uses the local database by default If you have setup the database on a network you will have the option to select between the local or network to be the default database Click the Database Settings in the configuration screen Fig 2 2 for this option Database Settings x m uq EE Archive E Mail ECG Reports As Default Database Compressed Archive Report car f Local C SCP ECG F scp C Hetwork Holter ECG File Storage Path e rentwaod D atabase sHalter s Browse 1540 MBytes available Cancel Default Help Figure 2 3 Database Settings To select Network database as your default first check the Enable Network Database box then click Network The Archive E Mail ECG Report As setting 1s irrelevant to Holter The Holter ECG File Storage determines where the full disclosures will be stored You can select to use a different location from the Workstation database storage Each 24 hour Holter ECG file requires 33MBytes of storage The available storage space of the
62. v Channel 1 Channel 2 Channel 3 Entire Recording C First Full Hour C Selected Hours Select Haur s Linn ao 5 rst E rst ES orti FE ETE ian Tien isin ends ig 1 200 Dia Thin niin rein maag E Geert Dr oo Eng oos ao ggg 1000 Print Preview Cancel Help Close Strip Click to close the ECG strip view Using the Right Click Menu Options Right click a waveform in the Page Scan view or ECG strip view to access additional features The following menu appears Reclassifv Begin Group End Group Remove Analysis Results Measurements oom b Next Page Chrl Click Previous Page X ShifE Click Search Time Comment amp Save Save Co print Print Current Strip Print Continuous Strips Right Click Menu 32 Reclassify Begin Group End Group Remove Analysis Results Measurements Zoom Next Page Go To Table Of Contents IQmark EZ Holter Operation Manual Reclassify the beat to which the cursor is pointing This option is available only when the cursor is pointing to a beat in the ECG strip view See Sample Strips earlier in this section for more information about reclassifying beats Specify the beginning of a group This 1s used for reclassifying a group of continuous beats Specify the ending of a group This 1s used for reclassifying a group of continuous beats The Beat Activity Dialog Box appears automatically when the End Gro

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