Telemedicine Equipment Technical Resource Guide - Version 1

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Contributor: David Cooper Date: Aug 29-2016
Telemedicine Facilitation Course –
Sheridan College
Telemedicine Equipment Technical Resource Guide -
Version 1

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Table of Contents
Telemedicine Cart Hardware ……………………………................ 3
General Overview …………………………………………………… 4
Simulation Devices …………………………………………………. 6
Startup Process ……………………………………………………… 7
Telemedicine Workflow …………………………………………….. 10
Troubleshooting …………………………………………………….. 37
Important Contacts …………………………………………………. 49
Technical Requirements/Specs …………………………………..... 50
Appendix A – Telus EMR Config ……………….………………..... 52

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TELEMEDICINE CART HARDWARE
 Surface 3 Computer
and Docking Station
 DELL 24” External
Monitor
OphthoSim (Eye) Base
Unit 
 Logitech BCC950
Camera + Remote
Control
Avizia HorusScope
↓
TF Cart Base + Storage 
3M Littmann Tele-
Stethoscope 

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(a) General Overview
The Telemedicine Equipment for the Telemedicine Facilitation Course
consists of a Telemedicine Facilitator (herein referred to as “TF”) Station (or
cart) and a Doctor Station (or cart). There are various software, electronic and
conventional components that comprise the stations.
The TF station consists of the following items:
Telemedicine Devices, Software and Accessories
» Luxor Industrial Locking Cart with Monitor Mount
» Microsoft Surface 3 Computer running Windows 10 with a docking station
» DELL 24” LCD Monitor
» Logitech BCC950 Conference Camera/Mic with Remote Control
» Avizia Electronic HorusScope with Charging Cradle, General Attachment and
Otoscope Attachment
» 3M Littmann 3200 Electronic Tele-Stethoscope with Case
» OphthoSim Eye Simulation Device and Case from OtoSim
» Anker 7 Port USB3 Hub
» Wireless Mouse
» MD Matrix Telemedicine Software
» TELUS Med Access Electronic Medical Record (EMR) Software
The Doctor station consists of the following items:
Telemedicine Devices, Software and Accessories
» Luxor Industrial Locking Cart with Monitor Mount
» Microsoft Surface 3 Computer running Windows 10 with a docking station
» DELL 24” LCD Monitor
» Logitech C920 HD Pro Webcam
» Jabra Speak 410 Hands-Free Speakerphone
» 3M Littmann 3200 Electronic Tele-Stethoscope with Case
» OtoSim Ear Simulation Device and Case from OtoSim
» Anker 7 Port USB3 Hub
» Wireless Mouse
» MD Matrix Telemedicine Software
» TELUS Med Access Electronic Medical Record (EMR) Software

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Conventional Medicine Devices
» OMRON Blood Pressure Monitor
» BRAUN Digital Ear Thermometer
» Urinalysis Dipstick
The Microsoft Surface 3 computers are the main computers running the
software and hardware. They are currently running Windows 10 Home
operating system. The other 2 important software components are the MD
Matrix Telemedicine Software and the TELUS Med Access EMR software
(accessed through Internet Explorer Browser running remotely on the Telus
Cloud server).
The majority of the telemedicine peripherals are connected via Universal Serial
Bus – commonly known as “USB” (either directly at the back of the Surface 3
docking station or through the 7 port USB Hub in the base of the carts). The
DELL 24” external monitors are connected to the Surface 3 computers via a
“Mini-display to Display Port” cable using the “DP” input on the monitors.
The Surface 3 displays and DELL 24” monitor displays can either be
configured for “duplicate” mode (which means to display the same video on
both screens) or in “extended” mode (which means the Surface 3 can display a
different image/video compared to the DELL monitors). The “extended”
mode can be useful for displaying the Telemedicine Software session on one
screen and the EMR software on another screen.
The external Logitech cameras, Jabra speakerphone and Avizia HorusScope
are connected via USB. The Logitech BCC950 Conference Camera on the TF
cart is a motorized camera with a remote control. The 3M Littmann Tele-
Stethoscope is connected via Bluetooth/USB dongle.

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(b) Simulation Devices
There are 2 OtoSim Simulation devices used for teaching and training that are
physically located on the carts…but would not part of the typical Telemedicine
equipment in real-life. One device for the ear (OtoSim) and one for the eye
(OphthoSim). They are mainly used as a teaching tool for the instructor to help
minimize the risk of injury by teaching the students how to examine the ear
and eye first before practicing on a human. The carts are currently
installed/configured to run the Ear Simulator on the Doctor Cart and the Eye
Simulator on the TF Cart. They are connected to the Surface 3 computers via 2
USB cables – one cable for the large Base Unit and 1 cable for the smaller
Interface Box – and currently the video is displayed on the Surface 3 screens
and the 24” DELL monitors on the carts.
If the Simulation devices are connected to a standalone laptop on the TF or
Doctor Cart, then the video can be displayed on the DELL monitors via an
HDMI cable (the cable is roughed-in on the carts and is currently connected
to the monitor on one end and loose on the other end stored in the base of the
cart). In order to view the simulator software on the DELL 24” monitor, you
would need to switch the input on the DELL monitor to “MHL/HDMI input”
by pushing the input button on the bottom right of the monitor.
If the OtoSim hardware and software is being run on a separate laptop
independent of the Telemedicine stations, then it can be hooked up via a VGA
or an HDMI cable to the Sheridan Classroom Projector Interface Module to
display the simulator software on the large projector screens.

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(c) Startup Process
Referencing the basic Startup Flowchart above, the portable Telemedicine
carts require power to function and have a long master power cord that needs
to be plugged into a grounded electrical outlet to function.
NOTE: The Surface 3 Computers have an internal LI-ION rechargeable battery and can run
without AC power for several hours when fully charged.
The carts have a black main power bar at the back of the cart and a second
power bar in the base of the lockable cabinet (which all of the devices are

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plugged into – except for the external DELL monitor which is plugged into the
external black power bar at the back).
Once the master power cord is plugged in, the Surface 3 computers need to be
powered on. The removable Surface 3 computers are stored in the base of the
cabinet and need to be installed in the external docking station on the
keyboard pull-out tray. In order to dock them, this needs to be completed by
lining up the 2 Surface 3 ports on the top right side with the Docking station
ports and then carefully sliding the computers from LEFT to RIGHT. Once
fully pushed to the right gently pushed back on the bottom left to lock them in
place (the reverse needs to occur when removing the computers from the
docking stations). It may be easier to remove the magnetic detachable
keyboard when doing this but it is not necessary. The power switch is on the
top left of the Surface 3 screen. The switch needs to be pushed and held for
approximately 4 -5 seconds in order to turn on. The computers power up with
a Surface logo and will boot to directly to the Windows Desktop screen
because the option to login first to Windows has been disabled. If this auto-
login option become disabled, then the computers will boot up to a Windows
10 landing screen.
By clicking on the mouse, touchpad or swiping up the Surface 3
Touchscreen…this will take you to a login screen.

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A 4 digit quick login PIN has been enabled for ease of login. The password is
“1234” (you do not have the press the “enter” or “return” key). Once you are
logged in and fully operational, the monitors should display the main Windows
Desktop screen.

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(d) Telemedicine Workflow
MD Matrix Telemedicine Software takes the traditional in-person physician
visit and makes it truly virtual – without impacting the quality of care. By
providing patients with secure technology and the ability to access a physician
through a high-speed Internet connection, quality healthcare can be offered
that is convenient, accurate and easy with typically no waiting room.
There are 3 types of users: Patient, Doctor and Healthcare Professional (the
Healthcare Professional user is synonymous with the Telemedicine Facilitator
role at Sheridan). Depending on user credentials entered on the login screen,
the software will display the corresponding user interface (UI) to the type of
user.
In order to initiate a Telemedicine session, the first thing you want to check is
whether or not the computers are connected to the Sheridan WI-FI network.
After the initial WI-FI connection, normally when they boot up within the
Sheridan network they will automatically connect. However, this is not always
the case and sometimes they won’t be connected on WI-FI. Please check the
WI-FI connection icon in the “system tray” on the bottom right corner of the
display. The picture below shows a good connection.
If they are connected then you can continue. If not, then the picture will look
like one of 2 icons:
If not connected, click on the icon and choose “Sheridan Secure Network” and
ensure the check box “connect automatically” is enabled in order to connect.
For the purpose of this section, we will assume that they are connected (if they
will not connect right away then proceed to the WI-FI troubleshooting section
later in the manual).

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The next step is to launch the MD Matrix Telemedicine Software. You do this
by clicking on the small icon with the orange capital “M” in the Quick Launch
Toolbar on the bottom…or alternatively you can double click on the icon on
the desktop.
This will prompt you for a login.

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The login credentials are as follows:
TF STATION:
UNAME – scfacilitator
PW - scfacilitator
DOCTOR STATION:
UNAME – scdoctor
PW - scdoctor
NOTE: Make sure the “Remember” radio button is enabled. Then click “LOGIN”.
 Telus Med Access EMR
To enter information in the Electronic Medical Record, manually launch the
Telus EMR software by clicking on the Internet Explorer icon in the Quick
Launch toolbar or double clicking on the Desktop icon. Internet Explorer is
currently configured to launch the Telus Med Access EMR software as the
home page and will take you to the login screen.

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The Telus Med Access login is a 2 step login. If you click “Remember my
credentials” on the 1st
login, then on subsequent logins the UNAME and PW
will auto-populate and you can just click on “ok”. The login process from
scratch is as follows for the 1st
step login:
To logon to Med Access EMR:
1. Open any internet browser (including Google Chrome, Internet Explorer, or Firefox) and
then, at the top of the window, in the address field, enter: https://brasco.med-access.net
You are prompted to enter the authentication/validation and the username/password.
2. Enter the following credentials:
Username: brasco
Password: 6PYNOoT1dAMr3eYA0r7x
(Please note that O is a capital o and o is a lowercase o, while 0 is a zero)
The Med Access EMR login screen should open.
Tip: If the computer you are using is secure (i.e. you have a unique Windows username and
password that no other users have access to, you can save the password. This way, you don’t
have to enter your external credentials every time.
This next screen is expecting a particular user login in order to setup the
permissions and credentials. The instructor login is as follows:
Username: abose
Password: Sheridan0426tf

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Note: All users have the same password (Time2change) when they first login; however,
you are prompted to change your password upon first logon.
Any and all applicable EMR information should be entered real-time in the
Telus Med Access software during the registration and intake of the patient.
 Telemedicine Facilitator Station
Once you login then the Telemedicine Software is launched. An EMR
Authentication Window will pop up…leave this blank and then click “ok”.

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This will bring you to a landing window where you will initiate the
telemedicine session with the Remote Doctor. The 1st
step is to register and
intake the patient. In order to do this, you will need to capture information in
the Electronic Medical Record as described above.
To start the Telemedicine session, both the Facilitator station and the Doctor
station require a green circle icon beside the names in order to be online and
ready for the call. If the connection is not good, there will be no green circle
and the names will be greyed out. See below:
If the connection is good, then the display should look like the one below:

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On the TF station, once you click on the applicable Remote Doctor Station
that you want to connect with, an Avatar or picture will be displayed and a
Green “Register New Session” Icon will be displayed. There will also be a
message at the bottom left of the window indicating the status.

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By clicking on this icon, this will confirm that the TF has completed the initial
intake and registered the patient. This will then prompt the next step to
confirm that the patient is now in the Exam Room by clicking on the Green
“Patient in Chair” icon.
Once this icon is clicked, then a Green “Request a Session” Phone Icon will
be displayed.

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By clicking on the Green Phone icon, this will initiate the call with the Remote
Doctor.
 Remote Doctor Station
On the Remote Doctor side, the MD Matrix Telemedicine software will need
to be launched in the same way as described above for the TF station….except
of course with different login credentials (as indicated earlier). Once logged in,
there is a landing screen and it should show the Telemedicine Facilitator name
with a Green Icon which means they are online and ready to initiate a call.

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Depending on the status of the patient being communicated within the
software by the TF, the doctor will see different messages on their screen.
When the TF registers the patient and clicks the Green “Register New
Session” Icon, then the following message will be displayed on the bottom left
of the Doctor Telemedicine Window – “Patient Registered”.
Once the patient is in the room and the TF clicks on “notify Patient is in
Room” Icon, then the following message will be displayed on the bottom left
of the Doctor Telemedicine Window – “Patient in Room”.

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Once the Green “Request a Session” Phone Icon is clicked by the TF to
initiate the call with the remote Doctor, no message is displayed but the 3
Green/Red/Yellow icons will be displayed…as well the Doctor should hear an
audible ringing to indicate that a call is being initiated by the TF.
Green Phone Icon - Accept call
Red Phone Icon - Reject Call
Orange Message Icon - Reject Call with Message
If the Doctor accepts the call, then the green icon will be clicked and the
remote telemedicine session is confirmed. The audio/video streaming will
begin and will come up on the displays (just like a “Facetime” or “Skype”
call). The Doctor station would see the Facilitator/Patient in the large Video
window and they would see what they are transmitting in the small Video
window in the bottom right hand corner. The TF on their end should see the
image of the Doctor as the large display…and the image that is being
transmitted from the TF/Patient to the doctor will be a small video in the
bottom right corner. The green circle icons beside the names then change to
yellow to indicate that a call is in session and both the TF and Doctor are busy.

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IMPORTANT: Currently, the call can only be initiated by the Telemedicine Facilitator…but once
connected, the call can be terminated by either party.

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Once the AV streaming session is activated, then the streaming audio and
video is displayed in the right side of the window and several camera icons will
be displayed in the video screen on the left (2 green and 1 yellow icon) and
several medical device streaming icons will also be displayed under the video
area on the right side (greyed out).
The active camera will be displayed in yellow (busy) while the inactive
cameras are displayed in green (idle). The cameras on both the TF and Doctor
Stations default to the Surface 3 front camera, so the TF and Doctor (if
applicable) will need to choose the external Logitech camera by clicking on
the Green camera icon on the left side of the screen below the yellow face
camera icon. Another visual indication to let you know whether the external
camera are active or not is that they display a small blue LED on the TF
Camera and a blue LED outline on both sides of the Doctor camera. The TF
should adjust the camera using the base or remote controls to ensure that the
best view of the patient and TF is being transmitted.
NOTE: You will encounter feedback from the computer microphones if the carts are close to each
another. This would not be an issue that would occur in a real-life situation, but it is a reality in the
classroom setting. If there is feedback, then you can mute the audio by hitting the F1 key and/or
separating the carts from one another.
There are 2 other options (and icons) for the doctor regarding the original
incoming call. They can decide to reject the call by clicking on the red icon. If
this is done, the Telemedicine session is aborted and the TF should proceed to
try and connect with another available doctor. They will receive the following
message back on their screen:
If they click on the Orange Message Icon then this will abort the call but it
gives the opportunity to send a message back to the TF explain why. The
doctor can use one of the auto-populated messages or can type in a custom
message. Once they do this then they will need to click on the “send message”
icon. The TF will see a message similar to one below:

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Depending on the nature of the visit and patient (as well as the clinic’s policy),
the TF will need to then either wait for the same doctor or decide to engage a
different doctor.
Notes:
+ Required bandwidth of the video call function for HD resolution at 30fps is 2.5 Mbps, if lower,
video quality will be automatically degraded. If network connectivity of an end point degrades to a
degree that bandwidth is not enough for video and audio streaming, the video is dropped on that end
point (without affecting the other end), and the end point receives audio only. If connectivity improves,
the video returns.
+ USB video devices should not be unplugged from its attaching machine when it is in use, users
should switch to other cameras before unplugged it from the machine.
 Medical Devices Streaming
Once the Telemedicine session has started, the doctor will provide guidance
and direction on patient care. There will most likely be some further questions
for the TF and/or patient which will be communicated by the audio and video
within the MD Matrix software. Depending on the clinic/doctor/protocols
established, there may have been some further information/images that would
have been uploaded to the EMR system depending on the symptoms
communicated by the patient (i.e. Flu-like symptoms may require the TF to
take initial pictures of the ears/throat to be ready for the doctor to view).
The doctor most likely will require further diagnostic information which may
require video from the HorusScope or audio from the digital Tele-Stethoscope.
As a good practice, the TF should be organized and prepared by connecting
the HorusScope and Tele-Stethoscope in advance in order to be better
prepared to provide this information efficiently to the doctor. This will also be
helpful if there is any issue connecting the devices so the TF can try and rectify

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these issues before the session begins with the doctor. The process for
connecting and streaming the devices is provided below.
CONNECTING/STREAMING HORUS SCOPE
The Avizia HorusScope, designed specifically for telemedicine, is an easy-to-
use hand-held video system used for capturing images of the body. Optional
interchangeable lenses make it ideal for multi-discipline medical applications.
There are several attachments available including one designed for ear nose &
throat, dermatology, ophthalmology, audiology, women’s health, and general
examinations. The device used in the Sheridan Telemedicine program has 2
lenses – a General lens and an Otoscope lens.

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As mentioned above, the MD Matrix telemedicine software needs to be
running in order to be able to connect and stream the video from the
HorusScope. Once the Telemedicine software is connected, the icons appear
on the right side under the streaming video for the HorusScope and
Stethoscopes. These appear in grey as they are not instantly and automatically
connected. The first step is to ensure that the HorusScope is turned on and
connected properly. The power on button is located on the top left side of the
HorusScope screen. This needs to be held for 1-2 seconds to power on. If there
is no attachment on the HorusScope, then the display on the HorusScope
screen will just show Avizia name with a blue background. See below:
Also, if you try and connect the HorusScope with a proper lens attached, then a
message will pop up instructing you to connect Otoscope.

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Depending on what the doctor requires to see, this will determine whether the
General Attachment (for general use) or the Otoscope Attachment (for
ear/nose/throat use) is used. Regardless, both attachments are installed and
removed the same way onto the HorusScope. See below a step by step
diagram showing how to properly install a lens:
Once the lens is attached properly, the video will be shown on the HorusScope
LCD screen. The next step is to connect the device in order to stream the
Video within the Telemedicine Software. This is done by clicking on the grey
“hammer-like” icon. This will start the video streaming and a Video streaming
window will pop up on the Left Quadrant of the telemedicine software screen.
This does not automatically show up on the Doctors screen. The doctor would

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need to do the same thing as the TF by clicking on the grey “hammer-like”
icon. If everything is connected and working properly, the grey icon will turn
to green and a Video screen will appear on the left quadrant showing the Video
that is being transmitted from the HorusScope at the TF station. See below a
typical screen shot showing this connection:
Both the TF and Doctor can control the Video streaming box independently.
They can maximize the video to full screen and back by double-clicking on the
top bar of the video window. They can also “stretch” the screen and maximize
it within the left while still seeing the patient video on the right side. If the
doctor asks to see a different part of the patients’ anatomy which requires the
TF to change the lens, then this can be done real time by turning the current
lens counter-clockwise to remove and then turning the new lens clockwise
(ensuring first that the black alignment dots are aligned) ¼ turn until it locks
in place. In the spirit of open and transparent communication, The TF should
always remember to communicate clearly and fully regarding the tasks they are
performing. In order to stop the HorusScope streaming, this is done by closing
the steaming window (as opposed to clicking on the green hammer icon).
Note: Always remember to install the protective covers on the lenses and HorusScope attachment
window when not in use.

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CONNECTING/STREAMING STETHOSCOPE
The compatible stethoscope model which can be used with MD Matrix
software is 3M™ Littmann® Electronic Stethoscope Model 3200. The 3M
Littmann Model 3200 Electronic Stethoscope brings you the very latest in
advanced auscultation and wireless electronics technology in a highly
ergonometric and easy-to-use format. It is useful for auscultating infant,
pediatric or adult patients, in quiet or noisy environments, or picking up
difficult-to-hear heart and body sounds.
The Model 3200 detects and displays an acoustic-based heart rate when
presented with consistent heart sounds (heart rate variation < 10%). It takes
five seconds to compute the initial heart rate and updates are provided every
two seconds. The heart rate will then be displayed for 10 seconds after removal
of the chestpiece from the patient. Prior to the initial reading, the display
shows two dashes (--). For heart rates outside a range of 30-199 bpm, the
display will also show two dashes (--). The acoustic-based heart rate display

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functions best when the Model 3200 is placed near the apex of the patient’s
heart and can be monitored while using any filter mode and/or volume level. If
the heart rate changes from consistent to inconsistent or if there is excessive
ambient noise, patient movement or lung sounds during auscultation, the
heart rate display number will display two dashes (--).
As mentioned above, the MD Matrix telemedicine software needs to be
running in order to be able to connect and stream audio sounds from the
Stethoscope. The stethoscopes work with MD Matrix software via Bluetooth
2.0 connectivity. Make sure Bluetooth interface is enabled on the machine
running MD Matrix software before pairing/connecting stethoscopes.
Using stethoscope streaming function, heartbeat and lung sound collected
from the patient is sent over the Internet and can be heard by the doctor
through his stethoscope.
BLUETOOTH MANAGER WINDOW

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The Bluetooth Manager window is a component of MD Matrix software, it
helps users to pair and connect stethoscopes.
(1) List of paired stethoscopes
(2) Name box, used to name stethoscopes. Naming stethoscopes helps a user
to decide which stethoscope to connect easier in case he has more than one
stethoscope.
(3) Status text
(4) Remove button, used to remove (unpair) a device.
(5) Pair button, used to start the pairing process.
(6) Connect button, used to connect a stethoscope to the software.
Naming Stethoscopes
By default, each paired stethoscope is represented by its Serial Number ID in
the stethoscope list of the Bluetooth Manager window.
Follow these steps to name a stethoscope
Step 1: Select a stethoscope which need to be named, its ID is now shown in
the Name box.
Step 2: Type the new name to the name box, the name will be remembered for
later use after the Bluetooth Manager window is closed.
PAIRING

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Before MD Matrix software can connect a stethoscope via Bluetooth, the
stethoscope must be paired with the machine running MD Matrix software.
There are two ways to pair a stethoscope to a PC.
Method 1: Using the Bluetooth Manager window of MD Matrix software
Step 1: When a healthcare professional is in a call, he can pair a stethoscope
using the Bluetooth Manager window of MD Matrix software. To open the
Bluetooth Manager window, click the stethoscope button when there is no
stethoscope connected (the button’s background is grey).
Step 2: Turn the stethoscope to pairing mode:
On the stethoscope, depress and release the (M) button. The MAIN menu will
be displayed. Use the (-) button to scroll down to the PAIR option. Select this
option by pressing and releasing the (M) button. The LCD screen will signal
that pairing is in progress with the following animated display:
Step 3: Press “Pair Stethoscopes” button in the Bluetooth Manager window,
the software will try to pair the stethoscope device. The status text on the
Bluetooth Manager window shows “Pairing…”.
Step 4: If the MD Matrix software successfully paired the stethoscope, its Id is
shown in the stethoscope list of the Bluetooth Manager window and the LCD
display of the stethoscope will show a flashing Bluetooth icon (Connect mode)
and the stethoscope will be ready for wireless operations.

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Method 2: Using Windows Bluetooth Settings program (applies to Windows
8/8.1/10)
To open the Windows Bluetooth Manager, press Start on your keyboard, then
type “Bluetooth settings”, then press Enter, the Bluetooth Settings window
will show up.
Step 2: Turn the stethoscope to pairing mode (same as above)

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Step 3: The stethoscope Id will show up in the device list of Bluetooth Settings
program and its status is “Ready to pair”, click on the device Id and press the
Pair button.
A pop up will appear for the user to enter the PIN code (displayed in the
stethoscope’s LCD).
Enter the PIN code and press Next button to proceed pairing.
If pairing process is success, the status of the stethoscope Id will be shown as
“Paired” and the LCD display of the stethoscope will show a flashing
Bluetooth icon (Connect mode) and the stethoscope will be ready for wireless
operations.

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CONNECTING
To send stethoscope data to the doctor during a call, a stethoscope has to be
connected first, follow the steps below
Step 1: Turn the stethoscope to Connect mode: depress and release the (M)
button. Select the CONNECT option by again pressing and releasing the (M)
button. The LCD screen will signal that the Bluetooth link is active, the
stethoscope is ready to connect.
Step 2: On MD Matrix software, press the grey “Stethoscope Connect” icon.
The software will try to connect to a previous connected stethoscope first,
therefore, if the waiting stethoscope was connected to the software in the last
running, the software will connect it automatically. If no stethoscope is
connected previously, the Bluetooth Manager window will show up for the user
to select a stethoscope to connect.

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On the Bluetooth Manager window, select a desired stethoscope by click on its
Id and then press “Connect” button. If success, the Bluetooth Manager will be
closed automatically and the Stethoscope turns green. Stethoscope data
streaming function is started automatically (Stream button turns green) on
stethoscope connected if it was not stopped previously.

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When the stethoscope is connected, the streaming should start automatically
and the grey “stethoscope streaming” icon should be green. The nice feature is
the fact that you can click on the green streaming icon to stop the
streaming…but still have the Stethoscopes “connected” The advantage of this
is the fact that you can start and stop the streaming depending on the doctors
instructions…but still keep the stethoscope connected.
To disconnect the stethoscope from the software, press the Stethoscope button
again, if the stethoscope is disconnected successfully, the Stethoscope and
Stream button turn grey, and the software status text will show “Stethoscope
disconnected”.
Notes:
+ The limitation of the distance between the stethoscope and its connecting machine varies depending
on the Bluetooth Adapter used on the connecting machine. In case of the Littmann USB Bluetooth
dongle is used (found in the box of Littmann Stethoscope 3200 model), the maximum distance is 10
meters. If integrated Bluetooth interface (of the machine) is used, the maximum distance should be
lower. On Microsoft Surface machines, internal Bluetooth interfaces should NOT be used.
+ If the stethoscope is turned off while it’s still connected to the software, it should take up to 30
seconds for the software to be aware of this event.

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(e) Troubleshooting
The one thing you can count on for any type of electronic/computer/software
component is that things will not always work properly. Many things have to
occur in the right order and several components have to “talk” or “handshake”
with each other successfully to ensure optimal functioning. In light of the
environment you are working in and the fact that most patients will feel
somewhat anxious and/or vulnerable visiting a clinic or doctor, you want to
remain calm and in control when problems arise with the Telemedicine
equipment. The key is to remain calm and communicate courteously and
professionally!
For the most part, by remaining calm and using common sense, most issues
can be handled efficiently and effectively. If the problem is minor and can be
resolved quickly, you don’t necessarily need to communicate this to the
patient. However, if the problem is taking longer to resolve and/or will result
in delays, then please be transparent and communicate clearly and confidently
(not negatively) to the patient and/or doctor if applicable that there is a minor
issue and that you are trying to rectify it…but there will be slight delay. Try not
to be intimidated by the technology and the problem, use your observation
skills as well as the material in this document, and escalate problems when
necessary to resolve the issue at hand.
TIPS:
1. It is useful to have a notebook and write down your observations and/or error messages when
issues arise.
2. When initiating the troubleshooting scenarios for students to test their ability to calmly and
efficiently figure out the issue while maintaining professional and courteous behavior in front of
the patient/doctor, it is recommended for the student (and/or teacher if applicable) to always
test the functionality of the system before going to the next scenario. It is easy to forget to re-
attach a cable or correct an intentional software bug which can then lead to confusion as well
as potential extra time or further support that may be unnecessary.
Troubleshooting Table for Instructor

38
ISSUE STEPS TO CORRECT
Cart will not
power up
1. Check to insure master power is plugged in
2. Check to insure AC outlet is working
3. Check to see if DELL external monitor is working as
this is the only device plugged into black power bar
at back of cabinet.
4. Check power bar in bottom of cabinet is plugged
into main power bar at back
5. Check for power indicator lights on Power Bar
(RED) and USB hub (GREEN) in base of cart
6. Call Sheridan IT Support – Ryan Green - 905-459-
7533 ext 5602 or ext 2510
Cart has power
but Surface 3
Computer will not
turn on
1. Check Docking station power indicator light on top
right of docking station (white LED)
2. Ensure Power on button is held for 5 seconds
3. Computer Battery Dead – recharge battery for at
least 10 minutes and check again
4. If battery not charging, plug Surface 3 into separate
standalone power adapter (located in base of
cabinet)
5. Check for solution online -
https://www.microsoft.com/surface/en-
ca/support/warranty-service-and-recovery/surface-
wont-turn-on?os=windows-10&=undefined
7533 ext 5602 or ext 2510
Surface 3
Computer turns
on but will not
boot to Windows
1. Power off Surface 3 and reboot
2. Remove Surface 3 from docking station and try to
boot standalone
3. Check online for solution -
ca/support/warranty-service-and-recovery/surface-
wont-turn-on-windows-wont-start?os=windows-
10&=undefined
7533 ext 5602 or ext 2510
Computer not
connected to WI-
FI network
1. Check WI-FI icon status to ensure it is a WI-FI
connection issue (hold mouse over WI-FI icon)
2. Ensure WI-FI is enabled

39
3. Ensure that you are selecting “Sheridan Secure
Access” as the WI-FI name and that it is in range.
4. Uncheck the box “Connect automatically” and re-
enter Sheridan WI-FI credentials.
5. Power Down and reboot system
6. Check online for solution -
ca/support/networking-and-connectivity/cant-
connect-to-a-wireless-network?os=windows-
10&=undefined
7533 ext 5602 or ext 2510
Mouse not
working
1. Check to make sure the power switch is in the on
position on the bottom of the mouse.
2. Make sure the battery is good. Replace battery.
3. Since the mice are identical, they
4. The mice used on the carts go into sleep mode and
can only be woken up by clicking on the button (just
moving the mouse around will not wake it up).
5. Isolate problem to external mouse by making sure
the Surface 3 trackpad and touchscreen are still
operational.
MD Matrix
Telemedicine
Software not
connecting (users
1. Check WI-FI connection and correct
2. If issue was a WI-FI issue and is now corrected, wait
patiently for 30 seconds as the Telemedicine software
will try and reconnect automatically

40
are greyed out and
no green light)
3. Close MD Matrix and re-launch
4. Power Down and reboot system…try logging in again
5. Call Sheridan IT Support – Ryan Green - 905-459-7533
ext 5602 or ext 2510
6. Escalate to MD Matrix Technical Support – Basil
Rafikalli – 647-882-9230
Avizia
HorusScope not
functioning or
powering up
1. Check to make sure unit is powering up by holding
down power button on top left of HorusScope
screen.
2. If unit not powering up and there is no light on front
to indicate battery level, then recharge battery by
plugging in unit.
3. If unit is plugged in properly at both ends (plug
cable in directly to handle instead of charging
cradle) and is still not charging, remove and re-insert
LI-ION battery. Refer to HorusScope manual for
instructions.
4. If battery still not charging, battery may require
replacing. Call Avizia Technical Support for
warranty status before replacing. Battery type is
Rechargeable Lithium Ion Battery - 3.7V /
2600mAh. NOTE: It is recommended to remove the battery if
the Horus Scope is stored more than 2 weeks.
5. Replace Battery and make sure to charge for at least
5 hours before first use.
7533 ext 5602 or ext 2510
7. Escalate to Avizia Technical Support – 1-888-637-
7605 or online - https://www.avizia.com/contact/
Avizia
HorusScope not
connecting and
streaming within
Telemedicine
Software
1. Ensure HorusScope is powered on. Recycle power
on HorusScope.
2. Ensure that the Video Streaming Display is not
“hidden” by clicking on the MD Matrix Quick
Launch Icon.
3. Check to make sure that there is either the General
or Otoscope attachment is correctly installed.
Remove be turning counter clockwise, line up
alignment dots, and re-attach accessory. Ensure the
accessory is turned a full ¼ turn clockwise.
4. Close the Telemedicine Software and re-launch.

41
5. Shutdown and reboot system. Relaunch
Telemedicine software and try re-connecting.
6. Check the cable connections on computer and
device ends. Remove and re-attach. Use a different
USB port.
7533 ext 5602 or ext 2510
8. Escalate to Avizia Technical Support – 1-888-637-
7605 or online - https://www.avizia.com/contact/
Camera(s) not
working within
MD Matrix
Telemedicine
Software
1. Shutdown and reboot system. Reconnect and launch
telemedicine software.
2. Verify which cameras are/not functional (i.e.
internal front and rear Surface cameras and external
Telemedicine cameras). Use “Camera App” on
Quick Launch Toolbar.
3. If internal cameras are functional within Windows
but external camera is not, check and re-connect
connections on computer and device end. Use a
different USB port.
7533 ext 5602 or ext 2510
Computer Audio
not working
1. Make sure audio is not muted by toggling F1 key.
2. Adjust/increase audio by pressing F1 and
adjusting…or by clicking on the volume control icon
in the system tray. You should hear a confirmation
tone at or above 50%.
3. Shutdown and reboot system. Reconnect and launch
telemedicine software.
4. Test both internal and external audio sources to
determine if it is a software or device problem.
5. If problem is isolated to external Jabra or Logitech
audio devices, check and re-connect connections on
computer and device end. Use a different USB port.
7533 ext 5602 or ext 2510
3M Littmann
Tele-Stethoscopes
not powering on
1. Ensure mater power switch is pushed fully and held
for 1-2 seconds

42
2. Check battery level indicator. If low, replace battery
with AA Alkaline battery (not rechargeable battery).
Refer to manual for removing and replacing battery.
3. Recheck to make sure that the battery handle is fully
turned and locked into place by experiencing a
“lock” and checking alignment arrows.
7533 ext 5602 or ext 2510
5. Escalate to 3M Littmann Technical Support - 1-800-
228-3957 or 1-800-563-2921 – or online at
http://www.littmann.ca/wps/portal/3M/en_CA/3
M-Littmann-CA/stethoscope/customer-
service/contact-us/
3M Littmann
Tele-Stethoscopes
unable to connect
or not working
optimally within
Telemedicine
Software
1. Check and ensure power is on and battery is ok.
2. Make sure the Stethoscope is positioned correctly. It
will only work if the flat diaphragm face is towards
your chest.
3. Power off and re-connect Stethoscope by powering
on and going into Stethoscope Menu (hit “M” twice)
…and then reconnect within the MD Matrix
software by clicking on the Stethoscope “Connect”
icon.
4. Close and re-launch Telemedicine software. Try re-
connecting.
5. Make sure you are connecting the correct
stethoscope. The software recognizes the
stethoscope by name or serial number that is etched
on the left side of the device.
6. Shutdown and reboot system. Launch telemedicine
software and try re-connecting.
7. Try removing and re-pairing device (hitting “M”
once, arrowing down to “PAIR”, then hitting “M”
again)…and then re-connect device.
8. Try the other stethoscope from the other station to
determine if it is the actual device…or a software
problem.
9. If device is connecting but is losing the connection
or audio is not clear, make sure the Network
connection is strong. Re-locate telemedicine cart if
necessary and try again.

43
7533 ext 5602 or ext 2510
11. Escalate to 3M Littmann Technical Support - 1-800-
228-3957 or 1-800-563-2921 – or online at
http://www.littmann.ca/wps/portal/3M/en_CA/3
M-Littmann-CA/stethoscope/customer-
service/contact-us/
“OtoSim” Devices
not connecting
1. Verify which device has the problem. If small
Interface Box is connected properly, then there
should be a message “OtoSim (or OphthoSim)
Peripheral Version: 3.0” displayed the bottom center
of the window. If large base unit is connected
properly, then there should be message “Monitors:1”
displayed at the bottom left of the screen.
2. Check the cable connections on computer and
device ends. Remove and re-attach. Use a different
USB port.
3. Shutdown and reboot system. Launch OtoSim
software to see if devices connect.
7533 ext 5602 or ext 2510
5. Escalate to OtoSim Technical Support – Brian
Carrillo at (647) 717-5182 or Vito Forte at (416) 813-
6846
Telus EMR
Software not
functioning
properly
1. Test the functionality on both Telemedicine stations
to determine if problem is the Telus software itself
or with a particular Telemedicine cart
2. If problem is not just happening on one cart and
related to the general functionality of the Telus
software, try closing the browsers and restarting the
browsers. If this does not correct the problem, try
shutting down and restarting the computers
3. If problem is not resolved and still is common to
both carts, then escalate to Sheridan IT – Ryan
Green - 905-459-7533 ext 5602 or ext 2510
4. Escalate to Telus Technical Support - 1-888-781-
5553, option 1 or online -
https://www.telushealth.co/health-
solutions/electronic-medical-
records/support/?solution=med-access-emr

44
5. If problem seems to be unique to one station, make
sure the web address and all username and
passwords are correct, try another username and
password, and then try shutting down the particular
system and restarting.
6. If not resolved, follow steps 3 & 4 above
 IT/3rd
Party Remote Technical Support
In case technical support is required from Sheridan IT and/or 3rd
party
suppliers (i.e. MD Matrix, OtoSim), they may want to connect remotely to the
carts for troubleshooting. A program to support this functionality is installed
which is called TeamViewer. They will need the TeamViewer ID’s of the carts.
The software is launched by clicking on the TeamViewer icon in the Quick
Launch toolbar and the ID’s will be displayed. These are as follows:
TF CART – 519 694 511
DOCTOR CART – 519 702 586
Troubleshooting Scenarios for Students
SCENARIO OBSERVATIONS SOLUTION
1. Plug main power
cord into wall just
lightly to simulate
“no power”
situation
No power or lights on
cart or devices…but
Surface 3 will still turn
on and boot up if
battery is charged.
Nothing else will work
Check and Fully insert
main power cable
2. Turn off breaker on
power bar in base
of cabinet to
on and boot up (if
battery is charged) and
Turn on breaker on
power bar in bottom of

45
simulate devices
not connecting
external DELL monitor
will still work. All other
devices will not work
cabinet. Test
functionality
3. Unplug USB hub
power cord in base
of cabinet to
simulate some
devices not
working
on and boot up (if
battery is charged) and
external DELL monitor
will still work. Mouse
and trackpad don’t
work but touchscreen
does work. Only USB
devices plugged into
the USB hub will not
work
Re-connect power
adaptor to USB hub.
Test functionality
4. Disconnect WI-FI
from Sheridan
Secure Access
Network on either
or both carts by
clicking on Wi-Fi
Icon to simulate
network
connection
problem
In general, everything
looks fine except that
the Wi-Fi icon will have
a “not connected”
status.
Reconnect WI-FI to
Sheridan Secure Access
Network. Test
functionality
5. Unplug power cord
from DELL
external monitor to
simulate no video
display on DELL
monitor
No power or display on
Dell monitor.
Everything else with
still function normally
and you can actually
use the Telemedicine
stations as normal. The
video will only be
displayed on the
Surface 3 monitor
Reconnect power cord
at back of monitor.
Test functionality
6. Unplug “mini-
display” port cable
from the back of
Surface 3 docking
station to simulate
No display on Dell
monitor but the
monitor still has power.
The display will
indicate that the
monitor is searching for
Reconnect min-display
cable at back of
docking station. Test
functionality

46
no video display on
DELL monitor
the signal. Everything
else with still function
normally and you can
actually use the
Telemedicine stations
as normal. The video
will only be displayed
on the Surface 3
monitor
7. Remove Surface 3
from docking
station and place it
loosely on docking
station stand to
simulate an
incorrect dock.
This can be done
with or without
power on
on and boot up if
battery is charged. No
video will be displayed
on 24” monitor.
Nothing else will work.
Place Surface 3
properly in docking
station. This can be
done while powered up
and the stations should
recover and function
normally without the
need to restart. If not,
shutdown, restart and
test functionality
8. Plug HorusScope
cable into the
cradle instead of
the handle to
simulate
HorusScope
unable to connect
Everything will work
fine except for the
HorusScope. When you
try and connect
HorusScope, it will not
connect and will display
a message to connect
OtoScope
Plug cable directly into
HorusScope handle
and test functionality
9. Put HorusScope
streaming video in
background to
simulate
HorusScope
connected and
streaming but
cannot see the
video
Everything will be
working but you will
not be able to see the
HorusScope video
Click on MD Matrix
Quick Launch icon
and click on
HorusScope image to
bring the HorusScope
streaming video into
the foreground window
10. Don’t connect
General or Ear
HorusScope
attachment fully to
No video in
HorusScope small LCD
screen. The
HorusScope will
Fully turn lens ¼ turn
and then disconnect
and reconnect
HorusScope by

47
simulate
HorusScope
connection issue
connect but will not
stream any video
clicking on icon. Test
functionality
11. While in
Telemedicine
Session, disconnect
Doctors station
from network to
simulate a network
connection end on
the remote doctors
side
This problem may not
be immediately
obvious….but the first
thing that you will
notice is no audio. The
next thing that happens
is that the video will
stop streaming and
then the Telemedicine
session will be
disconnected
Reconnect Doctor
station to Wi-Fi. In real
life situation, ask
Doctor to observe
messages on his screen
and to check his/her
Wi-Fi connection. Test
functionality
12. Disconnect USB
cables from either
or both OtoSim
base unit and
interface box to
simulate bad
connection on
OtoSim devices
All Telemedicine and
other devices will
function normally.
There will be a message
at the bottom middle of
the OtoSim screen
when you open the
software that “device is
waiting to connect”.
Also, the Monitors:1
message on the left will
now state Monitors:0
Reconnect USB cables,
verify error messages
go away, and retest
OtoSim software.
13. Turn off power
switch on bottom
of mouse to
indicate faulty
mouse
Mouse will not work
but touchpad and
touchscreen will work
normally. System
functionality will be ok
Turn on switch on
bottom of mouse
14. Switch off
Bluetooth on
Surface 3 via
Bluetooth settings
to simulate
unpaired
Stethoscope
Telemedicine software
will still connect.
Neither Stethoscope
will show up.
Everything else will
look ok until you try
and connect
Stethoscope. An error
message will come up
Turn on Bluetooth via
Bluetooth settings.
Test functionality

48
stating that the “system
could not Bluetooth
antenna and to check
and ensure Bluetooth is
enabled
15. Remove or
“unpair” 3M
Stethoscope to
simulate
Stethoscope not
paired.
Telemedicine software
will still connect.
Everything else will
look ok until you try
and connect
Stethoscope. The other
Stethoscope will show
up in the Stethoscope
manager window
Go through
Stethoscope pairing
and connecting
process in 3M
Littmann manual. Test
functionality
16. Disconnect
external camera
from either system
The video will still work
fine as it will be using
the Surface 3 camera.
The external camera
icon will not come up
in the Telemedicine
window
Reconnect USB cable
and test functionality

49
(f) Important Contacts
CONTACT CONTACT INFO FUNCTION
Marcela Velez-
Pulgarin
905-8459430 x4057 or
marcela.velezpulgarin@sheridancollege.ca
Program Manager -
Telemedicine Facilitation
Program – Sheridan College
Alicia Bose 647-299-9306 or alicia.bose@sheridancollege.ca
aliciabose@gmail.com
Telemedicine Facilitation
Instructor - Sheridan
College
Hayley White 905-459-7533 ext 32273 or
hayley.white@sheridancollege.ca
Program Officer –
Technology, Health and
Culture - Sheridan College
Ryan Green 905-459-7533 ext 5602 (direct) or ext 2510 (main
IT helpdesk) or ryan.green2@sheridancollege.ca
Tier 2 Support Specialist –
Sheridan College
Ashley Misurka 905-459-7533 or
ashley.misurka@sheridancollege.ca
Nursing lab Leader –
Sheridan College
David Cooper 647-242-8994 or david.cooper@rogers.com
david.cooper1@sheridancollege.ca
Telemedicine Equipment
Specialist – Sheridan College
Dr. Nayyar Razvi 905-330-9828 or nayyar@md-matrix.com Chief Medical Officer – MD
Matrix
Basil Rafikalli 647-822-9230 or
basil@md-matrix.com basil.rafikalli@gmail.com
Technical Support – MD
Matrix
Mike Redekop 587-990-3436 or mike.redekop@telus.com Project Manager/Trainer –
Telus Health
Telus Technical
Support
1-888-781-5553, option 1 or online –
https://www.telushealth.co/health-
solutions/electronic-medical-
records/support/?solution=med-access-emr
Telus Technical Support
Hotline/Chat
Vito Forte (416) 813-6846 or vito.forte@sickkids.ca CTO – OtoSim Inc.
Brian Carrillo (647) 717-5182 or brian.carrillo@sickkids.ca R&D/Technical Support –
OtoSim Inc.
Robert May 416-697-7017 or rmay@cbcitelecom.com Director of Sales – CBCI
Telecom (Avizia
HorusScope)
Avizia Technical
Support
1-888-637-7605 or online –
https://www.avizia.com/contact
Avizia Technical Support
Hotline/Chat
3M Littmann
Technical Support
1-800-228-3957 or 1-800-563-2921 – or online at
http://www.littmann.ca/wps/portal/3M/en_CA/
3M-Littmann-CA/stethoscope/customer-
service/contact-us/
3M Littmann Technical
Support Hotline Chat
Robbie Kennedy (905) 470-6665 or robbie@kennedysalesparts.com Fore Tenn Marketing Sales
(Luxor Telemedicine Carts)

50
(g) Technical Requirements/Specs
 MD Matrix (MD Matrix has standardized on the Microsoft Surface
Platform)
Minimum system requirements
CPU: Intel® Pentium® Dual Core 1.2 GHz or faster
RAM: 2 GB
Free of hard disk space: 200 MB
OS: Windows 7/8/8.1/10
Internet access with Up Link and Down Link bandwidth from 2 Mbps or
higher.
 Telus Med Access EMR
Reliable and High Speed Secure internet connection
Telus Med Access Web EMR: Citrix receiver software has to be installed.
MD Matrix Local EMR: EMR Advantage Tablet software has to be installed.

51
 Equipment Model and Serial Number Info

52
(h) Appendix A – Telus EMR Config
In order for the Telus EMR to function optimally, there are browser settings
for configuring Med Access. Configuring these settings will allow Med Access
to perform successfully.
For the Sheridan Telemedicine setup, we have only IE installed. However, the
settings for Google and Firefox are listed here for future reference or
configuration.
Internet Explorer
Settings-130116-1444-16.pdf
IE 11 Opening links
from other programs.pdf
Google Chrome
Mozilla Firefox

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