Manage

1. Manage Triage Customize Integrate LifeStream™ Manager Basic Training October 2013 Compatible with LifeStream Version 4.11 CP352.01 Honeywell Confidential – Do not forward or distribute

2. LifeStream Manager Basic Training Module Length: Approximately 60 minutes Best Practice: Access to the LifeStream Manager application is recommended if completing training as a self-study, or in conjunction with HomMed Clinical Consultant training Evaluation: LifeStream Application Competency – C3002.03 Honeywell Confidential – Do not forward or distribute

3. Training Agenda • What is LifeStream Manager? • User Interface Overview • Login • Tool bars and navigation pane • Icons, filters, and hover feature • Data Management • Creating lists to customize your application • Admitting Patients into LifeStream • Clinical Management • Familiarizing yourself with Current Status • Responding to patient data or ‘Charting’ • Utilizing reports to share information across the care continuum

4. Create a More Complete Picture of Patient Health LifeStream Manager helps streamline clinical workflows while improving coordination throughout the care continuum. Through the consolidation of patient biometric data from Genesis Touch and Genesis DM monitors, care providers can effectively monitor patients for more informed clinical-decision making . Customized care plans can be created to tailor the way patient care is delivered, and enable clinicians to manage multiple patient populations across a variety of risk factors. LifeStream Manager Overview

5. Indications for Use LifeStream receives, displays, and stores monitored biometric data for review and interpretation by qualified healthcare professionals after patients complete their scheduled biometric collection LifeStream is not intended for emergency use and does not provide real-time, critical-care monitoring of patient vital signs * Reference the LifeStream Product Manual for a complete list of warnings and cautions for use

6. LifeStream Manager Benefits Improve quality of care Create a more complete picture of patient health by expanding the type of information being monitored, and analyze trends over time Help patients stay healthy at home by providing reliable and continuous clinical oversight Easy to use Manage a large number of patients at any time Generate a wide range of reports to help demonstrate the value of your telehealth program User interface offers care providers the ability to modify how patient data/workflows are viewed on their desktop Flexible, customized solutions Customized user interface increases care provider efficiencies by providing a holistic picture of the patient’s condition

7. User Interface Overview

8. LifeStream Manager Login To begin, enter your username and password into the login screen Note: • Before you can view and work with patient data or perform other tasks in LifeStream, your LifeStream Administrator must enter you into the system as an authorized user. • Only you should use your user name and password. Sharing user names and passwords may violate your organization’s privacy policies and could result in a violation of patient privacy.

9. Home Screen Overview Title Bar Menu Bar Tool Bar Icons Navigator Pane / Quick Select

10. User Interface Navigation Feature Action The Title Bar provides the name of the application, the name of the patient selected for review and the window control buttons in the upper right corner. Title Bar The Menu Bar features a series of menus that control the operations of the Application. Clicking on any menu title opens up a drop-down box of options and commands that control the Application. Menu Bar The Toolbar contains navigation icons that open up various screens for the user and provide common features of the application along with certain specific screen commands. Tool Bar Hint: Hover over any icon for a description of the tool

11. User Interface Navigation Feature Action Navigator Pane The Navigator Pane, located on the left side of the Home Screen, offers the most common options available for each user’s role and privileges. Quick Select displays ACTIVE patient names associated with the site/category selected , replacing the Navigator Pane temporarily. Quick Select

12. Password Settings Only the assigned user should use this user name and password. Sharing user names and passwords may violate your organization’s privacy policies and could result in a violation of patient privacy. • LifeStream security relies on every user maintaining their own User Name & Password • To change password go to: • Tools • Change Password • User access hints • LifeStream requires passwords between 6 and 16 characters in length. For security purposes your password should include both letters and numbers (alphanumeric) • LifeStream will default to the Login screen if left idle for 30 minutes • You will not be prompted to change your password on a scheduled basis, but it is recommended that you do so periodically, or according to your organization’s IT security policies

13. Individual User Settings • User Settings: Located under Tools • The Vitals pane can be turned on or off in User Settings. If this option is turned off, some of the features may not be visible. • Font size may also be adjusted. • Column Selection: • To select which columns appear hover over one of the existing column headers and right click to select Column choices. • Click and drag columns to reposition them once you have made your selections.

14. Data Management

15. Data Management Functions Organizational Navigator: Creating Lists Care Provider Diagnoses Equipment and Manual Entry Monitor Insurers and Medication Sites and Categories

16. Organizational Navigator Field Best Practice: To avoid duplication and/or multiple sites and categories, assign one owner of data management functions Define ownership responsibilities in your telehealth policies and procedures

17. Creating Lists: Care Providers 3. Add, Edit, or Delete Care Providers 2. Review Care Provider Types and enter additional types, as needed 7. Click Save 1. Click Care Providers 4. Enter the provider data 6. Phone and Address 5. Designate as Category (optional) • Note: • To edit an existing Care Provider, select their name from the Care Provider list

18. Creating Lists: Diagnosis 2. Choose Add Diagnosis 3. Enter Diagnosis (Required) and ICD Code (optional) 4. Check Patient Category box to designate as a Category (optional) 1. Click Diagnoses 5. Click OK

19. Creating Lists: Equipment List • Equipment List allows you to: • Edit Equipment Status / Location • Assign Selected Equipment • Unassign Selected Equipment • Replace Equipment • Add Notes

20. Creating Lists: Equipment List Manual Entry Monitor in Equipment List: Utilizes Clinician Entered Vitals Allows for patients to be on manual vitals collection only, without a physical monitor Allows switching to a real monitor at any time without loss of data Behaves as a real monitor Allows user to set a schedule (reminder for calling patient for readings) Requires a monitor number utilizing the PIN number 7 digits and 3 additional alpha numeric digits.

21. Admitting Patients into LifeStream

22. Admitting Patients: Overview The process of adding patients into LifeStream involves the following series of steps: • Identify the patient and provide their demographic information • Identify the patient’s emergency contacts, who may include family members, friends, neighbors, and/or care providers • Assign care providers who are responsible for the patient’s care • Assign insurer(s) who are responsible for reimbursements • Assign patient diagnosis(es) • Set alert limits, which identify a range of vital sign parameters for each patient Best Practice: • While you are not required to enter data into all patient fields, the more details you can provide, the better record you will have for each patient

23. Admit a Patient: Search Patient Records 1. Select the ADMIT PATIENT Icon 2. Enter the first and last names 3. Search All Sites 4. SEARCH RESULTS: Duplicate Record Existing Patient Found? Select the Correct Patient from the list of patient names Click the Use Selected Patient button. New Patient? a. Click the Create New Patient button b. The Demographics page is automatically displayed. If no match is found – demographics page will be displayed

24. Admit a Patient: Demographics 7. Title Bar displays the patient name AFTER Saving 6. Save 2. Patient Demographics: Shaded fields are required - include as much data as possible. 1. Select a Site from the drop down menu to group patients assigned to similar sites 3. Custom Fields may be tailored by the Administrator 4. Outcomes Questionnaire: Refers to Vital Sign questions directed to the patient 5. Enter PatientPhone Number (s) The more complete information you have on each patient, the more robust your system will be.

25. Add Patient Contacts 1. Add Contact Icon 2. Required fields are highlighted in yellow 3. Choose Relationship to Patient and click OK

26. Assign Care Providers: Doctors, Nurses, Therapy 1. Edit Care Providers 2. Search For, and Choose Care Provider 3. Highlight Care Provider, Click Left Arrow to Assign

27. Assign Insurers 2. Add Insurer 3. Choose Insurer 4. Click Primary and OK 1. Click Insurer • Note: • All other fields are optional • Only Primary Insurers are displayed on the LifeStream screens and Standard reports

28. Assign Equipment 5. Verify Patient 6. Click Assign to complete the process 2. Click Monitor Tab 3. Find Monitor: Sort by Serial Number column, or use Search field 4. Choose desired monitor 1. Click Equipment List • Repeat steps above to assign additional equipment • A monitor must be assigned before adding a Scale or Oximeter

29. Assign Diagnosis 2. Click Edit Diagnosis 1. Select Patient Information 4. Click Primary 3. Choose Diagnosis, click left arrow to add to Patient Diagnosis 5. Click Close to save • You may choose as many diagnoses as applicable for each patient • If the desired diagnosis is not in the Available Diagnosis list, it will first need to be added into LifeStream under the Organization. Refer to “Creating Lists” training topics for further information

30. Set Alert Limits • Alert Limits are part of the admit process and will be customized for each patient. • Develop vital sign parameters based upon the patient’s history, current assessment and physician’s orders. • Recommendations: • Use a default set of parameters and adjust as needed, or • Use the smart limits and adjust over time Meaningful alert limits assist clinicians with providing timely interventions to prevent or reduce re-hospitalizations. Edit Alert Limits icon • Setting Alert Limits: • All Vital Sign measurements need alert limits set • Each Vital will have a Low and High range entered • Check Alert Enabled to activate each limit and enter a low and high setting • Alert if Missing provides an indicator of Missing Data any time data does not transmit • Monitor for CHF sends an alert with a daily / weekly weight change even when within the pound parameters. • Smart Limits will set alerts limits based on the last received Vital Sign packet • Click the Save icon when complete • Follow the above steps for other peripherals as needed Save

31. Equipment Setup

32. Equipment Setup: Remote Programming Option 4. Remotely program monitors 2. Schedule monitor prompt times 1. Patient | Equipment Setup • Available for remotely programmable monitors with transmission connections • Streamlines the monitoring process by allowing LifeStream users to change options without the need for an in-person patient visit 3. Schedule readings up to 4 times/day • Best Practices: • Monitor daily at the same time to help establish behavior for improved wellness • Schedule Readings whether the monitor is remotely programmable or not • Scheduled Readings notify LifeStream when to expect readings and will generate a Transmit Error if none are received. • Confirm settings on all tabs prior to continuing, including Schedule, Patient Settings, Questions, Peripherals, and Equipment Settings

33. Equipment Setup: Patient Settings • Language: Select the language in which the patient will receive instructions • Only the languages available in the selected monitor will appear • Inflation Pressure: Select the inflation pressure to be used for the blood pressure cuff. • The default inflation pressure is 175 mmHg, and is used only the first time blood pressure is taken after powering up • The monitor saves the last blood pressure reading into memory and the next inflation pressure is 35 mmHG above the last saved systolic reading • To reset the default, power the monitor off, then on again

34. Equipment Setup: Questions • Question Types • Outcomes Questions: • Patient can self-report hospitalizations, ER visits, med changes, or unexpected physician visits • Commonly asked once/week • Check the Outcomes Questionnaire box in Demographics to include in reports • Disease Management Questions: • Associated with educational content • When patient answers Yes to any questions they will be presented with educational content 5. Click Save 2 1 • Choose questions • Click All to ask questions every day of the week, or select specific days only • Incorporate subjective questions with the monitoring process to help further assess patients’ condition • Tip: Up to 10 questions may be selected, but 3 – 5 is most common

35. Equipment Setup: Multi-Level & Expanded Questions • Question Tree structure for selecting and programming questions in LifeStream • Questions arranged into Disease management categories/folders for easy selection • Multi-Level Questions* • Pain Management (NEW Category) • Fall Management (NEW Category) • Patient Satisfaction (9) • Total New Questions (35) * Genesis DM v4.13 ONLY

36. Equipment Setup: Peripherals 1. Select Edit icon on the toolbar 3. Select the Schedule: Customize Daily, Off, First Reading, or All Readings 2. Choose a peripheral 4. Select mode of acquisition if using Genesis Touch: Off, Patient Entered, or Connected Device 5. Repeat steps 1 – 4 with each Peripheral Peripherals must be scheduled and active prior to use When finished setting up peripherals, select the Save icon to activate Unavailable devices on this monitor will be grayed out

37. Equipment Setup: Equipment Settings Configuring Equipment Settings • You have the ability to set up equipment individually, one at a time from scratch, or to use presets. Select the Edit Icon to make changes. • Key fields to adjust include: • Volume • Spoken Vitals • Oximeter Port • Daylight Savings • Verify the BP and Scale are ON • Assign Ports as needed Notes: • Assign only one peripheral to each port • Gray fields indicate not available on this particular monitor, or not remotely configurable.

38. Clinical Management

39. Clinical Management Agenda • Familiarizing with Current Status • Charting:Responding to patient data • Reporting: Share patient data with other care providers across the continuum

40. Current Status • Content Descriptions • Opening Screen displays unacknowledged vitals • Readings pane is in the center of the display • Vitals Display Pane in the upper right corner • Questions Pane immediately below Vitals Display • Graphic Trend of selected vitals displayed Readings Pane Vitals Pane Questions Pane Graphic Trend of selected vitals

41. Customize View • Users may choose the columns to be displayed in the Current Status window based on their preferences • Click and drag columns to change the order in which they are displayed, or adjust column width 1. Hover mouse over any column heading and right-click 2. Select Column Chooser and check all boxes to be displayed

42. Lockout/Read Access Only • Choose the Locked setting to identify when another clinician is working on the same patient to avoid duplication of efforts, or accidentally overriding their work • When active, the lock indicates the chart is in use by another clinician

43. Responding to Patient Data • Respond to Readings Options: • Hold • Acknowledge • Invalidate • Charting: • Responses are a Clinical Record tied to the name of the clinician attached to each action • Comments should follow good clinical documentation practices, including notes to support an “alert” and calls to other Providers • Your clinical documentation should make your Nursing instructors proud!

44. Responding to Patient Data 1. Patient Data being addressed 2. Response Selections 3. Patient Messages Selections • Response Selections: Utilize check boxes for documentation purposes and to run reports within LifeStream • Patient Messages: Clinical may send responses to patient with additional questions or to request a retest (Optional) • Comments: Free-text section for additional information • Invalid/Valid: Erroneous information may be invalidated and re-entered if needed. • Uncheck the invalid vital sign • Add explanation in Comments • Click Save Validity • Note: A reading can only be invalidated BEFORE it is acknowledged 4. Comments section for free text 5. Validation buttons 6. Signature / Completion buttons

45. Place a Reading On Hold Should you place a reading on hold, follow up documentation options include Keep on Hold, Take off Hold or Acknowledge. • Hold allows the user to provide comments to a reading packet when placed on hold and have the reading packet remain on hold. • Three options include: • Place on hold: Place patient on hold • Keep on hold: Document again when on hold, then keep on hold • Take off hold: Take off hold if no longer needed • Best Practice: Create a process within the organization to take off hold and escalate to a different user role in the event that the patient was placed on hold by mistake

46. Clinician-Entered Vital Signs: Overview • Clinicians may manually enter vital signs in the event of a transmission error • Clinician Entered manual packet will display in current status • The ( C ) indicator identifies vital signs reported by a patient, but entered by a clinician • Clinician-entered vital signs will be tracked and trended the same way as those coming directly from the monitor • Alert limits will apply as normal and manually entered vitals packets will be designated with • a color indicator as to their status. • Note: Clinician-entered vital signs do not • auto-acknowledge previous packets – they • must be responded to like any other vital sign Current Status:

47. Clinician-Entered Vitals: Workflow • Access Clinician-Entered Vitals through: • Tabular Trends • Equipment Setup • Respond to Readings 1. Click icon Click the Icon located on the toolbar to launch the vital sign dialog box: 2. Enter Vital Signs and Date/Time • Separate tabs are availble for core Vitals, Glucose, Peak Flow, and PT/INR • Enter comments prior to saving (optional) • Creates packet on Current status that must be handled like a standard monitor packet • Note: Remember to also identify the Date/Time before saving 3. Enter Comments (Optional) 4. Save

48. Patient Reports: Share Data with Other Care Providers Patient data reports may be exported electronically, or printed, based on preference To print reports: • Select the Print icons on the Tool Bar • Any patient data screen may be printed in LifeStream including Current Status and Tabular Trends • To Customize Reports use the Standard Reports drop down menu Reports include: • Patient Reports: Graphical Trends, Multi-Patient Trends and Tabular Trends • Site Reports: Equipment List, Patient Compliance, Multi-Patient Response • Organization Reports: Clinician Activity, Outcomes Questions & System Log

49. Patient Reports: Tabular Trends • Patient Reports offers many individual and groups of patient reports • Tabular & Graphical Trends are used for individual patient reporting • Multi-Patient Trends may be used for multiple patients filtered by care provider, diagnosis, location, etc. • Notes Reports allows you to review many days of charting on a single page Standard Reports

50. Patient Reports: Tabular Trends • All reports have similar options. Follow the steps below to customize them. 5. Print Report 1. Click Reports Options icon 6. Click Save as Default icon if you wish to reuse the same template next time 2. Select Report Period 3. Select details to be included in report Choose from default Quick Date options, or choose a specific Begin Date and End Date. 4. Preview Report