Demonstration Outline

Attached is a brief outline for a Holter Demonstration. This outline centers on the User Interface.

The Holter System is a flexible system allowing the user to have:

A totally Hands Free One Button Holter Report.

OR

A complete Morphology Editing, Superimposition Analysis,

and QRS Editing / Review System.

The attached demonstration outline focuses on the operator interface.

With the Holter System the user uses only the features and functions they require to obtain the report they desire. The system is capable of operating in a totally automated mode. The system can also be used to go to the most detailed level of editing where a single QRS may be Added, Deleted or declared Artifact for the report.

Holter Software Demonstration Outline

After installation start the Holter Software either from a Windows ICON or from the

Start | Programs Menu.

If the Holter Program is not registered the following Dialog Box will appear:

Select OK. The system will allow all system operations with the Demonstration (DEMO) recording only.

If the demonstration program is being run NO setup items need to be entered or checked. Before a Holter Recording is loaded into the system there are many Setup items that can be changed. Among these are:

  • Physician Information
  • Report Configuration
  • Full disclosure – channel to include in the report (can be 1, 2, 3, or all).
  • Full Scale Strips – Number of automatically included Strips in the Report.

– Number of Compressed Strips per page (4, 6, 8, 12, 16, 24, or 36).

  • Standard Report – Print the Standard Report.

– Print the Compressed Strips with the Standard Report.

  • ST Analysis Channels in the Report.
  • Line Weighting for the Printed ECG
  • RR Interval Analysis.
  • Display Settings.
  • Language for the Report.

Once these setting are set they are written to the Windows System Register for the Holter Application and then are used for each procedure. The can be changed after a patient is loaded but are then valid only for that patient.

Note: If the actual software is being used the user must check to be sure the

Setup |Select Input Device is set to the Compact Flash Card Reader. The correct Disk Drive letter can easily be checked in the My Computer ICON (usually in the Top Left portion of the windows display). This will be either “removable Disk” or PCMCIA drive depending upon which is being used.

Once the Holter Software is running select the Patient Button from the TOOLBAR.

The Patient Entry Dialog box will appear.

Enter the Patient Last Name as DEMO (This must be typed exactly as is - including capitals - otherwise the system will NOT run the demonstration data).

The Holter software will read the demonstration data from the disk drive (C) rather than the Flash Card Reader. After reading the ECG Data the Holter Software will then analyze the ECG data.

Once the Holter Software has read and analyzed the ECG data a blank (white) screen will appear.

The operator can then Review and Edit the results or print the report.

To Review and Edit the results first select the Morphology Class Button from the TOOLBAR.

There are several Morphology classes detected by the analysis on DEMO recording.

To demonstrate this window:

  • Move the mouse cursor over each of the Templates.
  1. In the Single Morphology Template Window (right side) will be displayed all channels of each Morphology Template.
  2. In the Status Bar (Bottom of Screen) will be displayed the total counts of the QRS’s in each class (template) and the Morphology Class Number as the mouse is moved across the screen.
  • Left Click on the first Morphology Class.
  1. The #1(The Morphology Template with the most QRS’s) Morphology Template will be highlighted.
  2. Left Click in the Single Morphology Template Window.
  3. By continuing to left click the individual QRS’s will be displayed in the right hand window and also “in context” on the top “Full Scale” ECG Window.
  4. Select the small (NOT the large) Superimposition Button in the Window TOOLBAR.

All the QRS’s in the selected morphology class will be displayed in a superimposed format.

This is especially useful if a large quantity of QRS’s are in a Morphology Class (i.e. > 1000).

  1. The Superimposition can be started and stopped by selecting the Small Superimposition Button on the TOOLBAR.
  2. The QRS’s can also be viewed in single step fashion by clicking the right (back) or left (forward) mouse buttons in the Single Morphology Template Window.
  • If the analysis of the Morphology Classes was incorrect from this window the following operations can be completed.

Morphology Templates

The user can select up to 12 templates to put the computer detected templates into.

Declares the entire morphology template Supraventricular Ectopics.

Declares the entire morphology template Normal.

Declares the entire morphology template Artifact.

All the above operations are completed on an entire Morphology Class.

Presents all QRS’s within the Morphology Template in a separate window.

To view all the QRS’s in a specific Morphology Class (template) select the Button. The specific Morphology Class (template) must be highlighted.

  • A 40 X 40 matrix (possibility of 1600 QRS’s) will be displayed. The initial matrix size is adjustable in the Settings menu item.
  • The Individual QRS’s can be can be made (GREEN) by clicking on them. Then the appropriate operation can be selected.

Declares the single QRS Supraventricular ectopics.

Declares the single QRS Normal.

Declares the single QRS Artifact.

Note: In the Morphology Display the Mouse Right Button selects the “from”Morphology and displays a RED Box around the morphology. The Mouse Left Button selects the “to”Morphology and displays a GREEN Box around the morphology.

To Review The Automatically Selected Arrhythmia Strips select the View Selected Strips is selected.

A Dialog Box will appear to select:

  • All Strips
  • Report Strips.
  • Individual Arrhythmia Strips.

Select the All Strips Check Box and the following will appear:

A 4X4 display of All the detected ECG Strips.

Depending upon the size of the users display the size of the matrix can be changed in the setup menu item.

By moving the mouse over the ECG Strips the Status Bar will Display:

  • Heart Rate of the ECG Strip.
  • Arrhythmia Type of the Strip.
  • Time of the ECG Strip.
  • If the ECG Strip is included in the Report.

By “Double Clicking” on any of the Arrhythmia ECG Strips the Selected ECG Strips is displayed Full Screen. By “Double Clicking” again the 4X4 ECG Strip display is again presented.

By Right Clicking on any of the ECG Strips. The following Dialog Box is Displayed.

The operator can:

  • Add an ECG Strip to Report by selecting the ECG Strip is included in the Report.
  • Add a specific comment to the ECG Strip for printing with the Report.
  • Manually set the Maximum or Minimum Heart Rate for the report strip.
  • Declare the ECG Strip Artifact.
  • The Specific ECG Strip
  • The Full Disclosure Page that was viewed
  • Define a start time and End time for the artifact Declaration
  • Set the system to print the calipers with the ECG strip.

To view the ECG is the Classic Superimposition Format, select the Superimposition Button from the TOOLBAR.

  • The Superimposition Display can be started and stopped by the left mouse button.
  • When the Superimposition Display is stopped the Full Disclosure and Full Scale Displays will automatically be updated to the time.
  • From the menu item View ECG. The Superimposition Display can be viewed in 1, 2, 3, or 4 BEAT format.

To review the Heart Rate Graph along with the ECG Select the Heart Rate Button from the Main TOOLBAR.

To review the ST Graph along with the ECG Select the Heart Rate Button from the Main TOOLBAR.

Select the ST Graph Channel to view.

To review the Abnormal Graph along with the ECG Select the Heart Rate Button from the Main TOOLBAR.

To review the QT Graph along with the ECG Select the Heart Rate Button from the Main TOOLBAR.

To review the Arrhythmia Tabular Summary along with the ECG Select the Heart Rate Button from the Main TOOLBAR.

To see the specific ECG corresponding to a specific area on the Graph or the Table “Double Click” the area in question. The Full Disclosure ECG and Full Scale will automatically be updated to the highlighted area. By left clicking in the Full Disclosure the Full Scale will automatically be updated to the pointed to time. A RED box will appear around the selected area in the Full Scale Display.

The Graphs can be ZOOMED by pointing the mouse cursor above and to the left of the desired area. Hold the Left Button down while moving the mouse to the right. The selected area will be darkened. When the left Button is lifted the Graph will now display the highlighted (darkened) area. This operation can be done again to further highlight the desired area (To ZOOM OUT - the View ECG menu item has the Zoom Out function).

The ECG Strip Editing functions are available if the mouse is pointing to an area of ECG (Note the Window MUST be active -Left Click). By Right Clicking over and area of ECG the operator can:

  • Add or Delete an ECG Strip to Report by selecting the ECG Strip is included in the Report.
  • Add a specific comment to the ECG Strip for printing with the Report.
  • Declare the ECG Strip Artifact.
  • Declare the area around the ECG Strip Artifact (20 Minutes)

The Single QRS Edit functions are available from the Full Scale ECG and Full Disclosure ECG Display.

Morphology Templates

The user can select up to 12 templates to put the computer detected templates into

Declares the entire morphology template or single QRS Supraventricular ectopics.

Declares the entire morphology template or single QRS Normal.

Declares the entire morphology template or single QRS Artifact.

The Artifact Editing Function is available from the Full Scale ECG and Full Disclosure ECG Display. This is used on the Full Disclosure and Full Scale ECG Displays.

  • Select the Declare Artifact Function .
  • Select a START Time with the Left Mouse Button
  • Select the End Artifact time with the Left Mouse Button.
  • A Dialog box will appear asking if the QRS’s should be declared artifact or normal.
  • After selecting Artifact or Normal the system will automatically reanalyze the ECG Data. This operation can be made manual by selecting the Edit Menu item and checking the Analyze On Command item. Also in the Edit Menu Item is the ANALYZE ECG DATA. This will analyze the Arrhythmia Data when selected.

To view the Full Disclosure ECG select the Button.

Select the “Full Disclosure” to view the ECG in Compressed + Full Scale mode.

1. “Left click” either of the Tool Bar Buttons below.

2. Select the Edit Artifact Mode.

  • The QRS Colors will automatically be turned on.
  • The Status Bar will show the current mode and if a start time or an end time is to be selected.

Edit Artifact mode is on.

The cursor will select a start time.

  1. The system is now in the Edit Artifact mode.

The First “Left” Click will define the Start time.

The second “Left Click” will define the end time.

  • The Full Scale ECG will be displayed above the Full Disclosure ECG.
  • The Full Disclosure ECG can be displayed in 3, 6, or 12 minute formats
  • All Channels of ECG data are always displayed.
  • The Mouse is used to give specific information about the ECG in the Status Bar:
  • Time.
  • Heart Rate.
  • QRS ST level.
  • QRS QT Distance.
  • The Full disclosure and ECG Displays can be changed by “grabbing” the Scroll Bar on either of the Displays and going to the desired time.

To see the QRS Morphology Class Analysis or the Detected Arrhythmias on the display in color. Select the QRS / Arrhythmia Color Button . A Dialog Box will appear asking the user to select whether or not to color the QRS Morphologies of the Arrhythmias. If selected these colors will appear on either the Full Scale ECG or the Full Disclosure ECG Displays.

The Arrhythmia coloring is as follows:

The Atrial Arrhythmias are colored BLUE

The Ventricular Arrhythmias are colored RED

The ST Arrhythmias are colored YELLOW

Operator added ECG Strips are colored GREEN

The QRS Morphology Class coloring is as follows:

The QRS Morphology Classes # 1 are colored RED

Artifact is colored Magenta

To display arrows to the QRS”s select the Tool Bar button. Arrows will be displayed along with the individual RR intervals in milliseconds.

Some other useful functions available from the Full Scale ECG and Full Disclosure ECG Displays are:

  • A page of Full Disclosure can be easily included in the Report by selecting the Include Full disclosure in Report Button . The operator can tell whether or not an area of ECG is already included by moving the mouse over the area in question and whether or not the Full Disclosure is included will be displayed in the Status Bar.
  • The Full disclosure can be set into an Automatic Paging Mode with the Automatic Page Button .

The ECG Gain can be changed by select the desired gain factor or or .

The ECG Speed can be changed by select the desired speed factor or or or .

To print the Report select the Print Report Button from the TOOLBAR.

Note: Printing of the ECG may require special setup on the Printer. For examople on the HP 1100 Laser printer the printer should be set to operate in the raster mode. If the raster mode is not set the printout of the Full Disclosure ECG can take an extremely long time to complete.

Some of the other options and settings for the system are highlighted below:

  • One Button Operation: Before the patient data is loaded go to the Setup option on the Menu bar and select the Automatic Report print function. The system will automatically print the final report after analysis.
  • Total Cover Page Programmability: Edit the Cover Page Template ion the Programs\HOLTER USA\Ambulatory ECG directory (See Help for instructions). This will allow the operator to create a totally unique Cover Page (even in the local language).
  • Printout ECG Strip Size. The ECG strips can be printed in several miniature formats: 2, 4, 6, 8, 10 12, 16, 24 or 32 per page. Before the patient data is loaded go to the Setup | Report Configuration option on the Menu Bar.
  • Arrhythmia Settings: All Arrhythmia Settings can easily be changed in the Setup | Analysis Parameters area.
  • Patient Diary Entries: The patient Diary Entries can easily be entered from the Setup | Patient Diary Menu item. A dialog Box will appear to enter times and comments. These entries will be highlighted as operator ECG Strip Entries (GREEN if Arrhythmia Color Selected).
  • File Storage: The Holter files are stored as 1 Complete File (Patient Information, ECG Data and Analysis results). This file is named by the Patient Last Name + Date + Time. This allows the user to easily use off the shelf storage devices (I.e. Read/Write CD’s) to store all the Holter information.
  • Report Selection: The Final Report Pages are ALL Selectable and can be automatically included or excluded in the report.
  • Windows Registry is used for Application Information: All Settings set before a patient is loaded are stored in the Windows Registry. This means these SETTINGS NEED ONLY BE SET ONCE but can easily be changed at any time.

Some of the unique features about these presentations are:

  • All these tables have the standard Windows Cut and Paste to the clipboard function enabled.
  • The reason the minute tabular summary was added is that research institutions always wanted the data minute by minute to be feed into their analysis programs. By using cut and paste (Edit / Copy), Edit Cut, Edit Paste) this becomes an easy process.
  • A report Summary is automatically entered into the windows clipboard. The user can use this to copy (“CTL V”) a summary of the report into the EMR (Electronic Medical Records) system.
  • A pdf printer driver can be loaded and the report printed to a pdf file. This allows the user to email a copy of the report.

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