3M Littmann TeleSteth Online Auscultation System User Manual Version 2.6.X

3M Littmann TeleSteth Online Auscultation System User Manual Version 2.6.X Page 1 of 18

TABLE OF CONTENTS 1.0 General Information... 3 2.0 Getting Started... 6 3.0 Hosting & Joining a Real-Time Streaming Session... 9 4.0 Streaming Session Features... 10 5.0 Uploading, Downloading & Reviewing Auscultatory Recordings... 12 6.0 TeleSteth Software Account Information... 14 7.0 Methods and Technique for Proper Auscultation... 15 8.0 Troubleshooting... 16 Page 2 of 18

1.0 General Information 1.1 General Overview of 3M Littmann TeleSteth System 3M Littmann TeleSteth Online Auscultation System was developed to extend the practice of auscultation (listening with a stethoscope to situations and environments where face-to-face encounters are not always convenient or feasible. This platform allows healthcare professionals to share heart, lung and other body sounds with colleagues located across the globe using the internet or a private network. The TeleSteth System is designed to be accessed from a user s PC and is compatible with the 3M Littmann StethAssist Heart and Lung Sound Visualization Software. For organizations requiring users to access stethoscope sounds from within their private network, the TeleSteth System can be deployed using the Local Client Server Solution. 1.2 Intended Use The TeleSteth System is intended to provide and control the real time data transfer of body sounds between two 3M Littmann Electronic Stethoscopes Model 3200 over a data network. Patient body sounds may be remotely evaluated in realtime or in store-and-forward mode. The TeleSteth Online Auscultation System can be used on any person undergoing a physical assessment. 1.3 Operator Profile The TeleSteth System is designed to be used by anyone who is familiar with the Model 3200 stethoscope and who wishes to transfer body sounds over a data network in real time. The TeleSteth Online Auscultation System user manual provides complete information on how to operate the software program; thus no additional operating training is required. 1.4 Functional Description The TeleSteth System provides for the real-time transmission of body sounds from one Model 3200 stethoscope to another Model 3200 stethoscope over a data network. The sound captured by the stethoscope chestpiece at the Patient site can be heard equivalently at both the Patient and Consulting sites through the Model 3200 s stethoscope s binaural headset. Page 3 of 18

Both site s 3M Littmann Stethoscope Electronic Model 3200 are connected to a Microsoft Windows -based personal computer (PC) via a Bluetooth wireless link. The two PC s are then connected to each other via a central server over a TCP/IP data network. 1.5 Safety Information Consult instructions for use This user manual provides instructions for use of the 3M Littmann TeleSteth Auscultation System System and assumes that all users are familiar with the Windows operating system. It is recommended that all personnel who operate the TeleSteth System thoroughly read and understand this user manual. Please retain these instructions for future reference. A CAUTION or NOTE used in this user manual will be boxed and will have the following significance: CAUTION: Indicates a situation in which the software may present inaccurate or incomplete information to the user. NOTE: Information that is considered important to emphasize. 1.6 Minimum System Requirements 1 gigahertz processor 512 megabytes available hard disk space 512 megabytes RAM Network bandwidth of 1.5 megabits/second Java 1.6.0 through Java 1.8.0 Windows Vista, Service Pack 2 (32 bit) Windows 7 (32 and 64 bit) Windows 8 (32 and 64 bit) Windows 8.1 (32 and 64 bit) Windows 10 (32 and 64 bit) USB 1.1 port to support a Bluetooth dongle using the Microsoft Bluetooth drivers Microsoft Internet Explorer versions 8, 9, 10, or 11 Microsoft Edge 1.7 IT Network Requirements A standard TCP/IP based network with DHCP or static IP address assignment. Connectivity is supported via hardwire (i.e. CAT5) or wireless Page 4 of 18

(i.e. 802.11g). The minimum dedicated bandwidth required per active Consultant/Patient Site connection is 100kbps. The 3M Littmann TeleSteth Software requires communication through a TCP/IP port assignment. The application uses bidirectional TCP/IP communication. The port utilized by the application is in the range of 1100-1300 (For the Local Client Server Solution, the port range can be changed using the administrator application). The TeleSteth Software incorporates SSL encryption techniques to encrypt the network communications between the Patient Site and Consultant applications. 1.8 Bluetooth USB Dongle Requirements Compliant with Bluetooth V1.1 Interface: Compliant with USB 1.1 & 2.0 Working distance: 5-10m U.S.A. ONLY CAUTION: Federal law restricts this device to sale by or on the order of a physician. NOTE: The 3M Littmann TeleSteth Online Auscultation System should only be installed on a PC that meets the System Requirements. NOTE: The 3M Littmann TeleSteth Online Auscultation System will only function with the 3M Littmann Stethoscope Electronic Model 3200. NOTE: The USB dongle device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 1. This device may not cause harmful interference, and 2. This device must accept any interference received, including interference that may cause undesired operation. FCC NOTE: THE MANUFACTURER IS NOT RESPONSIBLE FOR ANY RADIO OR TV INTERFERENCE CAUSED BY UNAUTHORIZED MODIFICATIONS TO THIS EQUIPMENT. SUCH MODIFICATIONS COULD VOID THE USER S AUTHORITY TO OPERATE THE EQUIPMENT. Page 5 of 18

1.9 Patient Privacy The 3M Littmann TeleSteth Online Auscultation System is not designed to include individually identifiable health information in order to function. Records can be stored and recalled through the use of a timestamp or an arbitrarily assigned identifier. If you do use personally identifiable health information with the TeleSteth System, you should understand that the privacy and security of certain individually identifiable health information may be protected by state, federal, international, and/or foreign laws that regulate and restrict how such information can be used, disclosed, stored and transmitted. In some instances, you may even be prohibited from permitting any third party to access such information without first obtaining prior written authorization to do so. You are solely and fully responsible for determining, understanding, and complying with any and all laws that affect how you may store and transmit any electronic individually identifiable health information through use of the TeleSteth System. If you determine that you are not able to comply with a law or restriction that applies to your use and disclosure (including transmission) of individually identifiable health information through the TeleSteth System, then you should not proceed to use the system. By proceeding to use the TeleSteth System, you hereby assume all risks, responsibilities and liabilities associated with using, storing, and/or transmitting such information, including sound files, electronically or otherwise. 2.0 Getting Started 2.1 Installing the USB Bluetooth Adaptor (Dongle) A USB dongle allows communication between the PC running the TeleSteth System and the 3M Littmann Stethoscope Electronic Model 3200. The USB dongle receives and transmits data via the commonly accepted Bluetooth short range wireless connectivity standard. To install the USB dongle, plug the device into an open USB port on the PC. NOTE: The TeleSteth System was designed and validated using the USB dongle, and therefore it is recommended that you use the USB dongle as opposed to an internal Bluetooth radio. Furthermore, the wireless range will likely be better with the external USB dongle. The USB dongle must be inserted into the PC prior to launching the TeleSteth Software. If the TeleSteth Software tries to connect to the stethoscope but does not detect a USB dongle on the PC, the following screen will be displayed: Page 6 of 18

USB Dongle Detection Window 2.2 Launching the 3M Littmann TeleSteth Software The 3M Littmann TeleSteth System is a web-based software tool that is designed to belaunched through a standard internet browser. The web address (URL) that youenter into the internet browser will be dependent upon which TeleSteth Server you are using (3M Hosted USA, 3M Hosted outside of the USA, or a Local Client). In the USA, you can connect to 3M Hosted Server by entering http://www.littmann.com/telemedicine/launch in the address bar. If you are connecting to a 3M Hosted Server outside of the USA, contact your local 3M Representative for the correct URL. If you are using your institution s Local Client Server instead of the 3M Hosted Server, contact your institution s IT or telemedicine department for the correct URL. A valid username and password is needed to log into the TeleSteth Software. When the application appears, sign in using your username and password. 2.3 Pairing & Connecting the Stethoscope to the TeleSteth Software To connect a 3M Littmann Electronic Stethoscope Model 3200 to the TeleSteth Software for the first time, it is necessary to pair the stethoscope and the software. To initiate the pairing process, go to the Real-Time Streaming Session tab and make sure that Add Scope appears in the field under the My Stethoscope heading. Then, click on the circular stethoscope icon located to the left of My Stethoscope and follow the instructions on the pop-up window that will appear. Page 7 of 18

3M Littmann TeleSteth Real-Time Streaming Session Tab Make sure Add Scope is selected in this drop-down field NOTE: Prior to pairing or connecting a 3M Littmann Stethoscope Model 3200 to the 3M Littmann TeleSteth Software, make sure the stethoscope is not currently connected to any other open Littmann stethoscope Software such as 3M Littmann StethAssist Software. An easy way to ensure this is to simply turn stethoscope off and then back on again. The screen below will appear each time a stethoscope is attempting to connect to the TeleSteth Software. Stethoscope Connection Window Page 8 of 18

2.4 Connecting Your Stethoscope Once a 3M Littmann Stethoscope Electronic Model 3200 has been paired to the 3M Littmann TeleSteth Software, that stethoscope can now be connected. To connect the stethoscope, follow these steps: 1. Turn the stethoscope on and click the (M) button on the stethoscope 2. Press the (M) button again to select CONNECT 3. Make sure the stethoscope s ID appears in the My Stethoscope field on the Real-Time Streaming Session tab, and then click the circular stethoscope icon located to the left of the My Stethoscope field. NOTE: When the stethoscope is connected to the TeleSteth Software, the Stethoscope Connection button will display a green check mark. If the stethoscope is not connected, the Stethoscope Connection button will display a red X. NOTE: Multiple stethoscopes can be paired to the TeleSteth Software, but only one stethoscope can be actively connected to the TeleSteth Software. 3.0 Hosting & Joining a Real-Time Streaming Session To initiate a real-time streaming session, click the blue Host a Session button on the upper right side of the TeleSteth Real-Time Streaming Session Tab. When the Host a Session button is clicked, a Session ID for the streaming session will appear below the button. This Session ID needs to be provided to the remote site. To join the streaming session, click the blue Join a Session button on the upper right side of the TeleSteth Real-Time Streaming Session Tab and enter the Session ID that has been provided by the Patient Site. NOTE: The Patient Site clinician should Host the session while the remote consultant/specialist should Join the session. The acoustic sounds stream from the site that hosts the session to the site that joins the session. The site that hosts a session will be referred to as the Patient Site while the site that joins a session will be referred to as the Consultant. Page 9 of 18

If the Patient Site stethoscope is not connected to the 3M Littmann TeleSteth Software when the Host a Session button is clicked, a pop-up window will appear instructing the user to put the stethoscope in CONNECT mode. The Session Status icon indicates the connection status between the PC and the TeleSteth Server. If the Session Status icon is green, the PC is connected to the TeleSteth Server and the session is active. If the Session Status icon is red, the session has not been started or the session has been terminated. TeleSteth Real-Time Streaming Session Tab Session Status icon: Green indicates an active streaming session. The streaming session ID will be listed here. 4.0 Streaming Session Features 4.1 Shared Waveform Display During an active streaming session, the rectangular window at the bottom of the Real-Time Streaming Session tab displays the waveform for the incoming signal from the Patient Site stethoscope. This waveform is simultaneously visible at both sites. A blue colored waveform line indicates a good network connection and proper operation. A red colored waveform line indicates that the network connection has been interrupted or stopped. Page 10 of 18

4.2 Shared Scale Selector The Scale Selector, located on the right-hand side of the Shared Waveform Display, provides the user the ability to increase or decrease the volume, or the amplitude, of the heart sounds that is both heard and being displayed at the Consultant site. At the Patient site, the Scale Selector will adjust only the display. The Scale Selector can be controlled by both sites. In situations where the signal is faint, select the High setting in order to increase the volume. In situations where the displayed signal is exceptionally loud and being clipped on the display, select the Low setting. The default setting will be Mid for Medium. 4.3 Shared Auscultatory Site Indicator and Patient Posture During an active streaming session, both sites have the ability to adjust the position of the white dot on the blue torso image and/or select the patient posture, and any change to these features is seen immediately at both sites. During an active streaming session, the Patient Site clinician may wish to use these features to inform the Consultant as to patient site and/or posture. Alternatively, the Consultant can use these features to guide the Patient Site clinician to the proper patient location and/or posture. The thumbnail images located beneath the blue torso image can be used by both sites to change the large image to a back or side view. The blue Preset Sites button located beneath the thumbnail images can be used to automatically position the white dot over any one of a number of standard cardiovascular and pulmonary auscultatory listening locations. The Other Preset Site selection can be used to convey a listening location that is not available in the provided images. 4.4 Shared Chat Window The right side of the 3M Littmann TeleSteth Real-Time Streaming Session Tab provides an instant messaging chat window for use by both sites. 4.5 Audio Mode Settings During an active streaming session, the Consultant will see an Audio Mode settings box at the top left corner of the Real-Time Streaming Session tab. The Consultant has the option of using the 3M Littmann Stethoscope Electronic Model 3200 to listen to the streaming auscultation, the speaker system inherent to the PC, or speakers connected to the audio jack of the PC, such as headphones, desktop speakers, etc. Page 11 of 18

CAUTION: The audio quality of the sounds played through the PC speakers or PC audio jack may not be a faithful reproduction of the actual sounds due to the acoustical performance of the PC s sound card, sound card drivers, and/or the frequency response of the headphones/speakers, potentially resulting in not being able to hear clinically relevant sounds. It is strongly recommended that a 3M Littmann Stethoscope Electronic Model 3200 is used to listen to the auscultation session as the sound quality at the remote site will be equivalent to what is heard at the local site. The drop-down arrow in the box allows the Consultant to change the filter setting (bell, diaphragm and extended mode) applied to the incoming sounds. NOTE: Aside from the Shared Scale Selector described in Section 4.2, the filter setting and the volume level are independent for the Patient Site and the Consultant, e.g., a change to the filter setting or the volume level on the Patient Site s stethoscope during an active streaming session does not affect the sound the Consultant hears, and a change by the Consultant to the on-screen filter setting does not impact the filter setting on the Patient Site s stethoscope. NOTE: Do not use this software to send or receive any other types of sound other than those indicated by this manual and the Intended Use statement. Doing so may result in sounds that are not reproduced as expected. 4.6 Shared End Session Button Both sites can terminate a streaming session at any time by clicking the blue End Session button. NOTE: For patient data security purposes, exit or logout of the 3M Littmann TeleSteth System at the conclusion of the session. 5.0 Uploading, Downloading & Reviewing Auscultatory Recordings NOTE: The Uploading and Downloading feature is not available on the Hosted TeleSteth Server. Page 12 of 18

5.1 Uploading Previously Recorded Files Auscultatory recordings saved in the 3M Littmann StethAssist Heart & Lung Sound Visualization Software can be uploaded to the 3M Littmann TeleSteth System. To upload files of this type, go to the Upload tab in TeleSteth Software (shown below) and follow the four simple listed steps. TeleSteth Upload Tab 5.2 Downloading Previously Recorded Files To download auscultatory files that have been uploaded to the TeleSteth System for your access, go to the Download tab in TeleSteth Software. If files are available for download, the files will appear in a list at the top of the window. Use ctrl + click (or Shift + click) to select the files you wish to download. NOTE: Files in bold have either never been downloaded or they contain changes that have not yet been downloaded. NOTE: Files may become unavailable at a predetermined time following the last upload. Page 13 of 18

3M Littmann TeleSteth Download Tab 5.3 Reviewing Previously Recorded Files 3M Littmann StethAssist Files downloaded from the 3M Littmann TeleSteth System can be opened and reviewed within the StethAssist Software. 6.0 TeleSteth Software Account Information The My Account tab in TeleSteth Software displays the account holder s username along with the email address to which account-related messages are delivered. This tab also displays the expiration date for the account. To extend a subscription or to initiate a new account, contact 3M Littmann Stethoscopes at 1-800-327-5380 (U.S.A. only). The My Account tab also contains links to change the account password or security questions, view the end user license agreement, view this user manual, and change the language within the application. Page 14 of 18

Additions or deletions to your contact list can be made on the My Account tab. The contact list stores the usernames of other 3M Littmann TeleSteth Subscribers (when uploading an auscultatory recording to the TeleSteth Software for transfer to another TeleSteth Subscriber, you must enter his or her TeleSteth Username). 7.0 Methods and Technique for Proper Auscultation When using the 3M Littmann Electronic Stethoscope model 3200, there are several techniques that are important to consider that can substantially improve your auscultation experience. a. The sound sensor, where all sound acquisition occurs, is quite small and located in the very center of the chestpiece (lift the edge of the diaphragm and look for the indentation under the white sticker). The area around the sound sensor does not contribute to sound acquisition. Therefore, it is important to focus the point of contact with the patient on the very center of the chestpiece. b. Only light contact is necessary with the Model 3200 stethoscope. This includes both the handling of the stethoscope and the contact on the patient. Excessive pressure on the patient may result in artifact sounds. c. Contact with the patient must remain steady and consistent for optimal sound quality. Movement of the chestpiece against the patient will induce frictional noise. d. It is a best practice to start your auscultation exam at a lower amplification level. Then, if you are trying to listen to a difficult-to-hear sound, adjust the amplification upward. Using the amplification on an as needed basis will help reduce distracting noises during your exam. Finally, it is important to recognize the difference in technique between nonelectronic and electronic stethoscopes. Holding the Model 3200 stethoscope lightly, making light contact with the patient, focusing the point of contact on the center of the chestpiece, and remaining steady will assure the highest sound quality auscultation experience. Page 15 of 18

8.0 Troubleshooting Problem Potential Cause Solution Cannot connect to stethoscope No USB dongle installed/usb dongle not properly installed Install USB dongle. See Section 2.1 of this user manual titled, Installing the USB Bluetooth Adaptor (Dongle) USB dongle not detected USB dongle not detected The USB dongle is inserted after the TeleSteth Client is launched Stethoscope not paired Each unique Stethoscope ID can only be connected to one stethoscope Excessive stethoscope motion Only one Bluetooth radio can be active on any one PC at any one time. Disable the internal Bluetooth radio. Update the Bluetooth driver on the PC to the Windows Generic Bluetooth Radio Close the TeleSteth Client and relaunch Pair the stethoscope. See Section 2.3 of this user manual titled, Pairing & Connecting the Stethoscope to the TeleSteth Software If your office has multiple stethoscopes, make sure you are trying to connect to the correct Stethoscope ID. Hold the stethoscope with a steady hand and lightly press against the patient s skin while auscultating. See Section 7.0 of this user manual titled, Improving Sound Quality. Page 16 of 18

Problem Potential Cause Solution Users see a Bluetooth Connection Poor Bluetooth reception.. This can be caused by: Error when 1) Low battery in the streaming. stethoscope Cannot connect to remote site 2) No line-of-sight between the stethoscope and the dongle 3) A user covering the stethoscope head (i.e. the antenna) with his/her hand 4) Other system processes competing for limited system resources on the PC (e.g. WiFi, virus scanner, etc) 5) Not running on dedicated hardware (e.g. using a Virtual Machine, Citrix,etc) No internet connection TeleSteth Server is unavailable Use the external Bluetooth dongle. Ensure clear line of sight from the stethoscope chestpiece and Bluetooth dongle. Use a USB elbow adaptor or a USB extender cable to improve antenna transmission. Check the network connection and try again Server is in maintenance mode. Contact the IT department For questions or concerns regarding to the 3M Littmann TeleSteth Online Auscultation System or the 3M Littmann Stethoscope Model 3200, please contact our customer service hotline at 1-800-228-3957, or visit www.littmann.com to find your local country 3M Littmann Stethoscope website, view Frequency Asked Questions, or send an email via the Contact Us page. Page 17 of 18

3M, Littmann, StethAssist and TeleSteth are registered trademarks of 3M. Windows is a registered trademark of Microsoft. Bluetooth is a registered trademark of the Bluetooth SIG, Inc. Page 18 of 18