manual herzklang database version 2.2.1 version 20161101-02

Manual herzklang database version 2.2.1

version 20161101-02

Herzklang Services GmbH & Co KG

Eggersallee 15

22763 Hamburg

Germany

fon + 49 [0]40 556 201-181

fax +49[0]40556201-188

[email protected]

www.herzklang-services.com

Manual herzklang database version 2.2.1 – page. 1 / 27

herzklang database is a software designed to examine, edit and organize your hrv-data as well as order, play and distribute „Your Personal Herzklang“ for your clients. In addition to this functionality it ofers a PDF export sheet ofyour HRV analysis, enables you to send messages to your exclusive herzklang live users and can act like a network due to it s server based . The scope of the software is to make „Your Personal Herzklang“ available to the therapist, to be used in the context of a therapy e.g. Herzklang-Therapy, assist the therapist with organizing the HRV data and handle the communication with the therapists' exclusive herzklang live users.

Your herzklang database account is set up to work seemlessly with the herzklang pro software. Herzklang pro is our software for recording HRV-data. It also ofers realtime monitoring of essential HRV-markers and an easy to use upload functionality for your HRV-data into your herzklang database account. You can use any other recording-software to accquire your HRV-data, as long as it provides you with a CSV-fle-export that meets our fle-formating specifcations to import it into herzklang database.

Installation:

No installation is required other than an up to date browser-software (e.g. frefox, chrome, safari) on your computer or tablet and a working internet connection. Herzklang database is a web-app and running entirely inside your browser.


Start up:

Please make sure you have a working internet connection and open the following link: www.herzklang-database.com

Please log into your herzklang database account with your username and password provided to you by Herzklang-Services.

The frst time you log into your herzklang database account you will be asked to agree to our terms of use. (fg. 02) This is necessary to protect Herzklang-Services GmbH & Co. KG and its’ ofcers and employees against any claims in respect of any losses you sufer in connection with the use of the herzklang pro application. Please DO NOT sign of on the terms of use, if you disagree or do not understand the conditions laid out in the terms of use to full extent, as you will be held responsible for any violation of the agreed terms of use.

The terms of use are also available in the about section of our website: www.herzklang-database.com for future reference.Please scroll to the bottom of the agreement and click on the checkbox on the left „I agree“ and click „OK“ to agree to our terms of use and to proceed with the login.

Terms of use window (fg. 02)


http://www.herzklang-database.com/

http://www.herzklang-database.com/

Menu bar:

Herzklang database is structured like a website – even though it is an application running in your browsercommunicating with our server via a secure https connection. On the left you will see the words: patients, analysis, audio, account, about, logout. (fg. 03)The currently selected view is high-lighted in gray (e.g. patients). All available views are white (e.g. account, about, logout), all currently unavailable views are shown grayed out (e.g. analysis, audio).

Menu bar (fg. 03)

Patients View:

Here you will fnd all patients registered in your database account (fg. 04). You can sort them by clicking on the column-names (e.g. First Name, Last Name, Last Record Date). If you have currently no patients registered you can add patients by clicking „Add Patient“ on the right hand side.

Patients View (fg. 04)


Patient Details:

You can view the patients' detailed information by clicking on any feld in the line of the patient (fg. 05) Now you can also edit the patients data, by clicking on the designated buttons.

Patient Details (fg. 05)

Add Patient:

Click on the „Add Patient“ button on the right to add a patient to your herzklang database account.

These Text-felds are mandatory: Frist Name, Last Name, Country, Language, Gender, Birthday, Height, WeightYou will be prompted with an error message if one of these felds is not flled out correctly.

These Text-felds are optional: Title, Email, Phone, Medication, Conditions, Comment

It is however advisable to fll out at least Email and Phone, since this information may be needed later to distribute „Your Personal Herzklang“ or to use our messenger.

Add Patient Window (fg. 06)


Delete Patient:

Click on „Delete Patient“ to permanently delete a Patient from your herzklang database account.

PLEASE NOTE: since this is a web app there is no undo functionality in place – if you deleted the patient then there is no way to get back the data! This includes the herzklang live-key as well as all records that were stored in the patients' account.

Edit Patient:

Click on „Edit Patient“ to correct any mistakes, or change the personal data of the patient.

Edit Patient Window (fg. 07)

Show Record:

If you click on the „Show Record“ button it will take you to analysis view and show the latest record in the patients' account. For detailed Information please refer to the chapter analysis view.


Send Message:

This button is only available if the patient is one of your exclusive herzklang live users. Herzklang live is a software that enables your patient to record HRV-data at home and send it directly to the patients' account for your expertise. This makes it easier to collect HRV-data and to monitor HRV trends over bigger timeframes. By clicking „Send Message“ you can send your exclusive herzklang live patient a message of up to 512 characters, which is sent to the patients' email adress and is going to be displayed at startup in the patients' herzklang live application. (fg. 08)

Messenger Window herzklang live (fg. 08)


Analysis View:

If you select a patient in the patient view, you are presented with a new option in the menu bar: analysis

Select analysis view to:

1 add and edit records 2 select from a list of stored records3 view a detailed analysis of the selected record4 order „Your Personal herzklang“5 Export a PDF of the records analysis6 Send messages to your exclusive „herzklang live“ users

analysis view (fg. 09)


1 Add and Edit records:

Add Record:

Click on the „Add Record“ button to add a record to the patients' account. Record Date, Record Time are autoflled-out with the current date and time. They can be edited to the actual date and time the recording took place. Please stick to the formatting as shown in grey letters to the right of the Record Date and Record Time feld. Height and Weight are autoflled from the patients' current personal data, but can be changed in case the data is not correct.

PLEASE NOTE: All data is exclusively stored with the record, so you can keep track of what may have infuenced the HRV-data on a case by case basis. Also height and weight might change as the patient grows up, gains or loses weight, which can be of interest later.

Click on the „Import Samples“ button to select a fle from your browser.

Click on the „Clear Samples“ button to clear all samples.

You may as well copy and paste samples (numbers that represent the time between the RR Spikes of an EKG in ms)into the gray outlined window to the left of „Samples:“. It is possible that you have to experiment with the formatting, as there is no common standard on how to store HRV-data. Comma separated integers should always work, as well as linefeed separated integers.

NOTE: The length of the Imported data should not exceed 30 minutes in total. Depending on the HRV-data itself the app will truncate samples that exceed the bufersize of the application, which is somewhere around the 30 minute mark calculated from samples.

Click on the „Cancel“ button if you wish to abort the procedure.

Add Record Window (fg.10)


Print Record:

Click on the „Print Record“ button to export the analysis of the currently chosen selection of the record as a printable PDF document. (fg. 11 & 12) You may want to use this feature to share the data with other entities involved with the therapy of your patient, hand it out to the patient, or include it in your referral letter.

PDF export page 1. (fg.11)


PDF export page 2. (fg.12)

Delete Record:

Click on the „Delete Record“ button if you wish to delete the currently chosen record.

PLEASE NOTE: since this is a web app there is no undo functionality in place – if you delete the record there is no way of getting the data back!


Edit Record:

Click on the „Edit Record“ button if you need to edit the currently chosen record. Please refer to „Add Record“ to read all detailed information about editing a record.

Edit Record Window (fg. 13)

Send Message:

Click on the „Send Message“ button if you want to send a feedback to you exclusive herzklang live user. Please refer to the „Send Message“ on page 7 for detailed information about it s functionality.

Artefact Correction:

Click on the „Artefact Correction“ button to apply an artefact correction to the HRV-data. Should the recording show serious dropouts it is possible to repair artifacts which would make the recording unreadable otherwise.

PLEASE NOTE: This processing is permanent and can not be undone later. If you wish to revert to the raw data, youwill need to edit the record and re-import your data from the original source! However typically it is not desirable to revert to the raw data since it can be assumed that the artefact correction was applied to improve the overall readability of the HRV-data.


2 Select from a list of stored records:

If you have more than one record in your patients account, you can easily swap from one record to another by clicking on the dropdown menu (fg. 14) to the right of „Record:“, and selecting the record you want to view, edit or order as „Your Personal Herzklang“. Once you selected the record by clicking onto the date in question all displays will update to the new record.

Select Record (fg.14)

3 View a detailed analysis of the selected record:

Selection Window:

herzklang database provides you with a great number of markers to help you interpret the HRV-data as accuratly as possible. All displayed values refer to the selection window (fg.15) You can click-drag the selection window to move it along the timeline in order to isolate specifc parts of the record for examination.

Selection Window (fg.15)


Selection Window Size:

You can alter the size of the selection window in up to 3 steps (fg.16)depending on the length of your record:1 minute, 3 minutes or 5 minutes.

NOTE: The window sizes 3 + 1 and 5 + 2 are only relevant for ordering „Your Personal Herzklang“ since special technical requirements have to be met in order to work with algorithms. Please refer to „4 order Your Personal herzklang“ for more detailed information about how to order „Your Personal Herzklang“.

Select Selection Window Size (fg.16)

Analysis Header:

Here you can fnd all general information that will not vary with the currently selected record.

Analysis Header (fg.17)


Analysis Personal Data:

Here you can fnd all information associated with the currently selected record. (fg.18)

State: shows the state of the record. This can be „New“, „Ordered“, or „Delivered“ according to it s status as a „YourPersonal Herzklang“ order. If the records' State is „Ordered“ it is locked and can only be viewed as is.

Height: shows the height of the patient that was measured when the recording was added.

Weight: shows the weight of the patient that was measured when the recording was added.

Medication: shows the medication if notes were taken when the recording was added.

Conditions: shows the conditions if notes were taken when the recording was added.

Comment: shows the comment if notes were taken when the recording was added.

Created: shows the date and time when the record was added, and by who. Ideally the date and time were edited to match the actual date and time the HRV-data was recorded.

Updated: shows the date and time when the record was edited, and by who.

Sample Count: shows the exact number of samples detected by herzklang database.

Duration: shows the exact length of the record in seconds.

Sample Size: shows which size of the selection is currently used.

Selection: shows the start-time and end-time of the currently selected selection.

Analysis Personal Data (fg.18)


Analysis Health Trends:

herzklang database provides you with information of great detail about your HRV-data. We make great eforts to meet the scientifc needs and standards of the HRV-science. But with great power comes great responsibility, and it takes high expertise and an in depth knowlege of the HRV-science to interpret and make sense of all the information and to fnally arrive at a detailed medical report.With health trends (fg.19) we have accumulated the most important markers of the HRV-data into an easy to read display. We will discuss the diferent indicators in detail below, but as much as we would like to have an „on the spot healthstatus detecting diagnosis tool“ it has to be said that health trends can never and in any way be seen as a substitute for a trained therapists’ or specialists’ expertise. That being said, we can still ofer an easy to understand and up to date tool to evaluate the health of an individual based on its’ HRV-data taking into account the current state of the scientifc knowlege of the HRV-science.

stress: This indicator shows the ratio of VLF in percentage. A high ratio (40+) of VLF in the hrv-signal indicates a highstress level.

regulation: This indicator shows the standard deviation also known as SDNN. The SDNN is commonly associated with the sympathetic activity of the autonomic nervous system.

recovery: This indicator shows the standard deviation root mean squared also known as RMSSD. The RMSSD is commonly associated with the parasympathetic activity of the autonomic nervous system.

balance: This indicator shows the ratio of LF in percentage. A high percentage of LF in the hrv-signal is usually associated with a well balanced ratio of sympathetic and parasympathetic activity. The autonomic nervous system will however in most cases tend towards either the sympathetic or the parasympathetic side in response to its’ current requirements. NOTE: The data taken into account for the health trend is all data available to the selection window.

Analysis Health Trends (fg.19)


Analysis Heart Rate Diagram:

This diagram shows the entire recording with the heartrate (bpm) in relation to time (hh:mm:ss) and time of the recording (hh:mm:ss). All statistical values shown are refering to the selection-window (white).

Analysis Time Domain Values:

This section shows the most common statistical time domain based values. Please visit https://en.wikipedia.org/wiki/Heart_rate_variability for further reference.

heartrate distribution: This diagram shows the quantity of occurances of intervals within its dedicated bandwidth.

Analysis Time Domain Values (fg.20)


https://en.wikipedia.org/wiki/Heart_rate_variability

Analysis Frequency Domain Values:

time domain values: This section shows the most common statistical time domain based values.

frequency distribution: This diagram shows the frequency response of the FFT-spectrum analysis of the hrv-data. Itis split into 3 bands that are most commonly used to examine the ratio of sympathic and parasympathic activity, aswell as a tool to detect the ratio of the scored respiratory sinus arrhythmia in which case the FFT-spectrum will show a clear peak typically around 0.1hz .

power distribution: This piechart shows the power ratio of each band of the FFT-spectrum analysis in percentage. High VLF ratios indicate stress, high HF ratios indicate hypersensitivity and high LF ratios indicate typically a good balance between symathetic and parasympathetic activity. The ratio of LF is signifcantly increased for sections of the recording that show respiratory sinus arrhytmia.

Analysis Frequency Domain Values (fg.21)


4 order „Your Personal herzklang“:

Ordering „Your Personal Herzklang“ will produce additional costs, which are defned in detail in the basic agreement you signed with us to use this premium on demand service.

To order „Your Personal Herzklang“ the selected record needs to exceed 4 minutes in total length. Idealy the lengthof your record exceeds 10 minutes in total so you get the chance to select a part of the recording that is showing the best marker values. Due to our processing we need 7 minutes of HRV-data in total to deliver excatly 5 minutes of audio, as indicated by the white 5 + 2 minute selection window. (Full Mode)

NOTE: Please always apply artefact correction to the record in order to get the best results from our processing. If your recording contains a lot of artefacts (e.g. very large samples) it may not qualify after artefact correction has been applied.

To order „Your Personal Herzklang“ please select one of the available Herzklang Order Modes from the sample sizedropdown menu (fg.25):

3 + 1 min – Herzklang Order (Quick Mode) : This mode will produce up to 3 minutes of audio, depending on the HRV-data.

5 + 2 min - Herzklang Order (Full Mode) : This mode will produce exactly 5 minutes of audio.

Select Order Mode (fg.25)

Please include the part of the record that you wish to hear as „Your Personal Herzklang“ in the selection window. (fg.26) You can click-drag the selection to move it along the timeline. It is good practise to select a part of the recording which shows the best marker values.

Defne Order Selection (fg.26)


When you have sucessfully applied artefact correction to your record, selected the part of the record you want to hear as „Your Personal Herzklang“ in either „3 + 1 min selection mode“ or „5 + 2 min selection mode“ you can order„Your Personal Herzklang“ by clicking on the „Herzklang Order“ button (fg.27).

This option is only available in one of the two available Herzklang Order modes from the Sample Size dropdown menu!

Order „Your Personal Herzklang“ (fg.27)


Order Details „Your Personal Herzklang“:

Ordered by: Shows the accountable Herzklang Partner for the order.

Patient: Shows the Patient Account of the respective record to be ordered.

Recorded: Shows the registered date and time of the recording.

Download Code: Shows a 13 digit number which enables the patient to download the exclusive „Your Personal Herzklang“ mp3 version. This makes it easy for you to distribute the fles - all you need to do is to send the download code to the patient. We suggest to wait with handing out the download code until after the one on one listening session with the patient.

Email-Adress for Download Code: Please fll out this feld with the desired Email-Adress. The download code will be sent automatically to this Email-Adress. The default setting is the Email-Adress of the doctor / therapist. >>> Please check!

Optional Audio CD: You can choose from „no audio CD“ to up to 3 audio CDs of „Your Personal Herzklang“.

NOTE: Ordering an audio CD produces additional costs to the order, which are defned in detail in the basic agreement you signed with us to use this premium on demand service.

CD Language: You can choose the language of the CD packaging. Currently you can choose between German and English.

Delivery Address: Please fll out the delivery address for easy distribution of the physical CD. The default setting is the address of the accountable Herzklang Partner, as we assume that the doctor / therapist want s to present the CD to the patient in person.

Comment for Admin: You can leave a comment with your order, that is directly sent to the adminstrator for review.e.g. request for express handling of the order, additional billing information, or other requests associated with the respective order of „Your Personal Herzklang“.

Order Details (fg.29)


Click on the „Order“ button to place the order. You will be presented with a confrmation of the order window showing your order details. (fg.30)

Confrmation of the Order (fg.30)

General information about „Your Personal Herzklang“ orders:

The order will be processed as fast as possible and are available online ususally within 48 hours from Mo. - Fr.

Orders placed later than 15:00 h on a friday will be available on the following tuesday 15:00.

If you need your order to be processed and online within 24 hours please contact us for express handling of the order.

Once your order is processed and is available in the patients' account, you will receive an email from the administrator.

We will invoice all orders on a monthly basis.

CDs will be packed within 48 hours. Shipping time will vary, depending on where you live, and which shipping-option you choose:

Standard Shipping (3 – 4 days)

Express Shipping (1 – 2 days)

Courier Shipping (1 day)

Shipping costs are defned in detail in the basic agreement you signed with us to use this premium on demand service.

5 Export a PDF of the records analysis:

Please refer to the „Print Record“ section on page 10 /11.

6 Send messages to your exclusive „herzklang live“ users:

Please refer to the „Send Message“ section on page 7.


Audio View „Your Personal Herzklang“:

Herzklang database provides your with a powerful audio player (fg.22) that was developed to suit a wide range of playback situations for the use in the context of your therapy sessions. With „Your Personal Herzklang“ we ofer a diferentiated auditory system for therapists and patients for the musical representation of HRV-data. It is a algorithm based sonifcation of the HRV-data and can be (to a certain degree) interpreted like the statistical values shown in the analysis view just by listening to the audio. We will not argue that it also provides you and your patients with a fascinating and entertaining listening experience, but our original scope was to process the audio based on HRV-scientifc research as much as possible to create a direct access to the otherwise abstract data, and to trigger a neural efect that is described by Othmer by which the brain will auto detect its „Your Personal Herzklang“ as a familiar dimension and will recognize and correct harmful elements by itself.

A spectral print of the audio is shown to provide you with a detailed view of the audio components of „Your Personal Herzklang“. Initially 3 of the 4 audio components are playing and shown: Heartbeat (red), Melody (green) and Harmony (blue). The brighter the color, the louder the respective audio component will be in the mix you hear. The fourth audio component is called Spectrals (white) and is a representation of the three commonly used frequency spectrums VLF,LF and HF. We fgured that this audio component, though it provides very useful information, can be quite irritating to listen to and have therefore turned it of as the default setting.

Your Personal Herzklang Audio Player (fg.22)


Audio Player Options:

Audio Player Options (fg.23)

1. Play-Button: Click on this button to start the playback. It will toggle into a Pause-Button which can be useful if you want to stop the playback but resume later from this playback position.

2. Stop-Button: Click on this button to stop the playback. It will also take you directly to the top of the currentselection.

3. Loop-Button: If this option is enabled the player will cycle through the loop defnded by the left and right selection handle (5.). If the option is disabled (grayed out) the player will stop at the right selection handle, and jump back to the top of the current selection.

4. Playhead: The vertical line shows the actual playing position. You can click-drag the handle below it to jump directly to a desired playback position within the current selection.

5. Selection Handles: to the left and the right of the spectral print which represents the audible audio you fnd a handle on each side. You can click-drag them to select a desired area in the timeline of the audio.

6. Playback-Volume: You can adjust the overall playback volume with this slider7. Playback-Mute: Click on this button to instantly mute all playback of the player. 8. Timeline: The timeline shows the length of the recording, as well as the length of the recording in relation

to it s registered recording time. 9. Time: Shows the exact time position of the playhead in minutes and seconds. Shows in brackets the exact

time position of the left and right selection handle in minutes and seconds.


Audio Track Options:

We take care to make „Your Personal Herzklang“ sound great. So generally speaking you don t need to adjust the levels of the audio components at all to listen to „Your Personal Herzklang“. You may however wish to adjust the levels in order to either accomodate your patients listening preferences or to adjust for the needs of your listening environment. In some situations it may be desirable to isolate e.g. the heartbeat to demonstrate how it modulates with the breathing pattern. You can adjust the level of each audio component with its dedicated slider. You can mute and unmute an audio component by clicking on the designated button.

Audio Tracks (fg.24)

Account View:

Here you can view and edit all your account settings. (fg.31)

Username: Shows your login and can not be changed or edited. If you need to have your username changed or edited please contact the administrator.

Role: Shows your authorization level and can not be changed.

Title: Shows your doctors' degree or title of nobility.

First Name: Shows your frst name

Last Name: Shows your last name

Address: Shows your registered adress

Email: Shows your registered email address

Phone: Shows your registered phone number

Created: Shows the date your account was created

Updated: Shows the date your account was last modifed


Account Details (fg.31)

Account Update:

Click on the „Update Account“ button to change your account settings.

Account Update Details (fg.32)

Change Password:

Click on the „Change Password“ button if you need to change your password. (e.g. if you feel it might be compromised, or a change of staf makes it necessary)NOTE: If you forget your password please contact the administrator.

Account Change Password Details (fg.33)


About View:

Here you can fnd all legal information about our terms of use and Herzklang-Services GmbH & Co. KG

Logout:

Click on „Logout“ to log out of your account to prevent misuse of the sensitive data.NOTE: If you do not use herzklang database for 20 minutes you will be logged out automatically to prevent misuse of your account.


manual herzklang database version 2.2.1 version 20161101-02

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