Implementation Guide for IT / CSU Support

Purpose

As Medicus is a web-based application, the IT support resource requirements are much lower than a fully installed clinical system. However, the implementation of Medicus does require a named IT / CSU support contact who can lead  a small number of configuration and IT related tasks. This could in total require no more than 2-3 days of resource in total.

On-Site vs. Remote Support

Most of the tasks outlined in this document can be actioned remotely, other than hardware configuration tasks, where we require IT engineer on-site support. For a Medicus implementation this would be:

1. 1 days on-site the week before go-live to configure and test hardware e.g. scanners.
2. 1-2 days floor-walking during go-live week for any final configuration and on the day troubleshooting.

Note: if the practice is multi-site then we require 1 IT engineer per site for floorwalking.

Server Requirements

Because Medicus is a web-based application it does not have any on-site server requirements. All connections to the Medicus servers are made using HTTPS on port 443.

Medicus Desktop App Installation

The Medicus system is a web-based application, however, there is a small installation requirement which is the Medicus Desktop App. The Medicus Desktop App is required to enable the physical panic button functionality and to enable the integration with GP Order Comms systems such as tQuest and ICE.

The app needs to be installed on all machines at the practice. This can usually be done remotely and then pushed to all practice devices.

Here is detailed guidance and installation instructions for downloading the Medicus Desktop App: How to Install the Windows Desktop App as a Local IT Administrator

Once live, if there is an update required, we will inform the CSU of this in good time. To update the Medicus Desktop App you should uninstall the old version using the uninstall instructions (included int he guide linked above) and then install the new version. We have designed the app to minimise the need for future updates to minimise the maintenance burden that arises from deploying updates.

Desktop Shortcut

To allow users ease of access to Medicus, we request that a desktop shortcut to england.medicus.health is added to the desktop of all practice devices.

Please include the Medicus logo on the shortcut for clarity.

Scanner Configuration

Medicus is an end-to-end solution for document management which includes receiving documents via MESH, NHS Mail and scanned post. For paper documents received in the post that need to be coded, actioned and filed, Medicus requires the scanner to be configured to scan directly into the Medicus Web Application.

Here is a detailed article on configuring your practice scanner to Medicus: Configuring your Practice Scanners.

Minimum Technical Requirements

In order for your scanners to be able to send documents directly to the Medicus Document workflow, the scanners must:

• Be able to connect to a network - through either Ethernet or Wi-Fi
• Support SFTP or WebDAV (HTTPS) as a scan destination

Scanners that do not meet these requirements (for example, USB-only models or those that only support scan-to-PC or scan-to-email) are not compatible with this workflow.

It is possible to manually upload documents to Medicus from a computer, which is suitable for ad-hoc use but not ideal for an end-to-end document workflow.

Recommended Scanner Models

This Epson model offers the best balance of reliability, ease of setup, and protocol support.

Model	Connectivity	Price (ex. VAT)	Recommendation
Epson DS-790WN	Ethernet and Wi-Fi	£525	Most reliable option. Ideal for practices that want fast scanning and wired stability.

The Epson ES-580W could be a lower-cost alternative, however, it will only work if your practice has strong Wi-Fi. If your practice does not have strong Wi-Fi, ensure it has the ability to connect to the network through an Ethernet Connection.

The Epson ES-580W can mostly be configured from the device screen, while the DS-790WN has similar setup options. Some network and credential details will need to be entered during configuration using the scanner's touchscreen interface.

Step-by-step guides on how to configure some specific scanner models are available here:

• How to Configure an Epson ES-580W Scanner
• How to Configure a Brother ADS-4700W Scanner

If you're configuring another make / model of scanner, then please consult the manufacturing guide for detailed configuration guidance.

Can I Use a Different Scanner?

Yes but only if the scanner:

• Is network-enabled
• Supports SFTP or WebDAV
• Allows manual configuration of hostname, port, path, and credentials

If you're considering another brand please ensure to check the manufacturer documentation.

Important Notes

• Most non-Epson models support SFTP only (not WebDAV).
• Setup can be more involved - often requiring use of a vendor-specific web interface or software tool.
• Make sure that you perform an end-to-end test with a multi-page document (with no patient identifiable information) to ensure that the document is successfully scanned, uploaded, and can be accessed within Medicus.

We do not support scan-to-email or scan-to-shared-drive (SMB) as part of the direct Medicus document workflow.

Networking Scanners

• Scanners using SFTP connect to sftp.england.medicus.health on port 22. The IP addresses associated with this domain name will change over time but are currently 3.9.52.129, 13.40.58.131 and 52.56.135.100. The IP addresses will always be within the AWS eu-west-2 IP address range.
• Scanners using WebDAV connect over HTTPS to {tenant-id}.api.england.medicus.health on port 443. The IP addresses associated with this domain name will change over time but are currently 3.9.148.234 and 18.130.198.14. The IP addresses will always be within the AWS eu-west-2 IP address range.

Printer Configuration

Printers are routinely used in practices for a variety of use cases:

• Printed FP10s or other prescriptions
• Printing of lab request forms and specimen labels
• Printing a manual referral form for a patient e.g. private referral

Each of the above use cases may require printing to a specific template form, and often practices have set up their printers whereby e.g. FP10s in drawer 1 and Lab forms in drawer 2.

As a web based solution, there is no configuration in Medicus to target a specific drawer for a specific use case.

We recommend IT support to run a small number of tests on printing lab forms, labels and FP10 scripts to ensure the paper is aligned correctly, and the printers continue working as expected. Small configuration tweaks for realignment may be required, but this is on the desktop itself rather than within the Medicus system.

Medicus Call-in Board

The Medicus Call-In Board is an optional component that displays messages for patients in the waiting area at the practice to call them in for consultations. It can also display a YouTube video playlist.

Requirements

The call-in board software is a web app like the main Medicus web app and has the same basic operating system, browser and networking requirements.

• For ease of management we recommend using a PC to run the call-in board, attached to one or more large display screens. You can use any model of PC, including small and micro form-factor machines such as from the Dell Optiplex Micro PC or the Lenovo ThinkCentre ranges.
• The PC hardware should meet the Windows 11 minimum specifications (https://www.microsoft.com/en-us/windows/windows-11-specifications). It should also have audio and video outputs compatible with the display screens to be used (see below).
• We recommend at least 8Gb of RAM to guarantee good performance.
• As with the Medicus web app, the PC will need to be connected to your local network and have access to the internet. From a network firewall perspective, the PC must have access to the same Medicus servers / domain names as machines running the Medicus web app. In addition, the youtube.com and www.youtube.com domain names must be accessible if the YouTube video playlist functionality is to be used.
• While you can use a wireless network connection, we recommend a wired connection for best possible reliability.

Display Screens

• Any sufficiently large monitor or television meeting the following requirements can be used:
• Minimum resolution 1920×1080 (Full HD)
• Built-in speakers
• External video input connection matching the call-in board PC
  • Typically HDMI or DisplayPort (DP)
• External audio input connection
  • This can be combined with video input if using HDMI
• For ease of connection we recommend using an HDMI connection so that the audio and video connection can be combined into a single HDMI cable.
• If you wish to have multiple display screens in the same waiting area then we recommend using an HDMI splitter to ensure that all the screens stay synchronised, rather than using multiple call-in board PCs.

Medicus Check-in Kiosk

The Medicus Check-in Kiosk is an optional component that allows patients to check-in for their appointment on a touch screen device, instead of having to go to reception.

Requirements

The kiosk user interface is designed to run in any supported web browser on a tablet or other device such as a desktop that has a touchscreen.

The device must have reliable internet connectivity and should be receiving automatic security updates.

Display Screens

iPads

Any iPad model that meets the following specifications is supported:

• Runs a version of iPadOS that receives security support

For supported versions of iPadOS see https://endoflife.date/ipados and https://support.apple.com/en-gb/guide/ipad/ipad213a25b2/ipados 

Android Tablets

Any Android tablet that meets the following specifications is supported:

• Runs a version of Android OS that receives security support
• 4Gb RAM or greater

For supported versions of Android OS see https://endoflife.date/android 

Other Devices

Any other device that meets the following specifications is supported:

• Runs a supported web browser
• Runs an operating system that receives security support
• 4Gb RAM or greater

Physical Panic Buttons

Medicus has a virtual panic button built into the system. Medicus also offers the addition of a physical panic button for practices to use.

The physical panic button is an Arduino Leonardo-compatible microcontroller that connects over USB as a virtual (CDC) serial / COM port. It is also powered over USB. It runs microcode written by Medicus.

As part of the setup, please ensure the practice has available USB ports in each clinical room and by the reception to accomodate the physical panic button devices. If there are not enough USB ports then you may need to procure USB adapters.

Removing EPS Pop-ups

By default, the NHS Credential Management software has two “annoying pop ups” when signing prescriptions:

There is a way to remove these by adding the following settings to the Windows Registry:

Path: Computer\HKEY_LOCAL_MACHINE\SOFTWARE\Policies\NHS Digital\CredentialManagement

Add these 3 registry keys to disable the pop-ups:

• ShowSigningLoadingSplash (Type = REG_SZ, Data = False)

• SigningConfirmationMsg (Type = REG_SZ, Data = False)

• SigningSuccessMsg (Type = REG_SZ, Data = False)

Notes from previous implementations:

• On occasion, the Credential Management files were not located under Policies. The IT Support moved the files to the Policy folder to exactly match the above set up. This then allowed the changes to apply correctly.
• Note that on some CSU setups the registry keys for NHS Credential Management software may be instead located under Computer\HKEY_LOCAL_MACHINE\Software\WOW6432Node\NHS Digital\CredentialManagement.
• This was located by searching for “CredentialManagement” on the registry of one of the GP practice computers to see where the NHS Credential Management software put its registry keys.

CIS2 Smartcards

Please ensure that all practice devices have the latest version of credential manager installed so users are able to pair their NHS Smartcard to Medicus.

The following RBAC (Role-Based Access Control) Activity Codes are required to perform specific NHS API functions within Medicus:

Most existing Smartcard users will already have the required RBAC Activity Codes linked to their Smartcard. In these cases, no changes to RBAC permissions are typically required. 

Access to individual Medicus modules is managed separately from NHS RBAC permissions. Module-level access is controlled within Medicus in the Staff & User Management module.