Release Notes – Silhouette v4

Silhouette 4.14 Summary

Nov 21, 2022

Silhouette release 4.14 includes the following items:

• Layout improvements for small screens
  SilhouetteCentral has been updated to make the clinical workflows more functional on mobile phone sized screens, down to a minimum viewport width x height of 375px x 667px. This includes most current iPhone models and many Android based devices.

  The changes include updates to the image tracer, the patient banner, the location of buttons and actions, changes to the patient sidebar, and the addition of a breadcrumb to aid navigation.
   
  ARANZ medical has tested different mobile devices, with a focus on Apple iPhones.

• Assessment creation workflow improvements
  There is a simplified assessment creation workflow, allowing more natural flow between reviewing a captured image to creating an assessment using that image and tracing it.

• New Help and About page
  There is a new combined help and about page in both SilhouetteCentral and SilhouetteConnect. The software now carries UDI labelling to help identify the product and is available to unauthenticated users as required by labelling standards.

• New Data Export (CSV) for Users, Clinical Data Access Groups, and Roles
  A new data export has been added, allowing users with appropriate permissions to export a list of user accounts with their assigned data access rights and application permissions in a CSV file format.

  The export is intended to assist with permission and user account reviews. 

• Anonymized usage data is now recorded and included in license request files
  The SilhouetteConnect and SilhouetteCentral license request files now include usage metrics to help clarify enterprise level commercial discussions. Usage metrics are limited to the previous 12 months and only start recording from the upgrade to v4.14.

  Details on the usage metrics recorded can be requested from ARANZ Medical.

• Update to SilhouetteStar 2 software to support TLS1.2 on Wi-Fi
  v4.14 of Silhouette is the first version of Silhouette to include the v1.10 of the SilhouetteStar 2 software, which enables usage with TLS1.2 servers.

• Microsoft Internet Explorer (IE) web browser is no longer supported
  The Microsoft IE web browser is no longer supported when using SilhouetteCentral. In previous versions, the website still operated in IE with some limitations. In v4.14, the support for IE is removed completely.

Silhouette 4.13 Summary

Apr 1, 2022

Silhouette release 4.13 includes the following items:

• Updated permissions and clinical data access controls
  Permissions and data access controls have been split into Roles and Clinical Data Access Groups. Users can now be assigned to more than one role and more than one clinical access group to enhance support for SSO integration.

• A dynamic, per user, patient shortlist
  A new patient shortlist feature keeps track of patients you are most likely to interact with and allows you filter them in a shortlist. Users of SilhouetteLite apps will see improved patient list download times based on their shortlist from app v1.11 when used with v4.13 SilhouetteCentral.

• A new Can Connect SilhouetteStar using WiFi permission
  A new permission has been added to hide WiFi connection barcodes from SilhouetteCentral when the user is never going to use a Wireless SilhouetteStar 2 device.

Silhouette 4.12 Summary

Nov 25, 2021

Silhouette release 4.12 includes the following items:

• SilhouetteConnect Standalone Deployment User Provisioning Changes
  SilhouetteConnect Standalone (non-syncing) deployments now provision a Silhouette user record per Windows user profile.

• SilhouetteConnect Synchronized Mode uses SQL Server Express LocalDB
  SilhouetteConnect synchronized deployments now use a SQL Server Express LocalDB edition database. The database and all other data that is synchronized with SilhouetteCentral is stored in the Windows user profile local appdata folders. In standalone deployments, the SQL Server Express edition is used as the database and data is stored in the programdata folders, common to all Windows users on the PC.

• Organizational Settings are now Available to all Users with the Can Manage Settings Permission
  Organizational setting that were previously hidden from the UI are now available to all admin users with the Can Manage Settings permission.

• Organizational Setting to Set SilhouetteConnect Database Backup Policy
  The backup policies for SilhouetteConnect have been enhanced to include daily and weekly backups, with settings available to set the policy.

• SilhouetteConnect Expires Old Data Archives
  SilhouetteConnect data archives are now deleted if they are older than 31 days when the application starts up.

• Locking, Disabling or Deleting Silhouette User Accounts Invalidated Existing Refresh Tokens
  Refresh tokens used in offline clients (e.g. SilhouetteConnect or SilhouetteLite+) are now invalidated if the user’s account is disabled or deleted in SilhouetteCentral. This forces the user to re-authenticate when they wish to sync the offline client data with SilhouetteCentral.

• SilhouetteCentral User Managers can now Disable or Delete Silhouette User Accounts Provisioned for Externally Authenticated Users
  Silhouette user accounts that were automatically provisioned by an external SSO authentication provider can now be disabled or deleted by a Silhouette user manager, rather than waiting for the accounts too expire based on lack of activity.  Disabled or deleted accounts will automatically be re-provisioned if the user successfully authenticates with the external authentication provider again.

• SilhouetteConnect First Launch Setup Wizard
  A blank install of SilhouetteConnect will now show a setup screen to allow the selection of a deployment mode. This setup screen can also be used to clear data from the installation.

• Tracing Screen Enhancements for Small Screens
  The size of the on-screen stylus for touch interfaces is now adjustable and the toolbar in the image viewer and tracer can be hidden to allow better use of the available screen.

• The SilhouetteConnect Upgrade on Sync Feature has been Removed
  SilhouetteConnect will no longer attempt to automatically update if it detects a version mismatch. The user is now shown a URL they can navigate to manually download the update.
   

Silhouette 4.11 Summary

Jul 9, 2021

Silhouette now includes the following new features:

• Single Sign On (SSO) Integration
  Single Sign On (SSO) using Saml2 is now supported, allowing users to sign-in to Silhouette using their federated identity. Silhouette implements Just-In-Time user provisioning with role assignment based on provided group claims to reduce user management overhead.

• Patient Search Enhancements
  Patient search has been enhanced to allow a unit filter to be applied to the search results and to require user interaction before showing patient data.

• New User Login Flows for Silhouette Client Software
  All Silhouette clients now use web-based login flows (authorization code flow with PKCE), reducing the distribution of user credentials and updating the system in line with best current practice.

• Maximum Offline Session Time for SilhouetteConnect
  SilhouetteConnect now has a maximum offline session time to limit the amount of time it can be used without connecting to SilhouetteCentral. This feature helps reduce the instances of orphaned data.

• Improvements to the SilhouetteCentral Idle Session Timeout
  The session idle timeout can now be configured to a wider range of values and a warning is shown to the user if the idle timeout is about to expire.

• Data Hiding Screen
  A data hiding (pattern hiding) display is shown after a period of inactivity to protect personal information from casual observers.

• Login Banner and System Identification
  A new login screen and unauthenticated landing page can be configured to show a system name and a login banner (system use notification).

• Configurable Help Links
  The system can be configured to use help links to self-hosted websites, rather than ARANZ Medical hosted help documentation.

• Support for Admin Roles with No Clinical Access
  Admin roles can now be created that do not have access to any clinical data.

• Specific Integration Client
  A pseudo user account is no longer required to support system integration.

• PDF Assessment Report can Exclude Unused Notes
  The PDF Assessment Report template has been enhanced to allow unused notes from the assessment to be excluded from the report. 

Silhouette 4.10R2 Summary

Oct 9, 2020

Silhouette now includes the following new features:

• Home User 
  Home User access is an optional licensed feature that allows a Silhouette user account to be created for a patient, providing them with access to review their own patient record and submit images from a personal mobile device. The inclusion of the Home User feature also adds a new administrator role, which enables the administrator to create and edit home user accounts, and grant and revoke access to and from patient records.

• Welcome Email
  Silhouette now includes the ability to configure and send welcome emails to both Clinical Users and Home Users. These emails are a great way to distribute basic instructions and terms of use, as well as important privacy information.

• JPEG Image Capture and Upload
  Silhouette now allows .jpg images to be included in wound assessments. This enables Home Users to capture images of their wounds using their personal mobile phone cameras and send them directly to SilhouetteCentral.

• UI Enhancements to support small screens
  

Silhouette 4.9 Summary

Jul 23, 2020

Silhouette now includes the following new features:

• Area Reduction
  Silhouette can now show the % area reduction when an area measurement is made in a wound assessment. This figure enables clinicians to easily see how well a wound is healing. The area reduction is a % of the area deceased from the wounds baseline measurement and is shown with the number of days since the baseline measurement to provide meaningful context. The area reduction is a dynamic measurement and is calculated for an assessment whenever the assessment is viewed or exported (including when exported in the PDF Assessment Report), taking into account any changes in wound baseline measurement or wound baseline date.

• Wound Baseline Date
  Silhouette now tracks a single wound baseline date for a wound and displays it on the patient and wound timeline. The wound baseline date is used when calculating the area reduction for a wound. The first non-zero measurement on or after the wound baseline date is the wound’s baseline area measurement and is used by subsequent assessments to calculate wound area reduction. Users with appropriate permissions can set the baseline date for a wound to any date an assessment has been performed for the wound. This feature is particularly useful when a decision is made to change the treatment plan for a wound and clinicians wish to monitor the effectiveness of the treatment plan using the wound area reduction.

• Zero Measurements
  Silhouette now allows a user to select an image and record zero measurements for that image. This allows users to explicitly record the absence (healed state) of a wound or other feature of interest in the image. This record zero measurement records 0 measurements for the area, perimeter, length, width, maximum depth, mean depth, and volume for that image. The recording of zero measurements for a given image does not automatically change the wound state with the assessment.

• Persistent Notes
  The persistent notes feature enables the notes from the patient’s previous assessment to be available in a new assessment, helping clinicians to quickly identify important patient notes and significantly reduce the amount of time spent inputting notes at each assessment. Notes set to persist value get a default value copied through from the previous assessment completed for the same patient and wound. The default install includes some notes marked as persistent as a demonstration, specifically notes in the Admission Assessment, Discharge Assessment, and the Wound Assessment. These can be reviewed and removed or added to as required by contacting ARANZ support. 

• The on-screen stylus can be used with all image tracing tools

• Silhouette integration API supports the delivery of discrete values directly to integrated EMR systems as part of HL7 integration
  Silhouette, in combination with the NextGen Connect integration engine, can be configured to deliver captured notes and measurements in OBX HL7 segments. The measurements available are assessment summary measurements and align with the measurements shown in the assessment PDF report.

Silhouette 4.8 Summary

Mar 17, 2020

Silhouette now includes the following new features:

• Patient Merge
  The Data Administration tooling now includes a Patient Merge function for users with the ‘Can Manage Clinical Data’ permission. Patient Merge allows the selection of ‘from’ and ‘to’ patient, moving all images, wounds, assessments, encounters and orders from the ‘from’ patient to the ‘to’ patient.  The ‘from’ patient details are then deleted. Patient data captured for the ‘from’ patient in offline applications will be migrated to the new patient on data sync. The Patient merge function is also supported on the Silhouette Integration Interface to allow for HL7 patient merge requests to be handled.

• Orders and Encounters
  Silhouette now supports the creation, update and deletion of patient encounters and orders through the Silhouette Integration Interface.  Orders can also be deleted by Silhouette users with appropriate permissions.  Assessments performed in Silhouette can be linked to orders and can also be unlinked from orders to correct mistakes. Orders can be marked as completed and can also be reactivated by Silhouette users to correct mistakes. An orders search feature has been added to Silhouette, allowing users to find orders based on status, facility and scheduled date.  SilhouetteConnect will automatically download any patient with an active order scheduled in a configurable number of days into the future. It can also be configured to automatically remove orders on completion. The Silhouette Outbound Integration Interface creates outgoing events for order to assessment linking, unlinking and order status changes (completed). These events can be used in the NextGen Connect integration engine to generate PDF reports of the associated assessments. The fields recorded from HL7 order messages on encounter and order records in Silhouette can be configured by ARANZ Medical staff (e.g. observation request placer field from an OBR segment can optionally be recorded against the order and the assigned patient location from a PV1 segment can optionally be recorded against the encounter in Silhouette).

• SilhouetteConnect – automatically remove patient feature
  The function to automatically remove patients from SilhouetteConnect after a specified number of days has been updated to monitor the last time a patient was viewed in a specific instance of SilhouetteConnect.  It can be set to remove patients not viewed in that instance of SilhouetteConnect for between 1 and 365 days. These settings are organizational settings and can only be configured by ARANZ Medical staff. 

• SilhouetteCentral and SilhouetteConnect tracing screen update
  The image viewing, tracing screens and tools in SilhouetteCentral and SilhouetteConnect have been updated. The highlights are:
  • More of the screen is used to display images.
  • Higher resolution display of images to support better zoom.
  • Mouse mode tracing with drop points and continuous drawing modes.
  • An on-screen stylus for touch screen drawing when adding outlines.
  • Support for both undo and redo.
  • Support for viewing SilhouetteStar laser detections on the tracing screen.
  • Hides lasers from SilhouetteStar images when first opened.
  • Add and remove point functionality for editing outlines.

          See the on-line help for a full description of these tools.

• Can Trace Image permission has been added
  The ‘Can Trace Image’ permission has been added to allow the creation of separate imaging and tracing/reader user groups. On upgrade, existing groups will be granted this permission.

• Additional gender options can be added
  ARANZ Support can now add additional values to the list to support other gender recording requirements. The default notes only have a selection for Male or Female.

• Support for upgrading v3 systems with multiple patient identifiers
  In previous v4 upgrades, v3 systems using multiple patient identifiers were not supported. The upgrade for v4.8 will request that the system administrator select one of the patient identifiers to be the main patient identifier used for searching patients within Silhouette. All other identifiers are migrated to notes on the patient details page.

• Support for upgrading systems that have duplicate wound indexes
  Previous v4 upgrades from v3 systems blocked any upgrades that had patients with duplicate wound indexes (e.g. two wounds labelled A or wound 1). This upgrade allows those wounds to be upgraded, keeping the duplicate index.

• Removes support for wound level SilhouetteLite Assessment
  SilhouetteCentral no longer displays SilhouetteLite Assessments as a special heading under wounds. Any SilhouetteLite Assessments are now treated as Patient Level Assessments and will appear on the Patient Timeline and all Wound Timelines.

• Image improvements for 5MP SilhouetteStar 1 (model number 2005)
  Image captures from the SilhouetteStar model 2005 have been improved to give better exposure and color.

Silhouette 4.7 Summary

Dec 6, 2019

• Silhouette now includes an Automatic Wound Boundary Detection tool.
  • The tool is optionally available to users when tracing wounds or can be disabled by a system administrator if it is not required.
  • The tool is tuned for use with DFUs and returns the best effort boundary detection, allowing users to accept, reject, or edit the result.
• The Silhouette Integration Interface is now an optionally licensed feature that enables:
  • Coldfeed integration of PDF assessment reports from Silhouette.
  • Silhouette patient management using HL7 ADT messages from an EMR, including patient creation, patient updates and patient delete.
• The Silhouette Integration Interface works with an appropriately configured instance of the NextGen Connect integration engine, which requires configuration assistance from the ARANZ Medical Support Team.

Silhouette 4.6 Summary

Aug 19, 2019

• Silhouette now provides the ability to track the state of a wound. Users are able to record a wound opening date and assess a wound as having an outcome of ‘Healed’, ‘Amputated’ or ‘Released from follow-up’.
• Note fields can now have a visibility expression defined that allows them to hide or show based on the user’s selection of another value within the same note group. For example: if “Wound Pain Location” is set to “Other” then a text box called “Other Wound Pain Location” can be shown and required.
• A new wound data export has been added to allow the export of a wound list with all wound state records for the selected patients.
• The CTEULA has been updated, see full CETULA here.

Silhouette 4.5 Summary

May 10, 2019

• Silhouette data administration now has these new tools: Delete Patient, Delete Wound, Delete Assessment, Move Image, Move Assessment.
• SilhouetteCentral to SilhouetteConnect Synchronization improvements.
• Improved web app memory performance when viewing patient and wound timelines.

Silhouette 4.4 Summary

Nov 9, 2018

• Silhouette now provides multi-time zone support enabling the correct sequencing of assessments where the assessments are performed in different time zones.
• Silhouette can now export comma separated values (csv) files of patient and assessment data.

Silhouette 4.3 Summary

Sep 7, 2018

• SilhouetteCentral now has the ability to automatically send an email to selected recipients when an assessment is updated or created. This is an optional licensed feature and supports the following:
  • Grouping of Silhouette users into different email lists.
  • Multiple assessment email actions per assessment type.
  • Conditionally expressions allowing email to be sent based on an assessment note value.
  • Email templates, which allow the email to contain links to the assessment within Silhouette or assessment notes to be sent directly in the email body.
  • The ability to attach a PDF assessment report to the email.
  • The ability to see how many emails have been sent and the status of the email queue for the last 30 days.
• SilhouetteConnect uses Microsoft SQL Server Express
  • SilhouetteConnect has been upgraded from using the Microsoft SQL Server Compact Edition database to using Microsoft SQL Server Express Edition. This improves the reliability and performance of the application.
  • Any data stored in SilhouetteConnect is migrated to the new database when SilhouetteConnect is upgraded.

Silhouette 4.2 R2 Summary

May 31, 2018

• SilhouetteStar 2 v1.5R3 camera firmware update.
• The initial release of SilhouetteConnect for v4. This will restore the offline capabilities of Silhouette to the equivalent of v3.x. SilhouetteConnect will work with both SilhouetteStar and SilhouetteStar 2 (5MP) cameras in wired mode.
• Enhanced support for the SilhouetteStar 2 (5MP) camera in wired mode, which provides a more reliable camera and image transfer experience.
• License management, which enables admin users to view or configure their software license.
• Improved group permission support.
• Improved discoverability for creating new wounds and assessments.

Silhouette 4.1 Summary

Dec 20, 2017

• New capture device SilhouetteLite+ app and sensor.
• Improved support for connection for SilhouetteStar 2 cameras when using HTTPS.
• Clinical User Interface now enables users to trace and edit SilhouetteLite+ captured images and assessments, and select a specific Wi-Fi network when connecting SilhouetteStar 2 cameras. There is no longer support for date and time fields in the notes and the default Admission Assessment definition includes expected discharge date, rather than expected discharge date/time. 
• The administration user interface enables the configuration of multiple Wi-Fi networks for SilhouetteStar 2 cameras.

Silhouette 4.0 Summary

Jul 11, 2017

• This is the first release of the v4 redesign of the Silhouette system. It does not completely replace all of the features available in v3. 
• New capture devices SilhouetteStar 2 over Wi-Fi and SilhouetteLite iOS application.
• Clinical user interface updates.
• Administration user interface updates.
• Other system changes and log visibility available via ARANZ Medical support users.
• Email for password reset.