Note: Descriptions are shown in the official language in which they were submitted.
m c-5~4
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~z~poRT r~~aAGrT s~sT~t w~xT~
CAPABILITY FOR GETIER~,TIOTd OF' REPORT S'UM~RRIES
~3ackground of the Invention
Records management is a critical function for modern
organizations. :Lt is a particularly critical function for
hospitals and other acute care health facilities where the
Medical Records Departments compile the documentation that
ZO .represents the complete records of a patient's health care
administered at that facility. Accurate and complete
records are vital to 'the operation of a hospital for the
following reasons.
1. These records contain information required to
provide the appropriate health care for
patients .
2. These records contain information required
for the prompt and accurate billing the
patient, and for the appropriate
reimbursement of patients in the hospital
by
third parties such as insurers and government
agencies.
3. Medical records are periodically audited
by
government agencies to review hospital
certification, and are also audited to
review
physicians' credentials.
4. If a claim of malpractice is brought against
either the physician, the hospital, or
staff
members, information in the patient's medical
records can have significant judicial
implications.
5. Information in medical records is frequently
reviewed to determine patients' demographics
to plan the availability of future health
care services.
For these reasons the accuracy and completeness of
patients' medical records is vital, both to the day to day
operation and to the strategic planning of a hospital. They
are also critical factors considered in granting and
renewing hospital certification. Further, in this era of
~.~~~~~ ~3~~
extensive and continuous "cost containment" efforts, it is
zrital that hospitals promptly and accurately bill patients
and 'third parties while, at the same time exercising the
upmost control over their costs.
One approach to these problems in hospitals and other
organizations requiring efficiewt records maxragement
functions has been the use of central dictation systems.
Such systems may either be analog, such as the system
marketed by the assignee of the present Application under
the Trademark Nucleus, or digital such as the systems
marketed by the assignee of the present Application under
the Trademarks DX 2000 and DX 7000. Such systems allow
physicians or other professionals to dictate reports for
later transcription by a pool of skilled transcriptionists.
Document management systems are known and axe commercially
available to manage and track records, and some of these
systems have been customized for medical records
applications. However, most of these systems are highly
sophisticated and very expensive and are usually only
affordable by larger hospitals (350 or more beds).
Systems such as Nucleus and the DX 2000 have been
combined with medical records management systems in order to
facilitate the generation of "exception reports" indicating
those reports which have not been provided by the
responsible physician. Due to the delay which sometimes
occurs in transcribing of dictated reports, it will
frequently happen that a physician will dictate a report,
yet receive and have to respond to a request for the report
during the 'time between dictation and transcription. Since
physicians tend to resent 'these intrusions, central
dictation systems such as Nucleus and the DX 2000 have bean
provided with communications links to medical document
management systems to inform the document management system
as soon as a report is dictated in order to avoid having the
document management system generate an inaccurate reception
report indicating that the physician is delinquent.
A related problem faced by hospitals is the prompt and
accurate generation of "discharge summaries". In order to
generate a bill .for a patient's stay in a hospital, a
_ 2 _
CA 02004855 1999-07-09
discharge summary containing information such
as the primary and secondar~~ diagnosis, procedures
performed, length of stay, e~tc. must be prepared, and
reviewed, and signed by the patient's physician. At
present, many hospitals employ skilled para-
professionals for the purpo~;e of reviewing and
summarizing a patient's medical record to prepare such
summaries when the patient i.s discharged.
Thus, it is an object of an aspect of the present
invention to provide an improved, cost effective
system for record management; and more particularly,
medical record management.
It is another object of an aspect of the
present invention to provide a system which will
facilitate the efficient and. timely generation of
summaries of records relating to a particular subject;
and more particularly, the generation of a summary
report from medical records which may then be used as
a basis for preparation of discharge summaries.
-3-
CA 02004855 1999-07-09
Brief Summary of the Invention
The above objects are achieved and the
disadvantages of the prior art overcome in accordance
with the subject invention x>y means of a system for
generating reports which includes apparatus for the
input of reports relating to identified subjects and
apparatus for selecting pred;etermined portions of the
reports. The system also includes apparatus for
compiling the selected portions to form summary reports
for identified subjects. An operator is provided with
an input device for specification of identified
subjects and the system further includes apparatus
responsive the input device for outputting summary
reports for the specified subjects.
In a preferred embodiment of the subject
invention the reports are medical reports and the
identified subjects are patients.
In still another preferred embodiment of the
subject invention, the input apparatus further includes
a dictation system for input, storage and retrieval of
the reports in the form of voice files and a
transcription work station for transcription of the
voice files into text reports.
Thus, it may be seen that the subject invention
overcomes the disadvantages of the prior art by
advantageously combining record creation and record
management functions in a manner not previously
considered in the art.
Therefore, various aspects of the invention are
provided as follows:
A server computer pro~~rammed to:
maintain respective summary reports for a
-4-
CA 02004855 1999-07-09
plurality of patients;
receive a text document relating to one of the
patients from a word processing system;
determine whether portions of the received text
document meet predetermined criteria; and
as to such portions of the received text
document as are determined to meet the predetermined
criteria, merge such portions of the received text
document into the summary report maintained for said
one of the patients.
A method of compiling a discharge summary for a
patient, the method comprising the steps of:
maintaining a summary report for the patient;
receiving from a word processing system a text
document relating to the patient; determining whether
portions of the received text document meet
predetermined
criteria; and
as to such portions of the received text
document as are determined to meet the predetermined
criteria, merging such portions of the received text
document into the summary report maintained for the
patient.
Other objects and advantages of the subject
invention will be apparent to those skilled in the art
from consideration of the Detailed Description set
forth below and the attached drawings.
-4a-
CA 02004855 1999-07-09
Brief Description of the Drawings
Fig. 1 shows a schematic block diagram of a
system in accordance with the subject invention.
Figs. 2A and 2B show a flow chart of the
operation and interaction of various components of the
system of Fig. 1 during the creation of a report.
Figs. 3A and 3B show a more detailed flow chart
of a portion of the operation of the data processing
system and one of the word processing system
incorporated in the system o:f Fig. 1.
Fig. 4 shows a more detailed flow chart of the
operation of a data processing system incorporated in
the system of Fig. 1.
Fig. 5 shows a flow chart of the operation and
interaction of various components of the system of Fig. 1
during an alternate mode of ~~reation of the report.
Detailed Description of Preferred Embodiments
Fig. 1 shows a schematic block diagram of a
system in accordance with the' subject invention. Digital
dictation system l0 is substantially a conventional
system such as the DX 2000 or DX 7000 marketed by the
assignee of the subject Application. Dictation system
10 receives dictation jobs over conventional dictation
terminals 12 which are telephone-like devices for the
input of audio signals arid which include a DTMF keypad
for the input of control signals. The dictation jobs are
stored in the form of voice files of digitized audio
signals and output over conventional transcription
terminals 14. Dictation system 10 also includes optional
inputs from the telephone network over lines 16 for off-
site dictation.
The function and operation of digital dictation
system 10 is essentially conventional to input, edit,
store, and output for transcription voice files of
dictation jobs, and
-5-
a further description of these functions is not believed
necessary for an understanding of the subject invention.
bictation system 10 is connected by communications link
18 to data base server 20. Communications link 18 is
substantially a conventional communications link by which
dictation system 10 transmit a11, or appropriate portions,
of the job record to server 20 when any of the following
events relating to a dictation job occur.
1. A dictator compiles a dictation job.
2. A dictation job is assigned to a transcriptionist.
3. A transcriptionist commences transcribing a job.
4. A transcriptionist signs off a job.
5. A job is reviewed by the dictator or another party
having access to the voice files on dictation
system 10.
6. A voice file is purged from system 10.
Server 20 is a database server which provides database
management for a medical records database stored on disk
unit 22. It controls and manages all access to the system
database. Preferably, server 20 will include a Texas
Instruments System 1000 Series computer which runs
substantially conventional database management software such
as "Informix", produced by Informix Software, Tncorporated,
to implement applications as described further below.
Server 20 communicates over input/output link 2~ with work
station hub 26 and printer hub 28.
Server 20 also communicates with administrative work
station 34, through which a system operator may enter
requests for services such as updating of patient and
physician data file in the system database, communication of
information in the patient or physician data files, or of
reports generated by server 20, to other information
management systems over conventional communications link 36,
and the transfer and retrieval of data files to and from
archival storage unit 38. Each of these functions is well
known in the art of database management, and need not be
- 6 --
discussed furt:he:r here for era understanding of the subject
invention.
Returning to work station hub 26, a conventional
interface is provided to work stations 40 through ward
processors 42. Preferably, word processors 42 include a
conventional microcomputer such as a Texas Tnstrurnents Model
955 workstation running substantially conventional te:~~t
processing software. As can be seen frorn Fig, 1, work
stations 40 also include transcription terminals 1~
connected 'to dictation system 10. Hub 26 provides a
substantially conventional communications link between word
processor 42 and server 20. This communication is an
important feature of the subject invention since, as will be
described further below, it provides heretofore unknown
advantages in the transcription of reports intended for
medical, or other records systems.
Turning to printer hub 2F3, a conventional
communications link to conventional printers 44 is provided
for the generation of hard copy reports on request. A
:Further description of the operation of printers 44 is not
believed necessary for an understanding of the subject
:invention.
Figs. 2A and 2B show a flow chart of the concurrent
operation of the operation of dictation system 10, server
20, and word processors ~2 during the creation of a
dictation job representing a medical report, and the
corresponding updating of the system database. At 100 a
dictator (e.g. a physician) logs on to provide his or her
identification in a conventional manner and inputs
information for the job record using the DTMF keypad of
dictation units 12 ar a telephone connected to inputs 16.
At x.10 dictation system 1.0 records the dictation jab as a
digital voice file in a conventional manner. Once the
dictation job ~.s completed, at 120 system 10 sends the job
retard to server 20 at A.
As indicated above, the jab record is a data file
maintained by system 10 reflecting information about a
dictation job and is updated periodically as events occur.
_ 7 _
~'.~~~ z~~~ ~'3;~;:e
Preferably, job reco.r.ds will include the following
i.nfarmatian.
1. ,Tab I:D Assigned by System 10.
2. Physician ID Entered by Physician During Lag On.
3. Report Type Entered by Physician
9:. Patient ID Entered by Physician
5. Transcription
Work Station ID Assigned by Systern 10
6. Data/Time of
Greatian Determined by System 10.
7. Length of
Dictation Calculated by System 10
As the voice file for the dictation job is accessed,
additional information is captured arid added to tkze jab
record. Such information includes the following.
8. Transcriptianist ID Entered by the
Transcriptionist During Log On.
9. Tra,nscriptionist
Station ID Assigned by System
10.
10. Date/Time Of
Assignment Determined by System 10.
11. Date/Time Of Sign Off Determined by System 10.
by Transcriptionist
12. Turnaround, total Determined by System 10.
l3. Turnaround,
working time Determined by System 10.
c~.t ~~ ~ ~ ~~ a.9 a~
14. Date/Time of Review Determined by System 10.
1.5. Reviewer ID B'ntered by Reviewer during
hog On.
(By "review" herein is meant access by the dictator or other
party having access to system 1U for the purpose of audio
access to the voice file of a dictation job. Such review
access is conventionally provided by digital dictation
systems in order that, for example, an attending physician
may obtain the results of the report of a specialist without
ZO waiting for that report to be transcribed. Further
descriptian of the review function is not believed necessary
for an ~.nderstanding of the subject inventian.)
By transmission of the job record from dictation system
to server 20 a file may be maintained within the system
database of the status of any medical report at all times
from its initial dictation through transcription and
incorporation into the system database. Further information
from the job record is used by server 20 to facilitate
management of the system database and the transcriptian of
the voice files corresponding to dictation jobs representing
various medical reports.
Returning to Fig. 2, at 140 server 20 inputs a job
record at A and at 150 updates the patient records to
reflect the present status of the dictation jobs arid
corresponding medical report.
At 160 dictation system 10 assigns a transcription
priority in accordance with a predetermined priority
algorithm in a canventional manner well understood by those
skilled in the art. At 170 system 10 loops until a
transcriptionist is available, and at 180 system 10 assigns
the dictation job to a transcription work station. At 190
dictation system 10 sends the job record, updated to reflect
the assignment to the selected transcription work station to
server 20.
At 200 server 20 receives the jab record and at 210
server 20 gets the appropriate patient and physician data
(e. g. patient name and social security number, etc.,
- 9 -
~A~3~.~ ~~'~a.l~a~
physician name and ID number, etc.) :Ear the particular
report type as° identified :in the job record, and at 220
server 20 sends this data arid the report type to the
identified one of work stations 40,
At 2:30 dictation system 10 loops until the
transcriptionist logs on and enters his ar her :ID.
At 240 word processor 42 receives tree patient and
physician data and the identification of the report type and
at 250 word processor 4?.uses the received repast type to
retrieve information identifying the proper format for the
identified report type from a file of report formats stared
locally at ward processor 42, and merges the patient and
physician data w~ah the identified format and displays the
merged information. Thus, the initially displayed report
farm will include necessary information which is already in
the system database; relieving the transcriptionist of the
need to transcribe that information, and the dictator of the
need to originally provide it.
As can be seen from the above description, it is
preferable in the subject invention that ward processors 42
store data files of formats for each report type to be
processed by the system. IWard processor 42 may also store
data files duplicating the definition .files in server 20
used to identify the patient and physician information to be
included in each report type so that word processor 42 can
properly identify the report .format and the information to
be merged with 'that format.) ~3awever., it is also within the
contemplation of the subject invention that the report
formats could be maintained by server 20 and the merged
information transmitted to word processor 42, avoiding the
need and expense of maintaining storage .for these files at
each work station 40.
Continuing, at 260 word processor 42 would then run its
text processing program. At this time the transcript:ianist
would sign-on to dictation system 10 through transcription
unit 24 in a conventional manner.
At 265 dictation system 10 would respond to sign-on by
the transcriptionist to update the job record and send it to
server 20 at A. Server 20 would 'then update the patient
- 10 -
~;~ ~~ ~3:~,"~
records again to ref lect the current status of ~:he
corresponding medical report. At 270 dictation system 10
would output the dictation job voice file to the selected
one of work stations 40 in a conventional manner for
transcription. At this paint, 'the transcriptianist wauJ.d
transcribe 'the voice file into 'the displayed format in a
conventional manner, using ward processor 42 to create the
text and transcription unit 14 to access the voice file.
Word processor 42 loops through 280 while dictation system
10 loops through 290 until the transcriptianist is satisfied
that the voice file has been properly and accurately
transcribed into the display format. At this time the
transcri.ptionist would sign-off again using the DTMF keypad
of transcription unit 14. Also at this time the
transcriptionist would signal server 20 that transcription
was completed through ward processor 42.
As will be clear to those skilled in the art Pram the
above description, it is preferable that the
transcriptionist sign-off through the DTMF keypad of unit 14
and signal to server 2U through word processor 42 in artier
to minimize the necessary software changes to the existing
communications routines of dictation system 10 and the word
processing software of ward processor 42. However, it is
also within the contemplation of the subject invention that
the transcriptionist indicate that transcription is
completed (i.e. sign-off) only to either dictation system 10
or server 20 with the other system being notified through
communications link 18. The necessary modifications to the
communication software would be readily apparent to those
skilled in the art.
At 300 dictation system 10 again updates the job
record.
At 320 word processor 42 transmits the completed
document (i.e. the format and merged information together
with the transcribed voice file) to server 20 at A.
At 320 server 20 inputs the document and at 330 server
20 updates the patient records by incorporating the
document . '
- 11 -
~'()'~~ ~,'~;a
At 340 server 20 then determines if the report type
represented by 'the document includes information to be
summarized in the pa'tient's summary report. If so, at 350
server 20 updates the :patient's surrunary report with
information selected from the document in accordance with
the report definition files fox that report type. The
summary report may be maintained tin the system either
.Logically, or actually. That is, by maintaining a logical
record of those portions of documents which comprise the
summary report, or by maintaa.ning the summary report as a
separate document. Preferably, 'the summary report is
maintained logically and compiled each time it is accessed;
and converted to a separate document if and when it is
edited so that it differs from the logical summary report.
Fox reasons of clarity, the alcove description has been
provided in terms of a single report and the transcription
of its corresponding voice file. However, those skilled in
the art will recognize that known digital dictation systems
such as system 10 have the capability to process a plurality
of dictation jobs concurrently, and that known database
management systems also have the capability to concurrently
process a numbex of 'tasks. Accordingly, it is within the
contemplation o:~ the subject invention 'that the system
process a plurality of dictation jobs and other tasks
concurrently. The necessary programming techniques for such
concurrent processing are well known and well within the
skill of those in the art and need not be discussed further
here for an understanding of the subject invention.
~.imi~tations on the number of tasks that can be processed
concurrently are essentially economic in nature and are
determined by the storage capacity and processing power of
dictation system 10 and server 20 and by the number of
input/output ports of various types which can be afforded.
Figs. 3A and 3B show a more detailed description of the
operation of server 20 and word processor 42 in initializing
a report for transcription. Within block 210 of Fig. 2 at
210-1 server 20 gets the jab record for the jab and
determines the report 'type. At 210-2 server 20 gets the
report definition far the identified report type, and at
-- 12 -
~:~~:~~~~ ~3a;
210-3 determines if any physician data stored in the
physician data files is needed for that report type. If
there is, at 210-4 sower 20 gets that physician data from
the physician data files. Tn either case, at 210-5 server
2,0 determ:i_nes if patient data is noed~:d for that report type
and, if so, gets the patient data at 210-6, and in either
case, goes to block 220, as shown in F'ig. 2, to send the
data and report type to word processor 42 at block 240. In
block 250 at 250-1 word processor 42 gets a duplicate report
definition and format type stored at word processor 42 for
the identified report type from local data files. At 250-2
word processor 42 determines if that report 'type includes
any physician data and, if so, at 250-3 merges the received
physician data. with the appropriate format. In either
event, at 250-4 word processor 42 then determines if any
patient data is necessary for that report type, and if so,
merges the received patient with the appropriate format at
250-5. Then at 250--6 the merged data and format are
displayed in a conventional manner on, for example, a CRT
2U display.
Fig. 4 shows a flaw chart in more detail of 'the
operation of server 20 in updating a patient's summary
report. In decision block 340, at 340-1 server 20 first
gets the report definition for the identified report type.
At 340-2 server 20 determines if selected portions of the
document are defined as part of the summary report, and, if
so, gets those portions from the document filed in the
patient's records.
It is also within the contemplation of the subject
invention that portions of a report may be identified by a
system user, such as a para-professional reviewing the
document, for incorporation in the summary report.
It is also within 'the contemplation of the subject ,.
invention that a dictator may wish to include comments for
the patient's summary report in addition to any portions of
a medical report which are defined as part of 'the patient's
summary report. Accordingly, at 340-4 server 20 determines
if the document contains any "comments". The dictator may '
direct the transcriptionist to specially marked portions of
- 13
a transcribed documents °'cornments" by inserting control
charactr~rs in the transcribed text. E'o.r example, cornments
may be distinguished from other text material by being set
off by characters otherwise not norrnally used in the report,
such as angled brackets ar asterisks. At 340-5 server 20
then gets any "comments" which are included in the document,
and at 340--6 determines if the document contains any
information for the patient's summary. If sa, the system
continues to black 350, and at 350-1 gets the patient's
summary report, at 350-2 server 20 merges the information
identified at 340 into the summary report, and at 350-3
stores the summary report in the patient's medical records.
As indicated, such a summary report is highly
advantageous to a hospital since the patient's summary
report is essentially always current arid may be rapidly
generated when the patient is discharged. Further, even in
the event that some medical reports have been dictated, but
not yet transcribed, the system administrator may readily
request dictation system 10 to increase the priority of
these reports to expedite preparation of the patient's
summary report. This summary report may then be sent to the
attending physician for review, additions and changes, and
signature in order to generate a patient discharge summary.
The patient discharge summary includes information
required by providers of third party coverage before they
will provide reimbursement, fox example, primary and
secondary diagnosis, procedures carried out, length of stay,
etc. In the present era of high expense and tight cost
constraints for hospitals, the ability to expedite the
generation of the patient discharge summary by providing the
attending physician with an accurate summary of the
pati.ent's medical records is highly advantageous.
The above description comprises an on-line, or system,
mode of operation of 'the subject invention wherein reports
are generated through dictation system 10. However, it is
also within the contemplation of the subject invention 'that
reports may be initially generated off-line, for example,
using portable dictation equipment or in written form. Fig.
5 thus shows the operation of the system of the subject
- 14 -
invention i.n an off-)_ine mode. At 400 a transcription:ist
logs-on to one of word processors 42 at one of work stations
40 irx the oF.f.-line mode. In this rnode, at 410 the
transcriptionist transmits the patient ID, ph~rsician ID,
report type, work station ID, etc, to server 2o through word
processor 42. At 420 server receives the data, and at 430
updates the patient records.
Server 20 then goes to D, shown in Fig. 2 and continues
operation as described above; except of course that the
transcriptionist will neither sign-an nor sign-off to
dictation station 10.
It is also within the contemplation of the subject
invention that word processors 42 may be used in a wholly
conventional manner as stand alone ward processors.
the above descriptions of preferred embodiments of the
subject invention haves been provided by way of illustration
only, and those skilled in the art will readily recognize
numerous other embodiments of the subject invention from the
detailed description and the attached drawings.
Accordingly, limitations on the subject invention are to be
found only in the claims set forth below.
._ 1 S ._
