Note: Descriptions are shown in the official language in which they were submitted.
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01 FIELD OF T~IE INVENTION
Q2 This invention relates to data systems for
03 hospital operation and particularly to a method of
04 operating point of care data terminals.
05 BACKGROUND_OF THE INVE TION
06 Hospital administration staff have
07 attempted to control costs associated with operation
08 of hospitals by implementing computerized
09 administration systems, including bookkeeping systems,
material control systems, etc. Such systems, however,
11 require manual input of data into computers from stock
12 control forms, equipment usage forms, time sheets,
13 etc. filled in by hospital staff. This has been prone
14 to error because it depends on the memories of
fallible persons, sometimes imperfect diligence in
16 completing the forms by often over-worked personnel,
17 etc.
18 The main function of a hospital, that of
19 patient care, has resisted efficiency introducing
machines. The patient care system typically operates
21 with a doctor prescribing tests and courses of
22 treatment, which are carried out by caregivers such as
23 nurses (hereinafter referred to generally as nurses).
24 In this case also, due to human fallability, the times
of administration of treatment or testsl completion of
26 all tests, and erroneous recording of the results of
27 tests sometimes occurs, which can have dangerous
28 effects and legal consequences. The collection of
29 data tabulating the quantities of medicines used, the
labor involved, and other costs associated with
31 specific patient care is done manually by the nurse
32 recording it on paper, which is prone to error.
33 The present invention substantially
34 automates the above functions providing to the nurse a
portable electronic terminal, referred to herein as a
36 point-of-care terminal, that displays on command tests
37 and courses of treatment for an identified patient.
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01 ~rhe nu~se ~eL~oLms the tests and~or tLeatmerlts, and
02 enteLs the results o~ the tests directly into the
03 teLminal, the system recording the entered data in a
04 standardized format. The system can confiLm the
05 treatment steps and test results already entered, and
06 can warn her of entries outside of predetermined
o7 thresholds. This can reduce the incidence of error in
08 tests and treatment, making the job of the nurse
o9 easier. The data is recorded in a computer to which
the portable terminal is connected and can be
11 collected by the hospital adrninistration computer.
12 DESCRIPTION OF THE PRIOR ART
13 A medical information system which
14 standardizes treatment steps is described in the
article "Medical Data Dictionary for Decision Support
16 Applications" by S.M. Huff et al of AT~T Bell
17 Laboratories, pp 310-317, 1987 SCAMC, Inc. In this
18 system, precise names of functions performed by the
19 nurse or doctor, are input into a terminal. The
article promotes the definition of a standard medical
21 dictionary for use in a medical care electronic
22 information system. The system described utilizes
23 individual pages defining events which are input from
24 a nursing station, each event being a "happening"
relating to a patient, such as writing an order for a
26 medication, the occurrence of pain, the birth of a
27 child, a surgical procedure, etc. Attributes are
28 associated with each event, which are qualitative and
29 quantitative descriptors of the event, with a time of
occurrence of the event and a time of recording of the
31 event. Associated with each recorded event is the
32 name or definition of a particular patient or relative
33 of the patient. Operation of the system requires
34 positive recording of the event in the course of
treatment of a patient at a central nursing station by
36 personnel who must be trained in the use of database
37 systems. The nurses must know the course of treatment
38 - 2 -
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01 of a patient, which is descLibed to them in the
02 t~aditional of manner. The nurse simply inputs at the
03 nursing station what has occurred according to a
04 w~itten schedule of a course of treatment, or other
05 occurring events involving the patient, and from tests
06 and their results written on paper.
o7 The above-described system contains
08 several disadvantages. Firstly the system by which
o9 the nurse gives care to the patient remains exactly as
it has always been, that is, that the functions
11 performed by the nurse are recorded by spelling out
12 what functions have been performed. The recording is
13 done at a nursing station at a central location. The
14 nurse first records on paper the results of tests
performed, which is then typed into the nursing
16 station computer. Therefore some tests can be missed
17 and errors can occur.
18 Secondly, and importantly, a standard
19 dictionary of terms must be used when the information
is typed into the computer for the system to work
21 properly. Misspellings, non-standard (but otherwise
22 understandable) words used by the nurse, result in
23 data which is not accepted or if accepted by the
24 system, cannot be collected by a central computer
which expects to receive standard terms. The learning
26 of a set of standard terms from which the nurse may
27 not deviate puts additional burden on the nurse,
28 rather than a relief from burden.
29 Thirdly, all of the data of a group of
patients is input into one central location. This
31 provides a significant opportunity to make errors and
32 to miss the inputting of data since nurses are
33 typically busy and sometimes are subject to emergency
34 distractions. Therefore data recorded on paper by the
nurse may not be entered into the central computer
36 until long after it is needed by an administration
37 computer, or it may be missed completely.
38 - 3 -
01 SUMMARY_OF_THE__NVEN_ION
02 The present system, as noted above,
o3 includes a small portable point-of-care terminal
04 carried by the nurse which is used by the nurse to
05 input the test results data and treatment steps such
06 as quantities and types of medicines used right at the
07 location and the time of the tests or administration
08 of treatment. The nurse need not memorize or input
09 standard names of medicines or other medical terms.
Further, the nurse need not have a written description
11 of the course of treatment or test which she is to
12 administer on a patient. The exact list of treatment
13 and the exact tests prescribed by the doctor are
14 displayed on her portable terminal and she need merely
fill in the blanks of numbers which are the results of
16 tests or quantitites of the medicines shown on her
17 display. She can also invoke and input standard
18 nursing notes. The data input for each treatment or
19 test and nursing notes are automatically transmitted
to a central location, such as a nursing working
21 station, for central storage. Each input is stored in
22 association with an automatically generated time
23 entry. The entire sequence of tests, treatment and
24 results or specific categories thereof can be
displayed at the point of care terminal so that the
26 nurse can see what tests have already been
27 administered, the results, and she can estimate trends
28 if necessary.
29 The course of treatment for each patient
is obtained after inputting a patient code number, as
31 well as a security code associated with the nurse.
32 The same portable terminal can therefore be carried
33 from patient to patient, plugged into a local area
34 network having terminal connectors adjacent each
patient bed, for transmission of patient-specific data
36 back to the central station. Therefore the number of
37 point of care terminals need be only equal to the
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nl numt)eL of nUISeS on duty at any paLticula~ time, and
02 need no~ be equal in number to the vastly larger
03 numbeL of patients receiving tLeatment in the hospital
04 at a given time. Because the exact course of
05 treatment is available to the nurse at all times on
06 her local display using computer generated instruction
o7 terms, and because the results of treatments or tests
08 are input directly into the portable terminal when
o9 performed, the intermediate step of marking the
results on paper, resulting in errors and missed
11 reports described earlier with respect to prior art
12 proposed systems is avoided.
13 Because all input data is stored in
14 association with a time indication, including separate
corrections made to input data, a complete track of
16 patient treatment is permanently recorded, which may
17 be needed later formedical or legal purposes. Since
18 there is no intermediate paper marking step, the
19 possibility of losing or varying the origin document
is avoided.
21 Because the exact course of treatment is
22 described by computer, and the quantities of
23 administered medicines and other supplies are directly
24 input on the portable point-of-care terminal, data
identifying materials and medicines identification and
26 quantities, and labor involved in treatment of a
27 patient are clearly recorded automatically in a
28 standard format in the central computer. As noted
29 earlier this can be linked to the hospital
administration computer, to obtain an accurate
31 inventory track and cost base for treatment of each
32 individual patient. This should substantially help in
33 control of hospital costs, and increase efficiency of
34 operation of the hospital.
The operation of the present invention is
36 based on a novel method of operating a point-of-care
37 terminal wherein there is a central library of
38 predefined patient tasks stored in a central memory.
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01 ~rhe library is comprised of electronic data storage
02 defining all expected possible tasks involving care of
03 a patient. Each of those tasks is herein called an
04 event (which is distinguished in definition from the
05 form of "event" defined in the aforenoted article).
06 Each event contains a set of attributes. Out of this
07 pool of events, specific events relating to the care
08 of a particular patient forming a group of events, is
09 selected to define the care to be given to a specific
patient in an electronic kardex. That group of
11 events, or one or more groups of groups of events, is
12 provided to the point-of-care terminal. The nurse
13 need merely display the list of events specific to an
14 identified patient on the terminal and input the
results of tests carried out at times prescribed by
16 the doctor and listed in the list of events shown on
17 the display of the terminal.
18 Stored event definitions required by
19 several patients are used in common. Attribute
definitions, defining the events themselves, are used
21 in common by plural events.
22 To provide the above, an embodiment of the
23 invention is a method of operating a point of care
24 terminal comprising storing in an electronically
accessable memory associated with a central computer
26 terminal a library of data defining a large number of
27 generic patient care events. Data correspondin~ to
28 certain ones of the care events specific to the care
29 of a particular patient is selected from the libary.
A signal corresponding to an identifier of the
31 particular patient is input into a point of care
32 terminal which is in electronic communication with the
33 central computer terminal. At least one group of the
34 selected data specific to the patient is provided to
the point-of-care terminal from the central computer
36 terminal in response to the inputting step. The at
37 least one group of data is displayed at the
38 - 6 -
0l point-of-care terminal, which defines a group of care
02 events. After per~orming tests on the patient
03 corresponding to the events displayed, the nurse
04 inputs data resulting from the tests into the
05 point-of-care terminal relating to at least certain
06 ones of the group of data defining the group of care
07 events. The data is transmitted to the central
08 terminal, and is stored at the central terminal for
o9 subsequent access.
Another embodiment of the invention is a
11 method of operating a point of care terminal
12 comprising establishing a specific patient related
13 electronic kardex formed of data signals defining a
14 group of individual patient care events, each care
event being defined by a predetermined collection of
16 possible attributes therefor, each attribute defining
17 a characteristic of the event, selecting particular
18 attributes for a corresponding event related to the
19 specific patient, and displaying the care events with
the selected attributes at a point-of-care terminal,
21 whereby an individual care program specific to the
22 patient is displayed to a care giver.
23 BRIEF INTRODUCTION TO THE DRAWINGS
24 A better understanding of the invention
will be obtained by reference to the detailed
26 description below, in conjunction with the following
27 drawings, in which:
28 Figure 1 is a block diagram of a system
29 incorporating the invention,
Figure 2 is a more detailed block diagram
31 of specific parts of the system illustrated in Figure
32 1 for illustrating the invention,
33 Figure 3 is a plan view of a point-of-care
34 terminal preferred to be used to operate the
invention, and
36 Figure 4 is a block digram of the
37 point-of-care terminal of Figure 3.
38 - 7 -
01 DE8CRIPTION OF_~HE pRE-E-RREn-ElMBoD-IMENT
02 OF THE INVENTION
Q3 Figure 1 is a block diagram used to
04 illustrate the invention. A centLal computer station
o5 1 which is used as a nursing station, has a printer 2
06 connected to it in a well known manner and is
07 comprised of a memory 3, 3A. The computer station is
08 connected to a local area network 4. Bridges 5
o9 connect the local area network to branch local area
networks 6, which are terminated at connectors 7, each
11 one preferably adjacent the bed of a patient. The
12 branch local area networks are preferably organized by
13 ward, so that the representative branch local area
14 network 6 at the left of the drawing serves e.g. a
nursing ward 1 while the branch local area network 6
16 at the right of the drawing serves representative
17 nursing ward 2.
18 Each nurse carries a point-of-care
19 terminal 8, which has a plug 9 that ean be plugged
into any of the connectors 7.
21 A hospital administration computer 10 can
22 be connected to the local area network 4 to
23 communieate with station 1.
24 As a nurse makes her rounds, or otherwise
takes care of a patient, she plugs her point-of-care
26 terminal 8 into connector 7 adjacent the patient. A
27 list of care events is displayed. She administers
28 medicines, performs tests, and enters the amount of
29 medicine and results of the tests into point of care
terminal 8. In the list of care events, a schedule of
31 medicines and tests appears on a display of the point
32 of care terminal, which the nurse can call up by
33 depressing predetermined buttons on the terminal. The
34 amount of medieines and results of tests are similarly
entered by pushing buttons on the terminal. This data
36 is transmitted to terminal 1 for storage in memory 3.
37 A block diagram showing certain of the
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01 abo~e elements is illustrated in ~igure 2, in block
02 diagram at the top with certain elements in more
03 detail below. A nursing work station 1 having an
04 associated memory 3, 3A is connected to point of care
05 terminal 8. The nursing work station is connected to
06 printer 2, which can generate reports 10 under control
o7 of the nursing work station 1, which can be a printout
08 of the entire treatment schedule oE a patient,
o9 including the times when administered and quantities
of various medicines used from data stored in memory
11 3A. The data supporting the report is also made
12 available to the hospital administration computer
13 which is also connected to the nursing work station 1
14 through the local area network 4, so that
identification and quantities of medicine, amount of
16 nursing and other labor, equipment used, etc. can be
17 tabulated for administration purposes.
18 An important aspect of the present
19 invention is the organization of the memory 3. This
provides means whereby the nurse can be efficiently
21 instructed as to the care events to be undertaken and
22 whereby she can enter the aforenoted results from
23 storage without resorting to memorizing and inputting
24 of standard medical nonenclature. The organization
thus provides for efficient use of the point-of-care
26 terminal. The memory 3 is divided into memory
27 elements 12, each of which contains a data signal
28 identifying a patient care event. The total of these
29 elements define a care element library 11 which
contains data signals identifying all possible care
31 events. These events define the smallest meaningful
32 unit of care or work involving a patient that can be
33 performed. Each event is comprised of a set of
34 attributes which describe individual characteristics
of an event, as well as standard nursing notes, as
36 will be described later.
37 Examples of care events are pulse, blood
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01 pressul-e, oncology assessment, psycho-social
02 assessment, diqestive system, heat and cold
03 application, cardiovascular system, hemotology system,
04 neurologic system, oxygen saturation etc.
05 The memory 3 also contains memory elements
06 12A containing data signals defining generic
o7 attributes, represented by attribute library 13. The
08 attribute library memory elements contain data
09 representing e.g. site, temperature, degree of
assistance, duration, frequency, test name, altered
11 body image, volume of feeding, frequency of feeding,
12 method of delivery, food record frequency, patient
13 position, volume ingested etc. ~ach care element
14 is linked to usually plural attribute elements which
define the care element. By maintaining a generic
16 library of care element attributes, many of which are
17 used in common to define particular care elements, a
18 massive library defining each care element and each
19 attribute, separately defined for each patient, is not
required. Since each separate care element and each
21 separate attribute for each patient need not be
22 defined, the risk of error in definition is
23 substantially avoided.
24 As an example of the association of
standard care elements with standard care element
26 at~ributes, for the care element "temperature", site
27 is the care attribute. For the care element "blood
28 pressure", the attributes are "diastolic" (pressure),
29 "systolic" (pressure) and "site" (of measurement).
The attribute definitions for diastolic and systolic
31 pressures indicate that these pressures require
32 numeric values in a specific range. The attribute
33 definition for site includes alist of possible sites
34 to be used.
When a patient is admitted to the
36 hospital, his course of treatment is prescribed by a
37 doctor. The nurse at nursing work station 1 reserves
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01 a poLtion of memo~:y 3, lefeLLed to herein as a patient
02 electronic kardex 14. FOL example, if a patient A iS
03 admitted ~or a gallbadder operation, an electronic
04 kardex 14 Leserved for and specific to that patient A
05 is established by control from the nursing work
06 station. FiguL-e 2 also illustrates kardexes for
07 patients B and C.
08 The work station nurse, reading the
09 prescribed course of treatement from the doctor's
notes, enters in one memory cell of the kardex for
11 that patient a data signal identifying the first care
12 element, e.q. special preoperative nutrition, which
13 would have the attributes definitions defining food
14 diet. The second care element specified might be
hourly psychological assessment, the third might be
16 blood pressure every four hours, the fifth might be a
17 special medicinal tranquilizer to be administered
18 6:00 a.m. the day of the operation, the seventh might
19 be transport to operating room 7:00 a.m., the next
might be observation of patient at 10 minute intervals
21 following the operation for the first three hours, the
22 next take blood pressure every half hour for first
23 three hours, etc.
24 Thus a portion of the memory 3 is
dedicated to the specific course of treatment of a
26 patient, which course of treatment is formed of care
27 elements, each one of which is formed of care
28 attributes selected from the care element library 11
29 and care attribute library 13 used in common by each
patient kardex particular care elements. The result
31 is that each patient is assigned a separate electronic
32 kardex. The memory elements in each of the kardexes
33 14 can simply contain pointers to memory elements 12
34 which define the specific care elements. Each care
element defined by memory element 12 can be comprised
36 of pointers to various care attributes defined by data
37 in elements 12A in the attribute library 13. In this
38 - 11 ~
01 manne~ theLe is substantially conservation of memory
02 space and at the same time each patient can have its
03 own individual course of treatment uniquely specified.
04 In operation, the nurse plugs her
05 point-of-care terminal 8 into the network, as
06 described earlier with respect to Figure 1, and enters
o7 certain identification indicia, as will be described
08 in more detail below, of the particular patient to be
o9 treated, and her passcode identifier. In response the
nursing work station 1 accesses the memory 14, and
11 causes display of the care event list relating to the
12 identified patient on the point-of-care terminal
13 display 8. The nurse can thus see which tests are to
14 be administered.
The nurse also select specific categories
16 of care elements defined in kardex 14 to be displayed
17 on her point-of-care terminal, as will be described
18 below.
19 Figure 3 illustrates a preferred form of
20 point-of-care terminal 8 for use in the invention. It
21 is preferably comprised of liquid crystal display 15
22 and a plurality of pushbuttons, e.g. formed of
23 calculator type keys 16 and specialized function keys
24 17 and 18.
When a nurse plugs the point-of-care
26 terminal 8 into a connector adjacent a patient and has
27 initiated communications as described earlier, and
28 will be described in more detail below, and pushes the
29 button of the group of buttons 18 labelled "VITALS", a
predetermined data code formed of signals stored in a
31 ROM (read only memory) within the point of care
32 terminal is transmitted to the nursing station 1. The
33 nursing station computer accesses certain of the
34 memory elements in the kardex 14 which are associated
with "vitals" care elements for the identified
36 patient. Data for display of "VITALS" is transmitted
37 by the nursing station 1 via the networks 4 and 6 to
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01 the point-of~caLe terminal 8, which displays only the
02 "VI~ALS" tests from the particulal- patient's kardex 14
03 on the display 15.
04 For example, as may be seen on the display
05 15, the vitals tests of blood pressure (BP), pulse,
06 temperature (temp) and respiration are displayed,
07 coupled with their corresponding attributes, shown as
08 left (L) brachial lying ###.### Hg, left radial
o9 ###/min normal, oral ###.###C., ###/min regular
10 eupnea. The nurse recognizes that she is to take the
11 blood pressure at the left brachial position with the
12 patient lying and is to enter the pressure numerically
13 in millimeters of mercury of both dyastolic and
14 systolic measurements. The pulse is to be taken at
15 the left radial position and entered numerically as
16 pulses per minute. The temperature is to be orally
17 taken and entered numerically as C. She is to check
18 the respiration rate and enter it numerically as
19 breaths per minute.
The results of all of the above is entered
21 at screen cursor positions defined by the # indicia
22 using the keypad 16. The particular positions on the
23 screen of the cursor where the values are entered
24 (which may simply be a shading of the particular
25 attribute selected) are controlled by a four direction
26 cursory key 17, which controls the position of the
27 cursor (or a shading) on the display screen.
28 It is preferred that the display screen
29 should be split into three panes. The top pane is
30 preferred to identify the patient by name, sex and
31 identification code, and the name of the doctor, the
32 data of which is sent to the point-of-care terminal
33 from the nursing station after acceptance of the nurse
34 identification (passcode).
The second, middle pane is preferred to
36 display the instructions information and care elements
37 from the memory at the nursing work station, and is
38 - 13 -
01 used to enteL data such as the results of tests as
02 noted above. It is also used to initially request the
03 identification code of the nurse and of the patient
04 after the point-of-care terminal is plugged into the
05 network to identify a request to communicate.
06 The third, bottom pane is referred to as a
o7 dialog pane, and is preferred to provide information
08 to the nurse as to the previous series of tests, such
o9 as the data and time a particular selected even~ was
last performed, the name of the nurse, the planned
11 frequency of the test, and other information entered
12 at the workstation. The third pane is preferred to be
13 typically used only as an information pane to the
14 nurse.
In the event the nurse wishes to obtain a
16 list of medications to be administered for the already
17 identified patient, she pushes the "MEDS" button,
18 which, as described above, sends a code to the nursing
19 station 1. The nursing station in response accesses
the medications care event memory locations in the
21 specific patient's kardex, and transmits those care
22 elements with attributes back to the point of care
23 terminal 8. The list is displayed on display 15 in a
24 manner similar the display of vitals shown in Figure
3, and the nurse can administer the medicines,
26 immediately enter the quantities that have been
27 administered at the corresponding # indicia, etc. In
28 this manner various specific groups of care elements
29 from the electronic kardex of a particular patient can
be selected for view by the nurse and entry of the
31 results of tests, etc. The entered data is
32 temporarily stored in a local memory of the
33 point-of-care terminal, and is transmitted to the
34 nursing workstation 1 by the nurse pushing the Tx
button on the point-of-care terminal 8.
36 The preferred groups of care elements that
37 can be called up by function button and displayed on
38 - 14 -
01 the point oF caLe teLminal R is indicated as VITALS,
02 MEDICATIONS, ADL, ASSESSMENT, PArIENT PROFILE, an~
o3 TESTS.
04 A "CALC" key is pushed to convert the
05 numeric keypad into use as a calculator, by invoking a
06 microprogram stored in the local ROM of the terminal
07 8, whereupon the entered numbers and result of
08 calculation can be displayed, e.g. in the lower
o9 right-hand corner of the middle pane.
When the nursing workstation 1 receives
11 the various data from the point-of-care terminal 8, it
12 stores it in a patient stack in association with
13 locally generated time and date data, which can be
14 formulated into a report and printed on printer 2
using well known techniques.
16 A preferred structure of the point of care
17 terminal 8 is shown in a block diagram in Figure 4. A
18 microprocessor 20 is connected via address and data
19 buses 21 to a read only memory, shown as EPROM 22, and
to a random access memory 23.
21 Keypad 24, which provides the numeric key
22 input functions of keys 16, cursor key 17 and special
23 function keys 18 is connected to the microprocessor.
24 Also connected to the microprocessor is a liquid
crystal display controller 25, to which a liquid
26 crystal display 15 is connected.
27 A bar code reader 26 is connected to a bar
28 code wand controller 27, which is connected to a bar
29 code decoder 28, which is itself connected to the
buses 21. A serial communication controller 29 is
31 connected to plug 9.
32 The point of care terminal can be powered
33 in one of several ways. For example a power supply 30
34 can contain rechargeable batteries, which are charged
by plugging the power supply into a source of primary
36 power. Alternatively a power supply 30 can be
37 connected to a power plug 31 which connects to a low
38 - 15 -
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0I voltage (e.q. 24-26 volts DC) Leliable hospital power
02 distribution network. Power supply 30 functions to
03 provide the appropriate voltages to microprocessor 20
04 and other elements in the point-of-care terminal.
o5 The point-of-care terminal operates as
06 follows. Upon plugging the plug 9 into connector 7 at
o7 a patient location, and upon applying power via power
08 supply 30 either from a local battery or from a
o9 hospital power source via power plug 31, the
microprocessor is powered up and accesses an
11 initiation program stored in EPROM 22. The
12 microprocessor sends a signal to LCD controller 25
13 which causes liquid crystal display 15 to display the
14 three panes on the display. The microprocessor also
transmits a signal to the nursing computer station 1.
16 In return, the nurse is prompted by the computer to
17 enter the patient's numeric code, e.g. #47836, and her
18 own passcode on keypad 24. ThiS prompt is received by
19 microprocessor 20, which causes display on display 15
through LCD controller 25 of the prompt. The nurse
21 enters the patient code and her own passcode on the
22 keypad. The point-of-care terminal stores the entered
23 data in RAM 23. It is preferred that the patient
24 code, but not the nursels passcode, should be echoed
on the display.
26 The nurse then pushes the TX button on
27 keypad 24, which causes microprocessor 20 to access a
28 transmit program from the EPROM 22, and to transmit
29 the data entered by the nurse and stored in RAM 23
through serial communication controller 29, along the
31 LAN to the nursing workstation 1. The nursing
32 workstation registers the data in its memory 3A
33 (Figure 2), and operates a program which checks the
34 validity of the passcode and if it is correct,
transmits a validation signal back to the
36 point-of-care terminal through controller 29, which is
37 displayed under control of microprocessor 20 through
38 - 16 -
01 LCD cont~olleL 25 on display l5.
02 Each nl~rse's code can be maintained at the
03 nuLsing work station in association with one or plural
04 doctors' names, i.e. authorizing only certain nurses
05 receive a list of care elements to perform the care
06 elements on the patient associated with that
07 particular doctor. This provides further security for
08 the patient, in that only certain of the secret
09 nursing codes would be authorized for that particular
patient.
11 After forwarding an authorization signal
12 to the point-of-care terminal, which code can be
13 stored in RAM 23, microprocessor 20 is enabled thereby
14 to allow operation of the special function keys 18 to
request an outline list or special function list of
16 care elements from the nursing workstation 1 from the
17 patient kardex portion of memory 14 as described
18 earlier. Upon request by a function key being pushed,
19 causing a code stored in EPROM 22 to be sent to the
nursing workstation, the so designated memory elements
21 in memory 14 are accessed, and the resulting care
22 elements and attributes data is transmitted along the
23 local area network from workstation 1 through serial
24 communication controller 29 to microprocessor 20, for
display via LCD controller 25 on the middle pane of
26 display 15. As described earlier the nurse, after
27 viewing the list displayed on the middle pane, can
28 select by means of function keys 18 any grouped kinds
29 of care elements such as VITALS, MEDS, ADL, ACCESS,
PROFILE, or TESTS. When groups of care elements are
31 selected by pressing a function key on keypad 24,
32 microprocessor 20 accesses a specific corresponding
33 code from EPROM 22 and causes it to be transmitted
34 through serial communication controller 29 to the
nursing workstation 1. The nursing workstation, as
36 described earlier, selects the specific kinds of care
37 elements with the element attributes from the
38 - 17 -
Ol e1ectronic katdex 14 and 1ibLaLies ll and 13 defined
02 by memoLy 3 as described earlier, and transmits the
03 code back through serial controller 29 for display,
04 also as described earlier, on display 15 at the
05 point-of-care terminal.
06 AS noted earlier, data input via keypad 24
07 is temporarily stored in RAM 23 by microprocessor 20,
08 and is transmitted to nursing station l upon pushing
09 the TX key. A microprogram stored in EPROM 22 causes
microprocessor 20 to access the stored data in RAM 23
ll and to transmit it to nursing station l where it is
12 stored (stacked) in local memory 3A, from where it can
13 later be formulated into a report and printed.
14 To speed, make easier, and avoid mistakes
in entering the patient code, nurse passcode and
16 doctor number (if the system is set up to accept
17 doctor designation) on the keypad 16, a bar code
18 reader wand 26 is preferred to be used. A barcode
l9 wand 26 is connected to bar code wand controller 27.
The nurse can thereby read the patient's code (and
21 doctor's code, if used) from bar code on the patient's
22 wrist band, and her own number from her own
23 identification badge. A bar code decoder 28 decodes
24 the bar code from controller 27 that was applied from
reader 26, translating it into parallel bus signals
26 and applying it to bus 21 for reception by
27 microprocessor 20 in place of a code keyed in from the
28 keypad.
29 General operation of a microprocessor and
its peripherals is known in the art, and is described
31 in the publication Microcomputer Primer by Mitchell
32 W. Waite and Michael Pardee, published by Howard W.
33 Sams & Co. Inc., Indianapolis, Indiana. The specific
34 programs to provide the algorithms described in this
patent application can thus be prepared by such person
36 skilled in the art without the exercise of inventive
37 ingenuity, once the description of the invention
38 - 18 -
01 herein is understood.
02 In addition to providing a display such as
03 that shown in Figure 3, various more detailed displays
04 can be provided. For example by entering
05 predetermined numeric codes or by providing other
06 special function keys, the nurse can obtain, by
o7 prompting the nursing workstation, a list of all of
08 the blood pressure readings for a patient over a
o9 course of treatment, listed by date and time. This
can allow her to estimate whether the patient has been
11 exhibiting significant variations, or a fairly
12 constant blood pressure over a given period. The
13 attributes which form the various care elements can
14 contain upper and lower limits or thresholds so that
when the data transmitted to the working nurse station
16 is received, it can be compared with the limits and an
17 error signal or an alarm signal can be generated for
18 transmittal back to the point-of-care terminal. This
19 can prompt the nurse to reenter the data correctly, or
to be alerted to a reading which designates an
21 emergency condition.
22 A list of standard comments can also be
23 provided from the nursing workstation to the
24 point-of-care terminal which can be selected by cursor
and/or number and which can be recorded as an
26 integrated nursing note with the set of readings
27 (e.g. "patient uncooperative"). An example of the
28 nursing note ("PATIENT UNCOOPERATIVE") can be seen on
29 the display in Figure 3.
The nurse, by means of a predetermined
31 entry code, can request help instructions stored in
32 the memory at the workstation 1 in association with a
33 particular care element, in order to prompt her as to
34 test procedures, or if she is unsure as to an unusual
displayed prescribed dosage, to reassure herself as to
3Ç the range of acceptable dosages, etc.
37 Thus the point-of-care terminal described
38 - 19 -
~; ~ , "' ~, !, '
Ol helein and the method of operation of the system
02 utilizing that terminal augments and eases the nursing
03 function. It displays a prescribed course of
04 treatment for the patient and aids her in recording of
05 data at the time that it is to be first recorded. It
06 provides the nurse with a complete list of prescribed
o7 care elements required for a particular patient,
08 allows her to select specific ones of those care
09 elements for display (thus forming a reminder system),
10 and facilitates entry, as performed, of the results of
11 tests and the nature and amounts of medicines
12 administered with no intermediate recording step on
13 paper, thus avoiding accidental misrecording or
14 accidental duplicate administration of tests.
15 warnings can be provided to the nurse as to out of
16 range entries, out of range test results, etc. which
17 provides an early warning to her of possible errors in
18 administration of care elements, thus increasing the
19 reliability of patient care.
The point of care terminal can be used by
21 a single nurse to administer many patients, thus
22 avoiding the requirement to have one terminal per
23 patient, thus keeping cost to a minimum.
24 Because of the standardized library of
25 care elements and care attributes used universally and
26 recorded in the memory for all nurses and throughout
27 the hospital, there is no possibility of misentering
28 names of tests or medicines, since their designations
29 are automatically generated. All of the above
30 advantages are obtained due to the formation of the
31 memory, wherein electronic kardexes specific to each
32 patient are set up upon prescription of the course of
33 treatment by the physician, and formation of the
34 kardexes out of a library or pool of standard care
35 elements, whi~h themselves are made up of a pool of
36 standard attribute designations. As various care
37 elements are used by many patients in common, and care
38 - 20 -
~J '~J ~ sJij:~
01 elements use the va~-ious att~ibutes in common,
02 substantial economy o~ memory usage is achieved using
o3 the standard predefined and preentered care elements
04 and attributes, allowing a sophisticated, easy to use,
oS error avoiding, economical hospital administration
06 system and method of instructing nurses as to care of
07 patients and gathering of test results to be achieved.
08 With the input of data by the nurse in a
o9 very easy manner at the point of conducting the tests,
administering medicines and other care functions, and
11 since standard care elements and attributes are used,
12 without the requirement of the nurse to spell out what
13 care functions she has performed, the hospital
14 computer system can gather from the nursing work
lS station quantities and lists of actual materials used,
16 actual medications used, actual procedures used,
17 accept increments of labor, etc. from the memory 3A of
18 the nursing workstation using predetermined standard
19 designations. This can allow the hospital information
system to create standard costs, to input data into a
21 billing system, to calculate labor and material cost
22 of treatment of each patient based on actual
23 procedures performed, and to perform variance analysis
24 of actual vs planned expenditures. It can also
facilitate materials ordering, and management of
26 materials, medication and labor flow.
27 A person understanding this invention may
28 now conceive of alternative structures or variations
29 in design which use the principles of this invention.
~11 are considered to be within the sphere and scope
31 of the invention as defined in the claims appended
32 hereto.
33 - 21 -
