Note: Descriptions are shown in the official language in which they were submitted.
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METHOD AND SYSTEM FOR DISPENSING COMMUNICATION DEVICES TO
PROVIDE ACCESS TO PATIENT-RELATED INFORMATION
Background of the Invention
Field of the Invention
[0001] The present invention relates in general to the use of computing
devices in a
hospital environment, and relates in particular to renting computing devices
to individuals
for access to patient specific information.
Description of the Related Art
[0002] Family members of acutely hospitalized patients are usually very
concerned
about the health of their loved ones. Immediate family members and relatives
for a
hospitalized patient often gather for hours or days in hospital waiting rooms,
lobbies, and
cafeterias while awaiting information on the status of their hospitalized
relative. They
often take hotel rooms nearby for extended stays. Many times, relatives are
viewed as a
"necessary nuisance" by clinicians and caregivers because they want to know
more and
more information. Relatives will many times make many attempts in person and
by phone
to request more information while at the same time sometimes interfering with
the jobs
that clinicians and caregivers are attempting to complete.
[0003] In a hospital setting, relatives of critically ill hospitalized
patients often receive
information that is frequently insufficient, incomplete, and less than timely.
Much of the
time, relatives are away from the patient's bedside and do not have access to
information
they would like to have. The severity of the problem varies from hospital to
hospital as
well as from setting to setting within a given hospital. Much of the
inconsistency results
from availability, workload, qualification and personal interests of the
critical care and
administrative staff. A study of 24 ward doctors from 5 medical departments
showed that
from the average daily working time of 8.6 hours, including the time spent on
communication with patients and their families, an average of 4 minutes was
spent on
communication with each patient and 1 minute with the patient's family.
(Hauser, W., &
Schwebius, P. (1999). [Four minutes for the patient and one minute for the
families.
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Physician-patient-family communication in medical departments.) Psychother
Psychosom
Med Psychol, 49(5), 168-70).
[0004] The main reason for this lack of information is the current method of
communication. Presently, some information communicated to relatives comes
from
person-to-person verbal communications which are usually untimely and
sometimes
difficult to comprehend in lay person's terms. Information is simply given in
a
disorganized manner as relatives have to wait to receive information verbally
from nurses
or attending physicians on a catch-as-catch-can basis. Other information
communicated to
relatives comes from information fliers, pamphlets, and brochures distributed
to relatives
that are often outdated. Relatives have to make a concerted effort to gather
and interpret
diverse types of information, which may or may not be entirely pertinent to
the stay of the
patient and which may not address the specific questions that the relatives
may wish to
have answered. Further, all of the present methods of communication force
patients'
relatives to consume information in a passive fashion. Relatives rarely play a
significant
role in providing information that will be helpful for treatment of the
patient.
[0005] Based on the foregoing, a need exists for providing information to
relatives and
for relatives to provide information to medical personnel in a more efficient
and effective
manner. Relatives should have the ability to find out the current status of
the hospitalized
patient at any given time. There should also be access to the principal
diagnoses and
outcome prognosis in addition to disease-specific information. Relatives
should also be
promptly informed about critical new information about the patient's status.
Post-
discharge plans such as follow up care and explanations of physicians' plans
for further
treatment and tests should also be easily accessible. Many times, relatives
would like to
see the cost of treatment and the proportion which the insurance company is
expected to
cover.
[0006] To help put relatives at ease, relatives also need easy access to
subjects that are
difficult to discuss with medical personnel such as exploring different
alternatives, such as
second opinions or referrals. Finally, to help make relatives feel more at
ease during their
wait, general information such as travel information and local hotels and
restaurants
should be provided to relatives.
[0007] Physicians also have a need for more efficient and organized data.
Physicians
must perform different tasks such as clinical, case management, and
administrative
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functions. Physicians are in need of a portable one stop location to perform
all of these
fiu~ctions at one time.
Summary of the Invention
[0008] One aspect of the present invention is a method of supplying
information
concerning a patient. In accordance with this aspect, the method comprises
providing a
display device that is a dedicated part of a system to a person. The display
device is
configured to display information concerning a patient. The system receives a
first data
set concerning the patient, transmits the first data set in digitized form to
a server, and
stores the first data set as patient information. The system also transmits at
least a portion
of the stored patient information from the server to the display device.
Preferably, the
method processes the first data set before the portion of the data set is
transmitted from the
server to the display device. In particular embodiments, the information
transmitted to the
display device includes at least a portion of data from the first data set.
For example, the
data set concerning the patient includes one or more of vital sign data,
historical data
concerning the patient, physical examination data, lab result data, and
imaging results
data. Advantageously, the person to whom the display device is provided is a
relative of
the patient, a friend of the patient, a physician, a nurse, or another member
of the medical
personnel of a hospital or other care facility. Advantageously, the display
device is
integrated with a computing device to allow display of the information. For
example, the
computing device can be a Personal Digital Assistant (PDA), a two-way pager
with
Personal Digital Assistant functionality, a Wireless Application Protocol
(WAP) phone.
Preferably, the computing device is a microprocessor-based computer. The
connections to
the computing device are preferably wireless connections, and the information
is
transmitted from an RF transmitter to an RF receiver. The transmitted
information
advantageously ~ includes case management information, such as, for example,
administrative data, clinical data. The display device may be provided to the
person by
renting, selling or lending.
[0009] Another aspect of the present invention is a method of supplying
information
concerning a patient. In accordance with this aspect, the method comprises
providing a
display device to a person, the display device configured to display
information
concerning a patient; receiving a first data set concerning the patient;
transmitting the first
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data set in digitized form to a server; storing the first data set as patient
information; and
transmitting at least a portion of the stored patient information from the
server to the
display device.
[0010] Another aspect of the present invention is a method of providing
information
concerning a patient. In accordance with this aspect, the method comprises
dispensing a
display device that is a dedicated part of a system to a person. The display
device is
configured to display information concerning a patient. The system receives a
first data
set concerning the patient; transmits the first data set in digitized form
over a network to a
server that stores the first data set as patient information; transmits at
least a portion of the
patient information from the server to a display device over the network; and
receives
additional patient information over the network from a person to enhance
delivery of
health care to the patient.
[0011] Another aspect of the present invention is a system of providing
information
concerning a patient. In accordance with this aspect, the system comprises a
hospital
information service, which manages patient related information. A first server
receives
data from the hospital information service. The first server stores data in a
first database.
The system includes patient monitors which receive a data set concerning a
patient, and
includes a monitor acquisition module which receives data from the patient
monitors. The
monitor acquisition module stores the data from the patient monitors in a
second database.
A second server accesses the second database and transmits data over a network
to a
display device that is dispensed to a person. In particular embodiments, the
first database
and the second database axe combined in a single database. In certain
embodiments, the
display device is advantageously integrated with a computing device to allow
display of
the information.
[0012] Another aspect of the present invention is a method of renting a device
to a
person affiliated with a patient situated in a hospital. In accordance with
this aspect, the
method comprises contacting the person to make the person an offer to rent the
device,
and entering into a contract with the person regarding usage and rental
conditions. The
method creates a customized account for the person, and then provides
communication
capability between the hospital and the person wherein the person can request
and receive
patient related information via the device, and wherein the hospital can
communicate with
the patient when needed. The customized account preferably includes a level of
access, an
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enabled service, or a charge level. The patient related information
advantageously
includes at least one of patient specific information, hospital specific
information, or
disease specific information. Preferably, the hospital can page the person via
the device.
j0013] Another aspect of the present invention is a method of providing a
communication service between a hospital and a person affiliated with a
patient. In
accordance with this aspect, the method comprises contacting the person to
make the
relative an offer to buy the communication service; entering into a contract
with the person
regarding usage and purchase conditions; loading a software module on to the
PDA of the
person; activating the software module for the duration of the contract; and
providing
communication capability between the hospital and the person, wherein the
person can
request and receive patient-related information.
j0014] Another aspect of the present invention is a method of providing a
display
device to medical personnel to communicate with a hospital regarding patient-
related
information. In accordance with this aspect, the method comprises dispensing a
display
device to a medical person; enabling the medical person to log on to a server
via the
display device; providing to the medical person a list of patients via the
display device;
transmitting to the medical person relevant patient specific data in response
to a selection
made by the medical person from the list of patients; receiving case
management
information entered by the medical person via the display device after
reviewing the
patient specific data and examining the patient, and providing the physician
with
transmission capabilities through the display device for the data in the
session. For
example, the medical person may be a doctor, a nurse, or other staff member.
The case
management information advantageously includes clinical data, and may also
advantageously include administrative data.
[0015] Another aspect of the present invention is method of providing
information
concerning a patient. In accordance with this aspect, the method comprises
dispensing a
software module configured to be integrated with a display device that is a
dedicated part
of a system to a person. The display device is configured to display
information
concerning a patient. The system receives a first data set concerning the
patient; transmits
the first data set in digitized form over a network to a server for storage
therein as patient
information; and transmits at least a portion of the patient information from
the server to a
display device over the network.
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Brief Description of the Drawings
[0016] The embodiments of the present invention are described in more detail
below
in connection with the accompanying drawings in which:
[0017] Figure 1 illustrates a schematic illustration of a system for
dispensing display
devices to provide information to people regarding patients in a hospital;
[0018] Figure 2 illustrates one embodiment of a system to gather patient data
and
transmit it to the display device in Figure 1;
[0019] Figure 3 shows a software configuration developed to enable a person
affiliated
with the patient to obtain the patient related information;
[0020] Figure 4 shows a network diagram of the hospital-wide hardware and
network
infrastructure for the software shown in Figure 3;
[0021] Figure 5 is a schematic view of the support system used to maintain the
software and hardware configurations shown in Figures 3 and 4;
[0022] Figure 6 shows one embodiment of a method for providing information a
display device in the possession of the person affiliated with the patient;
[0023] Figure 7 shows one embodiment of a method for dispensing device to
medical
personnel to communicate with a hospital regarding patient related
information;
[0024] Figure 8 shows one embodiment of a method for dispensing a PDA to a
person
affiliated with a patient (e.g., a relative or significant other); and
[0025] Figures 9A-9G are screen shots of the GUI seen by the person affiliated
with
the patient or the physician when using the display device 110.
Detailed Description of the Preferred Embodiment
[0026] Embodiments of the present invention are described in detail below with
reference to the figures, wherein like elements are referenced with like
numerals
throughout.
[0027] Figure 1 illustrates a schematic illustration of a system for
dispensing display
devices to provide information to people regarding patients in a hospital 102.
A dispenser
108 dispenses display devices 110 to a doctor 112, a nurse 114, a patient's
relative 116, or
any significant other or member of medical personnel that would be interested
in acquiring
information concerning a patient 104. The dispenser 108 receives information
concerning
the patient 104 from the sensor 106.
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[0028] In one embodiment, the dispenser 108 is the hospital. Alternatively,
the
dispenser 108 is advantageously a third party vendor, such as, for example a
medical
supply service. The hospital can rent, sell, or lend a display device 110,
such as a hand
held device, to a person affiliated with the patient, such as, for example,
relatives,
significant others, or friends of patients in order to provide continuous
patient specific
information in a user friendly manner. Hand held devices include Personal
Digital
Assistants (PDAs) such as Palm Pilots, Pocket PCs, two-way pagers with PDA
functionality (e.g., pagers made by Research In Motion (RIM) Limited), and
Wireless
Area Protocol (WAP) phones. In one embodiment, the hand held devices are
wireless.
The person affiliated with the patient can receive current information
concerning the
patient via the wireless handheld device whether the person is inside the
hospital 102 or at
a remote location.
[0029] According to another embodiment, the dispenser 108 sells, rents, or
lends a
software module to be configured with the person's own handheld device. The
software
module can be stored on a computer readable medium such as a disk or a data
storage
card. Alternatively, the software module can be beamed using infrared
technology or RF
technology to an infrared port or to an RF port located on the handheld
device. Medical
personnel can load the software module on to the handheld device for the
person.
Alternatively, the dispenser 108 can provide self serve machines that dispense
the
software modules. Payment methods such as credit cards and debit cards can be
used in
conjunction with dispensing the software modules. The dispenser 108 can
program the
software module to provide dedicated access to one particular patient upon
request for a
software module for that particular patient. The person affiliated with the
patient can have
a customized account with limited access rights to the system for the
particular patient that
the person is affiliated with. This embodiment is compliant with the Health
Insurance
Portability and Accountability Act (HIPAA) by maintaining the privacy and
confidentiality of patient information. Generally, persons affiliated with one
patient will
not have access to patient information of another patient unless there is a
separate
affiliation. For instance, medical personnel would have access to multiple
patients'
prof les. Alternatively, the hospital 102 can provide the software module to
the person
who can then access multiple patients' data upon providing the necessary log
in
information.
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[0030] In this configuration, the hand held device includes a 2-way
interactive
interface that allows the person to input patient related information in
addition to receiving
patient related information. The bi-directional flow of information enhances
the delivery
of health care because it allows people having a close relationship to the
patient to provide
information to medical personnel as the importance of certain information
becomes
necessary or more apparent. For instance, relatives of patients may remember
some
medical history after they leave the tense atmosphere of an Intensive Care
Unit (ICU) and
can then enter the data in a more relaxed setting. Accordingly, this
embodiment allows
people affiliated with the patient to advantageously take a more active role
and thereby
less stressful role in the patient's recovery.
[0031] In another embodiment, the hospital has an Internet site which the
person can
access to retrieve patient related information. The person can use a
microprocessor-based
computer, such as, for example, a PC, to log on to the web site. If the person
has a
Personal Digital Assistant (PDA), the person can synchronize the data on the
PC with a
PDA. For example, the Palin Pilot produced by Palin Inc. offers a HotSync
function
which enables synchronization between a Pahn Pilot and a PC. Alternatively,
the person
can log on to the web site through a PDA. In one embodiment, a software module
can be
downloaded using the HotSync function in order to use the handheld device for
the
transmission and receipt of patient related information.
[0032] In yet another embodiment, the hand held devices are distributed to
medical
personnel. As discussed above, medical personnel include a doctor 112, a nurse
114, or
any other person working in the hospital to care for the patient. Medical
personnel can
access clinical data and lab data in addition to case management and
administrative data in
one portable location. A lengthy list of parameters or signals that can be
accessed includes
bio-potentials that provide information about the cerebral cortex, integrity
of neural
pathways, and muscle function or connectivity of a patient. In addition, the
data includes
vital signs such as, for example, heart rate, blood pressure, blood flow, and
intracranial
pressure. Finally, imaging modalities such as PET, MR, CT, and X-ray can be
accessed
through the handheld devices.
[0033] The data that can be accessed by either medical personnel or a person
affiliated
with the patient includes a variety of clinical, administrative, and
historical data. The data
that the person affiliated with. the patient views is processed to provide the
person with
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relevant data in an understandable fashion. Many people are not versed in
medical
terminology and clinical concepts. Fox example, detailed charts and graphs are
advantageously summarized in layperson's terms. In one embodiment, a Natural
Language Processing (NLP) system is used to interpret official clinical
reports into a form
more understandable by lay people. The NLP system can include computer based
translation systems with or without the need for human assistance. The person
can also
access clinical events such as, for example, new reports, new test results,
detected changes
from normative values of the monitored parameters, and significant clinical
observations
made by the nurses. The person can also access a list of current medications,
dosages,
expected effects, observed effects and side effects of treatments.
[0034] In one embodiment, the dispenser 108 is a third party who dispenses the
device
to a person affiliated with the patient or medical personnel. The third party
can sell, rent,
or lend a handheld device to a person affiliated with a patient at a counter
set up within the
hospital, at a counter set up at a location outside of the hospital, or
through a dispensing
machine located inside or outside of the hospital 102. The third party
coordinates with the
hospital 102 to gain access to patient data and to perform subsequent
processing of the
data. Alternatively, the third party is responsible for only dispensing the
devices, in which
case, the hospital 102 provides the infrastructure to summarize and provide
data to the
devices.
[0035] In another embodiment, the dispenser 108 provides additional services
that can
be accessed through the display device 110. The person affiliated with the
patient can
access online reports on the patient status generated by the physicians.
Further, the
dispenser 108 automatically interprets the meaning of abnormal lab data and
provides
explanations of physician reports viewed by the person affiliated with the
patient. If the
person would like, the person can access the daily physicians' reports after
patient rounds
to be updated on the patient's progress. In addition, a person affiliated with
the patient
may take more comfort in knowing more information about the caregiver.
Biographical
information can be retrieved regarding the caregivers such as, for example,
the physicians
and nurses. The person can even access photographs of the caregivers to become
more
familiar with the roles of different people the person interacts with.
[0036] . These additional services are helpful to the person affiliated with
the patient
because the additional services allow the person to monitor the treatment of
the patient
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from a remote site. The person can access an online list of medications and
dosages and a
time line of their administration. Outbound and inbound paging is supported by
the
display device 110 to enable the medical persomiel to contact the person in
the case of an
important event and to enable the person to page the medical personnel if the
person
notices some irregularity while viewing the data.
[0037] Figure 2 illustrates one embodiment of a system to gather patient data
and
transmit it to the display device 110. The system includes at least one sensor
106 that
receives patient data 202 and that transmits the patient data to a server 206
for eventual
transmission to a web-based client 216 or to an RF Receiver 218.
[0038] The sensor 106 is preferably a patient monitor or a bedside device. For
example, a patient monitor is advantageously a vital sign monitor (e.g.,
Hewlett Packard
Viradia, Marquette Solar 8000) or a conventional EEG monitor (e.g., Niclolet
Endeavor).
Exemplary bedside devices include ventilators (e.g., Puritan Bennet 7200),
infusion pumps
(e.g., Baxter FIo-Gard), or the like. The sensor is operably connected to the
patient to
receive current patient data. The sensor converts the patient data to a
digitized form and
transmits the data to the server 206.
[0039] In one embodiment, the server 206 preferably processes the data before
transmitting the data set it receives from the sensor 106. As discussed above
with respect
to Figure 1, the average person affiliated with the patient wants an
understandable
summary of the patient data 202. Therefore, the server 206 transmits the
patient data 202
to a data processing module 210. The data processing module 210 advantageously
employs the NLP system discussed above with respect to Figure ,1 or any other
data
processing system that summarizes data for a Iayperson. After the patient data
202 is
processed, the patient data 202 is stored as patient information in a data
file 208. Upon a
request for patient information or upon an automatic transmission such as an
alert, the
server can access the data file 208 to retrieve at least a portion of the data
file for
transmission. The server 20b may advantageously include voice recognition
software and
voice generation software so that the requests to and the information from the
data
processing module 210 may be provided verbally.
[0040] The alerts are calculated by a softwaxe module using automatic medical
rules
execution (AMItEx). Clinical data such as labs or vitals can be used as inputs
to clinical
calculations, which are performed on-line in a quasi-real time fashion without
the need of
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manual intervention by the caregiver. The calculations can yield diagnostic
and/or
prognostic statements like Fever, Hypertension, Metabolic Acidosis, etc. For
instance, the
Arterial Blood Gasses rule uses five vital signs to determine whether the
patient has
alkalosis or acidosis and whether the origin is metabolic or respiratory. When
an
abnormal lab or vital sign is recorded, the medical rule to which the
parameters serve as
inputs is automatically applied. Other data is also retrieved to refine the
assessment of the
abnormality. For instance, if Na+ is low, osmolality, urine output, and
glucose levels are
also checked and applied in the rules process. Further, the same software
module or a
different software module can perform automatic analysis of clinical events.
Clinical
events are signif cant changes of one or more measure parameters, i.e., when a
parameter
goes in or out of the normal range. For example, a clinical event would be a
significant
intracranial pressure (ICP) change such as more than 20 mm Hg for more than
five
minutes, an EEG seizure, or abnormal Burst-Suppression pattern. Tn response,
at least a
portion of the data file is transmitted to medical personnel with a suggested
course of
action.
[0041] The server 206 can then transmit at least a portion of the stored
patient
information to a network 212 or to a radio frequency (RF) transmitter 214 or
to both. One
skilled in the art will recognize that the network 212 can be the Internet, a
local area
network (LAN), a wireless network, a cable television (CATV) network, a
satellite
network, a Public Switched Telephone Network (PSTN), or any other
communications
network. As discussed above with respect to Figure 1, the person affiliated
with the
patient can log on to the web site of the hospital 102 through the Internet
via a web-based
client 216. The web-based client 216 can be any microprocessor-based computer
such as,
for example, a PC. If the network 212 includes a wireless network, the server
206 can
transmit to an RF receiver 218 through a wireless Internet Service Provider
(ISP) or local
area Wireless Ethernet (802.1 1b) network. The RF receiver 218 is preferably
integrated
with a PDA or other wireless handheld device that the person affiliated with
the patient
can use to access at least a portion of the stored patient information.
[0042] The RF transmitter 214 can also transmit at least a portion of the
stored patient
data to the RF receiver 218. This configuration is advantageous for a system
based in the
hospital 102 that includes the RF transmitter 214 for transmitting at least a
portion of the
stored patient information to handheld devices integrated with the RF receiver
218.
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[0043] Alternatively, the server can transmit the patient data 202 that it
receives from
the sensor 106 in real time. This configuration is preferable for medical
personnel because
they usually like to see more detailed data than the person affiliated with
the patient so that
they can make their own summaries and conclusions.
[0044] Figure 3 shows a software configuration developed to enable a person
affiliated
with the patient to obtain the patient related information. In one embodiment,
a
client/server architecture is used to provide patient related information in a
real time. The
software component of the server resides preferably on a Windows NT/2000/XP
server
installed in the hospital 102. Other servers having other operating systems
can also be
used. The software component retrieves information and disseminates the
information on
demand to web-based clients or handheld devices. The software component
abstracts and
delivers only relevant information. In one embodiment, the software component
includes
a collection of software modules.
[0045] In one embodiment, the software component includes automated critical
path
(ACP) technology. A critical path is a plan for treatment of a patient, who
has a particular
diagnosis. The plan is followed as closely as possible by a team of
caregivers, and the
progress of the patient is monitored on a daily basis. If the progress is
within well-known
and expected boundaries, the critical path is continued as outlined and
planned. If any
parameters deviate significantly from the norm, an alternate and more
individually tailored
path is taken. If a critical path is followed as outlined, ordinarily it does
not require much
extra involvement on the part of the physician except for small tasks needed
to be
performed at various stages of the path. However, if a deviation from the
critical plan is
necessary, the physician needs to. be notified and needs to get more involved
in the
treatment. As opposed to a paper-based recording system, the software
component stores
the steps of the critical path in a database. The software component includes
a critical path
manager, which is a rule-based system that is pre-coded to issue
recommendations based
upon the level of compliance with the treatments in accordance with the
critical path. If
there is a mismatch between the level of compliance and the predefined set of
treatments,
an alert is issued to a physician. The alert will notify the physician that a
critical path step
has not been executed or that there is a deviation in the patient's progress.
Further, an on-
line ordering system notifies the physician when an order does not fall within
the critical
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path. This notification helps to avoid the ordering of non-essential tests,
scans,
procedures, etc., and contributes to cost effectiveness.
[0046] The software component of the client resides on the handheld devices.
The
software operates on the handheld devices in PUSH and PULL modes. The person
uses
PULL to retrieve data from the server such as specific patient related
information. The
person uses PUSH to provide the server with additional information. For
instance, a
family member may become aware of additional information historical
information that
may be of some use to physicians. The family member uses PUSH in order to send
the
information to the server. Different development kits (SDKs) are used to write
software
depending on the handheld device or PC used by the family member. In one
embodiment,
the Code Warrior for Palm OS R6 and Palm OS SDK 3.5 is used for wireless palms
348.
The Blackberry handheld SDK 2.0 is used for the two-way pagers with PDA
functionality
344. The UP SDK 4.0 is used for WAP phones 342. The software component of the
client retrieves data through PULL mode and displays it to the end user via a
graphical
user interface (GUI) whose design is based on in-depth research of the
perceived needs of
the relatives. Preferably, the software component is user-friendly and
consists of multiple
interrelated display screens.
[0047] The software modules include a monitor acquisition module 310, an HL7
server 306, a MedServer 342, web-based data entry forms 334, client software,
and
databases for temporary storage. The software modules connect to monitors,
internal
information systems, and external networks to transmit and receive patient
related data.
[0048] The monitor acquisition module 310 serves as an interface to the
Intensive
Care Unit (ICU) monitors and bedside devices. The ICU monitors include vital
sign
monitors 316, EEG monitors 318, and other patient monitors 320. The bedside
devices
include ventilators 322, infusion pumps 324, and other bedside devices 326.
The monitor
acquisition module 310 acquires the patient related data and stores the data
in patient
specific dynamic databases 308. The patient specific dynamic databases 308
stores patient
specific data that changes on a daily basis. The stored patient specific data
includes lab
results, diagnoses and predicted outcomes, abstracted monitor data, abstracts
from clinical
reports, and, if needed, NLP processed data. The monitor acquisition module
310 is
preferably built upon ClC++ technology.
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[0049] The HL7 server 306 also stores data in the patient specific dynamic
databases
308. The HL7 server is connected to a Hospital Information Service (HIS)
datagate,
which broadcasts hospital admission and discharge data (ADT), clinical labs,
and
medications to the HL7 server 306. The HIS datagate 340 is preferably
connected to a
Pyxis MedStation 302. The HL7 server 306 then stores the ADT, clinical labs,
and
medications in the patient specific dynamic databases 308. The information in
the patient
specifc dynamic database 308 and the hospital information service may be
advantageously combined in a single database.
[0050] The MedServer 342 is effectively a gateway between the databases and
the
software component of the client. The MedServer transmits data that is stored
in the
patient specific dynamic databases 308 to the Internet 336. The data can then
be
transmitted via active server pages (ASP) to a web portal 340 or to a wireless
ISP 338.
The wireless ISP 338 transmits the data to a variety of handheld devices such
as, for
example, wireless palms 348, pocket PCs 346, two-way pagers with PDA
functionality
344, and WAP phones 342. The MedServer 342 also receives data through the
Internet
336 from people affiliated with patients. The MedServer 342 then transmits the
data to the
patient specif c dynamic databases 308 which can be accessed by the HIS
datagate 340
through the HL7 server 306 or by the monitor acquisition module 310. The
MedServer
312 also accesses a local area static database 332, an ICU database 330, and a
management database for related devices 328. The local area static database
332 includes
data that rarely changes and is hospital specific, such as local general
information about
hotels and restaurants, and descriptions of the types of monitoring equipment
used. The
ICU team database 330 includes physician and nurse biographies and
qualifications.
Finally, the management database for related devices 328 includes descriptions
of the
types of monitoring equipment used.
[0051] The local area static database 332, the ICU Team Database 330, and the
management database for related devices 328 are accessed by the web-based data
entry
and system configuration 334. The web-based data entry and system
configuration 334
includes data entry forms used by the administrator to configure and maintain
the systems.
The data types supported are textual data, images, monitored parameters, labs,
and ECG
analysis. Textual data is preprocessedlabstracted reports from the HIS such as
OP, CT,
XR, DC, DS, or NC. The images include MRI, CT, and PET. The monitored
parameters
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include current snapshots of BP, ICP, ECG, HR, BT, SA02, and MAP. The Labs
include
the most recent plus charted trends for change of critical or peri-critical
values and
explanation of their meaning. Finally, the EEG analysis includes neurocritical
reports.
[0052] Figure 4 shows a network diagram of the hospital-wide hardware and
network
infrastructure for the software shown in Figure 3. Similar to the way software
is
differentiated, the hardware needed to support the system can also be
differentiated so that
there is hardware internal to the system provided at the time of installation
and hardware
external to the system and presumably existing in the hospital 102 already.
[0053] The internal hardware includes the MedServer 312, a web server 406, and
the
monitor acquisition module 310. Preferably, theses systems are Windows
98/NT/2000/Xf
based computers with CPU speed greater than 500 MHz, memory greater than 64 MB
of
RAM, and a storage capacity greater than 1 GB. Depending on the traffic load
at the
particular hospital facility, these three separate pieces of hardware can be
integrated into
one machine or further distributed over many workstations using Network Load
Balancing
software (NLB) for Windows 2000.
[0054] The monitor acquisition module 310 is connected to the Ethernet line
410. The
monitor acquisition module 310 acquires data from the bedside devices 408 and
the patient
monitors 412 through the Ethernet line 410. The three pieces of hardware are
connected
to the Hospital LAN 414. Data is stored in the system databases 404. The
Hospital LAN
is a fiber optic backbone based on Ethernet or TokenRing technology.
[0055) A firewall 480 ensures that data stored in the HIS datagate 304 is
protected
from users that access the web server 406 or the MedServer 312. The firewall
methodology is any standard methodology as recognized by one of ordinary skill
in the
art, such as, for example, a proxy server.
[0056] Figure 5 is a schematic view of the support system used to maintain the
software and hardware configurations shown in Figures 3 and 4. The GCQ server
508
receives EEG and vitals from the ICU monitors 504, ADT and Lab data from the
HIS 304,
and data from the static databases 506. The rental and configuration personnel
520
includes an administrator that monitors the service on a daily basis and staff
that dispense
handheld devices or software modules to end-users. The programming support
personnel
530 set up and maintain the service. The GCQ server 508 is connected to the
Internet 336.
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A PC 512, a wireless device 510 with access to the wireless ISP 338, or both
are
connected to the Internet 336.
[0057] Electronic patient records are guarded with stringent security
features, which
include biometric user authentication via electronic signatures and device
serial numbers,
user authorization using encrypted passwords, and encryption of all textual
data. In
addition, all patient relevant data is permanently stored on the GCQ server
508 side and
only segments of it are maintained temporarily on the handheld device for the
purpose of
off line patient management. The data are promptly uploaded to the GCQ server
508 by
wireless or through hot sync technology.
[0058] Figure 6 shows one embodiment of a method for providing information to
a
display device 110 in the possession of the person affiliated with the
patient. As discussed
above with respect to Figure 1, the dispenser 108 of the display device 110
can be the
hospital 102 or a third party vendor. In a step 602, a display device that is
part of a system
is dispensed to the person affiliated with the patient. As discussed above,
the display
device is preferably integrated with a computing device such as, for example,
a PDA.
After learning that the patient is in the hospital, the person affiliated with
the patient can
purchase, rent, or borrow the display device from the dispenser. In one
embodiment
discussed above, the person can simply go to a dispensing machine to retrieve
a PDA or to
retrieve a software module for the person's own PDA.
[0059] In a step 604, a data set concerning the patient is received from the
sensor 106
by the server 206 as shown in Figure 2. Alternatively, the data set can also
be received
from medical personnel making observations and transmitting the data to the
server. In
one embodiment, a handheld device used to receive data from the server can
also be used
by medical personnel to transmit patient related information to the server.
[0060] In a step 606, the data set is transmitted to the server 206. The data
set is
digitized before transmission to the server. If the data set needs to be
processed for so that
the person can understand it, the server 206 can transmit the data set to the
data processing
module 210 as shown in Figure 2.
[0061] In a step 608, at least a part of the stored patient information in the
data file 208
can be transmitted to a display device 110 over the network 212. The display
device is
preferably integrated with a computing device as discussed above.
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[0062] Figure 7 shows one embodiment of a method for dispensing device 110 to
medical personnel to communicate with a hospital regarding patient related
information.
Although relatives of patients are the individuals that presently have the
least amount of
information, renting devices to medical personnel can improve the medical care
process by
providing care givers with more organized and centrally located data. As
described above
with respect to Figure 1, in one embodiment, the device can be a wireless
device or a web
based client.
[0063] In a step 704, the hospital 102 dispenses a PDA to a physician (or
another
caregiver, such as a nurse). By providing the physician with a wireless
handheld device
such as a PDA, the physician can execute and complete all necessary
fiuictions, such as,
for example, clinical, management, administrative, and billing tasks. These
functions are
normally performed in multiple sessions with and without the patient. For
example, a
doctor presently records clinical data in the presence of the patient and
records most
administrative data outside the presence of the patient. The physician
advantageously uses
the PDA to perform these functions in a single session with the patient. One
embodiment
includes a schedule notification feature that automatically notifies a
physician when a
patient has arrived in the hospital. The schedule notification feature also
notifies the
physician that the patient is fully induced/anaesthetized in the Operating
Room (OR). The
physician can thereby adjust his or her schedule accordingly to time the
patient's arrival.
[0064] In a step 706, the physician carries the PDA to a point of care. The
point of
care can be a hospital ward bed, an ICU bed, or any other place where the
physician
encounters the patient. In a step 708, the physician logs on to the server 206
via client
software loaded on to the PDA. The client software allows the physician to
access the
server 206, which in turn can access databases holding patient specific
information. In a
step 710, the physician selects the name of the patient from a list of patient
names
displayed on the PDA. After making the selection, the physician receives the
status of the
patient in a step 712 and reviews the status in a step 714.
[0065] In conjunction with the physician's review of at least a portion of the
data
stored in the data file 208, the physician conducts a physical examination of
the patient in
a step 716. In a step 718, the physician enters case management information,
which
includes the physician's observations and administrative, clinical, and
historical data. For
example, the physician enters diagnoses, recommendations, and billing data
into the data
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file 208 via the handheld device 110. The physician records observations and
notes on the
PDA to be stored in the data file 208. The PDA also transmits the data to the
server 206,
which stores the data in the data file 208 either as transmitted or after any
necessary
processing.
[0066] In a step 720, the physician can transmit data via the PDA. Data can be
transmitted to the PDA in the possession of a person affiliated with the
patient without the
person making a request for the information. For example, the physician can
page the
person affiliated with the patient in the event of an emergency. Further, the
physician can
send an update to the person's PDA of the current status of the patient. In
one
embodiment, there is a multiple destination export feature which allows the
history and
physical exam notes written by the physician to be sent to multiple
destinations such as,
for example, a refernng MD, a primary care MD, an HMO case-manager, other in-
hospital
care team members or consultants, MD office record, or a billing agent.
[0067] In one embodiment, the nurse transmits data over a PDA to a physician
with a
PDA. In an ICU environment, the process of taking care of the in-house
hospitalized
patients is cyclical in nature. The work flow in the ICU is such that nurses
are constantly
in the ICU and in contact with the ICU patients, while the physicians visit
the ICU and
interact with nurses and other caregivers periodically through day and night.
At these
times, the nurses are expected to report any new and significant changes in
the patient's
clinical status or other relevant observations or issues. There are two types
of
communication between nurses and doctors in terms of urgency. The first type
of
communication is routine, which waits for the physician to show up in the ICU.
Some of
these routine communications involve observations that cannot be automatically
recorded
and must be observed by medical personnel (e.g., vomiting, complaining,
agitation). The
second type is acute or urgent, which requires immediate contact and
information
exchange.
[0068] Routine communications can be recorded by the nurse on a PDA when the
nurse makes an observation. The routine communications are stored in the
patient specific
dynamic databases 308. When the physician logs on through the physician's PDA,
the
physician can view the routine communications. This embodiment advantageously
allows
the nurse to make one recording of the observation at the time of its
occurrence instead of
waiting for a physician to enter the hospital 102 and be available for
discussion. On the
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other hand, acute communications require immediate dispatch. The nurse can
pipe a
message with the use of the PDA to the physician's PDA to page the physician.
In one
embodiment, a time window is created to measure that amount of time that can
pass before
the physician does not receive the page and a repeated attempt to page must be
made.
[0069] In another embodiment, after step 720, the physician's diagnosis is
automatically coded by the system. The code is linked to an appropriate list
of clinical
guidelines. There are many web sites that publish clinical guidelines. The
physician can
then access an Internet site through a web hyperlink to view an evidence-based
clinical
practice guideline.
[0070] In one embodiment, a software module automatically formats a
physician's
notes for transmission to insurance companies. The softwaxe module includes an
automated method for calculating CPT codes and exam level from check-marked
entries
mad by the physician or automatically entered at a from various data sources.
In addition,
the software module can also provide pricing information for services that the
physician is
about to perform or has performed.
[0071] Figure 8 shows one embodiment of a method for dispensing a PDA to a
person
affiliated with a patient (e.g., a relative or significant other). In a step
804, a patient is
admitted into the hospital 102. In an optional step 806, relatives of the
patient are
contacted and arrive at the hospital 102 if they do not arrive with the
patient.
Alternatively, significant others or friends can also be contacted and arrive
at the hospital
102.
[0072] In a step 808, the hospital offers to sell, rent, or lend a PDA or
other handheld
device to the relatives. Alternatively, a third party can dispense PDAs to the
relatives.
This offer can take place in the form of medical personnel asking the
relatives to use the
PDA. Alternatively, the offer can be an advertisement such as, for example, a
sign or a
television commercial. In a step 810, if the relatives accept the offer, the
hospital and the
relatives enter into a contract outlining usage and rental conditions for the
PDA. Although
some hospitals may choose to provide the PDA as a free service, the hospital
generally
will want to control the usage of the device to ensure that the device is
returned and is not
abused.
[0073] In a step 812, the hospital sets up a customized account for the
relatives. In
one embodiment, a PDA with limited access to the specific patient's data is
dispensed to
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the relatives. In another embodiment, a PDA with access to the server 206 is
given to the
relatives along with log-on information specific to the specific patient.
[0074] In a step 814, the relative carries the PDA either inside the hospital
or at a
remote location. In a step 816, the relative uses the PDA to request patient
related
information or provide patient related information. Accordingly, the relative
is
advantageously enabled to take a more active role in the treatment of the
patient than seen
in present method of health care. In a step 818, the hospital communicates
with the
relatives as needed. As discussed above with respect to Figure 7, the medical
personnel
are also enabled to communicate with the relatives by sending updates to the
PDA or by
paging the relatives in case of an emergency.
[0075] In a step 820, the relative returns the PDA to the hospital upon
expiration of the
contract. In another embodiment, the relative uses the relative's own PDA and
borrows or
rents a software module on a storage disk or storage card from the hospital.
After the
duration of the contract expires, the storage disk or storage card becomes non-
operational.
The relative can then discard the storage disk or storage card.
[0076] Figures 9A-9F are screen shots of the GUI seen by the person affiliated
with
the patient or the physician when using the display device 110. The exemplary
screen
shots are advantageously designed for the Palin.platform to provide the
maximum amount
of relevant information in the limited 2D space of the Palin screen in an
intuitive and user-
friendly fashion with touch screen control over the mode of data displays.
Similar screens
are designed for the Windows CE / Power PC platform.
[0077) Figure 9A shows a snapshot of clinical labs data. In contrast to the
typical text-
based form of display of lab data which is provided by the HIS, the lab data
is organized
into groups 902. The abnormal values are highlighted using a color coding
scheme (e.g.,
white for normal range, blue for low and red for high values). The person
affiliated with
the patient can browse through the whole set of historical lab tests using the
< and >
arrows.
(0078] Figure 9B shows the historical trend of one individual lab parameter pH
904.
Touching the (*) symbols 906 on the graph with a stylus or a fingertip allows
the user to
read out individual parameter values for different test times. Touching the
(+) symbol 908
shows associated lab notes.
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[0079] Figure 9C is a screen shot displaying biographical information
regarding the
attending physician. As discussed above, a person affiliated with the patient
may become
more comfortable about the treatment of the patient if the person knows more
about the
attending physician. A title field for the physician 910, a position field for
the physician
912, and contact information fields 914 are displayed in the screen shot. The
information
is received from the HIS 304. Each communication mode in the communication
fields can
s
be activated by tapping on that communication mode.
[0080] Figure 9D is a screen shot displaying the current patient status. A
name field
916 displays the name of the patient while an id field 918 displays the id of
the patient. If
the person affiliated with the patient forgets the location of the patient,
the person can
view the unit field 922 and bed field 924 to determine the location of the
patient. A
variety of other information such as the attending physician field 930 can be
found in the
GUI. The current patient status is recorded in the HIS 304. Other data such as
admission
date 932, refernng physicians 934, and a post admission day (pad) 936 can be
accessed.
[0081] Figure 9E is a screen shot displaying a clinical document. The clinical
data
940 includes reports on treatment for the patient. The clinical data 940 also
includes the
physician's diagnosis.
[0082] Figure 9F is a screen shot of a CT image thumb set 950 comprising a
plurality
of thumbnail-sized views of CT images. The person selects one of the plurality
of CT
images to view. After selecting a CT image to view, the person can select a
window in a
color table to show the best image possible for the range of Hounsfeld numbers
associated
with the CT image.
[0083] Figure 9G shows a caregivers form. The person can assign names from an
address book to individual caregiver roles. For example, names can be assigned
to the
caregiver role of Attending Physician in an AttMD field 960, to the caregiver
role of
Refernng Physician in a ReIMD field 962, to the caregiver role of Personal
Physician in a
PerMD field 964, and to the caregiver role of Primary Care Physician in a PCP
field 966.
For each of the caregivers, the person selects a preferred mode of
communication. The
person selects a mode of communication by checking a box in an EM field 970
for e-mail,
checking a box in a PG field 972 for pager, checking a box in a FX field 974
for fax, or
checking a box in a PR field 976 for printer. These preferences are saved for
future use.
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Forms and other documents can be transmitted to the caregivers according to
the saved
preferred modes of communication.
[0084] In yet another embodiment of the GUI, a variety of data types can be
displayed
on the space-limited screen of handheld devices. The variety of data types
includes
sporadic time series (e.g., lab tests, Glasgow Coma Score (GCS)) and
continuous time
series (e.g., vital signs and their trends, continuous EEG and trends). The
results of Lab
tests are displayed in tabular, graphic trend and chronological paging mode.
Switching
between these display modalities is ,achieved with a single tap of the stylus.
Continuous
trends captured from the bedside monitors are also displayed in a graphical
format. With
one-tap of the stylus, there is a readout of the values of all vital sign
parameters associated
with a given time stamp.
[0085] While the above description contains many specifics, these should not
be
construed as limitations on the scope of the invention, but rather as an
exemplification of
preferred embodiments thereof. One skilled in the art will recognize that many
of the various
features and capabilities described in connection with the invention are also
applicable to
other embodiments as well. One skilled in the art will recognize that these
features, and thus
the scope of the present invention, should be interpreted in light of the
following claims and
any equivalents thereto.
