System and method for prioritizing medical conditions

• US 20060293573A1
• Filed: 08/29/2006
• Published: 12/28/2006
• Est. Priority Date: 11/16/1999
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Bardy, Gust H.
• Granted Patent: US 8,092,382 B2
• Time in Patent Office: Days
• US Class Current: 600/301
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/60 for the operation of medical equipment or devices
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: Y10S 128/923 by comparison of patient data to other data

Abstract

A system for ordering and prioritizing multiple health disorders for automated remote patient care is presented. A database maintains information for an individual patient by organizing monitoring sets in a database, and measures relating to patient information previously recorded and derived on a substantially continuous basis into a monitoring set in the database. A server retrieving and processing the monitoring includes a comparison module comparing stored measures from each of the monitoring sets to other stored measures from another of the monitoring sets with both stored measures relating to the same type of patient information, and an analysis module ordering each patient status change in temporal sequence and categorizing health disorder candidates by quantifiable physiological measures, and identifying the health disorder candidate having the pathophysiology substantially corresponding to the patient status changes which occurred substantially least recently as the index disorder.

Claims

1. Stored multiple health disorders data for use in automated patient care, comprising:

patient information identifying a patient under automated patient care and comprising at least one of treatment profile information and medical history; and

a monitoring set comprising measures relating to patient information previously recorded and derived on a substantially continuous basis and formed by processing the measures through derived measure determination and statistical value calculation into an index health disorder.

2. Stored multiple health disorders data according to claim 1, further comprising:

health disorder candidates categorized by pathophysiology, wherein the health disorder candidate has a pathophysiology substantially comparable to a change in pathophysiology that occurred either substantially least or most recently.

3. Stored multiple health disorders data according to claim 1, further comprising:

a stored reference baseline comprising at least one of treatment profile information and medical history recorded during an initial time period or derived therefrom.

4. Stored multiple health disorders data according to claim 1, further comprising:

stored quality of life measures comprising qualitative patient information.

5. Stored multiple health disorders data according to claim 1, wherein the measures comprise physiological measures for at least one of an individual patient, a peer group, and a overall patient population.

6. Stored multiple health disorders data according to claim 1, wherein the measures comprise physiological measures recorded by at least one of an implantable medical device and an external medical device.

7. A medical device providing an index health disorder for use in automated patient care, comprising:

one or more signal monitors sensing physiological data of a patient under automated patient care as telemetered signals;

a memory store storing the telemetered signals sensed by the signal sensors for a short term; and

an interface providing external access to the staged telemetered signals, wherein the staged telemetered signals are periodically retrieved and processed through derived measure determination and statistical value calculation into an index health disorder.

8. A medical device according to claim 7, further comprising:

a processor to record the telemetered signals during an initial time period, and to derive values therefrom.

9. A medical device according to claim 7, further comprising:

a processor to record the telemetered signals on a substantially continuous basis, and to derive values therefrom.

10. A medical device according to claim 7, further comprising:

a stored indicator threshold corresponding to a pathophysiology indicative of at least one of congestive heart failure, myocardial ischemia, respiratory insufficiency, and atrial fibrillation health disorders; and

a processor to detect changes against the indicator thresholds to determine pathophysiologies indicating one of an absence, onset, progression, regression, and status quo of the health disorder.

11. A medical device according to claim 7, further comprising:

programming specifying therapy for health disorders selected from the group comprising congestive heart failure, myocardial ischemia, respiratory insufficiency, and atrial fibrillation.

12. A medical device according to claim 7, wherein the medical device comprises at least one of a pacemaker, cardioverter defibrillator and event monitor.

13. An analysis system for providing an index health disorder for use in automated patient care, comprising:

a database storing a set of device measures and providing quantitative health care data indicators regularly recorded by a medical device for a patient under automated patient care; and

a processor retrieving the collected device measures and forming an index health disorder through derived measure determination and statistical value calculation.

14. An analysis system according to claim 13, further comprising:

an ordering component to compare a plurality of the processed raw and physiological measures to quantify one or more changes in pathophysiology, and to order the pathophysiology changes in temporal sequence.

15. An analysis system according to claim 13, further comprising:

a categorizing component to categorize health disorder candidates by pathophysiology, and to identify the health disorder candidate having a pathophysiology substantially comparable to a change in pathophysiology that occurred either substantially least or most recently.

16. An analysis system according to claim 13, further comprising:

a comparison component to compare at least one of the processed raw and physiological measures to at least one other of the processed raw and physiological measures that were previously recorded within an adjustable time window.

17. An analysis system according to claim 13, further comprising:

an evaluation component to sort a plurality of previously-related pathophysiologies for at least one health disorder candidate into a symptomatic event ordering set, and to evaluate each pathophysiology in the symptomatic event ordering set in response to an observed change in the pathophysiology being evaluated.

18. An analysis system according to claim 13, further comprising:

a comparison component to prioritize pathophysiology changes using a predefined ordering, and to compare the pathophysiology changes having higher priorities that occurred least recently before the pathophysiology changes having lower priorities.

19. An analysis system according to claim 13, further comprising:

a hysteresis component to track temporal changes in pathophysiology, and apply hysteresis in patient diagnosis and treatment to the temporal changes.

20. An analysis system according to claim 13, further comprising:

a stored indicator threshold corresponding to a pathophysiology indicative of at least one of congestive heart failure, myocardial ischemia, respiratory insufficiency, and atrial fibrillation health disorders; and

a testing component to test observed pathophysiology changes against the indicator thresholds to determine pathophysiologies indicating one of an absence, onset, progression, regression, and status quo of the health disorder.

21. A structured record storing an index health disorder for use in automated patient care, comprising:

structured data for a patient under automated patient care, comprising at least one of;

physiological measures directly recorded by a medical device; and

physiological measures derived from the directly recorded physiological measures,

wherein the structured data is collected and processed through derived measure determination and statistical value calculation into an index health disorder.

22. A structured record according to claim 21, further comprising:

recording the at least one recorded physiological measure and the at least one other recorded physiological measure with at least one of an implantable medical device and an external medical device.

23. A structured record according to claim 21, further comprising:

physiological measures for at least one of an individual patient, a peer group, and a overall patient population.

24. A structured record according to claim 21, further comprising:

health disorders selected from the group comprising congestive heart failure, myocardial ischemia, respiratory insufficiency, and atrial fibrillation.

25. A process for forming an index health disorder for use in automated patient care, comprising:

collecting device measures for a patient under automated patient care;

assembling the collected device measures into at least one of raw and derived physiological measures;

processing the raw and physiological measures through derived measure determination and statistical value calculation; and

forming an index health disorder.

26. A process according to claim 25, further comprising:

comparing a plurality of the processed raw and physiological measures to quantify one or more changes in pathophysiology; and

ordering the pathophysiology changes in temporal sequence.

27. A process according to claim 25, further comprising:

categorizing health disorder candidates by pathophysiology; and

identifying the health disorder candidate having a pathophysiology substantially comparable to a change in pathophysiology that occurred either substantially least or most recently.

28. A process according to claim 25, further comprising:

comparing at least one of the processed raw and physiological measures to at least one other of the processed raw and physiological measures that were previously recorded within an adjustable time window.

29. A process according to claim 25, further comprising:

sorting a plurality of previously-related pathophysiologies for at least one health disorder candidate into a symptomatic event ordering set; and

evaluating each pathophysiology in the symptomatic event ordering set in response to an observed change in the pathophysiology being evaluated.

30. A process according to claim 25, further comprising:

prioritizing pathophysiology changes using a predefined ordering; and

comparing the pathophysiology changes having higher priorities that occurred least recently before the pathophysiology changes having lower priorities.

31. A process according to claim 25, further comprising:

tracking temporal changes in pathophysiology; and

applying hysteresis in patient diagnosis and treatment to the temporal changes.

32. A process according to claim 25, further comprising:

defining an indicator threshold corresponding to a pathophysiology indicative of at least one of congestive heart failure, myocardial ischemia, respiratory insufficiency, and atrial fibrillation health disorders; and

testing observed pathophysiology changes against the indicator thresholds to determine pathophysiologies indicating one of an absence, onset, progression, regression, and status quo of the health disorder.

33. A computer-readable storage medium holding code for performing the process according to claim 25.