SYSTEM FOR PROVIDING EXPERT CARE TO OUTPATIENTS FROM A REMOTE LOCATION

• US 20090259495A1
• Filed: 05/26/2009
• Published: 10/15/2009
• Est. Priority Date: 11/18/1999
• Status: Active Grant

• Current Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Rosenfeld, Brian A.
• Granted Patent: US 8,326,649 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/024 Detecting, measuring or recording pulse rate or heart rate A61B5/0205, A61B5/021 take precedence
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 5/4833 Assessment of subject's compliance to treatment
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G08B 21/0476 Cameras to detect unsafe condition, e.g. video cameras
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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

Abstract

A system for providing expert care to a basic care medical facility (OPCL) from a remote location. The system facilitates real-time, continuous assessment of patients receiving care in an OPCL that is not generally equipped to provide expert medical care on a twenty-four basis. Patient monitoring equipment acquires monitored data elements from a patient monitoring station and transmits the monitoring data over a network to a remote command center. The remote command center also receives other patient data to the extent available from the OPCL. Alternatively, the patient monitored data is sent to a remote command center along with patient data at a pre-established time or when requested by remote command center. The delivery of stored monitoring data and patient data may be expedited if an urgent consultation is warranted. A rules engine continuously applies a patient-specific rule or rule set to the data elements selected from the assessment data from each OPCL monitored patient to determine whether intervention is warranted. Patient-specific rules may be created that are consistent with the capabilities of the OPCL.

Claims

1. A system for providing expert care from a remote location to outpatients located at outpatient care locations (OPCLS) comprising:

a network;

patient monitoring stations located at the OPCLs for monitoring patient data elements from outpatients, wherein the monitored patient data elements comprise data elements indicative of medical conditions of the outpatients and wherein each patient monitoring station comprises a communications interface that transmits the monitored patient data elements to a remote command center via the network; and

the remote command center connected to the network, wherein the remote command center comprises a rules engine, wherein the rules engine comprises patient-specific rules comprising conditions, and wherein the remote command center comprises instructions which when executed by the remote command center cause the remote command center to;

receive the monitored patient data elements from the OPCLs;

acquire other patient data elements, wherein the other patient data elements are indicative of the medical conditions of the outpatients and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

patient data elements;

”

utilize the rules engine to apply patient-specific rules in accordance with the requirements of the patient-specific rules to at least two patient data elements;

determine when the conditions of any one of the patient-specific rules have been satisfied; and

when the conditions of any one of the patient-specific rules has been satisfied, taking an action in accordance with the any one of the patient-specific rules with respect to a particular one of the outpatients to whom the any one of the patient-specific rules applies, and

wherein the monitoring and determining when the conditions of the any one of patient-specific rules has been satisfied occurs in an automated fashion at the remote command center 24 hours per day 7 days per week.

2. The system of claim 1, wherein the action is selected from the group consisting of issuing an alert with respect to the outpatient, issuing an intervention order with respect to the outpatient, issuing a release protocol and order with respect to the outpatient, and maintaining monitoring of the outpatient.

3. The system of claim 1, wherein a patient monitoring station further comprises monitoring equipment for acquiring patient data elements from an outpatient;

a storage device for receiving and storing the patient data elements from the monitoring equipment; and

a communications scheduler for establishing communications between the storage device and the communications interface and for sending the stored patient data elements to the remote command center.

4. The system of claim 3, wherein the communications scheduler establishes communications according to a schedule received from the remote command center.

7. The system of claim 1, wherein one of the at least two patient data elements comprises a physiological data element of the outpatient and another of the at least two patient data elements comprises a clinical data element of the outpatient.

8. The system of claim 1, wherein one of the at least two patient data elements comprises a physiological data element of the outpatient and another of the at least two patient data elements comprises a medication data element of the outpatient.

9. The system of claim 1, wherein one of the at least two patient data elements comprises a physiological data element of the outpatient and another of the at least two patient data elements comprises a laboratory data element of the outpatient.

10. The system of claim 1, wherein one of the at least two patient data elements comprises a clinical data element of the outpatient and another of the at least two patient data elements comprises a laboratory data element of the outpatient.

11. The system of claim 1, wherein one of the at least two patient data elements comprises a physiological data element of the outpatient and another of the at least two patient data elements comprises a physiological data element of the outpatient.

12. The system of claim 1, wherein a monitoring station further comprises monitoring equipment and wherein the monitoring equipment comprises instructions which when executed by the monitoring equipment cause the monitoring equipment to monitor patient data elements from the outpatient and to send the monitored patient data elements to the remote command center via the network.

13. The system of claim 1 further comprising a data server/data warehouse for storing and analyzing data from the remote command center.

14. The system of claim 1 further comprising a decision support system and wherein the decision support system comprises instructions which when executed by the decision support system cause the decision support system to:

receive information relating to a medical condition of an outpatient;

apply a decision support algorithm; and

provide a response based upon application of the decision support algorithm to the information.

15. The system of claim 10 wherein the decision support algorithm comprises a guideline of practice relating to:

Bradyarrhythmias diagnosis &

treatment, Congestive heart failure diagnosis &

treatment, Fluid resuscitation indications &

treatment, Myocardial infarction diagnosis &

treatment, MI with left bundle branch block diagnosis, Pulmonary embolism diagnosis, Supra-ventricular tachyarrhythmias diagnosis &

treatments, Unstable angina diagnosis &

treatment, Venous thromboembolism prophylaxis treatment, Venous thrombosis;

diagnosis &

treatment, Ventricular arrhythmias diagnosis &

treatment, Warfarin treatment, Pneumonia, community acquired diagnosis and treatment, Asthma diagnosis &

treatment, Chronic Obstructive Pulmonary Disease diagnosis and treatment, Diuretic treatment, Hyperkalemia;

diagnosis &

treatment, Hypernatremia;

diagnosis &

treatment, Hypokalemia;

diagnosis &

treatment, Hyponatremia;

diagnosis &

treatment, Oliguria diagnosis and treatment, Wound healing treatment, Deep Venous Thrombosis prophylaxis treatments, Acid-base disturbance diagnosis and treatment, and Electrolyte disturbance diagnosis and treatment.

16. The system of claim 10, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

17. The system of claim 1 further comprising an order writing module, and wherein the order writing module comprises instructions which when executed by the order writing module cause the monitoring equipment to provide knowledge-based orders based upon the patient data elements, wherein a knowledge-based order is selected from the group consisting of an authorization to administer medication, an authorization to subject the outpatient to a laboratory protocol, and an authorization to subject the outpatient to a surgical procedure.

18. The system of claim 1 wherein the OPCLs further comprise means for transmitting video and wherein the remote command center further comprises instructions which when executed by the remote command center cause the remote command center to receive and display video.

19. The system of claim 1, wherein the OPCLs further comprise means for transmitting audio and wherein the remote command center comprises instructions which when executed by the remote command center cause the remote command center to receive and reproduce audio.

20. The system of claim 1, wherein the network is selected from the group consisting of a wired network, a wireless network, a satellite network, a public switched telephone network, an IP network, a packet switched network, a cell phone network, a cable network, and a coax network, a hybrid fiber coax network.

21. The system of claim 1, wherein the an OPCL comprises a site assessment module, wherein the site assessment module comprises instructions which when executed by the site assessment module cause the site assessment module to:

receive site assessment data, wherein the site assessment data are indicative of the capability of the OPCL to provide diagnostic and treatment services to the outpatients; and

determine from the site assessment data service level measures of the OPCL indicative of a capability of the OPCL to provide diagnostic and treatment services to the outpatients, and

wherein the communications interface comprises instructions which when executed by the communications interface cause the communication interface to transmit the service level measures to the remote command center by the network, and wherein the remote command center wherein the remote command center further comprises instructions which when executed by the remote command center cause the remote command center to receive the service level measures from the OPCL and create the patient-specific rules for the outpatients consistent with the service level measures.

22. The system of claim 21 further comprising a decision support system comprising instructions which when executed by the decision support system cause the decision support system to:

receive information relating to the medical conditions of the outpatients;

apply a decision support algorithm to selected data elements consistent with the service level measures; and

provide responses based upon application of the decision support algorithm to the information consistent with the service level measures.

23. The system of claim 22 wherein the decision support algorithm comprises a guideline of practice relating to:

Bradyarrhythmias diagnosis &

treatment, Congestive heart failure diagnosis &

treatment, Fluid resuscitation indications &

treatment, Myocardial infarction diagnosis &

treatment, MI with left bundle branch block diagnosis, Pulmonary embolism diagnosis, Supra-ventricular tachyarrhythmias diagnosis &

treatments, Unstable angina diagnosis &

treatment, Venous thromboembolism prophylaxis treatment, Venous thrombosis;

diagnosis &

treatment, Ventricular arrhythmias diagnosis &

treatment, Warfarin treatment, Pneumonia, community acquired diagnosis and treatment, Asthma diagnosis &

treatment, Chronic Obstructive Pulmonary Disease diagnosis and treatment, Diuretic treatment, Hyperkalemia;

diagnosis &

treatment, Hypernatremia;

diagnosis &

treatment, Hypokalemia;

diagnosis &

treatment, Hyponatremia;

diagnosis &

treatment, Oliguria diagnosis and treatment, Wound healing treatment, Deep Venous Thrombosis prophylaxis treatments, Acid-base disturbance diagnosis and treatment, and Electrolyte disturbance diagnosis and treatment.

24. The system of claim 22, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

25. The system of claim 22, wherein the decision support system further comprises instructions which when executed by the decision support system cause the decision support system to:

access an order writing module; and

issue an order consistent with the service level measures, wherein the order is selected from the group consisting of an authorization to administer medication, an authorization to subject the outpatient to a laboratory protocol, and an authorization to subject the outpatient to a surgical procedure.

26. The system of claim 21, wherein the site assessment module further comprises instructions which when executed by the site assessment module cause the site assessment module to:

prompt a user for the site assessment data; and

determine the service level measures based on the user response.

27. The system of claim 21, wherein the patient monitoring station comprises a site assessment code and the site assessment module further comprises instructions which when executed by the site assessment module cause the site assessment module to:

acquire the site assessment code from the patient monitoring station; and

determine the service level measures at least in part based on the site assessment code.

28. The system of claim 21, wherein the service level measures comprise:

an inventory of available monitoring data elements;

an inventory of available diagnostic services;

an inventory of available surgical treatment services; and

an inventory of available laboratory services.

5. The system of 3, wherein the communications scheduler establishes communications in response to a command received from the remote command center.

6. The system of 3, wherein the patient monitoring station further comprises an urgent consultation warning system and wherein the urgent consultation warning system comprises instructions which when executed by the urgent consultation warning system cause the urgent consultation warning system to:

evaluate the patient data elements before receipt of the patient data elements at the storage device and to determine if an event has occurred that warrants an urgent consultation; and

when an urgent consultation is warranted, then instruct the communications scheduler to establish communications between the storage device and the communications interface to send the stored patient data elements to the remote command center.

29. A method for providing expert critical care from a remote location to outpatients located at outpatient care locations (OPCLs) comprising:

communicating over a network monitored patient data elements of the outpatients to a remote command center, wherein the remote command center comprises patient-specific rules;

acquiring at the remote command center other patient data elements, wherein the other patient data elements are indicative of the medical conditions of the outpatients and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

patient data elements;

” and

using a rules engine to apply patient-specific rules in accordance with the requirements of the patient-specific rules to at least two patient data elements;

determining when the conditions of any one of the patient-specific rules associated have been satisfied; and

when the conditions of any one of the patient-specific rules has been satisfied, taking an action in accordance with the patient-specific rule with respect to a particular one of the outpatients to whom the any one of the patient-specific rule applies, and

wherein the monitoring and determining when the conditions of the any one of patient-specific rule has been satisfied occurs in an automated fashion at the remote command center 24 hours per day 7 days per week.

30. The method of claim 29, wherein the action is selected from the group consisting of issuing an alert with respect to the outpatient, issuing an intervention order with respect to the outpatient, issuing a release protocol and order with respect to the outpatient, and maintaining monitoring of the outpatient.

31. The method of claim 29 further comprising:

receiving and storing the patient data elements from patient monitoring equipment in a storage device; and

establishing communications between the storage device and the communications interface using a communications scheduler; and

sending the stored patient data elements to the remote command center.

32. The method of claim 31, wherein establishing communications between the storage device and the communications interface using a communications scheduler comprises establishing communications between the storage device and the communications interface using a communications scheduler according to a schedule received from the remote command center.

35. The method of claim 29, wherein the at least two patient data elements comprise a physiological measure and a clinical data element of the outpatient.

36. The method of claim 29, wherein the at least two patient data elements comprise a physiological data element of the outpatient and a medication data element of the outpatient.

37. The method of claim 29, wherein the at least two patient data elements comprise a physiological data element of the outpatient and a laboratory data element of the outpatient.

38. The method of claim 29, wherein the at least two patient data elements comprise a clinical data element of the outpatient and a laboratory data element of the outpatient.

39. The method of claim 29, wherein the at least two patient data elements comprise two physiological data elements of the outpatient.

40. The method of claim 29 further comprising:

receiving information relating to a medical condition of an outpatient;

applying a decision support algorithm to selected data elements of the outpatient; and

providing a response based upon application of the decision support algorithm to the information.

41. The method of claim 40 wherein the decision support algorithm comprises a guideline of practice relating to:

Bradyarrhythmias diagnosis &

treatment, Congestive heart failure diagnosis &

treatment, Fluid resuscitation indications &

treatment, Myocardial infarction diagnosis &

treatment, MI with left bundle branch block diagnosis, Pulmonary embolism diagnosis, Supra-ventricular tachyarrhythmias diagnosis &

treatments, Unstable angina diagnosis &

treatment, Venous thromboembolism prophylaxis treatment, Venous thrombosis;

diagnosis &

treatment, Ventricular arrhythmias diagnosis &

treatment, Warfarin treatment, Pneumonia, community acquired diagnosis and treatment, Asthma diagnosis &

treatment, Chronic Obstructive Pulmonary Disease diagnosis and treatment, Diuretic treatment, Hyperkalemia;

diagnosis &

treatment, Hypernatremia;

diagnosis &

treatment, Hypokalemia;

diagnosis &

treatment, Hyponatremia;

diagnosis &

treatment, Oliguria diagnosis and treatment, Wound healing treatment, Deep Venous Thrombosis prophylaxis treatments, Acid-base disturbance diagnosis and treatment, and Electrolyte disturbance diagnosis and treatment.

42. The method of claim 40, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

43. The method of claim 29 further comprising:

accessing an order writing module; and

issuing an order, wherein the order is selected from the group consisting of an authorization to administer medication, an authorization to subject the outpatient to a laboratory protocol, and an authorization to subject the outpatient to a surgical procedure.

44. The method of claim 29 further comprising transmitting video from an OPCL via the network to the remote command center.

45. The method of claim 29 further comprising transmitting audio from an OPCL via the network to the remote command center.

46. The method of claim 29, wherein the network is selected from the group consisting of a wired network, a wireless network, a satellite network, a public switched telephone network, an IP network, a packet switched network, a cell phone network, a cable network, and a coax network, a hybrid fiber coax network.

47. The method of claim 29 further comprising:

receiving site assessment data, wherein the site assessment data are indicative of the capability of an OPCL to provide diagnostic and treatment services to patients;

determining service level measures of the OPCL indicative of a capability of the OPCL to provide diagnostic and treatment services to patients; and

communicating over the network the service level measures to a remote command center, and wherein creating the patient-specific rules for the outpatient further comprises creating the patient-specific rules consistent with the service level measures.

48. The method of claim 47, wherein the method further comprises:

receiving information relating to the medical conditions of the outpatients;

applying a decision support algorithm to selected data elements of the outpatients consistent with the service level measures; and

providing responses based upon application of the decision support algorithm to the information consistent with the service level measures.

49. The method of claim 48 wherein the decision support algorithm comprises a guideline of practice relating to:

Bradyarrhythmias diagnosis &

treatment, Congestive heart failure diagnosis &

treatment, Fluid resuscitation indications &

treatment, Myocardial infarction diagnosis &

treatment, MI with left bundle branch block diagnosis, Pulmonary embolism diagnosis, Supra-ventricular tachyarrhythmias diagnosis &

treatments, Unstable angina diagnosis &

treatment, Venous thromboembolism prophylaxis treatment, Venous thrombosis;

diagnosis &

treatment, Ventricular arrhythmias diagnosis &

treatment, Warfarin treatment, Pneumonia, community acquired diagnosis and treatment, Asthma diagnosis &

treatment, Chronic Obstructive Pulmonary Disease diagnosis and treatment, Diuretic treatment, Hyperkalemia;

diagnosis &

treatment, Hypernatremia;

diagnosis &

treatment, Hypokalemia;

diagnosis &

treatment, Hyponatremia;

diagnosis &

treatment, Oliguria diagnosis and treatment, Wound healing treatment, Deep Venous Thrombosis prophylaxis treatments, Acid-base disturbance diagnosis and treatment, and Electrolyte disturbance diagnosis and treatment.

50. The method of claim 48, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

51. The method of claim 48 further comprising:

accessing an order writing module; and

issuing an order consistent with the service level measures.

52. The method of claim 51, wherein the order is selected from the group consisting of an authorization to administer medication, an authorization to subject the outpatient to a laboratory protocol, and an authorization to subject the outpatient to a surgical procedure.

54. The method of claim 47, wherein the method further comprises:

prompting a user for the site assessment information; and

determining the service level measures based on the user response.

55. The method of claim 47, wherein the patient monitoring station comprises a site assessment code and the method further comprises:

acquiring the site assessment code from the patient monitoring station; and

determining the service level measures at least in part based on the site assessment code.

56. The method of claim 47, wherein the service level measures comprise an inventory of available monitoring data elements.

33. The method of 31, wherein establishing communications between the storage device and the communications interface using a communications scheduler comprises establishing communications between the storage device and the communications interface using a communications scheduler according to a command received from the remote command center.

34. The method of 31, wherein the patient monitoring station further comprises an urgent consultation warning system and wherein the method further comprises:

evaluating the patient data elements using the urgent consultation warning system before receipt of the patient data elements at the storage device;

determining whether an event has occurred that warrants an urgent consultation; and

when an urgent consultation is warranted, then instructing the communications scheduler to establish communications between the storage device and the communications interface to send the stored patient data elements to the remote command center.

57. A system for providing expert care from a remote location to outpatients located at outpatient care locations (OPCLs) comprising:

a network;

patient monitoring stations located at the OPCLs for monitoring patient data elements from outpatients, wherein the monitored patient data elements comprise data elements indicative of a heart condition of the outpatients and wherein each patient monitoring station comprises a communications interface that transmits the monitored patient data elements to a remote command center via the network; and

the remote command center connected to the network, wherein the remote command center comprises a rules engine, wherein the rules engine comprises patient-specific rules comprising conditions, and wherein the remote command center comprises instructions which when executed by the remote command center cause the remote command center to;

receive the monitored patient data elements from the OPCLs;

acquire other patient data elements, wherein the other patient data elements are indicative of the heart condition of the outpatients and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

patient data elements;

”

utilize the rules engine to apply patient-specific rules in accordance with the requirements of the patient-specific to at least two patient data elements;

determine when the conditions of any one of the patient-specific rules have been satisfied; and

when the conditions of the any one of the patient-specific rule has been satisfied, taking an action in accordance with the any one of the patient-specific rules with respect to a particular one of the outpatients to whom the any one of the patient-specific rules applies, and

wherein the monitoring and determining when the conditions of the any one of patient-specific rules has been satisfied occurs in an automated fashion at the remote command center 24 hours per day 7 days per week.

58. A method for providing expert critical care from a remote location to outpatients located at outpatient care locations (OPCLs) comprising:

communicating over a network monitored patient data elements of the outpatients to a remote command center, wherein the remote command center comprises patient-specific rules;

acquiring at the remote command center other patient data elements, wherein the other patient data elements are indicative of a heart condition of the outpatients and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

patient data elements;

” and

using a rules engine to apply patient-specific rules in accordance with the requirements of the patient-specific rules to at least two patient data elements;

determining when the conditions of any one of the patient-specific rules associated have been satisfied; and

when the conditions of any one of the patient-specific rules has been satisfied, taking an action in accordance with the any one of the patient-specific rules with respect to a particular one of the outpatients to whom the any one of the patient-specific rules applies, and

wherein the monitoring and determining when the conditions of the any one of patient-specific rules has been satisfied occurs in an automated fashion at the remote command center 24 hours per day 7 days per week.