System for providing expert care to a basic care medical facility from a remote location

• US 20060271409A1
• Filed: 05/31/2006
• Published: 11/30/2006
• Est. Priority Date: 06/23/1999
• Status: Active Grant

• Current Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Original Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Inventors: Breslow, Michael, Rosenfeld, Brian A.
• Granted Patent: US 7,991,625 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 5/412 Detecting or monitoring sepsis
• CPC Class Codes: G08B 21/04 responsive to non-activity, e.g. of elderly persons G08B21/06 takes precedence
• CPC Class Codes: G08B 21/0476 Cameras to detect unsafe condition, e.g. video cameras
• CPC Class Codes: G08B 21/182 Level alarms, e.g. alarms responsive to variables exceeding a threshold
• CPC Class Codes: G08B 25/08 using communication transmission lines G08B13/19658, G08B21/0286, G08B25/016 take precedence
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• 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: G16H 70/20 relating to practices or guidelines
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

A system for providing expert care to a basic care medical facility (BCMF) from a remote location. The system facilitates real-time, continuous assessment of patients receiving care in a BCMF 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 BCMF. 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 BCMF monitored patient to determine whether intervention is warranted. Patient specific rules may be created that are consistent with the capabilities of the BCMF.

Claims

1. A system for providing expert care to a basic care medical facility (BCMF) from a remote location, the system comprising:

a network;

the BCMF, wherein the BCMF comprises;

a patient monitoring station adapted for monitoring patient data elements from a patient;

a communications interface adapted for transmitting the monitored patient data elements to a remote command center by the network; and

the remote command center connected to the network and comprising;

a database, wherein the database comprises stored patient data elements relating to the patient;

a decision support system connected to a workstation, wherein the decision support system is adapted for;

receiving the monitored patient data elements from the BCMF;

storing the monitored patient data elements in the database;

applying a rules generator to create a patient-specific rule for the patient, wherein the patient specific rule utilizes at least two patient data elements stored in the database to search for patterns of data indicative of a medical condition of the patient;

applying a rules engine continuously to the patient-specific rule;

utilizing the output from the rules engine to determine if intervention is warranted, wherein the monitoring and intervention is directed from the remote command 24 hours per day 7 days per week.

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

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

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

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

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

7. The system of claim 1 wherein the monitoring station comprises monitoring equipment.

8. The system of claim 7 wherein the BCMF further comprises a nurses'"'"' station connected to the monitoring equipment and to the remote command center over the network.

9. The system of claim 1 wherein the decision support system further comprises a data server/data warehouse for storing and analyzing data from the remote command center.

10. The system of claim 1 wherein the decision support system is further adapted for:

receiving information relating to the medical condition;

applying a decision support algorithm; and

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

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

Acalculous Cholecystitis, Acute Pancreatitis, Acute Renal Failure Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Insufficiency, Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms, Antibiotic associated Colitis, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hypercalcemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypematremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Antibiotics for Meningitis, Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complications, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Surgery, Post-Op Management of Carotid Surgery, Post-Op Management of Open Heart Surgery, Post-Op Management of Thoracotomy Surgery, Post-Op Myocardial Ischemnia, Cardiac Arrhythmias after Non-Cardiac Surgery, Post-Op Power Weaning, Pressure Ulcers, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrythmia, Supra-Ventricular Tachycardia, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thirombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoiectic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythmia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

12. 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.

13. The system of claim 1 wherein the decision support system further comprises an order writing module adapted for providing knowledge-based orders based upon the patient data elements, wherein the order is selected from the group consisting of an authorization to administer medication, an authorization to subject the patient to a laboratory protocol, and an authorization to subject the patient to a surgical procedure.

14. The system of claim 1 wherein the decision support system further comprises knowledge-based vital sign/hemodynamic algorithms.

15. The system of claim 1 wherein the BCMF further comprises means for transmitting video and wherein the patient care management system is further adapted to receive video.

16. The system of claim 1 wherein the BCMF further comprises means for transmitting audio and wherein the patient care management system is further adapted to receive audio.

17. The system of claim 1 wherein the decision support system further comprises knowledge-based ventilatory algorithms.

18. The system of claim 1 wherein the decision support system is further adapted for:

determining whether the patient requires monitoring by the monitoring station; and

in the event the patient does not require monitoring by the monitoring station, issuing a release protocol and order.

19. The system of claim 1, wherein the BCMF further comprises a site assessment module, wherein the site assessment module is adapted for:

receiving site assessment data, wherein the site assessment data are indicative of the capability of the patient care management system to provide diagnostic and treatment services to patients; and

determining from the site assessment data service level measures of the BCMF indicative of a capability of the BCMF to provide diagnostic and treatment services to patients, and wherein the communications interface is further adapted for transmitting the service level measures to the remote command center by the network, and wherein the decision support system is further adapted for receiving the service level measures from the BCMF and creating the patient-specific rule for the patient consistent with the service level measures.

20. The system of claim 19 wherein the decision support system is further adapted for:

receiving information relating to the medical condition;

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

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

21. The system of claim 20 wherein the decision support algorithm comprises a guideline of practice relating to:

Acalculous Cholecystitis, Acute Pancreatitis, Acute Renal Failure Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Insufficiency, Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms, Antibiotic associated Colitis, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hypercalcemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypematremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Antibiotics for Meningitis, Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complications, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Surgery, Post-Op Management of Carotid Surgery, Post-Op Management of Open Heart Surgery, Post-Op Management of Thoracotomy Surgery, Post-Op Myocardial Ischemnia, Cardiac Arrhythmias after Non-Cardiac Surgery, Post-Op Power Weaning, Pressure Ulcers, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrythmia, Supra-Ventricular Tachycardia, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thirombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoiectic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythmia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

22. The system of claim 19, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

23. The system of claim 19, wherein the decision support system is further adapted for:

accessing an order writing module; and

issuing 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 patient to a laboratory protocol, and an authorization to subject the patient to a surgical procedure.

24. The system of claim 19 wherein the decision support system further comprises knowledge-based vital sign/hemodynamic algorithms.

25. The system of claim 19, wherein the site assessment module is further adapted for:

prompting a user for the site assessment information; and

determining the service level measures based on the user response.

26. The system of claim 19, wherein the patient monitoring station comprises a site assessment code and the site assessment module is further adapted for:

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.

27. The system of claim 19, 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.

28. A method for providing expert care to a basic care medical facility (BCMF) from a remote location comprising:

monitoring patient data elements of a patient in a BCMF;

communicating over a network the monitored patient data elements to a remote command center, the remote command center comprising a database and a workstation;

storing the monitored patient data elements in the database, wherein the database comprises stored patient data elements;

applying a rules generator to create a patient-specific rule for the patient, wherein the patient-specific rule utilizes at least two patient data elements stored in the database to search for patterns of data indicative of a medical condition of the patient;

applying a rules engine to the patient-specific rule;

utilizing the output from the rules engine to determine if intervention is warranted; and

wherein the monitoring and determining if intervention is warranted is directed from the remote command center 24 hours per day 7 days per week.

29. The method for providing expert care to a BCMF of claim 28, the method further comprising:

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

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

30. The method for providing expert care to a BCMF of claim 29 wherein the decision support algorithm comprises a guideline of practice relating to:

Acalculous Cholecystitis, Acute Pancreatitis, Acute Renal Failure Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Insufficiency, Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms, Antibiotic associated Colitis, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hypercalcemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypematremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Antibiotics for Meningitis, Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complications, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Surgery, Post-Op Management of Carotid Surgery, Post-Op Management of Open Heart Surgery, Post-Op Management of Thoracotomy Surgery, Post-Op Myocardial Ischemnia, Cardiac Arrhythmias after Non-Cardiac Surgery, Post-Op Power Weaning, Pressure Ulcers, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrythmia, Supra-Ventricular Tachycardia, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thirombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoiectic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythmia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

31. The method for providing expert care to a BCMF of claim 29, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

32. The method for providing expert care to a BCMF of claim 28 further comprising transmitting video from the BCMF via the network to the remote command center.

33. The method for providing expert care to a BCMF of claim 28, wherein the at least two patient data elements comprise a physiological measure and a clinical data element of the patient.

34. The method for providing expert care to a BCMF of claim 28, wherein the at least two patient data elements comprise a physiological data element of the patient and a medication data element of the patient.

35. The method for providing expert care to a BCMF of claim 28, wherein the at least two patient data elements comprise a physiological data element of the patient and a laboratory data element of the patient.

36. The method for providing expert care to a BCMF of claim 28, wherein the at least two patient data elements comprise a clinical data element of the patient and a laboratory data element of the patient.

37. The method for providing expert care to a BCMF of claim 28, wherein the at least two patient data elements comprise two physiological data elements of the patient.

38. The method for providing expert care to a BCMF of claim 28 further comprising transmitting audio from the ICU via the network to the remote command center.

39. The method for providing expert care to a BCMF of claim 28 further comprising:

determining whether the patient requires monitoring; and

issuing a release protocol and order in the event the patient does not require monitoring.

40. The method for providing expert care to a BCMF of claim 28, 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.

41. The method for providing expert care to a BCMF of claim 28 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 patient to a laboratory protocol, and an authorization to subject the patient to a surgical procedure.

42. The method for providing expert care to a BCMF of claim 28 further comprising:

receiving site assessment data, wherein the site assessment data are indicative of the capability of the patient care management system to provide diagnostic and treatment services to patients;

determining service level measures of the BCMF indicative of a capability of the BCMF 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 rule for the patient further comprises creating the patient-specific rule consistent with the service level measures.

43. The method for providing expert care to a BCMF of claim 42, wherein the method further comprises:

receiving information relating to the medical condition;

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

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

44. The method for providing expert care to a BCMF of claim 43 wherein the decision support algorithm comprises a guideline of practice relating to:

Acalculous Cholecystitis, Acute Pancreatitis, Acute Renal Failure Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Insufficiency, Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms, Antibiotic associated Colitis, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hypercalcemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypematremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Antibiotics for Meningitis, Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complications, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Surgery, Post-Op Management of Carotid Surgery, Post-Op Management of Open Heart Surgery, Post-Op Management of Thoracotomy Surgery, Post-Op Myocardial Ischemnia, Cardiac Arrhythmias after Non-Cardiac Surgery, Post-Op Power Weaning, Pressure Ulcers, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrythmia, Supra-Ventricular Tachycardia, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thirombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoiectic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythmia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

45. The method for providing expert care to a BCMF of claim 44, wherein the response is selected from the group consisting of a diagnosis, a method of treatment, and a laboratory protocol.

46. The method for providing expert care to a BCMF of claim 42 further comprising:

accessing an order writing module; and

issuing an order consistent with the service level measures.

47. The method for providing expert care to a BCMF of claim 46, wherein the order is selected from the group consisting of an authorization to administer medication, an authorization to subject the patient to a laboratory protocol, and an authorization to subject the patient to a surgical procedure.

48. The method for providing expert care to a BCMF of claim 42, wherein the method further comprises:

prompting a user for the site assessment information; and

determining the service level measures based on the user response.

49. The method for providing expert care to a BCMF of claim 42, 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.

50. The method for providing expert care to a BCMF of claim 42, 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.

67. The method for providing expert care to a BCMF of claim 42, wherein the method further comprises:

receiving information relating to the medical condition;

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

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

51. A system for providing expert care to a basic care medical facility (BCMF) from a remote location comprising:

a network;

a communications scheduler adapted for establishing communications between the BCMF and a remote command center at a pre-determined interval;

the BCMF, wherein the BCMF comprises;

a patient monitoring station adapted for monitoring patient data elements from a patient;

a communications interface adapted for transmitting the monitored patient data elements to a remote command center by the network at the pre-determined interval;

the remote command center connected to the network and comprising;

a database, wherein the database comprises stored patient data elements relating to the patient;

a decision support system connected to a workstation,

wherein the decision support system is adapted for;

receiving the monitored patient data elements from the BCMF at the pre-determined interval;

storing the monitored patient data elements in the database;

applying a rules generator to create a patient-specific rule for the patient, wherein the patient specific rule utilizes at least two patient data elements stored in the database to search for patterns of data indicative of a medical condition of the patient;

applying a rules engine to the patient-specific rule;

utilizing the output from the rules engine to determine if intervention is warranted, wherein the monitoring and intervention is directed from the remote command center.

52. The system of claim 51, further comprising an urgent consultation warning system (herein, the “

UCWS”

), wherein the UCWS is adapted for;

establishing a UCWS rule for the patient, wherein the UCWS rule operates on the monitored patient data elements and the stored patient data elements;

determining whether UCWS rule has been contravened; and

issuing an urgent communication signal if the UCWS rule has been contravened; and

wherein, the communications scheduler is further adapted for;

receiving the urgent communication signal; and

establishing communications between the BCMF and the remote command center without regard to the predetermined interval.

53. The system of claim 51, wherein one of the at least two patient data elements comprises a physiological data element of the patient and another of the at least two patient data elements comprises a clinical data element of the patient.

54. The system of claim 51, wherein one of the at least two patient data elements comprises a physiological data element of the patient and another of the at least two patient data elements comprises a medication data element of the patient.

55. The system of claim 51, wherein one of the at least two patient data elements comprises a physiological data element of the patient and another of the at least two patient data elements comprises a laboratory data element of the patient.

56. The system of claim 51, wherein one of the at least two patient data elements comprises a clinical data element of the patient and another of the at least two patient data elements comprises a laboratory data element of the patient.

57. The system of claim 51, wherein one of the at least two patient data elements comprises a physiological data element of the patient and another of the at least two patient data elements comprises a physiological data element of the patient.

58. The system of claim 51 wherein the monitoring station comprises monitoring equipment.

59. The system of claim 51 wherein the decision support system is further adapted for:

receiving information relating to the medical condition;

applying a decision support algorithm; and

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

60. A method for providing expert care to a basic care medical facility (BCMF) from a remote location comprising:

monitoring patient data elements of a patient in a BCMF;

communicating the monitored patient data elements to a remote command center at a pre-determined interval via a network, the remote command center comprising a database and a workstation;

storing the monitored patient data elements in the database, wherein the database comprises stored patient data elements;

applying a rules generator to create a patient-specific rule for the patient, wherein the patient specific rule utilizes at least two patient data elements stored in the database to search for patterns of data indicative of a medical condition of the patient;

applying a rules engine to the patient-specific rule; and

utilizing the output from the rules engine to determine if intervention is warranted, wherein the monitoring and intervention is directed from the remote command center.

61. The method for providing expert care to a BCMF of claim 60, further comprising:

establishing an urgent consultation rule for the patient, wherein the urgent consultation rule operates on the monitored patient data elements and the stored patient data elements;

determining whether urgent consultation rule has been contravened; and

establishing communications between the BCMF and the remote command center without regard to the predetermined interval if the urgent consultation rule has been contravened.

62. The method for providing expert care to a BCMF of claim 60, wherein the at least two patient data elements comprise a physiological measure and a clinical data element of the patient.

63. The method for providing expert care to a BCMF of claim 60, wherein the at least two patient data elements comprise a physiological data element of the patient and a medication data element of the patient.

64. The method for providing expert care to a BCMF of claim 60, wherein the at least two patient data elements comprise a physiological data element of the patient and a laboratory data element of the patient.

65. The method for providing expert care to a BCMF of claim 60, wherein the at least two patient data elements comprise a clinical data element of the patient and a laboratory data element of the patient.

66. The method for providing expert care to a BCMF of claim 60, wherein the at least two patient data elements comprise two physiological data elements of the patient.