Remote psychological diagnosis and monitoring system

• US 6,334,778 B1
• Filed: 03/17/1999
• Issued: 01/01/2002
• Est. Priority Date: 04/26/1994
• Status: Expired due to Term

• Current Assignee: Health Hero Network Incorporated (Robert Bosch GmbH)
• Original Assignee: Health Hero Network Incorporated (Robert Bosch GmbH)
• Inventors: Brown, Stephen J.
• Primary Examiner(s): TRAMMELL, JAMES P
• Application Number:
  US09/271,188
• Time in Patent Office: 1,021 Days
• Field of Search: 434/258, 434/236, 434/335, 434/362, 273/429, 273/430, 273/431, 273/432, 273/440, 273/441, 273/445, 705/1, 705/2, 705/3
• US Class Current: 434/258
• CPC Class Codes: A61B 2560/0443 Modular apparatus
• 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 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/14532 for measuring glucose, e.g. by tissue impedance measurement
• CPC Class Codes: A61B 5/6896 Toys
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/70 relating to mental therapies, e.g. psychological therapy or autogenous training
• CPC Class Codes: G16H 40/63 for local operation
• 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 networked system for remotely assessing and monitoring psychological conditions. The system includes a server and a remote interface for entering in the server prompts, such as queries and instructions, to be responded to by the individual. The server is preferably a web server and the remote clinician interface is preferably a personal computer connected to the server via the Internet. The system also includes a remotely programmable patient apparatus connected to the server via a communication link, preferably the Internet. The patient apparatus interacts with the individual in accordance with a script received from the server. The server includes a script generator for generating the script from the set of prompts entered through the remote interface. The script is received and executed by the patient apparatus to communicate the prompts to the individual, to receive responses to the prompts, and to transmit the responses from the patient apparatus to the server. In accordance with the invention, the patient apparatus is programmed to prompt a patient to interactively operate one or more switches. Information recorded during an interactive diagnostic assessment procedure is analyzed to provide a health care professional with information that is helpful to determine whether clinical therapy and/or medication may be required. The preferred embodiment of the invention relates to diagnostic assessment of Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder with a game-like video display being used to obtain a measure of various neuropsychologic indicia of attention.

Claims

1. A system for assessment of a psychological condition of a patient comprising:

(A) a patient system including;

(1) a display for displaying an image to the patient;

(2) a patient processor unit including a patient processor, a switch operable for supplying an electrical signal that is detectable by the patient processor, and circuit means responsive to signals supplied by the patient processor for generating the image on the display; and

(3) a memory for storing program instructions for displaying an image on the display for provoking operation of the switch, and for changing the image in response to the operation of the switch by the patient;

(B) a clinician system located remotely from the patient system and including;

(1) a memory for storing administrator program instructions for establishing a diagnostic assessment procedure and for retrieving a diagnostic signal which results from the operation of the switch and which is representative of a diagnostic measure indicated by the diagnostic assessment procedure, wherein the administrator program instructions further comprise a script and the diagnostic assessment procedure includes executing the script for displaying queries on the display and retrieving the patient'"'"'s responses to the queries; and

(2) a clinician processor for executing at least one of the administrator program instructions; and

(C) a communications link connectable in signal communication with the patient system and the clinician system for the exchange of signals between the patient system and the clinician system.

2. The system of claim 1 wherein the diagnostic assessment procedure established by the administrator program further comprises execution of the program instructions for administration of a diagnostic task selected from the group of tasks comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions;

a continuous performance task without distractions.

3. The system of claim 1 wherein the administrator program further comprises program instructions for display of a main menu screen allowing a clinician using the clinician system to select a menu item from the group comprising:

opening of a new file for establishing the diagnostic assessment procedure for the patient;

opening an existing file for storing the diagnostic measure resulting from the diagnostic assessment procedure in the memory of the clinician'"'"'s computer workstation;

opening an existing file for storing a particular configuration of the diagnostic assessment procedure in the memory of the clinician'"'"'s computer workstation;

saving a file associated with a particular the patient;

closing a file;

producing the diagnostic assessment procedure;

storing the program instructions in the memory of the patient processor unit of the patient system; and

initiating execution of the diagnostic assessment procedure with the patient processor unit that is connected to the clinician'"'"'s computer workstation.

4. The system of claim 1 wherein the clinician system is a clinician computer workstation.

5. The system of claim 1 wherein the clinician processor of the clinician system further comprises an input/output unit connected in signal communication with the clinician processor and connectable in signal communication with peripheral devices selected from the group comprising:

a printer for printing diagnostic measurement information generated from the diagnostic measure resulting from the diagnostic assessment procedure;

a facsimile machine for displaying diagnostic measurement information generated from the diagnostic measure resulting from the diagnostic assessment procedure;

a receptacle for receiving a removable and insertable external memory unit; and

a patient system located locally relative to the clinician processor and wherein the signal communication with the clinician processor is accomplished by a serial data cable.

6. The system of claim 5 wherein:

(A) the external memory unit connectable in signal communication with said input/output unit further comprises means for storage of the program instructions for controlling the operation of the patient processor unit and the diagnostic measurement information generated from the diagnostic measure resulting from the diagnostic assessment procedure; and

(B) the patient processor unit includes a receptacle for receiving the external memory unit.

7. The system of claim 1 wherein the clinician system further comprises a clearinghouse:

(A) for receiving the diagnostic signal resulting from the interactive operation of the switch of at least one of the patient processor units; and

(B) connectable in signal communication for data transmission with the clinician system.

8. The system of claim 7 wherein the administrator program instructions further comprise a script and the diagnostic assessment procedure includes executing the script for displaying queries on the display and retrieving the patient'"'"'s responses to the queries.

9. The system of claim 8 wherein:

(A) the clearinghouse further comprises a server including a script generator capable of generating the script and a database means connected to the script generator for storing scripts created by the script generator; and

(B) the clinician system further comprises means for entering into the server the queries to be responded to by the patient, and for causing the script generator to generate the script.

10. The system of claim 9 wherein the clearinghouse further comprises means for receiving and storing a plurality of the diagnostic signals from a plurality of the patient processor units.

11. The system of claim 10 wherein the program instructions for retrieving a diagnostic signal representative of a diagnostic measure resulting from the diagnostic assessment procedure further include program instructions for transmitting the plurality of diagnostic signals stored in the clearinghouse to the clinician system.

12. The system of claim 1 further comprising analytical signal processing means for executing at least one instruction from a set of instructions that performs one or more analyses of the patient'"'"'s interactive operation of the switch in response to the image on the display for provoking operation of the switch.

13. The system of claim 12 wherein the analytical signal processing means is the patient processor unit, and wherein:

(A) the program instructions further include at least one instruction from the set of instructions which perform the one or more analyses;

(B) the patient processor unit is further programmable for executing the at least one instruction;

(C) the memory of the patient processor unit further comprises an addressable memory for storage of the diagnostic signal and the at least one instruction for implementing the analyses; and

(D) the patient processor of the patient processor unit further comprises means for accessing the at least one instruction and processing the diagnostic signal stored in the addressable memory.

14. The system of claim 12 wherein the analytical signal processing means is the clinician processor of the remotely located clinician system, and wherein

(A) the administrator program instructions further include at least one instruction from the set of instructions which perform the one or more analyses;

(B) the clinician processor is further programmable for executing the at least one instruction;

(C) the memory of the clinician processor further comprises an addressable memory for storage of the diagnostic signal retrieved as a result of execution of the administrator program instructions and the at least one instruction for implementing the analyses; and

(D) the clinician processor further comprises means for accessing the at least one instruction and processing the diagnostic signal stored in the addressable memory.

15. The system of claim 12 wherein the analytical signal processing means is a clearinghouse;

and wherein the clearinghouse;

(A) includes a memory for storing, and a processor for executing, program instructions for retrieving a diagnostic signal resulting from the operation of the switch and representative of a diagnostic measure indicated by the diagnostic assessment procedure; and

is

(B) connectable in signal communication for data transmission with the clinician system.

16. The system of claim 12 wherein the analytical signal processing means further comprises a data management unit, said data management unit being programmable for executing the at least one instruction from the set of instructions which perform the one or more analyses;

and including;

(A) an addressable memory for storage of the diagnostic signal;

(B) means for accessing the at least one instruction and processing the diagnostic signal stored in the addressable memory; and

(C) connecting means for connecting in signal communication with the patient processor unit for coupling and transmitting signals representative of the interactive operation of the switch from the patient processor unit to the data management unit.

17. A system for remotely assessing and monitoring the psychological condition of a patient, the system comprising:

(A) a server including;

(1) a script generator for generating a script from clinician information;

(2) a database coupled to the script generator for storing scripts created by the script generator;

(B) a clinician interface for;

(1) receiving entered clinician information;

(2) generating the script based upon the entered clinician information;

(C) a patient system comprising;

(1) a remotely programmable apparatus including;

a. a memory for storing the script;

b. a processor that is coupled to the memory for implementing the script;

(2) a user interface for displaying an output determined by the processor implementing the script;

(3) monitoring means for obtaining diagnostic signals representative of the psychiatric condition of the patient;

(4) circuitry for communicating signals between the remotely programmable apparatus, the user interface, and the monitoring means; and

(D) a communication link for providing communication between the patient system, the server and the clinician interface.

18. The system of claim 17 wherein the server comprises a web server for generating a web page for entry of the clinician information.

19. The system of claim 17 wherein the clinician information further comprises patient message information not intended to cause the script to elicit a response from the patient.

20. The system of claim 17 wherein the clinician information further comprises patient prompt information which is intended to cause the script to elicit a response from the patient.

21. The system of claim 20 wherein the patient prompt information is intended to cause the script to generate queries to be answered by the patient.

22. The system of claim 20 wherein the patient prompt information is intended to cause the script to generate instructions for the patient.

23. The system of claim 20 wherein:

(A) the remotely programmable apparatus provides the monitoring means for obtaining the diagnostic signals;

(B) the user interface is included within the remotely programmable apparatus;

(C) the memory for storing the script further includes memory for storing the diagnostic signals;

(D) the remotely programmable apparatus includes means for causing the diagnostic signals to be transmitted to the server via the communication link; and

(E) the clinician interface further comprises means for receiving the diagnostic signals from the server.

24. The system of claim 23 wherein:

(A) the remotely programmable apparatus further includes user input buttons operable for supplying an electrical signal that is detectable by the processor that is coupled to the memory;

(B) the user interface includes a display for displaying an image and presenting audible signals to the patient;

(C) the memory further comprises means for storing program instructions for generating the patient prompt information;

(D) the patient prompt information further comprises an animated sequence of images displayed on the display for provoking interactive operation of the user input buttons by the patient;

(E) the program instructions further cause changes to the animated sequence and generate the diagnostic signals in response to the patient'"'"'s interactive operation of the user input buttons; and

(F) the communication provided by the communication link includes transmission of diagnostic signals from the patient system to the server and from the server to the clinician interface, and transmission of script from the server to the patient system.

25. The system of claim 24 wherein the animated sequence presents a diagnostic task selected from the group of tasks comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions;

a continuous performance task without distractions.

26. The system of claim 20 wherein the monitoring means is a separate monitoring device that is connectable in signal communication with the remotely programmable apparatus of the patient system.

27. The system of claim 26 wherein the monitoring device further comprises:

(A) a display for displaying an image and presenting audible signals to the patient;

(B) a patient processor unit including;

(1) a patient processor;

(2) a switch operable for supplying an electrical signal that is detectable by the patient processor;

(3) circuitry responsive to signals supplied by the patient processor for generating a visual display on the display;

(4) a memory for storing program instructions for;

a. generating an animated sequence of images on the display for provoking interactive operation of the switch, and

b. changing the animated sequence and generating the diagnostic signal in response to interactive operation of the switch by the patient.

28. The system of claim 27 wherein the server comprises a web server for generating a web page for entry of the clinician information, and wherein the clinician interface is connected to the web server.

29. The system of claim 27 further comprising analytical signal processing means for executing at least one instruction from a set of instructions that performs one or more analyses of the patient'"'"'s interactive operation of the switch of the patient processor unit in response to the animated sequence generated by the program instructions.

30. The system of claim 20 wherein the patient user interface includes a speech synthesis means for audibly communicating the patient prompt information to the patient;

and wherein the patient prompt information includes a sequence of audio signals communicated by the speech synthesis means for provoking interactive operation of the user input buttons.

31. The system of claim 20 wherein the patient user interface includes a speech recognition means for receiving spoken responses to the patient prompt information.

32. The system of claim 20 wherein the patient user interface comprises a display for displaying the patient prompt information and user input buttons for entering the patient'"'"'s responses;

and wherein the patient prompt information includes an animated sequence of images on the display for provoking interactive operation of the user input buttons.

33. The system of claim 32 wherein the animated sequence presents a diagnostic task selected from the group of tasks comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions;

a continuous performance task without distractions.

34. The system of claim 17 wherein the communication link includes means for establishing a first communication link to the server to receive the script and means for establishing a subsequent communication link to the server to transmit the responses, and wherein the script specifies a connection time at which to establish the subsequent communication link.

35. The system of claim 17 wherein the remotely programmable apparatus further includes notification means connected to the processor for notifying the patient that output of at least one of the scripts has not been communicated to the patient.

36. The system of claim 35 wherein the notification means is a visual indicator displayed by the user interface for visually notifying the patient.

37. The system of claim 35 wherein the notification means is an audible prompt displayed by the user interface for audibly notifying the patient.

38. The system of claim 17 further comprising a plurality of remotely programmable apparatuses in communication with the server for remotely monitoring a plurality of patients, wherein the database means includes means for storing a plurality of scripts, the clinician interface includes means for entering script assignment information, the server includes script assignment means for assigning to each of the patients at least one of the scripts from the database means in accordance with the script assignment information, and the database further includes means for storing a list of the patients, and for each of the patients, a respective pointer to the script assigned to the patient.

39. The system of claim 17 wherein the user interface of the patient system further comprises user input buttons and presents a diagnostic task selected from the group of tasks comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions;

a continuous performance task without distractions.

40. The system of claim 17 wherein the monitoring means further comprises at least one monitoring device to gather the diagnostic signals representative of the psychological condition of the patient and to transmit the diagnostic signal to the remotely programmable apparatus, wherein the remotely programmable apparatus further includes a device interface means connected to the processor for receiving the diagnostic signals from the monitoring device, and wherein the memory for storing the script includes memory for storing the diagnostic signals, and the communication provided by the communication link includes transmission of the diagnostic signals to the server.

41. The system of claim 40 wherein the device interface means includes means for interfacing with a plurality of monitoring devices, and the script specifies a selected monitoring device from which to collect the diagnostic signals.

42. The system of claim 40 wherein the server further comprises report means for reporting the responses and the diagnostic signals to the clinician interface.

43. The system of claim 40 wherein the monitoring device further comprises:

(A) a display for displaying an image and presenting audible signals to the patient;

(B) a patient processor unit connectable in signal communication with the remotely programmable apparatus and including;

(1) a patient processor;

(2) a switch operable for supplying an electrical signal that is detectable by the patient processor;

(3) circuit means responsive to signals supplied by the patient processor for generating a visual display on the display;

(4) a memory for storing program instructions for;

a. generating an animated sequence of images on the display for provoking interactive operation of the switch, and

b. changing the animated sequence and generating the diagnostic signals in response to interactive operation of the switch by the patient;

(C) means for transmitting the diagnostic signals from the patient processor unit to the remotely programmable apparatus.

44. A method of assessing and monitoring the psychological condition of a patient comprising the method steps of:

(A) receiving a script at a patient apparatus;

(B) executing the script to generate a series of stimuli on a display;

(C) including within the series a stimulus for provoking interactive operation of a switch by the patient;

(D) executing an analytical signal processing instruction that analyses the patient'"'"'s interactive operation of the switch in response to the series of stimuli;

(E) generating a diagnostic measure from the analysis of the interactive operation of the switch; and

(F) transmitting a diagnostic signal representative of the diagnostic measure to a clinician system located remotely from the patient by means of a communication link.

45. The method of claim 44 further comprising the method steps of:

(A) executing an administrator program instruction for prescribing a diagnostic assessment procedure for obtaining the diagnostic measure;

(B) retrieving the diagnostic signal representative of the diagnostic measure prescribed by the diagnostic assessment procedure via the communication link;

(C) storing the diagnostic signal in a memory coupled to the communication link.

46. The method of claim 44 wherein the display further includes a visual display, wherein the stimuli includes visual stimuli, and wherein the stimulus for provoking interactive operation of the switch is a visual stimulus.

47. The method of claim 44 wherein the display includes an audio display, wherein the stimuli includes auditory stimuli, and wherein the stimulus for provoking interactive operation of the switch is an auditory stimulus.

48. A method for remotely assessing and monitoring the psychological condition of a patient, the method comprising the following steps:

entering clinician information;

generating a script based on the clinician information

transmitting the script to a server, and from the server to a patient apparatus through a communication link;

executing the script at the patient apparatus for generating output for the patient, wherein the output generated by execution of the scripts comprises output of a type selected from the group comprising;

(A) messages for the patient'"'"'s information which are not intended to elicit a patient reply to be transmitted to the server;

(B) queries intended to elicit a patient reply to be transmitted to the server;

(C) prescriptive instructions intended to cause the patient to perform a patient-administered diagnostic procedure and to communicate the results of the procedure to the server through the patient apparatus and the communication link.

49. The method of claim 48:

(A) wherein the step of entering the clinician information comprises a step selected from the group of steps comprising;

(1) entering script information for generation of the script through a script entry means;

(2) assigning a predefined script to a specific patient through a script assignment means;

(3) modifying a predefined script through the script entry means;

(4) creating a new script through the script entry means; and

(B) further comprising the step of providing means within the server for storing information selected from the following types of information;

(1) the script;

(2) the patient replies to the queries; and

(3) the results of the patient-administered diagnostic procedure.

50. The method of claim 49 wherein the server comprises a web server;

wherein the script entry means and script assignment means further comprise a web page hosted on the web server, wherein the clinician information is entered by accessing the web page through the Internet and wherein the step of entering clinician information comprises the step of entering the clinician information in the web page.

51. The method of claim 49 further comprising the steps of:

providing a plurality of patients with a corresponding plurality of patient apparatuses such that each of the patients is associated with a respective one of the patient apparatuses,

entering in the server a plurality of sets of the clinician information;

generating in the server a plurality of scripts such that each of the scripts corresponds to a respective one of the sets of clinician information;

assigning to each of the patients at least one of the scripts;

storing in the server the scripts, a list of the patients, and for each of the patients, a respective pointer to the script assigned to the patient; and

transmitting to each of the patient apparatuses the script assigned to the patient associated with the patient apparatus.

52. The method of claim 48 wherein the patient apparatus includes a device interface for receiving the results from the patient-administered diagnostic procedure, and wherein the method further comprises the steps of:

collecting the results in the patient apparatus through the device interface;

transmitting the results from the patient apparatus to the server; and

receiving and storing the results in the server.

53. The method of claim 52 wherein the device interface includes means for interfacing with a plurality of monitoring devices, the script specifies a selected monitoring device from which to collect the diagnostic signals, and the method further comprises the step of prompting the patient to connect the selected monitoring device to the device interface.

54. The method of claim 52 wherein the patient-administered diagnostic procedure comprises the method step of operating a monitoring device to generate the results, wherein the results further comprise diagnostic signals representative of diagnostic measurements of a psychological condition of a patient.

55. The method of claim 54 further comprising the step of reporting on a remote interface the diagnostic signals received in the server.

56. The method of claim 54 further comprising the method steps of:

(A) providing as the monitoring device a patient processor unit;

(B) providing for the patient processor unit;

(1) a patient processor,

(2) a switch operable for supplying an electrical signal that is detectable by the patient processor,

(3) circuit means responsive to signals supplied by the patient processor for generating a visual display on the display,

(4) a memory for storing program instructions;

(C) operating the monitoring device by executing the program instructions for performing the method steps of;

(1) generating an animated sequence of images on the display for provoking interactive operation of the switch, and

(2) causing operation of the patient processor and changing the animated sequence in response to interactive operation of the switch by the patient.

57. The method of claim 56 wherein the animated sequence of images presents a psychiatric diagnosis task selected from the group comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions; and

a continuous performance task without distractions.

58. The method of claim 48 wherein the script is transmitted from the server to the patient apparatus through a first communication link, the responses to the script output presented to the patient are transmitted from the patient apparatus to the server through a subsequent communication link, the script specifies a connection time at which to establish the subsequent communication link.

59. The method of claim 48 wherein the patient apparatus includes a user interface;

the user interface including a display and input buttons, and wherein the script output presented to the patient is communicated through the display and the patient responses to the output are received through the input buttons.

60. The method of claim 48 wherein the patient apparatus includes a user interface;

the user interface including a speech synthesizer, and wherein the script output presented to the patient is communicated through the speech synthesizer.

61. The method of claim 48 wherein the patient apparatus includes a user interface;

and wherein the user interface includes a speech recognizer for receiving the patient replies and the results of the procedure.

62. The method of claim 48 further comprising the steps of:

providing a plurality of patients with a plurality of patient apparatuses such that each of the patients is associated with a respective one of the patient apparatuses;

entering in the server a plurality of sets of the clinician information, generating in the server a plurality of scripts such that each of the scripts corresponds to a respective one of the sets of clinician information;

assigning to each of the patients at least one of the scripts;

storing in the server the scripts, a list of the patients, and for each of the patients, a respective pointer to the script assigned to the patient; and

transmitting to each of the patient apparatuses the script assigned to the patient associated with the patient apparatus.

63. The method of claim 62 wherein the patient apparatus includes a device interface for receiving the results from the patient-administered diagnostic procedure, and wherein the method further comprises the steps of:

collecting the results in the patient apparatus through the device interface;

transmitting the results from the patient apparatus to the server; and

receiving and storing the results in the server.

64. The method of claim 63 wherein the patient-administered diagnostic procedure comprises the method step of operating a monitoring device to generate the results, wherein the results further comprise diagnostic signals representative of diagnostic measurements of a psychological condition of a patient.

65. The method of claim 64 wherein:

(A) the monitoring device further comprises a patient processor unit including;

(1) a patient processor,

(2) a switch operable for supplying an electrical signal that is detectable by the patient processor,

(3) circuitry responsive to signals supplied by the patient processor for generating a visual display on the display,

(4) a memory for storing program instructions; and

(B) the step of operating the monitoring device further comprises the method step of executing the program instructions for performing the method steps of;

(1) generating an animated sequence of images on the display for provoking interactive operation of the switch; and

(2) causing operation of the patient processor and changing the animated sequence in response to interactive operation of the switch by the patient.

66. The method of claim 65 wherein the animated sequence of images presents a psychiatric diagnosis task selected from the group comprising:

a delayed reaction task with distractions;

a delayed reaction task without distractions;

a continuous performance task with distractions;

a continuous performance task without distractions.