System and method for providing continuous, expert network critical care services from a remote location(s)

• US 6,804,656 B1
• Filed: 11/18/1999
• Issued: 10/12/2004
• Est. Priority Date: 06/23/1999
• Status: Expired due to Term

• Current Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Original Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Inventors: Breslow, Michael, Rosenfeld, Brian A.
• Primary Examiner(s): Chilot, Richard
• Assistant Examiner(s): HARLE, JENNIFER I
• Application Number:
  US09/443,072
• Time in Patent Office: 1,790 Days
• Field of Search: 705/2, 705/3, 600/300
• US Class Current: 705/3
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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 40/67 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
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

A system and method for providing continuous expert network critical care services from a remote location. A plurality of intensive care units (ICU'"'"'s) with associated patient monitoring instrumentation is connected over a network to a command center which is manned by intensivists 24 hours a day, 7 days a week. The intensivists are prompted to provide critical care by a standardized series of guideline algorithms for treating a variety of critical care conditions. Intensivists monitor the progress of individual patients at remote intensive care units. A smart alarm system provides alarms to the intensivists to alert the intensivists to potential patient problems so that intervention can occur in a timely fashion. A data storage/data warehouse function analyzes individual patient information from a plurality of command centers and provides updated algorithms and critical care support to the command centers.

Claims

1. A system for providing expert critical care simultaneously to a plurality of geographically dispersed intensive care units (ICUs) from a remote location, the system comprising:

a network;

a plurality of geographically dispersed ICUs comprising means for monitoring patient data elements from a patient and means for transmitting the monitored patient data elements to a remote command center by the network;

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 computerized patient care management system connected to a workstation,

wherein the computerized patient care management system is adapted for;

receiving the monitored patient data elements from the plurality of geographically dispersed ICUs;

storing the monitored patient data elements in the database;

applying a rules engine to at least two patient data elements stored in the database; and

monitoring the medical condition in the patients and utilizing the output from the rules engine to determine if intervention is warranted; and

wherein the monitoring and intervention for individual patients in the plurality of geographically dispersed ICUs occurs 24 hours per day 7 days per week.

2. The system of claims 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 claims 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 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 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 means for monitoring comprises monitoring equipment.

8. The system of claim 7 wherein the critical care site 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 computerized patient care management 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 computerized patient care management system is further adapted to:

receive information relating to a medical condition;

apply a decision support algorithm; and

provide 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 1 wherein the computerized patient care management system further comprises order writing software means for providing knowledge-based recommendations and prescriptions for medication based upon the patient data elements.

13. The system of claim 1 wherein the computerized patient care management system further comprises knowledge-based vital sign/hemodynamic algorithms.

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

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

16. The system of claim 1 wherein the computerized patient care management system further comprises knowledge-based ventilatory algorithms.

17. A method for providing expert critical care simultaneously to a plurality of geographically dispersed intensive care units (ICUs) from a remote location comprising:

monitoring patient data elements of patients in a plurality of geographically dispersed ICUs;

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 engine to at least two patient data elements stored in the database to monitor the medical condition in the patients; and

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

wherein the monitoring and determining if intervention is warranted for individual patients occurs 24 hours per day 7 days per week.

18. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location claim of 17, wherein the method further comprises consulting a decision support algorithm selected from the group consisting of 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, Hypernatremia;

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 Ischemia, 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, Thrombolytic 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.

19. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location claim of 17 further comprising:

storing data from the remote command center in a data server/data warehouse;

analyzing the data from the command center; and

providing results of the analysis over a second network to the remote command center.

20. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location claim of 17 further comprising transmitting video from the critical care site via the network to the remote command center.

21. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location claim of 17, wherein applying a rules engine to at least two patient data elements stored in the database to monitor the medical condition in the patients comprises applying a rules engine to a physiological measure and a clinical data element of the patient.

22. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location of claim 17, wherein applying a rules engine to at least two patient data elements stored in the database to monitor the medical condition in the patients comprises applying a rules engine to a physiological data element of the patient and to a medication data element of the patient.

23. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location of claim 17, wherein applying a rules engine to at least two patient data elements stored in the database to monitor the medical condition in the patients comprises applying a rules engine to a physiological data element of the patient and a laboratory data element of the patient.

24. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location of claim 17 wherein applying a rules engine to at least two patient data elements stored in the database to monitor the medical condition in the patients comprises applying a rules engine to a clinical data element of the patient and a laboratory data element of the patient.

25. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location of claim 17, wherein applying a rules engine to at least two patient data elements stored in the database to monitor the medical condition in the patients comprises applying a rules engine to two physiological data elements of the patient.

26. The method for providing expert critical care simultaneously to a plurality of geographically dispersed ICUs from a remote location of claim 17 further comprising transmitting audio from the ICU via the network to the remote command center.