System, method and program product for delivering medical services from a remote location

• US 7,912,733 B2
• Filed: 05/02/2006
• Issued: 03/22/2011
• Est. Priority Date: 05/04/2005
• Status: Active Grant

• Current Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Original Assignee: Board of Regents of the University of Texas System (University of Texas System)
• Inventors: Davis, Michael J., Boultinghouse, Oscar, Whipkey, William, Cloutier, Kaye S., Black, Oliver M., Calhoun, Jason, Hammack, Glenn G., Clements, Leon M.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): WOODS, TERESA S
• Application Number:
  US11/415,936
• Publication Number:
  US 20060271400A1
• Time in Patent Office: 1,785 Days
• Field of Search: 600/301, 705/1, 705/2, 705/3, 705/20
• US Class Current: 705/2
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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 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, program product, and methods related to enhanced medical services delivery to geographically distributed patient populations by remotely located physicians are provided. An embodiment of the system includes a remote medical services server, a plurality of patient electronic medical records stored in the memory of the remote medical services server, and a remote medical services program product stored in the memory of the remote medical services server adapted to access the plurality of patient electronic medical records to thereby allow display of and data entry in a selected patient electronic medical record. A patient medical service delivery station captures patient video images and displays remote physician video images. A remote physician medical service delivery suite in communication with the patient medical service delivery station through the communications network captures remote physician video images and displays patient video images and patient electronic medical records, to allow the remote physician to perform remote patient medical service delivery.

Claims

1. A system of enhanced medical services delivery to geographically distributed patients by remotely separated physicians located at a remote physician site, the system comprising:

an at least one remote medical information management computer including memory to store data therein to thereby define a remote medical services server;

a database associated with the remote medical services server and including a plurality of patient electronic medical records providing a single consolidated medical service delivery record for each of a corresponding plurality of patients, each record accessible by a patient clinic medical service provider, a medical services scheduler, and a remote physician;

a remote medical services program product stored in the memory of the remote medical services server and adapted to accept remote input from medical personnel to access the plurality of patient electronic medical records to thereby provide display of and data entry in a selected patient electronic medical record of a selected patient;

a dedicated communications link in communication with the remote medical services server and providing dedicated communications between a patient treatment location and the remote physician site located remote from the patient treatment location to thereby establish a private network connection between the patient treatment location and the remote physician site defining a private physician'"'"'s network;

a plurality of patient medical service delivery stations each positioned in a patient clinic located at the patient treatment location and in communication with the remote medical services server through the private physician'"'"'s network, each patient medical service delivery station including;

a remotely controllable video input device to capture patient video images, the remotely controllable video input device controllable by the remote physician to provide enhanced patient viewing,

a video display device positioned to be monitored by the patient clinic medical service provider and positioned to display patient video images captured by the patient medical service delivery station video input device and video images of the remote physician captured by a remote physician medical service delivery suite video input device ; and

a computer in communication with the remote medical services server through the private physician'"'"'s network and positioned to provide access to the remote medical services program product to provide data to display the selected patient electronic medical record, patient video images captured by the patient medical service delivery station video input device and video images of the remote physician to thereby provide feedback to the respective patient and patient clinic medical service provider; and

a remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and in communication with the remote medical services server and each of the plurality of patient medical service delivery stations through the private physician'"'"'s network to thereby facilitate the remote physician to perform remote patient medical service delivery through the remote physician medical service delivery suite and a respective patient medical service delivery station, the remote physician medical service delivery suite including;

an audio input device to capture remote physician audio,

a video input device to capture video images of the remote physician, and

a plurality of video display devices including those to display patient areas of interest of the selected patient and to display the selected patient electronic medical record, and including;

a first video display device configured to display near images of the patient area of interest of the selected patient,

a second video display device configured to display far images of the patient area of interest of the selected patient, the first and the second video display devices together configured to simultaneously display both the near and far patient images of the patient area of interest of the selected patient to the remote physician when operating the remote physician medical service delivery suite with the respective medical service delivery station, and

at least one electronic medical record video display to display portions of the selected patient electronic medical record of the selected patient to the remote physician when operating the remote physician medical service delivery suite with the respective medical service delivery station; and

the remote medical services program product including instructions that when executed by the remote medical services server cause the remote medical services server to perform the following operations;

receiving remote input from medical personnel to initiate access to the plurality of patient electronic medical records to thereby provide display of and data entry in the selected patient electronic medical record,

providing electronic medical record access to the patient clinic medical service provider through a computer located at the patient clinic and positioned remote from the remote physician medical services delivery suite and in communication with the remote medical services server through the private physician'"'"'s network to thereby provide a computer-assisted review of current patient medical administration data by the patient clinic medical service provider and entry in and receipt of additional patient medical administration data into the selected patient electronic medical record,

providing electronic medical record access to the medical services scheduler through at least one medical services scheduler computer positioned remote from the patient treatment location and in communication with the remote medical services server through the private physician'"'"'s network to thereby provide a computer-assisted screening of the remote physician medical services request, examination of remote physician schedule availability, and scheduling of the remote physician and the patient clinic medical service provider by the medical services scheduler to thereby initiate remote patient medical service delivery to the selected patient through one of the plurality of patient medical service delivery stations at a preselected time,

establishing a communications link between the remote physician medical service delivery suite and the patient medical service delivery station through the private physician'"'"'s network to facilitate provision of remote physician medical services,

providing electronic medical record access to the remote physician through the remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and through the private physician'"'"'s network to thereby provide patient electronic medical record access to the remote physician when the remote physician is providing remote physician medical services to the selected patient,

providing data to display the real-time near video image of the patient area of interest of the selected patient received from the patient medical service delivery station, on a video display screen of the first video display device of the remote physician medical service delivery suite,

providing data to display the real-time far video image of the patient area of interest of the selected patient received from the patient medical service delivery station, on a video display screen of the second video display device of the remote physician medical service delivery suite, and

providing data to display the selected patient electronic medical record on a video display screen of the third video display device of the remote physician medical service delivery suite,

simultaneously displaying the selected patient electronic medical record and both the real-time near and far video images of the selected patient to the remote physician when the remote physician is providing remote physician medical services responsive to operation of the remote physician medical service delivery suite with the patient medical service delivery station.

2. A system as defined in claim 1, further comprising:

at least one patient clinic computer associated with the patient clinic and positioned remote from the remote physician medical services delivery suite and in communication with the remote medical services server through the private physician'"'"'s network, and adapted to provide access to the remote medical services program product to provide for remote computerized physician medical service request entry of a physician'"'"'s medical service request by the patient clinic medical service provider and to display the selected patient electronic medical record to provide for computer-assisted review of the current patient medical administration data and entry in and receipt of additional patient medical administration data by the patient clinic medical service provider;

the at least one medical services scheduler computer positioned remote from the patient treatment location and in communication with the remote medical services server, adapted to provide access to the remote medical services program product to provide for the computer-assisted screening of the remote physician medical services request, examination of remote physician schedule availability, and scheduling of a remote physician and a patient clinic medical service provider, to thereby initiate remote patient medical service delivery to the selected patient through the one of the plurality of patient medical service delivery stations at the preselected time; and

at least one utilization review or case management computer in communication with the remote medical services server and adapted to provide access to the remote medical services program product, a medical services referral request record, and the patient electronic medical record, to provide computer-assisted utilization review of a remote physician medical services delivery request by a patient clinic medical service provider.

3. A system as defined in claim 1, further comprising:

a pharmacy located remote from the patient treatment location to provide pharmacy services;

at least one pharmacy computer positioned in the pharmacy and in communication with the remote medical services server and adapted to provide access to the remote medical services program product to display a patient electronic medical record for the selected patient to a pharmacy member to thereby provide pharmacy services; and

at least one pharmacy prescription compliance computer positioned remote from the pharmacy, in communication with the remote medical services server through the private physician'"'"'s network and adapted to provide access to the remote medical services program product to thereby record a patient medication administration compliance for a respective patient medication order.

4. A system as defined in claim 1, further comprising:

a medical decision monitoring system server configured to receive and process document medical services requests, associated clinical data, medical services request evaluation results, and proposed modifications to the medical services requests entered by a utilization review or case management nurse; and

a database associated with the medical decision monitoring system server and including a plurality of medical decision monitoring system records accessible by the utilization review or case management nurse to document medical services requests, associated clinical data, medical services request evaluation results, and proposed modifications to the medical services requests.

5. A system as defined in claim 1, further comprising:

a treatment facility located remote from the patient treatment location to provide additional in-person physician medical services delivery not receptive to remote physician medical services delivery at the patient clinic; and

at least one treatment facility physician workstation positioned remote from the at least one physician medical service delivery suite and located in the treatment facility, in communication with the remote medical services server through the private physician'"'"'s network and adapted to provide access to the remote medical services program product to display the patient electronic medical record for the preselected patient to a treatment facility physician to thereby provide treatment facility physician medical services.

6. A system as defined in claim 1,

wherein the system further comprises a treatment facility located remote from the patient treatment location and remote from the remote physician site to provide additional in-person physician medical services delivery;

wherein the private physician'"'"'s network further comprises a dedicated communications link in communication with the remote medical services server providing dedicated communications between the treatment facility and the remote physician site to thereby establish a private network connection between the treatment facility and the remote physician site; and

wherein the system further comprises at least one patient medical service delivery station positioned in the treatment facility and in communication with the remote medical services server through the private network connection, and including a video input device to capture patient video images and a video display device adapted to be monitored by a treatment facility medical service provider.

7. A system as defined in claim 1,

wherein the video display device for each patient medical service delivery station is configured to display both patient video images captured by the patient medical service delivery station video input device and the video images of the remote physician captured by the remote physician medical service delivery suite video input device, to provide feedback to the respective patient and patient clinic medical service provider;

and

wherein each patient medical service delivery station further comprises;

a video visualizer adapted to communicate with the remote physician medical service delivery suite, through the private physician'"'"'s network to provide video visualizations of documents to the remote physician during the remote patient medical service delivery,

an electronic stethoscope adapted to communicate with the remote physician medical service delivery suite, through the private physician'"'"'s network to provide for an electronic auscultation of a preselected patient,

a multi-function medical video scope adapted to communicate with the remote physician medical service delivery suite, through the private physician'"'"'s network to provide ear, nose, and throat visualizations of a preselected patient to the remote physician during remote patient medical service delivery,

an ECG connected to ECG leads adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide electrocardiograph visualization of a preselected patient to the remote physician during remote patient medical service delivery, and

a point-of-care laboratory testing device adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide real-time laboratory results during provision of the remote medical service delivery.

8. A system as defined in claim 1,

wherein each patient medical service delivery station is adapted to be manned by a patient clinic physician and a patient clinic medical staff supporting member;

wherein the system further comprises a plurality of remote physician medical service delivery suites;

wherein the plurality of remote physician medical service delivery suites are adapted to be manned by a corresponding plurality of remote physicians; and

wherein the remote patient medical service delivery is remotely provided through the remote physician medical service delivery suite by the patient clinic physician through one of the patient medical service delivery stations manned by the patient clinic medical staff supporting member responsive to the patient clinic physician being temporarily afflicted with a medical condition preventing provision of in-person patient medical services at the patient clinic, negating a need to provide an on-site replacement patient clinic physician, to thereby enhance physician-patient appointment attendance and reduce physician employment costs.

9. A system as defined in claim 1, wherein the patient medical service delivery station is positioned to provide remote monitoring of patient medication administration and to record corresponding patient medication self-administration compliance for a respective patient medication order.

39. A non-transitory computer readable medium as defined in claim 3, wherein the operation of providing data to display a patient electronic medical record includes the operations of providing data to display portions of the electronic medical record to the remote physician on two separate video display screens when the remote physician is providing the remote physician medical services.

10. A system of enhanced medical services delivery to geographically distributed patients by a remotely separated physician located at a remote physician site, the system comprising:

at least one remote medical information management computer including memory to store data therein to thereby define a remote medical services server;

a plurality of patient electronic medical records stored in the memory accessible to the remote medical services server and providing a medical service delivery record for a corresponding plurality of patients;

a remote medical services program product stored in the memory of the remote medical services server adapted to accept remote input from medical personnel to access the plurality of patient electronic medical records to thereby provide display of and data entry in a selected patient electronic medical record;

a patient medical service delivery station positioned in a patient clinic located at a patient treatment location in communication with the remote medical services server through a communications network and adapted to capture patient video images and to display remote physician video images; and

a remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and in communication with the patient medical service delivery station and the remote medical services server through the communications network and adapted to display patient video images and a respective selected patient electronic medical record, to thereby facilitate performing remote patient medical service delivery by the remote physician through the remote physician medical service delivery suite and the patient medical service delivery station, the remote physician medical service delivery suite including a plurality of video display devices, including;

a first video display device configured to display near images of a patient area of interest of the selected patient,

a second video display device configured to display far images of the patient area of interest of the selected patient, the first and the second video display devices together configured to simultaneously display both the near and far patient images of the patient area of interest of the selected patient to the remote physician when operating the remote physician medical service delivery suite with the respective medical service delivery station, and

at least one electronic medical record video display device configured to display at least portions of the selected patient electronic medical record of the selected patient to the remote physician when operating the remote physician medical service delivery suite with the respective medical service delivery station; and

the remote medical services program product including instructions that when executed by the remote medical services server cause the remote medical services server to perform the following operations;

establishing a communications link between the remote physician medical service delivery suite and the patient medical service delivery station through the communications network to facilitate provision of remote physician medical services,

providing electronic medical record access to a patient clinic medical service provider through the communications network to thereby provide a computer-assisted review of current patient medical administration data by the patient clinic medical service provider and entry in and receipt of additional patient medical administration data into the selected patient electronic medical record,

providing electronic medical record access to the remote physician through the remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and through the communications network to thereby provide electronic medical record access to the remote physician when the remote physician is providing remote physician medical services to the preselected patient,

providing data to display a real-time near video image of the selected patient received from the patient medical service delivery station on the video screen of the first video display device of the remote physician medical service delivery suite,

providing data to display a real-time far video image of the preselected patient received from the patient medical service delivery station on a video screen of the second video display device of the remote physician medical service delivery suite, and

providing data to display the electronic medical record of the selected patient on a video screen of the at least one electronic medical record video display device of the remote physician medical service delivery suite,

simultaneously displaying both the real-time near and far video images and the electronic medical record of the patient to the remote physician when the remote physician is providing remote physician medical services responsive to operation of the remote physician medical service delivery suite with the patient medical service delivery station.

11. A system as defined in claim 10, further comprising:

a medical services scheduler computer in communication with the remote medical services server and adapted to provide access to the remote medical services program product adapted to provide computer-assisted scheduling of a remote physician and the patient clinic medical service provider to thereby initiate remote patient medical service delivery to the selected patient through the patient medical service delivery station at a preselected time; and

a utilization review or case management computer in communication with the remote medical services server and adapted to provide access to the remote medical services program product, a medical services referral request record, and patient electronic medical records, to provide computer-assisted utilization review of a remote physician medical services delivery request by the patient clinic medical service provider.

12. A system as defined in claim 10, further comprising:

at least one pharmacy computer located in the pharmacy and in communication with the remote medical services server and adapted to provide access to the remote medical services program product to display the selected patient electronic medical record to a pharmacy member to thereby provide pharmacy services.

13. A system as defined in claim 10,

wherein the system further comprises a hospital located remote from the patient treatment location and remote from the remote physician site to provide additional in-person physician medical services delivery;

wherein the communications network further comprises a dedicated communications link in communication with the remote medical services server providing dedicated communications between the hospital and the remote physician site to thereby establish a private network connection between the hospital and the remote physician site; and

wherein the system further comprises at least one patient medical service delivery station positioned in the hospital and in communication with the remote medical services server through the private network connection, and including a video input device to capture patient video images and a video display device adapted to be monitored by a hospital medical service provider.

14. A system as defined in claim 10,

wherein the system further comprises a laboratory located remote from the patient treatment location and remote from the remote physician site to provide laboratory services;

and

wherein the communications network further comprises a limited access communications link in communication with the remote medical services server providing communications between the laboratory and the remote physician site to thereby update the electronic medical records with laboratory data.

15. A system as defined in claim 10, further comprising:

a customer medical information management computer positioned at the patient treatment location and including memory to store data therein to thereby define a customer medical services server;

a duplicate copy of the patient electronic medical records stored in the memory of the customer medical services server associated with the patient treatment location; and

wherein the remote medical services program product is further adapted to perform the following operations;

maintaining the duplicate copy of associated electronic medical records,

simultaneously updating both the electronic medical records stored in the memory of the remote medical services server and the electronic medical records stored in the memory of a respective customer medical services server,

maintaining a log of electronic medical record changes, responsive to network interruption, and

reconciling the changes responsive to network reestablishment.

16. A system as defined in claim 10,

wherein the remote physician medical service delivery suite further comprises:

a computer having a memory and software stored in the memory and adapted to control video display image selection to define a physician command console, and

an automated encounter document creator stored in the memory to provide automated encounter document creation; and

wherein the remote physician medical service delivery suite is configured to receive and display multi-functional medical video scope visualizations for an electronic visualization of the patient'"'"'s ear, nose, and throat, document visualizations and electrocardiograph visualizations, and audio from an electronic stethoscope, and point-of-care laboratory data.

17. A system as defined in claim 10,

wherein the remote physician medical service delivery suite includes a remote physician medical service delivery suite video input device adapted to capture remote physician video images;

and

wherein the patient medical service delivery station further comprises;

a video input device to capture patient video images,

a video display device adapted to display patient video images captured by the patient medical service delivery station video input device and video images of the remote physician captured by the remote physician medical service delivery suite video input device, to provide feedback to the respective patient and patient clinic medical service provider, and

a computer in communication with the remote medical services server through the communications network and adapted to provide access to the remote medical services program product to provide for display of the patient electronic medical record.

18. A system as defined in claim 10, further comprising:

a plurality of remote physician medical service delivery suites adapted to be manned by a corresponding plurality of remote physicians to provide remote medical services simultaneously to a corresponding plurality of geographically separated patients, each remote physician medical service delivery suite including a plurality of video display screens to simultaneously display both near and far patient images; and

a plurality of patient medical service delivery stations, each including a remotely controllable video input device controllable by any one of the plurality of remote physicians to provide enhanced patient viewing.

19. A method of providing enhanced medical services delivery by a remote physician to a patient being serviced in a facility having a facility medical service provider and a patient medical service delivery station, the method comprising the steps of:

assigning a facility medical service provider to a patient medical service delivery station, the facility medical service provider defining a physician extender;

assigning a remote physician to a remote physician medical service delivery suite positioned at a remote physician site located remote from the facility having a physician extender and the patient medical service delivery station;

initiating a remote physician medical service delivery encounter by connecting the remote physician medical service delivery suite with the patient medical service delivery station through a communication network;

displaying a real-time live near video image of a patient area of interest of the patient being examined by the remote physician on a first remote physician medical service delivery suite video display screen of a plurality of remote physician medical service delivery suite video display screens, the real-time live near video image received from the patient medical service delivery station;

displaying a real-time live far video image of the patient area of interest of the patient being examined by the remote physician on a second remote physician medical service delivery suite video display screen, the real-time live far video image received from the patient medical service delivery station;

displaying an electronic medical record of the patient on a third remote physician medical service delivery suite video screen;

providing audio data of the remote physician from the remote physician medical service delivery suite to the patient medical service delivery station; and

displaying a real-time live video image of the physician extender assisting the remote physician with examination of the patient area of interest through the remote physician medical service delivery suite and the patient medical service delivery station,

simultaneously displaying the real-time live near video image of the patient area of interest being examined by the remote physician, the real-time live far video image of the patient area of interest being examined by the remote physician, the electronic medical record, and the real-time live video image of the physician extender assisting the remote physician with examination of the patient area of interest, and providing the audio data responsive to operation of the remote physician medical service delivery suite in communication with the patient medical service delivery station.

20. A method as defined in claim 19, further comprising:

the step of transmitting the following to the remote physician medical service delivery suite for display on at least one other video display screen of the plurality of remote physician medical service delivery suite video display screens;

electronic stethoscope data for an electronic auscultation;

multi-functional video scope data for an electronic visualization of the patient'"'"'s ear, nose, and throat; and

point-of-care laboratory data.

21. A method as defined in claim 19, further comprising the steps of:

producing an encounter record of the remote physician medical service delivery encounter by an automated encounter document creator configured to provide automated encounter document creation;

providing a utilization review or case management nurse access to the encounter record; and

reviewing by the utilization review or case management nurse data comprising the encounter record to determine if additional medical services were requested and to perform a utilization review of the remote physician medical consultation encounter.

22. A method as defined in claim 19, further comprising the steps of:

requesting by the medical service provider a remote physician medical service delivery consultation referral;

providing consultation to the patient and the medical service provider during the remote physician medical service delivery encounter;

receiving feedback real-time from the patient and the medical service provider during the remote physician medical service delivery encounter responsive to the consultation;

recording data summarizing the remote physician medical consultation encounter; and

updating a remote physician medical consultation referral request by a scheduler with results of the remote physician medical service delivery encounter.

23. A method as defined in claim 19, further comprising the steps of:

accessing a medical service delivery schedule by the medical service provider and the remote physician to determine their respective daily remote physician medical service delivery appointments; and

reporting to the assigned medical service delivery suites at a substantially same predetermined scheduled time.

24. A method as defined in claim 19, wherein the remote physician assigned to the remote physician medical service delivery suite is a patient clinic physician, and wherein the step of initiating a remote physician medical service delivery encounter further comprises the step of:

providing the remote medical service delivery by the patient clinic physician responsive to the patient clinic physician being temporarily afflicted with a medical condition preventing provision of in-person patient medical services at the patient clinic, negating a need to provide an on-site replacement patient clinic physician, to thereby enhance physician-patient appointment attendance and reduce physician employment costs.

25. A method as defined in claim 19, further comprising the steps of:

evaluating a patient medical services request, the evaluation including the step of comparing patient clinical information contained in the patient medical services request against predetermined screening criteria;

generating an patient medical services request authorization for a remote patient medical service encounter with a scheduled remote specialist physician via an automated process responsive to the patient medical services request evaluation and responsive to approval data recordation;

accessing a patient electronic medical record and admitting the patient to add the patient to a remote physician medical service delivery schedule to thereby initiate the remote patient medical service encounter with the scheduled remote specialist physician; and

providing the remote patient medical service delivery through the patient medical service delivery station and a remote physician medical service delivery suite remotely positioned with the scheduled remote specialist physician.

26. A method as defined in claim 25, further comprising the steps of:

accessing the patient electronic medical record by a scheduler on the scheduled date to admit the patient to thereby initiate the remote patient medical service encounter and to thereby add the remote patient medical service encounter to a daily physician work schedule; and

accessing the remote physician medical service delivery schedule by the requesting medical service provider and the scheduled remote specialist physician to determine their respective daily remote physician medical service delivery appointments.

27. A method as defined in claim 19, further comprising the steps of:

providing point-of-care laboratory data to the remote physician medical service delivery suite, transmitted from the patient medical service delivery station; and

displaying the point-of-care laboratory data on a fourth video display screen of the plurality of remote physician medical service delivery suite video display screens, when simultaneously displaying the real-time near video image on the first video display screen, the real-time far video image on the second video display screen, and the electronic medical record on the third video display screen.

28. A method as defined in claim 19, further comprising the step of:

remotely controlling a remotely controllable patient medical service delivery station video input device by the remote physician to capture patient video images of the patient, when simultaneously displaying the real-time near video image;

the real-time far video image, and the electronic medical record.

29. A method as defined in claim 19, further comprising the steps of:

receiving electrocardiograph data for the patient from the patient medical service delivery station responsive to operation of the remote physician medical service delivery suite with the patient medical service delivery station when the remote physician is providing remote physician medical services; and

displaying a visualization of the electrocardiograph data on a fourth video display screen of the plurality of remote physician medical service delivery suite video display screens, when simultaneously displaying the real-time near video image, the real-time far video image, and the electronic medical record.

30. A method as defined in claim 19, further comprising the step of:

providing automated encounter document creation to include providing real-time record transcriptions and preformatted remote services delivery templates selectable by the remote physician to thereby produce an encounter record of the remote physician medical service delivery encounter.

31. A method as defined in claim 19, further comprising the step of:

generating an automated patient medical services request authorization responsive to approval data recordation and responsive to a patient medical services request evaluation to include the step of comparing patient clinical information contained in the patient medical services request against predetermined screening criteria.

32. A tangible non-transitory computer readable medium that is readable by a computer to provide enhanced medical services delivery by a remote physician to a patient being serviced in a facility having a patient medical service delivery station, the non-transitory computer readable medium storing a set of instructions that when executed by the computer, cause the computer to perform the following operations:

establishing a communications link between a remote physician medical service delivery suite and the patient medical service delivery station through a communications network to facilitate provision of remote physician medical services, the remote physician medical service delivery suite positioned at a remote physician site located remote from the facility having the patient medical service delivery station;

providing data to display an electronic medical record of the patient on a first remote physician medical service delivery suite video display screen of a plurality of remote physician medical service delivery suite video display screens;

providing data to display a real-time near video image of a patient area of interest being examined by the remote physician received from the patient medical service delivery station, the real-time near video image of a patient area of interest being examined by the remote physician being displayed on a second remote physician medical service delivery suite video display screen; and

providing data to display a real-time far video image of both the patient area of interest being examined by the remote physician and a physician extender located at the patient medical service delivery station and assisting the remote physician with the with examination of the patient area of interest, received transmitted from the patient medical service delivery station, the real-time far video image of both the patient area of interest being examined by the remote physician and the physician extender assisting the remote physician with examination of the patient area of interest being displayed on a third remote physician medical service delivery suite video display screen,

simultaneously displaying the electronic medical record and both the real-time near video image of the patient area of interest being examined and real-time far video image of the patient area of interest being examined and the physician extender assisting the remote physician with examination of the patient area of interest, to the remote physician when the remote physician is providing remote physician medical services responsive to operation of the remote physician medical service delivery suite in communication with the patient medical service delivery station.

33. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operations:

providing multi-functional video scope data to the remote physician medical service delivery suite received from the patient medical service delivery station, the multi-functional video scope data providing an electronic visualization of the patient'"'"'s ear, nose, and throat;

providing data to display the multi-functional video scope data received from the patient medical service delivery station on a fourth video display screen of the plurality of remote physician medical service delivery suite video display screens; and

providing document visualization video data generated from a document video visualizer and point-of-care laboratory data generated from a point-of-care laboratory testing device to the remote physician medical service delivery suite received from the patient medical service delivery station.

34. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operations:

providing point-of-care laboratory data to the remote physician medical service delivery suite, received from the patient medical service delivery station; and

providing data to display the point-of-care laboratory data on a fourth video display screen of the plurality of remote physician medical service delivery suite video display screens, when simultaneously displaying the real-time near video image, the real-time far video image, and the electronic medical record.

35. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operation:

providing data to remotely control a remotely controllable patient medical service delivery station video input device by the remote physician to capture patient video images of the patient, when simultaneously displaying the real-time near video image, the real-time far video image, and the electronic medical record.

36. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operations:

receiving electrocardiograph data for the patient from the patient medical service delivery station responsive to operation of the remote physician medical service delivery suite with the patient medical service delivery station when the remote physician is providing remote physician medical services; and

providing data to display a visualization of the electrocardiograph data on a fourth video display screen of the plurality of remote physician medical service delivery suite video display screens, when simultaneously displaying the real-time near video image, the real-time far video image, and the electronic medical record.

37. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operation:

providing automated encounter document creation to include providing real-time record transcriptions and preformatted remote medical services delivery templates selectable by the remote physician to thereby produce an encounter record of the remote physician medical service delivery encounter.

38. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operation:

generating an automated patient medical services request authorization responsive to approval data recordation and responsive to patient medical services request evaluation data to include the operation of performing an automated comparison of patient clinical information contained in the patient medical services request against predetermined screening criteria.

40. A non-transitory computer readable medium as defined in claim 32, further comprising a set of instructions that when executed by the computer, cause the computer to perform the following operation:

providing a laboratory a limited access communications link to the electronic medical records to provide for updating the electronic medical records with laboratory data.

41. A tangible non-transitory computer readable medium that is readable by a computer to provide enhanced medical services delivery by a remote physician to a patient being serviced in a facility having a patient medical service delivery station, the non-transitory computer readable medium storing a set of instructions that when executed by the computer, cause the computer to perform the following operations:

capturing video images of the a remote physician with a video input device positioned at a remote physician medical service delivery suite to display the video images of the remote physician to a patient facility medical service provider defining a physician extender positioned to assist the remote physician and to a patient when the remote physician is providing remote physician medical services, the video images of the remote physician displayed on a video display device positioned at the patient medical service delivery station defining a patient medical service delivery station video display device, the remote physician medical service delivery suite located remote from the facility having the patient medical service delivery station;

providing data to display patient areas of interest captured by a patient medical service delivery station video input device and the video images of the remote physician captured by the remote physician medical service delivery suite video input device when the remote physician is providing remote physician medical services, the video images of patient areas of interest and the video images of the remote physician displayed on the patient medical service delivery station video display device to thereby provide feedback to the patient and physician extender;

providing data to display a patient electronic medical record of the patient on the patient medical service delivery station video display device to thereby provide for review of current patient medical administration data and entry in and receipt of additional patient medical administration data to the patient medical service delivery station;

receiving electronic medical record data entered by the physician extender through the patient medical services delivery station;

providing data to display a real-time live near image of a patient area of interest being examined by the remote physician to the remote physician on a first video display screen of a remote physician medical service delivery suite when the remote physician is providing remote physician medical services;

providing data to display a real-time live far image of the patient area of interest being examined by the remote physician to the remote physician on a second video display screen of the remote physician medical service delivery suite when providing the remote physician medical services; and

providing data to display the electronic medical record of the patient on a third video display screen of the remote physician medical service delivery suite,

simultaneously displaying to the remote physician both the real-time live near image of the patient area of interest being examined by the remote physician on the first video display screen, the real-time live far image of the patient area of interest being examined by the remote physician on the second video display screen, and portions of the electronic medical record entered by the physician extender assisting the remote physician in examining the patient area of interest on the third video display screen, when the remote physician is providing remote physician medical services through operation of the remote physician medical service delivery suite in communication the patient medical service delivery station.

42. A system of enhanced medical services delivery to geographically distributed patients by remotely separated physicians located at a remote physician site, the system comprising:

at least one remote medical information management computer including memory to store data therein to thereby define a remote medical services server;

a dedicated communications link in communication with the remote medical services server and providing dedicated communications between a patient treatment location and the remote physician site located remote from the patient treatment location to thereby establish a private communications network connection between the patient treatment location and the remote physician site, defining a private physician'"'"'s network;

a database associated with the remote medical services server and including a plurality of patient electronic medical records providing a single consolidated medical service delivery record for each separate one of a corresponding plurality of patients that combines both outpatient and inpatient records, each consolidated record accessible by a patient clinic medical service provider, a medical services scheduler, and a remote physician;

a plurality of patient medical service delivery stations each positioned in a patient clinic located at the patient treatment location, in communication with the remote medical services server through the private physician'"'"'s network, and each patient medical service delivery station including;

a remotely controllable video input device to capture patient video images, the remotely controllable video input device controllable by the remote physician, to provide enhanced patient viewing,

a video display device positioned to be monitored by the patient clinic medical service provider and configured to display patient video images captured by the patient medical service delivery station video input device and a video image of the remote physician captured by a video input device of a remote physician medical service delivery suite to thereby provide feedback to the respective patient and patient clinic medical service provider,

a patient medical delivery station computer in communication with the remote medical services server through the private physician'"'"'s network, and including memory and software stored in the memory and positioned to provide access to remote medical services program product and to provide for display of a patient electronic medical record,

a video visualizer adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide video visualizations of documents to the remote physician during the remote patient medical service delivery,

an electronic stethoscope adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide for an electronic auscultation of a preselected patient,

a multi-function medical video scope adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide ear, nose, and throat visualizations of a preselected patient to the remote physician during remote patient medical service delivery,

an electrocardiograph connected to electrocardiograph leads adapted to communicate with the remote physician medical service delivery suite through the private physician'"'"'s network to provide electrocardiograph visualization of a preselected patient to the remote physician during remote patient medical service delivery, and

a point-of-care laboratory testing device adapted to provide real-time laboratory results during provision of the remote medical service delivery;

the remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and in communication with the remote medical services server and each of the plurality of patient medical service delivery stations through the private physician'"'"'s network to thereby allow the remote physician to perform remote patient medical service delivery through the remote physician medical service delivery suite and a respective patient medical service delivery station, the remote physician medical service delivery suite including;

an audio input device to capture audio, a video input device to capture video images of the remote physician, and

a plurality of video display screens positioned to simultaneously display to the remote physician both near and far patient images of a patient area of interest, portions of a patient electronic medical record, and one or more of the following;

multi-functional video scope data and point-of-care laboratory data for the preselected patient, when operating the remote physician medical service delivery suite and a respective one of the plurality of medical service delivery stations, the plurality of video display screens comprising;

a first video display screen positioned to display a near image of the patient area of interest of the preselected patient to the remote physician when providing remote physician medical services,

a second video display screen positioned to display a far image of the patient area of interest to the remote physician when providing the remote physician medical services,

a third video display screen positioned to display portions of an associated patient electronic medical record of the preselected patient to the remote physician,

a fourth video display screen also positioned to display portions of the associated patient electronic medical record of the preselected patient to the remote physician, and

a fifth video display screen positioned to display one or more of the following;

multi-functional video scope data and point-of-care laboratory data defining auxiliary data, transmitted from the patient medical service delivery station; and

the remote medical services program product including instructions that when executed by the remote medical services server cause the remote medical services server to perform the following operations;

establishing a communications link between the remote physician medical service delivery suite and a respective one of the plurality of patient medical service delivery stations through the private physician'"'"'s network to facilitate provision of remote physician medical services,

providing electronic medical record access to a patient clinic medical service provider through the private physician'"'"'s network to thereby provide a computer-assisted review of current patient medical administration data by the patient clinic medical service provider and entry in and receipt of additional patient medical administration data into the selected patient electronic medical record,

providing electronic medical record access to the remote physician through the remote physician medical service delivery suite positioned remote from the patient clinic at the remote physician site and through the private physician'"'"'s network to thereby provide electronic medical record access to the remote physician when the remote physician is providing remote physician medical services to the preselected patient,

providing data to display a real-time near video image of the selected patient received from the respective patient medical service delivery station on the first video display screen of the of the remote physician medical service delivery suite, providing data to display a real-time far video image of the preselected patient received from the respective patient medical service delivery station on the second video display screen of the remote physician medical service delivery suite,

providing data to display the electronic medical record of the selected patient on the third video display screen of the remote physician medical service delivery suite, and

providing data to display the multi-functional video scope data, and the point-of-care laboratory data transmitted from the respective patient medical service delivery station,

simultaneously displaying both the real-time near and far video images of the patient, the electronic medical record of the patient, and auxiliary data to the remote physician when the remote physician is providing remote physician medical services through operation of the remote physician medical service delivery suite with the respective patient medical service delivery station.