System and method for providing continuous, expert network care services from a remote location(s) to geographically dispersed healthcare locations

• US 8,170,887 B2
• Filed: 08/10/2005
• Issued: 05/01/2012
• Est. Priority Date: 06/23/1999
• Status: Expired due to Fees

• Current Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Rosenfeld, Brian A., Breslow, Michael
• Primary Examiner(s): O'Connor, Gerald J.
• Assistant Examiner(s): LE, LINH GIANG
• Application Number:
  US11/200,554
• Publication Number:
  US 20060025657A1
• Time in Patent Office: 2,456 Days
• Field of Search: 705 2- 4, 600/300
• US Class Current: 705/2
• CPC Class Codes: A61B 5/002 Monitoring the patient using a local or closed circuit, e.g. in a room or building A61B5/0017 takes precedence
• 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 5/4094 Diagnosing or monitoring seizure diseases, e.g. epilepsy
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 5/412 Detecting or monitoring sepsis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G08B 21/0211 Combination with medical sensor, e.g. for measuring heart rate, temperature
• CPC Class Codes: G08B 21/0476 Cameras to detect unsafe condition, e.g. video cameras
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 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: H04L 67/12 specially adapted for proprietary or special-purpose networking environments, e.g. medical networks, sensor networks, networks in vehicles or remote metering networks

Abstract

A system and method for providing continuous expert network critical care services from a remote location. A plurality of healthcare locations 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 computerized expert care support simultaneously to patients in geographically separate health care locations (HCLs) from a remote location comprising:

a network;

a remote command center for simultaneously managing the care of HCL patients in the geographically separate HCLs over the network, wherein the remote command center has access to a database;

monitoring stations located in the geographically separate HCLs, wherein the monitoring stations comprise instructions for obtaining monitored patient data elements wherein the monitored patient data elements are communicated to the database via the network, and wherein the database comprises stored atient data elements comprising the monitored patient data elements and other patient data elements associated with medical conditions of the patients; and

wherein the remote command center has access to a computerized patient care management system, which comprises instructions for;

accessing patient data elements from the stored patient data elements;

utilizing a rules engine to apply rules repeatedly and automatically to at least two patient data elements, wherein the rules identify existing or potential patient conditions;

using information generated by the rules engine to determine if an alert should be available to the remote command center; and

providing alerts to be concurrently available at the remote command center for all patients for whom the computerized patient care management system determines that an alert should be available at that time.

2. The system of claim 1, wherein the at least two patient data elements comprise a physiological data element of the HCL patients and a clinical data element of the HCL patients.

3. The system of claim 1, wherein the at least two patient data elements comprise a physiological data element of the HCL patients and a medication data element of the HCL patients.

4. The system of claim 1, wherein the at least two patient data elements comprise a physiological data element of the HCL patients and a laboratory data element of the HCL patients.

5. The system of claim 1, wherein the at least two patient data elements comprise a clinical data element of the HCL patients and a laboratory data element of the HCL patients.

6. The system of claim 1, wherein the at least two patient data elements comprise a physiological data elements of the HCL patients.

7. The system of claim 1, wherein the monitoring stations comprise monitoring equipment.

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

9. The system of claim 8, wherein the network comprises a wireless sub-network and wherein the nurse'"'"'s station is connected to the monitoring equipment via the wireless sub-network.

10. The system of claim 1, wherein the computerized patient care management system further comprises instructions for:

receiving information relating to the medical condition;

applying a decision support algorithm; and

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

11. The system of claim 1, wherein an HCL is a hospital.

12. The system of claim 1, wherein an HCL is a floor bed.

13. The system of claim 1, wherein an HCL is a bed in an emergency room.

14. The system of claim 1, wherein an HCL is a bed in an intensive care unit.

15. The system of claim 1, wherein an HCL is an operating room.

16. The system of claim 1, wherein an HCL is a step down unit.

17. The system of claim 1, wherein an HCL is a mobile health care facility.

18. The system of claim 17, wherein the mobile health care facility is selected from the group consisting of a ship, a helicopter, and an ambulance.

19. The system of claim 1, wherein an HCL is a nursing home.

20. The system of claim 1, wherein an HCL is a space-based health care facility.

21. The system of claim 1, wherein a an HCL is a field health care facility.

22. The system of claim 1, wherein an HCL is a residence.

23. The system of claim 1, wherein an HCL is a labor and delivery unit.

24. The system of claim 1, wherein the monitoring stations comprise transportable monitoring stations for monitoring patient data elements.

25. The system of claim 24, wherein a transportable monitoring station comprises a cart.

26. The system of claim 25, wherein the transportable monitoring station comprises a video camera, a microphone, a speaker, patient monitoring devices, a printer, a network interface, and a data entry device.

27. The system of claim 24, wherein the transportable monitoring station is wearable by an HCL patient.

28. The system of claim 27, wherein the HCL patient is a fetus carried by an expectant mother and wherein the transportable monitoring station comprises a tocodynamometer.

29. The system of claim 1, wherein a monitoring station comprises sensors that are integrated into a patient support device.

30. The system of claim 29, wherein the HCL patient support device is selected from the group consisting of a bed, a chair, a recliner, and a wheelchair.

31. The system of claim 1, wherein the network comprises a wireless sub-network and wherein the monitoring stations use the wireless sub-network for transmitting the monitored patient data elements to the remote command center.

32. The system of claim 31, wherein the monitoring stations comprise a transportable monitoring station for monitoring patient data elements.

33. The system of claim 32, wherein the transportable monitoring station is wearable by an HCL patient.

34. The system of claim 33, wherein a monitoring station comprises sensors that are integrated into a patient support device.

35. The system of claim 34, wherein the HCL patient support device is selected from the group consisting of a bed, a chair, a recliner, and a wheelchair.

36. 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.

37. The system of claim 1, wherein the alert is selected from the group consisting of admitting an HCL patient to an HCL, transferring an HCL patient from a first HCL to another HCL, and discharging an HCL patient from the HCL.

38. The system of claim 1, wherein the medical condition comprises sedation and the information generated by the rules engine comprises a determination that an HCL patient is undersedated.

39. The system of claim 1, wherein the medical condition comprises sedation and wherein the information generated by the rules engine comprises a determination that an HCL patient is oversedated.

40. The system of claim 1, wherein an HCL patient is a fetus carried by an expectant mother, wherein the medical condition comprises pregnancy, and wherein the at least two patient data elements comprise a physiological data element of the expectant mother and a physiological data element of the fetus, and wherein the information generated by the rules engine comprises information about a medical condition of the fetus.

41. The system of claim 40, wherein the physiological data element of the expectant mother is at least one measure selected from the group consisting of the expectant mother'"'"'s heart rate and an intra-amniotic fluid pressure.

42. The system of claim 40, wherein the physiological data element of the fetus is at least one measure selected from the group consisting of a fetal heart rate and a fetal pH.

43. The system of claim 1, wherein the computerized patient care management system further comprises order writing software and wherein the order writing software comprises instructions for providing knowledge-based recommendations and prescriptions for medication based upon the HCL patient data elements.

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

45. The system of claim 1, wherein the system further comprises a video system comprising instructions for obtaining bideo from the geographically separate HCLs and for communicating the video via the network, to the remote command center.

46. The system of claim 1, wherein the system further comprises an audio system comprising instructions for obtaining audio from the geographically separate HCLs and for communicating the audio via the network, to the remote command center.

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

48. The system of claim 1, wherein the rules engine applies the rules in a time-driven fashion.

49. The system of claim 1, wherein the rules engine applies the rules in an event-driven fashion.

50. The system of claim 1, wherein the monitored patient data elements are physiological data elements.

51. The system of claim 1, wherein the other patient data elements associated with the medical conditions of the HCL patients are selected from the group consisting of patient medical histories, physician notes, lab reports and medications.

52. A method for providing computerized expert care support simultaneously to geographically separate health care locations (HCLs) from a remote command center, wherein the remote command center has access to a database, the method comprising:

receiving monitored patient data elements from patients who are located in the geographically separate HCLs;

communicating the monitored patient data elements to the database via the network, wherein the database comprises stored patient data elements comprising the monitored patient data elements and other patient data elements associated with medical conditions of the HCL patients;

receiving at the remote command center alerts, wherein the alerts are provided by a computerized patient care management system, which system utilizes a rules engine to apply rules, repeatedly and automatically to at least two patient data elements, wherein the rules identify existing or potential patient conditions; and

wherein the computerized patient care management system;

uses information generated by the rules engine to determine if an alert should be available to the remote command center, and

provides alerts to be concurrently available at the remote command center for all patients for whom the computerized patient care management system determines that an alert should be available at that time.

53. The method of claim 52 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.

54. The method of claim 52 further comprising:

obtaining video from of the geographically separate HCLs; and

communicating the video to the remote command center.

55. The method of claim 52, wherein the at least two patient data elements comprise a physiological measure and a clinical data element of the HCL patient.

56. The method of claim 52, wherein the at least two patient data elements comprise a physiological data element of the HCL patients and a medication data element of the HCL patients.

57. The method of claim 52, wherein the at least two patient data elements comprise a physiological data element of the HCL patients and a laboratory data element of the HCL patients.

58. The method of claim 52, wherein the at least two patient data elements comprise a clinical data element of the HCL patients and a laboratory data element of the HCL patients.

59. The method from a remote location of claim 52, wherein the at least two patient data elements comprise two physiological data elements of the HCL patients.

60. The method of claim 52 further comprising obtaining audio from the geographically separate HCLs;

and communicating the audio to the remote command center.

61. The method of claim 52, wherein an HCL is a hospital.

62. The method of claim 52, wherein an HCL is a floor bed.

63. The method of claim 52, wherein an HCL is a bed in an emergency room.

64. The method of claim 52, wherein an HCL is a bed in an intensive care unit.

65. The method of claim 52, wherein an HCL is an operating room.

66. The method of claim 52, wherein an HCL is a step down unit.

67. The method of claim 52, wherein an HCL is a mobile health care facility.

68. The method of claim 67, wherein the mobile health care facility is selected from the group consisting of a ship, a helicopter, and an ambulance.

69. The method of claim 52, wherein an HCL is a nursing home.

70. The method of claim 52, wherein an HCL is a space-based health care facility.

71. The method of claim 52, wherein an HCL is a field health care facility.

72. The method of claim 52, wherein an HCL is a residence.

73. The method of claim 52, wherein an HCL is a labor and delivery unit.

74. The method of claim 52, wherein monitoring patient data elements is performed using a transportable monitoring station.

75. The method of claim 74, wherein the transportable monitoring station is wearable by an HCL patient.

76. The method of claim 75, wherein the HCL patient is a fetus carried by an expectant mother and wherein the transportable monitoring station comprises a tocodynamometer.

77. The method of claim 52, wherein monitoring patient data elements is performed using a monitoring station comprising sensors that are integrated into a patient support device.

78. The method of claim 77, wherein the patient support device is selected from the group consisting of a bed, a chair, a recliner, and a wheelchair.

79. The method of claim 52, wherein the alert is selected from the group consisting of admitting an HCL patient to an HCL, transferring an HCL patient from a first HCL to another HCL, and discharging an HCL patient from an HCL.

80. The method of claim 52, wherein the medical condition comprises sedation and wherein the information generated by the rules engine comprises a determination that an HCL patient is undersedated.

81. The method of claim 52, wherein the medical condition comprises sedation and wherein the information generated by the rules engine comprises a determination that an HCL patient is oversedated.

82. The method of claim 52, wherein an HCL patient is a fetus carried by an expectant mother, wherein the medical condition comprises pregnancy, and wherein the at least two patient data elements comprise a physiological data element of the expectant mother and a physiological data element of the fetus, and wherein the information generated by the rules engine comprises information about a medical condition of the fetus.

83. The method of claim 74, wherein the physiological data element of the expectant mother is at least one measure selected from the group consisting of the expectant mother'"'"'s heart rate and an intra-amniotic fluid pressure.

84. The method of claim 82, wherein the physiological data element of the fetus is at least one measure selected from the group consisting of a fetal heart rate and a fetal pH.

85. The method of claim 52, wherein the network comprises a wireless sub-network and wherein communicating over a network the monitored patient data elements to a remote command center is accomplished using the wireless sub-network.

86. The method of claim 85, wherein monitoring patient data elements is performed using a transportable monitoring station.

87. The method of claim 86, wherein the transportable monitoring station is wearable by an HCL patient.

88. The method of claim 85, wherein the transportable monitoring station comprises sensors that are integrated into a patient support device.

89. The method of claim 88, wherein the patient support device is selected from the group consisting of a bed, a chair, a recliner, and a wheelchair.

90. The method of claim 52, wherein the rules engine applies the rules in a time-driven fashion.

91. The method of claim 52, wherein the rules engine applies the rules in an event-driven fashion.

92. The method of claim 52, wherein the monitored patient data elements are physiological data elements.

93. The method of claim 52, wherein the other patient data elements associated with the medical conditions of the HCL patients are selected from the group consisting of patient medical histories, physician notes, lab reports and medications.

94. The method of claim 52, wherein the monitoring stations comprise monitoring equipment.

95. The method of claim 94 further comprising connecting a nurses'"'"' station to the monitoring equipment and to the remote command center via the network.

97. The method of claim 52 further comprising:

receiving information relating to the medical condition;

applying a decision support algorithm; and

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

98. The method of claim 74, wherein a transportable monitoring station comprises a cart.

99. The method of claim 98, wherein the transportable monitoring station comprises a video camera, a microphone, a speaker, patient monitoring devices, a printer, a network interface, and a data entry device.

96. The method of method 95, wherein the network comprises a wireless sub-network and wherein the nurses'"'"' station is connected to the monitoring equipment via the wireless sub-network.

100. A system for providing computerized expert care support simultaneously to patients in geographically separate intensive care units (ICUs) comprising:

a network;

a remote command center wherein the remote command center has access to a database;

monitoring stations located in the geographically separate ICUs, wherein the monitoring stations comprise instructions for obtaining monitored patient data elements and for communicating the monitored patient data elements to the database via the network, and wherein the database comprises stored patient data elements comprising the monitored patient data elements and other patient data elements associated with medical conditions of the ICU patients; and

wherein the remote command center has access to a computerized patient care management system, which comprises instructions for;

accessing patient data elements from the stored patient data;

utilizing a rules engine to apply rules repeatedly and automatically to at least two patient data elements according to the rules of the rules engine, wherein the rules identify existing or potential medical conditions that may warrant management by a health care provider;

using information generated by the rules engine to determine if an alert should be provided; and

displaying alerts to be concurrently displayed at the remote command center for all patients for whom the computerized patient care management system determines that an alert should be displayed at the remote command center at that time.

101. The system of claim 100, wherein the rules engine applies the rules in a time-driven fashion.

102. The system of claim 100, wherein the rules engine applies the rules in an event-driven fashion.

103. The system of claim 100, wherein the separate geographic locations are locations within a building.

104. The system of claim 100, wherein the separate geographic locations are locations within different buildings.

105. The system of claim 100, wherein the monitored patient data elements are physiological data elements.

106. The system of claim 100, wherein the other patient data elements associated with the medical conditions of the ICU patients are selected from the group consisting of patient medical histories, physician notes, lab reports and medications.

107. The system of claim 100, wherein the at least two patient data elements comprise a physiological data element of the ICU patients and a clinical data element of the ICU patients.

108. The system of claim 100, wherein the at least two patient data elements comprise a physiological data element of the ICU patients and a medication data element of the ICU patients.

109. The system of claim 100, wherein the at least two patient data elements comprise a physiological data element of the ICU patients and a laboratory data element of the ICU patients.

110. The system of claim 100, wherein the at least two patient data elements comprise a clinical data element of the ICU patients and a laboratory data element of the ICU patients.

111. The system of claim 100, wherein the at least two patient data elements comprise physiological data elements of the ICU patients.

112. The system of claim 100, wherein the monitoring stations comprise monitoring equipment.

113. The system of claim 112, wherein the system further comprises a nurses'"'"' station connected to the monitoring equipment and to the remote command center via the network.

114. The system of claim 100, wherein the computerized patient care management system further comprises a data server/data warehouse for storing and analyzing data from the remote command center.

115. The system of claim 100, wherein the system further comprises a video system comprising instructions for obtaining video of the ICU patients who are located in the geographically separate ICUs and for communicating the video via the network, wherein the video from the video system is received at the remote command center.

116. The system of claim 100, wherein the system further comprises an audio system comprising instructions for obtaining audio of the ICU patients who are located in the geographically separate ICUs and for communicating the audio via the network, wherein the audio from the audio system is received at the remote command center.

117. A method for providing, from a remote command center, computerized expert care support simultaneously to geographically separate intensive care units (ICUs), wherein the remote command center has access to a database, the method comprising:

obtaining patient data elements from monitoring stations located in the plurality of ICUs, wherein the monitoring stations obtain data elements from patients who are located in the geographically separate ICUs;

communicating the monitored patient data elements to the database via the network, wherein the database comprises stored patient data elements comprising the monitored patient data elements and other patient data elements associated with medical conditions of the ICU patients;

receiving at the remote command center alerts, wherein the alerts are provided by a computerized patient care management system, which system utilizes a rules engine to apply rules, repeatedly and automatically to at least two patient data elements according to the rules of the rules engine, wherein the rules applied by the rules engine identify existing or potential indent conditions, and

wherein the computerized patient monitoring system;

uses information generated by the rules engine to determine if an alert should be provided, and

displays alerts concurrently at the remote command center for all patients for whom the computerized patient care management system determines that an alert should be displayed at the remote command center at that time.

118. The method of claim 117, wherein the rules engine applies the rules in a time-driven fashion.

119. The method of claim 117, wherein the rules engine applies the rules in an event-driven fashion.

120. The method of claim 117, wherein the geographically separate locations are locations within a building.

121. The method of claim 117, wherein the geographically separate locations are locations within different buildings.

122. The method of claim 117, wherein the monitored patient data elements are physiological data elements.

123. The method of claim 117, wherein the other patient data elements associated with the medical conditions of the ICU patients are selected from the group consisting of patient medical histories, physician notes, lab reports and medications.

124. The method of claim 117, wherein the at least two patient data elements comprise a physiological measure and a clinical data element of the ICU patient.

125. The method of claim 117, wherein the at least two patient data elements comprise a physiological data element of the ICU patients and a medication data element of the ICUpatients.

126. The method of claim 117, wherein the at least two patient data elements comprise a physiological data element of the ICU patients and a laboratory data element of the ICU patients.

127. The method of claim 117, wherein the at least two patient data elements comprise a clinical data element of the ICU patients and a laboratory data element of the ICU patients.

128. The method of claim 117, wherein the at least two patient data elements comprise two physiological data elements of the ICU patients.

129. The method of claim 117, wherein the monitoring stations comprise monitoring equipment.

130. The method of claim 129 further comprising connecting a nurses'"'"' station to the monitoring equipment and to the remote command center via the network.

131. The method of claim 117 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.

132. The method of claim 117 further comprising:

obtaining video of the ICU patients who are located in the geographically separate ICUs; and

accessing the video at the remote command center.

133. The method of claim 117 further comprising obtaining audio of the ICU patients who are located in the geographically separate ICUs;

and

accessing the audio at the remote command center.