Rules-based system for maternal-fetal care

• US 8,401,874 B2
• Filed: 03/04/2009
• Issued: 03/19/2013
• Est. Priority Date: 06/23/1999
• Status: Expired due to Term

• Current Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Original Assignee: Koninklijke Philips Electronics N.V. (Koninklijke Philips N.V.)
• Inventors: Rosenfeld, Brian A.
• Primary Examiner(s): Phongsvirajati, Sind
• Application Number:
  US12/397,536
• Publication Number:
  US 20090216564A1
• Time in Patent Office: 1,476 Days
• Field of Search: 705 2- 3, 600/300
• US Class Current: 705/3
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 5/7275 Determining trends in physiological measurement data; Predicting development of a medical condition based on physiological measurements, e.g. determining a risk factor
• CPC Class Codes: G08B 21/0476 Cameras to detect unsafe condition, e.g. video cameras
• 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 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/20 relating to practices or guidelines
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A rules-base patient care method for managing the care of a plurality of pregnant patients from a remote command center for use in healthcare locations using patient-specific rules for each of the plurality of pregnant patients. A patient rules generator creates rules for the patients. Performance measures indicative of the ability of a rule to predict changes in the condition of the patient are acquired by the rules generator. A determination is made from the rules performance measures whether to revise the rule. A rules engine applies a rule to selected data elements stored in the database to produce an output indicative of a change in the medical condition of a pregnant patient and/or a fetal patient. The output from the rules engine is used to determine when intervention is warranted.

Claims

1. A rules-based system for maternal-fetal care of pregnant patients comprising:

a network;

a plurality of pregnant patient monitoring stations configured to monitor patient data elements from the pregnant patients, wherein the monitored patient data elements comprise data elements indicative of medical conditions of the pregnant patients and fetuses carried by the pregnant patients (hereinafter, “

fetal patients”

);

wherein each pregnant patient monitoring station comprises a communications interface that transmits tile monitored patient data elements to a remote command center via the network; and

a remote command center connected to the network, wherein the remote command center comprises a rules engine, wherein the rules engine comprises rules tailored to the medical condition of a patent, and wherein the rules engine comprises instructions which when executed by the remote command center cause the remote command center to;

receive the pregnant patient data elements;

acquire other patient data elements, wherein the other patient data elements are indicative of the medical conditions of the pregnant patients and their fetal patients, and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

pregnant patient data elements”

;

utilize the rules engine to apply rules tailored to the medical condition of a patient to at least two pregnant patient data elements;

determine when the conditions of any one of the rules tailored to the medical condition of the pregnant patients have been satisfied; and

when the conditions of the any one of the rules tailored to the medical condition of the pregnant patients have been satisfied, take an action in accordance with the rule with respect to a particular one of the pregnant patients to whom the rule applies, and wherein the monitoring and determining when the conditions of the any one of the rules tailored to the medical condition of the pregnant patient has been satisfied occurs in an automated fashion at the remote command center according to the rules of the rules engine whenever the rules engine is in operation.

2. The system of claim 1, wherein when the satisfaction of the conditions of the rule tailored to the medical condition of the pregnant patient indicates that intervention in the treatment of the pregnant patient is warranted, then the action comprises issuing a mother alert.

3. The system of claim 1, wherein when the satisfaction of the conditions of the rule tailored to the medical condition of the pregnant patient indicates that intervention in the treatment of the fetal patient is warranted, then the action comprises issuing a fetal alert.

4. The system of claim 1, wherein a rule tailored to the medical condition of the pregnant patient comprises conditions to establish the medical condition of the pregnant patient.

5. The system of claim 1, wherein a rule tailored to the medical condition of the pregnant patient comprises conditions to establish the medical condition of the fetal patient.

6. The system of claim 1, wherein a rule tailored to the medical condition of the pregnant patient comprises an algorithm.

7. The system of claim 1, wherein the at least two pregnant patient data elements are selected from the group consisting of a physiological data element of the pregnant patient, a clinical data element of the pregnant patient, a medication data element of the pregnant patient, a laboratory data element of the pregnant patient, a physiological data element of the fetal patient, a clinical data element of the fetal patient, a medication data element of the fetal patient, and a laboratory data element of the fetal patient.

8. The system of claim 1, wherein the satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the pregnant patient that does not pose a risk to the fetal patient.

9. The system of claim 1, wherein the satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the pregnant patient and to the fetal patient.

10. The system of claim 1, wherein satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the fetal patient that does not pose a risk to the pregnant patient.

11. The system of claim 1 wherein the pregnant patient monitoring stations comprise:

pregnant patient monitoring equipment, wherein the pregnant patient monitoring equipment comprises instructions which when executed by the pregnant patient monitoring equipment cause the pregnant patient monitoring equipment to monitor pregnant patient data elements from the pregnant patient and to send the monitored pregnant patient data elements to the remote command center via the network; and

fetal patient monitoring equipment, wherein the fetal patient monitoring equipment comprises instructions which when executed by the fetal patient monitoring equipment cause the fetal patient monitoring equipment to monitor fetal patient data elements from the fetal patient and to send the monitored fetal patient data elements to the remote command center via the network.

12. The system of claim 1 further comprising a wireless subnetwork connected to the network and wherein the pregnant patient monitoring stations comprise;

pregnant patient monitoring equipment, wherein the pregnant patient monitoring equipment comprises instructions which when executed by the pregnant patient monitoring equipment cause the pregnant patient monitoring equipment to monitor pregnant patient data elements from the pregnant patient;

fetal patient monitoring equipment, wherein the fetal patient monitoring equipment comprises instructions which when executed by the fetal patient monitoring equipment cause the fetal patient monitoring equipment to monitor fetal patient data elements from the fetal patient;

a wireless interface connected to the wireless subnetwork, wherein the wireless interface comprises instructions which when executed by the wireless interface cause the wireless interface to;

receive the monitored pregnant patient data elements and the monitored fetal patient data elements; and

send the monitored pregnant patient data elements and the monitored fetal patient to the remote command center via the wireless subnetwork.

13. The system of claim 1 further comprising a patient rules generator, wherein the patient rules generator comprises instructions which when executed by the patient rules generator cause the patient rules generator to:

create the rule tailored to the medical condition of the pregnant patient;

acquire rules performance measures indicative of the ability of the rule tailored to the medical condition of the pregnant patient to predict the change in the condition of the pregnant patient and the fetal patient; and

determine from the rules performance measures whether to revise the rule.

14. The system of claim 13, wherein the patient rules generator further comprises instructions which when executed by the patient rules generator cause the patient rules generator to:

access historical data, wherein the historical data comprises other patient data elements for a plurality of other patients and wherein the patient data elements of another patient are associated with an outcome of the other patient;

apply multivariate analyses to the historical data to produce a result that relates the other patient data elements, the rule tailored to the medical condition of the pregnant patient, and the other patient outcomes; and

generate a rules performance measure by comparing the result to the rule.

15. The system of claim 13, wherein the rules performance measures are derived from information provided by health care providers.

16. The system of claim 14, wherein patient rules generator further comprises instructions which when executed by the patient rules generator cause the patient rules generator to generate a new rule tailored to the medical condition of the pregnant patient from the result.

17. The system of claim 13, wherein the patient rules generator further comprises instructions which when executed by the patient rules generator cause the patient rules generator to test the new rule against the historical data.

18. The system of claim 1, wherein the system further comprises a site assessment module, wherein the site assessment module comprises instructions which when executed by the site assessment module cause the site assessment module to:

receive site assessment data, wherein the site assessment data are indicative of the capability of a healthcare facility to provide diagnostic and treatment services to perinatological patients; and

determine from the site assessment data service level measures indicative of a capability of the healthcare facility to provide diagnostic and treatment services to perinatological patients; and

wherein the rules generator further comprises instructions which when executed by the patient rules generator cause the patient rules generator to;

receive service level measures; and

create the rule tailored to the medical condition of the pregnant patient so as to be consistent with the service level measures of the healthcare facility.

19. The system of claim 18, wherein the site assessment module further comprises instructions which when executed by the site assessment module cause the site assessment module to:

prompt a user for the site assessment data; and

determine the service level measures based on the user response.

20. The system of claim 18, wherein the healthcare facility is associated with a site assessment code and the site assessment module further comprises instructions which when executed by the site assessment module cause the site assessment module to:

acquire the site assessment code associated with the healthcare facility; and

determine the service level measures at least in part based on the site assessment code.

21. The system of claim 18, wherein the service level measures comprise:

an inventory of available monitoring data elements;

an inventory of available diagnostic services;

an inventory of available surgical treatment services;

an inventory of available perinatological treatment services; and

an inventory of available laboratory services.

22. The system of claim 1, wherein the network is selected from the group consisting of a wired network, a wireless network, a satellite network, a public switched telephone network, an IP network, a packet switched network, a cell phone network, a cable network, and a coax network, a hybrid fiber coax network.

23. A method for managing the care of pregnant patients from a remote command center comprising:

communicating over a network monitored patient data elements of the pregnant patients to the remote command center, wherein the remote command center comprises rules tailored to the medical condition of the pregnant patients;

at least one computer processor coupled to a datastore acquiring other patient data elements, wherein the other patient data elements are indicative of the medical conditions of the pregnant patients and their fetal patients, and wherein the monitored patient data elements and the other patient data elements are collectively referred to as “

pregnant patient data elements”

; and

the at least one computer processor using a rules engine to apply rules tailored to the medical condition of the pregnant patients rules to at least two pregnant patient data elements;

the at least one computer processor determining when the conditions of any one of the rules tailored to the medical condition of the pregnant patients have been satisfied; and

when the conditions of the any one of the rules tailored to the medical condition of the pregnant patients have been satisfied, taking an action in accordance with the rule with respect to a particular one of the pregnant patients to whom the rule applies, and

wherein the monitoring and determining when the conditions of the any one rule has been satisfied occurs in an automated fashion at the remote command center repeatedly and automatically according to the rules of the rules engine whenever the rules engine is in operation.

24. The method of claim 23, wherein when the satisfaction of the conditions of the rule tailored to the medical condition of the pregnant patient indicates that intervention in the treatment of the pregnant patient is warranted, then taking an action in accordance with the rule comprises issuing a mother alert.

25. The method of claim 23, wherein when the satisfaction of the conditions of the rule tailored to the medical condition of the pregnant patient indicates that intervention in the treatment of the fetal patient is warranted, then taking an action in accordance with the rule comprises issuing a fetal alert.

26. The method of claim 23, wherein a rule tailored to the medical condition of the pregnant patient comprises conditions to establish the medical condition of the pregnant patient.

27. The method of claim 23, wherein a rule tailored to the medical condition of the pregnant patient comprises conditions to establish the medical condition of the fetal patient.

28. The method of claim 23, wherein a rule tailored to the medical condition of the pregnant patient comprises an algorithm.

29. The method of claim 23, wherein at least two pregnant patient data elements are selected from the group consisting of a physiological data element of the pregnant patient, a clinical data element of the pregnant patient, a medication data element of the pregnant patient, and a laboratory data element of the pregnant patient, a physiological data element of the fetal patient, a clinical data element of the fetal patient, a medication data element of the fetal patient, and a laboratory data element of the fetal patient.

30. The method of claim 23, wherein satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the pregnant patient that does not pose a risk to the fetal patient.

31. The method of claim 23, wherein satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the pregnant patient and to the fetal patient.

32. The method of claim 23, wherein satisfaction of the any one of the rules tailored to the medical condition of the pregnant patient is indicative of a risk to the fetal patient that does not pose a risk to the pregnant patient.

33. The method of claim 23, communicating over a network monitored patient data elements of the pregnant patients to the remote command center comprises:

receiving pregnant patient data elements from pregnant patient monitoring equipment associated with the pregnant patient;

sending the monitored pregnant patient data elements to the remote command center via the network;

receiving fetal patient data elements from fetal patient monitoring equipment associated with the fetal patient; and

sending the monitored fetal patient data elements to the remote command center via the network.

34. The method of claim 23, wherein communicating over a network monitored patient data elements of the pregnant patients to the remote command center comprises:

sending pregnant patient data elements from pregnant patient monitoring equipment associated with the pregnant patient to a wireless interface;

sending fetal patient data elements from fetal patient monitoring equipment associated with the fetal patient to the wireless interface; and

sending the monitored pregnant patient data elements and the monitored fetal patient from the wireless interface to the network via a wireless subnetwork.

35. The method of claim 23, further comprising:

creating the rule tailored to the medical condition of the pregnant patient;

acquiring rules performance measures indicative of the ability of the rule to predict the change in the condition of the pregnant patient and the fetal patient; and

determining from the rules performance measures whether to revise the rule.

36. The method of claim 35 further comprising:

accessing historical data, wherein the historical data comprises other patient data elements for a plurality of other patients and wherein the patient data elements of another patient are associated with an outcome of the other patient;

applying multivariate analyses to the historical data to produce a result that relates the other patient data elements, the rule tailored to the medical condition of the pregnant patient, and the other patient outcomes; and

generating a rules performance measure by comparing the result to the rule tailored to the medical condition of the pregnant patient.

37. The method of claim 35, wherein the rules performance measures are derived from information provided by health care providers.

38. The method of claim 36, further comprising generating a new rule tailored to the medical condition, of the pregnant patient from the result.

39. The method of claim 35, further comprising testing the new rule against the historical data.

40. The method of claim 23, further comprising:

receiving site assessment data, wherein the site assessment data are indicative of the capability of a healthcare facility to provide diagnostic and treatment services to perinatological patients;

determining from the site assessment data service level measures indicative of a capability of the healthcare facility to provide diagnostic and treatment services to perinatological patients; and

creating the rule tailored to the medical condition of the pregnant patient so as to be consistent with the service level measures of the healthcare facility.

41. The method of claim 40, further comprising:

prompting a user for the site assessment data; and

determining the service level measures based on the user response.

42. The method of claim 40, wherein the healthcare facility is associated with a site assessment code and the method further comprises:

acquiring the site assessment code associated with the healthcare facility; and

determining the service level measures at least in part based on the site assessment code.

43. The method of claim 40, wherein the service level measures comprise:

an inventory of available monitoring data elements;

an inventory of available diagnostic services;

an inventory of available surgical treatment services;

an inventory of available perinatological treatment services; and

an inventory of available laboratory services.

44. The method of claim 23, wherein the network is selected from the group consisting of a wired network, a wireless network, a satellite network, a public switched telephone network, an IP network, a packet switched network, a cell phone network, a cable network, and a coax network, a hybrid fiber coax network.