Abstract:
A system and a method by which a clinician may monitor and communicate with a plurality of remotely located patients. This monitoring may be facilitated using a variety of communication protocols. Modular treatments and institutionally created standards are combined with clinician-provided input and decisions to provide the patient an individualized treatment regimen.

Description:
FIELD OF THE INVENTION  
       [0001]     The present invention pertains to the field of biotelemetry and remote patient care.  
       BACKGROUND OF THE INVENTION  
       [0002]     The rising cost of health care is of concern to patients and hospital administrators alike. One way to reduce the cost of medical treatment is to reduce the number of days spent in the hospital as there are large fundamental costs associated with each night spent in a hospital bed. As a result, there has been a continued push towards home centered and/or remote off-site patient treatment and/or convalescence. This presents significant challenges for health care providers due to the lack of personal interaction and the lack of a suitably dedicated IT infrastructure. A particular difficulty with home centered or remote off-site treatment is the lack of a patient-care provider interaction which results in the inability of the health care provider to observe the subtle indicators that are relevant to evaluate the current treatment protocol or any adverse reactions to current treatment. Another challenge of remote care is providing 24/7 care to patients that may live alone. Furthermore, remote off-site care presents new challenges in overcoming the distance between the patient and the health care provider upon the detection of an adverse reaction or event.  
         [0003]     The field of remote patient monitoring, or biotelemetry, has developed modern technologies and techniques for the remote physiological monitoring of patients. The current modern communication infrastructure including, but not limited to, WIFI, cellular, TCP/IP, and VOIP platforms is suitable to support health care provider-patient communications. These platforms may be used individually or in combination to provide a medical treatment network supporting voice and data transmission. Therefore, it is desirable in the field of biotelemetry to provide a system that is capable of integrating these technologies to build a cohesive care delivery system that facilitates the provision of remote patient care. It is also desirable in the field of biotelemetry to have a system of care that prioritizes patient needs to facilitate the efficient provision of care to remote patients. SUMMARY OF THE INVENTION  
         [0004]     Remote patient care could be better supported through the use of modern communications infrastructure and monitoring devices that are combined with new forms of traditional diagnostic instrumentation and control. The provision of remote care is facilitated by integrating these technologies to build a cohesive care delivery system that better enables the monitoring of patient vital parameters, medication, and treatment while supporting full bidirectional communication.  
         [0005]     A patient monitoring device kept on the patient facilitates the patient monitoring and communication back to a centralized computer network. This network provides for the transmission of treatment and medication information which can better advance treatment delivery and compliance through treatment schedule reminders and access to treatment information. This works in conjunction with the monitoring of vital parameters to increase the ability to monitor and/or detect adverse reactions to medication.  
         [0006]     The communications network allows for the bidirectional transmission of voice and data information between the remote patient and the centralized network. The increased communication capability helps the health care provider to bridge the distance between the health care provider and the remote patient by providing the health care provider with a new means to confer with the patient and to confer the subtle observations that promote patient monitoring.  
         [0007]     A complex array of institutional and health care provider created rules within a patient treatment file is used to regulate the monitoring of patient vital parameters for signals that are outside of specified limits. The treatment of remote patients is facilitated by escalation levels that are associated with exceeding rule limits in addition to the use of more traditional and simplistic rate level or quantity triggers. In an embodiment of the present invention, multiple levels of escalation allow for a more controlled proactive response in kind to the level of escalation leading to a variety of anticipated conditions. The gradation of patient escalation facilitates the ability to queue, route, and triage patients for the efficient provision of treatment to patients at remote locations.  
         [0008]     Various other features, objects and advantages of the invention will be made apparent from the following description taken together with the drawings. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0009]     The drawings illustrate the best mode presently contemplated of carrying out the invention.  
         [0010]     In the drawings:  
         [0011]      FIG. 1  is a schematic diagram of an embodiment of the remote patient care system of the present invention;  
         [0012]      FIG. 2  is a flowchart of the provision of a patient prescription for use in the present invention;  
         [0013]      FIG. 3  is a schematic diagram of the escalation of patient condition and prioritization of patient treatment of the present invention. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0014]     As shown in  FIG. 1 , a remote care network  10  provides data and voice communication between a centralized computer network  12  and a variety of remote patients  14 . The remote patients may consist of a patient at a remote location within the hospital  14   a , a remote patient in their home  14   b , or a remote patient outside their home  14   c . Each patient is equipped with a monitoring device  16  that is kept on the person and specifically programmed for each patient  14   a - 14   c , respectively. The monitoring device  16  communicates to a local network  20  which may be a hospital network  20   a , a home network  20   b , or an area network  20   c  outside the home or hospital. These networks  20  may comprise a variety of network means and/or protocols including but not limited to WIFI, cellular, TCP/IP, and VOIP. In an embodiment of the present invention, the patient monitoring device  16  connects to the local network  20  via the optimal available connection means. Once the monitoring device  16  has connected to the remote care network  10 , bidirectional voice and data transmission is possible with any of a variety of on-line health care providers  24  and/or information databases  26  which may be available at a hospital  30  or another medical center  32  that is a part of the network  10 .  
         [0015]     The bidirectional voice and data transmission of the remote care network  10  helps the system of the present invention to overcome limitations associated with the provision of care to remotely monitored patients. The ability of the patient and/or the clinician to initiate contact with the other allows for the remotely monitored patient to maintain a sense of being cared for that the patient would experience if admitted in a hospital. This makes the patient more comfortable in the remote setting for treatment and/or convalescence and aids in patient treatment compliance. Additionally, the bidirectional communication of the remote care network of the present invention enables the clinician to contact the patient to obtain so-called “soft” information such as patient responsiveness, reasoning ability, and mood that aids a clinician in evaluating the progression of a treatment. The clinician may also use the communication abilities of the remote care network as a confirmation of a detected manual or automatic escalation alert, or may provide a first stage of response by the clinician to the notification of an escalation alert.  
         [0016]     The patient monitoring device  16  remains operational despite the lack of a sufficient local network  20 . In the absence of a proper communications signal, the monitoring device  16  buffers and stores its measured data. The monitoring device  16  then transmits all of the stored information to the centralized computer network  12  when a suitable local network  20  is available. This allows the patient to leave a local network  20  without fear of losing medical data or monitoring device  16  functionality. Additionally, monitoring device  16  may include circuitry (not shown) for the evaluation and optimization of the local network  20  platform. For example, a patient may already have a WIFI connection in his home, or may be in a location where free WIFI connectivity is provided. In these instances, while a cellular connection would also probably be available, it would come at a much greater connectivity cost. Therefore, the circuitry would select to use the WIFI connection. Alternatively, the patient may be in a location where only expensive cellular connectivity is available, therefore the circuitry would choose to store and buffer the medical data, only connecting cellularly at standardized intervals to transmit recorded patient data, or connect upon the action of the patient or the clinician to connect.  
         [0017]     Referring now to  FIG. 2 , a patient that has been designated for remote care is first brought into the remote care network by creating a patient treatment file that combines a base physician approved model treatment plan  40  that has been adopted by the institution with an individualized care prescription  42  as written by a physician to create a patient medication prescription  44 . This prescription  44  is screened with the patient drug advisory library  46  to check for any potential complication from the proposed treatment. Patient home care instructions  48 , which may include additional information regarding medication and/or treatment, are added to create a patient treatment file  50  which is downloaded to the patient monitoring device  16 . The patient treatment file  50  downloaded to the monitoring device  16  in an embodiment of the present invention, provides the patient with information about the medication and treatment, a medication treatment schedule, and medication dosage reminders.  
         [0018]     The patient medication prescription  44  and the patient home care instructions  48  within the patient&#39;s treatment file  50  include useful treatment information for the patient which is aimed at patient treatment compliance. Embodiments of the present invention may include alarms that are scheduled based on the prescription that reminds the patient of when, what, and how to take the medication. These alarms may be stored as information files that are replayed as audio files and/or may be displayed as a textual display on the monitoring device  16 . An embodiment of the present invention may also include a means for detecting, identifying, and confirming the medications that have been prescribed to the patient. This may be facilitated by, but is not limited to, an identification means such as a bar code label that is placed on the medication bottle and a bar code scanner integrated with the monitoring device. As a further aspect of an embodiment of the present invention, a notification of a medication event may be sent back to the centralized computer network for recording in a database, or so that the clinician may use the communications features of the remote care network to confirm that the patient has complied with the medication alert.  
         [0019]     On the health care provider side of the remote care network, after the prescription  44  has been screened with the patient drug advisory library  46 , the prescription is combined with care provider instructions  52 , provider adverse reaction indicators  54 , and provider adverse reaction instructions  56  to create a patient care file  58 . The care provider instructions  52  may include additional directions and/or reminders of tests to be performed by the health care provider. The provider adverse reaction indicators  54  comprise a series of escalation rules comprising a combination of boolean statements, value range limits, and/or patient parameter level triggers. The provider adverse reaction instructions  56  correspond with the adverse reaction indicators identified in  54  to provide instructions to the health care provider for the action to be taken in the event of a triggering of an adverse reaction indicator.  
         [0020]     The patient care file  58  is saved in a patient care on-line library  64  within the remote care network  10  and is used to facilitate the analysis of incoming patient physiological data transmitted from the patient monitoring device  16 .  
         [0021]      FIG. 3  depicts a schematic diagram of the operation of the system of the present invention. The system includes the transmission of physiological signals, the interpretation of patient escalation, and the prioritization of patient treatment. A patient  14  is being monitored by a monitoring device  16 . This monitoring device  16  is collecting and transmitting parametric data  92  and other treatment events  94  to a centralized computer network  12 . These parametric data  92  may be collected by modular biomedical instruments (not shown) that are added to the monitoring device  16  to tailor the monitoring to the individual patient. These parametric data  92  may also be collected by stand-alone biomedical instruments that are independently connected to a patient (not shown), but communicate with the monitoring device  16  and transmit measured data to monitoring device  16 .  
         [0022]     These modular components may comprise, but are not limited to, temperature, ECG, pulse oximetry, respiration rate, blood pressure, and blood glucose monitoring devices. The addition of a GPS system to monitoring device  16  would allow the clinician to track a patient&#39;s position and would also facilitate locating the patient if emergency medical treatment is needed. Treatment events  94  may include patient activities, times at which medications were taken, or patient communications.  
         [0023]     The centralized computer network  12  records the received data in a data storage  60 . The data storage  60  provides a useful log for the full disclosure recordation of patient treatment. The event log combined with the physiological data can provide a useful tool for data analysis and patient trend tracking. The data is also transmitted to a complex rules engine  62  where the parametric data and recorded events are compared to the patient escalation rules and triggers in the patient care file  58  from the patient care on-line library  64 . If the patient&#39;s parametric data and/or treatment events are outside of any escalation rule limits or escalation trigger levels, an escalation alert  66  is created. This alert may then be sent through a confirmation process  68  to determine the validity of the escalation alarm. Upon confirmation, the escalation alerts  66  of all monitored patients are combined with any alerts that have been manually activated by any patients  14  using a designated alert key (not shown) on the monitoring device  16 .  
         [0024]     The combined alerts are analyzed using a database of institutional prioritization rules  74  to separate the alerts into high priority alerts and low priority alerts. The high priority alerts  96  will then be transmitted to an on-line health care provider  76  with the patient care file so that the on-line clinician  78  may take the appropriate actions. The low priority alerts  98  are sent to on-line health care providers  80  where the low priority alerts are triaged and queued based upon the institutional prioritization rules  74 . These alerts are then reviewed and responded to by an on-line clinician  82  in the order that they are queued.  
         [0025]     The prioritization and queuing feature of an embodiment of the present invention adds to the efficiency of the remote patient care system. As the remote patient care system may be providing care to patients that are physically removed from a health care facility by up to a substantial distance. Therefore, this distance must be taken into account when evaluating the order in which additional on-site patient care is provided. The prioritization and queuing feature enables the remote patient care system to automatically prioritize and queue the received incoming patient escalation alerts based upon the severity of the escalation and the need for additional care by a clinician. Under this system, a patient with a severe escalation alert will receive treatment and a clinician&#39;s attention before a lower priority or severity alert is addressed. This optimizes the clinician&#39;s ability to treat the patient, especially when large and time consuming distances must be traversed to provide the additional care to a remote patient.  
         [0026]     This written description uses examples to disclose the invention, including the best mode, and also to enable any person skilled in the art to make and use the invention. The patentable scope of the invention is defined by the claims, and may include other examples that occur to those skilled in the art. Such other examples are intended to be within the scope of the claims if they have structural elements that do not differ from the literal language of the claims, or if they include equivalent structural elements with insubstantial differences from the literal languages of the claims.  
         [0027]     Various alternatives and embodiments are contemplated as being within the scope of the following claims particularly pointing out and distinctly claiming the subject matter regarded as the invention.