Abstract:
A wireless bi-directional portable patient monitor incorporated into a mobile clinical information management system is disclosed. The portable patient monitor includes a communications interface to receive patient data from a wireless local area network (WLAN) within a medical care facility and transmit care parameters as needed to the wireless network (WLAN) in response. The portable patient monitor includes a processor connected to the communications interface to process the patient data and the care parameters. A display is connected to the processor to display the processed patient data to the health care provider. The monitor includes an input device connected to the processor to allow a change in the care parameters by the health care provider. The portable patient monitor is also configured to allow wireless transport on the health care provider for extended periods. The mobile clinical information management system includes a number of bedside patient monitors to connect to the patients and transmit the patient data. The system also includes the wireless network coupled to the bedside patient monitors and the portable patient monitors to improve efficiencies in the delivery of health care in the medical care facility.

Description:
CROSS REFERENCE TO RELATED APPLICATIONS  
       [0001]     The present application is a continuation of and claims priority of U.S. Ser. No. 09/689,374 filed Oct. 12, 2000. 
     
    
     BACKGROUND OF THE INVENTION  
       [0002]     The present invention pertains to clinical information systems and more specifically, to a two-way, wireless clinical patient information monitoring system and a portable patient monitor.  
         [0003]     Clinical patient monitoring systems generally consist of individual patient monitoring terminals connected to a centralized monitoring system staffed by a nurse or clinician. The centralized character of these systems allows a small number of caregivers to monitor a large number of patients. The patient monitor terminals typically stationed in the patients&#39; rooms register activity such as heart rate, ECG, respiratory patterns, and other pertinent signs. In addition, drug infusion devices stationed by the patient deliver regulated dosages as prescribed and programmed by doctors and nurses. For bedside monitoring, these devices work adequately. However, patient mobility is hindered and becomes a hazard when transporting the bulky, inelegant bedside patient monitoring systems.  
         [0004]     Another drawback of present clinical patient monitoring systems is that, while providing increased efficiency compared to earlier methods, nurses and other caregivers are still very dependent upon the information displayed at the patient&#39;s bedside. At the central nurses&#39; station the monitoring system registers alarms and notifies health care providers when attention is required for a particular patient. However, without proceeding to the patient&#39;s room, a caregiver cannot discern the nature or seriousness of the alert. Some more recent systems have incorporated remote patient monitoring through the use of laptop computers, but that has not eliminated the necessity of accessing the bedside equipment manually to adjust alarm parameters or change drug administration. An added burden placed upon the health care provider by using laptop systems is the cumbersome nature of carrying a laptop throughout the day. For example, placing the laptops on rolling carts eliminates the physical burden of carrying the device, but simultaneously eliminates the flexible nature of the mobile system initially envisioned.  
         [0005]     Further inhibiting healthcare dispensation and endangering patient welfare is the risk of incorrect drug and dosage administration. Within existing systems, patient data such as prescription information and test results are not readily available in a real time format to on-the-scene health care providers. This problem creates the need for a solution that decreases the likelihood that a health care provider could deliver an erroneous prescription or dosage. A real time connection between prescribed data on file and the delivered quantity, in addition to test results from labs, would considerably enhance the quality and efficiency of the health care provided.  
         [0006]     There is therefore a need for a two-way clinical patient information system. Addressing additional needs such as real time patient information, pharmacological data, and lab results, a two-way system would furnish caregivers with an effectual manner to deliver health care. For instance, a two-way patient monitoring device could permit a nurse to monitor real time patient vital signs, as well as change care parameters such as alarm status, all from a remote location, therefore saving time and energy. Scanning and comparing patient bar codes with prescription bar codes would prevent drug mishandling, and access to recent lab results would reduce the time needed for care decisions. Combining two-way communications ability with a wireless patient monitoring system answers the need for comprehensive, efficient, and accurate health care administration.  
       SUMMARY OF THE INVENTION  
       [0007]     The present invention provides a system and method of offering two-way, remote, mobile clinical care to patients within a health care facility by health care providers utilizing portable patient monitoring devices of a clinical patient information management system that solves the aforementioned problems.  
         [0008]     In accordance with one aspect of the present invention, a wireless, bi-directional, portable patient monitoring device for integration with patient monitoring systems interfaces to receive, process, display, and allow for changes in patient care parameters. A communication interface of the device transmits and receives patient data from a wireless local area network (WLAN) within a medical facility. A processor connected to the communication interface processes patient data and parameters, displays the data in human discernable form on the device display, and implements changes in care parameters.  
         [0009]     In accordance with another aspect of the invention, a wireless clinical information management system decentralizes patient monitoring by networking information and health care devices through an Ethernet. These devices include life support systems such as ventilators and infusion pumps, along with pharmacy databases, laboratory reports, central patient monitors, telemetry devices, and portable patient monitoring devices. The clinical information management system further involves wireless characteristics through a plurality of wireless LAN access points coupled to a server that process patient telemetry data and PPM instructions.  
         [0010]     In accordance with yet another aspect of the present invention, a computer program is provided that resides in the memory of the portable patient monitor, causing the processor to remotely scan a WLAN to find any patient alarms, sound an alarm if the patient alarm occurs, and allow user silencing of the alarm at the portable patient monitor and/or at a bedside monitor. The program also displays patient data in real time. The computer program can further cause the processor to periodically check battery charge and display a warning if the rechargeable battery charge is low. The computer program also allows user adjustment of alarm parameter violation limits, relay patient admission and discharge information to the WLAN, and to process audio data from a health care provider to a recorded medical history of a patient.  
         [0011]     The portable patient monitor can include a personal data assistant (PDA) that optionally provides PDA functions to a health care provider. A few of the PDA functions accessible to the health care provider consist of a scheduler, reminders, to-do lists, and other PDA functions. The system can optionally include a speaker and microphone voice module, wherein the processor is programmed to process data to permit voice-over-internet protocol (IP) transfer. Also helpful, the program can permit alarm silencing of a bedside monitor, bedside admitting and discharging of patients, and adjustment of alarm parameter violation limits.  
         [0012]     Various other features, objects and advantages of the present invention will be made apparent from the following detailed description and the drawings. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]     The drawings illustrate one preferred embodiment presently contemplated for carrying out the invention.  
         [0014]     In the drawings:  
         [0015]      FIG. 1  is a schematic diagram of a prior art one-way wireless clinical information management system.  
         [0016]      FIG. 2  is a schematic diagram of a bi-directional, wireless clinical information management system according to the present invention.  
         [0017]      FIG. 3  is a block diagram of a network connecting the clinical information management system of  FIG. 2 .  
         [0018]      FIG. 4  is a block diagram of a portable patient monitoring device in accordance with present invention.  
         [0019]      FIG. 5  is a flow chart of a process and software in accordance with the present invention. 
     
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
       [0020]      FIG. 1  is a prior art clinical information management system  36  that relays telemetry signals  20 , such as patient vital signs and waveforms, from a plurality of patients  18  in patient rooms  34  to a plurality of mobile health care providers  28 , for use in a health care facility  38 . A centralized patient monitor (CPM)  32  includes a computer  10  staffed by a health care provider  29  in the vicinity of a central monitoring point such as a nurses&#39; station  33 . The CPM  32  is connected via a communications link  12  to a series of telemetry receivers  14  for each of a plurality of patient telemetry transmitters  16 . The telemetry transmitters  16  are carried by patients  18  and send a one-way, wireless signal  20  to the receivers  14  from ECG leads  15 . The receivers  14  then relay the signals  20  to the CMP  32 . The CPM  32  is also connected via a communications link  22  to a server  24  that stores and relays data. The server  24  relays signals  26  to the mobile health care providers  28  who carry a receiving device  30  to display the signal information  26 .  
         [0021]     For instance, if an irregularity initiates an alarm sequence on a bedside patient monitor (not shown), the roaming health care provider  28  can be notified regardless of his or her position in the hospital, or other such health care facilities  38 . In addition, the patient  18  gains the ability to move freely by use of a wireless link between the patient telemetry transmitter  26  and cumbersome stationary bedside monitoring systems. Although this system increases patients&#39;  18  and attendants&#39;  28  roaming capability, it retains rigid one-way communication abilities and on-site patient care requirements.  
         [0022]      FIG. 2  is a block diagram of the present invention. A clinical patient information management system  51  according to the present invention includes a centralized patient monitor CPM  41  connected by a communications link  42  to a server  44  to store and retrieve patient data from patients  62  in patient rooms  67 . The CPM  41  also is linked to a plurality of telemetry receivers  46  to relay telemetry transmitter signals  48  through the common network  42 . The CPM  41  optionally includes a computer terminal  40  operated by a health care provider  58  within a central location such as a central nurses&#39; station  43  in a health care facility  39 . However, with implementation of the present invention, as will become apparent, the health care provider  58 , positioned at nurses&#39; station  43 , can be eliminated since the mobile health care providers  58  will now have the data and control previously reserved for the nurse in the centralized patient monitor  41 . The server  44  is connected peripherally to hospital labs  52 , a pharmacy  50 , a voice router  54 , and to a number of portable patient monitoring devices (PPMs)  56  by a wireless local area network (WLAN). Simultaneously, the server  44  can access real time data from labs  52  and the pharmacy  50 , and can transmit such data to the PPMs  56 , keeping the health care providers  58  updated at remote locations. The server  44  can also convey signals from the CPM  41  to the PPMs  46 . Such signals can include current patient data, ECG waveforms, and alarm signals.  
         [0023]     The PPMs  56  are carried by the mobile health care providers  56  and are connected by bi-directional, wireless communication  64  to the server  44 . WLAN access points  45  are connected to the server  44  to relay signals  64  between the server  44  and the plurality of PPMs  56 . WLAN access points  45  include commercially available two-way modem technology transmitters/receivers and antennas that preferably operate on an industry standard protocol. PPMs  56 , positioned on mobile health care providers  58 , receive signals  64  from the WLAN access points  45  and display them in clear, comprehensive, and user-friendly form. The two-way wireless signals  64  are transmitted between the server  44  via the WLAN  45  and the health care providers  58  to enhance the caregivers&#39; mobility.  
         [0024]     Wireless patient telemetry transmitters/receivers (i.e., transceivers)  60  are carried by patients  62  and accord patients  62  with a degree of freedom and flexibility to accelerate their recovery. While vital sign signals  48  that are captured by the ECG leads  68  are normally displayed on stationary bedside monitoring equipment, with wireless telemetry transceivers  60 , patients  62  can get exercise while ECG leads  68  monitor vital signs and send the signals  48  to the PPMs  56 . This allows health care providers  58  to maneuver and obtain the clinical information without bulky monitoring systems.  
         [0025]      FIG. 3  shows a block diagram of the infrastructure for a clinical patient information monitoring system  51  connected through a network, such as an Ethernet  42 . In a preferred embodiment, the network  42  is a GE Marquette Unity™ Ethernet network available from GE Medical Systems Information Technologies, Inc. The network  42  utilizes IEEE 802.3 standard Ethernet protocols and IEEE 802.11 WLAN as an extension of the wired system to network devices such as ventilators  57 , infusion pumps  55 , bedside patient monitoring systems  53 , telemetry systems  46 , and other hospital information systems in a comprehensive, efficient manner. The network  42  allows multiple devices connected to the network to operate in synchronization with each other while distributing patient information among the various hospital information systems. The pharmacy  50 , labs  52 , WLAN access points  45 , the CPM  41 , server  44 , and portable patient monitors  56  comprise various hospital information systems.  
         [0026]     In a preferred embodiment of the invention, life-sustaining devices such as ventilation systems  57  and infusion pumps  55 , along with bedside monitors  53 , are networked through network  42  to communicate with server  44  and CPM  41 . Pharmacy  50  and labs  52  information systems provide data to health care providers  58  through the server  44 , WLAN access points  45 , patient telemetry systems  46 , and the portable patient monitors  56  over the network  42 . Optionally, a wireless patient bedside monitor  69  can operate within the clinical information management system  51 . In that case, the signals  64  are also transmitted over the WLAN access points  45  to the wireless bedside monitor  69 .  
         [0027]     Other networked systems within the facility can interface with the clinical patient information monitoring system  51  through the use of standard based networking. Critical reports and diagnostic analysis prepared in various regions of the facility are available as they are completed by direct interfaces between the clinical patient information monitoring system and the decentralized diagnostic locations. The clinical patient information management system  51  also provides a decentralized, wireless, real-time monitoring capability for infusion pumps  55 , ventilators  57 , and other potentially non-networked machines such as the bedside monitors  53 , the wireless bedside monitors  69 , etc.  
         [0028]     In a preferred embodiment, the wireless patient telemetry transceivers  60  transmit data  48  to the telemetry receivers  46  that then relays the information to appropriate appendages of the network  42 . Such appendages include the PPM remote terminals  56 . Any required modification in patient care parameters by a health care provider  58  can be relayed back to the patient through the network  42  to control patient care by using the PPMs  56 . In response to patient status, a two-way wireless connection  64  between the server  44  and the PPMs  56  allow the health care provider  58  to adjust patient care parameters and/or to modify alarms. The health care provider  58  has the advantage in this system of the ability to send and receive information across the two-way wireless connection  64 . For example, the health care provider  58  is able to compare dosage instructions on prescription medicine from the pharmacy  50 , adjust alarm parameters, communicate through a voice module  72 , and monitor real-time patient information such as ECG waveforms. The two-way wireless remote nature of the system  51  provides the health care provider  58  with a way to achieve more accurate and efficient care.  
         [0029]      FIG. 4  is a block diagram of a PPM remote terminal  56  according to the present invention. The PPM  56 , in general, has a size and shape that allows health care providers to carry it for extended periods of time. At the hardware level of a preferred embodiment, the PPM is based on a Personal Data Assistant (PDA) platform. The PDA provides a direct interface to the user with the various functions of the clinical information management system, in addition to personal efficiency functions such as a calendar, to-do lists, reminders, e-mail, and other such functions. The PPM is also designed to record voice reports to enable immediate recordation of patient events. Preferably, the invention could support dictation functions to record patient medical events. In one embodiment of the invention, the PDA can be adapted from a commercially available device, such as Symbol Technologies SPT 1700. The device can be based on the Palm Computing® platform, the Windows CE® platforms, or any other comparable or similar platform. Windows CE® is a registered trademark of Microsoft Corp.  
         [0030]     In the preferred embodiment, the PPM  56  includes a microcontroller  70  connected to a speaker/microphone voice module  72  to receive and transmit voice data. A memory unit  74  is preferably a combination of ROM and RAM, wherein the ROM is used for static data, such as computer programs, and the RAM is used for dynamic data, such as the ECG signals received from the patient  62 . A bar code scanner  76  is provided to read bar codes, such as those used to identify patients and those used on reports and pharmaceutical products. An A/D converter  78  converts analog to digital data for processing by the microcontroller  70 , and conversely converts the digital data from the microcontroller to analog form which is then supplied to encoder  90  to code and decode the analog data for transmission through the communications interface  92  and an antenna  94 . An input select key  80  is provided to select which particular menu is to be displayed on display  88 . A control device input  86  is used to navigate through each of the menus that are displayed. Page input  82  is provided to acknowledge a page to a particular health care provider. An RF communications card  84  is connected to the microcontroller  70  which can include an industry standard PCMCIA card for RF communication. These components, in the aggregate, achieve functions that enable the health care provider to administer efficient and accurate care.  
         [0031]     More specifically, the microcontroller  70  is programmed to receive and process patient data, display the data, and receive and transmit care parameters via the ancillary devices connected to the microcontroller  70 . The microcontroller  70  is programmed to receive and transmit patient data in conjunction with the PPM communication interface  92 . Some of the data contained includes bar code data that the microcontroller  70  is programmed to receive from the bar code scanner  76 . The microcontroller  70  is also programmed to receive and transmit audio data from a speaker/microphone module  72 , and to display information through the display  88  of the PPM  56 . The health care provider  58 , by utilizing attributes of the PPM  56 , can input selections that the microcontroller  70  is programmed to receive.  
         [0032]     The multiple functions of the PPM  56  include devices that interface with the microcontroller  70 , and utilize capabilities of the clinical patient information system  51 . Audio data received and transmitted by the microcontroller  70  from the audio module  72  is possible through “voice over IP” protocols that support transmitting compressed voice data over an Ethernet. The Ethernet network  42 , in conjunction with the PPM  56 , supports telephony and paging functions anywhere within the coverage area. No additional RF infrastructure is required to attain telephony or paging services. This solution eliminates the need for a health care provider  58  to carry multiple devices throughout the day such as mobile phones and/or pagers. Additionally, the use of a single RF protocol reduces the likelihood of interference from other wireless systems.  
         [0033]     Automated data entry and retrieval via an integrated bar-code scanner  76  further involves multiple aspects of the clinical information management system  51 . Information encoded on patient wristbands and pharmaceutical barcodes is acquired by the bar code scanner  76  and processed by the microcontroller  70 . The microcontroller  70  compares the corresponding data from a centralized database maintained by the pharmacy  50 , and standing doctors&#39; orders contained in the patient record, for prescription and dosage accuracy.  
         [0034]     In a typical preferred embodiment of this invention the microcontroller  70  is programmed to interact with components of the PPM  56  to allow the health care provider  58  to communicate on a two-way basis with other segments of the clinical information management system  51 . The preferred implementation sequence of the present invention is expressed by the flow chart of  FIG. 5 .  
         [0035]     At the start  100  of the software sequence of the PPM  56  the battery charge is checked at  102 . In accordance with the invention, a setup procedure request is initiated  104  if the battery charge is sufficient for operation. If desired at this point, the health care provider can access alarm-warning parameters and define warnings  106 , advisories  108 , and messages  110 . If not desired  112 , the routine commences scanning the network  114 .  
         [0036]     Initially, the scanning purpose is to check the validity of the network connection  116 . The next scan is of the patients on the system  118 . The health care provider is primarily concerned with current alarm flags that would require instant attention. If there are alarms  120 ,  122 , the PPM will sound an audio alarm  124  through the audio module, and patient information is displayed  126 . If there are no alarms  120 ,  128 , then the health care provider enters a subroutine to monitor specific patients  130 . After entering a patient ID  132 , the subroutine joins with the main routine to display pertinent information, such as patient ID, ECG data, vital signs, and alarm type at  126 . The health care provider can then decide to change any of the patient parameters  134 , including turning alarms off.  
         [0037]     During specific patient monitoring, the health care provider can scan barcode IDs that are then compared by the microcontroller with information gleaned from hospital lab and pharmacy data. This data is compared in real time with the earliest data available. In the background, the microcontroller is programmed to periodically check the battery charge  136 . There are several stages of alert for the battery charge, ranging from 30-minute charge warnings, to urgent five-minute warnings. The health care provider can power down the PPM  138 ,  140  at the end of a shift which then automatically triggers a save function for all the data  142 , and the sequence ends at  144 . If the battery charge is sufficient for continued use and the health care provider desires continued use  138 ,  146 , patient scanning and monitoring continues until the device is powered down  138 ,  140 .  
         [0038]     As previously discussed, the portable patient monitor (PPM) is preferably packaged within a housing that is transportable on a health care provider for extended periods. Preferably, the PPM has an approximate length of 7″ (17.8 cm), a width of approximately 3.75″ (7.5 cm) and a thickness of approximately 1.0″ (2.54 cm).  
         [0039]     The present invention has been described in terms of the preferred embodiment, and it is recognized that equivalents, alternatives, and modifications, aside from those expressly stated, are possible and within the scope of the appending claims.