Abstract:
Self-contained examination guide and information storage apparatus comprising a flat rectangular enclosure having a front panel with first display arrays along side edges of the front panel associated with a plurality of general patient examination categories, and an LCD centrally positioned on the front panel and configured to comprise a plurality of individually controllable display segments. A microprocessor-based controller includes a light pen for reading bar codes on the enclosure front panel and thereby selecting among the general examination categories. A microcontroller memory has prestored sets of specific examination indicia associated with each of the general examination categories, and is responsive to the category-selection process for retrieving from memory a specific set of examination indicia associated with selected general examination category. The light pen is then employed to scan bar code arrays adjacent to the specific examination indicia at each LCD segment for identifying specific indicia of interest and loading corresponding indicia information into microcontroller memory. Information so stored may be selectively downloaded to a central computer for processing and generation of records for the patient files.

Description:
The present invention is directed to apparatus assisting or guiding examination or inspection in accordance with predetermined examination categories, and more particularly to self-contained apparatus for guiding a physician during patient examination and recording information as observed and entered ,by the physician. 
     BACKGROUND AND OBJECTS OF THE INVENTION 
     It is a general object of the present invention to provide self-contained apparatus for guiding examination in accordance with predetermined examination categories which is battery-operated for enhanced mobility, which is easy to use, which may be readily reprogrammed to alter or modify examination information, and/or which produces a permanent record of examination results. 
     Another and more specific object of the invention is to provide apparatus of the described character which is particularly adapted to assist a physician in conducting a patient examination, which enhances efficiency and economy of the examination process, and which produces a clear and legible permanent record for the patient file. 
     A further object of the invention is to provide apparatus of the described character which may be employed in a centralized information storage and retrieval system to download examination information from one or more remote stations distributed around a medical office or hospital complex. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The invention, together with additional objects, features and advantages thereof, will be best understood from the following description, the appended claims and the accompanying drawings in which: 
     FIG. 1 is a functional block diagram of a physician office complex in which a centralized patient information storage and retrieval system is implemented in accordance with the principles of the present invention; 
     FIG. 2 is a perspective view of apparatus in accordance with a presently preferred embodiment of the invention; 
     FIG. 3 is a functional block diagram of apparatus electronics in accordance with the presently preferred embodiment of the invention; and 
     FIG. 4 is an elevational view of the operator panel in apparatus in accordance with the present invention illustrating an exemplary examination screen. 
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     FIG. 1 is a functional block diagram of a physician&#39;s office complex 10 embodying a centralized patient information storage and retrieval system 12 in accordance with a presently preferred embodiment of the invention. System 12 includes a central computer 14 having internal memory and suitable control programming for driving a printer to generate a chart note 16 for placement in the patient file, for printing patient prescriptions 18 and corresponding treatment instructions 20, and for receiving patient history input 22 from a patient or medical technician and generating a corresponding history hardcopy 24 for placement in the patient file. In accordance with a principal feature of the present invention, central computer 14 also receives input from one or more dataports 26, which in turn are electronically coupled to corresponding penboards 28. 
     As shown in FIG. 2, penboard 28 comprises a flat rectangular enclosure 30 having a front panel 32 for displaying examination information and prompting data input by the physician. Referring to both FIGS. 2 and 4, panel 32 includes a first display 34 listing general examination categories 34a-34ff along opposed side edges of panel 32. Preferably, category display 34 comprises general information diagnosis categories identified by suitable indicia permanently and legibly printed along the left-hand panel side edge--e.g., &#34;vital signs&#34; 34a, &#34;appearance&#34; 34b, &#34;cardiovascular&#34; 34e and &#34;neurologic-1&#34; 34 m. Likewise, general examination and treatment categories 34r-34ff are permanently and legibly printed in suitable indicia along the right-hand edge of panel 32--e.g., &#34;chemistry profile&#34; 34s, &#34;medications&#34; 34z and &#34;follow-up&#34; 34ee. Immediately adjacent to each examination indicia 34a-34ff, there appears a bar code 36a-36ff for uniquely optically identifying the corresponding adjacent category. Likewise, an LED 38a-38ff  appears immediately adjacent to each category indicia 34a-34ff for indicating the general examination category selected by a physician. 
     Centrally of panel 32, there is positioned a liquid crystal display (LCD) 40 consisting of a multiplicity of individually-controlled display segments 40a-40jj configured in two adjacent rows. As will be described in detail hereinafter, the several segments of LCD 40 display specific examination indicia coordinated with the individual general examination (diagnosis or treatment) category 34 selected by the physician. Immediately outwardly adjacent to each display segment 40a-40jj, there is positioned a corresponding bar code segment 42a-42jj for uniquely identifying the corresponding display segment, and an LED 44a-44jj for indicating to the physician the display segments selected. Along the top edge of panel 32, there is provided a central elongated LCD 46 for indicating the patient&#39;s name; indicia, bar codes and LEDs 48a-c and 50a-c for indicating &#34;start&#34; and &#34;stop&#34; of data entry respectively; and indicia, bar codes and LEDs 52a-c, 54a-c and 56a-c for indicating entry of diagnostic &#34;history&#34;, &#34;symptoms&#34; and &#34;signs&#34; respectively. Dataport 26 (FIG. 2) comprises a generally rectangular housing 60 having an open upper edge 62 for removably receiving penboard 32, and suitable means (not shown) on the rear face for mounting housing 60 on a wall or the like. 
     Referring to FIG. 3, penboard 28 internally includes a microprocessor-based controller 64 with internal memory having prestored therein sets of specific examination indicia for display at segments 40a-40jj of LCD 40 and associated with each general examination category 34a-34ff. Controller 64 also includes suitable memory space for storing patient examination information as will be described, and control programming for operating panel 32, receiving and storing patient examination data, and subsequently transmitting or downloading such data through dataport 26 to central computer 14 (FIG. 1). Microcontroller 64 has output ports P1.0-P1.7 connected through LED drivers 66, 68 to drive LEDs 38a-38ff and 48c-56c on panel 32. Likewise, microcontroller 64 has output ports PA0-PB7 connected through an LCD data and control driver 70 for driving LCD 46 and the several segments 40a-4jj of LCD 40. Microcontroller 64 and the remainder of the penboard circuitry receive power from a power supply 72 coupled to a battery 74 contained within penboard enclosure 30 (FIG. 2). A reset input to microcontroller 64 is coupled to an operator pushbutton 76, and to a delay circuit 78 for resetting the microcontroller on the initial power-up. 
     A further input to microcontroller 64 is received from a light pen 80 that is manipulated by the physician for scanning one or more bar codes on panel 32. Light pen 80 is connected through a socket 82 (FIGS. 2 and 3) on a sidewall of enclosure 30, through filtering circuitry 84 (FIG. 3) and through Schmitt triggers 86 to ports PC6 and 7 of microcontroller 64. The input/output ports PC0 and PC3 of microcontroller 64 are coupled to a connector 88 positioned at the lower edge of penboard 28, as are the transmit/receive and interrupt ports of the microcontroller. A mating connector 90 is internally positioned at the lower portion of dataport housing 60 for mating engagement with connector 88 when penboard 28 is fully inserted into dataport 26, as shown in FIG. 2. The input/output data and control ports of microcontroller 64 are thus connected through dataport 26 to central computer 14 (FIG. 1) for downloading patient examination information and/or uploading modified control programming to the penboard. A battery-charger 92 within dataport 26 is responsive to a switch 94 for detecting insertion of penboard 28 to recharge penboard battery 74 through connectors 90, 88. As shown in FIG. 2, dataport housing 60 also includes a slot 96 at the lower edge thereof for selectively receiving penboard 28 so as to mate connectors 88, 90 for downloading patient data without inserting penboard 28 into dataport 26. 
     As previously noted, penboard 28 in the preferred embodiment of the invention has general examination category indicia 34a14 34ff permanently preprinted along with the side edges of panel 32. The general category indicia illustrated in FIGS. 2 and 4 represent suitable examination categories for a general practice physician. It will be noted that a number of blank spaces are provided in general information category display 34 for entry of suitable general examination or treatment categories as desired by the individual practitioner. Penboard 28 also has specific examination indicia prestored in microcontroller 64 coordinated with each general examination category. In addition, through central computer 14, the physician may add or modify specific examination indicia to be displayed at LCD 40. The specific indicia at display 40 illustrated in FIGS. 2 and 4 correspond to &#34;neurologic&#34; general examination category 34 m. The following Table 1 lists penboard display abbreviations 40a-40jj and the corresponding text which would be printed on chart note 16 (FIG. 1) for the patient file copy: 
     
                                           TABLE 1__________________________________________________________________________         CHART-NOTE PRINTOUTS GENERATEDPENBOARD SCREEN         BY SCREEN ABBREVIATIONABBREVIATION  SELECTION__________________________________________________________________________CORT SEN FUNCT         CORTICAL SENSORY FUNCTIONOBJ IDEN      OBJECT IDENTIFICATION INTACTCORT SEN FUNCT         CORTICAL SENSORY FUNCTION2-POINT DISCROPTIC NERV    OPTIC NERVE FUNCTION INTACTOCULOMOTOR NERV         OCULOMOTOR NERVE WITHOUT         IMPAIRMENTVISUAL FIELDS VISUAL FIELDS BILATERALLYINTACTFUNDOSCOPY    FUNDOSCOPIC EXAM SHOWS NORMAL         RETINAL PATTERNCORNEAL REFLX CORNEAL REFLEX BILATERALLY         INTACTPUPIL RELFX, ACOM         PUPILS ACCOMMODATE WITH INTACT         REACTIVITY TO LIGHT7TH CRAN NERV NO FACIAL ASYMMETRY OR WEAKNESS         DURING CONVERSATIONAUD VIBR SEN  AUDITORY AND VIBRATORY         SENSATIONBILAT GAG REFLX         BILATERAL GAG REFLEX NORMALRESIS HD TURN RESISTANCE TO HEAD TURNING         DEMONSTRATES INTACT llTH         CRANIAL NERVE12TH CRAN NERV         NO ATROPHY, FASCICULATIONS,         DEVIATION OF TONGUEGAIT DISTUR   UNSTEADY WEAVING GAITSCOTOMAS      NEGATIVE SCOTOMA WITH CENTRAL         FIELD INVOLVEMENT INTER-         FERRING WITH VISUAL ACUITYMUSCLE WAST   DECREASED MUSCLE BULK OUT OF         PROPORTION TO WEAKNESSVIBR POSIT SEN         VIBRATORY POSITION SEND INTACTATAXIA        REELING WIDE-BASED GAITDYSARTHRIA    DIMINISHED ABILITY TO         PRONOUNCE WORDS WITH NO         EVIDENCE OF APHASIAINTEN TREM    INTENTIONAL TREMORPHYSIOL TREM  NORMAL FINE, RAPID TREMORFESTINATION   FESTINATING GAITASTERIXIS     COARSE, SLOW, NON-RHYTHMIC         TREMOR - LIVER FLAPPULS EXOPHTH  PULSATING EXOPHTHALMOSAUTONOM DYSFUNCT         BLOOD PRESSURE FLUCTUATIONS,         CARDIAC ARRHYTHMIAS,         PUPILLARY CHANGESPROX LIMB WK  PROXIMAL LIMB WEAKNESSLINGUAL ATROPHY         LINGUAL ATROPHYPTOSIS        PTOSIS RT/LT EYELIDDYSPHAGIA     DYSPHAGIAFASCICULATION FASCICULATION R/O LOWER MOTOR         NEURON DISEASERADIC PAIN    RADICULAR PAINSCIATICA      RADIATING RT/LEFT SCIATIC         PAININCR DP TEN REFLX         HYPERACTIVE DEEP TENDON         REFLEXESPROPRIO DEF   PROPRIOCEPTIVE DEFICITCOGWH RIGID   COGWHEEL RIDGIDTIY SUGGESTIVE         OF PARKINSON&#39;S DISEASEMEIGE SYNDR   INVOLUNTARY BLINKING OF EYES         AND JAW-GRINDING MOVEMENTS__________________________________________________________________________ 
    
     Likewise, the following Table 2 lists penboard display abbreviations appearing at LCD 40, and corresponding chartnote text, for &#34;cardiovascular&#34; general examination through category 34e: 
     
                                           TABLE 2__________________________________________________________________________          CHART-NOTE PRINTOUTS GENERATEDPENBOARD SCREEN          BY SCREEN ABBREVIATIONABBREVIATION   SELECTION__________________________________________________________________________ATRIAL PREM BEAT          ATRIAL PREMATURE BEATSVENTR PREM CONTR          VENTRICULAR PREMATURE          CONTRACTIONATHER COR VESSEL          ATHEROSCLEROTIC CORONARY VESSEL          DISEASECONGEST FAILURE          CONGESTIVE HEART FAILURELT BUN BR BLOCK          LEFT BUNDLE BRANCH BLOCKMITRAL REGUR   MITRAL VALVE REGURGITATIONMITRAL STENOSIS          MITRAL VALVE STENOSISAPEX BEAT      APEX BEAT ENLARGE &amp; PROLONGED          IN SITTING POSITIONINTERMITT CLAUD          INTERMITTENT CLAUDICATIONPAROXY NOC DYS PAROXYSMAL NOCTURNAL DYSPNEAPUL HYPERTEN   PULMONARY HYPERTENSIONSICK SINUS SYNDER          SICK SINUS SYNDROME (SSS)          TACHYCARDIA-BRADYCARDIASUBAORT STENOSIS          SUBAORTIC STENOSISAORTIC EJECT SD          AORTIC EJECTION SOUNDSYSTOL CLICK   SYSTOLIC CLICK SUGGESTINGM V PROLAP     MITRAL VALVE PROLAPSESINGLE S2 NOR VAR          SINGLE S2 - NORMAL VARIATIONEPIGAST PULSAT EPIGASTRIC PULSATIONORTHO DECR BP  ORTHOSTATIC DECREASED BLOOD          PRESSURECAROTID PULSE  CAROTID PULSE WITHIN NORMAL          LIMITSPANSYST REG MUR          PANSYSTOLIC REGURGITANT MURMUREARLY DIASTOL MUR          EARLY DIASTOLIC MURMUR AT BASE          AND STERNAL BORDERMID DIASTOL MUR          MID DIASTOLIC MURMUR AT APEXCOSTOCH TEND   TENDERNESS TO PALPATION OVER          COSTOCHRONDRAL ARTICULATIONS          (TIETZE&#39;S SYNDROME)LANCIN CHT PAIN          FLEETING, LANCINATING CHEST          PAIN UNRELATED TO EFFORT OR          EMOTIONAL EXCITEMENT, NOT          INDICATING ANGINAPARADOX SPLIT S2          PARADOXICAL SPLITTING OF S2PAROXY TACH RECUR          PAROXYSMAL TACHYCARDIAS,          RECURRENT R/O DIGITALIS          INDUCEDPERICARD FRIC RUB          PERICARDIAL FRICTION RUBAUDIBLE OVER THE PRECORDIUM,          INCR. ON INSPIRATIONNORM 3RD SOUND VENTRICULAR GALLOP, S3, NORMAL          FOR PATIENT UNDER 30 YRSCANNON SOUNDS  CANNON SOUNDS SUGGESTIVE OF AVAV DISSOC/BLK  DISSOCIATION OR COMPLETE AV          BLOCKJUG VEN PUL    NORMAL RANGE 7-9 CM WITH A WAVEWAVE           SYNCHRONOUS WITH S1 AND A          SYNCHRONOUS WITH S2S1 &amp; S2 WNL    FIRST AND SECOND HEART SOUNDS          NORMAL SPLITTINGFIXED SPLIT S2 FIXED SPLITTING OF S2S4 PRECD S1 LVH          S4 PRECEEDING S1, LIKELY          INDICATING LEFT VENTRICULAR          HYPERTROPHYS3 IN DIASTROL S3 IN DIASTOLEORTHOPNEA      ORTHOPNEA, MODERATELY SEVEREINC CARD DULL  INCREASED CARDIAC DULLNESSSINUS TACHY    SINUS TACHYCARDIA 100-150100-150        BEATS/MINATRIAL FLUTTER ATRIAL FLUTTER 220-350 BEATS/220-350        MIN__________________________________________________________________________ 
    
     Indicia and text for the other general examination (diagnosis and treatment) categories may be selected and/or modified as desired. 
     With all such information prestored in penboard 28 and penboard battery 74 (FIG. 3) fully charged, the penboard is now ready for use by the physician in examining a patient. The examining physician first employs light pen 80 to scan a bar code or other suitable indicia on the patient file, resulting in storage of patient identification data in penboard microcontroller 64 and display of the patients&#39; name at LCD 46 (FIGS. 2 and 4). The physician then scans bar code 48b with the light pen to indicate commencement of a data-entry process, and LED 48c is correspondingly illuminated. Assuming that the physician is examining the patient for a neurological disorder, the physician first scans bar code 36 m (FIG. 4) to indicate examination in general category 34 m. Specific examination indicia as shown in FIG. is then displayed at LCD segments 40a-40jj, and LED 38 m is illuminated to remind the physician that general examination category 34 m is under study. The physician then scans one or more bar codes 42a-42jj reflecting examination L of the patient, with LEDs 44a-44jj being illuminated as appropriate. In the event that one of the specific examination indicia 40a-40jj is incorrectly selected, the physician may rescan the corresponding bar code, whereupon selection is cancelled and the LED is extinguished. The physician may then select another (diagnosis or treatment) category and repeat the specific display selection process. If the physician wishes to dictate information for the patients&#39; file not reflected in the prestored indicia, bar code 36ff is scanned during the examination process. When data-entry is complete, the physician scans bar code 50b and LED 50c is illuminated. 
     When examination is complete, penboard 28 is returned to dataport 26 so that connectors 88, 90 (FIG. 3) are brought into mating engagement. The patient information stored in microcontroller 64 is then downloaded to central computer 14 (FIG. 1) for preparation of file charts, prescription forms, etc. The penboard may alternatively be inserted into dataport slot 96 (FIG. 2) for transmission of patient data and reset pushbutton 76 (FIG. 3) may be depressed to reset the microcontroller, whereupon penboard 28 is ready for examination of a new patient. Suitable software for operating central computer 14 and microcontroller 64 in the manner described will be self-evident to the artisan. 
     Although the self-contained examination guide and information storage apparatus has been described in conjunction with a presently preferred embodiment thereof, it will be readily appreciated that modifications may be implemented without departing from the general principles of the invention. For example, although the invention has been described in connection with the presently preferred implementation for assisting patient examination by a physician, the invention in its broadest aspects may be readily applied to other types of examination or inspection processes. For example, penboard 28 may be configured for inspection of automobile engines, with general inspection categories such as &#34;carburetor&#34;, &#34;valve timing&#34;, etc. being listed along with outside edges of the penboard panel, and specific examination indicia such as &#34;idle screw adjust&#34; displayed at LCD 40 as a function of selected general examination category. While use of a light pen 80 and of bar codes on the penboard is presently preferred both for reasons of reliability and because the light pen may also be employed to scan patient identification data on the patient file, other means for entering general and specific examination information may be employed, such as membrane switches or the like positioned in place of the various bar codes adjacent to the indicia as shown in FIGS. 2 and 4. Communication at connectors 88, 90 (FIG. 3), with penboard 28 inserted in either dataport top 62 or slot 96 (FIG. 2), may be by direct mechanical connection and electrical transmission, or by alignment of optical couplers for fiberoptic transmission.