Abstract:
A communications and documentation system is disclosed that improves staff communication, education, and/or documentation. This system is interactive and integrates speech recognition, telephony, wireless, and/or database technologies, and innovative algorithms in a novel way that allows for assigning staff, scheduling staff activities, and data collection and reporting. The system also incorporates features that promote ease of use by persons who are not skilled at using technology.

Description:
TECHNICAL FIELD OF THE INVENTION  
       [0001]     The present invention relates to an interactive voice activated communications, information, and/or documentation system. The present invention can be used, for example, in a healthcare facility such as a nursing home (a) by nurses or other healthcare professionals to assign, manage, and monitor staff and patients via real-time computer reports, and (b) by nursing assistants or other staff to receive their remaining assignments and other information, to document patient care, and to communicate with other staff. The present invention can also be used to provide other functions such as education, reporting, reminders, scheduling, and management functions.  
       BACKGROUND OF THE INVENTION  
       [0002]     In a nursing home, a supervisory nurse or other healthcare professional is responsible for managing the work of several nursing assistants, assessing patient needs, and providing additional patient care. Nursing assistants are responsible for conducting or assisting with patients&#39; “activities of daily living”, which include but are not limited to bathing, dressing, grooming, meals, and transfers. All work must be documented for regulatory and legal reasons.  
         [0003]     Documenting patient care is a time consuming task that is traditionally performed with pen and paper and that takes away from time spent with patients. Moreover, such “manual documentation” is often illegible. Staff learns their care plans by reading paper-based plans that are constantly being updated or by talking to the nurse. They do not always have the most up-to-date information.  
         [0004]     Recently, wall mounted computers and personal digital assistants (PDAs) have been used by staff in some facilities to enter patient data. Such systems are extremely challenging and stressful for nursing assistants, who typically fear technology or may otherwise find such technology difficult to use.  
         [0005]     Also, PDAs have small keys that are difficult to use and small screens that are difficult to read. Wall mounted computers cannot be located at an ergonomically correct height for all staff, and compliance with legislation (e.g., Health Insurance Portability and Privacy Act) that protects patient privacy is problematic. Further, touch screen versions of wall mounted computers promote bacteria transmission by the staff who use them. Bedside computers offer a more costly alternative and do not resolve the problems with training staff on computer use and the spread of infections.  
         [0006]     Staff also needs to communicate with each other to discuss observations or to request assistance with patient care. The present alternatives, such as searching the corridors and rooms, yelling down the hall, or using a traditional speaker based paging system, are time consuming, noisy, and disruptive, and intercom systems used at some facilities require the staff to be physically near the intercom terminals when help is needed.  
         [0007]     In addition, staff requires constant training to keep up with new methods and healthcare advances. This training is traditionally accomplished in person and occasionally with audio and video tapes and other presentation equipment. As a result, current training methods require the staff to be in a location where they are unable to provide patient care.  
         [0008]     Moreover, nurses communicate with physicians and family members of their patients in person and by phone while referring to paper based charts. It is often time consuming to find the charts, which may be in use by others. In addition, information from paper based charts that is entered into a computer system is typically several days out of date.  
         [0009]     Therefore, it would be desirable for the long-term care industry and other care providing environments to have a lightweight, mobile, voice-activated, hands-free technology for improved documentation, communication, information dissemination, and education. It would also be desirable for this technology to operate in real time so that the staff is always working with up-to-date information, and the information is readily available in some form to all authorized persons.  
         [0010]     The present invention presents a novel way of overcoming one or more of these or other problems.  
       SUMMARY OF THE INVENTION  
       [0011]     In accordance with one aspect of the present invention, a method of providing care to patients implemented by wireless transmission between at least one mobile terminal and a server comprises the following: audibly receiving a user voice message by the mobile terminal, wherein the user voice message is spoken by a user of the mobile terminal; wirelessly transmitting the user voice message from the mobile terminal to the server; matching the user voice message to a corresponding response voice message associatively stored by the server; wirelessly transmitting the response voice message from the server to the mobile terminal; wirelessly receiving the response voice message at the mobile terminal; and, audibly reproducing the response voice message for hearing by the user.  
         [0012]     In accordance with another aspect of the present invention, a method performed by a personal terminal is provided to receive instructions regarding the care of a patient by a care provider and to transmit information relating to the care provided to the patient by the care provider. The personal terminal is located remotely from a database, and the database stores the instructions provided to the care provider and the information provided by the care provider. The method comprises the following: receiving the instructions, wherein the instructions identify the patient and the care to be provided to the patient; audibly reproducing the instructions for hearing by the care provider; receiving the information from the care provider by way of spoken messages; and, wirelessly transmitting the information to the database.  
         [0013]     In accordance with yet another aspect of the present invention, a server for a care provider communication and documentation system comprises a speech recognition engine, a database, and a speech output device. The speech recognition engine receives and interprets a spoken message from a remote terminal, and the spoken message relates to care given to persons. The database stores response messages regarding care to be given to the persons. The speech output device communicates one of the response messages back to the remote terminal when the one response message corresponds to the spoken message.  
         [0014]     In accordance with still another aspect of the present invention, a care provider communication and documentation system comprises at least one remote terminal, a speech recognition engine, a database, and a speech output device. The at least one remote terminal is used by a care provider to receive first voice messages containing instructions related to the care of a patient and to transmit second voice messages containing information related to the care provided to the patient by the care provider. The speech recognition engine receives and interprets the second voice messages from the at least one remote terminal. The database stores the first voice messages. The speech output device communicates one of the first voice messages back to the remote terminal when a corresponding one of the second voice messages is recognized by the speech recognition engine as matching the one of the first voice messages.  
         [0015]     In accordance with a further aspect of the present invention, a method of providing care to a patient implemented by at least one terminal used by a care giver to give care to the patient comprises the following: audibly receiving a user voice message by the terminal, wherein the user voice message is spoken by the care giver and relates to the care of the patient; transmitting the user voice message from the terminal to a server; receiving a response voice message at the terminal, wherein the response message is automatically generated at the server, and wherein the response voice message relates to care of the patient; and, audibly reproducing the response voice message for hearing by the care giver.  
         [0016]     In accordance with yet a further aspect of the present invention, a method of transmitting messages comprises the following: receiving an information request; if the requested information relates to a scheduled activity, transmitting a scheduled message (S) related to the scheduled activity; if the requested information relates to a scheduled activity and a scheduled message (S) related to the scheduled activity is transmitted, transmitting a tied message (T), if any, that is tied to the transmitted scheduled message (S); and, if there is an information message (I) to transmit, transmitting the information message (I) whether or not the scheduled message (S) is transmitted and whether or not the tied message (T) is transmitted. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]     These and other features and advantages will become more apparent from a detailed consideration of the invention when taken in conjunction with the drawings in which:  
         [0018]      FIG. 1  illustrates a healthcare communication and documentation system in accordance with an embodiment of the present invention;  
         [0019]      FIG. 2  is a flow chart illustrating the use of the healthcare communication and documentation system of  FIG. 1 ;  
         [0020]      FIG. 3  is a flow chart representing a program that may be executed by the healthcare communication and documentation system of  FIG. 1 ; and,  
         [0021]      FIG. 4  is a flow chart representing another program that may be executed by the healthcare communication and documentation system of  FIG. 1 . 
     
    
     DETAILED DESCRIPTION  
       [0022]     As shown in  FIG. 1 , a communication and documentation system  10  useful in providing care to persons includes a server  12  containing an application portion  14  and a database portion  16 . The server  12 , for example, may comprise one or more computers. For example, the application portion  14  can reside on one or more computers or servers, and the database portion  16  can reside on one or more computers or servers. The server  12  provides both database and web server capabilities.  
         [0023]     A host computer  18 , which may be a standard desktop personal computer, provides an interface which can be used, for example, by a supervisor or nurse (a) to enter and update patient care plans and associated data, (b) to enter patient care requirements that are linked to speech segments that can be retrieved when needed by staff members at any time, (c) to enter staff member assignments such as which patients are assigned to which staff members on a given shift, (d) to schedule patient tasks that result in the server  12  calling the staff members at scheduled times (e.g., to communicate appointment reminders), and (e) to enter other information that is linked to the server  12 . This other information can include, for example, the names of new staff members and/or new patients. This information is then integrated by the server  12  into dialogues (e.g., James Jones gets dressing; or Hello Mary Smith).  
         [0024]     The host computer  18  can also be used (a) to generate reports based on patient data (e.g., vital signs, falls) entered either by voice or by use of a screen display on the host computer  18 , (b) to display text in a screen display (e.g., that indicates that a NOTE is available for a patient and that includes a LINK that can be clicked on in order to listen to the NOTE through a headset where the NOTE is archived in the form of a sound file, and (c) to generate reports on staff performance (e.g., productivity reports indicating the number of tasks recorded per hour and exception reports that indicate activities not completed by staff members for each resident.  
         [0025]     Moreover, the host computer can further be used to set system parameters, to conduct training sessions, to provide immediate advice on the care of patients, and to perform additional or alternative functions.  
         [0026]     The host computer  18 , for example, may include a standard web browser in order to support communications between the host computer  18  and the server  12 . However, alternative apparatus may be used to support communications between the host computer  18  and the server  12 .  
         [0027]     The server  12  contains host media processing software  20 . This software, for example, is obtainable from Intel Corporation and can support bi-directional voice communication with the users of mobile terminals  22   1 ,  22   2 , . . . ,  22   n . The database portion  16  of the server  12  supports database connectivity for the communication and documentation system  10 . The database portion  16  provides a central repository for all communication and documentation system data and, thus, acts as a bridge between the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  and the host computer  18 .  
         [0028]     The mobile terminals  22   1 ,  22   2 , . . . ,  22   n  can be any type of suitable devices such as cordless telephones, portable data assistants (PDAs), Notebook PCs, Tablet PCs, and/or other mobile devices equipped to wirelessly communicate with the server  12 . A computerized device that is not mobile, such as a landline telephone, may also be used to communicate with the server  12  in the same manner as a mobile user device. In one embodiment of the present invention, the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  can be SpectraLink NetLink cordless telephones that operate using 802.11 b wireless Voice-Over-Internet-Protocol, and thus communicate directly with telephony hardware of the server  12 . The H.323 protocol may be used for call control.  
         [0029]     Also, the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  may be arranged to communicate with the server  12  and with each other using any desired network such as a wireless Internet Protocol network  24 .  
         [0030]     Accordingly, examples of communications in the communication and documentation system  10  comprise the following: (i) Voice-Over-Internet-Protocol (VoIP) calls; (ii) calls that retrieve selected sound files stored on the server  12  and that play the sound files to the staff members over the mobile terminals  22   1 ,  22   2 , . . . ,  22   n ; (iii) interactive calls that interpret the staff members&#39; key presses on the mobile terminals  22   1 ,  22   2 , . . . ,  22   n ; (iv) interactive calls that process the staff members&#39; speech by sending it to a speech recognition engine  26  in the application portion  14  for interpretation and for storing of the interpretation results as text files on an application logic  28  of the database portion  16 ; and, (v) interactive calls that process the staff members&#39; speech by recording it as a file stored on the application logic  28 .  
         [0031]     As described above, the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  are located on the same wireless Internet Protocol network  24  as the server  12 . Appropriate routes can be established in the wireless Internet Protocol network  24  by software settings so that calls are directed to the server  12 . The server  12  uses the speech recognition engine  26 , which executes speech recognition software, such as from ScanSoft, Inc., to interpret spoken responses from the users of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  and to convert them into text that can be processed by application logic  28  of the telephony system.  
         [0032]     Based on the interpretation results, the server  12  executes software in the application logic  28  that matches the text equivalent of the voice message (for example, requesting a patient&#39;s bathing schedule) received from the user of the mobile terminal  22  to corresponding text stored in the database portion  16  in order to select the appropriate responses from the database portion  16 . For example, the text equivalent of the voice messages can be used as pointers into the database portion  16  to retrieve the appropriate responses. Alternatively, the voice messages can be used a pointers into the database portion  16  without first converting the voice messages to text. The application logic  28  assembles speech segments selected from a speech segment database  29  based on the responses into complete voice messages. These complete voice messages are then transmitted as voice signals to the mobile terminal  22  using the host media processing software  20 .  
         [0033]     The server  12  and the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  may be located, for example, in the same local area as the staff members that use them. In an alternative embodiment, the server  12  and the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  may be connected to the public Internet and the server  12  can be located at a different site from the mobile terminals  22   1 ,  22   2 , . . . ,  22   n .  
         [0034]     The host computer  18  and the server  12  communicate through a data network  30 . The supervisor enters, updates, or corrects patient care information data using a mouse or other data entry device. Furthermore, data may be exported to and imported from an external database  32  by way of translation logic  34  included in the software of the communication and documentation system  10 .  
         [0035]     The supervisor can use the host computer  18  to review data collected via the communication and documentation system  10  on patient care and staff member performance in the form of real time host interface reports. For this purpose, the host computer  18  includes a report generator that generates reports based on data stored in the database portion  16 . In addition, selected reports from the host interface provided by the host computer  18  can be made available to physicians and family members on their computers  36  through a secure web site or web connection.  
         [0036]     The application software of the communication and documentation system  10  is comprised of dialogue scripts that control the “conversation” between the staff members and the server  12 . These scripts can follow rules that establish how messages in the communication and documentation system  10  are linked to each other in a database  38  of the database portion  16 . Sample scripts are shown in Appendix A.  
         [0037]     Accordingly, the database  38  of the communication and documentation system  10  includes a speech file database that stores a set of prerecorded responses, the text of all of the elements of patient care information, the patient data entered by the users of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  and the host computer  18 , and the voice messages recorded by the users via the mobile terminals  22   1 ,  22   2 , . . . ,  22   n . Based on the responses stored in the database  38 , the application logic concatenates the speech segments stored in the speech segment database  29  to assemble all possible voice responses of the communication and documentation system  10  to staff member commands.  
         [0038]     The software of the communication and documentation system  10  converts the patient care messages selected on the host computer  18  to speech messages and establishes relationships between the patient care activities. The selected patient care messages are then made available to be heard on the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  at scheduled times or time intervals or otherwise.  
         [0039]     Every message is characterized as either (i) a scheduled message (S), (ii) a message (T) that is tied into, and to be played in conjunction with, a scheduled message (S), or (iii) an information message (I) that is for information only and does not, therefore, require a specific activity to be completed.  
         [0040]     “S-messages” can be heard by the staff members over the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  any time during the prescribed time interval. The prescribed time interval, for example, may be the time of a staff member&#39;s shift or some other time interval entered by use of the host interface of the host computer  18 . “S-messages” stay active during the prescribed time interval until the staff member reports the activity as completed, at which point they are removed from the list of active messages and are reported as completed in the database portion  16  of the communication and documentation system  10 . When the activity is reported to be completed, the “S-messages” are also removed from the list of uncompleted activities displayed by the host interface provided by the host computer  18 .  
         [0041]     “T-messages” are active during the same time period as the associated “S-messages”.  
         [0042]     “I-messages” are active and available for the user to hear at all times.  
         [0043]     All patient care activities tracked by the communication and documentation system  10  may be scheduled at specific times of the day for each patient. This scheduling allows the staff member to hear only relevant activities over the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  in the order in which they need to be completed for the current shift time period. For example, the Day Shift staff will hear that they must complete Breakfast and Lunch, in that order. They will not hear that they must complete Dinner, because that occurs on the Evening Shift.  
         [0044]     The staff members can enter patient data by speaking a number such as temperature. The software of the communication and documentation system  10  establishes an acceptable range for each parameter and each entry must be within this range to be accepted. If the entry is not within the acceptable range, the communication and documentation system  10  asks the staff member to try again.  
         [0045]     The communication and documentation system  10  provides scheduled outbound calls with messages for the users (staff members) of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  at specific times based on scheduling provided through use of the host interface provided by the host computer  18 . Each scheduled call may be simultaneously directed to specified one(s) of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  without a user request. The user(s) of the specified one(s) of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  may either accept the call or ask the communication and documentation system  10  to call back later.  
         [0046]     The communication and documentation system  10  can also provide unscheduled outbound calls when a staff member says a specified word option into the mobile terminal  22 . For example, saying “Emergency” will result in all logged in staff members receiving an emergency call. Other such outbound calls can be triggered by a staff member&#39;s voice command or by a set of specified system conditions.  
         [0047]     In one embodiment of the invention, each staff member wears a headset that is connected to the corresponding mobile terminal  22 . This headset enables the staff member to “converse” hands free with the communication and documentation system  10  from any place within the area covered area by the wireless system antennas and at any time. Thus, the staff members can obtain their latest assignments, ask for patient care information, hear patient care messages, input patient data, record the completion of a patient care activity, talk directly to other staff members wearing headsets and logged into the communication and documentation system  10 , and/or record spoken messages that can be accessed by other staff member on the same shift or later shifts.  
         [0048]     A schematic that provides an example of the overall process is shown in  FIG. 2 . The flexible design of the communication and documentation system  10  is not strictly hierarchical and, thus, the sequence of events can vary to meet the user&#39;s needs.  
         [0049]     As shown by the process of  FIG. 2 , the supervisor, using the host computer  18 , enters or modifies the individualized care plan for each patient and assigns each patient to a staff member. This data is imported to the server  12  from an administrative database stored, for example, on the host computer  18 . The staff member turns on his or her mobile terminal  22  and logs in with the appropriate password. Thereafter, the process of  FIG. 2  follows one of two paths.  
         [0050]     Along one of these two paths, the staff member speaks into the corresponding mobile terminal  22  to record a clinical note or to record a reminder to send a message to the server  12 . The supervisor using the host computer  18  sees a message on the host computer interface that a clinical note is available for retrieval and listens to the note through a voice interface or reads the note that has been converted to text and displayed on the host computer interface.  
         [0051]     Along the other path, the staff member uses one of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  to access assignments and/or up-to-date patient care information of interest. The staff member then documents the care provided to, and the health data of, the patient using one of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n . The care and health data are automatically exported to the database portion  16  for storage as described herein. Also, the supervisor reviews such stored care and health data on the host computer  18 . Moreover, the staff members use the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  to communicate with other staff members as needed.  
         [0052]     The users must log in to start using and to be recognized by the communication and documentation system  10  and must log out when finished using the system. The dialogues of the communication and documentation system  10  are designed for primarily non-hierarchical navigation, allowing the user to rapidly move from one dialogue section to another when hearing a response message. In an alternative embodiment, a hierarchical dialogue structure may be used. Appendix A illustrates typical dialogues in a nursing home environment, consistent with  FIG. 2 .  
         [0053]     The following list includes additional features that can be incorporated into the communication and documentation system  10 : triggering a call to a supervisor and posting an alert note on the host interface provided by the host computer  18  when patient data, such as blood pressure, is out of a predefined “clinically acceptable range”; allowing a user to enter and correct data using either one of the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  or the host interface of the host computer  18 , and retaining an audit trail of changes; recognizing unavailability of staff (e.g., staff on lunch break) to receive an outbound call and redirecting such call to another person logged into the system; reading data inputs from written or printed data sheets that are scanned and storing such data in the database portion  16 ; automatically inactivating a message for a specified time period when a patient is designated to not receive such message for such specified time period; notifying staff members when a patient is designated to not receive a message for a specified time period; reading data from a bar code or radio frequency identification (RFID) scanner or other scanning device and storing such data in the database portion  16 ; allowing a free-form spoken message to be recorded, converted to text by commercially available speech-to-text software, displayed by the host interface, and stored in the database portion  16  as a text message; scheduling reminder messages to the mobile terminals in advance of the reminded activity, where the amount of advance notice may vary by message type; sending an alert message to a mobile terminal that a change in patient care has been entered on the host interface; sending an alert message to a mobile terminal when a parameter in a patient&#39;s record has changed; automatically reviewing and analyzing patterns of data in the database portion  16  and sending an alert message to a mobile terminal when the data analysis indicates that a critical value or range was exceeded; sending a reminder or educational message to the mobile terminal when a patient is to receive a specified type of care by the user; sending a reminder or educational message to the mobile terminal when specified types of data are entered by the user; sending a reminder to the mobile terminal about the patient&#39;s personal information, such as a birthday; sending an outbound message to all mobile terminals simultaneously; causing the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  to automatically log out at the end of a shift after notification of the users; causing the host interface provided by the host computer  18  to automatically log out at the end of a shift after notifying the users; interfacing the communication and documentation system  10  to third party wireless systems such as nurse call systems via interface software such as that provided by SpectraLink and converting the alerts produced by the wireless system into a text or speech message on the mobile terminal; interfacing the communication and documentation system  10  with a telephone system so the mobile terminals  22   1 ,  22   2 , . . . ,  22   n  can make calls via a public telephone network; interfacing the communication and documentation system  10  with third party software in a way that allows review of data on the host interface before the data are exported to the third party software; capturing a telephone message from an authorized caller from outside the facility and recording such message as a voice or text note in the database portion  16 ; and, a word option on the mobile terminal that retrieves previously recorded data such as vital signs and that communicates such data to the user in a voice message.  
         [0054]     The application logic  28  executes a program  300  to perform the functions as described herein.  FIG. 3  is a high level flow chart which illustrates the program  300  of the application logic  28 . When a voice message is received by the server  12  from one of the mobile terminals  22  as indicated by a block  302 , a check is made at a block  304  to determine whether the message is a page in which a staff member using the mobile terminal  22  is paging an individual staff member or is paging a group of other staff members.  
         [0055]     If the received message is a page, a channel is opened and the page is transmitted at a block  306 . If the individual being paged acknowledges the page as determined at a block  308 , the individual staff member and the page originator use the mobile terminals as telephones to conduct a conversation, and program flow returns to the block  302 . If a group of staff members being paged acknowledge the page as determined at a block  308 , the staff members in the group hear a message recorded by the group page originator by speaking into the mobile terminal when the group page is placed, and program flow returns to the block  302 . However, if all staff members being paged do not acknowledge the page, the identities of those staff members not acknowledging the page are stored at a block  310  so that those staff members can be paged at a later time, the staff members acknowledging the page hears a message recorded by the originator of the group page by speaking into the mobile device when the group page is placed, and program flow returns to the block  302 .  
         [0056]     If the received message is not a page, a determination is made at a block  312  as to whether the received message is information, such as a response to a question previously asked by the server  12  of the user of the mobile terminal  22 , or a word option that engages the server in a continued dialogue. If the message is a response containing information to be stored, a determination is made at a block  314  as to whether the user has verified the information (this verification step may be skipped in some cases as with many YES/NO responses). If the information has not been verified, then a request is made of the user at a block  316  to verify the information and program flow returns to the block  302 . If the received information is verified, a determination is made at a block  318  as to whether the information has a range check associated with it and whether the information is within the valid range. If so, the information is stored at a block  320 , a next message in the dialogue, if any, is transmitted to the mobile terminal, and program flow returns to the block  302 . If the received information is not in the valid range, or if the received information is not verified, the server  12  transmits a request for retransmission of the information at a block  322  and program flow returns to the block  302 .  
         [0057]     If the received message is not information, the received message is compared to the dialogue stored in the database portion  16 . A determination is then made at a block  326  to determine if the received message matches any of the dialogue stored in the database portion  16 . If not, the received message must contain an invalid word option and the system cannot act on the received information and thus communicates its inability to proceed to the staff member with a tone or message at a block  328 . Program flow then returns to the block  302 .  
         [0058]     If the received message matches the dialogue stored in the database portion  16 , the matching response stored in the database portion  16  is retrieved from the database portion  16  at a block  330  and is transmitted at a block  332 . Program flow then returns to the block  302 .  
         [0059]      FIG. 4  is a flow chart of a program that can be executed by the block  330  when a request for information is received by the server  12 . Specifically, when the part of the dialogue initiated by the staff member through use of a mobile terminal  22  is a request for information as indicated at a block  402 , a check is made at a block  404  to determine if the information requested relates to a current activity, i.e., whether the request relates to an activity to occur during a scheduled time period, for example the current shift.  
         [0060]     The blocks  402  and  404  can be arranged to cover different types of scheduled activities. For example, some scheduled messages may occur only once during the scheduled time period such that, if the activity has already been performed, the message is not played. Some scheduled messages may occur a fixed number of times greater than one during the scheduled time period such that, if the activity has been performed less than the prescribed number of times, the scheduled message is played. Some scheduled messages may have a start and stop time and must be performed every X hours such that, if current time is between the specified start and stop times, the scheduled message is played along with a message stating the timeframe and stating that the last time activity was performed, regardless of how many times it has been performed.  
         [0061]     If the requested information relates to a current activity, the requested information is played at a block  406 . That is, the requested information is assembled from speech segments into a complete voice message and the voice message is transmitted at the block  332 . This message is referred to above as a scheduled message (S).  
         [0062]     Thereafter, a check is made at a block  408  to determine if there is a tied message (T) tied into, and to be played in conjunction with, the scheduled message (S). If there is a tied message (T) tied into the scheduled message (S), the tied message is played at a block  410 .  
         [0063]     If the requested information does not relate to a current activity as determined at the block  404 , or if there is no tied message (T) tied into the scheduled message (S) as determined at the block  408 , of after the tied message is played at the block  410 , a check is made at a block  412  to determine if there is an information message (I) to be played. If there is an information message (I) to be played, the information message (I) is played at a block  414 . After the information message (I) is played at the block  414 , or if there is no information message (I) to be played as determined at the block  412 , the routine of  FIG. 4  is ended and program flow returns to the block  302  of  FIG. 3 .  
         [0064]     The communication and documentation system  10  can be used in a variety of care giving settings including nursing homes, assisted living facilities, hospitals, home healthcare facilities, and rehabilitation centers.  
         [0065]     Therefore, the terms “supervisor” and “staff member” as used herein are meant to be generic to cover any person capable of using the communication and documentation system  10  for its intended purpose. Similarly, the term “patient” as used herein is meant to be generic to cover other people, such as assisted care and/or nursing home residents, who receive care by the users of the communication and documentation system  10 .  
       Appendix A. Sample Dialogues  
       [0066]     LOGIN Process—At the beginning of the shift, each user (staff member and/or supervisor) logs in to the communication and documentation system  10 . The login process allows the communication and documentation system  10  to link the user with the user&#39;s patient assignments. Here is an example with a fictitious healthcare professional using the communication and documentation system  10 . The material not in brackets represent verbal dialogue.  
       Login Process—Passcode is Correct  
       [0067]                                                Definitions:   SM:   Staff Member           CDS:   Communication and Documentation System           SM:   [Press the specified button on the               mobile terminal]           CDS:   Please log in           SM:   [Keys in correct passcode on mobile               terminal]           CDS:   Donald Smith. Is this correct?           SM:   YES.           CDS:   &lt;Ending tone&gt;                    
 The ending tone signals to the user that the communication and documentation system  10  is finished speaking and it is now the user&#39;s turn. 
 
         [0068]     ASSIGNMENT Option—The ASSIGNMENT option allows the staff member to review his or her patient assignment list.  
       Assignment Option (Beginning of Shift)  
       [0069]    
       
         
               
               
               
             
           
               
                   
                   
               
               
                   
                   
               
             
             
               
                   
                 SM: 
                 ASSIGNMENT 
               
               
                   
                 CDS: 
                 You have activities assigned for 5 
               
               
                   
                   
                 patients. Miranda Miller Room 290; Chris 
               
               
                   
                   
                 Culbertson Room 291; James Jackson Room 292; 
               
               
                   
                   
                 Betty Erving Room 293; and Penny Henderson 
               
               
                   
                   
                 Room 311A. 
               
               
                   
                 CDS: 
                 &lt;Double beep&gt; 
               
               
                   
                   
               
             
          
         
       
     
         [0070]     RESIDENT OPTION—The RESIDENT option allows the staff member to access a care plan and database associated with a specific patient to either hear or record information about such patient. In the option, the staff member speaks the resident&#39;s room number, and the communication and documentation system  10  then allows the staff member to get or record patient related information.  
         [0071]     For example, the communication and documentation system  10  can retrieve many types of information that is sent to the mobile terminal as voice messages including: (i) BACKGROUND when spoken elicits background information that is individualized to the patient, (ii) TASK LIST when spoken elicits information that includes activities of daily living in the care plan during a particular shift, (iii) &lt;A SPECIFIC TASK NAME&gt; when spoken elicits messages with details for a specific task (e.g., the task name GROOMING when spoken may elicit a message at the mobile terminal such as “provide wig care”, and (iv) &lt;A SPECIFIC DATA NAME&gt; when spoken elicits a message with the most recently recorded data for the patient (e.g., the data name WEIGHT when spoken may elicit a message at the mobile terminal such as “the patient&#39;s weight is 150 pounds”). Following are some examples:  
                                                       SM:   TASK LIST           CDS:   James Jackson Room 292 needs vital               signs, bathing, mouth care, dressing,               grooming, meals, toilet,               positioning, transfers, and ambulation.           CDS:   &lt;Ending tone&gt;                      
 
         [0072]    
       
         
               
               
               
             
           
               
                   
                   
               
               
                   
                   
               
             
             
               
                   
                 SM: 
                 GROOMING. 
               
               
                   
                 CDS: 
                 James Jackson Room 292. Caution: He 
               
               
                   
                   
                 is diabetic. Check with nurse before 
               
               
                   
                   
                 grooming. He needs a shave. Use 
               
               
                   
                   
                 an electric razor. 
               
               
                   
                 CDS: 
                 &lt;Ending tone&gt; 
               
               
                   
                   
               
             
          
         
       
     
         [0073]    
       
         
               
               
               
             
           
               
                   
                   
               
               
                   
                   
               
             
             
               
                   
                 SM: 
                 TEMPERATURE. 
               
               
                   
                 CDS: 
                 James Jackson Room 292. The 
               
               
                   
                   
                 temperature on September 2nd at 3:15 PM was 
               
               
                   
                   
                 99.8 degrees Fahrenheit. 
               
               
                   
                 CDS: 
                 &lt;Ending tone&gt; 
               
               
                   
                   
               
             
          
         
       
     
         [0074]     Similarly, after a staff member has spoken a patient&#39;s room, the staff member can tell information to the communication and documentation system  10  information about a patient at the point of care. This information will be automatically recorded in the patient&#39;s database. The kinds of patient information that the nursing assistant can tell include: (i) &lt;SPECIFIC TASK NAME&gt; DONE when spoken allows the staff member to document the completion of a specific task (e.g., the words “Grooming Done” when spoken may elicit at the mobile terminal a question such as “Has the patient had breakfast?”; and, (ii) &lt;SPECIFIC DATA NAME&gt; when spoken allows the staff member to speak patient data to be recorded into the mobile terminal (e.g., the word option “PULSE” when spoken may elicit in the mobile terminal a question such as “What is the pulse?”). Following are some examples:  
                                                       SM:   PULSE           CDS:   What is the pulse?           SM:   86.           CDS:   86. Is this correct?           SM:   YES.           CDS:   &lt;Ending tone&gt;                      
 
         [0075]    
       
         
               
               
               
             
           
               
                   
                   
               
               
                   
                   
               
             
             
               
                   
                 SM: 
                 MEALS DONE 
               
               
                   
                 CDS: 
                 James Jackson, room 292. 
               
               
                   
                 SM: 
                 YES. 
               
               
                   
                 CDS: 
                 Did the patient eat lunch? 
               
               
                   
                 SM: 
                 YES. 
               
               
                   
                 CDS: 
                 What was the percentage of meal eaten? 
               
               
                   
                 SM: 
                 75. 
               
               
                   
                 CDS: 
                 75 percent. Is this correct? 
               
               
                   
                 SM: 
                 YES. 
               
               
                   
                 CDS: 
                 What was the fluid intake in ccs? 
               
               
                   
                 SM: 
                 100. 
               
               
                   
                 CDS: 
                 100 ccs. Is this correct? 
               
               
                   
                 SM: 
                 YES. 
               
               
                   
                 CDS: 
                 How many calories? 
               
               
                   
                 SM: 
                 500. 
               
               
                   
                 CDS: 
                 500 calories. Is this correct? 
               
               
                   
                 SM: 
                 YES. 
               
               
                   
                 CDS: 
                 &lt;Ending tone&gt; 
               
               
                   
                   
               
             
          
         
       
     
         [0076]     Other options can also be provided using similar dialogues. For example, NOTE when spoken allows the nurse to record a note or to listen to one or more previously recorded notes. NOTE in the RESIDENT allows the staff member to record a note or to listen to a note about a specific patient. After recording, the staff member may be offered the options of saving, adding to, deleting and listen to the note. A skip option can also be used to allow the user to skip to the next note by saying the option word SKIP.  
         [0077]     PAGE when spoken enables a user to talk with one or more other staff members as discussed above.  
         [0078]     REPORT when spoken enables the staff member to hear the end-of-shift report from the previous shift at any time.  
         [0079]     Certain modifications of the present invention have been described above. Other modifications of the present invention will occur to those practicing in the art of the present invention. For example, although as described above staff members are the users of the mobile terminals  22 , the supervisor of the staff members can also use a mobile terminal to communication with the server  12  and/or with the staff members.  
         [0080]     Accordingly, the description of the present invention is to be construed as illustrative only and is for the purpose of teaching those skilled in the art the best mode of carrying out the invention. The details may be varied substantially without departing from the spirit of the invention, and the exclusive use of all modifications which are within the scope of the appended claims is reserved.