Abstract:
A communications network for providing continuous patient monitoring to provide critical care services from a remote location. A plurality of patient monitoring stations with associated patient monitoring instrumentation is connected over a communications network to a command center to which data flows continuously for analysis. A standardized series of guideline algorithms for treating a variety of critical care conditions are prompted to provide critical care by caregivers who monitor the progress of individual patients at remote patient monitoring stations. A smart alert system that can be flexibly set from the command center provides for patient-specific rules to be established to alert the caregivers to potential patient problems so that intervention can occur in a timely fashion. A data storage/data warehouse function analyzes individual patient information from a plurality of command centers and provides updated algorithms and critical care support to the remote command centers.

Description:
BACKGROUND  
       [0001]     This invention relates generally to a communication system for medical applications and monitoring of equipment used in the care of hospitalized patients. More particularly this invention uses a telecommunications network to provide a real-time, continuous data transfer from patient monitoring equipment into a computer system that continuously assesses such monitored data for medical assessment, tracking of progress of treatment, and other applications for hospitalized patients in geographically dispersed locations.  
         [0002]     While the severity of illness of hospitalized patients over the past 15 years has increased dramatically, the level of and type of care of those patients has remained constant. Most hospitalized patients receive brief minutes of attention during morning rounds from physicians with limited critical care experience. During the remainder of the day and night, nurses are the primary caregivers, with specialists called only after patient conditions have started to deteriorate. The result of this mismatch between severity of illness and physician coverage is an unacceptably high mortality rate. In ICUs, where patients are assumed to get the best care, the mortality rate is 10% nationwide, and marked by a high prevalence of avoidable errors that result in clinical complications. In 1998, the Institute of Medicine (IOM) determined that avoidable patient complications were responsible for 98,000 deaths per year and was the single largest problem in medical care delivery. A 2003 study estimated that 18 patient safety indicators attributed $9.3 billion in excess charges per year and a more recent study (Health Grades Quality Study—July 2004) estimated that the IOM study had grossly underestimated the avoidable deaths and that the figure was closer to 190,000 deaths per year.  
         [0003]     Numerous studies have shown that increasing the involvement of skilled care providers with patients can markedly improve patient outcomes. While providing additional skilled care providers would seem an obvious solution, current trends suggest that the demand for skilled care providers will continue to exceed the supply.  
         [0004]     Attempts to automate various aspects of patient care have been the subject of various inventions. For example, U.S. Pat. No. 5,868,669 to Iliff was issued for “Computerized Medical Diagnostic and Treatment Advice System.” The disclosed invention is for a system and method for providing computerized knowledge based medical diagnostic and treatment advice to the general public over a telephone network.  
         [0005]     U.S. Pat. No. 5,823,948 to Ross, Jr. et al was issued for “Medical Records Documentation, Tracking and Order Entry System”. The disclosed invention is for a system and method that computerizes medical records, documentation, tracking and order entries. A teleconferencing system is employed to allow patient and medical personnel to communicate with each other. A video system can be employed to videotape a patient&#39;s consent.  
         [0006]     U.S. Pat. No. 4,878,175 to Norden-Paul et al. was issued for A Method for Generating Patient-Specific Flowsheets By Adding/Deleting Parameters.” The disclosed invention is for an automated clinical records system for automated entry of bedside equipment results, such as an EKG monitor, respirator, etc. The system allows for information to be entered at the bedside using a terminal having input means and a video display.  
         [0007]     U.S. Pat. No. 5,544,649 to David et al. was issued for Ambulatory Patient Health Monitoring Techniques Utilizing Interactive Visual Communications.” The disclosed invention is for an interactive visual system, which allows monitoring of patients at remote sites, such as the patient&#39;s home. Electronic equipment and sensors are used at the remote site to obtain data from the patient, which is sent to the monitoring site. The monitoring site can display and save the video, audio and patients data.  
         [0008]     U.S. Pat. No. 5,867,821 to Ballantyne et al. was issued for “Method and Apparatus for Electronically Accessing and Distributing Personal Health Care Information and Services in Hospitals and Homes.” The disclosed invention is for an automated system and method for distribution and administration of medical services, entertainment services, and electronic health records for health care facilities.  
         [0009]     U.S. Patent No. 5,832,450 to Myers et al. issued for “Electronic Medical Record Using Text Database.” The disclosed invention is for an electronic medical record system, which stores data about patient encounters arising from a content generator in freeform text.  
         [0010]     U.S. Pat. No. 5,812,983 to Kumagai was issued for “Computer Medical File and Chart System.” The disclosed invention is for a system and method which integrates and displays medical data in which a computer program links a flow sheet of a medical record to medical charts.  
         [0011]     U.S. Pat. No. 4,489,387 to Lamb et al. was issued for “Method and Apparatus for Coordinating Medical Procedures.” The disclosed invention is for a method and apparatus that coordinates two or more medical teams to evaluate and treat a patient at the same time without repeating the same steps.  
         [0012]     U.S. Pat. No. 4,731,725 to Suto et al. issued for “Data Processing System which Suggests a Pattern of Medical Tests to Reduce the Number of Tests Necessary to Confirm or Deny a Diagnosis.” The disclosed invention is for a data processing system that uses decision trees for diagnosing a patient&#39;s symptoms to confirm or deny the patient&#39;s ailment.  
         [0013]     U.S. Pat. No. 5,255,187 to Sorensen issued for “Computer Aided Medical Diagnostic Method and Apparatus.” The disclosed invention is for an interactive computerized diagnostic system which relies on color codes which signify the presence or absence of the possibility of a disease based on the symptoms a physician provides the system.  
         [0014]     U.S. Pat. No. 5,839,438 to Chen et al. issued for “Intelligent Remote Visual Monitoring System for Home Health Care Service.” The disclosed invention is for a computer-based remote visual monitoring system, which provides in-home patient health care from a remote location via ordinary telephone lines.  
         [0015]     U.S. Pat. No. 5,842,978 to Levy was issued for “Supplemental Audio Visual Emergency Reviewing Apparatus and Method.” The disclosed invention is for a system which videotapes a patient and superimposes the patient&#39;s vital statistics onto the videotape.  
         [0016]     U.S. Pat. No. 6,364,834 issued to Reuss, et al. was issued for a “Method and System for Remotely Monitoring Multiple Medical Parameters in an Integrated Medical Monitoring System.” The disclosed invention is for an integrated medical monitoring system having a patient monitor, a central monitor, and a remote access device. Each of these devices is tied together through an integrated communications link. The communications between various components of the system are bi-directional, an attribute described as affording the opportunity to change data sampling rates and select which parameters to monitor from the remote location The thrust of the Reuss Patent is the collection of data from monitors so that the data are available to a caregiver. The caregiver may view the data on a display or request the data for viewing.  
         [0017]     U.S. Pat. No. 4,838,275 issued to Lee for a “Home Medical Surveillance System,” describes an apparatus for use in a patient&#39;s home that includes special furniture on which the patient lies and sits. Embedded in this special furniture are devices that automatically sense multiple parameters related to the patient&#39;s health. The disclosed invention is directed to monitoring individual ambulatory patients in a home environment. However, this monitoring is not stated to be continuous.  
         [0018]     U.S. Pat. No. 3,646,606 issued to Buxton et al. for a “Physiological Monitoring System,” describes an apparatus for measuring physiological parameters indicative of the condition of a patient and sending those parameters to a central monitoring station. The central monitoring station would display the parameters in analog and digital form issue an alert signal in the event certain parameter values are detected. Viewing patient data is accomplished by selecting a patient using a switch ( FIG. 3 , callout  122 ). Thus, not all patients are monitored at all times. The described invention is directed to a data gathering system combined with a single event driven process to manage “emergencies.” Data is presented to a single operator and, except for certain alert conditions, the evaluation of that data is charged to the single operator.  
         [0019]     While these inventions provide useful records management and diagnostic tools, none of them provides a comprehensive communications system that incorporates for monitoring and providing real time continuous assessment and intervention of monitored hospitalized patients at disparate patient monitoring stations.  
         [0020]     What would be useful would be a communication network for automated monitoring of multiple hospitalized patients, capable of using diverse data sources to provide a continuous assessment of a patient&#39;s condition. Such a network would support computerized diagnostic tools to aid caregivers in identifying and treating hospitalized patients who would benefit from monitoring and assessment. Such a network would further comprise the ability to flexibly and individually establish and/or revise alerts for patients from a central location based on individualized patient parameters and to utilize computer based algorithms to a communications network optimized for intervening appropriately.  
       SUMMARY  
       [0021]     An embodiment of the present invention uses a telecommunications network to facilitate real-time, continuous assessment of hospitalized patients in geographically dispersed locations. For the purpose of this and other embodiments of the present invention, a “hospitalized patient” refers to a person admitted to a treatment facility capable of providing twenty-four hour care. By way of illustration and not as a limitation, a treatment facility may be a hospital, a nursing home, or other long-term institution that is capable of providing twenty-four hour care. A patient may be selected for monitoring based on criteria established by the treatment facility. By way of illustration and not as a limitation, a ‘monitored patient” comprises a critically ill patient, an acutely ill patient, a patient with a specific illness, an emergency room patient, an operating room patient, and a patient with an uncertain diagnosis.  
         [0022]     Patient monitoring equipment acquires monitored data elements from a hospitalized patient which can come from a patient monitoring station and transmits the monitoring data over a network to a remote command center. Monitored data comprises physiological data elements, video data elements, and audio data elements. The remote command center receives the monitoring data from all of the patient monitoring stations. The remote command center also accesses other data relating to the condition of a patient. By way of illustration and not as limitation, the remote command center has access to data relating to personal information about the patient (name, address, marital status, age, gender, ethnicity, next of kin), medical history (illnesses, injuries, surgeries, allergies, medications), admissions information (symptoms, physiological data, time of admission, observations of admitting caregiver), treatment, lab data, test reports (radiology reports and microbiology reports for example), physician&#39;s notes, a patient&#39;s diagnosis, prescriptions, history, condition, laboratory results and other health-relevant data (collectively “patient data”). The data available to the remote command center over the network, that is, the monitoring data and the patient data, is collectively referred to as “assessment data.” 
         [0023]     A rules engine continuously applies a patient-specific rule or rule set to the data elements selected from the assessment data from each monitored hospitalized patient to determine whether the patient-specific rule for that site has been contravened. In the event the patient-specific rule has been contravened, an alert at the remote command center is triggered. Patient-specific rules for each monitored hospitalized patient may be established and changed at the remote command center for each as the patients&#39; conditions warrant. In one embodiment of the present invention, a patient-specific rule is established to determine whether a patient&#39;s condition is deteriorating. In another embodiment, a patient specific rule is established to determine whether a patient&#39;s condition is improving. In yet another embodiment of the present invention, an alert that a patient-specific rule has been contravened comprises advice on treatment of the patient.  
         [0024]     Another embodiment of the present invention provides continued care software that uses elements of the assessment data to provide decision support and that prompts a user for input to provide decision support to caregivers. A decision support algorithm responds to elements of assessment data to produce textural material describing a medical condition, scientific treatments and possible complications. This information is available in real time to assist in all types of clinical decisions from diagnosis to treatment to triage.  
         [0025]     In still another embodiment of the present invention, order writing software facilitates the ordering of procedures and medications using patient-specific data. The order writing software and the continued care software are interactive allowing a caregiver to access features of both applications simultaneously, so that patient orders are given that are consistent and not conflicting with a patient&#39;s status and condition (i.e., allergies to medications or medications that may conflict with the order in question).  
         [0026]     In yet another embodiment of the present invention, a video visitation system allows remote visitation participants (RVPs) at remote terminals to participate in a video/audio conferencing session with a local visitation participant (LVP) (e.g., the patient or the patient&#39;s caregivers) at a patient site.  
         [0027]     It is therefore an aspect of the present invention to receive at a remote command center monitoring data from a monitored hospitalized patient over a communications network.  
         [0028]     It is another aspect of the present invention to make available other data relating to the condition of a patient to the remote command center.  
         [0029]     It is yet another aspect of the present invention to establish and/or revise patient specific rules at the remote command center and to apply a rules engine to “assessment data” to determine whether a patient-specific rule is contravened.  
         [0030]     It is another aspect of the present invention to determine based on assessment data whether the condition of a monitored hospitalized patient warrants revising a patient-specific rule at the remote command center.  
         [0031]     It is still another aspect of the present invention to issue an alert from the remote command center in the event a patient-specific rule is contravened.  
         [0032]     It is an aspect of the present invention to provide treatment information in an order for an intervention issued by the remote command center to a treatment facility where a monitored hospitalized patient is receiving care.  
         [0033]     It is a further aspect of the present invention to apply decision support algorithms to data relating to the condition of a patient to provide decision support to caregivers.  
         [0034]     It is another aspect of the present invention to provide a video visitation system that allows a remote visitation participant to participate in a video/audio conferencing session with a patient and/or a local visitation participant.  
         [0035]     In an embodiment of the present invention, a hospitalized patient care system comprises a telecommunication network and monitoring stations. The monitoring stations comprise monitoring equipment adapted to monitor data elements from geographically dispersed hospitalized patients and to send the monitored data elements to a remote command center via the telecommunications network. In an embodiment of the present invention, monitoring equipment comprises physiological sensors and monitored data elements comprise physiological data elements. In still another embodiment of the present invention, monitoring equipment comprises a video imaging system that sends video image data elements to the remote command center and a voice communication system that sends audio data elements to remote command center.  
         [0036]     The remote command center receives the monitored data elements from the geographically dispersed hospitalized patients, accesses patient data elements indicative of a medical condition associated with each of the geographically dispersed hospitalized patients, establishes patient-specific rules associated with each of the geographically dispersed hospitalized patients, and applies the patient-specific rules continuously and simultaneously using a rules engine. In an embodiment of the present invention, a patient specific rule comprises an algorithm.  
         [0037]     The rules engine selects data elements from the monitored data elements and the patient data elements associated with a hospitalized patient, applies a patient-specific rule associated with the hospitalized patient to the selected data elements, determines whether the patient-specific rule for the hospitalized patient has been contravened; and in the event the patient-specific rule for the hospitalized patient has been contravened, issues an alert from the remote command center. By way of illustration and not as a limitation, the alert comprises a patient intervention protocol and order.  
         [0038]     In an embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a clinical data element of the hospitalized patient. In an alternate embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a medication data element of the hospitalized patient. In yet another embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a laboratory data element of the hospitalized patient. In still another embodiment of the present invention, the selected data elements comprise a clinical data element of the hospitalized patient and a laboratory data element of the hospitalized patient. In another embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and another physiological data element of the hospitalized patient. In yet another embodiment of the present invention, the selected data elements comprise at least two data elements of the hospitalized patient selected from the group consisting of a physiological data element, a clinical data element of the hospitalized patient, a medication data element of the hospitalized patient, and a laboratory data element of the hospitalized patient.  
         [0039]     Additionally, the rules engine determines whether the hospitalized patient requires monitoring by the monitoring station. In the event the hospitalized patient does not require monitoring by the monitoring station, the rules engine issues a release protocol and order.  
         [0040]     In another embodiment of the present invention, the hospitalized patient care system further comprises an audio/video teleconferencing server. The audio/video teleconferencing server bridges a local visitation terminal and a remote visitation terminal, sends audio and video signals generated by the local visitation terminal to the remote visitation terminal, sends audio and video signals generated by the remote visitation terminal to the local visitation terminal, and provides the audio data elements and video image data elements to both the remote visitation terminal and the local visitation terminal.  
         [0041]     Additionally, the hospitalized patient care system accesses a decision support algorithm and applies the decision support algorithm to selected data elements of a hospitalized patient and user input to provide patient care advice to the user. Patient care advice may be a diagnosis, a method of treatment, and a laboratory procedure. As will be appreciated by those skilled the art, patient care advice may take other forms without departing from the scope of the present invention.  
         [0042]     The patient support system may also access an order writing module that issues orders. By way of illustration and not as a limitation, the order writing module may authorize administering medication to a hospitalized patient, authorize subjecting the hospitalized patient to a laboratory protocol, and subjecting the hospitalized patient to a surgical procedure.  
         [0043]     An embodiment of the present invention provides a method for continuous assessment of geographically dispersed hospitalized patients. Monitored data elements from geographically dispersed hospitalized patients are received at a remote command center. By way of illustration and not as a limitation, monitored data elements comprise physiological data elements, video image data elements and audio data elements.  
         [0044]     In an embodiment of the present invention, patient data elements indicative of a medical condition associated with each of the geographically dispersed hospitalized patients are accessed. Patient-specific rules associated with each of the geographically dispersed hospitalized patients are established. Data elements from the monitored data elements associated with the hospitalized patient and the patient data elements associated with a hospitalized patient are selected and a patient-specific rule associated with the hospitalized patient is applied to the selected data elements.  
         [0045]     A determination is made whether the patient-specific rule for the hospitalized patient has been contravened. In the event the patient-specific rule for the hospitalized patient has been contravened, an alert is issued from the remote command center. By way of illustration and not as a limitation, an alert comprises a patient intervention protocol and order. Additionally, a determination is made whether the hospitalized patient requires monitoring by the monitoring station. In the event the hospitalized patient does not require monitoring by the monitoring station, the rules engine issues a release protocol and order.  
         [0046]     In an embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a clinical data element of the hospitalized patient. In an alternate embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a medication data element of the hospitalized patient. In yet another embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and a laboratory data element of the hospitalized patient. In still another embodiment of the present invention, the selected data elements comprise a clinical data element of the hospitalized patient and a laboratory data element of the hospitalized patient. In another embodiment of the present invention, the selected data elements comprise a physiological data element of the hospitalized patient and another physiological data element of the hospitalized patient. In yet another embodiment of the present invention, the selected data elements comprise at least two data elements of the hospitalized patient selected from the group consisting of a physiological data element, a clinical data element of the hospitalized patient, a medication data element of the hospitalized patient, and a laboratory data element of the hospitalized patient.  
         [0047]     In an embodiment of the present invention, a local visitation terminal and a remote visitation terminal are bridged. Audio and video signals generated by the local visitation terminal are sent to the remote visitation terminal and audio and video signals generated by the remote visitation terminal are sent to the local visitation terminal. The audio data elements and video image data elements are provided to both the remote visitation terminal and the local visitation terminal.  
         [0048]     Another embodiment of the present invention provides a method wherein a decision support algorithm is accessed. The decision support algorithm is applied to selected data elements of a hospitalized patient and to user input to provide patient care advice to the user. Patient care advice may be in the form of a diagnosis, a method of treatment, and a laboratory procedure. As will be appreciated by those skilled the art, patient care advice may take other forms without departing from the scope of the present invention.  
         [0049]     The patient support system may also access an order writing module that issues orders. By way of illustration and not as a limitation, the order writing module may authorize administering medication to a hospitalized patient, authorize subjecting the hospitalized patient to a laboratory protocol, and subjecting the hospitalized patient to a surgical procedure. 
     
    
     DESCRIPTION OF THE FIGURES  
       [0050]      FIG. 1  illustrates a block diagram of the components of a hospitalized patient care system (HPCS) according to embodiments of the present invention.  
         [0051]      FIG. 2  illustrates a block diagram of a patient monitoring station according to an embodiment of the present invention.  
         [0052]      FIG. 3  illustrates a display and control system according to an embodiment of the present invention.  
         [0053]      FIG. 4  illustrates a patient support system according to an embodiment of the present invention.  
         [0054]      FIG. 5  illustrates an order writing data flow according to an embodiment of the present invention.  
         [0055]      FIGS. 6A , B, C, and  6 D illustrate the flow of a decision support algorithm for acalculous cholecsystitis according to an embodiment of the present invention.  
         [0056]      FIG. 7  illustrates the components of a transportable patient care unit according to embodiments of the present invention. 
     
    
     DETAILED DESCRIPTION  
       [0057]     The following terms used in the description that follows. The definitions are provided for clarity of understanding: 
    assessment data—assessment data is all data relevant to the health of a patient.     caregiver—an individual providing care to a patient. Examples include a nurse, a doctor, medical specialist (for example and without limitation an intensivist, cardiologist or other similar medical specialist).     clinical data—data relating to the observed symptoms of a medical condition.     hospitalized patient—a person admitted to a treatment facility capable of providing twenty-four hour care.     monitored data—data received from monitoring devices connected to a monitored hospitalized patient.     monitored hospitalized patient—a hospitalized patient from whom monitored data is collected and whose condition is subject to continuous real-time assessment from a remote command center.     patient data—data relating to a patient&#39;s diagnosis, prescriptions, history, condition, laboratory results and other health-relevant data.     physiological data—any data relating to the functions of the human body and its processes.     symptom—any sign or indication of a health condition that can be identified from patient reports and/or assessment data.    
 
         [0067]     An embodiment of the present invention uses a telecommunications network to facilitate real-time, continuous assessment of hospitalized patients in geographically dispersed locations. Patient monitoring equipment acquires monitoring data from a hospitalized patient associated with a patient monitoring station and transmits the monitoring data over a network to a remote command center. The remote command center receives the monitoring data from all of the patient monitoring stations. The remote command center also accesses other data relating to the condition of a patient such as the “patient data” as defined above. The data available to the remote command center over the network, that is, the monitoring data and the patient data, is collectively referred to as “assessment data.” 
         [0068]     A rules engine continuously applies a patient-specific rule (or series of rules) to the selected data elements of the assessment data from each monitored hospitalized patients to determine whether the patient-specific rule for a hospitalized patient has been contravened. In the event the patient-specific rule has been contravened, an alert at the remote command center is issued. Patient-specific rules for each monitored hospitalized patient may be established and changed at the remote command center for each as the patients&#39; conditions warrant. In one embodiment of the present invention, a patient-specific rule is established to determine whether a patient&#39;s condition is deteriorating. In another embodiment, a patient specific rule is established to determine whether a patient&#39;s condition is improving. In yet another embodiment of the present invention, an alert that a patient-specific rule has been contravened comprises advice on treatment of the patient.  
         [0069]     Another embodiment of the present invention applies continued care software to selected data elements of the assessment data and user input to provide decision support to caregivers. A decision support algorithm responds to data relating to the condition of a patient to produce prompts for additional input or textural material describing a medical condition, scientific treatments and possible complications. This information is available in real time to assist in all types of clinical decisions from diagnosis to treatment to triage.  
         [0070]      FIG. 1  illustrates a block diagram of the components of a hospitalized patient care system (HPCS) according to embodiments of the present invention. A HPCS  100  comprises a plurality of patient monitoring stations. Patient monitoring station “A”  105  and patient monitoring station “N”  110  are illustrated, but the invention is not so limited. For the sake of clarity, the description that follows will refer to patient monitoring station “A”  105 . However, the description applies to all patient monitoring stations within the HPCS  100 .  
         [0071]     Patient monitoring station “A”  105  is connected to network  120  via network interface  155 . Network  120  is preferably a broadband network and may be wired, optical, wireless or a combination of wired, optical or wireless. Also connected to network  120  is remote command center  125 . Remote command center  125  comprises a patient rules generator  130 , a rules engine  135 , patient support system  140 , display and control system  145 , and audio/video (A/V) conferencing server  190 . A network interface  175  provides connectivity between network  120  and the other elements of the remote command center. Network  120  is configured to permit access to external networks  195 , such as the Internet.  
         [0072]      FIG. 2  illustrates a block diagram of a patient monitoring station according to an embodiment of the present invention. Referring to  FIG. 1  and  FIG. 2 , patient monitoring station “A”  105  comprises a patient bed  200 . A data entry means such as a keyboard, touchpad or similar data entry means known in the art  212  allows on site care givers to provide additional data that may be germane to the care of the patient. Video camera  205  is movable both horizontally and vertically and zoomable through remote commands from the display and control system  145  of remote command center  125  so that specific views of the patient may be obtained both up close and generally. A microphone  210  and a speaker  215  permit both one-way audio monitoring of the patient and two-way communication with the patient or others located in patient monitoring station “A”  105 . Patient monitoring devices  220 A- 220 D acquire physiological data from a patient in real-time. A printer  230  receives and prints orders from an authorized remote caregiver. By way of illustration and not as a limitation, an order comprises a lab order, a medication, and a procedure. A network interface  155  provides access to network  120  for transmission of the monitored data, video signal, and audio signals to the remote command center  125  and the receipt of the audio signals and printer signals at the monitoring station.  
         [0073]     Patient monitoring station “A”  105  may be implemented in an intensive care unit, an operating room, a post-operation recovery unit, an emergency room, or any site where a hospitalized patient receives care in accordance with the embodiments of the present invention. Patient monitoring station “A”  105  may be a dedicated site or may be a site that has been equipped to perform the functions of a patient monitoring station on a temporary basis. By way of illustration and not as a limitation,  FIG. 7  illustrates the components of a transportable patient care unit according to embodiments of the present invention. A transportable patient care unit  700  comprises the components illustrated in  FIG. 2  mounted on a cart  750 . Video camera  205  is movable both horizontally and vertically and zoomable through remote commands from the display and control system  145  of remote command center  125  so that specific views of the patient may be obtained both up close and generally. A microphone  210  and a speaker  215  permit both one-way audio monitoring of the patient and two-way communication with the patient or others located in proximity to patient monitoring station “A”  105 . Patient monitoring devices  220 A- 220 D acquire physiological data from a patient in real-time. A printer  230  receives and print orders from an authorized caregiver. By way of illustration and not as a limitation, an order comprises a lab order, a medication, and a procedure. A network interface  155  provides access to network  120  for transmission of the monitored data, video signal, and audio signals to the remote command center  125  and the receipt of the audio signals and printer signals at the monitoring station. A data entry means such as a keyboard, touchpad or similar data entry means known in the art  212  allows on site care givers to provide additional data that may be germane to the care of the patient.  
         [0074]     The remote command center  125  receives monitored data from patient monitoring station “A”  105  and patient condition data  115  via network  125  through network interface  175 . Monitored data comprises real-time data received from monitoring equipment at patient monitoring station “A”  125  that is configured to receive physiological data from a patient requiring critical care and associated with patient monitoring station “A.” The remote command center also receives “patient condition data”  115  applicable to the patient associated with patient monitoring station “A”  105 . Patient condition data comprises data relating to a patient&#39;s diagnosis, prescriptions, history, condition, laboratory results and other health-relevant data.  
         [0075]     The rules generator  130  and the rules engine  135  facilitate detection of impending problems and automate problem detection thereby allowing for intervention before a patient condition reaches a crisis state. The rules engine  135  continuously applies a patient-specific rule to selected data elements of the assessment data  115  to determine whether the patient-specific rule for a hospitalized patient has been contravened. In the event the patient-specific rule has been contravened, the remote command center issues an alert. In one embodiment of the present invention, a patient-specific rule is established to determine whether a patient&#39;s condition is deteriorating and an alert comprises an intervention order and protocol. In another embodiment of the present invention, the rules engine is further adapted to determine whether a monitored hospitalized patient requires monitoring by a monitoring station. If not, a release protocol and order are issued.  
         [0076]     Patient-specific rules may be established and revised at the remote command center for the hospitalized patient associated with each patient monitoring station. Thus, rules engine generator  130  establishes one or more rules for the hospitalized patient associated with patient monitoring station “A”  105 . By way of illustration, a patient-specific rule dictates threshold limits for changes over time of specific vital sign data. Thresholds that are patient-specific disease-specific are established. The rules engine then evaluates the monitored data for the specific vital sign data to determine if a change threshold has been exceeded.  
         [0077]     For example, a patient with coronary artery disease can develop myocardial ischemia with relatively minor increases in heart rate. Heart rate thresholds for patients with active ischemia (e.g. those with unstable angina in a coronary care unit) are set to detect an absolute heart rate of 75 beats per minute. In contrast, patients with a history of coronary artery disease in a surgical ICU have thresholds set to detect either an absolute heart rate of 95 beats per minute or a 20% increase in heart rate over the baseline. For this threshold, current heart rate, calculated each minute based on the median value over the preceding 5 minutes, is compared each minute to the baseline value (the median value over the preceding 4 hours).  
         [0078]     In another embodiment of the present invention, a patient-specific rule is based on multiple variables. By way of illustration, a patient-specific rule is contravened if the rules engine determines that monitored data reflects both a simultaneous increase in heart rate of 25% and a decrease in blood pressure of 20%, occurring over a time interval of 2 hours.  
         [0079]     For multi-variable patient-specific rules, thresholds rely on known or learned associations between changes in multiple variables, which variables may comprise diverse data types. Thus, a patient-specific rule may associate monitored physiological data with patient clinical data. The association may change depending on the diagnosis of the patient, the medication given the patient, and the results of laboratory data. For example, a patient-specific rule may associate central venous pressure and urine output, because simultaneous decreases in these two variables can indicate that a patient is developing hypovolemia. Another patient-specific rule may cause the rules engine to evaluate laboratory data (e.g. looking for need to exclude active bleeding and possibly to administer blood).  
         [0080]     In an embodiment of the present invention, a patient-specific rule established for a hospitalized patient and the hospitalized patient is associated with a particular monitoring station. In this embodiment, if the patient were associated with a different monitoring station, the remote command center would associate the patient-specific rule with the different monitoring station at the time that the association between the hospitalized patient and the different monitoring station is made. In this way, patient specific rules “move” with the patient without manual intervention.  
         [0081]     Referring to  FIG. 1 , the display and control system  145  provides the human interface for the remote command center.  FIG. 3  illustrates a display and control system according to an embodiment of the present invention. A display and control system  145  comprises a video display unit  305 , a computer terminal  310 , a camera control  315 , and an audio control  320 . The video display unit  305  displays real-time monitoring data and video images from patient monitoring station “A”  105 . The computer terminal  310  allows selecting the layout and content displayed on the video display unit  305 , provides access to the record of the patient associated with patient monitoring station “A”  105 , and permits entry of data into that record. The camera control  315  permits control from the remote command center  125  of the video camera  205  (see  FIG. 2 ) at the patient monitoring station “A”  105 . The audio control permits control from the remote command center  125  of a microphone  210  and a speaker  215  within patient monitoring station “A”  105 . Connectivity between the components of the display and control systems  145  and patient monitoring station “A”  105  is provided by network interface  175 , network  120 , and network interface  155 .  
         [0082]     Referring again to  FIG. 1 , the remote command center  125  comprises patient support system  140 .  FIG. 4  illustrates a patient support system according to an embodiment of the present invention. Referring to  FIG. 4 , patient support system  140  comprises a computer  405 . Computer  405  operates continued care software  420  and order writing software  415 . Diagnostic software  410  and order writing software  415  make calls to datastore  425  to access the assessment data related to a particular hospitalized patient associated with patient monitoring station “A”  105  (see,  FIG. 1 ).  
         [0083]     Continued care software  420  comprises decision support algorithms that operate on elements of assessment data and/or input from a caregiver to facilitate decisions relating to diagnosis, treatment and triage. Continued care software may be applied at the time the patient is admitted and throughout the patient&#39;s stay within a treatment facility. Thus, a diagnosis may be made based on the initial data acquired during admission, following the completion of laboratory procedures, or after other pertinent information is acquired. In an embodiment of the present invention, continued care software  420  evaluates continuously, selected data elements of assessment data and provides an alert if those data are indicative of a different diagnosis. The alert may take the form of suggested diagnoses that are vetted by a series of questions posed by the continued care software  420  to a caregiver. Based on the responses to the questions, a suggested diagnosis may be eliminated. The alert may also comprise instructions for specific tests to be run on the monitored hospitalized patient to help formulate a new diagnosis. Once a diagnosis is confirmed, the continued care software  420  continues to monitor changes in patient data and issues an alert if the current diagnosis should be reevaluated by a caregiver.  
         [0084]     In still another embodiment of the present invention, continued care software  420  operates on a diagnosis to “triage” a patient. For example and without limitation a caregiver requests an Apache II score based on the diagnosis. Continued care software  420  calls selected data elements from datastore  425  appropriate to the diagnosis. The values of the selected data elements are weighted according to an algorithm and a patient severity score is determined. This patient severity score is used to determine whether the patient is treated in a patient monitoring station. For example, if one embodiment of the present invention, if the severity score is greater than or equal to a particular threshold, the patient is identified as requiring observation via a patient monitoring station. If the severity score is less than that threshold, the patient is triaged to a facility other than a patient monitoring station, thereby assigning patient monitoring stations to patients who are most likely to benefit from monitoring and continued assessment.  
         [0085]     In another embodiment of the present invention, computer  405  operates order writing software  415 , either independently or in conjunction with the operation of continued care software  420  to order tests to complete the data required for a potential diagnosis.  
         [0086]      FIG. 5  illustrates an order writing data flow according to an embodiment of the present invention. Referring to  FIG. 5 , order entry user interface  500  allows the caregiver to order procedures and medication to assist the patients at a patient monitoring station. For example, the caregiver can order an ECG  504 . Thereafter the order is reviewed and a digital signature relating to the caregiver is supplied  506 . Once reviewed and signed off, the order is approved  507  and sent to the data output system  510 . Thereafter the data output system prints the order to the printer at a patient monitoring station  516 . For record keeping purposes the order is exported in the HL7 language to the hospital data system  518 . In addition the data output system adds an item to the database that will subsequently cause a caregiver to check the ECG results. This notification to the task list is provided to the database  514 . In addition, as part of the database an orders file relating to the specific patient is also kept. The fact that an ECG has been ordered is entered in the orders file for that patient.  
         [0087]     In a similar fashion using the order entry user interface  500  the caregiver can order medications  502  for a patient. The medication order then is provided to an order checking system  508 . The order checking system retrieves information from the database  514  relating to allergies of the patient and medication list that comprises medications that are already being administered to the patient. This allows for the order checking system to check for drug allergies and drug interactions. Further laboratory data is extracted from the database  514  and the order checking system checks to insure that there will be no adverse impact of the recommended dosage upon the renal function of the patient. Once the order checking system  508  is completed, the order is approved and provided to the order review and signature module  506 . In this module the digital signature of a caregiver is affixed to the order electronically and the order is approved  507 . Thereafter it is provided to the data output system  510  where again the orders are printed or transmitted via HL7 for the patient monitoring station  516 , for the pharmacy  517  and for the treatment facility data system  518 . In this case, any medications that are ordered are then provided to the medications list file in the database  514  so that the complete list of all medications that are being administered to the patient is current.  
         [0088]     As noted, the order writing software  415  may also interact with continued care software  410 . Referring again to  FIG. 4 , a caregiver selects a suggested diagnosis from the continued care software  420  and enters the order writing software  415 . The order writing software identifies the appropriate test or tests and issues the actual order or orders for the identified tests. Each order is then sent to the appropriate testing facility. The tests are conducted, and the completion of the order is reported to the data store  425  and the completion information is received by the order writing software  415 . Additionally, continued care software  420  acquires the test results from the datastore  425  and updates the list of suggested diagnoses.  
         [0089]     Continued care software  420  provides reference material directed to the standardized treatment of the hospitalized patient. In order to standardize treatment provided to monitored hospitalized patients at the highest possible level, decision support algorithms are used in the present invention. These include textural material describing the topic, scientific treatments and possible complications. This information is available in real time to assist in all types of clinical decisions from diagnosis to treatment to triage.  
         [0090]     As noted earlier, an aspect of the present invention is to standardize care and treatment across patient monitoring stations. This is effective in the present invention by providing decision support to caregivers as well as information concerning the latest care and practice standards for any given condition. Table  1  below is an exemplary list of a wide variety of conditions within the general categories of cardiovascular, endocrinology, general, gastrointestinal, hematology, infectious diseases, neurology, pharmacology, pulmonary, renal, surgery, toxicology, for which algorithms of care have been developed. As will be appreciated by those skilled in the art, the list in Table 1 is not exhaustive and other decision support algorithms may be developed for other conditions without departing from the scope of the present invention.  
                       TABLE 1                                       Bradyarrhythmias diagnosis &amp; treatment           Cardiogenic shock treatment           Cardio-pulmonary resuscitation treatment           Congestive heart failure diagnosis &amp; treatment           Emergency cardiac pacing indications           Fluid resuscitation indications &amp; treatment           Hypertensive crisis treatment           Implantable cardio-defibrillators indications           Intra-aortic balloon devices indications           Magnesium treatment           Treatment of hypotension           Myocardial infarction diagnosis &amp; treatment           MI with left bundle branch block diagnosis           Pulmonary artery catheter indications           Permanent pacemakers indications           Pulmonary embolism diagnosis           Pulmonary embolism treatment           Supra-ventricular tachyarrhythmias diagnosis &amp;           treatments           Unstable angina diagnosis &amp; treatment           Venous thromboembolism prophylaxis treatment           Venous thrombosis: diagnosis &amp; treatment           Ventricular arrhythmias diagnosis &amp; treatment           Adrenal insufficiency diagnosis and treatment           Diabetic ketoacidosis diagnosis and treatment           Hypercalcemia: diagnosis &amp; treatment           Hyperglycemia: insulin treatment           Steroid replacement treatment           Thyroid disease diagnosis and treatment           End of life treatment decisions           Pressure ulcers treatment           Organ procurement indications           Antibiotic associated colitis diagnosis and treatment           Hepatic encephalopathy diagnosis and treatment           Hepatic failure diagnosis and treatment           Treatment of patients with ascites           Nutritional management           Acute pancreatitis diagnosis and treatment           Upper gastro-intestinal bleeding: stress prophylaxis           treatment           Upper gastro-intestinal bleeding: non-variceal treatment           Upper gastro-intestinal bleeding: variceal treatment           Heparin treatment           Heparin-induced thrombocytopenia diagnosis and           treatment           The bleeding patient diagnosis and treatment           Thrombocytopenia diagnosis and treatment           Thrombolytic treatment           Transfusion indications           Hematopoetic growth factor indications           Warfarin treatment           Acalculus cholecystitis diagnosis and treatment           Bloodstream infections diagnosis and treatment           Candiduria diagnosis and treatment           Catheter related septicemia diagnosis and treatment           Catheter replacement strategies           Endocarditis prophylaxis           Endocarditis diagnosis and treatment           Febrile neutropenia diagnosis and treatment           Fever of Unknown Origin diagnosis           HIV+ patient infections diagnosis and treatment           Meningitis diagnosis and treatment           Necrotizing soft tissue infections diagnosis and treatment           Non-infectious causes of fever diagnosis           Ophthalmic infections diagnosis and treatment           Pneumonia, community acquired diagnosis and treatment           Pneumonia, hospital acquired diagnosis and treatment           Septic shock diagnosis and treatment           Sinusitis diagnosis and treatment           Systemic Inflammatory Response Syndrome diagnosis           and treatment           Transplant infection prophylaxis           Transplant-related infections diagnosis and treatment           Agitation, anxiety, depression &amp; withdrawal treatment           Brain death diagnosis           Guillain-barre syndrome diagnosis and treatment           Intracerebral hemorrhage diagnosis and treatment           Myasthenia gravis diagnosis and treatment           Neuromuscular complications of critical illness diagnosis           and treatment           Non-traumatic coma diagnosis           Sedation treatment           Status epilepticus diagnosis and treatment           Stroke diagnosis and treatment           Sub-arachnoid hemorrhage diagnosis and treatment           Aminoglycoside dosing and therapeutic monitoring           Amphotericin-b treatment           Analgesia treatment           Drug changes with renal dysfunction           Penicillin allergy diagnosis and treatment           Neuromuscular blocker treatment           Vancomycin treatment           Adult Respiratory Distress Syndrome: hemodynamic           treatment           Adult Respiratory Distress Syndrome: steroid treatment           Adult Respiratory Distress Syndrome: ventilator treatment           Asthma diagnosis &amp; treatment           Bronchodilator use in ventilator patients           Bronchoscopy &amp; thoracentesis indications           Chronic Obstructive Pulmonary Disease treatment           Chest X-ray indications           Noninvasive modes of ventilation indications           Endotracheal tubes &amp; tracheotomy indications           Treatment of airway obstruction           Ventilator weaning           Acute renal failure: diagnosis and treatment           Dialysis indications           Diuretic treatment           Hyperkalemia: diagnosis &amp; treatment           Hypernatremia: diagnosis &amp; treatment           Hypokalemia: diagnosis &amp; treatment           Hyponatremia: diagnosis &amp; treatment           Oliguria diagnosis and treatment           Obstetrical complications and treatment           Dissecting aortic aneurysm diagnosis and treatment           Post-operative hypertension treatment           Post-operative myocardial ischemia (non-cardiac surgery)           treatment           Diagnosis and treatment of arrhythmias after cardiac           surgery           Diagnosis and treatment of post-operative bleeding           Post-operative management of abdominal           Post-operative management of open heart           Post-operative management of thoracotomy           Post-operative management of carotid           Wound healing treatment           Diagnosis and treatment of acetaminophen overdose           Diagnosis and treatment of anaphylaxis           Diagnosis and treatment of cocaine toxicity           Diagnosis and treatment of alcohol withdrawal           Diagnosis and treatment of hyperthermia           Diagnosis and treatment of latex allergy           Diagnosis and treatment of unknown poisoning           Diagnosis and treatment of abdominal compartment           syndrome           Diagnosis and treatment of blunt abdominal injury           Diagnosis and treatment of blunt aortic injury           Diagnosis and treatment of blunt cardiac injury           Deep Venous Thrombosis prophylaxis treatments           Acid-base disturbance diagnosis and treatment           Electrolyte disturbance diagnosis and treatment           Severity adjustment calculation and outcome prediction           Ventilator treatment           Continuous renal replacement treatment           Infusion pump administration treatment           Fungal infection diagnosis and treatment           Viral infection diagnosis and treatment           Diagnosis and treatment of extremity compartment           syndrome           Diagnosis and treatment of head injury           Diagnosis and treatment of hypothermia           Diagnosis and treatment of identification of cervical cord           injury           Diagnosis and treatment of spinal cord injury           Diagnosis and treatment of open fractures           Diagnosis and treatment of penetrating abdominal injury           Diagnosis and treatment of penetrating chest injury           Admission criteria           Discharge criteria           Patient triage           Discharge planning                      
 
         [0091]      FIGS. 6A , B, C and  6 D illustrate an application of a decision support algorithm for the diagnosis and treatment of acalculous cholecystitis to patient data according to an embodiment of the present invention.  FIGS. 6A through 6D  are exemplary only and are not limiting. As will be appreciated by those skilled in the art, decision support algorithms (DSAs) for other conditions may be implemented in the continued patient care software without departing from the scope of the present invention.  
         [0092]     Referring to  FIG. 6A , a datastore comprising patient data is accessed by the DSA  600  for data indicative of clinical infection. A determination is made whether the data is sufficient to determine whether the patient is clinically infected  602 . If the data necessary to make the decision are not available, the system continues its monitoring  604  until data in the datastore indicates otherwise. Alternatively, an alert may be issued on a monitor at the command center although this is not a requirement for further tests to be ordered. Test that are ordered by the DSA are then performed on the patient to obtain the data required for the decision.  
         [0093]     If the data are sufficient, a determination is made whether the patient meets criteria for a clinical infection as measured by elevated temperature and leukocystosis  606 . In an embodiment of the present invention, the criteria are temperature great than 102 F, or a white blood cell count greater than 12,000. If the criteria for clinical infection are not met the system of the present invention goes back into its continuous monitoring mode  608 . The process is then complete and the continuous monitoring of the present invention continues.  
         [0094]     If the patient is clinically infected  606 , the DSA accesses the patient data datastore and acquires data indicative of whether the patient has had a previous cholecystectomy  610 . A determination is then made whether the data is sufficient to determine whether the patient has had a previous cholecsystectomy  612 . If the data necessary to make the decision are not available, the DSA prompts the caregiver to find out this information  613 . When the information is obtained it is put into the datastore. Notations of “incomplete data” are kept by the system so that treatment records and need for tests can be audited. This is accomplished by storing an “incomplete data” record  614 .  
         [0095]     If the data are sufficient, a determination is made whether the patient has had a previous cholecystectomy  616 . If the patient has had a previous cholecystectomy, it is very unlikely that the patient has acalculous cholecystitis. Therefore the DSA has completed its analysis for acalculous cholecytitis and the continuous monitoring of the present invention continues for other possible etiologies of infection  618 .  
         [0096]     Referring to  FIG. 6B , if the patient has not had a previous cholecystectomy, the DSA accesses the patient datastore and acquires data indicative of whether the patient has any of a set of risk factors  620 . In another embodiment of the present invention, the risk factors comprise: 1) Prolonged intensive care unit (ICU) stay (defined as greater than six (6) days); 2) recent surgery within the last two weeks (particularly aortic cross clamp procedures); 3) hypotension (BP less than 90 mmHg); 4) positive end-expiratory pressure (PEEP) greater than ten (10) centimeters (cm); 5) transfusion greater than six (6) units of blood; 6) inability to use the gastrointestinal (GI) tract for nutrition; or 7) immunosuppresssion (AIDS, transplantation, or leukemia).  
         [0097]     If the data are sufficient, a determination is made whether the patient has any of the risk factors  626 . If the patient does not have any of the risk factors, the diagnostic process is then complete and the continuous monitoring of the present invention continues  628 .  
         [0098]     If the patient has any of the seven risk factors, the DSA accesses the patient data datastore and acquires data indicative of whether the patient has any of a set of symptoms  630  or abnormal laboratory values. A determination is made whether the data is sufficient to determine whether the patient has any of the symptoms  632  or abnormal laboratory values. If the data necessary to make the decision are not available, the DSA directs the order writing software  415  (see  FIG. 4 ) to order the tests  633 . Results are sent to the datastore. Notations of “incomplete data” are kept by the system so that treatment records and need for tests can be audited. This is accomplished by storing an “incomplete data” record  634 . Alternatively, an alert may be issued on a monitor at the command center to check for right upper quadrant tenderness although this is not a requirement for further tests to be ordered. In another embodiment of the present invention, the symptoms comprise: right upper quadrant (RUQ) tenderness and the abnormal laboratory results comprising elevated alkaline phosphatase; elevated bilirubin; or elevated liver transaminases.  
         [0099]     If the data are sufficient, a determination is made whether the patient has any of the symptoms  636  or abnormal laboratory values. If the patient does not have any of the symptoms or abnormal laboratory values, the DSA concludes that it is very unlikely that the patient has acalculous cholecystitis. The process is then complete and the continuous monitoring of the present invention continues  638 .  
         [0100]     Referring to  FIG. 6C , if the patient has any of the symptoms or abnormal laboratory values, the DSA accesses the patient data datastore and acquires data indicative of whether alternative intra-abdominal infectious sources are more likely  640 . A determination is made whether the data is sufficient to determine whether the other infectious sources are more likely  642 . If the data necessary to make the decision are not available, the DSA prompts the user for a response as to whether other infectious causes are present and considered more likely  644 . The user can then provide the requested information that can be considered by the system  646  for further analysis.  
         [0101]     If the data are sufficient, a determination is made whether other sources of infection are more likely  646 . Regardless of the outcome of this determination, the DSA accesses the patient datastore and acquires data indicative of whether the patient is sufficiently stable to be subjected to testing outside of the critical care environment  650 . A determination is made whether the data are sufficient to determine whether the patient is stable to go outside of the critical care environment  652 . If the data necessary to make the decision are not available, the DSA prompts the user for a response  654  and may direct the order writing software  415  (see FIG. 4) to order tests or procedures  653  that will assist in such a determination. An “incomplete data” record is also created  651 . Test results are sent to the datastore. Notations of “incomplete data” are kept by the system so that treatment records and need for tests can be audited. This is accomplished by storing an “incomplete data” record  654 . Alternatively, an alert may be issued on a monitor at the command center although this is not a requirement for further tests to be ordered.  
         [0102]     Referring to  FIG. 6D , if the data are sufficient, a determination is made whether the patient is sufficiently stable to be subjected to testing outside of the critical care environment  656 .  
         [0103]     If the patient is not sufficiently stable to be subjected to testing outside of the critical care environment (regardless of whether other sources of infection are indicated), the DSA issues a message comprising a recommendation that empiric antibiotic be considered and a bedside ultrasound be performed and the results communicated to the patient datastore  658 . In still another embodiment of the present invention, the DSA directs the order writing software (see  FIG. 4 ) to order the bedside ultrasound. The DSA accesses the test results and other patient data  662 . If no other infectious etiologies are identified, no abnormalities of the gall-bladder are noted, and the patient is not improving, the DSA issues a message comprising a “provisional diagnosis of acalculous cholecystitis” and recommends an empiric cholecystectomy and systemic antibiotics  664 . If no other infectious etiologies are identified, no abnormalities of the gall bladder are noted, and the patient is improving, the DSA issues a message comprising a recommendation to observe the patient  666 .  
         [0104]     If the patient is sufficiently stable to go outside of the critical care environment for a test and a determination was made that no other sources of infection were indicated (see  FIG. 6C, 646 ), the DSA issues an order that empiric antibiotics be considered and a morphine sulfate Cholescintigraphy test be performed  668  and the results communicated to the datastore. In still another embodiment of the present invention, the DSA directs the order writing software  415  (see  FIG. 4 ) to order the test.  
         [0105]     A determination is made whether the results of the tests are normal  670 . If the test indicates an abnormality, the DSA issues a message comprising a recommendation to consider a diagnosis of acalculous cholecystitis, administer systemic antibiotics and perform either a cholecystectomy or a percutaneous drainage  672 . If the results are normal, acalculous cholecystitis is excluded  674 . The process is then complete and the continuous monitoring of the present invention continues.  
         [0106]     If the patient is sufficiently stable to go outside of the critical care environment for a test and a determination was made that other sources of infection were indicated (see  FIG. 6C, 646 ), the DSA issues an order to consider empiric antibiotics and for an abdominal CT scan to be performed  680  and the results communicated to the datastore. In still another embodiment of the present invention, the DSA directs the order writing software  415  (see  FIG. 4 ) to order the test.  
         [0107]     The test results and other data are analyzed  682  and a determination is made whether other infection sources are indicated and whether the gall bladder is normal or if abnormalities are present that are not diagnostic  684 . If other infectious etiologies are not apparent and the test: a) demonstrates abnormalities of the gall bladder but not diagnostic; or b) no gall-bladder abnormalities are noted, the DSA issues a report comprising a recommendation to maintain continued observation of the patient  686 . The process is then complete and the continuous monitoring of the present invention continues. Alternatively, if other infectious etiologies are apparent, the DSA will make recommendations as to further diagnostics and treatments.  
         [0108]     Referring again to  FIGS. 1 and 2 , the remote command center comprises an AN conferencing server  190 . In an embodiment of the present invention, A/V conferencing server  190  acquires audio and video signals from patient monitoring station “A” and provides a terminal (not shown) access to these signals via external network access  195 . In yet another embodiment of the present invention addition, a local terminal (not shown) operated by a “local visitation participant” or “LVP” and a remote terminal (not shown) operated by a “remote visitation participant” or “RVP” are bridged by AN conferencing server  190  to provide audio and video signals from the patient monitoring station, the local terminal and the remote terminal available simultaneously to LVP and RVP. Additionally, a terminal user may control the position of camera  205 . By way of illustration and not as a limitation, RVPs may be family members or other concerned parties while LVPs may be patients, nurses, doctors, family members or other concerned parties. This embodiment thus permits family members the capability to “virtually visit” other sick family members when a physical visit to a patient&#39;s location is not possible and/or desirable. The “virtual visit” further allows the possibility to see and speak with a care provider regarding a patient&#39;s care or related subjects without having to be physically located at the health care provider&#39;s location. The present invention also provides a means for the floor staff (i.e. those caregivers in the hospital at or near the patient&#39;s bedside) to instantly alert the command center of the conditions of patients who destabilize thereby allowing for more rapid response by those manning the command center.  
         [0109]     When each command center person logs onto the system of the present invention, a background service is started. This service subscribes to an emergency alert server that is connected to a video server. As noted earlier, the video server provides video feed from each beside to the command center as needed. Emergency message are passed from the bedside through the video server to the command center. As the emergency alert server receives a message from a video server, it sends a message to all of the subscribed services in the command center. This notification alerts the command center users by means of a “pop-up” alert window at the users&#39; workstation that an emergency condition exists at the bed calling for the alert, and that the floor caregiver has requested immediate backup.  
         [0110]     To facilitate the emergency call capability of the present invention, in addition to the various network connections of a more automated type, an emergency “call button” is provided at each critical care location. This could by or near each bed, at a nurse&#39;s station, at a mobile care bed or any location where the patient may be located. When pressed, the call button causes a message to be sent to the emergency alert server at the command center that a patient emergency has occurred.  
         [0111]     The present invention comprises a video/audio server (Axis  2401 ) dedicated to each critical care location. A button activation mechanism and associated wiring is provided to allow the call button to be positioned in the room at a location convenient to the caregiver calling for command center backup.  
         [0112]     Currently each video server can support up to 16 call buttons by using combinations of the four inputs to signify one alarm in a 4-bit binary pattern although this is not meant as a limitation. A typical installation would use one button or perhaps two (e.g. two beds per room) per video server.  
         [0113]     A software interrupt event handler is configured on the video server to respond to activation of the emergency call button.  
         [0114]     The emergency alert server comprises a web service called for sending emergency alert signals that is placed in service at system startup. When called, emergency alert web service responds with an acknowledgement message (e.g. “Alert Received”). The emergency alert web service identifies the ward and bed directly from the IP address (unique to each video server) and input number it was passed. It then sends a message to all subscribing clients identifying the emergency condition, the ward, and bed.  
         [0115]     When a user logs into a workstation at the command center a user alert service subscribes to the emergency alert server and waits for any emergency message in the background. Upon receiving an emergency message, the service will popup a window with the message on top of the desktop and stay there until the user dismisses or acknowledges the alert. The user alert service the loads video assessment module to allow the command center to view the bed with the emergency.  
         [0116]     In another embodiment of the present invention, a critical care hospital bed comprises monitoring instruments linked to a wireless network. This serves the needs of those patients who are transported from one location to another (either internal to a hospital or to other hospitals or diagnostic centers) for testing, procedures or other reasons. In this embodiment, monitoring continues using typical monitoring means that have been described above which include, without limitation, physiological monitoring equipment, video monitoring equipment and an emergency call button, all of which transmit their signals in a wireless fashion so that movement of the patient bed does not interrupt the transmission of information.  
         [0117]     A telecommunications network for remote patient monitoring has now been illustrated. It will be apparent to those skilled in the art that other variations of the present invention are possible without departing from the scope of the invention as disclosed. For example, one can envision different ratios of remote command center to patient monitoring stations. Certain types of decision support algorithms would be used by intensivists, other types of remote monitoring of not only patient monitoring stations but other types of hospital functions as well as industrial functions where critical expertise is in limited supply but where that expertise must be applied to ongoing processes. In such cases a system such as that described can be employed to monitor processes and to provide standardized interventions across a number of geographically dispersed locations and operations. Further, any reference to claim elements in the singular, for example, using the articles “a,” “an,” or “the” is not to be construed as limiting the element to the singular.