Abstract:
Mobile clinicians conduct in-home patient visits utilizing on-site diagnostic and treatment equipment, where service is enhanced by the use of portable computing and communications equipment. Initially, a mobile care entity provides a network of predesignated mobile clinicians, each having the use of a preprogrammed portable computer. Each computer is coupled to a wireless communications device, and includes local storage of patient data. Under a predetermined schedule, each portable computer updates patient data in the local storage utilizing the wireless communications device to download updates from a central storage facility. Whenever the mobile care entity receives requests for medical service at a patient&#39;s premises, the entity selects a mobile clinician and dispatches him/her to the patient&#39;s premises. The clinician visits the patient&#39;s premises accompanied by an assortment of electronic diagnostic and treatment devices, such as a pulse oximiter, x-ray machine, lab analyzer, EKG equipment, etc. To examine the patient, the doctor utilizes various diagnostic devices to prepare machine-readable reports of related aspects of the patient&#39;s condition. The clinician directs the portable computer to perform follow-up tasks including: (1) electronically collecting the prepared reports and graphically presenting them in human-readable form, (2) storing a machine-readable medical record including details of the patient&#39;s exam, and (3) utilizing the wireless device to transmit the reports and records to the central storage facility.

Description:
BACKGROUND OF THE INVENTION  
       [0001]     1. Field of the Invention  
         [0002]     The present invention relates to the provision of medical services through clinicians&#39; “house calls.” More particularly, the invention concerns a method providing a network of mobile clinicians that individually conduct in-home patient visits utilizing on-site diagnostic and treatment equipment, where service is enhanced by the use of portable computing and communications equipment.  
         [0003]     2. Description of the Related Art  
         [0004]     With the current American healthcare situation, many sick patients encounter difficulty when attempting to access a physician&#39;s office. Some of these difficulties include restrictions on the number or type of health maintenance organization (HMO) visits, limitations of visits to certain preselected physicians, scheduling difficulties, transportation and parking challenges, slow or non-existent insurance reimbursement, and the like. Aged, infirm, or other homebound patients are faced with the particularly difficult challenge of transporting themselves to a physician&#39;s office to receive medical attention. Even for ambulatory patients, the current setup can be frustrating to the patient, due to the need to schedule an appointment far in advance.  
         [0005]     In contrast to the traditional doctor&#39;s office, urgent care centers are geared toward minor, ambulatory emergencies and generally provide office-level care on a walk-in basis. For non-ambulatory patients, the emergency room provides similar barriers to availability as a personal physician&#39;s office. Whether ambulatory or not, many patients report a strong aversion to visiting this typically expensive, uncontrolled, slow-moving environment, even among those with a serious medical need. Additionally, gatekeeper triage of acute medical conditions can leave the patient feeling abandoned and the physician feeling that she has taken a measurable risk with the patient&#39;s outcome. Nonetheless, there are still more than one hundred thousand visits to American emergency rooms annually. And, even though more than eighty percent of emergency room visits are not necessary to save life and limb, this is sometimes the only alternative for patients requiring prompt service.  
         [0006]     As one alternative to visiting an emergency room or a personal physician, some patients call “911” to dispatch an ambulance, especially for medical conditions that are perceived to be particularly serious. Nonetheless, the fanfare and cost of ambulance services can be excessive for many ultimately non-serious medical conditions that typically prompt patients to call an ambulance.  
         [0007]     In contrast to the options of meeting a personal physician, visiting an emergency room, or calling an ambulance, many people would prefer to receive acute care in their home or workplace. In fact, the concept of rendering acute care in the home or workplace was the fundamental basis of healthcare for more than four thousand years until the mid-1950s. In the past forty years, however, the concept has fallen out of favor. In fact, between 1960 and 1975, the number of house calls made by family practitioners decreased by seventy-five percent to approximately seventeen million. In 1989, only one million house calls were billed to Medicare. Physicians stopped-making house calls because of many reasons, including inadequate reimbursement, perceived liability, and questions about the quality of care. Each of these concerns is enhanced when dealing with acutely ill patients.  
         [0008]     Due to these and other unsolved problems, then, patients&#39; options for obtaining prompt, convenient, acute medical care are not completely adequate today.  
       SUMMARY OF THE INVENTION  
       [0009]     Broadly, the present invention concerns a method of providing medical care, in which mobile clinicians conduct in-home patient visits utilizing on-site diagnostic and treatment equipment, where service is enhanced by the use of portable computing and communications equipment. Initially, a mobile care entity provides a network of predesignated mobile clinicians. The mobile care entity provides each clinician with use of a preprogrammed portable computer, called a “clinician device.” Each clinician device is coupled to a wireless communications device and includes local storage of patient data.  
         [0010]     According to a predetermined schedule, each clinician device updates patient data in the local storage by utilizing the wireless communications device to download updates from a central storage facility. As an example, this may occur during off-hours on a daily basis, or another appropriate schedule. The mobile care entity receives requests for mobile service to be rendered at a patient&#39;s premises. These requests may originate directly from the patient, or from a referral source such as a personal physician, a health care organization, etc. In response to the request for service, the mobile care entity selects one of its predesignated mobile clinicians and dispatches the selected clinician to the patient&#39;s premises.  
         [0011]     The clinician visits the patient&#39;s premises accompanied by an assortment of electronic medical care devices, such as a pulse oximeter, x-ray machine, laboratory analyzer, cardiac output monitoring equipment, etc. The clinician examines the patient, which may include selecting and operating one or more of the on-site medical care devices to analyze one or more aspects of the patient&#39;s condition and prepare representative outputs. Beneficially, the clinician device may also interact with off-site diagnostic devices, utilizing a communications interface to access remotely located diagnostic equipment that is unsuitable for transportation to the patient&#39;s premises due to size, expense, etc. Then, the clinician directs the clinician device to perform various operations, including (1) electronically collecting the medical care device outputs and presenting them in human-readable form, (2) storing a machine-readable medical record including details of the clinician&#39;s examination of the patient, and (3) utilizing the wireless communications device to transmit the machine-readable reports and medical records to the central storage facility.  
         [0012]     The foregoing features may be implemented in a number of different forms. For example, the invention may be implemented to provide a method to render on-site medical care. In another embodiment, the invention may be implemented to provide an apparatus, such as a portable computer programmed to assist the on-site clinician as discussed herein. In still another embodiment, the invention may be implemented to provide a signal-bearing medium tangibly embodying a program of machine-readable instructions executable by a digital data processing apparatus to perform operations as discussed herein. Another embodiment concerns logic circuitry having multiple interconnected electrically conductive elements configured to perform operations as discussed herein.  
         [0013]     The invention affords its users with a number of distinct advantages. Importantly, the provision of in-home medical services enhances the bond between patient and doctor, as the doctor enters the patient&#39;s home and receives the patient&#39;s trust. Also, the provision of on-site medical services saves time of busy people, since they can avoid having to drive to the hospital and wait for medical attention and prescription filling. This invention also enables doctors to save money by avoiding the substantial overhead costs of maintaining traditional medical offices. Patients also save money by receiving at-home care rather than hospital commitment, ambulance services, or emergency room visits. This invention is especially useful for elderly or other infirm patients that simply cannot travel to the doctor&#39;s office. Also, in non-life threatening cases, the invention helps non-ambulatory patients obtain medical care without the flashing lights, sirens, costs, and other excessive attributes of ambulance service. By providing in-home care, the method of this invention also encourages more rapid discharge of patients after surgery. As another benefit, the invention can be used to provide on-site medical services for sporting events, air shows, beaches, and other public gatherings. The invention also provides a number of other advantages and benefits, which should be apparent from the following description of the invention. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0014]      FIG. 1  is a block diagram of the hardware components and interconnections of an in-home medical care environment, according to the invention.  
         [0015]      FIG. 2  is a block diagram of a digital data processing machine according to the invention.  
         [0016]      FIG. 3  shows an exemplary signal-bearing medium according to the invention.  
         [0017]      FIG. 4  is a flowchart of a patient call initiation sequence, according to the invention.  
         [0018]      FIG. 5  is a flowchart of an automatic call initiation sequence, according to the invention.  
         [0019]      FIG. 6  is a flowchart of a clinician notification sequence, according to the invention.  
         [0020]      FIG. 7  is a flowchart of an on-site patient diagnosis/treatment sequence, according to the invention.  
         [0021]      FIG. 8  is a flowchart of a mobile care setup sequence, according to the invention. 
     
    
     DETAILED DESCRIPTION  
       [0022]     The nature, objectives, and advantages of the invention will become more apparent to those skilled in the art after considering the following detailed description in connection with the accompanying drawings.  
       Hardware Components &amp; Interconnections  
       [heading-0023]     In-Home Medical Care Environment  
         [0024]     One aspect of the invention concerns a system for dispatching medical services, which may be embodied by various hardware components and interconnections. This system is illustrated, along with other related components, utilizing the exemplary operating environment  101  of  FIG. 1 . The operating environment  101  includes the patient&#39;s home  100 , a call center  110 , clinician device  140 , on-site medical care devices  185 , the Internet  200 , and various secondary components  130 - 137 . Generally, the call center  110  receives and processes requests for in-home medical visits to patients. Medical services are provided at the patient&#39;s home  100 , which may be equipped with various devices for monitoring and reporting the patient&#39;s condition, as shown below. The clinician utilizes the computer-based clinician device  140  to aid in conducting house calls, as explained in greater detail below. As further described below, the secondary components  130 - 137  include other related components such as remote diagnostic equipment, records storage, third parties, Internet web sites, local hospitals, billing facilities, etc.  
         [0025]     In the environment  101 , employees or other agents of a “mobile care entity” screen and process incoming calls, dispatch clinicians, store records, process billings, and perform other services related to the providing of on-site medical care. The mobile care entity may comprise a corporation, non-profit group, partnership, sole proprietorship, or other suitable organization.  
         [0026]     Patient&#39;s Home  
         [0027]     Central to the provision of in-home medical services (“house calls”) is the patient&#39;s home  100 , workplace, relative&#39;s home (not the patient&#39;s), restaurant, mall, sporting event, or any other place where the patient desires to receive medical attention. For ease of reference, this place is referred to as the patient&#39;s “home”  100 . However, the site  100  is not limited to the patient&#39;s living quarters, although this may constitute an illustrative embodiment.  
         [0028]     Although the invention contemplates clinicians making self-supported house calls without requiring any equipment at the patient&#39;s home  100 , the mobile care entity may optionally pre-equip the home  100  with various electronics. For example, the patient&#39;s home  100  may be equipped with a telephone  102  for use by the patient in placing calls to the call center  110 , and also for use by on-site clinicians. Moreover, the patient&#39;s home  100  may also include an internet capable communication device  104 , such as a personal computer, web-enabled phone, web-TV, etc. As explained below, the device  104  may serve the patient&#39;s requests for medical attention, as well as by on-site clinicians&#39; need to gather information, file reports, etc. The patient&#39;s home  100  may also include an internet-capable medical device  106 , which comprises one or more machines capable of monitoring the patient&#39;s medical condition and transmitting representative reports by the Internet  200 , administering medication or other treatment pursuant to remotely transmitted commands, etc. As an example, the device  106  may comprise heart monitoring equipment, dialysis machinery, blood pressure monitoring equipment, respiratory equipment, etc. A custom device programmed to contact the mobile care entity may also be installed at the patient&#39;s home  100 .  
         [0029]     In one embodiment, one or more of the telephone  102 , communication device  104 , medical device  106  are interconnected to one another other.  
         [0030]     Call Center  
         [0031]     The mobile care entity operates the call center  110  to receive requests for in-home patient visits. Alternatively, the mobile care entity may hire a subcontractor to perform the services of the call center  110 . The call center  110  includes a telephone bank  112 , triage processing block  114 , clinician location block  116 , pre-scheduled appointment information block  120 , and wireless clinician paging system  118 . In one embodiment, one or more of the telephone  112 , triage processing block  114 , clinician location block  116 , appointment information block  120 , and paging system  118  are interconnected to one another.  
         [0032]     Depending upon whether the blocks  114 - 120  are implemented with humans or computers, the telephone bank  112  may be implemented by traditional telephones (used by humans), or automated switching equipment (compatible with computers). The triage processing block  114  includes personnel and/or equipment trained or programmed to receive incoming calls, assess whether the reported medical condition is appropriate for treatment by mobile care entity&#39;s clinicians. The mobile care facility may field some conditions appropriate for emergency room treatment, such as influenza, broken bones, non-life threatening abrasions, etc. The triage processing block  114 , however, refers life-threatening conditions to more appropriate ambulance, life-flight, or other critical care services.  
         [0033]     The clinician location block  116  includes personnel and/or equipment trained or programmed to identify appropriate clinicians and dispatch them to serve incoming requests. The clinician location block  116  may operate based on geographic proximity, time availability, and other considerations. Once identified, the clinician is paged, called, or otherwise contacted by the wireless clinician paging system  118 , which includes personnel and/or equipment that is appropriately trained or programmed for this purpose. As described below, clinicians may be contacted via their clinician devices  140 . In one embodiment, the clinician location block  116  receives input from the clinician devices  140  as to the clinician&#39;s current geographic location. The clinician location block  116  stores this information for reference at the time of dispatch.  
         [0034]     The pre-scheduled appointment information block  120  includes personnel and/or equipment trained or programmed to maintain schedules for the mobile care entity&#39;s network of clinicians. Thus, the block  120  may be implemented by scheduling software, physical calendars, or a combination.  
         [0035]     Clinician Tools  
         [0036]     In addition to operating the call center  110 , the mobile care entity hires, contracts, or otherwise maintains a network of mobile clinicians that are available on a full-time, part-time, on-call, or other basis. The mobile care entity provides each clinician with access to a clinician device  140  and a selection of “clinician tools” for on-site patient diagnosis/treatment, billing, and record keeping. Broadly, the clinician tools include a host of diagnostic and treatment devices, including the on-site medical care devices  185  along with the typical accoutrements of a family physician.  
         [0037]     As explained below, each of the medical care devices  185  includes a wireless (as illustrated) or non-wireless communications interface with the clinician device  140 . Although the precise details may vary depending upon the application, the devices  185  may include the following items, which may be conveniently stored in a van or other means of transportation: electro cardiograph machine, pulse oximeter, laboratory analyzer, x-ray machine, and the like.  
         [0038]     The clinician tools also include other devices without any wireless interface, such as a stethoscope, tongue depressor, thermometers, blood pressure cuff, splints, casts, bandages, sutures, syringes, and other typical equipment of an emergency room, family physician, etc. Furthermore, the clinician may arrive at the patient&#39;s house equipped with a mini-pharmacy, constituted by a representative selection of most commonly prescribed drugs. The clinician&#39;s tools may further include equipment for performing a broad range of diagnostic procedures and tests, including urinalysis, blood count/chemistry, cholesterol/triglyceride analysis, splinting fractures and broken bones, biopsies, suturing lacerations, constructing casts, pregnancy tests, visual acuity tests, draining abscesses, foreign body removal, pregnancy tests, and the like.  
         [0039]     As mentioned above, the clinician also arrives at the patient&#39;s home  100  with a portable computer, represented by the clinician device  140 . The mobile care entity provides each clinician with access to a clinician device  140 . To save costs, clinicians with different working hours may share the same clinician device  140 . In one embodiment, each clinician device  140  includes, in one or more housings, a wireless interface  142 , mapping device  144 , medical records  146 , wireless interface  148  for diagnostic equipment, human interface  150 , and location device  152 , although other embodiments may omit one or more of these. In one embodiment, one or more of these components are interconnected with one another.  
         [0040]     In one embodiment, the wireless interface  142  comprises a digital cellular telephone capable of accessing the public Internet  200 . As an alternative or additional feature, the interface  142  also include a system to receive pages and/or wireless telephone calls, such as paging messages from the wireless clinician paging system  118 . The location device  152  comprises self-locating device such as a global positioning system (GPS) engine, long range navigation (LORAN) module, OmniTRACS system, radio frequency receiver, inertial navigation system, etc. The locating device  152  cooperates with mapping device  144  hardware and software to display maps to assist the clinician in reaching the patient&#39;s home  100 . Although the mapping device  144  may include mapping software, the clinician device  140  may utilize the interface.  142  to access mapping software available through the Internet  200  or other remote site. The medical records  146  comprise a medical records database that is frequently synchronized with patient data contained in the medical record center  130 . The wireless interface  148  utilizes Bluetooth technology, infrared, RF, spread spectrum, or other wireless interface to conduct data exchange between the clinician device  140  and wireless components of the on-site diagnostic equipment  185 .  
         [0041]     The clinician device  140  also includes a human interface  150  data entry, which may include a keyboard, digitizing pen, voice interface, mouse, touch-operated input device, a combination of the foregoing, or other appropriate device(s).  
         [0042]     Internet &amp; Secondary Components  
         [0043]     As mentioned above, the system  101  also includes a number of secondary components  130 - 137 , with a variety of functions. These secondary components  130 - 137  as well as the patient&#39;s home  100 , call center  110 , and clinician&#39;s device  140  are selectively linked by an appropriate network such as the public Internet  200  (as shown), intranet, wide area network, token ring, etc. The selective linking between these components corresponds to the nature of interaction between components, which is described in greater detail below.  
         [0044]     The secondary components  130 - 137  include a medical record center  130 , remote medical care devices  132 , web server  133 , third party vendors  131 , interested third party with access authorization  134 , medical information web site  135 , local hospital admissions  136 , and a billing entity  137 . Each of these components has a different type and extent of information exchange with other parts of the system  101 , as shown below. Additional secondary components may also be incorporated into the environment  101 , depending upon the particular needs of the application.  
         [0045]     The medical record center  130  comprises a server, workstation, mass storage device, or other appropriate facility to store medical records for patients of the mobile care entity. The medical record center  130  may be co-located with the call center  110 , for example. As one example, the medical record center  130  may provide access to stored medical records through an Internet web site utilizing password checks, firewalls, encryption, or other suitable guarantees of patient security. This information, along with any other information to be shared, may be provided by the web server  133 . Depending upon the implementation requirements, communications may be expedited by integrating the web server  133  with one or more other components such as the call center  110 , medical records center  130 , etc.  
         [0046]     The remote medical care devices  132  represent diagnostic and/or treatment equipment located remotely from the patient&#39;s home. The devices  132  include computer or other electronic communication components for exchanging information with the on-site clinician and the clinician device  140 . Despite their remote location from the patient, the devices  132  are therefore available to diagnose/treat the patient. As illustrated, communications between the remote devices  132  and the clinician device  140  is relayed by the Internet  200 . The devices  132  may include equipment that is expensive, bulky, movement-sensitive, unique, or otherwise unsuitable for transportation to the patient&#39;s home. Some examples include a T c O 2  machine, End Tidal Capnometer, Pulmonary Function Machine, and the like.  
         [0047]     The third party vendor  131  represents an entity such as a home health agency, durable medical equipment manufacturer, or health maintenance organization. The vendor  131  may have reason to communicate with the web server  1 . 33 , medical record center  130 , clinician (via clinician device  140 ) or other clinical components for the purpose of fulfilling Health Care Financing Administration billing requirements, communicating medical info to the physician or receiving medical info, for example.  
         [0048]     The interested third party with access authorization  134  represents an entity such as a patient&#39;s personal care physician, close friend, partner, or relative with a valid reason to access the medical records  130  to monitor the patient&#39;s treatment. In the illustrated embodiment, the third party  134  may access the medical records  130  via the Internet  200 .  
         [0049]     The medical information web site  135  represents various Internet web sites with reference information that is helpful to mobile care clinicians. The clinicians may access these web sites during on-site patient visits, for example using the patient&#39;s internet capable communication device  104 , or by using the wireless interface  142  feature of the clinician device  140 . Clinicians may also access such web sites after patient visits, for the purpose of performing any follow-up research and diagnosis. Although some content may be provided by the mobile care entity through its web server  133 , the web sites  135  are chiefly operated by independent content providers supplying reference and other medical information.  
         [0050]     The local hospital admissions  136  represents an admissions desk or other similar facility in a hospital. Communications with the admissions  136  may be helpful, for example, to aid the on-site clinician in admitting the patient to a hospital. Furthermore, hospital admissions  136  may have reason to communicate with the medical record center  130 , clinician (via clinician device  140 ), and other clinical components for the purpose of medical records review, discharge planning or coordinating levels of service.  
         [0051]     The billing entity  137  represents an entity such as a contracted billing agency, in-house billing staff, automated billing service or software, etc. The entity  137  may have reason to communicate with the clinical and administrative components or the environment  101  for the purpose of generating Health Care Financing Administration compliant bills, reviewing utilization experience or analyzing trends.  
         [heading-0052]     Exemplary Digital Data Processing Apparatus  
         [0053]     Another aspect of the invention concerns a digital data processing apparatus, which may be used to implement the clinician device  140  and other components with data processing functions. This apparatus may be embodied by various hardware components and interconnections;.one example is the digital data processing apparatus  200  of  FIG. 2 . The apparatus  200  includes a processor  202 , such as a microprocessor or other processing machine, coupled to a storage.  204 . In the present example, the storage  204  includes a fast-access storage  206 , as well as nonvolatile storage  208 . The fast-access storage  206  may comprise random access memory (“RAM”), and may be used to store the programming instructions executed by the processor  202 . The nonvolatile storage  208  may comprise, for example, one or more magnetic data storage disks such as a “hard drive,” a tape drive, or any other suitable storage device. The apparatus  200  also includes an input/output  210 , such as a line, bus, cable, electromagnetic link, or other means for the processor  202  to exchange data with other hardware external to the apparatus  200 .  
         [0054]     Despite the specific foregoing description, ordinarily skilled artisans (having the benefit of this disclosure) will recognize that the apparatus discussed above may be implemented in a machine of different construction, without departing from the scope of the invention. As a specific example, one of the components  206 ,  208  may be eliminated; furthermore, the storage  204  may be provided on-board the processor  202 , or even provided externally to the apparatus  200 .  
         [heading-0055]     Logic Circuitry  
         [0056]     In contrast to the digital data storage apparatus discussed previously, a different embodiment of the invention uses logic circuitry instead of computer-executed instructions. Depending upon the particular requirements of the application in the areas of speed, expense, tooling costs, and the like, this logic may be implemented by constructing an application-specific integrated circuit (“ASIC”) having thousands of tiny integrated transistors. Such an ASIC may be implemented with CMOS, TTL, VLSI, or another suitable construction. Other alternatives include a digital signal processing chip (“DSP”), discrete circuitry (such as resistors, capacitors, diodes, inductors, and transistors), field programmable gate array (“FPGA”), programmable logic array (“PLA”), and the like.  
       Operation  
       [0057]     Having described the structural features of the present invention, the method aspect of the present invention will now be described. Although the present invention has broad applicability to medical care, the specifics of the structure that has been described is best suited for providing a network of mobile clinicians that individually conduct in-home patient visits enhanced by the use of portable computing and communications equipment, and the explanation that follows will emphasize such an application of the invention without any intended limitation.  
         [heading-0058]     Signal-Bearing Media  
         [0059]     In the context of  FIG. 1 , such a method may be implemented by operating the clinician device  140 , call center  110 , medical record center  130 , or other components (each as embodied by a digital data processing apparatus  200 ) to execute respective sequences of machine-readable instructions. In each case, these instructions may reside in various types of signal-bearing media. In this respect, one aspect of the present invention concerns a programmed product, comprising signal-bearing media tangibly embodying a program of machine-readable instructions executable by a digital data processor to perform a method of rendering mobile medical care as described below.  
         [0060]     As a specific example, this signal-bearing media may comprise, for example, RAM (not shown) contained within the clinician device  140 , as represented by the fast-access storage  206 . Alternatively, the instructions may be contained in another signal-bearing media, such as a magnetic data storage diskette  300  ( FIG. 3 ), directly or indirectly accessible by the processor  202 . Whether contained in the storage  206 , diskette  300 , or elsewhere, the instructions may be stored on a variety of machine-readable data storage media, such as direct access storage (e.g., a conventional “hard drive,” redundant array of inexpensive disks (“RAID”), or another direct access storage device (“DASD”)), magnetic tape, electronic read-only memory (e.g., ROM, EPROM, or EEPROM), optical storage (e.g., CD-ROM, WORM, DVD, digital optical tape), paper “punch” cards, or-other suitable signal-bearing media including transmission media such as digital and analog and communication links and wireless. In an illustrative embodiment of the invention, the machine-readable instructions may comprise software object code, compiled from a language such as “C,” etc.  
         [heading-0061]     Logic Circuitry  
         [0062]     In contrast to the signal-bearing medium discussed above, the method aspect of the invention may be implemented using logic circuitry, without using a processor to execute instructions. Logic circuitry may be implemented in the clinician device  140 , call center  110 , medical record center  130 , or other components, where the logic circuitry itself is configured to perform operations to implement the method of the invention. The logic circuitry may be implemented using many different types of circuitry, as discussed above.  
         [heading-0063]     Operating Sequences  
         [0064]      FIGS. 4-8  provide one illustrative, detailed example of the method aspect of the invention. For ease of explanation, but without any intended limitation, the examples of  FIGS. 4-8  are described in the context of the hardware components and interconnections of  FIG. 1 , as described above.  
         [heading-0065]     Mobile Care Setup  
         [0066]      FIG. 8  shows a mobile care setup sequence  800 , where use and operation of the mobile care environment  100  is initiated. The sequence  800  begins in step  802 , where the mobile care entity establishes its network of clinicians. The mobile care entity may construct this network by full-time or part-time hiring of clinicians, enrolling independent contractors, contracting with other agencies, or other suitable relationships. Clinicians may include physicians, specialists such as dermatologist, x-ray technicians, nurses, nurse practitioners, physicians&#39; assistants, paramedics, E.M.T. personnel, or other suitable medical care providers. In step  804 , the mobile care entity provides the clinicians with the clinician devices  140 , described above. Each clinician has access to at least one of the clinician device  140  while on-duty; clinicians may also have access to clinician devices  140  while on-call if the budget and number of clinician devices  140  permits.  
         [0067]     In step  806 , clinician devices  140  individually utilize their respective wireless interfaces  142  to self-initiate downloading of patient records from the medical record center  130 . To maintain current local records  146 , each clinician device  140  automatically repeats the synchronization step  806  whenever an appropriate criteria is met. This criteria may require a periodic, non-periodic, random, or other sufficiently frequent synchronization. The clinician devices  140  may be programmed to synchronize at the same or different times. Synchronization helps the clinician devices  140  preserve the currency of their medical records  146 . However, if the number and size of medical records does not permit downloading of all data from the medical records center  130 , the synchronization  806  may be limited to certain patients (such as those scheduled for future visits by clinicians associated to the particular device  140 ), medical records of prescribed recency/type, etc. As an alternative, the timing and extent of each clinician device&#39;s synchronization may be manually controlled by a clinician.  
         [heading-0068]     Patient Call Initiation  
         [0069]      FIG. 4  shows a patient call initiation sequence  400 . In the sequence  400 , a patient requests medical attention from the mobile care entity, and the call center  110  responds by selecting and dispatching a clinician from its network. The sequence  400  begins in step  402 , where the patient enters the mobile care facility&#39;s web site (supported by the web server  133 ). In this example, the patient initiates step  402  by using the internet capable communication device  104 . As an alternative, the patient may initiate the sequence  400  manually by using the telephone  102  to contact a call center telephone  112 , in which case the call processing and triage operations are performed manually by staff (not shown) at the call center  110 . For ease of explanation, the following description is limited to the embodiment where automated equipment at the call center  110  processes the patient&#39;s call.  
         [0070]     Upon receiving initial access by the patient in step  402 , the web server  133  queries the patient for name, password, or other indicia that identifies the patient as an existing customer of the mobile care entity. Having identified the patient, the web server  133  proceeds to gather information from the patient as to his/her medical condition (step  404 ). Namely, the patient answers certain predetermined “triage” or screening” questions, which may include a series of interactive inquiries based upon the appropriate triage algorithm. In one embodiment, the patient answers these inquiries by mouse-clicking on alternative choices, entering typed text, etc.  
         [0071]     Next, the web server  133  forwards the patient&#39;s triage answers to the triage processing block  114  (step  406 ), which determines whether there is enough information to process the patient&#39;s call (step  408 ). If not, the triage processing block generates additional inquiries (step  410 ) and returns to step  404 . When the triage processing block  114  determines that the patient has provided sufficient information to proceed (step  408 ), the triage processing block  114  determines whether the patient&#39;s condition presents a life-threatening situation (step  412 ). In one embodiment, the triage processing block accesses medical information stored locally or via Internet  200  in order to determine the outcome of the triage process. If the patient&#39;s condition constitutes a life-threatening situation, the triage processing block  114  directs the web server  113  to display a message instructing the patient to obtain emergency ambulance services, for example by dialing “ 911 ” (step  414 ). Thus, the call center  110  refuses the patient&#39;s call, since it is more appropriate for ambulance or other rapid deployment services rather than an on-site clinician visit.  
         [0072]     If the patient&#39;s situation is not an emergency, step  412  leads to step  416 , where the triage processing block  114  retrieves the patient&#39;s medical records. The medical records may be retrieved from a third party vendor  131  (such as the patient&#39;s primary care physician), from the medical record center  130 , locally from the call center  110 , or another source. Moreover, the records may be retrieved by hand, over the Internet  200 , by facsimile machine, or other automated or manual means.  
         [0073]     Next, in step  418  the triage processing block determines the appropriate clinician type and equipment required to treat the patient&#39;s reported condition. As mentioned previously, clinicians may have qualifications of various levels, such as nurses, nurse practitioners, physicians, x-ray technicians, and the like. In one exemplary case, an appropriate clinician/device may be a nurse qualified to take blood (clinician) and a blood analyzer (device). In a different case, an appropriate clinician/device may be a physician (clinician) accompanied by an x-ray technician (second clinician) and x-ray machine (device). Some examples of other clinician/device combinations include cardiologist, and impedance monitor, ultrasound machine and technologist, and other specialists. As one example, step  418  may be performed by utilizing a software module such as an expert system.  
         [0074]     After the triage processing block  114  identifies the appropriate type of clinician for the current patient (step  418 ), the clinician location block  116  identifies (step  420 ) and thereby selects a clinician in the mobile care entity&#39;s network to satisfy the requirements of clinician type from step  418 . This may be performed by consulting a look-up table or other cross-referencing guide, for example. Some exemplary considerations for step  420  include (1) the urgency of the patient&#39;s request, (2) the geographical location of both patient and candidate clinician, (3) the clinician&#39;s status as being on-duty busy, on-duty idle, on-call, off-duty but available, (4) the clinician&#39;s pre-scheduled appointments available from the pre-scheduled appointment information block  120 , etc. Step  420  may select multiple clinicians if required, such as an x-ray technician visit at one o&#39;clock and then a physician follow-up visit at two o&#39;clock.  
         [0075]     The wireless clinician paging system  118  then transmits a dispatch notification to the selected clinician, including forwarding of sufficient information to the clinician to initiate the house call (step  422 ). This information identifies the patient&#39;s name, the patient&#39;s address and telephone number, the reported medical condition, and other information needed to initiate the house call. Further information may include, for example, call center instructions resulting from patient triage/interview, information on the patient&#39;s reported condition, call priority, proposed or promised arrival time, etc. This information may be conveyed to the clinician by various means, such as (1) the call center  110  transmitting a message to the Internet  200  for subsequent retrieval by the clinician, wireless internet connection, (2) standard cellular telephone or paging system, (3) standard wireless paging system, (4) proprietary wireless system such as NEXTEL, or (5) other suitable means. The on-call clinician receives this information at his/her clinician device  140 , via the wireless interface  142 .  
         [0076]     In step  424 , the triage processing block  114  responds to the patient&#39;s initial call (from step  402 ) by providing the patient with certain follow-up information, such as the name of any clinicians that have been dispatched, proposed arrival time, etc. The block  114  may convey this information to the patient by telephone  102 , e-mail, updating a confidential patient status area on the web site  133 , etc. Furthermore, the triage processing block  114  may transmit e-mail or other suitable messages to other interested parties, or make such information available to parties with access authorization  134 . Such parties may include, for example, the patient&#39;s primary care physician, pre-registered friends/relatives, those with e-mail addresses entered by the patient during initial registration with the mobile care entity, insurance providers, etc. This completes the sequence  400 .  
         [heading-0077]     Automatic Call Initiation  
         [0078]      FIG. 5  shows an automatic call initiation sequence  500 . In the sequence  500 , automatic equipment installed at the patient&#39;s home requests medical attention from the mobile care entity, and the call center  110  responds by selecting and dispatching one or more clinicians from its network. The steps are initiated in step  502 , where the internet capable medical device  106  transmits notification to the triage processing block  114 . This notification can take various forms, such as a periodic report, an emergency request automatically generated in response to a condition such as dangerously low blood pressure, manually generated emergency request such as the patient&#39;s manual activation of a “panic button,” etc.  
         [0079]     In response to the notification of step  502 , the triage processing block  114  determines whether the notification contains sufficient information to begin the process of dispatching a clinician (step  504 ). If not, the call center  110  initiates a request for additional information (step  505 ). In one example, this request may occur manually, by call center staff placing a telephone call to the patient. In another example, the triage processing block  114  may submit a machine-initiated request for additional information, for example by querying the medical device  106 .  
         [0080]     When there is sufficient information to process the notification of step  502 , the triage processing block  114  determines whether the patient&#39;s situation constitutes a life-threatening emergency. If so, the call center  110  directs the patient to obtain emergency medical care (step  508 ), for example by dialing “911.” If the notification of step  502  arose from the patient activating a panic button, step  508  may be satisfied by call center  110  staff contacting the patient by telephone  102  or calling an ambulance on behalf of the patient. On the other hand, if the notification of step  502  arose from the medical device  106 , step  508  may involve the triage processing block  114  returning an automated message to the medical device  106  or calling an ambulance on behalf of the patient.  
         [0081]     If the present situation does not constitute an emergency, the triage processing block  114  retrieves the patient&#39;s medical record (step  510 ). The medical records may be retrieved from a third party vendor  131  (such as the patient&#39;s primary care physician), from the medical record center  130 , locally from the call center  110 , or another source. Moreover, the records may be retrieved by hand, over the Internet, by facsimile machine, or other automated or manual means.  
         [0082]     Next, in step  512  the triage processing block  114  determines whether any response by an on-site clinician is required. This step is performed by evaluating the notification (from step  502 ), any additional information (from step  505 ), and the patient&#39;s medical record (from step  510 ). The evaluation of step  512  may be performed, for example, by using an expert system software module, or performing pre-programmed comparison with a list of various conditions for which clinician dispatch is required. If clinician dispatch is not needed, the patient is contacted and advised accordingly. Namely, call center  110  staff may manually contact the patient, or the triage processing block  114  may automatically contact the patient by sending an appropriate message to the medical device  106  and/or the device  104 .  
         [0083]     On the other hand, if step  512  mandates clinician dispatch, the triage processing block  114  proceeds with step  516 . Particularly, the block  114  determines the appropriate clinician type and equipment required to treat the patient&#39;s reported condition, and then the clinician location block  116  identifies and thereby selects an on-call clinician in the mobile care entity&#39;s network to satisfy these requirements. The wireless clinician paging system  118  then transmits a dispatch notification to the selected clinician, including forwarding of sufficient information to the clinician to initiate the house call (step  518 ).  
         [0084]     In step  520 , the triage processing block  114  responds to the original notification of step  502  by providing the patient with certain follow-up information, such as the name of any clinician(s) scheduled to visit the patient and the proposed arrival time(s). This completes the sequence  500 .  
         [heading-0085]     Clinician Notification  
         [0086]      FIG. 6  shows a clinician notification sequence  600 , where the clinician receives dispatch notification from the call center  110  and responds accordingly. The steps are initiated in step  602 , when the clinician device  140  receives the call center&#39;s dispatch notification (transmitted previously in steps  422  or  518 , as discussed above). As mentioned above, this information identifies the patient, the reported medical condition, and other information needed to initiate the house call, and may include further information such as diagnosis/treatment instructions or allergy alerts resulting from patient triage/interview, information on the patient&#39;s reported condition, call priority, proposed arrival time, etc.  
         [0087]     In response to the dispatch notification from step  602 , the mapping device  144  component of the clinician device  142  consults the location device.  152  to determine the clinician&#39;s current location (step  604 ). Also in step  604 , the mapping device  144  prepares a map including the clinician&#39;s present location (from the device  152 ), the patient&#39;s location (from the call center&#39;s dispatch notification), and appropriate driving directions between these sites.  
         [0088]     Next, in step  606  the clinician device  140  transmits a message reporting the location of the clinician device  140 . To aid the call center  110  in monitoring the clinician&#39;s progress toward the patient&#39;s home, location reporting messages may be repeatedly transmitted to the call center  110  in response to: (1) occurrence of a repeating time period, such as one minute, (2) call center queries, (3) significant changes in clinician location, or (4) another reason.  
         [0089]     After step  606 , the clinician device  140  retrieves the patient&#39;s medical records. This is performed by operating the interface  142  to contact the medical record center  130  via the Internet  200 , and retrieving the patient&#39;s most updated medical records. Also, the clinician device  140  updates any locally stored medical records  146  with the current information from the medical record center  130 . Alternatively, rather than actively obtaining the patient&#39;s medical records, the clinician device  140  may receive unsolicited transmission of the patient&#39;s medical records by the call center  110 . After step  608 , the sequence  600  is complete and the clinician is ready to render on-site patient care upon arrival.  
         [heading-0090]     On-Site Patient Diagnosis/Treatment  
         [0091]      FIG. 7  shows the sequence for on-site patient diagnosis/treatment, as performed by the clinician. The sequence  700  begins in step  702 , when the clinician visits the patient&#39;s home  100  after having been dispatched as discussed above. The clinician is accompanied by the clinician device  140 , on-site electronic medical care devices  185 , and other clinician tools as discussed above.  
         [0092]     In step  704 , the clinician examines the patient. The clinician selects and operates various of the clinician&#39;s tools to conduct the examination. With traditional, manually-operated tools such as thermometers, blood pressure cuffs, and the like, use and feedback occurs in traditional fashion. The clinician may enter data from such manual examination into the clinician device  140  for inclusion into the patient&#39;s medical record and/or analysis by diagnostic programs of the clinician device  140 .  
         [0093]     In contrast to traditional examination means, the clinician may perform more automated examination by coupling appropriate sensors between one or more on-site electronic medical care devices  185  (such as a laboratory analyzer) and the patient&#39;s proximity, body, bodily fluids, or tissue, whereupon the device(s)  185  analyze the bodily component under scrutiny and provide a representative output. In one case, the output may comprise a human-readable output medical care devices  185  present directly to the clinician. In other cases, the output of one or more of the devices  185  may comprise a machine-readable output presented to the clinician device  140 ; in this embodiment, the clinician device  140  and device  185  communicate by the wireless link  148 , although other means may be used as well such as infrared link, cables, fiber optic lines, etc. If the output of the device  185  is machine-readable, then the clinician device  140  collects this output and responsively provides a table, graph, diagram, or other human-readable presentation by computer display, printing, etc.  
         [0094]     In addition to using on-site clinician tools, the clinician may also employ one or more remotely located medical care devices  132 . For this purpose, the clinician couples sensors between the clinician device  140  and the patient&#39;s proximity, body, bodily fluids, or tissue. The sensors measure various physiological conditions and relay representative information in machine-readable form to the clinician device  140 . In turn, the clinician device  140  invokes the wireless interface  142  to further relay these measurements to the remote device(s)  132 , retrieve any resultant analysis from the remote devices, and locally present the results for the clinician in human-readable form.  
         [0095]     In step  706 , the clinician manually enters data from the patient&#39;s examination, and also utilizes the clinician device  140  to store the output of the devices  185 / 132 , whether such output occurs in human or machine-readable form. Furthermore, the clinician may direct the clinician device  140  to store any human-readable reports that it has prepared utilizing machine-readable output of the devices  185 . If desired, the clinician may direct the clinician device  140  to transmit results from the diagnosis (including output from devices  185 ) to the call center  110  for immediate evaluation by another clinician, for inclusion in the patient&#39;s medical record by call center personnel, etc.  
         [0096]     As shown in step  708 , the clinician may supplement his/her evaluation of the patient&#39;s condition by utilizing the clinician device  140  and wireless interface  142  to access various medical information web sites  135  or other sources of information about drug interactions, symptoms, treatment strategies, etc. After step  708 , the clinician then diagnoses the patient (step  710 ) and renders any on-site treatment (step  712 ), if possible. The clinician may immediately prescribe and render medicine that s/he has brought along, as well as dispatch any available medical products, such as slings, casts, sutures, bandages, etc. As for medicine or products that are not immediately available, the clinician may choose to order them (step  714 ) from a third party vendor  131 . Advantageously, the order may be placed in immediately using the clinician device to contact the third party vendor  131  via the Internet  200 . Such products may include walkers, special beds, oxygen, leased medical equipment, and the like.  
         [0097]     Next, in step  716 , the clinician prepares a record of the at-home patient visit by assembling the clinician&#39;s notes, reports from the clinician device  140 , output from the equipment  185 / 132 , and the like. The clinician stores a machine-readable representation of this record, for example in the medical records  146 . At this time, or later, the clinician invokes the wireless interface  142  to transmit the machine-readable representation of the patient&#39;s report to the medical record center  130 .  
         [0098]     Having completed the patient&#39;s visit, the clinician then performs various follow-up steps  718 . For instance, on behalf of the patient, the clinician may utilize the clinician device  140  to complete an on-line admission process to a local hospital  136  if the patient&#39;s condition warrants. The clinician may also schedule one or more follow-up visits by manually contacting call center personnel, or by utilizing the clinician device  140  and wireless interface  142  to notify the pre-scheduled appointment information block  120  with follow-up information. In addition, the clinician device  140  may transmit an e-mail message to a friend, relative, personal care physician, or other pre-identified party after completion of the clinician&#39;s at-home visit. This e-mail message, which may be transmitted automatically by the clinician device  140  or manually by the clinician, contains information reporting the patient&#39;s examination, diagnosis, and treatment. At this time, the clinician may also receive, review, and respond to any e-mail messages that have been forwarded by the call center  110  from any interested third parties  134 . Other possible follow-up action includes various billing matters, such as transmitting messages to invoke the billing entity  137 , sending completed Health Care Financing Administration records to a referring home health agency, etc. Moreover, such billing operations may be performed automatically at the completion of the patient&#39;s visit, or by the clinician&#39;s use of the clinician device. Finally, the clinician utilizes the clinician device  140  to notify the call center  110  that the visit is complete.  
       OTHER EMBODIMENTS  
       [0099]     While the foregoing disclosure shows a number of illustrative embodiments of the invention, it will be apparent to those skilled in the art that various changes and modifications can be made herein without departing from the scope of the invention as defined by the appended claims. Furthermore, although elements of the invention may be described or claimed in the singular, the plural is contemplated unless limitation to the singular is explicitly stated. Additionally, ordinarily skilled artisans will recognize that operational sequences must be set forth in some specific order for the purpose of explanation and claiming, but the present invention contemplates various changes beyond such specific order.