Abstract:
This disclosure relates generally to patient monitoring techniques, and more specifically to a method and a system to reduce false alarms generated by the patient monitoring system, the false alarms being associated with clinical condition of the patient. Disclosed herein is a patient monitoring method that includes monitoring one or more clinical parameters associated with condition of a patient, identifying a clinical condition based on deviation of the monitored one or more clinical parameters from corresponding one or more first predefined criteria, determining a status associated with one or more devices that monitor the deviated one or more clinical parameters, and generating a clinical alert based on the determined status not indicating an error by the one or more devices.

Description:
This application claims the benefit of Indian Patent Application Filing Number 6130/CHE/2013, filed on Dec. 27, 2013, which is hereby incorporated by reference in its entirety. 
     FIELD 
     This disclosure relates generally to patient monitoring techniques, and more specifically to a method and system to reduce false clinical alerts triggered by the patient monitoring system, the false clinical alerts being associated with a clinical condition of a patient. 
     BACKGROUND 
     Various technological improvements in recent times have made monitoring of patients easy and useful. The monitoring of patients by one or more devices means real-time tracking of patient data which otherwise is not feasible to be conducted by a human care-giver, like a nurse or an attending physician. Such automated patient monitoring system has also made it possible to simultaneously monitor lot of patients without actually physically visiting them. Now, in case the patient data or vitals deviate from predefined criteria, the patient monitoring system automatically generates alerts to inform concerned person of the condition of the patient. The care-giver or a specialist then takes next measures in accordance with the reported data. The predefined criteria may be a set of defined clinical guidelines. 
     Such advanced automatic patient monitoring data providing improved patient care is based on fundamental premise that the patient data that is continuously reported is deemed accurate, and therefore the physician can blindly rely upon such data to decide next course of action or mediation for the patient. However, in some instances, the monitoring system may generate false alarms regarding the clinical condition of a patient due to some error or fault of the devices within the patient monitoring system. 
     It may be a matter of concern if the patient monitoring systems generates false alerts/alarms which are solely relied upon by the physician or the care-giver to decide the subsequent course of medication or patient care. Additionally, presently available patient monitoring systems suffer from lack of sufficient measures to prevent failure of the devices within the patient monitoring system which in turn has serious impact on delivering a sustained and safe patient care by the patient monitoring system. 
     SUMMARY 
     Disclosed herein is a patient monitoring method that includes: monitoring one or more clinical parameters associated with a patient; identifying a clinical condition based on deviation of the monitored one or more clinical parameters from a corresponding one or more first predefined criteria; determining a status associated with one or more devices that monitor the deviated one or more clinical parameters; and generating a clinical alert based on the determined status not indicating an error in the one or more devices. 
     In an aspect of the present disclosure, a patient monitoring system includes a memory, a processor coupled to the memory storing processor executable instructions which when executed by the processor causes the processor to instruct each of the one or more devices in communication with the one or more devices to monitor an associated clinical parameter, identify a clinical condition based on deviation of the monitored one or more clinical parameters from corresponding one or more first predefined criteria, determine a status associated with one or more devices monitoring the deviated one or more clinical parameters; and generate a clinical alert based on the status not indicating an error in the one or more devices. 
     It is to be understood that both the foregoing general description and the following detailed description are exemplary and explanatory only and are not restrictive of the present disclosure, as claimed. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  illustrates an exemplary patient monitoring system for preventing triggering of false alerts in accordance with some embodiments of the present disclosure. 
         FIGS. 2A and 2B  is an exemplary flowchart illustrating a method of preventing triggering of false alerts in accordance with some embodiments of the present disclosure. 
         FIG. 3  is an exemplary graphic display illustrating machine alert and clinical alert in accordance with some embodiments of the present disclosure. 
         FIG. 4  is a block diagram of an exemplary computer system for implementing embodiments consistent with the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Now, exemplary embodiments of the present disclosure will be described with reference to the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts. While exemplary embodiments and features are described herein, modifications, adaptations, and other implementations are possible, without departing from the spirit and scope of the disclosure. Accordingly, the following detailed description does not limit the subject matter. Instead, the proper scope of the subject matter is defined by the appended claims. 
       FIG. 1  illustrates an exemplary patient monitoring system  100  to prevent triggering of false alerts in accordance with some embodiments of the present disclosure. The patient monitoring system  100  comprises a processor  102  and a memory  104  in electronic communication with each other. The electronic communication may be wired or wireless. The electronic communication may be through means of a communication network that may include, without limitation, a direct interconnection, local area network (LAN), wide area network (WAN), wireless network (e.g., using Wireless Application Protocol), the Internet, etc. 
     The processor  102  may instruct one or more devices ( 106 ,  108 ,  110 ) in communication with the processor  102 , to monitor corresponding one or more clinical parameters. The processor  102  detects patient&#39;s clinical condition based on deviation of the monitored one or more clinical parameters from a corresponding one or more first predetermined criteria. The one or more first predefined criteria may pertain to a range of values within which the values related to the monitored one or more clinical parameters should lie. Therefore, the values related to the monitored one or more clinical parameters should not go below a predefined lower threshold or above a predefined upper threshold. For example, the range of values within which the blood pressure of a patient should lie is 80-120 mmHg. The alarm or clinical alert may trigger when the BP of the patient falls below 80 mmHg or goes beyond 120 mmHg. Further, some of the examples of the one or more clinical parameters may be respiration rate, heart rate, blood pressure, and temperature. Further, the one or more clinical parameters may include position or activity data of the patient, such as lying down, upright, walking, and sitting etc. 
     Further, the memory  104  is a repository of policy details defining the clinical condition of the patient. Such policy details may be a combination of clinical guidelines and specified standards of health care. Also, the memory  104  may comprise the technical specifications of the one or more devices ( 106 ,  108 ,  110 ). For example, the one or more devices ( 106 ,  108 ,  110 ) may be blood pressure (BP) or temperature or ECG device. Further, the memory  104  may comprise values pertaining to signal quality that indicates error free functioning of the patient monitoring system  100 . The memory  104  further provides the required benchmarking or threshold for the processor  102  to trigger a clinical alert. 
     Further, the processor  102  monitors one or more machine parameters related to the one or more devices ( 106 ,  108 , and  110 ). There may be deviation of the monitored one or more machine parameters from a corresponding one or more second predefined criteria. For example, the one or more second predefined criteria may comprise a range of values for proper connectivity for transfer of data, optimal operating values for the battery in the one or more devices for their proper functioning, optimal signal to noise ratio. So, the deviation may be loose electrical contacts in the one or more devices ( 106 ,  108 ,  110 ), low battery in the one or more devices, low signal to noise ratio, and connectivity loss (in continuous data monitoring scenario, connectivity can play spoilsport and conventional patient monitoring systems will generate machine alert on account of inadequate data or improper data). In an exemplary embodiment, the one or more machine parameters that are monitored may comprise electrical contacts in the patient monitoring system  100 , battery in the one or more devices ( 106 ,  108 ,  110 ), signal to noise ratio, and connectivity. 
     The processor  102  may trigger a clinical alert if there is no deviation of the monitored one or more machine parameters from the corresponding one or more second predefined criteria. The clinical alert would not be triggered if there is deviation of the monitored one or more machine parameters from the corresponding one or more second predefined criteria. The deviation of the monitored one or more machine parameters from the corresponding one or more second predefined criteria would indicate error/fault in the one or more devices ( 106 ,  108 ,  110 ). To indicate the error/fault in the one or more devices ( 106 ,  108 ,  110 ), a machine alert is generated. The processor  102  may determine a status associated with the one or more devices ( 106 ,  108 ,  110 ). If the determined status indicates an error/fault in the one or more devices ( 106 ,  108 ,  110 ), the processor may not generate a clinical alert. In this case, machine alert is generated. However, if the determined status does not indicate an error/fault in the one or more devices ( 106 ,  108 ,  110 ), the processor may generate a clinical alert. Therefore, non-generation of the clinical alert when there is fault in the one or more devices ( 106 ,  108 ,  110 ) would mitigate the problem of triggering of false clinical alerts. 
     The machine alert, when examined, provides intelligence regarding the following:
         a. Which component is faulty e.g. BP or temperature or ECG device. This information aids in quick solution fixing. As the patient monitoring system  100  is moving towards multi component design, this diagnosis also becomes important.   b. What is failing out of one or more machine parameters: the battery, the signal, the temperature of the component, the connectivity, the driver and so on. This helps to identify whether the machine alert can be fixed by the end user itself or need intervention by the biomedical department.       

     The generation of the machine alert helps a nurse to alert the biomedical department for rescue of the system and replace the faulty device with a new one or repair it. Additionally, the generated alert can also be automatically routed to the concerned technical department using the contact details as may be available in the system database. Also, the machine alert can be categorized and/or rated as per defined conditions to determine the nature of the failure or expected failure and its impact on the patient. Accordingly, the alert/alarm can be decided to be forwarded to the appropriate entities. 
     Data related to the patient and the one or more devices ( 106 ,  108 , and  110 ) received by the processor  102  may be stored locally and/or in cloud. Therefore, the data related to patient and devices ( 106 ,  108 , and  110 ) may be made available and visible by care-givers who are logging into the patient monitoring system  100  from outside hospital. 
       FIGS. 2A and 2B  illustrate a flowchart of an example of a method for patient monitoring to prevent triggering of false clinical alerts in accordance with an embodiment of the present disclosure. At step S 200 , one or more clinical parameters associated with the condition of a patient are monitored. In an exemplary embodiment, the one or more clinical parameters comprise respiration rate, heart rate, blood pressure, and temperature. Further, the one or more parameters may include position and activity data of the patient that indicates whether the patient is lying down, upright, walking, or sitting etc. Further, a clinical condition based on deviation of the monitored one or more clinical parameters from corresponding one or more first predefined criteria is identified (step S 202 ). The one or more first predefined criteria may include predefined range of values within which values related to the monitored one or more clinical parameters should fall. Therefore, the deviation in this case, may be values related to the monitored one or more clinical parameters falling outside the predefined range of values. As explained above, the processor  102  monitors the one or more machine parameters related to the one or more devices ( 106 ,  108 ,  110 ) (step S 204 ). At step S 206 , it is determined whether there is deviation of the one or more monitored machine parameters from the one or more corresponding predefined criteria. If answer is YES, machine alert is generated but no clinical alert is generated (step S 208 ). If answer is NO, it is further determined whether there is deviation of the one or more clinical parameters from the corresponding one or more first predefined criteria (S 210 ). If answer is YES, clinical alert is generated (S 212 ). If answer is NO, no clinical alert is generated (S 214 ). The method explained above would reduce the generation of false clinical alerts. 
       FIG. 3  is a graphic display illustrating machine alert and clinical alert in accordance with an embodiment of the present disclosure. The display  110  displays both clinical alert and machine alert. They are flagged with different colors so that they can be easily identified by the care-giver. This offers a great advantage as in existing systems, the care-giver have to manually come to a diagnosis after finding out the machine alert as an artifact of faulty patient monitoring system  100 . This is of critical importance when critical care and remote care is required. In critical care, time is important and in remote care, proactive rescue and restoring the one or more devices to their operational status is important. In present disclosure, the one or more machine parameters that can affect or influence the one or more clinical parameters are saved in the reference database  108 . The one or more machine parameters are monitored and compared against corresponding one or more second pre-defined criteria for deviation. As and when the one or more machine parameters deviate from the corresponding one or more second pre-defined criteria, machine alert is displayed. When the one or more machine parameters does not deviate, from the corresponding one or more second pre-defined criteria, it is further determined that whether there is deviation of the one or more clinical parameters from the corresponding one or more first predefined criteria. If there is deviation, the clinical alert is triggered and displayed. 
     Computer System 
       FIG. 4  is a block diagram of an exemplary computer system for implementing embodiments consistent with the present disclosure. Variations of computer system  401  may be used for implementing any of the devices presented in this disclosure. Computer system  401  may comprise a central processing unit (“CPU” or “processor”)  402 . Processor  402  may comprise at least one data processor for executing program components for executing user- or system-generated requests. A user may include a person, a person using a device such as those included in this disclosure, or such a device itself. The processor may include specialized processing units such as integrated system (bus) controllers, memory management control units, floating point units, graphics processing units, digital signal processing units, etc. The processor may include a microprocessor, such as AMD Athlon, Duron or Opteron, ARM&#39;s application, embedded or secure processors, IBM PowerPC, Intel&#39;s Core, Itanium, Xeon, Celeron or other line of processors, etc. The processor  302  may be implemented using mainframe, distributed processor, multi-core, parallel, grid, or other architectures. Some embodiments may utilize embedded technologies like application-specific integrated circuits (ASICs), digital signal processors (DSPs), Field Programmable Gate Arrays (FPGAs), etc. 
     In some embodiments, processor  402  may be disposed in communication with one or more input/output (I/O) devices via I/O interface  403 . The I/O interface  403  may employ communication protocols/methods such as, without limitation, audio, analog, digital, monoaural, RCA, stereo, IEEE-1394, serial bus, universal serial bus (USB), infrared, PS/2, BNC, coaxial, component, composite, digital visual interface (DVI), high-definition multimedia interface (HDMI), RF antennas, S-Video, VGA, IEEE 802.n/b/g/n/x, Bluetooth, cellular (e.g., code-division multiple access (CDMA), high-speed packet access (HSPA+), global system for mobile communications (GSM), long-term evolution (LTE), WiMax, or the like), etc. 
     Using the I/O interface  03 , the computer system  01  may communicate with one or more I/O devices. For example, the input device  404  may be an antenna, keyboard, mouse, joystick, (infrared), remote control, camera, card reader, fax machine, dongle, biometric reader, microphone, touch remote control, camera, card reader, fax machine, dongle, biometric reader, microphone, touch screen, touchpad, trackball, sensor (e.g., accelerometer, light sensor, GPS, gyroscope, proximity sensor, or the like), stylus, scanner, storage device, transceiver, video device/source, visors, etc. Output device  05  may be a printer, fax machine, video display (e.g., cathode ray tube (CRT), liquid crystal display (LCD), light-emitting diode (LED), plasma, or the like), audio speaker, etc. In some embodiments, a transceiver  06  may be disposed in connection with the processor  402 . The transceiver may facilitate various types of wireless transmission or reception. For example, the transceiver may include an antenna operatively connected to a transceiver chip (e.g., Texas Instruments WiLink WL1283, Broadcom BCM4750IUB8, Infineon Technologies X-Gold 618-PMB9800, or the like), providing IEEE 802.11a/b/g/n, Bluetooth, FM, global positioning system (GPS), 2G/3G HSDPA/HSUPA communications, etc. 
     In some embodiments, the processor  402  may be disposed in communication with a communication network  408  via a network interface  407 . The network interface  407  may communicate with the communication network  408 . The network interface may employ connection protocols including, without limitation, direct connect, Ethernet (e.g., twisted pair 10/100/1000 Base T), transmission control protocol/internet protocol (TCP/IP), token ring, IEEE 802.11a/b/g/n/x, etc. The communication network  408  may include, without limitation, a direct interconnection, local area network (LAN), wide area network (WAN), wireless network (e.g., using Wireless Application Protocol), the Internet, etc. Using the network interface  07  and the communication network  408 , the computer system  401  may communicate with devices  410 ,  411 , and  412 . These devices may include, without limitation, personal computer(s), server(s), fax machines, printers, scanners, various mobile devices such as cellular telephones, smartphones (e.g., Apple iPhone, Blackberry, Android-based phones, etc.), tablet computers, eBook readers (Amazon Kindle, Nook, etc.), laptop computers, notebooks, gaming consoles (Microsoft Xbox, Nintendo DS, Sony PlayStation, etc.), or the like. In some embodiments, the computer system  401  may itself embody one or more of these devices. 
     In some embodiments, the processor  402  may be disposed in communication with one or more memory devices (e.g., RAM  413 , ROM  414 , etc.) via a storage interface  412 . 
     The storage interface may connect to memory devices including, without limitation, memory drives, removable disc drives, etc., employing connection protocols such as serial advanced technology attachment (SATA), integrated drive electronics (IDE), IEEE-1394, universal serial bus (USB), fiber channel, small computer systems interface (SCSI), etc. The memory drives may further include a drum, magnetic disc drive, magneto-optical drive, optical drive, redundant array of independent discs (RAID), solid-state memory devices, solid-state drives, etc. 
     The memory devices may store a collection of program or database components, including, without limitation, an operating system  416 , user interface application  417 , web browser  418 , mail server  419 , mail client  420 , user/application data  421  (e.g., any data variables or data records discussed in this disclosure), etc. The operating system  416  may facilitate resource management and operation of the computer system  401 . Examples of operating systems include, without limitation, Apple Macintosh OS X, Unix, Unix-like system distributions (e.g., Berkeley Software Distribution (BSD), FreeBSD, NetBSD, OpenBSD, etc.), Linux distributions (e.g., Red Hat, Ubuntu, Kubuntu, etc.), IBM OS/2, Microsoft Windows (XP, Vista/7/8, etc.), Apple iOS, Google Android, Blackberry OS, or the like. User interface  17  may facilitate display, execution, interaction, manipulation, or operation of program components through textual or graphical facilities. For example, user interfaces may provide computer interaction interface elements on a display system operatively connected to the computer system  401 , such as cursors, icons, check boxes, menus, scrollers, windows, widgets, etc. Graphical user interfaces (GUIs) may be employed, including, without limitation, Apple Macintosh operating systems&#39; Aqua, IBM OS/2, Microsoft Windows (e.g., Aero, Metro, etc.), Unix X-Windows, web interface libraries (e.g., ActiveX, Java, Javascript, AJAX, HTML, Adobe Flash, etc.), or the like. 
     In some embodiments, the computer system  401  may implement a web browser  418  stored program component. The web browser may be a hypertext viewing application, such as Microsoft Internet Explorer, Google Chrome, Mozilla Firefox, Apple Safari, etc. Secure web browsing may be provided using HTTPS (secure hypertext transport protocol), secure sockets layer (SSL), Transport Layer Security (TLS), etc. Web browsers may utilize facilities such as AJAX, DHTML, Adobe Flash, JavaScript, Java, application programming interfaces (APIs), etc. In some embodiments, the computer system  401  may implement a mail server  419  stored program component. The mail server may be an Internet mail server such as Microsoft Exchange, or the like. The mail server may utilize facilities such as ASP, ActiveX, ANSI C++/C#, Microsoft .NET, CGI scripts, Java, JavaScript, PERL, PHP, Python, WebObjects, etc. The mail server may utilize communication protocols such as internet message access protocol (IMAP), messaging application programming interface (MAPI), Microsoft Exchange, post office protocol (POP), simple mail transfer protocol (SMTP), or the like. In some embodiments, the computer system  401  may implement a mail client  420  stored program component. The mail client may be a mail viewing application, such as Apple Mail, Microsoft Entourage, Microsoft Outlook, Mozilla Thunderbird, etc. 
     In some embodiments, computer system  401  may store user/application data  421 , such as, variables, records, etc. as described in this disclosure. Such databases may be implemented as fault-tolerant, relational, scalable, secure databases such as Oracle or Sybase. Alternatively, such databases may be implemented using standardized data structures, such as an array, hash, linked list, struct, structured text file (e.g., XML), table, or as object-oriented databases (e.g., using ObjectStore, Poet, Zope, etc.). Such databases may be consolidated or distributed, sometimes among the various computer systems discussed above in this disclosure. It is to be understood that the structure and operation of the any computer or database component may be combined, consolidated, or distributed in any working combination. 
     The specification has described a method and a system to reduce false alerts/alarms generated by the patient monitoring system  100 , the false alerts/alarms being associated with clinical condition of the patient. The illustrated steps are set out to explain the exemplary embodiments shown, and it should be anticipated that ongoing technological development will change the manner in which particular functions are performed. These examples are presented herein for purposes of illustration, and not limitation. Further, the boundaries of the functional building blocks have been arbitrarily defined herein for the convenience of the description. Alternative boundaries can be defined so long as the specified functions and relationships thereof are appropriately performed. Alternatives (including equivalents, extensions, variations, deviations, etc., of those described herein) will be apparent to persons skilled in the relevant art(s) based on the teachings contained herein. Such alternatives fall within the scope and spirit of the disclosed embodiments. 
     Furthermore, one or more non-transitory computer-readable storage media may be utilized in implementing embodiments consistent with the present disclosure. A non-transitory computer-readable storage medium refers to any type of physical memory on which information or data readable by a processor may be stored. Thus, a non-transitory computer-readable storage medium may store instructions for execution by one or more processors, including instructions for causing the processor(s) to perform steps or stages consistent with the embodiments described herein. The term “computer-readable medium” should be understood to include tangible items and exclude carrier waves and transient signals, i.e., be non-transitory. Examples include random access memory (RAM), read-only memory (ROM), volatile memory, nonvolatile memory, hard drives, CD ROMs, DVDs, flash drives, disks, and any other known physical storage media. 
     Other embodiments of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the embodiments disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the disclosure being indicated by the following claims.