Patent Publication Number: US-2002007287-A1

Title: System and method for electronic archiving and retrieval of medical documents

Description:
[0001] The present application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/171,089, entitled “System and Method for Electronic Archiving and Retrieval of Medical Documents,” filed Dec. 16, 1999, the entire contents of which are incorporated herein by reference. 
    
    
     
       [0002] This application includes material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent disclosure, as it appears in the Patent and Trademark Office files or records, but otherwise reserves all copyright rights whatsoever.  
       BACKGROUND OF THE INVENTION  
       [0003] 1. Field of the Invention  
       [0004] The invention relates in general to electronic document delivery, and in particular to providing enhanced communication regarding various medical procedures between the patient and the physician.  
       [0005] 2. Related Art  
       [0006] The power of a high-quality page layout on an inexpensive, portable medium like paper has not diminished since the advent of the internet. Most people still prefer reading documents on paper and appreciate the visual benefits of a properly laid-out page of text.  
       [0007] Although the Internet offers a quick, inexpensive, and easy method of delivering information, the currently available programming languages that support it are designed to deliver information to a monitor—not to paper. This means that typically a choice must be made between paper based and electronic document management techniques.  
       [0008] Paper based document management requires vast storage space and specialized filing systems, all of which must be managed by a person or group of people.  
       [0009] Traditional electronic document management systems improve over paper based systems by converting paper documents to electronic form. By creating electronic files, the physical storage and filing system management requirements are significantly reduced. In addition to the document itself, an electronic document management system may be provided to allow a user to store information about the document, known as metadata, in the database, thus allowing users to search for and retrieve documents.  
       OBJECTS AND SUMMARY OF THE INVENTION  
       [0010] In its preferred embodiment, the present invention provides a system for electronic archiving and retrieval of medical documents which provides users with a graphical interface that may be used to store, organize, locate, and retrieve files. The present invention also improves upon the prior art through a standardized or proprietary markup language, such as Hypertext Markup Language (HTML), Standardized Generalized Markup Language (SGML), or extensible Markup Language (XML), to store the content of, and/or metadata about, a file. In addition, the present invention may use a standardized or proprietary stylesheet language, such as Cascading Style Sheets (CSS), extensible Stylesheet Language (XSL), or Portable Document Format (PDF), to store and retrieve page layout information. The invention also improves upon the prior art by storing data both locally and on a database server, thereby providing redundant storage and also making data available via the Internet. The present invention further improves upon the prior art by incorporating high-resolution images and streaming multimedia content to a user, even under low-bandwidth conditions.  
       [0011] Documents stored as part of the present invention may be organized through an underlying database, and information returned by the database may be displayed through a graphical interface. Through a graphical interface, document data can be organized based on several criteria, and an underlying organizational structure may be displayed through a “tree view”. 
     
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
     [0012]FIG. 1 illustrates a system overview of the present invention displaying the computers, servers, and databases used for accessing and delivering the medical records.  
     [0013]FIG. 2 illustrates the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 2 specifically illustrates a preview of a document as it would appear when printed, with the Bookmarks window enabled.  
     [0014]FIG. 3 illustrates the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 3 specifically illustrates a preview of a document as it would appear when printed, with the Bookmarks window enabled.  
     [0015]FIG. 4 illustrates the tree view navigation and other aspects of the user interface to the present invention.  
     [0016]FIG. 5 illustrates a user interface used to provide status information to users while the I 10  local database is updated.  
     [0017]FIG. 6 illustrates the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 6 specifically illustrates an interface used to record notes and comments generated by a physician or other caregiver.  
     [0018]FIG. 7 illustrates a user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 7 specifically illustrates adding and editing caregiver or physician information.  
     [0019]FIG. 8 illustrates another example of the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 2 specifically illustrates a preview of a document as it would appear when printed, with the Bookmarks window enabled.  
     [0020]FIG. 9 illustrates another example of the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 3 specifically illustrates a preview of a document as it would appear when printed, with the Bookmarks window enabled.  
     [0021]FIG. 10 illustrates another example of the tree view and other aspects of the user interface to the present invention, with the Bookmarks window enabled.  
     [0022]FIG. 11 illustrates another example of a user interface used to provide status information to users while the local database is updated.  
     [0023]FIG. 12 illustrates another example of the user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 6 specifically illustrates an interface used to record notes and comments generated by a physician or other caregiver.  
     [0024]FIG. 13 illustrates another example of a user interface used to access and edit information pertaining to each document stored in the present invention. FIG. 7 specifically illustrates adding and editing caregiver or physician information. 
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT  
     [0025] The present invention provides an electronic archiving and retrieval of medical documents system which allows users to store, organize, locate, and retrieve files through an interactive a graphical interface. The present invention may also provide redundant storage by storing data both locally and on a database server. The database server is accessible via the internet as will be described in conjunction with FIG. 1.  
     [0026] The present invention consists of a proprietary Internet browser for document transmission and retrieval capable of delivering the content contained within the system. This content may include numerous guides and procedures in a multitude of languages. Typically, the guides and procedures are authored by nationally prominent physicians and subsequently are legally and professionally edited and reviewed.  
     [0027] The user can decide between from four versions for implementation of the present invention. The first versions include a CD installed, internet maintained and administered desk top, single computer site. Another version is a CD installed, internet maintained and administered server version, multi-computer site.  
     [0028] In addition to the CD installed versions, the user can utilize the Application Service Provider (ASP) version for a stand alone business model or the ASP version for an OEM or integrated business model. The ASP versions seamlessly integrates the components of the present invention within the total information system sold by other vendors meeting the requirements of hospitals and or physician organizations.  
     [0029] All versions are complimented with a public web site system on which any individual user worldwide with Internet access can access medical procedure specific information in a multitude of languages. The content, information, medical guides, records, and procedures stored by the present invention can be delivered by the present invention or included as part of other healthcare web systems.  
     [0030] In a preferred embodiment, the present invention makes use of a client/server architecture as shown in FIG. 1. The client/server architecture includes personal computers  101 ,  103 , which may be PC&#39;s, laptops, personal digital assistants, pagers, cell phone or other computerized devices, which are able to access the document retrieval system  100 . The user, through an electronic device, such as a computer  101 ,  103 , accesses the databases  108 ,  110 ,  112  through the World Wide Web  105  through web-server  107 . The present invention, or system  100  may contain multiple servers, such as web-server  107 , multimedia server  109 , and database server  111 .  
     [0031] The present invention includes a remote server system  106  which acts as a central document warehouse, as well as software run on a user&#39;s computer  101 ,  103  which acts as a “client”, providing an interface between a user and a central document warehouse.  
     [0032] A remote document warehouse system  100  may consist of a World Wide Web (WWW) server  107  (“web server”), a multi-media server  109 , and a database server  111 . Examples of World Wide Web servers  107  include Internet Information Server, published by Microsoft Corporation of Redmond, Washington, Netscape Enterprise Server, published by Netscape Corporation of Redondo, Calif., and Apache Server, published by The Apache Software Foundation of Lincoln, Nebr. Examples of database servers  111  include SQL Server, published by Microsoft, and Oracle, published by Oracle Corporation of Redwood Shores, Calif.  
     [0033] A web server  107  may be used to facilitate communications between client software running on a user&#39;s computer  101 ,  103 , and a database server  111 . A client  101 ,  103 , can create a specially formatted instruction set, utilizing Standardized Query Language (“SQL”), Hypertext Transmission Protocol (“HTTP”), Secure Hypertext Transmission Protocol (“HTTPS”), and/or other similar protocols, to open a connection with a web server (utilizing HTTP&#39;s GET command or a similar command). Data sent utilizing HTTPS may he encrypted, thus providing a secure method of transmitting data between a client  101 ,  103  and a document warehouse  112 .  
     [0034] With an open connection, such as through the World Wide Web  105 , a client  101 ,  103  may request data from or ask to store data in a document warehouse database  112 . When such a request is received, a web server  107  may pre-process the request, converting the request to a format used by a specific database server, or a request may be sent directly to a database server  111 .  
     [0035] A request from a web server  107  to a database server  111  may take the form of a SQL query, Open Database Connectivity (“ODBC”) statement, Microsoft JET command, or a combination of these and/or other query languages. A database server  111  receiving a request can process that request, and may return data for display on a user&#39;s computer  101 , 103 . Returned data can include query result sets, storage confirmation, and error codes.  
     [0036] When a web server  107  receives information from a database server  111 , the information can be transmitted to a user&#39;s computer  101 ,  103 . Transmission may be accomplished by keeping open the WWW connection  105  created by the client  101 ,  103  and returning the results through that connection, or results may be returned by pushing data to the client  101 ,  103 . Client software running on a user&#39;s computer  101 ,  103  may take the form of a World Wide Web “browser”, such as Microsoft&#39;s Internet Explorer, or Netscape&#39;s Navigator; a custom application; or a hybrid design, incorporating a custom application and a web browser.  
     [0037] When a user enters information into the present invention, the client  101 ,  103  may store a copy of the information on the local computer  101 ,  103  as well as on the database server  111  or in one of the databases  108 ,  110 ,  112 .  
     [0038] If a user requests information from a database server  111  and the result yields a large block of data, such as an image, the client software may first check for a local copy of the data. If a local copy exists, date and time stamps or other identifiers can be compared. If the identifier comparison shows that data stored in the data warehouse  112  is newer than that which is stored locally, the data is downloaded from the data warehouse  112 . However, if the local copy has the same identifier or is newer than the copy on the database server  111 , the local copy may be used, thus avoiding a lengthy download.  
     [0039] In addition to providing a customizable user interface, the present invention also improves upon the prior art through an infrastructure allowing components of the client portion of the present invention to be updated whenever newer versions are available. The client portion  101 ,  103 , of the present invention can periodically communicate with the server portion  106 , verifying that all components of the client are at the appropriate revision level. If a newer version of a component or components is available, the new version or versions may be automatically downloaded and installed, or a user may interact with the system, determining when any changes may be applied.  
     [0040] This same system or a similar system may also be used to deliver news and other information to a user. News may be generated by the present invention, or it may be generated at a local administrative level. Examples of news may include recently enacted legislation which may affect a user, updated billing or other requirements from healthcare or health insurance companies, reminders of overtime and other requirements, and other similar measures.  
     [0041] As a further improvement over the prior art, the present invention may create a unique number or other identifier that distinguishes a computer on which a document is created. Each document entered into the system on a computer contains a reference to this identifier. Files created on other computers may not be viewable unless authorization has been given for the viewing computer. Authorization may be specific to a file, or may include a range of computers. For example, one file entered into the system may restrict viewers to only those on the computer used to enter the file into the system. Another file may restrict viewing computers to all computers within an organizational unit. Another file may allow itself to be viewed by all computers within a hospital or system of hospitals.  
     [0042] The present invention also improves over the prior art by providing a user with not only graphics and text, but also multimedia content. Multimedia content deliverable to a desktop may include audio recordings and video recordings of patient sessions. The present invention may include a separate multimedia server  109  and multimedia database  110  for providing multimedia content, as seen in FIG. 1. The present invention may also provide a seamless and secure integration with existing database systems, such as accounting, E-mail, and scheduling systems. For example, scheduling changes may be presented to a user as part of the previously described news feature, and documents may be securely transmitted via an E-mail system.  
     [0043] In addition, the present invention stores data utilizing standardized markup and style sheet languages, which allows the present invention to properly render a document as it was meant to appear on paper each time it is printed. Storing data utilizing standardized markup and style sheet languages can allow the present invention to provide an alternative representation for display on a display device, such as a computer monitor, personal desktop assistant (PDA), pager, cell-phone, or other computerized device.  
     [0044]FIG. 2 illustrates an additional example of a user interface  200  which includes the Bookmarks window  220  available through the present invention. The Bookmarks window  220  enables the user to interact with the present invention to access various medical information and files stored within the system. The various features and functions of the user interface  200  include a files menu  201 , and data menu  203 , a docUguides menu  205 , a Language menu  207 , a Tools menu  209 , and a help menu  211 . The Bookmarks, as seen in window  220 , allow users to quickly access files stored in the present invention.  
     [0045] In the presently preferred embodiment, the invention utilizes a tree view (“view”) navigation as its primary method of organizing and displaying documents, as seen in the Bookmarks window  220 . A tree view navigation is a graphical representation of a hierarchical organizational scheme. A tree view can allow a user to combine multiple document types, such as images and text files, into a container (“folder”) for organizational purposes. In addition to individual files, a folder may also be used to hold other folders, thus providing a means of graphically organizing data stored in the present invention. A default set of views may be presented to a user when a user is initially given access to the system. However, users can customize a view or create their own views.  
     [0046] As shown in FIG. 2, the tree view depicted in Bookmarks window  220  includes various folders  222 ,  224 . Each of these folders  222 ,  224 , may contain various files, such as file  226 . The ability to store various folders and files in a tree view allows the user to quickly and accurately access the files and data they are interested in viewing. The user may also collapse the tree view by selecting the “Collapse Tree” tab.  
     [0047] A user may create a custom view as a means to limit the data displayed to them to only the data in which they are interested. For example, a user may limit the data displayed to only those patients scheduled for operations on a given day. Tree views can also be used to illustrate an hierarchical structure based on multiple criteria, and each user may view a structure differently. For example, an administrator may prefer to organize documents by creating a folder for each department. Within each department, a folder may be created for various specialties, and within a specialty a folder may be created for each doctor working in that specialty. Within a doctor&#39;s folder, documents may be organized by patient.  
     [0048] Although an administrator may prefer to see documents organized by department, individual physicians or technicians may prefer to see documents organized in a calendar format, with a folder for each day and subfolders dividing the day, such as morning and afternoon, or folders for each hour. Organizing based on the day can allow a user to limit the documents displayed to only those which a user may need on a given day.  
     [0049] Individual settings (“views”) may be stored by a user of the present invention. The present invention may also allow a user to retrieve those settings later. Views may be created based on the contents of one or more data or metadata fields. A view may be created that only display files or folders based on specific criteria, such as, but not limited to, keywords, entry date, appointment date, or priority. Although a view can allow a user to create an organized, graphical representation of data stored in the present invention, any underlying data structure may not be affected by changes to a view.  
     [0050] In addition, the present invention has additional features and functions which pertain to individual files  226  which are accessed by the user. As can be seen in FIGS. 2 through 7, the user can select the appropriate medical information they want to view. As seen in FIG. 2, the user can select which files to view through the various files tabs which include Content  206 , Search  208 , Favorites  210 , and History  212 . The user can print the medical document, record or file using print button  202  and can go to the start or home page using the “Home” button  204 . The file  226  selected by the user is highlighted in window  220  and indicated in title bar  230 . FIG. 2 displays a medical document window  240  which displays the appropriate selected information from the selected file  226 . The user can select which information to view regarding the selected file  226  by choosing between the viewing tabs which include the docUguide  244 , docuguide remarks, and “perimed” remarks  247 . The user can also view docUguide information by selecting tab  228  and can be shown patient specific information in window  242 . The user can scan the document up and down for viewing the entire medical document file by choosing viewing bar  232 .  
     [0051]FIG. 3 contains the same screen capture as displayed in FIG. 2, except the screen capture  300  includes the additional window  320  which indicates medical record files which had been marked under the favorites tab  310 . The medical document files can be added to the favorites list by use of bars  321  and  323 . The medical file selected is still shown in window  340 .  
     [0052]FIG. 4 represents a screen capture  400  indicating a home page  440  which is highlighted in the bookmark window  420  on the tree view, as previously described. The screen capture  400  also includes a remarks window  450  accessed by remarks tab  446 .  
     [0053]FIG. 5 illustrates a user interface screen  500  used to provide status information to users while the local database is updated. Data kept locally may be stored in a database or as part of the file.  
     [0054]FIGS. 6 and 7 illustrate additional portions of a user interface available through the present invention. FIG. 6 illustrates an interface used to record notes and comments generated by a physician or other caregiver. As indicated in FIGS. 2 through 7, the user may select from the files  226 , as seen in FIG. 2. Provided the user has proper access they will be able to add comments within the specific areas such as perimed remarks or docUguide remarks. Under the docUguide preferences tab  646  a user can review notes in window  650 .  
     [0055]FIG. 7 depicts another user interface  700  where physicians have the ability to select a patient in window  760  and edit or change information about the patient using window  770 . The physician, in window  770 , may select to review or edit the patient information under the “Patient” tab  771  or review or edit under the “Surrogate Decision Maker” tab  773 . All changes and modification can be saved using tab  775 .  
     [0056]FIGS. 8 through 13 provide additional examples of various user interface pages for the user to access, review, edit and save medical documents, records and files. FIG. 8 illustrates an additional example of a user interface  800  which includes the Bookmarks window  810  available through the present invention. The Bookmarks window  810  enables the user to interact with the present invention to access various medical information and files stored within the system. The various features and functions of the user interface  800  include a files menu  801 , and edit menu  803 , a view menu  805 , and a help menu  807 . The Bookmarks, as seen in window  810 , allow users to quickly access files stored in the present invention. The Bookmarks window  810  may be viewed or hidden by clicking the book icon  804  in the toolbar  836 , or by choosing Bookmarks under the View menu  805 .  
     [0057] Once again the invention may utilize a tree view (“view”) as its primary method of organizing and displaying documents, as seen in the Bookmarks window  810 . The tree view allows a user to combine multiple document types into a container (“folder”) for organizational purposes as well as hold other folders, thus providing a means of graphically organizing data stored in the present invention. A default set of views may be presented to a user when a user is initially given access to the system. However, users can customize a view or create their own views.  
     [0058] As can be shown in FIG. 8, the tree view depicted in Bookmarks window  810  includes various folders  812 ,  814 ,  816 . Each of these folders  812 ,  814 ,  816 , may contain various files, such as  818 . The ability to store various folders and files in a tree view allows the user to quickly and accurately access the files and data they are interested in viewing.  
     [0059] In addition, the present invention has additional features and functions which pertain to individual files  818  which are accessed by the user. As can be seen in FIGS. 8 through 13, the user can select the appropriate medical information they want to view. As seen in FIG. 8, the user can select between physician preferences  822 , CID (Consent Information Document) preview  824 , patient information  826 , caregiver information  828 , and details  830 . The file  818  selected by the user is also highlighted and indicated in title bar  820 . In addition, the user can select the language in which to view the information utilizing menu  835 . FIG. 8 represents a screen shot  840  of information available under the CID preview  824  tab. The information contained in each tab may include notes to the patient as indicated in  842 , as well as address patient information. The CID preview information can be used to verify and communicate patient consent for a medical procedure.  
     [0060] As seen in FIG. 9 which contains the same screen capture as displayed in FIG. 8, except the screen capture  900  includes the additional window  950  which indicates bookmarked files which have been accessed.  
     [0061]FIG. 10 represents a screen capture  1000  indicating a home page  1040  which is highlighted in the bookmark window  410  on the tree view, as previously described. The screen capture  1000  also includes the previously accessed files indicated in window  1050 .  
     [0062]FIG. 11 illustrates a user interface screen used to provide status information to users while the local database is updated. Data kept locally may be stored in a database or as part of the file.  
     [0063]FIGS. 12 and 13 illustrate additional portions of a user interface available through the present invention. FIG. 12 illustrates an interface used to record notes and comments generated by a physician or other caregiver. As indicated in FIGS. 8 through 13, the user may select from the various tabs  822 ,  824 ,  826 ,  828 ,  830  to review or add information in a specific area. Under the physician preferences tab  822  a one can review caregiver notes in window  1252  or caregiver comments in window  1254 . In addition, those with access to amend, edit or add text may do so through the user interface  1200 . Therefore, a physician or caregiver may add appropriate text to the caregiver notes  1252  or caregiver comments  1254 .  
     [0064]FIG. 13 specifically illustrates adding and editing caregiver or physician information. When the caregiver adds or edits information they access the caregiver tab  828 , as seen in FIG. 8. Upon selecting the caregiver tab  828  the physician is provided screen  1360  in which they indicate the file within which they would like to edit or add comments. A separate screen  1370  is displayed in which the caregiver can edit and add information.  
     [0065] It can thus be seen that the present invention improves over the prior art by providing an intuitive, graphical interface to the underlying data. The present invention further improves upon the prior art by operating remotely across the Internet, including storing duplicate copies of files on a remote data warehouse, and receiving software updates and news of interest to users through the Internet. The present invention also builds upon the prior art by integrating with E-mail, accounting, and scheduling.  
     [0066] Further, the present invention may also include an outcome measurement system and a complications data collection system. The Outcomes Measurement System will consist of Internet enabled branching questionnaires for both the physician and the patient to complete on a pre-scheduled basis for a defined time period, for example 3 years, following each medical procedure in a given category. The responses to the questionnaires and other pertinent data related to the procedure will be collected, accumulated, analyzed and stored in a dedicated data repository.  
     [0067] The present invention may also employ a Complications Data Collection System which will consist of Internet enabled event and data recording tools which are able to document extraordinary events which occur during and after each medical procedure. The data from the Complications Data Collection System will be collected, accumulated, analyzed, and stored in a dedicated data repository.  
     [0068] Other applications for which the present invention may acquire and analyze data and or obtain patient consent would include Clinical trials informed consent, pharmaceutical usage informed consent, advanced directives instructions, certain versions of medical best practices, and a synopsis or questionnaire format procedure which may include notes records at or immediately after a surgical or diagnostic procedure.  
     [0069] The present invention provides a dynamic Internet enabled tool for the patient-physician Informed Consent Process, in which each medical consent form may be mass customized for the specific patient-physician relationship, and contain the actual historical record of medical complications and outcomes measures for each client physician or organization. The present invention provides a medical information system to record, analyze, retrieve and distribute actual or physician specific medical data on the fly from a data repository.  
     [0070] While the invention has been particularly shown and described with reference to a preferred embodiment thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the spirit and scope of the invention.