Patent Publication Number: US-2007122783-A1

Title: On-line healthcare consultation services system and method of using same

Description:
RELATED APPLICATION  
      This application claims priority from U.S. Provisional Application No. 60/724,272, filed on Oct. 7, 2005, which is incorporated herein by reference. 
    
    
     FIELD OF THE INVENTION  
      The present invention relates to the field of providing healthcare consultation to human patients. More particularly, the present invention relates to a system and method for remotely connecting healthcare providers and human patients with a multi-disciplinary consulting team of healthcare consultants throughout a geographically dispersed area via robotics and video conferencing systems or other suitable means.  
     BACKGROUND OF THE INVENTION  
      Medicine is evolving through changes in technology and improved methods of delivering healthcare. New technologies and processes enhance the ability of connecting users and suppliers of healthcare.  
      For example, critical care medicine is undergoing rapid changes due in part to financial limitations, a shortage of intensivists (a physician who specializes in the care and treatment of patients in intensive care units (ICUs)) and nurses, and information overload. Care of critically ill patients consumes a disproportional amount of national medical healthcare dollars (greater than 1% of the GDP). Studies have shown that ICUs with intensivists have reduced ICU costs, hospital costs, mortality rates and lengths of stay in the ICU and the hospital. Moreover, improved patient recovery has been linked to care directed by trained intensivists. Intensivist-directed care has been demonstrated to be superior to traditional care with multiple specialists. However, the current supply of qualified intensivists is inadequate to meet demands. Attempts have been made to address this issue.  
      U.S. Pat. No. 6,850,817 to Green discloses a teleoperator system with telepresence that includes right and left hand controllers for control of right and left manipulators through use of a servomechanism that includes a computer. Cameras view workspaces from different angles for production of stereoscopic signal outputs at lines. In response to the camera output a 3-dimensional top-to-bottom inverted image is produced which is reflected by mirror toward the eyes of operator. A virtual image is produced adjacent control arms, which is viewed by the operator looking in the direction of the control arms. By locating the workspace image adjacent the control arms, the operator is provided with a sense that end effectors carried by manipulator arms and control arms are substantially integral. This sense of connection between the control arms and end effectors provide the operator with the sensation of directly controlling the end effectors by hand. By locating the visual display adjacent control arms, the image of the workspace is directly viewable by the operator. Use of the teleoperator system for surgical procedures is also disclosed.  
      U.S. Pat. No. 6,852,107 to Wang, et al., discloses a medical system that allows a mentor to teach a pupil how to use a robotically controlled medical instrument. The system can include a first handle that can be controlled by a mentor to move the medical instrument. The system can further have a second handle that can be moved by a pupil to control the same instrument. Deviations between movement of the handles by the mentor and the pupil can be provided as force feedback to the pupil and mentor handles. The force feedback pushes the pupil&#39;s hand to correspond with the mentor&#39;s handle movement. The force feedback will also push the mentor&#39;s hand to provide information to the mentor on pupil&#39;s movements. The mentor is thus able to guide the pupil&#39;s hands through force feedback of the pupil handles to teach the pupil how to use the system.  
      U.S. Pat. No. 6,804,656 to Rosenfeld, et al., discloses a system and method for providing continuous expert network critical care services from a remote location. A plurality of intensive care units (ICUs) with associated patient monitoring instrumentation is connected over a network to a command center which is manned by intensivists 24 hours a day, 7 days a week. The intensivists are prompted to provide critical care by a standardized series of guideline algorithms for treating a variety of critical care conditions. Intensivists monitor the progress of individual patients at remote intensive care units. A smart alarm system provides alarms to the intensivists to alert the intensivists to potential patient problems so that intervention can occur in a timely fashion. A data storage/data warehouse function analyzes individual patient information from a plurality of command centers and provides updated algorithms and critical care support to the command centers.  
      However, there remains a need for a cost-effective process that reduces lengths of stay in a hospital, including in an intensive care unit (ICU), enhances the effectiveness of physicians, especially intensivists, and improves handling of healthcare information.  
     SUMMARY OF THE INVENTION  
      It is an object of the present invention to provide a system and method of providing access to medical expertise from a healthcare professional or intensivist through broadband, cellular or satellite technology. More preferably, the present invention relates to a system comprising a resource center which comprises a knowledge database, a decision support server and an interactive help system and a method of using same. According to a preferred embodiment, the system further comprises healthcare user data.  
      It is another object of the present invention to provide an interactive help system that provides an interface between a healthcare provider, a healthcare manufacturer or healthcare user. More preferably, the present invention relates to a system and method to connect, preferably via an on-line or wireless connection, geographically dispersed patients and clinicians (users and suppliers) with experts, preferably intensivists, located at a dedicated remote resource center. According to a preferred embodiment, the interactive help system comprises at least one of an automated phone system, an intranet system, an internet access or a product provider help menu. According to another preferred embodiment, the system and method includes robotics means for connecting users, suppliers and/or experts.  
      It is another object of the present invention to provide improved home healthcare, health maintenance programs, extended care facilities, intermediate care units and intensive care units.  
      It is another object of the present invention to provide a system and method that uses a remote-controlled, computerized robot with two-way audiovisual capabilities to provide a plurality of geographically dispersed patients and clinicians access to a remote and dedicated resource center equipped with medical services, expertise, education and training. According to a preferred embodiment, the resource center is equipped with an intensivist-led multi-disciplinary team.  
      It is another object of the present invention to provide medical manufacturers and the healthcare industry access to intensivists at a dedicated resource center via robotics technology for the purpose of supporting customer training, education, trouble-shooting and medical consulting regarding the use of specific technology. In a preferred embodiment, the present invention provides medical expertise to medical manufacturers, the healthcare industry and their respective customers for the purpose of internal staff training, education, clinical application and sales support.  
      It is a further object of the present invention to provide healthcare providers, medical manufacturers and the healthcare industry access to a clinical resource center through voice data broadband (voice and data transmitted over a TCP/IP network, cellular or satellite) and other enabling technologies such as telephone (land line), cellular phone and email. According to a preferred embodiment, the present invention includes robotics and remote medical services to deliver healthcare and medical consulting services by connecting a user and a provider to such services regardless of their location, including but not limited to any of the following settings: ICU; pre-ICU or monitored/intermediate care units; emergency room or triage area; any emergency situation within a hospital; ambulances; medical evacuation helicopters; airports and airplanes; cruise ships; trains, subways and buses; shopping centers and malls; patient homes; home health emergency services; extended care facilities; home health maintenance services; sales and customer support for medical products and pharmaceuticals; military; and mass casualty and terrorism events.  
      It is a further object of the present invention to reduce the ICU length of stay by leveraging intensivist expertise over a large geographic area to enhance the effectiveness of intensivists. The present invention addresses the supply and demand issue by providing a dedicated service that allows member hospitals, medical industries and healthcare professionals access to intensivists 24 hours a day, 7 days a week (24/7).  
      It is yet another object of the present invention to provide a robot capable of self-powered mobility that is controlled remotely and capable of roaming to any patient care area where there is a wireless access point. According to a preferred embodiment, the robot is capable of providing bi-directional interactive video teleconferencing between the patient care area, preferably a hospital, and remote site(s) for educational or consulting purposes wherein clinicians are capable of accessing a network via broadband technologies from remote locations to access the robot.  
      It is yet another object of the present invention to utilize existing patient information systems for the purpose of centralizing and organizing patient information and providing a portal to leverage medical expertise, consulting and patient monitoring from geographically dispersed regions.  
      It is yet another object of the present invention to enable remote medical services to be offered through robotics and an on-line system, wherein the services include, but are not limited to, expert consulting services, patient monitoring, training, education and in-services (training sessions). According to a preferred embodiment, patients and hospital staff and healthcare personnel, including but not limited to registered nurses (RNs), respiratory therapists (RTs), respiratory care practitioners (RCP) and medical doctors (MDs), can utilize the enabled medical service.  
      It is yet another object of the present invention to provide a cost-effective system and method that reduces ICU length of stay, enhances the effectiveness of an intensivist and improves information handling by connecting clinicians with an intensivist-led multi-disciplinary team. According to a preferred embodiment, the present invention is utilized as an element in the integrated delivery system (DS) of a major medical facility or a consortium of hospitals, including any group of healthcare service units that typically includes hospitals, physicians (including, for example, medical groups and independent practice associations), and other non-hospital providers (for example, ambulatory surgery centers, home health providers, skilled nursing facilities, etc.).  
      There has thus been outlined, rather broadly, the more important features of the invention in order that the detailed description thereof that follows can be better understood, and in order that the present contribution to the art can be better appreciated. There are, of course, additional features of the invention that will be described further hereinafter.  
      In this respect, before explaining at least one embodiment of the invention in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of the components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and of being practiced and carried out in various ways. Also, it is to be understood that the phraseology and terminology employed herein are for the purpose of description and should not be regarded as limiting.  
      Accordingly, those skilled in the art will appreciate that the conception upon which this disclosure is based can be readily utilized as a basis for the designing of other structures, methods and systems for carrying out the several purposes of the present invention. It is important, therefore, that equivalent constructions, insofar as they do not depart from the spirit and scope of the present invention, are included in the present invention.  
      For a better understanding of the invention, its operating advantages and the aims attained by its uses, reference should be made to the accompanying drawings and descriptive matter which illustrate preferred embodiments of the invention. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       FIG. 1  is a schematic illustrating a preferred embodiment of the system of the present invention wherein a resource center is connected to various users;  
       FIG. 2  is a schematic illustrating a preferred embodiment of the system of the present invention wherein a site requiring medical consultation services is connected to the resource center with various means of communication;  
       FIG. 3  is a schematic illustrating a preferred embodiment of the system of the present invention wherein the system comprises a feedback loop;  
       FIG. 4  is a flowchart illustrating a preferred embodiment of the method of the present invention for building a knowledge database;  
       FIG. 5  is a flowchart illustrating a preferred embodiment of the method of the present invention wherein a resource center provides healthcare services to various users;  
       FIG. 6  is a flowchart illustrating a preferred embodiment of the method of the present invention as can be used in the event that a caregiver such as a nurse notices a change in patient status;  
       FIG. 7  is a flowchart illustrating a preferred embodiment of the method of the present invention as can be used in the event that a caregiver such as a physician who is at home requests a consultation;  
       FIG. 8  is a flowchart illustrating a preferred embodiment of the method of the present invention as can be used in the event that a caregiver such as a physician in an emergency room (ER) requests a consultation; and  
       FIG. 9  is flowchart illustrating a preferred embodiment of the method of the present invention wherein a resource center provides training and help services to healthcare manufacturers. 
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS  
      As seen in  FIG. 1 , the system of the present invention comprises a resource center  100  connected via a means of connection such as Internet/WAN  110  to various healthcare users  112 . A healthcare provider  120  is also connected via the Internet/WAN  110  to the resource center  100  and the healthcare users  112 . The healthcare user  112  can be a patient or secondary healthcare provider who in turn provides healthcare to a patient. The healthcare provider  120  includes any healthcare professional, such as a nurse, therapist, physician, surgeon, and dentist, etc. The healthcare user  112  can be located anywhere such as in an extended care facility  114 , in a hospital  116 , at home  118 , in a clinic (not shown), on an airplane (not shown), on a ship (not shown), on a bus (not shown), on a train (not shown), etc. A healthcare provider  120  can be located anywhere, such as at the office, at home, at another healthcare facility or at another location, collectively 122. A healthcare provider  120  can also be in transit, such in a car, on a ship or in an airport.  
      According to a preferred embodiment, the resource center  100  is in a location that is remote from the location where the primary care is being provided. Within the context of the present invention, remote means physically distinct, which could be as close as a few feet, e.g., down the hall from the location where the primary care is being provided or as far as thousands of miles away from where the primary care is being provided, e.g., on another continent.  
      The resource center  100  is connected via an internal TCP/IP network  132  or equivalent means to a decision support server  124  and a knowledge server  128 . The network  132  is connected to a router  134  that is connected thorough a firewall  136  to the Internet/WAN  110 . Further, the resource center  100  can be staffed with clinical experts  138 .  
      The decision support server  124  is connected to a decision support database  126 . The decision support server  124  is a computer server that operates software application(s), as would be known to one of skill in the art. The decision support database  126  stores the information necessary to support the decision support server  124 .  
      The resource center  100  also comprises a knowledge server  128  and a knowledge database  130 . The knowledge database  130  of the present invention comprises a retrievable database that gathers and stores medical information. As can be seen in  FIG. 3 , the medical information includes, but is not limited to, healthcare manufacturer information  330 , medical literature  340 , a laboratory  350 , clinical information  360 , clinical experts  138  and/or specialty consultants  142  (as seen in  FIG. 1 ). More preferably, the healthcare manufacturer information  330  comprises product reference material. Furthermore, the laboratory  350  can comprise a testing laboratory or an analysis laboratory for testing or analysis of healthcare products. The testing laboratory or analysis laboratory can be a testing area that tests and/or reproduces scenarios and interaction with medical devices to increase and enhance the safety and efficacy of a healthcare product such as a medical device or drug.  
      According to the present invention, the system includes a means for connecting the healthcare users  112  via the Internet/WAN  110  to the resource center  100 . Such means can include a deployable robot  140 . According to a preferred embodiment, the robot  140  can be a mobile, interactive video conferencing unit remotely controlled by the clinical expert  138  located at the resource center  100  or other locations.  
      The present invention further includes a system and method for remotely monitoring healthcare users  112 , such as a patient, including a system and method for generating and transmitting input commands to a robot  140  from a remote location such as the resource center  100 . The resource center  100  can include a personal computer that is operated by a clinical expert  138 , such as a doctor. The input commands can move the robot  140  so that a robot camera and microphone can capture the video image and sounds of the patient and transmit them back to the remote resource center  100 . The robot  140  can also have a monitor and a speaker to allow for two-way video conferencing between the patient and a doctor at the remote resource center  100 . The robot  140  can move from room to room so that a doctor can make “patient rounds” within a medical facility. The system thus allows a doctor to visit patients from a remote location, thereby improving the frequency of visits and the quality of medical care. An example of such a robot is disclosed in U.S. Published patent application No. 2004/0143421 to Wang, et al., entitled “Apparatus and method for patient rounding with a remote controlled robot,” the entire disclosure of which is herein incorporated by reference.  
      According to a preferred embodiment, specialty consultants  142 , located in a home  146 , office  148  or elsewhere, are connected to the resource center  100  via an Internet/WAN  144 . In one embodiment, Internet/WAN  144  is the same Internet/WAN  110  that connects the resource center  100  to the healthcare user  112 . In an alternate embodiment, Internet/WAN  144  is a separate and/or distinct means of connection. The specialty consultants  142  can be specialty healthcare consultants that provide an external source of medical information.  
      As seen in  FIG. 2 , the resource center  100  is preferably a dedicated site with multi-communication technologies staffed 24/7 by clinical experts  138  and connected via a connecting means such as the Internet/WAN  110 , a cellular connection  210  or a satellite connection  220  to a site requiring medical consulting services  240 . According to a preferred embodiment, the resource center  100  is a remote location staffed with clinical experts  138  at an interactive help system  200  or consulting station. The interactive help system  200  has access via an internal network  132  to a communication server  230  that is in turn connected to the knowledge database  130 , the decision support server  124 , medical devices and scenario reproduction (not shown). More preferably, clinical experts  138  in the interactive help system  200  are equipped with bi-directional interactive voice, data and image transmission capabilities and are available to healthcare users  112  such as patients or secondary healthcare providers located at the site requiring medical consulting services  240 . The site requiring medical consultation services  240  is preferably equipped with mobile two-way interactive audio-visual capabilities, such as a robot  140  that is connected via a wireless connection  250  to a TCP/IP network  260  that is in turn connected to a communication server  270 . More preferably, the resource center  100  is a critical care resource center, a rapid response resource center, an emergency care resource center or a mass casualty response center.  
      According to a preferred embodiment, the site requiring medical consulting services  240  is a hospital  116 , specialized transplant center or donor hospital in need of medical expertise to assist in providing support to the healthcare provider  120  that is to procure suitable donor organs. In this case, the transplant center or donor hospital would have access to the resource center  100  and the clinical experts  138  in the resource center  100  would provide the technical expertise to permit the healthcare provider  120  at the hospital  116  or transplant center to procure the organs.  
      The connection according to a preferred embodiment of the present invention can be a remote connection that connects the clinical experts  138  to healthcare providers  120 , healthcare users  112  and healthcare manufacturers  310  located at geographically dispersed locations. The connection can also be a wireless telephone connection, dial-up telephone connection, wireless internet connection, cable connection or DSL connection. The connection can also comprise a telephone system, a facsimile system, an electronic mail system, a video system, a video conferencing system, an intranet system, an internet system, a heads-up display or a robot  140 . According to a preferred embodiment, the robot  140  can comprise mobile video conferencing, more preferably, a clinical expert  138  located in a remote location such as the resource center  100  can control the robot  140 .  
      Further examples of wireless access points include Cisco®, a device that allows wireless access to a local or wide area network (WAN). Otherwise, a wireless access point can be any device with radio transmitting and receiving capabilities that typically operates using 802.11a, b or g protocol. “802.11” refers to a family of specifications developed by the Institute of Electrical and Electronics Engineers (IEEE) for wireless LAN technology. 802.11 specifies an over-the-air interface between a wireless client/customer and a base station or between two wireless clients/customers.  
      The heads-up display combines a micro-display with near-to-the-eye (NTE) technology and a forward-viewing miniature camera, bi-directional microphone and speaker contained in the headgear and connected to an intranet or internet via wireless broadband width or cellular spectrums. This system is further connected to a server that provides file sharing and interacts between the wearer of the headgear and a remote location for the purpose of real time audio video conferencing, data exchange and demonstration and instruction.  
      According to a preferred embodiment, the clinical experts  138  comprise an intensivist-led multi-disciplinary team. The multi-disciplinary team according to the present invention is a group of healthcare professionals with diverse specialties (medical, social, educational, developmental, etc.) who work together to develop an organized approach to the total management of a healthcare user  112  such as an ICU patient.  
      As seen in  FIG. 3 , the resource center  100  can also comprise a feedback loop  300 , wherein the feedback loop  300  provides feedback to a healthcare manufacturer  310  or to the knowledge database  130 , to enhance or improve products such as medical devices, medical protocols and/or drugs. As used herein, a healthcare manufacturer  310  comprises at least one of a medical device manufacturer or a drug manufacturer. More specifically, the step of providing the feedback loop  300  can comprise providing feedback to the healthcare manufacturer  310  via the feedback loop  300 , preferably to increase and enhance the safety and efficacy of a healthcare product such as a drug or medical device. The step of providing the feedback loop  300  can also comprise providing feedback to the knowledge database  130  via the feedback loop  300  to develop and build a comprehensive and robust knowledge database  130  as seen in  FIG. 3 .  
      According to a preferred embodiment, the resource center  100  can further comprise healthcare user data  320  such as demographic data, pharmacological data, physiological data, radiological images, hemodynamic parameters, laboratory data, device output data, audio data and/or video data. Demographic data includes information about a healthcare user  112 , such as the name, race, gender, etc. Pharmacological data includes information on the type, route and amount of pharmaceutical drugs that a healthcare user  112  receives. Radiological images include, but are not limited to, x-rays, CAT scans, MRI, angiography, and the like. Hemodynamic parameters include vital signs such as blood pressure, heart rate, respiratory rate, pulmonary artery pressure, etc. Laboratory data includes results of tests from blood, urine, spinal fluid, etc. as tested for cell count, bacteria, etc. Device output data includes data transmitted from a medical device to an application that displays or stores that data for retrieval. Audio and video data includes data generated from video conferencing with a mobile or stationary video conferencing device that is displayed and can be stored electronically. According to a preferred embodiment, the electronic feed for the healthcare user data  320  is available in real time, i.e., provides present time healthcare user data  320 .  
      Such healthcare user data  320  can be stored in information systems known by those of ordinary skill in the art. Such systems include, but are not limited to, systems made by Cerner, iMD Soft, CliniComp, Dräger, GE, Phillips, GCQ, Eclipsys and Piscis. Access to such information systems provides access to critical patient information when decisions need to be made.  
      According to another preferred embodiment, the step of building the knowledge database  130  comprises the step of collecting information and data  400  from clinical experts  138 , specialty consultants  142 , healthcare user data  320 , healthcare manufacturer information  330 , medical literature  340 , a laboratory  350  and/or clinical information  360  and the step of processing same  410  as seen in  FIG. 4 . Once the information and data is collected  400  and processed  410 , a document is drafted  420  and then validated  430  for content accuracy and quality assurance.  
      Where needed, there are several existing data warehousing technologies known by those of ordinary skill in the art. Examples of such technologies include, but are not limited to Oracle data warehouse, Microsoft SQL server, IBM DB2 data warehousing and Cognos and Brio data warehouse tools.  
      The present invention also relates to a method for healthcare manufacturers to provide training and help services to healthcare providers or healthcare manufacturer employees comprising the step of establishing a connection between a medical expert and the healthcare provider or healthcare manufacturer employee, wherein the medical expert provides education and training services. Preferably, the present invention relates to a method for providing training and help services to a healthcare provider  120 , a healthcare manufacturer  310  or a healthcare user  112  comprising the steps of providing a resource center  100  that comprises a knowledge database  130 , a decision support server  125  and an interactive help system  200 , building the knowledge database  130  by compiling information  400 , analyzing the information  410  in the knowledge database  130  to develop the decision support server  124 , establishing a connection  110  between the interactive help system  200  and the healthcare provider  120 , healthcare manufacturer  310  and healthcare user  112 , accessing the decision support server  124 , and delivering education, training and consultation services via the interactive help system  200  as illustrated in  FIGS. 2 and 5 . More preferably, the method can further comprise the step of collecting healthcare user data  320 . According to a preferred embodiment, the method further comprises the step of providing feedback to the healthcare manufacturer  310  or the knowledge database  130  via the feedback loop.  
      According to another preferred embodiment, the delivering step further comprises the step of delivering education, training and consultation services 24/7. The consultation services can include medical illness, medical device, educational, policy and procedure, ICU evaluation and assessment, staffing, protocol development and decision support and medical services, including corporate medical services. In one example the invention can be used to connect remote clinical experts  138  to healthcare providers  120  to enable real-time assistance with active patient issues. More specifically, the system and method of the present invention can be used in the event that a caregiver such as a nurse notices a change in patient status as shown in  FIG. 6 ; in the event that a caregiver such as a physician who is at home requests a consultation as shown in  FIG. 7 ; or also in the event that a caregiver such as a physician in an emergency room (ER) requests a consultation as shown in  FIG. 8 .  
      According to another preferred embodiment, the consultation could be initiated by a request from a healthcare provider  120  to monitor a healthcare user  112 . In this case, the resource center  100 , located in a location remote from the healthcare user  112 , would notify the healthcare provider  120  in the event of any noted anomaly that may affect the healthcare user  112 .  
      As seen in  FIG. 9 , also disclosed is a method for a healthcare manufacturer  310  to provide training and help services to a healthcare provider  120  or healthcare manufacturer employees comprising the step of establishing a connection between a clinical expert  138  and the healthcare provider  120  or healthcare manufacturer employee, wherein the clinical expert  138  provides education and training services.  
      Having now described a few embodiments of the invention, it should be apparent to those skilled in the art that the foregoing is merely illustrative and not limiting, having been presented by way of example only. Numerous modifications and other embodiments are within the scope of the invention and any equivalent thereto. It can be appreciated that variations to the present invention would be readily apparent to those skilled in the art, and the present invention is intended to include those alternatives.  
      Further, since numerous modifications will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation illustrated and described, and accordingly, all suitable modifications and equivalents can be resorted to as falling within the scope of the invention.