Patent Publication Number: US-2010115548-A1

Title: Patient entertainment system with supplemental patient-specific medical content

Description:
The following relates to the medical arts. It especially relates to providing medical advice to patients in a hospital or other clinical setting, and is described with illustrative reference thereto. The following relates more generally to providing medical advice to patients or other subjects in hospital, home, or other settings. 
     It is known to provide monitoring of a patient in a hospital. Such monitoring may include automated measurement of physiological parameters such as heart rate, blood pressure, or SpO 2  level, or less automated tracking of patient weight, food intake, bowel movements, urinary function, exercise, sleep periods, or so forth. Such information is typically recorded by hospital personnel automatically (for example, by storing trending information relating to measured physiological parameters) or by recording such information in electronic or paper-based patient charts. This information is used by physicians, nurses, or other care providers to tailor the patient&#39;s care to the current physical, and perhaps mental, condition of the patient. 
     It is also recognized that this information is advantageously conveyed to the patient, so as to enable the patient to alter his or her behavior accordingly. For example, a nurse may tell a patient that he or she needs more sleep, or more exercise, or should eat more or less, or so forth. The patient monitoring in raw form (such as heart rate data, food intake charting, or so forth) is typically of little value to the patient. Rather, a doctor, nurse, or other care provider typically filters the raw patient monitoring data by suitable analysis to construct appropriate behavioral modification recommendations. This filtering can be complex (e.g., analysis of an electrocardiogram to determine cardiac condition) or straightforward (e.g., comparing food intake with a caloric intake target). 
     Unfortunately, the conveyance of information to the patient is sometimes ineffective or inefficient. A typical patient may receive brief nurse visits a few times a day, and perhaps a brief visit from a physician. During these brief patient-caretaker encounters, the caretakers attempt to convey relevant information or advice to the patient. However, the nurse or physician typically has one or more specific tasks to perform during the brief visit, such as changing an intervenous drip, performing diagnostic probing, or so forth, and may therefore be distracted and fail to provide the patient with relevant information or advice. 
     Still further, even if the patient receives the information or advice, he or she may forget or ignore the information or advice. Repetitive communication would enhance the patient&#39;s memory and likely increase the chance of patient follow-through. However, staffing limitations and other tasks impose limitations on the amount of patient-caretaker interaction time. 
     The following provide improvements addressing the above-referenced problems and others. 
     In accordance with one aspect, a medical information delivery system is configured for operation in conjunction with an entertainment device configured to present an entertainment audio/video content datastream. The medical information delivery system includes means for inserting additional content into the entertainment audio/video content datastream, and means for selecting patient-specific content for insertion into the entertainment audio/video content datastream. 
     In accordance with another aspect, a medical information delivery method is disclosed, including presenting entertainment audio/video content via an entertainment device, and selectively presenting patient-specific content via the entertainment device with the presenting of the entertainment audio/video content. 
     In accordance with another aspect, an information delivery system is disclosed, including an entertainment device comprising one or more components configured to present an entertainment audio/video content datastream, and one or more additional components configured to select and insert viewer-specific content unrelated to the entertainment content into the entertainment audio/video content datastream for presentation by the entertainment device along with the entertainment audio/video content datastream. 
     One advantage resides in presenting patient-specific information or advice in conjunction with audio/video content presentation of interest to the patient. 
     Another advantage resides in leveraging existing audio/video equipment to provide patient-specific information and advice in an automated manner. 
     Another advantage resides in leveraging available entertainment-oriented audio/video equipment to additionally provide patient-specific information and advice. 
     Another advantage resides in providing medical information or advice to a patient using a television or entertainment system with which the patient is familiar and comfortable. 
     Another advantage resides in providing comprehensible medically-related advice to a patient based on real-time patient monitoring. 
     Still further advantages of the present invention will be appreciated to those of ordinary skill in the art upon reading and understand the following detailed description. 
    
    
     
       The invention may take form in various components and arrangements of components, and in various steps and arrangements of steps. The drawings are only for purposes of illustrating the preferred embodiments and are not to be construed as limiting the invention. 
         FIG. 1  diagrammatically depicts a patient in a hospital room, an entertainment device in the hospital room including a television and a digital video recorder, and a medical information delivery system configured for operation in conjunction with the entertainment device. 
         FIGS. 2-8  diagrammatically depict various illustrative ways the medical information delivery system of  FIG. 1  can insert patient-specific content into an entertainment audio/video content datastream being presented by the entertainment device. 
     
    
    
     With reference to  FIG. 1 , a patient  10  is disposed in a hospital room  12  or other clinical or home setting. The patient  10  is optionally monitored, for example using a body sensor network comprised of wireless sensors  14 . The sensors  14  may monitor, for example, cardiac cycling or heart rate, blood pressure, SpO 2 , respiration or respiratory rate, or so forth. The wireless sensors  14  communicate wirelessly with a wireless monitoring receiver  16  that collects patient measurements. The wireless communication employs a suitable wireless protocol such as Bluetooth, Zigbee, WiFi, or so forth. To facilitate patient mobility, for example to enable the patient to go outdoors, the sensors may be integrated into the patient&#39;s clothing or otherwise attached to the patient in a way that promotes patient mobility. The collected patient measurements may be forwarded to a caregiver, for example by transmission to a nurses&#39; station that collects and stores patient measurements. In some embodiments, the wireless sensors  14  also intercommunicate wirelessly amongst each other to form a body sensor network that optionally operates autonomously even if the patient  10  (and hence the sensors  14 ) move away from and out of range of the wireless monitoring receiver  16 . Although wireless sensors  14  are illustrated, in other embodiments wired sensors, or a combination of wired and wireless sensors, may be used. 
     The patient  10  additionally or alternatively optionally receives therapy or treatment, such as an illustrated intravenous (IV) fluid drip  20 . In a hospital setting, the patient  10  typically spends a significant amount of time in a bed  22 . When not sleeping, the patient will typically watch an entertainment audio/video content datastream  26  displayed by an entertainment device  30 , such as a television  32  having a display or screen  33  for displaying video, and optionally including additional components such as an illustrated digital video recorder  34 . The illustrated television  32  is ceiling-mounted by an articulated mounting rod  36 ; alternatively, the television  32  may be disposed on a stand, floor-mounted, or otherwise supported. Typically, the patient  10  can operate the television  32 , digital video recorder  34 , or other components of the entertainment device  30  using at least one hand-held remote controller  38 . 
     In some embodiments, the television  32  is a commercially available cathode ray tube television, LCD television, plasma television, front- or rear-projection television, or so forth. The television  32  can utilize substantially any audio technology, such as one or more built-in speakers, a wired or wireless sound system including two or more external speakers, incorporation of a stereo or high fidelity audio system, or so forth. The entertainment audio/video content datastream  26  can take various forms, including for example: a wireless broadcast signal; a cable television feed carrying television broadcasts; a satellite television feed carrying television broadcasts; a closed-circuit television broadcast that services residents of an assisted care community or patients of a hospital; or a non-broadcast audio/video content datastream such as a video cassette recorder output; a DVD output; an output from a digital video recorder; various combinations or juxtapositions of these; or so forth. The entertainment audio/video content datastream can be standard definition (e.g., standard definition television, typically denoted as SDTV), high definition (e.g., high definition television, typically denoted as HDTV), or another resolution, and can employ a standard 4:3 display, widescreen display, or other display size. Moreover, in some embodiments the entertainment device does not include a television. For example, the entertainment device can be a portable DVD player that plays back DVDs, in which case the entertainment audio/video content datastream includes the DVD output. The display can also be a computer or gaming monitor, a personal data assistant (PDA), a cellular telephone, or so forth. At least one component of the entertainment device  30  should include a display, such as the illustrated display or screen  33  of the illustrated television  32 , or the display of a PDA or cellphone, or so forth. 
     As used herein, the term “audio/video content” or the like is intended to encompass both video-only content and combined audio and video content. For example, “audio/video content” may include displayed text, silent video, a displayed static image, video with an accompanying soundtrack, or so forth. 
     In the illustrated embodiment, the entertainment device  30  is leveraged to additionally provide the patient  10  with patient-specific content delivered with the entertainment audio/video content datastream  26 . Advantageously, the patient  10  typically is interested in the entertainment audio/video content datastream  26 , and hence is watching and listening to the entertainment device  30 . Thus, when this entertainment device  30  delivers patient-specific content such as medical information or advice, the patient  10  is likely to perceive this information and advice. Moreover, in some embodiments the patient  10  is largely confined to (or at least spends a lot of time in) the hospital room  12  or another limited setting such as an assisted living community, a house in which the patient is house-bound, or so forth, and the patient likely spends a substantial amount of time watching the entertainment audio/video content datastream  26  via the entertainment device  30 . Thus, the patient-specific content such as behavior modification advice can be delivered continuously or on a periodic or other frequent basis—as a result, the patient  10  perceives this information or advice frequently and is likely to remember it and, ideally, act upon it. The behavior modification advice can be repeated to allow the patient to access it when desired, or to provide repetitive reinforcement to enhance the patient&#39;s learning of the content. Still further, in some embodiments the delivered patient-specific information is constructed in real time based on patient medical readings provided by the sensors  14 , which enables the provided information or advice to be timely. 
     With continuing reference to  FIG. 1 , a patient-specific content storage  40  stores patient-specific content that is selectable by a patient-specific content controller  42 . The patient-specific content can be generated or supplied in various ways. In one approach, a data analyzer  44  analyzes patient measurements acquired by the sensors  14  and wireless monitoring receiver  16 , or acquired by another wired or wireless sensor. The data analyzer  44  analyzes the patient measurements to generate information or advice in comprehensible language that is readily understood by the patient  10  even if the patient  10  has little or no specialized medical knowledge or expertise. For example, the data analyzer  44  may analyze heart rate measurements, blood pressure measurements, or other physiological measurements and determine whether the patient is in an excited state. If the patient is excited, and has a heart condition or other condition that makes the patient susceptible to a heart attack or other stress-aggravated trauma, then the data analyzer  44  generates patient-specific content to alleviate the stress. This patient-specific content may include textual advice such as “Calm down, you&#39;re getting too excited”, or a soothing static visual image such as a cloudscape, or a soothing video image such as an image of fish swimming in an aquarium, or a suggestion to perform a calming ritual, so forth. If the data analyzer  44  determines that the patient is undergoing an asthma attack, it may generate a patient-specific message such as “Please use your rescue inhaler immediately”. As another example, the data analyzer  44  may receive a patient food intake record from a hospital network or elsewhere. The data analyzer  44  compares this food intake record with a desired food intake profile (e.g., desired caloric intake, desired fruit/vegetable-to-meat ratio, or so forth) and constructs recommendations for dietary modifications that serve as patient-specific content. In some embodiments, the data analyzer  44  may provide the patient with feedback on recommended choices for meals. For example, the data analyzer  44  may recommend that a patient who has been eating too little fruit should elect the “apple sauce” side item from the lunch menu, rather than the “french fries” side item. 
     As another example, the data analyzer  44  may receive a weight measurement, and compare this weight measurement with a target weight for the patient  10 . If, for example, the weight measurement is too low, the data analyzer  44  constructs patient-specific advice content such as “You are still not gaining enough weight after your illness. You need to eat more high calorie foods.” The weight measurement can be acquired by directly reading a suitable sensor, such as a scale, when the patient is being weighed, or by reading a weight measurement that is manually input, for example entered by a nurse into an electronic patient chart that is accessible to the data analyzer  44 . 
     Another contemplated source of patient-specific content are pre-recorded audio/video content that may be arranged, for example, as one or more care modules  50 . Each care module  50  includes audio/video content directed toward a particular medical issue, and the physician or other care giver selects one or more of the care modules  50  that are appropriate for the condition of the patient  10  as patient-specific content to be presented to the patient  10  in accordance with a care plan schedule  52 . For example, if the patient  10  has recently suffered a heart attack, then the care plan schedule  52  may include a weight loss care plan module, a “quit smoking” care plan module, and a “get started with walking” care plan module as patient-specific content. As used herein, a given care plan module selected for presentation to the patient  10  is considered to be patient-specific content since it is selected for the patient  10 , although it is to be recognized that the same care plan module might also be independently selected for presentation to another patient. 
     Another contemplated source of patient-specific content is a message entry interface  54 , via which a physician, nurse, or other caregiver can input patient-specific content intended for delivery to the patient  10  via the entertainment device  30 . For example, the doctor may enter a message such as “Don&#39;t forget to take at least three walks each day down the hospital hallway” so as to encourage a post-surgery patient  10  to being to move about after surgery. As another example, reminders to take medications can be displayed at appropriate times. 
     The patient-specific content can also relate to information informing the patient about an action he or she should take. For example, an automatic pills dispenser  53  can be mounted on the IV stand or in another position within convenient reach of the patient. The patient specific-content may in this example be a message telling the patient that a scheduled administration of medicine in a pill form is available from the dispenser  53 . Such scheduling is suitably incorporated into the care plan schedule  52 . When the appointed time arrives for a pill dispensation, the patient-specific content controller  42  or another device outputs a wired or wireless triggering signal to the automatic pill dispenser  53 , which outputs a pill using a vending machine-type mechanism. Optionally, the automatic pill dispenser also provides an audibly and/or visually perceptible indication of the availability of the dispensed pill, for example as a light, buzzer sound, or so forth. Concurrently presented patient-specific content includes an audio/video message displayed on the television  32  notifying the patient of the scheduled medication intake and instructing the patient on where the pill is and how to take it (for example, with food, or with a full glass of water, or so forth). 
     The patient-specific content controller  42  selects content from the patient-specific content storage  40  for presentation to the patient with the entertainment audio/video content datastream  26 . The controller  42  selects what content to present, when to present it, and optionally how to present it. The patient-specific content storage  40  may serve as long-term storage for storing patient-specific content for hours, days, or even longer time intervals before delivery. In other embodiments, the patient-specific content storage  40  may be a short-term buffer that stores the patient-specific content for a short time interval sufficient for the controller to arrange for its presentation. In other embodiments, the patient-specific content storage  40  serves as both long-term storage for less urgent data and short-term buffering for urgent data that should be presented as soon as possible (such as, for example, the message “Please use your rescue inhaler immediately” displayed in response to an asthma attack). 
     The patient-specific content controller  42  selects content from the patient-specific content storage  40  for presentation. A multiplexor  56  inserts the selected patient-specific content into the entertainment audio/video content datastream  26  such that it is presented by the presentation device  30 . The content controller  42  and multiplexor  56  can operate in various ways to insert the patient-specific content into the entertainment audio/video content datastream  26 . The selected content insertion method depends upon the manner in which the patient-specific content is to be presented, and may further depend on the capabilities of the television  32  or other component or components of the audio/video entertainment device  30 . Some contemplated content insertion approaches take advantage of the wireless remote control capability incorporated into most audio/video entertainment system components. For example, the illustrated television  32 , like most televisions, is controllable by the hand-held remote controller  38  that communicates with the television via an infrared, radio frequency, or other wireless signal. In the illustrated embodiment, the hand-held remote controller  38  is a “universal” remote, that also controls the DVR  34 . In other embodiments, separate handheld remote controllers may be provided for different components of the entertainment device, or some components may not be remotely operable. The hand-held remote controller  38  has the capability, by transmitting appropriate wireless signals selected by buttons or other user operable inputs of the remote controller  38 , to turn the television  32  on or off, to select the channel, to adjust the audio volume, to turn subtitling on or off, and so forth. The content controller  42  can therefore control the television or other component of the audio/video entertainment device  30  by operating a wireless transmitter  58  to mimic these wireless signals to cause the television or other component of the audio/video entertainment device  30  to turn on or off, to switch to a desired channel, to turn subtitling on or off, or so forth. Typically, the signal from the wireless transmitter  58  takes priority over any signal produced by the handheld remote controller  38 . Some illustrative examples of methods for inserting patient-specific content into the entertainment audio/video content datastream  26  are described. Analogously, the patient can communicate with a transmitter/receiver via the controller  38  to confirm that a walk or medications were taken, a length of the walk, or so forth. 
     With continuing reference to  FIG. 1  and with further reference to  FIG. 2 , in one approach the entertainment audio/video content datastream  26  is displayed in a main window  60  (indicated by a dashed-line border in the FIGURES) that occupies most of the space of the video display screen  33 , while the patient-specific audio/video content is displayed in a superimposed patient-specific audio/video sub-window  62  (indicated by a dashed-line border in  FIG. 2 ). One approach for implementing this type of content insertion makes use of the built-in picture-in-picture capability of some televisions. If the television  32  has picture-in-picture capability, then insertion of the patient-specific content into a sub-window can be achieved as follows. A channel is designated for the patient-specific content, and the multiplexor  56  loads the patient-specific content by modulating the content into the frequency band of the designated channel Format conversion, interpolation to change pixel resolution, or other format adjustment is performed as appropriate. The controller  42  operates the transmitter  58  to send suitable mimicked remote control signals to configure the television  32  to display the sub-window  62  (that is, a “picture within a picture”) with the sub-window  62  tuned to the designated channel carrying the patient-specific content. The patient  10  optionally can use the hand-held remote controller  38  to manipulate the sub-window  62  in accordance with the built-in picture-in-picture capabilities of the television  32 . For example, with some televisions, the patient  10  may be able to move the sub-window  62  to a selected corner of the screen  33 , or may be able to re-size the sub-window  62 , or may be able to turn switch the sound output between the audio portion of the entertainment datastream  26  and an optional audio portion of the patient-specific content, or so forth. If allowing the patient to manipulate (and perhaps turn off) the sub-window  62  is undesirable, then the controller  42  can be configured to have the transmitter  58  re-send the mimicked remote control signals configuring the television  32  to display the sub-window  62  tuned to the designated channel carrying the patient-specific content on a recurring basis, such as every ten seconds or so. 
     With continuing reference to  FIG. 1  and with further reference to  FIG. 3 , in another approach the patient-specific content is displayed as subtitling  64  that is superimposed on the main window  60  that occupies most of the space of the display or screen  33 . Again, the main window  60  displays the video content of the entertainment audio/video content datastream  26 . One approach for implementing this type of content insertion makes use of the built-in closed captioning capability provided in some televisions to allow textual display of dialog for the hearing impaired. If the television  32  has built-in closed captioning capability, then insertion of the patient-specific content as closed captioning can be done as follows. The multiplexor  56  inserts the patient-specific content into the entertainment audio-video content datastream  26  as a closed captioning data, in the format ordinarily used for inserting closed captioning information. The controller  42  then operates the transmitter  58  to send suitable mimicked remote control signals to configure the television  32  to enable the built-in closed captioning display. In some embodiments, the patient  10  can elect to turn off the closed captioning using the hand-held remote controller  38 . If allowing the patient  10  to turn off the patient-specific closed captioning content  64  is undesirable, then the controller  42  can operate the transmitter  58  to re-send the mimicked remote control signals configuring the television  32  to display closed captioning on a recurring basis, such as every ten seconds or so. 
     With continuing reference to  FIG. 1  and with further reference to  FIG. 4 , in another approach the patient-specific content is displayed as a horizontally scrolling banner  66  that is superimposed on the main window  60  that occupies most of the display or screen  33 . Again, the main window  60  displays the video portion of the entertainment audio/video content datastream  26 . This type of content insertion is suitably performed at the datastream level. The video portion of the entertainment datastream  26  is processed to substitute pixels corresponding to the scrolling banner  66  for pixels of the entertainment datastream  26  in the region of the scrolling banner  66 . The modified content is then displayed in the main window  60 , with the scrolling banner  66  appropriately superimposed by the pixel-level video data substitution. If the entertainment audio/video content datastream  26  includes multiple channels (such as in some cable or satellite television feeds) then the pixel-level data substitution may be performed on each channel, or a feedback path (not shown) may be provided to tell the multiplexor  56  which channel is currently being viewed, so that the substitution is made only in the video portion of the currently viewed channel. 
     With continuing reference to  FIG. 1  and with further reference to 
       FIG. 5 , in another approach a time-domain multiplexing is used. That is, in these approaches the main window  60  presents either the entertainment audio/video content datastream  26  or the patient-specific substitute datastream, and the controller  42  switches between the entertainment and patient-specific content datastreams. One approach for implementing this type of content insertion is to designate a channel for the patient-specific content. The multiplexor  56  loads the patient-specific content by modulating the content into the frequency band of the designated channel Format conversion, interpolation to change pixel resolution, or other format adjustment is performed as appropriate. The controller  42  operates the transmitter  58  to send suitable mimicked remote control signals to switch to the designated channel when the controller  42  decides that patient-specific content should be presented. When the controller  42  decides that the patient-specific content should be turned off, it suitably operates the transmitter  58  to send a remote control signal mimicking the hand-held remote controller&#39;s “switch to last channel” operation to return to the entertainment content datastream  26 . This “switch to last channel” operation is provided in most commercially available television hand-held remote controllers to switch to the last displayed channel For example, if the patient  10  is watching channel  11 , then switches to channel 34 by typing “3” . . . “4” using the hand-held remote controller  38 , and then subsequently presses the “switch to last channel” button on the hand-held remote controller  38 , the television  32  returns to channel 11. In a multi-channel feed, using the “switch to last channel” operation ensures that the television  32  returns to the correct channel of the entertainment audio/video content datastream  26  after the viewing of the selected patient-specific content is complete. Alternatively, the current channel can be determined by suitable feedback (not shown) to the controller  42 , and then the controller can operate the transmitter  58  to send remote control signals mimicking the hand-held remote controllers operation selecting that channel to switch back. 
     With continuing reference to  FIG. 5  and with further reference to  FIG. 6 , the controller  42  can select when to interrupt the entertainment audio/video datastream  26  in various ways. In the example of  FIG. 6 , the controller  42  elects to interrupt the entertainment datastream  26  responsive to receipt of urgent patient-specific content  70 . The term “urgent” means here that the content is sufficiently important that the controller  42  elects to interrupt the entertainment datastream  26  to display it. For example, the urgent patient-specific content  70  may a scheduled goal module on the care plan schedule  52 , or may be a message telling the patient  10  to breath into a bag responsive to hyperventilation detected by the sensors  14 , or so forth. A portion  72  of the entertainment content  26  indicated by a dashed box is replaced by the urgent patient-specific content  70 . Typically, the replaced entertainment content portion  72  is lost—the patient  10  never sees it because it is replaced by the urgent patient-specific content  70 . In some embodiments, however, the entertainment device includes the digital video recorder (DVR)  34  or other recording device that provides time-shifting capability. As typical DVR devices are also remotely controllable, the controller  42  can readily implement time-shifting by having the transmitter  58  mimic suitable remote control signals to cause the DVR  34  to cache the entertainment content  26  while the urgent patient-specific content  70  is presented, and then mimic suitable remote control signals to cause the DVR  34  to initiate play back starting at the point where the entertainment content datastream  26  was interrupted. 
     With continuing reference to  FIGS. 1 and 5  and with further reference to  FIG. 7 , in another example the controller  42  elects to substitute patient-specific content for commercials  74  optionally included in the entertainment audio/video datastream  26 . Commercials  74  can be expected, for example, if the entertainment audio/video datastream  26  is a broadcast television signal, cable television signal, or other television signal whose availability is supported by inclusion of advertising content. This approach makes use of an optional commercial detector  76  ( FIG. 1 ) to detect when commercials  74  begin and end in the datastream  26 . Some commercial detectors contemplated for use as the commercial detector  76  are disclosed in DeLuca, U.S. Pat. No. 5,973,723, Vogel, U.S. Publ. Appl. No. 2003/0145320 A1, and Trajkovic et al., U.S. Publ. Appl. No. 2002/0178444 A1, all three of which are incorporated herein by reference in their entirety. During commercials  74  detected by the commercials detector  76 , selected patient-specific content  78  is substituted for the commercials  74 , under the assumption that the content  78  is more valuable to the patient  10  than the commercials  74 . 
     In some embodiments, the time-domain multiplexing is achieved by having the multiplexor  56  load the patient-specific content in a designated channel, and having the controller  42  switch to the designated channel during time intervals in which the patient-specific content is to be presented. In other embodiments, the multiplexor  56  inserts the time-domain multiplexed patient-specific content by directly overwriting the entertainment content in the entertainment content datastream  26 . For example, with reference again to  FIG. 7 , rather than switching to a designated patient-specific content channel during commercials, the time-domain multiplexor  56  can instead overwrite the commercials  74  in the currently presented entertainment channel with the patient-specific content  78 , which is then presented by continuing to present the currently presented entertainment channel without a change of channel. It is contemplated to buffer the entertainment audio/video content datastream  26  to provide time for detecting the commercials and making the substitution of patient-specific content for the commercials. Another approach for time-domain multiplexing is for the multiplexor  56  to act as an audio/video switch that receives two or more audio/video signals (such as the entertainment A/V datastream  26  and an additional datastream containing patient-specific content) and conveys a selected one of the received signals to the television  32  for presentation to the patient. The signal selection can be made through a suitable wired or wireless signal provided by the patient-specific content controller  42 . 
     In another contemplated embodiment, the message is flashed on the screen for a very short time duration to provide subliminal motivations. If the patient-specific content is of a type that should be acknowledged by the patient, then the content may be displayed until such feedback is received. For example, a message to take a pill dispensed by the automatic pill dispenser  53  may scroll across the television screen until a sensor on the automatic pill dispenser  53  detects that the patient has removed the dispensed pill from the automatic pill dispenser  53 . The sensor may be, for example, a pressure or contact sensor disposed on the bottom of a dispensing tray that detects when the weight of, or contact with, the dispensed pill is removed by the patient taking the pill off the dispensing tray. In some such embodiments, the presentation of the patient-specific content may change to become more intrusive if the patient does not respond immediately. For example, the message “Please take your pill” may start out as a scrolling steady message, and then switch to a blinking or flashing message if no patient response is detected, and if still no response is detected an audible signal may be activated. If the patient response is too long delayed, it is also contemplated to transmit a signal to a nurses&#39; station (in a hospital setting) or to a telephonic Lifeline (in the case of a patient at home), or to another third party. 
     If the patient-specific content is urgent (for example, a warning that the patient needs to stop and rest to control a palpitating heartbeat detected by cardiac sensors and the data analyzer  44 ) then suitable audio or visual cues are optionally provided to ensure that the receives the content promptly. For example, the television may make several loud “beeps” to get the patient&#39;s attention. If the patient-specific content is urgent and the patient is outdoors or otherwise away from the television  32 , it is contemplated to use an alternate communication pathway such as a cellular telephone to deliver the urgent patient-specific content. 
     With reference to  FIG. 1  and with further reference to  FIG. 8 , it is contemplated for the patient-specific content presented with the entertainment content datastream  26  may be interactive content. In  FIG. 8 , the time-domain multiplexing approach of  FIG. 5  is used.  FIG. 8  shows patient-specific content in the form of an interactive patient survey form  80 . The form suitably displays highlighting  82  to indicate a question currently under consideration. In one approach, the question is formatted to be answerable by selecting a number. For example, a question relating to difficulty in breathing could be suitably formulated as follows: 
     Question 1: Are you experiencing difficulty in breathing?
         Press “1” to indicate no difficulty;   Press “2” to indicate occasional difficulty;   Press “3” to indicate frequent difficulty;   Press “4” to indicate continuous difficulty.
 
The patient  10  then presses the appropriately responsive number button on the hand-held remote controller  38 . A receiver  84  operatively coupled with the controller  42  and located close to the television  32  detects the wireless signal generated by the patient&#39;s pushing the appropriate button, and the controller  42  receives this answer.
       

     The illustrated embodiments are in the context of the hospital room  12  or other clinical setting. However, it is contemplated to use such approaches for integrating patient-specific content into entertainment audio/video content datastreams in other settings, such as in the home of a person receiving care. Moreover, the illustrated and described approaches for inserting patient-specific content into the entertainment audio/video content datastream are illustrative examples, and other approaches can be used. Yet further, the illustrated and described sources of patient-specific content for insertion are illustrative examples, and other sources and types of patient-specific content can be used. The patient-specific content may also be delivered to other parties besides the patient, such as to the patient&#39;s doctor or to the patient&#39;s family members (preferably conditional upon patient consent to release of such information or other protections for the privacy of patient medical information). 
     An advantage of presenting the patient-specific content with the entertainment audio/video content datastream  26  on the entertainment device  30  is that the patient  10  typically engages in this activity a substantial amount of time (typically for a longer time, for example, than the cumulative time of nurse and doctor visits). Moreover, the patient  10  is typically paying attention to the entertainment content, and hence is likely to absorb the presented patient-specific content as well. However, the patient typically does not constantly use the entertainment device  30 —rather, the patient may spend significant time in other activities such as sleeping, reading, or so forth. In some embodiments, the patient-specific content is only presented when the entertainment device  30  is already operating to present the entertainment audio/video content datastream  26 . In these embodiments, when the device  30  is turned off (or is placed into a “sleep” mode, or is otherwise set to be inoperative for presenting the entertainment audio/video content datastream  26 ) it follows that no patient-specific content is presented. 
     In other embodiments, the controller  42  may be configured to operate the transmitter  58  to send suitable mimicked remote control signals to turn on the entertainment device  30 , or a selected portion thereof such as the television  32 . The controller  40  may, for example, selectively turn on the television  32  when the controller  42  receives urgent patient-specific content, such as advice for the patient on how to deal with a current asthma attack or other acute problem. It is also contemplated for the entertainment device  30  to be left on constantly, and for it to display only patient-specific content (optionally with no audio portion, optionally with the display  33  dimmed, or otherwise configured to be relatively unobtrusive) when the patient “turns off” the presentation of the entertainment audio/video content datastream  26 . 
     Still further, it is contemplated for the controller  42  and/or multiplexor  56  to actively intervene with the viewing by the patient  10  of the entertainment audio/video content datastream  26 . For example, the controller  42  may be configured to limit the patient&#39;s viewing during nighttime hours (e.g., after 10:00 p.m. and before 7:00 a.m.). In some embodiments, the controller  42  does so by operating the transmitter  58  to send suitable mimicked remote control signals to turn off the entertainment device  30 , or a selected portion thereof such as the television  32 , or to put the device to sleep or otherwise make it inoperative. In some embodiments, the controller  42  used in conjunction with a heart patient or other patient with a sensitive condition is configured to monitor the patient&#39;s vital signs via the sensors  14 , and to cause the entertainment device  30  to switch from a channel known for showing stimulating content (such as sporting events, X-rated movies, or the like) to a channel known for showing more soothing content if the monitored vital signs show that the patient is getting overly stimulated. Instead of switching to a soothing channel of the entertainment audio/video content datastream  26 , the controller  42  may switch to soothing patient-specific content, for example using the time-domain multiplexing approach diagrammatically depicted in  FIG. 5 . 
     In the illustrated examples, the controller  42  operates the entertainment device  30  via the wireless transmitter  58  mimicking signals of the wireless handheld remote controller  38 . In other contemplated embodiments, more direct operational control is provided, for example by including suitable wired control connections between the controller  42  and the entertainment device  30 , or by integrating the controller  42  into the entertainment device  30 . Similarly, the multiplexor  56  can be integrated into the entertainment device  30 , or into the controller  42 . Other physical embodiments can be used. For example, in some embodiments a computer or computer network embodies the data analyzer  44 , storage  40 , and message entry interface  54 . Such a computer or computer network can also optionally store the care plan schedule  52  and care plan modules  50 , and can optionally embody the controller  42 , and can optionally embody the multiplexor  56 . The storage and data components  40 ,  50 ,  52  are suitably embodied by memory or storage elements of the computer, such as RAM, hard disk space, or so forth. The processing components  42 ,  44  are suitably embodied by one or more general purpose microprocessors of a computer or computer network executing suitable software. The message entry interface  54  is suitably embodied by interface devices of a computer such as a keyboard, mouse, and so forth, or by a dumb network terminal, operating in conjunction with suitable executing software. The multiplexor  56  is suitably embodied by one or more general purpose microprocessors of a computer or computer network executing suitable software in embodiments in which the entertainment datastream  26  is digital, or may be embodied by an add-on application-specific integrated circuitry (ASIC) or other added or connected hardware for processing a digital datastream faster or for processing an analog datastream. In some embodiments, it is contemplated for the care plan audio/video modules  50  to be integrated closely with the entertainment device  30 , for example stored as content on the hard drive or other non-volatile storage of the DVR  34 . 
     The invention has been described with reference to the preferred embodiments. Modifications and alterations may occur to others upon reading and understanding the preceding detailed description. It is intended that the invention be constructed as including all such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.