Patent Publication Number: US-7220143-B2

Title: Overlay to permit delivery of telephony and mission-critical data services to hospital-wide points of care

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     The present application is related in subject matter to the following U.S. patent applications, each of which is incorporated by reference herein:
         Ser. No. 10/813,230 entitled “Integrated And Secure Architecture For Delivery Of Communications Services In A Hospital” to Graves et al., filed Mar. 31, 2004;   Ser. No. 10/813,358 entitled “Systems And Methods For Preserving Confidentiality Of Healthcare Information In A Point-Of-Care Communications Environment” to Graves et al., filed Mar. 31, 2004;   Ser. No. 10/819,349 entitled “Systems And Methods For Preventing An Attack On Healthcare Data Processing Resources In A Hospital Information System” to Graves et al., filed Apr. 7, 2004;   Ser. No. unknown, entitled “Communications System Using A Hospital Telephony Infrastructure To Allow Establishment Of Healthcare Information Sessions At Hospital-Wide Points Of Care” to Graves, filed on the same date as the present application.       

     FIELD OF THE INVENTION 
     The present invention relates generally to overlays for wall jacks and, in particular, to an overlay which permits delivery of telephony and mission-critical healthcare information services to hospital-wide points of care. 
     BACKGROUND OF THE INVENTION 
     The ability for healthcare users to interact with a hospital information system while at the point of care (POC), e.g., at a patient&#39;s bedside, is recognized as having the potential to dramatically reduce the incidence of certain medical complications. 
     Specifically, studies estimate that significant benefits are likely to arise through the provision of “computerized physician order entry” (CPOE), which consists of allowing healthcare users (e.g., doctors, nurses, orderlies, etc.) to place orders (e.g., prescription, blood test, clean towel, etc.) via a bedside location in the vicinity of the patient being treated. This simple yet elusive paradigm, dubbed “CPOE at the POC”, has the potential effect of reducing human error due to temporary memory loss and mistakes in transcription. In addition, when coupled with real-time decision information support tools (DIST), CPOE provides healthcare users with an additional level of assurance that their diagnosis or treatment plan falls within generally accepted parameters. 
     For background reading on the CPOE-at-the-POC paradigm and its predicted impact, the reader is referred to the following references, hereby incorporated by reference herein:
           Clinical Decision Support—Finding the Right Path , by J. Metzger, D. Stablein and F. Turisco, First Consulting Group, September 2002     Computerized Physician Order Entry: Costs, Benefits and Challenges—A case Study Approach , by First Consulting Group for Advancing Health in America and the Federation of American Hospitals, January 2003     Leapfrog Patient Safety Standards—The Potential Benefits of Universal Adoption , by J. D. Birkmeyer, The Leapfrog Group, November 2000     Computerized Physician Order Entry: A Look at the Vendor Marketplace and Getting Started , by J. Metzger, F. Turisco, First Consulting Group, December 2001     A Primer on Physician Order Entry , by First Consulting Group for the California Healthcare Foundation, Oakland, Calif., September 2000       

     Conventionally, hospitals have attempted to deploy CPOE at the POC by providing multiple POC access points throughout the hospital in communication with the core hospital network. In some implementations, the POC access points are wired directly to the core hospital network. However, it is apparent that the addition of hundreds of high-speed wiring connections throughout an existing hospital is a highly intrusive exercise, causing the shutting down of rooms or entire wards until installation is complete, due to the need to open unclean areas such as ceilings, wall interiors, etc. to place and pull new data network cables. 
     Clearly, there remains a need in the healthcare industry for implementing a CPOE-at-the-POC solution in a relatively non-disruptive manner. 
     SUMMARY OF THE INVENTION 
     A broad aspect of the present invention seeks to provide an overlay for a wall jack adapted to receive a telephony plug of a specific type. The overlay comprises a housing having an interior face and an exterior face, a telephony plug on the interior face of the housing, the telephony plug suitable for insertion into the wall jack and a telephony socket integrated to the housing and accessible from the exterior face of the housing. The telephony socket is adapted to receive a telephony plug of the specific type, and is equipped with a first physical lock mechanism for keeping the telephony plug of the specific type connected to the telephony socket. Also provided is a high-speed connector integrated to the housing, for connection to a mating connector leading to a digital apparatus, the high-speed connector being equipped with a second physical lock mechanism for keeping the mating connector connected to the high-speed connector. The second lock mechanism is designed to be more resistant to tension-induced disconnect than the first lock mechanism. Finally, there is provided a combiner-splitter unit electrically connected to the telephony plug, to the telephony socket and to the high-speed connector. 
     This and other aspects and features of the present invention will now become apparent to those of ordinary skill in the art upon review of the following description of specific embodiments of the invention in conjunction with the accompanying drawings. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the accompanying drawings: 
         FIG. 1  shows, in block diagram form, a communications system in accordance with an embodiment of the present invention; 
         FIG. 2  is a detailed block diagram of a centralized combiner-splitter module; 
         FIG. 3  illustrates a spectrum allocation scheme for the delivery of telephony-band signals and out-of-telephony-band signals; 
         FIG. 4  is a detailed block diagram of a remote combiner-splitter module; 
         FIG. 5  is a block diagram showing a communication link between a remote modem and a fixed-wire user device; 
         FIG. 6  is a block diagram showing a communication link between a remote modem and a plurality of wireless user devices; 
         FIG. 7  is a block diagram of the communications system of  FIG. 1  with VoIP conversion functionality; 
         FIG. 8  is a block diagram of the communications system of  FIG. 7  with the capability to deliver non-healthcare services from an external source; 
         FIG. 9  is a sectional view of an overlay that fits over a standard wall jack, for providing two connections, one to a telephone and another to a remote modem. 
     
    
    
     DETAILED DESCRIPTION OF THE EMBODIMENTS 
     With reference to  FIG. 1 , there is shown a communications system in accordance with an embodiment of the present invention. The communications system is of particular use in a hospital environment that provides a twisted-pair telephony infrastructure  100  leading from a facility housing a private branch exchange (PBX)  104  to a plurality of wall jacks  106  in various rooms throughout the hospital. The PBX  104  provides telephony switching for telephony-band signals originated from, and destined for, a plurality of telephones  108  communicatively coupled to the wall jacks  106 . The PBX  104  assigns logical “extensions” to different wall jacks  106 , which allows both internal and external telephone calls to be routed to specific locations in the hospital. 
     In accordance with the present invention, healthcare (e.g., clinical) information (e.g., data or mixed VoIP/data) sessions are supported over the telephony infrastructure  100 . The telephony infrastructure  100  can be part of a pre-existing wiring grid which extends in a ubiquitous manner throughout the hospital, notably with a phone jack at every patient bedside. The healthcare information sessions are end-to-end logical connections terminated at one end by a healthcare information system (HIS) server  110  connected to a core hospital network  112 , and at the other end by user devices  114  that are intended for use primarily by healthcare workers, such as physicians, nurses, orderlies, etc. Examples of the end user devices  114  include but are not limited to a fixed-wire terminal, a WLAN-connected or wired computer on wheels (COW), a personal digital assistant, a WLAN-connected tablet computer, a WLAN wireless telephone, as well as composite devices combining these and other functions such as bar code scanning, etc. 
     Depending on the requirements of the healthcare information sessions, the HIS server  100  may need to interact in a rather high-speed manner with the core hospital network  112 . This is achieved over a high-speed link  102  such as a Gigabit Ethernet link. The core hospital network  112  interconnects various hospital entities, such as radiology (connected to a PACS system), diet, scheduling, pharmacy, cardiology, billing, laboratories, local electronic health records, etc. The core hospital network  112  also maintains a healthcare authentication database  118 , which contains information allowing healthcare users to be authenticated. 
     The healthcare authentication database  118  receives admissions input from a hospital admissions server (not shown). In an embodiment, the healthcare authentication database  118  comprises a collection of healthcare user identities and securely held corroborating evidence, along with an associated access profile for each healthcare user, which will include a dynamic patient access list based on the admissions input from the admissions server, together with a specific mapping of who has what accessible data, based upon professional qualifications, status and allocation to patient treatment teams, which itself may be dynamic, especially for shift workers such as nurses. 
     Thus, in the course of establishing healthcare information sessions with the user devices  114 , the HIS server  110  controls authentication of the users purporting to establish these healthcare information sessions. With continued reference to  FIG. 1 , this can be achieved by providing access to a healthcare authentication entity  132  associated with the HIS server  110 . The HIS  110  accesses the healthcare authentication entity  132  when an authentication request is received. The healthcare authentication entity  132  then accesses the healthcare authentication database  118  in the core hospital network  112  in order to indicate to the HIS server  110  when a user has been authenticated and the permissions associated with that user. However, it is possible that the number of authentication requests processed in this manner may be so large as to cause an overload of the healthcare authentication entity  132 . Thus, a wireless security switch (such as the Nortel Networks 22xx product line) may be provided in association with the HIS  110 , which allows only authentication requests from recognizable authorized devices to be passed to the healthcare authentication entity  132  from the HIS  110 . 
     In order to transport data associated with healthcare information sessions over the telephony infrastructure  100  between the HIS server  110  and the user devices  114 , a variety of transport legs is established. Accordingly, the HIS server  110  is connected by a high-speed link  120  to a head-end unit  122  which is itself connected to the PBX  104 . The head-end unit  122  may reside in the facility that houses the PBX  104 , such as a PBX room, or the head-end unit  122  may reside in an IT room, for example. The head-end unit  122  comprises a bank of centralized modems  124 , each of which corresponds to a respective one of a plurality of remote modems  126  connected to a respective wall jack  106 . The centralized modems  124  in the head-end unit  122  exchange digital information (e.g., packets) with the HIS server  110  over the high-speed link  120 . A multiplexer  128  can be provided in order to allow multiple centralized modems  124  to communicate over the same high-speed link  120 . The centralized modems  124  convert the digital information received from the HIS server  110  into out-of-telephony-band signals which are destined for respective ones of the remote modems  126 . In the opposite direction of information flow, the centralized modems  124  convert out-of-telephony band signals sent from the remote modems  126  into digital information that is sent to the HIS server  110  over the high-speed link  120 . The centralized modems  124  may also apply error control (such as forward error correction, cyclic redundancy check (CRC), etc.) to the out-of-telephony-band signals being exchanged with the remote modems  126 . 
     The out-of-telephony-band signals sent and received by the centralized modems  124  are exchanged over the telephony infrastructure  100  using the same copper twisted pairs that transport the telephony-band signals handled by the PBX  104 . In order to allow this functionality to take place, a bank of centralized combiner-splitter modules  130  is provided. As shown in greater detail in  FIG. 2 , each centralized combiner-splitter module  130  is associated with one of the centralized modems  124  and interfaces to the associated centralized modem  124  by a first interface  200 . A second interface  202  is provided on each centralized combiner-splitter module  130  for interfacing with a twisted pair  204  and a third interface  206  is provided for interfacing with the PBX  104 . A filter circuit  208  executes the functionality of the centralized combiner-splitter module  130 , which is to permit the exchange of telephony-band signals with the PBX  104  over the twisted pair  204  while simultaneously permitting the exchange of out-of-telephony-band signals with the associated centralized modem  124  over that same twisted pair  204 . Since practical implementations of the filter circuit  208  which achieve the desired functionality will be known to those skilled in the art, a further discussion of the details of the centralized combiner-splitter module  130  is not required, other than to say that it may comprise a combination of high-pass and low-pass filter elements. 
     It should be noted that in an example implementation, one or more centralized combiner-splitter modules  130  and the associated centralized modems  124  may reside on a single circuit card. 
     The out-of-band telephony signals, which are sent and received by the centralized modems  124  over the telephony infrastructure  100 , occupy spectral region that can be chosen as a matter of design and, as a result, may selected to be in accordance with existing standards, such as DSL, ADSL, VDSL, etc., referred to collectively as “xDSL”. With reference to  FIG. 3 , xDSL operates in a simultaneous bidirectional mode by using different frequency bands outside the telephony band  300  for upstream  302  and downstream  304  transmission. A guard band  306  separates the upstream  302  and downstream  304  transmission bands. Several implementations for achieving this are already known, based upon bandwidth-efficient line coding techniques which match adaptively to the available channel path and extract close to the optimum reach over that path. For example, commonly used xDSL coding solutions are based upon Quadrature Amplitude Modulation (QAM) or Discrete Multi-Tone (DMT), although other coding schemes can be used. It is noted that between QAM and DMT, the latter usually offers a higher performance, but is also the more complex coding scheme of the two. 
     In the specific case of VDSL, advanced line coding permits a reach of up to approximately 1000 ft at 50 Mb/s downstream, 10 Mb/s return and up to approximately 3000 feet at 25 Mb/s downstream, 5 Mb/s return, which is more than adequate to cover most hospital sites. The MAC (Media Access Control) layer of a “54 Mb/s” 802.11a (the higher speed flavor of 802.11a/b) can deliver, under ideal conditions, a maximum of approximately 24–26 Mb/s of data with 1500-byte packets due to MAC inefficiencies so an available 25 Mb/s downstream VDSL feed will generally be fully adequate. In envisaged healthcare applications, the demand for upstream bandwidth is limited to a lower value than the downstream bandwidth, due to the nature of the services being delivered. For example, in CPOE, larger images are delivered to the user devices  114  but are rarely, if ever, generated at the user devices  114  or remote modems  126 , as the imaging modalities are typically hard-wired into core hospital network  112 . In any event, the upstream/downstream partitioning in VDSL need not be fixed, and the upstream capacity can be increased by moving the guard band  306  between the upstream  302  and downstream  304  bands higher in frequency and slightly reducing the downstream throughput. The placement of the guard band  306  is merely a matter of engineering optimization in the design of the system and is well within the knowledge of one skilled in the art. 
     Reference is now made to  FIG. 4 . Since the twisted pair  204  which leads to the wall jack  106  carries both telephony-band signals and out-of-telephony-band signals, a remote combiner-splitter module  400  is provided between the wall jack  106  and the remote modem  126 . The remote combiner-splitter module  400  is constructed and functions in much the same way as the centralized combiner-splitter module  130  at the other end of the twisted pair  204 . Specifically, the remote combiner-splitter module  400  has a first interface  402  connected to the remote modem  126 , a second interface  404  connected to the twisted pair  204  via the wall jack and a third interface  406  connected to a telephone  108 . A filter circuit  408  allows the remote combiner-splitter module  400  to execute its main functionality, which is to permit the exchange of telephony-band signals with the telephone  108  over the twisted pair  204  while simultaneously permitting the exchange of out-of-telephony-band signals with the remote modem  126  over that same twisted pair  204 . 
     A final transport leg for carrying data associated with healthcare information sessions established between the HIS server  110  and a particular one of the user devices  114  is provided by a communications link  134  between the remote modem  126  and the particular user device itself. As previously mentioned, the user devices  114  can take on many forms, and these can be classified into two basic categories, namely fixed-wire and wireless. In the fixed-wire case, shown in  FIG. 5 , the communication link  134  is a wireline link  500 , such as an Ethernet cable, which communicatively couples the remote modem  126  to a user device  114 , which can be a fixed-wire terminal  514  or computer on wheels (COW), for example. In the wireless case, shown in  FIG. 6 , the communication link  134  is a wireline link  600  up to a wireless access point  602  connected to the remote modem  126 . The wireless access point  602  establishes a wireless local area network (WLAN) between itself and one or more of the wireless user devices  114  in the vicinity and capable of maintaining wireless communication with the wireless access point  602 . The user devices  114  in this case may include personal digital assistants  614 , laptop and tablet computers and WLAN telephones  616 , to name a few, as well as custom composite devices possibly also including bar code scanning technology. It will be apparent from the foregoing that the communication link  134  between the remote modem  126  and the user device(s) involved in a healthcare information session may, in some instances, be wireless at least in part. 
     In addition to transporting data associated with healthcare information sessions, the out-of-telephony-band signals traveling over the telephony infrastructure  100  may carry other types of data, hereinafter referred to as ancillary data. For example, ancillary data may include VoIP data and/or patient entertainment data. 
     In the case of VoIP data, now described with reference to  FIG. 7 , an embodiment of the communications system of the present invention provides a VoIP conversion unit  700  connected between the PBX  104  and a router  702  in the high-speed link  120 . The VoIP conversion unit  700  is operative to convert telephony-band signals to VoIP packets  704  and vice versa as is known to those skilled in the art. The router  702  at the HIS server  110  mixes the VoIP packets  704  destined for the user devices  114  with healthcare information session data packets  706  also destined for the user devices  114 . In the opposite direction of information flow, the router receives, from the head-end unit  122 , a mix of packets including VoIP packets  704  and healthcare information session data packets  706  originating from the user devices  114 . The router  702  distinguishes the VoIP packets  704  from the healthcare information session data packets  706  (for instance by their address, their origin or by an embedded class mark), and routes the VoIP packets  704  towards the VoIP conversion unit  700 , while routing the healthcare information session data packets  706  towards the HIS server  110 . 
     In the case of patient entertainment data, now described with reference to  FIG. 8 , the communications system provides links to an entertainment entity  800 , such as a broadcast source, a cable source and/or the Internet. The entertainment entity  800  is accessed via a gateway  806 . A patient entertainment (PE) server  808  is connected to the gateway  806  and manages patient entertainment session(s) established with the user device  114 . Clearly, in this embodiment, the user devices  114  are not limited to devices exclusively used by healthcare workers. Rather, the user devices  114  as envisaged here are capable of being accessed by patients and/or their visitors, and include (without being limited to) bedside terminals and WLAN wireless telephones. In some cases, the user devices  114  will be accessible by both healthcare workers and non-healthcare workers, and are thus capable of establishing healthcare information sessions with the HIS server  110  or patient entertainment sessions with the PE server  808 . For further information as to authentication and other security issues which arise when the potential user of an end user device may belong to one of several classes of users, the reader is referred to U.S. patent application Ser. No. 10/813,230 entitled “Integrated And Secure Architecture For Delivery Of Communications Services In A Hospital” to Graves et al., filed Mar. 31, 2004, hereby incorporated by reference herein. 
     A router  802  in the high-speed link  120  mixes entertainment packets  804  destined for the user devices  114  with healthcare information session packets  706  (and possibly VoIP packets  704 ) also destined for the user devices  114 . In the opposite direction of information flow, the router  802  receives a mix of packets including entertainment packets  804 , healthcare information session packets  706  and possibly also VoIP packets  704  originating from the user devices  114 . The router  802  separates out the entertainment packets  804  and routes them towards the PE server  808  and the entertainment entity  800 , while routing VoIP packets  704  and the healthcare information session packets  706  as described above with reference to the router  702 . 
     Those skilled in the art will appreciate from the foregoing that in order to provide the delivery of healthcare information sessions to a particular room in the hospital, all that is required is the installation of a remote modem  126  in communication with a wall jack  106  in that room. This installation process, which re-utilizes a telephony infrastructure not necessarily designed for data delivery to the POC, has the advantage of being non-disruptive, as “unclean” areas of the hospital (such as the insides of walls and the space above suspended ceilings) do not need to be opened up to install new high-speed data-optimized wiring such as Cat  5  Ethernet cabling. In addition, the noise, dust and general inconvenience to staff associated with the opening up of such spaces is avoided. Meanwhile, telephony service is provided in the same manner as before the installation of the remote modem  126 . Specifically, a telephone  108  which would ordinarily have been plugged into the wall jack  106  can now be connected to the interface  406  of the remote combiner-splitter module  400 . For this to be as transparent as possible to the pre-existing telephony service offering, it is advantageous for the interface  406  to provide a socket that is physically and electrically compatible with the wall jack  106 . A solution for achieving this is now described with reference to  FIG. 9 . 
     Specifically, there is provided an overlay  900  for a standard wall jack  106  that is adapted to receive a telephony plug of a standard type, such as RJ-11. Typically, the wall jack  106  is defined in a plate  902  affixed to the wall  904  (or other architectural structure) by a number of fasteners  906  (e.g., screws) received in respective receiving areas  908  (e.g., threaded apertures) in the wall  904 . In the case of RJ-11 and other standard telephony plugs, the plug is secured into the wall jack  106  by means of a deformable plastic tang providing a positive lock. The tang mechanism tends to be physically fragile and, if broken, it will still permit the engagement of the RJ-11 telephony plug into the wall jack  106 , but it will not provide a positive lock of the plug with respect to the wall jack  106 . 
     The overlay  900  has a housing  910  with an interior face that faces towards the wall  904  and an exterior face that faces away from the wall  904 . A telephony plug  912  is affixed to the interior face of the housing  910 . The telephony plug  912  is similar to the telephony plug which the wall jack  106  is adapted to receive. In the case where the standard telephony plug is RJ-11, for example, then the telephony plug  912  may be identical to an RJ-11 plug except that a plastic tang is not required, since securing of the housing  910  to the wall  904  is guaranteed by other means (to be described later on with reference to fasteners  924 ). 
     In addition, the overlay  900  provides a telephony socket  914  integrated to the housing  910  and accessible from the exterior face of the housing  910 . The telephony socket  914  is adapted to receive a telephony plug of the same type as the telephony plug which the wall jack  106  was adapted to receive. In the example of an RJ-11 telephony plug, it is envisaged that such a telephony plug will be secured in the telephony socket  914  by way of its plastic tang in the usual manner. 
     The overlay  900  also provides a high-speed connector  916  integrated to the housing  910 , for connection to a mating connector (not shown) leading to the interface  402  and the remote modem. The high-speed connector  916  can be accessed from the exterior face of the housing  910 . 
     The telephony plug  912 , the telephony socket  914  and the high-speed connector  916  are electrically connected to the previously described combiner-splitter module  400 , which is disposed within the housing  910 . Specifically, the combiner-splitter module  400  is configured to allow telephony-band signals to be exchanged via the telephony socket  914 , to allow out-of-telephony-band signals to be exchanged via the high-speed connector  916  and to allow composite signals comprising the telephony-band signals and the out-of-telephony-band signals to be exchanged via the telephony plug  912 . In one embodiment, the combiner-splitter unit  400  is a passive electrical filter which does not require an external source of power. In another embodiment, the combiner-splitter unit  400  is active and is powered by the act of inserting the telephony plug  912  into the wall jack  106  when the latter is energized. 
     It is noted that when a standard telephony plug is inserted into the telephony socket  914  while the telephony plug  912  is inserted into the wall jack  106 , the electrical connectivity provided by the combiner-splitter module  400  is the same as if that same standard telephony plug were inserted into the wall jack  106  in the absence of the overlay  900 . 
     It is also noted that the high-speed connector  916  and its mating connector provide a lock mechanism that is designed to be more resistant to tension-induced disconnect than the telephony socket  914 . For example, instead of the plastic tang used to secure an RJ-11 plug in the telephony socket  914 , the mating connector could be designed to be removable from the high-speed connector  916  by unscrewing a nut. This reduces the probability of a catastrophic interruption of a potentially mission-critical healthcare information session, due to inadvertent pulling on the data cable. 
     In order to mount the overlay  900  to the wall  904 , the housing  910  has a number of receiving areas  922  at least as great as the number of fasteners  906  used to affix the plate  902  to the wall  904  (while the telephony plug  912  is received in the wall jack  106 ). In a specific embodiment, the receiving areas  922  in the housing  910  are aligned with the receiving areas  908  in the wall  904 . The receiving areas  922  receive a respective number of replacement fasteners  924  (e.g., screws) that affix both the overlay  900  and the plate  902  to the wall  904  when the replacement fasteners  924  are received in the receiving areas  908  of the wall  904 . As an example, there may be two replacement screws  924 , and the replacement screws  924  may be similar to the screws  906 , only longer. 
     While specific embodiments of the present invention have been described and illustrated, it will be apparent to those skilled in the art that numerous modifications and variations can be made without departing from the scope of the invention as defined in the appended claims.