Patent Abstract:
Methods and apparatuses to assist a user in the performance of a plurality of tasks are provided. The method may comprise storing at least one care plan in a voice assistant, the care plan defining a plurality of tasks to be performed, capturing speech input from the user, determining, from the speech input, a selected interaction with a care plan, and in response to the selected interaction, providing a speech dialog with the user reflective of the care plan. Alternatively, the method may comprise capturing speech input from a user, determining from the speech input, a first weight associated with a resident, associating the first weight with a care plan in turn associated with the resident, comparing the first weight to a second weight associated with the resident and the care plan, and providing a speech dialog regarding reweighting the resident based on the comparison.

Full Description:
CROSS-REFERENCE TO RELATED APPLICATION  
       [0001]    This application claims the benefit of U.S. Provisional Application No. 61/087,082, entitled “VOICE ASSISTANT SYSTEM”, filed Aug. 7, 2008, which application is incorporated herein by reference in its entirety. 
     
    
     FIELD OF THE INVENTION  
       [0002]    This invention generally relates to the use of speech or voice technology in a work environment to facilitate a variety of tasks. 
       BACKGROUND OF THE INVENTION  
       [0003]    Speech or voice technology, in the form of speech recognition, is used in a variety of different environments to facilitate the completion of work or various tasks. One example of a specific use for a voice-directed system is the direction of a worker to perform various tasks and to collect data associated with the task execution. 
         [0004]    In a typical voice-directed work system, the worker wears a mobile computer having voice or speech capabilities. The computer is worn on the body of a user, such as at their waist, and a headset device connects to the mobile computer, such as with a cable or possibly in a wireless fashion. In another embodiment, the mobile computer might be implemented directly in the headset. The headset includes one or more speakers for playing voice instructions and other audio that are generated or synthesized by the mobile computer to direct the work of the user and to confirm the spoken words of the user. The headset also has a microphone for capturing the speech of the user to determine the commands spoken by the user and to allow the entry of data using the user&#39;s speech and speech recognition. Through the headset and speech recognition and text-to-speech capabilities of the mobile computer, workers are able to receive voice instructions or questions about their tasks, to receive information about their tasks, to ask and answer questions, to report the progress of their tasks, and to report various working conditions, for example. 
         [0005]    The mobile and or wearable computers allow the users that wear or use them to maintain mobility at a worksite, while providing the users with desirable computing and data-processing functions. Generally, such mobile computers often provide a wireless communication link to a larger, more centralized computer system that directs the work activities of a user within a system and processes any user speech inputs, such as collected data, in order to facilitate the work. An overall integrated system may utilize a central system that runs a variety of programs, such as a prop-am for directing a plurality of mobile computers and their users in their day-to-day tasks. The users perform manual tasks and enter data according to voice instructions and information they receive from the central system, via the mobile computers. This process is generally referred to as voice-directed work as the user takes specific direction from the central system and their computer like they might take direction from a manager or supervisor or from reading a work order or to-do list. 
         [0006]    The mobile computers provide a significant efficiency in the performance of a user,s tasks. Specifically, using such mobile computers, the work is done virtually hands-free without equipment to Juggle or paperwork to carry around. However, while existing speech systems provide hands-free operations, voice-directed work may be overly structured for some users and for some work environments. Various work environments require that the worker know what they are doing in any particular task, and thus they do not have to be told how to specifically perform a particular task or what order to handle multiple tasks. Directing work in those environments in an automatic fashion, as is the case with typical voice-directed work, is not suitable and can be overbearing. 
         [0007]    One such environment that requires greater worker flexibility is the work environment in a nursing home or, assisted living facility. In such facilities, nurses create care plans for all of the residents, and the care plans define the different tasks to be performed by the nurses or by certified nursing assistants (“CNAs”) for the residents. In particular, each CNA, for example, has to be aware of and accountable for the tasks in the care plans of the residents that are assigned by the nurses to that CNA. Generally, the CNAs know how to perform the various tasks, such as bathing a resident, and do not need to be told by the central system how to perform the task. Furthermore, the CNA may also control the order in which they choose to address a multitude of tasks and thus take advantage of certain efficiencies in their workflow. The workflow will often depend upon the CNAs environment, their location, the urgency of the task and various other factors, and thus they have great flexibility in performing their work. For example, a CNA may want to first take the vitals of an assigned resident if the CNA has immediate access to the proper equipment for taking the vitals, and then bathe the resident. Or vice versa. 
         [0008]    Therefore, the rigid approach of traditional voice-directed work environments, while suitable for some work, would not be suitable in a resident or patient care environment. In fact, the CNA is more likely to be hindered by a computer or device that rigidly directs the CNA to perform their tasks in a certain order or to ignore their own judgment with respect to an efficient workflow. 
         [0009]    Furthermore, in traditional voice-directed work, the back and forth of the speech is usually constant as the worker is directed to a task, confirms completion of the task and then is immediately directed to the next task. The central system controls the dialog and thus, to some extent, controls the worker. As may be appreciated, in a patient or resident care facility, a CNA or other worker will often be speaking with the resident or other staff in the course of their day. As such, it would be disruptive to have to constantly be interfacing with an aggressive voice-directed system while also trying to converse with another person. Furthermore, many of the residents in such facilities are older and may find it disturbing and confusing when their CNA or other attendee has to speak at inappropriate times to maintain their workflow because the voice-directed system is controlling the dialog. 
         [0010]    A need therefore exists in improving how a speech recognition system might facilitate a more efficient work environment without being overly rigid and overly domineering. There is further a need for a voice or speech system that can act to assist users with their work as the user needs it, rather than aggressively control the workflow and the speech dialog interface. Still further, in patient or resident care facilities, there is a need for efficient delivery of information and communications regarding the work tasks to increase efficiency and accuracy in the environment. 
       SUMMARY OF THE INVENTION  
       [0011]    Embodiments of the invention provide for a method and apparatus to assist a user in the performance of a plurality of tasks. In one embodiment, the method comprises storing a care plan in a voice assistant carried by a user, the care plan defining a plurality of tasks to be performed by the user as part of a workflow. The method further comprises capturing speech input from the user with the voice assistant determining, from the speech input, a selected interaction with a care plan, and, in response to the selected interaction, providing a speech dialog with the user through the voice assistant that is reflective of the care plan. 
         [0012]    Alternative embodiments of the invention provide for a method of assisting a user with a plurality of tasks that comprises capturing speech input of a user with a voice assistant and determining, from the captured speech input of the use, a first weight associated with a resident. The method further comprises associating the first weight with a care plan using the voice assistant, the care plan being associated with the resident, comparing the first weight to a second weight for the resident, the second weight associated with the resident and the care plan, and providing a speech dialog regarding reweighing the resident based on the comparison of the first weight and the second weight. 
         [0013]    These and other advantages will be apparent in light of the following figures and detailed description. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0014]    The accompanying drawings, which are incorporated in and constitute a pall of this specifications illustrate embodiments of the invention and, together with a general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention. 
           [0015]      FIG. 1A  is a block diagram of a distributed implementation of a voice assistant system consistent with the principles of the present invention; 
           [0016]      FIG. 1B  is a block diagram of data flow in the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0017]      FIG. 2A-2B  is an example of a care plan for a resident that may be generated via a nursing workstation in the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0018]      FIG. 3  is a side perspective view of one embodiment of a voice assistant of the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0019]      FIG. 4  is one example of a document that may be physically carried by a user to interact with the voice assistant system of  FIG. 1  consistent with the principles of the invention; 
           [0020]      FIG. 5  is one embodiment of a main menu that a user may interact with, including selectable parameters in the form of questions and commands that the user may choose via the voice assistant of  FIG. 3 , consistent with the principles of the present invention; 
           [0021]      FIG. 6  is the main menu of  FIG. 5 , including tones that may be provided to the user, consistent with the principles of the present invention; 
           [0022]      FIG. 7  is an exemplary main menu routine executed by the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0023]      FIG. 8  is a detailed view of the parameters in the form of commands from the main menu of  FIG. 5  consistent with the principles of the present invention; 
           [0024]      FIG. 9  is a detailed view of the document command from  FIG. 8  consistent with the principles of the present invention; 
           [0025]      FIGS. 10A-10B  is an exemplary documentation of a vitals routine executed by the voice assistant system of  FIG. 1  consistent with the principles of the present invention, 
           [0026]      FIG. 10C  is an exemplary weight analysis routine that may be called from the documentation routine of  FIGS. 10A-10B  and that is also executed by the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0027]      FIG. 11  is an exemplary weight routine that may be called from the weight analysis routine of  FIG. 10C , and that is also executed by the voice assistant system of  FIG. 1  consistent with the principles of the present invention; 
           [0028]      FIG. 12  is an example of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0029]      FIGS. 13A-13B  are examples of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0030]      FIG. 14  is an example of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0031]      FIG. 15  is an example of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0032]      FIGS. 16A-16B  are examples of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0033]      FIGS. 17A-17B  are examples of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0034]      FIG. 18  is an example of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0035]    FIGS.  19 A- 19 B- 19 C are examples of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0036]      FIGS. 20A-20B  are examples of another care plan for a resident similar to  FIGS. 2A-2B ; 
           [0037]      FIG. 21  is an example of another care plan for a resident similar to  FIGS. 2A-2B ; and 
           [0038]      FIGS. 22A-22B  are examples of another care plan for a resident similar to  FIGS. 2A-2B . 
       
    
    
       [0039]    It should be understood that the appended drawings are not necessarily to scale, presenting a somewhat simplified representation of various features illustrative of the basic principles of embodiments of the invention. The specific design features of embodiments of the invention as disclosed herein, including, for example, specific dimensions, orientations, locations, and shapes of various illustrated components, as well as specific sequences of operations (e.g., including concurrent and/or sequential operations), will be determined in part by the particular intended application and use environment. Certain features of the illustrated embodiments may have been enlarged or distorted relative to others to facilitate visualization and clear understanding. 
       DETAILED DESCRIPTION  
       [0040]    Embodiments of the invention provide a voice assistant system for assisting a user. In some embodiments, the voice assistant assists a CNA or other care provider with performing a variety of tasks during the CNA&#39;s work shift. It is understood that the voice assistant system may be used in other work environments as well. Consistent with embodiments of the invention, the CNA may engage the inventive voice assistant via a main menu in the form of Situational Awareness Questions, and the CNA may be provided with a speech dialog that answers the various questions and/or provides other information. By doing so, the voice assistant system assists the CNA by providing information that is more pertinent to the situation the CNA is encountering, generally reducing the rigidity of voice-directed work. As will be readily understood, while a CNA is set forth herein as a particular person to utilize the present invention in a care facility, embodiments of the invention are not limited to a particular user. Alternative users of various embodiments of the invention are anticipated and understood to be beneficiaries of the features disclosed herein. For example, a physician, nurse, and/or other caregiver in a facility may use various embodiments of the invention. 
         [0041]    The CNA may also use a speech command, and the CNA may be provided with a speech dialog associated with the command to assist the CNA with the execution of a task. Moreover, the voice assistant system may also analyze data received from the CNA and provide a speech dialog at the point of care that may assist the CNA in the efficiency and accuracy of their work. Furthermore, the voice assistant system may provide reminders, pages and/or other indications (e.g., “all clear” indications or messages) to assist the CNA in managing their workflow. In one embodiment, the voice assistant system may be and/or may incorporate or include the AccuNurse® software and/or hardware offered by the assignee of this application, Vocollect Healthcare Systems, Inc. (“VHS”) of Pittsburgh, Pa. 
         [0042]    Those of ordinary skill in the art will appreciate that the voice assistant system described herein seeks to assist the CNAs with their tasks in a more flexible and fluid manner by providing audible tones, messages regarding instructions, information in response to the Situational Awareness Questions, and/or assistance with execution of the tasks and analysis of data via the commands, as opposed to rigid, conventional voice-directed systems that order users to perform specific tasks in a set order, set flow, set manner, and/or at a set time. Indeed, voice-directed work typically dictates each task to be performed, the order they are performed in, and when they are to be performed, whereas the voice assistant system described herein allows a CNA to decide what tasks to perform, the order to perform them, and when to perform them, with care plans providing guidance. As such, the voice assistant complements the CNA&#39;s task choices and provides assistance via a voice dialog as needed to the CNA (e.g., when the CNA initiates the assistance, when the CNA should be informed of something such as a page). In other words, in conventional voice-directed work systems, the system is typically in charge and the users follow the orders, whereas in a voice assistant system the CNA is in charge and the system follows orders to provide assistance as needed. 
         [0043]    Turning now to the Drawings, wherein like numbers denote like parts throughout the several figures,  FIG. 1A  is a diagrammatic illustration of a voice assistant system  5  that may be in the form of a distributed computing system, with computing activities associated with at least one onsite nursing home or assisted living facility as at  10 . The nurses, CNAs, and residents of a facility are typically physically located at the facility  10 , while centralized support and management capabilities for the voice assistant system  5  may be provided by an offsite VHS department and or by an onsite enterprise customer IT department  15 . 
         [0044]    As illustrated, the voice assistant system  5  may include more than one facility  10 , and each facility  10  may be subdivided into a plurality of units. All of the units may be referred to as a site, but will generally be referred to as the facility  10  for simplicity, unless otherwise stated. Also for simplicity, the discussion will primarily focus on a single facility  10  and its respective nursing workstation  20 , voice assistant  45 , and charger  65  (discussed farther hereinbelow), even though a plurality of these items are illustrated in  FIG. 1 . Those of ordinary skill in the art will appreciate, however, that embodiments of the invention may apply equally to the other facilities (including other nursing workstations, other voice assistants, and other chargers) in the voice assistant system  5 . Furthermore, the discussion of embodiments of the invention will be from the perspective of a single CNA utilizing the voice assistant  45  for simplicity, but those of ordinary skill in the art will appreciate that each CNA and/or each nurse may have a voice assistant  45 . 
         [0045]    Turning to the facility  10 , at least one care plan is generated by a nurse or other qualified personnel for each resident at the facility  10 . In one feature of the present invention, interactive care plans are created and maintained for interacting with the voice assistant  45 . As such, the care plans may be accessible through the nursing work station  20 . The information of the care plans may be accessed by the voice assistants  45  to assist the CNAs, by voice, in the various tasks associated with the care plans. Advantageously, it is believed that this is a significant improvement over the use of written care plans that are typically located in various binders at a nursing station. It is worth noting that the CNAs may not be authorized to generate and/or change care plans, but the CNAs can view and perform the tasks in the care plans. To generate and/or revise care plans, the facility  10  may include at least one nursing workstation  20 , and a nurse or other qualified personnel associated therewith may generate and/or revise a care plan as needed via a graphical user interface, such as an application displayed via a web browser, associated with the nursing workstation  20  (see  FIG. 1B ). Specifically, the application displayed may display a variety of information for the nurse to select, including pull-down, menus, boxes, etc. Using the pull-down menus, boxes, etc., the nurse may generate and/or revise a care plan as needed.  FIGS. 2A and 2B  illustrate an exemplary care plan  25  for toileting for a resident named Jane Doe as displayed in the application. Specifically,  FIGS. 2A and 2B  illustrate an exemplary care plan  25  prior to a nurse saving the changes to the toileting care plan. Various other care plans may exist as well. For example, the care plan of  FIG. 12  is directed to Ambulation of the Resident;  FIGS. 13A-13B  to Background Information;  FIG. 14  is directed to Bathing;  FIG. 15  to Dressing;  FIGS. 16A-16B  to Personal Hygiene,  FIGS. 17A-17B  to Meals;  FIG. 18  to Medical Precautions;  FIGS. 19A-19C  to Mood/Behavior;  FIGS. 20A-20B  to Positioning,  FIG. 21  to Transfers; and  FIGS. 22A-22B  to Vitals and Weight. However, one of ordinary skill in the art will appreciate that there may be additional care plans for other tasks and/or information. Each care plan may have various menus, boxes, and other selectable fields for entering or selecting information and parameters for the care plan. The care plans may be displayed via the application in the web browser, and the care plans may direct the workflow of the CNA via the voice assistant  45  (discussed further hereinbelow). The care plans for a particular resident may determine what tasks the CNA must perform for that resident during the shift. 
         [0046]    Furthermore, the nursing workstation  20  may also be utilized to generate and/or update work assignments for the CNAs. For example, before the start of the shift of a particular CNA, the nurse or other qualified personnel in the facility  10  (or unit thereof) may set tip and/or update the work assignment for the CNA via the nursing workstation  20 . As such, the nurse or qualified personnel may set up and/or update a work assignment for the CNA to include an assignment of residents to that CNA for a shift or appointments associated with the CNA (including an appointment with a resident), as well as make changes to a care plan for a resident. The nurse or other qualified personnel may also print out an exception report from the nursing workstation  20  that indicates the tasks that still need to be performed by a CNA. 
         [0047]    The nursing workstation  20  may represent practically any type of computer, computer system, appliance, or other programmable electronic device. The nursing workstation  20  may also be capable of functioning as a client and/or server or may be implemented using one or more networked computers, e.g., in a cluster or other distributed computing system. In some embodiments, the nursing workstation  20  may be similar to a client computer. 
         [0048]    Along with the web browser, the nursing workstation  20  may also include an operating system, at least one processor such as a central processing unit (CPU), a memory, mass storage, a user interface, a network interface, and/or routines that are configured to be executed to implement the embodiments of the invention, whether implemented as part of an operating system or a specific application, component, program, object, module or sequence of instructions, or even a subset thereof, which will be referred to herein as “computer program code”, or simply “program code.” Program code typically comprises one or more instructions that are resident at various times in various memory and storage devices in a computer, and that, when read and executed by one or more processors in a computer, cause that computer to perform the steps necessary to execute steps or elements embodying the various aspects of the invention. 
         [0049]    The information associated with at least one care plan may be transmitted (e.g., in digital form) from the nursing workstation  20  (e.g., using the network interface) via a local area network (LAN)  30  to a voice transaction manager  35 . Each facility  10  may have at least one voice transaction manager  35  to store the care plans and facility configuration information. Specifically, the voice transaction manager  35  may represent and/or include practically any networked appliance, device, or computer as described hereinabove in connection with the nursing workstation  25 . As such, and in some embodiments, the voice transaction manager  35  may include a web server and/or a database server as is known to a person of ordinary skill in the art. Thus, the voice transaction manager  35  may include at least one database for storing the data, which may in turn be transmitted from the voice transaction manager  35  to the nursing workstation  20 . 
         [0050]    Furthermore, in one embodiment of the invention, Solaris may be utilized as the native operating system in the voice transaction manager  35 , but no explicit operating system dependencies may be required for the web server and/or the database server. Java may be utilized as the native programming language of the voice transaction manager  35 , and the voice transaction manager  35  may be implemented and managed using conventional Internet technologies. The voice transaction manager  35  may also function as backup in case of data loss. From the perspective of the nurses and CNAs, the voice transaction manager  35  may not require onsite IT maintenance beyond turning the power on and off Furthermore, a type of network other than the LAN  30  may alternatively be utilized to transmit data from the nursing workstation  20  to the voice transaction manager  35 . 
         [0051]    Next, the information and data associated with at least one of the care plans in the voice transaction manager  35  may be transmitted (e.g., in digital form) from the voice transaction manager  35  (e.g., using the network interface) via wireless network  40  (e.g., a wireless local area network, or “WLAN”) to at least one voice assistant  45 . Data may also be transmitted from the voice assistant  45  to the voice transaction manager  35 , for example, for storage and/or processing at the voice transaction manager  35 . 
         [0052]    The voice assistant  45  may include three separate portions, including a headset portion (e.g., including a microphone, one or more earpieces, and one or more speakers), a device portion and a connecting portion. In some embodiments, the connecting portion may be a cable or a wireless link. 
         [0053]    Although the voice assistant  45  shown throughout the Figures has multiple different portions, the voice assistant  45  may represent and or include practically any networked appliance, device, or computer as described hereinabove. An exemplary voice assistant  45  with a headset portion (or “headset”)  50 , a device portion (or “portable computer portion”)  55 , and a connecting portion such as a cable  60  that couples the headset portion  50  to the device portion  55  is illustrated in  FIG. 3 . In alternative embodiments, the headset  50  is coupled to the device portion  55  through a wireless link, which may also be referred to as a “connecting portion.” In a further alternative embodiment the functionality of the device portion  55  may be incorporated into the headset  50  such that voice assistant  45  is one self-contained piece of equipment. 
         [0054]    The voice assistant  45  may also include at least one database to store data received from the voice transaction manager  35 . Furthermore, Situational Awareness Questions, as discussed below, may be answered by speech dialog utilizing the data in the database, and the data in the database may also be utilized to generate a speech dialog for certain commands (e.g., a “Review” command) and to store data from the user with respect to other commands (e.g., a “Document” command). The speech dialog may include at least one statement generated by the voice assistant  45 . 
         [0055]    In some embodiments, the voice assistant  45  is a wearable computer and/or a personal digital assistant (PDA) that includes WLAN capabilities. Alternatively, the voice assistant  45  may be a voice appliance that is deployed to perform specific functions for the CNA via a main menu associated with the voice assistant  45 , instead of being deployed for a general purpose. In particular, the voice assistant  45  may be a client, and more specifically a “thick client” that is configured to perform speech recognition and speech synthesis. As such, and in some embodiments, the voice assistant  45  may be similar to a client computer. 
         [0056]    In accordance with the principles of embodiments of the invention, each CNA at the facility  10  may have their own voice assistant  45  that they wear or carry. When a CNA connects the headset portion  50  to the device portion  55  via the connecting portion  60 , or when a CNA turns the voice assistant  45  on, this may activate the voice assistant  45  and “log” the CNA on to the voice assistant system  5  (e.g., establish a connection between the voice assistant  45  and the nursing workstation  20  and/or voice transaction manager  35 , as well as determine which particular CNA is logging onto the voice assistant system  5  based on an identification associated with the CNA and/or the voice assistant  45 , and retrieve data associated with that particular CNA and/or voice assistant  45 ). In response to logging the CNA on to the voice assistant system  5 , one or moose items may be transferred from the voice transaction manager  35  to the voice assistant  45 . These items may include the list of residents assigned to the CNA for the shift, the care plan data for all of the residents assigned to the CNA, the appropriate voice templates and/or the facility configuration information, such as, but not limited to, the list of CNAs generally assigned or logged into the current shift. Moreover, the CNA may physically carry a document (e.g., document  62  illustrated in  FIG. 4 ) that sets forth the speech vocabulary to interact with the voice assistant  45  (e.g., including the main menu  63  illustrated in  FIG. 5 ). In particular, the CNA may use the voice assistant  45  to interact with the main menu by selecting from the predefined parameters in the form of speech input (e.g., including Situational Awareness Questions, commands and/or other vocabulary, at least a portion of which is illustrated on the document  62 ). The speech recognition capabilities of the voice assistant  45  receives the speech input and utilizes the speech recognition capabilities to convent the speech input into machine readable input (e.g., data that can be processed by the voice assistant  45  or another potion of the voice assistant system  5 , including the nursing workstation  20  and/or voice transaction manager  35 , for example). The speech synthesis capabilities of the voice assistant  45  may then provide speech dialog in response to the speech input (e.g., answers to a Situational Awareness Question and/or speech dialog in response to a command and/or other vocabulary, for example). Furthermore, the voice assistant  45  may also be utilized to provide the CNA with audible tones and/or speech dialog in response to various statuses. The main menu and voice user interface (VUI) will be discussed hereinbelow in connection with  FIGS. 5-11 . 
         [0057]    Although one of ordinary skill in the art will appreciate that the voice assistant  45  may be implemented in a variety of ways (e.g., in some embodiments the voice assistant  45  includes only a headset  50  that in turn includes the functionality of the device portion  55 ), and one of ordinary skill will further realize that activation of the voice assistant  45  may cause transmission of the data from the voice transaction manager  35  to that voice assistant  45 , it may be advantageous to utilize a thick client model and configure speech recognition and speech synthesis capabilities in the voice assistant  45 . By doing so, the voice assistant  45  may avoid placing substantial amounts of network traffic on the wireless network (e.g., WLAN)  40 , LAN  30 , or WAN  70  (discussed hereinbelow in connection with area  15 ) during documentation or other activities. 
         [0058]    Furthermore, in the thick client model, aside from downloading the care plans from the voice transaction manager  35  to the voice assistant  45  at the start of the CNA&#39;s shift, the CNA may continue to work and document independent of whether she or he has a network connection. For instance, once this data transfer is complete, the voice assistant  45  may support documentation for the entire shift, even in the absence of a working wireless network  40 . As such, it may be advantageous to configure more processing and/or bandwidth intensive activities of the voice assistant  45  (e.g.; the speech recognition, processing and or speech synthesis capabilities) closer to the end users. 
         [0059]    However, in the presence of an available network, the voice assistant  45  may receive updates, including real-time updates and near real-time updates (e.g., updates to care plans). Moreover, some or all of the speech input spoken by the CNA (e.g., speech input in response to a speech dialog or, alternatively, specific speech input not otherwise spoken in response to speech dialog) may be captured and transmitted (e.g., to the voice transaction manager  35 ) in real-time, near real-time and or in a delayed manner (e.g., at the end of shift, day, and/or after a predetermined period of time) in the presence of an available network. Indeed, it is also worth noting that the voice assistant  45  may support real time paging. For example, a page may be first sent to the voice transaction manager  35  and then relayed to its final destination(s). In an alternative embodiment, voice assistants  45  may be configured communicate with each other directly via the wireless network  40  to send a page. 
         [0060]    It is worth noting that the care plans for the residents typically remain stable from day to day and from shift to shift. For example, a resident needs to eat meals every day, go to the bathroom every day, etc. A care plan may change if the nurse makes the change at the nursing workstation  20 , as the CNA cannot change the care plans on his or her voice assistant  45 , as discussed above. As such, care plans may be received by the voice assistant  45  at the start of every shift and/or upon activation to reflect any changes to the care plans that occurred prior to the start of the shift and/or activation, and the care plans may be dynamically maintained throughout the shift and/or activation to include any changes. 
         [0061]    As the CNA completes the different tasks associated with the items in the care plans, a data set reflective of the work completed by the CNA may be generated at the voice assistant  45 . The data set may be utilized for various purposes. For example, the data set may be utilized to answer the Situational Awareness Questions of the CNA (e.g., the answer may be based on the data set alone or the answer may be based on the data set and the care plans), to generate a historical report, to generate an MDS, and/or to generate an exception report (e.g., at the nursing workstation), among other purposes. Thus, the care plans on the voice assistant  45  are not configured to track the completed tasks or changes in response to the completion of work by the CNA. Rather, it is the generated data set that tracks completed work. Indeed, a new data set may be generated during each shift. 
         [0062]      FIG. 1B  illustrates an exemplary overview of the data flow throughout the voice assistant system  5 , including the care plans, pages, etc. Key attributes of the data flow in the voice assistant system  5  at the facility level may include the external interfaces (e.g., to ADT, MDS and/or nurse call systems), data that is primarily manipulated through the web interfaces (e.g., a web browser at the nursing workstation  20 ), data that is primarily manipulated through the voice interface (e.g., the voice assistant  45 , main menu  63  and/or VUI), key reports (e.g., MDS, exception reports, and/or historical reports), and/or the plan of care documentation (“Doc” in the drawing). In particular, the “Doc” illustrates the overlap between the web interface and the voice interface. 
         [0063]    Referring back to  FIG. 1A , the facility  10  may also include at least one charger  65  to charge the voice assistant  45 . As illustrated in  FIG. 1A , each charger  65  may charge up to five voice assistants  45 . Furthermore, a least one item in the facility  10  may transmit and/or receive data via the Internet or a corporate wide area network (WAN)  70  to the offsite Vocollect Healthcare Systems, Inc. department and/or the onsite enterprise customer IT department  15 . 
         [0064]    The offsite VHS department and/or the onsite enterprise customer IT department  15  may include a workstation for support, maintenance and monitoring (S&amp;M&amp;M) activities  75  as well as a server to aggregate S&amp;M&amp;M data and execute distributed maintenance  80 . The offsite VHS department and/or the onsite enterprise customer IT department  15  may further include metrics and at least one dashboard  85  such as EffectiveCare™ offered by VHS, an enterprise data repository that may be utilized for enterprise roll-up for enterprise customers  90  and/or at least one corporate dashboard  95 . For example, the offsite VHS department may be able to remotely maintain the voice transaction manger  35 , provide other remote support, and/or monitor performance of the voice assistant system  5 . 
         [0065]    In short, the voice assistant system  5  may emphasize distributed execution, but centralized platform management and data roll-up, as discussed hereinabove. Moreover, those of ordinary skill in the art will readily appreciate that other functionality may be possible as well. Those skilled in the all will recognize that the exemplary environments illustrated in  FIGS. 1A-1B ,  2 A- 2 B and  3 - 4  are not intended to limit the present invention. Indeed, those skilled in the art will recognize that other alternative hardware and/or software environments may be used without departing from the scope of the present disclosure. 
         [0066]    Turning now to  FIG. 5 , via the main menu  63 , the CNA may select at least one parameter through speech input that corresponds to a Situational Awareness Question and/or command. The speech recognition capabilities of the voice assistant  45  are utilized to receive the speech input of the user and determine the parameter selected by the CNA. A Situational Awareness Question may be utilized to query about certain situations often encountered by CNAs in their work shift such that the CNA may control their workflow with respect to various situations. For example, when a CNA faces a particular situation or is placed in a particular context, the CNA may be able to interact with the voice assistant  45  through a corresponding question and begin a speech dialog that answers the question based upon the available information. In other words, information that the CNA may need to be aware of, should be aware of, and/or needs while performing their tasks may be organized according to Situational Awareness Questions. For example, the situation or context may be related to the remaining work, time of shift (commencement of the shift, end of the shift, etc.), time of day (lunch time, snack time, etc.), current task or tasks (bathing, vitals, etc.), a particular resident the CNA is working with, a location in a facility, etc. 
         [0067]    Various Situational Awareness Questions are illustrated as interrogatories  100 - 130  in  FIG. 5  consistent with one embodiment of the invention. Respectively, these are, “Who are my residents?” (block  100 ), “Who needs vitals?” (block  105 ), “Who has updates?” (block  110 ), “Who needs restorative?” (block  115 ), “Who has appointments?” (block  120 ), “Who needs care?” (block  125 ), and “Who needs bathing?” (block  130 ). As such, these Situational Awareness Questions concern interrogatories associated with the identity of residents associated with a CNA, the identity of residents associated with a CNA that need their vitals recorded, the identity of residents associated with a CNA who have had updates made to their respective care plan, the identity of residents associated with a CNA who need one or more restorative programs, the identity of residents associated with a CNA who are in turn associated with appointments for care or other activities, the identity of residents associated with a CNA who currently need some sort of care, and the identity of residents associated with a CNA who currently need bathing. A restorative program, or restorative care, refers to activities that may help improve a resident&#39;s mobility, eating, muscle function, and the like that may be performed by a CNA. Those of ordinary skill in the ant will appreciate, however, that other Situational Awareness Questions may be supported as well by the invention, for example, “What&#39;s important?”, “What&#39;s different?”, or “What&#39;s changed?”, “What&#39;s left?”, “What&#39;s scheduled?”, “Who&#39;s assigned?”, “What is last shift report?”, among others. As such, embodiments of the invention are not limited to the specific Situational Awareness Questions and interrogatories discussed herein. 
         [0068]    In some embodiments, the answer to each Situational Awareness Question is provided by way of a speech dialog generated by the speech recognition and synthesis capabilities of the voice assistant  45 , with the answer based upon care plan information and/or other information accessed and received by the voice assistant  45 . In general, the speech dialog answering the “Who” related questions will provide the names and/or room numbers of the residents that satisfy the question. In some instances, the answer may be based upon information from some or all of the care plans associated with the voice assistant  45 . Furthermore, the answer may be based upon, or take into account, tasks that have already been completed. For example, if the CNA wants to know, “Who needs bathing?”, it may be advantageous for the speech dialog to inform the CNA of the assigned residents that still need bathing, and not inform the CNA of assigned residents that have already been bathed by the CNA (or assigned a task that has already been completed by another CNA). As such, the answer may reflect the completion of a task by the assigned CNA or even completion of a task by another CNA, as tracked by the voice assistant system  5 . For example, the CNA might ask, “Who needs care?” The voice assistant  45  may then provide a list of the residents for whom various tasks still remain. Then, through other commands, and as discussed below, the CNA may select and review the tasks for a particular resident. That is, if the answer to a Situational Awareness Question listed Mr. Smith of Room 312 as needing care (e.g., in response to the interrogatory “Who needs care?”) or some specific task (e.g., in response to the interrogatory “Who needs vitals?”), the CNA may use the select command  135  to select Mr. Smith and the review command  145  to obtain information about Mr. Smith. For example, “Review vitals” may be spoken by the CNA to obtain care plan in formation about vitals for Mr. Smith. In some embodiments, when the CNA begins to assist an unassigned resident, the care plan for that unassigned resident is sent to the voice assistant  45 . 
         [0069]    Similarly, the answers to any questions, such as, “Who has updates?” may be based upon information associated with a particular resident that has changed and/or information associated with one or more care plans that has changed since the CNAs last login. Changes may occur because of an action by a nurse at the nursing station  20  during the CNA&#39;s shift, because of a change in the care plan of an assigned resident, because of an assignment of another resident to the CNA, etc. Moreover, there may be updates as to the facility configuration data, such as the number of CNAs currently working or logged on. As noted above in connection with  FIG. 1A , updates may be sent from the nursing workstation  20  to the voice transaction manager  35  and/or to the voice assistant  45  during a shift. As such, the care plans may be dynamically maintained. Upon noting a resident with updates, the CNA can select the resident, and speak or issue a “Review updates” command for that resident. 
         [0070]    In general, the commands may be associated with various tasks and invoked by the CNAs for assistance with, and for execution of, pending tasks. Various exemplary commands are illustrated as commands  135 - 160  in  FIG. 5 . Respectively, these are “Select” (block  135 ), “Document” (block  140 ), “Review” (block  145 ), “Sleep” (block  147 ) “Record” (block  150 ), “Page” (block  155 ) and General Commands (block  160 ). Furthermore, each of these commands may have additional sub-commands and/or sub-categories associated with them. For example, the “Review” command may have a sub-category for “toileting” to review the toileting of a resident. Similarly, the “Document” command may have a sub-command for “meals,” the “Page” command may have a sub-command for “unit,” etc. However, those of ordinary skill in the art will appreciate that additional commands other than those listed may also be supported. 
         [0071]    For at least some commands, speech dialog is provided that corresponds to that command. The speech dialog may include asking the user to speak at least one input, repeating the CNAs input, etc. The speech dialog may be based upon the data in the voice assistant  45 , including the care plans and/or voice templates. Such dialogs may be generated by the voice transaction manager  35  and/or the voice assistant  45  using speech synthesis as is known to a person of ordinary skill in the art. The text of the speech dialog may depend on the specific command and the data requested by the voice assistant  45 , or the information to be provided by the voice assistant  45 . As may be appreciated, the speech dialog could take various different forms to provide information about a resident or a care plan to a CNA, or to obtain information and data about a resident pursuant to their care plan. Thus, the invention is not limited to the specific questions or format of any given speech dialog. 
         [0072]    In addition to providing speech dialog in response to Situational Awareness Questions and or commands, the voice assistant  45  may also provide a CNA with a variety of audible tones, or audible speech tones  163 , as well as speech dialog in response to various statuses, as illustrated in  FIG. 6 . In some embodiments, such as in response to a status change (e.g., a new page and/or reminder) while the user is at the main menu, in response to a user navigating to the main menu while a page and/or reminder is outstanding (e.g., unaddressed) and/or in response to a predetermined time period elapsing while a voice assistant  45  is in the sleep mode with a page and/or reminder outstanding, an audible tone and a speech dialog associated therewith is provided, followed by another audible tone. When the CNA is not at the main menu, such as when the CNA is reviewing or documenting information, all audible tone may be provided without either the speech dialog associated therewith or the second audible tone in response to a status change. For example, an “all clear” tone  165  may be provided when there are no active pages or reminders. The “all clear” tone  165  may be followed by speech dialog that indicates “You have no pages or reminders,” and that speech dialog may be followed by another “all clear” tone  165 . The “incoming page” tone  170  may be provided when the CNA has one or more active pages to listen to, and may sound like a doorbell. The “incoming page” tone  170  may be followed by speech dialog that indicates “You have {N} pages,” wherein “N” is the number of pages for that CNA, and that speech dialog may be followed by another “incoming page” tone  170 . The incoming page may be from another CNA and may include a recorded voice message similar to a conventional voicemail. However, the page is a silent page in that a public address system (i.e., PA system) need not be utilized, leading to less disruption. 
         [0073]    Moreover, a “reminder” tone  175  may be provided when the CNA has one or more active reminders to listen to, and may sound like a chime. The “reminder” tone  175  may be followed by speech dialog that indicates “You have {M.} reminders,” wherein “M.” is the number of reminders for that CNA, and that speech dialog may be followed by another “reminder” tone  175 . A reminder may be based upon the care plans of the assigned residents. For example, a specific task in a care plan may have to be completed at a certain time or by a certain time (e.g., preparation for an appointment), and the reminder tone  175  may be provided to the CNA to make them aware that the time has arrived or is approaching. 
         [0074]    The audible tones and/or speech dialogs associated therewith provide audible indications to the CNA of particular information that needs attention. Therefore, rather than acting as a visual icon regarding that information., such audible tones and/or speech dialogs operate as an “earcon” to indicate to the CNA that something needs attention. Generally, a reminder earcon will be associated with time-sensitive information, such as a resident appointment that is within the care plan of a particular resident, or a time for a particular task within the care plan of that resident. For example, if a certain resident needs toileting at a particular time, a reminder earcon may be triggered to remind the CNA of the time-sensitive task. Again, the reminder earcon may include the reminder tone  175 , followed by a speech dialog associated therewith, and then followed by another reminder tone  175  in response to a reminder status change while the user is at the main menu, in response to a user navigating to the main menu while there is a reminder outstanding, and/or in response to a predetermined time period elapsing while a voice assistant  45  is in the sleep mode and there is a reminder outstanding. Alternatively, the reminder earcon may include only the reminder tone  175  in response to a reminder status change when the CIA is not at the main menu, such as when the CNA is reviewing or documenting information. Through a command, such as “Review reminders” (see  FIG. 8 ), the CNA can access the information that the reminder earcon refers to. 
         [0075]    An incoming page earcon is generally triggered when there is a page that is available for the CNA. For example, if another CNA or nurse pages the particular CNA and leaves a recorded message, a page earcon may be triggered. Again, the page earcon may include the incoming page tone  170 , followed by a speech dialog associated therewith, and then followed by another incoming page tone  170  in response to a page status change while the user is at the main menu, in response to a user navigating to the main menu while there is a page outstanding, and/or in response to a predetermined time period elapsing while a voice assistant  45  is in the sleep mode and there is a page outstanding. Alternatively, the page earcon may include only the incoming page tone  170  in response to a page status change when the CNA is not at the main menu, such as when the CNA is reviewing or documenting information. Through a command, such as “Review pages” (see  FIG. 8 ), the CNA can access the information that the page earcon refers to. 
         [0076]    In some embodiments, if a care plan has been updated, a page earcon occurs such that the CNA can be alerted to updates. In those embodiments, the page earcon includes speech dialog that indicates “You have an update.” In that way, updates can be handled in a timely fashion, and the CNA can issue the command “Review updates” in response to the page earcon. 
         [0077]    In some embodiments, earcons may be provided to the CNA when the CNA returns to the main menu and there is an outstanding page and/or reminder. Until the CNA has addressed the information or tasks associated with a particular page or reminder, the respective earcon associated therewith will be provided each time that CNA returns to the main menu. However, if a page or reminder status changes multiple times while that CNA is not at the main menu, such as when the CNA is reviewing or documenting information, the respective single tone earcon is provided once. For example, if a CNA receives two pages while that CNA is reviewing or documenting information, the respective page earcon (which includes only the incoming page tone  170 , as the CNA is not at the main menu) is provided when the first page is received but not when the second page is received. Moreover, the timing of when an earcon is provided is determined intelligently. For example, if the voice assistant  45  is waiting for speech input from the CNA, an earcon may be delayed until such time as that speech input has been received but before another wait for additional speech input and/or speech dialog. In some embodiments, providing earcons while the CNA is not at the main menu is a configurable option. As such, earcons, and particularly earcons that include a tone, associated speech dialog, and the tone a second time, may not be provided outside of the main menu and/or the sleep mode. 
         [0078]    In regard to the sleep mode, an earcon may be played after a predetermined time while a voice assistant  45  is in the sleep mode when there is a page and/or reminder outstanding. For example, when there is a page and/or reminder outstanding and when the voice assistant is in the sleep mode  45 , a corresponding earcon may be provided about every 80 seconds. It will be appreciated by one having ordinary skill in the art that the corresponding earcon (e.g., for a page and/or reminder) may be played more or fewer than about every 80 seconds while the voice assistant is in sleep mode. 
         [0079]    Those of ordinary skill in the art will appreciate that other tones, speech dialogs and/or earcons (including sequences of tones and or speech dialogs in earcons) may also be supported, and that many variations are consistent with the embodiments of the invention. For example, CNAs may be able to set their preferences regarding the tones/speech dialogs/earcons that are provided, when those tones/speech dialogs/earcons are provided, whether or not to remind about a task, etc. Moreover, a CNA may prefer to not be interrupted while performing a task, and as such, if the CNA is interacting with the system but away from the main menu, any tones, speech dialogs and or earcons to be provided may be postponed until after the CNA completes the interaction in an effort to avoid interrupting the CNA and to avoid the perception of vocally directing the CNA. Indeed, consistent with the principles of the present invention, the voice assistant  45  seeks to minimize the interruptions to the CNA, and instead, the tones, speech dialogs and/or earcons may simply indicate that there is a reminder or a page for the CNA to listen to and make the reminders and pages available for the CNA to listen to via the main menu  63  when the CNA desires. As such, if the CNA is busy or otherwise unable to listen to a reminder, for example, because they are with a resident, the CNA may listen to the reminder later on as desired and constant interruptions may be reduced. 
         [0080]    Therefore, embodiments of the invention provide near real-time voice messaging as a communication mechanism without undesired interruption. The voice user interface provides information about the workflow of the CNA and the appropriate times for the CNA to be interrupted. The voice user interface provided by embodiments of the invention slots the notification into the workflow when appropriate using audible earcons, which may include audible tones, speech dialogs or combinations thereof Thus, information about the status of communications is conveyed without disruption of a workflow. 
         [0081]    Tuning now to  FIG. 7 , that figure illustrates an exemplary voice dialog and workflow routine  180  executed by the voice assistant system  5  depicting interaction between the CNA and the main menu  63 . First, the CNA logs on ad the care plans of the assigned residents and the facility configuration data, as well as any other pertinent data, may be sent to the voice assistant of the CNA as explained hereinabove. After logging on, the CNA may hear the all clear earcon indicating that there a-e no active pages or reminders, and the CNA may “sit” in the main menu  63  of the voice dialog until the CNA desires to ask a Situational Awareness Question, say a command, or put the voice assistant  45  to sleep. While the CNA sits in the main menu  63 , the voice assistant  45  may be awake and using its speech recognition capabilities to actively listen for speech input, interpret the speech input and/or determine if the CNA has spoken a valid parameter that is used in the voice dialog of the invention. The CNA may put the voice assistant  45  to sleep when the CNA wants to speak (e.g., to a resident) but does not want the voice assistant  45  to use its speech recognition capabilities and other functionalities. In some embodiments, the voice assistant  45  enters a sleep mode after a predetermined time during which is idle (e.g., including at the main menu  63 ), such as, for, example, about 20 seconds. 
         [0082]    When the CNA decides to ask a Situational Awareness Question, the CNA may say that Situational Awareness Question in block  185 . For illustration; the voice or speech input of the CNA is illustrated in blocks in the form of ovals, the speech dialog (e.g., generated speech) from the voice assistant  45  is illustrated in blocks in the form of rounded rectangles. Returning back to block  185 , the CNA may ask, “Who are my residents?” In response to the Situational Awareness Question, the CNA may be provided with the speech dialog in block  190 , indicating the name and room number of each assigned resident, such as, “Charles Wallerby, 301; Samantha Brubeck, 302; John Flowers, 303 . . . no more residents.” 
         [0083]    Next, control may pass to block  192  to determine if the CNA desires to continue to the main menu  63  or put the voice assistant  45  to sleep. Specifically, the voice assistant  45  may provide a speech dialog that asks “Continue or sleep?” When the CNA chooses to put the voice assistant  45  to sleep (“Sleep” branch of decision block  192 ), the CNA may use the “Sleep” command ( FIG. 8 ) to enter a sleep mode as shown at block  194 . In the sleep mode, the voice assistant  45  may continue to determine whether there is at least one page and/or reminder outstanding, but otherwise wait to detect a button press of a button of the voice assistant  45  to continue converting speech input into machine readable input. In the sleep mode, the voice assistant  45  may provide an earcon corresponding to a page and/or reminder in response to receiving a page and/or reminder. That earcon may be repeated every 80 seconds. Upon exiting sleep mode (block  194 ), the voice assistant may proceed to the main menu  63 . 
         [0084]    When the CNA wants to continue by using a “Continue” command (“Continue” branch of decision block  192 ), control may pass to block  195  to determine if the CNA has any active pages and/or reminders. If there is at least one active page and/or reminder (“Yes” branch of decision block  195 ), control may then pass to block  200 , and the voice assistant  45  may return to the main menu  63  as well as provide the page earcon and/or the reminder earcon when there is at least one outstanding page and/or reminder, respectively. When there is not at least one outstanding page and/or reminder (“No” branch of decision block  195 ), control may pass to block  205 , and the voice assistant  45  may return to the main menu  63  as well as provide the all clear earcon. Upon returning to the main menu  63 , the CNA may issue a command to the voice assistant, and may say “Review pages” if the CNA hears the page earcon or say “Review reminders” if the CNA hears the reminder earcon. The voice assistant  45  may then play the respective dialog regarding a page or reminder, respectively. After the pages or reminders have been reviewed, the all clear earcon may be provided. 
         [0085]    To continue the example, the CNA may decide to perform tasks associated with one of the residents (in the context of this example, which is not intended to limit embodiments of the invention, Charles Wallerby). As such, the CNA may choose from a variety of voice user interface parameters in the form of commands. In particular, the CNA may select a resident, and may say, “Select Room 301” (block  208 ), which is Charles Wallerby&#39;s room number. The CNA may then request information regarding the care for that resident. For example, “Review toileting” (block  210 ) might be spoken. When the CNA reviews certain information from the care plan, it may be read to the CNA, including the checked fields in the care plan (e.g.,  FIGS. 2A ,  2 B). For example, the CNA may be provided with speech dialog in block  215  based on the care plan of a resident and/or other information on the voice assistant  45 . For example, this speech dialog may be “Charles Wallerby,  301 , toileting. No updates. Cautions: Do not leave unattended in bathroom. High risk for falls. Physical functioning . . . ” (block  215 ). As such, the speech dialog provides information about the resident&#39;s care plan and assists the CNA by warning the CNA that Charles Wallerby should not be left unattended in the bathroom and is at a high risk for falls. Next, control may pass to the blocks  192 ,  194 ,  195 ,  200  or  205  as appropriate, and then to the main menu  63  as described hereinabove. As will be understood, various other care plans may be reviewed in a similar fashion. The voice assistant  45  thus interacts with the various care plans as necessary as directed by the CNA. As will be appreciated, the speech dialog resulting from the various commands and/or Situational Awareness Questions will vary based upon the fields selected in a care plan and other information about the resident contained in the system. 
         [0086]    An overview of what tasks remain within a shift may be obtained by the CNA by utilizing a Situational Awareness Question of, “Who needs care?”  125 . The CNA is provided with a list of the residents who still need various care procedures, or for whom certain tasks are still outstanding. Then, knowing such information, the CNA can then select a particular resident for their attention. For example, a resident could be selected, and then the command “Review care”  145  will indicate to the CNA what tasks or care procedures still remain for that particular resident. 
         [0087]    Alternatively, the CNA may say, “Page unit” (block  220 ), and may be provided with the speech dialog in block  225  stating, “Paging unit. Press and hold the play button to record a message.” Next, the CNA may press a play button on the voice assistant  45  to begin recording, record the message, and then release the play button as indicated in block  230 , and the page may be sent to all of the employees in the unit in block  235  wearing voice assistants  45 . Control may then pass to blocks  192 ,  194 ,  195 ,  200  or  205  as appropriate, and then to the main menu  63  as described hereinabove. It will be appreciated that, in some embodiments, pages may be sent to less than all employees in a unit wearing a voice assistant  45 . As such, pages may be selectively addressed to one, or a subset of (e.g., one, some or all), all those wearing a voice assistant. 
         [0088]    To complete tasks for a resident and document those tasks, the CNA may say “Select Room 301” (block  240 ), which is Charles Wallerby&#39;s room number, and then “Document meals” (block  245 ). As such, the CNA may be provided with speech dialog that corresponds to the “Document meals” command, such as that illustrated ill blocks  250 ,  260 ,  270 ,  280 ,  290 ,  300 , and  310 . Specifically, block  250  acknowledges the intentions of the CNA to document meals and indicates the predetermined vocabulary that the CNA may say when documenting a meal by stating “Charles Wallerby, 301, meals, Say breakfast, lunch, dinner . . . ” After the CNA says “breakfast” (block  255 ), block  260  acknowledges the documentation of breakfast and requests the CNA to indicate the percentage eaten by Charles Wallerby by stating “Breakfast. Percent eaten?” The CNA may respond with “Seventy-five” (block  265 ) and may then hear “Seventy five. Fluid intake?” (block  270 ). The CNA may respond to this request with “One-twenty” (block  275 ) and may then hear “One-twenty. Self-performance level?” (Block  280 ). The CNA may respond with “Extensive” (block  285 ) and may then hear “Extensive. Support Level?” (Block  290 ). The CNA may respond with “One-person” (block  295 ) and may then hear “One-person. Occurrence complete. Save or review the documentation?” (Block  300 ). In that way, various data associated with a particular task is handled and documented by the voice assistant. It will be appreciated that alternative values other than those illustrated and described herein may be documented without departing from the scope of embodiments of the invention. 
         [0089]    As may be appreciated, other data associated with other care plan segments may be captured in similar fashion with other appropriate voice dialogs that are reflective of the particular care plan and the fields therein. For example, “Document hygiene” may have a voice dialog associated with that portion of the care plan. 
         [0090]    The self-performance and the support levels generally refer to the amount of assistance that the resident needed, and may vary based upon the activity. The different self-performance levels and support levels that the CNA may say are illustrated in document  62  in  FIG. 4 , along with the Situational Awareness Questions and commands that the CNA may say. Next, the CNA may say “Save” (block  305 ) and may then hear “Documentation saved.” (block  310 ). Control may then pass to the blocks  192 ,  194 ,  195 ,  200  or  205  as appropriate, and then to the main menu  63  as described hereinabove. 
         [0091]    Turning now to  FIGS. 8-9 , these figures illustrate in more detail some of the commands, sub-commands, and information that the CNA may choose via the main menu  63 . One of ordinary skill in the art will appreciate that the commands and sub-commands are utilized to facilitate discussion related to the embodiments of the invention and are consistent with the principles of the present disclosure but not otherwise intended to be limiting. Similarly, one having ordinary skill in the art will appreciate that the information that may be chosen by the CNA in response to the speech dialog provided is also not intended to be limiting.  FIGS. 8-9  are merely illustrative of details of various items, with the hierarchy from broadest to narrow being command, sub-command, and information. Furthermore, those of ordinary skill in the art will appreciate that each command and sub-command combination may be associated with a separate executable routine and may provide different speech dialog as necessary to facilitate the task. For instance, many command and sub-command combinations were already illustrated in connection with the blocks  210 ,  220 , and  245  in the routine  180  in  FIG. 7 , and although illustrated as a single routine  180 , each one of these may be a separate routine with at least one speech dialog. 
         [0092]    Turning to  FIG. 8 , the “Select” command  135  may be utilized to select a room number, and then the “Document” command  140  or the “Review” command  145  may be chosen by the CNA. Starting with the “Document” command  140 , a variety of tasks indicated by the various resident care plans may be performed by the CNA and documented via the “Document” command  140  and the sub-commands that correspond with that task. Some of the sub-commands are illustrated under the “Document” command  140 . The sub-commands may be, but are not limited to, “ambulation”  315 , “bathing”  320 , “behavior”  325 , “dressing”  330 , “falls”  335 , “hygiene”  340 , “meals”  345 , “mood”  350 , “positioning”  355 , “restorative”  360 , “toileting”  365 , “transfers”  370 , and/or “vitals”  375 . Various of the sub-commands correspond to the care plans, as discussed herein with respect to  FIGS. 2A-2B  and  12 - 22 . And each one of these subs commands may have information for the CNA to choose, as illustrated in  FIG. 9 . For example, the CNA may choose the “Document” command  140  and the “ambulation” sub-command such that the CNA is prompted by speech dialog associated with the combined “Document ambulation” commands to choose between locomotion or orthotics for documentation purposes ( FIG. 9 ). Next, the CNA may be provided with the appropriate speech dialog based upon whether locomotion or orthotics was chosen. Such a speech dialog may, for example, consist of a series of questions for the CNA to answer as set forth in the example of  FIG. 7 . 
         [0093]    In another example, the CNA may choose the “all” term as illustrated in  FIG. 9  to document all of the information for a certain sub-command, like “vitals”  375  or “mood”  250 . Also, in some instances, the CNA may have to choose the “did not occur” terminology to affirmatively document that a task did not occur (e.g., “meals”  345  or “transfers”  270 ), or the “did not void” terminology for “toileting”  365  to indicate that the resident did not have to go to the bathroom (see  FIG. 9 ). 
         [0094]    Returning to FIG. S, each of the sub-commands (and tasks) listed under “Document” command  140  may also be utilized with the “Review” command  145  such that the CNA may review any of these portions of the care plan during his or her shift. The CNA may additionally review “medical precautions,” “updates” (e.g., to a care plan), “end-of-shift reports” (e.g., recorded by the nurses indicating information that the CNA should be aware of), “pages,” “reminders,” “last” (e.g., last weight, last urine, last bowel movement, last meals, last vitals, last fluids, etc.) and/or “care” (e.g., to see what tasks are outstanding for a resident). 
         [0095]    Next, the CNA may also use the “Record” command  15 D and the “clinical note” sub-command to record a clinical note. In particular, the clinical note may be recorded to inform a nurse of a problem or indicate some other observation of the CNA. Upon recording the clinical note, the clinical note may be transmitted from the voice assistant  45  of the CNA to the nursing workstation  20  for the nurse to address. Additionally, the nurse may be provided with a page earcon on their own voice assistant  45  to indicate that a clinical note has been received. As such, this process may ensure that the nurses address each clinical note recorded and that the corresponding care plan is updated as needed at the workstation  20  by the nurse. 
         [0096]    Furthermore, with respect to the “Record” command  150 , the sub-command of the “end-of-shift reports” and “welcome message” may be reserved for the nurses. In particular, a nurse may utilize the “end-of-shift reports” sub-command to record the reports during or after a meeting with the CNAs at the end of the shift, for example, in order to inform the CNAs scheduled for the next shift of anything that they should be aware about. The “welcome message” sub-command may be utilized to record a message that is sent to everyone with a voice assistant  45 . An audible earcon, such as a page earcon, may alert a CNA to such a welcome message. 
         [0097]    Although the CNAs may be restricted in their ability to utilize these sub-commands, a CNA may utilize the “Page” command  155  and the sub-commands associated therewith to page the site, to page a unit, to page a particular staff member by using the staff member&#39;s name and/or to page for a room number. Furthermore, the CNA may choose the “General” command  160  and sub-commands listed below it to request help with acceptable terminology that the CNA may say, place the voice assistant  45  to sleep and /o have the voice assistant  45  repeat the last speech dialog or say again. Moreover the CNA may utilize the sub-commands listed under the General Commands  160  to cancel, fix a mistake and/or to perform a sample of the background noise of the current environment. 
         [0098]      FIGS. 10A-10C  and  FIG. 11  illustrate an exemplary documentation routine. As discussed in connection with  FIG. 9 , various vitals might be documented along with other information. Referring to  FIG. 10A , the exemplary routines may include a documentation of vitals routine  380 , a weight analysis routine  390  (which may be, in turn, included in the documentation of vitals routine  380 )) and a weight routine  400  (which may be, in turn included in the weight analysis routine  390 ), respectively. The routine  380  assumes that the CNA chose the “Document” command  140 , the sub-command “vitals”  355 , and the additional sub-command “all”. As such, the exemplary routine  380  may be executed and may call routines  390  and  400  during its execution. As before, the CNA&#39;s speech input is illustrated in ovals while speech dialog from the voice assistant  45  is illustrated in rounded rectangles. 
         [0099]    Turning to  FIGS. 10A-10C  and routine  380 , when the CNA decides to engage in tasks related to the vitals of a resident, the CNA may say “Select room {Room Number}” (block  405 ), with the “Room Number” insert being the room number of the resident. The CNA may then say “Document vitals” (block  410 ). Upon receiving these commands, the voice assistant  45  may say “{Resident Name}, room {Room Number}, Vitals. Say temperature, pulse, respiration, BP, oximetry, weight, or all,” (Block  415 ). The CNA may choose any of the vitals individually and the appropriate path may be followed in the speech dialog via routine  380 , but in this example, the CNA chooses to document “all” vitals (block  420 ). As such, control may pass to block  425  to get the time. 
         [0100]    In some embodiments, block  425  may call a “get time” routine to determine and verify the current time. Specifically, the “get time” routine may determine a time then provide that time to the CNA through a speech dialog to verify. Alternatively, the CNA may be provided with speech dialog requesting they speak the time. Next, control may pass to block  435  to call a temperature routine to determine the temperature of the resident. Block  440  may asks the CNA to state “How was the temperature taken?”, and the CNA may say “oral,” “axillary,” “rectal,” or “ear” (block  445 ). 
         [0101]    When the CNA indicates that all the vitals are to be documented (“Yes” branch of decision block  450 ), control may then pass to block  455  to call a pulse routine to document a pulse of the resident and then to block  460  and block  465  for other vitals. The block  465  may call a respiration routine to document a respiration of the resident, and then to block  470  and block  475 , with block  475  calling a blood pressure, or “bp,” routine to document a bp of the resident. Next, the CNA may be asked to provide the position of the resident when the blood pressure was taken at block  480 . The CNA may say standing, sitting, or lying (block  485 ), and then control may pass to block  487  and block  685 , with block  685  calling for an oxygen saturation, or “oximetry,” routine to document a pulse-oxygen level of the resident. Next, the system may check to see if an “oxygen equipment needed” check box in a care plan is checked (block  690 ). When the check box is checked (“Yes” branch of decision block  690 ) the CNA may be asked how many liters of oxygen the resident is on (block  700 ). The CNA may then indicate the number of liters of oxygen the resident is on (block  705 ). After documenting the number of liters of oxygen the resident is on (block  705 ) or if the system determines that the check box for indicating whether oxygen equipment needed is not checked (“No” branch of decision block  690 ), the CNA may be asked whether the resident was at rest (block  710 ). The CNA may then indicate whether the resident was at rest or not (block  715 ), and then control may pass to block  720  to state “Occurrence complete. Save or review documentation?” when the CNA states “save” (block  725 ) control may pass to block  730  to send the pulse oximetry information one way (e.g., to the voice transaction manager  35 ). Likewise, control may pass to blocks  735 ,  500 ,  505 ,  510 ,  515 ,  520 ,  525 , and  535  to send the blood pressure information, respiration information, the pulse information, and the temperature information one way for storage. Next, control may pass to block  540 , which states “Documentation saved”, and then to block  542  to determine whether to continue or sleep. When the CNA indicates to put the voice assistant to sleep (“Sleep” branch of decision block  542 ) the voice assistant may enter a sleep mode (block  544 ). When the CNA chooses to continue (“Continue” branch of decision block  542 ) and/or after the sleep mode (block  544 ), the voice assistant may return to the main menu (block  545 ). 
         [0102]    However, if the CNA chooses to individually document the temperature, for example, control may pass through items  450 ,  550 ,  555 ,  535 ,  540 ,  542 ,  544  and/or  545 , as previously described. If the CNA only wants to document the pulse, control may flow from block  415  through the path that includes items  560 ,  565 ,  455 ,  460 ,  570 ,  580 ,  520 ,  525 ,  540 ,  542 ,  544  and/or  545 . If the CNA only wants to document the respiration, control may flow from block  415  through the path that includes items  585 ,  590 ,  465 ,  470 ,  595 ,  600 ,  510 ,  515 ,  540 ,  544  and/or  545 . Moreover, if the CNA only wants to document the blood pressure, control may flow from block  415  to items  605 ,  610 ,  475 ,  480 ,  485 ,  490 ,  495 ,  500 ,  505 )  540 ,  544  and or. Similarly, if the CNA only wants to document oximetry, control may flow from block  415  to items  617 ,  740 ,  745 ,  685 ,  690 ,  700 ,  705 ,  710 ,  715 ,  720 ,  725 ,  730 ,  735 ,  540 ,  544  and/or  545 . 
         [0103]    It is worth noting that in the illustrated routine  380 , weight was not one of the vitals that was documented when the CNA indicated that they wanted to document “all,” but those of ordinary skill in the art will appreciate that in other embodiments, weight may be included when the CNA chooses to document all. As such, attention will now turn to documentation of the weight. Starting with block  415 , if the CNA only wants to document the weight of the resident (block  615 ), control may pass to the weight analysis routine  390  and the appropriate speech dialog as illustrated in  FIG. 10C . 
         [0104]    As illustrated in  FIG. 10C  and the weight analysis routine  390 , block  620  may ask the CNA for the time, and the CNA may speak the time at block  625 . Next, block  630  may repeat the spoken time and ask the CNA for the weight; and the CNA may speak the weight as noted at block  635  (which may be obtained from a scale used to weigh the resident). In the corresponding exemplary weight speech recognition routine  400  as shown in  FIG. 11 , the weight is captured. In routine  400 , the CNA&#39;s speech is illustrated on the lines, and as the CNA speaks the numbers, different paths are traversed. In particular, routine  400  illustrates a corrective routine that intelligently determines the weight of the resident based on the speech input from the CNA. For example, the weight is also checked to determine it is a valid weight, and if it is, the weight is returned to routine  390 . As may be appreciated, other weight speech recognition routines might be used to capture the spoken weight. 
         [0105]    Nonetheless, with reference once again to the routine  390 , regardless of how the weight is determined, control may pass to block  640 . Block  640  determines if another weight has been documented for that same resident in the past three days. If so, block  640  determines if a variance (e.g., difference, differential) between that previous weight and the spoken weight from block  635  is more than about three pounds lower or more than about three pounds higher. However, those of ordinary skill in the art will appreciate that the variance may be compared to other preselected values consistent with the principles of the present invention, and may be based on, for example, best practices. 
         [0106]    If the variance is about three pounds lower or about three pounds higher, control may pass to block  645  to indicate to the CNA that the spoken weight is more or less than expected when compared to the last recorded weight. Moreover, the block  645  also indicates to the CNA that he or she should re-weigh the resident now. Next, control may pass to block  650  to determine if the CNA wants to document another weight, and if so, control may pass to items  655  and  660  to receive another weight, such as per routine  400 . The CNA may then be provided with an indication that the occurrence is complete, and asked whether to save or review the documentation at block  665 . After the CNA says “save” (block  670 ), control may pass to block  675  to send the weight information one way (e.g., to the voice transaction manager  35 ), and then back to routine  380  in  FIGS. 10A-10B  for the nurse assistant to inform the CNA that the documentation has been saved (block  540 ), to determine whether to continue or sleep (block  542 ), to enter a sleep mode (block  544 ) and or to proceed to the main menu (block  545 ). 
         [0107]    Returning to block  640  in routine  390  in  FIG. 10C , if a weight was not documented within the last three days, control may pass to block  680  to determine if a weight was documented within the past 30 days. If so, block  680  determines if a variance between the current weight and the weight of the past 30 days has more or less than about a five percent differential. If the differential is about five percent, control may pass to block  645  for the voice assistant to suggest to the CNA that the resident should be re-weighed, as previously discussed. Otherwise, control may pass to block  665 , as previously discussed. 
         [0108]    Those of ordinary skill in the art may appreciate that by immediately analyzing the weight for the CNA, by comparing the weight the CNA is entering to the previously entered weight at the point of care (e.g., at the scale), the CNA may be able to avoid documenting an erroneous weight, and may immediately weigh the resident again and provide a new weight. This presents a significant time savings in resident care, because normally an improper weight would not be noticed until significantly later and would require a duplicated, time consuming, and possibly difficult and intrusive effort to get the resident re-weighed. The present invention provides verification right at the point of care. Alternatively, if the weight is correct but lower than it should be, for example, the CNA may immediately learn about the lower weight and inform a nurse (e.g., by recording a clinical note an or page). In turn, the nurse may adjust a care plan of the resident, including adding warnings that the resident may be at a high risk for fails due to the lower weight, as needed. Indeed, those of ordinary skill in the art will appreciate that with the immediate weight analysis provided by the invention, the CNA may be assisted with weighing a resident and may learn about an anomalous weight thereof at the point of care to avoid having to transport the resident to the scale again for re-weighing days or weeks later. Rather, the appropriate actions may be taken immediately for a correct but possibly anomalous weight. 
         [0109]    While the present invention has been illustrated by the description of the embodiments thereof, and while the embodiments have been described in considerable detail, it is not the intention of the application to restrict or in any way limit the scope of the appended claims to such detail. Additional advantages and modifications will readily appear to those skilled in the art. Therefore, the invention in its broader aspects is not limited to the specific details or representative apparatus and method, and illustrative examples shown and described. For example, the principles of the present invention may be adapted for a setting different than a nursing home. Accordingly, departures may be made from such details without departure from the spirit or scope of applicant&#39;s general inventive concept.

Technology Classification (CPC): 6