Abstract:
Healthcare services at a patient&#39;s residence are monitored by placing an identification device in the residence and by a healthcare worker carrying a data acquisition device. Whenever proximate to the residence, the data acquisition device receives a wireless signal that carries an identifier from the identification device. The data acquisition device responds to receipt of that wireless signal by recording the identifier and measuring the amount of time that the signal continues to be received. At some later point in time, the information acquired by the data acquisition device is transferred to a computer system for processing and preparation of records about the quality and security of patient care and the time and attendance of the healthcare worker.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
       [0001]     This is a continuation in part of U.S. patent application Ser. No. 11/207,446 filed on Aug. 19, 2005. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT  
       [0002]     Not Applicable  
       BACKGROUND OF THE INVENTION  
       [0003]     1. Field of the Invention  
         [0004]     The present invention relates to time and attendance and staff scheduling systems for monitoring work hours of healthcare workers, and more particularly to a monitoring system that automatically logs when a healthcare worker is present at a residence of a patient being attended to at home.  
         [0005]     2. Description of the Related Art  
         [0006]     Healthcare workers at a medical facility historically used a time clock to record the time of day on an attendance card upon entering and exiting the workplace. Today computerized time and attendance systems have replaced the traditional time clocks. These systems read an unique employee number and other data from an identification badge when the employee arrives and departs the workplace. The acquired employee identification data are transmitted and recorded in a central computer along with the current date and time. That recorded information is subsequently used by a payroll program (amongst others) to calculate the amount of wages that each employee is to receive.  
         [0007]     With rising costs of in-patient medical care, a greater number of patients are receiving care in their homes. In those cases, a healthcare worker periodically attends to the patient at home. Depending upon the needs of a particular patient, the healthcare worker may visit the patient once a week, a few times a week, or on a daily basis. Each visit may be for a short period of time, in which case the healthcare worker visits several patients each day, or the healthcare worker may attend to the patient for an entire eight hour work shift. Because the healthcare worker is visiting the patients&#39; homes, conventional time and attendance and staff scheduling systems can not be used to record the time and monitor the schedule that the particular healthcare worker is working.  
         [0008]     Therefore, a need exists for a system that automatically monitors the time and attendance and staff scheduling data of healthcare workers at the homes of patients being treated.  
       SUMMARY OF THE INVENTION  
       [0009]     Services provided by a healthcare worker at a residence of a medical patient are monitored by an identification device placed in the residence and a data acquisition device carried by the healthcare worker. The identification device, either periodically or in response to activation, emits a first wireless signal that provides a first identifier. In a preferred embodiment, the first identifier is uniquely associated with one particular medical patient or residence.  
         [0010]     When proximate to the patient, the data acquisition device receives the first wireless signal and extracts and records the first identifier. Optionally, receipt of the first wireless signal also causes the data acquisition device to record the date and time of day along with the first identifier. In another option, the data acquisition device measures the interval that the first wireless signal continues to be received and when the receiving of that signal ceases, an indication of that interval is stored with the first identifier. Thus the indication represents the amount of time that the healthcare worker provided services to the medical patient. In this manner, the data acquisition device acquires information related to the healthcare worker attending to the medical patient. Similar information can be acquired about other medical patients attended to by this healthcare worker throughout the day.  
         [0011]     Thereafter, the acquired information is transferred from the data acquisition device to a computer. Any of several techniques can be employed to perform that transfer. For example, the data acquisition device may respond to receiving an wireless interrogation signal by transmitting the acquired information via another wireless signal to the computer. The wireless signals can be radio frequency signals, light within the infrared or visible spectrums, audible sound, ultrasound, or other forms of wireless communication. A cellular telephone connection, a land line telephone connection or an Internet connection also can be used to transfer the information from the data acquisition device to a computer. A cable connection could even be employed.  
         [0012]     The computer processes the information from the data acquisition device to supervise the provision of services to the patient. For example, the information enables to computer to determine when the healthcare worker visited the patient&#39;s residence and the length of each visit. This verifies that the worker actually performs the work assignments and provides information for billing the patient. The computer also can prepare a report regarding the treatment received by the patient.  
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]      FIG. 1  is a schematic diagram of a medical facility computer system that stores patient records, as well as information about hospital employees;  
         [0014]      FIG. 2  depicts a healthcare worker attending to a patient in bed at home;  
         [0015]      FIG. 3  is a block schematic diagram of an electronic identification device worn by the patient;  
         [0016]      FIG. 4  is a block schematic diagram of the data acquisition device carried by the healthcare worker;  
         [0017]      FIG. 5  illustrates the healthcare worker adjacent to a personal computer connected to medical facility computer system to transfer data from the data acquisition device into the computer system;  
         [0018]      FIG. 6  is a block schematic diagram of a data interrogator connected to a personal computer in the medical facility;  
         [0019]      FIG. 7  is a graphical representation of data fields of a treatment event record stored within the hospital computer system; and  
         [0020]      FIG. 8  is a block schematic diagram of another embodiment of an electronic identification device worn by the patient. 
     
    
     DETAILED DESCRIPTION OF THE INVENTION  
       [0021]      FIG. 1  illustrates a computer system  10  of a medical facility, such as a hospital, outpatient clinic, nursing home, extended care center, or a business office from which home health care workers are supervised, for example. The computer system  10  includes a computer  11 , that processes and stores patient records, and a time and attendance computer  12 , which executes software programs that schedule employees and then records the actual amounts of time that they work. The patient records computer  11  and the time and attendance computer  12  are connected to a conventional local area network (LAN)  14  of a type commonly found in work places. A plurality of personal computers  17  and  18  are connected to the LAN  14  to exchange data and commands with the computers  11  and  12 . It should be understood that many more personal computers than are illustrated are connected to the LAN  14  throughout the medical facility. For example, personal computers are located at nursing stations, treatment areas, and administrative offices. The computer system  10  is typical of a relatively large medical facility, whereas the present invention also can be used where the health care workers are supervised from one or more rooms in an office building. In this latter case computer system  10  could consist of a single personal computer.  
         [0022]     Employees working at the medical facility record when they start and end periods of work by using a badge readers  19  located throughout the medical facility and connected to the local area network  14 . The badge readers  19  can be any of a number of commercially available types. For example, each employee is issued an identification badge  13  ( FIG. 2 ) that has a magnetic strip or other mechanism which encodes a unique employee identifier (e.g. identification number) and the badge is read by the badge reader  19 . This process enters employee time and attendance data into the computer system.  
         [0023]     However, the time and attendance data gathering system at the medical facility cannot track healthcare workers who attend to patients at home. Instead, a unique system has been created for those workers. Now when home care is arranged for a patient, an office employee creates a record for that patient within the memory of the patient records computer  11 . That record contains standard information, such as the patient&#39;s name, home address, biographical information, insurance and other billing information, names of assigned healthcare workers, and the like. Then, as is common practice at most medical facilities, the personal computer  18  prints a label  15  for a wristband that is worn by the patient to provide identification of this patient to healthcare workers.  
         [0024]     Unlike that prior practice, the label  15  now is attached to a wristband  22  that contains an electronic identification device  24  depicted in  FIG. 2 , which emits a first radio frequency signal  23  carrying a unique identifier for this patient. That patient identifier, and a similar identifier to be described for a healthcare worker, may comprise only numerals (i.e. a patient ID number), only alphabetic characters, or a combination of alphanumeric characters, as well as other characters. Although the exemplary identification device  24  is being described as attached to a wristband  22  fastened around the lower forearm of the patient  20 , it should be understood that the identification device may be worn about other parts of the patient&#39;s body or take other forms.  
         [0025]     Because a patient may not desire to wear a wristband at home, the identification device  24  alternatively can be mounted in a housing  25  that is placed at a convenient location within the patient&#39;s residence. That location does not have to be close to the patient&#39;s bed. Although  FIG. 2  illustrates the patient in bed, the present monitoring system also can be used with ambulatory patients who are attended to at home. The housing  25  also may contain a power supply that receives electricity from a wall outlet in the home to power the identification device  24 .  
         [0026]     Identification device  24  may be preprogrammed with the patient identifier that is the same as or different than the standard identification number assigned to the medical facility patients upon admission. Alternatively, the patient identifier can be programmed into the identification device  24  by the personal computer  18 , thereby enabling a single number or other identifier to be used for all identification purposes. In that latter case, the personal computer can download other information about the patient, such as allergies, into the identification device prior to issuance to the patient.  
         [0027]     With reference to  FIG. 3 , the electronic identification device  24  has a control circuit  26  which governs the operation of the device and has the unique patient identifier stored therein. A switch  27 , connected to the control circuit, is used to turn on the identification device upon being issued to a patient. When operating, the control circuit  26  periodically activates a radio frequency (RF) transmitter  28  which modulates an RF carrier signal with the patient identifier using any standard modulation technique. The resultant first radio frequency signal is applied to an antenna  30  from which the signal radiates in an omnidirectional pattern. The components of the identification device  24  are connected to a power supply  32  that can be a battery when the identification device is on a wristband or an AC to DC power supply when the device is in housing  25 .  
         [0028]     Referring again to  FIG. 2 , the healthcare workers, visiting the patient&#39;s home, wear or carry data acquisition devices  40  that receive the first RF signal  23  while attending to the respective patient. For example, the data acquisition device  40  can be worn on the belt or waistband of a healthcare worker  42 , such as a physician, nurse, physical therapists, housekeeper, or other care giver. The first RF signal  23  from the patient&#39;s identification device  24  may have an effective signal strength within only a few feet around the patient  20  and beyond that limited range the data acquisition devices  40  will not detect that first RF signal. In this case, healthcare worker  42  must be relatively close to the patient in order for the data acquisition device to pick-up a patient&#39;s identifier. This arrangement is utilized when monitoring of a healthcare worker in close proximity of the patient is desired. In other situations, where it is desired to monitor when the healthcare worker  42  is anywhere in the patient&#39;s home, not just proximate to the patient, the identification device  24  broadcasts the first RF signal  23  in a larger area encompassing the entire residence.  
         [0029]     When the monitoring system is configured to record activity only when the healthcare worker  42  is relatively close to the patient, other types of wireless signals can be used instead of the first RF signal  23 . Such alternative signals include, light within the infrared or visible spectrums, audible sound, ultrasound and other electromagnetic frequencies. Therefore, the term “wireless signal” as used herein is intended to cover all means of wireless communication.  
         [0030]     The data acquisition device  40  also may measure the strength of the first RF signal  23  received from the identification device  24  as indicating the proximity of the healthcare to the patient wearing the device. The RF signal strength in that case indicates the level of treatment being administered, as a relatively high level denotes very close proximity between the worker and the patient, whereas a lower level indicates that the worker is performing other duties in the residence.  
         [0031]     With reference to  FIG. 4 , the data acquisition device  40  includes an antenna  44  that is connected to a transceiver  46 , which has a receiver section and a transmitter section. Upon receiving a first RF signal  23  from a patient identification device  24 , the transceiver section demodulates that signal and extracts the patient identifier. The patient identifier then is stored by a processor  48  in a memory  50 . The processor executes a software program that also is stored in the memory  50  and which controls the operation of the data acquisition device. An indicator  54  is connected to the processor  48  and comprises a light emitting diode, a liquid crystal display or similar component for presenting information about the operation of the data acquisition device to the wearer. A battery powers the components of the data acquisition device  40 .  
         [0032]     When a healthcare worker  42  is within the range of the first RF signal  23  emitted by an identification device  24 , as shown in  FIG. 2 , the data acquisition device  40  begins receiving the patient identifier. That event causes the processor  48  to record the patient identifier, the date, and time of day in the memory  50 . At that time the processor  48  also starts a software based timer to measure the time period during which the healthcare worker attends to the particular patient  20 . That timer is active as long as the data acquisition device  40  continues to receive periodically the first radio frequency signal  23  containing the same patient identifier. Since the patient identification device  24  transmits the first radio frequency signal at predetermined intervals, if a defined number of intervals pass without receiving a radio frequency signal, the data acquisition device  40  concludes that a healthcare worker  42  is no longer attending to the patient. Upon reaching that conclusion (which can also be reached through analysis of the recorded data), the processor  48  terminates the timer and stores the timer&#39;s final value into a location in memory  50  that is associated with the most recently stored patient identifier. Thus, the memory  50  now contains a patient data set comprising an indication of the patient, the date and time of day, RF signal strength, and the amount of time that the healthcare worker attended to that person. The determination that the healthcare worker  42  no longer is attending to the patient is based on analysis of recorded data or ceasing to receive the first RF signal  23 , which in the case of a periodically transmitted, or pulsed, signal is not merely when no signal is received, as that occurs between pulses, but rather when a pulse is not received for a given amount of time that is longer than the pulse cycle.  
         [0033]     Thereafter, if the healthcare worker  42  reenters the range of the first RF signal  23 , a new set of storage locations within memory  50  are employed to retain another patient data set of a patient identifier, the date and time of day, RF signal strength, and an amount of treatment time.  
         [0034]     When that same healthcare worker  42  goes to another residence, a new patient&#39;s identifier is obtained from the first radio frequency signal transmitted by a different identification device  24  and new treatment data is stored in the healthcare worker&#39;s data acquisition device  40 . Over the course of time, the data acquisition device  41  worn by a healthcare worker  42  will contain the patient data sets for each person to whom care is provided.  
         [0035]     A given residence may have more that one patient who is being attended to by the same healthcare worker  42 . As noted previously, the first RF signal  23  from the patient&#39;s identification device  24  has an effective signal strength only several feet around the patient  20  and beyond that range the data acquisition devices  40  will not detect the signal. That limited signal range reduces the likelihood of a data acquisition device  40  simultaneously receiving signals from two or more patients. The data acquisition device  40  is configured so that as long as an RF signal continues to be received from one identification device  24 , as determined based on the patient identification number carried by that signal, RF signals from other identification devices will be ignored. The RF signal strength can be employed to differentiate between signals that are received simultaneously from two or more identification devices  24  in which case the strongest signal is selected as likely received from the patient being treated.  
         [0036]     Other information stored in the patient identification device  24  also is transmitted to the data acquisition device  40  along with the patient identifier. For example, information indicating allergies of the patient can be displayed to the medical facility worker on indicator  54  of the data acquisition device  40 . The data acquisition device also may receive data, such as temperature and heart rate, from portable monitors carried by the patient. Such ancillary data is stored in the data acquisition device  40  as part of a patient&#39;s data set for subsequent transfer to the patient records computer  11 , as will be described.  
         [0037]     The patient identification device  24  periodically transmitting the patient identifier consumes electrical power even though a healthcare worker is not visiting the patient, which may be the vast majority of the time. As a variation to conserve power, especially for a battery powered identification device, the data acquisition device  40  in  FIG. 4  includes one or more infrared light emitters, such as LED  56 . The processor periodically activates the light emitter, which produces a wide beam  57  of infrared light. The patient identification device  24  in  FIG. 3  has an infrared light sensor  58  that responds to receiving the light beam  57  from the data acquisition device  40  by commencing periodic transmission of the patient identifier. Those transmissions continue for a short interval after the light beam no longer is received thus tolerating brief periods when the light beam may be blocked while the healthcare worker is attending to the patient.  
         [0038]     Referring to  FIGS. 1 and 5 , the data stored in the data acquisition device  40  are transferred to the computer system  10  at the medical facility via a plurality of data readers  63  connected to the LAN  14 . In addition, another data reader  63  can be connected to a personal computer at another location, such as the home of the healthcare worker  42 , from which data can be transferred to the medical facility via a telephone line or an Internet connection to an outside communication interface  16  connected to the LAN  14 . Each data reader  63  comprises a data interrogator  61  connected to a personal computer  17  or  18  which is configured as patient information transfer station  60 . The data interrogator  61  acquires the stored information from the healthcare worker&#39;s data acquisition device  40  and conveys that information to the personal computer.  
         [0039]     With additional reference to  FIG. 6 , the data interrogator  61  has an antenna  62  connected to a radio frequency transceiver  64  which exchanges commands and data with a controller  66  and passes that data through a data interface  68  to the personal computer  18 . Although communication between the data interrogator  61  and the data acquisition device  40  is being described in the context of radio frequency signals, other types of wireless signals can be used, including for example light within the infrared or visible spectrums, audible sound, ultrasound and other electromagnetic frequencies.  
         [0040]     Periodically, such as every second or two, the interrogator  61  transmits a radio frequency signal modulated with an interrogation command. When a healthcare worker  42  is within approximately ten feet of the interrogator  61 , that person&#39;s data acquisition device receives and responds to the interrogation command. With reference to  FIG. 4 , the transceiver  46  in the data acquisition device  40  extracts the interrogation command from the received radio frequency signal and the command is sent to the processor  48 . Upon receiving an interrogation command, the processor  48  executes a software routine which reads memory  50  to obtain a unique identifier that was assigned to the associated data acquisition device  40 . This identifier specifies the particular data acquisition device  40  as well as the healthcare worker  42  to whom the device was issued and thus is referred to as a “worker identifier”. The worker identifier is sent to the transceiver  46  which modulates a radio frequency carrier with that identifier and applies the resultant second radio frequency signal to the antenna  44 . Then the processor  48  sequentially (or in packet form) transfers the patient data sets from memory  50  to the transceiver  46  which transmits that data via the second radio frequency signal. Thus, the data acquisition device  40  responds to the interrogation command by transmitting a return signal that contains its healthcare worker&#39;s identifier and the patient identification and treatment time information stored within the memory  50 .  
         [0041]     That return signal is received by the interrogator antenna  62  and applied to the receiver section of the transceiver  64  in  FIG. 6 . The transceiver  64  demodulates the received signal extracting the information carried by the return signal. The worker identifier and each patient data set are transferred through the data interface  68  to the personal computer  18 . The personal computer temporarily stores the information received from the data acquisition device as a series of treatment event records  70 , one of which is graphically depicted in  FIG. 7 . Each treatment event record  70  contains the worker identifier field  71 , a patient identifier field  72 , date and time of day field  73 , an RF signal strength measurement field  74 , a treatment time interval field  75  and an ancillary data field  76 , if needed. After all the patient treatment information has been transferred, the patient data is erased from the data acquisition device  40 . The personal computer  18  transfers the acquired patient treatment information to the patient records computer  11 .  
         [0042]     Alternatively, the data interrogator may comprise a cable, that during data transfer, physically connects the personal computer  18  to a data acquisition device  40 . A software routine executed by the personal computer  18  issues an interrogation command via the cable to the data acquisition device and obtains the patient treatment information. Other types of data interrogators that perform this function can be employed.  
         [0043]     As a further alternative in  FIG. 4 , the data acquisition device may contain a cellular telephone  55  in which case the processor  48  is programmed to call, at a specific time of day, a telephone number connected to the outside communication interface  16  at the medical facility. After that connection is made the patient data sets are transferred to the computer system  10  at the medical facility.  
         [0044]     The patient records computer  11  parses the treatment information, received from the data readers  63 , based on the patient identifiers and stores that information in separate data records for each patient. Each such record for a given patient has data showing which healthcare worker treated that patient and the duration of each treatment. This patient treatment information then can be analyzed to determine the total time of treatment each patient received and the amounts of time that the particular patient was treated by each different class of healthcare worker, such as a physician, nurse, physical therapist, housekeeper, etc. Reports related to patient treatment are prepared by the computer system  10 .  
         [0045]     The patient treatment information also is transferred to the employee time and attendance computer  12  which tabulates the information based on the worker identifier associated with each treatment event record  70  from the data acquisition devices  40 . Thus, a record for a particular healthcare worker stored within the memory of the time and attendance computer  12  contains information identifying each patient that the respective healthcare worker treated and the amount of time of such treatments. This information can be analyzed to determine the total amount of treatment provided by a particular healthcare worker and the amount of pay due that person. The present monitoring system also verifies that the healthcare worker actually visited a particular patient to whom he or she is assigned for quality and security of patient care. Reports related to the healthcare workers job performances are prepared by the computer system  10 .  
         [0046]      FIG. 8  depicts second type of electronic patient identification device  85  for incorporation into the wristband  22  of the patient  20 . This second identification device is passive in that it does not require a power source, such as a battery. Instead, the second patient identification device  85  comprises a conventional radio frequency transponder tag, such as the type that is commonly used to identify products or used as a key-card for a building entry system. The second patient identification device  85  has an antenna  86  that is part of a tuned, resonant circuit connected to a transponder integrated circuit  87  which may be any one of a number of commercially available devices, such as one of a family of products available from Texas Instruments Incorporated, Dallas, Tex., USA. The transponder integrated circuit  87  is powered by energy derived from a radio frequency signal received at antenna  86  and used to store a charge on a capacitor  88 . That stored charge provides a voltage for powering the electronic circuits. Because the second patient identification device  85  does not require power from a battery, it can be utilized with patients requiring long term care or who will be permanent residents of a nursing facility.  
         [0047]     For use with the second patient identification device  85 , the data acquisition device  40  in  FIG. 4  carried by a healthcare worker  42  is modified to periodically, every second or so, emit a third radio frequency signal to which the second patient identification device  85  is tuned. Upon receiving that third radio frequency signal, the transponder integrated circuit  87  becomes energized by power derived from that signal. This causes the second patient identification device  85  emit the first radio frequency signal that carries the unique patient identifier which is stored within the transponder integrated circuit  87 . The data acquisition device  40  processes the patient identifier in that same manner as described previously.  
         [0048]     The foregoing description was primarily directed to preferred embodiments of the invention. Although some attention was given to various alternatives within the scope of the invention, it is anticipated that one skilled in the art will likely realize additional alternatives that are now apparent from disclosure of embodiments of the invention. Accordingly, the scope of the invention should be determined from the following claims and not limited by the above disclosure.