JP5214277B2 - Medical diagnosis support system - Google Patents

Description

  The present invention relates to a medical diagnosis support system capable of easily and reliably reflecting contents handwritten in a medical chart in an electronic medical chart and using the reflected contents with ease of use.

  The medical record is used to record the findings when a doctor makes an examination or the like to a patient (subject). For this reason, it is used when explaining to the patient during the examination as necessary, or used to fill in the items to be sent for treatment and to convey the contents of the examination request to the clerk. In the following, the doctor's intentions and actions to be entered in the medical record, such as formulation of a doctor's treatment policy and imaging instructions, including “prescription” in which medicine is dispensed, etc. are collectively referred to as “treatment”.

  In addition, electronic medical charts in which the contents of medical charts are digitized are replacing the conventional paper medical charts (hereinafter referred to as “paper medical charts” as appropriate). As an advantage of this electronic medical record, for example, since it is recorded as electronic data, it is easy to centrally store various information such as medical examinations on the subject, and it is possible to reduce storage locations and transport personnel It can be mentioned. In particular, in the current situation where medical regional collaboration is being promoted, the ability to use an electronic medical chart at a plurality of locations simultaneously is a significant advantage of the electronic medical chart.

  With regard to this electronic medical record, for example, as described in Patent Document 1 below, an input / output integrated device capable of inputting a tablet function directly on the display with a pen, and the input / output integrated device And a control / calculation device that reflects information input on the display to the display, and the control / calculation device displays an intuitive handwritten input chart screen on the display. An invention is disclosed in which an electronic information record is created based on input information handwritten on the displayed screen. By adopting such a configuration, the medical chart is expressed as an infinitely long scroll extending in the vertical direction, so that it is possible to easily enter medical information without worrying about the work area.

  Also, in Patent Document 2 below, a display control means for displaying on a display means a chart input screen including a chart in which an icon area for pasting an icon is formed for each line of a chart in a predetermined format, and a chart input screen Input means for inputting the description items necessary for the chart above, and icon registration means for pasting an icon for opening a file in which information on the items not required for the chart is described on the chart input screen to the icon area Prepare. Thereby, although it is a description item unnecessary for the paper chart, it is possible to create a chart that can easily extract various information to be managed in association with the paper chart.

Further, in the invention disclosed in Patent Document 3, a user draws a handwritten character portion of a medical chart that has become electronic information on a display screen so as to be surrounded by a surrounding line, and recognizes the surrounding line by stroke information and designates it as a tag. Then, a tag mark is added at a predetermined position of the encircling line, and at least encircling stroke information is input and recorded as “enclosing line stroke information” as tag information. When video characters within the range specified by the tag are converted into character data by the character recognition means, summary text is collected and stored as summary information by a dictionary created in advance. As a result, the description area of handwritten electronic information can be easily searched, and it can also be applied to uses for recording electronic information other than medical records that need to assist understanding of the description. The
JP 2003-225209 A JP 2005-196660 A JP 2006-31192 A

  However, in the inventions disclosed in Patent Documents 1 to 3, the following points are not sufficiently considered.

  Specifically, with respect to Patent Document 1 and Patent Document 3, only handwriting character recognition is performed and character information is registered in the database, and the linking process up to the receipt (medical remuneration statement) and the processing of the treatment is not performed. Absent. Therefore, the merit of using a paper chart as an electronic chart is limited to the possibility of a later search, and has not yet improved examination throughput. In addition, for Patent Document 2, an icon pasting instruction can be performed only on the screen of the electronic medical record. Therefore, in medical institutions that do not use electronic medical records and operate only with paper medical charts, it is not possible to affix desired X-ray images or electronic patient information on paper medical charts. I cannot expect improvement.

  Furthermore, although there is a merit by digitizing the contents described in the medical chart as an electronic medical chart, it is necessary to input various information using an input device such as a keyboard or a pen tablet in order to use the electronic medical chart. . For this reason, from the standpoint of a doctor who actually fills in a medical record, using a paper medical record is often more efficient in filling up at the time of medical examination than using an electronic medical chart, and the examination throughput is often higher. In particular, the number of medical workers has decreased due to factors such as reductions in medical costs and local localization of doctors, and the number of people receiving medical examinations has increased due to the aging of the population. In the current situation that the quality of medical examinations is decreasing, it is necessary to improve the medical examination throughput and maintain the quality of medical examinations. In such a case, it is the end of the fall that time (and input) is required for entry (input) to the electronic medical record, and the examination time for the patient is reduced or a sufficient response cannot be obtained.

  Furthermore, if the doctor keeps facing his face to the display displaying the electronic medical record instead of the patient, the time to face the patient is reduced even during the same medical treatment time. This can lead to patient distrust in the doctor's attitude.

  Also, even when a tablet is used, the pen input feeling (for example, the touch feeling between the pen and the tablet) is often not sufficient compared to a paper chart, and if it is not used, the examination throughput is reduced. It will be. For this reason, if an electronic medical record is used to fill in the medical record, the goodness of the paper medical record will be lost.

  Furthermore, even if an electronic medical record is used, since the input means and the like use a keyboard and a mouse as they are, if you are not used to using an information terminal such as a personal computer (personal computer, PC), for example, It is not possible to enjoy the merits of using paper charts when making medical examinations, such as quick access to past medical examination records. This may lead to a decrease in throughput during the examination.

  The present invention has been made to solve the above-mentioned problems, and the object of the present invention is to enjoy the benefits of using electronic medical charts while maintaining the benefits that doctors can enjoy by using paper charts. Accordingly, it is an object of the present invention to provide a medical diagnosis support system capable of improving the throughput of diagnosis more than ever and improving the quality of diagnosis.

According to the first aspect of the present invention, in the medical diagnosis support system, the information terminal that constitutes the medical diagnosis support system determines the character or the figure from the content when the content handwritten in the paper chart is read. Medical chart creation means for creating an electronic medical chart based on contents added or deleted by a determination section, an electronic medical chart operation section for operating information described in the electronic medical chart, a character / graphic determination section, and an electronic medical chart operation section when, and a storage means for storing a recognition pattern and object information, characters and graphics determination unit, when the contents entered by hand on paper chart is read, read characters on paper charts, graphics Recognizing means, a character and a figure recognized by the recognizing means are collated based on the recognition pattern, and confirmed as a character or a figure, and confirmed by the confirmation means The character of the paper chart that determines the content based on the shape, instructs the creation of an electronic medical record that the contents have been reflected in the chart creating means, operations to fill the paper chart for operating the electronic medical record Based on a table that defines the processing corresponding to the instruction content entered by the person, instruct the electronic medical record operating unit to acquire the target subject information, or search for and obtain the corresponding subject information already acquired The electronic medical chart operating unit is instructed to do so, and in addition, the electronic medical chart operating unit is instructed to paste the subject information obtained by the medical chart creating unit and stored in the storage unit in a region designated by the operator. And a medical diagnosis support system that outputs the electronic medical chart created by the medical chart creating means as a paper medical chart based on an instruction from the information terminal. An output device and for.

  According to the present invention, while maintaining the benefits that doctors and others can enjoy by using paper charts, the benefits of using electronic medical charts are also improved, thereby improving the throughput of the diagnosis and improving the diagnosis throughput. It is possible to provide a medical diagnosis support system capable of improving the quality.

(First embodiment)
Hereinafter, a first embodiment of the present invention will be described in detail with reference to the drawings. The medical diagnosis support system according to the present invention will be described below using an electronic medical record system as an example. The configuration of the electronic medical chart system is not particularly shown, but in general, when an information terminal and a paper medical chart used for viewing and processing the electronic medical chart are used, the contents are scanned and digitized by a scanner, an electronic It consists of a printer or the like for printing the contents of the medical chart, and these are connected via a communication network. This medical diagnosis support system (electronic medical record system) is, for example, a hospital information management system (HIS), a radiology information management system (RIS), a medical image management system (PACS: Picture Archiving Communication System). ) May be used in combination with various management systems built in medical institutions.

  The information terminal 1 corresponds to, for example, a general personal computer. Further, it may be a diagnosis workstation connected to various management systems as described above. Also, the scanner and printer may be general ones or specially made for medical workers. The communication network is a network that connects the information terminal 1, scanner, printer, etc., or another electronic medical chart system and various management systems, and a patient (subject) described in the electronic medical chart between each device and system. Exchange information about.

  Examples of this communication network include networks such as a LAN (Local Area Network) and the Internet. The communication standard used in this communication network may be any standard such as HL7 (Health Level 7) and DICOM (Digital Imaging and Communication in Medicine). Note that the number of information terminals 1, scanners, printers, and the like that constitute the electronic medical chart system is arbitrarily connected to the communication network.

  FIG. 1 is a block diagram showing an internal configuration of information terminal 1 according to the embodiment of the present invention. In the information terminal 1, a CPU (Central Processing Unit) 1a, a ROM (Read Only Memory) 1b, a RAM (Random Access Memory) 1c, and an input / output interface 1d are connected via a bus 1e. An input unit 1f, a display unit 1g, a communication control unit 1h, a storage unit 1i, and a removable disk 1j are connected to the input / output interface 1d.

  The CPU 1a reads and executes a boot program for starting the information terminal 1 from the ROM 1b based on an input signal from the input unit 1f, and reads various operating systems stored in the storage unit 1i. The CPU 1a controls various devices based on input signals from other external devices not shown in FIG. 1 via the input means 1f and the input / output interface 1d. Further, the CPU 1a reads a program and data stored in the RAM 1c, the storage unit 1i, and the like, loads them into the RAM 1c, and performs a series of processing such as calculation or processing of data based on a command of the program read from the RAM 1c. This is a processing device to be realized.

  The input means 1f is composed of an input device such as a keyboard, a tablet, a digital pen, etc., for inputting various operations by an operator of the information terminal 1 (a medical record entry person such as a doctor), and inputs based on the operations of the operator. A signal is generated and transmitted to the CPU 1a via the bus 1e. The information terminal 1 may be provided with a dedicated operation panel as well as a keyboard and the like, and an operation screen can be operated via an input device on the operation panel. The display unit 1g is, for example, a liquid crystal display, and is a unit that receives an output signal from the CPU 1a via the bus 1e and displays a processing result of the CPU 1a, an inspection reservation list, and the like.

  The communication control unit 1h is a unit such as a LAN card or a modem, and is a unit that enables the information terminal 1 to be connected to a communication network such as the Internet or a LAN. For example, the scanner, printer, tablet, digital pen, or other various systems and the information terminal 1 are connected via the communication control unit 1h and the communication network. Data (information) transmitted / received via the communication network is transmitted / received to / from the CPU 1a via the input / output interface 1d and the bus 1e as an input signal or an output signal.

  The storage means 1i is composed of a semiconductor or a magnetic disk, and stores programs and data executed by the CPU 1a, inspection images taken at the time of inspection, and the like.

  The removable disk 1j is an optical disk or a flexible disk, and signals read and written by the disk drive are transmitted to and received from the CPU 1a via the input / output interface 1d and the bus 1e.

  In the information terminal 1 according to the embodiment of the present invention, the electronic medical record creation program is stored in the storage means 1i or the removable disk 1j, and is read and executed by the CPU 1a, whereby the electronic medical record creation system 10 receives information. It will be mounted on the terminal 1.

  FIG. 2 is a block diagram showing an internal configuration when the electronic medical record creation system 10 is mounted on the information terminal 1. The electronic medical record creation system 10 includes a receiving unit 11, a character / graphic determination unit 12, an electronic medical record operation unit 13, a medical record creation unit 14, and a transmission unit 15.

  The character / graphic determination unit 12 plays a role of recognizing a character or a graphic written on the medical chart and determining the content when the content written by a doctor on the medical chart is read by a scanner. Specifically, it comprises a recognition means 12a, a confirmation means 12b, and a first determination means 12c. In the following, the explanation will be given by taking as an example the case where a doctor fills in a paper chart by hand, but the medium that the doctor fills in by hand is not only a paper chart but also a tablet or digital pen as described above. Special paper may be used.

  The recognizing means 12a is a means for recognizing characters and figures written on the paper chart when the scanner reads the paper chart. The recognition means 12a in the embodiment of the present invention employs a character recognition system or a figure recognition method that is generally used at present. For example, in the electronic medical chart system according to the embodiment of the present invention, it is necessary to reliably reflect the contents entered in the paper medical chart in the corresponding part of the electronic medical chart. A method of recognizing a figure or a method of providing an area like a character entry field or a figure entry field and recognizing that a display entered in the area is a character or a figure.

  The confirmation means 12b confirms the display on the paper chart recognized by the recognition means 12a as a character or a figure. In order to determine a character or a figure, a recognition pattern stored in advance in the storage unit 1i is referred to. Since the contents to be entered in the medical chart are determined to some extent by the doctor, characters (words representing symptoms) and figures (figures on the subject's chest) entered in the medical chart are previously stored in the storage means 1i as recognition patterns. deep. This makes it possible to maintain a high recognition rate quickly. In the electronic medical record system according to the embodiment of the present invention, an example in which the recognition pattern is stored in the storage unit 1i of the information terminal 1 is described. However, a recognition pattern database or the like is particularly provided on the communication network. May be.

  The first determination means 12c recognizes the display of the paper chart read by the scanner, and determines the contents entered in the paper chart based on the confirmed character or figure. Here, FIG. 3 is a schematic diagram showing an example of the paper chart PK. In this paper chart PK1, the doctor said, “S: Cough has not stopped since last night. Chest pain a little.”, “P: Methiev prescription based on history,“ Same ”” and the chest of the subject. (The painful area is displayed as “Pain”). The recognizing means 12a recognizes, the confirming means 12b confirms the character or the figure, and based on these information, the first judging means 12c instructs the chart creating means 14 to create the electronic chart, so that these The contents described in the paper chart PK1 are reflected in the electronic chart EK.

  In the paper chart PK1 shown in FIG. 3, the letter “S” or “P” is added to the beginning of the sentence in the recognized character portion. This represents “S: patient complaint and symptom” and “P: treatment policy”, respectively. Therefore, by having a doctor who fills in the paper chart PK fill in such words in advance, the first determination means 12c can grasp the description contents on the paper chart more accurately.

  The first determination means 12c in the embodiment of the present invention determines the contents entered in the paper chart PK using the above-mentioned “S” or “P” as a clue. Then, in order to reflect the contents in the corresponding part of the electronic medical chart EK, the contents are transmitted to the medical chart creating means 14 to create the electronic medical chart EK. Information on the electronic medical chart EK created by the medical chart creating means 14 is transmitted from the transmitting means 15 to the display means 1g and displayed. Alternatively, it is stored in a database separately provided on the communication network via the communication network.

  Further, as will be described later, for example, the prescription can be used as information for creating a medical fee remuneration statement called “receipt” based on the text described in the area “P” indicating the medical policy. That is, the prescription of “standard prescription” for the drug “Mechiev” from the sentence “P: Metiev standard prescription by looking at history.” Is read from the paper chart PK1. Reflected in one.

  The first determination unit 12c selects and determines a predetermined character among the characters determined by the determination unit 12b. That is, among various characters entered on the paper chart PK by the doctor, characters serving as a reference for creating an electronic medical record and a medical remuneration statement are stored in the storage means 1i in advance, and correspond to those characters. When the character is written in the paper chart PK, what the character means is judged and the contents written in the paper chart PK are appropriately reflected in the electronic chart EK. Taking the entry example mentioned above as an example, the letters “Metiev” are drug names, the letters “standard prescription” are prescribing methods for patients, and prescribe a standard prescription, that is, three days of medicine. And so on. In addition, what character is memorize | stored in the memory | storage means 1i is arbitrary. Further, the place where the first determination unit 12c stores the character used as the determination criterion may be another database connected to the communication network instead of the storage unit 1i described above.

  Furthermore, the first determination means 12c accesses, for example, a database in which items of medical fee remuneration specifications are stored, and determines whether or not the word represented by the letters “standard prescription” corresponds to items of the medical remuneration statement. Also judge. If it is a term corresponding to the item of the medical fee remuneration statement, information representing the contents is transmitted to the system for creating the medical fee remuneration statement, and the medical treatment taken at the time of the medical treatment read from the paper chart PK1 Used to calculate remuneration. In this way, by adopting a configuration in which the contents read from the paper chart PK are appropriately reflected in the items of the medical fee description, it is possible to greatly save the trouble of creating the medical fee description.

  In addition, when assistants such as other office workers reflect characters that are not entered in the paper chart PK according to the doctor's instructions (for example, the letters “standard prescription” described above) in the electronic medical chart (instructed verbally from the doctor) If a button that allows you to insert characters such as “standard prescription” and “procedure A” in advance is provided on the electronic medical chart, However, it can be quickly reflected in the electronic medical record, and the labor for preparing the medical fee remuneration statement can be saved greatly. In particular, for example, regarding a button relating to “treatment”, a plurality of treatment contents such as “drug standard prescription, chest radiography” can be assigned as the treatment, thereby further improving the work efficiency.

  In addition, in the “P” area of the paper chart PK1 in FIG. This “similar” indicates that the prescription, treatment, examination, and the like are the same as those at the previous examination (hereinafter, such treatment is referred to as “repeated treatment”). The first determination unit 12c determines whether or not the character determined by the determination unit 12b corresponds to, for example, a word stored in advance that represents the repeated treatment by accessing the storage unit 1i. As these phrases, for example, “same”, “same”, “same as before”, and the like may mean words that mean the same treatment as the previous treatment.

  However, these characters described above represent repetitive treatments and may be used even in portions that do not represent repetitive treatments entered in the medical chart. Therefore, for example, when a similar character is enclosed in parentheses (for example, “”) at the end of the sentence (that is, entered as “same”, see the paper chart PK1 in FIG. 3), it is an instruction for repeated treatment. It is also possible to do. In this way, it is possible to improve the recognition rate and to reflect the instruction more clearly by preliminarily defining it and having the doctor fill it in as described above.

  For example, when the first determination unit 12c determines that the word “same” is a word meaning that the same treatment as the previous treatment is performed, the first determination unit 12c displays the previous electronic medical record EK relating to the subject of the paper medical record PK. The contents of the treatment are obtained by accessing and reflected in the “P” area of the current electronic medical record EK. That is, since the doctor simply fills in the paper chart PK with the characters that mean the same treatment as the previous treatment, the contents are accurately reflected in the electronic chart EK. The benefits of the electronic medical record EK can be enjoyed to the full without impairing the costs.

  However, the characters meaning that the same treatment as the previous treatment may be different depending on the doctor. Therefore, in this case, the doctor who entered the paper chart PK and the character used by the doctor are associated with each other and the number of uses is counted (for example, counted by the first determination means 12c). It is possible to create a so-called dictionary for each. By providing such a learning function, the contents of the paper chart PK can be accurately reflected in the electronic chart EK regardless of the doctor who fills in the paper chart PK.

  Next, the flow until the contents entered in the paper chart PK are reflected in the electronic chart EK along the flow of the doctor's examination will be described using the flowcharts shown in FIGS. 4 is a flowchart showing the flow of the doctor's examination, and FIG. 5 is a flowchart showing the movement of the electronic medical record creation system 10 along the flow of the examination. The doctor uses the paper chart PK instead of the electronic chart EK. It is assumed to be used. In addition, in order to explain in accordance with the flow of medical examinations by doctors, not only the description up to the part where the contents handwritten in the medical record are reflected on the electronic medical record, but the reflected content is printed on paper. This will also be explained.

  First, the doctor examines and treats the patient and enters his / her findings on a paper chart PK (ST1 and ST2). Further, X-ray imaging may be performed on the patient as necessary (ST3). In this case, the doctor writes an instruction in a predetermined area of the paper chart PK in order to attach the photographed X-ray image to the paper chart PK (ST4). FIG. 6 shows a schematic diagram of the paper chart PK in such a state. In this paper chart PK2, in addition to the contents described in the paper chart PK1 shown in FIG. 3, two areas are described at the lower end of the paper chart PK2, and an arrow is shown between them. Specifically, the areas surrounded by solid lines are entered one by one on the left and right, and the arrows extend from the left area to the right area. In the left area, the letter “L” is entered in the case of FIG.

  Here, when a doctor fills in the chart by hand, for example, even if a square frame is entered and an area is designated, the shape and size of the square frame to be filled in will be 1000 thousand for each doctor who fills in. The difference is exceptional. Moreover, even if it is the same doctor, the square frame filled in from time to time differs. Therefore, an area handwritten in the medical chart is designated as “instruction area (area where instructions for the medical diagnosis support system are entered)” or “pasted area (area where appropriate subject information is pasted based on the doctor's instructions)” In order to accurately recognize and confirm "", it is necessary to set a reference for the first determination unit 12c to determine in advance. In addition, by showing this standard to the doctor who fills in the medical chart, it is possible to prompt the user to make a more accurate reading.

  FIG. 7 is a table showing an example of the standard. This table recognizes and confirms a plurality of areas as shown in FIG. 6 when they are indicated by arrows (or lines may be used. Hereinafter, the arrows are collectively described as an example). Shows the criteria for doing that. According to this table, the indication area and the pasting area are shown, and whether or not it is determined that the doctor designates the pasting instruction area and the pasting area is determined by the state of the arrow between them. That is, for example, when one end of an arrow “pierces 5 mm or more” in any of the areas, the state is not determined to be a designation area for a sticking instruction or a sticking area by a doctor. The same applies to “away from any region of 5 mm or more”. On the other hand, a doctor's sticking instruction area and a sticking area are appropriately provided, and an arrow is “connected to each area” (indicated in the table of FIG. 7 as “instructions and sticking area”), or If it is “within 5 mm even if it penetrates”, it is determined that an appropriate instruction has been given.

  FIG. 8 is a table showing an example of determination criteria when a line for designating an area is entered but an arrow or the like is not entered. This is the case, for example, when only the pasting area is specified without surrounding the pasting instruction. In this case, the determination is made based on the positional relationship between the character representing the paste instruction and the paste region. For example, when a character representing a sticking instruction “exceeds 3 mm or more” in an area written by the doctor as a sticking area, this area is not judged as a sticking area but is judged as a pointing area. In the case of “distant by 5 mm or more”, it is determined that the character and the area are not related to the character indicating the pasting instruction and the pasting area. In this case, the filled area is the pasting area. It is not judged. On the other hand, if it is determined from the positional relationship between the character indicating the pasting instruction and the pasting area that the two are closely related (in the table shown in FIG. 8, the character representing the pasting instruction penetrates the pasting area within 3 mm. If the distance is within a distance of 5 mm from the case of “there is a distance”, they are accurately determined as a character and a pasting area representing a pasting instruction.

  In addition, when an area is entered in a medical chart, it is determined whether the doctor's instruction is accurately transmitted to the medical diagnosis support system depending on the manner of entry. That is, for example, as shown in FIG. 9, when the instruction area or the pasting area is entered, if “the outer peripheral chip is 25% or more”, it is not determined that the area is designated. Even when “the outer periphery is 50% or longer”, it may be determined not as a region but as a figure. For example, in the paper chart PK2 shown in FIG. 6, since the designated area (the area where the character “L” is written) is completely closed, it is determined that there is no excess or deficiency in the outer periphery.

  By predetermining the above criteria and presenting them to the doctor, it becomes possible to accurately recognize and determine when writing in the medical chart by handwriting.

  Then, the paper chart PK2 shown in FIG. 6 is scanned by the scanner in a state filled in the chart according to such a standard (ST5).

  When the scanner scans the paper chart PK2 (ST11, see FIG. 5), the recognition means 12a recognizes the characters and figures entered on the paper chart PK (ST12). After that, the character or figure recognized by the confirming means 12b is confirmed with the recognition pattern (ST13). In the paper chart PK2 shown in FIG. 6, two areas surrounded by a solid line and an arrow connecting the two areas are entered as described above, and the determination means 12b also stores these areas and arrows in the storage means 1i. Confirm based on the recognition pattern. On the other hand, the first determination means 12c issues an instruction to the chart creation means 14 based on the entry contents of the paper chart PK2 determined by the determination means 12b, and registers and reflects each content in the electronic chart EK (ST14). ).

  At the same time, the second determination means 13a constituting the electronic medical chart operation unit 13 pastes an appropriate X-ray image that matches the doctor's instruction on the electronic medical chart EK from the two areas surrounded by the solid line and the arrow connecting between them. (ST15). That is, the second determination means 13a determines that the letter “L” written in the area surrounded by the solid line on the left side is an instruction to paste the X-ray image on the designated area by the doctor, and the paper chart PK2 The X-ray image obtained by photographing the subject is pasted on a designated area on the electronic medical chart EK (an area surrounded by a solid line on the right side in the paper chart PK2 shown in FIG. 6). In the embodiment of the present invention, this X-ray image pasting instruction is represented by the letter “L” in the region surrounded by the solid line on the left as shown in FIG. It may be an instruction by characters such as “no”, and characters and symbols indicating the instruction can be arbitrarily set.

  The table shown in FIG. 10 is a table showing the correspondence between the contents handwritten in the chart by the doctor and the instruction contents given to the medical diagnosis support system by the written characters. In addition, the correspondence with the contents (instructions for the medical fee billing system) in which the entered contents are reflected in the medical fee description is also shown.

  For example, the description is based on the “entry contents” written in the second row from the top of the table as follows. In this stage, “L” and “Head” are shown as characters handwritten on the chart by the doctor (entry content column). These characters are recognized and confirmed by the recognizing means 12a and the confirming means 12b as characters indicating the “imaging order” and “part”, respectively. The first determination means 12c issues an instruction to take a predetermined response from a character (pasting instruction) handwritten in the chart by a confirmed doctor.

  For the predetermined correspondence, when the subject information corresponding to the doctor's application instruction has not been acquired yet (when there is an uncaptured image), and when the corresponding subject information has already been acquired Divided by. That is, when the subject information has not been acquired, it is necessary to take an image that matches the sticking instruction in order to respond to the sticking instruction of the doctor. Therefore, an imaging device connected to a communication network so as to perform imaging in accordance with the entered content is determined by determining the imaging condition regarding an uncaptured image desired by the physician, and the character handwritten by the physician in the medical chart. Command to the modality of the CT device. This criterion is shown in the column “ordering” in the column indicating the content of instructions to the medical diagnosis support system indicated by the entered characters shown in FIG.

  On the other hand, if the corresponding subject information has already been acquired, the character entered by the doctor in the medical chart by hand is determined as the corresponding “file search condition”, and the first determination means 12c performs the second determination. The means 13a is instructed to search for subject information that matches the conditions via the search means 13b.

  In addition, it is arbitrarily set as a medical diagnosis support system whether the doctor should judge that the handwritten character is an instruction for “ordering” or give an instruction for “file attachment”. Can do. Since the use method differs depending on the medical institution and doctor who uses this medical diagnosis support system, for example, when the medical diagnosis support system is introduced, the handwritten characters are “ordering” and “file pasting”. It is possible to determine and set which one is an instruction or both.

  When “L” and “head” are entered, it is determined that the instruction to “ordering” is “X-ray (device)” and the imaging region is “head”. An imaging instruction is issued to the modality together with the “patient name”. The “patient name” is information necessary for specifying the subject to be imaged. For example, when handwritten characters are reflected in the electronic medical record EK, the patient name is acquired and the modality is obtained. Sent to. This “patient name” may be “patient ID”, for example.

  On the other hand, when it is understood that the instruction is “attach file” (when the corresponding subject information has already been acquired), the corresponding subject information is first searched. When “L” and “head” are entered, when these handwritten characters are regarded as “file search conditions”, it means “the latest file in the head image captured by the X-ray simple device”. (Condition). In other words, it can be seen that “L” means “latest” and “head” represents a part to be imaged. As a result of the search by the search means 13b, when the subject information corresponding to the doctor's instruction is found (“file exists” in the “file existence” column), the subject information (image) is stored. Affix to the doctor's designated area.

  Further, not only image information such as an X-ray image but also audio information, for example, can be pasted as the subject information. In that case, the doctor enters, for example, “Vo” in the medical chart. The meaning of “Vo” is determined not to be adopted as the “ordering” instruction when the third row from the bottom of the table of FIG. 10 is referred to. This is because, as described above, the character in which “ordering” is entered in the medical record is determined as the “imaging condition”, and in this case, it is determined that “order does not occur”. On the other hand, “file pasting” means “the latest file with the corresponding patient name / ID in the data stored in the voice recorder at the time of diagnosis” as the search condition. Therefore, the second determination unit 13a searches the stored data that matches this condition via the search unit 13b. As a result, if the file exists, the corresponding saved data is pasted on the electronic medical record EK, and if the file does not exist, “no file pasted” is set.

  As described above, the meaning of the characters handwritten by the doctor in the medical chart can be reflected in the medical remuneration statement. Taking the example given above, if “L” and “Head” are entered in the medical chart, this is reflected as an item “simple imaging request” to the medical fee claim system. This “simple imaging” indicates that imaging was performed without doing anything special to the patient. In addition, when “Vo” is entered, it is reflected in the medical fee remuneration statement, “If the“ reproduction time ”in the property of the audio file is 5 minutes or more, a medical examination addition request”. Recording starts at the start of the examination and ends at the end of the examination. In addition, by defining in this way, if the examination is longer than the standard examination time, the amount is reflected in the medical fee. Operation is also possible. This can improve the throughput and quality of the examination.

  The table shown in FIG. 10 is a table showing the correspondence between the contents entered in the medical record and the correspondence between the medical diagnosis support system and the medical fee billing system in accordance with the contents entered as described above. In other words, this also serves as a standard that should be followed by a doctor who fills in the chart when instructing the application of the file. A doctor can receive desired support from a medical diagnosis support system or the like by filling in according to this standard.

  As described above, the letter “L” shown in FIG. 6 indicates the last (latest) X-ray image taken on the subject of the paper chart PK2. Based on this pasting instruction, the second determination means 13a uses the X-ray image stored in the storage means 1i via the search means 13b or the corresponding X-ray from an image server connected to the communication network. The image is searched and obtained (ST16). The second determination means 13a instructs the medical chart creating means 14 to create the electronic medical chart EK by pasting the acquired X-ray image on the designated area on the electronic medical chart EK, and creates the electronic medical chart EK. Then, for example, it is stored in the storage means 1i (ST17). Up to this state, the flow of reflecting the contents handwritten in the medical chart on the electronic medical chart EK ends. You may complete | finish in this state, or you may print on the paper the content of the electronic medical chart EK reflected so that it may demonstrate below.

  The doctor sets paper in the printer and issues a print instruction (ST6 and ST7). This is because an electronic medical record including an X-ray image attached to a predetermined area based on a doctor's application instruction is printed using a printer, and a paper medical chart PK with the X-ray image attached (printed) is created. is there. The information terminal 1 confirms a print instruction from a doctor or the like (ST18). This is to determine which area of the electronic medical record EK to which the X-ray image of the patient is attached is to be printed. That is, in the embodiment of the present invention, since the paper chart PK that is the basis of the electronic chart EK already exists, only the X-ray image pasted by putting the paper chart PK in the printer is printed, or This is because it is possible to print or select the entire area of the chart including the X-ray image pasted by inserting a blank sheet into the printer.

  When only the pasted X-ray image is printed out of the electronic medical chart EK (NO in ST19), only the X-ray image instructed to be pasted is printed on the paper chart PK inserted in the printer (ST20). On the other hand, when the entire area of the electronic medical record EK is printed (YES in ST19), the entire area of the electronic medical record EK including the X-ray image instructed to be pasted is printed on a blank sheet inserted in the printer (ST21). By performing this printing, the doctor obtains the paper chart PK to which the X-ray image instructed by the doctor is attached (ST8). Then, the paper chart PK is used for diagnosis or the paper chart PK is stored (ST9).

  In the above description, an example in which the X-ray image is pasted on the electronic medical record EK based on the doctor's pasting instruction has been described. The subject information of the subject (patient) to be affixed to the electronic medical record EK has been described with reference to FIG. 10. In addition to the X-ray image, for example, another modality, for example, an X-ray diagnostic apparatus or CT ( Computed tomography (computed tomography) apparatus, ultrasonic diagnostic apparatus, magnetic resonance diagnostic apparatus, gamma camera or PET (positron-emission tomography) may be used. Moreover, as an example of the subject information affixed to the electronic medical record EK, a conversation with a patient at the time of medical examination may be recorded, or a voice such as a heart sound of the patient, an electrocardiogram, or the like may be used.

  In particular, it is important to record or record the communication with the patient who is the subject of the examination. This is because, from the viewpoint of informed consent, it is possible to leave evidence of when, what, where, how and how to obtain consent from the patient, and can serve as evidence of medical claims. In addition, language disorders and behavioral injuries can be recorded during interaction with patients, and can be used as a basis for diagnosis. Since such information can be referred to at a later date, it can be used as teaching data for education among medical staff, students, etc., for example, to improve the explanation skills of doctors to patients, improving the quality of medical care Can contribute.

  FIG. 11 is a schematic diagram showing an example in which a sheet of an electrocardiogram waveform discharged from the electrocardiograph is attached to the paper chart PK3. This paper chart PK3 is filled with the same characters and figures as the paper chart PK1 shown in FIG. In addition, an electrocardiographic waveform sheet is directly attached to the right side of the paper chart PK3. For example, an imaging number, a device ID of a captured modality, a patient ID of a captured patient, and the like are captured on this sheet. Some kind of identifier that can uniquely identify the recorded content is displayed.

  As described above, the contents of the paper chart PK3 are read by the scanner, and the characters and figures are recognized and confirmed. In addition to these characters and figures, an identifier represented on the electrocardiographic waveform sheet is also read. If the first determining means 12c determines that the identifier is an identifier, the information is sent to the second determining means 13a, and information on the corresponding electrocardiogram waveform is obtained via the search means 13b based on the information. The The obtained information on the electrocardiographic waveform is sent to the medical chart creating means 14 and attached to the electronic medical chart EK. However, at the time of this pasting, an electrocardiogram waveform figure is pasted as if the sheet was pasted on the paper chart PK3, and a link to the subject information on which the electrocardiographic waveform is based is also pasted. . Accordingly, a doctor who refers to the electronic medical record EK can refer to the entire waveform of the electrocardiogram waveform by clicking the region of the electrocardiogram waveform with, for example, a mouse, and stores the stored subject. Depending on the specimen information, it may be possible to confirm with a moving image.

  In this way, the information entered in the paper chart is read by the scanner and reflected in the electronic medical chart, and the doctor uses the paper chart to reflect it in the items of the medical remuneration statement and paste the patient's subject information. Accordingly, it is possible to provide a medical diagnosis support system that can maintain the merit that can be enjoyed by the user, can also enjoy the merit of using the electronic medical chart, and can improve the throughput of the diagnosis more than ever.

(Second Embodiment)
Next, a second embodiment of the present invention will be described. In the second embodiment, the same components as those described in the first embodiment are denoted by the same reference numerals, and the description of the same components is omitted because it is duplicated.

  The first embodiment can be enjoyed mainly by a doctor or the like using a paper chart, although the electronic chart system is used by reading the paper chart PK with a scanner and reflecting the entered contents in the electronic chart EK. The configuration that can maintain the merit was explained. In the second embodiment, a description will be given of a configuration that can mainly obtain merits when using the electronic medical record after the contents entered in the paper medical record PK are reflected in the electronic medical record EK.

  FIG. 12 is an example of a screen showing the electronic medical record EK1 when the entry contents of the paper medical record PK are reflected in the electronic medical record EK. On the left side of the screen of the electronic medical chart EK1, the contents of the paper chart PK are shown as a chart of “January 18, 2008”. On the lower right side of the area where the chart is shown, an area to which subject information about the subject of the chart is pasted is provided. On the other hand, on the right side of the chart area, an item for designating subject information to be pasted on the subject information pasting area is provided. In the example of the screen shown in FIG. 12, the modality in which the subject information to be pasted is imaged and the imaging region can be designated.

  A paste button (indicated as “paste” in FIG. 12) is provided below the item designation area of the subject information to paste the subject information that matches the designated item on the chart. . By clicking the paste button after designating an item, an image of the subject information corresponding to the medical record is pasted. It should be noted that the items and the like in the screen examples of the electronic medical chart EK shown in FIGS. 12 and 13 are arranged as examples only, and how to perform the layout can be freely determined.

  The electronic medical chart EK1 in the screen example shown in FIG. 12 is used in the following case. That is, in a general examination, a patient is photographed using a modality such as MRI or CT after a day after the examination rather than the day of the examination, for example, several days later. Therefore, the patient's subject information necessary at the time of the examination cannot be seen. On the other hand, since it is electronically stored if it is taken (acquired) subject information, the subject information can be affixed to the electronic medical record EK. It is difficult to grasp at what point in time between the examination and the next examination after the examination. Therefore, as a doctor, even if the patient's subject information has not been acquired, if it is possible to make a reservation for attaching the subject information to a desired position in the electronic medical record EK, it is monitored whether or not the subject information has been acquired. Even if not, the subject information can be referred to at the next examination.

  Therefore, in the electronic medical record EK1 in the second embodiment, even if the patient's subject information has not yet been acquired, the doctor makes a reservation for attaching the necessary subject information to a desired position on the medical record. be able to. The electronic medical chart EK1 shown in FIG. 12 designates which part is imaged with which modality to make reservation for the subject information, and clicks the paste button to place it in a desired position on the chart. A state in which the subject information is pasted is shown. That is, the region surrounding the entry of “X-ray” and “Icon” in the medical record is a region to be affixed based on the doctor's instruction when X-ray imaging is performed for the patient in the future and an X-ray image is acquired. Accordingly, since the X-ray image has not yet been acquired at this stage, it can be said that this area is a subject information pasting area.

  In the block diagram showing the internal configuration when the electronic medical record creation system 10 shown in FIG. 2 is mounted on the information terminal 1, the pasting button shown in the screen example of FIG. It corresponds to. When the paste button is clicked on the electronic medical record EK1, a paste signal is transmitted from the paste means 13c to the second determination means 13a and the confirmation means 13d. This pasting signal includes information on the subject information instructed as the subject to be pasted, which is subject information obtained by photographing which part of which patient by which modality. The confirmation unit 13d confirms to each modality via the communication network whether or not photographing has been performed based on this information. For this confirmation, for example, it is set to send a confirmation signal after a predetermined period of time in advance, or to confirm that the doctor opened this electronic medical record EK at the next examination. May be.

  When it is confirmed that the subject information to be pasted is confirmed by the confirmation means 13d and stored in, for example, an image server or the like, the fact is transmitted to the second determination means 13a. Based on this signal, the second determination means 13a instructs the search means 13b to acquire the corresponding subject information. When the search means 13b searches and acquires, the second determination means 13a obtains the corresponding subject information. The medical chart creating means 14 is instructed to be pasted on the subject information pasting area of the electronic medical chart EK.

  The above is also reflected in the instruction to the medical fee billing system. For example, when an instruction to the medical fee claim system is seen in the “MRI” column in the “entry content” of FIG. 10 described above, a response such as “simple MRI imaging request (if file exists when pasting file)” is described. Has been. This is because the MRI request should be made on the date of imaging at a later date, and it is possible to set the claim conditions so that the patient (subject) will be charged when the existence of the corresponding file can be confirmed at a later date. Is shown.

  In attaching the subject information, not only the subject information, for example, an image, but also a link accessible to the image may be provided. Then, as shown in the screen example of the electronic medical record EK2 in FIG. 13, when the subject information pasting area is clicked at the next examination, the corresponding subject information is displayed or stretched on the screen. Switch to the linked screen.

  By adopting such a configuration, even if it is subject information that cannot be pasted at the time of diagnosis, it is possible to automatically paste desired subject information by reserving the pasting. To provide a medical diagnosis support system that can improve the throughput of medical examination more than ever, while maintaining the benefits that doctors can enjoy by using paper charts, while also enjoying the benefits of using electronic medical records be able to.

(Third embodiment)
Next, a third embodiment of the present invention will be described. In the third embodiment, the same components as those described in the first or second embodiment are denoted by the same reference numerals, and the description of the same components is duplicated. Omitted.

  In the third embodiment, as described in the second embodiment described above, a configuration capable of mainly obtaining merits when using an electronic medical chart will be described. FIG. 14 shows a screen example of the electronic medical chart EK in which the electrocardiographic waveform sheet affixed to the paper medical chart PK is read by a scanner and the contents are reflected. As described in the first embodiment, a link is established in the area where the electrocardiogram waveform is represented in the electronic medical record EK2. When this area is clicked, as shown in FIG. And a list of past electrocardiographic waveforms related to the patient in the medical record is displayed.

  In the list of the electrocardiogram waveforms shown in FIG. 15, the latest electrocardiogram waveform (as of January 18, 2008) is shown at the right end, and the past electrocardiogram waveforms are shown as moving to the left side. In addition, the date when the electrocardiographic waveform was taken is displayed at the top of each electrocardiographic waveform. On these dates, there is a link to an electronic medical record that is an electronic version of the paper medical record filled out at the examination on that date. Therefore, when this date is clicked, the electronic medical record for that day is opened (see FIG. 16). In the third embodiment, an example is shown in which the chart shown in FIG. 16 is displayed in another viewer by clicking on the date January 7, 2008. Furthermore, when an electrocardiogram waveform is selected, another viewer is activated, and all waveforms of the corresponding electrocardiogram waveform can be referred to. An X-ray image or a moving image taken instead of the electrocardiographic waveform may be used.

  In addition, here, an example has been described in which another viewer for directly displaying the past electrocardiogram waveform shown in FIG. 15 is started by clicking the electrocardiogram waveform of the base chart (electronic medical chart EK2 shown in FIG. 14). However, for example, a pop-up display that asks the doctor which viewer to open when the electrocardiogram waveform is right-clicked may be displayed on the screen. That is, when right-clicking on an electrocardiogram waveform, for example, “display all waveforms of the clicked electrocardiogram waveform”, “display past electrocardiogram waveforms”, and “display the superimposed past electrocardiogram waveforms” Etc. may be displayed so that the doctor can select the necessary display.

  In this way, based on the electronic medical record EK2, the subject information of the patient of the medical record can be confirmed, and the past medical record can be referred to, so that the merit of the electronic medical record can be maximized. By adopting the configuration, while maintaining the benefits that doctors can enjoy by using paper charts, they can also enjoy the benefits of using electronic medical records and enable smooth medical examinations in line with the flow of thoughts of doctors. Therefore, it is possible to provide a medical diagnosis support system that can improve the throughput of diagnosis more than ever.

  The present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements without departing from the scope of the invention in the implementation stage. Various inventions can be formed by appropriately combining a plurality of constituent elements disclosed in the above embodiments. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, you may combine the component covering different embodiment suitably.

It is a block diagram which shows the internal structure of the information terminal in embodiment of this invention. It is a block diagram which shows an internal structure when an electronic medical chart preparation system is mounted in the information terminal. It is a schematic diagram which shows an example of the paper chart in embodiment of this invention. It is a flowchart which shows the flow of a doctor's examination. It is a flowchart which shows a motion of the electronic medical record preparation system along the flow of a doctor's examination. It is a schematic diagram which shows the example which the doctor filled in the paper chart. It is the table | surface which showed an example of the criteria in case the line which designates an area | region, the arrow, etc. are filled in. It is the table | surface which showed an example of the judgment criteria when the line which designates an area | region is filled in, but the arrow etc. are not filled in. It is the table | surface which showed an example of the criterion regarding the line which designates an area | region. It is the table | surface which showed a response | compatibility with the content which the doctor filled in in the medical chart and the instruction | indication content which the written character gives with respect to each of a medical diagnosis assistance system and a medical fee request system. It is a schematic diagram which shows the example which stuck the sheet | seat of the electrocardiogram waveform discharged | emitted from the electrocardiograph on the paper chart. It is an example of a screen which shows an electronic medical chart when the content of a paper medical chart is reflected in the electronic medical chart. 13 is a screen example of an electronic medical chart EK displayed when a predetermined area of the electronic medical chart shown in FIG. 12 is clicked. An example of an electronic medical record screen in which an ECG waveform sheet affixed to a paper chart is read by a scanner and the contents are reflected is shown. It is an example of a screen which shows the example of another viewer displayed when the electrocardiogram waveform of the example of a screen shown in FIG. 14 is clicked. 16 is a screen example showing an example of another viewer displayed when the date in the screen example shown in FIG. 15 is clicked.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Information terminal 10 Electronic medical record preparation system 11 Receiving means 12 Character and figure determination part 12a Recognition means 12b Determination means 12c First judgment means 13 Electronic medical record operation part 13a Second judgment means 13b Search means 13c Pasting means 13d Confirmation means 14 Medical chart preparation means 15 Transmission means

Claims (7)

An information terminal that constitutes the medical diagnosis support system has a character / graphic determination unit that determines a character and a graphic from the content when the content written in a paper chart by hand is read.
An electronic medical chart operation unit for operating information described in the electronic medical chart;
A chart creation means for creating an electronic chart based on the contents added or deleted by the character / figure determination section and the electronic chart operation section;
Storage means for storing a recognition pattern and subject information,
The character / graphic determination unit
If the contents entered by hand into the paper medical record has been read characters on the paper medical record, and recognizing means reads the graphic,
Confirming means for collating the character and the figure recognized by the recognition means based on the recognition pattern and confirming the character or the figure,
The contents of the paper chart determined by the determination means are determined based on the characters and figures, the creation of the electronic chart reflecting the contents is instructed to the chart creation means, and the electronic chart Based on a table that defines a process corresponding to the instruction content entered by the operator who entered the paper chart for operating the medical chart, the electronic medical chart operating unit is instructed to obtain the subject information to be targeted, or already The electronic medical record operating unit is instructed to retrieve and acquire the corresponding subject information that has been acquired, and the operator obtains the subject information obtained by the medical chart creating means and stored in the storage means. And a first determination means for instructing the electronic medical chart operation unit to stick to the area specified by
An output device constituting the medical diagnosis support system for outputting the electronic medical chart created by the medical chart creating means as a paper medical chart based on an instruction from the information terminal;
A medical diagnosis support system comprising: The electronic medical chart operation unit is
A pasting means for accepting a pasting instruction to the electronic medical record of the subject information;
Based on an instruction from the first judging means for judging the contents based on the characters and figures entered in the paper chart by the operator and reflected in the electronic chart, the subject to be pasted is selected. Second determination means for instructing the medical chart creation means to search for specimen information and to create the electronic medical chart;
Search means for searching for the subject information based on an instruction from the second determination means;
The medical diagnosis support system according to claim 1, further comprising: The first determination means selects and determines a reference word from the contents of the paper chart confirmed by the confirmation means, and reflects the contents of the treatment for the subject in the medical fee description. The medical diagnosis support system according to claim 1 or 2. When the first determination means determines that the treatment for the subject is the same treatment as the previous treatment from the content of the paper chart confirmed by the confirmation means, the previous treatment content 4. The method according to claim 1, wherein the content of the treatment is transmitted from the electronic medical record in which the medical record is written to the medical chart creating unit, and is reflected in the electronic medical record created by the medical chart creating unit. Medical diagnosis support system.   When the paper chart on which the subject information is affixed is read into the electronic medical chart operation unit, the first determination means determines the corresponding digitized subject from the identifier indicating the subject information. Instructing to retrieve and acquire information, the electronic medical chart operating unit instructs the medical chart creating means to paste the digitized subject information on a region designated by the operator. The medical diagnosis support system according to any one of claims 1 to 4. Said second determining means, with respect to the attaching means to thus affixed indicated the digitized object information, whether it is possible to sticking to the electronic medical record of the digitized object information When the information from the confirmation unit to be confirmed is received and the information is information indicating that the subject information can be pasted, the retrieval unit is instructed to retrieve the subject information, and the retrieval unit The medical diagnosis support system according to claim 2 , wherein the medical record creation unit is instructed to attach the subject information obtained by the method to the electronic medical record. The second determination means searches past information of the subject having the subject information when a link is selected that is attached to a region where the subject information of the electronic medical record is pasted. The medical diagnosis support system according to claim 2 or 6, wherein the search unit is instructed and displayed.

Images