RU2709225C1 - Home telemedicine radio channel system - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment. Radio-channel complex of home telemedicine comprises an emergency ambulance panel for emergency communication with a patient's control center, which includes a radio modem of the megahertz range, as well as a set of units for measuring parameters of vital functions and a radio modem of a gigahertz range network installed in the patient's location. Set of measurement units is made in the form of mobile portable telemedicine suitcase-laying, which includes set of telemedicine modules. Modules comprise a unit for measuring parameters of vital functions and a radio modem of the gigahertz range. In the coverage area of the network of the gigahertz range there is a module for transceiving telemedical data and a telemedical hub for receiving data from radio modems of the gigahertz range, which are part of telemedicine modules, exchanging over a channel of a megahertz range with emergency data associated with patient's life-threatening conditions, with a patient's state monitoring center, as well as with the possibility of exchange through the tele-medical data transceiver module and the Internet with the cloud data storage and the patient's state monitoring center with diagnostic data not directly related to the patient's life threatening.

EFFECT: higher volume and quality of the received and transmitted telemedical information on basic parameters of vital functions of a person to the level, allowing along with the possibility of emergency medical response to sudden acute diseases, which are life threatening to the patient, allowing to the attending physician and, if necessary, to a consultation of doctors to provide full consultation of the patient, as well as to conduct remote monitoring of vital human functions for the purpose of effective prevention, diagnosis and treatment of diseases, monitoring the condition or clinical course of the disease and evaluating functional capabilities of the patient.

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Description

The present invention relates to medical equipment, namely, to biomedical measurements for diagnostic purposes, including the simultaneous assessment of the conditions of the cardiovascular system and other body systems and the use of information and communication technologies, for example, the creation and transmission of electronic patient and medical records via communication channels reports.

As you know, from January 1, 2018, the Federal Law of July 29, 2017 N 242-ФЗ "On Amending Certain Legislative Acts of the Russian Federation on the Use of Information Technologies in the Field of Health Care" entered into force (hereinafter - the Law on Telemedicine ) According to this document, the concept of telemedicine technologies is introduced into the legal field and remote consultations of a doctor (paramedic) with a patient are allowed.

Since September 1, 2018, in effect, the first regulatory act in the field of telemedicine has been enacted - the national standard GOST R 57757-2017 "Remote evaluation of the parameters of functions vital to human life", which opens a series of documents on standardization in this new area . It contains general requirements for technologies for the remote acquisition and processing of information, its transmission and evaluation by a doctor (paramedic) in order to increase the availability and quality of medical care for the country's population, primarily for people living in large, sparsely populated areas, as well as for people with limited mobility, elderly people and persons with disabilities, due to pathology of internal organs and vision. Since this law does not imply permission to make a diagnosis and provide full medical care, at the moment telemedicine is reduced to consultations and remote monitoring of a patient after his full-time appointment with a doctor (paramedic), which, however, is an important step in the development of digital medicine (vademec.ru/news/2018/10/09). The procedure for organizing and providing medical care using telemedicine technologies is determined by order of the Ministry of Health of the Russian Federation of November 30, 2017 N 965н (hereinafter, the Order). According to this regulatory document, when interacting remotely with patients and (or) their legal representatives, the attending physician can correct the treatment previously assigned to the patient, including the formation of prescriptions for medicines in the form of an electronic document, provided that the attending physician is diagnosed and the treatment prescribed this appeal in person (examination, consultation). The result of such a consultation is a medical report or, subject to a preliminary diagnosis on an in-person appointment (examination, consultation) on this appeal, an appropriate record by the attending physician on the adjustment of the previously prescribed treatment in the patient’s medical documentation, including the formation of a prescription for the drug in electronic form document, the appointment of the necessary additional examinations and the issuance of a certificate (medical report) also in the form of an electronic document.

Thus, the patient and (or) his legal representative, on the one hand, and the attending physician on the occasion of treatment, in the framework of which remote monitoring of the patient’s state of health, and, if necessary, are participants in consultations and remote monitoring of the patient’s health status , a medical professional performing remote monitoring and (or) emergency response in case of a critical deviation of the patient’s health indicators from the limit values, on the other hand.

The well-known "Information-analytical system in the field of telemedicine" is presented in patent RU No. 2251965, A61B 5/0205, G06F 19/00, in which the procedure for organizing and providing medical care using telemedicine technologies is largely implemented. The specified system is a problem-oriented complex based on a multiprocessor cluster and remote personal computers (PCs) for creating, transmitting, processing, storing and displaying medical information in a computing environment using an intelligent interface and interactive mode, which includes the workplace of a remote user, program control unit, adaptation unit, operational consultation unit, switching unit, electrocardiograph with an electrocardiogram recording device (ECG) , temperature, blood pressure sensors, digital camera, intelligent interface and documentation unit. The complex operates on the basis of a client-server architecture using available software running on the Linux operating system. The PostgreSQL system was used as the database management system. It supports all SQL constructs, including user-defined nested queries and functions, which provides a powerful mechanism for storing and managing data.

The automated workstation (AWP) of the user - the attending physician (paramedic) operates on the basis of a PC and provides user interaction with the patient using the aforementioned medical devices. Entering patient data consists of filling out formalized forms, which for each type of data are automatically generated and stored in XML format. The examination results are optimized on the AWP computer and, if necessary, can be displayed on the monitor screen without contacting the server. Medical devices provide operational monitoring and transfer of clinical research results to the program control unit (core of the complex), including text descriptions, medical images and medical devices. To this end, mechanisms are used for maintaining an electronic medical history, the principles of which are defined in the standard GOST R 56636-2006 "Electronic medical history", General provisions. M .: "Standartinform", 2007.

The main disadvantage of this telemedicine system is the small coverage area due to the fact that the territorially distributed computing environment used in it is realized due to the wired connections of its elements. Such a system construction is possible only at the scale of a hospital or other medical institution with a distributed computer network. The expansion of the coverage of such networks requires significant capital costs and numerous approvals, which represents a serious organizational and technical problem.

A fundamental solution to this problem is the construction of a telemedicine system using modern radio channel communication and data networks and the Internet.

The well-known "Monitoring system of vital indicators of patient health" according to the patent for invention RU No. 2454924, АВВ 5/02, АВВ 5/0402, А61В 5/08, А61В 5/103, H04Q 5/20, G08B 1/04, containing mobile sets of patients, a center for monitoring the condition of patients with a central computer (server) and a database that contains an anamnesis, passport data and contact information with the patient’s confidential (legal representative), as well as medical emergency services and mobile communication kits based on a GSM cell phone and GPRS modem configured to detect the patient’s location according to the coordinates of the base stations of the standard cellular communication network, which are equipped with all controlled patients and their authorized confidants, as well as the aforementioned control center and medical emergency services. Moreover, each patient’s mobile kit contains a multichannel microcontroller, with which sensors for monitoring cardiac activity, respiratory activity, a hemodynamic sensor, patient’s motor activity, data input unit, microprocessor and display are connected. The system has the possibility of multi-channel access to the central computer and one of the mobile phones of the communication kit of the personnel of the point of duty medical care. The first GSM / GPRS modem is mounted at such a distance from the organs of hearing and speech that the patient can conduct verbal exchanges in speakerphone mode.

The use of a standard GSM / GPRS cellular cellular communication network as part of this system provides the ability to monitor the condition and determine the location of patients from the patient monitoring center at any location of the patient, i.e. implements a global monitoring and positioning mode, which, undoubtedly, is the advantage of this system. However, you have to pay for this advantage, both in the literal sense - a fee to the cellular network operator, and technical limitations. So, the use of a standard communication network limits, but in fact determines the choice of a programming language for the hardware of the system. For example, for cell phones - this is the JAVA language ("We write software for the phone" - www.mobilab.ru). This imposes severe restrictions on the possibility of expanding the set of external sensors for biomedical signals that could be connected to an ECG monitor to turn it into a full-fledged highly informative wearable telemetry device, which, in turn, reduces the accuracy of measurements and the reliability of predicting the patient's condition. In addition, cellular communication may be interrupted due to network congestion or shadowing, which is unpredictable and unacceptable in critical and terminal situations for the patient.

To address these shortcomings, the "Radio-channel system of cardiomonitoring, warning and action in critical situations" is directed according to patent RU No. 2630126, АВВ 5/0404, G08B 25/10, in which instead of a unified global cellular communication network such as GSM / GPRS it is proposed to use a combined intra-site radio network , which includes a “near” radio channel of the GHz frequency range, for example, a WiFi network - for indoor use within the coverage area of this network, and a “distant” radio channel operating in one of the permitted (non-licensed) networks los megahertz (MHz) range (433 or 868 MHz). When the patient is in the coverage area of the WiFi network, the "far" radio channel is in "sleep" mode and automatically turns on only when the patient leaves the coverage area of the "near radio channel".

The specified system, selected as the closest analogue of the present invention, contains an ambulance and portable telemetry devices (telemetrons) of patients, as well as a center for monitoring the patient’s condition as part of a server, data bank, workstation administrator, one or more workstations of medical personnel and a modem MHz band. Each telemetron is made in the form of a portable device placed on the patient’s body (or clothes) and containing, in addition to the cardiac monitoring sensor, a respiratory activity monitoring sensor, a hemodynamic control unit and a motor activity monitoring sensor connected to a microcontroller to which a keyboard and display are connected , sound notification unit and radio modems of the MHz and GHz bands. The patient monitoring center has a GHz radio modem connected to the server. Moreover, all the aforementioned MHz modems are made in the form of “short-range devices” using unlicensed frequency bands, for example, 433 or 868 Megahertz (Decision of the State Committee for Radio Frequency of 07.05.2007). A feature of such devices is the relatively low radiation power (not more than 10 mW), which does not require licensing, and in accordance with the Government of the Russian Federation dated 12.10.2004 No. 539, they can be used without registration with the Federal Service for Supervision of Communications, information technology and mass communications.

The medical tasks solved by the indicated system relate to that part of the diagnostic tasks that is associated with the identification of an immediate threat to human life and the adoption of emergency measures to eliminate it. However, the telemedicine diagnostic tasks are not limited only to the emergency form. As indicated in paragraph 14 of the aforementioned Order, consultations (doctors' consultations) can be carried out not only in an emergency form - with sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life, but also in urgent form - with sudden acute diseases, conditions exacerbation of chronic diseases without obvious signs of a threat to the patient’s life, as well as in a planned form - during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life about, not requiring emergency and emergency medical care, and delaying the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.

In urgent cases, the volume of medical data is small, since the automated processing of medical data is mainly of a threshold nature and comes down to identifying excesses of critical levels that threaten the patient's life. The main thing is that the indicated data should be reliably and as quickly as possible brought to the emergency response bodies - ambulance services. This problem is solved by using the MHz band used in the closest analogue radio modem. Devices of this class have a relatively low data transfer rate, but have a significantly larger coverage area (tens of kilometers) than GHz devices (WiFi, Bluetooth devices, etc.) and provide stable communication even in the presence of interference.

In urgent and planned forms of consultations, the amount of telemedicine information transmitted is orders of magnitude greater than in emergency situations. But at the same time, the delay and accumulation of the indicated information in a certain data bank with its subsequent “transfer” to the doctor’s workstation and / or to the cloud storage using, for example, the Internet, is permissible. The closest analogue does not have such technical capabilities, which is its drawback. Another drawback that does not allow us to consider it as an effective tool for these forms of consultations is that structurally the set of telemedicine modules is made in the form of a wearable monoblock placed on the patient’s body or clothes, which limits the number of measuring tools and the possibility of using their various configurations.

The technical result expected from the application of the proposed technical solution is to increase the volume and quality of the received and transmitted telemedical information on the basic parameters of vital functions of a person to a level that allows, along with the possibility of emergency medical response in case of sudden acute diseases that pose a threat to the patient's life; provide the attending physician and, if necessary, the consultation of doctors, full-fledged patient consultations, as well as conduct remote monitoring of the parameters of vital human functions in order to effectively prevent, diagnose and treat diseases, monitor the condition or course of the disease and evaluate the patient’s functional capabilities, such as Requires clause 5.3.1 of GOST R 57757-2017.

This technical result is planned to be achieved due to the fact that the system has the closest analogue containing an ambulance console, made with the possibility of emergency communication with a patient condition monitoring center, including a server and associated data bank, administrator workstation, one or more Workstation of medical personnel and a radio modem of the MHz range, as well as a set of telemedicine modules installed at the patient’s location, made with the ability to remotely evaluate the parameters of functions, is vital For human life and transmitting this data using the GHz radio modem and the Internet, a telemedicine hub installed in the coverage area of the GHz range and a telemedicine transceiver module have been introduced, while the telemedicine hub is configured to receive data from GHz radio modems included in the set of telemedicine modules, as well as with the possibility of transmitting over the MHz channel to the center for monitoring the condition of patients emergency data indicating threats to the life of the patient NTA. At the same time, data that does not indicate a threat to the patient’s life and, accordingly, does not require emergency medical care, is transmitted via the GHz channel of the band connected to the Internet to a cloud storage and / or storage in a patient monitoring center

The telemedicine hub contains a GHz radio modem and a MHz radio modem, a microcontroller connected to a memory unit and made with communication input / output of the GHz range channel and with communication input / output of the MHz range channel, as well as a series-connected wireless channel selection unit, the information input of which is connected with the output of the GHz radio modem and a controllable threshold device, the output of which is connected to the communication input of the GHz channel of the microcontroller range, at The first and second inputs of the microcontroller are connected, respectively, to the control body and to the GPS / GLONASS module, the first and second outputs of the microcontroller are connected, respectively, to the display and to the sound notification unit, and the communication output of the channel of the MHz range of the microcontroller is connected to the input of the MHz radio modem range, the first additional output of the microcontroller is connected to the control input of a controlled threshold device, the second additional output of the microcontroller is connected to the control input of the selection block to wireless communications, and the third additional output of the microcontroller is connected to the control input of the GHz radio modem, which is configured to receive telemetry data from wireless transmitters that are part of the set of telemedicine modules used to diagnose the patient, while the output of the MHz radio modem is connected to the second information input of the block of selection of wireless channels.

As a module for transmitting telemedicine data, a patient’s PC or smartphone can be used on which the corresponding medical software applications are installed.

The preferred embodiment of a set of telemedicine modules is a mobile portable telemedicine packing case, which includes the following telemedicine modules: electrocardiograph, blood pressure monitor, blood glucose meter, pulse oximeter, spirometer, safety bracelet, non-contact heart rate and respiration sensor, sound indicator of blood flow velocity, thermometer, urine analyzer, hematology analyzer, blood biochemistry analyzer, electronic stadiometer equipped with scales, visual elec a throne stethoscope, with each of these measurement modules containing a gigahertz wireless modem, for example, Bluetooth or Wi-Fi modem.

As an option, it is proposed to use existing telemedicine modules with the following distinctive features:

The electrocardiograph is made with 12-lead ECG recording capabilities and a USB connection.

The blood pressure meter is configured to automatically measure pressure and save the results for three users with the display of data using a digital liquid crystal display.

The meter is made with automatic temperature compensation and the ability to take up to 1000 measurements of blood glucose without changing the power source, as well as with the ability to save up to 220 measurement results and display the average value for 7, 14 and 28 days.

The pulse oximeter is made with the possibility of measurements in Clement, ECCS and Knudson systems of the vital capacity of the lungs, forced expiration, minute and maximum ventilation of the lungs and medication.

The security bracelet is made with the ability to measure heart rate, saturation (SpO2) and the user's temperature, as well as with the ability to determine its location, establish the fact of a fall (shock) and with the possibility of an alarm in manual and automatic modes.

The non-contact heart rate and respiration sensor is designed to measure heart rate and respiration rate and determine the degree of patient mobility.

Sound indicator of blood flow velocity is made with the ability to assess atherothrombotic diseases of peripheral vessels and the study of venous and arterial blood flow, as well as with the ability to perform the functions of a stethoscope and detection of fetal heartbeat.

The thermometer is made with the ability to measure the user's body temperature in the range from 34 to 42.9 degrees in 5 seconds and save the results up to 10 measurements.

The urine analyzer was designed to measure the following parameters: GLU - glucose, PRO - protein, BIL - bilirubin, URO - urobilinogen, KET - ketone bodies, PH - acidity, SG - density, BLD - red blood cells, LEU - leukocytes, KET - ketone bodies , NIT - bacteria in the urine.

The hematology analyzer was performed with automatic measurement capabilities of up to 20 of the following parameters: WBC - white blood cells or white blood cells, HGB - hemoglobin concentration, LYM # - number of lymphocytes, LYM% - percentage of lymphocytes, MON # - number of monocytes, MON% - percentage of monocytes , GRA # is the number of granulocytes, GRA% is the percentage of granulocytes, RBC is red blood cells or red blood cells, HCT is hematocrit, MCV is the average volume of red blood cells, MCH is the average hemoglobin content in erythrocytes, MCS is the average concentration of cellular hemoglobin in erythrocytes ite, RDW-CV is the width of the distribution of red blood cells. RDW-SD - width of the distribution of red blood cells (RBC anisocytosis), PLT - platelets, MPV - average platelet volume, PCT - platelet count, PDW - platelet anisocytosis, P-LCR - number of large platelets, RBC histogram - histogram of white blood cells , PLT histogram - a platelet histogram.

The blood biochemistry analyzer is designed to perform the following tests: ALT, ACT, alkaline phosphatase, acid phosphatase, cretinkinase, creatine kinase MB, LDH, GGT, aminalase, lipase; Substrates: Alubumin, Bilirubin (direct, total), hemoglobin, glucose, urea, creatinine, uric acid, total protein, total protein in the urine, lactate, microprotein; lipids: cholesterol, VP cholesterol, NP cholesterol, triglycerides; electrolytes: iron, calcium, magnesium, chlorides, sodium, potassium, phosphorus, zinc, copper.

An electronic stadiometer equipped with scales is made with the ability to measure patient growth in the range from 0.81 to 2.2 meters and its mass in the range from 1 to 150 kg.

A visual electronic stethoscope is configured to display an ECG, heart rate (HR), SpO2, a pulse curve and has a headphone output.

The invention is illustrated using the drawings and photographs shown in FIG. 1 - FIG. 8.

In FIG. 1 shows a structural diagram of the proposed radio channel complex home telemedicine.

In FIG. 2 shows a block diagram of a patient monitoring center.

In FIG. 3 and FIG. Figure 4 shows a block diagram and a photograph of a telemedicine hub, respectively.

In FIG. Figure 5 shows a photograph of a packing case with a possible configuration of telemedicine modules.

In FIG. 6-8 are photographs of telemedicine modules included in the preferred package of the stacking case shown in FIG. 4.

- electrocardiograph, blood pressure monitor, glucometer and urine analyzer (Fig. 6);

- pulse oximeter, thermometer, safety bracelet, spirometer, non-contact heart rate and respiration sensor, sound indicator of blood flow velocity (Fig. 7);

- hematological analyzer, blood analyzer, electronic stadiometer, equipped with scales, and a visual electronic stethoscope (Fig. 8).

In the structural diagrams shown in FIG. 1 - FIG. 3, the following block numbering was used: 1 - telemedicine hub; 2 - a set of telemedicine modules; 3 - GHz radio modem; 4 - block selection of wireless channels, 5 - control; 6 - microcontroller; 7-controlled threshold device; 8 - display; 9 - block sound alerts; 10 - MHz radio modem; 11 - center for monitoring the condition of patients; 12 - ambulance console; 13 - memory block; 14 - module transceiver telemedicine data; 15 - server; 16 - administrator workstation; 17 - AWP of medical personnel; 18 - data bank; 19 - GPS / GLONASS module.

The proposed radio-channel home telemedicine complex includes an ambulance console 12 configured to urgently communicate with a patient condition monitoring center 11, including a server 15 and associated data bank 18, an administrator’s workstation 16, one or more workstation 17 medical personnel, and a radio modem 10 megahertz range, as well as a set of 2 telemedicine modules installed at the patient’s location, made with the ability to remotely evaluate the parameters of functions that are vital for life human activity and transmitting this data on the air using a 3 GHz radio modem. A telemedicine hub 1 and a telemedicine data transceiver module 14 are located in the Gigahertz range network, while the telemedicine hub 1 is configured to receive data from the Gigahertz range radio modems 3 included in the set of telemedicine modules, transmit emergency data indicating a patient’s life threat, the channel of the Megahertz range to the center 11 for monitoring the condition of patients, and broadcasting other data that do not carry obvious signs of a threat to the life of the patient and, accordingly, do not require emergency medical assistance, to the cloud storage and / or to the center 11 for monitoring the status of patients - using the module 14 transceiver telemedicine data operating in the GHz band and connected to the Internet.

In a preferred embodiment of the proposed complex, the telemedicine hub contains a 3 GHz radio modem and a 10 MHz radio modem, a microcontroller 6 connected to a memory unit 13 and made with communication input / output of the GHz band and with communication input / output of the MHz band, as well as sequentially connected unit 4 selection of wireless channels, the information input of which is connected to the output of the radio modem 3 GHz and a controlled threshold a triad 7, the output of which is connected to the communication input of the GHz channel of the microcontroller 6 range, while the first and second inputs of the microcontroller 6 are connected, respectively, to the control body 5 and to the GPS / GLONASS module 19, the first and second outputs of the microcontroller 6 are connected, respectively, to the display 8, and to the sound notification unit 9, and the communication output of the MHz channel of the microcontroller 6 range is connected to the input of the megahertz radio modem 10, the first additional output of the microcontroller 6 is connected to the control input adjustable threshold device 7, the second additional output of the microcontroller 6 is connected to the control input of the unit 4 for selecting wireless communication channels, and the third additional output of the microcontroller 6 is connected to the control input of the radio modem 3 of the GHz range, which is configured to receive telemetric data from wireless transmitters included in the composition of the set of 2 telemedicine modules used to diagnose the patient, while the output of the 10 MHz radio modem is connected to oromu data input unit 4, the selection wireless communication channels.

In a preferred embodiment of a packing case, a set of 2 telemedicine modules includes the following telemedicine modules: an electrocardiograph, a blood pressure monitor, a glucometer, a pulse oximeter, a spirometer, a safety bracelet, a non-contact heart rate and respiration sensor, an audible blood flow velocity indicator, a thermometer, and a urine analyzer, hematological analyzer, blood biochemistry analyzer, electronic stadiometer equipped with scales, a visual electronic stethoscope, with each of these The telemedicine module contains a gigahertz wireless modem, such as a Bluetooth or Wi-Fi modem.

In the prototype of the telemedicine hub 1 developed by the applicant enterprise (Fig. 3), the purchased product — the NRF52832 microcontroller — is used as the microcontroller 6, a 2.4 GHz transceiver (Nordic Semiconductors) is built in, which acts as a 3 GHz radio modem (uses the WiFi CC3200MOD module or CC3220MOD by Texas Instrument).

The 10 MHz radio modem is implemented on an SX1272 type transceiver related to the aforementioned "short-range devices." Its distinguishing features are:

- high sensitivity;

- a wide range of measurement and regulation of the received signal power level;

- the ability to work without degradation at low (up to 1.8 V) supply voltage;

- the use of Frequency Hopping (“jumping in frequencies”) and LBT (“listening to the air before transmitting”) technologies, which make it possible to efficiently use the limited frequency range, avoid collisions with multiple access and combat signal “fading” due to interference.

The memory block 13 is made on the basis of a micro SD card, and the display 8 is based on the OLG indicator UG-6028GDEBF02 with 160 × 128 pixels 40 × 34 mm in size.

To implement the chain "block 4 selection of wireless channels - controlled threshold device 7", you can use the technical solution described in patent RU No. 2629960, Н04В 1/18 "Multi-band device for selection, amplification and signal conversion" for professional receiving devices. Each channel of such a device contains a serially connected input subband bandpass filter, a first controlled attenuator, a first radio frequency amplifier, a subband tunable bandpass filter, a second radio frequency amplifier, a second controlled attenuator, and an analog-to-digital converter, the output of which is the output of the entire device.

Used in the proposed complex, a set of 2 telemedicine modules can be implemented on the basis of existing medical devices (Fig. 6 - Fig. 8). Their main parameters are given in dependent paragraphs. 4-16 formulas of the present invention. Structurally, the kit is made in the form of a packing case (Fig. 4), presented in the certificate of Altonika LLC for the Ministry of Industry and Trade No. 2718-5 of 08/27/2018 "Portable system for remote diagnostics and integrated monitoring for people with limited mobility, elderly, persons with disabilities, due to the pathology of internal organs and people with visual impairments. " It should be noted that the packaging of the packing case described above is offered for the first time, since existing products of this kind, for example, the Arnega ™ family of wearable complexes manufactured by Traditsiya Group, are mainly intended for use by emergency rescue and emergency brigades, as well as for emergency medical services and disaster medicine.

Thus, the possibility of practical implementation of the proposed technical solution is not in doubt.

The considered radio-channel complex of home telemedicine works as follows.

A telemedicine hub is installed at the patient’s location. This device can be installed in any room agreed with a medical professional interacting with the patient or with his legal representative, for example, in the room of the nearest feldsher-midwife center (FAP) or at home. At the disposal of the user, which means the patient or his legal representative, is a set of 2 telemedicine modules that allow you to measure various parameters of the patient's functions, vital for human life, such as ECG, pulse rate, respiration parameters, blood pressure, etc.

Each such module contains a short-range wireless transmitter. This is a transmitter operating in the GHz range in the standards of Bluetooth or WiFi or other. Telemedicine hub 1, a possible construction of which is shown in FIG. 3, receives messages transmitted by the telemedicine module currently in use by the patient, selects the wireless channel through which the message is received, and using threshold processing determines to which class the specified message belongs. Reception in the telemedicine hub 1 of the data transmitted by the wireless transmitter of this telemedicine module is carried out by a 3 GHz radio modem - the “near” radio channel. The communication range is not large (no more than tens of meters). However, the throughput in this range can be quite large, which allows the telemedicine hub 1 to perceive the entire volume of telemedicine data obtained using products for various medical purposes. From the output of the Gigahertz 3 radio modem, the flow of telemedicine information enters the wireless channel selection unit 4, which switches the channels in accordance with the program selected by the patient using the control unit 5, for example, a keyboard connected to the microcontroller 6. The choice of channel determines those parameters of vital for human life functions that it is planned to receive, transfer and evaluate by a doctor (paramedic) in this remote examination session, for example, the parameters of th cardiovascular system. From the output of the selected channel, information is fed to the input of a controlled threshold device 7, with which the measured parameter is ranked according to the degree of threat to human life. The threshold levels are controlled by commands coming from the microcontroller 6, in accordance with a predetermined program, selected using the control body 5, for example, a keyboard. Visual control over the choice of channels and threshold setting is carried out using display 8. If a telemedicine parameter exceeds a threshold that corresponds to a critical situation, for example, if an unacceptable level of cardiac arrhythmia is detected in a patient, a sound notification unit 9 is turned on. At the same time, the microcontroller 6 sends information about this alarming event to the megahertz radio modem 10 for transmission via the "short-range" radio channel to the patient condition monitoring center 11 and through it to the ambulance console 12.

In the absence of exceeding the threshold corresponding to the critical situation, the microcontroller 6 directs the flow of telemedicine information arriving into it to the memory unit 13 for registration, storage and subsequent use in consultation with the attending physician in urgent or planned forms of their interaction.

Due to the large amount of monitoring information, in order to avoid overflow of the memory unit 13, the recorded telemedicine information is periodically transferred via the Internet to the cloud storage, which is connected with the telemedicine data transmission module 14, which is played by a PC or a patient’s smartphone, on which the corresponding software application is installed, as provided for in clause 5.2.1 of the aforementioned standard GOST R 57757. For this, by the command specified by the control body 5 On the contrary, the microcontroller 6 reads from the memory unit 13 the corresponding fragments of the registered telemedicine information and transmits them using the Gigahertz radio modem 3 to the telemedicine data transceiver module 14, for example, to the user's smartphone, which broadcasts it via the Internet. Information transmitted over the Internet is received at the center 11 for monitoring the status of patients installed in it 3 GHz radio modem. When transmitting information over the radio channel "short-range" it is received by the radio modem 10 megahertz range. In both cases, this information is sent to server 15, which processes it under the control of administrator 16 workstation.

If the transfer is carried out during the consultation in real time, the incoming information is viewed on AWP 18 of medical personnel, for example, by an ECG technician or attending physician. If the archive of telemedicine data is being downloaded from block 13 of the memory of the telemedical hub 1 or cloud data storage in the deferred consultation mode, then this archive is sorted and recorded in the automated workstation 16 of the center administrator. Reports based on events diagnosed by an ECG technician or in an archive record are sent to the appropriate workstation 17 of the medical staff, for example, the attending physician responsible for this patient and data bank 18 connected to server 15. Moreover, the center administrator has the opportunity to request from the data bank 18 any information he needs and transfer it using server 15 to the corresponding workstation 17 of the medical staff. In turn, the attending physician, on his own initiative, can contact the server 15 and generate with his help a request for obtaining the information he needs from the data bank 18 or from the cloud data storage. The overall coordination of the center 11 monitoring the status of patients is also carried out with AWP 16 administrator of this center.

In the remote monitoring (monitoring) mode of the patient’s state of health (paragraphs 51-55 of the Order), the entire archive of telemedical data is transmitted daily, which makes it possible to diagnose conditions that are difficult to detect during scheduled consultations. For example, the upper limit of anxiety in heart rate (HR) can be set at a level significantly higher than the patient’s normal heart rate. Thus, a slight increase in heart rate in a patient cannot be detected by the patient's arrhythmia detection device as an event to be recorded. However, a slight increase in heart rate can be repeated many times over a short period of time, or it can last continuously for a long period of time. Such finer cardiac rhythm behaviors can be recognized by more sophisticated analysis systems that work to fully disclose data, analyze each daily data archive, and create a daily report that identifies these symptomatic heart rhythm patterns. Identification of such subtleties in the daily archive with the help of sophisticated analysis programs included in the special software of the center 11 for monitoring the patient’s condition allows to establish an urgent diagnosis of the patient’s condition and / or provides the ability to reconfigure threshold levels and alarm indication limits to more effectively disclose the patient’s health status further.

During the observation, the patient’s doctor may decide to change the parameters of the pathology that should be detected. For example, the threshold for detected tachycardia can be set to an initial state of 160 beats / minute. Such a change can be set by a technical specialist and a new setting will be sent to the telemedicine hub of 1 patient as a change in the configuration of the measured parameters. New configuration information is sent by the server 15 via the Internet, received by the telemedicine data transceiver module 14, for example, by the patient’s smartphone, and from it enters the telemedicine hub 1 of the corresponding patient, where it is automatically installed in the controlled threshold device 7.

Thresholds can also be set manually using the keyboard 5 and display 8 (in the corresponding fields of the drop-down menu). So, when observing the patient’s cardiovascular system, these fields can relate to ventricular fibrillation, upper and lower heart rate, systole, pause in heart contractions, atrial fibrillation.

In addition to the detection limits, the user can also set the alarm priority, such as urgent, medium, or low priority. When the ECG technician at the patient monitoring center 11 set the desired thresholds and priorities for the workstation 17 of the medical staff, the configuration is saved using the "save" button. If monitoring has not yet begun, configuration information is stored on server 15 and transmitted to the telemedicine hub 1 upon initial placement of the corresponding telemedicine module (for example, securing the electrocardiograph leads on the patient’s body). During the first communication session of the telemedicine hub 1 with the center 11 for monitoring the status of patients 1, the telemedicine hub 1 checks the configuration information, which is then downloaded and installed in the managed threshold device 7. If monitoring has already begun, the new configuration is immediately downloaded for installation. For example, in addition to the seven standard alarms associated with cardiac arrhythmias, the doctor has the ability to set a custom alarm for a particular patient.

Telemedicine messages and patient information can be registered on the server 15 to be able to access them through specific accounts. The account may be the identification data of the attending physician, clinic, FAP, etc. Whenever the status of the telemedicine hub 1 changes, it sends a corresponding notification and these notifications are sent to the patient monitoring center 11 via the Internet. For example, when a telemedicine hub 1 "senses" that it is receiving ECG signals from a patient, a message is sent about the corresponding status. If the telemedicine hub 1 detects an unconnected ECG output, then a message is sent again, but about a different status. When the telemedicine hub 1 detects an unconnected lead and is again attached to the patient’s body, a status change message is sent again. Thus, the continuous flow of status messages allows the attending physician to assess the nature of the patient’s use of a particular telemedicine module, and the technician at the patient monitoring center 11 can intervene in the patient monitoring process by transferring a call over the Internet if the message flow indicates that the patient has a problem or misses something.

Previously, before using a set of 2 telemedicine modules, the patient is identified. To do this, in the data bank 18 on the basis of the voluntary consent of the patient make the following group of its distinctive characteristics:

1. "Normal", "threshold" or "critical" (predictor or terminal), which contains the body's controlled functions in related processes, data from a retrospective history, other manifestations of a physiological state (for example, short-term memory loss). These data are entered by the attending or district doctors or the FAP paramedic.

2. Passport data of the patient.

3. Contact numbers and addresses of the patient’s legal representatives (for example, members of his family).

Only the authorized services of the unified duty dispatch service of a medical institution, including the emergency medical service on duty, have access to the data bank 18. The current parameters taken by the sensors of the telemedicine modules (electrocardiograph, blood pressure meter, blood glucose meter, etc.), through block 4 of the selection of wireless channels and the controlled threshold device 7 are received in the microcontroller 6. A text message can be displayed on display 8 of the telemedicine hub 1, as well as on the monitor of the automated workplace 16 of the administrator of the center 11 monitoring the status of patients, and the voice message can be broadcast by a 3 GHz radio modem over the Internet. With normal health conditions, text and voice messages are intended for the current informing of the patient through the display 8. In this case, playback of the current indicators on the display 8 is carried out at the request of the microprocessor 6, which is formed using the control unit 5, for example, a keyboard.

The warning signal is a text and speech message that provides current indications of the patient’s health status, recommendations to the patient to reduce the likelihood of complications and transition to a critical state, and a request to determine the location of the patient. The warning signal is intended for the patient and the operator of the ambulance console 12. A warning signal is sent automatically through the transmission channels of voice or text information, in particular, over a cellular communication network. In case of detection of threshold signs, the operator contacts the patient and gives him recommendations to prevent the transition of the main health indicators to a critical state. In the absence of communication with the patient, the operator of the ambulance console 12 through the patient monitoring center 11 sends a request to the telemedicine hub 1 to determine its location and, accordingly, the patient’s location using the GPS / GLONASS module 19. This module determines the current location of the patient and sends this information through the center 11 for monitoring the status of patients to the console 12 of the emergency medical service. Having received these data, the operator sends an ambulance to the patient’s place of residence.

Thus, the expected technical result of applying the proposed technical solution is achieved, which consists in increasing the volume and quality of received and transmitted telemedical information about the main parameters of vital functions of a person to a level that allows, along with the possibility of emergency medical response in case of sudden acute diseases that threaten the patient's life; carry out consultations of the patient on the part of medical staff (if necessary, a consultation of doctors), and remote monitoring of the parameters of vital human functions in order to effectively prevent, diagnose and treat diseases, monitor the condition or course of the disease and evaluate the patient’s functional capabilities, as required 5.3.1 standard GOST R 57757.

Claims (2)

1. A radio-channel home telemedicine complex comprising an ambulance console configured to provide emergency communication with a patient’s health monitoring center, including a server and associated data bank, an administrator’s workstation, automated workstations for medical personnel, and a megahertz radio modem, as well as a set of units for measuring the parameters of functions vital to human life, installed in the patient’s location, and a radio modem set and gigahertz range, characterized in that the indicated set of units for measuring parameters of functions vital for human life is made in the form of a mobile portable telemedicine packing case, which includes a set of telemedicine modules in various configurations, each of which includes a unit for measuring parameters functions vital to human life, and a radio modem of the gigahertz range, and a receiver module is located in the coverage area of the gigahertz range telemedicine data providers and a telemedicine hub configured to receive data from gigahertz radio modems included in these telemedicine modules, exchange emergency data related to the life threat of the patient with the megahertz range channel, and the patient’s condition monitoring center, as well as the possibility of exchange via telemedicine data transceiver module and the Internet with a cloud data storage and a patient monitoring center with diagnostic data not related to Directly to the life threat of the patient. 2. The radio channel home telemedicine complex according to claim 1, characterized in that the telemedicine hub contains a GHz radio modem and a megahertz radio modem, a microcontroller connected to a memory unit and configured with communication input / output of a GHz channel and with communication input / output of a megahertz channel range, as well as series-connected wireless channel selection block, the first information input of which is connected to the output of a gigahertz radio modem range, and a controlled threshold device, the output of which is connected to the communication input of the gigahertz channel of the microcontroller, while the first and second inputs of the microcontroller are connected, respectively, to the control body and to the GPS / GLONASS module, the first and second outputs of the microcontroller are connected, respectively, to the display and to the sound notification unit, and the communication output of the channel of the megahertz range of the microcontroller is connected to the input of the radio modem of the megahertz range, the first additional output of the micro the controller is connected to the control input of the controlled threshold device, the second additional output of the microcontroller is connected to the control input of the wireless channel selection unit, and the third additional output of the microcontroller is connected to the control input of the GHz radio modem, while the output of the megahertz radio modem is connected to the second information input of the channel selection unit wireless connection.

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