EP2318968A2 - Procédé de surveillance de l'état médical d'un patient - Google Patents

Procédé de surveillance de l'état médical d'un patient

Info

Publication number
EP2318968A2
EP2318968A2 EP09776001A EP09776001A EP2318968A2 EP 2318968 A2 EP2318968 A2 EP 2318968A2 EP 09776001 A EP09776001 A EP 09776001A EP 09776001 A EP09776001 A EP 09776001A EP 2318968 A2 EP2318968 A2 EP 2318968A2
Authority
EP
European Patent Office
Prior art keywords
medical
category
taken
drug
measure
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
EP09776001A
Other languages
German (de)
English (en)
Inventor
Thomas LÖSER
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Loser Medizintechnik GmbH
Original Assignee
Loser Medizintechnik GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from DE102008034736A external-priority patent/DE102008034736A1/de
Priority claimed from DE102008059901A external-priority patent/DE102008059901A1/de
Application filed by Loser Medizintechnik GmbH filed Critical Loser Medizintechnik GmbH
Publication of EP2318968A2 publication Critical patent/EP2318968A2/fr
Ceased legal-status Critical Current

Links

Classifications

    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/63—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for local operation

Definitions

  • the invention relates to a method for monitoring the medical condition of a patient and to a system for carrying out this method.
  • patient data management systems are used to store patient data.
  • the patient data include the so-called master data of the patient such as name, first name and date of birth, the medical findings and initiated or already completed medical or nursing measures.
  • measures are also referred to below as medical measures.
  • the medical findings are usually laboratory results, such as heart disease relevant measurements such as the myoglobin value, the troponin I value and the CKMB value; in respiratory diseases relevant measurements such as
  • the data stored in the patient data management systems are transferred to the system by the persons treating the patient as well as by the laboratory personnel via standardized interfaces (in hospitals HL7, in practices xDT) entered and made available to the practitioner on request.
  • the object of the invention is to eliminate the disadvantages of the prior art.
  • a method for monitoring the medical condition of a patient is to be specified, which makes it possible to check the success of medical measures taken and thus proper medical treatment, which may involve a significant reduction in the treatment time of a patient.
  • a system for carrying out this method is to be specified.
  • step (d) assigning the category to which the medical intervention has been assigned in step (c) to one of the detected physiological parameters characteristic of the existence of a health disorder
  • the medical measure taken is the administration of a drug, in particular the administration of a drug.
  • the categories are preferably formed on the basis of predetermined features, which are each only a part of the potential medical measures zueigen.
  • Such features include, for example, the active ingredient of the drug, the drug class of this drug and / or the intended pharmacological effect of this drug.
  • step (b) For each medical measure to be taken for a particular patient, the beginning of the medical procedure is recorded. Appropriately, however, further information on this medical measure in step (b) are recorded. Such further information may be selected from the group which includes, for example, the intended end of the medical procedure taken, the actual end of the medical procedure taken, the name of the prescribed drug, the pharmacological parameters such as the dosage form, the dose, the frequency of the dose per day and the time distribution of the dosage over the day and the change in the dosage over a given period of time, as well as combinations of these indications.
  • the so-called therapy goal in addition to the medical measure name that is taken by a practitioner for a particular patient, also the goal of this medical measure is detected, the so-called therapy goal.
  • the goal of a medical procedure will usually be to change one or more of the parameters continuously acquired in step (a) in a given period of time.
  • the practitioner can therefore specify together with the medical measure name in which period of time a parameter predetermined by him reaches a specific value (also referred to below as the target value) or a specific range (also referred to below as the target range). Whether the predetermined parameters reach the target value or the target range is continuously checked during the continuous acquisition of the values of the predetermined parameter or parameters in step (a).
  • the continuous check reveals that the target value or the target range has not been reached within the specified time period, an alarm will be issued after the period has elapsed, indicating that the intended medical device did not succeed.
  • the practitioner is advised that a review of the action is required. For this, the practitioner must decide whether the medical measure should continue unchanged or whether another medical measure should be taken. Should the practitioner consider that the medical measure already taken should be continued, in one embodiment of the invention he will be prompted by means of a message to confirm the existing target value or the existing target range or to specify a changed target value or a changed target range which are to be achieved in a time period also specified by him.
  • This embodiment of the invention offers the advantage that the medical measure taken is subjected to a success check.
  • any medical action taken is simply continued because the responsible clinician is no longer aware that such a measure has been taken.
  • This practice is not only associated with unnecessary costs, but also with a health risk for the patient.
  • the proposed procedure is intended to induce the practitioner, at the same time as the meeting of the medical intervention To formulate therapeutic goal and to control the achievement of this therapeutic goal.
  • the practitioner can specify the target value or the target range of the parameter (s) that the practitioner wishes to influence with the medical measure taken based on his or her specialist knowledge. Alternatively or additionally, suggestions can be made to him. Such suggestions can be presented to the practitioner for example in the form of a listing. The suggestions are based on values taken from databases containing target ranges and target values. These target values and target areas preferably take into account the age and / or condition of the patient.
  • a body temperature of 36.7 0 C Under a target value, for example, a body temperature of 36.7 0 C, below a target range, a body temperature of less than or equal to 36.7 0 C ( ⁇ 36.7 0 C) or from 36.7 to 37.5 0 C understood.
  • a period can be understood as a period of 24 hours or seven days.
  • the therapy target of an antipyretic agent such as acetaminophen may be to within 24, the values of the parameter h body temperature to a target region from 36.7 to 37.5 0 C lower.
  • the medical measure in step (b) is assigned to a parameter for which a therapy goal is predetermined.
  • the name of the prescribed drug is recorded, with the name of the prescribed drug indicating the category of medications referring to a database in which the name of the medicinal product is linked to at least one of the characteristics of the active substance, active substance group or intended pharmacological action.
  • the indication of the name “Nebilet” or the name “Lobi- of” with the active ingredient “nebivolol”, the drug group “ß-adrenoreceptor blocker” and the pharmacological action "lowering of pulse rate and blood pressure” be linked.
  • step (e) in addition to the associated physiological parameter, for example, the category " ⁇ -adrenoceptor blocker" formed on the basis of the "drug group” feature would be displayed
  • step (b) the clinician may call details of the prescribed medical procedures, which may be used in step (b) to determine whether a ⁇ 1-adrenoceptor blocker has been prescribed, and which ⁇ 1 adrenoreceptor blocker actually is ) have been detected.
  • the assignment of a medical measure to a category in step (b) is preferably carried out automatically, ie, that the practitioner does not have to make the assignment of the action taken by him himself. Rather, it is automatically determined on the basis of the measure taken to which category this measure is assigned.
  • the physiological parameter to which the category is assigned in step (d) is the same parameter as the physiological parameter to which the medical procedure in step (b) has been assigned.
  • the physiological parameter to which the category is assigned in step (d) is a physiological parameter other than the physiological parameter to which the medical measure in step (b) has been assigned. The latter embodiment may be particularly advantageous in view of the broad spectrum of action of numerous drugs.
  • ⁇ -adrenoreceptor blocker For example, if a clinician prescribes a ⁇ -adrenoreceptor blocker to lower blood pressure, it may affect the patient's liver function. In this case, it may be advisable to associate the category " ⁇ -adrenoceptor blocker" not only with blood pressure readings but also with physiological parameters related to the liver function of the patient, for example glutamate pyruvate readings Transaminase (GPT).
  • GPT glutamate pyruvate readings Transaminase
  • the category and the associated physiological parameter (s) are represented in a diagram whose abscissa represents time, in which diagram measured values of the associated physiological parameter and the category of the measure taken are represented.
  • the category is expediently shown in the diagram as a bar that runs parallel to the abscissa, wherein in particular the beginning of the measure is shown as a bar beginning in the diagram.
  • the representation of the category for example the bar, ends in the diagram.
  • the category of action taken is shown as a color coded bar, the color coding is linked to the given feature.
  • physiological parameter is meant a value indicating (a) the measurement of a measured physiological characteristic of a patient or indicator substance (e.g., the oxygen partial pressure in a blood gas analysis, respiratory rate, body temperature, CKMB concentration); and (b) may include a classification of a physiological condition of a patient (eg, yellowing of the facial skin).
  • a measured physiological characteristic of a patient or indicator substance e.g., the oxygen partial pressure in a blood gas analysis, respiratory rate, body temperature, CKMB concentration
  • indicator substance refers to compounds or elements which, depending on their nature, are produced in biological systems or introduced into biological systems and their presence or their concentration (eg in a particular organ) Characteristic of a biological process or a biological state.
  • Such compounds and elements include, for example, those produced by tumor cells, induced by a tumor in other body cells and / or altered as tumor-specific substances in their concentration by a tumor.
  • Such indicator substances are, for example, macromolecules, eg. As proteins, or trace elements.
  • Such compounds and elements further include bonemarkers that are characteristic of bone degradation processes such as osteoporosis.
  • value refers to all numerical values for a physiological parameter (for example an oxygen partial pressure) arising in the medical field (a) (on classification results of a physiological condition of a patient at a blood gas analysis in the amount of 81.2 mmHg, a respiratory rate of 15 breaths per minute, a body temperature of 36.8 0 C, CKMB concentration of 152 ng / ml) or (b) z B. yellow coloration of the facial skin: no, whereby classifications should be assigned a numerical value, for example "0", by means of statements such as "no").
  • a physiological parameter for example an oxygen partial pressure
  • At least the values of one of the physiological parameters that are characteristic of the presence of a health disorder are determined using an indicator substance.
  • Physiological parameters should be chosen that are believed to be related to a particular health condition, such as respiratory failure, based on medical evidence.
  • physiological parameters are used, which are obtained by means of a blood gas analysis.
  • the physiological parameters obtained by the blood gas analysis may include the pH of the blood, the oxygen partial pressure of the blood, the carbon dioxide partial pressure of the blood and the oxygen saturation of the blood.
  • Other physiological parameters that can be used in the method according to the invention in addition to the values derived from the blood gas analysis for estimating the medical risk of respiratory insufficiency include the patient's respiratory rate (AF) and the age and sex of the patient.
  • the number of different physiological parameters whose values are detected in step (a) should be at least 2.
  • medical intervention includes any medical or nursing intervention that is undertaken to improve the patient's health, for example to bring one or more of the sensed physiological parameters into a range that is typically present in healthy individuals.
  • the medical measures taken can also be recorded continuously, d. H. Any further action, modification of an existing measure (eg dosing of a drug) and / or the actual end of a measure will be recorded.
  • an additional step may be provided in which the completeness of the data is checked.
  • the verification of the completeness of the data can be done continuously. Alternatively, it is performed after each elapse of a predetermined period of time, for example, every four, eight, sixteen, and / or twenty-four hours. These periods may correspond to the shift duration or a working day of the hospital.
  • the data is considered complete if it complies with the medical requirements, in particular the medical measures taken, as well as the physiological parameters and other information to be recorded in accordance with the hospital's general requirements and the doctor's specifications in particular.
  • expected data The data to be collected according to the medical prescriptions are also referred to as “expected data” in the following, since their acquisition is expected according to the medical prescriptions, and individual expected data are referred to as “expected data”.
  • the data actually collected is compared with the data to be recorded according to the medical specifications.
  • the collected data is assigned to the expected data. If, for example, the detection of the oxygen partial pressure is expected, then the actually measured and detected value of the oxygen partial pressure is assigned to the expected value.
  • Each expected indication may be associated with one or more times, indicating when a value for the expected indication is expected.
  • the comparison of the acquired data with the expected data either results in (i) that all expected data also correspond to detected data, ie that all expected data has also been acquired; that (ii) only a part of the expected data also corresponds to acquired data, ie that only a part of the expected data has also been detected while another part of the expected data has not been detected; or that (iii) none of the expected data speak, that is, that none of the expected data has been detected.
  • a warning is preferably issued after a predetermined time interval.
  • the fields in the screen display can be provided, for example, with a color coding.
  • the color of the field border and / or the field label is changed when one of the cases (ii) or (iii) occurs.
  • a warning is issued only at the predetermined time periods, that is, every four, eight, sixteen, and / or twenty-four hours to avoid a persistent warning, each for a different expected indication. In other words, if a check of the completeness of the collected data is given after four hours, no warnings are issued beforehand, even if the specification has not been fulfilled at an earlier time, for example one hour before the expiry of the four-hour period ,
  • the warning is given by color coding of the respective areas of the guard arch shown on the screen, in which the expected indication, for which no data has been collected. No warnings will be issued for the individual fields in which an expected specification has remained without entered data.
  • expected information is summarized according to predetermined criteria. Such areas include, for example, "perfusion,””infusion,” and “bedsores,” each of which includes multiple expected dates. It can be provided that by selecting such an area on the screen, a documentation sheet can be called by then the expected indication, for example by color coding, for which no data has been detected.
  • a system for monitoring the medical condition of a plurality of patients in accordance with the method of the present invention.
  • the system comprises a processor, a memory, an input device and a display device, wherein
  • the input device allows the user to specify the medical measures taken for each patient
  • the processor associates the taken medical procedure with a presumptive category and assigns the category to one of the detected physiological parameters characteristic of the existence of a health disorder
  • the display device represents the category and the associated physiological parameters together and time-dependent. Furthermore, databases for the categories and predetermined features for forming the categories can be stored in the memory.
  • the system may further comprise means for checking the completeness of the data.
  • the system can be a computer-implemented system.
  • FIG. 1 shows a schematic representation of a first embodiment of the method according to the invention
  • Fig. 2 is a schematic representation of a screen image of the display device according to the invention.
  • Fig. 3 is a further schematic representation of a screen image of the display device according to the invention.
  • FIG. 4 is a schematic representation of a second embodiment of the method according to the invention.
  • FIG. 5 shows a schematic representation of a screen image of the display device according to the invention.
  • Fig. 6 is a further schematic representation of a screen image of the display device according to the invention and Fig. 7 shows a schematic embodiment of a third embodiment of the method according to the invention.
  • a plurality of physiological parameters of a patient P are detected. 1.
  • a practitioner A for example a physician, now makes a medical procedure with regard to the condition of the patient P, which is reflected in the physiological parameters recorded reflects. This can be the prescription of a drug.
  • the medical measure that has been taken for a particular patient by the practitioner is detected by the system according to the invention, for example via an input device 2.
  • the practitioner will associate the medical procedure with at least one of the sensed physiological parameters to be influenced by medical intervention.
  • the medical measure taken is then assigned to a predetermined category 3.
  • the category is then assigned to one of the detected physiological parameters, usually the physiological parameter to be influenced by the medical action taken.
  • the category and the associated physiological parameter are displayed jointly and time-dependent on the display device of the system according to the invention 5.
  • Screens 11 of the display are shown in Figures 2 and 3.
  • a part of the detected physiological parameters is shown, namely the body temperature (Temp [ 0 C]) of the patient whose leukocyte count (Leuk / B [nl]), the heart rate (HF [min “1 ]), the respiratory rate (AF [ min "1 ]), the arterial carbon dioxide partial pressure (pCO2 [mmHg], the Horovitz quotient (paCO2 / FiO2 [mmHg]) and the concentration of the C-reactive protein (CRP [mg / 1]).
  • the physiological parameter 12, ie the leukocyte count, is plotted as a function of time representing the abscissa.
  • the physiological parameter 12 is the associated parameter (step d) in the sense of the present invention.
  • This physiological parameter is linked to a medical measure taken, as shown by the bar 13.
  • the bar 13 reveals with respect to the abscissa the beginning 14 and the end 15 of the taken medical measure.
  • the medical measure is assigned to a specific category, as can be seen from the hatching of the bar 13, which stands for a particular color coding.
  • the aim of the medical measure was to combat bacterial inflammation the leukocyte count diagram as assigned physiological parameter 12 that the prescription of the active ingredient "cefuroxime” had the following effect: the inflammation was successfully combated at times, which is reflected in the fall in the measured value.
  • further medical measures taken and physiological parameters associated therewith can be displayed simultaneously with the medical measure shown in FIGS. 2 and 3 and their associated physiological parameters.
  • FIG. 4 shows a second embodiment of the method according to the invention, which corresponds to the first embodiment (see FIG. 1), except that a check of the detected data for completeness is additionally carried out. 6. If the detected data prove to be incomplete, then a warning is issued 7.
  • Fig. 5 and 6 a screen 11 is shown, which reproduces a Wachbogen. The fields of the guard arch are divided into areas 21, in which several expected information is summarized. The areas are labeled 22 and color-coded. If the check after the predefined period of time reveals that the detected data are incomplete, the color of the inscription 22 of the area 21 and the color of the border 23 of the area 21 changes.
  • FIG. 5 shows the screen image 11 before the verification 6. while in Fig. 6, the screen display 11 after the review 6 is shown.
  • the areas 21 each have a black inscription 22 and a black border 23. It can be seen in Fig. 6 that warnings have been issued 7, which is represented by the respective white border 23 of the affected areas 21. Alternatively or additionally, a white inscription 22 of the affected areas 21 would also be possible.
  • the screen 11 corresponds to this - apart from the labeling and color coding of the areas 21 - the Wachbogen that the hospital commonly used.
  • the practitioner not only takes a medical measure 2 a that is detected by the system (2) but also specifies the goal that linked to this measure (6).
  • This goal is the goal of the therapy and includes the specification of the target value or range of the one or more parameters to be continuously recorded (1) and to be influenced by the medical intervention (2) and the period within which the target value or - area is to be achieved.
  • the therapy goal is detected by the system (7).
  • the continuously recorded values of parameters (1) for which a therapy goal has been formulated are continuously checked to determine whether the therapy goal has been achieved (8). If the target value or range has been reached within the predetermined time period, a message is generated which indicates to the practitioner that the therapy goal has been achieved. The practitioner is asked to end the medical procedure, to change or to formulate a new therapeutic goal. If the predetermined period has expired without the therapy goal having been achieved, a message is generated which indicates this to the practitioner (10). The practitioner is asked to end the medical procedure, to change or to formulate a new therapeutic goal. LIST OF REFERENCE NUMBERS

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Epidemiology (AREA)
  • General Health & Medical Sciences (AREA)
  • Medical Informatics (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • Biomedical Technology (AREA)
  • Business, Economics & Management (AREA)
  • General Business, Economics & Management (AREA)
  • Chemical & Material Sciences (AREA)
  • Bioinformatics & Cheminformatics (AREA)
  • Medicinal Chemistry (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)

Abstract

L'invention concerne un procédé de surveillance de l'état médical d'un patient, comportant les étapes suivantes: (a) détection continue de valeurs de paramètres physiologiques du patient, au moins une partie des paramètres physiologiques caractérisant la présence d'un trouble de santé; (b) détection des mesures médicales prises pour chaque patient, au moins l'instant de départ de la mesure médicale étant détecté pour chaque mesure médicale, et la mesure médicale étant affectée à au moins un paramètre physiologique détecté destiné à être influencé au moyen de la mesure médicale; (c) affectation de la mesure médicale prise à une catégorie prédéfinie, chaque catégorie comportant une pluralité de mesures médicales potentielles; (d) affectation de la catégorie à laquelle la mesure médicale à été affectée à l'étape (c), à un paramètre physiologique détecté caractérisant la présence d'un trouble de santé; et (e) représentation commune, en temps, de la catégorie et du paramètre physiologique affecté.
EP09776001A 2008-07-24 2009-07-23 Procédé de surveillance de l'état médical d'un patient Ceased EP2318968A2 (fr)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
DE102008034736A DE102008034736A1 (de) 2008-07-24 2008-07-24 Verfahren zur Überwachung des medizinischen Zustandes eines Patienten
DE102008059901A DE102008059901A1 (de) 2008-12-02 2008-12-02 Verfahren zur Überwachung des medizinischen Zustandes eines Patienten
PCT/DE2009/001027 WO2010009717A2 (fr) 2008-07-24 2009-07-23 Procédé de surveillance de l'état médical d'un patient

Publications (1)

Publication Number Publication Date
EP2318968A2 true EP2318968A2 (fr) 2011-05-11

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EP09776001A Ceased EP2318968A2 (fr) 2008-07-24 2009-07-23 Procédé de surveillance de l'état médical d'un patient

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US (1) US20110191116A1 (fr)
EP (1) EP2318968A2 (fr)
WO (1) WO2010009717A2 (fr)

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102010027486A1 (de) * 2010-07-16 2012-04-12 Löser Medizintechnik GmbH Verfahren zur Überwachung des medizinischen Zustandes eines Patienten
US11090003B2 (en) * 2013-09-09 2021-08-17 Healthy.Io Ltd. Systems for personal portable wireless vital signs scanner

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US8589174B2 (en) * 2003-12-16 2013-11-19 Adventium Enterprises Activity monitoring
CN1942891A (zh) * 2005-02-07 2007-04-04 松下电器产业株式会社 健康管理支援装置

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US20060206066A1 (en) * 2005-03-10 2006-09-14 Bozidar Ferek-Petric Communications system for an implantable device and a drug dispenser

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Publication number Publication date
WO2010009717A2 (fr) 2010-01-28
US20110191116A1 (en) 2011-08-04
WO2010009717A3 (fr) 2010-06-17

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