Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
  • A61B5/0015—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by features of the telemetry system
  • A61B5/0022—Monitoring a patient using a global network, e.g. telephone networks, internet
• • 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
  • G16H40/67—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 remote operation
• • G—PHYSICS
  • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
  • G16Z—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS, NOT OTHERWISE PROVIDED FOR
  • G16Z99/00—Subject matter not provided for in other main groups of this subclass
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/0002—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network
  • A61B5/0004—Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network characterised by the type of physiological signal transmitted
  • A61B5/0008—Temperature signals
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
  • A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
  • A61B5/021—Measuring pressure in heart or blood vessels
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
  • A61B5/024—Detecting, measuring or recording pulse rate or heart rate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B5/00—Measuring for diagnostic purposes; Identification of persons
  • A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
  • A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
• • 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
  • G16H40/20—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 management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Definitions

• the vital data of the patients eg. As blood pressure, weight, ECG ... and forwarded to a so-called telemedicine center. This data is evaluated manually or automatically. The patients are looked after by the medical staff inside or outside the telemedicine center.
• a health monitoring system is known in which health-related data of a patient are collected. Based on this collected data, evaluations are made by a health center as to whether there is a need to change a patient therapy program.
• a patient-side terminal there consists of a handheld microprocessor with alphanumeric input and a display. About a data management unit monitor systems for
• Blood sugar can be connected.
• US Pat. No. 6,224,805 B1 discloses a monitoring system for patients which regularly retrieves health data and also interacts with the patient via an interrogation program.
• contacts to a medical center can be reduced (gain in efficiency) or additional measurements / information queries can be arranged on site for the patient in order to enable a more appropriate treatment.
• additional measurements / information queries can be arranged on site for the patient in order to enable a more appropriate treatment.
• Vital data can only be meaningfully interpreted. For vital data, their absolute value is not decisive. The crucial information is derived from the trend and the context. Since a very high number of patients is older or multimoboid, a user-friendly interaction is clearly a surplus value for the acceptance and ultimately a decisive factor for the medical success of a telemedical application.
• the patient's vital data is linked to a patient profile and compared with thresholds that have been determined by the physician in order to detect deviations of the patient's condition from the desired target status.
• the patients can z. These can be divided into three levels (needing interaction, requiring interaction, ie interaction in a given timeframe and requiring strict interaction, ie immediate contact). This triage of patients can be done automatically or manually in a medical center.
• the medical center initiates further (medical) steps to provide the patient with advice, advice or instructions for medical treatment.
• a feedback is made to the patient from a telemedical center as to whether the vital data has been successfully transmitted and is valid. This gives patients the security of whether their measured values have been transmitted and are within a tolerable range. They may also be told in the feedback that someone will come to them from the medical center to help them with any necessary help.
• the medical staff within the medical center receives a kind of presorting of the condition of the patients, which goes beyond the simple exceeding of measured values. Emergencies can be filtered out so quickly. Contingencies and mistreatment are eliminated. It can provide system-based diagnostic and therapy guidance for simple treatment situations by non-medical personnel, such as B. use of a nurse instead of a doctor.
• the medical center is split into two instances in a suitable manner, with a first instance for routine support of the patient and a second instance for further support with additional infrastructure. This also contributes to the increase in efficiency, but also to a higher availability for the patient.
• the actual medical service providers get the possibility as "second level" technically very simple - ideally a PC
• the "First Level” covers all medical and / or technical queries of the patients and is the first communication instance for the doctors / nurses who are in private practice. treat it conventionally.
• the second level is initialized from the first level if medical or specialist advice is needed. This service does not have to be operated in the same place as e.g.
• the "second level” ideally consists of a combination of telemedicine center and conventional hospital infrastructure (hospital, doctors).
• a device For remote diagnostic monitoring and support of a patient, a device is provided with sensors and / or measuring devices for continuous
• a locating unit for the patient It is advantageous to integrate in the device a locating unit for the patient. This allows a patient to be tracked via RFID, GPS, Galileo, GSM or WLAN signals.
• Acoustic signal recording in the vicinity of the patient allows additional information to be transmitted to rescue personnel.
• the signal recording is automatic or can be unlocked by the medical center, can be switched in an emergency in the patient's apartment, this should not be able to reach a phone, etc. due to injury or bed rest.
• Figure 1 shows the structure of a base station and a medical center
• Figure 2 shows the process architecture in the base station and in the medical center.
• the remote diagnostic monitoring and support of the patient according to the invention is shown below using the example of heart failure.
• CHF Chironic Heart Failure
• sensors / sensor modules are being used in the direction of reducing and improving the wearing comfort with an increase in measuring accuracy / precision, eg in terms of accuracy.
• B. in scales sensors for recording previously not taken into account parameters, eg. B. activity of the patient, in particular through the use of microsystems technology and communication skills, z. B. via Bluetooth. Thanks to intelligent signal conditioning and processing, simple rules for medical interpretation of the measurement results are used, eg. B. Pattern recognition for automatic diagnostic support.
• the process efficiency can be increased as follows:
• the equipment of the patient-side device consists of Figure 1
• Sensors and / or measuring devices 1 for receiving different vital parameters a base station 2 for controlling the sensors 1, a signal processing of the recorded sensor / measurement signals and communication with a medical center.
• various sensors 1 are connected to the base station 2, or integrated into it, in order to record a plurality of measurement parameters, for Temperature, movement, pressure, weight, blood pressure, pulse.
• the devices and sensors must meet the living conditions and the condition of the patient (waterproof, disinfectable, shock-resistant, durable, inconspicuous against incorrect conditions, etc.). In terms of ergonomics, the devices / sensors are designed in such a way that they can be used by lay people, old people, sick people.
• the devices and sensors must be small, in many cases as directly as possible to be worn on the skin or under clothing.
• Two basic model variants are to be distinguished
• Measuring devices that do not require an additional base station ie transmit their signals directly to a telemedicine center; Measuring devices that communicate with a base station. The base station transmits the measured data to the medical center.
• Base station or in the medical center. There, the function of the patient terminal is controlled.
• Intelligent terminal Significant signal processing and evaluation is performed on the patient. Possible feedbacks can be carried out immediately. Only processed data will be passed on to the medical center.
• Figure 1 shows the second variant, d. H. an intelligent terminal / base station 2. There, the continuously recorded / measured vital data of the
• Sensors / measuring devices 1 are signal-technically interpreted in an evaluation device 3 and evaluated with respect to their course and the context in which they were recorded / measured.
• the evaluation is based on a stored in a memory 4 therapy plan, z. B. according to the European Society of Cardiology by CHF.
• the treatment plan is based on the measured values in a gikbaum automatically gone through.
• the adaptation of the measured values to the therapy plan takes place either sequentially or in parallel.
• Discrete values (constants, vectors, tensors) from a precise and reproducible signal evaluation with algorithms can be interpreted and compared in order to obtain a statement about the state or progression of the patient 's state of health
• the necessary signal evaluations may be, for. Example, a filtering of the raw data via a Fourier transform or a kernel (matrix operations) in signal patterns.
• the first derivative is currently to be formed by a regression function of temporally successive measured values, which can be obtained via iterations of polynomials.
• complex signal patterns eg. B. ECG
• self-learning algorithms can be used, for. B. non-linear mathematical methods.
• the body weight which was hitherto not very meaningful, is important, since these patients can be determined by certain patterns in the weight change water retention, indicating a worsening of the disease. This requires correspondingly sensitive scales (piezo elements), which should exceed the accuracy of commercially available personal scales by a factor of ten.
• vitamin data such as blood pressure, pulse activity, weight, ECG, oxygen saturation (SpG ⁇ ) are recorded over the time t, signal interpreted and evaluated, in particular filtered, Fourier transformed, subjected to a trend determination, on the first derivative of the value curve or an analysis of a complex signal pattern is performed and a value assignment of a pattern, e.g. Eg via self-learning iteration steps.
• the base station 2 contains a unit 6 for preparing a protocol of transmission data on the basis of the weighted vital data for the evaluation in the medical center 11. It also contains a unit 7 for signaling whether further vital data or information inputs are required on the basis of the evaluation and to signal whether the vital signs are valid and successfully transmitted.
• the signaling unit 6 consists of a display, possibly in conjunction with an acoustic output, possibly vibration alarm. This can also be used for feedback from the medical center 11.
• an input unit 8 For input of patient-side information, an input unit 8 is provided.
• the unit 6 for the preparation of transmission data is advantageously also set up to receive information by the medical center 11.
• the received information is forwarded on the one hand to the memory 4 for the possible updating of the therapy plan and on the other hand to the signaling unit 6 for visual display on a
• an acoustic recording device 9 is provided, in particular in the event that the patient is not able to actuate the input device 8. Then at least one cry for help and / or breathing sounds can be recorded.
• the receiving device 9 can also be automatically unlocked from the medical center 11 and also be coupled to a video camera to directly monitor the patient in the absence of inputs or emergencies.
• the base station 2 advantageously has a locating unit 10, which is also effective within buildings.
• a locating unit 10 which is also effective within buildings.
• locating methods eg. GPS, RFID, Galileo, WLAN.
• the data transmission from a base station 2 to a medical center 11 as well as the feedback from the medical center 11 to the base station 2 can be made via the landline or radio using conventional methods, e.g. B. GSM, GPRS, UMTS, ISDN, DLS, PSDN with the interposition of a telecommunications tion providers 12.
• Conventional medical service providers such as family doctor 13, emergency services 14, pharmacies 15 can be integrated into the data transfer via the transmission network 16.
• Such encryption is also suitable for the data transfer between sensors and / or measuring devices 1 to the base station 2.
• the telemedical center 11 is the central platform for the integration of all technical functions and procedural processes. In detail, this includes:
• Communication, call and data acceptance, forwarding Control of all communication channels (voice, data, video); Control of automatic data acquisition at the patient; Linking the evaluation of the measured data to a treatment plan;
• Ensuring the exchange of data with other health care providers eg. As a registered doctor, pharmacist, etc. about an electronic medical record (e-file) or electronic medical records.
• the process sequence in detail starts according to FIG. 2 with the data acquisition at the patient. Readings communicate the patient's values to the Smart Medical Logic at the medical center, which, if needed, enables the intervention of non-medical medical and medical staff at the medical center. These three Instances communicate with a local technical service or local medical service providers who support / treat the patient.
• Patients are categorized by the Smart Medical Logic into triage in the "non-interacting", “normal interaction” status within a given timeframe and “immediate interaction necessary” (emergency), which is followed by the operation of an automated control center with telemedicine workstations (PC workstations) possible to optimally utilize the resources of the medical center - extended individualized therapy function:
• the Smart Medical Logic provides a learning system due to the possibility of directly tracking therapeutic plans in their effect on the patient Adapting therapy measures or developing new forms of therapy in principle (feedback).
• the base station 2 has a simple structure, the evaluation described above, such as trend analyzes, analysis of complex signal patterns, shifts to the medical center 11.
• Previous medical centers usually provide only one call center, usually with only general advice Function for the patient. There is no automated integration with current measurement data and analyzes of the health status of the patient.
• the telemedical center 11 ensures this integration. For this purpose, it integrates the patient via bidirectional contact via status displays, text messages or telephone functions.
• a telemedical workstation (PC work station) 19 in the medical center 11 uses for patient care the stored data / values in the electronic patient database (electronic patient record 14).
• the Smart Medical Logic makes a preselection and corresponds to a telemedical workstation 19, e.g. Eg via an https-capable Java frontend.
• the Smart Medical Logic itself must be written in a non-object-oriented programming language.
• the data transfer between the PC workstations 19 and the linking device 18 is controlled via an application server 20.
• the workstation 19 comes into contact with the conventional service providers (hospital, specialist, private practice, emergency medicine and pharmacy) on the medical side.
• the activities on the patient and current patient data can be viewed by the leading physician (supervising specialist or general practitioner).
• the insight is active z. For example, e-doctor's letters, e-prescriptions as well as a direct call through the medical center in an emergency. Passively, the doctor can inform himself about secure and authorized access to the electronic patent file (e-file).
• the transmission protocols with evaluated vital data of the patients received via the telecommunication device 21 are linked in the linking device 18 with the aid of the already stored patient data in the electronic patient database 14 to a patient profile by means of threshold values in order to deviate the patient's condition from a previously determined one based on the stored patient data To recognize the target state and to decide whether the evaluation of an interaction with a patient immediately, in a given time frame or not required.
• This decision is displayed in the form of a feedback in the base station 2, as well as to the workstations 19 reported to the TM agents and, if necessary, transmitted to the service providers 13, 14 and 15.
• a translation is also made into a diagnosis and a treatment plan. If necessary, a change in the treatment plan based on the current evaluation in the medical center is made. If the base station is an intelligent terminal, this changed therapy plan is transmitted to the base station 2 and stored in its memory 4 and used for the evaluation by the evaluation device 3.
• the medical center 11 is divided into different instances.
• the "first level” service covers all medical and / or technical queries of patients, and is the first point of communication for doctors / nurses, in particular, who treat patients conventionally "initialized if medical or specialist advice is needed, this service does not need to be operated in the same place as the" first level ".
• the "second level” ideally consists of a combination of a telemedical center and a conventional hospital infrastructure (hospital doctors).
• FIG. 2 The entire process architecture with data flows is shown in FIG. 2 in an overview.
• Base station 2 powered by the meters and sensors.
• the patient provides information about this.
• the patient file (e-file) is supplied by this data and kept in the medical center 11.
• This smart medical logic SML is essentially located in the medical center 11, but may also be partially integrated into an intelligent base station 2.
• Remote medical services and technical support are located at the Medical Center 11. Downstream services such as local technical support, on-site care, medical attention, emergency medical service, are arranged by the medical center according to the decision (medical assistance necessary in the action).

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• Health & Medical Sciences (AREA)
• Engineering & Computer Science (AREA)
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• Life Sciences & Earth Sciences (AREA)
• Public Health (AREA)
• General Health & Medical Sciences (AREA)
• Medical Informatics (AREA)
• Molecular Biology (AREA)
• Computer Networks & Wireless Communication (AREA)
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• 2008
  • 2008-12-10 DE DE102008054442A patent/DE102008054442A1/de not_active Withdrawn
• 2009
  • 2009-10-30 WO PCT/EP2009/064353 patent/WO2010066507A1/de active Application Filing
  • 2009-10-30 CN CN2009801494275A patent/CN102245084A/zh active Pending
  • 2009-10-30 US US13/133,632 patent/US20110301429A1/en not_active Abandoned
  • 2009-10-30 CA CA2743658A patent/CA2743658A1/en not_active Abandoned
  • 2009-10-30 EP EP09748313A patent/EP2375964A1/de not_active Withdrawn

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