GB2249851A - Point-of-care medical computer system - Google Patents

Description

1 2 2' - t. 9- 3 ') 11 POINT 1 OF CARE NURSING SYSITM.

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 1 - 1 FIELD OF THE INVENTION

This invention relates to data systems for hospital operation and particularly to a method of operating point of care data terminals. BACKGROUND OF THE INVENTION

Hospital administration staff have attempted to control costs associated with operation of hospitals by implementing computerized administration systems, including bookkeeping systems, material control systems, etc. Such systems, however, require manual input of data into computers from stock control forms, equipment usage forms, time sheets, etc. filled in by hospital staff. This has been prone to error because it depends on the memories of fallible persons, sometimes imperfect diligence in completing the forms by often over-worked personnel, etc.

The main function of a hospital, that of patient care, has resisted efficiency introducing machines. The patient care system typically operates with a doctor prescribing tests and courses of treatment, which are carried out by caregivers such as nurses (hereinafter referred to generally as nurses). In this case also, due to human fallability, the times of administration of treatment or tests, completion of all tests, and erroneous recording of the results of tests sometimes occurs, which can have dangerous effects arid legal consequences. The collection of data tabulating the quantities of medicines used, the labor involved, arid other costs associated with specific patient care is done manually by the nurse recording it on paper, which is prone to error.

The present invention substantially automates the above functions providing to the nurse a portable electronic terminal, referred to herein as a point-of-care terminal,'that displays on command tests and courses of treatment for an identified patient.

01 02 03 04 05 o6 07 08 09 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 38 1 - 2 The nurse performs the tests and/or treatments, and enters the results of the tests directly into the terminal, the system recording the entered data in a standardized format. The system can confirm the treatment steps and test results already entered, and can warn her of entries outside of predetermined thresholds. This can reduce the incidence of error in tests and treatment, making the job of the nurse easier. The data is recorded in a computer to which the portable terminal is connected arid can be collected by the hospital administration computer. DESCRIPTION OF THE PRIOR ART

A medical information system which standardizes treatment steps is described in the article "Medical Data Dictionary for Decision Support Applications" by S.M. Huff et al of AT&T Bell Laboratories, pp 310-317, 1987 SCAMC, Inc. In this system, precise names of functions performed by the nurse or doctor, are input into a terminal. The article promotes the definition of a standard medical dictionary for use in a medical care electronic information system. The system described utilizes individual pages defining events which are input from a nursing station, each event being a "happening" relating to a patient, such as writing an order for a medication, the occurrence of pain, the birth of a child, a surgical procedure, etc. Attributes are associated with each event, which are qualitative and quantitative descriptors of the event, with a time of occurrence of the event and a time of recording of the event. Associated with each recorded event is the name or definition of a particular patient or relative of the patient. operation of the system requires positive recording of the event in the course of treatment of a patient at a central nursing station by personnel who must be t rained in the use of database systems. The nurses must know the course of treatment i i j i i i i J i 01 02 03 04 05 06 07 08 09 10 11 12 13 14 is 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 38 1 - 3 of a patient, which is described to them in the traditional of manner. The nurse simply inputs at the nursing station what has occurred according to a written schedule of a course of treatment, or other occurring events involving the patient, and from tests and their results written on paper.

The above-described system contains several disadvantages. Firstly the system by which the nurse gives care to the patient remains exactly as it has always been, that is. that the functions performed by the nurse are recorded by spelling out what functions have been performed. The recording is done at a nursing station at a central location. The nurse first records on paper the results of tests performed, which is then typed into the nursing station computer. Therefore some tests can be missed and errors can occur.

Secondly, and importantly, a standard dictionary of terms must be used when the information is typed into the computer for the system to work properly. Misspellings, non-standard (but otherwise understandable) words used by the nurse, result in data which is riot accepted or if accepted by the system, cannot be collected by a central computer which expects to receive standard terms. The learning of a set of standard terms from which the nurse may not deviate puts additional burden on the nurse, rather than a relief from burden.

Thirdly, all of the data of a group of patients is input into one central location. This provides a significant opportunity to make errors and to miss the inputting of data since nurses are typically busy arid sometimes are subject to emergency distractions. Therefore data recorded on paper by the nurse may riot be entered into the central computer until long after it is needed by an administration computer, or it may be missed completely.

1 01 02 03 04 05 06 07 o8 09 11 12 13 14 15 16 17 18 19 20 21 22 24 25 26 27 28 29 31 32 33 34 35 36 37 38 SUMMARY OF THE INVENTION

The present system, as noted above, includes a small portable point-ofcare terminal carried by the nurse which is used by the nurse to input the test results data and treatment steps such as quantities and types of medicines used right at the location and the time of the tests or administration of treatment. The nurse need not memorize or input standard names of medicines or other medical terms. Further, the nurse need not have a written description of the course of treatment or test which she is to administer on a patient. The exact list of treatment and the exact tests prescribed by the doctor are displayed on her portable terminal and she need merely fill in the blanks of numbers which are the results of tests or quantitites of the medicines shown on her display. She can also invoke and input standard nursing notes. The data input for each treatment or test and nursing notes are automatically transmitted to a central location, such as a nursing working station, for central storage. Each input is stored in association with art automatically generated time entry. The entire sequence of tests, treatment and results or specific categories thereof can be displayed at the point of care terminal so that the nurse cart see what tests have already been administered, the results. and she can estimate trends if necessary.

The course of treatment for each patient is obtained after inputting a patient code number, as well as a security code associated with the nurse. The same portable terminal can therefore be carried from patient to patient, plugged into a local area network having terminal connectors adjacent each patient bed, for transmission of patient-specific data back to the central station. Therefore the number of point of care terminals need be only equal to the t 1 1 1 i i 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 1 number of nurses on duty at any particular time, and need riot be equal in riumber to the vastly larger number of patients receiving treatment in the hospital at a given time. Because the exact course of treatment is available to the nurse at all times on her local display using computer generated instruction terms, and because the results of treatments or tests are input directly into the portable terminal when performed, the intermediate step of marking the results on paper, resulting in errors and missed reports described earlier with respect to prior art proposed systems is avoided.

Because all input data is stored in association with a time indication, including separate corrections made to input data, a complete track of patient treatment is permanently recorded, which may be needed later formedical or legal purposes. Since there is no intermediate paper marking step, the possibility of losing or varying the origin document is avoided.

Because the exact course of treatment is described by computer, and the quantities of administered medicines and other supplies are directly input on the portable point-of-care terminal, data identifying materials arid medicines identification and quantities, and labor involved in treatment of a patient are clearly recorded automatically in a standard format in the central computer. As noted earlier this can be linked to the hospital administration computer, to obtain an accurate inventory track and cost base for treatment of each individual patient. This should substantially help in control of hospital costs, and increase efficiency of operation of the hospital.

The operation of the present invention is based on a novel method of operating a point-of-care terminal wherein there is a central library of predefined patient tasks stored in a central memory.

01 - 6 - 02 The library is comprised of electronic data storage 03 defining all expected possible tasks involving care of 04 a patient. Each of those tasks is herein called an event (which is distinguished in definition from the 06 form of "event" defined in the aforenoted article).

07 Each event contains a set of attributes. Out of this 08 pool of events, specific events relating to the care 09 of a particular patient forming a group of events, is selected to define the care to,be.iven to a specific 11 patient in an electronic kardexk, That group of 12 events, or one or more groups of groups of events, is 13 provided to the point-of-care terminal. The nurse 14 need merely display the list of events specific to an identified patient on the terminal and input the 16 results of tests carried out at times prescribed by 17 the doctor arid listed in the list of events shown on 18 the display of the terminal.

19 It should be noted that the pre-defined patient tasks can be easily modified to reflect 21 dynamic patterns within the nursing unit and hospital.

22 Stored event definitions required by 23 several patients are used in common. Attribute 24 definitions, defining the events themselves, are used in common by plural events.

26 To provide the above, an embodiment of the 27 invention is a method of operating a point of care 28 terminal comprising storing in an electronically 29 accessable memory associated with a central computer terminal a library of data defining a large number of 31 generic patient care events. Data corresponding to 32 certain ones of the care events specific to the care 33 of a particular patient is selected from the libary.

34 A signal corresponding to an identifier of the particular patient is input into a point of care 36 terminal which is in electronic communication with the 37 central computer terminal. At least one group of the 38 selected data specific to the patient is provided to 1 1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 the point-of-care terminal from the central computer terminal in response to the inputting step. The at least one group of data is displayed at the point-ofcare terminal, which defines a group of care events. After performing tests on the patient corresponding to the events displayed, the nurse inputs data resulting from the tests into the point-of-care terminal relating to at least certain ones of the group of data defining the group of care events. The data is transmitted to the central terminal, and is stored at the central terminal for subsequent access.

Another embodiment of the invention is a method of operating a point-ofcare terminal comprising establishing a specific patient related electronic kardex formed of data signals defining a group of individual patient care events, each care event being defined by a predetermined collection of possible attributes therefor, each attribute defining a characteristic of the event, selecting particular attributes for a corresponding event related to the specific patient, and displaying the care events with the selected attributes at a point-of-care terminal, whereby an individual care program specific to the patient is displayed to a care giver. BRIEF INTRODUCTION TO THE DRAWINGS

A better understanding of the invention will be obtained by reference to the detailed description below, in conjunction with the following drawings, in which:

Figure 1 is a block diagram of a system incorporating the invention, Figure 2 is a more detailed block diagram of specific parts of the system illustrated in Figure 1 for illustrating the invention, Figure 3 is a plan view of a point-of-care terminal preferred to be used to operate the 01 8 02 invention, and 03 Figure 4 is a block digram of the 04 point-of-care terminal of Figure 3.

DESCRIPTION OF THE PREFERRED EMBODIMENT

06 OF THE INVENTION 07 Figure 1 is a block diagram used to 08 illustrate the invention. A central computer station 09 1 which is used as a nursing station, has a printer 2 connected to it in a well known manner and is 11 comprised of a memory 3, 3A. The computer station is 12 connected to a local area network 4. Bridges 5 13 connect the local area network to branch local area 14 networks 6, which are terminated at connectors 7, each one preferably adjacent the bed of a patient. The 16 branch local area networks are preferably organized by 17 ward, so that the representative branch local area 18 network 6 at the left of the drawing serves e.g. a 19 nursing ward 1 while the branch local area network 6 at the right of the drawing serves representative 21 nursing ward 2.

22 Each nurse carries a point-of-care 23 terminal 8, which has a plug 9 that can be plugged 24 into any of the connectors 7.

A hospital administration computer 10 can 26 be connected to the local area network 4 to 27 communicate with station 1.

28 As a nurse makes her rounds, or otherwise 29 takes care of a patienty she plugs her point-of-care terminal 8 into connector 7 adjacent the patient. A 31 list of care events is displayed. She administers 32 medicines, performs tests, and enters the amount of 33 medicine arid results of the tests into point of care 34 terminal 8. In the list of care events, a schedule of medicines arid tests appears on a display of the point 36 of care terminal, which the nurse can call up by 37 depressing predetermined-buttons on the terminal. The 38 amount of medicines and results of tests are similarly 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 entered by pushing buttons on the terminal. This data is transmitted to terminal 1 for storage in memory 3.

A block diagram showing certain of the above elements is illustrated in Figure 2, in block diagram at the top with certain elements in more detail below. A nursing work station I having an associated memory 3, 3A is connected to point of care terminal 8. The nursing work station is connected to printer 2, which can generate reports 10 under control of the nursing work station 1, which can be a printout of the entire treatment schedule of a patient, including the times when administered arid quantities of various medicines used from data stored in memory 3A. The data supporting the report is also made available to the hospital administration computer which is also connected to the nursing work station 1 through the local area network 4j so that identification arid quantities of medicine, amount of nursing and other labor, equipment used, etc. can be tabulated for administration purposes.

An important aspect of the present invention is the organization of the memory 3. This provides means whereby the nurse can be efficiently instructed as to the care events to be undertaken and whereby she can enter the aforenoted results from storage without resorting to memorizing and inputting of standard medical nonenclature. The organization thus provides for efficient use of the point-of-care terminal. The memory 3 is divided into memory elements 12, each of which contains a data signal identifying a patient care event. The total of these elements define a care element library 11 which contains data signals identifying all possible care events. These events define the smallest meaningful unit of care or work involving a patient that can be performed. Each event is comprised of a set of attributes which describe individual characteristics 01 02 03 o4 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 - 10 of an event, as well as standard nursing notes, as will be described later.

Examples of care events are pulse, blood pressure, oncology assessment, psycho-social assessment, digestive system, heat and cold application, cardiovascular system, hemotology system, neurologic system, oxygen saturation... etc.

The memory 3 also contains memory elements 12A containing data signals defining generic attributes, represented by attribute library 13. The attribute library memory elements contain data representing e.g. site, temperature, degree of assistance, duration, frequency, test name, altered body image, volume of feeding, freque.ticy of feeding, method of deliveryt food record frequency, patient position, volume ingested... etc. Each care element is linked to usually plural attribute elements which define the care element. By maintaining a generic library of care element attributes, many of which are used in common to define particular care elements, a massive library defining each care element and each attribute, separately defined for each patient, is riot required. Since each separate care element and each separate attribute for each patient need riot be defined, the risk of error in definition is substantially avoided.

As an example of the association of standard care elements with standard care element attributes, for the care element "temperature", site and value are the care attributes. For the care element "blood pressure", the attributes are "diastolic" (pressure), "systolic" (pressure) and "site" (of measurement). The attribute definitions for diastolic and systolic pressures indicate that these pressures require numeric values in a specific range. The attribute definition for site includes alist of possible sites to be used.

01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 When a patient is admitted to the hospital, his course of treatment is prescribed by a doctor. The nurse at nursing work station 1 reserves a portion of memory 3, referred to herein as a patient electronic kardex 14. For example, if a patient A is admitted for a gallbadder operation, an electronic kardex 14 reserved for and specific to that patient A is established by control from the nursing work station. Figure 2 also illustrates kardexes for patients B and C.

The work station nurse, reading the prescribed course of treatment from the doctor's notes, and using her judgement, assessments, and hospital policies and procedures, enters in one memory cell of the kardex for that patient a data siqnal identifying the first care element, e.g. special preoperative nutrition, which would have the attributes definitions defining food diet. The second care element specified might be hourly psychological assessment, the third might be blood pressure every four hours, the fifth might be a special medicinal tranquilizer to be administered 6:00 a.m. the day of the operation, the seventh might be transport to operating room 7:00 a.m., the next might be observation of patient at 10 minute intervals following the operation for the first three hours, the next take blood pressure every half hour for first three hoursr etc.

Of course the invention is not limited to nursing oriented activity; all forms of clinical activity can be supported.

Thus a portion of the memory 3 is dedicated to the specific course of treatment of a patient, which course of treatment is formed of care elements, each one of which is formed of care attributes selected from the care element library 11 arid care attribute library 13 used in common by each 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 31 32 33 34 35 36 37 38 - 12 patient kardex particular care elements. The result is that each patient is assigned a separate electronic kardex.- The memory elements in each of the kardexes 14 can simply contain pointers to memory elements 12 which define the specific care elements. Each care element defined by memory element 12 can be comprised of pointers to various care attributes defined by data in elements 12A in the attribute library 13. In this manner there is substantially conservation of memory space and at the same time each patient can have its own individual course of treatment uniquely specified. In operation, the nurse plugs her point-of-care terminal 8 into the network, as described earlier with respect to Figure 1, and enters certain identification indicia, as will be described in more detail below, of the particular patient to be treated, and her passcode identifier. in response the nursing work station 1 accesses the memory 14, and causes display of the care event list relating to the identified patient on the point-of-care terminal display 8. The nurse can thus see which tests are to be administered. The nurse can also obtain a display of the complete history of the care element.

The nurse also select specific categories of care elements defined in kardex 14 to be displayed on her point-of-care terminal, as will be described below.

Figure 3 illustrates a preferred form of point-of-care terminal 8 for use in the invention. It is preferably comprised of liquid crystal display 15 and a plurality of pushbuttons, e.g. formed of calculator type keys 16 arid specialized function keys 17 arid 18.

When a nurse plugs the point-of-care terminal 8 into a connector adjacent a patient and has initiated communications as described earlier, and will be described in more detail below, and pushes the z i i 01 02 03 04 05 o6 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 - 13 button of the group of buttons 18 labelled "VITALS", a predetermined data code formed of signals stored in a ROM (read only memory) within the point of care terminal is transmitted to the nursing station 1. The nursing station computer accesses certain of the memory elements in the kardex 14 which are associated with "vitals" care elements for the identified patient. Data for display of "VITALS" is-transmitted by the nursing station 1 via the networks 4 and 6 to the Point-of-care terminal 8, which displays only the "VITALS" tests from the particular patient's kardex 14 on the display 15.

For example, as may be seen on the display 15, the vitals tests of blood pressure (BP), pulse, temperature (temp) and respiration are displayed, coupled with their corresponding attributes, shown as >BP (L) Brachial Lying ###.### mmHg, >P Left Radial ###/min normal, >T oral ##.#C., >R ###/min Regular Apnea. The nurse recognizes that she is to take the blood pressure at the left bracbial position with the patient lying and is to enter the pressure numerically in millimeters of mercury of both dyastolic arid systolic measurements. The pulse is to be taken at the left radial position and entered numerically as pulses per minute. The temperature is to be orally taken and entered numerically as C. She is to check the respiration rate arid enter it numerically as breaths per minute.

The results of all of the above is entered at screen cursor positions defined by the # indicia using the keypad 16. The particular positions on the screen of the cursor where the values are entered (which may simply be a shading of the particular attribute selected) are controlled by a four direction cursor key or trackball 17, which controls the position of the cursor (or a shading) on the display screen.

01 02 03 04 05 o6 07 08 09 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 It is preferred that the display screen should be split into three panes. The top pane is preferred to identify the patient by name, sex and identification code, and the name of the doctor, the data of which is sent to the point-of-care terminal from the nursing station after acceptance of the nurse identification (passcode). However another style of display,.such as windowing, could alternately be used.

The second, middle pane is preferred to display the instructions information and care elements from the memory at the nursing work station, and is used to enter data such as the results of tests as noted above. It is also used to initially request the identification code of the nurse arid of the patient after the point-of-care terminal is plugged into the network to identify a request to communicate.

The third, bottom pane is referred to as a dialog pane, arid is preferred to provide information to the nurse as to the previous series of tests, such as the data and time a particular selected event was last performed, the name of the nurse, the planned frequency of the test, and other information entered at the workstation. The third pane is preferred to be typically used only as an information pane to the nurse.

In the event the nurse wishes to obtain a list of medications to be administered for the already identified patient, she pushes the "MEDS" button, which, as described above, sends a code to the nursing station 1. The nursing station in response accesses the medications care event memory locations in the specific patient's kardex, arid transmits those care elements with attributes back to the point of care terminal 8. The list is displayed on display 15 in a mariner similar the display of vitals shown in Figure 3, and the nurse can administer the medicines, immediately enter the quantities that have been i i i i 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 - 15 administered at the corresponding # indicia, etc. In this manner various specific groups of care elements from the electronic kardex of a particular patient can be selected for view by the nurse and entry of the results of tests, etc. The entered data is temporarily stored in a local memory of the point-of-care terminal, and is transmitted to the nursing workstation 1 by the nurse pushing the DONE button on the point-of-care terminal 8.

The preferred groups of care elements that can be called up by function button and displayed on the point of care terminal 8 is indicated as VITALS,, 1/0 (Intake and output), Meds, Tx (Treatments), ADL (Activities arid Daily Living), Tests, Assess, Ed/Com (Education and Communication), Pt Sum (Patient Profile Information), Results, and orders (functions destined from care elements).

A "CALC" key is pushed to convert the numeric keypad into use as a calculator, by invoking a microprogram stored in the local ROM of the terminal 8, whereupon the entered numbers and result of calculation can be displayed, e.g. in the lower right-hand corner of the middle pane.

When the nursing workstation 1 receives the various data from the pointof-care terminal 8, it stores it in a patient stack in association with locally generated time and date data, which can be formulated into a report and printed on printer 2 using well known techniques.

A preferred structure of the point of care terminal 8 is shown in a blockdiagram in Figure 4. A microprocessor 20 is connected via address and data buses 21 to a read only memory, shown as EPROM 22, and to a random access memory 23.

Keypad 24, which provides the numeric key input functions of keys 16, cursor key or trackball 17 arid special function keys 18 is connected to the i 01 - 16 - 02 microprocessor. Also connected to the microprocessor 03 is a liquid crystal display controller 25, to which a 04 liquid crystal display 15 is connected.

A bar code reader 26 is connected to a bar 06 code wand controller 27, which is connected to a bar 07 code decoder 28, which is itself connected to the 08 buses 21. A serial communication controller 29 is 09 connected-to plug 9.

The point of care terminal can be powered 11 in one of several ways. For example a power supply 30 12 cari contain rechargeable batteries, which are charged 13 by plugging the power supply into a source of primary 14 power. Alternatively a power supply 30 can be connected to a power plug 31 which connects to a low 16 voltage (e.g. 24-26 volts DC) reliable hospital power 17 distribution network. Power supply 30 functions to 18 provide the appropriate voltages to microprocessor 20 19 and other elements in the point-of-care terminal.

The point-of-care terminal operates as 21 follows. Upon plugging the plug 9 into connector 7 at 22 a patient location, and upon applying power via power 23 supply 30 either from a local battery or from a 24 hospital power source via power plug 31, the microprocessor is powered up arid accesses an 26 initiation program stored in EPROM 22. The micro 27 processor sends a signal to LCD controller 25 which 28 causes liquid crystal display 15 to display the three 29 paries on the display. The microprocessor also transmits a signal to the nursing computer station 1.

31 In return, the nurse is prompted by the computer to 32 enter the patient's numeric code, e.g. #47836, and her 33 own ID plus a passcode on keypad 24. This prompt is 34 received by microprocessor 20, which causes display on display 15 through LCD controller 25 of the prompt.

36 The nurse enters the patient code and her own passcode 37 on the keypad. The point-of-care terminal stores the 38 entered data in RAM 23.It is preferred that the 1 i 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 1 patient code, but not the nurse's passcode, should be echoed on the display.

The nurse then pushes the DONE button on keypad 24, which causes microprocessor 20 to access a transmit program from the EPROM 22, and to transmit the data entered by the nurse and stored in RAM 23 through serial communication controller 29, along the LAN to the nursing workstation 1. The nursing workstation registers the data in its memory 3A (Figure 2), arid operates a program which checks the validity of the passcode and if it is correct, transmits a validation signal back to the point-of-care terminal through controller 29, which is displayed under control of microprocessor 20 through LCD controller 25 on display 15.

Each nurse's code can be maintained at the nursing work station in association with one or plural patients' names, i.e. authorizing only certain nurses receive a list of care elements to perform the care elements on the patient associated with that particular patient. This provides further security for the patient, in that only certain of the secret nursing codes would be authorized for that particular patient.

After forwarding an authorization signal to the point-of-care terminal, which code can be stored in RAM 23, microprocessor 20 is enabled thereby to allow operation of the special function keys 18 to request an outline list or special function list of care elements from the nursing workstation I from the patient kardex portion of memory 14 as described earlier. Upon request by a function key being pushed, causing a code stored in EPROM 22 to be sent to the nursing workstation, the so designated memory elements in memory 14 are accessed, and the resulting care elements and attributes data is transmitted along the local area network from workstation I through serial 01 02 03 o4 06 07 08 09 10 11 12 13 14 15 16 17 18 19 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 - 18 communication controller 29 to microprocessor 20, for display via LCD controller 25 on the middle pane of display 15. As described earlier the nurse, after viewing the list displayed on the middle pane, can select by means of function keys 18 any grouped kinds of care elements such as VITALS, MEDS, ADL, ACCESS, PROFILE, or TESTS. When groups of care elements are selected by pressing a function key on keypad 24, microprocessor 20 accesses a specific corresponding code from EPROM 22 and causes it to be transmitted through serial communication controller 29 to the nursing workstation 1. The nursing workstation, as described earlier, selects the specific kinds of care elements with the element attributes from the electronic kardex 14 arid libraries 11 and 13 defined by memory 3 as described earlier, and transmits the code back through serial controller 29 for display, also as described earlier, on display 15 at the point-of-care terminal.

As noted earlier, data input via keypad 24 is temporarily stored in RAM 23 by microprocessor 20, and is transmitted to nursing station 1 upon pushing the DONE key. A microprogram stored in EPROM 22 causes microprocessor 20 to access the stored data in RAM 23 and to transmit it to nursing station 1 where it is stored (stacked) in local memory 3A, from where it can later be formulated into a report and printed.

To speed, make easier, and avoid mistakes in entering the patient code, nurse passcode and doctor number (if the system is set up to accept doctor designation) on the keypad 16, a bar code reader wand 26 is preferred to be used. A barcode wand 26 is connected to bar code wand controller 27. The nurse can thereby read the patient's code (and doctor's code, if used) f rom. bar code on the patient's wrist band, and her own number from her own identification badge. A bar code decoder 28 decodes 1 z f i 01 02 03 04 05 o6 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 1 - 19 the bar code from controller 27 that was applied from reader 26, translating it into parallel bus signals and applying it to bus 21 for reception by microprocessor 20 in place of a code keyed in from the keypad.

General operation of a microprocessor and its peripherals is known in the art, and is described in the publication Microcomputer Primer by Mitchell W. Waite arid Michael Pardee, published by Howard W. Sams & Co. Inc., Indianapolis, Indiana. The specific programs to provide the algorithms described in this patent application can thus be prepared by such person skilled in the art without the exercise of inventive ingenuity, once the description of the invention herein is understood.

In addition to providing a display such as that shown in Figure 3, various more detailed displays can be provided. For example by entering predetermined numeric codes or by providing other special function keys, the nurse can obtain, by prompting the nursing workstation, a list of all of the blood pressure readings for a patient over a course of treatment, listed by date and time. This can allow her to estimate whether the patient has been exhibiting significant variations, or a fairly constant blood pressure over a given period. The attributes which form the various care elements can contain upper and lower limits or thresholds so that when the data transmitted to the working nurse station is received, it can be compared with the limits and an error signal or an alarm signal can be generated for transmittal back to the point-of-care terminal. This can prompt the nurse to reenter the data correctly, or to be alerted to a reading which designates an emergency condition.

A list of standard comments can also be provided from the nursing workstation to the 01 02 03 04 05 06 07 08 09 11 12 13 14 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 - 20 point-of-care terminal which can be selected by cursor and/or number and which can be recorded as an integrated nursing note with the set of readings (e.g. "patient uncooperative"). An example of the nursing note ("PATIENT UNCOOPERATIVE") can be seen on the display in Figure 3.

The nurse, once logged in, can request help instructions stored in the memory at the workstation 1 in association with a particular care element, in order to prompt her as to test procedures,, or if she is unsure as to an unusual displayed prescribed dosage, to reassure herself as to the range of acceptable dosages, etc.

Thus the point-of-care terminal described herein and the method of operation of the system utilizing that terminal augments and eases the nursing function. It displays a prescribed course of treatment for the patient and aids her in recording of data at the time that it is to be first recorded. It provides the nurse with a complete list of prescribed care elements required for a particular patient, allows her to select specific ones of those care elements for display (thus forming a reminder system), arid facilitates entry, as performed, of the results of tests and the nature and amounts of medicines administered with no intermediate recording step on paper, thus avoiding accidental misrecording or accidental duplicate administration of tests. Warnings can be provided to the nurse as to out of range entries, out of range test results, etc. which provides an early warning to her of possible errors in administration of care elements, thus increasing the reliability of patient care.

The point of care terminal can be used by a single riurse to administer many patients, thus avoiding the requirement -to have one terminal per patient, thus keeping cost to a minimum.

1 1 i 1 1 i 01 02 03 o4 o6 07 08 09 lO 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 Because of the standardized library of care elements and care attributes used universally and recorded in the memory for all nurses and throughout the hospital, there is no possibility of misentering names of tests or medicines, since their designations are automatically generated. All of the above advantages are obtained due to the formation of the memory, wherein electronic kardexes specific to each patient are set up upon prescription of the course of treatment by the care team, and formation of the kardexes out of a library or pool of standard care elements, which themselves are made up of a pool of standard attribute designations. As various care elements are used by many patients in common, and care elements use the various attributes in common, substantial economy of memory usage is achieved using the standard predefined and preentered care elements and attributes, allowing a sophisticated, easy to use, error avoiding, economical hospital administration system and method of instructing nurses as to care of patients and gathering of test results to be achieved.

With the input of data by the nurse in a very easy manner at the point of conducting the tests, administering medicines and other care functions, and since standard care elements and attributes are used, without the requirement of the nurse to spell out what care functions she has performed, the hospital computer system can gather from the nursing work station and the point of care terminal quantities and lists of actual materials used, actual medications used, actual procedures used, accept increments of labor, etc. from the memory 3A of the nursing workstation using predetermined standard designations. This can allow the hospital information system to create standard costsf to input data into a billing system, to calculate labor and material cost of treatment of each patient based on actual 01 02 03 04 05 06 07 08 09 11 12 13 14 15 1 - 22 procedures performed, and to perform variance analysis of actual vs planned expenditures. It can also facilitate materials ordering, and management of materials, medication, hospital-wide resource scheduling, and labor flow. The information is gathered as a by-product of administering care, without creating additional work on behalf of the clinician.

A person understanding this invention may now conceive of alternative structures or variations in design which use the principles of this invention. All are considered to be within the sphere arid scope of the invention as defined in the claims appended hereto.

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Claims (18)

1. A method of operating a point-of-care terminal comprising:

(a) storing in an electronically accessable memory associated with a central terminal a library of data defining a large number of generic patient care events, (b) selecting data corresponding to certain ones of said care events specific to the care of a particular patient from the library, (c) inputting a signal corresponding to an identifier of a group of said care events for said particular patient into a point-of-care terminal which is in electronic communication with the central terminal.

(d) providing at said group of said selected data specific to said patient to the point-ofcare terminal from the central terminal in response to the inputting step, (e) displaying said group of data at the point-of-care terminal defining said group of care events, (f) inputting response data resulting from the performance of defined care events into the point-of-care terminal relative to at least certain ones of said group of care events, (g) transmitting said response data to the central terminal, and (h) storing the response data at the central terminal for subsequent access.

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2. A method as defined in claim 1 including storing a library of data corresponding to patient care event attributes in said memory, and selecting ones of said attributes to define each of said patient care events.

3. A method as defined in claim 1 including automatically generating a time of entry signal each time said response data is received by the central terminal and storing said time of entry with the response data.

4. A method as defined in claim 3 including inputting corrected response data into the point-of-care terminal in addition to the former response data and separately storing data corresponding to the corrected response data with their time arid date of entry at the central terminal, when said corrected response data is received by the central terminal.

5. A method as defined in claim 4 including storing a library of data corresponding to patient care event attributes in said memory, and selecting ones of said attributes to define each of said patient care events.

6. A method as defined in claim 3 including generating a request signal at the point-of-care terminal defining a request for a history listing relating to at least one care event, transmitting the request signal to the central terminal, retrieving at the central terminal a time sequential group of said response data relating to said one care event, transmitting from the central terminal signals corresponding to said sequential 1 i i 1 j 1 1 1 1 i i - 25 group of said data and corresponding times of entry, and displaying at the point-of-care terminal said sequential group of said response data and corresponding times of entry in order of time of input entry.

7. A method as defined in claim 1 including selecting a group of groups of data to define a puper event, and providing data signals defined by at least said super event to the point-of-care terminal in response to the inputting of said identifier whereby several events defining several associated tests to be performed on a patient are displayed at the pointof-care terminal.

8. A method as defined in claim 1. including providing from the central terminal to a hospital information system, computer data from said stored response data corresponding to at least one of medication, materials, arid labor relating to care events individual to each patient, for hospital management.

9. A method of operating a point-of-care terminal comprising:

(a) establishing a specific patient related electronic kardex formed of data signals defining a group of individual patient care events, each care event being defined by a predetermined collection of possible attributes each attribute defining a characteristic of the event, (b) displaying said care events with said selected attributes at a point- of-care terminal, whereby an in dividual care program specific to said patient is displayed to a care giver.

10. A method as defined in claim 9, in which the electronic patient related kardex is established by selecting said patient care events from a library of care events stored in a central memory.

11. A method as defined in claim 9, in which each event is comprised of at least one predefined attribute selected of a group of pooled attribute!5.

12. A method as defined in claim 9, including inputting into the point-ofcare terminal in response to the display, response data relating to patient response to tests corresponding to the event attributes in the individual care program, arid storing the response data with a time associated with the input of the response data.

13. A method as defined in claim 9 including selecting groups of particular care events for display at the point-of-care terminal by operating switches on the point-of-care terminal which are generic to Darticular kinds of care events.

14. A method as defined in claim 13 in which said particular kinds of care events are at least one of VITALS, 1/0 (Intake and Output), Meds, Tx (Treatments), ADL (Activities and Daily Living), Tests, Assess, Ed/Com (Education and Communication), Pt Sum (Patient Profile Information), Results, arid orders (functions destined from care elements).

15. A method of operating a pointof-care terminal as claimed in claim 1 or claim 9, substantially as described herein with reference to the accompanying drawings.

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16. A patient care system comprising apparatus for carrying out the operational steps defined in claim 1 or claim 9.

17. A patient care system as claimed in claim 16, further comprising apparatus for carrying out the operational steps defined in any of claims 2 to 8 or 10 to 14.

18. A patient care system as claimed in claim 16, substantially as described herein with reference to the accompanying drawings.