JP2006277559A - Telediagnosis system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To present data on a patient on a remote site to a plurality of doctors and obtain diagnosis results. <P>SOLUTION: Remote control from a networked doctor satellite operates patient data acquisition equipment on a patient satellite to transmit, display and store patient data to the doctor satellite. The doctor on the doctor satellite diagnoses the transmitted data and notifies the result to the patient. Concurrently, other doctors diagnose the same stored data and notify the results to the patient. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a remote diagnosis system for obtaining advice from a doctor who is away from a patient.

Traditionally, it has been relatively difficult for depopulated and home patients to receive medical advice. The difficulty was particularly high in fields with few specialists such as intractable diseases.
Therefore, a remote diagnosis system has been proposed to solve such problems.
As an example, Patent Document 1 discloses a technique in which a doctor remotely operates an ultrasonic diagnostic apparatus using a manipulator using an ISDN line and diagnoses a patient's condition from the obtained information.
Patent Document 2 discloses a technique in which a doctor remotely operates an electroacoustic transducer using a communication network, and performs auscultation and palpation to know a patient's state.
JP 2002-085353 A However, these techniques do not consider obtaining advice from a plurality of doctors.

In the past, diagnosis of illnesses in medical services has been carried out in most cases by examining a single patient by a single doctor, and the medical treatment by that doctor has been carried out automatically.
It is common practice that this doctor is fully responsible for its diagnosis and treatment. The doctor implicitly manualizes the contents to be examined, and as a proof that he has fulfilled his responsibility, the medical records are used with his / her own judgment so that he can know which manual item has actually been performed. It describes. Currently, this chart is also partly computerized. As a result, there is no problem if the disease is easily cured, but there are various diseases that occur in the complicated modern society, and there are some problems that are difficult to cure.
In many cases, the results of examinations do not lead to improvement, from diseases that actually do not have effective treatment to those that are not really ill. In such a case, the patient wants to see the diagnosis of another doctor and ask for a so-called second opinion.
In addition, when the doctor's ability is low or there is no specialist who can deal with the disease, so-called whirling occurs, and the patient may be in contact with multiple doctors but may not be able to receive appropriate treatment promptly.

In this medical system, using a medical device connected to a network, a single doctor who is far away from the doctor performs a medical examination that is substantially the same as that in an individual clinic. , Including collecting the whole process as diagnostic information and digitally recording it.
The doctor's judgment is not necessarily included in the record of this examination process, and all of the information such as the patient's response to the interview, auscultation sounds, complexion, pulse, blood pressure, respiratory rate, body movement, and general condition are organized as digital information. Recorded.
Further, a face and other local stereoscopic moving images, a moving image of an ultrasonic diagnostic apparatus, and an electrocardiogram are digitally recorded.
A biochemical test of blood is also automatically measured by the patient's finger on a small test device, and the data is sent and recorded. The same applies to urine tests.
If necessary, eyes can be examined, and the cornea, lens, vitreous, fundus, etc. can be recorded. All the above measurements can be performed on the patient by a robotic arm that can be remotely controlled via a network.

With such an apparatus, all information digitally recorded can be reproduced in the same manner as when all information was recorded. Therefore, in the present medical system, this information is sent to contracted doctors via the Internet, and the diagnosis opinions of other doctors who are not actually examined face-to-face are heard through video. Other doctors make independent diagnoses by looking only at recorded videos, images, and a lot of numerical data, not medical records. As other doctors, about 4 people are assumed to be normal depending on the difficulty of diagnosing the disease. A data interpretation request to a doctor is made by a system as a central operator.
The patient and the insurance company acting on his / her behalf will pay the prescribed fee to the hospital, but the payment will be the hospital's income, and the first doctor and contract doctor will be paid according to the number of examinations or diagnoses. Paid.

Hospitals with this system do not work (accept all patients who come)
Hospitals using this system can also make diagnoses based on answers provided by multiple doctors independently.
Hospitals with this system can remotely diagnose and issue prescriptions.
The hospital with this system accepts 24 hours.
Hospitals with this system will use computer analysis of data.
In this system, a simple procedure (robot arm) is used, but no surgery is performed.
In this system, patients can choose the number of doctors who will make a diagnosis.
This system can also accept patients living in remote areas such as foreign countries and remote islands.

When a person who is self-determined to have a disease wants to see a doctor, he / she can communicate the chief complaint and physical findings of his / her medical condition to the doctor via an electronic device and network (for example, the Internet) to obtain diagnosis and prescription from the doctor. Like that. The doctor who is requested to see the doctor starts the examination by operating the remote device. Examination data is sent to multiple physicians in the same way. The patient can specify the number of doctors who wish to diagnose.
Physicians discuss on the net to communicate one diagnosis to the patient, or communicate different diagnosis results. Each diagnosis should be accompanied by the need for prescription medication, visit visit advice, or face-to-face treatment including surgery. Payment is withdrawn from a credit card or using an electronic payment system.
Payment by credit is presented according to the selected menu, and the contract is completed by entering necessary data such as card number through the computer (booking of books at hotel reservations and virtual store sales on the Internet) It is a similar method). However, an additional fee may be charged depending on the final diagnosis result. At this time, after notifying by e-mail and confirming that you agree to the additional payment, the process according to the result proceeds. For example, if you agree to an additional payment, a prescription will be sent. A copy of the prescription is in the storage device of the center processing apparatus, and can be confirmed from the pharmacy terminal by the identification code and password written on the prescription. By confirming this, the pharmacist can identify and avoid mistakes.

To achieve these, virtual hospitals (VH) are built on the network. The patient accesses a virtual hospital web page (homepage) from a predetermined place equipped with facilities, and inputs a chief complaint. On the other hand, a virtual or real receptionist appears on the video image and responds to the doctor who is free. Electronic devices required for medical examinations are installed at designated locations (hereinafter referred to as “satellite”) such as hospitals, clinics, nursing centers, station stations, convenience stores, department stores, etc., or sent to homes by courier And this is connected to the Internet and used. The entire center is operated by a medical center (VH Association).
Such a diagnosis system is constructed on hardware such as a network (for example, the Internet) and a data management system, and there is no building like a normal hospital. In many places, there will be many medical stations as branch offices. An office as the operation headquarters is required, but large-scale items are not necessary. Establish a system for medical examinations based on various contracts with many doctors.

Information for making a diagnosis can be obtained remotely via the following device. Devices that can acquire diagnostic information with sufficient accuracy or presence include a robot arm that can be remotely controlled, a pan head device that can change the direction of the camera, and the like. Communication is performed via the high-speed Internet, but for voice, use of a telephone line is also included.
The equipment necessary for diagnosis is as follows. 1. Audio transmission device 2. Three-dimensional video camera and monitor High fidelity color reproduction video camera and monitor 4. Body temperature, blood pressure, heart rate, respiratory rate, blood oxygen saturation (pO2), finger pulse wave measurement device Auscultation device 6. Electrocardiogram measuring device 7. Ultrasonic diagnostic equipment (A mode, B mode)
8). X-ray camera and monitor9. 9. Simple blood collection device and automatic blood test device X-ray computed tomography (CT)
11. Nuclear magnetic resonance imaging system (MRI)
12 It shall include a plurality of remotely operated robot arms.
8 and 10 have legal restrictions on radiation handling, but they are technically possible. 9 can be obtained by self-collecting blood.
Although there is a limit to the equipment that can be installed depending on the size of the satellite, appropriate equipment should be installed according to individual restrictions. In satellites that do not have any equipment, the system mainly provides interviews based on the patient's subjective answers. It will remain at the advice level.

In the above system, the point of diagnosing a disease may correspond to an item that cannot be performed under the current domestic medical doctor law (possible in the United States). In this case, the doctor will not give the chief complainant the name of the diagnosed disease, but will give a guide as a medical consultant, and the actual medical diagnosis will be confirmed after meeting the appropriate doctor. And
This system can be extended not only in Japan but also abroad.
The organization operating this system is a company, a hospital, or a university, and doctors are hired by contracts with them. The place where a doctor works is a place prepared by those organizations or a place set by each person. The doctor and the organization are connected via a high-speed network. Doctors can join a medical consulting organization without significant self-investment. Moreover, it becomes possible to take the work form without time restrictions. Since it is possible to make a diagnosis by playing a video that has already been taken or by looking at examination findings data, the diagnosis result can be sent to the main complainant at any time.

By miniaturizing and assembling each testing device, a remote and automatic device for obtaining advanced medical test findings can be produced. Such a device can be sent or placed at an accident site or an emergency site to advance an immediate diagnosis, and at the same time, an emergency life-saving treatment can be performed. It is assumed that this apparatus and a doctor in a hospital are connected bidirectionally via the wireless internet.
The following items are possible for lifesaving.
1. Ensuring breathing with an oxygen mask2. 2. Ensuring breathing by endotracheal intubation Drug injection (cardiotonic, respiratory stimulant, steroid, analgesic)
4). Implementation of infusion (ensuring intravenous infusion)
5. Tracheotomy 6. 6. Heart massage Cardiac defibrillation8. 8. artificial respiration Hemostasis 10. 10. Gastric lavage Cleaning and cooling treatment Persons who are stuck in objects due to automobile accidents, highly burned persons, drowned persons, persons who are addicted to drugs, cerebrovascular disorders, heart disorders, acute abdomen, etc. Early lifesaving treatment for shocked people produces a positive improvement in prognosis.

FIG. 1 is a conceptual diagram of this system.
Desired facilities such as a stereoscopic camera (1), an electrocardiograph (2), an ultrasonic probe (3), a display (4) and a speaker (5) are installed on the patient-side satellite. The doctor-side satellite connected to the patient-side satellite via the network (6) includes an analog recorder (7), a digital recorder (8), a stereoscopic monitor (9), a monitor (10), a speaker (11), and a microphone ( 12) is installed. A server (13) and a center processing device (14) are also connected to the network (6).
Although not shown, the patient-side satellite is also provided with a microphone, a blood collection device, a blood analysis device, and the like. Depending on the size of the satellite, an X-ray camera, an X-ray computed tomography (CT), a nuclear magnetic resonance imaging apparatus (MRI) ) And remotely operated robot arms are also installed. Each satellite is also provided with a control device for dialogue and various controls.

A doctor who is present at the doctor-side satellite gives instructions to the patient via the network (6) and causes the patient to collect blood. Electrocardiograph electrode mounting, auscultation and palpation, and operation of the ultrasonic probe are performed by remote control by the patient himself / herself or an assistant or robot arm.
In addition, with the AI (artificial intelligence) of the device, automated electrode mounting and auscultation / palpation devices have also been developed, which can be used as a patient-side satellite that does not require an assistant or robot arm.
Each satellite may be in the same hospital, and a local network (LAN), a wide area network (WAN), the Internet (WWW), or the like is used as the network (6) according to the actual situation.

The doctor's instruction is transmitted from the microphone (12) to the patient through the speaker (5). The face color of the patient and the state of the affected area are imaged by the stereoscopic camera (1), displayed on the stereoscopic monitor (9) of the doctor satellite, and recorded on the analog recorder (7) and / or digital recorder (8). This recording is performed continuously during the examination, but it may be performed according to a recording instruction if desired.
In addition, blood analysis results and measurement data obtained by an electrocardiograph and an ultrasonic probe are displayed on the monitor (10). The patient's voice is acquired by a microphone (not shown) and is output from the speaker (11) on the doctor side. These pieces of information are also recorded in the analog recorder (7) and / or the digital recorder (8).
The doctor makes a diagnosis based on information from the devices installed in these patient-side satellites, and stores data serving as a basis for the diagnosis in the server (13). In addition, a center processing device (14) for controlling the entire system is provided. The storage of patient data in the server (13) may be performed by the center processing device (14).

In this system, it is desirable to provide a camera that creates a stereoscopic image, a monitor that displays the camera, and a device that performs auscultation using a robot arm as a basic diagnostic device.
The robot arm system for operating the auscultation and electrocardiogram electrodes and the probe of the echo diagnostic apparatus can feel the amount of repulsion by the special manipulator. As a remote control arm system, bilateral feedback control based on virtual impedance (presentation of force sensation during echo probe operation, force / motion can be arbitrarily scaled), operation support by autonomous function of slave (force It is preferable to provide an excessive pressing force by an adjustment function, a probe posture adjustment function, and the like.
The state of the robot arm is displayed as a video on a doctor's monitor via a network or the like, but a time delay due to network communication may hinder smooth operation. Therefore, it is also possible to display an image without delay by computer drawing on the actual image. The examining doctor can operate the robot arm so as not to go too far by viewing this display.
For this purpose, the position of the robot arm about 0.1 to 2 seconds ahead is predicted in consideration of the delay of the communication path and the response delay of the robot arm, and the preceding display is performed. The transmission delay of the communication path can be measured by transmitting and receiving a response request signal and a response signal, and the response delay of the robot arm can also be obtained in advance.

FIG. 2 is a diagram showing a diagnostic procedure.
The patient with the chief complaint goes to the nearest patient satellite first. The operation terminal provided in the patient-side satellite is connected to the center processing apparatus via the network, and the patient interacts with the system. The system calls an available physician from the patient's main complaint. For this call, available ones of various calls such as a mobile phone, a pager, flushing of a computer screen in use, and in-hospital broadcasting are used. Among the doctors who have received the call, the doctor who can see the patient calls the doctor satellite and operates the terminal. Patient data acquired by operating the terminal is stored in a server and becomes basic data for diagnosis by a plurality of doctors.
A doctor who has performed a medical examination and a doctor who has not performed a medical examination but can diagnose can make a diagnosis based on this basic data. When a diagnosis is made by a plurality of doctors, the system (center processing apparatus) notifies the patient. Depending on the situation, a form may be considered in which notification is made each time a diagnosis is made by a single doctor. Several doctors may discuss on the network and give a unified view, or inform the patient of their individual views.

In some cases, when the diagnosis doctor cannot be secured or the symptoms are typical, only the determination by the computer is made. For the determination by the computer, it is necessary to provide a table necessary for inference such as a case table. However, if the computer analysis is used, the contents of the data stored in the data file can be scanned in a search manner, and the range of conclusions estimated based on the case table can be narrowed. The doctor can refer to it. In addition, listening to only the results of the patient may be one of the menu options.
In some cases, doctors may not be selected based on the patient's wishes or the results of the interview. In this case, the patient data is limited to the blood pressure, electrocardiogram, etc. that can be automatically acquired by the inquiry result and the patient's operation. From these data, the judgment by the computer or the opinion by the diagnostic doctor as a consultant is presented to the patient.
In addition, although the interaction with the system is a response to the computer, it can be understood that a patient who is not good at the interaction with the computer can be modified to respond to a person. In this case, switching due to excessive operation time, installation of an operator call button, or the like can be considered.
The notification of the diagnosis result is mainly made on the patient-side satellite, but the patient may not be present at the time of notification, and a form in which a call is made by e-mail, a mobile phone, a number display board, or the like is also conceivable. In some cases, the notification text is short, or an e-mail may be sufficient if the patient wishes.

FIG. 3 is an example of a doctor selection table. It is used to identify each department from the symptoms reported by the patient.
FIG. 4 is an example of a doctor selection table showing the relationship between regions and doctors. This is the correspondence between the patient's residence and the doctors who can visit in the case of requesting face-to-face medical care.
FIG. 5 is an example in which the severity of patients is ranked from I to V, and doctors are allocated according to the severity.
FIG. 6 shows an example in which doctors are assigned based on the patient's wishes. From these doctor selection tables, the system selects the examining doctor and the diagnostic doctor.
It is desirable to weight each table according to the importance for selecting a doctor and call it sequentially from a higher-ranking doctor, but it is possible that the burden is concentrated on a specific doctor. It is also possible to make corrections in consideration of the latest call time.

  The condition of a patient away from a specialist such as a remote place, a depopulated place, or an intractable disease can be diagnosed by a plurality of doctors, and optimal treatment can be performed.

Diagram showing the system overview Diagram showing the diagnostic procedure in the system The figure which shows an example of the table for doctor selection which shows correspondence with a patient's chief complaint and medical department The figure which shows an example of the table for doctor selection which matches a patient's residence and a doctor's medical treatment area The figure which shows the table of doctor selection according to severity The figure which shows the correspondence table of patient's hope and doctor

Explanation of symbols

1 Stereo Camera 2 Electrocardiograph 3 Ultrasonic Probe 6 Network 7 Analog Recorder 8 Digital Recorder 9 Stereo Monitor 13 Server 14 Center Processing Device

Claims (5)

  A patient-side satellite equipped with a remotely-operated patient data acquisition device; and a doctor-side satellite that receives, displays and stores data from the patient data acquisition device and transmits instructions from the doctor to the patient data acquisition device; A remote diagnosis system comprising a center processing device for transferring a call from a patient to a doctor and a network connecting the patient satellite, the doctor satellite and the center processing device.   The remote diagnosis system according to claim 1, wherein the center processing device has a function of presenting accumulated patient data to a plurality of doctors and notifying a patient of a diagnosis result from each doctor.   The remote diagnosis system according to claim 1, wherein the center processing apparatus performs interactive processing with a patient, has a doctor selection table, and has a function of selecting a doctor based on an interaction result.   2. The robot arm system according to claim 1, wherein the patient data acquisition device includes a robot arm system in which a repulsion amount is sensed by an operator by a special manipulator and the operation is displayed in advance for about 0.1 to 2 seconds on a doctor's monitor. Remote diagnostic system.   The remote diagnosis system according to claim 1, wherein the patient data acquisition device includes a stereoscopic camera, and the doctor-side satellite includes a stereoscopic monitor.

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