JP2007128351A - Medical process chart creation support apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an apparatus which supports creation of a medical process chart which can provide high quality medical care by visualizing a medical process with versatility. <P>SOLUTION: A medical process creation support apparatus 10 is equipped with; a query display section 12 which displays a query relevant to treatments for the case; a treatment information input section 14 which receives input of a reply to the query displayed in the query display section 12; a format creation section 16 which creates a format of the process chart constituted of a plurality of medical processes to be implemented to a patient based on the treatment information inputted by the treatment information input section 14; and a format display section 22 which displays a format created in the format creation section 16. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an apparatus that supports creation of a medical process chart for managing the quality of a medical process performed on a patient.

Traditionally, the critical path (also called the clinical path or care map) has been known as a tool for systematic assurance and improvement of medical quality and efficiency. The critical path in medical care refers to the plan of medical care / care for other occupations, the vertical axis (row) indicating the area of care (examination, treatment, education of patient family, etc.), and the time (day, treatment phase, etc.) This is a two-dimensional structure with an axis (column). Specifically, through the standardization and visualization of medical planning and implementation, it aims to guarantee, improve and improve the quality of medical care, that is, to save time and medical resources. As a result, there is an advantage that medical-related actions over one patient, other occupations, and other fields are easily mapped. It is also expected to promote team medical care through the process of creating and revising critical paths. Furthermore, it also has a role as a process information disclosure tool for in-hospital and external medical professionals, patients, and consumers (Non-Patent Documents 1 to 3).
Toshihiko Hasegawa, “Critical Path and Hospital Management”, Yakuho Hokpo, Inc., November 10, 1998, pages 13-21 Hidehisa Soejima et al., “Medical Records Change! Definitive Clinical Path” Medical School, April 15, 2004, pages 7-18 Shoichiro Takeda, “Recent Advances in Critical Path 2004” Jiho Co., Ltd., June 20, 2004, pp. 27-34

  Although the critical path has a plurality of advantages as described above, the path is often not applied to a patient who cannot identify a diagnosis, a patient who has a basic disease, a patient who is judged to have a high risk of complications, and the like. Even if the path can be applied, it may deviate from the assumed standard course and deviate from the path. In this way, the application rate of the path is low. The applicants of the present invention invented a medical process quality management system capable of flexibly responding to patient individuality and guaranteeing medical quality, and applied for a patent (Japanese Patent Application No. 2004-340330). The medical process quality management system proposed by the applicants has an excellent effect that high-quality medical care can be provided by management using a medical process chart for each case.

  However, in order to create a medical process chart used in this medical process quality management system, it is necessary to precisely analyze medical procedures performed in an actual medical field, which is very difficult. In other words, in actual medical practice, patients visiting hospitals have various symptoms, past medical history, basic physical fitness, etc., so medical treatments suitable for each patient are performed and the same treatment is performed for everyone. Do not mean. In addition, since treatments that reflect the discretion of individuals are performed within an allowable range, medical treatments depend on personal abilities and experiences of doctors, nurses, and pharmacists. Therefore, it is not easy to create a unified medical process chart.

  Therefore, in view of the above background, an object of the present invention is to provide an apparatus for visualizing diverse medical processes and supporting creation of a medical process chart capable of providing high-quality medical care.

  The medical process creation support device of the present invention includes a question display unit that displays a question related to a treatment for a case, a treatment information input unit that receives an input of an answer to the question displayed in the question display unit, and the treatment information Based on the treatment information input by the input unit, a format generation unit for generating a format of a process chart configured by a plurality of medical processes performed on a patient, and the format generated by the format generation unit are displayed. A format display unit.

  The inventors of the present invention, while preparing medical process charts for various cases based on interviews with actual medical sites, etc. while trial and error, I discovered that there is a relationship between forms. By using this relationship, we have obtained knowledge that it is possible to show what form a medical process chart will be based on information on treatments for cases. According to the present invention, since the format of the medical process chart is displayed by answering a question related to the treatment for the case, when visualizing the medical practice being performed at the actual site, what kind of The direction of whether or not to create a medical process chart can be indicated, and the creator can be navigated. Thereby, creation of a medical process chart capable of providing high-quality medical care can be supported.

  The medical process creation support device of the present invention includes a contraindication information storage unit that stores a combination of contraindication information and a patient state, the treatment information input unit accepts input of contraindication information and patient state related to the treatment, The format generation unit may generate a format including a number of sequences excluding combinations that do not exist in the contraindication information storage unit among combinations of the contraindication information and the patient state.

  In this way, from the combination of contraindication information and patient status, by displaying a format based on the combination stored in the contraindication information storage unit, it is not considered in performing medical practice from any combination Good combinations can be eliminated and only necessary combinations can be displayed. Thereby, it is possible to support the creation of a medical process chart including all contraindication information to be considered. By using this medical process chart, high-quality medical care can be provided.

  In the medical process creation support device of the present invention, the treatment information input unit receives an input of the number of surgical procedures, and the format generation unit has a sequence of surgical procedures, and transfers between the sequences. A format that includes an acceptable medical process may be generated.

  In this manner, the format having a sequence of the number of techniques can be navigated to create a medical process chart for each technique, and can assist in the creation of a medical process chart that allows an easy overview of the medical process. In addition, a format that includes medical processes that allow transitions between each series, the medical process chart that navigates to include treatments that are not successful in each technique in the medical process chart, and that takes into account changes in the technique Can help create.

  In the medical process creation support apparatus of the present invention, the treatment information input unit accepts an input of a restriction on a patient state with respect to a surgical technique, and the format generation unit branches to select a surgical technique according to the restriction A format including may be generated.

  As described above, it is possible to support creation of a medical process chart in which an appropriate technique can be selected by a format that branches depending on a limitation of a patient state related to an operation technique. By using this medical process chart, high-quality medical care can be provided.

  In the medical process creation support apparatus of the present invention, the format generation unit may generate a format further including a sequence applied when any of the techniques is limited.

  In this way, when any surgical method is limited by the patient's condition, it can support the creation of a medical process chart with a high application rate that can be handled even when surgery is not performed by a format that can specify medical practice without surgery. .

  The medical process creation support apparatus of the present invention includes a progress treatment process storage unit that stores a medical process of a post-surgical progress treatment, and the treatment information input unit receives an input of a post-surgery follow-up treatment, and the format generation unit May read a medical process corresponding to the input progress process from the progress process storage unit and generate a format including the read medical process.

  The inventors of the present invention have discovered that the post-operative course treatment can be standardized to some extent regardless of the case, and invented the present invention based on this finding. In other words, when a post-surgery follow-up procedure is entered, by displaying a format including the medical process of the entered follow-up procedure, the creator can easily customize the follow-up procedure by simply customizing the follow-up procedure. Can be created.

  In the medical process creation support apparatus of the present invention, the treatment information input unit receives an input of selection as to whether or not the cause of the case can be removed by the treatment, and the format generation unit is selected to be unable to remove the cause In some cases, a loop-type format may be generated that transitions from the last medical process of each series to another series.

  In cases where the cause cannot be removed by treatment in this way, there is always a risk factor for the occurrence of symptoms, so by expressing it in a loop-type medical process chart, medical treatment that can accurately respond to changes in patient symptoms Can support creation of process charts.

  According to the present invention, by displaying the format of the medical process chart according to the information on the treatment for the case, what medical process chart is displayed when visualizing the medical practice being performed at the actual site. It has the excellent effect of indicating the direction of the creation and navigating the creator.

  Hereinafter, a medical process chart creation support apparatus according to an embodiment of the present invention will be described with reference to the drawings.

  FIG. 1 is a diagram illustrating a configuration of a medical process chart creation support apparatus 10 according to the present embodiment. Here, the “medical process chart” is a chart that describes a plurality of medical processes to be performed on a patient according to the execution order, and is a chart for quality management of the medical process proposed by the applicants of the present invention. is there. The “medical process chart” includes a clinical process chart that allows an overview of the entire medical process, and a unit sheet that defines treatments and the like to be performed in each process of the clinical process chart.

  FIG. 12 is a diagram illustrating an example of a clinical process chart, and FIG. 13 is a diagram illustrating an example of a unit sheet constituting the medical process chart. The medical process chart is defined so that each medical process has a target state to be achieved, and when each medical process is achieved, the process proceeds to the next medical process. In addition to the target state, the transition state of the patient is defined in each medical process. When a predetermined state other than the target state is reached, the process proceeds to the next medical process corresponding to the predetermined state. It is prescribed as follows. Accordingly, it is possible to cope with a case where the patient's state deviates from the standard transition, and the application rate of the medical process chart can be increased.

  The medical process chart creation support device 10 is a device that supports the creation of the above-described medical process chart. The medical process chart creation support device 10 receives the input of the medical process execution order and information on each medical process input from the creator. It has a function of visualizing and displaying a medical process chart in accordance with the order and medical process information. In addition, the medical process chart creation support apparatus 10 of the present embodiment has a navigation function for navigating the creator so as to support the creation of a medical process chart that allows an easy overview of the medical practice. In the following description, the navigation function will be described.

  The medical process chart creation support apparatus 10 includes a question display unit 12 that displays a question about a treatment for a case, a treatment information input unit 14 that receives an input of treatment information input in response to the question, and a medical process chart format. A format generation unit 16 for generating and a format display unit 22 for displaying the generated format are provided. The question display unit 12 and the format display unit 22 are configured by the same display as hardware.

  The question display unit 12 has a function of displaying a question regarding a treatment to be performed on a target case when creating a medical process chart.

  FIG. 2 is a diagram illustrating an example of a question screen displayed on the question display unit 12. As shown in FIG. 2, the question display unit 12 displays a question regarding a treatment to be performed on a case for which a medical process chart is to be created on a screen, and causes a check box to check an answer to the question. For example, when inputting an answer to a contraindication of a medical practice for which a medical process chart is to be created, a contraindication check box is checked, and then what is contraindicated is checked. Note that the screen shown in FIG. 2 is an example of a screen displayed by the question display unit 12, and may be a different screen design.

  The treatment information input unit 14 has a function of accepting information checked in the check box by the question display unit 12 as information (treatment information) related to treatment performed on a case.

  The format generation unit 16 generates a medical process chart format based on the treatment information input by the treatment information input unit 14. Since the shape of the medical process chart is related to the treatment to be performed on the case, the medical process chart format is generated based on the treatment information. The format generation unit 16 is connected to a contraindication information database (hereinafter referred to as “contraindication information DB”) 18 that stores contraindication information, and a progress treatment process database (hereinafter referred to as “processing process DB”) 20 that stores a progress treatment process. ing.

  FIG. 3 is a diagram illustrating an example of data stored in the contraindication information DB 18. The contraindication information DB 18 stores combinations of contraindication information and patient states. The contraindication information DB 18 is connected to a database in which past cases are accumulated, and stores incompatible combinations of contraindication information and patient status. For example, in the case of a patient in whom a neophylline contraindicated patient has a respiratory infection, since special care is required when performing medical treatment, a combination of neophylline contraindication and respiratory infection is stored.

  In the progress treatment format storage unit, a set of units is stored as a standard medical process of the follow-up treatment that is commonly performed for various cases as a follow-up treatment after surgery. For example, catheters and aspirations are commonly performed regardless of the operation for which case. By storing these common procedure procedures in advance, the creator can create a unit simply by customizing the common procedure to suit the case, and easily create a medical process chart.

  The format generation unit 16 generates a format using information stored in the contraindication information DB 18 and the progress treatment process DB 20.

  The format display unit 22 has a function of displaying the format generated by the format generation unit 16. A medical process chart can be created by designating each unit of the format displayed on the format display unit 22 and inputting the contents of the medical process.

  Next, an example of the format of a medical process chart displayed by the medical process chart creation support apparatus 10 of the present embodiment will be described.

  FIG. 4 is a diagram showing a format when “neophylline” is checked as contraindication information and “respiratory infection” is checked as a patient state. In this case, the neophylline contraindications are “present” and “none”, and the patient condition is “present” and “none”, so there are four combinations of combinations. The format generation unit 16 refers to the contraindication information DB 18 and determines whether or not there is a combination of “neophyrin” contraindication and “respiratory infection”. In the absence, there is no need to consider the combination of “neophylline” contraindications and “respiratory infection” patient status. Therefore, a format including three series of “neophylline” and “respiratory infection”, “neophylline” contraindication, and “respiratory infection” patient condition is created. If a combination of “Neophylline” contraindications and “respiratory infection” is present, a format including four sequences including the combination of “Neophylline” and “respiratory infection” is generated. A medical process chart can be easily created by fitting medical process information into each unit of the format shown in FIG.

  FIG. 5 is a diagram showing a format when the number of surgical techniques is input as three. As shown in FIG. 5, a format having a sequence of the number of techniques is generated. Each series includes a medical process for shifting to another series. In the case where there are a plurality of surgical methods, such a format is often adopted. Therefore, the creator can easily create a medical process chart by displaying the format shown in FIG. In addition, this process chart includes a medical process for transitioning between series, so you can navigate to include treatments when each technique does not work in the medical process chart and flexibly change the technique Can support the creation of medical process charts.

  In this example, a format including a series corresponding to the number of techniques is generated and displayed. However, a format further including a series when none of the techniques is applicable may be generated and displayed. This series can define medical processes that do not perform surgery. In addition, in the treatment information input unit, the input of the information on the restriction of the patient state for each surgical procedure is accepted, and a format including a unit for selecting each series according to the restriction of the patient state is generated and displayed. Also good. Thereby, the format of the medical process chart which can select an operation method easily can be provided.

  FIG. 6 is a diagram showing a format when “urinary catheter” is inputted as a course treatment after surgery. In this case, as shown in FIG. 6, a format including a set of units is displayed as a common medical process. Thereby, the creator can easily create a medical process chart by customizing the displayed format according to the case.

  Note that the format displayed by the medical process chart creation support apparatus 10 of the present embodiment is a format for supporting the creator, and therefore does not necessarily have the property that the creator must follow this format. For example, in FIG. 5, a medical process for shifting from each series to another series is provided, but in the case of a case in which the surgical procedure cannot be changed to another surgical procedure, the medical procedure for shifting to another series It is also possible to delete processes.

  The medical process chart creation support apparatus 10 of the present embodiment displays the format of the medical process chart corresponding to the case, so that the creator can easily perform the entire medical practice by fitting the medical process into the format. Medical process charts that can be viewed from above can be created.

  Next, a medical process chart creation support device 30 according to a second embodiment of this invention will be described. The medical process chart creation support apparatus 30 according to the second embodiment supports the input of conditional instructions to be performed by each unit in the format of the medical process chart. The “conditional instruction” is an instruction regarding a treatment to be performed when a patient condition satisfies a certain condition. For example, the instruction is “administer an antipyretic when the patient has a fever of 38 degrees or more”.

  FIG. 7 is a diagram illustrating a configuration of the medical process chart creation support device 30 according to the second embodiment. The medical process chart creation support device 30 according to the second embodiment analyzes a conditional instruction input unit 32 that inputs a conditional instruction to be executed by each unit, and analyzes the input conditional instruction. A conditional instruction analysis unit 34 for comparing with a conditional instruction pattern stored in a database (hereinafter referred to as “conditional instruction information DB”) 36, and the creator based on the analysis result of the conditional instruction analysis unit 34. And a condition presentation unit 38 for presenting information for navigating. In FIG. 7, only the configuration related to the input support for the conditional instruction is described, but a function for supporting the creation of the process chart by displaying the format of the process chart may be provided.

  FIG. 8 is a diagram illustrating an example of data stored in the conditional instruction information DB 36. A conditional instruction pattern is stored in the conditional instruction information DB 36. Each pattern includes a combination of “authority”, “implementer”, “determination difficulty”, and “action difficulty”. “Authority” is information about the authority to issue a conditional instruction, and there are three types of doctors, expert nurses, and general nurses. “Performer” is information about a person who executes a conditional instruction, and there are three types of doctors, expert nurses, and general nurses as well as authority. The “determination difficulty level” is information about the difficulty of condition determination of the conditional instruction. For example, “fever is 38 degrees or more” or the like can be easily determined by measuring the patient's body temperature, but is difficult to determine, for example, “side effects due to drugs”. The “activity difficulty level” is information on the difficulty of treatment performed in accordance with the conditional instruction.

  The conditional instruction information DB 36 is connected to a database of past medical practices, and is patterned based on information acquired from the database. Accordingly, the data stored in the conditional instruction information DB 36 can change sequentially.

  Next, the operation of the medical process chart creation support device 30 according to the second embodiment will be described. First, the creator selects a unit to be edited in the medical process chart. FIG. 9 is a diagram illustrating a display example of a format of a medical process chart. In such a medical process chart format, for example, a unit U is selected and a unit U to be edited is determined. In editing a unit, an instruction to be given in the unit, information on nursing, or a target state of the unit is input. In this embodiment, input of a conditional instruction to the unit is supported.

  FIG. 10 is a diagram illustrating an input screen for a conditional instruction. On the input screen for conditional instructions, input boxes for “authority”, “implementer”, “condition”, and “instruction” are provided. In the “authority” input box, a person who is authorized to issue the instruction is set according to the content of the conditional instruction. In the “executor” input box, a person who executes the conditional instruction is set. In the “condition” input box, a condition for issuing an instruction and a determination difficulty level of whether the determination of the condition is simple or complicated are set. In the “instruction” input box, the content of the conditional instruction and the action difficulty level of whether the action by the instruction is a medical action or a nursing action is set.

  The conditional instruction input unit 32 transmits information on the conditional instruction input on the input screen illustrated in FIG. 10 to the conditional instruction analysis unit 34. Based on the information from the conditional instruction input unit 32, the conditional instruction analysis unit 34 determines the conditional instruction from the “authority”, “implementer”, “judgment difficulty”, and “action difficulty level” of the input conditional instruction. Analyzes which pattern is applied to. Then, the conditional instruction analysis unit 34 analyzes all the patterns of the conditional instructions input for the unit and compares them with the pattern information stored in the conditional instruction information DB 36 to obtain an uninput pattern. . Then, the conditional instruction analysis unit 34 transmits information on an uninput pattern to the condition presentation unit 38. The condition presentation unit 38 receives information from the conditional instruction analysis unit 34 and displays a screen that prompts the user to input an uninput pattern. FIG. 11 is an example of a screen that prompts the user to input a conditional instruction for an uninput pattern.

  In the second embodiment, it is possible to prompt input of conditional instructions for all patterns by displaying a screen that prompts input of conditional instructions for uninput patterns. Thereby, it is possible to support the creation of a medical process chart that can reduce input leakage of conditional instructions and provide high-quality medical care.

  In addition, by inputting all patterns of conditional instructions in this way, the number of treatments performed in each unit can be made substantially constant. Thereby, the granularity of each unit can be made substantially constant, and the visibility of the medical process chart can be improved.

  The medical process chart creation support apparatus of the present invention has been described in detail with reference to the embodiment, but the present invention is not limited to the above-described embodiment.

  The format that can be displayed by the medical process chart creation support device of the present invention is not limited to the format described in the above embodiment. For example, a loop type that accepts input for selecting whether or not the cause of a case can be removed by treatment, and transitions from the last medical process of each series to another series when it is input that the cause cannot be removed May be displayed. As a result, cases that always have a risk factor for causing symptoms can be expressed by a loop-type medical process chart, and the creation of a medical process chart that can accurately respond to changes in the patient's symptoms can be supported.

  In the second embodiment described above, the conditional instruction input unit 32 causes the creator to set “authority”, “executor”, “determination difficulty”, and “action difficulty” on the input screen shown in FIG. However, the conditional instruction input unit 32 accepts a conditional instruction in a natural sentence, and the conditional instruction analyzer 34 analyzes the natural sentence to determine “authority”, “implementer”, and “determination difficulty level”. "" Action difficulty "may be extracted. In this case, a specific example of a conditional instruction and a pattern are stored in the conditional instruction information DB 36 in association with each other. Then, the conditional instruction analysis unit 34 determines the similarity between the specific example of the conditional instruction stored in the conditional instruction information DB 36 and the conditional instruction input in the natural sentence, and sets the conditional instruction based on the similarity. The instruction pattern is determined.

  Further, in the second embodiment described above, for example, “determination difficulty” and “action difficulty” are scored, and the total or average of the difficulty of judgment of the conditional instructions included in each unit and the action difficulty is obtained. Also good. Thereby, it is possible to know which unit has a higher difficulty level in the medical process chart.

  In addition, a database storing medicine prices and medical practice prices may be prepared, and medicines used in each unit and medical practice prices to be implemented may be obtained. This makes it possible to determine which unit in the medical process chart is increasing the cost of medical practice.

  ADVANTAGE OF THE INVENTION According to this invention, it has the outstanding effect that the creator of medical process chart can be navigated, and it is useful as an apparatus which assists creation of the medical process chart for managing the quality of the medical process performed with respect to a patient. It is.

It is a figure which shows the structure of the medical process chart preparation assistance apparatus of 1st Embodiment. It is a figure which shows the example of a question screen displayed in a question display part. It is a figure which shows the example of the data memorize | stored in the contraindication information database. It is a figure which shows the example of a display of a format. It is a figure which shows the example of a display of a format. It is a figure which shows the example of a display of a format. It is a figure which shows the structure of the medical process chart preparation assistance apparatus of 2nd Embodiment. It is a figure which shows the example of the data memorize | stored in the conditional instruction information database. It is a figure which shows the example of a selection screen of the unit which should be edited. It is a figure which shows the example of an input screen of a conditional instruction | indication. It is a figure which shows the example of a screen which prompts the input of a conditional instruction. It is a figure which shows the example of a medical process chart. It is a figure which shows the example of the unit which comprises a medical process chart.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Medical process chart creation assistance apparatus 12 Question display part 14 Treatment information input part 16 Format production | generation part 18 Contraindication information database 20 Progressive treatment process database 22 Format display part 30 Medical process chart creation assistance apparatus 32 Conditional instruction input part 34 Conditional instruction Analysis unit 36 Conditional instruction information database 38 Condition presentation unit

Claims (7)

A question display section for displaying questions related to the treatment of the case;
A treatment information input unit that receives an input of an answer to the question displayed in the question display unit;
A format generation unit that generates a format of a process chart configured by a plurality of medical processes performed on a patient based on the treatment information input in the treatment information input unit;
A format display unit for displaying the format generated by the format generation unit;
A medical process chart creation support device comprising: Contain contraindication information storage unit that stores the combination of contraindication information and patient status,
The treatment information input unit accepts input of contraindication information related to the treatment and patient status,
2. The medical process chart creation support according to claim 1, wherein the format generation unit generates a format including a series of numbers excluding combinations that do not exist in the contraindication information storage unit among combinations of contraindication information and patient states. apparatus. The treatment information input unit accepts an input of the number of surgical techniques,
The medical process chart creation support apparatus according to claim 1, wherein the format generation unit generates a format including a medical process that has a series of surgical technique numbers and allows a transition between the series. The treatment information input unit receives an input of a restriction on a patient state with respect to a surgical technique,
The medical process chart creation support device according to claim 3, wherein the format generation unit generates a format including a branch for selecting a technique according to the restriction.   The medical process chart creation support device according to claim 4, wherein the format generation unit generates a format further including a sequence applied when any of the techniques is limited. Provided with a follow-up process storage unit that stores a medical process of a follow-up treatment after surgery,
The treatment information input unit accepts an input of a follow-up treatment after surgery,
The medical process chart creation support apparatus according to claim 1, wherein the format generation unit reads a medical process corresponding to the input progress process from the progress process storage unit and generates a format including the read medical process. The treatment information input unit accepts an input of selection as to whether or not the cause of the case can be removed by treatment,
2. The medical process according to claim 1, wherein, when it is selected that the cause cannot be removed, the format generation unit generates a loop-type format that makes a transition from the last medical process of each series to another series. Chart creation support device.

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