JP2007213139A - Patient information management system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To achieve both the easiness and the protection enhancement of an authenticating operation relating to patient information by a higher order. <P>SOLUTION: This patient information management system is provided with a storage part 107 for storing patient information including patient personal information including a name and an address concerning a patient and medical examination/inspection information including medical examination records and inspection records and an authentication module 103 for requesting the authentication of a patient in response to the download request of the patient information from the storage part, and for requesting the authentication of a medical person concerned at an upload request origin and the authentication of the patient in response to the upload request of the patient information to the storage part. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to the protection of personal information in medical devices, and in particular, authenticates patients and medical personnel who have access rights to patient information on servers installed on an out-of-hospital network. It is an invention used to protect against leakage.

  When accessing (uploading and downloading) patient information existing in the information management server, authorization of the medical staff, the patient, or both is required. For this reason, patient authority unintended patient information is browsed by authority approval only by medical personnel, and there is a risk of leakage of patient information. On the other hand, with patient-only authentication, medical personnel need to attend patients to view patient information during preoperative conferences and conferences to determine treatment policies, and patients themselves have the right to make decisions about changing patient information. There is a risk of falsification of medical care and inspection records. When both medical personnel and patients need to be authenticated, the above-mentioned drawbacks occur twice, which requires excessive authentication work.

  An object of the present invention is to achieve both higher level of ease of authentication work related to patient information and enhanced protection.

  A patient information management system according to the present invention includes a storage unit that stores patient information including patient personal information including a name and address relating to a patient, and examination information including a diagnosis record and a test record, and the storage unit Requesting patient information for a request for downloading patient information, and requesting authentication of the patient in addition to authentication of the medical staff of the upload request source for a request for uploading the patient information to the storage unit And an authentication unit.

  ADVANTAGE OF THE INVENTION According to this invention, the ease of the certification | authentication operation | work regarding patient information and protection reinforcement can be made compatible at high order.

  Hereinafter, a patient information management system according to an embodiment of the present invention will be described. First, information handled by the patient information management system according to the present embodiment is largely divided into name, date of birth, address, telephone number, health insurance ID / credit card number / hospital insurance contract number, and other patient-specific information (patient Personal information) and information (diagnosis / examination information) represented by medical chart information generated in the course of examination and examination. These two types of information are collectively referred to as patient information. The right to permit the disclosure of the patient personal information is only the individual patient, and the right to permit the disclosure of the examination / examination information is in the doctor in charge together with the individual patient.

  For the purpose of promoting understanding, an outline of this embodiment will be described first. The authentication rules are asymmetrical when the patient information is downloaded from the server for browsing and when the patient information is uploaded to the server for editing / deleting / new registration. The identification information and authentication information of each patient and doctor (medical worker) are registered in the authentication system on the server. In order to give only the patient access authority regarding the patient's own patient information and prevent the leakage of unnecessary information from others, when accessing and downloading the patient information on the server at the time of examination, patient identification information (patient ID ) And patient authentication information (password), and allows access to the patient's own information. Doctor verification is not required.

  The patient can perform user authentication from the patient terminal to the user authentication module 103 on the server in order to access his / her information, and can access his / her information when approved. At this time, the patient can edit the patient personal information out of the patient's own patient information, but can only browse the information related to the medical treatment.

  When the examination / examination information is uploaded to the server after the examination / examination, it is necessary to authenticate the medical staff including the doctor in order to ensure the validity of the uploaded medical information. Authentication is performed from the user authentication information. Further, only the patient has access rights to his / her information, and authentication is performed using patient identification information and patient authentication information in order to manage his / her patient information.

  FIG. 1 shows the configuration of a patient information management system according to this embodiment. The patient information management server 100 is not limited in physical installation location, and may be installed outside the hospital as shown in FIG. 1 or in the hospital as shown in FIG. The patient information management server 100 includes a user registration module 101, a user authentication module 103, a patient information management module 105, and an information storage unit 106.

  The information storage unit 106 is a physical storage device, and includes a patient information space 107, a patient message box 109, a patient post box 111, and a patient information change history box 113. These patient information space 107, patient message box 109, patient post box 111, and patient information change history box 113 are not typically installed as individual physical storage units, but are related to information types and access restrictions. This is a logical storage category for distinguishing information attributes. For example, “patient information is stored or integrated in the patient information space 107” is “a type of information corresponding to the stage stored or integrated in the patient information space 107 and corresponding to the stage. It is flagged indicating that it has an attribute relating to access restriction, or is stored in a corresponding location (folder). The patient information space 107, the patient message box 109, the patient post box 111, and the patient information change history box 113 are provided for each patient by the user registration module 101 at the time of patient registration. Note that the patient information space 107, the patient message box 109, the patient post box 111, and the patient information change history box 113 are appropriately used for the sake of convenience of logical storage division and physical storage section.

  The in-hospital information system 200 installed in the hospital as a client for the patient information management server 100 includes a plurality of medical staff terminals 201, a plurality of patient terminals 203, and a reception / accounting terminal 205. A plurality of patient home terminals 300 are provided as client terminals that are assumed to be installed on an out-of-hospital network.

  The user registration module 101 is a module whose main functions are registration of personal information of patients and medical workers, and issuance / distribution of user identification information and user authentication information (password, biometric information). The user identification information includes a patient ID, a medical worker ID, and a medical facility ID. Further, the medical worker ID includes a doctor ID, a technician ID, a therapist ID, and a pharmacist ID. The user registration module 101 logically forms a patient information space 107, a patient message box 109, a patient post box 111, and a patient information change history box 113 in the storage unit 106 for each patient at the time of patient registration.

  The user authentication module 103 is a module whose main function is to determine whether the user is the user himself / herself from the user identification information and the user authentication information. When downloading (viewing) patient information, authentication is required only for the patient. When uploading patient information (when registering or updating), authentication between the health care provider and the patient (two steps) Authentication). This is an asymmetric authentication module in which the authentication target required for downloading and the authentication target required for uploading are different.

  The patient information management module 105 is a module for managing patient information. Specifically, the patient information management module 105 is responsible for the process of moving the patient information stored in the patient post box 111 to the patient information space 107 and integrating the information. In addition, the patient information management module 105 selects disclosure request information for patient information held in the message box 109 from the patient information space 107, and stores the information in the message box 109 as a lump (one file) for each patient. It has processing for requesting the user registration module 101 to create a temporary account (temporary authentication number) for a limited period of time for a group of disclosure request information. The temporary account is a browsing permission code with a target (patient information), time limit, and number of times for a disclosure request. Furthermore, the patient information management module 105 performs a process of recording history information (worker ID, work date, etc.) related to the information integration process, temporary account creation request process, etc. in the patient information change history box 113.

  The patient information space 107 is a storage unit for storing patient information including diagnosis / examination information and patient personal information relatively permanently. The patient information space 107 may share a physical storage device together with the patient message box 109, the patient post box 111, and the patient information change history box 113 to partition the storage area, or individually A typical storage device may be arranged. Under the user authentication module 103, only the patient himself can access the patient information space 107. Patients can only view patient information and change patient personal information (address, telephone number, health insurance ID, credit card number, hospitalization insurance policy number, etc.), and the right to change medical and examination information other than patient personal information There is no. Medical personnel cannot access the patient information space 107.

  The patient message box 109 is a storage unit that stores a patient information disclosure request from a medical staff to a patient regarding patient information stored in the patient information space 107 and a lump of patient information based on the patient information disclosure request. . The patient himself has access to all information. On the other hand, the medical staff can only access the patient information limited by the temporary account issued by the patient and post the patient information disclosure request.

  The patient post box 111 is a storage unit that temporarily stores medical information and examination information sent from a health care worker until the patient himself is allowed to integrate (store permission) information into the patient information space 107. is there. The patient can only view the summary of the medical / examination information until he / she has given the integration permission, but not the details. The medical staff can only post patient information to the patient post box 111.

  The patient information change history box 113 is a storage unit that stores history related to changes in the patient information space 107, the patient message box 109, and the patient post box 111. It can only be browsed by the patient and the information manager with the patient's consent. The patient information change history is automatically created and added at the time of operation, and no artificial operation related to the change is performed.

  The medical staff terminal 201 includes a viewer for viewing / editing (adding) patient information at the time of medical care, and medical care for requesting the patient information management server 100 to upload patient information after viewing the patient information. It is a client terminal for inputting information necessary for collation of a medical worker who uses the worker and makes an upload request to the user authentication module 103 of the information management server 100 at this time. The medical staff terminal 201 may be the same terminal as the patient terminal 203.

  The patient terminal 203 includes a viewer for viewing patient information, and inputs information necessary for verifying that the patient is the user to the user authentication module 103 of the information management server 100, thereby managing patient information by the patient. A request for downloading the patient information for the purpose of browsing the patient information to the server 100 and permission for integrating the medical care / examination information uploaded by the medical staff with the information of the patient information space 107 by the patient himself / herself. It is a client terminal. It may be the same as the medical staff terminal 201.

  The reception / accounting terminal 205 calculates the cost incurred in the medical care / examination, and is used by the medical office worker (accounting) when requesting the patient information management server 100 to upload the accounting information. At this time, the information management server It is a client terminal that inputs information necessary for collation of medical office workers who make requests to the 100 user authentication modules 103.

  The patient home terminal 300 includes a viewer for browsing patient information, and inputs information necessary for verifying that the patient is the person himself / herself to the user authentication module 103 of the information management server 100, so that the patient information by the patient A client that gives the management server 100 a request for downloading patient information for the purpose of browsing patient information and permission for integrating medical care / examination information uploaded by a medical worker with information in the patient information space 107 by the patient himself / herself It is a terminal. In principle, the patient home terminal 300 is assumed to be installed on an out-of-hospital network (for example, www).

Next, each operation | movement of the patient information management system which concerns on this embodiment is demonstrated in order.
(Patient registration)
As shown in FIG. 3, when a patient visits a medical facility at the first visit, patient personal information (name, age, sex, address, health insurance card number) is input from the in-hospital patient terminal 203. The patient personal information is transmitted from the in-hospital patient terminal 203 to the user registration module 101 on the server 100 together with the new registration request. The user registration module 101 performs patient registration, issues a patient ID accordingly, and registers a password designated by the patient himself via the in-hospital patient terminal 203. As a result, a patient information space 107, a patient post box, a patient message box, and a patient information change history box are opened on the server 100, and the patient's personal information is stored in the patient information space 107.

(Browsing patient information by patient (download))
FIG. 4 shows an operation of browsing (downloading) patient information by the patient. The patient can browse his / her patient information at the hospital or at home using the terminal 203 or the home terminal 300 in the hospital. The patient requests user authentication from the patient terminal 203 or 300 (hereinafter assumed to be 300) to the user authentication module 103 on the server 100. When receiving the user authentication request from the patient home terminal 300, the user authentication module 103 on the server 100 requests the patient home terminal 300 to input a patient ID and a password. The patient home terminal 300 prompts the patient to input a patient ID and a password. For example, a patient ID and password input screen shown in FIG. 5 is displayed on the display screen of the patient home terminal 300. The patient ID and password input by the patient are transmitted from the patient home terminal 300 to the user authentication module 103 on the server 100 to request user authentication. The user authentication module 103 on the server 100 authenticates with the patient ID and password, and if they match, displays the patient information main screen on the patient home terminal 300. For example, as shown in FIG. 6, in the left column of the patient information main screen, an information display instruction icon (diagnosis record) of the patient information storage space 107, an information display instruction icon of the post box 111, and an information display instruction of the message box 109 are displayed. An icon and an information display instruction icon of the history box 113 are arranged, and an area for displaying the instructed information is secured in the right column. The patient can freely check patient information, a request for disclosure, etc. regarding the patient using this main screen.

(Viewing (downloading) patient information by healthcare professionals)
In a situation where the patient does not attend, that is, the patient cannot obtain permission to disclose patient information on the spot, it is necessary to refer to the patient information only by medical personnel at a conference such as determination of surgery / treatment policy. There is a case. Even in this case, it is possible to refer to the patient information by remotely obtaining the disclosure permission from the patient in advance.

  As shown in FIG. 7, when a medical worker needs patient information of a specific patient at a conference or the like (disclosure of personal information personal information is not limited to this), the medical worker The corresponding patient ID, two electronic signatures of the medical staff and the medical facility, the disclosure destination (same as the normal requester), the range of necessary patient information, the browsing period, and the reason for browsing together with the request for disclosure request 100 to the patient information management module 105 on 100. The patient information management module 105 on the server 100 posts the information transmitted to the patient message box 109 of the corresponding patient based on the patient ID among the received information. The patient's terminal 300 is notified that there is a request for disclosure of patient information. The patient receives this notification via the terminal 300 and performs authentication from the patient home terminal 300 in the same manner as that of FIG. If the authentication is successful, the patient information main screen (FIG. 6) is displayed on the patient home terminal 300. When the patient selects the display instruction of the message box 109 on the patient information main screen, the patient information message box selection screen is displayed on the patient home terminal 300 (FIG. 8).

  When the patient presses the “detailed description” button on the screen, the detailed reason for disclosure is displayed. In response to the disclosure request, the patient selects “permit” or “reject” information disclosure and presses the “execute” button. When the “execute” button is pressed, the patient home terminal notifies the patient information management module 105 on the server of the screen information. The patient information management module 105 that has received the notification performs the following processing in response to the notification of permission or rejection.

  When “permit” is selected, the patient information management module 105 copies the patient information requested by the disclosure request, puts it in a lump in the patient message box 109. The patient information management module 105 issues a temporary account that is valid only for a limited number of times (for example, once) within a specific disclosure request period for patient information placed in a lump in the patient message box 109. Request to the user registration module 101. The user registration module 101 issues a user ID and password, and transmits them to the patient information management module 105. The patient information management module 105 distributes the received user ID and password to the terminal 201 of the disclosure destination (disclosure request source). The requesting medical facility and medical staff acquire the distributed user ID and password. An information disclosure request result notification screen (FIG. 9) to the medical institution is displayed on the requesting medical staff and the terminal of the medical facility. The requesting medical facility and the medical worker make an authentication request with the user ID and password distributed to the user authentication module 103 on the server from the same terminal as the patient home terminal or the medical worker terminal 201. If the authentication is successful, the corresponding patient information is displayed on the terminal screen. The displayed information cannot be duplicated and the patient information is automatically deleted from the terminal when it is closed.

  When “reject” is selected, the patient information management module 105 on the server 100 transmits a notification that the patient information disclosure is rejected to the requesting medical staff and the medical facility terminal 201. An information disclosure request result notification screen (FIG. 9) to the medical institution is displayed on the requesting medical staff and the terminal 201 of the medical facility.

(New patient information registration / update (upload) of patient information to the patient information storage space 107 after mass screening)
When a patient undergoes a mass examination, the examination result is not generated immediately at the time of the examination, but the patient's examination information is generated after a certain delay time, and uploading is necessary at that time. The patient goes home after the patient's examination is completed, and the examination result is issued after a certain period of time. As shown in FIG. 10, when a test result is output, the medical staff logs in from the medical staff terminal 201.

  The medical worker terminal 201 requests user authentication from the user authentication module 103 on the server 100. The user authentication module 103 on the server 100 receives a user authentication request from the medical worker terminal 201 and requests the medical worker terminal 201 to input a medical worker ID and a password. The medical worker terminal 201 prompts the medical worker to input the medical worker ID and password (FIG. 5). The medical worker ID and password input by the medical worker are transmitted from the medical worker terminal 201 to the user authentication module 103 on the server 100, and user authentication is requested. The user authentication module 103 on the server 100 authenticates with the medical worker ID and password, and if they match, displays a patient information transmission screen by the medical worker (FIG. 11). The medical staff enters the patient ID of the corresponding patient, and selects the storage location of patient information (examination information) to be uploaded by pressing the “select” button, or directly inputs the path and presses the “send” button.

  The transmitted patient information to be uploaded is temporarily stored in the patient post box 111 of the corresponding patient ID by the patient information management module 105 on the server 100. At the same time, the patient information management module 105 on the server notifies the patient that the unintegrated patient information is stored in the patient message box 109. In response, the patient receives patient authentication similar to that shown in FIG. 4 from the patient home terminal 300, and the patient information main screen (FIG. 6) is displayed on the patient home terminal 300. When the patient selects the post box 111 on the screen, a post box selection screen (FIG. 12) is displayed on the screen of the patient home terminal 300. The patient selects the “Yes” or “No” button for whether or not to read the patient information in the post box 111 in the pre-permission stage, that is, each unintegrated information, and presses the “Execute” button. When the “execute” button is pressed, information on the screen is sent to the patient information management module 105 on the server 100.

  When “Yes” is selected, the patient information management module 105 integrates the unintegrated patient information (for example, examination information) with the information in the patient information space 107 (added to the patient information space 107) and displays the integrated patient information. Store in the patient information space 107. When the storage of the patient information is completed, the patient information management module 105 notifies the medical staff and the medical facility that posted the corresponding patient information to the patient post box 111 that the corresponding patient information has been integrated. The medical staff and medical institution that posted the corresponding patient information in the post box 111 receive the notification.

  When “No” is selected, the patient information management module 105 causes the patient home terminal 300 to display a patient information post box rejection reason selection screen (FIG. 13) for asking the reason. The patient selects either “Not Visited” or “No Memory Received” and presses the “Send” button. When the “Send” button is pressed, the patient home terminal 300 notifies the patient information management module 105 on the server 100 of the reason for rejection. The patient information management module 105 on the server 100 receives the reason for refusal and sends back the refusal reason notification and unintegrated patient information back to the terminal 201 of the medical facility that posted the patient post box. Upon receipt of this, the medical facility performs medical worker authentication from the medical worker terminal 201, and when the authentication is successful, a rejection reason notification screen (FIG. 14) is displayed on the medical worker terminal 201, and the patient information is mistaken. The possibility of is warned.

  The in-hospital patient terminal 203 performs the same function as the patient home terminal 300 while the patient is in the medical facility. At this time, the in-hospital patient terminal 203 and the in-hospital medical worker terminal 201 may be the same terminal.

  The patient information management module 105 on the server 100 is updated each time patient information in the patient information space 107 is updated due to addition, change or the like, that is, every time patient information in the post box 111 is stored in the patient information space 107. Log information including the update date and the updater ID is recorded in the patient information change history box 113 as the update history.

  Here, in the patient information management system in which the server 100 is placed outside the hospital shown in FIG. 1, for example, the total amount of information inflow and outflow to the message box 109 and post box 111 is transmitted to the medical facility as the amount of information transmitted. Charges may be made based on the charge, and the patient may be charged according to the storage capacity assigned to each patient.

  The patient information management system according to the present embodiment can be modified as shown in FIG. An insurance target disease determination module 401 is installed on the server 100. The insurance company follows the same procedure as the medical staff and posts the insurance content contracted with the patient to the post box 111. The information relating to the contents of the posted insurance contract is integrated into the patient information in the patient information space 107 with the permission of the patient in the same manner as the patient information integration procedure.

  When the patient information is posted from the medical facility to the patient post box 111, the patient is allowed to be integrated, and is integrated with the patient information in the patient information space 107, the patient information management module 105 is insured by the insured disease determination module 401. Require a disease determination.

  The insured disease determination module 401 is based on the disease name / inspection name tag of the patient information posted in the post box 111, and the insured disease / treatment / inspection of the insurance contract contents stored in the patient information space 107 Etc. are determined. When an insured illness occurs, the insured disease determination module 401 sends a patient ID, a disease name (disease code), a treatment name (treatment code), an examination name ( (Inspection code) etc. The illness benefit calculation module 403 of the insurance company calculates the illness benefit to be paid to the patient from the received patient ID and the illness name (disease code), treatment name (treatment code), examination name (examination code), etc. Require illness benefits to be paid to accounts and medical institutions.

  In addition, the patient information management system according to the present embodiment may be in charge of the medical cost claim for the patient. As shown in FIG. 17, the module 403 calculates a medical fee charged to the patient from a disease name tag, a treatment tag, a test tag, etc. posted in the post box 111, and posts it in the post box 111 as accounting information.

  The posted accounting information is integrated into the patient information space 107 with the permission of the patient in the same manner as the patient information integration procedure. When the patient's integration permission is received, the credit company terminal refers to the patient personal information in the patient information space 107, obtains a credit number, etc., and executes a payment process to the medical institution using that number.

As described above, according to the present embodiment, it is possible to achieve both the ease of authentication work related to patient information and enhanced protection at a higher level, and more specifically,
・ Patients have the authority to disclose their patient information, and can control whether their patient information is disclosed.
・ The patient information listed is guaranteed by the medical institution and medical staff,
・ While protecting patient information, the patient information of necessary medical staff can be viewed.
・ By managing the medical / inspection information performed at multiple medical facilities with a single server, it is possible to eliminate redundant inspections that were performed at each facility.
・ Transparency increases as medical / inspection information is disclosed,
・ Patients can check the results of their medical care and examination records while at home.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the components without departing from the scope of the invention in the implementation stage. In addition, various inventions can be formed by appropriately combining a plurality of components disclosed in the embodiment. For example, some components may be deleted from all the components shown in the embodiment. Furthermore, constituent elements over different embodiments may be appropriately combined.

The figure which shows the structure of the patient information management system which concerns on this embodiment. The figure which shows the structure of the patient information management system which put the server in the hospital as a deformation | transformation of FIG. The operation explanatory view at the time of patient registration in this embodiment. The operation explanatory view at the time of patient information download by a patient in this embodiment. The figure which shows the example of a login screen displayed on a patient terminal etc. in this embodiment. The figure which shows the patient information main screen example displayed on a patient terminal etc. in this embodiment. In this embodiment, operation | movement explanatory drawing at the time of the download of patient information by a medical worker. The figure which shows the example of a screen at the time of message box selection in this embodiment. The figure which shows the example of a result notification screen of the information disclosure request to a medical institution in this embodiment. The operation explanatory view at the time of patient information upload in this embodiment. The figure which shows the patient information transmission screen example by a medical worker in this embodiment. The figure which shows the example of a screen at the time of patient information post box selection in this embodiment. The figure which shows the example of an integrated rejection reason selection screen regarding the patient information of a patient information post box in this embodiment. The figure which shows the example of a rejection reason notification screen to a medical institution in this embodiment. The figure which shows the structure of the patient information management system by the modification of this embodiment. The operation | movement explanatory drawing regarding payment of the sickness payment in the system of FIG. The operation | movement explanatory drawing regarding payment of medical expenses in the system of FIG.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 100 ... Patient information management server 101 ... User registration module 103 ... User authentication module 105 ... Patient information management module 106 ... Information storage part 107 ... Patient information space 109 ... Patient message box 111 ... Patient post box DESCRIPTION OF SYMBOLS 113 ... Patient information change log | history box, 200 ... Hospital information system, 201 ... Terminal for medical worker, 203 ... Terminal for patient, 205 ... Reception / accounting terminal, 300 ... Patient home terminal.

Claims (11)

A storage unit for storing patient information including patient personal information including a name and address relating to a patient, and medical examination information including medical examination records and examination records;
In response to a download request for the patient information from the storage unit, authentication of the patient is requested, and for a request for uploading the patient information to the storage unit, along with authentication of the medical staff who is the upload request source, A patient information management system comprising: an authentication unit that requests authentication of a patient.   The patient information management system according to claim 1, further comprising a patient information management module for prompting the patient to download permission in response to a request for downloading the patient information from a person other than the patient.   3. The patient information management system according to claim 2, wherein the patient information management module issues a temporary authentication number to a person other than the patient when a download permission is issued from the patient.   The patient information management system according to claim 1, further comprising a patient information management module for urging the patient to upload permission in response to an upload request for the patient information from the medical staff.   The patient information management system according to claim 4, further comprising a temporary storage unit that temporarily stores patient information to be uploaded to the storage unit until an upload permission is issued from the patient.   5. The patient information management system according to claim 4, wherein the patient information management module prompts the patient to input a reason for refusal when uploading is rejected from the patient.   The patient information management system according to claim 6, wherein the patient information management module transmits the reason for refusal input from the patient to a terminal of a medical worker who is the upload request source.   The patient information management system according to claim 1, further comprising a temporary storage unit that temporarily stores information related to the upload request.   A patient information management module for transmitting a notification indicating that the information related to the upload request is held to the patient's terminal when the information related to the upload request is stored in the temporary storage unit; The patient information management system according to claim 8, further comprising:   The patient information management system according to claim 1, further comprising a temporary storage unit that temporarily stores information related to a request for downloading the patient information from a person other than the patient.   A patient information management module for transmitting a notification indicating that the information regarding the download request is held to the patient terminal when the information regarding the download request is stored in the temporary storage unit; The patient information management system according to claim 10, further comprising:

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