JP2009288879A - Procedure manual creation support system of diagnosis-treatment business - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To create a diagnosis-treatment business procedure manual for dealing with urgency (incident). <P>SOLUTION: A procedure manual creation support system of diagnosis-treatment business includes: an existing procedure manual storage section 2 for storing data of an existing procedure manual relating to diagnosis/treatment business; and an editing processing section 5 for adding and editing the procedure manual according to the situation of a patient including anamnesis, a treatment history, and contents executed in a similar case. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a procedure manual creation support system for diagnosis and treatment work that supports creation of procedures for diagnosis and treatment performed in a hospital.

  This system is a patient-dependent procedure manual that subdivides the existing procedure manual into stages for each case. For example, the “Thoracic Simple Contrast Diagnosis Procedure Manual” has a plurality of stages, and each stage has a plurality of actions. First, the medical staff will inspect according to the procedure. If a situation not described in the procedure manual (eg, occurrence of arrhythmia) occurs during the examination, record the treatment details (patient attribute information, video under examination, start condition, end condition, and reason). The recorded contents will be reflected in the original procedure manual at a later date.

  This recorded content is defined as one action and is created by the action creation means of this system. At this time, the relationship with the existing action is defined by the action analysis means. For example, if the end condition of the previous action is A, an action branching condition such as transition to the next action is set by the action recombination means. Update the procedure with the added action. In addition, when the same case is used at a later date, if it is the same patient, a “chest simple contrast diagnostic procedure” for the day on which patient attribute information is taken into consideration is prepared. This procedure is continuously improved.

  Procedure manuals for examinations and treatments are created electronically from hospital guidelines, nursing records, examination records, treatment records, and the like.

However, this procedure manual does not cover every case, so it is supplemented by the experience of medical staff. For example, in response to an emergency situation (incident), an experienced medical staff accurately determines and responds to the situation. However, the occurrence of an accident cannot be denied due to the urgency.
JP 2005-063269 A

  An object of the present invention is to make it possible to create a diagnosis / treatment procedure manual that can cope with an emergency (incident).

  An aspect of the present invention is based on an existing procedure manual storage unit that stores data of an existing procedure manual related to diagnostic treatment work, and a patient's situation including a history of treatment, a history of treatment, and a content that is implemented in similar cases. Provided is a diagnosis / treatment procedure manual creation support system including an editing processing unit for additional editing.

  According to the present invention, it is possible to create a diagnosis / treatment procedure manual that can cope with an emergency (incident).

Hereinafter, embodiments of the present invention will be described with reference to the drawings.
The procedure manual creation support system for diagnosis and treatment work according to this embodiment is based on the radiological diagnosis created in the hospital and the procedure manual for treatment electronically from hospital guidelines, nursing records, examination records, treatment records, etc. Based on this procedure manual, the procedure manual for each case specialized for each patient and the procedure manual for each typical case can be updated while referring to the latest case.

FIG. 1 shows the configuration of a procedure manual creation support system for diagnosis and treatment work according to this embodiment. This configuration will be described together with the processing flow of the present embodiment shown in FIG.
(Procedure support processing during diagnosis)
• Scheduled actions are presented to the worker during diagnosis.
The procedure manual reading processing unit 4 uses an existing procedure manual (eg, “thoracic simple contrast diagnosis” procedure manual) corresponding to a procedure of a diagnosis or the like to be performed (eg, “chest simple contrast diagnosis”) as a procedure manual database. 2 or read from HIS / RIS3.
The procedure manual reading processing unit 4 reads patient attribute information from the medical record information database 1.

The procedure manual reading processing unit 4 captures and edits patient attribute information in the procedure manual.
・ The information to be captured includes information from inspection equipment and video of the inspection room.
・ The surgeon will start the examination.

The procedure manual reading processing unit 4 displays the current “stage” and “action” together with the display unit 7, and changes the “stage” and “action” according to the progress of the examination. Each “stage” displays the next “stage” when all the “actions” satisfy the end condition.

・ If there is a possibility of a medical accident during diagnosis but a minor contingency (this is called an incident) occurs at this stage, and this incident is not recorded in the procedure manual, edit The processing unit 5 performs the following procedure and records incident information.
1) Action start condition: ECG waveform records abnormal value.
The previous action satisfies the termination condition.
2) Action termination condition: Record the ECG waveform within the normal range.
3) Cause of action: Arrhythmia occurs during diagnosis.
4) Patient history: Presence of arrhythmia treatment.

5) Procedure contents (medical accidents, etc.) that have not been described in the case (medical accidents, etc.) should be recorded (patient attribute information, video under examination, start condition, end condition, and reason) and dealt with later. The contents are reflected in the procedure manual.

・ The surgeon finishes the examination.

Each process will be described in detail below.
(Editing the procedure)
Editing of existing procedure manuals digitized from electronic medical record systems, radiological examination records, nursing records, etc. is performed in units of “actions”. “Action” is the smallest unit of procedure for a patient in a diagnostic treatment operation, and “action” is individually independent. A "relationship" between "actions" is defined, thereby connecting "actions". This “relation” is made up of “action” start condition, end condition, action execution reason, estimated time, patient attribute information, and video under examination. In editing the existing procedure manual, the operator can freely change the connection state of each “action”. This “action” can be filtered for each work content of the medical staff.

  The procedures divided by “stage” and “action” are managed in a hierarchy as follows. The procedure manual edit processing unit 5 gives names to actions and stages, and each stage includes at least one action. FIG. 2 shows an example of a table indicating the correspondence between the stage flow stored in the database 2, the actions included in each stage, and the operator's work corresponding to each action.

  It is possible to control which stage is subordinated by mouse operation for movement between stages and name change of actions. For each “action”, an outline of the contents of execution, a start condition, an end condition, a reason for occurrence of the action, and patient attribute information are set as attribute information.

(Procedure acquisition)
There are guidelines for diagnosis and treatment in the hospital. These guidelines are typically electronic. The procedure manual reading processing unit 4 classifies the procedure contents into categories of “stage” and “action” when an electronic file is imported. The determination of “stage” and the determination of “action” are as follows.

(Stage judgment method)
-The position of the surgical instrument and the measured values of various sensors are measured and recorded together with the generation time information.
In the operation determination engine of the procedure manual reading processing unit 4, the presence / absence of the operation such as the suction operation and the incision operation based on the predetermined determination rule based on the measured (recorded) measurement data An implementation period is determined.

In the operation determination engine, determination results (operation name, time, execution period) of past and future operations in time series and time information of measured (recorded) data are also used.
-The stage determination engine is based on determination rules set in advance based on past and future actions and stage determination results (name, time, time), measured / recorded measurement data, and time information. The presence / absence of a stage and the period are determined.
The determined action and stage are recorded in the recording unit.

  Note that the characteristic of this embodiment is that the time information included in the determination result of the operation and the stage is applied again to the determination of another operation and the stage. Which stage is determined based on which stage does not always follow the temporal order in which the event occurred.

(Action judgment method)
Each medical practice for a patient is defined as an “action”. For example, as shown in FIG.
・ Patient entrance
・ Patient setup (bed movement, anesthesia, puncture, sheath insertion, etc.)
・ Fluoroscopy (guide wire, catheter movement, right annular artery imaging, left coronary artery imaging, aorta imaging, left ventricular function imaging, etc.)
・ Shooting (guide wire, catheter movement, right annular artery photography, left coronary artery photography, aorta photography, left ventricular function photography, etc.)
・ Patient functional analysis
・ Exiting patient (hemostasis, etc.)
・ Patient explanation
These “actions” are different in various circumstances for each facility.

(Flow after creating the procedure manual)
The existing procedure manual to be executed from now on (eg, “thoracic simple contrast diagnosis” procedure manual) is acquired by the procedure manual reading processing unit 4.
The patient attribute information is acquired by the procedure manual reading processing unit 4 and the patient attribute information is reflected in the procedure manual.
・ Information to be acquired includes information from inspection equipment and video of the laboratory.
・ The surgeon will start the examination.
If the start condition of the existing action is met from the information from the inspection device or the video information and if the patient is involved, the “action” is displayed as the procedure content of the “stage”.
・ Perform the “action”.

(Concrete example)
A case where an arrhythmia occurs in a patient during diagnosis will be described.
The procedure manual (example: “Thoracic simple contrast diagnosis” procedure manual) illustrated in FIG.
・ Acquire patient attribute information with a general-purpose computer and reflect the patient attribute information in the procedure manual.

・ Patient enters the room.
・ Put the patient on the bed.
・ Puncture.
• Place the sheath and advance the guide wire.
-Advance the catheter and repeat fluoroscopy and imaging of the target area.

-In parallel, this system continues to acquire information from inspection equipment and video of the inspection room.
・ From the information from the inspection equipment and video information, the start condition of “arrhythmia action” in the procedure manual was met, and “arrhythmia action” was recorded from the past inspection records. The procedure contents of the action are displayed.

The surgeon and medical staff refer to the “arrhythmic action” and set the defibrillator setting conditions, for example, in the past record.
• The patient's arrhythmia is removed and the procedure returns to "Thoracic simple contrast diagnosis".
As illustrated in FIG. 5, the cardiac function analysis action is usually followed, but since the arrhythmia action is performed, the process skips to “patient exit action” and ends the examination.

  By using an existing procedure manual in this system, it becomes possible to create an examination procedure manual for each case (considering the circumstances of the patient). In other words, it is possible to deal with individual circumstances that are not in the existing procedure manual, and the procedure manual is continuously improved, so that the occurrence of incidents can be suppressed.

  Note that the present invention is not limited to the above-described embodiment as it is, and can be embodied by modifying the constituent elements 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 procedure manual preparation assistance system of the diagnosis / treatment work by this embodiment. The figure which shows an example of the table which shows a response | compatibility with the flow of the stage memorize | stored in the database of FIG. 1, the action contained in each stage, and the operation | work of the operator corresponding to each action. The figure which shows the flow of a process of this embodiment. The figure which shows an example of the existing procedure manual of this embodiment. The figure which shows an example of the edited procedure manual of this embodiment.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Medical record information database, 2 ... Existing procedure manual database, 3 ... HIS / RIS, 4 ... Existing procedure manual reading process part, 5 ... Procedure manual edit process part, 7 ... Display part.

Claims (8)

An existing procedure manual storage unit for storing data of an existing procedure manual related to diagnostic treatment work;
A diagnostic / treatment work procedure manual creation support system, comprising: an editing processing unit that additionally edits the procedure manual according to a patient's situation including past history, treatment history, and contents implemented in similar cases. The content of the description which is not described in the said procedure manual which generate | occur | produced in the said diagnostic treatment work is further provided with the countermeasure content memory | storage part which records with the countermeasure content including the image | video of the said diagnostic treatment work, a start condition, an end condition, and a reason. Diagnosis / treatment procedure manual creation support system. The editing of the procedure manual by the editing processing unit is performed in units of “action”.
The “action” is a minimum unit of the procedure for the patient in the diagnostic treatment work, the “action” is independent, and the “relationship” between the “actions” is defined, The diagnosis / treatment procedure according to claim 1, wherein the “relationship” includes a start condition, an end condition, an action execution reason, an assumed time, patient attribute information, and an image under examination. Book creation support system. The diagnostic / treatment work procedure manual creation support system according to claim 3, wherein in the editing of the procedure manual by the editing processing unit, an operator can freely change the connection state of each of the “actions”. 4. The diagnosis / treatment task procedure manual creation support system according to claim 3, wherein the "action" is located in a superordinate concept of "stage". The diagnosis / treatment work procedure manual creation support system according to claim 3, wherein the “action” can be filtered for each work content of a medical worker. 2. The diagnosis / treatment work procedure creation support system according to claim 1, wherein the existing procedure manual is digitized from an electronic medical record system, a radiation examination record, a nursing record, or the like. The diagnostic / treatment work procedure manual creation support system according to claim 1, further comprising a reading processing unit that reads information related to a past history and treatment history from an in-hospital electronic medical record system, a hospital information system, and a radiation information system.

Images