JP2013073253A - Patient-derived information system and medical treatment information extraction system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To improve accuracy of medical treatment by a doctor and to achieve efficient diagnosing, in a patient-derived information system including a patient side terminal, a doctor side terminal, and a server.SOLUTION: In a patient-derived information system 1, a patient side terminal 2 includes a display part 21 for displaying a question, an input part 22 for receiving input of patient-derived information, and a transmission/reception part 25 for transmitting the patient-derived information to an in-hospital server 4. The in-hospital server 4 includes an analysis part 42 for analyzing a symptom of a patient on the basis of the patient-derived information acquired from the patient side terminal 2, a storage part 43 for storing an analysis result, and a transmission/reception part 41 for transmitting the analysis result to a doctor side terminal 3. The doctor side terminal 3 includes an acquisition part 31 for acquiring the analysis result on the symptom of the patient to be inquired from the in-hospital server 4, a display part 34 for displaying the acquired analysis result on a screen, and an input part 32 for operation input. By the configuration, in the patient-derived information system 1, the accuracy of the medical treatment by the doctor is improved and efficient diagnosing is achieved.

Description

  The present invention extracts patient-derived information (PDI: Patient-Derived Information) system that makes use of patient-derived information for medical care, and extracts medical information that is used for medical / clinical research support by extracting medical information from electronic medical information About the system.

  In recent years, medical institutions have introduced medical information systems in line with the informatization grand design in the medical field, such as digitization of medical records and digitization of receipts, which are medical remuneration statements. It has succeeded in giving a sense of security. However, even in the present situation, there is still room for improvement with regard to utilizing a huge amount of medical information accumulated in a large amount every day for diagnosis in the medical field and management efficiency.

  For example, in a hospital outpatient, a patient who has completed reception waits in a waiting room until his turn comes, and receives a doctor's examination when his turn comes. In a doctor's examination, a form in which various questions are asked to a patient to diagnose a disease symptom is still common.

  At the time of this examination, the patient started talking about unrelated topics such as complaining about poultice and athlete's foot despite the symptoms of abdominal pain, and doctors often start by organizing the complaints of patients without such context. is there. For this reason, there is a problem that doctors take time to diagnose and cause a misdiagnosis because the medical condition of the patient is not clear, and cannot provide high-quality medical care.

  Also, during interviews, QOL (Quality of life) and sexual functions that are not heard from the doctor may be difficult to tell the doctor, but the patient's compelling information may not be communicated to the doctor. It may cause diagnosis.

  By the way, although it is a general theory, it can be said that all medical treatments start with patient medical care. The medical practitioner said, “Would this patient be suspected of such a disease?” “Which test should I do? The test returned positive but I really have the disease.” I always have questions such as "Which treatment is better? Which is effective and safe?" And "What kind of preliminary strategy is effective to prevent further deterioration. How to promote behavioral change". In addition, medical professionals are rich in intellectual curiosity and aspirations, and always treat them as if they should improve the quality of medical care and patient outcomes. However, doctors have not acquired “literacy and skills in clinical training” to analyze these doctors' questions and get answers.

  That is, in recent years, a lot of medical information such as electronic medical records, receipts, and biopsy data such as blood and urine has been digitized. This medical information includes time series data such as patient medical care, examination data, medication, and surgery, and each item is managed as master data having a very complicated hierarchical structure. The vast amount of medical information accumulated in this way is currently accumulated for each medical institution, and doctors are required to solve medical treatment from the vast amount of accumulated medical information. There is no specific means to select and analyze data.

  Thus, in recent years, (1) there is a demand for the construction of a system that improves diagnosis supported by diagnosis from symptom and sign information. In addition, (2) improvement of diagnosis quality is demanded from process evaluation (medical quality) and examination / treatment contents. In addition, (3) QOL, patient-reported outcomes (disease progression, etc.), evaluation of patient outcomes (results), (4) symptom epidemiology, clinical evaluation science, etc. are required to be used for clinical research. ing.

  And in order to reduce the burden at the time of a doctor's diagnosis, the medical diagnosis assistance system which can grasp | ascertain the temporal change of a test result easily is known (for example, refer patent document 1). In addition, as a means of using medical information, multi-dimensional data analysis with high usability that supports knowledge discovery related to clinical judgment by interactively analyzing medical data accumulated in hospital information systems and management data A method is disclosed (for example, see Patent Document 2).

JP-A-6-309384 JP 2009-129031 A

  The present invention has been made in view of the above problems, and an object of the present invention is to provide a patient-derived information system that can improve the accuracy of medical treatment by a doctor and increase the efficiency of diagnosis.

  In addition, in conjunction with this patient-derived information system, a medical information extraction system that can extract medical information requested by doctors from computerized medical information that is accumulated in large quantities every day and can be used for medical care and clinical research support, etc. Also intended to provide.

  In order to achieve the above object, the present invention provides a patient-derived information system having a patient-side terminal, a doctor-side terminal, and a server, wherein the patient-side terminal directly displays a question for the patient and a patient. Input means for receiving input of patient-derived information, which is medical information obtained, and transmission / reception means for transmitting patient-derived information to the server, wherein the server is a patient based on patient-derived information acquired from the patient-side terminal. Analyzing means for analyzing the symptom of the patient, storage means for storing the analysis result in the analysis means, and receiving and transmitting the patient-derived information from the patient side terminal and transmitting the analysis result in the analysis means to the doctor side terminal And the doctor side terminal obtains the analysis result of the symptom of the patient to be interrogated from the storage means of the server, and the obtaining means Display means for displaying the acquired analysis result on a screen, characterized in that it comprises input means for operation input.

  In this patient-derived information system, the patient-derived information includes the patient's symptoms, physical signs noticed by the patient, QOL, contents of medical treatment received in the past, including examination and treatment, outcome after medical treatment such as onset, deterioration and hospitalization, and The information is preferably information including at least one degree of satisfaction with the doctor.

  In this patient-derived information system, the input means of the patient-side terminal is a touch panel, and questions to the patient displayed on the display means of the patient-side terminal are a unique identification number ID assigned to each patient, initial symptoms It is preferable that the selection screen, the detailed questions of the initial symptoms, and the questions to be heard by all people are hierarchically edited.

  In this patient-derived information system, it is preferable that the analysis unit of the server has a function of scoring a symptom of a patient before a diagnosis using a predetermined algorithm based on the patient-derived information.

  Further, the present invention is the above patient-derived information system, an external server connected to a server provided in the patient-derived information system via a network and acquiring extracted data which is medical information digitized from the server, In the medical information extraction system, the external server has a storage means for recording the extracted data and an application for extracting diagnostic information using the extracted data stored in the storage means. Distribution means for distributing to a server provided in the information system, the doctor side terminal provided in the patient-derived information system installs the application distributed by the distribution means, and uses the input means of the doctor side terminal to request Enter the medical information extraction condition to be performed, and the medical information requested by the user from the extracted data Extraction is characterized in that.

  In this medical information extraction system, it is preferable that the extracted data includes at least one of receipt data, DPC survey data, examination data, patient-derived information acquired from a patient, and an electronic medical record, which are medical remuneration specifications. .

  In this medical information extraction system, the extraction condition includes, as a name, basic information for setting a target period for extracting a target patient, patient attributes, and clinical departments, and medical treatment started in the hospital regarding the patient's medical history. Name of injury and illness that specifies the date, drug that sets the medical history of the patient's drug, medical action that sets the medical history of the patient's medical care, specific equipment that sets the medical history of the patient's specific equipment, and patient The patient-derived information that sets the extraction range for the test results, the diagnostic group classification that sets the diagnostic group classification of the patient hospitalization history, and the patient list information that is output from the patient-derived information It is preferable that at least one of information cooperation is included.

  In this medical information extraction system, it is preferable that the extraction condition further includes code information of an ICD10 code and a drug price reference code.

  In this medical information extraction system, the network is preferably encrypted.

  In order to achieve the above-mentioned object, the present invention is realized as a method in which characteristic constituent means of the patient-derived information system and the medical information extraction system are used as a step, or as a program including a characteristic instruction provided in the method. You can also Needless to say, such a program can be distributed via a recording medium such as a flash memory or a communication network such as the Internet.

  In the patient-derived information system according to the present invention, the patient-side terminal displays a question on the display unit, and accepts input of patient-derived information from the input unit. The in-hospital server analyzes the patient's symptoms based on the patient-derived information acquired from the patient-side terminal, and transmits the analysis result to the doctor-side terminal. The doctor terminal obtains in advance an analysis result of the symptoms of the patient to be interrogated from the in-hospital server. Therefore, according to the present invention, the analysis result of medical treatment based on the patient-derived information can be presented to the doctor in advance, and the accuracy of the medical treatment of the doctor can be improved and efficient diagnosis can be realized.

It is a whole block diagram of the patient origin information system which concerns on Embodiment 1 of this invention. It is a functional block diagram of a patient side terminal, a doctor side terminal, and a hospital server provided in the patient-derived information system. (A) thru | or (c) is a figure explaining the procedure of the said patient origin information system. (A) The figure which shows an example of the flowchart in case the question of dialysis is made by the said patient side terminal, (b) The figure which shows an example of the flowchart in case the question which asks all the people is made by the said patient side terminal. . (A) thru | or (c) are figures which show an example of the question screen displayed on the said patient side terminal. (A) thru | or (c) are figures which show an example of the question screen displayed on the said patient side terminal. (A) thru | or (c) are figures which show an example of the question screen displayed on the said patient side terminal. It is a figure which shows an example of the search screen of the patient displayed on the said doctor side terminal. It is a figure which shows an example of the analysis result screen displayed on the said doctor side terminal. It is a figure which shows an example of the information fed back to a patient in the said patient origin information system. It is explanatory drawing of the other function in the said patient origin information system. It is explanatory drawing of the other function in the said patient origin information system. It is a whole block diagram of the diagnostic information extraction system which concerns on Embodiment 2 of this invention. It is a figure explaining the flow of the extracted data and application in the said diagnostic information extraction system. It is a table which shows the information contained in the said extracted data. (A) thru | or (d) is a figure which shows the specific example of the data extraction in the said diagnostic information extraction system. It is a figure which shows an example of the "target person extraction" screen displayed on a doctor side terminal in the said diagnostic information extraction system. (A) The figure which shows an example of a screen when the "sickness name" tab is selected on the said screen, (b) The figure which shows an example of the preview part in the said screen. It is a figure which shows an example of the "target person output" screen displayed on a doctor side terminal in the said diagnostic information extraction system. It is a figure which shows an example of the "PDI cooperation" screen displayed on a doctor side terminal in the said diagnostic information extraction system.

(Embodiment 1)
A patient-derived information system (PDI system) according to Embodiment 1 of the present invention will be described with reference to the drawings. In the description of the first embodiment, “PDI” means patient-derived information obtained directly from a patient without going through a medical practitioner. Specifically, (1) symptoms and (2) patients noticed Information including physical signs, (3) QOL, (4) medical examination contents received in the past, including examination, treatment, (5) outcomes after medical treatment such as onset, worsening, hospitalization, and (6) satisfaction with doctors .

  As shown in FIG. 1, the patient-derived information system 1 includes a patient side terminal 2, a doctor side terminal 3, and an in-hospital server 4. Each of these terminals is network-connected in the medical institution A using a wired or wireless hospital LAN.

  The patient-side terminal 2 is, for example, a portable terminal that includes a screen for inputting symptoms and QOL during a waiting period until the patient visits the doctor. Since the patient is also intended for the elderly, a touch panel is adopted for the screen of the patient side terminal 2, and the patient-derived information is displayed according to the question displayed on the user interface in order to easily express the patient's intention intuitively. Entered.

  The doctor side terminal 3 is a computer terminal that is connected to the hospital server 4 via the hospital LAN, and is used by the doctor at the time of the interview. The doctor terminal 3 receives data, test data of biological information such as urine and blood, and the patient terminal 2. It has the search function of the patient origin information input using. In addition, the doctor side terminal 3 can also acquire patient origin information directly from the patient side terminal 2 via radio | wireless, and may have the barcode issuing function which provides a unique identification number to each patient.

  The in-hospital server 4 is communicatively connected to the patient-side terminal 2 and the doctor-side terminal 3 by using the in-hospital LAN. The in-hospital server 4 is installed with a dedicated application for analyzing patient-derived information. Based on the patient-derived information obtained from the terminal 2 for patients, the symptom is analyzed before each patient's inquiry. Hold.

  Next, functional configurations of the patient terminal 2, the doctor terminal 3, and the hospital server 4 will be described with reference to FIG.

  The patient side terminal 2 includes a display unit 21, an input unit 22, a control unit 23, a storage unit 24, and a transmission / reception unit 25. The display unit 21 is a liquid crystal screen or the like that outputs questions to be asked to each patient during the examination waiting period. The input unit 22 is a touch panel for inputting an answer from a patient to a question made to the patient in the display unit 21. Note that the input unit 22 is not limited to a touch panel, and may accept answers to questions using a keyboard, a voice recognition function, or the like. The control unit 23 has a CPU that executes a program stored in the storage unit 24. The storage unit 24 is a memory unit such as a flash memory or a hard disk, and stores a question program for each patient. The transmission / reception unit 25 is an I / O that performs transmission / reception of in-hospital server 4 and patient-derived information and the like, regardless of whether it is wired or wireless.

  When executing the program, it is necessary to input patient information such as an identification number in order to identify the patient first. However, the patient side terminal 2 has a barcode attached to the examination ticket, a mobile phone, etc. From the patient's personal information (patient's name, insurance card number, identification information for identifying the patient at the hospital, address, age, etc.).

  The in-hospital server 4 includes a transmission / reception unit 41, an analysis unit 42, and a storage unit 43. The transmission / reception unit 41 transmits / receives information between the patient-side terminal 2 and the doctor-side terminal 3, first acquires patient-derived information from the patient-side terminal 2, and sends the analysis result in the analysis unit 42 to the doctor-side terminal 3. Send. Based on the patient-derived information that is the answer result of the question in the patient-side terminal 2, the analysis unit 42 uses, for example, a predetermined algorithm (arithmetic expression) based on an input factor to perform MHI scoring, LSS scoring, OABSS score Analyze each patient's symptoms, such as a ring. The storage unit 43 is a memory unit that stores patient information such as name and ID, electronic medical records, analysis results of patient-derived information, and the like.

  The doctor side terminal 3 uses the acquisition unit 31 for acquiring the analysis result of the patient-derived information stored in the storage unit 43 of the hospital server 4 via the hospital LAN, the input unit 32 such as a keyboard, and the patient-derived information. A storage unit 33 for storing the program and a display unit 34 for displaying analysis results of patient-derived information, electronic medical records, and the like are provided. Before the actual inquiry to the patient, the doctor looks at the analysis result displayed on the display unit 34 of the doctor side terminal 3 to perform further detailed inquiry from the medical detection. And the symptom level and the like can be written in the electronic medical chart using the input unit 32.

  Next, in the patient-derived information system 1, a processing procedure in the hospital when acquiring patient-derived information will be described with reference to FIG. In addition, in this figure, in order to understand easily, it demonstrates using the case where a patient needs dialysis.

  As shown in FIG. 3 (a), for the patient who first visited the clinic from the outpatient department, the medical staff reads the barcode from the patient's examination ticket in the dialysis room, authenticates the patient identification number, and then touches the touch panel. The patient side terminal 2 with is handed over to the patient. At this time, in the case of a first visit patient without barcode information, a barcode is issued.

  Next, as shown in FIG.3 (b), a patient answers a question according to the instruction | indication of the touch panel of the patient side terminal 2, and self-inputs patient origin information. At this time, the patient can answer other automatically selected items in addition to the main complaint on the day of the examination. These question items reflected in the patient terminal 2 can be changed sequentially by application of a medical institution.

  And as shown in FIG.3 (c), the patient origin information which the patient input using the patient side terminal 2 is collected by the database (memory | storage part 43) with which the hospital server 4 is provided, and the result is in the analysis part 42. It is automatically scored and can be sequentially displayed on the doctor side terminal 3 as the analysis result of the patient-derived information. Thereafter, the doctor can refer to the analysis result of the patient acquired from the in-hospital server 4 by the doctor-side terminal 3 before the inquiry, and can use it for medical care / clinical research.

  Next, the flow of questions displayed on the patient side terminal 2 will be described using the flowchart shown in FIG. The patient terminal 2 sequentially displays questions to the patient on the screen based on the question flowchart stored in the storage unit 24 in advance.

  For example, in the case of the dialysis question shown in FIG. 4 (a), after logging in, there is no initial symptom selection and no re-examination setting, and “Did you finish dialysis today? (1) Dialysis has already ended. , (2) Currently dialysis is in progress (3) We are about to dialysis now (S41). Next, if it is selected that dialysis is over (Yes in S42), “How often do you see a dialysis specialist per month? (1) Less than once, (2) About once, (3) The question "about 2-4 times, (4) about 5-8 times, (5) about 9-12 times" is made (S43). And “How many minutes did you talk to the dialysis specialist during the consultation? (1) Less than 1 minute, (2) About 1 to 3 minutes, (3) About 3 to 5 minutes, (4) About 5 to 10 (5) 10 minutes or more "is made (S44), and the process proceeds to a question to be heard by all people.

  Fig. 4 (b) is a question asked to all people. First, "How is your physical condition compared to the previous dialysis? (1) Very good, (2) Good, (3 (4) Bad, (5) Very bad ”(S45). Next, if it is a woman (Yes in S46), the question "Is you pregnant now? (1) Pregnant, (2) Not pregnant" is asked (S47), and "Currently, Are you breastfeeding? (1) Breastfeeding, (2) Not breastfeeding "is asked (S48). Next, as a multiple choice, “Choose all the illnesses that have been referred to by doctors so far (1) High blood pressure, (2) Diabetes, (3) Strokes of head blood vessels such as stroke, (4) Myocardial infarction (5) Angina pectoris, (6) Heart failure, (7) Eye diseases such as cataract, (8) Lung diseases such as asthma, (9) Gastrointestinal diseases such as gastrointestinal and liver, (10) Kidney diseases, (11) Diseases of joints, bones and muscles such as rheumatism and back pain, (12) Skin diseases such as atopy, (13) Depression, and (14) Cancer "are asked (S49). Note that, as described above, these question flows can edit question items, branch conditions, and the like using a dedicated editing screen.

  Next, the question screen displayed on the patient terminal 2 will be described with reference to FIGS. First, for example, a screen 51 shown in FIG. 5A is displayed on the display unit 21 of the patient-side terminal 2, and the patient ID 51a is input and the “Enter” key is pressed. Moreover, the screen 52 shown in FIG.5 (b) is displayed, and the patient origin information system 1 is started by inputting a name 52a, sex 52b, and the date of birth 52c. It is assumed that this input is performed by the medical staff at the time of receiving a medical examination. Next, an initial symptom input screen 53 shown in FIG. 5C is displayed. For example, “head pain 53a”, “fever, dull body 53b”, “cough, sore throat / symptom 53c” are displayed. , "Breathing, breathing, chest pain symptom 53d", "stomach pain, heartburn symptom 53e", "skin symptom 53f", "stomach pain / symptom, constipation diarrhea 53g", "urine leakage, urination Symptoms 53h "," Neck / shoulder / waist / knee / limb symptoms 53i "," Sleep, insomnia 53j "," Depressed mood. Heart symptoms 53k "," Dizziness, fainting symptoms 53l " Patients choose their initial symptoms from. In addition, it is possible to deal with a plurality of symptoms by selecting initial symptoms again.

  In the screen 61 of the question for the dialysis patient shown in FIG. 6A, the contents regarding “Is dialysis already finished?” Are displayed. In the screen 62 shown in FIG. , "Do you want to see a dialysis specialist?" In addition, the screen 63 shown in FIG. 6C displays the content related to “How many minutes have you spoken with the dialysis specialist during the examination?”

  On the screen 71 of “Question to be asked to everyone at the end” shown in FIG. 7A, the contents regarding “How is your physical condition compared to the previous dialysis?” Are displayed. On the screen 72 shown in FIG. 7 (b), the contents related to “Have you ever taken medicine and have allergies?” Are displayed. In addition, on the screen 73 shown in FIG. 7C, the contents regarding the multiple selection “Please select all the illnesses that have been referred to by the doctor so far” are displayed. The patient answers all the questions according to these preset branch conditions via the touch panel of the patient terminal 2, and a completion screen is displayed.

  Thus, by using the patient-derived information system 1, data based on the patient's subjectivity can be collected. The patient side can automatically analyze and organize information related to direct health and transmit it to the doctor side only by inputting according to the screen instruction of the patient side terminal 2.

  Next, a screen displayed on the doctor side terminal 3 of the patient-derived information system 1 will be described with reference to FIGS. 8 and 9.

  First, the doctor uses the doctor side terminal 3 to log in with a password or the like, then clicks on the icon to launch the application of the patient-derived information system 1 and selects “display result”. The “patient list” screen 81 shown in FIG. When a doctor inputs search conditions such as name, date of birth, answer date, sex, patient ID, etc. and presses the search tab 82, a list of search results is displayed in the display field 83. For example, when the answer date is set in the search condition, the answer date is displayed in descending order, and when the answer date is not set, the patient ID is displayed in ascending order. Next, when the doctor selects a patient who browses the analysis results from the list of search results and presses the “analysis result display” tab 84, an “analysis result” screen 91 shown in FIG. 9 is displayed. Normally, only the patient of the day is displayed by default, and the doctor selects it by clicking from the list of patients in charge.

  In the screen 91 shown in FIG. 9, the analysis result 92 is displayed as “suspected of inflammatory bowel disease. Ulcerative colitis, Crohn's disease, intestinal tuberculosis”, “possibility of clinical depression”, etc. . As described above, the analysis result of the patient-derived information arrives as data arranged in the doctor terminal 3 before the inquiry. At this time, since the disease name is analyzed and displayed, the doctor can pinpoint the patient's symptom and can efficiently perform the examination.

  In addition, the analysis result information displayed on the screen 91 includes, for example, the time when symptoms appear “1 month”, the type of symptoms “feeling depressed”, the MHI scoring “32 points”, the QOL scale related to the kidney, etc. Data based on the subjectivity of is displayed.

  When “previous result 93” is pressed on the screen 91, if there is an answer before the result displayed in the analysis result list, the analysis result of the previous answer is displayed. When “next result 94” is pressed, if there is an answer after the result displayed in the list, the analysis result of the next answer is displayed. When “Result CSV output 95” is pressed, the contents displayed in the list are output as a CSV (Comma Separated Values) file. When “Question CSV output 96” is pressed, the question of the result displayed in the list and the answer result are output as a CSV file. When “Close 97” is pressed, the analysis result screen 91 is closed and the screen returns to the patient list screen 81.

  Next, medical information fed back to the patient will be described with reference to FIG. By using the patient-derived information system 1, the medical institution can present a patient with a medical treatment result feedback information screen 101 as shown in FIG. 10. The feedback information screen 101 displays the patient's QOL score 102. QOL score 102 includes “physical function 103 (PF)” for “how much physical activity is possible in daily life”, “daily work such as daily work or housework due to impaired physical function” “Daily Role Function 104 (RP)” related to “How Difficult Living Functions Feel”, “How Physical Pain and How Difficult to Do Daily Living Functions Due to Body Pain” "Pain 105 (BP)", "Overall health officer 106 (GH)" regarding "How the person feels his / her overall health", "How tired, how energetic “Vitality 107 (VT)” related to “Are you overflowing”, “How difficult are social life functions, such as everyday relationships, by losing your health? "Social life function 108 (SF)" related to "I do", "Daily role function 109 (RE) about how difficult daily life functions such as work and housework that are always performed due to impaired mental health" ) ”,“ Mental state such as how depressed you feel, anxiety, etc. ”score of“ Mental Health 110 (MH) ”is included.

  As described above, according to the patient-derived information system 1 according to Embodiment 1, the patient-side terminal 2 can answer questions hierarchically related to medical conditions while waiting for outpatients. And the doctor side terminal 3 can display the analysis result based on the patient origin information which is the data in which the patient's symptom is arranged on the screen before the inquiry, and can improve the efficiency of the medical examination time. You can get a sense of satisfaction that you were able to convey the symptoms and what you want to say.

  The in-hospital server 4 performs a diagnostic analysis based on a scientific basis such as symptom similarity based on patient-derived information, and obtains a symptom with a high probability based on a database in which a large amount of patient symptoms and disease names are accumulated. It will have a diagnostic support tool to determine. Therefore, it is possible to discover hidden diseases that have been missed in the past and reduce oversight.

  Furthermore, by using the patient-side terminal 2, it is possible to convey to the doctor the information that is hard to tell the doctor such as the QOL and the sexual function, which have been difficult to grasp in the past, and which is hard for the patient to understand. Furthermore, the doctor-side terminal 3 can acquire abundantly organized information from the in-hospital server 4, and the patient can be assured that the diagnosis can be overlooked and higher quality medical care can be received.

  As shown in FIG. 11, the patient-derived information system 1 can cope with diseases other than the purpose of visiting. For example, in addition to the question items of kidney-related patient-derived information, screening for depression tendency is performed, and if the depression tendency is suspected as a result, PHQ-9 or the like with higher accuracy is performed. Further, in the case of the gray zone, it is possible to ask the question again at the next reception, display it on the EMR for patients who tend to be depressed, and display an alert on the doctor terminal 3.

  Moreover, as shown in FIG. 12, it is also conceivable to stratify the target person based on the patient-derived information using the patient-derived information system 1. For example, semi-automatic measurement of behavioral change stages based on patient-derived information, classifying subjects for each behavioral change stage, prioritizing nutritional guidance, tailoring nutritional guidance, and multiple intervention methods depending on the behavioral transformation stage Can be formulated (intervention programs A and B).

(Embodiment 2)
A medical information extraction system according to Embodiment 2 of the present invention will be described with reference to the drawings. In addition, the same code | symbol is attached | subjected to the structure similar to the patient origin information system which concerns on the said Embodiment 1, and the detailed description is abbreviate | omitted (hereinafter the same).

  As shown in FIG. 13, the examination information extraction system 5 according to the second embodiment includes an external server 6 that cooperates with the patient-derived information system 1 according to the first embodiment. The external server 6 is a server for remote maintenance, and reads and obtains electronic medical information such as patient-derived information, receipt data, and examination data stored in the server 4 provided in each medical institution from the server 4. To do. Further, the external server 6 reads the master data of the Ministry of Health, Labor and Welfare notification and updates the master information. Since the electronic medical information is transmitted to the external server 6 on the WAN, it becomes an access target from an unspecified terminal on the Internet. Therefore, data encryption is performed using a VPN (Virtual Private Network) that restricts accessible terminals. Other encryption methods such as AES (Advanced Encryption Standard) may be used.

  Next, application (for example, “medical information platform”) management and management of extracted data in the examination information extraction system 5 will be described with reference to FIG. The server 4 of each medical institution manages electronic medical information such as patient-derived information, receipt data, examination data, and electronic medical records as extracted data in a database. The database of the external server 6 holds extracted data acquired periodically (for example, every month) from each medical institution, and data that satisfies the set extraction conditions can be extracted.

  In addition, the external server 6 includes a distribution unit 61 that distributes a dedicated application used in the medical information extraction system 5 to each medical institution, and acquires and shares extracted data from each medical institution. The external server 6 also performs application improvement, distribution, anonymized integration of extracted data, and maintenance by remote maintenance. There are a plurality of medical institutions A to C, and the latest application can always be acquired from the external server 6 and data along various research questions can be extracted from the existing medical information data and used.

  Next, an example of extracted data to be read in the diagnostic information extraction system 5 will be described with reference to FIG. The extracted data includes medical receipt 151, DPC survey data 152, and examination data 153. The item “medical receipt 151” corresponds to, for example, a file including the file name standard “(arbitrary character string: RECEIPTC.uke by default)”. The item “DPC survey data 152” corresponds to, for example, a file including the file name standard “(arbitrary character string: RECEIPTD.uke by default)”. The item “examination data 153” corresponds to a file whose file name standard includes, for example, “YYMM or YYYYMM (medical date of read target file)”.

  Next, a specific example of data extraction using the medical care information extraction system 5 will be described with reference to FIG. In this figure, data extraction is performed with respect to a clinician's request regarding “is a patient with heart failure susceptible to readmission if anemia (= low hemoglobin level)?”.

  First, as shown in FIG. 16A, the number of hospitalized patients for two years (n = 7503) is extracted from the extracted data. Next, as shown in FIG. 16 (b), patients (n = 108 patients) with test data (with WBC test using antibiotics) are extracted for heart failure and anemia. And as shown in FIG.16 (c), a doctor narrows down the number of patients further by the item of extraction conditions, and selects an analysis object person (n = 40 persons). Finally, as shown in FIG. 16D, the data sheet is created and the accuracy of the disease name is confirmed. In this way, various extraction conditions can be set for the extracted data that has been read, and the extraction result can be output to the screen or to a CSV file. In addition, when performing extraction / output processing on already read data, it is preferable to perform data reading processing for at least one month.

  Therefore, in the present invention, in the present invention, it takes several weeks to manually pick up the inspection value for at least 2-3 days to extract the subject. In the present invention, the digitized data is set as the extracted data, and the extraction condition is set. By doing this, it is possible to extract a data set corresponding to a clinician's research question in a short time from a large amount of medical information accumulated in the past. Data analysis is also completed in about 30 minutes. Therefore, in the past, most of the clinical research using test values has been performed, but by using the medical information extraction system 5, it is possible to realize automatic extraction of required data and a simple patient narrowing function, which has been satisfied in the medical field so far. We can meet the needs that have not been done.

  Next, screens displayed on the doctor terminal 3 will be described with reference to FIGS. 17 to 20.

  First, the doctor double-clicks the “medical information platform” icon, which is an application on the desktop, to activate the “main menu” of the “medical information platform”. At this time, the expiration date of the currently installed “medical information platform” and the version of the application are confirmed, and a message is displayed if an abnormality occurs. After starting the application, the doctor logs in using the user name and password.

  Next, the doctor activates the subject extraction screen 171 shown in FIG. 17 by pressing the “extract and output subject” button from the “main menu”. Then, the doctor uses the “basic information” tab 172 to select the target period of the data from which the target person is extracted, the determination target to select any of [all], [hospital only], and [outpatient only], the patient sex Patient age, department, etc. can be set as data extraction conditions.

  In addition, the doctor displays the “injury name” tab 182, the “medicine” tab 183, the “medical practice” tab 184, the “specific equipment” tab 185, the “examination” tab 186, and the “diagnosis group classification” on the screen 181 shown in FIG. Using the tab 187, a medical history, medical calendar, etc. can be set as data extraction conditions. On the screen 181, the doctor sets search conditions for the Ministry of Health, Labor and Welfare master data (injury / disease name, medicine, medical practice, specific equipment), examination history, diagnosis group classification, and presses the search tab 188. The search result is displayed in a preview 189 shown in FIG.

  Specifically, in the extraction conditions, the target period and patient attributes for extracting the target person, basic information 172 for setting the medical department, and target / exclusion are set for the patient's medical history, and medical treatment is started at the hospital. Injury / sickness name 182 that designates the month, medicine 183 that sets the target / exclusion for the medical history (medicine) of the patient, medical practice 184 that sets the target / exclusion for the medical history (medical practice) of the patient, patient Specific equipment 185 for setting the target / exclusion for the medical history (special equipment) of the patient, setting the target / exclusion for the test history of the patient, and setting the extraction range for the test result, the patient The diagnosis group classification 187 for setting the target / exclusion for the diagnosis group classification of the hospitalization history and the PDI cooperation for setting the patient list information output from the PDI as target data are included.

  The search result of the preview 189 includes a condition setting status 190 in which the setting status of each tab is displayed in three colors, a target patient count 191 in which the number of extracted patients is displayed, and the total number of patients in the stored data. Total number of patients displayed 192, target patient number display 193 for updating the number of target patients that match the set conditions, extraction 194 for updating the number of target patients that match the set conditions and extracting data, patient numbers assigned by patient Identification number 195, patient sex 196, patient date 197, patient age 198 at the time of preview, patient treatment start date 199, and patient last treatment date 200.

  The search includes a method of searching from a name such as an injury / disease name / medicine name and a method of searching from a code such as an ICD10 code / drug price reference code. For example, in (1) name search (injury / disease name, medicine, medical practice, specific equipment, inspection tab), the search condition in the column 201 in FIG. 18A is switched to [name search], and a name is entered in the search condition input field. Input and press the search button 188. In (2) code search (injury name, medical practice, diagnosis group classification tab), the search condition in the column 201 is switched to “code search”, the code is input in the search condition input field, and the search button 188 is pressed. To do. (3) In the code search (medicine tab only), the search condition in the column 201 is switched to “code search”, the code is input in the search condition input field, and the search button 188 is pressed. In this case, it is possible to search by specifying the components of the target pharmaceutical as an additional condition. (4) In the simple search (diagnostic group classification tab only), the search condition in the column 201 is switched to “simple search”, and the search conditions are “sickness name”, “surgery” / “surgery / treatment” / “sub-sickness name” "Is selected and the search button 188 is pressed.

  Next, the target person output screen will be described with reference to FIG. This screen 19 is activated by pressing the target person output setting button 173 from the target person extraction screen 171 after setting the extraction conditions.

  In the target person output screen 19, as a condition setting unit for setting an output condition in each tab, basic information 19a for setting a period for outputting target person data, selection of a medicine to be output, and a medicine 19b for setting a representative medicine, Selection of medical action to be output and medical action 19c for setting representative medical action, selection of specific equipment to be output, specific equipment 19d for setting representative specific equipment, selection of examination to be output, and inspection 19e for setting representative examination There is.

  When the preview 19f is pressed, an extraction result based on the set extraction condition is displayed. Specifically, the representative name 19g set in the medicine, medical practice, specific equipment, examination, the number of target patients 19h, the patient number 19i assigned to each patient, the patient's sex 19j, the patient's date of birth Day 19k, number of drug actions 19l set to representative name, number of medical action actions 19m set to representative name, number of specific equipment actions 19n set to representative name, number of test actions 19o set to representative name, representative The oldest execution date 19p of the inspection set in the name, the oldest result 19q of the inspection set in the representative name, the oldest unit 19r of the inspection set in the representative name, the latest execution date 19s of the inspection set in the representative name, the representative name The latest result 19t of the inspection set to “1” is displayed.

  Next, cooperation between the medical care information extraction system 5 and the patient-derived information system 1 according to Embodiment 1 will be described with reference to the screen 50 in FIG. In the PDI cooperation tab 51 of the “extract subject” screen 50, patient list information output from patient-derived information can be read and set as a condition for extraction. Moreover, the extraction result displayed on the preview part 52 can be output as a search condition for patient-derived information.

  Specifically, (1) the “read target person” button 53 is pressed to display the data identification number existing on the medical information platform in the target data list 54 and the non-existing data in the non-target data list 55. Is done. Next, check (2) “Set target data as extracted data 56” and (3) Press “Extract” button 57 to display the result. Further, by pressing the “PDI target person output” tab 58, the PDI target person can be output.

  As described above, in the medical care information extraction system 5 according to the second embodiment, patient information that is busy and difficult to grasp based on electronic medical information such as receipt data, examination data, electronic medical records, and patient-derived information. Will be available. In other words, from a large amount of medical information, doctors themselves set basic information and extraction conditions such as medicines using electronically received receipt data, test data, patient-derived information, etc. It is possible to extract patient information satisfying the extraction condition as being light. Furthermore, doctors can easily extract only the data necessary for request resolution by setting extraction conditions, and clinical information that cannot be obtained only by the receipt (eg, test results that are outcomes, onset, death, QOL, hospitalization, etc.) The patient information requested can be extracted using, and can meet the needs of clinical epidemiological research. Therefore, according to the medical information extraction system 5, it is possible to answer the needs of clinical researchers by automating the burden on doctors and medical sites as much as possible and providing a convenient data collection method.

  Moreover, by combining with the medical information extraction system 5 and the patient-derived information system 1, it becomes a powerful clinical research database and can be a diagnostic support tool provided by medical epidemiology. Among them, it can be used for hospital management, for example, (1) medical research of doctors whether diagnosis was really correct, or (2) comparison of drug usage.

  Furthermore, medical revenues are expected to increase due to the understanding of diseases that are not properly treated. Further, the manager of the medical institution can obtain information useful for management judgment such as patient satisfaction with respect to each doctor by using the medical care information extraction system 5.

DESCRIPTION OF SYMBOLS 1 Patient origin information system 2 Patient side terminal 21 Display part (display means)
22 Input section (input means)
23 control unit 24 storage unit 25 transmission / reception unit (transmission / reception means)
3 Doctor side terminal 31 Acquisition part (acquisition means)
32 Input section (input means)
33 storage unit 34 display unit (display means)
4 In-hospital server 41 Transmission / reception unit (transmission / reception means)
42 Analysis section (analysis means)
43 Storage unit (storage means)
5 Medical Information Extraction System 6 External Server 61 Distribution Department (Distribution Means)

Claims (9)

In a patient-derived information system having a patient-side terminal, a doctor-side terminal, and a server,
The terminal on the patient side includes display means for displaying a question for the patient, input means for receiving patient-derived information that is medical information directly obtained from the patient, and transmission / reception means for transmitting the patient-derived information to the server. ,
The server receives analysis means for analyzing patient symptoms based on patient-derived information acquired from the patient-side terminal, storage means for storing analysis results in the analysis means, and patient-derived information from the patient-side terminal And a transmission / reception means for transmitting the analysis result in the analysis means to the doctor side terminal,
The doctor-side terminal includes an acquisition unit that acquires an analysis result of a symptom of a patient to be interviewed from the storage unit of the server, a display unit that displays the analysis result acquired by the acquisition unit, and an operation input A patient-derived information system comprising an input means.   The patient-derived information includes at least the patient's symptoms, physical signs noticed by the patient, QOL, contents of medical treatment received in the past including examination and treatment, outcome after medical treatment such as onset, deterioration and hospitalization, and satisfaction with the doctor. The patient-derived information system according to claim 1, wherein the information is one piece of information. The input means of the patient side terminal is a touch panel,
Questions to the patient displayed on the display means of the patient side terminal are a unique identification number ID given to each patient, a screen for selecting an initial symptom, a detailed question of the initial symptom, and a question to be heard by all people The patient-derived information system according to claim 1, wherein the information is hierarchically edited.   4. The server according to claim 1, wherein the analysis unit of the server has a function of scoring a symptom of a patient before a diagnosis using a predetermined algorithm based on the patient-derived information. The patient-derived information system according to Item. The patient-derived information system according to any one of claims 1 to 4 and a server provided in the patient-derived information system are connected via a network and extracted as medical information digitized from the server. In a medical information extraction system comprising an external server for acquiring data,
The external server distributes storage means for recording the extracted data and an application for extracting diagnostic information using the extracted data stored in the storage means to a server provided in the patient-derived information system. Distribution means,
The doctor-side terminal provided in the patient-derived information system installs the application distributed by the distribution means, inputs the extraction condition of the requested medical information using the input means of the doctor-side terminal, and the extracted A medical information extraction system characterized by extracting medical information requested by itself from data.   6. The extracted data includes at least one of receipt data, DPC survey data, examination data, patient-derived information obtained from a patient, and an electronic medical record, which are medical remuneration specifications. Medical information extraction system.   In the extraction condition, as a name, a target period for extracting a subject patient, patient attributes, and basic information for setting a medical department, and a name of a sickness and disease specifying a date when medical treatment is started in the hospital regarding the patient's medical history And the medical results that set the medical history of the patient's medical care, the medical behavior that sets the medical history of the patient's medical care, the specific equipment that sets the medical history of the patient's specific equipment, and the test results regarding the patient's test history In contrast, at least one of the examination for setting the extraction range, the diagnosis group classification for setting the diagnosis group classification of the patient hospitalization history, and the patient-derived information linkage for setting the patient list information output from the patient-derived information as a target The medical information extraction system according to claim 5 or 6, wherein the medical information extraction system is included.   The medical information extraction system according to claim 7, wherein the extraction condition further includes code information of an ICD10 code and a drug price reference code.   The medical information extraction system according to any one of claims 5 to 8, wherein the network is encrypted.