JP2018022257A - Medical service support device, medical service support method and program - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical service support device which implements a mechanism to issue an order of a specific action and the like.SOLUTION: The medical service support device issues an order of a specific action by receiving a selection of the specific action from a medical doctor. When a condition instruction is a comprehensive instruction, the device issues the order by adding information indicating that the condition instruction is a comprehensive instruction. The medical doctor specifies a minimum proficiency required for the specific action so as to set a procedure corresponding to the proficiency and issue the order. Concerning a nurse receiving the order, the device determines whether the order can be realized on the basis of the proficiency and presence of the qualification of the nurse for the specific action and only the order determined to be realizable can be selected and realized.SELECTED DRAWING: Figure 17

Description

  The present invention relates to a medical service support apparatus, a medical service support method, and a program, and more particularly to a technique for efficiently instructing medical practice.

  The practice of medical practice by nurses, etc. is made in accordance with the doctor's examination and instructions based on the results, but in order to reduce the burden on the doctors, the instructions are given based on the instructions (conditional instructions) given in advance by the doctor. There is an ordering system that supports the work of performing certain medical actions within the scope at the discretion of the nurse. For example, in Patent Document 1, a doctor issues and registers a pseudo order in which an occurrence event such as “when body temperature exceeds 40 ° C.” and a medical practice instruction such as “medicine AAA tablet administration” are associated with each other. An ordering system is described in which, when a nurse inputs an occurrence event later, the contents are issued and displayed as a formal order.

JP-A-2005-49962

  In recent years, in order to promote home medical care and team medical care that provides high-quality medical care through multi-professional collaboration, the public health nurse midwife nurse law was revised in June 2014, and 38 specific acts were treated as medical assistance. Was positioned. This makes it possible for a nurse (qualified person) who has completed training starting in October 2015 to perform a specific act according to a procedure manual under comprehensive instructions without waiting for the judgment of a doctor or dentist (instructor). Can be implemented.

  However, there is not yet a system for issuing a specific action order. For this reason, there is a demand for the construction of a system that automates the issuance of orders for specific actions and appropriately supports doctors and nurses for specific actions. In particular, when automating the issuance of orders for specific actions, it is important to consider the attributes of nurses. For example, it is important to consider whether a nurse is qualified for a specific act. This is because a qualified person can carry out specific actions at his discretion under comprehensive instructions. In addition, nurses can perform specific actions regardless of their qualifications if they receive direct instructions from doctors, but specific actions are technically difficult and require advanced judgment, so It is also important to know the degree.

  The present invention has been made in view of the above-described problems, and an object thereof is to provide a medical service support apparatus, a medical service support method, and a program incorporating a mechanism for issuing an order for a specific action.

  A first invention for solving the above-described problem is a medical service characterized by including an action accepting unit that receives selection of a specific action and an order issuing unit that issues an order of the selected specific action It is a support device.

  A second invention is a medical work support method characterized by including an action accepting step for receiving selection of a specific action and an order issuing step for issuing an order for the selected specific action.

  A third invention is a program that causes a computer to function as an action receiving unit that receives selection of a specific action and an order issuing unit that issues an order of the selected specific action.

  ADVANTAGE OF THE INVENTION According to this invention, the medical service assistance apparatus etc. which implement | achieve the structure which issues the order of specific action are provided.

(A) The figure which shows the whole structure of the medical service support system 1, (b) The figure which shows the content of the database 120 The figure which shows the internal structure of the medical service support apparatus 10 (20) The figure which shows the internal structure of the client terminal 30 The figure which shows the contents of order classification master 121 The figure which shows the content of the specific action order classification master 122 The figure which shows the content of the comprehensive instruction | indication list | wrist 123 The figure which shows the content of the order classification master 124 The figure which shows the contents of skill level master 125 The figure which shows the contents of the procedure manual ID master 126 according to skill level The figure which shows the contents of specific action procedure manual master 127 The figure which shows the contents of qualification master 128 The figure which shows the content of the skill level table 129 The figure which shows the contents of experience number table 130 The figure which shows the contents of the order table 131 The figure which shows the content of the procedure manual data structure 200 The figure which shows the content of the procedure recording data structure 300 PAD diagram showing the flow of order issue processing PAD diagram showing the flow of acceptance processing of comprehensive instructions for specific actions The figure which shows the order issue screen 40a The figure which shows the order issue screen 40b The figure which shows the skill level designation screen 50 PAD diagram showing the flow of order delivery processing PAD diagram showing the flow of order issue processing from the comprehensive instruction list PAD diagram showing the flow of actor determination processing The figure which shows the order confirmation screen 41 PAD diagram showing the flow of order execution processing PAD diagram showing the flow of skill level update processing The figure which shows the order execution screen 42 The figure which shows the medical treatment recording surface 43 PAD diagram showing the flow of order issue processing from the comprehensive instruction list in the second embodiment PAD diagram showing the flow of the actor determination process in the second embodiment

[First Embodiment]
First, a first embodiment of the present invention will be described with reference to FIGS.
FIG. 1A is a diagram showing an overall configuration of the medical service support system 1. The medical operation support system 1 includes a medical operation support device 10 and a medical operation support device 20. Each of the medical service support apparatus 10 and the medical service support apparatus 20 functions as a server connected to a plurality of client terminals 30 via a local area network (LAN) 103 in the hospital. The client terminal 30 is a desktop computer, a notebook computer, a portable smartphone, a tablet terminal, or the like installed in an examination room or reception.

  The medical service support apparatus 10 is equipped with an ordering system 110 and an electronic medical record system 117. A user such as a doctor (instructor) or a nurse (actor) performs operations of the ordering system 110 and the electronic medical chart system 117 on a Web page displayed on the client terminal 30. That is, the Web server 11 generates an operation screen (Web page), displays it on a standard Web browser in each terminal of the client terminal 30, and accepts an input operation of patient information and medical information from the user.

  Unlike the present embodiment, the medical service support system 1 may be realized in the form of a client server system. In this case, an API server is used instead of the Web server 11, and client software is used instead of the Web browser in each client terminal 30.

  FIG. 2 is a diagram illustrating an internal configuration of a computer used as the medical work support apparatuses 10 and 20. The medical service support apparatuses 10 and 20 include a control unit 11, a storage unit 12, a media input / output unit 13, a peripheral device I / F unit 14, an input unit 15, a display unit 16, a communication I / F 17, and the like via a bus 19. Connected. However, FIG. 2 is a general example, and it is possible to adopt various configurations according to applications and purposes.

The control unit 11 is a CPU (Central Processing)
Unit), ROM (Read Only Memory), RAM (Random Access Memory) and the like. The CPU calls and executes a program stored in the storage unit 302, ROM, recording medium, or the like in a work memory area on the RAM, and drives and controls each device connected via the bus 19. The ROM is a non-volatile memory and permanently holds a computer boot program, a program such as BIOS, data, and the like. The RAM is a volatile memory, and temporarily stores a program, data, and the like loaded from the storage unit 12, ROM, recording medium, and the like, and includes a work memory area used by the control unit 11 to perform various processes. .

  The storage unit 12 is, for example, an HDD (hard disk drive), and stores a program executed by the control unit 301, data necessary for program execution, and the like. As for the program, a control program corresponding to the OS and application programs corresponding to each processing described later are stored. Each of these program codes is read by the control unit 11 as necessary, transferred to the RAM, read by the CPU, and executed as various means.

The media input / output unit 13 is, for example, a drive device that drives various recording media such as an optical disk and a magnetic disk, and writes and reads data to and from the recording medium (recording medium).
The peripheral device I / F unit 14 is a port for connecting a peripheral device to the computer.

The input unit 15 inputs data, and has an input device such as a keyboard, a pointing device such as a mouse, and a numeric keypad, and notifies the control unit 11 of the input signal.
The display unit 16 includes a display device such as a liquid crystal panel, a logic circuit for realizing a video function of a computer in cooperation with the display device (video adapter or the like), and displays display information sent from the control unit 301. Display on the device.

The communication I / F (interface) 17 is a communication interface that has a communication control device, a communication port, and the like and mediates communication with the LAN 103.
The bus 19 is a path that mediates transmission / reception of control signals, data signals, and the like between the devices.

  FIG. 3 is a diagram illustrating an internal configuration of a computer used as the client terminal 30. The client terminal 30 is connected to a control unit 31, a storage unit 32, a media input / output unit 33, a peripheral device I / F unit 34, an input unit 35, a display unit 36, a communication I / F 37, and the like via a bus 39. . However, the example of FIG. 3 is a general example, and various configurations can be adopted depending on the application and purpose.

  The ordering system 110 implemented in the medical service support apparatus 10 has various functions such as an order issue function 111, an order issue function 115 from a comprehensive instruction list, an order distribution function 112, and an order execution function 113.

  The order issuing function 111 receives an input of a medical practice instruction (order) by a doctor and issues an order. The order issuing function 111 includes a comprehensive instruction receiving function 119 for a specific action.

  The specific action comprehensive instruction reception function 119 generates a skill level designation screen 50 (FIG. 21) and displays it on the display screen when a comprehensive action order for a specific action is issued. Accept the minimum skill level input necessary to do so and register it in the comprehensive instruction list. If necessary, the procedure manual display / edit function 118 accepts confirmation and editing of the procedure manual by the doctor.

  The order issuing function 115 from the comprehensive instruction list displays each order of the registered comprehensive instruction list on the order confirmation screen 41 (FIG. 25), and accepts the selection of the order from the login user (nurse). At this time, the actor determination function 116 determines whether or not the logged-in user can execute each order (a comprehensive instruction for a specific action), and only selectable orders can be selected. When the logged-in user selects a predetermined order, a check item of the procedure manual is displayed on the display screen, and an input such as a check is accepted. If there is no problem in the check contents, an order for a specific action is issued (order table 131). To the state where the logged-in user (nurse) can execute the order.

The order distribution function 112 changes the issued order according to the workflow sequence.
The order execution function 113 reads the confirmation item (check list) of the specific action from the procedure manual and causes the nurse to input the confirmation result. Further, the user's experience count and skill level are updated by the skill level update function 114 included in the order execution function 113.

The electronic medical record system 117 installed in the medical service support apparatus 10 has a function of recording a medical record by referring to and copying a comment or the like as a result of the order by the doctor who issued the order.
In addition, the medical accounting system 210 installed in the medical service support apparatus 20 cooperates in each step of the workflow sequence as necessary, and counts medical accounting points and performs accounting processing.

The ordering system 110 and the electronic medical chart system 117 use a common database 120 shown in FIG. As shown in FIGS. 4 to 16, the database 120 includes an order classification master 121, a specific action order type master 122, a comprehensive instruction list 123, an order type master 124, a skill level master 125, and a skill level procedure manual ID. A master 126, a specific action procedure manual 127, a qualification master 128, an experience count table 130, and an order table 131 are included.
Hereinafter, each data content will be described.

  FIG. 4 is a diagram showing the contents of the order classification master 121. The order classification master 121 holds the name of the order classification in association with the order classification ID that uniquely identifies the order classification (“prescription order”, “specific action order”...).

  FIG. 5 shows the contents of the specific action order type master 122. The specific action order type master 122 is an order type ID that uniquely identifies the order type of the specific action ("adjustment of position of oral tracheal tube or nasal tracheal tube", "exchange of tracheal cannula (at home)"). Correspondingly holds the name of the order type of the specific action.

  FIG. 6 is a diagram showing an example of the contents of the comprehensive instruction list 123. The comprehensive instruction list holds an order ID that uniquely identifies an order and a patient ID that uniquely identifies a patient in association with each other. As will be described later, an order based on a comprehensive instruction issued by a doctor is added to the comprehensive instruction list 123.

  FIG. 7 is a diagram showing an example of the contents of the order type master 124. The order type master 124 holds the order type ID, order classification ID, order type name, and workflow data in association with each other. The workflow data holds information on who and in what order the order issued by the doctor changes. As will be described later, by changing the order according to the workflow data, the doctor can change the order sequentially without being conscious of who the order must be issued and in what order. It can be greatly reduced.

  FIG. 8 is a diagram showing an example of the contents of the skill level master 125. The skill level master 125 divides the skill level of the nurse into three levels of “H” (high skill level), “M” (medium skill level), and “L” (low skill level). Holds the skill level name.

FIG. 9 is a view showing an example of the contents of the skill level procedure manual ID master 126. The proficiency level procedure manual ID master 126 stores the proficiency level procedure manual ID in association with the order type ID and the specific action ID. That is, a procedure manual for specific actions is prepared for each skill level. The proficiency level H procedure manual is a procedure manual for nurses with high skill levels, and, for example, widely describes the range of discretion of treatment. On the other hand, the procedure manual of skill level L is a procedure manual for nurses with low skill levels, for example, a narrow range of treatment discretion, or a detailed description of the procedure of treatment.
Depending on the skill level, procedure manual data may not be prepared. In this case, a NULL value is set in the procedure manual ID of the skill-specific procedure manual ID master 126.

  FIG. 10 is a diagram showing an example of the content of the specific action procedure manual master 127. The specific action procedure manual master 127 holds the storage information of the procedure manual data in association with the procedure manual ID. The contents of the data included in the procedure manual data will be described with reference to FIG.

  FIG. 11 is a diagram showing an example of the contents of the nurse qualification master 128. The qualification master 128 holds qualification information (“qualified” and “not qualified”) of each nurse for each specific action.

  FIG. 12 is a diagram showing an example of the contents of the nurse skill level table 129. The skill level table 129 holds information on the skill level of each nurse for each specific action. “H” indicates a high skill level, “M” indicates a medium skill level, and “L” indicates a low skill level. “X” indicates that there is no treatment experience for the specific action. From the skill level table 129, it is possible to grasp how much skill (experience) the nurse has for a specific action.

  FIG. 13 is a diagram showing an example of the contents of the nurse experience count table 130. The skill level table 129 of FIG. 13 is created based on the experience count table 130. As shown in the figure, the experience count table 130 holds the number of experiences of performing each patient's specific action for each specific action. For example, the nurse with the nurse ID “G” has performed the specific action related to the specific action ID “001” “6 times” in the past and the specific action related to the specific action ID “002” “15 times” in the past. It can be seen that the specific action related to the specific action “006” has been performed “20 times” in the past.

  In addition, the number of times (described as “number of times M” and “number of times H”) set in the fields of the standard M and the standard H is the number of experiences as a standard for determining the skill level of the nurse. As will be described later, if the number of experiences is equal to or greater than the number of times H, it is determined that the skill level is H (high skill level). If the number of experiences is greater than or equal to number of times M and less than number of times H, it is determined that the skill level is M (medium skill level). If the number of experiences is less than the number M, it is determined that the skill level is L (low skill level). This determination result is reflected in the skill level table 129 of FIG.

  FIG. 14 is a diagram showing an example of the contents of the order table 131 for storing and managing order information. In the order table 131, order data including various pieces of order information (order ID 2801, current number 2802,..., Procedure record ID 2812) is registered. Order data related to one order is created and updated at each stage from when the order is issued to when it is executed, such as when the order is issued, when the order is confirmed, when the order is executed, and after the order is executed. For example, the order data 2820 is created as order data at the time of order issuance, the order data 2830 is created at the time of order execution, and the order data 2840 is created after the order is executed.

FIG. 15 is a diagram showing a procedure manual data structure 200 showing the data contents of the procedure manual data. As shown in the figure,
(1) Specific action ID (2000)
(2) Name of procedure manual (2001)
(3) Target patient (2002)
(4) Patient medical condition range (checklist) (2003)
(5) Checklist judgment logic of (4) (2004)
(6) Message (2005) when the determination in (5) is NO
(7) Action content when the determination in (5) is a positive determination (2006)
(8) Items to be confirmed when performing specific actions (checklist) (2007)
(9) Checklist judgment logic of (8) (2008)
(10) Message at the time of determination of (9) is not determined (2009)
(11) Message when the determination in (9) is a positive determination (2010)
Various information is included. These pieces of information are all text information.

FIG. 16 is a diagram showing a procedure record data structure 300 showing the data contents of the procedure record data. As shown in the figure,
(1) Procedure record ID (2701)
(2) Specific action ID (2702)
(3) Minimum skill level or nurse ID (2703)
(4) Procedure manual ID (2704)
(5) Patient's medical condition range (checklist entry results) (2705)
(6) Checklist determination result of (5) (2706)
(7) Items to be confirmed when performing a specific act (result of checklist entry) (2707)
(8) Checklist determination result of (7) (2708)
Various information is included. These pieces of information are all text information.

Next, an order issuance process for displaying an order issuance screen, receiving a doctor's input, and issuing an order will be described.
FIG. 17 is a PAD (Problem Analysis) showing the flow of order issue processing executed by the order issue function 111 (see FIG. 1A).
Diagram). FIG. 19 is a diagram illustrating an example of an order issue screen 40a operated by a doctor. The order issuance process is realized by accepting an operation from a doctor via the order issuance screen 40a (user interface).

  First, the medical service support apparatus 10 generates and displays an order issue screen 40a (FIG. 19) for issuing an order for a patient (patient A) (step S201).

  Subsequently, the medical service support apparatus 10 issues an order ID for uniquely identifying the order and displays it in the order ID column 1201 of the order issue screen 40a (step S202). In the example of FIG. 19, the order ID “2016031303” is issued and displayed in the order ID column 1201.

  When the pressing operation of the order classification field 1202 is accepted on the order issuance screen 40a, the medical work support apparatus 10 refers to the order classification master 121 (FIG. 4) and displays a list of order classifications on the screen (not shown). The selection of the order classification is received from the doctor (step S203). FIG. 19 shows a case where “specific action order” is selected as the order classification by the doctor. In this case, “specific action order” is displayed in the order classification column 1202 as shown in the figure.

  Subsequently, the medical service support apparatus 10 determines whether or not the order classification selected in step S203 is “specific action” (step S204). In the case of “specific action” (step S204; Yes), the medical service support apparatus 10 refers to the specific action order type master 122 (FIG. 5) and displays a list of order types (not shown) of the specific action. The selection of the order type is accepted from the doctor (step S205). FIG. 19 shows a case where “replacement of tracheal cannula (home)” is selected by the doctor. In this case, “exchange of tracheal cannula (home)” is displayed in the order type column 1203 as shown in the figure.

  On the other hand, if it is not “specific action” (step S205; No), the medical service support apparatus 10 receives another order classification (for example, “prescription order”) from the doctor (step S206), and the other received in the order type column 1203 The order classification (for example, “prescription order”) is displayed.

  Subsequently, the medical work support apparatus 10 displays “general instructions”, “other condition instructions”, and “-(none)” as selections of condition instructions on the display screen, and accepts the selection from the doctor (step S207). FIG. 19 shows a case where “general instruction” is selected by the doctor. In this case, “general instruction” is displayed in the order condition column 1204 as shown in the figure.

Subsequently, the medical operation support apparatus 10 determines whether or not the order classification selected in step S203 is “specific action” and the condition instruction selected in step S207 is “general instruction” (step S208). In the case of “specific action” and “general instruction” (S208; Yes), the process proceeds to step S209, and a comprehensive instruction of the specific action is accepted.
With reference to FIG. 18, the reception process of the comprehensive instruction for the specific action will be described.

FIG. 18 is a PAD diagram showing the flow of the reception process for the comprehensive instruction for the specific action executed by the reception function 119 for the specific action for the specific action (see FIG. 1A).
First, the medical service support apparatus 10 displays the skill level designation field 1301 and the procedure manual ID field 1302 on the order issue screen 40a (step S301).
FIG. 20 shows an example of an order issue screen 40b in which a skill level designation field 1301 and a procedure manual ID field 1302 are displayed.

  Subsequently, the medical work support apparatus 10 displays a skill level designation screen 50 (pop-up screen) for designating the minimum skill level of the specific action (step S302). On this skill level designation screen 50, the number of qualified persons of the specific action according to skill level is displayed (step S303).

FIG. 21 is a diagram showing a skill level designation screen 50 when the specific action is “exchange of trachea new curry”.
The number of qualified persons with high skill level (= 1 person) is displayed in the skill level H column 1105, and the number of qualified persons with medium skill level (= 1 person) is displayed in the skill level M field 1106. In the skill level L column 1107, the number of qualified persons with low skill levels (= 3) is displayed.

  In the total number of people column 1104, when the doctor designates a minimum skill level for a specific action, the total number of qualified persons who satisfy the skill level is displayed. For example, in the case of FIG. 21, the total number of qualified persons (qualified persons with skill levels L, M, and H) that satisfy the skill level L is displayed as “5 people”. Further, the total number of qualified persons satisfying the skill level M (qualified persons with skill levels M and H) is displayed as “2 people”. Further, the total number of qualified persons satisfying the skill level H (qualified persons with skill level H) is displayed as “1 person”.

  Then, the medical work support apparatus 10 receives a specification (selection) of the minimum skill level from the doctor (step S304). Designation (selection) of the skill level is performed by pressing an H setting button 1101, an M setting button 1102, or an L setting button 1103. The doctor designates the skill level by determining how much discretion the nurse can leave in view of the patient's situation. For example, in the case of a treatment with a high degree of difficulty or a risk, a high skill level is designated so that a nurse having a high skill level can perform the order.

  Note that there are cases where a doctor who knows the skill level of a nurse can be relieved that the nurse can be directly designated regardless of the skill level. For this reason, a list of information (names of nurses, affiliations, facial photographs, etc.) of each nurse is displayed on the skill level designation screen 50 so that the doctor can designate (select) a specific nurse on the screen. May be. Thereby, the doctor can designate a specific nurse and give comprehensive instructions.

  When the minimum skill level is designated (selected) in step S304, the medical service support apparatus 10 closes the skill level designation screen 50 (step S305). Then, referring to the skill level master 125 (FIG. 8), the skill level name of the designated skill level is acquired and displayed in the skill level designation field 1301 (FIG. 20) of the order issue screen 40b. For example, it is assumed that the doctor presses the M setting button 1102 and designates the skill level M (medium skill level). In this case, the skill level name “skill level (medium)” of the skill level “M” is acquired from the skill level master 125 (FIG. 8), and “skill level ( Middle) ”is displayed.

  Subsequently, the medical service support apparatus 10 acquires and displays a procedure manual corresponding to the minimum skill level for the specific action (step S306). For example, as shown in FIG. 20, “exchange tracheal cannula (at home)” (order type ID = “0003”) is selected as the order type of the specific action, and the skill level M is designated as the minimum skill level. Suppose that In this case, the medical service support apparatus 10 accesses the procedure manual ID master 126 (FIG. 9) according to skill level, searches for a row corresponding to the order type ID “0003”, and acquires a procedure manual ID “006b-” of the skill level M. M ”is acquired. Subsequently, the specific action procedure manual master 127 (FIG. 10) is accessed to acquire the procedure manual data “... / Data012” corresponding to the acquired procedure manual ID “006b-M”.

  The medical work support apparatus 10 displays the acquired procedure manual data in the procedure manual display area 1310 of the order issue screen 40b (FIG. 20). Also, it is displayed in the procedure manual display area 1310 by selecting a print menu (not shown) displayed by right clicking the mouse or pressing a print button (not shown) arranged on the screen. The procedure manual can be printed as text. That is, it is possible to perform treatment while confirming the procedure manual for the paper medium even at a location away from the client terminal 30.

Here, when the procedure manual display area 1310 is pressed, the medical work support apparatus 10 accepts editing of the procedure manual (step S307). When the editing of the procedure manual is accepted, each text displayed in the procedure manual display area 1310 becomes editable. For example, if the text is a character string, the text is edited, and if the check list is checked, each item of the check list is edited ( Editing of the contents of each item, addition / deletion of items, etc.) If it is a determination logic, the determination logic can be changed (step S308).
The function for displaying and editing the procedure manual described above is realized by the procedure manual display / editing function 118 (see FIG. 1A) of the medical work support apparatus 10 (ordering system 110).

When the editing of the procedure manual is completed, the medical work support apparatus 10 issues a new procedure manual ID and registers it in the specific action procedure manual master 127 (FIG. 10).
Since a new procedure manual can be created by editing the procedure manual, for example, an existing procedure manual registered in the specific action procedure manual master 127 is replaced with a new procedure manual, or a procedure manual ID is set. A new procedure manual can be created and linked to the field (the NULL value is set in the skill-specific procedure manual ID master 126 (FIG. 9)).

Subsequently, the medical work support apparatus 10 creates procedure record data (FIG. 16), and sets a specific action ID 2702, a minimum skill level or nurse ID 2703, and a procedure manual ID 2704 in the procedure record data (step) S311).
Then, a procedure record ID 2701 is generated and set in the procedure record data, and is set in the procedure record ID 2812 of the order data (FIG. 14). Here, it is set to order data 2820 which is order data at the time of order issuance.

  As described above, even if the doctor does not know the qualification of the individual nurse and the skill level, it is easy to comprehensively specify specific actions by simply specifying the minimum skill level required from the patient's situation. It becomes possible to issue orders.

Returning to the description of FIG.
When the medical service support apparatus 10 accepts the comprehensive instruction for the specific action in step S209, the medical work support apparatus 10 sets the comprehensive instruction flag 2811 for the specific action in the order data 2820 of the order table 131 (FIG. 14) (step S210).

  Subsequently, when the doctor inputs the request content in the request content field 1303 of the order issue screen 40b and presses the registration button 1304, the medical service support apparatus 10 registers the input request content (step S211). Even if the registration button 1304 is not pressed, the request content is automatically registered when the issue button 1305 is pressed later. The registration button 1304 is used when, for example, it is desired to temporarily register the contents of a request for the current order when another order screen is displayed.

Subsequently, the medical operation support apparatus 10 accepts pressing of the order issue button 1305 or the cancel button from the doctor (step S212).
When the pressing operation of the order issue button 1305 is accepted (step S220; Yes), the process proceeds to step S221.

In step S221, the medical operation support apparatus 10 determines an order condition instruction, and when the condition instruction is “comprehensive instruction”, the comprehensive instruction list 123 associates the order ID with the patient ID as an order of the comprehensive instruction. It is additionally stored in (FIG. 6) (step S222).
On the other hand, if the condition instruction is not “comprehensive instruction”, the order ID and patient ID are linked and additionally stored in the promise instruction list (not shown) as an order for the promise instruction (step S223).

  The medical service support apparatus 10 sets information related to the order in the order data and registers it in the order table 131 (FIG. 14) (step S224). Here, information related to the order is set in order data 2820 which is order data at the time of order issuance.

  In the example of FIG. 14, the order data 2820 includes an order ID 2801, a current number 2802 (“0” in the first case) for distinguishing from order data having the same order ID, and a front number 2803 indicating the previous order data (previous time). Order data “NULL”), order issue date 2804 (“2016/3/13, 8:42”), patient ID 2805 (“12345”), physician user ID 2806 (“0002”), order Type ID 2807 (“0003” = “specific action”), order status 2808 (“generic instruction”), workflow step 2809 (“NULL” because before order delivery), order comment 2810 (“input to request content field 1303” After the implementation, various information of “Please contact me if SpO2 is 94% or less” is set.

  Then, the medical service support apparatus 10 executes processing for distributing the order (order distribution processing) (step S225), and changes the issued order according to the workflow data sequence of the order type master 124 (FIG. 7). The order distribution process will be described later with reference to FIG.

  With the above-described order issuance process, the doctor can easily select a specific action and issue an order with a comprehensive instruction condition when issuing an order. Moreover, it can manage as a list which distinguished comprehensive instructions and other commitment instructions.

FIG. 22 is a PAD showing a flow of order distribution processing executed by the order distribution function 112 (see FIG. 1A).
First, the medical service support apparatus 10 refers to the order type master 124 (FIG. 7) and acquires a workflow sequence (workflow data) corresponding to the issued order (step S401). For example, when the order type ID of the issued order is “0003” (replacement of tracheal cannula (at home)), the corresponding workflow data (“Start → (Home, Nurse) → Doctor → End”) from the order type master 124. ) To get.

Subsequently, the following processing is repeated until all the acquired workflow data sequences are completed (step S402).
(1) One next destination is read from the work flow data sequence. (2) The order is transmitted to the destination read in (1). (3) Wait until order completion is received from the destination in (2).

  By the above order distribution process, the issued order can be changed according to the workflow data sequence of the order type master 124. Thereby, since a doctor can change an order sequentially, without being conscious of who the order must be delivered to in what order, it is possible to greatly reduce the burden on the doctor.

  Next, processing executed by the order issuing function 115 (see FIG. 1A) from the comprehensive instruction list will be described. This process is performed by a user (nurse) who has logged in the ordering system 110 in an order (specific action) registered in the comprehensive instruction list 123 (FIG. 6) created by the order issuing process of FIG. 17 (FIG. 18). The order can be executed by selecting the comprehensive instruction). Here, it is assumed that a nurse whose nurse ID is “G” (also described as “login user”) is logged in to the ordering system 110.

FIG. 23 is a PAD diagram showing a flow of processing (order issuing processing from the comprehensive instruction list) executed by the order issuing function 115 from the comprehensive instruction list.
FIG. 25 is a diagram illustrating an example of the order confirmation screen 41 operated by the nurse. The order issuing process from the comprehensive instruction list is realized by receiving an operation from the nurse via the order confirmation screen 41 (user interface).

  First, the medical service support apparatus 10 sequentially acquires order IDs that match the corresponding patient IDs from the comprehensive instruction list 123 (FIG. 6) (step S501), and performs the following processing (steps S502 to S507) as order IDs. Repeat every time.

  It is determined whether or not the order classification related to the acquired order ID is “specific action” (step S502). For example, it is assumed that the order ID “2016033160005” is acquired in step S501. In this case, the order table 131 (FIG. 14) is accessed, and the order type ID 2807 of the latest order data of the corresponding order ID is acquired. Since the order is issued in the order issuance process of FIG. 17, the latest order data at this stage is the order data 2820 of FIG. That is, “0003” which is the order type ID 2807 of the order data 2820 is acquired.

  Next, the medical service support apparatus 10 confirms the order classification ID of the corresponding order classification ID “0003” in the order classification master 124 (FIG. 7), and if the order classification ID is “02”, “specific action”. (See FIG. 4) (step S502; Yes), the process proceeds to step S503. If it is not “specific action” (step S502; No), the selection of the corresponding order is validated (step S507).

In step S <b> 503, the medical work support apparatus 10 performs an actor determination process for determining whether the logged-in user (nurse) is an actor that satisfies a condition for performing a specific action. Thereby, it is automatically determined whether the logged-in user (nurse) is a nurse who has the qualification and skill level as intended by the doctor who has given a comprehensive instruction for the specific action.
With reference to FIG. 24, this actor determination process will be described. In order to simplify the explanation, it is assumed that the logged-in user's actor determination is performed for the specific action “replacement of tracheal cannula (at home)” with the specific action ID “006”.

FIG. 24 is a PAD showing a flow of actor determination processing executed by the actor determination function 116 (see FIG. 1A).
First, the medical service support apparatus 10 accesses the qualification master 128 (FIG. 11), and acquires the credential information (“qualified” and “not qualified”) of the login user of the specific action (step S601). Here, since the nurse ID of the login user is “G” and the specific action ID is “006”, “qualified” is acquired as the qualification information.

  Subsequently, the medical service support apparatus 10 determines whether or not the login user is a qualified person for the specific action (step S602). If “not qualified” is acquired in step S601 (step S602; No), the process proceeds to step S603, the determination result is output as “No”, and the process is terminated. If “qualified” is acquired in step S601 (step S602; Yes), the process proceeds to step S604.

In step S604, the medical service support apparatus 10 acquires a user designation method (minimum skill level (skill level designation) or user ID designation) of a comprehensive instruction.
Specifically, the user specified condition is that the order table 131 (FIG. 14) is searched using the order ID as a key, and the procedure record ID of the latest order data among the order data with the matched order ID is referred to, and this procedure record is made. It is acquired from “minimum skill level or nurse ID 2703” in the procedure record data (FIG. 16) associated with the ID. That is, if the minimum skill level is set in the “minimum skill level or nurse ID 2703”, the medical service support apparatus 10 uses the minimum skill level (skill level specification) as a user-specified method of comprehensive instruction. ) To get. On the other hand, if a specific nurse ID is set in the “minimum skill level or nurse ID 2703”, the medical work support apparatus 10 acquires the user ID designation as a user designation method of the comprehensive instruction.

  When the user ID designation is acquired in step S604, the medical service support apparatus 10 determines whether the nurse ID of the logged-in user matches the nurse ID set in the procedure record data (step S605). . If they do not match, the process proceeds to step S606, the determination result is output as “No”, and the process ends. If they match, the process proceeds to step S610, the determination result is output as “Yes”, and the process ends.

When the minimum skill level (skill level designation) is acquired in step S604, the medical service support apparatus 10 accesses the skill level table 129 (FIG. 12) and acquires the skill level of the specific action of the login user. (Step S607).
Here, since the nurse ID of the login user is “G” and the specific action ID is “006”, “M” (medium skill level) is acquired as the skill level.

  Subsequently, the medical work support apparatus 10 determines whether or not the acquired skill level is equal to or higher than the minimum skill level (step S608). If NO in step S609, the process advances to step S609 to output “No” as the determination result, and the process ends. If the determination is positive, the process proceeds to step S610, the determination result is output as “Yes”, and the process ends. For example, when the minimum skill level of the specific action ID “006” is “M”, the skill level of the login user is “M” (because the skill level of the login user is equal to or higher than the minimum skill level). ), And the determination result is “Yes”.

  By the above actor determination process, the order (specific action only) if it is a nurse directly designated by the doctor or a nurse who satisfies the qualification and skill level requirements of the specific action included in the comprehensive instruction list Therefore, the nurse who has issued the comprehensive instruction can perform the specific action as intended. For example, it is assumed that the skill level of the specific action “006” designated by the doctor is “L” (low skill level). In this case, referring to the skill level table 129 (FIG. 12), the skill level of the specific action “006” of the nurse whose nurse ID is “D” (referred to as “nurse D”) is “L” (skilled Therefore, the skill level requirement of the specific action requested by the doctor is satisfied. However, referring to the qualification master 128 (FIG. 11), the qualification information of the nurse D of the specific action “006” is “no qualification”. For this reason, since the skill level is satisfied but is not qualified, the nurse D does not rise to the candidate for instruction. As described above, by comprehensively determining the minimum skill level and the presence / absence of qualification for a specific action, an actor who performs the specific action can be suitably selected.

Returning to the description of FIG.
The medical work support apparatus 10 acquires the determination result of the actor determination process in step S503 (step S504), and when the determination result is a positive determination (step S505; Yes), validates the selection of the corresponding specific action ( Step S505). In the case of negative determination (step S504; No), the selection of the corresponding specific action is invalidated (step S506).

The medical operation support apparatus 10 displays a comprehensive instruction list on the order confirmation screen 41 and accepts the selection (step S510).
Specifically, as shown in FIG. 25, on the order confirmation screen 41, a comprehensive instruction list 1401 of specific actions is displayed, and a selection button 1402 is provided for each specific action. This selection button 1402 is displayed in a selectable state only when selection of a specific action is validated in step S505.

  In the procedure manual column 1403, a linked procedure manual ID is displayed. When a link of the procedure manual ID is clicked, another screen is displayed and a procedure manual is displayed. This procedure can be printed and carried as a paper medium. For the procedure manual ID, the order table 131 (FIG. 14) is searched using the order ID as a key, and the procedure record ID of the latest order data among the order data with the matched order ID is referred to. It is acquired from the procedure manual ID 2704 (FIG. 16) of the procedure record data to be associated. Since the order is issued in the order issuance process of FIG. 17, the latest order data at this stage is the order data 2820 of FIG. That is, it is acquired from the procedure record ID 2812 of the order data 2820.

  Subsequently, the medical operation support apparatus 10 determines whether or not the order (general instruction) selected in step S510 is a “specific action” (step S511). If the determination is positive, the process proceeds to step S512.

  The medical operation support apparatus 10 acquires the procedure manual data of the order selected by the login user (nurse) on the order confirmation screen 41 (step S512). Specifically, referring to the specific action procedure manual master 127 (FIG. 10), the procedure document data associated with the procedure document ID of the selected order is acquired.

  Then, the medical work support apparatus 10 displays the “patient medical condition range” (check list) included in the acquired procedure manual data (step S513). Specifically, the patient's medical condition range (check list) 2003 (FIG. 15) is acquired from the procedure manual data, and the acquired check list is displayed in the check list display field 1405 of the order confirmation screen 41 (FIG. 25). .

  The medical operation support apparatus 10 receives an input such as a check for each item in the check list from the nurse, and further receives a press of a medical condition determination button 1406 (step S514). In addition, when there is an item requiring numerical input such as vital data in the check list, the past measurement result (numerical value) of the patient is input automatically or manually.

  Upon accepting the pressing of the medical condition determination button 1406 from the patient, the medical service support apparatus 10 determines the check list (step S515). Specifically, the decision logic 2004 (FIG. 15) for the procedure manual data is read, and the decision logic 2004 is applied to the input content of the checklist to determine whether or not the patient is within the range of the medical condition in which the specific action is performed on the patient. Determine.

If the result of the determination is a positive determination (step S515; Yes), the action content 2006 (FIG. 15) at the time of the positive determination is read from the procedure manual data and displayed in the determination result column 1407 of the order confirmation screen 41 (FIG. 25). (Step S516).
If NO (Step S515; No), the message 2005 (FIG. 15) at the time of NO determination is read from the procedure manual data and displayed in the determination result column 1407 of the order confirmation screen 41 (FIG. 25) (Step S517). .

  Then, the medical service support apparatus 10 copies the procedure record data associated with the order ID with a new procedure record ID, and copies the checklist input contents and the determination result thereof to the patient of the procedure record data. The medical condition is stored in the range 2705 (FIG. 16) and the checklist determination result 2706 (FIG. 16) (step S518).

  When the pressing of the order registration button 1408 is received from the logged-in user (nurse) on the order confirmation screen 41 (step S520), the medical operation support apparatus 10 adds the current number / front number, date / time, etc. to the order data. The procedure record ID issued in S518 is set and stored as a new record in the order table 131 (FIG. 14). In FIG. 14, the order data 2830 corresponds to this.

  Next, an order execution process in which a nurse performs a comprehensive instruction for a specific action will be described. This process is a process in a case where the nurse who is the user actually executes the order issued by the order issuing process from the comprehensive instruction list of FIG.

  FIG. 26 is a PAD showing a flow of order execution processing executed by the order execution function 113 (see FIG. 1A). FIG. 28 is a diagram illustrating an example of an order execution screen 42 (screen displayed during or after a specific action) operated by the nurse. The order execution process is realized by accepting a nurse's operation via the order execution screen 42 (user interface).

  First, the medical service support apparatus 10 displays order items 1501 (order classification, order type, date, etc.) and request content 1502 in the order reference area 1500 of the order execution screen 42 (step S701).

  Subsequently, the medical service support apparatus 10 determines whether or not the currently executed order is a comprehensive instruction for a specific action (step S702). Specifically, the order table 131 (FIG. 14) is accessed, and the comprehensive instruction flag 2811 of the specific action of the order data being executed (order data 2830 in the example of FIG. 14) is read. It determines with it being a comprehensive instruction | indication of a specific action, and progresses to step S703.

In step S703, the medical service support apparatus 10 performs an actor determination process. Since this process is the same as that in FIG. 24, the description is omitted.
If the determination result of the actor determination process is a positive determination, the process proceeds to step S705. If the determination result is negative, the process ends.

  In step S705, the medical service support apparatus 10 displays a checklist of confirmation items from the procedure manual associated with the order, and receives an input such as a check of each item in the checklist from the nurse (step S705). Specifically, the order table 131 (FIG. 14) is searched using the order ID as a key, and the procedure record data associated with the procedure record ID of the latest order data among the order data with the matched order ID is acquired. In the order issuance process from the comprehensive instruction list described above (FIG. 23), new order data 2830 is created, so the latest order data at this stage is order data 2830.

  Subsequently, the procedure manual data associated with the procedure manual ID 2704 (FIG. 16) of the procedure record data is acquired, and the check list of “confirmation items 2007 when performing a specific action” (FIG. 15) of this procedure manual data is read. . Then, a check list is displayed in the confirmation item area 1503 of the order execution screen 42 (FIG. 28), and an input such as a check of each item in the check list is received from the nurse.

  If pressing of the item determination button 1504 is received from the nurse, the process proceeds to step S706. On the other hand, when the pressing of the cancel button is accepted, the order execution process is terminated.

  In step S706, the medical service support apparatus 10 determines the input checklist input by the nurse according to the determination logic. Specifically, the “check item determination logic 2008” (FIG. 15) of the procedure manual data is acquired, and the determination logic 2008 is applied to the input check list to determine whether the patient is within a normal medical condition range. Judgment is made.

  If the result of determination is positive determination (step S707; Yes), a message at the time of positive determination is displayed (step S708). Specifically, the “message 2010 at the time of correct determination” (FIG. 15) of the procedure manual data is read and displayed in the determination result column 1505 of the order execution screen 42 (FIG. 28). For example, “No problem. After exchanging the trachea new curry, if the medical condition worsens and there is an urgent need for medical treatment, it should be transported to an attending doctor by ambulance.”

  On the other hand, if the result of determination is negative (step S707; No), a message at the time of negative determination is displayed (step S709). Specifically, “message 2009 at the time of rejection” (FIG. 15) of the procedure manual data is read and displayed in the determination result column 1505 of the order execution screen 42 (FIG. 28). For example, the message “There is a problem. Contact your doctor immediately for direct instructions.” Is displayed.

  Subsequently, the medical service support apparatus 10 updates the procedure record ID, and associates the input confirmation items (check list) and the determination result with the newly created order data (order data 2840 in the example of FIG. 14) (step). S710). Specifically, the procedure record data associated with the order ID is duplicated with a new procedure record ID, and the confirmation items (check list) and determination results are respectively displayed in the “check list entry result 2707” of the procedure record data. "(FIG. 16) and" check list determination result 2708 "(FIG. 16). Then, the procedure record ID is stored in the order data 2840 of the order table 131 (FIG. 14).

  Subsequently, the medical work support apparatus 10 executes a nurse skill level update process (skill level update process) (step S711). This process will be described later with reference to FIG.

  Subsequently, the medical work support apparatus 10 validates the input of the result comment and receives the input from the nurse (Step S720). As a result, the result comment field 1506 of the order execution screen 42 can be input.

  If the registration button 1507 is pressed from the nurse (step S721, Yes), the medical service support apparatus 10 updates the current number / front number, date, etc. of the order data 2840 of FIG. 2810 stores the result comment information input in step S720.

  With the above order execution process, the nurse can report the result of a specific action as a reply to the order while checking the items to be confirmed in the procedure manual. It is possible to prevent mistakes such as medical errors.

  FIG. 27 is a PAD diagram showing the flow of skill level update processing. The skill level update process is executed when the specific action according to the comprehensive instruction is completed (step S711 in FIG. 26) or when the specific action is completed according to the direct instruction from the doctor.

  First, the medical service support apparatus 10 accesses the nurse experience count table 130 (FIG. 13) (step S801), and increments the experience count of the nurse ID of the corresponding nurse for the specific action ID (step S801). Step S802). For example, if the corresponding specific action ID is “006” and the nurse ID is “G”, the current number of experiences “20” is increased to “21”.

  Subsequently, the medical service support apparatus 10 reads the number of times (described as “number of times M”) set in the reference M of the corresponding specific action ID (step S803) and the number of times specified in the reference H ( (Described as “number of times H”) is read (step S804).

If the number of experiences increased in step S802 is equal to or greater than the number H, it is determined that the skill level is H (high skill level) (step S806). If the number of experiences is greater than or equal to the number of times M and less than the number of times H, it is determined that the skill level is M (middle skill level) (step S807). If the number of experiences is less than the number M, it is determined that the skill level is L (low skill level) (step S808).
In addition, when there is an experience of treating a patient with a high degree of difficulty designated by a doctor or an experience of assisting another nurse, the skill level may be determined by reflecting them in the number of experiences. For example, the skill level is determined after adding the number of treatments for a patient with high difficulty and the number of times assisting another nurse to the number of experiences.

The medical operation support apparatus 10 accesses the nurse skill level table 129 (FIG. 12), stores the skill level determination results in steps S806 to S808, and updates the skill level (step S809).
When the nurse is a qualified person for a specific action (step S810; Yes), the medical service support apparatus 10 also updates the number of persons for each skill level for displaying the skill level designation screen 50 (FIG. 21). (Step S811).

  With the skill level update process described above, the number of experiences is counted each time a specific action is performed, and the skill level table 129 is updated. In addition, the number of persons by skill level displayed on the skill level designation screen 50 in FIG. 21 is also displayed and updated. It should be noted that the skill level is updated as the experience increases, regardless of whether it is a comprehensive instruction or a direct instruction from a doctor. In other words, the skill level is updated regardless of the qualification of the specific action. For this reason, nurses who do not have qualifications immediately become candidates for implementation of specific actions by comprehensive instructions as soon as they receive training and qualifications for specific actions.

  FIG. 29 is a diagram showing a display example of a medical recording screen 43 on which a user (doctor or nurse) browses and inputs a medical record. The left side of the medical recording screen 43 is an area for displaying a patient's medical history and order history. The first order history 1601 is an order history when a doctor registers a comprehensive instruction for a specific action “exchange of tracheal new curry”. The next order history 1602 is an order history when the nurse issues an order from the comprehensive instruction list. The last order history 1603 is an order history when the nurse actually performs the issued order and inputs a result comment after the execution. By pressing the procedure record 1604 of the order history 1603, the nurse confirms the check list 2003 (FIG. 15) of the patient medical condition range in the procedure manual, the confirmation item 2707 (FIG. 16) when performing the specific action, and the like. be able to. The doctor can save the medical record by inputting the medical record on the medical record input screen 1605 while referring to the order history and pressing the registration button.

  The first embodiment has been described above. According to the first embodiment, a mechanism for issuing an order for a specific action is realized. When the order condition instruction is a comprehensive instruction, the information is set in the order status 2808 (see FIG. 14). In addition, the doctor can designate a minimum skill level necessary for a specific action, set a procedure manual according to the skill level, and issue an order. In addition, regarding the nurse who receives the order, whether or not the order can be performed is determined based on the skill level of the specific action and the presence or absence of the qualification, and only the order that is determined to be executable can be selected and executed. Thereby, it is possible to prevent a doctor from making a mistake in giving a comprehensive instruction to an unqualified nurse, and it is possible to prevent a mistake in which a non-qualified nurse performs a comprehensive instruction by mistake. In addition, simply specifying the skill level expected by the doctor according to the patient's condition and the situation at home, etc., for example, the procedure manual with the discretion changed according to the skill level of the nurse is automatically applied. Therefore, even a doctor who does not know the skill level of a nurse can appropriately give comprehensive instructions on specific actions. In addition, a nurse who has received a comprehensive instruction for a specific action can provide medical assistance while easily checking the procedure manual.

[Second Embodiment]
Next, a second embodiment of the present invention will be described with reference to FIGS.
The second embodiment uses a comprehensive instruction list created by the processing of FIGS. 17 and 18 so that a doctor issues an order as “general order” instead of a comprehensive instruction. is there.

  FIG. 30 is a PAD diagram showing a flow of processing for issuing a general order by a doctor using a comprehensive instruction for a specific action. FIG. 31 is a PAD showing the flow of the actor determination process executed during the process of FIG. 30 and FIG. 31 are modifications of FIG. 23 and FIG. 24 of the first embodiment, respectively. The main differences from the first embodiment are that it is determined whether or not the logged-in user is a doctor, and that if the user is a doctor, the order is issued as a “general order” rather than a comprehensive instruction. .

  As in the first embodiment, first, the medical operation support apparatus 10 sequentially acquires order IDs that match the corresponding patient ID from the comprehensive instruction list 123 (FIG. 6) (step S501), and performs the following processing. (Steps S502 to S507 and Step S901) are repeated for each order ID.

It is determined whether or not the order classification related to the acquired order ID is “specific action” (step S502). If it is not “specific action” (step S502; No), the selection of the corresponding order is validated (step S507). If it is “specific action”, an actor determination process is executed (step 901).
With reference to FIG. 31, this actor determination process will be described.

First, the medical service support apparatus 10 determines whether the login user is a doctor or a nurse (step S1001). When it is determined that the logged-in user is a doctor and the doctor corresponds to an actor of a specific action, the determination result is output as “Yes” and the process is terminated (step S1002).
On the other hand, when the logged-in user is determined to be a nurse, an actor determination process similar to that shown in FIG. 24 is executed for the nurse. That is, the medical service support apparatus 10 accesses the qualification master 128 (FIG. 11), acquires the credential information (“qualified” and “non-qualified”) of the login user of the specific action (step S601), and the specific action It is determined whether or not the person is a qualified person (step S602). In the case of “no qualification” (step S602; No), the determination result is output as “No” and the process is ended (step S603).

  In the case of “qualified” (step S602; Yes), the medical service support apparatus 10 acquires a user designation method (minimum skill level (skill level designation) or user ID designation) of the comprehensive instruction (step S604). ). When the user ID designation is acquired, it is determined whether the nurse ID of the logged-in user matches the nurse ID set in the procedure record data (step S605). “No” is output and the process ends (step S606). If they match, the determination result is output as “Yes” and the process is terminated (step S610).

  On the other hand, when the minimum skill level (skill level designation) is acquired, the medical service support apparatus 10 accesses the skill level table 129 (FIG. 12), and acquires the skill level of the corresponding specific action of the login user ( In step S607), it is determined whether the acquired skill level is equal to or higher than the minimum skill level (step S608). If NO, the determination result is output as “No” and the process is terminated (step S609). If the determination is positive, the determination result is output as “Yes” and the process is terminated (step S610).

Returning to the description of FIG.
The medical service support apparatus 10 acquires the determination result of the actor determination process in step S901 (step S504), and when the determination result is a positive determination (step S505; Yes), validates the selection of the corresponding specific action ( Step S505). In the case of negative determination (step S504; No), the selection of the corresponding specific action is invalidated (step S506).

  Subsequently, the medical service support apparatus 10 displays the order list of the comprehensive instructions on the order confirmation screen 41 and accepts the selection of the order (step S510). When the selected order is “specific action” (step S511; Yes), the procedure manual data associated with the selected order (specific action) is acquired and displayed (step S512). At this time, the “patient medical condition range” (check list) included in the procedure manual data is displayed (step S512).

  Thereafter, in the second embodiment, it is determined whether or not the login user is a doctor (step S902). If the logged-in user is a doctor (step S902; Yes), the procedure manual is linked to issue an order as “general order” instead of a comprehensive instruction, and the process is terminated (step S903).

  On the other hand, if the logged-in user is not a doctor but a nurse (step S902; No), as in the first embodiment, an input such as a check for each item in the checklist is received from the nurse, and a disease state determination button is further received. The pressing of 1406 is accepted (step S514).

  Upon receiving the pressing of the medical condition determination button 1406 from the patient, the medical service support apparatus 10 determines the checklist (step S515). If the result of determination is negative (step S515; No), the medical service support apparatus 10 Then, the name of the doctor who issued the order is displayed and displayed on a display screen for displaying a message for directly asking the doctor in charge, and the process is terminated (step S516).

  If the order selected in step S511 is not “specific action”, the “patient medical condition range” (check list) included in the procedure manual data associated with the order is displayed as in steps S512 and 513. The doctor inputs (fills in) a check or the like, associates the procedure manual data including the filled check list, and issues an order (step S520).

  As described above, according to the second embodiment, since a doctor can issue an order for a specific action using the comprehensive instruction list, the doctor qualifies the specific action while referring to the procedure manual. It becomes possible to perform a medical action to a nurse who does not have a direct instruction.

  The preferred embodiment according to the present invention has been described above, but the present invention is not limited to the above-described embodiment.

  For example, you may make it acquire and display the procedure manual according to the skill level of the nurse. In the first embodiment, the procedure manual data of the skill level designated by the doctor is acquired and displayed regardless of the skill level of the nurse. For example, when a doctor designates the skill level of a specific action as skill level L (low skill level), in the first embodiment, skill level H (high skill level) and skill level M (medium skill level) A procedure manual for nurses with low skill levels is acquired and displayed for the nurses. For this reason, some nurses may not have appropriate procedures. In order to avoid this, procedure manual data corresponding to the skill level of the nurse may be acquired and displayed. That is, the procedure manual data of skill level H is provided to nurses of skill level H, the procedure manual data of skill level M is provided to nurses of skill level M, and nurses of skill level L are provided. Is provided with procedure manual data of skill level L.

  Specifically, the process in step S512 in FIG. 23 changes as follows. In step S512, the medical service support apparatus 10 refers to the skill level table 129 (FIG. 12), acquires the skill level of the logged-in user (nurse), and then continues to the skill level procedure manual ID master 126 (FIG. 9), the procedure manual ID corresponding to the skill level is acquired. Then, the procedure manual data corresponding to the procedure manual ID acquired with reference to the specific action procedure manual master 127 is acquired. Thereby, a procedure manual that matches the skill level of the nurse is acquired. The subsequent check list display, input, and determination processing (steps S513 to S517) is performed based on the acquired procedure manual data.

In the first embodiment, only nurses who satisfy the skill level designated by the doctor can perform the order. However, all nurses may perform the order.
This is realized by omitting the process in step S209 (see FIGS. 17 and 18) and the process in step S503 (see FIGS. 23 and 24) for receiving the designation of the skill level from the doctor. Thereby, since the skill level is not specified and the actor determination is not executed, all the nurses can perform the order. The procedure manual is provided according to the skill level of the nurse as in the above example.

  It will be apparent to those skilled in the art that various changes and modifications can be made within the scope of the technical idea disclosed in the present application, and these naturally belong to the technical scope of the present invention. It is understood.

DESCRIPTION OF SYMBOLS 1 ... Medical care support system 10, 20 ... Medical work support apparatus 11 ... Web server 30 ... Client terminal 40a ... Order issue screen 40b ··· Order issuing screen 41 ··· Order confirmation screen 42 ··· Order execution screen 43 ··· Medical recording screen 50 ··· Skill level designation screen 110 Ordering system 210 Medical accounting system 111 Order issuing function 112 Order delivery function 113 Order execution function 114 Skilled Degree update function 115 · Order issue function 116 · Actor judgment function 117 · Electronic medical record system 118 · Procedure display / editing function 119 · Comprehensive Instruction reception function 120 ... ··· Database 121 ··· Order classification master 122 ··· Specific action order type master 123 ··· Comprehensive instruction list 124 ··· Order type master 125 · · · Skill level Level master 126 ··· Procedure according to skill level ID master 127 ··· Specific action procedure manual master 128 ··· Quality master 129 ··· Proficiency table 130 ··· Experience Number table 131... Order table 200 .. procedure manual data structure 300... Procedure record data structure

Claims (15)

An action accepting unit that accepts a selection of a specific action;
An order issuing unit for issuing an order of the selected specific action;
A medical service support apparatus comprising: A condition instruction receiving unit for receiving selection of a condition instruction including at least a comprehensive instruction;
2. The medical operation support apparatus according to claim 1, wherein, when a comprehensive instruction is selected, the order issuing unit issues the order with information indicating that the instruction is a comprehensive instruction. A skill level designating unit for designating a skill level necessary for the actor for the selected specific action;
The medical order support apparatus according to claim 1, wherein the order issuing unit issues an order according to the designated skill level. A storage unit that stores procedure manual data according to skill level for each specific action;
The medical order support apparatus according to claim 3, wherein the order issuing unit issues the order in association with the procedure manual data corresponding to the skill level designated by the skill level designation unit. A storage unit that stores information on the proficiency level of each actor and the presence or absence of qualification for each specific action in association with identification information of each actor,
An actor determination unit that determines whether or not an order of a specific action issued by the order issuing unit can be performed for a predetermined actor based on the skill level of the predetermined actor and the presence or absence of qualifications,
The medical work support apparatus according to claim 3, further comprising: The actor determination unit determines that the order can be performed when the skill level is higher than the skill level designated by the skill level designation unit and the qualification is given for the specific action. The medical operation support apparatus according to claim 5. The medical work support apparatus according to any one of claims 3 to 6, wherein the skill level is determined based on the number of experiences of performing a specific action. The procedure manual data determines whether or not the check list includes one or more items for specifying the range of the medical condition of the patient, and the range of the medical condition in which the specific action can be performed on the patient based on the check list. The medical operation support apparatus according to claim 4, further comprising: determination logic information. Means for receiving input of each item of the checklist;
Means for applying the determination logic to the input checklist, and determining whether or not the range of medical conditions in which a specific action can be performed on a patient;
The medical work support apparatus according to claim 8, further comprising: The procedure manual data includes a checklist including one or more items to be confirmed when performing a specific action on a patient, and a determination logic for determining whether the patient is within a normal medical condition range based on the checklist. The medical operation support apparatus according to claim 4, comprising information. Means for receiving input of each item of the checklist;
Means for applying the determination logic to the input checklist to determine whether the patient is in a normal medical condition range;
The medical operation support apparatus according to claim 10, further comprising: An action acceptance step for accepting a selection of a specific action;
An order issuing step for issuing an order of the selected specific action;
A medical service support method characterized by comprising: A condition instruction accepting step for accepting selection of a condition instruction including at least a comprehensive instruction, wherein the order issuing step adds the information indicating that the instruction is a comprehensive instruction when the comprehensive instruction is selected. The medical work support method according to claim 12, wherein the medical work support method is issued. Computer
An action accepting unit that accepts a selection of a specific action;
An order issuing unit for issuing an order of the selected specific action;
A program characterized by making it function. A condition instruction receiving unit for receiving selection of a condition instruction including at least a comprehensive instruction;
15. The program according to claim 14, wherein, when a comprehensive instruction is selected, the order issuing unit issues the order with information indicating a comprehensive instruction.

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