JP2018077915A - Ophthalmologic information system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a new technique for managing a disease state in a long term.SOLUTION: An ophthalmologic information system of an embodiment includes a server and a plurality of ophthalmologic inspection devices capable of communicating with a server via a communication line. The server stores setting information for controlling the ophthalmologic inspection devices by the piece of patient identification information. The ophthalmologic inspection devices are installed in facilities different from medical institutions. The ophthalmologic inspection devices transmit patient identification information and device identification information to the server. The server searches for setting information on the basis of the patient identification information, and transmits the setting information on the basis of the device identification information. The ophthalmologic inspection devices inspect eyes to be inspected on the basis of the setting information received from the server.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a system for processing ophthalmic information.

  There is home medical care as a medical treatment method for patients who need long-term management of the disease state. Home medical care refers to medical care given to a patient at a place other than a medical institution (for example, a home, a welfare facility for the elderly, etc., sometimes referred to collectively as “home etc.”). In home medical care, a medical device is installed at home or the like, and remote management of the medical device is performed (see, for example, Patent Documents 1-3).

  With the progress of an aging society in recent years, home medical care is expected to increase. On the other hand, ocular diseases such as age-related macular degeneration, diabetic retinopathy and glaucoma are expected to increase due to factors such as aging and changes in lifestyle habits. These ophthalmic diseases have a risk of blindness and require long-term management.

  However, it is difficult to manage such ophthalmic diseases with conventional home medical technology. In other words, management of these ophthalmic diseases requires understanding of the pathology, and in order to accurately grasp the pathology, not only subjective examinations using subjective targets (subjective tests), but also eye morphology and Inspection to understand the characteristics is also necessary.

For the examination for grasping the form of the eye, for example, the following apparatus is used.
・ Optical coherence tomography (OCT apparatus) for obtaining cross-sectional images of the fundus and cornea using optical coherence tomography (OCT)
-Fundus camera for photographing the fundus-Scanning laser opthalmoscope (SLO) for obtaining images of the fundus by laser scanning using a confocal optical system

Further, for example, the following apparatus is used for the examination for grasping the eye characteristics.
・ Eye refraction inspection device (refractometer, keratometer) that measures refractive characteristics of the eyeball
-Tonometer for measuring intraocular pressure-Specular microscope for obtaining corneal characteristics (corneal thickness, cell distribution, etc.)-Wavefront analyzer for obtaining aberration information of the eyeball using a Hartmann-Shack sensor

  As described above, various inspection apparatuses are used in the ophthalmic field, and attention to the OCT apparatus has been increasing in recent years. This is due to the remarkable advantages of the OCT apparatus, such as the ability to obtain high-definition images and the ability to obtain cross-sectional images and three-dimensional images. As shown below, there are various methods for OCT.

  Patent Document 4 discloses an apparatus using a technique called Fourier domain OCT (Fourier Domain OCT) or frequency domain OCT (Frequency Domain OCT). This device scans an object to be measured with a beam of low coherence light, superimposes the reflected light from the object to be measured on the reference light, generates interference light, and acquires the spectral intensity distribution of this interference light with a spectrometer. The scan cross section is imaged by subjecting the spectral intensity distribution to Fourier transform. Such a method using a spectroscope is also called a spectral domain.

  Patent Document 5 discloses an apparatus using a technique called a swept source OCT, which is a kind of Fourier domain OCT. This device scans the wavelength of the light irradiating the object to be measured (wavelength sweep), and sequentially detects the interference light obtained by superimposing the reflected light of the light of each wavelength with the reference light. And an image is formed by applying Fourier transform to the spectral intensity distribution.

  Patent Document 6 discloses an apparatus using a technique called full-field OCT or in-face OCT. This device irradiates an object to be measured with light having a predetermined beam diameter, and analyzes a component of interference light obtained by superimposing the reflected light with reference light, thereby obtaining a cross section orthogonal to the light traveling direction. It is configured to be imaged.

  Patent Document 7 discloses a configuration in which OCT is applied to the ophthalmic field. Patent Document 8 discloses an ophthalmic examination apparatus that provides a diagnostic material for macular disease or glaucoma by combining an OCT apparatus and a subjective visual acuity examination apparatus.

JP 2009-20794 A JP 2005-285033 A Japanese Patent Laid-Open No. 2004-199631 JP 11-325849 A JP 2007-24677 A JP 2006-153838 A JP 2013-248376 A Special table 2011-515194 gazette

  As described above, an ophthalmic apparatus such as an OCT apparatus is useful for grasping a pathological condition, and it is desirable that an ophthalmic apparatus is installed at each patient's home or the like to perform daily and easy examinations. However, in order to do so, it is necessary to solve various problems such as cost burden on the patient and proficiency in the operation of the ophthalmologic apparatus.

  An object of the present invention is to provide a new technique for performing long-term management of a disease state.

The invention according to claim 1 includes a server and a plurality of ophthalmic examination apparatuses that can communicate with the server via a communication line, and the server stores setting information for controlling the plurality of ophthalmic examination apparatuses. A storage unit pre-stored for each patient identification information, wherein each of the plurality of ophthalmic examination apparatuses is installed in a facility different from a medical institution, and a communication unit for performing communication via a communication line; and patient identification An information receiving unit that receives information, an inspection unit that generates inspection data by optically inspecting the eye, patient identification information received by the receiving unit, and device identification information of the ophthalmic examination apparatus are transmitted to the server The communication unit is controlled so that the server searches from the storage unit based on the patient identification information and transmits to the ophthalmic examination apparatus based on the device identification information A ophthalmic information system which comprises a control unit for executing a test of the eye by controlling the measurement part based on the distribution.
The invention described in claim 2 is the ophthalmologic information system according to claim 1, further comprising medical institution terminals installed in a plurality of medical institutions capable of communicating with the server via a communication line,
The medical institution terminal includes a user interface for editing the setting information stored in the storage unit of the server.
Invention of Claim 3 is an ophthalmologic information system of Claim 1 or Claim 2, Comprising: Any of these ophthalmic examination apparatuses can perform optical coherence tomography, The said setting information Includes a setting content related to at least one of a fixation position, a scan pattern, a focus position, a diopter correction value, and an analysis process.

  According to this invention, it is possible to provide a new technique for performing long-term management of a disease state.

It is a schematic diagram showing an example of composition of a system concerning an embodiment. It is a schematic diagram showing an example of composition of a cloud server concerning an embodiment. It is a schematic diagram showing an example of composition of a cloud server concerning an embodiment. It is a schematic diagram showing an example of composition of an ophthalmic examination device concerning an embodiment. It is a schematic diagram showing an example of composition of an ophthalmic examination device concerning an embodiment. It is a flowchart showing an example of the usage pattern of the system which concerns on embodiment. It is a schematic diagram showing an example of composition of a cloud server concerning an embodiment. It is a flowchart showing an example of the usage pattern of the system which concerns on embodiment. It is a schematic diagram showing an example of composition of a cloud server concerning an embodiment. It is a flowchart showing an example of the usage pattern of the system which concerns on embodiment. It is a schematic diagram showing an example of composition of a cloud server concerning an embodiment. It is a flowchart showing an example of the usage pattern of the system which concerns on embodiment.

  An example of an embodiment of the present invention will be described. It should be noted that the contents of the documents described in this specification can be appropriately incorporated as the contents of the following embodiments.

  The ophthalmologic information system according to the embodiment is configured around a cloud server. The cloud server provides services to various computers that can be connected via a communication line.

[System configuration]
1 includes one or more cloud servers 100, a plurality of ophthalmic examination apparatuses 200-a (a = 1, 2, 3,...), And a plurality of patient terminals 300-b ( b = 1, 2, 3,..., a plurality of designated person terminals 400-c (c = 1, 2, 3,...), and a plurality of diagnostic doctor terminals 500-d (d = 1, 2, 3,..., A plurality of medical institution servers 600-e (e = 1, 2, 3,...), And a plurality of medical worker terminals 650-f (f = 1, 2, 3,..., A plurality of financial institution servers 700-g (g = 1, 2, 3,...) And a plurality of insurance institution servers 800-h (h = 1, 2, 3,...) And one or more inspection data processing devices 900.

  Generally, the system according to the embodiment does not need to include all of these information processing apparatuses, and it is sufficient if an information processing apparatus for realizing a predetermined function is provided. In addition, a new information processing apparatus can be added to the system in accordance with function expansion.

  These information processing apparatuses are connected via a communication line N. The communication line N includes a wide area network (WAN) such as the Internet, a virtual private network, and a dedicated communication line. The communication line N includes a wired communication network and / or a wireless communication network. The communication line between the medical institution server 600-e and the medical worker terminal 650-f that can access the medical institution server 600-e may include a local area network (LAN).

[Cloud server 100]
The cloud server 100 will be described. The cloud server 100 is a server used for so-called cloud computing, and provides services such as data processing and data storage by a computer to a plurality of computers via a communication line N. In this example, the services provided by the cloud server 100 include an ophthalmic examination apparatus 200-a, a patient terminal 300-b, a designated person terminal 400-c, a diagnostic doctor terminal 500-d, a medical institution server 600-e, A financial institution server 700-g, an insurance institution server 800-h, and an inspection data processing apparatus 900 are included.

  The cloud server 100 includes a microprocessor, RAM, ROM, hard disk drive, and the like. The ROM and hard disk drive store computer programs and data for performing various controls and operations. Various processes are executed by the cooperation of hardware such as a microprocessor and software such as a computer program.

  An example of the internal configuration of the cloud server 100 is shown in FIGS. 2A and 2B. The cloud server 100 of this example includes an arithmetic control unit 110, a storage unit 120, a communication unit 130, a user information management unit 140, an inspection data processing unit 150, a report processing unit 160, a fee processing unit 170, An insurance processing unit 180.

(Calculation control unit 110)
The arithmetic control unit 110 controls each part of the cloud server 100 and performs various arithmetic processes. A specific example of processing executed by the arithmetic control unit 110 will be described later.

(Storage unit 120)
The storage unit 120 stores various data. The storage unit 120 stores information related to services provided by the cloud server 100. Customers who provide this service, that is, users of this service include patients, patients involved (family members, etc.), institutions where ophthalmic examination equipment is installed (testing equipment installation institutions), medical institutions, financial institutions, insurance institutions, etc. Is included. Examples of inspection apparatus installation organizations include pharmacies, spectacle stores, optometerists, and welfare facilities for the elderly. In order to store information related to these users, the storage unit 120 includes a patient information storage area 121, a medical institution information storage area 122, an examination apparatus information storage area 123, a financial institution information storage area 124, and insurance institution information. A storage area 125 is provided.

  The patient information storage area 121 is provided for each patient user. The patient information storage area 121 stores information related to patient users. Information on patient users includes user ID (identifier), authentication information (password, biometric information, etc.), name, gender, date of birth, contact information (address, telephone number, email address, IP address, etc.) in this system. , Billing information, related medical institution identification information, identification information (patient ID) of the patient user in the medical institution, medical information (information acquired by the ophthalmic examination apparatus 200-a, analysis result, created by a doctor) Diagnostic report, part of electronic medical record information, examination history, etc., identification information of the relevant financial institution, identification information of the patient user at the financial institution, identification information of the relevant insurance institution, the patient at the insurance institution There is user identification information (insured ID, etc.).

  Further, in the patient information storage area 121, information related to a patient user related person (related person user) is stored. Information related to related users includes user ID, authentication information (password, etc.), name, relationship with patient (relationship, etc.), contact information (address, telephone number, email address, IP address, etc.), billing, etc. There is information.

  The medical institution information storage area 122 is provided for each medical institution user. The medical institution information storage area 122 stores information related to medical institution users. Information related to medical institution users includes user ID, authentication information (password, etc.) in this system, type of medical institution (hospital, clinic, health examination center, etc.), name of medical institution, name of medical department, and related medical personnel Information (name of affiliation doctor, name of specialized disease, etc.), contact information (location, telephone number, email address, IP address, etc.), list of related medical institutions, related patient user identification information, billing information, etc. There is.

  In the inspection apparatus information storage area 123, information regarding a plurality of ophthalmic inspection apparatuses 200-a is stored. Information relating to the ophthalmic examination apparatus 200-a includes the identification information (apparatus ID) of the apparatus, the type of the institution in which the apparatus is installed (pharmacy, spectacle store, optometrist, welfare facility for the elderly, etc.) There are contact information (location, telephone number, e-mail address, IP address, name of person in charge, etc.), information on maintenance, history of inspections performed by the apparatus (number of inspections, frequency, etc.), and the like. The inspection device information storage area 123 may be provided for each ophthalmic inspection device 200-a or may be provided for each inspection device installation organization.

  The financial institution information storage area 124 is provided for each financial institution user. The financial institution information storage area 124 stores information related to financial institution users. Information related to financial institution users includes user ID, authentication information (password, etc.), financial institution type (bank, credit card company, etc.), financial institution name, contact information (location, telephone number, email address, IP) Address, etc.), related patient user ID and patient ID, information on billing, and the like.

  The insurance organization information storage area 125 is provided for each insurance organization user. The insurance institution information storage area 125 stores information related to insurance institution users. Information on insurance institution users includes user ID, authentication information (password, etc.), insurance institution type (public insurance, private insurance, etc.), insurance institution name, contact information (location, telephone number, email address) , IP addresses, etc.), related patient user IDs and insured IDs, information on billing, and the like.

  Information other than the above is also stored in the storage unit 120. As an example, there is a reward calculation rule 126. The remuneration amount calculation rule 126 is referred to in order to calculate remuneration amounts for various users based on the usage fee of the system. The reward calculation rule 126 may be provided for each type of system usage fee (charging type). As an example, the system usage fee is generated each time an examination (type of charge) using the ophthalmic examination apparatus 200-a is performed, and is charged to a patient user or an insurance organization. The fee based on this system usage fee is, for example, the institution where the ophthalmic examination apparatus 200-a used for the examination is installed, or the medical institution that has made a diagnosis based on the information (examination data) acquired by the examination. (Doctor) and the system operating organization (system operating organization). The remuneration amount calculation rule 126 is created in advance based on such a billing form or a remuneration form.

  As an example, the remuneration calculation rule 126 records the following information regarding each examination using the ophthalmic examination apparatus 200-a: the charge amount is X; the remuneration amount to the examination apparatus installation organization Y1; the remuneration amount to the medical institution is Y2; the remuneration amount to the system operating organization is Y3. Here, X = Y1 + Y2 + Y3 may be satisfied, but the present invention is not limited to this when tax is involved. Also, the amount of reward for a certain institution may be zero.

  Further, the reward calculation rule 126 may include information on various optional services. For example, the remuneration calculation rule 126 includes a charge amount for a predetermined analysis process for examination data, a remuneration amount to a medical institution (doctor) who has made a diagnosis based on the analysis result, and an institution (for example, the analysis process) The amount of remuneration to the system management organization) is recorded. The optional service is not limited to the analysis processing, and may include, for example, a request and provision of a second opinion.

  The information stored in the storage unit 120 is not limited to the above. Other information stored in the storage unit 120 will be appropriately described below.

(Communication unit 130)
The communication unit 130 performs data communication with other information processing apparatuses via the communication line N. The method of data communication is arbitrary. For example, the communication unit 130 includes a communication interface compliant with the Internet, a communication interface compliant with LAN, a communication interface compliant with near field communication, and the like. Data transmitted and received by the communication unit 130 may be encrypted. In this case, the arithmetic control unit 110 includes an encryption processing unit that encrypts transmission data and a decryption processing unit that decrypts received data.

(User information management unit 140)
The user information management unit 140 performs processing on information related to the user of this system. As described above, users of this system include patients, patient-related persons, medical institutions, financial institutions, insurance institutions, and the like. The user information management unit 140 is provided with a function corresponding to the type of user of this system. In this embodiment, a patient information management unit 141, a medical institution information management unit 142, an examination apparatus information management unit 143, a financial institution information management unit 144, and an insurance institution information management unit 145 are provided as a user information management unit. 140.

(Patient Information Management Unit 141)
The patient information management unit 141 manages the account of each patient user who uses this system. Each patient user account is associated with a storage area for the patient user provided in the patient information storage area 121. The account is identified by, for example, a user ID assigned to the patient user. A specific example of the process executed by the patient information management unit 141 will be described later.

  The patient information management unit 141 executes patient user authentication processing. As described above, a user ID is assigned to each user of the system. In particular, a patient user ID is given to each patient user, for example, at the start of use of the system (at the time of user registration). The registration of the patient user is performed, for example, after confirming the diagnosis of the disease targeted by this system. The issuance of the patient user ID is executed, for example, by the patient information management unit 141 receiving input of patient information and the like.

  An example of a patient user authentication process will be described. Similar authentication processing can be executed for other types of users. As described above, the patient information storage area 121 of the storage unit 120 stores the user ID of each patient user and the user authentication information.

  A user of the ophthalmic examination apparatus 200-a inputs a user ID and user authentication information to the ophthalmic examination apparatus 200-a or an apparatus connected thereto. After the examination is performed, the ophthalmic examination apparatus 200-a associates the acquired examination data with the input user ID and user authentication information, and sends them to the cloud server 100. In addition, when a person other than a legitimate patient user uses the ophthalmic examination apparatus 200-a, character string information similar to a user ID and / or character string information similar to user authentication information is sent to the cloud server 100. Sometimes.

  The patient information management unit 141 includes a combination of a user ID (or similar character string information or the like) sent from the ophthalmic examination apparatus 200-a and user authentication information (or similar character string information or the like), and patient information. The user ID stored in the storage area 121 is collated with the combination of the user authentication information. That is, the patient information management unit 141 searches the patient information management unit 141 for a combination of user ID and user authentication information that matches the combination of the user ID and user authentication information sent from the ophthalmic examination apparatus 200-a.

  When the target combination is searched, the patient information management unit 141 determines that the person who uses the ophthalmic examination apparatus 200-a is a user of this system. On the other hand, when the target combination is not searched, the patient information management unit 141 determines that the person who uses the ophthalmic examination apparatus 200-a is not a user of this system. The cloud server 100 executes a predetermined process according to the determination result.

  Note that an authentication function can be provided in the ophthalmic examination apparatus 200-a. In that case, the ophthalmic examination apparatus 200-a executes a patient user authentication process similar to that performed by the patient information management unit 141. When the authentication is successful, the ophthalmic examination apparatus 200-a associates the acquired examination data with the input user ID and sends the associated examination data to the cloud server 100. On the other hand, when the authentication fails, the ophthalmic examination apparatus 200-a prompts the user to re-enter the user ID and user authentication information, for example, and executes the patient user authentication process again.

  You may be comprised so that an authentication process may be performed by performing communication between the cloud servers 100 in real time at the time of the test | inspection using the ophthalmic examination apparatus 200-a. Upon receiving the user ID and user authentication information, the ophthalmic examination apparatus 200-a sends these information to the cloud server 100. The patient information management unit 141 executes patient user authentication processing as described above, and sends the result (success or failure of authentication) to the ophthalmic examination apparatus 200-a. When the authentication is successful, the ophthalmic examination apparatus 200-a permits the examination, and sends the examination data acquired thereby and the user ID to the cloud server 100 in association with each other. On the other hand, when the authentication fails, the ophthalmic examination apparatus 200-a prompts the user to re-enter the user ID and user authentication information, for example. Then, the same patient user authentication process is executed again.

(Medical institution information management unit 142)
The medical institution information management unit 142 manages information about each medical institution user who uses this system, for example, by providing an account for each medical institution user. Each medical institution user account is associated with a storage area for the medical institution user provided in the medical institution information storage area 122. The account is identified by, for example, a user ID assigned to a medical institution user. A specific example of processing executed by the medical institution information management unit 142 will be described later.

(Inspection device information management unit 143)
The inspection apparatus information management unit 143 manages information related to each ophthalmic inspection apparatus 200-a, for example, by providing an account for each ophthalmic inspection apparatus 200-a (or an account for each inspection apparatus installation organization). The account of each ophthalmic examination apparatus 200-a (or each examination apparatus installation organization) is a storage area for the corresponding ophthalmic examination apparatus 200-a (or the examination apparatus installation organization) provided in the examination apparatus information storage area 123. Is associated with. The account is identified by, for example, the apparatus ID of the ophthalmic examination apparatus 200-a or the ID of the examination apparatus installation organization. A specific example of processing executed by the inspection apparatus information management unit 143 will be described later.

(Financial Institution Information Management Department 144)
The financial institution information management unit 144 manages information related to financial institution users who use this system, for example, by providing an account for each financial institution user. Each financial institution user account is associated with a storage area for the financial institution user provided in the financial institution information storage area 124. The account is identified by, for example, a user ID assigned to a financial institution user. A specific example of processing executed by the financial institution information management unit 144 will be described later.

(Insurance Institution Information Management Department 145)
The insurance organization information management unit 145 manages information relating to insurance organization users who use this system, for example, by providing an account for each insurance organization user. Each insurance institution user account is associated with a storage area for the insurance institution user provided in the insurance institution information storage area 125. The account is identified by, for example, a user ID assigned to the insurance organization user. A specific example of processing executed by the insurance organization information management unit 145 will be described later.

(Inspection data processing unit 150)
The ophthalmologic information system 1 has a function of processing the inspection data of the eye E acquired by the ophthalmic inspection apparatus 200-a. This processing includes analysis processing. In this embodiment, the cloud server 100 (inspection data processing unit 150) and the inspection data processing device 900 execute analysis processing. Note that the analysis process executed by the cloud server 100 and the analysis process executed by the inspection data processing apparatus 900 may include the same process or may be all different. For example, the inspection data processing apparatus 900 can be configured to execute advanced analysis processing, and the cloud server 100 can execute other analysis processing. Further, the billing mode may be different between the analysis process executed by the cloud server 100 and the analysis process executed by the inspection data processing apparatus 900. For example, the analysis process executed by the cloud server 100 is not charged (that is, included in the examination fee by the ophthalmic examination apparatus 200-a), and an optional fee is added to the analysis process executed by the examination data processing apparatus 900. be able to. Hereinafter, an example of analysis processing that can be executed by the inspection data processing unit 150 and / or the inspection data processing apparatus 900 will be described.

The examination data processing unit 150 (or examination data processing apparatus 900; the same applies hereinafter) processes data (examination data) transmitted from the ophthalmic examination apparatus 200-a. Examples of inspection data include the following data.
(1) A signal output from the CCD image sensor 223 shown in FIG. 3 or the like (2) Image data formed by the image forming unit 250 shown in FIG. 4 (3) Obtained at an intermediate stage of processing executed by the image forming unit 250 Data (that is, data obtained during the image data formation process)
(4) Data obtained by processing signals output from the CCD image sensor 223 by components other than the image forming unit 250

  When the ophthalmic examination apparatus 200-a has a function of forming image data, that is, when the image forming unit 250 is provided in the ophthalmic examination apparatus 200-a, for example, any examination data among the above (1) to (4) Is input to the cloud server 100. On the other hand, when the ophthalmic examination apparatus 200-a does not have a function of forming image data, the examination data (1) and / or (4) is input to the cloud server 100, for example. In this case, the inspection data processing unit 150 has the same function as the image forming unit 250. When the ophthalmic examination apparatus 200-a has a function of processing the image data formed by the image forming unit 250, the examination data (4) may be data acquired by the function. Examples of the function include fundus layer thickness analysis, drusen analysis, and nipple shape analysis described later.

  The inspection data described above is acquired by OCT, but the inspection data may be data acquired by other inspections. Another example of the examination is a subjective visual acuity examination described later. The examination data may include image data acquired by fundus imaging or anterior segment imaging.

  An example of processing executed by the inspection data processing unit 150 will be described. As a first example, the examination data processing unit 150 can generate fundus layer thickness information based on examination data acquired by OCT. That is, the examination data processing unit 150 can execute fundus layer thickness analysis (such as retinal thickness analysis or RNFL thickness analysis). Furthermore, the examination data processing unit 150 can perform comparative analysis between layer thickness information acquired by fundus layer thickness analysis and a standard layer thickness value (for example, a standard layer thickness value for a healthy eye).

  The fundus layer thickness analysis is a process for obtaining the thickness (distribution) of a predetermined layer tissue of the fundus based on examination data acquired by OCT. As an example, retinal thickness analysis will be described. Similar processing is performed when the thicknesses of other layer structures are obtained.

  In retinal thickness analysis, for example, by analyzing a cross-sectional image or a three-dimensional image of the fundus, the thickness distribution of the retina in part or all of the scan range in OCT is obtained. There are various definitions of retinal thickness. For example, when the thickness from the inner boundary membrane to the inner granule layer (inscribed / external contact of photoreceptor cells) is used as the retinal thickness, the thickness from the inner border membrane to the retinal pigment epithelial layer may be used as the retinal thickness. . The retinal thickness obtained by retinal thickness analysis is one of such definitions.

  The retinal thickness analysis is performed as follows, for example. First, an OCT image of the fundus is analyzed to identify an image region corresponding to a predetermined boundary region (for example, the inner boundary membrane and the retinal pigment epithelium layer). Then, the number of pixels between the specified boundary portions is counted to obtain the retinal thickness (distance in the depth direction). The processing for analyzing the OCT image to determine the thickness of the fundus layer is, for example, Japanese Patent Application Laid-Open No. 2007-325831, Japanese Patent Application Laid-Open No. 2008-206684, Japanese Patent Application Laid-Open No. 2009-61203, Japanese Patent Application Laid-Open No. It is described in the 2009-66015 gazette.

  The comparative analysis of the retinal thickness is an analysis process for comparing the retinal thickness obtained by the retinal thickness analysis with standard data (normal data) stored in advance. Normal data is the standard value (standard thickness) of the retinal thickness of healthy eyes. The normal data is created by measuring a large number of retinal thicknesses of healthy eyes and obtaining statistical values (average value, standard deviation, etc.) of the measurement results. In the comparative analysis, it is determined whether or not the retinal thickness of the eye E is included in the range of the normal eye. The comparative analysis may be a process of obtaining a range of retinal thickness in a diseased eye and determining whether or not the retinal thickness obtained by the retinal thickness analysis is included in the range.

  The inspection data processing unit 150 may be configured to perform drusen analysis. The drusen analysis is an analysis process for obtaining a drusen distribution state in a part or all of the scan range by analyzing an OCT image, for example. This distribution state includes the position and size (area, volume, diameter) of drusen on the fundus.

  In the drusen analysis, for example, an OCT image is analyzed to identify an image region corresponding to the Bruch's membrane and an image region corresponding to the retinal pigment epithelium, and a small substantially circular raised shape based on the pixel value between these image regions It can be executed by specifying an image region corresponding to as a drusen (candidate). The image region specifying process based on such a shape can be performed by, for example, image matching with a template having the shape. Further, the inspection data processing unit 150 obtains the position, number, size, and the like of drusen based on the image area corresponding to drusen identified in this way. Moreover, evaluation information on the state of age-related macular degeneration can be generated based on the acquired distribution of drusen.

  When a front image of the fundus is included in the inspection data, drusen analysis can be performed based on the front image. This drusen analysis is executed, for example, by determining whether or not the pixel value of each pixel of the front image is included in a predetermined range and specifying the pixels included in the predetermined range. When the front image is a color image, drusen is drawn with a characteristic color (yellowish white), and thus a range of pixel values corresponding to this characteristic color is preset as the predetermined range. Further, when the front image is a monochrome image, drusen is drawn with a characteristic brightness (luminance), and therefore a range of pixel values corresponding to this characteristic luminance is preset as the predetermined range. It is also possible to specify an image region corresponding to drusen by performing template matching based on the standard shape of drusen (small, substantially circular raised shape).

  The papillary shape analysis may include an analysis process for analyzing the cross-sectional image or three-dimensional image of the fundus to detect the pores (cuts and missing parts) of the retina and obtaining the shape of the optic nerve head. The nipple shape analysis is performed by, for example, analyzing a cross-sectional image or the like to identify an image region corresponding to the optic nerve head and the retinal surface in the vicinity thereof, and analyzing the identified image region to analyze its global shape or local shape (unevenness). ) (Papillae shape parameter) is obtained. Examples of papillary shape parameters include the optic disc cup diameter, disc diameter, rim diameter, and nipple depth.

  The nipple shape analysis may include an analysis process for obtaining the inclination (shape asymmetry) of the optic nerve head. This analysis process is executed as follows, for example. First, the test data processing unit 150 analyzes the three-dimensional image obtained by scanning the region including the optic nerve head and identifies the center of the teat. Next, the inspection data processing unit 150 sets a circular area centered on the nipple center, and divides the circular area radially to obtain a plurality of partial areas. Subsequently, the inspection data processing unit 150 obtains the height position of a predetermined layer (for example, the retinal pigment epithelium layer) at each pixel position by analyzing a cross-sectional image of the circular region. Further, the inspection data processing unit 150 calculates an average value of height positions of predetermined layers in each partial region. Next, the examination data processing unit 150 obtains the inclination of the fundus in the facing direction by comparing a pair of average values obtained for the pair of partial regions corresponding to the facing position with respect to the nipple center. Then, the examination data processing unit 150 generates inclination distribution information indicating the distribution of the inclination of the fundus in the circular area based on the inclinations obtained in the plurality of facing directions. Note that the evaluation information of the disease state can be generated based on the generated inclination distribution information (and information indicating the standard distribution).

(Report processing unit 160)
The cloud server 100 sends the examination data and analysis results sent from the ophthalmic examination apparatus 200-a to the doctor in charge of the patient user (diagnostic doctor terminal 500-d or medical worker terminal 650-f). Note that examination data (including image data) may be transmitted to a doctor (an interpreting doctor) in charge of image interpretation. The doctor in charge (or an interpreting doctor) creates a diagnostic report (also referred to as a medical report or an interpretation report) based on the examination data, analysis results, and medical record information. The diagnostic report includes diagnostic results based on test data and analysis results. This diagnosis result includes, for example, the current medical condition, time-series change of the medical condition, necessity of medication, change of dosage, necessity of visit. The created diagnostic report is sent to the cloud server 100 from the diagnostic doctor terminal 500-d or the like.

  The report processing unit 160 executes processing related to a diagnostic report sent from the diagnostic doctor terminal 500-d or the like. As an example, the report processing unit 160 determines whether or not a visit request for a patient is included in the diagnosis report. The visit request includes at least information indicating whether or not to visit (character string information, presence / absence of check mark, etc.), and may further include a scheduled visit date. For example, the report processing unit 160 recognizes the necessity of the visit and the scheduled visit date based on the information input in the predetermined visit request description column. The processing related to the visit request will be described later with reference to FIGS. 6A and 6B.

  The report processing unit 160 may execute processing for extracting predetermined information from the diagnosis report. Information extracted from the diagnosis report is stored in the patient information storage area 121 of the patient user, for example. Information extracted from the diagnostic report is transmitted to the patient terminal 300-b and / or the designated person terminal 400-c corresponding to the patient user.

(Fee processing unit 170)
The fee processing unit 170 executes processing related to the usage fee for the service provided by the cloud server 100. The processing executed by the fee processing unit 170 includes billing processing for service users and processing for calculating a reward amount for a predetermined user.

  Billing is generated, for example, for any type of user among patient users, patient-related users, medical institution users, financial institution users, and insurance institution users. Each service for which a usage fee is generated may be an option or a default. The reward is generated, for example, for any one of a medical institution user, an inspection apparatus installation organization, and a system operating organization. Note that when an organization other than the system operating organization operates the inspection data processing apparatus 900, a reward may be generated for this organization.

The accounting process will be described. Examples of paid services that the cloud server 100 provides to patient users are given below.
・ Manage account by patient information management unit 141 ・ Install ophthalmic examination apparatus 200-a at home (rental, loan, buying and selling, etc.)
-Performing an examination using the ophthalmic examination apparatus 200-a-Processing the examination data by the examination data processing unit 150-Providing the processing result of the examination data to the patient user and the patient-related user-The patient user Storing examination data in an account ・ Providing a maintenance service for the ophthalmic examination apparatus 200-a ・ Providing a social networking service such as a blog function or a bulletin board function ・ A service provided by a financial institution user to a patient user -Acting for the services provided by insurance institution users to patient users

Examples of paid services that the cloud server 100 provides to patient-related users are given below.
・ Create and manage accounts for patient-related users ・ Provide patient-related users with test data processing results ・ Provide social networking services such as blog and bulletin board functions ・ Financial institution users Acting for services provided to patient-related users ・ Representing services provided by insurance institution users to patient-related users

Examples of paid services that the cloud server 100 provides to users of medical institutions are given below.
-Manage accounts by the medical institution information management unit 142-Introduce new patient users to medical institution users-Introduce patient users who wish to transfer to medical institution users-Success fee for referral services for patient users・ Provide statistical information about patient users ・ Access to specific or unspecified patient users (questionnaire, etc.)
・ Access to other medical institution users (second opinions, letters of introduction, etc.)
・ Use information related to analysis processing (Normal data, etc.) ・ Owner or use ophthalmic examination equipment (rental, loan, buying and selling, etc.)
・ Processing the test data by the test data processing unit 150 ・ Providing the medical institution user with the processing result based on the test data ・ Managing the test data of a predetermined patient user with the account of the medical institution user ・ The ophthalmic examination apparatus Providing maintenance services ・ Providing social networking services such as blog functions and bulletin board functions ・ Substituting services provided by financial institution users to medical institution users ・ Services provided by insurance institution users to medical institution users Acting ・ Providing medical institution user advertisements to patient users, etc.

Examples of paid services that the cloud server 100 provides to financial institution users are listed below.
・ Create and manage accounts for financial institution users ・ Provide information related to user billing (withdrawal amount, etc.)
・ Provide social networking services such as blog function, bulletin board function, etc. ・ Cloud server 100 acting as a financial institution user service ・ Provide financial institution user advertisements to patient users, etc.

Examples of paid services that the cloud server 100 provides to insurance organization users are listed below.
・ Create and manage accounts for insurance institution users ・ Provide information on patient user insurance (visit history, payment amount, etc.)
・ Provide information on insurance for medical institution users (medical reward points, receipts, etc.)
・ Provide social networking services such as blog function, bulletin board function, etc. ・ Cloud server 100 acts as insurance agency user service ・ Provide insurance agency user advertisement to patient users etc. ・ Success fee for advertisement

  The charge processing unit 170 stores the charge amount of each pay service in advance. This information is, for example, table information in which a chargeable service type is associated with a charge amount. When the paid service is provided to a certain user, the arithmetic control unit 110 sends the user ID of the user and the type information of the service to the fee processing unit 170. The fee processing unit 170 refers to the table information to acquire a billing amount corresponding to this type information. Then, the fee processing unit 170 associates this billing amount with the user ID and sends it to the calculation control unit 110. The arithmetic control unit 110 sends the information input from the fee processing unit 170 to the user information management unit 140. The user information management unit 140 stores the billing amount in the account identified by this user ID. At this time, information related to the service (provided date, type, etc.) can be stored together with the charge amount.

  The compensation amount calculation process will be described. As described above, the reward is generated, for example, for any one of a medical institution user, an inspection apparatus installation organization, and a system operating organization.

  For example, when the charge (system usage fee) as described above is generated, the fee processing unit 170 calculates a remuneration amount based on the system usage fee. For example, when the examination using the ophthalmic examination apparatus 200-a and the report creation by the medical institution user are performed and at least a part of the report is transmitted to the patient user or the related person, the fee processing unit 170 Based on the charge amount and the remuneration amount calculation rule 126, the remuneration amount to each of the medical institution user, the institution where the ophthalmic examination apparatus 200-a is installed, and the system operating organization is calculated. In addition, when the inspection data processing device 900 is operated by an organization other than the system operating organization and the analysis processing by the inspection data processing device 900 is executed, the inspection data processing device 900 is informed to the operating organization. A reward amount is also calculated. Such reward calculation processing is exemplified in the description of the reward calculation rule 126.

(Insurance processing unit 180)
The insurance processing unit 180 executes a process related to insurance. In addition, about the paid service regarding insurance, the fee processing unit 170 may be configured to execute charging processing and reward amount calculation processing. The insurance processing unit 180 performs, for example, a process related to insurance already concluded between a certain patient user and a certain insurance institution user. As described above, information indicating the relationship between the insurance institution user and the patient user is stored in the storage unit 120 (for example, the patient information storage area 121 and the insurance institution information storage area 125). This information is, for example, table information that associates the user ID of the patient user with the user ID of the insurance organization user. By referring to such information, the insurance processing unit 180 specifies to which insurance institution a certain patient user is contracted, and conversely to which patient user is contracted by a certain insurance institution. be able to.

  As a specific example, when a patient user receives a medical action at a medical institution, the cloud server 100 receives information (a disease name, a medical fee, etc.) set in advance from the medical institution server 600-e of the medical institution. Together with the patient user ID. The insurance process part 180 specifies the insurance organization user corresponding to this patient user by referring to said table information, for example. The arithmetic control unit 110 controls the communication unit 130 so as to transmit information (at least a part thereof) acquired from the medical institution server 600-e to the insurance organization user specified by the insurance processing unit 180.

  As another example, when the examination using the ophthalmic examination apparatus 200-a and the report creation by the medical institution user are performed and at least a part of the report is transmitted to the patient user or the related person, the insurance processing unit 180 Can perform the following processing. First, the insurance processing unit 180 specifies the user ID of the insurance organization user associated with the user ID of the patient user by referring to the table information. That is, the insurance processing unit 180 identifies the insurance organization user with whom the patient user has a contract. Further, the insurance processing unit 180 sends the patient user ID, the user ID of the identified insurance organization user, and information indicating the charge amount to the calculation control unit 110. The arithmetic control unit 110 controls the communication unit 130 to transmit the patient user ID and information indicating the charge amount to the insurance organization server 800-h of the insurance organization user.

[Ophthalmic examination apparatus 200-a]
A configuration example of the ophthalmic examination apparatus 200-a will be described. The ophthalmic examination apparatus 200-a is used for optical examination of the eye to be examined. The ophthalmic examination apparatus 200-a has a function as an ophthalmologic photographing apparatus and / or a function as an ophthalmic measurement apparatus. Examples of the ophthalmologic photographing apparatus include an optical coherence tomography (OCT apparatus), a fundus camera, and a scanning laser ophthalmoscope. In addition, examples of the ophthalmologic measurement apparatus include an eye refraction inspection apparatus, a tonometer, a specular microscope, and a wave front analyzer. In this embodiment, the case where an optical coherence tomography is applied will be described in detail, but the present invention can be applied to other ophthalmic examination apparatuses.

  In this specification, images acquired by OCT may be collectively referred to as OCT images. In addition, a measurement operation for forming an OCT image may be referred to as OCT measurement.

  In this embodiment, an optical coherence tomography using a so-called Spectral Domain type OCT equipped with a low-coherence light source and a spectroscope will be described. It is also possible to apply the present invention to an optical coherence tomography using the OCT type) method. The swept source OCT scans (wavelength sweep) the wavelength of the light irradiated to the object to be measured, and sequentially detects the interference light obtained by superimposing the reflected light of each wavelength and the reference light to obtain a spectrum. This is a technique for obtaining an intensity distribution and imaging the form of an object to be measured by applying a Fourier transform to the intensity distribution.

  The ophthalmic examination apparatus 200-a according to the embodiment may have an imaging function other than OCT. As an example of this additional imaging function, there is a function of acquiring a front image of the anterior eye part and / or the fundus. This example is realized by a configuration similar to that of a conventional fundus camera, for example.

  A configuration of the ophthalmic examination apparatus according to the embodiment will be described. The system according to this embodiment includes a plurality of ophthalmic examination apparatuses 200-a. A configuration example of the ophthalmic examination apparatus 200-a is shown in FIG. The ophthalmic examination apparatus 200-a illustrated in FIG. 3 includes an optical unit 210, a computer 230, and a user interface (UI) 280.

(Optical unit 210)
The optical unit 210 includes an optical system for performing OCT measurement and a mechanism for driving a predetermined optical element. The optical system divides the light from the light source 211 into measurement light and reference light, causes the return light from the eye E to be measured and the reference light to interfere with each other, and detects the interference light. This optical system has the same configuration as a conventional spectral domain type OCT apparatus. That is, this optical system divides low-coherence light (broadband light) into reference light and measurement light, and generates interference light by causing the measurement light passing through the eye E to interfere with the reference light passing through the reference light path. , Configured to detect a spectral component of the interference light. The detection result (detection signal) of the spectral component is sent to the computer 230.

  When the swept source type OCT is applied, a wavelength swept light source is provided instead of the low coherence light source, and an optical member for spectrally decomposing the interference light is not provided. Further, for example, a balanced photodiode is provided as an element for detecting interference light. In general, for the configuration of the optical unit 210, a known technique corresponding to the type of OCT can be arbitrarily applied.

  The light source 211 outputs broadband low-coherence light. The low-coherence light includes, for example, a near-infrared wavelength band (about 800 nm to 900 nm) and has a temporal coherence length of about several tens of micrometers. Note that near-infrared light having a wavelength band that cannot be visually recognized by the human eye, for example, a center wavelength of about 1040 to 1060 nm, may be used as the low-coherence light.

  The light source 211 includes a light output device such as a super luminescent diode (SLD), an LED, or an SOA (Semiconductor Optical Amplifier).

  The low coherence light output from the light source 211 is converted into a parallel light flux by the collimator lens 212 and guided to the beam splitter 213. The beam splitter 213 is, for example, a half mirror that reflects a predetermined ratio of light and transmits the remaining light. The beam splitter 213 splits this parallel light beam into measurement light and reference light.

  The measurement light is light irradiated to the eye E (also called signal light). An optical element group that forms an optical path (measurement optical path) of measurement light is called a measurement arm (also called a sample arm or the like). The reference light is light serving as a reference for extracting information included in the return light of the measurement light as an interference signal. The optical element group that forms the optical path of the reference light (reference optical path) is called a reference arm.

  One end of the reference optical path is a beam splitter 213, and the other end is a reference mirror 214. The reference light composed of the component transmitted through the beam splitter 213 is reflected by the reference mirror 214 and returns to the beam splitter 213.

  The reference mirror 214 is moved in the traveling direction of the reference light by the reference mirror driving unit 214A shown in FIG. Thereby, the length of the reference optical path is changed. The reference mirror driving unit 214A functions to relatively change the length of the measurement light path and the length of the reference light path, thereby changing the depth position where the interference intensity between the measurement light and the reference light is maximized. . Such an operation of changing the interference depth is an example of an operation of changing the focus position of the measurement light.

  In this embodiment, a configuration for changing the length of the reference optical path is applied. However, instead of this configuration or in addition to this configuration, a configuration for changing the length of the measurement optical path can be provided. The change in the length of the measurement optical path is realized by, for example, a corner cube that reflects incident measurement light in a direction opposite to the incident direction, and a mechanism for moving the corner cube in the incident direction and the reflection direction. The

  The measurement light composed of the component reflected by the beam splitter 213 is deflected by the fixed mirror 215 arranged to be inclined with respect to the measurement optical path and guided to the scanner 216. The scanner 216 is, for example, a two-axis optical scanner. That is, the scanner 216 has a configuration capable of deflecting measurement light two-dimensionally. The scanner 216 is, for example, a mirror scanner including two mirrors that can be deflected in directions orthogonal to each other. This mirror scanner is configured as, for example, a MEMS (Micro Electro Mechanical Systems). As another example, the scanner 216 can be configured using one mirror scanner and a rotary prism.

  Measurement light output from the scanner 216 is collimated light deflected two-dimensionally. The measurement light is focused by the relay lens 217 and is imaged in the air on a plane (fundus conjugate plane) Pc conjugate with the fundus oculi Ef. Further, the measurement light is again focused by the objective lens 219 having a function as a focusing lens and enters the eye E to be examined. The optical element (dichroic mirror 218) disposed on the fundus conjugate plane Pc will be described later.

  The objective lens 219 and the lens barrel portion 219A are moved along the measurement optical path by the lens barrel driving portion 219B shown in FIG. The objective lens 219 and the lens barrel 219A are moved in the optical axis direction according to the refractive power of the eye E. Thereby, the fundus conjugate surface Pc is arranged at a position conjugate with the fundus Ef. As a result, the measurement light is projected onto the fundus oculi Ef as spot light. The objective lens 219 (and the lens barrel drive unit 219B) functions as a diopter correction unit for performing diopter correction and as a focus position changing unit for changing the focus position of measurement light.

  Another example of the diopter correction unit will be described. For example, a diopter correction lens can be provided in the measurement optical path in order to deal with an eye to be examined having an extreme refractive power such as high myopia. The diopter correction lens is inserted / retreated with respect to the measurement optical path by a mechanism (not shown), for example. Further, for example, an optical element having a variable refractive power such as an Alvarez lens can be applied. Such an optical element for diopter correction is disposed, for example, at a position between the objective lens 219 and the eye E to be examined.

  The measurement light applied to the fundus oculi Ef is scattered (including reflection) at various depth positions of the fundus oculi Ef. The backscattered light (return light) of the measurement light from the fundus oculi Ef travels in the opposite direction on the same path as the forward path and is guided to the beam splitter 213.

  The beam splitter 213 causes the return light of the measurement light to interfere with the reference light that has passed through the reference light path. At this time, only the component of the return light that has passed through a distance substantially equal to the length of the reference optical path, that is, the backscattered light from the range within the coherent distance with respect to the length of the reference optical path, substantially interferes with the reference light. . The interference light generated via the beam splitter 213 is guided to the spectrometer 220. The interference light incident on the spectroscope 220 is split (spectral decomposition) by the diffraction grating 221, and is irradiated onto the light receiving surface of the CCD image sensor 223 via the lens 222. Although the diffraction grating 221 shown in FIG. 4 is a transmission type, other types of spectroscopic elements such as a reflection type diffraction grating may be used.

  The CCD image sensor 223 is, for example, a line sensor, and detects each spectral component of the split interference light and converts it into electric charges. The CCD image sensor 223 accumulates this electric charge, generates a detection signal, and sends it to the computer 230.

  As described above, the dichroic mirror 218 is inclined and disposed at a position corresponding to the fundus conjugate plane Pc of the measurement optical path. The dichroic mirror 218 is configured to transmit measurement light in the near infrared band and reflect light in the visible band.

  A flat panel display (FPD) 225 and a lens 226 are provided on the optical path branched from the measurement optical path via the dichroic mirror 218. The flat panel display 225 displays information under the control of the control unit 240. As information displayed on the flat panel display 225, there are various visual targets presented to the eye E to be examined. Examples of such a target include a target for a subjective eye test (Landolt ring, etc.), a fixation target for fixing the eye E to be examined, and the like.

  The flat panel display 225 is disposed at a position conjugate with the fundus conjugate plane Pc via the lens 226 (hence, a position conjugate with the fundus Ef). As the flat panel display 225, for example, a liquid crystal display (LCD) or an organic EL display (OELD) is used.

  Visible light output from the flat panel display 225 is reflected by the dichroic mirror 218 via the lens 226. Further, the visible light enters the eye E through the objective lens 219 and reaches the fundus oculi Ef. Thereby, an image (for example, a visual target image) based on the visible light is projected onto the fundus oculi Ef.

  Instead of the dichroic mirror 218, an optical element such as a half mirror may be provided. It is also possible to provide a reflection mirror configured to be inserted / retracted with respect to the measurement optical path. When the dichroic mirror 218 and the half mirror are provided, OCT measurement and target projection can be performed simultaneously. On the other hand, when a reflecting mirror is provided, OCT measurement and target projection are executed at different timings.

  In this embodiment, a Michelson type interferometer is employed, but any type of interferometer such as a Mach-Zehnder type can be appropriately employed. Further, instead of the CCD image sensor, a light receiving element of another form, for example, a CMOS (Complementary Metal Oxide Semiconductor) image sensor or the like can be used.

  In this embodiment, the light reflected by the beam splitter 213 is used as measurement light, and the light transmitted through the beam splitter 213 is used as reference light. On the other hand, it is also possible to apply a configuration in which light reflected by the beam splitter 213 is used as reference light, and light transmitted through the beam splitter 213 is used as measurement light. In this case, the arrangement of the measurement arm and the reference arm is reversed from that in FIG.

  A member for converting the characteristics of the measurement light and / or the reference light can be provided. For example, an optical attenuator (attenuator) or a polarization adjuster (polarization controller) can be provided in the reference optical path. The optical attenuator adjusts the amount of reference light under the control of the computer 230. The optical attenuator includes, for example, a neutral density filter and a mechanism for inserting / retracting the filter with respect to the reference optical path. The polarization adjuster adjusts the polarization state of the reference light under the control of the computer 230. The polarization adjuster includes, for example, a polarizing plate disposed in the reference optical path and a mechanism for rotating the polarizing plate. These are used to adjust the interference intensity between the return light of the measurement light and the reference light.

  It is possible to provide a front image acquisition optical system for photographing the eye E and acquiring the front image. This front image is an image in which the anterior eye portion or the fundus oculi Ef is drawn. The front image acquisition optical system forms an optical path branched from the measurement optical path, and includes, for example, an illumination optical system and a photographing optical system similar to a conventional fundus camera. The illumination optical system irradiates the eye E with illumination light composed of (near) infrared light or visible light. The photographing optical system detects the return light (reflected light) of the illumination light from the eye E. The photographing optical system has a zoom lens system. Further, the photographing optical system includes a focusing lens (such as an objective lens 219 and a diopter correction lens) common to the measurement optical path and / or a focusing lens independent of the measurement optical path. Another example of the front image acquisition optical system is an optical system similar to a conventional SLO.

  When a front image acquisition optical system is provided, an alignment optical system similar to a conventional fundus camera can be further provided. The alignment optical system forms an optical path branched from the measurement optical path, and generates a visual target (alignment visual target) for performing alignment (alignment) of the apparatus optical system with respect to the eye E. For alignment, alignment (xy alignment) in a direction (referred to as an xy direction) along a plane orthogonal to the measurement optical path (the optical axis of the objective lens 219) and a z direction that is a direction orthogonal to the xy plane. Alignment (z alignment). Although not shown, the alignment optical system generates two alignment light beams from a light beam output from an alignment light source (such as an LED) by a two-hole aperture. The two alignment light fluxes are guided to the measurement optical path via a beam splitter that is inclined with respect to the measurement optical path, and projected onto the cornea of the eye E to be examined. The cornea reflected light of the alignment light beam is detected by the image sensor of the front image acquisition optical system.

  When an alignment optical system is provided, auto-alignment can be performed. Specifically, the data processing unit 260 of the computer 230 analyzes the signal input from the image sensor of the front image acquisition optical system and specifies the positions of the two alignment visual target images. Further, the control unit 240 projects the two corneal reflection lights on a predetermined position (for example, the center position) of the light receiving surface of the image sensor based on the positions of the two specified alignment target images. The optical unit 210 is moved. The optical unit 210 is moved by the unit driving unit 210A.

  As another example of the alignment means, for example, there is a configuration using a pair of anterior segment cameras disclosed in Patent Document 7. The ophthalmic examination apparatus of the present example includes a support unit that supports the face of the subject, an optical system for examining the eye E, and a drive unit that relatively and three-dimensionally moves the support unit. . The pair of anterior eye camera images the anterior eye part of the eye E substantially simultaneously from different directions. The data processing unit 260 of the computer 230 obtains a three-dimensional position of the eye E by analyzing two anterior eye images obtained substantially simultaneously by the pair of anterior eye cameras. The control unit 240 moves the optical system and the support unit relatively by controlling the drive unit based on the obtained three-dimensional position. This control is performed so that the optical axis of the optical system passes through the three-dimensional position of the eye E and the distance between the three-dimensional position and the optical system (objective lens 219) is set to a predetermined working distance. Executed. According to this alignment method, there is an advantage that everything from the search for the eye E to be examined to the three-dimensional alignment of the optical system can be performed automatically. When using an alignment target, it is necessary to manually guide the optical system so that the alignment target is projected onto the eye E.

  When the front image acquisition optical system is provided, a focus optical system similar to a conventional fundus camera can be further provided. The focus optical system forms an optical path branched from the measurement optical path, and generates a visual target (split visual target) for performing focusing (focusing) on the fundus oculi Ef. Although not shown, the focus optical system generates two focusing light beams by the split target plate from the light beams output from the focusing light source (LED or the like). The two focusing light beams are guided to the measurement optical path through the reflecting member that is inclined with respect to the measurement optical path, and projected onto the fundus oculi Ef. The fundus reflection light of the focusing light beam is detected by the image sensor of the front image acquisition optical system.

  When a focus optical system is provided, autofocus can be performed. Specifically, the data processing unit 260 of the computer 230 analyzes the signal input from the image sensor of the front image acquisition optical system and specifies the positions of the two split visual target images. Further, the control unit 240 moves the focus optical system so that two fundus reflections are projected on a straight line with respect to the light receiving surface of the image sensor based on the positions of the two specified split target images. Control and focus lens control (movement control of the objective lens 219, diopter correction lens insertion / retraction control, etc.) are performed.

  When a front image acquisition optical system is provided, auto-tracking can be performed. Auto-tracking is to move the optical unit 210 in accordance with the movement of the eye E. When performing auto tracking, alignment and focusing are performed in advance. The auto tracking is executed as follows, for example. First, a moving image is taken of the eye E using the front image acquisition optical system. The data processing unit 260 monitors the movement (position change) of the eye E by sequentially analyzing frames obtained by this moving image shooting. The control unit 240 controls the unit driving unit 210A to move the optical unit 210 in accordance with the position of the eye E to be sequentially acquired. As a result, the optical unit 210 can follow the movement of the eye E in real time, and it is possible to maintain a suitable positional relationship in which the alignment is in focus.

(Control system / data processing system)
A control system and a data processing system of the ophthalmic examination apparatus 200-a according to the embodiment will be described. A configuration example of the control system and the data processing system is shown in FIG.

  The control system and the data processing system are configured around the computer 230. The computer 230 includes a microprocessor, a RAM, a ROM, a hard disk drive, a communication interface, and the like. A storage device such as a hard disk drive stores a computer program for causing the ophthalmic examination apparatus 200-a to execute various processes. The computer 230 may have a dedicated circuit board for executing a specific process. For example, a circuit board that performs processing for forming an OCT image may be provided.

(User interface 280)
A user interface 280 is connected to the computer 230. The user interface 280 includes a display unit 281 and an operation unit 282. The display unit 281 includes a display device such as a flat panel display. The operation unit 282 includes an operation device such as a button, a key, a joystick, or an operation panel provided on the casing or outside of the ophthalmic examination apparatus 200-a. When the computer 230 includes a personal computer, the operation unit 282 may include an operation device (mouse, keyboard, trackpad, button, etc.) of the personal computer.

  The display unit 281 and the operation unit 282 do not need to be configured as individual devices. For example, a device in which a display function and an operation function are integrated, such as a touch panel, can be used. In that case, the operation unit 282 includes the touch panel and a computer program. The operation content for the operation unit 282 is input to the control unit 240 as an electrical signal. Further, operations and information input may be performed using a graphical user interface (GUI) displayed on the display unit 281 and the operation unit 282.

(Control unit 240)
The control unit 240 is provided in the computer 230. The control unit 240 includes a microprocessor, a RAM, a ROM, a hard disk drive, and the like. The control unit 240 is provided with a main control unit 241 and a storage unit 242.

(Main control unit 241)
The main control unit 241 controls each unit of the ophthalmic examination apparatus 200-a. For example, control by the main control unit 241 includes a unit driving unit 210A, a light source 211, a reference mirror driving unit 214A, a scanner 216, a lens barrel driving unit 219B, a CCD (image sensor) 223, a flat panel display 225, and a display unit. 281, a data processing unit 260, and a communication unit 270 are included.

  The unit driver 210A moves the optical unit 210 in a direction along the measurement optical path (the optical axis of the objective lens 219) (z direction) and in a direction along the plane orthogonal to the z direction (xy direction). It has the mechanism of. The reference mirror driving unit 214A moves the reference mirror 214 along the reference optical path. The lens barrel drive unit 219B moves the objective lens 219 and the lens barrel unit 219A along the measurement optical path.

(Storage unit 242)
The storage unit 242 stores various data. The storage unit 242 stores various computer programs and data for operating the ophthalmic examination apparatus 200-a. The data stored in the storage unit 242 includes data acquired by the ophthalmic examination apparatus 200-a and data stored in advance. For example, the computer program is configured to operate the ophthalmic examination apparatus 200-a in conjunction with the cloud server 100.

  Examples of data acquired by the ophthalmic examination apparatus 200-a include OCT image data, examination data, and front image data. The examination data includes data indicating the state of the eye to be examined, which is generated by processing the detection result of the interference light by the optical unit 210 (details will be described later). Further, the inspection data may include visual acuity value data obtained by the subjective visual acuity inspection and data generated by processing the image data of the front image.

  Examples of data stored in the storage unit 242 include setting information described below. The setting information is information in which setting contents related to the optical unit 210 and the data processing unit 260 are recorded. For example, the setting information is acquired from the cloud server 100 and stored in the storage unit 242. As a specific example, in response to a patient user ID (and authentication information) being input, the control unit 240 transmits the patient user ID and the device ID and the device ID to the cloud server 100 via the communication unit 270. In the patient information storage area 121, setting information for each patient user is stored in advance. The patient information management unit 141 searches for setting information corresponding to this patient user ID. The arithmetic control unit 110 controls the communication unit 130 based on the device ID to send the searched setting information to the ophthalmic examination apparatus 200-a. The main control unit 241 of the ophthalmic examination apparatus 200-a stores the setting information received by the communication unit 270 in the storage unit 242. In addition, the main control unit 241 executes the examination of the eye E by controlling each part of the ophthalmic examination apparatus 200-a based on the setting information.

  An example of setting information will be described. The setting information includes, for example, setting contents regarding at least one of the following items: (1) fixation position; (2) scan pattern; (3) in-focus position; (4) diopter correction value; (5) analysis processing. The fixation position indicates the direction in which the eye E is fixed.

  (1) “Fixing position” indicates a direction in which the eye E is fixed, that is, a part of the eye E on which OCT measurement is performed. As the fixation position, the fixation position for performing OCT measurement of the macula and its surroundings, the fixation position for performing OCT measurement of the optic nerve head and its surroundings, and the OCT measurement of the macula and the optic nerve head and their surroundings There is a fixation position for. It is also possible to set a fixation position corresponding to an arbitrary part of the eye E. The fixation position includes, for example, information indicating the display position (pixel position) of the fixation target by the flat panel display 225.

  (2) “Scan pattern” indicates a pattern along which the projection position of the measurement light with respect to the eye E is moved. Examples of the scan pattern include one or more line scans (horizontal scan, vertical scan), one or more cross scans, radial scans, and circle scans. Further, when acquiring a three-dimensional image (three-dimensional data set), a three-dimensional scan in which intervals between a plurality of line scans are set sufficiently narrow is applied.

  (3) “Focus position” indicates a focus condition applied in OCT measurement. The in-focus position includes information indicating the position of the objective lens 219, for example.

  (4) “Diopter correction value” indicates a condition applied in diopter correction. Specifically, there are a value indicating the refractive power (eyesight value) of the eye E, application / non-application of the diopter correction lens, a value indicating the refractive power applied by the diopter correction lens, and the like.

  (5) “Analysis process” indicates the content of the process executed based on the data acquired by the optical unit 210, that is, the type of the acquired inspection data. Examples of the analysis processing include fundus layer thickness analysis, drusen analysis, and nipple shape analysis, as in the cloud server 100. The fundus layer thickness analysis is an analysis process for obtaining the thickness of a predetermined layer tissue of the fundus (retina, retinal sub-tissue, choroid, sclera, etc.). Drusen analysis is an analysis process for determining the distribution of drusen (a lump of waste) used as a diagnostic material for age-related macular degeneration. The nipple shape analysis is an analysis process in which a cross-sectional image or a three-dimensional image of the fundus oculi is analyzed to detect a hole portion (cut or defect portion) of the retina and obtain the shape of the optic nerve head. In the nipple shape analysis, the inclination (shape asymmetry) of the optic nerve head can also be obtained. These analysis processes will be described later.

  When OCT measurement is performed for both the left eye and the right eye of the subject, and when different settings are applied to the left and right, setting information about the left eye (setting information for the left eye) and the right eye Setting information (right eye setting information) can be provided separately.

  In creating the setting information, the examination result and examination conditions of the eye E, the disease name (the type of data serving as the diagnostic material, etc.) and the like are referred to. For example, the fixation position is set by referring to the fixation position applied in the past OCT measurement and the disease name. The scan pattern is set by referring to the scan pattern applied in the past OCT measurement and the disease name. The focus position is set with reference to the focus position applied in the past OCT measurement. The diopter correction value is set by referring to the visual acuity value and refractive power acquired in the past examination. The setting of the analysis process is performed with reference to the type of analysis process and the disease name applied in the past examination.

A specific example of the relationship between test results, test conditions and / or disease names, and setting contents will be described. The following settings can be adopted for macular inspection.
(1) As the fixation position, a fixation position where the scan range includes the macula, for example, a fixation position where the macula is located on the extension of the optical axis of the measurement optical path is adopted.
(2) As the scan pattern, three-dimensional scan, radial scan and / or line scan are adopted.
(3) As the in-focus position, the in-focus position applied in the OCT measurement performed in the past or the in-focus position obtained by calculation from the measured value (eye length, refractive power, etc.) of the eye E is employed. Is done.
(4) As the diopter correction value, a diopter correction value applied in the past OCT measurement or a diopter correction value obtained from a measured value of refractive power of the eye E is employed.
(5) Fundus layer thickness analysis (and comparative analysis with standard layer thickness values) is used as the analysis process. In this fundus layer thickness analysis, for example, the thickness of the retina is obtained (retinal thickness analysis).

The following settings can be adopted in the examination of the optic nerve head.
(1) As the fixation position, a fixation position in which the optic disc is included in the scan range, for example, a fixation position in which the optic disc is located on the extension of the optical axis of the measurement optical path is adopted.
(2) A three-dimensional scan and / or a circle scan is adopted as the scan pattern.
(3) As the in-focus position, the in-focus position applied in the OCT measurement performed in the past or the in-focus position obtained by calculation from the measured value (eye length, refractive power, etc.) of the eye E is employed. Is done.
(4) As the diopter correction value, a diopter correction value applied in the past OCT measurement or a diopter correction value obtained from a measured value of refractive power of the eye E is employed.
(5) Fundamental layer thickness analysis (and comparative analysis with standard layer thickness values) and / or nipple shape analysis are used as the analysis process. In this fundus layer thickness analysis, for example, the thickness of the retinal nerve fiber layer is obtained (RNFL thickness analysis).

The following settings can be used for glaucoma examination.
(1) As a fixation position, a fixation position where the scan range includes the macula (for example, a fixation position where the macula is positioned on the extension of the optical axis of the measurement optical path) and / or the scan range. A fixation position where the optic disc is included (for example, a fixation position where the optic disc is located on the extension of the optical axis of the measurement optical path) is adopted.
(2) A three-dimensional scan is adopted as the scan pattern.
(3) As the in-focus position, the in-focus position applied in the OCT measurement performed in the past or the in-focus position obtained by calculation from the measured value (eye length, refractive power, etc.) of the eye E is employed. Is done.
(4) As the diopter correction value, a diopter correction value applied in the past OCT measurement or a diopter correction value obtained from a measured value of refractive power of the eye E is employed.
(5) As analysis processing, retinal thickness analysis (and comparative analysis with standard layer thickness values), RNFL thickness analysis (and comparative analysis with standard layer thickness values), and / or nipple shape analysis are used. It is done.

The following settings can be adopted in the examination of age-related macular degeneration.
(1) As the fixation position, a fixation position where the scan range includes the macula, for example, a fixation position where the macula is located on the extension of the optical axis of the measurement optical path is adopted.
(2) A three-dimensional scan is adopted as the scan pattern.
(3) As the in-focus position, the in-focus position applied in the OCT measurement performed in the past or the in-focus position obtained by calculation from the measured value (eye length, refractive power, etc.) of the eye E is employed. Is done.
(4) As the diopter correction value, a diopter correction value applied in the past OCT measurement or a diopter correction value obtained from a measured value of refractive power of the eye E is employed.
(5) As analysis processing, retinal thickness analysis (and comparative analysis with standard layer thickness values) and / or drusen analysis are used.

  It is also possible to edit the setting information. For example, the doctor in charge or the like can edit (rewrite, add, delete, etc.) information on the examination result, examination conditions, and disease name of the eye E while referring to the electronic medical record of the subject. Further, the setting contents applied when the examination is performed at the medical institution may be compared with the current setting information, and the setting information may be automatically or manually edited based on the comparison result.

(Image forming unit 250)
The image forming unit 250 forms image data of a two-dimensional cross-sectional image of the eye E based on the detection signal from the CCD image sensor 223. This process includes processes such as noise removal (noise reduction), filter processing, dispersion compensation, and FFT (Fast Fourier Transform) as in the conventional spectral domain type OCT. When another type of OCT is applied, the image forming unit 250 executes a known process corresponding to the type.

  The image forming unit 250 includes, for example, a dedicated circuit board and / or a microprocessor. In this specification, “image data” and “image” based thereon may be identified.

  Part or all of the function of forming an OCT image can be provided in the cloud server 100. When all the functions for forming an OCT image are provided in the cloud server 100, it is not necessary to provide the image forming unit 250 in the ophthalmic examination apparatus 200-a.

  When the image forming unit 250 is not provided in the ophthalmic examination apparatus 200-a, the main control unit 241 controls the communication unit 270 to detect a detection signal (detection data) from the CCD image sensor 223 or data obtained by processing the detection data. Are transmitted to the cloud server 100. The examination data processing unit 150 of the cloud server 100 forms image data of a two-dimensional cross-sectional image of the eye E based on data received from the ophthalmic examination apparatus 200-a.

  When the image forming function is provided in both the ophthalmic examination apparatus 200-a and the cloud server 100, for example, image data of a two-dimensional cross-sectional image of the eye E is formed by linking the image forming unit 250 and the examination data processing unit 150. can do. As another example of processing in this case, when the processing load of the cloud server 100 is high, the ophthalmic examination apparatus 200-a can execute image forming processing, and when the processing load is low, the cloud server 100 can execute processing. This processing load is determined by the arithmetic control unit 110, for example. Further, in the determination of the processing load, it is possible to consider the usage status of the plurality of ophthalmic examination apparatuses 200-a.

(Data processing unit 260)
The data processing unit 260 executes various data processing. For example, the data processing unit 260 performs image processing on the image formed by the image forming unit 250. As an example, the data processing unit 260 can form image data of a three-dimensional image of the eye E based on a plurality of two-dimensional cross-sectional images having different cross-sectional positions. The image data of a three-dimensional image means image data in which pixel positions are defined by a three-dimensional coordinate system. As image data of a three-dimensional image, there is image data composed of voxels arranged three-dimensionally. This image data is called volume data or voxel data. When displaying an image based on the volume data, the data processing unit 260 performs rendering processing (volume rendering, MIP (Maximum Intensity Projection), etc.) on the volume data, and views the image from a specific line-of-sight direction. Image data of a pseudo three-dimensional image is formed. Further, the data processing unit 260 can image an arbitrary cross section of the three-dimensional image (MPR (Multi-Planar Reconstruction): cross section conversion).

  It is also possible to form stack data of a plurality of cross-sectional images as image data of a three-dimensional image. The stack data is image data obtained by three-dimensionally arranging a plurality of cross-sectional images obtained along a plurality of scanning lines based on the positional relationship of the scanning lines. That is, stack data is image data obtained by expressing a plurality of cross-sectional images originally defined by individual two-dimensional coordinate systems by one three-dimensional coordinate system (that is, by embedding them in one three-dimensional space). is there. The data processing unit 260 can perform MPR processing based on the stack data.

  The data processing unit 260 includes, for example, a microprocessor, a RAM, a ROM, a hard disk drive, a circuit board dedicated to predetermined data processing, and the like. In a storage device such as a hard disk drive, a computer program for causing a microprocessor to execute data processing described later is stored in advance.

  The data processing unit 260 includes an inspection data generation unit 261, a stillness determination unit 262, and a left / right determination unit 263.

(Inspection data generation unit 261)
The inspection data generation unit 261 generates inspection data indicating the state of the eye E by processing the detection result of the interference light by the optical unit 210. The inspection data generation unit 261 is an example of a processing unit. The “interference light detection result” processed by the inspection data generation unit 261 is, for example, one of the following.
(1) Signal output from the CCD image sensor 223 (2) Image data formed by the image forming unit 250 (3) Data obtained in an intermediate stage of processing executed by the image forming unit 250 (that is, image data forming processing) Data obtained in the middle of
(4) Data obtained by processing signals output from the CCD image sensor 223 by components other than the image forming unit 250

  The processing executed by the examination data generation unit 261 may include, for example, fundus layer thickness analysis (such as retinal thickness analysis, RNFL thickness analysis), retinal thickness comparison analysis, drusen analysis, and nipple shape analysis.

  When the flat panel display 225 can display a target for subjective visual acuity testing (Landolt ring or the like), the inspection data generation unit 261 can generate inspection data including the result of the subjective visual acuity inspection. . The subjective visual acuity test is performed when the subject responds to the visual target presented to the eye E to be examined. The test data generation unit 261 repeatedly performs a process of determining whether the subject's response is correct and a process of determining a target to be presented next according to the determination result in accordance with a predetermined computer program. The main control unit 241 displays the target determined by the inspection data generation unit 261 on the flat panel display 225. By repeatedly performing such processing, the test data generation unit 261 determines the visual acuity value of the eye E to be examined, and generates test data including the visual acuity value.

(Stillness determination unit 262)
The stationary determination unit 262 determines whether or not the eye E is substantially stationary based on the data acquired by the optical unit 210 (stationary determination processing). “Substantially stationary” includes not only the case where the eye E is stationary, but also the case where the eye E is moving so as not to affect the OCT measurement. This allowable range of movement is arbitrarily set in advance.

  An example of stillness determination processing will be described. As a first example, there is stillness determination processing based on the intensity of return light of measurement light. The intensity of the return light of the measurement light is maximized in the aligned state (because regular reflection from the cornea is maximized). The detection of the intensity of the return light can be obtained, for example, by detecting a part of the return light with a photodetector or the like. The stationary determination unit 262 can determine whether the eye E is substantially stationary based on the temporal change in the intensity of the return light. In addition, since the intensity of the return light affects the intensity of the interference light, it is possible to make a still determination based on a temporal change in the intensity of the signal from the CCD image sensor 223.

  As a second example, when the above-described front image acquisition optical system is provided, it is possible to execute the following still determination process. First, a moving image is taken of the eye E using the front image acquisition optical system. Thereby, a front image (frame) of the eye E is obtained at predetermined time intervals. The stillness determination unit 262 analyzes the front images that are sequentially input, and detects a characteristic part of the eye E to be examined. This characteristic site is, for example, the pupil (or its center) in the anterior segment image, and is, for example, the optic disc (or its center), macular (or its center), blood vessel, or diseased region in the fundus image. Furthermore, the stillness determination unit 262 can determine whether or not the eye E is substantially stationary by monitoring the change in the position of the characteristic part in the front image input in time series.

(Left / Right determination unit 263)
The left / right determination unit 263 determines whether the eye E is the left eye or the right eye (left / right determination processing). The left eye determination process is executed when the left and right eyes are examined using the ophthalmic examination apparatus 200-a. When only the right or left eye examination is performed, for example, information indicating whether the eye to be examined is the left eye or the right eye is stored in the storage unit 242 in advance.

  Even when only one eye is the object to be inspected, right / left determination processing may be performed in order to prevent a situation where the other eye is inadvertently inspected. That is, for example, when the left eye is set as an examination target, predetermined notification information is output when it is determined that the eye E is the right eye as a result of performing the left / right determination process. be able to. This notification information is, for example, display information by the display unit 281 or the flat panel display 225, or auditory information by a sound output unit (not shown). In addition, when the measurement light includes a visible component, it is possible to notify by blinking the measurement light.

  An example of the left / right determination process will be described. As a first example, there is a left / right determination process based on a control state for the unit driving unit 210A. This example is used when a configuration in which the position of the optical unit 210 is different between when the left eye is examined and when the right eye is examined. As described above, the optical unit 210 is moved by the main controller 241 controlling the unit driver 210A. Each time the main control unit 241 controls the unit driving unit 210 </ b> A, the main control unit 241 transmits the control content to the left / right determination unit 263. The left / right determination unit 263 is arranged at a position for inspecting the left eye by the optical unit 210 or at a position for inspecting the right eye based on the control content input from the main control unit 241. Judgment is made. Note that a range of positions for inspecting the left eye and a range of positions for inspecting the right eye are set in advance.

  As a second example, when the above-described front image acquisition optical system is provided, it is possible to perform the left / right determination process by analyzing the front image. When the front image is an anterior segment image, for example, the eye side and the eye corner side can be specified based on the shape of the eyelid, and it is possible to determine whether the eye E is the left eye or the right eye. If the front image is a fundus image, determine whether the eye E is the left eye or the right eye based on the position of the optic disc, the position of the macula, the positional relationship between the optic disc and the macula, the running state of the blood vessels, etc. Can do.

  It is also possible not to provide the left / right determination function as described above. For example, the subject or the examiner may be configured to input via the operation unit 282 whether the subject eye E is the left eye or the right eye.

  It is also possible to apply a configuration in which the data processing unit 260 is not provided in the ophthalmic examination apparatus 200-a. In that case, the main control unit 241 controls the communication unit 270 to detect a detection signal (detection data) from the CCD image sensor 223 or data obtained by processing the detection data, or image data formed by the image forming unit 250. It transmits to the cloud server 100 as inspection data. The examination data processing unit 150 of the cloud server 100 executes predetermined data processing based on the data received from the ophthalmic examination apparatus 200-a.

  When both the ophthalmic examination apparatus 200-a and the cloud server 100 are provided with a data processing function, for example, predetermined data processing can be executed by linking the data processing unit 260 and the examination data processing unit 150. As another processing example in this case, the ophthalmic examination apparatus 200-a executes predetermined data processing when the processing load of the cloud server 100 is high, and causes the cloud server 100 to execute predetermined data processing when the processing load is low. Can do. This processing load is determined by the arithmetic control unit 110, for example. Further, in the determination of the processing load, it is possible to consider the usage status of the plurality of ophthalmic examination apparatuses 200-a.

(Communication unit 270)
The communication unit 270 performs data communication via the communication line N. The method of data communication is arbitrary. For example, the communication unit 270 includes a communication interface compliant with the Internet, a communication interface compliant with LAN, a communication interface compliant with near field communication, and the like. Data communication may be wired communication or wireless communication. The communication destination is, for example, the cloud server 100 or the patient terminal 300-b.

  Data transmitted and received by the communication unit 270 may be encrypted. In this case, the control unit 240 (or the data processing unit 260) includes an encryption processing unit that encrypts transmission data and a decryption processing unit that decrypts reception data.

[Patient terminal 300-b]
The patient terminal 300-b is a computer terminal provided for use by a patient user. The patient terminal 300-b includes, for example, a computer terminal owned by the patient user and a computer terminal lent to the patient user. Examples of the patient terminal 300-b include a mobile phone, a smartphone, a tablet terminal, a laptop computer, and a desktop computer. An application program for using the service provided by the cloud server 100 is installed in the patient terminal 300-b. This application program includes, for example, a general-purpose browser and / or dedicated application software.

[Designated person terminal 400-c]
The designated person terminal 400-c is a computer terminal that is used by a person (designated person) designated as a person who can use the service provided by the cloud server 100. The designated person is a patient user or a user other than the user of the diagnostic doctor terminal 500-d. As the designated person, there are a patient-related person, a medical worker other than a user of the diagnostic doctor terminal 500-d or the medical worker terminal 650-f, and the like. The term “healthcare worker” is a general term for persons engaged in medical services. Examples of medical workers include doctors, dentists, nurses, pharmacists, public health nurses, midwives, clinical technicians, hygiene technicians, radiology technicians, medical radiographers, dietitians, dietitians, physical therapists, work There are therapists, vision trainers, paramedics, and medical accountants.

  The designated person terminal 400-c is, for example, a computer terminal owned by the designated person, a computer terminal rented to the designated person, or a predetermined place (for example, a pharmacy, a spectacle store, a welfare facility for the elderly, a hospital, a clinic, an optometer list). Etc.). Examples of the designated person terminal 400-c include a mobile phone, a smartphone, a tablet terminal, a laptop computer, and a desktop computer. An application program for using a service provided by the cloud server 100 is installed in the designated person terminal 400-c. This application program includes, for example, a general-purpose browser and / or dedicated application software.

[Diagnostic physician terminal 500-d]
The diagnostic doctor terminal 500-d is used for the use of a doctor who diagnoses a target disease of the service by the cloud server 100 (or a person who inputs the diagnosis result to a computer. Computer terminal. The diagnostic doctor terminal 500-d is, for example, a computer terminal owned by a diagnostic doctor, a computer terminal lent to a diagnostic doctor, or a predetermined place (for example, a hospital, a clinic, a health examination center, a medical examination center, a medical examination car, etc.) ) Is a computer terminal installed. Examples of the diagnostic doctor terminal 500-d include a mobile phone, a smartphone, a tablet terminal, a laptop computer, and a desktop computer. An application program for using a service provided by the cloud server 100 is installed in the diagnostic doctor terminal 500-d. This application program includes, for example, a general-purpose browser and / or dedicated application software.

  The user of the diagnostic doctor terminal 500-d may be a doctor in charge of the patient user. In that case, the doctor in charge creates a diagnostic report based on the examination data acquired by the ophthalmic examination apparatus 200-a and / or the analysis result by using the diagnostic doctor terminal 500-d. Further, the user of the diagnostic doctor terminal 500-d may be an interpretation doctor. In that case, the interpretation doctor creates an interpretation report based on the examination data (image data) acquired by the ophthalmic examination apparatus 200-a by using the diagnostic doctor terminal 500-d. This interpretation report is transmitted to the diagnostic physician terminal 500-d of the attending physician. The doctor in charge creates a diagnostic report while referring to the interpretation report.

[Medical institution server 600-e]
The medical institution server 600-e is a server installed in a medical institution (hospital, clinic, etc.) that can use the service provided by the cloud server 100. The medical institution server 600-e provides a service in cooperation with the cloud server 100, and operates in cooperation with, for example, a hospital information system (including an ordering system, an electronic medical record system, an image filing system, a reception system, etc.). It is configured as follows. The medical institution server 600-e provides a service provided by the cloud server 100 to a plurality of clients (medical worker terminals 650-f). An application program for using a service provided by the cloud server 100 is installed in the medical institution server 600-e. This application program includes, for example, dedicated application software.

[Medical worker terminal 650-f]
The medical worker terminal 650-f is used to use the service provided by the cloud server 100 via the medical institution server 600-e. The medical worker terminal 650-f is, for example, a computer terminal owned by the medical worker, a computer terminal lent to the medical worker, or a computer terminal installed in a predetermined place (hospital, clinic, etc.). Examples of the medical worker terminal 650-f include a mobile phone, a smartphone, a tablet terminal, a laptop computer, and a desktop computer. An application program for using a service provided by the cloud server 100 is installed in the medical staff terminal 650-f. This application program includes, for example, a general-purpose browser and / or dedicated application software. The medical worker terminal 650-f may include at least a part of the plurality of diagnostic doctor terminals 500-d.

[Financial institution server 700-g]
The financial institution server 700-g is a server for processing information handled by a bank or a credit card company. The financial institution server 700-g exchanges information about the financial institution (information about charging, information about payment of charges, etc.) with the cloud server 100 in the service provided by the cloud server 100. An application program for using a service provided by the cloud server 100 is installed in the financial institution server 700-g. This application program includes, for example, dedicated application software.

[Insurance institution server 800-h]
The insurance organization server 800-h is a server for processing information handled by public insurance organizations and insurance companies. The insurance institution server 800-h exchanges information regarding the insurance institution (information regarding charging, information regarding insurance benefits, etc.) with the cloud server 100 in the service provided by the cloud server 100. An application program for using a service provided by the cloud server 100 is installed in the insurance institution server 800-h. This application program includes, for example, dedicated application software.

[Inspection data processing apparatus 900]
The inspection data processing device 900 is used when executing analysis processing that is not mounted on the cloud server 100 or the ophthalmic inspection device 200-a, for example. This analysis process may be optional and may be a service that generates additional charges. The analysis process executed by the inspection data processing apparatus 900 is arbitrarily determined.

  The analysis processing by the inspection data processing device 900 is the same type of analysis processing as the analysis processing executed by the cloud server 100 or the ophthalmic inspection device 200-a, and includes analysis processing with higher accuracy and / or higher accuracy. It's okay. For example, the same kind of analysis processing as that of the cloud server 100 or the like can be executed using a clinical database (big data) obtained for a large number of eyes to be examined. This big data is updated regularly or irregularly to include new clinical data.

  The analysis process performed by the examination data processing apparatus 900 may include a different type of analysis process from the analysis process executed by the cloud server 100 or the ophthalmic examination apparatus 200-a.

  The examination data processing device 900 executes analysis processing according to an order from a patient user or a doctor, for example. This order is arbitrarily input for each inspection, for example. Alternatively, this order is automatically generated for a preset patient user and / or examination type.

[Usage form]
A usage pattern of the ophthalmologic information system 1 according to the embodiment will be described. Hereinafter, various phases of the service provided by the ophthalmologic information system 1 will be further described. In actual operation, it is possible to selectively apply one or more of a plurality of usage modes described below. Alternatively, in actual operation, a service different from any of the following usage forms may be provided. However, the service is included in the scope of the gist of the present invention.

〔Overview〕
First, the outline of the usage pattern will be described. FIG. 5 represents the overall flow of an exemplary usage pattern.

(S1: Patient user registration)
The process according to the usage pattern is executed for each patient user. The first step of the process relating to each patient user is registration to a service provided by the ophthalmologic information system 1. Registration of a new patient user is performed, for example, after receiving a diagnosis from a doctor. Specifically, when a doctor diagnoses a certain patient as having a predetermined disease (diseases subject to the service such as age-related macular degeneration, diabetic retinopathy or glaucoma), or may have a predetermined disease If there is a diagnosis, the doctor introduces the service to the patient. Subscription to the service is optional.

  The patient who has decided to subscribe to the service inputs necessary information such as patient information, a disease name, and information on a contracted insurance or financial institution. This input operation is performed, for example, through the web or by filling in a predetermined sheet. Information input by the patient is input to the cloud server 100 automatically or manually.

  The arithmetic control unit 110 sends the input information to the patient information management unit 141. The patient information management unit 141 performs user registration of the patient based on this input information. The user registration process includes issuing a patient user ID, creating a patient user account, storing information in this account (patient information storage area 121), and the like. When the user registration is completed, the cloud server 100 performs a process for sending information indicating that to the new patient user. As an example of this information transmission process, transmission of an e-mail addressed to the patient terminal 300-b (and / or a designated person terminal 400-c of a related person) of this new patient user, transmission to a mobile phone and / or a fixed phone Talking, sending to facsimile, creating and sending postcards and letters.

  Note that at least a part of information necessary for subscribing to the service may be provided to the cloud server 100 from the medical institution server 600-e.

(S2: Implementation of ophthalmic examination)
The patient user is provided with information indicating the location where the ophthalmic examination apparatus 200-a is installed. As an example of this processing, the cloud server 100 transmits a list or map indicating the installation location of the ophthalmic examination apparatus 200-a to the patient terminal 300-b. Alternatively, a list or map printed out by the cloud server 100 is provided to the patient user.

  The ophthalmic examination apparatus 200-a to be described in the provided list or map can be selected from the location of the patient user. For example, the patient information management unit 141 exists within a predetermined range (distance, distance, time, region, etc.) with respect to the address among all the ophthalmic examination apparatuses 200-a based on the address of the patient user. The ophthalmic examination apparatus 200-a is selected. The arithmetic control unit 110 creates a list or a map representing the installation location of the selected ophthalmic examination apparatus 200-a, and transmits it to the patient terminal 300-b of the patient user via the communication unit 130.

  As described above, the patient user can recognize the installation location of the ophthalmic examination apparatus 200-a. The patient user goes to a desired installation location at a desired timing or a predetermined timing and receives an examination using the ophthalmic examination apparatus 200-a. This test is performed by an examiner trained in the test or by the patient user himself. During the examination, the patient user inputs his / her user ID. The ophthalmic examination apparatus 200-a performs examination of the patient's eye to be examined and generates examination data. Furthermore, the ophthalmic examination apparatus 200-a sends the patient user ID and examination data to the cloud server 100.

  The patient information management unit 141 of the cloud server 100 searches for an account of the patient user based on the patient user ID input from the ophthalmic examination apparatus 200-a. Furthermore, the patient information management unit 141 stores the examination data in the searched account. In addition, the patient information management unit 141 adds the current examination content (examination date, examination type, etc.) to the examination history in the account.

  In addition, the patient information management unit 141 determines whether analysis processing is necessary based on predetermined information about the patient user or a request input in the current examination. When analysis processing is necessary, the patient information management unit 141 sends the patient user ID, examination data (and past medical information; the same applies hereinafter), and the analysis processing type to the arithmetic control unit 110. The arithmetic control unit 110 sends the patient user ID, the test data, and the analysis process type to the analysis unit (the test data processing unit 150 or the test data processing device 900) based on the analysis process type. The analysis unit that has acquired the information executes an analysis process based on the examination data, and sends the analysis result obtained thereby to the arithmetic control unit 110 together with the patient user ID. The arithmetic control unit 110 stores the analysis result in the account of the patient user, and adds the analysis content this time to the examination history.

(S3: Send test data to the medical institution terminal)
Subsequently, the patient information management unit 141, based on the medical institution identification information (and the patient ID in the medical institution) recorded in the patient user's account, the medical institution terminal (the medical institution terminal as a transmission destination of examination data) Diagnostic doctor terminal 500-d or medical institution server 600-e (and medical worker terminal 650-f)) is specified. The arithmetic control unit 110 transmits the examination data and the analysis result acquired in step S2 together with the patient user ID toward the specified medical institution terminal. The medical institution terminal which is a transmission destination is a computer terminal used by the doctor who performed the diagnosis of the patient user in step S1, for example.

(S4: Creation of diagnostic report)
The doctor who receives the examination data creates a diagnostic report. A medical institution terminal is equipped with a user interface for creating a report based on examination data (including analysis results). This user interface may include not only hardware such as a display device and an operation device, but also software for providing a report creation tool (display screen, software key, etc.). The medical institution terminal sends the created diagnostic report to the cloud server 100 together with the patient user ID.

(S5: Storage of diagnostic report)
The patient information management unit 141 of the cloud server 100 searches for an account of the patient user using the patient user ID, and stores a diagnosis report in the searched account.

(S6: Send diagnostic report to patient user)
The arithmetic control unit 110 executes a process for sending this diagnostic report to the patient user. This process is performed, for example, by attaching a diagnostic report to an e-mail and transmitting it to the patient terminal 300-b and / or the designated person terminal 400-c. Further, as described above, the diagnosis report may be sent by FAX, postcard, letter or the like.

(S7: Billing process and reward calculation process)
The fee processing unit 170 executes the billing process for the patient user and the process for calculating the reward amount for the predetermined user, for example, as described above.

  The patient information management unit 141 records information related to billing (service use date, service breakdown, billing amount, etc.) in the account of the patient user. Similarly, the financial institution information management unit 144 and / or the insurance institution information management unit 145 records information related to charging and information related to the patient user in a corresponding account. The recorded information related to billing is aggregated at a predetermined timing and sent to the user.

  Furthermore, the user information management unit 140 adds information related to remuneration (information related to patient users, service use date and time, service breakdown, remuneration breakdown, remuneration amount) to the account of the user receiving the remuneration (medical institution, inspection apparatus installation organization, etc.). Etc.). Information about the recorded reward is aggregated at a predetermined timing and sent to the user.

  The above is the overall flow of the usage pattern as an example. Hereinafter, examples of processing executed in several stages will be described.

[Processing for Visit Requests]
A diagnostic report may include a visit request. A visit request is a request from a doctor to a patient user for medical treatment at a medical institution. A visit request is generated, for example, when a doctor determines that a visit is necessary based on test data or analysis results, or when a next visit is due when a regular visit is necessary. For example, as described above, the visit request includes at least information indicating whether or not to visit (character string information, presence / absence of check mark, etc.), and may further include a scheduled visit date.

  When processing related to a visit request is applied, the report processing unit 160 of the cloud server 100 includes a visit request determination unit 161 (see FIG. 6A). The visit request determination unit 161 determines whether a visit request for the patient user is included in the diagnosis report. The visit request determination part 161 determines the necessity of a visit based on the information input into the visit request description column in the diagnosis report. When the scheduled visit date is described, the visit request determination unit 161 recognizes the scheduled visit date. When the scheduled visit date is not described, the patient information management unit 141 determines the visit date with the patient user (patient terminal 300-b and / or designated person terminal 400-c). It may be configured to send and receive information.

  An example of processing related to a visit request is shown in FIG. 6B. The diagnosis report created in the same manner as step S4 in FIG. 5 is sent to the cloud server 100 (S11, S12). The visit request determination unit 161 determines whether a visit request for the patient user is included in the diagnosis report (S13).

  When the visit request is included in the diagnosis report (S14: YES), the arithmetic control unit 110 executes a process for sending the diagnosis report and the visit request information to the patient user (S15). This process is transmission of an electronic mail and attached information to the patient terminal 300-b and / or the designated person terminal 400-c. The visit request information includes, for example, a message prompting the patient user to visit (visit), information on the corresponding medical institution or doctor, and scheduled visit date. When the scheduled visit date is included, information for returning whether or not it is possible to visit the hospital on that day may be included. For example, the patient user operates the patient terminal 300-b to notify the cloud server 100 of whether or not the patient can visit the day. The arithmetic control unit 110 transmits the notification content to the diagnostic doctor terminal 500-d or the medical institution server 600-e. Moreover, the patient information management part 141 records that there was a visit request | requirement and the notification content with respect to it to the said patient user account.

  When the visit request is not included in the diagnosis report (S14: NO), the arithmetic and control unit 110 executes a process for sending the diagnosis report to the patient user as in Step 6 of FIG. 5 (S17). A message indicating that there is no visit request may be sent together with the diagnosis report. This is the end of the process related to the visit request as an example.

[Processing for inspection requests]
The ophthalmologic information system 1 can execute processing for requesting the patient user to perform an examination. This examination request process is performed, for example, for a patient user whose examination frequency is low. Hereinafter, an example of the inspection request process will be described.

  An example of the configuration when the inspection request process is applied is shown in FIG. 7A. In the patient information storage area 121, examination history information 1211 and examination timing information 1212 are stored. As described above, the examination history information 1211 is information stored in each patient user's account, and includes the contents of examinations already performed (examination date, examination type, etc.). The inspection timing information 1212 represents the timing at which the inspection should be performed. The inspection timing information 1212 includes, for example, an inspection execution interval and an inspection execution schedule (date). In this example, examination timing information 1212 is provided for each patient user, but the present invention is not limited to this. For example, examination timing information 1212 can be provided for each attribute such as a disease or a drug used. In this example, the case where the examination timing information 1212 including the examination execution interval is provided for each patient user will be described in detail, but similar processing can be executed even in the case of other configurations.

  The patient information management unit 141 is provided with a terminal selection unit 1411. The terminal selection unit 1411 selects one of the patient side terminals (patient terminal 300-b and / or designated person terminal 400-c) based on the examination timing information 1212. In particular, in this example, the terminal selection unit 1411 selects a patient side terminal based on the latest examination execution date and the examination execution interval stored in the patient information storage area 121. The latest inspection execution date corresponds to the latest inspection date and time recorded in the inspection history information 1211. The inspection execution interval is included in the inspection timing information 1212.

  The terminal selection part 1411 performs the said process about the patient user designated beforehand, for example. In this case, the selection of the patient side terminal corresponds to determining whether or not to make an examination request to the patient user. In another example, the terminal selection unit 1411 identifies the patient user (patient side terminal) that is the subject of the examination request notification by executing the above-described processing for a plurality of patient users at a predetermined timing.

  A specific example of processing executed by the terminal selection unit 1411 will be described. It is assumed that “30 days” is recorded in the inspection timing information 1212 as the inspection execution interval. Also, it is assumed that “March 1, 2014” is recorded in the inspection history information 1211 as the latest inspection execution date. The terminal selection unit 1411 adds the inspection execution interval “30 days” to the latest inspection execution date “March 1, 2014”. As a result, “March 31, 2014” is obtained. This day is called “calculation date”.

  The terminal selection unit 1411 compares the calculation date “March 31, 2014” with the predetermined date. The predetermined date is arbitrarily set. For example, the predetermined date may be the current date (execution date of processing by the terminal selection unit 1411) or may be other than that. As an example of the latter, a date before the current date can be set. This retroactive period is set in consideration of, for example, a period considered necessary from the notification of the inspection request to the execution of the inspection.

  When the calculation date is the same as or before the predetermined date, the terminal selection unit 1411 determines that the patient user is a notification target of the examination request. On the other hand, when the calculation date is later than the predetermined date, the terminal selection unit 1411 determines that the patient user is not a notification target of the examination request. A specific example will be described. When the current date (predetermined date) is “April 1, 2014”, the calculation date “March 31, 2014” is earlier than the current date “April 1, 2014”. The calculation date “March 31, 2014” is the last day of the period in which the examination should be performed first after the latest examination execution date “March 1, 2014” recorded in the examination history information 1211. The fact that this last date is the same as or earlier than the current date “April 1, 2014” indicates that the patient user has been tested even if the current date is the last date of the period to be examined. Means no. Therefore, the patient user is a subject to be notified of the examination request. Conversely, when the current date (predetermined date) is “March 15, 2014”, the calculated date “March 31, 2014” is later than the current date “March 15, 2014”. In other words, the last day of the period to be examined has not yet arrived. In this case, the patient user is not a subject for notification of the examination request.

  An example of processing related to the inspection request is shown in FIG. 7B. The inspection history information 1211 and the inspection timing information 1212 are stored in advance. The arithmetic control unit 110 starts the operation of the terminal selection unit 1411 at a predetermined timing. The terminal selection unit 1411 acquires the latest inspection date and time by referring to the inspection history information 1211 (S21). Next, the terminal selection unit 1411 adds the inspection execution interval recorded in the inspection timing information 1212 to the acquired latest inspection execution date (S22). Subsequently, the terminal selection unit 1411 compares the calculated date obtained by this addition process with a predetermined date (current date, etc.) (S23).

  When the calculation date is later than the predetermined date (S24: NO), it is determined that the patient user is not the subject of the examination request notification, and the process related to the patient user is ended.

  On the other hand, when the calculated date is the same as or before the predetermined date (S24: YES), it is determined that the patient user is the subject of the examination request notification. When this determination result is obtained, the patient information management unit 141 acquires the address of the patient side terminal (patient terminal 300-b and / or designated person terminal 400-c) of the patient user from the account of the patient user. To do. The arithmetic control unit 110 controls the communication unit 130 so as to transmit information (examination execution request) requesting the execution of the examination to the patient side terminal at the address acquired by the patient information management unit 141 (S25). This inspection execution request includes, for example, a message prompting the inspection to be performed and a date on which the inspection should be completed. The examination execution request may include the location of the ophthalmic examination apparatus 200-a determined from the location of the patient user.

  Note that it is also possible to notify the inspection execution request using communication means such as a facsimile, a postcard, and a letter. Thus, the processing related to the inspection request as an example ends.

[Process to notify the location of ophthalmic examination equipment]
The ophthalmologic information system 1 can execute processing for notifying a patient user of the location of the ophthalmic examination apparatus 200-a. This processing is effective, for example, when the ophthalmic examination apparatus 200-a in the vicinity of the place of stay is provided when the patient user is staying at a place other than the normal location (home, etc.) (for example, while traveling). It is. It is also effective when the patient user moves. Hereinafter, processing according to this example will be described.

  FIG. 8A shows an example of a configuration when the process according to this example is applied. Patient location information 1213 is stored in the patient information storage area 121. Patient location information 1213 represents the location of the patient user. The patient location information 1213 may include information (a location such as a home, a travel schedule, etc.) input in advance by a patient user or the like. Further, the patient location information 1213 may include information acquired substantially in real time. The information acquired substantially in real time is information representing a place or region where the patient user is currently staying. This information is provided by, for example, a current location specifying function (such as a satellite positioning system) mounted on the patient terminal 300-b.

  In the inspection apparatus information storage area 123, the name of the institution where the ophthalmic examination apparatus 200-a is installed (pharmacy name, spectacle store name, etc.) and the contact information of the institution (location, telephone number, mail address, IP address, And the name of the person in charge). In particular, the location of the inspection device installation organization is stored as device location information 1231. The inspection device information management unit 143 of the user information management unit 140 is provided with an inspection device selection unit 1431. The examination apparatus selection unit 1431 selects one of the plurality of ophthalmic examination apparatuses 200-a based on the location of a certain patient user and the apparatus location information 1231. A specific example of this process will be described later.

  An example of processing for notifying the patient user of the location of the ophthalmic examination apparatus is shown in FIG. 8B. Consider a single patient user. The patient terminal 300-b (or designated person terminal 400-c) of this patient user acquires the current location by a satellite positioning system such as GPS (S31). This current location is considered the location of the patient user. The patient terminal 300-b sends information representing the acquired current location (current location information) to the cloud server 100 together with the patient user ID (S32). The patient information management unit 141 searches for an account corresponding to the patient user ID sent from the patient terminal 300-b, and stores the current location information in this account (S33). The stored current location information is used as patient location information 1213.

  The patient information management unit 141 sends the current location information recorded in the patient location information 1213 to the examination apparatus information management unit 143. The inspection apparatus selection unit 1431 selects one of a plurality of ophthalmic inspection apparatuses 200-a under management based on the current location information and the apparatus location information 1231. This process is performed, for example, by specifying the ophthalmic examination apparatus 200-a whose installation location is included in a predetermined range (distance, distance, time, region, etc.) with respect to the current location of the patient user (S34).

  The user information management unit 140 sends information related to each ophthalmic examination apparatus 200-a specified by the examination apparatus selection unit 1431 to the calculation control unit 110. This information (specific inspection device information) includes, for example, the name of the installation organization (pharmacy name, spectacle store name, etc.) and the contact information (location, telephone number, etc.) of the organization. The arithmetic control unit 110 notifies the patient user of the specific examination device information (S35). This notification process is performed, for example, by transmitting an e-mail to the patient terminal 300-b and / or the designated person terminal 400-c of the patient user. This is the end of the process of notifying the location of the exemplary inspection apparatus.

[Billing process / reward calculation process]
As described above, the fee processing unit 170 of the cloud server 100 executes billing processing and reward amount calculation processing. The billing process is performed to charge the user for the usage fee when a user uses a preset service. The reward calculation process is performed to determine a reward received by a user who provides a service when one user provides a predetermined service to another user. Hereinafter, an example of processing executed in the billing processing and the reward amount calculation processing will be described.

  When charging occurs, the fee processing unit 170 executes charging processing for a predetermined user and reward calculation processing for one or more other users based on the charging amount and the remuneration amount calculation rule 126. . As an example, in response to the diagnosis report being transmitted to the patient terminal 300-b or the like, the fee processing unit 170 and the medical institution (or doctor) that created the diagnosis report and the examination for the diagnosis report The remuneration amount is calculated for each of the installation organization (pharmacy, spectacle store, etc.) of the ophthalmic examination apparatus 200-a and the administration organization of the ophthalmologic information system 1 that implements the above. Remuneration to medical institutions is incurred for medical practices, including the creation of diagnostic reports. Remuneration to the inspection apparatus installation organization is generated for the ophthalmic inspection apparatus 200-a being installed. Remuneration to the system operating organization is generated for the use of the system. In addition, the object of reward is not limited to these. For example, when the inspection data processing apparatus 900 is used, a reward for the operating organization is generated. In addition, when an optional service is provided, a reward is generated for the provider.

  The ophthalmologic information system 1 can be configured to manage a reward for a medical institution with an account of each medical institution. In this case, an account (medical institution information storage area 122) corresponding to each medical institution user is provided in the storage unit 120 of the cloud server 100. Each medical institution information storage area 122 is associated with the user ID (medical institution ID, medical institution identification information) of the medical institution user.

  When the fee processing unit 170 calculates the remuneration amount and the medical institution is included in the remuneration target, the arithmetic control unit 110 manages the medical institution user ID and the remuneration information. To part 142. The medical institution information management unit 142 searches for an account associated with the medical institution ID and stores reward information in this account. The reward information includes, for example, the amount of the reward, the type of service targeted for the reward, the date and time when the service was provided, the identification information of the charged user (patient user ID, etc.), and the like.

  As described above, the reward information is accumulated in the account of each medical institution user. The medical institution information management unit 142 totals the reward information accumulated in each medical institution user account. The total reward information is notified to the corresponding medical institution user. This notification process includes, for example, a process in which the arithmetic control unit 110 transmits aggregated data to the medical institution server 600-e. Instead of performing the above-described aggregation process, the reward information may be transmitted every time a reward is generated. Moreover, when two or more medical institutions form a group, you may comprise so that the reward information about these medical institutions may be totaled.

  The usage fee (charge amount) of the ophthalmologic information system 1 is substantially charged to a user who uses the corresponding service, but the charge amount may be notified to a user different from the user. For example, when a patient user has insurance, a charge amount for using the service by the patient user may be sent to the insurance organization. An example of processing executed in such a case will be described.

  As shown in FIG. 1, the cloud server 100 can communicate with an insurance institution server 800-h of each insurance institution user via a communication line N. The storage unit 120 of the cloud server 100 is provided with an account of each insurance institution user (insurance institution information storage area 125), and the insurance institution information management unit 145 manages each account. Each account stores a user ID of a patient user who has joined the insurance institution. Similarly, each patient user's account stores the user ID of the insurance organization to which the patient user is subscribed. Information relating the patient user ID and the insurance organization user ID is not limited to such a form. For example, information that associates a patient user ID with an insurance institution user ID can be provided independently.

  When the patient user is charged, the patient information management unit 141 or the insurance organization information management unit 145 identifies the insurance organization user ID associated with the user ID of the patient user by referring to the related information. . The insurance institution information management unit 145 acquires the address of the insurance institution server 800-h of the insurance institution user from the account associated with the specified insurance institution user ID. In addition, the insurance organization information management unit 145 stores information related to the patient user (patient user ID and the like) and information related to the current billing (charge amount, service provision date and the like) in the account of the insurance organization user.

  The arithmetic control unit 110 controls the communication unit 130 to transmit information related to charging (charging information) to the insurance organization server 800-h at the address acquired by the insurance organization information management unit 145. This transmission process is performed, for example, by transmitting billing information collected by the insurance organization information management unit 145 at a predetermined timing. Alternatively, this transmission process is executed every time billing occurs.

  The case where the charging information is transmitted to the insurance organization has been described above. However, it is also possible to transmit the charging information to a financial institution user such as a bank or a credit card company. This processing is similarly performed by the patient information storage area 121, the financial institution information storage area 124, the patient information management unit 141, the financial institution information management unit 144, the calculation control unit 110, the communication unit 130, the financial institution server 700-g, and the like. Can be executed.

[effect]
The effect of the ophthalmologic information system according to the embodiment will be described.

  The ophthalmologic information system according to the embodiment includes a server, a plurality of medical institution terminals, a plurality of ophthalmic examination apparatuses, and a plurality of patient terminals. Each medical institution terminal, each ophthalmic examination apparatus, and each patient terminal can communicate with a server via a communication line.

  In the above example, the server corresponds to the cloud server 100, the plurality of medical institution terminals correspond to the diagnostic doctor terminal 500-d and / or the medical worker terminal 650-f, and the plurality of ophthalmic examination apparatuses include the ophthalmic examination apparatus 200. -A corresponds to the patient terminal 300-b and / or the designated person terminal 400-c.

  The ophthalmic examination apparatus is installed in a facility different from a plurality of medical institutions. Examples of such facilities include pharmacies, eyeglass stores, optometrists, and welfare facilities for the elderly. The ophthalmic examination apparatus includes a first communication unit, a reception unit, an examination unit, and a first control unit.

  The first communication unit has a function of performing communication via a communication line. In the above example, the first communication unit corresponds to the communication unit 270.

  The reception unit has a function of receiving patient identification information (patient user ID). In the above example, the reception unit corresponds to the user interface 280. The reception unit may be a reader that reads a patient user ID and the like from a recording medium.

  The inspection unit has a function of generating inspection data by optically inspecting the eye. In the above example, the inspection unit corresponds to the optical unit 210, the image forming unit 250, and the inspection data generation unit 261.

  The first control unit associates the patient identification information received by the receiving unit with the test data generated by the test unit. Furthermore, the first control unit controls the first communication unit to transmit the associated patient identification information and examination data to the server. In the above example, the first control unit corresponds to the control unit 240.

  A medical institution terminal is used in a medical institution. The medical institution terminal includes a second communication unit, a user interface, and a second control unit.

  The second communication unit has a function of performing communication via a communication line.

  The user interface is used to create a report based on examination data generated by the ophthalmic examination apparatus. The form for providing the user interface is arbitrary. For example, the user interface is provided as a desktop application, a web application, or a cloud application. The user interface includes, for example, display means for displaying various medical information including examination data and analysis results thereof, and operation means (input means) for performing an input operation for creating a report.

  The second control unit controls the second communication unit to transmit the report created using the user interface to the server. In the above example, the report is transmitted directly from the diagnostic doctor terminal 500-d to the cloud server 100, or transmitted from the medical staff terminal 650-f to the cloud server 100 via the medical institution server 600-e. The

  The server includes a third communication unit, a storage unit, a data processing unit, and a third control unit.

  The third communication unit has a function of performing communication via a communication line. In the above example, the third communication unit corresponds to the communication unit 130.

  The storage unit includes a plurality of patient information storage areas respectively associated with a plurality of patient identification information corresponding to a plurality of patients (patient users). Furthermore, the memory | storage part has memorize | stored beforehand the 1st relevant information with which medical institution identification information (medical institution user ID) of one of several medical institutions was linked | related with each patient identification information. In the above example, the storage unit corresponds to the storage unit 120, and the patient information storage area corresponds to the patient information storage area 121. Moreover, the 1st relevant information is memorize | stored in the account (patient information storage area 121) of each patient user, for example. Alternatively, the first related information may be independent information in which information related to a plurality of patients (patient user IDs and the like) and information related to a plurality of medical institutions (medical institution user IDs) are associated with each other. The medical institution identification information is a concept including identification information (doctor user ID) given to a doctor individual.

  When the third communication unit receives patient identification information and examination data from the ophthalmic examination apparatus, the data processing unit identifies a medical institution terminal corresponding to the patient identification information from among the plurality of medical institution terminals. This specifying process is performed by referring to the first related information. In the above example, this specifying process is executed by the user information management unit 140 or the like.

  The third control unit controls the third communication unit to transmit the patient identification information and the examination data transmitted from the ophthalmic examination apparatus to the server to the medical institution terminal specified by the data processing unit. Further, the third control unit executes at least the following two processes in response to the third communication unit receiving the patient identification information and the report from the medical institution terminal. As a first process, the third control unit stores at least a part of the report in the patient information storage area associated with the patient identification information. As the second process, the third control unit controls the third communication unit to transmit at least a part of the report to the patient terminal corresponding to the patient identification information. Note that the information stored in the patient information storage area in the first process and the information transmitted to the patient terminal in the second process may be the same or different. In the above example, the third control unit corresponds to the calculation control unit 110 (and the user information management unit 140).

  According to the ophthalmologic information system having such a configuration, an eye examination is performed at a facility other than a medical institution such as a pharmacy or an optometricist, and a doctor creates a report based on the examination data obtained thereby, This report can be provided to the patient. That is, the patient can obtain a diagnosis result only by performing an examination at a nearby facility. In addition, by instructing employees such as pharmacies how to operate the ophthalmic examination apparatus, the examination can be performed smoothly. Therefore, a test for a disease requiring long-term pathological condition management can be performed more routinely and easily than before. As described above, according to the ophthalmologic information system according to the embodiment, it is possible to provide a new technique capable of suitably performing long-term management of a disease state.

  In the ophthalmologic information system according to the embodiment, the data processing unit of the server may include a determination unit that determines whether or not the report received by the third communication unit includes a visit request for the patient. Furthermore, the third control unit can execute different processes depending on whether it is determined that the visit request is included and when it is determined that the visit request is not included. In the above example, the determination unit corresponds to the visit request determination unit 161. According to this configuration, it is possible to provide appropriate processing according to the presence or absence of a visit request.

  When it is determined that the visit request is included in the report, the third control unit may be configured to execute the following process. First, a 3rd control part specifies the medical institution identification information linked | related with the patient identification information of the said patient by referring 1st related information. Next, the third control unit performs the third communication so as to transmit information requesting a visit to the medical institution corresponding to the specified medical institution identification information to the patient side terminal corresponding to the patient identification information. Control part. According to this configuration, when a visit request is included in a report, it is possible to notify the target patient to that effect. By this notification, the patient can recognize that medical treatment at a medical institution is necessary.

  When it is determined that the visit request is included in the report, the third control unit determines the determination result by the determination unit in the patient information storage area associated with the patient identification information of the patient ) Can be stored. Further, although it is optional, the same processing (processing for storing that there was no visit request) may be executed even when the visit request is not included in the report. According to this configuration, by accumulating the presence / absence of a visit request, it is possible to grasp the visit status and pathological condition.

  The ophthalmologic information system according to the embodiment may include the following configuration. First, inspection timing information indicating the timing at which an inspection should be performed is stored in advance in the storage unit of the server. The data processing unit includes a first selection unit that selects one of the plurality of patient-side terminals based on the examination timing information. The third control unit controls the third communication unit to transmit information requesting the execution of the examination to the selected patient terminal. In the above example, the first selection unit corresponds to the terminal selection unit 1411. Further, the examination required by this example may be performed at a place other than the medical institution (that is, it may be carried out by any one of a plurality of ophthalmic examination apparatuses) or may be carried out at the medical institution. According to this configuration, it is possible to instruct the patient to perform an examination at a suitable timing. Therefore, long-term management of the disease state can be suitably performed.

  This configuration may be embodied as follows. In this example, the inspection timing information includes information indicating an inspection execution interval. When the third communication unit receives patient identification information and examination data from any of the plurality of ophthalmic examination apparatuses, the third control unit stores the examination data in the patient information storage area associated with the patient identification information. The inspection execution date representing the date on which is acquired is stored. Thereby, the examination history is managed for each patient. The first selection unit selects a patient-side terminal based on the latest examination execution date stored in the patient information storage area and the execution interval included in the examination timing information. According to this configuration, it is possible to selectively request a patient who has not been examined at an appropriate time interval.

  The ophthalmologic information system according to the embodiment may include the following configuration. First, the storage unit of the server stores in advance device location information indicating the location of each of a plurality of ophthalmic examination devices. The third control unit stores the patient location information indicating the location of the patient in the corresponding patient information storage area. The patient location information is automatically input to the server by, for example, a satellite positioning system. Alternatively, the patient location information is manually input by the patient and related parties. The data processing unit includes a second selection unit that selects one of the plurality of ophthalmic examination apparatuses based on the patient location information and the device location information of one patient. This selection process is performed based on, for example, distance, route, travel time, region, and the like. The third control unit controls the third communication unit to transmit information representing the location of the ophthalmic examination apparatus selected by the second selection unit to the patient terminal corresponding to the patient. According to this configuration, it is possible to provide the patient with the location of the ophthalmic examination apparatus that is easily accessible. Therefore, it is possible to reduce the burden on the patient required for the examination. In the above example, the second selection unit corresponds to the inspection device selection unit 1431.

  In the ophthalmologic information system according to the embodiment, the data processing unit of the server may include a reward processing unit. When a fee is charged, the remuneration processing unit, based on the amount of the fee and a predetermined rule, one of a plurality of medical institutions and one of a plurality of ophthalmic examination apparatuses installed The amount of remuneration for each of a plurality of organizations including the system operating organization is calculated. Here, the reward amount for any of the plurality of institutions may be zero. According to this configuration, it is possible to automatically distribute a reward amount to a plurality of users. In the above example, the reward processing unit corresponds to the fee processing unit 170, and the rule corresponds to the reward amount calculation rule 126.

  The reward processing unit may be configured as follows. In response to the report being sent to the patient terminal, the reward processing unit has installed the medical institution that created this report and the ophthalmic examination device that generated the test data used to create this report. The remuneration amount of each of a plurality of organizations including the existing organization and the system operating organization is calculated. According to this configuration, it is possible to automatically distribute the charge amount for the inspection and report creation to the users involved in them as a reward.

  The ophthalmologic information system according to the embodiment may be configured as follows. First, the storage unit of the server includes a plurality of medical institution information storage areas respectively associated with a plurality of medical institution identification information corresponding to a plurality of medical institutions. When the reward amount is calculated by the reward processing unit, the third control unit stores the reward amount of the medical institution in the medical institution information storage area associated with the medical institution identification information of the medical institution. In the above example, the medical institution information storage area corresponds to the medical institution information storage area 122. According to this configuration, the remuneration amounts for a plurality of medical institutions can be managed for each medical institution. Therefore, it is possible to suitably calculate and notify the remuneration amount for each medical institution.

  The ophthalmologic information system according to the embodiment may be configured as follows. The server can communicate with an insurance institution server that manages information on each of one or more insurance institutions via a communication line. The storage unit of the server stores in advance second related information in which any insurance institution identification information of one or more insurance institutions is associated with each patient identification information. When billing occurs, the data processing unit identifies insurance institution identification information associated with the patient identification information of the patient related to the billing based on the second related information. Further, the third control unit controls the third communication unit to transmit the amount of this billing to the insurance institution server corresponding to the specified insurance institution identification information. According to this configuration, this billing process can be automatically performed when a billing amount for a patient is billed to an insurance organization. In the above example, the insurance institution server corresponds to the insurance institution server 800-h. The second related information is stored, for example, in each patient user's account (patient information storage area 121). Alternatively, the second related information may be independent information in which information related to a plurality of patients (patient user IDs and the like) and information related to a plurality of insurance institutions (insurance institution user IDs) are associated. In the above example, the process executed by the data processing unit for charging corresponds to the charging process executed by the fee processing unit 170.

  The ophthalmologic information system according to the embodiment may be configured as follows. The storage unit of the server includes one or more insurance institution information storage areas respectively associated with one or more insurance institution identification information corresponding to one or more medical institutions. Further, the storage unit stores in advance second related information in which insurance institution identification information of any insurance institution is associated with each patient identification information. When charging occurs, the data processing unit specifies insurance institution identification information associated with the patient identification information of the patient related to the charging based on the second related information. The third control unit stores the charge type and amount in the insurance institution information storage area associated with the specified insurance institution identification information. According to this configuration, it is possible to manage the amount charged for each insurance institution. Therefore, it is possible to suitably perform summarization and notification of the amount charged to each insurance institution. In the above example, the insurance institution information storage area corresponds to the insurance institution information storage area 125. The second related information is stored, for example, in each patient user's account (patient information storage area 121). Alternatively, the second related information may be independent information in which information related to a plurality of patients (patient user IDs and the like) and information related to a plurality of insurance institutions (insurance institution user IDs) are associated. In the above example, the process executed by the data processing unit for charging corresponds to the charging process executed by the fee processing unit 170.

  The ophthalmic examination apparatus may have an OCT function. In that case, the inspection unit of the ophthalmic inspection apparatus includes an optical system for performing OCT measurement and an inspection data generation unit. The optical system divides the light from the light source into measurement light and reference light, generates interference light by superimposing the return light of the measurement light from the patient's eye and the reference light, and detects the interference light. The inspection data generation unit generates inspection data by processing the detection result by the optical system. According to this configuration, it is possible to acquire useful inspection data by using the superiority of OCT (capable of acquiring a high-definition image, acquiring a cross-sectional image or a three-dimensional image, etc.), and creating a report based on the acquired inspection data. Can do. In the above example, the optical system corresponds to the optical unit 210, and the inspection data generation unit corresponds to the image forming unit 250 and the inspection data generation unit 261.

[About Ophthalmology Information Processing Server]
The ophthalmologic information processing server according to the present invention can be operated as a server of the above ophthalmologic information system. The ophthalmologic information processing server includes a communication unit, a storage unit, a data processing unit, and a control unit.

  The communication unit has a function of communicating with each of the plurality of ophthalmic examination apparatuses, each of the plurality of medical institution terminals, and each of the plurality of patient side terminals via a communication line. Here, the ophthalmologic apparatus is installed in a facility different from a plurality of medical institutions, and generates inspection data by optically inspecting the eye. Medical institution terminals are installed in a plurality of medical institutions and are used to create reports based on examination data. The patient side terminal is used by a plurality of patients or related persons.

  The storage unit includes a plurality of patient information storage areas respectively associated with a plurality of patient identification information corresponding to a plurality of patients. Furthermore, a memory | storage part memorize | stores beforehand the relevant information with which any medical institution identification information of the some medical institution was linked | related with each patient identification information.

  When the communication unit receives the patient identification information and the examination data from any of the plurality of ophthalmic examination apparatuses, the data processing unit refers to the related information, so that the medical institution terminal corresponding to the patient identification information Specify from medical institution terminals.

  The control unit controls the communication unit to transmit the patient identification information and the examination data received by the communication unit to the medical institution terminal specified by the data processing unit. Further, when the communication unit receives the patient identification information and the report from the medical institution terminal, the control unit stores at least a part of the report in a patient information storage area associated with the patient identification information. Further, the control unit controls the communication unit to transmit at least a part of the report to the patient terminal corresponding to the patient identification information.

  According to the ophthalmologic information processing server having such a configuration, a process related to eye examination data acquired in a facility other than a medical institution such as a pharmacy or an optometry list, and a report created by a doctor based on this examination data By executing the process, a report can be provided to the patient. Therefore, a test for a disease requiring long-term pathological condition management can be performed more routinely and easily than before.

  The ophthalmologic information processing server according to the embodiment may be configured to execute arbitrary processing that can be executed by the server of the ophthalmologic information system described above.

  The configuration described above is merely an example for favorably implementing the present invention. Therefore, arbitrary modifications (omitted, replacement, addition, etc.) within the scope of the present invention can be made as appropriate.

  A computer program for realizing the above embodiment can be stored in any recording medium readable by a computer. Examples of the recording medium include a semiconductor memory, an optical disk, a magneto-optical disk (CD-ROM / DVD-RAM / DVD-ROM / MO, etc.), a magnetic storage medium (hard disk / floppy (registered trademark) disk / ZIP, etc.), and the like. Can be used.

  It is also possible to transmit / receive this program through a network such as the Internet or a LAN.

DESCRIPTION OF SYMBOLS 1 Ophthalmology information system 100 Cloud server 110 Operation control part 120 Storage part 121 Patient information storage area 122 Medical institution information storage area 123 Examination apparatus information storage area 124 Financial institution information storage area 125 Insurance institution information storage area 126 Compensation amount calculation rule 130 Communication Unit 140 User information management unit 141 Patient information management unit 142 Medical institution information management unit 143 Examination device information management unit 144 Financial institution information management unit 145 Insurance institution information management unit 150 Examination data processing unit 160 Report processing unit 170 Fee processing unit 180 Insurance Processing unit 200-a Ophthalmic examination apparatus 210 Optical unit 240 Control unit 241 Main control unit 242 Storage unit 250 Image forming unit 260 Data processing unit 261 Examination data generation unit 262 Stillness determination unit 263 Left / right determination unit 270 Communication unit 280 User interface 2 DESCRIPTION OF SYMBOLS 1 Display part 282 Operation part 300-b Patient terminal 400-c Designated person terminal 500-d Diagnostic physician terminal 600-e Medical institution server 650-f Medical worker terminal 700-g Financial institution server 800-h Insurance institution server 900 Inspection data processor N Communication line

Claims (3)

Server,
A plurality of ophthalmologic examination apparatuses capable of communicating with the server via a communication line,
The server includes a storage unit that stores in advance setting information for controlling the plurality of ophthalmic examination apparatuses for each patient identification information,
Each of the plurality of ophthalmic examination apparatuses includes
It is installed in a facility different from medical institutions,
A communication unit for performing communication via a communication line;
A reception unit for receiving patient identification information;
An inspection unit that generates inspection data by optically inspecting the eye;
The communication unit is controlled to transmit the patient identification information received by the reception unit and the device identification information of the ophthalmic examination apparatus to the server, and the server retrieves from the storage unit based on the patient identification information And a control unit that controls the examination unit based on the setting information transmitted to the ophthalmic examination apparatus based on the apparatus identification information, and performs an examination of the eye to be examined. Further comprising medical institution terminals installed at a plurality of medical institutions capable of communicating with the server via a communication line;
The ophthalmologic information system according to claim 1, wherein the medical institution terminal includes a user interface for editing the setting information stored in the storage unit of the server. Any of the plurality of ophthalmic examination apparatuses can perform optical coherence tomography,
3. The setting information according to claim 1, wherein the setting information includes a setting content related to at least one of a fixation position, a scan pattern, a focus position, a diopter correction value, and an analysis process. Ophthalmology information system.

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