JP2021053061A - Remote communication system - Google Patents

Abstract

To provide a remote communication system capable of reducing time from onset of a disease until start of treatment.SOLUTION: There are provided a medical facility 10 to which belongs a medical worker capable of communication operation or remote telephone call, a private room type surgical room 20 having a catheter operation robot 21 to be remote operated by the medical worker from the medical facility, a computer 30 capable of information communication with the medical facility and the private room type surgical room, and a patient data server 40 being accessible from the computer.SELECTED DRAWING: Figure 1

Description

The present invention relates to a remote communication system.

In recent years, a procedure using a catheter such as a balloon catheter has been performed for the treatment of a stenosis formed in a biological lumen such as a blood vessel. For example, in general PCI (Percutaneous Coronary Intervention), the operator places a balloon of a balloon catheter in the stenosis that occurs in the coronary artery along the preceding guide wire. Then, the surgeon expands the stenosis by expanding the balloon and improves the blood flow on the peripheral side of the stenosis (see, for example, Patent Document 1).

JP 2015-93122

In carrying out the above-mentioned PCI, it is required to shorten the time from the onset of a disease (for example, acute myocardial infarction) to the start of treatment. Of these, the time from arrival at the hospital to the start of treatment can be shortened by improving the operation within one facility where PCI is implemented.

On the other hand, it has been considered difficult to shorten the time from the onset of the disease to the arrival at a hospital where PCI can be performed because it depends on the place and situation of the patient's onset and the local medical system. It was.

In addition, instead of being directly transported to a hospital where PCI can be performed after the onset of the disease, there are cases where the patient is first transferred to a hospital where PCI cannot be performed, such as a family clinic, and then transferred to a hospital where PCI can be performed. is there. In this case, transportation between hospitals increases the time from the onset of the disease to the arrival at a hospital where PCI can be performed.

In general, about 60% of patients are directly transported to a hospital where PCI can be performed after the onset of the disease. That is, as many as 40% of patients are transferred from hospitals where PCI cannot be performed to hospitals where PCI cannot be performed.

Furthermore, in Japan, the average transfer distance from a hospital where PCI cannot be performed to a hospital where PCI can be performed is 8 km, which is about 10 minutes in terms of time, which has a great influence on the prognosis of patients. It could be. Also, in the United States, which has a large area, transfer distances and transfer times are significantly increased, which can have a greater impact on patient prognosis.

Furthermore, there is a possibility that the number of hospitals will decrease in rural areas in the future, and for patients living in rural areas, the time from the onset of the disease to the arrival at a hospital where PCI can be performed may increase.

From the above, in order to further reduce the adverse effect on the prognosis of patients, a system capable of shortening the time from the onset of the disease to the start of treatment is required.

The inventors of the present invention have come up with the remote communication system of the present invention as a result of diligent efforts in solving the above problems.

An object of the present invention is to provide a remote communication system capable of shortening the time from the onset of a disease to the start of treatment.

The remote communication system according to the present invention that achieves the above object is a private room type including a medical facility in which a medical worker capable of communication operation or remote communication is enrolled, and a medical device remotely operated by the medical worker from the medical facility. It has an operating room, a computer capable of communicating with the medical facility and the private room type operating room, and a patient data server accessible from the computer.

According to the above-mentioned remote communication system, a private room type for a patient who develops a disease by installing a private room type operating room inside or adjacent to a complex facility such as a clinic, an event venue, a shopping mall, an apartment (house), etc. Good access to the operating room. Therefore, the time from the onset of the disease to the start of treatment can be shortened.

It is a figure which shows the outline of the remote communication system which concerns on this embodiment. It is a block diagram which shows the structure of the computer of the remote communication system which concerns on this embodiment. It is a block diagram which shows the functional structure of the CPU of the remote communication system which concerns on this embodiment. It is a flowchart which shows the usage method of the remote communication system which concerns on this embodiment. It is a figure which shows the appearance that the stenosis part occurred just under the anastomosis part. It is a figure which shows the appearance that the stenosis part was formed downstream of a vein. It is a figure which shows the thrombotic occlusion part. It is a figure which shows the non-thrombogenic obstruction part. It is a schematic diagram which shows the remote communication system which concerns on the modification.

Hereinafter, embodiments of the present invention will be described with reference to the accompanying drawings. In the description of the drawings, the same elements are designated by the same reference numerals, and duplicate description will be omitted. In addition, the dimensional ratios in the drawings are exaggerated for convenience of explanation and may differ from the actual ratios.

FIG. 1 is a diagram showing an outline of a remote communication system 1 according to the present embodiment. FIG. 2 is a block diagram showing a configuration of a computer 30 of the remote communication system 1 according to the present embodiment. FIG. 3 is a block diagram showing a functional configuration of the CPU 31 of the remote communication system 1 according to the present embodiment.

As shown in FIG. 1, the remote communication system 1 according to the present embodiment includes a medical facility 10, a private operating room 20, a computer 30, and a patient data server 40.

The medical facility 10 is enrolled by a medical worker who can perform communication operations or make remote calls. As a medical worker enrolled in the medical facility 10, it is preferable to be a PCI specialist. A medical worker enrolled in the medical facility 10 can remotely control the catheter operating robot (medical instrument) 21 in the private operating room 20. In addition, the medical staff enrolled in the medical facility 10 can make a remote call with the patient in the private operating room 20. The medical staff enrolled in the medical facility 10 may be able to make a remote call with a caregiver who cares for the patient in the private operating room 20.

The private operating room 20 can be installed at any location, but is preferably installed inside or near an internal medicine clinic, an event venue, or the like. By installing the private room type operating room 20 in this way, it is possible to improve the access of the patient who has developed the disease to the private room type operating room 20. Further, it is more preferable that the private operating room 20 is installed near the medical facility 10 where a specialist is enrolled.

As shown in FIG. 1, the private operating room 20 includes a catheter operation robot (corresponding to a medical device) 21, an automatic external defibrillator (AED) 22, a medical inquiry terminal 23, an acquisition unit 24, and the like. It has an injection unit 25, a CPR device 26, and an X-ray contrast device 27.

As the catheter operating robot 21, a known catheter operating robot can be used. The catheter operating robot 21 has an introducer sheath, a guide wire, a catheter, a diagnostic imaging catheter, a balloon catheter, and the like.

The automatic external defibrillator 22 is provided with, for example, an electric pad or the like, and provides first-aid measures for recovering the heart function of a patient in a state of cardiopulmonary arrest. Specifically, the automatic external defibrillator 22 gives an electric shock to the heart by electrical defibrillation with the electrode pad applied to the chest of the patient, and performs a procedure for attempting to recover the function of the heart. Do.

The interview terminal 23 asks the patient a predetermined interview. In addition, the interview terminal 23 receives the response content to the interview content.

Specifically, the interview terminal 23 displays questions such as body weight, blood type, lifestyle, family structure, and medical history on a display unit such as a display for a patient using the private room type operating room 20. Then, the patient answers the question contents displayed on the display unit of the question terminal 23 with the touch panel.

The interview with the patient may be performed by voice output, and the response to the interview content may be performed by voice input.

The answer data of the inquiry acquired by the inquiry terminal 23 is transmitted to the medical facility 10 via the computer 30.

The acquisition unit 24 acquires the biological information of the patient. Specifically, the acquisition unit 24 acquires the user's blood pressure, body temperature, respiration, pulse rate, arterial oxygen saturation, and the like (vital signs). As the acquisition unit 24, a known vital sign measuring device can be used. Since the acquisition unit 24 is provided in this way, the catheter operation robot 21 can be operated with reference to the biological information.

The injection unit 25 injects a thrombolytic agent that dissolves the developed thrombus into the patient. A known liquid supply unit can be used as the injection unit 25. The injection unit 25 injects a thrombolytic agent dissolved in physiological saline.

The CPR (Cardio Pulmonary Resuscitation) device 26 includes an automatic cardiac massager and a ventilator. Specifically, the automatic cardiac massager includes a compression portion that compresses the patient's chest, and performs cardiac massage that repeatedly compresses and releases the compression on the patient's chest at predetermined intervals. The automatic cardiac massager may be provided with a fixing belt for fixing to the patient. A ventilator delivers gas into the patient's lungs to assist in breathing.

As the X-ray contrast device 27, a known X-ray contrast device can be used. By irradiating X-rays with the X-ray contrast device 27 during the operation step S10 described later, for example, the position of the guide wire in the living body by the X-ray opaque marker provided at the tip of the guide wire. You can operate while checking. The X-ray opaque material is, for example, platinum, gold, tungsten, iridium or an alloy thereof.

The computer 30 can communicate with the medical facility 10 and the private operating room 20. The computer 30 controls each of the above parts and performs various processes. As shown in FIG. 2, the computer 30 includes a CPU (Central Processing Unit) 31, a memory 32, a hard disk 33, and a communication I / F unit 34. Each configuration is communicably connected to each other via a bus 35.

The CPU 31 executes control of each configuration, various arithmetic processes, and the like according to a program recorded in the memory 32 and the hard disk 33.

The memory 32 is composed of a ROM (Read Only Memory) for storing various programs and various data, a RAM (Random Access Memory) for temporarily storing programs and data as a work area, and the like.

The hard disk 33 stores various programs including an operating system and various data.

The communication I / F unit 34 is an interface for communicating with the medical facility 10 and the private operating room 20 via a network, such as Ethernet (registered trademark), FDDI (Fiber Distributed Data Interface), and Wi-Fi (Wi-Fi). Use a standard such as Fibertity).

By executing various programs, the CPU 31 functions as, for example, an individual identification unit 311, a specific unit 312, a communication unit 313, an operation unit 314, a notification unit 315, and a selection unit 316, as shown in FIG. The functional configuration will be described below.

The personal identification unit 311 identifies the patient. Specifically, the patient is identified by personally authenticating the patient. The personal authentication is not particularly limited, but personal features such as fingerprints, voices, and faces can be used. Further, the individual identification unit 311 acquires the patient data of the patient identified by the individual identification unit 311 via the patient data server 40.

The specific unit 312 identifies the location where the symptom has occurred and which medical device to use, based on the content of the response to the content of the interview received by the interview terminal 23. In addition, the specific unit 312 identifies an unused medical device among the medical devices.

The liaison unit 313 informs the medical staff registered in the medical facility 10 of the patient's symptom acquired by the interview terminal 23 and the medical device specified by the specific unit 312.

The operation unit 314 operates the catheter operation robot 21, the acquisition unit 24, the injection unit 25, the X-ray contrast device 27, and the like according to the command of the medical staff registered in the medical facility 10. Here, the operation unit 314 may operate the catheter operation robot 21 by performing the same movement as the operation of the medical staff registered in the medical facility 10, or the catheter operation robot by fully automatic control. 21 may be operated.

In the following description, the content of the operation unit 314 operating the catheter operation robot 21 will be specifically described by taking as an example the case of TRI (Trans Radial intervention) in which the lesion portion developed in the coronary artery is treated via the radial artery. Explain to.

First, the operation unit 314 operates the introducer sheath or the like, punctures the introducer sheath into the radial artery by the Seldinger method, and inserts the guide wire into the artery via the introducer sheath. Next, the operation unit 314 operates a guide wire or the like to insert the guide wire into the lumen of the catheter, and inserts the catheter into the artery while leading the guide wire.

Then, the operation unit 314 operates a guide wire or the like to provide a medical device used for diagnosis / treatment such as a guide wire, a guiding catheter, an diagnostic imaging catheter, or a balloon catheter through the lumen of the introducer sheath. Insert into the radial artery. Then, using these medical devices, the lesion portion of the coronary artery is diagnosed and treated.

The notification unit 315 notifies the emergency hospital / large hospital, family members, related persons, etc. in an emergency. The means for the notification unit 315 to notify is not particularly limited, but for example, it is a telephone notification.

The sorting unit 316 selects a specific medical facility 10 from a plurality of medical facilities 10 based on the patient's symptom identified by the patient's specific unit 312. At this time, it is preferable that the sorting unit 316 sorts the medical facility 10 so that the load on the specific medical facility 10 is not concentrated. In addition, the sorting unit 316 selects a vacant medical facility 10 from a plurality of medical facilities 10. Further, for example, when Japan is at night, the sorting unit 316 may use the time difference to sort the medical facilities 10 in the country which is daytime when Japan is at night. In this way, by using the time difference, it is possible to construct a 24-hour system and to cooperate with overseas. Naturally, even in Japan, it is possible to build a 24-hour system in the region by coordinating between hospitals in each region and giving them functional roles such as hospitals dedicated to nights and holidays. This is a system that can only be achieved by a true regional medical cooperation that prioritizes improving the QOL of residents, providing peace of mind, and happiness beyond the income and expenditure (profit and loss) of each hospital. Clarifying the roles of hospitals in regional medical cooperation will lead to the reorganization and integration of hospitals in each region.

The patient data server 40 stores patient data about the patient. Here, the patient data is not particularly limited as long as it is data related to the patient, and for example, data such as patient identification ID (for example, my number), patient name, address, age, medical history, health condition, genetic information, etc. Can be mentioned. These data are stored in the patient data server 40 in a state of being linked to each patient. The medical history data can be configured by, for example, an electronic medical record. Health status data can be composed of, for example, medical examination results and interview results. The genetic information may include not only the genetic information of the patient himself / herself but also the genetic information of a relative. The genetic information can be composed of, for example, DNA test results and the like. The various patient data described above may be converted into an electronic medical record as medical information over the life of an individual and comprehensively managed by a system such as PHR (Personal Health Record) that is centrally managed. In that case, a mechanism that is managed on the cloud and accesses patient data as needed may be used.

Next, a method of using the remote communication system 1 will be described with reference to FIG.

FIG. 4 is a flowchart showing how to use the remote communication system 1 according to the present embodiment.

First, the patient visits his / her clinic when symptoms such as chest pain occur (visit step S1). Here, the medical staff enrolled in the family clinic is not a PCI specialist, and PCI cannot be performed at the family clinic. At this time, the patient may visit the family clinic by notifying the patient when an abnormality in vital signs is detected by the wearable terminal.

Next, the medical staff enrolled in the family clinic determines whether or not the patient's symptom is myocardial infarction (determination step S2). If it is determined that the patient's symptom is not myocardial infarction and is not urgent (S2: NO), the patient is returned home after appropriate treatment at the clinic. On the other hand, when it is determined that the patient's symptom is myocardial infarction and it is urgent (S2: YES), the process proceeds to the induction step S3.

Next, the medical staff enrolled in the clinic guides the patient to the private operating room 20 (guidance step S3). At this time, in order to minimize the time when moving from the clinic to the private room type operating room 20, the private room type operating room 20 is preferably installed in the clinic or adjacent to the clinic.

Next, the patient guided to the private room type operating room 20 is identified by the individual identification unit 311 (individual identification step S4). Specifically, the patient is identified by personally authenticating the patient.

Next, the patient is interviewed by the interview terminal 23 (interview step S5). In the interview step S5, the interview content displayed on the display unit of the interview terminal 23 may be answered by the touch panel, or the patient may be interviewed by voice.

Next, the specific unit 312 identifies the location where the symptom occurs depending on the content of the response to the interview content (specific step S6).

Next, the sorting unit 316 sorts a specific medical facility 10 from a plurality of medical facilities 10 (sorting step S7). At this time, for example, when Japan is at night, the time difference can be used to select overseas medical facilities 10.

The sorting step S7 may be performed based on the result of prior machine learning. Machine learning refers to analyzing input data using an algorithm, extracting useful rules and judgment criteria from the analysis results, and developing the algorithm. Machine learning algorithms are generally classified into supervised learning, unsupervised learning, reinforcement learning, and the like. In the supervised learning algorithm, a data set of input (answer to the interview) and result (which medical facility 10 was selected) is given, and machine learning is performed based on the data set. In the unsupervised learning algorithm, machine learning is performed by giving a large amount of input data. The reinforcement learning algorithm changes the environment based on the solution output by the algorithm, and makes corrections based on the reward of how correct the output solution is.

Next, the liaison unit 313 informs the medical staff of the medical facility 10 of the patient's symptoms (contact step S8).

Next, the medical worker enrolled in the medical facility 10 selects which medical device to use among the medical devices installed in the private room type operating room 20 (selection step S9). For example, in the present embodiment, the medical staff selects the catheter operation robot 21, the acquisition unit 24, the injection unit 25, and the X-ray contrast apparatus 27. The automatic external defibrillator 22 and the CPR device 26 are used in an emergency.

Next, the operation unit 314 operates the catheter operation robot 21 based on the command of the medical staff registered in the medical facility 10 (operation step S10).

If an emergency occurs in operation step S10, the notification unit 315 notifies the emergency hospital / large hospital, family members, related persons, etc. (notification step S11).

As described above, the remote communication system 1 according to the present embodiment is for medical facility 10 in which a medical worker who can perform communication operation or remote communication is enrolled, and for catheter operation which is remotely operated by the medical worker from the medical facility 10. It has a private room type operating room 20 provided with a robot (medical instrument) 21, a computer 30 capable of communicating information with the medical facility 10 and the private room type operating room 20, and a patient data server 40 accessible from the computer 30. According to the remote communication system 1 configured in this way, the disease can be caused by installing the private room type operating room 20 inside or adjacent to a complex facility such as a clinic, an event venue, a shopping mall, or an apartment (house). Access to the private operating room 20 of the affected patient can be improved. Therefore, the time from the onset of the disease to the start of treatment can be shortened.

Further, the computer 30 has an operation unit 314 that operates the catheter operation robot 21 according to a command from a medical worker registered in the medical facility 10. According to the remote communication system 1 configured in this way, the catheter operating robot 21 can be suitably operated.

In addition, the private operating room 20 dissolves an automatic external defibrillator 22, a medical inquiry terminal 23 that asks a predetermined question to a patient, an acquisition unit 24 that acquires biological information of the patient, and a blood clot that has developed in the patient. It has an injection unit 25 for injecting a solubilizer, a CPR device 26 including an automatic cardiac massager or a ventilator, and an X-ray contrast device 27 for irradiating X-rays. According to the remote communication system 1 configured in this way, PCI can be preferably performed.

The computer 30 has a notification unit 315 that can notify the emergency hospital or family in an emergency. According to the remote communication system 1 configured in this way, it is possible to take an appropriate response in an emergency. For example, if emergency response is required in the private operating room 20, it is sufficient if the medical staff present can handle it, but if it cannot be handled, the patient must be transferred to a facility that can handle it. Will be done. In this case, if the transfer candidate destination and the medical staff who can deal with the transfer after the transfer are selected in advance from the medical facilities 10 around the private room type operating room 20, the transfer can be smoothly handled even if the transfer is actually required. It becomes possible and the burden on the patient can be reduced. At this time, the selection of the emergency transfer destination and the medical staff to deal with may be executed by AI (artificial intelligence) in the computer 30. Since the candidates for the transfer destination and the medical staff to deal with change with the passage of time, it is possible to grasp the candidates for the transfer in real time. With the remote communication system 1 configured in this way, a safety net can be constructed, and safety and security can be provided to residents through regional medical cooperation.

<Example of deformation of the treatment target site>
Next, a modified example of the treatment target site will be described with reference to FIGS. 5 to 8. In the above-described embodiment, the case of TRI in which the lesion developed in the coronary artery is treated via the radial artery has been described as an example. However, the remote communication system 1 is not limited to this, and can be applied to repair by intervention of vascular access for hemodialysis (VAIVT: Vascular Access Interaction Therapy).

Hereinafter, VAIVT will be described in detail. VAIVT includes arterio-venous fistula (AVF) using an autologous blood vessel called a shunt and access using an artificial blood vessel (arterio-venous graft: AVG).

In particular, in AVF, arterial arteries and veins are artificially anastomosed, arterial blood is poured into superficial veins to cause arterialization of the veins, and the act of puncturing two puncture needles three times a week for hemodialysis. From the point of repetition, there is a risk of stenosis due to thickening of the meat membrane and scarring stenosis.

FIG. 5 is a diagram showing a state in which a stenotic portion N1 is formed immediately below the anastomotic portion in which the artery AR and the vein VE are anastomosed. FIG. 6 is a diagram showing a state in which an arterial AR and a vein VE are connected by an artificial blood vessel VG, and a stenotic portion N2 is formed downstream of the vein VE. FIG. 7 is a diagram showing a thrombotic obstruction A1. FIG. 8 is a diagram showing a non-thrombogenic obstruction A2.

There are a transvenous approach and a transarterial approach in the treatment method of such VAIVT. These treatment methods are similar to the PCI described above, and the catheter operating robot 21 described in the above-described embodiment can be applied.

Although the remote communication system 1 according to the present invention has been described above through the embodiments, the present invention is not limited to each of the described configurations, and can be appropriately changed based on the description of the scope of claims. is there.

For example, in the above-described embodiment, the private operating room 20 includes an automatic external defibrillator (AED) 22, a medical inquiry terminal 23, an acquisition unit 24, an injection unit 25, a CPR device 26, and X-ray imaging. It had the device 27, but it is not necessary to have all of them.

Further, in the above-described embodiment, the catheter operating robot has been described as an example as a medical device, but the present invention is not limited to this, and other medical devices can also be used.

Further, in the above-described embodiment, the private room type operating room 20 is installed in the clinic or adjacent to the clinic, but the present invention is not limited to this, and the private room type operating room 20 is inside or adjacent to the other medical facility 10. It may be installed to do so. Further, the private operating room 20 may be installed in the event venue or adjacent to the event venue. According to this configuration, even if a symptom occurs at the event venue, the time from the onset of the disease to the start of treatment can be shortened.

In addition, the private operating room 20 may be installed in a region where there is a shortage of medical staff. According to this configuration, the time from the onset of the disease to the start of treatment can be shortened even in regions where there is a shortage of medical staff. Further, the private operating room 20 may be provided in the medical facility 10 where the medical staff is enrolled, or in any means of transportation such as an automobile (including an ambulance), a train, a ship, an airplane, a large bus, and a spaceship. It may be provided in. According to this configuration, for example, in a private room type operating room 20 arranged inside a means of transportation such as an ambulance, thrombolytic treatment is performed during transportation, so that PCI treatment is promptly performed in the medical facility 10. Can be done and efficiency is improved.

Further, as shown in FIG. 9, the remote communication system may be provided with a plurality of private room type operating rooms 20 and medical facilities 10 (10A to 10C) (five private room type operating rooms 20 in FIG. 9). .. At this time, for example, one medical facility 10A may be the leader, and instructions may be given to the medical staffs enrolled in the other medical facilities 10B and 10C, and the operation step S10 may be performed in the private room type operating room 20. .. At this time, the private operating room 20 is arranged inside a means of transportation such as an ambulance, inside a clinic where PCI cannot be performed, inside one medical facility 10A, and the like. According to the remote communication system configured in this way, one medical facility 10A, which is a leader, can be systematically linked and operated as a core hospital. By doing so, it is possible to prevent the patient from turning around and to give calm instructions and respond even in an emergency. Further, in an emergency in the operation step S10, it is preferable to transport the patient to one medical facility 10 which is a leader.

In addition, when an abnormality in vital signs is detected by the wearable terminal, the signal is transmitted to the specific unit 312, and the specific unit 312 identifies an unused medical device among the medical devices and the signal is transmitted. It may be transmitted to the sorting unit 316, and the sorting unit 316 may sort the vacant medical facility 10. By doing so, the time from the onset of the disease to the start of treatment can be further shortened.

1 Remote communication system,
10 medical facilities,
20 private operating rooms,
21 Catheter operation robot (medical equipment),
22 Automatic External Defibrillator,
23 Questionnaire terminal,
24 Acquisition Department,
25 injection part,
26 CPR device,
27 X-ray contrast device,
30 computers,
40 Patient data server.

Claims (5)

Medical facilities with medical staff who can operate communication or make remote calls,
A private operating room equipped with medical equipment remotely controlled by the medical staff from the medical facility, and
A computer capable of communicating with the medical facility and the private operating room,
A remote communication system having a patient data server accessible from the computer. The remote communication system according to claim 1, wherein the computer has an operation unit for operating the medical device according to a command of the medical worker registered in the medical facility. The medical device is a catheter operating robot.
The private room type operating room
Automatic external defibrillator,
Questionnaire terminal that asks a prescribed question to a patient,
Acquisition unit that acquires biological information of the patient,
An injection unit that injects a solubilizer that dissolves the patient's thrombus,
The remote communication system according to claim 1 or 2, further comprising a CPR device including an automatic cardiac massager or a resuscitator, and an X-ray imaging device that irradiates X-rays. The remote communication system according to any one of claims 1 to 3, wherein the computer has a notification unit capable of notifying an emergency hospital or a family member in an emergency. A plurality of the medical facility and the private operating room are provided.
The remote communication system according to any one of claims 1 to 4, wherein the medical worker enrolled in the medical facility gives an instruction to the medical worker enrolled in another medical facility.

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