JP6014013B2 - Wireless medical data communication system and method - Google Patents

Wireless medical data communication system and method Download PDF

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JP6014013B2
JP6014013B2 JP2013252772A JP2013252772A JP6014013B2 JP 6014013 B2 JP6014013 B2 JP 6014013B2 JP 2013252772 A JP2013252772 A JP 2013252772A JP 2013252772 A JP2013252772 A JP 2013252772A JP 6014013 B2 JP6014013 B2 JP 6014013B2
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infusion
system
patient
central server
clinician
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JP2014112374A (en
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エル. シンプソン トーマス
エル. シンプソン トーマス
エム. レテリア ローラ
エム. レテリア ローラ
ピー. マルトゥッチ ジェイムス
ピー. マルトゥッチ ジェイムス
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バクスター・インターナショナル・インコーポレイテッドBaxter International Incorp0Rated
バクスター・インターナショナル・インコーポレイテッドBaxter International Incorp0Rated
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Priority to US44435003P priority Critical
Priority to US60/444,350 priority
Priority to US10/424,553 priority
Priority to US10/424,553 priority patent/US7698156B2/en
Priority to US48827303P priority
Priority to US60/488,273 priority
Priority to US10/659,760 priority
Priority to US10/659,760 priority patent/US8489427B2/en
Priority to US52810603P priority
Priority to US60/528,106 priority
Application filed by バクスター・インターナショナル・インコーポレイテッドBaxter International Incorp0Rated, バクスター・インターナショナル・インコーポレイテッドBaxter International Incorp0Rated filed Critical バクスター・インターナショナル・インコーポレイテッドBaxter International Incorp0Rated
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    • GPHYSICS
    • G06COMPUTING; CALCULATING; COUNTING
    • G06FELECTRIC DIGITAL DATA PROCESSING
    • G06F19/00Digital computing or data processing equipment or methods, specially adapted for specific applications
    • G06F19/30Medical informatics, i.e. computer-based analysis or dissemination of patient or disease data
    • G06F19/34Computer-assisted medical diagnosis or treatment, e.g. computerised prescription or delivery of medication or diets, computerised local control of medical devices, medical expert systems or telemedicine
    • G06F19/3418Telemedicine, e.g. remote diagnosis, remote control of instruments or remote monitoring of patient carried devices
    • GPHYSICS
    • G08SIGNALLING
    • G08BSIGNALLING OR CALLING SYSTEMS; ORDER TELEGRAPHS; ALARM SYSTEMS
    • G08B21/00Alarms responsive to a single specified undesired or abnormal operating condition and not elsewhere provided for
    • G08B21/02Alarms for ensuring the safety of persons
    • HELECTRICITY
    • H04ELECTRIC COMMUNICATION TECHNIQUE
    • H04LTRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
    • H04L1/00Arrangements for detecting or preventing errors in the information received
    • HELECTRICITY
    • H04ELECTRIC COMMUNICATION TECHNIQUE
    • H04LTRANSMISSION OF DIGITAL INFORMATION, e.g. TELEGRAPHIC COMMUNICATION
    • H04L29/00Arrangements, apparatus, circuits or systems, not covered by a single one of groups H04L1/00 - H04L27/00
    • H04L29/02Communication control; Communication processing

Description

(References)
This application is hereby incorporated by reference: US Patent Application No. 10 / 040,887 (filed January 7, 2002); US Patent Application No. 10 / 040,908 (filed January 7, 2002, publication number US) -2003-0130624-A1 (published on July 10, 2003)); U.S. Patent Application No. 10 / 059,929 (filed on January 29, 2002, publication number US-2003-0141981-A1 (July 2003) U.S. Patent Application No. 10 / 135,180 (filed April 30, 2002); U.S. Patent Application No. 10 / 424,553 (filed Apr. 28, 2003); No. 10 / 659,760 (filed Sep. 10, 2003); U.S. Patent Application No. 10 / 749,101 (filed Dec. 30, 2003); U.S. Patent Application No. 10 / 749,10 (Filed December 30, 2003); U.S. Patent Application No. 10 / 748,762 (filed Dec. 30, 2003); U.S. Patent Application No. 10 / 748,750 (filed Dec. 30, 2003) U.S. Patent Application No. 10 / 748,749 (filed December 30, 2003); U.S. Patent Application No. 10 / 749,099 (filed December 30, 2003); U.S. Patent Application No. 10 / 748,593 No. (filed on Dec. 30, 2003); U.S. Patent Application No. 10 / 748,589 (filed on Dec. 30, 2003); U.S. Provisional Patent Application No. 60 / 377,027 (filed on Apr. 30, 2002) U.S. Provisional Patent Application No. 60 / 376,625 (filed on Apr. 30, 2002); U.S. Provisional Patent Application No. 60 / 376,655 (filed on Apr. 30, 2002); U.S. Provisional Patent Application No. 6 No./444,350 (filed Feb. 1, 2003); US Provisional Patent Application No. 60 / 488,273 (filed Jul. 18, 2003); US Provisional Patent Application No. 60 / 528,106 (2003) Filed Dec. 8); and U.S. Pat. No. 5,842,841 expressly incorporated by reference and made a part hereof.

(Technical field)
The present invention generally relates to wireless medical data communication systems and methods. More particularly, the present invention relates to a system and method for reporting on the integrity of a wireless communication link.

(Background of the Invention)
A patient care system generally includes a computer network, medical equipment for treating a patient, and control over the medical equipment. Although patient care systems have been improved by utilizing computer-controlled automation systems and methods, patient care systems still rely heavily on manual data management processes for medical device and medical device control. For example, in modern hospitals, nursing stations are typically connected to a computer network, but it is not normal for a computer network to extend to a hospital room. The computer network provides an opportunity for automated data management processes including point-of-care medical device operation and monitoring and medical device control. Despite progress in this area, automatic data management techniques have not been fully utilized for point-of-care applications due to the lack of more efficient systems and methods. As the reliance on automated technology increases, the need to provide users with the ability to determine the operating state of a system or subsystem increases.

(Summary of Invention)
The present invention provides a system and method for reporting on the integrity of a wireless communication link within a medical facility.

  The present invention typically includes a system having a medication management module and a wireless remote device located within a medical facility. The medication management module is associated with a device for medication therapy such as an infusion pump. The wireless remote device includes a message display means, such as a visual display or audible alarm, which is transmitted over the wireless communication link in response to the status information output generated by the medication management module. The wireless remote device also includes a module or application that generates a timeout when the wireless communication link is lost.

  Other systems, methods, features, and advantages of the present invention will be or will be apparent to those skilled in the art upon consideration of the following drawings and detailed description. All such additional systems, methods, features and advantages contained herein are intended to be within the scope of the present invention and protected by the accompanying claims.

(Brief description of the drawings)
The invention can be better understood with reference to the following drawings. The components in the drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the present invention. In the drawings, like reference numerals designate corresponding parts throughout the several views.
1 is a schematic representation of a patient care system. The patient care system includes a pharmacy computer, a central system, and a digital assistant at the treatment location. FIG. 2 is a block diagram of a computer system representing the computer, central system, and / or digital assistant of the pharmacy of FIG. The system includes an infusion system or part thereof. 2 is a schematic representation of a portion of the patient care system of FIG. It is a block diagram which shows the functional element of the patient medical system of FIG. 2 is an exemplary computer screen for performing various functions of the patient care system of FIG. FIG. 3 is a block diagram showing functional elements of the injection system of FIG. 2. Functional elements include, among other things, blocks for infusion system parameter setting, infusion order creation, infusion order preparation, medication administration, infusion order modification, and messaging. It is a block diagram which shows the functional element for an injection | pouring system parameter setting of FIG. It is a block diagram which shows the functional element for injection | pouring order preparation of FIG. It is a block diagram which shows the functional element for the injection order preparation of FIG. It is a block diagram which shows the functional element for chemical | medical agent administration of FIG. FIG. 7 is a block diagram showing functional elements for injection order documentation, injection order modification, and messaging of FIG. 1 is a diagram of an emergency notification system showing communication. FIG. FIG. 4 is an emergency notification interface view from the notification party perspective showing preferred notification options provided to the notification party by the emergency notification system. FIG. 3 is an emergency notification interface view from the target party perspective showing preferred emergency information received by the target party. 6 is an embodiment of a flowchart of an alarm / alert escalation process. It is a figure of an alarm / alert interface screen. FIG. 10 is another diagram of an alarm / alert interface screen. FIG. 10 is another diagram of an alarm / alert interface screen. FIG. 6 is a diagram of an interface screen viewed from a clinician's handheld device. It is a figure of the interface screen of a login process. It is a figure of another interface screen of the login process of FIG. It is a figure of a department selection interface screen. It is a figure of a shift selection interface screen. It is a figure of a patient browsing interface screen. It is a figure of a patient selection interface screen. It is a figure of a patient information menu interface screen. It is a figure of an allergy / height / weight interface screen. It is a figure of a medicine history interface screen. It is a figure of a test result interface screen. It is a figure of a medicine delivery schedule interface screen. It is another figure of the interface screen of the medicine delivery schedule process of FIG . It is a figure of the interface screen of workflow injection | pouring stop. It is another figure of the interface screen of workflow injection | pouring stop. It is a figure of the interface screen of the workflow for restarting injection | pouring. It is a figure of the interface screen of the workflow for restarting injection | pouring . It is another figure of the interface screen of the medicine delivery schedule process of FIG. It is a figure of a medication failure interface screen. It is another figure of the interface screen of FIG. It is another figure of the interface screen of FIG. It is a figure of a schedule interface screen. It is a figure of a medicine interface screen. It is a figure of a scan interface screen. It is a figure of another scan interface screen. It is a figure of a medicine administration interface screen. It is a figure of a route confirmation interface screen. It is a figure of a pump channel scan interface screen. FIG. 12 is a diagram of another pump channel scan interface screen. It is a figure of a comparison interface screen. It is another figure of a comparison interface screen. It is another figure of a comparison interface screen. It is another figure of a comparison interface screen. It is another figure of a comparison interface screen. It is a figure of a pump status interface screen. It is a figure of a flow velocity history interface screen. It is a figure of a communication loss interface screen. It is a figure of a communication loss interface screen. It is a figure of a low battery interface screen. It is a figure of a hub. FIG. 6 is a diagram of various icons used on the interface screen. It is a figure of an implementation result recording interface screen. FIG. 3 is a medication order with a monitoring parameter link. It is a figure of the monitoring parameter input interface screen. It is a figure of a cycle count interface screen. It is a flowchart of an order comparison process. 1 is a schematic diagram of a flow control system with micro-electromechanical system (MEMS) elements connected to a line set. FIG. FIG. 4 is a schematic block diagram of software components loaded on the first central computer of FIG. 3. 3 is a flowchart of an exemplary injection implementation process. 3 is a flowchart of an exemplary injection implementation process. 3 is a flowchart of an exemplary injection implementation process. 3 is a flowchart of an exemplary channel scan process. 3 is a flowchart of an exemplary pump channel change process. 3 is a flowchart of an exemplary pump channel change process. 6 is a flowchart of another exemplary channel scan process. 6 is a flowchart of yet another exemplary channel scan process. 6 is a flowchart of an exemplary injection stop / stop process. 6 is a flowchart of an exemplary injection restart process. 3 is a flowchart of an exemplary pump removal process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process. 4 is a flowchart of an exemplary authentication process.

(Detailed explanation)
While the invention may be embodied in many different forms, preferred embodiments of the invention are shown in the drawings and are described in detail herein. This disclosure is to be regarded as illustrative of the principles of the invention and is not intended to limit the broad aspects of the invention to the illustrated embodiments.

  FIG. 1 is a diagrammatic representation of a patient care system. In one embodiment, the patient care system 100 includes a pharmacy computer 104, a central system 108, and a treatment location 106 linked by a network 102. As shown in FIG. 2, patient medical system 100 also includes an infusion system 210, also referred to as a medical system. The infusion system 210 is preferably a computer program, particularly a module or application (ie, a program or group of programs designed for the end user) that resides on one or more electronic computing devices in the patient care system 100. As a dosing system. As described in more detail herein, the infusion system 210 links clinicians such as doctors, pharmacists, and nurses in an interdisciplinary approach to patient care.

(General system)
Turning to FIG. 3, the patient medical system 100 can include a plurality of medical devices 120. In one embodiment, the medical device is an infusion pump 120. In yet another embodiment, the medical device is an infusion pump controller. For ease of reference, the present disclosure generally identifies the medical device of the system as an infusion pump, but the entire system 100 can incorporate any one or more of a variety of medical devices. Is understood. Accordingly, a plurality of infusion pumps 120 are connected to the hub or interface 107 as shown in FIG. As described in further detail herein, the infusion pumps 120 may be of a conventional design with each infusion pump 120 associated with a single patient. However, as will be appreciated by those skilled in the art, the infusion pump 120 shown in FIG. 3 need not be associated with the same patient or treatment location, even though the infusion pump is connected to the same hub 107. Further, each infusion pump 120 may be a single channel pump or a multichannel pump such as a three channel pump . In general, the pump periodically transmits a message containing pump status information to the hub 107. To centralize communication for cost effectiveness and / or to allow redesign of an existing medical device that is not currently in communication with the central computer system 108 so that each such medical device is connected to the central computer system 108 A separate hub 107 can be used away from the medical device 120 so that it can communicate.

(Communication hub for the entire system)
In one embodiment, the infusion pump 120 serial port or other I / O port is connected to the hub 107 using a conventional non-wireless transmission medium 105 such as twisted pair wire, coaxial cable, fiber optic cable, and the like. The hub 107 is preferably connectable to a plurality of infusion pumps 120 or only one pump via a one-way serial communication link 105. The hub 107 receives a signal from the connected pump and regenerates the received signal. Specifically, the received signal from the pump 120 is converted by the hub 107 into a format suitable for transmission to the system network 102 via the wireless communication path or wireless communication link 128 and the wired communication system 110. In general, the hub 107 transmits pump data to the system network 102. The hub 107 can also filter information received from the pump 120 to prevent duplicate messages. In addition, the hub 107 allows remote viewing of pump status information on the digital assistant 118 of the clinician 116. In general, hub 107 transmits pump data whenever hub 107 is connected to pump 120 and both hub 107 and pump 120 are powered. As will be described in detail herein, the hub 107 also allows a comparison with the pharmacy input order pump setpoint. In a preferred embodiment, the hub 107 is connected to an infusion pole that supports the pump 120, or the hub 107 is incorporated within the infusion pump 120 to create the integrated medical / communication device identified above. .

  One embodiment of the hub 107 is shown in FIG. In this embodiment, the hub 107 includes a pump port indicator 411 for up to four pumps, a radio signal loss indicator 413, a low battery indicator 415, an alert mute key 417, an on / off key indicator 419, and a charging indicator 421. The pump port indicator 411 is a status indicator for each of the pump ports of the hub 107. The indicator light indicates that the corresponding pump port is successfully communicating with the network 102. However, if the indicator light is not lit, this indicates that the corresponding pump port is not connected to the pump 120 or that the port is not communicating from the pump 120 to the network 102. The wireless signal loss indicator 413 indicates that the hub 107 cannot communicate with the network 102 over the wireless link. When a radio signal loss occurs, each of the pump port indicators 411 will also turn off, indicating that the hub 107 is not communicating with the network 102. If a radio signal loss occurs, the hub 107 will communicate this event to the system network 102 and the central computer system 108 and the server 109 and ultimately to the clinician 116. Alert mute key 417 allows clinician 116 to temporarily mute all audible alerts from hub 107. Alternative embodiments of the communication hub include a single dedicated wireless module physically within the pump or a separate module for reaching both the pump and server using wireless communication.

  Further, in alternative embodiments, the hub 107 can optionally be incorporated within the infusion pump 120 to create an integrated medical / communication device. The combined hub / medical device will continue to function in exactly the same way relative to each other.

(System-wide access point)
As shown in FIG. 3, the plurality of access points 114 in the medical facility serve as an interface between the wireless communication path and the wired communication system. Preferably, if system network 102 is not available, hub 107 stores the signal received from pump 120 and then transmits the converted signal to system network 102 once the system network is available. In the preferred embodiment, communication between the hub 107 and the access point 114 is unidirectional from the hub 107 to the access point 114 and ultimately the network 102. Therefore, in this embodiment, the infusion pump 120 can transmit data to the network 102, but the network 102 cannot transmit data to the infusion pump 120. However, it will be appreciated that in an alternative embodiment, also disclosed herein, communication between hub 107 and access point 114 is bi-directional. Thus, in these embodiments, data and other information can be transmitted from the network 102 to the infusion pump 120. In any case, information transmitted between the network 102 and the hub 107 is encoded for security.

(Central system server / Computer of the entire system)
With reference now to FIGS. 1 and 3, the central system 108 may include one or more servers or computers. Although the present disclosure generally refers to the servers 109, 108a, it will be appreciated that these components may be non-server computers. Although not necessarily so, the central system 108 can preferably include a first central server or central computer 109 and a second central server or central computer 108a. In one embodiment, a separate communication system 103 can be provided for communication between the first central server 109 and the second central server 108a. In a preferred embodiment, the separate communication system 103 is an isolated point-to-point wired communication Ethernet network. Since the communication system 103 is an isolated point-to-point system connection, data communicated between the two servers 109 and 108a is usually not encrypted. Usually, the communication system between the two servers 109 and 108a enables two-way communication.

  As will be described in detail herein, the first central server or computer 109 is a first database and a first set of functional features associated with medical devices and data and functions associated with the user interface. Have The medical device 120 and user interface 118 typically communicate directly with the first central computer 109. Further, as described in detail herein, the second central server or central computer 108a has a second database and a second set of functional features. The first central computer 109 is cryptographically connected to the second computer 108a, and the medical device 120 and the user interface 118 do not communicate directly with the second central computer 108a. The user interface 118 may receive data from the second database associated with the second set of functional features of the second central computer 108a via the first central computer 109.

  The second central server 108a and its software subsystem typically interface with pharmacy systems to provide information about drugs, patients, and provide standard workflows for nurses and other clinicians. The second central server 108a also interfaces with the first central server 109 to provide information regarding patients, nurses, clinicians, orders, and associations between the digital assistant 118 and the clinician. Some of the other functions of the second central server 108a may include patient management, item management, facility management, messaging, reporting / graphing, and various interfaces to other systems.

  Specifically, patient management refers to general information about each patient who enters a hospital or facility. This information is kept with information specific to each visit and typically includes demographic data, allergies, hospitalization dates, discharge dates, initial diagnosis, hospital rooms, beds, etc. In addition, information about each of the prescription, plan, and administered medication is maintained by the second central server 108a. Functionality of patient management functions includes pre-rejection tests, drug interaction tests, duplicate treatment tests, dose tests and drug / disease contraindications.

  Item management refers to information about each drug available in the facility. This information is managed and maintained in the second central server 108a. Such information includes the name, strength, drug efficacy classification, manufacturer, etc. of the drug. In addition, the second central server 108a maintains a continuous inventory of drug inventory and other smart warehouse item content in real time. The second central server 108a assists in updating when the warehouse is refilled and when doses are dispensed or disposed of.

  Facility management refers to the information described for the entire facility. This information is managed and maintained in the second central server 108a of the system 210. This information includes physical collapse into the building, floor, department, room and bed of the facility, list of programs and services provided and the storage department where the drugs and supplies are stored and Includes identification of where they are intended to be delivered.

  The messaging refers to the function of the second central server 108a that provides a communication link between the pharmacist and the clinician. The second central server 108a enables standardization of doses and special dosing instructions and automatically sends a dose deficiency notification. Reporting and graphing refers to the effectiveness of several business reports and management reports that can be executed on demand or in a planned manner by authorized users of the system 210.

  The second central server 108a also has various interfaces such as an ADT interface, billing interface, individual results interface, document results interface, prescription collection interface, pharmacy order interface, point-of-care medication management interface and inventory interface. . These interfaces will be described in more detail later, but a brief description will be given immediately below. The ADT interface refers to facility admission, transfer, discharge system (ADT). This system typically also operates prior admission permits and outpatient registration. The individual result interface refers to the interface with the test result. Typically, test results and accompanying orders are entered into an external test information system, and an individual results interface or laboratory interface within the HL7 engine transfers this data to the second central server 108a. Once the test results are stored in the second central server 108a, the user views them from the handheld device 118, the computerized physician order entry (CPOE) system, and the main application of the second central computer 108a. be able to. Laboratory interfaces are available for at least four interfaces: a radiology laboratory interface, a microbiology laboratory interface, a biochemical laboratory interface, and a pathology laboratory interface. These interfaces can be configured to operate on four different ports or on the same port. The document result interface typically receives a radiology report and a pathology report with reference to the second central server 108a. The prescription collection interface can typically refer to the second central server 108a to receive notification of the master file and synchronize the drug file of the external system. The change in the prescription book will trigger a transmission transaction from the server 108a to the external third party system. The pharmacy order interface allows the medication order to be sent to an external third party system. The inventory interface accepts pharmacy inventory fluctuations from an external third party system. In addition, a cart dump interface can be used with the system 100. The second central server 108a stores the order and drug file changes in the server database and then sends this information to any third party cart interface. The third party cart interface in the HL7 engine processes this information into HL7MFN and RDE messages. The MFN message includes drug file information, and the RDE includes patient order information. The HL7 engine then transmits these messages to the third party cart server. The HL7 engine also receives HL7 formatted DFT messages from third party cart servers. The DFT message includes billing information for drug administration. The HL7 engine processes this information and then sends it to the second central server 108a, which can then pass this information to the billing application. The billing application can then calculate the patient burden and send the billing statement to the patient. The billing interface refers to the interface with the patient burden software. The invoicing interface corresponds to the optional use of an invoicing algorithm for calculating the burden amount. The invoicing interface processes not only external inbound transactions from third party systems, but also internal transactions. The billing interface is the HL7 interface between the second central server 108a and the hospital's third party financial system. The amount charged can be sent directly or the patient contribution can be calculated at the billing interface and sent to the hospital's third party financial system. Information is transmitted in real time via HL7 messages. The point of care interface consists of web service communications that integrate information about point of care medication management with non-infusion related data. These data are communicated in real time so that the user interface can integrate medication management for infusion related and non-infusion related medications.

  Conversely, the first central server 109 has software loaded and configured to travel to and from the hubs 107, digital assistants or user interfaces 118, and send and receive data with the second central server 108a. . As will be described in detail below, the first central server 109 includes, but is not limited to, the ability to compare the prescription parameters received from the server 108a with the corresponding programmed pump settings received from the hub 107 system, A function for relaying notifications and messages to the digital assistant 118, a function for relaying alarm information and alert information received from the hub 107 system to the appropriate digital assistant 118, and a suitable digital assistant for pharmacy information and patient information communicated from the server 108a. Several functions can be performed, including the function of relaying to 118 and the function of aggregating pump status data and alarm monitoring data and periodically relaying this data to server 108a. If requested, the work performed by the server 109 conforms to the 1996 (August 21) law on portability of medical insurance, public law 104-191. Typically, the data residing on the first central computer or server 109 is the intersection with the data residing on the second central computer or server 108a. Server 109 includes a subset of the data contained within server 108a that is required to perform its functionality. Server 109 also includes data related to system network 102, hub 107 and infusion pump 120 that is required to perform its functionality. As explained above, such data is typically data required for the function or performance of the digital assistant 118 and the medical device 120.

  In one embodiment, cost-effective integration of the medical device 120 or other device and functionality with the hospital information system at the first and second central computers 109, 108a may include the above-described totals such as patient safety related information. This results from separating a subset of the data and placing such information and functionality in the validated / validated part of the system. In this situation, in the context of FDA regulations, verified means providing objective evidence that all requirements have been tested, and validated means that the product meets customer needs. This means providing objective evidence. In this embodiment, the validated part of the system is located in the first central computer 109. In one embodiment, the subset may include alarms and / or alerts generated by the infusion pump and / or programming information or operating parameter information of the medical device 120 / infusion pump 120 / controller 120. This subset is separated and placed in the validated part of the system in the first central computer 109, and the rest of the total data is the validity of the system in the second central computer 108a. Is stored in the unidentified part of the database. A validated database located at the first central computer 109 and an unvalidated database located at the second central computer 108a will be well understood by those skilled in the art from the details described below. And synchronized using web service replication. An alternative embodiment is the functionality separated by both validated and unvalidated parts of the system residing on one computer and software firewall (eg, operating system mechanism or other OTS software). Can be included. As described below, “synchronization” is performed periodically based on time intervals, other predetermined times, and / or as needed when important data changes such as patient registration status are made. be able to. In the meantime, a fresh new copy of the replicated data is sent to the other central computer, and the validated first central computer 109 replaces the local copy with the new copy. If the critical information changes, the change is immediately propagated to the validated first central computer 109 and treated as a change, not a replacement of the existing information. Thus, as will be appreciated from the details described herein, some or all of the subsets located in the database of the first central computer 109 are also present in the second central computer 108a. This process is better understood with reference to the details described below. Thus, by localizing a subset of the database, such as patient safety related data, at the first central computer, at least the cost of system development is further optimized and a third party unvalidated system and The time and cost effectiveness of integration with each data and information in the system is improved.

  In one embodiment, the first central computer 109 is a validated server, server, such as a Compaq DLG-380 having a Windows 2003 server OS that runs an active directory for user and device authentication. A certificate authority for issuing certificates and client certificates, an SQL server 2000 for temporary data storage, and an Internet information server (IIS) for application hosting (web services and web pages) can be provided. The second central computer 108a has external hospital information connected via a dedicated Ethernet TCP / IP connection 103 that accesses a data replication web service published by a validated server at the other end of the dedicated connection. A non-validated server such as a system (HIS) server can be provided. Alternatively, the second central computer 108a comprises software that performs one or more of the various functions generally described herein, such as pharmacy systems and other systems. Can do. Thus, the second central computer can provide these types of functions and can have an interface with other systems, such as an external hospital information system (HIS) server. The first central computer (ie, server 109) includes a database that includes a data storage package, ie, a first database. In one embodiment, the first database may be external or internal to the first central computer 109, but as shown in FIG. 54, a user of an application 5412 loaded on the first central computer. Is preferably accessible only to. The data table in the first database is used in the use cases described further herein. The data tables preferably include tables relating to medical devices, digital assistants, hubs, patients, clinicians, prescriptions, titrations, comparison information, alarms, and escalations. Further, the medical device table can include tables associated with pumps, pump channels, and pump subchannels. The alarm table may include a table related to a hub alarm, a pump alarm, a channel alarm, an alarm history log, and the like.

  In one embodiment, each table can include a key, and the data in the table is responsive to the key. For example, a key to a table relating to the pump channel information log can prove the identity of the pump channel log, and in response to the key, channel identification, pump speed, dosing method, dose, remaining amount. Table data relating to the primary injection amount and the like is provided. In addition, the tables can be linked. For example, a patient table with patient information can be linked to a clinician table, and the clinician table can be linked to a digital assistant table.

  The patient care system 100 of FIG. 3 includes a hub subsystem, a first central computer subsystem or a first central server subsystem, a medical equipment subsystem or pump subsystem, a second central computer subsystem, or a second central It can be divided into a server subsystem and a personal digital assistant (PDA) subsystem. The hub subsystem and the first central computer subsystem are discussed in further detail herein. With respect to the medical device subsystem, this subsystem includes one or more medical devices 120, such as infusion devices that enable delivery of medication to the patient, with status and infusion information for each infusion device being It is preferably transmitted periodically from a communication port associated with the device.

  Typically, the second central computer subsystem is a server 108a having computer hardware and computer software for interfacing with pharmacy systems and providing information about drugs, patients and standard nurse workflows. Server 108a may also have various other applications discussed earlier herein, such as an interface to a hospital information system (HIS). The second central computer interfaces with the first central computer subsystem, and the first central computer has information regarding the patient, nurse, order, and personal digital assistant and the relationship between the nurse or clinician. Is preferably provided.

  In one embodiment, the central computer has at least two environments, a validated environment and a non-validated environment. The validated environment can have a first operating system with a set of applications and a first database. The first database may have a first set of functional features associated with specific data therein. In one embodiment, this set of functional features includes functions associated with the medical device and the user interface for the medical device. The medical device and user interface communicate directly and securely with a validated environment. The non-validated environment has a second operating system with a set of applications and a second database. The second database can have a second set of functional features associated with specific data therein. There is usually a logical separation between a validated environment and a non-validated environment. The user interface may receive data from the non-validated portion of the database associated with the second functional feature via the validation portion of the system. In one embodiment, the validation portion is separated from the non-validation portion by a logical separation or firewall that can be implemented in software. Various software such as VMware and Virtual PC are examples of emulation software that emulates multiple environments on the same server. In another embodiment, the validation portion can be placed on the first central computer 109 and the non-validation portion can be placed on the second central computer 108a. In another embodiment, the central computer comprises a first server and a second separate server. The first and second servers are separated by a firewall, the central validation portion of the central computer resides in the first server, and the second non-validation portion of the central computer is the second Resident on other servers.

  Preferably, as described in detail elsewhere herein, the personal digital assistant subsystem includes an infusion that includes the relay of their patients, alarm information, and alert information to the clinician and nurse 116 (FIG. 1). And one or more small portable devices 118 that provide remote information regarding the status of the injection and the result of the infusion comparison. As discussed herein, the first central computer is operatively connected to one or more personal digital assistants 118 in the PDA subsystem. In one embodiment, the personal digital assistant is a WINDOWS® CE. Based on NET, it is used as a terminal device for clinicians. Specifically, as described in more detail herein, a personal digital assistant may be operably connected to a first central computer via an encrypted PKI authenticated wireless LAN (802.1x) connection. it can.

  The hub subsystem receives data from the medical device 120, transmits pump data to the first central computer subsystem 109, and detects conditions that can achieve data communication with one or more hubs. Preferably, one or more components such as hub 107 are included.

  As previously noted, in one embodiment, the hub 107 in the hub subsystem interfaces with up to four infusion devices 120 via a one-way serial communication link 105, and the infusion devices can provide pump status information. A message (i.e., a packet of data) including is periodically transmitted to the hub. Alternatively, the packets may be transmitted based on user-defined criteria such as regular time intervals, event occurrences, combinations of intervals and event occurrences, and so on.

  Each hub 107 in the hub subsystem filters the received information to reject duplicate messages and stores the received information, and in one embodiment, using a built-in wireless network transceiver, Transfer to one central computer subsystem. In one embodiment, the pump information is not transferred unless the data received from the medical device has been changed.

  A transceiver embedded in the hub 107 routes outgoing information to the wireless access point 114, which then uses the wired Ethernet subsystem 110 to route the outgoing information to the first central computer. Route to 109. This outgoing information preferably includes XML encoded data formatted as a SOAP message specially designed to be received by a web service type software interface.

  As will be appreciated by those skilled in the art, the term “XML” refers to a system for organizing and tagging the elements of a web document, and for XML, it generates custom tags, between applications and between systems or It can allow definition, transmission, validation and interpretation of data between subsystems. Further, as used herein, the term “web service” refers to integrating SOAP with web-based services using XML, and the term “SOAP” refers to web service request and response messages. Refers to a messaging protocol used to encode information before sending them over a network or channel.

  The first central computer subsystem is loaded and configured to send and receive data to and from the second central computer subsystem comprising a plurality of hubs 107, a plurality of digital assistants 118, and a server 108a. Preferably, the server 109 has a software application.

Turning to FIG. 54, this will be described. The server 109 is preferably a COMPAQ DLG-380 having a MICROSOFT WINDOWS® 2003 server operating system 5414. In one embodiment, the software components loaded into the storage device of the first central computer 109 are. A first central computer or server application 5412 in the NET Framework 5416, an Active Directory Domain Service 5418 for user and device authentication, a temporary data storage SQL server 5420 (shown as a database), and an Internet Information Server II for application hosting 5422 including. . NET Framework 5416 is a Microsoft. Preferably NET Framework 1.1 or above; NET Framework connects the first central computer application 5412 to the operating system, Internet Information Server 5422, SQL database 5420, and Active Directory Domain Service 5418 component. As will be appreciated by those skilled in the art, the Active Directory Domain Service 5418 provides a service utilized by the Windows® server operating system 5414 and the first central computer application 5412 to provide a genuine and authorized hub subsystem. , To help ensure that only users of the second central computer subsystem and the personal digital assistant subsystem can access the first central computer and thus the application 5412 of the first central computer.

  In one embodiment, the first central computer (ie, server 109 of FIG. 3) is: 1) the appropriate programmed pump settings received from the hub subsystem of the prescription parameters received from the second central computer subsystem. And / or comparison with the pump program, 2) relaying alarm information and alert information received from the hub subsystem to the appropriate personal digital assistant 118 (FIG. 3), 3) appropriate personal digital assistant Providing historical information on pump status and flow rate to 118, 4) relaying pharmacy information and patient information communicated from the second central computer 108a (FIG. 3) to the appropriate personal digital assistant 118, and 5 ) Compilation of pump monitoring data and alarm monitoring data and second It performs several functions including regular relay this data to a central computer 108a.

  The first central computer preferably includes a plurality of external software component interfaces. In one embodiment, three of these interfaces can be classified as “receiving interfaces” that receive incoming HTTP request messages and then issue outgoing HTTP response messages. The remaining two interfaces can be classified as “outgoing interfaces” that send HTTP request messages or XML formatted response messages, as described below. The five software interfaces used in this specification are referred to as a DatabaseRefreshListener reception interface and a Database RefreshListener transmission interface, a Route PDA reception interface and a Route PDA transmission interface, and a PumpDataListener reception interface.

  In one embodiment, four of the external software component interfaces are divided into two pairs, with two distinct bidirectionals between the first central computer 109 and the second central computer 108a of FIG. Create a communication channel. The first channel includes both a DatabaseRefreshListener receive interface and a Database RefreshListener send interface that are paired together. Accordingly, in this specification, the first channel is referred to as “Database RefreshListener” and is utilized by the second central computer 108a, and the data in its database table is located in the database table of the first central computer. Periodically synchronized with the data.

  Using the DatabaseRefreshListener channel, the second central computer 108a sends the XML encoded data formatted as a SOAP message to the web service type interface of the first central computer, whereby the database table of the first central computer Update. Similarly, the second central computer 108a updates its database table by sending an XML encoding request for data to the web service type interface of the first central computer, and then the interface One central computer 109 is made to respond with XML encoded data.

  As described above, the receive interface portion of the Database RefreshRefreshListener channel is utilized by the second central computer to update the database table located in the first central computer with data from the database table of the second central computer. Is done. In addition, the outgoing portion of the DatabaseRefreshListener channel is utilized by the second central computer for updating its own database with data from the database table of the first central computer.

  The DatabaseRefreshListener receive interface preferably includes several web service methods named “RefreshXXX” that correspond to the type of data to which “XXX” is transferred. In one embodiment, these methods receive a received HTTP request message that includes XML encoded data formatted according to the SOAP protocol. The XML encoded data has a structure in a format corresponding to a row in the database table. For example, the method “RefreshUsers” receives a data structure composed of a paired user name and user password corresponding to a row in a database table including a user name field and a user password field.

  As shown in FIG. 54, the received message includes Internet Information Server and. It is routed through the NET Framework component to the application 5412 loaded on the first central computer (ie, server 109 of FIG. 3). The first central computer application 5412 utilizes the Active Directory Domain Service 5418 to verify that the second central computer message is authentic, process the content, and then use the resulting data as SQL. Store in server database component 5420.

  The application 5412 loaded on the first central computer then. It responds to the second central computer by issuing an HTTP response method that is routed to the second central computer via the NET Framework component 5416 and the internet information server component 5422. This response message indicates the success or failure of the data transfer and processing.

  The DatabaseRefreshListener receive interface is asynchronous in nature, and therefore it is preferable to isolate the second central computer from the first central computer as much as possible. This separation allows the second central computer to be programmed to process data continuously while waiting for a response and to respond to communication loss under program control. Further, the DatabaseRefreshListener receive interface can also include a web method that is utilized by the second central computer to periodically send a signal to the first central computer that the second central computer is functioning. .

  In contrast to the DatabaseRefreshListener receive interface, the DatabaseRefreshListener outbound interface is utilized by the second central computer to update its own database with data from the database table of the first central computer. In order to ensure that data has been captured by the second central computer before it is permanently removed from the first central computer, the DatabaseRefreshListener outgoing interface uses the following multi-step approach for data transfer: . 1) The second central computer checks the availability of the data 2) The second central computer requires the first central computer to send data 3) The second central computer 4) The second central computer confirms that the data has been successfully stored in the database table.

  In order to check the availability of data, the second central computer first transmits that the corresponding web method of the DatabaseRefreshListener outgoing interface is an XML encoding request message formatted according to the SOAP protocol. The particular web method used preferably has the format “BeginGetXXXToArchive”, which corresponds to the type of data for which “XXX” is required. For example, the method “BeginGetChannelDataToArchive” requests the availability of a time-stamped pump channel record received from a pump by a first central computer via a hub subsystem.

  The request message includes an Internet Information Server component 5422 and. Passed through the NET Framework component 5416 to the application loaded in the first central computer. The application 5412 loaded in the first central computer decrypts the XML contained in the request message to determine what data is requested by the second central computer.

  An application 5412 loaded in the first central computer checks the availability of the requested data in the SQL server database 5420. If the data is available, the application prepares an XML encoded response message indicating that the data is available. If the data cannot be obtained, the application 5412 prepares an XML encoded response message indicating that the data is not available.

  If the data is not available, the second central computer can retry or continue with a different transfer method that conforms to its processing rules.

  If the data is available, the second central computer initiates the data transfer by sending a second XML encoding request message to the corresponding web method of the DatabaseRefreshListener outgoing interface. The particular web method used preferably has the form “EndGetXXXToAcactive”, where “XXX” is the same as used above.

  The application 5412 in the first central computer decrypts the XML contained in the request message to determine what data should be returned to the second central computer, and the data is received by the corresponding receiving interface. Place in an appropriate XML encoded response message configured in a format corresponding to the row in the database table that is compatible with the technique used.

  In one embodiment, the data is. Routed to the second central computer via the NET Framework component 5416 and the Internet Information Server component 5422. If the data is not received correctly, the second central computer can retry or continue with a different transfer method that conforms to its processing rules.

  If the data is received correctly, the second central computer then sends a third request message to the corresponding web method of this interface. The particular web method used preferably has the form “BeginDeleteArchivedXXX” where “XXX” is the same as used above.

  Upon receipt of this message, the application 5412 loaded in the first central computer marks the relevant data in the SQL Server database component as to be sent to the second central computer for archiving, Issue a response message notifying you that the data has been marked.

  In order to signal the success or failure of data storage in the second central computer database, the second central computer sends a fourth request message to the corresponding web method of this interface. The particular web method used has the form “EndDeleteArchivedXXX”, which is the same as “XXX” used above.

  If the second central computer indicates that the transfer was unsuccessful or sufficient time has passed, the first central computer determines that a loss of communication has occurred and then the second central computer. The relevant data is kept in the database of the first central computer in preparation for further transfers required by.

  If the second central computer indicates that the transfer was successful, then the archived data is erased from the first central computer database and the application 5412 loaded into the first central computer is A response message is issued confirming completion of the final stage of this transfer.

  The DatabaseRefreshListener outgoing interface is inherently asynchronous, and therefore preferably separates the second central computer database from the first central computer as much as possible.

  The second bi-directional channel between the first central computer 109 and the second central computer 108a, referred to herein as "Route PDA", is both a pair of Route PDA receive and Route PDA outbound interfaces including. The Route PDA channel is used by the first central computer 109 to route an HTTP request message originating from the PDA subsystem to the second central computer 108a, and then receive a corresponding HTTP response message from the second central computer. Process if applicable, then route back to the originating personal digital assistant 118.

  In the second channel (ie, Route PDA), messages received from or transmitted to the personal digital assistant 118 are sent to the hospital or medical facility's wired Ethernet system 110, wireless access point 114, each personal It is preferably transmitted back and forth through the first central computer 109 via a wireless transceiver incorporated in the digital assistant 118.

  The HTTP request message is preferably forwarded to the second central computer 108a without being processed through the first central computer 109. Next, the second central computer 108a issues an HTTP response message including information in XML format or information in HTML format. The response message in HTML format is routed through the first central computer 109 to the personal digital assistant 118 without further processing.

  The response message in XML format sends a signal to the first central computer 109 that the user 116 (FIG. 1) has requested a web page generated by the first central computer 109, such as a prescription comparison result page or a pump monitoring page. To be used by the second central computer 108a. The first central computer 109 examines the XML response, processes it appropriately, and issues a response message in HTML format or a response message in XML format to the sending personal digital assistant 118.

  As described above, the Route PDA channel routes the HTTP request message received from the PDA 118 to the second central computer, and then receives the corresponding HTTP response returned by the second central computer, and processes if applicable. And then used by the first central computer to route back to the sending PDA.

  Thus, the Route PDA receiving interface is used to communicate with a web browser located within the PDA 118. The interface receives an incoming HTTP request message that includes data encoded as a name-value pair consistent with the HTTP “GET” protocol and the HTTP “POST” protocol. The incoming message includes the Internet Information Server and. Routed via the NET Framework component to the application 5412 loaded on the first central computer. The application 5412 loaded on the first central computer, as discussed below,. The incoming message is routed to the second central computer using the NET Framework 5416 and the Route PDA outgoing interface.

  When an HTTP response is received at the Route PDA outgoing interface, the application 5412 loaded on the first central computer determines whether the response is in HTML or XML format. The HTML response is processed further by the first central computer without further processing. It is routed to the PDA via the NET Framework component 5416 and the Internet Information Server component 5422.

  However, the XML formatted response is sent to the second central computer in order to send a signal to the first central computer that the user has requested a web page generated by the first central computer, such as a prescription comparison result page or a pump monitoring page. Used by the central computer 108a. The first central computer examines the XML response from the second central computer and processes it appropriately. Issue a response in HTML or XML format to the appropriate PDA via the NET Framework and Internet Information Server components. The Route PDA interface is preferably synchronous in nature due to the inherent synchronous behavior of the web browser contained within the PDA.

  In contrast to the Route PDA receive interface, the Route PDA outbound interface is an HTTP request message received from the personal digital assistant subsystem by the application 5412 loaded on the first central computer to the second central computer for processing. Used to route and then receive the corresponding HTTP response sent by the second central computer as a reply.

  In both the DatabaseRefreshListener channel and the Route PDA channel, the first central computer 109 sends and receives information from the second central computer 108a, preferably through an isolated point-to-point Ethernet subsystem 103 dedicated to this purpose.

  As described above, in using the Database Refresh Refresher channel, the first central computer publishes a dedicated web service on the dedicated link 103, and the dedicated web service is used by the second central computer and newly updated. Database information (such as patient information, clinician information, pharmacy information, etc.) is replicated to the first central computer periodically and as needed. Data is also provided from the second central computer to the first central computer.

  Further, in utilizing the Route PDA channel at the clinician's terminal end, the first central computer 109 provides an HTTP-style web page and maintains an authenticated web session with the PDA device 118. Publish Server interface. In other words, the clinician's terminal device (ie, personal digital assistant 118) receives the authenticated web page from the first central computer 109.

  At the first central computer side end of the dedicated connection 103 to the second central computer, the first central computer sets up a virtual HTTP session for each PDA device 118 connected to the first central computer, and It relays HTTP requests from the PDA as it is being received by one central computer and mimics a web browser for the second central computer. In other words, the first central computer relays requests that require unvalidation to the second central computer through a dedicated connection 103 to the second central computer.

  Therefore, when the information flows between the PDA 118 and the server system, there is a need for information or combination information transmitted from the second central computer side, and the second central computer transmits the XML SOAP packet to the second central computer. The first central computer notifies the web service published on the dedicated link 103 by the first central computer, and the first central computer uses the XML data to perform a combination operation with information transmitted from the first central computer side of the system. And convert the obtained result to HTML, which is then sent back to the clinician's PDA device 118.

  A fifth external software component interface, called PumpDataListener, is a receiving interface for communication with the hub subsystem, described in more detail herein. In one embodiment, the PumpDataListener interface does not have a corresponding outgoing interface because the transfer of pump data is only one-way except for communication verification. However, in an alternative embodiment, an outgoing interface can be provided for the transfer of pump commands and control data to the medical device 120.

  The PumpDataListener receive interface is used for receiving data from the hub subsystem. This interface preferably includes a single web service method called “SendPumpData”. This method receives an incoming HTTP request message containing XML encoded data formatted according to the SOAP protocol. The XML encoded data is organized in a hierarchical form so that data from several pumps and several channels at several different times can be combined into a single large message structure. The

  The incoming message includes the Internet Information Server and. It is routed through the NET Framework component to the application 5412 loaded in the first central computer application. The first central computer application uses the Active Directory Domain Service component to verify that the message of the hub subsystem is authentic. The first central computer then processes the content and stores the resulting data in an SQL Server Database component. Finally, the first central computer application is. An HTTP response message is issued to the transmission-side hub device via the NET Framework and the Internet Information Server component. This response message indicated the success or failure of the data transfer and processing.

  Data packets received from the hub 107 by the first central computer (ie, server 109) are preferably stored in the first central database of the first central computer. Preferably, if an alarm event or alert event is included in the packet, the first central computer may immediately distribute the event to the appropriate clinician via the clinician's digital assistant 118. Well, or alternatively, the first central computer enters the event into the first central computer database and distributes the information later when requested by the appropriate clinician through its digital assistant. May be. As previously mentioned, the first central computer 109 maintains a log of all clinicians who have logged on to their digital assistant 118 that are authenticated each time the clinician logs on to the system.

  The PumpDataListener receive interface is asynchronous in nature and therefore preferably separates the hub subsystem from the first central computer subsystem as much as possible. Separation allows the hub 107 in the hub subsystem to be programmed to process data continuously while waiting for a response and to respond to communication loss under program control. Nevertheless, PumpDataListener maintains a “heartbeat” and monitors the continuity (lack) of communication between all wireless modules and / or remote pump devices and the central computer.

(Communication with clinician handheld device)
As described in more detail herein, pump status, alerts, alarms, patient information, chart information, comparison information, a list of things to do and other data / information may be displayed on display 118a as well as desired. For example, it is provided to the clinician via a personal digital assistant or user interface 118 having an audible sound generator or sound generator (not shown). The digital assistant 118 communicates with the central system 102 via the central network 102, specifically the wireless communication path or link 126 and the wired communication system 110. As mentioned above, one or more wireless access points 114 provide an interface between the wireless communication path and the wired communication system in a conventional manner. The digital assistant 118 can receive messages from both servers 109 and 108a.

  Communication between the central system 108 and the digital assistant 118 is preferably bi-directional. In addition, the digital assistant 118 has sufficient memory to store and execute a module or application (not shown) for testing the integrity of the communication link between the digital assistant and the central system 108 or the wireless access point 114. As well as including processing power.

  Although not necessarily so, modules or applications installed on the digital assistant 118 can be run at a high level, such as JAVA, that can be run with or without clinician intervention. Scripts or other computer instructions (ie, software code) written in any programming language. The script can be automatically downloaded from the server 108a or 109 to the digital assistant 118 or the medical device 120 as a receiving function of the present system. In one example, one type of script that can be automatically downloaded from a server to a digital assistant periodically polls or monitors communications, including notifications and messaging, from the central system 108 or access point 114. Is a script that tests the integrity of the communication link. In the preferred embodiment, a script running on the digital assistant polls the system 108 approximately every 3 seconds. If a response from the central system 108 or access point 114 is not received, a module or application installed on the digital assistant 118 generates a timeout, indicating that communication with the central system 108 is lost due to the timeout. An audible sound and / or notification to display device 118a is provided. The notification on the display device 118a can be, for example, activation of an information pop-up window telling that the communication link is lost, or changing the active icon display on the display device 118a. As used herein and understood by those skilled in the art, a timeout is an output generated by a module or application that indicates that the module or application waited for some time but did not receive it. It is. Another type of script can be polled to determine if an alarm or alert has been triggered. Many other scripts can be run simultaneously. One advantage of executing a script downloaded from the system to a digital assistant is that there is no need to introduce custom code on each digital assistant 118. If there is any event (ie, message, notification, alarm, alert, etc.), the digital assistant 118 automatically retrieves the event from the server and displays it on the digital assistant 118 interface screen. Other additional advantages of this scripting approach are: 1) Script code can be easily updated at the central server without requiring each digital assistant to update 2) Functionality is hardware dependent And therefore the script can be validated / validated relatively independently of the hardware platform of the digital assistant because the changes or upgrades to the digital assistant have a negligible impact on the script's behavior. Is a point.

  As previously mentioned, each clinician preferably has an associated digital assistant 118 that, in one embodiment, provides the clinician with a view of a page consisting of an HTML frameset with a dedicated frame for event display. . The dedicated frame can insert a JAVA script for the display of events, which is the first central computer for new events such as pump alarms and pump alerts directed to the digital assistant 118. An inquiry is made to 119. If any new event has occurred, the first central computer then provides this information to the digital assistant 118, which is displayed in a dedicated frame for displaying such events.

  One type of notification provided on the digital assistant 118 informs the clinician that the data presented by the digital assistant 118 is not up-to-date and does not have access to alerts and alarms. Conversely, the digital assistant 118 can also be notified to provide real-time access to alerts or alarms when the digital assistant 118 is linked to the central system 108.

  Other notifications that are normally communicated via script include, but are not limited to, “silent stop” of pump, change of pump injection limit, end of injection, blockage trend information, low battery, pre-blockage indicator, Overuse of bolus, alert to keep vein open, quick medication notification, order correction, test results, radiological diagnosis results, updates, telemetry data and / or vital sign information changes, attempts to contact nurses Doctors or pharmacies, patients seeking nurses, loss of communication, messages from other devices, new rates for medical devices based on vital information, subsequent purge rates, etc.

  As previously mentioned, clinicians within a medical facility can use a remote wireless device 118 (ie, also referred to as a personal digital assistant (PDA) 118), or a tablet computer with an operably attached barcode reader, or an infusion. An injection alert via another computer device connected to the network 108 wirelessly or wired, such as a laptop computer attached to a pole and having a bar code reader operably attached to the computer; Access alarms and messages.

  Infusion system 210 preferably provides clinicians and other users with the option to automate alert event-driven messages. In addition, healthcare facility managers and other users can customize the type of automated messaging that appears via the remote wireless device by message type or classification, anomaly severity, and time-based alerting. In addition, the infusion system provides clinicians and other users the ability to set audible messages, visual messages, or both.

  The messaging provided by the infusion system 210 preferably includes a user configurable rules engine, a scheduler, and an interface for connecting to the infusion pump system. Furthermore, result-driven messaging preferably provides clinicians with real-time decision support at the point of care via workstations, electronic tablets, wireless personal digital assistants, and the like.

  Typically, communication between the infusion pump 120 and the network 102, and also between the network 102 and the clinician's digital device 118, among other things, the clinician 116 is the pump setting value programmed with the pharmacy input order compared by electronic means. Use this system as a method to remotely monitor and / or program pumps and remotely monitor pump alerts and alarms, remotely monitor pump status, view notifications, and view infusion set change history Make it possible.

(Patient medical system)
Returning to FIG. 1, the patient care system 100 preferably includes a computerized physician order entry module (CPOE), a ward pharmacy module, a wireless nurse clinical record system, and an electronic patient chart module. In one embodiment, such systems and modules are applications of a second central server or second central computer 108a. The patient care system 100 desirably provides a comprehensive patient safety solution for drug delivery. Within the patient care system 100, a software module is provided that links existing patient care systems together using an interface, such as an HL7 interface known to those skilled in the art. The patient care system 100 preferably operates on various computers and personal digital assistant products to transmit orders, update patient charts, and access alerts, alarms and messages.

  The computerized physician order entry module allows physicians to enter medication orders and access alerts, alarms, messages, alerts, vital signs and results. The pharmacy module checks the prescribed drug for documented patient allergies and for compatibility with other drugs and food. The pharmacy module also provides real-time data for inventory management. The nurse medication record module is readily available at the patient's bedside and thus provides clinical information to ensure drug and dose verification at the point of care.

  The patient care system 100 integrates the drug delivery product with the information necessary to help ensure safe and effective delivery of the drug. The clinical decision support and associated alerts, alarms, warnings, and messaging of the patient care system 100 provide a safety net of assistance to the clinician when the clinician performs patient management under increasing time and cost pressures. This information is preferably provided through a wireless network that provides data in a way that improves the clinician's workflow and makes it easier to perform treatment.

(Overview of injection system)
The infusion system 210 or medical system 210 within the patient care system 100 provides, among other things, computerized prescription and electronic medical records (eMAR). The infusion system 210 makes clinical records, medication history management, inventory tracking, and messaging easy for clinicians. The patient care system 100 combines bar coding and real-time technology to help ensure that the right patient receives the right medication and the right amount at the right time, via the right route. Infusion system 210 provides alerts, alarms, messages, and alerts such as, but not limited to, test values, out of range, and dose errors. As part of the correct medication verification function, the system can also verify the infusion pump settings.

  As described in further detail herein, the infusion system 210 can be at least partially one or more of such as a wireless remote personal digital assistant, workstation, physician order entry module, electronic tablet, processor controlled infusion pump, and the like. It resides on more electronic computing devices. The infusion system 210 can be configured to display alerts and alarms that can be set by a number of hospitals in various forms via one or more electronic computing devices. In one embodiment, a time-based alert is provided and the clinician is reminded to perform patient management functions such as but not necessarily limited to infusion rate changes. Further, it provides an emergency alarm such as, but not necessarily limited to, an infusion break. Still further, it provides a less urgent message such as, but not necessarily limited to, completion of infusion or line closure. In addition, the infusion status can be viewed from anywhere in the medical facility via one or more wireless remote personal digital assistants or other electronic computing devices.

  As will be disclosed in more detail later, the system 210 escalates an alarm or alert that does not indicate that it has been modified within a predetermined time period. Conditions that can cause alarm or alert escalation are preferably defined by the healthcare facility. Similarly, the time until an alarm or alert escalates can also be defined by the healthcare facility. Thus, a predefined alarm or alert that is not corrected by the clinician within a predetermined time will result in an escalation of the associated alarm or alert. Accordingly, the frequency with which the system is notified by the system of an alarm or alert increase that can be the volume of the associated audible sound is preferably increased.

  As will be appreciated by those skilled in the art, the infusion system 210 helps to ensure patient safety by checking the infusion being administered by the patient's order. As described in more detail herein, a bar coding scheme is used in which the infusion bag and patient ID are scanned. Infusion information is displayed on both the electronic computing device and the pump to help ensure that the correct infusion is being given to the correct patient at the correct time, with the correct path and at the correct speed. In one embodiment, audible and visual alerts appear on the electronic device if the “rights” of the administration described above do not match. In addition, if the clinician has set the infusion pump speed, and if the programmed setting does not match the patient's infusion order, an audible alert and on the electronic computing device will be passed through the comparison process described in more detail later. A visible alert appears. In addition, at any time, the clinician can check the infusion pump setpoint via the electronic device to see if the setpoint matches the infusion order contained in the central database 108b.

  In one embodiment, the infusion system 210 can generate alerts and alarms with various tones or phrases, such as via one or more electronic computing devices, for quick identification of message severity or urgency. provide. Traditional infusion pump alerts and alarms may be displayed on, but not necessarily limited to, an electronic computing device such as a personal digital assistant to maintain a report to the clinician of infusion status for all patients in charge, thereby It would be desirable to be able to save time to solve problems and improve workflow safety.

  In particular, it is preferred that all alarms and alerts can be retrieved from the central system database for reporting purposes. Retrievable data can help the medical facility investigate and analyze the number of times that medication errors have been avoided by alarms, alerts and warnings.

  Audible alerts and alarms are preferably set to emit different sounds depending on the severity or urgency associated with the message or problem. Alarms that require first aid make a different sound than alerts that are less urgent. Visual text describing the problem is preferably displayed by one or more electronic computing devices. In one embodiment, an alert sounds on the personal digital assistant when the infusion is nearing completion or has completed. The personal digital assistant also displays the patient, location, type of infusion, and time remaining before the infusion bag is empty. The clinician can always access the infusion status via a personal digital assistant and can therefore respond accordingly. In one embodiment, before visiting the hospital room, the clinician can view the infusion status on a personal digital assistant to determine if another bag will be needed soon. If another infusion bag is needed, the clinician will save time by bringing a new bag on the first visit rather than recognizing that a new bag is needed after arriving in the room be able to. Similarly, the pharmacy can observe the condition, including time remaining, in order to plan the mixing and delivery of the next infusion bag.

  If desired, and as will be appreciated by those skilled in the art, other alarms and alerts associated with the infusion pump can be made available on an electronic computing device at a location remote from the infusion pump. Patient information can be displayed on an electronic computing device, thus saving nursing time and the step of solving problems. As noted above, if the pump is in an alarm or alert state, the clinician will check the patient information, drug order, on the personal digital assistant before going to the room and physically modifying the alarm or alert state. You can browse alarm messages or alert messages and collect necessary items.

  In one embodiment, the infusion system 210 provides a configurable time-based alert to signal the clinician about planned infusion orders. Thus, with a tapering order to operate the NS at 200 ml / hour for 2 hours and then reduced to 50 ml / hour, the infusion system 210 informs the nurse to reduce the speed 2 hours after the start of the infusion. In addition, a post-alert is provided to notify the clinician when the planned infusion exceeds the time tolerance set by the facility. In addition, a time-based protocol such as an alert is generated to assess pain, such as after initiation of epidural morphine infusion.

  Configurable aspects of the infusion system 210 also include audible alerts emitted by electronic computing devices such as personal digital assistants. Preferably, the audible alert can be settable by the medical facility within a specific department of the medical facility to satisfy the unique environment within the medical facility.

  As previously mentioned, multiple visual alerts and messages can be displayed by an electronic computing device such as a personal digital assistant to indicate the importance and urgency of the message. Color, blinking, and bold text are desirable display messaging options. In addition, hyperlinks can be provided when messages are generated. An icon can also be used on the display, and an emergency message can be set to interrupt the handheld electronic device and immediately notify the clinician. In addition, alarm / alert escalation is provided by the system 210. The alarm / alert and its escalation will be described in detail later.

  As also mentioned above, the infusion system 210 allows the clinician to observe all infusions or patients in charge on an electronic computing device such as a personal digital assistant and so move back and forth through the room. Making it possible to reduce the time spent on In addition, prescription information is displayed on the electronic computing device for verification of the amount of drug, diluent, dose, and infusion rate. In addition, it is possible to see the real-time status of the infusion and display the duration of the infusion, the infusion volume, the remaining time, and the uninjected volume, such as the number of milliliters per hour. As described above, the injection state and flow rate history can be viewed from anywhere in the medical facility via an electronic computing device.

  As described in more detail herein, the infusion system 210 can calculate an ordered dose based on the patient's weight and display the appropriate rate to perform the infusion. A message is generated if the infusion is set to run at a dose other than the ordered dose. In addition, pediatric dose administration is available and set in the pediatric department within the medical facility.

  In one embodiment, the status of secondary injection, such as primary injection and piggyback, is displayed by the injection system 210 on an electronic computing device such as a personal digital assistant. The clinician can constantly check the remaining infusion in the piggyback, and a message is displayed when the piggyback is complete and the primary infusion is resumed. In addition, a message is sent to the pharmacy to replenish inventory and infusion orders.

  If desired, the infusion system 210 allows the medical facility to define the infusion limits for the system to alert the clinician who programs the infusion to perform outside of the set range. The alert can be set so that the clinician overrides the alert or prohibits overrides. As will be appreciated by those skilled in the art, prohibiting overrides for certain infusions can prevent patients from being inadvertently overdose.

  The infusion system 210 can also provide for the display of reference information related to the needs of each specialized department within the healthcare facility. In addition to specialized department policies and procedures, drug information can be viewed on electronic devices such as personal digital assistants. Protocols and standard orders can be configured to provide messages based on patient status. For example, in one embodiment, the heparin infusion protocol is set to notify the clinician of a new blood glucose level test result and titrate the insulin infusion volume by the number of milliliters determined based on the sliding protocol.

  In addition, through established rules, messages or notifications about specific infusions are sent to the nurse as they relate to the patient's condition. For example, in one embodiment, a message is generated when the BUN and creatinine of a patient undergoing nephrotoxic infusion is increased. In addition, a protocol can be set up to generate a message when a specific injection volume is being titrated. For example, in one embodiment, a message can be set for recording blood pressure when the clinician titrates the dopamine infusion volume. In addition, hemodynamic monitoring parameters can be linked to the infusion and a message can be generated.

  As mentioned above, a new infusion order can be set up to provide a message notifying the clinician of the new order. Messages can be organized audibly and visually such as text, color alerts, blinking hyperlinks, icons, and the like. Rapid and abort orders can be set as high priority messages to distinguish them from non-emergency messages.

  An educational message is preferably generated and set by the medical facility. For example, in one embodiment, an infusion that requires a particular set of tubes (eg, non-PVC) will display a message that provides knowledge to the clinician. In yet another embodiment, for example, an infusion that requires central venous administration will display a warning not to infuse into the peripheral vein.

  In one embodiment, a scheduling message is generated and displayed on one or more electronic computing devices to remind the user to complete the next task. For example, in the case of gradual decrease injection, an alert to change the injection rate at the scheduled time is transmitted to the electronic computer. In addition, protocols with time-based alerts such as transfusion protocols can be set up.

  Turning again to FIG. 1 and as described above, the patient care system 100 allows medication orders, dispensing, and administration to take place at the patient's bedside. Physicians can order simple and complex prescriptions, intravenous therapy and total parenteral nutrition (TPN) using wireless handheld devices. The infusion system 210 checks not only the correct dose, but also drug interactions and other possible errors. The infusion system 210 then transmits this data in real time to the patient care facility or local pharmacy, hospital nursing department, home care department, and / or clinic.

  Clinicians can use a handheld device to access a medical record database. In one embodiment, the clinician scans the barcoded dosing method and the patient's barcoded bracelet to determine the correct dosage, dosage, and time to administer any drug. The infusion system 210 updates the medical records and dosing records, thereby eliminating paperwork that requires a great deal, if not all, of time. Thus, the infusion system 210 can reduce costs and improve efficiency while maximally saving lives. Patient care system 100 may include access controlled portable and stationary dosing methods and warehouses, including electronic patient charts and prescriptions, complete dispensing from point-of-care to pharmacies and inventory management. it can.

  As mentioned above, FIG. 1 is a schematic representation of a patient care system 100. The patient care system 100 includes a pharmacy computer 104, a central system 108, and a practice location 106 linked by a network 102. In one embodiment, the pharmacy computer 104 includes a processing device 104a, a keyboard 104b, a video display 104c, a printer 104d, a barcode reader 104e, and a mouse 104f. Although not shown in FIG. 1, the patient care system 100 includes a hospital management, nursing room subsystem, clinical information subsystem, hospital information subsystem, entrance and exit (ADT) subsystem, billing subsystem, and Other subsystems typically included in conventional patient care systems can also be included. Such a system generally works with a second central server 108a.

  In one embodiment, the central system 108 includes a central service computer 108a, a database 108b, a video display 108c, input / output components, and other conventional hardware components known to those skilled in the art. The network 102 preferably includes a wired communication system 110 portion and a wireless communication system portion. The wired communication system 110 can be, but is not limited to, an Ethernet (registered trademark) wiring system and a thin net system.

  In one embodiment, the treatment location 106 may include a treatment bed 106a, an infusion pump 120, and a medical cart 132. In FIG. 1, clinician 116 and patient 112 are shown within treatment location 106. The medication 124 can be of a type that is administered using the infusion pump 120 or other medical device. The drug 124 can also be of a type that is administered without using a medical device. The medicine can be stored in the medicine storage area 132 a of the medical cart 132. Clinician 116 uses digital assistant 118 in the process of administering medication 124 to patient 112.

  In one embodiment, the clinician 116 communicates with the wired communication system 110 of the network 102 via the first wireless communication path 126 using the digital assistant 118 during treatment of the patient 112. The infusion pump 120 has a function of communicating with the wired communication system 110 via the second wireless communication path 128. The medicine cart 132 also has a function of communicating via a wireless communication path (not shown in FIG. 1). The wireless transceiver 114 serves as an interface for the wired communication system 110. The wireless communication system portion of the network includes, but is not limited to, IEEE 802.11b “Wireless Ethernet”, local area network, wireless local area network, network with tree topography, ring topography ( Techniques well known to those skilled in the art such as networks with ring topologies, wireless Internet access point systems, Ethernet, Internet, wireless communications, infrared, optical fiber, and telephones can be used. Although shown as a wireless communication system in FIG. 1, the communication path may alternatively be a wired communication path.

  In the patient care system 100, the physician can order the medication 124 for the patient 112. In one embodiment, the order may begin with a clinician 116 at the point of care 106. The physician and / or clinician 116 can order the medication 124 for the patient 112 using a computerized physician order entry system (CPOE), medication cart 132 or similar device. Those skilled in the art are familiar with conventional computerized physician order entry systems. Regardless of its name, the clinician 116 can use a computerized physician order entry system. If it is efficient to administer medication 124 through infusion pump 120, the infusion order includes information for generating operating parameters for infusion pump 120. The operating parameter is a set of information and / or instructions required to program infusion pump 120 to operate according to the infusion order.

  Infusion orders can be entered at various locations, including pharmacies, nursing centers, nursing sites, and clinics 106. When an order is entered at the pharmacy, it can be entered into the pharmacy computer 104 via an input / output device such as a keyboard 104b, mouse 104f, touch screen display, CPOE system and / or medical cart 132. The processing device 104a can convert the manually entered order into computer readable data. A device such as CPOE can convert the order into computer readable data prior to introduction into the processing device 104a. The operating parameters are then printed in barcode format on the medication label 124a by the printer 104d. Next, a drug label 124a is affixed to the drug 124 container. Next, the drug 124 container is transported to the clinic 106. The drug 124 can then be administered to the patient 112 in a variety of ways known in the art, including oral methods and methods through the infusion pump 120. If the medication 124 is administered orally, the clinician 116 can communicate via the digital assistant 118 and / or the medical cart 132. The medical cart 132 is computerized and typically has other input / output devices such as a keyboard (not shown), a display 132b, and a barcode scanner (not shown).

  As will be appreciated by those skilled in the art, the infusion bag can also be pre-mixed and a non-patient specific barcode identifying the medication 124 is affixed to the bag. In addition, the infusion bag can be mixed at the pharmacy or in the field, with a drug 124 and, if desired, a patient specific barcode identifying the time when the drug should be administered to the patient.

  At the treatment site, the medication 124 can be mounted on the infusion pump 120 with an intravenous (IV) line 130 running from the infusion pump 120 to the patient 112. The infusion pump 120 can include a pumping unit 120a, a keypad 120b, a display 120c, an infusion pump ID 120d, and an antenna 120e. Prior art infusion pumps can be equipped with a wireless adapter (not shown) to fully implement the system 100. The wireless adapter can have its own battery if necessary to avoid battery life reduction of prior art infusion pumps. The wireless adapter can also use intelligent data management techniques such as, but not limited to, store-and-forward data management and data compression to minimize power consumption and network traffic. The wireless adapter may also include the ability to communicate with the digital assistant 118 even when the network 102 is not functioning.

  In one embodiment, the patient care system 100 can include various identifiers such as, but not limited to, staff identifiers, device identifiers, and medication identifiers. In FIG. 1, the clinician 116 can have a clinician badge 116a identifier, the patient 112 can have a wristband 112a identifier, the infusion pump 120 can have an infusion pump ID 120d identifier, 124 may have a medication label 124a identifier. Clinician badge 116a, wristband 112a, infusion pump ID 120d, and medication label 124a include information identifying personnel, equipment, or medication associated therewith. The identifier can also include additional information. For example, the medication label 124a may include information regarding the recipient of the medication 124, operating parameters for the infusion pump 120, and information regarding the lot number and expiration of the medication 124. The information contained in the identifier may be printed, but is not limited to device readable formats such as optically readable device formats such as barcodes, RFID, iButton, smart cards, etc. Radio frequency (RF) device readable formats and device readable formats such as laser readable formats are preferred. The digital assistant 118 can include a display 118a and can have an ability to read an identifier including biometric information such as a fingerprint.

  The wristband 112a is typically placed on the patient 112 when the patient 112 is admitted to the medical facility. The wristband 112a includes a patient identifier. The patient identifier may include additional information such as printed information for identifying the patient and the name of the physician performing the treatment. The patient identifier for patient 112 may include information such as, but not limited to, the patient's name, age, social security number, patient blood type, address, allergies, hospital ID number, and the name of the patient's relative. it can. In one embodiment, the patient identifier may include a unique reference code or password between patients, which is also stored in a central database in preparation for cross reference if necessary or desired.

(System hardware / software architecture of this system)
2 is included in any number of other subsystems that communicate via the network 102, such as the pharmacy computer 104, central system 108, CPOE, digital assistant 118, and / or medication treatment cart 132 of FIG. FIG. As previously mentioned, the computer 200 includes an infusion system 210 or a portion of the infusion system 210 for use within the patient care system 100. The infusion system described with reference to FIG. 2 is preferably a computer program. However, the infusion system may be implemented in whole or in part with methods and systems other than computer programs.

  A significant concern in the industry is that the correct drug is administered to the correct patient. Thus, the infusion system 210 includes features to help ensure that the correct medication is administered to the correct patient in an efficient manner. The infusion system 210 can be implemented in software, firmware, hardware, or a combination thereof. In one manner, the infusion system 210 is implemented in software as an executable program and is a personal computer (PC; IBM-compatible PC, Apple compatible PC, etc.), personal digital assistant, workstation, minicomputer, or mainframe. It is implemented by one or more special purpose digital computers or general purpose digital computers such as computers. An example of a general purpose computer that can implement the infusion system 210 is shown in FIG. The infusion system 210 can reside in or be within any computer such as, but not limited to, the pharmacy computer 104, the central system 108, the medication therapy cart 132, and the digital assistant 118. You can have various parts that are resident. Accordingly, the computer 200 of FIG. 2 is representative of any computer in which the infusion system 210 is resident or partially resident.

  As shown in FIG. 2, in general, in terms of hardware architecture, the computer 200 includes one or more input / output (I / O) communicatively connected via a processor 202, a storage device 204, and a local interface 208. O) Device 206 (peripheral device) is included. The local interface 208 can be, for example, without limitation, one or more buses or other wired or wireless connections known in the art. The local interface 208 may have additional elements such as controllers, buffers (caches), drivers, repeaters, and receivers that are omitted for the sake of simplicity to allow communication. In addition, the local interface can include address, control, and / or data connections to allow proper communication between other computer components.

  The processor 202 is a hardware device for executing software, particularly software stored in the storage device 204. The processor 202 can be any custom or commercially available processor, a central processing unit (CPU), an auxiliary processor among several processors associated with the computer 200, a semiconductor-based microprocessor (in the form of a microchip or chipset). , A macro processor, or any general device for executing software instructions. Examples of suitable commercially available microprocessors are: PA-RISC series microprocessor provided by Hewlett-Packard Company, 80 × 86 or Pentium (registered trademark) series microprocessor provided by Intel Corporation, PowerPC microprocessor provided by IBM, Sun Microsystems , Inc. The Sparc microprocessor provided by, or the 68xxx series microprocessor provided by Motorola Corporation. The processor 202 can also represent a distributed processing architecture such as, but not limited to, SQL, Smalltalk, APL, KLisp, Snobol, Developer 200, MUMPS / Magic.

  The storage device 204 can be any of a volatile memory element (eg, random access memory (RAM such as DRAM, SRAM, SDRAM, etc.)) and a non-volatile memory element (eg, ROM, hard drive, tape, CDROM, etc.). Or a combination thereof. Further, the storage device 204 may incorporate electronic, magnetic, optical, and / or other types of storage media. Storage device 204 may have a distributed architecture in which various components are remote from each other but are still accessed by processor 202.

  The software in the storage device 204 can include one or more separate programs. A separate program comprises an ordered list of executable instructions for performing logic functions. In FIG. 2, the software in the storage device 204 includes an injection system 210 and a suitable operating system (O / S) 212 according to the present invention. A non-exhaustive list of suitable commercially available operating systems 212 is as follows: (A) Windows® operating system available from Microsoft Corporation, (b) Novell, Inc. (C) Apple Computer, Inc. Macintosh operating system available from (d) Hewlett-Packard Company, Sun Microsystems, Inc. And the UNIX® operating system available from many vendors such as AT & T Corporation, (e) the freeware LINUX operating system readily available on the Internet, (f) Wind River Systems, Inc. The real-time VxWorks operating system provided by, or (g) an appliance-based operating system as implemented in a handheld computer or personal digital assistant (PDA) (eg, PalmOS available from Palm Computing, Inc., And Windows® CE available from Microsoft Corporation). The operating system 212 basically controls the execution of other computer programs, such as the infusion system 210, and performs scheduling, input / output control, file and data management, memory management, and communication control and related services.

  The injection system 210 can be a source program, executable program (object code), script, or any other entity comprising a set of instructions to be executed. In the case of a source program, the program is translated via a compiler, assembler, interpreter, etc., which may or may not be included in the storage device 204, so as to operate properly in connection with the O / S 212. The In addition, the injection system 210 may include (a) an object-oriented programming language having data and method classes, or (b) a procedural programming language having routines, subroutines, and / or functions, including but not limited to: Can be written as C, C ++, Pascal, Basic, Fortran, Cobol, Perl, Java®, and Ada. In one embodiment, the system program 210 is written in C ++. In another embodiment, the infusion system 210 is created using Power Builder. The I / O device 206 is an input device, but is not limited to, for example, a keyboard, a mouse, a scanner, a microphone, a touch screen, an interface to various medical devices, a barcode reader, a stylus, a laser reader, a high-frequency device reader, etc. Can be included. Further, the I / O device 206 can include an output device, such as, but not limited to, a printer, a barcode printer, a display, and the like. I / O device 206 is a device that communicates as both an input device and an output device, such as, but not limited to, a modulator / demodulator (modem; for accessing another device, system, or network) ), Radio frequency (RF) transceivers or other transceivers, telephone interfaces, bridges, routers, and the like.

  If the computer 200 is a PC, workstation, personal digital assistant, etc., the software in the storage device 204 may further include a basic input / output system (BIOS) (not shown in FIG. 2). The BIOS is a set of basic software routines that initialize and test the hardware at startup, start the O / S 212, and support the transfer of data between hardware devices. The BIOS is stored in the ROM so that the BIOS can be executed when the computer 200 is started.

  When the computer 200 is operating, the processor 202 executes software stored in the storage device 204, communicates data back and forth with the storage device 204, and performs overall operation of the computer 200 according to the software. Set to control. The infusion system 210 and O / S 212 are wholly or partially, generally the latter, but are read by the processor 202 and possibly buffered in the processor 202 and then executed.

  As shown in FIG. 2, if the infusion system 210 is implemented in software, the program of the infusion system 210 can be any computer-readable medium for use by or in connection with any computer-related system or method. Can be stored on top. Computer-readable media as used herein includes electronic, magnetic, optical, or other media that can contain or store a computer program for use by or in connection with a computer-related system or method. It is a physical device or means. The injection system 210 retrieves instructions from an instruction execution system, instruction execution device, or instruction execution device, and executes instructions such as a computer-based system, a system that includes a processor, or other systems that can execute the instructions. It can be implemented in any computer readable medium for use by or in association with a system, instruction execution device, or instruction execution device. Within the context of this document, a “computer-readable medium” is an instruction execution system, instruction execution device, or instruction execution device that stores, communicates, propagates, or transports a program for use by or in association with the instruction execution device. Any means that can be used. The computer readable medium can be, for example but not limited to, an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system, apparatus, device, or propagation medium. More specific examples (non-exhaustive list) of computer readable media include: Electrical connection with one or more wires (electronic), portable computer diskette (magnetic), random access memory (RAM) (electronic), read only memory (ROM) (electronic), erasable program ROM (EPROM, EEPROM, or flash memory) (electronic), optical fiber (optical), and portable compact disk read-only memory (CDROM) (optical). The program is captured by electronic means, for example via optical scanning of paper or other media, and if necessary then compiled, translated or otherwise processed in an appropriate manner and then stored in computer memory It should be noted that the computer-readable medium can be paper or even another suitable medium on which the program is printed.

  In another embodiment where the infusion system 210 is implemented in hardware, the infusion system 210 can be implemented with any of the following techniques, or combinations thereof, each known in the art. Discrete logic circuits with logic gates to perform logic functions on data signals, application specific integrated circuits (ASIC) with appropriate combinational logic gates, programmable gate arrays (PGA), field programmable gate arrays (FPGA), etc. .

  As will be appreciated by those skilled in the art, any process description or process block in the diagrams such as FIGS. 3-11 may include one or more executions to perform a particular logic function or step in the process. Represents a module, segment, or part of a hardware, software, etc. that can contain possible instructions and is shown in the figure, including substantially in parallel or reverse order, depending on the functionality involved Alternatively, alternative implementations that can perform functions in an order that deviates from those discussed are included within the scope of embodiments of the present invention.

(Components of patient medical system)
FIG. 4 is a first block diagram illustrating functional elements of the patient medical system 100 of FIG. As shown in FIG. 4, the patient care system 100 can be implemented as a modular system in which the modules represent various functions of the patient care system 100 including the infusion system 210 (FIG. 2). The flexibility of the patient care system 100 and the infusion system can be enhanced when the system is implemented as a modular system. The modules of the infusion system 210 (FIG. 2) can be included in various parts of the patient care system 100. In one embodiment, the functional components of the patient care system 100 can include, among other things, a medication management module 302, a prescription creation module 304, a prescription activation module 306, and a prescription authentication module 308.

The medication management module 302 can coordinate the functions of other modules of the patient care system 100 that are included in the management of medical therapy. The medication management module 302 cooperates with the rest of the patient care system 100 as a whole. The medication management module 302 operates with and / or interfaces with the CPOE, operates with and / or communicates with the point-of-care module, and operates with and / or communicates with the medical therapy comparison module Submodules can be included. In FIG. 4, an entrance and exit (ADT) interface 310, a billing interface 312, a laboratory interface 314, and a pharmacy interface 316 are shown. The ADT interface 310 is used to capture information such as patient demographic data, size, weight, and allergies. In a preferred embodiment, the ADT system uses an HL7 type interface to transfer events entered into the hospital ADT system into the second central computer 108a. HL7 is a protocol for formatting, transmitting and receiving data in a medical environment. This provides interoperability between medical information systems through messaging standards that allow disparate medical applications, such as a variety of different third party applications, to exchange key sets of clinical and management data. Normally, in the system 100 of the present invention, the HL7 ADT interface consists of three applications: an HL7 ADT server, an HL7 ADT client, and an HL7 ADT viewer. The pharmacy interface 316 imports orders from pharmacies. The pharmacy interface 316 may be an HL7 type interface, and the HL7 type interface interfaces with other systems and inputs an order such as CPOE. This feature reduces the need to enter data into the patient care system 100 more than once. The pharmacy interface 316 can be configured to communicate with commercially available third party systems such as, but not limited to, Cerner, HBOC, Pyxis, Meditech, SMS, Pharmous, and the like. The web service interface can provide near real-time coordination between point-of-care medication management systems that support oral medication administration, such as McKesson AdminRx, Pyxis, Verif5, etc., and infusion pump related medication management. Various other interfaces are known to those skilled in the art, but are not shown in FIG.

  The medication management module 302 includes additional features such as the ability to check for adverse reactions due to drug incompatibility, dual drug administration, drug allergy, drug dose limits, drug administration frequency limits, drug administration duration limits, and contraindications due to drug-related diseases Can have. The interaction of food and alcohol can also be noted. Drug restrictions may include, but are not limited to, restrictions on adults, children, infants, newborns, premature birth, the elderly, age classification, weight classification, height classification, and body surface area related restrictions. it can. In one embodiment, the medication management module 302 prevents entry of the same prescription for the same patient from two different prescription sources within the patient care system 100.

  The medication management module 302 can also include the ability to create reports. The report includes, but is not limited to, shift completion, titration information, patient event list, infusion history, pump operation history, pump position history, and pump maintenance history. The shift end report can include pump channel, start time, end time, primary infusion, piggyback infusion, drug, dose, rate, pump status, infusion volume, remaining amount, remaining time, and final completion time. . The infusion history report includes drug and infusion volume.

  The medication management module 302 can include a medical device status database. The medical device state database includes data indicating the position of the medical device 332 in the patient medical system 100. The medical device state database can also include data indicating past operation of the medical device 332. The medical device status database may also include data indicating a maintenance schedule and / or history of the medical device 332.

  The infusion prescription or infusion order is entered into prescription entry 324. Such orders may include, but are not limited to, prescriptions such as single dose, intermittent dose, continuous dose, sequential dose, titration, and alternate dose types. Infusion formulations can include total parenteral nutrition mixes (TPN), chemotherapeutic continuous infusions, piggybacks, bulk parenteral medications, and other infusion formulations. The patient care system 100 can function without an end date for the order. The patient medical system 100 uses a continuous schedule generator that predicts a predetermined time and generates a mixture filling schedule for the time. The predetermined time can be defined at the patient care system 100 level, or at a subsystem level such as the clinical field level and the tissue level. The predetermined time may be adjustable by the clinician 116 who enters the order. The schedule can be automatically extended as long as the order is active in the patient care system 100.

  The prescription creation module 304 creates a hard prescription and an electronic (E-copy) prescription. Three hard prescriptions are usually made in medical facilities. The first hard copy 318 is typically sent to the pharmacy, the second hard copy 320 is usually kept for patient records, and the third hard copy 322 is sent to the treatment location 106. The electronic prescription is transmitted to the medication management module 302.

  The prescription creation module 304 may include a function for confirming driving parameters. The operational parameters can be based on information from the prescription entry module 324. The prescription creation 304 can be performed in any of the patient medical systems 100 such as, but not limited to, a pharmacy, a treatment location 106, and a nursing center.

  A computerized physician order entry (CPOE) system or the like can be used to perform some or all of the functions of the prescription creation module 304. The clinician 116 can enter data in a variety of ways including, but not limited to, a tablet wireless computer, a personal digital assistant, a treatment cart 132, and a workstation. The medication management module 302 can interface with more than one prescription generation module 304. The medication management module can receive orders from anywhere within the patient care system 100.

  The pharmacy computer 104 can access the electronic copy from the medication management module 302. The prescription activation module 306 is a computer-aided system that coordinates prescription entry and labeling. Prescription entry and creation or placement of medication 124 from inventory is handled by the prescription activation module 306. In one embodiment, the medication label 124a will be created by an entry process as opposed to a prescription activation process.

  The patient care system 100 can bypass the prescription activation module 306. This can be done when the ordering clinician 116, such as the patient's physician, has the authority to immediately launch the order. If the order is activated immediately, the medication management module 302 can go straight to the entry and thus the prescription labeling module 326.

  At block 326, the patient care system 100 prints the medication label 124a. The prescription can be printed remotely and is often printed by the pharmacy printer 104d. After block 326, the patient care system 100 goes to block 328. At block 328, drug label 124a is affixed to drug 124. Typically, the pharmacist visually verifies 334 that the medication label 124a matches the first hard copy 318 of the prescription. FIG. 4 shows that visual verification 334 is also associated with prescription authorization module 308. The drug 124 can then be transported from the pharmacy to the treatment location 106. A portable medical cart 132 can be used for a portion of the path from the pharmacy to the treatment location 106.

  The medication label 124a can include information for preparing an infusion bag. If not created within the patient care system 100, the drug label 124a can be provided by the bulk drug supplier. If provided by the bulk drug supplier, the patient care system 100 collects information from the drug label 124a. Furthermore, the patient medical system 100 can add information such as a patient identifier to the drug label 124a.

  The drug labeling module 328 places the drug label 124 a on the drug 124. This can be accomplished manually. This can also be accomplished using an automatic prescription filling and packaging system (not shown). If an automatic prescription filling and packaging system is used, the drug labeling module 328 provides data for aligning the labeling of the drug 124 with the filling and packaging system.

  At treatment location 106, clinician 116 uses digital assistant 118 and / or wireless device 330 such as medical cart 132 to identify and administer medication 124 to patient 112. The wireless device 330 communicates with the medication management module 302 via a communication path such as the first communication path 126.

Clinician 116 identifies itself by scanning badge 116a, identifies patient 112 by scanning wristband 112a, identifies drug 124 by scanning drug label 124a, and scans label 120d. Thereby identifying a medical device 332, such as infusion pump 120. The clinician 116 may also identify himself / herself by providing the fingerprint and / or password described above and shown in the login screen 1903 of FIG. The medical device 332 can be a medical device capable of bidirectional communication with the medication management module 302. Alternatively, the medical device 332 may only be able to provide information to the medication management module 302. The infusion system 210 assists the clinician 116 in applying and validating medical therapy. In an alternative embodiment, the infusion system 210 can include the ability to download operating parameters to the medical device 332. The clinician 116 can perform visual verification to confirm that the third copy 322 and / or MAR matches the labeled drug 124. The scanner 338 can be used to input machine readable information from the third copy 322 to the wireless device 330 and the medical device 332.

  The patient care system 100 can make adjustments and changes to the infusion order. Among other modules that can include the ability to make infusion adjustments are a prescription entry module 324, a prescription activation module 306, a prescription permission module 308, and a prescription modification module 336. The clinician 116 accesses the prescription modification module 336 and adjusts the order. Clinician 116 can access prescription modification module 336 from anywhere in patient care system 100. However, one very useful place for the clinician 116 to access the prescription modification module 336 is the treatment place 106.

  In the prescription authorization module 308, the patient care system 100 determines whether the clinician 116 has the authority to modify the infusion order alone. The clinician 116 may be recognized by the patient care system 100 as having the authority to modify a particular part of the order alone. If the clinician 116 does not have the authority to modify the order alone, the pharmacist or doctor can be asked to approve the modification entered by the clinician 116.

  In one embodiment of the patient care system 100, the order is entered into the pharmacy computer 104. This order includes a first patient identifier and operating parameters. The pharmacy computer 104 creates a drug label 124a that is affixed to a drug bag or drug container. The medication 124 is sent to the treatment location 106. At the treatment location 106, the clinician 116 reads the clinician 116 badge 116 a, patient wristband 112 a, and medication label 124 a with the digital assistant 118. The digital assistant 118 reports whether the medication label 124a and the wristband 112a correspond to the same patient 112 based on the determination made by the central system 108. The system 100 then sends the medication identifier to the pharmacy computer 104. The pharmacy computer 104 identifies the medication label 124a, identifies the same patient as the order, and sends operating parameters to the infusion pump. The operating parameters can be sent directly to the infusion pump 120. The infusion pump is then programmed with operating parameters to administer medication 124 to the patient 112.

  FIG. 5 is an exemplary block diagram of a computer screen 400 useful for performing various functions of the infusion system 210 (FIG. 2). In addition to other functions, the computer screen 400 can be used to enter new infusion orders, modify existing infusion orders, and stop infusion orders. The computer screen 400 preferably includes a processing area 402, a search area 404, a drug information area 406, a titration / gradual reduction reference area 408, an instruction / note area 410, and a predicted solution area 412. Infusion drug order types include single dose, intermittent dose, continuous dose, sequential dose, and alternate dose. Computer screen 400 can be used with digital assistant 118, pharmacy computer 104, infusion pump 120, CPOE system, and medical cart 132. The computer screen 400 is generally designed to have a computer screen look and feel accessible to clinicians throughout the patient care system 100 of FIG. Some of the functions of computer screen 400 are accomplished by database linkage techniques well known to those skilled in the art, such as, but not limited to, hyperlinks, definition boxes, and drop-down menus.

  Processing area 402 includes functions for triggering creation of infusion orders, saving infusion orders, modifying infusion orders, and canceling infusion orders. The clinician 116 can customize the computer screen 400 to provide the clinician 116 with a preferred order entry procedure. The processing area 402 includes an order status indicator. The processing area 402 also includes an area for indicating whether a PRN order (“on demand” or “on demand” order) can be performed by the clinician 116. The treatment area 402 includes medical device 332 operating parameters, infusion order path, infusion line, infusion delivery site, infusion order disclosure time, infusion drug order type, infusion flow rate tolerance, infusion flow rate, infusion duration and formulation location (pharmacy or remote It further includes a function for displaying and adjusting (such as position). Processing area 402 is also an area for linking a medical order to another medical order or related clinical monitoring, such as linking a physician's infusion order to another medical order entered by another clinician 116. Can also be included. The processing area 402 can include triggers for displaying data in other areas of the computer screen 400 such as, but not limited to, the predicted solution area 412.

  The search area 404 allows searching for drugs, solutions and / or additives for the infusion order. A default diluent can be defined on the order. If a default dose for a drug is defined in the patient care system 100, the default dose automatically appears with search results that include the drug. As a result of the search from the search area 404, the name of the drug, the administration route, the cost, the package size, the dosage form, the general name, the presence / absence of anesthesia of the drug, the presence / absence of drug management, whether the drug is collected, and the drug The manufacturing location can be displayed.

  The drug information area 406 can be used to determine injection order additives and solutions. The drug information area 406 can include separate additive and solution areas. The solution area can include a label, “solution / diluent”. The patient medical system 100 can read data on the drug 124, the solution, and the additive into the drug information area 406 using the drug 124 database, the solution database, and the additive database. Substances identified in one database can also be identified in other databases. Each database can be linked to provide default values for the combination of drug 124 and solution.

  The titration / decreasing reference region 408 is typically applied for continuous infusion orders. Titration defines certain parameters on the order, such as dose and / or flow rate. The dose and flow rate can be entered as absolute. Also, entering information into the titration / gradual reduction reference area 408 includes, but is not limited to, mathematical symbols such as “greater than” “>”, smaller “<”, and “=” equal to “single”. Or they can be used in combination. Data can also be entered into the titration / graduation reference area 408 using a calendar. The dose and flow rate can also be entered as acceptable ranges. If a non-sustained infusion order is entered and / or modified, the titration / decreasing reference area 408 can be hidden. Titration criteria include, but are not limited to, various parameter values related to patient health such as various test results, vital signs, ability to ingest fluid, fluid inflow and outflow, etc. Can be included.

  The instruction / note area 410 includes a function for storing information such as a doctor note regarding the patient 112 and / or the infusion order. The indication / note area 410 may include a display and reference area for identifying a clinician 116 responsible for the patient 112, such as the patient's attending physician.

  The predicted solution area 412 displays a solution schedule and related factors based on the current state of the order being processed for the patient 112. The predicted time can be a default for the patient care system 100. The time can also be adjusted by the clinician 116. The predicted solution area 412 may include an adjustable display that shows the time predicted by the patient care system 100. Data displayed in the predicted solution area 412 is normally stored when order storage is triggered in the processing area 402. The predicted solution area 412 may include a function of looking back on a certain period while correcting the previously input order. This allows the clinician 116 to consider solutions that may have already been prepared according to the unmodified infusion order.

(Components of injection system)
FIG. 6 is a block diagram illustrating functional elements of the infusion system 210 of FIG. The functional elements include a block 502 for setting system parameters, an infusion order creation block 504, an infusion order preparation block 506, a medication administration block 512, an infusion order modification block 514, and a messaging block 520. FIG. 6 also includes a pharmacy permit block 508, a physician permit block 510, an order stop block 516, and an inventory / invoicing block 518. FIG. 6 presents one explanation for the injection system. However, FIG. 6 does not define a series of steps required to carry out the injection system. One advantage of the infusion system is that the clinician 116 can access and enter information from both a number of physical and functional locations within the patient care system 100. For example, infusion orders can be generated by a physician using CPOE, by a pharmacist using a pharmacy computer 106, by a clinician 116 using a digital assistant 118, and by a clinician using a medical cart 132. It is. In addition, patient vitals, test results, and other records can be checked from a number of locations within a medical facility including, for example, a ward pharmacy. Therefore, the user in the ward pharmacy 104 (FIG. 1) can browse the ward in the medical facility from the computer processing device 104c. When the user selects a ward, a patient list is provided from which the user can select a patient and associated records from the list for display on the computer processor. Alternatively, the user can enter all or part of the patient's name into the computer processor, whereby a record associated with the patient is provided by the computer processor for selection by the user. . As soon as you make a selection, the record is displayed.

  In one embodiment, FIG. 6 illustrates a first block for preparing the patient care system 100 to receive an infusion order—block 502 for setting system parameters; a second block for creating an infusion order—an infusion order creation block 504. Third, block to dispense based on infusion order—dispensing block 506; fourth, block to permit infusion order—pharmacy permit block and physician permit blocks 508 and 510; fifth, block to perform infusion order—drug administration Block 512; Sixth, Blocking and replenishing inventory used to dispense based on infusion order and issuing invoice to patient for infusion order—Inventory / Invoicing block 518; Seventh , Block to modify injection order—modify block 514; and eighth, progression of injection order. Block sending messages to various personnel and subsystems regarding status, infusion, messages to help ensure that the right medication is dispensed efficiently and delivered to the right patient in the right amount and at the right time- It can be seen as message block 520. The modification block 514 can include a block-stop order block 516 that stops the order based on information provided by the transfer interface 310.

  Block 502 for setting system parameters includes functional blocks that prepare the infusion system 210 to create and process infusion orders. The block 502 for setting system parameters includes, but is not limited to, a block 542 for setting an allowable value, a block 544 for setting a default value, a block 546 for building a database, a block 548 for defining a function, Block 550 for determining system settings. Block 502 for setting system parameters is further described below with reference to FIG.

The infusion order creation block 504 includes functional blocks that are used to create an infusion order. The infusion order creation block 504 includes functions similar to those described with reference to the prescription creation block 304 (FIG. 4). The infusion order creation block 504 includes, but is not limited to, a block 560 for inputting information, a calculation block 562, a check block 564, and an overriding block 566 . The injection order creation will be further described below with reference to FIG. The result of creating the injection order is the injection order 702 (FIG. 8). Infusion order 702 typically includes an infusion schedule 704 (FIG. 8).

  The infusion order may request permission as described with reference to block 308 (FIG. 4). In FIG. 6, prescription permission by the pharmacist and prescription permission by the doctor are considered separately in the pharmacy permission function block 508 and the doctor permission function block 510. Physician authorization 510 may not be required if the infusion order is initiated by the physician. Infusion orders typically require pharmacy permission 508 and doctor permission 510 if the order is created by a clinician other than a pharmacist or doctor at treatment site 106. However, if the medication 124 is needed immediately, the infusion system 210 allows the administering clinician to bypass the prescription permit 508 and the physician permit 510. In the case of an emergency order or a non-emergency order for daily medication, the infusion system 210 indicates that the medical information that the clinician 116 desires to apply to the patient 112 is not stored in the patient care system 100. Can be determined. If the infusion system 210 recognizes that the clinician 116 has the authority to initiate the desired medical care, the system 210 allows the medical care to be performed without going to blocks 508 and 510. This permission is then obtained in the following medications.

  Infusion order based preparation 506 can be accomplished at several locations throughout the medical facility, such as, but not limited to, pharmacies, nursing centers, floors, and treatment locations 106. Preparation 506 includes providing instructions for dispensing medication 124 and minimizing the potential for errors in dispensing medication.

  Drug administration 512 occurs at the treatment location 106. The infusion system 210 is designed to make order execution as efficient and accurate as possible. The infusion system 210 provides the management clinician with the tools to administer the correct medication to the correct patient in the correct amount at the correct pump settings and at the correct time. The medication management module provides status information output to the messaging module 520 when alerts, alarms, reminders, or other messages are appropriate to assist the clinician in administering medication. In response to the status information output, messaging module 520 forwards the associated text message, audible display enable, or both to one or more electronic computing devices.

  As known to those skilled in the art, infusion orders are frequently modified. The infusion system 210 performs a modification 514 to account for the infusion order modification. Modifications 514 include infusion duration, flow rate, infusion site changes, and stop order 516 modifications. The modification block 514 also includes the functional blocks necessary to perform an injection order modification.

  The infusion system 210 can include a patient care system wide 100 that defines a stop order 516. A change in the patient's condition can generate a message 520 for the appropriate action. The infusion system 210 automatically stops 516 in coordination with the transfer interface 310 upon discharge or death.

  The system 100 includes an inventory / invoicing module 518. The inventory and invoicing module 518 allows financial transactions related to patient care to proceed with minimal human intervention. Completion of medication management 512 may trigger billing to the patient via billing interface 312. The billing interface can include an HL7 interface. If the patient is billed based on completion of infusion order preparation 506, inventory and billing system 210 includes a credit book process. The credit book process can be triggered when the infusion bag is discarded or returned for re-registration to the pharmacy inventory management system.

  The infusion system 210 includes a message module 520 for communicating with entities throughout the patient care system 100. Specifically, the message module 520 sends a text message, an audible display enable, or both to one or more electronic computing devices in the patient care system 100. The message is sent in response to status information output provided by a medication management module or other infusion system module within the patient care system 100. The messages are associated with status information output and thus provide appropriate alerts, alarms, reminders, or other messages to assist the clinician in managing medication.

  For example, when a doctor enters a new order, a message appears at the pharmacy to inform the pharmacist that permission is required for the infusion order. Similarly, once the infusion order is properly authorized, the clinician 116 receives a message on the digital assistant 118 informing the clinician 116 that the infusion order should be processed according to the infusion schedule 704. Override 566 can generate 520 a message to the physician and / or pharmacy. Infusion system 100 can distinguish between system-wide and subsystem overrides in determining whether it is necessary to generate 520 a message. Messaging 520 includes messages sent to and received from the central system, pharmacy, physician, billing module, and inventory module.

  The system can present the clinician 116 with a personal computer display view. The personal computer display provides a view summarizing open clinical issues for the clinician's patient. The clinician 116 can quickly retrieve detailed information about the patient. The system 100 can also generate an email or page to the digital assistant 118 or other communication device when there is a particular serious patient condition.

  FIG. 6 also shows several communication paths that occur in the patient care system 100. The highlighted communication path is provided to facilitate the description of the infusion system 210. Those skilled in the art will understand that when the patient care system 100 is implemented on a network, the various functional blocks communicate with each other via the highlighted path of FIG. 6 and alternative paths not shown in FIG. I know you can. The system parameter setting block 502 receives data from the infusion order creation block 504 and / or the function of communicating data related to system parameters to the infusion order creation block 504 via the path 522 and how the received data is. To provide data that informs the infusion order creation block 504 whether it is associated with a system parameter.

  Infusion orders can be passed directly to infusion dispensing block 506 via path 524. The infusion order can also be passed via path 526 to pharmacy permission block 508 and / or via path 528 to the physician permission block before being sent to dispensing block 506. Path 530 highlights the delivery of drug 124 from the dispensing area to treatment site 106. Delivery can be accomplished using a dosing treatment cart 132. Paths 532, 534, 536, and 538 provide various other functions such as, but not limited to, inventory order creation 518 transactions, such as infusion order creation 504, preparation 506, medication administration 512, and modification 514. Emphasizing that it can be tied to Paths 572, 574, and 576 highlight that a greater number of functions and actors included in patient care system 100 can generate and receive information via message 520 block. Path 582 highlights that the pharmacist can create and / or change the system default value 544. Path 580 also emphasizes that various functional units throughout the system 100 can utilize information such as infusion orders.

  FIG. 7 is a block diagram showing functional elements for system parameter setting 502 in FIG. The system parameter settings 502 include, but are not limited to, an allowable range setting 542, a default value setting 544, a database construction 546, a function definition 548, and a system setting value determination 550. The tolerance 542 includes, but is not limited to, a net dosage tolerance 542a, flow rate tolerance 542b, administration time tolerance 542c, administration system duration 542d, administration duration tolerance 542e, and site change tolerance 542f, etc. Includes tolerance. Infusion system 210 can also include separate tolerances for order entry and modifications from the ordered tolerances. Identify distinct tolerances such as, but not limited to, administration system duration 542d, maximum infusion duration override availability setting in order entry, and maximum infusion duration override availability setting in administration Can do.

  Net dosing tolerance 542a is the maximum concentration of drug that is safe to administer to a patient at a given time. Infusion system 210 associates a net dosage tolerance with the drug. Net medication tolerance 542a may be defined in a drug identification file in the drug database. During infusion order creation 504, the infusion system 210 is responsible for the flow rate 560e, the number of infusion bags 562a required at a particular time, the concentration of the main component in each infusion bag, the time at which each infusion bag will be administered, each infusion. The total amount of bags can be determined. The flow rate can be manually entered or adjusted by changing the final concentration or duration of each infusion bag. In one embodiment, the infusion system 210 performs a net concentration check 564a (FIG. 8) to ensure that the drug does not exceed the maximum concentration. However, at any point when the final concentration of the solution exceeds the maximum concentration of the drug while the clinician 116 is changing the flow rate by adjusting the final concentration, the infusion system 210 can prompt the administering clinician to Send 520. The administering clinician can obtain permission to override the net dosage tolerance 542a. The infusion system 210 can request the clinician 116 to provide a reason for the override.

  The infusion system 210 can include adjustable flow rate tolerances 542b and flow rate adjustment tolerances for medication. The flow rate tolerance 542b is optionally defined for all tissue levels of the patient care system 100. The tolerance 542b can be for the entire patient care system 100 or for a subsystem of the patient care system 100. For example, different flow rate tolerances 542b may be applied to subsystems such as, but not limited to, neonatal, pediatric, psychiatric, and specific nursing departments, and specific patients. The flow rate allowable range 542b can be specified with respect to the flow rate originally ordered or with respect to the immediately preceding flow rate. The clinician 116 can also identify a flow rate tolerance that is specific to a particular order.

  The infusion system 210 can include a predetermined indication as to whether the administering clinician 116 is authorized to override the flow rate tolerance 542b without requiring a new order. This display can be applied to the entire patient care system 100, a subsystem, or an individual clinician 116.

  The maximum infusion duration 542d can be defined separately for various portions of the patient care system 100. The maximum infusion duration 542d can also be specific for a particular drug 124. Maximum infusion duration override 566 (FIG. 8) can be made if it is allowed to override the maximum infusion duration 542d at the time of order entry. Override of maximum infusion duration in dosing sets whether overriding maximum infusion duration 542d at the time of dosing is allowed and what group of users are allowed to do so Can be provided to. If overriding during order entry and / or administration, the infusion system 210 can define a subset of clinicians 116 that have the authority to override the maximum infusion duration 542d.

  Default values 544 include default values such as, but not limited to, drug diluent default value 544a, diluent amount default value 544b, dose default value 544c, and unit of measure default value 544d. The unit of measure (UOM) default value 544d includes the ability to identify the optimal unit of measure for various parts of the patient care system 100. For example, drugs can be measured in different units by physicians, medication clinicians, pharmacists, finance personnel, and drug sorters. The physician's UOM is generally a measurable value such as “mmol”, “mEq”, “ml”, and / or “mg” as opposed to “vial” and / or “puff”. The doctor's UOM is used for business purposes such as ordering and information input 560.

  The administering clinician's UOM is generally a value that reflects the UOM to which the drug will be administered, such as “puff”, “tbsp”, and “tab”. The administering clinician's UOM is used during drug administration 512. The administration clinician's UOM can also appear in documentation such as administration reports, admixture filling and manufacturing work orders.

  The pharmacy UOM is generally a value that reflects the physical form in which the drug is formulated, such as "tab", "vial", "inhalator", and "jar". The pharmacy UOM is used in preparation 506 and stockpiling and dispensing systems. Financial UOM is typically used to calculate the financial figures that appear on invoices and invoices. The drug sorter's UOM is generally used when sorting drugs.

  The default value 544d of the unit of measurement can be identified using a check box table in which check marks are arranged in a table that associates various UOMs with UOM users. The infusion system 210 can use the same UOM for more than one function. For example, the physician's UOM can be the same as the pharmacist's UOM. The default value setting 544 includes data necessary to adjust various UOMs. For example, the UOM default value 544d may include multipliers and divisors necessary to create a one-to-one correspondence between various UOMs. The UOM default value 544b can be changed to suit the needs of individual clinicians. However, a one-to-one correspondence must be maintained by the patient care system 100. The infusion system 210 can be designed to maintain a history of dosage unit default values.

  The infusion system 210 can also include a dosing measurement suffix. The medication measurement suffix can take a default value during order entry. The dosing measurement suffix can be a common unit of dosing measurement and can include units related to patient characteristics such as body surface area and weight. The dosing measurement suffix can be specified per drug, per order type, per dose, and per UOM.

  Database construction 546 is a database and / or, but is not limited to, dispensing area 546a, additive information 546b, solution 546c, premix definition 546d, preference 546e, timing override reason 546f, flow rate override reason 546g. , Conversion table 546h, flow rate description 546i, device / routing information 546j, and message trigger 546k, and part of a single database.

  The timing override reason 546f includes a displayable reason for changing the timing of the injection order. For example, the timing override reason 546f may include a reason selectable by the stylus for the digital assistant display 118a to execute the infusion order at a time other than the time specified in the original infusion order. If the clinician 116 administers a drug outside the ordered administration time tolerance 542c, the clinician 116 may be requested to select a reason code for the change from the displayed reason 1008f (FIG. 11). . Examples of other reason codes include, but are not limited to, a PRN administration reason code and a code for stopping an infusion.

  The drug 124 and / or infusion order can have a flow rate tolerance that includes the flow rate tolerance 542b of the system. The infusion system 210 can include a flow rate override reason table 546g. The flow rate override reason 546g is an annotation that the clinician 116 can select and / or provide if the clinician 116 needs to change the flow rate beyond the limits defined by the flow rate tolerance 542b. The infusion system 210 can include a predefined message trigger 546k to indicate whether the clinician 116 should send a message to the patient's physician if it overrides the flow rate tolerance defined by the order. The infusion system 210 also includes a predefined message trigger 546k that indicates whether a message should be exchanged when the clinician 116 overrides an acceptable range, such as the flow rate acceptable range 542b, to a level other than the order. be able to.

  The injection system 210 can include a conversion table 546h such as, but not limited to, a flow rate conversion table, a variable component conversion table, and a variable flow rate conversion table. Flow rate conversion is not limited in order to a specific concentration of dose / hour, body weight / hour per unit of volume, body surface area / hour of dose per unit, and total dose and total Converting the infusion order to a flow rate defined by volume / time when initially specified by a method such as duration.

  Variable component conversion includes converting a plurality of flow times of an infusion order having variable components in separate infusion bags into a flow rate for the infusion bag currently being administered. Orders having variable components include, but are not limited to orders such as ordered orders. In ordered orders, different bags have different components and potentially different flow rates.

  Variable flow rate conversion involves conversion to a flow rate for the solution currently being injected of an injection order with various flow rates. Variable flow rate orders include, but are not limited to, orders such as bolus / basal, order, dose order grading and dose order modification.

  The injection system 210 can include a predetermined injection flow rate 542b. The predetermined injection flow rate 542b allows selection from a drop-down list as a shortcut from the step of entering the flow rate from the keyboard, which can be associated with the flow rate description 546i.

  Predefined functions 548 include, but are not limited to, dispensing area function 548a, bag duration function 548b, override request verification function 548c, duration versus amount function 548d, duration versus flow rate function 548e, and flow rate versus infusion rate. Functions such as function 548f are included. Infusion system 210 can include a duration-to-volume function 548d to determine the amount to be infused per infusion order. The flow rate versus infusion rate function 548f uses information about the medical device 330 to convert the flow rate to an infusion rate.

  The determined settings 550 include, but are not limited to, settings such as override permission 550a, flow velocity accuracy 550b, quantity accuracy 550c, and time accuracy 550d. If desired, the infusion system 210 can determine the total infusion volume and the flow rate of the infusion order. Once these numbers are determined, it is desirable to round the calculated values to flow rate accuracy 550b and quantity accuracy 550c that can be understood by clinicians 116 such as doctors, pharmacists, and nurses. The flow velocity display accuracy 550b can be set so that the flow velocity is displayed up to a set number of decimal places. Different parts of the patient care system 100 can independently determine the accuracy for the displayed flow rate. For example, the infusion system 210 can display up to the first decimal place for adult treatment locations and the third decimal place for neonatal treatment locations. The flow rate accuracy 550b reflects the department in which the clinician's patient is located. Injection order flow rates can be rounded to system-defined accuracy. The accuracy may be the same for all infusion orders and may depend on the patient's department.

  Similarly, the amount display accuracy 550c can be set so as to display the injection amount up to a set number of decimal places. The configurable time accuracy 550d can be used to calculate the duration of administration based on the flow rate when the infusion is a single dose infusion or an intermittent infusion. The calculated total volume of each infusion bag is rounded according to the quantity accuracy 550c. The dosing time is rounded by the infusion system 210 according to the set time accuracy 550d. The time accuracy 550d may be the same for all infusion orders regardless of the patient's department, or may be department-specific.

(Order creation)
FIG. 8 is a block diagram illustrating functional elements for the injection order creation 504 of FIG. Infusion order creation 504 includes functional blocks for creating infusion orders. Infusion order creation 504 includes information input 560, calculations 562, checks 564, and overrides 566 . Information input 560 may include functions such as, but not limited to, order type identification 560a, drug identification 560b, dose identification 560c, diluent identification 560d, flow rate identification 560e, and injection site identification 560f.

  Infusion order creation 504 is linked to infusion bag preparation 506, infusion bag delivery (path 530), medication administration 512, and infusion order modification 514. Infusion order types 560a include, but are not limited to, order types such as single dose, loading dose, intermittent dose, and continuous dose. Continuous infusion includes alternating infusion, sequential infusion, tapering infusion, and titration infusion. When the first medication 560b is selected in the infusion order, the format of the infusion order type 560a for that medication can take a default value. The ordering clinician may have the option of selecting a different order type. The dose 560c and the measurement unit 544d can also take default values. The unit of measure 544d can be correlated with the drug and / or dose 544c. The infusion system 210 can include one default diluent or several default diluents for the medication. One default can be identified as the preferred diluent. The description can be associated with a diluent to assist the ordering clinician in determining which diluent to select. References can be included in the description of the diluent, and the use of certain diluents can be avoided if the patient has hypertension.

  Infusion system 210 may also allow additional infusion order subtypes 560a based on the infusion order types described above. Additional infusion order subtypes 560a may include, but are not limited to, TPN infusion orders, chemotherapy continuous infusion orders, piggyback infusion orders, and bulk parenteral infusion orders. Infusion order subtypes can be accessed from various parts of the infusion system 210, allowing for classification and filtering of infusion orders by subtype. In order to further customize the order of the infusion order subtype and the associated pharmacy workflow, a special label format for each infusion order subtype can also be defined.

  While searching for medication 124 during infusion order creation 504, the medication 124 can be flagged with additives and / or solutions to assist the clinician 116 in creating infusion orders. This designation can be made in the medicine identification file.

  The dose 560c of the drug is determined by several methods such as, but not limited to, body weight and body surface area, and can be input according to the speed. If no flow rate is entered, the infusion system 210 calculates the flow rate as a function of the specified dose and time. The ordering clinician can specify diluent 560d and its amount. The pharmacy can provide default values for such parameters—see line 582 (FIG. 6). A check 564 can be performed to ensure that the net concentration 564a and flow rate 564b for the drug 560b are appropriate.

  The infusion system 210 can identify and / or calculate the flow rate 560e based on the patient's weight, body surface area, and / or specific treatment frequency and duration of treatment. The ordered flow rate 560e is checked 564b against a flow rate tolerance, such as the system flow rate tolerance 542b. The net concentration of the drug 124 can be checked 564a against a net concentration tolerance, such as the system's net concentration tolerance 542a.

  In one embodiment, the flow rate 560e may also include a display of a description regarding the default flow rate to facilitate order entry. The flow rate 560e can refer to the flow rate description database 546i.

  Calculation 562 may include a dose calculation based on patient weight and / or height (possibly provided by ADT interface 310), amount of drug, amount of diluent, concentration, or rate. Calculation 562 includes, but is not limited to, flow rate, if not specified in the prescription, the number of bags 562a or the number of infusion bags required at a particular time, the time each infusion bag will be administered, and Calculation of the total amount of each injection as well as each injection bag based on the concentration of the components in the solution can be included. The flow rate, the amount to be injected and / or the duration can be varied. If changed, the infusion system 210 automatically calculates the amount dependent on the change, and based on the calculation, if the maximum dose of the component at that concentration exceeds that specified in the drug file for that component, The patient care infusion system 210 can alert the pharmacist and / or clinician 116 and request a reason code for the adjustment.

The calculations 562 can include calculations such as, but not limited to, a bag volume calculation 562a, a transformation calculation 562b, a duration versus volume calculation 562c, and a flow rate versus infusion rate calculation 562d. Check 564 includes various checks that can be received by the infusion order. Checks include, but are not limited to, a net concentration check 564a, a flow rate check 564b, an administration time check 564c, a duration check 564d, and an injection site check 564e. If the infusion order gets caught at check 564, clinician 116 can override the check. Overrides 566 can include overrides such as , but not limited to, net concentration override 566a , flow rate override 566b , dosing time override 566c , duration override 566d , and injection site override 566e . Override 566 can generate 520 a message for the physician and / or pharmacy. The infusion system 210 can distinguish between system-wide and subsystem overrides in determining whether it is necessary to generate 520 a message.

The override can include an indication of whether the clinician has the authority to override the tolerance. For example, the flow rate override 566b may indicate whether the clinician entering the infusion order has the authority to override the system flow rate tolerance 542b. This display can be applied to the patient care system 100 or subsystem. The duration override 566d may indicate whether the clinician 116 entering the infusion order has the authority to override the system duration 542d. This display can be applied to the patient care system 100 or subsystem. Override 566 also includes an indication of override reason 566f . The reason for overriding 568f can be selected by the clinician 116 from a drop-down menu.

  The result of the injection order creation 504 is the injection order 702. Infusion order 702 may include an infusion schedule 704. The infusion system 210 can predict the time as long as the infusion order 702 is active and, if not specified on demand, can generate an infusion schedule 704 for filling the infusion bag for that time. The ordering clinician does not need to specify an end date for the infusion order. The infusion system 210 can include automatic scheduling of infusion bag delivery based on the tolerance 542 defined for the infusion system 210.

(Order preparation)
FIG. 9 is a block diagram illustrating functional elements for the injection order preparation 506 of FIG. Infusion preparation 506 includes functional blocks for preparing infusion order 702 (FIG. 8). Infusion preparation 506 can include, but is not limited to, determination of preparation location 506a, component scan 506b, bag duration check 506c, and barcode printing 506d for medication label 124a. Barcode printing 506d can include the functions described above with reference to label printing 326 (FIG. 4).

  After the infusion order is entered into the infusion system 210, the preparation instructions are routed to the preparation location. The preparation location depends on the preparation program 506 of the injection system 210 and the injection elements. The infusion system 210 can include an adjustable database, such as a preparation area database 546a that identifies where infusion orders are to be prepared. The infusion order can be prepared at a pharmacy or at a remote location such as the floor or treatment location 106. Clinician 116 is guided through a preparatory process that includes component barcode verification using event management information that can be displayed on digital assistant 118 or other device having a display.

  The drug label 124a identifies the component and the component concentration. The medicine label 124a can be printed at any position. The medication label 124a preferably includes a bar code print 506d. Bar code print 506d may include a bar code label 124a print for each infusion bag. The label 124a helps to ensure that the correct medication is administered at the correct time and / or in the correct order. Alternating and sequential injection orders are particularly prone to sequence errors and over-time. Bar code printing 506d may include printing a unique bar code label for each bag of infusion order 702. Bar code printing 506d can also include printing a bar code label 124a that uniquely identifies the combination of components in the infusion bag and the concentration of those components. The barcode for medication 124 can include a prefix, a suffix, and a National Drug Code (NCD). In one embodiment, the barcode can also include a lot and an expiration date. Alternatively, a separate barcode containing the lot and expiration may be provided. Other embodiments of barcodes including active or passive RFID tags, magnetic strips, etc. may be used.

(Drug administration)
FIG. 10 is a block diagram showing functional elements for the drug administration 512 of FIG. Drug administration 512 includes functional blocks used to administer the drug to patient 112. Drug administration 512 includes drug barcode reading 512a, patient barcode reading 512b, execution of expiration date check 512c, titration notification 512d, flow rate versus drip rate display 512e, "as needed" infusion start 512f, operating parameter download 512g. , And time monitoring 512h. The infusion system 210 can also convert orders that may have one or more flow rates, such as tapering and alternating orders, into flow rates for the infusion bag currently being administered. The infusion system 210 can also convert an order having an infusion bag with different components, such as sequential orders, into a flow rate for the infusion bag currently being administered.

  Simultaneously with the administration of medication 124, clinician 116 scans medication label 124a. The infusion system 210 includes scanning the barcoded label 124a when initiating execution of the infusion order, changing flow rates, changing bags, and / or stopping the infusion order. The infusion system 210 confirms that an infusion bag having a label with a barcode should be administered at that time and to the patient 112. A history of drug administration, including flow rate and dose administered, can be collected and maintained. Some infusion orders require the infusion bag to be suspended with the intention of administering a specific amount of a small portion of the infusion bag. The infusion system 210 allows the clinician 116 to order a dose of an infusion bag. Most infusion pumps have the ability to determine the amount or flow rate and time to be administered. Once this time has elapsed, the infusion pump automatically prevents subsequent administration. Infusion system 210 provides a message to medication label 124a as a reminder to the administering clinician that it should be partially administered and that an appropriate amount should be administered.

  The flow rate versus drip rate display 512e uses the data generated by the flow rate versus drip rate function 548f to provide the administering clinician with the drip rate for the current infusion bag. During drug administration 512, the clinician 116 can use the digital assistant 118 to check the flow rate and other operating parameters. Flow rate change 1002b (FIG. 11) is communicated in real time.

  The infusion system 210 can include a start 512f of a PRN infusion or “anytime” infusion. The “anytime” infusion start 512 results in the creation of a new active order and the dispensing of PRN medication. This option includes prompting the clinician 116 to select a PRN infusion from a list of prior PRN orders made to the patient, and setting the requested infusion bag default value to 1. Can do. The clinician 116 may have the authority to change the amount of infusion bag requested.

  Operating parameter download 512g includes determining whether the patient identifier associated with the medical and / or patient identifier retrieved from wristband 112a is the same as the patient identifier associated with the medical at the central location. Can do. The determination is often made by a first computer, for example, the first central server 109. If the infusion system 210 determines that the various patient identifiers are not the same, the system can generate an alarm message 520. If the infusion system 210 determines that the various patient identifiers are the same, the infusion system 210 can download the operating parameters directly to the medical device 332. The infusion system 210 can send operating parameters to a medical device 332 such as the infusion pump 120.

  One advantage of the system program 210 is that the operational parameters for the medical device 332 can be used by the digital assistant 118 or any other computer at a remote location before the operational parameters can be used to program the medical device 332. There is no need to pass. Bypassing the remotely located computer eliminates a potential source of error in administering the medication 124 to the patient 112. The operating parameters for the medical device 332 can be sent “directly” to the medical device 332, assuming that various verifications are achieved. In this context, “directly” means that the operating parameters can be sent to the medical device without passing through the digital assistant 118 or any other computer at the remote location.

  In another embodiment, the infusion system 210 can include an additional block (not shown) in which the central computer receives the second medication identifier. The remote clinician 116 can enter a second medication identifier. The second medication identifier can be a revised first medication identifier. For example, the second medication identifier can be part of a prescription or electronic physician order that is the source of the first patient ID and operating parameters. The infusion system 210 can then confirm that the first and second medication IDs are equivalent before sending the operating parameters to the medical device. The second medication ID can be replaced with a revised first medication ID between the time the prescription is entered and the time when the medication 124 arrives at the treatment location 106. The infusion system 210 will then sound an alarm if the second medication identifier is not equivalent to the first medication identifier included in the medication label 124a. In yet another embodiment, the infusion system 210 can include additional blocks (not shown) whose operating parameters are used to program the medical device 332.

  Various blocks of the infusion system 210, such as block 512, can include the ability to display treatment information on the digital assistant 118. This can include the ability to display information that accurately reflects information on the display 120c of the infusion pump 120. Information on the display 120c of the infusion pump 120 can be supplemented with information about the patient 112, the patient's location, and the infusion order. This information can include information regarding multiple channels of infusion pump 120. The displayed information can include, but is not limited to, information such as personality, prompt line, status display line, operation icon, and head display. The operation icons include dripping, stop code, flow check piggyback, and delay start. The lift indication includes information such as drug label and injection rate. Those skilled in the art are familiar with the display information and operation icons described above.

  The time monitoring function 512h of the infusion system 210 calculates the remaining time to complete the order and the amount of infusion order remaining to be administered. When the clinician 116 uses the infusion system 210 to perform infusion orders, change flow rates, and check infusion status, the infusion system 210 calculates the time and amount remaining to be administered, and the calculation results are stored in the bag. If you indicate that you want to use a part of For example, in the last bag of an order that should be stopped before the full dose is administered and / or on the order bag that must be replaced before the full dose is administered, the clinician 116 may use the digital assistant 118 and / or Receive alerts on cart 132. The alert may include a message such as “administer only 150 ml”.

  Time monitoring 512h includes the ability to track any changes made to the flow rate using barcode scanning. The pharmacy is notified in real time to adjust the next required infusion bag preparation 506 according to the change. Monitoring of preparation 506 and drug administration 512 allows for just-in-time delivery of drug 124. Just-in-time delivery reduces waste due to cancellation or modification of infusion orders. Monitoring also ensures patient 112 safety.

  For titrations on the PRN order, the clinician 116 is automatically notified of the required flow rate change if the titration conditions within the order indicate that the flow rate should be changed. The injection system 210 includes a predefined function for calculating the flow rate to titration rate conversion 548f. The value defined by the infusion system 210 can be adjustable. The infusion system 210 can include an automatic conversion 548f of flow rate to infusion rate to assist the clinician 116 while performing the procedure.

(Documentation and correction of orders)
FIG. 11 is a block diagram illustrating functional elements for infusion order documentation 1012 and infusion order modification 514 and messaging 520 of FIG. Modification 514 includes functional blocks that are used to modify an existing infusion order. Modification 514 can also be viewed as creating a new order and updating an existing infusion order. Modification 514 includes modification change 1002, typically 1004 where all ordering options are available for a new order, recheck 1006, recheck override 1008, and new flow rate vs. new drip rate display 1010. be able to. Injection order modification often leads to documentation 1012 and messaging 520. The modification 514 includes the functionality described with respect to the prescription modification module 336 (FIG. 4). However, the modifications 514 can also be accessed from other parts of the patient care system 100 such as, but not limited to, prescription entry 324, prescription activation 306, and prescription permission 308.

  Corrections 514 include duration correction 1002a, flow rate correction 1002b, use of new injection site 1002c, correction reason identification 1002d, injection bag volume identification 1002e, and stop order processing 1002f. The clinician 116 may change the infusion rate without an order if the patient 112 complains of discomfort or promotes fluid balance, such as when the patient 112 is vomiting.

The modification change 1002 includes a new duration identification 1002a, a new flow velocity identification 1002b, a new injection site identification 1002c, a correction reason identification 1002d, a remaining amount identification 1002e in the injection bag, and a stop order 516. It is. The ordering options available during initial infusion order creation 504 are typically also available for infusion order modification. The ordering options available during initial order creation 504 include those shown in FIG. Recheck 1006 and recheck override 1008 are similar to check 564 and override 566 described with reference to FIG. The new flow rate versus new infusion rate display 1010 assists the clinician in minimizing the potential for errors during drug administration 512. The modified infusion order can result in a modified infusion schedule.

  The flow rate is frequently corrected at the treatment location 106, such as to regain delay without changing the dispensing schedule if the infusion is inadvertently stopped for a short time. With such a modification, it may not be necessary to communicate a new infusion schedule 704 to the pharmacy. In other cases, the new schedule 704 must be contacted by a pharmacy or other dispensing staff. The flow rate modification 1002b triggers an infusion order scheduling change and / or a message 520 to the appropriate clinician 116.

  When the clinician 116 enters the flow rate correction 1002b into the infusion system 210 at the treatment location 106, the clinician 116 may also choose to recalculate the infusion schedule 704 and send it to the pharmacy. The clinician 116 has the option to request that a new medication label 124a be printed by the barcode printing 506d module. The new drug label 124a includes data reflecting new information regarding any of the previously prepared infusion bags.

  The injection system 210 and / or clinician 116 may request an injection site modification 1002c. The site can be selected from a list of anatomical charts on the computer screen. The clinician 116 can be requested to identify 1002d the reason for the correction. Reasons stored in a database such as, but not limited to, timing override reasons 546f and flow rate override reasons 546g may be displayed to facilitate identification by the clinician 116. There may be a separate hard-coded reason for the correction ordered by the physician. For corrections ordered by the physician, the clinician 116 can be requested to identify the physician.

  Prior to performing the correction, the remaining amount in the current infusion bag is identified 1002e. The clinician 116 may be provided with an option to receive a quantity calculated from the displayed flow rate and / or quantity values before correction.

  If desired, the current injection can be stopped 1002f. If order stoppage is not required, for example, the same infusion bag can be used in conjunction with a new flow rate and / or a new additional drug, and the old flow rate can be identified and compared to the modified flow rate.

  Any previously prepared infusion bag can be checked for expiration based on the new infusion schedule 704. When the infusion order is resumed after a temporary stop or pending order, an expiration check can be performed regarding the expiration of the already prepared solution.

  The new infusion schedule 704 is used to control the preparation 506 at the pharmacy or other preparation location. The system default value 544 can be set as to whether any prepared bags should be credited to the patient 112 through the billing interface 312 and whether they should be credited to inventory. .

  Infusion order change 1002 includes all ordering options 1004 available for the new order. The modified flow rate can be rechecked 1006 for rules and tolerances such as, but not limited to, net concentration 1006a, flow rate 1006b, administration time 1006c, duration 1006e, and injection site 1006f. Override 1008 can be made available for out-of-tolerance modifications. The infusion system 210 can display 1008f the reason for the medication being administered at a time other than the time specified in the override and original order. The clinician 116 can be requested to identify the reason for the correction.

  The infusion system 210 can provide the clinician 116 with an indication of the modified infusion rate associated with the modified flow rate 1002. Display information can be calculated by a predefined function of flow rate versus drop rate 548f. The infusion system 210 can also be provided with a description of a typical infusion tube used within the infusion system 210 for use in calculating the infusion rate.

  The correction results in infusion system 210 confirming that the infusion bag has expired and providing a message to clinician 116 if the infusion bag expires before the order is completed. The message can request the clinician 116 to contact the pharmacy. Verification of infusion bag expiration for solutions such as, but not limited to, premixed solutions and solutions manufactured outside of infusion system 210 can include parsing scan code.

  The flow rate override 1008b can indicate whether the clinician 116 that modifies the infusion order has the authority to override the ordered limit without requiring approval for the new infusion order. This display can be applied to the patient care system 100 or subsystem.

Documentation 1012 captures injection order information in real time. Documentation includes, but is not limited to, documenting multiple injections in progress and duration change 1012a , flow rate change 1012b , volume change 1012c, and injection site change 1012d .

  The infusion system 210 can assist the clinician 116 to capture any changes in flow rate as changes occur. The clinician 116 can make the required flow rate changes in the infusion order, such as reducing the morphine infusion flow rate from 4 ml to 2 ml. Although the infusion system 210 can recognize the change as a new order, the infusion system 210 can be configured to avoid duplication so that the modified order does not result in the creation of a new bag.

  Documentation 1012 includes the ability to document changes such as, but not limited to, infusion suspend, infusion cessation, and / or infusion resumption. The clinician 116 can stop the infusion for a variety of reasons, such as a defect in the infusion site, a lack of infusion, and / or heparin / saline to facilitate patient 112 movement. Can be locked. The infusion can be resumed when the new site / infusion is restored. However, the amount of time this can be spent may be variable and is typically recorded by the infusion system 210.

  Government regulations often require tracking all outages in the infusion process. The infusion system 210 may be used by the digital assistant 118 or other computer by the dispensing clinician 116 to scan the drug label 124a and adjust 1002a the flow rate based on tolerances such as the tolerances generated by the tolerance setting 542. Allows the correction of flow rate to be documented on the device. The flow rate correction 1002b corresponds to the associated pharmacy infusion schedule 704 in real time and ensures just-in-time infusion bag inventory management for the patient treatment area 106. Documentation 1012 can allow for retrospective application of orders under certain circumstances.

  The injection system 210 includes the ability to document an injection site 1012d and a composite injection 1012e for multiple injection sites. In many situations, the patient 112 has multiple medications 124 and “unfinished” infusions so that some infusion medication flows into one site and other infusion medications are infused into another site. For example, morphine infusion, antibiotics and saline injected into the right arm (site 1) and TPN and 2/3 & 1/3 flowing into the dual lumen CVL (site 2). The infusion system 210 allows the clinician 116 to document through which site various fluids are being infused. In a treatment location 106, such as an intensive care unit, two or more many infusion drugs can flow into a line or a lumen. The clinician 116 can indicate which lumen of the CVL is infused or infused.

  The injection system 210 includes the ability to document the location 1012d of the site for injection and any site location changes. The injection site is frequently changed due to occlusion or strategy. Accordingly, the clinician 116 must document the site location change when the infusion is removed and then resumed.

  The injection system provides a centralized device configuration. Operating parameters for medical devices such as infusion pump 120 often include default values and / or tolerances. Default values and / or tolerances, such as flow rate tolerance 542b, may reside in storage system associated with infusion system 210 and / or device 332. For example, infusion pump 120 may include a database having a table of medications having an associated flow rate tolerance. If the clinician 116 enters a flow rate that exceeds the associated flow rate tolerance, the clinician 116 is alerted and then allowed to continue or prohibited from continuing. A device 332, such as a heart rate monitor, can also have a tolerance that can be set for alerts. In addition to alerts, many other features such as network name, IP address, polling period, and color can generally be set for the device 332. Infusion system 210 includes the ability to configure medical devices 332 individually or in groups from one or more central computers.

  System configuration parameters can be defined for the first type of medical device. System configuration parameters are sent and received by a first type of device unless the specific first type of device has more specific configuration parameters that apply to that specific first type of device. . For example, a first plurality of first type medical devices may be placed at a general medical procedure location. A second plurality of first type medical devices may be placed at the location of the intensive medical procedure. A general medical procedure location may not have specific setting parameters, while an intensive medical procedure location does not have specific therapeutic parameters. System configuration parameters apply to all first type medical devices throughout the infusion system 210, i.e. devices within a general medical procedure location, unless specific configuration parameters are applied to, for example, an intensive medical procedure location. Will be.

  For each type of device, the parameters that apply to all devices of that type across the devices grouped into a specific group are those specific configuration parameters if the specific device belongs to a group that has such a definition. Unless it is overridden to a more specific level in the infusion system 210. A group may be defined as a clinical service, a nursing room, and / or a combination of service and nursing room.

  For each type of device, the user can define a set of configuration parameters that apply to all types of devices used in operations that have a specific range of attributes that override any other definition. In hospitals, operations can consist of attributes that may include infusion order and patient weight, medication, patient pathology, and patient severity.

  A device can be associated with a specific patient by identifying it as a general group, part of a specific group, and / or including a device address in a table in a database. General or specific configuration parameters can then be transmitted to the device according to the device's identification information. That particular configuration parameter can then be read back to the infusion system 210 and compared to the configuration parameter originally transmitted to confirm that the first configuration parameter was received correctly by the device 332. If the configuration parameters are not received correctly, the infusion system 210 can provide a message 520 that identifies inconsistencies or communication failures.

  The infusion system 210 can detect changes to configuration parameters made at the instrument without going through the central computer and send messages and / or alerts 520. The infusion system 210 can also poll devices to confirm their configuration parameters. As the system and / or certain configuration parameters change, the change can be propagated to all devices 332 identified in the system as belonging to a group according to the grouping identified in the infusion system 210.

  Throughout this document and the associated claims, “central location” and “remote location” are terms relative to each other. A “remote location” is any location where the patient is being treated through a controlled medical device, such as the patient treatment location 106 where the patient 112 is being treated through the infusion pump 120. A “central location” is any location other than a remote location that is accessible to parameters for operating a medical device, such as, but not limited to, the location of the pharmacy computer 104 and the central system 108. In a typical arrangement, several remote locations, such as treatment location 106, are in communication with the central location.

Although the present disclosure focuses on the use of infusion pump 120 in system 210, it is understood that other medical devices can be used in system 210 without departing from the scope of the present invention. For example, various types of medical devices include, but are not limited to, infusion pumps, ventilators, dialysis machines, and the like. An additional type of medical device is a microelectromechanical system (MEMS) component. MEMS is a technique used to create very small devices that can be smaller than millimeters in size. MEMS devices are typically is manufactured from a glass wafer or silicon, this technology has grown far beyond its origins of the semiconductor industry. Each MEMS device is a microsystem integrated on a chip that can incorporate moving mechanical components in addition to optical, fluidic, electrical, chemical and biomedical elements. The resulting MEMS device or element is responsive to many types of inputs including pressure, vibration, chemicals, light, and acceleration. The MEMS component can be several different elements including various types of pumps, flow valves, flow sensors, tubes, pressure sensors or combinations of elements.

Thus, as further described in detail below, one use of the MEMS component is as an in-line MEMS pump 5314 shown schematically in FIG. The MEMS pump 5314 can pump fluid contained within the infusion bag 5320 through the tube 5312 and through the access device 5324 from there into the patient's body. The MEMS component has a MEMS local electronics element attached to it, the MEMS electronics element is connected to an external durable MEMS controller, the MEMS controller being described herein. Like the infusion pump 120 of the present invention described in the document, it can communicate with the system 210. In one embodiment of the MEMS pump 5314, the MEMS electronics element 5332 is preferably embedded in the MEMS pump 5314 and is capable of storing MEMS parameter operational information. The MEMS controller with its electronics and power supply can be physically or wirelessly connected to the MEMS electronics elements. In one embodiment, parameter operational information can be loaded from a removable MEMS controller 5338. The pump element 5314 preferably generates a fluid flow through the tube 5312 based on information stored locally within the MEMS electronics 5332. This information is preferably downloaded from a wired but removable MEMS controller 5338. Further, the MEMS component can communicate with system 210 via wireless communication. Further, the MEMS control device can transfer information to and from the system 210, and fully automates the control and inquiry processing of the MEMS components in the system 210 through a wireless or wired communication path.

  Utilization of MEMS or other emerging economic manufacturing technologies provides an opportunity to add MEMS elements to a disposable line set that provides additional functionality such as pumping, valvebing, and sensing. Some or all of the assistive local electronics could also be included in the disposable part of the line set. For example, it may be preferable to include a memory chip that contains calibration information for a combination of pumps, pressure sensors, and / or flow sensors, valves, or disposable elements. Disposability is desirable because it eliminates the need for costly sterilization of system components between each subsequent application.

(Pop-up window)
In one embodiment, the system can automatically provide clinicians with information related to one or more medications via a pop-up window. The medication table is preferably entered into the central database 108b. The medication table can include the generic name of one or more medications and any trade names associated therewith. Each message for display via a pop-up window is linked to each drug in the drug table. The message can be defined by the medical facility or predetermined by the system supplier. The message associated with each drug is 1) the risk associated with the drug, eg during handling or exposure, 2) how the drug is administered by the clinician, 3) the physician's reference information about the drug, 4) appropriate for drug infusion It is preferred to relate to a warning about the injection pumping channel and 5) injection setting procedures such as opening the roller clamp for piggyback injection.

  The pop-up window indicates that the medicine is in the calculator when the medicine is ordered by the doctor via CPOE, when the medicine is being processed by a pharmacy, etc., and when the medicine is being administered to the patient by the clinician. Displayed when selected or entered. In one embodiment, upon completion of selection or entry of a medication on a remote location computing device, a database in central system 108 is accessed and at least one of the pop-up window messages associated with the medication is remotely computed. Provided to the device and displayed to the clinician.

  At least one of the pop-up window messages associated with the medication is preferably provided for display at the same time as the start of certain steps of the medication order, processing, and administration procedure. For example, upon entering a medication into a computing device such as CPOE, a pop-up window with a message regarding doctor reference information about the medication is displayed, and in one embodiment, another pop-up window regarding the risk associated with the medication is displayed. be able to. Then, when processing the order by a pharmacy or the like, one or more pop-up windows are displayed on the computing device 104 in the pharmacy, providing general information about the drug and possible risks associated with the drug. . Next, when the order is being executed by the clinician, the clinician is informed to inform about the administration of the drug and, in one embodiment, possible risks associated with the drug, such as how to handle the drug. One or more pop-up windows are displayed on the associated computing device (ie, handheld 118).

  The pop-up window displayed on the computing device is preferably specific to the drug order, process, and step in the administration procedure being performed by the clinician. For example, a pop-up window containing doctor reference information is preferably not displayed to the nurse via the handheld device 118. Nevertheless, in one embodiment, a user or hospital can determine when and when a pop-up window should be displayed when a medication is selected or entered into a particular computing device.

  It is also preferred that the pharmacy determines when and when the pop-up window should be displayed. For example, the pop-up window is preferably not displayed for regular medicine. Instead, a pop-up window is preferably displayed for a drug that a pharmacy or medical facility considers that the additional information in the pop-up window will support drug ordering, dispensing, or administration.

(Drug administration)
A method for administering the drug 124 with the infusion system 210 is described below. The method includes the ability to modify the infusion order. Modifications include flow rate, modification of the injection site, temporary suspension of the injection, resumption of injection, and suspension of a new drug 124 container. The method includes scanning a barcode 512b associated with the patient, scanning a barcode 512a associated with the drug, confirming expiration 512c if the infusion is a mixture, and reason for modification And 1002e, which records the remaining amount of the infusion bag or receives a value calculated from the previous volume and flow rate. Infusion bag expiration confirmation 512c may include the use of a mixture table and / or barcode.

  The reason for the correction can be selected from the predefined table 546g. Reasons for correction can also include hard-coded values for changes ordered by the physician. When selecting a hard-coded value, the clinician 116 is prompted to select a physician from a list of physicians. The attending physician can be the default value in the list of physicians.

  There may be a quick selection function to stop the administration of the drug 124, for example a stop order 1002f. If rapid selection is not selected, the following steps can be included. Recording the flow rate and / or receiving a previous value relating to the flow rate-the previous value is displayed on the digital assistant display 118a, on the infusion pump display 120c, and / or on the medical cart 132; The comparison can be accomplished using the rules and tolerances of the injection system 210 or subsystem; displaying an appropriate message; converting between the flow rate and the infusion rate. The 1012-conversion that can be displayed can be calculated based on an infusion rate conversion table 548f that is predefined in the infusion system 210. Infusion system 210 generally uses a tube-based description to facilitate clinician 116 to select the correct infusion rate conversion.

  The step of changing the flow rate triggers the step of the infusion system 210 checking the expiration date of the infusion bag based on the scheduled flow rate. If the solution expires before or during administration, a message is sent to the clinician 116, for example, “This solution expires during the scheduled administration period. Please contact the pharmacy”. If it is a premixed infusion bag and / or a customized infusion bag, the expiration date is confirmed by parsing the scan code if possible. Either the pre-injection site is accepted or the location of the new injection site is selected from the list or graphical anatomy. The schedule 704 is then recalculated and a pharmacy inventory replenishment is performed. The infusion system 210 can include biometrics for identifying patients and clinicians 116.

  Prior to allowing the clinician 116 to access the infusion system 210, the infusion system 210 accesses information related to the identification of the clinician 116. The infusion system 210 can identify the clinician 116 using a device such as a bar code reader to read the clinician 116 badge 116a. The system also ensures that the clinician is an authorized user of the system, to ensure that the clinician 116 is identified, and that the clinician 116 has the authority to access each part of the infusion system 210. Biometrics can also be used to determine whether or not it has. Infusion system 210 may require a combination of clinician badge 116a, or other key, and a verified biometric match to authorize clinician 116 to access infusion system 210. The system is also configured to terminate access to the infusion system 210 when the clinician badge 116a has been removed from the proximity of the instrument used to read the clinician badge 116a or other key. You can also.

  Biometrics is a technique and science that statistically analyzes measured biological data. One field of biometrics is a field that determines unique physical characteristics such as fingerprints. Biometrics allows an individual to be identified to a digital system such as infusion system 210. A digital person is created to make transactions and interactions more convenient and secure. Biometric features for identification include, but are not limited to, features such as fingerprints, facial, iris and retina scanning, and voice identification. The biometric device includes a scanning or reading device, software for converting scanned information into digital form, and a storage device for storing biometric information for comparison with stored records. The software identifies specific matching points in the data processed by the algorithm and compares the data. Unlike passwords, PIN codes, and smart cards, the biometrics of the infusion system 210 cannot be lost, forgotten, or stolen.

  The biometric scanner can be associated with a device for reading the clinician 116 badge 116a. For example, the biometric scanner may be a thumb fingerprint reader on a bar code reader handle. In another embodiment, the biometric scanner and electronic key reader can be placed on a portable drug cart and / or medical device. When the clinician 116 places the electronic key within a certain distance from the medical device, the processor will identify the particular individual's electronic biometric identification file that it should seek. Infusion system 210 preferably prompts clinician 116 to scan his biometric information. Biometric information is input to the infusion system 210 by some type of biometric reader or biometric scanning device. A one-to-one comparison is made between the scanned biometric information and a particular individual's electronic biometric identification file stored in advance. This one-to-one match comparison is more efficient than a one-to-many match file because it does not require searching the entire clinician database for matches. Instead, only one specific comparison is made. If there is a match, the clinician 116 is then granted access to the medical device 332. If there is no match, the clinician 116 is denied access.

  Furthermore, in another embodiment, the medical device does not have a control device. For example, the medical device can be a pumping device that does not have a control device, and conversely it simply receives control signals from a separate control device. In one embodiment, the control device for such a medical device may be the first central computer 109. Accordingly, the first central computer 109 can directly send a control signal to the medical device to control the medical device.

  In another embodiment, after the infusion system 210 grants access to the clinician 116, the infusion system 210 grants the access when the electronic key is removed from the biometric scanner or the vicinity of the biometric scanner. finish. The neighborhood within which the electronic key must be held may be predetermined and / or may be a variable and programmable infusion system 210 parameter.

  In one embodiment, infusion system 210 includes an encrypted digital fingerprint template, clinician name, login name, and password. One technique for implementing clinician identifiers includes “IBUTTON 400” provided by Dallas Semiconductor technology. The injection system 210 can be activated when a clinician places a finger on a fingerprint scanner. If the infusion system 210 finds a match, the infusion system 210 can request the clinician 116 to log into the infusion system 210. If the infusion system 210 does not find a biometric match, the system does not allow the clinician 116 to access the infusion system 210.

  In another embodiment, a database storing biometric information may be maintained in the central system 108, the pharmacy computer 104, and / or the treatment location 106. At the treatment location 106, this database may be maintained within the portable cart 132, the digital assistant 118, and / or the medical device 332. Such a distributed database allows access to remote devices even when the network 102 cannot communicate between various locations. When network 102 communication is restored, the remote and central databases can be synchronized with any information modified at other locations so that both infusion system 210 databases can be properly updated.

  Infusion system 210 provides a closed loop infusion therapy management system. The closed loop begins with the clinician 116 order. Among other methods, the clinician 116 can enter orders through the digital assistant 118 and / or the medical cart 132. The order is then available in real time for pharmacy permit 508 and doctor permit 510. The order is available in real time as an electronic drug administration record (eMAR). The eMAR is available to the clinician 116 to perform the infusion. The infusion system 210 automatically documents modifications 514, such as drug administration 512 and flow rate change 1002b. Through the process of medication administration 512, the infusion system 210 simultaneously adjusts the infusion system 210 and / or subsystem inventory and billing 518. The infusion system 210 also provides event management and decision support data. The infusion system 210 is device independent in the sense that it can operate on workstations, wireless tablets, and handheld digital assistants 118. The infusion system 210 typically operates in real time, but batch processing and other messaging can be used to coordinate various stages of the infusion system 210 process.

  The closed loop infusion therapy management system includes infusion order entry 560, order preparation 506, and infusion status availability. Infusion order entry 560 is possible through several means such as, but not limited to, prescription entry module 324, prescription modification module 336, and pharmacy interface 316. The computer screen 400 can be used when inputting an injection order. The infusion status provides patient 112 specific infusion usage and informs the pharmacy of the need for additional infusion bags.

(Dialogue with clinician injection system)
Further, the infusion system 210 can use a login system to determine whether the clinician 116 has access to the infusion system 210. An example of a login system interface screen for the injection system 210 is shown in the login screen 1903 of FIG. On the interface screen, the clinician 116 enters both the username and password and clicks the “Login” key. The system 210 performs a check to confirm that the username and password are valid for the system 210. When either the user name or the password is not valid, the system 210 notifies the clinician 116 that the login has failed on the login screen 2005 shown in FIG. The clinician 116 will then have the opportunity to re-enter the username and password to correct any errors. If the username and password are valid, the clinician 116 will have access to the system 210. Further, if the clinician 116 logs in to the digital assistant 118 but does not use it for a period of time, the security measures of the system 210 prevent the digital assistant 118 from being used further until the clinician 116 logs in again. The

  The lead clinician can also log into the system 210. As described in detail herein, the lead clinician is usually the supervisor or specific person to whom the clinician belongs. In addition, the lead clinician may be a person who assists the workflow for the clinician or assists in monitoring alarm or alert conditions. In general, the lead clinician holds oversight or responsibility duties across at least one department. Thus, the lead clinician must log in with the login and password described above and then select the department associated with the lead clinician.

  After the clinician 116 completes the login process shown in FIG. 19 and is granted access to the system 210, the clinician 116 can perform several administrative functions. One such management function is to select a department. As shown in the department selection interface screen 2105 of FIG. 21, the clinician 16 can select a department from a drop-down menu 2107. In the example shown in FIG. 21, the clinician 116 has selected “Neurology ICU” as the department. After the clinician 116 selects the appropriate department from the drop-down menu 2107, the clinician 116 can enter the selected department by pressing the arrow key 4809.

  Another management function that the clinician can perform is to select the clinician shift. As shown in the shift selection screen interface 2211 of FIG. 22, the clinician 116 can select either a standard shift or a customized shift. For that input, several selectable standard shifts are provided in drop down menu 2107. However, if the clinician 116 selects a customized shift, the clinician is required to enter a start time and an end time for the customized shift. The clinician 116 can also manually enter a shift in the provided area 2255 and then tap the enter key 4809.

  An interface screen 2313 for viewing a patient is shown in FIG. In this screen 2313, after the shift is selected, the clinician 116 can see the patient associated with the clinician 116. The clinician 116 can also see work associated with the clinician 116. Thus, a list of “must do” can be provided based on patient, clinician work, or both. Different levels of shading and / or coloring can be utilized to distinguish between the levels of emergency care required for a particular patient. Further, various icons can be used in association with the patient to allow the clinician 116 to quickly understand the medical care required for the patient. The patient view interface screen 2313 of FIG. 23 provides the clinician 116 with the ability to add more patients with buttons 2315. When the clinician 116 selects the “add patient” key 2315, the clinician may be provided with a list of additional patients.

  The clinician 116 may also be provided with a patient selection interface screen 2417 shown in FIG. This screen 2417 allows the clinician 116 to select patients to be added to the clinician's shift. The patient may be from the department associated with the clinician or the clinician may choose to add patients from different departments. Clinicians 116 can also select the time they will be attached to the patient. In addition, the clinician 116 can find additional patients with the key 2419. It is also understood that the clinician 116 can remove the patient from the shift at any time.

  The system 210 may also provide a message to the clinician 116 specific to the patient assigned to the clinician shift. General messages can include items such as order profile changes and drug administration errors.

A patient information menu interface screen 2521 shown in FIG. 25 is also available on this system. The patient information menu screen 2521 provides a small patient chart for the selected patient. The patient menu screen 2521 also links the clinician 116 with patient related items such as drug / infusion administration, infusion infusion, infusion resumption, infusion titration, flow rate history, pump status, and removal of the patient from the shift. Also provides functionality. The patient menu screen 2521 also has tabs for allergies and Ht / Wt, medication history, and test results. An example of an allergy and Ht / Wt interface screen 2521a is provided in FIG. 25A . Normally, this screen 2521a is displayed when the mini chart is first opened. It displays information about the patient's drug allergies and general allergies, and the latest record of the patient's height and weight. An example of the medication history interface screen 2521b is provided in FIG. 25B . Typically, this screen 2521b provides the clinician with the patient's medication history within the selected lookback period. The lookback period can be adjusted by the clinician. Finally, an example of the inspection result interface screen 2521c is shown in FIG. 25C . Test results are made available in the system 210 through the laboratory interface. All available results are shown and displayed in new order.

An infusion schedule interface screen 2623 for the patient is shown in FIG. This screen 2623 shows the infusion schedule for the selected patient. By clicking on one of the identified orders, such as order 2625 for morphine sulfate on infusion schedule screen 2623, system 210 will link to the drug order interface screen 2627 shown in FIG. 26A . The drug order screen 2627 provides order details 2625 for a particular order (ie, morphine sulfate). As part of the detailed order 2625, treatment parameters 2629 are provided, as well as the ability to link to alerts 2631 and additional information 2633.

  FIG. 28 shows a patient profile infusion schedule interface screen 2835 in which one of the scheduled infusions has failed. As shown on screen 2835, a “medication failure” icon 4837 is shown next to the scheduled morphine sulfate infusion order 2839. By clicking on the “Medication Failure” icon 4837, the system 210 links the clinician 116 to the medication failure interface screen 2941 shown in FIG. The medication failure screen 2941 requests the clinician 116 to enter or select a reason 2943 for medication failure in the drop-down menu. The medication failure interface screen 2941 also queries the clinician 116 whether or not the medication schedule for order 2839 should be adjusted. To adjust the medication schedule, the clinician 116 selects a selection box 2945 on the interface screen 2941. When clinician 116 clicks on the drop-down menu and enters 2943 to select the reason for the medication failure, the drop-down menu will expand as shown on interface screen 3047 in FIG. Typically, if medication is no longer needed, the clinician will select “no need” reason 3045. If the clinician 116 selects a “no need” reason 3045 for a medication failure, the system 210 removes the medication failure icon 4837 and the “no need” icon as shown in the infusion schedule screen 3135 of FIG. 4857 is inserted.

  When the clinician 116 is ready to administer medication or order to the patient, the clinician 116 selects the order 3225 in the schedule interface screen 3235 and then “Get Item” as shown in FIG. ”Key 3249 to scroll down. After the clinician 116 selects the “Get Item” key 3249 in the screen 3249 of FIG. 32, the system 210 displays a medication interface screen 3351 as shown in FIG. On the medicine screen 3351, the clinician 116 scans the medicine selected from the medicine warehouse as indicated by the icon 3353 for scanning “medicine warehouse” or selects the “Omit warehouse scanning” key 3355 to store the medicine. It has a function of skipping scan blocks. When the clinician 116 scans an item, for example, by scanning a barcode on the item, the item information is displayed on the clinician's PDA 118. An example of the scan screen 3465 is shown in FIG. For example, when the clinician 116 scans a medicine, a prescription 3467 is displayed on the scan screen 3465. However, if the scanned item does not match the order for the patient, a scan error screen 3569 as shown in FIG. 35 will be displayed on the clinician's PDA 118. As shown in the interface screen 3569, when a scanning error is detected, the clinician 116 is provided with the identification information of the request or the item to be searched as shown in the screen 3569. For example, if the barcode cannot be scanned due to dirt or damage on the barcode label, the data required by the scan can be entered manually.

  If the selected medication is in the same efficacy category as another medication that was recently administered to the patient, the clinician's digital assistant 118 displays a warning message. Similarly, if the item has already been retrieved by another clinician, the digital assistant 118 displays a message indicating such occurrence.

  If the order to be removed is a mix at the administration site, the individual components will be identified on the digital assistant 118 and removed by the clinician 116. After the item is retrieved, the system 210 generates a bag ID and prompts the clinician 116 to print the label 124a. At this point, the clinician 116 also mixes the ingredients. After the clinician 116 prints out the label, the label is added to the bag and can be scanned with the digital assistant 118.

  A particular order can be on-call or on hold. These orders are displayed on a patient profile screen, such as interface screen 2835 of FIG. On-call or pending orders are only available for viewing, not for retrieval. These orders are later activated as needed.

  A scenario may also occur where the clinician 116 has items that include drug items that are not being used for the patient. Referring to the interface screen 3657 of FIG. 36, the clinician 116 has a function of identifying a reason for not administering the drug, such as not required by the monitoring result, inability to meet the patient, and medication refusal. If the patient has not yet been identified in the screen 3657, the clinician 116 can select the patient 3661 by scanning the patient or entering the patient's name. Further, the clinician 116 can select to return to the medicine item in the medicine cabinet by inputting using the “discard / return” selection key 3663. For certain narcotics and regulated drugs, two signatures (ie, a second authorization, typically in the form of a login and password), both for the initial drug acquisition and the drug return to the warehouse Signature).

  The interface screen 3657 of FIG. 36 also provides the clinician 116 with the ability to scan the patient ID and identify the patient. If the wrong patient is scanned, or if the patient ID does not scan properly, the system 210 displays a message that the scan is invalid. Further, if the clinician 116 is unable to administer the medication, the clinician will typically have to enter a reason 3659 for not administering the medication, as shown in screen 3657 of FIG. Some reasons for not administering the drug are that the monitoring results do not require the drug, cannot see the patient, or the drug is rejected by the patient.

  After the clinician 116 finishes confirming the patient and the item or drug, a route confirmation interface screen 3771 is displayed. As shown in FIG. 37, an example of the route confirmation screen 3771 assists the clinician 116 in confirming the route 3773, the line 3775, and the part 3777. A medication therapy 3778 can also be provided on the route confirmation screen 3771. After the clinician enters path 3773, line 3775, and site 3777, clinician 116 can select compare button 4817 and system 210 will verify that the entered data is correct.

Next, the clinician 116 can select the pump channel mode as shown in the interface screen 3881 of FIG. The pump channel mode interface screen 3881 shows the therapy 3882 and the clinician 116 has the option of specifying the therapy 3882 or the piggyback therapy 3883 as the primary therapy 3884. Each channel of the pump has the function of performing primary therapy in addition to piggyback therapy. After completing the selection of the pump channel mode, the clinician can perform a pump channel scan. FIG. 38A shows a pump channel scan interface screen 3885. On the pump scan screen 3885, the clinician 116 scans the medical device, such as by scanning a bar code corresponding to the pump channel 121 and then clicking the arrow key 4809.

The clinician 116 (a) scans the patient, for example on the interface screen 2313 of FIG. 23, (b) scans the drug, for example, on the interface screen 3465 of FIG. 34, and (c) the interface screen 385 of FIG. 38A , for example. After scanning the pump channel, such as above, the clinician 116 can program the infusion pump and compare the programmed infusion pump parameters or setpoint values with the pharmacy order parameters.

(Comparison of device setting value and order)
An exemplary flowchart of the comparison process 5200 is provided in FIG. This step can also be applied to the step of programming the injection setting value remotely from the server. Referring to FIG. 52, the comparison process 5200 begins at block 5202 after the clinician 116 has completed a scan of the patient ID 112a, drug container ID or drug bag ID 124a, and pump channel 121 as indicated above. By scanning the patient, drug bag, and pump channel, the associated baseline data is correlated so that the system 210, and more specifically the server 109, can further analyze and compare this additional data. Can do. First of all, however, the first central server 109 checks at block 5204 to ensure that the scanned or entered data for the patient, drug bag and pump channel provides a valid association. If the three data items do not result in a valid association, the system 210 displays an error message at block 5206 and the clinician 116 rescans the code for each of the patient ID, bag ID, and pump channel ID at block 5202 or Requires re-entry. If the three data items result in a valid association at block 5204, the server 109 will determine whether the identified pump channel 121 exists in the database of the server 109 and that it will utilize, as described below. The sequence will also be executed to determine if it is available.

  After the pump channel ID is entered into the system 210 by scanning, the first central server 109 checks at block 5208 to determine if the selected pump channel 121 is valid. Various reasons for determining pump channel invalidity are that the pump channel is not present in the system, the selected pump channel is already in operation, and so on. If the pump channel 121 check results in an invalid result, an error message is displayed and the clinician is notified that an invalid channel has been selected. Until the clinician 116 rescans the pump channel and a valid channel is recognized at block 5208, the comparison step 5200 is excluded and the system is unable to make a comparison, as shown at block 5214. However, if the result of the check confirms that the selected channel 121 is a valid channel, the system proceeds to block 5212 and establishes an appropriate link, as described below.

  At some point during the comparison process 5200, the second central server 108a generates an XML message that includes data related to the patient ID and the order ID. As shown in the flowchart for the comparison process 5200, XML data can be generated and transferred to the first central server 109 at any point prior to block 5212, as shown in block 5210. However, if the XML data received by the first central server 109 from the second central server 108a is invalid or incomplete, the comparison step is excluded and, as shown in block 5214, the system does not perform the comparison step. Do not allow to proceed. Conversely, if the XML data associated with the patient ID and order ID is complete and valid, after the first central server 109 receives the XML data from the second central server 108a, the comparison process 5200 proceeds to block 5212. move on.

  At block 5212, the first central server 109 attempts to establish a link or association with the patient ID, order ID, and pump channel 121. If the first central server 109 cannot establish a link between the data identified at block 5212, the comparison step 5200 is omitted and, as shown at block 5214, the system 210 indicates that the step proceeds. not allowed. In addition, the system 210 displays an error message that some data is missing or inaccurate and the system cannot perform a comparison. If the first central server 109 establishes an appropriate link between the identified data at block 5212, the system proceeds to block 5216 where the clinician 116 is required to press the comparison button 4817 on the digital assistant 118. move on. An example of the sequence of screens performed at block 5216 is described below.

  After the appropriate link is established by the first central computer 109, the system 210 proceeds to one of the comparison interface screens, such as the comparison interface screen 3986 of FIG. In this comparison interface screen 3986, the system 210 provides the clinician 116 with an instruction to program the infusion pump before making any comparisons. The comparison can be made to ensure that pharmacy parameters for the medication and pump settings are in sync. In a preferred embodiment, in the comparison step 5200 shown herein, the system 210 performs a speed comparison. However, the system can perform single or simultaneous multiple comparisons of any infusion parameter such as rate, volume, dose, etc.

  If the infusion is a primary infusion, an instruction is given to click on the “Compare” button 4817 on the comparison interface screen 3986 and then wait for instructions before starting the pump channel. If the infusion is a piggyback infusion, an instruction is given to press the start key on the pump 120 and then click the “compare” button 4817. In piggyback infusion, if the clinician 116 presses the comparison button 4817 at block 5216 before pressing the start key on the pump, an interface screen 4287 is displayed, usually as shown in FIG. 42, giving the clinician an error indication. Will be.

  Initially, before making the comparison, the system 210 polls the server 109 to ensure that the communication link between the pump 120, the server 109 and the digital assistant 118 is still active. If the communication link is active, the comparison process 5200 proceeds. If the communication link is lost, the comparison process cannot proceed.

  Thus, after the clinician 116 presses the comparison button 4817, the system 210 proceeds to block 5218 shown in FIG. At block 5218, the system 210 determines whether the channel 121 is ready. For example, if an infusion is identified as a primary infusion but the channel is already operational, the system will default to block 5214 and display an error message that the system cannot perform a comparison. Furthermore, if the infusion is identified as a piggyback infusion and the start key on the pump has not been pressed, the system defaults to the interface screen 4287 of FIG. 42 and presses the start key on the pump before pressing the compare button 4817. Notify clinician 116 to push.

  The comparison process 5200 also checks the pump 120 at block 5220 to determine if the setpoint or operating parameter programmed into the pump 120 contains fresh data. As an example, the system can require that the pump data has been programmed into the pump within a certain time limit (ie, 5 minutes) before requesting a comparison. Such a time limit for determining whether the data is new data can be set by the medical facility. If the data is not fresh data, the system will return to block 5214 and display an error message that the data is not fresh. The system 210 will then request that the pump 120 be reprogrammed so that the comparison process can proceed. If block 5220 determines that the data is fresh data, system 210 will perform a comparison at block 5222. The actual data comparison is usually performed by the first central server 109. As described above, the comparison is to determine if the parameters programmed into the pump match the physician's order. Additionally or alternatively, the pump settings can be remotely programmed by a remote controller or server.

  After making the comparison at block 5222, the system 210 determines at block 5224 whether there is a match or a mismatch and returns the result to the clinician 116 via the digital assistant.

An example of a comparison interface screen 3987 associated with a match as a result of the comparison is shown in FIG. 39A and identified in block 5226 of FIG. In this example, if the pharmacy prescription parameters match the programmed pump channel settings, the clinician 116 is instructed to start the infusion pump 120.

  An example of a comparison interface screen associated with the pharmacy prescription parameter and the programmed pump setting value not matching at block 5224 is shown in the mismatch comparison interface screen 4087 of FIG. 40 with the mismatch icon 4825 displayed. If this result occurs, the system 210 requires the clinician 116 to either accept the discrepancy identified at block 5228 or reprogram the infusion pump at block 5230 and make another comparison at block 5216. It will be. Normally, the parameter where the mismatch has occurred is displayed on the mismatch screen 4807. If the discrepancy is accepted, it is recorded in the system database 109 at block 5232. Further, if a mismatch is accepted at block 5228, server 108a directs the clinician to the appropriate screen.

  FIG. 41 shows an example of a comparison interface screen 4187 in which the system 210 cannot compare because part of the data cannot be obtained. Specifically, in the example of FIG. 41, the pump speed setting value is not input to the system 210. Thus, in this example, system 210 cannot make a comparison until additional data such as speed is entered. Typically, if an infusion is already in progress, the system is unable to receive updated pump information, there is a system communication error, or data from either programmed channel information or pharmacy prescription information If there are omissions, the system 210 cannot make a comparison. Finally, the comparison screen 4287 of FIG. 42 displays another scenario in which the system 210 cannot make a comparison until the displayed further steps are taken. Typically, this interface screen 4287 indicates that the infusion is a piggyback infusion, and the clinician 116 presses the start key on the infusion pump 120 before pressing the compare button 4817 as shown in the instructions on the interface screen 3986 of FIG. Provided when the comparison button 4817 in the interface screen 3986 in FIG. 39 is pressed without pressing.

After the infusion pump begins treatment, the clinician 116 can view the status of the pump on his or her digital assistant 118 in the pump status interface screen 4391 shown in FIG. The pump status display 4391 displays a list of all currently infusions for a given patient. Typically, one of five icons, an infusion indicator 4807, an infusion wait indicator 4810 , an infusion stop indicator 4811, an unknown icon, and a delay icon, will be displayed in conjunction with the infusion in this screen. become. The pump status display 4391 is not updated in real time while the current screen is displayed, but by tapping the refresh button 4819, the latest real-time pump status screen is displayed.

  As shown in FIG. 44, the clinician 116 can view the flow rate history interface screen 4493. The clinician 116 can go directly to the flow rate history screen 4493 by clicking the flow rate history link on the patient menu interface screen 2521 shown in FIG. The flow rate history shows the history of programmed flow rate history changes for the current infusion on a given channel. Typically, patient information associated with the channel is also displayed along with the latest prescription information for that channel. In addition, after the clinician 116 logs in on the digital device 118, selects shift, and selects a patient, the clinician 116 may record, but is not limited to, a record of an infusion performed, an infusion stop, or an infusion resumption. Includes recording, infusion stop recording, viewing the above pump flow rate history, viewing the above pump infusion status, responding to pump alarms and pump alerts described below, viewing messages / notifications and responding to messages / notifications Various tasks can be performed on the digital device 118. Specifically, regarding the records of infusions performed, after the clinician 116 scanned the item barcode, patient barcode, and pump channel barcode, the clinician programmed as detailed above. The pump setpoint can be compared with the order entered by the pharmacy. Typically, clinician 116 will then perform an infusion using pump 120 and record the infusion using digital device 118.

  To begin the infusion, the clinician 116 typically scans the patient's wristband barcode 112a and then the infusion bag barcode label 124a. When prompted by the digital device 118, the clinician 116 enters and compares infusion lines, sites and routes as shown in the interface screen 3771 of FIG. Next, on screen 3881 of FIG. 38, clinician 116 selects primary injection or piggyback injection 3883 and scans the pump channel. The clinician 116 then programs the pump as directed by the physician order. In programming the pump 120, the clinician 116 chooses to perform a pharmacy order and pump comparison check, as shown in FIGS. If the programmed pump settings match the pharmacy input order, an interface screen such as screen 4287 will indicate a match and the clinician 116 can tap the OK button 4805 to accept the match. Finally, the clinician 116 will press the start key on the pump 120. The digital assistant 118 will then display the administration result recording interface screen 4937 of FIG. 49, and the clinician 116 can enter the appropriate results from the choices in the drop-down list. These steps can be repeated for additional patients and / or additional pumps or channels.

Prior to administering the drug, the clinician 116 can be prompted to enter the parameters being monitored, such as the heart rate prior to administering digoxin , or the pain assessment prior to administering morphine. If the parameter being monitored is associated with a medication, each administration of the medication displayed on the digital assistant 118 has a link to an interface screen where the clinician 116 can enter a value. An example of such an order having a link 5001 to the input of the parameter being monitored is shown in the order displayed in FIG. After the monitored parameter link 5001 is selected, a monitored parameter input interface screen 5003 as shown in FIG. 50A is displayed. The clinician 116 can then enter the requested information into the system 210.

  In addition, the system 210 can request the clinician 116 to monitor the cycle count when retrieving a drug or regulated drug, usually from a pharmacy. In one example, when a warehouse drawer is opened to provide narcotics or regulated medicines, the digital assistant 118 may display a cycle count interface screen 5101 as shown in FIG. This interface screen 5101 prompts the clinician to count the unit of medication currently in the repository or storage location and prompts the user to enter this data into the provided field. The system 210 then compares this amount with the expected count. If the cycle counts do not match, the digital assistant 118 displays a message indicating the mismatch and then displays the cycle count screen 5101 again. If the cycle counts do not match again, the system 210 will log a mismatch and appropriate action can be taken.

If necessary, the clinician can stop an ongoing infusion before it ends. This can be done with or without a stop order to stop the infusion in the system. The aborted infusion can be resumed as needed, for example when titrating the order. When the infusion stop icon 4813 and the infusion in progress icon 4807 are both displayed on the digital assistant 118, the clinician 116 displays a list of all active infusions for the patient on the digital assistant 118. Receive instructions to move. An example of such an injection stop interface screen 2727a is shown in FIG. 27A . In FIG. 27A , the aborted infusion order will be highlighted and shown as being an aborted infusion order. The clinician 116 will then scan the bar code on the discontinued solution container for infusion and then scan the patient's ID. Next, an interface screen 2727b as shown in FIG. 27B is provided on the clinician's digital assistant 118. On the interface screen 2727b, the clinician can enter the time at which the infusion was stopped and the reason for the infusion being stopped. The clinician can then physically stop the infusion pump 120 by pressing a stop button on the infusion pump 120.

An infusion resume interface screen 2727c is provided in FIG. 27C . It is also possible to resume an infusion recorded as having been aborted without an order to abort. To resume the infusion, the clinician 116 must first go to the appropriate interface screen on the digital assistant 118. By tapping the infusion stop icon 4811 in the patient menu, a list of all infusions that are currently stopped for that patient will be displayed as shown in the interface screen 2727c of FIG. 27C . The clinician is prompted to select an infusion to resume. The clinician 116 then scans the barcode on the solution container for infusion to be resumed. The system 210 compares the scanned ID with that for the infusion that is currently discontinued for the patient. After the system 210 compares the ID with that currently suspended for the patient, the digital assistant 118 prompts the clinician 116 to scan the patient's ID. The system 210 then verifies that the scanned ID matches the patient's ID, after which the system 210 will display the scanned infusion prescription on the digital assistant 118 as shown in the interface screen 2727d of FIG. 27D . And prompts clinician 116 to select the reason set by the institution for resuming the infusion. Once the reason is selected, the clinician 116 can resume infusion with the pump 120 and then tap the arrow 4809 to continue. System 210 records the infusion as having been resumed.

Various icons are used to assist the clinician 116 as shown in the various screen shots / interfaces for the digital assistant 118. Many of these icons are shown in FIG. The patient list button 4801 is a key that, when tapped, allows the clinician 116 to move directly to a patient list screen such as the patient list screen 2313 shown in FIG. A return button 4803 is a key for returning the screen on the digital assistant 118 to the previous screen when tapped. An OK button 4805 is tapped to accept the data shown on the digital device 118. When the OK button 4805 is tapped, the next screen is normally displayed. An infusion in progress indicator button 4807 indicates that a programmed infusion is currently being performed for the selected pump 120 and channel. Infusion waiting indicator 4810 indicates that the programmed infusion for the selected patient, pump 120 and channel is on standby. The infusion stop indicator 4811 indicates that the programmed infusion for the selected patient, pump 120 and channel has been stopped. The infusion stop order indicator 4813 indicates that the infusion for the patient, pump 120 and channel selected by the pharmacy input order will be stopped. Physician note indicator 4815 indicates the presence of a physician note for the selected patient, pump 120 and channel. The clinician 116 can tap the note indicator 4815 to view the note. A compare button 4817 is provided on various screens and when tapped, causes the system 210 to perform a comparison between the scanned item and the pharmacy input order, and additional comparisons. A refresh button 4819 is tapped to update the latest data and display it on the screen. The exit button 4821 allows the clinician to exit the current screen and return to the previously displayed screen. The enter button 4809 is also an OK button, and is tapped to approve and input data selected from the options in the drop-down list or data manually entered in the field. The comparison match indicator 4823 indicates that the programmed pump setting value matches the pharmacy input order information. The comparison mismatch indicator 4825 indicates that the programmed pump setting value does not match the pharmacy input order information. Incomparable indicator 4827 indicates that the system is unable to compare the programmed pump settings with pharmacy input order information. Pump alarm / alert indicator 4872 indicates that an alarm condition or an alert condition has occurred. When the alarm / alert indicator 4872 is tapped, an enlarged pump alarm / alert screen is displayed. On the alarm / alert screen, a red alarm / alert icon 4872 indicates an alarm condition, and a yellow alarm / alert icon 4872 indicates an alert condition. The alarm / alert mute button 4874 is tapped to temporarily mute the audible alert on the digital device 118. Communication loss indicator 4833 indicates that pump 120 and / or hub 107 are not properly communicating with system 210. The message accompanying this indication describes the steps that should be taken to resolve the problem. The wireless module low battery alert indicator 4835 indicates that the hub 107 is currently operating on a spare battery with a remaining battery charge of less than 30 minutes.

  The above disclosure regarding settings and use of the digital assistant 118 has been discussed with respect to the clinician 116 performing these functions. However, it is understood that these tasks can be performed by any administrative staff or staff in the hospital, regardless of whether the individual is a clinician 116 or not.

(Emergency notification process)
Referring to FIG. 12, a preferred embodiment of an emergency notification system 1200 is shown. Notifying party 1210 is in communication with communication network 1220. Those skilled in the art will recognize that a variety of communication networks are operable including, but not limited to, Ethernet networks, coaxial cable networks, wireless local area networks, and wireless wide area networks. In addition, various communication network protocols such as, but not limited to, Transfer Control Protocol / Internet Protocol (“TCP / IP”), Wireless Application Protocol (“WAP”), and User Datagram Protocol (“UDP”) are available. It can be used. Further, the communication network 1220 can operate as part of a larger communication network. For example, the communication network 1220 can be, for example, a wireless communication network communicating with a wired communication network existing in a hospital.

  The communicating party 1210 is in communication with the communication network 1220. The notifying party 1210 can be a hospital clinician, for example, a nurse, doctor, hospital administrator, or security personnel. The notifying party 1210 can also be a patient. Further, the notification party 1210 can be an automated process, such as a computer program or a medical device. An automated process that serves as the notifying party 1210 can be programmed to broadcast emergency notifications across the communication network 1220 upon the occurrence of a particular condition or event. For example, the automated process can be programmed to broadcast an emergency notification simultaneously with the sensing of the patient condition.

  The emergency notification is received by one or more target parties 1230. Target party 1230 can be a clinician, such as a doctor and a nurse. Target party 1230 can also be an emergency response personnel or security personnel or an environmental disaster response team. Target party 1230 can be any individual in communication with communication network 1220. Embodiments of the present invention provide the notification party 1210 with the option of sending an emergency notification to a specific target party 1230 or multiple target parties 1230, or to all target parties 1230 only. This embodiment allows the notification party 1210 to select which target party 1230 will receive the emergency notification.

  Target party 1230 and notification party 1210 are in communication by communication network 1220. Those skilled in the art will recognize that various communication modes 1240 that can be provided to the notification party 1210 and the target party 1230 communicate with the communication network 1220. For example, the communication format 1240 can be a wired connection, such as a personal computer or a programmable controller. Communication format 1240 can also be a wireless network connection enabled through a handheld computer or mobile phone.

  Referring now to FIG. 13, a notification interface 1300 from the perspective of a notification party 1210 is shown. Those skilled in the art will recognize various interfaces that authorize the notifying party 1210 to broadcast emergency notifications over the communication network 1220. The notification interface can be a website connected to an intranet or the Internet. The notification interface can also be activated by a mobile phone or other phone, or by email. In one embodiment, the notification interface 1300 is a type of handheld computer that is commonly found commercially available. Examples include PalmOne, Inc. Palm device manufactured by PalmOne, Inc. Visor equipment, manufactured by Hewlett Packard, Inc. Jornada equipment manufactured by Dell, Inc. Axim equipment manufactured by Sony, Inc. The Clie device manufactured by Toshiba, Inc. PocketPC devices manufactured by Compaq and Symbol are included.

  In one embodiment, the notification interface 1300 includes a menu 1330 that lists one or more options 1340. For example, one notification option 1340 may allow the notification party 1210 to select a particular clinician or clinician type as the target party 1230 for emergency notification. Another notification option 1340 may allow the notifying party 1210 to choose to cancel the emergency notification if the emergency notification is sent in error. Additional notification options 1340 may include inputs for patient identification information, patient location, emergency type, and expected response time.

  Referring now to FIG. 14, one embodiment of a receiving interface 1400 from the perspective of the target party 1230 is shown. Similar to the notification interface 1300, the reception interface 1400 can operate on a variety of different platforms and can continue to be implemented under the principles of the present invention. In one embodiment shown in FIG. 13, the receiving interface 1400 is a handheld computer. Interface 1400 includes a screen 1420 for displaying configurable information 2350. The information 2350 may include emergency notification information such as patient identification information, emergency location, emergency type, and expected response time.

  Both the notification interface 1300 and the reception interface 1400 are optionally set with hot keys 1350, 1460. With regard to the notification interface 1300, the hotkey 1350 can be configured to send an emergency notification that includes information automatically obtained from the notification interface 1300 itself. For example, by pressing a hot key 1350 on the notification interface 1300, an emergency notification including the information can be automatically transmitted.

(Messaging & notification including alarm / alert notification)
The system provides functions for sending notifications and messages. Notifications include but are not limited to patient status lists, alarms, alerts, infusion schedules, orders, overrides, warnings, treatment parameters, links to additional information, medication failures, route confirmations, comparisons, flow rate information, physician notes, Loss of communication, low battery, administration results, etc. can be included. The system also provides the ability to display these and additional notifications. One means for displaying notifications is on the digital assistant 118. Notifications can also be provided to any one of a number of clinicians and / or primary clinicians.

As mentioned above, one type of notification is an alarm / alert notification. In this system, notifications can be increased step by step. The specific alarm / alert escalation process is shown in FIG. Typically, a notification step is provided for sending notifications to any number of clinicians 116. The identified alarm / alert escalation process 1500 of FIG. 15 has the ability to notify a set of clinicians via the clinician's device 118 when an alarm or alert is active on a medical device such as the infusion pump 120. provide. In a preferred embodiment, the clinician's device is a personal digital assistant (“PDA”) 118 as shown in FIGS. 1 and 3, generally having a display 118a and an audible sound or sound generator 118c. For illustrative purposes only, the clinician's device is identified below as digital assistant 118 in this detailed description. Further, the alarm / alert escalation process 1500 provides an escalation process if the clinician does not respond to the alarm / alert notification on the digital assistant 118. When the escalation process is initiated, a notification is sent to another or second clinician's digital assistant 118 identified in the escalation process. While alarm / alert notifications are sent to the digital assistant 118, it is understood that normally pump alarms and alerts can only be resolved at the pump. As described herein, as in block 1580 of FIG. 15, the mute of the alarm or alert in the digital assistant 118 may or may not act on the pump.

  The alarm / alert escalation process 1500 begins at block 1505 when at least one or both of an alarm condition or an alert condition is triggered in the medical device 120. In the preferred embodiment shown in FIG. 3, following an alarm or alert trigger at medical device 120, a signal including data related to the alarm condition or alert condition is generated and transmitted from medical device 120 to server 109 at block 1510. The In a wireless environment, a medical device 120 having a wireless transmitter is provided, or a medical device 120 connected to the wireless hub 107 is provided. In the latter example shown in FIG. 3, the hub 107 receives a signal from the medical device 120 and converts the signal into a form suitable for transmission to the system network 102 via the wireless communication path or wireless communication link 128. . Further, if the hub 107 recognizes that the alarm, alert, or other notification is a duplicate notification, the hub 107 can discard the duplicate notification. The transmitted signal is received by the wireless access point 114 in the medical environment. The wireless access point 114 serves as an interface between a wireless communication path (that is, the wireless path 128) and a wired communication path such as the wired communication path 110 shown in FIG.

  After server 109 receives the data related to the alarm or alert condition sent at block 1510, server 109 performs a prerequisite check at block 1515. Prerequisite check 3030 includes associating an alarm or alert condition in medical device 120 with a particular patient and associating the patient with a primary clinician, also referred to as a first clinician (this association is central system service device 108a). And associating the first clinician with the clinician's digital assistant 118. The server 109 uses the information obtained in its prerequisite check at block 1515 to use the medical device 120 (and in one embodiment the specific channel 121 of the infusion pump 120), patient, primary clinician or first clinician. And establish a relationship with the first clinician's digital assistant 118. It is understood that there is a many-to-many relationship between patient 112 and clinician 116. Thus, a number of first clinicians, a number of second clinicians, and a number of n-level clinicians can be associated with one particular patient. In addition, n-level escalation is possible within the system.

  The server 108a typically stores therein a patient-to-clinic many-to-many association and a patient-to-department association. Server 108a transmits these associations to server 109, which stores these associations. Similarly, server 108a sends the lead clinician-to-department association to server 109 for storage.

  Following the prerequisite check at block 1515, the server 109 determines the appropriate channel 121 mapping from the patient 112 to the clinician 116. Once the mapping is complete, at block 1520, the server 109 determines whether the first clinician's digital assistant 118 is active. If the first clinician's digital assistant 118 is active, then the server 109 generates a signal representing an existing alarm or alert condition. This signal includes data such as patient name, patient location, bed identification, room identification, alarm or alert type, status description, time, date, clinician identification and / or prescription. In the preferred embodiment, this signal is transmitted from server 109 to wireless access point 114. Next, at block 1525, the wireless access point 114 transmits a signal related to the alarm condition or alert condition to the clinician's digital assistant 118 via a wireless communication transmission.

  Signals related to the alarm condition or alert condition may also be transmitted to the primary clinician, the subordinates of the first clinician, or the second clinician at block 1525. Such a signal can be transmitted via wireless communication or wired communication. In addition, the lead clinician may be using a digital assistant 118, a desktop computer, or some other electronic device. The lead clinician is generally the supervisor or any person to whom the clinician directly belongs. In addition, the lead clinician can be a person who assists the clinician's workflow or assists in monitoring alarm or alert conditions.

The signal is received by the clinician's digital assistant 118 and subsequently displayed at block 1530 of FIG. In this block, an alarm or alert condition is displayed on the clinician's digital assistant 118. The display on the clinician's digital assistant 118 can be visible, audible, or both visible and audible. Further, the visual display can include one or more text, icons, symbols, and the like. Similarly, as described above, an audible display can include various audible sounds at various decibel levels. Visible indicators and audible indicators can be set by the hospital. FIG. 16A discloses a screen shot of an exemplary alarm / alert interface list screen 1662a on the clinician's digital assistant 118. FIG. The alarm / alert list interface 1662a includes a list of patients currently associated with the active channel alarm / alert. As shown in FIG. 16A , the clinician's digital assistant 118 currently has three active alarm / alert displays. There are alarm conditions for patient 1, 1664, alarm conditions for patient 2, 1666, and alert conditions for patient 3, 1668. As shown in FIG. 17, each patient name and the corresponding alarm / alert icon is hyperlinked to the appropriate pump alarm details interface screen. In one embodiment, the list of patients is filtered to include only patients currently associated with the clinician 116 logged into the digital assistant 118 displaying this interface screen. This clinician-to-patient association may be performed as a primary clinician or as a temporary clinician. The second clinician can also be accessed through the escalation process. The alarm / alert list interface 1662 is typically accessed by clicking on an alarm / alert icon 4872 displayed on the clinician 116 digital assistant 118 during normal clinician workflow.

As described above, if an alarm or alert condition is displayed on the clinician's digital assistant 118 at block 1530, this indication can be provided visually, audibly, or both. If an audible display is provided to the clinician's digital assistant 118, an alarm icon 4872 will appear on the display 118a of the clinician's digital assistant 118. If an audible indication is provided, the clinician may have the ability to silence the audible indication even if the clinician is not responding to an alarm or alert condition. If the clinician silences the alarm, the server 109 will activate a silence timer. The visual display will remain even if the audible display is muted. As shown in FIG. 16A , if an alarm / alert provides an audible indication to the clinician's digital assistant 118, but the sound is muted due to the clinician's silence, an alarm / alert silence icon 4874 is provided. The Furthermore, if the clinician does not respond to the alarm within the timer's time limit, at the same time as the alarm / alert status increases, the audible display can be silenced. An alternative embodiment of the audible display can be a vibration alert.

Further, it will be appreciated that multiple alarm / alert state times may occur simultaneously or overlapping. In response, a simultaneous or partially overlapping signal containing data related to a particular alarm condition or alert condition is generated and transmitted from the medical device 120 to the server 109 at block 1510. Alarm / alert signals can be generated from the same medical device 120 or from different medical devices 120. Furthermore, the alarm / alert signal can be related to the same patient or different patients. However, each alarm / alert signal is individually routed to the alarm / alert escalation process 1500 described herein for an individual alarm / alert state. As shown in FIG. 16A , a particular clinician may have multiple alarm / alert displays on his / her digital assistant 118. Another example of an alarm / alert screen is shown on the interface screen 1662b of FIG. 16B . As is common in the system, the line referenced as 1676 in the interface screen 1662b of FIG. 16B is the end of the list, specifically the alarm / alert display list for a particular clinician in this interface. Indicates.

FIG. 17 is a detailed view after selecting to view one of the alarm / alert indications for the patient hyperlink on the clinician's digital assistant 118 from the list 1662a in the interface of FIG. 16A . A patient alarm / alert interface 1765 is shown. Here, the clinician has selected an alarm display for patient 1, 1664. The alarm / alert details screen 1765 provides the clinician with a message detailing the reason for the alarm / alert. The clinician can click the refresh button 4819 to update the current information displayed on the screen 1765. As shown on the interface 1867 of FIG. 18, there may be multiple alarms or alerts 1878, 1882 for the same patient. This alarm / alert interface 1867 provides a list of all active pump alarms / alerts currently associated with a given patient. These active pump alarms / alerts may be from multiple channels 121 and / or pumps 120 and may even be spread across multiple hubs 107. This interface screen 1867 is accessed by identifying a given patient on the pump alarm list screen 1662.

  After a signal is sent to the clinician's digital assistant at block 1525 and received by the primary clinician's digital assistant 118 at block 1530, a timer is started at block 1535 at the server 109. This timer has a time limit. A typical escalation time limit is about 2 minutes, but this time limit can be set by the hospital. At block 1540, the system determines whether a response to the alert or alarm has been made within the timer time limit. If the timer time limit is reached without an acknowledgment from the primary clinician's digital assistant 118, the process proceeds to block 1545. At block 1545, the system further queries whether the medical device 120 has acknowledged or responded to an alarm / alert condition. If there is no response at the primary clinician's digital assistant 118 or medical device 120 or by the primary clinician, then at block 1545 the alarm / alert process is escalated.

  Whenever a communication loss occurs after the alarm / alert state is triggered but before the confirmation of the alarm / alert state, the alarm / alert state will be restored once the communication loss is repaired . Similarly, if an alarm / alert condition is triggered after a loss of communication, the alarm / alert condition will recover once communication is restored.

If the alarm is escalated, the server 109 performs another prerequisite check at block 1550 . This prerequisite check 1550 includes associating the patient with a second clinician (this association can be made at the central system service device 108a) and the second clinician with the second clinician's device or the first clinician. And associating with the second clinician's digital assistant 118, also referred to as the second clinician's digital assistant 118. Server 109 uses the information obtained in its prerequisite check at block 1550 to establish a relationship between medical device 120, patient, second clinician, and second clinician's digital assistant 118.

Following the second prerequisite check at block 1550 , the server 109 may also determine whether the second clinician's digital assistant 118 is active. If the second clinician's digital assistant 118 is active, then the server 109 generates an escalated signal representing an existing alarm or alert condition. This escalated signal also includes data such as patient name, patient location, room identification, bed identification, alarm or alert type, status description, time, date, clinician identification and / or prescription. In the preferred embodiment, the escalated signal is transmitted from server 109 to wireless access point 114. The wireless access point 114 then transmits, at block 1555, an escalated signal associated with the alarm condition or alert condition to the second clinician's digital assistant 118 via a wireless communication transmission.

  Escalated signals associated with alarm conditions or alert conditions may also be transmitted to the lead clinician at block 1555. Such escalated signals can be via wireless or wired communication. In addition, the lead clinician can use a digital assistant, a desktop computer, or some other electronic device. As discussed above, the lead clinician is usually the supervisor or specific person to whom the clinician belongs, or the person who assists the workflow for the clinician or monitors the alarm or alert condition.

  The escalated signal is received by the second clinician's digital assistant 118 and subsequently displayed at block 1560 of FIG. This block displays an alarm or alert condition on the second clinician's digital assistant 118. The display on the second clinician's device can be a visual display, an audible display, or both a visual display and an audible display. In addition, the visual display can include one or more text, icons, symbols, and the like. Similarly, as described above, the audible display can include various audible sounds. However, it is understood that the original signal transmitted to the first clinician (see block 1525) is still retained by the first clinician's digital assistant, as shown in block 1530 of FIG. . The signal at the first clinician's digital assistant 118 can be enhanced (ie, it can be shown in a larger size or font, it can flash, increase the volume of audible alerts, etc.).

  After the secondary signal is sent to the clinician's digital assistant at block 1555 and received by the second clinician's digital assistant 118 at block 1560, at least two individuals (first clinician and / or supervisor) There are at least two devices with active alarm / alert conditions. Accordingly, as shown in blocks 1540 and 1565, any of these clinicians can respond to an alarm / alert condition. At block 1570, the escalated alarm process continues until the alarm / alert condition is cleared at any one of the clinician's digital assistant 118, the lead clinician's computer or device, or the medical device 120. Become.

Referring to block 1520, if the server 109 determines that the primary clinician's digital assistant 118 is not active, and if the server 109 determines that an alarm / alert condition still exists at block 1545, the server 109 is discussed above. Proceeding to block 1550, a suitable second clinician or primary clinician will be determined to send an alarm / alert signal. Further, it is understood that block 1520 can occur at any time during the alarm / alert escalation process 1500. One reason that the clinician's digital assistant 118 is inactive may be a loss of signal from the server 109. As shown in the communication loss interface screen 4501 of FIGS. 45A and 45B , if a signal is lost, the digital assistant 118 provides the clinician 116 with a screen 4501 showing signal loss and / or an audible / vibration display. . The loss of communication screen 4501 also notifies the clinician 116 which patient's signal has been lost. In screen 4501, system 210 also provides clinician 116 with troubleshooting information to regain the signal. When hub 107 or digital assistant 118 is out of radio range, pump alarms and alerts cannot be received by digital assistant 118.

Other reasons why the digital assistant 118 is not active may be a decrease in the battery power of the digital assistant 118, a decrease in the battery power of the wireless hub 107, or a loss of signal of the digital assistant due to the access point 114. . System 210 provides the clinician 116 with a low battery screen. As shown in the interface screen 4603 of FIG. 46, one type of low battery screen is a screen that alerts the clinician that a low battery condition exists in the wireless hub 107 connected to the patient's infusion pump. When a low battery screen is provided, it includes a list of patients whose infusion is associated with that particular hub 107. The list of patients usually includes only patients currently associated with the clinician logged in to the digital assistant 118 displaying the screen 4603, and all patients sharing the same infusion pump 120 / hub 107 with the logged in clinician. Filtered to include. This clinician-to-patient association may be the first clinician or the second clinician throughout the escalation process. It will be appreciated that there may be other reasons why the clinician's digital assistant 118 is not active. Nevertheless, whenever the clinician's digital assistant 118 becomes inactive, the process 1500 may proceed to block 1550 so that a signal can be sent to the second clinician and / or the lead clinician. it can. Further, as described above with respect to the timeout feature and other features of the present disclosure, if a communication signal from the server 109 or medical device 120 is lost, the signal loss on the digital assistant 118 as shown in FIGS. 45A and 45B . A message can be provided.

  At any time during the alarm / alert process, the primary clinician can respond to the alarm / alert signal. If the primary clinician responds to the alarm / alert signal at block 1540, the escalated process will be avoided. However, if the escalated process is initiated at block 1550, at block 1565, the attending physician or second clinician can respond to the alarm / alert signal. Similarly, an alarm / alert condition can be cleared at any time at the medical device 120 or by the lead clinician before or during the alarm / alert escalation process. After the alarm / alert condition is cleared at block 1540 or block 1565 at the medical device 120 or by the primary clinician, at block 1540 the audible alarm of the medical device 120 and the clinician's digital assistant 118 is terminated. Become.

  At block 1585, the server 109 records all alarm / alert conditions as events. Recording the event includes recording information about the alarm / alert state, recording a clinician who responded to the alarm / alert state, and recording a start time of the alarm / alert state (see block 1505). And recording the time when the alarm / alert condition was corrected. Further, at block 1590, the server 109 will reset the timer and update the medical device alarm list. Alarm / alert conditions can also be recorded in the pump event history.

(Example use case)
55A-62 are flowcharts of exemplary operations that can be performed using the systems described herein. Exemplary operations include performing a new infusion, scanning the pump channel, changing the channel to which the pump is assigned, stopping / stopping the infusion, restarting the infusion, and removing the pump. In general, each of these operations includes information indicating the operation to be performed, information identifying which patient 112 will be affected (eg, patient ID), and which medication 124 for that patient 112. An input is received from an electronic device, such as digital assistant 118, that includes information (eg, RxID) that identifies whether it will be affected. This information is then transmitted to the first central server 109, which confirms that the channel identification information matches the infusion order information and confirms that the correct infusion operation has been performed. .

(Injection implementation process)
FIG. 55A shows an example of an implantation implementation process 5500. Part of the implantation implementation process 5500 is an alternative embodiment of the comparison procedure 5200 outlined above. The implant implementation process 5500 can be used to initiate a new implant. In general, infusion delivery process 5500 includes information indicating that the infusion delivery process will be performed, information identifying which patient 112 is affected (eg, patient ID), and which medication 124 for that patient 112. An input is received from an electronic device, such as digital assistant 118, that includes information (eg, RxID) identifying whether an infusion will be initiated. Step 5500 then sends this information to the first central server 109, which confirms that the channel identification information matches the injection order information and that the correct injection has started. Confirm.

  More specifically, this exemplary injection implementation process 5500 begins when the second central server 108a causes the digital assistant 118 to display a list of patients at block 5502. An example of a digital assistant display 118a showing a list of patients is shown in FIG. The list of patients is preferably limited to patients 112 associated with the user (eg, clinician 116) who is logged into the digital assistant 118 at that time. Once the user selects the patient 112, the selection and / or information identifying the patient 112 is returned from the digital assistant 118 to the second central server 108a. Communication between the digital assistant 118 and the second central server 108a can be via any suitable communication path, such as the wireless / wired network 102 described above. Next, at block 5504, the second central server 108a causes the digital assistant 118 to display a list of actions. An example of a digital assistant display 118a showing a list of operations is shown in FIG. The list of actions is preferably limited to actions associated with the selected patient 112. For example, the “perform infusion” operation will be available only if at least one infusion is currently associated with the selected patient 112.

  When the user selects a “perform injection” action from the action list, information identifying the selected action is sent to the second central server 108a. In response, at block 5506, the second central server 108a displays a screen on the digital assistant 118 prompting the user to select a medication 124 to be infused from the list of medications displayed on the digital assistant 118. Let An example of a digital assistant display 118a showing a list of drugs is shown in FIG. The list of medications is preferably retrieved from the database of the second central server 108a based on the actual order for this patient 112. Of course, this list can have any number of items including no injection runs or one injection run. Data indicating the selected medication 124 is then transmitted to the second central server 108a.

  Next, at block 5508, the second central server 108a causes the digital assistant 118 to display a screen that prompts the user to scan a machine readable identifier associated with the patient 112. An example of a digital assistant display 118a that prompts the user to scan a machine-readable identifier associated with the patient 112 is shown in FIG. The user can scan the bar code label on the patient wristband 112a using the scanner of the digital assistant 118. Alternatively, the user can manually enter the patient identifier into the digital assistant 118. Next, at block 5510, the patient identifier is sent to the second central server 108a for verification. The second central server 108a then attempts to retrieve the patient identifier in the database. If the patient identifier (eg, wristband ID) does not exist as a valid patient identifier in the database, the second central server 108a causes the digital assistant 118 to display a patient invalidation notification at block 5512. Once the user accepts the patient invalidation notification (or the notification times out), at block 5508, the digital assistant 118 redisplays a screen prompting the user to scan the machine readable identifier associated with the patient 112.

  If at block 5510 a patient identifier (eg, wristband ID) exists as a valid patient identifier in the database, then at block 5514, the second central server 108a provides a machine readable identifier associated with the medication 124 to be administered. A screen prompting the user to scan is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. The user can scan the medication label 124a on the medication 124 bag (eg, a barcode on the infusion bag) using the scanner of the digital assistant 118. Alternatively, the user can manually enter the medication identifier into the digital assistant 118. Next, at block 5516, the medication identifier is sent to the second central server 108a for verification. The second central server 108a attempts to search for drug identifiers in the database. If the medication identifier (eg, bag ID) does not exist as a valid medication identifier in the database, at block 5518, the second central server 108a causes the digital assistant 118 to display an item invalidation notification. Once the user accepts the item invalidation notification (or the notification times out), at block 5514, the digital assistant 118 re-displays a screen prompting the user to scan and resume the machine-readable identifier associated with the medication 124. indicate.

  Once a valid medication identifier is obtained, the second central server 108a uses the medication identifier to search for a patient identifier in the database. Next, at block 5520, the patient identifier from the database is compared to the scanned (or manually entered) patient identifier, and the scanned (or manually entered) drug 124 is scanned (or manually entered). ) It is determined whether the patient 112 belongs. If the two patient identifiers do not match, at block 5518, the second central server 108a causes the digital assistant 118 to display an item invalidation notification.

  If the two patient identifiers match (ie, this patient 112 matches this medication 124), at block 5522, the second central server 108a prompts the user to enter a route, line, and location. It is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to enter a route, line, and location is shown in FIG. Next, at block 5524, data indicating the route, line, and location is sent to the second central server 108a for verification. If a path mismatch occurs, at block 5526, the second central server 108a causes the digital assistant 118 to display a path mismatch notification. An example of a digital assistant display 118a with a mismatch notification is shown in FIG. Once the user accepts the route mismatch notification (or the notification times out), at block 5522, the digital assistant 118 redisplays a screen that prompts the user to enter the route, line, and location. If a path mismatch does not occur, at block 5528, the second central server 108a causes the digital assistant 118 to display a screen asking the user to make a selection between a manual prescription comparison and an automatic prescription comparison. If manual prescription comparison is selected at block 5530, then at block 5532, the second central server 108a causes the digital assistant 118 to display what is indicative of parameters that the user will manually verify.

  Subsequently, at block 5534, the second central server 108a determines whether there are more items (eg, medications) to be performed for this patient 112. For example, the injection order selected at block 5506 may require a primary injection and a piggyback injection. If there are more items (eg, medications) to be performed for this patient 112, at block 5514, the second central server 108a prompts the user to scan the machine readable identifier associated with the medication 124 to be administered. A prompt screen is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. If there are no more items (eg, medications) to be performed for this patient 112, at block 5536, the second central server 108a causes the digital assistant 118 to display a screen showing the results of the implementation. An example of the digital assistant display 118a showing the implementation result is shown in FIG.

  The implementation result is also passed to the first central server 109. For example, the implementation results can be passed as form variables to the first central server 109 (as if submitted from a web page). Next, at block 5538, the first central server 109 checks all of the implementation results for any errors. If there is no failure, at block 5540, the first central server 109 commits all new channel-patient-drug relationships to the database of the first central server 109. Next, at block 5542, the first central server 109 returns to control of the second central server 108a by navigating to a predetermined URL associated with the second central server 108a. If there are one or more failures, at block 5544, the first central server 109 discards the channel-patient-drug relationship associated with the error and the channel-patient-drug relationship associated with the success, Commit to the database of the first central server 109. The failure may be associated with the second central server 108a and / or the first central server 109. Accordingly, when the first central server 109 returns to control of the second central server 108a by moving the first central server 109 to a predetermined URL associated with the second central server 108a in block 5546. In addition, the failure (eg, maintenance failure) associated with the first central server 109 is preferably returned to the second central server 108a.

  Returning to block 5530, if automatic prescription comparison is selected, the second central server 108a sends a “prescription comparison” XML document to the first central server 109 at block 5531. The “prescription comparison” XML document includes a patient identifier (eg, wristband ID), a medication identifier (eg, bag ID), a completion URL, and a cancellation URL. The completion URL is a network address used when a prescription match is found. The cancellation URL is a network address used when a prescription match is not found.

  Once the first central server 109 receives the “prescription comparison” XML document, at block 5548, the first central server 109 determines whether the first central server 109 is valid for the “prescription comparison” XML document. Determine. For example, the first central server 109 can check whether data that would normally be predicted in a “prescription comparison” XML document is missing from the received “prescription comparison” XML document. If the first central server 109 determines that the “prescription comparison” XML document is not valid, at block 5550 the first central server 109 indicates that the first central server 109 was unable to perform the “prescription comparison” operation. Is displayed on the digital assistant 118. This display can include reasons such as which data is missing from the “prescription comparison” XML document. After the user presses the “OK” button to accept the error message, at block 5552, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the first central server 109 determines that the “prescription comparison” XML document is valid, the first central server 109 starts a channel scan process 5554. Typically, the channel scanning step 5554 scans for machine readable identifiers associated with “new” pump channels (eg, pump channel 103a) and determines whether the scanned channel is available (eg, assigned to any patient 112). The user is prompted to determine (not assigned, assigned to the current patient 112 but not used, assigned to another patient 112 and overwritten, etc.). If the scanned channel is not available, the “perform injection” operation is canceled. In such a case, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL. If the scanned channel is available, a new channel-patient-drug relationship is created. The channel scan process 5554 is described in more detail below with reference to FIG.

  If the channel scan process 5554 determines that the scanned channel is valid and available, at block 5556 the first central server 109 displays a screen prompting the user to program the pump channel with a digital assistant. 118 is displayed. The digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5560, the first central server 109 determines whether communication with the pump channel is functioning normally. For example, if the status information is not received from the channel within a predetermined time, the first central server 109 can determine that communication with the pump channel is not functioning properly.

  If communication with the pump channel is not functioning properly, at block 5562, the first central server 109 displays a screen to the digital assistant 118 indicating that prescription comparison cannot be performed due to loss of communication with the pump channel. Display. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5560, the first central server 109 rechecks whether communication with the pump channel is functioning properly.

  If communication with the pump channel is functioning normally, at block 5564, the first central server 109 determines whether any data associated with this channel is missing. For example, if the predicted sequence number received from the channel is missing, the first central server 109 can determine that the data associated with this channel is missing. If channel data is missing, at block 5564, the first central server 109 causes the digital assistant 118 to display a screen indicating that prescription comparison cannot be performed due to missing channel data. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5560, the first central server 109 rechecks whether communication with the pump channel is functioning properly.

  If no channel data is missing, at block 5568, the first central server 109 determines whether the channel is already operational. For example, the first central server 109 can determine whether the pump channel is in operation by reading status information received from the channel. If the channel is already operational, at block 5570, the first central server 109 causes the digital assistant 118 to display a screen indicating that the prescription comparison cannot be performed because the channel is already operational. An example of the digital assistant display 118a indicating that prescription comparison cannot be performed is shown in FIG. Digital assistant display 118a may also indicate that the user must press a particular key (eg, start) on pump 120. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5572, the first central server 109 rechecks whether communication with the pump channel is functioning normally.

  If communication with the pump channel is not functioning properly, at block 5574, the first central server 109 displays a screen to the digital assistant 118 indicating that prescription comparison cannot be performed due to loss of communication with the pump channel. Display. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5574, the first central server 109 rechecks whether communication with the pump channel is functioning properly. If communication with the pump channel is functioning normally, at block 5576, the first central server 109 performs the requested prescription comparison.

  Returning to block 5568, if the channel is not operational, at block 5578, the first central server 109 determines whether the pump channel is configured to transmit speed information. If the pump channel is not set to transmit speed information, at block 5580, a screen indicating that the first central server 109 cannot perform a prescription comparison because the channel is not transmitting speed information. Is displayed on the digital assistant 118. An example of a digital assistant display 118a indicating that prescription comparison cannot be performed is shown in FIG. Digital assistant display 118a may also indicate that the user must press a particular key (eg, speed) on pump 120. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5572, the first central server 109 rechecks whether communication with the pump channel is functioning normally. If the pump channel is configured to transmit speed information, at block 5576, the first central server 109 performs the requested prescription comparison.

  As part of the prescription comparison, the first central server 109 uses the channel identifier obtained by the channel scan step 5554 and the patient identifier transmitted by the second central server 108a to provide one medication identifier ( Or, search for two medication identifiers if both primary medication 124 and piggyback medication 124 are associated with this channel. Next, at block 5582, one or more drug identifiers from the database are compared to the scanned (or manually entered) drug identifiers. If the one or more medication identifiers from the database do not match the scanned (or manually entered) medication identifier, at block 5588, the first central server 109 causes the digital assistant 118 to display a medication invalidation notification. . For example, the digital assistant 118 displays a message that the scanned medication 124 is not associated with the scanned channel, and the actual medication 124 assigned to the scanned channel (if applicable, primary and piggy Both back) can be shown. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5572, the first central server 109 rechecks whether communication with the pump channel is functioning normally.

  As an additional part of the prescription comparison, the first central server 109 uses the channel identifier obtained by the channel scan step 5554 and the patient identifier transmitted by the second central server 108a to retrieve the medication rate in the database. . Next, at block 5584, the dosing rate from the database is compared to the actual rate received from the pump channel. If the medication rate from the database does not match the actual rate received from the pump channel, at block 5586, the first central server 109 causes the digital assistant 118 to display a rate mismatch notification. An example of a digital assistant display 118a with a mismatch notification is shown in FIG. For example, the digital assistant 118 may display a message indicating that the channel speed should be adjusted and indicate the correct value. Again, the digital assistant display 118a preferably includes a “compare” button and a “cancel” button. If the user presses the “Cancel” button, the first central server 109 discards the new channel-patient-drug relationship at block 5558 and passes a cancellation code to the second code via the cancellation URL at block 5552. Return to the central server 108a. If the user presses the “Compare” button, at block 5572, the first central server 109 rechecks whether communication with the pump channel is functioning normally.

  In addition, the digital assistant display 118a may include an “accept mismatch” button. If the user presses the “Accept Mismatch” button, at block 5588, the first central server 109 returns the mismatch code and unmatched speed to the second central server 108a via the completion URL. If the medication rate from the database at block 5584 matches the actual rate received from the pump channel, the first central server 109 causes the digital assistant 118 to display a match notification at block 5590. An example of a digital assistant display 118a with a match notification is shown in FIG. Once the user receives the match notification message, at block 5588, the first central server 109 returns the match code and matching speed to the second central server 108a via the completion URL.

(Channel scan process (for injection process))
FIG. 56 shows an example of the channel scan step 5554 used above with reference to FIG. Typically, the channel scan step 5554 scans the machine readable identifier associated with the pump channel to determine if the scanned channel is available (eg, assigned to the current patient 112 but not used). Prompt the user to make a decision. If the scanned channel is not available, the “perform injection” operation is canceled. In such a case, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL. If the scanned channel is available, a new channel-patient-drug relationship is created.

  More specifically, the exemplary channel scanning step 5554 selects a first screen that prompts the user to select a sub-channel (eg, primary or piggyback) at block 5602 and scan a machine-readable identifier associated with the channel. Start when the central server 109 displays on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with a channel is shown in FIG. For example, the user can scan a bar code label associated with a channel using the scanner of the digital assistant 118. Alternatively, the user can manually enter the channel identifier into the digital assistant 118. In addition, the user may select to omit the scanning step that causes a return to the second central server 108a via the completion URL, and return to the second central server 108a via the cancellation URL. You may choose to cancel the scan that causes

  Then, at block 5604, the channel identifier is sent to the first central server 109 for verification. The first central server 109 then attempts to find the channel identifier in the database. If the channel identifier does not exist as a valid channel identifier in the database (eg, not properly formatted, not configured in the first central server 109, etc.), at block 5606, the first central server 109 The channel assistant notification is displayed on the digital assistant 118. For example, the digital assistant 118 can display a message that the channel is not set up in the first central server 109 and a button that allows the user to rescan the channel identifier or cancel the operation. Can be included. If the user chooses to cancel the operation, in block 5608, the first central server 109 preferably sends a cancellation code to the second central server 108a via the cancellation URL.

  Once a valid channel identifier is obtained, the first central server 109 uses the channel identifier to look up the patient identifier in the database. Next, at block 5610, the first central server 109 compares the patient identifier from the database with the scanned (or manually entered) patient identifier. If there is a valid patient identifier in the database but the two patient identifiers do not match (ie, the channel is assigned to a different patient 112), at block 5612, the first central server 109 checks the database. To determine if the channel is operational (in primary and / or piggyback mode).

  If the channel is active, at block 5614, the first central server 109 is “non-overwriteable” indicating that a different patient 112 is associated with the scanned channel and that the channel is currently active. An error message is displayed on the digital assistant 118. The message may also include data indicating the patient 112 (eg, patient name), primary medication 124, and / or piggyback medication 124 associated with the scanned channel. The user is preferably given the option to cancel or rescan. If the user chooses to cancel the operation, at block 5608, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user has made a choice to rescan, at block 5602, the first central server 109 selects a subchannel (eg, primary or piggyback) and scans the machine readable identifier associated with the channel. A screen prompting the user is displayed on the digital assistant 118.

  If the channel is not operational, at block 5616, the first central server 109 may indicate a “continue overwrite” warning indicating that a different patient 112 is associated with the scanned channel but the channel is not currently operational. The message is displayed on the digital assistant 118. This warning message preferably indicates that continuation will overwrite existing data (eg, disassociate with other patients 112). The alert message may also include data indicating the patient 112 (eg, the patient's name), the primary medication 124 and / or the piggyback medication 124 associated with the scanned channel. The user is preferably given the option to cancel, rescan, or continue. If the user chooses to cancel the operation, at block 5608, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user has made a choice to rescan, at block 5602, the first central server 109 selects a subchannel (eg, primary or piggyback) and scans the machine readable identifier associated with the channel. A screen prompting the user is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with a channel is shown in FIG. If the user has made a choice to continue, at block 5618, the first central server 109 generates a new channel-patient-drug relationship, and the new channel-patient-drug relationship is updated to the latest “web session. ”. If this new channel-patient-drug relationship is ultimately retained, as detailed above, at block 5540 of FIG. 55, the first central server 109 determines that the new channel-patient-drug relationship. Is committed to the database of the first central server 109.

  If there is a valid patient identifier in the database and the two patient identifiers match at block 5620 (ie, the channel is assigned to this patient 112), the first central server 109 at block 5622 , Check the database to see if the subchannel is free. In other words, the first central server 109 checks that there is no primary injection associated with this channel when the primary subchannel is selected at block 5602, and the piggyback subchannel is selected at block 5602. Check that there is no piggyback injection associated with this channel. If the sub-channel is free, at block 5618, the first central server 109 generates a new channel-patient-drug relationship and places the new channel-patient-drug relationship in the latest “web session”. To store. If the subchannel is not free, at block 5624, the first central server 109 checks the database to see if the subchannel is operational (in primary and / or piggyback mode).

  If this subchannel is active, at block 5626, the first central server 109 indicates that this patient 112 is already associated with a scan channel and the selected subchannel is currently active. An “Unable to overwrite” error message is displayed on the digital assistant 118. The error message may also include data indicating the patient 112 (eg, the patient's name), the primary medication 124, and / or the piggyback medication 124. The user is preferably given the option to cancel or rescan. If the user chooses to cancel the operation, at block 5608, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user has made a choice to rescan, at block 5602, the first central server 109 selects a subchannel (eg, primary or piggyback) and scans the machine readable identifier associated with the channel. A screen prompting the user is displayed on the digital assistant 118.

  If the subchannel is not operational, at block 5628, the first central server 109 indicates that this patient 112 is associated with the scanned channel, but the selected subchannel is not currently operational. The “Continue” message is displayed on the digital assistant 118. The error message may also include data indicating the patient 112 (eg, the patient's name), the primary medication 124, and / or the piggyback medication 124. The user is preferably given the option to cancel, rescan, or continue. If the user chooses to cancel the operation, at block 5608, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user has made a choice to rescan, at block 5602, the first central server 109 selects a subchannel (eg, primary or piggyback) and scans the machine readable identifier associated with the channel. A screen prompting the user is displayed on the digital assistant 118. If the user has made a choice to continue, at block 5618, the first central server 109 generates a new channel-patient-drug relationship and updates the new channel-patient-drug relationship to the latest “web session”. Store in. When the user presses continue again, the first central server 109 returns control to the most recent operation (eg, performing an injection).

(Pump channel change process)
FIG. 57A shows an example of a pump channel change process 5700. The pump channel change process 5700 can be used to change the infusion from one pump channel to another without losing the channel-patient-drug relationship in the database (eg, by a nurse). Typically, the pump channel change process 5700 includes information indicating that the pump channel change process is to be performed, information identifying which patient 112 will be affected (eg, patient ID), and the patient 112 An input is received from an electronic device, such as the digital assistant 118, that includes information (eg, RxID) that identifies which medication 124 is to be affected. Step 5700 then sends this information to the first central server 109, which confirms that the channel identifier information matches the pump channel change order information.

  More specifically, the exemplary pump channel change process 5700 begins at block 5702 when the second central server 108a causes the digital assistant 118 to display a list of patients for selection. An example of a digital assistant display 118a showing a list of patients is shown in FIG. The list of patients is preferably limited to patients associated with the user (eg, clinician 116) who is logged into the digital assistant 118 at that time. Once the user selects the patient 112, the selection and / or information identifying the patient 112 is returned from the digital assistant 118 to the second central server 108a. Communication between the digital assistant 118 and the second central server 108a can be via any suitable communication channel, such as the wireless / wired network 102 described above. Next, at block 5704, the second central server 108a causes the digital assistant 118 to display a list of actions. An example of a digital assistant display 118a showing a list of actions is shown in FIG. The list of actions is preferably limited to actions associated with the selected patient 112. For example, a “change pump channel” operation could only be performed if the infusion associated with this patient 112 is currently listed in the database of the second central server 108a.

  When the user selects a “change pump channel” operation from the operation list, information identifying the selected operation is sent to the second central server 108a. In response, at block 5706, the second central server 108a displays a screen that prompts the user to scan for a machine readable identifier associated with the drug 124 that is affected by this "change pump channel" action. 118 is displayed. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. The user can use the scan of the digital assistant 118 to scan a medication label 124a (eg, a barcode on an infusion bag) on the medication 124 bag. Alternatively, the user can manually enter the medication identifier into the digital assistant 118.

  Next, at block 5708, the medication identifier is sent to the second central server 108a for verification. The second central server 108a attempts to search for drug identifiers in the database. If a medication identifier (eg, bag ID) does not exist as a valid medication identifier in the database, at block 5710, the second central server 108a causes the digital assistant 118 to display an item invalidation notification. Once the user acknowledges the item invalidation notification (or the notification times out), at block 5706, the digital assistant 118 provides the machine readable identifier associated with the medication 124 that is affected by this “change pump channel” action. Redisplay the screen that prompts the user to scan.

  If at block 5708 the medication identifier (eg, bag ID) is present as a valid medication identifier in the database, the second central server 108a transmits the “change pump channel” XML document to the first central server 109. . The “change pump channel” XML document includes a patient identifier (eg, selected from the list in block 5702), a medication identifier (eg, bag ID), a completion URL, and a cancellation URL. The completion URL is a network address used when an operation of “changing the pump channel” is attempted. The cancellation URL is a network address used when the operation of “changing the pump channel” fails.

  Once the first central server 109 receives the “Pump Channel Change” XML document, at block 5724, the first central server 109 determines whether the “Pump Channel Change” XML document is valid. For example, the first central server 109 may check whether any data that would normally be expected in a “pump channel change” XML document is missing from the received “pump channel change” XML document. If the first central server 109 determines that the “pump channel change” XML document is not valid, at block 5726 the first central server 109 was unable to perform a “pump channel change” operation. An error message shown to the user is displayed on the digital assistant 118. This indication may include reasons such as which data was missing from the “pump channel change” XML document. After the user presses the “OK” button to acknowledge this error message, at block 5728, the first central server 109 returns a failure code to the second central server 108a via the cancellation URL.

  If the first central server 109 determines that the “change pump channel” XML document is valid, the first central server 109 initiates a channel scan process 5730. This channel scan step 5730 is associated with the “old” channel (ie, the user is about to move from the “old” channel to the “new” channel). Typically, the channel scan step 5730 prompts the user to scan a machine readable identifier associated with the “old” pump channel and determines whether the scanned channel is associated with a patient identifier and a medication identifier (FIG. 58). As described in more detail below). If the scanned channel is not associated with a patient identifier and patient identifier, the “change pump channel” operation is canceled. In such a case, at block 5728, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the scanned channel is associated with a patient identifier and a medication identifier (ie, the old channel is valid), at block 5732, the first central server 109 sends the patient 112, the old channel of the primary infusion, and the piggyback infusion A message indicating the old channel is displayed on the digital assistant 118. The digital assistant 118 preferably also displays a message indicating that both infusions (primary and piggyback) have been moved by this operation, along with a “continue” button and a “cancel” button. If the user presses the “Cancel” button, at block 5728, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the user presses the “Continue” button, the first central server 109 initiates another channel scan process 5734. This channel scan step 5734 is associated with the “new” channel (ie, the user is about to move from the “old” channel to “new”). Typically, the channel scan step 5734 prompts the user to scan the machine readable identifier associated with the “new” pump channel and whether the scanned channel is available (eg, assigned to any patient 112). No, assigned to the current patient 112 but not used, assigned to another patient 112 and overwritten, etc.). If the scanned channel is not available, the “change pump channel” operation is canceled. In such a case, at block 5728, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL. The channel scan process 5734 is described in more detail below with reference to FIG.

  If the scanned channel is associated with a patient identifier and a medication identifier (ie, a new channel is valid), at block 5736, the first central server 109 determines that any other infusion is currently To determine whether it is associated with a different channel. If another infusion is already associated with the new channel, at block 5738, the first central server 109 sends a message to the user indicating that another infusion is currently associated with the new channel and the user. A message is displayed on the digital assistant 118 asking if she wants to overwrite the current infusion. This message preferably includes a “Yes” button, a “No” button, and a “Cancel” button. If the user presses the “Cancel” button, at block 5728, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL. If the user presses the “No” button, the first central server 109 initiates another channel scan process 5834.

  If the user presses the “No” button, at block 5740, the first central server 109 attempts to resolve the channel-patient-drug relationship in the database for this new channel. If the attempt to resolve the channel-patient-drug relationship in the database for the new channel is unsuccessful at block 5742, then at block 5744, the first central server 109 associates the patient identifier with the unmoved primary infusion. Causes the digital assistant 118 to display a "change pump channel" error message that includes the drug identifier (if applicable) and the drug identifier (if applicable) associated with the piggyback infusion that was not moved . Once the user accepts the “Pump Channel Change” error message by pressing the “OK” button, at block 5746, the first central server 109 sends a failure code to the second central server 108a via the completion URL. Return to

  If another infusion was not already associated with the new channel at block 5736, or if the attempt to resolve the channel-patient-drug relationship in the database for the new channel was successful at block 5742, at block 5748, The first central server 109 attempts to change the channel-patient-drug relationship in the database for both primary and piggyback injections from the old channel to the new channel. If the attempt to move the channel-patient-drug relationship in the database from the old channel to the new channel is unsuccessful at block 5750, the first central server 109 displays a "pump channel change" error message to the digital assistant 118. Let

  If at block 5750 the attempt to move the channel-patient-drug relationship in the database from the old channel to the new channel is successful, at block 5752 the first central server 109 is associated with the patient identifier, the moved primary infusion. The digital assistant 118 displays a “change pump channel” success message that includes the medication identifier (if applicable) and the medication identifier (if applicable) associated with the moved piggyback infusion. This indication preferably also includes a message to the user to move the tube to a new channel. Once the user acknowledges the “change pump channel” success message by pressing the “OK” button, at block 5746, the first central server 109 sends a success code to the second central server 108a via the completion URL. Will be returned.

(Channel scan process)
FIG. 58 shows an example of the channel scan step 5730 used above with reference to FIG. Typically, the channel scanning step 5730 prompts the user to scan a machine readable identifier associated with the pump channel and determines whether the scanned channel is associated with a pre-scanned patient identifier and medication identifier. If the scanned channel is not associated with these patient and drug identifiers, the current action (eg, stop, stop, resume, channel change, pump removal, etc.) is canceled.

  More specifically, the exemplary channel scan step 5730 causes the digital assistant 118 to display a screen that prompts the user to scan the machine readable identifier associated with the channel at block 5802 at the first central server 109. To start. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with a channel is shown in FIG. For example, the user can scan a bar code label associated with a channel using the scanner of the digital assistant 118. Alternatively, the user can manually enter the channel identifier into the digital assistant 118.

  Then, at block 5804, the channel identifier is sent to the first central server 109 for verification. The first central server 109 then attempts to find the channel identifier in the database. If the channel identifier does not exist as a valid channel identifier in the database (eg, not properly formatted, not configured in the first central server 109, etc.), at block 5806, the first central server 109 The channel assistant notification is displayed on the digital assistant 118. For example, the digital assistant 118 can display a message that the channel is not set up in the first central server 109 and a button that allows the user to rescan the channel identifier or cancel the operation. Can be included. If the user chooses to cancel the operation, in block 5808, the first central server 109 preferably sends a cancellation code to the second central server 108a via the cancellation URL.

  Once a valid channel identifier is obtained, the first central server 109 uses the channel identifier to look up the patient identifier in the database. Next, at block 5810, the patient identifier from the database is compared to the scanned (or manually entered) patient identifier. If the two patient identifiers do not match, at block 5812, the first central server 109 causes the digital assistant 118 to display a patient invalidation notification. For example, the digital assistant 118 may display a message that the scanned patient 112 is not associated with the scanned channel and indicate the actual patient 112 assigned to the scanned channel. Again, the PDA display can include a button that allows the user to rescan the channel identifier or cancel the operation. If the user chooses to cancel the operation, in block 5808, the first central server 109 preferably sends a cancellation code to the second central server 108a via the cancellation URL.

  Once a valid channel-patient relationship is established, the first central server 109 uses the channel identifier and patient identifier to identify one drug identifier (or both primary drug 124 and piggyback drug 124 in the database). If associated with this channel, search for two drug identifiers). Next, at block 5814, one or more drug identifiers from the database are compared to the scanned (or manually entered) drug identifiers. If the one or more medication identifiers from the database do not match the scanned (or manually entered) medication identifier, at block 5816, the first central server 109 causes the digital assistant 118 to display a medication invalidation notification. . For example, the digital assistant 118 displays a message that the scanned medication 124 is not associated with the scanned channel and the actual medication 124 assigned to the scanned channel (primary and piggyback if applicable). Both). Again, the PDA display can include a button that allows the user to rescan the channel identifier or cancel the operation. If the user chooses to cancel the operation, in block 5808, the first central server 109 preferably sends a cancellation code to the second central server 108a via the cancellation URL.

  If a valid channel-patient-drug relationship has been established, at block 5818, the first central server 109 indicates that a valid channel scan has been performed without issuing an additional indication on the digital assistant 118. Return control to the latest operation (eg, administration, stop, stop, resume, channel change, pump removal, etc.).

(Channel scan process (new channel))
FIG. 59 shows an example of the channel scan step 5734 used above with reference to FIG. Typically, the channel scanning step 5734 prompts the user to scan a machine readable identifier associated with the pump channel, and the scanned channel is available (eg, assigned to the current patient 112 but used). Not). If the scanned channel is not available, the current action (eg channel change) is canceled.

  More specifically, the exemplary channel scanning step 5734 causes the digital assistant 118 to display a screen in block 5902 that prompts the user to scan the machine readable identifier associated with the channel at the first central server 109. To start. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with a channel is shown in FIG. For example, the user can scan a bar code label associated with a channel using the scanner of the digital assistant 118. Alternatively, the user can manually enter the channel identifier into the digital assistant 118.

  Next, at block 5904, the channel identifier is sent to the first central server 109 for verification. The first central server 109 then attempts to find the channel identifier in the database. If this channel identifier does not exist as a valid channel identifier in the database (eg, not properly formatted, not set in the first central server 109, etc.), at block 5906, the first central server 109 Causes the digital assistant 118 to display a channel invalidation notification. For example, the digital assistant 118 can display a message that the channel is not set up in the first central server 109 and a button that allows the user to rescan the channel identifier or cancel the operation. Can be included. If the user chooses to cancel the operation, in block 5908, the first central server 109 preferably sends a cancellation code to the second central server 108a via the cancellation URL.

  Once a valid channel identifier is obtained, the first central server 109 uses the channel identifier to look up the patient identifier in the database. Next, at block 5910, the first central server 109 compares the patient identifier from the database with the scanned (or manually entered) patient identifier. If a valid patient identifier exists in the database but the two patient identifiers do not match (ie, the channel is assigned to a different patient 112), at block 5912, the first central server 109 checks the database and Check if this channel is operational (in primary and / or piggyback mode).

  If the channel is active, at block 5914, the first central server 109 indicates that a different patient 112 is associated with the scanned channel and indicates that the channel is currently active. "An error message is displayed on the digital assistant 118." The error message may also include data indicating the patient 112 associated with the scanned channel (eg, patient name), primary medication 124, and / or piggyback medication 124. The user is preferably given the option to cancel or rescan. If the user chooses to cancel the operation, at block 5908, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user chooses to rescan, at block 5902, the first central server 109 causes the digital assistant 118 to display a screen that prompts the user to scan the machine readable identifier associated with the channel.

  If the channel is not operational, at block 5916, the first central server 109 indicates a “continue overwrite” warning indicating that a different patient 112 is associated with the scanned channel but the channel is not currently operational. The message is displayed on the digital assistant 118. This warning message preferably indicates that continuing will overwrite existing data (eg, disassociate with other patients 112). The alert message may also include data indicating the patient 112 associated with the scanned channel (eg, patient name), primary medication 124, and / or piggyback medication 124. The user is preferably given the option to cancel, rescan, or continue. If the user chooses to cancel the operation, at block 5908, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user chooses to rescan, at block 5902, the first central server 109 causes the digital assistant 118 to display a screen that prompts the user to scan the machine readable identifier associated with the channel. If the user has made a choice to continue, at block 5918, the first central server 109 causes the digital assistant 118 to display a message indicating that it is allowed to use the selected channel. If the user presses “continue”, the first central server 109 returns control to the most recent operation (eg, dosing, channel change, etc.) without issuing an additional display to the digital assistant 118.

  If there is a valid patient identifier in the database at block 5920 and the two patient identifiers match (ie, the channel is assigned to this patient 112), the first central server 109 at block 5922 Check the database to see if the channel is free (eg, neither primary injection nor piggyback injection is associated with this channel). If the channel is free, at block 5918, the first central server 109 causes the digital assistant 118 to display a message indicating that it is allowed to use the selected channel. If the channel is not free, at block 5924, the first central server 109 checks the database to see if the channel is operational (in primary and / or piggyback mode).

  If this channel is active, at block 5926 the first central server 109 “overwrites” indicating that this patient 112 is associated with a channel that has already been scanned and that the channel is currently active. An “impossible” error message is displayed on the digital assistant 118. The error message may also include data indicating the patient 112 (eg, the patient's name), the primary medication 124, and / or the piggyback medication 124. The user is preferably given the option to cancel or rescan. If the user chooses to cancel the operation, at block 5908, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user chooses to rescan, at block 5902, the first central server 109 causes the digital assistant 118 to display a screen that prompts the user to scan the machine readable identifier associated with the channel.

  If this channel is not operational, at block 5928, the first central server 109 indicates that the patient 112 is associated with the scanned channel but the channel is not currently operational. Is displayed on the digital assistant 118. The message may also include data indicating the patient 112 (eg, the patient's name), the primary medication 124, and / or the piggyback medication 124. The user is preferably given the option to cancel, rescan, or continue. If the user chooses to cancel the operation, at block 5908, the first central server 109 sends a cancellation code to the second central server 108a via the cancellation URL. If the user chooses to rescan, at block 5902, the first central server 109 causes the digital assistant 118 to display a screen that prompts the user to scan the machine readable identifier associated with the channel. If the user has made a choice to continue, at block 5918, the first central server 109 causes the digital assistant 118 to display a message indicating that it is allowed to use the selected channel. When the user presses continue again, the first central server 109 returns control to the most recent operation (eg, channel change) without issuing an additional display to the digital assistant 118.

(Injection stop / stop process)
FIG. 60 shows an example of the injection stop / stop process 6000. The infusion stop / stop step 6000 can be used to temporarily stop (ie, pause) the infusion or completely stop (ie, terminate) the infusion step. Typically, the infusion stop / stop process 6000 includes information regarding whether a stop or stop will be performed, information identifying which patient 112 will be affected (eg, patient ID), and the patient An input is received from an electronic device, such as the digital assistant 118, that includes information identifying which medication 124 for 112 will be stopped or discontinued (eg, RxID). Step 6000 then sends this information to the first central server 109, which confirms that the channel identification information matches the stop / stop order information and stops the correct injection. Or confirm that it will be canceled.

  More specifically, the example infusion stop / stop process 6000 begins when the second central server 108a causes the digital assistant 118 to display a list of patients at block 6002. An example of a digital assistant display 118a showing a list of patients is shown in FIG. The list of patients is preferably limited to patients associated with the user (eg, clinician 116) who is logged into the digital assistant 118 at that time. Once the user selects the patient 112, the selection and / or information identifying the patient 112 is returned from the digital assistant 118 to the second central server 108a. Communication between the digital assistant 118 and the second central server 108a can be via any suitable communication channel, such as the wireless / wired network 102 described above. Next, at block 6004, the second central server 108a causes the digital assistant 118 to display a list of actions. An example of a digital assistant display 118a showing a list of actions is shown in FIG. The list of actions is preferably limited to actions associated with the selected patient 112. For example, the “stop infusion” and “stop infusion” operations would be available only if the infusion associated with this patient 112 is currently in progress.

  When the user selects a “stop injection” or “stop injection” operation from the list of operations, information identifying the selected operation is sent to the second central server 108a. In response, at block 6006, the second central server 108a describes all active infusions for that patient 112 and scans the machine readable identifier associated with the medication 124 to be stopped or stopped. A screen prompting the user is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. The user can scan the medication label 124a on the medication 124 bag (eg, a barcode on the infusion bag) using the scanner of the digital assistant 118. Alternatively, the user can manually enter the medication identifier into the digital assistant 118.

  Next, at block 6008, the medication identifier is sent to the second central server 108a for verification. The second central server 108a attempts to search for drug identifiers in the database. If a medication identifier (eg, bag ID) does not exist as a valid medication identifier in the database, at block 6010, the second central server 108a causes the digital assistant 118 to display an item invalidation notification. Once the user accepts the item invalidation notification (or the notification times out), at block 6006, the digital assistant 118 prompts the user to scan the machine readable identifier associated with the medication 124 to be stopped or stopped. Redisplay.

  If a medication identifier (eg, a bag ID) is present as a valid medication identifier in the database at block 6008, the second central server 108a may cause the user to scan a machine-readable identifier associated with the patient 112 at block 6012. A screen prompting the user to display is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine-readable identifier associated with the patient 112 is shown in FIG. The user can scan the bar code label on the patient wristband 112a using the scanner of the digital assistant 118. Alternatively, the user can manually enter the patient identifier into the digital assistant 118. Next, at block 6014, the patient identifier is sent to the second central server 108a for verification. The second central server 108a then attempts to retrieve the patient identifier in the database. If the patient identifier (eg, wristband ID) does not exist as a valid patient identifier in the database, at block 6016, the second central server 108a causes the digital assistant 118 to display a patient invalidation notification. Once the user accepts the patient invalidation notification (or when the notification times out), at block 6012, the digital assistant 118 redisplays a screen prompting the user to scan for a machine readable identifier associated with the patient 112.

  If a patient identifier (eg, wristband ID) is present as a valid patient identifier in the database at block 6014, the second central server 108a may return a code indicating the reason for the “stop infusion” or “stop infusion” operation. To prompt the user. If this reason code is not provided, the system preferably displays a message to the user that the reason code must be provided. Furthermore, the second central server 108a can stamp the order and / or prompt the user for the time to perform this action. Still further, the second central server 108a preferably checks the status of the infusion order to determine whether the infusion order is active or aborted.

  If the infusion order is active, at block 6018, is the second central server 108a attempting to issue a “stop infusion” or “stop infusion” operation based on the user selection from block 6004? Determine if. If the user is attempting to issue a “stop injection” operation, at block 6020, the second central server 108a sets “DCFlag” in the “stop injection” XML document to “FALSE”. If the user is attempting to issue a “stop injection” operation, at block 6022, the second central server 108 a sets “DCFlag” in the “stop injection” XML document to “TRUE”. Of course, any known method for displaying the state of a variable can be used.

  A “stop infusion” XML document that includes a patient identifier (eg, wristband ID), medication identifier (eg, bag ID), completion URL, cancellation URL, and DCFlag (indicating stop vs. stop) is then It is transmitted to the server 109. The completion URL is a network address used when the injection is successfully stopped or stopped. The cancellation URL is a network address used when an “injection stop” operation or an “injection stop” operation fails or is canceled.

  Once the first central server 109 receives the “stop injection” XML document, at block 6024, the first central server 109 determines whether the “stop injection” XML document is valid. For example, the first central server 109 can check whether any data that would normally be expected in a “stop injection” XML document is missing from the received “stop injection” XML document. If the first central server 109 determines that the “stop injection” XML document is not valid, at block 6026, the first central server 109 may perform a “stop injection” or “stop injection” operation. An error message is displayed on the digital assistant 118 to indicate to the user that it was not possible. This indication may include reasons such as which data was missing from the “stop injection” XML document. After the user presses the “OK” button to acknowledge the error message, at block 6028, the first central server 109 returns a failure code to the second central server 108a via the cancellation URL.

  If the first central server 109 determines that the “stop injection” XML document is valid, the first central server 109 initiates a channel scan process 5730. Typically, the channel scan step 5730 prompts the user to scan the machine readable identifier associated with the currently executing pump channel for infusions that will be stopped or stopped, and the scanned channel becomes a patient identifier and drug identifier. Determine if it is associated (as detailed above with reference to FIG. 58). If the scanned channel is not associated with a patient identifier and medication identifier, the “stop infusion” or “stop infusion” operation is canceled. In such a case, at block 6028, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the scanned channel is associated with a patient identifier and a medication identifier (ie, the channel is valid), at block 6032 the first central server 109 determines that the patient 112 and the medication 124 and medication 124 to be stopped are A message is displayed on the digital assistant 118 indicating the injection to be stopped, including details of existing channels. The PDA display preferably also includes a “Continue” button and a “Cancel” button. In this way, the user can manually stop the displayed infusion and then press the “Continue” button to check whether the correct infusion has actually been stopped or stopped to check whether the first central server 109. Can be notified. Alternatively, the user can press the “Cancel” button, at which point the first central server 109 returns the cancellation code to the second central server 108a via the cancellation URL at block 6028. To do.

  If the user presses the “Continue” button, at block 6034, the first central server 109 determines whether the infusion has been stopped by reading the status information sent by the pump 120 to the first central server 109. to decide. If the pump 120 is unable to communicate with the first central server 109, the first central server 109 generates a loss of communication events for that channel. If communication with a channel is lost, the state of injection on that channel cannot be changed to “stop” or “stop” until communication with that channel is restored. If the communication is functioning normally but the infusion has not been stopped, at block 6036, the first central server 109 indicates that the infusion has not been stopped and a warning message indicating the patient 112 and the infusion to be stopped. Is displayed on the digital assistant 118. The display preferably also includes an “OK” button and a “Cancel” button. If the user presses the “OK” button, at block 6034, the first central server 109 checks again to see if the correct infusion was actually stopped or stopped. If the user presses the “Cancel” button, at block 6028, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

If the infusion is stopped at block 6034, then at block 6038, the first central server 109 checks whether this is a "stop infusion" or "stop infusion" operation. For example, the first central server 109 can check the state of flags such as DCFlag set by block 6020 or block 6022. If this is a “stop infusion” operation (ie, pause infusion), at block 6044, the first central server 109 passes the success code and DCFlag− = FALSE to the second central server 108a via the completion URL. Return it.

  Otherwise, if this is a “stop infusion” operation (ie, end of infusion), at block 6040, the first central server 109 determines the patient identifier, medication for the infusion that is a temporary or piggyback infusion, but preferably not both. It is preferable to attempt to break the database association between the identifier and the channel identifier. If the user wants to stop or stop both the primary injection and the piggyback injection that are running on a channel, the user will perform two “stop injection” or “stop injection” operations, once for each injection. Can be executed. If the first central server 109 did not successfully disassociate the database at block 6042, then at block 6028, the first central server 109 passes the failure code to the second central via the cancellation URL. Return to the server 108a. If the first central server 109 successfully disassociates the database at block 6042, then at block 6044, the first central server 109 receives the success code and DCFlag = TRUE via the completion URL. To the central server 108a.

  The first central server 109 releases the association between the patient identifier, medication identifier, and channel identifier for the selected infusion only if the “Cancel Infusion” operation is successful. In other cases, this association is maintained. For example, if the “stop infusion” operation is successful or the “stop infusion” operation fails, the association between the patient identifier, the drug identifier, and the channel is maintained. Similarly, the second central server 108 a only receives the success code from the first central server 109 and at the same time updates the state of the injection to “stopped” or “stopped”. Any other result (eg, cancellation code or failure code) causes the second central server 108a to keep the infusion in its previous state. At any point in step 6000, the user preferably has the option to cancel step 6000. The stop / stop process can be used to document that the infusion has been resumed for MAR purposes.

(Injection restart process)
FIG. 61 shows an example of the injection resumption process 6100. The injection restart process 6100 can be used to restart a stopped (ie, paused) injection process. However, the resume injection process 6100 cannot be used to resume an aborted (ie, terminated) injection process. Typically, the infusion resumption process 6100 includes information indicating that the resumption process will be performed, information identifying which patient 112 will be affected (eg, patient ID), and which for that patient 112 An input is received from an electronic device, such as the digital assistant 118, that includes information identifying whether the medication 124 is to be resumed (eg, RxID). Step 6100 then sends this information to the first central server 109, which confirms that the channel identification information matches the resume order information and correct injection is resumed. Make sure.

  More specifically, the exemplary infusion resumption process 6100 begins when the second central server 108 a causes the digital assistant 118 to display a list of patients at block 6102. An example of a digital assistant display 118a showing a list of patients is shown in FIG. The list of patients is preferably limited to patients associated with the user (eg, clinician 116) who is logged into the digital assistant 118 at that time. Once the user selects the patient 112, the selection and / or information identifying the patient 112 is returned from the digital assistant 118 to the second central server 108a. Communication between the digital assistant 118 and the second central server 108a can be via any suitable communication channel, such as the wireless / wired network 102 described above. Next, at block 6104, the second central server 108a causes the digital assistant 118 to display a list of actions. An example of a digital assistant display 118a showing a list of actions is shown in FIG. The list of actions is preferably limited to actions associated with the selected patient 112. For example, the “resume infusion” operation would only be available if the infusion associated with this patient 112 is currently stopped.

  When the user selects a “resume infusion” operation from the list of operations, information identifying the selected operation is sent to the second central server 108a. In response, at block 6106, the second central server 108a causes the digital assistant 118 to display a screen prompting the user to scan for a machine readable identifier associated with the medication 124 to be resumed. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. The user can scan the medication label 124a on the medication 124 bag (eg, a barcode on the infusion bag) using the scanner of the digital assistant 118. Alternatively, the user can manually enter the medication identifier into the digital assistant 118.

  Next, at block 6108, the medication identifier is sent to the second central server 108a for verification. The second central server 108a attempts to search for drug identifiers in the database. If the medication identifier (eg, bag ID) does not exist as a valid medication identifier in the database, at block 6110, the second central server 108a causes the digital assistant 118 to display an item invalidation notification. Once the user accepts the item invalidation notification (or the notification times out), at block 6106, the digital assistant 118 scans the machine readable identifier associated with the medication 124 again and prompts the user to resume. indicate. If the user scans the machine readable identifier associated with the medication 124 to be resumed but the medication 124 has been suspended, the second central server 108a may resume the medication 124 due to its suspended status. Preferably, a message to the user indicating that it is not possible is displayed on the digital assistant 118.

  If a medication identifier (eg, a bag ID) exists as a valid medication identifier in the database at block 6108 but has not been aborted, then at block 6112, the second central server 108a provides a machine readable identifier associated with the patient 112. A screen prompting the user to scan is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine-readable identifier associated with the patient 112 is shown in FIG. The user can scan the bar code label on the patient wristband 112a using the scanner of the digital assistant 118. Alternatively, the user can manually enter the patient identifier into the digital assistant 118. Next, at block 6114, the patient identifier is sent to the second central server 108a for verification. The second central server 108a then attempts to retrieve the patient identifier in the database. If the patient identifier (eg, wristband ID) does not exist as a valid patient identifier in the database, at block 6116, the second central server 108a causes the digital assistant 118 to display a patient invalidation notification. Once the user accepts the patient invalidation notification (or the notification times out), at block 6112, the digital assistant 118 redisplays a screen prompting the user to scan the machine readable identifier associated with the patient 112.

  At block 6114, if the patient identifier (eg, wristband ID) is present as a valid patient identifier in the database, the second central server 108a prompts the user for a code indicating the reason for the “resume infusion” operation. You can also. If no reason code is provided, the system preferably displays a message to the user that a reason code must be provided. Further, the second central server 108a can stamp a time stamp on the order and / or prompt the user for the time to perform the action. Still further, the second central server 108a preferably checks the status of the infusion order to determine whether the infusion order is active or aborted.

  If the infusion order is active, the second central server 108 a transmits a “resume infusion” XML document to the first central server 109. The “resume infusion” XML document includes a patient identifier (eg, wristband ID), a medication identifier (eg, bag ID), a completion URL, and a cancellation URL. The completion URL is a network address used when the resumption of injection is successful. The cancellation URL is a network address used when the “injection restart” operation fails or is canceled.

  Once the first central server 109 receives the “resume infusion” XML document, at block 6124, the first central server 109 determines whether the “resume infusion” XML document is valid. For example, the first central server 109 can check whether any data that would normally be expected in an “injection resume” XML document is missing from the received “injection resume” XML document. If the first central server 109 determines that the “injection resume” XML document is not valid, at block 6126, the first central server 109 indicates an error message indicating to the user that the “resume injection” operation could not be performed. Is displayed on the digital assistant 118. This indication may include reasons such as which data was missing from the “Reinjection” XML document. After the user presses the “OK” button to acknowledge the error message, at block 6128, the first central server 109 returns a failure code to the second central server 108a via the cancellation URL.

  If the first central server 109 determines that the “resume injection” XML document is valid, the first central server 109 initiates a channel scan process 5730. Typically, channel scan step 5730 prompts the user to scan a machine readable identifier associated with the pump channel currently associated with the infusion to be resumed, and whether the scanned channel is associated with a patient identifier and a medication identifier. A determination is made (as detailed above with reference to FIG. 58). If the scanned channel is not associated with a patient identifier and drug identifier, the “resume infusion” operation is canceled. In such a case, at block 6128, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the scanned channel is associated with a patient identifier and a medication identifier (ie, the channel is valid), at block 6132, the first central server 109 sends a message indicating the patient 112 and the infusion to be resumed to the digital assistant. 118 is displayed. The PDA display preferably also includes a “Continue” button and a “Cancel” button. In this way, the user can manually resume the displayed infusion and then inform the first central server 109 to check whether the correct infusion has actually been resumed by pressing the “continue” button. Alternatively, the user can press the “Cancel” button, at which point the first central server 109 returns the cancellation code to the second central server 108a via the cancellation URL at block 6128. To do.

  If the user presses the “Continue” button, at block 6134, the first central server 109 reads whether the infusion has been resumed by reading the status information sent by the pump 120 to the first central server 109. judge. If the pump 120 is unable to communicate with the first central server 109, the first central server 109 generates a communication loss event for that channel. If communication with a channel is lost, the state of injection for that channel cannot be changed to “restarted” until communication with that channel is restored. If communication is functioning normally but the infusion has not been resumed, at block 6136, the first central server 109 indicates that the infusion has not been resumed and a warning message indicating the patient 112 and the infusion to be resumed. Is displayed on the digital assistant 118. This display preferably also includes an “OK” button and a “Cancel” button. If the user presses the “OK” button, at block 6134, the first central server 109 checks again to see if the correct infusion was actually resumed. If the user presses the “Cancel” button, at block 6128, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

If injection is resumed at block 6134, at block 6144, the first central server 109 returns a success code to the second central server 108a via the completion URL. The first central server 109 maintains an association between the patient identifier, medication identifier, and channel identifier for the selected infusion . The second central server 108 a only updates the injection state to “running” upon receipt of the success code from the first central server 109. Any other result (eg, cancellation code or failure code) causes the second central server 108a to keep the infusion in its previous state. Preferably, if the user wishes to resume both the primary injection and the piggyback injection that are running on one channel, the user performs the “resume injection” operation twice, once for each injection. can do. The resume process can be used to document that the infusion has been resumed for MAR purposes.

(Pump removal process)
FIG. 62 shows an example of the pump removal step 6200. The pump removal process 6200 determines the channel-patient-drug relationship in the database of the first central server 109 independently of the existing infusion order in the pharmacy database and without going through the infusion stop / stop process 6000 described above. Can be used to terminate. Typically, the pump removal process 6200 includes information indicating that a pump removal process will be performed, information identifying which patient 112 will be affected (eg, patient ID), and for that patient 112 Input including information (eg, RxID) indicating which medication 124 will be affected is received from an electronic device such as the digital assistant 118. Step 6200 then sends this information to the first central server 109, which confirms that the channel identification information matches the pump removal order information, and the correct pump 120 is removed. Make sure that

  More specifically, the exemplary pump removal process 6200 begins at block 6202 when the second central server 108a causes the digital assistant 118 to display a list of patients for selection. An example of a digital assistant display 118a showing a list of patients is shown in FIG. The list of patients is preferably limited to patients associated with the user (eg, clinician 116) who is logged into the digital assistant 118 at that time. Once the user selects a patient 112, information identifying the selection and / or patient 112 is returned from the digital assistant 118 to the second central server 108a. Communication between the digital assistant 118 and the second central server 108a can be via any suitable communication channel, such as the wireless / wired network 102 described above. Next, at block 6204, the second central server 108a causes the digital assistant 118 to display a list of actions. An example of a digital assistant display 118a showing a list of actions is shown in FIG. The list of actions is preferably limited to actions associated with the selected patient 112. For example, a “pump removal” operation would be available only if the infusion associated with this patient 112 is currently listed in the database of the first central server 109.

  When the user selects a “Remove Pump” operation from the list of operations, information identifying the selected operation is sent to the second central server 108a. In response, at block 6206, the second central server 108a displays a screen that prompts the user to scan the machine readable identifier associated with the medication 124 affected by this “pump removal” operation. To display. An example of a digital assistant display 118a that prompts the user to scan a machine readable identifier associated with medication 124 is shown in FIG. The user can scan the medication label 124a on the medication 124 bag (eg, a barcode on the infusion bag) using the scanner of the digital assistant 118. Alternatively, the user can manually enter the medication identifier into the digital assistant 118.

  Next, at block 6208, the medication identifier is sent to the second central server 108a for verification. The second central server 108a (or digital assistant 118) checks whether a properly formatted medication identifier has been received. Since the purpose of the “pump remove” operation is to remove associations from the first central server 109 database that do not have corresponding injections in the second central server 108a database, the second central server 108a Preferably, there is no need to check whether the medication identifier matches the current infusion in the database of the second central server 108a.

  If the medication identifier (eg, bag ID) is not properly formatted, at block 6210, the second central server 108a causes the digital assistant 118 to display an item invalidation notification. Once the user accepts the item invalidation notification (or the notification times out), at block 6206, the digital assistant 118 re-displays a screen prompting the user to scan the machine readable identifier associated with the medication 124 to be resumed. indicate.

  If the medication identifier (eg, bag ID) was properly formatted at block 6208, then at block 6212, the second central server 108a displays a screen that prompts the user to scan the machine readable identifier associated with the patient 112. It is displayed on the digital assistant 118. An example of a digital assistant display 118a that prompts the user to scan a machine-readable identifier associated with the patient 112 is shown in FIG. The user can scan the bar code label on the patient wristband 112a using the scanner of the digital assistant 118. Alternatively, the user can manually enter the patient identifier into the digital assistant 118. Next, at block 6214, the patient identifier is sent to the second central server 108a for verification. The second central server 108a (or digital assistant 118) then checks whether a properly formatted patient identifier has been received. Since the purpose of the “pump remove” operation is to remove associations from the first central server 109 database that do not have corresponding injections in the second central server 108a database, the second central server 108a It is preferably not necessary to check whether the patient identifier matches the current infusion in the database of the second central server 108a. However, the second central server 108a (or digital assistant 118) can check whether the patient identifier matches the patient 112 selected at block 6202.

  If the patient identifier (eg, wristband ID) is not properly formatted, or if the patient identifier does not match the patient 112 selected at block 6202, then at block 6216, the second central server 108a sends a patient invalidation notification. It is displayed on the digital assistant 118. Once the user accepts the patient invalidation notification (or the notification times out), at block 6212, the digital assistant 118 redisplays a screen that prompts the user to scan the machine readable identifier associated with the patient 112.

  If the patient identifier (eg, wristband ID) is properly formatted at block 6214 and matches the patient 112 selected at block 6202, then at block 6217, the second central server 108 a determines that the “alarm routing stop” XML The document is transmitted to the first central server 109. The “alarm routing stop” XML document includes a patient identifier (eg, wristband ID), a medication identifier (eg, bag ID), a completion URL, and a cancellation URL. The completion URL is a network address used when the removal of the pump 120 is successful. The cancellation URL is a network address used when the “pump removal” operation fails or is canceled.

  Once the first central server 109 receives the “Alarm Routing Stop” XML document, at block 6224, the first central server 109 determines whether the “Alarm Routing Stop” XML document is valid. For example, the first central server 109 may check whether any data normally expected in the “Alarm Routing Stop” XML document is missing from the received “Alarm Routing Stop” XML document. If the first central server 109 determines that the “alarm routing stop” XML document is not valid, at block 6226, the first central server 109 was unable to perform the “stop alarm routing” operation. Is displayed on the digital assistant 118. This indication may include reasons such as which data was missing from the “Alarm Routing Stop” XML document. After the user presses the “OK” button to acknowledge the error message, at block 6228, the first central server 109 returns a failure code to the second central server 108a via the cancellation URL.

  If the first central server 109 determines that the “alarm routing stop” XML document is valid, the first central server 109 starts a channel scan process 5730. Typically, the channel scan step 5730 prompts the user to scan a machine readable identifier associated with the pump channel currently associated with the pump 120 to be removed, and whether the scanned channel is associated with a patient identifier and a medication identifier. A determination is made (as detailed above with reference to FIG. 58). If the scanned channel is not associated with a patient identifier and a medication identifier, the “pump removal” operation is canceled. In such a case, at block 6228, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the scanned channel is associated with a patient identifier and a medication identifier (ie, the channel is valid), at block 6232, the first central server 109 indicates the patient 112 and the infusion associated with this action. The message is displayed on the digital assistant 118. The PDA display preferably also includes a “Continue” button and a “Cancel” button. In this way, the user can notify the first central server 109 to manually stop the displayed infusion and then press the “Continue” button to check if the correct infusion has actually been stopped. . Alternatively, the user can press the “Cancel” button, at which point the first central server 109 sends the cancellation code to the second central server 108a via the cancellation URL at block 6228. Return it.

  If the user presses the “Continue” button, at block 6234, the first central server 109 determines whether the infusion has been stopped by reading the status information sent by the pump 120 to the first central server 109. judge. If the infusion has not been stopped, at block 6236, the first central server 109 causes the digital assistant 118 to display a warning message indicating that the infusion has not been stopped. This display preferably also includes a “Continue” button and a “Cancel” button. If the user presses the “Cancel” button, at block 6228, the first central server 109 returns a cancellation code to the second central server 108a via the cancellation URL.

  If the user presses the “Continue” button, at block 6240, the first central server 109 is preferably the patient identifier, the medication identifier, and the channel identifier for the primary or piggyback infusion, but not both. Attempts to break the database association between identifiers. If the user wishes to stop the alarm routing associated with both the primary and piggyback injections running on one channel, the user will perform a “pump removal” operation twice for each injection. It can be executed once. If the first central server 109 did not successfully release the database association at block 6242, then at block 6228, the first central server 109 passes the failure code to the second central server 108a via the cancellation URL. Return it. If the first central server 109 succeeds in releasing the database association at block 6242, then at block 6244, the first central server 109 returns a success code to the second central server 108a via the completion URL. .

  The first central server 109 releases the association between the patient identifier, medication identifier, and channel identifier for the selected infusion only if the “pump removal” operation is successful. Otherwise, this association is maintained. The second central server 108a need not update the state of the injection that was “released” when it received the success code from the first central server 109.

(Encryption communication process)
As described above, the system can include a plurality of digital assistants 118 and a plurality of medical devices (eg, infusion pump 120) that communicate via a wired or wireless network. Since some of the transmitted data is sensitive medical data, the data is preferably communicated only in a free environment to encrypted and authorized users and devices. In order to set up a new digital assistant 118 or medical device 120, a start-up phase of the authentication process can be performed. Each time a device in service is strengthened, an authentication process is preferably performed to verify that communication with the authorized device and / or user is taking place. Once authorized by the device and / or user, it is encrypted to send parameters, instructions, data, alarms, status information, and any other type of information between the digital assistant, medical device, and / or server. One-way communication and / or two-way communication can be performed.

  Referring to FIG. 63, the digital assistant use initiation phase (ie, server registration phase) of the encrypted communication process 6300 begins when the first central server 109 generates a digital assistant user account (block 6302). For example, the user account of the digital assistant can be set by a well-known method by using Microsoft Active Directory. Next, at block 6304, the first central server 109 generates a digital certificate for the digital assistant 118. The digital certificate can be generated by any method. For example, the digital certificate can be generated in a well-known manner at the first central server 109 using Microsoft Digital Certificate Services. The digital certificate preferably includes the digital assistant's public key digitally signed with the first central server's private key. In other words, the first central server 109 functions as a certificate authority (CA) for the digital certificate of the digital assistant. Once the digital certificate is generated, at block 6306, the first central server 109 maps the digital certificate to a user account.

  Next, at block 6308, the digital assistant's digital certificate and digital assistant's private key are sent by the first central server 109 to the digital assistant 118 at block 6310. The digital assistant's digital certificate and the digital assistant's private key are preferably sent to the digital assistant 118 via a secure connection. For example, an RS-232 cable that is not connected to any other device can be used. Further, the digital certificate of the first central server is sent by block 6312 by the first central server 109 to the digital assistant 118 of block 6314. Again, the digital certificate of the first central server is preferably sent to the digital assistant 118 via an encrypted connection such as an RS-232 cable that is not connected to any other device. At this point, the digital assistant 118 begins to be used (ie, registered with the server).

  Of course, any method of communicating with the digital assistant 118 can be used. In one example, the digital assistant's private key can be stored in a storage device (e.g., EPROM) associated with the digital assistant 118 when the digital assistant 118 is manufactured. Further, each digital assistant 118 may have the same secret key with a different identification code that is used to distinguish the digital assistants 118 from each other.

  Each time the activated digital assistant 118 is powered on, the digital assistant 118 and the first central server 109 move from an unsecured wireless connection to an encrypted wireless connection. The certification process must be performed. In the illustrated example, the digital assistant 118 establishes an unencrypted 802.11 (Wireless Ethernet) connection with the first central server 109 at block 6316 and block 6318. Of course, any type of connection can be used, such as a wired connection or a connection using another protocol.

  Moving to FIG. 64, at block 6402, the digital assistant 118 sends a request to the first central server 109 to establish an encrypted connection. The first central server 109 receives the digital assistant's request to establish an encrypted connection at block 6404. The first central server 109 sends a copy of the first central server's digital certificate to the digital assistant 118 via an unencrypted connection to establish an encrypted connection at block 6406. Respond to the request. At block 6408, the digital assistant 118 receives the digital certificate of the first central server.

  At block 6410, the digital assistant 118 authenticates the first central server 109 using the first central server's digital certificate. Further, at block 6412, the digital assistant 118 retrieves the uniform resource locator (URL) associated with the embedded first central server 109 using the first central server's digital certificate. The digital assistant 118 now knows that it is talking to the real first central server 109 and can request data and services from the retrieved URL.

  Next, at block 6414, the first central server 109 sends a request to the digital assistant 118 to establish the other half of the encrypted connection. The digital assistant 118 receives the first central server request at block 6416. The digital assistant 118 responds to the request to establish an encrypted connection at block 6418 by sending a copy of the digital assistant's digital certificate to the first central server 109. At block 6420, the first central server 109 receives the digital certificate of the digital assistant.

  At block 6422, the first central server 109 authenticates the digital assistant 118 using the digital assistant's digital certificate. The first central server 109 now knows that it is talking to the digital assistant 118 that has begun to use and can communicate with the digital assistant 118. Moving further to FIG. 65, the first central server 109 maps the files for the digital assistant 118 to access by mapping the session for the digital assistant user account to the active directory at block 6502. Check.

  Since the digital assistant 118 is now communicating with the first central server 109 via an encrypted connection, the digital assistant 118 is authorized to access a specific file on the first central server 109, At block 6504, the digital assistant 118 can establish an encrypted communication session with the first central server 109 by accessing the URL retrieved from the digital certificate of the first central server. The first central server 109 also establishes an encrypted communication session at block 6506. Further, at block 6508, the application on the first central server 109 verifies that the digital assistant 118 belongs to the appropriate active directory.

  Although the digital assistant 118 can now be authenticated, the first central server 109 still does not know the identity of the user using the digital assistant 118. This is important because some users can have different access rights than others, and certain alarms and other data are only sent to certain users. Accordingly, the application on the first central server 109 may request a username and password from the user of the digital assistant 118 at block 6510. Once the digital assistant 118 receives a request for username and password at block 6512, at block 6514, the digital assistant 118 retrieves the username and password from the user via a prompt on the digital assistant display 118a. The username and password are then sent by the digital assistant 118 at block 6516 and received by the first central server 109 at block 6518. Then, at block 6520, an application on the first central server 109 can authenticate the user.

  Once a user is authenticated on a server (eg, first central server 109), the authentication credentials are used to automatically authenticate digital assistant 118 on another server (eg, second central server 108a). Can do. In one example, a user can only authenticate if the user is authenticated by both the first central server 109 and the second central server 108a. Thus, whenever a username or password is generated or modified, the username and password are preferably synchronized between the first central server 109 and the second central server 108a.

  After authenticating the user, the first central server 109 preferably returns a token that is unique to the session between the user and the first central server 109. This session token is sent with each request made to the first central server 109 as a means of authenticating the request source and hence the response destination (eg in the HTTP header or as a cookie). Once this token is in place, the digital assistant 118 can move continuously from one wireless access point 114 to another.

  Turning to FIG. 66, the medical device usage start phase (ie, server registration phase) of step 6300 begins at block 6602 when the first central server 109 generates a medical device user account. For example, a user account of a medical device can be set by a well-known method using Microsoft Active Directory. Next, at block 6604, the first central server 109 generates a digital certificate for the medical device 120. The digital certificate can be generated by any method. For example, the digital certificate can be generated by a well-known method using Microsoft Digital Certificate Services in the first central server 109. The digital certificate preferably includes the medical device's public key digitally signed with the first central server's private key. In other words, the first central server 109 functions as a certification authority (CA) for digital certificates of medical devices. Once the digital certificate is generated, at block 6606, the first central server 109 maps the digital certificate to a user account.

  Next, at block 6608, the digital certificate of the medical device and the private key of the medical device are transmitted by the first central server 109 to the medical device 120 at block 6610. The medical device digital certificate and the medical device private key are preferably transmitted to the medical device 120 via an encrypted connection, such as an RS-232 cable that is not connected to any other device. Further, the digital certificate of the first central server 109 is transmitted by the first central server 109 to the medical device 120 of block 6614 at block 6612. Again, the digital certificate of the first central server is preferably sent to the medical device 120 via an encrypted connection such as an RS-232 cable that is not connected to any other device. At this point, the medical device 120 begins to be used (ie, registered with the server).

  Of course, any method of communicating with the medical device 120 can be used. In one example, the medical device private key may be stored in a storage device (eg, EPROM) associated with the medical device 120 at the time the medical device 120 is manufactured. In addition, each medical device 120 can have the same secret key with a different identification code that is used to distinguish the medical devices 120 from each other.

  Each time the powered-on medical device 120 is powered on, the medical device 120 and the first central server 109 perform an authentication process to move from an unencrypted wireless connection to an encrypted wireless connection. There must be. In the example shown in FIG. 67, the medical device 120 establishes an unencrypted 802.11 (wireless Ethernet) connection with the first central server 109 at block 6702 and block 6704. Of course, any type of connection can be used, such as a wired connection or a connection using another protocol.

  Next, at block 6706, the medical device 120 sends a request to the first central server 109 to establish an encrypted connection. The first central server 109 receives the medical device request to establish an encrypted connection at block 6708. The first central server 109 sends a copy of the first central server's digital certificate to the medical device 120 via an unencrypted connection to establish an encrypted connection at block 6710. Respond to the request. At block 6712, the medical device 120 receives the digital certificate of the first central server.

  At block 6714, the medical device 120 authenticates the first central server 109 using the digital certificate of the first central server. Further, at block 6716, the medical device 120 retrieves the uniform resource locator (URL) associated with the embedded first central server 109 using the digital certificate of the first central server. The medical device 120 now knows that it is talking to the real first central server 109 and can request data and services from the retrieved URL.

  Next, at block 6718, the first central server 109 sends a request to the medical device 120 to establish the other half of the encrypted connection. The medical device 120 receives the first central server request at block 6720. The medical device 120 responds to a request to establish an encrypted connection at block 6722 by sending a copy of the digital certificate of the medical device to the first central server 109. At block 6724, the first central server 109 receives the digital certificate of the medical device.

  Moving to FIG. 68, at block 6802, the first central server 109 authenticates the medical device 120 using the digital certificate of the medical device. The first central server 109 now knows that it is talking to the medical device 120 that it has begun to use and can communicate with the medical device 120. Further, the first central server 109 verifies the files that the medical device 120 is allowed to access by mapping a session for the medical device user account to an active directory at block 6804.

  Since the medical device 120 is now communicating with the first central server 109 via an encrypted connection, the medical device 120 is authorized to access a particular file on the first central server 109, At block 6806, the medical device 120 can establish an encrypted communication session with the first central server 109 by accessing the URL retrieved from the digital certificate of the first central server. The first central server 109 also establishes an encrypted communication session at block 6808. Further, at block 6810, an application on the first central server 109 verifies that the medical device 120 belongs to the appropriate active directory.

  Although the medical device 120 can now be authenticated, the first central server 109 still does not know the identity of the user using the medical device 120. In many cases, no user is associated with the medical device 120. This may be important for some applications because some users may have different access rights than others. Furthermore, medical devices can have different “roles”. For example, the medical device may have a “one-way communication” role or a “two-way communication” role. In this way, a medical device 120 capable of two-way communication can be placed in a system that requires only a one-way communication device. Similarly, a system that can handle both one-way communication devices and two-way communication devices may need to notify the type of device to be connected.

  Accordingly, the application on the first central server 109 may request a username and password from the user of the medical device 120 at block 6812. Once the medical device 120 receives a request for a username and password at block 6814, at block 6816, the medical device 120 receives the username and password from the user via a prompt on the medical device 120 or an associated digital assistant display 118a. Retrieve the password. 69, the username and password are then transmitted by the medical device 120 (or other device) and received by the first central server 109 at block 6904. Then, at block 6906, an application on the first central server 109 can authenticate the user.

  Once a user is authenticated on a server (eg, the first central server 109), authentication credentials can be used to automatically authenticate users on another server (eg, the second central server 108a). . In one example, a user can only authenticate if the user is authenticated by both the first central server 109 and the second central server 108a. Thus, whenever a username or password is generated or modified, the username and password are preferably synchronized between the first central server 109 and the second central server 108a.

  After authenticating the user, the first central server 109 preferably returns a token that is unique to the session between the user and the first central server 109. This session token is sent with each request made to the first central server 109 as a means of authenticating the request source and hence the response destination (eg in the HTTP header or as a cookie).

  The encrypted one-way communication can now be sent from the medical device 120 to the digital assistant 118. For example, the medical device 120 can perform setting value reporting, alarm generation, and the like. In the illustrated example, the medical device 120 determines data to be transmitted to the digital assistant 118 via the first central server 109 at block 6908. This data is then transmitted to the first central server 109 at block 6910 and received by the first central server 109 at block 6912. Next, at block 6914, the first central server 109 determines users who are authorized to receive this data, and at block 6916, determines the digital assistant 118 to which those users are currently associated. Can do. For example, a reference table stored in the database of the first central server 109 can be used.

  Next, at block 6918, the first central server 109 sends the data to the appropriate digital assistant 118, and at block 6920, the digital assistant 118 receives and displays the data. Furthermore, encrypted two-way communication can be achieved. For example, the digital assistant 118 and / or the first central server 109 can send data, instructions, configuration information, or any other type of information to the medical device 120.

  It should be emphasized that the above-described embodiments of the present invention, in particular any "preferred" embodiment, are possible examples and are merely set forth for a clear understanding of the principles of the invention. Many variations and modifications may be made to the above-described embodiments of the invention without substantially departing from the spirit and principles of the invention. All such modifications are intended to be included herein within the scope of this disclosure, and the present invention is protected by the following claims.

Claims (17)

  1. A system for reporting on the integrity of a wireless communication link in a medical facility,
    The system
    A module associated with a device for medication therapy application, the module having a status information output responsive to a signal output generated by the device for drug therapy application;
    A wireless remote device within the medical facility having a message indicator responsive to the status information output transmitted over the wireless communication link, wherein the message indicator represents a signal generated by the device for medication treatment application Wireless remote devices,
    A central computer subsystem in communication with the device for medication treatment application and the wireless remote device;
    And software installed on the wireless remote device,
    The software
    (I) sending a signal from the wireless remote device to the central computer subsystem over the wireless communication link;
    (Ii) waiting for a response to the signal transmitted from the wireless remote device to the central computer subsystem over the wireless communication link for a predetermined time;
    In (iii) where the said response is not received by the wireless remote device within the predetermined time, it shows a loss of the wireless communication link between (a) the central computer sub system and the wireless remote device, and (B) reporting on the integrity of the wireless communication link between the central computer subsystem and the wireless remote device by generating a timeout output indicating that the status information output is not up-to-date Configured system.
  2.   The system of claim 1, wherein the association of the module with the device for medication treatment application provides at least some data in the status information output passing through the module.
  3.   The system of claim 1, wherein the device for medication treatment application is an infusion pump that infuses a patient.
  4.   The system of claim 1, wherein the output generated by the medication therapy device includes data related to an alarm condition.
  5.   The system of claim 1, wherein the output generated by the medication therapy device includes data related to an alert condition.
  6.   The system of claim 1, wherein the output generated by the medication therapy device includes data related to infusion rate.
  7.   The system of claim 1, wherein the output generated by the medication therapy device includes data related to time remaining until an infusion bag is empty.
  8.   The system of claim 1, wherein the wireless remote device is a personal digital assistant.
  9.   The system of claim 1, wherein the wireless communication link operates within a radio frequency range.
  10.   The system of claim 9, wherein the radio frequency is in a 2.4 gigahertz band.
  11.   The system of claim 9, wherein the radio frequency is in a 2.45 gigahertz band.
  12.   The system of claim 9, wherein the radio frequency is in a 5 gigahertz band.
  13.   The system of claim 1, wherein the message indicator is an audible alarm.
  14.   The system of claim 1, wherein the message indicator is a visual display.
  15.   The system of claim 13, wherein the audible alarm generates an audible sound in response to the timeout output.
  16.   The system of claim 14, wherein an icon responsive to the timeout output is provided on the visual display.
  17.   The system of claim 14, wherein a pop-up window is provided on the visual display in response to the timeout output.
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US44435003P true 2003-02-01 2003-02-01
US60/444,350 2003-02-01
US10/424,553 2003-04-28
US10/424,553 US7698156B2 (en) 2002-01-29 2003-04-28 System and method for identifying data streams associated with medical equipment
US48827303P true 2003-07-18 2003-07-18
US60/488,273 2003-07-18
US10/659,760 2003-09-10
US10/659,760 US8489427B2 (en) 2002-01-29 2003-09-10 Wireless medical data communication system and method
US52810603P true 2003-12-08 2003-12-08
US60/528,106 2003-12-08

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