JP6550637B2 - Medical information management device - Google Patents

Description

  Embodiments of the present invention relate to a medical information management apparatus.

  In recent years, with the spread of multi-slice CT (computed tomography) and MRI (magnetic resonance imaging), the number of examinations read by doctors is increasing. For this reason, techniques for efficiently performing interpretation work such as use of past reports, association with findings, switching of conversion candidate prediction, detection of lesions, and presentation of related examinations have been developed. Similarly, presentation of medical status is a technique for efficiently performing interpretation work. Since the medical status is not included in examination information such as examination order, medical image information, medical report, etc., it is manually extracted by the user in the selection format or extracted by pattern matching from the character string contained in the examination information. There is a need.

JP, 2012-053632, A JP, 2009-238037, A JP, 2009-87038, A JP, 2009-09550, A JP 2007-287018 A

  However, the user's manual input takes time for input. If the examination information does not include a character string indicating the medical status, it cannot be extracted by pattern matching. In this case, the medical status for the target examination cannot be determined.

  An object of the embodiment is to provide a medical information management apparatus capable of determining the medical care status even when the examination information does not include a character string indicating the medical care status.

The medical information management apparatus according to the present embodiment includes a transition information storage unit that stores, in association with each of a plurality of lesion identifiers, status transition information indicating a standard transition process of a medical status of a lesion, and a target lesion of a target patient Is stored in the transition information storage unit and associated with the identifier of the target lesion , using the previous medical status and the specific character string regarding the degree of determination of the lesion included in the examination information regarding the target lesion And a status determination unit that determines current medical status of the target lesion from specific status transition information.

The figure which shows the structure of the medical information system which concerns on this embodiment. The figure which shows the structure of the medical information management apparatus of FIG. The figure which shows an example of the treatment event database managed by the treatment event storage part of FIG. FIG. 3 is a view showing an example of a lesion determination parameter database managed by the lesion determination parameter storage unit of FIG. 2; FIG. 5 is a view showing an association between a search character string managed by the lesion determination parameter storage unit of FIG. 2 and expressing the lesion determination parameter database of FIG. 4 in an XML language and a lesion determination parameter. The figure which shows an example of the lesion information and database managed by the lesion information storage part of FIG. The figure which shows the flow of operation | movement of each apparatus of the medical information system regarding the determination process of the medical treatment status which concerns on Example 1 of this embodiment. FIG. 3 is a diagram schematically illustrating the status transition information stored in the status transition information storage unit of FIG. 2 in a flowchart form; FIG. 9 is a view showing a flow of determination processing of the medical care status of the present examination in the case where the medical care status of the previous examination is “screening” which is executed by the medical care status determination unit in step SA9 of FIG. 7; The figure which shows the flow of the determination process of the medical status of this test | inspection performed by the medical status determination part in step SA9 of FIG. FIG. 9 is a view showing a flow of determination processing of the medical care status of the current examination in the case where the medical care status of the previous examination is “following observation A” which is executed by the medical care status determination unit in step SA9 of FIG. FIG. 9 is a view showing a flow of determination processing of the medical care status of the current examination in the case where the medical care status of the previous examination is “following observation B” which is executed by the medical care status determination unit in step SA9 of FIG. 7; The figure which shows the flow of the determination process of the medical status of this test | inspection performed by the medical status determination part in step SA9 of FIG. The figure which shows the flow of operation | movement of each apparatus of the medical information system regarding the determination process of the medical treatment status which concerns on Example 2. FIG.

  The medical information management apparatus according to this embodiment will be described below with reference to the drawings.

  The medical information management device according to the present embodiment is a computer device included in a medical information system.

  FIG. 1 is a diagram showing the configuration of a medical information system 100 including the medical information management device 1 according to the present embodiment. As shown in FIG. 1, a medical information system 100 according to the present embodiment includes an examination order issuing device 200, an examination order storage device 300, a medical image utilization device 400, a medical image storage device 500, which are connected to each other via a network. A medical image photographing apparatus 600, a medical report creation apparatus 700, a medical report storage apparatus 800, a medical report reference apparatus 900, and a medical information management apparatus 1 are included. The examination order issuing device 200 and the examination order storage device 300 constitute a RIS (Radiology Information System), and the medical image utilization device 400 and the medical image storage device 500 constitute a PACS (Picture and Archiving Communication System). The creation device 700, the medical report storage device 800, and the medical report reference device 900 constitute a report system.

  As image communication between devices included in the medical information system 100, any existing standard such as DICOM standard which is a standard standard of medical images may be used. As information communication, industry standard TCP / IP (Transmission Control Protocol / Internet Protocol) communication is typically employed. Information is transmitted and received in units of packets (basic unit of information to be transferred) via the network.

  The inspection order issuing device 200 is installed, for example, in an examination room. The examination order issuing device 200 issues an examination order relating to an examination received by the patient in accordance with an operation by the attending physician. The examination order issuing device 200 transfers the issued examination order to the examination order storage device 300 and the medical information management device 1.

  The inspection order storage device 300 stores the inspection order transferred from the inspection order issuing device 200. The examination order storage apparatus 300 transfers the examination order transferred from the examination order issuing apparatus 200 to the medical image photographing apparatus 600.

  The medical image utilization apparatus 400 is used for interpretation of a medical image by an interpretation doctor. The medical image utilization apparatus 400 acquires a medical image from the medical image storage apparatus 500 in accordance with an operation by an interpreting doctor, and displays the acquired medical image.

  The medical image storage device 500 stores the medical image generated by the medical imaging device 600. In response to the acquisition request from the medical image utilization apparatus 400, the medical image storage apparatus 500 distributes the medical image according to the acquisition request to the medical image utilization apparatus 400.

  The medical imaging apparatus 600 acquires an examination order from the examination order storage apparatus 300 according to the operation by the medical engineer. The medical imaging apparatus 600 performs a medical examination of the patient according to the obtained examination order. Specifically, the medical image capturing apparatus 600 performs medical imaging on a patient and generates a medical image related to the patient. The medical image photographing apparatus 600 transfers the generated medical image to the medical image storage apparatus 500.

  The medical report creation apparatus 700 creates a report (hereinafter referred to as a medical report) as a result of interpretation by the interpretation doctor using the medical image utilization apparatus 400 in accordance with an operation by the interpretation doctor. Further, the medical report creation apparatus 700 may display the medical care status determined by the medical information management apparatus 1. The medical report creation apparatus 700 transfers the created medical report to the medical report storage apparatus 800 and the medical information management apparatus 1.

  The medical report storage device 800 acquires the medical report created by the medical report creation device 700, and stores the acquired medical report. The medical report storage device 800 transfers a medical report corresponding to the acquisition request to the medical report reference device 900 in response to the acquisition request from the medical report reference device 900.

  The medical report reference device 900 acquires the medical report stored in the medical report storage device 800 and displays the acquired medical report. Medical reports are typically used when referring to interpretation results.

  The medical information management apparatus 1 automatically determines the medical status for each lesion of the patient. The medical status indicates one stage of medical care in the whole medical care process from the start of diagnosis to complete cure. The medical care status includes, for example, screening, detailed examination, and follow-up observation. The medical information management device 1 transfers the determined medical status to the medical report creation device 700.

  FIG. 2 is a diagram illustrating a configuration of the medical information management apparatus 1 according to the present embodiment. As shown in FIG. 2, the medical information management apparatus 1 has a control unit 11 as a center, a treatment event storage unit 13, a lesion determination parameter storage unit 15, a status transition information storage unit 17, a lesion information storage unit 19, and a read / write unit 21. The communication unit 23, the lesion information creation unit 25, the lesion determination parameter specification unit 27, the medical treatment status determination unit 29, the display unit 31, and the operation unit 33 are included.

  The treatment event storage unit 13 stores information related to a plurality of treatment events (hereinafter referred to as treatment event information). The treatment event information is information for specifying each treatment event such as a patient identifier, treatment date and time, and a treatment lesion name. Treatment event information is created each time treatment is performed on a patient's lesion. The patient's name or ID may be used as the patient identifier. Hereinafter, for simplicity, it is assumed that the patient identifier is a patient ID. Each item of the treatment event information is associated in a known form such as a database. Hereinafter, it is assumed that each item of treatment event information is associated in the database. This database will be referred to as a treatment event database.

  FIG. 3 is a diagram showing an example of a treatment event database. As shown in FIG. 3, the treatment event database has items of event ID, patient ID, treatment date and time, and treatment lesion name. The treatment date is the date when the treatment was performed. The treatment disease name is the name of the disease treated. For example, the record of event ID "1" has the value "A" in the patient ID item, the value "2012/04/13" in the treatment date item, and the value "lung cancer" in the treatment lesion name item. doing. Thus, the treatment event storage unit 13 stores treatment event information in a record format for each treatment event.

  The lesion determination parameter storage unit 15 stores a parameter indicating the degree of lesion determination (hereinafter referred to as a lesion determination parameter) in association with each of a plurality of search character strings. In other words, it can be said that the lesion determination parameter storage unit 15 stores the change rule of the lesion determination degree parameter. The search character string and the lesion determination parameter are associated with each other in a known form such as a database. Hereinafter, it is assumed that the search character string and the lesion determination parameter are associated by the database. This database is called a lesion determination parameter database. The lesion determination parameter database may associate not only the search character string and the lesion determination parameter but also other information.

  FIG. 4 is a diagram showing an example of a lesion determination parameter database. As shown in FIG. 4, the lesion determination parameter database has items of a rule ID, a search destination, a search string, and a lesion determination parameter. The search destination means an item to be searched for in the inspection character string. Search destinations include, for example, “inspection purpose”, “findings”, and “Impression”. "Inspection purpose" is an item included in an inspection order. “Findings” and “Impression” are items included in the medical report. The examination purpose is the purpose of the examination ordered by the attending physician or the like. For example, as the purpose of examination, there are "good and malignant diagnosis", "staging", "effect determination", "follow-up observation", "screening" and the like. Findings are judgments and opinions after an interpretation doctor's interpretation. Impression is the conclusion after a reading doctor's reading. The search character string is a character string to be searched in the search destination. As a search character string, for example, "preoperative scrutiny", "lesion name" + "suspect", "" lesion name + + suspicion "", "lesion name" + "signs of Not seen "", "" lesion name "+" not recognized "" etc. An arbitrary lesion name is used as the "lesion name". Lesion determination parameters include "confirm", "suspect", "no doubt" and the like. The record of ID “2” has the value “examination purpose (examination order)” in the search destination item, the value ““ lesion name ”+“ suspect ”” in the search character string item, and the lesion determination parameter item Have the value "suspect". Thus, the lesion determination parameter storage unit stores the lesion determination parameter in the form of a record for each combination of the search destination and the search character string.

  Note that the association between the search character string and the lesion determination parameter is not limited to the database format. For example, the association between the search string and the lesion determination parameter may be defined by a description language such as XML (extensible markup language) or HTML (hypertext markup language). FIG. 5 is a diagram illustrating an example of an association between a search character string in XML format and a lesion determination parameter. FIG. 5 represents the lesion determination parameter database of FIG. 4 in XML language. The character string of the description language that defines the association may be stored in a file format in the lesion determination parameter storage unit 15. Hereinafter, in order to simplify the explanation, it is assumed that the association between the search string and the lesion determination parameter is defined in a database format.

  The status transition information storage unit 17 stores information indicating a standard transition process of the medical treatment status of the lesion (hereinafter referred to as medical treatment status transition information) in each of the identifiers of a plurality of lesions. The description about medical treatment status transition information is mentioned later. As the lesion identifier, the name or abbreviation of the lesion may be used. Hereinafter, for simplicity, it is assumed that the lesion identifier is the name of the lesion.

  The lesion information storage unit 19 stores information related to the lesion (hereinafter referred to as lesion information) for each combination of the patient ID and the lesion name. The lesion information is created by the lesion information creation unit 25. The lesion information includes items such as a patient ID, a lesion name, a medical status, and a lesion determination parameter, for example. The patient ID, lesion name, medical status, and lesion determination parameter may be associated with each other in a known form such as a database, or may be associated with a description language such as XML or HTML. Hereinafter, it is assumed that the patient ID, the lesion name, the medical care status, and the lesion determination parameter are associated by a database. This database is called lesion information / database. The lesion information / database may be associated with other information in addition to the patient ID, lesion name, medical status, and lesion determination parameter.

  FIG. 6 is a diagram showing an example of a lesion information database. As shown in the figure, the lesion information / database has items of lesion information ID, patient ID, order ID, lesion name, lesion confirmation parameter, medical treatment status, examination date and time, and previous examination date and time. The order ID is an identifier of the inspection order. The inspection date / time is the inspection date / time of the current inspection. This examination means an examination for which the medical care status is to be determined. The previous inspection date / time is the inspection date / time of the previous inspection. The previous inspection means an inspection performed before the current inspection, typically an inspection performed one time before the current inspection. As shown in FIG. 6, for example, the record of the lesion information ID “1” has a value “A” in the patient ID item, a value “1000” in the order ID item, and a value “lung cancer” in the lesion name item. And the value “suspected” in the lesion determination parameter item, the value “examination A” in the medical care status item, the value “2012/05/11” in the examination date and time item, and The previous inspection date / time item has a value “2012/02/11”. As described above, the lesion information storage unit 19 stores the lesion determination parameter and the medical treatment status in a record format for each combination of the patient ID and the lesion name.

  The read / write unit 21 reads information in the treatment event storage unit 13, the lesion determination parameter storage unit 15, the status transition information storage unit 17, and the lesion information storage unit 19, and writes other information.

  The communication unit 23 includes an examination order issuing device 200, an examination order storage device 300, a medical image utilization device 400, a medical image storage device 500, a medical image photographing device 600, a medical report creation device 700, and a medical report included in the medical information system 100. It communicates with other devices such as the storage device 800 and the medical report reference device 900 via a network. For example, the communication unit 23 receives an examination order from the examination order issuing device 200, and receives a medical report from the medical report creation device 700. In addition, the communication unit 23 transmits the medical status determined by the medical status determination unit 29 to the medical report creation apparatus 700.

  The lesion information creation unit 25 creates lesion information according to an instruction from the user via the operation unit 33 or the like. The created lesion information is written into the lesion information storage unit 19 by the read / write unit 21. Further, the lesion information creation unit 25 may change the lesion information read by the read / write unit 21 in accordance with an instruction from the user via the operation unit 33 or the like. The changed lesion information is also written into the lesion information storage unit 19 by the read / write unit 21.

  The lesion determination parameter specification unit 27 is associated with the search character string in the lesion determination parameter database using a character string (search character string) related to the degree of lesion determination included in the examination information of the current examination. Identify lesion determination parameters. The examination information is at least one of an examination order and a medical report. The lesion determination parameter identified by the lesion determination parameter identification unit 27 is used as a lesion determination parameter of the current examination. As described above, the lesion determination parameter is one of a plurality of items constituting lesion information. The lesion determination parameter identified by the lesion determination parameter identification unit 27 is reflected by the lesion information creation unit 25 on the lesion information of the current examination. The lesion information corrected by the lesion information creation unit 25 is written to the lesion information storage unit 19 by the read / write unit 21.

  The medical care status determination unit 29 applies the medical care status of the previous examination of the target lesion of the target patient to the medical care status transition information on the target lesion stored in the status transition information storage unit 17 to obtain the medical care status of the current examination. decide. For example, the medical care status determination unit 29 determines the medical care status of the current examination from the medical care status transition information on the target lesion, using the medical care status of the previous examination and the lesion confirmation parameter identified by the lesion confirmation parameter identification unit 27. . As described above, the medical treatment status is one of a plurality of items constituting lesion information. The medical treatment status determined by the medical treatment status determination unit 29 is reflected by the lesion information generation unit 25 on the lesion information of the current examination. The lesion information corrected by the lesion information creation unit 25 is written to the lesion information storage unit 19 by the read / write unit 21.

  The display unit 31 displays the medical status and the like on the display device. As a display device, for example, a CRT display, a liquid crystal display, an organic EL display, a plasma display or the like can be appropriately used.

  The operation unit 33 receives various instructions from the user via the input device. As an input device, a pointing device such as a mouse or a trackball, a selection device such as a mode switching switch, or an input device such as a keyboard can be used as appropriate.

  The control unit 11 functions as the center of the medical information management device 1. The control unit 11 stores an information processing program for determining the medical status in the memory. The control unit 11 receives the instruction to start the medical status determination process, reads the information processing program, controls each unit according to the read information processing program, and executes various processes for determining the medical status.

Hereinafter, an operation example of the medical information system related to the medical status determination process by the medical information management apparatus 1 will be described. The medical status determination processing according to the present embodiment is roughly divided into two types: a type for determining a lesion determination parameter using an examination order and a type for determining a lesion determination parameter using a medical record. Hereinafter, a type using an examination order will be described in the first embodiment, and a type using a medical record will be described in a second embodiment.
Example 1
FIG. 7 is a diagram illustrating an operation flow of each device of the medical information system 100 related to the medical status determination process according to the first embodiment. As shown in FIG. 7, order information for the examination order of the current examination and the name of the lesion to be examined in the current examination are input by the attending physician or the like via the input device of the RIS examination order issuing apparatus 200 (step SA1). The order information is information necessary for issuance of the inspection order of the current inspection. The lesion name is the name of the lesion to be examined in the current examination. The lesion name to be input may be one or more. The lesion name may be extracted from the order information by pattern matching. The lesion name to be input may be input by distinguishing the main lesion from the metastatic lesion, or may be input as one lesion. For example, in the case of lung cancer, the main lesion of lung cancer, the brain metastasis of lung cancer, and the lymph node metastasis of lung cancer may be input separately, or may be input collectively as lung cancer.

  When step SA1 is performed, the RIS inspection order issuing apparatus 200 issues the inspection order for the current inspection based on the input order information (step SA2). The issued examination order is transmitted to the medical imaging apparatus 600. The medical imaging apparatus 600 receives an examination order from the examination order issuing apparatus 200 of RIS, executes medical imaging in accordance with the received examination order, and generates a medical image of a patient (step SA3). The generated medical image is transmitted from the medical imaging apparatus 600 to the medical image storage apparatus 500 of PACS. The PACS medical image storage device 500 receives a medical image from the medical image photographing device 600 and stores the received medical image. Medical images are used for subsequent interpretation.

  When step SA2 is performed, the RIS examination order issuing device 200 transmits the examination order and the lesion name related to the current examination to the medical information management device 1. The medical information management apparatus 1 receives the examination order and the lesion name regarding the current examination from the RIS.

  Next, the read / write unit 21 of the medical information management device 1 reads treatment event information related to the current examination from the treatment event storage unit 13 (step SA4). As shown in FIG. 3, the treatment event information includes a patient ID, treatment date and time, and a treatment lesion name. The read / write unit 21 searches the treatment event storage unit 13 by the patient ID and the lesion name included in the order information input in step SA1, and the treatment event information associated with the lesion input in step SA1 is treated as a treatment event It is read from the storage unit 13. Note that the method for reading treatment event information is not limited to the above method. For example, in order to read treatment event information on the current examination, the user inputs at least one of the patient ID, treatment date and time, and treatment lesion name on the current examination via the operation unit 33, and the reading and writing unit 21 inputs The treatment event storage unit 13 is searched using the obtained information as a keyword, and the treatment event information associated with the input information is read from the treatment event storage unit 13.

  The following processing from step SA5 to step SA11 is repeated for each lesion name. For example, when lung cancer and pneumonia are read as lesion names, the process from step SA5 to step SA11 is performed for each of lung cancer and pneumonia. When distinguishing the main lesion from the metastatic lesion, the processes from Step SA5 to Step SA11 are performed for each of the main lesion and the metastatic lesion. For example, the main lesion of lung cancer may be distinguished from brain metastasis and lymph node metastasis.

  The end stage of step SA4 is a stage where the examination order of the present examination is issued and medical imaging is performed. At this stage, in general, lesion information for this examination is not created. That is, the lesion information on the target lesion stored in the lesion information storage unit 19 at the end of step SA4 is the lesion information of the previous examination on the target lesion.

  When step SA4 is performed, the read / write unit 21 reads the lesion information of the previous examination for the target lesion from the lesion information storage unit 19 based on the patient ID and the lesion name included in the order information (step SA5). As shown in FIG. 6, the lesion information includes a patient ID, an order ID, a lesion name, a lesion determination parameter, a medical status, an examination date and time, and a previous examination date and time. In order to read the lesion information of the previous examination for the target lesion, the user searches the lesion information storage unit 19 using the combination of the patient ID and the lesion name inputted in step SA1 as a keyword, and the patient ID and the lesion name The lesion information associated with the combination of the two is read from the lesion information storage unit 19. This read lesion information is the lesion information of the previous examination.

  When step SA5 is performed, the lesion information creation unit 25 of the medical information management apparatus provisionally creates the lesion information of the current examination using the lesion information of the previous examination read in step SA5 (step SA6). For example, the value of the lesion confirmation parameter is set to the value of the lesion confirmation parameter of the previous examination read in step SA5, the value of the medical status is set to the value of the medical status of the previous examination read in step SA5, The value of the previous inspection date / time is set to the value of the inspection date / time read in step SA5. Further, the order ID and the inspection date and time values are set to the inspection date and time of the current inspection. The lesion information creation unit 25 may set a value input by the user via the operation unit 33 as the value of the examination date and time of the current examination, or may set it automatically.

  In step SA5, the lesion information of the previous examination may not be stored in the lesion information storage unit 19. For example, when the current examination is the first examination, there is no lesion information of the previous examination in the lesion information storage unit 19. In this case, the lesion information creation unit 25 provisionally creates lesion information of the current examination using predetermined lesion information determined in advance (step SA7). The predetermined lesion information can be arbitrarily set in advance by the user via the operation unit 33 or the like for each lesion information item. Hereinafter, the value of each item of the lesion information set in advance is referred to as a preset value. For example, "no doubt" is set as the preset value of the lesion determination parameter, "screening" is set as the preset value of the medical care status, "N / A" is set as the preset value of the previous examination date, and the examination date is preset. The date and time of the current examination is set as the value. In this case, the lesion information creation unit 25 sets the value of the lesion determination parameter to "no doubt", sets the value of the medical care status to "screening", and sets the value of the previous examination date to "N / A". The inspection date is set to the current inspection date. The lesion information creation unit 25 may set a value input by the user via the operation unit 33 as the value of the examination date and time of the current examination, or may set it automatically. Thereby, the lesion information of the current examination is provisionally created.

  When step SA6 or SA7 is performed, the lesion determination parameter specification unit 27 specifies a lesion determination parameter of the current examination using a specific character string included in the examination order transmitted from the RIS (step SA8). Specifically, first, the lesion determination parameter identification unit 27 reads out the lesion determination parameter database stored in the lesion determination parameter storage unit 15. The lesion determination parameter identification unit 27 identifies a search string defined in the lesion parameter database from among the strings described in the examination order transmitted from the RIS.

  More specifically, first, the lesion determination parameter specifying unit 27 specifies a search destination related to the examination order from search destinations defined in the lesion parameter database. For example, in the case of FIG. 4, the inspection purpose included in the record of rule ID 1 and the record of rule ID 2 corresponds to the search destination regarding the inspection order. Next, the lesion determination parameter specification unit 27 specifies a search character string associated with the search destination regarding the examination order. For example, in the case of FIG. 4, a search string in which “preoperative scrutiny” of the record of record ID 1 and ““ lesion name ”+“ suspect of ”of the record of record ID 2 are associated with the search destination regarding the examination order. It corresponds to Next, the lesion determination parameter specification unit 27 specifies the specified search character string from among the character strings included in the examination order. For example, when the search character string is “preoperative examination”, the character string “preoperative examination” is specified from the character strings included in the examination order. If the search character string is "" "lesion name" + "suspect" ", the character string" "" lesion name "" suspicious "is specified from among the character strings included in the examination order. As "lesion name", the lesion name transmitted from RIS or the lesion name included in the treatment event is used. The lesion determination parameter specification unit 27 replaces the lesion name and the lesion name included in the treatment event transmitted from RIS with the “lesion name” of the search character string, and “from“ the character string described in the examination order Identify the character string "suspect". For example, when the "lesion name" is "lung cancer", the character string "suspect to lung cancer" is specified from among the examination orders. Alternatively, a dictionary of variations of lesion names may be prepared in advance, and the variation of lesion names may be replaced with “lesion name” to specify a character string from among character strings included in the examination order. For example, for "liver cancer", prepare a dictionary of modified examples such as "liver cancer", "liver cancer", "liver cancer" and "liver cancer", and from among the character strings included in the examination order You may specify "suspected liver cancer", "suspected liver cancer", "suspected liver cancer", "suspected liver cancer", "suspected liver cancer". When a search character string is identified from the examination order, the lesion confirmation parameter associated with the search character string in the lesion confirmation parameter database is set as the lesion confirmation parameter of the current examination. For example, in FIG. 4, when the character string “preoperative examination” is specified from the examination order, the lesion confirmation parameter for the current examination is set to “confirmed”. Further, in FIG. 4, when the character string “suspect to lung cancer” is specified from the examination order, the lesion determination parameter of the present examination is set to “suspect”.

  When step SA8 is performed, the medical status determination unit 29 applies the lesion determination parameter specified in step SA7 and the lesion name of the current examination to the status transition information regarding the lesion name of the current examination, and determines the medical status of the current examination. It determines (step SA9). As described above, the status transition information storage unit 17 stores status transition information in association with each of a plurality of disease names. The status transition information is information indicating the transition of the medical status according to the lesion determination parameter. For example, the status transition information is a file expressing the transition of the medical status according to the lesion determination parameter. The status transition information may be expressed in a database format, or may be expressed in a description language such as XML or HTML.

  FIG. 8 is a diagram schematically illustrating status transition information in the form of a flowchart. The status transition information in FIG. 8 shows the status transition information of solid cancer as an example. Status transition information is created based on the general diagnostic flow of solid cancer. Screening is the clinical status of a test that searches for lesions. If a lesion is added in the course of the examination, the examination status of the examination is set to screening. If, as a result of the screening, it is determined that there is no doubt of solid cancer before the test, the diagnosis for solid cancer ends. On the other hand, when it is determined that there is a solid cancer, the medical care status shifts to the detailed examination A. The close examination A is a medical status of examination for differential diagnosis before treatment. As a result of the interpretation in the detailed examination A, when it is judged that there is no doubt of the lesion, the diagnosis for solid cancer is finished. On the other hand, when it is determined that the presence of the solid cancer is confirmed as a result of the interpretation in the detailed examination A, the medical status shifts to the follow-up observation A. The follow-up observation A is a medical treatment status of an examination for observing a lesion before treatment. As a result of the follow-up A, when it is determined that there is a suspicion of metastasis, the medical care status shifts to the detailed examination A again. As a result of follow-up A, when the treatment event occurs (that is, when treatment for solid cancer is performed after follow-up of a lesion whose presence has been determined by a close examination), the medical care status shifts to follow-up B. The follow-up observation B is a medical treatment status of a test for observing a lesion after treatment. As a result of the interpretation in the follow-up observation B, when it is judged that there is a suspicion of recurrence or metastasis, the medical care status shifts to the detailed examination B. Detailed examination B is the medical treatment status of examination for differential diagnosis of recurrence and metastasis after treatment. When the presence of recurrence or metastasis is determined as a result of the interpretation in the detailed examination B, the diagnostic status shifts to the follow-up A. On the other hand, if it is determined that no recurrence or metastasis is suspected as a result of the detailed examination B, the diagnostic status shifts to the follow-up B. If it is determined as a result of follow-up B that the patient has been completely cured, the diagnosis of solid cancer is completed.

  “No doubt”, “suspected”, and “confirmed” in FIG. 8 are used as lesion confirmation parameters in this embodiment. The present inventors have found that if the lesion determination parameters of the previous examination and the medical care status are known, the medical care status of the current examination can be determined.

  The medical care status determination unit 29 according to the present embodiment determines the medical care status of the current examination from the status transition information using the lesion determination parameter of the previous examination and the medical care status.

  Next, the details of the process of determining the medical care status at each stage of FIG. 8 will be described. FIG. 9 is a diagram showing a flow of determination processing of the medical care status of the current examination when the medical care status of the previous examination is “screening”. As shown in FIG. 9, first, the medical treatment status determination unit 29 determines whether the lesion determination parameter of the previous examination is "no doubt" (step SA9-1A). Specifically, the medical treatment status determination unit 29 reads the value of the lesion determination parameter item in the lesion information of the previous examination, and determines whether or not the value is “no doubt”. When it is determined that the lesion determination parameter of the previous examination is “no doubt” (step SA9-1A: YES), the medical status determination unit 29 sets the medical status of the current examination to “screening” (step SA9-2A). ). On the other hand, when it is determined in step SA9-1A that the lesion determination parameter of the previous examination is not “no doubt” (step SA9-1A: NO), the medical status determination unit 29 sets the medical status of the current examination to “fine examination A”. (Step SA9-3A).

  FIG. 10 is a diagram showing a flow of the determination process of the medical status of the current examination when the medical status of the previous examination is “fine examination A”. As shown in FIG. 10, first, the medical treatment status determination unit determines whether or not the lesion determination parameter of the previous examination is "confirmed" (step SA9-1B). Specifically, the medical treatment status determination unit reads the value of the lesion determination parameter item in the lesion information of the previous examination, and determines whether the value is “finalized”. When it is determined that the lesion determination parameter of the previous examination is "confirmed" (step SA9-1B: YES), the medical care status determination unit 29 sets the medical care status of the current examination to "follow-up A" (step SA9- 2B). On the other hand, when it is determined in step SA9-1B that the lesion determination parameter of the previous examination is not "confirmed" (step SA9-1B: NO), the medical care status determination unit 29 sets the medical care status of the current examination to "fine examination A". The setting is made (step SA9-3B).

  FIG. 11 is a diagram showing a flow of determination processing of the medical care status of the present examination in the case where the medical care status of the previous examination is “following observation A”. As shown in FIG. 11, first, the medical treatment status determination unit 29 determines whether there is treatment event information that satisfies the previous examination date and time <treatment date and time ≦ examination date and treatment lesion name = lesion name (step SA9). -1C). Specifically, the medical status determination unit 29 obtains the value of the treatment date / time item in the treatment event information read in step SA4, the value of the previous examination date / time item and the value of the examination date / time item in the lesion information of the current examination. read. Then, the medical care status determination unit 29 determines whether or not the previous examination date and time <treatment date and time ≦ examination date and time. Further, the medical care status determination unit 29 reads the value of the treatment disease name item in the treatment event information read in step SA4 and the value of the lesion name item in the lesion information of the current examination. The medical status determination unit 29 determines whether or not the treatment lesion name = lesion name. Then, if there is treatment event information of the previous examination date and time <treatment date and time ≦ examination date and treatment lesion name = lesion name (step SA9-1C: YES), the medical treatment status determination unit 29 sets the medical treatment status of the current examination. Follow-up observation B "is set (step SA9-2C). On the other hand, when it is determined in step SA9-1C that there is no treatment event information satisfying the previous examination date and time <treatment date and time ≦ examination date and treatment lesion name = lesion name (step SA9-1C: NO), the medical care status determination unit 29 Determines whether the lesion determination parameter of the previous examination is "confirmed" (step SA9-3C). When it is determined in step SA9-3C that the lesion determination parameter is "determined" (step SA9-3C: YES), the medical care status determination unit 29 sets the medical care status of the current examination to "follow-up A" ( Step SA9-4C) If it is determined in step SA9-3C that the lesion determination parameter is not "determined" (step SA9-3C: NO), the medical care status of the current examination is set to "fine examination A".

  FIG. 12 is a diagram showing a flow of determination processing of the medical care status of the present examination in the case where the medical care status of the previous examination is “follow-up observation B”. As shown in FIG. 12, first, the medical treatment status determination unit 29 determines whether or not the lesion determination parameter of the previous examination is "no doubt" (step SA9-1D). When it is determined that the lesion determination parameter of the previous examination is “no doubt” (step SA9-1D: YES), the medical status determination unit 29 sets the medical status of the current examination to “follow-up observation B” (step SA9). -2D). On the other hand, when it is determined in step SA9-1D that the lesion determination parameter of the previous examination is not “no doubt” (step SA9-1D: NO), the medical status determination unit 29 sets the medical status of the current examination to “fine examination B”. (Step SA9-3D).

  FIG. 13 is a diagram illustrating the flow of the determination process of the medical status of the current examination when the medical status of the previous examination is “final examination B”. As shown in FIG. 13, first, the medical treatment status determination unit 29 determines whether or not the lesion determination parameter of the previous examination is “no doubt” (step SA9-1E). When it is determined that the lesion determination parameter of the previous examination is “no doubt” (step SA9-1E: YES), the medical status determination unit 29 sets the medical status of the current examination to “follow-up observation B” (step SA9). -2E). On the other hand, when it is determined in step S that the lesion confirmation parameter of the previous examination is not “no doubt” (step SA9-1E: NO), the medical status determination unit 29 determines whether the lesion confirmation parameter of the previous examination is “confirmed”. It is determined whether or not it is (step SA9-3E). When it is determined in step SA9-3E that the lesion determination parameter is “confirmed” (step SA9-3E: YES), the medical status determination unit 29 sets the medical status of this examination to “follow-up observation A” ( In step SA9-4E), if it is determined in step SA9-3E that the lesion confirmation parameter is not “confirmed” (step SA9-3E: NO), the medical status of the current examination is set to “detail examination B”.

  Thus, when step SA9 is performed, the lesion information creation unit 25 updates the lesion information of the current examination based on the medical treatment status of the current examination and the lesion determination parameter (step SA10). Specifically, the lesion information creation unit 25 replaces the medical treatment status associated with the patient ID and the lesion name related to the current examination in the lesion information storage unit 19 with the medical treatment status of the current examination determined in step SA9. In addition, the lesion information creation unit 25 replaces the lesion determination parameter associated with the patient ID of the current examination and the lesion name in the lesion information storage unit 19 with the lesion determination parameter of the current examination specified in step SA8. The lesion information is updated by this replacement. The read / write unit 21 writes the lesion information of the current examination after updating to the lesion information storage unit 19.

  When step SA10 is performed, the display unit 31 displays the lesion information of the current examination (step SA11). Specifically, the display unit 31 displays the patient ID of the current examination, the order ID, the lesion determination parameter, the medical care status, the examination date and time, and the previous examination date and time. As a result, the user can confirm the lesion determination parameter and the medical status of this examination.

This is the end of the description of the operation of each device of the medical information system 100 regarding the determination processing of the medical care status according to the first embodiment.
(Example 2)
FIG. 14 is a diagram illustrating the flow of the operation of each device of the medical information system 100 regarding the determination processing of the medical care status according to the second embodiment. In addition, the same code | symbol is attached | subjected to the processing process of the same content as each processing process of FIG. 14, and description is simplified. At the start time of step SB1, the lesion information of the current examination is not stored in the lesion information storage unit 19, and the lesion information of the previous examination is stored.

  As shown in FIG. 14, the interpretation doctor or the like inputs an interpretation start instruction via the input device of the PACS medical image utilization apparatus 400 (step SB1). Upon receiving the interpretation start instruction, the medical image utilization apparatus 400 reads the medical image to be interpreted from the PACS medical image storage apparatus 500 and displays it. Further, the image interpretation doctor or the like inputs a medical report creation start instruction via the input device of the medical report creation apparatus 700 of the report system (step SB3). Receiving the creation start instruction, the medical report creation apparatus 700 transmits a transmission request of the lesion name and the medical care status displayed on the creation screen of the medical report to the medical information management apparatus 1 according to the instruction via the input device such as an image interpretation doctor. To do (step SB4). Along with this transmission request, the medical report creation apparatus 700 transmits information necessary for reading a lesion name and a medical status, for example, an order ID, to the medical information management apparatus 1.

  The communication unit 23 of the medical information management apparatus 1 receives the transmission request and the order ID. The read / write unit 21 searches the lesion information storage unit 19 using the order ID as a keyword, and reads the lesion information associated with the keyword. Multiple lesion names may be associated with a single order ID. In this case, lesion information is read for all lesion names associated with the order ID. The communication unit 23 transmits the read lesion information to the medical report creation apparatus 700 of the report system. When lesion information relating to a plurality of lesion names is read, all these lesion information is transmitted. The lesion information includes the lesion name and the medical care status. The communication unit 23 may transmit the lesion information as it is, or may transmit the item value of the lesion information with modification. For example, the communication unit 23 may replace both the follow-up observation A and the follow-up observation B of the medical treatment status with the follow-up observation and transmit.

  Next, the medical report creation apparatus 700 receives the lesion information such as the lesion name and the medical care status transmitted from the medical information management apparatus 1. Then, the medical report creation apparatus 700 displays a medical report creation screen. The medical report creation screen displays lesion information such as the received lesion name and medical treatment status. In addition, findings may be displayed on the medical report creation screen, and patient information such as patient name, sex, and age may be displayed. The image interpretation doctor inputs an instruction to add, delete, or edit a finding or a lesion name in the medical report creation screen through the input device. The medical report creation apparatus 700 creates a medical report of the current examination in accordance with the instructions of addition, deletion, and editing via the input device (step SB6).

  When the medical report of the examination this time is decided, the medical report creation device 700 transmits the medical report of the examination this time and the lesion name to the medical information management device 1. The medical report creation apparatus 700 transmits the medical report and the lesion name of the current examination to the medical report storage apparatus 800, and the medical report storage apparatus 800 stores the transmitted medical report and the lesion name of the current examination. .

  The communication unit 23 of the medical information management apparatus 1 receives the medical report and the lesion name of the current examination. Then, the medical information management apparatus 1 repeats steps SA4 to SA11 for each lesion name as in the first embodiment. Thereby, the lesion determination parameter and the medical treatment status of the current examination are determined. In step SA8 according to the second embodiment, the lesion determination parameter identification unit 27 identifies a search character string not from the examination order but from the character string included in the medical report transmitted from the medical report generation device 700 of the report system. The lesion determination parameter associated with the identified search character string in the lesion determination parameter database is set as the lesion determination parameter of the current examination.

  This is the end of the description of the operation of each device of the medical information system 100 regarding the process of determining the medical care status according to the second embodiment.

(Modification 1)
In the above embodiment, either one of Example 1 and Example 2 is performed. However, the present embodiment is not limited to this. The examination order and the medical report may not contain a search string. In the first embodiment, when the search character string is not included in the examination order, even if the search character string is included in the medical report, the lesion determination parameter specifying unit 27 specifies the lesion determination parameter of the current examination. It is not possible to determine the treatment status of the examination this time. In the second embodiment, when the search character string is not included in the medical report, even if the search character string is included in the examination order, the lesion determination parameter specifying unit 27 specifies the lesion determination parameter of the current examination. It is not possible to determine the treatment status of the examination this time. In order to avoid such a disadvantage, the lesion determination parameter specifying unit 27 may specify the lesion determination parameter of the current examination using both the examination order and the medical report. As a result, it is possible to prevent the omission of the specific lesion determination parameter and the omission of the determination of the medical status when the search character string is included in only one of the examination order and the medical report.

(Modification 2)
In the above embodiment, the lesion determination parameter is automatically identified by the lesion determination parameter identification unit 27 using the examination order or the medical report. However, the present embodiment is not limited to this. For example, the lesion determination parameter may be input by the user via the operation unit 33. Thus, even when the examination order and the medical report do not include the search character string, the medical care status determination unit 29 can determine the medical care status of the current examination.

(Modification 3)
In the above embodiment, the lesion determination parameter exemplifies three types of "suspicious", "no doubt" and "definite". However, the lesion determination parameter of the present embodiment is not limited to this. For example, other character strings such as “diagnosis start”, “final cure”, “treatment event occurrence” and the like in FIG. 8 may be added as necessary. In addition, three types of “suspicious”, “no doubt”, and “confirmed” are not essential as the lesion determination parameters, and may be deleted or replaced with other lesion determination parameters as appropriate. In addition, the lesion determination parameter is not limited to a character string. For example, the lesion determination parameter may be a numerical value or a symbol indicating the degree of lesion determination.

(Modification 4)
In the above embodiment, the medical information management device 1 is a computer device separate from other devices in the medical information system 100. However, this embodiment is not limited to this. That is, the medical information management apparatus 1 includes an examination order issuing apparatus 200, an examination order storage apparatus 300, a medical image utilization apparatus 400, a medical image storage apparatus 500, a medical image photographing apparatus 600, and a medical report creation apparatus included in the medical information system 100. It may be incorporated in other devices such as the medical report storage device 800 and the medical report reference device 900.

[effect]
As described above, the medical information management apparatus 1 according to the present embodiment includes at least the status transition information storage unit 17 and the medical care status determination unit 29. The status transition information storage unit 17 stores, in association with each of a plurality of lesion names, status transition information indicating a standard transition process of a medical treatment status of a lesion. The medical status determination unit 29 applies the medical status of the previous examination for the target lesion of the target patient to specific status transition information stored in the status transition information storage unit 17 and associated with the target lesion, and the target lesion Determine the clinical status of this exam about.

  Thus, according to the present embodiment, even when the examination information such as the examination order and the medical report does not include the character string indicating the medical care status, it is possible to determine the medical care status of the current examination.

  Although several embodiments of the present invention have been described, these embodiments are presented by way of example and are not intended to limit the scope of the invention. These novel embodiments can be implemented in various other forms, and various omissions, substitutions, and modifications can be made without departing from the scope of the invention. These embodiments and modifications thereof are included in the scope and the gist of the invention, and are included in the invention described in the claims and the equivalent scope thereof.

  DESCRIPTION OF SYMBOLS 1 ... Medical information management apparatus, 11 ... Control part, 13 ... Treatment event storage part, 15 ... Lesion decision parameter storage part, 17 ... Status transition information storage part, 19 ... Lesion information storage part, 21 ... Reading / writing part, 23 ... Communication Part 25: Lesion information creation part 27: Lesion confirmation parameter specification part 29: Medical care status decision part 31: Display part 33: Operation part 100: Medical information system 200: Examination order issuing device 300: Examination Order storage device 400 Medical image utilization device 500 Medical image storage device 600 Medical imaging device 700 Medical report creation device 800 Medical report storage device 900 Medical report reference device

Claims (10)

A transition information storage unit that associates and stores status transition information indicating a standard transition process of a medical treatment status of a lesion with each of a plurality of lesion identifiers;
A parameter storage unit that associates and stores a lesion determination parameter indicating the degree of lesion determination with each of a plurality of character strings;
Parameter specification for specifying a lesion determination parameter stored in the parameter storage unit and associated with the specific character string using a specific character string related to the degree of determination of the lesion included in the examination information regarding the target lesion of the target patient Department,
Using the status of the previous stage for the target lesion and the identified lesion determination parameter , from the specific status transition information stored in the transition information storage unit and associated with the identifier of the target lesion, A status determination unit that determines the current medical status of the target lesion;
Medical information management device equipped with. A lesion information storage unit that associates and stores a medical care status for each combination of a patient identifier and a lesion identifier;
A medical status specifying unit that specifies the medical status of the previous stage for the target lesion stored in the lesion information storage unit and associated with the target lesion identifier of the target patient;
The status determination unit uses the specified previous-stage medical status, the specific character string, and the specified lesion determination parameter to determine the current-stage medical status from the specific status transition information. decide,
The medical information management device according to claim 1.   The medical information management apparatus according to claim 2, further comprising: an update unit that associates the determined medical care status with the identifier of the target patient and the identifier of the target lesion in the lesion information storage unit.   The medical unit according to claim 3, wherein the update unit replaces the previous medical status associated with the target patient identifier and the target lesion identifier in the lesion information storage unit with the determined medical status. Information management device.   The medical information management apparatus according to claim 1, wherein the examination information is at least one of an examination order and a medical report. A lesion information storage unit that associates and stores a lesion determination parameter for each combination of a patient identifier and a lesion identifier;
And an updating unit for associating the identified lesion determination parameter with the identifier of the target patient and the identifier of the target lesion in the lesion information storage unit.
The medical information management device according to claim 1 . The update unit lesions determined parameters of the previous step associated with the identifier of the target lesion and the identifier of the subject patient in the lesion information storage unit, the replaced by a specific lesion determined parameters, according to claim 6, wherein Medical information management device. An input unit for inputting the identifier of the target lesion and the medical status of the previous stage,
The status determination unit stores the input medical status and the specified lesion determination parameter in the transition information storage unit and is associated with the input target lesion identifier. Apply to and determine the current medical status
The medical information management device according to claim 1. The status determination unit, when the clinical status of the previous step is not, the setting a predetermined status as the clinical status of the current stage, the medical information management apparatus according to claim 1.   The medical information management apparatus according to claim 1, further comprising a display unit that displays the determined medical status.

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