RU2683898C1 - Mobile complex of multichannel diagnostics and monitoring for remote studies of patients in the real time mode - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medical equipment, namely to a mobile remote monitoring complex. Mobile complex includes a monitor and a tonometer cuff, a nasal cannula, electrodes for electrocardiogram (ECG) removal, a pulse oximeter, a temperature sensor and a remote camera with a microphone, which connected to it with the possibility of multiple separate connections. Monitor is designed as a portable monoblock and includes a unit for measuring physiological parameters, a control unit, data processing and storage, a remote data transfer unit, data input-output unit, an autonomous power supply system and a thermal printer. Unit for measuring physiological parameters via the data bus is connected with the data control and processing and storage unit, the unit for remote data transmission, the data input-output unit, the remote camera, the thermal printer and the power supply system. Power supply system via the power bus is connected with a unit for measuring physiological parameters, data control and processing and storage unit, a thermal printer, a remote camera with a microphone, a remote data transmission unit and data input-output unit and includes tonometer, pulse oximeter, ECG recorder, capnograph and temperature unit, removable connected to each other to change the configuration of the unit depending on the tasks of monitoring studies and associated with connectors installed on the monitor body. Data control and processing and storage unit includes a processing unit. Processing unit is programmed to implement switching between measuring channels, forming on the monitor screen graphs of signals recorded from a patient, values of vital state parameters, windows of audio-visual data exchange between the complex and the remote subscriber, light and sound alarms when the patient’s parameters go beyond the normal range, the trend parameters for the entire monitoring period, the diagnostics of the measuring channels, the mobile communication channel and the charge level of the built-in batteries.EFFECT: quality, efficiency, reliability and validity of remote medical research are improved for first-aid decisions in extreme conditions and emergency situations.9 cl, 7 dwg

Description

Region

The invention relates to medical equipment, is intended for use in equipping medical salons of ambulance and catastrophe medicine, resuscitation and intensive care units, for long-term monitoring of non-transportable / seriously ill patients at the place of residence, studies of the population of remote regions and allows you to quickly conduct a survey of vital functions and systems of the patient’s body, exchanging remotely through the channels of the mobile / wire / satellite Vågå native Internet information with experts specialized medical institutions.

The invention allows to build medical logistics from the first minutes of the inclusion of the remote examination of the patient, preparing the conditions for effective decisions by specialists of medical institutions.

State of the art

Modern complexes for monitoring the patient’s condition are designed for continuous monitoring of vital signs of patients, both in a hospital and during transportation by ambulances.

During monitoring, the vital parameters of the patient are monitored, i.e. those by which one can judge the state of vital systems and (or) body functions and an additional set of parameters for advanced research in various areas of medicine.

Patient monitors are used when working with patients of various age groups: from newborns to the elderly. Standardly controlled parameters are arterial blood oxygen saturation (SpO2), electrocardiogram (ECG), non-invasive blood pressure (NIBP), heart rate (HR), respiratory rate (BH), body temperature (T °).

The complexes are often equipped with a built-in battery, thermal printer, channels for recording invasive pressure (IAD), capnometry, analysis of the gas mixture, measurement of cardiac output (SV), monitoring the depth of sedation, neuromuscular conduction and electroencephalography (EEG). Currently, about 50 companies in the world specialize in the production of patient monitors. Patient monitors are used: anesthetic, bedside, ward, neonatal, fetal and transport. Anesthetics are designed to control the patient’s parameters during anesthesia and use the following set of controlled parameters: pulse oximeter, ECG, capnograph, NIAD, IAD, blood anesthetics. Bedsides are used for long-term monitoring of vital signs of the patient in intensive care units and intensive care units and use the channels of pulse oximetry, ECG, NIAD, ID, capnometry, T °, SV, EEG. Wards are used for a single measurement of the vital parameters of patients and monitor pulse oximetry, NIBP, T ° and ECG. Neonatal monitors are used for long-term monitoring of vital parameters of newborns and record ECG, NIBP, ID, SpO2, BH, T °, capnometry, EEG. Fetal monitors are used in obstetric practice to analyze the condition of a pregnant woman and the fetus, perform ECG monitoring, control blood pressure, blood oxygenation, the intensity of uterine contractions and fetal movements, intrauterine pressure, and pulse. Transport monitors are used during in-hospital transportation or at the prehospital stage, including: in automobile, air and river transport of ambulance services. Such monitors have built-in autonomous power supply systems, thermal printers and are equipped with pulse oximetry, ECG, capnography, NIBP and temperature recording channels.

By the number of measured parameters, all patient monitors are divided into single-channel and multi-channel. The former are used to control one of the body functions: respiration, heart function, oxygen saturation, etc. Such monitors include a Nihon Kohden pulse oximeter, Drager gas analyzers, BioNet fetal monitors, and BIOSOFT-M IAD.

Multifunctional measure the "complete" set of vital signs of the patient. The best known monitors are Philips, Mindray, and Nihon Kohden.

Famous mobile (transport) monitors are lightweight, carry handle or are equipped with a mobile transport stand, have built-in batteries, are equipped with sensors, including electrochemical, paramagnetic, piezoelectric, pressure, temperature sensors, as well as pulse oximetry and infrared photometry and others.

For medical examinations, cardiomonitors are most often used for measuring and recording bioelectric potentials of the heart, as well as for measuring heart rate (HR) and generating an alarm when the heart rate exceeds the established limits.

Known transport monitors require that the accompanying medical personnel analyze the information recorded from the patient, interpret it, and promptly make independent decisions. As a rule, the composition of ambulance crews is staffed with specialists of low or medium qualifications. For example, paramedics who do not have versatile and in-depth knowledge in all areas of medicine work on SMP cars of class “A” and “B”. Even experienced doctors working on a visit to the patient are often limited in making decisions in an emergency due to the lack of means of on-line prompt exchange of information recorded from the patient (schedules, trends, parameters of critical functions) with specialized specialists or a group of experts .

Similar problems arise for the tasks of continuous monitoring of critical parameters of the condition of seriously ill non-transportable patients outside hospitals, remote emergency investigations, equipping feldsher facilities with monitoring studies of the population of hard-to-reach regions.

In this regard, the urgent problem is to integrate the monitor into a remote mobile communication system for the implementation of bidirectional on-line exchange of monitoring data with remote diagnostic centers and specialized services for the purpose of qualified consultation of specialized specialists and / or preparation of the hospital in advance for receiving a patient. In this case, the monitor is used as a device for multichannel recording, processing and analysis of biomedical signals, their broadcasting via the Internet to medical consumers and the implementation of a bi-directional doctor-patient exchange of audiovisual information in real time. This solution provides effective information support for medical specialists in the conditions of remote diagnostics.

The prior art in the field of remote monitoring of health is represented by the systems disclosed in patents RU No. 118178, RU No. 110946, RU No. 105778. In published application US 2014371617 A1 related to this area, a system is presented in which patient information is transmitted through a local area network. The remote device analyzes the received data, and the analysis results may be available to all authorized users - carers, doctors, relatives of the patient.

The published application US 2011301429 A1 discloses a system for remote diagnostic monitoring and patient support, including sensors for the patient’s current state of health, measuring channels, a multi-channel device for evaluating information received from a patient, a device for remote transmission of information, a power supply. Based on the analysis of the patient’s data, the evaluation device makes a decision on establishing an emergency communication between the patient and specialists, or postpones it for a certain period, or issues a conclusion that there is no need for such communication. The known system is not intended for transport or portable use, it does not implement multi-channel monitoring and it is not mobile.

However, in the prior art there is no information about universal, mobile, small-sized, autonomous, multi-function monitors having a wide range of field operation, when transporting a patient by water, air and air transport, in emergency working conditions of the Ministry of Emergency Situations, ensuring stable transmission of data recorded from the patient real-time biomedical signals via mobile, wired or satellite Internet channels to a remote medical operator.

There are no monitoring tools that implement remote transmission, saving and viewing on mobile devices of remote specialists registered with the patient in the on-line ECG mode, plethysmograms, capnograms, spirograms and other native information synchronized with trends, calculated parameters of the patient’s state and data of audiovisual exchange in the remote mode.

There are no patient monitors combining the tools and methods of monitoring and diagnostics in one device, which allow performing advanced functional diagnostics of the patient’s condition according to the selected methods, without interrupting the registration of vital patient parameters and providing real-time patient data simultaneously to a group of specialized experts performing independent analysis of native information and sharing the results with each other.

There are no tools that provide medical professionals with authorized access to the full amount of data on the Web site for remote research for the purpose of advanced analysis, additional processing, editing, and documentation of the results.

Disclosure of invention

The problem to which the present invention is directed, is the creation of a mobile device for multi-channel monitoring and functional diagnostics in remote mode for transport and portable use in medicine of disasters and ambulance vehicles, for remote monitoring of non-transportable and seriously ill patients outside hospitals and remote examination of the population hard-to-reach regions and the implementation of monitoring studies in the field by the specialized services of the Ministry of Health and the Ministry of Emergencies, which eliminates the shortcomings of well-known solutions and allows you to provide remotely qualified emergency care in the form of a diagnosis, consultations, organization of an on-line consultation of specialized specialists, automatic preliminary diagnosis and make informed effective decisions on analyzing the clinical situation and prescribing treatment in healthcare institutions of the corresponding specialization, and also provide a change in the configuration of the hardware and software of the complex for specific diagnostics skie tasks and research facilities as well as to carry out the current diagnosis of the equipment in real time.

The technical result that is achieved by using the present invention is to improve the quality, efficiency, reliability and validity of remote medical research for decision-making on first aid in extreme conditions and emergency situations. The technical result also consists in providing remote monitoring and functional diagnostics and remote storage, processing, viewing research results on medical devices’s mobile devices and realizing the possibility of remote audiovisual data exchange and round-the-clock patient monitoring at the place of residence. The technical result also consists in providing the possibility of remote examination of the population of hard-to-reach regions and optimizing the logistics of transporting victims and patients to specialized medical facilities.

The technical result is achieved due to the fact that in the mobile complex of multi-channel diagnostics and remote monitoring for transport and portable applications, including a transport monitor and recording channels, sensors with connectors for multiple connections to the complex and including a tonometer cuff, nasal cannula, electrodes for ECG, a pulse oximeter, a temperature sensor and an external camera with a microphone, the transport monitor is made in the form of a portable monoblock and includes a unit for measuring physiological pairs human meters, control unit, data processing and storage, remote information transfer unit, information input-output unit, autonomous power supply system and thermal printer, human physiological parameters measuring unit is connected via data bus to control unit, data processing and storage, remote information transfer unit , an information input / output unit, a remote camera, a thermal printer, and a power system, which is connected through a power bus to a unit for measuring physiological parameters of a person, a thermal printer, a unit m control, a remote camera with a microphone and an input / output unit, the unit for measuring physiological parameters is modular and includes modules for a tonometer, pulse oximeter, ECG, capnograph and temperature, removably connected to each other to change the configuration of the unit depending on diagnostic tasks and connected with connectors installed on the housing of the transport monitor, a control unit, while the control unit, processing and storage of data includes a processor programmed to implement switching between measuring channels, forming on the monitor screen graphs of signals recorded from the patient, forming values of vital status parameters, forming windows of audiovisual data exchange between the complex and the remote subscriber, automatically generating light and sound alarms when patient status parameters go beyond the norm, forming parameter trends for the entire monitoring period and for diagnosing the state of measuring channels, assessing the quality of a mobile ligature and charge level of built-in batteries.

The technical result is enhanced due to the fact that the control unit, processing and storage of data includes a memory card with a database of research results as part of the patient registration card and associated monitoring records, including graphs of native signals, trends and values of vital parameters of the patient’s condition, audio and video recording of bidirectional information exchange of the complex with the remote subscriber, configuration of the complex settings, alarms and diagnostics messages for the patient and the unit from Eren physiological parameters.

The transport monitor is equipped with a connector for connecting the mains cable connected to the power system and a power on / off button.

The case of the transport monitor is equipped with a carrying handle, made of shockproof plastic and sealed, while the connectors of the case are also sealed.

The screen of the transport monitor is divided into the following areas: the area of touch control containing the function keys for controlling the display, settings, printing and saving of signals recorded from the patient; signal area for displaying and visualizing graphs of signals from the patient and controlling the scale of their sweep; a video communication area for bidirectional data exchange between the complex and the remote subscriber; and a calculation parameters area for displaying critical parameters of the patient’s state.

The complex processor is programmed with the ability to simultaneously perform tasks of monitoring studies and functional diagnostics in real time on the basis of a single platform of hardware and software.

The remote data transmission unit is capable of realizing Internet broadcasting of information recorded from a patient, in particular, graphs of native signals, trends, patient status parameters, audio-visual data, simultaneously to several remote subscribers in real time.

The remote data transmission unit is capable of transmitting native biomedical signals, in particular, ECG, plethysmograms, capnograms, respirograms, blood pressure trends in a format available for storage and additional processing to remote subscribers.

The processor of the complex is configured to set limits for the norm for each of the measured parameters of the patient’s state for automatic processing and storage of data. It includes a processor programmed with the ability to switch between measurement channels, generate graphs of signals recorded from the patient and calculate parameters of his condition, form critical trends - important parameters of the patient and displaying windows of video communication of the complex with the remote subscriber and displaying on-li text on the screen ne diagnostics of the patient's condition for the entire monitoring period, placement of all information on the monitor display and diagnostics of the status of the measuring channels.

Description of the figures of the drawings

The invention and the possibility of achieving a technical result will be more clear and shown below with reference to the position of the drawings, which depict:

FIG. 1 is a structural diagram of a monitor,

FIG. 2 is a structural diagram of a unit for measuring physiological parameters,

FIG. 3 is a structural diagram of a control unit for processing and storing data,

FIG. 4 is a structural diagram of an autonomous power system,

FIG. 5 is a block diagram of an input / output information unit,

FIG. 6 is a block diagram of a remote data transmission unit, and

FIG. 7 is a drawing of a general view of a transport monitor.

In all the figures of the drawings, the following uniform designations are adopted:

1 - pneumatic connector connecting the tonometer cuff,

2 - pneumatic connectors connecting the nasal cannula and air vent,

3 - connector connecting the ECG cable,

4 - connector for connecting the SpO2 sensor,

5 - connector for connecting a temperature sensor,

6 - unit for measuring physiological parameters of a person,

7 - thermal printer,

8 - camera with microphone,

9 - cable entry

10 - block input-output information

11 - control unit, data processing and storage,

12 - block remote data transmission,

13 - autonomous power supply system,

14 - connector for connecting the power cable,

15 - power button,

16 - standard RJ-45 connector,

17 - air pump,

18 is a linear solenoid valve,

19 - driver,

20 - pressure sensor,

21 - analog filters,

22 - analog-to-digital Converter,

23 - tonometer module microcontroller,

24 - protection circuit from static electricity,

25 is an analog filter

26 - analog-to-digital integrated module,

27 - microcontroller module pulse oximeter

28 - galvanic isolation of digital signals and power,

29 - protection circuit from static electricity,

30 - analog filter

31 - analog-to-digital Converter,

32 - microcontroller ECG module,

33 - galvanic isolation of digital signals and power,

34 - dehumidifier,

35 - switching valve

36 - air pump,

37 - carbon dioxide sensor,

38 - a system of analog filters and amplifiers,

39 - analog-to-digital Converter, 40- microcontroller module capnograph,

41 - load circuit

42 - filter

43 - analog-to-digital Converter,

44 - microcontroller temperature module,

45 - FLASH memory card

46 - single board computer,

47 - hub

48 - node matching logical levels of the data bus,

49 - node power management measuring modules,

50 - AC-DC power supply converter,

51 - smart charger,

52 - power keys

53 - controlled fuse,

54 - battery pack,

55 - control system and protection of the battery,

56 - site selection of the active power source,

57 - electronic power switch,

58 - step-down DC-DC Converter,

59 - display

60 - touch panel

61 - display driver,

62 - touch panel controller,

63 - SIM card

64 - GSM modem,

65 - transport monitor, transport monitor housing,

66 - data bus

67 - power bus

68 - handle of the housing of the transport monitor.

The implementation of the invention

The complex represents a system for collecting, analyzing and transmitting data on mobile, wired or satellite channels about the patient’s condition, with the ability to change its configuration depending on the diagnostic tasks to be solved. The complex has the ability to expand the configuration by connecting new diagnostic modules. The built-in autonomous power supply system allows you to place it on board the water, road and air transport of the NSR and MK. The portable execution of the complex provides for use in the field outside specialized vehicles. The built-in audio-visual exchange channel, implemented through the remote data transmission unit, allows remote examination and interrogation of the patient, performing functional tests, and advising medical personnel.

The complex allows monitoring studies with the possibility of switching to the functional diagnostics mode via the selected registration channel. In this case, the monitoring mode is not interrupted, and the researcher can return to it without losing the signals recorded from the patient.

The measuring channels of the complex are synchronized between themselves and the channel of audiovisual exchange. All data streams from the patient are transmitted via the Internet to authorized mobile means of medical personnel, servers of medical institutions and communication equipment of stationary and mobile dispatching points of medical services.

The complex contains a database of patients, which includes patient registration cards and associated records of the results of distance research, consisting of: native signals, trends, patient parameters, online diagnostic results, audiovisual recordings, alarm messages. Access to the database is implemented from mobile devices of authorized users, servers and communication tools of medical organizations and their services.

The complex implements an alarm system for each of the registration channels with the ability to adjust the range of values of the monitored parameters of the patient's condition, the duration of the notification and the volume of alarms.

The complex includes a transport monitor 65 and diagnostic tools connected with it with the possibility of multiple connection and disconnection: a blood pressure monitor cuff connected through connector 1, a nasal capnograph cannula connected to monitor 65 through connector 2, ECG electrodes connected through connector 3 for ECG cable connections, a pulse oximeter connected through connector 4, a temperature sensor connected through connector 5 and a remote camera 8 with a microphone connected via cable entry 9.

The transport monitor 65 (Fig. 1) is made in the form of a portable monoblock and includes a unit 6 for measuring the physiological parameters of a person (Fig. 2), a unit 11 for controlling, processing and storing data (Fig. 3), a unit 12 for remote data transmission (Fig. 6 ), information input-output unit 10 (Fig. 5), an autonomous power supply system 13 (Fig. 4), and thermal printer 7. A unit 6 for measuring physiological parameters of a person is connected to a control unit 11 for processing, processing and storage of data through a data bus 11, block 12 remote information transfer, block 10 input-output information through cable entry 9 - to a remote chamber 8 with a microphone, a thermal printer 7 and an autonomous power supply system 13, which is connected via a power bus 67 to a unit 6 for measuring physiological parameters of a person, a thermal printer 7, a remote camera 8 with a microphone, an information input / output unit 10, and block 12 remote data transmission.

Block 6 (Fig. 2) of measuring physiological parameters has a modular construction and includes tonometer, pulse oximeter, ECG, capnograph and temperature modules, removably connected to each other to change the block configuration depending on diagnostic tasks. The modules are connected to the corresponding connectors 1-5 installed on the housing 65 of the transport monitor. Modules implement measurement channels.

Block 6 performs registration of patient signals, their synchronization, processing and display in numerical and graphic formats.

Registration of the patient's ECG signals is carried out through 12 channels with a frequency of 250 Hz through connector 3. The ECG module includes a circuit for protection against static electricity 29, an analog filter 30, an analog-to-digital converter 31, a microcontroller 32, a galvanic isolation circuit for digital power signals 33. Using a microcontroller 32 ECG modules, the calculation of the respiratory rate by impedance respirography, the calculation of heart rate (HR) and ST segment, the detection of basic rhythms, the calculation of all types of arrhythmias. An information input / output display 59 shows ECG signals on selected channels, a heart rate trend, and parameter values. The real-time ECG channel detects the following arrhythmias: asystole, ventricular fibrillation, ventricular flutter, paroxysmal ventricular tachycardia, accelerated ventricular rhythm, ventricular bradycardia, paroxysmal supraventricular tachycardia, extreme bradycardia, extreme brachardia, extremism ventricular extrasystole (ZhE), supraventricular extrasystole (NJE), deformed QRS complex, interpolated (insert a) ventricular extrasystole, interpolated (inserted) supraventricular extrasystole, steam (couplet) ZhE, steam (couplet) NZhE, ventricular bigeminia, ventricular trigeminia, ventricular quadroheminia, supraventricular hemiformes, supraventricular hemogemin hemogemia, supraventricular hemogemia Trigeminus extrasystoles, skipping contractions, pause, irregular rhythm, no pulse pacemaker. The ECG module implements the function of automatically determining the connection of the electrodes of the ECG cable to the patient (open lines).

The pulse oximetry module includes a static electricity protection circuit 24, an analog filter 25, an analog-to-digital integrated module 26, a microcontroller 27, and a means for galvanically decoupling the digital signals and power 28. The SpO ₂ signal is recorded through connector 4 with a frequency of 50 Hz by the pulse oximetry module. Microcontroller 27 calculates SpO ₂ saturation parameters, heart rate, and perfusion index. An information input / output display 59 shows the SpO2 trend, graphs of the heart rate, perfusion index, and parameter values.

The pulse oximetry module excludes the possibility of connecting sensors designed for measuring other physiological parameters to it.

The capnometry module includes a dryer 34, a switch valve 35, a pneumatic pump 36, a carbon dioxide sensor 37, an analog filter and amplifier system 38, an analog-to-digital converter 39, and a microcontroller 40. Using a nasal cannula through a pneumatic connector 2, block 6 registers a CO ₂ signal with a frequency 25 Hz. The microcontroller 40 of the capnograph module calculates the parameters of the CO ₂ content in the blood by inspiration (FiCO ₂ ) and expiration (EtCO ₂ ), calculation of the BH parameter. The CO ₂ trend, FiCO ₂ , EtCO ₂ , BH graphs and parameter values are displayed on the monitor screen. The pulse oximeter module implements the function of automatically detecting the connection of the sensor to the monitor (open lines).

The tonometer module includes a pneumatic pump 17, a linear solenoid valve 18. driver 19, a pressure sensor 20, analog filters 21, an analog-to-digital converter 22, and a microcontroller 23. Using the tonometer cuff, a system pressure signal obtained by a non-invasive measurement method (NIBP) is recorded through connector 1 ) with a frequency of 10 Hz. The microcontroller 23 of the tonometer module allows you to calculate the pressure parameters - systole (S), diastole (D), myastole (M). Trends S, D, M and parameter values are displayed on the screen. The tonometer module implements the function of automatically detecting the connection of the sensor to the monitor (open lines).

The temperature module includes a load circuit 41, a filter 42, an analog-to-digital converter 43, and a microcontroller 44. Using a temperature sensor, a temperature signal is recorded through connector 5 with a frequency of 40 Hz, and its values are displayed on the screen. The temperature measurement module implements the function of automatically detecting the connection of the sensor to the monitor (open lines). The temperature measurement module excludes the possibility of connecting sensors to it, designed to measure other physiological parameters.

The complex allows video monitoring of the patient's condition using a camera 8 equipped with a microphone. The video signal is recorded at a frequency of 10 frames per second. in RGB 24 format with a resolution of 640 × 480, 30 FPS. The screen displays video data in compressed (250 × 200) and full-screen (830 × 620) modes. Camera 8 is connected to the monitor 65 via cable entry 9 - USB 2.0 interface. The driver implementation of the video stream is UVC Video, support for video format.JPEG for storing and transmitting video data over wireless Internet channels. The video camera 8 is mounted on the handle 68 of the monitor 65 and can be carried 1.8 meters outside the housing.

Monitor 65 has a built-in thermal printer 7, which allows you to print graphs of native signals and the calculated parameters of the vital functions of the patient, recorded at intervals of 4, 8 and 16 seconds. in real time.

The complex software performs diagnostics of all systems and monitor modules during operation and displays their status for operator information.

Block 11 of the control, processing and storage of data includes (Fig. 3) a processor (single-board computer) 46 programmed with the ability to implement switching between measuring channels, generating graphs of signals recorded from the patient, forming trends of parameters for the entire monitoring period and diagnosing the state of the measuring channels. Block 11 includes a hub 47, a node 48 for matching logical levels of the data bus 66, a node 49 for power management of the measuring modules, and a FLASH memory card 45.

The transport monitor is equipped with a connector 14 for connecting the power cable connected to the autonomous power supply system 13 (Fig. 4), and a power button 15 for turning the monitor on / off in operation. The autonomous power supply system 13 includes an intelligent charger 51. power switches 52, a controlled fuse 53, a battery pack 54, a control and protection system for the battery 55, an active power source selection unit 56, an electronic power switch 57, and a step-down DC / DC converter 58. The autonomous system power supply 13 allows you to switch power between mains and battery sources. The batteries of the autonomous power supply system are located inside the monitor case - accumulator pack 54, which ensure uninterrupted operation of the complex. Intelligent charger 51 power system provides control of the process of charging / discharging the battery; management of internal modes; emergency protection against over current and voltage; monitoring the operation of the autonomous power supply control system of the complex; displaying information about the working condition of the batteries, the value and state of charge of the batteries of the SAE; sound and light indication in case the battery charge approaches zero or the complex goes into emergency operation mode.

The software of the complex forms an indicator of the battery charge level, consisting of segments and displays the charge level, with a certain step. If the battery charge drops below 20%, an alarm is triggered. The batteries are charged when connected to a network source of 220 V, 50 Hz. The identification of the power source used is displayed on the screen.

The housing of the transport monitor 65 is equipped with a handle 68 for carrying, made of shockproof plastic and sealed. Housing connectors are also available in a sealed version.

The principle of the complex’s operation is to receive information that comes from the channels for registering the parameters of the vital functions of the patient’s body and the audio-video channel, process this information, analyze the signals for the on-line diagnosis of the patient’s condition, display on the display 59, save it to the database, generate and transmit via mobile / wired / satellite Internet channels in real time to remote specialists of specialized medical services for the purpose of consultation, diagnosis and justification of transport logistics when delivering the patient to the hospital.

Processing the information obtained consists in performing a number of transformations: amplifying the information signal to a certain level; multiplexing (for switching between channels); digitization (using ADC information is converted from analog to digital form); filtering (noise reduction).

The incoming processed information is displayed on the monitor screen of the Complex and transmitted to a remote specialist or their group of the patient medical support service. It includes: graphs of signals recorded from the patient (pressure, temperature, ECG, respirogram, plethysmogram, capnogram); calculated values of its state parameters; trends of critical parameters for the entire monitoring period; video image of the patient and the examined parts of the body; voice messages; parameters of the technical condition of the complex: the level of charge of the SAE batteries, an indicator of the quality of remote communications, messages of the alarm system; video data (video + sound) from the patient’s surveillance camera to the mobile gadget of the remote medical subscriber and video data of the remote subscriber to the patient’s console.

The algorithm of the complex includes three stages. At the first stage, configuration settings are read from the Complex file system to build a working window for the program. Then, the structure of the user interface is formed and the screen form of the registration mode of the native signals is displayed. The second stage of the algorithm implements real-time processing of data on transport monitoring of the patient’s condition and parameters of the state of the technical systems of the complex: autonomous power supply systems, remote data transmission and alarm systems. Based on the data processing results, on-line graphs are built, alarm messages are displayed and the numerical values of the monitored parameters are displayed.

The third stage implements the processing of interactive user operations: setting up the interface and entering / editing a patient registration card.

Before use, the complex is installed next to the patient. Next, connect the cables of the patient registration channels to the connectors 1-5. The sensors of the electrocardiograph, pulse oximeter, capnograph, tonometer and temperature are installed on the patient. Button 15 turns on the power supply.

If the Complex is connected to the mains, then the power is supplied from a 220 V 50 Hz network source, otherwise, from the built-in accumulators 54 of the autonomous power supply system. If the batteries are discharged, a warning message is displayed on display 59. In this case, when the Complex is connected to the mains, charging of the batteries 54 built into the console will begin.

Indication of the charge level is carried out on the display 59 in the form of an image.

The video camera 8 is placed in a position convenient for the examination of the patient: having fixed it on the handle for carrying the complex or in the remote version using a connection cable 1.8 meters long.

The complex is controlled in touch mode when the user touches the image of the control keys on the touch screen of the monitor.

The display 59 includes 4 areas: a control area containing function keys for controlling the display, setting, printing, and saving signals recorded from the patient; signal area, intended for displaying in the visualization graphs of biomedical signals and controlling the scale of their sweep; The video communication area is used for bi-directional data exchange (video + sound) between the complex and the remote subscriber. On the left, the video connection window of the remote subscriber with the complex is displayed, on the right, the video communication window of the complex with the remote subscriber. The fourth area is the area of the calculated parameters, which is designed to display critical parameters of the patient’s condition.

Internet access is provided through a modem of a mobile operator integrated in the complex: in case of video footage, any available cellular or wired communication channel is used.

Field of application: emergency and emergency medicine, transportation and dispatching services for NSR, MK, Ministry of Emergency Situations and Ministry of Defense, remote military medicine, intensive care and rehabilitation departments, preventive medicine, rural medicine, internal medicine of ministries and departments of the Russian Federation.

The complex has a built-in communication modem such as LTE, with support for GSM, 3G, 4G, GPRS standards for broadcasting data on mobile Internet channels.

Management of the complex is implemented on the basis of touchscreen - monitor. Support for all functions of the Complex in touch control mode has been performed for the following tasks: displaying signals recorded from the patient, parameter values and their trends, displaying windows of functional diagnostics on all channels for registering the patient’s status, managing the database of transport monitoring, setting up the parameters of the Complex, displaying patient video monitoring windows and remote video communications, an indication of the status parameters of the autonomous power supply system (SAE) and the quality of remote communications.

Examples of studies conducted using a mobile complex

1. The studies were conducted in St. Petersburg and Moscow. The complex was installed in the office of BIOSOFT-M LLC at the following address: Moscow, ul. Baltiyskaya, 9. The power supply of the Complex was carried out from built-in batteries throughout the entire period of research (about 8 hours). An employee of the company was installed measuring channels of the Complex, recording: plethysmogram, 12-lead ECG, impedance spirogram, NIBP, body temperature, capnogram. Simultaneously with the measurement, audio-video recording and calculation of critical parameters of the body state were carried out: heart rate, ST segment value for 1 ECG lead, arterial oxygen saturation with SpO ₂ , pulse rate (PE), PaI perfusion index, EtCO ₂ expiratory oxygen content, oxygen content on inspiration FiCO ₂ , respiratory rate (BH), systolic S, diastolic D and myastolic M blood pressure, body temperature T °. The ECG graphs, spirogram, plethysmogram, capnogram, trends in heart rate, BH, SpO ₂ , EtCO ₂ , S, and D parameters were displayed on the monitor’s screen of the Complex. During the tests, two audio-video communication windows were displayed on the monitor screen: “Complex - medical operator” and “medical operator - Complex. ”

The medical operator was at the I.I. Dzhanelidze at the address: St. Petersburg, Budapest Str., 3, lit. BUT.

As a personal device of the operator for receiving information coming from the Complex, a Lenovo Lenovo TV3-850M tablet computer was used.

The full flow of information synchronized with the employee synchronized with audio and video data was received via the mobile communication channel (MegaFon operator) via the LTE communication modem integrated into the Complex with support for GSM, 3G, 4G and GPRS standards.

After the launch of the Complex in Moscow and the start of registration, processing and visualization of information in 3-5 seconds, the full amount of data appeared on the tablet computer of a medical operator in St. Petersburg. All information was broadcast over the mobile Internet in real time. The operator carried out monitoring studies of respiratory functions, heart function, oxygen saturation of arterial blood, monitored the employee’s state parameters, and performed extensive diagnostics of myocardial function and blood pressure.

Audiovisual exchange channels were used for interviewing and examining an employee, his consultation, issuing recommendations on drug therapy, and controlling the execution of functional tests (respiratory and exercise).

In the process of distance research, an employee revealed stage 1 hypertension. The remote medical operator prescribed medication and gave recommendations on nutrition and daily routines, determined the frequency of the examination at the place of residence.

The total duration of the remote study was 42 minutes.

With an interval of 5-10 minutes, studies were conducted for 7 more employees of BIOSOFT-M LLC. One of them showed signs of respiratory failure (smoker with more than 22 years of experience). A method of respiratory therapy and drug therapy were prescribed.

The total duration of distance research was 5 hours 21 minutes.

At the end of the research, the medical operator opened a database on the tablet computer and reviewed the records of distance research in both manual and automatic modes. Separate fragments of monitoring and functional diagnostics records were printed on a printer.

During the research of employees at the Complex in Moscow, the screen settings and the configuration of the measuring channels changed, which in 3-5 seconds. synchronized with changes on the tablet computer of the operator in the Research Institute of Emergency Medicine of St. Petersburg.

Thus, the content and scope of distance research of employees of BIOSOFT-M LLC, performed by the medical operator of the Research Institute of Emergency Medicine, showed high efficiency in the implementation of the solutions for practical medicine described in the patent.

2. Tests were conducted for a mobile version of the Complex. In this case, the transport monitor was located in the passenger compartment of the car, which moved within the Moscow ring road. The power supply of the Complex was carried out from the built-in batteries for 3.5 hours. During the movement, the channels of measurement of saturation, blood pressure and capnography were installed on the passenger. The complex performed Internet broadcasting of signals recorded from a passenger simultaneously to 3 medical operators located in the Northern, Southeast and Western administrative districts of Moscow. Smartphones from Samsung, Asus and Huawei were used as receiving devices of the operators.

After turning on the transport monitor and connecting remote medical subscribers to it after 1-3 seconds. on smartphones of all 3 operators there appeared graphs of registered signals, calculated parameters, trends, channels of the audiovisual exchange of the mobile complex with subscribers. The complex was switched sequentially with an interval of 10 to 15 minutes to one of the remote operators for audio-visual information exchange. At the same time, the quality of patient data transmission via mobile communication channels and the stability of Internet broadcasting of audio-visual flows during monitoring studies were evaluated.

The research results showed that when the quality of mobile communications deteriorates during transportation, the Complex switched to the adaptation mode of the Internet broadcast algorithm for the currently available network traffic. Adaptation of remote transmission was manifested in thinning signals, reducing the refresh rate and resolution of video frames, reducing the refresh rate of passenger status parameters. With the improvement of mobile communications, the quality of Internet broadcasting of recorded information was restored to its original state. In the absence of molar communication channels, data transfer from the Complex stopped and the entire data stream was recorded on the monitor’s built-in flash drive and guaranteed to be stored in its database. When restoring mobile Internet, transmission was restored in full. Using personal mobile communication devices, the full range of remote patient research functions was available to all operators during their transportation by car.

Advantages of the mobile complex

1. Implementation of Internet broadcasts via mobile, satellite or wired Internet to personal devices of employees and dispatching services of medical institutions of a synchronized stream of native, audiovisual and processed information about the patient's condition in real time.

2. The organization in real time of a consultation of specialized specialists for studying the patient’s condition in a remote mode, based on the simultaneous synchronous transmission of each of them the full amount of information recorded from the patient.

3. Automatic on-line diagnostics of the patient’s condition in remote mode and Internet broadcasting of the results to mobile devices of medical specialists.

4. Implementation of a database of distance research, which provides authorized subscribers (medical specialists, relatives, ...) with the ability to remotely view, analyze, document monitoring results using mobile means (smartphone, tablet, laptop, ...) regardless of the place and time of day.

5. Combining in one device the functional of a patient monitor and functional diagnostics, which made it possible to improve the quality and reliability of studies and diagnosis in a remote mode.

6. A wide range of operation: from a hospital to field conditions with an autonomous power supply system, on automobile, air and sea types of medical transport and transmitting research results through any of the available channels: mobile, satellite, wired Internet in real time.

7. Internet broadcasting of natural information to medical subscribers (12-channel ECG, plethysmogram, capnogram, spirogram, blood pressure trends) in a format available for processing by external software and hardware in order to more in-depth and comprehensive analysis of research results.

8. High reliability and the absence of losses during Internet broadcasting to medical consumers of signals recorded from a patient through the implementation of a complex of adaptive communication algorithm in hardware and software that takes into account poor quality or temporary lack of a communication channel.

9. Expanding access to highly qualified surgical care for various categories of patients, primarily emergency patients, non-transportable and seriously ill patients, the population of remote regions and patients in emergency situations.

10. Improving the quality and effectiveness of medical care through the implementation of automatic recording and viewing the results of distance research on a Web server by an independent expert.

Claims (12)

1. A mobile complex for remote monitoring, including a monitor and connected to it with the possibility of multiple separate connection of the cuff of the tonometer, nasal cannula, electrodes for taking an electrocardiogram (ECG), pulse oximeter, temperature sensor and a remote camera with a microphone, in which the monitor is made in the form of a portable monoblock and includes a unit for measuring physiological parameters, a control unit, data processing and storage, a remote data transmission unit, an information input-output unit, an autonomous power supply system and a thermal printer, the unit for measuring physiological parameters via a data bus is connected to a control unit for processing and storing data, a remote data transmission unit, an information input / output unit, a remote camera, a thermal printer and a power supply system, which is connected through a power bus to a unit for measuring physiological parameters, a unit control, processing and storage of data, a thermal printer, an external camera with a microphone, a remote data transmission unit and an information input-output unit, and includes tonometer, pulse oximeter modules electrocardiograph, capnograph and temperature, removably connected to each other to change the configuration of the unit depending on the tasks of monitoring studies and associated with the connectors installed on the monitor body, and the control unit, data processing and storage includes a processor programmed to implement switching between measuring channels, generating graphs of signals recorded from the patient on the monitor screen, generating values of vital status parameters, forming windows for audiovisual data exchange between the complex and the remote subscriber, forming light and sound alarms when the patient’s condition parameters go beyond the norm, formation of parameter trends for the entire period of mon itoring, diagnostics of the state of the measuring channels, the mobile communication channel and the charge level of the built-in batteries. 2. The mobile complex according to claim 1, characterized in that the control, processing and storage unit includes a memory card with a database of research results as part of a patient registration card and associated monitoring records, including graphs of native signals, trends and vital signs important parameters of the patient’s condition, audio and video recording of bidirectional information exchange of the complex with the remote subscriber, complex settings, alarms and messages of the unit for measuring physiological parameters. 3. The mobile complex according to claim 1, characterized in that the transport monitor is equipped with a connector for connecting a power cable connected to the power system and a power on / off button. 4. The mobile complex according to claim 1, characterized in that the monitor case is equipped with a carrying handle, made of shockproof plastic and sealed, while the case connectors are sealed. 5. The mobile complex according to claim 1, characterized in that the screen of the transport monitor is divided into the following areas: a touch control area containing function keys to control the display, settings, printing and saving of signals recorded from the patient; signal area for displaying and visualizing graphs of signals from the patient and controlling the scale of their sweep; a video communication area for bidirectional data exchange between the complex and the remote subscriber; and a calculation parameters area for displaying critical parameters of the patient’s state. 6. The mobile complex according to claim 1, characterized in that the processor is programmed with the ability to simultaneously perform tasks of monitoring studies and functional diagnostics in real time. 7. The mobile complex according to claim 1, characterized in that the remote data transmission unit is capable of realizing Internet broadcasting of information recorded from the patient, in particular, graphs of native signals, trends, patient status parameters, audio-visual data simultaneously to several remote subscribers in real time time. 8. The mobile complex according to claim 1, characterized in that the remote data transmission unit is configured to transmit native biomedical signals, in particular ECG, plethysmograms, capnograms, respirograms, blood pressure trends in a format available for storage and further processing to remote subscribers. 9. The mobile complex according to any one of paragraphs. 1, 2, characterized in that the processor is configured to set the limits of the norm for each of the measured parameters of the patient’s state to automatically alert medical personnel in the event of life-threatening situations for the patient.

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