US20050075544A1 - System and method for managing an endoscopic lab - Google Patents
System and method for managing an endoscopic lab Download PDFInfo
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- US20050075544A1 US20050075544A1 US10/846,245 US84624504A US2005075544A1 US 20050075544 A1 US20050075544 A1 US 20050075544A1 US 84624504 A US84624504 A US 84624504A US 2005075544 A1 US2005075544 A1 US 2005075544A1
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- G—PHYSICS
- G06—COMPUTING; CALCULATING OR COUNTING
- G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
- G06Q10/00—Administration; Management
- G06Q10/10—Office automation; Time management
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/40—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for data related to laboratory analysis, e.g. patient specimen analysis
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H15/00—ICT specially adapted for medical reports, e.g. generation or transmission thereof
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
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- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04N—PICTORIAL COMMUNICATION, e.g. TELEVISION
- H04N23/00—Cameras or camera modules comprising electronic image sensors; Control thereof
- H04N23/60—Control of cameras or camera modules
- H04N23/63—Control of cameras or camera modules by using electronic viewfinders
- H04N23/633—Control of cameras or camera modules by using electronic viewfinders for displaying additional information relating to control or operation of the camera
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- H—ELECTRICITY
- H04—ELECTRIC COMMUNICATION TECHNIQUE
- H04N—PICTORIAL COMMUNICATION, e.g. TELEVISION
- H04N23/00—Cameras or camera modules comprising electronic image sensors; Control thereof
- H04N23/50—Constructional details
- H04N23/555—Constructional details for picking-up images in sites, inaccessible due to their dimensions or hazardous conditions, e.g. endoscopes or borescopes
Definitions
- the present invention relates generally to imaging systems and workstations for medical applications, and particularly an system designed to support the entry, by various users associated with an endoscopic laboratory, of information and data including the capture, processing and storage of endoscopic images during an endoscopic exam, and especially for managing workflow for all user roles pertaining to the endoscopic laboratory, from registration and scheduling of patient information through pre-procedure, procedure and post-procedure phases through the generation of procedure notes via an integrated user interface.
- the workflow processes associated with these lifecycle stages are flexible enough to support small, independent endoscopic practices and endoscopic departments that are integral to large healthcare institutions.
- users of the system can, at appropriate points in the lifecycle, capture, process, and generate reports on all the required endoscopy information.
- the information captured at the different stages is managed by the system application and processed to create medical records, produce reports, and provide necessary information to perform exams, etc.
- the present invention supports the entry, by various users associated with an endoscopic laboratory, of information and data including the processing and storage of endoscopic images captured during an endoscopic exam of a patient, for association with a patient record stored in a database, and facilitates the generation of procedure notes and other reports that include the stored images, all via an integrated user interface.
- the clinical information management system designed for the practice of endoscopy facilitates the tracking of each patient's state (such as what stage of the process the patient is in, what information has already been captured, and which information is yet to be captured) and enables the basic lifecycle to be followed so that clinical staff can ensure that all required information is in place prior to implementing the next stage.
- the clinical information management system designed for the practice of endoscopy according to the invention implements a set of business rules encouraging a particular order of activities based on the current state of the patient. Via these rules, the system incrementally captures all relevant information associated with the patient and orchestrates interactions with all users including physicians, nurses, schedulers and system administrators while providing the services necessary to perform all required actions.
- the invention further supports the flow of a patient and related information through the various phases associated with the endoscopic practice, which includes: scheduling, patient file management, pre-procedure, procedure, and post-procedure phases.
- the system interface is integrated, yet allows the physician to reduce the time associated with producing procedure notes. For example, it provides alerts while incorporating annotated and labeled images into written reports.
- the invention further provides a multi-media platform for clinical documentation.
- the system of the present invention By integrating image capture and advanced graphics with an endoscopic medical knowledge base, the system of the present invention generates complete Procedure Notes and related documents.
- the system further automates the endoscopy clinic by managing patient examination schedules and equipment inventories while controlling “paper management.”
- the invention further provides for secure, remote access of patient and exam related information by physicians through the integrated, web-enabled system interface.
- a system and method for managing information flow in an endoscopy laboratory including a computer device, the laboratory adapted to enable users to perform endoscopic procedures upon patients, the method including: inputting patient information and setting up schedules for endoscopic examinations via the computer device during a registration phase of care; inputting preparatory examination information relating to the patient via the computer device prior to performing the procedure; inputting information during performance of the procedure including the real time endoscopic image capture via the computer device; inputting information regarding the patient via the computer device after performance of the procedure; storing the input registration and scheduling information, preparatory information, captured images obtained during the procedure, and post-procedure information regarding the patient in database records; organizing presentation of information included in the database records and managing access to the information and images stored in the database records via an integrated user interface associated with the computer device, the presentation and access controlled according to a user's role, wherein full support for the full flow of a patient and related information is provided through various phases associated with all users involved in an endoscope practice.
- the based clinical information system designed for the practice of Endoscopy enables physicians and other medical personnel to utilize clinical records created directly from their procedures. It enhances clinical workflow, reduces time and cost, minimizes errors and enables interaction among disparate hospital information systems.
- the based clinical information system designed for the practice of Endoscopy enables reduced equipment maintenance costs through the automation of equipment use and maintenance tracking.
- FIG. 1 ( a ) illustrates an overview of an endoscopic examination system according to the invention
- FIG. 1 ( b ) depicts generally the endoscopy lab for obtaining, processing and displaying of real-time endoscopic images in which the comprehensive, clinical information management system of the present invention is employed;
- FIG. 2 illustrates a high-level Registration and Scheduling business workflow diagram depicting functionality enabled by the system application according to the invention
- FIG. 3 illustrates a high-level Pre-Procedure clinical flow diagram depicting functionality enabled by the system application according to the invention
- FIG. 4 illustrates a high-level Procedure clinical flow diagram depicting functionality enabled by the system application according to the invention
- FIG. 5 illustrates a high-level Post-Procedure clinical flow depicting functionality enabled by the system application according to the invention
- FIG. 6 illustrates a Home tab user interface according to the invention
- FIG. 7 ( a ) illustrates a Patient File tab user interface according to the invention
- FIG. 7 ( b ) illustrates a Patient Demographics interface screen enabling functionality for recording all patient demographics information
- FIG. 7 ( c ) illustrates Medical Alerts interface screen for association with a patient to record a patient's medical condition
- FIG. 7 ( d ) illustrates a Patient Summary interface screen for viewing insurance, contacts and scheduled visits information for a patient
- FIG. 8 ( a ) illustrates a Registration tab of a user interface according to the invention
- FIG. 8 ( b ) illustrates a New Visit interface screen according to the invention
- FIG. 8 ( c ) illustrates a Modify Visit interface screen according to the invention
- FIG. 8 ( d ) illustrates an Exam Detail interface screen according to the invention
- FIG. 8 ( e ) illustrates a Lexicon interface screen according to the invention
- FIG. 8 ( f ) illustrates a Document Distribution interface screen according to the invention
- FIG. 9 ( a ) illustrates a Pre Procedure tab of a user interface according to the invention
- FIG. 9 ( b ) illustrates a Patient Process interface screen according to the invention
- FIG. 9 ( c ) illustrates a Consent Checklist interface screen according to the invention
- FIG. 9 ( d ) illustrates a Patient Assessment interface screen according to the invention
- FIG. 9 ( e ) illustrates a Vitals and Meds interface screen according to the invention.
- FIG. 9 ( f ) illustrates a Physical Exam screen for a physician to perform pre-procedure checks such as a physical examination according to the invention
- FIG. 9 ( g ) illustrates a pre-procedure summary information Screen display of according to the invention
- FIG. 10 ( a ) illustrates a Procedure tab user interface according to the invention
- FIG. 10 ( c ) illustrates an Equipment used interface screen according to the invention
- FIG. 10 ( d ) illustrates an endoscopic Image Capture interface screen according to the invention
- FIG. 10 ( e ) illustrates a Pathology Request interface screen according to the invention
- FIG. 10 ( f ) illustrates a Lexicon interface screen for the procedure lifecycle stage according to the invention
- FIG. 10 ( g ) illustrates a Print on Mavigraph interface screen according to the invention
- FIG. 10 ( h ) illustrates a Document Distribution interface screen for the procedure lifecycle stage according to the invention
- FIG. 10 ( i ) illustrates a Nursing Administration interface screen according to the invention
- FIG. 11 ( a ) illustrates a Post-Procedure tab of a user interface screen according to the invention
- FIG. 11 ( b ) illustrates an ICU Synchronization interface screen according to the invention
- FIG. 11 ( c )( 2 ) illustrates the Other Exam feature displayed via the Image Management interface screen to enable image comparisons according to the invention
- FIG. 11 ( d ) illustrates a Surgical Changes window according to the invention
- FIG. 11 ( g ) illustrates a Document Distribution interface screen for the post-procedure lifecycle stage according to the invention
- FIG. 12 illustrates an Analysis tab user interface according to the invention
- FIG. 13 ( a ) illustrates a System Administration tab user interface screen according to the invention
- FIGS. 13 ( b )( 1 ) and 13 ( b )( 2 ) illustrates a Clinical Staff user interface screen according to the invention
- FIG. 13 ( d ) illustrates an Application Flow user interface screen according to the invention
- FIG. 13 ( f ) illustrates a Node Settings user interface screen according to the invention
- FIG. 13 ( h ) illustrates an AutoMask Settings user interface screen according to the invention
- FIG. 13 ( j ) illustrates a Reports Section customization user interface screen according to the invention
- FIG. 13 ( k ) illustrates a Phase of Care user interface screen according to the invention
- FIG. 13 ( l ) illustrates a Document Type user interface screen according to the invention
- FIG. 13 ( o ) illustrates an example Document template window for creating a new document template from a previously created Document template according to the invention
- FIG. 14 ( a ) illustrates a System Administration tab user interface displaying a User List screen according to the invention
- FIG. 14 ( b ) illustrates a User Maintenance user interface screen according to the invention
- FIG. 14 ( d ) illustrates a Role Maintenance user interface screen according to the invention
- FIG. 14 ( e ) illustrates a System Log utility user interface screen according to the invention
- FIG. 14 ( f ) illustrates a Scope Model list user interface screen according to the invention
- FIG. 14 ( g ) illustrates a Scope list user interface screen according to the invention
- FIG. 14 ( h ) illustrates a Scope Item user interface screen according to the invention
- FIG. 14 ( i ) illustrates an Accessory Maintenance user interface screen according to the invention.
- FIG. 14 ( j ) illustrates an Equipment Category user interface screen according to the invention.
- the clinical information management system designed for the practice of endoscopy includes a web-browser interface that supports all the data acquisition and care-giving functions performed by users during patient registration, pre-endoscopic procedure, endoscopic procedure and post-procedure phases of care.
- the clinical information management system designed for the practice of endoscopy further includes a medical terminology “Knowledge Base” (KB) comprising keywords relating to the procedure, e.g., such as gastrointestinal, endoscopic and bronchoscopic terminology keywords.
- the keywords are captured via a graphical user interface (GUI) before, during, and/or after a procedure.
- GUI graphical user interface
- the keywords are made available for labeling images captured during an examination to be used in reports, auto-populating appropriate sections of a report such as a Procedure Note, described further below, based on patient history, and building Procedure Note templates or models to auto-populate sections of information.
- the system also facilitates the use of custom terms that apply to a specific department or location.
- a user may select KB terms for a procedure via a common user interface, which is employed wherever the user needs to locate or extract keywords. This also provides a consistent way to select and use terminology.
- FIGS. 1 ( a ) and 1 ( b ) depict the hardware infrastructure comprising various hardware devices and components required to either enable the application, hereinafter alternately referred to as the EndoWorksTM system (hereinafter “EW system” manufactured by Olympus Corporation) that provides functionality for automating the endoscopy lab by, to run, or to support the required business functionality.
- EW system EndoWorksTM system
- the hardware infrastructure of the invention includes an endoscopic workstation 110 , a printer device 112 (e.g., a Mavigraph printer), an RGB monitor 20 and video processor 40 .
- the user provides inputs to the workstation 110 via a keyboard, mouse interface, or the like.
- the workstation includes a second monitor, e.g., a VGA monitor 55 , and implements a web browser interface that provides the necessary information during all phases of care relating to the endoscopic exam, and facilitates for users of endoscopic equipment, e.g., physicians, nurses or clinicians, the efficient capture, management, organization and presentation of endoscopic images and patient and examination data.
- endoscopic equipment e.g., physicians, nurses or clinicians
- the workflow processes associated with this aspect of the system are flexible enough to support small endoscopic practices in addition to endoscopic departments within large healthcare institutions.
- the video processor is further connected to an imaging station or node 50 , comprising a personal computer (PC) or workstation, and including processor 60 , video display driver 65 , and memory 70 devices for capturing the real-time video image, digitizing the image for storage in memory 70 , and for further displaying a scaled version of the image, for example, on both the RGB monitor 20 and a second monitor, e.g., a VGA monitor device 55 .
- the processor implemented at the imaging node 50 includes a frame grabber board and associated hardware drivers that captures standard analog composite and Y/C video in NTSC/PAL formats from the video processor 40 and, includes analog to digital converters for capturing the component RGB in the NTSC/PAL video formats. The captured field are stored in a main memory 70 of the imaging node.
- a graphics controller (not shown) provided with the Matrox board is provided for handling VGA display output and includes a graphics overlay and video scaling.
- the workstation may have the additional capability of connecting to the institution or facility network, and, to support this, may be provided with an Ethernet 100 Base T network interface card (NIC), or like equivalent, to provide network connectivity.
- NIC Network 100 Base T network interface card
- the NIC drivers shall be compatible with Windows 2000 (or later version OS) and support the TCP/IP protocol.
- the system may also include a network server 140 and database element 145 or like memory storage system for storing system application data records including patient records and associated patient data and image information.
- This server may be connected via a gateway application to various “external” systems such as a hospital information system where the gateway facilitates the transfer of certain healthcare information between the system and other applications.
- the application's software instructions may be stored in any type of program storage device or devices, also referred to as computer-readable media.
- the software is executed by a processor in a known manner to achieve the functionality described herein.
- the registration and scheduling clinical flow 200 of FIG. 2 includes a collection of all the information necessary to set up a visit. It is initiated through an exam request made by either the patient, a surrogate for the patient, or a referring physician. The nurse and physician share the activity of preparing prep instructions and medical advice for the patient.
- the Pre-Procedure clinical flow 300 of FIG. 3 starts with the arrival of the patient at the endoscopy facility and addresses all administrative and medical activities necessary to prepare the patient for the exam.
- the Procedure clinical flow 400 of FIG. 4 depicts the actual examination that takes place during the Procedure phase of care.
- the system is used to capture images, record vital signs, and administer medications during this stage.
- a user is an individual who is authorized access to the EndoWorksTM application through a system login comprising a user ID and a password.
- the user logs into a specific department, selected at login time.
- a user may have access to one or more departments.
- the user When logging in to the selected department, the user is assigned a default facility.
- a user may be a specific clinical staff member, which in turn identifies the user's qualifications (role), such as physician, nurse, or scheduler, for the department.
- the application based on the user's privileges
- Other non-medical users also exist, such as system administrators.
- the predefined application layout or interface is based on user roles, i.e., actions that user performs using the system, including roles such as Physician, Nurse and scheduler, for example.
- Facilities or medical departments use roles to give users access to different options within the application.
- a facility can configure the system to allow a scheduler to access only the Patient Registration tab.
- a user logs in the system, for example, by entering a user ID and password, and depending on that user's role, that user may access the features associated with that user's role using the tabs located at the top of the screen, with each permitting access to a specific functionality.
- the Home tab 600 ( FIG. 6 ).
- the Home tab is the default home page, and is pre-defined for each role.
- a default homepage is generated predefined for that role by the application, but it can be changed to another to suit the user's needs.
- the most common tasks that can be performed via the Home tab include: view Scheduled Exams; Create a New Visit; view Pending Items; view Pathology Status; view Unsigned Reports which enables an attending physician to view and sign unsigned Procedure Notes; Sign Reports, which enables a user to view unsigned Procedure Notes for a specific physician and mark them as signed; Carbon Copies which function automatically generates and sends a notification to the recipients that a document is available for them in the system when the user distributes a document to a medical provider, clinical staff, or contact via email.
- a recipient may then log on to the system and view a list of documents on the Carbon Copies screen; an Intensive Care Unit (ICU) Synchronization, that ensures that the user's imaging station is not connected to the network server when the user performs an exam in ICU mode.
- ICU Intensive Care Unit
- the user When the user finishes the exam, the user must upload images and data from the workstation to the server repository.
- the workstation is re-connected to the network, a series of simple commands will upload the data and images captured during the exam.
- the user uses the ICU Synchronization option to synchronize images and data; and, a feature of viewing Recall Letters that enables a user to recall a patient for another examination.
- access to these tasks is based on the user's role. For example, if the user logs into the application as a scheduler, then the user would not see the Sign Reports menu option, since that option is reserved for the physician role.
- Patient File tab 700 (FIGS. 7 ( a )- 7 ( d ))—allows a user to capture information specific to the individual patient. This tab is used to record a patient's demographic information; a patient's medical alerts, GI/pulmonary, medication, family, and social history information, and view a summary of the patient information.
- Registration tab 800 (FIGS. 8 ( a )- 8 ( f )). This tab is used to: (a) create and modify visit and/or exam information; (b) view past, current, or future schedules; (c) assign resources for an examination including procedure rooms and equipment; and (d) distribute registration documents.
- Pre-Procedure tab 900 (FIGS. 9 ( a )- 9 ( g )). This tab is used to: (a) record care plan information for a specific visit; (b) record medical alert information; (c) record GI, pulmonary, family, and social history information, (d) manage physical examination, patient assessment, and physician check information, (e) manage prep status information for the patient; (f) manage consent information for a visit; (g) capture vital signs and medications administered before the examination; (h) display a summary of selected Pre-Procedure information and capture nurse handoff information; and (i) distribute Pre-Procedure documents.
- the Post Procedure Tab 1100 ( FIG. 11 ( a )- 11 ( g ))—After an examination is completed, this tab is used to perform post-procedural tasks. These tasks include synchronizing images in the ICU mode, monitoring a patient's vital sign and medication information, managing captured images, and writing Procedure Notes. Images from a current procedure, e.g., image 1 and image 2, and from a prior procedure, e.g., image 3, image 4, and image 5, can be displayed together for comparison.
- This tab is used to: (a) record patient recovery information; (b) manage images captured during an exam; (c) label, annotate, enhance, and print images; (d) import and export images to and from the current examination; (e) manage video clips recorded during an examination; (f) write and sign Procedure Notes; (g) capture patient recall information; (h) assess performance of a trainee participating in an examination; (i) capture patient survey information; (j) distribute Post-Procedure documents; and (k) perform ICU synchronization.
- the Analysis Tab 1200 ( FIG. 12 )—used to generate redefined template-based management reports to satisfy end-user administrative reporting requirements related to patient, procedure and facility management, efficiency analysis, and resource utilization. This tab is used to generate: (a) Continuous Quality Improvement (CQI) reports; (b) efficiency reports; (c) equipment analysis reports; (d) procedure analysis reports; and (e) administration reports.
- CQI Continuous Quality Improvement
- the Admin Tab 1300 (FIGS. 13 ( a )- 13 ( o ) and 14 ( a )- 14 ( j ))—used to perform administrator tasks and ensure the efficiency and security of the system.
- the system can be customized based on the needs and requirements of the facility, physician, and clinical staff.
- This tab is used to: (a) maintain system data (such as Patient ID type and department information); (b) maintain application resource data (such as clinical staff and contact information); (c) perform system configuration (such as configure Mavigraph printer and video settings); (d) customize how the application will flow and generate information (for example, changing the order and location of menus within the application and editing or creating templates/models that are used to create Procedure Notes); (e) customize user-defined fields (such as other patient information and other visit information); (f) control access to or within the application (such as user and role maintenance); and (g) maintain equipment used during the procedure.
- system data such as Patient ID type and department information
- application resource data such as clinical staff and contact information
- system configuration such as configure Mavigraph printer and video settings
- customize how the application will flow and generate information for example, changing the order and location of menus within the application and editing or creating templates/models that are used to create Procedure Notes
- customize user-defined fields such as other patient information and other visit information
- control access to or within the application such as
- a user may create a new visit by selecting the New Visit button 612 to access a New Visit screen, as will be described herein with respect to FIG. 8 ( b ), which enables the user to enter the desired information associated with the scheduling of a new visit for a patient. More details regarding the registration of patients will be explained in greater detail herein.
- a user may access the Pending Items interface screen by selecting a Pending Items menu option 604 enabling that user to view all pending tasks.
- a user may search for a pending item based on task, date, or the patient, and further select a Task Details icon to view the task. From a Task dropdown a user may perform activities including, but not limited to: modifying a database record, deleting a database record, add a note, or delete a note.
- a user may access a Pathology Status interface screen (not shown) by selecting Pathology Status menu option 606 enabling a user to view the status of pathology requests or, search the database for an existing request by entering search criteria such as attending, date, patient, or request status. If the user is not an attending, a default list is not displayed.
- the user may additionally edit or delete existing pathology results. When a pathology result is deleted, all of the specimens associated with that record are deleted.
- the user may select an Edit Pathology Status icon to access the Pathology Result screen where a user may further edit the status of the request, review the request, or delete the request.
- the information entered is captured and stored in a patient file that is the repository for all patient data required by different clinical staff. It manages the input and presentation of relevant historical data such as past tests and lab results, medical alerts, and medications currently prescribed for the patient.
- the user may access Patient File menu selection options based on that user's role.
- relevant patient information may be captured including: Demographics, Medical alerts, GI history, Pulmonary history, Medication history, Social history, and Family history.
- a user selects the Patient Search menu choice 702 which causes for display the Patient search screen 720 including a “new” button 722 , that, when selected initiates display of a Patient Demographics screen to capture the new patient's information. Including ID Type, Patient ID, Last Name, and First Name, insurance and medical contact information and enter any optional information, if necessary.
- the Patient Demographics screen 730 includes icons enabling functionality for adding all patient demographics information including a new Insurance Carrier (or editing an existing one) and adding a new physician or editing the selected physician.
- Further functionality enabled via the patient demographic screen 730 includes: assigning or adding a new patient ID to a selected patient by access the Patient Demographic screen for the patient and clicking a New button next to the ID Type; and, deleting a patient ID by clicking the Delete icon located to the right of the patient ID that is to be deleted.
- the Medical Alerts screen 750 includes two sections: Medical Alerts and Notes.
- the Medical Alerts section is used to record a patient's medical condition and the Notes section is used to record relevant or detailed information regarding a patient's condition.
- the user To add a medical alert record for a patient via the Medical Alerts screen 740 , the user first selects the required category of medical alerts from the Medical Alerts dropdown list, selects a Yes radio button to enable a medical alert; and, clicks a Select from Calendar icon 769 to enter the date in the Date Recognized field.
- a Select Date window appears where a user may select the date the patient was first diagnosed with the condition (related to the alert), and, enter details of the alert if the corresponding Details field is active. The user may also click a New button on the right of the Notes section, and enter notes related to the medical alert category.
- FIG. 7 ( c ) Further functionality enabled via the Medical Alerts screen 740 shown in FIG. 7 ( c ) includes: removing a medical alert record and, deleting a note. Further, any comorbidity that requires special consideration in the performance of an endoscopic procedure is referred to as an alert.
- a system administrator may define system alerts at the system level without regard to facility or department.
- a system alert is a criteria for determining whether a medical alert item is to be set to indicate an alert, i.e., warrants a system alert display indication. If the patient in the context has one of the comorbidities designated as an alert, for example, an allergy, the Medical Alerts icon 759 is displayed in the status bar.
- a user may view system alerts set by the system administrator via the Medical Alerts screen by clicking a System Alerts button to display the system-defined alerts for the selected category.
- the System Alerts window for the selected medical category is displayed for user viewing.
- the system further includes functionality for managing a patient's GI History Information via a GI History screen (not shown) by recording and editing information about a patient's past diagnoses, surgeries, and other procedures related to the gastrointestinal system.
- the GI History screen is displayed when the user logs in to the application in the GI department.
- an authorized user may select the GI History menu option 706 to enable functionality for retrieving and displaying the patient's GI History.
- Functionality enabled via the displayed GI History screen includes: adding a past diagnosis by opening a Past Diagnosis window and entering the date, diagnosis, organ, and comments about the patient's past diagnosis and, updating past diagnosis information where a date field, a certainty/disease status field, are provided to enable entry of the date and certainty/disease status information.
- Other functionality via the GI history screen includes: modifying a past diagnosis, deleting a past diagnosis by deleting an existing record; viewing a procedure note report associated with the past diagnosis; adding a past surgery record via Date, Surgery, Organ, and Comments entry fields in a Past Surgery section and, modifying or deleting a past surgery record; and, adding a past procedure record via Date, Procedure, and Comments entry fields in a Past Procedures section, modifying or deleting a past procedure record, and viewing a Procedure Note report associated with a past procedure.
- a user logs into a Bronchoscopy department of a hospital, for instance, functionality will be provided for managing a patient's Pulmonary History Records via a Pulmonary History screen (not shown) by recording and editing information about a selected patient's previous pulmonary procedures; adding a pulmonary history record; modifying a Past Procedure Record for Pulmonary History and deleting a pulmonary history record; and, and viewing a Procedure Note report associated with a past pulmonary procedure.
- the system includes functionality for managing a patient's medical medication history via a Medication History screen (not shown) by recording and editing information about a patient's current and past medications.
- the Medication History screen (not shown) is displayed by selecting the Medication History menu option 708 to enable functionality for retrieving and displaying a selected patient's Medication History.
- Functionality enabled via the Medication History screen includes: adding a medication to the history record, for example, by entering either the full drug or brand name, or the first few letters of the name followed by a wildcard in a Search field, where a list of all medications matching the criteria will be displayed for selection in a Medication Search window.
- a user may further select a Search icon next to a Strength field to search for the strength of the medication.
- a user may then select the drug strength from a Drug Strength window (not shown) and enter a start date for the medication to the Date Started field and, enter a stop date for the medication to the Date Stopped field (if not a current medication). It is understood that a user may further delete a medication from patient's history record.
- the system includes functionality for updating a patient's Social History via a Social History screen (not shown) that enables a user to record information about the social behavior and legal considerations of a patient.
- the Social History screen is displayed by selecting the Social History menu option 710 to enable functionality for retrieving and displaying a selected patient's Social History.
- Functionality enabled via the Social History screen includes: adding a Social History Record for a patient including entry of information relating to five areas: 1) Tobacco use including entry of the date the patient stopped using tobacco and the pack years (i.e., the number of packs per day and the number of packs years); 2) Alcohol use including entry of the date the patient stopped consuming alcohol and the drink years (i.e., the number of drinks per week and the number of drink years); 3) IV Drug use including entry of the date the patient stopped IV drug abuse and detailed information about the IV drug abuse; 4) living will information; and 5) a power of attorney, whereby a user may enter information via a DNR (Do Not Resuscitate) Details field. It is understood that the user's Social History Record may be further modified.
- DNR Do Not Resuscitate
- the system includes functionality for updating a patient's Family History via a Family History screen (not shown) that enables a user to record information about the occurrences of cancer or other relevant family medical conditions.
- a Family History screen (not shown) that enables a user to record information about the occurrences of cancer or other relevant family medical conditions.
- the Family History screen is displayed by selecting the Family History menu boption 712 to enable functionality for retrieving and displaying a selected patient's Family History.
- an Add button is provided adjacent to GI Cancer that is selected to display a GI Cancer window.
- a user may select the type of cancer from the Type dropdown list, or select Other-Details, where a Details field is provided to enable the user to enter comments in the Details field.
- the user may finther click a New button next to a Relation which enables the addition of a line to the section, where the user may select the relative from the Relation dropdown list and enter the age that the relative was diagnosed with the cancer.
- a user may further add a non-GI cancer record for a relation, or add a Bronch Cancer record of a patient's relation.
- another relevant family history record may be added (e.g., non-cancer), and further be deleted or modified.
- further system functionality is enabled for entering or modifying other patient information via an Other Patient Information screen (not shown) which is generated to enable the capture of additional preset and user-defined data that relates to a patient by selecting the Other Patient Information menu choice 714 which enables functionality for retrieving and displaying a selected patient's other information.
- an Other Patient Information screen (not shown) which is generated to enable the capture of additional preset and user-defined data that relates to a patient by selecting the Other Patient Information menu choice 714 which enables functionality for retrieving and displaying a selected patient's other information.
- Registration tab 800 ( Figure (a)) functionality is provided that allows the user to create, modify or delete a visit, or create, modify or delete examination(s) within a visit.
- the user may schedule an exam for a patient. It is understood that a visit may include a series of one or more procedures performed on a patient.
- the user may select “New Visit” and “Modify Visit” screens to schedule a patient visit or modify an existing visit.
- a user will select the New Visit menu option choice 802 that causes the display of a New Visit screen 820 such as shown in FIG. 8 ( b ).
- a user may select the facility for the visit from the Facility dropdown list 822 (a default is the facility to which the user is currently logged in); enter the visit ID in the Visit ID field 824 which is a unique facility-supplied identifier for the visit; click the Patient Search icon 825 next to the Patient field to select the patient or, return to the Patient Demographics window ( FIG.
- a user may select a Patient Summary option 703 which causes display of a Patient Summary screen 750 shown in FIG. 7 ( d ) which displays all of a patient's demographics data captured when the patient's record was created or last modified, and, from which a user may select the existing visit from the Visit Information section 766 of the screen.
- the user may further select a Modify Visit icon 767 to initiate display of a Modify Visit screen which provides functionality for modifying an existing Visit Record or deleting a Visit Record.
- the system includes functionality for enabling scheduling of an exam only after a visit record is created.
- the user may access the Modify Visit screen 830 shown herein in view of FIG. 8 ( c ), by selecting the Modify Visit menu option 804 from the Registration tab of FIG. 8 ( a ).
- clicking the Add button 832 next to Exam causes display of an Exam Detail screen 840 , shown in FIG. 8 ( d ) from which a user may enter an exam date in the Date field 842 , a time of the exam in the Time field 844 and, select an exam type from the Exam Type dropdown list 845 .
- the attending physician may be selected from the Attending dropdown-list 846 .
- the Clinical Staff icon 848 may be selected to cause display of a Clinical Staff List window (not shown) where a user may select a clinical staff from the list. If the clinical staff is not found in the list, the user may select a New Attending icon 849 that displays a Clinical Staff window (not shown) via which relevant information about the clinical staff may be entered.
- the user may select the attending and click the Edit Attending icon 850 that causes the Clinical Staff window to be displayed via which the user may make the relevant changes.
- the user will further be prompted to: enter accession number from the Accession Number field 853 ; select room number from the Room dropdown list 866 ; select a duration of the exam from the Duration dropdown list 868 ; select the needed resource type from the Available dropdown list 869 ; and, select the resource needed for the exam from the Available dropdown list 870 .
- An arrow icon 855 may be selected by the user to move the resource to the Assigned list box 875 .
- a user may desire to allocate a special accessory or endoscope to an exam, in which case the system may generate a Special Accessory/Scope required icon 878 for display next to the exam in the Modify Visit screen 830 ( FIG. 8 ( c )).
- the system includes functionality for displaying the Scheduled Exams for the current day via a Scheduled Exam screen 880 which is the default screen displayed upon user access to the Registration tab 800 .
- a user may: select a Schedule for Today icon 882 , which when selected, causes display of the current day's schedule (a default view); select a Schedule for the Week icon 884 , which when selected displays the schedule for a week (e.g., from Sunday to Saturday).
- the week selected for display is controlled with the date increment and date decrement icons 885 a , 885 b that respectively, increments or decrements the date by the interval currently displayed on the schedule; select a schedule for the Month icon 887 , which when selected displays the schedule for a month starting with the first day of the selected month.
- the month selected for display is also controlled with the date increment and date decrement icons; select a Scheduled icon 888 , which when selected, indicates that the exam has been scheduled and has not been performed (appears under status); select a Performed icon (not shown), which, when selected, indicates that the exam has been performed (appears under status); select a Procedure Note Signed icon (not shown), which, when selected, indicates that the exam has been performed and the associated Procedure Note has been signed (appears under status); select a Select this Exam icon 889 which, when selected, enables a user to select exams, document, etc . . . ; select a Modify Visit icon 890 , which when selected, enables a user to modify exams, document etc . . . ; and, select a Select Date from Calendar icon, that causes the display of a calendar used to select a date.
- the system further provides a “Lexicon” function to select and organize terms from a Knowledge Base.
- the Knowledge Base is a medical terminology database.
- the Lexicon function is used to record that observation.
- a Lexicon screen 895 is displayed such as shown in FIG. 8 ( e ) via which a user may pick terms (based on his/her observation) from the Knowledge Base which comprises a frame 896 having terms stored logically in a tree format. From this structure, a user can select and use this information to write a Procedure Note comprising a plurality of sentences formed from selected keywords.
- the Knowledge Base includes keywords, which are the medical terms that are the basic building blocks of the Knowledge Base; menus that organize keywords; and views which are collections of menus and their associated keywords organized within a tree and are used navigate through the Knowledge Base and select appropriate medical terms or keywords.
- keywords which are the medical terms that are the basic building blocks of the Knowledge Base
- menus that organize keywords
- views which are collections of menus and their associated keywords organized within a tree and are used navigate through the Knowledge Base and select appropriate medical terms or keywords.
- each Knowledge Base term is called a keyword.
- menus are classified into categories, called menu types, which comprise keywords that are similar in nature. For example, a size menu type would contain the keywords small, medium, and large.
- a menu can be single-select, multi-select, or unique. If a user selects a keyword from a single-select menu, other keywords within the menu are disabled. For example, if size of polyp is a single-select menu, a user can select only one size from the available sizes such as small, medium, or large; if a user selects a keyword from a multi-select menu, the selected item is appended to the same level as any other keyword from the menu.
- the organ is a multi-select menu and a user selects stomach as the first organ and duodenum as the second, duodenum appears at the same level as stomach; and, if a keyword is selected from a unique menu, the user cannot select the keyword again. That is, when a user attempts to select the keyword again from the right panel, the keyword is highlighted in the left panel to indicate that it has already been selected.
- the organ menu is unique, and the user selects stomach as the first organ. If that user selects stomach again in the right panel frame, the keyword stomach in the left panel is highlight to indicate that stomach has already been selected.
- the Lexicon arranges Knowledge Base content to different report sections, based on phases of care.
- a facility determines which Report Sections 898 are to be available in the Lexicon screen for a Phase of Care.
- the Lexicon screen 895 includes icons 897 for: initiating functionality for generating a report via the Lexicon screen 895 ; initiating functionality to move up in the Knowledge Base tree; initiating functionality to move down in the Knowledge Base tree; initiating functionality to add billing codes; and, initiating functionality to delete a keyword from the tree; and, icons 898 for: initiating functionality to add a new term from Knowledge Base; initiating functionality to move to the last multi-select menu in the left side; and, initiating functionality to move to the previous keyword.
- a grammar engine is implemented in cooperation with the Lexicon to ensure proper sentence generation from the selected keywords in the manner as described in U.S. patent application Ser. No. ______ (Atty Docket 17282).
- the system includes functionality for printing and distributing documents such as letter to the referrer and appointment letter via a Document Distribution screen 860 shown in FIG. 8 ( f ).
- Generated documents may be distributed via, email, or fax.
- a user may distribute a maximum of nine copies of a document which documents may be previewed and edited prior to printing or distributing.
- a user may additionally edit the recipient list for each document type.
- a user selects a template for the document from a Template dropdown list 861 and, clicks an Edit Document icon 862 corresponding to the document that user needs to edit or review.
- the document will be displayed in a new window where the required changes may be made to the document.
- the user will be further able to review, edit and print the document by selecting icons from the Document Distribution screen.
- recipients of the document there are three types of recipients: a Contact, Medical Provider, and Clinical Staff, and a user may add or remove a recipient, via a recipient list.
- a user may then click an Edit Recipient List icon 864 adjacent to the current recipient list which initiates functionality for displaying an Edit Recipient window (not shown). Via this window, a user may click Contact to modify a recipient other than a medical provider or clinical staff.
- the Contacts List window is displayed with categories of recipients. Additionally provided is a Medical Provider to select a medical provider from the Medical Provider List window and a Clinical Staff that may be clicked to select a clinical staff from the Clinical Staff List window.
- the system provides further functionality initiated by the user to distribute a document via the Document Distribution screen ( FIG. 8 ( f )) by clicking a checkbox on the left side of the document that is to be distributed and selecting a template for the document from the Template dropdown list, prior to clicking Distribute.
- the system provides additional functionality for distributing education documents to patients that inform them about procedures or findings. For example, if a user finds a polyp in the stomach of a patient, and the system has set an education trigger for the word “polyp,” a document based on an education template is generated for that user to distribute to the patient. Printing is one of the many medium options available to distribute education documents. It is understood that, if the user's facility has not set an education trigger, no education document will be generated.
- An education document may be distributed by a Document Distribution screen by clicking the checkbox next to the document to be distributed and selecting a template for the document from the Template dropdown list and a number of copies that need to be printed from the Copies dropdown list.
- Pre-Procedure tab 900 ( FIG. 9 ( a ))
- functionality is provided that allows the user to: retrieve scheduled exams; search for an exam; create a new visit; review the schedule summary; record a pre-procedure call; search for a patient record; manage patient demographic information; manage medical alert information; manage GI history information; manage pulmonary information; manage social history information; manage family history information; manage patient process information; manage consent checklist information; manage patient prep status information; manage patient assessment information; manage physical exam information; manage vital sign and medication data; manage physician check information; review/edit pre-procedure documents; review/edit clinical lexicon data; review the pre-procedure summary; and, manage other visit information.
- a user may select the scheduled exams menu choice 902 to initiate functionality for viewing the details of an exam such as its date, time, and location, the attending physician, and any required resources; make changes to exam information (if required); add an exam to a patient visit (if an exam does not exist); and, add notes about the condition of the patient or any other information about the exam.
- the patient's exam information is first retrieved.
- the Scheduled Exams screen display 930 such as shown and described with respect to FIG.
- a user may verify and record pertinent information for a patient.
- a Patient Search screen (not shown) is displayed to search for a patient in response to entry of search criteria (e.g., last name), and verify or record that patient's demographics (name, address, emergency contact, patient insurance coverage information, medical provider's information, etc.), a patient's comorbidities and medical alert information such as shown and described with respect to FIG. 7 ( b ).
- search criteria e.g., last name
- patient's demographics name, address, emergency contact, patient insurance coverage information, medical provider's information, etc.
- medical alert information such as shown and described with respect to FIG. 7 ( b ).
- this medical information may be recorded before the exam is performed on the patient.
- the user will further be able to verify or record the patient's GI history; Pulmonary history; Social history; and Family history.
- patient demographics information may be captured at the time of registration just prior to an exam via a Patient Demographics screen such as shown and described with respect to FIG. 7 ( b ) which may be accessed in the pre-procedure phase to record or modify, for an existing patient, non-clinical patient data such as: Name; Address; Emergency Contact; Patient Insurance Coverage Information; Medical Provider Information; and other Information.
- a new patient demographics record may additionally be created with new demographic information captured.
- a Medical Alerts menu option 908 may be selected to enable a user to view, modify or remove information about a patient's comorbidities and related medical history, as shown and described herein with respect to FIG. 7 ( c ), and further record or delete any information in the Notes field 741 .
- the GI History menu option 910 may be selected to enable a user to view, modify or remove a patient's GI diagnosis information (or Pulmonary diagnosis information if the user is logged in the Bronch department) relating to that patient's past surgery or procedure.
- the Social History menu option 912 may be selected to view, modify or remove that patient's past social history information or add a new record
- a Family History menu option 914 may be selected to enable a user to view, modify or remove information relating to that patient's family history (e.g., Bronch and GI Cancer, Non-GI Cancer, and Other Relevant Family History) in order to maintain occurrences of cancer or other relevant medical conditions within the patient's family.
- a user may additionally manage exam-based information.
- a user may capture relevant patient care information by selecting the Patient Process menu option 915 which causes display of a Patient Process interface screen 950 as shown in FIG. 9 ( b ) enabling a user to create a patient process record including information such as arrival, registration, and pre-procedure times and, to create a care plan for the patient based on a patient class (e.g., inpatient, inpatient transfer, and outpatient). If the facility is to store any patient belongings, this information, in addition to the location of the belongings, is to be recorded via this screen.
- a patient process record including information such as arrival, registration, and pre-procedure times and, to create a care plan for the patient based on a patient class (e.g., inpatient, inpatient transfer, and outpatient).
- a user may record or edit information via the Patient Process Screen 950 including the patient's arrival date and time, registration start and end times, and pre-procedure start and end times and select a patient's scheduled care plan class from the Current dropdown list 951 . If the user selects Inpatient transfer, the department and unit in the From field 958 is entered. Select the current care plan (if different from scheduled plan) from the Care Planned dropdown list 952 .
- a user may further enter information via the Patient Process Screen including other information relevant to care planned in the Details entry field 953 ; select the planned disposition of the patient following the procedure from the Plan Specifics dropdown list 954 ; select the ID Bracelet, Vascular Bracelet, or Allergy Bracelet checkboxes (if applicable); enter the name and phone number of the person transporting the patient in the Contact and Phone fields (if applicable); select the In Waiting Room checkbox 955 if the person transporting the patient is in the waiting room; enter the location where the patient's belongings are being stored in the Default Location field 956 ; and, select a checkbox(s) for each applicable patient belonging. This automatically populates the associated Location field with the default location, however, a user may change the location if a belonging had been stored elsewhere.
- a user Before performing any procedure, a user needs to ensure that the patient has provided consent to perform the procedure.
- a user may select a Consent Checklist menu option 916 via the Pre-Procedure tab 900 ( FIG. 9 ( a )) which causes display of a Consent Checklist screen 960 as shown in FIG. 9 ( c ) enabling a user to record whether or not the patient gives consent for the procedures that will be performed.
- the user may modify any of the information but cannot delete the consent checklist record.
- a user may modify existing information or enter information via the Consent Checklist screen 960 including the consent checklist information by selecting the Consent Form, Reviewed, Signed, and Witnessed radio button 961 if the user has obtained signed consent.
- the user may select the Not Obtained radio button 962 . Selecting Not Obtained disables the Explanation and Obtained For sections. The reason consent was not obtained may be selected from the Details dropdown list. If consent was obtained, a user may select the person from the Given To dropdown list to whom the consent explanation is given and enter the name of the person to whom the explanation is given in the Name(s) field shown in FIG. 9 ( c ). The user may further indicate the method(s) by which the explanation is given by selecting the appropriate check box (verbal, brochure, etc.) and, select the appropriate checkboxes to indicate consent was obtained for the Procedure, Sedation/Anesthesia, or Blood or Blood Products. To select all of these, click the Select All button.
- the appropriate check box verbal, brochure, etc.
- the user may further enter the name of the staff member who reviewed the discharge instructions with the patient and witnessed the patient signing the discharge instructions in the Name field and enter the date and time when the discharge instructions were provided using the Date or time icon to populate the respective Date or time field or, by manually entering the date or time. Furthermore, the user may enter any other information in the Notes text entry box shown in FIG. 9 ( c ).
- a Prep Status screen when preparing a patient for an exam, the user may use a Prep Status screen to record information such as: NPO (nothing by mouth); Bowel preparation; Prep results and Current medications.
- NPO nothing by mouth
- Bowel preparation preparation
- Prep results Current medications.
- a user may select a Prep Status menu option 917 via the Pre-Procedure tab 900 of FIG. 9 ( a ), which causes display of a Prep Status screen (not shown) enabling a user to enter the prep status information in a database record.
- a Prep Status screen There may be different Prep Status screens for the Bronch and GI departments and an exam must be selected before accessing the Prep Status screen.
- the user may select the appropriate NPO from the NPO dropdown list, select either the Taken or Not Taken radio button (GI only) for bowel preparation, and, select the appropriate prep result from the Bowel Prep Results dropdown list (GI only). The user may further enter any other information in the Other Results field, if appropriate (GI only).
- a user may view the patient's medication history via a Medication History screen (not shown) and add new current medication(s) for the patient, if appropriate.
- an Add Medication screen is displayed that enables a user to enter the first few letters of the medication name in the Drug (Brand) Name search field to search for the medication that needs to be added.
- the user may additionally search by drug and/or brand names. By selecting search icons, additional Search screens (not shown) may be displayed that enables a user to select the medication that is to be added, select a dosage and delivery method.
- An Update Medication History checkbox may be selected to add the medication to the medication history of the patient and, the start date of the medication.
- a user may select a Patient Assessment menu choice 918 via the Pre-Procedure tab 900 of FIG. 9 ( a ), which causes display of a Patient Assessment screen 970 as shown in FIG. 9 ( d ) providing functionality enabling a user to record information relevant to patient pain, emotional status, learning needs, and IV initiation.
- the data captured on this screen is important when assessing the patient's overall condition and may be modified via the Patient Assessment screen.
- the user may select a value from the Pain Score dropdown list 972 , enter the location, quality, and/or duration of pain in the Location/Quality/Duration field 974 , enter relevant information in the Measures to Alleviate Pain field 976 , enter relevant information in the Management Plan field 977 , select a radio button 978 representing the patient's Emotional Status.
- the available selections for Emotional Status include: Calm/Relaxed, Anxious/Participates in Care, and Agitated/Unable to Participate in Care.
- the user may select a radio button 975 corresponding to the patient's preferred learning method (e.g., seeing, hearing, or doing) and, enter the patient's preferred language in the Preferred Language field.
- the user may further select a Needs Interpreter checkbox if the patient needs an interpreter, and, select one or more barriers to the patient's ability to learn via available checkbox selections for Vision, Hearing, Physical, Emotional, and Cognitive reasons.
- the user may set the appropriate IV Type and Needle Gauge dropdown fields in a Venous Access section shown in FIG. 9 ( d ).
- a user may select system defaults for these, by clicking a Default button, or, if “other” choice is selected for Gauge, the user may enter the needle size in the Specify field provided.
- the user may further select a site of the IV from the Site dropdown list, enter the start time of the IV in the Start Time field, select the name of the clinical staff member who started the IV from the Administered By dropdown list, and, select an Existing IV checkbox if an existing IV is used.
- a user may further select a Physical Exam menu choice 920 via the Pre-Procedure tab 900 of FIG. 9 ( a ), which causes display of a Physical Exam screen (not shown) enabling a user to record information such as the patient's weight and height (a patient's estimated and actual height and weight in either inches or centimeters/pounds or kilograms (the system will fill in the other unit field by calculation)), general appearance (from a dropdown list to select the patient's appearance as either well or ill), nourishment (select whether the patient is well-nourished, poorly nourished, or emaciated from the dropdown list), stated age, appearance, color (select whether the patient's color is normal, pallor, jaundice, or rash from a dropdown list, for example), skin palpation (select whether the patient's skin palpation is warm, cold, dry, or diaphoretic from a dropdown list, for example), GI system function (for example, by clicking Yes/No
- a user Before performing any procedure, it is advantageous to record the patient's vital signs, medication information and intraprocedural assessment information.
- a user may select a Vitals and Meds menu choice 922 from the Pre-procedure tab 900 of FIG. 9 ( a ), which causes display of a Vitals and Meds screen 980 such as shown in FIG. 9 ( e ), enabling a user to enter a patient's vital and administered medication information.
- a user may also record pre-procedure Aldrete scores to compare the patient. As shown in FIG.
- the Vitals And Meds screen interface includes two tabs: a Vitals And Meds tab, and Assessment tab.
- the Vitals And Meds tab includes two displayed sections: a Vitals which include, for example, rows for entry of information for a patient such as pulse rate, respiration, systolic, diastolic, O 2 saturation, quantity and method of O 2 , and temperature, for example; and, Medications for a patient including information about medications administered during the different phases of care.
- the Assessment tab includes the other two sections: Aldrete Scores which are scores for activity, respiration, circulation, consciousness, O 2 saturation, dressing, pain, ambulation, fasting—feeding, and urine output; and, Intraprocedural Assessments which include intraprocedural observations for the patient before and during an exam.
- This information comprises LOC (level of consciousness), skin/circulation, rhythm strip, emotional status, pain, and notes.
- a user may add more columns for different time intervals.
- a user may click an icon to initiate functionality for causing the addition of multiple columns.
- an add multiple columns window is displayed the user is able to click a Date icon to enter the date or, type it in manually. By default, the current date is populated.
- the user may further click the Time icon to enter the time or type it in manually. By default, the current time is populated. Further, the user is enabled to enter the interval and columns to the Interval and Columns fields (not shown).
- a column is available to record the vitals values in the Vitals section of the Vitals And Meds tab. If not, the user will be prompted to add a column or add multiple columns. The values may then be entered to any or all of the vitals (except O 2 ) using a slider interface entry mechanism, spinners, or a text box.
- a user may select a Physician Checks menu option 923 via the Pre-Procedure tab 900 of FIG. 9 ( a ), which causes display of a Physical Exam screen 990 shown in FIG. 9 ( f ) that enables a user to: select the Nurse Documentation Reviewed checkbox to indicate that the physician has performed a review of the nurse documentation; select either the Normal or the Abnormal radio buttons for each of the items listed in the Focused Physician Exam section displayed. To set the unselected radio buttons to normal, the user may click the Set Unselected To Normal button. This is useful because in may cases they are almost normal.
- the corresponding Details field is enabled to allow entry of information.
- the user may further: select a value from the ASA (American Society of Anesthesiologists) physical status classification dropdown list; select an item from the Patient is suitable candidate for planned procedure with dropdown list; select an item from the Level of Consciousness dropdown list; select the Emergency Equipment Available checkbox, if appropriate; select the Authorize Post-Procedure discharge when standard criteria are met checkbox, if appropriate; and, select the name of the clinical staff member who performed the physician checks from the Reviewed By dropdown list.
- This is a mandatory field and must be filled before the record can be saved. Further, the user must provide the date that physician checks were performed by entering the date manually or by using the Date icon and provide the time that physician checks were performed by entering the time manually or by using the Time icon.
- the user may access the Lexicon function to select terms from the Knowledge Base as described herein with respect to FIG. 8 ( e ) and, in further detail as described in commonly-owned, co-pending U.S. patent application Ser. No. ______ (Atty Docket 17282).
- the Lexicon arranges the Knowledge Base content into different report sections, based on Phases of Care. These report sections appear as tabs in the Lexicon screen, and for the Pre-Procedure phase of care, the report sections include “indications”, Unplanned events, and codes.
- a user is provided with the ability to associate Billing Codes with selected Keywords.
- a user may use these codes in Procedure Note and thus to bill certain other medical institutions for services rendered.
- To associate a billing code with a selected keyword via the Lexicon screen the user selects the keyword that the user wants to associate the billing code with, and selects a type of code set from a Code Set dropdown list (not shown).
- a user After entering the number of code that the user is searching for in the Number field, a user may enter description of the code in a Description field and the system will respond by displaying a list of billing codes based on the search criteria entered. If the user does not enter any search criterion, all the billing codes from the selected code set are displayed from which the user may select one or more billing codes.
- a user may select a Pre-Procedure Summary menu choice 924 which causes display of a Pre-Procedure Summary screen 995 shown in FIG. 9 ( g ) that enables a user to record, review and/or edit a summary of pre-procedure and nurse handoff information. This includes the status of the prep, consent, current medications, and abnormal findings from the physical examination.
- the user accesses the Pre-Procedure Summary screen 995 , and selects either the Yes or No radio button to indicate whether the pre-procedure nurse's report has been provided.
- An Edit button may be clicked to display the Capture Visit Times screen from which the user may enter the pre-procedure end date and time using the Date and Time icons.
- the name of the prep nurse is also selectable from the Prep Nurse dropdown list, and the name of the procedure room nurse may be selected from the Room Nurse dropdown list. Any other relevant information may be entered in the Nursing Notes field via this display. It is understood that the pre-procedure summary information may be modified via the screen display of FIG. 9 ( g ).
- a user may select a Pre-Procedure Docs menu choice 926 that causes display of a Document Distribution screen (not shown) that enables a user to print and distribute documents related to pre-procedure information in a manner such as described herein with respect to FIG. 8 ( f ).
- Generated documents may be distributed via email or fax.
- the documents may be previewed and edited prior to printing or distributing and, as described herein, the user may also edit the recipient list for each document type.
- a user may also access an Other Visit Information screen (not shown) via the Pre-Procedure tab 900 of FIG. 9 ( a ) to record custom pre-procedure visit information that is not yet captured in one of the other screens. Based on the requirements of the particular facility, the system can be used to record specific information if an exam is selected.
- Procedure tab 1000 functionality is provided enables the user to: review the pre-procedure summary; modify patient visit information; record items used during the exam; manage scope information; capture images and record video clips; modify pathology and specimen information; record a patient's vital signs and medication information; view other exam information; update the lexicon; manage the printer (e.g., Mavigraph) queue; manage procedure documents; and, record and maintain nursing administration information.
- the printer e.g., Mavigraph
- a physician Before performing a procedure, a physician may need to view the following information: the particulars of a scheduled exam to give the physician exam details; a Pre-Procedure summary to picture pre-procedure information about the patient; visit information if another visit/exam is required for the patient; Pathology record to view the result or lab tests; and, any equipment necessary to capture the information about the equipment used for the procedure.
- a user may view the Scheduled Exams option via the procedure tab to view details of exam, to search for an exam, or to add a new visit.
- a user may select the Pre-Procedure Summary menu choice 1001 which causes display of the Pre-Procedure Summary screen 1020 shown and described herein with respect to FIG. 10 ( b ) that provides functionality enabling the automatic population of a synopsis of information obtained during the pre-procedure phase of care in the display screen.
- a user may select the Modify Visit menu choice 1002 that enables a user to schedule a patient visit and to modify an existing visit record as shown and described herein with respect to FIG. 8 ( c ).
- the user may select the Equipment Used menu option 1003 which causes display of an Equipment Used screen 1030 such as shown in FIG. 10 ( c ).
- an Equipment Used screen 1030 such as shown in FIG. 10 ( c ).
- a user may record the information pertaining to equipment used in the examination, particularly by adding the media information in a displayed Media section, or, click a New button next to Accessory, to add a new entry in the Accessory section which enables a user to select an accessory category from a Category dropdown list and enter the item number and quantity.
- an Equipment Detail screen (not shown) is displayed from which the user may select the accessory category from a Category dropdown list.
- Electrosurgical Generators from the Category dropdown list, for example, an Electrocautery section is enabled via which a user may enter other equipment information, e.g., a serial number, etc. All of the entered equipment information in the Equipment Used and equipment detail screen may be saved.
- a user may: manage scope information; capture images and record video clips; modify pathology and specimen information; record a patient's vitals and medication information; view other exam information; manage a mavigraph printer queue; distribute documents; and, maintain nursing administration information.
- a user may select the Image Capture menu choice 1004 that enables generation and display of an image capture interface screen 1050 such as shown in FIG. 10 ( d ) that provides the user with the ability to: capture images and record video clips, modify and delete these images, and incorporate them into a report document. If an endoscope device to be used is not connected to the application, a warning message may be generated that the device cannot communicate and the user prompted to ensure the scope device is connected to the system.
- an endoscope device employed includes an ID chip that provides information such as scope name, serial number, etc. and this data is sent to the EW system (e.g., imaging node) through the video processor.
- the system adds new scope information automatically when it receives this data. If a scope does not contain ID chip, the user nay add the new scope information manually.
- a user may click New button on the right of Scope Information, click a Search icon and locate the scope type that needs to be added via a displayed Scope Model dropdown list (not shown).
- the user may select a scope model number and a serial number.
- the user may additionally select a Time icon 1053 to enter the current time or type it in manually, and, click on a Calculate Duration icon 1054 that initiates functionality for calculating the duration and the Total Duration time that the scope is being used.
- the user may click a Pause icon in order to freeze the image.
- a user may click a Capture icon which initiates functionality for displaying the image in an Images box 1055 such as shown in FIG. 10 ( d ). If a user double clicks the image, the image is generated for display in a further space as shown by the enlarged image 1056 in FIG. 10 ( d ). If, during an exam, the scope device is disconnected, the user must re-initialize the system, e.g., reconnect the device to the system within the Image Capture screen. The system will automatically re-initialize or it may be manually reset.
- the system provides three mask settings: an automask, primary and secondary settings.
- a Toggle Mask function is provided that enables the user to toggle between these video settings. If a system administrator has applied the automask setting, then the user may either switch between these video settings, or select a new video setting. For example, by clicking a Toggle Mask button 1057 located next to a Mask dropdown list 1058 , the automask settings will change to the primary settings. By clicking the Toggle Mask button again, the primary settings will change to the secondary settings.
- the default automask settings are applied. The user may change the default automask settings by selecting a setting from a Mask dropdown list.
- a user may click a Record Clips icon 1059 a that enables functionality for recording a video clip and storing the clip for later playback via the Image Management section 1055 or, delete Video Clips.
- Delete Clips icon 1059 b By clicking the Delete Clips icon 1059 b all unsaved video clip(s) are displayed in a screen (not shown) that enables a user to select the clip(s) to be deleted.
- a user may select the Pathology Request menu option 1005 that enables generation and display of a Pathology Request screen 1060 for the selected exam such as shown in FIG. 10 ( e ).
- the user selects an Add button to enable selection of a laboratory from a Lab dropdown list and enter other relevant information including the jar number, collecting method and specimen information in a specimen section associated with a specimen record (not shown).
- a user may make further edits or required changes to the pathology request and specimen record, or add or delete records via the Pathology Request screen.
- a user may select a Vitals and Meds menu choice 1006 from the procedure tab 1000 in FIG. 10 ( a ) which causes display of a Vitals and Meds screen (not shown) enabling a user to enter a patient's vital signs and administered medication information via the graphical user interface in the manner as described in greater detail herein with respect to FIG. 9 ( e ).
- the user may access the Lexicon function 1007 to select terms from the Knowledge Base as described herein with respect to FIG. 8 ( e ) and, in further detail as described in commonly-owned, co-pending U.S. patent application Ser. No. ______ (Atty Docket 17282), the whole contents and disclosure of which is incorporated by reference as if fully set forth herein.
- One feature of the lexicon is that the Knowledge Base arranges content to different report sections based on the phases of care. A facility determines which Report Sections should be available in the Lexicon screen for a Phase of Care (endoscopic procedure lifecycle stage).
- a user will select a Report Section to display the hierarchal tree of items (menus and keywords) for the report section and current examination and the tree of the lexicon interface displays the available items.
- the lexicon screen will result in the display 1065 as shown in FIG. 10 ( f ).
- the printer e.g., Mavigraph
- manage procedure documents e.g., Mavigraph
- record and maintain nursing administration information e.g., Mavigraph
- a user may select the Mavigraph Printing menu choice 1008 that generates a Mavigraph Printing screen (not shown) enabling a user to search for a printing queue for the printer device, e.g., a mavigraph, particularly by entering a facility and selecting a printer.
- a user may further print images for current exam, for example, by selecting the number of images a user needs to print on a page from the Images per Page dropdown list and selecting one or more print options from Annotations, Enhancements, and Anatomical Diagram choices as shown in the print on mavigraph interface screen 1070 shown in FIG. 10 ( g ).
- Further functionality via this phase of care includes the ability to manage procedure documents, particularly by selecting a Procedure Docs menu option 1009 via the Procedure tab 1000 which causes display of a Document Distribution screen 1075 such as shown and described herein in further detail with respect to FIG. 10 ( h ).
- a user may review, edit, and print a document from the Document Distribution screen, and further, select a recipient and cause the distribution of patient and exam related documents to the intended recipient (e.g., clinical staff), for example, by print, email, or FAX.
- a user may select the Nursing Admin menu choice 1010 that enables generation and display of a Nursing Administration screen 1080 for the selected exam such as shown in FIG. 10 ( i ).
- a user may click a button 1081 to display a Capture Visit Times screen that enables a nurse to enter a Room In date and time, a Procedure/Sedation Start time, a Procedure End time, and a Room Out date and time.
- the user may further enter relevant Safety and Position information in respective displayed Safety and Position sections, and, select the present medical staff information from a Resource dropdown list.
- a Scheduled button a user may further enter the medical staff person who is assigned to the procedure in the Assigned textbox and, further enter information about the Room Nurse and Recovery Nurse in the Handover section 1082 .
- Post-Procedure tab 1100 ( FIG. 11 ( a ))
- functionality is provided that allows the user to: synchronize images in ICU mode; manage exam images; print images on either mavigraph or laser printer; create procedure notes for the exam; sign procedure notes; gather a patient's current vitals and medication information; prepare a patient recovery sheet; create a patient recall letter; perform a trainee assessment; distribute post procedure documents such as billing reports, Procedure Notes, and referral letters.
- a physician may perform the following operations: synchronize images in the ICU mode: manage images; review/edit clinical Lexicon; generate Procedure Notes; record patient's current vital signs and medication information; prepare a recovery sheet for a patient; prepare recall patient letter; complete patient satisfaction survey; perform trainee assessment; and, distribute post procedure documents.
- FIG. 11 ( a ) when a user is performing an exam in ICU mode, his/her imaging station is not connected to the network server (see FIG. 1 ( a )), i.e., is physically disconnected from the network.
- the application supports the capture of all necessary data, perform the examination and store the information until reconnected to the network.
- the locally stored data is then uploaded to the server database.
- the user when an exam is finished, the user must upload and synchronize images and data from the workstation to the server repository.
- the user when a user re-connects the workstation to the network and logs in to the system, the user enters a series of commands that will initiate functionality to upload and synchronize the data and images captured during the exam.
- a user may first view the details of exams from the Scheduled Exams display by selecting menu option 1102 via the post-procedure tab 100 of FIG. 11 ( a ) to view details of exam, to search for an exam, or to add a new visit.
- a user may select the ICU Synchronization menu choice 1104 which causes display of the an ICU Synchronization screen 1130 , such as shown in FIG. 11 ( b ), to synchronize images in the ICU mode within the database.
- a user may select a node from a Node dropdown list that generates for display a list of exams on the selected node that are conducted in ICU Mode. After the user selects the exam to be synchronized, the ICU Exam screen is displayed with a list of likely matches. The user will search for a scheduled exam, or retrieve a list of exams for display, based on user search input, if the exam is not in the list of matches.
- the user may, via the ICU Exam screen, select the facility for the visit from the Facility dropdown list (e.g., the default facility is the facility to which the user is currently logged in); enter visit ID in the Visit ID field.
- a visit ID is a unique facility-supplied identifier for the visit; click a Patient Search icon next to a Patient field to display a Patient Search screen. If no patient record is found in the Patient Search field, a new record for the patient may be created by clicking a New Patient icon to display the Patient Demographics window having functionality as described herein to assign a resource for synchronization.
- the images and data are synchronized to the repository and the ICU Synchronization screen is displayed again.
- the user then navigates to the Image Management function by selecting the Image Management menu choice 1106 that causes display of the Image Management screen 1140 such as shown and described herein with respect to FIG. 11 ( c ) that provides functionality for managing images captured during a procedure, particularly: annotate images, label images or associate findings to an image; display details of an image; enhance the quality of images; import and export images; view other exam images; print images on either a mavigraph or laser printer; and delete images.
- a few exam images in a folder may be imported in the current exam (by clicking an Import an Image to the current exam icon 1141 ), using an import image function.
- an Export the selected Image icon 1142 image(s) files are exported to a destination folder including BITMAP, JPG or TIFF images, for example, using an image export function, via the Image Management screen 1140 for storage.
- a user can add lines, circles, ellipses, arrows, and text as annotations, and further, may also change the color, shape, dimensions, and location of an annotation.
- Annotations that are created via the image management interface are stored as overlays, and do not affect the original image, and further can show or hide annotations.
- the Image Management screen 1140 of FIG. 11 ( c )( 1 ) displays all the images captured during the selected exam from which a user may click select the image to annotate from an image list 1145 .
- a line, a rectangle, an ellipse, or a circle may be clicked and dragged onto the image, such as the exemplary annotation 1132 shown in the selected image 1133 shown in FIG. 11 ( c )( 1 ).
- the selected shape will appear on the image in which a text message may be inserted via selection of a text icon, which is dragged to create a textbox on the image.
- a user selects a Selection Mode icon 1148 on the selected image, and clicks a previously-created annotation shape that he/she wants to move and drag to the desired location.
- the Selection Mode icon is used to switch back and forth from drawing a new image to selecting an existing one.
- Enhance Image icon 1151 selects a Enhance Image icon 1151 on the selected image, which initiates display of an enhancements window (not shown) including mechanisms such as: a Zoom slider to change the size of the image, if desired, a Sharpness slider to change the sharpness of the image, if desired, a Contrast slider to change the contrast view of the image, if desired, and a Brightness slider to increase or decrease brightness of the image.
- the enhanced image may be reset by to its original setting by clicking a Reset button.
- the user may further select functionality for showing or hiding an annotation on a selected image by clicking the Show/Hide Annotation icon 1153 , and further, initiate functionality for viewing Other Exam Images.
- an Other Exam dropdown list 1155 is provided to enable a user to select image results from the other exam.
- the other exam images are accessed and generated for display in an image list 1156 format simultaneously with the display of a current image list of captured images for user comparison.
- a user may Magnify images from the other exam using the View Large Image icon next to the Other Exam dropdown list, and further view Procedure Notes recorded for the other exam using the View the Procedure Note icon 1157 .
- the tide bar of the Procedure note may include the date and type of the other exam.
- a user may label the image for future identification via the Image Management screen by clicking the Label all selected images from the current exam icon 1158 to display a Label window in which a label may be entered in the label text entry pop-up textbox (not shown). Subsequently, the label may be modified or deleted via the Image Management screen.
- the user may further delete all unlabeled images from the current exam with just a click by selecting a Delete all unlabeled images from the current exam icon 1159 via the Access the Image Management screen 1140 of FIG. 11 ( c )( 1 ).
- the Lexicon menu option 1107 may be selected from the Image Management screen 1100 shown in FIG. 11 ( c )( 1 ) to enter a finding using the knowledge base section 1149 .
- a Findings tab 1146 is selected from the displayed Knowledge Base section and a finding title is clicked from the displayed Knowledge Base tree.
- the finding information will be generated by and appear in the left side of the Knowledge Base interface in the manner as described herein and in greater detail in commonly-owned, co-pending U.S. Ser. No. ______ (Atty. Docket 17282).
- the Associate Findings icon 1160 from the image management screen shown in FIG. 11 ( c )( 1 )
- the finding is associated with the selected image.
- the image is also marked for printing.
- Disassociate Findings icon 1162 is clicked by the user. It is noted that when a user disassociates a finding from an image, the image does not get unmarked for printing.
- the system of the invention provides an anatomical diagram to document any surgical changes.
- a user associates a finding that includes a site with an image, a dot is displayed corresponding to site of the finding.
- To view the surgical diagram the user clicks an image that is associated with a finding via the Image Management screen 1140 shown in FIG. 11 ( c ) and selects a Surgical Changes icon 1163 to display the Surgical Changes window 1165 such as shown with respect to FIG. 11 ( d ).
- Functionality is further provided to enable a user to annotate a surgical diagram by using the toolbar in the Surgical Changes screen for drawing arrows, circles, lines, rectangles, and solid rectangles in the selected image as described herein with respect to image capture.
- a user may additionally type and format text, move, hide, and delete annotations as described herein.
- the images for printing must be first marked by clicking the Mark selected images for printing icon 1172 via the Image Management screen 1140 and printed on a mavigraph or any other suitable printer (for example).
- a suitable indication such as a “P”, as shown in FIG. 11 ( c )( 1 ) for example, is provided in the corner of a captured image that marks that image for printing. Subsequently, a user may click the Unmark selected image for printing icon 1173 to unmark an image, and remove the “P” indication on the top-right corner of the image.
- the Mavigraph Printing functionality is provided for adding a print job for the currently selected mavigraph printer.
- a user may print one or more print jobs, and reprint an existing print job.
- a user may select the Mavigraph Printing menu option 1108 from the Image Management screen of FIG. 11 ( c )( 1 ) which displays a Mavigraph Printer dropdown list from which a mavigraph printer may be selected. It is understood that, as described herein with respect to FIG.
- an Annotation checkbox may be selected if the user wants to print images with their annotations; an Enhancements checkbox may be selected to print images with their enhancements in terms of sharpness, contrast, and brightness; and, an Anatomical Diagram checkbox may be selected to print the anatomical diagram for the exam. Further functionality is provided for deleting a print job, clicking on the checkbox next to the print job to be deleted.
- a user may manage those clips via the Post Procedure tab, and particularly play and delete video clips, and save a video clip to another file.
- a Video Clips icon 1176 may be selected to display the Video Clips List window where the user may further click a Preview icon (not shown) to play the video clips in a suitable viewer such as Windows Media Player, or, delete video clips.
- a Video clip(s) may be selected for deletion or be saved to another File via the Image Management screen, e.g., by clicking a Download icon and selecting a destination file location.
- a user may use the Lexicon function to select terms from the Knowledge Base. For example, when it is desired to record procedure related information for the exam, the user may select the Lexicon function to record findings.
- the Lexicon arranges the Knowledge Base content into different report sections, based on Phases of Care, these report sections appearing as tabs in the Lexicon screen 1065 such as shown in FIG. 10 ( f ) including an indications tab 1177 a , a procedure tab 1177 b , a findings tab 1177 c , an unplanned events tab 1177 d , a recommendations tab 1177 e , a summary tab 1177 f , and a billing codes tab 1177 g .
- a facility determines which report sections should be available in the Lexicon screen for a phase of care.
- a system administrator can make a report section available to appropriate phases of care via an Admin tab 1300 .
- Functionality enabled via the Lexicon screen is described in greater detail herein and in applicants' herein incorporated co-pending U.S. patent application Ser. No. ______ (Atty Docket 17282).
- the user picks or selects an available term (based on that user's findings) from the right hand side pane, it is copied to the left hand side pane that displays the selected terms thus logically build a comprehensive description of the exam.
- These selected terms along with other exam data collected during various phases of care are used to generate Procedure Note and other exam related documents.
- Lexicon One particular use of the Lexicon is the ability to associate Billing Codes with selected keywords. These codes may be used in Procedure Note and thus provides the ability to bill certain other medical institutions for services.
- To associate a billing code with a selected keyword the user accesses the Lexicon screen portion 1179 such as shown in FIG. 11 ( a ), selects the keyword desired to be associated with the billing code; clicks the Code icon 1180 and select a code set display option (not shown) from a displayed Select Billing Codes window (not shown). After selecting a Code Set, a Code Sets window is displayed whereby the user may search for a billing code from this window.
- the user selects a type of code set from the Code Set dropdown list and, enters number of the code to be searched for in an optional Number field, or further enter a description of the code in an optional Description field.
- a list of billing codes based on the entered search criteria is displayed or, by default, all the billing codes from the selected code set are displayed if no search criteria is entered. A user from this list may then click a billing code to select it, or further select multiple billing codes.
- a Procedure Note is documented information about a specific exam and is used to document findings, diagnosis, medication, recommendation, and other information such as past diagnosis; a user may additionally use the Procedure Note function to manage images; view information such as images and Procedure Notes for other exams; select terms from the Knowledge Base tree; generate report text; select billing codes; sign a note; generate different versions of a note; and discard or delete a note.
- a previously created Procedure Note template configured in a manner as specified by a facility or a physician to display captured information in a document.
- a system administrator previously creates the Procedure Note template.
- a user selects a Procedure Note menu option 1109 via the tab 1100 of FIG. 11 ( a ) and a Select Procedure Note Template screen (not shown) is displayed that enables a user to search for a Procedure Note template based on facility and/or physician name.
- a resulting list of Procedure Note templates is displayed that are selectable by a user.
- an example selected Procedure Note screen 1190 is shown that includes three sections: an Image Strip 1145 , to manage images for the current exam as described herein with respect to FIG. 11 ( c )( 1 ); a Procedure Note Builder 1182 providing an interface for editing and generating Procedure Note documentation; and, a Knowledge Base Interface 1179 , to pick Knowledge Base terms to generate a report.
- a user may use the Images section similar as a user would use the Image Management screen ( FIG. 11 ( c )( 1 )).
- the Image section of the Procedure Note screen buttons enables functionality for: deleting selected images from the current exam; deleting all unlabeled images from the current exam; mark/unmark selected images for printing; viewing a larger image; labeling all selected images from the current exam; deleting the label from all selected images from the current exam; associate/disassociating findings; showing/hiding a menu or a strip; and, viewing images and Procedure Notes for other exams associated with the selected patient.
- a user may further use the Procedure Note function to select Knowledge Base terms for an examination.
- the Knowledge Base section is used to select terms and when a Note is created, the user may select a Generate Report icon 1192 to generate a report including sentences in the document section.
- the Generate Report icon is activated if changes are made to the selected terms. If any of the selected keywords are associated with a sentence model, the sentence is generated and populated in the displayed report within the specific Report Section.
- STOMACH There was a polyp found in the stomach.
- the finding sentence When a sentences are generated for findings, and if there is an image associated with that finding, the image number appends at the end of the finding. For example, if there is a finding of polyp with “image 1” within stomach, the finding sentence would appear like:
- a keyword in the Knowledge Base may have a sentence model for the Summary section associated with it. If a selected template has a Summary section and a selected keyword has a summary sentence model, the summary sentence for the keyword appears in the Summary section. For example, if a polyp is found in the stomach and a diagnosis of polyp, the summary sentence would be:
- a user may use the Procedure Note function to select relevant billing codes for the exam. If a keyword has a billing code associated with it, a user would see all billing codes and descriptions associated with the keyword in response to selecting the Code icon 1180 and select relevant billing codes associated with a keyword for the current exam.
- Procedure Note screen 1190 of FIG. 11 ( a ) Further functionality enabled via the Procedure Note screen 1190 of FIG. 11 ( a ) includes: saving a Procedure Note by clicking Save; and, signing a Procedure Note if the Procedure Note text is completed. It is understood that only attending physicians for the examination can sign the Procedure Note. If a Validate & Sign Procedure Note setting is set to Yes, the physician will be asked to validate his/her user ID and password. Signing a note will lock the report from further editing. It is further understood that signing a Procedure Note updates a patient's past procedure, past diagnosis, and past surgeries records; saving a Procedure Note As a Template, for example, for those situations where a user makes changes to an existing Procedure Note and wants to apply those changes to future Procedure Notes.
- the modified Procedure Note may be saved as a template which can be used to generate future Procedure Notes.
- a user may select the Save As button and assign a name to the template, select either a facility or physician name to assign an owner to the template.
- Procedure Notes are created by: providing procedure reporting via the medical knowledge base interface that implements shortcuts for commonly used items; and, incorporating annotated and labeled images into the written reports. Further, the appropriate sections of the report may be auto-populated based on patient data previously gathered during Pre-Procedure, Procedure, and Post-Procedure phases.
- Procedure Note As mentioned, once a Procedure Note is signed, it is locked and cannot be edited. To make any changes to an existing, signed Procedure Note, the user must create a new version of the Procedure Note.
- the new version of the Procedure Note is an exact copy of the current signed Procedure Note, without regenerating any sentences or updating any database fields.
- To generate a new version via the Procedure Note screen a user may clicks a New button and a new version of the Procedure Note is generated.
- a procedure note may further be deleted by clicking Discard via the Procedure Note screen.
- Discarded Procedure Notes are stored in a Discard Bin, where they can be viewed but not restored.
- a Procedure Note may be deleted as long as the Note is not signed.
- Further functionality enabled via the Procedure Note screen includes functionality for creating a new exam follow-up request by selecting an Exam Follow-up icon 1198 from the Procedure Note screen.
- a New Exam follow-up window (not shown) is displayed in response that enables a user to: select an assignee from the Assigned To section; select the status of the request from a Status dropdown list; and click New if the user has any notes to enter.
- An exam follow-up request is generated, which the user may view from a Pending Items screen in the Home tab associated with that user.
- a user may record the current condition of a patient, and particularly: prepare a recovery sheet based on the patient's vitals and meds information; determine the level of service provided to the patient; record a patient satisfaction survey; access trainees, if any trainees are involved in the procedure; and distribute exam-related documents.
- the user may record the patient's vital information, administer any medication provided, note the Aldrete scores, and record intraprocedural assessment information to determine the condition of the patient upon selection of the Vitals and Meds menu choice 1111 shown in FIG. 11 ( a ).
- This functionality is implemented via the Vitals And Meds screen to record the data as shown and described herein with respect to FIG. 9 ( e ).
- the user may further use a Recovery screen 1195 such as shown herein with respect to FIG. 11 ( e ) to capture recovery data for a patient.
- the recovery sheet also serves as a discharge document, where the user enters arrival and departure times, post procedure discharge information, the last Aldrete score, the patient's venous details, etc. If the user needs to call the patient for a follow-up, the user may create a new post-exam follow up request from this screen.
- the user may prepare a recovery sheet from the Recovery screen 1195 as shown in FIG. 11 ( e ) after selecting the Recovery menu choice 1112 from the Post Procedure tab 1100 and selecting an exam. Via the Recovery screen, a user may further display the Capture Visit Times window where the user may enter a Recovery Arrival date and time and a Time Out of Unit time and date. The user may further select the relevant Authorize Post Procedure Discharge information. In one embodiment, a Last Aldrete Score section is populated automatically with the last Aldrete Score that was captured in the Vitals And Meds screen of FIG. 9 ( e ). The user may further enter Venous Details.
- a user may setup a post call meeting and select an assignee for the post-exam call from the Assigned To section.
- a Clinical Staff icon may be displayed and a clinical staff selected from a Clinical Staff Lists.
- a user may further select the status of the post exam call from the Status dropdown list. If it is a new call, the status would be Open.
- Other information in the New Post Exam Call window may be populated from the system database. The user may further enter the Discharge Details and enter relevant information in the Patient Belongings section. If there are no belongings to return to the patient, there will be No Belonging(s) to Return indication.
- a Recall Patient screen may be used to add an item to the Recall Letter Queue to remind a patient of a follow-up examination.
- Recall letters are exam notifications which are generated and then sent to a patient.
- a user To add an item to Recall Letter Queue via the post-procedure screen, a user must navigate to the Post Procedure screen 1100 in FIG. 11 ( a ), and, for a selected exam, select Recall Patient menu option 1113 to display the Recall Patient screen 1196 such as shown in FIG. 11 ( f ). Via the Recall Patient Screen of FIG.
- the user may select the facility where the patient is to visit, and enter the patient name and enter the return time in provided entry fields. The user then selects the exam for which the user wants to recall the patient from the Exam dropdown list, selects the attending physician from the Attending dropdown list and enters any notes.
- the user may view and print recall letters from the Recall Letters screen in the Home tab shown in FIG. 6 .
- a user selects Recall Letters menu option 607 to display the Recall Letters screen, and selects a facility from the Facility dropdown list (not shown).
- Other search input if desired, may be entered as well.
- the system generates for display a list of recall letters, sorted by patient return date.
- the user may then click a Details icon to view the details of the recall.
- the Recall Patient screen is displayed where the user may make changes to the recall, if desired.
- a Select checkbox may be clicked to select a letter and subsequently printed.
- a recall letter may be selected and printed from a Select Template pop-up window from which a user may select a recall letter from the Template Name dropdown list for printing.
- the system provides a Patient Satisfaction Survey screen to capture the patient's level of satisfaction on certain elements, such as procedure, staff, exam time, and overall visit.
- the ratings for each item include excellent, very good, good, fair, or poor.
- a user selects a Patient Survey menu option 1114 to cause display of the Patient Survey screen (not shown) wherein the user may enter the patient's satisfaction rating for each of a plurality of rating items including Endoscopist's manner, technical skills, patient's wait time, etc.
- a trainee is involved in a procedure, the user may use a Trainee Assessment screen to access the performance record of a trainee.
- the Intubation and Therapeutic Maneuvers may also be assessed.
- a trainee may be selected from the Trainee dropdown list and Assessment information and the optional Intubation and Therapeutic Maneuvers information may be entered.
- a Document Distribution function may be implemented.
- the user may distribute post procedure documents such as billing reports, Procedure Notes, discharge instructions, exam images, nurse reports, or referral letters, by email or fax.
- the user may further preview and edit the documents prior to printing or distribution, and further edit the recipient list for each document type. An exam must be selected to view the Document Distribution screen.
- Post Procedure Docs menu option 1116 to display a Document Distribution screen 1120 for a particular exam, such as shown in FIG. 11 ( g ).
- a user may edit or review a document by accessing the Document Distribution screen, selecting a template for the document from the Template dropdown list 1121 , and select an Edit Document icon corresponding to the document that needs to be edited or reviewed.
- the document will be displayed in a new window where the required changes may be made.
- a document may also be printed without distributing it via the Document Distribution screen.
- a user may edit the recipients of a document from the Document Distribution screen 1120 and particularly add and delete recipients from the list via the Document Distribution screen.
- a user may select an Edit Recipient List icon 1122 adjacent to the document which causes for display an Edit Recipient window providing a contact choice to add a recipient other than a medical provider or clinical staff.
- the Contacts List screen is displayed with categories of recipients. An icon is provided to delete a recipient.
- a user accesses the Document Distribution screen 1120 of FIG. 11 ( g ), and clicks the checkbox 1123 associated with the document to be distributed.
- a template is selected for the document from a Template dropdown list and the user may click Distribute via a selected media, e.g., print on a default printer, or e-mail for the recipient to view.
- education documents may be distributed to patients to inform them about procedures or findings. For example, if the user's facility has set an education trigger for the word “polyp”, then when a polyp is found in the stomach of a patient, a document based on an education template can be generated for the user to distribute to that patient. If the facility has not set an education trigger, no education document will be generated.
- An education document may be selected via the Document Distribution screen 1120 by selecting the document, clicking the checkbox next to the document to be distributed, selecting the template for the document from the Template dropdown list, and selecting the number of copies that need to be printed.
- the EW system provides menu selections for invoking a pre-defined queries for a category defined in the menu.
- a user selects a report from the menu list and pushes execute button, the system invokes a pre-defined query and displays the results according to a pre-defined template.
- Predefined queries shown in the analysis tab 1200 of FIG. 12 enable the generation of a statistics report regarding CQI (Continuous Quality Improvement).
- Other pre-defined queries may be invoked to generate reports regarding efficiency, equipment analysis, procedure analysis and administration.
- System Administration tab 1300 ( FIG. 13 ( a ))
- functionality is provided that allows a user having administration privileges to: maintain system data; maintain application resource data; manage patient and clinical staff information; customize application settings and functions; manage user and role information; configure facility, node, mavigraph, and video settings; manage logs and queues; manage equipment information; modify the user-defined screen.
- a system administrator is also responsible for configuring the system to maximize system performance; maintain the Knowledge Base by adding new keywords, sentence models, and menu structures; record and maintain resource information such as endoscopy equipment information and clinical staff records; add and remove users and assign appropriate privileges to each user; review system and activity logs for periodic administration and take corrective measures to solve any problems.
- System menu option 1301 initiates display of a system screen such as shown in FIG. 13 ( a ), that provides functionality to enter, store, delete and/or modify system information stored in the database, including, but not limited to, the following: 1) Insurance Carrier information: by further selecting the Insurance sub-menu option 1302 shown in FIG.
- Procedure Room information by selecting the Procedure Room sub-menu option 1303 shown in FIG. 13 ( a ), functionality is enabled for creating, modifying, storing and deleting database records about the procedure rooms (e.g., room names or room numbers) in the facility for storage in the system database. Adding procedure room information would enable clinical staff to allocate a room to an examination. Each procedure room is identified by its name and facility; 3) Race information: by selecting the Race system sub-menu option 1304 shown in FIG.
- Ethnicity information by selecting the Ethnicity system sub-menu option 1305 shown in FIG. 13 ( a ), functionality is enabled for creating, modifying, storing and deleting entries in a standard list of Ethnicities including, but not limited to: American, Australian, Canadian, Caribbean, Chinese, European, Hispanic, Indian, Japanese, etc. 5) Name Prefixes information: by selecting the Name Prefix system sub-menu option 1306 shown in FIG.
- 13 ( a ) functionality is provided for enabling an administrator to create, modify, store and delete entries of defined name prefixes (and associated genders) that can be assigned to a person such as: Dr., Father, Miss, Mr., Mrs., Ms., etc.; 6) Academic Degree information: by selecting the Academic Degree system sub-menu option 1307 shown in FIG. 13 ( a ), functionality is enabled for creating, modifying, storing and deleting information relating to Academic Degrees that can be assigned to a person such as: D.O., L.P.N., M.D., M.S.N., R.N., etc.; 7) State/Provinces information: by selecting the State/Province system sub-menu option 1308 shown in FIG.
- 13 ( a ) functionality is enabled for modifying, storing and deleting states/provinces records that are installed within the application or create new state/provinces (and their abbreviations).
- the application includes all 50 states, their corresponding US post office state abbreviations, and all Canadian provinces and territories; 8) Country information: by selecting the Country system sub-menu option 1309 shown in FIG. 13 ( a ), functionality is enabled for modifying, storing, adding and deleting country names (e.g., USA and Canada) and their abbreviations or to add new countries to the list; 9) Department information: by selecting the Department system sub-menu option 1310 shown in FIG. 13 ( a ), functionality is enabled for modifying, storing creating and deleting Departments information (and abbreviations).
- a department is a sub-organization or practice within an institution or facility that specializes in one or more medical areas, such as Gastroenterology (GI) or Bronchoscopy (Bronch). It provides services for one or more exam types (specialty), such as EGD or ERCP. Clinical staff can be qualified to perform or work in one or more departments and specific accessory equipment is associated with the department.
- the system supports multiple departments with department records established and maintained using the department maintenance function. When a Department List screen is accessed, the defined departments are displayed alphabetically by name; 10) Patient Identifier Type information: by selecting the Patient Identifier Type system sub-menu option 1311 shown in FIG.
- functionality is enabled for modifying, storing, creating or deleting the Patient Identifier Type information for a facility which is a code used to identify a patient.
- the identifier code “MRN” is the default patient identifier type.
- a facility can create its own identifier type and edit, add, or delete departments via a Patient Identifier Type screen. It is understood that a default patient identifier type must be set using the facility settings function. This unique patient identification can also be helpful if one facility decides to merge another;
- Medical Alerts information by selecting the System Alerts sub-menu option 1312 shown in FIG. 13 ( a ) functionality is enabled for modifying, storing, creating or deleting medical alerts or comorbidities for a facility.
- system medical alerts are system level comorbidities identified by a facility. If a patient has a designated system medical alert, the medical alerts icon 759 such as shown in FIG. 7 ( c ) is displayed in the status bar 749 . This medical alerts icon is displayed and stays on the status bar whenever the concerned patient is selected. Medical staff can click on the medical alert icon to view a list of all medical alerts for the patient.
- a further function provided via the System Administration tab 1300 is the maintenance of application resource data.
- functions are provided that are accessible by a user having administrative privileges to perform functions such as: creating or modifying patient information, clinical staff information or contact information.
- Clinical staff is defined as the professional and certified medical personnel employed by or affiliated with an institution, facility, or clinic. Each clinical staff is associated with a role defined in the system.
- a member can have the following roles for an exam type: attending physician, EGD, Nurse, and others such as ERCP. Only a clinical staff member with the proper qualifications can perform the roles required for an exam type.
- the system of the invention supports the search for addition, modification, and deletion of clinical staff records.
- selection of the system Clinical and Patient menu choice 1315 enable the maintenance of these application resource data types by displaying a Clinical Staff List screen providing available clinical and patient sub-menu choices.
- a user further selects the Clinical Staff sub-menu option 1316 which displays the Clinical Staff List screen (not shown) which enables the user to search for a clinical staff using one or more criteria entered in the search fields provided that include the following: a Primary function; a Facility; a Staff ID; and a first and last name of the medical staff member.
- Clinical Staff List screen To add a physician in the system via the Clinical Staff List screen, user may click a new button which enables display of a Clinical Staff screen 1340 as shown in FIGS. 13 ( b )( 1 ) and 13 ( b )( 2 ) providing fields for entering clinician's personal information data such as: staff ID, a prefix, last name of the physician and first name, and, enabling selection of “Physician” from a Primary Function dropdown list.
- Further functionality enabled via the Clinical Staff screen includes the ability to: assign a facility to the physician by selecting a facility from the Facility dropdown list (e.g., more than one facility may be assigned to the physician); assign an academic degree to the physician by selecting a degree from a Degree dropdown list (e.g., more than one degree may be assigned to the physician); assign an exam to the physician by selecting an exam from an Exam dropdown list; and, select a role that the physician would be performing in the selected exam from the Role dropdown list.
- a nurse may be entered into the system by creating a nurse record. That is, before a nurse is assigned to an exam, the nurse's information must be added in the system that is accomplished via the Clinical Staff screen 1340 of FIGS. 13 ( b )( 1 ) and 13 ( b )( 2 ).
- the administrator may access the Clinical Staff List screen, search for the clinical staff record to be modified, click the Details icon next to the clinical staff, and via the Clinical Staff screen, make the desired changes or click a Delete icon to delete the selected record.
- the system enables display of a Contacts List (not shown) enabling addition of a new contact such as a new pharmacy, or a new vendor.
- a Contacts List (not shown) enabling addition of a new contact such as a new pharmacy, or a new vendor.
- the system enables the facility to maintain contacts other than clinical staff, including but not limited to: Pharmacy; Billing; Pathology; Quality assurance; Biomedical department; Medical records; Outside physician office; Outside hospitals; Ambulance services; Infection control; Hospital contacts; Vendors and Regulatory agencies.
- the administrator may enter a search query for an existing contact record.
- the existing contact record is brought up in a contacts screen display (not shown) that enables a user to modify the contact information or delete the contact record.
- the Configuration Management function of the present invention maintains application configuration items including: System Settings, Node Settings for a specific node, Printer (e.g., Mavigraph) Settings, Video Settings, Auto Mask Settings, and Facility Settings.
- the system may further enable the set-up parameters for the system to record and display data.
- System settings are configured when the application is installed, but they can be changed at anytime via a System Settings screen.
- a user may select a Configuration menu choice 1318 to display available configuration sub-menu options.
- a select System Settings sub-menu choice 1320 is provided that, when selected, generates for display the System Settings screen 1350 such as shown in FIG. 13 ( c ).
- a user may modify the required System Settings information by providing entry fields for entering system parameters such as: Institution Name and Institution logo which is an image file containing the institution's logo in formats such as BMP, JPEG or JPG, for example; SSN/SIN Format which setting is used to specify the format for entering a Social Security Number (SSN) or Social Identification Number (SIN), depending on the country (e.g., a default value is ####-##-#### where # is a number between 0 and 9); a Phone Format setting used to specify the institution's phone number entry format; a Thousand Separator format setting that determines the separator used when entering numbers over 999; a Decimal Separator setting that determines the separator used in decimal numbers; a Time Format setting that determines the time format for the institution, and is a choice of Military or Standard time; a Date Format setting is used to specify the institution's date entry format; a Compression format setting that is used to specify the institution's preferred graphics compression format (e.g.
- a further function provided by the system is the maintenance of the layout of the application based on a facility's requirements. That is, the system is a highly customizable application with the ability to decide which options that are to be made available to users. For example, the administrator can choose to allow or forbid a user in the nurse role to access the Procedure Notes section.
- the administrator may access the Application Flow configuration sub-menu option 1322 which causes for display the available configuration options in an Application Flow screen 1355 such as shown in FIG. 13 ( d ).
- the user may select a tab from the Tab dropdown list 1356 which provides all of the available sub-menu option choices in an Available textbox 1357 a , and provides all assigned options listed in an Assigned textbox 1357 b .
- the user may then select options from the Available menu choices list that are to be assigned to users by clicking a Right Arrow icon to add the selected options to the Assigned list 1357 a , or select options from the Assigned list to remove, and, click the Left Arrow icon to remove the selected options from the Assigned textbox 1357 b.
- the administrator may further add a new facility, customize a facility's preferences and operating procedures from a Facility Settings screen, and also set system default options for the facility such as primary patient identifier type, default patient class, and IV type. Other settings that affect the operation of the application are not specific to the facility and are controlled through the system settings function.
- a Facility List screen is accessed via the Admin tab 1300 by selecting the Facility Settings sub-menu option 1324 from the available configuration options displayed. Upon selection of the Facility Settings menu choice 1324 , the Facility List screen is displayed (not shown) from which an administrator is enabled to modify information by selecting the Details icon next to a selected facility to be modified, or delete a particular facility.
- the Facility List screen is accessed to select a new option which displays a Facility screen 1360 such as shown in FIG. 13 ( e ) enabling user entry of new facility information such as: name in a Name field; facility abbreviation in the Abbreviation field; a state of the facility from the State dropdown list; a country of the facility from the Country dropdown list; a primary patient identifier type for the facility from the Primary Patient Identifier Type dropdown list; a default patient class from the Default Patient Class dropdown list (e.g., there are three options available—inpatient, inpatient transfer, and outpatient); an IV Type that is to be set as a default for the facility from the IV Type dropdown list; the new facility's work start time, end time, week start day, week end day, and interval information in the Hours of Operation section; and, a name and phone number of the system administrator.
- new facility information such as: name in a Name field; facility abbreviation in the Abbreviation field; a state of the facility from the
- the administrator is further able to define node settings for nodes or computers that the facility will use to perform exams.
- a Node Settings screen 1365 such as shown in FIG. 13 ( f )
- the administrator can: define node settings such as node name, physical address of the node, and communication port, set a primary video mask setting; set a secondary video mask setting; define a video automask setting; and, select a default mavigraph printer for the node.
- the administrator may select the Node Settings configuration sub-menu option 1325 .
- a Node Settings List screen is displayed (not shown) enabling a user to edit, add, or create new node setting records.
- the Node Settings List screen is accessed, the defined nodes are displayed.
- an administrator is enabled to modify information by selecting a Details icon next to a selected node to be modified, or, delete a particular node.
- the Node Settings List screen is accessed to select a new option which displays a Node Settings screen 1365 such as shown in FIG.
- a default mavigraph printer may be selected from the Default Mavigraph dropdown list (a list of mavigraph printer is generated when a mavigraph printer device is added to the facility in the Mavigraph Settings screen as described herein), and, a default label is assigned to the printer in the Default Printer field.
- the administrator may further select a primary video setting for the node from a Primary Setting dropdown list 1366 .
- the administrator may further select a secondary video setting from a Secondary Setting dropdown list 1367 and, select an Apply Automask checkbox 1368 if an automask setting is to be enabled.
- the administrator is further able to add, modify and delete a printer, e.g., a mavigraph printer, from a Mavigraph Printer List screen (not shown).
- a printer e.g., a mavigraph printer
- the administrator may select the Mavigraph Settings configuration sub-menu option 1326 initiating display of the Mavigraph Settings List screen enabling an administrator to add, modify and delete a mavigraph settings record.
- a list of mavigraph printers is displayed which may be further used to assign a default mavigraph printer to a node in the Node Settings screen.
- the Mavigraph Settings List screen is accessed to select a new option which displays a Mavigraph Settings screen (not shown) enabling user entry of new printer information such as: the name of the mavigraph printer in the Mavigraph Name field, the location of the mavigraph printer, and the facility to which the mavigraph printer belongs from a Facility dropdown list.
- An Active checkbox may be selected to make the printer available for the clinical staff.
- the administrator is further able to add, modify, and delete video configuration settings, and configure mask settings that define how information is displayed on the RGB monitor via a Video Settings List screen.
- the user may preview the video settings on the RGB monitor where the changes are automatically displayed.
- the administrator may select the Video Settings configuration sub-menu option 1328 .
- a Video Settings List screen is displayed (not shown) enabling an administrator to view the currently defined video settings, e.g., sorted alphabetically by name.
- the administrator may delete a video configuration (provided it is not associated with a node) and may further modify information by selecting a Details icon next to a selected video setting to be modified.
- the Video Settings List screen is accessed to select a new option which displays a Video Settings screen 1370 such as shown in FIG. 13 ( g ) enabling user entry of new video settings information such as: a name to the video configuration in the Name field; a video signal from the Video Signal dropdown list; and select an Active checkbox to make the configuration settings available to users.
- a user may assign top, left, bottom, and right mask settings for live video, thumbnail, and patient info in the Mask Settings section 1372 .
- the administrator is further able to edit, add, or create mask settings for a specific video processor and chip-type combination via an Auto Mask Settings screen.
- the defined auto mask settings, processor-type, chip-type, and defined video settings are displayed and sorted by processor-type. It is understood that the combination of processor-type and chip-type must be unique.
- the administrator may select the Auto Mask settings configuration sub-menu option 1329 .
- an Auto Mask settings screen (not shown) is displayed enabling a user to view the currently defined auto mask settings.
- an administrator may delete an auto mask configuration and may further modify information by selecting a Details icon next to a selected auto mask setting to be modified.
- the Auto Mask settings screen is accessed to select a new option which displays an Auto Mask Settings screen 1375 such as shown in FIG. 13 ( h ) enabling a user define a new Auto Mask Setting by selecting a Processor Type, Chip Type, and Video Settings from respective Processor Type, Chip Type, and Video Settings dropdown lists. It is understood that once defined, masks are automatically selected by the system based on the scope or processor being used.
- a further function provided by the system is the ability to customize certain aspects of how the application functions. These functions include: the editing of Exam Type information; the editing of information that defines a Report Section; the maintenance of Report Sections included within the Phases of Care for the application; the management of Report Templates and of Document Types; the editing or creating of templates for all documents; and, the maintenance of the system Knowledge Base.
- the administrator may access the Customization menu choice 1330 that causes for display the available customization sub-menu options.
- the Exam Type sub-menu option 1331 an Exam Type List screen (not shown) is displayed enabling a user to view the currently defined exam types.
- a user may add, delete, and modify exam types, including, but not limited to: Bronchoscopy, Colonoscopy, Esophagogastroduodenoscopy, Esophagogastroduodenosopy/Colonoscopy, Esophagogastroduodenosopy/Sigmoidoscopy, Cholangiopancreatography, Endoscopy Retrograde, EGD/Sigmoidoscopy, Esophagoscopy, Sigmoidoscopy, Ileoscopy, Liver Biopsy, Lower Endoscopy Ultra Sound, Paracentesis, Enteroscopy, and, Upper Endoscopy Ultra Sound, etc. Following each listed exam is an abbreviation, associated department, and a Details icon.
- a current record may be deleted unless it is an application default or if it is referenced elsewhere.
- the Exam Type List screen is accessed to select a new option which displays an Exam Type screen 1380 such as shown in FIG. 13 ( i ) enabling an administrator entry of a new Exam type including information such as: a name of the exam type in the Name field name; select a department from the Department dropdown list; assign an abbreviation to the exam type in the Abbreviation field; click New next to Report Sections to add a new report section; select a report section from the Section dropdown list; click New next to the Default Medications to add a new medication including the entry of the drug name, strength, unit, and the route of the medication.
- an administrator is further able to add a Report Section to or remove a report Section from an Exam Type, and, include an optional default medication to the exam type record.
- a further function provided by the system is the ability to edit information that defines a Report Section and maintain the Report Sections included within the Phases of Care for the application.
- the administrator may access the Report Sections menu option 1332 , a Report Sections List screen (not shown) is displayed enabling a user to add, delete, and modify report sections types.
- report sections are used to generate Procedure Notes for a specific exam type.
- the administrator When the administrator creates a Procedure Note template, he/she may choose to include a few or all the report sections in it, and further assign these report sections to a phase of care and then use them in the Lexicon screen as tabs to record data.
- the user may create, modify, and delete report sections from the Report Section List screen.
- the Report Sections List screen is accessed to select a new option which displays a Report Sections screen 1382 such as shown in FIG. 13 ( j ) enabling an administrator entry of a new Report Sections type including information such as: the name of the report section in the Name field; a display order for the report section; and, click the Active checkbox to make the report section available to users.
- a further function provided by the system is the ability to edit manage the four phases of care namely, Registration, Pre-Procedure, Procedure, and Post-Procedure. These phases are illustrated as the Registration, Pre-Procedure, Procedure, and Post Procedure tabs in the application.
- the Lexicon screen of the Registration tab includes the Introduction, Indications, and Code report sections.
- the administrator may configure the Lexicon screen of the Registration phase of care by adding or removing a report section.
- the administrator may access the Phase of Care customization sub-menu option 1333 that causes the display of a Phase of Care List screen (not shown) enabling an administrator to view the currently defined phases of care.
- a Phase of Care List screen (not shown)
- an administrator may assign a report section record by clicking a Details icon next to one of the phase of care records.
- the Phase of Care screen 1383 such as shown in FIG. 13 ( k ) is displayed in response, enabling a user to select a report section from the Default Report Section dropdown list, click the Report Sections from the Available column 1376 , assign or add the necessary report section, and click the Right Arrow icon to add the report section to the Assigned column 1377 .
- the administrator may un-assign a report section record via the Phase of Care screen 1383 by clicking the Report Sections from the Assigned column 1377 to remove it from a Phase of Care and click the Left Arrow icon to remove the report section 1376 from the Phase of Care.
- Document types are the categorization of different documents required by clinical staff at different phases of care. These documents are generated by using document templates in the application.
- a list of document types predefined in the system include but are not limited to: an Appointment Letter, a Recall Letter, a Pre-Discharge Instruction, a Pathology Request, a Procedure Note, a Nurse Report, a Discharge Instruction, a Referral Letter, a Billing Report and Pathology Labels.
- the administrator may select the Document Types customization sub-menu option 1334 that causes the display of a Document Type List screen (not shown), enabling a user to view the currently defined document types.
- a Document Type List screen a user may: create/modify a document type; Assign the document to a Phase of Care; and assign the document type to an exam type. Further, a clinical staff member and/or a contact may be added as the document recipient.
- the Document Type List screen is accessed to select a new option which displays a Document Type screen 1384 such as shown in FIG.
- a further function provided by the system is the ability to manage Report Templates.
- a Report Template function is provided via a Report Template Screen.
- the administrator may select the Report Template customization sub-menu option 1335 that causes the display of a Select Procedure Note Template screen (not shown) enabling a user to search for a procedure note template by selecting an exam type, facility, or physician which generates for display a list of Procedure note templates, based on the entered search criteria. If no criteria were entered, all records would be displayed.
- a New Procedure Note Template is generated via the Select Procedure Note Template screen by selecting a New option which causes for display a Procedure Note Template window 1386 such as shown in FIG.
- a blank Procedure Note Template frame 1385 is additionally generated for display as shown in FIG. 13 ( m ). From this interface, the administrator may select a report section from the Report Section tab 1391 as shown in FIG. 13 ( m ), and click Insert button to insert the section in the template in the right-hand pane 1392 ; and, further modify the text with the text tools found in the right pane.
- the template record may then be saved in the database. It is understood that a new version of an existing template may additionally be created. Further, from the originally displayed Select Procedure Note Template screen (not shown), the user may modify or delete a procedure note template.
- the document template functionality provided in the system may be used to generate document templates for documents other than Procedure Notes. These documents include pathology labels, recall letter, and letters of referrers.
- a Document Template Search screen (not shown), the administrator may search for a document and create, modify, or delete a document.
- the administrator may select the Document Template customization sub-menu option 1336 that causes the display of a Document Template search screen enabling an administrator to enter search criteria such as such as document type, facility, and/or physician which generates for display a list of document type templates based on the entered search criteria.
- a New document template is generated via the Select Document Template screen by selecting a New option which causes for display a Document Template window 1387 , such as shown in FIG. 13 ( n ).
- the administrator may enter the following information including, but not limited to: the Name in a text field; and perform functions such as: select an exam type from the Exam Type dropdown lists; select either the Facility Owner or Physician Owner radio button to choose an owner of the document template; and, select a Facility or Physician from the appropriate dropdown list.
- a blank template may be additionally created.
- the administrator may further select a report section from the Report Section tab 1393 of the Document Template screen such as the example Document Template screen 1389 as shown in FIG. 13 ( o ), click Insert button to insert the section in the template in the right pane; and, further modify the text with the text tools found in the right pane 1394 . These steps may be repeated to create multiple sections in the document template.
- the template record may then be saved in the database, or create a new version of an existing template. It is understood that, from the Document Template Search screen (not shown) the user may modify or delete a document template.
- a further function provided by the system is the ability to control user access to or within the application or portions of the application.
- These security functions include: User Maintenance—the ability to allow the creation and modification of application user accounts; and, Role Maintenance—the ability to allow the creation and modification of user roles.
- the administrator may access the Security menu choice 1402 and select User security sub-menu option 1404 that initiates the display of a User List screen 1420 , such as shown in FIG. 14 ( a ) enabling an administrator to query the database for an existing user record such by entering search criteria, e.g., letters and wildcards. If no criteria is entered, the pre-populated User List screen is displayed with records displayed alphabetically by user ID.
- a new user record is generated via the User List screen 1404 , by selecting a New option which causes for display a User Maintenance screen 1430 such as shown in FIG. 14 ( b ). From this screen, the administrator may enter a user ID in the User ID field, enter a password in the Password field; and select a user type from the User Type dropdown list. A user type can be either clinical staff or contact. The Search icon may be selected to insert a user's full name.
- the Contact List window is displayed and likewise, if a clinical staff is selected from the User Type dropdown list, the Clinical Staff List window is displayed where a user may be searched and selected. Alternatively, the name of the user may be entered in the User Name field. Further information for the new user record includes: the selection of a facility for the user from a Facility dropdown list; selection of the Active checkbox to activate the user; and, the selection of a Role to be assigned to the user. To select a Role to be assigned, a department is selected from the Department dropdown list and a role is selected from the Role dropdown list. It is understood that, from the User List screen 1420 ( FIG.
- the user may modify or deactivate a user record.
- changes may be made to required fields except, for example, read-only fields, screen by searching for a user and selecting a details icon 1422 .
- a role may be assigned to a user, and further, an assigned user role may be deleted by selecting a delete icon 1432 ( FIG. 14 ( b )).
- a further function provided by the system is the ability to manage roles.
- Each user created in the system must have an assigned role. Based on the role, a user would be able to use specific functions of the system application.
- Predefined roles may include, but are not limited to: Administrator, All, BronchNurse, BronchPhysician, GINurse, GIPhysician, and, Scheduler.
- the Role Maintenance function allows the administrator to create, copy, modify, and delete roles for the application. Any role may be deleted that is not associated to a user and is not an application-defined role. Each user is assigned one role; which is associated with specific screens or functionality. The selected role gives the user access to these specific screens. The role data can be changed and saved while the role member is logged into the system. Every role has access to the system Home tab 600 ( FIG. 6 ).
- the role maintenance function may be used to add a new tab record by selecting a tab name from the dropdown lists and Default Tab Page fields. These fields are mandatory and cannot be left blank if this function is selected.
- the administrator may select the Role security sub-menu option 1406 that causes the display of a Role List screen 1440 , such as shown in FIG. 14 ( c ) enabling an administrator to view the current roles, modify or delete existing roles, and add a new role.
- a new user Role is generated via the Role List screen 1440 , by selecting a New option which causes for display a Role Maintenance screen 1450 such as shown in FIG. 14 ( d ). From this screen, the administrator may enter a name in the Role Name field and select a default tab page for the role from the Default Tab Page dropdown list. Any tab that is not to be assigned to the role may be deleted by clicking the Delete icon on the appropriate line. The administrator may further select menu options from the Available textbox to assign to the role, and add the selected menu options in the Assigned textbox.
- the list of roles is displayed as shown in FIG. 14 ( c ).
- An existing record may be modified as required.
- the Role List screen is accessed and a Details icon selected next to the record to be modified.
- the Role Maintenance screen is displayed enabling an administrator to locate the field requiring change and enter a change or select the correct entry from the dropdown list, add a new tab record, or select menu changes as necessary.
- a user may further copy a record, all the tabs and menu options from a previous role to a new role which requires the assignment of a name to the role.
- An existing role record may be deleted from the database via the Role List screen, as long as it is not associated to a user and is not an application-defined role.
- a further function provided by the system is the ability to maintain the system application.
- Utilities used to maintain the application a system log function to view and manage the log of application errors and messages generated by the application; an Activity Log function to manage the log of application activity, a Mavigraph Queue function to manage the print queue for a Mavigraph printer, and, a Discarded Notes function to view a list of discarded Procedure Notes, and an Unlock Function to unlock the locked functions of the application.
- the administrator may access the Utilities menu choice 1502 providing the described system application functions as shown in FIG. 14 ( e ).
- selecting the System Log utilities sub-menu option 1504 enables a user to search for a system log record using date, facility name, user id, and node name options and then view or delete the selected log.
- selecting the Mavigraph Printing Utilities sub-menu option 1506 enables generation of a Mavigraph Printing screen provided to allow the user to manage the mavigraph printers available in the facility, and particularly view all the mavigraph print queues and, delete a mavigraph print queue job(s).
- selecting the Activity Log Utilities sub-menu option 1508 enables generation of an Activity Log screen provided to list the records made when a user reads or writes information in the application. These entries are stored with a date/time stamp, user ID, menu name, page, and access (read or write) and may be viewed or deleted. These entries also contain patient ID if there is a patient in the context.
- Discarded Notes Utilities sub-menu option 1510 enables generation of a Discarded Procedure Note screen provided to enable viewing of discarded procedure notes, however, prevents the deletion or editing of Procedure Note(s) listed in the screen.
- the system provides unlock functions to unlock the locked functions.
- Unlock Functions selecting the Unlock Functions Utilities sub-menu option 1512 enables generation of an Unlock Functions screen providing a list of unlock functions from which a user may select a function to unlock.
- a further function provided by the system is the ability to maintain the system equipment.
- inventory functions are used to track items used during procedures. These functions include: the maintenance of Scope Model, i.e., different types of scopes; the maintenance of actual scope items; the maintenance of different types of equipment items (i.e. equipment and accessories).
- the Scope Model Maintenance function allows the administrator to view and manage different types of scopes used by the application.
- the Scope Model Maintenance screen displays a list of available scope models which are defined by category and used for the following exam types: Bronchoscopy; EGD; Esophagoscopy; Ileoscopy; ERCP; Enteroscopy; Sigmioidoscopy; Colonoscopy; and, EUS (upper and lower).
- the administrator may access the Equipment menu choice 1602 providing a display of available equipment options as shown in FIG. 14 ( f ).
- the Scope Model equipment sub-menu menu option 1604 is selected to display a Scope Model List screen 1620 as shown in FIG. 14 ( f ), from which a user may select a Scope Model Record, and view, modify, edit or delete it.
- a Scope Model data entry screen is displayed in response to selecting a New button, that enables entry of relevant scope data (e.g., a name, category and channel size, and use for a particular Exam type) in a series of fields and stored as a record in the database.
- relevant scope data e.g., a name, category and channel size, and use for a particular Exam type
- a Scope Item Maintenance screen may be further displayed enabling an administrator to create, edit, and delete each of the individual scope item entries.
- the application displays a list of all scopes available to the user based on the input criteria. This function allows the administrator to search for a scope item by entering the scope model, name, serial number, and facility.
- a Scope Item List the administrator selects the Scope equipment sub-menu option 1606 , a Scope List screen 1625 is accessed, as shown in FIG. 14 ( g ), from which the administrator is given the option to select the scope model in use (based on input criteria) from a list of all active scope models. Models are listed alphabetically by name and records in the list may be modified or deleted.
- the administrator may further create a new scope record by selecting the New button.
- This causes display of a Scope Item screen 1630 as shown in FIG. 14 ( h ), that includes blank fields for entry of scope equipment data including: the Scope Model, serial number of the Scope Model, the name of the scope in the Name field, the facility, and optionally, the purchase date.
- This equipment maintenance function also includes a repair history record that provides details including, but not limited to: the scope's repair date, by whom, a repair description, and the cost of the repair.
- the administrator has the option to add, modify, or delete the repair history record.
- a new repair history record a user first searches for a scope item or create a new scope item record and navigates to display a Repair History section as shown in FIG. 14 ( h ). By selecting a New button, entry fields are provided to enter the date of repair in the Date field, enter the name of the company or person who repaired the scope item in the Repaired By field, enter a brief description about the repair in the Description field, and enter the cost of repair in the Cost field.
- An existing scope item record may be further modified or deleted from the database if it is not associated with other database records via the Scope List screen.
- the system provides an accessory category function that allows the user to view and manage different types of accessories that are used by the application.
- the default accessory categories that are provided with the application include, but are not limited to: Aspiration, Electrosurgical Knife, Injection Needles, Biopsy Needles, Endoscopic Mucosal Resection (EMR), Ligating Device, Biliary Stents, ERCP Cannulae, Lithotriptors, Biopsy Forceps, Esophogeal Stents, Liver Biopsy Device, Clip Fixing Device, EUS Probes, Metal Stents, Coagulation Electrodes, Grasping Forceps, Microbiology Brushes, Cytology Brushes, Guide Wire, Miscellaneous, DilatingCatheter, Hemostasis Probes, Naso/Biliary Drains, Dilation Balloons, Hot Biopsy Forceps, PEG/PEJ, Polypectomy Snares, Retrieval Balloons, Retrieval Basket, Sphincterotomes
- the administrator may select the Accessory Category equipment sub-menu option 1608 to display a Accessory Category List screen (not shown) from which a user may select and modify a current Accessory Category record, create a new one, or delete the current record.
- the application After deletion of a current Accessory Category record, the application returns to the list function.
- the system further provides an optional function for the entry of model information.
- the user further has the option to add a new model or delete a model, as long as there are no accessory records associated with that model.
- Further functionality includes the ability to view and manage the accessories used by the system via an Accessory List screen (not shown) which is accessed by selecting the Accessories equipment sub-menu option 1610 as shown in FIG. 14 ( f ).
- the user may create, modify, or delete an accessory entry and, further, has the option to delete the current Accessory record as long as it has not been associated with an examination; after deletion the application displays the search function.
- the Accessory List screen is accessed, the defined accessory entries are displayed and may be sorted by model and serial number, for example, in ascending order. It is understood that the combination of model and serial number must be unique.
- the administrator selects a New button from the Accessory List screen that initiates display of an Accessory Maintenance data entry screen 1650 , such as shown in FIG. 14 ( i ) via which the administrator may enter all pertinent information relating to the new accessory item to be entered including: a category of the accessory item from a Category dropdown list, a facility for the item from a Facility dropdown list, an item name in an Item Name field, and, other optional information.
- An Active checkbox may be selected to make the item available to the clinical staff.
- the system further provides an equipment category function that allows the user to view and manage different types of equipment used by the application.
- the list of equipment categories (name and settings type) predefined in the system include, but are not limited to: Cryotherapy generators, Curvilineareus unit, Electrocautery device, Electrosurgical generators, Fluorescence imaging unit, Fluoroscope, Heat probe generators, and Laser devices.
- the administrator may select the Equipment Category equipment sub-menu menu option 1612 to display an Equipment Category List screen (not shown) from which a user may edit, add, or create new equipment category records.
- An optional function enables a user to enter model information. If this optional function is used, the fields shown as required are mandatory (e.g., model name) and are not left blank.
- a checkbox may be further provided to indicate if the model is reusable. The user may further have the option to add a new model or delete a model, as long as there are no clinical staff or equipment records associated with that model.
- the administrator selects a New button from the Equipment Category List screen that initiates display of an Equipment Category data entry screen 1660 , such as shown in FIG. 14 ( j ) via which the administrator may enter all pertinent information relating to the new equipment item to be entered including: a name of the equipment, an Exam Type to associate the equipment category with one or more exam types, and, other optional information.
- An Active checkbox may be selected to make the equipment item available to the clinical staff.
- Further functionality includes the ability to view and manage the equipment used by the application via an Equipment List screen (not shown).
- the administrator may select the Equipment sub-menu menu option 1614 which causes display of the Equipment List screen (not shown) from which the user may create, modify, or delete an equipment entry.
- the user further has the option to delete the current record as long as it has not been associated with an examination.
- the Equipment List screen is accessed, the defined equipment entries are displayed and may be sorted by model and serial number in ascending order. It is understood that the combination of model and serial number must be unique.
- a user may access the Equipment List screen, and in response to selecting a new button option, the system generates an Equipment Maintenance screen (not shown) from which the user may select a category from a Category dropdown list, select a facility from a Facility dropdown-list, and, enter a serial number of the equipment in the Serial Number field, and enter other optional information.
- CI contextual information
- “Department” information is set when a user logs in to the application and is not changed until the user logs out of the application.
- “User” information is additionally set when a user logs in to the application, however, can be changed by logging out of the application.
- “Facility” information is set when a user logs in to the application based on the user's default facility. The current facility is updated to reflect the facility at which the visit is taking place once the user selects a visit (or an examination within a visit).
- Patient information is set when a user selects either a patient using a Patient File function, a visit from Scheduled Exams, or the Patient Summary, or an examination from Scheduled Exams, Patient Summary, Pending Items, or New/Modify Visit.
- a Patient File function a visit from Scheduled Exams
- the Patient Summary or an examination from Scheduled Exams, Patient Summary, Pending Items, or New/Modify Visit.
- there is no patient in the CI when the user first logs in to the application. If there is currently a patient in the CI and a new patient is selected, the visit and examination information will be cleared from the CI.
- System functions using the patient that is currently in the CI include but are not limited to: Patient Summary, Patient Demographics, Patient Insurance Coverage, Medical Alerts, Gastroenterology and Bronchoscopy, GI History, Pulmonary History, Medication History, Social History, Family History, Gastroenterology and Bronchoscopy, Unplanned Events Summary, Related Tests and Labs Summary, and Other Patient Information. If one of the previous functions requiring a patient in the CI is accessed and there is no patient in the CI, the application indicates that no patient has been selected. The user shall then be redirected to the Patient Search function to select a patient.
- “Visit” information is set when a user selects a visit for a patient (Scheduled Exams, and Patient Summary) or saves a visit from New/Modify Visit. When the visit is selected, the patient and the visit itself will be placed into the CI. If there is currently a visit selected, the examination information is cleared from the CI.
- System functions using the visit that is currently in the CI include, but are not limited to: Schedule Visit, Scheduler's Medical Alert Questions, Patient Preparation Instructions, Gastroenterology, Patient Preparation Instructions, Bronchoscopy, Appointment Letter, Schedule Summary, Patient Assessment, Patient Process, Physical Exam, Gastroenterology and Bronchoscopy, Related Labs, Gastroenterology and Bronchoscopy, Related Tests, Prep Status, Gastroenterology and Bronchoscopy, Vitals and Medications, Consent Checklist, Physician Checks, Pre-Procedure Summary, Recovery, Patient Survey. If one of the above functions requiring a visit in the CI is accessed and there is no visit in the CI, the application automatically indicates that no visit has been selected and the user is redirected to the Scheduled Exams function to select a visit.
- the EndoworksTM system is adaptable to interface to hospital systems, as well as other external systems via dedicated gateway interfaces such as: Health Level 7 (HL7), Digital Imaging and Communication in Medicine (DICOM), and generic Extensible Markup Language (XML) Gateway interfaces.
- HL7 Health Level 7
- DICOM Digital Imaging and Communication in Medicine
- XML generic Extensible Markup Language
- system of the invention results in improved administrative efficiency by supporting the flow of procedure information between the hospital, performing physician, referring physician, and patient through extensive integration capabilities including: HL7 which is the standard that currently addresses the interfaces among various systems that send or receive patient admissions, registration, discharge or transfer (ADT) data, queries, resources, patient schedules, orders, results, clinical observations, billing information, medical records, referral, and patient care; DICOM which provides a detailed specification describing the means of formatting and exchanging image, reporting, and patient information; and, XML which may be employed when data is distributed between the EndoWorksTM system and other hospital systems using industry standard XML formatting.
- ADT admissions, registration, discharge or transfer
- DICOM which provides a detailed specification describing the means of formatting and exchanging image, reporting, and patient information
- XML which may be employed when data is distributed between the EndoWorksTM system and other hospital systems using industry standard XML formatting.
- EndoWorksTM system provides support for clinical-studies and research whereby a ‘study’ may be customized to capture specific patient- and exam-related data over a period of time.
- the application supports user-definable clinical research studies and provide a means of compiling and publishing resultant data. Interfacility and intrafacility studies are additionally possible.
- the application permits customization of patient selection criteria, data collection forms, study duration, and number of patients to include in the study.
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Also Published As
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CA2526078A1 (en) | 2004-12-02 |
JP2007505419A (ja) | 2007-03-08 |
JP2007516498A (ja) | 2007-06-21 |
JP2007516011A (ja) | 2007-06-21 |
EP1627357A4 (en) | 2010-01-06 |
JP2007503282A (ja) | 2007-02-22 |
EP1627356A4 (en) | 2006-12-20 |
WO2004104742A3 (en) | 2006-08-10 |
EP1627356A2 (en) | 2006-02-22 |
EP1629350A4 (en) | 2007-08-01 |
EP1625751A2 (en) | 2006-02-15 |
EP1629350A2 (en) | 2006-03-01 |
CA2526073A1 (en) | 2004-12-02 |
WO2004103151A3 (en) | 2005-10-20 |
WO2004104754A3 (en) | 2005-03-03 |
WO2004104921A3 (en) | 2005-03-31 |
WO2004104921A2 (en) | 2004-12-02 |
CA2526149A1 (en) | 2004-12-02 |
US20050114283A1 (en) | 2005-05-26 |
CA2526135A1 (en) | 2004-12-02 |
WO2004104742A2 (en) | 2004-12-02 |
US7492388B2 (en) | 2009-02-17 |
EP1627357A2 (en) | 2006-02-22 |
WO2004104754A2 (en) | 2004-12-02 |
WO2004103151A2 (en) | 2004-12-02 |
EP1625751A4 (en) | 2009-11-04 |
US20050075535A1 (en) | 2005-04-07 |
US20050073578A1 (en) | 2005-04-07 |
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