WO2001078592A2

WO2001078592A2 - Blood pressure measurement system

Info

Publication number: WO2001078592A2
Application number: PCT/US2001/012082
Authority: WO
Inventors: Charles Bluth; James Bluth
Original assignee: Computerized Screening, Inc.
Priority date: 2000-04-14
Filing date: 2001-04-11
Publication date: 2001-10-25
Also published as: WO2001078592B1; AU2001251597A1; CA2405838A1; EP1272103A2; WO2001078592A3

Abstract

A blood pressure measurement device and associated operating method utilize a measurement algorithm based on a plurality of measurements, supplying a unique ability to increase diagnostic and analytical success in detection. In an illustrative implementation, three measurement techniques are used in combination to improve overall measurement accuracy. A first of the three techniques is an ascultatory technique. A sound measurement acquired from a microphone located in the measurement cuff detects start and end Korotkoff sounds using a combination of filters. A second technique is an oscillometric technique that is commonly found in many low-cost blood pressure measurement devices. A pressure cuff is used to measure pressure oscillations, which are detected and monitored using mean pressure, and systolic and diastolic pressure ratios to identify systolic and diastolic blood pressure. A third technique, called a pattern recognition to identify systolic and diastolic pressures. A signal from the pressure sensor is used in addition to the three techniques to quantify the regions of sound under analysis.

Description

BLOOD PRESSURE MEASUREMENT SYSTEM

BACKGROUND OF THE INVENTION The field of medicine has long employed health care screening to diagnose and tract patients' health. An annual physical examination is a well-known part of patient medical care.

A number of portable monitoring devices are used in medical monitoring. One well known device is the so-called Holter monitor which is an EKG monitor which typically uses a magnetic tape recorder to record EKG signals from a patient over extended periods of time. Another is a monitor for obtaining blood pressure readings over extended periods of time.

Hospitals, health clinics, and pharmacies, in addition to an active role is supplying medical supplies and pharmaceuticals, have actively promoted various health care screenings and wellness programs. Programs are sometimes offered with the help of other health care providers or coordinated on a national basis with groups such as the American Lung Association, the American Diabetes Association and the American Podiatric Medical Association.

Health care screening devices in hospitals, physician's offices, businesses, and the like, in combination with the growing number of home diagnostic kits that are available have increased the efficiencies in health care delivery. Chain drug store operators have increasingly encouraged individual testing by making available in-store diagnostic testing devices. For example, a pharmacist who fills a high-blood pressure medicine for a customer may encourage the customer to regularly check blood pressure. The customer may use a blood pressure measurement and screening device in the drug store.

The offer of in-store testing commonly is highly popular among customers and greatly boosts the number of people visiting the store. In-store testing is valuable for positioning stores as health and wellness centers as well as retailers of health care products. In-store testing increases sales since a consumer who learns of a health problem through screening in the store has some likelihood of purchasing a home test kit to monitor the problem. For example, a customer who discovers a problem of high blood pressure through an in-store test is a likely candidate to purchase a home test kit.

In-store health care screening expands the pharmacist's role in patient care through education. Test device manufacturers have advanced the design and functionality of products to simplify usage and improve accuracy. The challenge for further improvements in health care screening is to educate consumers about the need for medical tests, and demonstrate that many tests are effectively performed by publicly available devices or at home.

A present concern is that health screening is performed on an insufficient segment of the population to efficiently prevent or treat ailments. Other concerns are that health screening is too costly, limited in scope, and time-consuming both for individual patients and health care providers. Despite these deficiencies, a strong awareness exists of a need and desire for improved health screening procedures and equipment. Health care providers, insurance companies, and employers that ultimately pay for health care have encouraged development and usage of improved, accurate yet economic health screening facilities both for treatment and prevention of health care problems.

Generally individual doctors and small groups of doctors have insufficient capital to maintain a complete health screening facility. Even if more health care providers were suitably equipped, typically only a small part of the population exploits health screening facilities due to time and cost considerations and apathy.

What are needed are health screening devices, facilities, and methods that can be placed in locations that are convenient to health care customers. Suitable locations include retail outlets such as pharmacies or drug stores where customers already make health care purposes, but also include medical offices or hospitals, convalescence and elderly care homes, work places such as offices or factory sites, college dormitories, and the like. What are further needed are health screening devices, facilities, and methods that are convenient, efficient, low in cost, and professionally accurate in screening health care data.

SUMMARY

A blood pressure measurement device and associated operating method utilize a measurement algorithm based on a plurality of measurements, supplying a unique ability to increase diagnostic and analytical success in detection. In an illustrative implementation, three measurement techniques are used in combination to improve overall measurement accuracy. A first of the three techniques is an ascultatory technique. A sound measurement acquired from a microphone located in the measurement cuff detects start and end Korotkoff sounds using a combination of filters. The auscultatory technique is a conventional method that is recommended by the American Heart Association and is similar to manual techniques used by a nurse or technician. The auscultatory technique and associated filtering techniques are well known by those having ordinary skill in the art. A second technique is an oscillometric technique that is commonly found in many low-cost blood pressure measurement devices. A pressure cuff is used to measure pressure oscillations, which are detected and monitored using mean pressure, and systolic and diastolic pressure ratios to identify systolic and diastolic blood pressure. A third technique, called a pattern recognition technique, measures a sound envelope and incorporates pattern recognition to identify systolic and diastolic pressures. A signal from the pressure sensor is used in addition to the three techniques to quantify the regions of sound under analysis.

The combination of measurement techniques produce multiple measurements that are combined using a voting technique to identify and discard improper results. Remaining measurements are averaged to within a predefined tolerance to improve the final results. Use of additional measurement techniques improve the measurement accuracy.

The ascultatory technique employs Korotkoff sounds to determine systolic and diastolic pressure points to determine measurement cycle timing. The oscillometric technique senses and monitors oscillations in a pressure waveform to locate systolic and diastolic pressures. A pattern analysis technique senses a pressure envelope and monitors the pressure envelope to locate characteristic changes in a sound envelope to determine systolic and diastolic pressures.

In some embodiments, the blood pressure measurement device includes a controller for controlling a pressure cuff to inflate the cuff in preparation for a blood pressure measurement and to slowly deflate, or bleed, the cuff to determine systolic and diastolic pressures and to generate a pressure waveform.

In accordance with one aspect of the present invention, a test apparatus includes an ascultatory analyzer, an oscillometric analyzer, and a pattern recognition analyzer. The ascultatory analyzer is capable of sensing and analyzing an audio signal using Korotkoff sounds to determine a systolic pressure and a diastolic pressure. The oscillometric analyzer is capable of sensing and analyzing oscillations of a pressure signal to determine the systolic pressure and the diastolic pressure. The pattern recognition analyzer is capable of sensing a pressure envelope and monitoring the envelope pattern to locate characteristic changes and thereby identify systolic and diastolic pressures. A comparing block compares the parameters measured using the distinct measurement techniques, determines mutually consistent limits for the distinct measurement techniques, and rejects measurement samples outside the determined limits. Results produced by the distinct measurement techniques are combined to quantify an optimal systolic pressure result and an optimal diastolic pressure result. In accordance with another aspect of the blood pressure measurement device and operating method, a blood pressure measurement system includes a kiosk, a blood pressure interface coupled to the kiosk and capable of detecting a pressure signal, a microphone coupled to the blood pressure interface and capable of detecting an audio signal, and a blood pressure analyzer coupled to the kiosk, the blood pressure interface, and the microphone. The blood pressure analyzer includes a plurality of separate analyzers that detect blood pressure using a plurality of separate analysis techniques, the plurality of analysis techniques being based on analysis of audio signals, pressure oscillations, and pattern recognition of a pressure envelope.

In accordance with another aspect of the blood pressure measurement device, a method of measuring blood pressure of a test subject includes acquisition of at least three distinct measurement techniques that measure a plurality of physiological parameters. A first technique is an auscultatory technique including sensing an audio signal and analyzing the audio signal using an ascultatory analysis of Korotkoff sounds to determine a systolic pressure and a diastolic pressure. A second technique is an oscillometric technique including sensing pressure oscillations and analyzing the pressure oscillations using an oscillometric analysis to determine mean pressure, systolic and diastolic blood pressure, and to identify systolic and diastolic pressures. A third technique is a pattern analysis technique including sensing a pressure envelope and monitoring the envelope pattern to locate characteristic changes and thereby identify systolic and diastolic pressures. The method further includes comparing the parameters measured using the distinct measurement techniques, determining mutually consistent limits for the distinct measurement techniques, and rejecting measurement samples outside the determined limits. Results produced by the distinct measurement techniques are combined to quantify an optimal systolic pressure result and an optimal diastolic pressure result.

BRIEF DESCRIPTION OF THE DRAWINGS

The features of the described embodiments believed to be novel are specifically set forth in the appended claims. However, embodiments of the invention relating to both structure and method of operation, may best be understood by referring to the following description and accompanying drawings.

FIGURE 1 is a schematic block diagram illustrating a suitable network for interconnecting one or more health information kiosks and a health information server.

FIGURE 2 is a pictorial diagram illustrating a suitable health information kiosk for usage in interfacing to a health care information system. FIGURE 3 is a pictorial diagram illustrating another view of the suitable health information kiosk with improved visualization of a blood pressure cuff.

FIGURE 4 is a schematic block diagram showing functional elements of a blood pressure measurement operation that can be performed by the health care information system.

FIGURE 5 is a schematic flow chart that depicts a suitable control routine for controlling the blood pressure measurement.

FIGURE 6 is a schematic block diagram that illustrates a test interface that is suitable for performing multiple analysis operations.

FIGURE 7 is a schematic block diagram showing a pulse discriminator for extracting a user pulse signal directly from an output terminal of a pressure transducer attached to a pressure cuff.

FIGURE 8 is a schematic block diagram illustrating a measurement cycle controller that generates signals governing a measurement cycle based on sensed sound signals.

FIGURE 9 is a schematic block diagram that shows a sample counter that generates a sample count for marking event times.

FIGURE 10 is a schematic block diagram that shows an example of a suitable ascultatory interface for measuring blood pressure using an ascultatory technique.

FIGURE 11 is a schematic block diagram that shows an example of a suitable oscillometric interface for measuring blood pressure using an oscillometric technique.

FIGURE 12 is a schematic block diagram that shows an example of a suitable pattern recognition interface for measuring blood pressure using a pattern recognition technique.

FIGURE 13 is a pictorial computer screen display illustrating a main menu screen that is initially displayed when health services and information system software is activated.

FIGUREs 14A and 14B depict pictorial computer screen displays including a blood pressure testing start screen and a blood pressure testing end screen.

FIGUREs 15A, 15B, and 15C are graphic displays showing pressure waveforms depicting examples of data that are analyzed to perform blood pressure measurements. FIGURES 16A and 16B are pictorial computer screen displays associated with a health risk appraisal function, including a questionnaire form for setting user parameters and a health care appraisal result screen.

FIGURES 17A and 17B are pictorial computer screen displays associated with a medication encyclopedia display function.

FIGURES 18A and 18B are pictorial computer screen displays that illustrate a health information display function.

FIGURES 19A, 19B, 19C, and 19D are pictorial computer screen displays that illustrate a local community information display function.

FIGURES 20A and 20B are pictorial computer screen displays that illustrate a

"Shopping Mall" business access display function.

FIGUREs 21A and 2 IB are pictorial computer screen displays showing a blood pressure history access screen to allow protected access to a user's blood pressure history information.

FIGUREs 22A, 22B, and 22C depict several examples of schematic graphs that show collective user health data.

FIGURE 23 is an example of a table showing a compilation of acquired samples of health care data that can be generated by the health services and infoπnation system.

FIGURE 24 is an example of a test printout that can be produced by the health services and information system.

FIGURE 25 is a schematic screen display showing an entry screen for user identifying information for use in saving and accessing secured patient information.

FIGURE 26 is a schematic screen display that illustrates a registration form for a web site.

FIGURE 27 is a schematic screen display illustrating a weight measurement result screen.

FIGUREs 28A, 28B, 28C, and 28D are four three-dimensional pictorial diagrams showing various frontal views of a health care information kiosk with a retractable seat. DESCRIPTION OF THE EMBODIMENTS

Refeπing to FIGURE 1, a schematic block diagram illustrates a suitable network 102 for interconnecting one or more health information kiosks 110 and a health information server 104. Typically, an individual health information kiosk 110 includes a processor 106 or controller with a storage 108 or memory that maintains a local archive of user information that stores a relatively small number of relatively recent test results, measurements, and possibly other information. The processor 106 executes a logic (not shown), typically a computer program, that is stored as software, firmware, control logic or other executable forms as are known by one of ordinary skill in the art. In an illustrative health care information system 100, the health information kiosk 110 employs additional computing power by adding a digital signal processor (DSP) 112 that operates in conjunction with the processor 106 to perform computation-intensive operations such as various health test operations.

The local archive includes tracking of health reading including blood pressure, heart rate and weight. Individual users also have an individual personal health site on the health information server 104. The health information server 104 is generally used to store a long- term archive of user results, measurements, and information received from the individual health information kiosks 110. In one example, the local health information kiosk 110 stores information from many users and all information that is generated on the health information kiosk 110 is automatically loaded, for example on a daily basis, to the central health information server 104. The results are sent to the health information server 104 for long-term storage and archiving. The information for the individual users are stored on coπesponding personal health sites that are assigned to the particular individual users so that accurate and current infoπnation are available for all of the individual users.

In the illustrative example, the individual users determine the degree and level of health care infoπnation to be acquired and stored on the site. The individual user assigns a privilege level to allow the user's physician or pharmacist to enter information to the site with a desired level of security. The physician or pharmacist having the privilege granted by the individual user gains entry to the user site upon entry of a physician or pharmacist license or registration number granted by a federal, state, or local licensing authority. Entry of the licensing or registration number enforces user security and privacy concerns, preventing fraudulent change to the user database. Using the secured access to the user's site, the physician can be allowed to download health care information to the user site. Information is not changed on the site so the physician's level of security insures accuracy of the downloaded information. The physician's security specification permits the physician to transmit secured prescription orders and records to the individual health care site.

The health care information system 100 benefits the individual users by permitting secured accessibility of health care information and prescription needs anywhere in the world through usage of the internet. The health care information system 100 supplies accurate and current individual health care information that is accessible in a crisis or emergency situation.

In one example, the health information server 104 includes a layered security program for protecting user data from privacy violations. In an example of a layered security program, a user's personal health site can have a sixteen digit security card for entry into the health information kiosk 110 and an individual personal identification (PID) number to access the user's personal health site on the health information server 104. The level of security is equivalent to the security of an ATM machine in which the only person having access is the user since the user establishes the PID number.

The health information kiosks 110 are generally accessible to the public. For example, pharmacies or drug stores are suitable facilities for supplying floor space for a health information kiosk 110. Other suitable facilities include other retail outlets, health care providers such as physician offices, clinics, hospitals, and the like. The facilities housing a health information kiosk 110 typically have an agreement with the kiosk supplier to supply information, services, and products. The health information kiosk 110 executes various functions such as health testing and health evaluation. In some systems, the health infoπnation kiosk 110 supports operations including health testing and measurement, health and fitness evaluation, and various health care information sources. Various health tests may be supported. Common health tests include blood pressure testing, heart rate testing, and the like. For example, some systems may support various noninvasive blood analyses using pulse oximetry data acquisition. Measurements may include simple or complex measurements. One common measurement is a weight measurement that is supplied using a seat scale that is installed into the seat of the health information kiosk 110. Health care information sources may include a medication encyclopedia, a vitamin and supplement encyclopedia, an electronic health care library, health care provider directories, and the like.

The health information kiosk 110 interfaces to a server such as a store computer system or to a centralized server that services a wide geographical area. For example, the health information kiosk 110 may interface to a local pharmacy or drug store computer. The health information kiosk 110 may alternatively interface to a main frame health information server 104 that services a large area such as a country or region of the world. The health information kiosk 110 in combination with the health information server 104 typically includes a highly comprehensive pharmacy library covering prescription medications and over-the-counter remedies.

The individual health information kiosks 110 commonly include display software that displays a selected idle presentation, an attract screen with still-frame or dynamic graphics, or plays video clips that promote a selected party such as the sponsoring store or medical service providers.

Software programs in the individual health information kiosks 110 is updated by downloading, for example via internet access, or media transfer such as removable disk loading.

The health information server 104 commonly supports Internet sites for user access of health information, storage of personal history information, and to shop for products that are not available local to the health information kiosk 110.

Refeπing to FIGUREs 2 and 3, a pictorial diagram shows a suitable health information kiosk 110 for usage in interfacing to a health care information system 100. The health information kiosk 110 includes a test interface 212 and a display 216. The display 216 can be configured as a touch-screen user input interface such as a touch-screen keyboard for operation as an input device. Some examples of the health information kiosk 110 can include a measurement interface 222 such as a weighing scale. The test interface 212 and display 216 are connected to a processor or controller (not shown) that executes diagnostic test operations using data acquired using the test interface 212. In an illustrative example, the test interface 212 is a blood pressure cuff 213 for acquiring blood pressure measurements. A microphone 211 is attached to the blood pressure cuff 213 to measure a sound or audio signal. The touch screen display 216 in the configuration as a user interface or keyboard is used to acquire patient data and other information from the user. The processor includes communication interfaces for communicating with the test interface 212, the display 216, and a remote terminal so that the health information kiosk 110 can be connected into a communication network (not shown). In some systems, the health care information system 100 includes a telephone handset 218 that a user may employ to receive information from the health care information system 100 in privacy or for usage in telephone communication. Some versions of the health information kiosk 110 optionally include a printer 220 for printing test results, information materials, advertisements, coupons, and the like. The illustrative test interface 212 is a blood pressure cuff 213 with one or more pressure transducers (not shown) for acquiring blood pressure waveforms from the user. The pressure transducer has an electrical connection to the processor via the communication interface so that pressure waveform data is supplied to the processor. The processor executes a computerized blood pressure detection algorithm to produce highly accurate measurements of systolic and diastolic blood pressure, and mean blood pressure. The processor also analyzes the blood pressure waveforms to detect heart rate information.

The processor executes software programs including data analysis routines that produce highly accurate blood pressure and heart rate measurements. The health care information system 100 acquires other health care information from the patient and from various health care databases via network communication linkages to generate a full health appraisal. The health care information system 100 includes local storage and the network communication link to external storage resources to allow a user to access pertinent health care information. For example, the health care information system 100 permits the user to access a full medication encyclopedia that lists pharmaceutical medications that are cuπently available on the market. A health care provider directory is accessible via the network interconnection, either on the kiosk or by an Internet connection, to enable the user to find area physicians, specialists, clinics, hospitals, health maintenance organizations (HMOs), and the like.

One example of a suitable display 216 is a high-resolution Active Matrix color touchscreen display. The display 216 is used to present menus and controls, as well as to present information including test results, measurements, health information such as seasonal health information. A text display shows text in one or more of various selected languages. Many other displays of various sizes, specifications, and utilizing various technologies are also suitable.

One example of a suitable test interface 212 is a blood pressure cuff 213 including a nylon washable exterior cuff with a seamless inner natural latex bladder that is inflated using a pneumatic power system. A suitable cuff size is 30x12.5 cm. The cuff can be constructed of medical grade silicone tubing that is non-reactive, and thus allergy-free, to body tissue. Cuff pressure is regulated by pressure monitors (not shown) that are inherently stable and are calibrated to function accurately with cuff pressure variations of less than +1-1% over a full operating range of systolic maximum pressure 250mm-Hg and minimum pressure 80mm-Hg, and diastolic maximum pressure 130mm-Hg and minimum pressure 38mm-Hg, a differentiation of 8 points between systolic and diastolic pressure, and a heart rate from 38 to 200bpm. The monitors use automatic zero pressure variations to prevent accuracy from being affected by altitude level or other changes in atmospheric pressure, temperature, and humidity. The exemplary test interface 212 also detects sound signals for usage with Korotkoff sound detection. Both pressure signals and sound signals are converted to digital form and transmitted to the processor to perform blood pressure measurements using both oscillometric and auscultatory analysis. The pressure and sound signals can be processed to determine heart rate measurement using a beat-to-beat averaging method. In some examples, tests are activated using a touch screen in which a virtual green start button initiates a test procedure by inflating the cuff positioned about the patient's arm. Touching the display screen halts the test and returns the pneumatic cuff to the open position. Various other specifications, materials, and technologies or combinations of technologies that are known by those having ordinary skill in the art are also suitable.

An illustrative measurement interface 222 is a weighing scale formed into a moveable seat 224 that is attached to the health information kiosk 110. The seat scale has accuracy within one pound. In some systems, the seat 224 of the health information kiosk 110 is moveable so that the test interface 212 and display 216 are wheel-chair accessible and easily used by the disabled without assistance.

Refeπing to FIGURE 4, a schematic block diagram shows functional elements of a blood pressure measurement operation that can be performed by the health care information system. In an illustrative embodiment, a blood pressure measurement routine 400 is implemented for usage on the digital signal processor 112 that operates in combination with control operations executed on the processor 106. One suitable digital signal processor 112 is a 32-bit floating-point processor. Basis operating routines in the blood pressure measurement routine 400 that can be functionally divided into operating system functions 402 and measurement operations 404. The operating system functions 402 include a basic integrity diagnostic routine 410, a communications interface 412, and a monitoring routine 414 for monitoring switch input signals and sensor data. The measurement operations 404 include a control routine 416 that controls cuff inflation and bleed cycles and a pulse rate measurement routine 418 to compute the blood pressure result. The measurement operations 404 return processing control back to the operating functions 402 to execute a limit checking routine 420 and a display routine 422 for displaying individual blood pressure measurements, or values associated with a combination of measurement values.

Refeπing to FIGURE 5, a schematic flow chart depicts suitable measurement operations 404 including the control routine 416 for controlling the blood pressure measurement. The control routine 416 inflates the blood pressure cuff 213 shown in FIGURE 2. The user presses a START button 502 on the health information kiosk 110, sending a signal to the processor 106 to begin inflating the blood pressure cuff 213. The control routine 416 initializes a pressure setpoint 504 to a common level of 160mm-Hg and starts a Pump-up cycle 506 that inflates the cuff bladder to the initial pressure setpoint. During the Pump-up cycle 506, the pressure is increased at a controlled rate to avoid blood vessel compliance issues that could reduce measurement accuracy. Four pumping levels are used to attain a reduced or minimal pumping pressure level, thus reducing the noise level during detection of Korotkoff sounds. For example, if the Pump-up cycle 506 increases the pressure to 160mm-Hg as determined by a pressure limit test 508 and an audio test for Korotkoff sounds 510 does not sense a "silent" level, then the setpoint is first increased to 190mm-Hg 514 and the Pump-up cycle 506 gradually increases the pressure to 190mm-Hg. If the absence of Korotkoff sounds is not detected in function block 510 at pressures of 160mm-Hg and 190mm-Hg, the setpoint is set and tested for setpoints of 220mmHg and 260mm-Hg in function blocks 518 and 522, respectively, as controlled by logic operations in blocks 512, 516, and 520. If Korotkoff sounds are not eliminated even at a pressure of 260mm-Hg, then the test is aborted and an eπor message is generated in block 524.

When the pressure is set to the setpoint, as determined by the cessation of Korotkoff sounds in block 510, then a measurement initialization operation 526 initializes the blood pressure measurement parameters. A bleed rate is selected that is either a high bleed rate in operation 530 or a low bleed rate 532, depending on the user's heart or pulse rate, as determined by logic operation 528.

During a cuff bleed cycle 534, the blood pressure measurement routine 400 gradually reduces pressure in the cuff 213 while executing three separate analysis operations 536 that analyze sampled data. In the illustrative blood pressure measurement routine 400, the three test techniques including an ascultatory technique, an oscillometric technique, and a pattern recognition technique. In some systems, the three analysis operations are executed sequentially. In other systems, the analysis operations can execute simultaneously or concuπently. For example, some systems may include multiple processors or may use multithreading, multi-processing or superscalar processing techniques and the like to attain computational efficiencies.

The blood pressure measurement routine 400 supplies results from the three separate analysis techniques to an operating system 502 executing in the processor 106 which executes a limit checking operation 538, a blood pressure calculation operation 540, a display operation 542, and an end operation 544. The multiple separate analysis operations 536 are performed by the test interface 112 depicted in a block diagram shown in FIGURE 6 in which an ascultatory interface 602, an oscillometric interface 604, and a pattern recognition interface 606 function in combination to improve the accuracy of a blood pressure measurement. The ascultatory interface 602 functions as a controlling measurement that determines diastolic and systolic pressure points from audio signals. The diastolic and systolic pressure points that are determined using the ascultatory technique 602 are used to define the sequence of the measurement cycle for the oscillometric technique 604 and the pattern recognition technique 606. The measurement using the oscillometric technique 604 uses oscillations on a measured pressure waveform to locate systolic and diastolic pressures. The pattern recognition technique 606 employs pattern recognition to locate characteristic changes in the sound envelope to determine systolic and diastolic pressures.

Input signals to the test interface 112 include a sound signal from the microphone 211 located in the pressure cuff 213, and a pressure signal which indicates cuff pressure. A pulse discriminator 700 shown in FIGURE 7 extracts the user pulse signal directly from an output terminal of a pressure transducer (not shown) attached to the pressure cuff 213. The pulse discriminator 700 extracts the user's pulse signal directly from the pressure signal produced by the pressure transducer. The pulse discriminator detects a pulse by monitoring variations in the pressure signal including the slope and the rate of change of the slope of the pressure signal.

Refeπing to FIGURE 8, a schematic block diagram illustrates a measurement cycle controller 800 that generates signals governing a measurement cycle based on sensed sound signals. Korotkoff sounds detected from the microphone 211 in the pressure cuff 213 control the measurement cycle. The measurement cycle controller 800 initially waits for first sounds. When the measurement cycle controller 800 detects the first sounds, a cycle begins. The measurement cycle controller 800 detects subsequent sounds and times the duration between sounds. When the duration between Korotkoff sounds is more than a selected duration, the measurement cycle controller 800 registers that a period of silence has occuπed, which ends the measurement cycle.

Refeπing to FIGURE 9, a schematic block diagram shows a sample counter 900 that generates a sample count for marking event times. The sample counter 900 is synchronized by an external signal and maintains a sample count that is used by each of the ascultatory interface 602, the oscillometric interface 604, and the pattern recognition interface 606 to mark event times. The sample counter 900 marks the systolic and diastolic events for external displays. Refeπing to FIGURE 10, a schematic block diagram shows an example of an ascultatory analyzer 1000 such as a suitable ascultatory interface 602 (shown in FIGURE 6) for measuring blood pressure using the ascultatory technique 602. The ascultatory technique 602 determines systolic and diastolic pressures by using a microphone and signal processing to detect an onset of Korotkoff sounds and a lapse of Korotkoff sounds. The ascultatory technique 602 is similar to the manual technique that is conventionally used by health care practitioners. The ascultatory interface 602 detects and stores the systolic and diastolic pressures. The ascultatory interface 602 has an input terminal that connects to the microphone 211, a filter 604, and a threshold detector 606. The filter 604 has filter characteristics that are similar to the characteristics of a stethoscope and operates by sorting sound components that are characteristic of the Korotkoff sounds. The threshold detector 606 detects the presence or absence of the Korotkoff sounds. To avoid false detection, the ascultatory interface 602 employs sequential analysis techniques to detect false conditions.

The techniques for detecting Korotkoff sounds are well known the health care practitioners having ordinary skill in the art. The ascultatory interface 602 implements the well known manual ascultatory techniques using computer hardware and software techniques that are well known to those having ordinary skill in the computer arts.

Refeπing to FIGURE 11, a schematic block diagram shows an example of a suitable oscillometric interface 1100 for measuring blood pressure using an oscillometric technique. The oscillometric interface 604 has an input terminal that is connected to the pressure cuff 213 and receives the pressure signal. The oscillometric interface 604 monitors the pressure oscillations in the pressure cuff 213. The oscillometric interface 604 includes a peak detector 1102, an analog-to-digital converter 1104, and a computation block 1106. For a pulse, the oscillometric interface 604 detects the peak pressure using the peak detector 1102, determines the amplitude of the pressure at the peak by sampling the pressure signal waveform using the analog-to-digital converter 1104. The oscillometric interface 604 saves the sampled peak amplitude. The computation block 1106 averages the pressure measurements throughout the pulse cycle. Upon determination of the mean pressure, the computation block 1106 uses an empirical systolic ratio to find the systolic pressure pulse and associated cuff pressure. The computation block 1106 then uses the diastolic pressure to subsequently find the diastolic pulse and the cuff pressure associated with the diastolic pulse. Both systolic and diastolic measurement techniques employ heuristic filtering techniques to ignore known pressure pulse events that would otherwise produce eπoneous results. Refeπing to FIGURE 12, a schematic block diagram shows an example of a suitable pattern recognition interface 606 for measuring blood pressure using a pattern recognition technique. The pattern recognition interface 606 includes a first input terminal 1202 that is connected to the microphone 211 and a second input terminal 1204 that is connected to the pressure cuff 213. The first input terminal 1202 is connected to a smoothing filter 1206, a differentiator 1208, pattern analyzer 1210, and glitch logic 1211. The pattern recognition interface 606 searches for a pattern recognition signature by first smoothing the audio signal from the distal microphone 211 using the smoothing filter 1206, and using the differentiator 1208 to determine the second derivative of the audio signal, thereby magnifying a residual noise component of the audio signal. To affirm that a valid pattern recognition signature is found, the pattern analyzer 1210 searches for a characteristic asymmetric "W" pattern during the pulse interval. The negative edge of the pulse signal is delayed with the duration of the delay being indicative of validity and invalidity of the systolic pattern. The glitch logic 1211 includes J-K flip-flops 1212 and 1214 and is used to eliminate spurious match signals to verify that two consecutive match signals exist. The first J-K flip-flop 1212 latches the systolic pressure and sample count. The second J-K flip-flop 1214 latches the pressure and sample count for the last match that occurs. The diastolic pressure and sample count are updated for every match and coπespondingly latch the pressure and sample count for the last match that occurs.

The pattern recognition interface 606 and technique use pattern recognition to determine sound signal characteristics that are highly coπelated to intra-arterial measurements of systolic and diastolic blood pressure.

The multiple facets of the illustrative blood pressure measurement, including the ascultatory interface 602, the oscillometric interface 604, and the pattern recognition interface 606, assure accuracy. Results of the three separate measurements are checked against a set of predetermined limit values and compared. The resulting numbers are used to calculate a mean systolic pressure and a mean diastolic pressure.

The test interface 112 uses digital signal processor technology to implement a multiple- method measurement technique. The test interface 112 uses the digital signal processor to simultaneously execute separate measurements in real time, but at a low cost, to permit a choice of the optimum measurement result. Furthermore, usage of the digital signal processor employs processing of digital signals rather than analog signal processing. Analog signal processing results in eπors and spurious variation in measurement results due to variations in environmental conditions. In contrast, digital signal processing is generally immune to environmental variations.

A health kiosk provides blood pressure testing, a health and fitness evaluation, and a medication encyclopedia. The health kiosk typically interfaces to a computer or server, such as a pharmacy computer or a remote server which compares pharmaceuticals selected by a user to infoπnation in the medication encyclopedia to determine compatibility for prescription medications and over-the-counter medications. In some systems, the kiosk also supplies one item or more of an extended health information, a weight scale constructed into the seat of the kiosk, a directory of health care service and product providers, an a directory of community health, support, and service groups.

The health services and information system delivers services in areas ranging from patient education, medical research, dispensing of counseling and health information, and disease state management to database centralization of pharmacist-owners' credentials. The health services and information system includes a network web site that supplies consumers with information about such topics as nutrition and fitness, women's and men's health, diabetes, asthma, HTN and other health conditions. Consumers also use the web site to locate a nearby pharmacy.

Health care screenings are integral to delivery of services since screenings clearly set forth a customer's goals and needs. The health services and information system supports third-party prescription plans and uses a managed care network to contract for third-party business on behalf of its network of stores. The managed care network allows a retailer to compete on an equal basis with chains for third-party contracts. Otherwise, most independent retailers would be locked out of the third party contracts.

Along with increased buying power, franchisees have access to support services including a nationally coordinated marketing program with health care screenings. Although, only basic blood pressure testing is described, the health services and information system can additionally support more sophisticated evaluations including vision tests, and evaluations of cholesterol levels and body fat. For example, other tests that can be performed include colorectal cancer tests, blood glucose screenings, glaucoma tests, screening for foot fungus infections, and others.

Refeπing to FIGURE 13, a pictorial computer screen display illustrates a main menu screen 1302 that is initially presented when health services and information system software 120 is activated. The health services and information system software 120 is a program employing a graphical user interface to receive information from a user and to display selected display screens to the user. The graphical user interface of the health services and information system software 120 is generally a touch screen display in which various touch buttons are actuated when the user touches a defined region on the display screen. In one example, the main menu screen 1302 has several touch buttons including a blood pressure test button 1310, a health risk appraisal button 1312, a medication encyclopedia button 1314, a health information selection button 1316, a community directory button 1318, a special coupons access button 1320. The main menu screen 1302 further includes a vitamins and minerals selection button 1322, a blood pressure history button 1324, a weighing function request button 1326, and a personal health site button 1328. The main menu screen 1302 permits the user to touch a selection to begin multifaceted access to the health services and information system database. The main menu screen 1302 facilitates user access to information concerning the specific user's health, the local community, the business or businesses sponsoring the health information kiosk 110 executing the health services and information system software 120.

When the user actuates the blood pressure test button 1310, the health services and information system software 120 displays a blood pressure testing start screen 1400, shown in FIGURE 14A, that instructs the user in performing a self-test of blood pressure. The blood pressure testing start screen 1400 includes a graphic 1402 that instructs the user to place an arm in the blood pressure cuff test interface 212 in an appropriate position. The blood pressure testing start screen 1400 also has soft buttons including an illustration button 1404 for displaying additional educational and instructional material regarding the blood pressure test procedure, a start button 1406 that initiates operation of the test interface 212 to begin acquiring data, and a main menu button 1408 that allows the user to return to the main menu screen 1302.

The user places the left arm in the cuff as is shown on the display 216, touches a virtual start button on the display screen and the health services and information system 100 controls the test interface 212 to perform a blood pressure measurement in conjunction with computation operations executed by the processor 106 and, in some systems, the DSP 112. When the test is completed, the user touches a virtual touch print button to receive a printout of blood pressure results.

Pressing the start button 1406 actuates the test interface 212 to begin the blood pressure testing, typically by inflating the blood pressure cuff 213, then gradually deflating the cuff while acquiring pressure and sound readings from the cuff. The sound and pressure measurements acquired by the test interface 212 are sent to processors including a digital signal processor (not shown) and a central processor (not shown) which process the measurements to determine blood pressure using one or more techniques. A first technique is a conventional sound (auscultatory) method. A second technique is a conventional pressure (oscillometric) method. A third technique calculates blood pressure using a combination of sound and pressure measurements. In some systems, blood pressure samples are deteπnined using all three of the auscultatory, oscillometric, and combination techniques. A complete blood pressure waveform is acquired for a plurality of heart cycles and stored in memory for analysis, allowing a determination of both systolic and diastolic blood pressure after cuff pressure is deflated. In an illustrative system, the digital signal processor is capable of executing thirty- five million operations per second, to permit analysis of approximately 6500 samples in a single blood pressure test. In some systems, the heart rate is determined using a beat-to-beat averaging technique.

Referring to FIGUREs 15A, 15B, and 15C, graphic displays of pressure waveforms are depicted which show examples of data that is analyzed to perform blood pressure measurements. FIGURE 15A shows a Bell Curve of an actual blood pressure wave. FIGURE 15B shows a magnified section of the blood pressure waveform. FIGURE 15C displays a pressure waveform showing systolic and diastolic pressures.

When the blood pressure test is complete, the health services and information system software 120 displays a blood pressure testing end screen 1420, shown in FIGURE 14B, that displays results of the blood pressure test. The blood pressure testing end screen 1420 includes a graphic 1422 showing results of the blood pressure test including systolic pressure, diastolic pressure, and heart rate. The blood pressure results display rates the measured systolic and diastolic pressures in relation to desirable and unhealthy rates. The blood pressure testing end screen 1420 has soft buttons including a store results button 1424 for storing the patient's results in the patient's individual database, a health care appraisal button 1426 which, like the health risk appraisal button 1312 of the main menu screen 1302, generates a health care appraisal screen. The blood pressure testing end screen 1420 also has a main menu button 1408 that allows the user to return to the main menu screen 1302. The blood pressure testing end screen 1420 has a print button that the user can actuate to generate a printout of the results for user record-keeping. In some systems an icon (not shown) may be supplied that allows a user to store history information to a personal secured database.

When the user actuates the health care appraisal button 1426 on the blood pressure testing end screen 1420 or the health risk appraisal button 1312 on the main menu screen 1302, the health services and information system software 120 generates and displays a health risk appraisal screen. The pictorial computer screen displays associated with a health risk appraisal function, include a health care appraisal questionnaire form 1600 for setting user parameters and a health care appraisal result screen 1620, respectively shown in FIGURES 16A and 16B. The health services and information system software 120 first displays the health care appraisal questionnaire form 1600 filled with any previously available information. Fields in which data has not been entered request updating. The user may update filled fields by actuating a display bar showing a value in the field. In the illustrative system, the health care appraisal questionnaire form 1600 displays the user's age 1602, height 1604, weight 1606, gender 1608, frame size 1610, exercise habits 1612, and smoking habits 1614. Additional fields may be added to the health care appraisal questionnaire form 1600 or a subsequent screen for setting additional conditions. The health care appraisal questionnaire form 1600 also includes a continue button 1616 for proceeding to additional questionnaire forms or for proceeding to the health care appraisal result screen 1620.

The health care appraisal result screen 1620 shown in FIGURE 16B, displays results of the health risk appraisal including systolic pressure, diastolic pressure, heart rate, and appraisal ratings. The appraisal function is typically executed by the processor and combines blood pressure results, heart rate results, and answers to health-related questions to determine a health risk category for the user. The appraisal ratings include an appraisal score, a health rating, and the health risk rating.

User information including test results, measurement results, analysis, and personal information, if authorized by the user, can be entered into a customer database for usage by sponsors of the health information kiosk 110. The sponsors to attract user patronage of the kiosk and the sponsor of the kiosk may support a user rewards sign-up program.

The health care appraisal result screen 1620 has a main menu button 1630 that allows the user to return to the main menu screen 1302, and has a print button which the user can actuate to generate a print-out of the results for user record-keeping.

The health risk appraisal operation is based on data made available by the U.S. government in combination with the user blood pressure results. The user answers questions that are presented on the display 216. The health services and information system 100 determines a health risk appraisal and presents the appraisal results on the display screen. The user can actuate a virtual print button 1632 on the display screen to print the results on the printer 220. Refeπing to FIGURES 17A and 17B, several pictorial computer screen displays exemplify a medication encyclopedia display function. When the user is accessing the main menu screen 1302 and actuates the medication encyclopedia button 1314, the health services and information system software 120 displays a medication encyclopedia index screen 1710, shown in FIGURE 17A. In one example, the health services and information system 100 includes an encyclopedia of over 7500 over-the-counter and prescription medications. The encyclopedia specifies directions for using the medications, side effects, proper and improper usage, and other pertinent infoπnation. The medication encyclopedia index screen 1710 includes a plurality of touch buttons in the form and aπangement of a virtual keyboard to allow the user to enter the first letters of a particular medication. In one example, when the user enters the first three letters of a medication, the health services and information system 100 displays the selected medication.

The medication infoπnation is supplied, for example, from the United States Pharmacopoeia leaflet patient version that is maintained as the information is regularly updated in government documents.

FIGURE 17B depicts a medication entry screen 1712, illustratively showing the description of an azatadine oral medication. The medication entry screen 1712 includes several touch buttons for accessing additional information relating to the medication. A first button (WHAT) 1714 is highlighted to signify that the display describes the medication. A second button (TELL) 1716 describes usage for the medication. A third button (TAKE) 1718 relates common dosages or dosages for the particular user, as determined by infoπnation from health care providers of the user or from user information in the database of the health services and information system 100. A fourth touch button (WARNING) 1720 describes warnings regarding usage of the medication. A fifth touch button (SIDE EFFECTS) 1722 informs the user of any known side effects of the medication. A sixth touch button (View Another Drug) 1724 is used to return to the medication database to select additional medications that are commonly used for the same purposes as the accessed medication. A seventh touch button (DRUG INTERACTION) 1726 is accessed to determine whether the medication taken in combination with any of the user's cuπent medications will cause adverse reactions. An EXIT touch button 1728 allows the user to return to the main menu screen 1302.

When the user actuates the seventh touch button (DRUG INTERACTION) 1726, a number keyboard is displayed to permit the user to enter a PIN number that protects the users private information database. The user first selects an over-the-counter product that is considered for usage and actuates the seventh touch button (DRUG INTERACTION) 1726 from the medication encyclopedia. The user enters a personal identification number (PIN). The health services and information system software 120, typically executing on the processor, checks the pharmacy database and generates a response of either: (1) Interaction, Please see the Pharmacist, or (2) No Interaction - Use Allowed. After the search is completed, information is made accessible to the local pharmacist. The pharmacist collects a file of customers and interactions that are checked in subsequent references. A warning screen may be displayed.

Refeπing to FIGURES 18A and 18B, pictorial computer screen displays exemplify a health information display function. When the user is accessing the main menu screen 1302 and actuates the health information selection button 1316, the health services and information system software 120 displays a health information menu screen 1810, shown in FIGURE 18A. The health information menu screen 1810 allows the user to link to various information sites relating to health care. Typically accessed entries are viewed and printed by the user, if desired. Many sites include color graphics and full motion video. The accessible selections can include standard entries or can be customized for a particular location of the health information kiosk 110. The illustrative health information menu screen 1810 includes touch buttons to access disease information 1814, information relating to the human body 1816, exercise and fitness information 1812, food facts 1818, and medical facts 1820. FIGURE 18B depicts a disease screen 1830 that can be displayed when user actuates the touch button for the disease information 1812. The disease screen 1830 includes touch buttons that the user can actuate to receive information relating to a particular disease or affliction.

The health information is displayed in several formats including text, graphics, full motion video, and on-line information optioned via Internet. For sensitive information, the user can lift the telephone handset (not shown) to listen to the topics in privacy.

Refeπing to FIGURES 19A, 19B, 19C, and 19D, pictorial computer screen displays illustrate a local community information display function. The community display generates a directory of local health care providers or medical facilities such as physicians, hospitals, emergency centers, crisis centers, and the like for display to a user. In addition to local health care providers and medical facilities, the health services and information system 100 also may generate entries that are regional, national, or international in scope, generally for providers of services that are more wide-ranging in scope. The community display also stores and displays information relating to schools, colleges, churches, and other public or service facilities.

When the user is accessing the main menu screen 1302 and actuates the community directory button 1318, the health services and information system software 120 displays a community services menu screen 1910, shown in FIGURE 19A. The community services menu screen 1910 allows the user to link to various information sites relating to health care. Typically accessed entries are viewed and printed by the user, if desired. Many sites include color graphics and full motion video. The accessible selections can include standard entries or can be customized for a particular location of the health information kiosk 110. The illustrative community services menu screen 1910 includes touch buttons to access a physician directory 1912, a school directory 1914, a hospital directory 1916, a civic group's directory 1918, and a support groups directory 1920.

When the user actuates the support groups directory touch button 1920, the health services and information system software 120 displays a support groups menu 1930 that presents touch buttons for accessing directories of particular types of support groups. FIGURE 19B depicts an example of a support groups menu screen 1930 that is displayed when user actuates a touch button for alcohol and drug abuse programs from the support groups menu screen 1930. The support groups menu screen 1930 includes touch buttons that the user can actuate to receive information relating to various treatment programs for treating a particular disease or affliction. In the illustrative system, one of the touch buttons on the support groups menu screen 1930 is an alcohol and drug abuse touch button 1932.

When the user actuates the alcohol and drug abuse touch button 1932, the health services and information system software 120 presents an alcohol and drug abuse service provider directory screen 1934, an example of which is shown in FIGURE 19C. Entries in the alcohol and drug abuse service provider directory screen 1934 show the name, address, and telephone number of a listed alcohol and drug abuse service provider. The alcohol and drug abuse service provider directory screen 1934 has a cursor for pointing to a particular entry, an "up" button and a "down" button for scrolling through the list, and a "select" button for selecting a particular entry that is designated by the cursor.

When the user selects an entry, the health services and information system software 120 displays a screen showing additional information relating to the selected group. FIGURE 19D shows a group screen for an alcoholics anonymous support group.

Using the community information display function, the user can obtain local and wide ranging information in a list format. Alternatively, if the health services and information system 100 includes the telephone handset (not shown), the user can use telephone communication via the telephone handset to connect directly to the community service organization of interest. The community directory supplies a listing of local services and information that give the user finger-touch access to communicate with local physicians, hospitals, or support groups directly from the kiosk. Although the community information screen is described as including local information, this description is made primarily to indicate that information is customized for particular local communities. The community information commonly also includes groups, individuals, or organizations that are national or international in scope.

The community listing directory typically includes a full listing for each entry. The health services and information system 100 also supports more extension coverage of a particular entry. For example, a health care provider, group, or other entity may aπange for one or more information pages or an expanded video presentation on the display 216.

In some systems, a local bulletin board is supported and displayed on the health information kiosk 110 to supply information to employees of the organization supporting the kiosk. The bulletin board may be accessed via a selection on the community groups function or may be accessed in other ways.

Refeπing to FIGURES 20A and 20B, pictorial computer screen displays illustrate a special coupons access display function. When the user is accessing the main menu screen 1302 and actuates the "Shopping Mall" business access button 1320, the health services and information system software 120 displays a "Shopping Mall" business access menu screen 2000, shown in FIGURE 20A. The "Shopping Mall" business access menu screen 2000 allows the user to access various advertisements, special offers, and coupons. Typically, accessed advertisements, offers, and coupons are viewed and printed by the user, if desired. The accessible selections can include standard entries or can be customized for a particular location and to support selected advertisers or clients associated with the health information kiosk 110. The illustrative "Shopping Mall" business access menu screen 2000 includes touch buttons to access pharmacy items 2002, groceries 2004, household items 2006, and mail order specials 2008. FIGURE 20B depicts a grocery coupon screen 2010 that can be displayed when user actuates the touch button for the groceries 2004. The grocery coupon screen 2010 includes touch buttons that the user can actuate to receive printed grocery coupons, advertisements, and special offers. The coupons and informational materials are printed on the printer 220 when requested by the user.

Coupons can be printed from the health information kiosk 110, permitting point-of- purchase advertising and usage of seasonal specials. A mail-order program effectively expands the floor-space of a store using e-commerce by offering hundreds or thousands of additional products or services that a customer can order directly from the health information kiosk 110. The user can order the products or services directly from the health information kiosk 110 and aπange for purchased items to be made available for delivery at the kiosk location or delivered to the user. The "Shopping Mall" business access display function permits advertising using full motion commercials and coupons at a fraction of the cost of other media sources. The health services and information system 100 also supports online ordering for supported clients.

The health services and information system software 120 generates similar screens for accessing informational and ordering materials for purchases of vitamin and mineral supplements via a vitamins and minerals selection button 1322. Information on vitamins, herbs, and minerals is available at a touch of the display screen. The information includes various remedies, studies, and documented interactions of concuπent remedies.

When the user actuates the blood pressure history button 1324, the health services and information system software 120 displays a blood pressure history access screen 2100, shown in FIGURE 21A, that allows protected access to the users blood pressure history information. The blood pressure history is stored as a sequence of time and date entries in a memory accessed and written by the processor within the health infoπnation kiosk 110. Entries are identified with a particular user and protected against access of others by usage of a PIN number or ID card. Upon identification of a user, the user can retrieve records from previous tests.

The blood pressure history access screen 2100 includes a numerical touch button pad that permits the user to enter an access number such as a social security number, a password, a PIN number, or the like. A system that utilizes personal identification numbers (PIN), the PIN number may be assigned according to a workplace (corporate) account, a store account at which the user is a customer, or a customer account assigned directly to the user.

In the illustrative health services and information system software 120, the user enters a Personal Identification Number (PIN) and/or inserts an access card and enters a PIN number to access the blood pressure history data. Also in the illustrative system, local memory of the health information kiosk 110 stores the most recent ten results. The user may select any desired result or group of results, including statistics that are derived from the results.

Blood pressure test results for the patient are displayed in FIGURE 21B.

The health services and information system 100 collects and stores data for a plurality of users and generates overall average and trend information from the collective data, while maintaining the privacy of individual users. Various parties may use the collective data to supply inventory information, marketing studies, business planning, and the like. For example, parties using the collective data may include the store or facility in which the health information kiosk 110 is located, suppliers of medications and supplements, health care providers, insurers, and the like. Refeπing to FIGUREs 22A, 22B, and 22C, several schematic graphs are depicted which show collective user health data. FIGURE 22A shows a graph of health risk appraisal scores and data, according to gender, FIGURE 22B shows a graph of health risk appraisal value according to smoking habits. FIGURE 22C shows a graph of systolic and diastolic blood pressure. The illustrative graphs exemplify only a few of a myriad of possible statistical displays that may be displayed, as is known by those having ordinary skill in the art.

The health services and information system 100 stores and categorizes data from a user according to identification number. Stored data can be accessed for usage by commonly available spreadsheet software programs for review or presentation. Data may be stored according to identification number, data and time, or other aπangement.

Refeπing to FIGURE 23, an example of a table show a compilation of acquired samples of health care data that can be generated by the health services and infoπnation system 100. The table is a compilation of the sequential transactions executed by the health services and information system 100 over a real time interval.

Refeπing to FIGURE 24, an example of a test printout 2400 shows data that can be produced by the health services and information system 100 for access by a user. The kiosk produces a personal waveform printout with a blood pressure result printout 2402 when the user actuates the print button on the blood pressure testing end screen 1420 to show the blood pressure result. A health risk appraisal result printout 2404 is generated by the health services and information system 100 when the user actuates the print button from the health care appraisal result screen 1620. A blood pressure history result printout 2406 is produced when the user actuates the print button from the blood pressure history access screen 2100.

The user can actuate the Personal Health Site button 428 on the main menu screen 1302 shown in FIGURE 13 to store and access a secure personal health history. The user enters identifying information on a touch-screen display 2500, shown in FIGURE 25, that is displayed following actuation of the Personal Health Site button 1328. PIN numbers or other security measures secure patient information and prevent unauthorized access to confidential information. In some systems, the user can be automatically connected to a proprietary web site after registration with the site. FIGURE 26 is a schematic screen display that illustrates a registration form for a web site.

The user can actuate the weighing function request button 1326 on the main menu screen 1302, shown in FIGURE 13, to activate the weight scale formed into the seat of the kiosk. The user reads the result from a weight measurement result screen 2700 shown in FIGURE 27.

A health care test kiosk includes a caπel body, a controller, a physiological test interface, a seat, and a weight scale. The caπel body supports a console housing and includes a support side panel forming a lateral side and extending beyond the console housing. The controller is housed within the console housing and includes a display and user interface. The physiological test interface is coupled to and supported by the caπel body on the support side panel. The physiological test interface is communicatively coupled to the controller for supplying physiological information to the controller for analysis and display. The seat is coupled to the support side panel of the caπel body. The weight scale is coupled to and supported by the seat. The weight scale is communicatively coupled to the controller for supplying weight information to the controller for analysis and display in combination with the physiological data.

A seat assembly for use in a health care test kiosk includes a seat and a weight scale. The health care kiosk includes a caπel body supporting a console housing and having a vacant knee-space beneath the console housing. The caπel body includes a support side panel forming a lateral side and extending beyond the console housing and the knee-space. The health care test kiosk further includes a physiological test interface coupled to and supported by the carrel body on the support side panel. The seat assembly includes the seat and the weight scale. The weight scale is coupled to and supported by the seat, the weight scale being communicatively coupled to the controller for supplying weight information to the controller for analysis and display in combination with the physiological data.

A health care test kiosk includes a caπel body that supports a console housing and has a vacant knee-space beneath the console housing. The caπel body includes a support side panel forming a lateral side and extending beyond the console housing and the knee-space. A physiological test interface is connected to and supported by the caπel body on the support side panel. A retractable seat is movably connected to the support side panel of the caπel body for selective positioning in a location ranging from withdrawn into the knee-space beneath the console housing to extended completely from the knee-space.

A retractable seat assembly includes a retractable seat and a connector fixedly coupled to the retractable seat and capable of moveable coupling to the support side panel of the caπel body for selective positioning in a location ranging from withdrawn into the knee-space beneath the console housing to extended completely from the knee-space.

A method of fabricating the health care test kiosk includes forming a caπel body supporting a console housing and having a vacant knee-space beneath the console housing, and attaching a support side panel as a side of the caπel body. The support side panel forms a lateral side and extends beyond the console housing and the knee-space. The method further includes attaching a physiological test interface to the caπel body on the support side panel, and movably coupling a retractable seat to the support side panel of the caπel body for selective positioning in a location ranging from withdrawn into the knee-space beneath the console housing to extended completely from the knee-space.

Refeπing to FIGUREs 28A, 28B, 28C, and 28D, four three-dimensional pictorial diagrams show various frontal views of a health care information kiosk 110. FIGURE 28A illustrates a frontal view of the full health care information kiosk 110 with a retractable seat assembly 2812 in a enclosed position within the kiosk. FIGURE 28B illustrates a frontal view of the full health care information kiosk 110 with a retractable seat assembly 2812 in a withdrawn from the enclosed position with respect to the kiosk. FIGURE 28C shows a locking mechanism of the retractable seat assembly with the seat enclosed into the kiosk. FIGURE 28D shows the locking mechanism of the retractable seat assembly 2812 with the seat assembly in an extended position. The health care test kiosk 110 includes a caπel body 2810 and a moveable and retractable seat assembly 2812.

The caπel body 2810 has an entry side panel 2814 and a support side panel 2818 that are opposing and connect at right angles to a back panel 2816, forming three sides of a console housing 2808. The console housing 2808 contains a health care test controller (not shown) with input interface 2817 and display 2819 that respectively control a test acquisition and display a test result. The console housing 2808 also includes a planar top panel 2820 connected at right angles to top edges of the entry side panel 2814, the back panel 2816, and the support side panel 2818. The console housing 2808 also includes a planar bottom panel 2822 that forms a plane parallel to the plane of the top panel 2820 and is affixedly attached at a position medial to the top and bottom edges of the entry side panel 2814, the back panel 2816, and the support side panel 2818. The bottom panel 2822 is interposed at the medial position at a suitable height from the floor to allow sufficient vacant knee-space for a person seated on the seat assembly 2812. The structure of the console housing 2808 is completed by a display panel 2824 that opposes the back panel 2816, connects to edges of the top panel 2820 and the entry side panel 2814, connects to an edge and surface of the support side panel 2818, and connects to a surface of the bottom panel 2822. A portion of the bottom panel 2822 extends forward beyond the display panel 2824 to form a resting surface for the convenience of a user.

The support side panel 2818 extends forward beyond the forward edges of the display panel 2824 and the entry side panel 2814. The support side panel 2818 supports a physiological test structure 2826 that, in the present example, is a blood pressure test interface 2828. The physiological test structure 2826 is moveable or positionable to permit testing of different sized users. For example, the illustrative physiological test structure 2826 is connected to the support side panel 2818 at a pivot point so that a test acquisition element, such as a blood pressure cuff, can be moved to various positions along a radius to allow testing of users ranging from large adults to small children. The moveable or positionable characteristics of the physiological test structure 2826 are also useful for allowing test access to users in different positions. For example, a user in a wheel chair may position the seat assembly 2812 in the knee-space beneath the console housing 2808, move the wheel chair into a position near the physiological test structure 2826, and pivot the physiological test structure 2826 into a suitable position for acquiring a measurement.

The support side panel 2818 has a mounting surface 2830 upon which is mounted a seat track 2832. In the illustrative health care test kiosk 110, the seat track 2832 is an elongated bar with a C-shaped cross-sectional form 2834. The seat track 2832 extends longitudinally from front to back of the support side panel 2818 in a horizontal configuration so that the seat assembly 2812 that is movably attached to the health care test kiosk 110 can move horizontally beneath the console housing 2808 and retracted forward from the console housing 2808. The physiological test structure 2826 is positioned so that the seat assembly 2812 is clear from obstruction whether the seat assembly 2812 is enclosed beneath the console housing 2808 or extended from the console housing 2808. A seat lock 2836 is also affixed to the mounting surface 2830 of the support side panel 2818, typically positioned near a forward portion of the seat track 2832. The seat lock 2836 permits the seat assembly 2812 to be held firmly in place when a user is using the health care test kiosk 110.

The illustrative seat assembly 2812 has a top horizontal planar support 2850 that is supported on a support side 2837 by a moveable connection to the seat track 2832 and supported on an entry side 2839 by a fixedly attached seat support 2840. The illustrative top horizontal planar support 2850 is shown as a planar, level panel that is generally in the form of a rectangle except with corners rounded on the entry side of the health information kiosk 110. The top horizontal planar support 2850 serves as a brace for holding a weighing scale 2852 that measures the weight of a user. In some systems, the weighing scale 2852 has a cable (not shown) that extends to the edge of the seat assembly 2812 through an aperture (not shown) in the support side panel 2818 to the console housing 2808, then into the console housing 2808 to the health care test controller. The cable may carry data signals, control signals, and power. In some systems, the cable may carry data and control signals alone and be powered by a battery. Some systems may communicate data and control signals using wireless techniques. Any combination of wired and wireless communication may be used.

A top seat panel 2838 is supported by the weighing scale 2852 and serves as a sitting surface for the user. The illustrative top seat panel 2838 has the form of a planar, horizontal panel or flat bench-top panel. The top seat panel 2838 in other examples may take various other forms. For example, instead of a planar surface, the top seat panel 2838 may have a contoured top surface for comfort of the user.

In the exemplified seat support 2840 includes a side seat support 2842 and a front seat support 2844 that are firmly attached at an angle, such as a right angle, that supports the top seat panel 2838 in two dimensions. Top surfaces of the seat support 2840 lie in a single plane and are fastened to the top seat panel 2838. The seat assembly 2812 is removably and retractably attached to the caπel body 2810 by a moveable connector (not shown) that is firmly affixed to the top seat panel 2838 and movably connects to the seat track 2832. The seat assembly 2812 is generally a suitable size to fit completely within the cavity beneath the console housing 2808 when the seat assembly 2812 is positioned in a withdrawn position.

In an illustrative example, the moveable connector is a horizontal bar (not shown) with a T-shaped cross-section so that the T-connector is movably held within the C-shaped cross- section of the seat track 2832. In other suitable examples, the moveable connector may be a plurality of T-brackets (not shown) that are affixed at regular (or otherwise) intervals along the side of the top seat panel 2838. In other examples, the seat track 2832 may include a horizontally-disposed rod (not shown) that is disposed within one or more cylindrical hinges that are attached to the top seat panel 2838 and have a hollow cylindrical central lumen encasing the rod. A lock handle 2846 is attached to the seat assembly 2812 and is operated to engage the seat lock 2836. Other moveable attachment structures that are known to one having ordinary skill in the art may be used to movably connect the seat assembly 2812 to the caπel body 2810.

An alternative structure may include more than one seat lock 2836 disposed at various positions on the support side panel 2818 to selectively hold the seat assembly 2812 at a plurality of positions. For example, one seat lock 2836 may be disposed near the forward edge of the support side panel 2818 to permit a large adult to sit a comfortable distance from the console housing 2808. A second seat lock may be positioned a few inches back from the first seat lock to permit a smaller adult to more easily reach the console housing 2808. A third seat lock may be positioned a few more inches back from the second seat lock to fit a child within the health care test kiosk 110. A seat lock may or may not be positioned at an innermost location closest to the back panel 2816 so that the seat assembly 2812 may be fully enclosed into the health care test kiosk 110 to permit a user in a wheel chair to use the physiological test structure 2826. An inner seat lock may be omitted in consideration of allowing a weaker user to withdraw the seat assembly 2812 without reaching beneath the caπel body 2810 knee-space and having to disengage the lock. Alternatively, an inner seat lock may be employed to prevent the seat assembly 2812 from inadvertently rolling from beneath the caπel body.

While the invention has been described with reference to various embodiments, it will be understood that these embodiments are illustrative and that the scope of the invention is not limited to them. Many variations, modifications, additions and improvements of the embodiments described are possible. For example, those skilled in the art will readily implement the steps necessary to provide the structures and methods disclosed herein, and will understand that the process parameters, materials, and dimensions are given by way of example only and can be varied to achieve the desired structure as well as modifications which are within the scope of the invention. Variations and modifications of the embodiments disclosed herein may be made based on the description set forth herein, without departing from the scope and spirit of the invention as set forth in the following claims.

In the claims, unless otherwise indicated the article "a" is to refer to "one or more than one".

Claims

WHAT IS CLAIMED IS;

1. A test apparatus comprising: an ascultatory analyzer (1000) that is capable of sensing and analyzing an audio signal using Korotkoff sounds to determine a systolic pressure and a diastolic pressure; an oscillometric analyzer (1100) that is capable of sensing and analyzing oscillations of a pressure signal to determine the systolic pressure and the diastolic pressure; a pattern recognition analyzer (1200) that is capable of sensing a pressure envelope and analyzes the pressure envelope using a pattern recognition analysis by monitoring the envelope pattern to locate characteristic changes, and identifying systolic and diastolic pressures from the characteristic changes; and a comparison block (416) coupled to the ascultatory analyzer, the oscillometric analyzer, and the pattern recognition analyzer that determines an optimal systolic pressure result and an optimal diastolic pressure result based on results from the ascultatory analysis, the oscillometric analysis and the pattern recognition analysis.

2. A test apparatus according to Claim 1 further comprising: a pulse discriminator (700) that is capable of sensing and analyzing an audio signal including determining an audio signal slope and slope rate of change, the pulse discriminator generating a pulse signal that is used by one or more of the ascultatory analyzer, the oscillometric analyzer, and the pattern recognition analyzer to define a measurement cycle that is used for analysis.

3. A test apparatus according to Claim 1 or Claim 2 further comprising: a measurement cycle controller (800) that is capable of sensing and analyzing an audio signal using Korotkoff sounds to determine a measurement cycle start at a first Korotkoff sound and a measurement cycle end at a cessation of Korotkoff sounds.

4. A test apparatus according to any of Claims 1-3 wherein: the ascultatory analyzer includes a filter that sorts sound components of Korotkoff sounds.

5. A test apparatus according to any of Claims 1-4 wherein: the oscillometric analyzer senses a pressure pulse height, determines a mean pressure and an empirical systolic ratio to find a systolic pressure pulse and associated systolic pulse cuff pressure, and determines a mean pressure and an empirical diastolic ratio to find a diastolic pressure pulse and associated diastolic pulse cuff pressure.

6. A test apparatus according to any of Claims 1-5 wherein the pattern recognition analyzer further includes: an input terminal (1202) that is capable of being coupled to a microphone (211) for detecting an audio signal; a filter (1206) coupled to the input terminal that smoothes the audio signal; a differentiator (1208) that magnifies a residual noise component of the audio signal; and a pattern analyzer (1210) that detects an asymmetric "W" pattern during a pulse interval.

7. A test apparatus according to any of Claims 1-6 wherein the pattern recognition analyzer further includes: an input terminal that is capable of being coupled to a microphone for detecting an audio signal; a first latch (1212) that latches a systolic pressure and sample count; and a second latch (1214) that latches a diastolic pressure and sample count.

8. A test apparatus according to any of Claims 1-7 further comprising: a blood pressure cuff (213); a pressure pump (506) coupled to the blood pressure cuff; and a controller (106) coupled to the pressure pump for controlling pressure in the blood pressure cuff.

9. A method of measuring blood pressure of a test subject comprising: sensing an audio signal; analyzing the audio signal using an ascultatory analysis of Korotkoff sounds to determine a systolic pressure and a diastolic pressure; sensing pressure oscillations; analyzing the pressure oscillations using an oscillometric analysis; further including: determining mean pressure, systolic and diastolic blood pressure from the pressure oscillations; and identifying systolic and diastolic pressures from the mean pressure, and systolic and diastolic blood pressure; sensing a pressure envelope; analyzing the pressure envelope using a pattern recognition analysis including: monitoring the envelope pattern to locate characteristic changes; identifying systolic and diastolic pressures from the characteristic changes; and determining an optimal systolic pressure result and an optimal diastolic pressure result based on results from the ascultatory analysis, the oscillometric analysis, and the pattern recognition analysis.

10. A method according to Claim 9 further comprising: comparing the parameters measured using the distinct measurement techniques, determining mutually consistent limits for the distinct measurement techniques, and rejecting measurement samples outside the determined limits. Results produced by the distinct measurement techniques are combined to quantify an optimal systolic pressure result and an optimal diastolic pressure result.

11. A method according to any of Claims 9-10 further comprising: analyzing the audio signal including: determining an audio signal slope and slope rate of change; detecting a pulse based on the audio signal slope and slope rate of change; and generating a pulse signal that is by used one or more of the ascultatory analysis, the oscillometric analysis, and the pattern recognition analysis to define a measurement cycle.

12. A method according to any of Claims 9-11 further comprising: analyzing the audio signal using Korotkoff sounds to determine a measurement cycle start at a first Korotkoff sound and a measurement cycle end at a cessation of Korotkoff sounds.

13. A method according to any of Claims 9-12 further comprising: filtering the audio signal; sorting sound components of Korotkoff sounds in the audio signal.

14. A method according to any of Claims 9-13 further comprising: sensing a pressure pulse height; determining a mean pressure and an empirical systolic ratio to find a systolic pressure pulse and associated systolic pulse cuff pressure, and determining a mean pressure and an empirical diastolic ratio to find a diastolic pressure pulse and associated diastolic pulse cuff pressure.

15. A method according to any of Claims 9-14 further comprising: detecting an audio signal; filtering the detected audio signal; differentiating the audio signal to magnify a residual noise component of the audio signal; and detecting asymmetric "W" pattern during a pulse interval.