WO2005055111A2

WO2005055111A2 - Remote monitoring and reviewing of diagnostic, physiological and/or pathophysiological data

Info

Publication number: WO2005055111A2
Application number: PCT/GB2004/005106
Authority: WO
Inventors: Stewart Gregor Boyd; Ralph Andrew Smith; Alan Christopher Marshall Worley
Original assignee: Great Ormond Street Hospital For Children Nhs Trust
Priority date: 2003-12-05
Filing date: 2004-12-03
Publication date: 2005-06-16
Also published as: EP1706835A2; GB0328271D0; WO2005055111A3

Abstract

There is disclosed a method for reviewing one or more of diagnostic, physiological or pathophysiological data, comprising: monitoring said data; transmitting a request for a review of said data from a remote terminal to a server; creating a representation of said specified data at said server; and transmitting said representation of said data from the secure server to the remote terminal. The representation of the specified data can comprise an image representing the data, waveforms representing the data and video of the subject associated with the data.

Description

REMOTE MONITORING FOR DATA

Field of the Invention

The present invention relates to the provision of remote monitoring of data. The invention is preferably concerned with the remote monitoring of diagnostic or physiological and/or pathophysiological data. Such data may originate from a human or non-human source. The invention is particularly, but not exclusively, concerned with the remote monitoring of such data ordinarily available only in a private network.

Background to the Invention

Systems for monitoring physiological data from human patients are known in the art. Typically such systems may monitor information such as brain activity, muscle movements, heart rate, breathing, and blood pressure for example. Such physiological data is recorded electronically, and made available for diagnostic and/or analysis purposes.

Such monitoring systems have particular advantage in relation to patients having intermittent changes in behaviour, particularly epileptic seizures and sleep disturbances, which often require prolonged recordings of physiological variables in order to make a correct diagnosis.

At present, a patient is usually admitted to a specially equipped unit and is connected to various medical recording devices which measure various physiological data. It is also known, in such systems, for the physiological data to be synchronised to continuous video recordings of the patient's behaviour. Such recordings may continue for many days, and close review of the continuous traces or waveforms representing the physiological data and associated with the video recordings may be required to make decisions on treatment and/or further recording. During this review process, the waveforms are scrutinised and interpreted by an expert, often after changing various parameters such as amplitude, time-scale, and other aspects of the display. This expert opinion is often not available in an optimal time-frame fox the patient's management, because the expert is away from trie special unit, or because consultation between several people, each reviewing the recorded data, is needed to achieve a consensus. In addition, such expertise is not always locally available, and there may be a need to refer recordings elsewhere for a specialist opinion.

There is thus a technical problem associated with current monitoring systems, insofar as access to the system is only available at specific locations.

There are known in the art systems which allow data to be monitored from locations remote from the specialist equipment, for example by an authorised user logging-in to a patient monitoring system remotely. However in such known systems the data available for monitoring is determined at the location of the specialist equipment. For example, a user requiring remote access to data must establish the data to be accessed remotely before leaving a site where the specialist equipment is located. That specific data may then be accessed remotely by that user. It is an aim of the present invention to provide improved techniques for monitoring of such physiological data. Problems associated with the remote monitoring of patients, and monitoring or processing of data obtained from patients, also arise in the remote monitoring of other sources of diagnostic data. Diagnostic data is provided, for example, in engineering applications for assessing the performance of mechanical and electrical systems. In general, it is an aim of the invention to generally provided improved techniques for the remote monitoring and/or processing of diagnostic data.

Summary of the Invention

The invention provides, in various embodiments, secure and interactive remote access to waveforms representing captured physiological and/or pathophysiological data. In accordance with the present invention there is provided a method for remotely reviewing diagnostic data, comprising: transmitting a request for diagnostic data from a remote terminal to a server; and responsive thereto receiving a representation of said diagnostic data at the remote terminal.

In accordance with the present invention there is provided a method for remotely reviewing physiological and/or pathophysiological data, comprising:: transmitting a request for physiological and/or pathophysiological data from a remote terminal to a server; and responsive thereto receiving a representation of said physiological and/or pathophysiological data at the remote terminal . Said diagnostic data may be physiological or pathophysiological data. The method may further comprise the step of processing the received representation of the diagnostic data. The representation may be an image representing said diagnostic data. The representation may be an image representing said physiological and pathophysiological data. The representation may be at least one waveform representing diagnostic data. The representation may be at least one waveform representing physiological and pathophysiological data. The step of transmitting a request for diagnostic or physiological and/or pathophysiological data may further include the step of transmitting information to control the representation of the data.

The method may further comprise transmitting a request for an image to the server, and responsive thereto receiving said image .

Said image may be a video of a subject associated with said physiological and/or pathophysiological or diagnostic data. Said subject may be a patient. Said subject may be any living subject, including a human, animal or plant subject. Said subject may be an electrical or mechanical device.

Said video and said representation of the diagnostic data may be synchronised in time. Said video and said representation of the physiological, pathophysiological data may be synchronised in time. Said representation of said diagnostic data may represent such data over a certain period of time, a timing mark being provided on said representation to illustrate a correspondence with a currently displayed video image of the subject. Said representation of said physiological and/or pathophysiological data may represent such data over a certain period of time, a timing mark being provided on said representation to illustrate a correspondence with a currently displayed video image of the subject. The step of transmitting a request for an image may further include the step of transmitting information to control the image . Said image may comprise an image of a positioning sensor location for obtaining the requested physiological, pathophysiological data. Said image may comprise an image of an anatomical sensor location for obtaining the requested physiological, pathophysiological data.

The step of transmitting a request may comprise accessing a web browser, and selecting an option to request a representation of diagnostic or physiological or pathophysiological data.

Said server may be a secure server.

In a further aspect the invention provides a method for enabling remote reviewing of one or more of diagnostic, physiological, or pathophysiological data, comprising: receiving a request for a review of said data from a remote terminal at a server; creating a. representation of said data at said server; and transmitting said representation to the remote terminal. Said diagnostic data may be physiological and/or pathophysiological data. The method may further comprise the step of processing the received representation of the diagnostic, physiological, or pathophysiological data. The step of creating a representation of said diagnostic data may comprise creating an image representing such data. The image may comprise at least one waveform. The step of creating may comprise generating a portable network graphic file. In a further aspect the invention provides a method for reviewing one or more of diagnostic, physiological, or pathophysiological data, comprising: monitoring said data; transmitting a request for a review of said data from a remote terminal to a server; creating a representation of said specified data at said server; and transmitting said representation of said data from the server to the remote terminal.

Said diagnostic data may be physiological or pathophysiological data.

The method may further comprise the step of processing the received representation of the diagnostic, physiological or pathophysiological data.

The method may further comprise storing monitored diagnostic or physiological or pathophysiological data, wherein the requested data is stored data. The requested data may be currently monitored data. A computer program product may be adapted to store computer program code for performing any method herein. A computer program may perform any method herein^ The invention may also provide a central server for controlling access to monitored data, said data comprising one or more of diagnostic data, physiological data, or pathophysiological data, the server including means for receiving a request for data from a remote terminal; means for creating a representation of the requested data; and means for transmitting said representation to said remote terminal. The central server may comprise a web server, said means for receiving a request including means for receiving a request via an Internet access. The means for transmitting said representation to said remote terminal may comprise means for displaying a web page on a display of said remote terminal.

The specified physiological and/or pathophysiological data is preferably provided in combination with the specified video data. Preferably, the requested data is provided as a movie or video file, and combined with the video data. The physiological and/or pathophysiological data and the video data are provided in corresponding time segments. The physiological and/or pathophysiological data is preferably matched, in time, to the video data. When a segment of physiological and/or pathophysiological data is displayed as a waveform, a timing mark is preferably displayed thereon, which indicates a correlation to a currently displayed video image at an instant in time. The data provided for monitoring may be provided from a human or human source or patient. Reference to a patient in the following description may be considered to be a reference to a human or non-human patient or subject.

Brief Description of the Drawings

The present invention is now described by way of example with reference to the accompanying Figures, in which :- Figure 1 illustrates a system environment for implementing preferred embodiments of the invention; Figure 2 illustrates the method steps in implementing a first embodiment of the invention;

Figures 3(a) to 3(f) illustrate user interfaces in implementing the first embodiment of the invention;

Figure 4 illustrates the method steps in implementing a second embodiment of the invention;

Figure 5 illustrates the method steps in a preferred embodiment of the invention; Figure 6 illustrates a message flow in the system of Figure 1 in accordance with the preferred embodiment of Figure 1; and

Figures 7(a) and 7(b) illustrate exemplary waveforms displayed to a remote user in various embodiments of the invention.

Description of Preferred Embodiments The present invention is described herein by way of reference to particular examples and specifically with reference to certain preferred embodiments/implementations . It will be understood by one skilled in the art that the invention is not limited to the details of the specific embodiments given herein. It should be noted, in particular, that embodiments of the invention are described herein by way of reference to a particular example application for the monitoring of the physiological data of a human patient. The invention is not, however, limited to such an area of application. As will be understood by one skilled in the art, and become apparent from an understanding of the following description, the principles of the invention are not limited to the monitoring of physiological data. The invention may also be applied, for example, in the monitoring of pathophysiological data. The invention may also be applied, for example, in the monitoring of non-human data. Still further the invention is not limited to the monitoring of physiological or pathophysiological data, but rather may be applied to the monitoring of any diagnostic data. This may be diagnostic data obtained, for example, from monitoring an electrical or mechanical system.

Thus the preferred embodiments of the invention described herein are illustrative for conveying an understanding of the principles of the invention, and are not limiting to the scope of the invention.

Referring to Figure 1, there is illustrated a private network environment within which there is interconnected patient monitoring equipment and means for storing and displaying patient data; and remote equipment for accessing said private network via a public network, such as the Internet, in accordance with embodiments of the invention. In Figure 1, a secure private network 102 provides for interconnection of various network elements. These elements may be, for example, computers 114 and 116 connected to the network via communication links 115 and 117. The secure private network may support a large number of such computers 114 and 116. In addition, patient monitoring equipment is connected to the secure private network 102. The patient monitoring equipment may be connected to the secure private network directly or via a computer, as discussed below. Referring again to Figure 1, a data collection and control means 104 for collecting patient data is shown. The data collection means receives data on a plurality of input lines, in accordance with a given embodiment. In the embodiments of Figure 1, a video camera 106 transmits video data (either in analogue or digital form) on a communication link 107 to the data collection means 104. Similarly, audio data may be transmitted by audio detection means (not shown) to the data collection means 104. EEG sensors 108 transmit EEG (ElectroEncephaloGram) data on a communication link 109 to the

•data collection means 104. ECG (ElectroCardioGram) sensors 110 transmit ECG data on a communication link 111 to the data collection means 104. EMG (ElectroMyoGram) sensors 112 transmit EMG data on a communication link 113 to the data collection means 104. Other detectors may provide other patient data to the data collection means, as known in the art. In general, detectors may provide any desired physiological and/or pathophysiolocal data, which may be generally considered patient data, to the data collection means. In non- physiological applications, the sensors may monitor any parameters of a subject, such as a mechanical or electrical device, under test. In dependence on the implementation, one or more sensors are thus connected to communicate data to the data collection means 104. Such one or more sensors may include one of the sensors shown in Figure 1, or may include different sensors. It will be understood by one skilled in the art that the invention is not dependent upon any specific arrangement for sensing or collecting patient data. As further discussed herein below, the control functionality of the data collection and control means 104 is preferably adapted to control adjustment of the sensors 106 to 112, for example by turning the sensors on and off and adjusting the sensor settings.

The data collection and control means 104 may in practice be dedicated medical equipment specifically provided for the purpose of recording physiological data variables.

The data collection and control means 104 of Figure 1 is further adapted in the illustrated embodiment to be connected into the secure private network 102. As such, the data collection and control means 104 may be controlled by one or more appropriately adapted computers connected in the secure private network, such as computers 114 and 116. In addition, any appropriately adapted computer connected in the secure private network 102, such as computers 114 and 116, may be used to access data from the data collection means. Thus, for example, a user may monitor collected data by reviewing results presented on a screen of the computer 116, and may control the collection of results by transmitting commands from the computer 116 to the data collection and control means 104. Preferably control of the data collections means and control means 104, and access to collected data, is by a secure access. For this purpose, a central server 124 is preferably provided to control access to patient data. The central server 124 is connected to the secure private network 102 via communication link 125. Associated with the central server 124 there is provided two data storage means 136 and 128, and a further computer 122. The two data storage means 126 and 128 are connected to the secure private network 102 via communication links 127 and 129. The computer 122 is connected to the secure private network 102 via a communication link 123. The computer 122, central server 124, and data storage means 126 and 128, are further preferably interconnected by a communication lin! 142. In this preferred embodiment as illustrated in Figure 1, all patient data collected by patient monitoring systems associated with the secure private network, such as trie data collection means 104, is stored centrally in the data storage means 126 and 128. Although two distinct data storage means 126 and 128 are shown in Figure 1, the system may be implemented with one data storage means for all data. Alternatively there may be provided multiple data storage means determined by the capacity of data storage recquired. Alternatively there may be provided a distinct data storage means for each type of data. Alternatively there may be provided a distinct data storage means for each patient monitoring equipment. Such data storage means may be provided centrally, as in Figure 1, or may be distributed with the associated monitoring equipment. The storage of data in the data storage means 126 and 128, and access to data stored therein, is preferably controlled by the computer 122 adapted to perform a data management function. Thus data collected by the data collection and control means 104 is stored in the data storage means 126 and 128. The collection and storage of data from various patient monitoring systems, and access to such data, in an arrangement such as Figure 1 is well-known to one skilled in the art, and is not described in detail herein. In a preferred arrangement, the central server 124 or the computer 122 is adapted to run software for controlling access to the data stored in the data storage means 126 and 128. The computer 122 may be considered to be a host computer for the control of data collection, storage and monitoring.

Access to stored data may be enabled by providing a user interface on computers connected to the secure private network, such as computers 116 and 118, which enables users to ^Λlog-in' to access data stored by the data storage means 126 and 128. An authorised user may then access stored data. The central server 124 preferably provides the platform for such access, and stores the necessary authorisation information for users to access data, such as user names and passwords. The user ^log-in' to access the stored data is preferably in accordance with standard techniques for allowing registered users to access reserved data, the registration techniques for such systems similarly being conventional. With further reference to Figure 1, there is illustrated a further data collection means 120, for receiving patient data on input lines 144. The data collection means 120 provides the collected data on a communication link 121 to a computer 118 , which in turn is connected to the secure private network 102 via communication link 119. The data collection means 120 in combination with the computer 118 illustrate the interconnection of a data collection means to the secure private network 102 via a computer rather than via direct connection. It will be understood that the secure private network 102 is not necessarily provided in a single geographical location . The private network may encompass separate geographical sites , such as multiple hospital sites. Thus, the data collection and control means 104 may be provided at one location, and the computer 114 provided at a different location. An authorised user ^Λlogging-on' to the system at the computer 114 can thus access data accumulated at a different geographical location through a secure, internal' connection. Embodiments of the invention do not propose any adaptation to the arrangement for accumulating patient data in a secure private network environment as illustrated in Figure 1, or for the monitoring of such data in the secure private networ environment . The accumulated raw data is processed and presented in a form for analysis when a user logs-on to assess data within the secure private network. Specifically, the data is typicall presented as waveforms, plotting various accumulated data. The user logging-on to assess the data is typically an expert, the opinion of which is necessary for patient treatment. The provision of patient treatment is thus dependent upon the appropriate expert being available at a hospital site at which a terminal is provided connected to the secure private network 102. Thus, the technical platform for analysing data enabled by the secure private network 102 of Figure 1 may result in delayed intervention in the provision of patient treatment, owing to the appropriate expert not being on hospital premises . Often the opinion of multiple experts may be required. It becomes even more difficult to obtain the necessary opinions for patient treatment where there is a requirement for multiple experts to assess data together, such as by viewing from multiple computers such as computers 114 and 116, if one or more experts are not at the hospital site(s). The technical platform for viewing data is such that there may have to b a delay until all experts are available on a site having a connection to the secure private network.

Expertise may also, in some circumstances, be impossible to obtain locally, due to the necessary experts being permanently remote from the hospital sites associated with the secure private network 102. In such cases the expert may work at a location which does not have a connection in the secure private network. In such a scenario, the necessary data may have to be copied to disk and physically transported to the expert for assessment.

Thus, the ability to access the data depends on a user being able to access a computer which is connected to the secure private network, or to copy such data from the secure private network and transfer it to an individual for review. The technical platform for reviewing and assessing patient data provided by the secure private network arrangement thus has a technical disadvantage. Whilst the platform allows for an efficient and secure technique for capturing monitored patient data, the use of that data is limited by the technical limitations of the secure private network arrangement. However the access to the data through the secure private network 102 is important, due to the need for high security to ensure confidentiality of the accumulated data, which constitutes patient data. In accordance with embodiments of the present invention, there is provided a mechanism for remote access to the data within the secure private network. In the preferred embodiment the remote access is via a public network such as the Internet. Referring again to Figure 1, the secure private network 102 is provided with an external communication link 146, to enable communication for devices connected to the secure private network 102 external to the secure private network 102. For example, the external communication link may provide for external e-mail communication and Internet access. In addition the communication link provides for communication into the secure private network 102 from external sources. Although not shown in Figure 1, it will be understood by one skilled in the art of computer networks that the external connection from/to the secure private network on link 146 is preferably provided with some gateway means, which at least provides for security protection, such as a firewall.

As shown in Figure 1, the communication link 146 may provide a communication interface to a public network 130 such as the Internet. As further illustrated in Figure 1, many varied devices may be connected to the public network 130. For example, a desktop computer may connect to the public network via communication link 132, a laptop computer 134 may connect to the public network 130 via communication link 135, and a communication device 136, such as a PDA (personal data assistant) or mobile telephone (such as a ^λsmartphone' ) , may connect to the public network 130 via communication link 137. As is further discussed herein below, in accordance with embodiments of the invention a registered user of the patient monitoring system supported by the secure private network 102 may use a remote device, such as a computer 132, a laptop 134, or a communication device 136 connected to the Internet in order to access the patient monitoring system of the secure private network 102. In addition, a remote device such as a personal computer 140 may be connected to a further private network 138 via a communication link 141, which in turn is connected to the public network 130 via a communication link 139. The remote device 140 may further be used by a registered user for accessing the patient monitoring system of the secure private network 102 in accordance with embodiments of the invention, as described further herein below.

With reference to the flow diagram of Figure 2, a first embodiment of the present invention is now described. A remote user of the personal computer 132, for example, opens an Internet web browser in a step 202 of Figure 2 in accordance with standard Internet access techniques. Typically, this is a client web browser provided on a personal computer. The computer 132, in such an arrangement, may be considered to be a remote terminal. The user then utilises the Internet web browser to access an application interface to access patient data. An example of an application interface is shown in Figure 3(a). The application interface is provided as an Internet web page of a patient monitoring website, the website being supported by web server functionality of the central server 124. As illustrated in Figure 3(a), the application interface provides a user log-on screen for the user. The remote user logs onto the website using pre-registered log-in details. Preferably, the remote user is provided with a user name and password by the website administrator, to allow secure access. The username and password are entered into fields 302 and 304 respectively of the log-on screen, and then the user clicks (using a mouse, for example) on a ^Λclick here' icon 306. Other means of secure access to the website may be provided. In this way, a registered user logs-in as denoted by step 204 of Figure 2. The log-on details provided by the user are preferably the same log-on details required to access patient data when using a computer, such as computer 116, connected directly in the secure private network 102.

Once logged in, the website displays to the remote user a ^Λhome-page' on the screen of the computer 132. The home-page may be generic to all users, or specific to the logged-in user. The home-page provides, either directly or through a sub-page, a link for the remote user to access patient data. For the purposes of the present example, it is assumed that the home-page at least has a link to an option for selecting EEG data. It will be understood, however, that the website may allow various different types of data to be accessed. Figure 3(b) illustrates an example web page, with various options listed for selecting data. In this example, the user has an option for choosing between EEG data, ECG data or EMG data. A respective icon 308, 310, 312 is selected for the desired data. It should be noted that this is one possible example of a selection provided to the user. Before reaching the web page of Figure 3 (b) , the user may have to identify a patient, and the list provided in the web page may then list the available data types for that specific patient. Other options may exist for the presentation of options to a user, compatible with the menu options provided when accessing the data internally through a terminal, such as terminal 116, connected in the secure private network 102. Preferably the user interface and web pages provided to a user making a remote access in accordance with embodiments of the invention are consistent with the user interface provided when using the system directly on the secure private network, for ease of use. In the described example, the user selects EEG data by clicking the ^ΛEEG' icon 308, and in a step 206 the EEG home page is displayed. An example EEG home page is illustrated in Figure 3(c). Again, it should be understood that the EEG home page presented is preferably consistent with that which would be presented when accessing the system from within the secure private network 102.

Referring to Figure 3(c), the EEG home page may, for example provide a field 314 for entering a patient identifier, a field 316 for indicating whether real-time' data is required, and a field 318 for indicating whether archived data is required. Where archived data is required, then a field 320 provides for a start point to be entered (e.g. date and time), and field 322 provides for a finish point to be entered (e.g. date and time) . The user then makes the desired selection of EEG data from the EEG homepage of Figure 3(c) in step 208. On selection of the EEG data, a request message is transmitted from the remote computer 132 to the central server 124 hosting the website, for the identified data to be provided for display on the remote computer 132. Thus, a request for remote access to specified data is sent to the central server 124 from the remote computer 132. This request is for data specified by the remote user. The central server 124 then either accesses the stored data in the data stores 126 and 128, or real-time data direct from a data collection means such as data collection means 104 or 120. The server selects an appropriate segment of data.

In accordance with the invention, the system is adapted to transmit a display' of results based on the requested data to the remote user, and does not transmit the raw data to the remote terminal.

The generation of the display of results for the remote user, in dependence on the available raw data, is by an EEG generation software application running, for example, on the host computer 122 and/or the central server 124. The software application creates generic Portable Network Graphic (PNG) files from the raw data to display waveforms illustrative of the data. This graphic format is ^lossless' , allowing completely faithful replication of the data as recorded, while allowing better compression compared with other formats. This improved compression enables the waveform images thus created to be transmitted to the remote computer terminal with minimal transmission time and less bandwidth consumption. In a preferred embodiment, the server 124 is adapted to provide a portion of ^λx' seconds of data, as a waveform image, to a remote user at any one time. Thus if x is 30 seconds, and the user requests ten minutes of data, this is transmitted to the user as twenty separate transmissions. Referring again to Figure 2, responsive to the request for data, in step 210 the server converts ^λx' seconds of raw data, in this example raw EEG data, into a certain number of waveform images as web pages. Thus, for example, where x is 30 seconds, this may require the data to be displayed in three separate web pages, each of ten seconds duration. The number of web pages required for displaying x' seconds of data is denoted y^r . It should be noted that the data is converted into waveforms images and sent to the remote computer terminal as web pages for viewing at the central server; the raw data is not transmitted to the remote user for processing into a displayed format at the user side. All the manipulation of the data is performed within the secure private network 102 under the control of the central server 124.

Once the ^λx' seconds of raw EEG data are converted into y' web pages of waveform images, the web pages are ready to be displayed on the remote user's computer. In the example of multiple pages, the first of such pages is initially transmitted to the remote computer 132 from the central server 124 and displayed in a step 212.

An example of such a displayed web page is illustrated in Figure 3 (d) . For ease of illustration, Figure 3 (d) does not show the actual waveform display, although it is assumed that this would be displayed in a main window 324 of the page. An example of a waveform which maybe displayed in the window 324 is illustrated in Figure 7(a). Figure 7(a) merely illustrates an example set of a plurality of waveforms which may typically be analysed in assessing EEG data, as is familiar to one skilled in the field. The web page may be displayed with a number of options, presented as icons which may be selected by use of a mouse. For example, an option may be displayed to ^λgo to next page' as an icon 326. On selecting the next page in a step 216, by clicking on the appropriate icon 326 or menu option, the next page of EEG data is displayed. Thus on clicking on the go to next page' option, a request .for the next page is sent to the central server 124 from the remote computer 132, and the central server responds thereto by moving to the next page of EEG data in a step 218.

The central server, in a step 220, then determines if the current page is the last of the y pages. If not, then the next page is transmitted to the remote terminal and displayed in the step 212 again.

If the current displayed page is the last of the y pages, then the central server locates the next x' seconds of data, and converts such into a further y' web pages in step 222. These pages are then displayed successively responsive to requests from the remote user in step 212, by way of selection of ^λgo to next page' options, in the same manner.

The web page of Figure 3 (d) preferably also displays a properties' icon 328. If the properties icon 328 is selected, than a properties list is displayed on the remote user' s computer screen. The properties list is illustrated in Figure 3 (e) and includes, by way of example, icons 332 and 334 to enable a user to select an option to adjust the sensitivity settings and the filter settings respectively for the data. If after reviewing the properties list the remote user does not wish to change any parameters, then an icon 336 labelled ^Λhide' is selected to hide the event list, and the server reverts to displaying the page of EEG data. If the remote user does wish to change any parameters, then the icon 332 or 334 is selected to change the parameter. In one embodiment, this links to a further page whether the details of the changed parameter may be entered. In another embodiment, the properties list' web page of Figure 3(e) provides an input field (not shown) for entry of a new parameter.

The web page of Figure 3 (d) preferably also displays an ^Λevent-list' icon 331. If the event list icon 331 is selected, than an event list is displayed on the remote user' s computer screen in a step 224. An example event-list' page is illustrated in Figure 3(f). The event list may be provided as a pop-up screen or as an entire page.

The event list permits the remote user to obtain clinical annotations made during a recording. A user can click on the event list and have a resultant image sent to them. For example, the event may be EEG changes during eye closure as represented by icon 338 in Figure 3(f). Other events may be listed, as represented by icon 340. Step 226 of Figure 2 represents selection of an icon on the event list web page of Figure 3 (f) . Step 228 represents the action of hiding the event list, or closing the event list web page, responsive to selection of a hide icon 342. As a result of selection of an event from the appropriate web page, a message is transmitted to the central server 124 from the remote computer 132. The central server then converts x' seconds of raw EEG data as before, but in dependence upon one of more new parameters as represented by step 230. The ^Λy' web pages of waveform image generated from the data are then displayed as before in step 212. Preferably, each web page displays an option to terminate the reviewing of data, such as by display of an end' icon, which is not shown in Figure 3. On selection of the option to terminate the reviewing of data, a terminate message is sent to the central server. The central server then drops the transmission of web pages to the remote user terminal, and deletes the web pages compiled for such purpose. This is represented by step 240. As is illustrated by the foregoing embodiment, the invention provides a reliable and secure method for remotely viewing results based on physiological data and associated derived parameters. The invention merely requires an Internet browser, without any special adaptation or modification. The results can thus be viewed using a standard personal computer, laptop computer, PDA or mobile phone, or any other device providing Internet access.

The physiological data may be any one of a plurality of types of physiological data which may be monitored electronically. The physiological data may include, but is not limited to, EEG, ECG, EMG, limb and body movement, respiratory rate, air flow, oxygen saturation, and blood pressure. Any data which may be monitored securely through computers connected to the secure private network 102, may be monitored remotely in accordance with techniques described in accordance with embodiments of the invention. The review application enables a remote user to scroll through a physiological recording. The physiological recording may be a playback of an archived recording, or an active - ^λreal- time'- - recording. As well as scrolling through a physiological recording of based on captured data, the user can alter the format of the displayed physiological data, thus enabling remote control of the displayed data. The data format may be varied by, for example, varying the sensitivity or filter settings. The remote user can select and display any data stored or connected to the web server or data processing computer. Thus, in the embodiment of the invention described with reference to Figure 2, by use of a remote terminal provided with a web browser, a user can review physiological data by reviewing a display representing such data. The display is a waveform, presented as an image on a web page. The user may also use the web browser to adapt the display, by varying settings associated with the physiological data. In this way the user is able to view on demand a display representing physiological data, and control such display on demand.

In a further embodiment, the remote user utilising a system in accordance with the present invention is additionally able to access video information synchronised to a patient's physiological data. Referring to the flow chart of Figure 4, there is illustrated the flow chart of Figure 2 adapted to provide the functionality of remote video access in an alternative embodiment. Where steps of Figure 4 correspond to steps of Figure 2, like reference numerals are used. With reference to Figure 4, as in Figure 2 the steps 202, 204, 206, 208 and 210 are performed in order to select the EEG data to be displayed to the remote user. In a modification to the embodiment described hereinabove with reference to Figure 2, the web page as shown in Figure 3 (b) may be adapted to provide a further icon to select an option to display video with all data. In the example of Figure 4, it is assumed that such option to display video has been selected.

As such, after step 210 in a step 402 the central server 124 converts the image data in the ^λy' web pages into a movie file. The movie file is then combined with any available video footage .

The thus generated movie footage, preferably including video footage, is transmitted to the remote computer 132 and displayed for the user, as represented by step 404.

As represented by step 410, on display of the movie opening page on the remote terminal 132, the user selects an option to start the movie. After a certain elapsed time, the movie ends as represented by step 412. On completion of the movie, the central server 124 converts the next x' seconds of raw data into y' web pages in step 414. In step 416 the central server converts the y' web pages into a movie file. The thus converted movie file is then combined with video, if available. The thus generated video file is then transmitted to the remote computer terminal 132, and displayed in step 404 as before. As discussed hereinabove with reference to the embodiment of Figure 2, there is preferably further provided functionality to display an ^Λevent list' in step 224, and modify parameters associated with the display of data. As in the embodiment of Figure 2, in a step 226 the user may select the option to change parameters . If the parameters are changed, in step 418 the server converts ^Λx' seconds of raw data into the ^λy' web pages. Then in step 420, as in step 402 or step 416, the central server converts the web pages into a movie file, and combines such with an available video. The movie file is then transmitted to the remote computer terminal 132 and displayed on the screen thereof in step 404 as before. The purpose of providing the video data in conjunction with physiological data is to enable the patient to be viewed in conjunction with the data. In order for this information to be most useful, it is advantageous for the video data to be synchronised to the physiological data. The instantaneous physiological data thus corresponds to the instantaneous video display, enabling a remote user viewing such information to make a more accurate assessment of a situation in certain circumstances . The desirability of providing the video data synchronised to the physiological data provides a technical problem in so far as the time-locking of the physiological data to the video date must be achieved. Whilst the current video image presented on the display is a captured instant of video, this may be displayed in conjunction with a ten second waveform segment. It is advantageous for the point in this ten second waveform to which the current instant of displayed video corresponds to be displayed. It is therefore desirable to provide a mechanism for this, as the physiological data and the video data are recorded by separate recording means. Thus the picture' or image representing the raw physiological data must be matched in time with a video of the patient. In a preferred embodiment of the invention, this is achieved by controlling the video data such that it is played to the remote user at an appropriate time associated with the physiological data. In a preferred embodiment, the movie information is prepared for a remote user in ten second segments. A ten second portion of raw physiological data is captured, having a start point associated with a certain timing point. Once this ten second data is captured, it is converted to a PNG file. The PNG file is then converted to a movie file.

The video footage is similarly separated into ten second segments, each starting at a given timing mark. The movie file based on raw data associated with a given timing mark, is associated with a corresponding segment for movie footage having the same timing mark. The two associated segments, of movie file and video footage, are then transmitted together to a remote user. The movie file, corresponding to the raw data, is then preferably played by displaying the ten second portion of waveform on the display of the remote computer, with a sliding line, or other time indicator, indicating the 'current' point of the waveform corresponding to the displayed video. By virtue of this arrangement, a remote user does not strictly view physiological data in real-time, but with an approximate ten second delay. In practice, however, a ten second capture of physiological data is the minimum necessary to provide useful information, and as such this does not provide a drawback. In any event, the length of the segment of the data displayed to a remote user at any time may be varied from implementation to implementation. The ten second example given above is for illustrating an example only, and embodiments of the invention are not limited to such a specific arrangement. Referring to Figure 7 (b) , there is illustrated an example of display of such combined waveform and video data. The waveforms are displayed in a window 702. The video is displayed in a window 704. The waveforms in window 702 represent, for the sake of example, a ten second segment of data. The video in window 704 represent a current played frame of video. As discussed above, in order to fully synchronised the waveforms to the displayed video, a sliding line 706 is displayed in the waveform window 702. This line 706 represents the instant in time on the waveform corresponding to the currently displayed video image.

In this described embodiment of the invention, therefore, physiological data can be accessed and reviewed remotely in conjunction with video images by utilising an Internet browser, in conjunction with one or more generic plug-ins on the associated computer to support the video functionality. The functionality to enable a remote user to view video synchronised to a patient' s physiological data is thus provided. This embodiment of the invention further enables on-going recordings to be remotely controlled. For example, a recording may be started or stopped remotely. It is envisaged also that the video camera may be controlled to alter a view captured by the camera. As in the embodiment of Figure 2, parameters such as sampling rate may be remotely controlled for the captured physiological data. it should be noted that the display of video in conjunction with a display based on physiological data is not limited to the specific arrangement described above, where a movie file is generated from a PNG file based on the physiological data. The waveform images may simply be displayed in conjunction with the video images, without any generation of a movie file. Embodiments of the invention utilising the display of video are not limited to any specific technique for representation of the physiological data in conjunction with the data representation . In a further embodiment, the representation of the physiological data, preferably a waveform image, may be displayed in combination with a further image. For example, an image of a part of the human anatomy may be displayed, which is associated with the physical points from which the physiological data is being obtained. Where a waveform image displays a plurality of waveforms, each waveform may be associated with an individual sensor. An image maybe displayed of, for example, a head indicating where each sensor is located on the head. Such image may be two or three dimensional. The user may be able to 'click-on' a specific waveform, and responsive thereto the location of the associated sensor maybe displayed on an image. Thus, in general, in embodiments the invention provides for the display of physiological data in combination with at least one image. In one embodiment the image is video footage of a patient under observation. In another embodiment the image is alternatively, or additionally, a representation of the physical location of physiological sensors. The central server 124 may be further adapted, in embodiments, to maintain a log of accesses made by remote users, and the information requested. This may comprise centrally storing a copy of the image files transmitted to the remote user, or simply details of the request that was made. In this way a system use audit may be carried out. Historical data available in the data stores associated with the central server may preferably be accessed, as discussed above, for clinical diagnostic purposes. In alternative arrangements, however, such information may be used for other purposes, for example teaching. The use of the remote access is particularly advantageous for teaching purposes, where the teaching location is remote from a site having a connection in the secure private network 102.

With reference to Figures 5 and 6, a more detailed example of the operation of a preferred embodiment of the invention is now described.

Figure 5 illustrates a flow process in the preferred embodiment, and Figure 6 illustrates a messaging flow in the preferred embodiment. This preferred embodiment may be implemented in the exemplary network arrangement of Figure 1. For the purposes of this preferred embodiment, the interconnection between a client web browser running on the remote computer terminal 132, the central server, or web server, 124, and the EEG generation software application, for example running on the computer 122, is illustrated. The EEG home page or sub-page is displayed, as discussed above, on the display of a remote computer terminal being used by an authorised user. The page is caused to be displayed by the central server 124. In a step 502, the user selects an EEG type on the client web browser. In a step 504, the user then selects an EEG recording (patient specific physiological data) on the client web browser. The selected EEG recording, i.e. user specified physiological data, is then requested by the user by selecting an appropriate action on the client web browser in step 506. As a result, a data request message "DATA REQUEST (value)" 602 is transmitted from the remote terminal 132 to the central server 124. The data request message includes user defined information in at least one value field thereof, being the identity of the data requested by the user.

On receipt of the data request message 602, the central server starts an EEG CGI (common gateway software) script in a step 508. THE CGI is a set of rules, as known in software, for describing how a web server communicates with another piece of software running on the same machine. In a step 510, the central server then launches the EEG generation software. The launch of the EEG generation software is initiated by the central server 124 transmitting an EEG launch message EEG LAUNCH 604 to the computer 122.

Responsive to receipt of the EEG launch message 604, the EEG generation software application running on the computer 122 processes the EEG data for display to the remote user. In a first step 512, the EEG parameters passed from the client web browser are parsed. In a step 514, the user is then provided with options to: delete files; generate an EEG; or to generate an event list. If the user requests the option to delete a file, then in step 516 the requested files are deleted. In step 518 the user is prompted for any further requests. If the user answers that there are' further requests, then the process returns to step 514. If there are no further requests, then the process moves to step 520. In step 520, a finish message FINISH 606 is sent directly from the application running on the computer 12 to the remote computer 132. The message writes directly to the client web browser, with a hyperlink back to an EEG request. As represented by step 522, the web page is shown and then in step 504 the user may again select EEG recordings as before. If the user requests the option to generate an event list in step 514, responsive to selection of an event/event update, then in a step 574 an event file is found. The located event list is then processed into a bar chart in a step 576. In a step 578 an ASP is generated with a montage, filter and sensitivity features.

In a step 580 the user then selects whether the operation is for an event or an event update. If the operation is an event update, then the process returns to step 514 with the option to: delete files; generate an EEG; or to generate an event list.

If in step 580 the operation is for an event, then an event response message EVENT RESPONSE 608 is transmitted from the application on the computer 122 to the client web browser running on the remote computer 132. The message writes directly to the client web browser with the event image. On the client web browser, an event bar is displayed in a step 584 for the event. In a step 586, the user clicks on the event bar to select a portion of the EEG to review. In a step 588 the request to review the EEG is submitted to the web server, and the process reverts to step 508. Thereafter, a further data request message 606 is transmitted, as above, with the selected portion of the EEG for review included as a variable therein. If the user requests the option to generate an EEG in step 514, then in a step 524 an event file is found. In step 526 an event list is then compiled. In step 528 the requested section of the EEG is then found. The details of the preceding section of the EEG are then obtained in step 530. The number of web pages associated with the requested EEG section are then determined in step 532. A predetermined maximum number of pages may be set.

In a step 534 the event list is evaluated up to the time of the first page for montage, filter and sensitivity settings. In step 536 the settings for the requested montage, filter and sensitivity settings are adjusted. Then in a step 538 the current page number is set to zero in preparation of construction of the first page. In step 540, a filename is created based on an index number, the section of the EEG, and the page number. In succession, the following steps are then performed to create the page associated with the file name: - in step 548 the data is read; - in step 550 a data montage is created; - in a step 552 filters are applied; - in a step 554 an image matrix is generated from the data; - in a step 556 any event text is added; - in step 558 a calibration bar is added; - in step 560 the montage text, date and time are added; - in step 562 a PNG image file is generated; - in step 564 an ASP is generated, including links for next/previous pages, event ASP and delete command. Thereafter, in a step 566 it is determined whether the page just created is a first page or a specifically requested page. If it is not a first page or specially requested page, then in a step 544 it is determined whether the last page has been finished. If the last page has been finished then the process moves to step 546, and the software routine is exited.

If the last page has not been finished, then the page number is incremented in step 542, and then steps 540 to 564 are repeated for the new page. If in step 566 it is determined whether the page just created is a first page or specifically requested page, then in step 568 a page response message PAGE RESPONSE 610 is transmitted from the application on the computer 122 to the client web browser running on the remote computer 132. The message writes directly to the client web browser with the event image for the created web page. This web page includes links for the next/previous web page, event ASP, and delete command. As a result, the EEG page is displayed in step 594 on the client web browser. If the user clicks on the option for the event ASP, then in step 590 the event montage is shown, with filter and sensitivity settings. The user may select changes to any of the displayed information. Such changes are submitted to the web server in step 592 by reverting to step 508 and generating a further request message including a variable identifying the selected changes . If, after display of the EEG page in step 594, the user selects the next/previous page, then in step 596 it is determined whether the next/previous page exists. If the next/previous page does exist, then the page is requested internally^' to the client web browser, and displayed in step 594. If the next/previous page does not exist, then in step 598 a request for the next web page is submitted to the web server by reverting to step 508, and a data request message is again transmitted to the central server with variable data included identifying the next page to be provided.

Embodiments of the invention described herein do not any modification to the operation of the control mechanism for the access and provision of physiological data and images as provided for access from within the secure private network, other than to adapt the server 124 and/or the host computer 122 to respond to a remote request, and to compile results for remote review in a given format responsive to such request. The server 124 is also preferably adapted to support a website providing external access to the new functionality. As mentioned at the outset, the invention is described herein by way of reference to an illustrative embodiment in which physiological data of a human patient is monitored. In general, however, the invention is not limited to such an implementation, and more generally is suitable for monitoring physiological and/or pathophysiological data collected from monitoring of a human or non-human subject. Still further, in alternative arrangements the principles of the invention apply to the monitoring of any diagnostic data, other than physiological and/or pathophysiological data. In such alternative applications there may particularly be provided a method for remotely reviewing diagnostic data, which comprises transmitting a request for diagnostic data from a remote terminal to a server, and responsive thereto receiving said said diagnostic data and a video image associated with sad data at the remote terminal. In this way, a diagnostic signal in combination with a video signal may be used to, for example, remotely diagnose and repair engines or mechanical/electrical equipment generally. The video representation is preferably a video of a source associated with said data, such as the device under diagnosis. The video and the representation of the data are preferably synchronised in time. The representation of the diagnostic data may be at least one waveform representing data. The step of transmitting a request for data may further include the step of transmitting information to control the representation of the data. The technique may comprise transmitting a request for an image to the server, and responsive thereto receiving said image. Said representation of said diagnostic data preferably represents such data over a certain period of time, a timing mark being provided on said representation to illustrate a correspondence with a currently displayed video image. Said image may comprise a representation of a sensor location for obtaining the requested data. This may, for example, be a location of a sensor on a vehicle. The step of transmitting a request may comprise accessing a web browser, and selecting an option to request a representation of data. In another implementations a method for enabling remote reviewing of diagnostic data is provided, comprising receiving a request for a review of data from a remote terminal at a server; creating an image of said data at said server; and transmitting said representation to the remote terminal. The image may comprise at least one waveform. In a further alternative implementation a method for reviewing diagnostic data is provided comprising: monitoring data; transmitting a request for a review of data from a remote terminal to a server; creating a video image of said specified data at said server; and transmitting said video image of said data from the server to the remote terminal.

Monitored data may be stored, wherein the requested data is stored data. The requested data may be currently monitored data.

The data may be obtained from mechanical or electrical equipment .

A central server may control access to monitored data, the server including means for receiving a request for data from a remote terminal; means for creating a video representation of the requested data; and means for transmitting said video representation to said remote terminal. The central server may comprise a web server, said means for receiving a request including means for receiving a request via an Internet access. The means for transmitting said representation to said remote terminal comprise means for displaying a web page on a display of said remote terminal. Thus, in alternative arrangements, features of the described embodiments of the invention may be combined to allow the remote monitoring of data in combination with video images of the source of such data. This allows, for example, test data to be accumulated from a vehicle engine and monitored, remotely, in conjunction with contemporaneous video images of the engine from which the data is derived.

In addition to the example of monitoring data and vdeo images from an engine, other examples of the use of this principles may allow for the remote monitoring of any electrical or mechanical device. In the field of automotive technology, this may, for example, monitoring parameters obtained from sensors fixed to the vehicle, in combination with an image of the vehicle .

Other subejects which may e diagnosed include, for example, such electrical equipment which is located at inaccessible locations .

The invention is described herein generally by way of reference to exemplary embodiments. The invention is not limited, however, to the details of any such embodiments. The scope of protection afforded by the invention is defined by the appended claims.

Claims

CLAIMS 1. A method for remotely reviewing diagnostic data, comprising: transmitting a request for diagnostic data from a remote terminal to a server; and responsive thereto receiving a representation of said diagnostic data at the remote terminal .

2. A method for remotely reviewing physiological and/or pathophysiological data, comprising: transmitting a request for physiological and/or pathophysiological data from a remote terminal to a server; and responsive thereto receiving a representation of said physiological and/or pathophysiological data at the remote terminal.

3. A method according to claim 1 wherein said diagnostic data is physiological or pathophysiological data.

4. A method according to any one of claims 1 to 3 further comprising the step of processing the received representation of the diagnostic data.

5. A method according to any one of claims 1 to 4 wherein the representation is an image representing said diagnostic data.

6. A method according to any one of claims 2 to 5 wherein the representation is an image representing said physiological and pathophysiological data.

7. A method according to any one of claims 1, 4 or 5 wherein the representation is at least one waveform representing diagnostic data.

8. A method according to any one of claims 2, 3 or 6 wherein the representation is at least one waveform representing physiological and pathophysiological data.

9. A method according to any preceding claim wherein the step of transmitting a request for diagnostic or physiological and/or pathophysiological data further includes the step of transmitting information to control the representation of the data.

10. A method according to any preceding claim further comprising transmitting a request for an image to the server, and responsive thereto receiving said image.

11. A method according to any one of claims 5 to 10 wherein said image is a video of a subject associated with said physiological and/or pathophysiological or diagnostic data.

12. A method according to claim 11 when dependent upon any one of claims 2, 3, 6, or 8 to 11 wherein said subject is a patient .

13. A method according to claim 11 when dependent upon any one of claims 2, 3, 6, or 8 to 11 wherein said subject is any living subject, including a human, animal or plant subj ect .

14. A method according to claim 11 when dependent upon any one of claims 1, 3, 4, 5, 7 or 9 to 11 wherein said subject is an electrical or mechanical device.

15. A method according to any one of claims 7 to 12 to 15 wherein said video and said representation of the diagnostic data are synchronised in time.

16. A method according to any one of claims 7 to 12 or 15 wherein said video and said representation of the physiological, pathophysiological data are synchronised in time .

17. A method according to any one of claims 7 or 9 to 16 wherein said representation of said diagnostic data represents such data over a certain period of time, a timing mark being provided on said representation to illustrate a correspondence with a currently displayed video image of the subject .

18. A method according to any one of claims 7 or 9 to 17 wherein said representation of said physiological and/or pathophysiological data represents such data over a certain period of time, a timing mark being provided on said representation to illustrate a correspondence with a currently displayed video image of the subject.

19. A method according to any one of claims 10 to 18 wherein the step of transmitting a request for an image further includes the step of transmitting information to control the image .

20. A method according to any one of claims 10 to 18 wherein said image comprises an image of a positioning sensor location for obtaining the requested physiological, pathophysiological data.

21. A method according to any one of claims 10 to 18 wherein said image comprises an image of an anatomical sensor location for obtaining the requested physiological, pathophysiological data data.

22. A method according to any preceding claim wherein the step of transmitting a request comprises accessing a web browser, and selecting an option to request a representation of diagnostic or physiological or pathophysiological data.

23. A method according to any preceding claim in which said server is a secure server.

24. A method for enabling remote reviewing of one or more of diagnostic, physiological, or pathophysiological data, comprising: receiving a request for a review of said data from a remote terminal at a server; creating a representation of said data at said server; and transmitting said representation to the remote terminal.

25. A method according to claim 24 wherein said diagnostic data is physiological and/or pathophysiological data.

26. A method according to claim 24 or claim 18 further comprising the step of processing the received representation of the diagnostic, physiological, or pathophysiological data.

27. A method according to any one of claims 24 to 26 wherein the step of creating a representation of said diagnostic data comprises creating an image representing such data.

28. A method according to claim 27 wherein the image comprises at least one waveform.

29. A method according to claim 27 or claim 28 wherein the step of creating comprises generating a portable network graphic file.

30. A method for reviewing one or more of diagnostic, physiological, or pathophysiological data, comprising: monitoring said data; transmitting a request for a review of said data from a remote terminal to a server; creating a representation of said specified data at said server; and transmitting said representation of said data from the server to the remote terminal.

31. A method according to claim 30 wherein said diagnostic data is physiological or pathophysiological data.

32. A method according to claim 30 or claim 31 further comprising the step of processing the received representation of the diagnostic, physiological or pathophysiological data.

33. A method according to any one of claims 30 to 32 further comprising storing monitored diagnostic or physiological or pathophysiological data, wherein the requested data is stored data.

34. A method according to any one of claims 30 to 33 wherein the requested data is currently monitored data.

35. A computer program product adapted to store computer program code for performing the method of any one of claims 1 to 34.

36. A computer program for performing the method of any one of claims 1 to 34.

37. A central server for controlling access to monitored data, said data comprising one or more of diagnostic data, physiological data, or pathophysiological data, the server including means for receiving a request for data from a remote terminal; means for creating a representation of the requested data; and means for transmitting said representation to said remote terminal.

38. A central server according to claim 37 comprising a web server, said means for receiving a request including means for receiving a request via an Internet access.

39. A central server according to claim 38 wherein the means for transmitting said representation to said remote terminal comprises means for displaying a web page on a display of said remote terminal.

40. A method of accessing diagnostic or physiological or pathophysiological data substantially as herein described with reference to, or as shown in, any of the Figures.

41. Apparatus for accessing diagnostic, or physiological or pathophysiological data substantially as herein described with reference to, or as shown in, any of the Figures.