WO2005098726A2 - Systeme et dispositif pour l'enregistrement interactif d'un ecg/eeg et la commande interactive d'une procedure de diagnostic - Google Patents

Systeme et dispositif pour l'enregistrement interactif d'un ecg/eeg et la commande interactive d'une procedure de diagnostic Download PDF

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Publication number
WO2005098726A2
WO2005098726A2 PCT/HR2005/000023 HR2005000023W WO2005098726A2 WO 2005098726 A2 WO2005098726 A2 WO 2005098726A2 HR 2005000023 W HR2005000023 W HR 2005000023W WO 2005098726 A2 WO2005098726 A2 WO 2005098726A2
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Prior art keywords
communication
users interface
ecg
eeg
computer
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PCT/HR2005/000023
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English (en)
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WO2005098726A3 (fr
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Sasa-Ivan Vrdoljak
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Sasa-Ivan Vrdoljak
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Publication of WO2005098726A2 publication Critical patent/WO2005098726A2/fr
Publication of WO2005098726A3 publication Critical patent/WO2005098726A3/fr

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    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/60—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
    • G16H40/67—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation
    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q10/00—Administration; Management
    • G06Q10/10—Office automation; Time management

Definitions

  • This invention comprise not only client program that runs at a computer with standard operation system but also portable device (hardware) and embedded software for analog digital conversion of electrical signals and mechanical values (Blood pressure).
  • This invention enables measurement of the electrical signals and mechanical values at the body of a patient (ECG/EEG/Blood pressure) connected to the appropriate hardware controlled by the embedded program.
  • Video information i.e. picture of the patient in a real time is generated by standard system for video conferencing that has certificates for medical applications (i.e. PolyCom or Tandberg).
  • the standard system for video conferencing on the patient's side can establish communication (live video presentation of the patient) with the standard system for video conferencing at specialist medical doctor practice after commutation of communication channels enabled by web-agent at the host computer.
  • the standard system for video conferencing and digital blood pressure device are not subjects of this invention. Mentioned client-server program and mobile hardware of ECG/EEG device and connected digital blood pressure device enable acquisition, communication and analysis of ECG/EEG curves and blood pressure in a real time for remote patient.
  • invention is about portable ECG EEG device, standard digital blood pressure and standard system for video conferencing that can be controlled from a remote personal computer, PDA, cell phone or similar device that runs client program or equivalent of client program and communicates with server program through the Internet or other type of public network.
  • the Internet or other type of public network carries parameters that define functioning of mentioned device/blood pressure device/video conferencing system. Downloaded parameters define mode and way of functioning of the diagnostic equipment.
  • the portable ECG/EEG device, standard digital blood pressure and standard system for video conferencing transmit digitalized electrical value of ECG/EEG curves, value of measured systolic/diastolic blood pressure or picture/live video of patient's organs.
  • the class of invention is A 61 B 5/04 in its part that corresponds to ECG device.
  • EEGpart of the invention belongs to class A61 B 5/0476.
  • International class G 06F 15715 describes client-server program and its functions regarding distribution of signals/video information through the communication network, access control, arc-hive and compilation of the records and communicated data.
  • Background Art There is a need for medical diagnostic equipment that is simple to use in medical practices or by patients at their homes which enables communication and real time diagnostics by specialist ?MD. The need for remote i.e. telemedical specialist check-ups and examination exists in urban areas without specialist ?MD practices. Additionally, if a patient feels need for specialist MD diagnostics she can get it at her convenience at her home /office business trip/vacation in real time.
  • ECG/EEG/blood pressure and video conferencing examination of a patient is possible by means of adequate diagnostic equipment that can communicate through a pubhc communication network with the host computer and specialist - D's computer.
  • Web-agent application (pro-am) installed at the host computer provides commutation of communication between both sides.
  • On the client side are patients or GPs and on the server side are specialist ?MDs.
  • access to Web-agent application is possible by simple www, WAP or similar browsing program that brings clients and servers to DNS name or IP address of the host computer.
  • the host computer program must have the following functions: access control, archive and compilation of the records and communicated data.
  • Electrocardiography The first description of acquisition and recording of electric potential of human heart was in 1887. In 1887, scientists applied an instrument called “Electrometer", a device that was complicated and inaccurate by today's standards. Physicist and physician W.Einthoven did the first attempts to measure electric potential of human heart in order to recognize damage of heart muscle (Einthoven W. "The telecardiagram", American Heart Jurnal, 1957). W .Einthoven got Nobel Prize for medicine in 1924.
  • Einthoven introduced three standard leads i.e. electrodes on the human body that enable simultaneous acquisition of electric potential at the two spots.
  • the state of horizontal plane of a heart muscle derives from so-called pre-cordial leads defined by Wilson.
  • DrJEfolter introduced a method of continuous monitoring of bipolar leads for 24 hours or longer.
  • Electrocardiography is a wide applied diagnostic method that enables explanation for arrhythmia, logical explanation of correlation between variable link and T wave and ischemia of myocardium and hypertrophy of ventricul. From extensive literature, it can be recommended: Wolferth CC "Clinical electrocardiography: Offspring of science or empirism? Circulation 1957; Baric Lj. "ECG in practice” Zagreb, Libelli Medici Vol V.
  • ECG Electroencephalograph
  • Peterson is the author of an US patent 3,853,119 for a device that measures and displays ECG signals. Harris invented US patent 3,874,370 for a device that analyzes recorded waveforms of ECG signals. In 1977 Cherry was awarded a patent for Elecrocardiograp-hic computer i.e. computer that has hardware and software developed for measurement a d display of ECG curves.
  • Relevant EEG literature WO9533404, 12/1995, author is Aspect medical systems Inc.; US patent US5724987, author is Gevins et al (1998).; US patent US5687291, author is Smyth (1997.); and US patent US 5846208 filed by Pichl eyer, Eckert & Siemens AG(1998).
  • the purpose of this invention is to enable distribution and remote control of digital electronic techniques for acquisition, monitoiing and recording of ECG/EEG/blood pressure and video presentation of a patient. Electrodes placed at the skin of a patient gather ECG/EEG signals. Portable digital blood pressure device measures systolic and diastolic pressures. Video presentation of patient's body or her organs records standard video conferencing system.
  • the purpose of this invention is to enable commutation and direct communication of ECG/EEG/blood pressure/video conference, enabled by computer program at host computer, in a real time between client computer and server computer. The client computer and server computer exchange data on purpose to enable remote monitoring and control of diagnostic procedure. Remote specialist ?MD conducts diagnostic examination of a patient.
  • the Client and server computer exchange data before and during diagnostic examination.
  • Invented system stores patient's records and recorded signals/video information.
  • Invented system also includes billing functions based on records related diagnostic services.
  • -Invention makes possible simultaneous consultation/supervision of several GPs or teams of -MDs.
  • the purpose of this invention is to enable distribution and remote control of digital electronic techniques for acquisition, momtoring and recording of ECG/EEG/blood pressure and video presentation of a patient.
  • Acquired signals and live video of a patient have purpose to enable remote diagnostics of heart, brain or other parts of human anatomy, in its stationary and portable version.
  • FIG. 1 is a block schema of a general embodiment of the invention with the whole infrastructure necessary for functioning of the invention.
  • Established connection (l.i) s(4), after positive authorization or other kind of access control, makes possible for medical Doctor (l.i), in a real time, to observe and control electrical signals of ECG/EEG, value of systolic/diastolic blood pressure and video conference of remote patient.
  • a standard remote examination procedure comprise monitoring of ECG/EEG curves, measurement of blood pressure and video streaming of patients body/organs, display of heart rate/pulsing heart picture and analysis of recorded signals according to Minnesota algorithm in case of ECG and forecasting.
  • Medical Doctor (l.i) can set new conditions/parameters for the next signal acquisition session; she can communicate text, voice and pictures with patient (lO.j) or Medical Doctor who is with the patient.
  • the administration of all mentioned data (information) of the system is a function of a program at the host computer (4) that is two level communication.
  • Client and server program interface to the agent program using standard web-browser or WAP-browser.
  • Agent program checks IP addresses of communication devices (2.i) and (6.k) by sent queries to programs in devices (2.i) and (6.k). Agent program at host computer (4) checks whether gathered -EP addresses are authorized to access to services of the host computer (4). In case of positive authorization of both IP addresses, program exchanges IP addresses of both parties that are about to establish direct communication. After receiving IP address of the commimication counterpart, client program at the communication device (6.k) sends message to server program at communication device (2.i) in order to establish direct communication channel between these devices. Agent program at the host computer (4) that was a mediator in process of IP address exchange records start stop of direct communication between two communication devices.
  • the agent program at the host computer (4) records start stop of the communication, duration of the communication and the first part of communicated data like patient name/given name, diagnostic service.
  • Program at the host computer (4) also records the whole length of ECG EEG/video stream communicated between communication devices (6.k) and (2.i) on purpose to enable analysis and archive of data.
  • Patients (10.1, 10.2, ... 10.m) use corresponding devices (6.1, 6.2,....6.m), stationary or mobile and communicate through appropriate computer network (5.1).
  • Each device (6.j) that belongs to patient (lO.j) has similar technical characteristics like before mentioned devices that used by Medical Doctor (2.i).
  • Every device (6.j) is through communication channel (7.j) linked to the device (8.j) for communication and acquisition of electrical/mechanical values on the patient or live video of the patient/patient's organs.
  • Communication channel (7.j) can be LAN, parallel, serial, infrared or ultra sound or any other reliable communication in one and/or both directions between communication device (6.j) and the device for signal acquisition (8.j).
  • the device for signal acquisition (8.j) is connected by appropriate cables to a patient (lO.j) which comprise communication in above mentioned second level i.e. opportunity that Medical Doctor from group (1) supervise/control setup of parameters for acquisition and the acquired signals at one of the devices from the group (8) linked to die patient (10).
  • Communication channels (8.j) can be realized in various ways that are standardized and additional explanation is not necessary.
  • Communication channels (8.j) can be easily established by using standard parallel/serial interfaces at personal computer.
  • Communication channels (3) and (5) also belong to existing networking infrastructure that can be wired/wireless supported by adequate standardized communication protocols. Those communication channels are minimal preconditions for telecommunication channels/means for on-line link to host computer (4).
  • Device (8) can store once downloaded parameters that define acquisition/recording. The stored parameters define the way of acquisition and communication electrical signals if communication channel (7) is established.
  • FIG.2. shows one device (8.1) from the group shown at the ?FIG.l. used for acquisition "in situ” and that is a subject of this invention.
  • the device (8.1) has an input-output unit (UI) as an interface to communication channel (7.1) and further to hardware (6.1) that runs client program.
  • Hardware (6.1) using communication channel (7.1) communicates data to the device (8.1).
  • UI unit can be realized as standard parallel/serial connection but also as other adequate type of connection is not excluded like infrared, "Bluetooth” or IEEE standard 811.2b.
  • UI gathers information about inadequate voltage of batteries from an integrated circuit for power supply control (SPB) of batteries (B).
  • SPB integrated circuit for power supply control
  • UI unit communicates the information about inadequate voltage to hardware (6.1). Further, UI communicates all states important for proper function of device (8.1) to the hardware (6.1).
  • UI unit receives digital parameters and distributes them not only to integrated circuits that sore parameters (SP) but also to integrated circuits that control functioning of the device.
  • Digital parameters mean a routine check up of connected electrodes to a patient, parameters that define die way of acquisition of analog electrical signals (amplitude i.e. level of amplification, type of digital filter to be used, number of samples in A/D conversion per second etc.) and parameters that define the communication between device (8.1) and device (6.1).
  • a cable (9.1) transmits electrical signals from chosen spots at the patient's body (10.1) to the physical interface for the cables (INP). From this interface (INP), signals se led to the circuits for signal amplification (AMP).
  • AMP signal amplification
  • Opposite side of these cables (9.1) is connected to the electrodes that are attached to patients s-kin (10.1) Mentioned electrodes are covered with gel that minimizes resistance of the human skin. Gel has to be non-allergic in order to avoid reactions of the skin that is familiar to dermatologists.
  • Electric signal acquired at the skin of patient is amplified in the circuits for signal amplification (AMP) from the potential of human body (mV for ECG or uV for EEG) to level that is an input level to the integrated circuit for A/D conversion (A D). Range of digitalization is between - 2,5 and +2,5 V. Digitahzed values of signals are results of analog-digital conversion of amplified signal.
  • the inputOutput unit (UI) communicates signal via serial/parallel communication interface (7.1) to the hardware (6.1).
  • Communication channel (7.1) must provide Galvanic decoupling between hardware (1.1) and (6.1) in order to avoid potential problems with noise in signal from hardware (6.1) and environment.
  • FIG 2. shows a preferred embodiments of one device (8.1) according to the invention, that is shown in the HG 1.
  • FIG 3,4,5,6 and 7 show detailed schemes of circuits for signal amplification, A/D conversion and communication, respectively
  • MG 8. shows a whole scheme of the device shown in partial schemes at FIG 3-7
  • FIG 9,10,11,12,13 and 14 are a flowcharts showing the logical checks that are realized in a computer program
  • HG 15. shows a virtual console i.e. users interface for the device
  • ?FIG 16. shows an interface for manipulation of program parameters
  • FIG 17. is a flowchart showing the interface of the web-agent process on the host computer
  • FIG 20. is a flowchart showing the method of commutation between chent and server at the web-agent process on the host computer;
  • FIG 21. shows a schematic structure of the system according to the invention and its interfaces with the LAN and public communication network; FIG L and 2.
  • the device (6.1) is an IBM compatible PC with standard serial input output (RS232 interface) connected to serial communication cable (7.1) that is a pair of glass- fibers connected to the hardware (8.1).
  • a preferred embodiment of the present invention has 12 independent channels of ECG/EEG that make connection (9.1) and enable measurement at 12 different spots at a body of a patient.
  • the number of channels and level of signal amplification are not relevant for the present invention.
  • the level of signal amphfication the only difference between ECG and EEG version of the device, defines ratio of resistors connected to the input of operation amplifiers at the first and second level of signal amplification. Circuits (8.1) and program that runs at IBM compatible PC can operate in a mode when they are independent of communication with host computer.
  • Medical Doctor controls the functions of hardware (8.1) by typing in specific commands on chent IBM compatible PC (6.1) and monitors/controls/analyzes ECG/EEG signals at the screen of the chent IBM compatible PC (6.1).
  • a precondition for remote i.e. telemedical mode of operation when specialist ?MD controls/monitors at server computer operation of hardware (8.1) is exchange of IP addresses of the computers that are about to communicate. The exchange of the IP addresses of the both participants in the future communication is obtained after they access the web site that runs at the host computer. That web site includes a web-agent application that exchanges IP addresses of the computers that accessed the web site in order to communicate with adequate participant.
  • chent and server application can start the chent program.
  • the virtual console is realized at the chent IBM compatible PC and makes it possible to set parameters like amplitude (mV/mm or uV/mm), paper velocity i.e. time axe unit, number and representation of leads, various digital filters (base filter, 50/60Hz filter , 35Hz filter, fuzzy filter). It is common to fill the form with the patient's data before the acquisition and communication of the signals/video conference.
  • ECG/EEG strip by defining the duration in seconds or minutes.
  • screens of the client and server computers present pulsating heart (4x4 cm) in order to make it visible the pulse rate of the patient's heart.
  • user of the client and server application can shift signals left right on the time axe by moving slide-bar on the virtual console.
  • User of the client and server apphcation can stop signal acquisition whenever they want.
  • the client and server application can select the appropriate interface i.e. instrument at the virtual console that defines the diagnostic procedure.
  • At the virtual console user can choose between ECG/EEG/blood pressure devices. After selection of the appropriate device, user will see virtual console that represents ECG/EEG curves or two values in case of blood pressure.
  • the web-agent application at the host computer leaves the control to the video conferencing equipment (OSI apphcation level 4, ANSI level 7) at the both sides until the end of direct communication.
  • the host computer stores the streamed data together with the appropriate record containing: IP addresses of client and server video conferencing equipment, time of beginning/end of communication, duration of communication, name of the patient, type of the diagnostic procedure and the way of payment for the diagnostic service.
  • a program module in client application of the invention checks whether software and hardware parts of the invention function properly. In case of malfunction, mentioned program module in client apphcation stops measurement/video conference and informs users of client and server application.
  • the mentioned program module in the chent application can recognize that an electrode is detached from the patient's body or that voltage of the batteries is below allowed level. Mentioned program module in the client application displays an appropriate message about discovered problems at the virtual console of the client and server computer (remote diagnostic mode). Analyses of the data acquired by this invention are realized in a microprocessor of the IBM compatible PC. Parameters defining acquisition of ECG/EEG/blood pressure communicates IBM compatible PC through a serial output to the preferred embodiment of the present invention.
  • the preferred embodiment of the present invention is galvanic decoupled by glass-fiber (7.1) that has laser diodes placed at the ends. The glass fiber can withstand 10000V.
  • FIG 3 shows input circuits of the hardware of the preferred embodiment of the present invention for ECG/EEG apphcation.
  • the difference of hardware for ECG and EEG is only in ratio of the resistors at the input of the operation amplifiers that comprise first and second level of amplification of the signal.
  • the ratio of the resistors at the input of the operation amplifiers defines the level of amplification of the operation amplifier.
  • the input signal is in range of mV and for ECG input signal is in range of uV so the EEG signal needs 1000 times stronger amplification than ECG signal.
  • the ratio of resistors is chosen.
  • the values of resistors that define the level of amplification of the operation amplifiers are not essential for this invention. All 12 channels of the preferred embodiment of the present invention have the same elements embedded in the same electric circuits.
  • the first level of amplification is connected to the one side of the resistor Rl and R2.
  • the other side of the resistor Rl is connected to the output of the resistor R52 i.e. referent voltage.
  • the other side of the resistor R2 is connected to the pin number 5 i.e. "+" pole of operation amplifier UI (e.g. type TL071P).
  • Resistor R4 is connected between referent voltage at the output of the resistor R52 and pin number 2 i.e.
  • the other side of the resistor R3 is connected to the output of the operation amplifier i.e. pin number 7.
  • the pin number 7 is connected to the resistor R53 and capacitor CIO.
  • the other side of the capacitor CIO is connected to the one side of the capacitor Cl 1 and resistor R54 that is the beginning of the second level of the amplification.
  • Capacitor Cll is also connected to the "ground” (further GND) i.e. zero potential.
  • the second level of amplification begins from the resistor R54 that is connected to the resistor R57.
  • the other side of the resistor R57 is connected to the resistors R113, R128 and R129.
  • the common spot where the resistors R54 and R57 are connected is linked to the pin number 3 i.e. "+" pole of operating amplifier U15 (e.g. type TL071P).
  • the resistor R55 is on the one side connected to the same spot where "-"pole i.e. pin number 2 of an operating amplifier U15 and the resistor R56 connected.
  • the other side of resistor R55 is connected to the output of the operating amplifier U13 i.e. to the pin number 6 that is also connected to the pin number 2 at the operating amplifier U13.
  • One side of the resistor R56 is connected to the spot where pin number 6 i.e. output of the operating amplifier U15 connects with the resistor R116.
  • Diode Dll is connected in conductible direction (type e.g. BAT42).
  • Diode D10 is connected in a way that it short circuit to GND and the capacitor C35.
  • the side of the capacitor C35 is linked to GND.
  • Diode Dll is connected to potential of +5 V.
  • the common spot of the capacitor C35, resistor Rl 16, diodes Dl 1 and D10 are linked to the pin number 9 at A/D converter (e.g.type 4067).
  • the pin number 9 of the A D converter is the input for X0 signal at the integrated circuit number c (further IC4).
  • FIG 4. shows connection of operation amplifiers U13 and U14, both of type TL071P or similar.
  • Resistor R50 is connected to the electrode that is a referral potential of a patients body (conventionally right leg in case of ECG).
  • the other side of the resistor R50 is connected to the same spot where pin number 6 of operating amplifier U14 and resistor R51 connect.
  • the other side of the resistor R51 is connected to the pin number 2 i.e. "-"pole of operating amplifier U14.
  • Pin number 3 of U14 is connected to GND.
  • Pin number 2 of U14 is also connected to resistor R52 that is on its other side connected to the resistors at the input of the first level of amphfication as described in FIG 3.
  • Resistor 52 is also connected to pin number 3 i.e. "+" pole of operating amplifier U13.
  • Pin number 2 i.e. "-" pole of the operating amplifier U13 is short connected to pin number 6 and group of resistors of second level of amplification that are described in FIG 3.
  • Connected operating amplifiers U13 and U14 stabilize referral potential that is led to "-"inputs of operating amplifiers of the first and second level of amphfication.
  • Control circuit depicted in M?G 5 stabilizes voltage of power supply from a battery.
  • circuit In case of low voltage, circuit triggers adequate message to that is sent by serial communication to the client program that runs at IBM compatible PC. Client program interprets that particular message as a diagnosis of too law voltage and displays that information at the users interface i.e. virtual console. Batteries' voltage lower than 4,8V is considered as too law and inadequate for the accurate functioning of the device.
  • batteries In circuit for voltage control, batteries are connected to the spot where capacitors Cl and Clx meet. The other pole of capacitor Clx is connected to GND and output of diode D2 (e.g. type 1N4007 or similar), input of voltage regulator (e.g. IC 78T05 or similar). Output of voltage regulator is the spot where connect input of diode D2, one side of capacitors C2 and C3.
  • FIG 6 shows IC3,IC4,IC5 and IC6.
  • IC3 is ADM705 or similar in DIL8. This IC watches over the functioning of controller IC5.
  • IC3 is in charge of reset signal for IC5.
  • Pin number 1 of IC 3 is directly connected to pin number 8 of IC3.
  • Pin number 4 is at +5V.
  • Pin number 2 is connected to +5V together with pin number 28 and pin number 2 of IC5.
  • Pin number 3 at IC3 is at GND.
  • IC3 that is A D converter (e.g.type 4067 or similar) receives outputs of second level of amplification of signals.
  • Output signals are connected to the pins 9,8,7,6,5,4,3,2 and comprise X0 to X7.
  • Pins 23,22,21 and 20 comprise analog inputs for X8,X9,X10 and XI 1, respectively.
  • Pin number 15 is connected to GND.
  • Pins 10,11,14 and 13 are address bits that are set by controller and define the binary number of input signal (X0-X11) that has to be A/D converted. After A/D conversion, the digital value appears at the pin number 1 (x) and from there it is transmitted to the pins number 16 and l7 at IC5.
  • IC4 is a controller e.g. type 68HC705 (or similar in DIL28).
  • the pins 27 and 28 are connected to the system clock circuit.
  • the system clock is adjusted by quartz oscillator that has oscillation frequency of 3,68 MHz.
  • Pin number 26 is connected to resistor R10, one side of quartz oscillator and one side of capacitor C8.
  • the other side of resistor R10, other side of quartz oscillator and side of capacitor C7 are connected to pin number 27 of IC5.
  • the side of capacitor C8 and side of capacitor C7 are connected to GND.
  • Pin number 28 is connected to pin number 2 of IC3 and +5V.
  • Pin number 15 is connected to referral voltage.
  • Pins 10,9,8 and 7 are address outputs that define addresses of the input signal at the A/D converter IC4. Mentioned pins are connected to address inputs at the IC4.
  • Pin number 11 is output for serial communication of IC5 that is connected to pin number 10 at IC6 that is controller of serial communication.
  • FIG 7. shows IC6 that is controller of serial communication e.g. type Max232 (or similar in DILI 6). Between pins 1 and 3 is capacitor C4. Between pins 4 and 5 is capacitor C5. Pin number 10 is an input for serial communication with controller. Pin number 16 is linked to +5V and one side of capacitors C6 and CIO. The other side of capacitor C6 is linked to the pin number 2 while the other side of capacitor CIO is linked to pin number 15 and GND. The pin number 6 is connected to one side of capacitor C9 linked to GND.
  • Pin number 7 is an output for serial communication that can be connected to 2 nd pin of serial connector (type D9 as it is on the scheme) or laser diode that enables communication of pulses through the glass-fiber in case of optical cable.
  • Invented device is connected with adequate communication interface to similar device at the IBM compatible PC. Signals from the pin number 7 can transmit Bluetooth /811.2b or Infra Red interface but that is not essential for this invention.
  • FIG 8. shows the complete scheme of the hardware of the invention that is analyzed in MG 3,4,5,6 and 7.
  • FIG 9,10,11,12,13 and 14 FIG 9, 10,11,12,13 and 14 are flowcharts showing the logical checks that are realized in a computer program.
  • MG 9. shows logical start of the chent program.
  • FIG 14 shows logical start of the server program. Both, client and server programs use the same program functions that are shown in the flowcharts that follow in FIG10,11,12 and 13.
  • chent program can work in a stand-alone mode or in mode when it communicates with server program.
  • client program functions as ECG/EEG/blood pressure while video conference does not make sense.
  • server program specialist ?MD will be able to see ECG/EEG/blood pressure/video conference in a real time.
  • the precondition for client-server communication is a connection of a client program to the web application that runs at the host computer.
  • a standard web browser program is used for simple access to the web apphcation (number 4 in MG 1.) at the host computer.
  • Both parties in the communication, chent and server program independently connect to the web agent program with demand to communicate with its adequate counterpart (ECG/EEG/blood pressure/video conference).
  • Web agent program at the host computer checks and exchanges IP addresses between chent and server (sort of commutation) in order to enable their direct communication.
  • the part of the users program if comprises names, diagnosis, charged services can include encryption of data for security reasons.
  • Correct filed in communication parameters displayed at standard users interface (FIG 16) are stored by the chent application in the client's IBM compatible PC.
  • the next stage is setup of the parameters that define way of diagnostic procedure (sensitivity, velocity, duration of examination etc.). All mentioned parameters are checked up whether they are correct and only correct parameters are passed to the server application via TCP/IP communication protocol.
  • MG 15. virtual console
  • Chent application also checks whether all preconditions for the proper functioning of the device are fulfilled: voltage of the batteries, attachment of all electrodes to the patient's body and communication channels. Accepted and correct parameters are sent from client application to the device that does ECG/EEG/blood pressure acquisition. During the signal acquisition, chent apphcation continuously checks gathered signals and functionality of the device. After completion of the acquisition, client apphcation displays a message about successful completion of the measurement at the virtual console.
  • All acquired signals and values of the measured blood pressure is communicated either in a real time or after the measurement (data file) to the server apphcation via TCP IP protocol.
  • server apphcation via TCP IP protocol.
  • logical organization of client/server apphcations is one of the possible ways to reahze an interactive ECG EEG measurement by invented device (8.1) at FIG 2.
  • clinical studies also include various statistical tests that are commonly applied by specialist MDs.
  • MG 15 shows an example of preferred virtual console according to the invention. Virtual console has the same content for client and for server apphcation (same for MD and speciahst ?MD).
  • FIG 16 shows an example of preferred interface for the setup of the parameters that define communication of the virtual console with client server counterpart. In FIG 16 is visible "options" at the toolbar and pull down menu with "settings”.
  • FIG 17. shows an example of preferred interface of the web-agent and the method of commutation i.e. direct connection that occurs at the host computer. Additionally, FIG 17a,17b,17c and 17d show elements of the proffered interface that follow up after direct connection between chent and servers is established. MG 18. MG 18.
  • FIG 19. MG 19. shows content and format of preferred "record” that is saved in the memory of the host computer after completion of optical examination of a patient by video conference.
  • the “record” contains: equipment code, date of communication, time of beg ⁇ -ming and end of the communication, duration of the communication, type of communication (incoming/out coming), usage of e.g. first ISDN channel, usage of e.g. second ISDN channel, address type H 323, flag for voice transmission, -IP/phone number of the called party, IP/phone number of the calling party, bandwidth, bandwidth adaptation, selection of e.g. ISDN channel, cause for end of the communication, in case of communication error the full description why communication error occurred, code for type of call, code for call direction, code for H323 address, code for type of bandwidth, code for bandwidth adaptation, code for selection of e.g. ISDN channels, code for end of communication and code for detailed description of the end of communication.
  • MG 20. MG 20. shows method of commutation and communication between client application (at chent computer) and web agent apphcation (at host computer) until direct communication between chent and server at the applications level is established after exchange of IP addresses.
  • web agent supports HTTP protocol that is common for all web browsers.
  • Client application MD (10.k, FIG1) and server apphcation (l.i, FIG1) are maximum simplified for the users because the classical "dial in” and extensive and complicated configuration of IBM compatible PC are not necessary at all. Functionality is explained for the client side of the ECG application, which is analog for EEG/blood pressure and video conference. Communication protocol is TCP/IP.
  • FIG 21 shows one example of preferred system and location of the equipment and software (e.g. ECG) of the device according to the invention.
  • ?MD defines IP address of the host computer (or it is already defined) in web browser.
  • Web agent application at the host computer will enable communication with cardiologist who is at that moment also logged in to the host computer.
  • the names of available specialist ?MDs are displayed at the web board on purpose that MD can select one of them after successful log in procedure (user ID and password). MD selects cardiologist by clicking on the left button of mouse while cursor points to the cardiologist name at the web board.
  • Web agent apphcation recognizes ?MDs intention to communicate and conducts all needed steps until direct communication between client and server is estabhshed at application level (ANSI layer 7). Cardiologist if necessary sets up parameters before the examination (sensitivity, velocity etc.) and starts remote on-line acquisition of ECG.
  • Start of ECG acquisition means that client and server ECG application displays in a real time up to 12 ECG curves.
  • cardiologist stops the measurement and does the analysis of the ECG strip.
  • cardiologist informs ?MD about patient's diagnosis and recommends action therapy.
  • Record that contains all information regarding the communication is stored at the host computer. Those records are stored as archive of patient's database. Records are also base for billing of provided diagnostic services. Every record in database at the host computer has stored corresponding ECG EEG/blood pressure/video conference data.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • General Health & Medical Sciences (AREA)
  • General Business, Economics & Management (AREA)
  • Epidemiology (AREA)
  • Business, Economics & Management (AREA)
  • Medical Informatics (AREA)
  • Primary Health Care (AREA)
  • Public Health (AREA)
  • Measuring And Recording Apparatus For Diagnosis (AREA)
  • Management, Administration, Business Operations System, And Electronic Commerce (AREA)
  • Medical Treatment And Welfare Office Work (AREA)

Abstract

L'invention concerne un dispositif (8.k) à communication bidirectionnelle destiné à permettre l'établissement d'un diagnostic interactif fondé sur ECG/EEG/contrôle de la pression sanguine/vidéoconférence. A cette communication bidirectionnelle participe au moins un docteur en médecine (1.i) chargé de régler des paramètres numériques utilisés pour commander une procédure de diagnostic (fondée sur ECG/EEG/contrôle de la pression sanguine/vidéoconférence) et commander l'examen d'un patient (10.k), ou de quelques patients. A cet effet, on utilise un dispositif de communication (2.i) dont l'application du programme client est reliée, par un canal de communication (3.i), à un ordinateur (4) jouant le rôle d'ordinateur hôte effectuant des commutations et acceptant des paramètres numériques d'une procédure de diagnostic. Lesdits paramètres numériques de procédure de diagnostic sont communiqués, par l'intermédiaire du canal de communication (5.k), au dispositif de communication (6.k) du patient pourvu de l'application du programme client. Le dispositif de communication (6.k) du patient communique avec le dispositif (8.k) par l'intermédiaire du canal de communication (7.k). Les autres tâches effectuées par ce dispositif (8.k) sont les suivantes: a) échange des paramètres de ECG/EEG/contrôle de la pression sanguine/vidéoconference avec le dispositif de communication (6.k) du patient (10.k), lesdits paramètres et les informations concernant l'état du dispositif étant communiqués en retour au docteur en médecine (1.i); b) conduite, en fonction des paramètres numériques définis, de la procédure de diagnostic par liaison par câbles (9.k) concernant le patient (10.k) et fondée sur ECG/EEG/contrôle de la pression sanguine; c) réalisation, conformément aux paramètres numériques définis communiqués à l'équipement de vidéoconférence (à l'emplacement du dispositif 8.k), de la procédure de diagnostic fondée sur l'examen vidéo du patient (10.k); d) utilisation occasionnelle des paramètres stockés quand les dispositifs (8.k et 6.k) sont utilisés en mode indépendant en l'absence du canal de communication (5.k). Une interface utilisateur avec un programme client permet la connexion simple à l'application de l'agent Web sur l'ordinateur hôte (4). L'application de l'agent Web effectue la commutation qui est une condition préalable à la communication directe entre le client et le serveur. Au niveau de l'ordinateur hôte (4), l'application de l'agent Web effectue la commande d'accès, l'archivage et la compilation des comptes-rendus et des données communiquées.
PCT/HR2005/000023 2004-04-08 2005-04-07 Systeme et dispositif pour l'enregistrement interactif d'un ecg/eeg et la commande interactive d'une procedure de diagnostic WO2005098726A2 (fr)

Applications Claiming Priority (2)

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HR20040332A HRP20040332A2 (en) 2004-04-08 2004-04-08 Equipment for interactive electrocardiography or electroencephalography and interactive control of diagnostic process of ecg/eeg/blood pressure/video conference using communication network and recording, deposing and processing communicated signals and video data
HRP20040332A 2004-04-08

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CN107589700B (zh) * 2017-10-16 2024-06-04 浙江大学 一种脑电信号模拟发生装置

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