WO2008011063A2 - Procédé et système de revue à distance de données cliniques - Google Patents

Procédé et système de revue à distance de données cliniques Download PDF

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Publication number
WO2008011063A2
WO2008011063A2 PCT/US2007/016279 US2007016279W WO2008011063A2 WO 2008011063 A2 WO2008011063 A2 WO 2008011063A2 US 2007016279 W US2007016279 W US 2007016279W WO 2008011063 A2 WO2008011063 A2 WO 2008011063A2
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WO
WIPO (PCT)
Prior art keywords
data
server
medical
handheld device
physician
Prior art date
Application number
PCT/US2007/016279
Other languages
English (en)
Other versions
WO2008011063A8 (fr
WO2008011063A3 (fr
Inventor
Seema Holla
Praveen Dala-Krishna
Original Assignee
Mdatalink, Llc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US11/778,751 external-priority patent/US7974924B2/en
Priority claimed from US11/778,744 external-priority patent/US20080021741A1/en
Application filed by Mdatalink, Llc filed Critical Mdatalink, Llc
Priority to CA2657614A priority Critical patent/CA2657614C/fr
Publication of WO2008011063A2 publication Critical patent/WO2008011063A2/fr
Publication of WO2008011063A3 publication Critical patent/WO2008011063A3/fr
Publication of WO2008011063A8 publication Critical patent/WO2008011063A8/fr

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Classifications

    • 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
    • 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
    • G16H30/00—ICT specially adapted for the handling or processing of medical images
    • G16H30/40—ICT specially adapted for the handling or processing of medical images for processing medical images, e.g. editing
    • 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
    • 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
    • G16H80/00—ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records

Definitions

  • FIG. 1 is an illustration of a system for communicating medical information to a physician's handheld device according to an embodiment.
  • FIG. 13 is a flow diagram of a method for presenting moving images at a proper frame rate for presentation on a handheld device according to an embodiment.
  • patients' personal and medical information For diagnosing and treating patients, physicians rely on patients' personal and medical information. This sensitive information is collected and stored as patients' medical records and may include information such as patients' personal identity (e.g., name, address, date of birth, social security number, etc.), present and past medical history, physical examinations, vital signs, laboratory data, imaging data and any other measurements taken or treatments planned by healthcare providers. Because physicians rely on this data to manage patients, ready access to such records is important to reducing the time and cost of patient care and medical services.
  • patients' personal identity e.g., name, address, date of birth, social security number, etc.
  • present and past medical history e.g., physical examinations, vital signs, laboratory data, imaging data and any other measurements taken or treatments planned by healthcare providers.
  • Accessibility to medical records is particularly important when effective diagnosis and treatment depends on timely assessment of medical data.
  • quick diagnosis and proper treatment of an illness, injury or condition can mean the difference between life and death.
  • a patient with chest pain may be suffering a heart attack, in which case timely diagnosis and treatment may prevent death or long term disability of the patient.
  • the various embodiments provide systems, methods and apparatus for managing and transmitting various types of patient information to a physician's mobile device, such as a cellular telephone, and for transmitting the physician's orders back to an attending facility.
  • the various embodiments allow patient data from a collection device (e.g., medical diagnostic equipment) or a database containing patient data to communicate with a physician's mobile device thorough a server.
  • a collection device e.g., medical diagnostic equipment
  • a database containing patient data to communicate with a physician's mobile device thorough a server.
  • Such servers can be configured so that the importance of a medical emergency or situation may be accurately transmitted to the physicians.
  • the servers may also have a graded response capability wherein the server may contact the physicians in one or more different ways to ensure delivery of the data,
  • Examples of the types of data managed and communicated to a physician's mobile device include: patient demographic data, such as name, age, sex, current medications, prior diagnosis, etc.; time-variant one-dimensional data, such as electrocardiograms and electroencephalograms; still or moving images, such as ultrasound, X-ray, and catheterization lab images; laboratory results, such as cholesterol levels, urine test results, blood dissolved oxygen levels, etc.; and/or measurements of critical patient parameters, such as blood pressure, pulse rate, and body temperature.
  • patient demographic data such as name, age, sex, current medications, prior diagnosis, etc.
  • time-variant one-dimensional data such as electrocardiograms and electroencephalograms
  • still or moving images such as ultrasound, X-ray, and catheterization lab images
  • laboratory results such as cholesterol levels, urine test results, blood dissolved oxygen levels, etc.
  • measurements of critical patient parameters such as blood pressure, pulse rate, and body temperature.
  • the data may be processed prior to transmission in order to minimize file sizes to allow it to travel over
  • the various embodiments allow medical data to be accessed directly by a physician using a mobile device.
  • This access may include data interactions, such as on-demand data transfers between electronic medical record databases and the physician's mobile device.
  • the performance of such interactions may be optimized using multi-format networking, such as switching between wireless Ethernet and cell phone networks.
  • the SMS server 132 may include software to send timed and/or multiple messages to a physician's mobile device 150 until the relevant message data is successfully downloaded by the physician's device, or a response from the physician is logged by the data server 131 or the console 120. Alternatively, such functionality may reside in the console 120.
  • messages are received by physicians, they are able to declare whether they are available to review the patient's data. This declaration may be entered into the handheld device as a message or as a response to a menu option. If the response is in the negative, the server 130 may be configured to inform the user at the console 120 as to the physicians' lack of availability. The consult request can then be re-routed to other available physicians by the user via the console 120.
  • Authentication of a mobile device may be achieved by identifying unique identifiers on the cell phone, such as the telephone number, the serial number of the device, the transponder ID number, or any such identification data, all of which can be loaded on the server 130 during the mobile device registration process.
  • the user may select to add data such as, ECG records, step 230, of a patient to the message destined for the consulting physician. It will be appreciated that downloading ECG data, patient medical records and vital sign data may be performed in any order or sequence.
  • a mobile device 150 which receives an SMS message, step 260 will typically be configured with software applications capable of receiving and identifying SMS messages from data servers 131.
  • the background application may launch a main data review application on the mobile device 150.
  • the reviewing party may first need to authenticate his/her identity, step 261.
  • the data review application may, automatically or manually, download the data files, step 262, such as the ECG records, from the data server 131 through a wireless cellular network.
  • Medical image may also be a collection of three-dimensional (3D) data sets, such as a 3D CAT scan, or time-dependent 3D data sets (sometimes referred to herein as four- dimensional medical images), such as a cardiac 3D scan using a CAT scanner or an echocardiogram.
  • 3D images In order to display 3D images on two-dimensional display screens, such as a physician's handheld device, the images may be displayed in isometric form as isometric images. Similarly, time-dependent 3D data sets may be displayed as rotating isometric movies. Additionally, in some circumstances the physician may need to view photographs or video of the patient, the patient's injury, or a site of an operation (e.g., an image from an arthroscopic probe).
  • the data server 131 receives the transmission from the console 120, 317.
  • the data received at the data server 131 may include complete or partial image files in a known format along with the spatial and temporal description of the regions of interest identified, as applicable.
  • the image and message data are either transmitted to the mobile device 150 or are stored to be accessed by the mobile device 150.
  • the data server 131 then prepares to transmit the message and image data to the physician's handheld device.
  • image processing software operating on the server may format the images for that device. While an embodiment features the image processing software running on the processor within the mobile device 150, the preferred embodiment performs the image processing on an external processor, such as the console 120 or data server 131. Running the image processor software on an external processor shifts the processing load from the mobile device 150, which necessarily has limited processing and memory capability, to a processor which can be provided with sufficient processor and memory capabilities to complete image processing tasks very rapidly. Performing image processing on an external processor, such as the console 310 or the data server 320, can enable speedy transmission of data to the mobile device 150 by reducing the size of the file that must be transmitted.
  • the external processor performs the image processing steps of determining the portion of the image to display, including setting the aspect ratio, but instead of sending another image, it sends parameters (e.g., memory locations or image coordinates) that the processor can use to quickly generate the desired display from the image data stored in the handheld device's memory.
  • parameters e.g., memory locations or image coordinates
  • This embodiment may include software tools operating on the handheld device 150 and/or the data server 131 to facilitate the physician's tasks when the situation requires multiple actions as well as establishing multiple follow-up events or appointments. For example, the discharge of a pre-term birth patient may require a neonatologist referral, a pediatrics appointment, an obstetrics/gynecology office appointment, etc.
  • Software decision tools can aid the physician by presenting electronic fillable forms on the handheld device's screen that remind the physician of all actions, orders and events appropriate for the particular medical activity being addressed. For example, the handheld device may present a form in which the physician first selects from a menu the type of situation being addressed.
  • This continuous HTTP polling process also alerts the server 131 of the availability of the handheld device 150 for sending and receiving data.
  • the server can assume that the handheld device is not available or easily reachable through the cell phone data network.
  • the server 131 may then notify the handheld device of any new messages destined for that particular handheld device using an SMS message through the SMS server 132, step 755.
  • the server software will select one in every five pixels in the Y dimension.
  • the processed image is delivered to the handheld device as either a downloadable file or an image file delivered directly to the handheld device, 812.
  • the embodiment method illustrated in FIG. 8 is described above as transpiring on the server 131, the embodiment method may alternatively performed on the console 120 in a substantially similar manner.
  • the embodiment method may be performed on a processor connected or integral to the medical imaging system that is the source of the medical images (e.g., CT scanner, ultrasound imaging system, EKG system, etc.).
  • computer software configured to accomplish the method can be loaded onto or integrated into the functional software stored on the server 131 or medical imaging system.
  • the physician's notes, orders and/or requests can then be uploaded to the server using any data transmission protocol and system available via the wireless network.
  • the server then forwards the physician's notes, orders and/or requests to the appropriate network address. This address may be the point of data origination or other points in the hospital infrastructure. If the physician has requested additional data that is available on the server, such as display of another portion of a medical image, the server will prepare a data package in response and send it to the cell phone in a reply message as described above.
  • the server performs image processing on the received data by sub- sampling the image to generate images for transmission that appropriately suit the handheld device's screen resolution.
  • An embodiment of this process is illustrated in FIG. 10.
  • This embodiment solves three problems associated with displaying medical images on a handheld device.
  • a medical image 1010 can be quite large both in physical size and data content. Yet, only a small portion of the image may be of diagnostic significance to a physician.
  • a handheld device has a small screen and typically that screen has a low resolution compared to displays on workstations and personal computers that may be used to view medical images in the hospital setting.
  • Third, a handheld device has limited processing power given its power, size, and environmental constraints, and therefore cannot manage and display large files effectively.
  • the server may shift the sub-sampling function 1305 to the console, or even to the imaging unit providing the realtime data stream.
  • the server determines the best frame rate, 1303, such as by using the methods described above, and then sends the frame rate information to the console or imaging unit.
  • the console or imaging unit samples the real-time data stream to select data or image frames at the specified frame rate for transmission to the server.
  • the server then performs image resolution optimization on the receive frames, 1304, and transmits them on to the handheld device, 1306.
  • the server 130 receives the message performance information and determines the appropriate message repetition and reminder rates (i.e., time to wait before repeating a message transmission or sending a reminder) that should be implemented, 1406.
  • the server delivers the primary notification message to the handheld device, such as by posting an HTML polling or sending an SMS message, 1407, and begins a timer. If no response is received from the handheld device, which may be in the form of a request for the relevant data associated with a message, within the appropriate response time period, the server 130 will retransmit the message or send a reminder message to the handheld device, 1409. This process of waiting and retransmitting/reminding may continue a predetermined number of times, with the number of repetitions determined by preset policies or based upon the importance of the message.
  • step 1415 the server may send an SMS message to the handheld device and notify the console 120 of the changing in message methods, 1416.
  • the automatic recognition capability of the server, console, or server/console combination displays recognized diagnostically significant patterns to an operator on the console.
  • the system may display an ECG on the console and when a diagnostically significant pattern is recognized, shade, box, color or otherwise highlight the pattern on the display for the operator.
  • the operator can select the identified pattern for transmission to the physician's cell phone.
  • the system tools provides a semi-autonomous selection function where the system guides the operator to data of potential significance, but it is the operator that determines what is sent to the physician's cell phone.
  • the consoles are configured via software and/or security devices to limit access to authorized individuals. Any of well known security mechanisms may be used, including for example, recognition of a user's password, fingerprint, face shape, palm print, voice, and/or iris pattern, or a combination of one or more of these techniques. Additionally, the criticality or security level of uploaded data types of data can be manually or automatically defined.
  • the server may be configured by software to authenticate the identity of the user of the handheld device prior to sending data to the handheld device. Such authentication may be in addition to authentication accomplished by the handheld device itself. In such an embodiment, if the user of the handheld device will first authenticate himself/herself to the device in order to begin data communications with the server, followed by an authentication exchange with the server in order to begin receiving patient information.
  • user authentication methods may include, for example, a password which must be inputted on the handheld within a predefined time span following a prompt prior to the data request being sent to the server.
  • the server processes some or all of the data within the decrypted data layer to facilitate communication of medical diagnostic and image data to a physician's handheld device (e.g., a cell phone). Due to the limited memory and processing power of handheld devices like a typical cellular telephone, as well as the limited bandwidth for transmitting data via cellular telephone networks, the communication system my communicate only those portions of the data layer to be displayed or of interest to the physician. Thus, in a first example embodiment, the server may be programmed to process an image within the data layer to select for transmission to the handheld device only that portion of the image which will be displayed on the device.
  • the demographic data layer 2400 may be stored in server memory 2403 in a database of demographic files 2404 that is in a different file location or even on a physically separate memory (e.g., on a separate hard drive) from a database of data layers 2405.
  • This alternative file storage and data layer linkage configuration allows for complete blinding of the data layer (e.g., clinical data) from the encrypted patient demographics data.
  • this alternative adds an additional layer of security for data stored on the server, even from persons authorized to access the server.
  • the handheld 1 SO user logs onto the handheld using a unique user ID and password 2221.
  • This user authentication information is then combined with an identifier unique to the handheld device 2222 and the combination is sent to the server 2223.
  • Handheld unique identifier may be the telephone number of the phone, a number separately stored on the handheld in an undisclosed location and accessed internally by the software, the IMEI number which is unique to each cell phone handset, or other such unique identifier.
  • the server compares the received combination data to the user ID and password list 2214 and the authorized user list by phone number/device ID 2215 and authorizes the log in to the handheld device if a match is obtained 2216, 2224.
  • the process installs the key necessary for decryption or set of decryption keys, and/or the algorithm for choosing or generating the decryption keys 2304 for the demographics layer and for the data layer.
  • the server has no knowledge of the encryption and decryption of the demographic layer.
  • the key used to decrypt data layers may be the same key that is used to encrypt the layer originally (i.e., mirror keys), a different key.
  • each way-point may have a decryption key unique to the data layer it must access to enable its portion of the message processing and communication process.
  • a message may be separated into a demographics layer and data layer as described above, plus a message routing layer, a physician action layer, and a record-link layer.

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Abstract

L'invention concerne un procédé visant à sécuriser des informations médicales de patients pour une communication sur un système potentiellement vulnérable qui comprend la séparation du dossier médical du patient en une couche démographique et une couche de données, le codage de manière séparée de la couche démographique et de la couche de données à l'aide de différentes clés de codage, et la fourniture aux serveurs dans un système de communication de traitement d'une clé de décodage pour la couche traitée par un tel serveur. Les données de dossier médical peuvent être séparées en plus de deux couches. Les utilisateurs qui accèdent au système sont authentifiés à l'aide de techniques standard. Par le codage séparé des différentes parties d'un enregistrement médical de patient, le traitement et la communication de dossiers médicaux d'un patient par des serveurs intermédiaires est autorisée sans risquer une divulgation d'informations de patient sensibles si de tels serveurs sont compromis.
PCT/US2007/016279 2006-07-19 2007-07-18 Procédé et système de revue à distance de données cliniques WO2008011063A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CA2657614A CA2657614C (fr) 2006-07-19 2007-07-18 Procede et systeme de revue a distance de donnees cliniques

Applications Claiming Priority (6)

Application Number Priority Date Filing Date Title
US83182006P 2006-07-19 2006-07-19
US60/831,820 2006-07-19
US11/778,744 2007-07-17
US11/778,751 US7974924B2 (en) 2006-07-19 2007-07-17 Medical data encryption for communication over a vulnerable system
US11/778,744 US20080021741A1 (en) 2006-07-19 2007-07-17 System For Remote Review Of Clinical Data
US11/778,751 2007-07-17

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WO2008011063A2 true WO2008011063A2 (fr) 2008-01-24
WO2008011063A3 WO2008011063A3 (fr) 2008-11-20
WO2008011063A8 WO2008011063A8 (fr) 2009-07-23

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