WO2018171853A1 - Système de télémédecine pour le traitement à distance de patients - Google Patents

Système de télémédecine pour le traitement à distance de patients Download PDF

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Publication number
WO2018171853A1
WO2018171853A1 PCT/DK2018/050052 DK2018050052W WO2018171853A1 WO 2018171853 A1 WO2018171853 A1 WO 2018171853A1 DK 2018050052 W DK2018050052 W DK 2018050052W WO 2018171853 A1 WO2018171853 A1 WO 2018171853A1
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WIPO (PCT)
Prior art keywords
patient
therapist
data
processing unit
telemedicine system
Prior art date
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PCT/DK2018/050052
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English (en)
Inventor
Bettina Drefeld ERIKSEN
Peter Laugesen
Original Assignee
EWII Telecare A/S
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Publication date
Application filed by EWII Telecare A/S filed Critical EWII Telecare A/S
Publication of WO2018171853A1 publication Critical patent/WO2018171853A1/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
    • 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
    • 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
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/20—ICT specially adapted for the handling or processing of medical references relating to practices or guidelines
    • 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
    • G16H70/00—ICT specially adapted for the handling or processing of medical references
    • G16H70/60—ICT specially adapted for the handling or processing of medical references relating to pathologies
    • 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
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/091—Measuring volume of inspired or expired gases, e.g. to determine lung capacity
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/14532—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring glucose, e.g. by tissue impedance measurement
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
    • A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
    • A61B5/14551—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters for measuring blood gases
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/316—Modalities, i.e. specific diagnostic methods
    • A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]

Definitions

  • the present invention relates to a telemedicine system for remote treatment of persons in need of care. More specifically, the invention relates to remote treatment of persons in need of care by use of a common health database comprising person-specific data for targeting the information, treatment data, and treatment presented to the person in need of care by a therapist through a communications link between a set of processing units.
  • the health care sector is one of the largest expenses in a developed country. A significant part of these expenses are due partly to an aging demographic and partly to people suffering from chronic diseases. The need for periodic monitoring and/or care for an extended period, possibly lifelong, is characteristic for these demographics. Other, non- chronic or age-related cases may be in need of similar care, causing expenses to increase further. Another characteristic of the aforementioned demographics is the inevitable lack of bed capacity in institutions. This has the consequence that persons - having acute and/or non-acute needs - may be moved to aisles thus increasing the risk of contamination and decreasing the dignity of the hospitalised.
  • a well-known method for avoiding the need for hospitalisation in institutions, but still maintain monitoring and providing care, is by healthcare personnel visiting the person periodically.
  • a major drawback of such a model is the need for personnel spending time on transportation and thereby, personnel expenses are remained almost unchanged when compared to hospitalisation in institutions.
  • Another method is by use of a telemedicine system, where a therapist is in remote communication with the person in need of care through a communications link, e.g. through video and/or voice.
  • a communications link e.g. through video and/or voice.
  • the person may be hospitalised at home, while receiving instructions by a therapist situated in an institution. Persons not requiring hospitalisation, but rather periodic control, may further avoid travelling to an institution if such procedures may be carried out through remote guidance by a therapist.
  • a known telemedicine system discloses a health and security management apparatus for facilitating the management of health and security of a patient.
  • the apparatus comprises a communications device for communicating between a patient residence and a remote location, where the patient may be remotely monitored, a health monitoring arrangement arranged to obtain health data on patient health, the communications device being arranged to communicate the health data to the remote location, and a security monitoring arrangement arranged to obtain security data on security of the patient.
  • a major drawback of known telemedicine systems is the lack of interaction with the person in need of care, when no live consultation is scheduled, and lack of optimised working procedures for therapists performing telemedicine consultations. Further, known telemedicine systems do not provide targeted information and complete functionality of the possibilities offered by technology.
  • An object of the present invention is to solve some of the aforementioned problems. More specifically, it is an object of the present invention to target the care and treatment of the person in need of care. Targeting is manifested through both presenting targeted guidance and treatment when in remote communication with a therapist, and by presenting targeted treatment data when such remote communication has not been established.
  • a telemedicine system for remote treatment of at least one patient by at least one therapist
  • the telemedicine system comprising a therapist-operated processing unit comprising a first graphical user interface and a patient-operated processing unit comprising a second graphical user
  • said therapist-operated processing unit and said patient-operated processing unit are adapted for mutual communication via a public communication network of treatment data using said graphical user interface.
  • the system further comprises means for accessing health data in a common health database, said health database comprising patient-specific data of the at least one patient,
  • a therapist any health care person or care-giving person.
  • the occupation of the therapist is dependent on the specific case, but they may be doctors, nurses, care assistants, psychologists, psychiatrists, or physiotherapists. Multiple therapists may participate in the remote treatment.
  • a patient By a patient is meant any person in need of care or any person whose condition requires care, monitoring, or treatment, but where the condition is considered eligible for telemedicine. Conditions may be age-related, chronic diseases, cancer, mental disorders, or rehabilitation. For the person in need of care to be eligible for remote telemedicine, his/her condition may be evaluated by a relevant therapist. Multiple patients may participate in the remote treatment.
  • a processing unit comprising a graphical user interface (GUI)
  • GUI graphical user interface
  • any electronic device capable of performing computational tasks thus establishing a communications link and presenting information in a graphical user interface, preferably a screen.
  • processing units comprising a GUI being relevant for the present invention include tablets, phablets, smartphones, laptops, computers, and smartwatches. All said processing units are commercially available and may all be equipped with relevant modules such as cameras, speakers, and microphones.
  • mutual communication is meant the existence of a communications link between the therapist-operated processing unit and the patient-operated processing unit, wherein information or data is transferred, and which may be turned off occasionally without loss of targeting.
  • the communications link may be turned off by centrally turning off the Internet capabilities of the processing unit. Maintaining targeting, when the communications link is turned off, may be provided by saving treatment data onto a server.
  • the communications link is based on a public communication network, e.g. a public Internet technology, being either wireless or wired.
  • the network may also be a local network or non-public.
  • the communications link may be permanent or at least be required to allow functionality of the telemedicine system.
  • a permanent communications link may be understood that the patient-operated processing unit, or at least the aspects relating to the telemedicine system (e.g. a specific app), cannot be used without said processing unit being in communication with the common health database. Thereby, data obtained by the patient is necessarily communicated to the common health database. This has the advantage that said patient cannot refuse to share or prevent sharing his/her health data with the telemedicine system. Refusing to share his/her health data with the therapist contradicts the purpose of the telemedicine system according to the invention.
  • the communications link is permanent, data obtained or provided by the patient is ensured to enter the common health database, where it may be analysed or shared with a therapist.
  • a patient cannot oppose/work against the purpose of his/her treatment - this could be the case when the patient is mentally unstable or simply when said patient is incapable of managing technical aspects of the patient-operated processing unit.
  • a database any database adapted to write, store, and read data or information.
  • the data and/or information may be related to the patient.
  • a database management system is employed for the database to interact with other applications, such as processing units. Examples of database management systems include MySQL, Microsoft SQL Server, or Oracle Database.
  • database management system may support the relational model as represented by the SQL language.
  • any collection of data readable and writeable by a processing unit is meant.
  • health data any known health facts regarding the patient.
  • the health data may be physical measures of the patient, including weight, height, body composition, heartbeat, body temperature, blood pressure, and the like.
  • the health data may be previous and/or present diseases, conditions, medicine usage, prescriptions, preferences, and other data stored in external databases.
  • External databases may be already existing databases or logbooks in use in health institutions such as hospitals.
  • the common health database may read data from such external databases for improving the content of said common health database.
  • treatment data is meant any data relevant to the patient, including new prescription medicine, relevant newsletters, publications, instructions for exercises, nutrition schemes, operating instructions for sensors, videos, or any other material having a relevance to the condition of the patient, such that said patient is kept informed.
  • the treatment data may be communicated through text, video, or audio. Instructions and treatment advice given by the therapist orally is considered treatment data in the present context as well.
  • the treatment data presented are based on the patient-specific data stored in the health database, preferably having been related to inputs by the therapist.
  • treatment data communicated between the therapist-operated processing unit and the patient-operated processing unit is targeted by being modified according to the health data stored in the common health database.
  • the modification may be carried out manually following a notification from the therapist- operated processing unit highlighting deviations from the patient-specific data.
  • the treatment data being targeted is meant that the treatment data presented to the patient is relevant which is ensured through the modification being based on the health data comprised within the common health database.
  • the modification of treatment data is based on a comparison between inputs, preferably treatment data in text, but may as well be orally presented, from the therapist and patient-specific data stored within the health database.
  • the process of comparing inputs from the therapist to the patient-specific data stored in the health database may be carried out by relating input and patient-specific data word by word, abbreviation by abbreviation, number by number, or by any other comparison readily carried out by a computer.
  • the computer may be the therapist-operated or the patient-operated processing unit. Advanced comparison algorithms may be employed as well. Use of abbreviations for designating conditions is well known within the health sector.
  • software within the processing unit may decide whether the inputs are relevant to the condition of the patient. Decision may be based on predefined settings or may be incorporated through artificial intelligence. Following the above procedures, targeted treatment data is generated which may be presented to the patient through the second graphical user interface.
  • the means for accessing health data in the common health database could be a processing unit programmed to read patient-specific data in a database, e.g. via a patient ID. In one embodiment, it could be the therapist-operated processing unit which is further programmed to read this data, but as an alternative, a dedicated processing unit could be included for reading the data.
  • the means for modifying treatment data communicated between said therapist-operated processing unit and said patient-operated processing unit are based on said health data.
  • These means could be a processing unit enabling presentation of patient-specific health data on a graphical user interface of the therapist-operated processing unit and an input device such as a microphone, mouse, keyboard, or touch screen enabling the therapist to amend the treatment data based on the health data before communication.
  • Treatment data is to be understood as any data between the patient and the therapist relating to the treatment of the patient. This data could be shared via writing, audio, video etc.
  • the system further comprises means for comparing treatment data to be communicated from said therapist-operated processing unit to said patient-operated processing unit with health data in said common health database.
  • the means may comprise programmed computer algorithms embodied in a processing unit for comparing text and/or numbers.
  • the comparison may be word by word, number by number, or abbreviation by abbreviation. More advanced computer algorithms may be employed, such as artificial intelligence software or machine learning, thereby increasing the quality of the comparisons.
  • the comparison means may be used to assess whether content, e.g.
  • said means for comparing comprises means for deciding based on a predefined comparison criterion whether said treatment data should be communicated or a warning should be given to the therapist via said therapist-operated processing unit.
  • Pre-set values may be a guidance interval or known contradictions, such that the recommendation is not unhealthy or unrealistic.
  • Unhealthy recommendations may include the prescription of medicine contradicting other medicine already prescribed.
  • Unrealistic recommendations may be to perform an exercise not physically possible for the patient, e.g. due to lack of motion ability.
  • the system may produce a warning on the first graphical user interface of the therapist-operated processing unit, thereby requiring confirmation by the therapist before communicating such treatment data to the patient.
  • pre-set values may be based on previous recommendations set forth in other cases, or the entire comparison and control may be improved gradually during consecutive use of the system.
  • said means for comparing comprises means for suggesting alternative treatment data to said therapist based on said health data in said common health database.
  • the treatment data may be the therapist- recommended prescription of medicine contradicting already prescribed medicine known from the common health database.
  • the system may suggest an alternative to the therapist-recommended prescription, thereby easing the working procedure and optimising the treatment of the patient through the knowledge of said patient's condition and needs.
  • Other examples include the comparison between a therapist-recommended video and the knowledge stored in the health database. If the system finds the therapist-recommended video irrelevant to the patient based on the health data stored in the common health database, said system may have access to alternative videos, e.g. through an online video library or videos shared to other patients.
  • a clinical stage of a condition may be determined based on a comparison between patient-specific data and predefined limit values relating to the specific condition, both being contained in the common health database.
  • a clinical stage of a condition By a clinical stage of a condition is meant that multiple conditions/diseases are preferably divided into stages in order to better assess the symptoms or feelings experienced by the patient. The division into stages may follow rules according to common practice. Thus, determination of the clinical stage of the given condition/disease helps targeting the care/treatment.
  • a set of limit values are commonly employed.
  • a lower bound (a first limit value of the set) and an upper bound (a second limit value of the set) may delimit the stage, where the bounds/limit values relate to physical measures, e.g. lung capacity, oxygen saturation, body weight, body height, body temperature, etc.
  • each stage is bounded by a set of values, each set relating to a single physical measure.
  • the stage may as well be considered a range, to which certain treatment/care applies.
  • a body mass index (BMI) below 18.5 is considered underweight in the art which may therefore prompt a certain action, e.g. to focus on nutrition assisted through certain adjustments of the interface, e.g. by targeting nutrition plans to follow while in the given stage (e.g. BMI ⁇ 18.5).
  • the limit values/bounds/ranges may be predefined according to commonly applied practice or by the therapist. Thus, the predefined limit values may be contained in the common health database prior to said database being supplied with the health data of the patient.
  • the telemedicine system may comprise means for comparing said health data with the predefined limit values in order to categorise the condition of the patient and determine his/her clinical stage of a known condition/disease.
  • the determination may be carried out by said means capable of comparing the patient-specific health data with predefined limit values/bounds/ranges. The determination may be confirmed by the therapist.
  • the patient may receive targeted care/treatment while using the telemedicine system according to the invention.
  • the care/treatment is targeted because the system, and thereby the therapist, is aware of the clinical stage and may thereby provide the most relevant treatment options.
  • the determined clinical stage may prompt a change in functionality of the telemedicine system.
  • the clinical stage may be determined due to the comparison means as disclosed and described above. The determination may then result in a change in/adjustment of the functionality of the telemedicine system.
  • the telemedicine system e.g. its governing algorithm, may adjust its functionality depending on the clinical stage determined based on a measurement/input and comparison procedure. Thereby, the system becomes targeted said stage of a condition and may thereby provide a more efficient care/treatment by providing the most relevant information to its users.
  • the adjustments may comprise more or less provision of education/information/news content, increased focus on symptom management, more or less physical measurements, provision of practical matters, and the like.
  • the adjustments may for example be manifested through modules in the graphical user interface of the processing unit of the patient or through certain actions being scheduled in a calendar accessible by the patient. Such manifestation may be the result of the underlying algorithm of the telemedicine system being programmed to execute the requested adjustments.
  • the requests may follow guidelines set out generally by a therapist or commonly employed actions/protocols depending on the given condition/disease.
  • the telemedicine system may change its layout in at least the second graphical interface, that relevant questionnaires are prompting the patient to study his/her subjective/objective condition in more detail, and/or that the telemedicine system becomes specifically targeted conditions expected to occur in the given stage.
  • the adjustment may involve a change of software solution, information presented to the patient and/or the therapist, or in any other way a change reflecting the information being most relevant to the specific clinical stage.
  • the telemedicine system automatically asks for certain measurements to be carried out or automatically schedules more or less sessions between the patient and the therapist.
  • the telemedicine system may not only be targeted a specific condition, but may even be targeted a specific clinical stage of the specific condition.
  • the adjustment/change according to the clinical stage may be carried out entirely automatically by the telemedicine system, or it may be carried out by the therapist, or in cooperation between the telemedicine system and the therapist. In the end, it is preferred that the therapist approves any changes proposed by the telemedicine system to ensure a high degree of quality and targeting based on human knowledge.
  • changes e.g. change in functionality, software solution, or data sets
  • changes carried out by the telemedicine system according to the clinical stage may be considered suggestions to be approved by the therapist.
  • the therapist may manually adjust the functionalities proposed by the telemedicine system according to the clinical stage. Over time, the telemedicine system may adapt to such manual changes, thereby proposing more targeted changes in functionality.
  • the telemedicine system may be automatically updated according to the condition and/or needs of the patient, such that progression in the condition of said patient is automatically tracked and targeted.
  • Such automatic detection/tracking of the patient e.g. specifically of his/her clinical stage, ensures a higher degree of supervision and targeted care.
  • the system is targeted the clinical stage of the condition/disease, and may, based on the determined stage, request specific measurements to be made or in any other way prompt the patient or the therapist with information relevant to the specific stage.
  • said first graphical user interface of said therapist-operated processing unit comprises two sections, a first section enabling the therapist to review treatment data to be communicated to said patient and a second section, wherein data from said common health database are provided to said therapist.
  • the working-procedure of the therapist is eased, since all relevant information and data is presented in the same window.
  • the therapist may communicate more easily with the patient since the treatment data and health data are comprised in the same window, such that fewer interruptions in the communication occur due to the therapist having trouble finding the relevant health data in the first graphical user interface.
  • said second graphical user interface of said patient-operated processing unit comprises at least two sections, a first section partly enabling the patient to receive treatment data communicated to said patient and partly enabling visual contact to the therapist, and a second section, wherein patient-specific health data is presented based on health data stored in the common health database.
  • treatment data is easily found by the patient.
  • One of said sections may further be substituted by a live video connection to the therapist with a communications link based on an Internet technology.
  • the sections may be editable by the therapist or even by the patient, such that the second graphical user interface may be targeted and designed individually thus increasing the targeting experience. By being editable, the therapist may even decide exactly what treatment data to present the patient.
  • the treatment data is created and/or selected by the computer through artificial intelligence.
  • the system e.g. the therapist-operated processing unit
  • Artificial intelligence may be artificial intelligence software installed on the therapist-operated processing unit, or it may be installed in a cloud service or on a server connected to the telemedicine system through a communications link, thereby accessing health data stored in the common health database and the inputs by the therapist or by the patient via the processing units.
  • Artificial intelligence may be manifested as machine learning software, wherein the software increases the precision of suggestions gradually through learning the inputs and recommendations set forth by the therapist or others working on the system, such as developers.
  • the therapist-operated processing unit and the patient-operated processing unit are both connected to a camera module and a microphone module for providing video and voice communication of treatment data between the at least one therapist and the at least one patient.
  • the therapist and the patient may be in visual and audial contact during a live session or live consultation.
  • a live session or live consultation may take place through the communications link established between the therapist-operated and the patient-operated processing units.
  • the processing-units may include speakers.
  • the therapist may guide and inspect the patient, thereby increasing the targeting and knowledge of the patient which may improve the treatment data presented to the patient.
  • Visual and audial contact are known to improve the feeling of a consultation with a therapist despite being separated by distance.
  • a sensor adapted for reading physiological data of said patient is adapted to transmit data relating to a sensor signal to the said common health database via said patient-operated processing unit.
  • physiological data of the patient may be transmitted data to the common health database, thereby increasing the amount of health data stored within said common health database.
  • the sensor signal may be an electrical signal reflecting a physiological measure, said electrical signal being transmitted to the common health database via the patient-operated processing unit and the communications link.
  • the ability to measure physiological measures of the patient may increase the knowledge of the patient, more specifically the patient's condition or state of a disease.
  • the physiological measures are readable by the therapist-operated processing unit, such that the therapist may decide future treatment which further improves the targeting of treatment data sent to the patient.
  • the physiological data may be sent directly to the therapist-operated processing unit thus bypassing the common health database. Thereby, the response time may be lowered and the therapist may observe the measures in real-time, should the common health database be slow.
  • the physiological data may be sent in parallel to both the common health database and the therapist-operated processing unit simultaneously.
  • the senor is adapted to record at least one of the following patient- physiological data: heartbeat, electrocardiography, oxygen saturation, lung capacity, or blood sugar levels.
  • the senor is able to record common physiological data/measures used to characterise the condition of a patient.
  • the listed physiological data is characterised in that the data may be obtained without the presence of a therapist, but visual and audial contact through camera and microphone modules may be used by the therapist to guide the patient in the use.
  • the physiological data to be obtained by a sensor in the present telemedicine system are not limited to the mentioned measures.
  • Other physiological data may be weight, body composition, lengths relating to physical size, body temperature, or any other easily obtained measures.
  • the senor is operated by an authorised person.
  • an authorised person is meant a person being educated in the correct use of the sensor.
  • the person may be health care personnel, a therapist, or it may be a technician.
  • the sensor reading and the health data thereby obtained may be regarded as being more reliable since the inexperienced patient is not involved in the reading.
  • the person is trusted by the prescribing therapist.
  • the prescribing therapist is meant the therapist ordering the authorised person to collect the data or perform the measurements.
  • the authorised person may perform the measurements at home with the patient.
  • the authorised person is in communication with the common health database, such that he/she can communicate the measurements, readings, or sensor output to said common health database.
  • the authorised person may be in communication with the common health database through a processing unit comprising a third graphical user interface.
  • Said processing unit may have similar properties as the therapist and/or the patient operated processing unit.
  • the authorised person may log in to the patient-operated processing unit and thereby access the common health database.
  • treatment data are uploaded to a server, where it is saved prior to downloading onto the patient-operated processing unit.
  • the treatment data may be uploaded from the health database or the therapist-operated processing unit and subsequently downloaded to the patient-operated processing unit when a communications link is established to the server. Further, this allows treatment data to be saved in a secure location as a backup.
  • Such use of servers for uploading and downloading content is well known.
  • the therapist is in simultaneous communication with at least two patients.
  • the patients may receive the same treatment data.
  • This may be advantageous in the case of rehabilitation, wherein the therapist may be physiotherapist giving instructions for exercises.
  • the common health database may take in patient-specific needs for all patients, such that treatment data may be targeted to each participant in the live consultation without compromising personal health details. The latter may be achieved through the use of filters, such that non-public treatment data is not disclosed to all participants. LIST OF FIGURES
  • Fig. 1 shows a diagram depicting a preferred embodiment of the present invention.
  • Fig. 2 shows a diagram depicting another embodiment of the present invention.
  • Fig. 3 shows a diagram depicting the principle of multiple connections according to the present invention.
  • Fig. 4 shows a diagram depicting a third embodiment of the present invention.
  • Fig. 5 shows a graphical user interface suitable for the present invention.
  • Fig. 6 shows a comparison being made between patient-specific data and predefined limit values.
  • Fig. 1 illustrates the principle of a preferred embodiment of the present invention.
  • the telemedicine system comprises three main components; a therapist-operated processing unit T, a patient-operated processing unit P, and a common health database D. Said components are mutually connected using a communications link L via a public communication network based on an Internet technology. The communications link L may only be provided when needed for reducing costs or energy consumption.
  • the therapist-operated processing unit T is in communication with a first camera 1 1 , a first microphone 12, a first speaker 13, and a first graphical user interface (GUI) 14.
  • GUI graphical user interface
  • the patient-operated processing unit T is in communication with a second camera 21 , a second microphone 22, a second speaker 23, and a second GUI 24.
  • the patient-operated processing unit P may for example be a tablet, whereby the second camera 21 , the second microphone 22, the second speaker 23, and the second GUI 24 are all assembled into a single device.
  • the therapist-operated processing unit T may be a computer, wherein similar options of assembling the first camera 11 , the first microphone 12, the first speaker 13, and the first GUI 14, exist.
  • a sensor 25 may be connected to the patient- operated processing unit P.
  • the sensor 25 is adapted to transmit, through the communications link L, a sensor signal to the common health database.
  • the sensor signal may be any physiological measure or data relevant to the treatment.
  • Said data is stored in the common health database D, wherein it is readable by the therapist-operated processing unit T.
  • the data may be readable by the patient-operated processing unit P as well.
  • Fig. 1 the process of performing a remote telemedicine session is presented in the following.
  • COPD chronic obstructive pulmonary disease
  • the process depicts the process from the beginning of a treatment period and the subsequent consultations between a therapist and a patient.
  • the common health database D is updated, preferably by the therapist, to contain health data regarding the patient, such as the condition of the disease, gender, age, physical measures, and/or present and/or previous physical conditions.
  • the health data may be found in already existing databases, or they may be provided by the patient during an interview. Depending on the actual condition of the patient, a therapist may find him or her eligible for receiving telemedicine treatment.
  • the patient When telemedicine treatment is found eligible for his or her condition, the patient receives a patient-operated processing unit P comprising a second GUI 24, and preferably a second camera 21 , a second microphone 22, and a second speaker 23.
  • the processing unit may be a tablet, such that said equipment is assembled into a single device.
  • the therapist may find it relevant to measure the patient's lung capacity periodically using a sensor 25, such as a peak flow meter.
  • the patient further receives such equipment capable of recording the lung capacity.
  • the sensor 25 is digital and connectable with the patient-operated processing unit P or directly to the common health database D.
  • the sensor 25 may be adapted to measure other relevant physiological parameters.
  • the therapist receives access to a therapist-operated processing unit T comprising a first GUI 14 and preferably a first camera 1 1 , a first microphone 12, and a first speaker 13.
  • the therapist-operated processing unit T is a computer, such as a stationary computer, wherein large computational capabilities are achieved.
  • the therapist schedules remote telemedicine consultations in a calendarwithin the common health database D, and a reminder is automatically sent to both the patient-operated processing unit P and the therapist-operated processing unit T when a consultation is coming up.
  • the system may be set up to send a reminder 24 hours before a consultation and immediately prior to a consultation.
  • the therapist may immediately know from the first GUI 13 the condition of the patient he/she is to consult. Thereby, the therapist reduces the time needed for preparation before each consultation.
  • the therapist and the patient are both logged into the telemedicine system through their respective processing units T, P, and a mutual communications link L is established between the processing units T, P, and the common health database D.
  • video and voice is sent through the communications link L, such that the therapist and the patient can see and hear each other in their respective GUI's 14, 24.
  • the therapist and the patient may discuss the condition of the disease, or the therapist may decide to perform a test of the lung capacity.
  • the decision to carry out a test is related to the patient-specific data, such that it is ensured the test is relevant to the patient. If it is not found relevant, treatment data (e.g. oral instructions) is modified to abandon a test.
  • treatment data e.g. oral instructions
  • the patient may have had a recent lung transplant, making a test of lung capacity irrelevant at the specific time. Thereby, the patient receives controlled and targeted treatment data, such that risk of improper treatment is minimised.
  • the therapist may guide and control the use of the sensor 25. Guiding and control is simplified due to the use of cameras 1 1 , 21 , speakers 13, 23, and microphones 12, 22.
  • an authorised person may meet the patient at home, said authorised person operating and controlling the use of the sensor, such that the patient is not involved in the reading.
  • the use of an authorised person for carrying out the readings may be useful in case of impaired patients or patients with special needs.
  • the sensor signal obtained is sent through the communications link L and stored in the common health database D.
  • the sensor signal comprises the physiological data of the patient.
  • the therapist may inspect the data, and relate to previous measurements for deciding upon further treatment. All data stored within the common health database D may be chosen to be displayed in the first GUI 14, and the therapist may further choose to display at least part of the data on the second GUI 24.
  • a new consultation may be scheduled in the common health database D, and steps 5-9 may be repeated.
  • the above procedure discussed a live consultation between a therapist and a patient.
  • the patient may be presented to relevant treatment data in the same section of the second GUI 24. Due to the therapist having knowledge of the condition of the patient through the common health database D, he or she may decide what treatment data is presented in the second GUI 24.
  • Treatment data may for example comprise prescriptions, news, newsletters, videos, exercises, or similar data relevant to the treatment. Thereby, the presented treatment data is specifically targeted the patient's condition.
  • Fig. 2 illustrates the principle of targeting treatment data to the person in need of care, when a live consultation is not taking place, using a telemedicine system as disclosed.
  • the system disclosed in Fig. 2 comprises a news source N, the therapist-operated processing unit T, the common health database D, multiple communications links L, a server S, and the patient-operated processing unit P.
  • the therapist becomes aware of news N relevant to a single patient or a group of patients.
  • the therapist may become aware of the news due to his/her profession.
  • the news N may also be news regarding prescription medicine or similar news relevant to the patient.
  • the therapist makes a look-up in the common health database D for finding patients relevant to the news N.
  • the therapist-operated processing unit relates the news believed to be relevant to the at least one patient to the patient-specific data thus ensuring the treatment data presented to the at least one patient is relevant.
  • the therapist sends the news N either to a server S or directly to the patient- operated processing unit P.
  • the news N is sent through the communications link L.
  • a communications link L between the therapist-operated processing unit T and the patient-operated processing unit P is not required at all times, this means that the news N is downloaded to the patient- operated processing unit P from the server S, when a communications link L is established to said patient-operated processing unit P.
  • This may be advantageous if the patient-operated processing unit P is turned off, and the server S further functions as a back-up. Downloading content from a server S is a well-known process in communication technology.
  • the patient may receive a notification in the second GUI 24 of the patient-operated processing unit P, the notification saying news N is available.
  • the news N is already downloaded, or it is immediately downloaded from the server S.
  • the patient is thereby supplied with news N specifically targeted his/her condition, and may act upon the news N.
  • Fig. 3 illustrates the principle of multiple connections. Cameras, microphones, speakers, GUI's, and sensors have not been shown in this figure for simplicity.
  • the therapist- operated processing unit T may connect remotely to multiple patient-operated processing units P1 , P2, P3, P4, P5 using a communications link L.
  • the connection may be one at a time, or the connection may be simultaneously between a group of patient-operated processing units P1-P5.
  • the therapist-operated processing unit T and the patient- operated processing units P1-P5 are further in communication with the common health database D using a communications link L for targeting the treatment based on patient- specific health data stored within the common health database D.
  • the therapist may look up patients suffering from a specific condition, thereby creating groups of patients. For example, the therapist may form a group of patients all suffering from COPD. Thereby, the therapist can easily target news to a larger group of patients.
  • the grouping may be assisted by the processing unit having knowledge of all patients within the health database.
  • the possibility of the therapist-operated processing unit T being in simultaneous communication with multiple patient-operated processing units P1-P5 may be advantageous if the therapist is a physiotherapist presenting exercises for a rehabilitation programme, wherein multiple patients are to receive the same instructions. Either the patients P1-P5 may see each other alongside the therapist in their respective second GUI 24, or they may solely see the therapist in their second GUI 24.
  • Fig. 4 illustrates an extended embodiment of a telemedicine system as disclosed and described in Fig. 1.
  • the common health database D is in further communication with an external database E and a news source N through a communications link L provided by an Internet technology.
  • an artificial intelligence software 40 may be connected to the common health database D.
  • the artificial intelligence processor 40 is a processor capable of performing computational operations autonomously by being based on e.g. machine learning.
  • the common health database D preferably receives patient-specific health data automatically from external databases E.
  • External databases E may be logbooks, records, journals, prescriptions, or other databases.
  • News sources N may be any relevant source, wherein news, videos, or similar content may be published by independent news channels, third-parties, and/or authorities.
  • a list of trusted news sources may be created by a therapist or similar authoritarian personnel.
  • third-party content may be targeted the patient without compromising confidentiality.
  • third-parties/independent news channels may be prohibited access to the potentially confidential data contained in the common health database D.
  • Such ban results in said third-parties being unable to target their content to the patient based on traditional methods, e.g. through the use of third-party cookies.
  • data contained in the common health database is compared with the content of the news source N by comparison means contained within the telemedicine system, and as such, no confidential data leaves the database, but rather third-party contents enter the database with the purpose of being analysed and assessed by the comparison means.
  • Another aspect of the embodiment is that the news contents are updated and the targeting may be adjusted immediately by the system once new patient-specific data enters the common health database D.
  • the optional use of artificial intelligence software 40 allows the common health database D to become autonomous in targeting the treatment data presented in the second GUI 24.
  • the therapist does not need to be involved in the targeting of content at all times, but rather focused on the actual treatment during live consultations. Further, the use of artificial intelligence may reduce the workload of the therapist and ease the working procedures by taking over particular tasks.
  • the remaining part of the telemedicine system of Fig. 5 is similar to other embodiments disclosed.
  • Fig. 5 illustrates a preferred assembly to be given a patient.
  • the assembly is a tablet comprising the patient-operated processing unit P, the second camera 21 , the second microphone 22, the second speaker 23, and the second GUI 24.
  • the specific placement of the components and design depends on the tablet model.
  • the second GUI 24 comprises a first content module 31 partly for communicating in video with a therapist through a communications link and partly for showing targeted treatment data when no live consultation is taking place.
  • the first content module 31 is editable and depends on the use.
  • the content shown in the first content module 31 is editable by the therapist such that targeted news may be shown there.
  • a second 32 and a third content module 33 are for presenting further treatment data, such as health data, settings, or calendar.
  • the content of these modules may further be editable by the therapist.
  • the therapist may for example choose to provide the patient with an overview of the physiological data obtained through the treatment period, or the therapist may choose to provide the patient with a calendar module for easy overview of upcoming events/consultations.
  • Fig. 6 illustrates a comparison being made between patient-specific data 100 contained in the common health database D and predefined limit values 1 10 relating to a specific condition, said limit values likewise being contained in the common health database D.
  • the patient-specific data 100 could for example be data provided by sensors measuring a physical measure of the patient, e.g. lung capacity or oxygen saturation.
  • the physical measure is stored in the common health database D, preferably time-stamped or otherwise documented to provide the most accurate entry of the data into said database.
  • the common health database D comprises a set of predefined limit values 1 10 of physical measures.
  • the limit values 100 may relate to a condition, such that said set of predefined limit values provides a means to classify and divide said condition into clinical stages.
  • Reference number 110' points to a scale illustrating four different stages (l-IV).
  • Each of said four stages (l-IV) is defined by a set of predefined limit values or bounds (an upper and lower bound).
  • a physical measure is compared to the limit values 110 provided in the common health database D, whereby the telemedicine system may output the clinical stage l-IV of a given condition.
  • the comparison may be carried out using comparison means 120 provided in the software of the telemedicine system.
  • the condition may already be known by the patient and the therapist - e.g. through a preceding clinical investigation.
  • the condition may for example be known to be chronic or progressing slowly, whereby it is relevant to monitor the progression continuously/over time, e.g. over days, weeks, months, or even years.
  • the known condition could be divided into four stages, 1-4, where stage 1 may correspond to an initial stage of the condition, whereas stage 4 may correspond to a terminal stage of said condition.
  • stage 1 may correspond to an initial stage of the condition
  • stage 4 may correspond to a terminal stage of said condition.
  • Each of said four stages may be classified by a variety of, or at least one, physical measure(s), e.g. lung capacity.
  • Such classification of the stages allows the definition of limit values or ranges bounded by an upper bound and a lower bound which can be compared to measured values. If the measured value falls in between the limit values (upper/lower bound) defining a certain stage, then the system may output said stage and preferably adjust the functionality of the telemedicine system to the specific stage.
  • the adjustment of functionality may for example involve an adjustment of software solution, layout/design of the graphical user interfaces, the news presented to the patient, the targeting of material.
  • a certain stage of a condition may be known to result in certain characteristic symptoms only experienced in said stage, whereby the telemedicine system according to the invention is capable of both detecting the stage and adjusting accordingly to present information only relevant when such symptoms are experienced, i.e. in the specific stage. Thereby, the patient does not have to worry about other parts of the course of the disease/condition.
  • the telemedicine system may for example be targeted patients suffering from chronic obstructive pulmonary disease (COPD).
  • COPD chronic obstructive pulmonary disease
  • the following example therefore focusses on COPD, but the skilled reader acknowledges that the same procedures may relate to other conditions/diseases, where it may be favourable to divide said condition/disease into stages to understand and monitor it more efficiently - for example cancer or obesity.
  • the common health database may comprise limit values set out by the Global initiate for chronic Obstructive Lung Disease (GOLD), said limit values being compared to the patient-specific data for assessing the COPD stage of the patient by the telemedicine system using comparison means embedded in the software of said system.
  • the clinical stage of COPD may be determined according to the global strategy for the diagnosis, management, and prevention of COPD; the Global initiative for chronic Obstructive Lung Disease (GOLD).
  • the clinical stage of COPD is found by comparing measured physical measures with the limit values defined according to the GOLD. If the physical measures fall in between the limit values of stage 1 of COPD, then the system may output such classification.
  • the GOLD system may be considered a standard within COPD-research and treatment, and is a way for doctors/therapists to categorise COPD stages. Thus, the GOLD system is often used for understanding the severity of symptoms in more detail.
  • COPD is a chronic, progressive disease, meaning it will worsen over time. COPD affects everyone differently and at different rates. There is no way of predicting COPD prognosis or COPD life expectancy accurately. However, there are ways to measure and estimate symptoms and severity, such as with the GOLD COPD stages. This description of COPD may be applied to other conditions/diseases and thus serves as a relevant example.
  • COPD is a progressive lung disease having symptoms ranging from mild to severe.
  • a common way to determine the COPD stage is by using the GOLD staging system.
  • the GOLD system uses the forced expiratory volume (FEV1) test from the pulmonary function test of the patient to categorise the severity of the COPD into stages. Simply put, FEV1 means the amount of air one can forcefully exhale in one second. As the severity of COPD progresses, the stage number shows how airflow is limited.
  • the GOLD COPD stages comprise four stages. As the COPD worsens over time, the stage number will increase from stage 1 to stage 4.
  • Stage 1 is characterised by a FEV1 of 80 percent or more of normal lung capacity, whereas stage 4 reflects a FEV1 lower than 30 percent of normal, and low oxygen levels in the blood.
  • the GOLD stages consider both FEV1 and the oxygen saturation of the blood.
  • the measured FEV1 is compared to the predefined set of limit values.
  • a predefined set of limit values could be a FEV1 of 80 % (lower bound) and 100 % (upper bound) of normal, meaning that a measured FEV1 falling between said set of limit values/bounds results in the classification of stage 1-COPD.
  • COPD Chronic Obstructive Pulmonary Disease
  • such conditions require continuous monitoring of the patient to determine further actions to be taken by the therapist.
  • monitoring is essential in order to determine the progression of the condition over time.
  • the monitoring of the patient may preferably be carried out at home, thereby reducing the need for the patient to leave home and further reducing the costs for/stress on the health care system.
  • the telemedicine system allows the patient to perform the relevant measurements at home, supervised by a therapist through a telemedicine system according to the invention. Since the relevant measurements are carried out at home and since less scheduling and transportation are needed, a more continuous monitoring of the patient may be employed,.
  • the telemedicine system may ensure a more thorough monitoring, and thereby assessment, of the health of a patient, than what may be achieved in conventional physical meetings between the patient and a therapist.
  • the telemedicine system may be programmed such that the patient receives news contents, information, educational material, etc., in order to prepare said patient to a progression of the condition, and in order to provide useful background material, or to provide contents focussed on prevention of progression in order to keep the patient free of symptoms for a longer period of time.
  • Such provision may be facilitated through the graphical user interface (GUI) of the patient being designed to have modules/windows containing such content.
  • GUI graphical user interface
  • the graphical user interface may be designed to prompt more measurements, e.g.
  • stage 3 may provide practical matters or considerations or even mental/psychological relief in case of a terminal condition, e.g. through such contents being provided in a module of the graphical user interface of the patient.
  • the adjustments of the telemedicine system taking place according to the clinical stages are governed by the algorithm of said system.
  • the input/determination of a stage results in said algorithm adjusting the graphical user interface to accommodate the relevant content.
  • the algorithm ensures that the contents provided are in accordance with the clinical stage.
  • What kind of contents to be provided may be determined or set out by the therapist from a general perspective or adjusted on an individual basis.
  • the therapist may initially decide what contents to provide to patients in a given clinical stage, and the algorithm then takes over, following the rules set out by said therapist.
  • the rules may be applied on a general basis, e.g. for all patient suffering from the same condition/disease, and the system individually adjusts according to the progression in stages of each patient.
  • GUI First graphical user interface
  • a telemedicine system for remote treatment of at least one patient by at least one therapist comprising a therapist-operated processing unit comprising a first graphical user interface and a patient-operated processing unit comprising a second graphical user interface, wherein said therapist-operated processing unit and said patient-operated processing unit are adapted for mutually communication via a public communication network of treatment data using said graphical user interfaces characterised in that said system further comprises means for accessing health data in a common health database, said common health database comprising patient-specific data of the at least one patient,
  • a telemedicine system comprising means for comparing treatment data to be communicated from said therapist-operated processing unit to said patient-operated processing unit with health data in said common health database.
  • said means for comparing comprises means for deciding based on a predefined comparison criterion whether said treatment data should be communicated or a warning should be given to the therapist via said therapist-operated processing unit.
  • said means for comparing comprises means for suggesting alternative treatment data to said therapist based on said health data in said common health database.
  • a telemedicine system according to claims 1-4, wherein a clinical stage of a condition is determined based on a comparison between patient-specific data and predefined limit

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Abstract

La présente invention concerne un système de télémédecine pour le traitement à distance d'au moins un patient par au moins un thérapeute, le système de télémédecine comprenant une unité de traitement actionnée par un thérapeute comprenant une interface utilisateur graphique et une unité de traitement actionnée par un patient comprenant une interface utilisateur graphique. Les données de traitement communiquées entre l'unité de traitement actionnée par le thérapeute et l'unité de traitement actionnée par le patient sont ciblées en étant modifiées en fonction des données de santé stockées dans une base de données de santé commune. La modification peut être effectuée manuellement après une notification provenant de l'unité de traitement actionnée par le thérapeute indiquant des écarts par rapport aux données spécifiques au patient.
PCT/DK2018/050052 2017-03-21 2018-03-21 Système de télémédecine pour le traitement à distance de patients WO2018171853A1 (fr)

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