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WO2004042596A1 - Systeme et procede de gestion des risques cliniques - Google Patents

Systeme et procede de gestion des risques cliniques Download PDF

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Publication number
WO2004042596A1
WO2004042596A1 PCT/AU2003/001479 AU0301479W WO2004042596A1 WO 2004042596 A1 WO2004042596 A1 WO 2004042596A1 AU 0301479 W AU0301479 W AU 0301479W WO 2004042596 A1 WO2004042596 A1 WO 2004042596A1
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WIPO (PCT)
Prior art keywords
clinical
patient
health care
care professional
interactive
Prior art date
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Ceased
Application number
PCT/AU2003/001479
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English (en)
Inventor
Malcom Pradhan
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ALCIDION Corp Pty Ltd
Original Assignee
ALCIDION Corp Pty Ltd
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Filing date
Publication date
Priority claimed from AU2002952582A external-priority patent/AU2002952582A0/en
Priority claimed from AU2003902777A external-priority patent/AU2003902777A0/en
Application filed by ALCIDION Corp Pty Ltd filed Critical ALCIDION Corp Pty Ltd
Priority to AU2003277999A priority Critical patent/AU2003277999B2/en
Publication of WO2004042596A1 publication Critical patent/WO2004042596A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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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
    • G16H40/20—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 management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
    • G—PHYSICS
    • G06—COMPUTING OR CALCULATING; 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
    • 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
    • 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
    • G16H15/00—ICT specially adapted for medical reports, e.g. generation or transmission thereof
    • 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
    • G16H40/63—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 local operation

Definitions

  • the present invention relates to monitoring medical treatment environments for clinical risk monitoring and mitigation purposes, and in particular, discloses clinical a risk monitoring and mitigation system for a time critical hospital environment.
  • ED hospital emergency departments
  • diagnostic test results provides an example of an area where valuable and practical support to busy health care professionals in the clinical environment is deficient. Large volumes of diagnostic test orders are continuously generated and equally large volumes of test results are fed back into the health care system. In the busy clinical environment, many system factors impede the full value and effectiveness of diagnostic investigations and often lead to serious adverse clinical outcomes. Some examples of typical deficiencies include: • Long delays before potentially serious test results are brought to the attention of the responsible health care professional.
  • Health care professionals having to log into computer records systems to search for their results; often requiring a time consuming log in process, and taking valuable time to query the system for specific patient results. This results in the wastage of health care professional time.
  • MI myocardial infarction
  • Clinical guideline One well-established response to the problem of unexplained variations in clinical practice is the development of standardised Clinical Guidelines. Groups of appropriate experts are brought together to synthesise relevant new knowledge and to prepare clinical practice summaries, referred to as a "clinical guideline". However, some clinical guidelines still run to tens of pages of printed material, although there have been many attempts to reduce the content using diagrams. Furthermore, in any clinical practice environment, one can expect a large number of clinical guidelines to be applicable.
  • Paper guidelines are difficult to use at the point of care. This can be overcome through the presentation of clinical guidelines on appropriate hospital information systems in a structured format that enables a health care professional to quickly step though the pertinent clinical considerations, at the point of care and customized for a patient's specific characteristics. Such an approach would greatly support health care professionals in dealing with complex clinical patient care related decisions, especially in an environment of constantly changing and improving knowledge.
  • a system for providing health care professional interactive information in a clinical environment relating to one or more patients comprises: a computer system connected to at least one interactive display device for processing the interaction between the health care professional and said device; at least one interactive display device located in a clinical environment, each said device adapted to display clinical and other information associated with a said patient associated with said environment, the displayed information including: (a) a list of all of said patients, as have been entered into a patient computer records system, (b) for each patient on the list, one or more interactive icons representative of a diagnostic test ordered by a health care professional and for accessing a completed test result for a said patient, the icons being visually encoded with at least one indicator representative of the type of test; whether the icon represents a test order (investigation not yet reported upon) or a test result (investigation report is available) ; whether the diagnostic test result has been accepted by a predetermined health care professional and the date/time of the diagnostic test order placement.
  • each patient in said list there are one or more interactive icons for alerting health care professionals of a predetermined potential clinical risk or unrecorded task as assessed by said system based on the one or more tests that have been ordered and their result(s).
  • each patient in said list there are one or more predetermined clinical guideline icons that in detailed view present patient-specific information in accordance with a clinical guideline associated with said patient.
  • a said indicator comprises a colour coding associated with a said icon to alert health care professionals to a predetermined degree of clinical risk associated with a test result for a respective patient.
  • the system operates in conjunction with existing computer records systems or a data warehouse for the provision of existing, basic clinical information associated with the patients.
  • the system can interrogate the computer records systems or a data warehouse for the provision of patient lists, test results for patients and other clinical data within the environment.
  • the system operates in the emergency department of the hospital with the display information including a medical triage rating and/or an identifier to indicate the location of the patient in the emergency area.
  • the interactive icons can include alphanumeric letter code and associated date information as well as colour coding, to convey the nature and importance of the diagnostic test and date/time when the indicated diagnostic test result was either ordered or posted.
  • the interactive icons can comprise a touch screen button, which upon activation displays details of an associated medical report associated with the interactive designator.
  • the display information can be divided into a series of rows, one for each patient, with each row containing a series of report indicators further including an overflow indicator indicating an overflow in the number of reports for a patient. Upon accessing the overflow indicator a separate menu appears listing the additional reports associated with a particular patient.
  • Each result icon in the row can be sorted by time order, time posted, or by predetermined risk rating.
  • the display information can be further sortable by treating health care professional.
  • the system allows for the selection of a treating health care professional identification and only those patients associated with that health care professional are displayed.
  • the system can include a proximity detector for detecting a predetermined health care professional in proximity to the display and listing only those patients relevant to that individual.
  • the clinical guidelines are included in the displayed information, under predetermined conditions.
  • the health care professional is able to select a particular clinical guideline by selecting, on screen, from a menu of relevant clinical guidelines from a clinical guideline framework provided by said system.
  • the user is prompted to consider a clinical guideline in response to particular patient conditions that may arise from time to time and /or as a result of new or modified clinical data for a patient (or combinations of clinical data for a patient).
  • certain aspects of the clinical guideline will be customised to take account of particular aspects of the patient's patho-physiology, clinical events and/or other relevant circumstances.
  • the clinical guideline will present structured options and choices to the user and will record the choices made.
  • the system therefore can record and present a log of the clinical and care choice options that have been selected.
  • the records created can be taken into account in reviewing the efficacy of specific clinical guidelines.
  • the records can also be used in gauging user compliance with agreed clinical practice and investigating opportunities to further improve clinical guidelines.
  • Fig. 1 is a schematic illustration of the hardware arrangement of the preferred embodiment
  • Figs. 2, 3, 7-14 illustrate various screen views utilised in the preferred embodiment
  • Fig.4 to Fig. 6 illustrate various icon components utilised in the preferred embodiment
  • Fig. 15 to Fig. 20 illustrate various screen shots showing the provision of clinical guidelines in accordance with the present invention.
  • an interactive computer system including a series of touch panel screens that are designed for utilisation in a clinical service environment, for example, the emergency department of a hospital.
  • a hospital environment and in particular the Emergency Department is used for the embodiment of the invention as it represents probably the most time critical environment.
  • the system hereinafter referred to for convenience as the "SecondScreen" system, is designed to supplement the established or legacy information systems within a clinical environment so as to provide ongoing surveillance of all diagnostic test results, for all patients in a nominated clinical work area.
  • the clinical users of such a system are referred to herein as health care professionals that may include health care professionals, clinicians, specialists, surgeons, psychiatrists, physiotherapists, nurses, etc.
  • the ability for any particular health care professional to use the system can be predetermined by the administrator of the system and enforced by physical or operational means.
  • the SecondScreen system is based around software running on a core hardware facility 2.
  • the computer hardware facility 2 can comprise a high end personal computer or server type device utilising a modern operating system such as presently is the case including Linux or Windows NT, 2000 or XP operating systems.
  • the operating system in turn runs a number of application type programs that are developed in accordance with the teachings described herein.
  • the application programs can be written in a wide range of computer languages, for example in languages such as Visual Basic, Visual C++, .NET, XML, Perl (with TCL extensions) etc.
  • the language provides a wide functionality including full network interactivity and user interface design capability. Indeed utilising appropriate interfaces, such as Web Services or CORBA, multiple different languages could be utilised.
  • the programmed software running on the hardware facility 2 interacts with a number of other devices.
  • the software interacts with and controls a number of touch screen display devices 4 — 6.
  • Each of these devices is placed in an appropriate location in a hospital clinical work area for accessing the system on demand.
  • a printer facility 7 can also be provided for printing out results as will become more apparent hereinafter.
  • the system 2 is connected to a hospital network environment including networking nodes 9 eg. which interact with a number of databases which are assumed to contain the historical data associated with operations in a hospital environment. It is assumed that existing clinical systems contain the usual administrative information stored in databases. These databases are typically part of what is termed a legacy computer records system and are readily made to be accessible by the system of the preferred embodiment.
  • a first database 11 contains laboratory results, which can be queried by users in a database format.
  • the laboratory results might be stored in a SQL compliant database for access via user queries.
  • a second database 12 is designed to carry patient details.
  • the databases, 11, 12 continue to operate as they have previously operated with the preferred SecondScreen system embodiment providing a unique user interface which is particularly suitable for utilisation in time critical environments to deliver improved surveillance of all diagnostic test results ordered using the existing system of an interface provided by the SecondScreen system.
  • the SecondScreen system is set up to watch for both ordered (but not completed) test results and for completed and available test results, for all patients assigned to a predetermined clinical work area (for example, the Emergency Department). For all completed and available test results, the SecondScreen will calculate a clinical risk rating for each result (serious, moderate, normal or high, moderate, low) and generate a test icon with the appropriate colour coding, for presentation to health care professionals on the display panels 4-6.
  • the criteria for assessing the potential risk rating of a test result can be determined by local experts and transcribed into the appropriate software elements in the SecondScreen system.
  • the SecondScreen system also provides an alerting system via screens 4 — 6 that proactively displays risk-prioritised laboratory results in the clinical environment, such as the clinical work areas of an Emergency Department. SecondScreen provides this type of information rather than requiring the health care professional to check each result individually via an existing system, assuming they have remembered to do so.
  • the SecondScreen system may also be used to alert health care professionals when radiology results are available. Since radiology is a key factor in the management of many clinical conditions, any delay in viewing X-Rays can lead to delays in treatment and hence increase risks to patient treatment being timely and complete. It is assumed that the hospital's radiology system stores key work flow metrics, such as signalling the availability of films, or completed reports and the SecondScreen system is configured to alert these events to the relevant health care professionals.
  • the SecondScreen system is particularly valuable in high workload, high complexity clinical areas such as Hospital Emergency Departments.
  • the SecondScreen system supports clinical risk management by providing easy visual access to risk stratified test results and by using a colour graphical display showing each test result, it optimises the communication of risk information to the health care professional.
  • the SecondScreen graphical displays provide easily read output and with proper placement in the Emergency Department, allows for accurate viewing for all care givers and health care professionals.
  • Fig. 2 there is illustrated an example output display 20 of a SecondScreen system.
  • Laboratory results eg. 21 are listed against the relevant patient 25 in a visually encoded way such as using a colour coded format that allows easy identification of the type of test result and its potential risk rating for the patient.
  • Other types of visual encoding could include shapes, shading, patterns, movement and changes at predetermined intervals of any of the prior encoding types.
  • the risk rating can be determined via a risk assessment process within the SecondScreen system.
  • the risk assessment rules can be determined by the hospital clinical organisation, the head of the clinical service or other appropriate health care professional and encoded in the system.
  • results that are judged to be of high risk for the patient are displayed with a red icon 24, medium risk results are displayed with a yellow icon 23, and low risk results are colour coded green 21. Therefore, results that are abnormal and clinically important can be differentiated at a distance from test results with mildly abnormal results, as determined by local policy.
  • the SecondScreen system does not override local procedural standards. It is programmed to conform to them and ultimately improves compliance with them. The relevant health care professional can access the details of a result by simply touching the icon on the SecondScreen display device. This opens a window containing all of the test details and allows an immediate print option for creating a paper record of the patient details and test results available at the time.
  • the system may be configured for more or less levels of risk, and for different colours for each risk level.
  • Desirable attributes of the interface can include:
  • the system uses large format flat display panel to allow health care professionals to see the alert condition of new and existing lab results from a distance.
  • the panel can have touch screen capability so that a health care professional can access a specific result simply by touching the associated icon of interest on the display panel.
  • the panel can be fitted with a proximity device that reads the identity of a health care professional (preferably from an identification badge fitted with a passive Radio Frequency Identity Device RFID) and displays that health care professional's patients and diagnostic test results as a priority.
  • the system can be extended to include audible alerts where critical results go unread, or to other structured alerts such as pager or mobile phone messages.
  • Additional features that can be provided can include:
  • the SecondScreen system provides important test results to the right health care professional in an effective time frame, which gives rise to:
  • the SecondScreen clinical risk management system also supports a powerful clinical audit capability.
  • the SecondScreen system will support the clinical audit function by capturing and recording essential indicators of diagnostic services ordering, review and application.
  • the system of the preferred embodiment has the significant advantage in that it allows for a 'non disruptional technological change'. That is the structuring of new technology in a way that allows it to be introduced into complex health environment work flow patterns without causing disruption to those practices.
  • the preferred human interface component is the 17" (or larger) touch screen LCD display panel 4-6 (Fig. 1). In an example embodiment, three panels are deployed within an Emergency Department (ED).
  • ED Emergency Department
  • the system can be constructed to support an increasing level of complexity or number of displays over time.
  • Fig.3 there is provided an example screen of the standard touch screen for which the user has selected the display of patient names in descending order of priority, in accordance with their overall risk rating.
  • the essence of the Display is a list of 'patient lines' 31, each showing that patient's identification (Name and Unit Record (UR) Number), their triage rating and the test icons for that patient.
  • UR Unit Record
  • Even the name of patients that have been discharged from the environment can be maintained on the SecondScreen system if certain conditions are not met. Such as for example if not all the tests ordered have been "accepted" by the relevant health care professional the patient name remains on the list.
  • the SecondScreen system can be used in a General Practitioner environment where patients are expected to leave the surgery before the results of tests can be reviewed.
  • the SecondScreen system maintains the patient identification on the system until all ordered test results have been "accepted”. This approach ensures the proper follow up of diagnostic tests by the health care professional.
  • the availability of clinical guidelines in addition to the test alerts also
  • touch screens as part of the human interface between the system and the clinical staff.
  • Each laboratory test has an interactive icon associated with it; the details of the test status can be read by simply touching the test icon of interest on the screen. This opens a further on screen window to display the complete test report details.
  • the clinical work environment backroom computer system eg. an Emergency Department computer support system
  • a typical interactive test icon in this embodiment is shown separately 40 in Fig 4.
  • the type of test is described by the three or four letter code 41.
  • the code LFT stands for a Liver Function Test.
  • the date/time stamp for when the order for the test was received is also displayed 42.
  • the code used can be one that conforms to a standard or a local convention.
  • the colour coding of the test icon is also used in this embodiment to convey important information about the test.
  • the first icon to be displayed is a white colour- coded icon that is generated whenever the SecondScreen system is advised of new test orders, via the internal hospital systems (11,12 of Fig. 1).
  • the icon includes a date/time stamp to record when the order was placed.
  • a laboratory test result is returned from the pathology system, the relevant icon will be coloured as shown pictorially in Fig.5 in red, yellow or green background.
  • a red background signifies potential high risk in the result for the patient as assessed by the SecondScreen system.
  • a date /time stamp records when the order was returned and displayed.
  • a yellow background signifies potential medium risk in the result for the patient.
  • a green background signifies potential low risk in the result for the patient.
  • the results may be ordered on screen by date, or by multiple ordered criteria such as risk, date, and whether the result has been read.
  • a health care professional can read the details of any laboratory result, alerts or clinical guidelines by interacting with the icon and in this embodiment that is achieved by simply touching the appropriate icon e.g.45 on the display screen.
  • the icon may be interacted with by way of electronic wireless means or by audio commands.
  • This action opens, a larger "overlay" window containing the full detail for the report on the test result, alert, or guideline and optionally can offer a choice of actions to the health care professional, including the ability to print off a copy of the report, to record that the result has been read and noted or to leave the result active for reading at a later date.
  • the SecondScreen system will also provide as a function of the interactive icons an alert to the health care professional of potential clinical risks or unrecorded tasks.
  • An example of which is a framework of prompts to check and record vital signs of the patient and dependant on the result prompt none, one or more alerts or suggested tests. Such a framework can be in accordance with known or agreed clinical guidelines.
  • the associated test icon When a health care professional has read a test result and has made a selection on the touch screen to signify the result has been read, the associated test icon will be shaded out to indicate the test result has been read and thereby "accepted". The shading of an icon retains the original colour coding but with a lighter shade of that colour applied.
  • a triage rating 32 assigned at time of admission is shown in the patient line next to the patient identification details.
  • the rating is 1 for high priority through to 5 for lowest priority.
  • the rating number can be obtained from the Hospital database system.
  • SecondScreen There may be more than one work area sharing the patient clinical load and in this embodiment of SecondScreen, three work areas are provided for; Area A, Area B and Area C.
  • Area A At the time of admission, the patient is usually assigned to a work area.
  • This data is collected in the Hospital database system and is transferred to the SecondScreen system.
  • the clinical work area code is displayed with the triage rating.
  • the triage rating for a patient is displayed in a column headed 'Triage' and the work area to which the patient is assigned is shown directly beneath the triage-rating figure.
  • Fig. 3 The default for the display screen in 'Risk Rating' display is shown in Fig. 3.
  • the purpose of this mode is to show those patients who are potentially at most risk.
  • the name of the patient is highlighted with the colour of the highest risk rating of un-read test result for them.
  • Patients with a high risk rating e.g. 31 A are displayed first, followed by those with medium risk 31B, then low risk and finally those with no unread test results. If more than one patient has the same test result risk assessment, the display will show those patients in descending order of the number of results that remain un-read ie not "accepted".
  • a user of the Display can choose to see the patient list in alphabetical order. This option is invoked by touching the button labelled "Alphabet" 37 in the 'Name List Select' area of the Display panel. Similarly, a user of the Display can also choose to see the patient list in Triage Rating order/This option is invoked by touching the button labelled "Triage Rating" 38 on the 'Name List Select' area of the Display panel.
  • Example screens showing the patient line reordering are shown in Fig. 7 and Fig. 8 respectively.
  • the overlay window contains the complete laboratory report data for that test, as provided by the Hospital's Pathology system.
  • test results as delivered from the Hospital Pathology system are contained in the middle of the overlay panel 60, with the patient identifiers at the top of the panel 61.
  • Three action buttons 62-64 are available for further user control, as follows:
  • PRINT RESULT allows a paper record to be printed, for health care professional reference or filing.
  • the overlay window may offer a second (and subsequent) page(s) to deliver the full laboratory report information.
  • the Display panel provides for 'workplace options' 70 in a top right hand area of the Display labelled "work area".
  • the work areas should reflect actual physical work spaces and is a user-defined field. This feature allows the patient list to be filtered to display only those patients assigned to a nominated work area.
  • Display screens are likely to be allocated to separate work places. However, a user in that work place will also be able to view test results for patients located in other work areas of the Emergency Department or the hospital.
  • Data overflow that is, the existence of more patient data than can be shown in the viewing area of the Display, may be an issue in some work environments.
  • the display of patient data is deliberately in large easily read format so that it can be seen from a distance, thereby making it easier for busy clinical staff to be aware of the test result situation from most points within the service area.
  • Two types of data overflow can occur:
  • FIG. 10 illustrates test icon overflow for patients Seagoon, Neddie and Hayward, Ruxton. As illustrated in Fig. 11, by touching the test overflow icon a new window is opened for the patient and displays all test icons 81 for that patient. Touching any one of these icons (test result rather than test order) will produce a new window with the result details.
  • the Display panel has two 'scroll' buttons e.g. 83 located in the Name List Select area (top left-hand corner of display).
  • a user can view unseen patient lines by touching the appropriate scroll button.
  • a second option for patient line overflow may be to physically mount another Display panel beneath an existing one and then invoke "tandem" operation of the pair of screens via the Display Panel Software.
  • the lower screen can act as an extension of the viewing area, enabling twice the number of patient lines to be viewed. All other functions can remain the same.
  • the SecondScreen it is also possible for the SecondScreen to shift the location of a patient on a list to the then visible portion of the display screen if certain criteria are met. Such as if the most recent test result for a patient is rated as critical and requires urgent attention by the treating health care professional, that patient's details may be shifted to the top of whatever list is being currently displayed accompanied by an alerting visual and or audible indicator. Thus with the health care professional in proximity to the display screen, it is appropriate that the SecondScreen system prompts them of critical information availability.
  • a further alternative viewing mechanism provides for matching of a treating health care professional with the patients assigned to them, or to the clinical unit/group to which they belong.
  • Implementation of this function requires the interface with other clinical and/or patient management computer records systems, for example, an Emergency Department patient management system, to provide not only the individual patient details but also the assigned treating health care professional for each patient, or a hospital system that assigns each inpatient to a clinical unit.
  • the purpose of this function is to make it easier for any particular health care professional to quickly view their list of patients and/or to quickly access their list of patients, without wasting time scrolling through all patients recorded in the system.
  • An example of this refinement is shown in Fig. 12.
  • Each patient line includes the name or in some examples the identification of the treating health care professional e.g. 91.
  • the system can provide the option of displaying "health care professional lines” instead of "Patient lines”.
  • PROXIMITY uses a sensor to detect the presence of a health care professional near the Display.
  • Dr Jones 95 was to be selected from the health care professional list, then only those patients of Dr Jones are subsequently displayed.
  • Suitable proximity devices include a range of commercially available devices that are able to detect passive transponders at a distance of up to 40 centimetres from the display screen antenna. As described earlier as RFID. With the "PROXIM ⁇ " button selected the display device, incorporating the antenna and suitable software, detects an electronically encoded health care professional nametag within its proximity that contains the passive transponder device. Such devices are small and inexpensive typically passive devices that can be affixed to the health care professional's identifying name badge.
  • the system detects their presence and decodes the information contained in it.
  • the decoded information includes the health care professional's name and the SecondScreen filters out the patients for that health care professional and shows only those patients in the patient list on the display.
  • the health care professional's name or identification code will be prominently displayed so that there is no confusion that the patient list is a selective list for a specific health care professional.
  • Figure 14 illustrates the resultant display. With the "OFF" button 100 selected in the Doctor or health care professional Select panel, the display includes all patients recorded with the system.
  • the Name List Select functions 101 of Alphabet, Risk Rating, Triage Rating and the Scroll function work with any of the Doctor or health care professional Select functions.
  • the system can be adapted to allow the ordering of diagnostic tests from the SecondScreen system, with a two-way data transfer link established with the respective clinical and /or patient management system.
  • test order data can be generated in the SecondScreen System and passed into the appropriate computer records system patient record where that exists.
  • This addition provides health care professionals with the time saving ability to use the human interface of the SecondScreen System to rapidly compile a new test order for a patient, via a touch screen menu selection with all the advantages of the SecondScreen interface.
  • the SecondScreen system can provide a health care professional focused display. This function, controlled by the system administrator, changes the focus of the display from patient lines to health care professional lines. There is still a specific display line for each treating health care professional/patient combination, but rather than showing the patient's name in a prominent fashion, the treating health care professional's name is displayed.
  • the Name List Select functions will then work on health care professionals' names, rather than patients' names.
  • the patient's name can be included in the health care professional line (for example, the patient's family and given names) or it can be omitted, as determined by the system administrator.
  • the system can provide a coded identification function.
  • the system allows the option of displaying "coded identifiers" for the identification of either the treating health care professional or of patients. Under this option, the actual name for the treating health care professionals or patients will be omitted, in favour of individual codes, to be set by the system administrator.
  • the system can include access to results such as radiology results and options that are more sophisticated for alerting health care professionals to results that have remained 'un-read' for a period of time, including interactive alert icons that appear if clinical actions have not been completed in a timely manner.
  • results such as radiology results and options that are more sophisticated for alerting health care professionals to results that have remained 'un-read' for a period of time, including interactive alert icons that appear if clinical actions have not been completed in a timely manner.
  • radiology and other reports are often stored as free text
  • the SecondScreen can signal the availability of those results but not assess the risk of the test findings. If hospitals allow radiologists and others involved in conducting and assessing the tests to enter alert states in their systems and reports, then the SecondScreen System can use this to risk stratify such results.
  • radiology results reporting requires an interface connection with the Radiology Reporting system and assumes that the risk rating of Radiology reports will be done in that Department and satisfactorily communicated to the SecondScreen system via the interface.
  • the visual encoded graphical display output can be supplemented with a variety of additional alerts.
  • the alert types are user controlled and can include any or all of the following:
  • an escalation of alert process can be invoked.
  • the parameters for the escalation process can also be user controlled and typically would include the dispatch (and further management if required) of the alert to supervisory staff, Head of Unit, Consultant or other persons.
  • FIG. 15 there is illustrated a possible software arrangement.
  • the various modules involved in the arrangement 110 can be programmed utilising the previously mentioned software languages.
  • a first series of modules 111, 112 are responsible for interaction with the relevant touch screen displays.
  • the displayed driver modules 111- 112 are driven by a GUI drive module 114 which stores the current GUI state of information in a GUI state database 115.
  • the information associated with a patient located within the Emergency Department can be stored in a separate database 116.
  • the information associated with patient's pathology test can be stored in a separate database 116A.
  • the algorithms and rules for risk rating individual test results and for external alert escalation can be stored in a database 116B.
  • the system is under the overall control of a control module 118 which regularly interrogates the databases 116, 116A, 116B and monitors changes in the Graphical User Interface (GUI) driver module 114 so as to provide overall control of the system.
  • the control module 118 interacts with a computer records system interface 120, which is designed to interrogate any of the computer systems used by the hospital to acquire information therefrom.
  • the control module 118 interacts with the external alerting rules data base 116B as an external alerting system interface 120B which is designed to pass alerting information to health care professionals, administrators and other staff, as is pre-determined in the alerting rules data base 116B, via a range of established, commercially available modalities, including but not limited to email, Short Message Service and Radio Paging.
  • the control module 118 also communicates with a printer and report module 122 and other communication devices as required 124.
  • the arrangement of Fig 15 provides for an overall control system to implement the user interface as previously described.
  • FIG. 16 illustrates one software module design suitable for implementing the preferred embodiment (clinical guidelines) at the point of care, in that it shows the system generation of a clinical guideline interactive icon (the touch screen "button” coloured in this embodiment "blue” and labelled “Warfarin” 126, to signify the availability, on the display, of the guideline for the anti-coagulant drug Warfarin.
  • the Warfarin clinical guideline interactive icon was generated by the SecondScreen system because the relevant patient had a red rated test result (INR) 128, indicating a problem with the administration of Warfarin.
  • Figure 17 illustrates one software module design suitable for implementing the structured clinical process, wherein a new display provides additional interactive touch screen "buttons" to order new diagnostic tests (Repeat INR) 130, to record the clinical observations (No Bleeding or Mild Bleeding) 132 and/or to move to a further display screen to consider further clinical options 134.
  • Repeat INR new diagnostic tests
  • Figure 18 illustrates one software module design suitable for assisting a user to calculate the optimal dosage of a particular drug, taking into account a relevant patient risk factor (eg Weight).
  • a relevant patient risk factor eg Weight
  • Figure 19 illustrates one software module design suitable for collecting additional patient specific data, directly from the display using interactive touch screen "buttons" (Patient's weight).
  • Figure 20 illustrates one software module design suitable for configuring the system, again from the display, to check for a specific clinical event at a later point in time. For example, re-checking the existing pathology system for an INR result for the specific patient.
  • Fig. 20 illustrates one software module design suitable for implementing the preferred embodiment.

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Abstract

Le système offre des informations interactives professionnelles des soins de santé concernant un ou plusieurs patients dans un environnement clinique. Le système comporte un système informatique connecté à au moins un dispositif d'affichage interactif permettant le traitement de l'interaction entre le professionnel des soins de santé et le dispositif. On prévoit au moins un dispositif d'affichage interactif dans l'environnement clinique, chaque dispositif étant conçu pour afficher l'information clinique et d'autres informations associées à un patient en rapport avec ledit environnement. L'information affichée comporte une liste de tous les noms des patients qui ont été saisis dans un système d'enregistrement informatique de patients. Pour chaque patient sur la liste, le système propose un ou plusieurs icones interactifs représentant un test diagnostique classé par un professionnel des soins de santé. Les icones sont codés visuellement avec au moins un indicateur permettant d'indiquer la capacité d'accès à un résultat de test effectué pour ledit patient et/ou d'indiquer si un classement de test (examen non encore rapporté), si un résultat de test (rapport d'examen disponible) ou si le résultat du test diagnostique a été accepté par un professionnel des soins de santé prédéterminé. Les icones sont codés visuellement en vue de l'évaluation des risques cliniques du résultat. Par ailleurs, on propose la date/heure de la mise en place du classement du test diagnostique. L'icone peut être actionné et les résultats du test ainsi que d'autres informations sont mis à disposition du professionnel des soins de santé autorisé.
PCT/AU2003/001479 2002-11-07 2003-11-07 Systeme et procede de gestion des risques cliniques Ceased WO2004042596A1 (fr)

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US7949545B1 (en) 2004-05-03 2011-05-24 The Medical RecordBank, Inc. Method and apparatus for providing a centralized medical record system
US8239218B1 (en) 2004-05-03 2012-08-07 The Medical RecordBank, Inc. Method and apparatus for providing a centralized medical record system
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US10991185B1 (en) 2020-07-20 2021-04-27 Abbott Laboratories Digital pass verification systems and methods
US10991190B1 (en) 2020-07-20 2021-04-27 Abbott Laboratories Digital pass verification systems and methods
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US11574514B2 (en) 2020-07-20 2023-02-07 Abbott Laboratories Digital pass verification systems and methods
CN119132553A (zh) * 2024-11-13 2024-12-13 瑞达智极医疗科技(厦门)有限公司 一种临床护理导管安全管理系统以及知识库智能更新方法

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