Patent Application
20210166812
The present invention relates to methods and apparatus for use in emergency rooms and in other clinical settings, and particularly apparatus and methods that are used to increase the diagnostic accuracy and the patient throughput during emergency room or clinical procedures.
The execution of emergency room medicine is usually described as being made up of five elements, which are as follows:
(i) identification;
(ii) triage;
(iii) anamnesis;
(iv) diagnosis; and
(v) prognosis.
Emergency room medicine is characterized by two distinctive features, which makes emergency room practice dissimilar from that of other hospital functional units. The first feature is the need for speedy handling and diagnosis of the patients. This requirement is compounded by the need to operate in situations which are often high load situations, especially in situations of mass casualty events, but also in extreme weather conditions, when elderly and weak patients are highly prone to illnesses. The second feature follows partly from the need for speedy diagnoses, and relates to the accuracy of the diagnosis and recommended treatment that can be achieved, under the conditions of urgency and load in a typical emergency room setting. The accuracy of the diagnosis can have a bearing on decisions regarding priority of treatment, which could have repercussions on the survival rate both of the patient being examined, and of other patients. Speedy diagnosis is especially important for medical conditions relating to cerebrovascular incidents, strokes and cardiac events. Furthermore, statistics have been presented indicating that incorrect diagnosis is a common cause of death in the medical field, and that 30 percent of such events occur as a result of a delay in treatment or incorrect diagnosis in the setting of the emergency room.
In accordance with some applications of the present invention, at least one computer processor is configured to assess a patient's clinical condition within a medical setting in an autonomous or semi-autonomous manner. Typically, the at least one computer processor includes a computer processor of a patient-testing station, and the computer processor combines multiple sources of medical information, as obtained, inter alia, from:
(i) tests and examinations performed using the patient-testing station, a robotic station of the patient-testing station, and/or robotic components of the patient-testing station, e.g., using non-contact, contact and minimally invasive sensors,
(ii) machine interpretation and processing of medical images generated during the tests,
(iii) information obtained automatically and interactively at a patient-testing station, and
(iv) the patient's medical history,
together with artificial intelligence interrogation of databases of medical situations for comparing with and analyzing the above assembled patient medical information.
Typically the computer processor connects to historical databases of previous measurements (e.g., textual, structural, and/or visual measurements, etc.), and uses machine-learning based methods and/or general artificial-intelligence methods to mine patterns with high correlation to previously given patient anamnesis, diagnosis, prognosis, etc. Using the derived patterns, the computer processor typically applies such patterns to the analysis of current patients to classify them based on the historical patterns to the most probable diagnosis, prognosis, etc.
For some applications, a machine-learning stage is performed during which the at least one computer processor receives data relating to a plurality of patients, as well as conditions that respective patients belonging to the plurality of patients are diagnosed as having. By analyzing the aforementioned inputs, the computer processor determines correlations between respective patient parameters and the conditions that the patients are diagnosed as having. By way of example, the computer processor may determine that, whether or not a patient feels chest pains, is highly correlated with diagnosing a patient as suffering from a cardiac arrest, or it may determine that the age and/or sex of a patient is highly correlated with their susceptibility to liver disease.
During a patient diagnosis stage, a given patient is typically assessed. For some applications, the computer processor determines that the patient is suspected as having one or more conditions. For example, the computer processor may determine the one or more conditions that the patient is suspected of having, by asking the patient a preliminary set of questions, by automatically measuring one or more physiological parameters of the given patient using one or more sensors and/or one or more imaging devices, by automatically measuring one or more physiological parameters of the given patient using one or more robotic components, and/or by accessing the patient's medical history.
Subsequently, based at least partially upon the correlations determined during the machine-learning step, and based at least partially upon the one or more conditions that the given patient is suspected of having, the computer processor determines a set of questions to ask the patient. Typically, the set of questions is determined by selecting a set of questions that is such as to (a) determine that the patient has one of the one or more conditions with a likelihood that passes a threshold likelihood, with (b) a minimum number of questions being asked.
For some applications, the computer processor then chooses which question to ask the patient next, based upon the output of the previous step.
Typically, the machine-learning stage is ongoing and temporally overlaps with the patient-diagnosis stage, inasmuch that at the same time as a given patient is diagnosed, data relating to that patient is fed into the one or more computer processors that are configured to perform the machine-learning analysis of the data. For some applications, the data received in the machine-learning stage is received automatically, e.g., by being received from the computer processors of patient-testing stations, and/or by being received from other sources, e.g., by analyzing the medical records of a large number of patients that are stored on a database.
For some applications, during the machine-learning stage, the computer processor generates predictive models that relate patient-related data to patient diagnoses, for example, using machine-learning techniques. During the patient-diagnosis phase, the computer processor receives parameters relating to a given patient. For example, such parameters may be obtained by asking the patient questions via a user interface, by automatically measuring one or more physiological parameters of the given patient using one or more sensors and/or imaging devices, by automatically measuring one or more physiological parameters of the given patient using one or more robotic components, and/or by accessing the patient's medical history. In response to the received parameters, and using the predictive models that were determined during the machine-learning step, the computer processor diagnoses the patient as having one or more conditions.
For some applications, the computer processor generates an output indicating the one or more conditions that the patient is suspected of having, and additionally generates an output indicating the contribution of a given portion of the parameters, toward diagnosing the patient as having the one or more conditions. For example, the computer processor may generate an output indicating that the main contributing factor toward diagnosing the patient as having a given condition was his/her answer to a given question, was the result of a given test that was performed, was the result of an image that was acquired, was the result of an item in his/her medical history, etc. Alternatively or additionally, the computer processor may indicate a weighting of a given one of the parameters (or respective weightings of a plurality of parameters) in diagnosing the patient as having the given condition. For some applications, the computer processor generates a textual explanation of how the diagnosis was arrived at. For example, the text may include a description of a correlation between a given set of the received parameters and a condition that the patient has been diagnosed as having.
Typically, by outputting the indication of the contribution of a given portion of the parameters toward diagnosing the patient as having the one or more conditions, the confidence of the patient, and moreover, the confidence of the doctor in the machine-generated diagnosis is strengthened. Alternatively, by outputting the indication of the contribution of a given portion of the parameters toward diagnosing the patient as having the one or more conditions, the doctor is able to better assess whether he/she agrees with the diagnosis, and/or whether he/she would like any additional tests or examinations to be performed.
There is therefore provided, in accordance with some applications of the present invention, apparatus for performing a differential diagnosis of a patient, the apparatus including:
an output device; and
at least one computer processor configured:
In some applications the computer processor is configured to choose the next question to ask the given patient by choosing a question the answer to which would carry the greatest weight in diagnosing the patient as suffering from the one of the one or more conditions with more than the threshold likelihood.
In some applications, the computer processor is further configured, in response to receiving a response from the given patient to one of the set of questions that indicates that it is more likely that the patient is suffering from a different condition from the one of the one or more conditions, to determine a new set of questions to ask the subject.
In some applications, the computer processor is configured to determine the set of questions that the given patient should be asked by using natural language processing to determine which words to use in the set of questions.
In some applications, the computer processor:
is further configured, in the machine-learning-stage, to identify a question that can be asked to a patient in order to resolve a contradiction between responses that the patient has given to two or more previous questions, and
is configured, in the patient-diagnosis stage, to choose the next question to ask the given patient by choosing to ask the given patient the identified question, in response to the given patient having given responses to two or more previous questions that result in the contradiction.
In some applications, the computer processor is configured to determine the one or more conditions that the given patient is suspected of having, at least partially by:
asking the given patient a preliminary set of questions; and
determining the one or more conditions that the given patient is suspected of having, based upon the responses of the given patient provides to the preliminary set of questions.
In some applications, the computer processor is configured to determine the one or more conditions that the given patient is suspected of having, at least partially by:
automatically measuring one or more physiological parameters of the given patient, using one or more sensors; and
determining the one or more conditions that the given patient is suspected of having, based upon the one or more physiological parameters.
In some applications, the computer processor is configured to determine the one or more conditions that the given patient is suspected of having, at least partially by:
automatically measuring one or more physiological parameters of the given patient, using one or more robotic components; and
determining the one or more conditions that the given patient is suspected of having, based upon the one or more physiological parameters.
In some applications, the computer processor is configured to determine the one or more conditions that the given patient is suspected of having, at least partially by:
accessing the patient's medical history; and
determining the one or more conditions that the given patient is suspected of having, based upon the patient's medical history.
There is further provided, in accordance with some applications of the present invention, a method for performing a differential diagnosis of a patient, the method including:
using at least one computer processor:
There is further provided, in accordance with some applications of the present invention, apparatus for performing a differential diagnosis of a patient, the apparatus including:
at least one output device; and
at least one computer processor configured:
In some applications, the computer processor is configured to receive the plurality of parameters relating to the given patient at least partially by outputting questions to the patient, and receiving answers to the questions.
In some applications, the computer processor is configured to receive the plurality of parameters relating to the given patient at least partially by automatically receiving parameters relating to the given patient's medical history.
In some applications, the computer processor is configured to receive the plurality of parameters relating to the given patient at least partially by automatically measuring one or more physiological parameters of the given patient, using one or more sensors.
In some applications, the computer processor is configured to receive the plurality of parameters relating to the given patient at least partially by automatically acquiring one or more images of the given patient.
In some applications, the computer processor is configured to receive the plurality of parameters relating to the given patient at least partially by automatically measuring one or more physiological parameters of the given patient, using one or more robotic components.
In some applications, the computer processor is configured to generate the output indicating the contribution of the given portion of the received parameters toward diagnosing the patient as having the one or more conditions by indicating a weighting of a given one of the received parameters in diagnosing the patient as having the one or more conditions.
In some applications, the computer processor is configured to generate the output indicating the contribution of the given portion of the received parameters toward diagnosing the patient as having the one or more conditions by indicating respective weightings of a plurality of respective received parameters in diagnosing the patient as having the one or more conditions.
In some applications, the computer processor is configured to generate the output indicating the contribution of the given portion of the received parameters toward diagnosing the patient as having the one or more conditions by generating an output in which a correlation between a given set of the received parameters and the one or more conditions is indicated.
There is further provided, in accordance with some applications of the present invention, a method for performing a differential diagnosis of a patient, the method including:
using at least one computer processor:
There is additionally provided, in accordance with some applications of the present invention, a computer software product, for performing a differential diagnosis of a patient and for use with an output device, the computer software product comprising a non-transitory computer-readable medium in which program instructions are stored, which instructions, when read by a computer cause the computer to perform the steps of:
in a machine-learning stage:
There is additionally provided, in accordance with some applications of the present invention, a computer software product, for performing a differential diagnosis of a patient, the computer software product comprising a non-transitory computer-readable medium in which program instructions are stored, which instructions, when read by a computer cause the computer to perform the steps of:
in a machine-learning stage:
in a patient-diagnosis stage:
The present invention will be more fully understood from the following detailed description of applications thereof, taken together with the drawings, in which:
Reference is now made to
Referring to
3, for example), a mouse, a joystick, a touchscreen device (such as a smartphone or a tablet computer), a touchpad, a trackball, a voice-command interface, and/or other types of input devices that are known in the art. Typically, the computer processor generates an output via an output device 36 of the user interface. For some applications, the output device includes a monitor 39 (as shown in
Referring now to the procedure that is described in the flowchart of
Typically, patient-testing station 17 is configured to output questions to the patient via output device 36, and to receive answers to the questions from the patient via input device 37.
For some applications, computer processor 18 of the patient-testing station is configured to receive data relating to the patient by accessing the patient's medical history records, as described in further detail hereinbelow. Typically, the computer processor obtains additional data relating to the patient by performing tests upon the patient, e.g., by performing such tests in an autonomous or semi-autonomous manner using robotic components, sensors, and/or imaging components of the patient-testing station, as described in further detail hereinbelow. The computer processor typically performs the methods described herein, and generates an output to the patient and/or to a healthcare professional, e.g., an emergency room doctor or nurse. For some applications, the computer processor communicates with one or more additional computer processors (not shown). For example, computer processors that are disposed remotely from computer processor 18 may store machine-learning data, and/or medical history records, and computer processor 18 may access such data by communicating with the one or more remotely-disposed computer processors.
In step 1 of the procedure shown in
Typically, less critical patients are handled at step 2, in which the patient's identity is automatically checked using either a facial imaging device, a fingerprint or handprint device, an iris image signature, and/or any similar system for biometric identification. This identification is optionally backed up by the scanning of the patient's ID card or other similar identification document in step 3. If, however, a patient is not recognized by the system in step 2, or it is known that the patient will not be recognized, then step 2 may be omitted and step 3 may be used alone.
The patient's identity is typically used to register the patient by one of two paths; either the patient is identified in the hospital records, and then all that he/she has to do is to verify that identity in step 3, or, for a new patient, the patient or his accompanying person has to register with personal details in step 3.
In step 4, for patients not determined in the primary triage to be in a life-threating situation, an automatic triage procedure is performed, the implementation being based on a sensor guided robotic system, cameras, and/or sensors (e.g., non-contact, contact non-invasive, and/or contact minimal invasive sensors), and optionally being artificial intelligence based.
In step 5, upon reaching the patient's turn in the triage, the patient undergoes an interactive automated anamnesis session, and at the same time, the system searches accessible records for any relevant historical medical data on that particular patient. Such relevant and accessible historical medical data is understood to be included in the stored data of step 5, subsequent steps, and throughout this disclosure. If relevant historical medical data on the patient is not found, the system proceeds with only the information obtained during the automated anamnesis session.
In step 6, the results of the anamnesis session, and optionally of the historical medical data accessed in step 5, are used to identify a primary differential illness group or category, for example “chest pain,” upon which a tailored examination program will be based. Such an examination program may include a physical examination portion, which may include examinations based on sensor-guided robotic systems, and a testing portion which may include blood tests, urine tests, etc. In step 7, an examination program is generated based on the primary differential illness category, which defines the routine and the non-routine tests, images and consultations which are advised to be performed on that patient.
In step 8, the patient undergoes the physical tests and imaging prescribed by the examination program. Automatic physical examinations are typically performed using patient-testing station 17. For some applications, the patient-testing station is based on sensor-guided robotic systems, and/or remote manipulation by a doctor, who can give instructions to the robotic system to check a specific response of a patient, which the overseeing doctor believes to be necessary, and which is not in the examination protocol of the station itself. The test procedures can all be performed in one patient-testing station (which may, for example, have multiple robotic systems for executing various tests), or separate stations may be used for each specific test or group of tests, with the patient transferred between the separate stations. If at any point during this process, test results are generated which cannot be readily associated with one or more diagnoses, there may be protocol regarding the need to repeat tests for the purpose of yielding more applicable results.
In step 9, based on the results from the physical examination and other steps that have been performed, the system makes a decision as to whether there is a high enough certainty regarding the next steps to enable the system to continue autonomously. If so, in step 10, automatic standing orders are initiated for tests such as imaging, blood tests, urine tests, etc., based on the examination program. If not, then the system proceeds to step 16, in which an attending doctor is required to review the case, and the doctor decides whether or not to proceed with the standing order tests. The certainty of the system to proceed autonomously may be based on a comparison of the physical exam results to a database, for example, to determine the likelihood of providing a diagnosis based on such results, or to identify unusual results that may require further examination by a doctor. As mentioned previously, the system may determine that there should be additional tests in an attempt to gain results that will offer higher certainty, instead of referring directly to step 16.
In step 11, the totality of intake and historical data, and of all of the test results generated, is compared with a background database of patients whose symptom profiles and/or test results are similar to those of the patient being treated, and an assessment of the likely diagnoses, and, optionally, suggested treatments and/or prognoses, is performed and is output to the emergency room digital records system. At this stage, there may be one or more likely diagnoses provided. As described in further detail hereinbelow, typically this comparison is performed using machine-learning techniques.
In step 12, one or more diagnoses, prognoses, and/or treatment plans are provided, based upon the comparison performed in step 11. In step 13, the system, based on the data generated, decides if there is a high certainty regarding the final diagnosis, and optionally prognosis and treatment plan, and if so, it is sent for review by the attending physician in step 14, so that a confirmed diagnosis and optionally prognosis and treatment plan may be made. In situations in which there more than one likely diagnosis is indicated, a grading system is typically provided, based on the statistical likelihood of the accuracy of each of the possible diagnoses. Additionally, in a situation in which more than a predetermined number of diagnoses are provided by the system, additional tests or information regarding the patient's current condition may be accumulated to reduce the number of likely diagnoses, such as to reduce the diagnoses to below a predetermined number.
For some applications, if the final diagnosis and prognosis does not have a high certainty of accuracy, predetermined protocol is followed to determine whether the case is returned to the medical staff at step 16, for further review and testing, or is returned to step 5 or step 7 to obtain new information and/or new test results. For example, this may be obtained by performing new tests and/or asking new questions, and/or by repeating previous tests and/or questions. Alternatively or additionally, further historical data is accumulated in this step. Such a lack of high certainty may occur, for example, when there are many suggested diagnoses by the system that are all given a high statistical probability or grading. As another example, even if there are only two suggested diagnoses, but they both have a 50 percent probability of accuracy according to the grading system, then this may also constitute a lack of high certainty and may warrant further information or testing.
After a physician has confirmed a diagnosis in step 14, the system, in step 15, stores the confirmed diagnosis and generates instructions for the next steps regarding hospitalization or check out and follow up.
It is to be understood that the procedure shown in
Reference is now made to
In step 20, the system uses the patient's data from the initial stages of accepting and generating the intake of the patient and accessible medical records, in accordance with steps 1-5 of
On the basis of the primary differential category, a tailored examination program is determined for the patient, of which typical details are outlined, in step 21. The patient is sent, in step 22, to a patient-testing station (such as patient-testing station 17 described herein), e.g., an automatic physical examination station, which may include:
a robotic ECG/EKG examination apparatus, using a sensor guided robotic system, or an examination chair or bed outfitted with electrodes;
a robotic system with blood sampling capabilities for providing samples for tests such as for CRP, D-dimer, or Troponin levels;
a robotic system with pressure sensors for creating contact in the relevant areas on the patient's torso;
a chest x-ray; and/or
a blood test.
For some applications, the patient-testing station includes an analysis system for performing analysis of one or more of the above-mentioned tests, in situ.
Once the automated physical tests have been concluded, in step 23 the system decides if there is high certainty regarding the next steps that should be taken. If there is not high certainty, the patient's case may be referred to medical staff, in accordance with step 16 of
Typically, in performing the comparison of step 25, the system uses artificial intelligence methods and detects correlations to previous clinical patterns to provide one or more likely diagnoses in step 26. If the system is unable to generate a likely diagnosis, the system may determine that further testing is warranted or may refer the patient to the medical staff in step 16 of
Step 27 illustrates an exemplary algorithmic step in which the system determines if there is a high enough certainty regarding an accurate diagnosis from the diagnoses of step 26. This discrimination may be performed using any suitable statistical method. In the example shown, the system determines if there is a single diagnosis of the likely diagnoses generated in step 26, which has more than a predetermined level of likelihood of accuracy, Dref, and which exceeds the likelihood of accuracy of each of the other diagnoses of step 26 by at least a second predetermined value, Dref2. To continue the aforementioned example, if, for instance, Dref=80 percent, and, for instance, Dref2=10 percent, and if X percent is higher than 80 percent and has more than 10 percent likelihood of accuracy over Y percent and over Z percent, there is shown a single diagnosis which fulfills these requirements for providing a diagnosis having a high certainty of accuracy. Thus, in the example shown, the patient would be diagnosed as having “stable angina”, X percent being associated with the diagnosis of “stable angina”. The system may then also determine if there is a high accuracy regarding the prognosis and treatment plan at this stage.
Thus, in this example, there is determined to be a high certainty regarding the diagnosis. However, the hospital protocol may mandate that all automatic diagnoses be confirmed by a human physician. Under these circumstances, the method may then proceed to step 28 in which the physician may then confirm the diagnosis of “stable angina”. The physician may optionally confirm or determine of his/her own accord a prognosis and a treatment plan at this stage. In step 29, the system stores the confirmed diagnosis and generates instructions for hospitalization, or for check out and follow up. In the example shown, the system generates instructions for hospitalization and an angioplasty procedure.
Reference is now made to
For some applications, robotic station 30 includes robot activation arm or arms. For some such applications, the arms have palpating facilities, imitating those activated by a human doctor, enabling the arms to make physical contact with the patient where necessary, in order to perform a bodily examination. In order to successfully achieve most of the functions of the stations described, the robotic station may be equipped with some form of artificial vision, with optical or other sensors on any robotically controlled arm to view and assure the position of the patient being examined. For some applications, the robotic station includes or works in conjunction with image-processing facilities in order to analyze and focus on the region which the robotic station is intended to interact with. For some applications, the robotic station communicates with the patient (e.g., via user interface 19, shown in
For some applications, a robotic station is used to extract a sample of bodily fluids from the patient. For some such applications, the activation arm or arms are equipped with equipment for withdrawing the sample, e.g., equipment for drawing a saliva sample, or equipment (such as a syringe), in order to make a puncture in order to draw blood, as described in further detail hereinbelow.
For some applications, computer processor 18 is configured to perform artificial-intelligence processing. For some applications, the computer processor is configured to access databases that include records not only of standard expected situations and responses with regard to any bodily part being examined, but also a large bank of historic diagnostic responses to such examinations. In this way, by using such historical data banks, and by use of deep learning procedures, the results are more accurately interpreted. Further typically, the database is updated based upon tests that are performed on each patient, the corresponding diagnoses, and/or the accuracy of such diagnoses.
For some applications, robotic station 30 is a general-purpose station, and is used, for example, for palpable interactive examinations of the patient, the patient's temperature, the patient's sweating level, and force reaction examinations. For some applications, the robotic station is equipped with specific instruments, sensors or cameras, in order to fulfill specific tests or image-based examinations. Typically, the robotic station is adapted to perform multiple examinations, to increase efficiency and to save the need for movement of the patient from one station to another.
Referring again to
The robotic mechanism includes one or more artificial feeling extremities 35, typically shaped as a human hand (as shown). Typically, the extremities have flexibility and agility similar to a human hand. For some applications, the patient-testing station (e.g., the robotic station) includes one or more imaging devices 34 for imaging the patient. For some applications, the imaging device include a three-dimensional imaging system, and the computer processor is configured to relate the position of the feeling extremities with the region of the patient's body which is being examined, using three-dimensional images acquired by the imaging system. For some applications, the robotic mechanism incorporates robotically activated artificial fingers 32 that are configured to find and feel the organs being examined. For some such applications, the fingers have force feedback sensors and/or tactile sensors, which are configured to extract meaningful data regarding size, consistency, texture, location, and tenderness of the organ or body part being palpated. For example, such a robotic station can be used for abdominal examinations, for breast examinations, and/or for orthopedic examination of muscular or bone damage.
For some applications, the robotic station is equipped with user interface 19, which is typically generally as described hereinabove. During the examination, the robotic station may be programmed to ask the patient questions, e.g., relating to the level of pain during motion or during palpation, or during pressure, or relating to the limits of motion during manipulation of limbs, or similar questions of the type that a human doctor would ask patient during such a bodily contact examination.
For some applications, the robotic station is configured to operate at least partially autonomously, based either on artificial-intelligence algorithms, on a programed pre-determined routine, or both. For example, the robotic station may use sensor guiding of the robotic system with feedback from the patient. For some applications, in addition to operating in an autonomous mode, the station is also configured to be operated by a remotely-located physician, who can operate or provide guidelines to the robotic system to check a specific response of the patient. For some applications, an interactive remote terminal that provides haptic feedback is provided to assist the doctor in this task.
Reference is now made to
As shown in
For some applications, semi-rigid curved arm 41 includes a sternum plate of a semi-rigid ECG electrode belt, such as is provided by LevMed Ltd., of Zichron Ya'akov, Israel. The position of the electrode belt upon the patient's chest is typically maintained by its weight, or by positive robotic arm pressure. For some applications, the patient-testing station also connects electrode clamps 43 to the peripheral limb extremities, e.g., the patient's wrists and/or ankles. For some applications, electrical contact between the electrodes and the patient's skin is facilitated by robotic application of electrode solution to the skin-contact side of the electrodes, such as by a fluid pump and fine channels or pipes. For some applications, once there is electrical contact between the electrodes and the patient's skin, the robotic arm withdraws a connection 45 used to position the ECG belt, and the robotic station activates the ECG recording until a useful trace is obtained. This can be ascertained either by analysis by the computer processor of the trace output, or by remote inspection by the attending doctor. For some applications, the robotic station thus enables the entire ECG procedure to be performed without active participation of attending medical personnel, and typically within a relatively short space of time (e.g., less than 5 minutes, e.g., approximately 2 minutes), depending on the cooperation of the patient.
Although the normal ECG procedure is for the patient to undergo the test after at least partially undressing, such that the electrodes touch the skin directly, for some applications, the patient-testing station is configured to perform ECG testing on a clothed patient, e.g., using drops of electrode contact solution applied automatically to the clothing which the tips of the ECG electrodes touch, to maintain electrical contact between the skin surface and the tips of the ECG electrodes. For some applications, the patient-testing station utilizes a closed loop feedback system to continue dispensing solution until the ECG signal at any electrode is sufficiently identifiable. For some applications, such an arrangement saves time in performing the ECG test, relative to if the patient were required to become undressed.
Reference is now made to
In an alternative application, not shown in the drawings, electrodes are used that project from a bed on which the patient is instructed to lie, preferably in the prone position to provide optimum signal from the cardiac region, but also possibly in the supine position for a posterior ECG examination.
Reference is now made to
For some applications, an infra-red vein imager is used, such as the VeinViewer® Vision product, provided by Christie Medical Products of Memphis, Tenn., which uses near-infrared light to project a digital image of the patient vasculature directly onto the surface of the skin. A conventional video image processor is used to guide the robotic needle inserter to the correct angle and location, based upon the digital image of the patient vasculature on the surface of the skin. Alternatively, direct image processing of the image is used to guide the robotically aligned needle. For some applications, a bio-sensitive detection system is used in order to ensure that the needle or catheter has been inserted into a blood vessel and not into surrounding tissue. Typically, once the needle location within the vein has been confirmed, a mechanical mechanism, preferably within needle drive mechanism module 58, is used to connect a vacuum container or a flexible collection tube to the needle end to draw the blood. Use of such an automated venous puncture station typically enables the speed and accuracy of blood collection to be substantially increased over a manual system operated by medical personnel.
For some applications, blood testing is performed using alternative or additional methods, for example, using a drop of capillary blood obtained from a finger prick, and applying micro fluid detection techniques on that drop of blood. Alternatively or additionally, a patch of micro-needles, typically measuring only a few millimeters (e.g., up to 20 mm) across, is applied to the skin of the patient, to withdraw bodily fluid, which may be analyzed within the micro-needles themselves. For some applications, the needles are at least 1 mm in length, so that they penetrate to the epidermis and the dermis, such that it is possible to draw and analyze capillary blood from a small area. For some such applications, each micro-needle, or group of micro-needles, is adapted to execute a blood test for a different blood component, depending on the reagent contained in the micro-needle, and the method used for the analysis. For some applications, spectral analysis is used to analyze the blood in the micro-needles. Alternatively or additionally, other analysis methods are used. For some applications, use of such a patch analysis method enables the patient-testing station, or the portion thereof that is used for blood analysis, to perform blood analysis without the need for any significant accuracy of placement of the patch upon the patient's skin.
The above-described patient-testing stations, robotic stations, robotic components, and techniques for use therewith, are examples of the type of examinations which can be performed using the emergency room autonomous, semi-autonomous, and/or robotic techniques of the present disclosure. Additional examples include the use of infrared imaging (e.g., using imaging device 34 of
For some applications, a combination of the tests that are described herein as being performed by patient-testing station 17 and/or robotic station 30 are performed on a single patient, e.g., using a single patient-testing station, or using a combination of patient-testing stations each of which has different testing capabilities.
For some applications, a computer processor as described herein is configured to combine multiple sources of medical information regarding the patient's status, as obtained, inter alia, from:
(i) tests and examinations performed using a patient-testing station, a robotic station, and/or robotic components, e.g., using non-contact, contact and minimally invasive sensors,
(ii) machine interpretation and processing of medical images generated during the tests,
(iii) information obtained automatically and interactively at a patient-testing station, and
(iv) the patient's medical history,
together with artificial intelligence interrogation of large databanks of medical situations for comparing with and analyzing the above assembled patient medical information.
Typically the computer processor connects to historical databases of previous measurements (e.g., textual, structural, and/or visual measurements, etc.), and uses machine-learning based methods and/or general artificial-intelligence methods to mine patterns with high correlation to previously given patient anamnesis, diagnosis, prognosis, etc. Using the derived patterns, the computer processor typically applies such patterns to the analysis of current patients to classify them based on the historical pattern to the most probable diagnosis, prognosis etc.
Typically, the computer processor thus enables the speedy and accurate assessment of the patient's clinical condition within a medical setting, whether that assessment is uniquely determined, or whether it results from a choice of more than one potential condition, combined with recommendations regarding the preferred continued treatment of the patient. In situations where there is indicated more than one likely diagnosis, a grading system is typically provided, based on the statistical likelihood of the accuracy of each of the possible diagnoses, e.g., as described hereinabove. Additionally, in a situation in which more than a predetermined number of diagnoses are provided by the system, additional tests or information regarding the patient's current condition may be accumulated to reduce the number of likely diagnoses, such as to reduce the diagnoses to below a predetermined number, e.g., in accordance with the techniques described herein. For some applications, a summary of all cases is referred to an attending doctor, in order to confirm the feasibility and logic of the determined diagnosis, especially in cases in which the system indicates that more than one diagnosis is possible, and a decision has to be made regarding which course of treatment to follow, e.g., in accordance with the techniques described hereinabove.
Reference is now made to
A machine-learning stage is typically performed at least partially by at least one computer processor that is remote from computer processor 18 of patient-testing station 17. During the machine-learning stage, the at least one computer processor receives data relating to a plurality of patients, as well as conditions that respective patients belonging to the plurality of patients are diagnosed as having (step 70 of
During a patient diagnosis stage, a given patient is typically assessed, for example using the apparatus and methods described hereinabove. For some applications, in step 74, at least one computer processor (which typically includes computer processor 18 of patient-testing station 17) determines that the patient is suspected as having one or more conditions. For some applications, step 74 corresponds with step 6 of
Subsequently, in step 75, based at least partially upon the correlations determined during the machine-learning step, and based at least partially upon the one or more conditions that the given patient is suspected of having, the computer processor determines a set of questions to ask the patient. Typically, the set of questions is determined by selecting a set of questions that is such as to (a) determine that the patient has one of the one or more conditions with a likelihood that passes a threshold likelihood, with (b) a minimum number of questions being asked.
Purely by way of example, the threshold likelihood may be 90 percent. It may be determined that based at least partially upon the correlations determined during the machine-learning step, and based at least partially upon the one or more conditions that the given patient is suspected of having, there is a set of five questions, based upon which (depending upon the answers that the patient gives), it may be possible to diagnose the patient as suffering from one of the one or more conditions with more than a 90 percent likelihood. It may further be determined that there is a different set of six questions, based upon which (depending upon the answers that the patient gives), it may be possible to diagnose the patient as suffering from one of the one or more conditions with more than a 90 percent likelihood. Therefore, the computer processor may determine that the set of five questions should be asked. For some applications, in determining the set of questions that the patient should be asked, the computer processor uses natural language processing to determine which words to use in the questions.
For some applications, additional considerations are taken into account when determining the set of questions to ask the subject. For example, the computer processor may be able to diagnose the patient as suffering from one of the one or more conditions with more than the threshold likelihood either by (a) asking the patient a first set of questions, or by (b) performing tests on the subject in combination with asking the subject a second set of questions that is shorter than the first set of questions. In such a case, the computer processor may choose to ask the first set of questions, even though it is longer, because this may minimize the number of questions that need to be asked, without additionally requiring performance of the tests. Thus, more generally, for some applications, when determining the set of questions to ask the subject, the computer processor accounts for additional parameters (e.g., test results, imaging results, and/or medical history parameters) regarding the patient that may be required in order to diagnose the patient as suffering from one of the one or more conditions with more than the threshold likelihood. The computer processor determines for a given set of additional parameters that may be required, a set of questions that could be combined with the additional parameters that would be such as to (a) determine that the patient has one of the one or more conditions with a likelihood that passes a threshold likelihood, with (b) a minimum number of questions being asked.
For some applications, the method then proceeds to step 78, in which the computer processor chooses which question to ask the patient next, based upon the output of step 76. To continue with the example provided in the above paragraph, of the set five questions that were determined in step 76, the computer processor may choose the question the answer to which would carry the greatest weight in diagnosing the patient as suffering from one of the one or more conditions with more than a 90 percent likelihood.
For some applications, during the machine-learning stage, the computer processor identifies a question that can be asked to a patient in order to resolve a contradiction between responses that the patient has given to two or more previous questions. Subsequently, in the patient-diagnosis stage, the computer processor chooses to ask the patient the identified question, in response to the given patient having given responses to two or more previous questions that result in the contradiction.
Typically, the steps described with reference to the patient diagnosis stage of
It is noted that, typically, the machine-learning stage is ongoing and temporally overlaps with the patient-diagnosis stage, inasmuch that at the same time as a given patient is diagnosed, data relating to that patient is fed into the one or more computer processors that are configured to perform the machine-learning analysis of the data. It is further noted that the data received in step 70 of the machine-learning stage may be received automatically, e.g., by being received from the computer processors of patient-testing stations, and/or by being received from other sources, e.g., by analyzing the medical records of a large number of patients that are stored on a database.
Reference is now made to
For some applications, in step 90, at least one computer processor receives data relating to a plurality of patients, and receives conditions that respective patients belonging to the plurality of patients are diagnosed as having. As described with reference to step 70 of
During the patient-diagnosis phase, in step 94, at least one computer processor (e.g., computer processor 18 of patient-testing station 17) receives parameters relating to a given patient. For example, such parameters may be obtained using techniques as described hereinabove, e.g., by asking the patient questions via user interface 19, by automatically measuring one or more physiological parameters of the given patient using one or more sensors and/or imaging devices, by automatically measuring one or more physiological parameters of the given patient using one or more robotic components, and/or by accessing the patient's medical history.
In step 96, in response to the received parameters, and using the predictive models that were determined during the machine-learning step, the computer processor diagnoses the patient as having one or more conditions. In step 98A, the computer processor generates an output indicating the one or more conditions that the patient is suspected of having, and in step 98B (which is typically performed concurrently with step 98A, and using the same output device as that used for step 98A), the computer processor generates an output indicating the contribution of a given portion of the parameters, toward diagnosing the patient as having the one or more conditions. For some applications, the outputs described with reference to steps 98A and 98B are generated on user interface 19 of the patient-testing station. Alternatively or additionally, the outputs are sent to a healthcare professional, such as an attending doctor or nurse. For example, a printout may be generated for the healthcare professional, or the outputs may be generated on a device that is used by the healthcare professional.
By way of example, in step 98B, the computer processor may generate an output indicating that the main contributing factor toward diagnosing the patient as having a given condition was his/her answer to a given question, was the result of a given test that was performed, was the result of an image that was acquired, was the result of an item in his/her medical history, etc. Alternatively or additionally, the computer processor may indicate a weighting of a given one of the parameters (or respective weightings of a plurality of parameters) in diagnosing the patient as having the given condition. For some applications, the computer processor generates a textual explanation of how the diagnosis was arrived at. For example, the text may include a description of a correlation between a given set of the received parameters and a condition that the patient has been diagnosed as having.
Typically, by outputting the indication of the contribution of a given portion of the parameters toward diagnosing the patient as having the one or more conditions, as described with reference to step 98B, the confidence of the patient, and moreover, the confidence of the doctor in the machine-generated diagnosis is strengthened. Alternatively, by outputting the indication of the contribution of a given portion of the parameters toward diagnosing the patient as having the one or more conditions, the doctor is able to better assess whether he/she agrees with the diagnosis, and/or whether he/she would like any additional tests or examinations to be performed.
It is noted that for some applications, the machine-learning and artificial intelligence related techniques described herein (e.g., the techniques described with reference to
Applications of the invention described herein can take the form of a computer program product accessible from a computer-usable or computer-readable medium (e.g., a non-transitory computer-readable medium) providing program code for use by or in connection with a computer or any instruction execution system, such as computer processor 18. For the purpose of this description, a computer-usable or computer readable medium can be any apparatus that can comprise, store, communicate, propagate, or transport the program for use by or in connection with the instruction execution system, apparatus, or device. The medium can be an electronic, magnetic, optical, electromagnetic, infrared, or semiconductor system (or apparatus or device) or a propagation medium. Typically, the computer-usable or computer readable medium is a non-transitory computer-usable or computer readable medium.
Examples of a computer-readable medium include a semiconductor or solid-state memory, magnetic tape, a removable computer diskette, a random-access memory (RAM), a read-only memory (ROM), a rigid magnetic disk and an optical disk. Current examples of optical disks include compact disk-read only memory (CD-ROM), compact disk-read/write (CD-RAY) and DVD.
A data processing system suitable for storing and/or executing program code will include at least one processor (e.g., computer processor 18) coupled directly or indirectly to memory elements through a system bus. The memory elements can include local memory employed during actual execution of the program code, bulk storage, and cache memories which provide temporary storage of at least some program code in order to reduce the number of times code must be retrieved from bulk storage during execution. The system can read the inventive instructions on the program storage devices and follow these instructions to execute the methodology of the embodiments of the invention.
Network adapters may be coupled to the processor to enable the processor to become coupled to other processors or remote printers or storage devices through intervening private or public networks. Modems, cable modem and Ethernet cards are just a few of the currently available types of network adapters.
Computer program code for carrying out operations of the present invention may be written in any combination of one or more programming languages, including an object-oriented programming language such as Java, Smalltalk, C++ or the like and conventional procedural programming languages, such as the C programming language or similar programming languages.
It will be understood that blocks of the flowcharts shown in the figures and combinations of blocks in the flowcharts, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general-purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer (e.g., computer processor 18) or other programmable data processing apparatus, create means for implementing the functions/acts specified in the flowcharts and/or algorithms described in the present application. These computer program instructions may also be stored in a computer-readable medium (e.g., a non-transitory computer-readable medium) that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable medium produce an article of manufacture including instruction means which implement the function/act specified in the flowchart blocks and algorithms. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide processes for implementing the functions/acts specified in the flowcharts and/or algorithms described in the present application.
Computer processor 18 is typically a hardware device programmed with computer program instructions to produce a special purpose computer. For example, when programmed to perform the algorithms described with reference to the figures, computer processor 18 typically acts as a special purpose patient-analysis computer processor. Typically, the operations described herein that are performed by computer processor 18 transform the physical state of a memory, which is a real physical article, to have a different magnetic polarity, electrical charge, or the like depending on the technology of the memory that is used.
For some applications, operations that are described as being performed by a computer processor are performed by a plurality of computer processors in combination with each other.
There is therefore provided, in accordance with some applications of the present invention, the following inventive concepts:
assigning an identity to said patient using at least one of (i) biometric identification and (ii) patient input to said autonomous system;
for a patient determined to be in non-life-threatening condition, performing a procedure to determine precedence of the treatment of said patient relative to other patients;
accumulating information relevant to the current condition of the patient; performing a series of tests to ascertain current clinical parameters of said patient, at least some of said tests being indicated by the results of previous tests or by said accumulated information;
using said autonomous system to combine said accumulated information and said current clinical parameters to generate a combination parameter set;
using said autonomous system to compare said combination parameter set with a database to find previously obtained clinical patterns having high correlation to said combination parameter set; and
using the results of said comparison to determine one or more likely diagnoses for the clinical condition of said patient.
performing additional tests to acquire additional clinical parameters relating to said patient to generate an enhanced combination parameter set;
comparing said enhanced combination parameter set with a database to find previously obtained clinical patterns having high correlation to said enhanced combination parameter set; and
using clinical patterns having high correlation to said enhanced combination parameter set in order to reduce the number of likely diagnoses for the clinical condition of the patient.
Inventive concept 42. The robotic test station according to any one of inventive concepts 38 to 40, wherein said electrodes are adjustable according to feedback relating to the position of said patient in said location, the feedback being selected from the group consisting of: electronic feedback and visual feedback.
It will be appreciated by persons skilled in the art that the present invention is not limited to what has been particularly shown and described hereinabove. Rather, the scope of the present invention includes both combinations and subcombinations of the various features described hereinabove, as well as variations and modifications thereof that are not in the prior art, which would occur to persons skilled in the art upon reading the foregoing description.
The present application claims priority from US Provisional Patent Application No. 62/514,023 to Amir, filed Jun. 02, 2017, entitled “System for the management of patients in a medical setting,” which is incorporated herein by reference.
| Filing Document | Filing Date | Country | Kind |
|---|---|---|---|
| PCT/IB2018/053869 | 5/31/2018 | WO | 00 |
| Number | Date | Country | |
|---|---|---|---|
| 62514023 | Jun 2017 | US |
