Patent Application
20080103828
The area of this invention is clinical reporting systems, especially in preparation for surgery by surgeons and other clinicians and their associates.
Surgeons and other clinicians rely on information to plan and perform their surgeries or procedures. Information takes on many forms: radiological images, medical records, allergies, photographs, reports, consultations and collaborations and more are all utilized in determining the best means to accomplish the surgical goal. Most of the time, these records are in various locations, on multiple systems, non-digital in nature (paper) and difficult to place into a common system.
A large source of this pre-surgical information is radiological in nature, and there are many systems that provide a digital record of this. An example is Kodak RIS/PACS solution (www.kodak.com/global/en/health/productsByType/pacs/pacs_Product.jhtml?pq-path=5809), Kodak VIPArchive, Kodak DIRECTVIEW DR Systems and other radiology systems including MRI, CT, PET and ultrasound image capture. These patient imaging systems provide entire image records of a patient's scans and X-rays. These systems often provide dozens to hundreds of images that are analyzed by radiologists who summarize and report their findings. Often, a surgeon uses some of these images, in planning the surgery that may result from the findings. In some instances, access is provided to these systems by surgeons and other clinicians. These patient imaging systems are extremely powerful in their capabilities and features, but require substantial training and experience to become proficient with them. In addition, easy access to other patient information systems (medical records, Emergency Department information, outpatient radiology clinics, non-radiological procedures and others) is not provided.
Medical records are also available from primary care physicians and specialists who have examined or performed procedures on patients. Many of these records are paper-based but medical record systems, such as SOAPWare from Docs, Inc. provide for digital medial record keeping. The U.S. Veteran's Administration has a multimedia medical record system called VISTA that is an excellent example of a record that contains text, images, graphics and other data (www.va.gov/vdl/). In addition, tools like scanners (HP, Epson, etc) and the Anoto Pen (www.anoto.com/) allow for paper-based technology to be digitized for use in computerized medical information systems.
There are also a number of software products that allow for teleconferencing of information including NetMeeting from Microsoft and WebEx (www.webex.com) which allows for the real-time exchange of information for collaboration. In addition, real-time exchange of image information is available through the use of the JPEG 2000 standard (wwwjpeg.org/jpeg2000/). Streaming technology has been shown on may applications including QuickTime and, specifically for medical applications, through Medical Insights (www.medical-insight.com/) which provides streaming technology for all types of medical information.
The American Society of Plastic Surgeons and the Plastic Surgery Educational Foundation have published a series of image templates for Plastic Surgery that not only show what pictures should be taken, but also the procedure for capturing them (“Photographic Standards in Plastic Surgery”).
All of this information can lead to “information overload” and surgeons and clinicians do not have the time to handle all of the information that can be made available to them. A system that can automatically filter information and arrange it in an easy-to-use manner where pertinent information is available quickly would be a useful tool. Several issues, however, stand in the way of this. The answer needs to be specialty-specific (cancer surgery and plastic surgery, for example, would require different sets of information, in most cases). Physicians also have specific needs and wants particular to them, as individuals. Some may prefer a single x-ray while others may prefer a 3-D rendering of the scans. Some prefer a text-based system while others prefer and image or graphic centric system.
The customization and integration of these and other records is the basis of the current invention, as well as the interface to optimize the ease-of-use through hierarchical choices and a multi-modal selections system. Patient medical information acquired, organized and displayed using the present invention enables healthcare professionals and their patients to more effectively evaluate relevant patient images and information. The present invention can be used in a variety of medical situations including pre-procedure patient consultation, second opinions, procedure evaluation and selection, procedure planning, use while performing the surgical/clinical procedure and for post-procedure follow-up. Multimodal selection systems are quite common as seen by voice recognition systems, eye tracking systems, joysticks and other selection methods. The Microsoft OS (Windows 2000, Windows XP) allow for multiple selection means connected at the same time.
Dynamically updates menus are shown in standard web browsers when “favorite” URLs are added to the list using the “add to favorites” option under the “favorites” main menu as seen in Internet Explorer by Microsoft.
U.S. Pat. No. 6,611,846 (Stoodley) describes a “Method And System For Medical Patient Data Analysis.” This application has a diametrically opposite purpose to the present invention as it searches across all patients for data having similar criteria to examine trends and common issues as opposed to providing data for a particular patient as in the present invention.
U.S. Patent Application Publication No. 2006/0150242 (Doyle) describes a system that allows information about a procedure to be made available to patients in an effort to minimize risk to the clinician. It is not intended for use by a clinician for use during a procedure. No mention of medical procedural data or images/reports is claimed.
In U.S. Pat. No. 6,182,047 (Dirbas), a means to provide a logging system for medical visits is described. There is no intent to filter the information for a particular upcoming procedure, no method to determine the preferences of the clinician, and no mention of a system to bring the information together for a specific purpose in a customizable manner. Interactive links to other data is not mentioned.
Currently, surgeons and other clinicians can access systems used by other medical professionals (RIS/PACS, medical record systems, ED systems and other CIS) and use them in their current embodiments. These systems can be very complicated and difficult to master, especially for occasional users. In addition, the systems rarely communicate images and information with each other and generally lack a common user interface, common data format, nor are they customizable. They also do not allow modification of the system by individuals for the purpose of the present invention. RIS/PACS systems do allow access to surgeons and other clinicians other than the radiologists and even provide viewing applications for looking at the radiographic information, even from multiple procedures. They do not, however, integrate the reports with the images, combine the images with other content, or provide access into other systems to combine the information together into a coherent package. In addition, they do not provide many of the features illustrated in the current invention, including: collaboration, history, teaching tools, dynamic and changeable content, and so on. A standard feature of most RIS/PACS systems is the ability for the radiologist to acknowledge certain images as key images. The preference file (below) can be sent to the radiologist to provide him with information that the surgeon or clinician using the custom reporting system desires from the radiologist.
The most common method in use today is to print out the pertinent information (or provide copies of radiological imagery) and view them in the place of interest (OR, office, exam room, et al.). In some cases, the clinician prepares a display of the information on an electronic display in the place of interest, but the burden of all the composition, hierarchy, and the other features of this invention are all left to the clinician to do in a manual manner for each procedure.
The Olympus offering called the “AlphaOR” system (www.olympussurgical.com/index.cfm/page/products.index.cfm/cid/132/navid/89 8/parentid/1) is an example of a system meant to monitor an operating room. This system does provide a method to link to a picture archiving and communication system (PACS) in the institution. However, it does not create a customized reporting system of this and other patient medical information as specified by the surgeon or clinician.
The present invention offers significant advantages to the art mentioned above and can be used with them as well with significant savings in cost, workflow and ease-of-use. A key differentiator of the present invention is the capability for image and information selection and report customization by the surgeon, clinician and their staff who are preparing for the procedure (i.e. allowing them to look-up, electronically ‘pull’ into their application and organize only the desired information for customized display) instead of relying on other clinicians (e.g. radiologists) to provide the information needed and understand the priority and image and information display protocol the surgeon or clinician want to be displayed.
Briefly, according to one aspect of the present invention a medical evaluation system for a procedural event comprises: determining key medical images and medical reports; determining a clinician's preferences for medical records obtained from a physician; determining the clinician's preferences for clinical information system records; determining the clinician's preferences for display of the medical images, medical reports, medical records, and clinical information system records; and displaying the medical images, medical reports, medical records, and clinical information system records.
In preparation for surgery, many surgeons and other clinicians are presented with a problem in the gathering and displaying of information without tedious, manual interventions. Either there is an overload of information, from many sources, or the information is difficult to find and often not used. This invention provides a methodology that allows for the customization of a computerized preparation and reporting system for surgeons and other clinicians in preparation for surgery or other events such as an examination requiring special preparation and attendance by a clinician. Examples are angiography, interventional radiology or others where the procedure can be invasive, minimally invasive or non-invasive. It includes information from other clinicians, medical records and preferences as to the means and method of display of this information in a simple and easy-to-understand program.
The present invention will be directed in particular to elements forming part of, or in cooperation more directly with the apparatus in accordance with the present invention. It is to be understood that elements not specifically shown or described may take various forms well known to those skilled in the art.
In the present invention clinical information systems (CIS) is defined as any form of information provided from a clinical source. This includes hospital systems, regional health information organizations (RHIO), or from internal and remotely located clinicians (including specialists, nurses, therapists, other doctors or information from clinicians using the system). The data can be of digital or non-digital form in its original state, but input of non-digital data requires conversion to digital form for computer display. However, non-digital paper forms and reports, pictures or x-rays can be referred to in the system and noted to the clinician. The digital data used in the present invention can be clinical in nature, educational in nature (training, references, background info and the like), or include current or past (via video/audio files) collaborations with others.
The present invention includes methods for preparing the data for use in the system and allowing for multiple instantiations of the results depending on the intended use, such as one reporting system for in-office use and another for in-surgery use. In order to have a customizable system, two elements are added to the main reporting system seen and used by the clinician. The first is a set-up program and the other is a method to define and update preferences that the clinician may have.
The set-up program is used as a one-time means (modification is possible, of course) to configure the rudimentary features of the program. In software programs, this is akin to the page setup facility that sets defaults on layout, printer, and page size. In many cases this is done by the person preparing the system for use (support person, service provider or the clinician/staff). These include:
The second is surgeon and clinician preferences that may need to be adjusted on a per case basis as the decisions here are pertinent to the specific case. For the most part, the clinician or a staff member, who is familiar with the surgery or clinical procedure workflow and the information used by that clinician in similar procedures, makes these decisions. In a preferred embodiment, this is a separate computer program used before the customized reporting system. Examples of surgeon or clinician preferences for the custom reporting system include (but are not limited to):
The need for different views, based on the intended usage, allows for different user interfaces (hands free in the OR while a mouse may be preferred in the office or planning stages; the level of detail, number of views and resolution requires for images would be different in patient explanation versus planning; or any number of other differences as deemed appropriate by the clinician using the system). The concept of a multi-modal human/computer user interface is important to the usability of the custom reporting system. Not only for the hands-busy need for voice input in the operating room (OR), but for personal preference of the different pointing systems (mouse, joystick, wireless, touch, trackball, gesture, and others).
Many of these are shown in
In some cases the preferences are chosen at a different time and in a different program than the reporting system (although modification of these preferences is possible within the reporting system).
The customized reporting system is now ready to be implemented.
Additional information can be requested as a third party application 95 and added to the display results 30 in a separate window.
If there is a need for more data 65, the link to information source(s) 55 is used to identify potential sources of the additional data 65. The user can review available data and request additional information 50 using the patient medical image and information requestor 90. The patient medical image and information requester 90 uses the standard communications protocol to contact the appropriate data sources 70, 75, 80 and request the information. The information requested is then sent to the custom reporting system to create customized files and menus 15, assembled into a revised report 20 and displayed as revised report 30. This can be done at any time before or during the actual procedure.
If no additional data is needed 60, the system analyzes what has transpired to determine if a preference file modification should be made 40. For example, if a clinician accesses the same database for 20 out of 25 times for similar procedures, this would become a default information source instead of an optional one. If yes 47, the preference file 85 will be updated. If no 45, the completed report 135 made available for the system to display results 95 immediately and stored for subsequent display. This frequency of use analysis and preference file modification assessment 40 is optional.
Film and paper patient records are converted to digital format by the film and paper record scanning 180 operation using commercially available scanners such as the Kodak i40 and i100 series scanners and the Vidar X-Ray Film Scanner. The results of the film and paper record scanning 180 are stored in digital format in one of the other images/data 150 repositories. The scanning function may occur in several locations. One option is for the facility housing the paper and film patient records 175 to perform the scanning and transmit the resulting digital information to the other images/data 150 storage system using conventional digital media (e.g. CD or DVD) or Internet communications protocols. The digital information may be encrypted if required without materially affecting this invention. Alternatively, the facility may choose to send the original film and paper patient records 175 to the destination location using conventional means (e.g. postal service, courier service, hand carried by the patient) with the film and paper record scanning 180 function being performed at the destination location. A further variant would perform the film and paper record scanning 180 at an independent service provider location without affecting this invention. The other images/data 150 storage system is requested to send the information to the other image/data preparation station 125 that can convert the images and other data into a format usable by the current invention for custom report preparation 130. In many cases the information is already in a format that is usable and this step can be eliminated.
Radiology information is often kept in picture archive and communications system (PACS) storage 105. Preferences here may include, among other things: key images (as decided by the radiologist) 100, a video file of a scan, the radiologist's report, and a 3D rendering of the area of interest. The key images are often a standard output associated with a radiologist's report and it can be indicated via e-mail or note stored in the radiology system that the surgeon or clinician would like this information as a matter of routine for his patients. The PACS storage system 105 is requested to send the information to an image/report preparation station 110 that can convert the images and other data into a format usable by the current invention. In many cases the information is already in a format that is usable and this step can be eliminated. One example where the conversion may be needed is DICOM to JPEG image file conversion, or, due to privacy issues, the patient information is removed from the image/report and then sent to custom report preparation 130.
In custom report preparation 130, the information is combined with other sources of information, and other preferences (priority of this information, how displayed, etc.) to create the actual final report 135. Several other reports 140, 145 can be generated depending on specific preferences and the intended use of the report (pre-surgical planning, surgical reporting system in the OR, patient explanation or others). When requesting information 90 from a primary care physician (PCP), for example, regarding medical records 80, the surgeon or clinician of note may prefer 85 the entire record, specific issues (like allergies and alerts), procedure reports, or any number of others. This preferred information is brought into the present invention and records prepared 115 for integration with the other components 130 for a customized report 135, 140, 145.
Similarly, a clinical information system (CIS) 70, 75 may have pertinent information (such a pathology reports and images, urology reports, or any number of others). CIS preparation 120 is performed if needed to enable this information to be used for custom report preparation 130. Not only is the requested information itself a preference 85, but the hierarchy in which it is viewed in the custom report 135, 140, 145 is also preference as well.
Other sources of information not previously described can be found in one or more other image/data 150 storage locations, such as photographs in preparation for a cosmetic surgery, data from a regional health information organization (RHIO) and/or other physicians, can be handled and prepared 125 for use in custom report preparation 130 and reports generated 135, 140, 145.
Examples of preferences 85 here are: what pictures are to be included, what metadata is needed, who is the PCP, and others.
In addition, the image/report preparation 110, record preparation 115, CIS preparation 120 and other image/data preparation 125 receive information about the doctor's preferences 85 that enable these functions to adapt the preparation based on direct knowledge of the doctor's preferences 85 information as well as the information actually received. Similar variations of this invention are possible but not exhaustively described as they will be obviously apparent to those skilled in the art.
Similarly in
Key to this concept is how it differs from a simple link to a RIS/PACS system in the OR. The present invention is meant to be easy-to-use, automated and customizable. None of these are apparent in a simple link to a RIS/PACS system as it requires significant training to become proficient is using RIS/PACS functionality originally designed to meet the needs of diagnostic radiologists and there is little customization provided. It is the easy access to the potentially vast patient medical record data, the extraction of the most relevant information for the surgical or clinical procedure and the display protocol specified in the doctor's preferences 85 that is most important for the surgical or clinical procedure that makes this especially valuable. Another difference here is the all inclusive, integrated solution (retrieval, storage, collaboration, and assessment).
Image recognition methods (like those used to associate objects in consumer photography or find objects in images in security applications) can be used to further the ease of use and utility of this reporting system. Finding these objects in the medical images can make determining the ROIs much easier. In addition, knowledge of the patient orientation can allow all the relevant imagery be aligned accordingly. This could potentially improve the workflow and reduce errors. This could be easily accomplished by having an orientation icon added to the screen, which allows the clinician or assistant, at the time of the procedure, to determine how the patient is oriented and the images would change their orientation to match that of the patient.
The use of tele-illustration (like that seen on sports broadcasts like Monday Night Football) can be used with this system to aid in collaborative efforts. Unlike the sports broadcasts, however, this functionality could be used by any of those collaborating on the procedure, regardless of their location. This is shown in web-based demonstrations exampled by annotations using the Zoomify™ toolkit (www.zoomify.com).
It is intended that the present invention be usable in several forms depending on the network architecture and computing resources deployed at each site (e.g. as a stand-alone application, accessible via a local area network or over the Internet). While certain features would not be available in the stand-alone version (such as remote collaboration), the utility of the system would remain.
The invention has been described in detail with particular reference to certain preferred embodiments thereof, but it will be understood that variations and modifications can be effected within the scope of the invention.
