U.S. patent application number 10/846245 was filed with the patent office on 2005-04-07 for system and method for managing an endoscopic lab.
Invention is credited to Agarwal, Deepak, Cohen, Michael, Cotton, Peter B., Divinsky, Aaron, Lee, Joan, Odlivak, Andrew, Pearson, Philip, Pollachi, Sai Kumar, Rogers, Mary, Seidman, Ken, Shapiro, Marc, Whatiley, Christopher.
Application Number | 20050075544 10/846245 |
Document ID | / |
Family ID | 33476833 |
Filed Date | 2005-04-07 |
United States Patent
Application |
20050075544 |
Kind Code |
A1 |
Shapiro, Marc ; et
al. |
April 7, 2005 |
System and method for managing an endoscopic lab
Abstract
A system designed to support and manage the workflow for all
user roles pertaining to an endoscopic laboratory, from
registration and scheduling of patient information through
pre-procedure, procedure and post-procedure phases of an endoscopic
examination, including support for the entry, by various users
associated with an endoscopic laboratory, of information and data
including the processing and storage of endoscopic images captured
during an endoscopic exam of a patient, for association with a
patient record stored in a database, and including the entry of
procedure notes and generation of reports that include the stored
images, all via an integrated user interface.
Inventors: |
Shapiro, Marc; (Dix Hills,
NY) ; Odlivak, Andrew; (Oakdale, NY) ;
Pearson, Philip; (Sea Cliff, NY) ; Agarwal,
Deepak; (Hicksville, NY) ; Cohen, Michael;
(Flushing, NY) ; Divinsky, Aaron; (Sayville,
NY) ; Lee, Joan; (Holbrook, NY) ; Pollachi,
Sai Kumar; (Holtsville, NY) ; Rogers, Mary;
(Henderson, NC) ; Seidman, Ken; (Marietta, GA)
; Whatiley, Christopher; (Manorville, NY) ;
Cotton, Peter B.; (Mt. Pleasant, SC) |
Correspondence
Address: |
SCULLY SCOTT MURPHY & PRESSER, PC
400 GARDEN CITY PLAZA
GARDEN CITY
NY
11530
|
Family ID: |
33476833 |
Appl. No.: |
10/846245 |
Filed: |
May 14, 2004 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
|
60471349 |
May 16, 2003 |
|
|
|
Current U.S.
Class: |
600/300 ;
705/3 |
Current CPC
Class: |
H04N 2005/2255 20130101;
G16H 40/20 20180101; G16H 10/60 20180101; G16H 15/00 20180101; G16H
10/40 20180101; G06Q 10/10 20130101; H04N 5/232939 20180801 |
Class at
Publication: |
600/300 ;
705/003 |
International
Class: |
G06F 017/60; A61B
001/04; A61B 001/00; A61B 005/00 |
Claims
Having thus described our invention, what we claim as new, and
desire to secure by Letters Patent is:
1. A method for managing information flow in an endoscopy
laboratory including a computer device, said endoscopy laboratory
adapted to enable users to perform endoscopic procedures upon
patients, said method including: a) inputting patient information
and setting up schedules for endoscopic examinations via said
computer device during a registration phase of care; b) inputting
preparatory examination information relating to said patient via
said computer device prior to performing said procedure; c)
inputting information during performance of said procedure
including the real time endoscopic image capture via said computer
device; d) inputting information regarding said patient via said
computer device after performance of said procedure; e) storing
said input registration and scheduling information, preparatory
information, captured images obtained during said procedure, and
post-procedure information regarding said patient in database
records; f) organizing presentation of information included in said
database records and managing access to said information and images
stored in said database records via an integrated user interface
associated with said computer device, said presentation and access
controlled according to a user's role, wherein support for the full
flow of patient and related information is provided through various
phases associated with all users involved in an endoscope
practice.
2. The method as claimed in claim 1, further including the step of
tracking a patient's state to ensure all information is captured in
a particular order prior to implementing a next phase of care stage
based on the current user state.
3. The method as claimed in claim 1, wherein said patient
information includes historical data, medical alerts, and
medications currently prescribed for the patient, said system
further enabling the presentation of said historical data, medical
alerts, and medications currently prescribed for the patient.
4. The method as claimed in claim 1, wherein said patient
information includes scheduling information for setting up an
endoscopic examination to be performed, said method further
including the step of: assigning resources for an examination
including procedure rooms and equipment to be used for a
procedure.
5. The method as claimed in claim 1, wherein the step of inputting
preparatory examination information includes providing check of
preparation, medication, and consent relating to the start of a
patient's visit.
6. The method as claimed in claim 1, wherein the step of inputting
information during performance of said procedure includes enabling
interaction with a knowledge base including selectable keywords via
said integrated user interface that enable the build of a
hierarchical list of keywords that will be used to automatically
generate documentation related to the examination at each phase of
care stage.
7. The method as claimed in claim 1, wherein the step of inputting
information during performance of said procedure includes enabling
a user to record each of a patient's vital signs, medication
details, equipment use details and pathology specimen information
relative to the procedure.
8. The method as claimed in claim 1, wherein the step of inputting
information regarding said patient after performance of said
procedure includes information relating to monitoring a patient in
a recovery room, including medications administered.
9. The method as claimed in claim 1, wherein the step of inputting
information regarding said patient after performance of said
procedure includes adding annotations to images captured during
said exam.
10. The method as claimed in claim 1, further including the step of
enabling comparison of captured images related to a current exam
with saved images relating to a patient's prior exam.
11. The method as claimed in claim 1, further including the step of
providing predefined template-based management reporting
capability, including the generation of templates for generating
procedure notes, reports, and other documentation at each phase of
care stage.
12. The method as claimed in claim 1, further including the step of
customizing a hardware configuration of said endoscopic laboratory
via said integrated user interface.
13. The method as claimed in claim 1, further including the step of
creating and modifying user roles, and the access to system
functionality based on said roles.
14. The method as claimed in claim 1, further including the step of
automatically associating billing codes with specific medical
terminology to enable generation of billing information related to
specific exams.
15. The method as claimed in claim 6, further including the step of
maintaining the knowledge base by enabling the addition of new
keywords, sentence models and menu structures associated with each
phase of care stage.
16. The method as claimed in claim 1, further including the step of
maintaining resource information including equipment resources and
clinical staff records.
17. The method as claimed in claim 1, further including the step of
tracking contextual information including user, patient,
examination, department and facility where an examination is to be
performed as a user navigates though each phase of care stage via
said integrated interface.
18. A program storage device readable by a machine, tangibly
embodying a program of instructions executable by the machine to
perform method steps for managing information flow in an endoscopy
laboratory including a computer device, said endoscopy laboratory
adapted to enable users to perform endoscopic procedures upon
patients, said method steps comprising: g) inputting patient
information and setting up schedules for endoscopic examinations
via said computer device during a registration phase of care; h)
inputting preparatory examination information relating to said
patient via said computer device prior to performing said
procedure; i) inputting information during performance of said
procedure including the real time endoscopic image capture via said
computer device; j) inputting information regarding said patient
via said computer device after performance of said procedure; k)
storing said input registration and scheduling information,
preparatory information, captured images obtained during said
procedure, and post-procedure information regarding said patient in
database records; l) organizing presentation of information
included in said database records and managing access to said
information and images stored in said database records via an
integrated user interface associated with said computer device,
said presentation and access controlled according to a user's role,
wherein support for the full flow of patient and related
information is provided through various phases associated with all
users involved in an endoscope practice.
19. The program storage device readable by a machine as claimed in
claim 18, wherein said method steps further include the step of
tracking a patient's state to ensure all information is captured in
a particular order prior to implementing a next phase of care stage
based on the current user state.
20. The program storage device readable by a machine as claimed in
claim 18, wherein said patient information includes historical
data, medical alerts, and medications currently prescribed for the
patient, said system further enabling the presentation of said
historical data, medical alerts, and medications.
21. The program storage device readable by a machine as claimed in
claim 18, wherein said patient information includes scheduling
information for setting up an endoscopic examination to be
performed, said method further including the step of: assigning
resources for an examination including procedure rooms and
equipment to be used for a procedure.
22. The program storage device readable by a machine as claimed in
claim 18, wherein the step of inputting preparatory examination
information includes providing check of preparation, medication,
and consent relating to the start of a patient's visit.
23. The program storage device readable by a machine as claimed in
claim 18, wherein the step of inputting information during
performance of said procedure includes enabling interaction with a
knowledge base including selectable keywords via said integrated
user interface that enable the build of a hierarchical list of
keywords that will be used to automatically generate documentation
related to the examination at each phase of care stage.
24. The program storage device readable by a machine as claimed in
claim 18, wherein the step of inputting information during
performance of said procedure includes: enabling a user to record
each of a patient's vital signs, medication details, equipment use
details and pathology specimen information relative to the
procedure.
25. The program storage device readable by a machine as claimed in
claim 18, wherein the step of inputting information regarding said
patient after performance of said procedure includes information
relating to monitoring a patient in a recovery room, including
medications administered.
26. The program storage device readable by a machine as claimed in
claim 18, wherein the step of inputting information regarding said
patient after performance of said procedure includes adding
annotations to images captured during said exam.
27. The program storage device readable by a machine as claimed in
claim 18, further including the step of enabling comparison of
captured images related to a current exam with saved images
relating to a patient's prior exam.
28. The program storage device readable by a machine as claimed in
claim 18, further including the step of providing predefined
template-based management reporting capability, including the
generation of templates for generating procedure notes, reports,
and other documentation at each phase of care stage.
29. The program storage device readable by a machine as claimed in
claim 18, further including the step of customizing a hardware
configuration of said endoscopic laboratory via said integrated
user interface.
30. The program storage device readable by a machine as claimed in
claim 18, further including the step of: creating and modifying
user roles, and the access to system functionality based on said
roles.
31. The program storage device readable by a machine as claimed in
claim 18, further including the step of automatically associating
billing codes with specific medical terminology to enable
generation of billing information related to specific exams.
32. The program storage device readable by a machine as claimed in
claim 23, further including the step of: maintaining the knowledge
base by enabling the addition of new keywords, sentence models and
menu structures associated with each phase of care stage.
33. The program storage device readable by a machine as claimed in
claim 18, further including the step of maintaining resource
information including equipment resources and clinical staff
records.
34. The program storage device readable by a machine as claimed in
claim 18, further including the step of tracking contextual
information including user, patient, examination, department and
facility where an examination is to be performed as a user
navigates though each phase of care stage via said integrated
interface.
Description
CROSS REFERENCE TO RELATED APPLICATION
[0001] This application claims the benefit of U.S. Provisional
Patent Application Ser. No. 60/471,349 filed May 16, 2003 and
incorporated by reference as if fully set forth herein. This
application further relates to commonly-owned, co-pending U.S.
patent application Serial Nos. ______, and ______ (Atty. Dockets
17282, 17283 and 17284) incorporated by reference herein.
BACKGROUND OF THE INVENTION
[0002] 1. Field of the Invention
[0003] The present invention relates generally to imaging systems
and workstations for medical applications, and particularly an
system designed to support the entry, by various users associated
with an endoscopic laboratory, of information and data including
the capture, processing and storage of endoscopic images during an
endoscopic exam, and especially for managing workflow for all user
roles pertaining to the endoscopic laboratory, from registration
and scheduling of patient information through pre-procedure,
procedure and post-procedure phases through the generation of
procedure notes via an integrated user interface.
[0004] 2. Discussion of the Prior Art
[0005] There currently exists a prior art clinical information
management systems that manages patient examination data at
different phases of patient care.
[0006] Typically, however, for the case of endoscopic laboratories
for performing endoscopic procedures, a variety of system programs
and interfaces are used to support the management of patient
related examination information, including a separate program that
function to schedule patient's exams and visits and separate
programs that capture examination related information at various
endoscopic procedure lifecycle stages, e.g., from pre-procedure
through post-procedure. At best, the current clinical management
system platforms for endoscopy comprise a single media platform
providing standard graphics features and image capture and
presentation features.
[0007] Moreover, such prior art clinical information management
systems do not accurately support and manage the workflow of all
users having roles pertaining to an endoscopic laboratory.
[0008] It would therefore be highly desirable to provide a clinical
information management system for an endoscopic lab with reporting
features, that manages and organizes clinical information,
endoscopic images and related patient data, at various levels of
detail, for creating efficiencies and facilitating functions
performed by users of endoscopic equipment, e.g., physicians,
nurses, clinicians, schedulers, etc., based on their roles.
Integral to this management system is the enablement of real-time
data capture and presentation of endoscopic images and related
examination data (e.g., patient ID, practitioner information,
endoscope ID type).
[0009] It would be highly desirable to provide an integrated
interface for an endoscopic laboratory that supports and manages
the workflow of all users based on their different roles to access
the database contents associated with those roles and further, a
system that will automatically configure the interface screen
depending upon the role of the person logged in to the system.
[0010] It would additionally be highly desirable to provide a
clinical information management system designed for the practice of
endoscopy that provides for the secure, remote access of patient
and exam related information by physicians through a web-enabled
interface.
SUMMARY OF THE INVENTION
[0011] Accordingly, it is an object of the present invention to
provide a novel clinical information management system designed for
the practice of endoscopy that supports and manages the workflow of
all users having roles pertaining to an endoscopic laboratory, and
particularly, the execution of an endoscopic procedure performed
upon a patient, sequentially, through various lifecycle stages
associated with the endoscopic practice. Preferably, the workflow
processes associated with these lifecycle stages are flexible
enough to support small, independent endoscopic practices and
endoscopic departments that are integral to large healthcare
institutions.
[0012] Further, it is an object of the present invention to provide
a clinical information management system designed for the practice
of endoscopy that supports the flow of a patient and related
information through the various lifecycle stages associated with
the endoscopic practice, each stage representing a grouping of
related activities. Thus, users of the system can, at appropriate
points in the lifecycle, capture, process, and generate reports on
all the required endoscopy information. The information captured at
the different stages is managed by the system application and
processed to create medical records, produce reports, and provide
necessary information to perform exams, etc.
[0013] As a patient typically follows the lifecycle stages in
sequential order: from registration and scheduling of patient
information through pre-procedure, procedure and post-procedure
phases of an endoscopic examination, the present invention supports
the entry, by various users associated with an endoscopic
laboratory, of information and data including the processing and
storage of endoscopic images captured during an endoscopic exam of
a patient, for association with a patient record stored in a
database, and facilitates the generation of procedure notes and
other reports that include the stored images, all via an integrated
user interface.
[0014] Further, according to the invention, the clinical
information management system designed for the practice of
endoscopy facilitates the tracking of each patient's state (such as
what stage of the process the patient is in, what information has
already been captured, and which information is yet to be captured)
and enables the basic lifecycle to be followed so that clinical
staff can ensure that all required information is in place prior to
implementing the next stage. Thus, the clinical information
management system designed for the practice of endoscopy according
to the invention implements a set of business rules encouraging a
particular order of activities based on the current state of the
patient. Via these rules, the system incrementally captures all
relevant information associated with the patient and orchestrates
interactions with all users including physicians, nurses,
schedulers and system administrators while providing the services
necessary to perform all required actions.
[0015] The invention further supports the flow of a patient and
related information through the various phases associated with the
endoscopic practice, which includes: scheduling, patient file
management, pre-procedure, procedure, and post-procedure phases.
The system interface is integrated, yet allows the physician to
reduce the time associated with producing procedure notes. For
example, it provides alerts while incorporating annotated and
labeled images into written reports.
[0016] The invention further provides a multi-media platform for
clinical documentation. By integrating image capture and advanced
graphics with an endoscopic medical knowledge base, the system of
the present invention generates complete Procedure Notes and
related documents. The system further automates the endoscopy
clinic by managing patient examination schedules and equipment
inventories while controlling "paper management."
[0017] The invention further provides for secure, remote access of
patient and exam related information by physicians through the
integrated, web-enabled system interface.
[0018] Thus, according to the preferred aspects of the invention
there is provided a system and method for managing information flow
in an endoscopy laboratory including a computer device, the
laboratory adapted to enable users to perform endoscopic procedures
upon patients, the method including: inputting patient information
and setting up schedules for endoscopic examinations via the
computer device during a registration phase of care; inputting
preparatory examination information relating to the patient via the
computer device prior to performing the procedure; inputting
information during performance of the procedure including the real
time endoscopic image capture via the computer device; inputting
information regarding the patient via the computer device after
performance of the procedure; storing the input registration and
scheduling information, preparatory information, captured images
obtained during the procedure, and post-procedure information
regarding the patient in database records; organizing presentation
of information included in the database records and managing access
to the information and images stored in the database records via an
integrated user interface associated with the computer device, the
presentation and access controlled according to a user's role,
wherein full support for the full flow of a patient and related
information is provided through various phases associated with all
users involved in an endoscope practice.
[0019] Advantageously, the based clinical information system
designed for the practice of Endoscopy enables physicians and other
medical personnel to utilize clinical records created directly from
their procedures. It enhances clinical workflow, reduces time and
cost, minimizes errors and enables interaction among disparate
hospital information systems.
[0020] Moreover, the based clinical information system designed for
the practice of Endoscopy according to the invention enables
reduced equipment maintenance costs through the automation of
equipment use and maintenance tracking.
[0021] Further benefits include, the inclusion of procedure reports
in the organization's electronic medical record and, the automating
the exchange of procedure and pathology information eliminating
medical errors and paper-based processes.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] The objects, features and advantages of the present
invention will become apparent to one skilled in the art, in view
of the following detailed description taken in combination with the
attached drawings, in which:
[0023] FIG. 1(a) illustrates an overview of an endoscopic
examination system according to the invention;
[0024] FIG. 1(b) depicts generally the endoscopy lab for obtaining,
processing and displaying of real-time endoscopic images in which
the comprehensive, clinical information management system of the
present invention is employed;
[0025] FIG. 2 illustrates a high-level Registration and Scheduling
business workflow diagram depicting functionality enabled by the
system application according to the invention;
[0026] FIG. 3 illustrates a high-level Pre-Procedure clinical flow
diagram depicting functionality enabled by the system application
according to the invention;
[0027] FIG. 4 illustrates a high-level Procedure clinical flow
diagram depicting functionality enabled by the system application
according to the invention;
[0028] FIG. 5 illustrates a high-level Post-Procedure clinical flow
depicting functionality enabled by the system application according
to the invention;
[0029] FIG. 6 illustrates a Home tab user interface according to
the invention;
[0030] FIG. 7(a) illustrates a Patient File tab user interface
according to the invention;
[0031] FIG. 7(b) illustrates a Patient Demographics interface
screen enabling functionality for recording all patient
demographics information;
[0032] FIG. 7(c) illustrates Medical Alerts interface screen for
association with a patient to record a patient's medical
condition;
[0033] FIG. 7(d) illustrates a Patient Summary interface screen for
viewing insurance, contacts and scheduled visits information for a
patient;
[0034] FIG. 8(a) illustrates a Registration tab of a user interface
according to the invention;
[0035] FIG. 8(b) illustrates a New Visit interface screen according
to the invention;
[0036] FIG. 8(c) illustrates a Modify Visit interface screen
according to the invention;
[0037] FIG. 8(d) illustrates an Exam Detail interface screen
according to the invention;
[0038] FIG. 8(e) illustrates a Lexicon interface screen according
to the invention;
[0039] FIG. 8(f) illustrates a Document Distribution interface
screen according to the invention;
[0040] FIG. 9(a) illustrates a Pre Procedure tab of a user
interface according to the invention;
[0041] FIG. 9(b) illustrates a Patient Process interface screen
according to the invention;
[0042] FIG. 9(c) illustrates a Consent Checklist interface screen
according to the invention;
[0043] FIG. 9(d) illustrates a Patient Assessment interface screen
according to the invention;
[0044] FIG. 9(e) illustrates a Vitals and Meds interface screen
according to the invention;
[0045] FIG. 9(f) illustrates a Physical Exam screen for a physician
to perform pre-procedure checks such as a physical examination
according to the invention;
[0046] FIG. 9(g) illustrates a pre-procedure summary information
Screen display of according to the invention;
[0047] FIG. 10(a) illustrates a Procedure tab user interface
according to the invention;
[0048] FIG. 10(b) illustrates a Pre-Procedure Summary interface
screen according to the invention;
[0049] FIG. 10(c) illustrates an Equipment used interface screen
according to the invention;
[0050] FIG. 10(d) illustrates an endoscopic Image Capture interface
screen according to the invention;
[0051] FIG. 10(e) illustrates a Pathology Request interface screen
according to the invention;
[0052] FIG. 10(f) illustrates a Lexicon interface screen for the
procedure lifecycle stage according to the invention;
[0053] FIG. 10(g) illustrates a Print on Mavigraph interface screen
according to the invention;
[0054] FIG. 10(h) illustrates a Document Distribution interface
screen for the procedure lifecycle stage according to the
invention;
[0055] FIG. 10(i) illustrates a Nursing Administration interface
screen according to the invention;
[0056] FIG. 11(a) illustrates a Post-Procedure tab of a user
interface screen according to the invention;
[0057] FIG. 11(b) illustrates an ICU Synchronization interface
screen according to the invention;
[0058] FIG. 11(c)(1) illustrates an Image Management interface
screen according to the invention;
[0059] FIG. 11(c)(2) illustrates the Other Exam feature displayed
via the Image Management interface screen to enable image
comparisons according to the invention;
[0060] FIG. 11(d) illustrates a Surgical Changes window according
to the invention;
[0061] FIG. 11(e) illustrates a Recovery interface screen according
to the invention;
[0062] FIG. 11(f) illustrates a Recall Patient interface screen
according to the invention;
[0063] FIG. 11(g) illustrates a Document Distribution interface
screen for the post-procedure lifecycle stage according to the
invention;
[0064] FIG. 12 illustrates an Analysis tab user interface according
to the invention;
[0065] FIG. 13(a) illustrates a System Administration tab user
interface screen according to the invention;
[0066] FIGS. 13(b)(1) and 13(b)(2) illustrates a Clinical Staff
user interface screen according to the invention;
[0067] FIG. 13(c) illustrates a System Settings user interface
screen according to the invention;
[0068] FIG. 13(d) illustrates an Application Flow user interface
screen according to the invention;
[0069] FIG. 13(e) illustrates a Facility user interface screen
according to the invention;
[0070] FIG. 13(f) illustrates a Node Settings user interface screen
according to the invention;
[0071] FIG. 13(g) illustrates a Video Settings user interface
screen according to the invention;
[0072] FIG. 13(h) illustrates an AutoMask Settings user interface
screen according to the invention;
[0073] FIG. 13(i) illustrates an Exam Type customization user
interface screen according to the invention;
[0074] FIG. 13(j) illustrates a Reports Section customization user
interface screen according to the invention;
[0075] FIG. 13(k) illustrates a Phase of Care user interface screen
according to the invention;
[0076] FIG. 13(l) illustrates a Document Type user interface screen
according to the invention;
[0077] FIG. 13(m) illustrates a Procedure Note template window and
interface used to generate new Procedure Notes according to the
invention;
[0078] FIG. 13(n) illustrates a Document template window used to
generate new Document types according to the invention;
[0079] FIG. 13(o) illustrates an example Document template window
for creating a new document template from a previously created
Document template according to the invention;
[0080] FIG. 14(a) illustrates a System Administration tab user
interface displaying a User List screen according to the
invention;
[0081] FIG. 14(b) illustrates a User Maintenance user interface
screen according to the invention;
[0082] FIG. 14(c) illustrates a Role List user interface screen
according to the invention;
[0083] FIG. 14(d) illustrates a Role Maintenance user interface
screen according to the invention;
[0084] FIG. 14(e) illustrates a System Log utility user interface
screen according to the invention;
[0085] FIG. 14(f) illustrates a Scope Model list user interface
screen according to the invention;
[0086] FIG. 14(g) illustrates a Scope list user interface screen
according to the invention;
[0087] FIG. 14(h) illustrates a Scope Item user interface screen
according to the invention;
[0088] FIG. 14(i) illustrates an Accessory Maintenance user
interface screen according to the invention; and,
[0089] FIG. 14(j) illustrates an Equipment Category user interface
screen according to the invention.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0090] The present invention is a comprehensive, real-time,
interactive clinical information management system designed for the
practice of endoscopy. It includes integrated reporting features,
that manages and organizes clinical information obtained during
phases of care relating to an endoscopic exam, and endoscopic
images and related patient data, at various levels of detail, for
creating efficiencies and facilitating functions performed by users
of endoscopic equipment, e.g., physicians, nurses, clinicians,
etc.
[0091] Particularly, the clinical information management system
designed for the practice of endoscopy includes a web-browser
interface that supports all the data acquisition and care-giving
functions performed by users during patient registration,
pre-endoscopic procedure, endoscopic procedure and post-procedure
phases of care.
[0092] The clinical information management system further includes
the ability to capture, process and record endoscopic images during
a procedure and further includes an Image Management function
enabling a user to annotate, label, import, export, and enhance the
quality of images, including the ability to manage, record, and
export live video clips and generate reports that include the
stored images. Further to the aspect of image capture and display,
the system provides an "auto-masking" feature that automatically
selects an appropriate video mask based on a particular endoscope
imager device being utilized by the health care practitioner.
[0093] The clinical information management system designed for the
practice of endoscopy further includes a medical terminology
"Knowledge Base" (KB) comprising keywords relating to the
procedure, e.g., such as gastrointestinal, endoscopic and
bronchoscopic terminology keywords. The keywords are captured via a
graphical user interface (GUI) before, during, and/or after a
procedure. The keywords are made available for labeling images
captured during an examination to be used in reports,
auto-populating appropriate sections of a report such as a
Procedure Note, described further below, based on patient history,
and building Procedure Note templates or models to auto-populate
sections of information. The system also facilitates the use of
custom terms that apply to a specific department or location. Thus,
for example, during an exam, a user may select KB terms for a
procedure via a common user interface, which is employed wherever
the user needs to locate or extract keywords. This also provides a
consistent way to select and use terminology.
[0094] Overview of the System
[0095] FIGS. 1(a) and 1(b) depict the hardware infrastructure
comprising various hardware devices and components required to
either enable the application, hereinafter alternately referred to
as the EndoWorks.TM. system (hereinafter "EW system" manufactured
by Olympus Corporation) that provides functionality for automating
the endoscopy lab by, to run, or to support the required business
functionality. As shown in FIG. 1(a), the hardware infrastructure
of the invention, includes an endoscopic workstation 110, a printer
device 112 (e.g., a Mavigraph printer), an RGB monitor 20 and video
processor 40. The user provides inputs to the workstation 110 via a
keyboard, mouse interface, or the like. The workstation includes a
second monitor, e.g., a VGA monitor 55, and implements a web
browser interface that provides the necessary information during
all phases of care relating to the endoscopic exam, and facilitates
for users of endoscopic equipment, e.g., physicians, nurses or
clinicians, the efficient capture, management, organization and
presentation of endoscopic images and patient and examination data.
The workflow processes associated with this aspect of the system
are flexible enough to support small endoscopic practices in
addition to endoscopic departments within large healthcare
institutions.
[0096] FIG. 11(b) is a block diagram depicting in greater detail,
the endoscopy lab 110 for supporting all EndoWorks application
functions including the capture, processing and displaying of
real-time endoscopic images. As shown in FIG. 1(b), the system
comprises an endoscope device 25 connected via a connector device
30 to the video processor device 40, for example, an Olympus CV-160
device. As mentioned the endoscopic device includes a solid state
CCD imager for generating real-time frame image signals, e.g.,
simultaneously generated RGB signals, which are processed by the
video processor device to generate real-time video signals of the
image for display on an RGB monitor 20. As shown the video
processor is further connected to an imaging station or node 50,
comprising a personal computer (PC) or workstation, and including
processor 60, video display driver 65, and memory 70 devices for
capturing the real-time video image, digitizing the image for
storage in memory 70, and for further displaying a scaled version
of the image, for example, on both the RGB monitor 20 and a second
monitor, e.g., a VGA monitor device 55. In one embodiment, the
processor implemented at the imaging node 50 includes a frame
grabber board and associated hardware drivers that captures
standard analog composite and Y/C video in NTSC/PAL formats from
the video processor 40 and, includes analog to digital converters
for capturing the component RGB in the NTSC/PAL video formats. The
captured field are stored in a main memory 70 of the imaging node.
A graphics controller (not shown) provided with the Matrox board is
provided for handling VGA display output and includes a graphics
overlay and video scaling.
[0097] While the system may function as a stand-alone system, the
workstation may have the additional capability of connecting to the
institution or facility network, and, to support this, may be
provided with an Ethernet 100 Base T network interface card (NIC),
or like equivalent, to provide network connectivity. The NIC
drivers shall be compatible with Windows 2000 (or later version OS)
and support the TCP/IP protocol. Thus, referring back to FIG. 1(a),
the system may also include a network server 140 and database
element 145 or like memory storage system for storing system
application data records including patient records and associated
patient data and image information. This server may be connected
via a gateway application to various "external" systems such as a
hospital information system where the gateway facilitates the
transfer of certain healthcare information between the system and
other applications. For example, patient information stored in the
system may be downloaded from or uploaded to external systems
(e.g., a legacy system) via a gateway interface. The workstation
110 may communicate with the network server 140 via the Internet
170 or other network, such as a LAN or intranet. It is understood
however, that the network server may function as a web server and a
central repository for Endoworks.TM. system definitions and data
that is shared by simultaneous users. Further, the network server
shall be capable of supporting a database manager. Additional
processor capacity shall be required for additional concurrent
users, and, a symmetric multiprocessor (SMP) computer may be
implemented for supporting large numbers of simultaneous users. In
such a multiuser environment, multiple client workstations access
the shared server including centralized data, and appropriate
serialization and locking capabilities is provided to ensure that
concurrent access to data is enabled where reasonable, and to
ensure the consistency of data that is being updated.
[0098] The workstation 110 may further communicate with a fax
server 160, for instance, for faxing reports via a fax modem
162.
[0099] Generally, the application's software instructions,
including firmware and microcode, may be stored in any type of
program storage device or devices, also referred to as
computer-readable media. The software is executed by a processor in
a known manner to achieve the functionality described herein.
[0100] Clinical Flow
[0101] FIGS. 2-5 illustrate clinical flow diagrams that describe
the most common activities associated with the system and their
relationship in time in the context of managing an endoscopic
laboratory according to the invention. Clinical flow is based on
patient flow, which relates to how a patient is processed before,
during, and after an endoscopic procedure. The overall flow across
all phases of care starts with an exam request and ends with the
generation of a Procedure Note, the release of the patient, and the
generation of a set of related reports. User roles are represented
as horizontal bands in the figures.
[0102] The registration and scheduling clinical flow 200 of FIG. 2
includes a collection of all the information necessary to set up a
visit. It is initiated through an exam request made by either the
patient, a surrogate for the patient, or a referring physician. The
nurse and physician share the activity of preparing prep
instructions and medical advice for the patient.
[0103] The Pre-Procedure clinical flow 300 of FIG. 3 starts with
the arrival of the patient at the endoscopy facility and addresses
all administrative and medical activities necessary to prepare the
patient for the exam.
[0104] The Procedure clinical flow 400 of FIG. 4 depicts the actual
examination that takes place during the Procedure phase of care.
The system is used to capture images, record vital signs, and
administer medications during this stage.
[0105] The Post-Procedure clinical flow 500 of FIG. 5 depicts the
activities that take place after the completion of an exam. These
activities include a nurse continuing to monitor the patient's
recovery, a nurse completing discharge instructions, releasing the
patient, and preparing billing code reports, and a physician
reviewing and editing the analysis of an exam by generating a
Procedure Note. A physician signs the Procedure Note when it is
complete. Afterward, management reports, patient recall requests,
and referral letters can be created and distributed.
[0106] User Interface
[0107] The invention is now described in connection with a user
interface that permits the user to access specific features
associated with managing an endoscopic laboratory. It is understood
that a user is an individual who is authorized access to the
EndoWorks.TM. application through a system login comprising a user
ID and a password. The user logs into a specific department,
selected at login time. A user may have access to one or more
departments. When logging in to the selected department, the user
is assigned a default facility. A user may be a specific clinical
staff member, which in turn identifies the user's qualifications
(role), such as physician, nurse, or scheduler, for the department.
As will be described in greater detail herein, after successful
authentication, the application (based on the user's privileges)
authorizes the user to access specific functions associated with
the user's role in the department. Other non-medical users also
exist, such as system administrators.
[0108] According to this aspect of the invention, the predefined
application layout or interface is based on user roles, i.e.,
actions that user performs using the system, including roles such
as Physician, Nurse and scheduler, for example. Facilities or
medical departments use roles to give users access to different
options within the application. For example, as described in
greater detail herein, a facility can configure the system to allow
a scheduler to access only the Patient Registration tab.
[0109] Once a user logs in the system, for example, by entering a
user ID and password, and depending on that user's role, that user
may access the features associated with that user's role using the
tabs located at the top of the screen, with each permitting access
to a specific functionality.
[0110] I. Home tab 600 (FIG. 6). The Home tab is the default home
page, and is pre-defined for each role. Preferably, based on a
user's role in the selected department, a default homepage is
generated predefined for that role by the application, but it can
be changed to another to suit the user's needs. The most common
tasks that can be performed via the Home tab include: view
Scheduled Exams; Create a New Visit; view Pending Items; view
Pathology Status; view Unsigned Reports which enables an attending
physician to view and sign unsigned Procedure Notes; Sign Reports,
which enables a user to view unsigned Procedure Notes for a
specific physician and mark them as signed; Carbon Copies which
function automatically generates and sends a notification to the
recipients that a document is available for them in the system when
the user distributes a document to a medical provider, clinical
staff, or contact via email. A recipient may then log on to the
system and view a list of documents on the Carbon Copies screen; an
Intensive Care Unit (ICU) Synchronization, that ensures that the
user's imaging station is not connected to the network server when
the user performs an exam in ICU mode. When the user finishes the
exam, the user must upload images and data from the workstation to
the server repository. When the workstation is re-connected to the
network, a series of simple commands will upload the data and
images captured during the exam. After the data is uploaded, the
user uses the ICU Synchronization option to synchronize images and
data; and, a feature of viewing Recall Letters that enables a user
to recall a patient for another examination. As mentioned, access
to these tasks is based on the user's role. For example, if the
user logs into the application as a scheduler, then the user would
not see the Sign Reports menu option, since that option is reserved
for the physician role.
[0111] II. Patient File tab 700 (FIGS. 7(a)-7(d))--allows a user to
capture information specific to the individual patient. This tab is
used to record a patient's demographic information; a patient's
medical alerts, GI/pulmonary, medication, family, and social
history information, and view a summary of the patient
information.
[0112] III. Registration tab 800 (FIGS. 8(a)-8(f)). This tab is
used to: (a) create and modify visit and/or exam information; (b)
view past, current, or future schedules; (c) assign resources for
an examination including procedure rooms and equipment; and (d)
distribute registration documents.
[0113] IV. Pre-Procedure tab 900 (FIGS. 9(a)-9(g)). This tab is
used to: (a) record care plan information for a specific visit; (b)
record medical alert information; (c) record GI, pulmonary, family,
and social history information, (d) manage physical examination,
patient assessment, and physician check information, (e) manage
prep status information for the patient; (f) manage consent
information for a visit; (g) capture vital signs and medications
administered before the examination; (h) display a summary of
selected Pre-Procedure information and capture nurse handoff
information; and (i) distribute Pre-Procedure documents.
[0114] V. The Procedure Tab 1000 (FIGS. 10(a)-10(i)). This tab is
used to: (a) capture images during an endoscopic procedure; (b)
record live video clips; (c) record scope time used during an
examination; (d) view images and Procedure Notes from a previous
exam; (e) print images for an exam on a laser jet or a Mavigraph
printer; (f) record nurse administration information; (g) record
accessories and equipment used during an examination; (h) generate
pathology requests; (i) distribute procedure documents; and, (j)
according to the present invention, capture vital signs and
medications administered during the examination.
[0115] VI. The Post Procedure Tab 1100 (FIG. 11(a)-11(g))--After an
examination is completed, this tab is used to perform
post-procedural tasks. These tasks include synchronizing images in
the ICU mode, monitoring a patient's vital sign and medication
information, managing captured images, and writing Procedure Notes.
Images from a current procedure, e.g., image 1 and image 2, and
from a prior procedure, e.g., image 3, image 4, and image 5, can be
displayed together for comparison. This tab is used to: (a) record
patient recovery information; (b) manage images captured during an
exam; (c) label, annotate, enhance, and print images; (d) import
and export images to and from the current examination; (e) manage
video clips recorded during an examination; (f) write and sign
Procedure Notes; (g) capture patient recall information; (h) assess
performance of a trainee participating in an examination; (i)
capture patient survey information; (j) distribute Post-Procedure
documents; and (k) perform ICU synchronization.
[0116] VII. The Analysis Tab 1200 (FIG. 12)--used to generate
redefined template-based management reports to satisfy end-user
administrative reporting requirements related to patient, procedure
and facility management, efficiency analysis, and resource
utilization. This tab is used to generate: (a) Continuous Quality
Improvement (CQI) reports; (b) efficiency reports; (c) equipment
analysis reports; (d) procedure analysis reports; and (e)
administration reports.
[0117] VIII. The Admin Tab 1300 (FIGS. 13(a)-13(o) and
14(a)-14(j))--used to perform administrator tasks and ensure the
efficiency and security of the system. The system can be customized
based on the needs and requirements of the facility, physician, and
clinical staff. This tab is used to: (a) maintain system data (such
as Patient ID type and department information); (b) maintain
application resource data (such as clinical staff and contact
information); (c) perform system configuration (such as configure
Mavigraph printer and video settings); (d) customize how the
application will flow and generate information (for example,
changing the order and location of menus within the application and
editing or creating templates/models that are used to create
Procedure Notes); (e) customize user-defined fields (such as other
patient information and other visit information); (f) control
access to or within the application (such as user and role
maintenance); and (g) maintain equipment used during the
procedure.
[0118] It should be understood that certain pages within the
application are provided with a "Next" option such as the "Next"
button 723 indicated in the Patient file Tab screen 700 shown in
FIG. 7(a). Selection of the Next option will initiate a save of the
data on the current page after a validation, and navigate the user
to the next page within the current Phase Of Care (i.e., tab)
according to the pre-defined order. Limiting the navigation within
the current Phase Of Care is valuable for the user who conducts
each procedure of different phase of care in a different place.
[0119] Home Tab
[0120] With further respect to the homepage tab 600 such as shown
in FIG. 6, a user may access the Scheduled Exams interface screen
620 by selecting a Scheduled Exams menu option 602 that initiates
display of a list of scheduled exams and provides the ability to
create a new visit and exam. Via the Scheduled Exams screen 620, a
user may enter the facility name, date, or attending physician to
search for an exam. A list 630 of scheduled exams will be displayed
depending upon the search data input and details of an exam may be
viewed by clicking a Details icon 609 corresponding to the
exam.
[0121] Via the Scheduled Exams tab, a user may create a new visit
by selecting the New Visit button 612 to access a New Visit screen,
as will be described herein with respect to FIG. 8(b), which
enables the user to enter the desired information associated with
the scheduling of a new visit for a patient. More details regarding
the registration of patients will be explained in greater detail
herein.
[0122] Via the home page tab 600 of FIG. 6, a user may access the
Pending Items interface screen by selecting a Pending Items menu
option 604 enabling that user to view all pending tasks. Via a
pending task interface screen (not shown), a user may search for a
pending item based on task, date, or the patient, and further
select a Task Details icon to view the task. From a Task dropdown a
user may perform activities including, but not limited to:
modifying a database record, deleting a database record, add a
note, or delete a note.
[0123] Via the home page tab, a user may access a Pathology Status
interface screen (not shown) by selecting Pathology Status menu
option 606 enabling a user to view the status of pathology requests
or, search the database for an existing request by entering search
criteria such as attending, date, patient, or request status. If
the user is not an attending, a default list is not displayed. The
user may additionally edit or delete existing pathology results.
When a pathology result is deleted, all of the specimens associated
with that record are deleted. The user may select an Edit Pathology
Status icon to access the Pathology Result screen where a user may
further edit the status of the request, review the request, or
delete the request.
[0124] Patient File Tab
[0125] With further respect to the Patient File tab 700 (FIG.
7(a)), the information entered is captured and stored in a patient
file that is the repository for all patient data required by
different clinical staff. It manages the input and presentation of
relevant historical data such as past tests and lab results,
medical alerts, and medications currently prescribed for the
patient. Thus, via the interface Patient File tab 700 (FIG. 7(a)),
the user may access Patient File menu selection options based on
that user's role. Before any endoscopic exam or procedure is
performed, the user must register a patient. When registering a
patient, relevant patient information may be captured including:
Demographics, Medical alerts, GI history, Pulmonary history,
Medication history, Social history, and Family history. Once the
patient's information is entered, it does not have to be entered
again for any other exam or procedure for that patient.
[0126] To add a New Patient Record via the Patient File tab, a user
selects the Patient Search menu choice 702 which causes for display
the Patient search screen 720 including a "new" button 722, that,
when selected initiates display of a Patient Demographics screen to
capture the new patient's information. Including ID Type, Patient
ID, Last Name, and First Name, insurance and medical contact
information and enter any optional information, if necessary. As
shown in FIG. 7(b), the Patient Demographics screen 730 includes
icons enabling functionality for adding all patient demographics
information including a new Insurance Carrier (or editing an
existing one) and adding a new physician or editing the selected
physician.
[0127] Referring back to FIG. 7(a), to modify an existing patient's
record:
[0128] a user may first search for a patient by entering search
criteria in search entry fields, and click a Details icon 709 where
the Patient Demographic screen 730 shown in FIG. 7(b) is displayed.
The user may then modify the information as desired. The user may
view a summary of a patient's information by first accessing the
Patient Search screen to search for a patient, click a Select icon
719 to select the patient which causes a display of a Patient
Summary screen such as shown in FIG. 7(d). It should be understood
that a patient record may be deleted from the Patient Demographic
screen shown in FIG. 7(b) by selecting the delete button 739.
[0129] Further functionality enabled via the patient demographic
screen 730 includes: assigning or adding a new patient ID to a
selected patient by access the Patient Demographic screen for the
patient and clicking a New button next to the ID Type; and,
deleting a patient ID by clicking the Delete icon located to the
right of the patient ID that is to be deleted.
[0130] Referring back to the patient file tab of FIG. 7(a), the
system includes functionality for managing medical alert
information, which is associated with a patient having a condition
that requires special consideration. Via selection of the Medical
Alerts option 704, there is initiated for display a Medical Alerts
screen 740 such as shown in FIG. 7(c). Via the Medical Alerts
screen 740, a plurality of medical alert categories can be selected
from a Medical Alerts dropdown list 742. When a user sets a medical
alert for a selected patient, a View medical alerts for the patient
icon 759 is generated for display in the status bar 749. As long as
the patient is selected, the icon remains on the status bar. To
view all medical alerts set for the patient, a user may select the
View medical alerts for the patient icon 759. As shown in FIG.
7(c), the Medical Alerts screen 750 includes two sections: Medical
Alerts and Notes. The Medical Alerts section is used to record a
patient's medical condition and the Notes section is used to record
relevant or detailed information regarding a patient's
condition.
[0131] To add a medical alert record for a patient via the Medical
Alerts screen 740, the user first selects the required category of
medical alerts from the Medical Alerts dropdown list, selects a Yes
radio button to enable a medical alert; and, clicks a Select from
Calendar icon 769 to enter the date in the Date Recognized field. A
Select Date window appears where a user may select the date the
patient was first diagnosed with the condition (related to the
alert), and, enter details of the alert if the corresponding
Details field is active. The user may also click a New button on
the right of the Notes section, and enter notes related to the
medical alert category.
[0132] Further functionality enabled via the Medical Alerts screen
740 shown in FIG. 7(c) includes: removing a medical alert record
and, deleting a note. Further, any comorbidity that requires
special consideration in the performance of an endoscopic procedure
is referred to as an alert. As will be described in greater detail
herein, a system administrator may define system alerts at the
system level without regard to facility or department. A system
alert is a criteria for determining whether a medical alert item is
to be set to indicate an alert, i.e., warrants a system alert
display indication. If the patient in the context has one of the
comorbidities designated as an alert, for example, an allergy, the
Medical Alerts icon 759 is displayed in the status bar. A user may
view system alerts set by the system administrator via the Medical
Alerts screen by clicking a System Alerts button to display the
system-defined alerts for the selected category. The System Alerts
window for the selected medical category is displayed for user
viewing.
[0133] Referring back to the patient file tab of FIG. 7(a), the
system further includes functionality for managing a patient's GI
History Information via a GI History screen (not shown) by
recording and editing information about a patient's past diagnoses,
surgeries, and other procedures related to the gastrointestinal
system. The GI History screen is displayed when the user logs in to
the application in the GI department. After selecting a patient via
the Patient Search screen (FIG. 7(a)), an authorized user may
select the GI History menu option 706 to enable functionality for
retrieving and displaying the patient's GI History. Functionality
enabled via the displayed GI History screen includes: adding a past
diagnosis by opening a Past Diagnosis window and entering the date,
diagnosis, organ, and comments about the patient's past diagnosis
and, updating past diagnosis information where a date field, a
certainty/disease status field, are provided to enable entry of the
date and certainty/disease status information. Other functionality
via the GI history screen includes: modifying a past diagnosis,
deleting a past diagnosis by deleting an existing record; viewing a
procedure note report associated with the past diagnosis; adding a
past surgery record via Date, Surgery, Organ, and Comments entry
fields in a Past Surgery section and, modifying or deleting a past
surgery record; and, adding a past procedure record via Date,
Procedure, and Comments entry fields in a Past Procedures section,
modifying or deleting a past procedure record, and viewing a
Procedure Note report associated with a past procedure.
[0134] Via the patient file tab of FIG. 7(a), it should be
understood that if a user logs into a Bronchoscopy department of a
hospital, for instance, functionality will be provided for managing
a patient's Pulmonary History Records via a Pulmonary History
screen (not shown) by recording and editing information about a
selected patient's previous pulmonary procedures; adding a
pulmonary history record; modifying a Past Procedure Record for
Pulmonary History and deleting a pulmonary history record; and, and
viewing a Procedure Note report associated with a past pulmonary
procedure.
[0135] Further, via the patient file tab of FIG. 7(a), the system
includes functionality for managing a patient's medical medication
history via a Medication History screen (not shown) by recording
and editing information about a patient's current and past
medications. The Medication History screen (not shown) is displayed
by selecting the Medication History menu option 708 to enable
functionality for retrieving and displaying a selected patient's
Medication History.
[0136] Functionality enabled via the Medication History screen
includes: adding a medication to the history record, for example,
by entering either the full drug or brand name, or the first few
letters of the name followed by a wildcard in a Search field, where
a list of all medications matching the criteria will be displayed
for selection in a Medication Search window. A user may further
select a Search icon next to a Strength field to search for the
strength of the medication. A user may then select the drug
strength from a Drug Strength window (not shown) and enter a start
date for the medication to the Date Started field and, enter a stop
date for the medication to the Date Stopped field (if not a current
medication). It is understood that a user may further delete a
medication from patient's history record.
[0137] Referring back to the patient file tab of FIG. 7(a), the
system includes functionality for updating a patient's Social
History via a Social History screen (not shown) that enables a user
to record information about the social behavior and legal
considerations of a patient. The Social History screen is displayed
by selecting the Social History menu option 710 to enable
functionality for retrieving and displaying a selected patient's
Social History. Functionality enabled via the Social History screen
includes: adding a Social History Record for a patient including
entry of information relating to five areas: 1) Tobacco use
including entry of the date the patient stopped using tobacco and
the pack years (i.e., the number of packs per day and the number of
packs years); 2) Alcohol use including entry of the date the
patient stopped consuming alcohol and the drink years (i.e., the
number of drinks per week and the number of drink years); 3) IV
Drug use including entry of the date the patient stopped IV drug
abuse and detailed information about the IV drug abuse; 4) living
will information; and 5) a power of attorney, whereby a user may
enter information via a DNR (Do Not Resuscitate) Details field. It
is understood that the user's Social History Record may be further
modified.
[0138] Referring back to the patient file tab of FIG. 7(a), the
system includes functionality for updating a patient's Family
History via a Family History screen (not shown) that enables a user
to record information about the occurrences of cancer or other
relevant family medical conditions. Preferably, there are different
Family History screens for the Bronch and GI departments. The
Family History screen is displayed by selecting the Family History
menu boption 712 to enable functionality for retrieving and
displaying a selected patient's Family History. To add a GI cancer
record, for instance, for a selected patient via the Family History
screen, an Add button is provided adjacent to GI Cancer that is
selected to display a GI Cancer window. From that window, a user
may select the type of cancer from the Type dropdown list, or
select Other-Details, where a Details field is provided to enable
the user to enter comments in the Details field. The user may
finther click a New button next to a Relation which enables the
addition of a line to the section, where the user may select the
relative from the Relation dropdown list and enter the age that the
relative was diagnosed with the cancer.
[0139] Via the Family History screen, a user may further add a
non-GI cancer record for a relation, or add a Bronch Cancer record
of a patient's relation. Furthermore, another relevant family
history record may be added (e.g., non-cancer), and further be
deleted or modified.
[0140] Via the patient file tab of FIG. 7(a), further system
functionality is enabled for entering or modifying other patient
information via an Other Patient Information screen (not shown)
which is generated to enable the capture of additional preset and
user-defined data that relates to a patient by selecting the Other
Patient Information menu choice 714 which enables functionality for
retrieving and displaying a selected patient's other
information.
[0141] Registration Tab
[0142] With further respect to the Registration tab 800 (Figure
(a)), functionality is provided that allows the user to create,
modify or delete a visit, or create, modify or delete
examination(s) within a visit. Thus, after creating a patient
record, the user may schedule an exam for a patient. It is
understood that a visit may include a series of one or more
procedures performed on a patient. The user may select "New Visit"
and "Modify Visit" screens to schedule a patient visit or modify an
existing visit. Thus, as shown in the Registration tab 800 of FIG.
8(a), to create a new visit, a user will select the New Visit menu
option choice 802 that causes the display of a New Visit screen 820
such as shown in FIG. 8(b). Via the New Visit screen 820, a user
may select the facility for the visit from the Facility dropdown
list 822 (a default is the facility to which the user is currently
logged in); enter the visit ID in the Visit ID field 824 which is a
unique facility-supplied identifier for the visit; click the
Patient Search icon 825 next to the Patient field to select the
patient or, return to the Patient Demographics window (FIG. 7(b))
to create a new record for the patient if no patient record is
found after the Patient Search; select a referring physician from
the Referring dropdown list 826 that includes the names of all
medical providers for the patient (The default value is the
patient's Primary Care Physician); select a patient class from the
Patient Class dropdown list 828; enter the date of the visit in the
Date field 830 (a default is the current date); click a clock icon
832 to enter time of the visit (a default is the current time);
and, click the Add button 833 beside Exam if the user needs to add
an exam for the visit in which an Exam Detail screen is
displayed.
[0143] Referring back to the Patient File tab 700 (FIG. 7(a)),
subsequent to creation of a patient visit record, a user may select
a Patient Summary option 703 which causes display of a Patient
Summary screen 750 shown in FIG. 7(d) which displays all of a
patient's demographics data captured when the patient's record was
created or last modified, and, from which a user may select the
existing visit from the Visit Information section 766 of the
screen. The user may further select a Modify Visit icon 767 to
initiate display of a Modify Visit screen which provides
functionality for modifying an existing Visit Record or deleting a
Visit Record.
[0144] Referring back to the Registration tab of FIG. 8(a), the
system includes functionality for enabling scheduling of an exam
only after a visit record is created. To add an Exam to a visit,
the user may access the Modify Visit screen 830 shown herein in
view of FIG. 8(c), by selecting the Modify Visit menu option 804
from the Registration tab of FIG. 8(a). In FIG. 8(c), clicking the
Add button 832 next to Exam causes display of an Exam Detail screen
840, shown in FIG. 8(d) from which a user may enter an exam date in
the Date field 842, a time of the exam in the Time field 844 and,
select an exam type from the Exam Type dropdown list 845. The
attending physician may be selected from the Attending
dropdown-list 846. If the user wants to search for an attending or
clinical staff, the Clinical Staff icon 848 may be selected to
cause display of a Clinical Staff List window (not shown) where a
user may select a clinical staff from the list. If the clinical
staff is not found in the list, the user may select a New Attending
icon 849 that displays a Clinical Staff window (not shown) via
which relevant information about the clinical staff may be entered.
To edit an attending information, the user may select the attending
and click the Edit Attending icon 850 that causes the Clinical
Staff window to be displayed via which the user may make the
relevant changes. The user will further be prompted to: enter
accession number from the Accession Number field 853; select room
number from the Room dropdown list 866; select a duration of the
exam from the Duration dropdown list 868; select the needed
resource type from the Available dropdown list 869; and, select the
resource needed for the exam from the Available dropdown list 870.
An arrow icon 855 may be selected by the user to move the resource
to the Assigned list box 875. For example, a user may desire to
allocate a special accessory or endoscope to an exam, in which case
the system may generate a Special Accessory/Scope required icon 878
for display next to the exam in the Modify Visit screen 830 (FIG.
8(c)).
[0145] Referring back to the Registration tab of FIG. 8(a), the
system includes functionality for displaying the Scheduled Exams
for the current day via a Scheduled Exam screen 880 which is the
default screen displayed upon user access to the Registration tab
800. Via the Scheduled Exam screen 880, a user may: select a
Schedule for Today icon 882, which when selected, causes display of
the current day's schedule (a default view); select a Schedule for
the Week icon 884, which when selected displays the schedule for a
week (e.g., from Sunday to Saturday). Preferably, the week selected
for display is controlled with the date increment and date
decrement icons 885a, 885b that respectively, increments or
decrements the date by the interval currently displayed on the
schedule; select a schedule for the Month icon 887, which when
selected displays the schedule for a month starting with the first
day of the selected month. The month selected for display is also
controlled with the date increment and date decrement icons; select
a Scheduled icon 888, which when selected, indicates that the exam
has been scheduled and has not been performed (appears under
status); select a Performed icon (not shown), which, when selected,
indicates that the exam has been performed (appears under status);
select a Procedure Note Signed icon (not shown), which, when
selected, indicates that the exam has been performed and the
associated Procedure Note has been signed (appears under status);
select a Select this Exam icon 889 which, when selected, enables a
user to select exams, document, etc . . . ; select a Modify Visit
icon 890, which when selected, enables a user to modify exams,
document etc . . . ; and, select a Select Date from Calendar icon,
that causes the display of a calendar used to select a date.
[0146] Referring back to the Registration tab of FIG. 8(a), the
system further provides a "Lexicon" function to select and organize
terms from a Knowledge Base. The Knowledge Base is a medical
terminology database. When a user, e.g., physician, finds something
noticeable during an exam, the Lexicon function is used to record
that observation. By selecting the left menu choice 806, a Lexicon
screen 895 is displayed such as shown in FIG. 8(e) via which a user
may pick terms (based on his/her observation) from the Knowledge
Base which comprises a frame 896 having terms stored logically in a
tree format. From this structure, a user can select and use this
information to write a Procedure Note comprising a plurality of
sentences formed from selected keywords. More specifically, as
described in commonly-owned, co-pending U.S. patent application
Ser. No. ______ (Atty Docket 17282), the Knowledge Base includes
keywords, which are the medical terms that are the basic building
blocks of the Knowledge Base; menus that organize keywords; and
views which are collections of menus and their associated keywords
organized within a tree and are used navigate through the Knowledge
Base and select appropriate medical terms or keywords.
Particularly, each Knowledge Base term is called a keyword. When a
user selects a keyword or term from the right frame 896 (list of
available terms), it appears in the left panel (list of selected
terms). The menus are classified into categories, called menu
types, which comprise keywords that are similar in nature. For
example, a size menu type would contain the keywords small, medium,
and large. Preferably, a menu can be single-select, multi-select,
or unique. If a user selects a keyword from a single-select menu,
other keywords within the menu are disabled. For example, if size
of polyp is a single-select menu, a user can select only one size
from the available sizes such as small, medium, or large; if a user
selects a keyword from a multi-select menu, the selected item is
appended to the same level as any other keyword from the menu. For
example, if the organ is a multi-select menu and a user selects
stomach as the first organ and duodenum as the second, duodenum
appears at the same level as stomach; and, if a keyword is selected
from a unique menu, the user cannot select the keyword again. That
is, when a user attempts to select the keyword again from the right
panel, the keyword is highlighted in the left panel to indicate
that it has already been selected. For example, the organ menu is
unique, and the user selects stomach as the first organ. If that
user selects stomach again in the right panel frame, the keyword
stomach in the left panel is highlight to indicate that stomach has
already been selected.
[0147] The Lexicon arranges Knowledge Base content to different
report sections, based on phases of care. A facility determines
which Report Sections 898 are to be available in the Lexicon screen
for a Phase of Care. As shown in FIG. 8(e), the Lexicon screen 895
includes icons 897 for: initiating functionality for generating a
report via the Lexicon screen 895; initiating functionality to move
up in the Knowledge Base tree; initiating functionality to move
down in the Knowledge Base tree; initiating functionality to add
billing codes; and, initiating functionality to delete a keyword
from the tree; and, icons 898 for: initiating functionality to add
a new term from Knowledge Base; initiating functionality to move to
the last multi-select menu in the left side; and, initiating
functionality to move to the previous keyword.
[0148] A grammar engine is implemented in cooperation with the
Lexicon to ensure proper sentence generation from the selected
keywords in the manner as described in U.S. patent application Ser.
No. ______ (Atty Docket 17282).
[0149] Referring back to the Registration tab of FIG. 8(a), the
system includes functionality for printing and distributing
documents such as letter to the referrer and appointment letter via
a Document Distribution screen 860 shown in FIG. 8(f). Generated
documents may be distributed via, email, or fax. A user may
distribute a maximum of nine copies of a document which documents
may be previewed and edited prior to printing or distributing. A
user may additionally edit the recipient list for each document
type. Thus, after navigating to the Registration tab 800 in FIG.
8(a) and selecting a particular exam, a user clicks on the
Registration Docs menuchoice 808 to display a Document Distribution
screen 860 shown in FIG. 8(f). To edit or review a document, from
the Document Distribution screen 860, a user selects a template for
the document from a Template dropdown list 861 and, clicks an Edit
Document icon 862 corresponding to the document that user needs to
edit or review. The document will be displayed in a new window
where the required changes may be made to the document. The user
will be further able to review, edit and print the document by
selecting icons from the Document Distribution screen. With respect
to recipients of the document, there are three types of recipients:
a Contact, Medical Provider, and Clinical Staff, and a user may add
or remove a recipient, via a recipient list. To edit recipient
list, a user clicks a checkbox 863 associated with the document to
be edited. A user may then click an Edit Recipient List icon 864
adjacent to the current recipient list which initiates
functionality for displaying an Edit Recipient window (not shown).
Via this window, a user may click Contact to modify a recipient
other than a medical provider or clinical staff. The Contacts List
window is displayed with categories of recipients. Additionally
provided is a Medical Provider to select a medical provider from
the Medical Provider List window and a Clinical Staff that may be
clicked to select a clinical staff from the Clinical Staff List
window.
[0150] Thus, the system provides further functionality initiated by
the user to distribute a document via the Document Distribution
screen (FIG. 8(f)) by clicking a checkbox on the left side of the
document that is to be distributed and selecting a template for the
document from the Template dropdown list, prior to clicking
Distribute. Further to this feature, the system provides additional
functionality for distributing education documents to patients that
inform them about procedures or findings. For example, if a user
finds a polyp in the stomach of a patient, and the system has set
an education trigger for the word "polyp," a document based on an
education template is generated for that user to distribute to the
patient. Printing is one of the many medium options available to
distribute education documents. It is understood that, if the
user's facility has not set an education trigger, no education
document will be generated.
[0151] An education document may be distributed by a Document
Distribution screen by clicking the checkbox next to the document
to be distributed and selecting a template for the document from
the Template dropdown list and a number of copies that need to be
printed from the Copies dropdown list.
[0152] Pre-Procedure Tab
[0153] With further respect to the Pre-Procedure tab 900 (FIG.
9(a)), functionality is provided that allows the user to: retrieve
scheduled exams; search for an exam; create a new visit; review the
schedule summary; record a pre-procedure call; search for a patient
record; manage patient demographic information; manage medical
alert information; manage GI history information; manage pulmonary
information; manage social history information; manage family
history information; manage patient process information; manage
consent checklist information; manage patient prep status
information; manage patient assessment information; manage physical
exam information; manage vital sign and medication data; manage
physician check information; review/edit pre-procedure documents;
review/edit clinical lexicon data; review the pre-procedure
summary; and, manage other visit information.
[0154] With respect to retrieving visitlexam information via the
Pre-Procedure interface screen 900 shown in FIG. 9(a), a user may
select the scheduled exams menu choice 902 to initiate
functionality for viewing the details of an exam such as its date,
time, and location, the attending physician, and any required
resources; make changes to exam information (if required); add an
exam to a patient visit (if an exam does not exist); and, add notes
about the condition of the patient or any other information about
the exam. Thus, when a patient comes to the endoscopic facility for
a procedure, the patient's exam information is first retrieved. Via
the Scheduled Exams screen display 930 such as shown and described
with respect to FIG. 9(a), a user may view a list of all exams
scheduled at the facility (by default, scheduled exams are
displayed for the current day), and review the scheduled exam
information to: review allocated medical staff and equipment
resources; modify exam information (i.e. assign other resources);
and add an exam to a patient's visit (if one does not exist).
Particular functionality enabled in this phase of care, is the
ability to enter notes about the condition of the patient or any
other information relevant to the exam. That is, before a user
enters pre-procedure data for a patient, a user may review the
patient's schedule summary and either enter, view, or modify
pre-procedure call information. Thus, via the Pre-Procedure
interface in FIG. 9(a), a user may select the Schedule Summary menu
option 904 to initiate functionality for selecting an exam and view
a summary of the pre-procedure call for the selected exam, enter or
modify pre-procedure call information for an exam.
[0155] During pre-procedure, a user may verify and record pertinent
information for a patient. Thus, by selecting a Patient Search
option 906 from the pre-procedure screen, a Patient Search screen
(not shown) is displayed to search for a patient in response to
entry of search criteria (e.g., last name), and verify or record
that patient's demographics (name, address, emergency contact,
patient insurance coverage information, medical provider's
information, etc.), a patient's comorbidities and medical alert
information such as shown and described with respect to FIG. 7(b).
For example, if a patient is allergic to latex, this medical
information may be recorded before the exam is performed on the
patient. The user will further be able to verify or record the
patient's GI history; Pulmonary history; Social history; and Family
history. Such patient demographics information may be captured at
the time of registration just prior to an exam via a Patient
Demographics screen such as shown and described with respect to
FIG. 7(b) which may be accessed in the pre-procedure phase to
record or modify, for an existing patient, non-clinical patient
data such as: Name; Address; Emergency Contact; Patient Insurance
Coverage Information; Medical Provider Information; and other
Information. A new patient demographics record may additionally be
created with new demographic information captured.
[0156] Further, from the Pre-procedure screen 900 shown and
described with respect FIG. 9(a), a Medical Alerts menu option 908
may be selected to enable a user to view, modify or remove
information about a patient's comorbidities and related medical
history, as shown and described herein with respect to FIG. 7(c),
and further record or delete any information in the Notes field
741.
[0157] Further, from the Pre-procedure screen 900, the GI History
menu option 910 may be selected to enable a user to view, modify or
remove a patient's GI diagnosis information (or Pulmonary diagnosis
information if the user is logged in the Bronch department)
relating to that patient's past surgery or procedure.
[0158] Further, from the Pre-procedure screen 900, the Social
History menu option 912 may be selected to view, modify or remove
that patient's past social history information or add a new record,
and a Family History menu option 914 may be selected to enable a
user to view, modify or remove information relating to that
patient's family history (e.g., Bronch and GI Cancer, Non-GI
Cancer, and Other Relevant Family History) in order to maintain
occurrences of cancer or other relevant medical conditions within
the patient's family. Preferably, there are different family
history screens for Bronch and GI departments.
[0159] Besides managing patient-based information via the
Pre-Procedure tab 900 as described herein, a user may additionally
manage exam-based information. Thus, before performing a procedure,
a user may capture relevant patient care information by selecting
the Patient Process menu option 915 which causes display of a
Patient Process interface screen 950 as shown in FIG. 9(b) enabling
a user to create a patient process record including information
such as arrival, registration, and pre-procedure times and, to
create a care plan for the patient based on a patient class (e.g.,
inpatient, inpatient transfer, and outpatient). If the facility is
to store any patient belongings, this information, in addition to
the location of the belongings, is to be recorded via this
screen.
[0160] Thus, for a selected exam, a user may record or edit
information via the Patient Process Screen 950 including the
patient's arrival date and time, registration start and end times,
and pre-procedure start and end times and select a patient's
scheduled care plan class from the Current dropdown list 951. If
the user selects Inpatient transfer, the department and unit in the
From field 958 is entered. Select the current care plan (if
different from scheduled plan) from the Care Planned dropdown list
952. A user may further enter information via the Patient Process
Screen including other information relevant to care planned in the
Details entry field 953; select the planned disposition of the
patient following the procedure from the Plan Specifics dropdown
list 954; select the ID Bracelet, Vascular Bracelet, or Allergy
Bracelet checkboxes (if applicable); enter the name and phone
number of the person transporting the patient in the Contact and
Phone fields (if applicable); select the In Waiting Room checkbox
955 if the person transporting the patient is in the waiting room;
enter the location where the patient's belongings are being stored
in the Default Location field 956; and, select a checkbox(s) for
each applicable patient belonging. This automatically populates the
associated Location field with the default location, however, a
user may change the location if a belonging had been stored
elsewhere.
[0161] Before performing any procedure, a user needs to ensure that
the patient has provided consent to perform the procedure. Thus,
before performing a procedure, a user may select a Consent
Checklist menu option 916 via the Pre-Procedure tab 900 (FIG. 9(a))
which causes display of a Consent Checklist screen 960 as shown in
FIG. 9(c) enabling a user to record whether or not the patient
gives consent for the procedures that will be performed. The user
may modify any of the information but cannot delete the consent
checklist record. Thus, for a selected exam, a user may modify
existing information or enter information via the Consent Checklist
screen 960 including the consent checklist information by selecting
the Consent Form, Reviewed, Signed, and Witnessed radio button 961
if the user has obtained signed consent. If the user has not
obtained consent, then he/she may select the Not Obtained radio
button 962. Selecting Not Obtained disables the Explanation and
Obtained For sections. The reason consent was not obtained may be
selected from the Details dropdown list. If consent was obtained, a
user may select the person from the Given To dropdown list to whom
the consent explanation is given and enter the name of the person
to whom the explanation is given in the Name(s) field shown in FIG.
9(c). The user may further indicate the method(s) by which the
explanation is given by selecting the appropriate check box
(verbal, brochure, etc.) and, select the appropriate checkboxes to
indicate consent was obtained for the Procedure,
Sedation/Anesthesia, or Blood or Blood Products. To select all of
these, click the Select All button. The user may further select the
appropriate checkboxes to indicate explanation was given for the
potential Risks, Benefits, Limitations, and Alternatives or select
all by clicking Select All. The user may further select the person
from whom consent was obtained from the Obtained From dropdown list
and enter the name of the person from whom consent was obtained in
the Name(s) field. The user may further enter the date and time the
consent was obtained in the Obtained On and Time fields,
respectively, and indicate the name of the staff member who
obtained the consent by selecting from the Obtained By dropdown
list shown in FIG. 9(c). The user may further indicate the name of
the staff member who witnessed the consent given by selecting from
the Witnessed By dropdown list and, select the Discharge
instructions reviewed, signed and witnessed check box, if
instructions were provided and accepted by the patient. The user
may further enter the name of the staff member who reviewed the
discharge instructions with the patient and witnessed the patient
signing the discharge instructions in the Name field and enter the
date and time when the discharge instructions were provided using
the Date or time icon to populate the respective Date or time field
or, by manually entering the date or time. Furthermore, the user
may enter any other information in the Notes text entry box shown
in FIG. 9(c).
[0162] Further, when preparing a patient for an exam, the user may
use a Prep Status screen to record information such as: NPO
(nothing by mouth); Bowel preparation; Prep results and Current
medications. Thus, before performing a procedure, a user may select
a Prep Status menu option 917 via the Pre-Procedure tab 900 of FIG.
9(a), which causes display of a Prep Status screen (not shown)
enabling a user to enter the prep status information in a database
record. There may be different Prep Status screens for the Bronch
and GI departments and an exam must be selected before accessing
the Prep Status screen. Via the Prep Status screen, the user may
select the appropriate NPO from the NPO dropdown list, select
either the Taken or Not Taken radio button (GI only) for bowel
preparation, and, select the appropriate prep result from the Bowel
Prep Results dropdown list (GI only). The user may further enter
any other information in the Other Results field, if appropriate
(GI only). By clicking the history next to Current Medications, a
user may view the patient's medication history via a Medication
History screen (not shown) and add new current medication(s) for
the patient, if appropriate. To add a new medication via the Prep
Status screen, an Add Medication screen is displayed that enables a
user to enter the first few letters of the medication name in the
Drug (Brand) Name search field to search for the medication that
needs to be added. The user may additionally search by drug and/or
brand names. By selecting search icons, additional Search screens
(not shown) may be displayed that enables a user to select the
medication that is to be added, select a dosage and delivery
method. An Update Medication History checkbox may be selected to
add the medication to the medication history of the patient and,
the start date of the medication.
[0163] Further, before performing a procedure, a user may select a
Patient Assessment menu choice 918 via the Pre-Procedure tab 900 of
FIG. 9(a), which causes display of a Patient Assessment screen 970
as shown in FIG. 9(d) providing functionality enabling a user to
record information relevant to patient pain, emotional status,
learning needs, and IV initiation. The data captured on this screen
is important when assessing the patient's overall condition and may
be modified via the Patient Assessment screen. To record patient
assessment information via the Patient Assessment screen 970, the
user may select a value from the Pain Score dropdown list 972,
enter the location, quality, and/or duration of pain in the
Location/Quality/Duration field 974, enter relevant information in
the Measures to Alleviate Pain field 976, enter relevant
information in the Management Plan field 977, select a radio button
978 representing the patient's Emotional Status. The available
selections for Emotional Status include: Calm/Relaxed,
Anxious/Participates in Care, and Agitated/Unable to Participate in
Care. Further, via the Patient Assessment screen 970, the user may
select a radio button 975 corresponding to the patient's preferred
learning method (e.g., seeing, hearing, or doing) and, enter the
patient's preferred language in the Preferred Language field. The
user may further select a Needs Interpreter checkbox if the patient
needs an interpreter, and, select one or more barriers to the
patient's ability to learn via available checkbox selections for
Vision, Hearing, Physical, Emotional, and Cognitive reasons. Via
the Patient Assessment screen 970, the user may set the appropriate
IV Type and Needle Gauge dropdown fields in a Venous Access section
shown in FIG. 9(d). A user may select system defaults for these, by
clicking a Default button, or, if "other" choice is selected for
Gauge, the user may enter the needle size in the Specify field
provided. The user may further select a site of the IV from the
Site dropdown list, enter the start time of the IV in the Start
Time field, select the name of the clinical staff member who
started the IV from the Administered By dropdown list, and, select
an Existing IV checkbox if an existing IV is used.
[0164] Before performing a procedure, a user may further select a
Physical Exam menu choice 920 via the Pre-Procedure tab 900 of FIG.
9(a), which causes display of a Physical Exam screen (not shown)
enabling a user to record information such as the patient's weight
and height (a patient's estimated and actual height and weight in
either inches or centimeters/pounds or kilograms (the system will
fill in the other unit field by calculation)), general appearance
(from a dropdown list to select the patient's appearance as either
well or ill), nourishment (select whether the patient is
well-nourished, poorly nourished, or emaciated from the dropdown
list), stated age, appearance, color (select whether the patient's
color is normal, pallor, jaundice, or rash from a dropdown list,
for example), skin palpation (select whether the patient's skin
palpation is warm, cold, dry, or diaphoretic from a dropdown list,
for example), GI system function (for example, by clicking Yes/No
radio buttons for the choices listed), and other information (such
as Karnovsky Status information from a dropdown list, for example)
that is appropriate before the physician begins the exam. There are
different Physical Examination screens for the GI and Bronch
departments and, a user must select an exam before accessing the
Physical Examination screen. The Physical Examination record for a
patient may subsequently be modified.
[0165] Before performing any procedure, it is advantageous to
record the patient's vital signs, medication information and
intraprocedural assessment information. Thus, before performing a
procedure, a user may select a Vitals and Meds menu choice 922 from
the Pre-procedure tab 900 of FIG. 9(a), which causes display of a
Vitals and Meds screen 980 such as shown in FIG. 9(e), enabling a
user to enter a patient's vital and administered medication
information. Additionally, via the Vitals and Meds screen 980
display of FIG. 9(e), a user may also record pre-procedure Aldrete
scores to compare the patient. As shown in FIG. 9(e), the Vitals
And Meds screen interface includes two tabs: a Vitals And Meds tab,
and Assessment tab. The Vitals And Meds tab includes two displayed
sections: a Vitals which include, for example, rows for entry of
information for a patient such as pulse rate, respiration,
systolic, diastolic, O.sub.2 saturation, quantity and method of
O.sub.2, and temperature, for example; and, Medications for a
patient including information about medications administered during
the different phases of care. The Assessment tab includes the other
two sections: Aldrete Scores which are scores for activity,
respiration, circulation, consciousness, O.sub.2 saturation,
dressing, pain, ambulation, fasting--feeding, and urine output;
and, Intraprocedural Assessments which include intraprocedural
observations for the patient before and during an exam. This
information comprises LOC (level of consciousness),
skin/circulation, rhythm strip, emotional status, pain, and
notes.
[0166] As further shown in FIG. 9(e), the vitals and meds interface
980 displays generated columns that are populated with values of
the patient's vitals data at the time of each reading. That is,
each column is created and associated with an instant of time
(i.e., a "timestamp") as indicated. For each time new patient vital
data is entered, a column is created in the right side portion of
the interface. To add a column via the Vitals And Meds screen, a
user may click an icon to initiate functionality for causing the
addition of a column associated with a current time. A column is
thus added to the vital and meds display with the current time. A
patient's vitals and meds information may be captured at different
time-intervals. However, by default, a user will only see one
column in the Vitals And Meds screen of FIG. 9(e). Therefore, the
user may add more columns for different time intervals. To add
multiple columns via the Vitals And Meds screen, a user may click
an icon to initiate functionality for causing the addition of
multiple columns. Particularly, an add multiple columns window is
displayed the user is able to click a Date icon to enter the date
or, type it in manually. By default, the current date is populated.
The user may further click the Time icon to enter the time or type
it in manually. By default, the current time is populated. Further,
the user is enabled to enter the interval and columns to the
Interval and Columns fields (not shown). Thus, to record a
patient's vital information it is first required that a column is
available to record the vitals values in the Vitals section of the
Vitals And Meds tab. If not, the user will be prompted to add a
column or add multiple columns. The values may then be entered to
any or all of the vitals (except O.sub.2) using a slider interface
entry mechanism, spinners, or a text box.
[0167] Further information with respect to the entry and
recordation of Vitals and medication information, Aldrete scores,
and interprocedural assessments and unplanned events is described
in commonly-owned, co-pending U.S. patent application Ser. No.
______ (Atty. Docket 17283) incorporated by reference as if fully
set forth herein. It should be understood that further vitals and
medication information may be recorded via the Vitals and Meds
interface during the Procedure phase of care. If any information
was recorded during the pre-procedure phase of the examination,
this information will be displayed in the screen during the
Procedure.
[0168] Before performing a procedure, it is necessary for the
physician to document his/her review of a patient before an exam.
Thus, a user may select a Physician Checks menu option 923 via the
Pre-Procedure tab 900 of FIG. 9(a), which causes display of a
Physical Exam screen 990 shown in FIG. 9(f) that enables a user to:
select the Nurse Documentation Reviewed checkbox to indicate that
the physician has performed a review of the nurse documentation;
select either the Normal or the Abnormal radio buttons for each of
the items listed in the Focused Physician Exam section displayed.
To set the unselected radio buttons to normal, the user may click
the Set Unselected To Normal button. This is useful because in may
cases they are almost normal. If an item is set to Abnormal, the
corresponding Details field is enabled to allow entry of
information. The user may further: select a value from the ASA
(American Society of Anesthesiologists) physical status
classification dropdown list; select an item from the Patient is
suitable candidate for planned procedure with dropdown list; select
an item from the Level of Consciousness dropdown list; select the
Emergency Equipment Available checkbox, if appropriate; select the
Authorize Post-Procedure discharge when standard criteria are met
checkbox, if appropriate; and, select the name of the clinical
staff member who performed the physician checks from the Reviewed
By dropdown list. This is a mandatory field and must be filled
before the record can be saved. Further, the user must provide the
date that physician checks were performed by entering the date
manually or by using the Date icon and provide the time that
physician checks were performed by entering the time manually or by
using the Time icon.
[0169] Further, via the Pre-Procedure tab 900 shown in FIG. 9(a),
the user may access the Lexicon function to select terms from the
Knowledge Base as described herein with respect to FIG. 8(e) and,
in further detail as described in commonly-owned, co-pending U.S.
patent application Ser. No. ______ (Atty Docket 17282). As
described, the Lexicon arranges the Knowledge Base content into
different report sections, based on Phases of Care. These report
sections appear as tabs in the Lexicon screen, and for the
Pre-Procedure phase of care, the report sections include
"indications", Unplanned events, and codes. Thus, via the Lexicon,
a user is provided with the ability to associate Billing Codes with
selected Keywords. A user may use these codes in Procedure Note and
thus to bill certain other medical institutions for services
rendered. To associate a billing code with a selected keyword via
the Lexicon screen, the user selects the keyword that the user
wants to associate the billing code with, and selects a type of
code set from a Code Set dropdown list (not shown). After entering
the number of code that the user is searching for in the Number
field, a user may enter description of the code in a Description
field and the system will respond by displaying a list of billing
codes based on the search criteria entered. If the user does not
enter any search criterion, all the billing codes from the selected
code set are displayed from which the user may select one or more
billing codes.
[0170] Further, via the Pre-Procedure tab 900 shown in FIG. 9(a), a
user may select a Pre-Procedure Summary menu choice 924 which
causes display of a Pre-Procedure Summary screen 995 shown in FIG.
9(g) that enables a user to record, review and/or edit a summary of
pre-procedure and nurse handoff information. This includes the
status of the prep, consent, current medications, and abnormal
findings from the physical examination. To record pre-procedure
summary information, the user accesses the Pre-Procedure Summary
screen 995, and selects either the Yes or No radio button to
indicate whether the pre-procedure nurse's report has been
provided. An Edit button may be clicked to display the Capture
Visit Times screen from which the user may enter the pre-procedure
end date and time using the Date and Time icons. The name of the
prep nurse is also selectable from the Prep Nurse dropdown list,
and the name of the procedure room nurse may be selected from the
Room Nurse dropdown list. Any other relevant information may be
entered in the Nursing Notes field via this display. It is
understood that the pre-procedure summary information may be
modified via the screen display of FIG. 9(g).
[0171] Further, via the Pre-Procedure tab 900 shown in FIG. 9(a), a
user may select a Pre-Procedure Docs menu choice 926 that causes
display of a Document Distribution screen (not shown) that enables
a user to print and distribute documents related to pre-procedure
information in a manner such as described herein with respect to
FIG. 8(f). Generated documents may be distributed via email or fax.
The documents may be previewed and edited prior to printing or
distributing and, as described herein, the user may also edit the
recipient list for each document type.
[0172] A user may also access an Other Visit Information screen
(not shown) via the Pre-Procedure tab 900 of FIG. 9(a) to record
custom pre-procedure visit information that is not yet captured in
one of the other screens. Based on the requirements of the
particular facility, the system can be used to record specific
information if an exam is selected.
[0173] Procedure Tab
[0174] With further respect to the Procedure tab 1000 (FIG. 10(a)),
functionality is provided enables the user to: review the
pre-procedure summary; modify patient visit information; record
items used during the exam; manage scope information; capture
images and record video clips; modify pathology and specimen
information; record a patient's vital signs and medication
information; view other exam information; update the lexicon;
manage the printer (e.g., Mavigraph) queue; manage procedure
documents; and, record and maintain nursing administration
information.
[0175] Before performing a procedure, a physician may need to view
the following information: the particulars of a scheduled exam to
give the physician exam details; a Pre-Procedure summary to picture
pre-procedure information about the patient; visit information if
another visit/exam is required for the patient; Pathology record to
view the result or lab tests; and, any equipment necessary to
capture the information about the equipment used for the procedure.
Thus, according to functionality described herein with respect to
FIG. 8(a), a user may view the Scheduled Exams option via the
procedure tab to view details of exam, to search for an exam, or to
add a new visit.
[0176] Further, via the Procedure tab 1000, as shown in FIG. 10(a),
a user may select the Pre-Procedure Summary menu choice 1001 which
causes display of the Pre-Procedure Summary screen 1020 shown and
described herein with respect to FIG. 10(b) that provides
functionality enabling the automatic population of a synopsis of
information obtained during the pre-procedure phase of care in the
display screen.
[0177] Further, via the Procedure tab 1000, a user may select the
Modify Visit menu choice 1002 that enables a user to schedule a
patient visit and to modify an existing visit record as shown and
described herein with respect to FIG. 8(c).
[0178] Further, via the Procedure tab 1000, the user may select the
Equipment Used menu option 1003 which causes display of an
Equipment Used screen 1030 such as shown in FIG. 10(c). Via the
Equipment Used screen 1030 a user may record the information
pertaining to equipment used in the examination, particularly by
adding the media information in a displayed Media section, or,
click a New button next to Accessory, to add a new entry in the
Accessory section which enables a user to select an accessory
category from a Category dropdown list and enter the item number
and quantity. By clicking the Add button next to Equipment, an
Equipment Detail screen (not shown) is displayed from which the
user may select the accessory category from a Category dropdown
list. If the user selects Electrosurgical Generators from the
Category dropdown list, for example, an Electrocautery section is
enabled via which a user may enter other equipment information,
e.g., a serial number, etc. All of the entered equipment
information in the Equipment Used and equipment detail screen may
be saved.
[0179] With respect to the performance of a procedure, during the
actual exam, a user may: manage scope information; capture images
and record video clips; modify pathology and specimen information;
record a patient's vitals and medication information; view other
exam information; manage a mavigraph printer queue; distribute
documents; and, maintain nursing administration information.
[0180] Thus, via the Procedure tab 1000, a user may select the
Image Capture menu choice 1004 that enables generation and display
of an image capture interface screen 1050 such as shown in FIG.
10(d) that provides the user with the ability to: capture images
and record video clips, modify and delete these images, and
incorporate them into a report document. If an endoscope device to
be used is not connected to the application, a warning message may
be generated that the device cannot communicate and the user
prompted to ensure the scope device is connected to the system.
[0181] Initially, via the Image Capture screen 1050, a user may add
and delete scope information via the Add Scope Information section
1052 of the interface shown in FIG. 10(d). Typically, an endoscope
device employed includes an ID chip that provides information such
as scope name, serial number, etc. and this data is sent to the EW
system (e.g., imaging node) through the video processor. The system
adds new scope information automatically when it receives this
data. If a scope does not contain ID chip, the user nay add the new
scope information manually. To add new scope information, a user
may click New button on the right of Scope Information, click a
Search icon and locate the scope type that needs to be added via a
displayed Scope Model dropdown list (not shown). The user may
select a scope model number and a serial number. The user may
additionally select a Time icon 1053 to enter the current time or
type it in manually, and, click on a Calculate Duration icon 1054
that initiates functionality for calculating the duration and the
Total Duration time that the scope is being used.
[0182] During the procedure, in order to capture images, the user
may click a Pause icon in order to freeze the image. To capture an
image, a user may click a Capture icon which initiates
functionality for displaying the image in an Images box 1055 such
as shown in FIG. 10(d). If a user double clicks the image, the
image is generated for display in a further space as shown by the
enlarged image 1056 in FIG. 10(d). If, during an exam, the scope
device is disconnected, the user must re-initialize the system,
e.g., reconnect the device to the system within the Image Capture
screen. The system will automatically re-initialize or it may be
manually reset.
[0183] With respect to image capture, the system provides three
mask settings: an automask, primary and secondary settings. A
Toggle Mask function is provided that enables the user to toggle
between these video settings. If a system administrator has applied
the automask setting, then the user may either switch between these
video settings, or select a new video setting. For example, by
clicking a Toggle Mask button 1057 located next to a Mask dropdown
list 1058, the automask settings will change to the primary
settings. By clicking the Toggle Mask button again, the primary
settings will change to the secondary settings. When a scope is
connected to the system, the default automask settings are applied.
The user may change the default automask settings by selecting a
setting from a Mask dropdown list. Further details regarding the
automasking function provided are described in commonly-owned,
co-pending U.S. patent application Ser. No. ______ (Atty Docket
17284), the whole contents and disclosure of which is incorporated
by reference as if fully set forth herein.
[0184] To record video clips: a user may click a Record Clips icon
1059a that enables functionality for recording a video clip and
storing the clip for later playback via the Image Management
section 1055 or, delete Video Clips. With further regard to
deleting clips, by clicking the Delete Clips icon 1059b all unsaved
video clip(s) are displayed in a screen (not shown) that enables a
user to select the clip(s) to be deleted.
[0185] Further functionality enabled by the system during the
performance of an endoscopic procedure is the ability to capture
and view pathology and specimen information such as: Lab, Specimen,
Cytology, and Biohazard details. Thus, via the Procedure tab 1000
of FIG. 10(a), a user may select the Pathology Request menu option
1005 that enables generation and display of a Pathology Request
screen 1060 for the selected exam such as shown in FIG. 10(e). To
create a pathology request record via the Pathology Request screen,
the user selects an Add button to enable selection of a laboratory
from a Lab dropdown list and enter other relevant information
including the jar number, collecting method and specimen
information in a specimen section associated with a specimen record
(not shown). During the course of the examination, a user may make
further edits or required changes to the pathology request and
specimen record, or add or delete records via the Pathology Request
screen.
[0186] During the procedure, it is advantageous to record the
patient's vital signs, medication information and intraprocedural
assessment information. Thus, a user may select a Vitals and Meds
menu choice 1006 from the procedure tab 1000 in FIG. 10(a) which
causes display of a Vitals and Meds screen (not shown) enabling a
user to enter a patient's vital signs and administered medication
information via the graphical user interface in the manner as
described in greater detail herein with respect to FIG. 9(e).
[0187] Further, via the Procedure tab 1000 shown in FIG. 10(a), the
user may access the Lexicon function 1007 to select terms from the
Knowledge Base as described herein with respect to FIG. 8(e) and,
in further detail as described in commonly-owned, co-pending U.S.
patent application Ser. No. ______ (Atty Docket 17282), the whole
contents and disclosure of which is incorporated by reference as if
fully set forth herein. One feature of the lexicon is that the
Knowledge Base arranges content to different report sections based
on the phases of care. A facility determines which Report Sections
should be available in the Lexicon screen for a Phase of Care
(endoscopic procedure lifecycle stage). Thus, a user will select a
Report Section to display the hierarchal tree of items (menus and
keywords) for the report section and current examination and the
tree of the lexicon interface displays the available items. Thus,
for example, if a physician finds a small polyp in the anterior
wall of the antrum of stomach, the lexicon screen will result in
the display 1065 as shown in FIG. 10(f).
[0188] As mentioned, during the procedure phase of care, it is
possible manage the printer (e.g., Mavigraph) queue; manage
procedure documents; and, record and maintain nursing
administration information.
[0189] Thus, via the Procedure tab 1000 of FIG. 10(a), a user may
select the Mavigraph Printing menu choice 1008 that generates a
Mavigraph Printing screen (not shown) enabling a user to search for
a printing queue for the printer device, e.g., a mavigraph,
particularly by entering a facility and selecting a printer. Via
this screen, a user may further print images for current exam, for
example, by selecting the number of images a user needs to print on
a page from the Images per Page dropdown list and selecting one or
more print options from Annotations, Enhancements, and Anatomical
Diagram choices as shown in the print on mavigraph interface screen
1070 shown in FIG. 10(g).
[0190] Further functionality via this phase of care, includes the
ability to manage procedure documents, particularly by selecting a
Procedure Docs menu option 1009 via the Procedure tab 1000 which
causes display of a Document Distribution screen 1075 such as shown
and described herein in further detail with respect to FIG. 10(h).
Via the Document Distribution screen 1075 a user may review, edit,
and print a document from the Document Distribution screen, and
further, select a recipient and cause the distribution of patient
and exam related documents to the intended recipient (e.g.,
clinical staff), for example, by print, email, or FAX.
[0191] During the procedure, it is further advantageous to capture
and maintain nursing administration information. Thus, via the
Procedure tab 1000 shown in FIG. 10(a), a user may select the
Nursing Admin menu choice 1010 that enables generation and display
of a Nursing Administration screen 1080 for the selected exam such
as shown in FIG. 10(i). Via the Nursing Administration screen 1080,
a user may click a button 1081 to display a Capture Visit Times
screen that enables a nurse to enter a Room In date and time, a
Procedure/Sedation Start time, a Procedure End time, and a Room Out
date and time. The user may further enter relevant Safety and
Position information in respective displayed Safety and Position
sections, and, select the present medical staff information from a
Resource dropdown list. By clicking a Scheduled button, a user may
further enter the medical staff person who is assigned to the
procedure in the Assigned textbox and, further enter information
about the Room Nurse and Recovery Nurse in the Handover section
1082.
[0192] Post-Procedure Tab
[0193] With further respect to the Post-Procedure tab 1100 (FIG.
11(a)), functionality is provided that allows the user to:
synchronize images in ICU mode; manage exam images; print images on
either mavigraph or laser printer; create procedure notes for the
exam; sign procedure notes; gather a patient's current vitals and
medication information; prepare a patient recovery sheet; create a
patient recall letter; perform a trainee assessment; distribute
post procedure documents such as billing reports, Procedure Notes,
and referral letters.
[0194] After performing a procedure, a physician may perform the
following operations: synchronize images in the ICU mode: manage
images; review/edit clinical Lexicon; generate Procedure Notes;
record patient's current vital signs and medication information;
prepare a recovery sheet for a patient; prepare recall patient
letter; complete patient satisfaction survey; perform trainee
assessment; and, distribute post procedure documents.
[0195] According to functionality described herein with respect to
FIG. 11(a), when a user is performing an exam in ICU mode, his/her
imaging station is not connected to the network server (see FIG.
1(a)), i.e., is physically disconnected from the network. The
application supports the capture of all necessary data, perform the
examination and store the information until reconnected to the
network. The locally stored data is then uploaded to the server
database. Thus, for example, when an exam is finished, the user
must upload and synchronize images and data from the workstation to
the server repository. In one embodiment, when a user re-connects
the workstation to the network and logs in to the system, the user
enters a series of commands that will initiate functionality to
upload and synchronize the data and images captured during the
exam.
[0196] Thus, according to functionality described herein, a user
may first view the details of exams from the Scheduled Exams
display by selecting menu option 1102 via the post-procedure tab
100 of FIG. 11(a) to view details of exam, to search for an exam,
or to add a new visit.
[0197] Further, via the Post-Procedure tab 11(a) of FIG. 11(a), a
user may select the ICU Synchronization menu choice 1104 which
causes display of the an ICU Synchronization screen 1130, such as
shown in FIG. 11(b), to synchronize images in the ICU mode within
the database. A user may select a node from a Node dropdown list
that generates for display a list of exams on the selected node
that are conducted in ICU Mode. After the user selects the exam to
be synchronized, the ICU Exam screen is displayed with a list of
likely matches. The user will search for a scheduled exam, or
retrieve a list of exams for display, based on user search input,
if the exam is not in the list of matches. A user clicks the
Synchronize This Exam icon next to the exam to be synchronized and
initiates synchronization for the selected exam. Entry into the
Image Management screen within the Post Procedure tab will confirm
whether the synchronization has been performed successfully. If the
user does not find the exam to be synchronized, the user may create
a new visit and thus add an exam to the visit.
[0198] Particularly, the user may, via the ICU Exam screen, select
the facility for the visit from the Facility dropdown list (e.g.,
the default facility is the facility to which the user is currently
logged in); enter visit ID in the Visit ID field. A visit ID is a
unique facility-supplied identifier for the visit; click a Patient
Search icon next to a Patient field to display a Patient Search
screen. If no patient record is found in the Patient Search field,
a new record for the patient may be created by clicking a New
Patient icon to display the Patient Demographics window having
functionality as described herein to assign a resource for
synchronization. The images and data are synchronized to the
repository and the ICU Synchronization screen is displayed again.
To verify if the synchronization was successful, the user then
navigates to the Image Management function by selecting the Image
Management menu choice 1106 that causes display of the Image
Management screen 1140 such as shown and described herein with
respect to FIG. 11(c) that provides functionality for managing
images captured during a procedure, particularly: annotate images,
label images or associate findings to an image; display details of
an image; enhance the quality of images; import and export images;
view other exam images; print images on either a mavigraph or laser
printer; and delete images.
[0199] By selecting an import image button, a few exam images in a
folder may be imported in the current exam (by clicking an Import
an Image to the current exam icon 1141), using an import image
function. By selecting an Export the selected Image icon 1142,
image(s) files are exported to a destination folder including
BITMAP, JPG or TIFF images, for example, using an image export
function, via the Image Management screen 1140 for storage.
[0200] To highlight or comment on certain critical areas of an
image, a user can add lines, circles, ellipses, arrows, and text as
annotations, and further, may also change the color, shape,
dimensions, and location of an annotation. Annotations that are
created via the image management interface are stored as overlays,
and do not affect the original image, and further can show or hide
annotations. To annotate an image, for a selected exam, the Image
Management screen 1140 of FIG. 11(c)(1) displays all the images
captured during the selected exam from which a user may click
select the image to annotate from an image list 1145.
[0201] By selecting an appropriate shape icon from a displayed
annotation menu 1147, a line, a rectangle, an ellipse, or a circle
may be clicked and dragged onto the image, such as the exemplary
annotation 1132 shown in the selected image 1133 shown in FIG.
11(c)(1). The selected shape will appear on the image in which a
text message may be inserted via selection of a text icon, which is
dragged to create a textbox on the image.
[0202] To move a shape in an image, a user selects a Selection Mode
icon 1148 on the selected image, and clicks a previously-created
annotation shape that he/she wants to move and drag to the desired
location. The Selection Mode icon is used to switch back and forth
from drawing a new image to selecting an existing one. To draw
another shape, a user clicks the Selection Mode icon 1148 again to
switch to Drawing Mode. The user may further delete a shape in an
image.
[0203] To enhance an image a user selects a Enhance Image icon 1151
on the selected image, which initiates display of an enhancements
window (not shown) including mechanisms such as: a Zoom slider to
change the size of the image, if desired, a Sharpness slider to
change the sharpness of the image, if desired, a Contrast slider to
change the contrast view of the image, if desired, and a Brightness
slider to increase or decrease brightness of the image. The
enhanced image may be reset by to its original setting by clicking
a Reset button.
[0204] The user may further select functionality for showing or
hiding an annotation on a selected image by clicking the Show/Hide
Annotation icon 1153, and further, initiate functionality for
viewing Other Exam Images. If a patient has undergone a similar
exam in the facility and the user wants to view images from that
exam, an Other Exam dropdown list 1155 is provided to enable a user
to select image results from the other exam. As shown in the
example image management screen 1140' of FIG. 11(c)(2), the other
exam images are accessed and generated for display in an image list
1156 format simultaneously with the display of a current image list
of captured images for user comparison.
[0205] Returning back to FIG. 11(c)(1), via the interface, a user
may Magnify images from the other exam using the View Large Image
icon next to the Other Exam dropdown list, and further view
Procedure Notes recorded for the other exam using the View the
Procedure Note icon 1157. The tide bar of the Procedure note may
include the date and type of the other exam.
[0206] It is understood that, in situations when the user has no
findings to associate with an image, a user may label the image for
future identification via the Image Management screen by clicking
the Label all selected images from the current exam icon 1158 to
display a Label window in which a label may be entered in the label
text entry pop-up textbox (not shown). Subsequently, the label may
be modified or deleted via the Image Management screen.
[0207] The user may further delete all unlabeled images from the
current exam with just a click by selecting a Delete all unlabeled
images from the current exam icon 1159 via the Access the Image
Management screen 1140 of FIG. 11(c)(1).
[0208] If the user captures images relating to specific findings
and wants to associate the findings description to the captured
images, the Lexicon menu option 1107 may be selected from the Image
Management screen 1100 shown in FIG. 11(c)(1) to enter a finding
using the knowledge base section 1149. First, for a selected image,
a Findings tab 1146 is selected from the displayed Knowledge Base
section and a finding title is clicked from the displayed Knowledge
Base tree. The finding information will be generated by and appear
in the left side of the Knowledge Base interface in the manner as
described herein and in greater detail in commonly-owned,
co-pending U.S. Ser. No. ______ (Atty. Docket 17282). Then, by
clicking the Associate Findings icon 1160 from the image management
screen shown in FIG. 11(c)(1), the finding is associated with the
selected image. When the user associates a finding to an image, the
image is also marked for printing.
[0209] To disassociate a finding from an image, an image that has a
finding is selected and the Disassociate Findings icon 1162 is
clicked by the user. It is noted that when a user disassociates a
finding from an image, the image does not get unmarked for
printing.
[0210] The system of the invention provides an anatomical diagram
to document any surgical changes. When a user associates a finding
that includes a site with an image, a dot is displayed
corresponding to site of the finding. There are different surgical
diagrams for different exam types. To view the surgical diagram the
user clicks an image that is associated with a finding via the
Image Management screen 1140 shown in FIG. 11(c) and selects a
Surgical Changes icon 1163 to display the Surgical Changes window
1165 such as shown with respect to FIG. 11(d). Functionality is
further provided to enable a user to annotate a surgical diagram by
using the toolbar in the Surgical Changes screen for drawing
arrows, circles, lines, rectangles, and solid rectangles in the
selected image as described herein with respect to image capture. A
user may additionally type and format text, move, hide, and delete
annotations as described herein.
[0211] Returning to FIG. 11(c)(1), if the user desires to print
images for an exam, the images for printing must be first marked by
clicking the Mark selected images for printing icon 1172 via the
Image Management screen 1140 and printed on a mavigraph or any
other suitable printer (for example). Preferably, a suitable
indication, such as a "P", as shown in FIG. 11(c)(1) for example,
is provided in the corner of a captured image that marks that image
for printing. Subsequently, a user may click the Unmark selected
image for printing icon 1173 to unmark an image, and remove the "P"
indication on the top-right corner of the image.
[0212] To print images on a mavigraph printer, the Mavigraph
Printing functionality is provided for adding a print job for the
currently selected mavigraph printer. A user may print one or more
print jobs, and reprint an existing print job. Thus, after marking
the images to be printed in the Image Management screen, a user may
select the Mavigraph Printing menu option 1108 from the Image
Management screen of FIG. 11(c)(1) which displays a Mavigraph
Printer dropdown list from which a mavigraph printer may be
selected. It is understood that, as described herein with respect
to FIG. 10(g), for the current exam, an Annotation checkbox may be
selected if the user wants to print images with their annotations;
an Enhancements checkbox may be selected to print images with their
enhancements in terms of sharpness, contrast, and brightness; and,
an Anatomical Diagram checkbox may be selected to print the
anatomical diagram for the exam. Further functionality is provided
for deleting a print job, clicking on the checkbox next to the
print job to be deleted.
[0213] If video clips were recorded during the procedure, a user
may manage those clips via the Post Procedure tab, and particularly
play and delete video clips, and save a video clip to another file.
To play a video clip, via the Image Management screen, a Video
Clips icon 1176 may be selected to display the Video Clips List
window where the user may further click a Preview icon (not shown)
to play the video clips in a suitable viewer such as Windows Media
Player, or, delete video clips. By clicking the Video Clips icon to
display the Video Clips List window, a Video clip(s) may be
selected for deletion or be saved to another File via the Image
Management screen, e.g., by clicking a Download icon and selecting
a destination file location.
[0214] As mentioned previously herein, a user may use the Lexicon
function to select terms from the Knowledge Base. For example, when
it is desired to record procedure related information for the exam,
the user may select the Lexicon function to record findings. The
Lexicon arranges the Knowledge Base content into different report
sections, based on Phases of Care, these report sections appearing
as tabs in the Lexicon screen 1065 such as shown in FIG. 10(f)
including an indications tab 1177a, a procedure tab 1177b, a
findings tab 1177c, an unplanned events tab 1177d, a
recommendations tab 1177e, a summary tab 1177f, and a billing codes
tab 1177g. By clicking on a tab to see the Knowledge Base terms
associated with the report section, a facility determines which
report sections should be available in the Lexicon screen for a
phase of care. A system administrator can make a report section
available to appropriate phases of care via an Admin tab 1300.
Functionality enabled via the Lexicon screen is described in
greater detail herein and in applicants' herein incorporated
co-pending U.S. patent application Ser. No. ______ (Atty Docket
17282). When the user picks or selects an available term (based on
that user's findings) from the right hand side pane, it is copied
to the left hand side pane that displays the selected terms thus
logically build a comprehensive description of the exam. These
selected terms along with other exam data collected during various
phases of care are used to generate Procedure Note and other exam
related documents.
[0215] One particular use of the Lexicon is the ability to
associate Billing Codes with selected keywords. These codes may be
used in Procedure Note and thus provides the ability to bill
certain other medical institutions for services. To associate a
billing code with a selected keyword the user accesses the Lexicon
screen portion 1179 such as shown in FIG. 11(a), selects the
keyword desired to be associated with the billing code; clicks the
Code icon 1180 and select a code set display option (not shown)
from a displayed Select Billing Codes window (not shown). After
selecting a Code Set, a Code Sets window is displayed whereby the
user may search for a billing code from this window. The user
selects a type of code set from the Code Set dropdown list and,
enters number of the code to be searched for in an optional Number
field, or further enter a description of the code in an optional
Description field. A list of billing codes based on the entered
search criteria is displayed or, by default, all the billing codes
from the selected code set are displayed if no search criteria is
entered. A user from this list may then click a billing code to
select it, or further select multiple billing codes.
[0216] As mentioned herein, a Procedure Note is documented
information about a specific exam and is used to document findings,
diagnosis, medication, recommendation, and other information such
as past diagnosis; a user may additionally use the Procedure Note
function to manage images; view information such as images and
Procedure Notes for other exams; select terms from the Knowledge
Base tree; generate report text; select billing codes; sign a note;
generate different versions of a note; and discard or delete a
note.
[0217] Via the Post-Procedure tab 1100 of FIG. 11(a), a previously
created Procedure Note template configured in a manner as specified
by a facility or a physician to display captured information in a
document, is selected. A system administrator previously creates
the Procedure Note template. Thus, for a selected exam a user
selects a Procedure Note menu option 1109 via the tab 1100 of FIG.
11(a) and a Select Procedure Note Template screen (not shown) is
displayed that enables a user to search for a Procedure Note
template based on facility and/or physician name. A resulting list
of Procedure Note templates is displayed that are selectable by a
user.
[0218] As shown in FIG. 11(a), an example selected Procedure Note
screen 1190 is shown that includes three sections: an Image Strip
1145, to manage images for the current exam as described herein
with respect to FIG. 11(c)(1); a Procedure Note Builder 1182
providing an interface for editing and generating Procedure Note
documentation; and, a Knowledge Base Interface 1179, to pick
Knowledge Base terms to generate a report.
[0219] As mentioned herein with respect to FIG. 11(a), a user may
use the Images section similar as a user would use the Image
Management screen (FIG. 11(c)(1)). The Image section of the
Procedure Note screen buttons enables functionality for: deleting
selected images from the current exam; deleting all unlabeled
images from the current exam; mark/unmark selected images for
printing; viewing a larger image; labeling all selected images from
the current exam; deleting the label from all selected images from
the current exam; associate/disassociating findings; showing/hiding
a menu or a strip; and, viewing images and Procedure Notes for
other exams associated with the selected patient.
[0220] A user may further use the Procedure Note function to select
Knowledge Base terms for an examination. Thus, the Knowledge Base
section is used to select terms and when a Note is created, the
user may select a Generate Report icon 1192 to generate a report
including sentences in the document section. The Generate Report
icon is activated if changes are made to the selected terms. If any
of the selected keywords are associated with a sentence model, the
sentence is generated and populated in the displayed report within
the specific Report Section.
[0221] If a Use Organ Labels function has been previously activated
for the exam type, the sentences for findings are prefixed with the
name of the organ. For example, if there were a finding of "polyp"
in "stomach" and the Use Organ Labels is set to Yes for the exam
type, the sentence in the report would look like:
[0222] STOMACH: There was a polyp found in the stomach.
[0223] When a sentences are generated for findings, and if there is
an image associated with that finding, the image number appends at
the end of the finding. For example, if there is a finding of polyp
with "image 1" within stomach, the finding sentence would appear
like:
[0224] There was a polyp found in the stomach (1).
[0225] A keyword in the Knowledge Base may have a sentence model
for the Summary section associated with it. If a selected template
has a Summary section and a selected keyword has a summary sentence
model, the summary sentence for the keyword appears in the Summary
section. For example, if a polyp is found in the stomach and a
diagnosis of polyp, the summary sentence would be:
[0226] Diagnosis--polyp
[0227] A further mentioned herein, a user may use the Procedure
Note function to select relevant billing codes for the exam. If a
keyword has a billing code associated with it, a user would see all
billing codes and descriptions associated with the keyword in
response to selecting the Code icon 1180 and select relevant
billing codes associated with a keyword for the current exam.
[0228] Further functionality enabled via the Procedure Note screen
1190 of FIG. 11(a) includes: saving a Procedure Note by clicking
Save; and, signing a Procedure Note if the Procedure Note text is
completed. It is understood that only attending physicians for the
examination can sign the Procedure Note. If a Validate & Sign
Procedure Note setting is set to Yes, the physician will be asked
to validate his/her user ID and password. Signing a note will lock
the report from further editing. It is further understood that
signing a Procedure Note updates a patient's past procedure, past
diagnosis, and past surgeries records; saving a Procedure Note As a
Template, for example, for those situations where a user makes
changes to an existing Procedure Note and wants to apply those
changes to future Procedure Notes. The modified Procedure Note may
be saved as a template which can be used to generate future
Procedure Notes. Thus, via the Procedure Note screen 1190 a user
may select the Save As button and assign a name to the template,
select either a facility or physician name to assign an owner to
the template.
[0229] It is understood that the time in which Procedure Notes are
created is reduced by: providing procedure reporting via the
medical knowledge base interface that implements shortcuts for
commonly used items; and, incorporating annotated and labeled
images into the written reports. Further, the appropriate sections
of the report may be auto-populated based on patient data
previously gathered during Pre-Procedure, Procedure, and
Post-Procedure phases.
[0230] As mentioned, once a Procedure Note is signed, it is locked
and cannot be edited. To make any changes to an existing, signed
Procedure Note, the user must create a new version of the Procedure
Note. The new version of the Procedure Note is an exact copy of the
current signed Procedure Note, without regenerating any sentences
or updating any database fields. To generate a new version via the
Procedure Note screen a user may clicks a New button and a new
version of the Procedure Note is generated.
[0231] A procedure note may further be deleted by clicking Discard
via the Procedure Note screen. Discarded Procedure Notes are stored
in a Discard Bin, where they can be viewed but not restored. A
Procedure Note may be deleted as long as the Note is not signed.
Further functionality enabled via the Procedure Note screen
includes functionality for creating a new exam follow-up request by
selecting an Exam Follow-up icon 1198 from the Procedure Note
screen. To create a new exam follow-up request: A New Exam
Follow-up window (not shown) is displayed in response that enables
a user to: select an assignee from the Assigned To section; select
the status of the request from a Status dropdown list; and click
New if the user has any notes to enter. An exam follow-up request
is generated, which the user may view from a Pending Items screen
in the Home tab associated with that user.
[0232] Further, via the Post-Procedure tab 1100, a user may record
the current condition of a patient, and particularly: prepare a
recovery sheet based on the patient's vitals and meds information;
determine the level of service provided to the patient; record a
patient satisfaction survey; access trainees, if any trainees are
involved in the procedure; and distribute exam-related
documents.
[0233] Thus, after performing the procedure, the user may record
the patient's vital information, administer any medication
provided, note the Aldrete scores, and record intraprocedural
assessment information to determine the condition of the patient
upon selection of the Vitals and Meds menu choice 1111 shown in
FIG. 11(a). This functionality is implemented via the Vitals And
Meds screen to record the data as shown and described herein with
respect to FIG. 9(e).
[0234] After a procedure is completed, the user may further use a
Recovery screen 1195 such as shown herein with respect to FIG.
11(e) to capture recovery data for a patient. The recovery sheet
also serves as a discharge document, where the user enters arrival
and departure times, post procedure discharge information, the last
Aldrete score, the patient's venous details, etc. If the user needs
to call the patient for a follow-up, the user may create a new
post-exam follow up request from this screen.
[0235] The user may prepare a recovery sheet from the Recovery
screen 1195 as shown in FIG. 11(e) after selecting the Recovery
menu choice 1112 from the Post Procedure tab 1100 and selecting an
exam. Via the Recovery screen, a user may further display the
Capture Visit Times window where the user may enter a Recovery
Arrival date and time and a Time Out of Unit time and date. The
user may further select the relevant Authorize Post Procedure
Discharge information. In one embodiment, a Last Aldrete Score
section is populated automatically with the last Aldrete Score that
was captured in the Vitals And Meds screen of FIG. 9(e). The user
may further enter Venous Details. Further, by clicking a New button
in a Post-Exam Call section (not shown), a user may setup a post
call meeting and select an assignee for the post-exam call from the
Assigned To section. To assign a clinical staff, a Clinical Staff
icon may be displayed and a clinical staff selected from a Clinical
Staff Lists. A user may further select the status of the post exam
call from the Status dropdown list. If it is a new call, the status
would be Open. Other information in the New Post Exam Call window
may be populated from the system database. The user may further
enter the Discharge Details and enter relevant information in the
Patient Belongings section. If there are no belongings to return to
the patient, there will be No Belonging(s) to Return
indication.
[0236] To recall a patient for another examination, the user must
issue a recall letter to the patient. A Recall Patient screen may
be used to add an item to the Recall Letter Queue to remind a
patient of a follow-up examination. Recall letters are exam
notifications which are generated and then sent to a patient. To
add an item to Recall Letter Queue via the post-procedure screen, a
user must navigate to the Post Procedure screen 1100 in FIG. 11(a),
and, for a selected exam, select Recall Patient menu option 1113 to
display the Recall Patient screen 1196 such as shown in FIG. 11(f).
Via the Recall Patient Screen of FIG. 11(f), the user may select
the facility where the patient is to visit, and enter the patient
name and enter the return time in provided entry fields. The user
then selects the exam for which the user wants to recall the
patient from the Exam dropdown list, selects the attending
physician from the Attending dropdown list and enters any
notes.
[0237] The user may view and print recall letters from the Recall
Letters screen in the Home tab shown in FIG. 6. To print recall
letters via the home tab 600, a user selects Recall Letters menu
option 607 to display the Recall Letters screen, and selects a
facility from the Facility dropdown list (not shown). Other search
input, if desired, may be entered as well. In response, the system
generates for display a list of recall letters, sorted by patient
return date. The user may then click a Details icon to view the
details of the recall. The Recall Patient screen is displayed where
the user may make changes to the recall, if desired. A Select
checkbox may be clicked to select a letter and subsequently
printed.
[0238] It is understood that a recall letter may be selected and
printed from a Select Template pop-up window from which a user may
select a recall letter from the Template Name dropdown list for
printing.
[0239] The system provides a Patient Satisfaction Survey screen to
capture the patient's level of satisfaction on certain elements,
such as procedure, staff, exam time, and overall visit. The ratings
for each item include excellent, very good, good, fair, or poor. To
record a patient's satisfaction details via the Post Procedure tab
1100, for a selected exam, a user selects a Patient Survey menu
option 1114 to cause display of the Patient Survey screen (not
shown) wherein the user may enter the patient's satisfaction rating
for each of a plurality of rating items including Endoscopist's
manner, technical skills, patient's wait time, etc.
[0240] If a trainee is involved in a procedure, the user may use a
Trainee Assessment screen to access the performance record of a
trainee. The Intubation and Therapeutic Maneuvers may also be
assessed. To record trainee assessment information via the Post
Procedure tab 1100 shown in FIG. 11(a), the user selects a Trainee
Assessment menu option 1115 to display a Trainee Assessment screen
(not shown). A trainee may be selected from the Trainee dropdown
list and Assessment information and the optional Intubation and
Therapeutic Maneuvers information may be entered.
[0241] In a situation where a user wants to distribute documents
(such as referral letters) to another physician or facility, a
Document Distribution function may be implemented. The user may
distribute post procedure documents such as billing reports,
Procedure Notes, discharge instructions, exam images, nurse
reports, or referral letters, by email or fax. The user may further
preview and edit the documents prior to printing or distribution,
and further edit the recipient list for each document type. An exam
must be selected to view the Document Distribution screen.
[0242] To preview, edit, and distribute documents via the Post
Procedure tab 1100 shown in FIG. 11(a), the user selects Post
Procedure Docs menu option 1116 to display a Document Distribution
screen 1120 for a particular exam, such as shown in FIG. 11(g).
From this screen, a user may edit or review a document by accessing
the Document Distribution screen, selecting a template for the
document from the Template dropdown list 1121, and select an Edit
Document icon corresponding to the document that needs to be edited
or reviewed. The document will be displayed in a new window where
the required changes may be made. A document may also be printed
without distributing it via the Document Distribution screen.
[0243] A user may edit the recipients of a document from the
Document Distribution screen 1120 and particularly add and delete
recipients from the list via the Document Distribution screen.
After selecting a document to be distributed, a user may select an
Edit Recipient List icon 1122 adjacent to the document which causes
for display an Edit Recipient window providing a contact choice to
add a recipient other than a medical provider or clinical staff.
The Contacts List screen is displayed with categories of
recipients. An icon is provided to delete a recipient.
[0244] To distribute a document, a user accesses the Document
Distribution screen 1120 of FIG. 11(g), and clicks the checkbox
1123 associated with the document to be distributed. A template is
selected for the document from a Template dropdown list and the
user may click Distribute via a selected media, e.g., print on a
default printer, or e-mail for the recipient to view.
[0245] Furthermore, education documents may be distributed to
patients to inform them about procedures or findings. For example,
if the user's facility has set an education trigger for the word
"polyp", then when a polyp is found in the stomach of a patient, a
document based on an education template can be generated for the
user to distribute to that patient. If the facility has not set an
education trigger, no education document will be generated. An
education document may be selected via the Document Distribution
screen 1120 by selecting the document, clicking the checkbox next
to the document to be distributed, selecting the template for the
document from the Template dropdown list, and selecting the number
of copies that need to be printed.
[0246] Analysis Tab
[0247] With respect to the Analysis tab, as shown in FIG. 12, the
EW system provides menu selections for invoking a pre-defined
queries for a category defined in the menu. When a user selects a
report from the menu list and pushes execute button, the system
invokes a pre-defined query and displays the results according to a
pre-defined template. Predefined queries shown in the analysis tab
1200 of FIG. 12, for example, enable the generation of a statistics
report regarding CQI (Continuous Quality Improvement). Other
pre-defined queries may be invoked to generate reports regarding
efficiency, equipment analysis, procedure analysis and
administration.
[0248] System Administration Tab
[0249] With further respect to the System Administration tab 1300
(FIG. 13(a)), functionality is provided that allows a user having
administration privileges to: maintain system data; maintain
application resource data; manage patient and clinical staff
information; customize application settings and functions; manage
user and role information; configure facility, node, mavigraph, and
video settings; manage logs and queues; manage equipment
information; modify the user-defined screen. A system administrator
is also responsible for configuring the system to maximize system
performance; maintain the Knowledge Base by adding new keywords,
sentence models, and menu structures; record and maintain resource
information such as endoscopy equipment information and clinical
staff records; add and remove users and assign appropriate
privileges to each user; review system and activity logs for
periodic administration and take corrective measures to solve any
problems.
[0250] With respect to the administrator function of maintaining
system data, functions are provided that are accessible by a user
having administrative privileges to perform the functions that
allow the maintenance of system data. Via the system administration
tab 1300, selection of the System menu option 1301 initiates
display of a system screen such as shown in FIG. 13(a), that
provides functionality to enter, store, delete and/or modify system
information stored in the database, including, but not limited to,
the following: 1) Insurance Carrier information: by further
selecting the Insurance sub-menu option 1302 shown in FIG. 13(a)
functionality is enabled for creating, modifying, storing and
deleting of carrier name, carrier code, and other insurance carrier
information, including an active checkbox which is selectable to
make the insurance carrier record available to the clinical staff;
2) Procedure Room information: by selecting the Procedure Room
sub-menu option 1303 shown in FIG. 13(a), functionality is enabled
for creating, modifying, storing and deleting database records
about the procedure rooms (e.g., room names or room numbers) in the
facility for storage in the system database. Adding procedure room
information would enable clinical staff to allocate a room to an
examination. Each procedure room is identified by its name and
facility; 3) Race information: by selecting the Race system
sub-menu option 1304 shown in FIG. 13(a), functionality is enabled
for creating, modifying, storing and deleting records of race
information such as American Indian, Native Alaskan, White or
Caucasian, Asian, Black or African American, etc.; 4) Ethnicity
information: by selecting the Ethnicity system sub-menu option 1305
shown in FIG. 13(a), functionality is enabled for creating,
modifying, storing and deleting entries in a standard list of
Ethnicities including, but not limited to: American, Australian,
Canadian, Caribbean, Chinese, European, Hispanic, Indian, Japanese,
etc. 5) Name Prefixes information: by selecting the Name Prefix
system sub-menu option 1306 shown in FIG. 13(a) functionality is
provided for enabling an administrator to create, modify, store and
delete entries of defined name prefixes (and associated genders)
that can be assigned to a person such as: Dr., Father, Miss, Mr.,
Mrs., Ms., etc.; 6) Academic Degree information: by selecting the
Academic Degree system sub-menu option 1307 shown in FIG. 13(a),
functionality is enabled for creating, modifying, storing and
deleting information relating to Academic Degrees that can be
assigned to a person such as: D.O., L.P.N., M.D., M.S.N., R.N.,
etc.; 7) State/Provinces information: by selecting the
State/Province system sub-menu option 1308 shown in FIG. 13(a)
functionality is enabled for modifying, storing and deleting
states/provinces records that are installed within the application
or create new state/provinces (and their abbreviations). The
application includes all 50 states, their corresponding US post
office state abbreviations, and all Canadian provinces and
territories; 8) Country information: by selecting the Country
system sub-menu option 1309 shown in FIG. 13(a), functionality is
enabled for modifying, storing, adding and deleting country names
(e.g., USA and Canada) and their abbreviations or to add new
countries to the list; 9) Department information: by selecting the
Department system sub-menu option 1310 shown in FIG. 13(a),
functionality is enabled for modifying, storing creating and
deleting Departments information (and abbreviations). A department
is a sub-organization or practice within an institution or facility
that specializes in one or more medical areas, such as
Gastroenterology (GI) or Bronchoscopy (Bronch). It provides
services for one or more exam types (specialty), such as EGD or
ERCP. Clinical staff can be qualified to perform or work in one or
more departments and specific accessory equipment is associated
with the department. The system supports multiple departments with
department records established and maintained using the department
maintenance function. When a Department List screen is accessed,
the defined departments are displayed alphabetically by name; 10)
Patient Identifier Type information: by selecting the Patient
Identifier Type system sub-menu option 1311 shown in FIG. 13(a),
functionality is enabled for modifying, storing, creating or
deleting the Patient Identifier Type information for a facility
which is a code used to identify a patient. For example, the
identifier code "MRN" is the default patient identifier type. A
facility can create its own identifier type and edit, add, or
delete departments via a Patient Identifier Type screen. It is
understood that a default patient identifier type must be set using
the facility settings function. This unique patient identification
can also be helpful if one facility decides to merge another; 11)
Medical Alerts information: by selecting the System Alerts sub-menu
option 1312 shown in FIG. 13(a) functionality is enabled for
modifying, storing, creating or deleting medical alerts or
comorbidities for a facility. As mentioned herein, the system is
programmed to notify the user of a patient comorbidity by means of
a medical alert. System medical alerts are system level
comorbidities identified by a facility. If a patient has a
designated system medical alert, the medical alerts icon 759 such
as shown in FIG. 7(c) is displayed in the status bar 749. This
medical alerts icon is displayed and stays on the status bar
whenever the concerned patient is selected. Medical staff can click
on the medical alert icon to view a list of all medical alerts for
the patient. There are 13 categories of medical alerts defined in
the system, e.g., allergy, coagulation, etc. Each category includes
alerts that cannot be edited or changed.
[0251] As mentioned, a further function provided via the System
Administration tab 1300 (FIG. 13(a)), is the maintenance of
application resource data. With respect to the administrator
function of maintaining application resource data, functions are
provided that are accessible by a user having administrative
privileges to perform functions such as: creating or modifying
patient information, clinical staff information or contact
information. Clinical staff is defined as the professional and
certified medical personnel employed by or affiliated with an
institution, facility, or clinic. Each clinical staff is associated
with a role defined in the system. With respect to the maintenance
of clinical staff, for example, a member can have the following
roles for an exam type: attending physician, EGD, Nurse, and others
such as ERCP. Only a clinical staff member with the proper
qualifications can perform the roles required for an exam type. The
system of the invention supports the search for addition,
modification, and deletion of clinical staff records.
[0252] Thus, via the system administration tab 1300 shown in FIG.
13(b)(1) selection of the system Clinical and Patient menu choice
1315 enable the maintenance of these application resource data
types by displaying a Clinical Staff List screen providing
available clinical and patient sub-menu choices. After selection of
the Clinical & Patient menu option 1315, a user further selects
the Clinical Staff sub-menu option 1316 which displays the Clinical
Staff List screen (not shown) which enables the user to search for
a clinical staff using one or more criteria entered in the search
fields provided that include the following: a Primary function; a
Facility; a Staff ID; and a first and last name of the medical
staff member. To add a physician in the system via the Clinical
Staff List screen, user may click a new button which enables
display of a Clinical Staff screen 1340 as shown in FIGS. 13(b)(1)
and 13(b)(2) providing fields for entering clinician's personal
information data such as: staff ID, a prefix, last name of the
physician and first name, and, enabling selection of "Physician"
from a Primary Function dropdown list. Further functionality
enabled via the Clinical Staff screen includes the ability to:
assign a facility to the physician by selecting a facility from the
Facility dropdown list (e.g., more than one facility may be
assigned to the physician); assign an academic degree to the
physician by selecting a degree from a Degree dropdown list (e.g.,
more than one degree may be assigned to the physician); assign an
exam to the physician by selecting an exam from an Exam dropdown
list; and, select a role that the physician would be performing in
the selected exam from the Role dropdown list. There are only three
roles available--attending, assisting, and trainee, however,
functionality is available to add another exam and role. It is
understood that all exams may be assigned to the physician.
[0253] In the same manner as described with respect to adding a
physician into the system by creating a physician record, a nurse
may be entered into the system by creating a nurse record. That is,
before a nurse is assigned to an exam, the nurse's information must
be added in the system that is accomplished via the Clinical Staff
screen 1340 of FIGS. 13(b)(1) and 13(b)(2). To modify or delete a
clinical staff member from the system, the administrator may access
the Clinical Staff List screen, search for the clinical staff
record to be modified, click the Details icon next to the clinical
staff, and via the Clinical Staff screen, make the desired changes
or click a Delete icon to delete the selected record.
[0254] Further, via the system administration tab 1300, selection
of the system Clinical & Patient menu option 1315, and further,
the Contacts 1317 sub-menu choice enables display of a Contacts
List (not shown) enabling addition of a new contact such as a new
pharmacy, or a new vendor. Thus, the system enables the facility to
maintain contacts other than clinical staff, including but not
limited to: Pharmacy; Billing; Pathology; Quality assurance;
Biomedical department; Medical records; Outside physician office;
Outside hospitals; Ambulance services; Infection control; Hospital
contacts; Vendors and Regulatory agencies. Specifically, via the
Contacts List screen, the administrator may enter a search query
for an existing contact record. The existing contact record is
brought up in a contacts screen display (not shown) that enables a
user to modify the contact information or delete the contact
record.
[0255] The Configuration Management function of the present
invention maintains application configuration items including:
System Settings, Node Settings for a specific node, Printer (e.g.,
Mavigraph) Settings, Video Settings, Auto Mask Settings, and
Facility Settings. With respect to system settings, the system may
further enable the set-up parameters for the system to record and
display data. System settings are configured when the application
is installed, but they can be changed at anytime via a System
Settings screen. Particularly, via the administration tab 1300, a
user may select a Configuration menu choice 1318 to display
available configuration sub-menu options. A select System Settings
sub-menu choice 1320 is provided that, when selected, generates for
display the System Settings screen 1350 such as shown in FIG.
13(c).
[0256] Via the System Settings screen 1350 a user may modify the
required System Settings information by providing entry fields for
entering system parameters such as: Institution Name and
Institution Logo which is an image file containing the
institution's logo in formats such as BMP, JPEG or JPG, for
example; SSN/SIN Format which setting is used to specify the format
for entering a Social Security Number (SSN) or Social
Identification Number (SIN), depending on the country (e.g., a
default value is ####-##-#### where # is a number between 0 and 9);
a Phone Format setting used to specify the institution's phone
number entry format; a Thousand Separator format setting that
determines the separator used when entering numbers over 999; a
Decimal Separator setting that determines the separator used in
decimal numbers; a Time Format setting that determines the time
format for the institution, and is a choice of Military or Standard
time; a Date Format setting is used to specify the institution's
date entry format; a Compression format setting that is used to
specify the institution's preferred graphics compression format
(e.g., a default value is none (i.e., no compression); other
acceptable values are loss less, high, medium, and low); and, a
Language setting that is used to specify the predominant local
language and which setting is used to determine the value displayed
as the preferred language on the Patient Assessment screen.
[0257] As mentioned, a further function provided by the system is
the maintenance of the layout of the application based on a
facility's requirements. That is, the system is a highly
customizable application with the ability to decide which options
that are to be made available to users. For example, the
administrator can choose to allow or forbid a user in the nurse
role to access the Procedure Notes section.
[0258] Thus, via the via the System Administration tab 1300 (FIG.
13(c)), the administrator may access the Application Flow
configuration sub-menu option 1322 which causes for display the
available configuration options in an Application Flow screen 1355
such as shown in FIG. 13(d). To modify the existing layout via the
Application Flow screen 1355, the user may select a tab from the
Tab dropdown list 1356 which provides all of the available sub-menu
option choices in an Available textbox 1357a, and provides all
assigned options listed in an Assigned textbox 1357b. The user may
then select options from the Available menu choices list that are
to be assigned to users by clicking a Right Arrow icon to add the
selected options to the Assigned list 1357a, or select options from
the Assigned list to remove, and, click the Left Arrow icon to
remove the selected options from the Assigned textbox 1357b.
[0259] The administrator may further add a new facility, customize
a facility's preferences and operating procedures from a Facility
Settings screen, and also set system default options for the
facility such as primary patient identifier type, default patient
class, and IV type. Other settings that affect the operation of the
application are not specific to the facility and are controlled
through the system settings function. A Facility List screen is
accessed via the Admin tab 1300 by selecting the Facility Settings
sub-menu option 1324 from the available configuration options
displayed. Upon selection of the Facility Settings menu choice
1324, the Facility List screen is displayed (not shown) from which
an administrator is enabled to modify information by selecting the
Details icon next to a selected facility to be modified, or delete
a particular facility. To add a new facility information in the
system, the Facility List screen is accessed to select a new option
which displays a Facility screen 1360 such as shown in FIG. 13(e)
enabling user entry of new facility information such as: name in a
Name field; facility abbreviation in the Abbreviation field; a
state of the facility from the State dropdown list; a country of
the facility from the Country dropdown list; a primary patient
identifier type for the facility from the Primary Patient
Identifier Type dropdown list; a default patient class from the
Default Patient Class dropdown list (e.g., there are three options
available--inpatient, inpatient transfer, and outpatient); an IV
Type that is to be set as a default for the facility from the IV
Type dropdown list; the new facility's work start time, end time,
week start day, week end day, and interval information in the Hours
of Operation section; and, a name and phone number of the system
administrator.
[0260] The administrator is further able to define node settings
for nodes or computers that the facility will use to perform exams.
From a Node Settings screen 1365, such as shown in FIG. 13(f), the
administrator can: define node settings such as node name, physical
address of the node, and communication port, set a primary video
mask setting; set a secondary video mask setting; define a video
automask setting; and, select a default mavigraph printer for the
node. To access the Node Settings List screen, via the System
Administration tab 1300 (FIG. 13(c)), the administrator may select
the Node Settings configuration sub-menu option 1325. Upon
selection of the Node Settings configuration option, a Node
Settings List screen is displayed (not shown) enabling a user to
edit, add, or create new node setting records. When the Node
Settings List screen is accessed, the defined nodes are displayed.
From the Node Settings List screen, an administrator is enabled to
modify information by selecting a Details icon next to a selected
node to be modified, or, delete a particular node. To add a new
node information in the system, the Node Settings List screen is
accessed to select a new option which displays a Node Settings
screen 1365 such as shown in FIG. 13(f) enabling user entry of new
node information such as: name of the node in a Node Name field; a
facility from the Facility dropdown list; a physical address of the
node in a Physical Address field; an input type from the Input Type
dropdown list; a COM port from the COM Port dropdown list; and
other relevant information. Further, via the Node Settings screen
1365, a default mavigraph printer may be selected from the Default
Mavigraph dropdown list (a list of mavigraph printer is generated
when a mavigraph printer device is added to the facility in the
Mavigraph Settings screen as described herein), and, a default
label is assigned to the printer in the Default Printer field. Via
the Node Settings screen 1365, the administrator may further select
a primary video setting for the node from a Primary Setting
dropdown list 1366. The administrator may further select a
secondary video setting from a Secondary Setting dropdown list 1367
and, select an Apply Automask checkbox 1368 if an automask setting
is to be enabled.
[0261] The administrator is further able to add, modify and delete
a printer, e.g., a mavigraph printer, from a Mavigraph Printer List
screen (not shown). To access the Mavigraph Printer List screen,
via the System Administration tab 1300 (FIG. 13(c)), the
administrator may select the Mavigraph Settings configuration
sub-menu option 1326 initiating display of the Mavigraph Settings
List screen enabling an administrator to add, modify and delete a
mavigraph settings record. When a user accesses the Mavigraph
Printer List screen, a list of mavigraph printers is displayed
which may be further used to assign a default mavigraph printer to
a node in the Node Settings screen. To add a new mavigraph settings
record in the system, the Mavigraph Settings List screen is
accessed to select a new option which displays a Mavigraph Settings
screen (not shown) enabling user entry of new printer information
such as: the name of the mavigraph printer in the Mavigraph Name
field, the location of the mavigraph printer, and the facility to
which the mavigraph printer belongs from a Facility dropdown list.
An Active checkbox may be selected to make the printer available
for the clinical staff.
[0262] The administrator is further able to add, modify, and delete
video configuration settings, and configure mask settings that
define how information is displayed on the RGB monitor via a Video
Settings List screen. The user may preview the video settings on
the RGB monitor where the changes are automatically displayed. To
access the Video Settings List screen, via the System
Administration tab 1300 (FIG. 13(c)), the administrator may select
the Video Settings configuration sub-menu option 1328. Upon
selection of the Video Settings configuration option 1328, a Video
Settings List screen is displayed (not shown) enabling an
administrator to view the currently defined video settings, e.g.,
sorted alphabetically by name. The administrator may delete a video
configuration (provided it is not associated with a node) and may
further modify information by selecting a Details icon next to a
selected video setting to be modified. To add a new video settings
record, the Video Settings List screen is accessed to select a new
option which displays a Video Settings screen 1370 such as shown in
FIG. 13(g) enabling user entry of new video settings information
such as: a name to the video configuration in the Name field; a
video signal from the Video Signal dropdown list; and select an
Active checkbox to make the configuration settings available to
users. Further, via the Video Settings screen 1370, a user may
assign top, left, bottom, and right mask settings for live video,
thumbnail, and patient info in the Mask Settings section 1372.
[0263] The administrator is further able to edit, add, or create
mask settings for a specific video processor and chip-type
combination via an Auto Mask Settings screen. When the screen is
accessed, the defined auto mask settings, processor-type,
chip-type, and defined video settings, are displayed and sorted by
processor-type. It is understood that the combination of
processor-type and chip-type must be unique. To access the Auto
Mask settings screen, via the System Administration tab 1300 (FIG.
13(c)), the administrator may select the Auto Mask settings
configuration sub-menu option 1329. Upon selection of the Auto Mask
settings configuration option 1329, an Auto Mask settings screen
(not shown) is displayed enabling a user to view the currently
defined auto mask settings. Via this Auto Mask settings screen, an
administrator may delete an auto mask configuration and may further
modify information by selecting a Details icon next to a selected
auto mask setting to be modified. To add a new auto mask settings
record in the system, the Auto Mask settings screen is accessed to
select a new option which displays an Auto Mask Settings screen
1375 such as shown in FIG. 13(h) enabling a user define a new Auto
Mask Setting by selecting a Processor Type, Chip Type, and Video
Settings from respective Processor Type, Chip Type, and Video
Settings dropdown lists. It is understood that once defined, masks
are automatically selected by the system based on the scope or
processor being used.
[0264] As mentioned, a further function provided by the system is
the ability to customize certain aspects of how the application
functions. These functions include: the editing of Exam Type
information; the editing of information that defines a Report
Section; the maintenance of Report Sections included within the
Phases of Care for the application; the management of Report
Templates and of Document Types; the editing or creating of
templates for all documents; and, the maintenance of the system
Knowledge Base.
[0265] Thus, via the System Administration tab 1300 (FIG. 13(i)),
the administrator may access the Customization menu choice 1330
that causes for display the available customization sub-menu
options. Upon selection of the Exam Type sub-menu option 1331, an
Exam Type List screen (not shown) is displayed enabling a user to
view the currently defined exam types. From this screen, a user may
add, delete, and modify exam types, including, but not limited to:
Bronchoscopy, Colonoscopy, Esophagogastroduodenoscopy,
Esophagogastroduodenosopy/Colonoscopy,
Esophagogastroduodenosopy/Sigmoidoscopy, Cholangiopancreatography,
Endoscopy Retrograde, EGD/Sigmoidoscopy, Esophagoscopy,
Sigmoidoscopy, Ileoscopy, Liver Biopsy, Lower Endoscopy Ultra
Sound, Paracentesis, Enteroscopy, and, Upper Endoscopy Ultra Sound,
etc. Following each listed exam is an abbreviation, associated
department, and a Details icon. A current record may be deleted
unless it is an application default or if it is referenced
elsewhere. To add a new exam type record in the system, the Exam
Type List screen is accessed to select a new option which displays
an Exam Type screen 1380 such as shown in FIG. 13(i) enabling an
administrator entry of a new Exam type including information such
as: a name of the exam type in the Name field name; select a
department from the Department dropdown list; assign an
abbreviation to the exam type in the Abbreviation field; click New
next to Report Sections to add a new report section; select a
report section from the Section dropdown list; click New next to
the Default Medications to add a new medication including the entry
of the drug name, strength, unit, and the route of the medication.
As mentioned, an administrator is further able to add a Report
Section to or remove a report Section from an Exam Type, and,
include an optional default medication to the exam type record.
[0266] As mentioned, a further function provided by the system is
the ability to edit information that defines a Report Section and
maintain the Report Sections included within the Phases of Care for
the application. Thus, via the System Administration tab 1300 (FIG.
13(i)), the administrator may access the Report Sections menu
option 1332, a Report Sections List screen (not shown) is displayed
enabling a user to add, delete, and modify report sections types.
As described herein with respect to FIG. 10(f), report sections are
used to generate Procedure Notes for a specific exam type. When the
administrator creates a Procedure Note template, he/she may choose
to include a few or all the report sections in it, and further
assign these report sections to a phase of care and then use them
in the Lexicon screen as tabs to record data. The user may create,
modify, and delete report sections from the Report Section List
screen. To add a new report section record in the system database,
the Report Sections List screen is accessed to select a new option
which displays a Report Sections screen 1382 such as shown in FIG.
13(j) enabling an administrator entry of a new Report Sections type
including information such as: the name of the report section in
the Name field; a display order for the report section; and, click
the Active checkbox to make the report section available to
users.
[0267] As mentioned, a further function provided by the system is
the ability to edit manage the four phases of care namely,
Registration, Pre-Procedure, Procedure, and Post-Procedure. These
phases are illustrated as the Registration, Pre-Procedure,
Procedure, and Post Procedure tabs in the application. There are
specific report sections available that can be assigned to each
phase of care. These report sections are used to generate a
Procedure Note. As shown in FIG. 13(k), the Phase of Care function
is used to assign these report sections to a phase of care. These
report sections are viewed as tabs 898 in the Lexicon screen as
described herein with respect to FIG. 8(e) and FIG. 10(f), for
example. Thus, for example, the Lexicon screen of the Registration
tab includes the Introduction, Indications, and Code report
sections. Via the Phase of Care screen, the administrator may
configure the Lexicon screen of the Registration phase of care by
adding or removing a report section.
[0268] Thus, via the System Administration tab 1300 (FIG. 13(i)),
the administrator may access the Phase of Care customization
sub-menu option 1333 that causes the display of a Phase of Care
List screen (not shown) enabling an administrator to view the
currently defined phases of care. From this Phase of Care List
screen, an administrator may assign a report section record by
clicking a Details icon next to one of the phase of care records.
The Phase of Care screen 1383 such as shown in FIG. 13(k) is
displayed in response, enabling a user to select a report section
from the Default Report Section dropdown list, click the Report
Sections from the Available column 1376, assign or add the
necessary report section, and click the Right Arrow icon to add the
report section to the Assigned column 1377. In a like manner, the
administrator may un-assign a report section record via the Phase
of Care screen 1383 by clicking the Report Sections from the
Assigned column 1377 to remove it from a Phase of Care and click
the Left Arrow icon to remove the report section 1376 from the
Phase of Care.
[0269] As mentioned, a further function provided by the system is
the ability to manage Report Templates and of Document Types.
Document types are the categorization of different documents
required by clinical staff at different phases of care. These
documents are generated by using document templates in the
application. A list of document types predefined in the system,
include but are not limited to: an Appointment Letter, a Recall
Letter, a Pre-Discharge Instruction, a Pathology Request, a
Procedure Note, a Nurse Report, a Discharge Instruction, a Referral
Letter, a Billing Report and Pathology Labels.
[0270] Thus, via the System Administration tab 1300 (FIG. 13(i)),
the administrator may select the Document Types customization
sub-menu option 1334 that causes the display of a Document Type
List screen (not shown), enabling a user to view the currently
defined document types. From this Document Type List screen, a user
may: create/modify a document type; Assign the document to a Phase
of Care; and assign the document type to an exam type. Further, a
clinical staff member and/or a contact may be added as the document
recipient. To add a new document type record in the system
database, the Document Type List screen is accessed to select a new
option which displays a Document Type screen 1384 such as shown in
FIG. 13(1) enabling an administrator entry of a new Document Type
including information such as: a name for the document in a
Document Type Name field; and, a default number of copies desired
to be printed at the time of document distribution; and enable
system functions such as: the ability to enable assignment of a
Phase of Care to the document type; the ability to select a phase
of care from the Phase of Care dropdown list; the ability to add
another phase of care; the ability to add an Exam Type; the ability
to select an exam type from the Exam Type dropdown list; the
ability to add another exam type; the ability to add all the exam
types; the ability to add a Clinical Staff recipient (e.g., a
person such as referring, primary care physician, or nurse from the
Person dropdown list; and, the ability to add a Contact Recipient,
e.g., by selecting a category and person. By clicking the Active
checkbox the new document type is available for the staff.
[0271] As mentioned, a further function provided by the system is
the ability to manage Report Templates. For example, to create a
Procedure Note template for an exam type, a Report Template
function is provided via a Report Template Screen. Via the System
Administration tab 1300 (FIG. 13(i)), the administrator may select
the Report Template customization sub-menu option 1335 that causes
the display of a Select Procedure Note Template screen (not shown)
enabling a user to search for a procedure note template by
selecting an exam type, facility, or physician which generates for
display a list of Procedure note templates, based on the entered
search criteria. If no criteria were entered, all records would be
displayed. A New Procedure Note Template is generated via the
Select Procedure Note Template screen by selecting a New option
which causes for display a Procedure Note Template window 1386 such
as shown in FIG. 13(m). From this template window 1386, the
administrator may enter the name of the new Procedure Note in a
Name text field, and perform functions such as: selecting an exam
type from the Exam Type dropdown list; select either the Facility
Owner or Physician Owner radio button to choose an owner of the
procedure note template; and, select a Facility or Physician
depending on the previous choice. A blank Procedure Note Template
frame 1385 is additionally generated for display as shown in FIG.
13(m). From this interface, the administrator may select a report
section from the Report Section tab 1391 as shown in FIG. 13(m),
and click Insert button to insert the section in the template in
the right-hand pane 1392; and, further modify the text with the
text tools found in the right pane. These steps may be repeated to
create multiple sections in the new Procedure Note template. The
template record may then be saved in the database. It is understood
that a new version of an existing template may additionally be
created. Further, from the originally displayed Select Procedure
Note Template screen (not shown), the user may modify or delete a
procedure note template.
[0272] It is understood that the document template functionality
provided in the system may be used to generate document templates
for documents other than Procedure Notes. These documents include
pathology labels, recall letter, and letters of referrers. From a
Document Template Search screen (not shown), the administrator may
search for a document and create, modify, or delete a document.
Thus, via the System Administration tab 1300 (FIG. 13(i)), the
administrator may select the Document Template customization
sub-menu option 1336 that causes the display of a Document Template
search screen enabling an administrator to enter search criteria
such as such as document type, facility, and/or physician which
generates for display a list of document type templates based on
the entered search criteria.
[0273] A New document template is generated via the Select Document
Template screen by selecting a New option which causes for display
a Document Template window 1387, such as shown in FIG. 13(n). From
this template, the administrator may enter the following
information including, but not limited to: the Name in a text
field; and perform functions such as: select an exam type from the
Exam Type dropdown lists; select either the Facility Owner or
Physician Owner radio button to choose an owner of the document
template; and, select a Facility or Physician from the appropriate
dropdown list. A blank template may be additionally created.
[0274] The administrator may further select a report section from
the Report Section tab 1393 of the Document Template screen such as
the example Document Template screen 1389 as shown in FIG. 13(o),
click Insert button to insert the section in the template in the
right pane; and, further modify the text with the text tools found
in the right pane 1394. These steps may be repeated to create
multiple sections in the document template. The template record may
then be saved in the database, or create a new version of an
existing template. It is understood that, from the Document
Template Search screen (not shown) the user may modify or delete a
document template.
[0275] As mentioned, a further function provided by the system is
the ability to control user access to or within the application or
portions of the application. These security functions include: User
Maintenance--the ability to allow the creation and modification of
application user accounts; and, Role Maintenance--the ability to
allow the creation and modification of user roles. Thus, via the
System Administration tab 1300 (FIG. 14(a)), the administrator may
access the Security menu choice 1402 and select User security
sub-menu option 1404 that initiates the display of a User List
screen 1420, such as shown in FIG. 14(a) enabling an administrator
to query the database for an existing user record such by entering
search criteria, e.g., letters and wildcards. If no criteria is
entered, the pre-populated User List screen is displayed with
records displayed alphabetically by user ID.
[0276] To add a New User ID, the user must have been defined as a
clinical staff or contact before an ID is assigned to a user. A new
user record is generated via the User List screen 1404, by
selecting a New option which causes for display a User Maintenance
screen 1430 such as shown in FIG. 14(b). From this screen, the
administrator may enter a user ID in the User ID field, enter a
password in the Password field; and select a user type from the
User Type dropdown list. A user type can be either clinical staff
or contact. The Search icon may be selected to insert a user's full
name. If a contact is selected from the User Type dropdown list,
the Contact List window is displayed and likewise, if a clinical
staff is selected from the User Type dropdown list, the Clinical
Staff List window is displayed where a user may be searched and
selected. Alternatively, the name of the user may be entered in the
User Name field. Further information for the new user record
includes: the selection of a facility for the user from a Facility
dropdown list; selection of the Active checkbox to activate the
user; and, the selection of a Role to be assigned to the user. To
select a Role to be assigned, a department is selected from the
Department dropdown list and a role is selected from the Role
dropdown list. It is understood that, from the User List screen
1420 (FIG. 14(a)) the user may modify or deactivate a user record.
With respect to modification, changes may be made to required
fields except, for example, read-only fields, screen by searching
for a user and selecting a details icon 1422. Further, a role may
be assigned to a user, and further, an assigned user role may be
deleted by selecting a delete icon 1432 (FIG. 14(b)).
[0277] As mentioned, a further function provided by the system is
the ability to manage roles. Each user created in the system must
have an assigned role. Based on the role, a user would be able to
use specific functions of the system application.
[0278] Predefined roles may include, but are not limited to:
Administrator, All, BronchNurse, BronchPhysician, GINurse,
GIPhysician, and, Scheduler.
[0279] The Role Maintenance function allows the administrator to
create, copy, modify, and delete roles for the application. Any
role may be deleted that is not associated to a user and is not an
application-defined role. Each user is assigned one role; which is
associated with specific screens or functionality. The selected
role gives the user access to these specific screens. The role data
can be changed and saved while the role member is logged into the
system. Every role has access to the system Home tab 600 (FIG. 6).
The role maintenance function may be used to add a new tab record
by selecting a tab name from the dropdown lists and Default Tab
Page fields. These fields are mandatory and cannot be left blank if
this function is selected.
[0280] With respect to Role maintenance, via the System
Administration tab 1300 (FIG. 14(a)), the administrator may select
the Role security sub-menu option 1406 that causes the display of a
Role List screen 1440, such as shown in FIG. 14(c) enabling an
administrator to view the current roles, modify or delete existing
roles, and add a new role. A new user Role is generated via the
Role List screen 1440, by selecting a New option which causes for
display a Role Maintenance screen 1450 such as shown in FIG. 14(d).
From this screen, the administrator may enter a name in the Role
Name field and select a default tab page for the role from the
Default Tab Page dropdown list. Any tab that is not to be assigned
to the role may be deleted by clicking the Delete icon on the
appropriate line. The administrator may further select menu options
from the Available textbox to assign to the role, and add the
selected menu options in the Assigned textbox.
[0281] When the role maintenance function is accessed, the list of
roles is displayed as shown in FIG. 14(c). An existing record may
be modified as required. To modify an existing role record, the
Role List screen is accessed and a Details icon selected next to
the record to be modified. The Role Maintenance screen is displayed
enabling an administrator to locate the field requiring change and
enter a change or select the correct entry from the dropdown list,
add a new tab record, or select menu changes as necessary. A user
may further copy a record, all the tabs and menu options from a
previous role to a new role which requires the assignment of a name
to the role. An existing role record may be deleted from the
database via the Role List screen, as long as it is not associated
to a user and is not an application-defined role.
[0282] As mentioned, a further function provided by the system is
the ability to maintain the system application. Utilities used to
maintain the application a system log function to view and manage
the log of application errors and messages generated by the
application; an Activity Log function to manage the log of
application activity, a Mavigraph Queue function to manage the
print queue for a Mavigraph printer, and, a Discarded Notes
function to view a list of discarded Procedure Notes, and an Unlock
Function to unlock the locked functions of the application.
[0283] Thus, via the System Administration tab 1300 (FIG. 14(e)),
the administrator may access the Utilities menu choice 1502
providing the described system application functions as shown in
FIG. 14(e). Thus, with respect to managing the system log,
selecting the System Log utilities sub-menu option 1504 enables a
user to search for a system log record using date, facility name,
user id, and node name options and then view or delete the selected
log. With respect to managing the Mavigraph Queue function,
selecting the Mavigraph Printing Utilities sub-menu option 1506
enables generation of a Mavigraph Printing screen provided to allow
the user to manage the mavigraph printers available in the
facility, and particularly view all the mavigraph print queues and,
delete a mavigraph print queue job(s). With respect to managing the
Activity Log, selecting the Activity Log Utilities sub-menu option
1508 enables generation of an Activity Log screen provided to list
the records made when a user reads or writes information in the
application. These entries are stored with a date/time stamp, user
ID, menu name, page, and access (read or write) and may be viewed
or deleted. These entries also contain patient ID if there is a
patient in the context. With respect to the Discarded Notes
function, selecting the Discarded Notes Utilities sub-menu option
1510 enables generation of a Discarded Procedure Note screen
provided to enable viewing of discarded procedure notes, however,
prevents the deletion or editing of Procedure Note(s) listed in the
screen.
[0284] When a user closes the browser window instead of logging out
of the system, the last function used by the user gets locked. As
mentioned, the system provides unlock functions to unlock the
locked functions. There are three types of locks: 1) Exam related
lock: Exam related lock locks the image capture, vitals and
medication, nursing admin, equipment used, Lexicon, image manager,
and Procedure Note functions; 2) a Visit related lock: Visit
related lock locks contains the recovery function; and 3) Function
level lock: Function level locks lock contain the ICU
Synchronization, and the Knowledge Base maintenance functions. With
respect to Unlock Functions, selecting the Unlock Functions
Utilities sub-menu option 1512 enables generation of an Unlock
Functions screen providing a list of unlock functions from which a
user may select a function to unlock.
[0285] As mentioned, a further function provided by the system is
the ability to maintain the system equipment. Thus, inventory
functions are used to track items used during procedures. These
functions include: the maintenance of Scope Model, i.e., different
types of scopes; the maintenance of actual scope items; the
maintenance of different types of equipment items (i.e. equipment
and accessories).
[0286] The Scope Model Maintenance function allows the
administrator to view and manage different types of scopes used by
the application. The Scope Model Maintenance screen displays a list
of available scope models which are defined by category and used
for the following exam types: Bronchoscopy; EGD; Esophagoscopy;
Ileoscopy; ERCP; Enteroscopy; Sigmioidoscopy; Colonoscopy; and, EUS
(upper and lower).
[0287] Thus, via the System Administration tab 1300 (FIG. 14(f)),
the administrator may access the Equipment menu choice 1602
providing a display of available equipment options as shown in FIG.
14(f). Thus, with respect to managing Scope Models, the Scope Model
equipment sub-menu menu option 1604 is selected to display a Scope
Model List screen 1620 as shown in FIG. 14(f), from which a user
may select a Scope Model Record, and view, modify, edit or delete
it. To add a new Scope Model Record, a Scope Model data entry
screen is displayed in response to selecting a New button, that
enables entry of relevant scope data (e.g., a name, category and
channel size, and use for a particular Exam type) in a series of
fields and stored as a record in the database.
[0288] A Scope Item Maintenance screen may be further displayed
enabling an administrator to create, edit, and delete each of the
individual scope item entries. The application displays a list of
all scopes available to the user based on the input criteria. This
function allows the administrator to search for a scope item by
entering the scope model, name, serial number, and facility. To
access a Scope Item List, the administrator selects the Scope
equipment sub-menu option 1606, a Scope List screen 1625 is
accessed, as shown in FIG. 14(g), from which the administrator is
given the option to select the scope model in use (based on input
criteria) from a list of all active scope models. Models are listed
alphabetically by name and records in the list may be modified or
deleted. The administrator may further create a new scope record by
selecting the New button. This causes display of a Scope Item
screen 1630 as shown in FIG. 14(h), that includes blank fields for
entry of scope equipment data including: the Scope Model, serial
number of the Scope Model, the name of the scope in the Name field,
the facility, and optionally, the purchase date.
[0289] This equipment maintenance function also includes a repair
history record that provides details including, but not limited to:
the scope's repair date, by whom, a repair description, and the
cost of the repair. The administrator has the option to add,
modify, or delete the repair history record. To add a new repair
history record, a user first searches for a scope item or create a
new scope item record and navigates to display a Repair History
section as shown in FIG. 14(h). By selecting a New button, entry
fields are provided to enter the date of repair in the Date field,
enter the name of the company or person who repaired the scope item
in the Repaired By field, enter a brief description about the
repair in the Description field, and enter the cost of repair in
the Cost field. An existing scope item record may be further
modified or deleted from the database if it is not associated with
other database records via the Scope List screen.
[0290] As part of the scope maintenance function, the system
provides an accessory category function that allows the user to
view and manage different types of accessories that are used by the
application. The default accessory categories that are provided
with the application include, but are not limited to: Aspiration,
Electrosurgical Knife, Injection Needles, Biopsy Needles,
Endoscopic Mucosal Resection (EMR), Ligating Device, Biliary
Stents, ERCP Cannulae, Lithotriptors, Biopsy Forceps, Esophogeal
Stents, Liver Biopsy Device, Clip Fixing Device, EUS Probes, Metal
Stents, Coagulation Electrodes, Grasping Forceps, Microbiology
Brushes, Cytology Brushes, Guide Wire, Miscellaneous,
DilatingCatheter, Hemostasis Probes, Naso/Biliary Drains, Dilation
Balloons, Hot Biopsy Forceps, PEG/PEJ, Polypectomy Snares,
Retrieval Balloons, Retrieval Basket, Sphincterotomes, Spray
Catheters, and Suturing Device.
[0291] Thus, with respect to managing Accessories, via the System
Administration tab 1300 (FIG. 14(f)), the administrator may select
the Accessory Category equipment sub-menu option 1608 to display a
Accessory Category List screen (not shown) from which a user may
select and modify a current Accessory Category record, create a new
one, or delete the current record. After deletion of a current
Accessory Category record, the application returns to the list
function. The system further provides an optional function for the
entry of model information. The user further has the option to add
a new model or delete a model, as long as there are no accessory
records associated with that model.
[0292] Further functionality includes the ability to view and
manage the accessories used by the system via an Accessory List
screen (not shown) which is accessed by selecting the Accessories
equipment sub-menu option 1610 as shown in FIG. 14(f). From the
displayed Accessory List screen (not shown), the user may create,
modify, or delete an accessory entry and, further, has the option
to delete the current Accessory record as long as it has not been
associated with an examination; after deletion the application
displays the search function. When the Accessory List screen is
accessed, the defined accessory entries are displayed and may be
sorted by model and serial number, for example, in ascending order.
It is understood that the combination of model and serial number
must be unique. To add an accessory, the administrator selects a
New button from the Accessory List screen that initiates display of
an Accessory Maintenance data entry screen 1650, such as shown in
FIG. 14(i) via which the administrator may enter all pertinent
information relating to the new accessory item to be entered
including: a category of the accessory item from a Category
dropdown list, a facility for the item from a Facility dropdown
list, an item name in an Item Name field, and, other optional
information. An Active checkbox may be selected to make the item
available to the clinical staff.
[0293] As part of the equipment maintenance function, the system
further provides an equipment category function that allows the
user to view and manage different types of equipment used by the
application. The list of equipment categories (name and settings
type) predefined in the system include, but are not limited to:
Cryotherapy generators, Curvilineareus unit, Electrocautery device,
Electrosurgical generators, Fluorescence imaging unit, Fluoroscope,
Heat probe generators, and Laser devices.
[0294] Thus, via the System Administration tab 1300 (FIG. 14(f)),
the administrator may select the Equipment Category equipment
sub-menu menu option 1612 to display an Equipment Category List
screen (not shown) from which a user may edit, add, or create new
equipment category records. An optional function enables a user to
enter model information. If this optional function is used, the
fields shown as required are mandatory (e.g., model name) and are
not left blank. A checkbox may be further provided to indicate if
the model is reusable. The user may further have the option to add
a new model or delete a model, as long as there are no clinical
staff or equipment records associated with that model. To add an
equipment category, the administrator selects a New button from the
Equipment Category List screen that initiates display of an
Equipment Category data entry screen 1660, such as shown in FIG.
14(j) via which the administrator may enter all pertinent
information relating to the new equipment item to be entered
including: a name of the equipment, an Exam Type to associate the
equipment category with one or more exam types, and, other optional
information. An Active checkbox may be selected to make the
equipment item available to the clinical staff.
[0295] Further functionality includes the ability to view and
manage the equipment used by the application via an Equipment List
screen (not shown). Thus, via the System Administration tab 1300
(FIG. 14(f)), the administrator may select the Equipment sub-menu
menu option 1614 which causes display of the Equipment List screen
(not shown) from which the user may create, modify, or delete an
equipment entry. The user further has the option to delete the
current record as long as it has not been associated with an
examination. When the Equipment List screen is accessed, the
defined equipment entries are displayed and may be sorted by model
and serial number in ascending order. It is understood that the
combination of model and serial number must be unique. To add a new
equipment maintenance record, a user may access the Equipment List
screen, and in response to selecting a new button option, the
system generates an Equipment Maintenance screen (not shown) from
which the user may select a category from a Category dropdown list,
select a facility from a Facility dropdown-list, and, enter a
serial number of the equipment in the Serial Number field, and
enter other optional information.
[0296] Context Information
[0297] It is understood that, as a user navigates within the
application, certain contextual information (CI) is tracked. This
information is used as input to many of the system application's
functions. The CI consists of the following:
[0298] Department, User, Facility, Patient, Visit, and
Examination.
[0299] Thus, for example, "Department" information is set when a
user logs in to the application and is not changed until the user
logs out of the application. "User" information is additionally set
when a user logs in to the application, however, can be changed by
logging out of the application. "Facility" information is set when
a user logs in to the application based on the user's default
facility. The current facility is updated to reflect the facility
at which the visit is taking place once the user selects a visit
(or an examination within a visit).
[0300] "Patient" information is set when a user selects either a
patient using a Patient File function, a visit from Scheduled
Exams, or the Patient Summary, or an examination from Scheduled
Exams, Patient Summary, Pending Items, or New/Modify Visit. By
default, there is no patient in the CI when the user first logs in
to the application. If there is currently a patient in the CI and a
new patient is selected, the visit and examination information will
be cleared from the CI. System functions using the patient that is
currently in the CI, include but are not limited to: Patient
Summary, Patient Demographics, Patient Insurance Coverage, Medical
Alerts, Gastroenterology and Bronchoscopy, GI History, Pulmonary
History, Medication History, Social History, Family History,
Gastroenterology and Bronchoscopy, Unplanned Events Summary,
Related Tests and Labs Summary, and Other Patient Information. If
one of the previous functions requiring a patient in the CI is
accessed and there is no patient in the CI, the application
indicates that no patient has been selected. The user shall then be
redirected to the Patient Search function to select a patient.
[0301] "Visit" information is set when a user selects a visit for a
patient (Scheduled Exams, and Patient Summary) or saves a visit
from New/Modify Visit. When the visit is selected, the patient and
the visit itself will be placed into the CI. If there is currently
a visit selected, the examination information is cleared from the
CI. System functions using the visit that is currently in the CI
include, but are not limited to: Schedule Visit, Scheduler's
Medical Alert Questions, Patient Preparation Instructions,
Gastroenterology, Patient Preparation Instructions, Bronchoscopy,
Appointment Letter, Schedule Summary, Patient Assessment, Patient
Process, Physical Exam, Gastroenterology and Bronchoscopy, Related
Labs, Gastroenterology and Bronchoscopy, Related Tests, Prep
Status, Gastroenterology and Bronchoscopy, Vitals and Medications,
Consent Checklist, Physician Checks, Pre-Procedure Summary,
Recovery, Patient Survey. If one of the above functions requiring a
visit in the CI is accessed and there is no visit in the CI, the
application automatically indicates that no visit has been selected
and the user is redirected to the Scheduled Exams function to
select a visit.
[0302] Gateway Interfaces
[0303] As mentioned, in view of FIG. 1(a), the Endoworks.TM. system
is adaptable to interface to hospital systems, as well as other
external systems via dedicated gateway interfaces such as: Health
Level 7 (HL7), Digital Imaging and Communication in Medicine
(DICOM), and generic Extensible Markup Language (XML) Gateway
interfaces. Thus, system of the invention results in improved
administrative efficiency by supporting the flow of procedure
information between the hospital, performing physician, referring
physician, and patient through extensive integration capabilities
including: HL7 which is the standard that currently addresses the
interfaces among various systems that send or receive patient
admissions, registration, discharge or transfer (ADT) data,
queries, resources, patient schedules, orders, results, clinical
observations, billing information, medical records, referral, and
patient care; DICOM which provides a detailed specification
describing the means of formatting and exchanging image, reporting,
and patient information; and, XML which may be employed when data
is distributed between the EndoWorks.TM. system and other hospital
systems using industry standard XML formatting.
[0304] Further benefits provided by the EndoWorks.TM. system
include support for clinical-studies and research whereby a `study`
may be customized to capture specific patient- and exam-related
data over a period of time. Thus, the application supports
user-definable clinical research studies and provide a means of
compiling and publishing resultant data. Interfacility and
intrafacility studies are additionally possible. The application
permits customization of patient selection criteria, data
collection forms, study duration, and number of patients to include
in the study.
[0305] While there has been shown and described what is considered
to be preferred embodiments of the invention, it will, of course,
be understood that various modifications and changes in form or
detail could readily be made without departing from the spirit of
the invention. It is therefore intended that the invention be not
limited to the exact forms described and illustrated, but should be
constructed to cover all modifications that may fall within the
scope of the appended claims.
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