U.S. patent application number 12/553451 was filed with the patent office on 2011-03-03 for patient interactive healing environment.
This patent application is currently assigned to CERNER INNOVATION, INC.. Invention is credited to DANIEL P. COWAN, CHRISTOPHER M. RUFF.
Application Number | 20110054936 12/553451 |
Document ID | / |
Family ID | 43626180 |
Filed Date | 2011-03-03 |
United States Patent
Application |
20110054936 |
Kind Code |
A1 |
COWAN; DANIEL P. ; et
al. |
March 3, 2011 |
PATIENT INTERACTIVE HEALING ENVIRONMENT
Abstract
Systems, methods, and computer-readable media for providing an
interactive healing environment to a patient are provided. Servers
in a network may operate a set of modules to communicate with a
client device of the patient. The set of modules may operate to
enhance communication between the patient and the healthcare
providers of patient in the healthcare facility. The modules may
also interact with medical devices associated with the patient. The
medical devices may be connected to a component, such as a bus,
that receives data from the medical devices and determines where
the data should be sent.
Inventors: |
COWAN; DANIEL P.; (KANSAS
CITY, MO) ; RUFF; CHRISTOPHER M.; (OLATHE,
KS) |
Assignee: |
CERNER INNOVATION, INC.
OVERLAND PARK
KS
|
Family ID: |
43626180 |
Appl. No.: |
12/553451 |
Filed: |
September 3, 2009 |
Current U.S.
Class: |
705/3 ; 463/1;
705/2 |
Current CPC
Class: |
G16H 10/20 20180101;
H04L 67/18 20130101; G16H 10/60 20180101; H04L 67/42 20130101; G16H
40/20 20180101; G06F 16/9535 20190101; G06F 19/00 20130101; G06Q
10/06 20130101; G16H 40/67 20180101; G16H 10/65 20180101 |
Class at
Publication: |
705/3 ; 463/1;
705/2 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; A63F 13/00 20060101 A63F013/00 |
Claims
1. A system for providing an interactive healing environment to a
patient in a healthcare facility, comprising: one or more servers
operating in a private network wherein each server has a processor
coupled to a memory; the one or more servers operating a set of
modules to communicate with a client device of the patient wherein
the set of modules includes: an information module that provides a
set of information about the healthcare facility; a care team
module that provides the set of information about people who give
care to the patient in the healthcare facility; an education module
that provides at least one of a health education information, an
electronic document retrieval, and an interactive patient
education; a scheduling module that provides at least one of a
schedule for the patient and a task list for the patient; a health
records module that provides the patient access to at least one of
their personal care information and their personal health record;
and a treatment module that provides real-time information from one
or more medical devices associated with the patient; the one or
more servers retrieving data from the one or more medical devices
wherein the one or more medical devices operate to treat the
patient or operate to support the patient; and the client device
operating to provide an interactive interface between the patient
and the set of modules in the one or more servers.
2. The system of claim 1, further comprising the set of modules
includes at least one of: a television module that provides
television services; a gaming module that enables an interactive
gaming experience; a movie module that provides a first on-demand
selection of video content; a music module that provides a second
on-demand selection of audio content; and a menu module that
provides an access to food services and gift shops associated with
the healthcare facility.
3. The system of claim 2, further comprising the set of modules
includes a feedback module that solicits input from the patient to
correct and improve a stay of the patient in the healthcare
facility.
4. The system of claim 1, wherein the care team module is
associated with an indoor positioning system to track the physical
locations of people who give care to the patient in the healthcare
facility and wherein the care team module provides information such
as a name, a position and a picture of the healthcare giver, when
the healthcare giver enters a room of the patient.
5. The system of claim 1, wherein the education module monitors
when the patient has completed a health education information
learning activity.
6. The system of claim 4, wherein the health records module updates
an electronic medical record, associated with the patient, in the
healthcare recordkeeping system when the patient completes the
health education information learning activity.
7. The system of claim 1, wherein the feedback module solicits
feedback information from the patient regarding their treatment at
the healthcare facility, wherein the feedback information comprises
the response of the patient to one or more quality of care
surveys.
8. The system of claim 6, further comprising a notification
component that alerts a healthcare facility management team and the
healthcare provider when positive feedback information provided by
the patient falls below a predetermined threshold.
9. The system of claim 1, further comprising an environmental
module that allows the patient and the people who give care to the
patient to control the environmental conditions in a room of the
patient, wherein the environmental conditions include lighting and
temperature.
10. The system of claim 2, further comprising a parental control
module that limits a material accessed by the patient in the
television, gaming, movies and music modules.
11. One or more computer-readable storage media having
computer-executable instructions embodied thereon, that, when
executed perform a method for providing an interactive healing
environment to a patient, the method comprising: receiving an
identification of the patient; receiving the identification of one
or more medical devices; receiving the identification of a set of
healthcare services provided by a healthcare facility associating
the patient, the one or more medical devices, and the set of
healthcare services provided by a healthcare facility to one
another for a period of time determined by a treatment of the
patient in the healthcare facility; customizing a set of system
services that are accessed by the patient wherein the set of system
services enables the patient to interact with a set of modules that
include at least one of information module, a care team module, an
education module, a scheduling module, a health records module and
a treatment module; and providing the set of system services to a
client device wherein the patient retrieves and inputs information
by using the set of system services.
12. The computer-readable storage media of claim 11 wherein the set
of modules includes at least one of: a television module that
provides television services; a gaming module that enables an
interactive gaming experience; a movie module that provides a first
on-demand selection of video content; a music module that provides
a second on-demand selection of audio content; and a menu module
that provides an access to food services and gift shops associated
with the healthcare facility.
13. The computer-readable storage media of claim 11, further
comprising, maintaining an association of an identified patient and
the one or more medical devices until an occurrence of a
disassociation event, wherein the disassociation event includes one
or more of a disassociation by a clinician, an indication that the
one or more medical devices is offline, or an override caused by
the association of another patient to the one or more medical
devices.
14. The computer-readable storage media of claim 11, wherein one or
more of the identification of the patient, or the identification of
the one or more medical devices are received by scanning a barcode
that is associated with the patient, or the one or more medical
devices.
15. The computer-readable storage media of claim 11, wherein one or
more of the identification of the patient, or the identification of
the one or more medical devices are received by a user selection of
the patient identification, or one or more medical devices
identification found in an electronically searchable database that
contains a plurality of identifications.
16. The computer-readable storage media of claim 11, wherein the
care team module is associated with an indoor positioning system to
track the physical locations of people who give care to the patient
in the healthcare facility and wherein the care team module
provides information such as a name, position and a picture of a
healthcare giver, when the healthcare giver enters a patient
room.
17. The computer-readable storage media of claim 11, wherein the
education module monitors when the patient has completed a health
education information learning activity.
18. The computer-readable storage media of claim 11, further
comprising updating an electronic medical record associated with
the patient when the patient has completed a health education
information learning activity.
19. The computer-readable storage media of claim 11, wherein the
feedback module solicits feedback information from the patient
regarding their treatment at the healthcare facility, wherein the
feedback information comprises the response of the patient to one
or more quality of care surveys.
20. The computer-readable storage media of claim 19, further
comprising alerting a healthcare facility management team and the
people who give care to the patient when positive feedback
information provided by the patient falls below a predetermined
threshold.
21. One or more computer-storage media having computer-executable
instructions embodied thereon, that, when executed perform a method
for providing an interactive healing environment to a patient, the
method comprising: operating one or more servers in a private
network wherein each server has a processor coupled to a memory;
utilizing the one or more servers to operate a set of modules,
wherein the set of modules communicates with a client device of the
patient wherein the set of modules includes: an information module
that provides the set of information about the healthcare facility;
a care team module that provides a set of information about people
who give care to the patient in the healthcare facility; an
education module that provides at least one of a health education
information, an electronic document retrieval, and an interactive
patient education; a scheduling module that provides at least one
of a schedule for the patient and a task list for the patient; a
health records module that provides the patient access to their
personal care information and their personal health record; and a
treatment module that provides real-time information from one or
more medical devices associated with the patient; retrieving data
from the one or more medical devices wherein the one or more
medical devices operate to treat the patient or operate to support
the patient; storing the retrieved data on the one or more servers;
and utilizing the client device to provide an interactive interface
between the patient and the set of modules in the one or more
servers.
22. The computer-readable storage media of claim 21, further
comprising the set of modules includes a feedback module that
solicits input from the patient to correct and improve a stay of
the patient in the healthcare facility.
Description
BACKGROUND
[0001] Typically, a patient in a healthcare facility spends most of
their time confined to a bed without a complete understanding of
their care regimen or team of care providers. In many instances,
this lack of personal care information may reinforce patient
perceptions of helplessness and isolation during treatment at a
healthcare facility. The overall unawareness of what is to take
place during their stay at the healthcare facility can make
patients feel out of control and detached from the care they are
receiving. In-patient stays in clinical institutions can be
nerve-wracking experiences for many individuals and simple
knowledge about the patient's schedule, team of care providers, or
information regarding their health record can aid dramatically in
easing a patient's mind and reduce a patient's discontent with
in-patient stays. The patient hospital experience may be improved
by enhancing communication between the patient and the care team
and by empowering patients in the management of their
healthcare.
SUMMARY
[0002] This Summary is provided to introduce a selection of
concepts in a simplified form that are further described below in
the Detailed Description. This Summary is not intended to identify
key features or essential features of the claimed subject matter,
nor is it intended to be used as an aid in determining the scope of
the claimed subject matter. The present invention is defined by the
claims.
[0003] Embodiments of the present invention provide systems and
methods for providing an interactive healing environment to a
patient in a healthcare facility. Servers in a network may operate
a set of modules to communicate with a client device of the
patient. The set of modules may operate to enhance communication
between the patient and the people who give care to the patient in
the healthcare facility. Medical devices may be connected to a
component, such as a bus, that receives data from the medical
devices and determines where the data should be sent. This data may
be published by the bus, in one instance, to the patient's
electronic medical record, may be routed to a data store so that
the data can be archived and queried by a healthcare provider in
the future, and may also be retrieved by the operating the set of
modules and selectively presented to the patient by way of a client
device. Data may be continuously received from a particular medical
device during a period of time that the medical device is connected
to the bus, or a component therein. The client device of the
patient may operate to provide an interactive interface between the
patient and the set of modules in the servers.
[0004] More particularly, a first aspect of an embodiment of the
present invention is directed toward a system for providing an
interactive healing environment to a patient in a healthcare
facility. The system includes various components, including servers
operating in a private network, each server having a processor
coupled to a memory for operating a set of modules to communicate
with a client device of the patient. The set of modules includes an
information module that provides a set of information about the
healthcare facility; a care team module that provides a set of
information about people who give care to the patient in the
healthcare facility; and an education module that provides at least
one of a health education information, an electronic document
retrieval, and an interactive patient education. Further, the set
of modules includes a scheduling module that provides at least one
of a schedule for the patient and a task list for the patient; a
health records module that provides the patient access to at least
one of their personal care information and their personal health
record provider; and a treatment module that provides real-time
information from medical devices associated with the patient. The
medical devices operate to treat the patient or operate to support
the patient. The client device operates to provide an interactive
interface between the patient and the set of modules in the
servers.
[0005] In a second aspect, embodiments of the present invention
take the form of computer-readable storage media having
computer-executable instructions embodied thereon, that, when
executed perform a method for providing an interactive healing
environment to a patient. Initially, the method involves receiving
an identification of the patient, receiving an identification of
medical devices, and associating the patient, the medical devices,
and a set of healthcare services provided by a healthcare facility
to one another for a period of time determined by a treatment of
the patient in the healthcare facility. The method further includes
customizing a set of system services that are accessed by the
patient. The set of system services enables the patient to interact
with a set of modules that include at least one of an information
module, a care team module, an education module, a scheduling
module, a health records module and a treatment module. The set of
system services is provided to a client device. The patient
retrieves and inputs information by using the set of system
services.
[0006] A further aspect of an embodiment of the present invention
takes the form of computer-storage media having computer-executable
instructions embodied thereon, that, when executed perform a method
for providing an interactive healing environment to a patient The
method includes, operating servers in a private network. Each
server has a processor coupled to a memory. The servers operate a
set of modules. The set of modules communicates with a client
device of the patient. The set of modules includes an information
module that provides a set of information about the healthcare
facility; a care team module that provides a set of information
about people who give care to the patient in the healthcare
facility; an education module that provides at least one of a
health education information, an electronic document retrieval, and
an interactive patient education; a scheduling module that provides
at least one of a schedule for the patient and a task list for the
patient; a health records module that provides the patient access
to at least one of their personal care information and their
personal health record; and a treatment module that provides
real-time information from medical devices associated with the
patient. provider. The method further includes retrieving data from
medical devices. The medical devices operate to treat the patient
or operate to support the patient. The retrieved data is stored on
the servers. The client device is used to provide an interactive
interface between the patient and the set of modules in the
servers.
BRIEF DESCRIPTION OF THE DRAWINGS
[0007] Embodiments are described in detail below with reference to
the attached drawing figures, wherein:
[0008] FIG. 1 is a block diagram of an exemplary computing
environment suitable for use in implementing embodiments of the
present invention;
[0009] FIG. 2 is an exemplary system architecture suitable for use
in implementing embodiments of the present invention;
[0010] FIG. 3 is a block diagram of an exemplary system, according
to an embodiment of the present invention;
[0011] FIG. 4 is a block diagram of an exemplary system, according
to an embodiment of the present invention;
[0012] FIG. 5 is an illustrative flow diagram of a method for
providing an interactive healing environment to a patient in a
healthcare facility, in accordance with an embodiment of the
present invention; and
[0013] FIG. 6 is an illustrative flow diagram of a method for
providing an interactive healing environment to a patient in a
healthcare facility, in accordance with an embodiment of the
present invention.
DETAILED DESCRIPTION
[0014] The subject matter of the present invention is described
with specificity herein to meet statutory requirements. However,
the description itself is not intended to limit the scope of this
patent. Rather, the inventors have contemplated that the claimed
subject matter might also be embodied in other ways, to include
different steps or combinations of steps similar to the ones
described in this document, in conjunction with other present or
future technologies. Moreover, although the terms "step" and/or
"block" may be used herein to connote different elements of methods
employed, the terms should not be interpreted as implying any
particular order among or between various steps herein disclosed
unless and except when the order of individual steps is explicitly
described.
[0015] Embodiments of the present invention provide systems,
methods, and computer-readable media for, among other things,
providing an interactive healing environment to a patient in a
healthcare facility. Initially, a healthcare facility may be any
hospital, doctor's office or facility where patients are treated.
An interactive healing environment may include a combination of
hardware components and software applications that provide
comprehensive communication, education and entertainment for
patients within a healthcare facility.
[0016] Servers in a network may operate a set of modules to
communicate with a client device of the patient. The set of modules
may operate to enhance communication between the patient and a
healthcare provider. As used herein, the term "healthcare provider"
or "provider" refers to the people who provide healthcare services
to the patient in the healthcare facility. Healthcare providers may
include clinicians. Clinicians may include, but are not limited to,
a treating physician or physicians, specialists such as surgeons,
radiologists, cardiologists, and oncologists, emergency medical
technicians, physicians' assistants, nurse practitioners, nurses,
nurses' aides, pharmacists, dieticians, microbiologists, laboratory
experts, laboratory technologists, genetic counselors, researchers,
veterinarians, students, and the like.
[0017] Medical devices may be connected to a component, such as a
bus, that receives data from the medical devices and determines
where the data should be sent. A medical device may be any device,
stationary or otherwise, that may be used to treat a patient in a
hospital, doctor's office, etc. For exemplary purposes only and not
limitation, medical devices may include monitors, ventilators,
pumps (e.g., infusion pumps, balloon pumps), a patient's bed,
sequential compression devices, electronic security devices, and
the like. Some medical devices may be capable of being associated
with orders, such as a patient's bed (e.g., order compliance data
for a falls risk patient including head rails up and head angle of
the bed), and others may not, such as monitors, ventilators, etc.
Orders are typically given or made by clinicians who are authorized
to give such orders, and may vary depending on the patient, or by
type of device required, if any, to carry out a particular
order.
[0018] Initially, patients, medical devices, and orders for
healthcare services provided by the healthcare facility may be
identified in a number of ways, such as by scanning a barcode
corresponding to the patient, device, or order; entering some type
of identification corresponding to the patient, device; or order
into a computing device (e.g., PDA or other handheld computing
device), or searching an electronically searchable database that
contains a plurality of identifications corresponding to patients,
devices, and orders. Orders may be associated to patients, as
orders are typically made for a particular patient.
[0019] The data received from the one or more medical devices may
be published by the bus, in one instance, to the patient's
electronic medical record or may be routed to a data store so that
the data can be archived and queried by a healthcare provider in
the future. In various embodiments of the present invention, data
from various medical devices may be transferred or routed to a
patient's electronic medical record (EMR). As utilized herein, the
acronym "EMR" is not meant to be limiting, and may broadly refer to
any or all aspects of the patient's medical record rendered in a
digital format. Generally, the EMR is supported by systems
configured to co-ordinate the storage and retrieval of individual
records with the aid of computing devices. As such, a variety of
types of healthcare-related information may be stored and accessed
in this way. By way of example, the EMR may store one or more of
the following types of information: patient demographic; medical
history (e.g., examination and progress reports of health and
illnesses); medicine and allergy lists/immunization status;
laboratory test results, radiology images (e.g., X-rays, CTs, MRIs,
etc.); evidence-based recommendations for specific medical
conditions; a record of appointments and physician's notes; billing
records; and data received from an associated medical device.
Accordingly, systems that employ EMRs reduce medical errors,
increase physician efficiency, and reduce costs, as well as promote
standardization of healthcare.
[0020] The data may also be retrieved by the one or more severs
operating the set of modules and selectively presented to the
patient via the client device. Data may be continuously received
from a particular medical device during a period of time that the
medical device is connected to the bus, or a component therein. The
client device of the patient may operate to provide an interactive
interface between the patient and the set of modules in the one of
more servers.
[0021] Having briefly described embodiments of the present
invention, an exemplary operating environment suitable for use in
implementing embodiments of the present invention is described
below.
[0022] Referring to the drawings in general, and initially to FIG.
1 in particular, an exemplary computing system environment, for
instance, a medical information computing system environment, with
which embodiments of the present invention may be implemented is
illustrated and designated generally as reference numeral 20. It
will be understood and appreciated by those of ordinary skill in
the art that the illustrated medical information computing system
environment 20 is merely an example of one suitable computing
environment and is not intended to suggest any limitation as to the
scope of use or functionality of the invention. Neither should the
medical information computing system environment 20 be interpreted
as having any dependency or requirement relating to any single
component or combination of components illustrated therein.
[0023] The present invention may be operational with numerous other
general purpose or special purpose computing system environments or
configurations. Examples of well-known computing systems,
environments, and/or configurations that may be suitable for use
with the present invention include, by way of example only,
personal computers, server computers, hand-held or laptop devices,
multiprocessor systems, microprocessor-based systems, set top
boxes, programmable consumer electronics, network PCs,
minicomputers, mainframe computers, distributed computing
environments that include any of the above-mentioned systems or
devices, and the like.
[0024] The present invention may be described in the general
context of computer-executable instructions, such as program
modules, being executed by a computer. Generally, program modules
include, but are not limited to, routines, programs, objects,
components, and data structures that perform particular tasks or
implement particular abstract data types. The present invention may
also be practiced in distributed computing environments where tasks
are performed by remote processing devices that are linked through
a communications network. In a distributed computing environment,
program modules may be located in association with local and/or
remote computer storage media including, by way of example only,
memory storage devices.
[0025] With continued reference to FIG. 1, the exemplary medical
information computing system environment 20 includes a general
purpose computing device in the form of a control server 22.
Components of the control server 22 may include, without
limitation, a processing unit, internal system memory, and a
suitable system bus for coupling various system components,
including database cluster 24, with the control server 22. The
system bus may be any of several types of bus structures, including
a memory bus or memory controller, a peripheral bus, and a local
bus, using any of a variety of bus architectures. By way of
example, and not limitation, such architectures include Industry
Standard Architecture (ISA) bus, Micro Channel Architecture (MCA)
bus, Enhanced ISA (EISA) bus, Video Electronic Standards
Association (VESA) local bus, and Peripheral Component Interconnect
(PCI) bus, also known as Mezzanine bus.
[0026] The control server 22 typically includes therein, or has
access to, a variety of computer-readable media, for instance,
database cluster 24. Computer-readable media can be any available
media that may be accessed by server 22, and includes volatile and
nonvolatile media, as well as removable and non-removable media. By
way of example, and not limitation, computer-readable media may
include computer storage media and communication media. Computer
storage media may include, without limitation, volatile and
nonvolatile media, as well as removable and non-removable media
implemented in any method or technology for storage of information,
such as computer-readable instructions, data structures, program
modules, or other data. In this regard, computer storage media may
include, but is not limited to, RAM, ROM, EEPROM, flash memory or
other memory technology, CD-ROM, digital versatile disks (DVDs) or
other optical disk storage, magnetic cassettes, magnetic tape,
magnetic disk storage, or other magnetic storage device, or any
other medium which can be used to store the desired information and
which may be accessed by the control server 22. Communication media
typically embodies computer-readable instructions, data structures,
program modules, or other data in a modulated data signal, such as
a carrier wave or other transport mechanism, and may include any
information delivery media. As used herein, the term "modulated
data signal" refers to a signal that has one or more of its
attributes set or changed in such a manner as to encode information
in the signal. By way of example, and not limitation, communication
media includes wired media such as a wired network or direct-wired
connection, and wireless media such as acoustic, RF, infrared, and
other wireless media. Combinations of any of the above also may be
included within the scope of computer-readable media.
[0027] The computer storage media discussed above and illustrated
in FIG. 1, including database cluster 24, provide storage of
computer-readable instructions, data structures, program modules,
and other data for the control server 22.
[0028] The control server 22 may operate in a computer network 26
using logical connections to one or more remote computers 28.
Remote computers 28 may be located at a variety of locations in a
medical or research environment, for example, but not limited to,
clinical laboratories (e.g., molecular diagnostic laboratories),
hospitals and other inpatient settings, veterinary environments,
ambulatory settings, medical billing and financial offices,
hospital administration settings, home health care environments,
and clinicians' offices. The remote computers 28 may also be
physically located in non-traditional medical care environments so
that the entire health care community may be capable of integration
on the network. The remote computers 28 may be personal computers,
servers, routers, network PCs, peer devices, other common network
nodes, or the like, and may include some or all of the elements
described above in relation to the control server 22. The devices
can be personal digital assistants or other like devices.
[0029] Exemplary computer networks 26 may include, without
limitation, local area networks (LANs) and/or wide area networks
(WANs). Such networking environments are commonplace in offices,
enterprise-wide computer networks, intranets, and the Internet.
When utilized in a WAN networking environment, the control server
22 may include a modem or other means for establishing
communications over the WAN, such as the Internet. In a networked
environment, program modules or portions thereof may be stored in
association with the control server 22, the database cluster 24, or
any of the remote computers 28. For example, and not by way of
limitation, various application programs may reside on the memory
associated with any one or more of the remote computers 28. It will
be appreciated by those of ordinary skill in the art that the
network connections shown are exemplary and other means of
establishing a communications link between the computers (e.g.,
control server 22 and remote computers 28) may be utilized.
[0030] In operation, a clinician may enter commands and information
into the control server 22 or convey the commands and information
to the control server 22 via one or more of the remote computers 28
through input devices, such as a keyboard, a pointing device
(commonly referred to as a mouse), a trackball, or a touch pad.
Other input devices may include, without limitation, microphones,
satellite dishes, scanners, or the like. Commands and information
may also be sent directly from a remote healthcare device to the
control server 22. In addition to a monitor, the control server 22
and/or remote computers 28 may include other peripheral output
devices, such as speakers and a printer. Furthermore, remote
computer 28 may include an output to a client device 30, the client
device 30 may operate to provide an interactive interface between
the patient and the set of modules in the control server 22. As
used herein, the term client device refers to a computing device
that is accessibly by the in-patient, the family members and/or
friends of the in-patient and the like. The client device may
include a display device attached to it. Embodiments of the present
invention contemplate that information pertaining to the patient
may be views by individuals outside of the healthcare facility, for
instance, the information may be viewable by a family member at his
or her place of residence. Client device 30 may include a flat
panel monitor having an interactive touch screen located in
proximity to the patient and readily available to the patient and
the patient's family members/friends at all time. For example,
client device 30 may include a bedside unit that uses a touch
screen personal computer mounted on an articulating arm or a flat
screen television mounted on a footwall.
[0031] Although many other internal components of the control
server 22 and the remote computers 28 are not shown, those of
ordinary skill in the art will appreciate that such components and
their interconnection are well known. Accordingly, additional
details concerning the internal construction of the control server
22 and the remote computers 28 are not further disclosed
herein.
[0032] FIG. 2 is an exemplary system architecture 200 suitable for
use in implementing embodiments of the present invention.
Generally, the exemplary system architecture 200 advantageously
allows for communication with medical devices, for example, through
a bus or server, instead of communication directly with the medical
devices. A patient to device association may be initiated, and the
existence of a bus or server may assist in maintaining that
association until the occurrence of a disassociation event. If a
computing device, such as a PDA, for example, were to communicate
directly with a medical device, the relationship or association
between the patient and medical device may terminate when that
particular medical device is no longer being used for that
particular patient. There may be instances, however, when a
healthcare provider may want the association between that patient
and medical device to continue until the occurrence of some
disassociation event. In that case, a bus may assist in maintaining
and managing that relationship.
[0033] Initially, the exemplary system architecture 200 includes
device connectivity 210, device messaging services 212, and
application services 214. The device connectivity 210 includes one
or more medical devices that are connected to the device messaging
services 212 such that the devices may, at a later time, be
associated to a particular patient and/or an order. These devices
may include, but are not limited to monitors, cardiac ventilators,
balloon pumps, patient beds, infusion pumps, sequential compression
devices, electronic security devices, vital signs devices, or any
other device that a health care provider may use for a patient
while the patient is in the hospital. These devices are shown in
FIG. 2 as items 216, 218, 220, 222, 224, and 226.
[0034] Each medical device may communicate with the device
messaging services 212 in a different way. For example, some
devices, such as device 216, may utilize a device gateway 228. A
gateway is generally a device that connects networks or other
devices using different communications protocols so that
information can be easily passed from one to the other. A gateway
may both transfer information and convert it to a form compatible
with the protocols used by the receiving network. Here, the device
gateway assists in the transfer of data from the device 216 to the
device messaging services 212. As will be described in greater
detail below, an adapter, such as adapter 240 may be used in
instances where the device gateway 228, was provided by the device
manufacturer. The adapter 240 is typically used to facilitate
communication from a consumer to the gateway over the consumer's
protocol. It should be noted that an adapter may reside on or near
the device messaging services, or may reside near the actual device
or device gateway. In other instances, a device gateway may be a
third-party device gateway 230. In these instances, an adapter may
not be necessary, as the device messaging services 212 may already
know what type of messages to expect from that device 218 through
the third-party device gateway 230. Many different connection types
may be utilized between devices, gateway servers, and components of
the device messaging services 212, including, but not limited to,
HL7 TCP/IP, a software development kit (SDK), RS 232, etc.
[0035] Other devices, such as device 220, may have an internal
gateway or other component such that a gateway like 228 or 230
would not be needed. These devices may have all of the required
capability built into it, and, if necessary, may even have their
own adapters incorporated therein such that a separate adapter
would not be necessary. Still other devices, such as devices 222,
224, and 226, may be legacy devices that are older and don't have
networking built-ins. For example, it may not be possible to plug
in a CAT 5 network to the legacy devices, the devices may not have
wireless networking capabilities, etc. A serial port may be the
only connection mechanism that exists on these devices. For these
devices, a connectivity engine 238 and device adapters 232, 234,
and 236 may be used. The device adapter is a hardware device that
is affixed directly onto the medical device, and acts as the sole
source of identification and connection to the connectivity engine
238. Device adapters 232, 234, and 236 are configurable with device
specific information including, but not limited to, manufacturer,
device name, device model, port settings, and the like. Device
adapters 232, 234, and 236 may use various connection mechanisms to
connect to the connectivity engine 238 including, but not limited
to, Universal Serial Bus (USB) or Personal Area Network (PAN). The
connectivity engine 238 is a piece of hardware that may be
connected to devices 222, 224, and 226 either wirelessly or via a
wired connection. Even if there is a wired connection between the
connectivity engine 238 and a device, there may still be a wireless
connection over a wireless network between the connectivity engine
238 and the device messaging services 212.
[0036] The connectivity engine 238 may also assist in detecting
types of devices so that the appropriate driver may be loaded,
which may be based on the make and model of the particular device.
The connectivity engine 238 may be located on the device messaging
services 212 or as part of the device subsystems 210, as
illustrated in FIG. 2. The device messaging services 212 or a
component thereof may communicate with the connectivity engine 238
to establish a connection to the device itself. In one embodiment,
the connectivity engine 238 may be physically present in a
patient's room so that when a new device, such as a legacy device,
is brought into that room, it may be connected to the connectivity
engine 238 if needed. At that time, a connect event may occur, and
the device messaging services 212 may broadcast the connect event
to other components who may need to know.
[0037] The medical devices, either directly or indirectly through a
gateway, connectivity engine, or other component are connected to
the device messaging services 212. The device messaging services
212, in some embodiments, may generally include one or more
adapters 240, one or more bus hosts, such as bus hosts 242 and 244,
a main bus 246, a device lifecycle 248, a driver library 250, and a
device message routing 252. As previously described, an adapter may
be used when the device gateway, such as device gateway 228, is
provided by the manufacturer of a device, for example. The adapter
240 assists to facilitate communication from a consumer to the
gateway over the consumer's protocol. While one adapter 240 is
illustrated in FIG. 2, it is contemplated to be within the scope of
the present invention that more than one adapter 240 may be used.
In one embodiment, one adapter 240 may be used for more than one
medical device, but in another embodiment, each medical device
requiring an adapter may require a separate adapter. Further, the
adapter 240 may be used to communicate data from the device
messaging services 212 to healthcare service providers 254. In
these cases, the data may not be transferred through any system
services or applications, but may be transferred directly to other
healthcare service providers 254. Typically, an inbound and
outbound adapter would be provided to transform messages to and
from a standard format and protocol, such as HL7.
[0038] A bus host, such as bus host 242 or 244 may be used to
perform several functions, including, but not limited to, detecting
hardware that is plugged in or directly connected to the host,
loading appropriate device drivers after the device has been
identified, dynamically locating and installing drivers if the
driver is not currently present on the host, and for unloading the
device driver after the device has been disconnected. A bus host
may not be utilized for each and every medical device, but may be
used for some that don't have device adapters, for example, which
perform many of the functions listed above. The embodiment of FIG.
2, for example, has a bus host for devices 216, 218, and 220, which
are not shown as having device adapters, such as device adapters
232, 234, and 236, nor do they require use of the connectivity
engine 238. In addition to the above described functionality of the
bus hosts 242 and 244, they may also allow for communication to the
device to get various types of information to and from the device.
This information may be, for example, determining whether the bed
rails are up or down, or even determining the patient's weight when
the patient is sitting or lying on the bed.
[0039] The main bus 246 provides connection framework, as it may
create and manage all connections to the device messaging services
212. The main bus 246 also provides messaging architecture for the
device messaging services 212. The main functionality of the main
bus 246 includes providing general operational and management
capabilities for connected devices, which may vary depending on the
system service that is subscribing or requesting the data from the
devices.
[0040] A device lifecycle 248 may detect the presence of a device
on the main bus 246. The device lifecycle 248 also may maintain an
accurate directory of currently connected medical devices to the
main bus 246 as various medical devices become connected. Further,
it may ensure "active" connectivity of a medical device to the main
bus 246 via a device heartbeat. A heartbeat is an indication given
at a certain interval of time that a particular medical device is
connected to the main bus 246. This interval may vary, and may be
regular, such as every 20 seconds, for example. Additionally, the
interval may depend on each medical device. As a medical device
deregisters, or becomes unconnected to the main bus 246, the device
lifecycle 248 may be responsible for sending out a notice of a
disconnect event, and will then stop sending that device's
heartbeat out to certain components that require that information.
There are various phases of the device lifecycle 248, which may
include, in one embodiment, a notification phase that notifies of
an event generated at the device connection and of a device
connected as directly to the main bus 246; an interrogation phase;
an identification phase that identifies the vendor, make, model,
etc. of each medical device and that finds and downloads the
appropriate driver when necessary; an activation phase that loads
the device driver and registers the medical devices; and an
execution phase that is responsible for tracking the medical
devices' heartbeats and gathers and transmits data to and from the
medical devices.
[0041] A driver library 250 may store a plurality of drivers that
may be used and installed on particular devices, when required.
Further, a device message routing component 252 handles routing
messages from source to destination across the device messaging
services 212. Messages may take on a variety of forms, and may
contain vastly different types of content. Various types of
messaging may include request and reply messaging, publish and
subscribe messaging, and asynchronous one-way messaging. Request
and reply messaging includes taking a message from a source,
routing it to a single destination, and routing a reply message
from the destination back to the original source. Publish and
subscribe messaging involves a publisher sending messages out on a
named topic, which may be received by multiple subscribers.
Asynchronous one-way messaging includes doing requests and reply
messaging without needing to receive a reply. The only receipt
message may be an indication that the message was successfully
sent.
[0042] With continued reference to FIG. 2, application services 214
includes various components, including healthcare service providers
254, a database 256, system services 260, and an application 268.
The system services 260 may consume some or all of the information
that the main bus 246 provides. In some instances, the system
services 260 may be application programming interfaces (APIs),
which may support requests made by computer programs, such as
applications. For instance, the system services 260 may use the
main bus 246 to determine where a connected device is located. The
application services 214 may include various components that may
all utilize information sent by the main bus 246. These may
include, for example, an aggregation component 262, a data store
264, and a patient to device association 266, which is further
discussed herein. The aggregation component 262 allows for a user
to query a patient by a patient identification over a large number
of patient identifications. Once a match is found, information
relating to that patient, such as devices that the patient is
associated with, may be retrieved. The data store 264 stores data
that is published by the medical devices.
[0043] In various embodiments of the present invention, the system
services 260 run on the main bus 246, and thus together with the
main bus 246, may provide additional functionality to the system as
a whole. For example, when various system services 260 run on the
main bus 246, the main bus 246 may store discrete data posts, such
as heart rate, systolic blood pressure, diastolic blood pressure,
etc., in a data store, such as data store 264, for historical
queries and archiving. Further, the main bus 246 may chart acquired
discrete data into a patient's EMR; publish medical device
outcomes, such as lab results and other test results, to a
patient's EMR; and publish digital media from a device into a
patient's EMR, publish infusion data, if required, and infusion
events (e.g., infusion rate, volume infused, volume to be infused,
rate change, begin bag, end bag) into a patient's EMR.
[0044] The application 268 works with the system services 260 to
facilitate specific functionality, such as a patient to device
association. The application 268, in one embodiment, may be a user
interface. For example the user interfaces may be screen shots of
associating a patient to a device, or to an order, or screen shots
of associating a patient with a particular healthcare provider.
While one application 268 is illustrated in FIG. 2, more than one
application is considered to be well within the scope of the
present invention. The system services 260 and the application 268
are incorporated such that the system services 260 retrieve raw
data from the main bus 246 and other components, while the
application 268 uses that information and presents it to a user
through a user interface.
[0045] While only a main bus 246 is illustrated in FIG. 2, more
than one bus may be used in implementing embodiments of the present
invention. By way of example only and not limitation, the main bus
246 may be a first bus that is responsible for managing all of the
medical devices. This main bus 246 may be located at the facility,
such as a hospital. One or more local busses may be present that
can store and facilitate the transfer of information from one or
more medical devices, and that transfer that information to the
main bus 246. The main bus 246 may not even be aware that there are
local busses, as the local busses may just be proxying messages
that they receive from the medical devices. Local busses may also
be present at the facility (e.g., hospital), but may be physically
located in a patient's room, for example, such as on a cart where
an associated medical device is located. In one embodiment of the
present invention, more than one main bus 246 may be available to
provide a backup system. One main bus may be a primary node, and
the other may be a secondary node. If one node goes down, the
secondary node may be utilized. Additionally, the nodes or busses
may be used in conjunction with one another such that each has
certain responsibility, for example.
[0046] The database 256, in one embodiment, may be sent patient,
medical device, and order association information. For instance,
identification of a patient and medical device that have been
associated may be sent to the database 256. Any data that it
released by the medical device may also be routed to the database
256 so that this information can be stored in a flowsheet, for
example. A clinician may then make the decision as to what to do
with the data. For example, the clinician may decide that certain
data points should be included in the patient's chart, and the
others may be completely deleted from the database 256. A specific
example of this may be when a clinician looks at data in the
database 256 that is associated with a certain patient. The data
may include values at different times, such as 12:00 PM, 12:15 PM,
and 12:30 PM. The clinician may not wish for all of these values to
be entered into the patient's chart, but may choose, for example,
just the 12:00 PM and 12:30 PM entries to officially document.
Additionally, having this information in the database 256 allows
for a higher accuracy. In one instance, a clinician may write down
in a patient's chart that an infusion pump began at 12:10 PM, when
it actually started at 12:06 PM. Having this information in the
database 256 allows for the clinician to officially document
accurate start and end times, as well as other values whose
accuracy is important to the patient's health.
[0047] As previously discussed, various healthcare service
providers 254 may wish to receive data or information regarding a
particular medical device or patient. In this case, the adapters
240 may be configured to send this information via an HL7 or ASTM
connection, for example, to the healthcare service providers 254.
In one embodiment, the system services 260 may communicate with
various healthcare service providers 254, and this communication
takes place via the main bus 246.
[0048] Turning now to FIG. 3, a block diagram of an exemplary
system is shown, in accordance with an embodiment of the present
invention, designated generally as reference numeral 300. System
300 includes a server 310, a network 312, a client device 314 and a
database 316. Server 310 includes and may operate a set of modules,
318, 320, 322, 324, 326, 328 and 330. Server 310 may communicate
with client device 314 by way of network 312 to provide interactive
in-patient experience. Server 310 may retrieve data via network 312
from database 316. Database 316 may include data received from one
or more medical devices, data published by the bus, and data
transferred from a patient's electronic medical record (EMR).
[0049] The set of modules 318, 320, 322, 324, 326, 328 and 330 may
communicate with client device 314 to present via a user interface
various forms of information to the patient. Server 310 may include
an information module 318, for providing the patient or the
patient's family with information about the healthcare facility.
For instance, information module 318 may provide information such
as the mission statement of the healthcare facility, a welcome
video, and provide of list of amenities available to patient.
Information module 318 may also provide maps and other directional
information to enable patients to find their way around the
healthcare facility. Additionally, the information module 318 may
provide patients with information about the geographical area
surrounding the healthcare facility, such as local events and
venues for food and lodging.
[0050] Care team module 320 may provide the patient or the
patient's family with information about the people designated to
care for the patient throughout their stay at the healthcare
facility. For example, care team module 320 may provide information
such as the name, position, picture and personal and professional
biography of the healthcare providers that interact with the
patient during their hospital stay. When a patient is admitted,
discharged or transferred within the healthcare facility, the care
team module may initiate a servlet to obtain information about the
healthcare providers associated with the admission, discharge or
transfer of the patient. Alternatively, the care team module may
automatically associate a healthcare provider to the care team of
all patient or allow manual association of a healthcare provider to
a patient. The care team module may also facilitate the creation
and updating of healthcare provider profiles containing the
healthcare providers information. In one example, the care team
module may associate a particular healthcare provider with the care
team of a patient when the healthcare provider accesses the
patient's medical chart in the EMR. The care team module 320 may
also be associated with an indoor positioning system to track the
physical locations of the patient's healthcare providers.
Additionally, care team module 320 in association with the indoor
positioning system may enable a patient to request biography
information about a healthcare provider based on a healthcare
provider's name or picture and may provide information such as a
name, a position and a picture of the healthcare provider, when the
healthcare provider enters a patient's room.
[0051] Education module 322 may provide the patient with health
education information. For instance, education module 322 may
enable a patient to retrieve electronic documents related to their
illness or course of treatment. Alternatively, education module 322
may provide interactive education tutorials for the patient.
Additionally, education module 322 may allow a patient post
questions in response the retrieved electronic documents or
interactive tutorials, and alert a member of the patient's
healthcare team about the patient's concerns. The education module
may also keep track of when a patient has competed a health
education information learning activity such as retrieving an
electronic document or completing an interactive tutorial.
[0052] Scheduling module 324 may provide patients with a
representation of their specific events and/or a task list for the
day. The events populated on the patient's schedule may include
scheduled test, standard food service times, chapel services and
hospital events. In addition to the schedules events, scheduling
module 324 may provide the patient with a patient-specific task
list. For example, the task list may include instructions for the
patient related to their treatment or education such as designated
patient education tutorials and required or recommended
exercises.
[0053] Health records module 326 may enable a patient to access
information regarding their personal care. For example, module 326
may enable patient to access portions of their Personal Health
Record and update pertinent information. Module 326 may access the
healthcare facility's records keeping system and determine via
parameters set by a healthcare provider, the portions of a
patient's EMR accessible by a patient. The heath records module 326
may also allow the patient to edit select portions of their EMR.
For example health records module 326 may enable a patient to
update information relating to allergies or update emergency
contact information. Additionally, the health records module 326
may allow a patient to communicate with their physician or member
of their care team.
[0054] Treatment module 328 may provide real-time information from
medical devices associated with the patient. Treatment module 328
may retrieve the information from a bus associated with the medical
devices or from data published from the devices to database 316.
The bus associated with treatment module 328 may be similar to the
bus previously described with reference to FIG. 2.
[0055] Feedback module 330 may allow patients to provide real-time
opinion information regarding their stay at the healthcare
facility. The feedback module 330 may solicit input from the
patient via quality of care surveys. Module 330 may include instant
feedback notices to allow the healthcare providers and healthcare
facility to take immediate action regarding an issue and work to
improve the overall patient experience. The notification component
of the feedback module may include an escalation and relay measure,
which alerts the healthcare providers when the results of a patient
feedback survey fall below a satisfactory level. The feedback
module 330 allows the management of the healthcare facility to
target specific areas for feedback regarding new protocols or
processes. Feedback module 330 may eliminate the delays often
associated with standard written survey results.
[0056] Referring now to FIG. 4, a block diagram of an exemplary
system, according to an embodiment of the present invention is
illustrated and designated generally as reference numeral 400.
System 400 includes a server 410, a network 412, a client device
414 and a database 416. Server 410 includes and may operate a set
of modules, 418, 420, 422, 424, 426, 428, 430, 432, 434, 436, 438,
440, and 442. Server 410 may communicate with client device 414 by
way of network 412 to provide interactive in-patient experience.
Server 410 may retrieve data via network 412 from database 416.
Database 416 may include data received from one or more medical
devices, data published by the bus, and data transferred from a
patient's electronic medical record (EMR).
[0057] As previously described in relation to FIG. 3, the set of
modules may include an information module 418, a care team module
420, an education module 422, a scheduling module 424, a health
records module 426, a treatment module 428 and a feedback module
430. The set of modules may also include an environmental module
432. Environmental module 432 may allow the patient, a care
provider or the family members and/or friends of the patient to
control the environmental conditions of the patient's room. For
instance, the environmental module 432 may enable a patient to
adjust the lighting setting in a room. Alternately, module 422 may
allow a patient to control the temperature of his or her room.
[0058] The set of modules may also include a television module 434,
a gaming module 436, a movie module 438, a music module 440 and a
menu module 442. The television module 434 may provide television
services to the patient. For example the television module may
facilitate a patient's ability to pause/rewind or record live
television. Additionally, a healthcare provider and/or a parent of
a patient may control via module 434 the times when television
services are available to the patient and the type of programming
accessible by the patient.
[0059] The gaming module 436 may provide an interactive gaming
experience for the patient. For example, the module 436 may
facilitate gaming though externally connected gaming systems of
built-in computer based games. The movie module 438 may provide
movies to the patient. The module 438 may provide the movies upon
the demand of the patient. As with the television module 434 a
healthcare provider and/or a parent of a patient may control via
module 438 the times when movies are available to the patient and
the type of movie content accessible by the patient.
[0060] The music module 440 may provide music upon the demand of
the patient. The module 440 may provide a music library that can be
accessed via the client device 414. Care providers may control via
the music module 440 the time when the patient is allowed to access
the music content. For instance, patient's may be prohibited from
accessing music content during scheduled quiet periods.
[0061] The menu module 442 may provide patients with access to the
food service system of the healthcare facility as well as the
restaurants of the healthcare facility. The menu module may also
provide access to the gift shops associated with the healthcare
facility.
[0062] FIG. 5 is an illustrative flow diagram 500 is shown of a
method for providing an interactive healing environment to a
patient, in accordance with an embodiment of the present invention.
Initially, an identification of a patient is received at step 510.
A patient's identification may be received in one of many ways. For
exemplary purposes only and not limitation, a patient may be
identified by scanning a barcode located on or near the patient.
Alternatively, an identification corresponding to the patient
(e.g., identification number, patient's name) may be entered into a
computer device, such as a PDA or some other type of portable
computing device). In one aspect of the present invention, a
database containing a plurality of patient identifications may be
searched by a user to locate a particular patient. The database may
contain only those patients located in a certain portion of a
hospital, or may contain a broader range of patients, such as any
that have been checked into the hospital, for example. Further, the
database, in one embodiment, is an electronically searchable
database.
[0063] At step 520, an identification of a medical device is
received. Medical device identification may be received in the same
way as patient identifications, as outlined above. For example, a
barcode associated with the device may be scanned, identification
information for the device may be entered into a computing device,
a device may be searched for in a database, or the like. At step
530, an identification of a set of healthcare services provided by
a healthcare facility is received. The set of healthcare services
may relate to the in-patient's treatment, and may include
diagnostic tests, and therapies that are patient specific.
Identification of the patient specific healthcare services may be
received in the same way as patient identifications, as outlined
above. For example, a barcode associated with a particular
healthcare service may be scanned, identification information for
the healthcare service may be entered into a computing device, a
healthcare service may be searched for in a database, or the
like.
[0064] In response to receiving the identifications of the patient,
the medical devices, and the healthcare facility service, the
patient, medical device and healthcare service may be associated to
one another at step 540. Once an association has been formed
between the patient, the medical device, and the healthcare
service, data from the medical device may be continuously routed to
a data store, where associations and related data are stored. At
step 550, the association or the patient, the medical device and
the healthcare service is maintained until the occurrence of a
dissociation event. While the association is maintained, as
previously mentioned, data from the medical device may be
continuously routed and saved in a data store, such as, for
example, data store 264 in FIG. 2. Data routed from the medical
devices to the data store may be routed by a bus, such as main bus
246, also in FIG. 2.
[0065] In one embodiment, a disassociation event may occur by a
clinician disassociating the device from a patient (e.g., selecting
the device by scanning it or selecting the checkbox, and selecting
a disassociate button on a screen display). This may also be done
by the selection of a patient and a device (e.g., selected by
scanning a barcode or selecting a checkbox), followed by a
clinician selecting a disassociate button on a screen display.
Alternatively, more than one device may be disassociated at the
same time. As previously described, a select all button may be
available if it is desired that all of the devices be selected.
[0066] In another embodiment, an indication may be received that a
device that is currently associated to a patient has gone offline.
As used herein the term, "online" indicates a state of connectivity
between a device and a patient, while "offline" indicates a
disconnected state between a device and the patient. One mechanism
for determining whether a device is online or offline is a device
heartbeat, which is described in relation to FIG. 2. A device
heartbeat is a message sent from the device to device messaging
services 212 in FIG. 2, for example, that indicates that the device
is online. If this device heartbeat is not received for a certain,
and perhaps predetermined period of time, it may be determined that
the device is offline.
[0067] In yet another embodiment, a user (e.g., clinician) may
choose to override an existing association between another patient
and a medical device so that a new patient is associated with the
device. If the user chooses to override the existing association,
that association will be terminated in favor of a new association
with a new patient.
[0068] At step 560, the set of system services that are accessed by
the patient are customized. The set of system services enable the
patient to interact with a set of modules. As described in relation
to FIGS. 3 and 4, the set of modules may include an information
module, a care team module, an education module, a scheduling
module, a health records module, a treatment module, and a feedback
module. In response to customizing the set of system services
accessible by the patient, the set of system services is provided
to a client device at step 570. The client device enables the
patient to retrieve and/or input information by using the set of
customized system services interacting with the set of modules of
the control server 22.
[0069] Turning to FIG. 6, an illustrative flow diagram 600 is shown
of a method for providing an interactive healing environment to a
patient, in accordance with an embodiment of the present invention.
Initially, a control sever (not shown) is operated in a private
network at step 610. At step 620, the control server is utilized to
operate a set of modules. As described in relation to FIGS. 3 and
4, the set of modules may include an information module, a care
team module, an education module, a scheduling module, a health
records module, a treatment module, and a feedback module. At step
630, the control server communicates with a client device of the
patient. The client device enables the patient to retrieve and/or
input information by using the set of customized system services
interacting with the set of modules of the control server 22. At
step 640, the control server retrieves data from one or more
medical devices. As previously describe, the medical devices may be
used to treat or support the patient and may be associated with the
patient via a bus as described in relation to FIG. 2. At step 650
the retrieved data is stored on the control server. The control
server then utilizes the client device to provide an interactive
interface between the patient an the set of modules of the control
server, at step 660.
[0070] It will be understood that certain features and
sub-combinations of utility may be employed without reference to
features and sub-combinations and are contemplated within the scope
of the claims. Furthermore, the steps performed need not be
performed in the order described.
* * * * *