U.S. patent application number 12/897113 was filed with the patent office on 2011-12-08 for heart failure monitor quicklook summary for patient management systems.
This patent application is currently assigned to Medtronic, Inc.. Invention is credited to Tom Dean Bennett, James D. Webb.
Application Number | 20110301445 12/897113 |
Document ID | / |
Family ID | 30001155 |
Filed Date | 2011-12-08 |
United States Patent
Application |
20110301445 |
Kind Code |
A9 |
Webb; James D. ; et
al. |
December 8, 2011 |
HEART FAILURE MONITOR QUICKLOOK SUMMARY FOR PATIENT MANAGEMENT
SYSTEMS
Abstract
Continuous remote monitoring of patients based on data obtained
from an implantable hemodynamic monitor provides an interactive
patient management system. Using network systems, patients are
remotely monitored to continuously diagnose and treat heart-failure
conditions. A screen displayable summary provides continuous
feedback and information to physicians, patients and authorized
third parties. The quick look summary includes various sites and
presentation tailored to match the patients' and physicians' needs.
The quick look summary further includes intelligent features that
understand and retain the user's interests, preferences and use
patterns. Patients, physicians and other caregivers are seamlessly
connected to monitor and serve the chronic needs of heart-failure
patients in a reliable and economic manner.
Inventors: |
Webb; James D.; (Maple
Grove, MN) ; Bennett; Tom Dean; (Shoreview,
MN) |
Assignee: |
Medtronic, Inc.
|
Prior
Publication: |
|
Document Identifier |
Publication Date |
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US 20110021897 A1 |
January 27, 2011 |
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|
Family ID: |
30001155 |
Appl. No.: |
12/897113 |
Filed: |
October 4, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10612856 |
Jul 3, 2003 |
7831301 |
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12897113 |
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09809915 |
Mar 16, 2001 |
6599250 |
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10612856 |
|
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60190272 |
Mar 17, 2000 |
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Current U.S.
Class: |
600/364 ;
600/485; 600/508 |
Current CPC
Class: |
A61B 5/0031 20130101;
A61B 5/02055 20130101; A61B 5/02158 20130101 |
Class at
Publication: |
600/364 ;
600/508; 600/485 |
International
Class: |
A61B 5/021 20060101
A61B005/021; A61B 5/145 20060101 A61B005/145; A61B 5/02 20060101
A61B005/02 |
Claims
1. A heart failure monitor including a quick look summary
implemented in a network having a web browser and portal interfaces
to transfer and manage data from the heart failure monitor, the web
browser and portal interfaces comprising: a patient portal; a
physician portal; and a device manufacturer portal; said patient,
physician and device manufacturer portals having shared databases
and further including secure databases and encryption systems in
data communications thereof.
2. The interface of claim 1 wherein said patient portal includes a
quick look summary tailored to the patient.
3. The interface of claim 2 wherein said quick look summary is
customizable for various patient preferences.
4. The interface of claim 1 wherein said physician portal includes
a quick look summary tailored to the physician.
5. The interface of claim 1 wherein said quick look summary is
customizable for various physician preferences.
6. The interface of claim 1 wherein the data includes at least a
one of the following: an internal cardiac pressure value, an oxygen
saturation value, a pulmonary artery diastolic pressure, a
pulmonary artery systolic pressure, a cardiac-blood temperature
value, a right atrial pressure value.
Description
[0001] This application is a divisional of U.S. application Ser.
No. 10/612,856 filed Jul. 3, 2003, now allowed, which is a
divisional of U.S. application Ser. No. 09/809,915 filed Mar. 16,
2001, now U.S. Pat. No. 6,599,250.
FIELD OF THE INVENTION
[0002] The present invention relates to implantable hemodynamic
monitors (IHMs). Specifically, the invention relates to systems
that interface with various hospital monitoring systems to transfer
data from the IHMs to doctors and other data processing centers.
More specifically, the invention pertains to heart failure data
management systems that provide a concise and reliable summary view
of information in a manner that is useful for clinicians and health
care personnel to monitor, assess, evaluate and treat heart failure
conditions in patients. Further, the invention pertains to a system
of a bi-directional communication system that is network, Internet,
intranet and worldwide web compatible to enable chronic monitoring
based on data obtained from the IHMs.
BACKGROUND OF THE INVENTION
[0003] The need to monitor, on a frequent and continuous basis, the
vital signs associated with hospitalized patients particularly
those who are seriously ill is an important aspect of health care.
Virtually every hospitalized patient requires periodic measurement
in logging of blood pressure, temperature, pulse rate, etc. Such
monitoring has typically been performed by having a health care
worker periodically visit the bedside of the patient and measuring
and/or observing the patient's vital signs using dedicated
equipment that is either hooked up to the patient or brought into
the patient's room. Such a monitoring procedure is not ideally
cost-effective because of its being highly labor intensive.
[0004] A great many implantable medical devices (IMDs) for cardiac
monitoring and/or therapy whose sensors are located in a blood
vessel or heart chamber and coupled to an implantable monitor or
therapy delivery device are used for diagnosis and therapy. Such
systems include, for example, implantable heart monitors, therapy
delivery devices, and drug delivery devices. All these systems
include electrodes for sensing and sense amplifiers for recording
and/or deriving sense event signals from the intracardiac
electrogram (EGM). In current cardiac IMDs that provide a therapy,
sensed event signals are used to control the delivery of the
therapy in accordance with an operating algorithm. Selected EGM
signal segments and sensed event histogram data or the like are
stored in an internal RAM for telemetry to be transmitted to an
external programmer at a later time. Efforts have also been
underway for many years to develop implantable physiologic signal
transducers and sensors for temporary or chronic use in a body
organ or vessel usable with such IHMs for monitoring a physiologic
condition other than, or in addition to, the disease state that is
to be controlled by a therapy delivered by the IMD.
[0005] A comprehensive listing of implantable therapy devices are
disclosed in conjunction with implantable sensors for sensing a
wide variety of cardiac physiologic signals in U.S. Pat. No.
5,330,505, incorporated herein in its entirety by this
reference.
[0006] Typically, an IHM measures blood pressure and temperature
signal values which stem from changes in cardiac output that may be
caused by cardiac failure, ventricular tachycardia, flutter or
fibrillation. These variations may reflect a change in the body's
need for oxygenated blood. For example, monitoring of a substantial
drop in blood pressure in a heart chamber, particularly the right
ventricle, along or in conjunction with an accelerated or chaotic
EGM, was proposed as an indicator of a fibrillation or tachycardia
sufficient to trigger automatic delivery of defibrillation or
cardioversion shock. More recently, it has been proposed to monitor
the changes in blood pressure by comparing those values that
accompany the normal heart contraction and relaxation to those that
occur during high-rate tachycardia, flutter or fibrillation.
[0007] A number of cardiac pacing systems and algorithms for
processing monitored mean blood pressure or monitored dp/dt have
been proposed and in some instances employed clinically for
treating bradycardia. Such systems and algorithms are designed to
sense and respond to mean or dp/dt changes in blood pressure to
change the cardiac pacing rate between an upper and a lower pacing
rate limit in order to control cardiac output. Examples of IHMs
blood pressure and temperature sensors that derive absolute blood
pressure signals and temperature signals are disclosed in commonly
assigned U.S. Pat. Nos. 5,368,040, 5,535,752 and 5,564,434, and in
U.S. Pat. No. 4,791,931, all incorporated by reference herein.
[0008] The Medtronic.RTM. Chronicle.TM. Implantable Hemodynamic
Monitor (IHM) disclosed in U.S. Pat. Nos. 6,024,704 and 6,152,885,
both incorporated herein by reference in their totality, employ the
leads and circuitry disclosed in the above-incorporated commonly
assigned 5,535,752 and 5,564,434 patents to record absolute blood
pressure values for certain intervals. The recorded data is
transmitted to a programmer under the control of a physician in an
uplink telemetry transmission from the IHM during a telemetry
session initiated by downlink telemetry transmission from the
programmer's radio frequency (RF) head and receipt of an
integration command by the IHM. Thus, in accordance to the '704 and
'885 patents, a method is disclosed in which an IHM is used for
deriving reference and absolute pressure signal values using
implantable physiologic sensors to detect relative cardiac pressure
signal values for storage and transmission.
[0009] Further, in accordance with the '704 and '885 patents,
calibration of the reference pressure and/or temperature sensors in
relation to an external calibrated barometric pressure and/or body
temperature sensors could be accomplished. In addition, the same
system may be used to interlace digital signal values related to
pulmonary artery diastolic pressures with the primary cardiac
pressure signal values derived from the right ventricle as
disclosed in U.S. Pat. No. 6,155,267, incorporated herein by
reference.
[0010] Heart failure is a progressive disease. While treatment
slows the progression of the disease, current technology does not
provide a cure. The best treatment regimen available to date is a
combination of continuous diagnosis and drug therapy. Once a heart
failure patient is in the hospital, current technology does not
provide a continuous means of monitoring the patient during their
stay in the hospital. Current practice is based on a dedicated
programmer that is used to gain access to the pressure waveforms.
Only trained physicians can currently uplink the data, and this is
available only when such a trained physician is present, and is
therefore not available on a continuous basis.
[0011] The present invention enables continuous remote monitoring
of patients. In sharp contrast, prior heart failure management
involves taking measurements of a few variables in the clinic with
accurate catheterization pressures taken only occasionally because
of the difficulty of obtaining them.
[0012] Accordingly, there is a need to provide continuous and
reliable measurements over sustained long period of time. Further,
emerging trends in health care including remote patient management
systems require that the IMD/IHM be compatible with communication
systems, including the Internet, the worldwide web, and similar
systems to provide real-time communications and data exchange
between the IHM in a patient and a remote center where physicians
and other experts reside.
SUMMARY OF THE INVENTION
[0013] The present invention relates to chronic data management for
cardiac systems. Specifically, the invention pertains to IHMs that
monitor heart failure. In its broader aspect, the invention relates
to patient management that enables the collection of chronic data
for remote patient management, including remote delivery of
clinical diagnosis and therapy.
[0014] Yet another aspect of the invention includes a user-friendly
screen-displayable data management system that presents clinically
relevant measurements. Another aspect of the invention provides a
software system that enables the translation and transposition of
IHM collected data to be presented to a clinician in a manner to
enable efficient and reliable evaluation of patient conditions
remotely.
[0015] The invention further relates to data reduction in a
monitoring system as generally disclosed in co-pending application
entitled "Implantable Medical Devices Monitoring Method and System
Regarding Same" filed on Dec. 15, 1999, U.S. application Ser. No.
09/992,978, incorporated herein by reference in its entirety.
[0016] The present invention, inter alia, enables the transfer of a
patient's medical data to one or more monitoring stations staffed
by expert personnel to have access to the data in real time.
Although the IHM device implemented in the present invention
relates to the measurement of cardiac pressure, other IHM devices
that detect and transmit additional physiological signals such as
oxygen saturation, pulmonary artery diastolic and systolic
pressure, temperature and related data may be used as the
originating device or data source. Transferring real-time signals
from IHMs to various physician portals and locations provides a
highly accentuated medical service and effective chronic monitoring
of patients.
[0017] In one aspect of the present invention an IHM device
determines the hemodynamic status of a patient from measurement of
pulmonary pressure and right atrial pressure obtained from a single
absolute pressure sensor implanted in the right ventricle. Both of
these values have been shown to correlate to the degree and extent
of cardiac failure of a patient. The IHM continually monitors the
right ventricular pressure using an absolute pressure sensor and
marks the right ventricular pressure at the moment of specific
events.
[0018] One aspect of the present invention is to provide a means by
which physicians could view data available via real-time telemetry
other than using a local data retrieving system, such as a
programmer. Currently, physicians use the programmer to view the
real-time pressure wave along with the EGM tracing. Using the
present invention, the IHM device would be able to telemeter real
time signals to a system via a programmer or other instrument to a
remote location.
[0019] Another aspect of the present invention relates to the
presentation of data from IHMs in a summary view that's useful and
familiar to clinicians and patients. Yet another aspect of the
present invention includes a process by which data is collected by
IHMs, which data includes but is not limited to heart rate patient
activity and pressure data, to establish that the patient is in a
state of repeatable data routine on a daily basis. For example,
this might mean application of a magnet when the patient is lying
down, or using devices such as time-of-day counters, activity
sensors, posture sensors, etc. Such data is retrieved for analysis
via home monitors, programmers or similar devices, and the data
sent over an Internet/intranet, worldwide web or a similar network
to a remote location for analysis by clinicians or for storage and
archiving at a Medtronic server.
[0020] The data is processed for collection with past pull-up
records to compose a continuous patient record. Specifically,
clinically relevant measurements are pulled out of the data. This
would mean observing the average values measured during a daily
test, including, for example, the patient reclining for 5 minutes.
These values and the deviation or change are compared against
clinical norms and flagged for the user if they are abnormal. For
example, color plus footnote designations may be used to identify
or flag abnormal data. Other variations such as italics,
specialized fonts, bigger fonts, e-mail reports, faxed reports may
be used to identify deviations from normal clinical data or
established chronological data for the patient. The clinical norms
can optionally be modified for each patient by the clinician and
then serve as a clinical baseline for the particular patient.
[0021] One other aspect of the present invention is the display of
data which without limitation, includes the most recent daily test
data along with data from the previously interrogated data. A
comparative value between the two and a previous interrogation date
to compare collected data with chronological data are used.
[0022] Yet another aspect of the present invention includes a
single page view of chronic heart failure status, translation of
raw data into clinical indicators of heart failure status, analysis
of changes in indicators over a user-selectable time period, flags
and indicators to identify changes that are outside of clinical
norms, tailoring of graphical displays and data management to a
patient's clinical norms, means to determine if the patient is in a
state of repeatable condition from day to day, and automated data
analysis triaging which provides a foundation for further data
analysis and automation.
BRIEF DESCRIPTION OF THE DRAWINGS
[0023] FIG. 1A shows a diagram illustrating an implantable medical
device that incorporates an absolute cardiac blood pressure sensor
and an IHM device in accordance with the present invention.
[0024] FIG. 1B is a block diagram illustrating various data
communication systems from the IMD.
[0025] FIG. 1C is a block diagram illustrating signal transmission
from the IMD to a remote station.
[0026] FIG. 2 is a block diagram illustrating the remote
communication system within which the present invention is
incorporated.
[0027] FIG. 3 is a block diagram representing a web browser and
portal interface for the present invention.
[0028] FIG. 4A is a block diagram representation illustrating a
Medtronic home page at the Medtronic server in which data may be
archived in accordance with the present invention.
[0029] FIG. 4B is a logic flowchart representing high level quick
look summary in accordance with the present invention.
[0030] FIG. 5A is a representative sample of a welcome screen.
[0031] FIG. 5B is a representative hemodynamic variables display
screen.
[0032] FIGS. 6& 7 is a quick look summary in accordance with
the present invention.
[0033] FIG. 8 is a representative screen for a trends report.
[0034] FIG. 9 is a representative screen for a trends report
similar to FIG. 8.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0035] FIG. 1A represents a patient with implanted medical device
incorporating an absolute cardiac blood pressure sensor such as the
IHM discussed hereinabove. Specifically, IHM/IMD 100 is coupled to
an absolute cardiac blood pressure sensor 120 in a patient's heart
10 for recording absolute blood pressure values. IMD 100 is
depicted implanted subcutaneously in the patient's chest region and
it is coupled at its connector module 180 to a lead 112 extending
through blood vessels into the right ventricle of the patient's
heart 10. The blood pressure sensor 120 is located on lead 112 just
proximal to the lead's distal tip 130 for passively fixing it in
position to accommodate continuous movement of the heart 10. In
this structure lead 112 and blood pressure sensor 120 correspond to
those disclosed in detail in the above-incorporated commonly
assigned '434 and '752 patents for deriving absolute blood
pressure. The IMD 100 that monitors the physiological condition or
state is programmable and/or can be interrogated by an external
instrument such as a programmer through the use of bi-directional
or RF telemetry that exchanges data and commands via uplink and
downlink RF telemetry transmissions through the patient's skin.
[0036] In the context of an implantable blood pressure monitor a
series of absolute blood pressure signal values are sensed
periodically or in response to a signal provided by hospital
personnel for example, a telemetry downlink signal to initiate real
time data transmission. The absolute blood pressure value signals
are continuously transmitted so that physicians, clinicians, nurses
or other medical experts can determine the status of the patient's
cardiac pressures and associated episodes recorded within the
required time of day. The physician uses an external programmer to
generate and transmit an interrogation command via a downlink
telemetry transmission to the IMD 100. IMD 100 recognizes the
command and initiates a continuous uplink telemetry transmission of
the absolute pressure data in response. The uplink telemetry
continues until the IMD system fails to detect further
commands.
[0037] FIG. 1B illustrates a general scheme by which patient data
could be transmitted to a remote clinician's station. The
communication scheme enables continuous monitoring of patients
either in a hospital setting or in a home environment. Pressure
signals are acquired from the IMD via telemetry head 22 or
equivalent device and uplinked to instrument 24. Instrument 24 may
represent a programmer or an in-home monitor adapted to communicate
with IMD 20. Instrument 24 maintains wireless communication 27 to
transfer data to clinician's station 28. Alternatively, instrument
24 may be adapted to transfer data via network 30 representing
Internet, extranet, worldwide web or a similar network. The data is
then transferred to clinician's station via modem, cable or
equivalent data transfer system.
[0038] FIG. 2 represents a detailed aspect of network 30 that is
accessible to patients and physicians within which search engine 40
enables access to various zones 42, including a dedicated public
zone 44, confidential zone 46 and private zone 48. These zones
represent various data management centers that are either
interconnected or segregated based on privacy and security
requirements. For example, public zone 44 is accessible to all
patients, physicians and the public to provide general information
about medical devices and related medical information and services.
In sharp contract, confidential database 46 and private information
48 are accessible to patients and physicians based on strict
security and encryption systems for access on a need-to-know
basis.
[0039] Referring now to FIG. 3, web browser and portal interface 50
representing patient portal 52, physician portal 54 and Medtronic
(MDT) portal 56 are shown. These portals share a common database
with additional secure database 58 and encryption system 60
interconnected therewith.
[0040] FIG. 4A is a general representation of a Medtronic home page
70 in accordance with the present invention. The home page is
segregated between public and private/secure pages. Specifically, a
physician section, patient section and a general public information
section are depicted. The physician's section is highly scalable
and operates both on the public and private secure sections.
Similarly, the patient section relates to information on various
medical devices including related therapy and diagnosis. Further,
similar to the physician's site, the patient site includes
private/confidential segments.
[0041] FIG. 4B represents a general logic flow diagram for a quick
look summary in accordance with the present invention.
Specifically, the system is initiated under logic step 80 where
long-term data is collected via IMD 100. The long-term data is
refined to determine if the patient is in a repeatable state under
logic step 82. Subsequently, the data is retrieved and processed
under logic step 84. Thereafter, under decision step 86 the values
of the processed data are reviewed to see if they are abnormal. If
these values prove to be abnormal, they are flagged as abnormal
values under logic step 88 and the results are displayed under
logic step 90. In the alternate, if the values are found to be
normal, they are displayed under logic step 90. One of the
significant aspects of the present invention is the presentation of
highly user-friendly quick look summary of data collected by
IMD/IHM 100 to clinicians, patients and other health providers.
[0042] Referring now to FIG. 5A, a representative screen
encountered by a doctor using the Internet site provided in
accordance with the present invention is shown. Specifically, the
screen includes various tabs, one of which is to welcome the user.
The welcome screen identifies the doctor and updates him or her on
how many home monitoring records have been reviewed and how many
abnormal events have been detected. The doctor is also informed of
the number of patients who may require review. The doctor is also
given various information regarding his or her practice and is also
informed on what is new in the art vis a vis specific devices and
medical conditions. The screen is highly interactive and based on
past site use behavior of the doctor, the software is able to
understand and retain the doctor's interests and highlight unused
features.
[0043] In the "What is New" section, for instance, the screen
interactively provides the doctor with the latest information
regarding clinical studies including the devices that are released
in the user's countries. The "Links" section provides links to
related medical sites. The list of links is maintained by
Medtronic, so only approved sites will appear. The list of
potential links is narrowed by the user's areas of interest.
Clinicians can also provide recommended links to their patients.
This will appear in the patient portal and are customized by the
recommended links, the type of devices the patient has implanted,
the local language to be used and a track record of previous links
that have been used.
[0044] Further, patient records of device and recorded data will be
available for viewing and entry. This data may have been collected
by home monitors, programmers, extenders, registration database or
imported from clinic databases. Users can arrange the view of
records, listable to their liking by date, name, ID and status.
Specifically, status indicators are used for home monitoring data
yet to be viewed or with errors. The records may include in-office
follow-up test results, interrogated diagnostic data settings and
measurements, data imported from pacing databases such as EKG
indication, medications including control of compliance, monitoring
functions, key physiologic data such as indications for implant,
links to other online components of a patient's chart such as lab
results, notes entered, data integrated across patient sessions
such as episode logs and trends, patient demographics and patient
diary entries.
[0045] The system may also be customized based on whether the
portal is used to store in-home or programmer records for the
particular patient. All parts of the patient's records that are
attributable to the patient are clearly patient private data.
Encryption and adequate authentication must be used for access.
Attribution of who enters and edits changes is also supported by
the system software.
[0046] Appointment scheduling provides an automatic means for
scheduling home-monitoring sessions so home monitoring could be
conducted without additional burden on the clinic scheduling staff.
Physicians may enter their prescribed follow-up intervals and then
the system can schedule the follow-up days. Patients can customize
their schedule without the help of the clinical staff. The
scheduling may also integrate with the clinic's in-office
scheduling enabling doctor appointments to be made online.
[0047] Accounts billing are automated. Automation of the filling
out of billing statements is also provided. Medical device
follow-up regiments can often automatically be determined from
session data. The data is forwarded to the clinician's billing
system or a third party billing clearing house. Medtronic device
registration forms will be web-enabled. Direct entry on the web or
import from un-tethered data entry applications will be supported.
Entry on the web will enable access by customers rather than field
representatives without the high distribution and support cost
encountered today with PC applications.
[0048] Clinical study content will be available to clinical study
investigators. This could include entry of clinical data forms,
discussion groups, newsletter and results reports. The site is
customized based on which studies the user is a part of and the
local language used. Physicians can compare their practice by
comparing their practice data to data aggregated from other
practices and practice guidelines. Specific comparison and points
can be offered with custom filters. Eventually data mining may be
offered. This will include and expand on the current capabilities
of the CV views extranet applications. This part of the site could
be customized based on collected user's data that is also made
available for comparisons. Further, information about the user's
practice to derive comparison definitions, for example with other
practitioners in the area of expertise may be provided.
[0049] The site also includes reports for tracking product
performance and will maintain tags on the referring physician. The
distribution of reports is greatly enhanced through web-enabled
features. Specifically, the content is tailored to each practice.
For example, product performance can be incorporated with web
devices such as a palm device which may be on the person of the
patient or the physician. Similarly, the accuracy of reports can be
enhanced by joining data. For example, closer monitoring reports
may contain more accurate battery projections derived from
follow-up and continuous monitoring of actual device data.
[0050] The system enables remote viewing. Specifically, users can
remotely view patient stations through instruments connected to the
Internet 30. Sessions with programmers, extenders, acute monitors
and home monitors will be viewed through web browsers or a PC.
Users will have access to a switchboard of available instruments
they have rights to connect to and access the contents thereof. The
connection is supported in any order whether it is browser or
instrument first. Preferably, the site is customized by identifying
which instruments the user has access rights to. Rights are
assigned to physicians and clinical personnel as needed.
[0051] In the same manner, the link for patient portal 52 is a
secure website for patients already implanted with Medtronic
devices and their families. It includes the web content that
requires secure access not available in the Medtronic public
website 56. Patient portal 52 provides personalization,
automatically providing only the information pertinent to the
patient's device and disease. This is combined with a consistent
user interface for the diverse applications being provided for a
highly distributed user-friendly web experience.
[0052] Welcome screen 155 of FIG. 5A highlights important
information with more detailed features. The site is customized by
patient's names, what devices the patient has implanted, marketing
preferences of what news or new products are of interest, physician
control of what the patient has access to, past portal use to
understand interests and highlight unused features, and what local
language the patient uses.
[0053] One of the significant aspects of this site includes a home
monitoring section which closes the loop for home-monitored
patients. These patients can view whether sessions were successful
or trouble-shoot errors. They can gain reassurance by viewing
high-level results. Clearly this will reduce the burden of phone
calls on clinicians. The site is customized by results of home
monitoring sessions. The type of implanted device and home monitor
that are proper to a patient are generally decisions made by the
patient's physician. For security reasons home-monitoring results
may be considered patient private data and will require encryption
and user authentication. The site also provides appointment
scheduling in which an automated means for scheduling
home-monitoring sessions is implemented without additional burden
on clinic scheduling staff. Physicians can enter their prescribed
follow-up intervals and the system is intelligent to schedule the
follow-up days. Patients can customize their schedule without the
help of the clinical staff. The scheduling may also integrate with
a clinic's in-office scheduling enabling doctor appointments to be
made online.
[0054] Patient portal 52 also includes a diary section where daily
medical journal entries can be captured. Voice or text can be
captured either on the diary screen or potentially on a home
monitor. Regardless of where it is entered, the diary screens would
provide options to review and edit the contents of a diary. By
putting the diary online, it is instantly available to all medical
caregivers. Further, the diary does not need transcription or
transfers to become part of a medical chart because of automatic
entry.
[0055] Yet another significant aspect of the screen display at
patient portal 52 includes the management of patient ID cards.
Requests for replacements and validation of patient's information
is automated on patient portal 52. Patients can also print out
replacement ID cards for use while the processing of a permanent
card is in progress. Patient portal 52 also enables patients to
control the rights to their records. Specifically, patients will
have rights to grant control and access rights to their records as
they may deem necessary.
[0056] Referring to FIG. 5B, a quick look summary of hemodynamic
variables 125 is represented. The screen provides one-week trends
for hemodynamic variables RV pressure waves. For example, triggered
episodes could be selected under a tachy-, brady- or
patient-triggered events. A tachy-triggered event, for example,
would inform the user if the patient has tachy-triggered events.
Similarly, a brady-triggered event informs the user if the patient
has brady-triggered events. Further, patient-triggered events
relate to information indicating patient-triggered events.
[0057] Referring to FIG. 6, quick look summary screen 140
represents various parameters useful to determine a tachy or brady
trigger. A tachy-trigger notification informs the user if the
patient has tachy-triggered events. If there are tachy-triggered
events the device information network for example, IHM 100, will
notify the designated person, for instance a nurse, doctor or
health provider electronically that events have occurred by e-mail,
pager or other means. Similarly, a brady-triggered notification
would be dispatched in the event there are brady-triggered events.
IHM 100 will notify the designated person about the event.
Patient-triggered notification is also dispatched in the same
manner.
[0058] Referring to FIG. 7, under display screen 150, the software
system enables analysis of comparative values based on a comparison
of recent values to values interrogated on a prior time period.
Patient portal 52 and physician portal 54 provide various ways of
presenting clinical information. Specifically, daily minimums of
heart rate for quick look, RV systolic pressure, daily minimums of
RV diastolic pressure, daily minimums of estimated pulmonary artery
pressure, daily minimums of RV pulse pressure, daily minimums of RV
dp/dt, highlighting out-of-range heart rate, highlighting
out-of-range RV systolic pressure, highlighting out-of-range RV
diastolic pressure, highlighting out-of-range ePAD pressure,
highlighting out-of-range RV pulse pressure, highlighting
out-of-range RV dp/dt, notification of heart rate out-of-range,
notification of RV systolic pressure out-of range, notification of
RV diastolic pressure, notification of ePAD pressure, notification
of RV pulse pressure, notification of RV dp/dt out-of-range,
highlighting changes in heart rate. Specifically, the quick look
will determine and report changes in heart rate which have occurred
in a patient between the daily minimum values contained in the file
selected for examination and the daily minimum values from a
previous file. More specifically, values are compared to determine
if the differences lie outside a user-defined threshold is defined
in the quick look setup and can be tailored on a patient-by-patient
basis. This feature allows the user to define differences either
based on actual values or percentages. Highlighting changes in RV
systolic pressure relates to pressures which have occurred in a
patient between the daily minimum values contained in the file
selected for examination and the daily minimum values from a
previous file.
[0059] Highlighting changes in RV diastolic pressure enables the
quick look to determine and report changes in RV diastolic pressure
which have occurred in a patient between the daily minimum values
contained in the file selected for examination and the daily
minimum values from a previous file. Similarly, the quick look will
determine and report changes in RV pulse pressure which have
occurred in a patient between the daily minimum values contained in
the file selected for examination and the daily minimum values from
a previous file. Highlighting changes in RV dp/dt includes
determination and reporting of changes in RV dp/dt which have
occurred in the patient between the daily minimum values contained
in the file selected for examination and the daily minimum values
from a previous file. Notification of large heart rate change is
implemented by enabling IHM 100 information network to notify a
designated person electronically that changes in heart rate greater
than set targets have occurred. A notification may be sent by
e-mail, pager and an equivalent medium.
[0060] Similar notification of large RV systolic pressure changes,
large RV diastolic pressure changes, large ePAD pressure changes,
large RV pulse pressure change, and RV dp/dt changes may be made.
The quick look allows the user to select from a list of previous
files. A specific file may be selected for data against which the
current file is compared to determine if hemodynamic values have
changed. Accordingly, quick look compares the daily minimum values
from the selected file set of previous files to show the user
variation that may have occurred. Additionally, while the quick
look page allows the user to examine a selected file, its
comparison to threshold values and comparison to a previous file,
it also provides the daily minimum plots to enable the user to see
a time/trend plot of all daily minimum values for all variables.
Further, a daily minimum list may be used to examine a selected
file, its comparison to threshold values and its comparison to a
previous file to see a listing of all daily minimum values for all
variables.
[0061] Referring now to FIGS. 8 and 9, trends report 160 and 170
are represented. Specifically, heart rate, patient activity,
systolic and diastolic pressures and similar cardiac/physiologic
parameters collected over a period of several weeks. Trend reports
for night heart rate, +dp/dt and -dp/dt including pre-ejection
systolic time intervals may be displayed. Trend directions for 12
months to 1 hour may be selected for review.
[0062] The preceding specific embodiments are illustrative of the
practice of the invention. It is to be understood, therefore, that
other expedients known to those of skill in the art or disclosed
herein may be employed without departing from the invention or the
scope of the appended claim. It is therefore to be understood that
the invention may be practiced otherwise than is specifically
described, without departing from the scope of the present
invention. As to every element, it may be replaced by any one of
infinite equivalent alternatives, only some of which are disclosed
in the specification.
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