U.S. patent application number 12/930132 was filed with the patent office on 2012-06-28 for visual charting method for creating electronic medical documents.
This patent application is currently assigned to Allscripts Health Care Solutions, Inc.. Invention is credited to Richard P. Mansour.
Application Number | 20120166219 12/930132 |
Document ID | / |
Family ID | 46318158 |
Filed Date | 2012-06-28 |
United States Patent
Application |
20120166219 |
Kind Code |
A1 |
Mansour; Richard P. |
June 28, 2012 |
Visual charting method for creating electronic medical
documents
Abstract
A method of creating medical documentation uses selection of
images representing synonyms for complex medical concepts. The
images can be of two types, one corresponding to a parameter or Key
in a Key/Value pair and the other corresponding to possible values
of the selected parameter or Key. The user first selects an image
or portion thereof corresponding to the parameter they wish to
record observations, such as the heart or a valve of the heart. A
set of images representing possible values of the parameter is then
displayed e.g., images representing possible murmurs the selected
valve may have. The user selects the image representing the value
corresponding to the observation of the patient. A document is
created by recording either the Key/Value image pairs or,
alternative, text representing the synonyms for the images. Other
methods of recording the document are possible, such as
instantiating a set of class objects.
Inventors: |
Mansour; Richard P.;
(Shreveport, LA) |
Assignee: |
Allscripts Health Care Solutions,
Inc.
|
Family ID: |
46318158 |
Appl. No.: |
12/930132 |
Filed: |
December 28, 2010 |
Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 30/20 20180101;
G16H 10/60 20180101; G16H 15/00 20180101; G16H 30/40 20180101 |
Class at
Publication: |
705/3 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; G06Q 10/00 20060101 G06Q010/00 |
Claims
1. A method of creating a medical document using a computing device
having a display using visual charting, comprising the steps of:
(a) presenting on the display an image representing a medical
concept, such as an organ or organ system of a human or animal
body; (b) enabling selection of a parameter associated with the
medical concept by selecting a portion of the image corresponding
to the parameter; (c) responsive to the selecting in step (b),
presenting on the display a set of images comprising values
associated with selected parameter; (d) enabling selection one of
the images in the set of images presented in step (c); and (e)
constructing a medical document based on the selecting in steps (b)
and step (d) and storing the medical document in a computer system,
wherein the images selected in steps (b) and (d) are
interchangeable with a language description of the selected
parameter and the selected value of the selected parameter.
2. The method of claim 1, further comprising repeating steps (b),
(c), (d) and (e), wherein the repeated step (b) comprises the
selection of a different parameter associated with the medical
concept.
3. The method of claim 2, further comprising the step of displaying
a textual description on the display associated with the images
selected in steps (b) and (d).
4. The method of claim 1, further comprising the step of saving the
medical document as a text file in a predetermined format.
5. The method of claim 4, wherein the predetermined format
comprises an XML format.
6. The method of claim 1, wherein the medical document is saved as
a Key/Value pair in a database, the Key corresponding to the
selection in step (b) and the Value corresponding to the selection
in step (d).
7. The method of claim 1, wherein the selections in step (b) and
(d) are saved as properties of a class object in a object-oriented
system.
8. The method of claim 1, wherein the medical concept comprises an
organ or organ system selected from the group of organs and organ
systems consisting of the heart, the circulatory system, the
respiratory system, the kidneys, the digestive system, the skeletal
system and the central nervous system.
9. The method of claim 1, wherein computing device comprises a
portable computing device.
10. In a computing device having a display, and memory storing
instructions for execution by a processing unit in the device, and
communications apparatus for connecting the device to a network,
the improvement comprising: a visual charting application coded as
a set of instructions executed by the device, wherein creation of a
medical document by the visual charting application is performed by
selection of images presented on the display of the computing
device, the images including images of a first type acting as a
synonym for a medical parameter and images of a second type of
acting as synonyms of values of said medical parameter, wherein a
selection by the user of an image of the first type causing a
display of a set of images of the second type to be presented on
the display.
11. The device of claim 10, wherein in the visual charting
application an image of the second type is selected to represent a
value for a medical parameter.
12. The device of claim 10, wherein the medical document is created
using a descriptive format for the selected images of the first and
second type.
13. The device of claim 12, the device of claim 10 wherein the
descriptive format for the selected images comprises a text-based
format.
14. The device of claim 12, wherein the descriptive format for the
selected image comprises an XML document.
15. The device of claim 12, wherein the descriptive format for the
selected image comprises properties of a class object in an
object-oriented system.
16. The device of claim 11, wherein the descriptive format for the
selected image is defined in a proprietary language.
17. The device of claim 11, wherein the descriptive format for the
selected image is defined according to a distributed standard.
18. The device of claim 10, wherein the computing device comprises
a portable computing device.
19. The device of claim 10, wherein the portable computing device
is selected from the list of computing devices consisting of a
Smart Phone and a tablet PC.
20. The device of claim 10, wherein the display comprises a touch
sensitive display.
21. The device of claim 10, wherein the selection of images of the
first and second type are saved as key/value pairs in a data
structure.
22. The device of claim 10, wherein the images of the first type
correlates to a primary Key in an electronic medical record.
23. A method of creating electronic medical documents using visual
charting, comprising the steps of: creating a data structure with
persistent data comprising descriptive information associated with
a plurality images to be presented on a medical documentation
template displayed on a computing device, the images representing
medical concepts such as an organ or organ system of a human or
animal body; rendering one of the images in the medical
documentation template on the computing device; receiving a user
selection on the computing device of a parameter of the medical
concept by selecting a feature in the image corresponding to the
parameter; responsively displaying on the display a set of images
associated with values of the selected parameter; receiving a
selection of one of the images in the set of images; and creating a
medical document reflecting the selection of the images and storing
the medical document in a database.
24. The method of claim 23, wherein the medical document is stored
in the form of an XML document.
25. The method of claim 22, wherein the medical document is stored
as entries in a relational database comprising either data
indicating the selected feature and image or language descriptors
associated with the selected feature and image.
26. The method of claim 23, wherein the computing device comprises
a portable computing device.
27. The method of claim 26, wherein the portable computing device
is selected from the list of computing device consisting of a Smart
Phone and a tablet PC.
28. The method of claim 22, wherein the user selections of the
feature and images are achieved by means of a touch sensitive
display on the computing device.
Description
BACKGROUND
[0001] 1. Field
[0002] This invention relates generally to the field of
computerized systems for storing and creating electronic records,
and in particular to methods and systems for creating medical
documentation regarding a patient.
[0003] 2. Description of Related Art
[0004] In the medical arena, hand written patient record keeping
systems have evolved through many years of careful refinement and
enhancement into systems which maintain a detailed manual record of
medical information concerning each patient. To meet the needs of
different hospital entities (such as doctors, nurses, pharmacy,
accounting, laboratory, etc.) a manual record keeping system often
requires that one piece of information be entered into multiple
records. In addition it often requires that the same information
that has not changed from visit to visit (such as family/social
history, allergies, immunization status) be re-asked of the patient
and re-documented in the current record. In certain instances, such
as in the Emergency Department, this information may be asked and
recorded as many as three separate times (on the Triage Note; the
main ED record; and MD documentation) leaving the patient to wonder
if there is any communication between healthcare providers and
frustrating those healthcare providers who must fill out more and
more paperwork. If the patient is admitted, this same information
is then asked and recorded again by the admitting nurse and
attending physician.
[0005] In a typical manual patient record keeping system a patient
chart, usually in the form of a notebook, is maintained at the
nursing station for each patient. The notebook is divided into a
plurality of individual tabbed sections, such as Physicians Orders,
Kardex, Nursing Care Plan, Nursing Assessment, and Laboratory.
[0006] Each of the above sections is further subdivided into a
number of forms. The forms are those which are appropriate to the
individual patient and/or such patient's physician. For example,
within the Laboratory section there may appear forms for chemistry,
hematology, blood gas, and microbiology.
[0007] In addition, a "flowsheet" chart is usually kept at the
patient's bedside, particularly in a critical care environment. On
the "flowsheet" chart there are individual areas for medication
records, vital signs, intake/output, laboratory results, and other
categories which are dependent upon the patient's affliction, such
as intravenous (IV) drips.
[0008] Referring in particular to nursing functions, annotations to
charts and/or nursing progress notes are made manually. Typically,
brief notations are jotted down in various places through-out a
shift. Sometime during the shift, typically at the end, the nurse
makes a full notation into the nursing progress notes based on the
brief notations or remembered items. This process can be very
inefficient since notations may be forgotten or not copied
appropriately. In particular, documentation and entry of physician
orders, prescriptions and other activity has been viewed as two
separate activities or steps, one step completing the documentation
and a second step of entry of the order or prescription in the
medical records of the patient.
[0009] The need for more efficiency of workflow and coordination
between multiple departments and healthcare providers in a hospital
environment has led to the advent of computerized medical records
applications. Medical records management systems are known in the
art and include the systems disclosed in the following U.S. Pat.
Nos. 5,325,478; 5,247,611; 5,077,666; 5,072,383 and 5,253,362 all
assigned to the assignee of this invention, and have been
commercialized by the Assignee of this invention and others. Other
background prior art of interest includes Cantlin et al., US
2006/0173858; Kim et al. U.S. Pat. No. 7,793,217; Britton et al.
U.S. 2004/0015778 and Goede et al. U.S. Pat. No. 7,453,472.
[0010] Some software applications for creating medical
documentation require a user to type in textual entries
representing observations of a patient. Often, such observations
may encompass complex medical concepts. As one example, in the
context of a examination of a cardiac patient, the observations may
include observations about particular heart murmur patterns present
in the aortic, tricuspid, mitral and pulmonary valves. Medical
documentation (e.g., a structured note) is created by the physician
that documents all such observations. A text-based approach to
creating such documentation (i.e., typing in all of the clinical
observations) is time consuming and inefficient.
SUMMARY
[0011] This invention meets a long-felt need in the art for a
method for creating medical documentation more quickly than
traditional text-based approaches. In particular, this invention
provides a visual, symbolic approach to creating documents,
referred to herein as "visual charting." In visual charting,
complex medical concepts are presented on a user interface display
as symbols which are selected by the physician as part of a medical
documentation creation process. The symbols are, in essence,
synonyms for a textual description of the complex medical concept.
By means of selection of symbols, and in preferred embodiments a
sequence of such symbols, the visual charting method preserves the
complexity and nuance in the content of a medical document that
text-based approaches provide, while substantially reducing the
amount of time it takes the practitioner to create the
documentation. In essence, medical charting concepts requiring the
recording of detailed information can be represented by specific
images, the selection of which allowing medical documentation to be
created in a more efficient manner.
[0012] The features of this invention provide a number of
additional advantages, and solve problems heretofore present in the
art. The images can serve as synonyms for concepts which might
require detailed descriptions (in text). Visual charting can
conserve space on forms and reduce the need for scrolling a form or
navigating to multiple forms, further adding efficiencies to the
process. The images in the visual charting approach can be
converted into specific properties of class objects in an
object-oriented programming environment, which can populate or be
populated by a Key/Value pair relational data construct using a
database or XML (extensible markup language) or other text-based
representation of object properties. Visual charting further
improves the ability to efficiently chart on small platforms such
as Smart Phones, Pocket PCs, iPhones, iPads and similar devices.
Additionally, the visual charting methods provides the ability to
chart (i.e., create documentation) without a keyboard, i.e.,
without entering any text at all.
[0013] The invention will be described below in several different
aspects. In one aspect, a method of creating a medical document
using a computing device (for example a desktop workstation, smart
phone, tablet computer, or the like) having a display, is
described. The method includes the steps of:
[0014] (a) presenting on the display an image representing a
medical concept, such as an organ or organ system of a human or
animal body;
[0015] (b) enabling selection of a parameter associated with the
medical concept by means of selecting a portion of the image
corresponding to the parameter;
[0016] (c) responsive to the selecting in step (b), presenting on
the display a set of images comprising possible values associated
with selected parameter;
[0017] (d) enabling selection one of the images in the set of
images presented in step (c); and
[0018] (e) constructing a medical document based on the selecting
in steps (b) and step (d) and storing the medical document in a
computer system. The images selected in steps (b) and (d) are
interchangeable with (i.e., synonyms of) a language description of
the selected parameter and the selected value of the selected
parameter. The selection of the parameter in step (b) may be
accomplished using visual methods, such as selecting (e.g., by
touch or mouse click) a portion image of medical concept image
representing the parameter. Examples of this method will be
described below in further detail in conjunction with visual
charting of a cardiac patient, in which the image representing the
medical concept is an image of the heart, the parameter selected
from the image is one of the heart valves, and the selection of one
of the heart valves causes display of a set of images associated
with murmurs (or other possible values) of the selected heart
valve.
[0019] The method can be performed iteratively in which additional
parameters are selected and visual charting is used to select
values for additional parameters. Thus, the method may include the
repeating steps (b), (c), (d) and (e), wherein the repeated step
(b) comprises the selection of a different parameter associated
with the medical concept. In this manner a medical document
consisting of multiple parameter/value pairs can be created.
[0020] To facilitate ease of use and understanding of the images,
the method may further include the steps of displaying on the
display the language textual description or synonym for each of the
images selected in steps (b) and (d).
[0021] In one possible embodiment, the medical document created
using the method can be saved as a text file in a predetermined
format, such as an XML format. Additionally, the medical document
can be saved as a Key/Value pair in a database, the Key
corresponding to the selection in step (b) (either in the form of
text or in the form of data representing the portion of the image
selected) and the Value corresponding to the selection in step (d)
(again, either as image or its textual synonym). Alternatively, the
selections in step (b) and (d) can be saved as properties of a
class object in a object-oriented system.
[0022] The visual charting system can be used with the charting of
virtually any medical concept which lends itself to medical note
writing in terms of parameter and value pairs. For example, the
medical concept that is displayed can be a organ or organ system
such as the heart, the circulatory system, the respiratory system,
the kidneys, the digestive system, the skeletal system and the
central nervous system.
[0023] In another aspect, the invention can be considered an
improvement to a computing device used for medical document
creation. The computing device can take the form of a desktop
workstation, smart phone, tablet computer, or the like. The
computing device has a display, and memory storing instructions for
execution by a processing unit in the device, all of which is
conventional. The improvement takes the form of a visual charting
application coded as a set of instructions executed by the
processing unit in the device, wherein creation of a medical
document by the visual charting application is performed by
selection of images or portions thereof presented on the display of
the computing device, the images including images of a first type
acting as a synonym for a medical parameter and images of a second
type of acting as synonyms of values of the medical parameter,
wherein a selection by the user of an image of the first type
causing a display of a set of images of the second type to be
presented on the display.
[0024] Since the images are synonyms for a textual description, the
selections of the user can be saved as either textual descriptions
or alternative as a set or sequence of images. For example the
images can be selected as "key/value" pairs or "parameter/charted
observation" pairs using concepts configured with primary keys of a
relational database to achieve the same data relationships that are
created when text-based language forms are used to capture
information.
[0025] In still another aspect, a method of creating electronic
medical documents is described using visual charting. The method
includes the steps of:
[0026] (a) creating a data structure with persistent data
comprising descriptive information associated with a plurality
images to be presented on a medical documentation template
displayed on a computing device, the images representing medical
concepts such as an organ or organ system of a human or animal
body;
[0027] (b) rendering one of the images in the medical documentation
template on the computing device (e.g., an image of the heart);
[0028] (c) receiving a user selection on the computing device of a
parameter of the medical concept by selecting a feature in the
image corresponding to the parameter (e.g. selecting a portion of
the heart image corresponding to one of the heart valves);
[0029] (c) responsively displaying on the display a set of images
associated with values of the selected parameter (e.g. images of
possible murmurs or types of murmurs of the selected heart
valve);
[0030] (d) receiving a selection of one of the images in the set of
images; and
[0031] (e) creating a medical document reflecting the selection of
the images and storing the medical document in a database.
BRIEF DESCRIPTION OF THE DRAWINGS
[0032] Exemplary embodiments are illustrated in referenced figures
of the drawings. It is intended that the embodiments and figures
disclosed herein are to be considered illustrative rather than
restrictive.
[0033] FIG. 1 is a block diagram of a computer electronic medical
records system implemented in a medical facility such as a
hospital.
[0034] FIG. 2 is a schematic representation of a portion of the
clinical database of FIG. 1, showing an electronic patient record
for patient X, with the record including a number of fields or
categories, each associated with a different portion of the
database record. These categories, which may be user or customer
defined, include categories such as Orders, Documents,
Prescriptions, Allergies and still others. The illustration of FIG.
1 shows a relational database implementation wherein data is
organized in rows and columns. However, the use of object-oriented
database design in which data is stored as objects is an
alternative implementation.
[0035] FIG. 2A is a flow chart showing a process of creating a
visual charting capability in the medical records system of FIG. 1
and using it to create clinical documentation which can be stored
in the database of FIG. 2.
[0036] FIGS. 3-11 are a series of screen shots of a workstation,
smart phone, or other computing device used by a medical
practitioner showing the process of creating a medical document
concerning a patient using a visual charting method.
DETAILED DESCRIPTION
[0037] Visual charting is a form of medical note writing that
incorporates images as synonyms for Key/Value pairs. The process of
visual charting results in the development of structured
information for an electronic medical record that can be stored or
rendered as either a "language" (i.e., textual) medical note or as
an image medical note. Some of the images used in visual charting
represent a description of a "key", also known as a parameter or a
question regarding a medical concept (e.g., organ or organ system).
Other types of images used in visual charting represent an observed
finding regarding the parameter, also known as a charted
observation or a value or an answer. Together, the images of both
the parameter and the value represent unique combinations within
the electronic medical record, commonly known as key/value
pairs.
[0038] The result of the visual charting method is the creation of
a medical document, which may take the form of a textual note, as
well as the storage of key/value pairs within the database (e.g.,
in an electronic medical record). The result can also be stored or
represented in other forms, such as an XML (extensible markup
language) document representing the information. The concept of
visual image synonyms representing the definition keys of
structured note writing make the images interchangeable with a
textual description of the concept captured or conveyed by the
image selected. Alternatively, the result of visual charting can be
saved as properties of a class object in a object-oriented
system.
[0039] The visual charting methods of this disclosure will be
described in detail later in this document in conjunction with
FIGS. 2A-11. In brief, the methods involve presenting on the
display of a computing device an image representing a medical
concept, such as an organ or organ system of a human or animal
body. From that image, a body part or sub-region of the image is
selected which represents selection of a parameter or set of
parameters related to the body part or region. In response to that
selection, the user is presented with a display of a set of images
comprising possible values associated with selected parameter. In
other words, the user is presented with multiple images that can be
selected to describe the appearance, or the physical exam or verbal
answers to questions related to the body part or region, i.e.,
values associated with the selected parameter. A medical document
is then constructed based on the selections of the parameter and
values, and the medical document is stored in a computer system.
For example, as the user selects the images during visual charting,
the computer system is building an XML representation of the
textual synonyms of the selected images. The medical document can
be represented in other equivalent manners, such as a textual
representation of the questions and answers associated with the
images, or as a class object properties and values representing a
structured or non-structured set of key/value pairs or
question/answer pairs.
[0040] A description of one possible hardware and software
environment in which the invention can be practiced will be
described next. In the following section an example of visual
charting will be provided.
A. Hardware and Software Environment of Invention
[0041] Referring now to FIG. 1, a representative and non-limiting
example of an environment in which visual charting can be practiced
is shown in block diagram format. In particular, FIG. 1 depicts a
computerized medical records system 10 that is used by clinicians
(physicians, nurses and other medical personnel) and hospital
administration staff. The system is shown installed in a medical
facility 12 indicated in dashed lines. The medical facility may for
example be a hospital, nursing home, clinic, or other medical
enterprise. The details on the medical enterprise and type of
health care services it may render to patients are not particularly
important. One possible application of this invention is in the
hospital environment, and therefore the following description will
be made in conjunction with a hospital, but again this is only by
way of non-limiting example.
[0042] The medical records system 10 includes a plurality of
distributed computing devices or workstations, e.g., client
computers 14, a central database server 16, and a database 18
storing, among other things electronic patient records including
medical documentation created using the visual charting methods of
this disclosure. Clinical data can be extracted from the database
18 and loaded into an analytics database 18A for data analysis and
reporting in the manner described in US Patent Application
Publication No. 2009/0024414. The workstations 14 could be for
example general purpose computers with a processing unit and
graphical display unit and mouse or other pointing device for
section of images using the methods of this disclosure. The
workstations 14 could also be portable computing devices such as
hand-held computer, smart phone or tablet PC shown at 17 having a
display 19 in the lower left of FIG. 1. The portable computing
device communicates with the network 32 via a wireless base station
15 using a suitable and known telecommunication methods (e.g.,
Bluetooth, WiMax or cellular telephone network). The workstations
14 include a memory storing an interactive, client-server based
patient documentation application that is executed by the processor
in the workstation. The application provides user interface tools
in the form of graphical screen displays which allow the user
access the electronic patient records stored in the database and
create clinical documentation regarding a patient being treated at
the facility 12 using the visual charting methods described in
FIGS. 2A-12.
[0043] As shown in FIG. 1, the facility 12 may include an Intensive
Care Unit 20 with a workstation 14, which may be used by ICU
physicians and ICU nurses to access patient records and input
orders, write prescriptions, view patient allergies, and create
medical documentation. The facility may also include one or more
laboratories 22, each of which may include a workstation. Lab
personnel may input test results into the patient record stored in
the database 18. The facility may also include an Emergency Room
(ER) 24, where a workstation 14 is provided for ER clinicians to
records and input orders, write prescriptions, view patient
allergies, note significant events and chief complaints, etc. of
the patients and input them into the electronic patient record
stored in the database 18. The facility may also have a number of
patient rooms and provide nurses stations (NS) 26 on each floor,
each of which has a workstation 14. Additionally, physicians'
offices 28 may also include workstations 14, in the form of
personal computers. The facility 12 may have other operations,
clinics, departments, etc. as indicated at 30, each of which may be
provided with additional workstations. The workstation are
networked on a local area network 32 wherein all of the
workstations may exchange data with the central database server 16
and thereby access the patient records stored in the database 18
and write documentation and orders, prescriptions, and other
information to the database 18.
[0044] The network 32 may include a router (not shown) providing a
connection to an internet service provider (ISP) 40 providing
access to an external wide area internet protocol network 42 such
as the Internet 42. A workstation 14A may be coupled to the
enterprise network 32 via the ISP 40 whereby a clinician authorized
to access patient records in the database 12 may do so via the
Internet 42, ISP 40 network access server and local area network
32. Thus, a workstation 14, 14A creating patient documentation need
not necessarily physically reside on the network 32 or be
physically located within or at the enterprise 12.
[0045] The medical records system 10 allows clinicians to create
new medical documentation and store such documentation in the
database 18, as well as access patient records in a clinical
database 18. The system 10 may take the form of a hospital medical
records information system, and such systems are generally known in
the art and commercially available from Allscripts Health Care
Solutions, Inc., and others. The preferred embodiment of such a
system provides clinicians information they need, when and where
they need it--at the point of care, e.g., in the ER or at the
nursing stations 26, in the offices 28, via Smart Phones or
portable PCs 17, and even at home via a computer 14A and the
Internet 42.
[0046] A schematic representation of the database 18 is shown in
FIG. 2. The database includes a multitude of electronic patient
records 50, 52 each comprising rows and columns of data. A first
field 54 is shown directed to patient information, such as name,
address, insurance carrier, date of birth, etc.
[0047] A second field 56 contains orders for the patient. The
orders are determined by health care personnel treating the
patient. Each row in the orders field 56 may constitute a specific
order, and the various columns in the row devoted to different
aspects of the order, such as the entering physician's name, the
type of order, the date it was placed, etc.
[0048] A third field 58 is directed to documents (i.e., medical
documentation) entered by a physician or nurse. Each row may
represent specific instances of documentation created by a
user.
[0049] A fourth field 60 contains prescription medications ordered
for the patient. A fifth field 62 contains data of all the
patient's allergies. Other fields 64 are also present, and may
include fields devoted to significant events, health issues, care
providers and others. The name of the categories in the electronic
patient record, and the number of categories is not particularly
important and may vary depending on the environment and the choices
made by a system administrator.
B. Visual Charting Example
[0050] Visual Charting represents the development of medical
charting tools that incorporate images as synonyms for
interchangeable values in Key/Value pairs in a data structure or
properties of class objects representing medical concepts, such as
a description of a cardiac examination or any other body area or
organ system. The image of the anatomic representation of the organ
or the finding related to the organ system correlate to a primary
Key in an electronic medical record to represent the concepts. The
concepts represented by the images are interchangeable with the
language descriptions of the same concept such that the concepts
could be represented in a medical note as the image or the language
description. The persistent data representing the medical note
could be held in a database in FIG. 2 in a variety of forms, for
example a text based representation of a data such as XML.
[0051] When computing with these forms and collecting the medical
data the organ systems and descriptions are represented as class
objects with properties (or XML) that can be populated by the
medical worker through a forms system, an electronic medical record
database or a text based data structure such as XML. The medical
charting tool can be defaulted to normal images representing
"normal status" in medical language. The medical language is
interchangeable with the images and is represented by unique keys
which could be defined in a proprietary language or a distributed
standard such as SNOMED CT. Computer code handles the definition of
the class objects and the assignment of the class property values
to the class objects, the reading and writing of XML, the reading
and writing to the database structures and the rendering of the
user interface. This technology will be used any type of computer
workstation to include the smart phone, iPhone, iPad, laptop,
tablet, fixed workstation of any other electronic device that is
used to interact as a user interface for the electronic medical
record.
[0052] FIG. 2A shows how a visual charting system is created and
operates. In box 70, configuration software creates in the database
persistent data defining images for medical documentation
templates, and the textual synonyms associated with such images.
The configuration software could alternatively create XML documents
with such data. Such database (or XML document) is represented at
72. The system includes software code represented at 74 which reads
and writes data and renders forms (document templates) on the
displays of the computing device used for visual charting. Such
forms include the images to represent complex medical concepts and
values (charted observations) as described herein using class
objects or XML, depending on the implementation. User interface
software 78 resident on the computing device displays the images to
represent unique concepts for Keys and Values to create Key/Value
pairs, and the user interacts with this software to create medical
documentation. As a result of the user interacting with the
software 78 during the visual charting, resulting medical documents
76 are created and stored in the database 18 of FIG. 1, which can
be in either text or image format, or in some other format.
[0053] An example of the use of visual charting will be now
described in conjunction with FIGS. 3-11. The display 100 of a
computing device (workstation 14, or portable computer 17 of FIG.
1) includes a text box 102 in which textual synonyms for images
displayed on the display and selected by the user is set forth for
the convenience of the user. The workstation includes a pointing
device such as mouse or touch sensitive screen which controls a
cursor 104 for making selection of images or portions of the image.
In this example, the display 100 shows two views 110 and 112 of a
human body and in particular the heart 108.
[0054] In general, the user interface of FIG. 3 displays an image
or images (110, 112 108) which can be used to select a specific
medical concept (key) and a specific value for the concept. In this
example the user is controlling the cursor 104 to point to the
trachea as part of the examination of the neck. The first click of
the mouse may set the Key or Parameter as the unique concept of
neck anatomic part "Trachea," which is represented with the
configuration of the database as a specific parameter or
observation (Key). The next click over the midline of the neck
indicates the value is "is midline." The selections just described
would lead to the saving of the Key/Value pair at the Class Object
Property level, the XML representation level and the database
level. If this note were to be recalled from the database,
"Key/Value" pair could recreate the annotation through
interpretation by the computer code.
[0055] In software relational database development and structured
note configuration, each row has a unique identifier often referred
to as the primary key. Each column of the table is an attribute of
the primary key. If the primary key is related to a row in another
table one of the columns will contain a pointer to that row and
this is known as the foreign key.
[0056] The primary and foreign key together is a type key/value
pair as are the descriptors for the rows, such as "Trachea/is
midline" in the preceding example. These concepts can have an image
synonym or a location on an image synonym. The interchangeable
nature of the image and image location synonyms is one of the
unique feature of this invention. The primary and foreign keys can
both be represented with language or visual image descriptors and
they are interchangeable.
[0057] Another example of selection of a Parameter/Key and
Value/Charted Observation is shown in FIG. 4. In this example, the
medical concept shown in the image is the Heart. The user moves the
cursor over the aortic valve area of the image and selects a
portion of the image, in this example selects the key of "aortic
valve auscultation" or simply "aortic valve." In response, the text
"aortic valve" appears in the window 120 of the text box 102
indicating this selection. Furthermore, selection of the parameter
"aortic valve" causes a set of images 130 on the left hand side of
the display to be presented. These images 130 provide a menu of
possible values or charted observations for the selected
parameter/key "aortic valve", and in this example the images 132,
134, 136 and 138 represent different types of murmurs. Referring to
FIG. 5, the first image 132 in the set or series 130 is selected as
indicated by the cursor position 104 by clicking, and then language
description shown at 140 is written to the form. The language
description correlates with the database row associated with the
selected parameter Aortic Valve. The database row contains a unique
identifier for image 132, for example a textual description for a
systolic crescendo/decrescendo murmur that begins shortly after the
first heart sound (closure of the mitral and tricuspid valves),
reaches a peak in volume just after mid-systole (ejection of the
blood from the left ventricle into the aorta) and tapers off in
late systole before the second heart sound (closure of the aortic
and pulmonary valves). This image 132 demonstrates a pathologic
condition of the aortic valve. This example demonstrates the
extraordinary efficiency of a small image (132) to convey and very
large and complex physiologic concept, and the simple act of
selecting such an image shortening the time needed to enter
associated information into a medical document. Instead of the
physician having to type this concept (or dictate it), the
physician can simply select the image and move on to recording
other observations regarding the patient.
[0058] Just as the images 130 come from a finite selection of
abnormal findings, the language descriptions of these abnormalities
are also finite in number and have a one to one correlation with
the images. Therefore, the image and its language descriptor relate
to a unique compound concept represented by a Key/Value pair.
[0059] The Key of a Key/Value pair (such as the Aortic Valve in
FIGS. 4 and 5 or the Trachea in FIG. 3) will have different values
depending on the patient answers or clinician observations.
[0060] On the charting forms (such as for example the charting form
or template shown in FIGS. 3-5) the keys are represented by images
or portions thereof, as are the values. In one example, selecting
an image (or portion thereof) to indicate selection of a key, such
as the Trachea, or Aortic Valve, causes the appearance of one or
more selectable images (130). Selecting an image in the set of
images 130 creates one key/value pair, e.g., Aortic Valve/systolic
diamond shaped murmur in the example of FIG. 5.
[0061] A structured medical note is typically made of many
key/value pairs. An example of how a structured medical note
consisting of many key/value pairs is constructed will be
demonstrated in FIG. 6 and the following figures. In essence, the
selection of parameters/keys and values as described above is
repeated as many times as deemed necessary by the user in order to
complete the creation of the note. For example, after the selection
of the value (image 132) for the aortic valve parameter, the user
moves the cursor 104 to another area of the heart as shown in FIG.
6. In this example the user holds the cursor over the mitral valve
area of the heart and clicks the mouse or otherwise selects that
portion of the image. The text box 102 now displays "mitral valve",
indicating the selection of mitral valve as the key/parameter. In
response, a new set of images 130 is displayed on the display, each
one of the images 150, 152, 154, 156, 158 associated with a
different murmur or observation ("Value") associated with the
mitral valve. In this example, and with reference to FIG. 7, the
user selected the image 150. This image is a synonym for a
text-based representation of a particular mitral valve murmur, in
this example a mid-systolic click followed by a 2/6 late systolic
crescendo murmur. The selection of image causes the additional text
shown at 160 to be added to the medical note. (Depending on space
constraints and the user interface design, the text shown in the
text box 102 may be a complete rendering of the textual synonym
associated with the selected image 150, or it may be a shorthand or
abbreviation of that textual synonym. In the case of an
abbreviation, the display may include a feature by which the user
can see displayed the entire text corresponding to the image, such
as a link or an icon which when selected causes a window to pop up
that displays the entire text).
[0062] Continuing on with FIG. 8, the user has now moved the cursor
over the triscuspid valve area of the heart and clicked the mouse,
thereby indicating selection of the tricuspid valve as the next Key
in a Key/Value pair. The selection of the tricuspid valve causes
the text "tricuspid valve" to appear in the window 120, confirming
the selection to the user. At this point, two new images appear in
the area 130 representing potential Values for this Key. The images
170 and 172 represent two murmur types associated with the
tricuspid valve. Referring to FIG. 9, the user moves the cursor
over to the image 170 and clicks it to indicate selection. The text
associated with the image 170 now appears in the text box 102.
[0063] Referring now to FIG. 10, the user has proceeded to move the
cursor 104 over to the pulmonary valve portion of the heart image
and selected it by clicking the mouse. The text "pulmonary valve"
now appears in the window 120. The selection of this Parameter/Key
causes a new set of images 190, 192, 194 and 196 to be displayed,
each one associated with different potential values for the
selected parameter "pulmonary valve." Referring to FIG. 11, the
user selects image 190 by moving the cursor 104 to the location of
the image and clicking the mouse, which causes the textual
description 200 associated with image 190 to appear in the text box
102 ("2/6 systolic diamond shaped murmur").
[0064] The process described above can of course continue further,
by the user selecting additional portions of the image of the body
or the heart to signify selection of different parameters and then
selecting one of the images associated with different values for
the selected parameter. Additional tools for going back, saving,
editing, selection of different organ systems, and so on are not
shown but can of course be part of the user interface design, and
these details are considered within the ability of persons skilled
in the art.
[0065] In the software code, in one possible embodiment the
key/value pairs are represented as class objects, class members,
properties and property values. More than one class object may be
defined as part of the coding process. If a note has been started
and saved but not finalized, the note may be opened in an edit
mode, in which case the software code will read the key/value pairs
from the database or XML document containing the key/value pairs
selected in a prior session, populate the class objects and
property values or XML, and render the form with the image
representation of the saved data.
[0066] In some cases, visual charting of key/value pairs will be
used to display text when the document is rendered to the user. In
other cases, the key/value pairs can be used to render charted
values displayed or superimposed on images. A unique feature the
invention is the interchangeability of the image synonyms and
specific image locations with the language descriptors of the
specific concepts.
[0067] The recorded, saved and persisted data can be stored in a
database, or as a text file with a specific format such as XML. The
computer code can be written in any language capable of rendering a
form, reading and writing to a database and reading or writing to
XML or other formatted text file and creating an object or object
like structure in which member and properties can be assigned
values, methods can be created and object state can be loaded from
a persistent data representation or unloaded to a persistent data
representation. An example of such code is set forth below:
TABLE-US-00001 Object Oriented Class Class Physical_Exam Private
Cardiac_S1 as string Private Cardiac_S2 as string Private
Cardiac_S3 as string Private Cardiac_S4 as string Private
Cardiac_Aortic_Value as string Private Cardiac_Mitral_Value as
string Private Cardiac_Tricuspid_Value as string Private
Cardiac_Pulmonary_Value as string Public Property pCardiac_S1 as
String Get RETURN Cardiac_S1 End Get Set (ByVal value As String)
Cardiac_S1 = value End Set ...... End Class
[0068] There are many potential commercial use(s) for the
invention: Hospital Clinician Charting; Medical Office Clinician
Charting; Long-term care facility Clinician Charting; Nursing Home
Clinician Charting; Rehabilitation facility Clinician Charting; and
Clinician Charting on Mobile User Interface Platforms, including
smart phones, iPhones, iPads, Pocket PCs, or any other mobile
device used for medical charting. Additionally, the computer device
used for medical charting can include laptop computers, tablet
computers and fixed workstations. The invention is suitable for
touch screen user interface systems. In general, any computing
device having a processing unit, a memory storing software computer
instructions and a user interface adapted for medical charting
against an electronic medical record can be used.
[0069] In view of the above description, it will be appreciated
that a method of creating a medical document using a computing
device (14/17) having a display using visual charting has been
described, comprising the steps of:
[0070] (a) presenting on the display (FIG. 4) an image representing
a medical concept, such as an organ or organ system of a human or
animal body (e.g., the heart in FIG. 4);
[0071] (b) enabling selection of a parameter associated with the
medical concept by selecting a portion of the image corresponding
to the parameter (e.g., selection of the parameter "aortic valve"
in FIG. 4);
[0072] (c) responsive to the selecting in step (b), presenting on
the display a set of images (130, FIG. 4) comprising possible
values associated with selected parameter;
[0073] (d) enabling selection one of the images in the set of
images presented in step (c) (selection occurring by clicking the
cursor while the cursor is over the image as shown in FIG. 5, or by
means of touching the image in a touch sensitive display
embodiment); and
[0074] (e) constructing a medical document based on the selecting
in steps (b) and step (d) (see FIG. 4, text box 102) and storing
the medical document in a computer system (FIG. 1, e.g., in the
database 18) wherein the images selected in steps (b) and (d) are
interchangeable with a language description of the selected
parameter and the selected value of the selected parameter.
[0075] It will further be appreciated from the foregoing
description that a new and improved computing device for visual
charting has been described. The computing device (FIG. 1, 14, or
17) has a display (FIG. 4), and memory, not shown but conventional)
storing instructions for execution by a processing unit (not shown,
but conventional) in the device. The improvement takes the form of
a visual charting application coded as a set of instructions
executed by the device, described by way of example in FIGS. 4-11),
wherein creation of a medical document by the visual charting
application is performed by selection of images presented on the
display of the computing device, the images including images of a
first type acting as a synonym for a medical parameter (e.g., the
image of the heart or a portion thereof corresponding to a
particular valve) and images of a second type (images 130 in FIGS.
4-11) acting as synonyms of values of the medical parameter,
wherein a selection by the user of an image of the first type
(selection of aortic valve in FIG. 4) causing a display of a set of
images of the second type to be presented on the display (FIG. 4,
images 132, 134, 136 and 138).
[0076] In still another aspect, a method of creating electronic
medical documents has been described comprising the steps of:
[0077] creating a data structure (e.g., XML document) with
persistent data comprising descriptive information associated with
a plurality images to be presented on a medical documentation
template displayed on a computing device, the images representing
medical concepts such as an organ or organ system of a human or
animal body;
[0078] rendering one of the images in the medical documentation
template on the computing device (FIG. 4);
[0079] receiving a user selection on the computing device of a
parameter of the medical concept by selecting a feature in the
image corresponding to the parameter (FIG. 4, selection of "aortic
valve" feature of the heart image);
[0080] responsively displaying on the display a set of images
associated with values of the selected parameter (display of images
132, 134, 136, 138, FIG. 4);
[0081] receiving a selection of one of the images in the set of
images (FIG. 5, clicking on the image 132); and
[0082] creating a medical document reflecting the selection of the
images and storing the medical document in a database (FIG. 1,
18).
[0083] While a number of exemplary aspects and embodiments have
been discussed above, those of skill in the art will recognize that
various modifications, permutations, and additions are possible. It
is therefore intended that the following appended claims and claims
hereafter introduced are interpreted to include all such
modifications, permutations, additions and sub-combinations as are
within their true spirit and scope.
* * * * *