U.S. patent application number 15/902193 was filed with the patent office on 2018-08-30 for system for displaying medical monitoring data.
The applicant listed for this patent is Masimo Corporation. Invention is credited to Peter Scott Housel, Massi Joe E. Kiani, Bilal Muhsin.
Application Number | 20180247712 15/902193 |
Document ID | / |
Family ID | 61691560 |
Filed Date | 2018-08-30 |
United States Patent
Application |
20180247712 |
Kind Code |
A1 |
Muhsin; Bilal ; et
al. |
August 30, 2018 |
SYSTEM FOR DISPLAYING MEDICAL MONITORING DATA
Abstract
A patient monitoring hub can communicate bidirectionally with
external devices such as a board-in-cable or a dongle. Medical data
can be communicated from the patient monitoring hub to the external
devices to cause the external devices to initiate actions. For
example, an external device can perform calculations based on data
received from the patient monitoring hub, or take other actions
(for example, creating a new patient profile, resetting baseline
values for algorithms, calibrating algorithms, etc.). The external
device can also communicate display characteristics associated with
its data to the monitoring hub. The monitoring hub can calculate a
set of options for combined layouts corresponding to different
external devices or parameters. A display option may be selected
for arranging a display screen estate on the monitoring hub.
Inventors: |
Muhsin; Bilal; (San
Clemente, CA) ; Kiani; Massi Joe E.; (Laguna Niguel,
CA) ; Housel; Peter Scott; (Irvine, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Masimo Corporation |
Irvine |
CA |
US |
|
|
Family ID: |
61691560 |
Appl. No.: |
15/902193 |
Filed: |
February 22, 2018 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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62463452 |
Feb 24, 2017 |
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62463614 |
Feb 25, 2017 |
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62594398 |
Dec 4, 2017 |
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62594504 |
Dec 4, 2017 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G08B 21/02 20130101;
A61B 5/746 20130101; A61B 5/744 20130101; G16H 50/30 20180101; A61B
5/0205 20130101; A61M 2205/18 20130101; A61B 5/002 20130101; A61B
2562/225 20130101; A61B 5/7445 20130101; G16H 40/40 20180101; A61M
2205/3561 20130101; A61B 2562/222 20130101; G16H 10/60 20180101;
G06F 21/84 20130101; A61B 2560/045 20130101; A61M 2205/52 20130101;
A61B 5/743 20130101; A61M 5/14 20130101; G08B 29/06 20130101; A61M
2205/505 20130101; G16H 40/60 20180101; G16H 40/63 20180101; G16H
40/67 20180101; A61B 5/7435 20130101 |
International
Class: |
G16H 40/63 20060101
G16H040/63; G16H 50/30 20060101 G16H050/30; G08B 21/02 20060101
G08B021/02; A61B 5/00 20060101 A61B005/00 |
Claims
1. A medical device cable configured to be connectable to a patient
monitoring hub, the medical device cable comprising: a main cable
portion; a board-in-cable device without a display, the
board-in-cable device connected to the main cable portion and
configured to couple with a sensor configured to obtain
physiological information from a patient; a connector connected to
the main cable portion, the connector configured to connect to a
patient monitoring hub; the board-in-cable device comprising a
hardware processor configured to: calculate a first physiological
parameter based on the physiological information; receive a second
physiological parameter from the patient monitoring hub, the second
physiological parameter provided by a second board-in-cable device
of a second medical device cable also connected to the patient
monitoring hub; process the first and second physiological
parameters to generate a third physiological parameter; and
communicate the third physiological parameter to the patient
monitoring hub so that the patient monitoring hub is configured to
output the third physiological parameter on a display of the
patient monitoring hub.
2. The medical device cable of claim 1, wherein the third
physiological parameter represents a wellness index.
3. The medical device cable of claim 1, wherein the hardware
processor is further configured to: determine a display
characteristic associated with the third physiological parameter,
wherein the display characteristic comprises a display layout
associated with the third physiological parameter; and communicate
the display characteristic to the patient monitoring hub.
4. The medical device cable of claim 1, wherein said communication
of the display characteristic to the medical monitoring hub causes
the patient monitoring hub to override a native display
characteristic with the display characteristic.
5. The medical device cable of claim 1, wherein the hardware
processor is further configured to access an application
programming interface associated with the patient monitoring hub to
cause the patient monitoring hub to output a settings user
interface.
6. The medical device cable claim 5, wherein the settings user
interface is user-selectable to cause the board-in-cable device to
receive an updated setting from the settings user interface.
7. The medical device cable of claim 6, wherein the updated setting
comprises adjusting a limit of an alarm.
8. The medical device cable of claim 6, wherein the updated setting
comprises enabling a function of the board-in-cable device.
9. The medical device cable of claim 1, wherein the hardware
processor is further configured to receive an indication from the
patient monitoring hub that a new patient has connected with the
patient monitoring hub.
10. The medical device cable of claim 9, wherein the hardware
processor is further configured to do one or more of the following
responsive to receiving the indication: reset a parameter
calculation algorithm and reset a baseline calculation.
11. A method of sharing data between connected medical devices, the
method comprising: under control of a hardware processor of a first
medical device cable: calculating a first physiological parameter
based on physiological information received from a sensor coupled
with the medical device cable; receiving a second physiological
parameter from a patient monitoring hub connected to the first
medical device cable, the second physiological parameter calculated
by either the patient monitor or by a second medical device cable
also connected to the patient monitoring hub; processing the first
and second physiological parameters to generate a third
physiological parameter; and communicating the third physiological
parameter to the patient monitoring hub so that the medical
monitoring hub can output the third physiological parameter on a
display.
12. The method of claim 11, wherein the third physiological
parameter represents a wellness index.
13. The method of claim 11, further comprising sending a function
call to the patient monitoring hub to cause the patient monitoring
hub to output a settings user interface.
14. The method of claim 13, further comprising receiving a setting
from the settings user interface.
15. The method of claim 14, wherein the setting comprises: an
adjusted alarm limit or a toggle to enable a function of the
medical device cable.
16. The method of claim 11, further comprising receiving an
indication from the patient monitoring hub that a new patient has
connected with the patient monitoring hub.
17. The method of claim 16, further comprising adjusting a
parameter calculation algorithm based on the indication.
18. A method of controlling an operation of an external device
connected to a patient monitoring hub, the method comprising: under
control of a hardware processor of a patient monitoring hub
connectable to a plurality of external devices to the patient
monitoring hub, the external devices comprising a wireless dongle,
a board-in-cable, or both: receiving device information of a first
one of the external devices at the patient monitoring hub, the
device information comprising a display characteristic associated
with a patient parameter monitored by the first external device;
establishing a connection between the patient monitoring hub and
the first external device; generating, based at least in part on
the display characteristic, a user interface element for managing
the patient parameter at the patient monitoring hub; detecting an
actuation of the user interface element on a display of the patient
monitoring hub; determining one or more adjustments associated with
the patient parameter in response to the actuation of the user
interface element; and communicating the one or more adjustments to
the patient parameter to the first external device, causing the
first external device to automatically update its operation based
on the one or more adjustments.
19. The method of claim 18, wherein the display characteristic
comprises an instruction to call a graphics library on the patient
monitoring hub to draw the user interface element.
20. The method of claim 18, wherein the device information
comprises at least one of: a measurement channel supported by the
first external device, measured parameters, or display layouts for
the measured parameters.
21. The method of claim 18, wherein the one or more adjustments
associated with the patient parameter comprises an adjustment to a
value which triggers an alarm associated with the patient
parameter.
22. The method of claim 18, the one or more adjustments to the
patient parameter further cause the first external device to enable
or disable a function associated with the patient parameter.
23. The method of claim 18, further comprising: detecting a
triggering event for updating a setting of the external device and
communicate information of the triggering event to the first
external device which causes the external device to automatically
change the setting in response.
24. The method of claim 18, further comprising: sending data of
another parameter to the first external device, the other parameter
being acquired by a second one of the external devices, wherein the
data of another parameter automatically triggers the second
external device to perform a second operation.
25. The method of claim 24, wherein the second operation performed
comprises calibrating an algorithm for calculating the patient
parameter at the second external device.
Description
INCORPORATION BY REFERENCE TO ANY PRIORITY APPLICATIONS
[0001] Any and all applications, if any, for which a foreign or
domestic priority claim is identified in the Application Data Sheet
of the present application are hereby incorporated by reference
under 37 CFR 1.57.
BACKGROUND
[0002] Today's patient monitoring environments are crowded with
sophisticated and often electronic medical devices servicing a wide
variety of monitoring and treatment endeavors for a given patient.
Generally, many if not all of the devices are from differing
manufactures, and many may be portable devices. The devices may not
communicate with one another and each may include its own control,
display, alarms, configurations and the like. Complicating matters,
caregivers often desire to associate all types of measurement and
use data from these devices to a specific patient. Thus, patient
information entry often occurs at each device. Sometimes, the
disparity in devices leads to a need to simply print and store
paper from each device in a patient's file for caregiver
review.
[0003] The result of such device disparity is often a caregiver
environment scattered with multiple displays and alarms leading to
a potentially chaotic experience. Such chaos can be detrimental to
the patient in many situations including surgical environments
where caregiver distraction is unwanted, and including recovery or
monitoring environments where patient distraction or disturbance
may be unwanted.
[0004] Various manufacturers produce multi-monitor devices or
devices that modularly expand to increase the variety of monitoring
or treatment endeavors a particular system can accomplish. However,
as medical device technology expands, such multi-monitor devices
begin to be obsolete the moment they are installed.
SUMMARY
[0005] In some aspects, a medical device cable can be configured to
be connectable to a patient monitoring hub. The medical device
cable can comprise: a main cable portion; a board-in-cable device
without a display, the board-in-cable device connected to the main
cable portion and configured to couple with a sensor configured to
obtain physiological information from a patient; a connector
connected to the main cable portion, the connector configured to
connect to a patient monitoring hub; the board-in-cable device
comprising a hardware processor configured to: calculate a first
physiological parameter based on the physiological information;
receive a second physiological parameter from the patient
monitoring hub, the second physiological parameter provided by a
second board-in-cable device of a second medical device cable also
connected to the patient monitoring hub; process the first and
second physiological parameters to generate a third physiological
parameter; and communicate the third physiological parameter to the
patient monitoring hub so that the patient monitoring hub is
configured to output the third physiological parameter on a display
of the patient monitoring hub.
[0006] The medical device cable in the preceding paragraph can also
include one or more of the following features. The third
physiological parameter can represent a wellness index. The
hardware processor can further be configured to: determine a
display characteristic associated with the third physiological
parameter, wherein the display characteristic comprises a display
layout associated with the third physiological parameter; and
communicate the display characteristic to the patient monitoring
hub. The communication of the display characteristic to the medical
monitoring hub can cause the patient monitoring hub to override a
native display characteristic with the display characteristic. The
hardware processor can further be configured to access an
application programming interface associated with the patient
monitoring hub to cause the patient monitoring hub to output a
settings user interface. The settings user interface can be
user-selectable to cause the board-in-cable device to receive an
updated setting from the settings user interface. The updated
setting can comprise adjusting a limit of an alarm. The updated
setting can comprise enabling a function of the board-in-cable
device. The hardware processor can further be configured to receive
an indication from the patient monitoring hub that a new patient
has connected with the patient monitoring hub. The hardware
processor can further be configured to do one or more of the
following responsive to receiving the indication: reset a parameter
calculation algorithm and reset a baseline calculation.
[0007] In some aspects, a method of sharing data between connected
medical devices is described. The method can be performed under
control of a hardware processor of a first medical device cable.
The method can comprise: calculating a first physiological
parameter based on physiological information received from a sensor
coupled with the medical device cable; receiving a second
physiological parameter from a patient monitoring hub connected to
the first medical device cable, the second physiological parameter
calculated by either the patient monitor or by a second medical
device cable also connected to the patient monitoring hub;
processing the first and second physiological parameters to
generate a third physiological parameter; and communicating the
third physiological parameter to the patient monitoring hub so that
the medical monitoring hub can output the third physiological
parameter on a display.
[0008] The method of the preceding paragraph can also include one
or more of the following features. The third physiological
parameter can represent a wellness index. The method can further
comprise sending a function call to the patient monitoring hub to
cause the patient monitoring hub to output a settings user
interface. The method can further comprise receiving a setting from
the settings user interface. The setting can comprise: an adjusted
alarm limit or a toggle to enable a function of the medical device
cable. The method can further comprise receiving an indication from
the patient monitoring hub that a new patient has connected with
the patient monitoring hub. The method can further comprise
adjusting a parameter calculation algorithm based on the
indication.
[0009] In some aspects, a method of controlling an operation of an
external device connected to a patient monitoring hub is described.
The method can be performed under control of a hardware processor
of a patient monitoring hub connectable to a plurality of external
devices to the patient monitoring hub, the external devices
comprising a wireless dongle, a board-in-cable, or both. The method
can comprise: receiving device information of a first one of the
external devices at the patient monitoring hub, the device
information comprising a display characteristic associated with a
patient parameter monitored by the first external device;
establishing a connection between the patient monitoring hub and
the first external device; generating, based at least in part on
the display characteristic, a user interface element for managing
the patient parameter at the patient monitoring hub; detecting an
actuation of the user interface element on a display of the patient
monitoring hub; determining one or more adjustments associated with
the patient parameter in response to the actuation of the user
interface element; and communicating the one or more adjustments to
the patient parameter to the first external device, causing the
first external device to automatically update its operation based
on the one or more adjustments.
[0010] The method of the preceding paragraph can also include one
or more of the following features. The display characteristic can
comprise an instruction to call a graphics library on the patient
monitoring hub to draw the user interface element. The device
information can comprise at least one of: a measurement channel
supported by the first external device, measured parameters, or
display layouts for the measured parameters. The one or more
adjustments associated with the patient parameter can comprise an
adjustment to a value which can trigger an alarm associated with
the patient parameter. The one or more adjustments to the patient
parameter can further cause the first external device to enable or
disable a function associated with the patient parameter. The
method can further comprise: detecting a triggering event for
updating a setting of the external device and communicate
information of the triggering event to the first external device
which causes the external device to automatically change the
setting in response. The method can further comprise: sending data
of another parameter to the first external device, the other
parameter being acquired by a second one of the external devices,
wherein the data of another parameter automatically can trigger the
second external device to perform a second operation. The second
operation performed can comprise calibrating an algorithm for
calculating the patient parameter at the second external
device.
[0011] In some aspects, a patient monitoring hub connectable to a
plurality of sensors, the patient monitoring hub can comprise: a
plurality of ports operable to be in communication with a plurality
of sensors; a display; and a hardware processor configured to:
identify a plurality of parameters to be displayed by the patient
monitoring hub based at least in part on the sensors connected to
the patient monitoring hub; determine display characteristics
corresponding to the plurality of parameters; generate a set of
display layout options based on the display characteristics
corresponding to the plurality of parameters; automatically
populate a display layout manager with the set of display layout
options; receive a user selection of one of the display layout
options; and output the plurality of parameters on the display
according to the selected display layout option.
[0012] The patient monitoring hub of the preceding paragraph can
also include one or more of the following features. The hardware
processor can further be configured to: detect a change to the
plurality of medical devices or the plurality of parameters; and
automatically update the set of display layout options and the
display layout manager based at least in part on the change. The
change can comprise an addition or a removal of a sensor or a
parameter. The display characteristics can be automatically
provided to the patient monitoring hub by the sensor while the
sensor and the patient monitoring hub are establishing a
connection. The display characteristics can comprise at least one
of: an instruction to call a graphics library on the patient
monitoring hub to draw the user interface element; a set of
preconfigured display layouts for a parameter; layout restrictions
for displaying information of the parameter; or images or texts
associated with displaying the parameter. The plurality of
parameters can comprise a parameter calculated by the patient
monitoring hub. The display can be divided into a plurality of
subdivisions wherein each subdivision comprises one or more
parameters. The hardware processor can be further configured to:
receive a user input for adjusting a size or location of a
subdivision; and automatically update displays of parameters in the
plurality of subdivisions in response to the user input. The
hardware processor can be further configured to automatically
select a display layout option among the set of display layout
options and automatically render information of the plurality of
parameters in accordance with the selected display layout
option.
[0013] In some aspects, a method of managing displays of a patient
monitoring hub is described. The method can be performed under
control of a hardware processor of a patient monitoring hub
comprising a display. The method can comprise: identifying a
plurality of medical devices connected to a patient monitoring hub;
identify a plurality of parameters to be displayed by the patient
monitoring hub based at least in part on information of the
plurality of medical devices; determining display characteristics
corresponding to the plurality of parameters; generating a set of
display layout options based on the display characteristics
corresponding to the plurality of parameters; automatically
populating a display layout manager with the set of display layout
options; and rendering the display layout manager with the set of
display layout options on the display of the medical monitoring
hub.
[0014] The method of the preceding paragraph can also include one
or more of the following features. The method can further comprise
detecting a change to the plurality of medical devices or the
plurality of parameters; and automatically updating the set of
display layout options and the display layout manager based at
least in part on the change. The change can comprise an addition or
a removal of a medical device or a parameter. The display
characteristics can be automatically provided to the patient
monitoring hub by the medical device while the medical device and
the patient monitoring hub are establishing a connection. The
display characteristics can comprise at least one of: an
instruction to call a graphics library on the patient monitoring
hub to draw the user interface element; a set of preconfigured
display layouts for a parameter; layout restrictions for displaying
information of the parameter; or images or texts associated with
displaying the parameter. The plurality of parameters can comprise
a parameter calculated by the patient monitoring hub. The display
can be divided into a plurality of subdivisions wherein each
subdivision comprises one or more parameters. The method can
further comprise receiving a user input for adjusting a size or
location of a subdivision; and automatically updating displays of
parameters in the plurality of subdivisions in response to the user
input. The method can further comprise: automatically selecting a
display layout option among the set of display layout options; and
automatically rendering information of the plurality of parameters
in accordance with the selected display layout option. A parameter
can be displayed with a user interface element for managing a
feature on a medical device which can provide data of the parameter
to the monitoring hub, and the method can further comprise
receiving a user input for the user interface element and
communicate to the medical device of the user input to manage the
feature on the medical device.
[0015] For purposes of summarizing the disclosure, certain aspects,
advantages and novel features are discussed herein. It is to be
understood that not necessarily all such aspects, advantages or
features will be embodied in any particular example of the
invention and an artisan would recognize from the disclosure herein
a myriad of combinations of such aspects, advantages or
features.
BRIEF DESCRIPTION OF THE DRAWINGS
[0016] The following drawings and the associated descriptions are
provided to illustrate examples of the present disclosure and do
not limit the scope of the claims.
[0017] FIGS. 1A-1C illustrate perspective views of an example
medical monitoring hub. For example, FIG. 1A illustrates the hub
with an example docked portable patient monitor, FIG. 1B
illustrates the hub with a set of medical ports and a noninvasive
blood pressure input, and FIG. 1C illustrates the hub with various
example temperature sensors attached thereto.
[0018] FIG. 2 illustrates a simplified block diagram of an example
monitoring environment including the hub of FIG. 1.
[0019] FIG. 3 illustrates a simplified example hardware block
diagram of the hub of FIG. 1.
[0020] FIG. 4 illustrates a perspective view of an example
removable docking station of the hub of FIG. 1.
[0021] FIG. 5 illustrates a perspective view of example portable
patient monitors undocked from the hub of FIG. 1. Moreover, FIG. 5
illustrates an example alternative docking station.
[0022] FIG. 6 illustrates a simplified block diagram of traditional
patient device electrical isolation principles.
[0023] FIG. 7A illustrates a simplified block diagram of an example
optional patient device isolation system of the disclosure, while
FIG. 7B adds example optional non-isolation power levels for the
system of FIG. 7A.
[0024] FIG. 8 illustrates a simplified example universal medical
connector configuration process.
[0025] FIGS. 9A-9B, 10, 11A-11F, 11G1-11G2, and 11H-11K illustrate
simplified block diagrams of example universal medical connectors
having a size and shape smaller in cross section than tradition
isolation requirements.
[0026] FIG. 10 illustrates a perspective view of a side of the hub
of FIG. 1, showing example instrument-side channel inputs for
example universal medical connectors.
[0027] FIGS. 11A-11F, 11G1-11G2, and 11H-11K illustrate various
views of example male and mating female universal medical
connectors.
[0028] FIG. 12 illustrates a simplified block diagram of a channel
system for the hub of FIG. 1.
[0029] FIG. 13 illustrates an example logical channel
configuration.
[0030] FIG. 14 illustrates a simplified example process for
constructing a cable and configuring a channel.
[0031] FIG. 15 illustrates a perspective view of the hub of FIG. 1,
including an example attached board-in-cable to form an input
channel.
[0032] FIG. 16 illustrates a perspective view of a back side of the
hub of FIG. 1, showing an example instrument-side serial data
inputs.
[0033] FIG. 17A illustrates an example monitoring environment with
communication through the serial data connections of FIG. 16.
[0034] FIG. 17B illustrates an example connectivity display of the
hub of FIG. 1.
[0035] FIG. 18 illustrates a simplified example patient data flow
process.
[0036] FIGS. 19A-19J illustrate example displays of anatomical
graphics for the portable patient monitor of FIG. 1 docked with the
hub of FIG. 1.
[0037] FIGS. 20A-20C illustrate example displays of measurement
data showing data separation and data overlap on a display of the
hub of FIG. 1, respectively.
[0038] FIGS. 21A and 21B illustrate example displays of measurement
data showing data separation and data overlap on a display of the
portable patient monitor of FIG. 1, respectively.
[0039] FIGS. 22A and 22B illustrate example analog display
indicia.
[0040] FIGS. 23A-23F illustrate example displays of measurement
data showing, for example, data presentation in FIGS. 23A-23D when
a depth of consciousness monitor is connected to a channel port of
the hub of FIG. 1, data presentation in FIG. 23E when temperature
and blood pressure sensors communicate with the hub of FIG. 1 and
data presentation in FIG. 23F when an acoustic sensor is also
communicating with the hub of FIG. 1.
[0041] FIG. 24 illustrates another example of a monitoring
environment including the hub of FIG. 1.
[0042] FIG. 25 illustrates a translation message handling
process.
[0043] FIGS. 26-39 and 46-71 illustrate additional example hub
displays, including displays of measurement data.
[0044] FIG. 40A illustrates an example first medical device and an
example second medical device that communicate with one another via
a translation module.
[0045] FIG. 40B illustrates an example first medical device and an
example second medical device that communicate with one another via
a translation module and a communication bus.
[0046] FIG. 41A illustrates an example input message received by
the translation module.
[0047] FIG. 41B illustrates an example message header segment of an
input message that has been parsed into fields.
[0048] FIG. 41C illustrates an example encoded version of the
parsed message header segment of FIG. 41B.
[0049] FIG. 41D illustrates an example output message of the
translation module based on the input message of FIG. 41A.
[0050] FIG. 42 illustrates an example translation process for
generating an output message based on an input message and a
comparison with translation rules associated with the translation
module.
[0051] FIG. 43A illustrates an example translation process in which
the translation module facilitates communication of an HL7 message
from a Hospital Information System ("HIS") having a first HL7
format to an intended recipient medical device having a second HL7
format.
[0052] FIG. 43B illustrates an example translation process in which
the translation module facilitates communication of an HL7 message
from a medical device having a first HL7 format to a HIS having a
second HL7 format.
[0053] FIG. 44 illustrates an example screenshot from a messaging
implementation tool for manually configuring translation rules to
be used by the translation module.
[0054] FIGS. 45A and 45B illustrate example automatic rule
configuration processes that can be performed by the translation
module.
[0055] FIGS. 45C and 45D illustrate example automatic rule
configuration processes that can be performed by the translation
module for messages utilizing the HL7 protocol.
[0056] FIGS. 46-71 illustrate additional example hub displays,
including displays of measurement data.
[0057] FIG. 72A illustrates an example of interfacing with the hub
using a board-in-cable.
[0058] FIG. 72B illustrates an example of interfacing the hub with
an external sensor using a dongle.
[0059] FIG. 73A illustrates an example computing environment of
communications between sensors and the monitoring hub.
[0060] FIGS. 73B, 73C, and 73D illustrate example processes for
various aspects of communications between the hub and external
devices.
[0061] FIG. 73E illustrates example user interface elements of a
monitoring hub for remotely controlling one or more operations of
an external device.
[0062] FIG. 74 illustrates some example features of a software
development kit.
[0063] FIGS. 75A and 75B show example user interfaces of a display
layout manager.
[0064] FIGS. 76A, 76B, 76C illustrate examples of a configurable
display screen of the monitoring hub.
[0065] FIG. 77 illustrates an example process of configuring a
monitoring hub's display.
[0066] While the foregoing "Brief Description of the Drawings"
references generally various examples of the disclosure, an artisan
will recognize from the disclosure herein that such examples are
not mutually exclusive. Rather, the artisan would recognize a
myriad of combinations of some or all of such examples.
DETAILED DESCRIPTION
I. Introduction
[0067] Based on at least the foregoing, a solution is needed that
coordinates the various medical devices treating or monitoring a
patient Such a solution can provide patient identification
seamlessly across the device space and such a solution can expand
for future technologies without necessarily requiring repeated
software upgrades. In addition, such a solution may include patient
electrical isolation where desired.
[0068] Therefore, the present disclosure relates to a patient
monitoring hub that is the center of patient monitoring and
treatment activities for a given patient. The patient monitoring
hub can interface with legacy devices without necessitating legacy
reprogramming, provide flexibility for interfacing with future
devices without necessitating software upgrades, and offer optional
patient electrical isolation. The hub may include a large display
dynamically providing information to a caregiver about a wide
variety of measurement or otherwise determined parameters.
Additionally or optionally, the hub can include a docking station
for a portable patient monitor. The portable patient monitor may
communicate with the hub through the docking station or through
various wireless paradigms known to an artisan from the disclosure
herein, including WiFi, Bluetooth, Zigbee, or the like.
[0069] The portable patient monitor can modify its screen when
docked. The undocked display indicia is in part or in whole
transferred to a large dynamic display of the hub and the docked
display presents one or more anatomical graphics of monitored body
parts. For example, the display may present a heart, lungs, a
brain, kidneys, intestines, a stomach, other organs, digits,
gastrointestinal systems or other body parts when it is docked. The
anatomical graphics may advantageously be animated. The animation
may generally follow the behavior of measured parameters, such as,
for example, the lungs may inflate in approximate correlation to
the measured respiration rate and/or the determined inspiration
portion of a respiration cycle, and likewise deflate according to
the expiration portion of the same. The heart may beat according to
the pulse rate, may beat generally along understood actual heart
contraction patterns, and the like. Moreover, when the measured
parameters indicate a need to alert a caregiver, a changing
severity in color may be associated with one or more displayed
graphics, such as the heart, lungs, brain, or the like. The body
portions may include animations on where, when or how to attach
measurement devices to measurement sites on the patient. For
example, the monitor may provide animated directions for CCHD
screening procedures or glucose strip reading protocols, the
application of a forehead sensor, a finger or toe sensor, one or
more electrodes, an acoustic sensor, and ear sensor, a cannula
sensor or the like.
[0070] The present disclosure relates to a medical monitoring hub
configured to be the center of monitoring activity for a given
patient. The hub can comprise a large easily readable display, such
as an about ten (10) inch display dominating the majority of real
estate on a front face of the hub. The display could be much larger
or much smaller depending upon design constraints. However, for
portability and current design goals, the preferred display is
roughly sized proportional to the vertical footprint of one of the
dockable portable patient monitors. Other considerations are
recognizable from the disclosure herein by those in the art.
[0071] The display can provide measurement data for a wide variety
of monitored parameters for the patient under observation in
numerical or graphic form, and can be automatically configured
based on the type of data and information being received at the
hub. The hub can be movable, portable, and mountable so that it can
be positioned to convenient areas within a caregiver environment.
For example, the hub can be collected within a singular
housing.
[0072] The hub may advantageously receive data from a portable
patient monitor while docked or undocked from the hub. Typical
portable patient monitors, such as oximeters or co-oximeters can
provide measurement data for a large number of physiological
parameters derived from signals output from optical and/or acoustic
sensors, electrodes, or the like. The physiological parameters
include, but not limited to oxygen saturation, carboxy hemoglobin,
methemoglobin, total hemoglobin, glucose, pH, bilirubin, fractional
saturation, pulse rate, respiration rate, components of a
respiration cycle, indications of perfusion including perfusion
index, signal quality and/or confidences, plethysmograph data,
indications of wellness or wellness indexes or other combinations
of measurement data, audio information responsive to respiration,
ailment identification or diagnosis, blood pressure, patient and/or
measurement site temperature, depth of sedation, organ or brain
oxygenation, hydration, measurements responsive to metabolism,
combinations of the same or the like, to name a few. The hub may
output data sufficient to accomplish closed-loop drug
administration in combination with infusion pumps or the like.
[0073] The hub can communicate with other devices in a monitoring
environment that are interacting with the patient in a number of
ways. For example, the hub advantageously receives serial data from
other devices without necessitating their reprogramming or that of
the hub. Such other devices include pumps, ventilators, all manner
of monitors monitoring any combination of the foregoing parameters,
ECG/EEG/EKG devices, electronic patient beds, and the like.
Moreover, the hub advantageously receives channel data from other
medical devices without necessitating their reprogramming or that
of the hub. When a device communicates through channel data, the
hub may advantageously alter the large display to include
measurement information from that device. Additionally, the hub
accesses nurse call systems to ensure that nurse call situations
from the device are passed to the appropriate nurse call
system.
[0074] The hub also communicates with hospital systems to
advantageously associate incoming patient measurement and treatment
data with the patient being monitored. For example, the hub may
communicate wirelessly or otherwise to a multi-patient monitoring
system, such as a server or collection of servers, which in turn
many communicate with a caregiver' s data management systems, such
as, for example, an Admit, Discharge, Transfer ("ADT") system
and/or an Electronic Medical Records ("EMR") system. The hub
advantageously associates the data flowing through it with the
patient being monitored thereby providing the electronic
measurement and treatment information to be passed to the
caregiver' s data management systems without the caregiver
associating each device in the environment with the patient.
[0075] The hub may advantageously include a reconfigurable and
removable docking station. The docking station may dock additional
layered docking stations to adapt to different patient monitoring
devices. Additionally, the docking station itself is modularized so
that it may be removed if the primary dockable portable patient
monitor changes its form factor. Thus, the hub is flexible in how
its docking station is configured.
[0076] The hub may include a large memory for storing some or all
of the data it receives, processes, and/or associates with the
patient, and/or communications it has with other devices and
systems. Some or all of the memory may advantageously comprise
removable SD memory.
[0077] The hub communicates with other devices through at least (1)
the docking station to acquire data from a portable monitor, (2)
innovative universal medical connectors to acquire channel data,
(3) serial data connectors, such as RJ ports to acquire output
data, (4) Ethernet, USB, and nurse call ports, (5) Wireless devices
to acquire data from a portable monitor, (6) other wired or
wireless communication mechanisms known to an artisan. The
universal medical connectors advantageously provide optional
electrically isolated power and communications, are designed to be
smaller in cross section than isolation requirements. The
connectors and the hub communicate to advantageously translate or
configure data from other devices to be usable and displayable for
the hub. A software development kit ("SDK") can be provided to a
device manufacturer to establish or define the behavior and meaning
of the data output from their device. When the output is defined,
the definition is programmed into a memory residing in the cable
side of the universal medical connector and supplied as an original
equipment manufacture ("OEM") to the device provider. When the
cable is connected between the device and the hub, the hub
understands the data and can use it for display and processing
purposes without necessitating software upgrades to the device or
the hub. The hub can negotiate the schema and even add additional
compression and/or encryption. Through the use of the universal
medical connectors, the hub organizes the measurement and treatment
data into a single display and alarm system effectively and
efficiently bringing order to the monitoring environment.
[0078] As the hub receives and tracks data from other devices
according to a channel paradigm, the hub may advantageously provide
processing to create virtual channels of patient measurement or
treatment data. A virtual channel may comprise a non-measured
parameter that is, for example, the result of processing data from
various measured or other parameters. An example of such a
parameter includes a wellness indicator derived from various
measured parameters that give an overall indication of the
wellbeing of the monitored patient. An example of a wellness
parameter is disclosed in U.S. patent application Ser. Nos.
13/269,296, 13/371,767 and 12/904,925, by the assignee of the
present disclosure and incorporated by reference herein. By
organizing data into channels and virtual channels, the hub may
advantageously time-wise synchronize incoming data and virtual
channel data.
[0079] The hub also receives serial data through serial
communication ports, such as RJ connectors. The serial data is
associated with the monitored patient and passed on to the
multi-patient server systems and/or caregiver backend systems
discussed above. Through receiving the serial data, the caregiver
advantageously associates devices in the caregiver environment,
often from varied manufactures, with a particular patient, avoiding
a need to have each individual device associated with the patient
and possible communicating with hospital systems. Such association
is vital as it reduces caregiver time spent entering biographic and
demographic information into each device about the patient.
Moreover, through the SDK, the device manufacturer may
advantageously provide information associated with any measurement
delay of their device, thereby further allowing the hub to
advantageously time-wise synchronize serial incoming data and other
data associated with the patient.
[0080] When a portable patient monitor is docked, and it includes
its own display, the hub effectively increases its display real
estate. For example, the portable patient monitor may simply
continue to display its measurement and/or treatment data, which
may be now duplicated on the hub display, or the docked display may
alter its display to provide additional information. The docked
display, when docked, can present anatomical graphical data of, for
example, the heart, lungs, organs, the brain, or other body parts
being measured and/or treated. The graphical data may
advantageously animate similar to and in concert with the
measurement data. For example, lungs may inflate in approximate
correlation to the measured respiration rate and/or the determined
inspiration/expiration portions of a respiration cycle, the heart
may beat according to the pulse rate, may beat generally along
understood actual heart contraction patterns, the brain may change
color or activity based on varying depths of sedation, or the like.
When the measured parameters indicate a need to alert a caregiver,
a changing severity in color may be associated with one or more
displayed graphics, such as the heart, lungs, brain, organs,
circulatory system or portions thereof, respiratory system or
portions thereof, other body parts or the like. The body portions
may include animations on where, when or how to attach measurement
devices.
[0081] The hub may also advantageously overlap parameter displays
to provide additional visual information to the caregiver. Such
overlapping may be user definable and configurable. The display may
also incorporate analog-appearing icons or graphical indicia.
[0082] The hub of the present disclosure can be highly configurable
and capable of communicating with previously unknown medical
systems. The connectable medical systems can be a dongle with a
built-in processor providing specialized software processing
capabilities that can expand the capabilities of the hub.
Optionally, the connected medical systems can be medical devices
communicating via a communication cable with the hub. The cable can
include a processing board in the cable. Optionally, the processor
on the medical device itself can communicate directly with the
hub.
[0083] When a medical system is initially connected, for example,
using a wired connection such as a cable or dongle device, an EPROM
on the cable or dongle device initially describes the necessary
physical communication parameters for speaking with the medical
system's processor. For example, the EPROM can provide parameters
including ISO/non-ISO communication requirements, baud rates,
etc.
[0084] Once initial communication parameters are established, the
hub can begin communicating with the processor of the medical
system. The medical system then describes itself and its
capabilities to the hub. For example, the self-description can
include the measurement channels supported by the device; the
measured parameters (metrics) supported by each channel, including,
but not limited to: names, relationship to metrics and coding
systems defined by standards bodies, valid ranges and units of
measure, body sites involved, parameter exceptions, visual
presentation requirements and characteristics; alarm limits and
other parameter settings; alarm, alert and other event conditions;
actions that can be performed by the device (such as requests to
begin performing measurements); patient demographics and
externally-measured metrics needed by the device to perform its
computations; manufacturer branding information; or other
information as would be desired for patient monitoring.
[0085] The "self-describing" nature of the platform can permit a
high degree of flexibility, allowing the protocol and its
capabilities to evolve while maintaining compatibility across
protocol and software versions. For example, the platform can be a
patient hub device (or just "hub") that communicates with a
third-party device (which may be an external device or a medical
device) to receive patient data from the third-party device and
display the patient data on a screen of the hub. The third-party
device can communicate with the hub by accessing a library of code,
represented by an application programming interface ("API"), which
may be stored at the hub or in a dongle or cable connected to the
hub. The code library can provide functionality that enables
creating user interface controls on the hub that can be used to
control aspects of the third-party device.
[0086] For example, sliders could be provided as user interface
controls on the hub, which allow a user to adjust alarm limits or
other settings of the third-party device. Upon receipt of an
updated setting, the hub can communicate this setting update to the
third-party device (for example, over a cable, a network, or the
like). The third-party device can know how to read the setting
update because the third-party device can include code that can
interpret the settings update from the hub (for example, the hub
can format the settings update in a way that the third-party device
can understand it). Similarly, the hub can send patient data
obtained from any sensor connected to the hub (such as an SpO2 or
pulse rate sensor) and send that patient data (such as SpO2 % or
pulse rate) to the third-party device, which may use this data to
update its algorithms or for other purposes.
[0087] Moreover, when a new patient connects to the hub, the hub
can report that a new patient has connected to the third-party
device. That way, the third-party device can know to restart a
measurement or treatment algorithm, for example, by resetting a
baseline for the new patient. Without this feature, when a new
patient connected to the hub, the third-party device may have
continued to measure or treat the patient using old baseline data
about the patient (which in fact would have referred to a previous
patient).
[0088] The medical systems, once connected to the hub, can then
pull from or push to the hub any information. For example, a
connected Medical System A can pull measured parameters from
connected Medical System B. Medical System A can then use that
information to generate a new measured parameter which can then be
pushed to the platform for display or use by other connected
medical systems.
[0089] The data obtained from the various connected medical system
can be time-stamped using the hub's system clock. Time-stamping can
allow various measurements to be synchronized with other
measurements. Synchronization can aid with display of the data and
further calculations using the data.
[0090] The third-party device can perform calculations based on
patient data and communicate the results of the calculations to the
hub. For example, the third-party device can calculate a wellness
index based on patient parameter data received from the hub or
other third-party devices. The third-party device may be a
board-in-cable configured to perform the calculations. For example,
the third-party device can execute algorithms to calculate a
patient's parameter(s) based on data acquired from a sensor
connected to the board-in-cable.
[0091] The platform can provide standardized graphical interfaces
depending on the display characteristics of the medical systems.
For example, the medical systems can self-define to a numerical
readout, a graph, or other specified display options which can be
self-defined. Optionally, the attached medical device can provide
image data used by the hub to provide display graphics.
[0092] The third-party device can also control at least a portion
of the display settings on the hub. For example, the third-party
device can communicate the display characteristics or the
self-defined display options of a medical system to the hub, which
can override or supplement the display on the hub that is
associated with the data provided by the medical system. The
self-describing features as well as other functions and
communications of the third-party device described herein can be
programmed with a software development kit (SDK). The SDK can be
provided by a supplier of the hub to a supplier of the third-party
device, which can allow the supplier of the third-party device to
create customized functions and to interface with the hub.
[0093] In the interest of clarity, not all features of an actual
implementation are described in this specification. An artisan will
of course be appreciate that in the development of any such actual
implementation (as in any development project), numerous
implementation-specific decisions must be made to achieve a
developers' specific goals and subgoals, such as compliance with
system- and business-related constraints, which will vary from one
implementation to another. Moreover, it will be appreciated that
such a development effort might be complex and time-consuming, but
would nevertheless be a routine undertaking of device engineering
for those of ordinary skill having the benefit of this
disclosure.
[0094] To facilitate a complete understanding of the disclosure,
the remainder of the detailed description describes the disclosure
with reference to the drawings, wherein like reference numbers are
referenced with like numerals throughout.
II. Examples of a Medical Monitoring Hub
[0095] FIG. 1A illustrates a monitoring environment including a
perspective view of an example medical monitoring hub 100 with an
example docked portable patient monitor 102. The hub 100 can
include a display 104, and a docking station 106, which can be
configured to mechanically and electrically mate with the portable
patient monitor 102, each housed in a movable, mountable and
portable housing 108. The housing 108 includes a generally upright
inclined shape configured to rest on a horizontal flat surface,
although the housing 108 can be affixed in a wide variety of
positions and mountings and comprise a wide variety of shapes and
sizes.
[0096] The display 104 may present a wide variety of measurement
and/or treatment data in numerical, graphical, waveform, or other
display indicia 110. The display 104 can occupy much of a front
face of the housing 108, although an artisan will appreciate the
display 104 may comprise a tablet or tabletop horizontal
configuration, a laptop-like configuration or the like. The display
104 may include communicating display information and data to a
table computer, smartphone, television, or any display system
recognizable to an artisan. The upright inclined configuration of
FIG. 1A can present display information to a caregiver in an easily
viewable manner.
[0097] FIG. 1B shows a perspective side view of the hub 100
including the housing 108, the display 104, and the docking station
106 without a portable monitor docked. Also shown is a connector
for noninvasive blood pressure.
[0098] The housing 108 may also include pockets or indentations to
hold additional medical devices, such as, for example, a blood
pressure monitor or temperature sensor 112, such as that shown in
FIG. 1C.
[0099] The portable patient monitor 102 of FIG. 1A may
advantageously comprise an oximeter, co-oximeter, respiratory
monitor, depth of sedation monitor, noninvasive blood pressure
monitor, vital signs monitor or the like, such as those
commercially available from Masimo Corporation of Irvine, Calif.,
and/or disclosed in U.S. Pat. Pub. Nos. 2002/0140675, 2010/0274099,
2011/0213273, 2012/0226117, 2010/0030040; U.S. Pat. App. Ser. Nos.
61/242,792, 61/387457, 61/645,570, Ser. No. 13/554,908 and U.S.
Pat. Nos. 6,157,850, 6,334,065, and the like. The monitor 102 may
communicate with a variety of noninvasive and/or minimally invasive
devices such as optical sensors with light emission and detection
circuitry, acoustic sensors, devices that measure blood parameters
from a finger prick, cuffs, ventilators, and the like. The monitor
102 may include its own display 114 presenting its own display
indicia 116, discussed below with reference to FIGS. 19A-19J. The
display indicia may advantageously change based on a docking state
of the monitor 102. When undocked, the display indicia may include
parameter information and may alter orientation based on, for
example, a gravity sensor or accelerometer.
[0100] The docking station 106 of the hub 100 includes a mechanical
latch 118, or mechanically releasable catch to ensure that movement
of the hub 100 doesn't mechanically detach the monitor 102 in a
manner that could damage the same.
[0101] Although disclosed with reference to particular portable
patient monitors 102, an artisan will recognize from the disclosure
herein a large number and wide variety of medical devices that may
advantageously dock with the hub 100. Moreover, the docking station
106 may advantageously electrically and not mechanically connect
with the monitor 102, and/or wirelessly communicate with the
same.
[0102] FIG. 2 illustrates a simplified block diagram of an example
monitoring environment 200 including the hub 100 of FIG. 1. As
shown in FIG. 2, the environment may include the portable patient
monitor 102 communicating with one or more patient sensors 202,
such as, for example, oximetry optical sensors, acoustic sensors,
blood pressure sensors, respiration sensors or the like. Additional
sensors, such as, for example, a NIBP sensor or system 211 and a
temperature sensor or sensor system 213 may communicate directly
with the hub 100. The sensors 202, 211 and 213 when in use are
typically in proximity to the patient being monitored if not
actually attached to the patient at a measurement site.
[0103] As disclosed, the portable patient monitor 102 can
communicate with the hub 100, through the docking station 106 when
docked and, wirelessly when undocked, however, such undocked
communication is not required. The hub 100 communicates with one or
more multi-patient monitoring servers 204 or server systems, such
as, for example, those disclosed with in U.S. Pat. Pub. Nos.
2011/0105854, 2011/0169644, and 2007/0180140. In general, the
server 204 communicates with caregiver backend systems 206 such as
EMR and/or ADT systems. The server 204 may advantageously obtain
through push, pull or combination technologies patient information
entered at patient admission, such as demographical information,
billing information, and the like. The hub 100 accesses this
information to seamlessly associate the monitored patient with the
caregiver backend systems 206. Communication between the server 204
and the monitoring hub 100 may be any recognizable to an artisan
from the disclosure herein, including wireless, wired, over mobile
or other computing networks, or the like.
[0104] FIG. 2 also shows the hub 100 communicating through its
serial data ports 210 and channel data ports 212. As disclosed in
the forgoing, the serial data ports 210 may provide data from a
wide variety of patient medical devices, including electronic
patient bed systems 214, infusion pump systems 216 including closed
loop control systems, ventilator systems 218, blood pressure or
other vital sign measurement systems 220, or the like. Similarly,
the channel data ports 212 may provide data from a wide variety of
patient medical devices, including any of the foregoing, and other
medical devices. For example, the channel data ports 212 may
receive data from depth of consciousness monitors 222, such as
those commercially available from SEDLine, brain or other organ
oximeter devices 224, noninvasive blood pressure or acoustic
devices 226, or the like. A channel device may include
board-in-cable ("BIC") solutions where the processing algorithms
and the signal processing devices that accomplish those algorithms
are mounted to a board housed in a cable or cable connector, which
may have no additional display technologies. The BIC solution
outputs its measured parameter data to the channel port 212 to be
displayed on the display 104 of hub 100. The hub 100 may
advantageously be entirely or partially formed as a BIC solution
that communicates with other systems, such as, for example,
tablets, smartphones, or other computing systems.
[0105] Although disclosed with reference to a single docking
station 106, the environment 200 may include stacked docking
stations where a subsequent docking station mechanically and
electrically docks to a first docking station to change the form
factor for a different portable patent monitor as discussed with
reference to FIG. 5. Such stacking may include more than 2 docking
stations, may reduce or increase the form fact for mechanical
compliance with mating mechanical structures on a portable
device.
[0106] FIG. 3 illustrates a simplified example hardware block
diagram of the hub 100 of FIG. 1. As shown in FIG. 3, the housing
108 of the hub 100 positions and/or encompasses an instrument board
302, the display 104, memory 304, and the various communication
connections, including the serial ports 210, the channel ports 212,
Ethernet ports 305, nurse call port 306, other communication ports
308 including standard USB or the like, and the docking station
interface 310. The instrument board 302 comprises one or more
substrates including communication interconnects, wiring, ports and
the like to enable the communications and functions described
herein, including inter-board communications. A core board 312
includes the main parameter, signal, and other processor(s) and
memory, a portable monitor board ("RIB") 314 includes patient
electrical isolation for the monitor 102 and one or more
processors, a channel board ("MID") 316 controls the communication
with the channel ports 212 including optional patient electrical
isolation and power supply 318, and a radio board 320 includes
components configured for wireless communications. Additionally,
the instrument board 302 may advantageously include one or more
processors and controllers, busses, all manner of communication
connectivity and electronics, memory, memory readers including
EPROM readers, and other electronics recognizable to an artisan
from the disclosure herein. Each board comprises substrates for
positioning and support, interconnect for communications,
electronic components including controllers, logic devices,
hardware/software combinations and the like to accomplish the tasks
designated above and others.
[0107] An artisan will recognize from the disclosure herein that
the instrument board 302 may comprise a large number of electronic
components organized in a large number of ways. Using different
boards such as those disclosed above advantageously provides
organization and compartmentalization to the complex system.
[0108] FIG. 4 illustrates a perspective view of an example
removable docking station 400 of the hub 100 of FIG. 1. As shown in
FIG. 4, the docking station 400 provides a mechanical mating to
portable patient monitor 102 to provide secure mechanical support
when the monitor 102 is docked. The docking station 400 includes a
cavity 402 shaped similar to the periphery of a housing of the
portable monitor 102. The station 400 also includes one or more
electrical connectors 404 providing communication to the hub 100.
Although shown as mounted with bolts, the docking station 400 may
snap fit, may use movable tabs or catches, may magnetically attach,
or may employ a wide variety or combination of attachment
mechanisms know to an artisan from the disclosure herein. The
attachment of the docking station 400 may be sufficiently secure
that when docked, the monitor 102 and docking station cannot be
accidentally detached in a manner that could damage the
instruments, such as, for example, if the hub 100 was accidently
bumped or the like, the monitor 102 and docking station 400 can
remain intact.
[0109] The housing 108 of the hub 100 also includes cavity 406
housing the docking station 400. To the extent a change to the form
factor for the portable patient monitor 102 occurs, the docking
station 400 is advantageously removable and replaceable. Similar to
the docking station 400, the hub 100 includes within the cavity 406
of the housing 108 electrical connectors 408 providing electrical
communication to the docking station 400. The docking station 400
can include its own microcontroller and processing capabilities,
such as those disclosed in U.S. Pat. Pub. No. 2002/0140675. The
docking station 400 can pass communications through to the
electrical connector 408.
[0110] FIG. 4 also shows the housing 108 including openings for
channel ports 212 as universal medical connectors discussed in
detail below.
[0111] FIG. 5 illustrates a perspective view of example portable
patient monitors 502 and 504 undocked from the hub 100 of FIG. 1.
As shown in FIG. 5, the monitor 502 may be removed and other
monitors, like monitor 504 may be provided. The docking station 106
includes an additional docking station 506 that mechanically mates
with the original docking station 106 and presents a form factor
mechanically matable with monitor 504. The monitor 504 can
mechanically and electrically mate with the stacked docking
stations 506 and 106 of hub 100. As can be readily appreciated by
and artisan from the disclosure herein, the stackable function of
the docking stations provides the hub 100 with an extremely
flexible mechanism for charging, communicating, and interfacing
with a wide variety of patient monitoring devices. As noted above,
the docking stations may be stacked, or removed and replaced.
[0112] FIG. 6 illustrates a simplified block diagram of traditional
patient electrical isolation principles. As shown in FIG. 6, a host
device 602 is generally associated with a patient device 604
through communication and power. As the patient device 604 often
comprises electronics proximate or connected to a patient, such as
sensors or the like, certain safety requirements dictate that
electrical surges of energy from, for example, the power grid
connected to the host device, should not find an electrical path to
the patient. This is generally referred to a "patient isolation"
which is a term known in the art and includes herein the removing
of direct uninterrupted electrical paths between the host device
602 and the patient device 604. Such isolation is accomplished
through, for example, isolation devices 606 on power conductors 608
and communication conductors 610. Isolation devices 606 can include
transformers, optical devices that emit and detect optical energy,
and the like. Use of isolation devices, especially on power
conductors, can be expensive component wise, expensive size wise,
and drain power. Traditionally, the isolation devices were
incorporated into the patient device 604, however, the patient
devices 604 are trending smaller and smaller and not all devices
incorporate isolation.
[0113] FIG. 7A illustrates a simplified block diagram of an example
optional patient isolation system. As shown in FIG. 7A, the host
device 602 communicates with an isolated patient device 604 through
isolation devices 606. However, a memory 702 associated with a
particular patient device informs the host 602 whether that device
needs isolated power. If a patient device 708 does not need
isolated power, such as some types of cuffs, infusion pumps,
ventilators, or the like, then the host 602 can provide
non-isolated power through signal path 710. This power may be much
higher that what can cost-effectively be provided through the
isolated power conductor 608. The non-isolated patient devices 708
can receive isolated communication as such communication is
typically at lower voltages and is not cost prohibitive. An artisan
will recognize from the disclosure herein that communication could
also be non-isolated. Thus, FIG. 7A shows a patient isolation
system 700 that provides optional patient isolation between a host
602 and a wide variety of potential patient devices 604, 708. The
hub 100 can include the channel ports 212 incorporating similar
optional patient isolation principles.
[0114] FIG. 7B adds an example optional non-isolation power levels
for the system of FIG. 7A. As shown in FIG. 7B, once the host 602
understands that the patient device 604 comprises a self-isolated
patient device 708, and thus does not need isolated power, the host
602 provides power through a separate conductor 710. Because the
power is not isolated, the memory 702 may also provide power
requirements to the host 602, which may select from two or more
voltage or power levels. In FIG. 7B, the host 602 provides either
high power, such as about 12 volts, but could have a wide range of
voltages or very high power such as about 24 volts or more, but
could have a wide range of voltages, to the patient device 708. An
artisan will recognize that supply voltages can advantageously be
altered to meet the specific needs of virtually any device 708
and/or the memory could supply information to the host 602 which
provided a wide range of non-isolated power to the patient device
708.
[0115] Moreover, using the memory 702, the host 602 may determine
to simply not enable any unused power supplies, whether that be the
isolated power or one or more of the higher voltage non-isolated
power supplies, thereby increasing the efficiency of the host.
[0116] FIG. 8 illustrates a simplified example universal medical
connector configuration process 800. As shown in FIG. 8, the
process includes step 802, where a cable is attached to a universal
medical connector incorporating optional patient isolation as
disclosed in the foregoing. In step 804, the host device 602 or the
hub 100, more specifically, the channel data board 316 or EPROM
reader of the instrument board, reads the data stored in the memory
702 and in step 806, determines whether the connecting device
requires isolated power. In step 808, when the isolated power is
required, the hub 100 may advantageously enable isolated power and
in step 810, enable isolated communications. In step 806, when
isolated power is not needed, the hub 100 may simply in optional
step 812 enable non-isolated power and where communications remain
isolated, step 810 can enable isolated communications. In step 806,
when isolated power is not needed, the hub 100 in step 814 may use
information from memory 702 to determine the amount of power needed
for the patient device 708. When sufficient power is not available,
because for example, other connected devices are also using
connected power, in step 816 a message may be displayed indicating
the same and power is not provided. When sufficient power is
available, optional step 812 may enable non-isolated power.
Optionally, optional step 818 may determine whether memory 702
indicates higher or lower power is desired. When higher power is
desired, the hub 100 may enable higher power in step 820 and when
not, may enable lower power in step 822. The hub 100 in step 810
then enables isolated communication. The hub 100 in step 818 may
simply determine how much power is needed and provide at least
sufficient power to the self-isolated device 708.
[0117] An artisan will recognize from the disclosure herein that
hub 100 may not check to see if sufficient power is available or
may provide one, two or many levels of non-isolated voltages based
on information from the memory 702.
[0118] FIGS. 9A and 9B illustrate simplified block diagrams of
example universal medical connectors 900 having a size and shape
smaller in cross section than tradition isolation requirements. The
connector 900 physically separates non-isolated signals on one side
910 from isolated signals on another side 920, although the sides
could be reversed. The gap between such separations may be dictated
at least in part by safety regulations governing patient isolation.
The distance between the sides 910 and 920 may appear to be too
small.
[0119] As shown from a different perspective in FIG. 9B, the
distance between connectors "x" appears small. However, the gap
causes the distance to includes a non-direct path between
conductors. For example, any short would have to travel path 904,
and the distance of such path is within or beyond such safety
regulations, in that the distance is greater than "x." It is
noteworthy that the non-straight line path 904 occurs throughout
the connector, such as, for example, on the board connector side
where solder connects various pins to a PCB board.
[0120] FIG. 10 illustrates a perspective view of a side of the hub
100 of FIG. 1, showing example instrument-side channel inputs 1000
as example universal medical connectors. As shown in FIG. 10, the
inputs include the non-isolated side 910, the isolated side 920,
and the gap. The memory 710 can communicate through pins on the
non-isolated side.
[0121] FIGS. 11A-11K illustrate various views of example male and
mating female universal medical connectors. For example, FIGS. 11G1
and 11G2 shows various preferred but not required sizing, and FIG.
11H shows incorporation of electronic components, such as the
memory 702 into the connectors. FIGS. 11I-11K illustrate wiring
diagrams and cabling specifics of the cable itself as it connects
to the universal medical connectors.
[0122] FIG. 12 illustrates a simplified block diagram of a channel
system for the hub of FIG. 1. As shown in FIG. 12, a male cable
connector, such as those shown in FIG. 11 above, includes a memory
such as an EPROM. The memory advantageously stores information
describing the type of data the hub 100 can expect to receive, and
how to receive the same. A controller of the hub 100 communicates
with the EPROM to negotiate how to receive the data, and if
possible, how to display the data on display 104, alarm when
needed, and the like. For example, a medical device supplier may
contact the hub provider and receive a software development kit
("SDK") that guides the supplier through how to describe the type
of data output from their device. After working with the SDK, a
map, image, or other translation file may advantageously be loaded
into the EPROM, as well as the power requirements and isolation
requirements discussed above. When the channel cable is connected
to the hub 100 through the channel port 212, the hub 100 reads the
EPROM and the controller of the hub 100 negotiates how to handle
incoming data.
[0123] FIG. 13 illustrates an example logical channel configuration
that may be stored in the EPROM of FIG. 12. As shown in FIG. 13,
each incoming channel describes one or more parameters. Each
parameter describes whatever the hub 100 should know about the
incoming data. For example, the hub 100 may want to know whether
the data is streaming data, waveform data, already determined
parameter measurement data, ranges on the data, speed of data
delivery, units of the data, steps of the units, colors for
display, alarm parameters and thresholds, including complex
algorithms for alarm computations, other events that are parameter
value driven, combinations of the same or the like. Additionally,
the parameter information may include device delay times to assist
in data synchronization or approximations of data synchronization
across parameters or other data received by the hub 100. The SDK
can present a schema to the device supplier which self-describes
the type and order of incoming data. The information may
advantageously negotiate with the hub 100 to determine whether to
apply compression and/or encryption to the incoming data
stream.
[0124] Such open architecture advantageously provides device
manufacturers the ability to port the output of their device into
the hub 100 for display, processing, and data management as
disclosed in the foregoing. By implementation through the cable
connector, the device manufacturer avoids any reprogramming of
their original device; rather, they simply let the hub 100 know
through the cable connector how the already existing output is
formatted. Moreover, by describing the data in a language already
understood by the hub 100, the hub 100 also avoids software
upgrades to accommodate data from "new-to-the-hub" medical
devices.
[0125] FIG. 14 illustrates a simplified example process for
configuring a channel. As shown in FIG. 14, the hub provider
provides a device manufacturer with an SDK in step 1402, who in
turn uses the SDK to self-describe the output data channel from
their device in step 1404. The SDK can include a series of
questions that guide the development, The SDK provides a language
and schema to describe the behavior of the data.
[0126] Once the device provider describes the data, the hub
provider creates a binary image or other file to store in a memory
within a cable connector in step 1405; however, the SDK may create
the image and simply communicated it to the hub provider. The cable
connector is provided as an OEM part to the provider in step 1410,
who constructs and manufactures the cable to mechanically and
electrically mate with output ports on their devices in step
1412.
[0127] Once a caregiver has the appropriately manufactured cable,
with one end matching the device provider's system and the other
OEM'ed to match the hub 100 at its channel ports 212, in step 1452
the caregiver can connect the hub between the devices. In step
1454, the hub 100 reads the memory, provides isolated or
non-isolated power, and the cable controller and the hub 100
negotiate a protocol or schema for data delivery. A controller on
the cable may negotiate the protocol. The controller of the hub 100
may negotiate with other processors on the hub the particular
protocol. Once the protocol is set, the hub 100 can use, display
and otherwise process the incoming data stream in an intelligent
manner.
[0128] Through the use of the universal medical connectors
described herein, connection of a myriad of devices to the hub 100
is accomplished through straightforward programming of a cable
connector as opposed to necessitating software upgrades to each
device.
[0129] FIG. 15 illustrates a perspective view of the hub of FIG. 1
including an example attached board-in-cable ("BIC") to form an
input channel. As shown in FIG. 15, a SEDLine depth of
consciousness board communicates data from an appropriate patient
sensor to the hub 100 for display and caregiver review. As
described, the provider of the board need only use the SDK to
describe their data channel, and the hub 100 understands how to
present the data to the caregiver.
[0130] FIG. 16 illustrates a perspective view of a back side of the
hub 100 of FIG. 1, showing an example serial data inputs. The
inputs can include such as RJ 45 ports. As is understood in the
art, these ports include a data ports similar to those found on
computers, network routers, switches and hubs. A plurality of these
ports can be used to associate data from various devices with the
specific patient identified in the hub 100. FIG. 16 also shows a
speaker, the nurse call connector, the Ethernet connector, the
USBs, a power connector and a medical grounding lug.
[0131] FIG. 17A illustrates an example monitoring environment with
communication through the serial data connections of the hub 100 of
FIG. 1. As shown and as discussed in the foregoing, the hub 100 may
use the serial data ports 210 to gather data from various devices
within the monitoring environment, including an electronic bed,
infusion pumps, ventilators, vital sign monitors, and the like. The
difference between the data received from these devices and that
received through the channel ports 212 is that the hub 100 may not
know the format or structure of this data. The hub 100 may not
display information from this data or use this data in calculations
or processing. However, porting the data through the hub 100
conveniently associates the data with the specifically monitored
patient in the entire chain of caregiver systems, including the
foregoing server 214 and backend systems 206. The hub 100 may
determine sufficient information about the incoming data to attempt
to synchronize it with data from the hub 100.
[0132] In FIG. 17B, a control screen may provide information on the
type of data being received. A green light next to the data can
indicate connection to a device and on which serial input the
connection occurs.
[0133] FIG. 18 illustrates a simplified example patient data flow
process. As shown, once a patient is admitted into the caregiver
environment at step 1802, data about the patient is populated on
the caregiver backend systems 206. The server 214 may
advantageously acquire or receive this information in step 1804,
and then make it accessible to the hub 100. When the caregiver at
step 1806 assigns the hub 100 to the patient, the caregiver simply
looks at the presently available patient data and selects the
particular patient being currently monitored. The hub 100 at step
1808 then associates the measurement, monitoring and treatment data
it receives and determines with that patient. The caregiver need
not again associate another device with the patient so long as that
device is communicating through the hub 100 by way of (1) the
docking station, (2) the universal medical connectors, (3) the
serial data connectors, or (4) other communication mechanisms known
to an artisan. At step 1810, some or the entirety of the received,
processed and/or determined data is passed to the server systems
discussed above.
[0134] FIGS. 19A-19J illustrate example displays of anatomical
graphics for the portable patient monitor docked with the hub 100
of FIG. 1. As shown in FIG. 19A, the heart, lungs and respiratory
system are shown while the brain is not highlighted. Thus, a
caregiver can readily determine that depth of consciousness
monitoring or brain oximetry systems are not currently
communicating with the hub 100 through the portable patient monitor
connection or the channel data ports. However, it is likely that
acoustic or other respiratory data and cardiac data is being
communicated to or measured by the hub 100. Moreover, the caregiver
can readily determine that the hub 100 is not receiving alarming
data with respect to the emphasized body portions. The emphasized
portion may animate to show currently measured behavior or,
optionally, animate in a predetermined fashion.
[0135] FIG. 19B shows the addition of a virtual channel showing an
indication of wellness. As shown in FIG. 19B, the indication is
positive as it is a "34" on an increasingly severity scale to
"100." The wellness indication may also be shaded to show problems.
In contrast to FIG. 19B, FIG. 19C shows a wellness number that is
becoming or has become problematic and an alarming heart graphic.
Thus, a caregiver responding to a patient alarm on the hub 100 or
otherwise on another device or system monitoring or treating the
patient can quickly determine that a review of vital signs and
other parameters relating to heart function is needed to diagnose
and/or treat the patient.
[0136] FIGS. 19D and 19E show the brain included in the emphasized
body portions meaning that the hub 100 is receiving data relevant
to brain functions, such as, for example, depth of sedation data or
brain oximetry data. FIG. 19E additionally shows an alarming heart
function similar to FIG. 19C.
[0137] In FIG. 19F, additional organs, such as the kidneys are
being monitored, but the respiratory system is not. In FIG. 19G, an
alarming hear function is shown, and in FIG. 19H, an alarming
circulatory system is being shown. FIG. 19I shows the wellness
indication along with lungs, heart, brain and kidneys. FIG. 19J
shows alarming lungs, heart, and circulatory system as well as the
wellness indication. Moreover, FIG. 19J shows a severity contrast,
such as, for example, the heart alarming red for urgent while the
circulatory system alarms yellow for caution. An artisan will
recognize other color schemes that are appropriate from the
disclosure herein.
[0138] FIGS. 20A-20C illustrate example displays of measurement
data showing data separation and data overlap, respectively. FIGS.
21A and 21B illustrate example displays of measurement data also
showing data separation and data overlap, respectively.
[0139] For example, acoustic data from an acoustic sensor may
advantageously provide breath sound data, while the plethysmograph
and ECG or other signals can also be presented in separate
waveforms (FIG. 20A, top of the screen capture). The monitor may
determine any of a variety of respiratory parameters of a patient,
including respiratory rate, expiratory flow, tidal volume, minute
volume, apnea duration, breath sounds, riles, rhonchi, stridor, and
changes in breath sounds such as decreased volume or change in
airflow. In addition, in some cases a system monitors other
physiological sounds, such as heart rate to help with probe off
detection, heart sounds (S1, S2, S3, S4, and murmurs), and change
in heart sounds such as normal to murmur or split heart sounds
indicating fluid overload.
[0140] Providing a visual correlation between multiple
physiological signals can provide a number of valuable benefits
where the signals have some observable physiological correlation.
As one example of such a correlation, changes in morphology (for
example, envelope and/or baseline) of the plethysmographic signal
can be indicative of patient blood or other fluid levels. And,
these changes can be monitored to detect hypovolemia or other
fluid-level related conditions. A pleth variability index may
provide an indication of fluid levels, for example. And, changes in
the morphology of the plethysmographic signal are correlated to
respiration. For example, changes in the envelope and/or baseline
of the plethysmographic signal are correlated to breathing. This is
at least in part due to aspects of the human anatomical structure,
such as the mechanical relationship and interaction between the
heart and the lungs during respiration.
[0141] Thus, superimposing a plethysmographic signal and a
respiratory signal (FIG. 20B) can give operators an indication of
the validity of the plethysmographic signal or signals derived
therefrom, such as a pleth variability index. For example, if
bursts in the respiration signal indicative of inhalation and
exhalation correlate with changes in peaks and valleys of the
plethysmographic envelope, this gives monitoring personnel a visual
indication that the plethysmographic changes are indeed due to
respiration, and not some other extraneous factor. Similarly, if
the bursts in the respiration signal line up with the peaks and
valleys in the plethysmographic envelope, this provides monitoring
personnel an indication that the bursts in the respiration signal
are due to patient breathing sounds, and not some other
non-targeted sounds (for example, patient non-breathing sounds or
non-patient sounds).
[0142] The monitor may also be configured to process the signals
and determine whether there is a threshold level of correlation
between the two signals, or otherwise assess the correlation.
However, by additionally providing a visual indication of the
correlation, such as by showing the signals superimposed with one
another, the display provides operators a continuous, intuitive and
readily observable gauge of the particular physiological
correlation. For example, by viewing the superimposed signals,
users can observe trends in the correlation over time, which may
not be otherwise ascertainable.
[0143] The monitor can visually correlate a variety of other types
of signals instead of, or in addition to plethysmographic and
respiratory signals. For example, FIG. 20C depicts a screen shot of
another example monitoring display. As shown in the upper right
portion of FIG. 20C, the display superimposes a plethysmographic
signal, an ECG signal, and a respiration signal. In other
configurations, more than three different types of signals may be
overlaid onto one another.
[0144] The hub 100 can provide an interface through which the user
can move the signals together to overlay on one another. For
example, the user may be able to drag the respiration signal down
onto the plethysmographic signal using a touch screen interface.
Conversely, the user may be able to separate the signals, also
using the touch screen interface. The monitor can include a button
the user can press, or some other user interface allowing the user
to overlay and separate the signals, as desired. FIGS. 21A and 21B
show similar separation and joining of the signals.
[0145] In certain configurations, in addition to providing the
visual correlation between the plethysmographic signal and the
respiratory signal, the monitor is additionally configured to
process the respiratory signal and the plethysmographic signal to
determine a correlation between the two signals. For example, the
monitor may process the signals to determine whether the peaks and
valleys in the changes in the envelope and/or baseline of the
plethysmographic signal correspond to bursts in the respiratory
signal. And, in response to the determining that there is or is not
a threshold level of correlation, the monitor may provide some
indication to the user. For example, the monitor may provide a
graphical indication (for example, a change in color of pleth
variability index indicator), an audible alarm, or some other
indication. The monitor may employ one or more envelope detectors
or other appropriate signal processing componentry in making the
determination.
[0146] The system may further provide an audible indication of the
patient's breathing sounds instead of, or in addition to the
graphical indication. For example, the monitor may include a
speaker, or an earpiece (for example, a wireless earpiece) may be
provided to the monitoring personnel providing an audible output of
the patient sounds. Examples of sensors and monitors having such
capability are described in U.S. Pat. Pub. No. 2011/0172561 and are
incorporated by reference herein.
[0147] In addition to the above described benefits, providing both
the acoustic and plethysmographic signals on the same display in
the manner described can allow monitoring personnel to more readily
detect respiratory pause events where there is an absence of
breathing, high ambient noise that can degrade the acoustic signal,
improper sensor placement, etc.
[0148] FIGS. 22A-22B illustrate example analog display indicia. As
shown in FIGS. 22A and 22B, the screen shots displays health
indicators of various physiological parameters, in addition to
other data. Each health indicator can include an analog indicator
and/or a digital indicator. Where the health indicator includes an
analog and a digital indicator, the analog and digital indicators
can be positioned in any number of formations, such as
side-by-side, above, below, transposed, etc. The analog indicators
are positioned above and to the sides of the digital indicators. As
shown more clearly in FIG. 22B, the analog displays may include
colored warning sections, dashes indicating position on the graph,
and digital information designating quantitate information form the
graph. In FIG. 22B, for example, the pulse rate PR graph shows that
from about 50 to about 140 beats per minute, the graph is either
neutral or beginning to be cautionary, whereas outside those
numbers the graph is colored to indicate a severe condition. Thus,
as the dash moves along the arc, a caregiver can readily see where
in the range of acceptable, cautionary, and extreme the current
measurements fall.
[0149] Each analog indicator of the health indicator can include a
dial that moves about an arc based on measured levels of monitored
physiological parameters. As the measured physiological parameter
levels increase the dial can move clockwise, and as the measured
physiological parameter levels decrease, the dial can move
counter-clockwise, or vice versa. In this way, a user can quickly
determine the patient's status by looking at the analog indicator.
For example, if the dial is in the center of the arc, the observer
can be assured that the current physiological parameter
measurements are normal, and if the dial is skewed too far to the
left or right, the observer can quickly assess the severity of the
physiological parameter levels and take appropriate action. Normal
parameter measurements can be indicated when the dial is to the
right or left, etc.
[0150] The dial can be implemented as a dot, dash, arrow, or the
like, and the arc can be implemented as a circle, spiral, pyramid,
or other shape, as desired. Furthermore, the entire arc can be lit
up or only portions of the arc can be lit up based on the current
physiological parameter measurement level. Furthermore, the arc can
turn colors or be highlighted based on the current physiological
parameter level. For example, as the dial approaches a threshold
level, the arc and/or dial can turn from green, to yellow, to red,
shine brighter, flash, be enlarged, move to the center of the
display, or the like.
[0151] Different physiological parameters can have different
thresholds indicating abnormal conditions. For example, some
physiological parameters may upper a lower threshold levels, while
others only have an upper threshold or a lower threshold.
Accordingly, each health indicator can be adjusted based on the
physiological parameter being monitored. For example, the SpO2
health indicator can have a lower threshold that when met activates
an alarm, while the respiration rate health indicator can have both
a lower and upper threshold, and when either is met an alarm is
activated. The thresholds for each physiological parameter can be
based on typical, expected thresholds and/or user-specified
thresholds.
[0152] The digital indicator can provide a numerical representation
of the current levels of the physiological parameter the digital
indicator may indicate an actual level or a normalized level and
can also be used to quickly assess the severity of a patient
condition. The display can include multiple health indicators for
each monitored physiological parameter. The display can include
fewer health indicators than the number of monitored physiological
parameters. The health indicators can cycle between different
monitored physiological parameters.
[0153] FIGS. 23A-23F illustrate example displays of measurement
data showing, for example, data presentation in FIGS. 23A-23D when
a depth of consciousness monitor is connected to a channel port of
the hub of FIG. 1. As shown in FIGS. 23A-23C, the hub 100
advantageously roughly bifurcates its display 104 to show various
information from the, for example, SEDLine device, commercially
available from Masimo Corp. of Irvine, Calif. In FIG. 23D, the hub
100 includes an attached PhaseIn device, commercially available by
PHASEIN AB of Sweden, providing, for example, information about the
patient's respiration. The hub 100 also includes the SEDLine
information, so the hub 100 has divided the display 104
appropriately. In FIG. 23E, temperature and blood pressure sensors
communicate with the hub of FIG. 1 and the hub 100 creates display
real estate appropriate for the same. In FIG. 23F, an acoustic
sensor is also communicating with the hub of FIG. 1, as well as the
forgoing blood pressure and temperature sensor. Accordingly, the
hub 100 adjust the display real estate to accommodate the data from
each attached device.
[0154] The term "and/or" herein has its broadest least limiting
meaning which is the disclosure includes A alone, B alone, both A
and B together, or A or B optionally, but does not require both A
and B or require one of A or one of B. As used herein, the phrase
"at least one of" A, B, "and" C should be construed to mean a
logical A or B or C, using a non-exclusive logical or.
[0155] The term "plethysmograph" includes it ordinary broad meaning
known in the art which includes data responsive to changes in
volume within an organ or whole body (usually resulting from
fluctuations in the amount of blood or air it contains).
III. Additional Monitoring Environments
[0156] FIG. 24 illustrates another example of a monitoring
environment 2000 including the hub 100 of FIG. 1. The monitoring
environment 2000 may include all the features of the monitoring
environment 200 of FIG. 2, as well as any of the other features
described above. In addition, the monitoring environment 2000
depicts another example of the multi-patient monitoring system 204,
namely, the multi-patient monitoring system (MMS) 2004. The MMS
2004 includes a translation module 2005 that can receive serial
data, translate the serial data into a format recognizable by the
monitoring hub 100, and provide the serial data to the monitoring
hub 100 (among possibly other devices). Also shown is an auxiliary
device 2040 that may communicate with the MMS 2004, the monitoring
hub 100, or the PPM 102, wired or wirelessly.
[0157] As described above, the hub 100 may receive serial data from
a variety of medical equipment, including the patient's bed 214,
infusion pumps 216, a ventilator 218, and other vital signs
monitors 220. The hub 100 can pass serial data from these sources
on to the MMS 2004. As described above, the MMS 2004 may then store
the serial data in a caregiver backend system 206 such as an EMR
system or ADT system.
[0158] The medical equipment providing this serial data may use a
variety of different proprietary protocols, messaging
infrastructure, and the like that may not be natively recognizable
by the hub 100. Accordingly, the hub 100 may not have native
capability to read parameter values or other data from this medical
equipment, and as a result, may not have the capability to display
parameter values or other data from these devices. Advantageously,
however, the translation module 2005 at the MMS 2004 can receive
serial data from these devices, translate the serial data into a
format recognizable by the monitoring hub 100, and provide the
serial data to the monitoring hub 100. The monitoring hub 100 can
then read parameter values and other data from the translated
information and output these values or data to a display, such as
any of the displays described above.
[0159] The translation module 2005 can apply one or more
translation rules to the serial data to translate or transform the
serial data from one format to another format. The serial data may
be formatted according to a Health Level Seven ("HL7") protocol.
The HL7 protocol has been developed to provide a messaging
framework for the communication of clinical messages between
medical computer systems and devices. However, the HL7 standard is
quite flexible and merely provides a framework of guidelines.
Consequently, medical devices or clinical computer systems that are
all HL7-compliant may still be unable to communicate with each
other. For example, the medical equipment 214-220 may each
implement a version of the HL7 protocol, but these implementations
may be different from an HL7 protocol implemented by the monitoring
hub 100. Accordingly, the monitoring hub 100 may not be able to
parse or read messages from the medical equipment 214-220, even
though both use the HL7 standard. Further, the translation module
2005 may translate between different implementations of a common
standard other than the HL7 protocol implemented by the hub 100 and
medical equipment 214-220.
[0160] In addition to translating between different implementations
of a common electronic medical communication protocol (for example,
different formatting of HL7 messages), the translation module 2005
can also translate between input and output messages adhering to
different communication protocols. The translation module 2005 can
be capable of responding to and translating messages from, for
example, one medical communication protocol to a separate medical
communication protocol. For example, the translation module 2005
can facilitate communication between messages sent according to the
HL7 protocol, the ISO 11073 protocol, other open protocols, or
proprietary protocols. Accordingly, the translation module 2005 can
translate an input message sent according to the HL7 protocol to an
output message according to a different protocol, or vice-versa.
The translation module 2005 can implement any of the translation
features described below in greater detail under the section
entitled "Translation Module Embodiments," as well as further in
U.S. application Ser. No. 14/032,132, filed Sep. 19, 2013, titled
"Medical Monitoring System," the disclosure of which is hereby
incorporated by reference in its entirety.
[0161] Advantageously, the translation module 2005 can pass
translated serial data back to the hub 100 or PPM 102. Since the
translated data is in a format readable by the hub 100 or PPM 102,
the hub 100 or PPM 102 can output the data from the medical
equipment 214-220 on the display of the hub 100 or PPM 102. In
addition, the translation module 2005 can provide the translated
data to devices other than the hub 100, including clinician devices
(such as cell phones, tablets, or pagers) and an auxiliary device
2040 that will be described below. Moreover, since the serial data
provided by the medical equipment 214-220 may include alarm
notifications, the translation module 2005 can pass these alarm
notifications to the hub 100 or PPM 102. The hub 100 or PPM 102 can
therefore generate visual or audible alarms responsive to these
alarm notifications. Further, the translation module 2005 can
provide the alarm notifications to clinician devices, for example,
over a hospital network or wide area network (such as the
Internet). In addition, the translation module 2005 can provide the
alarm notifications to the auxiliary device 2040.
[0162] The translation module 2005 is shown as implemented in the
MMS 2004 because it may be beneficial to maintain and update the
translation rules of the translation module 2005 in a single
location. However, the translation module 2005 may also be (or
instead be) implemented in the hub 100 or PPM 102. Accordingly, the
hub 100 or PPM 102 can access an internal translation module 2005
to translate serial data for output to the display of the hub 100
or PPM 102.
[0163] The auxiliary device 2040 can be a computing device having
physical computer hardware, a display, and the like. For example,
the auxiliary device 2040 may be a handheld computing device used
by a clinician, such as a tablet, laptop, cellphone or smartphone,
personal digital assistant (PDA), a wearable computer (such as a
smart watch or glasses), or the like. The auxiliary device 2040 may
also be simply a display device, such as a computer monitor or
digital television. The auxiliary device 2040 can provide a second
screen functionality for the hub 100, PPM 102, or MMS 2004. As
such, the auxiliary device 2040 can communicate wirelessly or
through a wired connection with the hub 100, MMS 2004, or PPM
102.
[0164] As a second screen device, the auxiliary device 2040 can
depict a copy of at least a portion of the display of the hub 100
(or the PPM 102) or a different version of the hub 100 (or the PPM
102) display. For instance, the auxiliary device 2040 can receive
physiological parameter data, trend data, or waveforms from the hub
100, PPM 102, or MMS 2040 and display the parameter data, trend
data, or waveforms. The auxiliary device 2040 can output any
information available to the hub 100, PPM 102, or MMS 2004. One use
of the auxiliary device 2040 is as a clinician device usable by a
clinician to view data from the hub 100, PPM 102, or MMS 2004 while
away from a patient's room (or even while in a patient's room). A
clinician can use the auxiliary device 2040 to view more detailed
information about physiological parameters than is displayed on the
hub 100 or PPM 102 (see, for example, FIG. 39). For instance, the
auxiliary device 2040 may include zoom functionality or the like
that enables a clinician to zoom into trends or waveforms to more
closely inspect parameter activity.
[0165] One example reason for copying at least a portion of the
display of the hub 100 or PPM 102 is to enable different clinicians
to have the same view of the data during a surgical procedure. In
some surgical procedures, for instance, two anesthesiologists
monitor a patient, one anesthesiologist monitoring the brain
function and brain oxygenation of the patient, while the other
monitors peripheral oxygenation of the patient. A brain sensor,
such as has been described above, may be attached to the patient
and provide brain monitoring and oxygenation data that is output to
the hub 100 or the PPM 102 for presentation to the first
anesthesiologist. A finger or toe/foot optical sensor can also be
attached to the patient and output data to the hub 100 or PPM 102.
The hub 100 or PPM 102 can transmit this data to the auxiliary
device 2040, which the second anesthesiologist can monitor to
observe oxygenation in the patient's peripheral limbs. The second
anesthesiologist may also need to know the oxygenation at the brain
to help interpret the seriousness or lack thereof of poor
peripheral oxygenation values. However, in many surgical
procedures, a curtain or screen is placed over the patient as part
of the procedure, blocking the second anesthesiologist's view of
the hub 100 or PPM 102. Accordingly, the hub 100 or PPM 102 can
output a copy of at least a portion of its display to the auxiliary
device 2040 so that the second anesthesiologist can monitor brain
function or oxygenation.
[0166] The auxiliary device has a larger display area than the
display of the hub 100. For instance, the hub 100 may have a
relatively smaller display, such as about 10 inches, while the
auxiliary device 2040 may be a television monitor or the like that
has a 40 inch or larger display (although any size display may be
used for the auxiliary device 2040). The auxiliary device 2040 as a
television can include a hardware module that includes a processor,
memory, and a wireless or wired networking interface or the like.
The processor can execute programs from the memory, including
programs for displaying physiological parameters, trends, and
waveforms on the display of the television. Since a television
monitor may be larger than the hub 100, the television monitor
version of the auxiliary device 2040 can display more fine detail
of patient waveforms and trends (see, for example, FIG. 39).
[0167] The auxiliary device 2040 may display one portion of any of
the displays described herein while the hub 100 displays another
portion thereof. For instance, the auxiliary device 2040 may
display any of the anatomical graphics described above with respect
to FIGS. 19A-19J, while the hub 100 displays any of the parameter
displays described above with respect to FIGS. 20A-23F (or vice
versa). Likewise, the auxiliary device 2040 may display the
translated data received from the translation module 2005 while the
hub 100 displays channel data (or vice versa). The auxiliary device
2040 can display both translated data and channel data (see., for
example, FIG. 38).
[0168] The auxiliary device 2040 can perform at least some
processing of physiological parameters, including any of the
functionality of the monitoring hub 100. For instance, the
auxiliary device 2040 may include the translation module 2005 and
perform the features thereof.
[0169] FIG. 25 illustrates a translation message handling process
2100. The process 2100 can be implemented by the translation module
2005 described above or by any other computing system. At block
2502, the translation module 2005 receives a message from the hub
100 (or PPM 102) that includes a message from a medical device not
natively compatible with the hub 100 (or PPM 102). At block 2504,
the translation module 2005 can translate the message based on one
or more translation rules to produce a translated output message
that can be processed by the hub 100 (or PPM 102). At block 2506,
the translation module can provide the translated output message to
the hub 100 for display at the hub 100 (or PPM 102) or at an
auxiliary device 2040. The hub 100 (or PPM 102) may route the
translated data to the auxiliary device 2040, or the auxiliary
device 2040 may receive the translated data directly from the
translation module 2005.
[0170] For example, a first medical device having digital logic
circuitry can receive a physiological signal associated with a
patient from a physiological sensor, obtains a first physiological
parameter value based on the physiological signal, and outputs the
first physiological parameter value for display. The first medical
device can also receive a second physiological parameter value from
a second medical device other than the first medical device, where
the second physiological parameter value is formatted according to
a protocol not used by the first medical device, such that the
first medical device is not able to process the second
physiological parameter value to produce a displayable output
value. The first medical device can pass the physiological
parameter data from the first medical device to a separate
translation module, receive translated parameter data from the
translation module at the first medical device, where the
translated parameter data is able to be processed for display by
the first medical device, and output a second value from the
translated parameter data for display. The first medical device may
be, for example, the hub 100, PPM 102, or MMS 2004, and the second
medical device may be the infusion pump 216 or ventilator 218 or
the like.
[0171] FIGS. 26-38 and 46-71 illustrate additional example hub
displays, including displays of measurement data. Each of these
displays may be implemented by the auxiliary device 2040, although
similar displays may also be output on the hub 100 (or PPM 102)
directly. The example Figures shown are depicted as being
implemented for a tablet computer that includes touchscreen
functionality. Touchscreen functionality is optional and be
replaced by other suitable input devices, such as keyboards, mice,
track wheels, and the like.
[0172] Turning to FIG. 26, the user interface shown depicts a
device connected to the auxiliary device 2040. The device shown is
"Omar's Hawk," which can be the monitoring hub 100. The auxiliary
device 2040 is connected wirelessly to the hub 100 so as to receive
data from the hub 100. The auxiliary device could also connect
wirelessly to the MMS 2004 or PPM 102.
[0173] FIG. 27 depicts a default parameter view on the auxiliary
device 2040. Parameter values are shown together with waveforms in
an upper portion of the display, and other parameters (such as
SpHb, SpMet, PVI, etc.) are shown at the bottom of the display
without their corresponding waveforms. Any of these parameters at
the bottom of the display may be dragged and dropped onto the upper
portion of the display to cause their waveforms to be shown. For
instance, FIG. 28 depicts a similar display as in FIG. 27 except
that the SpHb parameter has been dragged and dropped onto the upper
portion of the display, causing the SpHb waveform and additional
details on alarm limits (18 and 7) to be shown. Similarly, FIG. 29
shows the same display as FIG. 28 except that the SpMet parameter
has been dragged and dropped on the upper portion of the display,
causing its waveform and alarm limit (3) to be shown.
[0174] In each of the displays of FIGS. 27-29, a time window button
is shown in the upper right corner. This time window button says "1
hr" in FIGS. 27-29 but may be selected by a user to change the time
window, which can affect the window of trend or waveform data shown
in the display. A user selection of this time window button and
change to a 10 minute window is shown in FIG. 30. As can be seen,
the waveforms in FIG. 30 are shown in a smaller window of time than
in the previous Figures.
[0175] FIG. 31 shows another version of the display of FIG. 29 with
stacked waveforms, including a stacked SpO2 and respiratory
waveform, similar to other stacked waveforms described elsewhere
herein. FIG. 32 shows a similar display to FIG. 29 with the pulse
rate (PR) and SpMet (methemoglobin) parameters highlighted as being
in alarm condition. The alarm condition can be represented as a red
box around the parameter values and waveforms, or with red
transparency coloring at least a portion of the box. The red box or
transparency may also flash, and an audible alarm may sound. Other
ways to represent an alarm condition can also be used.
[0176] FIG. 33 shows a popup interface that enables a user to
adjust alarm limits for a parameter (for example, SpHb or total
hemoglobin). The popup interface includes scroll wheels that allow
a user to quickly scroll among and select possible parameter limit
values.
[0177] FIGS. 34-38 show landscape display views in contrast to the
portrait-oriented displays of FIGS. 26-33. These landscape display
views may be accessed by rotating the auxiliary device 2040 (such
as tablet etc.) to a landscape orientation. FIG. 34 shows a first
set of parameters, while FIGS. 35 and 36 add additional
drag-and-dropped parameters with their waveforms and additional
alarm limit details, similar to those described above with respect
to FIGS. 27-29. FIG. 37 depicts stacked parameter waveforms,
stacking SpO2 and respiratory waveforms. FIG. 38 depicts both
channel parameters (such as SpO2, PR (pulse rate), and RRa
(acoustically-measured respiratory rate)) while also showing
translated serial data parameters 2210, including parameters from a
pump and a vent. These translated serial data parameters 2210 may
have been received from the translation module 2005, either through
the hub 100 or directly from the MMS 2004.
[0178] Referring again to FIG. 24, as described above, the hub 100
or PPM 102 can output a copy of at least a portion of the display
to the auxiliary device 2040. The hub 100 or PPM 102 can output
data with respect to a subset of the full parameters shown on the
hub 100 or PPM 102 to the auxiliary device 2040. For instance, the
hub 100 or PPM 102 may provide functionality for a clinician to
select one or more of the parameters displayed thereon to see just
that one or more parameters displayed on the auxiliary device 2040.
Doing so may allow the auxiliary device 2040 to show more detail
about the selected one or more parameters because fewer parameters
may be shown on the auxiliary device's 2040 display than on the hub
100 or PPM 102.
[0179] FIG. 39 depicts one example display of an auxiliary device
2040 that depicts data with respect to one parameter, respiratory
rate. Unlike the main display of the hub 100 or PPM 102, the
display shown in FIG. 39 includes more than just the current value
2215, a recent trend 2230, and small waveform of the respiratory
rate. In addition, the display depicts a histogram 2220 of
historical highs and lows (for example, for the past several days)
of the patient being monitored. In addition, a detailed waveform
2240 is shown, which may be larger than the waveforms shown on the
main display of the hub 100 or PPM 102, which may give the user
more detailed insight into the patient's respiratory condition. A
user may choose to zoom into the waveform 2240 (or other aspects of
the display), causing the waveform 2242 to be enlarged to fill the
display in place of the other elements of the display, or the like.
Other graphs, tables, waveforms, and data may be shown for the
respiratory parameter on the auxiliary device display 2040. Of
course, parameters other than respiratory rate may also be selected
for detailed display on the auxiliary device 2040.
IV. Translation Module
[0180] Any of the following features described with respect to
FIGS. 40A through 45D can be implemented by the translation module
2005 of FIG. 24 or together with any of the devices described above
with respect to FIG. 24.
[0181] Healthcare costs have been increasing and the demand for
reasonably-priced, high-quality patient care is also on the rise.
Health care costs can be reduced by increasing the effectiveness of
hospital information systems. One factor which may affect the
efficacy of a health institution is the extent to which the various
clinical computer systems employed at the health institution can
interact with one another to exchange information.
[0182] Hospitals, patient care facilities, and healthcare provider
organizations typically include a wide variety of different
clinical computer systems for the management of electronic
healthcare information. Each of the clinical computer systems of
the overall IT or management infrastructure can help fulfill a
particular category or aspect of the patient care process. For
example, a hospital can include patient monitoring systems, medical
documentation and/or imaging systems, patient administration
systems, electronic medical record systems, electronic practice
management systems, business and financial systems (such as
pharmacy and billing), and/or communications systems, etc.
[0183] The quality of care in a hospital or other patient care
facility could be improved if each of the different clinical
computer systems across the IT infrastructure (or even within the
same hospital room; see, for example, FIGS. 1 and 24) were able to
effectively communicate with each other. This could allow for the
exchange of patient data that is collected by one clinical computer
system with another clinical computer system that could benefit
from such patient data. For example, this may allow decisions
relating to patient care to be made, and actions to be taken, based
on a complete analysis of all the available information.
[0184] In current practice, individual clinical computer systems
can be, and often are, provided by different vendors. As a result,
individual clinical computer systems may be implemented using a
proprietary network or communication infrastructure, proprietary
communication protocols, etc.; the various clinical computer
systems used in the hospital cannot always effectively communicate
with each other.
[0185] Medical device and medical system vendors sometimes develop
proprietary systems that cannot communicate effectively with
medical devices and systems of other vendors in order to increase
their market share and to upsell additional products, systems,
and/or upgrades to the healthcare provider. Thus, healthcare
providers are forced to make enterprise or system-wide purchase
decisions, rather than selecting the best technology available for
each type of individual clinical computer system in use.
[0186] One example where this occurs is in the area of life-saving
technology available for patient monitoring. For example, many
different bedside devices for monitoring various physiological
parameters are available from different vendors or providers. One
such provider may offer a best-in-class device for monitoring a
particular physiological parameter, while another such provider may
offer the best-in-class device for another physiological parameter.
Accordingly, it may be desirable in some circumstances for a
hospital to have the freedom to use monitoring devices from more
than one manufacturer, but this may not be possible if devices from
different manufacturers are incapable of interfacing and exchanging
patient information. Accordingly, the ability to provide
reasonably-priced, high-quality patient care can be compromised. In
addition, since each hospital or patient care facility may also
implement its own proprietary communication protocols for its
clinical computer network environment, the exchange of information
can be further hindered.
[0187] As described above, the Health Level Seven ("HL7") protocol
has been developed to provide a messaging framework for the
communication of clinical messages between medical computer systems
and devices. The HL7 communication protocol specifies a number of
standards, guidelines, and methodologies which various
HL7-compliant clinical computer systems can use to communicate with
each other.
[0188] The HL7 communication protocol has been adopted by many
medical device manufacturers. However, the HL7 standard is quite
flexible, and merely provides a framework of guidelines (for
example, the high-level logical structure of the messages);
consequently, each medical device or medical system manufacturer or
vendor may implement the HL7 protocol somewhat differently while
still remaining HL7-compliant. For example, the format of the HL7
messages can be different from implementation to implementation, as
described more fully herein. In some cases, the HL7 messages of one
implementation can also include information content that is not
included in messages according to another HL7 implementation.
Accordingly, medical devices or clinical computer systems that are
all HL7-compliant still may be unable to communicate with each
other.
[0189] Consequently, a translation module can be provided that can
improve the communication of medical messages between medical
devices or systems that use different allowed implementations of an
established communication protocol (for example, HL7), thereby
increasing the quality of patient care through the integration of
multiple clinical computer systems.
[0190] FIG. 40A illustrates a first medical device 2405 and a
second medical device 2410 that communicate with one another via a
translation module 2415. The first medical device 2405 is
configured to transmit and receive messages according to a first
allowed format or implementation of an accepted electronic medical
communication protocol, while the second medical device 2410 is
configured to transmit and receive messages according to a second
allowed format or implementation of the electronic medical
communication protocol. The first and second protocol formats are
different implementations of the HL7 communication protocol. Other
electronic medical communication protocols besides HL7 can also be
used.
[0191] The translation module 2415 receives input messages having
the first protocol format from the first medical device 2405 and
generates output messages to the second medical device 2410 having
the second protocol format. The translation module 2415 also
receives input messages having the second protocol format from the
second medical device 2410 and generates output messages to the
first medical device 2405 having the first protocol format. Thus,
the translation module 2415 can enable the first and second medical
devices 2405, 2410 to effectively and seamlessly communicate with
one another without necessarily requiring modification to the
communication equipment or protocol implemented by each device.
[0192] The translation module 2415 can determine the protocol
format expected by an intended recipient of the input message based
on, for example, the information in the input message or by
referencing a database that stores the protocol format used by
various devices, and then generates the output message based on the
protocol format used by the intended recipient device or system.
The output message can be generated based upon a comparison with,
and application of, a set of translation rules 2420 that are
accessible by the translation module 2415.
[0193] The translation rules 2420 can include rules that govern how
to handle possible variations between formatting implementations
within a common protocol. Examples of variations in formatting
implementation of an electronic medical communication protocol
include, for example, the delimiter or separator characters that
are used to separate data fields, whether a particular field is
required or optional, the repeatability of portions of the message
(for example, segments, fields, components, sub-components), the
sequence of portions of the message (for example, the order of
fields or components), whether a particular portion of a message is
included, the length of the message or portions of the message, and
the data type used for the various portions of the message.
[0194] The translation rules 2420 can define additions, deletions,
swappings, and/or modifications that can be performed in order to
"translate" an input message that adheres to a first HL7
implementation into an output message that adheres to a second HL7
implementation. The output message can have, for example, different
formatting than the input message, while maintaining all, or a
portion of, the substance or content of the input message.
[0195] In addition to translating between different implementations
of a common electronic medical communication protocol (for example,
different formatting of HL7 messages), the translation module 2415
can also translate between input and output messages adhering to
different communication protocols. The translation module 2415 can
be capable of responding to and translating messages from, for
example, one medical communication protocol to a separate medical
communication protocol. For example, the translation module 2415
can facilitate communication between messages sent according to the
HL7 protocol, the ISO 11073 protocol, other open protocols, and/or
proprietary protocols. Accordingly, an input message sent according
to the HL7 protocol can be translated to an output message
according to a different protocol, or vice-versa.
[0196] The operation of the translation module 2415 and the
translation rules 2420 will be described in more detail below.
Various examples of system architectures including the translation
module 2415 will now be described.
[0197] The first medical device 2405, the second medical device
2410, and the translation module 2415 can be communicatively
coupled via connection to a common communications network or
directly (via cables or wirelessly), for example, through the hub
100, PPM 102, and/or MMS 2004. The translation module 2415 can be
communicatively coupled between the first medical device 2405 and
the second medical device 2410 (with or without a communications
network) such that all messages between the first and second
medical devices 2405, 2410 are routed through the translation
module 2415. Other architectures are also possible.
[0198] The first and second medical devices 2405, 2410 and the
translation module 2415 can be included in, for example, a portion
of the monitoring environments of FIG. 1 or 24 described above. The
first medical device 2405 may be, for example, the infusion pump(s)
216 or ventilator 218, while the second medical device 2410 may be,
for example, the monitoring hub 100, PPM 102, MMS 2004, or
auxiliary device 2040. The translation module 2415 is an example
implementation of the translation module 2005.
[0199] The translation module 2415 can facilitate communication
across multiple networks within a hospital environment.
Additionally or optionally, the translation module 2415 can
facilitate communication of messages across one or more networks
extending outside of the hospital or clinical network environment.
For example, the translation module 2415 can provide a
communications interface with banking institutions, insurance
providers, government institutions, outside pharmacies, other
hospitals, nursing homes, or patient care facilities, doctors'
offices, and the like.
[0200] The translation module 2415 of FIG. 40 can be a component
of, for example, the environment 2000 described above with respect
to FIG. 24. For example, the translation module 2415 can be
communicatively coupled with a hospital network or other networks
or monitoring environments described above. The translation module
2415 can facilitate the exchange of patient monitoring information,
including, for example, physiological parameter measurements,
physiological parameter trend information, and physiological
parameter alarm conditions between bedside medical monitor devices,
nurses' monitoring stations, a Hospital or Clinical Information
System (which may store Electronic Medical Records), and/or many
other medical devices and systems. The translation module 2415 can
enable seamless communication between different medical devices and
systems, each of which may use a different implementation of an
electronic medical communication protocol such as, for example, the
HL7 communication protocol, within a clinical or hospital network
environment.
[0201] The translation module 2415 can also facilitate
communication between a first medical device that is part of the
patient monitoring sub-system and a second medical device that is
not part of, or is external to, the patient monitoring system 200.
As such, the translation module 2415 can be capable of responding
to externally-generated medical messages (such as patient
information update messages, status query messages, and the like
from an HIS or CIS) and generating external reporting messages
(such as event reporting messages, alarm notification messages, and
the like from patient monitors or nurses' monitoring stations).
[0202] The first and second medical devices 2405, 2410 can
communicate with each other over a communication bus 2421.
Communication bus 2421 can include any one or more of the
communication networks, systems, and methods described above,
including the Internet, a hospital WLAN, a LAN, a personal area
network, etc. For example, any of the networks describe above can
be used to facilitate communication between a plurality of medical
devices, including first and second medical devices 2405, 2410,
discussed above. One such example is illustrated in FIG. 40B.
[0203] In FIG. 40B, first medical device 2405 provides a message to
the communication bus 2421. The message is intended for receipt by
the second medical device 2410; however, because first and second
medical devices 2405, 2410 communicate according to different
communication protocol format, second medical device 2410 is unable
to process the message.
[0204] Translation module 2415 monitors the communication bus 2421
for such messages. Translation module receives the message and
determines that first medical device 2405 is attempting to
communicate with second medical device 2410. Translation module
2415 determines that message translation would facilitate
communication between first and second medical devices 2405, 2410.
Translation module 2415 therefore utilizes an appropriate
translation rule stored in a translation module 2420. Translation
module 2420 can include a memory, EPROM, RAM, ROM, etc.
[0205] The translation module 2415 translates the message from the
first medical device 2405 according to any of the methods described
herein. Once translated, the translation module 2415 delivers the
translated message to the communication bus 2421. The second
medical device 2410 receives the translated message and responds
appropriately. For example, the second medical device may perform a
function and/or attempt to communication with the first medical
device 2405. The translation module 2415 facilitates communication
from the second medical device 2410 to the first medical device
2405 in a similar manner.
[0206] The first medical device 2405 and the second medical device
2410 can be, for example, any of the medical devices or systems
communicatively coupled to a hospital network or hub 100, PPM 102,
and/or MMS 2004. These medical devices or systems can include, for
example, point-of-care devices (such as bedside patient monitors),
data storage units or patient record databases, hospital or
clinical information systems, central monitoring stations (such as
a nurses' monitoring station), and/or clinician devices (such as
pagers, cell phones, smart phones, personal digital assistants
(PDAs), laptops, tablet PCs, personal computers, pods, and the
like).
[0207] The first medical device 2405 can be a patient monitor for
communicatively coupling to a patient for tracking a physiological
parameter (for example, oxygen saturation, pulse rate, blood
pressure, etc.), and the second medical device 2410 is a hospital
information system ("HIS") or clinical information system ("CIS").
The patient monitor can communicate physiological parameter
measurements, physiological parameter alarms, or other
physiological parameter measurement information generated during
the monitoring of a patient to the HIS or CIS for inclusion with
the patient's electronic medical records maintained by the HIS or
CIS.
[0208] The first medical device 2405 can an HIS or CIS and the
second medical device 2410 can be a nurses' monitoring station, as
described herein. However, the translation module 2415 can
facilitate communication between a wide variety of medical devices
and systems that are used in hospitals or other patient care
facilities. For example, the translation module 2415 can facilitate
communication between patient physiological parameter monitoring
devices, between a monitoring device and a nurses' monitoring
station, etc.
[0209] Using the translation module 2415, a patient monitoring
sub-system, such as those described herein (for example,
physiological monitoring system 200), can push data to the HIS or
pull data from the HIS even if the HIS uses a different
implementation of the HL7 protocol, or some other electronic
medical communication protocol.
[0210] The patient monitoring sub-system can be configured to
push/pull data at predetermined intervals. For example, a patient
monitor or clinician monitoring station can download patient data
automatically from the HIS at periodic intervals so that the
patient data is already available when a patient is connected to a
patient monitor. The patient data sent from the HIS can include
admit/discharge/transfer ("ADT") information received upon
registration of the patient. ADT messages can be initiated by a
hospital information system to inform ancillary systems that, for
example, a patient has been admitted, discharged, transferred or
registered, that patient information has been updated or merged, or
that a transfer or discharge has been canceled.
[0211] The patient monitoring sub-system can be configured to
push/pull data to/from the HIS only when the HIS is solicited by a
query. For example, a clinician may make a request for information
stored in a patient's electronic medical records on the HIS.
[0212] The patient monitoring sub-system can be configured to
push/pull data to/from the HIS in response to an unsolicited event.
For example, a physiological parameter of a patient being monitored
can enter an alarm condition, which can automatically be
transmitted to the HIS for storing in the patient's electronic
medical records. Any combination of the above methods or
alternative methods for determining when to communicate messages to
and from the HIS can be employed.
[0213] Example system architectures and example triggers for the
communication of messages involving the translation module 2415
have been described. Turning now to the operation of the
translation module, FIGS. 25A-25D illustrate an example medical
message at different phases or steps of a translation process. The
translation process will be described in more detail below in
connection with FIGS. 26, 27A and 27B.
[0214] FIG. 41A illustrates an example ADT input message 2505
received by the translation module 2415 from an HIS. The ADT input
message 2505 is implemented according to the HL7 communication
protocol and contains information related to the admission of a
patient to a hospital. The ADT message 2505 includes multiple
segments, including a message header segment 2506, an event
segment, a patient identification segment, a patient visit segment,
role segments, a diagnosis segment, and multiple custom
segments.
[0215] The message header ("MSH") segment 2506 can define how the
message is being sent, the field delimiters and encoding
characters, the message type, the sender and receiver, etc. The
first symbol or character after the MSH string can define the field
delimiter or separator (in this message, a "caret" symbol). The
next four symbols or characters can define the encoding characters.
The first symbol defines the component delimiter (".about."), the
second symbol defines the repeatable delimiter ("|"), the third
symbol defines the escape delimiter ("\"), and the fourth symbol
defines the sub-component delimiter ("&"). All of these
delimiters can vary between HL7 implementations.
[0216] The example header segment 2506 can further include the
sending application ("VAFC PIMS"), the receiving application
("NPTF-508"), the date/time of the message ("20091120104609-0600"),
the message type ("ADT.about.A01"), the message control ID
("58103"), the processing ID ("P"), and the country code ("USA").
As represented by the consecutive caret symbols, the header segment
also contains multiple empty fields.
[0217] FIG. 41B illustrates the message header segment 2506 after
it has been parsed into fields or elements based on an identified
field delimiter (the caret symbol). The parsed input message
comprises an XML message that is configured to be transformed
according to extensible stylesheet language transformation (XSLT)
rules.
[0218] The parsed input message can be encoded. FIG. 41C
illustrates the parsed message header segment of the input message
after being encoded (for example, using a Unicode Transformation
Format-8 ("UTF-8") encoding scheme).
[0219] The encoded message header segment shows some of the various
data types that can be used in the message. For example, the
sending application ("VAFC PIMS") of the third parsed field and the
receiving application ("NPTF-508") of the fifth parsed field are
represented using a hierarchic designator ("HD") name data type.
The date/time field (the seventh parsed field) is represented using
the time stamp ("TS") data type. The processing ID field (the
eleventh parsed field) is represented using the processing type
("PT") data type. The fields that do not include a data type
identifier are represented using the string ("ST") data type. Other
possible data types include, for example, coded element, structured
numeric, timing quantity, text data, date, entry identifier, coded
value, numeric, and sequence identification. The data types used
for the various fields or attributes of the segments can vary
between formatting implementations.
[0220] FIG. 41D illustrates an example output message 2510 from the
translation module 2415 based on the example input message 2505 of
FIG. 41A. The output message 2510 includes a message
acknowledgement segment 2512.
[0221] Turning to the operation of the translation module, the
translation module 2415 can, for example, create, generate, or
produce an output message that is reflective of the input message
based on an application of the set of translation rules 2420. The
translation module 2415 can, for example, translate, transform,
convert, reformat, configure, change, rearrange, modify, adapt,
alter, or adjust the input message based on a comparison with, and
application of, the set of translation rules 2420 to form the
output message. The translation module 2415 can, for example,
replace or substitute the input message with an output message that
retains the content of the input message but has a new formatting
implementation based upon a comparison with, and application of,
the set of translation rules 2420.
[0222] FIG. 42 illustrates a translation process 2600 for
generating an output message based on an input message and a
comparison with the set of translation rules 2420 associated with
the translation module 2415. The translation process 2600 starts at
block 2602 where the translation module 2415 receives an input
message from a first medical device.
[0223] At block 2604, the translation module 2415 determines the
formatting implementation of the input message and the formatting
implementation to be used for the output message. The input message
can include one or more identifiers indicative of the formatting
implementation. The determination of the formatting implementation
can be made, for example, by analyzing the message itself by
identifying the delimiter or encoding characters used, the field
order, the repeatability of segments, fields, or components, the
data type of the fields, or other implementation variations. The
translation module 2415 can separate or parse out the formatting
from the content of the message (as shown in FIG. 41B) to aid in
the determination of the formatting implementation. The translation
module 2415 can determine the formatting implementation of the
input message by referencing a database that stores the
implementation used by each device with which the translation
module 2415 has been configured to interface.
[0224] The determination of the formatting implementation used by
the output message can also be determined from the input message.
For example, the input message can include a field that identifies
the intended recipient application, facility, system, device,
and/or destination. The input message can optionally include a
field that identifies the type of message being sent (for example,
ADT message) and the translation module 2415 can determine the
appropriate recipient from the type of message being sent and/or
the sending application, device, or system. The translation module
2415 can then determine the formatting implementation required by
the intended recipient of the input message.
[0225] At decision block 2605, the translation module 2415
determines whether a rule set has been configured for the
translation from the identified formatting implementation of the
input message to the identified formatting implementation to be
used for the output message. The rule set may have been manually
configured prior to installation of the translation module software
or may have been automatically configured prior to receipt of the
input message. If a rule set has already been configured, then the
translation process 2600 continues to block 2606. If a rule set has
not been configured, then a rule set is configured at block 2607.
The configuration of the rule set can be performed as described
below in connection with FIGS. 44 and 45A-45D. The translation
process 2600 then continues to block 2608.
[0226] At block 2606, the translation module 2415 identifies the
pre-configured rules from the set of translation rules 2420 that
govern translation between the determined formatting implementation
of the input message and the formatting implementation of the
output message. The identification of the pre-configured rules can
be made manually.
[0227] At block 2608, the translation module 2415 generates an
output message based on the configured rule set(s) of the
translation rules 2420. The output message can retain all, or at
least a portion of, the content of the input message but has the
format expected and supported by the intended recipient of the
input message.
[0228] The translation rules 2420 can include, for example,
unidirectional rules and/or bidirectional rules. A unidirectional
rule can be one, for example, that may be applied in the case of a
message from a first medical device (for example, 2405) to a second
medical device (for example, 2410) but is not applied in the case
of a message from the second medical device to the first medical
device. For example, a unidirectional rule could handle a
difference in the delimiters used between fields for two different
formatting implementations of, for example, the HL7 communication
protocol. The translation module 2415 can apply a field delimiter
rule to determine if the field delimiter is supported by the
intended recipient of the input message. If the field delimiter of
the input message is not supported by the intended recipient, the
field delimiter rule can replace the field delimiter of the input
message with a field delimiter supported by the intended
recipient.
[0229] For example, an input message from an input medical device
can include a formatting implementation that uses a "caret" symbol
(" ") as the field delimiter or separator. However, the formatting
implementation recognized by the intended recipient medical device
may use a "pipe" symbol ("|") as the field delimiter. The
translation module 2415 can identify the field delimiter symbol
used in the formatting implementation recognized by the intended
recipient medical device from the set of translation rules 2420 and
generate an output message based on the input message that uses the
pipe field delimiter symbol instead of the caret field delimiter
symbol used in the input message. The rule to substitute a pipe
symbol for a caret symbol would, in this case, only apply to
messages that are sent to a recipient device that recognizes the
pipe symbol as a field delimiter. This rule could be accompanied by
a complementary rule that indicates that a caret symbol should be
substituted for a pipe symbol in the case of a message that is
intended for a recipient device that is known to recognize the
caret symbol as the field delimiter.
[0230] Another unidirectional rule can handle the presence or
absence of certain fields between different formatting
implementations. For example, an input message from an input
medical device can include fields that would not be recognized by
the intended recipient medical device. The translation module 2415
can generate an output message that does not include the
unrecognized or unsupported fields. In situations where an input
message does not include fields expected by the intended recipient
medical device, the set of translation rules 2420 can include a
rule to insert null entries or empty "" strings in the fields
expected by the intended recipient medical device and/or to alert
the recipient device of the absence of the expected field. The
sender device may also be notified by the translation module 2415
that the recipient device does not support certain portions of the
message.
[0231] Other unidirectional rules can facilitate, for example, the
conversion of one data type to another (for example, string ("ST")
to text data ("TX") or structured numeric ("SN") to numeric
("NM")), and the increase or decrease in the length of various
portions of the message. Unidirectional rules can also be used to
handle variations in repeatability of portions of the message. For
example, the translation module 2415 can apply a field
repeatability rule to repeated instances of a segment, field,
component, or sub-component of the message to determine how many
such repeated instances are supported by the recipient device, if
any, and deleting or adding any repeated instances if necessary.
For example, a phone number field of a patient identification
segment can be a repeatable field to allow for entry of home, work,
and cell phone numbers.
[0232] Bidirectional rules can also be used. Such rules may apply
equally to messages between first and second medical devices (for
example, 2405, 2410) regardless of which device is the sender and
which is the recipient. A bidirectional rule can be used to handle
changes in sequence, for example. An input message from an input
medical device can include a patient name field, or fields, in
which a first name component appears before a last name component.
However, the intended recipient medical device may be expecting an
implementation where the last name component appears before the
first name component. Accordingly, the set of translation rules
2420 can include a bidirectional rule to swap the order of the
first and last name components when communicating between the two
medical devices, or between the two formatting implementations. In
general, field order rules can be applied to determine whether the
fields, components, or sub-components are in the correct order for
the intended recipient and rearranging them if necessary. Other
bidirectional rules can be included to handle, for example, other
sequential variations between formatting implementations or other
types of variations.
[0233] The translation rules 2420 can also include compound rules.
For example, a compound rule can include an if-then sequence of
rules, wherein a rule can depend on the outcome of another rule.
Some translation rules 2420 may employ computations and logic (for
example, Boolean logic or fuzzy logic), etc.
[0234] As discussed above, the messages communicated over the
hospital-based communication network can employ the HL7 protocol.
FIGS. 43A and 43B illustrate translation processes 2700A, 2700B in
which HL7 messages are communicated between a HIS and a medical
device over a hospital-based communications network or a clinical
network. The translation processes 2700A, 2700B will be described
with the assumption that the rules governing "translation" between
the first and second HL7 formats have already been configured.
[0235] FIG. 43A illustrates a translation process 2700A in which
the translation module 2415 facilitates communication of an HL7
message, such as the ADT message of FIG. 41A, from an HIS having a
first HL7 format to an intended recipient medical device, such as a
patient monitor or a clinician monitoring station, having a second
HL7 format.
[0236] The translation process 2700A starts at block 2701, where
the translation module 2415 receives an input message having a
first HL7 format from the HIS. The input message includes
information regarding, for example, the admission of a patient
and/or patient identification and patient medical history
information from an electronic medical records database.
[0237] At block 2703, the translation module 2415 determines the
formatting implementation of the input message and the formatting
implementation to be used for the output message. These
determinations can be made in a similar manner to the
determinations discussed above in connection with block 2604 of
FIG. 42.
[0238] At block 2705, the translation module 2415 identifies the
rules that govern translation between the determined HL7 format of
the input message and the HL7 format of the output message and
generates an output message having the second HL7 format based on
the identified rules. The output message can retain the content of
the input message sent by the HIS but can have the format expected
and supported by the intended recipient of the input message.
[0239] At block 2707, the translation module 2415 can output the
output message to the intended recipient over the hospital-based
communications network. The intended recipient can transmit an
acknowledgement message back to the hospital information system
acknowledging successful receipt or reporting that an error
occurred.
[0240] FIG. 43B illustrates a translation process 2700B in which
the translation module 2415 facilitates communication of an HL7
message from a medical device, such as a patient monitor, having a
first HL7 format to an HIS having a second HL7 format. For example,
the patient monitor can transmit reporting event data m such as
patient alarm data, to the HIS to store in the patient's electronic
medical records.
[0241] The translation process 2700B starts at block 2702, where
the translation module 2415 receives an input message having a
first HL7 format from the medical device. The input message can
include patient monitoring data or alarm data regarding one or more
physiological parameters of the patient being monitored for storage
in an electronic medical records database associated with the
HIS.
[0242] At block 2704, the translation module 2415 determines the
formatting implementation of the input message and the formatting
implementation to be used for the output message. These
determinations can be made in a similar manner to the
determinations discussed above in connection with block 2604 of
FIG. 42.
[0243] At block 2706, the translation module 2415 identifies the
rules that govern translation between the determined HL7 format of
the input message and the HL7 format of the output message and
generates an output message having the second HL7 format based on
the identified rules. The output message can retain the content of
the input message sent by the medical device but can have the
format expected and supported by the HIS.
[0244] At block 2708, the translation module 2415 can output the
output message to the hospital information system over the
hospital-based communications network. The HIS can transmit an
acknowledgement message back to the medical device acknowledging
successful receipt or reporting that an error occurred.
[0245] FIGS. 42, 43A and 43B described the operation of the
translator module 2415. FIGS. 44 and 45A-45D will be used to
illustrate the description of the configuration of the translation
rules 2420.
[0246] The translation rules 2420 can be implemented as one or more
stylesheets, hierarchical relationship data structures, tables,
lists, other data structures, combinations of the same, and/or the
like. The translation rules 2420 can be stored in local memory
within the translation module 2415. The translation rules 2420 can
be stored in external memory or on a data storage device
communicatively coupled to the translation module 2415.
[0247] The translation module 2415 can include a single rule set or
multiple rule sets. For example, the translation module 2415 can
include a separate rule set for each medical device/system and/or
for each possible communication pair of medical devices/systems
coupled to the network or capable of being coupled to the network.
The translation module 2415 can include a separate rule set for
each possible pair of formatting implementations that are allowed
under a medical communication protocol such as, for example, the
HL7 protocol.
[0248] The translation rules 2420 can be manually inputted using,
for example, the messaging implementation software tool 2800
illustrated in FIG. 44. For example, the software developer for a
particular hospital network can determine the protocol message
formats used by the devices and/or systems that are or can be
coupled to the hospital network and then manually input rules to
facilitate "translation" between the various protocol message
formats supported or recognized by the devices and/or systems.
[0249] FIG. 44 illustrates an example screenshot from a messaging
implementation software tool 2800 for manually configuring
translation rules 2420 to be used by the translation module 2415.
The screenshot from the messaging implementation software tool 2800
illustrates various parameters that may differ between formatting
implementations of an electronic medical communication protocol,
such as HL7. The screenshot also includes areas where a user can
input information that defines, or is used to define, translation
rules for converting between different HL7 implementations. The
messaging implementation software tool 2800 can store a variety of
pre-configured rule sets based, for example, on known communication
protocol implementations of various medical devices. A user may
configure one or more translation rules 2420 to be used in
communications involving such devices by entering identification
information, such as the device manufacturer, model number, etc.
Based on this identification information, the messaging
implementation tool 2800 can identify a pre-configured set of
translation rules for communication with that device.
[0250] The translation rules 2420 can be automatically generated.
For example, the automatic generation of a new set, or multiple
sets, of rules can be triggered by the detection of a newly
recognized "communicating" medical device or system on a network.
The automatic generation of a new set or multiple sets of rules can
occur at the time a first message is received from or sent to a new
"communicating" medical device or system coupled to the network.
The automatic generation of rule sets can include updating or
dynamically modifying a pre-existing set of rules.
[0251] The automatic generation of translation rule sets can be
carried out in a variety of ways. For example, the translation
module 2415 can automatically initiate usage of a pre-configured
set of translation rules 2420 based upon, for example, the make and
model of a new device that is recognized on the network. The
translation module 2415 can request one or more messages from the
new device or system and then analyze the messages to determine the
type of formatting being implemented, as illustrated by the
automatic rule configuration process 2900A of FIG. 45A. The
automatic rule configuration process 2900A starts at block 2901,
where the translation module 2415 receives one or more messages
from a detected medical device or system on the network. The
messages can be received upon transmission to an intended recipient
medical device or system or in response to a query sent by the
translation module 2415 or another medical device or system coupled
to the network.
[0252] At block 2903, the translation module 2415 determines the
protocol of the one or more received messages by, for example,
analyzing the message or by consulting a database that indicates
what communication protocol/format is implemented by each medical
device or system on the network. The translation module 2415 can be
configured to handle medical messages implemented using a single
common protocol, such as HL7. Accordingly, if a determination is
made that the received messages are implemented using a
non-supported or non-recognized protocol, the translation module
can ignore the messages received from the detected medical device
or system, output an alert or warning, or allow the messages to be
sent without being translated.
[0253] At block 2905, the translation module 2415 determines the
formatting implementation of the received message(s). The received
messages can include one or more identifiers indicative of the
formatting implementation. Additionally or optionally, the
determination of the formatting implementation can be made, for
example, by analyzing the message itself by checking field order,
the delimiter or encoding characters used, or other implementation
variations. The translation module 2415 can separate or parse out
the formatting from the content of the message to aid in the
determination of the formatting implementation.
[0254] At block 2907, the translation module 2415 configures one or
more rules or rule sets to handle messages received from and/or
sent to the detected medical device or system. The configuration of
the rules may involve the creation or generation of new rules.
Additionally or optionally, the configuration of the rules may
involve the alteration or updating of existing rules. The
configured rules or rule sets can be included with the translation
rules 2420. If a set of rules already exists for the formatting
implementation used by the new device or system, then the
configuration of new translation rules may not be required.
Instead, existing translation rules can be associated with the new
device or system for use in communication involving that device or
system. The translation module 2415 can create a new set of rules
geared specifically for the new device or system or can modify an
existing set of rules based on subtle formatting variations
identified.
[0255] The translation module 2415 can generate test message(s)
that may be useful in identifying the communication protocol and
implementation used by a device or system. For example, the
translation module can generate test messages to cause the newly
detected device or system to take a particular action (for example,
store information) and then query information regarding the action
taken by the newly detected device to determine whether or how the
test message was understood. This is illustrated by the automatic
rule configuration process 2900B of FIG. 45B.
[0256] The automatic rule configuration process 2900B starts at
block 2902, where the translation module 2415 transmits one or more
test, or initialization, messages to a remote device or system
detected on a network. The test messages can be configured, for
example, to instruct the remote device or system to take a
particular action (for example, store patient information). The
test messages can be configured to generate a response indicative
of the type of formatting recognized or supported by the remote
device or system. The test messages can be configured such that
only devices or systems supporting a particular formatting
implementation will understand and properly act on the test
messages.
[0257] At block 2904, the translation module 2415 queries the
remote device or system to receive information regarding the action
taken based on the test message sent to the remote device or system
to determine whether the test message was understood. For example,
if the test message instructed the remote device or system to store
patient information in a particular location, the translation
module 2415 can query the information from the location to
determine whether the test message was understood. If the test
message was not understood, the translation module 2415 can, for
example, continue sending test messages of known formatting
implementations until a determination is made that the test message
has been understood.
[0258] At block 2906, the translation module 2415 determines the
protocol and formatting implementation based on the information
received. As an example, the test message can include an
instruction to store patient name information. The test message can
include a patient name field having a first name component followed
by a surname component. The translation module 2415 can then query
the remote device or system to return the patient surname.
Depending on whether the patient surname or the first name is
returned, this query can be useful in determining information about
the order of fields in the formatting implementation being used by
the remote device or system. As another example, the test messages
can instruct the detected device or system to store repeated
instances of a component. The translation module 2415 can then
query the device or system to return the repeated instances to see
which, if any, were stored. This repeatability information can also
be useful in determining whether certain fields are allowed to be
repeated in the formatting implementation being used by the remote
device for system, and, if so, how many repeated instances are
permitted.
[0259] At block 2908, the translation module 2415 configures one or
more rules to handle messages received from and/or sent to the
detected medical device or system. For example, the rules can
convert messages from the message format used by a first medical
device to that used by a second medical device, as described
herein. The configuration of the rules can involve the creation or
generation of new rules. Additionally or optionally, the
configuration of the rules can involve the alteration or updating
of existing rules. If a set of rules already exists for the
formatting implementation used by the new device or system, then
the configuration of new translation rules may not be required.
Instead, existing translation rules can be associated with the new
device or system for use in communication involving that device or
system.
[0260] FIGS. 29C and 29D illustrate automatic rule configuration
processes performed by the translation module 2415 for messages
utilizing the HL7 protocol. The HL7 protocol can be used, for
example, to communicate electronic messages to support
administrative, logistical, financial, and clinical processes. For
example, HL7 messages can include patient administration messages,
such as ADT messages, used to exchange patient demographic and
visit information across various healthcare systems.
[0261] The automatic rule configuration process 2900C illustrated
in FIG. 45C is similar to the process 2900A illustrated in FIG.
45A. At block 2911, the translation module 2415 receives one or
more messages from an HL7 medical device. At block 2915, the
translation module 2415 determines the formatting implementation of
the HL7 medical device from the one or more messages received. As
discussed above, the determination of the formatting implementation
can be made, for example, by checking field order or sequence,
field delimiter characters, repeatability, cardinality, and other
HL7 implementation variations.
[0262] At block 2917, the translation module 2415 configures one or
more rules to handle messages received from and/or sent to the HL7
medical device. The configuration of the rules can involve the
creation or generation of new rules for the detected formatting
implementation. Additionally or optionally, the configuration of
the rules involves the dynamic alteration or updating of existing
rules. If a set of rules already exists for the formatting
implementation used by the new HL7 medical device, then the
configuration of new translation rules may not be required.
Instead, existing translation rules can be associated with the new
HL7 medical device for use in communication involving that
device.
[0263] The automatic rule configuration process 2900D illustrated
in FIG. 45D is similar to the process 2900B illustrated in FIG.
45B. At block 2912, the translation module 2415 can transmit one or
more test, dummy, or initialization messages to an HL7 medical
device. Additionally or optionally, the translation module 2415 can
cause one or more test messages to be transmitted to the new HL7
medical device from another HL7 medical device. As described above,
the test messages can include messages having known HL7 formats
configured to determine whether the HL7 device understands the test
messages. The test messages can include test ADT messages, for
example.
[0264] At block 2914, the translation module 2415 queries the HL7
medical device to receive information regarding an action taken or
information stored in response to the test message. At block 2916,
the translation module 2415 determines the formatting
implementation of the HL7 device based on the information received.
The translation module 2415 can analyze the information received to
determine whether the test message or messages were properly
understood. If none of the test messages were properly understood,
the translation module 2415 can send additional test messages
having other known HL7 formats and repeat blocks 2914 and 2916.
[0265] At block 2918, the translation module 2415 configures one or
more translation rules to handle messages received from and/or sent
to the detected HL7 medical device. The configuration of the
translation rules can involve the creation or generation of new
translation rules. Additionally or optionally, the configuration of
the rules can involve the alteration or updating of existing rules.
If a set of translation rules already exists for the formatting
implementation used by the new HL7 medical device, then the
configuration of new translation rules may not be required.
Instead, existing translation rules can be associated with the new
HL7 medical device for use in communication involving that HL7
medical device.
[0266] The automatic rule configuration processes described above
can be triggered by the detection of a network device or system by
the translation module 2415. The medical devices referred to in
FIGS. 45A-45D can include any of the devices or systems illustrated
in FIG. 1 or 24.
[0267] The automatic generation of translation rules can
advantageously occur post-installation and post-compilation of the
messaging sub-system software, which includes the translation
module 2415. The automatic generation or dynamic modification of
the translation rules 2420 can occur without having to recompile or
rebuild the translation module software. This feature can be
advantageous in terms of efficiently complying with U.S. Food and
Drug Administration ("FDA") requirements regarding validation of
software used in healthcare environments.
[0268] Take, for example, a situation where a medical device
manufacturer plans to use the translation module 2415 to facilitate
communication between a particular medical device or system that is
to be installed in a hospital (for example, a patient monitoring
system, as described herein), or other patient care facility, and
other devices or systems that are already installed at the hospital
(for example, the HIS or CIS). Any software required for the
operation of the new medical device to be installed may be at least
partially validated for FDA compliance prior to installation at the
hospital despite the fact that, for example, the HL7
implementations of other existing devices or systems at the
hospital may still be unknown. For example, any aspects of the
software for the new medical device that are dependent upon
receiving messages from other hospital devices can be validated
pre-installation as being capable of fully and correctly operating
when the expected message format is received. Then, once the
medical device is installed at the hospital, the validation of the
software can be completed by showing that the translation module
2415 is able to provide messages of the expected format to the
newly installed device. In this way, FDA validation tasks can be
apportioned to a greater extent to the pre-installation timeframe
where they can be more easily carried out in a controlled manner
rather than in the field.
[0269] In addition, the translation module 2415 can further help
streamline FDA validation, for example, when a medical device or
system is expected to be installed at different hospitals whose
existing devices use, for example, different implementations of the
HL7 protocol. Normally, this type of situation could impose the
requirement that the entire functionality of the software for the
new medical device be completely validated at each hospital.
However, if the translation module 2415 is used to interface
between the new medical device and the hospital's existing devices,
then much of the software functionality could possibly be validated
a single time prior to installation, as just described. Then, once
installed at each hospital, the software validation for the medical
device can be completed by validating that correct message formats
are received from the translation module (the translation rules for
which are field-customizable). This may result in making on-site
validation procedures significantly more efficient, which will
advantageously enable more efficient FDA compliance in order to
bring life-saving medical technology to patients more quickly by
the use of field-customizable translation rules.
V. Example Connections with the Hub Via a Board-In-Cable
[0270] As described with reference to FIGS. 2 and 12, the
monitoring hub 100 can be connected to medical systems and receive
data acquired by various sensors such as, for example, sensors 202,
222, 224, 226. For example, with reference to FIG. 12, various
sensors can be connected to the monitoring hub 100 via a
Board-in-Cable (BIC) device. The BIC device of FIG. 12 may be a
custom device, with hardware and software built at least in part by
a third-party manufacturer other than the provider of the
monitoring hub 100. For example, a third-party manufacturer may
design and build the BIC device to be compatible with the
monitoring hub 100. Such a custom BIC can beneficially expand the
capability of the monitoring hub 100, for example, by adding new
physiological parameter monitoring capability. However, designing a
custom BIC for each parameter can be a labor-intensive process.
[0271] The BIC of FIG. 12 can also be an off-the-shelf device. The
provider of the monitoring hub 100 can supply a BIC that can be
programmed by any third-party to monitor a new parameter when
connected to a third-party sensor. The BIC may, for instance,
include a processor, memory, and a programming environment that
enables rapid development of parameter calculation algorithms
without having to reinvent the wheel to design a BIC. This type of
BIC--which may be considered an off-the-shelf BIC--can beneficially
reduce or eliminate the need for third parties to manufacturer
their own hardware (other than perhaps sensors and cables) and
design firmware.
[0272] As an example, a third party may desire to expand the
functionality of the monitoring hub by adding noninvasive blood
pressure (NIBP) monitoring capability. The third party can obtain
an off-the-shelf BIC from the provider of the monitoring hub 100
(optionally together with an associated cable for attaching to the
hub 100), rather than designing its own BIC that interfaces with
the monitoring hub 100. The third party can then access an SDK
(described above and in more detail below) from the provider of the
monitoring hub and use this SDK to program the BIC with a NIBP
monitoring application. The third party can then sell the BIC (and
optionally cable), together with its sensors, to hospitals or other
patient care providers, who can then connect the BIC to the
monitoring hub 100 to add NIBP functionality to the monitoring hub
100.
[0273] The off-the-shelf BIC may include an operating system and
applications, including an API, that permit interactions with the
hub 100. For instance, the API can enable an application running on
the BIC to expose settings of the application to the monitoring hub
100. Thus, the off-the-shelf BIC may not only output data to be
displayed on the hub but may also permit the hub to control aspects
of the BIC. For example, the third-party application on the BIC may
access an API that causes the hub to expose a user interface with
settings that can affect the BIC, such as an alarm limit user
interface control (like a slider). A clinician can access the
settings on the hub, change them, and thereby cause the hub to use
an API call to transmit the settings update to the BIC.
[0274] The above-described features are now described in more
detail starting with FIG. 72A. FIG. 72A depicts a BIC and other
associated components that can include any of the features
described above, as well as optionally additional features. FIG.
72A illustrates an example of interfacing with the hub using an
off-the-shelf BIC 7210. The computing environment 7200a can include
sensor(s) 7202 and the monitoring hub 100. The sensors 7202 can be
physiological sensors for measuring one or more of a patient's
parameters. The sensor(s) 7202 can connect to the monitoring hub
100 via a sensor cable 7204 (also shown in FIG. 15) and a cable
connector 7220. The sensor cable 7204 can include two ends where
the first end can be connected to a sensor 7202 while the second
end can be connected to the BIC 7210. The BIC 7210 may be connected
to the cable connector 7220 which can connect to the monitoring hub
100.
[0275] The sensor cable 7204 can include the off-the-shelf BIC
7210, which can be programmed with algorithms for parameter
calculations and for interfacing with the monitoring hub 100. The
BIC 7210 can include a parameter calculation application(s) 7212
(optionally provided by a third party other than the hub 100
provider), an application programming interface (API) 7214 (e.g.,
provided by the hub 100 provider), and an operating system 7216
(e.g., provided by the hub 100 provider), although one or more of
three components of BIC 7210 may be optional. Further, although not
shown in FIG. 72A, the BIC 7210 can also include a hardware
processor and a non-transitory memory to support the parameter
calculation application 7212, the API 7214, and the operating
system 7216.
[0276] The parameter calculation application can comprise
executable code which implements algorithms for processing
parameter data received from the sensor 7202. The executable code
(such as, for example, the parameter calculation application(s)
7212, the API 7214, etc.) may be programmed by the SDK described
above and in more detail below with reference to FIG. 74.
[0277] As an example of data processing by the BIC 7210, the BIC
7210 can be connected to the sensor 7202, which can measure a
patient's blood pressure. The BIC 7210 can receive the patient's
blood pressure data acquired from the sensor 7202 and generate data
packets with the blood pressure changes over time. As another
example, the BIC 7210 can additionally receive the patient's heart
rate data from the monitoring hub 100 or another BIC associated
with a different medical system. The parameter calculation
application 7212 can use the blood pressure data and the heart rate
data (among other data) to calculate a wellness index of the
patient. The wellness index can be communicated to the monitoring
hub 100 for display or further processing.
[0278] Additionally or optionally, the BIC 7210 can communicate
display configurations associated with the sensor 7202 to the
monitoring hub 100. Example display configurations can include the
size of display, amount of information to be shown on the hub 100,
frequency of display updates, color or font of the display,
parameters to be displayed, and format of the display (for example,
in graphical or numerical format), layout of information, etc. As
an example of controlling the display setting of the monitoring hub
100 via the BIC 7210, the BIC 7210 can provide two, three, or more
different sizes of display such as, for example, large, medium, and
small sizes where the large size of the display may include more
information associated with a patient parameter. For example, the
large size may provide a graph showing heart rate changes over time
while the small size may include a numerical number showing the
current heart rate. The BIC 7210 may be configured to control a
subdivision of monitoring hub's display. With reference to FIG.
23F, where the BIC 7210 communicates blood pressure data to the
monitoring hub, the BIC 7210 may manage the settings for the bottom
left region of the display (where the blood pressure is shown).
Another BIC associated with a temperature sensor can be configured
to manage the display settings on the bottom right region of the
display in FIG. 23F.
[0279] The API 7214 can be configured to provide interfaces between
the BIC 7210 and the hub 100. In this example, the API 7214 is
illustrated separately from the parameter calculation application
7212. However, the API 7214 may be part of the parameter
calculation application 7212. A user of the hub 100 (for example, a
nurse or a doctor) can manage the BIC 7210 (for example, the
parameter calculation application 7212) on the hub 100. A call to
the API 7214 can be made for the BIC 7210 to implement the user
inputs. For example, the BIC 7210 (for example, the parameter
calculation application 7212) can provide an alert to the
monitoring hub 100 when the patient's heart rate is above (or
below) a certain threshold number. The monitoring hub 100 can
present a user interface element (for example, a slider) for a user
to configure the threshold number. A user of the monitoring hub 100
can actuate the user interface element to set or update the
threshold number. The changes to the threshold number can be
communicated by the monitoring hub 100 to the BIC 7210 such that
the BIC 7210 will update the threshold to the new number and
generate an alert when the new threshold number is met. The
monitoring hub 100 can invoke one or more functions in the API 7214
to pass the threshold number to the BIC 7210.
[0280] When the hub 100 or the sensor 7202 is attached to a new
patient, the hub 100 can automatically notify the BIC 7210 such
that the BIC 7210 may automatically update the parameter
calculation application 7212 or algorithms associated with how
parameter data is interpreted. For example, once a new patient is
attached to the monitoring hub 100 and the sensor 7202, the
monitoring hub 100 can call the API 7214 to reset patient's
baseline data for calculating the parameter associated with the
sensor 7202. Although these examples are described with reference
to changing the settings of the BIC 7210 by the hub 100, similar
techniques can also be used to update other medical devices or
components of medical systems.
[0281] The operating system (OS) 7216 can be configured to support
the parameter calculation application(s) 7212, the API 7214, other
components of the BIC 7210 that are not shown in FIG. 72A,
individually or in combination. The OS 7216 can be a real-time
operating system (RTOS), a non-RTOS, or other type of proprietary
or non-proprietary OS (such as a form of Linux).
[0282] As shown in FIG. 72A, the sensor cable 7204 can connect to a
cable connector 7220. The cable connector 7220 can include a cable
which connects with the BIC 7210 to achieve connection with the
sensor cable 7204. The cable connector 7220 can be connected to the
monitoring hub 100 via the channel ports 212 (for example, by
plugging into a channel port of the monitoring hub). In various
other implementations, the cable connector can also connect to the
monitoring hub 100 via other types of ports. For example, the
sensor cable 7204 can also be connected to the monitoring hub 100
via the serial ports 210. Although not shown, the cable connector
7220 can also include a processor. Optionally, the BIC can be
entirely located in the cable connector 7220 instead of in a
separate board elsewhere in the cable.
[0283] The cable connector 7220 can include the example cable
connectors shown in FIGS. 11A-11K. The cable connector 7220 can
include a memory 7220 for storing information describing the type
of data the hub 100 can expect to receive and how to receive the
same. The memory 7220 can be the EPROM shown in FIG. 12. The cable
connector 7220 can include software or firmware stored in the
memory 7220. For example, the software or firmware may cause the
cable connector 7220 to self-describe the type and order of
incoming data using a self-describing language, as discussed above.
The cable connector 7220 can also implement at least a portion of
the functions for the parameter calculation application 7212 or the
API 7214.
[0284] The sensor cable 7204 and/or the cable connector 7220 may be
provided by a manufacturer or a supplier of the monitoring hub. The
third-party provider may use the SDK described herein to program
the BIC 7210 with various functionality. For example, the
third-party provider can provide various functions of the parameter
calculation application(s) 7212 and the API 7214 to expand the
functionalities of the monitoring hub 100. Detailed descriptions
related to functions that can be enabled by the SDK are further
described below with reference to FIG. 74.
VI. Examples of Interfacing Sensors and the Hub Via a Dongle
[0285] The monitoring hub 100 may be connected to the BIC or to
other sensors or devices via a wireless connection. The wireless
connections may involve Bluetooth, Wi-Fi, ZigBee, or other types of
wireless connections. FIG. 72B illustrates an example of wireless
connections to the monitoring hub. In the example computing
environment 7200b, the wireless connection to the monitoring hub
100 is achieved through a dongle 7250. The dongle 7250 can be a
wireless version of the BIC 7210 described above. The dongle 7250
can be connected to the monitoring hub via a connection port, such
as, for example, a USB port, or other types of ports on the
monitoring hub. The dongle can be paired with the monitoring hub
100 and the sensor 7282 (or the device associated with the sensor
7282). The dongle can receive patient data wirelessly from the
sensor(s) 7282 and communicate the data to the monitoring hub
100.
[0286] The dongle 7250 can include a processing unit which may
include a hardware processor 7262, a non-transitory memory 7264,
and a network interface 7266. The processing unit can perform
functions such as, for example, pairing, data receiving and
transmissions, data processing, parameter calculations, and various
other functions for the dongle 7250. The dongle 7250 can be
configured to implement certain functions similar to those of the
BIC 7210. For example, the dongle 7250 can be configured to execute
the parameter calculation application(s) 7212, the API 7214, and
the OS 7216.
[0287] As an example of data processing by the dongle 7250, the
dongle 7250 can receive data for a patient parameter from the
sensor 7282. The dongle 7250 can execute an algorithm in the
parameter calculation application 7212 to generate a numerical
value describing the patient parameter and communicate such
numerical value to the monitoring hub 100 for further processing or
display. As another example, the dongle 7250 can communicate
display settings associated with the patient parameter to the
monitoring hub 100 which may override or supplement a default
setting of the display of the monitoring hub 100.
VII. Example Communications Between Sensors and the Hub
[0288] FIG. 73A illustrates an example computing environment for
communications between BICs and the monitoring hub 100. The
computing environment 7300 shown in FIG. 73A includes a sensor A
7310a and its corresponding BIC A 7320a, as well as a sensor B
7310b and its corresponding BIC B 7320b. The sensors A 7310a and B
7310b can be connected to the monitoring hub 100 via the respective
BICs 7320a and 7320b. Although not shown, the sensors A and B may
be part of a medical system or a patient device for monitoring one
or more patient parameters. The BICs 7320 can include any of the
functionality of the BICs described above.
[0289] The BICs 7320a and 7320b can pass data acquired by the
sensors 7310a, 7310b respectively to the monitoring hub 100 where
the monitoring hub 100 can perform data processing to derive
patient parameter data, waveforms, alarms, and other results. The
hub 100 can receive data from any BIC and incorporate the data in
the calculation of one or more parameters. As an example, the
monitoring hub 100 may calculate a respiratory rate from an
acoustic sensor using an algorithm native to the monitoring hub 100
and may also calculate a heart rate from the respiratory rate data.
If an external ECG device is attached to the monitoring hub 100
(for example, as a BIC connected to ECG sensors), the monitoring
hub can use the ECG data (which may be more accurate than the
acoustic data) to calibrate the acoustic heart rate algorithm or to
update a confidence value for outputs generated based on the
acoustic data (e.g., the closer the acoustic HR is to the ECG HR,
the higher the confidence value output to the user).
[0290] In addition to or in alternative to communicating data
acquired by the corresponding sensor, a BIC can also communicate
display settings to the monitoring hub 100 to affect or control the
graphical configurations of the monitoring hub 100. The monitoring
hub 100 can provide a display framework for various patient
parameters or other indices. For example, the hub 100 can provide
standardized graphical interfaces depending on the display
characteristics of the medical systems. The framework may include
default location, layout, size, format associated with the display
for various of parameters. The BIC can provide data to the hub 100
to populate the framework.
[0291] The BICs can self-define a numerical readout, a graph, or
other specified display characteristics. The self-defined display
characteristics can be programmed into the BICs associated with the
respective medical systems (for example, via the SDK described in
FIG. 75). The BICs can provide these display characteristics to the
monitoring hub, which may override or supplement one or more
display configurations of the monitoring hub 100. As an example,
the monitoring hub 100 can initially be connected to the BIC 7320a.
The BIC 7320b can be added to the monitoring hub 100 to provide
data on a new parameter. When there is a new parameter to be added
to the display, the BIC 7320b can provide the display
characteristics for this parameter, such as, for example, the label
to be shown on the hub 100, forms of how the values are to be
displayed (for example, a numerical value, graphs, letter grades,
etc.) color on the screen of the hub 100 (for example, a blue v. a
green color), layout of information for the parameter, etc. The
display characteristics can be published on the bus of the
monitoring hub 100, and the monitoring hub 100 can implement the
display characteristics for displaying the values received from the
BIC 7320b.
[0292] The BICs can also send images or display graphics for use in
place of monitoring hub's graphics. For example, the BIC can
provide an image or an animation of a pumping heart to the hub 100
for displaying the heart rate measurements from the BIC. The heart
may change color or increase in size in response to an alarm
associated with the heart rate (for example, when the heart rate is
too fast or too slow). As another example, the display
characteristics received from the BIC can include a graphics
command that accesses a graphics library (such as OpenGL). With
reference to the preceding example, the command can cause the hub
100 to call one or more functions in the graphics library to draw a
heart shape.
[0293] Advantageously, the BICs, once connected to the hub 100, can
pull from or push to the hub any information. For example, a
connected BIC A can pull measured parameters of connected BIC B
from the hub 100. For example, the connected BIC A can notify the
hub 100 to send data associated with a parameter labeled x. The hub
100 can accordingly communicate the data with label x to the
connected BIC A as the hub 100 obtains such data. The BIC A can
then use that information to generate a new measured parameter
which can then be pushed to the hub for display or use by other
connected medical systems. As an example, a BIC (or the monitoring
hub) can calculate a wellness index (described above) based on any
parameter data from any other BIC(s) and/or from the monitoring
hub.
[0294] A BIC can perform data processing based on data acquired
from its corresponding sensor (or medical system), other sensors
(or medical systems), or the hub 100, alone or in combination. With
continued reference to FIG. 73A, BIC 7320a can use data from the
sensor 7310a, the sensor 7310b, the BIC B 7320b, or the monitoring
hub 100, individually or as a combination, to perform data
processing. As an example, sensor A 7310a can measure a patient's
respiratory information and BIC A 7320a can calculate the
respiratory rate from data acquired from sensor A 7310a. BIC A
7320a can also calculate the respiratory rate from the heart rate
data (for example, where the heart rate modulates respiratory
rate). BIC B 7320b can receive the ECG data from the sensor B
7310b. The BIC B 7320b can calculate the heart rate based on the
ECG data and pass the heart rate to BIC A 7320a for the
determination of the respiratory rate. The BIC B can also pass the
ECG data to BIC A and BIC A can perform the calculation of the
heart rate. The resulting respiratory rate and the heart rate can
be communicated to the hub 100 for further processing or
display.
[0295] The monitoring hub 100 may implement a restriction mechanism
associated with types of data that can be obtained by a BIC. Or,
the monitoring hub 100 may adopt an open port policy such that
there is no restriction on what the BIC can obtain from the hub
100. In one example policy, the BIC can obtain all waveforms from
the monitoring hub 100, such as those associated with SpO2, pulse
rate. Every time when the BIC receives a message from the hub, in
this example, the BIC can pull these waveforms out of the received
message.
[0296] In addition to or in alternative to performing calculations
based on data received from a BIC, the BIC can use the information
received from the hub or other BICs for other types of actions. For
example, the received data may be used to calibrate an algorithm
used for processing data received from a sensor connected to the
BIC. As another example, the BIC can restart its processing
algorithm or establish a new baseline based on information received
from the hub or other devices. In this example, a BIC may receive a
message from the hub 100 which includes indications that the hub
100 or the sensor corresponding to the BIC is attached to a new
patient. The BIC can accordingly reset the processing algorithm or
calculated baseline value for different physiological parameters in
response to this message. Additionally or optionally, the BIC may
create a new profile for the new patient and may start monitoring
of patient parameters or calculations associated with the patient
parameters from scratch.
[0297] As another example, the BIC can calculate an alert for the
patient and output the alert to the hub 100. The hub 100 can
display a graphical user interface element for adjusting settings
of an alert. For example, the user of the hub 100 can actuate the
graphical user interface element to change the threshold condition
for triggering the alert. The hub 100 can communicate the updated
alarm setting to a BIC for incorporating in its calculation. For
example, a user may increase the value of the heart rate for
triggering the alarm by the BIC. Such increase can be sent to the
BIC, which may no longer generate the alarm if the heart rate is
below this updated value. The hub 100 can also remotely control
other operations of the BIC in addition to or optionally changing
the alarm settings, as will further be described with reference to
FIG. 73D.
[0298] Although examples in FIG. 73A are described with reference
to bidirectional communications between BICs and the monitoring hub
100, in various other situations, the similar data or communication
techniques can also be applied for communications between the
monitoring hub 100 and other types of medical devices. Further,
similar techniques and functions can also be applicable when the
sensor (or the BIC) is connected to the hub 100 via a dongle. For
example, the dongle can pull information from the monitoring hub
100, such as, for example, patient's alert information, waveform,
patient parameter data, medical event information, etc. Such
information can be acquired from various channels such as, for
example, via the monitoring hub 100 itself, or other external
medical devices connected to the monitoring hub 100. The dongle can
also communicate display settings, perform calculations on this
information, and communicate the results of the calculations to the
monitoring hub 100.
[0299] FIGS. 73B, 73C, and 73D illustrate example processes for
various aspects of communications between the hub and external
devices. The external devices may be the BIC 7210, the dongle 7250,
or other patient devices described herein.
[0300] FIG. 73B illustrates an example process which an external
device can perform data processing based on data acquired form the
monitoring hub or other external devices. The example process 7330
in FIG. 73B may be performed by the external device.
[0301] At block 7332, a connection can be established between a
first external device and the monitoring hub. The external device
can implement the parameter calculation application 7212 described
with reference to FIG. 72A to perform calculations on data received
at the external device, where the data may come from a sensor, a
monitoring hub, or another external device. The connection between
the external device and the monitoring hub may be a wired or
wireless connection. For example, the external device can connect
wirelessly to the monitoring hub or in a wired connection through a
BIC.
[0302] At block 7334, the external device can obtain patient data
from the monitoring hub. The first patient data may include data
acquired from one or more sensors native to the monitoring hub or
another external device. Additionally or optionally, the first
patient data may include results outputted by one or more
algorithms derived by the monitoring hub or the other external
device. For example, the first patient data can include values
associated with one or more patient parameters, such as, for
example, a value associated with the patient's blood pressure or
heart rate. Although in this example, the external device can
obtain the first patient data acquired by another external device
through the monitoring hub, the external device can also acquire
the first patient data directly from the other external device.
[0303] At block 7336, the external device can receive second
patient data from a sensor corresponding to a second external
device. The second external device can be a BIC, dongle, or other
patient device. The sensor can monitor and acquire patient data and
communicate the patient data to the second external device for
further processing.
[0304] At block 7338, the first external device can perform a
calculation based at least in part on the first patient data and
the second patient data. For example, the first external device can
calculate a wellness index based on heart rates and blood
pressures.
[0305] At block 7440, the first external device can output the
result of the calculation to the monitoring hub. The monitoring hub
can further process the data from the first external device or
display the result on a user interface of the monitoring hub. The
first external device can also communicate the result to other
external devices.
[0306] FIG. 73C illustrates an example process where the external
device can initiate an action based on data received from a
monitoring hub. The example process 7350 can be performed by an
external device.
[0307] At block 7351, a connection is established between the
external device and the monitoring hub. At block 7352, the external
device can receive medical data from a monitoring ub. The medical
data can include instructions to the external device to perform an
action (for example, an instruction to reset a baseline in an
algorithm or to set a threshold for an alarm) or data describing a
triggering event (for example, a message informing that the new
patient is linked). Additionally or optionally, the medical data
can also include values associated with patient parameters as
described with reference to FIG. 73B.
[0308] At block 7354, the third-party device can detect whether the
medical data received from the monitoring hub includes an
instruction to change a setting of the external device.
[0309] If the instruction to change the setting is present in the
medical data, at block 7356, the external device can automatically
update the setting based on the received medical data. For example,
when a new patient is linked to the monitoring hub, the monitoring
hub can send an instruction to the external device to reset the
external device's calculations or baselines for algorithms. As
another example, the instruction can include an adjustment to a
threshold condition for triggering an alarm.
[0310] Additionally or optionally, the external device may analyze
the medical data and generate one or more instructions for actions
based on the medical data. For example, the monitoring hub can send
information to the external device that a new patient is linked.
Upon receiving this information, the external device can determine
one or more actions to be taken due to the newly added patient. For
example, the external device can reset the patient's baseline data
or create a new profile for the patient.
[0311] FIG. 73D illustrates an example process of adjusting display
settings of a monitoring hub by an external device. The example
process 7370 can be performed by the monitoring hub described
herein.
[0312] At block 7372, the monitoring hub can receive display
settings from an external device, such as, for example, a dongle or
a BIC. The display settings can be configured to manage display
characteristics of at least a portion of the display for the
monitoring hub. For example, the display settings can provide the
labels, colors, images, layout, format of data presentation, etc.,
for values and parameters communicated from the external device.
The display settings can override, set, or supplement existing user
interface configurations for the monitoring hub as described with
reference to FIG. 73A.
[0313] At block 7374, the monitoring hub can automatically
determine applicable display configuration based at least in part
on the display setting. For example, the monitoring hub may be
connected to two external devices. The first external device can
provide values for a first patient parameter while the second
external device can provide values for a second patient parameter.
The display setting received from the first external device may
include several options for displaying information of the first
patient parameter. The monitoring hub can select a display option
for the first patient parameter in view of the display
characteristics of the second patient parameter. For example, if
the second patient parameter requires a large display region on the
user interface, the monitoring hub may select a display setting
which occupies a small amount of user interface space for the first
patient parameter.
[0314] At block 7376, the monitoring hub can automatically render
patient data in accordance with the display configuration. As the
monitoring hub continuously receives values associated with the
patient parameters, the monitoring hub can update the values on its
user interface in accordance with the display configuration.
[0315] FIG. 73E illustrates some example user interface elements
for controlling an operation of a BIC or other external device
remotely. Three user interface elements 7380, 7386, and 7390 are
shown in FIG. 73E. These user interface elements can be output on
the hub 100 and can receive a user input to control the operation
of one or more medical devices connected to the hub 100.
[0316] The user interface 7380 shows an example slider bar 7382 for
changing a safety feature between two states (for example the on
and off states). As shown in FIG. 73E, the user interface element
7384 of the slider bar is all the way to the left of the slider bar
which shows that the safety feature is currently turned off. The
user can move the user interface element 7384 to the right side of
the slider bar to enable the safety feature.
[0317] The user interface element 7384 controls the blink speed for
information associated with a parameter. The blink speed feature
may also have two states: an on state and an off state.
Additionally or optionally, the blink speed feature can be adjusted
based on numerical values. For example, a user can slide the user
interface element 7388 on the slider bar of the user interface
element 7386 to adjust the blink speed.
[0318] FIG. 73E also illustrates a user interface element 7390
where a user can adjust the limits of an alarm. The user interface
element 7390 includes two slider bars 7396a and 7396b. The slider
bar 7396a can be configured to adjust an upper limit of an alarm,
whereas the slider bar 7396b can configured to adjust a lower limit
for triggering the alarm. A user can move the user interface
elements 7398a and 7398b to adjust the upper and lower limits
respectively. The slider bars 7396a, 7396b may be associated with a
row of user interface indicators 7392a, 7392b respectively. The
user interface indicators 7392a, 7392b can provide visual cues on
the values of the alarm limits in a spectrum of possible values.
For example, the current position of the user interface element
7398a on the slider bar 7396a corresponds to two illuminated
circles of the row of user interface indicator 7392a. Because there
are nine circles in the row while two of them are illuminated, this
can provide a cue that the upper limit for the alarm is set at a
relatively low end. The slider bars 7396a and 7396b can also
correspond to the user interface elements 7394a and 7394b which can
which can show the numeric values of the current alarm limits. In
addition to or in alternative to moving the user interface elements
7398a, 7398b to adjust the slider bars 7396a, 7396b respectively, a
user may input the values of the alarm limits into the user
interface elements 7394a, 7394b to adjust the alarm limits. The
positions of the user interface elements 7398a, 7398b on the slider
bars 7396a, 7396b may be automatically updated in response to the
inputted values.
[0319] As will further be described with reference to FIG. 74, the
adjustments on the user interface elements 7388, 7390 or the state
change made on the user interface element 7380 can be communicated
to the medical device by invoking the interface code 7430
associated with the medical device. Further, the hub 100 may
communicate the adjustments to multiple connected medical devices
where the adjustments on a user interface element affect more than
more medical devices.
VIII. Example SDK Architecture for Enabling Functions of the Hub
and Third-Party Devices
[0320] As described above, the hub provider can provide an SDK to a
device supplier. The SDK can define various aspects of the
communications between the hub 100 and external device. The device
supplier can use SDK to program various external devices, such as
BICs, cable connector, or other medical devices.
[0321] As one example, the SDK can establish or define the behavior
and meaning of the data output from the devices. The SDK can define
communication protocols or the interpretations of the patient's
parameter data (for example, formats, identifiers, etc.), display
characteristics, waveforms, and alarms that can be communicated
from the devices to the hub 100. The SDK can also allow the device
supplier to specify display settings associated with data of the
device. For example, the device supplier can use the SDK to specify
available display format, layout for the data communicated to the
monitoring hub 100 from the device. The data outputted by the
device can be used as an input for the monitoring hub 100 and the
monitoring hub 100 can apply one or more algorithms based on the
data outputted by the device.
[0322] In addition to or in alternative to defining data output for
communications from the device to the monitoring hub, the SDK can
also support data acquisition by the external devices from the
monitoring hub 100. For example, the SDK can be used to define an
API 7214 which can receive messages from the hub and cause the
device to perform one or more actions based on the information in
the messages. For example, the monitoring hub can inform the device
that there is a new patient or different patient connected to the
monitoring hub. Based on this information, the device may restart
its processing algorithm, create a new profile for the new user and
start monitoring from scratch, or perform other actions that are
suitable based on this new information.
[0323] The SDK can also be used to define the algorithms for
performing calculations on data associated with the device. For
example, the SDK can be used to implement an algorithm which
calculates a value (for example, a wellness index) based on data
received from devices or the monitoring hub 100.
[0324] FIG. 74 illustrates some example features of an SDK software
architecture. The computing environment 7400 includes a monitoring
hub 100 and instrument software 7410 which can be implemented on
the external device (which as described above, can be a BIC,
dongle, or other patient device). The instrument software 7410 can
be programmed using the instrument declarative description language
sources 7460, which can provide tools and functions for creating
the instrument software 7410.
[0325] The SDK may model an external device as a remotely
accessible database of objects (illustrated as the object database
7420 in FIG. 74). This database of objects may be part of the
parameter calculation application 7212 shown in FIGS. 72A and 72B.
An object may be associated with an identity, an object class
(which may be defined using the instrument declarative description
language 7460), a set of attributes, a set of possible actions or
methods that can be invoked remotely, a set of possible events that
the object may signal to notify other devices, etc. The object
database 7420 may include a set of predefined objects and/or new
objects.
[0326] The object database 7420 is shown to have a medical device
system (MDS) object 7422 which can be shown as an object
representation of a medical device (e.g., an external device). A
MDS object can include attributes, such as, for example, system
type, system manufacturer and model name, unique identifiers (for
example, serial number), system software and hardware version
numbers, system status and operating mode, battery or power supply
status, time, time zone, and clock synchronization information,
etc.
[0327] Sometimes a single external device may include multiple
relatively independent subsystems, either hardware or software. The
virtual medical device (VMD) objects 7242 can model these
subsystems. Attributes of a VMD object may include device status,
device manufacturer and model name, software and hardware version
numbers, principle or technology used to perform the measurement,
etc.
[0328] Measurements for patient parameters (for example, vital
signs) may be modeled as metrics class 7426a through 7426n. The
measurements can include direct measurement values, as well as
derived values that may depend on one or more vital signs
measurements. The metrics class may include various metric
characteristics such as, for example, update rate, relevance,
whether it is directly measured or derived, measurement validity
status, identifiers for the metric in nomenclature systems, unit of
measure used, body site or sites involved in the measurement, other
metrics used to compute a derived metric, calibration status,
measurement times and periods, associated settings, etc. The
metrics class can be further subdivided by the kind of data
representation it uses. The measures can be represented as a
numeric metric which may represent an ordinary scalar measurement
value or as an array metric which may represent a series of
measurements (for example, as a time series such as a waveform, or
some other type of series such as histogram or spectrum
distribution measurement).
[0329] Although not shown in FIG. 74, SDK can also configure
conditions that trigger an alert by the medical device. The alert
can be a patient alert representing some abnormal condition noted
in the patient, or a technical alert representing some abnormal
condition that may affect the operation of the device itself.
[0330] Certain aspects of the external device can be remotely
changed by another device, such as, for example, the hub 100 or
another external device. As an example, the SDK can configure a
limit alert operation which can control the triggering condition
for the alarm. For example, SDK can configure attributes for
supporting high, low limits that will trigger the alert. The SDK
can also configure a set value operation which can allow another
device to control a numeric value of the external device (for
example, a value for a patient parameter or a time that will
trigger the alert). As another example, other types of operations
of the medical device, such as, for example, blink speed (for
example, of an indicator), safety mode, etc., can also be
controlled remotely (for example, on a hub). The other device
cannot directly access the object database 7420 within the medical
device. The remote operations may be achieved by referencing the
instance numbers of the operations through a service and control
object which contains the operations.
[0331] Additionally or optionally, the SDK can also define control
operations on the medical device for configuring display
characteristics of the medical device's data on the monitoring hub.
The SDK can define several attributes which can be communicated
from the medical device to the monitoring hub as part of the
display setting. As one example, the SDK can be used to configure a
Vmo-Reference attribute of a control operation indicating what
object the control is associated with (for example, a VMD object
for device level controls, or a metric object for controls specific
to a particular measured parameter). This association can control
the layout of the hub's menus, so that VMD-related controls can be
placed within sub-menus of the top-level menu for the device, and
metric-level controls can be placed in sub-menus associated with
the individual metrics. As another example, the placement of
controls within the menus can also be configured by the SDK. For
example, controls for the same group of operations can be placed
within the same sub-menu.
[0332] A device remote to the medical device (for example, the hub
100) can control various settings and options via the interface
code 7430. The interface code 7430 can be configured for
controlling device-level, channel-level, and metric level
functionalities of the medical device and can be configured to
respond to requests for modifying the corresponding settings and
options. The interface code 7430 can include code stubs 7432 which
may be software executable code for controlling the settings and
options. For example, the code stub 7432 can include software
routines for a toggleflag operation which can enable, disable, or
adjust a feature (for example, a blink speed or a safety mode of
operation, etc.).
[0333] A user of the hub can adjust the user interface element (for
example, the user interface elements 7380, 7386, or 7390 in FIG.
73E) to control the feature on the medical device. The software
routines can be called in response to a user input on one or more
user interface elements on the hub 100. As one example, the alert
operation may include an upper limit and a lower limit (for example
as shown in FIG. 73E) which can cause an alarm to be generated by
the medical device. The upper limit can correspond to a first user
interface element (for example, a slider bar or a box for inputting
a value of the limit) while the lower limit can correspond to
another user interface element. The actuation of either user
interface element can cause the hub 100 to make a call to the
interface code 7430 to implement changes to the upper or lower
limit.
[0334] The instrument software 7410 can include one or more
libraries for supporting functions associated with the memory
object database 7420 and the interfaces between the hub 100 and the
medical device. Some example libraries can include a MOAR library
7442 for dealing with functions associated with another device (for
example, the hub 100), a MOAT library 7444 for transporting
messages within the subsystems of the medical device or with
another device, and a MOAF library 7446 which can be used in
connection with the MOAT library 7444 and can frame data packets
for message transportation.
[0335] The medical device can connect to the monitoring hub 100 via
the USB serial interface 7450 although other types of interfaces
can also be used. The serial interface 7450 may be part of the
cable connector 7220 (which may have one or more pins supporting a
USB interface).
IX. Examples of Display Management for the Monitoring Hub
[0336] As described in the preceding sections, the monitoring hub
100 can display patient data and alarms based on data received from
various connected medical systems or sensors native to the hub 100.
The connected medical systems can include BICs, dongles, medical
devices, or sensors external to the hub 100, etc., alone or in
combination. The sensors external to the hub 100 can be connected
to the hub 100 using various connections described herein and do
not have to be connected to the hub 100 via the BIC or the dongle
described in the preceding sections.
[0337] The monitoring hub 100 can provide standardized graphical
interfaces depending on the display characteristics of connected
medical systems. The monitoring hub 100 can also receive display
settings from the medical systems, where the display settings can
be incorporated into the default graphical interfaces. For example,
the medical systems can self-define to a numerical readout, a
graph, or other specified display options which can be
self-defined. The medical systems can also self-define display
characteristic of the medical systems or parameters provided by the
medical systems. For example, the medical systems can provide the
size of the layout, the color of the layout, the parameters or
graphics formats to be presented by the hub, etc. The attached
medical system can also provide image data used by the hub to
provide display graphics or provide instructions to call one or
more graphics libraries on the hub to draw certain shapes. Based on
the device information, parameter information, connected devices,
or the display characteristics provided by the medical system, the
hub can identify default graphical interface options. The hub can
also modify or supplement default graphical interfaces based on the
display setting received from the medical system.
[0338] The hub 100 can include a display layout manager that
provides self-configurable display options. The hub 100 can
determine which systems are connected to the hub 100 and what
parameters or data will be provided by the systems. Such
information may be obtained via the self-describing functions
described in the preceding sections. The hub 100 can accordingly
determine the self-configurable display options, such as, for
example, how many rows or columns or subdivisions of the display
that are needed to present the data from the connected system. Once
the hub 100 obtains the display configuration information for each
connected medical system, the hub 100 can automatically determine
display real estate for each medical system parameter. The options
for display real estate can be presented in the display layout
manager. When a new system is linked or when an old system is
removed, the hub 100 can automatically re-determine the display
real estate. For example, when a sensor is removed from or
connected to the hub 100, the hub 100 can automatically determine
available display layouts based on changes or additions to
parameters being displayed as a result of the removal or addition
of the sensor.
[0339] The connected medical systems connected to the hub 100 can
be preconfigured (for example, via the SDK described above) with a
set of acceptable display layouts of various sizes. For example, a
medical device can be configured to calculate and provide values
for one or more patient parameters and the medical device can be
pre-programmed with a set of display layouts for showing the values
of the one or more parameters. As an example, the medical device
may include an approximately rectangle-shaped display layout in
which a label of a parameter and a value of the parameter are
displayed on the top half of the rectangle while displaying a
waveform of the parameter on the bottom half of the rectangle. The
monitoring hub 100 can execute a display layout algorithm to
determine different combinations of display layouts for the
connected medical systems. The display layout algorithms can break
display of the hub into known sizes, for example, a 2-column by
10-row grid. Because each connected system has a known set of
layouts, a search engine of the display layout algorithms can use
the know layouts for each connected system to find all possible
combinations of layouts corresponding to the respective systems.
The hub 100 can accordingly output the possible layouts and provide
an option to a user to select any of the combined layouts. At least
some of the combined layouts may cause the entire display or
substantially the entire display to be occupied with data from the
connected systems.
[0340] A display layout that uses the entire display may but need
not use every pixel of the display to display data. Rather, such a
display layout may allocate the entire display to the available
parameters. For instance, if two parameters are displayed, each of
the parameters may be allocated half of the display real estate
(and each parameter may include waveforms and/or numerals that
occupy a substantial portion of that allocated real estate). If ten
parameters are displayed, each of the parameters may similarly be
allocated 1/10th of the available display real estate. Thus, the
same waveforms and/or numerals for a parameter may be larger if
fewer other parameters are displayed or smaller if more other
parameters are displayed. Optionally, instead of merely enlarging
parameter numerals or waveforms, the display may provide additional
data when additional real estate is available. For instance, a more
detailed waveform or additional past trend values may be depicted.
Of course, in other situations, at least some of the combined
layouts may have unused or unallocated space on the display.
[0341] As further described with reference to FIGS. 76A-76C, a user
may have the option to rearrange the layouts within the combined
layout. The monitoring hub 100 can automatically select a default
combination of layouts and the user can change the default using
the display layout manager.
[0342] Additionally or optionally, the display layout management
can also manage display options at a parameter-level. For example,
each parameter may come with pre-configured spacing requirements or
display requirements, for example, sizes of display options for the
parameters, the amount of information provided for the parameter,
etc. As an example, a parameter may come with two display options,
where one display option requires two columns and two rows of the
display and the other display option specifies two columns and four
rows of the display. As another example, the display setting for
the parameter may require two columns of space without specifying
the number of rows.
[0343] As an example of managing display layouts at a
parameter-level, a blood pressure sensor can be connected to the
hub 100. The blood pressure sensor may have particular constraints,
such as, for example, requirements for certain amount of space to
display the blood pressure. The monitoring hub can look at all
other parameters that need to be displayed and determine different
configurations that can fit the blood pressure data. The monitoring
hub 100 can use display layout algorithms similar to those
described with reference to determining system-level display
layouts to determine display layouts at the parameter-level. The
monitoring hub 100 may display all variations of acceptable display
layouts for the parameter and a user can automatically select a
layout. The monitoring hub 100 can automatically select a default
layout and the user can change the default layout using the display
layout manager.
[0344] The hub 100 can consider both system-level layouts and
parameter-level layouts. For example, the hub 100 can determine a
set of combined layouts. One option in the set of combined layouts
may include a first subdivision which includes a combined layout of
two parameters from a first medical device and includes a second
subdivision for a parameter from a second medical device. As
another example, the set of combined layouts may include an option
which has three subdivisions, where the subdivision one is for the
first parameter from the first device, the subdivision two is for
the second parameter from the first device, and the subdivision
three is for the parameter from the second device.
[0345] The hub 100 can also support screen captures of current
displays. For example, a user can capture a current screen by using
hand gesture (for example, a three-finger swipe). The hub 100 can
also provide an indication of the screen capture. For example, the
screen can temporarily freeze and the background colors can be
lightened momentarily to indicate the screen capture was
successful. The screen captures can be time stamped and saved for
later access or downloading from the hub 100.
[0346] FIGS. 75A-75B shows example user interfaces of a display
layout manager. In FIG. 75A, the hub's display 7500 can provide a
display options menu 7510 which graphically illustrates a plurality
of potential display configurations 7512, 7514, 7516, and 7518
(which schematically illustrate combined display layouts for each
display configuration option). As described above, these layout
options can be optimized and changed based on the types and number
of connected systems or parameters.
[0347] FIG. 75B, for example, shows an alternative display layout
manager screen with additional layout options when an additional
medical system is connected to the hub. For example, the display
7500 of the hub additionally shows the layout options 7522, 7524,
7526, and 7528 when the additional device is connected. As more or
different devices (or parameters) are linked to the hub, the hub
automatically determines layout options and updates the layout
options menu. Due to the display constraints of various devices or
parameters, the number of layout options may decrease when
additional systems or parameters are added to the hub.
[0348] The hub 100 can provide self-configuring options to the user
such that the user can modify the display layouts. For example,
when only one medical system is connected, the display
configuration options can include a first plurality of display real
estate allocation options to the user. When an additional medical
system is connected, a second plurality of display real estate
allocation options can be provided to the user that are different
than, or in addition to, the first plurality of display real estate
allocation options. The user can select an option or modify the
layouts of subdivisions within the selected option.
[0349] FIG. 76A illustrates an example of a configurable display
screen of the monitoring hub. The screen 7600 of the hub 100
includes multiple different configurable display spaces (also
referred to subdivisions) for different individual parameters or
groups of parameters. The screen 7600 can include the display
spaces 7630 and 7650 where each display space can present
information of a parameter or a group of parameters. As an example,
the parameter display grouping 1 7630 can correspond to the
parameters SpO2, PR, SpHb, PVI, SpMet, SpCO shown in FIG. 23F
whereas the parameter display grouping 2 7650 can correspond to the
display of blood pressure and temperature shown in FIG. 23F. As an
example, the parameter display grouping 1 7630 can be used to
present data for SpO2, PR, SPHb, while the parameter display
grouping 2 7650 is associated with the display of SEDLine shown in
FIG. 23D.
[0350] In the example in FIG. 76B, the display spaces can be
dynamically adjustable by the user without having to enter a menu
program. For example, a user can simple resize or reshape the
display area using a touch screen monitor by dragging the display
spaces to resize. As shown in FIG. 76B, the parameter display
grouping 1 7630 can be adjusted to occupy larger space and the
parameter display grouping 2 7650 can be adjusted to have less
space at the same time. This can be done by using a finger touch
7651 to "grab" and resize the corners of the display by sliding a
finger across the screen to the desired resized area and removing
the finger touch 7653.
[0351] The hub 100 can optimize the display by resizing and/or
adding or removing display features. For example, in addition to
changing text size automatically through a reallocation of screen
space, a trend display can be added when sufficient real estate
space is provided. Additionally or optionally, the display areas
7630 and 7650 can be readjusted according to a snap grid operation.
Thus, a user would need to adjust the display size until the
display reaches the next snap grid for the adjustment to take
place. FIG. 76C illustrates a further display change using the
dynamic finger adjustments. In this figure, the area for the
parameter display grouping 1 7630 is further enlarged through
finger movements, and the hub 100 can automatically reduce the size
for the parameter display grouping 2 7650 so as to fit both display
groupings on the screen 7600.
[0352] As described above, a medical system (for example, a BIC,
dongle, or a medical device, etc.) can use a function call through
the API of the hub 100 to expose a user setting of the medical
system on the hub's 100 display. This can be any settings--alarm
settings, settings for inputting patient demographics, enabling or
disabling monitoring functions or calculation of certain
parameters, or any other settings. As one example, if the hub 100
is connected to a blood pressure device, it can connect to a
neonate, child, or adult cuff. The blood pressure device can inform
the monitoring hub (for example, via a BIC) to output user
interface controls that allow a user to specify which type of cuff
is connected to the hub 100 so that the blood pressure device (or
the BIC) can apply the appropriate algorithm.
[0353] FIG. 77 illustrates an example process of configuring a
monitoring hub's display. The example 7700 can be performed by the
monitoring hub 100 described herein.
[0354] At block 7710, the monitoring hub can identify medical
systems connected to a hub and parameters to be displayed by the
hub. The monitoring hub can obtain such information when the
medical systems self-describe their functions to the monitoring hub
upon connection. The self-description functions can be programmed
using functions of the SDK described with reference to FIG. 74. The
medical systems can also provide the monitoring hub display
characteristics associated medical systems. For example, the
medical systems can provide pre-configured display layout options
for the parameters that will be communicated from the medical
systems to the monitoring hub.
[0355] At block 7720, the monitoring hub can automatically
determine display layout options based on the display
characteristics associated with the medical systems and/or the
parameters. For example, the monitoring hub can execute an
algorithm which determines the display constraints of the medical
systems or information associated with the parameters to be
displayed. The output of the algorithms can include a set of
potential display layout options for displaying the various
parameters. The display characteristics can be supplied by the
medical systems directly or can be determined by the monitoring hub
100 (for example, based on information of the medical systems and
the parameters).
[0356] At block 7730, the monitoring hub can determine whether a
new system is connected to the monitoring hub or a new parameter is
added to the hub's display. For example, the monitoring hub can
detect whether a new device is linked to the hub through the
self-describing functions of the device. The monitoring hub can
detect whether there are any new patient parameters based on the
information provided by the newly connected device. A user of the
monitoring hub can enable or disable the monitoring of some patient
parameters. For example, the user can actuate a user interface
element on the monitoring hub to cause a connected medical device
to start monitoring a patient's parameter. As a result, the
monitoring hub can automatically adjust the display layout options
to accommodate the newly added parameter or device.
[0357] If there is no new system or parameter added to the hub, at
block 7740, the monitoring hub 100 can determine whether a user
input is received on the monitoring hub. A user can select a
display layout among the display layout options. The user can also
modify a display layout, for example, by changing the location or
size subdivisions of the display layout or by adjusting display
characteristics (for example, size, shape, location) of parameters
within a subdivision.
[0358] If the user input is not received, at block 7754, the
monitoring hub can automatically select a default option and render
the display screen of the monitoring hub based on the default
option. If the user input is received, at block 7752, the
monitoring hub can automatically adjust the display screen and
render the display screen based on the user input. Where the user
changes a setting of a medical system (for example, by adjusting an
alarm setting, or enabling/disabling a feature of the medical
system, etc.), the monitoring hub 100 can also inform the medical
system of the user's changes and the medical systems can take
appropriate actions based on the user's changes.
[0359] Although the examples in FIGS. 72A through 77 are described
with reference to a monitoring hub 100, similar functions and
techniques described with reference to these figures can also be
applied to an auxiliary device, such as, for example, the auxiliary
device 2040 shown in FIG. 24.
X. Additional Examples
[0360] In certain aspects, a system for providing medical data
translation for output on a medical monitoring hub can include a
portable physiological monitor comprising a processor that can:
receive a physiological signal associated with a patient from a
physiological sensor, calculate a physiological parameter based on
the physiological signal, and provide a first value of the
physiological parameter to a monitoring hub for display. The
monitoring hub can include a docking station that can receive the
portable physiological monitor. The monitoring hub can: receive the
first value of the physiological parameter from the portable
physiological monitor; output the first value of the physiological
parameter for display; receive physiological parameter data from a
medical device other than the portable physiological monitor, the
physiological parameter data formatted according to a protocol
other than a protocol natively readable or displayable by the
monitoring hub; pass the physiological parameter data to a
translation module; receive translated parameter data from the
translation module, where the translated parameter data can be
readable and displayable by the monitoring hub; and output a second
value from the translated parameter data for display.
[0361] The system of the preceding paragraph can be combined with
any subcombination of the following features: the monitoring hub is
further configured to output the first value of the physiological
parameter and the second value from the translated parameter data
on separate displays; the monitoring hub is further configured to
output the second value from the translated parameter data to an
auxiliary device having a separate display from a display of the
monitoring hub; the auxiliary device is selected from the group
consisting of a television, a tablet, a phone, a wearable computer,
and a laptop; the physiological parameter data comprises data from
an infusion pump; the physiological parameter data comprises data
from a ventilator; and the translation module is configured to
translate the physiological parameter data from a first Health
Level 7 (HL7) format to a second HL7 format.
[0362] In certain aspects, a method of providing medical data
translation for output on a medical monitoring hub can include:
under the control of a first medical device comprising digital
logic circuitry, receiving a physiological signal associated with a
patient from a physiological sensor; obtaining a first
physiological parameter value based on the physiological signal;
outputting the first physiological parameter value for display;
receiving a second physiological parameter value from a second
medical device other than the first medical device, where the
second physiological parameter value is formatted according to a
protocol not used by the first medical device, such that the first
medical device is not able to process the second physiological
parameter value to produce a displayable output value; passing the
physiological parameter data from the first medical device to a
separate translation module; receiving translated parameter data
from the translation module at the first medical device, the
translated parameter data able to be processed for display by the
first medical device; and outputting a second value from the
translated parameter data for display.
[0363] The method of the preceding paragraph can be combined with
any subcombination of the following features: further including
translating the message by at least translating the message from a
first Health Level 7 (HL7) format to a second HL7 format; the
message can include data from a physiological monitor; the message
can include data from an infusion pump or a ventilator; and the
message can include data from a hospital bed.
[0364] In certain aspects, a system for providing medical data
translation for output on a medical monitoring hub can include a
first medical device including electronic hardware that can: obtain
a first physiological parameter value associated with a patient;
output the first physiological parameter value for display; receive
a second physiological parameter value from a second medical device
other than the first medical device, the second physiological
parameter value formatted according to a protocol not used by the
first medical device, such that the first medical device is not
able to process the second physiological parameter value to produce
a displayable output value; pass the physiological parameter data
from the first medical device to a translation module; receive
translated parameter data from the translation module at the first
medical device, the translated parameter data able to be processed
for display by the first medical device; and output a second value
from the translated parameter data for display.
[0365] The system of the preceding paragraph can be combined with
any subcombination of the following features: the first medical
device can also output the first value of the physiological
parameter and the second value from the translated parameter data
on the same display; the first medical device can also output the
first value of the physiological parameter and the second value
from the translated parameter data on separate displays; the first
medical device can also output the second value from the translated
parameter data to an auxiliary device; the auxiliary device can be
a television monitor; the auxiliary device can be selected from the
group consisting of a tablet, a phone, a wearable computer, and a
laptop; the first medical device can include the translation
module; the first medical device can also pass the physiological
parameter data to the translation module over a network; and the
physiological parameter data can include data from an infusion pump
or a ventilator.
XI. Terminology
[0366] Many other variations than those described herein will be
apparent from this disclosure. For example, certain acts, events,
or functions of any of the algorithms described herein can be
performed in a different sequence, can be added, merged, or left
out altogether (for example, not all described acts or events are
necessary for the practice of the algorithms). Moreover, acts or
events can be performed concurrently, for example, through
multi-threaded processing, interrupt processing, or multiple
processors or processor cores or on other parallel architectures,
rather than sequentially. In addition, different tasks or processes
can be performed by different machines and/or computing systems
that can function together.
[0367] It is to be understood that not necessarily all such
advantages can be achieved in accordance with any particular
example of the examples disclosed herein. Thus, the examples
disclosed herein can be embodied or carried out in a manner that
achieves or optimizes one advantage or group of advantages as
taught herein without necessarily achieving other advantages as may
be taught or suggested herein.
[0368] The various illustrative logical blocks, modules, and
algorithm steps described in connection with the examples disclosed
herein can be implemented as electronic hardware, computer
software, or combinations of both. To clearly illustrate this
interchangeability of hardware and software, various illustrative
components, blocks, modules, and steps have been described above
generally in terms of their functionality. Whether such
functionality is implemented as hardware or software depends upon
the particular application and design constraints imposed on the
overall system. The described functionality can be implemented in
varying ways for each particular application, but such
implementation decisions should not be interpreted as causing a
departure from the scope of the disclosure.
[0369] The various illustrative logical blocks and modules
described in connection with the examples disclosed herein can be
implemented or performed by a machine, such as a general purpose
processor, a digital signal processor (DSP), an application
specific integrated circuit (ASIC), a field programmable gate array
(FPGA) or other programmable logic device, discrete gate or
transistor logic, discrete hardware components, or any combination
thereof designed to perform the functions described herein. A
general purpose processor can be a microprocessor, but in the
alternative, the processor can be a controller, microcontroller, or
state machine, combinations of the same, or the like. A processor
can include electrical circuitry or digital logic circuitry
configured to process computer-executable instructions. In another
example, a processor can include an FPGA or other programmable
device that performs logic operations without processing
computer-executable instructions. A processor can also be
implemented as a combination of computing devices, for example, a
combination of a DSP and a microprocessor, a plurality of
microprocessors, one or more microprocessors in conjunction with a
DSP core, or any other such configuration. A computing environment
can include any type of computer system, including, but not limited
to, a computer system based on a microprocessor, a mainframe
computer, a digital signal processor, a portable computing device,
a device controller, or a computational engine within an appliance,
to name a few.
[0370] The steps of a method, process, or algorithm described in
connection with the examples disclosed herein can be embodied
directly in hardware, in a software module stored in one or more
memory devices and executed by one or more processors, or in a
combination of the two. A software module can reside in RAM memory,
flash memory, ROM memory, EPROM memory, EEPROM memory, registers,
hard disk, a removable disk, a CD-ROM, or any other form of
non-transitory computer-readable storage medium, media, or physical
computer storage known in the art. An example storage medium can be
coupled to the processor such that the processor can read
information from, and write information to, the storage medium. In
the alternative, the storage medium can be integral to the
processor. The storage medium can be volatile or nonvolatile. The
processor and the storage medium can reside in an ASIC.
[0371] Conditional language used herein, such as, among others,
"can," "might," "may," "for example," and the like, unless
specifically stated otherwise, or otherwise understood within the
context as used, is generally intended to convey that certain
examples include, while other examples do not include, certain
features, elements and/or states. Thus, such conditional language
is not generally intended to imply that features, elements and/or
states are in any way required for one or more examples or that one
or more examples necessarily include logic for deciding, with or
without author input or prompting, whether these features, elements
and/or states are included or are to be performed in any particular
example. The terms "comprising," "including," "having," and the
like are synonymous and are used inclusively, in an open-ended
fashion, and do not exclude additional elements, features, acts,
operations, and so forth. Also, the term "or" is used in its
inclusive sense (and not in its exclusive sense) so that when used,
for example, to connect a list of elements, the term "or" means
one, some, or all of the elements in the list. Further, the term
"each," as used herein, in addition to having its ordinary meaning,
can mean any subset of a set of elements to which the term "each"
is applied.
[0372] Disjunctive language such as the phrase "at least one of X,
Y, or Z," unless specifically stated otherwise, is otherwise
understood with the context as used in general to present that an
item, term, etc., may be either X, Y, or Z, or any combination
thereof (for example, X, Y, and/or Z). Thus, such disjunctive
language is not generally intended to, and should not, imply that
certain examples require at least one of X, at least one of Y, or
at least one of Z to each be present.
[0373] Unless otherwise explicitly stated, articles such as "a" or
"an" should generally be interpreted to include one or more
described items. Accordingly, phrases such as "a device configured
to" are intended to include one or more recited devices. Such one
or more recited devices can also be collectively configured to
carry out the stated recitations. For example, "a processor
configured to carry out recitations A, B and C" can include a first
processor configured to carry out recitation A working in
conjunction with a second processor configured to carry out
recitations B and C.
[0374] While the above detailed description has shown, described,
and pointed out novel features as applied to various examples, it
will be understood that various omissions, substitutions, and
changes in the form and details of the devices or algorithms
illustrated can be made without departing from the spirit of the
disclosure. As will be recognized, the inventions described herein
can be embodied within a form that does not provide all of the
features and benefits set forth herein, as some features can be
used or practiced separately from others.
[0375] Additionally, all publications, patents, and patent
applications mentioned in this specification are herein
incorporated by reference to the same extent as if each individual
publication, patent, or patent application was specifically and
individually indicated to be incorporated by reference.
* * * * *