U.S. patent number 3,727,190 [Application Number 05/087,784] was granted by the patent office on 1973-04-10 for patient signal dispatcher.
This patent grant is currently assigned to Chromalloy American Corporation. Invention is credited to Bernard Feinerman, Joseph H. Vogelman.
United States Patent |
3,727,190 |
Vogelman , et al. |
April 10, 1973 |
PATIENT SIGNAL DISPATCHER
Abstract
In various medical electrical apparatus a patient's clinical
information is entered, transmitted, and stored electrically.
Accompanying this clinical data is information as to the patient's
identity, e.g., name, age, when and where the clinical data was
taken, etc. The invention is a novel and improved apparatus for,
and a method of, entering patient identification information. The
information is entered manually, stored in a memory, the stored
information is displayed to an operator and then added to the
clinical information.
Inventors: |
Vogelman; Joseph H. (Roslyn,
NY), Feinerman; Bernard (Suffern, NY) |
Assignee: |
Chromalloy American Corporation
(New York, NY)
|
Family
ID: |
22207235 |
Appl.
No.: |
05/087,784 |
Filed: |
November 9, 1970 |
Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H
10/60 (20180101); G06F 3/0489 (20130101); G16H
40/63 (20180101) |
Current International
Class: |
G06F
19/00 (20060101); G06F 3/023 (20060101); G06f
003/00 () |
Field of
Search: |
;340/172.5 ;178/24 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Zache; Raulfe B.
Claims
What is claimed is:
1. Apparatus comprising: means for receiving clinical information
concerning a patient's medical condition; means for entering
patient identification information into a memory; optical display
means for displaying the patient identification information
entered; and means for transmitting the displayed patient
identification information with the clinical information.
2. Apparatus according to claim 1, wherein the display means are
operator viewable and the transmitting means includes
operator-operable means for initiating the transmission of the
patient identification information.
3. Apparatus according to claim 2, wherein the means for initiating
the transmission of the identification information also includes
means for initiating transmission of the clinical information
immediately adjacent to the identification information.
4. Apparatus according to claim 1, in which the means for entering
patient identification information into the memory is a plurality
of multi-position arrays with each position thereof corresponding
to a different information character.
5. Apparatus according to claim 4 wherein the multi-position arrays
are dials.
6. Apparatus according to claim 4 wherein the multi-position arrays
are matrix switches.
7. Apparatus according to claim 4 further including a plurality of
different tone sources; and means for selectively combining two
tone sources into a two tone signal in accordance with the selected
position of the array.
8. Apparatus according to claim 5 wherein the means for
transmitting the patient identification information includes
sequencing means for sequentially enabling the two tone signal
which corresponds to the dial portion to an output.
9. Apparatus according to claim 4 wherein the means for displaying
the information in the memory includes a plurality of information
characters, each character being associated with a particular
position on the array; and means for identifying the information
characters in accordance with the position of the array.
10. A method of reducing error in entering electrically represented
patient identification information which accompanies separately
originated electrically represented patient clinical information
comprising the steps of entering the patient identification
information into a memory, displaying the entered information, and
transmitting the information in the memory together with the
clinical information.
Description
The invention relates generally to medical electronics and more
particularly to methods and means for entering information about
the identity of a patient which accompanies clinical information
about the patient.
In the field of medical electronics, clinical information about a
patient, and identification information about the same patient
although stored together, originate from separate sources. For
example, in the taking of an electrocardiogram, the
electrocardiogram machine may be connected to a transmission line,
for transmission of the electrocardiogram information to a remote
recorder or diagnostic computer. The clinical information is taken
directly from the leads attached to the patient. The patient
identification information, i.e. which patient the leads are
attached to, is entered by a technician. It is essential that the
technician enter the proper patient identification information, for
if the wrong patient identification information is entered, the
record or diagnosis may then be applied to another patient. The
consequences of patient mis-identification are grave. In extreme
cases, failure to connect the clinical information with the proper
patient may produce lack of proper medication or treatment; or
might produce a medication or treatment for a patient who does not
require it; and in extreme cases this may prove fatal. It is,
therefore, of grave importance that the patient identification
information that accompanies clinical information always identify
the correct patient.
The clinical information is most often automatically produced from
sensing electrodes connected to the patient. The identification
information is almost always entered manually by a technician such
as by punching a keyboard. It is important to minimize any error in
the entry of patient identification information by the technician.
The present invention is a method of and means for reducing the
human error in entering patient identification information.
A separate but additional problem in medical electronics has to do
with the efficient use of the electronic equipment. Electrical
recording and electrical transmission of medical information is
relatively fast. A great deal of information can be transmitted or
recorded in a very short period of time. The manual entry of
information, such as by a typewriter, or pushing buttons on a
telephone is relatively slow. It is therefore not efficient to
operate most medical electrical devices in a recording or
transmitting mode with a manual input. The present invention has
the further advantage of overcoming the inefficiencies associated
with manual inputs by provided means for entering the patient
identification information into a temporary memory, and when the
recording or transmitting device is ready to receive the
information, it is automatically entered into the recording or
transmitting device at a rapid pace, which is comparable with the
speed of the device.
The present invention provides a means and method of efficient
utilization of electronic recording and transmission facilities
used in medical electronics.
Heretofore, in a specific example, it has been common when taking
an electrocardiogram for transmission over a commercial telephone
line to a remote recorder or diagnostic center, to add to the
electrocardiogram clinical information (which is recorded directly
from the patient) as to the patient's hospital identification
number, his date of birth, the date and hour on which the recording
is being made, patient height, weight and sex, etc. Heretofore,
this identification information was taken from the patient, or from
his chart and noted by the technician. After connecting the leads
and setting up the transmitting portion of the ECG machine, the
technician would dial on a telephone into the remote recording
station, which for example, might be in a hospital. After the
recording station answers, he would then dial in (or if a touch
tone telephone, punch the buttons on the touch tone telephone) to
enter the patient identification number, his date of birth, sex,
height, weight, any clinical data code, and date and time at which
the cardiogram was being taken. All in all, the technician might
have to punch the button some 24 times to enter the 24 items of
information. The drawbacks of doing this manually are several.
First, the chance of error in making more than 24 dials is
considerable. Moreover, the technician has no way of knowing if he
has made a mistake in the dialing, due to pushing the wrong button,
or dialing the wrong number. Furthermore, the time required to do
the dialing or pushing the buttoms, is relatively slow. The present
invention avoids these shortcomings of the prior art by providing a
means and methods of reducing human error entering patient
identification information, and which also makes more efficient use
of the transmission and recording facilities used in medical
electronics.
According to an embodiment of the present invention, a unit is
provided in which a technician enters the patient identification
information from the patient or from his chart. The unit includes
means for displaying the entered information. After reviewing the
entered information, the technician may actuate the transfer of the
information to a remote station. This transfer is made at a speed
consistent with the electrical capabilities of the transmitting
line, and the recording medium. The transmittal of the patient
identification information would be immediately followed by the
automatic sensing and transmittal of the clinical information. In
one embodiment the identification information is continuously
displayed to the technician. Should it be discovered, that an error
has been made in the identification information, he can then easily
correct the identification information and retransmit it along with
the clinical information.
It is an object oof the present invention to provide a novel method
and means of minimizing error in the entry of patient
identification information which accompanies clinical
information.
It is a further object of the present invention to provide a novel
method and means for the efficient use of recording facilities
and/or the transmission facilities used in medical electronics.
According to the invention, there is provided an apparatus for
transmitting clinical information concerning a patient's medical
condition having means for entering patient identification
information into a memory; means for displaying the patient
identification information stored in the memory, and means for
transmitting the patient identification information with the
clinical information.
According to the invention, there is also provided a method of
reducing error in entering electrically represented patient
identification information which accompanies separately originated
electrically represented clinic patient information comprising the
steps of entering the patient identification information into a
memory, displaying the entered information, and transmitting the
information in the memory.
The construction of an illustrative embodiment as well as further
objects and advantages thereof, will become apparent when read in
conjunction with the accompanying drawings wherein:
FIG. 1 is a block diagram of an automatic medical data acquisition
unit showing an embodiment of the invention.
FIG. 2 is a plane view of a typical control panel of the patient
identification information apparatus.
FIG. 3 is a partial isometric and schematic view of a dial shown in
FIG. 2.
FIG. 4 is a schematic view of the patient identification
information apparatus.
FIG. 5 is a table of the relation between tones and numbers
represented by two tone signals.
FIG. 6 is a schematic drawing of a manually operated switch in
which patient identification information may be entered.
FIG. 1 shows in block diagram form, an automatic electrocardiograph
data acquisition unit having an apparatus of this invention. The
operation of the unit as a whole may be very briefly reviewed as
follows. At the left hand side there is schematically shown 14
leads or electrodes 10 which are connectable to a patient. The
electrodes are connected through a buffer 18 to a matrix 20 which
generates the twelve standard ECG leads or waveforms as well as
three waveforms of the Frank Orthogonal System. These outputs are
provided three at a time to an output 12 shown here (right hand
side of the drawing) as a telephone line, for transmission to a
remote diagnostic center or a remote recording unit (not shown). At
the same time, the outputs of the amplifiers 23, 24 and 25 are fed
to a three-channel chart-writer (not shown) to provide a visual
record of the patient's cardiogram. The unit also includes a
patient identification apparatus shown generally by the legend 13.
At the time of attaching the electrodes 10 to the patient, the
medical technician would also enter into the patient identification
apparatus 13, information as to the patient's name or
identification number, the date, clinical data, if appropriate,
patient's age, his sex, height, weight, and the time that the
cardiogram is being taken. Apparatus 13 would then provide an
optical display of the information so entered and when the data
acquisition unit commences operation, the entered data in the
patient identification apparatus is transferred to the output
12.
Referring now to the elements in FIG. 1 in detail, the fourteen
electrodes 10 have the legends RA, LA, RL, LL, V.sub.1, V.sub.2,
V.sub.3, V.sub.4, V.sub.5, V.sub.6, H, M, I, and E. These legends
identify the location on the patient's body where the electrode is
attached. Namely, RA for right arm, LA for left arm, RL for right
leg, LL for left leg. The next six electrodes V.sub.1 to V.sub.6
are connected to the six precordial or chest points from which the
chest measurements are derived. The electrodes identified H, M, I
and E are connected respectively to the right or left side of the
neck posteriorly; to the center of the spine opposite to the chest
leads; to the right mid-axillary line at fifth intercostal space;
and to the mid sternum at the level of the fifth intercostal space
of the patient to provide the Frank Orthogonal measurements. The
outputs from the electrodes 10 are applied to a buffer 18 which for
example, presents a high impedance to the electrodes and a low
impedance to the next stage matrix 20. The buffer 18 typically
consists of fourteen unity gain amplifiers with an input impedance
of ten megohms shunted by 470 pf capacitance. The outputs from the
buffer are applied to matrix 20 which generates the twelve output
electrocardiogram leads or waveforms and the three Frank Vector
waveforms. The leads or waveforms generated in the
electrocardiogram group are the three standard limbleads I, II,
III; the three aV leads; and the six V leads from 1-6 inclusive.
The three Frank Vector waveforms, X,Y,Z, are also generated. A
sequencer 22 is connected to tthe matrix 20 and successively gates
three of the leads or waveforms to output amplifiers 23, 24, and
25. For example, in a first time interval t.sub.1, which typically
might be six seconds in duration, the three standard limbleads, I,
II, III are applied respectively to amplifiers 23, 24 and 25. The
sequencer 22 would then cause a marker signal of approximately 1/10
second duration to be applied to the three amplifiers, after which
the sequencer would cause the three generated aV leads or waveforms
to be applied respectively to the amplifiers 23, 24 and 25 for a
time duration of approximately 6 seconds, after which a spacer
signal of one-tenth second would again be applied to the three
amplifiers, after which the first three of the six V leads or
waveforms is applied, from the matrix 20 to the amplifiers etc.
After the 15 generated leads or waveforms, three at a time, have
been passed to the amplifiers, a marker signal is applied
afterwhich a calibration signal of known time duration and voltage
amplitude is added. The amplified leads or waveforms from
amplifiers 23, 24 and 25 are shaped as required for the particular
transmission system and are applied to three voltage controlled
oscillators 27, 28 and 29. Each oscillator has a carrier frequency
compatible with voice transmission on a telephone line; and
typically oscillator 27 has a carrier frequency of 1,075 Hertz,
oscillator 28 has a carrier frequency of 1,935 Hertz, and
oscillator 29 has a carrier frequency of 2,365 Hertz. The incoming
signals or leads from the amplifiers 23, 24 and 25 frequency
modulate the carriers of the oscillators. The frequency modulated
output signals from the oscillators are then applied to a mixer 30
which combines the signals on a single lead 31. The signal is sent
to a directional coupler 42; which for example, is a hybrid
transformer of a kind adapted to pass signals in one direction of a
given frequency range, and to pass signals in the other direction
of a selected frequency range. The combined frequency modulated
signals from the mixer 30 pass through directional coupler 42 and
go out over telephone line 12 to a remote recording station or
remote diagnostic station. Alternatively, the directional coupler
42 may be replaced by a tape recorder for making a tape recording
of the frequency modulated and mixed signals. The entire patient
clinical information is sensed, generated, and transmitted in less
than 1 minute.
The directional coupler 42 passes incoming signals from the
telephone line 12 to a filter 44 and a lamp 46, provided the
signals are in a predetermined frequency range (e.g. typical
frequencies; 385 and 445 Hertz). The incoming signals from the
telephone line are warnings indicating that the remote receiving
unit is not in a condition for receiving information or the
information source is not operating properly.
Patient identification is provided from an apparatus shown
generally by legend 13. It includes a manually operable control 50
connected between a scanner 51 and a group of oscillators 52. The
front panel of the control 50 is shown in detail in FIG. 2. On the
face of the panel there is a plurality of thumb-wheel
operator-operable dials 54. In FIG. 2 there is shown 36 dials 54,
arranged in three rows. Each one of the dials 54 is arranged to
take any one of 10 possible positions and each dial 54 has a knob
55 adapted to be turned by an operator. A group of legends numbered
0 through 9 are mounted on the dial next to the knob and any one
legend may be displayed in a window 57. The different positions of
the dial, the positions of the window and the location of the
legends on the dial are so arranged that one of the legends will
appear on the window for each different position on the dial.
In the drawing, the first knob is at position 1 with the number 1
displayed in the window 57. The technician operating the ECG data
accumulation unit will turn the knob 55 of the dials 54 on the
front panel to enter information to identify the patient. A total
of 41 items of information make up the patient identification.
Thirty-six items are entered by the manipulation of the knobs of
the dials. A remaining four are pre-wired and identify the machine
being used. The last item is a scale signal and is controlled by
the "half-stand" switch 58 on the control panel. When the switch 58
is in the "standard" position all of the transmitted ECG signals
are full amplitude. However, for certain patients, this magnitude
is too large, and an antenuator (not shown) is connected in the
output line by operation of the standard - half stand switch to
reduce the effective magnitude of the transmitted signal by 50
percent. When the switch 58 is in the half stand position, a signal
is transmitted (as the 41st item of information) to indicate that
the ECG has been attenuated and that the receiving equipment should
amplify the received signal by a factor of two to bring them up to
their correct size.
The 36 items of information entered manually on the dials can be
seen in FIG. 2. The items of information are as follows: beginning
with the top row and progressing from left to right -- six
positions for the patient identification number; the next three are
for clinical data; the next two are for age; and one for sex. On
the next line, the first three positions are for height; then three
positions for weight; and then six positions for the date -- month,
day and year. On the third line, 10 positions are reserved for
extra information and then the last two positions for the hour at
which the measurement is being made. Some of the information which
is entered here may also be used to provide a check or error
detection to insure that the operator has the correct patient. For
example, if the patient identity number does not agree with his
sex, or his approximate height and weight, then there would be an
indication that the data being accumulated is not that of the
patient whose identity is being entered into the machine.
Furthermore, a technician who enters the wrong day and wrong hour
is apt to make other mistakes on entering the data, and is an
indication to check further.
Referring now to FIG. 3 there is shown a partial isometric view of
the dial 54 with legends 56 appearing in the window 57, connected
by a shaft shown schematically as 58 to a ten positon rotary switch
64. The switch 64 has 10 fixed contacts 65 and a movable contact
66. The movable contact 66 is mechanically linked by the shaft 58
to the rotary dial 54. When the dial 54 is moved from one of its
positions to the next, tthe movable contact 66 makes electrical
connection with different fixed contacts corresponding to the
different numbers being displayed in the window 57. The legends 0-9
next to the fixed contacts 65 indicate which contact is connected
to movable contact 66 when the corresponding number 0-9 is being
displayed in the window 57.
FIG. 4 schematically shows the control 50, scanner 51 and
oscillators 52 in detail. In the previously given example, the
patient identification information includes forty-one items of
information. The scanner 51 has 41 information output leads and
sequentially provides on each output lead a pulse typically of 100
milliseconds duration. The scanner is a 48 stage shift register 70
driven by a clock source 72. The output from each stage is provided
on a different lead and the output from the last stage is fed back
to the clock 72 to block further pulses. The scanner 51 is set in
operation by a signal applied to a rest and start lead 73.
Thirty-six of the outputs from the shift register 70 are connected
to the 36 switches 64; four outputs are connected through fixed
wiring and one output is connected to the half stand switch 58. The
outputs from the switches 64, fixed wiring and switch 58 are
applied to matrix 82 and then to a group of tone oscillators 52 for
transmission. It might be helpful here to next examine the tone
oscillators. The recording or receiving equipment (not shown) which
receives the information from the unit, is of the kind adapted to
receive identification and supervisory information as a
simultaneous two-tone signal. This kind of signal is commonly used
in touch tone telephone dialing. For those unfamiliar with this
method of signaling, the following brief description may be
helpful. Each item of information, which here is a number from 0
through 9 (and two command signals identified as a star * and a
diamond #) is made up of two simultaneous tones. For example, the
number 1 is represented by a tone of 697 Hertz simultaneous with a
tone of 1,209 Hertz. The number 2 is represented by the two tones
of 697 Hertz and 1,336 Hertz. Tone sensitive decoders receive these
two tone signals to provide information as to the number it
represents. The sources of the tones are typically two oscillators
taped at four and three frequencies respectively, and activated in
pairs to indicate the number. The oscillators are shown in FIG. 4
(for simplicity) as seven separate oscillators F1 through F7. It
will be appreciated that seven tones may be combined two at a time
to produce 12 different combinations of pairs of tones.
FIG. 5 is a table showing the number representations 1, 2, 3, 4, 5,
6, 7, 8, 9, 0, *, #, arranged in rows and columns. Above each
column and to the left of each row, is listed the frequency of the
tones that are combined to represent the number appearing at the
intersection of a particular row and column. For example, the
number 1, first row and first column, is made up of the two tone
signals of 697 Hertz and 1,209 Hertz. Two is represented by 697
Hertz and 1,336 Hertz, etc.
In the table, there is also shown the legends F1 through F7
associated with various rows and columns. These numbers designate
the oscillators which provide the signals at the associated tone.
For example, the F1 oscillator will provide a signal of 697 Hertz.
The * (F4 and F5; 942 Hertz and 1,209 Hertz) and the # (F4 and F7;
942 Hertz and 1,477 Hertz) are used as command signals to initiate,
terminate and space operation of the remote recording or of
diagnostic equipment (not shown).
Referring again to FIG. 4, the oscillator 52 includes seven
oscillators, F1 - F7 which provide, when activated, the tones
required for two tone signaling. The oscillators are connected to a
coding matrix 82 having 12 input leads corresponding to the numbers
0-9, * and #. The coding matrix 82 is interconnected such that when
an input signal is applied for example, on the "1" lead, L-1, the
oscillators F1 and F5 are energized. This will be appreciated by
tracing the connection from the one lead L-1 to the oscillators F1
and F5. Likewise, an input on any other of the leads L-1 through
L-0 and L* and L# will cause actuation of the appropriate pair of
tone oscillators F-1 through F-7 that represent that number with
which the lead is associated. Ten of the twelve outputs L-1 through
L-0 are connected to the corresponding fixed contacts 65 on each of
tthe rotary switches 64, i.e. the L-1 input is connected to the "1"
fixed contact of each of the 36 rotary switches 64, and the L-2
input is connected to the "2" fixed contact of each of the 36
rotary switches 64, etc. The connections are shown schematically
being made to only two of the switches 64 but it is understood that
the connections are made to all oof the switches. Thirty-six of the
41 output leads 74 of the scanner 51 are connected respectively to
the movable contact 66 of the switches 64. Thus, the output pulses
from the scanner 51 are sequentially applied through the movable
contact 66 to the fixed contact 65 with which it is in contact and
then to the matrix 82 which applies the pulse to activate the two
tone oscillators associated with the fixed lead through which the
signal passes. The output two tone signal is determined by the
position of the rotary switch, which in turn is determined by the
position of the thumb knob 54.
The first or left most output from the scanner 51 is connected to
the L# lead. This is a control signal to indicate that the "patient
identification information is coming". The 38th through 41st
outputs from the scanner 51 (right hand side of the scanner) are
connected by fixed wiring to leads L-9, L-1, L-3, L-0 of the matrix
82. This information or code (9130) represents the number of the
machine. Each machine has a different number. Should a machine
become faulty in operation, all clinical information obtained from
that machine may be identified and reviewed for accuracy. The 42nd
output is connected to the half stand switch 58, whose function is
defined above.
The remaining output leads (43rd through 48th) from the scanner 51
may be connected (not shown) to the sequencer 22 to begin
generation and transmission of the patient clinical information
immediately after complete sending of the patient identification
information. Finally, the last output pulse (or the pulse after the
last used pulse) is applied to the clock 72 to turn off the clock
and stop further pulses from the shift register.
The output from the two groups of oscillators F-1 through F-4 and
oscillators F5, F6 and F7 are combined and applied (via the mixer
30) to the directional coupler 42 for transmission on output line
12.
An alternative embodiment to the dial 54 rotary switch 64
combination is to use a matrix switch 90 as shown schematically in
FIG. 6. The matrix switch 90 has 12 output conductors 91 which are
joined to the 12 leads L1 through L# of the matrix 82. Switch 90
has 36 input conductors 92 which are connected to the second
through 37th outputs of shift register 70. The conductors 91 and 92
are located adjacent to each other in a con-conducting electrical
relation. Thirty-six manually operated contacts 93, such as
sliders, are activated by the technician entering the patient
identification information. There is one contact 93 for each input
conductor 92. The contacts 93 join each of the conductors 92 to any
one of the output conductors 91. There is shown schematically in
the figure a contact being made between the first of the conductors
92 and the first of the output leads 91 which makes contact to the
L1 lead on the matrix 82. Alternatively (not shown) diodes can be
used to provide isolation between positions in the matrix. This
corresponds to the entry of the numeral 1 in the first position of
the first item of patient identification information (i.e. a 1 in
the first number of the patient identity). Contact is made by a
manually operative contact knob located on the control panel of the
patient signal dispatcher. A suitable matrix switch of the kind
described is manufactured by the Cherry Electrical Products Corp.,
Highland Park, Ill. Alternatively, any convenient or conventional
matrix switch may be used.
Thus, there has been shown a data acquisition unit in which the
patient identification information is entered manually by a
technician, and the information entered is displayed to the
technician for him to check. When the ECG lead or other source of
clinical information is ready, the technician causes the patient
identification information displayed to him, along with the
clinical information, to be transmitted to a recording medium and
transmitting line.
The above description of the invention is intended to be
illustrative only, and various changes and modifications in the
embodiment described may occur to those skilled in the art. These
changes may be made without departing from the scope of the
invention, and thus it should be apparent that the invention is not
limited to the specific embodiment described or illustrated in the
drawings.
* * * * *