US20020046346A1 - Electronic medical records system - Google Patents

Abstract

A medical records system that creates and maintains all patient data electronically. The system captures patient data, such as patient complaints, lab orders, medications, diagnoses, and procedures, at its source at the time of entry using a graphical user interface having touch screens. Using pen-based portable computers with wireless connections to a computer network, authorized healthcare providers can access, analyze, update and electronically annotate patient data even while other providers are using the same patient record. The system likewise permits instant, sophisticated analysis of patient data to identify relationships among the data considered. Moreover, the system includes the capability to access reference databases for consultation regarding allergies, medication interactions and practice guidelines. The system also includes the capability to incorporate legacy data, such as paper files and mainframe data, for a patient.

Description

RELATED APPLICATIONS
• This application is a continuation of and incorporates by reference, U.S. patent application Ser. No. 09/628,390, filed August. 2000, which is a continuation of application Ser. No. 09/333,170, filed Jun. 14, 1999, now abandoned, which is a continuation of U.S. Pat. No. 5,924,074, filed Sep. 27, 1996, issued Jul. 13, 1999.[0001]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0002]
• The present invention relates to electronic healthcare systems, and more particularly, to a system for storage and retrieval of electronic medical records in a computer environment, such as a local or wide area network including portable computers.[0003]
• 2. Description of Related Technology[0004]
• Healthcare providers, such as physicians, create large volumes of patient information during the course of their business at healthcare facilities, such as hospitals, clinics, laboratories and medical offices. For example, when a patient visits a physician for the first time, the physician generally creates a patient file including the patient's medical history, current treatments, medications, insurance and other pertinent information. This file generally includes the results of patient visits, including laboratory test results, the physician's diagnosis, medications prescribed and treatments administered. During the course of the patient relationship, the physician supplements the file to update the patient's medical history. When the physician refers a patient for treatment, tests or consultation, the referred physician, hospital, clinic or laboratory typically creates and updates similar files for the patient. These files may also include the patient's billing, payment and scheduling records.[0005]
• Healthcare providers can use electronic data processing to automate the creation, use and maintenance of their patient records. For example, in U.S. Pat. No. 5,277,188, assigned to New England Medical Center Hospitals, Inc., Selker discloses a clinical information reporting system having an electronic database including electrocardiograph related patient data. Similarly, Schneiderman discloses a computer system for recording electrocardiograph and/or chest x-ray test results for a database of patients in U.S. Pat. No. 5,099,424. In U.S. Pat. No. 4,315,309, Coli discloses a patient report generating system for receiving, storing and reporting medical test data for a patient population. Mitchell, in U.S. Pat. No. 3,872,448, likewise discloses a system for automatically handling and processing hospital data, such as patient information and pathological test information using a central processing apparatus. In U.S. Pat. No. 5,065,315, Garcia discloses a computerized scheduling and reporting system for managing information pertinent to a patient's stay in the hospital. However, these electronic data processing systems can not handle patient data in the wide variety of data formats typically produced by healthcare providers, such as physicians, laboratories, clinics and hospitals.[0006]
• Physicians often use paper based forms and charts to document their observations and diagnosis. Laboratories also produce patient data in numerous forms, from x-ray and magnetic resonance images to blood test concentrations and electrocardiograph data. Clinics and hospitals may use a combination of paper based charts and electronic data for patient records. The same patient data may exist in remote patient files located at clinics, hospitals, laboratories and physicians' offices. Similarly, patient files at one healthcare provider typically have different information than patient files at another healthcare provider. When in use, patient files are generally not available to other healthcare providers. In addition, at the time of creation, patient data is generally not available for use by remotely located healthcare providers. Moreover, relationships among specific patient data, such as abnormal laboratory test results, prescribed medications to address the abnormality, and specific treatments administered by the physician, may not be apparent within a patient file.[0007]
• In the current environment, specific patient data is difficult to access when needed for analysis. The creation of patient data in remote locations exacerbates this problem. In addition, the wide variety of data formats for patient data hinders electronic processing and maintenance of patient files. Moreover, the use of a patient's file by one healthcare provider can preclude its simultaneous use by another healthcare provider. Ongoing consolidation of healthcare providers into large health maintenance organizations (HMOs) and preferred provider organizations (PPOs) create issues in the transfer and maintenance of patient data in large enterprises having numerous remote locations. Under these circumstances, healthcare providers have difficulty providing effective treatment for their patients.[0008]
SUMMARY OF THE INVENTION
• The electronic medical record (EMR) system of the present invention automates and simplifies existing methods of patient chart creation, maintenance and retrieval. In contrast to other systems, the present invention creates and maintains all patient data electronically and thus can eliminate or supplement creating and maintaining of physical data records. The EMR system furnishes healthcare providers with an intuitive, easy-to-use, icon-based interface that enables them to capture and analyze patient data quickly and efficiently. Using the present invention, healthcare providers enter patient data immediately at the point of care. Thus, the EMR system captures each piece of data at its source at the time of entry to provide a complete audit trail for all patient data. In this manner, the EMR system transforms a patient chart from a static record of a few clinical interactions into a dynamic, real-time comprehensive record linked to an enterprise-wide clinical database. In addition, the EMR system of the present invention includes the capability to manage a wide variety of patient data formats, including patient data from external sources, such as laboratories and pharmacies. The EMR system can also incorporate a patient's legacy data, such as a paper chart, into the patient record as well as legacy data from mainframe computers.[0009]
• The present invention likewise provides instant access to a patient's electronic medical record by authorized healthcare providers from any geographical location. Thus, the EMR system enables authorized healthcare providers to access and update patient files using wireless pen-based personal computers. To enable complete replacement of physical records, the present invention permits healthcare providers, such as physicians or nurse practitioners, to electronically annotate patient data. Thus, a healthcare provider can acknowledge reviewing patient data, provide instructions, such as prescriptions for medication to administer to a patient, and approve recommendations for treatment by other providers, all by electronically annotating a patient's record. In addition, authorized healthcare providers can access a record while other providers use the same record allowing for real-time collaboration. The availability of electronic data permits instant, sophisticated analysis of patient data. Moreover, the EMR system enables enhanced analysis of patient data by providing access to reference databases for diagnosis, procedures and medication.[0010]
• One aspect of the present invention includes a medical records system, comprising a point of care system to capture patient data at a point of care and a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care system.[0011]
• Another aspect of the present invention includes a medical records system comprising a point of care system to capture data in a patient record at a point of care, wherein the patient record includes a patient identifier and at least one data structure including the patient identifier and the data.[0012]
• Yet another aspect of the present invention includes a medical records system comprising a point of care system to capture data at a point of care and a patient data repository, in communication with the point of care system and with external systems to store and organize the data in a patient record for access by the point of care system, wherein the patient record includes a patient identifier and at least one data structure including the patient identifier and the data.[0013]
• In addition, another aspect of the present invention includes a method of using an electronic medical records system, comprising the steps of capturing patient data electronically at the point of care, organizing the patient data so as to form a patient record, filing the patient record, and retrieving the patient record to access the patient data for use in the care of a patient.[0014]
• Yet another aspect of the present invention includes a method of retrieving patient data in an electronic medical records system having a patient data repository, comprising the steps of obtaining a patient identifier, locating a patient record corresponding to the patient identifier in the patient data repository, and determining the location of the patient data within the patient record.[0015]
• Another aspect of the present invention includes a method of managing a patient data repository having a cache and a data archive, comprising the steps of monitoring a status of data within the cache, and moving the data to the data archive when the status exceeds a threshold.[0016]
• Still another aspect of the present invention includes a method of communicating with an external source having an interface to an electronic medical records system, comprising the steps of finding an interface for the external source, connecting to the external source using the interface, and converting patient data for transfer between the external source and the electronic medical records system.[0017]
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a block diagram illustrating the electronic medical record (EMR) system architecture of the present invention.[0018]
• FIG. 2 is a flowchart illustrating the process flow of the EMR system of the present invention.[0019]
• FIG. 3 shows an example of a graphical user interface of the EMR system useful for the scheduling of a patient appointment as shown in FIG. 2.[0020]
• FIG. 4 is a block diagram illustrating the structure of the point of care system of FIG. 1.[0021]
• FIG. 5 shows an example of a graphical user interface of the point of care system of FIG. 4.[0022]
• FIG. 6 shows an example of a new form window of the point of care system of FIG. 4.[0023]
• FIG. 7 shows an example of an annotate window of the point of care system of FIG. 4.[0024]
• FIG. 8 shows an example of a viewer window displaying an image of patient data of the point of care system of FIG. 4.[0025]
• FIG. 9 is a block diagram illustrating the structure of a medication data capture in the point of care system of FIG. 4.[0026]
• FIG. 10 is a block diagram illustrating the structure of a practice guideline in the point of care system of FIG. 4.[0027]
• FIG. 11 is a block diagram illustrating the structure of the medication data capture and the practice guideline in the point of care system of FIG. 4.[0028]
• FIG. 12 is a block diagram illustrating the structure of the patient data repository of FIG. 1.[0029]
• FIG. 13 is a block diagram illustrating the structure of a patient record within the patient data repository of FIG. 12.[0030]
• FIG. 14 is an example of the patient record of FIG. 13.[0031]
• FIG. 15[0032]ais a flowchart illustrating the process flow of the patient data repository of FIG. 12.
• FIG. 15[0033]bis a flowchart illustrating the process for a transfer of data from a cache to a data archive in the patient data repository of FIG. 12.
• FIG. 16 is a block diagram illustrating the structure of the data interface of FIG. 12.[0034]
• FIG. 17[0035]ais a flowchart illustrating the process flow of the data interface of FIG. 16 when receiving patient data from an external source.
• FIG. 17[0036]bis a flowchart illustrating the process flow of the data interface of FIG. 16 when transmitting patient data to an external source.
• FIG. 18 is a block diagram illustrating the structure of the reference database of FIG. 1.[0037]
• FIG. 19 shows an example of a graphical user interface of the point of care system of FIG. 4 having a reference access button and a medication manager button.[0038]
• FIG. 20 shows an example of a graphical user interface for the diagnosis module and the procedure module of the reference database of FIG. 18.[0039]
• FIG. 21 shows an example of a graphical user interface for the medication manager of the reference database of FIG. 18.[0040]
• FIG. 22 shows an example of a medication interaction window of the medication manager of FIG. 21.[0041]
• FIG. 23 is a block diagram illustrating the structure of the legacy data system of FIG. 1.[0042]
• FIG. 24 is an example of a typical configuration for the electronic medical records system of the present invention.[0043]
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
• The following detailed description of the preferred embodiments presents a description of certain specific embodiments to assist in understanding the claims. However, one may practice the present invention in a multitude of different embodiments as defined and covered by the claims.[0044]
• For convenience, the description comprises three sections: EMR System Architecture and Overview, EMR System Configurations and Summary. The first section provides an overview of the EMR system architecture, the following section describes EMR system applications and preferred embodiments for practicing the EMR system of the present invention, and the remaining section summarizes advantageous features of the present invention.[0045]
• I. EMR System Architecture and Overview[0046]
• FIG. 1 illustrates the architecture of the EMR system. Healthcare providers, such as physicians, at hospitals, laboratories and clinics, generally capture and access patient data using a point of[0047]care system100 that communicates with apatient data repository102. Patient data, such as vital signs, x-ray images and laboratory results, resides in thepatient data repository102. Thepatient data repository102 also communicates with external sources to obtain patient data, such as laboratory test results and x-ray images, and to transfer patient information, such as prescriptions for medication, from the EMR system to other healthcare providers. The point ofcare system100 captures patient data in real-time at the point of care, that is, where healthcare providers interact with their patients. For example, physicians can use a point ofcare system100 to enter, access, process, analyze and annotate data from patient records in real-time at the point of care. Thus, using the point ofcare system100, a physician, who has many patients in a hospital, can visit each patient in their room, access their electronic patient record there, enter results of the current examination, evaluate their medical history, electronically annotate their x-rays images and prescribe medications and treatments instantaneously as the point ofcare system100 captures and organizes patient data into the patient record stored in thepatient data repository102. The point ofcare system100 may likewise communicate with areference database104 to assist a healthcare provider in making diagnoses, prescribing medications and administering treatments. Moreover, thepatient data repository102 may also communicate with alegacy data system106 to access pertinent patient data in paper files and mainframe electronic databases.
• Referring now to FIG. 2, a flowchart illustrates the operation of the EMR system. For example, a patient having a complaint contacts a[0048]healthcare provider110, such as a physician, to schedule an appointment. The EMR system obtains thepatient record111 from the patient data repository102 (FIG. 1) prior to the scheduled appointment. The EMR system is also capable of handling patients on a walk-in basis by scheduling an appointment and requesting the patient's record immediately thereafter. The EMR system updates thepatient record112 to include the complaint and other information pertinent to the appointment, such as insurance information. A healthcare provider, such as a physician, examines thepatient113 using the point of care system100 (FIG. 1) to make a diagnosis and to treat the patient's condition. As determined at114, if a diagnosis is not possible on the basis of this examination, the physician may need to obtain additionalclinical data115, such as laboratory tests and x-rays. When available, the physician uses the point of care system100 (FIG. 1) to evaluate theresults116 and to examine thepatient113 again in light of the results. Upon making a diagnosis, the physician may need to prescribemedications117 for the patient's condition. Similarly, the physician may need to administer atreatment118 to address the patient's condition. At the conclusion of the patient's visit, the EMR system files the patient'srecord119 in the patient data repository102 (FIG. 1) for future reference.
• In a preferred embodiment, the EMR system includes graphical user interfaces to access system functions. For example, as shown in FIG. 3, a[0049]chart puller window120 enables a healthcare provider to schedule a patient appointment using its point and click interface. To schedule an appointment, a healthcare provider activates theselect button121 with a pointing device, such as a mouse or electronic pen, to obtain a list of patients. The healthcare provider then scans the list to select the name of the appropriate patient using a pointing device. The EMR system places the name of the selected patient in thepatient box123. Similarly, the healthcare provider uses the up/downbuttons125 to select an appointment date and an appointment time. An adjacent box, such as thedate box126, displays the selected date and time. Lastly, the healthcare provider enters a textual description of the patient's complaint in areason box127. Note that the healthcare provider can review prior or future scheduled appointments by clicking on theappointments button128. Similarly, the healthcare provider can track referrals by entering the identity of persons who referred this patient to their care in thereferral box129.
• Referring now to FIG. 4, a block diagram illustrates the structure of the point of[0050]care system100. The point ofcare system100 includes the following modules: apatient data capture140, aclinical data capture142, progress notes144 and anencounter data capture146. During a patient visit, the healthcare provider (not shown) can enter, review and annotate patient information, such as family history, appointments, current medications and complaints, using thepatient data capture140. The healthcare provider can likewise enter, review and annotate clinical data obtained during the visit, such as body temperature and blood pressure, using theclinical data capture142. Similarly, the healthcare provider can enter laboratory data for patients with theclinical data capture142. Theclinical data capture142 communicates with thepatient data capture140 to assist in identifying needs for further clinical data. For example, a family history of high blood pressure may indicate a need to obtain the patient's blood pressure during the visit. Thepatient data capture140 also communicates with theencounter data capture146, where a healthcare provider can enter, review and annotate data regarding diagnoses and procedures administered to the patient. Moreover, the healthcare provider can use the progress notes144 to summarize details of the patient's condition and to review the patient's progress over time. Thus, the progress notes144 communicates with thepatient data capture140, theclinical data capture142 and theencounter data capture146.
• Referring now to FIG. 5, in a preferred embodiment, the point of care system[0051]100 (FIG. 1) includes a graphical user interface having apatient chart window150 to capture patient information. The point ofcare system100 presents a patient record graphically using a tabbed layout to organize patient data. Thepatient chart window150 includes tabs forpatient data151,clinical data152,encounter data153 and progress notes154. Pointing and clicking on a tab on thepatient chart window150 opens afolder window155 where a healthcare provider can enter and review patient data within the folder. For example, to activate progress notes144 (FIG. 4), the healthcare provider selects the progress notestab154 to display a list of progress note data in thefolder window155. In a similar manner, to activate thepatient data capture140, theclinical data capture142 or theencounter data capture146, one selects thepatient data tab151, theclinical data tab142, or theencounter data tab153, respectively.
• To enter patient data, the healthcare provider clicks on the scroll down[0052]button156 to select a form from a list of available forms to enter patient data. This activates thenew forms box157. The provider then points and clicks on thenew form button158. For example, FIG. 6 shows anew form window161 displaying thepediatric problem form162 selected by the healthcare provider using the scroll down button156 (FIG. 5). The healthcare provider fills out thepediatric problem form162 using an input device, such as a keyboard, a mouse or an electronic pen. For example, the provider uses a keyboard to enter text “6/7/96 Stomach Ache”164 and an electronic pen to enterinitials166 for identification. When done with patient data entry, the provider exits the form using theFile Menu168 and the point ofcare system100 returns the provider to the patient chart window150 (FIG. 5). Referring back to FIG. 5, the new form appears as the top entry of the list in thefolder window155.
• Similarly, to annotate patient data, the healthcare provider first selects an item to annotate by pointing and clicking on the item in a list displayed in the[0053]folder window155. The provider then clicks on theannotate button159 to open the item in anannotate window170, as shown in FIG. 7. For example, theannotate window170 of FIG. 7 displays ablood test result172. As before, the healthcare provider annotates the bloodtest result document172 using an input device, such as a keyboard, a mouse or an electronic pen. For example, the provider uses a keyboard to enter text “Out of Range”174 and an electronic pen tocircle176 the out of range result. When done with annotations, the provider exits the form using theFile Menu178 and the point ofcare system100 returns the provider to the patient chart window150 (FIG. 5). Note that the point ofcare system100 tracks the review of patient data and identifies reviewed files with amark160 in thefolder window155. By annotating patient data, a healthcare provider, such as a physician, can acknowledge reviewing patient data, provide instructions, such as directions for additional tests and procedures or prescriptions for medication to administer to the patient, and approve recommendations for treatment by other healthcare providers. Lastly, as shown in FIG. 8, a healthcare provider uses thepatient chart window180 to view patient data. First, the healthcare provider selects aview item182 by either pointing and clicking twice on the item in a list displayed in thefolder window184 or by pointing at the item in the list and pressing theview button183. The double click opens aviewer window185 to display theview item182. For example, theviewer window185 of FIG. 8 displays anx-ray186. As before, the healthcare provider may annotate thex-ray186 with comments and observations by clicking on theannotate button187. The healthcare provider may likewise close theviewer window185 by clicking on theclose button189.
• Certain additional structures in the point of care system[0054]100 (FIG. 1) will now be discussed with reference to FIGS. 9, 10 and11. Referring now to FIG. 9, an optionalmedication data capture148 supplements the structure of the point ofcare system100 of FIG. 4. Amedication data capture148 allows a healthcare provider to monitor a patient's medications. Themedication data capture148 communicates with thepatient data capture140 to account for medications the patient is currently taking. Themedication data capture148 similarly communicates with the progress notes144, where a practitioner can monitor changes in a patient's condition resulting from medication therapies. Referring now to FIG. 10, anoptional practice guideline149 supplements the structure of the point of care system of FIG. 4. Thepractice guideline149 provides references for practitioners to consult regarding courses of action to obtain a diagnosis and alternative treatments for various conditions. Thepractice guideline149 communicates with thepatient data capture140, theclinical data capture142 and theencounter data capture146 to assist the practitioner in selecting the appropriate course of action. Thepractice guideline149 likewise communicates with the progress notes144 to provide a healthcare provider with a historical context of the patient's condition and alternative treatments already attempted.
• FIG. 11 shows a point of[0055]care system100 having amedication data capture148 and apractice guideline149. As before, themedication data capture148 communicates with thepatient data capture140 and with theprogress note144. Similarly, thepractice guideline149 communicates withpatient data capture140, theclinical data capture142, theencounter data capture146 and theprogress note144. However, thepractice guideline149 may now communicate with themedication data capture148 to address situations where accepted practice guidelines require a healthcare provider to prescribe and administer medications. In a preferred embodiment, the point ofcare system100 includes the graphical user interface illustrated in FIG. 5. Referring back to FIG. 5, thepatient chart window150 includes tabs formedication data191 andpractice guidelines193 that activate themedication data capture148 and thepractice guideline149, respectively. Similarly, pressing themedication manager button192 activates themedication data capture148 and thepractice guideline149. A healthcare provider can enter, review and annotate patient medication data and practice guideline data as described previously.
• Referring now to FIG. 12, a block diagram illustrates the structure of the[0056]patient data repository102. Thepatient data repository102 includes apatient locator200, adata manager202 and adata interface204. Thepatient locator200 generates a unique patient identifier (PID)221 (FIG. 14) for each patient and creates and maintains a table having PIDs for all patients who have data in thepatient data repository102. All data records related to apatient211,212,213,214,215,216,219 include and reference the patient's unique PID as shown in FIG. 13.
• With reference to FIG. 13, upon creation of a patient record, the[0057]patient locator200 creates apatient data structure210 having the PID and the patient's name. In a preferred embodiment, thepatient data structure210 includes pointers to data structures having data within a patient record captured by the point ofcare system100 and incorporated from external sources (e.g., a digital x-ray image file stored in a raster pixel format). Thus, thepatient data structure210 maintains a pointer to an interface filesstructure211 having patient data transmitted from external sources. Thepatient data structure210 likewise maintains pointers to aclinical data structure212, aprogress note structure213 and anencounter data structure214. These data structures include patient data captured by theclinical data capture142, progress notes144 andencounter data capture146, respectively (FIG. 4). In another preferred embodiment, thepatient data structure210 may include pointers to data structures having data generated by thereference database104 and transferred by thelegacy data system106. Thus, thepatient data structure210 may maintain pointers to amedication data structure215 and aguideline data structure216. As described above, themedication215 andguideline216 data structures include patient data captured by themedication data capture148 and thepractice guideline149, respectively. In this embodiment, areference data structure217 may maintain pointers to theencounter data structure214 and to themedication data structure215 for access to reference information contained in areference database104. Lastly, thepatient data structure210 may maintain a pointer to a legacy filesstructure219 having patient data transmitted from thelegacy data system106, such as an image of a patient chart.
• FIG. 14 shows a logical view of a[0058]patient record220 corresponding to the structure illustrated in FIG. 13. Thepatient record220 includes the PID generated by the patient locator200 (FIG. 12) in the patient data repository102 (FIG. 1). In addition, thepatient record220 includes patient data in a variety of data types generated by healthcare providers. Thus, the patient record includestext data223, such as electronic mail and word processing documents from other healthcare providers,image data225, such as scanned physical documents, x-rays and CATSCANs, andaudio data227, such as a physician's dictation and voice mail. Lastly, thepatient record220 has data tables229, such as a physician's ICD9 diagnosis codes and CPT procedure codes. In view of the structure of apatient record220, referring back to FIG. 12, thedata manager202 uses the PID to store and retrieve patient records. Moreover, the data interface204 permits communication with external sources to obtain patient data, such as demographic data, laboratory test results and x-ray images, and to transfer patient information, such as prescriptions for medication, from thepatient data repository102 to external healthcare providers.
• With reference to FIG. 12, the[0059]patient data repository102 may optionally include acache206 for temporary storage of patient data and adata archive208 for long term storage of patient data. In this embodiment, thedata manager202 coordinates the transfer of patient data to and from adata archive208 into acache206. For example, thedata manager202 may identify patient records that a healthcare provider needs for appointments scheduled at a future time and then transfer these patient records from the data archive208 into thecache206 for quick access prior to the scheduled appointment. Similarly, thedata manager202 may purge from thecache206 records of patients who have not had recent appointments and whose records are already archived. Thedata manager202 likewise tracks the location and description of patient data within the data archive208 by associating the file name of the patient data within apatient record220 with thepatient identifier221. When possible, thedata manager202 will group data associated with a patient within the data archive208 for rapid retrieval in a manner similar to files within a directory in an operating system. Thus, thedata manager202 assigns a directory to each patient identifier and then stores patient data within this directory.
• FIG. 15[0060]aillustrates the process flow for the patient data repository102FIG. 1). For example, the point of care system100 (FIG. 1) issues a request forpatient data250. With reference to FIGS. 15aand12, thepatient locator200 receives the request from the point ofcare system100 and, at251 attempts to find the PID for the record having the requested patient data. As determined at252, if no PID is found, thepatient locator200 reports anerror253. At this point, the patient data repository102 (FIG. 1) may recover from theerror253 by either restarting the process or by ending the process. Otherwise, thepatient locator200 communicates the PID to thedata manager202. Thedata manager202 locates the patient record using the PID at254. As determined at255, in a system withoutcache206 and without adata archive208, thedata manager202 delivers the requesteddata256 to the point ofcare system100. In a system having acache206 and adata archive208, thedata manager202 determines at257 if the requested data exists in thecache206. If so, thedata manager202 delivers the requesteddata256 to the requester from thecache206. Otherwise, thedata manager202 first moves thedata258 from the data archive208 to thecache206 and then delivers the requesteddata254 to the requester from thecache206.
• In addition, FIG. 15[0061]b, in conjunction with FIG. 12, illustrates the process for transferring data from acache206 to adata archive208. Thedata manager202 monitors the contents of thecache206. To improve the performance of thecache206, thedata manager202 requests transfer260 of data to the data archive208 under certain conditions. For example, thedata manager202 may purge thecache206 when data requested for storage in the cache would exceed its memory capacity. In this circumstance, thedata manager202 first transfers to the data archive208 signed files and then data files in chronological order, i.e., oldest files first. Similarly, a healthcare provider can specify a predetermined time, such as 3 calendar days, or other selected conditions for transfer to the data archive208. As determined at262, if thecache206 does not have the data to transfer, the process ends as thedata manager202 ignores the request. As determined at264, if the data in thecache206 is not ready for transfer, the process ends and thedata manager202 queues the request for the next transfer of data to the data archive208. Data in thecache206 is ready for transfer when a physician has reviewed and accepted it and when it has not been previously committed to the data archive208. Otherwise, thedata manager202 transfers data from thecache206 to the data archive208 at266.
• Referring now to FIG. 16, the data interface[0062]204 of thepatient data repository102 includes aninterface manager270, adata handler272 and acommunication interface274. To transfer and receive patient data from external sources (not shown), theinterface manager270 communicates with adata handler272 and acommunication interface274. In addition, thecommunication interface274 communicates with thedata handler272 for conversion of received external patient data into formats recognized by the EMR system. Theinterface manager270 creates and maintains an interface registry of data formats for external sources. Prior to data transfer or receipt by the EMR system, theinterface manager270 registers an interface for an external source. Upon registration of an interface, theinterface manager270 can provide the appropriate conversion routines for thedata handler272 to use for transfer of data to and receipt of data from an external source. These conversions are well understood by the relevant technologist.
• FIGS. 17[0063]aand17billustrate the operation of the data interface204 of the patient data repository102 (FIG. 12). Referring now to FIG. 17a, thedata manager202 issues arequest280 for patient data from an external source. At282, theinterface manager270 determines if the registry includes an interface for the external source, such as a laboratory or pharmacy. As determined at282, if the registry includes an interface for the external source, thecommunication interface274 connects to theexternal source284 to receive patient data. Thedata handler272 retrieves the appropriate conversion routine for the external source to convertdata286. In a preferred embodiment, thedata handler272 converts data from an external source into a database table for the appropriate PID. Lastly, thedata manager202 incorporates converteddata288 into the patient record. Otherwise, theinterface manager270 reports anerror289. Thedata manager202 may recover from theerror289 in several ways. First, thedata manager202 may invoke a module to register an interface for the external source so as to allow the process to continue. Second, thedata manager202 may end the process at this point. Lastly, thedata manager202 may restart the process in the event the external source was specified incorrectly.
• Referring now to FIG. 17[0064]b, an external source requestsdata290 from a patient record. As described above, theinterface manager270 determines at292 if the registry includes an interface for the external source. As determined at292, if the registry includes an interface for the external source, thedata manager202 locates the requested data at294 and thedata handler272 converts requested data at296 to the format required by the external source. Thecommunication interface274 then sends the converted data to the external source at298. For example, thepatient data repository102 may transmit a physician's prescription for medication to a hospital or pharmacy. If the registry includes no interface for the external source, theinterface manager270 reports anerror299. Similarly, as discussed above for the process flow of FIG. 17a, theinterface manager270 may recover from theerror299 by restarting the process, ending the process or invoking a module to register the external source to allow the process to continue.
• Referring now to FIG. 18, a block diagram illustrates the structure of the optional reference database[0065]104 (FIG. 1). Thereference database104 includes adiagnosis module300, amedication manager302 and aprocedure module304. A healthcare provider can use thereference database104 for assistance in diagnosing a patient's disease, prescribing medications and ordering supplemental procedures to treat the disease. Thediagnosis module300 communicates with amedication manager302 to obtain information on medications indicated by a diagnosis. Themedication manager302 provides information on medications, such as proper dosages, allergies, contraindications, adverse interactions with other medications, and side effects. Thediagnosis module300 likewise communicates with aprocedure module304 to obtain information on the proper administration of procedures indicated by a diagnosis. Theprocedure module304 provides information on procedures for treatment as indicated by the diagnosis. In many instances, themedication manager302 communicates with theprocedure module304 regarding the administration of various medications.
• In a preferred embodiment, the point of[0066]care system100 provides access to thereference database104 through a graphical user interface having apatient chart window310 shown in FIG. 19. A healthcare provider accesses thediagnosis module300 and theprocedure module304 by pointing and clicking on areference access button312.
• As shown in FIG. 20, the[0067]reference access button312 produces areference window330 including the graphical interfaces for thediagnosis module300 and theprocedure module304. For example, to enter a diagnosis, a physician clicks on the scroll downbutton331 adjacent to thesystem box332 to produce a list of body systems. The physician selects the appropriate system and thediagnosis module300 enters the selected system in thesystem box332 and provides a list having specific diagnosis codes for the selected body system in thediagnosis box334. The physician then selects the appropriate diagnosis code and clicks on theadd button336 adjacent to thediagnosis selection box337. Thediagnosis module300 enters the selected diagnosis code to thediagnosis selection box337. The physician may repeat the above steps to add multiple diagnosis codes to thediagnosis selection box337. In a similar manner, a physician uses the scroll downbutton331 adjacent to thetopic box333 to select the appropriate procedure topic. Theprocedure module304 enters the selected procedure topic in thetopic box333 and provides a list of procedure codes in theprocedure box335. The physician now selects the appropriate procedure code and adds it to theprocedure selection box338 by clicking on theadd button336 adjacent to theprocedure selection box338. The physician may likewise repeat the above steps to add multiple procedure codes to theprocedure selection box338. The physician completes entry of diagnoses and procedures by clicking on the donebutton339 to return to thepatient chart window310 of FIG. 19.
• The healthcare provider similarly accesses the medication manager[0068]302 (FIG. 18) by clicking on a medication button192 (FIG. 19). Referring now to FIG. 21, the medication button314 activates amedication manager window350. The physician can review the patient's history by viewing themedication history box351 and thediagnosis history box352 before prescribing any new medications. The physician can also review any patient allergies in theallergy box353. The physician can select a medication by entering the name of the medication in thename box354. Note that as the physician enters the root letters of a medication name, a list of medications with the root letters appears in themedication list box355. As before, the physician selects a medication from the list by clicking on it and themedication manager302 places the selected medication in aselection box356. If there are no contraindications or allergies for the patient, the physician prescribes the medications listed in theselection box356 by clicking on the prescribebutton357.
• Otherwise, if a contraindication exists, a warning appears in a[0069]warning bar358 to alert the physician. In view of the warning, the physician can investigate the effects of the medication by clicking on theresults button359. Referring now to FIG. 22, the results button produces amedication interaction window361. Amedication selection box362 displays the medications selected and under consideration by the physician. Anallergy list box363 displays the patient's allergens.Folder tabs364 include labels describing the medication combinations and interactions. The physician clicks on one of thesefolder tabs364 to display the contents of the folder in theviewing box365. The physician can then evaluate the information on the interaction including potential adverse patient reactions. The physician clicks on the donebutton366 to return to themedication manager window350 of FIG. 21. The physician can make any needed revisions to the medications selected in the manner described above. Afterwards, the physician exits themedication manager302 by clicking on theexit button360.
• Referring now to FIG. 23, a block diagram illustrates the structure of the optional[0070]legacy data system106 as shown in FIG. 1. Thelegacy data system106 includes adata source370 and aconverter372. Thedata source370 comprisesphysical data374, such as paper based records and photographs, andelectronic mainframe data376. Theconverter372 receives information from thedata source370 and transforms the information into an electronic format compatible with the EMR system. For example, to inputphysical data374, such as paper or image based data, into a patient record, theconverter372 comprises a scanner to digitize the physical data into a binary file format for incorporation into the patient's record. To inputelectronic mainframe data376, theconverter372 employs the same mechanism used for transfer or receipt of patient data from external sources. As described before, theconverter372 determines if an interface exists for the mainframe data, selects the appropriate data handler and converts the data into the proper format for incorporation into a patient record.
• II. EMR System Configurations[0071]
• FIG. 24 illustrates one possible configuration for the EMR system of the present invention. The system comprises a wide area network (WAN)[0072]402, the World Wide Web (Web)404 portion of the Internet, andremote web servers406,408,410 communicating withweb browsers412. TheWAN402 comprises a plurality of local area network (LAN) servers supporting local and remotely located healthcare providers. For example, theWAN402 includes LANs supportingScripps Health414 andSharp Memorial430 in San Diego andCedars Sinai432 andLoma Linda434 in Los Angeles, Calif. In one presently preferred embodiment, the server comprises a multi-processor personal computer having Intel Pentium processors, such as a Compaq Proliant 4500R 5/100Model 2, communicating with a fault tolerant, error correcting storage device, such as a Hewlett Packard 20XT Optical Jukebox having 20 gigabytes of storage capacity. TheLAN400 includes abackup server426 and several peripherals, such as a scanner424 to input documents and alaser printer422 to print out documents. In a preferred embodiment, the LAN backbone comprises an Ethernet twisted pair cable configured in a general star topology. Similarly, the scanner424 comprises a Fujitsu M3093EX scanner using Kofax KIPP ImageControls software and thelaser printer422 comprises a Hewlett Packard LaserJet 4Plus. Healthcare providers may access theLAN400 using adesktop computer416, alaptop computer418 orwireless pen computer420. In a preferred embodiment, thedesktop computer416 comprises a Compaq Deskpro 5/75 Model 630, thelaptop computer418 comprises a IBM ThinkPad 760CD and thepen computer420 comprises a Fujitsu Stylist 1000 configured with a Solectek AirLAN PCMCIA network adapter for wireless LAN access. The EMR system also provides for communication through the World Wide Web. For example, remote healthcare providers may access theWAN402 on the Web using the domain name “www.westcst.com”436. Thus, a healthcare provider located in Boston, Mass. may access a patient record resident on theScripps Health server414, located in San Diego, Calif., using aweb browser412, such as Microsoft Explorer or Netscape Navigator, communicating with a Web server in Boston, Mass. having the domain name “www.boston.com”406.
• In a preferred embodiment,[0073]servers414,426,desktop416, orlaptop418 computers and peripherals, such asprinters422 or scanners424, communicate with each other and with the Web using a network operating system, such as Microsoft Windows NT, Windows 95 or Windows for Workgroups. Similarly,pen computers420 use the Microsoft Windows for Pen Computing operating system. In another preferred embodiment, the servers, computers and peripherals communicate using an operating system supporting Web browsers on computer networks, such as Unix, Novell Netware or Apple System 7.0. In yet another preferred embodiment, the EMR system includes servers, computers and peripherals networked using mixed network operating systems, such as Unix, Netware and Windows. For example, theLAN400 may operate on a Windows NT network operating system, whereas theLAN430 may operate on an Apple System 7.0 network, and the Web server “www.boston.com”406 may operate on a Unix operating system. Thus, the EMR system supports communication among a variety of hardware components, such asprinters422, scanners424 andpen computers420, using a variety of network operating systems, such as Windows, Netware or Unix. In a preferred embodiment, healthcare providers, such as clinics and laboratories, may also communicate with the EMR system using modem links and standard v.34 modem devices, such as a US Robotics Sportster 28,800 modem.
• The EMR system includes several databases of electronic information, such as the[0074]medication manager302 and thedata manager202. In a preferred embodiment, the EMR system implements a relational database language that conforms to American National Standards Institute (ANSI) standard SQL-92, a 580 page specification for the SQL relational database language. A database language standard specifies the semantics of various components of database management systems (DBMS). In particular, it defines the structures and operations of a data model implemented by the DBMS, as well as other components that support data definition, data access, security, programming language interface and data administration. The SQL-92 standard specifies data definition, data manipulation, and other associated facilities of a DBMS that supports the relational data model. SQL is old in the art and additional information on SQL-92 is available in ANSI specification X3.135-1992, hereby incorporated by reference.
• Similarly, in another preferred embodiment, relational databases in the EMR system support the Open Database Connectivity (ODBC) model. ODBC is an application program interface (API) that allows client applications running under Microsoft Windows to access data from a variety of data sources, including relational and non-relational DBMS. These data sources may reside on a client machine or they may be located on a remote server communicating through a network common to the client machine. Under ODBC, data sources may vary in complexity from shrink-wrap databases, such as Microsoft Access, running under Windows on a client machine to more sophisticated, proprietary relational DBMS running on a Unix server or mainframe computer. For a client application to access data from a data source, a dynamic link library (DLL) driver must exist for each data source to be accessed. For additional information on ODBC is available from[0075]Inside ODBC, by Karl Geiger, hereby incorporated by reference.
• III. Summary[0076]
• The electronic medical record system of the present invention advantageously overcomes several limitations of existing technologies and alternatives. Because it is more efficient and cost effective to move data, instead of physical records and healthcare providers, the present invention eliminates the need to create and maintain any physical data records. In contrast to other systems, the present invention creates and maintains all patient data electronically. Thus, there is no need to find, pull, move, update, file and replace physical charts. As a result, healthcare providers no longer require substantial shelving and storage space for physical files. The present invention likewise eliminates the mishandling, loss and destruction of patient data typically associated with maintenance of physical data records.[0077]
• Using the present invention, healthcare providers enter patient data immediately at the point of care. Thus, the EMR system captures each piece of data at its source at the time of entry, including time and healthcare provider identification. The EMR system thus provides a complete audit trail for all patient data. The audit trail, in turn, permits inexpensive analysis of outcomes, utilization and compliance. For example, outcomes typically refer to the effectiveness of a treatment plan. Thus, the EMR system enables a healthcare provider to analyze patient recovery times and incurred costs to measure the efficacy of the treatment plan. Similarly, utilization typically refers to how well available resources are utilizing time. Thus, the EMR system provides the capability to analyze utilization of physicians, nurses, staff and equipment as well as time utilization for patients, such as wait times for referrals, lab results and physician examinations. Lastly, compliance typically refers to conformance with government and accreditation standards and regulations. The EMR system provides tools to enable healthcare providers to measure conformance to standards and regulations. To facilitate entry of patient data at the point of care, the invention provides touch screens for entry of lab orders, medications, diagnoses and procedures. The invention likewise provides instant access to a patient's electronic medical record by authorized healthcare providers from any geographical location. Thus, the EMR system enables authorized healthcare providers to access and update patient files using wireless pen-based personal computers. In addition, authorized healthcare providers can access a record while other healthcare providers use the same record. By providing simultaneous access to patient data, the present invention enables real-time collaboration among multiple healthcare providers.[0078]
• The availability of electronic data permits instant, sophisticated analysis of a patient's clinical data. Thus, the EMR system can create graphs of a patient's vital signs and lab results or the system can provide an analyze patient information to identify medication interactions and allergies. Using the present invention, a healthcare provider can likewise select, sort, and analyze patient data to identify relationships among the data considered. In addition, the EMR system provides flexibility in the creation and maintenance of patient data repositories. Thus, the present invention can support a large healthcare enterprise distributed across a large geography as well as a single physician office. Moreover, the present invention ensures patient confidentiality through the use of a tiered password system. The EMR system provides several levels of security for access to patient data. For example, a system administrator may have global password access to any patient data for system maintenance and debug purposes, whereas physicians may have access only to patient records within their specialty and nurses and staff may have access to only those patient records within their immediate care. In addition, a patient may request restricted access to their data by only certain personnel. Thus, in contrast to physical records, the EMR system provides superior protection of patient data.[0079]
• In addition, the present invention is useful in legal, manufacturing and general administration environments. For example, the present invention is capable of organizing, maintaining and protecting legal files in an attorney's office. Thus, the EMR system can store and retrieve scanned images of paper documents, such as deeds and assignments, as well as other native file formats, such as word processing files. The EMR system organizes and retrieves this data in a manner akin to that of a patient's medical record. Upon entry of a client data into the EMR system, attorneys can annotate documents, transfer information to and from other systems, or create new data for automatic filing in the client or case file. Similarly, the EMR system is useful for management of procurement or regulatory data in a manufacturing context. Thus, the EMR system can organize and maintain material safety data sheets (MSDS) as well as other data pertinent to materials procurement, such as conformance to specification measurements and inspection data for received lots, in a manufacturing environment. Lastly, the EMR system is useful for general administrative files in any organization. For example, the present invention is applicable to employee files in human resources, customer files in sales and approved suppliers in procurement. The EMR system can organize and retrieve data within these files in the manner as patient data in a patient data record. As discussed above, upon entry of a data into the EMR system, users can annotate documents, transfer information to and from other systems, or create new data for automatic filing in the respective file.[0080]
• Those skilled in the art may practice the principles of the present invention in other specific forms without departing from its spirit or essential characteristics. Accordingly, the disclosed embodiments of the invention are merely illustrative and do not serve to limit the scope of the invention set forth in the following claims.[0081]

Claims (22)

What is claimed is:

1. A medical records system, comprising: a point of care system to capture patient data at a point of care wherein the point of care system comprises:

a patient data capture to enter information provided by a patient;

a clinical data capture, in data communication with the patient data capture, to enter clinical data for the patient;

an encounter data capture, in data communication with the patient data capture, to enter diagnoses and procedures administered to the patient;

progress notes, in data communication with the patient data capture, the clinical data capture and the encounter data capture, to enter information related to changes in the patient's condition;

a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care system;

a medication data capture, in data communication with the patient data capture and the progress notes, to enter medication information for the patient; and

a practice guideline for reference to accepted medical practices, wherein the practice guideline communicates with the patient data capture, the clinical data capture, the progress notes and the encounter data capture.

2. A medical records system, comprising:

a point of care system to capture patient data at a point of care; and

a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care system, wherein the patient data repository comprises:

a patient locator having a patient identifier;

a data manager, in communication with the patient locator, to organize patient data for storage and retrieval using the patient identifier;

a data interface, in communication with the data manager, to transmit patient data to external systems and to receive patient data from the external systems;

a cache, in communication with the data manager, to temporarily store the patient data for retrieval, wherein the cache is located on a server computer, and wherein the cache is distributed across a computer network; and

a data archive, in communication with the cache, to permanently store the patient data.

3. The medical records system ofclaim 2, wherein the data archive comprises a jukebox having at least one storage device.

4. The medical records system ofclaim 3, wherein the at least one storage device is a recordable optical disk.

5. The medical records system ofclaim 3, wherein the at least one storage device is a magnetic disk drive.

6. The medical records system ofclaim 2, wherein the data interface comprises:

a communication interface to send and receive patient data from external systems;

an interface manager, in communication with the communication interface, to set the communication interface for either transmission or receipt of the patient data from the external systems; and

a data handler, in communication with the interface manager and with the communication interface, to convert selected patient data into a selected data format.

7. A medical records system comprising:

a point of care system to capture patient data at a point of care wherein the patient data includes clinical data and progress notes;

a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care system; and

a reference database in communication with the point of care system, wherein the reference database comprises:

a diagnosis module having diagnosis codes indicative of a condition of a patient;

a procedure module, in communication with the diagnosis module, having procedure codes indicative of a treatment to administer to the patient; and

a medication manager, in communication with the diagnosis module and with the procedure module, having information on medication to administer to the patient.

8. A medical records system comprising:

a point of care system to capture patient data at a point of care;

a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care systems; and

a legacy data system in communication with the patient data repository, wherein the legacy data system comprises:

a data source having patient data, wherein the data source comprises physical data, and wherein the data source comprises a computer network having electronically stored patient data; and

a converter, in communication with the data source, to convert the patient data into a selected format for transfer to the patient data repository.

9. The medical records system ofclaim 8, wherein the converter comprises a scanner.

10. A medical records system, comprising:

a point of care system to capture patient data at a point of care wherein the point of care system provides for annotation of the patient data, wherein the annotation acknowledges review of the patient data, and wherein the annotation includes instructions for patient care; and

a patient data repository, in communication with the point of care system and with external systems, to store and organize the patient data for access by the point of care system.

11. The medical records system ofclaim 10, wherein the annotation indicates approval.

12. A method of using an electronic medical records system, comprising:

capturing patient data electronically at the point of care;

organizing the patient data so as to form a patient record;

filing the patient record;

retrieving the patient record to access the patient data for use in the care of a patient, wherein retrieving the patient record includes annotating the patient data; and

evaluating the patient data so as to make a diagnosis.

13. The method ofclaim 12, wherein evaluating the patient data comprises consulting a diagnosis module to review diagnosis information.

14. The method ofclaim 12, further comprising prescribing a medication.

15. The method ofclaim 14, wherein prescribing a medication comprises consulting a medication manager to review medication information.

16. The method ofclaim 12, further comprising administering a treatment.

17. The method ofclaim 16, wherein administering a treatment comprises consulting a procedure module to review procedures to administer the treatment.

18. A method of retrieving patient data in an electronic medical records system having a patient data repository, comprising:

obtaining a patient identifier;

locating a patient record corresponding to the patient identifier in the patient data repository, wherein the patient data repository includes a cache and a data archive;

determining the location of the patient data within the patient record; and

delivering the patient data.

19. The method ofclaim 18, further comprising delivering the patient data when the patient data is located in the cache.

20. The method ofclaim 18, further comprising:

moving the patient data from the data archive when the patient data is not located in the cache; and

delivering the patient data.

21. A method of communicating with an external source having an interface to an electronic medical records system, comprising:

finding an interface for the external source;

connecting to the external source using the interface; and

converting patient data for transfer between the external source and the electronic medical records system, wherein converting patient data for transfer comprises converting patient data for transfer from the electronic medical records system to the external source, and wherein converting patient data for transfer also comprises converting patient data for transfer from the external source to the electronic medical records system.

22. A program storage device storing instructions that when executed perform the method, comprising:

capturing patient data electronically at the point of care;

organizing the patient data so as to form a patient record;

filing the patient record; and

retrieving the patient record to access the patient data for use in the care of a patient.

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