US20100305971A1 - Managing Medical Case Chronology Data - Google Patents

Abstract

Techniques for managing medical case chronology data are supported. A system may include a central medical information management system that provides practice-specific or location-specific templates for tracking and recording events during medical treatment. The system permits medical professionals to use handheld devices to record and access, in near real time, patient treatment information.

Description

RELATED APPLICATIONS
• This application claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Application Ser. No. 61/182,686 filed May 29, 2009.
TECHNICAL FIELD OF THE INVENTION
• The present invention relates generally to managing medical data, and more specifically to managing medical case and chronology information for one or more medical practices.
BACKGROUND OF THE INVENTION
• Many medical care establishments use and share medical case information between medical professionals. For this purpose, medical professionals may use various physical files, written displays, and electronic systems. For example, many anesthesia care locations use a white board to track patients being treated. Many medical professionals also document progress through medical procedures using forms or other paperwork. Such documentation may be used to record events during patient treatment and generate invoices.
SUMMARY OF THE INVENTION
• In accordance with the present disclosure, an apparatus, method, and system is provided which substantially eliminates or reduces disadvantages and problems associated with previous systems and methods.
• According to a particular embodiment, a handheld apparatus is provided, which includes a user interface having a display and capable of receiving user input, a wireless network interface coupled to a central medical information management system, a memory for maintaining a medical information management application, and a processor capable of executing the medical information management application. The central medical information management system maintains multiple case chronology templates where each of the templates corresponds to a particular practice location and defines a series of medical events customized for the location. The central medical information management system also maintains a collection of patient treatment records for patients receiving care at the practice locations. Each of the patient treatment records is linked to a practice location and corresponds to a patient treatment record having a time record associated with each of the medical events defined by the case chronology template corresponding to the location. The medical information management application can be executed to identify a practice location, display a list of patient treatment records received from the medical information management system that correspond to that location, identify a patient treatment record based on user input, receive a patient treatment record corresponding to the selected patient treatment record from the medical information management system, and display the medical events defined by the case chronology template corresponding to the selected location and a current value of the time record associated with each of the medical events as indicated by the received patient treatment record. The medical information management application can further receive input of a time update indicating a time for a medical event for the received patient treatment record, communicate the time update to the medical information management system, receive updated information for the received patient treatment record from the medical information management system where the updated information incorporates the time update, and update the display of the medical events to reflect the updated information.
• Particular embodiments provide various technical advantages. These techniques provide wide-spread sharing of case information between medical professionals of an anesthesia, surgical or other medical team without requiring medical professionals to use a common physical case board. In addition, techniques of the present disclosure provide updates to case status as they occur, at or near the time of corresponding changes in the field. Moreover, case supervisors or other managers no longer need to check a physical case board or physical location (such as a holding room or operating room) to determine case status.
• Particular embodiments provide wide-spread access to medical event data, such as anesthetic or surgical events, thereby sharing information that would otherwise be limited to the few people with physical access to a corresponding paper form for the medical event. Such techniques may also facilitate proactive medical, resource, and manpower management. These techniques may also enable simultaneous access by other team professionals who may be spread throughout a particular location or even at other remote locations.
• Particular embodiments provide case status alerting. These techniques facilitate targeted case status alerting that requires neither a callback nor the multicast of alert messages to all medical professionals. Such techniques also facilitate automatic case status alerting without any requirement that the user actively request case status. Thus, important case status information can be sent to appropriate medical professionals allowing them to take appropriate action, such as making a necessary physical location visit.
• Particular embodiments may facilitate secure authentication and login to a medical information management system. Techniques for secure login can maintain secure access procedures while eliminating or substantially reducing the use of long usernames and passwords that introduce delay and complexity to those seeking access to the system using a mobile device that may have constrained user input capabilities. Such secure login techniques also provide authenticated access to medical professionals through external networks not located at a health care facility.
• Particular embodiments may facilitate the entry of patient and case data items. These techniques allow checklist data to be immediately searchable through appropriate information systems. Such techniques also eliminate transcription error associated with paper-based patient and case data and alleviate possible legibility issues. Additionally, these techniques facilitate the automatic entry of related case items and/or identify data elements that are in conflict. Moreover, such techniques can present or record data elements that may have been overlooked by a medical professional but were appropriate for the medical care rendered.
• Particular embodiments may facilitate assuming case roles and handing-off case roles between medical professionals. These techniques accurately record the time associated with case roles and case role-handoff. Such techniques may further enable case roles and any subsequent changes to case roles to be communicated to all medical professionals of a team, thereby eliminating confusion and any patient care difficulties.
• Other technical advantages of the present invention will be readily apparent to one skilled in the art from the following figures, descriptions, and claims. Moreover, while specific advantages have been enumerated above, various embodiments may include all, some, or none of the enumerated advantages.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a block diagram illustrating a system environment with elements that interoperate to manage and display medical case information;
• FIG. 2 is a block diagram illustrating an example medical information management system for facilitating management of medical case information;
• FIG. 3 is a block diagram illustrating an example embodiment of a handheld device for executing a medical information management application for displaying and tracking medical case information;
• FIG. 4 is a system architecture diagram describing an example user interface for a medical information management application operating on a handheld device;
• FIG. 5 illustrates an example system hierarchy of a graphical user interface on a handheld device;
• FIG. 6 illustrates an example case board interface presented on a handheld device for interacting with a medical information management system;
• FIG. 7 illustrates an example patient treatment interface for displaying patient treatment information for a specific medical case;
• FIG. 8 is a block diagram illustrating an example case alert system for sending, processing, and transmitting case alerts to users of a medical information management system;
• FIG. 9 illustrates an example process flow for secure authentication, login, and access to a medical information management system;
• FIG. 10 illustrates an example process flow for conducting role-handoffs between users of a medical information management system; and
• FIG. 11 illustrates an example case summary interface for summarizing case details and facilitating role-handoffs between medical professionals using a medical information management system.
DETAILED DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a block diagram illustrating asystem100 with elements that interoperate to manage and display medical case information. The elements ofsystem100 can support a number of different operations, including maintaining a central, unified repository of patient and case information for one or more practices, facilitating maintenance and display of a graphical case board, enabling entry and display of patient treatment records including case chronology information, facilitating case status alerting in conjunction with tracked medical cases, providing an intuitive graphical user interface for interacting with the system, facilitating entry of medical case information, enabling electronic tracking of medical case assignments and roles in addition to techniques for assuming new assignments and roles and passing assignments and roles between users, and establishing secure authentication and access techniques to facilitate medical case information management functions.
• Medical professionals can use the medical information and functionality ofsystem100 to manage one or more cases for a particular medical practice with one or more practice locations. Users ofsystem100 can include medical professionals and associated staff, such as surgeons, anesthesiologists, other physicians, certified registered nurse anesthetists (CRNAs), hospital management, billing personnel, medical record managers, and any other medical staff. Under appropriate circumstances,system100 may further provide patients access to selected information. According to particular embodiments,system100 may be used to manage information for one or more medical practices. A medical practice is any organization of associated medical professionals and associated personnel, such as a group of doctors and support staff with a common specialty that potentially practice at one or more different practice locations, a group of doctors and support staff associated with a particular hospital, or any other suitable organization of medical professionals. For example, an anesthesia practice may include anesthesiologists, CRNAs, and other support staff that practice at a set of particular medical treatment facilities.
• In the illustrated embodiment,system100 includes a number of elements interconnected by various networks, including acommunications network102, awireless telephony network104, alocal area network106, and awireless network108.Networks102,104,106, and108 represent communications equipment, including hardware and any appropriate controlling logic, for interconnecting elements and facilitating communication between these elements.Communications network102 may include local area networks (LANs), metropolitan area networks (MANs), wide area networks (WANs), any other public or private network, local, regional, or global communication network, enterprise intranet, other suitable wireline or wireless communication link, or any combination thereof.Communications network102 may include any combination of gateways, routers, hubs, switches, access points, base stations, and any other hardware, software, or a combination of the preceding that may implement any suitable protocol. For illustrative purposes,system100 is also shown as including other specific types of networks, includingwireless telephony network104,local area network106, andwireless network108. The use of these or similar networks facilitate seamless communication between components ofsystem100 regardless of their geographic location or communication protocols.
• As illustrated,system100 includes awireless telephony network104 coupled tocommunications network102.Wireless telephony network104 represents communications equipment, including hardware and any appropriate controlling logic, for interconnecting elements and facilitating communications by wireless devices.Wireless telephony network104 may include gateways, call managers, routers, hubs, switches, access points, base stations, cellular towers, radio networks, satellite telephone equipment implementing appropriate protocols for wireless telephony communications. While only onewireless telephony network104 has been illustrated, it should be understood that various embodiments may operate using more than one wireless telephony network. In addition, various embodiments may incorporatewireless telephony networks104 in other networks ofsystem100 such as, for example,wireless network108.
• The illustrated embodiment ofsystem100 also includes alocal area network106 coupled tocommunications network102.Local area network106 represents communications equipment, including hardware and any appropriate controlling logic, for interconnecting elements within a limited network area (as compared with, for example, wide area networks).Local area network106 may include any combination of gateways, routers, hubs, switches, access points, base stations, and any other hardware, software or combination thereof using suitable protocols to support communications. For example,local area network106 may be the established network infrastructure deployed at a particular hospital or other medical facility. While only onelocal area network106 has been illustrated, it should be understood that various embodiments may operate using multiplelocal area networks106. In addition, various embodiments may incorporatelocal area networks106 in other networks ofsystem100.
• System100 also includeswireless network108 coupled tocommunications network102.Wireless network108 represents communications equipment, including hardware and any appropriate controlling logic, for wirelessly interconnecting elements and facilitating communication between other elements ofsystem100. For example,wireless network108 may operate according to one or more of the 802.11 standards promulgated by the Institute of Electrical and Electronic Engineers (IEEE).Wireless network108 may include any combination of gateways, routers, hubs, switches, access points, base stations, wireless telephone systems and any other hardware, software, or combination thereof. While only onewireless network108 has been illustrated, it should be understood that various embodiments may operate usingmultiple wireless networks108. In addition, various embodiments may incorporatewireless networks108 in other networks ofcommunications network102.
• These networks interconnect other elements ofsystem100, includingmobile phones110, abilling system112, personal computers (PCs)114,patient information system116,mobile devices118, and a medicalinformation management system120. It should be understood that whilesystem100 is illustrated as including specific types of networks, various embodiments may operate using any suitable arrangement and collection of networks that enable appropriate communications.
• Mobile phones110 represent portable hardware and appropriate controlling logic for providing telephony and/or advanced data services. For example,mobile phones110 may support voice and data communications.Mobile phones110 may include smart phones capable of transmitting and receiving multiple forms of media including but not limited to still audio, text messages, video, images, and content from disparate services. As illustrated,mobile phones110 may be coupled towireless telephony network104 and capable of communicating to other components ofsystem100. According to particular embodiments,system100 may use mobile phones to provide alerts or other information to medical personnel.
• Billing system112 represents hardware, appropriate controlling logic, and data associated with billing for medical services. For example,billing system112 may be a computer server designed to manage billing for a particular medical practice, such as an anesthesia practice.Billing system112 may be network accessible to facilitate communication with other elements ofsystem100.
• Personal computers (PCs)114 represent general-purpose computers, including appropriate hardware, controlling logic, and data that may be used to interface with other system components such asbilling system112,patient information system116,mobile devices118, and medicalinformation management system120. For example,PCs114 may be workstations, laptops, netbooks, tablet computers, personal data assistants (PDAs), or any other suitable computing device.PCs114 may support a wide variety of operations such as web browsing, word processing, and managing business data. According to particular embodiments,PCs114 provide access, potentially through web-based interfaces, to information managed by other elements.
• Patient information system116 represents suitable hardware components, controlling logic, and data for managing patient information, such as patient demographic information, medical histories, and/or other relevant medical information such as practice employees and work schedules. For instance,patient information system116 may be embodied in a computer system or a network of computers, which are capable of maintaining patient information such as patient identifiers, case identifiers, surgery types, date-of-birth, surgery schedule, operating room, attending surgeon and/or anesthesiologist, insurance information, medical history, and other patient-specific information as appropriate for various aspects of a medical practice. Some embodiments of the present disclosure may include apatient information system116 deployed at a medical practice or other medical care facility, while other embodiments may include a globalpatient information system116 for maintaining patient information. As illustrated,patient information system116 may be coupled to a network, such aslocal area network106, to facilitate communication to other elements ofsystem100. While only onepatient information system116 is shown, it should be understood that various embodiments may include multiple appropriately deployedpatient information systems116.
• Mobile devices118 represent any suitable portable hardware, including appropriate controlling logic and data, capable of communicating with remote devices to facilitate management of medical information. For example,mobile devices118 may include, but are not necessarily limited to, mobile telephones, advanced (“smart”) phones, personal digital assistants (PDAs), wireless handsets, notebook computer systems, and tablet computer systems. According to particular embodiments,mobile devices118 include wireless devices with advanced user interfaces, such as the APPLE iPhone, iPod Touch, or iPad.
• Medicalinformation management system120 represents any appropriate combination of hardware, controlling logic, and data for managing medical information and supporting interactive access to that data from multiple remote (and potentially highly mobile) devices. For example, medicalinformation management system120 may include a networked server or collection of networked servers, or could include in one or more virtual servers capable of acquiring computing resources on-demand depending on the dynamically determined needs of the system. Using virtual servers, medicalinformation management system120 could be scaled dynamically based on system requirements and real-time usage, without limiting operation to a particular physical computer server having fixed computing resources. This could facilitate the scalability, efficient operation, high availability, and cost effectiveness of the system. As illustrated, medicalinformation management system120 couples to networks, such ascommunications network102, to facilitate communication to other elements ofsystem100.
• Particular embodiments are designed to operate in a network environment that facilitates the retrieval and presentation of medical data to end users, facilitating real-time tracking of medical professional activity related to the provision of patient care (events tracked at or near in time to the actual provision of patient care) provided at a medical facility such as a hospital or other medical care establishment. Systems, methods, and software exemplified in the present disclosure may increase the coordination of patient care, enhance the reliability of medical information, and help ensure the accuracy of medical record keeping and billing.
• In operation, elements ofsystem100 operate together to perform various medical information management functions including but not limited to maintaining a central, unified repository of patient and case information for one or more practices, facilitating maintenance and display of a graphical case board, enabling entry and display of medical professional activity information and patient treatment information having case chronology information, facilitating case status alerting in conjunction with tracked medical cases, providing an intuitive graphical user interface for interacting with the system, facilitating entry of medical case information, enabling electronic tracking of medical case assignments and roles in addition to techniques for assuming new assignments and roles and passing assignments and roles between users, and establishing secure authentication and access techniques to facilitate ease-of-use and other medical case information management functions.
• For example, medicalinformation management system120 is capable of maintaining a central, unified repository of patient, medical professional activity, and case information for one or more medical practices. For example, medicalinformation management system120 may maintain patient treatment records that dynamically track care provided to patients for one or more medical practices. Medicalinformation management system120 can dynamically update this information based on communications with medical personnel using mobile devices118 (or other suitable access devices). Medicalinformation management system120 may also access and exchange information with other information management and processing elements ofsystem100. In particular embodiments, medicalinformation management system120 acquires patient management information from one or morepatient information systems116. For example, medicalinformation management system120 can upload patient information for all patients scheduled for treatment on a particular day.
• Medicalinformation management system120 maintains information on patients and medical professional activity and supports interactions with other devices to manage and display the medical and logistics information. For instance,mobile devices118 can access medicalinformation management system120 to download information for display in the form of a graphical case board showing all cases mapping to a particular medical practice or even a particular location for a medical practice. In certain implementations,mobile devices118 may present the medical case board information in tabbed interfaces with tabs corresponding to predefined phases of care for a medical practice.Mobile devices118 could further interface with medicalinformation management system120 to receive and manage more detailed patient treatment information through other specialized interfaces, such as a case summary interface for summarizing information for a case or a case details interface for detailing the chronology and other medical events associated with a case. For example,mobile devices118 may present a graphical user interface showing patient treatment records in tabbed interfaces with the ability to list medical events for real-time tracking of cases. Users ofmobile devices118 can use these interfaces to provide real-time entry of information corresponding to treatment events, which medicalinformation management system120 can then use to update the case board and progress patients through phases of treatment. This type of process uses the capture of treatment information (such as billable events or other required records) to feed other processes that, in typical systems, require separate efforts to track, such as a case white board that requires case board runners to physically update.
• Particular embodiments support secure access to medicalinformation management system120 using an access scheme designed to maintain a high level of security while supporting user-friendly access with devices that may have limited or non-traditional user interfaces. The access techniques may use a combination of authorization information checked in one or more steps, such as a username, password, quick access code (such as a personal identification number (PIN) or other string of characters or gestures), secure hash, device identifiers, or other secure authentication information. In certain embodiments, secure authentication is a multi-step process that uses different types of information provided at different stages of access. According to particular embodiments, one step may involve device identification. For example, a particularmobile device118 may have a secure device hash or other suitable unique identifier that can be registered with and verified by medicalinformation management system120. Another step may involve a secure token or key that uniquely maps to a particular medical practice (which may use information from other steps, such as a secure device hash that links a specificmobile device118 to a particular medical practice). Another step may involve providing a user name and associated password, for example, by selecting a user name from a list of available users and then providing a password that meets certain length and character requirements. Another step may require entry of a quick access code, such as a four or six number pin or a particular pre-recorded gesture. These different steps and secure authentication information may be combined and used at particular times to ensure that access to medical information is suitably restricted while allowing authorized users ofmobile devices118 relatively easy access to information. For example, after requiring one or more relatively high-security authentication steps, subsequent access over the course of some period of time may only require a subset of credentials, such as a quick access code. During that period of time,mobile device118 could enter sleep modes or other application and, upon a user wishing to restart access to medical information,mobile device118 would simply require reentry of the quick access code. Ifmobile device118 were restarted or some extended period of time passed,system100 could require reprocessing through one or more of the higher security steps.
• After access is granted, the user may select a practice location from a list of available practice locations for the medical practice and thereby gain access to the corresponding medical case information and functionality of the system. Following authentication,mobile devices118 and medicalinformation management system120 may interoperate to present medical information in an intuitive graphical case board interface to the user. For example, the graphical case board may enable entry and display of a patient treatment record including case chronology, case status alerting in conjunction with tracked medical cases, electronic tracking of medical case assignments and roles, assuming new assignments and roles, and passing assignments and roles between users.
• The graphical user interface allows medical professional activity, case board information, and patient treatment records to be securely accessed and displayed. In addition, this information can be used to track billing-related events as a patient progresses through various medical events or sub-events of a particular surgery or other medical procedure. For example,mobile devices118 may securely present a graphical case board to view the status of a patient scheduled for a medical procedure, where medicalinformation management system120 actually maintains all of this information. Similarly,PCs114 may securely access medicalinformation management system120 to view similar information. Thus, for instance, an interface available atPCs114 may display patient information or medical events maintained by medicalinformation management system120, portions of which may be indirectly derived from other components ofsystem100 such aspatient information system116 or one or moremobile devices118.
• In addition to viewing medical case board information in a graphical case board interface, embodiments of the present disclosure facilitate the presentation and tracking of patient treatment records for particular cases. A patient treatment record represents any collection of information (or subset of that information) detailing information about a patient and the patients case(s). For example, a patient treatment record could include general demographic information for the patient (name, age, medical history, etc.) and case specific information, such as assigned or current treatment rooms (e.g., and assigned operating room), a chronology of treatment events, codes, involvement by specific medical personnel, notes, and other suitable case information.
• A patient treatment record may be accessed to display a graphical representation of a sequence of steps or medical events corresponding to the chronology of a medical procedure for a particular case. For this purpose, a patient treatment record may include a time record associated with each step or medical event corresponding to a case chronology. Thus, medical personnel may view and track billing-related events such as the performance of a step in a medical procedure. For example, an anesthesiologist may track the time spent attending to a patient or administering anesthesia by recording anesthesia start and stop using a graphical user interface onmobile devices118. The entry of these events can feed other aspects of the system, such as the tracking of patients on electronic case boards.
• System100 may also use a set of case checklist items and patient information to track cases, including non-time specific billing information, procedure and diagnostic codes, and information on general quality of care rendered by one or more medical professionals. In a similar fashion, other events and checklists may be incorporated into the graphical user interface to implement a set of institutional policies and procedures for delivering patient care as required at a particular medical practice or facility. The listed medical events and case checklist items can be based on customized templates, potentially customized for individual practice locations, such as for a specific hospital.
• In addition to tracking medical cases, embodiments of the present disclosure may use medical information from medicalinformation management system120 to manage medical case assignments and roles among a team of medical professionals. For example, a medical professional may use features provided in a graphical user interface onmobile device118 to handoff or take over a medical role. In an anesthesia setting, this may involve a first CRNA who is actively providing care for a patient handing-off this management role to a second CRNA when the first CRNA requires a break. Another example may include an anesthesiologist who is supervising multiple CRNAs handing-off his supervisory role to another anesthesiologist when he can no longer act in that capacity. In particular implementations, the role-handoff process may require that the relieving party initiate the role-handoff process to take-over a case role from another medical professional. Moreover, this role-handoff process may work within constraints established by institutional policies and procedures for a particular facility or collection of facilities. For example, supervising anesthesiologists may be prohibited from relieving other anesthesiologists when they are already supervising a maximum of four CRNAs. Similarly, CRNAs may be prohibited from relieving other CRNAs when they are already providing care for another patient. Medicalinformation management system120 may maintain a set of role handling rules that define permitted roles for classes of medical personnel, limits on those roles (e.g., only supervise up to four cases, and not while performing any procedure), and details for how handoffs must be processed and verified.
• System100 may further provide case alerting functionality that enables targeted messaging to appropriate medical professionals using a variety of communication techniques and protocols. Case alerts may occur automatically or may be user-initiated. Additionally, case alerts may take on a variety of forms including voice, text, multimedia, or application specific (e.g., embedded notification in a customer medical information management application running on mobile devices118). In the case of automatic notifications, case alerting schemes may deliver alerts or notifications on the occurrence of some predefined case event. Case alerts can be sent to a variety of individuals and can based on various roles including medical case role, team management role, or context-based role such as those who respond to specific clinical changes
• In one example, supervising anesthesiologists may be alerted on their correspondingmobile device118 by medicalinformation management system120 when a particular event occurs for a case for which they are responsible. Another case alert may involve supervising anesthesiologists being alerted when a patient transitions from one predefined phase of care to another, such as from a pre-operation phase to intra-operation phase. Case alerts may also be used in conjunction with role-handoffs. For example, medicalinformation management system120 may notify one or more supervised CRNAs when a role-handoff results in a change to their supervising anesthesiologist.
• Case alerts may also be delivered on disparate networks. For example, medicalinformation management system120 may deliver a case alert message or notification viacommunications network102 andwireless telephony network104 tomobile phones110. Thus, certain embodiments may allow a medical professional to be notified of changes occurring in the field in the form of voice, text, or multimedia messages even after leaving the associated medical facility. In conjunction with case alerts and notifications, users receiving alerts may confirm delivery and/or issue an appropriate response. Thus, for example,mobile phones110 may receive a case alert and send one or more responsive messages to medicalinformation management system120 and/ormobile devices118 deployed at a particular medical facility through the coordination of medicalinformation management system120 andnetworks104,102, and108. Therefore, medical professionals can use case alerts and notifications to stay apprised of real-time changes occurring at a medical facility, assess the requirements for immediate patient care, and coordinate with other medical professionals to respond as medically appropriate.
• Elements ofsystem100 may also facilitate coordination with abilling system112 to develop invoices and reports. For example, medicalinformation management system120 may communicate with one ormore billing systems112 to support billing-related functions. Thus, medicalinformation management system120 can supportbilling systems112 to produce appropriate invoices for surgical procedures, anesthesia services and/or other billing-related medical events corresponding to a medical provider site (e.g., a particular hospital or hospital floor) or individual patients.Billing system112 may then forward invoices or other billing information to the appropriate insurance provider, patient, or other responsible party. Thus, a billing system may be seamlessly integrated with other functionality described in this disclosure to perform various medical billing operations.
• Whilesystem100 is illustrated as including specific components arranged in a particular configuration, it should be understood that various embodiments may operate using any suitable arrangement and collection of components capable of providing functionality such as that described.
• FIG. 2 is a block diagram illustrating asystem200 representing an example embodiment of medicalinformation management system120 which has elements that interoperate to facilitate the management of medical case information. The elements ofsystem200 can support a number of different operations including maintaining a central unified repository of patient and case information for one or more practices, which permits the maintenance of case board information, patient treatment records, and case summary information. The elements ofsystem200 may also facilitate case status alerting in conjunction with tracked medical cases and the graphical display of a user interface for interacting with the system and the entry of medical case information from one or more devices such asmobile phones110,PCs114, andmobile devices118. In addition,system200 may facilitate the management of medical case assignments and roles and enable the assumption of new assignments and roles and passing assignments and roles between members of a medical care team.System200 further is operable to establish secure authentication techniques to facilitate secure access to medical information management functions and data.
• System200 represents any appropriate combination of hardware, controlling logic, and data. For example,system200 may be one or more computer servers or virtual computer servers capable of providing the appropriate functionality for centrally managing patient and case information for one or more practices. As illustrated,system200 includes aweb server200, acase alert module204, adatabase206, a standards-based application programming interface (API)208,business logic210, and one ormore processors212.
• Web server202 represents any appropriate combination of hardware, controlling logic and data for interfacing with remote devices using web-based protocols to provide web-based access to the medical information and functionality provided bysystem200. For example,web server202 may be a web host that serves web pages to facilitate access to some or all functions ofsystem200.
• Case alert module204 represents any appropriate combination of hardware, controlling logic, and data for facilitating case status alerting in conjunction with tracked medical cases and activities of a medical care team. In addition,case alert module204 may be coupled to one or more networks such as a telephone network, a wired or wireless computer networks, a cellular network, a radio network, a satellite network, or any other appropriate network capable of delivering case status alerts.
• Database206 represents any appropriate combination of hardware, controlling logic, and data for maintaining patient information, case information, medical professional activity information, and other system-related data. As illustrated,database206 has various data components including patient data, case data, user data, practice data, system metadata, location data, device registry data, user access logs, and rules data.
• Patient data includes information regarding patients tracked bysystem200. For example, for each patient tracked bysystem200,database206 may maintain a patient identifier (such as a name), general demographic information (such as the patient's date-of-birth), and any appropriate responsible party or insurance information.
• Case data represents a collection of information corresponding to a particular case associated with a scheduled medical procedure for a patient at a defined medical facility. Such information may include a case identifier or reference, information on a procedure scheduled to occur or currently occurring (such as surgery type), an assigned operating room, the attending physician or anesthesiologist, records of the case chronology of a scheduled medical procedure, various medical events in the case chronology, involvement by specific medical professionals, procedure and diagnostic codes, modifiers, and audit logs corresponding to various medical events entered by specific practice personnel. According to particular embodiments,system200 updates case data based on real-time inputs frommobile devices118.System200 can provide patient treatment records to other devices based on information maintained in patient and case data.
• User data represents a collection of information corresponding to various users who interact withsystem200, including users ofPCs114,mobile phones110, andmobile devices118. Such user information may include authentication data such as authorized users corresponding to a defined practice location, each authorized user's passwords, each authorized user's system access history, each authorized user's usage preferences, and other access codes. This information can be used to provide secure access tosystem200 and as appropriate, prohibit unauthorized access to medical information maintained bysystem200.
• Practice data represents practice wide settings and preferences corresponding to a medical practice and, potentially, for one or more specific practice locations. This may include rules and policies for managing medical data instituted by a particular medical practice. Practice data may also include a core set or subset of medical procedure terminology for a medical practice or procedure. Such medical procedure terminology may conform to Current Procedural Terminology (CPT) or International Classification of Diseases (ICD) codes. Such codes may be used in conjunction with recording billing-related events for a particular practice. Practice data may also include information related to historic utilization and appropriate future allocation of medical professional resources available to the practice. Other information included in practice data may include billing report preferences, billing export preferences, and any translation or transmission settings necessary to communicate various reports to the defined medical practice at a particular location. This information facilitates the generation of billing reports and invoices in the desired format for a practice.
• Location data includes information corresponding to a defined practice location, either tied to a particular medical practice at that location or based on rules of information about multiple medical practices that may provide care at that location. Location data may include case chronology templates, checklist templates, quality control templates (such as a physician quality reporting incentives (PQRI) template), and other templates for capturing information in a form customized to a particular practice location or practice location/medical practice specified manner. These templates facilitate the recording of medical events occurring in the field, in addition to facilitating the real-time tracking of quality control measures. For example, a case chronology template may define a set of rules regarding entry of medical events associated with a procedure and include time events or other entries. Case chronology templates may be manually and/or dynamically adjusted based on operations at one or more practice locations, such as based on feedback showing a particular event that consistently must be manually entered at a particular practice location.
• Rules data defines permitted or prohibited activities corresponding generally to users, medical professional roles, specific medical practices, locations, medical procedures, or other activities. For example, these rules may implement practice-specific or location-specific policies affecting medical professionals or relevant medical events. For example, a rule for an anesthesia practice may prohibit an anesthesiologist from managing more than four CRNAs. Thus these rules provide guidelines for active case management in terms of a workflow that can be specific to a medical specialty or a medical facility.
• Standards-basedAPI 208 represents hardware, appropriate controlling logic, and data for interfacing with remote components using standardized processes and protocols. For example, standards-basedAPI 208 may interface withpatient information systems116 to retrieve patient information from one or more medical practices. As another example, standards-basedAPI 208 may facilitate interactions with remote devices to support alerting functions, such as through text messaging withmobile phones110.
• Business logic210 represents hardware, controlling logic and data associated that controls the fundamental operation and administration ofsystem200, including interactions of elements to provide the interactive medical information management processes described herein. For example,business logic210 may be software for execution by one or more processors to provide a central medical information management service that tracks medical professional activity and patient care, and interfaces withmobile devices118.Processor212 represents one or more computer processors for executingbusiness logic210 or other software or controlling logic associated with elements ofsystem200.
• In operation, elements ofsystem200 operate together to perform various functions of the present disclosure, including maintaining a central, unified repository of patient and case information for one or more practices and facilitating the maintenance of medical professional activity information, patient treatment information including case chronology, and medical case summary information.System200 uses this information to support applications onmobile devices118 that can interface with and graphically present that information. In addition,system200 facilitates case status alerting for tracked medical cases, providing an intuitive graphical user interface for interacting with the system and enabling the electronic tracking of medical case assignments and roles and medical case role-handoffs between assigned medical professionals. Elements ofsystem200 can ensure that users ofsystem200 are securely authenticated prior to accessing medical information and case management functions. Accordingly, only those users who are properly authenticated may interact withsystem200.
• For example, elements ofsystem200 are operable to maintain a central, unified repository of patient and case information for one or more medical practices. In particular,processors212 may executeappropriate business logic210 to communicate with one or morepatient information systems116 to retrieve patient information corresponding to a medical practice.System200 stores information indatabase206, generates day-of-care information (for example, based on patient information retrieved from one or more patient information systems116), communicates information fromdatabase206 to computing devices (e.g.mobile phones110,PCs114, and/or mobile devices118), and receives updates, including real-time information, from one or more computing devices. This information can then be used by a graphical user interface to display and facilitate real-time data entry and management of medical case and chronology information. Any changes occurring at these computing devices that are relevant to real-time case management and medical professional coordination may then be received over a network. Accordingly, elements ofsystem200 interact with one another to actively manage medical case information as patients receive care.
• As discussed above,system200 may impose various authentication requirements before permitting access to functions and information ofsystem200. These may include one or more levels of interactive authentication steps requiring user interactions as well as ongoing, automated exchanges. For example, each communication or request from a particularmobile device118 may include a secure device hash identifying thatmobile device118 tosystem200.
• According to particular embodiments,system200 implements a multi-level access scheme that requires different types of credentials at each level. For example,system200 could require a user name and password (potentially in combination with a device hash) for first-level access and then a quick access code for second level access and for re-access over some period of time.System200 may compare these received values with stored user data according tobusiness logic210 to determine whether the user identified in the request has appropriate credentials for accessing the medical information and functionality ofsystem200. Using these secure authentication means,system200 can guarantee that access to case information and specific patient medical data is appropriately protected.
• During operation,system200 provides medical information, such as case board, medical professional activity, or patient treatment information, for presentation and use by graphical user interfaces presented onmobile devices118. To support this functionality,system200 maintains real-time tracking information for patients receiving care, and activities of identified medical professionals, provides the information tomobile devices118, and receives and processes requests to update the information. For responding to medical case board information requests, case data for multiple cases may be accessed for retrieving a subset of the case details for forwarding to the remote computing device to display on its graphical user interface. For example, in response to a case board request frommobile device118,system200 may compile selected information for all patients scheduled to or receiving care at a practice location for a medical practice associated with the requestingmobile device118 and then provide that information to the requestingmobile device118, for example, as a collection of patient treatment records.
• Mobile devices118 may also request information or provide updates for particular cases. In response,system200 may provide responsive patient treatment records that include details of the requested patient and case extracted from database206 (potentially with more information than for case board requests). The accessed case data may include medical professional activity data relative to the case, procedure information, diagnosis information, case chronology data such as medical events associated with a particular case and any related checklist items. As appropriate,system200 may log requests or other access events in the access logs ofdatabase206 according tobusiness logic210 and any corresponding rules maintained in the rules data ofdatabase206.
• In responding to information requests,system200 may process the response information as appropriate based on the requesting computing device. Such processing may include formatting the case board or patient treatment record according to location data indatabase206. For example, case board information may be arranged according to a template that may organize all cases for a location into categories corresponding to predefined phases of care defined in the location data for a specific practice. For an anesthesia or other appropriate practice those predefined phases of care may correspond to schedule, pre-operation, intra-operation, and post-operation phases. As another example, aspects of a patient treatment record may be organized according to an event chronology template, a modifier checklist template, and/or a quality control template defined in the location data. Thus, the templates and other information in the location data ofdatabase206 instructprocessor212 andbusiness logic210 how a practice wishes the requested information to be populated, organized, and delivered for subsequent presentation on a graphical user interface of a requesting computing device. However, some or all of the customization and formatting of information may be handled by other elements, such asmobile devices118.
• In addition to facilitating the display of chronological stages at one or more remote computing devices,system200 can also receive real-time updates corresponding to specific billing-related events such as the performance of a step in a medical procedure. According to particular embodiments, some or all of these may be “real-time,” that is, provided from care-givers as (or very nearly in time to) a patient receiving care indicated by an update. For example, an anesthesiologist may usemobile device118 to track, in real-time, time spent with a patient or time spent actually administering anesthesia from start to finish. Such durational information may be provided tosystem200 and maintained in an appropriate time record of a patient treatment record. Updates may also include specific checklist items corresponding to events having no time value, or policy-based requirements of a medical procedure. Once an update is processed, other computing devices may securely receive case information including these updates in the form of case board information, patient treatment records, case alert, or other appropriate form. In this manner, all medical professionals associated with the case can be kept aware of any changes occurring in real-time for a particular case.
• In operation,system200 may also manage medical case assignments and roles among a set of medical professionals. In particular, a medical case may include multiple roles corresponding to responsibilities of various medical professionals with respect to a specific case. In certain embodiments of the present disclosure, a medical professional may use features provided at their respective computing device to assume a role or handoff a medical role to another medical professional. Such handoffs may be necessary for shift changes, breaks, or for any other number of practical reasons. To facilitate the assumption of roles and role-handoff,system200 may receive a request to handoff the role from a relieving party. In particular implementations, requiring the relieving party to initiate the role-handoff ensures that a case is not inadvertently abandoned when a role-handoff is not successful. For example, if the party seeking relief from a case were to initiate the role-handoff, a situation may arise where the relieving party refuses to accept the role or is otherwise unable to accept the role and the case may be abandoned altogether. If, however, the relieving party were required to initiate the role-handoff process, the role for that case continues to remain assigned to the party seeking relief until the role-handoff is in fact successful.
• In response to a role assumption or role-handoff request,system200 may access rules data found indatabase206 to determine whether the role change is permitted for this particular practice. Checking against such rules ensures that policies specific to a medical specialty or facility are properly implemented. For example, as a matter of institutional policy, an anesthesia practice may prohibit the role-handoff of a case from one anesthesiologist to another if the relieving anesthesiologist is already supervising more than four cases as outlined in the rules data ofdatabase206. As with all other events,system200 may log the requests and subsequent role changes. In some embodiments,system200 may facilitate role-handoff coordination between medical professionals by seeking appropriate approvals prior to a role-handoff. For example, if a relieving party initiates the role-handoff process, thensystem200 may seek approval from the party that would be relieved through a confirmation or other appropriate message. Likewise, if a party seeking relief initiates the role-handoff process, thensystem200 may seek similar approval from the relieving party. If a role change is appropriate and finalized,system200 updates the case data to indicate the successful assumption or role-handoff for the case. This case update can then be accessed by other computing devices and/or systems such that they are made aware of the role-handoff in real-time. In particular implementations, this change in case data may cause computing devices associated with the practice or case to receive a real-time update in the form of case board information, patient treatment record, case alert, or any other appropriate form for receiving case updates.
• During operation,system200 may also provide case alerting functionality to notify medical professionals of relevant medical events or concerns. According to particular design considerations, case alerts may be automatically generated or user-initiated. For automatic case alerts,system200 is operable to maintain a list of customizable events for which a case alert should be issued. In particular,database206 may include a set of alert rules specifying alerts, rules for triggering an alert (such as occurrence of a particular event), and alert execution information (such as contact information and procedures for handling a triggered alert). Subsequent events, such as updates to case data can then trigger case alerts. For example, an event trigger may require all role-handoffs for a case to notify the party being relieved and/or supervising medical personnel. Once an event trigger is associated with a medical event in the case data, subsequent events matching the event trigger can cause thecase alert module204 to notify the medical professional indicated in the event trigger in the form of a case alert.
• Case alert module204 may send a alert messages using any appropriate formats and protocols, including voice, text, or multimedia messages, based on the targeted device. As discussed, the form and network for delivering a case alert may be defined by the contact information of the event trigger. For example, the contact information may indicate that a supervising medical professional wishes to be notified of relevant role-handoffs in the form of a text message using a short message service (SMS) network. In certain implementations,case alert system204 may support interactive case alerts. For example, in addition to notifying particular medical professionals of successful role-handoffs,case alert module204 may facilitate the role-handoff process by allowing medical professionals to accept, decline, and confirm role-handoffs. Accordingly, embodiments of the present disclosure support configuring, sending, and receiving automatic case alerts for communicating medical events to medical professionals.
• Case alert module204 can also process user-initiated messages. For example, a user of a particularmobile device118 may choose to alert other users to a particular event or information. Once thecase alert module204 receives this user-initiated message,case alert module204 can determine how, when, and where to send the message based on the received message and intended recipient. In a similar manner,case alert module204 can also receive responses to user-initiated messages and forward them to the intended computing devices. User-initiated messages may be sent in any suitable form and using any appropriate network. For example, the messages may be a text, voice, or multimedia message sent over a wired, wireless, cellular, or any other network. Thus,system200 allows medical professionals to stay apprised of real-time changes to case information and communicate with each other efficiently to assess the requirements of immediate patient care and coordinate effectively with each other.
• System200 may also interact with billing systems such asbilling system112 to develop billing invoices and reports. In particular, upon request or at defined intervals,system200 may access practice data residing atdatabase206 that defines report preferences for delivery of billing-related events. In addition,system200 may access export preferences, and translation and transmission settings for placing reports in appropriate form for delivery to thebilling system112 corresponding to a medical practice. Alternatively, export preferences may define the intended destination of bill reports or invoices. Thus, insurance companies and other responsible parties may receive a bill or an invoice developed according to their predefined report preferences.
• Whilesystem200 is illustrated as including specific components, it should be understood that various embodiments may operate using any suitable arrangement and collection of components.
• FIG. 3 is a block diagram illustrating amobile device300 representing an example embodiment ofmobile device118. As illustrated,mobile device300 includes a number of components that operate together to facilitate the management of medical information.Mobile device300 can support a number of different operations, including receiving practice location and user configuration information, case board information, patient treatment information, and case summary information for presentation and management on a graphical user interface. In addition,mobile device300 may facilitate case status alerting and tracking medical cases.Mobile device300 is further operable to facilitate the management of medical case assignments and roles through a graphical user interface. Specifically, the graphical user interface enables assuming assignments and roles and conducting assignment and role-handoffs between users. Additionally,mobile device300 is capable of securely accessing medical case information from a remote medical information management system using appropriate authentication and secure access techniques.
• As illustrated,mobile device300 includes a number of components for maintaining and displaying medical information.Mobile device300 may represent any suitable portable hardware, including appropriate controlling logic and data capable of communicating with remote devices and systems, receiving user input, and displaying medical information. As shown,mobile device300 includes several components, which may include anetwork interface302, aprocessor304, amemory306 and auser interface308. The illustrated embodiment further disclosesmemory306 as including a non-volatile portion ofmemory310 and a volatile portion ofmemory312.
• Network interface302 represents any appropriate combination of hardware and controlling logic for coupling to one or more networks.Network interface302 may support any number of suitable protocols for communicating on a communication network. For example,network interface302 may be a wireless local area network interface, cellular network interface, satellite interface, and/or any other appropriate interface for communicating on a communication network.Network interface302 may have multiple interfaces for handling different communication protocols.
• Processor304 represents one or more processing elements, including hardware, logic, and data capable of controlling the operation ofmobile device300. For example,processor304 may be a computer processor for executing a medical information management application stored inmemory306, or any other software or controlling logic associated withmobile device300, such as a mobile operating system.
• Memory306 represents appropriate hardware and control logic for maintaining a medical information management application and case information corresponding to one or more medical practices.Memory306 may also include storage for other data, such as a mobile operating system ofmobile device300. As illustrated,memory306 includes anon-volatile portion310 and avolatile portion312.Non-volatile portion310 ofmemory306 represents memory for maintaining persistent applications and/or data.Volatile portion312 ofmemory306 represents storage for maintaining non-persistent applications and/or data. According to particular design considerations, the medical information management application and practice, location, and user configuration data may be stored in thenon-volatile portion310 ofmemory306, while medical professional, location, practice activity, patient data, and case information retrieved from a medical information management system may be stored in thevolatile portion312 ofmemory306. Such an implementation provides added security to critical data and helps to ensure that confidential user, patient, and/or case information is not readily accessible even ifmobile device300 is lost or otherwise compromised. In some implementations, some or all of the practice, location, and user credentials may be stored in non-volatile memory to facilitate seamless access and/or quick reentry into the system, while some other credential may be stored in volatile memory to ensure that a lost device cannot be improperly used.
• Mobile device300 also includes auser interface308.User interface308 represents any appropriate combination of hardware, control logic, and data for displaying information to a user and receiving inputs from a user. Thus,user interface308 includes any input and/or output interface. For example, a user interface may be a touch screen interface that is capable of both displaying graphical information and receiving user inputs.User interface308 ofmobile device300 may be used to display medical case information using a medical information management application, and receive real-time updates of medical case information for appropriate processing and forwarding by the medical information management application.
• In particular embodiments,mobile device300 is capable of transmitting, receiving, and modifying medical case information to track changes occurring in real-time at a medical facility and forward such information to a medical information management system.Mobile device300 may be used by medical professionals to receive real-time information corresponding to one or more cases and enter real-time updates for transmission to a medical information management system. Such updates, in turn, can be delivered to other computing devices or systems. In particular embodiments,mobile device300 must transmit updates to medicalinformation management system120, which controls whether data is actually updated. Thus, a handheld device, such asmobile device300, enables medical case information to be managed and coordinated between medical professionals actively rendering care to one or more patients.
• In operation, elements ofmobile device300 perform various functions including facilitating maintenance and display of a graphical case board, enabling entry and display of medical professional activity information and patient treatment records having case chronology information, facilitating case status alerting for tracked medical cases, providing an intuitive graphical user interface for interacting with the system, enabling tracking of medical case assignments and roles in addition to handing-off assignments and roles between medical professionals, and facilitating secure authentication and access techniques.
• To provide a graphical case board,mobile device300 retrieves and presents information maintained by medicalinformation management system120. For example,processor304 may execute a medical information management application residing in anonvolatile portion310 ofmemory306 to receive medical case board information. Once this information is received,mobile device300 may display a graphical case board usinguser interface308. In operation,user interface308 may graphically present multiple predefined phases of care in multiple tabs where each tab is selected through theuser interface308. In particular embodiments, each tab may correspond to a single predefined phase of care. In those embodiments,user interface308 may receive user selections for each tab to display patient entries for patients for the corresponding predefined phase of care. In an embodiment designed for an anesthesia practice, the predefined phases of care may correspond to schedule, pre-operation, intra-operation, and post-operation stages for providing anesthesia care.
• In some embodiments, each tab corresponding to a predefined phase of care may present a list of rows of patient tracking entries that list pertinent case information from a patient tracking record. This may include, for example, a patient information such as the patient's name, the medical procedure, the attending physician, surgeon, or anesthesiologist, any supervising or assisting medical professional, the operating room, scheduled operating room time, case role information, and any specific sub-events within the predefined phase of care such as the last anesthetic or surgical event with the corresponding time.
• In operation, as a patient proceeds through medical phases of care, patient tracking entries may transition from being listed under the tab for one predefined phase of care to another. For example, in an anesthesia practice, the event of a patient arriving at a medical facility may cause a patient tracking entry to transition from being listed under a “schedule” phase to a “pre-operation” phase. Similarly, when an update indicating anesthesia administration is started for a patient, the corresponding patient tracking entry may transition from a “pre-operation stage” to an “intra-operation phase.” When an update indicating that anesthesia administration has ended, the patient tracking entry may transition from a “intra-operation”phase a “post-operation” phase. At some predetermined point in time, such as midnight, all post-operation cases may be clear (with potentially exceptions for cases completed within a set period of time near midnight). Thus, the functionality provided by a graphical case board interface can receive updates to track real-time transitions between phases of medical care at a defined medical practice location.
• In addition, selecting a row corresponding to a patient may cause the medical information management application to retrieve either a patient treatment record or case summary information. In one implementation, if the medical professional has a role associated with the case, a patient treatment record may be presented. If the medical professional does not have a role associated with the case, then case summary information may be presented.Mobile device300 can request a patient treatment record or case summary information usingnetwork interface302 to communicate across the communication network to the medical information management system.Mobile device300 can also receive corresponding patient treatment record or case summary information for display onuser interface308 usingnetwork interface302.
• In addition to displaying the predefined phases of care for all cases corresponding to a medical practice at a defined location,mobile device300 is capable of tracking medical events corresponding to a specific patient. In some embodiments,mobile device300 may graphically display either a patient treatment record or a case summary based on whether the medical professional using this system has a role associated with the case. A patient treatment record corresponds to a single case and may include a case chronology that specifies timing of events during treatment. For the purposes of tracking timing and other related information, a patient treatment record may include a time record for medical events in the case chronology of the patient treatment record. A case summary may include case details for a specific case and facilitate the assumption or handing-off of medical roles with respect to the case.
• Mobile device300 is capable of presenting a patient treatment record in a graphical form onuser interface308. In some implementations, a patient treatment records may be presented in a tabbed interface. For example, a patient treatment record may be organized and displayed under multiple selectable tabs. One tab may present information corresponding to the case in a summary form including patient and medical procedure information. Another tab may list a chronology of related medical events for a medical procedure corresponding to the selected case based a predefined template for the medical practice. For example, listed medical events for an anesthesia practice may include, preparation start and stop, anesthesia start and stop, antibiotic administration, intubation, and surgery start and end. Each medical event that is presented in the chronology tab may be selected to log a timestamp corresponding to the medical event in a corresponding time record. Among other things, the time record for each presented medical event may have a current value of time, which could be a specific time value or no time value at all, for example, in the case of previously unrecorded medical events. Logging timestamps as the new current value for a time record permits the proper recording of the time for a billing-related event. For example, the beginning of anesthesia may be logged by selecting anesthesia start and the end of administering anesthesia may be logged by selecting anesthesia stop. In particular embodiments, selecting a billing-related event presents an interface for allowing the user to accept the current time as the time value for a timestamp. Determining a difference between two such timestamps facilitate the generation of appropriate invoices and reports for billing-related events. As changes or updates to a patient treatment record occur, corresponding changes and updates to case board information may also be triggered. Thus, other users can view a graphical representation of case board information, which includes information corresponding to the updated patient treatment record.
• The graphical representation of a patient treatment record may also include a tab for checklist items for recording medical events that occur during a medical procedure but may not have a time or duration associated with them. Such events may include having to insert an extra intravenous line for a patient or other events that are performed for a medical procedure on an as needed basis. In addition, the checklist items may be displayed under appropriate categories or subcategories. The order, content, number, and organization of checklist items may be defined based on a template maintained for the practice or location at a medical information management system. Also, the tab for checklist items may be pre-populated based on rules triggered by non-checklist data or other checklist items. In operation, selecting a specific checklist item may cause the toggling of a YES/NO indicator for specifying whether the item has occurred during the case. Thus, the checklist presentation may entail a summary view that facilitates checklist data review, and a checklist entry view that facilitates toggling a state (e.g. YES/NO) for a particular checklist item. In some implementations, checklist items can be used to ensure quality control by requiring medical professionals to indicate whether specific policies or steps were followed. In addition to case specific items presented in a tabbed form, the graphical patient treatment interface may also include a contextual return tab for returning to the graphical case board. For example, the graphical patient treatment interface may have a back tab labeled according to the previous screen (e.g. “Board” for the graphical case board), which if selected, causes the graphical case board to be displayed onuser interface308.
• Mobile device300 is also capable of displaying a case summary interface for presenting a list of relevant medical information corresponding to a case. In certain implementations, when the user selects a particular patient tracking entry in the graphical case board interface but has no role associated with the case, the medical information management application ofmobile device300 causes theuser interface308 to display the case summary interface. The presented case summary information may include a patient identifier, the specific medical procedure, the attending surgeon, any anesthesiologists that are supervising or managing the case, any procedure or diagnosis codes, specific case identifiers and any other detailed information about the selected case or patient. In addition, the information presented may include relevant medical events of the case that have occurred or are currently taking place. In some implementations, this allows medical professionals to view case details for cases for which they do not have a role but may wish to now assume a role. In those implementations, medical professionals can assess a case in summary form prior to assuming a role. Some embodiments may also include color and/or icon depictions of data incompleteness. The manner in which data incompleteness is indicated is configurable based on location-specific rules and/or templates. Thus, the case summary interface presents a variety of relevant information to the user in an accessible form.
• Some embodiments of the graphical case summary interface may also include multiple tabs. The tabs may correspond to specific roles that a medical professional can assume with respect to the case. For example, these roles may include assisting, supervising or directing, and personally providing care on the case. For an anesthesia practice, these roles may correspond to responsibilities associated with the administration of anesthesia.User interface308 may receive a selection corresponding to a role, and in response, may require confirmation. If confirmed,mobile device300 may then transmit a role-handoff request to medicalinformation management system120. If the information management system authorizes the role-handoff,mobile device300 may receive a confirmation that the role assumption has occurred and, in response, present a case summary which includes the new assumed role. In particular implements, the graphical case summary interface may also include a contextual return tab for returning to a graphical case board interface. For example, a contextual return tab labeled as “Board” may be selected using theuser interface308 for returning to a graphical case board interface.
• Embodiments ofmobile device300 may also provide case alerting functionality for necessary medical professionals. As discussed, case alerts may be automatically generated or be initiated by a user. Case alerts may take on a variety of forms including voice, text, or multimedia. For example, a user ofmobile device300 may be notified when a case that is being managed by the user ofmobile device300 enters a particular predefined phase of care. As an additional example, another case alert may cause a party being relieved to be notified when a role-handoff is successfully processed. In operation,mobile device300 is capable of receiving a case alert corresponding to a case onnetwork interface302 for processing by a medical information management application being executed by aprocessor304. After appropriate processing of the case alert,mobile device300 may present the case alert onuser interface308 in any appropriate form. For example,mobile device300 may present the case alert as a pop-up that may require the user ofmobile device300 to acknowledge receipt of the case alert or even take some action, such as accept a role-handoff request. In other embodiments, the case alert may be presented in a non-intrusive form such as a sliding banner or a pop-up that fades away after a predefined time interval. In this manner, the user ofmobile device300 is informed of relevant case events corresponding to a patient undergoing a medical procedure at a defined location. In certain embodiments,mobile device300 may facilitate responding to case alert messages, for example, to acknowledge the receipt of the alert or to otherwise engage other medical professionals to take appropriate action in response to the indicated case event. In those embodiments, the response may be received byuser interface308 and the medical information management application being executed byprocessor304 may process the response for delivery to a remote medical information management system over a communication network usingnetwork interface302. The medical information management system may then process the response and forward corresponding messages to one or more handheld devices and/or systems as appropriate.
• Users ofmobile device300 may also manually initiate their own messages for delivery to other systems to request information related to a case or provide information about a case to appropriate medical professionals. In certain embodiments,user interface308 may present a predefined list of user initiated messages for delivery to other medical professionals corresponding to a medical practice. For example, messages included in a predefined list includes but are not limited to “need break,” “need assistance,” “induction,” “emergency,” or other suitable predefined message. In alternative embodiments,user interface308 may facilitate the entry of user initiated messages in a free form field. In those embodiments,user interface308 may facilitate the entry of fully customizable messages for addressing concerns with respect to a case, or any real-time need associated with a medical practice or procedure. Accordingly,mobile device300 supports automatic and user-initiated case alerts for coordinating and interacting with medical professionals associated with a medical practice.
• Whilemobile device300 is illustrated as including specific components, it should be understood that various embodiments may operate using any suitable arrangement and collection of components.
• FIG. 4 is a diagram illustrating asystem architecture400 for describing a user interface for a medical information management application operating on a handheld device. As illustrated,system architecture400 includes a collection ofdata review modes402 and a collection ofdata entry modes404. In general, the data review modes correspond to display modes of the graphical user interface that facilitate the display of medical case board information, patient treatment information, and case summary information. The various data reviewmodes402, permit users of the system to review real-time data for multiple concurrent cases.Data entry modes402 represent a collection of display modes for entering case-specific information.Data entry mode404 enable multiple users of the medical information management system to enter data for multiple concurrent cases of a medical practice. Thus, the various display modes ofsystem architecture400 together provide an intuitive graphical interface for data entry and retrieval for cases associated with a medical practice.
• FIG. 5 is asystem hierarchy500 for a graphical user interface on a handheld device. As illustrated,system hierarchy500 includes a number of modes corresponding to display modes of a graphical user interface, including auser login interface502, acase board interface504, acase summary interface506, and apatient treatment interface508. As illustrated, these display modes may be used to display case information and facilitate data entry for cases in an efficient manner using the graphical user interface at a handheld device, such asmobile device300.
• System hierarchy500 shows a first display mode having a user login interface that first requires a device authentication. In operation, device authentication may be performed by comparing a practice or user key code (or any other suitable identifier) to values stored in a medical information management system. Once the device itself is authenticated, the graphical user interface may provide an interface for indicating a medical practice and selecting an authorized user corresponding to the medical practice. Once a user is selected, the device may receive a password and PIN from the user. Once the user is properly authenticated with the medical information management system, the graphical user interface may display a list of one or more supported locations for a medical practice. In some implementations, these locations correspond to medical facilities for providing care to patients. In operation, the selection of a location may cause the display ofcase board interface504. Thecase board504 provides information regarding all cases at a defined location organized into predefined phases of case. The case board interface is further operable to receive a selection of a case corresponding to a particular patient. In response to receiving a selection, acase summary interface506 orpatient treatment interface508 may be displayed based on design considerations. Thecase summary interface506 provides detailed information about a particular case, including both patient-specific information and current information regarding medical events corresponding to an ongoing or scheduled medical procedure. In particular implementations, a case summary interface is presented when a user is not affiliated with the case. A user may not be affiliated with a case, for example, when the user has not assumed an active role with respect to the case.
• In other implementations, selecting a particular case at thecase board interface504 causes the graphical user interface to proceed to apatient treatment interface508. According to design considerations,patient treatment interface508 may be presented if the user using the graphical user interface actually has an active role in the selected case. For example, as shown in the illustration, apatient treatment interface508 may present a patient treatment record in three different display modes. One mode may present patient and case information in such a manner that facilitates modification of specific data elements. Another display mode may display case chronology and facilitate the tracking of medical events for the case in corresponding time records. Another display mode ofpatient treatment interface508 may permit the recording of case data items corresponding to medical events or items not having a time or duration associated with them. Such case items may be listed in a checklist form. In some embodiments, checklist items may include case items for ensuring quality control or conformity with institutional policies for a medical practice. Thus, the hierarchy of display modes ofsystem hierarchy500 facilitate streamlined access to medical case information in an aggregate form throughcase board interface504, and the real-time tracking of specific cases throughpatient treatment interface508.
• FIG. 6 is a diagram illustrating acase board600 representing an example graphical case board interface for a handheld device interacting with a system according to the present disclosure. As shown,case board600 includes various elements that together provide a distinctive interface for interacting with the graphical case board. In the illustrated embodiment,case board600 includes two elements:case board tabs602 and multiplepatient tracking entries604. Among thepatient tracking entries604 is a user-affiliatedpatient tracking entry606. The displayed user interface, organization of patient entries and phases of care, color and other visual schemes, level of detail, and other information displayed bycase board600 may be customized based on the particular user, practice group associated with the user, location at which the user is working, or other appropriate settings and data. In addition, some embodiments may also include color and/or icon depiction of data incompleteness. The manner in which data incompleteness is indicated is also configurable based on location-specific rules and/or templates.
• As illustrated,case board tabs602 ofcase board600 represent an organization of patient tracking entries according to predefined phases of care corresponding to a medical practice at a defined location. These predefined phases of care may be defined in a template configured for a medical practice and maintained by a central medical information management system. In the illustrated embodiment, each of thecase board tabs602 correspond to a phase of providing anesthesia care. For example, the “schedule” phase corresponds to a phase of providing medical care where each of the patients listed are scheduled but have not yet arrived in the peri-operative area. Another phase, an anesthesia pre-operation phase shown in the illustration as “pre-op,” represents a phase of care prior to an anesthetic (or surgical) procedure where patients are waiting in the surgical holding room or pre-operation area. The next tab corresponds to an intra-operation phase shown in the illustrated embodiment as “intra-op.” The intra-operation phase represents a phase of care wherein the patients have in-process anesthetics or are in the operating room. Finally, the last tab corresponds to a post-operation anesthesia phase, shown in the figure as “post-op.” This final stage corresponds to a phase of care after the anesthetic (or surgical) procedure where the patients are in the surgical recovery room or post-operation area.
• In operation, each of the illustrated tabs may be selected to list patient tracking entries corresponding to that phase. For example, in the illustrated embodiment, “intra-op” is currently selected and correspondingpatient tracking entries604 are displayed.Case board tabs602 may also indicate case count information as shown by the numbers below each labeled tab for a predefined phase of care. These numbers allow a user presented withcase board600 to determine, at a quick glance, how many patient tracking entries can be found under each of thecase board tabs602. In certain implementations, the case count may correspond to the number of cases under each of thecase board tabs602 that correspond to the user. For example, the case count may be the total number of cases within a predefined phase of care for which the user has a case role. Thus, thecase board tabs602 provide a user-friendly organization of patients as they proceed through predefined phases of anesthesia care.
• As specific patients associated with the patient tracking entries progress from one predefined stage to another,case board600 may be updated with appropriate listings under the correspondingcase board tabs602, potentially in real-time as these changes occur in the field. For example, when a user of a particularmobile device118 provides a patient treatment update indicating that a patient has begun receiving anesthesia, and medicalinformation management system120 transitions that patient from a pre-operation stage to an intra-operation stage, and allmobile devices118 tracking that patient or that patient's surgical location can be updated. Accordingly, the corresponding patient tracking entry transitions from being listed under the illustrated “pre-op” tab to being listed under the illustrated “intra-op” tab. The case count information corresponding to the tabs may also be updated to reflect such transitions.
• The illustrated embodiment ofcase board600 shows multiplepatient tracking entries604. Each patient tracking entry ofpatient tracking entries604 corresponds to a particular predefined phase of care indicated by the appropriate case board tab. As illustrated, multiplepatient tracking entries604 are listed for the intra-operation phase of anesthesia care. In particular, each patient tracking entry has specific information corresponding to the indicated case. For example, as the illustration shows, the patient tracking entry may include patient information such as the patient's name, the medical procedure, the assigned operating room, the attending surgeon/physician, the anesthesiologist and any supervising anesthesiologist, and sub-events within the predefined phase of care such as surgery start, entering an operating room, or an antibiotic being administered. In addition, each of these sub-events may include a timestamp indicating when the sub-event occurred. In particular embodiments,case board600 may display icon-based depictions of specific medical events or status for a given case.
• The illustration also shows a user-affiliatedpatient tracking entry606 ofpatient tracking entries604. In particular embodiments,case board600 may cause the list ofpatient tracking entries604 to be sorted where cases affiliated with the user are brought to the top of the list. For example, user-affiliatedpatient tracking entry606 is shown at the top of the list ofpatient tracking entry604 because it is affiliated with the user of the handheld device on whichcase board600 is being displayed. A user affiliation, for example, may be established when the user ofcase board600 has a particular role with respect to the indicated case. Also, as shown in the illustration, user-affiliatedpatient tracking entry606 may be highlighted using color or some other suitable visual emphasis. In addition to distinguishing the user-affiliatedpatient tracking entry606 from other patient tracking entries, the provided visual emphasis may further indicate the nature of the role that the user ofcase board600 has with respect to the patient indicated by the patient tracking entry. For example,case board600 may use a color scheme defined for the practice where one color indicates that the user is in a supervisory role and another color indicates that the user is actively providing care for a case identified by the patient tracking entry. While a color scheme is disclosed by this particular illustration, any suitable visual emphasis for separating user-affiliated patient tracking entries from other patient tracking entries is envisioned by the present disclosure. The information displayed in the rows corresponding to user-affiliated patient tracking entries, such as user-affiliatedpatient tracking entry606, may be further based on the user's case role. For example, a user-affiliated patient tracking entry where the user is in a supervisory role may result in particular information being displayed in a particular format. Another user-affiliated patient tracking entry where the user is actively providing care, for example, may result in other information being displayed and/or another information format being used. The illustrated embodiment also indicates thatcase board600 relies on receiving case status and event data from a remote medical information management system which is updated in real-time by multiple medical professionals actively engaged in patient care at a practice location.
• In operation, each of thepatient tracking entries604, including user-affiliatedpatient tracking entry606 are capable of being selected through a user interface. The selection of one of thepatient tracking entries604 may result in either a case summary or patient treatment interface being displayed. Design considerations may dictate which one of these interfaces is displayed. For example, in the illustrated embodiment, selecting user-affiliatedpatient tracking entry606 may result in the patient treatment interface being displayed since the user ofcase board600 has a specific role with respect to the user-affiliatedpatient tracking entry606. If one of the other patient tracking entries are selected, a case summary interface is displayed. A case summary interface lists details about a particular case including relevant medical events and specific medical data corresponding to the patient (e.g. patient identification and medical history). In certain implementations, thecase board600 may be visually distinguished from a patient treatment and/or case summary interface. For example, the case board may be monochromatic while the patient treatment interface and/or case summary interface may use colorful tabs or menu selections.Case board600 may also be operable to receive a user request for a refresh of the case board information. For example, shaking the device may generate a case board refresh request that causescase board600 to fetch updated case board information from a remote medical information management system for display on the graphical case board interface. Thus,case board600 provides a user-friendly interface for tracking all medical cases for a medical practice at a particular location.
• FIG. 7 is a diagram illustrating an examplepatient treatment interface700 for displaying a patient treatment record for an active case at a medical practice. As described, thepatient treatment interface700 may be displayed when a graphical user interface of a handheld device presenting acase board600 receives a user selection corresponding to a specific patient tracking entry. The displayed user interface, organization of case and checklist items, specific medical events, color, icons and other visual schemes, the level of information detail, and other information displayed bypatient treatment interface700 may be defined by a template configured for a medical practice and maintained remotely by a medical information management system. For example, some embodiments may also include color and/or icon depiction of data incompleteness. The manner in which data incompleteness is indicated is configurable based on location-specific rules and/or templates. The illustrated embodiment showspatient treatment interface700 as includingpatient treatment tabs702 andcase chronology events704 corresponding to a chronology of medical events for a particular case at a medical facility. Unlike checklist items, these medical events typically have or will have a time value or duration associated with them. Among thecase chronology events704, is anantibiotic administration event706 shown as the last recorded medical event.
• Patient treatment tab702 ofpatient treatment interface700 provides a tabbed interface for displaying case specific information. In the illustrated embodiment,patient treatment tab702 includes four tabs. While the first tab facilitates return to thegraphical case board600, the other tabs provide further details for the selected case. For example, the information tab provides detailed information about the patient, such as medical history and other identifying data along with relevant medical events corresponding to the medical care being provided. Another tab, shown as the checklist tab, lists specific case items in a checklist format. These items correspond to medical events that may be necessary on an as needed basis during a medical procedure but do not have a time or duration associated with them. Thus, for example, an anesthesiologist may record a medical event that became necessary for a particular patient, such as starting an extra intravenous line, which may not include a time value or duration. Other case items may relate to quality control measures or institutional policies enforced by a medical practice. Finally, the selected chronology tab displays medical events for a particular medical procedure shown in the illustrated embodiment ascase chronology events704. As shown, the case chronology events have timing associated with them, which may be recording in an appropriate time record. Further,patient treatment tabs702 may be visually distinguished from each other to discern one tabbed display mode from another.
• In the illustration, the chronology tab ofpatient treatment tabs702 is selected. The chronology tab displays multiplecase chronology events704. Each of these case chronology events corresponds to an medical event for the medical procedure corresponding to the selected patient and may have an associated time record for recording a time value or duration. The medical events that are listed under the chronology tab may be defined by a practice and/or location-specific template maintained by a medical information management system. For example, as the illustration shows, these events may include prep start, prep stop, anesthesia start, operating room (OR) enter, antibiotic admin, intubation, surgery start, surgery end, and OR exit. Other events may include, arrival in the holding room, anesthesia stop, bypass start/stop, heart stop/start, C-section start/stop, vaginal delivery start/stop.Case chronology events704 may be visually nested to define relationships between collections of events. For example, all case chronology events between OR enter and OR exit are considered part of an operating room event. This relationship is shown by the indentation of associated sub-events relative to the case chronology events that they are considered to be part of. For example, antibiotic admin, intubation, surgery start and surgery end rows are indented in relation to OR enter and OR exit to show that those events are to take place between entry and exit of the operating room.Patient treatment interface700 also illustrates nested relationships and the relative duration of medical events by visually emphasizing the range of medical events using color-coded vertical bars in the left margin. The colors or other visual emphasis for the vertical bars may be configured in a practice template maintained by a medical information management system. In certain implementations, some of thecase chronology events704 may facilitate visual reordering of medical events based on location or practice rules. At the same time, certaincase chronology events704 may not facilitate visual reordering if the location or practice rules prohibit it.
• In operation, the rows corresponding to each of thecase chronology events704 are operable to receive a user selection through a user interface to cause thepatient treatment interface700 to record a timestamp corresponding to the appropriate case chronology event. This timestamp may be recorded in a time record corresponding to the event. For example, when a row corresponding to one of thecase chronology events704 is selected,patient treatment interface700 may present a button enabling rapid entry of the current time as the timestamp for the selected case chronology event or present another interface, which allows the user to enter another time for the selected case chronology event. As shown, the last recorded event in the illustrated embodiment is “antibiotic admin” at time 13:20, which was recorded by selecting the arrow shown in the right margin of the row corresponding toantibiotic administration event706. This time value may be recorded as the current value for the time record corresponding toantibiotic administration event706. Other events such as intubation, surgery start and surgery end, and OR exit may be recorded in a similar fashion as the medical procedure progresses. Since these other events are unrecorded, their corresponding time records would have no current value at all. In operation, thepatient treatment interface700 is operable through the chronology tab to respond to the receipt of a user selection of one of thecase chronology events704, such as, for example, theantibiotic administration event706, record a timestamp in the appropriate timing record and send an event update corresponding to the selected medical event over a network to central medical information management system. In this manner, other computing devices and systems managing case information can receive and review changes to case chronology events of a patient tracking record in real-time, including update of the last case event parameter oncase board600. In some implementations,patient treatment interface700 may permit a medical professional to add new medical events using the graphical user interface. For example, selecting a specialty row for adding events may allow a user to define a new medical event for medical tracking purposes.
• Some embodiments ofpatient treatment interface700 may implement other features. For example, some of thecase chronology events704 may facilitate the reversal of a medical event recording. For example, selecting particular events may allow user to undo the recording of an event. This may be useful to correct user entry errors, or for other medical reasons. Based on design considerations, certain medical events may be irreversible as defined by the associated medical practice. For example, a particular medical practice may not choose to allow medical professionals rendering anesthesia care to undo the event of anesthesia start. Some embodiments may display a countdown timer for indicating the time remaining for a medical procedure, and this information may be transmitted in real-time to a medical information management system. As yet another feature, thepatient treatment interface700 may also be operable to receive a user request for a refresh of the patient treatment information. For example, shaking the device may generate a refresh request for a patient treatment record that causespatient treatment interface700 to retrieve updated patient treatment information from a remote medical information management system for display on the graphical case board interface. Thus,patient treatment interface700 provides an user-friendly interface for tracking and recording medical events in real-time.
• FIG. 8 is a block diagram illustrating acase alert system800 with elements that interoperate to receive, process, and transmit case alerts to various users of a medical information management system. The elements ofcase alert system800 can support a number of operations associated with generating and sending case alerts, including configuring alert event triggers for maintenance by a central case alert system processing, processing real-time medical events for comparison with alert event triggers to determine whether to issue a case alert, and formatting and transmitting case alert messages for delivery on various networks using disparate protocols. Various example networks for sending alerts include a wired/wireless computer network, pager networks, cellular SMS networks, email networks, and instant-messaging networks.
• In the illustrated embodiment,case alert system800 includes a number of elements that work together to alert one or more medical professionals. As shown,case alert system800 includes an eventtrigger configuration interface802, a casealert manager804, and one or moreintended recipients806. Some or all of the functionality ofsystem800 may be provided bycase alert module204. As a particular example, the functionality ofcase manager804 may be implemented incase alert module204 ofsystem200.
• Eventtrigger configuration interface802 represents any suitable interface for configuring medical events for which a case alert should be issued to one or moreintended recipients806. For example, an eventtrigger configuration interface802 may be a web interface for supplying a casealert manager804 with specific event triggers. In addition, the eventtrigger configuration interface802 may couple to an appropriate communication network to transmit event trigger configurations to casealert manager804 for updating an appropriate database.
• Case alert manager804 represents appropriate hardware, control logic, and data for storing case alert configurations and determining when and how to issue an alert according to the configured event triggers. For example, casealert manager804 may be a computer server or virtual computer server capable of processing case alerts. In certain implementations, case alert manager may be embodied in a module of a larger medical information management system, such ascase alert module204 ofsystem200.
• Intended recipients806 represent one or more medical professionals of a medical practice or surgical location identified in an event trigger for receiving case alerts on the occurrence of predefined medical events. For example, as shown, the intended recipients may include a nurse, a case board runner, an anesthesiologist, or a CRNA. The actual alert method used to notifyintended recipients806 may conform to any appropriate protocol on any suitable network. For instance, a medical professional may receive case alerts in a text message using an SMS service or in an email using a wired/wireless network.
• In operation, the casealert manager804 may issue a case alert to one or moreintended recipients806 when a real-time medical event matches an event in a stored event trigger configured through an eventtrigger configuration interface802. In particular, casealert manager804 receives one or more event triggers through the eventtrigger configuration interface802 for storage in an appropriate database. Next, casealert manager804 monitors medical events for one or more cases in a medical practice. For example, casealert manager804 may monitor updates to a central database maintaining case information tracking patients receiving care.Case alert manager804 may then process these medical events to determine whether the identified medical events match the events in any stored event triggers. If a match is found, casealert manager804 may issue a proper case alert message in an appropriate format and using a suitable network to notify one or more indicated intendedrecipients806. Accordingly, embodiments of the present disclosure can receive, process, and send case alerts to facilitate coordination of medical activities for one or more cases.
• FIG. 9 is a process flow diagram illustrating aprocess flow900 for secure user authentication, login, and access to a medical information management system. The steps ofprocess flow900 correspond to an example sequence of steps for securely accessing medical information from a medical information management system. Such an authentication process ensures that confidential patient information and medical case information are protected from unwanted disclosure. A user authentication process like process flow900 may be implemented on the front-end of medical information management system such that access to features, functionality, and confidential information require users to be first authenticated by the system.
• In the illustration,process flow900 includes a number of steps for providing user authentication, login, and access to a medical information management system. As shown, these steps include adevice authorization step902, auser selection step904, auser authorization step906, alocation selection step908, auser login step910 and a caseboard presentation step912. This collections of steps may be performed, for example, on a handheld device, such asmobile device300, through a graphical user interface interacting with a remote medical information management system.
• The illustration also shows anauthentication system914 and an exampleuser login interface916.Authentication system914 represents a system for authenticating and facilitating access users of the system. For example,authentication system914 may be embodied in a larger medical information management system, such assystem200. The authentication system may be configured with users and locations through an appropriate configuration interface. For example, a web interface may be used to configureauthentication system914 with users and locations having access to the system.User login interface916 represents an example user login interface for supplying a PIN to theauthentication system914.
• In operation,process flow900 begins at thedevice authorization step902. In this step, the user of a handled device supplies a practice key identifying a particular medical practice or a user key identifying a user within a particular medical practice. This information is sent across a network viapath1A along with a device hash corresponding to theauthentication system914. The device hash ensures that only authorized devices may access the system, thereby providing a first level of access protection to the system. Once the practice key or user key and device hash are determined to be valid byauthentication system914, the system responds by sending two lists viapath1B over one or more networks to the handheld device: a list of authorized users for the identified medical practice and a list of specific practice locations for the medical practice.
• Next, the graphical user interface of the handheld device proceeds to theuser selection step904. At this step the graphical user interface may be used to indicate one of the authorized users in the list supplied byauthentication system914.Process flow900 then enters theuser authentication step906 where the graphical user interface may receive a password for the selected authorized user. Requiring the selection of an authorized user and corresponding password provides a second level of access protection to the system.User authentication step906 may transmit this information over one or more networks to theauthentication system914 for validation, shown aspath3A of the illustration. Once the authentication system confirms that the password is valid, the authentication system sends a personal identification number (PIN) over a network throughreturn path3B to the handheld device. This PIN corresponds to the medical practice and the user identified from the authorized list of users delivered to the handheld device followingdevice authorization step902.Process flow900 then proceeds to thelocation selection step908 where a selection of a particular practice location associated with the medical practice is received by the graphical user interface. This causesprocess flow900 to enter auser login step910.
• In operation,user login step910 may present an appropriate user login interface such as, for example, the illustrateduser login interface916. The user login interface may accept a user-supplied PIN using the graphical user interface. Requiring a user PIN specific to the selected authorized user provides a third level of access protection to the system. Once this information is received,user login step910 may validate the user-supplied PIN against the PIN received fromauthentication system914 followinguser authentication step906. A validated PIN can be used again later after validation for quick access to medical information and functionality provided by the system, thereby obviating repeated validations of the practice key or user key and password corresponding to the selected authorized user. Finally, if the entered PIN is valid, process flow900 proceeds to a caseboard presentation step912.
• In the illustrated embodiment, entering caseboard presentation step912 indicates that all proper authentication steps for accessing the medical information management system have been properly processed and that access to the system has been granted. Thus, in the caseboard presentation step912, the graphical user interface may display an appropriate interface for interacting with a medical information management system. Such an interface may include a graphical case board interface for performing various case-related functions corresponding to the selected medical practice and location. Some embodiments may support the retention of selected authorized user and location information for rapid system re-entry which may require a subset of the original authentication information as user input. Similarly, in some implementations where there are more than one locations associated with practice, entering another practice location may only require an appropriate subset of the original authentication information as user input. For example, a graphical user interface may request entry of a user PIN to regain access to information and functionality supplied by a previously accessed medical information management system, or to switch practice locations. Thus,process flow900 describes an example sequence of steps for user authentication, login, and access to a medical information management system.
• While process flow900 is illustrated as including specific steps, it should be understood that various embodiments may implement a user authentication login and access scheme using any appropriate combination of steps for providing secure access to a medical information management system.
• FIG. 10 is a process flow diagram illustrating anexample process flow1000 for conducting role-handoffs between medical professionals associated with a medical practice or an anesthesia care location. As illustrated,process flow1000 includes a caserole selection step1002, role-handoff confirmation step1004, a caserole confirmation step1006, arole assumption step1008, and a patienttreatment interface step1010. Various steps inprocess flow1000 interact with other systems and interfaces. For example, the steps ofprocess flow1000 may interact with a user andlocation configuration interface1014 and a caserole management system1016. An example role-handoff confirmation message1020 for confirming a selected role-handoff is also illustrated.
• Caserole management system1016 represents a system for managing cases and case role assignments at an anesthesia care location. For example, caserole management system1016 may be embodied as an element or combination of appropriate elements of a medical information management system, such assystem200. Thus, for example, caserole management system1016, may be implemented bybusiness logic210 ofsystem200. A userlocation configuration interface1014 represents any appropriate interface for configuring assignments and case roles and communicating such configuration to a caserole management system1016. For example, a user location configuration interface may be web interface for configuring case roles over a network to caserole management system1016.
• In operation, the illustratedprocess flow1000 begins at the caserole selection step1002. As discussed, a role indicates a responsibility of medical professionals associated with a medical case. Incase selection step1002, a graphical user interface at a handheld device, such assystem300, permits a medical professional to select a case role. These case roles may be presented, for example, in a case summary interface describing a particular medical case. In certain embodiments, a tab of the case summary interface may receive a role selection for the case. For example, a user may select one of many tabs corresponding an assisting role, a supervisory or directing role, or a care provider role.
• As shown inprocess flow1000, once a case role is selected, caserole selection step1002 may proceed to an optional role-handoff confirmation step1004. At this optional step, the graphical user interface may request confirmation of a role-handoff request when another medical professional currently has that role. This optional step thus confirms a medical professional's desire to relieve another medical professional who is already acting in that particular role with regard to a case. For example, a graphical user interface may present a role-handoff confirmation message1020 to seek confirmation of a role-handoff from one specific medical professional to another. Thus, the option role-handoff confirmation step1004 ensures that a role-handoff was not inadvertently requested.
• In operation, the caserole confirmation step1006 is entered from the caserole selection step1002 or the optional role-handoff confirmation step1004, as shown in the illustratedprocess flow1000. In the caserole confirmation step1006, the graphical user interface seeks a confirmation from the user that a case role assumption is requested. For example, a graphical user interface may present a pop-up panel that appears momentarily on the screen for confirming a case role selection or handoff. Once confirmed, caserole confirmation step1006 communicates over one or more networks through the shownpath2A with a caserole management system1016, which may be configured by userlocation configuration interface1014. Asprocess1000 further shows, caserole management system1016, after receiving a confirmed case role request responds over one or more networks viapath2B to a handheld device.
• Process flow1000 then proceeds torole assumption step1008.Role assumption step1008 accepts confirmation of a successful role assumption or role-handoff and updates the graphical user interface accordingly. As shown byprocess1000,role assumption step1008 can, for example, transition the graphical user interface to presenting a case information interface at patienttreatment interface step1010. Patienttreatment interface step1010 presents further details about the case for which the user of a handheld device now holds an assumed role. Among other things, this interface facilitates retrieval and real-time management of case information. In some embodiments, caserole management system1016 is further capable of logging the time corresponding to a role assumption or role-handoff. Recording such timestamps enables medical professionals associated with the case to determine all medical professionals who were and are currently involved with a case. This information can also be used to generate appropriate invoices and billing reports for a medical practice. In certain implementations, appropriate medical professionals may be notified, such as by a case alert, based on predefined event triggers or rules maintained by a medical information management system.
• FIG. 11 illustrates an examplecase summary interface1100 for summarizing case details and facilitating role-handoffs. Case details may include details about a patient such as identifying information, medical history, and past and ongoing medical events corresponding to a medical procedure being conducted on the identified patient. Thecase summary interface1100 also facilitates the assumption of roles by medical professionals or role-handoffs between medical professionals. Thus, for example, the showncase summary interface1100 may implement theprocess flow1000 for assuming roles and conducting role-handoffs. In particular implementations,case summary interface1100 may be presented when a user selection of a particular patient tracking entry corresponding to a case is received at a graphical case board interface and the user does not already have a role associated with the case.
• As shown in the illustrated embodiment,case summary interface1100 includescase summary tabs1102 and a case detailslist1104. These components ofcase summary interface1100 facilitate quick data review of a case and also enable assumption of roles and role-handoffs. As shown,case summary tabs1102 include a number of tabs for interacting withcase summary interface1100. For example, as shown, a contextual return tab may receive a user selection to return to a graphical case board interface. In addition, other shown tabs such as the preparation or assist tab, the supervise or direct tab, and the provide care tab may receive selections through a user interface for assuming a role or handing-off roles between medical professionals. Case details list1104 displays specific information corresponding to the case in list form, including patient information and medical history. Case details list1104 may also present a sequence of medical events corresponding to events that have occurred with respect to a case and any other informational items relevant to the case.
• Whilecase summary interface1100 is demonstrated as including specific components and displaying particular information, it should be understood that various embodiments may operate using any suitable arrangement and collection of components having any appropriate display format and such arrangements and components may be configurable by a particular medical practice or anesthesia care location.
• Although the present disclosure describes several embodiments, it should be understood that a myriad of changes, substitutions, and alterations can be made without departing from the spirit and scope of the invention as defined by the appended claims.

Claims (24)

1. A handheld apparatus comprising:

a user interface comprising a display and capable of receiving user input;

a wireless network interface capable of coupling to a central medical information management system, the central medical information management system maintaining a plurality case chronology templates, each of the case chronology templates corresponding to a particular one of a plurality of practice locations and defining a series of medical events customized for the particular location, and a plurality of patient treatment records for patients receiving care at the practice locations, each of the patient treatment records linked to one of the practice locations and corresponding to a patient treatment record having a time record associated with each of the medical events defined by the case chronology template corresponding to the location;

a memory maintaining a medical information management application; and

a processor operable, when executing the medical information management application:

to identify a selected one of the practice locations;

to display a list of patient treatment records, received from the medical information management system, that correspond to the selected location;

to identify a selected one of the patient treatment records based on user input;

to receive a patient treatment record corresponding to the selected patient treatment record from the medical information management system;

to display the medical events defined by the case chronology template corresponding to the selected location and, for each of the medical events, a current value of the time record associated with the medical event as indicated by the received patient treatment record;

to receive input of a time update indicating a time for a selected one of the medical events for the received patient treatment record;

to communicate the time update to the medical information management system;

to receive updated information for the received patient treatment record from the medical information management system, the updated information incorporating the time update; and

to update the display of the medical events to reflect the updated information.

2. The apparatus ofclaim 1, wherein displaying the list of patient treatment records further comprises, for each of the patient treatment records, displaying an indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

3. The apparatus ofclaim 1, wherein displaying the medical events defined by the case chronology template corresponding to the selected location comprises organizing and displaying the medical events based on predefined relationships between the medical events defined by the case chronology template, wherein organizing the medical events further comprises nesting the medical events within a related one or more other medical events and visually emphasizing the nested medical events to convey the predefined relationships.

4. The apparatus ofclaim 1, wherein the processor is further operable, when executing the medical information management application, in response to a refresh request, to display an updated list of patient treatment records received from the medical information management system, wherein displaying the updated list comprises, for each of the patient treatment records, displaying an updated indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

5. The apparatus ofclaim 1, wherein the processor is further operable, when executing the medical information management application, to display a countdown timer to indicate a remaining time for a medical procedure, the medical procedure corresponding to the displayed medical events.

6. The apparatus ofclaim 1, wherein receiving input of the time update comprises confirming a current time as the indicated time for the selected one of the medical events for the received patient treatment record.

7. The apparatus ofclaim 1, wherein the received patient treatment record further comprises a case checklist for treatment case items, and the processor is further operable, when executing the medical information management application to:

display the case checklist of case items defined by a case checklist template maintained by the medical information management system and corresponding to the selected location and, for each of the case items, a current case item value as indicated by the received patient treatment record;

receive input of a case item update indicating a case item value for a selected one of the case items for the received patient treatment record;

communicate the case item update to the medical information management system; and

receive updated information for the received patient treatment record from the medical information management system, the updated information incorporating the case item update; and

update the display of the case checklist of case items to reflect the updated information.

8. The apparatus ofclaim 1, wherein communicating the time update to the medical information management system causes transition of a current phase of care indicated in the selected patient treatment record from a first one of a plurality of predefined phases of care to a second one of the predefined phases of care.

9. A method comprising:

identifying a selected one of the practice locations;

displaying a list of patient treatment records, received from a medical information management system, that correspond to the selected location, the central medical information management system maintaining a plurality case chronology templates, each of the case chronology templates corresponding to a particular one of a plurality of practice locations and defining a series of medical events customized for the particular location, and a plurality of patient treatment records for patients receiving care at the practice locations, each of the patient treatment records linked to one of the practice locations and corresponding to a patient treatment record having a time record associated with each of the medical events defined by the case chronology template corresponding to the location;

identifying a selected one of the patient treatment records based on a user input;

receiving a patient treatment record corresponding to the selected patient treatment record from the medical information management system;

displaying the medical events defined by the case chronology template corresponding to the selected location and, for each of the medical events, a current value of the time record associated with the medical event as indicated by the received patient treatment record;

receiving input of a time update indicating a time for a selected one of the medical events for the received patient treatment record;

communicating the time update to the medical information management system;

receiving updated information for the received patient treatment record from the medical information management system, the updated information incorporating the time update; and

updating a display of the medical events to reflect the updated information.

10. The method ofclaim 9, wherein displaying the list of patient treatment records further comprises, for each of the patient treatment records, displaying an indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

11. The method ofclaim 9, wherein displaying the medical events defined by the case chronology template corresponding to the selected location comprises organizing and displaying the medical events based on predefined relationships between the medical events defined by the case chronology template, wherein organizing the medical events further comprises nesting the medical events within a related one or more other medical events and visually emphasizing the nested medical events to convey the predefined relationships.

12. The method ofclaim 9, further comprising, in response to a refresh request, displaying an updated list of patient treatment records received from the medical information management system, wherein displaying the updated list comprises, for each of the patient treatment records, displaying an updated indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

13. The method ofclaim 9, further comprising displaying a countdown timer to indicate a remaining time for a medical procedure, the medical procedure corresponding to the displayed medical events.

14. The method ofclaim 9, wherein receiving input of the time update comprises confirming a current time as the indicated time for the selected one of the medical events for the received patient treatment record.

15. The method ofclaim 9, wherein the received patient treatment record further comprises a case checklist for treatment case items, and the method further comprises:

displaying the case checklist of case items defined by a case checklist template maintained by the medical information management system and corresponding to the selected location and, for each of the case items, a current case item value as indicated by the received patient treatment record;

receiving input of a case item update indicating a case item value for a selected one of the case items for the received patient treatment record;

communicating the case item update to the medical information management system; and

receiving updated information for the received patient treatment record from the medical information management system, the updated information incorporating the case item update; and

updating the display of the case checklist of case items to reflect the updated information.

16. The method ofclaim 9, wherein communicating the time update to the medical information management system causes transition of a current phase of care indicated in the selected patient treatment record from a first one of a plurality of predefined phases of care to a second one of the predefined phases of care.

17. A system, comprising:

a central medical information management system operable to maintain a plurality case chronology templates, each of the case chronology templates corresponding to a particular one of a plurality of practice locations and defining a series of medical events customized for the particular location, and a plurality of patient treatment records for patients receiving care at the practice locations, each of the patient treatment records linked to one of the practice locations and corresponding to a patient treatment record having a time record associated with each of the medical events defined by the case chronology template corresponding to the location;

one or more medical information management applications each resident on a wireless handheld device and operable, when executed, to:

identify a selected one of the practice locations;

display a list of patient treatment records, received from the medical information management system, that correspond to the selected location;

identify a selected one of the patient treatment records based on a user input;

receive a patient treatment record corresponding to the selected patient treatment record from the medical information management system;

display the medical events defined by the case chronology template corresponding to the selected location and, for each of the medical events, a current value of the time record associated with the medical event as indicated by the received patient treatment record;

receive input of a time update indicating a time for a selected one of the medical events for the received patient treatment record;

communicate the time update to the medical information management system;

receive updated information for the received patient treatment record from the medical information management system, the updated information incorporating the time update; and

update a display of the medical events to reflect the updated information.

18. The system ofclaim 17, wherein displaying the list of patient treatment records further comprises, for each of the patient treatment records, displaying an indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

19. The system ofclaim 17, wherein displaying the medical events defined by the case chronology template corresponding to the selected location comprises organizing and displaying the medical events based on predefined relationships between the medical events defined by the case chronology template, wherein organizing the medical events further comprises nesting the medical events within a related one or more other medical events and visually emphasizing the nested medical events to convey the predefined relationships.

20. The system ofclaim 17, wherein the one or more medical information management applications are further operable, when executed, in response to a refresh request, to display an updated list of patient treatment records received from the medical information management system, wherein displaying the updated list comprises, for each of the patient treatment records, displaying an updated indication of the one of medical events with the most current time record in the corresponding patient treatment record and the time value of the most current time record.

21. The system ofclaim 17, wherein the one or more medical information management applications are further operable, when executed, to display a countdown timer to indicate a remaining time for a medical procedure, the medical procedure corresponding to the displayed medical events.

22. The system ofclaim 17, wherein receiving input of the time update comprises confirming a current time as the indicated time for the selected one of the medical events for the received patient treatment record.

23. The system ofclaim 17, wherein the received patient treatment record further comprises a case checklist for treatment case items, and the one or more medical information management applications are further operable, when executed, to:

display the case checklist of case items defined by a case checklist template maintained by the medical information management system and corresponding to the selected location and, for each of the case items, a current case item value as indicated by the received patient treatment record;

receive input of a case item update indicating a case item value for a selected one of the case items for the received patient treatment record;

communicate the case item update to the medical information management system; and

receive updated information for the received patient treatment record from the medical information management system, the updated information incorporating the case item update; and

update the display of the case checklist of case items to reflect the updated information.

24. The system ofclaim 17, wherein communicating the time update to the medical information management system causes transition of a current phase of care indicated in the selected patient treatment record from a first one of a plurality of predefined phases of care to a second one of the predefined phases of care.

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