US20130043997A1 - Weight loss or weight management system - Google Patents

Abstract

A system for weight loss or weight management of a person may include a monitoring unit and remote computing system. The monitoring unit includes a transducer arranged to generate a signal representative of the patient's weight. It further includes a processor operatively coupled to the transducer and to a memory device. Further, an output device and an input device are operatively coupled to the processor. The memory device is programmed with a set of instructions causing the processor to cooperate with the output device to present questions directed toward weight loss and to cooperate with the input device to receive answers to the questions. The remote computing system is in communication with the monitoring unit. The remote computing system is programmed to receive the answers provided by the person and to receive the signal representative of the person's weight. The remote computing system generates an alert on the basis thereof.

Description

RELATED APPLICATIONS
• This application is a continuation-in-part of U.S. application Ser. No. 10/093,948 filed on Mar. 7, 2002, entitled “REMOTE SYSTEM FOR AMBULATORY COPD PATIENTS,” which is a continuation-in-part of U.S. application Ser. No. 09/949,197 filed on Sep. 7, 2001, entitled “APPARATUS AND METHOD FOR TWO-WAY COMMUNICATION IN A DEVICE FOR MONITORING AND COMMUNICATING WELLNESS PARAMETERS OF AMBULATORY PATIENTS,” which is a continuation-in-part of U.S. Pat. No. 6,290,646 filed on Apr. 16, 1999, entitled “APPARATUS AND METHOD FOR MONITORING AND COMMUNICATING WELLNESS PARAMETERS OF AMBULATORY PATIENTS,” all of which are hereby incorporated by reference in their entirety.
BACKGROUND
• There is a need in the medical profession for an apparatus and method capable of monitoring and transmitting physiological and wellness parameters of ambulatory patients to a remote site where a medical professional caregiver evaluates such physiological and wellness parameters. Specifically, there is a need for an interactive apparatus that is coupled to a remote computer such that a medical professional caregiver can supervise and provide medical treatment to remotely located ambulatory patients.
• There is needed an apparatus that monitors and transmits physiological and wellness parameters of ambulatory patients to a remote computer, whereby a medical professional caregiver evaluates the information and provokes better overall health care and treatment for the patient. Accordingly, such an apparatus can be used to prevent unnecessary hospitalizations of such ambulatory patients.
• Also, there is needed an apparatus for monitoring and transmitting such physiological and wellness parameters that is easy to use and that is integrated into a single unit. For example, there is a need for an ambulatory patient monitoring apparatus that comprises: a transducing device for providing electronic signals representative of measured physiological parameters, such as weight; an input/output device; and a communication device as a single integrated unit that offers ambulatory patients ease of use, convenience and portability.
• Patients suffering from chronic diseases, such as chronic heart failure, will benefit from such home monitoring apparatus. These patients normally undergo drug therapy and lifestyle changes to manage their medical condition. In these patients, the medical professional caregiver monitors certain wellness parameters and symptoms including: weakness, fatigue, weight gain, edema, dyspnea (difficulty breathing or shortness of breath), nocturnal cough, orthopnea (inability to lie flat in bed because of shortness of breath), and paroxysmal nocturnal dyspnea (awakening short of breath relieved by sitting or standing); and body weight to measure the response of drug therapy. Patients will also benefit from daily reminders to take medications (improving compliance), reduce sodium intake and perform some type of exercise. With the information received from the monitoring device, the medical professional caregiver can determine the effectiveness of the drug therapy, the patient's condition, whether the patient's condition is improving or whether the patient requires hospitalization or an office consultation to prevent the condition from getting worse.
• Accordingly, there is needed an apparatus and method for monitoring the patients from a remote location, thus allowing medical professional caregivers to receive feedback of the patient's condition without having to wait until the patient's next office visit. In addition, there is needed an apparatus and method that allows medical professional caregivers to monitor and manage the patient's condition to prevent the rehospitalization of such patient, or prevent the patient's condition from deteriorating to the point where hospitalization would be required. As such, there are social as well as economic benefits to such an apparatus and method.
• The patient receives the benefits of improved health when the professional caregiver is able to monitor and quickly react to any adverse medical conditions of the patient or to any improper responses to medication. Also, society benefits because hospital resources will not be utilized unnecessarily.
• As a group, patients suffering from chronic heart failure are the most costly to treat. There are approximately 5 million patients in the U.S.A. and 15 million worldwide with chronic heart failure. The mortality rate of patients over 65 years of age is 50%. Of those that seek medical help and are hospitalized, 50% are rehospitalized within 6 months. Of these, 16% will be rehospitalized twice. The patients that are hospitalized spend an average of 9.1 days in the hospital at a cost of $12,000.00 for the period. Accordingly, there is a need to reduce the rehospitalization rate of chronic heart failure patients by providing improved in-home patient monitoring, such as frequently monitoring the patient's body weight and adjusting the drug therapy accordingly.
• Approximately 60 millionAmerican adults ages 20 through 74 are overweight. Obesity is a known risk factor for heart disease, high blood pressure, diabetes, gallbladder disease, arthritis, breathing problems, and some forms of cancer such as breast and colon cancer. Americans spend $33 billion dollars annually on weight-reduction products and services, including diet foods, products and programs.
• There is a need in the weight management profession for an apparatus and method capable of monitoring and transmitting physiological and wellness parameters of overweight/obese patients to a remote site where a weight management professional or nutritionist evaluates such physiological and wellness parameters. Specifically, there is a need for an interactive apparatus that is coupled to a remote computer such that a weight management professional or nutritionist can supervise and provide nutritional guidance to remotely located individuals.
• The apparatus allows overweight individuals to participate in a weight loss/management program with accurate weight monitoring from home. The apparatus improves the convenience for the individual participant by eliminating the need to constantly commute to the weight management center and “weigh-in.” Furthermore, the individual can participate in a weight management program while under professional supervision from the privacy and comfort of their own home. Moreover, the apparatus allows the weight management professional to intervene and adapt the individuals diet and exercise routine based on the weight and wellness information received.
• For the foregoing reasons, there is a need for an apparatus, system and method capable of monitoring and transmitting physiological and wellness parameters of ambulatory patients, such as body weight, to a remote location where a medical professional caregiver, weight management professional or nutritionist can evaluate and respond to the patient's medical wellness condition.
SUMMARY
• Against this backdrop the present invention was created. A system for weight loss or weight management of a person may include a monitoring unit and a remote computing system. The monitoring unit may include a transducer arranged to generate a signal representative of the patient's weight. It may further include a processor operatively coupled to the transducer and to a memory device. Further, an output device and an input device may be operatively coupled to the processor. The memory device is programmed with a set of instructions causing the processor to cooperate with the output device to present questions directed toward weight loss and to cooperate with the input device to receive answers to the questions. The remote computing system may be in communication with the monitoring unit. The remote computing system may be programmed to receive the answers provided by the person and to receive the signal representative of the person's weight. The remote computing system may generate an alert on the basis thereof.
• According to another embodiment, a system for weight loss or weight management of a person may include a monitoring unit and a remote computing system. The monitoring unit may include a transducer arranged to generate a signal representative of the patient's weight. It may further include a processor operatively coupled to the transducer and to a memory device. Further, an output device and an input device may be operatively coupled to the processor. The memory device is programmed with a set of instructions causing the processor to cooperate with the output device to present questions directed toward weight loss, to cooperate with the input device to receive answers to the questions, and to cooperate with the output device to present an indication of the person's weight loss progress. The remote computing system may be in communication with the monitoring unit. The remote computing system may be programmed to receive the answers provided by the person and to receive the signal representative of the person's weight. The remote computing system may generate an alert on the basis thereof.
• According to another embodiment, a method for weight loss or weight management of a person may include generating a signal representative of the person's weight with a transducer. Questions directed toward weight loss are presented with a processor operatively coupled to an output device and to the transducer. Answers provided by the person via an input device operably coupled to the processor are received. Answers to the questions and the signal representative of the person's weight are transmitted to a remote computing system. The remote computing system may generate an alert on the basis of answers to the questions presented to the person and the signal representative of the person's weight.
BRIEF DESCRIPTION OF THE DRAWINGS
• These and other features, aspects and advantages of the invention will become better understood with regard to the following description, appended claims and accompanying drawings where:
• FIGS. 1A-E illustrates several embodiments of the monitoring apparatus in accordance with the invention;
• FIG. 2 illustrates a monitoring apparatus with a support member in accordance with one embodiment of the invention;
• FIG. 3 illustrates a monitoring apparatus with a support member in accordance with one embodiment of the invention;
• FIG. 4 is a functional block diagram of a microprocessor system forming an environment in which one embodiment of the invention may be employed;
• FIG. 5 is functional block diagram of a microprocessor system forming the environment in which one embodiment of the invention may be employed;
• FIG. 6 is a functional block diagram of a microprocessor system forming the environment in which one embodiment of the invention may be employed;
• FIG. 7 illustrates a system in which one embodiment of the invention may be employed;
• FIG. 8 is a logic flow diagram illustrating the steps utilized to implement one embodiment of the invention;
• FIG. 9 illustrates a sectional view of the electronic scale in accordance with one embodiment of the invention; and
• FIG. 10 illustrates a top plate of the electronic scale in accordance with one embodiment of the invention.
• FIG. 11 illustrates a high-level depiction of a monitoring system utilizing two-way communication, in accordance with one embodiment of the present invention.
• FIG. 12 depicts a flow of operation that permits two-way communication between a central computer and a monitoring apparatus.
• FIG. 13 depicts another flow of operation that permits two-way communication between a central computer and a monitoring apparatus.
• FIG. 14 depicts yet another flow of operation that permits two-way communication between a central computer and a monitoring apparatus.
• FIG. 15 depicts a flow of operation that permits real-time two-way communication between a central computer and a monitoring apparatus.
• FIG. 16 depicts a scheme of asking customized questions and collecting the answers thereto.
• FIG. 17 illustrates a graphical user interface that may be used in conjunction with software running on a central computer for the purpose of scheduling questions to be uploaded each day to a monitoring apparatus for questioning of a patient.
• FIG. 18 illustrates a graphical user interface that may be used in conjunction with software running on a central computer for presenting a set of trending data.
• FIG. 19 depicts a collapsible scale with carpet-spike pads, in accordance with one embodiment of the invention.
• FIG. 20 depicts an embodiment of the present invention, in which a physiological parameter-measuring device is an optional component.
• FIG. 21 depicts an embodiment of a system, in which a physiological parameter-measuring device is an optional component.
• FIG. 22 depicts a memory device programmed with a set of question hierarchies.
• FIG. 23 depicts a particular question hierarchy logical structure, according to one embodiment of the present invention.
• FIG. 24 depicts another question hierarchy logical structure, according to one embodiment of the present invention.
• FIG. 25 depicts another question hierarchy logical structure, according to one embodiment of the present invention.
• FIG. 26 depicts yet another question hierarchy logical structure, according to one embodiment of the present invention.
• FIG. 27 depicts one method of determining whether a patient is in need of medical assistance, based upon the patient's response to questions presented from a question hierarchy.
• FIG. 28 depicts another method of determining whether a patient is in need of medical assistance, based upon the patient's response to questions presented from a question hierarchy.
• FIG. 29 depicts a questioning scheme according to one embodiment of the present invention.
• FIG. 30 depicts an exemplary question sequence composed of four categories, according to one embodiment of the present invention.
• FIG. 31 depicts a questioning scheme influenced by a mode of operation, according to one embodiment of the present invention.
• FIG. 32 depicts an example of execution flow for a monitoring unit designed for encouraging weight loss or weight management, according to one embodiment of the present invention.
• FIG. 33 depicts a program phase screen that permits a user of the remote computing system to divide the person's weight loss or weight management program into phases, according to one embodiment of the present invention.
• FIG. 34 depicts a verification screen that may be executed by the remote computing system according to one embodiment of the present invention.
• FIG. 35 depicts a set-up screen that may be executed by the remote computing system according to one embodiment of the present invention.
DESCRIPTION
• The embodiments of the invention described herein are implemented as a medical apparatus, system and method capable of monitoring wellness parameters and physiological data of ambulatory patients and transmitting such parameters and data to a remote location. At the remote location a medical professional caregiver monitors the patient's condition and provides medical treatment as may be necessary.
• The monitoring device incorporates transducing devices for converting the desired measured parameters into electrical signals capable of being processed by a local computer or microprocessor system. The device interacts with the ambulatory patient and then, via an electronic communication device such as a modem, transmits the measured parameters to a computer located at a remote site. At the remote location the various indicia of the ambulatory patient's condition are monitored and analyzed by the medical professional caregiver. To provide the ambulatory patient with an added level of convenience and ease of use, such monitoring device is contained in a single integrated package. Communication is established between the monitoring apparatus and a remote computer via modem and other electronic communication devices that are generally well known commercially available products. At the remote location, the caregiver reviews the patient's condition based on the information communicated (e.g. wellness parameters and physiological data) and provokes medical treatment in accordance with such information.
• Referring now toFIG. 1A, as this embodiment of the invention is described herein, an integrated monitoring apparatus is shown generally at10. The integratedmonitoring apparatus10 includes anelectronic scale18. Theelectronic scale18 further includes atop plate11 and abase plate12. The integratedmonitoring apparatus10 further includes ahousing14 and asupport member16A. Thebase plate12 is connected to thehousing14 through thesupport member16A. Thehousing14 further includes output device(s)30 and input device(s)28. Theapparatus10 is integrated as a single unit with the support member coupling thebase plate12 and thehousing14, thus providing a unit in a one piece construction.
• It will be appreciated that other physiological transducing devices can be utilized in addition to theelectronic scale18. For example, blood pressure measurement apparatus and electrocardiogram (EKG) measurement apparatus can be utilized with the integratedmonitoring apparatus10 for recordation and/or transmission of blood pressure and EKG measurements to a remote location. It will be appreciated that other monitoring devices of physiological body functions that provide an analog or digital electronic output may be utilized with themonitoring apparatus10.
• Referring toFIGS. 1B,1C,1D and1E it will be appreciated that thesupport member16A (FIG. 1A) can be made adjustable. For example,FIG. 1B illustrates an embodiment of the invention utilizing atelescoping support member16B. Likewise,FIG. 1C illustrates an embodiment of the invention utilizing a folding articulatedsupport member16C.FIG. 1D illustrates yet another embodiment of the invention utilizingsupport member16D that folds at apivot point25 located at its base. It will also be appreciated that other types of articulated and folding support members may be utilized in other embodiments of the invention. For example,FIG. 1E illustrates an embodiment of the invention providing asupport member16E that is removably insertable into asocket23. Acable22 is passed through thesupport member16E to carry electrical signals from theelectronic scale18 to thehousing14 for further processing. Atether20 is provided to restrain the movement of thesupport member16E relative to thebase plate12 once the it is removed from thesocket23.
• FIG. 2 illustrates an embodiment of the invention where thesupport member82 folds aboutpivot point84. Folding the integrated monitoring apparatus aboutpivot point84 provides a convenient method of shipping, transporting or moving the apparatus in a substantially horizontal orientation. The preferred direction of folding is indicated in the figure, however, thesupport member82 can be made to fold in either direction. Furthermore, an embodiment of the invention providesrubber feet85 underneath thebase plate12.
• Furthermore,FIG. 3 illustrates one embodiment of the invention providing an articulated, foldingsupport member86. Thesupport member86 folds at two hinged pivot points88,90. Also illustrated is a sectional view of thescale18,top plate11,base plate12,load cell100 andstrain gage102.
• Referring now toFIG. 4, amicroprocessor system24 including aCPU38, amemory40, an optional input/output (I/O)controller42 and abus controller44 is illustrated. It will be appreciated that themicroprocessor system24 is available in a wide variety of configurations and is based on CPU chips such as the Intel, Motorola or Microchip PIC family of microprocessors or microcontrollers.
• It will be appreciated by those skilled in the art that the monitoring apparatus requires anelectrical power source19 to operate. As such, the monitoring apparatus may be powered by: ordinary household A/C line power, DC batteries or rechargeable batteries.Power source19 provides electrical power to the housing for operating the electronic devices. A power source for operating theelectronic scale18 is generated within the housing, however those skilled in the art will recognize that a separate power supply may be provided or thepower source19 may be adapted to provide the proper voltage or current for operating theelectronic scale18.
• Thehousing14 includes amicroprocessor system24, an electronic receiver/transmitter communication device such as amodem36, aninput device28 and anoutput device30. Themodem36 is operatively coupled to themicroprocessor system24 via theelectronic bus46, and to aremote computer32 via acommunication network34 andmodem35. Thecommunication network34 being any communication network such as the telephone network, wide area network or Internet. It will be appreciated that themodem36 is a generally well known commercially available product available in a variety of configurations operating at a variety of BAUD rates. In one embodiment of the invention themodem36 is asynchronous, operates at 2400 BAUD and is readily available off-the-shelf from companies such as Rockwell or Silicon Systems Inc. (SSI).
• It will be appreciated that output device(s)30 may be interfaced with themicroprocessor system24. Theseoutput devices30 include a visualelectronic display device31 and/or asynthetic speech device33.Electronic display devices31 are well known in the art and are available in a variety of technologies such as vacuum fluorescent, liquid crystal or Light Emitting Diode (LED). The patient reads alphanumeric data as it scrolls on theelectronic display device31.Output devices30 include a syntheticspeech output device33 such as a Chipcorder manufactured by ISD (part No. 4003). Still,other output devices30 include pacemaker data input devices, drug infusion pumps or transformer coupled transmitters.
• It will be appreciated that input device(s)28 may be interfaced with themicroprocessor system24. In one embodiment of the invention anelectronic keypad29 is provided for the patient to enter responses into the monitoring apparatus. Patient data entered through theelectronic keypad29 may be scrolled on theelectronic display31 or played back on thesynthetic speech device33.
• Themicroprocessor system24 is operatively coupled to themodem36, the input device(s)28 and the output device(s)30. Theelectronic scale18 is operatively coupled to thecentral system24. Electronic measurement signals from theelectronic scale18 are processed by the A/D converter15. This digitized representation of the measured signal is then interfaced to theCPU38 via theelectronic bus46 and thebus controller44. In one embodiment of the invention, the physiological transducing device includes theelectronic scale18. Theelectronic scale18 is generally well known and commercially available. Theelectronic scale18 may include one or more of the following elements: load cells, pressure transducers, linear variable differential transformers (LVDTs), capacitance coupled sensors, strain gages and semiconductor strain gages. These devices convert the patient's weight into a useable electronic signal that is representative of the patient's weight.
• In will be appreciated that Analog-to-Digital (A/D) converters are also generally well known and commercially available in a variety of configurations. Furthermore, an A/D converter15 may be included within the physiological transducing device or within themicroprocessor system24 or within thehousing14. One skilled in the art would have a variety of design choices in interfacing a transducing device comprising an electronic sensor or transducer with themicroprocessor system24.
• Thescale18 may provide an analog or digital electronic signal output depending on the particular type chosen. If theelectronic scale18 provides an analog output signal in response to a weight input, the analog signal is converted to a digital signal via the A/D converter15. The digital signal is then interfaced with theelectronic bus46 and theCPU38. If theelectronic scale18 provides a digital output signal in response to a weight input, the digital signal may be interfaced withelectronic bus46 and theCPU38.
• FIG. 5 illustrates one embodiment of the invention where the communication device is a radio frequency (RF) transceiver. The transceiver comprises a firstradio frequency device50 including anantenna52, and a secondradio frequency device54, including anantenna56. The firstradio frequency device52 is operatively coupled to themicroprocessor system24 via theelectronic bus46, and is in radio communication with the secondradio frequency device54. The secondradio frequency device54 is operatively coupled through amicroprocessor55 which is operatively coupled to amodem58. Themodem58 is coupled to thecommunication network34 and is in communication with theremote computer32 via themodem35. The firstradio frequency device50 and the secondradio frequency device54 are remotely located, one from the other. It will be appreciated that suchradio frequency devices50,54 are generally well known and are commercially available products from RF Monolithics Inc. (RFM).
• In one embodiment of the invention, such transceivers operate at radio frequencies in the range of 900-2400 MHz. Information from themicroprocessor system24 is encoded and modulated by thefirst RF device50 for subsequent transmission to thesecond RF device54, located remotely therefrom. Thesecond RF device54 is coupled to aconventional modem58 via themicroprocessor55. Themodem58 is coupled to thecommunication network34 via a in-house wiring connection and ultimately to themodem35 coupled to theremote computer32. Accordingly, information may be transmitted to and from themicroprocessor system24 via theRF devices50,54 via a radio wave or radio frequency link, thus providing added portability and flexibility to themonitoring apparatus10. It will be appreciated that various other communications devices may be utilized such as RS-232 serial communication connections, Internet communications connection as well as satellite communication connections. Other communications devices that operate by transmitting and receiving infra-red (IR) energy can be utilized to provide a wireless communication link between thepatient monitoring apparatus10 and a conveniently located network connection. Furthermore, X-10™ type devices can also be used as part of a communication link between thepatient monitoring apparatus10 and a convenient network connection in the home. X-10 USA and other companies manufacture a variety of devices that transmit/receive data without the need for any special wiring. The devices works by sending signals through the home's regular electrical wires using what is called power line carrier (PLC).
• Referring now toFIG. 6, one embodiment of the invention wherein a digital electronic scale21 is provided. Digital weight measurements from the digital electronic scale21 may be interfaced with the microprocessor system andCPU38 without requiring additional amplification, signal conditioning and A/D converters.
• Referring now toFIG. 7, a two way communication system in accordance with the principals of the present invention is shown. The physiological data of an ambulatory patient is monitored utilizingmonitoring apparatus10 at alocal site58 and is transmitted to aremote computer32 located at aremote computer site62 viacommunication network34. At the remote computer site62 a medical professional caregiver such as a nurse, physician or nurse practitioner monitors the patient data and provokes treatment in accordance with such data.
• Operations to perform the preferred embodiment of the invention are shown inFIG. 8.Block64 illustrates the operation of monitoring or measuring the ambulatory patient's physiological parameter. In one embodiment of the invention, namely for chronic heart failure patients, the physiological parameter monitored is the patient's weight. However, it will be appreciated by those skilled in the art that the physiological parameters may include blood pressure, EKG, temperature, urine output and any other.
• Block66 illustrates the operation of converting a monitored or measured physiological parameter from a mechanical input to an electronic output by utilizing a transducing device. In one embodiment of the invention the transducing device is anelectronic scale18, which converts the patient's weight into a useable electronic signal.
• Atblock68, themicroprocessor system24 processes the electronic signal representative of the transduced physiological parameter. If the resulting parameter value is within certain preprogrammed limits themicroprocessor system24 initiates communication within theremote computer32 via thecommunication device36 over thecommunication network34.
• Block70 illustrates the operation whereby information such as wellness parameters and physiological data are communicated between themonitoring apparatus10 and the ambulatory patient. An exemplary list of the questions asked to the patient by the monitoring apparatus are provided in Table 5.
• Referring now toFIGS. 7 and 8, upon establishing communication between thelocal monitoring apparatus10, at thelocal site58, and theremote computer32, atremote site62, block72 illustrates the operation of communicating or transmitting processed signals representative of physiological data and wellness parameters from thelocal site58 to theremote site62.
• FIG. 9 is a sectional view thescale18 portion of one embodiment of the invention. Thescale18 comprises atop plate11 and abase plate12. Thetop plate11 and thebase plate12 having a thickness “T”. Aload cell100 is disposed between thetop plate11 and thebase plate12 and rests on support/mountingsurfaces96 and98.
• Theload cell100 is a transducer that responds to a forces applied to it. During operation, when a patient steps on theelectronic scale18, theload cell100 responds to a force “F” transmitted through thetop plate11 and a first support/mountingsurface96. The support/mountingsurface96 is contact with a first end on a top side of theload cell100. A force “F” that is equal and opposite to “F” is transmitted from the surface that theelectronic scale18 is resting on, thorough thebase plate12 and a second support/mountingsurface98. The second support/mountingsurface98 is in contact with a second end on a bottom side of theload cell100. In one embodiment, theload cell100 is attached to thetop plate11 and thebase plate12, respectively, with bolts that engage threaded holes provided in theload cell100. In one embodiment theload cell100 further comprises astrain gage102.
• Thestrain gage102 made from ultra-thin heat-treated metallic foils. Thestrain gage102 changes electrical resistance when it is stressed, e.g. placed in tension or compression. Thestrain gage102 is mounted or cemented to theload cell100 using generally known techniques in the art, for example with specially formulated adhesives, urethanes, epoxies or rubber latex. The positioning of thestrain gage102 will generally have some measurable effect on overall performance of theload cell100. Furthermore, it will be appreciated by those skilled in the art that additional reference strain gages may be disposed on the load cell where they will not be subjected to stresses or loads for purposes of temperature compensating thestrain gage102 under load. During operation over varying ambient temperatures, signals from the reference strain gages may be added or subtracted to the measurement signal of thestrain gage102 under load to compensate for any adverse effects of ambient temperature on the accuracy of thestrain gage102.
• The forces, “F” and “F”, apply stress to the surface on which thestrain gage102 is attached. The weight of the patient applies a load on thetop plate11. Under the load the strain gage(s)102 mounted to the top of theload cell100 will be in tension/compression as the load cell bends. As thestrain gage102 is stretched or compressed its resistance changes proportionally to the applied load. Thestrain gage102 is electrically connected such that when an input voltage or current is applied to thestrain gage102, an output current or voltage signal is generated which is proportional to the force applied to theload cell100. This output signal is then converted to a digital signal by A/D converter15.
• The design of theload cell100 having a first end on a top side attached to thetop plate11 and a second end on a bottom side attached to thebase plate12 provides a structure for stressing thestrain gage102 in a repeatable manner. The structure enables a more accurate and repeatable weight measurement. This weight measurement is repeatable whether thescale18 rests on a rigid tile floor or on a carpeted floor.FIG. 10 illustrates one embodiment of thetop plate11 that provides four mountingholes106 for attaching thebase plate12 to one end of theload cell100. Thebase plate12 provides similar holes for attaching to the other end of theload cell100. Thetop plate11 and the base plate12 (not shown) each comprise a plurality of stiffeningribs108 that add strength and rigidity to theelectronic scale18.
• Table 1 shows multiple comparative weight measurements taken with theelectronic scale18 resting on a tile floor and a carpeted floor without rubber feet on thescale18. The measurements were taken using thesame load cell100. The thickness “T” of thetop plate11 and supporting ribs was 0.125″ except around the load cell, where the thickness of the supporting ribs was 0.250″. The thickness of theload cell100 support/mountingsurfaces96,98 (FIG. 9) was 0.375″. As indicated in Table 1, with thescale18 resting on a tile floor, the average measured weight was 146.77 lbs., with a standard deviation of 0.11595. Subsequently, with thescale18 resting on a 0.5″ carpet with 0.38″ pad underneath and an additional 0.5″ rug on top of the carpet, the average measured weight was 146.72 lbs., with a standard deviation of 0.16866.

• TABLE 1
  Thick Scale Parts Around Load Cell 0.250″

  	TILE (lbs.)	CARPET (lbs.)

  	146.9	146.7
  	146.7	147
  	146.9	146.6
  	146.8	146.7
  	146.6	146.6
  	146.8	147
  	146.8	146.5
  	146.7	146.6
  	146.9	146.8
  	146.6	146.7

  	0.11595 (stddev)	0.16866	(stddev)
  	146.77 (average)	146.72	(average)

• Table 2 shows multiple weight measurements taken with thescale18 on a tile floor and a carpeted floor with rubber feet on the bottom of thescale18. The measurements were taken using thesame load cell100. The thickness “T” of thetop plate11 was 0.125″ including the thickness around the load cell. As indicated in Table 2, with thescale18 resting on a tile floor on rubber feet, the average measured weight was 146.62 lbs., with a standard deviation of 0.07888. Subsequently, with thescale18 resting on a 0.5″ carpet with 0.38″ pad underneath and an additional 0.5″ rug on top of the carpet, the average measured weight was 146.62 lbs., with a standard deviation of 0.04216.

• TABLE 2
  Thin Scale Parts Throughout 0.125″

  	TILE (lbs.)	CARPET (lbs.)
  	146.7	146.7
  	146.7	146.7
  	146.6	146.6
  	146.6	146.6
  	146.6	146.6
  	146.6	146.6
  	146.5	146.6
  	146.7	146.6
  	146.5	146.6
  	146.7	146.6
  	0.07888 (stddev)	0.04216 (stddev)
  	146.62 (average)	146.62 (average)

• Table 3 shows multiple weight measurements taken with an off-the-shelf conventional electronic scale. As indicated in table 3, with the off-the-shelf conventional scale resting on the tile floor, the average measured weight was 165.5571 lbs., with a standard deviation of 0.20702. Subsequently, with the off-the-shelf conventional scale resting on a 0.5″ carpet with 0.38″ pad underneath and an additional 0.5″ rug on top of the carpet, the average measured weight was 163.5143 lbs., with a standard deviation of 0.13093.

• TABLE 3
  Off-The-Shelf Conventional Scale

  TILE (lbs.)	CARPET (lbs.)
  165.9	163.5
  165.5	163.4
  165.8	163.7
  165.4	163.6
  165.5	163.6
  165.4	163.5
  165.4	163.3
  —	163.4
  0.20702 (stddev)	0.13093 (stddev)
  165.5571 (average)	163.5143 (average)
  2.042857 (% of difference)	1.249345 (% of difference)

• The summary in Table 4 is a comparative illustration of the relative repeatability of each scale while resting either on a tile floor or on a carpeted floor.

• TABLE 4
  SUMMARY OF DATA:
  Heavy Scale Parts All 0.125″ Except Cell Around the Load Cell 0.250″

  					TILE VS.
  TRIAL	TILE	STDDEV	CARPET	STDDEV	CARPET

  1	146.77	0.1159	146.72	0.1686	0.05
  2	146.67	0.0823	146.72	0.1906	0.05

  Thin Scale Parts All 0.125″

  1

  146.62

  0.0788

  146.62

  0.04216

  0.00

  Off-The-Shelf Conventional Scale

  1	165.55	0.207	163.51	0.1309	2.04

• The foregoing description was intended to provide a general description of the overall structure of several embodiments of the invention, along with a brief discussion of the specific components of these embodiments of the invention. In operating theapparatus10, an ambulatory patient utilizes themonitoring apparatus10 to obtain a measurement of a particular physiological parameter. For example, an ambulatory patient suffering from chronic heart failure will generally be required to monitor his or her weight as part of in-home patient managing system. Accordingly, the patient measures his or her weight by stepping onto theelectronic scale18, integrally located within thebase plate12 of themonitoring apparatus10.
• Referring now toFIG. 4, themodem36 of themonitoring apparatus10 will only activate if the measured weight is within a defined range such as +/−10 lbs, +/−10% or any selected predetermined value of a previous weight measurement. The patient's previous symptom free weight (dry weight) is stored in thememory40. The dry weight is the patient's weight whenever diuretics are properly adjusted for the patient, for example. This prevents false activation of themodem36 if a child, pet, or other person accidentally steps onto theelectronic scale18.
• Upon measuring the weight, themicroprocessor system24 determines whether it is within a defined, required range such as +/−10 lbs. or +/−10% of a previously recorded weight stored inmemory40. Themonitoring apparatus10 then initiates a call via themodem36 to theremote site62. Communications is established between thelocal monitoring apparatus10 and theremote computer32. In one embodiment of the invention, the patient's weight is electronically transferred from themonitoring apparatus10 at thelocal site58 to theremote computer32 at theremote site62. At theremote site62 the computer program compares the patient's weight with the dry weight and wellness information and updates various user screens. The program can also analyze the patient's weight trend over the previous 1-21 days. If significant symptoms and/or excessive weight changes are reported, the system alerts the medical care provider who may provoke a change to the patient's medication dosage, or establish further communication with the patient such as placing a telephone to the patient. The communication between the patient's location and the remote location may be one way or two way communication depending on the particular situation.
• To establish the patient's overall condition, the patient is prompted via the output device(s)30 to answer questions regarding various wellness parameters. An exemplary list of questions, symptoms monitored and the related numerical score is provided in Table 5 as follows:

• TABLE 5
  Health Check Score

  Question	Symptom	Value

  Above Dry Weight?	Fluid accumulation	10
  Are you feeling short of breath?	Dyspnea	10
  Did you awaken during the night	Paroxysmal nocturnal	5
  short of breath?	dyspnea
  Did you need extra pillows last night?	Congestion in thelungs	5
  Are you coughing more than usual?	Congestion in thelungs	3
  Are your ankles or feet swollen?	Pedal edema	5
  Does your stomach feel bloated?	Stomach edema	3
  Do you feel dizzy or lightheaded?	Hypotension	5
  Are you more tired than usual?	Fatigue	2
  Are you taking your medication?	Medication compliance	7
  Has your appetite decreased?	Appetite	2
  Are you reducing your salt intake?	Sodium intake	1
  Did you exercise today?	Fitness	1

• At theremote site62 the medical professional caregiver evaluates the overall score according to the wellness parameter interrogation responses (as shown in Table 5). For example, if the patient's total score is equal to or greater than 10, an exception is issued and will either prompt an intervention by the medical professional caregiver in administering medication, or prompt taking further action in the medical care of the patient.
• The output device(s)30 varies based on the embodiment of the invention. For example, the output device may be asynthetic speech generator33. As such, the wellness parameters are communicated to the patient via the electronicsynthetic speech generator33 in the form of audible speech. It will be appreciated that electronic speech synthesizers are generally well known and widely available. The speech synthesizer converts electronic data to an understandable audible speech. Accordingly, the patient responds by entering either “YES” or “NO” responses into theinput device28, which may include for example, anelectronic keypad29. However, in one embodiment of the invention, the input device may also include a generic speech recognition device such as those made by International Business Machines (IBM), Dragon Systems, Inc. and other providers. Accordingly, the patient replies to the interrogations merely by speaking either “YES” or “NO” responses into the speech recognition input device.
• In embodiments of the invention that includeelectronic display31 as anoutput device30, the interrogations as well as the responses are displayed and/or scrolled across the display for the patient to read. Generally, the electronic display will be positioned such that it is viewable by the patient during the information exchanging process between the patient and theremote computer32.
• Upon uploading the information to theremote computer32, the medical professional caregiver may telephone the patient to discuss, clarify or validate any particular wellness parameter or physiological data point. Furthermore, the medical professional caregiver may update the list of wellness parameter questions listed in Table 5 from theremote site62 over the twoway communication network34. Modifications are transmitted from theremote computer32 viamodem35, over thecommunication network34, throughmodem36 and to themonitoring apparatus10. The modified query list is then stored in thememory40 of themicroprocessor system24.
Two-Way Communication
• FIG. 11 is presented in furtherance of the previous discussion regarding two-way communication between the patient monitoring apparatus and the central computer.FIG. 11 is a high-level depiction of the monitoring system, and may be used as a starting point for a more detailed discussion of the two-way communication schemes.
• As can be seen fromFIG. 11, the system comprises apatient monitoring apparatus1100 and acentral computer1102. Thecentral computer1102 is housed within afacility1104 that is located remote from thepatient monitoring apparatus1100. For example, thepatient monitoring apparatus1100 may be located in the home of anambulatory patient1105, while thecentral computer1102 is located in acardiac care facility1104.
• As described previously, thepatient monitoring apparatus1100 is composed of acentral processor unit1106, which is in communication with aninput device1108, anoutput device1110, and asensor1112. As also previously described thesensor1112 may be a transducer used to convert a physiological measurement into a signal, such as an electrical signal or an optical signal. For example, thesensor1112 may comprise a load cell configured with a strain gauge, arranged to determine the patient's1105 weight; thesensor1112 would represent the patient's1105 weight as an electrical signal.
• As discussed previously, theoutput device1110 may be used to prompt thepatient1105 with questions regarding the patient's wellness. Theoutput device1110 may consist of a visual display unit that displays the questions in a language of the patient's1105 choosing. Alternatively, theoutput device1110 may consist of an audio output unit that vocalizes the questions. In one embodiment, theaudio output unit1110 may vocalize the questions in a language of the patient's1105 choosing.
• As discussed previously, theinput device1108 may be used to receive the patient's1105 response to the questions posed to him/her1105. Theinput device1108 may consist of a keyboard/keypad, a set of buttons (such as a “yes” button and a “no” button), a touch-screen, a mouse, a voice digitization package, or a voice recognition package.
• Thepatient monitoring apparatus1100 communicates with thecentral computer1102 via anetwork1118; thepatient monitoring apparatus1100 uses acommunication device1114 to modulate/demodulate a carrier signal for transmission via thenetwork1118, while the central computer uses acommunication device1116 for the same purpose. Examples ofsuitable communication devices1114 and1116 include internal and external modems for transmission over a telephone network, network cards (such as an Ethernet card) for transmission over a local area network, a network card coupled to some form of modem (such as a DSL modem or a cable modem) for transmission over a wide area network (such as the Internet), or an RF transmitter for transmission to a wireless network. Communication may occur over a television network, such as a cable-based network or a satellite network, or via an Internet network.
• A system composed as described above may be programmed to permit two-way communication between thecentral computer1102 and thepatient monitoring apparatus1100.
• Two-way communication may permit thecentral computer1102 to upload a customized set of questions or messages for presentation to apatient1105 via themonitoring apparatus1100. For example, in the case where themonitoring apparatus1100 monitors the patient's1105 weight, a sudden increase in weight following a high sodium meal might cause the health care provider to send a customized question for presentation to the patient1105: “Did consume any salty food in the last 24 hours?” Such a customized question could be presented to thepatient1105 the next time the patient uses themonitoring apparatus1100 or could be presented to the patient in real time (these options are discussed in greater detail, below). Additionally, a customized message may be scheduled for delivery at certain times (such as every Friday of the week—this is also discussed in greater detail, below). Further, these customized messages may be entered on the fly or selected from a list (this is also discussed in greater detail below).
• FIG. 12 depicts a flow of operations that permits two-way communication between thecentral computer1102 and themonitoring apparatus1100.FIG. 12 presents a flow of interactions between thecentral computer1102 and themonitoring apparatus1100 on a first day (operation1200-1210) and on a second day (1212-1222). In the discussion that follows, it will be assumed that themonitoring apparatus1100 is formed as a scale that monitors a patient's weight, although this need not be the case. It is further assumed that the patient1105 measures his/her weight on a daily basis (although, in principle, any frequency of measurement would operate within the bounds of this embodiment), after which a communication session is initiated between thecentral computer1102 and themonitoring apparatus1100.
• On the first day, operation begins with thepatient1105 stepping on the scale, as shown in operation1200; the patient's1105 weight is measured, transduced, and stored by thecentral processing unit1106. Next, inoperation1202, a memory device is accessed by thecentral processing unit1106 for the purpose of retrieving a set of customized questions downloaded during the previous day. Each question is asked, in a one-by-one fashion, and a corresponding answer received from thepatient1105 via theinput device1108 is recorded (if the customized prompt is merely a statement, the statement is output to the patient and no answer is requested of the patient1105). Next, in operation1204, a communication session is initiated. The session may be initiated manually (for example, by the patient pushing a button); the session may be initiated automatically by the scale at a specific time of the day (such as at midnight, after thepatient1105 is assumed to have weighted himself/herself and recorded his/her answers to the customized wellness questions); the session may be initiated automatically by the scale upon thepatient1105 answering the final question; finally, the session may be initiated by thecentral computer1102 at a specific time of the day (such as at midnight, after thepatient1105 is assumed to have weighted him/herself and recorded his/her answers to the customized wellness questions). During the communication session, customized questions to be asked to thepatient1105 the next day are downloaded by themonitoring apparatus1100, as depicted in operation1206. Additionally, the answers recorded inoperation1202 are uploaded to thecentral computer1102, as depicted inoperation1208. Finally, in operation1210, the communication session is terminated.
• On the second day, the same set of operations takes place, with references to previous and future days now referring to “DAY 1” and “DAY 3,” respectively: in operation1214, the set of questions downloaded during the first day (in operation1206) are asked, and the answers are recorded; similarly, in operation1218, a set of customized questions to be asked on a third day are uploaded to themonitoring apparatus1100.
• Downloading operations (such as operations1206 and1218) and uploading operations (such asoperation1208 and1220) may be influenced by the form ofinput device1108 oroutput device1110 chosen for use by themonitoring apparatus1100. For example, if theoutput device1110 is a visual display, then a set of data representing the text of the question is transmitted to themonitoring apparatus1100 during thedownloading operations1206 and1208. If, however, theoutput device1110 is an audio output device, then a set of data representing a vocalization of the question may be transmitted to themonitoring apparatus1100 during thedownloading operations1206 and1208. In any case, the data being transmitted to themonitoring apparatus1100 may be compressed for the sake of preservation of bandwidth. Similar considerations apply to theuploading operations1208 and1220, based upon the choice ofinput device1108. If theinput device1108 is a set of buttons (for example, a “yes” button and a “no” button), then the data uploaded to thecentral computer1102 is representative of the button that was pushed. If theinput device1108 is a voice digitization package, then the data uploaded to thecentral computer1102 is representative of the digitized voice pattern from thepatient1105. As in the case of the downloading operations, the data being uploaded to thecentral computer1102 may be compressed for the sake of preservation of bandwidth.
• FIGS. 13,14, and15 depict other flows of operation for two-way communication between acentral computer1102 and apatient monitoring apparatus1100. The considerations regarding the format of the data being uploaded and downloaded also apply to the schemes illustrated therein.
• FIG. 13 depicts a flow of operations that permits two-way communication between thecentral computer1102 and themonitoring apparatus1100.FIG. 13 presents a flow of interactions between thecentral computer1102 and themonitoring apparatus1100 on a first day (operation1300-1314) and on a second day (1316-1328). In the discussion that follows, it will be assumed that themonitoring apparatus1100 is formed as a scale that monitors a patient's weight, although this need not be the case. It is further assumed that the patient1105 measures his/her weight on a daily basis (although, in principle; any frequency of measurement would operate within the bounds of this embodiment).
• On the first day, operation begins with a communication session between thecentral computer1102 and themonitoring apparatus1100 being initiated, as shown in operation1300. During this communication session, a set of customized questions to be asked to thepatient1105 later in the day are downloaded by themonitoring apparatus1100, as depicted inoperation1302. Then, in operation1304, the communication session is terminated. The communication session initiated in operation1300 may be initiated by the monitoring apparatus. Additionally, the session may be initiated at a time of the day that justifies the assumption that any new customized questions would have already been entered for downloading by themonitoring device1100. At some point in the day after the termination of the communication session, thepatient1105 weighs himself on the monitoring apparatus, as shown inoperation1306, and the weight is stored by thecentral processor unit1106. Next, in operation1308, a memory device is accessed by thecentral processing unit1106 for the purpose of retrieving the set of customized questions downloaded earlier in the day duringoperation1302. Each question is asked, in a one-by-one fashion, and a corresponding answer received from thepatient1105 via theinput device1108 is recorded. Next, inoperation1310, a communication session is initiated. As in the scheme depicted inFIG. 12, the session may be initiated manually or automatically. During this session, the answers recorded in operation1308 are uploaded to thecentral computer1102, as depicted inoperation1312. Finally, inoperation1314, the communication session is terminated.
• As can be seen fromFIG. 13, the set of operations performed on the second day (operations1316-1328) are identical to the operations performed on the first day (operations1300-1314).
• FIG. 14 depicts another flow of operations that permits two-way communication between thecentral computer1102 and themonitoring apparatus1100. The flow of operations depicted inFIG. 14 is the same as that which is shown inFIG. 13, with minor exceptions. The flow depicted inFIG. 14 is arranged such that thecentral computer1102 initiates the first communication session (in operation1400), during which a set of customized questions are downloaded by the monitoring device; however, later in the day, themonitoring device1100 initiates the second communication session (in operation1410), during which the patient's1105 weight and answers to the customized questions are transmitted to thecentral computer1102. This scheme has the advantage of allowing thecentral computer1102 to initiate the session during which the customized questions are uploaded to themonitoring apparatus1100, thereby ensuring that the communication session occurs after the new questions have been entered by the health care provider (if themonitoring apparatus1100 initiates the communication session, as inFIG. 13, the session may be initiated before the new questions are entered). Just as in the scheme depicted inFIG. 13, the scheme depicted inFIG. 14 employs the same set of operations from day to day.
• FIG. 15 depicts a flow of operations that permits real-time two-way communication between thecentral computer1102 and themonitoring apparatus1100. In the discussion that follows, it will be assumed that themonitoring apparatus1100 is formed as a scale that monitors a patient's weight, although this need not be the case. It is further assumed that the patient is free to weight himself/herself at any time during the day and that the measured weight will be stored. The scheme depicted inFIG. 15 permits thepatient1105 to initiate a communication session, during which the health care provider may, via the central computer, enter questions that are posed to the patient in real-time via themonitoring apparatus1100. The communication session does not end until the health care provider indicates that it has no further questions to ask the patient. Thus, the health care provider may adapt its questions in real-time, based upon the answers received from thepatient1105.
• Operation begins with a communication session between thecentral computer1102 and themonitoring apparatus1100 being initiated, as shown inoperation1500. Next, inoperation1502, thecentral computer1102 generates a visual cue on its graphical user interface to indicate that a particular patient is logged in. A health care provider/operator at thecentral computer1102 is thereby made aware of his/her opportunity to prompt thepatient1105 with customized questions in real-time. Subsequently, inoperation1504, the weight of thepatient1105 is uploaded to the central computer. As mentioned earlier, thepatient1105 is assumed to have weighed himself/herself at a point in the day prior to the initiation of the communication session inoperation1500. This permits thepatient1105 to consistently measure his/her weight at a given point in the day (perhaps immediately upon waking in the morning), yet answer questions regarding his/her symptoms at a point later in the day, so that thepatient1105 has had a chance to judge his/her general feeling of health/illness before answering the questions. Of course, this is an optional feature of the invention and is not crucial. In operation1506, a first customized question is uploaded to the monitoring apparatus. During operation1506, a health care provider/operator may enter a question to be posed to thepatient1105; it is immediately transmitted to themonitoring apparatus1100 and posed to thepatient1105. Inoperation1508, the patient's answer is transmitted to thecentral computer1102. Next, inoperation1510, the operator/health care provider at thecentral computer1102 indicates whether or not any additional questions are pending. If so, control is passed to operation1506, and the additional questions are asked and answered. Otherwise, the communication session is terminated inoperation1512.
Scheduling of Questions and Presentation of Trending Data
• FIG. 16 illustrates a scheme of asking customized questions and collecting the answers thereto. As can be seen fromFIG. 16, a set of customized questions may be downloaded to amonitoring device1100 on DAY N. The customized questions will be asked to thepatient1105, and the answers recorded either later in the day on DAY N or on DAY N+1 (depending upon the particular 2-way scheme employed). The answers to the customized questions are retrieved by thecentral computer1102 onDAY N+1. The particular questions asked from day-to-day may vary, based upon instruction from the health care provider.
• FIG. 17 illustrates a graphical user interface that may be used in conjunction with software running on thecentral computer1102 for the purpose of scheduling the questions to be uploaded each day to the monitoring apparatus1100 (as illustrated byFIG. 16) for questioning of thepatient1105. As can be seen fromFIG. 17, amessage field1700 is provided that permits an operator/health care provider to enter a customized message to be uploaded to themonitoring apparatus1100. A start-date field1702 and an end-date field1704 define the period during which the questions are to be asked; a frequency field indicates1706 the frequency with which the question entered infield1700 is to be asked. For example, if themessage field1700 contained the question “Did you remember to take your medication this week?”, the start-date field1702 contained “Aug. 1, 2001,” the end-date field1704 contained “Sep. 1, 2001,” and thefrequency field1706 contained “Friday,” then thepatient1105 would be prompted with the question “Did you remember to take your medication this week?” on each Friday between Aug. 1, 2001 and Sep. 1, 2001. Analert field1708 permits an operator/health care provider to define an answer that, when provided bypatient1105, sends an alert to the health care provider. For example, in the case where the question was “Did you remember to take your medication this week?”, thealert field1708 may contain the answer “No,” so that the health care provider would be alerted if thepatient1105 indicated that he/she had failed to take his/her medication during the week.
• The data entered via the graphical user interface depicted inFIG. 17 is stored in a database. The data may be organized based upon dates for transmission to themonitoring device1100, so that all of the questions to be uploaded to themonitoring device1100 on a given day may be easily acquired. The data may be sorted other ways, as well. For example, the data may be sorted based upon which questions were asked on which days, so that a presentation of the questions posed to a patient on a given day (or set of days) and the corresponding answers thereto may be easily developed. A graphical user interface that provides such a presentation is depicted inFIG. 18.
• FIG. 18 depicts a graphical user interface that presents all of the customized questions presented to a patient over a particular duration and all of the corresponding answers for each day. This sort of information is referred to as “trending data,” because it permits a health care provider to quickly determine if a particular symptom began regularly exhibiting itself on a certain day, or if a particular symptom is randomly exhibited. As can be seen fromFIG. 18, amessage field1800 is provided which presents a customized question that was asked during the timeframe indicated by thedate bar1801. Under each date presented in thedate bar1801 is an answer field1802-1816, which presents the patient's1105 answer to the question presented in themessage field1800. If a particular question was not asked on a given day, the graphical user interface may so indicate. For example, an answer field1802-1816 may be grayed out on a particular day if the question was not asked, or an answer field may be highlighted on days in which the particular question was asked. As described earlier, the data used to populate fields1800-1816 is retrieved from a database containing each of the questions asked on a given day and each of the corresponding answers.
• Other reporting schemes and graphical user interfaces are taught in U.S. application Ser. No. 09/399,041 filed on Sep. 21, 1999, entitled “MEDICAL WELLNESS PARAMETERS MANAGEMENT SYSTEM, APPARATUS AND METHOD,” which is hereby incorporated by reference in its entirety.
Collapsible Scale/Carpet-Spike Pads
• FIG. 19 depicts acollapsible scale1900 with integrated carpet-spike pads, in accordance with one embodiment of the present invention. As can be seen fromFIG. 19, acollapsible scale1900 is comprised of abase1902, upon which apatient1105 stands in order to weigh himself/herself. Perpendicular to thebase1902 is asupport member1904 which elevates a housing1906 at about waist level. The housing1906 may contain an input device, an output device, a processor, and a communication device. Thesupport member1904 is coupled to thebase1902 via ahinge1914. Thehinge1914 enables thesupport member1904 to fold into a position approximately parallel (though not necessarily coplanar) with thebase1902, thereby permitting thescale1900 to fit easily (and in one piece) into a box suitable for shipping. Another advantage of the collapsible embodiment is that it relieves thepatient1105 of having to assemble the scale at his/her home.
• Thebase1902 may be composed oftop plate1908, upon which thepatient1105 stands, and abase plate1910. Thehinge1914 may be coupled to thesupport member1904 and thetop plate1908, so that if the patient leans upon the housing1906, the force is conducted down thesupport member1904, though thehinge1914, and to thetop plate1908, thereby preserving the validity of the weight measurement. Alternatively, thetop plate1908 may havemember1912 rigidly coupled thereto. In such a case, thehinge1914 may be coupled between thesupport member1904 and the rigidly coupledmember1912.
• In one embodiment of thescale1900, a plurality of carpet-spike pads1916 are attached to the bottom of thebase1902. A carpet-spike pad1926 is a disk with a plurality of spikes that protrude downwardly therefrom. The carpet-spike pads1916 improve the stability of thescale1900 upon carpet-like surfaces, thereby enhancing the accuracy and repeatability of measurements taken therewith. The carpet-spike pads1916 may be attached to thebase1902 by an adhesive, by force fit, or may be integrated into thebase1902 itself.
Question Hierarchies
• FIG. 20 depicts an embodiment of thepatient monitoring apparatus2000, in which thehousing2002, theoutput device2004, and theinput device2006 stand alone as a complete unit. (A physiological parameter-measuring unit, such as a scale, is not required to interface with theunit2000, but may be added). As in other embodiments, circuitry for operation of the device is held within thehousing2000. Theoutput device2002 may be a display, such as an LCD screen, and may include an audio output unit. Theinput device2006 is depicted as two buttons, a “YES” button and a “NO” button. One skilled in the art understands that the input device may be a keypad, a mouse, a button, a switch, a light pen, or any other suitable input device. In one embodiment of the invention, the input andoutput devices2004 and2006 are combined into a touch-screen device.
• Thepatient monitoring apparatus2000 ofFIG. 20 may be programmed to contain a plurality of question hierarchies, each of which relates to a health-related symptom. Each hierarchy contains a set of questions. Each question in a given hierarchy is aimed at characterizing a particular symptom in a particular way. Certain questions within a hierarchy may be deemed moot (and thus will not be asked) in light of a patient's answer to a previous question. Details regarding question hierarchies will be discussed in greater detail, below.
• By programming thepatient monitoring apparatus2000 to contain a plurality of question hierarchies, theunit2000 attains great flexibility as a tool for monitoring chronic diseases of many varieties. A particular chronic disease may be monitored by asking questions about symptoms associated with the disease. Thus, for example, theunit2000 may be made to monitor the health status of a patient with chronic obstructive pulmonary disease (COPD) by querying the patient, using questions extracted from question hierarchies relating to symptoms associated with COPD. Thesame unit2000 may be used to monitor a patient with diabetes by asking questions extracted from a different set of question hierarchies, which are related to symptoms associated with diabetes.
• FIG. 21 is a high-level depiction of a monitoring system employing theembodiment2000 depicted inFIG. 20, and may be used as a starting point for a more detailed discussion of thepatient monitoring apparatus2000.
• As can be seen fromFIG. 21, the system comprises apatient monitoring apparatus2000 and acentral computer2100. Thecentral computer2100 is housed within afacility2102 that is located remote from thepatient monitoring apparatus2000. For example, thepatient monitoring apparatus2000 may be located in the home of anambulatory patient2104, while thecentral computer2100 is located in ahealth care facility2102.
• As described previously, thepatient monitoring apparatus2000 is composed of acentral processor unit2106, which is in communication with aninput device2006, anoutput device2004, and amemory device2108. Thememory device2108 has a plurality of question hierarchies stored within it, as discussed more fully, below.
• As discussed previously, theoutput device2004 may be used to prompt thepatient2104 with questions regarding the patient's wellness. Theoutput device2004 may consist of a visual display unit that displays the questions in a language of the patient's2104 choosing. Alternatively, theoutput device2004 may consist of an audio output unit that vocalizes the questions. In one embodiment, theaudio output unit2004 may vocalize the questions in a language of the patient's2104 choosing.
• Thepatient monitoring apparatus2000 communicates with thecentral computer2100 via anetwork2110; thepatient monitoring apparatus2000 uses acommunication device2112 to modulate/demodulate a carrier signal for transmission via thenetwork2110, while the central computer uses acommunication device2114 for the same purpose. Examples ofsuitable communication devices2112 and2114 include internal and external modems for transmission over a telephone network, network cards (such as an Ethernet card) for transmission over a local area network, a network card coupled to some form of modem (such as a DSL modem or a cable modem) for transmission over a wide area network (such as the Internet), or an RF transmitter for transmission to a wireless network.
• A system composed as described above may be programmed to carry on periodic (e.g., daily) questioning of apatient2104, with respect to the patient's2104 perception regarding his or her own status vis-à-vis a particular set of symptoms. For example, a patient suffering from COPD is likely to experience shortness of breath, both during the day and during the night (amongst many other symptoms). Thus, the system may question thepatient2104 about his own perceptions regarding his shortness of breath. The questions used to determine the patient's2104 judgment about his own shortness of breath during the day are contained in a first question hierarchy. Similarly, questions related to the patient's2104 shortness of breath during the night are contained in a second question hierarchy.
• The first hierarchy, which is related to shortness of breath during the day, may be structured as follows:

• TABLE 5
  Question Hierarchy: Shortness of Breath During theDay

  Question #

  1	Are you feeling more short of breath?
  Question #2	Do you feel more short of breath in response to
  	physical exertion?
  Question #3	Do you feel more short of breath during periods of rest?
  Question #4	Does stress make you feel more short of breath?

• Each of the questions in the hierarchy is related to day-time shortness of breath. The first question is broadly focused, simply asking “Are you feeling more short of breath?” Clearly, if thepatient2104 were to answer “no” to such a question, the remainder of the questions would be unnecessary. Thus, the system may be designed to prevent the remaining questions from being asked (this will be discussed in greater detail, below).Question #2 asks a question that is more particularized than question #1: “Do you feel more short of breath in response to physical exertion?” An affirmative answer to this question is more serious, and provides more particularized information, than an affirmative answer to the broader query presented inquestion #1. Although not essential, each question hierarchy may be constructed in accordance with this paradigm: (1) a negative answer to a preceding questions negates the need to ask any additional questions in the hierarchy; (2) successive questions relate to increasingly more particularized aspects of a given symptom; and (3) successive questions relate to an increasing severity level of a given symptom.
• FIG. 22 depicts the partial contents of thememory device2108 ofFIG. 21. As can be seen fromFIG. 21, thememory device2108 is programmed with a set ofquestion hierarchies2200. In the example depicted inFIG. 22, the memory device is programmed with sixquestion hierarchies2201,2202,2203,2204,2205, and2206 (collectively referred to as “the set ofquestion hierarchies2200”). As described previously, each hierarchy relates to a symptom condition to be monitored, meaning that the number of question hierarchies stored in thememory device2108 is dependent upon the number of symptoms to be monitored.
• Hierarchy2201 has a basic structure that includes a first question Q1, followed by a first decision point D1. At decision point D1, thepatient monitoring apparatus2000 decides whether or not to ask the subsequent question, Q2. For example, Q1 may be a question that reads “Are you feeling more short of breath?” If thepatient2104 answers “no,” this answer is analyzed at decision point D1, and the questioning terminates at terminal point T1. Otherwise, the questioning continues with the next question, Q2, and the process continues.
• Each of thehierarchies2200 depicted inFIG. 22 possesses the above-recited structure, although other structures are possible, some of which are described below. One skilled in the art understands that although eachhierarchy2200 is depicted as consisting of three questions, a hierarchy may consist of any number of questions, including a single question.
• As depicted inFIG. 22, thememory device2108 is in data communication with the monitoring device's2000microprocessor2106, which, in turn, is in data communication with a remote computer2100 (not depicted inFIG. 22) via anetwork2110 and via a communication device2112 (also not depicted inFIG. 22). Theremote computer2100 transmits asymptom identifier2208 to the monitoring device's2000microprocessor2106. Thesymptom identifier2208 corresponds to aquestion hierarchy2200. For example, a symptom identifier with a value of “1” may correspond tohierarchy2201, while a symptom identifier with a value of “2” corresponds tohierarchy2202, etc. Themicroprocessor2106 responds to having received asymptom identifier2202 by executing the corresponding hierarchy (i.e., asking a question within the hierarchy, and deciding whether or not to ask a subsequent question therein). Thus, thepatient monitoring device2200 may be made to execute n number of question hierarchies by transmitting to it n number of symptom identifiers.
• Given that a known set of symptoms are correlated with any given chronic disease, thepatient monitoring device2000 may be tailored to monitor the health status of apatient2104 with a particular disease by executingquestion hierarchies2200 relating to symptoms corresponding with the patient's2104 particular disease. Thus, theremote computer2100 may be programmed with software that presents a menu for eachpatient2104. The menu allows the health care provider to select from among a set of chronic diseases. Based upon the selected chronic disease, theremote computer2100 transmits one or more symptom identifiers (which correspond to symptoms known to accompany the selected disease) to thepatient monitoring apparatus2000. Theremote computer2100 receives the patient's2104 responses, and scores the response in accordance with a scoring algorithm, discussed in detail below. Based upon the outcome of the score, an exception report may be generated, meaning that a health care provider will be notified of the patient's possible need for assistance. Alternatively, theremote computer2100 may be programmed to transmit an e-mail message or a numeric page to communicate the information concerning thepatient2104. In principle, any data transmission communicating the patient's2104 potential need for assistance may be transmitted.
• In certain situations, it may be desirable for thepatient monitoring device2000 to obtain information regarding a physiological parameter. For example, if a particular chronic disease is associated with a fever, the patient monitoring device may want to know information concerning the patient's2104 body temperature. Two general approaches exist for gaining information concerning a physiological parameter. Themonitoring system2000 may be adapted for interfacing with a physiological parameter-measuring unit, as has been disclosed with reference to other embodiments of the invention. The parameter-measuring unit can then directly measure the physiological parameter and transmit the data to thecentral computer2100. Many times, this is an appropriate approach. Accordingly, according to one embodiment of the invention, themicroprocessor2106 may interface with a physiological parameter-measuring device, such as a scale or a thermometer, as previously described herein. On the other hand, oftentimes it is possible to ask the patient to measure the parameter for himself (e.g., take his own temperature). This approach has an advantage, in that the cost of obtaining the information is minimized. This approach is particularly useful when an exact measurement of a physiological parameter is not as useful as simply knowing whether the parameter crosses some threshold. Under these circumstances, the cost of directly obtaining precise information may outweigh the financial benefit of knowing such information. Thus, as depicted inFIG. 23, aquestion hierarchy2200 may be designed to ask a patient whether one of his physiological parameters exceeds a threshold, T.
• Thequestion hierarchy2200 depicted inFIG. 23 is similar to thequestion hierarchies2200 discussed with reference toFIG. 22. Thequestion hierarchy2200 corresponds to asymptom identifier2208, which is transmitted to thepatient monitoring device2000 by aremote computer2100. Thehierarchy2200 possesses several questions Q1, Q2, and Q3, some of which may go unasked, if a decision point D1, D2, or D3 terminates the flow of questioning by transferring execution flow to a terminal point T1, T2 or T3. Of particular note in thequestion hierarchy2200 ofFIG. 23 is the first question, Q1, and the first decision point D1. The first question, Q1, asks thepatient2104 if a particular physiological parameter of his exceeds a given threshold, T. The value represented by T is transmitted to thepatient monitoring device2000 by theremote computer2100, as is depicted bythreshold datum2300. Therefore, to invoke thisparticular hierarchy2200, the remote computer should transmit both asymptom identifier2208 and athreshold datum2300. In response, thepatient monitoring device2000 responds by asking thepatient2104 if his particular physiological parameter exceeds the threshold, T. Next, as is depicted by decision point D1, thepatient monitoring device2000 determines whether or not to proceed with further questions, on the basis of whether or not the parameter exceeded the threshold, T.
• Another situation likely to arise in the context of monitoring apatient2104 with a chronic illness is that thepatient2104 is to be queried regarding his faithfulness to a prescribed health care regimen. For example, if thepatient2104 is a diabetic, the patient is likely to be on a strict diet. Thepatient monitoring device2000 may be programmed to ask thepatient2104 if he has been following his diet. If thepatient2104 answers “yes,” thedevice2000 may respond by praising thepatient2104—a tactic that may be particularly advantageous for young patients. On the other hand, if thepatient2104 answers “no,” thedevice2000 may respond by reminding thepatient2104 to adhere to his diet.
• FIG. 24 depicts aquestion hierarchy2200 designed to achieve the results of praising apatient2104 for adhering to a prescribed regimen, or reminding thepatient2104 of the importance of adhering thereto. Of particular note in thequestion hierarchy2200 depicted inFIG. 24 is the first question, Q1. The first question, Q1, asks thepatient2104 if he has been adhering to a health care regimen (such as, a diet or a medication regimen). Next, at decision point D1, flow of execution is adjusted based upon whether or not thepatient2104 has been adhering to the regimen. If thepatient2104 has been adhering to the regimen, thepatient2104 is presented with a statement, S1, praising the patient. Otherwise, thepatient2104 is presented with a statement, S2, reminding thepatient2104 to adhere to his regimen. In either event, execution flow is passed to the second question, Q2, and hierarchy execution continues in accordance with the flow described with reference toFIG. 22.
• FIG. 25 depicts aquestion hierarchy2200 that has been modified to permit theremote computer2100 to command specific questions within thehierarchy2200 to be asked, regardless of any answer that may have been previously given by thepatient2104. To achieve this result, theremote computer2100 should transmit asymptom identifier2208 corresponding to thequestion hierarchy2200. Additionally, a question set2500 should be transmitted. The question set2500 may define a set of questions to be forced “on.” For example, the question set2500 may be {3, 5}, meaning thatquestions 3 and 5 are to be asked, no matter what thepatient2104 has previously answered.
• Continuing the discussion assuming that a question set2500 of {3, 5} had been transmitted, execution of the hierarchy commences with the asking of the first question, Q1. Next, at decision point D1, the patient's2104 answer to the first question is assessed to determine whether the subsequent question in the hierarchy should be asked. If the answer is such that ordinarily none of the remaining questions should be asked, execution would typically flow to terminal point T1. However, in this embodiment, a second decision point, D2, is interposed between decision point D1 and terminal point T1. At the second decision point, D2, it is determined whether the question set2500 contains a question number that is higher than the question number that was just asked. In the case of the present example, the question set2500 contains two such question numbers, becausequestion numbers 3 and 5 are higher than the present question number, 1. If the question set2500 does contain a question number that is higher than the question number just asked, then execution flows to the smallest such question number (in this case,question number 3, Q3). Thereafter the process repeats, thereby ensuring that each of the question numbers in the question set will be asked.
• FIG. 26 depicts aquestion hierarchy2200 that has been modified to permit theremote computer2100 to command a specific sequence in which the questions within thehierarchy2200 should be asked. To achieve this result, theremote computer2100 should transmit asymptom identifier2208 corresponding to thequestion hierarchy2200. Additionally, asequence set2600 should be transmitted. The sequence set2600 is a set of data defining the order in which the questions are to be asked. For example, thesequence set2600 may be {3, 1, 2}, meaning that the question that would ordinarily be asked third should be asked first, that the question that would ordinarily be asked first should be asked second, and that the question that would ordinarily be asked second should be asked third.
• Continuing on with the example, execution of thehierarchy2200 ofFIG. 26 commences with a look-up operation, L1. During the look-up operation L1, the first element of thesequence set2600 is used to index into an array containing the questions within the hierarchy. In the present example, since “3” is the first element of the sequence set, the third question from the array is retrieved. Next, the retrieved question (identified as Q1 inFIG. 26) is asked, and execution of the hierarchy proceeds as has been generally described with reference toFIG. 22. Thus, by inserting a look-up operation L1, L2, or L3 prior to each questioning operation Q1, Q2, or Q3, any desired sequence of questioning may be commanded.
• The question hierarchies disclosed inFIGS. 22-26 may be programmed into thememory device2108 of thepatient monitoring device2000, thereby obviating the need to transmit the text of the questions from thecentral computer2100 to thepatient monitoring device2000. One skilled in the art understands that thequestion hierarchies2200 may be implemented in the form of an application-specific integrated circuit, as well. Optionally, the questions within thehierarchies2200 may written to be answered with either a “yes” or “no,” achieving the advantage of simplifying the input required from thepatient2104, and thereby necessitating only “yes” or “no” buttons for theinput device2006. Further, any of thepreceding question hierarchies2200 forms may be combined.
• As described earlier, thememory device2108 may store each of thequestion hierarchies2200 in a plurality of languages, so as to permitpatients2104 of many nationalities to use thedevice2000. If theoutput device2004 is an audio output unit, the questions within each of thequestion hierarchies2200 may be stored in a digital audio format in thememory device2108. Accordingly, the questions are presented to thepatient2104 as a spoken interrogatory, in the language of the patient's2104 choice.
• FIG. 27 depicts a method by which the patient's2104 answers to the questions presented in thehierarchies2200 may be analyzed. As mentioned earlier, depending upon the outcome of the analysis, an exception report may be issued and a health care provider may be notified. According to the method depicted inFIG. 27, during operation2700 a point value is assigned to each question in each of the invokedquestion hierarchies2200. The points assigned to a given question are “earned” by apatient2104, if the patient answers the question in a particular way. Otherwise, no points are earned. For example, an affirmative response to the question “are you experiencing shortness of breath?” may be worth 10 points, while a negative response to that question is worth nothing. A standard point value may be assigned to each question (each question has a point value of 10, for instance), or different questions may be assigned different point values (a first question is worth 10 points, while a question directed toward a more serious issue may be worth 30 points, for example). A default point assignment scheme may be presented for approval by a health care provider. The health care provider may then adjust the point assignment scheme to fit the needs of anindividual patient2104.
• Inoperation2702, the point value of each of the questions actually asked to thepatient2104 is determined. Thus, questions that were not asked to apatient2104 are not included in this point total. Inoperation2704, the patient's2104 earned point value is totaled. Then, inoperation2706, the patient's2104 earned point total (determined in operation2704) is divided by the total possible point value (determined in operation2702).
• Inoperation2708, it is determined whether the fraction found inoperation2706 exceeds a threshold (as with the point assignment scheme, the threshold may be defined by the health care provider). If so, the patient's health care provider is notified (perhaps by the issuance of an exception report), as shown inoperation2710. Finally, the process terminates inoperation2712.
• FIG. 28 depicts another method by which the patient's2104 answers to the questions presented in thehierarchies2200 may be analyzed. According to the method depicted inFIG. 28, during operation2800 a point value is assigned to each question in each of the invokedquestion hierarchies2200. The details of the point assignment scheme are identical to those inoperation2700 ofFIG. 27.
• Next, inoperation2802, a threshold is assigned to each invokedhierarchy2200. Again, this threshold may be assigned by default, and the health care provider may be given an option to adjust this threshold. The threshold ofoperation2802 applies to eachhierarchy2200, meaning that a decision will be made, on a hierarchy-by-hierarchy basis, whether thepatient2104 has accumulated sufficient points in a particular hierarchy to cross a threshold assigned to thathierarchy2200. Inoperation2804, a second threshold is assigned. The threshold ofoperation2804 relates to the number ofhierarchies2200 that may be allowed to exceed the threshold ofoperation2802.
• Inoperation2806, the number of points earned by thepatient2104 in eachhierarchy2200 is determined. Then inoperation2808, it is determined whether the number ofhierarchies2200 in which the threshold ofoperation2802 was crossed exceeds the threshold ofoperation2804. If so, the patient's health care provider is notified, as shown inoperation2810. Finally, the process terminates inoperation2812.
• The methods ofFIGS. 27 and 28 are preferably performed by theremote computer2100, although they may be performed by any other processing device. The aforementioned methods are preferably embodied as software stored in a memory device within thecentral computer2100. However, they may be embodied on a computer-readable medium, such as a compact disc, a floppy disc, a network cable, or any other form of media readable by a computer.
Weight Loss/Weight Management System
• FIG. 29 depicts a questioning scheme that may be employed by any of the embodiments of the system depicted or referred to in any of the twenty-eight preceding figures. As can be seen fromFIG. 29 there is shown a first sequence of questions which have been organized intocategories2900,2902,2904, and2906 and a second sequence of questions which have been organized intocategories2908,2910,2912, and2914. Typically, all of the questions within a category such ascategory2900 relate to a given topic. In the case of a system for weight loss or weight management, for example, the category may relate to overeating, and each of the questions may related to different facets of overeating.
• As shown inFIG. 29, the typical flow for such a scheme is for the questions within a first category, such ascategory 12900, to be asked followed by the questions within a second category, such ascategory 22902, to be asked. Following this, the questions incategory 32904 are asked, and finally the questions incategory 42906 are asked. Of course, in principle, a questioning scheme may have questions organized into any number of categories not simply four as is shown inFIG. 29. Further, it is not necessary that the categories be preceded through in sequential fashion, although this is has been shown inFIG. 29.
• As shown by the question sequence composed ofcategories2908,2910,2912, and2914, a given category of questions may be deactivated. In thisexample category 22910 is deactivated, as is indicated by the cross hatching. In such an instance, the questions withincategory 12908 are asked,category 2 is skipped because it is deactivated, and the execution flow proceeds tocategory 32912 andcategory 42914. As is discussed later, it is possible for any number of categories to be activated or deactivated and it is also possible to activate or deactivate categories based on a predetermined schedule such as activating or deactivating categories based on the day of the week. For example,category 22910 may be activated on Mondays, Wednesdays and Fridays and deactivated on Tuesdays, Thursdays, Saturdays and Sundays. Similarly,example category 42914 may be activated on Mondays, Tuesdays and Wednesdays, but deactivated on Wednesdays, Thursdays, Fridays, Saturdays, and Sundays. Categories may be activated and deactivated based on date ranges, as well.
• FIG. 30 depicts a question sequence composed of fourcategories3000,3002,3004, and3006. As was the case inFIG. 29, the flow from category to category is largely sequential, in that the flow moves fromcategory3000 tocategory3002, skips overcategory3004 because it is cross hatched and depicted as deactivated for the sake of example, and proceeding on tocategory3006.
• Intracategory execution flow is shown for the sake of example. Turning toquestion category3000, it can be seen that therein is included aquestion3008 followed by abranch instruction3010. If, for example,category3000 were related to the topic of overeating,question3008 may read “did you eat more than three meals today?” Atbranch instruction3010 the answer of the person using the monitoring unit is evaluated, and the flow of execution is directed based on the person's answer. For example if the person answered “no,” i.e., he did not eat more than three meals that day, the flow may go on tostatement instruction3012, which may be a praise statement. Forexample praise statement3012 may read “good job.” Execution flow would then move on tocategory3002. On the other hand, if the person answered that he had eaten more than three meals, execution flow would have moved frombranch instruction3010 directly tocategory3002.
• Category3002 shows an intracategory execution flow that is a little more complicated than the one shown with reference tocategory3000. Assuming for the sake of example thatquestion category3002 was directed toward the topic of emotional eating, then question3014 may read “were you happy today?” The flow then moves on tobranch instruction3016. If the person had answers “yes,” flow proceeds on to the next active question category, question category3006 (becausequestion category3004 is depicted as being deactivated). On the other hand, if the person answers “no” to the question “where you happy today,” then flow proceeds frombranch instruction3016 to follow-up question3018, which may read “did you eat to feel better?” The person's answer is evaluated atbranch instruction3020. Assuming the person answered that he did not eat to feel better, once again flow would move on toquestion category3006. On the other hand, if the person answered that he had eaten to feel better, then execution flow moves on to reminder statement3022 which may read “Remember to stick to your meal plan.” Thereafter execution flow would move on tocategory3006.
• Thus, as can be seen from the preceding example,question categories3000,3002,3004, and3006 may include: (1) questions related to a topic; (2) branch instructions that control the flow of execution based upon the person's answer to the questions; (3) follow-up questions; and (4) praise or reminder statements based upon the person's answers to the questions. Generally, the flow from category to category is sequential, although this is not necessary. Generally, execution flow skips over deactivated question categories and proceeds on to the next active question category.
• FIG. 31 depicts a question set havingquestions3100,3102,3104,3106,3108,3110, and3112. The question set inFIG. 31 is directed toward the topic of meal planning. Thus each question within this category relates to determining whether the person using the monitoring unit exhibited deliberate dietary habits throughout the day.
• FIG. 31 also depicts the principle that the monitoring unit, such asmonitoring unit14, may be put into a mode of operation. In the case wherein monitoringunit14 is programmed for the purpose of encouraging weight loss or weight management, the monitoring unit may be programmed in either a weight loss mode or a weight management mode. Execution flow within a question category may be altered depending upon the mode that the monitoring unit is in. This principle is illustrated inFIG. 31.
• Execution flow begins with question3100: “Are you having regular meals/snacks?” If the person answers “yes,” and if the monitoring unit is in weight management mode, execution flows to praisestatement3101, which may read, “You are focused on your goals!” Thereafter, execution flow proceeds toquestion3102. On the other hand, if the monitoring unit is in weight loss mode, execution flow moves on toquestion3102, regardless of the person's answer.Question3102 reads, “Are you choosing healthy foods?” Once again, if the person answers “yes,” and if the monitoring unit is in weight management mode, execution flow moves on to praisestatement3103, which may read “Great job with this system! Keep it up!” As before, if the monitoring unit is in weight loss mode, execution flow moves on toquestion3104, irrespective of the person's answer.Question3104 reads “did you follow your meal plan?” If the person answers “yes,” execution flow moves on to praisestatement3105.Praise statement3105 may be different based upon whether the monitoring unit is in weight loss mode or weight management mode. For example, if the monitoring unit is in weight loss mode,praise statement3105 may read, “You're on your way to success.” If on the other hand the monitoring unit is in weight management mode,praise statement3105 may read, “Good job!” Thereafter as can be seen fromFIG. 31 the remaining questions in this question category are skipped and the next activated category is executed. On the other hand if the person were to answer “no” toquestion3104, execution flow moves on toquestion3106, which reads “Did you eat more than N calories”. “N” is a variable which may be set by the remote computer, such as theremote computer32 depicted inFIG. 4, and may be individualized for a particular user. Thereafter, execution flow moves on toquestion3108, which reads “Did you follow your breakfast meal plan?” Irrespective of the person's answer, execution flow moves on toquestion3110, which reads “Did you follow your lunch meal plan”. If the person answers “yes,” and the monitoring unit is in weight loss mode, execution flow moves on to praisestatement3114, which may read “Great job with this system! Keep it up!” Thereafter, execution flow moves on toquestion3112. On the other hand, if the monitoring unit is in weight management mode execution flow moves fromquestion3110 to question3112 irrespective of the person's answer. The final question in the exemplary question category reads “did you follow your meal plan?” Upon answering this question execution flow moves on to the next active category.
• AlthoughFIG. 31 shows specific questions that may be included within a question category directed to meal planning, other question categories may exist in a system for weight loss or weight management. Those categories may include categories directed toward dietary recording, overeating, skipping of meals, eating at home, portion size, eating out, grocery shopping behavior, label reading, water consumption, happiness, stress, depression, support, body image, fit of clothing, body measurements, program satisfaction, exercise and lesson plans.
• In sum,FIG. 31 depicts the following general principles. The monitoring unit may be programmed to be in one of a plurality of modes of operation. Based on the mode of operation, the monitoring unit may alter intracategory and/or intercategory execution flow. For example, the monitoring unit may ask a different follow-up question, may give a different praise or reminder statement, may execute a different category, may omit a follow-up question, and/or may omit a praise or reminder statement, based upon the selected mode of operation. Although not depicted byFIG. 31, each of the questions (such as3100-3112) within a category are individually activatable and deactivatable. Individual questions may be activated or deactivated according to a schedule, or may be activated or deactivated indefinitely. For example, any question within a group may be deactivated for a given use, although the group as a whole may be active. Thus, for example, the question “Are you choosing healthy foods?” (question3102) may be activated on Mondays, Wednesdays and Fridays, but deactivated on Tuesdays, Thursdays, Saturdays and Sundays. Conversely, a question may be activated, although the group in which the question resides is deactivated. Such programmability permits a manageable number of questions to be presented to the person using the monitoring unit. Further, such programmability allows the person's experience to vary from day to day, so that the person maintains his or her interest in the unit.
• The questioning schemes depicted inFIGS. 29-31 may be embodied according to the question hierarchy technology described with reference toFIGS. 20-28 herein. Such an embodiment is within the scope of the invention and disclosure herein.
• FIG. 32 depicts an example of execution flow for a monitoring unit designed for encouraging weight loss or weight management. As can be seen fromFIG. 32, the monitoring unit may initially ask the person questions related to weight loss or weight management according to a questioning scheme as described with reference toFIGS. 29 through 31. Further, the monitoring unit may measure the weight of the person as shown inoperation3202. After execution ofoperation3202, the monitoring unit may transmit the person's answers to the questions and the person's weight to a remote computing system so that the information can be processed and stored and so that the remote computing system can determine if a health care provider should be alerted. Details related to generation of alerts for health care providers are discussed below. Finally, as shown inoperation3204, the monitoring unit may present weight loss progress statements to the person. The weight loss progress statements may take on several forms, each of which may be activated or deactivated during designated time intervals, as is discussed below. For example, one form of progress statement may be activated during Mondays, Tuesdays, and Wednesdays, while another form is activated on Thursdays, Fridays, Saturdays, and Sundays.
• Examples of weight loss progress statements include a presentation of the person's present weight followed by the presentation of the person's weight at some point in the past such as a week ago, a month ago, three months ago, six months ago, nine months ago, a year ago or even two years ago. Alternatively, a weight loss progress statement may include a presentation of the person's present weight followed by the person's average weight (or some other measure of central tendency) over a particular time interval such as that person's average weight one week ago, one month ago, three months ago, six months ago, nine months ago, a year ago, or even two years ago. As another alternative, the person may be presented with their weight when they began using the monitoring unit and may also be presented with his or her present weight. Yet another alternative is a presentation of the person's present weight and a presentation of the person's milestone weight. A milestone weight is a weight that is intermediate the person's weight when he or she began using the monitoring unit and a final goal weight that the person wants to achieve. Still further, a weight loss progress statement may include a statement of the percentage of the total weight loss goal the person has met, or a statement of the person's total weight loss goal. If the monitoring unit is in weight maintenance mode as opposed to weight loss mode, the progress statement may include a statement of what the maintenance weight is for the particular person. The maintenance weight may actually be a range. For example a person having a weight goal of 165 pounds may have a maintenance weight range between 160 and 170 pounds.
• Although the discussion related to the progress statements generated inoperation3204 ofFIG. 32 has been in the context of discussing weight loss, progress statements may be produced for any other measurable parameter. For example, a progress statement may be generated to show the variation, over an interval of time, in activity level or number of steps a person has taken. Other examples of parameters that may be the subject of progress statements include caloric intake, fat intake, water consumption, intake of dietary fiber, vitamin intake, or intake of any other nutritional item.
• FIG. 33 depicts a program phase screen that permits a user of the remote computing system, such asremote computing system32 shown inFIG. 4, to divide the person's weight loss or weight management program into phases. A phase is an interval of time during which certain question categories are asked while other question categories are not asked. A phase may be added by selecting the “add phase”button3310. This selection allows the user to select a phase name entered infield3300, a start date for the phase entered infield3302, and end date for the phase entered infield3304, and an emphasis group entered infield3306. The emphasis group identifies the question categories that are to be executed by the monitoring unit between thestart date3302 andend date3304. For example, if the user of the remote computing system wished the person using the monitoring unit to have questions related to meal planning and overeating presented to them during a first phase, theemphasis group3306 would include meal plan and overeating categories but may exclude other categories not appropriate for this phase. Notes associated with each phase may be stored in thenote field3308. To remove a phase, highlight the particular phase and select the “remove phase”button3312. In principle a weight loss or weight management program may be divided into any number of phases, not simply a weight loss and weight management phase.
• Phases permit a user of the remote computing system to customize questioning appropriate to a particular person's needs. One additional benefit of phases is that it prevents the person using the monitoring unit from always being presented with the same set of questions.
• FIG. 34 depicts a verification screen in which patient data is displayed in the upper left-hand corner. As can be seen fromFIG. 34, the patient data portion of the screen is a grid having rows labeled Acute, Sx Score, Sx Variance, Compliance and Weight and columns labeled Today, Last, Change and Trigger. The first four row labels relate to different types of questions. The monitoring unit may be programmed to ask three different kinds of questions: (1) acute questions; (2) compliance questions; and (3) scored questions. Acute questions are questions that attempt to determine whether the person needs immediate attention. For example, the person's answers to acute questions may indicate that the person needs contact with an operator, case manager, health care professional, dietician, counselor or any individual responsible for monitoring the person's information or overseeing the person's weight loss or weight management. Compliance questions determine whether the person needs follow-up because that person is simply not complying with the plan, and scored questions may be used to determine whether the person needs follow-up because the person's answers, in general, indicate that the plan is not working for one reason or another. The term “Sx” (which typically is known to be an abbreviation for “symptom”) is used to refer to scored questions. As the term is used herein, the term “symptom” or “Sx” refers not just to physical symptoms, but to lifestyle modifications (e.g., cooking at home more often), behavior modifications (e.g., reading food labels), psychological outlook (e.g., having a happy or depressed state of mind), actions undertaken by the person using the monitoring unit, or other information relating to success or failure of weight loss or weight management for the person using the monitoring unit. Thus, questions relating to “symptoms” may inquire into any sort of information relating to success or failure of weight loss or weight management for the person using the monitoring unit.
• Turning first to the row labeled “acute,” there are two fields,fields3400 and3402, which may contain data.Field3400 contains an indication of whether the person is considered acute on the present day, andfield3402 contains an indication of whether the person was considered acute the last time the person used the monitoring unit. If a person is determined to be acute, an alert may be sent to a health care professional so that the health care professional can contact the person. The determination of whether a person is acute may be made on the basis of a person's answer to a single question. For example, if a person were to answer “no” to the question “Do you feel life is worth living,” this single answer would cause the system to determine that the person was acute. On the other hand, the system may determine that a particular person is acute on the basis of answers to several questions. For example consider the following three questions: (1) Were you stressed today?; (2) Are you finding ways to manage your stress?; and (3) Were you angry today? An affirmative response to all three questions may be sufficient to trigger the decision that the patient is acute.
• Moving on to the next row, which is labeled “Sx Score,” it can be seen that this row contains four fields,fields3404,3406,3408 and3410. This row and the following row, labeled “Sx Variance,” relate to scored questions. Scored questions are general questions that have a point value or score associated with them. “Points” are accumulated based upon the person's answers to the scored questions. A total score may tallied for each use of the monitoring unit. Field3404 shows the person's present total score, whilefield3406 shows the total score earned by the person the last time the person used the monitoring unit.Field3408 shows the difference between the person's present score and the score the last time he or she used the unit.Field3410 shows a triggering condition, which indicates whether an alert will be generated based upon the person's answers to the scored questions. The trigger condition may be a simple threshold to which the person's score is compared or can be a threshold based upon a percent score. For example, the threshold may be a score of twenty, with any score exceeding the threshold causing the remote computing system to generate an alert. Alternatively thetrigger3410 may express a trigger condition that is activated when a person's score changes by more than a given number of points in a given number of days. For example, an alert may be generated if the person's score changes by more than ten points in three days.
• As stated above, the trigger condition may be expressed as a percentage value. Per such a scenario, the scoring scheme may be implemented as follows. A score is assigned to each answer provided by the person using the monitoring unit. A total score is arrived at by summing each of the scores earned by the person's various answers. The total score is divided by the total possible score the person could have earned. The total possible score, which serves as the divisor, is arrived at by summing the highest scores available for each question actually posed to the person using the monitoring unit. Questions not actually posed to the person using the monitoring system do not figure into the calculation of the total possible score. The quotient arrived at per the preceding procedure is compared to a percentage threshold. If the quotient exceeds the threshold, an alert is generated.
• The third row, labeled “Sx Variance” relates to the variance in scores earned by the person using the monitoring unit. For example,field3412 presents the variance in score earned by the person using the monitoring unit, andfield3414 presents the variance in scores earned by the person the last time the person used the monitoring unit.Field3416 shows the difference betweenfield3412 and3414.Field3418 relates to a trigger condition which if satisfied, may cause the remote computing system to generate an alert. For example, an alert may be generated if a person exhibits a change in variance that exceeds a given percentage over a given number of days.
• The fourth row is labeled “Compliance” and has four fields,fields3420,3422,3424, and3426. This row relates to the way the person using the monitoring unit answers the compliance questions. One point may be earned for each answer indicating that a person is not complying with the plan.Field3420 shows the number of compliance points earned, andfield3422 shows the number of compliance points earned the last time the person used the monitoring unit.Field3424 shows the difference betweenfields3420 and3422. Field3426 presents a trigger condition which if satisfied may cause the remote computing system to generate an alert. For example, an alert may be generated if a person earns more than a given number of compliance points in a given number of days.
• The fifth and final row is labeled Weight and contains four fields,field3428,3430,3432 and3434.Field3428 shows the person's current weight, andfield3430 shows the person's weight the last time the he or she used the monitoring unit.Field3432 shows the difference betweenfield3428 and3430.Field3434 indicates a trigger condition which if satisfied may cause the remote computing system to generate an alert. The alert condition expressed infield3434 may be a simple threshold. For example, if the person's weight exceeds a threshold of 180 pounds, a health care professional may be alerted. Alternatively, the trigger condition expressed infield3434 may relate to a change in the person's weight. For example, if the person's weight changes by more than a given number of pounds in a given number of days, an alert may be generated.
• The screen depicted inFIG. 34 also contains a weight parameter section, which containsfields3436 through3446. The data presented in this portion of the screen allows the user of the remote computing system to obtain a quick overview of the weight condition of the person using the monitoring unit.Field3436 presents the weight of the person using the monitoring unit at the point in time in which he began using the monitoring unit.Field3438 presents a person's goal weight, which is a weight at which the person using the monitoring unit ultimately wants to reach.Field3440 presents the person's milestone weight, which is a weight somewhere between the person'sstarting weight3436 andgoal weight3438. The person's maintenance weight range is indicated infield3442. This weight range is the range the person should stay in after reaching his or her goal weight.Field3444 shows a threshold weight which if exceeded may cause the remote computing system to generate an alert andfield3446 indicates a trigger condition caused by weight change which if satisfied may cause the remote computing system to generate an alert. For example, iffield3446 contains the data “5/10,” this would mean that an alert may be generated if the person exhibited a weight change of more than 5 pounds in 10 days.
• The screen depicted inFIG. 34 also contains an exception portion, which containsfields3448 and3450. The data infields3448 and3450 is intended to provide an indication to the user of the remote computing system of which questions caused an alert to be generated. In field3448, data is contained which indicates whether the alert was generated due to answers to acute questions, scored questions or compliance questions.Field3450 contains the particular question that caused an alert to be generated. For example, a person using the monitoring unit may be indicated as being acute because of affirmative answers to the questions: (1) Were you stressed today?; (2) Are you finding ways to manage stress?; (3) Were you angry today? Per such a scenario, three entries are found in the exceptions portion. The exceptions type field3448 reads “Acute” for all three entries. The first entry reads “Were you stressed today”. This second entry reads “Are you finding ways to manage stress,” and the third entry would read “Were you angry today.” Thus, for each question that contributed to an alert being generated, there exists an entry in the exception portion of the screen depicted inFIG. 34. The text of the question is presented infield3450 and the type of the question is presented in field3448.
• The screen depicted inFIG. 34 also contains a portion relating to two-way messages. This portion of the screen contains two fields,fields3452 and3454.Field3454 presents the text of a two-way message and field3452 presents the person's corresponding answer. Two-way messaging is discussed in detail herein in the portions of the specification related toFIGS. 11 through 18.
• Patient notes may be entered infield3456, which is located in a note portion of the screen.
• A set-up screen is depicted inFIG. 35. The set-up screen contains a health check portion of the screen, which contains fields3500-3508. Infield3500, the user of the remote computing system can schedule the days of the weeks on which reminders are to be turned on. An example of a reminder was presented inFIG. 30 and labeled by reference numeral3022. (“Remember to stick to your meal plan.”) These forms of reminders may be turned off. If reminders are deactivated, a reminder statement is not presented, even if execution flow would ordinarily indicate that a reminder is to be given. Thus, for example, reminders may be scheduled for Monday, Wednesday, and Friday. On these days reminders will be presented to the patient. On Tuesdays, Thursdays, Saturdays and Sundays no reminders will be given to the patient. Similarly, praise statements (field3502) may be scheduled for certain days of the week.Fields3504,3506, and3508 permit weight loss progress statements to be scheduled for certain days of the week.
• The screen depicted inFIG. 35 also contains a symptom parameter section in which the trigger condition depicted infields3410 and3418 onFIG. 34 may be set.
• The screen depicted inFIG. 35 also contains a weight parameter section in which the information shown infields3436,3438, and3442-3446 inFIG. 34 may be set.
• The screen depicted inFIG. 35 also contains an “Other Parameters” portion. Infield3510 and3512, the height in feet and inches of the person using the monitoring unit may be entered. Infield3514 the number of ounces of water the person using the monitoring unit is to consume may be entered, and via the selection buttons identified byreference numeral3516, the phase in which the monitoring unit is programmed to be may be selected. For example, the monitoring unit may be selected for weight loss phase or weight maintenance phase. Other parameters may be set from this screen, as well. In principle, this portion of the screen may contain fields that allow entry of ideal values for any parameter characterizing the person using the monitoring unit. For example, this portion of the screen may contain fields that allow entry of ideal values distance the person is to walk, number of steps the person is to take in a day, number of calories the person is to consume in a day, and so on. The values entered in these fields may be used in the process of generating an alert (described above) or in progress reports. For example, an alert may be generated if the activity level of the person falls short of a threshold. Additionally, an alert may be generated if, over a span of time, the person's number of calories burned, number of steps taken over, or distance walked falls short of a threshold. Still further, an alert may be generated if the number of calories consumed by the person using the monitoring device exceeds a threshold. The values compared against these thresholds may be input manually (e.g., may be estimated) by the person using the monitoring device, or may be directly measured by a measuring device that communicates such data to the monitoring device. The thresholds may be equal to the ideal values entered into the fields in this portion of the screen, or may be calculated therefrom, such as by multiplying the values in these fields by a factor (e.g., multiplying ideal caloric intake by 1.1 or 1.2).
• The screen depicted inFIG. 35 also contains a “Questions” section. This section relates to the question hierarchy technology discussed with reference toFIGS. 20-28. For example thecheck box3518 pertains to a first question hierarchy, which is depicted as consisting of two questions. Thecheck box3518 allows the entire hierarchy to be activated or deactivated. Checkbox3520 permits a particular question, which is within the hierarchy controlled bycheck box3518, to be activated or deactivated.
• A monitoring unit may be programmed to utilize a personal identifier code. In such an embodiment the monitoring unit is rendered usable by more than one person. For example, a user of the monitoring unit commences his use of the monitoring unit by entering a personal identifier code. The monitoring unit uses the personal identifier code to determine the identity of the user. The monitoring unit proceeds to execute on the basis of data (such as data presented on the screens depicted inFIGS. 33-35) that is associated with the personal identifier code. Thus, for example, the monitoring unit asks questions appropriate for the particular user and responds with praise and reminder statements appropriate for the particular user. The particular user's answers and measured weight are transmitted to a remote computing system in association with the personal identifier code. This permits the remote computing system to know whose data it has just received.
• Such an embodiment may be useful in a setting in which multiple members of a family all desire to use the same monitoring unit. Alternatively, such an embodiment with the system may be useful in a health club setting in which one or a small number of monitoring units are used for a large populace of users. The personal identifier code may be a name and/or a password that are entered into the input device of the monitoring unit (e.g., the personal identifier may be entered via a keypad into the monitoring unit). Alternatively, the personal identifier code may be any sequence of data uniquely associated with a user of a monitoring unit. The personal identifier code may be encoded upon a magnetic strip, upon an infrared signal, or upon a radio frequency signal.
• According to one embodiment, the monitoring unit may require its user to wear an activity meter. An activity meter is a device that measures the activity level of a person wearing the meter and determines a numeric indication of that activity level. Examples of activity meters include pedometers, accelerometers, and calorie counters. A calorie counter is a device in which dietary input is entered, and on the basis thereof, calories consumed is arrived at. The monitoring unit may ask the user to enter readings from the activity meter so that this information may be transmitted to the remote computing system. Alternatively, the monitoring unit may interface directly with the activity meter so that the readings may be transmitted without intervention by the user. For example, with reference toFIG. 4, the activity meter may be interfaced withIO port28 so that the information therein can be communicated directly toCPU38. The activity meter may communicate with the monitoring unit via a radio frequency link, an infrared link, a wireless network, a wireless communication technology and protocol such as Bluetooth® which is a set of wireless technologies owned and made available from Bluetooth SIG Inc., or via a serial or parallel port embodied in a cradle, for example.
• Activity meters provide a way for the monitoring unit and remote computing system to verify the answers provided by the user of the monitoring unit with respect to exercise levels. In some cases the readings provided by the activity meter may supplant any questioning regarding the exercise level of the person using the monitoring unit.
• Activity meters may be used to gather information related to a person's activity level over a period of time, so that the information can be presented to that person. For example, the monitoring unit may prepare a status presentation that compares the person's present activity level to the person's activity level a week ago, two weeks ago, a month ago, six months ago, a year ago, or two years ago. Alternatively, the monitoring unit may compare the person's present activity level with the person's average (or median or other measure of central tendency) activity level over a past interval of time. The status presentation may be presented to the person via the output device of the monitoring unit. Alternatively, the status presentation may be e-mailed to the person (from the remote computing system, for example), may be made available to the person via a web site, may be presented via a printed report, or may be faxed to the person, for example.
• A website may be provided as a front end access point to allow the person using the monitoring unit (or another designated person such as a health care provider, spouse, or parent) to access information collected by the monitoring unit. For example, the website may allow access to a database that stores information collected by the monitoring unit. The person gains access to the information in the database by entering a personal identifier, which is a set of data uniquely associated with the particular person. The database is accessed based upon the personal identifier, and one or more webpages are then presented to the person. The webpages may include indications of the person's weight loss progress (as discussed above), comparisons regarding the person's activity level (such as has been discussed above), or may present any of the information presented on the screen shown inFIG. 34. Alternatively, the indications of the person's weight loss progress, comparisons regarding the person's activity level, or any of the information presented on the screen shown inFIG. 34 may be communicated from the monitoring unit to a device such as a palm-top computer, a television set, or a telephone (e.g., via a modem) for presentation to a designated person.
• Thus, it will be appreciated that the previously described versions of the invention provide many advantages, including addressing the needs in the medical profession for an apparatus and method capable of monitoring and transmitting weight loss and/or weight maintenance parameters of persons to a remote site whereby a medical professional caregiver can evaluate such physiological and wellness parameters and make decisions regarding the patient's treatment.
• Also, it will be appreciated that the previously described versions of invention provide other advantages, including (according to certain embodiments) addressing the need for an apparatus for monitoring and transmitting such weight loss and/or weight maintenance parameters that is available in an easy to use portable integrated single unit.
• Also, it will be appreciated that the previously described versions of the invention provide still other advantages, including addressing the need for medical professional caregivers to monitor and manage the patient's condition to prevent unnecessary weight gain and the occurrence of health problems that are concomitant therewith.
• Although the invention has been described in considerable detail with reference to certain preferred versions thereof, other versions are possible.
• Therefore, the spirit and scope of the appended claims should not be limited to the description of the preferred versions contained herein.

Claims (22)

1.-220. (canceled)

221. A medical device for monitoring a patient on a central computer, the medical device comprising:

a processing unit;

a computer-readable medium associated with the processing unit;

a sensor, operably coupled with the processing unit, the sensor detecting at least one physiological parameter of the patient;

an output device operably coupled to the processing unit;

an input device operably coupled to the processing unit;

a communication device operably coupled to the processing unit;

wherein the computer-readable medium is programmed with a set of instructions that

a) causes the processing unit to prompt the patient with a first question via the output device, and to receive at least one response to the first question via the input device; and thereafter

b) causes the processing unit to cooperate with the communication device to automatically initiate a communication session with the central computer, wherein during the communication session, data associated with the at least one physiological parameter is uploaded to the central computer.

222. The medical device ofclaim 221, wherein the computer-readable medium is further programmed with a set of instructions that cause the processing unit to download data associated with the first question from the central computer.

223. The medical device ofclaim 221, wherein the computer-readable medium is further programmed with a set of instructions that cause, during the communication session, the processing unit to upload data associated with the at least one response to the central computer.

224. The medical device ofclaim 223, wherein the computer-readable medium is further programmed with a set of instructions that cause, during the communication session, the processing unit to download data associated with a second question from the central computer, based at least in part on the at least one response.

225. The medical device ofclaim 221, wherein the processing unit initiates the communication session after receiving the at least one response to the first question.

226. The medical device ofclaim 221, wherein the processing unit initiates the communication session after the sensor detects the at least one physiological parameter.

227. The medical device ofclaim 221, wherein the first question comprises one of a plurality of wellness parameter questions, wherein the processing unit initiates the communication session after receiving a final response to a final question of the plurality of wellness parameter questions.

228. The medical device ofclaim 221, wherein the computer-readable medium is further programmed with a set of instructions that cause, during a subsequent communication session, the processing unit to download data associated with a customized question from the central computer.

229. The medical device ofclaim 228, wherein the customized questions are entered by a health care provider at a workstation remote from the central computer.

230. A system for monitoring a patient, the system comprising:

a central computer;

a processing unit;

a computer-readable medium associated with the processing unit;

a sensor, operably coupled with the processing unit, the sensor detecting at least one physiological parameter of the patient;

an output device operably coupled to the processing unit;

an input device operably coupled to the processing unit;

a communication device operably coupled to the processing unit to communicate with the central computer;

wherein the computer-readable medium is programmed with a set of instructions that

a) causes the processing unit to prompt the patient with a first question via the output device, and to receive at least one response to the first question via the input device; and thereafter

b) causes the processing unit to cooperate with the communication device to automatically initiate a communication session with the central computer, wherein during the communication session, data associated with the at least one physiological parameter is uploaded to the central computer.

231. The system ofclaim 230, wherein the central computer further comprises a computer-readable medium programmed with a set of instructions that cause the central computer to upload data associated with a second question to the processing unit, based on at least one of the at least one response and the data associated with the at least one physiological parameter.

232. The system ofclaim 231, wherein the central computer computer-readable medium is further programmed with a set of instructions that cause the central computer to upload at least one of the at least one response and the data associated with the at least one physiological parameter to a workstation accessed by a healthcare provider.

233. The system ofclaim 232, wherein the central computer computer-readable medium is further programmed with a set of instructions that cause the central computer to receive a healthcare provider question from the workstation and to upload the healthcare provider question to the processing unit.

234. A method for monitoring a patient, the method comprising:

providing a monitoring device comprising:

a processing unit;

a computer-readable medium associated with the processing unit;

a sensor operably coupled with the processing unit;

an output device operably coupled to the processing unit;

an input device operably coupled to the processing unit;

a communication device operably coupled to the processing unit to communicate with the central computer;

detecting, by the sensor, at least one physiological parameter of the patient;

prompting the patient with a first question via the output device;

receiving at least one response to the first question via the input device;

initiating, after the receiving step, a communication session between the communication device and the central computer; and

uploading, during the communication session, data associated with the at least one physiological parameter to the central computer.

235. The method ofclaim 234, further comprising downloading from the central computer to the processing unit, data associated with the first question.

236. The method ofclaim 234, further comprising uploading from the processing unit to the central computer, during the communication session, data associated with the at least one response.

237. The method ofclaim 236, further comprising downloading to the processing unit to the central computer, during the communication session, data associated with a second question based at least in part on the at least one response.

238. The method ofclaim 234, further comprising initiating the communication session after receiving the at least one response to the first question.

239. The method ofclaim 234, further comprising initiating the communication session after the sensor detects the at least one physiological parameter.

240. The method ofclaim 234, further comprising downloading to the processing unit from the central computer, during a subsequent communication session, data associated with a customized question.

241. The method ofclaim 240, further comprising receiving, by the central computer, the customized question from a health care provider located remote from the central computer.

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