DE10163095B4 - Telemedicine system, with a physician-side consultation center and at least one patient-side, in particular mobile telemedicine device - Google Patents

Abstract

Telemedicine system (10) with
(a) a physician-side consultation center (12) with qualified medical personnel (14) and with diagnostic aids (22) for automatically and / or interactively influenceable diagnosis support,
(b) at least one patient-side telemedicine device (30) comprising
At least one diagnostic device (42) for acquiring medical data (D _med ) of a patient (32) to be supplied,
At least one therapy device (46) for carrying out therapeutic measures on the patient (32) and
- at least one audiovisual communication unit (40) for receiving communication data (D _kom ) and for transmitting the data (D _med , D _kom ) to the consultation center (12),
(c) a communication system (28) for wireless and / or wired transmission of audiovisual data between the consultation center (12) and the at least one telemedicine device (30),
(d) a database (18) of digital patient records (20) comprising patient data (D _PA ), and
(e) means for assigning a patient file (20) of the database (18) to the patient to be treated (32) and means for the physician-side visual and / or auditory presentation of the information in the associated ...

Description

The The invention relates to a telemedicine system with a physician side Consultation center and at least one patient-side, in particular mobile Telemedicine device.

Of the Use of systems for telemedical diagnosis and / or treatment of patients is potentially desirable in places or situations in which no medical professionals, especially no doctor, to disposal stands. Typical examples are about airplanes or ships or also remote, thin populated areas. Especially in a medical emergency a quick diagnosis and therapy is necessary, stands on such Places usually do not have enough time available to to bring together an emergency physician and the affected patient. to Remedy can therefore diagnostic devices on such medically underserved Places, for example in airplanes, are stationed with which individual diagnostic functions such as blood pressure measurements can. These devices must It should be designed to be used by lay people or, where appropriate trained personnel. Traditionally, the helper must then by telephone or radio connection or the like with a Get in touch with doctor from the information available to him must derive a diagnosis to therapy or first aid measures to instruct. At the same time, the doctor is completely informed of him Information instructed. It is obvious that with conventional Communication device diagnostic Options, the reliability the diagnosis and of course also the quality the treatment measures far behind that usual for direct doctor-patient contact Standard lingering.

From recent developments, mobile telemedicine devices are known in which the diagnostic data are sometimes transmitted even to a doctor. The EP 1 051 945 A2 describes a mobile telemedicine device that combines various diagnostic functional elements and transmits the recorded data and voice and image information to a ground station over narrow frequency band ranges. The disadvantage here on the one hand, the coherent structure of the device in which the individual diagnostic instruments are wired connected to a central computer. As a result, the flexibility of the device is severely limited because the use requires the transport of the complete device to the patient. Furthermore, in the known device only low data transmission rates are possible, so that about real-time image transmissions (video) or the transmission of extensive diagnostic data are not possible.

The older patent application DE 101 54 908.3 The applicant also describes a patient-side telemedicine device which communicates with a doctor-side consultation center and has a modular design with a multiplicity of diagnostic, communication and / or therapy modules. This preferably wirelessly with a base unit. the telemedicine device associated functional modules allow easy handling of the device, flexible equipment and / or conversion and especially high data transfer rates, which also allow transmission of image and audio data in real time.

Out WO 01/15056 A1 is a telemedicine system for requesting medical Services are known.

task The present invention is a further over the prior art on to provide improved telemedicine system, the faster and more reliable Remote diagnostics and remote therapies and thus enables the telemedical Patient care improved overall.

These The object is achieved by a telemedicine system having the features of the claim 1 solved.

The The invention thus essentially aims at the integration of a database with digital patient records, after identification of a Emergency patient who calls this associated patient record and the patient data stored therein automatically a medical Professionals of the Consultation Center. Of course required this concept the previous registration of the patient and the Storage of his medically relevant data. For privacy reasons is easily possible, manage the database anonymously with patient records. Misses the system - though less favorable - of course to the medical remote care of patients who do not are registered and therefore not via a digital patient record feature.

Immediately after reporting a medical emergency, medical professionals, such as a physician or medical team, receive important diagnostic-relevant information that, together with the current transmitted medical data and / or communication data, facilitates the position of a fast and reliable diagnosis. The otherwise cumbersome, often in the required verbosity not possible information exchange with the patient or a helper, to determine about medical preliminary findings of the patient, is omitted. As a result, patient-side therapeutic measures or first-aid measures can be instructed and initiated more quickly, thus ensuring better and more effective patient care. In addition, preparatory actions, for example in a receiving clinic, can be initiated more quickly. Of course, it is additionally conceivable to display the data contained in the patient file also on the patient side of the helper, preferably by means of the telemedicine device, so that the helper can also benefit from this.

The All patient data stored in digital patient records can be used include medically relevant data of the patient, which also in conventional Patient files are included. In particular, this may include age, gender, Weight, blood type, blood values, allergies, medical findings, Anamnesis data, family Dispositions, medication data and / or the like. Besides can the patient data can also be retrieved by the doctor digital image data, for example of x-rays, Ultrasound images, magnetic resonance imaging, electrocardiograms or like that. This gives the doctor a comprehensive overview of the Health and general condition of the patient. In individual cases can in this way even a direct comparison with by means of the telemedicine device currently recorded and transmitted Image data, such as an electrocardiogram done. hereby the diagnostic reliability is further improved. Especially in the In addition, the patient record case sustained patient can also information about a medical device Equipment, such as with an electrocardiograph, and / or on a drug Include patient equipment. This facilitates the doctor, individual Decisions regarding further diagnostics or therapy hold true.

The The database containing digital patient records can be patient-side be associated with the telemedicine device. However, such an execution requires a large number of copies of the database and also a certain amount Time Delay through the transmission relevant content to the Consultation Center, It is preferable for the database to be sent to the physician's consultation center assigned. However, it is also conceivable that the patient has a corresponding identification card carries with it, on which said Patient data are stored. In this case, the database constituted by the plurality of individual identification cards.

According to one simple embodiment of the invention, the assignment of the patient file by simple entry of the name or a recognition number of the patient about about a keyboard or the like is done by the helper. According to a preferred embodiment, the telemedicine system comprises however, an automatic identification system for recording and Recognition of identification data of the emergency patient. The identification system comprises in particular a patient-side, preferably the telemedicine device associated reading device for receiving the identification data of the patient. This can in particular be a reading device (scanner) for Recording a fingerprint, the iris, the face or the Be the patient's voice or read an identification card of the patient. Further includes the identification system is a recognition system for recognizing the recorded identification data of the patient to an automatic assignment the associated Patient record. In particular, programs come into question that are known per se Apply image or pattern recognition method. there become the currently recorded identification data of the patient matched with a reference database, the corresponding stored Identification data of registered patients contains. each Of course, this method requires a previous one-off Recording and storing the corresponding identification feature of the patient, for example his fingerprint. The reference database can be separately. exist and with the database with the patient records connected be or be integrated into the latter. By the automatic Identification system gives a further time advantage.

The The invention further provides that the physician's consultation center furthermore about Diagnostic tools for automatic and / or interactive part the doctor has modifiable diagnostic support. These diagnostic tools preferably contain stored algorithms that depend on from the medical transmitted by the telemedicine device Data and / or communication data and / or from the patient data of associated patient file make diagnostic and / or therapeutic suggestions. It can also be provided in particular, the corresponding proposals together with weights that, for example, set a benchmark for safety the diagnosis suggestion or the urgency of a therapy suggestion represent. Such aids contribute significantly to increasing the Diagnostic safety and to speed up the diagnosis at.

The patient-side telemedicine device according to the invention comprises at least one diagnosis tikgerät, which is operated about by the aid workers and allows the recording of medical data on the emergency site and their transmission to the consultation center. Such a diagnostic device may be, for example, an electrocardiograph, a pulse oximeter, a spirometer, a sphygmomanometer, a thermometer, a sonograph, a Doppler sonograph, a cardiotocograph, a minilab unit and / or the like. The modular equipment of the telemedicine device with a variety of different mobile diagnostic devices is particularly advantageous.

Further can the telemedicine system be operated via patient-side monitoring devices (so-called event recorders)? feature, preferably at risk Automatically and permanently monitor at least one vital function, about to acute heart rhythm disorders too detect and signal a medical emergency. The Use of monitoring devices allowed the automatic and immediate notification of the emergency both at the scene of the accident itself as well as the doctor's consultation center. One or several such monitoring devices can also be associated with the telemedicine device.

The According to the invention, the telemedicine system comprises at least one patient-side, preferably also the telemedicine device associated Kommuni kationseinheit for recording and transmission audio data and / or visual data of the patient and / or the patient Rescuer. As a communication unit, in particular a microphone and speaker means for mutual transmission of voice data and a camera for transmission of video data, preferably in real time.

In Another advantageous embodiment of the invention is a location system intended to determine a position of the telemedicine device, which may for example be based on a satellite-based method. In particular, the telemedicine device can do this via a GPS device (Global Positioning System). This allows a quick coordination of possibly required transports of the Patient in a clinic or a doctor to the patient.

The data transmission between the patient-side telemedicine device and the physician-side Consultation center is preferably - in some cases (for Example in airplanes or on ships) necessarily - wireless, wherein particularly advantageous broadband data transmission techniques, in particular using Internet Protocols (TCP / IP). It can in principle, all known data transmission systems be used, in particular landline, mobile, preferably UMTS mobile, Satellite, Local Area Network (LAN), Wide Area Network (WAN) and / or wireless local area network (WLAN) transmissions. It can too Several of these systems can be used in combination. For this purpose, the communication module has corresponding Facilities and interfaces. In this way, that allows inventive system the transmission very large amounts of data in no time Time. Thus, also a transmission Real-time video (live mode) takes place over the video Communication system associated doctor, for example, in a video conference circuit conveys a direct visual impression of the patient and allows him to therapeutic measures to monitor, too comment and direct.

The Invention will be described below in an embodiment with reference to the accompanying drawings explained in more detail. It demonstrate:

1 schematically an overview of a structure of the telemedicine system according to the invention according to an advantageous embodiment of the invention and

2 schematically a more detailed structure of the telemedicine device and the database with the digital patient records of the telemedicine from 1 ,

According to 1 and 2 includes the total with 10 As a first essential component, the telemedicine system referred to a physician (inpatient) consultation center 12 that has medical personnel, in particular at least one doctor 14 , as well as a central data processing system 16 ,

The data processing system 16 In addition to conventional peripheral devices, such as one or more screens, a keyboard and / or other input means includes a specially designed computer that contains the usual components not shown here, such as system board, processor, memory, memory and the like. The data processing system 16 also has access to a database 18 containing a variety of digital patient records 20 contains ( 2 ). The patient files 20 include stored, medically relevant patient data D _PA registered patients, such as age, sex, weight, blood type, blood levels, allergies, medical findings, history data, family dispositions, medication data, and the like. In addition, the patient records 20 Also digital image data of patients, such as X-ray images, as well as a possible device medicine including and / or medical equipment of the patient.

The data processing system 16 also has access to diagnostic tools 22 in the form of at least one stored algorithm, the automatically and / or interactively influenceable a diagnosis of the doctor 14 supported. Both the database 18 with the digital patient files 20 as well as the diagnostic tools 22 can be stored on a hard drive of the computer of the data processing system 16 stored or on external equipment connected via a data transmission network.

The consultation center 12 In addition, if necessary, for example, via live conference calls with other medical experts 24 and / or clinics 26 be connected.

The consultation center 12 is about a communication system 28 with at least one patient-side (mobile) telemedicine device 30 connected. Usually, a variety of telemedicine devices 30 that are stationed in different locations, such as airplanes, on ships or other hard-to-reach places, with the Consultation Center 12 connected.

The communication system 28 uses particularly advantageous broadband data transmission techniques, in particular using Internet protocols (TCP / IP) to ensure the highest possible data transfer rates. For example, the transmission can take place via a satellite system. Both the data processing system 16 of the Consultation Center 12 as well as a central, not shown here computer of the telemedicine device 30 For this purpose they have the necessary protocols, connections and interfaces.

On the part of an emergency patient 32 becomes the telemedicine device 30 usually by a relief worker 34 operated simultaneously with the doctor 14 of the Consultation Center 12 communicated.

As a telemedicine device 30 can be particularly advantageous in the already mentioned earlier patent application DE 101 54 908.3 described device can be used. The more detailed structure of such a telemedicine device 30 and their interaction with the Consultation Center 12 especially with the database 18 , will be out 2 seen.

The telemedicine device 30 has a modular structure. The heart is a basic module 36 which essentially includes a specially designed PC. The telemedicine device 30 also includes a communication unit 38 for connection to the communication system 28 ,

Beside it has the telemedicine device 30 via a number of different functional modules, preferably completely from the base module 36 can be separated and thus enable a mobile self-sufficient use. For this purpose, the function modules have their own power supply, in particular accumulators, as well as a wireless data transmission system, which they use for data exchange with the base module 36 capable. First, according to the illustrated example, a communication module is a first functional module 40 is provided, which typically comprises a microphone and / or a video camera and thus the transmission of voice and video data both of the helper 34 as well as the patient 32 allows. The telemedicine device 30 is also available with a variety of diagnostic equipment 42 of which, for the sake of clarity, only two are shown here by way of example, for collecting and passing on medical data D _med1 , D _med2 . These may be, for example, an electrocardiograph, a blood pressure measuring device, a sonograph or the like. In addition, a monitoring device, also referred to as an event recorder, is provided 44 provided that certain vital functions (heart rhythm, blood pressure, etc.) continuously monitored especially by high-risk patients and signals a medical emergency in case of abnormalities. In particular, event recorders for the detection of cardiac arrhythmias are known.

In addition, is a therapy module 46 for the execution of therapeutic or emergency measures before, for example, a self-employed or according to the instructions of the doctor 14 from the helper 34 can be operated defibrillator.

Finally, the telemedicine device has 30 via a reading device 48 , with the specific identification data D _{ID of} the patient 32 can be detected. According to the illustrated example, the reading device is 48 to get a fingerprint scanner, the patient's fingerprint 32 records and digitizes. For automatic identification of the patient 32 is also a recognition system 50 provided, preferably in the data processing system 16 of the Consultation Center 12 is integrated. This is preferably a suitable per se known pattern recognition system, which reads the recorded and transmitted identification data D _ID and compares it with a reference database, which includes the corresponding identification data (here fingerprints) of all registered patients. In this example, this reference database is an integral part of the database 18 with the digi talen patient records 20 where each patient file 20 includes the identification data D _{ID of} the corresponding patient. The recognition system 50 thus allows assignment of the emergency patient 32 associated patient file 20 so this file 20 in a working memory of the data processing system 16 loaded and the included patient data D _PA the doctor 14 in the consultation center 12 for example, can be visually displayed on a monitor.

The typical procedure of the method will be clarified below using the example of an emergency. Of course, deviating applications of the telemedicine system according to the invention are also possible 10 conceivable and useful, for example, for simple doctor consultations or for monitoring chronically ill patients.

The beginning of the process is the medical acute situation, for example an acute cardiac arrhythmia of a patient on board an aircraft 32 The cardiac arrhythmias are from the event recorder 44 detected and reported to the flight crew. At the same time the telemedicine device is transmitting 30 an alarm signal S _AL to the consultation center 12 to make an automatic contact with the consultation center 12 perform. When the telemedicine system 10 via no monitoring device 44 Alternatively, of course, the flight crew or a passenger can be directly aware of the medical emergency or by the affected patient 32 be informed yourself. In this case, the contact with the consultation center 12 by a trained assistant 34 manufactured by the flight crew.

In the consultation center 12 the call is automatically accepted and a new electronic case is created in the database 20 , If the telemedicine system 10 has an automatic identification system, takes the helper 34 Immediately after recognition of the emergency, the identification data D _{ID of} the patient 32 with the help of the reading device 48 on which the identification data D _ID preferably via a wireless connection to the base module 36 transmitted. From here, using the communication unit 38 over the communication system 28 the identification data D _ID to the consultation center 12 Posted. This is where the detection system starts automatically 50 the comparison of the transmitted identification data D _ID with those in the patient records 20 contained identification data. For this purpose, pattern recognition methods are used, which are known per se and therefore will not be explained in detail here. In the event that no identification system 48 . 50 is provided, the selection and the loading of the corresponding patient file takes place 20 by transmitting the name of the patient 32 or an ID number or the like. Is for the affected patient 32 a patient file 20 available, there is an automatic electronic entry of the currently occurring medical care case in the patient record 20 , On the other hand, is it a previously unregistered patient? 32 , it automatically becomes a new digital patient record 20 created with the appropriate entry. The in the patient 32 associated patient file 20 available patient data D _PA will be the doctor 14 of the Consultation Center 12 for example, displayed on a screen.

Furthermore, the assistant begins 34 - if necessary under the direction of the doctor 14 - Primary diagnosis, by means of diagnostic devices 42 Medical data D _{med be} included. For example, an electrocardiogram (D _med1 ) can be recorded with an electrocardiograph and sent to the consultation center 12 transmitted and / or recorded with a Doppler sonograph an ultrasound _image (D _med2 ) and transmitted. At the same time, the communication module allows 40 the transmission of voice and image data, so that the doctor 14 with the helper 34 communicate and instruct them. The image data, preferably transmitted in real time, help the doctor 14 to a comprehensive overall impression of the patient 32 , These communication data D _com are also transmitted to the consultation center and _displayed acoustically and visually together with the medical data D _med1 , D _med2 . At the same time, an automatic storage of the data D _med1 , D _med2 and optionally D _com in the patient record 20 to provide a permanent documentation and database update 18 to support.

The doctor 14 _{uses the} available data D _PA , D _com , D _med1 , D _{med2 to make} a diagnosis and instructs the assistant 34 to appropriate relief and therapy measures. For example, he can use a therapy module 46 or to instruct the administration of drugs or to initiate further diagnostic tests.

The diagnosis of the doctor is supported 14 also by the diagnostic tools 20 which, based on the available data D _PA , D _com , D _med1 , D _{med2, submit} weighted or unweighted diagnostic _suggestions and, if appropriate, therapeutic _measures . Through the continuous monitoring of the recognized passenger 32 and the continuing transmission of medical data and communication data is the physician's responsibility 14 in the consultation center 12 it is possible to assess the effectiveness of the therapy and to decide on the further procedure.

10

Telemedicine System

12

consultation center

14

doctor

16

Data processing system (PC)

18

Database with digital patient records

20

digital medical record

22

diagnostic tools

24

Experts |

26

clinic

28

communication system

30

Telemedicine device

32

patient

34

Help Leis Tender

36

base module

38

communication unit

40

auditory-visual communication module

42

diagnostic device

44

Monitoring device (event recorder)

46

therapy module

48

reader

50

recognition system

D _ID

identification data

D _kom

communications data

D _med

medical dates

D _PA

patient information

S _Al

alarm

Claims (17)

Telemedicine system ( 10 ) with (a) a physician consultation center ( 12 ) with medical professionals ( 14 ) and diagnostic tools ( 22 ) for automatically and / or interactively influenceable diagnosis support, (b) at least one patient-side telemedicine device ( 30 ), comprising - at least one diagnostic device ( 42 ) for collecting medical data (D _med ) of a patient to be treated ( 32 ), - at least one therapy device ( 46 ) for performing therapeutic measures on the patient ( 32 ) and - at least one audiovisual communication unit ( 40 ) for receiving communication data (D _kom ) and for transmitting the data (D _med , D _kom ) to the Consultation Center ( 12 ), (c) a communication system ( 28 ) for the wireless and / or wired transmission of audiovisual data between the Consultation Center ( 12 ) and the at least one telemedicine device ( 30 ), (d) a database ( 18 ) with digital patient records ( 20 ) comprising patient data (D _PA ), and (e) means for associating a patient record ( 20 ) of the database ( 18 ) to the patient to be treated ( 32 ) and means for the physician's visual and / or auditory presentation of the in the associated patient record ( 20 ) contained patient data (D _PA ), the transmitted medical data (D _med ) and communication data (D _com ) and the diagnostic tools ( 22 ) issued diagnostic and / or therapeutic suggestions. Telemedicine system ( 10 ) according to claim 1, characterized in that the patient data (D _PA ) of the digital patient files ( 20 ) include medically relevant data such as age, gender, weight, blood type, blood levels, allergies, medical findings, history data, familial dispositions, medication data, and the like. Telemedicine system ( 10 ) according to claim 1 or 2, characterized in that the patient data (D _PA ) of the digital patient files ( 20 ) Include image data such as X-ray images, ultrasound images, MRI scans, electrocardiograms, and the like. Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the patient data (D _PA ) of the digital patient files ( 20 ) Information about a medical device and / or a medical equipment of the patient ( 32 ). Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the database ( 18 ) with the digital patient files ( 20 ) the medical consultation center ( 12 ) and / or the patient-side telemedicine device ( 30 ) and / or by a plurality of individual, patient-stored patient records ( 20 ) is embodied. Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the means for assigning a patient file ( 20 ) an identification system ( 48 . 50 ) for receiving and recognizing identification data (D _ID ) of the patient ( 32 ). Telemedicine system ( 10 ) according to claim 6, characterized in that the identification system ( 48 . 50 ) a patient-side reading device ( 48 ) for receiving the identification data (D _ID ) of the patient ( 32 ), in particular for taking a fingerprint, the iris, the face or the voice of the patient ( 32 ) or reading a patient identification card ( 32 ). Telemedicine system ( 10 ) according to claim 7, characterized in that the patient-side reading device ( 48 ) into the telemedicine device ( 30 ) is integrated. Telemedicine system ( 10 ) according to claim 1, characterized in that the diagnostic aids ( 22 ) at least one stored algorithm depending on the telemedicine device ( 30 ) transmitted medical data (D _med ) and / or communication data (D _com ) and / or the patient data (D _PA ) of the associated patient record ( 20 ) Provides diagnostic and / or therapeutic suggestions. Telemedicine system ( 10 ) according to claim 1, characterized in that the diagnostic device ( 42 ) for acquiring the medical data (D _med ), in particular an electrocardiograph, a pulse oximeter, a spirometer, a sphygmomanometer, a thermometer, a sonograph, a Doppler sonograph, a cardiotocograph or a minilab unit. Telemedicine system ( 10 ) according to one of the preceding claims, characterized by at least one patient-side, in particular the telemedicine device ( 30 ), monitoring device ( 44 ) for automatically monitoring at least one vital function of the patient ( 32 ) and to signal a medical emergency depending on the monitored function. Telemedicine system ( 10 ) according to claim 1, characterized in that the audiovisual communication unit audio data and / or visual data of the patient ( 32 ) and / or an assistant ( 34 ) to the Consultation Center ( 12 ) transmitted. Telemedicine system ( 10 ) according to one of the preceding claims, characterized by a, in particular the telemedicine device ( 30 ), locating system for determining a position of the telemedicine device ( 30 ). Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the communication system ( 28 ) for wireless and / or wired data exchange between the telemedicine device ( 30 ) and the Consultation Center ( 12 ) comprises broadband data transmission, in particular using Internet protocols. Telemedicine system ( 10 ) according to claim 14, characterized in that the communication system ( 28 ) for wireless and / or wired data exchange a fixed network, mobile, in particular UMTS mobile, satellite, local area network (LAN), wide area network (WAN) and / or WLAN transmission , Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the physician-side consultation center ( 12 ) with further consultation centers, clinics ( 26 ) and / or the like is connectable. Telemedicine system ( 10 ) according to one of the preceding claims, characterized in that the patient-side telemedicine devices are located in places where no medical professionals are present, in particular for the care of patients in emergencies.