6,014,626
`[11] Patent Number:
`[19]
`United States Patent
`
`Cohen
`[45] Date of Patent:
`Jan. 11, 2000
`
`USOO6014626A
`
`[54] PATIENT MONITORING SYSTEM
`INCLUDING SPEECH RECOGNITION
`CAPABILITY
`
`[76]
`
`Inventor: Kopel H. Cohen, 2362 Harbour Oaks
`Dr., Longboat Key, Fla. 34228
`
`[21] Appl. No.: 08/695,466
`[22]
`Filed:
`Aug. 12, 1996
`
`_
`_
`Relate‘l U-S- Apphcatl‘m Data
`.
`.
`.
`.
`.
`Contmuation—m—part of applicatlon No. 08/305,108, Sep. 13,
`1994, pat. No. 5,633,910.
`,
`
`[63]
`
`Int. Cl.
`[51]
`....................... G10L 3/00
`
`[52] U..S. Cl.
`............
`04/275; 704/271; 706/924
`[58] Fleld of Search .................................. 395/2.79, 2.81,
`379/38, 93, 106; 704/270, 275, 273, 272;
`
`L. Baer, et al., “Automated Telephone Screen Survey For
`Depression,” JAIl/IA, vol. 273, No. 24, pp. 1943—1944, Jun.
`28, 1995.
`“VProTM Speech Recognition on AntaresTM,” Dialogic®
`On—Line Information Retrieval System, pp. 1_2.
`“VRSoftTM, Discrete,Multi—Language Speech Recognition
`Software”, Dialogic® On—Line Information Retrieval Sys-
`tem pp. 1_3.
`“AntaresTM Platform Overview,” Dialogic® On—Line Infor-
`mation Retrieval System, 1—3.
`“2000/33, 2000/50, 6000/50 ISA Platform,” Dialogic®
`On—Line Information Retrieval System, pp. 1—6.
`“
`.
`.
`D/160SC—LSTM 16—Port V01ce Processing & Analog Inter-
`face Board,” Dialogic® On—Line Information Retrieval Sys-
`tem pp.1—9.
`“VR/160TM 16—Port ASR Board,” Dialogic® On—Line
`Information Retrieval System, pp 1_7
`
`[56]
`
`References Cited
`U.S. PATENT DOCUMENTS
`
`706/924’ 60’ 61
`
`Primary Examiner—Richemond Dorvil
`Attorney, Agent, or Firm—Kenyon & Kenyon
`[57]
`ABSTRACT
`
`4/1973 Vogelman et a1.
`.......................... 705/3
`3,727,190
`11/1973 Osterberg et a1.
`395/850
`3,774,164
`
`5/1975 De Pedro et a1.
`379/1062
`3,882,277
`8/1976 Kalman ................................... 600/519
`3,972,320
`..................................... 379/38
`1/1978 Verriest
`4,068,097
`
`
`10/1981 Dunmvg et al' "
`GOO/529
`472967756
`3132; Zen}: Rlper et al'
`379/3225
`4934312929;
`
`7/1984 Bidifilsfi'el'u.’.......600/528
`4:458:693
`........................ 600/485
`4,712,562 12/1987 Ohayton et a1.
`
`
`.. 379/106.02
`.......
`4,751,726
`6/1988 Hepp et a1.
`2/1989 Fu et a1. ............... 600/483
`4,803,625
`
`340/523
`4,843,377
`6/1989 Fuller et a1.
`..
`
`
`4,858,121
`8/1989 Barber et a1.
`705/2
`
`--
`600/509
`4,883,064
`11/1989 015011 91 al-
`8/1991 Leishman ................................ 600/301
`5,036,852
`
`(List continued on next page.)
`OTHER PUBLICATIONS
`
`Paper entitled “Telecommunications in Managed Self Care”,
`by Farrokh Alemi, Ph.D., presented at 17th Annual Sympo-
`sium on Computer Applications in Medical Care, Oct. 31,
`1993.
`
`A Patient monitoring System A Patient ha? access to a
`telephone. The telephone is operated by a patient. Acentral
`monitoring system is coupled to the telephone. The central
`monitoring system generates questions concerning a health
`condition of the patient for the patient to answer using the
`keys of the telephone or by speaking the correct response.
`The central monitoring system stores answers to the ques-
`lions for later retrieval' The central monltgring SyStem ‘3”
`Indude a DTMF mOdem deCOder f9” recelYmg and deCOdlng
`DTMF tones generatéd by the Patlent 115mg thefouch-tone
`telephone and transmitted to the central monitoring system.
`The DTMF tones represent
`the health condition of the
`patient. A computer processor is coupled to the DTMF
`modem decoder. A voice generator is also coupled to the
`computer processor and generates voice output under the
`control of the computer processor. The voice output
`is
`transmitted to the touch-tone telephone. A database is
`coupled to the computer processor, storing a patient record
`reflecting the health condition of the patient and also storing
`the questions concerning the health condition of the patient.
`
`21 Claims, 9 Drawing Sheets
`
`
`
`/\/11
`
` Outpatienl
`Module
`
`
`12
`
`
`
`Interface
`
`Subsystem
`
`Cardiocom Ex. 1002
`
`Voice/DTMF
`Module
`
`
`
`ASR
`Module
`
`
`
`Cardiocom Ex. 1002
`
`

`

`6,014,626
`
`Page 2
`
`US. PATENT DOCUMENTS
`
`5,289,521
`
`2/1994 Coleman et a1.
`
`......................... 379/52
`
`5 038 800
`8/1991 Ob
`600/509
`5’065’315
`11/1991 Gag;““““““““““““““““““““““
`705/2
`
`5,099,424
`3/1992 Schneiderman
`...... 205/3
`
`
`5,107,831
`128/20426
`4/1992 Halpern et a1.
`5,142,484
`..... 222/638
`.
`8/1992 Kaufman et a1.
`
`
`~~ 340/574
`5,159,317 10/1992 Brav ...............
`
`"3269393553
`thanlEotu1.
`3733723: 13133;
`e a.
`..
`,
`,
`oc
`.
`
`340/825“
`5,204,670
`4/1993 Stimon
`
`5/1993 Strecher ..
`. 434/238
`5,207,580
`10/1993 Alheim ...................................... 379/52
`5,253,285
`
`2/1994 Levine ................................. 379/93.23
`5,289,531
`4/1994 Starr, III et a1.
`........................ 702/176
`5,305,238
`6/1994 Gessman ..................................... 607/5
`5,321,618
`5,357,427 10/1994 Langen et a1.
`.......................... 364/413
`5,377,258 12/1994 Bro .......
`. 379/106
`
`8/1995 David et a1.
`............................ 128/670
`5,441,047
`5,544,649
`8/1996 David et a1.
`............................ 128/630
`5,633,910
`5/1997 Cehen ....................................... 379/38
`5,660,176
`8/1997 Ihff .......................................... 128/630
`5,668,928
`9/1997 Groner .................................... 704/243
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 1 0f 9
`
`6,014,626
`
`E65830
`
`E2m>mnsm
`
`rmsmi
`
`E2333”
`
`$550
`
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 2 0f 9
`
`6,014,626
`
`:\<
`
`m—
`
`.5235
`
`52:35
`
` 56.950
`
`86>
`
`m93ml
`
`833
`
`
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 3 0f 9
`
`6,014,626
`
`<N9%;
`
`3
`
`Eggs
`
`82383
`
`885.5
`
`2822
`
`u__>:.Q\mo_o>
`
`2:32
`
`mw<
`
`@5002
`
`595
`
`83mm
`
`
`
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 4 0f 9
`
`6,014,626
`
`29
`
`
`QUESTION # 2:
`
`
`
`IF YOU ARE
`
`
`HAPPY MOST OF THE TIME, PRESS OR SAY "1"
`
`HAPPY MORE THAN SAD OR BLUE, PRESS OR SAY “2"
`
`SAD OR BLUE MORE THAN HAPPY, PRESS OR SAY "3"
`
`SAD OR BLUE MOST OF THE TIME, PRESS 0R SAY "4"
`
`SAD OR BLUE ALL OF THE TIME, PRESS OR SAY "5"
`SO SAD | COULDN'T STAND IT, PRESS OR SAY "6"
`
`
`
`
`
`27
`
`
`
`QUESTION # I:
`
`HAVE YOU TAKEN THE
`
`PRESCRIBED MEDICATION?
`
`PRESS "1" FOR YES
`
`PRESS "2" FOR NO
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`TABLE 1: DEPRESSION HISTORY FOR PATIENT 1544028: AMY HOPKINS
`
`—-_—_
`8AM
`
`——__-m-
`
`
`
`30
`
`
`
`
`
`
`
`FIG. 3
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 5 0f 9
`
`6,014,626
`
`SET STRIKES TO 0
`
`START
`
`103
`
`1 O1
`
`QUESTION # 1:
`
`
`HAVE YOU TAKEN THE
`
`PRESCRIBED MEDICATION?
`
`
`PRESS '2” FOR NO
`
`
`PRESS '1' FOR YES
`
`28
`
`
`
`
`
`
`STIRKES : STRIKES - 1
`
`1
`
`2
`
`11 I
`
`
`IS STRIKES = = 3?
`
`RECORD THIS ANSWER
`
`YES
`
`29
`
`107
`
`
`
`QUESTION # 2:
`IF YOU ARE
`HAPPY MOST OF THE TIME, PRESS OR SAY '1 '
`
`
`
`HAPPY MORE THAN SAD OR BLUE, PRESS OR SAY '2'
`' STRIKES = STRIKES-1
`SAD OR BLUE MORE THAN HAPPY, PRESS OR SAY '3'
`
`SAD OR BLUE MOST OF THE TIME, PRESS OR SAY '4'
`
`SAD OR BLUE ALL OF THE TIME, PRESS OR SAY '5'
`
`SO SAD | COULDN'T STAND IT, PRESS OR SAY '6"
`
`
`
`
`
`
`
`
`
`
`
`
`IS STRIKES = = 3?
`
`”l. 6
`
`RECORD THIS ANSWER
`
`YES
`
`QUESTION #3:
`QUESTIONS CONTINUE
`
`"THANK YOU."
`
`HANG UP
`
` 'SORRY, I DO NOT
`
`
`UNDERSTAND"
`HANG UP
`
`
`FIG. 4
`
`109
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 6 0f 9
`
`6,014,626
`
`OUTPAHENT
`
`SUBSYSTEM
`
`00
`
`
`
`TELE-
`COMMUMCAHONS
`SYSTEM
`
`VOKE
`ENERATOR
`
`PROWDEH
`
`
`
`
`INTERFACE
`
`
`PAHENT
`
`LOGON
`
`SCHEDUUNG
`
`
`
`
`SCREEN
`WALKTHROUGH
`INTERFACE
`
`
`
`
`MODULE
`
`
`533E
`
`INTERFACE
`
`*ODULE
`
`
`SERVER
`
`CLIENT
`550
`560
`
`
`COMMUNICATION
`
`
` DAEABASE
`
`INTERFACE
`
`LANGUAGE
`
`
` SECURHY
`
`FIG. 5
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 7 0f 9
`
`6,014,626
`
`MODULE
`
`
`TELE-
`COMMUNICATIONS
`
`
`SYSTEM
`
`
`INTERFACE
`
`
`MODULE
`
`
`
`ASR
`
`
` .ROVIDERINTERFACE
`
`
`
`
`PATIENT
`
`LOG ON
`
`SCHEDULING
`
`SCREEN
`INTERFACE
`
`
`
`
`WALKTHROUGH
`INTERFACE
`
`
`
`
`
`
`
`INTERFACE
`
`
`PATIENT
`
`
`
`
`
`
`_EPORT
`MODULE
`M—DULE
`MODULE
`
`
`
`CLIENT
`60
`
`
`
`
`
`-ERVER.OMMUNICATION
` DATABASE
`
`
`INTERFACE
`LANGUAGE
`
`FIG. 5A
`
`

`

`US. Patent
`
`Jan. 11, 2000
`
`Sheet 8 0f 9
`
`6,014,626
`
`Figure 6
`
`
`
`31/\/
`
`Identification
`Number
`
`32/\_/
`
`
`
`Consult Data Base
`and Select Question
`
`or Instruction
`
` Obtain Valid
`
`
`
`
`
`
`
`
`
` Ask Questions
`And Record
`
`33/\./
`
`Responses
`
`34/\./
`
`
`
`
`Issue Final
`instructions
`
`35%
`
`Terminate
`Call
`
`Consult Data Base
`
`For Analysis
`
`374/
`
`Generate Report
`For Health Care
`Provider
`
`
`
`
`
`
`

`

`US. Patent
`
`Jan. 11,2000
`
`Sheet 9 0f 9
`
`6,014,626
`
`Figure 6A
`
`31A/\./
`
`
` Obtain Valid
`
`Identification
`Number
`
`
`
`
`
`
`
`Consult Data Base
`and Select Question
`or Instruction
`
`
` Ask Questions
`Decode And Record
`
`Responses
`
`
`
`
`
`
`34 4/
`
`
`
`issue Final
`_
`Instructions
`
`Terminate
`Call
`
`35 /\/
`
`Consult Data Base
`For Analysis
`
`374/
`
`
`
`Generate Report
`For Health Care
`
`Provider
`
`
`
`

`

`6,014,626
`
`1
`PATIENT MONITORING SYSTEM
`INCLUDING SPEECH RECOGNITION
`CAPABILITY
`
`RELATED APPLICATIONS
`
`This application is a continuation-in-part of application
`Ser. No. 08/305,108 filed on Sep. 13, 1994, now issued as
`US. Pat. No. 5,633,910.
`
`FIELD OF INVENTION
`
`invention is directed to a computer-
`The present
`implemented method and system for monitoring the health
`status of patients, and in particular, a method and system
`utilizing a standard telephone to monitor the health status of
`outpatients.
`
`COPYRIGHT NOTICE
`
`A portion of the disclosure of this patent document
`contains material which is subject to copyright protection.
`The copyright owner has no objection to the facsimile
`reproduction by anyone of the patent document or patent
`disclosure as it appears in the Patent and Trademark Office
`patent file or records, but otherwise reserves all copyright
`rights whatsoever.
`
`BACKGROUND OF THE INVENTION
`
`Much of the cost of providing health care is associated
`with time spent by medical personnel consulting with
`patients. Whereas equipment is relatively easy to procure, it
`is costly to provide the extensive training and experience
`required by health care professionals to enable them to
`provide quality health care. The growing demand for medi-
`cal services at a reasonable cost has placed unprecedented
`demands on the health-care provider.
`An outpatient usually resides at a location away from a
`health care provider. For example, an outpatient typically
`resides at home and not in the hospital where his or her
`doctor may have an office. Thus, the health care provider has
`far less opportunity to monitor the health status of an
`outpatient on day to day basis. Moreover, an outpatient may
`be required to see a doctor on a regular basis, often for
`simple and routine tests. In such a case, the outpatient must
`travel to the doctor’s office or to a hospital, wait to be seen
`by the relevant health care provider, have the tests
`performed, and travel home. This inconvenient way of
`monitoring the health of an outpatient often does not assist
`the outpatient in the recovery process.
`In short, patients in a hospital are regularly monitored.
`However, outpatients often do not receive this same level of
`health care.
`
`A system is needed that will help close the gap between
`the level of care received by hospitalized patients and
`non-hospitalized patients who must visit the doctor or other
`health care provider for treatment. It would be advantageous
`if a health care provider could regularly monitor the health
`status of patients, including outpatients, without requiring
`these patients to physically travel to and make an appoint-
`ment with the health care provider unless it is absolutely
`necessary to do so.
`Many of the advantages of a remote outpatient monitoring
`system would be negated if the system were exceedingly
`costly or complex to use. Existing outpatient monitoring
`systems require the patient to use expensive equipment that
`is complex and unfamiliar to the patient. For example, many
`existing monitoring systems involve connecting sensors to
`
`10
`
`15
`
`20
`
`25
`
`30
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`
`40
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`
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`
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`
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`
`2
`the patient to monitor vital signs, such as blood pressure or
`temperature. Other systems require that one or more sensors
`be physically implanted into the patient’s body.
`Moreover, these systems often have a dedicated use, for
`example,
`they can only be used to monitor one or two
`physical conditions of the patient. These systems are less
`flexible, each being directed towards reporting a fairly
`narrow range of data to the health care provider, often on an
`intermittent basis. For example, one system may be capable
`of transmitting only heart rate and blood pressure; another
`may monitor and transmit sounds from implanted heart
`valves; yet another may be needed to monitor and transmit
`“biologic signals.”
`For example, US. Pat. No. 4,712,562 to Ohayon et al.
`describes a system to monitor the blood pressure and heart
`rate of an outpatient that requires the outpatient be provided
`with a special device that can take blood pressure and heart
`rate readings, store these readings, and later generate signals
`for transmission. These signals represent the stored readings
`and the identity of the patient.
`In such a system,
`the
`outpatient must be supplied with a measurement, storage
`and signal generating device that is programmed for use by
`that particular outpatient only.
`US. Pat. No. 5,172,698 to Stanko describes a dedicated
`telephonic pacemaker monitoring device that has four elec-
`trode touch pads that can detect pacemaker signals or a
`patient’s pulse and transmit the detected information over a
`telephone line.
`US. Pat. No. 3,882,277 to DePedro et al. describes a
`portable battery-powered EKG signal detector and transmit-
`ter. EKG signals can be transmitted over a telephone link to
`monitoring equipment at another location.
`US. Pat. No. 4,068,097 to Verriest describes a system that
`requires a specially adapted telephone set that is capable of
`direct communication with a central monitoring station
`without the handset being lifted.
`US. Pat. No. 4,337,377 to Van Riper et al. describes an
`apparatus to monitor biologic signals of a patient from a
`telephone handset. This system requires the patient to carry
`a special unit that must be coupled to the telephone handset.
`In the above systems, the patient has to obtain and use an
`electronic device capable of taking readings and transmitting
`data over a telephone line, often using complex communi-
`cation protocols. Many of these devices have a dedicated
`use, i.e., are programmed for use by one patient only or are
`programmed for use for one set of measurements only.
`Thus, there is a need for a system for remotely monitoring
`the health status of patients that does not require special
`training or complex equipment that is likely to be expensive.
`In particular, there is a need for a monitoring system that
`does not require that
`the patient be provided with any
`electronic equipment, thus allowing the patient to use com-
`munications equipment that the patient already has in his or
`her own home.
`
`Some known systems used to obtain information from
`patients contact patients at predetermined times. There
`exists a need for a patient monitoring system that allows the
`patient
`to contact
`the central system at
`times and from
`locations convenient to the patient.
`Further, there is a need for a single system that is capable
`of being adapted to an individual’s evolving physical con-
`dition. Each patient may have different conditions that
`require monitoring. For example, for one patient, pulse
`information may be important, for another, blood pressure,
`and for a third patient, temperature. The health care provider
`needs a single system to easily monitor all conditions of all
`patients.
`
`

`

`6,014,626
`
`3
`Further, as a patient’s condition improves, some informa-
`tion may not be needed. Existing systems are not flexible
`and cannot easily be adapted for each patient’s differing and
`evolving conditions.
`Existing monitoring systems concentrate on obtaining
`information relating to physical conditions, such as blood
`pressure, pulse, EKG and the like. Often, for example, when
`a patient is taking medicine or has a psychological problem,
`the health care provider must additionally monitor other
`factors, such as how well a patient sleeps, whether the
`patient feels drowsy or depressed, and whether the patient
`has an appetite. Existing monitoring systems do not enable
`health care providers to remotely monitor psychological and
`other related conditions of a patient.
`SUMMARY OF THE INVENTION
`
`The present invention is directed to a method and system
`for remotely monitoring the health status of patients, in
`particular outpatients, using telecommunications hardware
`systems already likely to exist in a patient’s home, such as,
`for example, a telephone or personal computer with a
`modem.
`
`The representative embodiment of the present invention
`can be regarded as having two subsystems, namely, a central
`monitoring subsystem and a patient subsystem.
`The central monitoring subsystem receives, stores and
`processes health information provided by one or more
`patients, and generates periodic reports for the relevant
`health care providers. Typically,
`the central monitoring
`subsystem is located in a central
`location so as to be
`accessible by telephone to all patients who require monitor-
`ing. Further,
`the central monitoring subsystem is often
`located so as to be readily available to the health care
`providers using the system, for example, in a hospital or
`doctor’s office. However, since the central monitoring sub-
`system could be used and shared by a number of doctors and
`hospitals, it could be located in a remote location, accessible
`by modem, local area network (“LAN”)/wide area network
`(“WAN”) or the Internet, so that relevant reports could be
`distributed electronically to the relevant health care provid-
`ers who require such reports.
`In the representative embodiment, the central monitoring
`subsystem comprises at
`least one computer processor
`coupled to a telecommunications line by (for example) a
`modem capable of interpreting dual tone multifrequency
`(DTMF) and/or voice signals, software to control the opera-
`tion of the computer processor, a database and DBMS to
`store information and generate reports regarding the health
`status of patients, and a voice generator capable of gener-
`ating voice instructions understandable by humans over the
`telecommunications system. Optionally, the central moni-
`toring subsystem can include a speech recognition board
`such as a discrete, multiword speech recognizer or speaker-
`independent continuous digit recognizer, and/or a printer for
`printing the generated reports. Further, the computer pro-
`cessor can be part of a LAN.
`The patient subsystem enables a patient to transmit infor-
`mation about the patient’s health status to the central moni-
`toring subsystem. There is likely to be more than one patient
`being monitored at a time. Thus,
`in the representative
`embodiment, each patient will have (or have access to) a
`patient subsystem. Typically, the patient subsystem will be
`located in the home or office of the patient. It is noted,
`however, that (depending on the condition of the patient) the
`patient requires no special equipment to successfully utilize
`the capabilities of the present invention. The patient may
`
`10
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`20
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`25
`
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`
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`
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`
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`
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`
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`
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`4
`use, for example, any telephone as the patient subsystem.
`The patient subsystem of the present invention may be a
`touch-tone telephone generating DTMF tones or,
`if the
`central monitoring system includes speech recognition
`means, a regular pulse telephone.
`In the representative embodiment, the patient subsystem
`comprises an instrument capable of receiving instructions
`from the central monitoring subsystem and capable of
`sending data to the central monitoring subsystem. Typically,
`the patient subsystem comprises a touch tone telephone
`coupled to a telephone line. (For patients without a home
`telephone or traveling, a pubic telephone may be used.
`Alternatively, patients may use a cellular telephone as the
`patient subsystem.) For more sophisticated users, the patient
`subsystem may be a computer and modem.
`Thus, in a typical embodiment of the present invention,
`the patient needs only a telephone. This is the same kind of
`telephone already owned by most households. Further, the
`telephone used in the present
`invention need not be in
`addition to the one used for everyday calls; nor is any
`additional
`telephone line required.
`(More sophisticated
`patients can use a computer with a modem to communicate
`with the central monitoring subsystem.) Thus, there will be
`no additional cost to the patient for special equipment. Nor
`does the health care provider acquire expensive equipment
`according to the present invention.
`In a representative embodiment, the central monitoring
`subsystem includes a general purpose, off-the-shelf, home
`computer, software, a voice generator, and a DTMF modem.
`These components are relatively simple devices commonly
`available. As is known in the art,
`the DTMF modem is
`capable of receiving the dual tones generated by a touch-
`tone telephone keypad that have been transmitted over the
`telephone line and translating the tones into characters
`recognizable by the computer processor. The equipment
`used in the representative embodiment of the present inven-
`tion is readily available commercially, is inexpensive, and is
`easy to use.
`In the representative embodiment, the computer processor
`of the central monitoring subsystem is capable of receiving
`and decoding information from patients received via the
`DTMF modem. Patients communicate with the central
`
`monitoring subsystem using a touch tone telephone or a
`computer with a modem. The information received and
`decoded at the central monitoring subsystem is stored in the
`database. The computer processor makes decisions based
`upon the information received and other information previ-
`ously stored in the database.
`The representative embodiment of the present invention
`operates as follows: A health care provider supplies a patient
`with a telephone number. When dialing this number from a
`telephone, the patient is connected to the central monitoring
`subsystem. The computer processor of the central monitor-
`ing subsystem, controlled by software, sends information
`(for example,
`instructions or questions)
`to the patient.
`Typically, these instructions or questions will be communi-
`cated orally to the patient, for example, they will be gener-
`ated by the voice generator. The computer processor asks the
`patient
`to identify himself or herself,
`for example, by
`entering an alphanumeric identification or patient code using
`the touch tone keypad. For example, the patient presses the
`keys corresponding to the assigned patient code on the
`keypad on the patient’s touch-tone telephone. It is noted that
`there can be added security measures, such as passwords or
`keycodes that may also have to be entered by the patient.)
`The patient code is received at
`the central monitoring
`
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`

`6,014,626
`
`5
`subsystem, decoded, and the patient’s record is retrieved
`from the database.
`
`The patient’s record typically comprises information
`about the patient’s medical condition including information
`previously entered by the patient using the system of the
`present invention. Using the information in the patient’s
`record, the central monitoring subsystem can generate ques-
`tions that
`the patient must respond to so that relevant
`information can be entered by and received from the patient.
`Additionally, or in the alternative,
`the patient can be
`provided with a printed chart of questions that the patient
`must answer prior to calling the central monitoring sub-
`system. Each patient may have a chart that corresponds to
`that patient’s individual condition. The patient fills in the
`answers to the questions on the chart. The patient commu-
`nicates by telephone with the central monitoring subsystem
`and enters the patient code (and, if required, a chart code
`identifying the chart that the patient is using). The central
`monitoring subsystem will then ask the patient for each
`answer that the patient has entered on the chart. The patient
`answers using the touch tone keypad. The chart that the
`patient uses may be that of the type described in US. Pat.
`No. 4,346,697 entitled “Method For Treating Depression
`and Other Maladies By Means Of Patient-Created Symptom
`Graphs”, which is expressly incorporated herein by refer-
`ence.
`
`Thus, in short, after the patient has entered the patient
`code, the central monitoring subsystem asks the patient one
`or more questions, which the patient answers using keys on
`the patient’s touch-tone telephone. The patient is instructed
`to respond by entering information through the keypad of
`the telephone, such as selecting the best answer by touching
`its corresponding key. The computer processor of the central
`monitoring subsystem records and processes the patient’s
`response. The computer processor may select the next query
`by consulting the database and considering the patient’s
`response to previous questions. The central monitoring
`subsystem asks the patient the next question, records and
`processes the response, and so on. This process continues
`until sufficient
`information has been obtained from the
`
`patient, and then the central monitoring subsystem issues
`final instructions and terminates the call.
`
`When each call is terminated, or at regular intervals, the
`central monitoring subsystem will produce reports for each
`of the health care providers utilizing the present invention.
`Typical reports that may be generated are patient status
`reports, reports of patients who have not entered information
`for a recent period and reports of patients who should be
`called in for an appointment, for example, due to a change
`in condition or because of unsatisfactory progress. In a
`representative embodiment,
`the central monitoring sub-
`system can quickly alert the relevant health care provider in
`the event of an exigency revealed in the data gathered from
`the patient.
`Thus, based upon the reports, the health care provider can
`decide upon a course of action, including whether a personal
`consultation with the patient
`is necessary, whether the
`patient should be contacted by telephone, or whether a
`change in medication is needed.
`The central monitoring subsystem can include an artificial
`intelligence expert system that intelligently questions each
`patient according to that patient’s needs, and intelligently
`assists doctors in determining which patients require a
`physical consultation.
`The database of the central monitoring subsystem can be
`the same database used by the health care provider to store
`patient records, such as name, address, billing information
`and the like.
`
`10
`
`15
`
`20
`
`25
`
`30
`
`35
`
`40
`
`45
`
`50
`
`55
`
`60
`
`65
`
`6
`the central monitoring
`In an alternative embodiment,
`subsystem can receive and interpret the patient’s informa-
`tion in voice format. For example, the patient may be asked
`to identify himself or herself. Instead of or in addition to
`entering a patient code, the patient can speak his or her name
`into the telephone, which is received by the central moni-
`toring subsystem and compared with voice fingerprints
`previously stored, thus providing a secure way of identifying
`patients.
`Additionally, the present invention can be adapted so that
`patients can also provide information to the central moni-
`toring subsystem by means of a computer, such as a personal
`computer, and modem, of the type usually found in a home.
`The patient can directly dial up the computer processor of
`the central monitoring subsystem using the modem or indi-
`rectly via the Internet, and interactively provide answers to
`questions communicated over the modem by the central
`monitoring subsystem. The questions could be presented to
`the patient in the format of the forms described in US. Pat.
`No. 4,346,697 referred to above.
`the patient can be
`In the representative embodiment,
`charged for use of the present invention. For example, the
`central monitoring subsystem may only be accessible via a
`“1-900” telephone number, where the patient is charged a
`premium rate per minute of call. Alternatively, the central
`monitoring subsystem can record the number of calls made
`by the patient, and charge the patient a fixed rate per call.
`However, it is recognized that the present invention can be
`provided free of charge to patients, for example, as a service
`by a doctor or through other health care providers, such as
`HMOs or drug companies, to attract new patients or cus-
`tomers.
`
`In an alternative embodiment of the present invention,
`automatic speech recognition (“ASR”) technology is used at
`the central monitoring subsystem to recognize patient’s
`verbal responses. With this additional functionality,
`the
`patient can choose to respond to the computer processor’s
`questions using either DTMF signals or verbal responses.
`In summary, the present invention provides a screening
`process that is significantly more efficient than the primary
`care systems in place today. It is less costly because it makes
`no demands on the time and expertise of the health-care
`provider for the purpose of gathering data on the health and
`status of patients. Rather, the provider uses his time and
`expertise far more effectively by analyzing the raw data that,
`prior to the invention, the health care provider would have
`had to gather manually.
`The patient does not have to visit a hospital or occupy a
`hospital bed for regular monitoring of health status, but
`rather, is able to provide such information conveniently from
`any telephone. Needed hospital beds are made available and
`unnecessary office visits are avoided, saving both the patient
`and health care provider time and money.
`The present invention can be used to report and analyze
`more than just the vital signs and physiological character-
`istics of a patient. For example, the present invention can
`also be used to report and analyze emotional, mental and
`psychological characteristics of a patient, and indications of
`general well being. For example, when the patient is taking
`medication, the present invention can be used in the treat-
`ment of depression and other maladies. It can also be used
`to carry out an extensive psychological evaluation of a
`patient on an on-going basis.
`The present invention can also be used within a hospital
`or nursing home to obtain information from patients. Thus,
`for example, psychological related information can be
`
`

`

`6,014,626
`
`7
`obtained from patients at regular intervals using the hospi-
`tal’s or nursing home’s internal telephone system.
`Also, unlike the other existing systems, the present inven-
`tion is adaptive. That is, it can, if required, actively decide
`what
`information is needed from a patient based upon
`information received from the patient. This gives the present
`invention a degree of flexibility and value to the physician
`that is superior to that afforded by other monitoring systems.
`The present invention is capable of meeting the conflict-
`ing demands of providing higher quality health care at lower
`cost. It is easy to use, is economical, and multiplies the
`utility of the medical professional in the health care system
`by making more efficient use of time and expertise. It also
`reduces the cost of medical care by allowing the health care
`provider to regularly obtain certain information while the
`patient is at home. By increasing the number of inpatients
`who can be treated on an outpatient basis,
`the present
`invention allows hospital beds to be used more efficiently for
`those with more severe conditions.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`FIG. 1 is a block diagram of the two main subsystems of
`the present invention.
`FIG. 2 is a block diagram illustrating in further detail the
`components of the two subsystems of FIG. 1.
`FIG. 2A is a block diagram illustrating an alternative
`embodiment of the components of the two subsystems of
`FIG. 1.
`
`FIG. 3 is an example of a patient history, as recorded in
`the database of FIG. 2.
`
`FIG. 4 is an example walkthrough flowchart.
`FIG. 5 is a detailed block diagram elaborating on the
`components of the system described in FIG. 2.
`FIG. 5A is a detailed block diagram elaborating on the
`components of the system described in FIG. 2A.
`FIG. 6 is a diagram in flow chart form of a method of
`operating a representative embodiment of the present inven-
`tion.
`
`FIG. 6A is a diagram in flow chart form of a method of
`operating an alternative embodiment of the present inven-
`tion.
`
`DETAILED DESCRIPTION
`
`Referring now to the drawings, and initially FIG. 1, there
`is illustrated a representative embodiment of an outpatient
`monitoring system comprising two subsystems, namely, a
`central monitoring subsystem 11 and an outpatient sub-
`system 12. The central monitoring subsystem 11 is located
`so as to be readily accessible to one or more health care
`providers. The outpatient subsystem 12 is located so as to be
`readily accessible to an outpatient. The central monitoring
`subsystem 11 and the outpatient subsystem 12 are coupled
`by a telecommunications system 13, such as, for example, a
`public tel