United States Patent [19J
`United States Patent [19J
`Crawford, Jr.
`Crawford, Jr.
`
`111111111111111111111111111111111111111111111111111111111111111 111111111111
`111111111111111111111111111111111111111111111111111111111111111111111111111
`USOO5331549A
`USOO533I 549A
`(IIJ Patent Number:
`(lIJ Patent Number:
`[45J Date of Patent:
`[45J Date of Patent:
`
`5,331,549
`5,331,549
`Jul. 19, 1994
`Jul. 19, 1994
`
`[54J MEDICAL MONITOR SYSTEM
`[54J MEDICAL MOl'<ITOR SYSTEM
`
`[76)
`[76)
`
`Jnvcnlor:
`Jnvcnlor:
`
`John M. Crawford, Jr., 15 Water St.,
`John M. Crawford, Jr .• 15 Water St.,
`Clinlon. Hunterd on Counly, N.J.
`Clinton, Huncerdon County. N.J.
`08809
`08809
`
`[21J App!. No., 922,577
`Apr!. No., 922,577
`[21J
`J ul. 30, 1992
`Jul. 30, J992
`
`[22J
`[22J Filed,
`Filed,
`
`.. ............................ G06F 15/42
`Int. CI.' .......
`Jnt. Ci.'
`............ G06F 15/42
`[51J
`[51J
`[52J U.S. CI. ......................... 364/ 413.02; 364/413.01;
`[52J U.S. CI.
`...................... 364/413.02; 364/4 13.01;
`364/4 13.03
`364/413.03
`
`[58) Field of Search ...................... ~64/4I3.03. 413.02. Field of SC<lrch ._ •................... ~64/4I3.03. 413.02.
`[58)
`364/413.01
`364/4 13.0 1
`
`[56)
`[56)
`
`
`References Cited References Cited
`U.S. PATENT DOCUMENTS
`U.S. PATENT DOCUMENTS
`358/86
`
`4,051.522 9/1977 Healy ct ::I\. .......................... 358/86 4,051.522 9/ 1977 Healy ct rt\. .......... .
`5.121,470 6/1992 Trautm"n
`..... 395/140
`5, 121,470 6/ 1992 Ttau[m ~n
`. .... 395/140
`5,199,439 4/1993 Zimmerman CI 31. ....
`.. .... 128/670
`5,199,439 4/1993 Zimmerman CI 31. ...
`...... 128/670
`
`Primary Examiner-Roy N. Envall, Jr.
`Primary Examiner-Roy N. Envall, Jr.
`Assisranr Examiner-An M. Bai
`Assistant Examiner-Ari M. Bai
`Anornep. Agent, or Firm-McAulay Fisher Nissen
`Auorney, Agent, or Firm-McA ulay Fisher Nissen
`Goldberg & Kid
`Goldberg & KicJ
`ABSTRACT
`ABSTRACT
`[57)
`[571
`A medical monitOring system in which a plural ity of
`A medical monitoring system in which a plurality of
`vital signs monitors for a plurality of patients provide
`vital signs monitors for a plurality of patients provide
`data on a continuing basis to a central server which in
`data on a continuing basis to a central server which in
`tum provides supervisory scn:cn display that indicates
`tum provides supervisory scrc:cn display that indicates
`
`the normal status or varying levels of alarm status of (he normal status or varying levels of alarm status of
`individu al patients. Th e system permits an overview
`individual patients. The system permits an overview
`
`display of a floor and also provides a zoom-in display of display of a noor and also provides a zoom-in display of
`
`3n individual site patient together with an indication of an individual site patient together with an indication of
`
`a limited number of vi tal signs and a warning a13m a limited number of vi lal signs and a warning alam
`signal when anyone or more vital signs is outside of a
`signal when anyone or more vital signs is outside of a
`ffr S! warning set ofpredetennined limits or a more cri ti(cid:173)
`ftrst warning set of predetermined limits or a more criti·
`cal al.um set of prcdctcnnined limits.
`cal alarm set of prcdctemlined limits.
`
`18 Onims, 7 Drawing Sheets
`18 Oairns, 7 Drawing Sheets
`
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`
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`
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`CENTRAL
`SERVER 16
`SERVER 16
`
`LOCAL
`LOCAL
`WORK
`WORK
`STATION
`STATION
`PC
`PC
`
`WORK
`
`SCREEN
`SCREEN
`DISPLAY
`DISPLAY
`
`Cardiocom Ex. 1002
`Cardiocom Ex. 1002
`CARDIOCOM EXH 1034
`CARDIOCOM v. BOSCH IPR2013-00468
`
`1
`
`

`
`/2
`r----L -
`VITAL
`SIGNS
`MONITOR
`
`/'
`
`CONVERTER
`
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`
`114
`
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`MONITOR
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`MONITOR
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`
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`
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`
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`110
`INTERFACE
`
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`w
`DOE
`DRIVER
`
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`SCREEN --
`
`CENTRAL
`SERVER 16
`
`24- -
`FIG. I
`
`LOCAL
`WORK
`STATION
`PC
`
`2
`
`

`
`U.S. Patent
`
`July 19, 1994
`
`Sheet 2 of 7
`
`5,331,549
`
`OVERVIEW SCREEN
`NORMAL CONDITION
`
`IN PROGRESS
`
`SECOND FLOOR, ROOMS 200-254
`
`50
`
`IREMOVEI
`
`FIG.2
`
`3
`
`

`
`u.s. Patent
`
`July 19, 1994
`
`Sheet 3 of 7
`
`5,331,549
`
`OVERVIEW SCREEN
`DURING AL ARM
`
`r
`
`"'\
`
`IN PROGRESS
`221 Criticol BP16:13
`228Worning 13:22
`Resp
`208Worning 15:43
`Resp
`
`y58
`SECOND FLOOR, ROOMS 200-254
`52
`1.
`dbb
`1.
`c.bbHlll 11111ii]
`53
`~11 ii1l11 ~
`'"54
`
`II L LL L
`1111111
`
`-50
`
`---
`
`IREMOVEI
`
`CRITICAL EMERGENCY -,.-57
`Room 22115Aug 9316:30
`Diostotic Pressure =260
`-
`I CLOSE I
`
`-56
`
`ISILENCEI
`
`.J
`
`FIG. 3
`
`4
`
`

`
`U.S. Patent
`
`July 19, 1994
`
`Sheet 4 of 7
`
`5,331,549
`
`INDIVIDUAL BED SCREEN
`NORMAL CONDITIONS
`
`[lpulse[1
`
`I]Resp[1 88
`
`00
`
`00
`
`220
`
`220
`
`100
`
`!
`
`0
`
`0
`
`260/150
`
`;'\
`,
`( .'
`
`0
`
`86
`
`~.
`
`0
`
`20
`
`(
`,;.
`~
`
`~~
`
`98.9
`
`0
`
`96
`
`15 AUG 93 16:30
`ROOM 221
`Patient: Lawrence Philips Primary Ailment: Hypertension
`
`ITrent II Limi? IIStatus II Signs IIDial-aut II Reset II Exit
`"80
`'64
`
`61
`
`FIG.4
`
`5
`
`

`
`U.S. Patent
`
`July 19, 1994
`
`Sheet 5 of 7
`
`5,331,549
`
`iNDIVIDUAL BED SCREEN
`DURING ALARM
`
`88 8
`
`220
`
`220
`
`115
`
`100
`
`00
`
`joo
`
`o
`
`0
`
`260/150
`
`o
`
`86
`
`0
`
`'
`
`20
`
`'i
`
`1,. }
`..1:
`
`98.9
`
`o .
`
`96
`
`15 AUG 93 16:30
`ROOM 221
`Pati.ent: Lawrence Philips Primary Ailment: Hypertenslan
`ITrent II Limiis IIStatus II Signs I IDial-out II Reset II Exit
`8~ 64
`
`61
`
`FIG.5
`
`6
`
`

`
`U.S. Patent
`
`July 19, 1994
`
`Sheet 6 of 7
`
`5,331,549
`
`pop-uP WINDOW VIEW
`PATIENT STATUS
`Level1- sporadic monitoring (ambulatory ,non-criticol)
`•
`o L evel2 -semi -continous (sem i-ambulatory, non-crit ical)
`o Level3-continous monitoring (non-ambulatorY,critical)
`--70
`I Cancel
`OK
`
`RESET ALL BED PARAMETERS
`
`This button will reset all bed
`parameters to their default
`values. This includes signs
`selected, sign limits, patient
`age and stotus,and dial-out
`options.
`
`Are sure you wanltodothis?
`
`I OK
`
`I I Cancel I
`
`TELECOMMUNICATIONS DIAl:OUTOPTIONS
`o Del iver signs to
`central stalion 1 908 735 2727
`
`IllIDeliver alarms
`tocentralstotion 19087352727
`Il/I Deliver alarms
`to pager
`
`t 800222 42863594
`
`I I Cancel I
`
`I OK
`68
`
`SET VITAL SIGN LIMITS
`
`SELECT VITAL SIGNS
`
`SIGN
`
`Warning Crilical
`low high low high 72 ....
`Diastolic pressure 90 220 50 270
`Systolic pressure 50 180 30 230
`
`Il/I Blood pressure
`
`!ill Pulse Rate
`
`!ill Respiration Rate
`
`Pulse rate
`
`35 130 250 180
`
`Respiration role
`
`.3... J.SL ~ 130
`
`Body temperature 92 102 85 105
`
`Ill! Body Temperature
`
`IllI Oxygen Saturation
`
`IllI All Signs
`
`I OK
`
`I
`
`ICancell
`
`Oxygen saturation 60 nla 20 nla
`
`t Adult «3enior
`GB....-0Child
`67 6G
`69
`I I Reset) 1
`I Cance l I
`
`I OK
`
`,
`,
`
`v
`
`FIG.6
`
`)
`
`7
`
`

`
`U.S. Patent
`
`July 19, 1994
`
`Sheet 7 of 7
`
`5,331,549
`
`TRENDS WINDOW VIEW
`
`Trends
`
`300
`
`200L-__ ------------~-------
`
`100
`
`Blood
`• Pressure
`o Pulse
`o Respiration
`o Temperature
`o Oxygen
`Saturation
`Starting Date
`07/15/93
`
`o~--------------------------
`Ending Dole '--___ ~;:===::;__:===:::;_---~
`I Cancel
`08 / 15/93
`Graph
`
`FIG.7
`
`8
`
`

`
`1
`
`MEDICAL MONITOR SYSTEM
`
`5,331,549
`
`.5
`
`10
`
`BACKGROUND OF THE INVENTION
`T his invention relates to, in gener:!l, a supervisory
`system that monitors the vital signs of patients at home
`or in a health-care facility.
`There is currently no cost effective means of continu(cid:173)
`ously supervising an entire building full of patients from
`a central point. Accordingly, several problems have
`developed with patient care. When an emergency situa(cid:173)
`tion develops, it must be dcle<.:ted by supervisory staff
`before it can be dealt with. After detection. the response
`to emergencies cnn only occur after the proper profes- 15
`sionals have been informed, and the problem is diag(cid:173)
`nosed . This process can take from several minutes to
`several hours. even in a fully-staffed hospital. There is
`no feasible way to employ the number of stafT required
`to effectively supervise p:uients located in hundreds of 20
`separnrc rooms throughout a facility .
`The inahility to record the vital signs of patients (lo(cid:173)
`cated outside Intensive Care UnilS) on a 24-hour basis
`leads to problems with medical .malysis. Individual
`readings can be missed or conductt:d improperly, lead- 25
`illg to intlccuratc interpretation of results. Lengthy time
`intervals between readings increase the probahility that
`sma. ller trend!> wi!1 be missed, and tIm! errant readings
`will aller results.. Difficulties in manually storing 'and
`retrieving the results of hundreds or thousands of tests 30
`m3ke it ncarly impossible to examine several consecu(cid:173)
`tive weeks Or months of a patient's vital signs.
`When a substan tial distance, such as several miles,
`5ep,mlt(:s a doctor from his or her patients. all these
`problems increase by several magnitudes. Outpatients 35
`an~ rarely examined more than a few times a week, so
`their medico! emergencies often go entirely undetected.
`When outp::ltienl problems are discovered, ir takes sev(cid:173)
`eral times longer for Ihe proper personnel 10 diagnose
`and respond to (he condi tion them it would for inpa- 40
`tients . Medical trend analysis is aJso much Jess effective
`and accurate for outpatients.
`Existillg electronic mean s of patient monitoring have
`becn developed to avoid such difficulties, such systems
`typically consist of high-cost intelligt!nt patient moni- 45
`tors linkcd together in local area networks. However,
`bec"us~ of design and capability limitations, these sys(cid:173)
`te ms do not serve as feasible, cost-effective, facility(cid:173)
`wide cenlral monitoring systems. They are typically
`more suited for limited !lumbers o f palients requi. JIg 50
`specific services.
`Currene solutions generally sufTer from several short(cid:173)
`comings. The high cost of these systems prohibits rhe
`purchase of sufficient resources
`to monitor entire
`health-care facilities, or renders such purchases as non 55
`cost-effective. Tht!)' do not have the power to effec(cid:173)
`tively supervise large Jlumbers of patients simulta·
`neousl>'. especially over expansive geographic areas.
`They do not provide the nc"ibil ity needcd 10 account
`for vadous If!ve ls of patient mobility. to easily and 60
`quickly Fe·distribute resources such as patient monitOrs
`to new locations. or to efficiently upgrade system ca·
`pacity as technology improveS. Exist ing systems arc
`difficult for non-technical personnel to learn and oper·
`att, and they do not provide the fault-tolerance for 65
`operator error/abuse and equipment failure which is
`needed in a critical medical application. Furthermore,
`the selecti?" and prcscm3tion of thl;: data gathered by
`
`2
`these systems docs not facilitate the effective supervi(cid:173)
`sion of Jarge numbers of patients.
`A major purpose of this invention is to provide a
`system which provides an optimum selection of data to
`be presented and optimuOl arrangement of that data so
`as to makc feasible and useful the monitoring of a large
`number of patients in a fasbion thai increases the likeli(cid:173)
`hood and enhances the ability of having an immcdiate
`response to conditions which require imrnedia!e re·
`sponse.
`Another purpose of this invention is to employ
`known, low-cost, standard types of units. in a configura(cid:173)
`ti on which provides the capacity (0 monitor large num·
`bers of patients. allows for the flexible, dynamic distri(cid:173)
`bution of resources, provides sufficient fault-tolerance,
`and permits the efficient upgrade of system components
`as component design increases capacity of dau han(cid:173)
`dling, sensitivit y, and scope of vital signs monitored.
`More speCificall y, it is a purpose of (his invention to
`1) provide earlier detection and diagnosis of medical
`emergencies, 2) provide better warning and notification
`of p3tient emergencies, 3) reduce the time interval be(cid:173)
`tween readings of vit31 signs, 4) reduce the number of
`staff required to supervise patients, 5) provide better
`histone records of vital signs, 6) allow greater accuracy
`in medical trend analysis when compared to present
`methods, and 7) to provide the above al a cost which
`makcs it feasible for an institution to adopt the system.
`
`BRIEF DESCRIPTION
`This invention gathers data on patient vital signs
`using portable bedsid e medic:l1 monitors. As the data is
`collected, it is sent to a centra] computer.
`Using the computer, users can e;t,:amine the currcnt or
`past vital signs of any patient simply by selecting thc
`patient's room from a geographic facility map displa.yed
`on a computer screen (CRT). The system will also alert
`users when the monitored signs of any supervised pa(cid:173)
`tient go above or below preset limits. Should such con·
`ditions occur, the system will flash a warning display on
`its CRT describing the emergency. The system tllso
`illustrates the location of the emergency by highlighting
`the proper room on the facility map.
`With the emergency located on a overview flo or
`screen, the attendant can select an individual bed or site
`screcn which provides more detailed information on the
`patic:nt having the emergency.
`Othcr options for notification of patient emergencies
`include paging doctors and nurscs with :·lphan·lmeric
`pagers, and dialing out over telephone lines to alcn
`cJCternal parties. This feature enables doctors or other
`healthc:lre profcssion31s in .l central building to super(cid:173)
`vise patients in remote facilities, or even their own
`homes. This invention can also transmit live video of
`outpat ients over telephone Jines, for doctor viewing.
`Workstations allow users located away from the main
`computer to have access to all system functions. Patient
`data is stored at regular inte rvals. allowing future re(cid:173)
`tricval of readings, and detailed medical trend analysis.
`This system allows one person to monitor the vital
`signs of hundreds of patients located in separate rooms
`on various floors ofa facility, SUbstantially reducing thc
`number of staff required for such a purpose. Because the
`location and exact condition of monitored emergencies
`arc known the instant problems ~re detected, effective
`response time to medical emergencies is substantially
`reduced. The system's abilities to display and graph all
`pasl readings (taken 24 hours a day) makes the analysis
`
`9
`
`

`
`5,331,549
`
`3
`of vital signs and medica l trends much more effec tive
`and accurate. These benefits ~re several magnitudes
`gfc.Her for patients located in o ther buildings or other
`towns, since distance and lack of supervisory staff com(cid:173)
`pound problems with analysis of medical tfends, delce- 5
`lion ?f emergencies, and response time to those cmer-
`gencles.
`
`4
`driver also provides ability to send comm::mds from the
`CPU 17 to the various monitors 12. The DDE only
`communicates c hanges in duea. thcreby avoidi ng redun-
`d:mt transmissions.
`Each medical monitor 12 comes with a standard out-
`put plug known as a RS232 plug to providt! data appro(cid:173)
`priate to the central server 16. A standard converter ]4
`is employed which is known as a RS232 to RS485 inter(cid:173)
`face converter. It is a commercially available item. It is
`10 plugged into the ompul of each medical monitor 12.
`The output of this converter 14 is transmitted in digital
`form over a two wire data grade telephone cable to an
`RS485 adapter at the input of the central server 16. In a
`preferred embodiment, a card is employed which has
`I s sixteen RS485 adapters On it as an input/output inkr(cid:173)
`face 15 to the CPU 12. Each RS485 on the card can
`connect to 32 telephone line pairs and thus to 32 medi(cid:173)
`cal monitors 12. Accordingly. the interface card 15
`employed permits the central server 16 to receive con-
`20 tinuous communication from up to 1,024 medical moni(cid:173)
`tors 12.
`It is contemplated that in a preferred embodiment, it
`might be possible to redesign a standard medical moni (cid:173)
`tor 12 so that its output is compatiblt: with the RS485
`25 plug input to thc central server J6 and in such a case the
`commercially available RS232 to RS485 converter 14
`would not be needed.
`Anyone or a number of general purpose. multi(cid:173)
`par3meter portable or even non·portable monitor de-
`30 vices can be employed 3t each station 10 provide the
`mUltiple signals indicating the multiple viml signs being
`measured. One such device is sold by Datascopc Corpo(cid:173)
`ration of 580 Winters Avenue in Paramus. N.J. under its
`trademark Passport.
`Such multi-parameter monitoring devices can be
`selected to provide ent irely non-invasive monitoring o r
`a COmbination of non-invasive and invasive monitoring.
`The si;o; vital signs are systolic, diastolic. pulse. respira(cid:173)
`tion, temperature, a.nd oxygen satumtiOIl. The sensors
`for these signs also make wavc~forms and EKG read(cid:173)
`ings availabJe to user and/or server.
`The interface converter 14 is manufactured by Black
`Box Corporation and another model is also made by
`South Hills Datacom. The RS485 interface which con(cid:173)
`stitutes the individual components of the ::tdapter 15 is
`manufactured by Quatech or by Emulex.
`The CPU 17 incorporates a DDE driv~r which is a
`known type of device; one of which i!; the Texas ]nstru(cid:173)
`ments Direct Driv( r RS-232. Another example of the
`DDE driver is the Siemans 3964R and the GE-F ANU
`CC M2 Serial Port.
`The C PU]7 i!scJfcan be an 80486 s~ri es PC-Compat(cid:173)
`ible CPU with super VGA graphics card. super VGA
`touch-screen monitor, mouse, keyboard. sixteen mega-
`55 bytes of RAM and a minimum of two-hundred mega(cid:173)
`bytes of hard drive together with a two gigabyte read(cid:173)
`write laser disk drive. This laser disk drive need only be
`employed with the CPU 17 at Ihe central server J6 and
`need not be employed with a local workstation PC 24 or
`60 remote workstation PCs.
`The modem 25 can be a standard 14,400 bps V -32 bis
`modem.
`The application program for this invention can be
`created by use of a process graphics software such as
`th(:" InTouch software availab}c from Wonderwa re Soft(cid:173)
`ware Qevelopment Corporation of 16 Technology
`Drive in Irvine, Calif. With the InTouch software resi(cid:173)
`dent in the CPU 17, the user can generate the particular
`
`BRIEF DESCRIPTION OF THE FIGURES
`FIG. 1 is a block diagram of the overall system ar(cid:173)
`rangem ent of this invention.
`FIG. 2 illustrates a typical screen display which pro(cid:173)
`vides an overview of a floor in a hospital under normal
`conditions.
`FIG. 3 is an illustration similar to that of FIG. 3
`illustrating one critical alarm si tuat ion and two wamillg
`alarming situations.
`FIG. 4 illustrates a typical screen display of a particu(cid:173)
`lar patient site on the flotlr represented by FIG. 3 under
`normal conditions.
`FIG. S is si milar to FIG. S except that it shows a
`critical alarm situation at the patient site.
`FIG. 6 illust rates various windows which can be
`called up by the user to facilitate user st:leclion of op(cid:173)
`tions and modification of operating parameters.
`FIG. 7 illustrates a trends window which can be
`called up by the user to iliUM rate long term patient
`parameter trends.
`
`DESCRIPTION OF THE PREFERRED
`EMBODIMENTS
`As shown in FIG. 1, a plurality of vital sign monitors
`]2 are coupled through converters 14 to J central server
`16. The central server ]6 essentially consists of a fault
`tolerant PC compatible central processing unit ]7 35
`(CPU) with appropriate programming including a
`DDE driver, monitoring application software and pref(cid:173)
`erably a remote control communica tion software. At
`the central server 16, a screen display 18 is provided and
`b a criti ca l part of the system of this invention. The 40
`screen display is what provides the appropriate selected
`information to facilitate response to various OUI of nor(cid:173)
`mal range conditions. The screen displays are described
`in greater detail in connecdon with FIGS. 3 through 8
`herein. A data slOT3ge 20 is employed to store data so 4S
`that it call be retrieved and reviewed for analysis that is
`deemed appropriate. An audible alarm and in panicular
`a siren 22 responds to the CPU 17 comparing an input
`vital sign signal and finding that it is out of limits for
`patients requiring cOnlinuous OK: semi-eonlinuous moni- 50
`taring. The less severe situadons do nOl trigger the siren
`22.
`Funher as indicated in FIG. J, the output of the CPU
`n CUll be sen t to other stations 24 either in th e same
`hospital or Over a modem 2S to other locatior'J~. At these
`other stations, a remote server is located with its screen
`display 18 a nd, ir desi red, a siren. It is more efficient for
`there to be a sing le data storage 20 which stores all the
`information in the system. Data can also be received
`from other locations such as homes and nursing homes.
`The Dynamic Data Exchange (DDE) driver is a
`program incorporated in the CPU 17 that allows com(cid:173)
`munic::Hion with other devices and in particular pro(cid:173)
`vides a data distribution function in addition to support
`for the peripheral devices. The DDE driver program 65
`sends local digitized patient data to the monitoring
`program jll the CPU 17 oflhL' central server and to locaJ
`work station!' 24 and remote' work stations. The DDE
`
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`
`5,331,549
`
`5
`screen display arrMgement shown in FIGS. 2 through
`7 or any variation thereon. The techniques of generat(cid:173)
`ing the program for the particular screen displays illus(cid:173)
`trated herein arc techniques that arc known to those
`skilled in the an who employ a process graphics soft- 5
`ware package such a'> InTouch. The process graphics
`software remains resident in the CPU 17 as part of the
`applications operating system so that data from the
`monitors 12 can be applied to affect the screen displays
`18 discussed in connection with FIGS. 2 through 1. An to
`adequate set of programing instructions are sct forth
`under an Appendix at the end of this specification.
`Critical to the utility of this system in prov iding an
`enhanced degree of patient supervision are the displays
`made available on a display screen ]8 al the central 15
`server 16 as well as on display screens that arc in any
`remote work stations.
`FIGS. 2 through 7 illustrate the displays made avail·
`able. FIG. 2 shows a typical overview screen display in
`which a floor arrangement is shown with each room or 20
`site indicated by icons which arc mapped to simulate
`the geometry of the floor. F1G. shows the overview
`screen when there is an alarm condition. Two windows
`are provided. The In Progress window 50 (having the 25
`titile bar 58) lists all alarms from the Notification States
`1,2 and 3 discussed below in connection with FIG. 6.
`The Notification States are a function of paticnt stat us
`and alarm severity. The window 50 lists alarms as a
`function of importance (Ihe higher Notificatio n States 30
`first) and w ithin a Notification SHHC in time sequence o f
`occurrcncc. The window 50 provides an indication of
`the site or room involved and whe ther or not the out of
`limits situation is critical or if less serious indicates
`"warning". The In Progress window 50 also lists the 35
`natur~ of the vital sign which is out of limits and the
`time of occurrence_
`As shown in FIG. 3, showing, Room 221. show n at
`reference number 52, has :1 critical blood pressure out of
`limits situation which occurred at 16:30 hours. Simi- 40
`larly, Room228, shown as reference number 53, has a
`warning Out of limits situation (less serious Ihan critical)
`with respec t to the palient's respiration and that oc(cid:173)
`curred at 13:22 hours. Room 208. shown al reference
`num ber 54, has a warning out of limits respiration prob· 45
`lem that occurred at 15:43 hours.
`On thc same FIG. 3 screen, the Critical Emergency
`window 6 provides somewhat marc detailed in forma·
`lion con~ernjng the critical situation in Room 221 ond in
`particular shows that the blood pressure problem is that 50
`diastolic pressure is at 260. Because the critical emer·
`gency siruations are accompanied by an audible siren.
`the FIG. 3 pop-up wind ow S6 provides a touch zone
`designated "Silence" which permits the u~er to tum off
`the siren. The pop-up wjlld~lW 56 is an alarm window 55
`and will have the: title "Critit:al Emerging" or "Off(cid:173)
`Lin e Emergency" or "Warning Condition" as a func(cid:173)
`tion of the nature of the alarm.
`Each window 50, 56 has a touch zonc, "Remove" 'or
`"Close" to either remove all of the dat:l in the In 60
`Progress window 50 or to close out the Critical Emer(cid:173)
`gency window 56. The Remove button will only re(cid:173)
`move onc of the alarms listcd, and only if the alarm is
`not a critical alarm. User selects the alarm to be re(cid:173)
`moved (usi ng mouse-click, etc.) and then presses Re- 65
`move button. Otherwise, al:lrms remain on the list until
`the conditions which triggered them cease. Alarms can
`be forced off the list by going to the individ ua l room
`
`6
`screen and altering the vilal sign limits, signs monitored,
`or patient status.
`It is important to note thai certain coJors are used to
`reinforce the information involved. Most of the sites are
`in a normal condition. They are in a green color (colors
`not shown in the Figurcs). The warning sitcs (Rooms
`228 and 208) are shown in a yellow color and the criti(cid:173)
`cal site, Room 221, is shown in a red color. In addition,
`the title bar 57 of the Critical Emergency window 56
`has 3 red background. The tide bar 58 of the In Progress
`window 50 has a red ba.ckground when there is a criti·
`cal item in that window, a yellow background when
`there are only warning items in that window and a
`green background when the window is empty. In addi·
`tion, the red room icon 52 will be a flashing red in order
`to attract a.ttention. However, (he yellow room icons
`53, 54 will not be nash ing. In addition, the color purplc
`is used to indicate a disconnect of the vital sign sensor.
`This purple color off-line warning is in response to a
`null signal from the medical monitor. A null signal from
`the monitor will cause the central server 16 to generate
`a disconnect signal which can provide a unique audio
`alarm 22 and a uniquc (purple) color designation for the
`tide bars 57 in the POJrup window 56 and on the rele(cid:173)
`vant room jcon. The background of the ritle bar 61 on
`the FIG. 5 zoom-in display will also be purple.
`If there is more than one alarm condition requiring a
`pop·up window 56, multipJe windows 56 will be shown.
`overla id and offset to provide the observer with an
`indication that there is a plurality of windows 56 and to
`permit access to each window by whatever accessing
`teChnique is employed such as the mouse click.
`FIG. 4 indicates the screen display that could be
`called up for a particular room. This zoom·in screen
`display can be called up through a keyboard input of the
`room number o r by an appropriate touch on the over·
`view screen. FIG. 4 shows the non-alam display for
`Room 221, corresponding to the FIG. 2 normal display
`condition. FIG. 5 shows the zoom·in display for the
`critical condition in Room 221, which critical condition
`is flagged by the FIG. 3 display. In FIG. 5, the BP
`(blood pressure) symbol 60 at the upper left is red and
`flashing indicating a critical condition. Each of the six
`vital signs is indicated in both analog and digital form .
`The patient is identified and the primary ailment is indi(cid:173)
`cated.
`In the normal FJG. 4 condition, the title bar 61 has a
`green background color nnd the icons indicating the
`various vital signs are green providing the vital s.gns arc
`within the normal range. 'I11is usc of green for normal
`condition helps to make sure that the yellow and red for
`lesser :It;l.d greater level of emergency conditions st~nd
`out when they do occur. Tn FIG. 5, not only is the BP
`icon 60 red and flashing but the left column 62 repre(cid:173)
`senting diastolic prc!'sure in analog for m is also red and
`fl ashi ng. TIle rest of the vital sign kons ~ud analog bar
`graphs arc .a normal grcen color representing n non·
`emergency condition.
`This display arrangement shown in FIGS. 2 through
`5 provides a useful twdc·off of selection and focus in
`real time against a more comprehensive data presented
`in a less focused fa.<;hion and/or not bein g in real time.
`Thus the ovcrvii!w screen of FIGS. 2 and 3 provides
`a real time indication that there is an emergency, wherc
`it is occurring, how severe the emergency is (thot is,
`whether it is at a warning level or a critical level) and
`which type of vital sign function is out of line. The
`
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`
`5,331,549
`
`7
`overview screen also provides a geographic presenta..
`tion of where the emergency is.
`The lOom· in screen (single site screen) of FIGS. 4
`and 5 also provides all information in real time. How·
`ever, it displays all of the functi~ms and nOI only the
`function that is out of normal range. Furthermore, .the
`zoom-in screen displays data in both digital fcnn and
`analog fonn.
`Furthennorc. all program screens display informa(cid:173)
`tion in both digital and analog form, show ing both a 10
`numeric Md abstract representation. This provides an
`intuitive grasp of the information presented. eliminating
`the time I:tg, confusion, and user error associated with
`inform.3 ti on which must be skill full y interpreted.
`By limiting the vital signs monitored to six, it be- 15
`comes possible and feasible to monitor a large number
`of sites. Thus the system is pa rticularly adapted to the
`general hospital si tuation more than to the intensive
`care unit silUation (leU). In an leu situation, very
`specific and ind ividual monitoring of many other pa- 20
`ramelers and conditions may be involved. But the cost
`and complexity of doing such nlilkcs the leu type of
`:situation inappropriate and in fact not used in the gen(cid:173)
`eral hospital situation. More particularly. it is also the
`depth of information gathered from each sign that in- 25
`crew.es the dnta requircd dramatically, not just the num(cid:173)
`ber of signs monitored. The transmission and analysis o f
`wave forms is what requires hundreds of limes more
`processing power. However, it is useful on ly for a seleci
`few patients who are deemed critical enough to be 30
`placed in {he high-cost leU monitoring area. The six
`vital signs themselves are meaningful enough for most
`pati~nts, and the number of patients who require this
`level of monilOring is a signific'lnt percentage of those
`occupying hospitnl rooms, a numbt:r many times greater 35
`than even the largest leU's can hnndlc.
`Thc operat iona l features which ore crilical to why
`this systcm is an improvement over anything presently
`known and in particular why it provides a meaningful
`moni toring of a large number of patients include the 40
`following:
`1. The selection of a limited number of vital signs (six
`in panicular).
`2. The provision of a two stage alarm system based on
`a vital sign having passed a thrcshold whercin two 45
`separate thresholds arc used to distinguish between a
`warning alarm and a critical alarm.
`3. The display of a sel of vila I sign warning indicators
`in cOlljunction wil h the geographl'; di