`
`, ,
`
`
`United States Patent [19J United States Patent 119J
`
`Cohen Cohen
`
`154J
`[54J
`
`
`m:nENT MONITORING SYSTEM m:nENT MONITORING SYSTEM
`
`\NC!.UI)[NG S\'\':ECH RECOGNITION \NC!.UI)[NG S\'\':ECH RECOGNITION
`
`CAI'AmLlTY CAI'AmLiTY
`
`
`Invenlor: Kopel II. Cohen, 2362 IIarholJr Oaks [(opel II. Cohen, 2362 IIarholJr Oaks
`Invenlor:
`
`Dr., Longboat Key, l'Ja. 3422K Dr., Longboat Key, l'Ja. 3422K
`
`1211
`1211
`1221
`[22[
`
`1631
`163[
`
`15J I
`[51 [
`[S2[
`[52[
`1581
`[58[
`
`
`
`[5o[ [5o[
`
`Appl. No.: 08/695,466
`Appl. No.: 08/695,466
`
`
`
`J!i1cLi: J!i1cLi:
`
`
`
`Allg. 12. 1996 Allg. 12. 1996
`
`
`
`H.clatcd U.S. Application Data H.clatcd U.S. Application Data
`
`
`Continua[i\ln-il1-p~H[ of ;IJlpJicatiun No, U813(J5,I08, Scpo 13, Continua[i\ln-il1-p~H[ of ;IJlpJicatiun No, U813(J5,I08, Scpo 13,
`l(JiM, Pat. No. 5 . .tJ:B,9W.
`I'NtI, Pat. No. 5 . .tJ:B,9W.
`
`
`Int. CI.' Int. CI.'
`.................................................... Gill!. 31041 .................................................... Gill!. 31041
`
`U.S. CI. U.S . CI.
`
`704/275; 704/271; 706/924 704/275; 704/271; 706/924
`Fidel of SeaI'd
`Fidel of Scardl
`395/2.79,2.81;
`395/2.79,2.81;
`379n~, 93, 106; 7041270, 175, 2n. 272;
`J79n~, 93, 106; 7041270, 175, 2n. 272;
`
`706/924.00, 61 706/924.00, 61
`
`
`
`References Cited References Cited
`
`
`
`us. PArENT DOCUMENTS us. PArENT DOCUMENTS
`
`3,727.1()(j
`3,727.1()(j
`
`3,774,11>4 3,774,11>4
`
`3,.'l.'Q.n7 3,.'l.'Q.n7
`
`.l(J72.J20 .l(J72.J20
`
`'I,068,Un 'I,068,fJln
`4,2%,756
`4,2%,756
`
`'U37377 'U37.377
`4.34f>N!7
`4.-''-IbN!?
`4.45H,rhJ
`4.45H,rh3
`
`'1.71 :~.~()? '1.71 :~.~()?
`
`4.7:'>1.77.(; 4.7:'>1.77.(;
`
`,um3,CJ1:'> II.KOJ.1J2:'>
`
`4.S'LU77 4.S'LU77
`4}s5H,J2J
`4}~5K,J21
`'1.&')3.1 )(;·1
`'1.&')3.1 )()·1
`
`5,(36)1:'i2 5,(36)1:'i2
`
`
`4/1 (J73 Vogclnwil d ni. 4/1 (J73 Vogclnwil d ni.
`tI/I ()73 Osterberg d al.
`tl/J!J73 Osterberg cI al.
`
`I)c Pedro t'I al. I)c Pedro t'I al.
`
`5/1 'l75 5/1 'l75
`
`k/l976 Kalman k/l976 Kalman
`
`l/ltJ7S Vcrric.~l l/ltJ7S Vcrric.~l
`1011981 Dunning ct al.
`1011981 Dunning ct al.
`(Jj I (1.S2 Vall Riper ct al.
`(Jj I (1.S2 Vall Riper d al.
`
`Po/I()HZ Cohen Po/I()K2 Cohen
`7il()Po4 Badzin!;ki ct ;d.
`7/19Po4 Badzin!;ki ct ;d.
`
`17.!10H7 Ohay[oll d al. 17.!10H7 Ohay[oll ct al.
`rijl()&'l
`rijl()&'l
`
`llerp d al. llerp d al.
`2/1 ()8'J Fu cl al. 2/1 ()8!J Fu cl al.
`
`
`6/J()8lJ Fuller ct a1. 6/J()89 Fuller ct a1.
`
`8/1 (JSq B;uber ct a!. 8/1 (JSq B;uber ct a!.
`
`1J/[()k<J Ol~oll d al. II/[ ()H') Ol~oll d al.
`
`KII()()[ KII()()[
`
`I.ci~hlllan I.ci~hlllan
`
`
`70S/3 70S/3
`
`j(>5/R50 j(>5/R50
`
`.17'Jjlf)().2 .17'Jjlf)().2
`
`..... (j()()/519 ..... (j()()/519
`
`370j3H 370j3H
`
`6rxl/:'>2() 6()(J/:'>2()
`
`379/100.02 379/100.02
`
`......... (i04/4') ......... (jO'-l/4()
`6()O/:'>28
`6(~l/:'>28
`
`{JO(l/'lk5 6()()/'IH5
`J7!);,Hh02
`37'>;'Hh02
`6()(J/48J
`600/48"
`34()/523
`J4()/523
`705/2
`705/2
`
`()()(l/:'>ljlJ ()()(J/:'>ljlJ
`
`...... ()OO/30t ...... ()OO/30l
`
`(I.ist continlled on next page.)
`(I.ist continlled on next page.)
`
`
`
`OiliER PUIHJC/\TIONS OiliER PUIHJC/\TIONS
`
`I'aper elltitlcd "'It:kcornrntlilicalions ill Mallaged Self ('are",
`I'aper elltitlcd "'It:kcomrntlilications ill Mallaged Self ('are",
`
`by j,'<t(fnkh Alemi, Ph.D., presented ,It J 7th Annual Sympo(cid:173)by j,'<t(fnkh Akmi, Ph.D., presented ,It J 7th Annual Sympo(cid:173)
`sium on ('Olllputcr Applications in Medica! ('are, ()ct. 31,
`sium on ('Olllputcr Applications in Medica! ('are, ()ct. 31,
`1993.
`1993.
`
`
`111111111111111111111111111111111111111111111111111111111111111111111111111 111111111111111111111111111111111111111111111111111111111111111111111111111
`
`USOO6014626A USOO6014626A
`
`PIJ Patent Number: PIJ Patent Number:
`
`[451 Date of Patent: 1451 Date of Patent:
`
`
`6,014,626 6,014,626
`
`Jan.ll,20()() Jan.ll,20()()
`
`
`L Bael', et a1., "Automated '!blepholli:: Screen Survey For L Bael', et a1., "Automated '!blepholli:: Screen Survey For
`Depression," lAMA, vol. 273, No. 24, pp. 1943-1944, .lUll.
`Depression," lAMA, vol. 273, No. 24, pp. 1943-1944, .lUll.
`
`28, 1995. 28, 1995.
`"VPro'fM Speech Hecognition on Antares'Lll," Dia/ogic@
`"VPro'fM Speech Hecognition on Antares'Lll," Dia/ogic@
`Oll-UIIC Informtltion Rl'frieFa{ System, pp. 1-2. Oll-Ulle Informtltion Rl'frieFa{ System, pp. 1-2.
`
`"VRSoftui, l)iscrdl.:,Multi-T.angtlage Spl.:ech Recognition
`"VRSoftTM, l)iscrdl.:,Multi-T .anguage Spl.:ech Recognition
`
`Sol'l\v<lre", /)ia/ogic@ On--J,ine InlorJ/llIliofl Relriel'{{/ Sy\'(cid:173)Solhvare", /)ia/ogic@ Oll--/,inc InlorJ/llIliofl Rclriel'{{/ Sy\'(cid:173)
`fem, pp. ]·-3,
`fem, pp. 1·-3,
`
`"Antares'I'M Platform Overview," Dia/ogic(fj) On-Une IIlfor(cid:173)"Antares'I'M Platform Overview," Dia/ogic@On-Unelllfor(cid:173)
`lII(1tioN Relriem/.)'yslem. 1-3.
`III(1/ioll Relriem/.)'yslem. 1-3.
`"2000/33, 2000/50, 6000150 ISA Platform," Dia/ogic@
`"2000!33, 2000/50, 6000150 ISA Platform," Dia/ogic®
`
`Ofl-I,ine Informatiun Reiricl'al System, pp. 1-6. Ofl-I,ine Illformatiun Retrieval System, pp. 1-6.
`"D/160SC-IS'nl 16-Por1 Voice Processing & Anaiog Inter(cid:173)
`"D/160SC-IS'nl 16-Por1 Voice Processing & Anaiog Inter(cid:173)
`face Board," Diaiogic@ On-I.inc Information Retrieval Sp'(cid:173)
`face Board," Dialogic@) Oll-I.jlle Information Retrieval Sp'(cid:173)
`(em, pp.I-9.
`(em, pp.1-9.
`I (i-Port ASR Board," f)i(llogic@ Of/-l.ine
`"VR/I(iO'fM
`ICi-Port ASR Board," f)i(llogic® Of/-l.ine
`"VR/ICiO'fM
`Infol'mation Relriel'lll SyS/CIII, pp. 1-7.
`Infol'mation Relriel'lll SyS/CIII, pp. 1-7.
`
`
`{)rimary Fxmlliner-Riebelnond ))orvil {)rimary Fxmlliner-Riebelnond ))orvil
`Af/orll(TJ Agl'fll, or Firm-Kenyon & Kenyon lifforll(TJ ligent, or Firm-Kenyon & Kenyon
`
`
`
`
`[571 [571
`
`
`
`ABSTRACT ABSTRACT
`
`A palient lllonit()ring systcm. A palit.;nt has nccc."s 10 a
`A patient lllonit()ring system. A patit.;nt has ncce."s to a
`h.:kphoIlC. The tekphone is opcraled by a patient.;\ central
`h.:kpholle. The telephonc is operated by a patient.;\ ccntral
`ll1()nitoring systcm is coupled to the telephone. The central
`ll1()nitoring system is coupled to the telcphone. The central
`lllonitoring system generates questions concerning a heall11
`lllonitoring system generates questions concerning a heall11
`condition of [he patient for the patient to answer using the
`condition of [he patient for the patient to answer using the
`
`keys or the telephone or hy speaking the correct response. keys or the telephone or hy speaking the correct response.
`The central monitoring system stores answers to Ihe ques(cid:173)
`The central monitoring system stores answers to the ques(cid:173)
`tions for later retrieval. The central moniloring system can
`tions for later retrieval. The central Illonitoring system can
`include a DTMI; m(xkm decmkr for receiving and decoding
`include a DTMI; m(xkm decmkr for receiving and decoding
`DTMF tones generakd hy the patient using the (ouch-tone
`DTMF tones generakd hy the patient using the touch-tone
`tr.:Jepholle and transmitted to the central monitoring system,
`tr.:Jepholle and transmitted to the central monitoring system,
`Tht; DTMF tones represenl the health condition of the
`Tht; DTMF tones represent the health condition of the
`patien!. A compllter pron:ssor is coupled to the DTMF
`patient. A compllter pron:ssor is coupled to the DTMF
`1ll(l(km decoder. A voice generator is <l\so coupled 10 the
`1ll(l(km decoder. A voice generator is <llso coupled tn the
`compu1er prot:essor and generates voice OU1put ullder the
`compu1er prot:essor and generates voice OU1put ullder the
`control of Ihe computer processor. The voice output is
`control of the computer processor. The voice output is
`lransll1iHed to the touch-tone telephone. ;\ dataha . ......:
`is
`is
`lransllliHed to the touch-tone telephone. ;\ dataha . ......:
`coupled to the computer processor, storing a patient record
`coupled to the computer processor, storing a patient record
`rd1ecting the health condition of the patient and also storing
`rd1ecling the health condition of the patient and also storing
`1he questiolls concerning the hea \tl1 cOll(\i1ioll of Ihe patient.
`1he questiolls concerning the hea Itl1 cOIl(\i1ion of the patient.
`
`
`
`21 Claims, 9 DnlWing Sheets 21 Claims, 9 DnlWing Sheets
`
`
`13 13
`
`S S
`
`
`12 12
`
`S S
`
`
`OUlPillicll1 OU1Pillicill
`
`Sub'lystcfIl Subsystcm
`
`
`
`21 >'V 23A 21 >'V 23A
`
`
`Cardiocom Ex. 1002 Cardiocom Ex. 1002
`CARDIOCOM EXH 1035
`CARDIOCOM v. BOSCH IPR2013-00468
`
`1
`
`

`

`•
`
`6,014,62(,
`Page 2
`
`U.S. PATENT DOCUMENTS
`
`5,(m';)';(Io
`5,065,315
`S,(l99,424
`5,107,8.31
`5, Hl/1S4
`5,159,317
`5,172,ms
`5,179,587
`5.204,670
`.'i,207,SKO
`5,L'\3,285
`
`........ (jrX"ljS09
`H/l99t Oha
`..................... .......... 705j2
`11/19(H Garcia
`...................... 205/3
`3/l9()2 Schneiderman
`17Hj)()4.26
`I !:tlpern ct <II.
`4/t!)()),
`227./(j38,
`S/.l()n Kaufman d al.
`.............. 340/574
`LO/U)n Brav
`......... 6DOjSlO
`12/19!J2 Stanko
`329NJJ)2
`11 [fl(J3 Bock ct ,d.
`{~/[ 9(J3 Stinlon ....
`.............. 340/825.54
`.... 434/23X
`5/19(J3 Slrcchcl
`. ... :37(Wi2
`10/19()j ;\lhcim .
`
`2/[1)94
`5,2R9,521
`5.289531
`2/1994
`4jl()94
`5305,218
`5,321,618
`6/1991
`5,357,427 W/1994
`5377.258
`J2/1994
`5,441,()47
`8/1995
`5,5·1'1,MIJ
`8/19%
`5,633,910
`5/1997
`5,(j(jO,176
`8/1997
`5.668.928
`9/1997
`
`Coleman e( al.
`Levine
`Stan, III d .11.
`cressman
`J ,angen et al.
`Bro ..
`David ct <11.
`David d
`;11.
`Cohen
`Iliff ...
`(;roner
`
`.179/52
`379/93.23
`702/17()
`........ 607/5
`364/413
`........... 37!)j106
`................... 128/670
`128/630
`37Qj38
`128/630
`.................... 704/243
`
`2
`
`

`

`"
`
`•
`
`U.S. Patent
`
`Jan. 11,2000
`
`Sheet 1 of 9
`
`6,014,626
`
`NS
`......
`
`...., E
`,.... - Cl)
`CD --
`.- en
`....,
`ttl >.
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`ell
`UCf)
`
`ill
`"-
`::J
`0)
`.-
`LL
`
`3
`
`

`

`U.S. Patent
`U.S. Patent
`
`.Jan. 11,2000
`
`fi
`Sheet 2 01' 9
`66.
`.9
`
`6,014,626
`6,014,626
`
`2.,
`
`m22:33
`
`c E
`OJ w
`'"
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`

`e .
`[J'] .
`
`:..,
`
`? .... -
`
`24/V Da\a Base
`
`/\,/ 11
`
`Voice/DTMF t-
`Module
`~
`22A
`
`21 tV
`
`23A"v
`
`A SR
`Module
`
`I-
`
`21A
`~
`Inlerface
`t- Module
`
`13
`~
`
`-........
`
`12
`~
`
`Ou\palien\
`Subsyslem
`
`25/\/
`
`Oulput
`Device
`
`Figure 2A
`
`5
`
`

`

`U.S. Patent
`
`Jun. 11,2000
`
`Sheet 4 of 9
`
`6,014,626
`
`29
`
`28
`
`QUESTION # 1:
`HAVE YOU TAKEN THE
`PRESCRIBED MEDICATION?
`PRESS '1' FOR YES
`PRESS '2" FOR NO
`
`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 OR SAY "4'
`SAD OR BLUE ALL OF THE TIME, PRESS OR SAY "5'
`SO SAD I COULDN'T STAND IT, PRESS OR SAY '6"
`
`TABLE 1· DEPRESSION HISTORY FOR PATIENT 1544028· AMY HOPKINS
`DATE
`QUESTION 1 QUESTION 2 QUESTION 3 QUESTION 4
`8/3/94
`YES
`8AM
`NORMAL
`4
`8/4/94
`YES
`5
`8AM
`NORMAL
`NORMAL ~ 7
`8/5/94
`YES
`3
`8:30AM
`8/6/94
`NO
`5
`8:15AM
`NORMAL
`8!7194
`YES
`ABNORMAL
`3
`10AM
`8/8/94
`YES
`3
`8:30AM
`ABNORMAL
`8/9/94
`YES
`2
`8AM
`NORMAL
`8/10/94
`YES
`2
`8:15AM
`NORMAL
`
`\ 30
`
`FIG. 3
`
`6
`
`

`

`· ,
`
`U.S. Patent
`
`.JaJl. ll , 2000
`
`Sheet 5 of 9
`
`6,014,626
`
`\
`
`START
`
`101
`
`(STIRKES = STRIKES· 1
`~
`( ISSTRIKES
`
`3?
`
`105
`
`, NO
`
`YES
`
`1~7
`
`39
`
`( SET STRIKES TO 0 '\
`103
`
`QUESTION # 1:
`HAVE YOU TAKEN THE
`PRESCRIBED MEDICATION?
`PRESS 'I' FOR YES
`PRESS '2' FOR NO
`
`28
`
`OTHER
`
`1
`
`2
`
`11G---z;
`RECORD THIS ANSWER
`
`QUESTION # 2:
`IFYOUARE
`HAPPY MOST OF THE TIME, PRESS OR SAY 'I'
`HAPPY MORE THAN SAD OR BLUE, PRESS OR SAY '2' ~
`THE 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'S'
`SO SAD I COULDN'T STAND IT, PRESS OR SAY 'S'
`
`( IS STRIKES = = 3?
`
`) NO
`
`1
`
`2
`
`3
`
`4
`
`5
`
`6
`
`RECORD THIS ANSWER
`
`YES
`
`QUESTION #3:
`(QUESTIONS CONTINUE)
`~
`"THANK YOU."
`HANG UP
`
`FIG.4
`
`t--
`
`'SORRY, I DO NOT
`UNDERSTAND'
`HANG UP
`
`).J
`109
`
`7
`
`

`

`u.s. Patent
`
`.Tan. 11, 2000
`
`Sheet 6 of 9
`
`6,014,626
`
`OUTPATIENT
`SUBSYSTEM I),
`12
`
`);00
`
`TELE·
`COMMUNICATIONS
`SYSTEM
`
`~13
`
`22___..
`VOICE
`GENERATOR
`
`DTMF
`INTERFACE
`
`540~ PROVIDER
`INTERFACE "
`"
`
`(536
`
`PATIENT
`
`~
`
`SCREEN
`INTERFACE
`MODULE
`
`f.-.
`
`SCHEDULING
`\
`)44
`REPORT I- WALKTHROUGH
`MODULE
`INTERFACE
`
`PATIENT
`INTERFACE
`
`534
`
`f...---538
`
`~2 yo
`\ lOGON0~
`\ ;oo~
`
`r----550
`
`-562
`
`SERVER
`CLIENT
`COMMUNICATION
`+
`DATABASE
`INTERFACE ~ )4
`
`/
`SECURITY
`
`LANGUAGE
`
`64
`
`DATABASE
`
`FIG. 5
`
`)60
`
`5~6
`OPERATING
`SYSTEM
`
`8
`
`

`

`· ,
`
`u.s. Patent
`
`.1ao.11,2000
`
`Sheet 7 of 9
`
`6,014,626
`
`OUTPATIENT
`SUBSYSTEM ~2
`
`AOO
`
`TELE·
`COMMUNICATIONS ~13
`, - - - - - - - - - - l SYSTEM
`~;;:;:;:;;;:::;;;~-I
`~ INTERFACE r-.-21 A
`MODULE
`DTMF -;f "" ASR
`1;:;-,
`MODULE
`MODULE 23A
`
`22A----
`
`540~ PROVIDER
`,...536
`INTERFACE '"
`f
`~-,", '" PATIENT
`
`PATIENT
`INTERFACE
`
`\
`
`54,2
`/
`SCREEN
`INTERFACE --
`MODULE
`
`....---538
`
`SC~~~~L~NGr/s~
`r-"\~----'/~'"
`)44
`REPORT _ WALKTHROUGH
`INTERFACE
`-
`MODULE
`MODULE
`
`~\/
`
`SERVER
`CLIENT
`COMMUNICATION
`
`-----550
`
`LANGUAGE ~ 2/
`
`DATABASE
`INTERFACE
`
`,------1./:..., 564
`SECURITY
`
`I
`
`62
`
`5~6
`" " DATABASEI--..-J0PERATING
`SYSTEM
`
`FIG.5A
`
`9
`
`

`

`U.S. Patent
`
`Jan. 11, 200t)
`
`Sheet 8 of 9
`
`6,014,626
`
`Figure 6
`
`31 ./\...---
`
`Obtain Valid
`Identification
`Number
`
`32 ./\...---
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`Consult Data Base
`and Select Question
`or Instruction
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`33~
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`Ask Questions
`And Record
`Responses
`
`34/\....----
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`Issue Final
`Instructions
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`35 /\......---
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`Terminate
`Call
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`36/\....----
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`Consult Data Base
`F or Analysis
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`37/\......---
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`Generate Report
`For Health Care
`Provider
`
`10
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`

`

`u.s. Patent
`
`Jan. 11,2()()()
`
`Sheet 9 of 9
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`6,014,626
`
`Figure 6A
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`31 A./\.---
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`Obtain Valid
`Identification
`Number
`
`Consult Data Base
`and Select Question
`or Instruction
`
`Ask Questions
`Decode And Record
`Responses
`
`34 /'"'\...----
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`Issue Final
`Instructions
`
`35 /\...----
`
`Terminate
`Call
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`36 /'"'\...----
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`Consult Data Base
`For Analysis
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`37/\...----
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`Generate Report
`For Health Care
`Provider
`
`11
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`•
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`6,014,626
`
`1
`PATIENT MONITOHING SYSTEM
`INCLUDING SPEI';CH IlECOGNITION
`CAI'ABILITY
`
`REI .ATE!) APPI JCATlONS
`
`'Ibis application is a continuation-in-part of application
`Scr. No. 08/305,108 filed on Sep. 13, 1994, now isslIcd as
`U.S. Pal. No. 5,633,910.
`
`HEW 01' INVENTION
`
`is dircc-tcu 10
`inv(;nlioll
`The pr!..:senL
`it compuLer(cid:173)
`irnpJcnwnled method <lnd sysh.:m for monitoring the health
`slalus of palicnls, alld ill parlil:uiar. a rm;lhod and system
`utilizing a standard h.:kphom: 10 monitor the health status of
`{1Il1palil:n\s.
`
`COI'YRI(;[[,[, NOTICE
`
`A portion of tIll; disdoSlH<J of Ihis patent document
`contains material which is subjcci 10 copyright protection.
`The copyright owner bas no objection (0 tht.: bcsimilc
`reproduction by anyolle or the patent document or patent
`disclosure as it appears in the Palent and Trademark Ollict.:
`patl:nt file Of records, but otherwise rl:save.<; all copyright
`rights whatsoeYl:r.
`
`BACKGROUND O[C TilE INVENTION
`
`2
`thc patient to monitor vital signs, such as blood pres.o.;ure or
`temperature. Other systcms require that one or more scnsors
`be physically implnnted into the patient's hody.
`Moreover, thcsc systems often have a dedicated usc, for
`5 example, they can only be used to monitor Olll: or two
`physical conditions of the patient. These systems arc less
`Ilexible, cach being directed towards reporting a fairly
`narrow range of data to thc health care provider, often on an
`inte.:rmiUenl basis. For example, one system may be capable
`j[J of transmitting only hcarL rate and blood prl:ssurc; another
`may monitor and transmit sOltnds from impiankd heMt
`valves; ycl anothcr lllay be nel:ded 10 monitor and transmil
`"biologic signals."
`For cxamplc, U.S. Pal. No. 4,712,562 to Ohayon e.:t al.
`15 descrihes a system to monitor the blood pres.<;urc and heart
`r;1I0 of an ol1tpatient that wquiws the outpatient be provided
`with a special tkviee that can take blood prcsslIfe and heart
`rate readings, store these rcadings, (lmllakr gCllerate signals
`for transmis.<;ion. These signals reprcscntti1e storl:d readings
`and the identity or the patient. In such a SYStCIll,
`tIn.:
`:!o Olltpatient must be supplied with ,I mcasuremeIlI, storage
`
`and signal gencrating dcvice that is programmed for usc by
`that particular outpatient only.
`U.S. Pat. No. 5,172,69f: to Stanko dcscrihl:s a (blicatl:d
`tdepilonie paeemakcr monitoring (il:vice that has four ekc-
`2S trode touch p:lds tl1:11 can detect p.u.:emakef signals Of a
`patil:nt's pulse ,lIlel trallsmitthe de1eded informalion over a
`tckphone Jine.
`U.S. Pal. No. 3{-'1f1,2,277 to DePcdro et al. descrihl:s a
`portabk batlcry-powl:ret! EKG signal dclector and transmit(cid:173)
`ter. EKG signals call bl: transmitted ovcr a tciepl10ne link to
`monitoring equipm~nt at another location.
`U.S. Pal. No. 4,068,097 to Verriest describes a systcrn th;lt
`rcquircs a specially aclaptcd tciephone sc1that is capabk of
`dirl:ct cornrilUnic,ltiol1 with a centnll 1Il0nit()ring station
`without thc handS(;t be.:ing lifted.
`U.S. Pat. No. 4,337,377 10 Van Riper l:\ al. de!;cribes an
`apparatus to monitor biologic signals of a patient from a
`telephone handS(;\. This system rl:quircs the patient to carry
`40 a spl:eial unit that must be coup1cd to thc tekphonl: handsc!.
`In thc ahovc syskms, thc patient has to obtain and us~ an
`electronic device eapablc of taking readings and transmitting
`data over a tckphone.: linl:, often lIsing complex communi(cid:173)
`cation protocols. Many of thesc devices havl: a dedicatcd
`usc, i.e., arc programmed for usc by one.: paticnt only Of arc
`programmed for uS(; for one set of Illcasurements only.
`TIlliS, thl:rl: is a llGed fOf a system for remotely monitoring
`the health status of patients that docs not rcquire spl:eial
`training or complex equipmenl that is likl:ly to hc expensiw.
`50 In particular, there is a need for it monitoring systl:1ll that
`docs not require that Ihe patient be providl:d wi1h any
`l:kctronic equipment, Ihus allowing the patient to usc COI11-
`munications t:quipIlll:nt that till: patient already has in his or
`her own hUllle.
`Some known sy:-;terns uS(;d to obtain information from
`patients conlact patients at predl:\ermined times. '111erc
`exists a need for a paticnt monitoring system tlMt allows the
`pati01lt to contact the central systl:Jl1 at times and from
`locations C()J1vcnil:[1t 10 the patient.
`Further, thcre is a need for a single systclll that is capable
`of hdng adapkd to an individual's cvolving physical COIl(cid:173)
`ditiun. Each patient may haw dilrefl;nt cnmlitillns th:1t
`require monitoring. For cxamplc, for O[)l: patient, ]lulse
`infurmation may he importanl, for :lIlOlhl:r, hlood pressure,
`(,s and fur a third palimll, tempt.:rature. The health carc provider
`nel:ds a ~inglc system to l::tsily monitor all condition!; of all
`
`.,5
`
`.'0
`
`Much of the cost of providing health cart.: is ilssuciated
`with
`tinw Spl:llt by medical pt.:rsollild cOllslIitillg with
`patil:llts. Wherl:as equipment is rdativdy easy to pro(;ure, it
`is costly to provide the 0xtensiv0 training and 0xperience
`requirnl by health care professionals to l:nablc them to
`provide quality health care. The growing clem.mel for medi(cid:173)
`cal sl:cvict.:s at a fl:asonahlc cost has placed ullpcl:cedl:llted
`demands on th0 health-caw providl:f.
`An outpatient usually fesides at a location away from a
`health carc pcovkkr. I;or cxample, an (lutpalil:nt typically
`rcsides at home and 110t in the hospital where his or her
`doctor may have an olliee. Thus, the health care provider has
`far lcs.'i opportunity 10 monitor the health status or an
`outpatient on day to day basis. MO[l;over, an outpatient lTlay
`be required to sec a doctor on a regular basis, oftcn for
`sirnp1c and routine tl:sts. In such a case, the outpatielll must
`travd to the doctor's ollice or to a hospital, wait to be seen 45
`hy the rclevanl health care provider, h<lve
`the tcsts
`pl:rfofmed, and travd horne. This inconvcnient way of
`Illollitoring tilc he.dth of an outpatient often docs not as.<;isl
`thl: outpatient in the recov.:ry process.
`III short, patients in a hospital ar.: rcgularly monitored.
`J lowevl:r, olltpatil:nts ortell do ilot recl:ivc this sallll: !cvd of
`Iwalth .:afC.
`A sy.'>telll is needl:d Ihal will hdp dus.: the g:l[l ht.:tw.:.:n
`the kvd or care received by hospilalil',l:d pati.:nts and
`1101l-hospitalized patil:nts who IlIUSt visilllw doctor or othec 55
`hl:al1h care provider for treatment. It would he adv<llltagl:O\)s
`if <l health caw provitkr could rl:gularly monitor the lwalth
`status ur patients, including tlIttpatil:llt.'>, witbllut fl:quiring
`these patients to physically travel to and make an appllillt-
`1llt:llt with thc ill:ailh care provider unless it is ahsuilltdy (ill
`Ill:CCs.'>;lry I\l do so.
`Many ur the adv:llltagl:s of a relllo\l: olltpaticntlllonitoring
`sysl\;111 would he neg;l\ed if Ihe systelll Wl:rc l:xcecdingly
`cnstly or t'n!1)pkx 1(l 11."C. I~xisling Olttpatil:llt !l1onitoring
`Sy.'>tl:IllS fl:quin.: the patil:nltlllISl: t:xpellsive l:quiptlwnt Ihat
`i~ cUlllpkx and unfailliliar to tilt: p:llit.:nt. For cxalllplc, nlany
`l:xisling !lH)flih)ling .,>y.o.:.ll:l11s im'()lv(.: e()1lIlcc1illg SCIISOr.o.:. tu
`
`12
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`

`

`· .
`
`6,014,626
`
`3
`hJl"th~I" as a patient's condition improves, some informa.
`[ion may lW[ he needed. Existing systems arc not Ilcxibk
`and (,;'lIlnOl cilsily be adapted f{lf clU.:b pat ient's dilIcring and
`evolving ~()nd it i()ns.
`Exislillg Inoniloring systcn ls t,:olll.:cntralc on obl'linin,!,;
`infu[m:lIioli rdal ing 10 physical cond ili()Os, s nc h as blood
`prCs.<.;ufc, pu!se, EKG ,lfId thl: like . OrIel). l'orcx;Lmpk, ""hell
`a patient is laking medicine (If h,IS u psychulogical prob lem,
`the hca\lh care provider must additionally monitor other
`factors, Sl!(:i1 as how well a patient sleeps, whether the
`patient feds dn)wsy or dcpn:sscd, alld whdher the patient
`has an app(.; [itc. Existing monitoring systems do not cnahlc
`health care prov iders to rcmOlI,;]Y monitor psychologicnl and
`other rclated t..'onditions or ,1 p:lli~n L
`SUMMARY OF TI If ' INVENTION
`
`l(J
`
`4
`usc, for example, ally h.:lephone as the patienl subsystem.
`The p.:lliellt sllbsyslem of the prt!sent invclliioll may he a
`touch-tone telephone gt:ncrating DTMF tones Of, if tile
`ce nlr:d Illoniloring syslem includes spcel!h mcngnilioll
`5 me ans. a rt:g.u lar pu is..: [elephone.
`In 'he I\:prcSCnlalivc emhodiment, Ihe. piI[ien l s uhsys[em
`(,:OltlllCises an instrumenl t'''p"ble uf rccei\'ing instructions
`['mill [he central m~Hlit{l(ing subsystem amI cap.tllie o r
`sending dala to the central m<w it'lring subsystem, Typically,
`lile patient subsystem (;ofllpriscs II touch lone telephone
`coupled 10 a tc\cphOllt: Jilll..'. (For patients without a bome
`lekpholle or Iraveling, a pubi.: tckpbOlw may be used,
`Alternatively, palients mlly usc ;1 cellular lelephone as the
`]>;llleot subsystem.) For Illorc sophisticated users,lhe palient
`I!' s uhs}'stem Illily he a eompu [er and mudeill.
`Thus, in a typical embodimenl o f the prescnt invention,
`the p;nient llGcds only a lelcphoo",. 'nlis is thc same kind of
`telephone already owned by mosl households. Further, Ihe
`ti.!lephone USGd in lite prcst:lll im't:l1tion need nol he in
`20 add iliml 10 the olle used for everyday calls; nor is any
`additi'lna l telepholle tine ct:quired, (More sophisticatt:(\
`patients Cllll usc a COmpll\Cr wilh a modem 10 comrnunic:lle
`wilh tbe ct:ntral monitoring suhsY!'lem.) 'Ihus, Ihere wi ll he
`no additional cosl 10 Ihl..' palient for specia l equipment. Nor
`25 docs the hC<l lth car~ pwvidt:r ;1t..'Xluirc expens ive equ ipmenl
`Olccvrding 10 the prese nt inv..:nlioll .
`In :t repres~n[ative (;'llIbodimcn[, the central mo nitori ng
`s llbsy~tet11 indmiGs a ~eneral purpose, orr-Ihe-shelf, homc
`t.:Oll1pllter, sothv;lfe, it voit.:1.: gCllerator, and a DTMF I1lm\cm.
`TIlese components an.; rcialivt:Jy simple devices commonly
`aVili lablc. As is known in tllc art, the DTMJ.' modem is
`capilhk of receivillg IIle clu:lI I Oll~.s gcnerated by a lOuch(cid:173)
`tOot: tclepholle keypad Ihat h:lve hCt:ll Irat1;.,milled (\Vcr the
`.t~ telephone
`line and translaling the tone:-; into characters
`r,,;c()g,nizahle by [he computer pf(lct;. ... snr. ·Ibe equipment
`used in thc rcprese lltrl tive emhodime llt of the present inven(cid:173)
`tiotl is rc'ld i!y ava ilahle ~,:(lnllllereially, is inexpensive, and is
`c:lsy 10 lise.
`III the representativc elllhndil11cnt, the computer pror.:cs.'.;()r
`of the central r1lonilming sllhs),stcJl1 is r.:apable or recciving.
`ami dccoding informatioll f«1111 pati<,;nts received via lht!
`DTMl-' Illodem,
`l'at i<,;llls
`r,;ollli1lunir,;ale wilh the ct:111(.1\
`rnnllil()r;ll~ suhsystem using iI louch tOile h:;lcpho ne ur a
`<.:\ll1lpu[er with a 1I10d':II1. The information mcc ived and
`decl lded ;II Ihe L"CIl[ral m{)nilori ll~ s uhsysh.:m i.s stored in the
`(I;lt ilh;ISC, The r,;ol1lpuler pmc~s.'i()r nukes decisions h :lscd
`upon Ihe inrormalion rccc ;veci and ut li ..: r inrormation l)fevi(cid:173)
`()1I~ly stored in the dalahasc.
`Tltt: (epreselllal;ve t:lllhlldi lllr.:!l t of tht: present iuvelltiUIl
`opt:rales as follows: A heallh I,;are provider sllpplie,-. <I P;][it:lll
`wilh a tcJephollc lIIlmhl:f. Wilen di:i1ing this Il\lmhcr t'rom a
`teicplllJ!lc, the paliwl is t.:0!1 11ecled III tlrc cl:l1lr;l l llIt'ulit Pri llg
`sllhsystelU , ·Ille ClInrpU[l:r pfl't:es, ..... ,( Ill' Ihe ct:l1Ir;llllluni'llr(cid:173)
`ing. SUh:-oysh.:m, .... nntwllt:d hy .sufl w:lfe, :-'<,;II<Js iufi lO\wtiuu
`[(I Ihe palien!.
`(for c~a mJlIt:. insl rue[jolls ()f '1ue.-.[iIlIlS)
`Typica lly, these inslrtlc li\ IHS I)r (ll!eslit!Jl'" will 1')(.: ,,;oIlUllUlli(cid:173)
`c.:al~d ura lly In thc p:lti~ lIt , (11' example, they wi ll he gCllc r(cid:173)
`alcd hy [he vnil:e g..:lleratu r. Thc r,;u lllpult:f j1wccssur :lsks thc
`hi) paticlll
`III
`idclllif), hilll:-.eJt' ur hcr:-oclf, I'm r.:x'lIllpic, hy
`"': llI eri ll !::', an alphall1:meric idell! itical inn Of pal i~ll[ c(ldl: IIsin)!,
`the tOllch 11\IlC keypad , For t:X:II11plc, Ihe patient pr<,;ssc...; th~
`kt:y:-. ..:orrcspondill!!, 1(1 Ihe :ls .... igncd p;llie\1[
`,,;o(h; Oil [ht!
`k..:yp;ltl nil [hc pat iel l1·:-.1iIIl\.~h -h" l<'; [c!ephon<,; , II is nllj,,;d lila l
`115 Ihere <:'HI he added s..;curil y II1<,;a:-.11f1.;:-o. :-ouch as P:'''''''\\'\,c((...; (lr
`ke)'o.:ude:-o [hal m:ly also 11;1\ ... .: h) he e u[ercd hy [he paliellt.)
`'111c ]1;1[ ie111 cllde is rect:iv",d al lire celllr:ll
`Ili1In j lorjn~
`
`The pl\:scnt inwntion is din.:;eled ill it me thod Jnd systelll
`fm n.:mowly nlOnitorin~ the he:llth stltus of patients, in
`particular outpa tien ts, using teJccommunk'ations hardware
`syS!l.:l1ls :dready likely 10 exisl in it pa lien t's hOIl1G, such as,
`for Gxamplc, a lGiepbonG or person.ll cornptlter with a
`modem ,
`'1111.': r,,;prcS(.;l)talive emhodim";lH (If the pre~cnl invention
`c;m he rC£,ilrded as hilving I WO su bsys tems, name ly. a cenlra l
`monitoring subsYMelll ,11](1 :1 l)lIl ie lli subsyste m.
`' 1110.,; e..:nlra l Inllllitoring subsystem receives. s tores and
`illfnrlllation provided hy O!1G or more
`proCC,'i:-:o.;s hGul lh
`patients. HiKI generates pcri(Kli(: reports for [he relevan[
`hc;dlh C;lr~ providtTs, Typically. the cClltrai monitoring JO
`subsystem is Incakd in a cenlral location so as to he
`accessible hy telep holle to all palielllS Wil(l require monitor(cid:173)
`ing, I:u rlher, thc central mOlliltlJ'il1g subsystem i:-; often
`local.:d so :\s 10 he readily :Lv:li lilhh.: 10 Ih(.; health care
`pfOvi<i(.;rs using [he system, fo r eX:lmple. in a hospi[al o r
`doc[or's (lnice, lIowever. since [he t:en tr.lIlllunilo ring su h(cid:173)
`system cou ld he used ,lOti Sh:lfed hy :l numher n f doctors ,md
`hospi[al.<:. it (,·utdd he i<Kaled in a rClllo le 1(Kil tion, ilecessibk
`by modeill. jocalafea ndwork ("I.J\N'·)iwide area network
`("WAN ") or tile Internet. so thai rele vant n,:pofts cOlild be 40
`distrihuled e lectro nic:dly to the rclevant healt h care provid-
`ers who require s uch reports,
`lnlhc rcprcscillative <:mbodirnclll, I hI..: c(.;n lraJ monitoring,
`least Hue cO lllpuler processor
`stthsys!em cumprises at
`coupled t~l a leicuulllll llll i .. ::lliulls lille hy (fur eXilUlple) a ,15
`modclll C<lp<lhk Ill' illh.;q)f(.;tillg. dual 101le. IUllltifreqllellt:y
`(DTMl') "ndior voit:e siguab. sllf!w:lre hI ctJ!ltru ll he npe.ra(cid:173)
`lioll (,f tho.,; 1,;l)IllJllllcr prul.:l.;s.·".or, :1 d.!I;lilaSl.: ;Hld DBMS to
`slOfe i1Jf(lfJlwti(l!l and generate rq)(lrIS cegardillg the hcalth
`slalll ~ or p:dicllls, ami a voict: ge l1t:calur l:,I Jlablc of gener-
`ating v{ licl.: inSlflictiuns ullderst:lnd :lhJc by iJumans llvcr the
`leIcCllI!1 I1II11 1ir.:;llions syskrll. OPliOIl:dly. the c!.:ntral moni(cid:173)
`toring :-.lIhsy.<:tc1l1 r.:all include a spe<:r.:h recognition board
`slIch liS , I diM'rele, I!1ll ltj wurd specd! rec..:\ lglli:t.cr or sJlcaker(cid:173)
`ind!.:Jlcndeul cuul inllous digit rccllJ:!,lIi:t.cr, ;mdior:1 pri11lcr fu r 55
`pri lllilig the geno.,;r;lkd rCp.'rls. FllnJrer, thc compuler PIlI-
`c~ ..... w r t:ao hI,; purl o f <I LAN .
`'Illt.: palielll ,'ilJilSy,-.tt.:1ll cn:thks a p;11;elll t(llransmil in ro r(cid:173)
`rnalir,'lI ;iI'ulil Ihc palicnt·s Ile;,111I ~lalUs lu Ill!.: ceni ralllloni(cid:173)
`luring SlI),systl.: llI , Tlrer...: is likcly III 11t: Illure 111<1[1 one palicllt
`heill ~ 1l1onitnred ill a lime, Tllll:-',
`in tllc represel1ta[ivc
`ellllllldilll l..:ll l. c:lc..:h palir.:nt will Ilave (llr hav...: aeccss (0) a
`p:lt;enl sllhsys[elll, Typically, thc p:rlient subsystem will he
`illI:<lh.:d in the horne Of oll'icc tit' thc P:l1 ;t:111. It is nOll;d,
`Ilowcver, [h:11 (depl.:mlil1g Ililthe c])l1d i[i<)11 til' the p;ltiel1l) the
`p;lIieHI requires no :-.peeial CII Il ;Plllt:lI t to sllClx:-;.. ... fu lly IIt ili:!...:
`lito.,; C:l p:.I~ili 'ie,-. of lite pfl::-.el1[ iU"nllioll , T he p;l[ienl may
`
`51]
`
`13
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`

`

`6,014,626
`
`II)
`
`.~:;
`
`5
`subsys[l,;rn, dc(;oc1cd, and the palicllt's record is n:tricwd
`from !he dall1bilsc.
`The palienl 's rt:cord typically I.:ompriscs informat ion
`abou llhc palient's medical comlilion including inl{lfInlllioo
`previously clllCftxl hy the p:llicnl usin£ the s)'!'lcm of !he
`prescnt invention. Using Ihe informatioJl in Ihl; patient's
`record. the central monitoring suhsystem C;III generate qm;s(cid:173)
`lions IIl:ll the Piltil,;l1[ must respond to !'o() thaI relevant
`informatiun c:m be entered hy and n.,a.:civcd frml1 tht: palien!.
`Additionally. or in the allcm:ttivc, [hI.: p:llicnt can be
`provith.:d witb a printed chart of questions thaI the patient
`must answer prior to calling Ihe I,:cnlral monitoring, sub(cid:173)
`system. Each palient rnay have a (.;barl tilal corresponds to
`thaI p:l,j c nl'~ individual condition. The palii,;nl fills in the
`,1I1.o.;wcrs 10 the questions o n the dlarl. The palient comOlU ·
`nicatc.s hy tclep hom; w ilh Ihe (."C ll lf:11 IIIlHlilllring subsyste m
`<l nd enters the 1);llienl code (and, if re(luired, a chart (:ode
`identifying the chart Ihal thl: patient i~ u~in~). Thl; <.:enlral
`mUlIiwr ing SU1'l:'iysh:m will Ihe!! ilsk Ihe patil;1I1 for 1;;1I.:h
`answer that the patient has enh.;red on Ihl; chart. The patient
`answers using the touch lone keypild . 'rbe chart that Ihl.:
`palil.:nt USl.:S may bl.: thaI of till.: Iype descrihed in U.S. Pal.
`No. <1.346,697 en litled ';Method F(lr Tn; atin!,'. Ikprcssion
`and Othec Maladies By Me;lIls Of P.:1.Ilent-Cre;lled Symptom
`(;r"phs", which is expressly illc(lrporato:d berein h}i rcICr(cid:173)
`e nCt;.
`'Illlls, in s hurl, a fler the pa lit;lIt h:ls ente re d the palient
`code, Ille central Illunitnring s ubsystem :I .... k.o.; the patient nile
`or Illlife queslions, which the patient a1lswers llsing kl;Ys (In
`the patil;tlt's tOlll'h-lOne lClcpho]J(; . The p:ltient is inslnll'led
`to n,;:-;polld hy l: llkring inf()rmatiol1 thl'ullgh Ihl.; keypad of
`Ihe teh;p ho t1 I;, s uch as selecting the best :1I1SWef by tOllChing
`its corn:spol1ding key. The COI11IHltl:f pfOCeSS(lf urlhe centcal
`lIIonitoring SIIh.o.;yslelll reconls :Ind prlll:"':sscs the palicllt's
`rC!-.IXltlSC. Thl; C(lmputl;r proO';S.<;Of Illay sck;!;t the nexl quay
`hy !;()llsttlt ing, Ihe clalahase <llId l'( ~nsidering Ihe p:lIient":-;
`'J'Jtc c.:clllr;,1 mOll ilorill~
`rCSI)(IIlSC It I previo