`
`||||||||||||||||||||||||||||||||lllll ||IIII11le"III11111Ill11
`
`USOU75395333
`
`(12) United States Patent
`Tran
`
`[10) Patent No.:
`[45} Date of Patent:
`
`US 7,539,533 32
`May 26, 2009
`
`(54)
`
`MESH NETWORK MONITORING
`APPLIANCE
`
`(76)
`
`Inventor:
`
`Baa Tran. 6768 Meadow Vista FL. San
`Jose. CA {US} 95135
`
`(*1
`
`Notice:
`
`Subject to any disclaimer. the term ol‘this
`patent
`is extended or adjusted under 35
`U.S.C. 154(13) by 445 days.
`
`(21)
`
`(22)
`
`(65)
`
`(51}
`
`(52)
`(58)
`
`(56)
`
`Appl. No;
`
`1 [1435.068
`
`Filed:
`
`May 16, 2006
`
`Prior Publication Data
`
`US 200770273504 Al
`
`Nov. 29. 2007
`
`(2006.01)
`
`Int. Cl.
`A613 5X04
`.. 6007509: 6007513
`U.S. (.‘l.
`6001528.
`Field chlassificatiun Search
`I 287903
`6001509. 513:
`See application file for complete search history.
`References Cited
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`(Continued)
`OTHER PUBLICATIONS
`
`US. Appl. No. 107933.783. Wen.
`
`
`Primary Examiner
`("arl H Layno
`Assistant Examiner Brian T Gedeon
`
`(74).:11107‘1331‘. Agent, or Firm- Tran & Associates
`
`(57)
`
`ABSTRACT
`
`A health care monitoring system for a person includes one or
`more wireless nodes forming a wireless mesh network: a
`wearable appliance havng a sound transducer coupled to the
`wireless transceiver; and a biocleclric impedance (1311 Sensor
`coupled to the wireless mesh network to cvrmnunicale 131 data
`over the wireless mesh network to detect a heart attack or a
`stroke attack.
`
`20 Claims. 14 Drawing Sheets
`
`
`
`l 1 I 930
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`
`
`
`
`
`
`0001
`
`US. Patent No. 8,652,040
`
`Apple Inc.
`APL1046
`
`A5
`
`4.234.926
`"
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`1\
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`1"
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`4.922.229
`4.964.411
`
`AA\A >
`
`1Pbibbb>>3i>
`
`A
`
`Apple Inc.
`APL1046
`U.S. Patent No. 8,652,040
`
`0001
`
`

`

`US 7,539,533 B2
`
`Page 2
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`65543-24 31
`4.22003 0,0611%“ch
`6555350 31
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`222003 Hadzls
`6.592.944 Bl
`822003 Tellerctal.
`6.605.038 Bl
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`9.22003 Ken-.11
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`522004 (36116616161.
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`523004 Ammo
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`fi_247‘551 31
`222004 Sippens Grmnewegen
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`6.283.492 132
`aflkfifiBl mQWdRmmkmmfi
`6.816.266 132
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`1022002 Siivoricclal.
`
`6002513
`
`6002300
`
`0002
`
`0002
`
`

`

`US 7,539,533 B2
`Page 3
`
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`
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`
`A1
`(‘1 *
`Al
`Al
`Al
`Al
`A1
`A1
`A1
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`112 006
`112006
`312 006
`412 006
`412006
`412006
`512 006
`512 006
`
`Park et :1].
`Bauer et al.
`Di Stefano et a1.
`Jannzml
`Kettuuen
`Poiyshchuk el al.
`Banet cl a1.
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`Akay cl aL
`Richardson
`Planet (31 a1.
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`DcLuca ct a1.
`Bolger at a].
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`Mama
`Benesch e1 21].
`
`* cilcd by examiner
`
`0003
`
`0003
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet] of 14
`
`US 7,539,533 32
`
`
`REMOTE SERVER 200
`
`
`
`
`
`
`‘7
`
`Internal
`100
`
`
`AUTHORIZED THIRD
`
`PARTY {DOCTOR
`FAMILY, EMERGENCY
`
`
`SERVICES.
`CAREGNER, HOSPITAL.
`NURSING HOME, CALL
`
`
`CENTER. ETC.) 21o
`
`
`
`
`
`
`
`
`
`IEE
`
`BASE STATION —
`LOCAL SERVER 20
`
`go
`
`
`
` 10
`
`Mesh Network
`
`Appliances 8
`
`C
`
`30
`
`FIG. 1
`
`0004
`
`0004
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 2 0f 14
`
`US 7,539,533 32
`
`Place a calibration sheet with known dots at a known distance
`
`and perpendicular to a camera View
`
`Take snap shot of the sheet, and correlate the position of the
`dots to the camera image
`
`Place a different calibration sheet that contains known dots at
`
`another different known distance and perpendicular to camera
`View.
`
`defining a cone center where the camera can view
`
`Take snap shot of the sheet and correlate the position of the
`dots to the camera image
`
`Smooth the dots to the pixels to minimize digitization errors
`
`For each pixel, draw a line from Dot1(x,y,z) to Dot2 (x, y, z)
`
`FIG.2A
`
`CUCDODOU
`
`one-0.0!
`
`CUOUOUOU
`
`OIOIOIOI
`
`OUODODOD
`
`OIOIOIOI
`
`ODOUCUCB
`
`OIOIOIOI
`
`FIG. 2B
`
`0005
`
`0005
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 3 of 14
`
`US 7,539,533 32
`
`
`
`
`
`Find floor space area
`
`Define camera view
`
`background 3]) scene
`
`Calculate patient’s key features
`
`Detect fall
`
`FIG. 3
`
`
`
`
`
`Find floor space area
`
`
`
`Define camera View backgmund 3D scene
`
`Detect facial expression
`
`Calculate patient’s key features
`
`Extract facial objects
`
`Detect facial orientation
`
`FIG. 4
`
`0006
`
`0006
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 4 of”
`
`US 7,539,533 32
`
`Set up mesh network appliances (1000)
`
`Determine if patient needs assistance based on in-dOOl’ position, fall
`
`detection and vital parameter (1008)
`
`Confirm prior to calling third party (1010)
`
`
`
`
`
`
`
`Determine patient position using inndoor positioning system (1002)
`
` Determine patient movement using accelerometer output (1004)
`
`Determine vital parameter including patient Heart rate (1006)
`
`
`
`If confirmed or non~re5ponsive, make connection with third party and
`
`
`
`
`
`
`
`
`
`
`send voice over mesh network to appliance worn by the patient (1012)
`
`If needed, call emergency personnel to get medical care (1014)
`
`FIG. 5
`
`1332
`
`1388
`
`FIG. 6A
`
`0007
`
`0007
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 5 MN
`
`US 7,539,533 32
`
`HEAD BAND OR HEAD CAP
`1402
`
`\
`
`HDTV REMOTE
`CONTROL 1399
`
`I g
`
`PATCH
`1400
`
`-'
`
`LIGHTING
`
`CONTROL 1393
`
`ROOM
`THERMOSTAT
`CONTROL 1396
`
`HOME SECURITY
`MONITOR 1394
`
`FIRE ALARMS
`1393
`
`MEDICINE
`CONTAINERIS)
`
`1 1 82
`1391
`
`HOME
`APPLIANCE(S}
`1 392
`BASE STATION
`
`POTSIPSTN OR THE
`OR PERSONAL
`
`INTERNET
`
`SERVER 1390
`
`
`
` AUTHORIZED THIRD PARTY (FRIEND. FAMILY. COMMUNITY, EMERGENCY SERVICES.
`
`HOSPITALI CAREGIVER. OR MONITORING CALL CENTERI AMONG OTHERS} 1194
`
`FIG. 6B
`
`0008
`
`0008
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 6 of 14
`
`US 7,539,533 132
`
`Star . PAN CooranatortFFn}
`
`O Router Node (FFD)
`@ End Device (RFD or FFD]
`
`FIG. 7
`
`130
`
`132
`
`FIG. 8
`
`0009
`
`0009
`
`

`

`US. Patent
`
`May 26,2009
`
`Sheet 7 of 14
`
`US 7,539,533 132
`
`{
`
`3
`
`l
`}
`
`I
`:
`
`1,-‘5hl
`L .._i~
`
`\\
`
`FIG. 9
`
`149
`
`FIG. 10
`
`0010
`
`0010
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 8 of 14
`
`US 7,539,533 B2
`
`152
`
`1?2
`
`FIG. 11
`
`
`
`0011
`
`0011
`
`

`

`US. Patent
`
`May 26, 2009
`
`Sheet 9 of 14
`
`US 7,539,533 32
`
`
`
`192
`
`FIG. 14A
`
`0012
`
`0012
`
`

`

`U.S. Patent
`
`May 26, 2009
`
`Sheet 10 of14
`
`US 7,539,533 32
`
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`U.S. Patent
`
`May 26, 2009
`
`Sheet 11 of 14
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`US 7,539,533 B2
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`US. Patent
`
`May 26, 2009
`
`Sheet 12 of 14
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`US 7,539,533 32
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`US. Patent
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`May 26, 2009
`
`Sheet 13 MM
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`US 7,539,533 132
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`US. Patent
`
`May 26,2009
`
`Sheet 14 MM
`
`US 7,539,533 132
`
`Generate a blood pressure model of a patient (2002)
`
`Determine a blood flow velocity using a piezoelectric transducer (2004)
`
`
`
`
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`Provide the blood flow velocity to the blood pressure model to
`continuouely estimate blood pressure (2006)
`
`FIG. 16A
`
`Attach monitoring device and calibration device to patient (2010)
`
`Determine blood flow velocity from the monitoring device and actual
`blood pressure from the calibration device (2012)
`
`Generate a blood pressure model based on the blood flow velocity and the
`actual blood pressure (2014)
`
`Remove calibration device (2016)
`
`Determine blood flow velocity (2018)
`
`pressure (2020)
`
`Provide blood flow velocity to the blood pressure model to estimate blood
`
`FIG. 16B
`
`0017
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`

`

`US 1539.533 B2
`
`2
`
`1
`NIESl-I NETWORK MONITORING
`APPLIANCE
`
`BAC KG ROUN D
`
`In another aspect, a heart monitoring system for a person
`includes one or more wireless nodes fomiing a wireless mesh
`network and a wearable appliance having a sound transducer
`coupled to the wireless transceiver: and a heart disease rec-
`ognizer coupled to the sound transducer to determine cardio-
`vascular health and to transmit heart sound over the wireless
`mesh network to a remote listener if the recognizer identifies
`a cardiovascular problem. The heart sound being transmitted
`may be compressed to save transmission bandwidth.
`In yet another aspect. a monitoring system for a person
`includes one or more wireless nodes; and a wristwatch having
`a wireless transceiver adapted to communicate with the one or
`more wireless nodes; and an aCcelerometer to detect 3 dan-
`gerous condition and to generate a warning when the danger—
`ous condition is detected.
`In yet another aspect. a monitoring system for a person
`includes one or more wireless nodes forming a wireless mesh
`network; and a wearable appliance having a wireless traits-
`ceiver adapted to communicate with the one or more wireless
`nodes: and a heartbeat detector coupled to the wireless trans-
`ceiver. The system may also include an accelerometer to
`detect a dangerous condition such as a falling condition and to
`generate a warning when the dangerous condition is detected.
`Implementations of the above aspect may include one or
`more ofthe following. The wristwatch detemtines position
`based on triangulation. The wristwatch determines position
`based on RF signal strength and RF signal angle. A switch
`detects a confirmatory signal from the person. The continua—
`tory signal includes a head movement. a hand movement. or
`a mouth movement. The confirmatory signal includes the
`person‘s voice. A processor in the system executes computer
`readable code to transmit a help request to a remote computer.
`The code can encrypt or scramble data for privacy. The pro-
`cessor can execute voice over I? (VOIP) code to allow a user
`and a remote person to audibly communicate with each other.
`The voice communication system can include Zigbee VOIP
`or Bluetooth VOIP or 802.XX V'OIP. The remote person cart
`be a doctor. a nurse. at medical assistant. or a caregiver. The
`system includes code to store and analyze patient informa-
`tion. The patient information includes medicine takinghabits,
`eating and drinking habits. sleeping habits. or excise habits. A
`patient interface is provided on a user computer for accessing
`information and the patient interface includes in one imple—
`mentation a touch screen: voice-activated text reading: and
`one touch telephone dialing. The processor can execute code
`to store and analyze information relating to the person's
`ambulation. A global positioning system (GPS) receiver can
`be used to detect movement and where the person falls. The
`system can include code to map the person‘s location onto an
`area for viewing. The system can include one or more cam-
`eras positioned to capture three dimensional (3D) video ofthe
`patient; and a server coupled to the one or more cameras. the
`server executing code to detect a dangerous condition for the
`patient based on the 3D video and allow a remote third party
`to view images ofthe patient when the dangerous condition is
`detected.
`
`In another aspect, a monitoring system for a person
`includes one or more wireless bases: and a cellular telephone
`having a wireless transceiver adapted to communicate with
`the one or more wireless ba ses; and an accelerometer to detect
`a dangerous condition and to generate a warning when the
`dangerous condition is detected.
`In yet another aspect. a monitoring system includes one or
`more cameras to determine a three dimensional {3D} model
`of a person; means to detect a dangerous condition based on
`the 31') model: and means to generate a warning when the
`dangerous condition is detected.
`
`to
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`15
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`This invention relates generally to methods and apparatus
`for monitoring a person.
`According to the National Center for Health Statistics
`Monitoring Health Care in America. Quarterly Fact Sheet.
`September 1996, cerebrovascular disease is the third leading
`cause of death in America, accounting for over 154.000
`deaths in 1994. This fact is true despite death rates from stroke
`having actually dropped nearly every year since 1950. In
`l993. [09 years of potential life were lost due to stroke for
`every 100,000 persons under age 65. Stroke is the third lead
`ing cause ot'death lbr all people age 45 and over. In 1993 the
`national death rate from stroke was 26.5 deaths per 100,000
`population. During the period 1990-92. agdadjusted death
`rates by State ranged from 20.8 for Rhode Island to 40.0 for
`South Carolina. Regionally, ccrebrovascular disease [nonal-
`ity is highest for Indiana and what is referred to as the “stroke
`belt." the southeastern states of Louisiana, Mississippi. Ala-
`bama. Georgia. North Carolina. South Carolina. Virginia.
`Tennessee. Kentucky. and Arkansas. The lowest rates are in
`Colorado. New Mexico. Arizona. Nebraska.
`Iowa. and ~
`Florida. as well as the northeastern states ot'Maine. Vermont.
`New York. Massachusetts. (‘otmecticuu and Rhode island.
`According to 1994 data. nearly 3 million Americans have
`sutTered strokes at some point. or l per 100 population. Five
`percent ot'males aged 65 and over and 6 percent of wotnen in
`the same age group have suftered a stroke.
`A stroke occurs when a blood vessel (artery) that supplies
`blood to the brain bursts or is blocked by a blood clot. Within
`minutes. the nerve cells in that area ol'the brain are damaged.
`and they may die within a few hours. As a result. the part ofthe
`body controlled by the damaged section of the brain cannot
`l'tutction properly. An ischemje stroke is caused by a reduc-
`tion in blood flow to the brain. This can be caused by a
`blockage or narrowing in an arter that supplies blood to the
`brain or when the blood flow is reduced because ot'a heart or
`
`3o
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`35
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`other condition. A hemorrhagic stroke develops when an
`artery in the brain leaks or bursts and causes bleeding inside
`the brain tissue or near the surface of the brain. Prior to a
`stroke. a person may have one or more transient ischemic
`attacks (HAS). which are a waming signal that a stroke may
`soon occur. 'l'lAs are often called mini strokes because their
`
`symptoms are similar to those of a stroke. However. unlike
`stroke symptoms. TIA symptoms usually disappear within 10
`to 20 minutes. although they may last up to 24 hours. Symp-
`toms ofa stroke begin suddenly and may include: numbness.
`weakness. or paralysis of the face, amt. or leg. especially on
`one side ofthe body: vision problems in one or both eyes.
`such as double vision or loss of vision; confusion, trouble
`speaking or tutderstand ing; trouble walking. dizziness, loss of
`balance or coordination, or severe headache.
`
`Early detection and treatment of stroke is essential
`recovery from a stroke.
`
`to
`
`SUMMARY
`
`In one aspect, a health care monitoring system for a person
`includes one or more wireless nodes forming a wireless mesh
`network: a wearable appliance having a sound transducer
`coupled to the wireless transceiver“. and a bioelectric imped-
`ance (BI) sensor coupled to the Wireless mesh network to
`communicate Bl data over the wireless mesh network.
`
`45
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`[r1 anotheraspect. a method to detect a dangerous condition
`for an infant includes placing a pad with one or more sensors
`in the infant's diaper: collecting infant vital parameters: pro-
`cessing the vital parameter to detect SIDS onset: and gener-
`ating a warning.
`Advantages of the invention may include one or more of
`the following. The system for non-invasively and continually
`monitors a subject‘s arterial blood pressure, with reduced
`susceptibility to noise and subject movement. and relative
`insensitivity to placement of the apparatus on the subject. The
`system does not need frequent recalibration of the system
`while in use on the subject.
`In particular. it allows patients to conduct a low-cost, com-
`prehensive. real-time monitoring of their blood pressure.
`Using the web services software interface. the invention then
`avails this information to hospitals. home-health care organi-
`zations. insurance companies. pharmaceutical agencies con-
`ducting clinical trials and other organizations. Infomtation
`can be viewed using an Internet-based website. a personal
`computer. or simply by viewfng a display on the monitor.
`Data measured several times each day provide a relatively
`comprehensive data set compared to that measured during
`tnedical appointments separated by several weeks or even
`months. This allows both the patient and medical professional
`to observe trends in the data. such as a gradual increase or ‘
`decrease in blood pressure. which may indicate a medical
`condition. The invention also minimincs effects ofwhite coat
`syndrome since the monitor automatically makes measure-
`ments with basically no discomfort: measurements are made
`at the patient’s home or work. rather than in a medical oilice.
`The wearable appliance is small. easily worn by the patient
`during periods of exercise or day-to-day activities. and non-
`invasiver measures blood pressure can be dotte in a matter of
`seconds without atfecting the patient. An onwboard or remote
`processor can analyze the time-dependent measurements to
`generate statistics on a patient‘ s blood pressure (e.g.. average
`pressures. standard deviation. beat ~to-beat pressure varia-
`tions) that are not available with conventional devices that
`only measure systolic and diastolic blood pressure at isolated
`times.
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`to
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`35
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`4E]
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`The wearable appliance provides an in—depth. cost—eflbm
`tive mechanism to evaluate a patient‘s cardiac condition.
`(‘ettaiii cardiac conditions can be controlled. and in some
`cases predicted. before they actually occur. Moreover. data
`from the patient can be collected and analyzed while the
`patient participates in their normal, day-to-day activities.
`In cases where the device has fall detection in addition to
`blood pressure measurement. other advantages of the inven-
`tion may include one or more of the following. The system
`provides timely assistance and enables elderly and disabled
`individuals to live relatively independent lives. The system
`monitors physical activity patterns. detects the occurrence of
`falls. and recognizes body motion patterns leading to falls.
`Continuous monitoring of patients is done in an accurate.
`convenient. unobtrusive. private and socially acceptable manw
`ner since a computer monitors the images and human involve
`ment
`is allowed only under pro—designated events. The
`patient’ s privacy is preserved since httman access to videos of
`the patient is restricted: the system only allows human view-
`ing under emergency or other highly controlled conditions
`designated in advance by the user. When the patient is healthy.
`people cannot view the patient’s video without the patient’s
`consent. Only when the patient‘s safety is threatened would
`the system provide patient information to authorized medical
`providers to assist the patient. When an emergency occurs.
`images of the patient and related medical data can be com-
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`US 1539.533 B2
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`4
`piled and sent to paramedics or hospital for proper prepara—
`tion for pick up and clteck into emergency room.
`The system allows certain designated people such as a
`fantin member. a friend. ora neighbor to informally check on
`the well-being of the patient. The system is also effective in
`containing the spiraling cost ofhealthcare and outpatient care
`as a treatment modality by providing remote diagnostic capa—
`bilin so that a remote healthcare provider (such as a doctor.
`nurse. therapist or caregiver) can visually communicate with
`the patient
`in performing remote diagnosis. The system
`allows skilled doctors, nurses, physical therapists. and other
`scarce resources to assist patients in a highly cfftc ient matuter
`since they can do the majority oftheir functions remotely.
`Additionally. a sudden change ofactivity [or inactivity} can
`indicate a problem. The remote healthcare provider may
`receive alerts over the Internet or urgent notifications over the
`phone in case of such sudden accident indicating changes.
`Reports of healthfactivity indicators and the overall well
`being ofthe individual can be compiled for the remote health-
`carc provider. Feedback reports can be sent to monitored
`subjects, their designated informal caregiver and their remote
`healthcare provider. Feedback to the individual can encour—
`age the individual to remain active. The content of the report
`may be tailored to the ta rgct recipient’ s needs. and can present
`the information in a format understandable by an elder person
`unfamiliar with computers. via an appealing patient interface.
`The remote healthcare provider will have access to the health
`and well—being status of their patients without being intrusive.
`having to call or visit to get such information interrogatively.
`Additionally, remote healthcare provider can receive a report
`on the health of the monitored subiects that will help them
`evaluate these individuals better dining the short rotttine
`check up visits. For example. the system can perform patient
`behavior analysis such as eating/dritikingfsmoke habits and
`medication compliance, among others.
`The patient‘s home equipment is simple to use and modu-
`lar to allow for the accormnodation of the monitoring device
`to the specific needs ofeaclt patient. Moreover. the system is
`simple to install. Regular monitoring of the basic wellness
`parameters provides significant benefits in helping to capture
`adverse events sooner.
`reduce hospital admissions. and
`improve the effectiveness of medications, hence. lowering
`patient care costs and improving the overall quality of care.
`Suitable users for such systems are disease management corn-
`panies, health insurance companies. self-insured employers,
`medical device manufacturers and pharmaceutical firms.
`The system reduces costs by automating data collection
`and compliance monitoring. and hence reduce the cost of
`nurses for hospital and nursing home applications. Atwhome
`vital signs monitoring enables reduced hospital admissions
`and lower emergency room visits ofchronic patients. Opera-
`tors in the call centers or emergency response units get high
`quality information to identify patients that need urgent care
`so that they can be treated quickly. so fely, and cost effectively.
`The Web based tools allow easy access to patient information
`for authorized parties such as family members. neighbors.
`physicians, nurses, pharmacists. caregivers, and other afl'ili—
`ated parties to improved the Quality of Care for the patient.
`In an on-line pharmacy aspect. a method for providing
`patient access to medication includes collecting patient medi-
`cal information t'rom a patient computer: securing the patient
`medical information and sending the secured patient medical
`information from the patient computer to a remote computer:
`remotely examining the patient and reviewing the patient
`medical information; generating a prescription for the patient
`and sending the prescription to a pharmacy: and performing a
`drug interaction analysis on the prescription.
`
`0019
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`US 1539.533 B2
`
`5
`
`Implementations of the on-line pharmacy aspect may
`include one or more of the following. The medical informa-
`tion can include temperature. EKG. blood pressure. weight.
`sugar level. image of the patient. or sound of the patient.
`Responses from the patient to a patient medical questionnaire
`can be captured. The doctor can listen to the patient‘s organ
`with a digital stethoscope. scanning a video of the patient.
`ruiuu'ng a diagnostic test on the patient. verbally communi-
`eating with the patient. The digital stethoscope can be a
`microphone or piezeoelectric transducer coupled to the Zig-
`bee network to relay the sound. A plurality of medical rules
`can he applied to the medical information to arrive at a diag-
`nosis. Genetic tests or pltarntacogenetic tests can he rttn on
`the patient
`to check compatibility with the prescription.
`Approval for the prescription can come from one of: a doctor.
`a physician. a physician assistant. a nurse. The system can
`monitor drug compliance. and can automatically ordering a
`medication refill from the pharmacy.
`For pharmacy applications. advantages of the pharmacy
`system may include one or more of the following. The system
`shares the patient‘s medical history and can be updated by a
`remote physicianand the remote dispensing pharmacy. As the
`doctor and the phamtacy have the same access to the patient
`medical history database. patient data is updated in real time.
`and is as current and complete as possible. The patient. doc-
`tor. pharmacy. and third party testing entities benefit from a
`uniform pricing structure that is based on the diagnosis and
`treatment. The patient only pays for standard medical treat—
`ments for his or her illness. The physician is paid a standard
`fee which covers the average work spent with a patient with
`the specific type 0 1' medical situation. The dispensing phar-
`macy is able to provide the highest level ol‘service. since it is
`able to double check all medications dispensed to each patient
`along with the optimal way to detect anticipated negative drug
`interactions. The pricing structure is competitive as physiw
`cians do not need to be distributed physically. and those with
`specialty areas may remain centrally located and yet be able
`to interact clustronically with patients. The system still pro-
`vides physical access to specialists since the patients which
`are evaluated can be directed to visit a specialists physically.
`when remote review and contact is inelfectual. The on-line
`pharmacy tracks the specific needs and medical history of
`each patient and can provide an expert system to advise the
`patient on proper drug usage and potential drttg interactions.
`The system automates the purchasing of drugs. pricing the
`prescription or submission of the claims to a third party for
`pricing. entering the complete prescription in their computer
`system. and auditing from third parties which provide pay-
`ment. The on-line pharmacy provides detailed multimedia
`guidance or assistance to the patient regard